Injury Hospital Research Articles

Pediatric firearm injury related emergency department visits and hospitalizations: a population-based study in the United States

Firearm injury (FI) is the leading cause of death in children and adolescents in the United States (US). We describe the epidemiology of pediatric FI-associated emergency department (ED) visits and hospitalizations in the US stratified by race and ethnicity. Data on pediatric (0-17-year-olds) FI were analyzed using the 2019 Nationwide Emergency Department Sample (NEDS) and Kids' Inpatient Database (KID), the largest all-payer databases in the US for ED visits and pediatric hospitalizations, respectively. FI encounters were stratified by race and ethnicity. Poisson regression was used to identify factors associated with in-hospital mortality. Sampling weights were applied to generate nationally representative estimates. There were 7017 pediatric ED visits with FI (NEDS); 85.0% (5961/7017) were male and 73.0% (5125/7017) were adolescents (15-17 years). Overall, 5.5% (384/7017) died in the ED; 53.1% (3727/7017) of ED encounters did not result in hospitalization. There were 2817 pediatric FI hospitalizations (KID); 84.1% (2369/2817) were male and 71.6% (2018/2817) were adolescents; 51.4% (1447/2817) of FI were unintentional, 42.8% (1207/2817) were assault-related, and 5.8% (163/2817) were self-inflicted. Black children had the highest proportion (52.6%; 1481/2817) of hospitalizations among all race and ethnicities (p<0.0001 vs. White). White children had the highest proportion of hospitalizations for self-inflicted injuries (16.6% [91/551] vs. 4.9% [25/504; p<0.0001] in Hispanics and 1.7% [24/1481] in Blacks; p<0.0001). The majority (56.5%; 1591/2817) of hospitalizations were patients from low-income zip codes (median annual-household-income <$44,000); 70% (1971/2817) had Medicaid as the primary insurance payer. Overall, 8.0% (225/2817) died during FI-associated hospitalizations. Self-inflicted injuries had the highest in-hospital mortality (prevalence ratio=8.20, 95% CI=6.06-11.10 vs. unintentional). Black children and children with lower household incomes were disproportionately impacted by FI resulting from assaults and accidents, while White children had the highest proportion of self-inflicted FI injuries. Public health and legal policy interventions are needed to prevent pediatric FI. US National Institutes of Health.

History of pediatric TBI hospitalization and current child-parent relationship quality in China

ABSTRACT Background Long-term child-parent relationship quality following hospitalization for pediatric traumatic brain injury (TBI) remains poorly understood. Objective We tested whether current child-parent conflict and closeness were related to the children’s history of TBI-related experiences and contemporary child/family characteristics. Methods The sample included 202 Chinese children (Boys: 60.4%) with a history of hospitalization for TBI. On average, the children were 11.2 years old (SD = 1.59) and sustained TBI at 8.5 years old (SD = 1.6). TBI-related data were obtained from hospital medical records. Parents provided data on child-parent closeness, child-parent conflict, and parental efficacy 2–4 years (M = 2.7, SD = 0.7) after discharge. Results Forty-nine children (24.3%) had mild TBI, 139 (68.8%) had moderate TBI, and 14 (6.9%) had severe TBI. Surgical intervention occurred among 128 (63.4%) of the 202 children. Contemporaneous child and family characteristics explained 19% of the variance, history of surgery, length of hospitalization, and recovery status explained another 7%, and the interaction between length of hospitalization and parental efficacy explained another 4% in child-parent conflict. Contemporaneous child and family characteristics explained 29% of the variance, and TBI-related variables explained another 2% in child-parent closeness. Conclusion Post-TBI child-parent relationship was more associated with child/family characteristics than with TBI variables. Practitioners and families should be aware of the long-term challenges to child-parent relationship following hospitalization for pediatric TBI.

The Patient Experience of Adolescents With Traumatic Injuries: Recommendations for Improvement.

