Injury-related Mortality Research Articles

Deaths and Injuries from Unintentional Falls: An Analysis of Nepal Police Records

Falls are a major cause of unintentional injury-related global mortality and morbidity. The actual mortality and morbidity from falls in Nepal have been overlooked and not systematically studied. This study, therefore, aims to present the national status of fall-related deaths and injuries. The study analyzed the fall incidents recorded by Nepal Police for five fiscal years (17 July 2014 to 16 July 2019). These incident recordings were in the form of narratives, and possible variables were extracted for the analysis. In five years, 4,714 people were injured or died from falls in Nepal. The average age of the fall victim was 35.6 years (SD=19.94); the mean age of the person who died from falls was slightly lower (30.9 years) than the injured person (40.4 years). The analysis showed that the fall cases were remarkably greater for males than females. This study found that Bagmati Province, where the capital city was located has the highest death and injury rates from falls, followed by Gandaki Province and Province 1. The study identified 11 different locations of falls. These findings revealed that Nepal has a considerable burden of fall deaths and injuries. However, the actual burden of fall injuries might be higher due to the under-reporting of the incidents through the Nepal Police data recording system.

Comparison of indicators of injuries in military personnel serving on conscription in the Armed Forces of Russia and the Republic of Belarus (2003–2020)

Relevance. Injury indicators in military personnel reflect injuries and their consequences that occur in a certain period, as a rule, over a year. Injury indicators in the Armed Forces (AF) are important for assessing occupational safety.Intention: To compare injury indicators in military conscripts between the Russian Armed Forces and the Republic of Belarus for 18 years from 2003 to 2020.Methodology. We carried out a selective statistical analysis of medical reports on the health status of personnel and the activities of the medical service according to 3/MED form in military units where at least 80 % of the total number of conscripts of the Armed Forces of Russia and Belarus served. Groups (blocks) of injuries in Chapter XIX “Injuries, poisoning and certain other consequences of exposure to external causes” were agreed with the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Injury data were calculated per 1000 military personnel or ‰, mortality rates – per 100 000 military personnel.Results and their Discussion. In the Russian Armed Forces compared to the Belarusian Armed Forces, the average annual injury rates (primary morbidity) of conscripts were (15.91 ± 1.65) ‰ vs (20.23 ± 1.96) ‰, hospitalizations with injuries (14.16 ± 1.29 ) vs (14.50 ± 0.96) ‰, work days lost (303.4 ± 27.0) vs (303.4 ± 27.0) ‰, dismissal due to injuries (0.552 ± 0.066) vs (0.551 ± 0.051) ‰, injury-related mortality (21.96 ± 4.26) vs (24.18 ± 4.29) per 100 000, respectively. As a rule, polynomial trends with high determination coefficients showed a decrease in the levels of injury, hospitalization, work days lost and mortality. Dismissal trends showed decrease in the Russian Armed Forces and increase in the Belarusian Armed Forces. The conscripts of the Armed Forces of Russia and Belarus have a positive statistically significant congruence in indicators of injuries, hospitalizations, work days lost and mortality, which may indicate the influence of the same (unidirectional) factors in the formation of annual indicators. Injuries of the head (Group 1, Chapter XIX by ICD-10), shoulder girdle and upper limbs (Groups 5–7), the area of the hip joint and lower extremities (Groups 8–10), injuries, affecting several areas of the body (Group 11), and the consequences of injuries, poisoning and other external causes (Group 22) are of high military-epidemiological significance for conscripts in the Russian Armed Forces and the Belarusian Armed Forces. These injuries accounted for 78.7 % and 82.8 % of the generalized estimate in the Russian Armed Forces and the Armed Forces of Belarus, respectively.Conclusion. Taking into account the indicators of injuries will allow the medical service to optimize the calculation of forces and assets for treatment and rehabilitation of servicemen with injuries. Injuries are not only a medical problem; it is necessary to involve more extensively military professionals from various services to analyze the cause-and-effect relationships of injuries and develop measures for their prevention.

