US Hospital Emergency Departments Research Articles

Bathroom injuries in children less than 15 years old

ObjectiveTo quantify and describe non-fatal, unintentional bathroom injuries among children less than 15 years of age treated in US hospital emergency departments (EDs).MethodsThis study used 2008 data from a nationally...

Emergency department visits for fall-related fractures among older adults in the USA: a retrospective cross-sectional analysis of the National Electronic Injury Surveillance System All Injury Program, 2001–2008

ObjectivesTo describe the demographic characteristics and incidence of unintentional fall-related fractures among older adults treated in the US hospital emergency departments (EDs).DesignRetrospective observational study.SettingsHospitals’ ED participants in the National Electronic...

Chronic Pain at 4 Months in Hospitalized Trauma Patients

Many studies report on the incidence of chronic pain. However, deficiencies exist in prior research making it difficult to generalize results to trauma patients. This study evaluated the incidence of chronic pain in trauma patients at 4 months posttrauma and effect chronic pain has on life interference. The incidence of chronic pain was present in 79.2% of trauma patients 4 months posttrauma and a strong positive correlation (n = 80, r = 0.79, P < 0.001) existed between chronic pain severity and the effect on life interference. Chronic pain is prevalent and causes significant life interference in traumatically injured patients.

Non-fatal dog bite injuries in the USA, 2005–2009

Dog bites are a significant cause of injury, particularly among children. Although a few population-based studies from the USA have examined the epidemiology of dog bite injuries, to the author’s knowledge, there are currently no published reports utilizing injury data beyond2003. To address this issue, the most recent 5 years of data from a nationally representative surveillance system were analysed to describe the magnitude and age distribution of non-fatal dog bite-related injuries treated in US hospital emergency departments. Public use data for 2005e2009 were obtained online from the Web-based Injury Statistics Query and Reporting System (WISQARS), which allows access to data from the National Electronic Injury Surveillance System e All Injury Program (NEISS-AIP). NEISS-AIP, which is a collaborative effort between the US Consumer Product Safety Commission and the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, collects detailed information about initial visits for all non-fatal injuries from the emergency department records of a nationally representative stratified probability sample of approximately

Trimming- and pruning-related injuries in the United States, 1990 to 2007

Trimming and pruning equipment is used frequently in the United States, and associated injuries are common. The National Electronic Injury Surveillance System database was used to examine trimming- and pruning-related injuries treated in US hospital emergency departments from 1990 through 2007. An estimated 648,100 individuals (95% confidence interval: 535,500-760,700) were treated in US hospital emergency departments for trimming- and pruning-related injuries during the 18-year study period. The average annual injury rate was 13.0 per 100,000 US population, and the annual rate of injury increased 35.1% from 11.4 in 1990 to 15.4 in 2007 (slope = 0.241, p < 0.01). Approximately two-thirds (67.6%) of the injuries occurred among males, and 62.8% of incidents occurred to individuals 18 years to 54 years of age. Lacerations and puncture injuries occurred most often (71.0%), and injuries to the arms and hands accounted for 67.8% of cases. A majority (56.8%) of injuries involved the use of a power tool. The most common project at the time of injury was hedge/shrub trimming (66.5%), followed by grass/lawn trimming (24.3%) and tree trimming (9.1%). Patients required hospitalization in 2.1% of cases. Most injury incidents (98.5%) occurred around the home. This is the first study to examine trimming- and pruning-related injuries in the United States using a nationally representative sample. The increasing number and rate of injuries associated with trimming activities in the United States underscore the need for increased prevention efforts, including enhanced safety features of trimming equipment and better education of equipment operators regarding the potential hazards of trimming activities.

Pediatric Eye Injuries Treated in US Emergency Departments, 1990-2009

This study investigates activity- and consumer product-related eye injuries treated in US hospital emergency departments among children <18 years old using National Electronic Injury Surveillance System data from 1990 through 2009. An estimated 1,406,200 (95% confidence interval = 1,223,409-1,588,992) activity- and consumer product-related pediatric eye injuries occurred during the study period, averaging 70,310 annually. The annual number of injuries declined significantly by 17%. Patients ≤ 4 years of age accounted for 32% of all injuries and had the highest mean annual eye injury rate (11.31 per 10,000 population). Eye injuries associated with sports and recreation (24%) and chemicals (17%) occurred most frequently. The majority (69%) of eye injuries occurred at home. Opportunities exist to further decrease these injuries. Pediatricians should educate child caregivers and children about risks for eye injuries in the home and about use of appropriate protective eyewear during sports.

