Injuries Requiring Hospital Admission Research Articles

The incidence of cancer following hospitalisation for a burn injury in Scotland 2009-2019: A retrospective cohort study

BackgroundStudies suggest increased occurrence of cancer in persons who have experienced a burn injury with hospital admission. ObjectiveTo determine the incidence of cancer among those hospitalised for burn injuries in Scotland compared with a similar group without a history of burn injury hospitalisation. MethodA retrospective cohort design was used to compare cancer (ICD10 C00–97, excluding C44) incidence in two groups: 6805 burn injury patients discharged from Scottish hospitals between 2009 and 2019, and 25,946 subjects from the general population who were matched to burn patients by sex, year of birth, and degree of social deprivation. Cancer incidence was identified from the Scottish cancer registry. Cox proportional hazard regression was used to model time to cancer incidence adjusting for age, sex, degree of deprivation and presence of a comorbidity. Cancer risk was presented as standardised incidence ratios (SIRs) and hazard ratios (HR). ResultsWe found a higher prevalence of pre-existing conditions, particularly alcohol abuse among patients with burns. Pre-existing cancers were more common in the burn cohort (3.5%) than the comparison group (1.7%) and were excluded from further analysis. Over a median follow-up of 4–5 years, a total of 236 (3.5%) burn patients and 969 (3.7%) persons in the comparison group were diagnosed with cancer. At 0–6 months the cancer SIR for burn patients was 1.88 95% CI (1.40–2.52). After excluding the first six months of follow-up, the overall incidence of cancer was marginally elevated in burn patients (SIR 1.04, 95% CI 0.90–1.19, p = 0.62) and not statistically different from the incidence in comparison subjects (adjusted HR 1.03, 95% CI 0.88–1.21, p = 0.71). ConclusionsPatients that suffer burn injury have a higher incidence of cancer than the general population and a group matched by age, sex and degree of deprivation. A higher incidence of adverse health-related behaviours such as smoking, alcohol use and pre-existing health conditions among many patients that suffer a burn most likely explain this observed increase. Any persisting inflammatory or immune dysfunction following burn injury is unlikely to account for the increase in cancers in this study.

Ocular injuries sustained at home in five metropolitan cities: a review of 5008 cases.

In Iran, ocular injuries sustained at home are a growing public health issue, and few studies have explored their prevalence and the frequencies of different causes of these injuries. We investigated the features of ocular injuries at home among children and adolescents (aged < 18 years), adults (18 - 64 years), and the elderly ( ≥ 65 years) in five metropolitan cities. In this cross-sectional study, we recruited individuals with ocular injuries sustained at home who presented to 12 public/teaching hospitals in five metropolitan cities during a 5-month period. Using clinical records within the emergency department archives, we collected the following data: age, sex, frequency of injuries requiring hospital admission or surgical intervention, and causes of eye injuries, documented as 1) cleaning products, 2) chemical products, 3) kitchen items, 4) cooking activities, 5) toys, 6) falls from height, 7) sports equipment, 8) penetrating or cutting, 9) abrasions, 10) foreign bodies, and 11) direct blows by other individuals. Of 5008 participants from the five cities, 74% (n = 3711) were male and 26% (n = 1297) were female. The most frequent causes of injury among children and adolescents, adults, and the elderly were toys, kitchen items, and cooking activities, respectively. In children and adolescents, injuries were caused by kitchen items, toys, foreign bodies, and direct blows by other individuals more frequently than in adults or the elderly, and by cleaning products and abrasions more frequently than in the elderly (all P < 0.05). In adults, injuries were caused by cleaning products, cooking activities, falls from height, sports equipment, penetrating or cutting, and abrasions more frequently than in children and adolescents or the elderly (all P < 0.05), and by kitchen items, toys, and blows by other individuals more frequently than in the elderly (all P < 0.05). In the elderly, injuries were caused by chemical products more frequently than in children and adolescents or adults, and by cooking activities, falls from height, and sports equipment more frequently than in children and adolescents (all P < 0.05). In adults, the frequency of ocular injuries was significantly higher in Tehran and lower in Mashhad when comparing each with that of the other four cities (all P < 0.05). We found a significantly higher frequency of ocular injuries by cleaning and chemical products in Tehran, by toys in Shiraz, by falls from height in Isfahan, and by direct blows by other individuals in Ahvaz when comparing each to that of the other four cities (all P < 0.05). Regarding the prevalence of severe ocular injuries among the children/adolescent and adult age groups, conditions were relatively better in Shiraz and relatively unfavorable in Mashhad. Ocular trauma was more common in male individuals and the younger age groups. Approximately half of the causes were kitchen items, toys, and foreign bodies, which are avoidable by enhancing public eye health awareness. The prevalence of severe ocular injuries in individuals aged < 18 years was high, highlighting the necessity of nationwide preventive strategies for pediatric ocular injuries.

