US Hospital Emergency Departments Research Articles

Structural housing elements associated with injuries in older adults in the USA

ObjectiveTo quantify the unintentional injuries associated with housing elements among older adults treated in US hospital emergency departments (EDs). To identify modifiable home hazards.MethodsThe National Electronic Injury Surveillance System (NEISS)...

What Is the Epidemiology of Cervical and Thoracic Spine Fractures?

Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury. What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021? The United States National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition. The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period. This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age. Level III, prognostic study.

Comprehensive analysis of power tool injuries: implications for safety and injury prevention

BackgroundPower tools are essential for productivity but carry significant injury risks. Addressing power tool injuries across diverse age groups is vital, as existing research predominantly focuses on specific occupational or non-occupational groups, leaving a gap in understanding various age cohorts within the diverse American population. This study aims to comprehend power tool injury epidemiology, raising awareness about the importance of targeted safety measures for enhancing public health. MethodsUsing a ten-year retrospective approach, this study analyzed National Electronic Injury Surveillance System (NEISS) data from US hospital emergency departments (2013–2022). Demographic and temporal trends were examined, and associations between injury occurrence and categorical variables, including injured body parts, gender, and race, were explored. ResultsIn 2013, power tool injuries were highest in the "51–60″ age group (23.70 %), followed by "41–50″ (17.31 %) and "61–70″ (19.38 %). Injury rates varied across age groups over the years. Notably, the "41–50″ age group showed a significant decrease in injuries over time (χ² = 17.12, p < .05), indicating a notable temporal trend. Hand injuries were predominant (39.08 %), followed by finger (19.19 %), lower arm (11.25 %), upper arm (8.79 %), and face (4.04 %). Lacerations constituted the most frequent injury type (60.89 %), alongside fractures, amputations, foreign body insertions, and contusions/abrasions. Significant associations emerged between injury occurrence and gender (χ² = 6.19, p < .001), as well as race (χ² = 7.42, p < .001). Males accounted for the majority of injuries (95.97 %), while white individuals constituted the largest proportion (91.84 %). Females and domestic settings exhibited increasing proportions of power tool injuries. ConclusionsThe higher incidence among middle-aged individuals in domestic settings, coupled with evolving gender dynamics, underscores the need for targeted safety measures. Our findings contribute crucial novel insights, emphasizing tailored preventive strategies to enhance safety outcomes in the multifaceted landscape of power tool use.

Using the NEISS database to understand pressure cooker related injuries in the USA

ObjectiveTo determine the incidence of pressure cooker related injuries in US hospital emergency departments. To quantify injury patterns associated with pressure cookers and inform prevention recommendation messaging.MethodsThe National Electronic Injury...

Poster 375: Incidence of Tendon Ruptures in the US: Comparison of Differences Across Racial Groups

Poster 375: Incidence of Tendon Ruptures in the US: Comparison of Differences Across Racial Groups