Pediatric Injuries Attributable to Falls From Windows in the United States in 1990–2008

To examine the epidemiological features of pediatric injuries related to falls from windows. By using the National Electronic Injury Surveillance System, emergency department (ED) data for pediatric injury cases associated with window falls in 1990-2008 were reviewed. An estimated 98 415 children (95% confidence interval [CI]: 82 416-114 419) were treated in US hospital EDs for window fall-related injuries during the 19-year study period (average: 5180 patients per year [95% CI: 4828-5531]). The mean age of children was 5.1 years, and boys accounted for 58.1% of cases. One-fourth (25.4%) of the patients required admission to the hospital. The annual injury rate decreased significantly during the study period because of a decrease in the annual injury rate among 0- to 4-year-old children. Children 0 to 4 years of age were more likely to sustain head injuries (injury proportion ratio [IPR]: 3.22 [95% CI: 2.65-3.91]) and to be hospitalized or to die (IPR: 1.65 [95% CI: 1.38-1.97]) compared with children 5 to 17 years of age. Children who landed on hard surfaces were more likely to sustain head injuries (IPR: 2.05 [95% CI: 1.53-2.74]) and to be hospitalized or to die (IPR: 2.23 [95% CI: 1.57-3.17]) compared with children who landed on cushioning surfaces. To our knowledge, this is the first study to investigate window fall-related injuries treated in US hospital EDs by using a nationally representative sample. These injuries are an important pediatric public health problem, and increased prevention efforts are needed, including development and evaluation of innovative prevention programs.

Unintentional paediatric ingestion poisonings and the role of imitative behaviour

ObjectiveTo quantify the relationship between imitative behaviour and poisonings in children.SettingUSA.MethodsThis study is based on the evaluation of a large national database of unintentional oral ingestion poisonings involving children aged...

Pediatric Volleyball-Related Injuries Treated in US Emergency Departments, 1990-2009

This study describes the epidemiology of pediatric volleyball-related injuries treated in US hospital emergency departments. Data for children younger than 18 years obtained from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission from 1990 through 2009 were analyzed. An estimated 692 024 volleyball-related injuries to children younger than 18 years occurred during the study period. The annual number of injuries declined significantly by 23% during the study period; however, the annual injury rate remained unchanged, and the number of volleyball-related concussions/closed head injuries increased significantly. Upper (48%) and lower (39%) extremity injuries occurred most frequently, as did strains/sprains (54%). Contact with the net/pole was associated with concussions/closed head injury our findings indicate opportunities for making volleyball an even safer sport for children. Protective padding, complying with US volleyball standards, should cover all volleyball poles and protruding hardware to prevent impact-related injuries.

Home Exercise Equipment-Related Injuries Among Children in the United States

This study investigated home exercise equipment-related injuries to children in the United States. Data from the National Electronic Injury Surveillance System were analyzed for children 18 years old and younger. An estimated 241 573 children with home exercise equipment-related injuries were treated in US hospital emergency departments from 1990 through 2008, averaging 12 714 children per year. There was a statistically significant increase in the annual number (41.9%) and rate of home exercise equipment-related injuries during the study period. Children younger than 10 years accounted for 71.4% of these injuries. Laceration (37.2%) was the leading injury diagnosis, and the most commonly injured body regions were the head (28.6%), finger/hand (22.0%), and foot (10.9%). The majority of injuries were associated with stationary bicycles (26.5%), treadmills (25.3%), and jump ropes (21.5%). The increasing number and rate of home exercise equipment-related injuries to US children underscores the need for increased efforts to prevent these injuries.

Epidemiology of fall related forearm and wrist fractures among adults treated in US hospital emergency departments

ObjectiveTo examine national estimates of forearm and wrist fractures among adults treated in US emergency departments.MethodsThe National Electronic Injury Surveillance System All Injury Program was used to estimate emergency department...

