Violence-related Injuries Research Articles

Factors Affecting Nurse Response Time in Handling Traffic Accident Cases in the Emergency Room of District Semarang

The emergency department (ED) of a hospital plays a crucial role in managing emergency cases, including initial examination, resuscitation, and stabilization. Timely and precise intervention in the ED is vital, as prompt treatment can reduce mortality by up to 30%. Conversely, delayed response times can lead to permanent disability or death. An emergency is defined as a clinical situation requiring immediate medical action to save lives and prevent disability. In this study, the majority of patients (over 80%) admitted to the ED were victims of traffic accidents, including motorcycle, car, bicycle, and pedestrian incidents, while the remainder involved falls, impacts with objects, and violence-related injuries. This research utilized a total sampling method, where all members of the population were included as samples. The study results indicate that training significantly improves nurse response times in handling traffic accident cases in the ED of Semarang Regency Hospital. Additionally, triage skills have a significant positive impact on nurse response times, as does the work environment. However, the workload was found to have an insignificant positive effect on response times. These findings underscore the importance of training, triage proficiency, and a supportive work environment in enhancing nurse response times in emergency situations, particularly in traffic accident cases. Further research may explore additional factors influencing response times and the potential for improving patient outcomes in emergency settings.

Pediatric Brain Injuries are Associated With Intimate Partner Violence-Related Brain Injuries Among Women in Adulthood.

Prior studies have reported associations between childhood physical abuse and intimate partner violence (IPV). However, there has been limited literature examining the relationship between pediatric brain injuries and IPV-related brain injuries later in life. We examined the association between childhood brain injuries and brain injuries sustained from IPV in adulthood. Participants were recruited through Mass General Brigham's "Rally," social media, and information sheets distributed in locations likely to serve women in current or past abusive relationships (eg, domestic violence shelters, and IPV support programs). Women who have experienced IPV with and without brain injury (n=129), ages 19 to 69. Retrospective, cross-sectional study design. We administered the Ohio State University Traumatic Brain Injury Identification Method and the Brain Injury Severity Assessment to assess brain injury history, and the Childhood Trauma Questionnaire (CTQ). A logistic regression was used to examine the association between pediatric brain injuries and IPV-related brain injuries, adjusting for childhood trauma, years of education, and age. A majority of participants (64.3%) reported experiencing at least 1 IPV-related brain injury, and 30.2% experienced at least 1 childhood brain injury. Child abuse-related brain injuries occurred in 10.9% of the sample, whereas childhood brain injuries from other causes occurred in 19.4% of participants. Participants who sustained at least 1 childhood BI were significantly more likely to sustain a future IPV-related brain injury as an adult (OR=4.652, P =.004). For each additional childhood BI sustained, participants were more likely to sustain an IPV-related BI (OR=3.198, P =.005). This study illustrates a high prevalence of childhood brain injuries among women who have experienced IPV and identifies an association between pediatric brain injuries and brain injuries due to partner violence in adulthood. Our findings speak to the urgency of increasing our understanding of childhood brain injuries and whether they or other related factors might confer an increased risk for brain injuries or possibly IPV later in life.

Trends and disparities in violence-related injury morbidity among pregnant and postpartum individuals

PurposeViolence against pregnant and postpartum individuals is a major public health problem. Homicides during the perinatal period have recently increased, yet these deaths reflect only the most extreme manifestation of violence. Far less is known about trends and disparities in pregnancy-associated violence morbidity. Examining emergency department (ED) utilization for violence-related injuries in this population can shed light on overall incidence and patterns of risk. MethodsWe used longitudinal, all-payer, statewide data from California, comprising all individuals with a live-birth hospital delivery in each year from 2010–2018 (N = 3068,921). We followed annual cohorts of women before and after their delivery hospitalizations to identify ED visits for violent injury. We analyzed trends and disparities in annual incidence rates. ResultsThe cumulative incidence of any pregnancy-associated ED visit for violence was 0.84 % overall; incidence increased slightly over the study period (annual ORadj = 1.01, 95 % CI = 1.01,1.02). The highest risk of pregnancy-associated violence was observed in younger individuals, non-Hispanic Black individuals, and Medicaid users. ConclusionOur findings suggest risk of pregnancy-associated violence morbidity has increased over the past decade and is amplified for structurally vulnerable populations. The emergency department may be a critical opportunity for screening and providing resources to at-risk individuals.