Poster 383: Incidence of Sports Related Tendon Ruptures in the United States

Objectives: Physical activity is known to have multiple beneficial health effects, including a reduced risk of cardiovascular disease, improved insulin sensitivity and cognitive function [1,2]. Sports participation inherently increases the risk of musculoskeletal injury, including tendon rupture [3]. Tendon ruptures can be debilitating injuries and often require multidisciplinary treatment and long recovery periods and potentially lead to significant reductions in quality of life, lost productivity, and considerable healthcare costs [4]. Previous studies have been focused primarily on specific types of tendon injuries and/or specific patient populations such as high-level athletes and military trainees, which is not generalizable to the US population [5-8]. There currently exist no updated, population-based studies describing the incidence and demographics of all athletic/sports-related tendon ruptures in the general US population. The purpose of this study was to describe the contemporary epidemiology of athletic tendon ruptures in the US in the most recent two decades using a nationally representative sample. Methods: The NEISS database, a nationally representative sample of US hospital emergency departments was used to ascertain the incidence rates of various types of tendon ruptures in the Unites States. All cases from 2001-2020 were reviewed for case narratives to select only those cases with a clear diagnosis of an acute primary tendon rupture. After exclusions, a total of n=5,765 unweighted cases were identified, representing a national estimate of N=235,189 tendon ruptures (95% CI=186,833- 283,546). Finally, each case narrative was manually reviewed and cross-referenced with the case’s product codes to assign a primary injury mechanism to each patient record, and only those cases involving exercise-/sports-related injury mechanisms were included in the final analyses. Statistical analysis was performed using the survey data commands in Stata/IC, version 17.0 (StataCorp, College Station, TX, US), accounting for sample weights and the complex survey designs. The incidence rate (IR) of tendon ruptures and mechanism were calculated and chi-square tests were used to compare estimated IRs between groups. Student t-test/analysis of variance and design-adjusted Rao-Scott chi- square analysis was used for direct comparisons of means for continuous variables and proportions for categorical variables, respectively [9,10]. Temporal trends and annual percentage changes were assessed via regression analysis. Results: An estimated total of 141,382 individuals (95% CI=107,478-175,286) presented to US EDs with a sports-related tendon rupture over the study period for an overall incidence of 22.9 Person-Years at-risk (PYR) (95% CI=17.4-28.3). Mean age was 37.7 years (95% CI=37.0-38.5). Peak incidence of tendon ruptures occurred in the fourth decade and persons aged 20-40 years accounted for a majority of cases (78.2%). Achilles tendon rupture was the most common injury, representing over half of all cases (55.9%). Basketball was the most common sports-related injury mechanism, accounting for more than one-third of all injuries (36.6%) and a common mechanism for all tendon ruptures of the lower extremity. For sports-related injuries involving upper extremity tendons, weight lifting was the most common mechanism for most, including biceps, rotator cuff, and triceps/pectoralis tendon ruptures. Nearly half of all injuries occurred in contact sports (46.8%). The annual incidence of all sports-related tendon ruptures in the US increased significantly from 2001 to 2020 (AAPC=1.9, 95% CI=1.0-2.8; P&lt;0.01). For comparison, the annual incidence of all non-sports-related tendon ruptures also increased significantly over the same time period (AAPC=4.9, 95% CI=3.7-6.1; P&lt;0.01), and in fact increased at a significantly higher rate than that of all sports-related ruptures (P&lt;0.01). Complete national injury estimate data for each specific type of sport or recreational activity, overall and for each type of tendon rupture, is reported in the Supplement Tables (Supplement 5,6). Conclusions: Tendon ruptures can be debilitating injuries for all patients and can especially affect personal and team performance of competitive athletes to differing degrees depending on the athlete’s particular sport [11]. There is a paucity of population-based studies describing the incidence and demographics of all athletic/exercise-related tendon ruptures in the general US population. This study highlights an increasing annual incidence of athletic tendon ruptures over the last two decades in the US, primarily affecting males of many different age groups. The incidence of nearly all types of tendon ruptures was significantly higher in males when compared with females, which is generally consistent with previous studies involving other large patient populations [12-16]. Previous population-based studies demonstrating an increased incidence of tendon ruptures in recent years have attributed these trends in part to increased athletic participation among adults of various ages [16–18]. Our results show the same trends and are likely attributed to increased participation in athletics, as well as the growing popularity of unconventional sports. [Table: see text][Table: see text][Table: see text][Table: see text]

536 Firework Injuries in Pediatric Patients: A 15 Year Review

Abstract Introduction The United States Consumer Product Safety Commission (CPSC) estimated that 15,600 firework-related injuries were treated in US hospital emergency departments during calendar year 2020 and that there has been a trend of increased injuries from 2005-2020. The goal of this project was to look at the experience of one center with a large referral network, to identify trends and opportunities. Methods A retrospective chart review was performed to analyze data points including mechanism, age, sex, TBSA, injury locations, procedures performed, outcomes and complications length of stay, and services involved. The burn registry was utilized to identify cases throughout a 15-year period. Results During this period, 24 pediatric patients required admission for firework injuries. Eighty-four percent were males compared to 16% in females. Most injuries (67%) occurred while the patient was holding the firework and lighting it as opposed to being struck by a firework. Most of the injuries had small TBSA percentages (84% &amp;lt; TBSA of 15). In addition, most were referred from outside facilities. Most common sites of injury included the hands and face, followed by the eyes. Sixty percent of patients required operative intervention for their injuries, some requiring multiple surgeries. The average length of stay was 2 days, while 8 patients stayed longer than 5 days. Ninety-two percent were admitted to the burn service with additional specialty consultants. Most children required multiple follow up visits. Conclusions Firework related injuries in children result in significant injury often requiring surgical procedures along with a long outpatient treatment course. This work highlights a need for continued advocacy, education, an intervention. This program uses a curriculum and process for children who are injured due to setting fires. The program is evaluating a similar model of intervention and 1:1 counseling for children injured due to fireworks. Applicability of Research to Practice This project is applicable to practice as it highlights the continued opportunity for intervention and prevention for firework related injuries. The trends are not decreasing, and the injuries are significant. Evaluation of a model for youth who have fireworks related injuries, similar to the youth fire-setting program, would be a beneficial next step.

