Injury Mortality Research Articles

Are migrant workers at greater risk of workplace deaths? A systematic review and meta-analysis

Abstract Background Globally, 170 million individuals migrate for work. Yet, evidence on their mortality risk remains unclear. Our aim was to synthesize global evidence on migrant worker mortality risk compared to local workers and to identify the multiple intersecting social determinants of mortality. Methods We conducted a systematic review of peer-reviewed literature which reported on mortality outcome of migrant workers. Studies published between 1 Jan 2000 to 17 Jan 2023 in English were searched in MEDLINE, Embase, PsycINFO, and Ovid Global Health. Meta-analysis using random effects model was used to calculate pooled estimates and narrative synthesis was used to develop a data-driven framework on intersectional social determinants. Results Out of 11,495 identified records, 44 were included, of which 11 were pooled in meta-analyses. The combined migrant worker death count was 44,338, with data from 16 countries, including migrants from agriculture, construction, and service industries. Compared to local workers, migrant workers had a higher risk of fatal occupational injury (pooled RR = 1.71, 95%CI: 1.22-2.38, I² = 99.4%), and a lower risk of all-cause mortality (pooled RR = 0.94, 95%CI: 0.88-0.99, I² = 90.7%). Key social determinants associated with increased mortality risk were either migration-related (e.g. lower language proficiency, undocumented status) or labour-related (e.g. precarious employment, labour migration policies) interacting over migrant workers’ life course. Conclusions As the largest evidence synthesis to date, these findings indicate that migrant workers have higher fatal occupational injury rates than local workers, indicating the need for tailored protections for migrant workers. These data confirm that the all-cause mortality advantage observed in migrant populations applies to the working population. Future interventions should be designed to address both migration- and labour-related determinants of migrant worker health. Key messages • Migrant workers have a higher risk of workplace fatality despite being generally healthier than local workers, explained by structural determinants such as precarious employment. • Future interventions must address migration- and labour-related social determinants of health at structural levels, such as extending labour protection laws to migrant workers.

Single arterial access versus standard access in TAVI: results from a large multicenter registry

Abstract Background The transfemoral approach has become the gold standard primary access for transcatheter aortic valve implantation (TAVI) due to low complication rates. An additional secondary access (ScA) is used for angiographic guidance of the procedure. Recently, small, single-center studies demonstrated feasibility of single-access for transfemoral TAVI without a secondary access. However, comparative and large-scale data are missing. Purpose We assessed vascular and bleeding complications of ScA and Single access (SA) approaches in a large multicenter registry to evaluate both strategies. Methods The PULSE registry (Plug or sUture based vascuLar cloSurE after TAVI) retrospectively evaluated data of 10,120 patients who underwent transfemoral TAVI at 10 high-volume German heart centers from 2016 to 2021. In 9,457 patients who qualified for analysis ScA (80.7% femoral, 19.3% radial) were performed in 8709 (92%) and SA in 748 (8%). Outcomes were evaluated in accordance with the Valve Academic Research Consortium (VARC-3) definitions. Results Median age was 81.9[IQR 78.2, 85.1] years and 48.9% of patients were female (median logistic EuroSCORE II: 3.3% [IQR 2.1, 5.6]). Peripheral artery disease was comparable between groups (13.5 vs. 14.0%, p=0.73). While overall major access-related vascular complications did not differ significantly (6.1% vs. 4.8%, p=0.20), there was a higher incidence of minor complications for ScA compared to SA (9.0% vs. 2.8%, p<0.001). Secondary access complications amounted to 2.7% in the ScA group and were mainly characterized as bleeding (1.2%) and pseudoaneurysms (1.2%) mostly treated conservatively (1.2%), yet in some cases surgical repair was needed (0.8%). No significant difference was observed regarding type III/IV bleeding (4.1% vs. 4.3%, p=0.91), stroke rate (2.4% vs. 3.6%, p=0.05), stage III/IV acute kidney injury (2.4% vs. 2.4%, p=1.00) or all-cause 30-day mortality (5.8% and 5.7%, p=0.99) for ScA compared to SA groups. Conclusion In patients treated with transfemoral TAVI, a single access approach was associated with lower rates of minor access-related vascular complications without compromising overall outcomes, suggesting potential benefits of a minimally-invasive TAVI approach with the omission of additional vascular access.