Positive patient experience is associated with less healthcare utilization, better treatment adherence, increased likelihood of returning to the same hospital, and fewer complaints. However, hospitals have been able to collect few insights into the experiences of pediatric patients due to age limitations. As an exception to that reality, adolescents (aged 12-20 years) are able to share their experiences and recommend improvements, yet little is known about their hospital experiences with traumatic injuries. We examined the patient experience of adolescents with traumatic injuries and collected their recommendations for improving care. We conducted 28 semistructured interviews with English-speaking adolescents hospitalized at two trauma Level 1 hospitals (pediatric and adult) for physical injuries from July 2018 to June 2021. Interviews were transcribed and analyzed using modified thematic analysis. The patients expressed three basic desires: (1) autonomy and active involvement in their care, (2) human connections with their clinicians, and (3) minimal discomfort. Study participants provided actionable recommendations for improving the patient experience for adolescents with traumatic injuries. Hospital administrators and clinicians can improve the patient experience for adolescents in their care by sharing information, expectations, and goals with them. Hospital administrators can also empower the clinical staff to connect with adolescents with traumatic injuries on a personal level.

Abstract #1406144: Safety and Efficacy of SGLT2 Inhibitors Use in Patient with Diabetes After Renal Transplant

The sodium glucose cotransporter2 inhibitors (SGLT2i) are preferred anti-glycemic agents for patients with diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been shown to slow the progression of kidney disease. There is limited experience of SGLT2i in renal transplantation (RT). Concerns have been that the glycosuria induced osmotic diuresis might cause a decrease in renal perfusion and there might be a possible increased risk of urinary tract infections (UTI). We therefore performed a retrospective review of data of patients with DM and RT treated with SGLT2i compared to those without SGLT2i. The primary outcome was the change in eGFR or serum creatinine at 1-year. Secondary outcomes were documentations of serious adverse events (SAE). Data were retrieved from the electronic medical record of a Midwestern academic medical center using the program Epic and the sub-program Slicer/ Dicer. The search algorithm inclusion criteria were: “Diabetes Mellitus” “kidney transplant”, and “medicine: sodium glucose transport inhibitor”, which resulted in an inclusion of 44 patients in the “SGLT2i group”. A comparator group of patients with DM and RT who matched the above screening criteria (except for SGLT2i use), was then retrieved. We then devised a propensity score by performing a multivariate regression analysis with the covariates of age, type of transplant, duration of transplantation, and baseline eGFR. Data from 44 patients on SGLT2i were closely matched (by standardized effects size) for age, estimated GFR, duration and source of transplant with 70 control patients with DM and RT who were not on SGLT2i. Weight changed in SGLT2i group from baseline at 3, 6 and 12months (by -4.1 ± 3.3 kg, -5.1 ± 5.0 kg and -5.2 ± 6.5 kg) and did not change in controls (p [ANOVA, drug] = 0.009). There was no significant difference at 3, 6 or 12 months in changes in: A1c, systolic or diastolic blood pressure, hematocrit, hemoglobin, total cholesterol, LDL cholesterol, HDL cholesterol, or serum triglycerides. There were no documented significant increases in SAE in those on SGLT2i compared with controls in hospitalizations for acute kidney injury, episodes of acute transplant rejections, amputations, cellulitis, diabetic ketoacidosis, or outpatient treatment for urinary tract infections, or genital mycotic infections. Use of SGLT2i in patients with diabetes and renal transplant showed beneficial effect in reducing weight without a higher risk of SAE. Longer follow up may be necessary to define the impact on eGFR.

E-scooter use continues to rev up fracture diagnoses and hospital admissions compared to other modes of transportation

IntroductionThe COVID-19 pandemic was associated with an increase in popularity of e-scooter usage and a rise in e-scooter related injuries. Recent studies have elucidated trends within e-scooter injuries but there are few epidemiological studies that evaluate injury rates amongst multiple modes of transportation. This study seeks to investigate trends of e-scooter orthopedic fracture injuries compared to other traditional methods of transportation using a national database. MethodsThe National Electronic Injury Surveillance System (NEISS) database was queried between 2014 and 2020 for patients who were injured after usage of e-scooters, bicycles, or all-terrain vehicles. Primary analysis included patients with a diagnosis of fracture and utilized univariate/multivariate models to evaluate risk of hospital admission. Secondary analysis included all isolated patients to evaluate the odds of fracture development amongst modes of transportation. ResultsA total of 70,719 patients with injuries associated with e-scooter, bicycle, or all-terrain vehicle use were isolated. 15997 (22.6%) of these patients had a fracture diagnosis. Both e-scooters and all-terrain vehicles reported increased odds of fracture-related injury and direct hospitalization when compared to bicycles. E-scooter users reported a greater odds of both associated fracture (OR 1.25; 95%CI 1.03–1.51; p = 0.024) and hospital admission (OR: 2.01; 95%CI: 1.26–3.21; p = 0.003) in 2020 compared to 2014–2015. DiscussionE-scooter related orthopedic injuries and hospital admissions had the largest incidence rate increase compared to bicycle and all-terrain vehicles between 2014 and 2020. E-scooter fractures were most commonly located in the lower leg in 2014–2017, the wrist in 2018–2019, and the upper trunk in 2020. In comparison, bicycle and all-terrain vehicle fractures was most commonly shoulder and upper trunk within the study period. Further research will help to promote further understanding of the e-scooter health care burden and in prevention of these injuries. Level of evidence3.

