External Causes Of Injury Research Articles

Challenges of Integrating ICD 11 into Automatic Alerting Systems.

Automatic alerting systems (AASs) can identify adverse health events but emergency communication relies on human operators and natural languages. For complete automation, we need to code the diversity of adverse events in a granularity that supports optimal dispatches. Hence, AAs shall integrate with the International Classification of Diseases (ICD). The ICD-11 coding system includes chapters for external causes of injury. However, ICD-11 supports coding injury incidents in electronic health records (EHRs) after they have occurred, while disregarding integrating real-time injury reporting within its framework. We explore the potential challenges associated with integrating ICD-11 into AAS by analyzing external causes of morbidity or mortality and the dimensions of external causes as potential areas of integration. We recognize the themes: (i) incident of injury, (ii) mode of transport, (iii) indoor location, (iv) outdoor location, and (v) type of building, and identify four challenges: (i) conceptual differences between the two systems, (ii) injury identification, (iii) presence of entities below the shoreline in ICD-11, and (iv) lack of specificity in certain ICD-11 codes related to AASs. For easy integration of ICD-11 into AASs, we recommend an AAS data dictionary and propose ICD-11 updates related to external causes of injury.

Mortality among Veterans following Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study.

Few studies have examined long-term mortality following traumatic brain injury (TBI) in a military population. This is a secondary analysis of a prospective, longitudinal study that examines long-term mortality (up to 10 years) post-TBI, including analyses of life expectancy, causes of death and risk factors for death in service members and veterans (SM/V) who survived the acute TBI and inpatient rehabilitation. Among 922 participants in the study, the mortality rate was 8.3% following discharge from inpatient rehabilitation. The mean age of death was 54.5 years, with death occurring on average 3.2 years after injury, and with an average 7-year life expectancy reduction. SM/V with TBI were nearly 4 times more likely to die compared with the US general population. Leading causes of death were external causes of injury, circulatory disease, and respiratory disorders. Also notable were deaths due to late effects of TBI itself and suicide. Falls were a significant mechanism of injury for those who died. Those who died were also more likely to be older at injury, unemployed, non-active duty status, not currently married, and had longer post-traumatic amnesia, longer rehabilitation stays, worse independence and disability scores at rehabilitation discharge, and a history of mental health issues prior to injury. These findings indicate that higher disability and less social supportive infrastructure are associated with higher mortality. Our investigation into the vulnerabilities underlying premature mortality and into the major causes of death may help target future prevention, surveillance, and monitoring interventions.

Management of Carotid Cavernous Fistula: a Case Report of Carotid Cavernous Fistula (CCF)

Abstract
 Introduction : Carotid-cavernous fistula (CCF) is an abnormal connection between the carotid arterial system and the sinus cavernous. Abnormal vascular shunt allowed blood to flow either direct or indirect from the carotid artery into the sinus cavernous. The indications for treatment of CCF are increased ocular pressure, double vision, bruits, severe headache, and severe proptosis resulting in keratopathy due to exposed cornea. Management of CCF include conservative management, endovascular intervention, surgery, and radiology intervention.
 Case Illustration : A 61 years old female came to the hospital complained redness on both eyes since 6 months ago, the redness in these eyes unrelieved even they had been treated. The patient have history given three types of drugs but there was not improvement. physical examination shown proptosis, injection of episcleral, cloudy lens with LOCSS NC2NO2C1P1 on both eyes, other examination also shown bruit on both eyes, Laboratory results was in normal limit. Funduscopic examination shown tigroid appearance.
 Discussion : Arterialization of the conjunctival vessels is a characteristic feature of CCF, other than physical examination, patient was planned for CT angiography examination to find external causes of injury assessing ICH and ischemia. Patient got external manual compression of the ipsilateral cervical carotid artery for about 30 to 40 seconds four times per hour several times daily for 4-6 weeks.
 Conclusion : Although CCF initially can be mistaken for conjunctivitis or episcleritis. Methods of therapy for CCF include conservative management, endovascular intervention, surgery, and interventional radiology. CCF itself is generally not life threatening but requires treatment to prevent worsening of the eye

Intentional Self-Harm Among US Veterans With Traumatic Brain Injury or Posttraumatic Stress Disorder: Retrospective Cohort Study From 2008 to 2017.