Sharps Injury Rates Reported Among US Workers: National Electronic Injury Surveillance System-Occupational Supplement 2006 to 2020.

To examine sharps injury (SI) rates among US workers treated in hospital emergency departments. A national probability-based sample of approximately 67 US hospital emergency departments from the National Electronic Injury Surveillance System-Occupational Supplement was used to examine annual national estimates of SI rates (number of injuries/10,000 full-time equivalents) for US workers from 2006 to 2020. Among the general US worker population, the 25- to 34-year age group experienced the highest annual SI rate. Health care industry workers experienced SI rates up to 16 times the rate of all US workers. Younger age (≤34 years) is associated with increased SI risk. Tailored prevention efforts should be developed to address the specific needs of these workers, especially among health care workers. Continual occupational surveillance will maximize the health and safety of US workers.

Workplace violence against healthcare workers using nationally representative estimates of emergency department data, 2015-2017.

Workers in the healthcare industry are at increased risk for workplace violence. The goal of this analysis is to determine the rate of injuries healthcare workers incurred as a result of intentional violence by patients in the workplace. Injuries linked to workplace violence that were treated in USemergency departments from 2015 to 2017 were identified using data from the National Electronic Injury Surveillance System-Occupational Supplement (NEISS-Work). All estimates and 95% confidence intervalswere calculated using SAS® 9.4 Proc Survey to incorporate the stratified sample design of NEISS-Work. Approximately 1.14 million injuries to workers in the healthcare industry were treated in UShospital emergency departments between 2015 and 2017. Intentional injuries by another person accounted for 15% of these healthcare-related injuries. The results also showed that male healthcare workers' rate of injuries was 2.3 times higher than their female counterparts despite composing a smaller proportion of the workforce. Injury rates were highest among the less-than-25 age group, and decreased as healthcare workers' age increased. Workplace violence is a serious problem in today's healthcare settings that affects both employees and patient care. Although violence in the healthcare industry has been researched for decades, there has been an increase in violent incidents in this industrial sector. The disparity in injury rates by sex and age are areas of concern. Further research in these areas is necessary to understand the root causes of these incidents and inform violence prevention strategies.