Valve unit instead of intensive care unit admission after transcatheter edge-to-edge tricuspid valve repair

Abstract Background Standardization of periprocedural pathways reduces the length of hospital stay and thus healthcare costs and increases patient safety. Post-procedure admission to the intensive care unit (ICU) after transcatheter edge-to-edge tricuspid valve repair (T-TEER) has been the standard of care. Due to the COVID-19 pandemic related decline in high-care hospital beds, our center established primary admission to a dedicated general cardiologic care ward, the valve unit (VU). Aim To assess benefits and risks of admission to the VU instead of ICU after T-TEER. Methods This retrospective observational study included 270 consecutive patients who underwent T-TEER between March 2017 and June 2023 at our university hospital. Patients were admitted to the ICU post-procedure up to April 9th 2020 as standard (ICU-group, n = 53). Subsequent patients were planned for admission to a dedicated VU (VU-group, n = 217). We compared the groups and assessed length of hospital stay and in-hospital complications. In the VU-group, we examined unplanned transfer to the ICU (cross-over) and its predictors. Results Monitoring at the VU included continuous telemetric ECG-recording, oxygen saturation assessment, periodical blood pressure measurements and 24-hours physician presence. In contrast to the ICU, only non-invasive blood pressure measurements, less frequent laboratory controls and less intense fluid monitoring took place. The postinterventional hospital stay of patients with planned VU admission was significantly shorter compared to patients with planned ICU admission (median 4 (interquartile range (IQR) 3 - 5) vs. 4 (IQR 4 - 5) days, p = 0.030). Remarkably, overall complication rates were low and cardiogenic shock, infections, bleeding, vascular complications, delirium and acute kidney injury requiring dialysis were similar in both groups. 37 patients that were planned for VU had to cross over to unplanned ICU admission (17.1 %). Patients that had crossed over to unplanned ICU treatment had significantly higher risk for acute kidney injury (20.0 vs. 10.0%, p = 0.039) and in-hospital mortality (5.6 vs. 0%, p = 0.045). Higher systolic pulmonary artery pressure (sPAP) (OR 1.048, 95 %-CI 1.015 – 1.082, p = 0.003), NYHA functional class >= III (OR 9.176, 95 % CI 1.141 – 74.396, p = 0.037), and pre-interventional tricuspid regurgitation (TR) grade V (OR 2.941, 95 % CI 1.089 – 7.970, p = 0.033) were found to independently predict cross-over to unplanned ICU treatment. Conclusion Postinterventional admission to the VU instead of ICU after T-TEER shortens postprocedural hospital stay. A small proportion of had an unplanned transfer to ICU, which was accompanied by slightly higher complication rates. This cross-over affects patients with more advanced disease indicated by high pulmonary pressures, NYHA class and TR grade. Thus, admission to a valve unit is favorable for most patients after T-TEER, but those with advanced disease should be monitored more closely.

Histological and Biochemical Effects of Lutein on Paraquat-induced Renal Toxicity in Wistar Rats

Introduction: Paraquat (PQ) poisoning in humans predominantly results from the generation of reactive oxygen species (ROS). To date, no proven antidote exists for PQ poisoning, which is characterized by severe kidney injury and high mortality rates globally. However, free radical scavengers and antioxidant agents have shown potentials to mitigate PQ toxicity. Aim: The study is aimed at investigating lutein, an antioxidant, for possible mitigation of paraquat-induced renal toxicity. Study Design: Preclinical experimental study. Place and Duration of Study: Department of Anatomy, Obafemi Awolowo University (OAU), Nigeria, between 2022 and 2023. Methods: Forty wistar rats weighing 150-180 grammes were randomly grouped (A to E) for this study. Paraquat (PQ) toxicity was induced in groups B to E. Lutein was administered at graded doses of 50 mg/kg, 100 mg/kg and 150 mg/kg to groups C to E for twenty-one days respectively. Group A (positive control) was given only normal saline, while group B had paraquat only. Twenty-four hours after the last administration, urine and blood samples were collected and the animals were sacrificed before the excision of the kidneys. Results: A marked histological distortion, which was characterized by compromised Bowman's space and renal tubule dimensions, was observed in Group B. In contrast, the lutein-treated groups exhibited dose-dependent improvements, with outcomes comparable to the control group. Notably, Group B showed significant elevations in plasma creatinine (P = 0.003) and urine protein (P = 0.001), accompanied by reduced plasma protein (P = 0.004), relative to the treated groups. However, Group E, which received the highest lutein dose, demonstrated substantial improvement in histoarchitectural and biochemical findings similar to the control group." Conclusion: This study demonstrated significant alterations in the histoarchitecture and biochemical profiles of renal tissue following paraquat exposure. Notably, the lutein-treated groups exhibited substantial improvement, with results comparable to the control group. These findings suggest that lutein may possess potential therapeutic properties to mitigate paraquat-induced renal toxicity.