Veterans with a history of traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) may be at increased risk of suicide attempts and other forms of intentional self-harm as compared to veterans without TBI or PTSD. Using administrative data from the US Veterans Health Administration (VHA), we studied associations between TBI and PTSD diagnoses, and subsequent diagnoses of intentional self-harm among US veterans who used VHA health care between 2008 and 2017. All veterans with encounters or hospitalizations for intentional self-harm were assigned "index dates" corresponding to the date of the first related visit; among those without intentional self-harm, we randomly selected a date from among the veteran's health care encounters to match the distribution of case index dates over the 10-year period. We then examined the prevalence of TBI and PTSD diagnoses within the 5-year period prior to veterans' index dates. TBI, PTSD, and intentional self-harm were identified using International Classification of Diseases diagnosis and external cause of injury codes from inpatient and outpatient VHA encounters. We stratified analyses by veterans' average yearly VHA utilization in the 5-year period before their index date (low, medium, or high). Variations in prevalence and odds of intentional self-harm diagnoses were compared by veterans' prior TBI and PTSD diagnosis status (TBI only, PTSD only, and comorbid TBI/PTSD) for each VHA utilization stratum. Multivariable models adjusted for age, sex, race, ethnicity, marital status, Department of Veterans Affairs service-connection status, and Charlson Comorbidity Index scores. About 6.7 million veterans with at least two VHA visits in the 5-year period before their index dates were included in the analyses; 86,644 had at least one intentional self-harm diagnosis during the study period. During the periods prior to veterans' index dates, 93,866 were diagnosed with TBI only; 892,420 with PTSD only; and 102,549 with comorbid TBI/PTSD. Across all three VHA utilization strata, the prevalence of intentional self-harm diagnoses was higher among veterans diagnosed with TBI, PTSD, or TBI/PTSD than among veterans with neither diagnosis. The observed difference was most pronounced among veterans in the high VHA utilization stratum. The prevalence of intentional self-harm was six times higher among those with comorbid TBI/PTSD (6778/58,295, 11.63%) than among veterans with neither TBI nor PTSD (21,979/1,144,991, 1.92%). Adjusted odds ratios suggested that, after accounting for potential confounders, veterans with TBI, PTSD, or comorbid TBI/PTSD had higher odds of self-harm compared to veterans without these diagnoses. Among veterans with high VHA utilization, those with comorbid TBI/PTSD were 4.26 (95% CI 4.15-4.38) times more likely to receive diagnoses for intentional self-harm than veterans with neither diagnosis. This pattern was similar for veterans with low and medium VHA utilization. Veterans with TBI and/or PTSD diagnoses, compared to those with neither diagnosis, were substantially more likely to be subsequently diagnosed with intentional self-harm between 2008 and 2017. These associations were most pronounced among veterans who used VHA health care most frequently. These findings suggest a need for suicide prevention efforts targeted at veterans with these diagnoses.

Association of early life physical and sexual abuse with premature mortality among female nurses: prospective cohort study

ObjectiveTo explore associations between early life physical and sexual abuse and subsequent risk of premature mortality (death before age 70 years).DesignProspective cohort study.SettingThe Nurses’ Health Study II (2001-19).Participants67 726 female...

Variations in all-cause mortality, premature mortality and cause-specific mortality among persons with diabetes in Ontario, Canada

IntroductionPatients with diabetes have a higher risk of mortality compared with the general population. Large population-based studies that quantify variations in mortality risk for patients with diabetes among subgroups in...

Clinical and epidemiologic features of persons accessing emergency departments for dog and cat bite injuries in California (2005-2019).