126. Epidemiology of cervical spinal fractures in the US: an NEISS analysis 2001-2019

BACKGROUND CONTEXT The epidemiology of cervical spinal fractures in the US general population remains largely unknown. These data may help optimize treatment and management interventions and reduce the incidence of cervical spinal fractures. PURPOSE The objective of this study is to evaluate the demographics, mechanism of injury and disposition over time in cervical fracture patients. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Patient information was retroactively obtained from the National Electronic Injury Surveillance System (NEISS). We identified all patients with cervical spinal injuries who presented to US hospital emergency departments between January 1, 2001 and December 31, 2019. OUTCOME MEASURES Study endpoints were incidence rates (IR), patient demographics including age, sex, race, disposition, and mechanism of injury. METHODS The National Electronic Injury Surveillance System (NEISS) was queried to identify all patients with cervical spinal injuries that presented to US hospital emergency departments between January 1, 2001 and December 31, 2019. Patient demographics including age, sex, race, disposition and mechanism of injury were also collected. Using census data provided by the US Census Bureau, we determined incidence rates (IR) (1 million person-years) over time of cervical spinal fractures with regard to patient age, sex and race per year. RESULTS A total of 7,760 patients were identified. An estimated national total of 53,514 cervical fractures occurred during this period, with an incidence rate of 9.0 [7.4 - 10.6]. Of the total cervical fractures, 4.0% occurred in patients aged 18-24 (IR 3.5 [2.2 - 4.82]), 5.8% aged 25-34 (IR 4.1), 6.2% aged 35-44 (IR 4.2), 9.7% aged 45-54 (IR 7.4), 12.0% aged 55-64 (IR 9.0), 15.8% aged 65-74 (IR 16.6), 22.2% aged 75-84 (IR 43.3), and 24.2% aged above 85 (IR 95.3). Among total fractures, 51.4% (IR 53.6) occurred in male patients while 48.6% (IR 46.8) occur in female patients; 88.9% were White (IR 6.7) and 6.7% were Black (IR 5.2); 77.1% of all fractures resulted from a fall. The most common disposition was inpatient admission of 54.3%. CONCLUSIONS Multiple trends with regard to patient-related demographics were observed in our statistical analyses. The rate of cervical fractures was greater with higher age resulting from falls. This study highlights the epidemiology of cervical spinal fractures in US patients, which can help optimize treatment and management plans targeted at high-risk groups. Future research should aim toward analyzing different interventional methods and their efficacy in minimizing the incidence of cervical fractures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. The epidemiology of cervical spinal fractures in the US general population remains largely unknown. These data may help optimize treatment and management interventions and reduce the incidence of cervical spinal fractures. The objective of this study is to evaluate the demographics, mechanism of injury and disposition over time in cervical fracture patients. Retrospective cohort. Patient information was retroactively obtained from the National Electronic Injury Surveillance System (NEISS). We identified all patients with cervical spinal injuries who presented to US hospital emergency departments between January 1, 2001 and December 31, 2019. Study endpoints were incidence rates (IR), patient demographics including age, sex, race, disposition, and mechanism of injury. The National Electronic Injury Surveillance System (NEISS) was queried to identify all patients with cervical spinal injuries that presented to US hospital emergency departments between January 1, 2001 and December 31, 2019. Patient demographics including age, sex, race, disposition and mechanism of injury were also collected. Using census data provided by the US Census Bureau, we determined incidence rates (IR) (1 million person-years) over time of cervical spinal fractures with regard to patient age, sex and race per year. A total of 7,760 patients were identified. An estimated national total of 53,514 cervical fractures occurred during this period, with an incidence rate of 9.0 [7.4 - 10.6]. Of the total cervical fractures, 4.0% occurred in patients aged 18-24 (IR 3.5 [2.2 - 4.82]), 5.8% aged 25-34 (IR 4.1), 6.2% aged 35-44 (IR 4.2), 9.7% aged 45-54 (IR 7.4), 12.0% aged 55-64 (IR 9.0), 15.8% aged 65-74 (IR 16.6), 22.2% aged 75-84 (IR 43.3), and 24.2% aged above 85 (IR 95.3). Among total fractures, 51.4% (IR 53.6) occurred in male patients while 48.6% (IR 46.8) occur in female patients; 88.9% were White (IR 6.7) and 6.7% were Black (IR 5.2); 77.1% of all fractures resulted from a fall. The most common disposition was inpatient admission of 54.3%. Multiple trends with regard to patient-related demographics were observed in our statistical analyses. The rate of cervical fractures was greater with higher age resulting from falls. This study highlights the epidemiology of cervical spinal fractures in US patients, which can help optimize treatment and management plans targeted at high-risk groups. Future research should aim toward analyzing different interventional methods and their efficacy in minimizing the incidence of cervical fractures.

Surveillance of acute nonfatal occupational inhalation injuries treated in UShospital emergency departments, 2014-2017.