Prolonged exposure to air pollution and risk of acute kidney injury and related mortality: a prospective cohort study based on hospitalized AKI cases and general population controls from the UK Biobank

BackgroundPrevious investigations identified a connection between air pollution and kidney diseases. Nevertheless, there is a lack of comprehensive evidence on the long-term risks posed by air pollution with respect to acute kidney injury (AKI) and AKI-related death.MethodsThis prospective cohort analysis included 414,885 UK Biobank (UKB) participants who did not exhibit AKI at the study’s outset. AKI was defined based on ICD-10 codes recorded for hospitalized patients. Cox proportional hazards models were used to assess the association between prolonged exposure to air pollutants (particulate matter with diameters of 2.5 micrometers or less (PM2.5), between 2.5 and 10 micrometers (PM2.5−10), and 10 micrometers or less (PM10), along with nitrogen dioxide (NO2) and nitrogen oxides (NOx)) and the risk of AKI and AKI-related death, adjusting for potential confounders including sex, age, ethnicity, education, income, lifestyle factors, and relevant clinical covariates. Restricted cubic splines were applied to evaluate non-linear dose-response relationships, and stratified analyses were performed to explore potential effect modification across subgroups.ResultsOver an average follow-up duration of 11.7 years, 14,983 cases of AKI and 326 cases of AKI-related death were diagnosed. Quartile analysis showed individuals exposed to higher levels of these air pollutants had a significantly higher risk of developing AKI and AKI-related death compared to those in the lowest quartile (all P < 0.05). The RCS curves depicting the relationship between PM2.5, PM2.5−10, PM10, NO2, NOx, and the risk of AKI showed a significant departure from linearity (P for non−linearity < 0.05), while the relationships between PM2.5, NO2, NOx, and the risk of AKI-related death did not exhibit a significant departure from linearity (P for non−linearity > 0.05). Sensitivity analyses confirmed the robustness of our findings.ConclusionOur study reveals a direct association between prolonged air pollution exposure and elevated risks of both AKI and AKI-related death. These findings offer scientific validation for the adoption of environmental and public health measures directed towards the reduction of air pollution. Such initiatives could potentially ease the impact associated with AKI and AKI-related death.

Trends in Road Traffic Injuries Mortality in India: An Analysis from the Global Burden of Disease Study 1990-2021.

Road traffic injury (RTI) is one of the most common causes of accidental deaths in India. The study investigates the changes in trends in age-standardised RTI mortality rates in India by sex and age groups, using data from the Global Burden of Disease (GBD) Study 2021. The trend segments are estimated from 1990 to 2021 employing a joinpoint regression model. Additionally, the influence of age, time period, and birth cohort on mortality rate trends was assessed using the age-period-cohort model. Over the past 32 years, the RTI mortality rates have experienced multiple trend segments. RTI mortality rate in the ≤ 14-year-old population has declined remarkably, dropping from 5.71 (4.65 to 6.88) per lakh population in 1990 to 3.66 (3.01 to 4.35) per lakh population in 2010, and further declining to 1.98 (1.65 to 2.37) per lakh population in 2021. The study found a positive correlation between RTI mortality rates and age, with rates consistently lower for women compared to men across all age groups. The variation in RTI mortality rates across Indian states has widened over time, with the coefficient of variation increasing from 30.58% in 1990 to 32.36% in 2010, and further to 35.11% in 2021. Despite efforts, Indian states are unlikely to achieve the goal of halving RTI deaths by 2030, based on 2010 levels. To address this, road conditions and road safety policies aimed at preventing the incidence of RTIs should be further intensified.

Sex-Based Differences in Polytraumatized Patients between 1995 and 2020: Experiences from a Level I Trauma Center.

Background/Objectives: The aim of this study was to examine sex-related differences in the outcomes of polytraumatized patients admitted to a level I trauma center. Methods: This was a retrospective data analysis of 980 consecutive polytraumatized patients admitted to a single level I trauma center between January 1995 and December 2020. Results: Among all patients, about 30% were female, with a significantly higher age and significantly higher rates of suicidal attempts. No sex-related differences regarding injury severity or trauma mechanisms could be seen, but female patients had significantly higher overall in-hospital mortality rates compared to male patients. Even in the elderly group of patients, elderly female patients were significantly older compared to elderly male patients, with significantly increased lengths of hospital stay. In the elderly group of patients, no sex-related differences regarding injury severity, trauma mechanisms or mortality could be detected. Multivariate analysis revealed suicidal attempt, severe head injury and age > 54 years as independent prognostic factors in the survival of polytraumatized patients. Conclusions: Distinctive sex-related differences can be found, with female polytraumatized patients being significantly older and having higher overall mortality rates with significantly increased LOS. Our study suggests a strong sex-independent influence of age, suicidal attempt and severe head injury on the outcomes of polytraumatized patients.