Change In Fall Risk-Increasing Drug Use Among Individuals with Parkinson Disease Before and After a Serious Injury (P2-5.032)

<h3>Objective:</h3> To describe fall risk-increasing drug (FRID) use before and after an unintentional traumatic injury or fall-related fracture and examine the extent to which hospital encounters affect medication prescribing in individuals with Parkinson disease (PD). <h3>Background:</h3> Individuals with PD are at increased risk of falls and fractures. FRIDs represent a major modifiable factor that can potentially reduce the risk of subsequent events. <h3>Design/Methods:</h3> We identified persons with PD hospitalized for injury or fracture and matched each person to up to 4 individuals with PD who were hospitalized for other reasons using 2013–2017 U.S. Medicare data. A difference-in-difference design was used to compare FRID dispensing before and after hospitalization between the two groups. We examined the changes in standardized daily doses of FRIDs in the two groups upon hospital admission and at 3-, 6-, and 12-months post-discharge, adjusting for covariates. Exploratory analyses were performed to evaluate potential medication discontinuation and tapering following discharge. <h3>Results:</h3> We identified 9,437 persons with PD who had a qualifying hospitalization for injury or fracture and 32,487 matched individuals. While both groups experienced reductions in standardized daily doses of FRIDs, the differences in dose reductions were minimal (−1.94, 95% CI [−2.05, −1.82] in the injury group vs. −1.91, 95% CI [−1.97, −1.84] in the non-injury group; p=0.66 at 12 months). Over 40% of subjects discontinued FRIDs at 3 months in both groups, and ~2/3 to 3/4 of these sustained discontinuations through one year. <h3>Conclusions:</h3> There were no clinically significant differences in FRID dose reductions pre- to post-hospitalization between PD individuals with injury or fracture versus those without. More efforts are needed to enhance deprescribing practices during transition of care, especially after a sentinel event, to prevent subsequent unintentional injuries or fractures. <b>Disclosure:</b> The institution of Dr. Pham Nguyen has received research support from National Institute of Health. The institution of Dr. Pham Nguyen has received research support from National Institute of Health. Dr. Gray has nothing to disclose. Mr. Newcomb has nothing to disclose. Miss Liu has nothing to disclose. The institution of Dr. Hamedani has received research support from Michael J. Fox Foundation. The institution of Dr. Hamedani has received research support from NIH. The institution of Dr. Hamedani has received research support from Biogen. The institution of Dr. Hamedani has received research support from Biohaven. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intercept Pharmaceuticals. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medullary Thyroid Cancer Consortium. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Provention Bio, Inc. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bluebird bio, Inc. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amylyx Pharmaceuticals. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen Bioscence Inc.. The institution of Dr. Hennessy has received research support from US Food and Drug Administration. The institution of Dr. Hennessy has received research support from US National Institutes of Health. The institution of Dr. Hennessy has received research support from US Centers for Disease Control and Prevention. Dr. Wright Willis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Pharmacoepidemiology and Drug Safety. The institution of Dr. Wright Willis has received research support from NIH. The institution of Dr. Wright Willis has received research support from NIA. The institution of Dr. Wright Willis has received research support from Biogen. The institution of Dr. Wright Willis has received research support from Parkinson Foundation. The institution of Dr. Wright Willis has received research support from Arcadia.