Utility of the Healthy Aging Brain Care Monitor as a Patient-Reported Symptom Monitoring Tool in Older Injury Survivors

IntroductionThe objective of this study was to evaluate the performance of the Healthy Aging Brain Care Monitor (HABC-M) as a patient-reported outcome tool to measure cognitive, functional, and psychological symptoms among older adults who sustained non-neurologic injuries requiring hospital admission. MethodsWe used data from a multicenter randomized controlled trial to evaluate the utility of the HABC-M Self-Report version in older patients recovering from traumatic injuries. A total of 143 patients without cognitive impairment were included in the analysis. Cronbach's alpha was used to measure the internal consistency, and Spearman's rank correlation test was used to evaluate the relationship of the HABC-M with standard measures of cognitive, functional, and psychological outcomes. ResultsThe HABC-M subscales and the total scale showed satisfactory internal consistency (Cronbach's alpha = 0.64 to 0.77). The HABC-M cognitive subscale did not correlate with the Mini-Mental State Examination. The HABC-M functional and psychological subscales correlated with corresponding standard reference measures (|rs| = 0.24-0.59). ConclusionsThe HABC-M Self-Report version is a practical alternative to administering multiple surveys to monitor functional and psychological sequelae in older patients recovering from recent non-neurologic injuries. Its clinical application may facilitate personalized, multidisciplinary care coordination among older trauma survivors without cognitive impairment.

Impact of Drug and Alcohol Use on Hospitalization for Injuries in Riders of Electric Bikes or Powered Scooters: A Retrospective Cross-Sectional Study.

The growing popularity of E-bikes and P-scooters has led to their increasing involvement in injuries. This study sought to evaluate the impact of drug and alcohol consumption on hospitalization rates for electric-vehicle-associated injuries. A retrospective cross-sectional study design was used, including patients evacuated to the emergency department (ED) of a tertiary medical center in 2014–2020 for injuries sustained while riding E-bikes or P-scooters. Data on clinical characteristics were collected from the medical files, including pre-accident usage of alcohol or drugs. Of the 1234 patients (75.7% male) who met the inclusion criteria, 90 (7.3%) were hospitalized. The mean (SD) number of admission days was 5.44 (±0.12). Alcohol consumption was associated with 2.2% of injuries and drug use with 0.6%. Patients who rode under the influence of alcohol were significantly more likely to be hospitalized than discharged (6.7% vs. 1.8%, χ2 (2) =19.25, p < 0.001); the odds ratio was 14.1. A similar association with hospitalization was found for drug use (χ2 (2) = 7.83, p = 0.02). Riding an E-bike or P-scooter under the influence of alcohol or drugs increases the probability of severe injury requiring hospital admission. These results should prompt the relevant authorities to initiate effective legislation of alcohol and drug use.