To describe the clinical and epidemiologic features of persons with dog and cat bite injuries who presented to emergency departments. Records of 648,492 dog and cat bite-related emergency department visits in California from 2005 to 2019. Visits were selected by standardized International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification codes that indicated a bite as an external cause of injury in the medical record. Incidence rates were calculated for patient demographics, location and month of bite incident, characteristics of bite injury, infection, patient outcome/disposition, and expected source of payment. Cross-sectional descriptive analysis was performed. The average annual incidence of dog bites was highest in children aged < 10 years and males, while that of cat bites was highest in adults aged ≥ 80 years and females. Bites were more likely to occur in rural settings, in private residences, and during the summer. The median household income for zip codes in which animal bite patients resided was lower than the statewide median household income. Both dog and cat bite injuries were more likely to occur to upper limbs. Bacteria were isolated from 3% of dog bite injuries and 21.5% of cat bite injuries at initial presentation. Epidemiologic findings about persons presenting to emergency departments for animal bite injuries can inform bite prevention efforts by identifying at-risk populations. Effective animal bite prevention demands an ongoing multisectoral program of veterinarians and other health professionals, collaborating with community and governmental organizations, to develop and implement integrated strategies within the context of other socially contributory factors.

25, 50 and 75 years ago.

25, 50 and 75 years ago.

Integrating unsupervised and supervised learning techniques to predict traumatic brain injury: A population-based study

This work aimed to identify pre-existing health conditions of patients with traumatic brain injury (TBI) and develop predictive models for the first TBI event and its external causes by employing a combination of unsupervised and supervised learning algorithms. We acquired up to five years of pre-injury diagnoses for 488,107 patients with TBI and 488,107 matched control patients who entered the emergency department or acute care hospitals between April 1st, 2002, and March 31st, 2020. Diagnoses were obtained from the Ontario Health Insurance Plan (OHIP) database which contains province-wide claims data by physicians in Ontario, Canada for inpatient and outpatient services. A screening process was conducted on the OHIP diagnostic codes to limit the subsequent analysis to codes that were predictive of TBI, which concluded that 314 codes were significantly associated with TBI. The Latent Dirichlet Allocation (LDA) model was applied to the diagnostic codes and generated an optimal number of 19 topics that concur with published literature but also suggest other unexplored areas. Estimated word-topic probabilities from the LDA model helped us detect pre-morbid conditions among patients with TBI by uncovering the underlying patterns of diagnoses, meanwhile estimated document-topic probabilities were utilized in variable creation as form of a dimension reduction. We created 19 topic scores for each patient in the cohort which were utilized along with socio-demographic factors for Random Forest binary classifier models. Test set performances evaluated using area under the receiver operating characteristic curve (AUC) were: TBI event (AUC = 0.85), external cause of injury: falls (AUC = 0.85), struck by/against (AUC = 0.83), cyclist collision (AUC = 0.76), motor vehicle collision (AUC = 0.83). Our analysis successfully demonstrated the feasibility of using machine learning to predict TBI due to various external causes and identified the most important factors that contribute to this prediction.

Pediatric injury due to wheeled recreational devices: a single-institution retrospective study

BackgroundInjuries are the number one cause of death in children and cause significant morbidity. Common scenarios for injury include wheeled recreational devices (WRDs) that allow children to be mobile and independent (example ATV-all terrain vehicles, dirt bikes, bicycles, skateboards, and scooters). We present a case series review of these external causes of injury. This study aims to evaluate epidemiologic trends in WRD injuries and patterns in usage of protective gear.ResultsA total of 263 patients were identified as meeting criteria for inclusion with the following causes of injuries-103 bicycle, 73 ATV, 27 dirt bike, 14 skateboard, 13 motorcycle, 7 go carts, 3 hover board, 3 roller skates, 1 dune buggy, 1 motor scooter, 1 rip stick, and 1 tractor toy. Ages of patients ranged from 2 to 18 years of age with the greatest range being noted for bicycles (2–17 years) and motorcycles (3–18 years). The mean age was higher for motorcycle and skateboard (12.9 and 11.6, respectively) and lowest for scooter and bicycle (8.3 and 9.2, respectively). The majority of [overall study (97%) and for each mode of transportation] patients were Caucasian, which is in contrast to our overall ED population, which is only 42% Caucasian. The majority of patients were male [190 (72%)]. Over half of the overall patients, 159 of the 263 (60%), were not wearing a helmet (with only 10 charts having no documentation of helmet use). In regard to ATV riders specifically, 58% were not wearing helmets at the time of injury, with an additional 5 patients who reported their helmet came off. The lowest percentage of riders reporting appropriate helmet use was skateboarders with only 21% wearing helmets, and the highest percentage was dirt bike riders with 74% reporting helmet use.ConclusionCommon scenarios for injury include WRDs that allow children to be mobile and independent. Most of these injuries were found in Caucasian males between the ages of 9–12 with low rates of helmet use. This study adds to the literature with a description of the breadth of products children use and are injured while using.