Incidence, treatment patterns and clinical outcomes associated with acute kidney injury in Fiji: a retrospective cohort study.

This study aims to describe the incidence and outcomes of acute kidney injury at Fiji's tertiary referral hospital. A retrospective study of adults aged ≥ 18years hospitalised at the Colonial War Memorial Hospital between 1 January and 30 June, 2015 was conducted. Acute kidney injury was defined using the 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines by medical record review. One hundred ten (2.1%) of 5140 hospitalised patients met the diagnostic criteria for acute kidney injury. Fifty-two cases (47%) of acute kidney injury were stage 1, 11 (10%) cases were stage 2, and 47 (43%) cases were stage 3. Acute sepsis (n = 68) and dehydrating illness (n = 52) were the most common causes. Thirty-nine patients had urinalysis and 36 received imaging; none underwent kidney biopsy. Treatment included antibiotics (n = 91), intravenous fluids (n = 84) and vasopressors (n = 25). Twenty-one (19%) patients were treated with intermittent haemodialysis. Forty-seven patients (43%) with acute kidney injury died including 16 (76%) dialysed patients. Crude mortality at 7days was 19 (40%). Of the 63 patients who survived their primary illness, 29 (46%) had a follow-up assessment at 3months. In patients needing hospitalisation for acute kidney injury in Fiji, the most common causes were sepsis and dehydration. Mortality was high, in particular in those who received dialysis. Follow-up after acute kidney injury is incomplete.

The epidemiology of sports and leisure-related injury hospitalisations in Queensland: A five-year review

To describe the epidemiology of sports and leisure-related injury hospitalisations in Queensland DESIGN, SETTING, AND PATIENTS: Retrospective analysis of routinely collected hospital admissions data from all Queensland hospitals (public and private) between 2012 and 2016 for injury-related admissions where the activity engaged in when injured was coded as sports or leisure activity. Number of hospitalisations; rate of hospitalisation per 100,000 population and demographic, injury, treatment, and outcome details of hospitalised injury patients. Between 01 January 2012 and 31 December 2016, 76,982 people were hospitalised for a sports or leisure-related injury in Queensland. More people were hospitalised in public hospitals than private. Rates were highest for those under 14 years (601.5/100,000 population) and were higher in males (130.6/100,000 population) than females (28.9/100,000 population). A total of 18,734 injuries (24.3%; 79.5/100,000 population) were sustained while playing team ball sports, with rugby codes (rugby union, rugby league and rugby unspecified) representing the single largest source of injuries with 6,592. The extremities were the most likely body location of injury (46,644; 198/100,000 population), and the most common injury type was a fracture (35,018; 148.6/100,000 population). The findings highlight the significant burden of sport and leisure-related injury hospitalisations in Queensland. This information is important for injury prevention and trauma system planning.

The effect of recreational cannabis legalization on rates of traffic injury in Canada.

To measure the impact of Canada's recreational cannabis legalization (RCL) in October 2018 and the subsequent impact of the COVID-19 lockdowns from March 2020 on rates of emergency department (ED) visits and hospitalizations for traffic injury. An interrupted time series analysis of rates of ED visits and hospitalizations in Canada recorded in population-based databases from January/April 2010 to March 2021. ED visits in Ontario and Alberta and hospitalizations in Ontario, Alberta, British Columbia, Prairies [Manitoba, Saskatchewan], and Maritimes [Nova Scotia, New Brunswick, Newfoundland, Prince Edward Island]. Cases Monthly counts of presentations to the ED or hospital for motor vehicle injury or pedestrian/cyclist injury, used to calculate monthly rates per 100,000 population. An occurrence of one or more International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) code for motor vehicle injury (V20-V29, V40-V79, V30-39, V86) and pedestrian/cyclist injury (V01-V09, V10-V19) within the National Ambulatory Care Reporting System and Discharge Abstract Database. There were no statistically significant changes in rates of ED visits and hospitalizations for motor vehicle or pedestrian/cyclist injury after RCL after accounting for multiple testing. After COVID-19, there was an immediate decrease in the rate of ED visits for motor vehicle injury that was statistically significant only in Ontario (level change ß = -16.07 in Ontario, 95% confidence interval [CI] -20.55 to -11.60, p=0.000; ß = -10.34 in Alberta, 95% CI -17.80 to -2.89, p=0.008; alpha of 0.004) and no changes in rates of hospitalizations. Canada's recreational cannabis legalization (RCL) did not notably impact motor vehicle and pedestrian/cyclist injury. The rate of emergency department visits for motor vehicle injury decreased immediately after COVID-19, resulting in rates below post-RCL levels in the year after COVID-19.