Acute nonfatal occupational inhalation injuries are caused by exposures to airborne toxicants and contaminants in the workplace. A 1990s study found that USemergency department (ED)-based inhalation injury rates were higher than those seen in the United Kingdom and Canada. This study examines 4 years of hospital ED data to estimate current rates of occupational inhalation injuries. Data from the National Electronic Injury Surveillance System Occupational Supplement were used to identify nonfatal occupational inhalation injuries treated in UShospital EDs from 2014 to 2017. A workplace inhalation injury was defined as any worker treated in an ED as a result of inhaling a harmful substance at work. From 2014 to 2017, there were an estimated 2.2 occupational inhalation injuries per 10,000 full-time equivalents(FTE) (95% confidence interval [CI]: 1.6-2.8) treated in EDs, a rate nearly four times that found in Bureau of Labor Statistics data. Although men incurred 60% (95% CI: 56%-64%) of the injuries, the overall injury rates for men and women were similar at 2.3 (95% CI: 1.7-2.9) and 2.1 (95% CI: 1.4-2.7) per 10,000 FTE, respectively. By age group, workers less than 25 years of age were at greater risk of injury at 4.1 injuries per 10,000 FTE (95% CI: 2.8-5.3). These results illustrate the burden of nonfatal occupational inhalation injuries, providing an understanding of how injuries are distributed based on demographics. While inhalation injury rates have declined over the last two decades,additional research is needed to determine whether interventions have reduced risk, or if the availability of alternate sources of medical treatment is a factor.

Erratum: National Estimates of Noncanine Bite and Sting Injuries Treated in US Hospital Emergency Departments, 2011-2015: Erratum.

[This corrects the article on p. 232 in vol. 113.].

Impact of the Voluntary Safety Standard for Liquid Laundry Packets on Child Injuries Treated in US Hospital Emergency Departments, 2012-2018.

Objectives. To evaluate the effect of the voluntary safety standard for liquid laundry packets on the rate of injury involving children younger than 5 years in the United States.Methods. Semiannual national estimates of child injuries involving liquid laundry packets treated in US hospital emergency departments were developed for the July 2012 through December 2018 study period. We used a negative binomial regression model to estimate the effect of the voluntary standard on the injury rate following the standard's publication at the end of 2015. The analysis controlled for the rapid growth of laundry packet use during the study period. Results are presented as relative risks and percentage changes in the injury rate.Results. The voluntary standard was associated with a 49.4% to 61.6% reduction in the rate of child injury.Conclusions. The results suggest that the requirements of the voluntary standard have effectively reduced the rate of child injury involving liquid laundry packets and may have prevented 9200 to 23 000 emergency department-treated injuries during the study period.

Estimating the number of traffic crash-related cervical spine injuries in the United States; An analysis and comparison of national crash and hospital data

BackgroundCervical spine injury is a common result of traffic crashes, and such injuries range in severity from minor (i.e. sprain/strain) to moderate (intervertebral disk derangement) to serious and greater (fractures, dislocations, and spinal cord injuries). There are currently no reliable estimates of the number of crash-related spine injuries occurring in the US annually, although several publications have used national crash injury samples as a basis for estimating the frequency of both cervical and lumbar spinal disk injuries occurring in lower speed rear impact crashes. PurposeTo develop a reliable estimate of the number of various types of cervical spine injuries occurring in the US by comparing data from national crash injury to national hospital ED and inpatient samples. Study DesignComparative cross-sectional MethodsCervical spine injury data were accessed, analyzed, and compared from 3 national databases; the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS), Nationwide Emergency Department Sample (NEDS), and the Nationwide Inpatient Sample (NIS). ResultsIt is estimated that there are approximately 869,000 traffic crash-related cervical spine injuries seen in hospitals in the US annually, including around 841,000 sprain/strain (whiplash) injuries, 2800 spinal disk injuries, 23,500 fractures, 2800 spinal cord injuries, and 1500 dislocations. Because of a highly restrictive inclusion criteria for both crash and injury types, as well as a very small sample size, the NASS-CDS underestimated all types of crash-related cervical spine injuries seen in US hospital emergency departments by 84 %. The injury type with the largest degree of underestimation in the NASS-CDS was cervical disk injuries, which were estimated at an 88 % lower frequency than in the NEDS. National insurance claim data, which include cases of cervical disk injury diagnosed both in and outside of the ED, indicate that the NEDS likely undercounts cervical disk injuries by 92 %, and thus the NASS-CDS correspondingly undercounts such injuries by 99 % or more. ConclusionsBecause of a limited sample size and restrictive criteria for both crash and injury inclusion, the NASS-CDS cannot be used to estimate the number of crash-related spinal injuries of any type or severity in the US. The most inappropriate use of the database is for estimating the number of spinal injuries resulting from low speed rear impact collisions, as the NASS-CDS samples fewer than 1 in 100,000 of the cervical spine injuries of any type occurring in low speed rear impact collisions.