Data-Driven Analysis for Detecting Transitions in Health Status in Traumatic Brain Injury: Implications For Prevention

<h3>Research Objectives</h3> To apply computational and data visualization techniques to categorize health records of patients with traumatic brain injury (TBI) in Ontario Canada, from preceding injury to the injury event. <h3>Design</h3> Big data reduction techniques, conditional logistic regression modeling, correlation matrices, and hierarchical clustering. <h3>Setting</h3> Health administrative data on publicly funded services provided to residents of Ontario, Canada, including information on acute care hospitalizations and emergency department (ED) visits. <h3>Participants</h3> Data from 235,003 unique patients with TBI and the same number of reference patients discharged from the ED or acute care hospitals during the same study period for a reason other than TBI, individually matched by sex, age, place of residence, and income quintile. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> We identified main and associated diagnoses according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision that were associated with a TBI event. To understand health status transitions from the time preceding TBI to the TBI event, we clustered all factors from each period into a single heatmap. <h3>Results</h3> Data-driven analysis revealed a remarkable extent of meaningful associations and health status transitions as they concern external causes of injury and injury severity. The strongest associations between health status preceding TBI and health status at the injury event were between clusters of multiple body system pathology and advanced age-related brain pathology. <h3>Conclusions</h3> Application of a health status transitions perspective to contextual injury event, and recognition that health status preceding injury makes a person more or less susceptible to TBI due to specific external cause of injury and developing a more or less severe TBI, entails new approaches to injury taxonomy, treatment and rehabilitation, and predictive classifications. <h3>Author(s) Disclosures</h3> The research reported in this presentation was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award R21HD089106 and the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award R01NS117921, and in part, by the Canada Research Chairs Program.

Causes of Mortality Among Veterans Previously Hospitalized After Traumatic Brain Injury

<h3>Research Objectives</h3> To examine mortality rates and causes among Veterans with traumatic brain injury (TBI) following discharge from inpatient rehabilitation. <h3>Design</h3> Secondary analysis; Cohort study. <h3>Setting</h3> Five Veterans Affairs (VA) Polytrauma Rehabilitation Centers. <h3>Participants</h3> Persons enrolled in the VA Traumatic Brain Injury Model Systems (TBIMS) who were admitted to rehabilitation within one year of TBI and discharged (alive) from rehabilitation between 01/01/2009 and 03/31/2020, and who died after rehabilitation discharge (N=82). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Mortality. <h3>Results</h3> The mortality rate was 8.3% for participants within this study's time frame. Most deaths (46.9%) occurred between 2 and 5 years from discharge. Reasons for death (among the known causes: 67.1%) were as follows: external causes of injury (29%), circulatory (22%), respiratory (18%), digestive (13%), neoplasm (9%), nervous system (7%), and infectious disease (2%). <h3>Conclusions</h3> Overall mortality rate was comparable to research in the civilian TBIMS (9-10%). Prior research implicated circulatory conditions as the most common cause of death, but in this study, the primary reasons were external causes (e.g., late effects of intracranial trauma; suicide). Digestive conditions (e.g., alcoholic liver disease) were the fourth most common cause of death yet a negligible cause in the general TBI population. Implications of the current findings include targeted clinical interventions for prevention or treatment of causes of mortality among veterans following discharge. <h3>Author(s) Disclosures</h3> Supported in part by NIDILRR [grant #90DPTB0002] (Hammond). Conducted with resources and use of facilities at the following: Hunter Holmes McGuire VA, Richmond, VA; James A. Haley VA, Tampa, FL; Minneapolis VA, Palo Alto VA, and South Texas VA. The authors declare no conflicts of interest. The views expressed here are the authors' and do not necessarily represent official policy/position of any federal government agency. This work was prepared under Contract HT0014-21-C-0012 [DHA Contracting Office (CO-NCR) HT0014] and defined as U.S. Government work under Title 17 U.S.C.§101. Per Title 17 U.S.C.§105, copyright protection is not available. For more information, contact TBICOEinfo@mail.mil. UNCLASSIFIED