Impact of Hurricane Sandy on Hospital Admissions 2 Years Later

Disaster exposure is often followed by acute illness and injuries requiring hospital admission in the weeks after the disaster. It is not known whether disaster exposure is associated with hospitalization in the years after the disaster. We examined the extent to which disaster exposure is associated with hospitalization two years after Hurricane Sandy. The analyses fill a gap in our understanding of long-term physical health consequences of disaster exposure by identifying older adults at greatest risk for hospitalization two years after disaster exposure. Older adults (n=909) who participated in a longitudinal panel study provided data before and after Hurricane Sandy. These data were linked with Medicare inpatient files to assess the impact of Hurricane Sandy on hospital admissions after the post-hurricane interview. Those who reported experiencing a lot of fear and distress in the midst of Hurricane Sandy were at an increased risk of being hospitalized in the second or third years after the hurricane [Hazard Ratio=1.81 (1.15 – 2.85)]. Findings held after controlling for pre-hurricane demographics, social risks, chronic conditions, and decline in physical functioning after the hurricane. These findings are the first to show that disaster exposure increases risk for hospital admissions two years after a disaster, and that older adults’ appraisal of their emotional distress during the disaster has prognostic significance that is not explained by known risks for hospital admissions. The findings suggest that interventions during the storm and after the storm, may reduce long-term health consequences of disaster exposure among older adults.

Long term impact of Hurricane Sandy on hospital admissions of older adults

RationaleIn the weeks and months following a disaster, acute illness and injuries requiring hospital admission increase. It is not known whether disaster exposure is associated with increased risk for hospitalization in the years after a disaster. ObjectiveWe examined the extent to which disaster exposure is associated with hospitalization two years after Hurricane Sandy. The analyses fill a clinical gap in our understanding of long-term physical health consequences of disaster exposure by identifying older adults at greatest risk for hospitalization two years after disaster exposure. MethodSurvey data from a longitudinal panel study collectedbefore and after Hurricane Sandy were linked with Medicare inpatient files in order to assess the impact of Hurricane Sandy on hospital admissions two years following the hurricane. ResultsWe found that people who reported experiencing a lot of fear and distress in the midst of Hurricane Sandy were at an increased risk of being hospitalized two years after the hurricane [Hazard Ratio = 1.75; 95% CI (1.12–2.73)]. Findings held after controlling for pre-disaster demographics, social risks, chronic conditions, hospitalizations during the year before the hurricane, and decline in physical functioning. ConclusionsThese findings are the first to show that disaster exposure increases the risk for hospital admissions two years after a disaster. Controlling for known risk factors for hospitalization, older adults who experience high levels of fear and distress during a disaster are more likely to be hospitalized two years following the disaster than older adults who do not have this experience.

Burden of Road Traffic Injuries in Tanzania: One-Year Prospective Study of Consecutive Patients in 13 Multilevel Health Facilities.

Background Road traffic injuries (RTIs) pose a severe public health crisis in Sub-Saharan Africa (SSA) and specifically in Tanzania, where the mortality due to RTIs is nearly double the global rate. There is a paucity of RTI data in Tanzania to inform evidence-based interventions to reduce the incidence and improve care outcomes. A trauma registry was implemented at 13 health facilities of diverse administrative levels in Tanzania. In this study, we characterize the burden of RTIs seen at these health facilities. Methods This was a one-year prospective descriptive study utilizing trauma registry data from 13 multilevel health facilities in Tanzania from 1 October 2019 to 30 September 2020. We provide descriptive statistics on patient demographics; location; share of injury; nature, type, and circumstances of RTI; injury severity; disposition; and outcomes. Results Among 18,553 trauma patients seen in 13 health facilities, 7,416 (40%) had RTIs. The overall median age was 28 years (IQR 22–38 years), and 79.3% were male. Most road traffic crashes (RTC) occurred in urban settings (68.7%), involving motorcycles (68.3%). Motorcyclists (32.9%) were the most affected road users; only 37% of motorcyclists wore helmets at the time of the crash. The majority (88.2%) of patients arrived directly from the site, and 49.0% used motorized (two- or three-) wheelers to travel to the health facility. Patients were more likely to be admitted to the ward, taken to operating theatre, died at emergency unit (EU), or referred versus being discharged if they had intracranial injuries (27.8% vs. 3.7%; p < 0.0001), fracture of the lower leg (18.9% vs. 6.4%; p < 0.0001), or femur fracture (12.9% vs. 0.4%; p < 0.0001). Overall, 36.1% of patients were admitted, 10.6% transferred to other facilities, and mortality was 2%. Conclusions RTCs are the main cause of trauma in this setting, affecting mostly working-age males. These RTCs result in severe injuries requiring hospital admission or referral for almost half of the victims. Motorcyclists are the most affected group, in alignment with prior studies. These findings demonstrate the burden of RTCs as a public health concern in Tanzania and the need for targeted interventions with a focus on motorcyclists.