Circulating T-lymphocyte subsets as promising biomarkers for the identification of sepsis-induced acute kidney injury.

This retrospective study investigated whether disturbances in circulating T-lymphocyte subsets could predict the incidence of acute kidney injury (AKI) and in-hospital mortality in patients with sepsis. Clinical data from patients with sepsis admitted to the intensive care unit were reviewed. Logistic regression analyses were used to identify independent predictors of in-hospital mortality and the development of AKI. Of 81 patients with sepsis, 50 developed AKI. Both non-survivors and patients with septic AKI exhibited dramatically higher Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Non-survivors exhibited more organ damage, with significantly lower levels of peripheral T-lymphocyte subsets, including total circulating lymphocytes, and CD3+, CD3+CD4+, and CD3+CD8+ T-lymphocytes. Patients with septic AKI exhibited fewer total peripheral lymphocytes and fewer CD3+, CD3+CD4+, and CD3+CD8+ T-lymphocytes, with higher serum lactate levels and lower nadir platelet counts. Independent predictors of 30-day hospital mortality included maximum SOFA and APACHE II scores, occurrence of encephalopathy, and peripheral CD3+ and CD3+CD8+ T lymphocyte counts. Moreover, the maximum SOFA score and CD3+ and CD3+CD8+ T-lymphocyte counts demonstrated good predictive power for AKI in receiver operating characteristic curve (ROC) analyses, with an area under the ROC curve of 0.810 (95% confidence interval [CI] 0.712-0.908) for SOFA score, 0.849 (95% CI 0.764-0.934) for CD3+ T-lymphocytes, and 0.856 (95% CI 0.772-0.941) for CD3+CD8+ T-lymphocytes. Patients with sepsis-induced AKI experienced T lymphopenia and increased in-hospital mortality. Higher maximum SOFA scores and reduced peripheral CD3+ and CD3+CD8+ T-lymphocyte levels were associated with in-hospital mortality and the development of AKI in patients with sepsis.

Timing of total joint arthroplasty post-COVID-19: an evaluation of the optimal window to minimize perioperative risks

BackgroundTotal hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed orthopedic procedures. This study aimed to evaluate the impact of COVID-19 status on postoperative complications and mortality in patients undergoing THA and TKA.MethodsA total of 110,186 underwent either THA or TKA. Patients were grouped based on their COVID-19 status, gathered from the National COVID-19 Cohort Collaborative (N3C) in the 12 weeks preceding surgery and compared for various variables, including age, sex, BMI, and Charlson Comorbidity Index (CCI) scores. COVID-19 status was defined as a positive test result that was closest to the date of surgery regardless of testing positive previously. Postoperative complications such as venous thromboembolism (VTE), sepsis, surgical site infection, bleeding, acute kidney injury (AKI), 30-day, and 1-year all-cause mortality were examined. To compare the variables, an odds ratio with a 95% confidence interval was calculated with a significant level set at P < 0.05. Logistic regression using R programming was utilized for these calculations.ResultsUnivariate analysis was performed and rates of VTE (1.02% vs. 3.35%), 30-day mortality (0.25% vs. less than 5%), and 1-year mortality (1.42% vs. 5.43%) were higher in the COVID-19-positive group for THA patients (P < 0.001). For TKA patients, only 30-day mortality was significantly higher in the COVID-19-positive group (P = 0.034). Multivariate logistic regression revealed that a positive COVID-19 diagnosis within two weeks of surgery and a CCI score > 3 were significant predictors of postoperative complications and mortality for both TKA and THA.ConclusionsPatients with a positive COVID-19 diagnosis within 12 weeks of THA or TKA carried a significantly higher risk for postoperative complications and mortality. In addition, a CCI score > 3 is also a significant risk factor. These findings emphasize the importance of vigilant preoperative screening and risk stratification in the era of COVID-19.

Impacting trauma care in resource-limited settings: Lessons learned from Tanzania's web-based trauma registry initiatives.