Comprehensive study of thoracic trauma at tertiary health care centre: a retrospective observational study

Background: Thoracic injuries account for a substantial proportion of all injury-related admissions, morbidity and mortality in all tertiary health care centres. The study was conducted to do comprehensive study of chest trauma at a tertiary health care centre.Methods: In this retrospective study we included all polytrauma patients with chest trauma admitted to Geetanjali medical college and hospital, Udaipur for a period of 2 years, from January 2017 until January 2019. Clinical details of the patients were recorded from their case sheets and were analyzed with reference to their age, sex, mode of injury, type of injury, severity of injury, treatment modalities, complications and final outcome.Results: Prevalence of chest trauma was 16.61% out of total cases of polytrauma. Males were predominantly involved (79.61%). Majority were in the age group of 21-30 years. Road traffic accidents (RTA) was the most common mode of injury (68.93%). A total of 53.40% patients required inter costal tube drainage (ICTD). About 17.47% of patients developed complications during treatment in the hospital.Conclusions: Chest trauma occurs in a significant number of polytrauma patients and majority of victims are males of 21-30 years of age. Majority of these patients were treatable with simple procedures like tube thoracostomy or ICU based treatment.

Is more better? Do statewide increases in trauma centers reduce injury-related mortality?

Trauma centers are inconsistently distributed throughout the United States. It is unclear if new trauma centers improve care and decrease mortality. We tested the hypothesis that increases in trauma centers are associated with decreases in injury-related mortality (IRM) at the state level. We used data from the American Trauma Society to geolocate every state-designated or American College of Surgeons-verified trauma center in all 50 states and the District of Columbia from 2014 to 2018. These data were merged with publicly available IRM data from the Centers for Disease Control and Prevention. We used geographic information systems methods to map and study the relationships between trauma center locations and state-level IRM over time. Regression analysis, accounting for state-level fixed effects, was used to calculate the effect of total statewide number of trauma center on IRM and year-to-year changes in statewide trauma center with the IRM (shown as deaths per additional trauma center per 100,000 population, p value). Nationwide between 2014 and 2018, the number of trauma center increased from 2,039 to 2,153. Injury-related mortality also increased over time. There was notable interstate variation, from 1 to 284 trauma centers. Four patterns in statewide trauma center changes emerged: static (12), increased (29), decreased (5), or variable (4). Of states with trauma center increases, 26 (90%) had increased IRM between 2014 and 2017, while the remaining 3 saw a decline. Regression analysis demonstrated that having more trauma centers in a state was associated with a significantly higher IRM rate (0.38, p = 0.03); adding new trauma centers was not associated with changes in IRM (0.02, p = 0.8). Having more trauma centers and increasing the number of trauma center within a state are not associated with decreases in state-level IRM. In this case, more is not better. However, more work is needed to identify the optimal number and location of trauma centers to improve IRM. Epidemiologic, level III; Care management, level III.

Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program: A randomized controlled trial.

Introduction:Falls are the leading cause of injury-related mortality and morbidity in the elderly. Physical activity plays a key role in the prevention of falls and stimulates postural control. The aim of this study was to compare a general physical activity program for the elderly with a Pilates program to evaluate the effects on balance and on reducing the risk of falling.Materials and Methods:Forty-six subjects were enrolled in this study, but only 41 were included in the study. The subjects were divided into 2 groups: Pilates group (P-G) and a group following a nonspecific program of physical activity (Pa-G). Each subject underwent the hand grip test, Berg balance scale test, and posturographic analysis.Results:Spearman correlation coefficient showed correlations between the following parameters: BBS versus hand grip test (r = 0.68); BBS versus ellipse surface area (r = −0.75). There were significant differences between groups after the exercise program: both groups showed an improvement in performance but the P-G recorded significantly better results than the Pa-G.Discussion and conclusions:This study confirmed that physical activity improves both balance and strength. However, our data show that Pilates has a greater effect on these physical abilities than a general physical activity program.