Common Injury Patterns from Standing Motorized Scooter Crashes.

Purpose of ReviewWith the rising popularity of standing motorized scooters in major cities in the United States, many hospitals are experiencing a surge of traumatic injuries associated with this new mode of transportation. The impact and characteristics of injuries associated with standing motorized scooters are evolving, and safety regulations for the riders are poorly defined. There is a need for a review for healthcare providers and policy makers on this topic.Recent FindingsSince its market introduction of rentable standing motorized scooters in late 2017, there has been an exponential rise in emergency department visits and hospitalization due to scooter-related trauma in urban hospitals. There have been a number of independent hospital-based and national-level studies describing demographics and trends of injury patterns in the last 2 years.SummaryPatients presenting to the hospital with injuries tend to be young male between 20 and 40 years of age, presenting at night. Head and extremity injuries are common, and patients often do not comply with helmets and other protective gears. Intoxication is a major risk factor for injuries requiring hospital admission and surgical interventions. These findings increase awareness for (1) healthcare providers to recognize and triage high-energy injuries, and (2) policy makers to advocate universal helmet use, increase public safety education, and enforce road safety regulations to minimize the impact of these injuries.

Severe Fireworks-Related Injuries: Demographic Characteristics, Injury Patterns, and Firework Types in 294 Consecutive Patients.

The relationship between fireworks and patient characteristics is not known. Our objective was to examine how severe fireworks-related injuries in children and teens compare to adults. We conducted a retrospective case series (2005-2015) study of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or operation at a single level 1 trauma/burn center. The distribution of race, use behavior, injury type, body region injured, and firework type was examined by age groups, 1 to 10 years, 11 to 17 years, and 18 years or older. Data from 294 patients 1 to 61 years of age (mean, 24 years) were examined. The majority (91%) were male. The proportion of injuries from different firework types varied by age, with rockets causing the highest proportion in children aged 1 to 10 years, homemade fireworks in those aged 11 to 17 years, and shells/mortars in adults 18 years or older. Compared with adults, children aged 1 to 10 years were more frequently American Indian/Alaska Native, Hispanic, or Asian than White. Compared with adults, children aged 1 to 10 years and 11 to 17 years were more frequently bystanders than active users. Compared with adults, children aged 1 to 10 years and 11 to 17 years had a greater proportion of burn and face injuries. Children aged 1 to 10 years had a decreased proportion of hand injuries. Three patients, 2 adults and 1 child aged 11 to 17 years, died. Children, teens, and adults experience severe fireworks-related injuries differently, by demographic characteristics, injury patterns, and firework types. Tailored public health interventions could target safety messaging and injury prevention outreach efforts to reduce firework injuries among children and adolescents.

Does the evidence justify routine transfer of residents of aged care facilities for CT scan after minor head trauma?