Trauma significantly impacts Tanzanian healthcare. Lacking standardized hospital-based minimal trauma data sets places further challenges for policymakers. In other resource-limited countries, implementing trauma systems and registries has reduced injury mortalities. In 2013, we introduced an electronic trauma registry, iTRAUMATM at the Tanzanian Muhimbili Orthopedic Institute (MOI) but noted several drawbacks. In 2023, we introduced a robust web-based trauma registry platform. This study assesses the feasibility and utility of implementing the platform at MOI and summarizes challenges, lessons, and results compared to existing systems. This prospective observational study involved clinicians collecting data directly on the platform at the point-of-care, following specific training. Semi-structured interviews with local stakeholders identified challenges and areas for improvement. Data were reported from July to December 2023. Data from 2930 patients showed 59% of injuries were from road traffic collisions (RTCs), with 43% of patients arriving at MOI by non-ambulances. Our findings show that non-ambulance arrivals were associated with higher injury severity (p<0.026), mortalities (p<0.017), and delayed hospital arrival (p<0.004), underscoring the critical role of prompt transport in trauma management. The new platform identified trauma care gaps, with a mean arrival-to-care time of 29.89min, prompting trauma training at MOI to enhance clinician capacities. It also demonstrated superiority over existing systems by improving data completeness, timeliness, and usability. Challenges included gaining support for the platform's functionality, technology integration, and navigating administrative changes. With continued communication, stakeholder acceptance and support were achieved. The web-based platform has become MOI's standard trauma database, demonstrating its feasibility and utility. It overcame the existing challenges of data completeness, timeliness, and usability for policymaking. Positive feedback has prompted plans to expand the platform to other hospitals, benefiting clinical benchmarking and trauma preventive efforts. Ensuring sustainability requires involvement from the Ministry of Health, ongoing training, functionality enhancements, and strengthened global partnerships.

Study protocol: process and outcome evaluation of the Walk with Ease program for fall prevention

BackgroundFalls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians.MethodsThe study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of ‘habit training’ resources (relative to generic behavior prompts) to improve compliance with exercises in this population.DiscussionThe study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination.Trial registrationClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

Evaluating the impact of occupational noise exposure on workplace fatal and nonfatal injuries in the U.S. (2006–2020)

ObjectivesThis study assessed the relationship between occupational noise exposure and the incidence of workplace fatal injury (FI) and nonfatal injury (NFI) in the United States from 2006 to 2020. It also examined whether distinct occupational and industrial clusters based on noise exposure characteristics demonstrated varying risks for FI and NFI. MethodsAn ecological study design was utilized, employing data from the U.S. Bureau of Labor Statistics for FI and NFI and demographic data, the U.S. Census Bureau for occupation/industry classification code lists, and the U.S./Canada Occupational Noise Job Exposure Matrix for noise measurements. We examined four noise metrics as predictors of FI and NFI rates: mean Time-Weighted Average (TWA), maximum TWA, standard deviation of TWA, and percentage of work shifts exceeding 85 or 90 dBA for 619 occupation-years and 591 industry-years. K-means clustering was used to identify clusters of noise exposure characteristics. Mixed-effects negative binomial regression examined the relationship between the noise characteristics and FI/NFI rates separately for occupation and industry. ResultsAmong occupations, we found significant associations between increased FI rates and higher mean TWA (IRR: 1.06, 95% CI: 1.01–1.12) and maximum TWA (IRR: 1.10, 95% CI: 1.07–1.14), as well as TWA exceedance (IRR: 1.04, 95% CI: 1.01–1.07). Increased rates of NFI were found to be significantly associated with maximum TWA (IRR: 1.06, 95% CI: 1.04–1.09) and TWA exceedance (IRR: 1.03, 95% CI: 1.01–1.05). In addition, occupations with both higher exposure variability (IRR with FI rate: 1.49, 95% CI: 1.23–1.80; IRR with NFI rate: 1.40, 95% CI: 1.14–1.73) and higher level of sustained exposure (IRR with FI rate: 1.27, 95% CI: 1.12–1.44; IRR with NFI rate: 1.21, 95% CI: 1.05–1.39) were associated with higher rates of FI and NFI compared to occupations with low noise exposure. Among industries, significant associations between increased NFI rates and higher mean TWA (IRR: 1.05, 95% CI: 1.02–1.08) and maximum TWA (IRR: 1.06, 95% CI: 1.04–1.08) were observed. Unlike the occupation-specific analysis, industries with higher exposure variability and higher sustained exposures did not display significantly higher FI/NFI rates compared to industries with low exposure. ConclusionsThe results suggest that occupational noise exposure may be an independent risk factor for workplace FIs/NFIs, particularly for workplaces with highly variable noise exposures. The study highlights the importance of comprehensive occupational noise assessments.