Electronic Cigarette Explosion and Burn Injuries

Objectives: E-cigarette explosions have resulted in severe injuries and fatalities. To date, only 2 studies have systematically estimated the prevalence of these injuries. This study updates these national estimates and describes the context of these explosion injuries. Methods: We conducted analyses on cross-sectional data from the US Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS). A key word search of case narrative text identified e-cigarette explosion and burn injuries reported by US hospital emergency departments. We applied sampling weights to make national incidence estimates, and reviewed text to identify contextual factors. Results: An estimated 2693 (95% CI 1478 to 3909) e-cigarette explosion and burn injuries were presented to US hospital emergency departments between 2015 and 2018. Case narratives indicated that a notable proportion of explosions occurred while a person was changing or replacing a device's battery. Conclusions: To prevent further injuries and fatalities, there is a need for strengthened regulation and monitoring of e-cigarette devices. The variety of contexts in which e-cigarettes have exploded suggests these devices have poorly understood technical problems that industry should be required to address. In addition, data recording and surveillance of e-cigarette injuries need improvement.

National Estimates of Noncanine Bite and Sting Injuries Treated in US Hospital Emergency Departments, 2011-2015.

Injuries resulting from contact with animals are a significant public health concern. This study quantifies and updates nonfatal bite and sting injuries by noncanine sources using the most recent data available (2011-2015) from the National Electronic Injury Surveillance System-All Injury Program with the purpose of using these updates to better understand public health consequences and prevention techniques. Increased rates of bites and stings can be expected in this study's time frame, possibly caused by the increasing human population expanding into animal territories, as well as changes in animal geographic distribution and pet ownership. The National Electronic Injury Surveillance System-All Injury Program is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal sources of bite and sting injuries being treated. Data from 2011-2015 were weighted to produce national annualized estimates, percentages, and rates based on the US population. An estimated 1.17 million people visited EDs for noncanine bite and sting injuries annually. This translates to a rate of 371.3/100,000 people. Insects accounted for 71.0% of noncanine bite and sting injuries, followed by arachnids (19.2%) and mammals (7.8%). The estimated annual total lifetime medical and work cost of unintentional noncanine injuries was $5,755,581,000. Various sources of bite and sting injuries had an outsized effect on injury rates and identify potential areas of focus for education and prevention programs to reduce the burden of these injuries on health and healthcare costs. The study describes the diversity of animal exposures based on a national sample of EDs. Noncanine bite and sting injuries significantly affect public health and healthcare resources. Priorities can be focused on animal sources with the most impact on bite and sting injury rates, healthcare costs, and disease burden.

Ankle Fracture Epidemiology in the United States: Patient-Related Trends and Mechanisms of Injury

Current nationwide epidemiological dataregardingankle fractures are scarce.Such information isimportant towards better quantifyingthe mortality associated with such injuries, financial impact, as well as the implementation of preventative measures.This studyevaluated the epidemiology of ankle fractures that occurred during a 5-year period. Specifically, we evaluated demographics, mechanism of injury, and disposition. The National Electronic Injury Surveillance System wasqueried to identifyall patients with ankle fractures that presented to US hospital emergency departments between 2012 and 2016. Census data were used to determine the incidence rates of ankle fractures in terms of age, sex, and race. There was an estimated total of 673,214 ankle fractures that occurred during this period, with an incidence rate of 4.22/10,000 person-years. The mean age of patients with an ankle fracture was 37 ± 22.86 (SD) years; 23.5% of ankle fractures occurred in patients aged 10 to 19 years (7.56/10,000 person-years). In addition, 44% of ankle fractures occurred in men (3.81/10,000 person-years), whereas 56% occurred in women (4.63/10,000 person-years). Data on race/ethnicity were available for 71% of the subjects, with incidence rates of 2.85/10,000 person-years for whites, 3.01/10,000 person-years for blacks, and 4.08/10,000 person-years for others. The most common mechanism of injury was falls (54.83%), followed by sports (20.76%), exercise (16.84%), jumping (4.42%), trauma (2.84%), and other (0.30%). For disposition, 81.84% of patients were treated and released, 1.43% were transferred, 16.01% were admitted, 0.59% were held for observation, and 0.13% left against medical advice. The highest incidence of ankle fractures in men occurred in the 10-to-19-years age group, but women were more commonly affected in all other age groups.