Epidemiology of balcony fall–related injuries, United States, 1990-2006

Background Falls from heights are common in urban areas in the United States. This study describes the epidemiology of balcony fall–related injuries requiring emergency department (ED) treatment among children and adults in the United States from 1990 through 2006. Methods In 2009, a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was conducted to describe the epidemiology of balcony fall–related injuries. Results An estimated 86 500 (95% confidence interval [CI], 68 400-104 600) balcony fall–related injuries were treated in US hospital EDs from 1990 through 2006; 70% of cases were male; 63% were adults (≥18 years old); 94% of injury events occurred at home; 24% of patients were hospitalized; and 8 patients died. The rate of balcony fall–related injuries among children decreased significantly during 1990 to 2006 and was similar to that of adults by the end of the study period. Fall heights ranged from 5 to 87.5 ft. Structural failure of the balcony was involved in an estimated 5600 cases. Patients younger than 18 years were more likely to sustain a concussion/closed head injury (relative risk, 2.42; 95% CI, 1.84-3.18) or skull fracture (relative risk, 5.86; 95% CI, 2.58-13.30) than adults. Conclusions This is the first study of balcony fall–related injuries requiring emergency treatment using a nationally representative sample. Balcony falls are an important cause of injury in the United States. Age, male sex, and warm months of the year were associated with balcony fall–related injuries in our study population.

Warfarin Sensitivity Genotyping: A Review of the Literature and Summary of Patient Experience

The antithrombotic benefits of warfarin are countered by a narrow therapeutic index that contributes to excessive bleeding or cerebrovascular clotting and stroke in some patients. This article reviews the current literature describing warfarin sensitivity genotyping and compares the results of that review to the findings of our study in 189 patients at Mayo Clinic conducted between June 2001 and April 2003. For the review of the literature, we identified relevant peer-reviewed articles by searching the Web of Knowledge using key word warfarin-related adverse event. For the 189 Mayo Clinic patients initiating warfarin therapy to achieve a target international normalized ratio (INR) in the range of 2.0 to 3.5, we analyzed the CYP2C9 (cytochrome P450 2C9) and VKORC1 (vitamin K epoxide reductase complex, subunit 1) genetic loci to study the relationship among the initial warfarin dose, steady-state dose, time to achieve steady-state dose, variations in INR, and allelic variance. Results were compared with those previously reported in the literature for 637 patients. The relationships between allelic variants and warfarin sensitivity found in our study of Mayo Clinic patients are fundamentally the same as in those reported by others. The Mayo Clinic population is predominantly white and shows considerable allelic variability in CYP2C9 and VKORC1. Certain of these alleles are associated with increased sensitivity to warfarin. Polymorphisms in CYP2C9 and VKORC1 have a considerable effect on warfarin dose in white people. A correlation between steady-state warfarin dose and allelic variants of CYP2C9 and VKORC1 has been demonstrated by many previous reports and is reconfirmed in this report. The allelic variants found to most affect warfarin sensitivity are CYP2C9*1*1-VKORC1BB (less warfarin sensitivity than typical); CYP2C9*1*1-VKORC1AA (considerable variance in INR throughout initiation); CYP2C9*1*2-VKORC1AB (more sensitivity to warfarin than typical); CYP2C9*1*3-VKORC1AB (much more sensitivity to warfarin than typical); CYP2C9*1*2-VKORC1AB (much more sensitivity to warfarin than typical); CYP2C9*1*3-VKORC1AA (much more sensitivity to warfarin than typical); and CYP2C9*2*2-VKORC1AB (much more sensitivity to warfarin than typical). Although we were unable to show an association between allelic variants and initial warfarin dose or dose escalation, an association was seen between allelic variant and steady-state warfarin dose. White people show considerable variance in CYP2C9 allele types, whereas people of Asian or African descent infrequently carry CYP2C9 allelic variants. The VKORC1AA allele associated with high warfarin sensitivity predominates in those of Asian descent, whereas white people and those of African descent show diversity, carrying either the VKORC1BB, an allele associated with low warfarin sensitivity, or VKORC1AB or VKORC1AA, alleles associated with moderate and high warfarin sensitivity, respectively.

The effect of counting principal and secondary injuries on national estimates of motor vehicle-related trauma: a NEISS–AIP special study

Objective:To demonstrate the effect of including both principal and secondary injuries in the calculation of national estimates of non-fatal motor vehicle-related injury, using the National Electronic Injury Surveillance System–All Injury...