Impact of injury mortality changes on life expectancy in Tianjin, 2003 and 2021

ObjectiveTo analyze the impact of injury mortality changes on life expectancy (LE) in Tianjin in 2021 compared with 2003 by age, gender, urban-rural, and cause-specific differences. MethodsThe abridged life table and Arriaga's decomposition method were applied to analyze the cause of death surveillance data of Tianjin residents in 2003 and 2021, calculating the age-specific and subcategory-specific contribution of injury to the increase of LE. ResultsFrom 2003 to 2021, the injury mortality rate dropped from 30.33 to 21.57 per 100,000 in Tianjin. Over this period, LE varied from 77.70 to 82.03 years, with an increase of 4.33 years. The reduction in injury mortality contributed 0.3111 years (7.18 %) to the growth of LE. The positive impact on LE was notably observed in the age group of 1–49 years, contributing 0.4348 years (10.04 %) cumulatively. The major injuries that contributed significantly to the increase of LE were transport accidents excluding motor vehicles (0.2558 years, 5.91 %), accidental poisoning (0.0845 years, 1.95 %), motor vehicle traffic accidents (0.0474 years, 1.09 %), and drowning (0.0359 years, 0.83 %). However, the rise in intentional self-harm mortality rate from ages 10–24 and increased mortality rates due to other accidents and adverse effects, motor vehicle traffic accidents, and falls from ages 50+ had negative impacts on LE. ConclusionDuring 2003–2021, the decline in injury mortality rates among children and young to middle-aged individuals in Tianjin played a crucial role in the increase of LE. It is essential to enhance primary prevention efforts, particularly focusing on key populations, to reduce the negative impact on LE growth from intentional self-harm, other accidents and adverse effects, motor vehicle traffic accidents, and falls.

TBI related death has become the new epidemic in polytrauma: a 10-year prospective cohort analysis in severely injured patients.

Advances in trauma care have attributed to a decrease in mortality and change in cause of death. Consequently, exsanguination and traumatic brain injury (TBI) have become the most common causes of death. Exsanguination decreased by early hemorrhage control strategies, whereas TBI has become a global health problem. The aim of this study was to investigate trends in injury severity,physiology, treatment and mortality in the last decade. In 2014, a prospective cohort study was started including consecutive severely injured trauma patients > 15years admitted to a Level-1 Trauma Center ICU. Demographics,physiology,resuscitation, and outcome parameters were prospectively collected. Five hundred and seventy-eight severely injured patients with predominantly blunt injuries (94%) were included. Seventy-two percent were male with a median age of 46 (28-61) years, and ISS of 29 (22-38). Overall mortality rate was 18% (106/578) with TBI (66%, 70/106) being the largest cause of death. Less than 1% (5/578) died of exsanguination. Trend analysis of the 10-year period revealed similar mortality rates despite an ISS increase in the last 2years. No significant differences in demographics,and physiology in ED were noted. Resuscitation strategy changed to less crystalloids and more FFP. Risk factors for mortality were age,brain injury severity,base deficit,hypoxia,and crystalloid resuscitation. TBI was the single largest cause of death in severely injured patients in the last decade. With an aging population TBI will increase and become the next epidemic in trauma. Future research should focus on brain injury prevention and decreasing the inflammatory response in brain tissue causing secondary damage, as was previously done in other parts of the body.

The trend of occupational injuries mortality and Disability Adjusted Life Years (DALYs) in Hamadan Province between 1990 and 2021

Background and Objectives: Occupational injuries are considered as one of the most important health, social and economic risk factors in industrial and developing societies. Therefore, the aim of the present study was to investigate the trend of mortality and Disability Adjusted Life Years rates due to occupational injuries in Hamedan province during 1990 to 2021. Methods: In this cross-sectional descriptive study, the trend of changes in the mortality and Disability Adjusted Life Years rates due to occupational injuries in Hamedan province in a period of 32 years was investigated using join point regression and Join Point Regression software version 5.1.0. Results: The Disability Adjusted Life Years (due to premature death and disability) from occupational injuries in Hamedan province decreased from 496.75 years per thousand population in 1990 to 229.98 years per thousand population in 2021 (the average annual percent changes (AAPC) was -2.40%). This decreasing trend in DALY caused by occupational injuries was also evident in men and women (the AAPC in men and women was -2.40% and -1.10%, respectively).On the other hand, the mortality rate due to injuries in both sexes had decreased from 7.55 cases per 100,000 population in 1990 to 3.46 cases per 100,000 population in 2021 (AAPC was -2.50%). Conclusion: Generally, the trend of mortality and Disability Adjusted Life Years rates due to occupational injuries in Hamedan province had a decreasing trend, which was consistent with other studies conducted in Iran and the world.