Sex-Specific Human, Agent, and Environment-Related Interactions in Traumatic Brain Injury: Utility of The Haddon Matrix

<h3>Research Objectives</h3> To explore sex differences in the Host, the Agent, and the Environment utilizing computational analysis of traumatic brain injury (TBI) events. <h3>Design</h3> The retrospective population-based study utilized province-wide population-based decade-long health administrative data collected through the routine operation of the publicly funded health system in Ontario, Canada. <h3>Setting</h3> We used a previously established cohort of patients discharged between the fiscal years 2007/2008 and 2015/2016 from acute care and from the emergency department (ED) with diagnoses of TBI. <h3>Participants</h3> We drew upon health records of 235,003 unique patients (57% male) with TBI and the same number of reference patients without TBI, who were individually matched based on sex, age, place of residence, and income level, to organize factors associated with the TBI event. We dissected complex and multidimensional TBI event data by exploiting data mining and information visualization methods in male and female patients separately. We adopted concepts of the Haddon Matrix (Human, Agent, Environment) to organize injury event factors and compare TBI events of male and female patients. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Sex differences in the health status of the Host, the Agent, and the Environment at the TBI event phase. <h3>Results</h3> Based on perceived similarities, the computational technique detected 35 injury event-related factors, allowing observation of a set of definable patterns within the Host, the Agent, and the Environment. We uncovered significant sex-based differences in Host, Agent, and Environment patterns. We found that the Host's health status is of great importance to injury severity, and the Agent and the Environment have implications for external causes of injury. <h3>Conclusions</h3> Study findings support the utility of computational data mining in examining patterns of information within the TBI event. <h3>Author(s) Disclosures</h3> Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (NIH) under Award Number R21HD089106 and the National Institute Of Neurological Disorders And Stroke of the NIH under Award Number R01NS117921 and partially by Canada Research Chair Programs.

Trend of Work-related Injuries in the Philippines from 2010-2020

Introduction. Although Occupational Health and Safety (OSH) has been introduced as early as 1971, the protection of workers remained insufficient globally as 360 million occupational accidents occurred annually. In the Philippines, the incidence rate of occupational injury is 4.27 percent which indicates that there are around 4 cases of occupational injuries with workdays lost per 100 workers.Objective. The study aims to determine the trend of work-related injuries using hospital data entries from 2010-2020, and factors that contribute to work-related injuries and worker fatalities in the Philippines.Methods. The work-related data from the Department of Health’s Online National Electronic Injury SurveillanceSystem (ONEISS) from 2010 to 2020 was processed and analyzed in the study using exploratory data analysispresented as table and graphs, and logistic regression and phi-coefficient analysis for statistical inference. Therelationships between patient fatality, type of injury sustained, and external factors for occupational injuries and fatalities were analyzed.Results. A total of 72,897 (6.6%) work-related injuries and worker fatalities were analyzed in this study. The reports of occupational injuries and fatalities increased and peaked in 2019 and declined by 2020. Phi coefficient determined that all injuries sustained were significantly associated with work-related activities. Phi coefficient showed that all types of injuries were significantly associated with patient fatality. The external causes that were found to be significantly associated with patient fatality using phi coefficient were contact with sharp objects, exposure to forces of nature, fall, and transport and vehicular crash. Fall was significantly associated with patient fatality while also increasing its odds (OR=2.57, 95% CI: 1.76 – 3.75), and increased odds for multiple injuries (OR=2.30, 95% CI: 2.17 – 2.45), abrasion (OR=2.10, 95% CI: 1.97 – 2.24), and fracture (OR=9.66, 95% CI: 8.92 – 10.46). Transport/vehicular crash was significantly associated with increased patient fatality (OR=2.94, 95% CI: 2.22 – 3.88), multiple injuries (OR=6.77, 95% CI: 6.48 – 7.07), abrasion (OR=12.87, 95% CI: 12.34), and fracture (OR=4.12, 95% CI: 3.82 – 3.45). &#x0D; Conclusion. The study determined the relationship between work-related injuries, patient fatalities, types of injuries, and external causes of injuries based on the ONEISS data from 2010 to 2020. It is recommended that the study results be used in evaluating work-related accidents and in conducting comprehensive health assessments.