A revised classification algorithm for assessing emergency department visit severity of populations.

Analyses of emergency department (ED) use require visit classification algorithms based on administrative data. Our objectives were to present an expanded and revised version of an existing algorithm and to use this tool to characterize patterns of ED use across US hospitals and within a large sample of health plan enrollees. Observational study using National Hospital Ambulatory Medical Care Survey ED public use files and hospital billing data for a health plan cohort. Our Johns Hopkins University (JHU) team classified many uncategorized diagnosis codes into existing New York University Emergency Department Algorithm (NYU-EDA) categories and added 3 severity levels to the injury category. We termed this new algorithm the NYU/JHU-EDA. We then compared visit distributions across these 2 algorithms and 2 other previous revised versions of the NYU-EDA using our 2 data sources. Applying the newly developed NYU/JHU-EDA, we classified 99% of visits. Based on our analyses, it is evident that an even greater number of US ED visits than categorized by the NYU-EDA are nonemergent. For the first time, we provide a more complete picture of the level of severity among patients treated for injuries within US hospital EDs, with about 86% of such visits being nonsevere. Also, both the original and updated classification tools suggest that, of the 38% of ED visits that are clinically emergent, the majority either do not require ED resources or could have been avoided with better primary care. The updated NYU/JHU-EDA taxonomy appears to offer cogent retrospective inferences about population-level ED utilization.

Broad-spectrum antibiotic use and poor outcomes in community-onset pneumonia: a cohort study.

Is broad-spectrum antibiotic use associated with poor outcomes in community-onset pneumonia after adjusting for confounders? We performed a retrospective, observational cohort study of 1995 adults with pneumonia admitted from four US hospital emergency departments. We used multivariable regressions to investigate the effect of broad-spectrum antibiotics on 30-day mortality, length of stay, cost and Clostridioides difficile infection (CDI). To address indication bias, we developed a propensity score using multilevel (individual provider) generalised linear mixed models to perform inverse-probability of treatment weighting (IPTW) to estimate the average treatment effect in the treated. We also manually reviewed a sample of mortality cases for antibiotic-associated adverse events. 39.7% of patients received broad-spectrum antibiotics, but drug-resistant pathogens were recovered in only 3%. Broad-spectrum antibiotics were associated with increased mortality in both the unweighted multivariable model (OR 3.8, 95% CI 2.5-5.9; p<0.001) and IPTW analysis (OR 4.6, 95% CI 2.9-7.5; p<0.001). Broad-spectrum antibiotic use by either analysis was also associated with longer hospital stay, greater cost and increased CDI. Healthcare-associated pneumonia was not associated with mortality independent of broad-spectrum antibiotic use. In manual review we identified antibiotic-associated events in 17.5% of mortality cases. Broad-spectrum antibiotics appear to be associated with increased mortality and other poor outcomes in community-onset pneumonia.

Another Look at the Persistent Moral Problem of Emergency Department Crowding

This article revisits the persistent problem of crowding in US hospital emergency departments (EDs). It begins with a brief review of origins of this problem, terms used to refer to ED crowding, proposed definitions and measures of crowding, and causal factors. The article then summarizes recent studies that document adverse moral consequences of ED crowding, including poorer patient outcomes; increased medical errors; compromises in patient physical privacy, confidentiality, and communication; and provider moral distress. It describes several organizational strategies implemented to relieve crowding and implications of ED crowding for individual practitioners. The article concludes that ED crowding remains a morally significant problem and calls on emergency physicians, ED and hospital leaders, emergency medicine professional associations, and policymakers to collaborate on solutions.