In 2014, the South Australian coroner recommended that residents of residential aged care facilities (RACF) who had sustained a head injury should be transported to emergency departments (ED) for assessment and a head CT scan, with the view to preventing mortality. The evidence base for the recommendation is unclear. To determine the rate of emergent intervention (neurosurgery, transfusion of blood products or reversal of anti-coagulation) in residents transferred to ED with minor head trauma who had their usual cognitive function on ED assessment. This was a retrospective cohort study by medical records review at two university-affiliated community ED. Participants were patients from RACF attending ED who had suffered minor head trauma and had their usual cognitive function. Exclusions were altered conscious state, new neurological findings or associated orthopaedic injury requiring hospital admission. The primary outcome was rate of emergent intervention in residents transferred to ED with minor head trauma who had their usual cognitive function on ED assessment. A total of 366 patients was studied; median age 86 years, 45% taking anti-coagulant/anti-platelet medication. Eighty per cent underwent head CT. Six per cent had intracranial haemorrhage (ICH; 95% CI 4-8.9%). No patient underwent neurosurgery. One had emergent intervention, reversal of anti-coagulation (0.3%, 95% CI 0.05-1.5%). The rate of emergent intervention for ICH in patients from RACF who sustained a minor head trauma but had their normal cognitive function was <1%. None underwent neurosurgical intervention. The low rate of intervention seriously challenges the appropriateness of routine transfer and CT for this patient group.

Hospital Readmission After Climbing-Related Injury in the United States

Rock climbing and mountaineering may result in injury requiring hospital admission. Readmission frequency after climbing-related injury is unknown. The aim of this study was to assess readmission frequency, morbidity, and mortality after admission for climbing-related injury. We performed a retrospective analysis of the 2012 to 2014 national readmission database, a nationally representative sample of all hospitalized patients. Rock climbing, mountain climbing, and wall climbing injuries were identified using International Classification of Diseases-Ninth Revision-Clinical Modification codes (E004.0). Outcomes evaluated included readmission frequency, morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed. Data are presented as mean±SD. A weighted-estimate 1324 inpatient admissions were associated with a climbing-related injury. Most patients were aged 18 to 44 y (64%), and 68% (n=896) were male. Isolated extremity injures were more common than other injuries (49%, n=645). Sixty-five percent (n=856) underwent a major operative procedure. Less than 1% of all climbing-related visits resulted in death. Within 6 mo of the index hospitalization, 2% (n=23) of the patients had at least 1 readmission, with a time to readmission of 9.9±6.6 (95% CI 4.5-15.4) d. Only female sex was associated with increased odds of readmission (odds ratio=5.5; 95% CI 1.5-20.1; P=0.01). There is a very low frequency of readmissions after being admitted to the hospital for climbing-related injury. A considerable opportunity to describe the long-term burden of climbing-related injury exists, and further research should be done to assess injury burden treated in the outpatient setting.

Effects of Computerized Cognitive Training and Tai Chi on Cognitive Performance in Older Adults With Traumatic Brain Injury.

To compare the effects of computerized cognitive training (CCT) and tai chi (TC) with usual care (UC) on cognitive functions and secondary outcomes in older adults with traumatic brain injury. Ninety-six patients aged 55 years and older who had a diagnosis of traumatic brain injury requiring hospital admission. Randomized controlled trial. The Mattis Dementia Rating Scale (MDRS), Mini-Mental State Examination, modified Telephone Interview of Cognitive Status, and Trail Making Tests A and B. Compared with UC, CCT increased scores on the MDRS's total, attention, and memory and those on the Mini-Mental State Examination and Telephone Interview of Cognitive Status over the 6-month intervention; TC increased scores on the MDRS's total and conceptualization and those on the Mini-Mental State Examination over the 6-month intervention, while it also increased scores on the MDRS's total and initiation/preservation and those on the Telephone Interview of Cognitive Status and reduced the time to complete the Trail Making Test B over the 12-month study. Furthermore, compared with UC, CCT increased handgrip strength and TC reduced the time to complete 5 sit-to-stands over the 6-month intervention. Both CCT and TC may improve global cognition and different specific cognitive domains in older traumatic brain injury patients; the TC's effect may last for at least an additional 6 months.