Estimated trends in hospitalizations due to occupational injuries in Korea based on the Korean National Hospital Discharge In-depth Injury Survey (2006-2019).

In recent years, occupational injuries have sparked a huge social and political debate. Thus, in this study, we focused on the characteristics and trends of occupational injuries requiring hospitalization in Korea. The Korea National Hospital Discharge In-depth Injury Survey was designed to estimate the annual number and characteristics of all injury-related hospitalizations in Korea. The annual number of hospitalizations due to occupational injuries and the age-standardized rates (ASRs) were estimated from 2006 to 2019. The annual percentage change (APC) and average annual percentage change (AAPC) of ASRs and their 95% confidence intervals (CIs) were calculated using joinpoint regression. All analyses were stratified by gender. In men, the APC of the ASRs of all-cause occupational injuries was -3.1% (95% CI, -4.5 to -1.7) in 2006-2015. However, a non-significant upward trend was observed after 2015 (APC, 3.3%; 95% CI, -1.6 to 8.5). In women, the APC of all-cause occupational injuries was -8.6% (95% CI, -12.1 to -5.1) in 2006-2012. However, a non-significant upward trend was observed after 2012 (APC, 2.1%; 95% CI, -0.9 to 5.2). A recent upward trend in stabbing injuries was observed after 2012 (APC, 4.7%; 95% CI, -1.8 to 11.8) in women. A non-significant overall increasing trend was also observed for occupational injuries caused by exposure to extreme temperatures (AAPC, 3.7%; 95% CI, -1.1 to 8.7) in women. A recent upward trend in all-cause injury hospitalizations and hospitalizations caused by stabbing injuries was observed. Therefore, active policy interventions are required to prevent occupational injuries.

Hospitalization For Acute Kidney Injury In Patients With Heart Failure & Atrial Fibrillation Is Associated With Greater Risk Of Cardiogenic Shock & Major Adverse Cardiovascular Outcomes

Hospitalization For Acute Kidney Injury In Patients With Heart Failure & Atrial Fibrillation Is Associated With Greater Risk Of Cardiogenic Shock & Major Adverse Cardiovascular Outcomes

A New Source of Mutilating Hand Injuries: The Side-by-Side Utility Terrain Vehicle.

Rates of mutilating hand injuries are increasing from accidents caused by all-terrain vehicles (ATVs) and the recently popularized side-by-side utility terrain vehicles (UTVs). Increasing surgeon familiarity with upper extremity (UE) injury patterns, severity, and outcomes following ATV and UTV accidents may improve patient care and advocacy. Retrospective comparisons of UE injury patterns, severity, hospital and intensive care unit (ICU) admission lengths, and number of operations were made between ATVs and UTVs. Findings were analyzed with Fisher exact tests, multivariate analysis of variance, analyses of variance with post hoc analyses, and multiple linear regressions. A total of 154 cases were identified for inclusion (ATV, n = 87; UTV, n = 67). Patient ages ranged from 4 to 89 years. The UTV group contained significantly more hand and finger injuries, and more of the fractures were open ( P = 0.005, P < 0.001, and P < 0.001, respectively). Riders of UTVs had nearly three times as many mutilating hand injuries and a nearly ninefold increase in amputations compared with ATV riders ( P < 0.001 and P < 0.001, respectively). On average, the UTV group spent 2.5 additional days in the hospital, 0.91 additional days in an ICU, and had 1.3 additional operations ( P = 0.001, P = 0.007, and P < 0.001, respectively). Vehicle type was the only variable significantly correlated with days in the hospital, ICU, and number of UE operations ( P = 0.002, P = 0.008, and P < 0.001, respectively). Hand surgeons are in a unique position to serve as forerunners for increasing public awareness of off-road vehicle risks and promoting rider safety. Collaborating with manufacturers and emergency care providers and directing teaching initiatives may improve patient outcomes. Risk, II.