Disparities in traumatic brain injury-related deaths—United States, 2020

Introduction: Traumatic brain injury (TBI) affects how the brain functions and remains a prominent cause of death in the United States. Although preventable, anyone can experience a TBI and epidemiological research suggests some groups have worse health outcomes following the injury. Methods: We analyzed 2020 multiple-cause-of-death data from the National Vital Statistics System to describe TBI mortality by geography, sociodemographic characteristics, mechanism of injury (MOI), and injury intent. Deaths were included if they listed an injury International Classification of Diseases, Tenth Revision (ICD-10) underlying cause of death code and a TBI-related ICD-10 code in one of the multiple-cause-of-death fields. Results: During 2020, 64,362 TBI-related deaths occurred and age-adjusted rates, per 100,000 population, were highest among persons residing in the South (20.2). Older adults (≥75) displayed the highest number and rate of TBI-related deaths compared with other age groups and unintentional falls and suicide were the leading external causes among this older age group. The age-adjusted rate of TBI-related deaths in males was more than three times the rate of females (28.3 versus 8.4, respectively); further, males displayed higher numbers and age-adjusted rates compared with females for all the principal MOIs that contributed to a TBI-related death. American Indian or Alaska Native, Non-Hispanic (AI/AN) persons had the highest age-adjusted rate (29.0) of TBI-related deaths when compared with other racial and ethnic groups. Suicide was the leading external cause of injury contributing to a TBI-related death among AI/AN persons. Practical application: Prevention efforts targeting older adult falls and suicide are warranted to reduce disparities in TBI mortality among older adults and AI/AN persons. Effective strategies are described in CDC’s Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative to reduce older adult falls and CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices for the best available evidence in suicide prevention.

Incidence and Epidemiology of Traumatic Tympanic Membrane Rupture: A National Trauma Data Bank Analysis.

The incidence of traumatic tympanic membrane rupture (TTMR) has increased over recent decades. The association of certain external injury causes and bone fracture patterns with TTMR is anecdotal. It has been suggested that a diagnosis of TTMR may be missed during the acute trauma admission. The authors sought to evaluate the incidence of TTMR according to external injury cause and evaluate the association of skull fracture patterns with TTMR using a national trauma database. A cross-sectional analysis of trauma encounters was conducted using the National Trauma Data Bank (NTDB) from 2008 to 2015. Demographic and injury data were abstracted. Poisson regression was used to determine the incidence rate ratios of tympanic membrane rupture by external injury cause and logistic regression was used to estimate odds ratios (OR) of TTMR by skull fracture type. A total of 8214 patients were identified with TTMR during acute admission. The majority were on average 30 years old, 76% male, 71% White, had a mean Injury Severity Score of 14, and 42% were admitted to level I centers. The incidence rate ratio was only higher in lightning related injuries [5.262; 95% confidence interval (CI): 4.194-6.602] when using those caused by explosives as a reference. Basilar skull (OR: 12.95; 95% CI: 12.095-12.866) and cranial vault (OR: 2.938; 95% CI: 2.647-3.260) fractures were most associated with TTMR. The high incidence TTMR in association with certain external causes of injury and types of skull fractures should drive screening in the acute setting in order to increase detection and reduce morbidity from missed injuries.

Differences in clinical characteristics of cervical spine injuries in older adults by external causes: a multicenter study of 1512 cases

Although traumatic cervical spine injuries in older adults are commonly caused by minor traumas, such as ground-level falls, their prognosis is often unfavorable. Studies examining the clinical characteristics of cervical spine injuries in older adults according to the external cause of injury are lacking. This study included 1512 patients of ≥ 65 years of age with traumatic cervical spine injuries registered in a Japanese nationwide multicenter database. The relationship between the external causes and clinical characteristics, as well as factors causing unfavorable outcomes at the ground-level falls, were retrospectively reviewed and examined. When fall-induced cervical spine injuries were categorized and compared based on fall height, the patients’ backgrounds and injury statuses differed significantly. Of note, patients injured from ground-level falls tended to have poorer pre-injury health conditions, such as medical comorbidities and frailty, compared with those who fell from higher heights. For ground-level falls, the mortality, walking independence, and home-discharge rates at 6 months post-injury were 9%, 67%, and 80%, respectively, with preexisting medical comorbidities and frailty associated with unfavorable outcomes, independent of age or severity of neurological impairment at the time of injury.