15 Use of Bioelectric Impedance Analysis in Burn Patients: A Pilot Study

Abstract Introduction Bioelectric Impedance Analysis (BIA) is a rapid, non-invasive, and inexpensive technology based on electrical conductivity. BIA assesses body composition, fluid shifts, and phase angle, an electrical force vector where smaller values suggest cellular injury. Our objective was to use BIA to longitudinally track the clinical status of burn patients. We hypothesized that BIA would detect progressive decreases in muscle mass throughout the patient’s hospital course and that low phase angle values would correlate with severity of injury. Methods A cohort study of 10 patients from January 1, 2020 to March 13, 2020 was performed at an ABA-verified burn center. Patient and burn characteristics and laboratory data were collected. BIA measurements were performed daily for the first 10 days of admission and then twice weekly until discharge. The primary outcome was to detect changes in body composition. The secondary objectives were to detect differences between low and high-risk patients in terms of water composition and phase angle. Patients with APACHE II > 15, measured at burn unit admission, were considered high risk for burn injury related morbidity and mortality. Results BIA detected a statistically significant negative correlation between time spent hospitalized and leg lean mass (LM) (r2=0.56, P< 0.0001), right arm LM (r2=0.52, P< 0.0001) and left leg LM (r2=0.57, P< 0.0001), and positive correlation between body fat mass (BFM) and time spent hospitalized (r2=0.50, P=0.0004). Water composition (volume of extracellular water (ECW) per total body water (TBW)) negatively correlated with low-risk patients: right arm (r2=0.51, P< 0.0001), left arm (0.71, P< 0.001), thorax (0.66, P< 0.0001), right leg (0.74, P< 0.0001), left leg (0.35, P=0.002). Full body phase angle increased with low-risk patients over their hospital course (r2=0.62, P< 0.0001), while phase angle decreased with high-risk patients (r2=0.71, P=0.0006). Full body phase angle differentiated high risk patients (P< 0.0001), and phase angle of thorax differentiated between patients with and without inhalation injury (P=0.002). Conclusions Our study demonstrates that BIA measures changes in body composition and fluid shifts, identifies inhalation injury, and correlates with severity of injury in hospitalized burn patients. This pilot study included a limited number of participants with varying anatomic injuries presenting unique measurement challenges. Regardless, our preliminary data justifies a larger prospective study to confirm these results and correlate them with clinical outcomes.

Opioids and Injury Deaths: A population-based analysis of the United States from 2006 to 2017

IntroductionIn the United States, the opioid epidemic claims over 130 lives per day due to overdoses. While the use of opioids in trauma patients has been well-described in the literature, it is unknown whether prescription opioid use is associated with mortality after trauma. We hypothesized that legally obtained prescription opioid consumption would be positively associated with injury-related deaths in the United States. MethodsCross-sectional time-series data was compiled using state-level mortality data from the Centers for Disease Control and Prevention Multiple Causes of Death database and prescription opioid shipping data to each state using the US Department of Justice Automated Reports and Consolidated Ordering System Retail Drug Summary reports from 2006 to 2017, with opioids shipped used as a proxy for local opioid consumption. Oxycodone and hydrocodone amounts were converted to morphine equivalent doses (MEDs). Our primary outcome was an association between MEDs and injury mortality rates at the state-level. We analyzed total injury-related deaths and subgroups of unintentional deaths, suicides, and homicides. We modeled the data using fixed effects regression to reduce bias from unmeasured differences between states. ResultsData were available for all states and the District of Columbia. Opioid deliveries increased through 2012 and then declined. Total injury-related mortalities have been increasing steadily since 2012. Opioid MEDs did not show a consistent or statistically significant relationship with injury-related mortality, including with any subgroups of unintentional deaths, suicides, and homicides. ConclusionIn every state examined, there was no consistent relationship between the amount of prescription opioids delivered and total injury-related mortality or any subgroups, suggesting that there is not a direct association between prescription opioids and injury-related mortality. This is the first study to combine national mortality and opioid data to investigate the relationship between legally obtained opioids and injury-related mortality. The US opioid epidemic remains a significant challenge that requires ongoing attention from all stakeholders in our medical and public health systems.