Risks of organ failures and deaths associated with young-onset dementia after hospitalizations for motor vehicle crash injuries: a nationwide population-based retrospective cohort study

Patients with dementia are at increased risks of adverse consequences associated with motor vehicle crash injury (MVCI). However, studies of the association for patients with young-onset dementia (YOD) are limited. Therefore, we aim to investigate whether YOD was associated with adverse outcomes after hospitalization for MVCI. In this retrospective cohort study, we identified 2052 MVCI patients with YOD (aged 40–64 years) between 2006 and 2015 and included 10 260 matched MVCI patients without YOD (matching ratio: 1:5) from Taiwan’s National Health Insurance Research Database and the Taiwan Police-Reported Traffic Accident Registry. We evaluated the intensive care unit (ICU) admission, organ failure, in-hospital and 30-day mortalities, length of hospital stay, and hospital costs. Compared with participants without dementia, patients with YOD had higher rates of ICU admission (34.31% vs. 20.89%) and respiratory failure (6.04% vs. 2.94%), with a covariate-adjusted odds ratio of 1.50 (95% CI 1.33–1.70) and 1.63 (95% CI 1.24–2.13), respectively. The patients also exhibited higher in-hospital mortality (4.73% vs. 3.12%) and 30-day mortality (5.12% vs. 3.34%) than their non-YOD counterparts, but the risk ratio was not significant after adjusting for transport mode. Moreover, the log means of hospital stay and cost were higher among patients with YOD (0.09 days; 95% CI 0.04–0.14 and NT$0.17; 95% CI 0.11–0.23, respectively). This cohort study determined that YOD may be adversely associated with hospital outcomes among MVCI patients. However, the association between YOD and mortality risk may depend on transport mode.

Study of injuries epidemiological charasteristics in Georgia on the example of Adjara region

Introduction. Injury is a significant public health concern that is a leading cause of mortality and disability worldwide. Injuries have a significant financial and quality-of-life impact on persons and communities. The absence of fundamental epidemiological data on the prevalence of injuries prevents developing countries from creating effective prevention programs. The goal of this study was to characterise the epidemiological features of injury in the Adjara region. Material and methods. The database and source of the data that we used in this article were provided from the Georgian National Center for Disease Control and Public Health’s 2019 database, which contains all hospitalizations in the Adjara area and was utilized to find trauma cases that were treated at medical facilities. Based on the ICD-10 diagnosis codes S and T, as well as V-Y, cases were chosen. Version 23.0 of SPSS was used to analyze the data. Results. Between the ages of 0 and 103, there were a total number of 2,239 patients, inclusive 1,321 (59%) – males, and 918 (41%) – women, who were hospitalized for treatment of an injury. The incidence was highest among those aged 65 and over (n=510; 23%), followed by those aged 20-34 (n= 488; 20%). The most prevalent cause of injury was falling (n=1,324; 59%), followed by exposure to inanimate mechanical forces (n=244; 11%). The range of hospital stays was from 1 to 3,652 days, with a median and mode of 3 and 2 days. Conclusions. This study provides information for public health decision-making. In order to enhance the standard of treatment and focus efforts on avoiding more injuries, intervention strategies may be devised using our data to understand better the extent of the injuries and outcomes linked to traumatic injury hospitalizations.

Standardized rate of hospitalization for violent injuries among different generations in counties and cities in Taiwan from 2000 to 2015.