Analysis of emergency centre recidivism for interpersonal violence in a district-level hospital in Cape Town, South Africa.

Interpersonal violence is a major cause of morbidity and mortality in low- and upper-middle-income countries. It is postulated that a significant portion of these patients have repeated presentations to an already overburdened healthcare system. Data describing the burden of interpersonal violence recidivism are poor. To determine and describe the burden of emergency centre recidivism for interpersonal violent injury presenting to Khayelitsha Hospital, Cape Town, over a 2-year period. An analysis of a prospectively collected observational database combined with a retrospective chart review was conducted of all trauma patients who presented to Khayelitsha Hospital from 1 October 2020 to 30 September 2022. All patients (aged ≥14 years) with ≥2 presentations for interpersonal violence-related injuries were included. Cases were limited to the inclusion of mechanisms of injury attributable to stab wounds, blunt assault, firearm injury and gender-based violence. Recidivist cases were identified by repeat hospital number on the electronic hospital patient system. Repeat cases were manually reviewed for inclusion. Summary statistics are used to describe all variables. In total, 10 218 interpersonal violence presentations were identified over the study period, and 1 125 (11.0%) were attributed to recidivists (522 patients). The mean (standard deviation) age was 30 (7.7) years, and most were male (n=463, 88.7%). Stab wounds (n=583, 51.8%) and blunt assault injuries (n=456, 40.5%) were the main mechanisms of injury. Repeat presentation occurred within a median of 198 (25th - 75th percentile, 81.5 - 373.9) days. A total of 337 (64.6%) patients presented with higher acuity at one of their subsequent visits. Recidivist presentations represent a significant proportion of interpersonally violently injured patients, and are likely to be under-documented. Recidivism poses a measurable burden, and further research is needed to facilitate the identification of at-risk individuals, and specific secondary prevention strategies should be developed to prevent or reduce escalating patterns of injury associated with interpersonal violence.

Improvements in Safety Outcomes Following Brief Healthcare-Based Intimate Partner Violence Interventions among Women Who Screen Positive for Intimate Partner Violence-Related Traumatic Brain Injuries.

Background: Traumatic brain injuries (TBIs) are a common consequence of experiencing intimate partner violence (IPV). IPV-related TBI contributes to adverse health outcomes among women, but it is unknown whether a history of IPV-related TBI negatively impacts safety outcomes following healthcare-based interventions for IPV. Methods: Using data from a larger randomized clinical trial, we explored the impact of IPV-related TBI status on safety-related outcomes in two healthcare-based IPV interventions. At baseline, 35% (n = 21) of the sample screened positive for IPV-related TBI history. We used repeated measures ANOVAs to examine differences in safety outcomes at post-treatment and 1-month follow-up based on treatment condition and IPV-related TBI status. Results: Significant interaction effects were found for safety outcomes, such that women with IPV-related TBI history experienced larger reductions in the frequency of physical IPV and similar reductions in sexual IPV across both treatment conditions compared to women without IPV-TBI (F(2, 102) = 10.88, p < 0.001; F(2, 98) = 3.93, p = 0.036). Conclusions: Findings suggest that brief healthcare-based IPV interventions may result in improvements in safety outcomes for women with a history of IPV-TBI. This highlights the continued need for implementation of promising IPV-focused interventions to promote safety and protect women from experiencing further IPV.