Evaluation of the Epidemiological Characteristics of the Patients Admitted to Our Clinic as a Result of Electric Shock.

Electric shocks (ESs) are common traumas in burn units that require treatment by specialists due to high mortality and morbidity. This study aimed to investigate the demographic and clinical characteristics of patients of ES, complications, and injury-related mortality and morbidity rates. The authors retrospectively analyzed data of 432 ES patients treated at the Gazi Yaşargil Training and Research Hospital Burn Center, Turkey, between January 2010 and December 2020. Of the 432 patients, 92 (21.3%) and 340 (78.7%) sustained high- and low-voltage injuries, respectively. While high-voltage burns were common in January and December, low-voltage burns peaked in September and July. Burn patients were mostly males and were between the ages of 19 and 59 years. The majority of the ES events occurred at home. All four patients who died had suffered high-voltage burns, with two of high-voltage burns (2.17%) requiring amputation. None of the patients with low-voltage burns underwent amputation. High-voltage injuries manifested with larger burn surfaces, longer hospitalization, and more complications. Electrical injuries are largely preventable with simple safety precautions in daily life as well as serious consideration of workplace safety.

Visual acuity and risk of overall, injury-related, and cardiovascular mortality: the Kangbuk Samsung Health Study.

The associations of visual impairment (VI) with cardio-metabolic risk factors have been reported but its association with cardiovascular mortality remains uncertain. Therefore, we evaluated the association of visual acuity (VA) with overall, injury-related, and cardiovascular mortality. A cohort study was performed in 580 746 Korean adults (average age, 39.7 years) who were followed for a median of 8.1 years (maximum, 16 years). Presenting VA was measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Visual acuity in the better vision eye was categorized as normal vision (≥0.8), lowered vision (0.5-0.8), mild visual impairment (VI) (0.3-0.5), or moderate to severe VI (<0.3). Vital status and cause of death were ascertained through linkage to national death records. During 4 632 892.2 person-years of follow-up, 6585 overall deaths, 974 cardiovascular deaths, and 1163 injury-related deaths were identified. After adjustment for possible confounders, the multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for overall mortality among participants with lowered vision, minimal VI, and moderate to severe VI were 1.21 (1.13-1.29), 1.26 (1.15-1.37), and 1.54 (1.40-1.68), respectively, compared with those with normal vision. The corresponding HRs (95% CIs) for injury-related mortality were 1.12 (0.96-1.32), 0.98 (0.76-1.26), and 1.36 (1.04-1.79), respectively, and the corresponding HRs (95% CIs) for cardiovascular mortality were 1.32 (1.12-1.57), 1.43 (1.15-1.77), and 2.41 (1.94-2.99). In this large cohort of young and middle-aged individuals, VI was associated with increased risk of mortality especially due to cardiovascular disease.

Are There Any Red Flag Injuries in Severely Injured Patients in Older Age?

Introduction: Severely injured elderly patients pose a significant burden to trauma centers and, compared with younger patients, have worse prognoses and higher mortality rates after major trauma. The objective of this study was to identify the etiological mechanisms that are associated with severe trauma in elderly patients and to detect which injuries correlate with high mortality in elderly patients. Methods: Using a prospect cohort study model over an 11-year period, severely injured patients (ISS ≥ 16) were divided into two age groups (Group 1: 18–64; Group 2: 65–99 years). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, distribution of affected body parts (AIS and ISS regions) and injury related mortality. Results: In total, 1008 patient were included (Group 1: n = 771; Group 2: n = 237). The most relevant injury in elderly patients was falling from low heights (<3 m) in contrast to traffic accident in young patients. Severely injured patients in the older age group showed a significantly higher overall mortality rate compared to the younger group (37.6% vs. 11.7%; p = 0.000). In both groups, the 30-day survival for patients without head injuries was significantly better compared to patients with head injuries (92.7% vs. 85.3%; p = 0.017), especially analyzing elderly patients (86.6% vs. 58.6%; p = 0.003). The relative risk of 30-day mortality in patients who suffered a head injury was also higher in the elderly group (OR: Group 1: 4.905; Group 2: 7.132). Conclusion: In contrast to younger patients, falls from low heights (<3 m) are significant risk factors for severe injuries in the geriatric collective. Additionally, elderly patients with an ISS ≥ 16 had a significantly higher mortality rate compared to severe injured younger patients. Head injuries, even minor head traumata, are associated with a significant increase in mortality. These findings will contribute to the development of more age-related therapy strategies in severely injured patients.