152 Fall-Related Injuries – using the Nationwide Population based Danish National Health Registers

Abstract One-third of the population ≥65 years of age fall at least once a year. Fall related injuries including fragility fractures are common causes of hospital admission and associated with high morbidity, mortality, and cost to society. The ageing population poses a significant challenge to the healthcare systems. Therefore, studies are warranted that enables focus on specific areas in need of preventive efforts. The aim of this talk is to give an overview of the importance of falls and fractures, to review the unique possibilities of conducting epidemiological studies using nationwide population based registers, and to present results from studies on fall related injuries. Examples of presented results includes “Fall injuries requiring hospital admission”, “Cardiovascular drugs and risk of fragility fractures”, and “Subsequent fractures following first fracture admission.

Risk Factors for Unplanned Admission to the Pediatric Intensive Care Unit in Pediatric Trauma Patients

Background and Hypothesis: A number of risk factors for unplanned pediatric intensive care unit (PICU) admission and readmission have been identified. However, little is known of the risk factors associated with unplanned admission to the PICU in pediatric trauma populations. We hypothesize specific risk factors can be identified which may be associated with unplanned admission to the PICU following traumatic injury.&#x0D; Methods: For this national retrospective study, we queried the 2016 National Trauma Data Bank for patients younger than 18 years experiencing a traumatic injury requiring hospital admission from the Emergency Department (ED). We excluded patients who had experienced burn injuries. Statistically significant (p&lt;.05) risk factors for unplanned PICU admission were identified in bivariate analysis and used to build a multiple logistic regression model.&#x0D; Results: Patients experiencing unplanned admission to the PICU had lower ED Glasgow Coma Scale (11.83 vs. 14.31; p&lt;0.001), higher Injury Severity Scores (ISS) (17.96 vs. 7.32; p&lt;0.001), and were older (age 11.35 vs. 9.60; p&lt;0.001). Initial ED disposition to the PICU was significantly associated with unplanned admission to the PICU (p&lt;0.001). Initial ED disposition to the OR was significantly associated with unplanned admission to the PICU (p=.018). After multiple logistic regression, ISS (p&lt;0.001), initial ED disposition to the PICU (p=0.002), initial ED disposition to the OR (p=0.005), and older age (p=0.005) remained statistically significant risk factors for unplanned admission to the PICU.&#x0D; Conclusion: ISS and ED disposition to the PICU, OR disposition to the PICU and age are significant risk factors for unplanned admission to the PICU in pediatric trauma. These findings will assist in identifying patients at risk for unplanned admission to the PICU, thereby reducing the adverse effects of unplanned PICU admission and ultimately improving the quality of care for pediatric trauma populations.

Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study

To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches. The PURE study is a prospective, population-based cohort study of individuals aged 35-70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years. This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5-10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs. Among adults aged 35-70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care. Full funding sources are listed at the end of the paper (see Acknowledgments).

Farm injury resulting in hospital admission: a review of farm work and non-farm work-related injury

ABSTRACT INTRODUCTIONOccupational health on farms is important because farms are not only workplaces where agriculture workers are vulnerable to high injury and fatality rates, they are also homes where families and visitors undertake a variety of activities that can result in injury. AIMTo profile and describe injuries requiring hospital admission that occurred on farms, both for injuries related to farming activities and injuries unrelated to farm work in the Midland region of New Zealand. METHODSA review of anonymised prospectively collected Midland trauma registry data from 1 July 2012 to 30 June 2018 was undertaken. Cases include unintentional injuries occurring on a farm. Non-major injuries are included to better quantify the trauma burden. RESULTSIn total, 2303 hospital admissions met the study criteria. Non-major injury accounted for 93.1% of events and 45.0% of injuries occurred during farming activities. Five people died in hospital; all injured while undertaking farm work. Males made up 84.8% of farm work and 70.9% of non-farm work injuries. Horse riding had the highest number of injuries, with off-road motorcycles, livestock, falls and quad bike injuries comprising the most common injury activities and mechanisms. Farming-related major injuries commonly involved quad bikes, non-traffic vehicles and motorcycles. Farmers in the Districts of Waitomo, Rotorua, Waipa and Taupō had the highest standardised hospitalisation rates. DISCUSSIONThe nature of farms and farming exposes people to different risks from the risks people in urban areas are exposed to. Injury prevention efforts should remain on work-related farming injuries, but also encompass the high number of injuries that are not related to farm work but happening on farms.