Pathophysiology, blood biomarkers, and functional deficits after intimate partner violence-related brain injury: Insights from emergency department patients and a new rat model

Intimate partner violence is a serious, but underappreciated, issue that predominantly affects women and often results in concussion (i.e., mild traumatic brain injury). However, concussion in intimate partner violence is unique because it often involves a concomitant strangulation which may exacerbate or alter the physiology and clinical presentation of the brain injury. Therefore, here we conducted human and rodent studies to provide insight into knowledge gaps related to the detection, pathophysiology, and functional consequences of intimate partner violence-related brain injury. We conducted the first study to analyze blood biomarkers and symptoms of brain injury in intimate partner violence patients presenting to an emergency department within 72 h of concussion. Intimate partner violence concussion patients, some of whom had also experienced a concomitant strangulation, had elevated serum neurofilament light and worse brain injury symptoms compared to healthy control, orthopedic trauma, and non-intimate partner violence concussion groups. We also developed the first rat model of non-fatal strangulation and examined the consequences of strangulation and concussion in isolation and in combination on pathophysiology, blood biomarkers, and behavior at 2 h and 1wk post-injury. Rats exposed to combined strangulation and concussion had exacerbated motor and cognitive deficits, neuroinflammation, and serum glial fibrillary acidic protein levels compared with either injury in isolation. Taken together, these rodent findings demonstrate that a concomitant strangulation modifies and exacerbates concussion pathophysiology, biomarkers, and functional consequences. Overall, these findings provide novel insights into intimate partner violence-related brain injury and provides a foundation for future translational studies.

Characterizing Pediatric Patients at Risk for Violence-Related Injuries at a Trauma Center in the Midwest United States

Introduction Hospital-based violence intervention programs (HVIPs) have emerged nationwide to help address the societal and economic costs of violence. Little literature exists regarding selecting those patients most likely to benefit from intensive case management. The study aims to describe the pediatric patient population presenting at a Level 1 ACS trauma center with a chief complaint of violent trauma and identify the characteristics of patients most at risk. Methods This retrospective study examined patients between the ages of eight- and nineteen-years old presenting with traumatic injury during the year 2019. Child abuse and non-accidental trauma patients were excluded. Results A total of 333 patients were included in the analysis. They were predominantly African American and male. The three-group design included those 8–11, 12–13, and 14–19 years. Most patients were over 14 years old (60.2%). “Classmates” was the most common relationship between assailant and victim overall (33.9%) and most prevalent in the youngest age group (8–11 year). The middle age group (12–13 year) were two times more likely to suffer from ADHD, and ADHD was a risk factor for self-harm in this age category. The oldest age group (14–19 year) suffered higher rates of gun violence and were attacked more often by unknown assailants. Conclusions There was a difference in the needs of the older and younger pediatric patients cared for. HVIPs should tailor their interventions to address the different age groups’ needs. HVIPs could also benefit from the integration of targeted mental health services and collaboration with local educational institutions.

Illicit cocaine and opioid drug-related maxillofacial trauma: a 10-year review of a state-wide database of all hospitals admissions

The aim of this study was to investigate the characteristics of illicit cocaine and opioid drug-related facial trauma and determine whether the presence of cocaine or opioid drug use in facial trauma patients influenced the cause of injury, morbidity, or management. A retrospective observational cohort study was performed using records from a state-wide database of all patients who presented to a Victorian hospital with a facial fracture between 2004 and 2014. Data collected included demographics, concomitant opioid and cocaine use, mechanism of injury, facial injuries, and management. Statistical analysis was done using chi-square test, Student's t tests, binary logistic regression analysis, and multivariable linear regression analysis. Results were considered statistically significant if P < .05. A total of 54,613 patient presentations for facial trauma were analyzed with 363 patients in the cocaine and opioid-related group, and 54,250 patients in the nondrug-related group. Patients with illicit drug use were more likely to have facial fractures caused by interpersonal violence when compared with nondrug users (47.9% vs 23.5%, OR = 2.23, P < .001). Opioid and cocaine users had 0.3 more total fractures per presentation, which included more midface and skull fractures, and more facial lacerations (P < .001). There was no statistically significant difference in the need for surgical management between the two groups. Opioid and cocaine affected patients also on average had a longer hospital stay of 3.4 days and required 0.9 more allied health inputs during their admission when compared with nondrug users (P < .05). This effect was similarly reflected when controlling for confounding variables (P < .001). Concomitant cocaine or opioid use in facial trauma patients leads to more violence-related injuries with higher morbidity and healthcare costs.