Evaluation of injury-related under-five mortality in Turkey between 2014-2017.

Injury is the most common cause of preventable morbidity and mortality among children. The aim of this study was to determine the epidemiological characteristics and trends of injury-related mortality in children under five and to provide evidence for future preventive strategies. Our study was designed as a descriptive cross-sectional study. National under-five mortality data from the Death Notification System database, entered between January 1st, 2014, and December 31th, 2017, was included in the study. Among all under-five deaths registered in the system, 2,560 injury-related death cases were included in the study. Overall, deaths related to injuries accounted for 4.1% of all deaths in children under five years old. Of all injury deaths, 59.9% of cases were male, 52.7% occurred at home or its close vicinity, and 80.3% were children aged 12-59 months. Injury-related under-five deaths were mainly attributed to traffic injuries (36.5%), falls (12.0%), and suffocation (10.2%). Traffic injuries were the most common cause of injury-related deaths both in infants 0-11 months and children 12-59 months old. The second and third most common causes of injury-related deaths among infants 0-11 months were suffocation and falls, while these were falls and drowning in children aged 12-59 months, respectively. The injury-related under-five mortality rate dropped from 11.3 per hundred thousand in 2014 to 9.1 in 2017. Causes of all unintentional injury-related deaths were associated with season except for other unintentional injuries and exposure to mechanical forces (p < 0.001). The injury-related mortality rate among children under five years declined from 2014 to 2017, however it is still high. To prevent injuries in children under five, it is important to raise awareness and increase the supervision of children by their caregivers. At the national level, multisectorial cooperation with a holistic approach will be of key importance.

Vascular injury-related in-hospital mortality in Ontario between 1991 and 2009.

ObjectiveTrauma-related vascular injuries are major contributors to morbidity and mortality worldwide. We conducted a retrospective, population-based, cross-sectional study to examine temporal trends and factors associated with traumatic vascular injury-related in-hospital mortality in Ontario, Canada from 1991 to 2009.MethodsWe obtained data on Ontario hospital admissions for traumatic vascular injury, including injury mechanism and body region; and patient age, sex, socioeconomic status, and residence from the Canadian Institute for Health Information Discharge Database and Registered Persons Database from fiscal years 1991 to 2009. We performed time series analysis of vascular injury-related in-hospital mortality rates and multivariable logistic regression analysis to identify significant mortality-associated factors.ResultsThe overall in-hospital mortality rate for trauma-related vascular injury was 5.5%. A slight but non-significant decline in mortality occurred over time. The likelihood of vascular injury-related in-hospital mortality was significantly higher for patients involved in transport-related accidents (odds ratio [OR[=2.21, 95% confidence interval [CI], 1.76–2.76), age ≥65 years (OR = 4.34, 95% CI, 2.25–8.38), or with thoracic (OR = 2.24, 95% CI, 1.56–3.20) or abdominal (OR = 2.45, 95% CI, 1.75–3.42) injuries.ConclusionsIn-hospital mortality from traumatic vascular injury in Ontario was low and stable from 1991 to 2009.

Preventing Fragility Fractures: A 3-Month Critical Window of Opportunity.