US Emergency Department Performance on Wait Time and Length of Visit

Prolonged emergency department (ED) wait time and length of visit reduce quality of care and increase adverse events. Previous studies have not examined hospital-level performance on ED wait time and visit length in the United States. The purpose of this study is to describe hospital-level performance on ED wait time and visit length. We conducted a retrospective cross-sectional study of a stratified random sampling of 35,849 patient visits to 364 nonfederal US hospital EDs in 2006, weighted to represent 119,191,528 visits to 4,654 EDs. Measures included EDs' median wait times and visit lengths, EDs' median proportion of patients treated by a physician within the time recommended at triage, and EDs' median proportion of patients dispositioned within 4 or 6 hours. In the median ED, 78% (interquartile range [IQR], 63% to 90%) of all patients and 67% (IQR, 52% to 82%) of patients who were triaged to be treated within 1 hour were treated by a physician within the target triage time. A total of 31% of EDs achieved the triage target for more than 90% of their patients; 14% of EDs achieved the triage target for 90% or more of patients triaged to be treated within an hour. In the median ED, 76% (IQR 54% to 94%) of patients were admitted within 6 hours. A total of 48% of EDs admitted more than 90% of their patients within 6 hours, but only 25% of EDs admitted more than 90% of their patients within 4 hours. A minority of hospitals consistently achieved recommended wait times for all ED patients, and fewer than half of hospitals consistently admitted their ED patients within 6 hours.

Baseball-Related Injuries to Children Treated in Hospital Emergency Departments in the United States, 1994–2006

To describe the epidemiology of baseball-related injuries among children in the United States. This was a retrospective analysis of data for children younger than 18 years of age from the National Electronic Injury Surveillance System (NEISS) of the Consumer Product Safety Commission from 1994 through 2006. Sample weights provided by the NEISS were used to calculate national estimates of baseball-related injuries. Injury rates were calculated according to age group by using both population and baseball-participation data. An estimated 1 596 000 (95% confidence interval: 1 330 100-1 861 800) children younger than 18 years were treated in US hospital emergency departments for baseball-related injuries during the 13-year period from 1994 through 2006. During the study period, the annual number of injuries declined by 24.9%, and the annual injury rate for children younger than 18 years decreased significantly (P < .000). The most commonly injured body parts were the face (33.5%) and the upper extremity (32.4%). The most common injury diagnoses were soft tissue injury (34.3%) and fracture (18.4%). The most common mechanism of injury was being hit by the baseball (46.0%). Children in the 9- to 12-year age group had the highest injury rate (2.4 per 1000 population). When injury rates were calculated by using baseball-participation data (2003), children in the 12- to 17-year age group had a higher injury rate (19.8 per 1000 participants) than those in the 6- to 11-year age group (12.1 per 1000 participants). Youth baseball is a relatively safe sport for children. Although injury rates and the total number of injuries declined during the study period, our findings indicate that there are opportunities for making baseball an even safer sport for children. We recommend that all youth baseball players wear properly fitted mouth guards, that all leagues, schools, and parks install safety bases, that all batters use helmets with face shields, and that all players use safety baseballs.

Unintentional Child Poisonings Treated in United States Hospital Emergency Departments: National Estimates of Incident Cases, Population-Based Poisoning Rates, and Product Involvement

The goals were to develop national estimates of unintentional child poisoning cases treated in US hospital emergency departments, to determine population-based poisoning rates, and to evaluate characteristics of the victims and the products involved. Cases reported through the US Consumer Product Safety Commission National Electronic Injury Surveillance System, involving a national probability sample of US hospital emergency departments, were used as a basis for developing national estimates of product-related poisonings involving children<5 years of age treated in US hospital emergency departments in 2004. There were an estimated 86194 child poisoning incidents treated in US hospital emergency departments in 2004, amounting to 429.4 poisonings per 100000 children. Approximately 70% of the poisonings involved children 1 or 2 years of age, slightly more than one half involved boys, and 13.3% resulted in hospital admission. Approximately 59.5% of the poisonings involved oral prescription drugs, oral nonprescription drugs, or supplements. Other major product categories resulting in poisonings included cleaning products (13.2%), drugs and ointment preparations intended for external use (4.9%), and personal care products (4.7%). Approximately 54.7% of the poisonings involved products already subject to child-resistant packaging requirements under the Poison Prevention Packaging Act. Despite advances in recent years, unintentional child poisonings remain an important public health concern. The circumstances surrounding poisonings need to be evaluated further, and intervention strategies need to be developed.