Fireworks type, injury pattern, and permanent impairment following severe fireworks-related injuries

BackgroundThere is a paucity of clinical data on severe fireworks-related injuries, and the relationship between firework types, injury patterns, and magnitude of impairment is not well understood. Our objective was to describe the relationship between fireworks type, injury patterns, and impairment. MethodsRetrospective case series (2005–2015) of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or an operation at a Level 1 Trauma/Burn Center. Fireworks types, injury patterns (body region, injury type), operation, and permanent impairment were examined. ResultsData from 294 patients 1 to 61years of age (mean 24years) were examined. The majority (90%) were male. 119 (40%) patients were admitted who did not undergo surgery, 163 (55%) patients required both admission and surgery, and 12 (5%) patients underwent outpatient surgery. The greatest proportion of injuries was related to shells/mortars (39%). There were proportionally more rocket injuries in children (44%), more homemade firework injuries in teens (34%), and more shell/mortar injuries in adults (86%). Brain, face, and hand injuries were disproportionately represented in the shells/mortars group. Seventy percent of globe-injured patients experienced partial or complete permanent vision loss. Thirty-seven percent of hand-injured patients required at least one partial or whole finger/hand amputation. The greatest proportion of eye and hand injuries resulting in permanent impairment was in the shells/mortars group, followed by homemade fireworks. Two patients died. ConclusionsSevere fireworks-related injuries from homemade fireworks and shells/mortars have specific injury patterns. Shells/mortars disproportionately cause permanent impairment from eye and hand injury.

The changing face of serious bicycle injuries from a UK Regional Trauma Centre

Introduction There has been an increase in popularity in cycling over the past 16 years in the UK. Whilst the number of killed or seriously injured (KSI) road users in Northern Ireland (NI) has decreased over this period, the proportion of KSI cyclists has increased steadily. We performed an epidemiological study of serious cycling-related injuries admitted to a UK Regional Trauma Centre and look at associated sporting, cultural, economic and infrastructural changes over this period. Method Retrospective Analysis of the NI Fractures Outcomes Research Database (FORD) of all significant cycling-related injuries presenting in NI requiring hospital admission and operative intervention between 2000 and 2016. Results Over 16 years we captured 734 patients with serious cycling injuries requiring hospital admission and operative intervention with a mean age of 38.73±16.3 (13-87), 85.6% (n=628) of which were male. Males were significantly younger: ANOVA (F2:732=15.363; p<0.001); Male mean age 37.77±15.93 (13-87), Female mean age 44.42±17.54 (14-84). Upper limb injuries predominate (47%), followed by lower limb (21%), spinal trauma (17%), hip fractures (10%), and pelvic trauma (5%). 10% were multiply-injured patients with operative fixation required for ³ 2 of these body regions. Males in general had higher energy injuries, with more pelvic and spinal injuries noted. 29/735 fractures were open (25 of which were in males 86.2%). 50/72 (69.4%) of femoral injuries were femoral neck fractures (Mean age 56.15±13.57, range 36-84) with 2x native hip dislocations. We had 18 patients admitted to our Intensive Care Unit (ICU), with total ICU bed days = 259.75 in 16years; mean 18.55±20.50days (Min 0.02 days, Max 68.54). Length of in-patient hospital stay was mean 8.66±15.85 days (Range 0-142 days). Emergency surgery was carried out in 554/735 (75.37%) of our patients. Over our study period the incidence of lower limb injuries (R 2 =0.037 over time) and pelvic injuries (R 2 =0.049 over time) remained static, whilst upper limb injuries (R 2 =0.690 over time) and spinal injuries (R 2 =0.603 over time) have increased. We show sporadic spikes in injury during seasons and following key sporting events and local infrastructural changes, however any causal link is difficult to demonstrate Conclusion Over the study period cycling has gained popularity as a mode of transport in NI and the UK. The percentage of KSI cyclists has dramatically increased. We demonstrate the preponderance for male patients with higher energy injuries and note an increase in incidence of upper limb and spinal injuries. Whilst the popularity of cycling, both for recreation and as a means of commuter transport have undoubtedly increased over our study period, unfortunately this has a direct correlation with the incidence of associated serious cycle-related injuries generated. This may have implications on healthcare provision, as well as regional government strategies for cycling infrastructure in NI.