Introduction:Low-energy falls are the leading cause of injury-related morbidity and mortality in the elderly. In the past, physicians focused on treating fractures resulting from falls rather than preventing them. The purpose of this study is to identify patients with a hospital encounter for fall prior to a fracture as an opportunity for pre-injury intervention when patients might be motivated to engage in falls prevention.Materials & Methods:A retrospective analysis of all emergency room and inpatient encounters in 2016 with an ICD10 diagnosis code including “fall” across a tri-state health system was performed. Subsequent encounters with diagnosis of fracture within 2 years were then identified. Data was collected for time to subsequent fracture, fracture type and location, and length of stay of initial encounter.Results:There were 12,382 encounters for falls among 10,589 patients. Of those patients, 1,040 (9.8%) sustained a subsequent fracture. Fractures were most commonly lower extremity fractures (661 fractures; 63.5%), including hip fractures (447 fractures; 45.87%). Median time from fall to fracture was 105 days (IQR 16-359 days).Discussion:Falls are an important, modifiable risk factor for fragility fracture. This study demonstrates that patients are presenting to the hospital with one of the main modifiable risk factors for fracture within a time window that allows for intervention.Conclusions:Presentation to the hospital for a fall is a vital opportunity to intervene and prevent subsequent fracture in a high-risk population.

Injury Morbidity and Mortality Among Older Adults and Elderly in the Eastern Mediterranean Region (EMR): Findings from the Global Burden of Disease 1990-2019

Background: Injury poses a major threat to older adults and elderly health and longevity. The increased longevity in the Eastern Mediterranean Region (EMR), warrants further understanding of the aging population inevitable changing health demands and challenges. This study examines injury morbidity and mortality among elderly populations aged 50 years and above in the 22 EMR countries and analyzes these outcomes based on Socio-demographic Index (SDI), Healthcare Access and Quality (HAQ), and risk factors. Methods: Drawing on data from the Global Burden of Disease (GBD) 2019, we categorized the population into older adults (50-69), and elderly (70 and above). We reported injury-related mortality rates; Years of Life Lost (YLLs); Years lived with Disability (YLDs) and disability-adjusted life years (DALYs); Socio-Demographic Index (SDI); Healthcare Access and Quality (HAQ), and Risk Factors of injury deaths in the EMR between 1990 and 2019. Findings: Estimated Injury death rates in EMR exceeded the global rates in 2019. Males had higher injury mortality rates compared to females. Transport injuries were the leading cause of deaths in older adults (43.0 (UI 31.0-51.8)) and elderly (66.2 (UI 52.5-75.5)) per 100,000. Conflict and terrorism were major causes of injury mortality for both age groups. The highest annual percent change in death rates due to injury between 1990 and 2019 was observed in Afghanistan among the elderly (5.5). The leading cause of DALYs was transport injuries for older adults at 1,798.8 (UI 1,394.1-2,116.0) and unintentional injuries for elderly at 2,013.2 (UI 1,682.2-2,408.7) per 100,000. The leading injury mortality risk factors were occupational exposure in older adults and low bone mineral density in the elderly. High SDI and HAQ scores in EMR countries were significantly associated with healthy life expectancy at 50 and 70 years. Interpretation: Injuries remains a major health problem in EMR countries, posing a real threat to older adults and elderlies, mainly due to transport and violence related injuries. Dedicated efforts should be implemented to ensure elderly-appropriate injury prevention strategies, cost-effective injury programs tailored to the need of local healthcare systems and to curtail injury-associated risk and promote healthy aging. Funding Information: This research was funded by the Bill & Melinda Gates Foundation. Declaration of Interests: All authors declare that they have no competing interests.

Approach to the Poisoned Patient.