Evidence-Based Approach for Disaster Preparedness Authorities to Inform the Contents of Repositories for Prescription Medications for Chronic Disease Management and Control

Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death. A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications. Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic disease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading causes of disease burden assessed by disability-adjusted life years are presented. The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53,000); (3) for stroke, non-narcotic analgesics (138,000); (4) for chronic obstructive pulmonary disease, anti-asthmatics/bronchodilators (3.2 million); and (5) for diabetes, hypoglycemic agents (261,000). Ten medication categories were common across four or more chronic conditions. Persons with chronic diseases have an urgent need for ongoing care and medical support after public health emergencies. These findings provide one evidence-based approach for informing public health preparedness in terms of planning for and review of the prescription medication needs of clinically vulnerable populations with prevalent chronic disease.

Gymnastics-related Injuries to Children Treated in Emergency Departments in the United States, 1990–2005

The objective of this study was to describe the epidemiology of gymnastics-related injuries among children in the United States. A retrospective analysis was conducted of data for children 6 through 17 years of age from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for 1990 through 2005. Sample weights provided by the National Electronic Injury Surveillance System were used to calculate national estimates of gymnastics-related injuries. Injury rates were calculated for the most frequently occurring types of injury using gymnastics participation data. An estimated 425,900 children 6 through 17 years of age were treated in US hospital emergency departments for gymnastics-related injuries during the 16-year period of 1990-2005. The number of injuries averaged 26,600 annually. The number of injuries sustained per 1000 gymnastics participants per year for the pediatric population was 4.8. The number of injuries sustained per 1000 participants per year was greater for the ages 12 to 17 years (7.4) than for the ages 6 to 11 years (3.6). The place where an injury occurred include school (40.0%), a place of recreation or sports (39.7%), home (14.5%), or on other public property (5.8%). The body parts injured were upper extremity (42.3%), lower extremity (33.8%), head/neck (12.9%), trunk (10.4%), and other (0.6%). Injury diagnoses were strain/sprain (44.5%), fracture/dislocation (30.4%), abrasion/contusion (15.6%), laceration/avulsion (3.7%), concussion/closed head injury (1.7%), and other (4.2%). The majority (97.1%) of patients with gymnastics-related injuries were treated and released from the emergency department. Gymnastics has one of the highest injury rates of all girls' sports. Establishment of a national database for gymnastics-related injuries, including exposure data for direct calculation of injury rates, would permit better identification and monitoring of risk factors for gymnastics-related injuries and aid in the development, implementation, and evaluation of injury prevention strategies based on epidemiologic evidence.

Pediatric Triage: A Review of Emergency Education Literature

Children represent about a fourth of the population treated each year in US hospital emergency departments. This means that approximately 30 million children enter the emergency health care system and undergo a triage assessment by a nurse. Pediatric triage involves rapid recognition of seriously ill or injured children, assigning an acuity rating level, and anticipating appropriate emergency care and referral. Acuity rating levels are used to prioritize patients for care and typically involve assigning a numeric score to patients, such as level 1 (most acute) to level 5 (least acute). Although no standard system for triage acuity rating exists in the United States, ENA and the American College of Emergency Physicians have recommended that emergency departments use a valid, reliable 5-level acuity system.2 Two such systems are the Emergency Severity Index (ESI) and the Canadian Triage and Acuity Scale (CTAS). Both systems recommend that triage nurses undergo general triage education in addition to acuity system-specific education. Furthermore, ENA and the ESI and CTAS materials recommend that triage be performed only by experienced ED nurses. Children often present with subtle signs and symptoms of illnesses and injuries, and emergency nurses must possess strong pediatric assessment skills to perform prompt, accurate triage of children. The pediatric triage process is critically important and may even warrant recognition as a specialty within emergency nursing. Yet, with the exception of a few programs, current pediatric emergency education resources include only a brief definition of what it is rather than on how to actually do it. Courses that have some focus on pediatric triage often are limited to describing specific disease states or categories such as trauma or medical resuscitation. This article is part of a larger project to improve pediatric triage acuity rating in ED settings. We sought to perform a comprehensive review of the literature to identify best practices and the best evidence that is relevant to pediatric triage. Our goal was to identify existing resources that we could recommend as a foundation for ED nurses, upon which we would provide education specific to pediatric triage acuity rating processes.