Towards an Evidence-Based Critical Incidents and Suicides Response Program in Australian Construction

Fatal and non-fatal accidents and suicides at work pose a substantial threat to workers’ physical and psychological safety, particularly within the construction industry. Managing these incidents is an essential component of workplace health and safety (WHS). Additionally, a formal program to support workers and provide feedback to improve the existing WHS management system is increasingly important. However, knowledge of the factors contributing to an effective critical incident (CI) or postvention response is limited by the lack of published evidence-based interventions, especially for occupations and industries that are exposed to higher rates of fatal and non-fatal injuries due to accidents and suicides. In addition, broader concerns surrounding the effectiveness of conventional critical incident programs highlight the need to develop innovative and evidence-based critical intervention and postvention responses addressing acute stress symptoms arising from exposure. This research outlines the development of the MATES Respond Training Program, a component of the WHO-endorsed MATES in Construction program, which is a charity charged with the task of improving mental health and suicide prevention in the construction industry in Australia and New Zealand. Development of the MATES Respond Training Program was informed by the following three key sources: a rapid literature review, interviews with 11 workers trained in peer support suicide prevention interventions, and an analysis of site notes on 193 critical incident and postvention construction site attendances by MATES in Construction field officers, case managers and social workers. Insights and recommendations obtained from these sources, along with the resulting program, are discussed in this paper.

Ventilatory pressure parameters impact the association between acute gastrointestinal injury and all-cause mortality in mechanically ventilated patients

Acute gastrointestinal injury (AGI) is common in mechanically ventilated (MV) patients, but the potential association between ventilatory pressure parameters and AGI grade and their impact on mortality remains unclear. This study aimed to explore the association between ventilatory pressure parameters and AGI grade, and their interaction on all-cause mortality in MV patients. This study was a secondary analysis of a multicenter, prospective, observational study that enrolled adult patients with an expected duration of mechanical ventilation ≥ 48 h from 14 general intensive care units in Zhejiang Province between March and August 2014. The AGI grade was assessed daily on the basis of gastrointestinal symptoms, intra-abdominal pressures, and feeding intolerance in the first week of admission to the ICU. This study included 331 patients (69.2% men; mean age, 64.6 ± 18.9 years). Multivariate regression analysis showed that plateau pressure (Pplat) (OR 1.044, 95% CI 1.009–1.081, P = 0.013), serum creatinine (OR 1.003, 95% CI 1.001–1.006, P = 0.042) and APACHE II score (OR 1.035, 95% CI 1.021–1.072, P = 0.045) were independently associated with global AGI grade III/IV within 7 days of ICU admission. Moreover, global AGI grade (HR 2.228, 95% CI 1.561–3.182, P < 0.001), serum creatinine (HR 1.002, 95% CI 1.001–1.003, P = 0.012) and APACHE II score (HR 1.039, 95% CI 1.015–1.063, P = 0.001) were independently associated with 60-day mortality. In addition, there were significant (Pint ≤ 0.028) interactions of Pplat and DP with AGI grade in relation to 60-days mortality, whereas no interaction (Pint = 0.061) between PEEP and AGI grade on 60-days mortality was observed. In the presence of Pplat ≥ 19 cmH2O, the patients with AGI grade III/IV had 60-day mortality rate of 72.2%, significantly higher than those with AGI grade I/II (48.7%, P = 0.018), whereas there were no significant differences (27.9% vs. 33.7%, P = 0.39) in 60-days mortality between AGI grade I/II and III/IV among the patients with Pplat < 19 cmH2O. In comparison with Pplat, DP had a similar interaction (Pint = 0.028) with AGI grade on 60-day mortality. Ventilatory pressure parameters (Pplat and DP) are independent risk factors of AGI grade III/IV. Pplat and DP interact with AGI grade on 60-days mortality, highlighting the importance of optimizing ventilatory pressure parameters to improve gastrointestinal function and survival outcomes of MV patients.Trial registration: ChiCTR-OCS-13003824.

Voluntary head dunking after exercise-induced hyperthermia rapidly reduces core body temperature in dogs.

To evaluate field-applicable cooling methods for treatment of exercise-induced hyperthermia in dogs. In this randomized, crossover study from June 27, 2023, to July 24, 2023, 12 working dogs exercised for 10 minutes until core body temperature reached 40.6 °C or above or ≥ 2 signs of heat stress were observed. Four different cooling protocols were evaluated: (1) neck chemical ice packs (2), (2) a wet (22 °C) neck towel, (3) wet (22 °C) axillae towels, or (4) voluntary head immersion ("dunking") into (22 °C) water. After intervention, dogs rested and were monitored for 40 minutes. The dunking protocol, which included limited water ingestion, produced the lowest mean core temperature in the initial 5 minutes after exercise, in the subsequent 35 minutes during which dogs cooled to baseline temperature and was the only protocol to prevent the initial postexercise temperature rise. All methods resulted in return to baseline temperature. Trained voluntary head dunk with limited water ingestion results in rapid cooling in field situations of exercise-induced hyperthermia in dogs with normal mental status and ability to pause panting. "Cool first, transport second" reduces morbidity and mortality of acute heat injury. When whole-body water immersion is not an option, the trained voluntary head dunk in mentally appropriate dogs prevents postexercise rise and rapidly reduces core body temperature within the first 5 minutes. Alternatively, allowing the dog to drink controlled amounts of cool water and pouring water on the dog's head may provide some benefit but warrants further study.