This video lecture is appropriate for emergency medical providers who are not comfortable with initial assessment of poisoned patients. Ideal learners include medical students and residents. Poisoning is the leading cause of injury-related mortality in the United States, with more than 40,000 deaths annually.1 Of all ED injury-related visits, 2.4% are related to poisoning.2 While providers may have access to support services (poison control center, medical toxicology consulting service), they are often responsible for the initial evaluation of poisoned patients. While a large portion of poisoned patients have good outcomes regardless of the care they receive, inappropriate risk assessment and lack of knowledge about basic interventions can put patients at risk. A standardized approach as outlined in the video will help evaluate and treat the vast majority of poisoned patients. By the end of the lecture, learners should be able to: 1) initiate the evaluation of a poisoned patient, 2) identify key interventions to support airway, breathing, and circulation, 3) identify the three components of risk assessment in the poisoned patient, 4) list the four options for gastric decontamination, and 5) select standard diagnostic labs and tests commonly used in evaluating poisoned patients. This is an enhanced live action greenscreen recording with video animation. This video has been made available for a variety of learners on social medial (Facebook and YouTube) and written feedback has been collected on YouTube. The video has been seen over three thousand times and has received positive comments on social media (Facebook, YouTube). Comments include "dropping some tox knowledge bombs, proving yet again that #ToxRocks," and "This is an excellent talk, thank you very much, but I think it would be worth mentioning antidotes." The goal is to expose learners to basic concepts in approaching poisoned patients and focusses on cognitive knowledge and diagnostic frameworks. The learner may watch the on-demand video as part of a flipped classroom experience with clinical cases, or as a just-in-time resource before seeing a patient who has been poisoned. Poisoning, resuscitation, risk assessment, gastric decontamination, occult ingestion, supportive care.

Exploring the Impact of Remoteness and Socio-Economic Status on Child and Adolescent Injury-Related Mortality in Australia

Injuries are a leading cause of harm for children. This study explores the impact of determinants of health on children (0–19 years) injury-related mortality (namely remoteness and socio-economic disadvantage, calculated using the index of relative socio-economic advantage and disadvantage (IRSAD)). Cause of death data from the Australian Bureau of Statistics were sourced for children in Australia between 1 July 2007 to 30 June 2017. Fifteen injury categories (ICD-10-AM external cause codes) were used. Burden and trends by injury mechanism were explored. A total of 5153 children died; with road traffic incidents (3.39 per 100,000 population), intentional self-harm (2.46) and drowning (0.72) being the leading mechanisms. Female fatality rates in very remote areas (8.73) were nine times higher than in major cities (Relative Risk [RR] = 8.73; 95% Confidence Interval [95% CI]: 4.23–18.00). Fatality rates increased with remoteness; very remote areas recording an injury-related fatality rated six times (RR = 5.84; 95% CI: 3.76–9.12) that of major city residents. Accidental poisoning and intentional self-harm fatalities were more likely in high IRSAD areas, while road traffic fatalities were more likely in low and mid socio-economic areas (X2 = 69.1; p < 0.001). People residing in regional and remote areas and from low socio-economic backgrounds already face significant health and lifestyle challenges associated with disadvantage. It is time to invest in injury prevention interventions for these populations, as well as upstream policy strategies to minimize any further preventable loss of life.

Trends in mortality from external causes in the Republic of Seychelles between 1989 and 2018

Data on injury-related mortality are scarce in the African region. Mortality from external causes in the Seychelles was assessed, where all deaths are medically certified and the population is regularly enumerated. The four fields for underlying causes of death recorded were reviewed in the national vital statistics register. The age-standardised mortality rates were estimated (per 100,000 person-years) from external causes in 1989–1998, 1999–2008, and 2009–2018. Mortality rates per 100,000 person-years from external causes were 4–5 times higher among males than females, and decreased among males over the three 10-year periods (127.5, 101.4, 97.1) but not among females (26.9, 23.1, 26.9). The contribution of external causes to total mortality did not change markedly over time (males 11.6%, females 4.3% in 1989–2018). Apart from external deaths from undetermined causes (males 14.6, females 2.4) and “other unintentional injuries” (males 14.1, females 8.0), the leading external causes of death in 2009–2018 were drowning (25.9), road traffic injuries (18.0) and suicide (10.4) among males; and road traffic injuries (4.6), drowning (3.4) and poisoning (2.6) among females. Mortality from broad categories of external causes did not change consistently over time but rates of road traffic injuries increased among males. External causes contributed approximately 1 in 10 deaths among males and 1 in 20 among females, with no marked change in cause-specific rates over time, except for road traffic injuries. These findings emphasise the need for programs and policies in various sectors to address this large, but mostly avoidable health burden.