Traumatic brain injury in a rural indigenous population in Canada: a community-based approach to surveillance.

Indigenous populations are disproportionately affected by traumatic brain injury. These populations rely on large jurisdiction surveillance efforts to inform their prevention strategies, which may not address their needs. We examined the incidence and determinants of traumatic brain injury in an indigenous population in the Terres-Cries-de-la-Baie-James health region of the province of Quebec and compared them with the incidence and determinants in 2 neighbouring health regions and in the province overall. We conducted a retrospective population-based cohort study of patients in Quebec admitted to hospital with incident traumatic brain injury, stratified by health region (Terres-Cries-de-la-Baie-James, Nunavik and Nord-du-Québec), from 2000 to 2012. We used MED-ÉCHO administrative data for case-finding. A subgroup analysis of adults in the Terres-Cries-de-la-Baie-James health region was completed to assess determinants of the severity of traumatic brain injury and patient outcomes. A total of 172 hospital admissions for incident traumatic brain injury occurred in the Terres-Cries-de-la-Baie-James region during the study period. The incidence was 92.1 per 100 000 person-years, and the adjusted incidence rate ratio was 1.84 (95% confidence interval 1.56-2.17) compared with the entire province. The incidence was higher than in the neighbouring nonindigenous population (Nord-du-Québec) but significantly lower than in the neighbouring indigenous population (Nunavik). Determinants of traumatic brain injury in the Terres-Cries-de-la-Baie-James region differed from those in the neighbouring populations and in the entire province. We found that the incidence rates and determinants of traumatic brain injury requiring hospital admission varied greatly between the three regions studied. Community-based surveillance efforts should be encouraged to inform the development of relevant prevention strategies.

Injury and illness among athletes during a multi-day elite cycling road race

Objectives: Although road bicycle races have been held for more than a century, injury and illness patterns during multi-day bicycle events have not been widely studied. The aim of this study was to determine the incidence of injury and illness among riders and describe the medical care interventions provided to participants of cycling road races. Methods: A prospective observational study was conducted on the Presidential Cycling Tour of Turkey, which was held between April 26 and May 3, 2015. The race lasted 8 days and covered 1258 km of road. There were 166 elite cycling athletes representing 21 teams from various countries. Data collected pertaining to incidents involving injury or illness included the following: type of injury; anatomical location of injury; details of the medical encounter; location of the intervention; treatment provided; medication administered and disposition of the rider. An injury was defined as a physical complaint or observable damage to the body produced by the transfer of energy of the rider. An illness was defined as a physical complaint or presentation not related to injury. Results: The overall incidence (injury and illness) was 5.83 per 1000 cycling hours. (Injury incidence was 2.82 vs illness incidence of 3.01 per 1000 hours cycling). A total of 31 incidents occurred. Of these, 15 were injuries, while 16 were complaints of a non-traumatic nature. A total of 43 interventions were made in the 15 cases of injury. The most commonly injured body regions were limbs; the majority of injuries involved the skin and soft tissue. The most common medical intervention was wound care (64% of all interventions). Two riders had to withdraw from the race, and one was hospitalized due to a traumatic pneumothorax. None of the non-traumatic cases resulted in withdrawal from the race. Conclusions: A broad spectrum of illness and injury occurs during elite multi-day road races, ranging from simple skin injuries to serious injuries requiring hospital admission. Most injuries and illnesses are minor; however, medical teams must be prepared to treat life-threatening trauma.