Listening to the Voices of Aboriginaland Torres Strait Islander Women in Regional and Remote Australia About Traumatic Brain Injury From Family Violence: A Qualitative Study.

Indigenous women experience high rates of family violence-related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts onthem and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence-related traumatic brain injury (TBI), including impacts on life, as well as decision-making processes about healthcare access and engagement. Purposeful sampling was used to complete semi-structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence. Three themes were conceptualised based on the data and research aims: interweaving of the past and the present-ways women experience brain injury; factors that inform decision-making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long-term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers. The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow-up support, co-designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided. Indigenouswomen shared their views and experiences of TBI from family violence as well as decision-making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research.

Epidemiology of Intimate Partner and Domestic Violence-Related Traumatic Brain Injury in the United States, 2018 to 2021: A National Trauma Data Bank Cohort Analysis of 3891 Patients.

Despite profound medico-socio-legal consequences of traumatic brain injury (TBI) from intimate partner violence and domestic violence (IPV/DV), the incidence and acute outcomes of concurrent IPV/DV-TBI are not well understood. We examined US IPV/DV patients with/without TBI (IPV/DV-TBI; non-TBI) using the National Trauma Data Bank. We hypothesized IPV/DV-TBI would be associated with elevated morbidity. National Trauma Data Bank Trauma Quality Programs Participant Use Files years 2018 to 2021 were queried for patients aged ≥18 years with IPV/DV using International Classification of Diseases, Tenth Revision external cause codes. TBI/non-TBI was defined using International Classification of Diseases, Tenth Revision diagnosis codes. TBI severity was defined by the Glasgow Coma Scale (severe = 3-8, moderate = 9-12, and mild = 13-15). Outcomes were intensive care unit (ICU) admission, in-hospital mortality, length of stay (LOS), and discharge home. Multivariable regressions examined associations between TBI and outcomes, controlling for sociodemographic and injury severity variables. Of 3891 IPV/DV-related cases, 31.1% were IPV/DV-TBI. Cranial injuries included skull fracture (30.2%), subdural (19.8%), subarachnoid (13.4%), and epidural (1.1%) hemorrhage, contusion (8.1%), and cerebral edema (3.3%). In IPV/DV-TBI, mild/moderate/severe TBI proportions were 87.4%/4.3%/8.3%, with mean LOS 11.5 ± 10.9/14.4 ± 27.3/5.0 ± 7.7-days and mortality 0.9%/22.5%/28.6%, respectively. Compared with non-TBI, IPV/DV-TBI had more female (77.2%/64.6%, P < .001) and fewer Black patients (28.9%/36.6%, P < .001), more ICU admissions (20.9%/7.5%, P < .001) and mortality (4.1%/1.8%, P < .001), longer LOS (5.3 ± 9.5/4.5 ± 6.4-days, P = .008), and decreased discharge home (79.8%/83.8%, P = .005). Multivariable regressions confirmed the associations between TBI and ICU admission (adjusted odds ratio [aOR] = 4.29, 95% CI [3.46-5.33]), mortality (aOR = 3.20 [1.99-5.15]), LOS (adjusted mean difference = +1.22 [0.68-1.76]), and inability to discharge home (aOR = 0.57 [0.46-0.71]). One-third of US IPV/DV-related trauma cases have TBI, comprising predominantly female patients. Black patients with IPV/DV-related trauma were overrepresented compared with US census estimates. IPV/DV-TBI had increased ICU admissions, LOS, in-hospital mortality, and inability to discharge home compared with non-TBI. Investigating morbidity risk factors and providing sociomedical resources during acute care are critically needed in this vulnerable population.

The associations of opioid and benzodiazepine prescriptions with injuries among US military service members.