The emerging infrastructure of US firearms injury data

For every fatal shooting in the United States, detailed information from reports of coroners or medical examiners, police departments, and other sources is recorded in the National Violent Death Reporting System. There is no such system in place for nonfatal shootings, which far outnumber fatalities. Hospital data systems are in place that could, with some improvements, provide access to reliable local, state and national estimates of firearm injuries. Such estimates are possible because most firearms injuries are treated in hospitals, and hospitals routinely assign “external cause of injury” codes to all injury encounters. Federal health agencies supervise a number of data systems that centralize hospital data. Challenges currently being addressed are public access, timeliness, and accuracy of coding of intent. (Hospitals misclassify many firearm assaults as accidents.)Law enforcement agencies provide detailed data on shootings in criminal circumstances, including shootings that are not treated in a hospital. The FBI's Uniform Crime Reports (UCR) system aggregates data from agencies. The FBI instituted a radical reform of this system beginning in 2021, resulting in a sharp agency participation drop that prevents valid national estimates. The reform requires agencies to report incident-level data instead of summary counts, which is all that was required for the previous 90 years. There are ongoing efforts to increase participation in the new system and restore its former status as the leading source of national crime estimates. In the meantime, data on nonfatal gunshot cases are available from a number of police departments.We discuss additional reforms needed to generate timely, accurate, publicly accessible data from hospitals and police.

Women’s intimate partner violence versus community violence: Comparing injuries as presented in Iceland’s largest emergency department

BackgroundIntimate partner violence (IPV) is a widespread, often unidentified and hidden public health problem, which has serious consequences. The purpose of this study was to describe and compare the clinical characteristics of women’s violence inflicted physical injuries, as presented at Iceland’s largest Emergency Department (ED). Three groups were created based on registered reason of injury: (1) IPV, (2) community violence (CV) with a history of IPV (HIPV), and (3) CV with no history of IPV. MethodsData was collected retrospectively by using the Nomesco classification system of external causes of injuries. Participants were adult women, residing in the capital area, visiting the ED during 2005–2019. ResultsIPV inflicted ED visits declined by 45% during the research period and CV visits declined by 61%. Women in the IPV group had the highest prevalence of repeated new ED visits per 1000 women in the capital area. The majority of IPV occurred in residential areas (86.4%), inflicted by a current partner (54.7%), and included only one perpetrator (95.3%). Women involved in CV were most likely to visit the ED on weekends (p = 0.003) and IPV women were most likely to visit between 08:00 and 16:00 (p < 0.001). Superficial injuries were the most common type of injury among all groups and IPV women were twice as likely (7.1%) to have injuries on their neck than CV women (3.5%). IPV women were most likely to be admitted (3.0%). ConclusionTime of ED visit, number of perpetrators and location of assault can be indicators of IPV inflicted injuries, as opposed to otherwise inflicted injuries. Repeated visits, superficial injuries and neck injuries might also be an indicator of IPV, however wounds and sprains and injuries on head and upper limbs are more likely to be non-IPV inflicted.

Decoding health status transitions of over 200 000 patients with traumatic brain injury from preceding injury to the injury event

For centuries, the study of traumatic brain injury (TBI) has been centred on historical observation and analyses of personal, social, and environmental processes, which have been examined separately. Today, computation implementation and vast patient data repositories can enable a concurrent analysis of personal, social, and environmental processes, providing insight into changes in health status transitions over time. We applied computational and data visualization techniques to categorize decade-long health records of 235,003 patients with TBI in Canada, from preceding injury to the injury event itself. Our results highlighted that health status transition patterns in TBI emerged along with the projection of comorbidity where many disorders, social and environmental adversities preceding injury are reflected in external causes of injury and injury severity. The strongest associations between health status preceding TBI and health status at the injury event were between multiple body system pathology and advanced age-related brain pathology networks. The interwoven aspects of health status on a time continuum can influence post-injury trajectories and should be considered in TBI risk analysis to improve prevention, diagnosis, and care.