Fatal and Nonfatal Firearm Injury Rates by Race and Ethnicity in the United States, 2019 to 2020.

Racial disparities in firearm injury death in the United States are well established. Less is known about the magnitude of nonfatal and total firearm injury. To combine health care data with death certificate data to estimate total firearm injuries in various racial and ethnic groups. Retrospective, cross-sectional study. Fatal injury data were collected from the Centers for Disease Control and Prevention. Data on nonfatal injuries were collected from the Nationwide Emergency Department Sample (NEDS), a 20% stratified sample of U.S. emergency department visits, weighted to provide national estimates for the United States, 2019 to 2020. All firearm injuries and deaths in the United States. Race and ethnicity were classified into 5 mutually exclusive categories: Asian or Pacific Islander, Black, Hispanic, Native American, and White. International Classification of Diseases, 10th Revision codes were used to classify firearm injury intent. Incidence of fatal and nonfatal injury in the U.S. population and case-fatality ratios (CFRs). There were 252 376 total firearm injuries, including 84 908 deaths from firearm injures. Of all firearm injuries, 37.8% were unintentional, 37.3% were assault related, 21.0% were self-harm, and 1.3% were law enforcement associated. Self-harm had the highest CFRs (90.9% overall). Unintentional injuries accounted for just 1021 (1.2%) deaths but 94 433 (56.4%) of nonfatal injuries. Rates of self-harm were highest among White persons (11.0 per 100 000 population in 2020) followed by Native Americans (8.6 per 100 000). Rates of assault were highest among Black persons (70.1 per 100 000), as were unintentional injuries (56.1 per 100 000). Findings are limited by the accuracy of discharge coding in NEDS, particularly regarding injury intent and patient race and ethnicity. From 2019 to 2020, the total burden of firearm injuries amounts to an average of 1 injury every 4 minutes and 1 death every 12 minutes in the United States. Racial disparities in firearm injury death are mirrored in nonfatal injury. None.

Proenkephalin Improves Cardio-Renal Risk Prediction in Acute Coronary Syndromes: The KID-ACS Score.

Circulating proenkephalin (PENK) is a stable endogenous polypeptide with fast response to glomerular dysfunction and tubular damage. This study examined the predictive value of PENK for renal outcomes and mortality in patients with acute coronary syndromes (ACS). Proenkephalin was measured in plasma in a prospective multicentre ACS cohort from Switzerland (n=4787) and in validation cohorts from the UK (n=1141), Czechia (n=927), and Germany (n=220). A biomarker-enhanced risk score (KID-ACS score) for simultaneous prediction of in-hospital acute kidney injury (AKI) and 30-day mortality was derived and externally validated. On multivariable adjustment for established risk factors, circulating PENK remained associated with in-hospital AKI (per log2 increase: adjusted odds ratio [OR] 1.53, 95% confidence interval [CI] 1.13-2.09, P=0.007) and 30-day mortality (adjusted hazard ratio [HR] 2.73, 95% CI 1.85-4.02, P<0.001). The KID-ACS score integrates PENK and showed an area under the receiver operating characteristic curve (AUC) of 0.72 (95% CI 0.68-0.76) for in-hospital AKI, and of 0.91 (95% CI 0.87-0.95) for 30-day mortality in the derivation cohort. Upon external validation, KID-ACS achieved similarly high performance for in-hospital AKI (Zurich: AUC 0.73, 95% CI 0.70-0.77; Czechia: AUC 0.75, 95% CI 0.68-0.81; Germany: AUC 0.71, 95% CI 0.55-0.87) and 30-day mortality (UK: AUC 0.87, 95% CI 0.83-0.91; Czechia: AUC 0.91, 95% CI 0.87-0.94; Germany: AUC 0.96, 95% CI 0.92-1.00) outperforming the CA-AKI score and the GRACE 2.0 score, respectively. Circulating PENK offers incremental value for predicting in-hospital AKI and mortality in ACS. The simple 6-item KID-ACS risk score integrates PENK and provides a novel tool for simultaneous assessment of renal and mortality risk in patients with ACS.