Potential for establishing an injury surveillance system in India: a review of data sources and reporting systems

BackgroundUnintentional injuries account for 10% of deaths worldwide; the majority due to road traffic injuries, falls, drowning, poisoning and burns. Effective surveillance systems provide evidence for informed injury prevention and treatment and improve recovery outcomes. Our objectives were to review existing sources of unintentional injury data, and quality of the data on the burden, distribution, risk factors and trends of unintentional injuries in India and to describe strengths and limitations of health facility-based data for potential use in injury surveillance systems.MethodsWe searched national and international organisations’ websites to identify unintentional injury-related mortality and morbidity data sources in India. We reviewed and evaluated data collection methods for surveillance attributes recommended by World Health Organization (WHO). We visited health facilities at all levels from public and private sectors, emergency transport centres, insurance offices and police stations in settings reporting significant number of injuries. In these sites, we interviewed key stakeholders using an explorative approach on current data collection processes and challenges to establishing an injury surveillance system based on WHO guidelines.ResultsMajor gaps were highlighted in injury mortality and morbidity data in India, including ill-defined causes of injury deaths and lack of standardisation in classification and coding. Site visits revealed that reporting standards of injuries varied, with issues around clarity of definitions, accountability, time points and lack of reporter/coder training. Major challenges were lack of dedicated staff and training.ConclusionsThere is an important need to build human resource capacity, integrate data sources, standardise and streamline data collected, ensure accountability and capitalise on digital health information systems including insurance databases.

Pancreatic Trauma: Imaging Review and Management Update.

Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. A high index of suspicion, as well as knowledge of the anatomy, mechanism of injury, injury grade, and role of available imaging modalities, is required for prompt accurate diagnosis. CT is the initial imaging modality of choice, although the severity of injury can be underestimated and assessment of the pancreatic duct is limited with this modality. The time from injury to definitive diagnosis and the treatment of potential pancreatic duct injury are the primary factors that determine outcome following pancreatic trauma. Disruption of the main pancreatic duct (MPD) is associated with higher rates of complications, such as abscess, fistula, and pseudoaneurysm, and is the primary cause of pancreatic injury-related mortality. Although CT findings can suggest pancreatic duct disruption according to the depth of parenchymal injury, MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography facilitate direct assessment of the MPD. Management of traumatic pancreatic injury depends on multiple factors, including mechanism of injury, injury grade, presence (or absence) of vascular injury, hemodynamic status of the patient, and associated organ damage. ©RSNA, 2020 See discussion on this article by Patlas.

Serious Injury and its Correlates among School Going Adolescents in Nepal: A cross-sectional study.

Injury-related mortality and morbidity, a leading cause of death and disability worldwide, is common among adolescents. However, there is insufficient information on the status and factors responsible for injury among adolescents in Nepal. Hence, the paper estimates the injury prevalence and identify the factors associated with it among adolescent Nepalese students. This study used national representative cross-sectional data of the Global School-based Student Health Survey 2015. Complex sample analysis was performed after adjusting the selection probability of each sample participants to identify the correlates of injury among 6529 students of 68 schools in Nepal. Out of 6529 study participants, 62.79% reported severe injury. The most common injury type was cut or stab wound (67.61%) followed by broken bone/dislocated joints (11.03%) and the most common cause of injury was fall (56.40%). Serious injury was significantly associated with a physical attack (AOR=1.54, CI=1.17-2.04), being involved in a physical fight (AOR=1.62, CI=1.2-2.2), being bullied (AOR=2.73, CI=2.25-3.31), feeling unsafe at school (AOR=1.53, CI=1.23-1.91), helmet use(never/rarely/sometimes) while driving a motorbike (AOR=1.69, CI=1.21-2.38) and drink and drive(AOR=2.28, CI=1.05-4.96). This study reported the injury as a significant public health concern in Nepal associated with several factors like physical attack, being involved in a physical fight, being bullied, feeling unsafe at school, helmet use while driving motorbike and drink and drive. The high prevalence of injury in Nepal suggests the application of appropriate prevention strategies.