This study aimed to understand the distribution of the standardized rate of hospitalization for violent injuries in counties and cities in Taiwan. The ICD-9 diagnosis code N-codes 995.5 (abused child) and 995.8 (abused adult) or E-code E960-E969 (homicide and intentional injury by others) were defined as research cases. The study analyzed the standardized medical treatment rate of children and adolescents aged 0 to 17, adults aged 18 to 64, and older adults over 65 years old suffering from violence for the first time. During the 15-year period, the counties and cities with the highest rate of medical treatment for violent injuries among children (unit: per 105 people) were Pingtung County (33.1 males, 22.9 females), Lienchiang County (8.8 males, 9.8 females), and New Taipei City (8.2 males, 8.8 females). For adults, Pingtung County (73.2 males, 36.8 females), New Taipei City (26.0 males, 14.3 females), and Yunlin County (19.7 males, 7.7 females) registered the highest rates. For older adults, Pingtung County (33.6 persons), New Taipei City (12.5 persons), Yun Lin County (11.2 persons), and Taichung City (9.2 persons) registered the highest rates. The highest rates of older female adults receiving treatment were recorded in Pingtung County (15.1 persons), Yunlin County (9.0 persons), Taichung City (5.5 persons), and New Taipei City (5.1 persons). With the Poisson regression model, the relative risk ratio of seeking medical care owing to violence in Pingtung County (reference: Taipei City) was 25.1 times for children, 20.1 times for adults, and 11.7 times for older adults. The counties and cities with higher rates of violent medical treatment for adults and older adults during the 15-year period were Pingtung County, New Taipei City, and Yunlin County. For children and adolescents, Pingtung County, Lienchiang County, and New Taipei City recorded the highest rates. Pingtung County had the highest risk of sexual violence. These results may be related to the local industrial structure, demographic composition, and other characteristics explained in the text.

Impact of substance-related harms on injury hospitalizations in Canada, from 2010 to 2020

Injuries continue to be a leading cause of death and contribute significantly to hospitalizations each year in Canada. Substance use has been associated with an increase in intentional and unintentional injuries, resulting in hospitalizations. This study examines trends in injury hospitalizations with a co-occurring substance diagnosis, to quantify the burden of injuries and identify at risk populations. We analyzed Discharge Abstract Database data between 2010/11 and 2020/21, for clinical and demographic information about hospital discharges across Canada. We used ICD-10 codes to identify injury hospitalizations with co-occurring substance diagnostic codes, by injury intent and substance type. Rates, proportions, age-specific rates and age-standardized rates were calculated, trends quantified using average annual percent change and results stratified by sex and age group. From 2010/11 to 2020/21, unintentional injuries accounted for over half of all substance-related injury hospitalizations. Substance-related injuries accounted for 12% of total injury hospitalizations over this period. Overall, substance-related injury hospitalizations with co-occurring use of stimulants, opioids, cannabinoids and alcohol increased significantly among males and females. Unintentional substance-related, injury hospitalizations were more common later in life, and intentional substancerelated injuries were more common among adolescents and young adults. These results highlight key demographic groups with higher rates of substance-related injury hospitalizations that would benefit from targeted prevention efforts.

DETERMINATION OF THE BENEFITS AND COMPLICATIONS OF CLEAN INTERMITTENT CATHETERIZATION TO SPINAL CORD INJURED PATIENTS

Introduction: Intermittent catheterization (IC) is the best method for bladder emptying in patients with spinal cord lesions who are suffering from neurogenic bladder dysfunction. The aim of the study was to determine the benefits of using clean intermittent catheters for patients with spinal cord injury at regular intervals daily to empty the bladder and identify the complications from its use. Methods: A quantitative descriptive design study was done at Ibn Al-Kuff hospital for spinal cord injuries in Baghdad city, including (60) male spinal cord injured patients from the 14th of February 2021 to the 20th of April 2022. A non-probability (purposive) sample of (60) male spinal cord-injured (SCI) patients with paraplegia and tetraplegia were selected. A questionnaire format was used, which consisted of three major parts with a total (of 26) items. Results: The present study included (60) male paraplegic and tetraplegic patients, half of them in the age group between (18-27) years old, and 33 (55%) of them were single. The majority24 (40%) of the study sample were primary school graduates. Furthermore, 24 (40%) were employees before they were injured. Concerning the clinical characteristics of patients, the study indicates that (48 (80%) of the sample were paraplegic patients, 41(68.3%) were complete paralysis and 55(91.7%) of them the cause of injury was Traumatic SCI. Furthermore, 51(85%) of them use selfclean intermittent catheterization; concerning the number of daily catheterizations, 33(55%) of them used it from 7- and more daily, while 34(56.7%) of them, the time between the catheter and the next was each two hours. Concerning the urinary complication occurs during the last 3 months associated with intermittent catheterization, 22(36.7%) of the sample had (UTIs). Conclusion: The current study has demonstrated that the practices of spinal cord injury patients about clean intermittent catheters were acceptable and regular, and it was beneficial to them, as it reduced complications, especially urinary tract infections, noting the need to increase the time between each interval of catheterization to (4-6) hours for each period.

Social Determinants of Health Impact Physical Recovery After Blunt Injury.

As defined by the United States Department of Health and Human Services, the Social Determinants of Health (SDOH) are conditions in the environment that affect health function and outcomes. The SDOH are divided into the following categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community content. It is known that SDOH impact long-term health outcomes. The influence that SDOH have on physical recovery after acute injury is less understood, however. In this study, patients who suffered a traumatic blunt injury completed a survey 12-14 months post-injury to assess their SDOH and physical health before and after their injury. The results showed that for the cohort of patients studied SDOH was the greatest predictor of long-term recovery, having a stronger correlation with recovery than injury severity score (ISS) or hospital length of stay (HLOS).

Novel and replicated clinical and genetic risk factors for toxicity from high-dose methotrexate in pediatric acute lymphoblastic leukemia.

Methotrexate (MTX) is a key component of treatment for high-risk pediatric acute lymphoblastic leukemia (ALL) but may cause acute kidney injury and prolonged hospitalization due to delayed clearance. The purpose of this study is to identify clinical and genetic factors that may predict which children are at risk for creatinine increase and prolonged MTX clearance. We conducted a single-center, retrospective cohort study of pediatric patients with ALL who received 4000-5000 mg/m2 of MTX. Measurements We performed germline genotyping to determine genetic ancestry and allele status for 49 single nucleotide polymorphisms (SNPs) identified from the literature as related to MTX disposition. Bayesian hierarchical ordinal regression models for creatinine increase and for prolonged MTX clearance were developed. Hispanic ethnicity, body mass index (BMI) < 3%, BMI between 85%-95%, and Native American genetic ancestry were found to be associated with an increased risk for creatinine elevation. Older age, Black race, and use of the intensive monitoring protocol were associated with a decreased risk for creatinine elevation. Older age, B- compared to T-ALL, and the minor alleles of rs2838958/SLC19A1 and rs7317112/ABCC4 were associated with an increased risk for delayed clearance. Black race, MTX dose reduction, and the minor allele of rs2306283/SLCO1B1 were found to be associated with a decreased risk for delayed clearance. These predictors of MTX toxicities may allow for more precise individualized toxicity risk prediction.

Effectiveness of arthroscopic excision based on the distribution of the tenosynovial giant cell tumor around knee joint

BackgroundThe mainstay treatment for tenosynovial giant cell tumor (TGCT) is open excision. However, open excision is associated with the risk of stiffness, infection, neurovascular injury, and prolonged hospital stay and rehabilitation. The purpose of this study was to evaluate the efficacy of arthroscopic excision of tenosynovial giant cell tumor (TGCT) of the knee joint, including the diffuse type of TGCT. MethodsPatients who underwent arthroscopic excision of TGCT between April 2014 and November 2020 were retrospectively analyzed. TGCT lesions were divided into 12 distributions (nine intra- and three extra-articular lesions). The distribution of TGCT lesions, portals used, degree of excision, recurrence, and magnetic resonance imaging (MRI) scans were evaluated. The prevalence of intra-articular lesions in diffuse TGCT was also analyzed to validate the existence of a connection between intra- and extra-articular lesions. ResultsTwenty-nine patients were included in the study. Fifteen patients (52%) had localized TGCT, and 14 patients (48%) had diffuse TGCT. The recurrence rates for localized, and diffuse TGCT were 0%, and 7%, respectively. Intra-articular posteromedial (i-PM), intra-articular posterolateral (i-PL), and extra-articular posterolateral (e-PL) lesions were found in all patients with diffuse TGCT. The prevalence rates of i-PM and i-PL lesions among e-PL lesions were both 100% (p = 0.026 and p < 0.001, respectively). Diffuse TGCT lesions were managed with posterolateral capsulotomy and viewed from the trans-septal portal. ConclusionsArthroscopic excision of TGCT was effective in both localized and diffuse TGCT. However, diffuse TGCT was associated with posterior and extra-articular lesions. Therefore, technical modification such as posterior, trans-septal portal, and capsulotomy were required. Study designRetrospective case series; level Ⅳ.