Given the high rates of physical trauma and pain among service members, opioid-prescribing practices and use patterns have significant implications for the well-being of service members and can affect military medicine and personnel readiness. This study measured the association between prescribed opioid and benzodiazepine medications and subsequently reported injuries (accidental, alcohol and drug related, self-inflicted, and violence related) among active duty military members. Participants were service members who entered the military between January 1, 2005, and June 30, 2010. In a nested case-control design, we compared individuals with injuries to individuals without injuries with respect to their opioid and benzodiazepine prescriptions in the 30 days before the injury of an index case. We used a multiintercept, logistic regression model to compare coefficient estimates by injury type. Overall, approximately 17% of individuals with an injury and 4% of individuals without an injury had a recorded opioid prescription. Individuals with an injury of any type had greater odds of prior exposure to opioid prescriptions than controls. Although a dose-response effect was observed for all injury types, it reached a plateau sooner for natural or environmental accidents and self-inflicted injuries relative to alcohol-related and drug-related injuries, violence-related injuries, vehicle accidents, accidental falls, and other accidents. Benzodiazepine prescriptions were found in 3.5% of individuals with an injury and 0.5% of individuals without an injury. The association between benzodiazepine prescriptions and injuries was strongest for natural and environmental accidents.

Violence-Related Injuries: The Most Common Cases in Hyderabad, Pakistan

The law influences every aspect of human activity, including medical practice. The nature of casualty is affected by geographical regions, cultures, and social values. Determining characteristics of casualty can guide health policy and can assist in managing healthcare resources. Objective: To profile the cases at casualty department of a tertiary teaching hospital. Methods: The study was conducted at the casualty department of Liaquat University Hospital Hyderabad, Pakistan and Department of Forensic Medicine &amp; Toxicology LUMHS, Jamshoro, over a period of one year from January 2021 to December 2021. A total of 3,487 cases were recorded and categorized into violence-related, transportation-related, substance-related, and sexual assault-related injuries. Results: The majority of cases were violence-related incidents (84.65%), followed by transportation-related accidents (14.65%), substance-related injuries (3.61%), and sexual assault-related injuries (0.69%). Violence-related injuries were divided into assault cases, firearm incidents, and police torture. Transportation-related injuries were categorized as road traffic accidents and train accidents. Assault and road traffic accidents were the leading cause of violence-related and transportation-related injuries, respectively. The highest numbers of cases were observed in April, June, and May. Conclusions: A substantial portion of cases at casualty department of Liaquat University Hospital, Hyderabad is contributed by violence-related injuries

Inflicted violence-related injuries among children and youth in Ontario during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, it was hypothesized that stay-at-home policies would impact cases of violence, abuse, and neglect among children and youth due to increased familial stressors. ObjectiveWe examined the effect of the implementation of pandemic policies on violence-related emergency department (ED) visits and hospitalizations among youth. ParticipantsViolence-related ED visits and hospitalizations among children and youth ages 0–19 in Ontario, Canada were obtained from April 2015 until the most recent available date, March 31, 2022. MethodsWe used an interrupted time series design to model the change in monthly violence-related ED visits and hospitalizations before and during the pandemic. We used negative binomial models to estimate the immediate effect of the policy and the change in the number of injuries during the pandemic. ResultsAfter adjusting for seasonality and population changes over our study period, we observed a 56% decrease in violence-related ED visits (RR: 0.44, 95%CI: 0.38, 0.50) and a 35% decrease in hospitalizations (RR: 0.65, 95%CI: 0.52, 0.82) immediately after the implementation of the pandemic policy, followed by moderate increasing trends. We observed no difference in the effect of the pandemic policies on the rate of violence-related ED visits and hospitalizations by sex, age or material deprivation; however, males aged 10–19 years and those in higher quintiles of material deprivation had higher average rates of injuries compared to females, those in younger age groups and lower quintiles of deprivation over the study period. ConclusionsWe observed an abrupt decrease in the rate of violence-related ED visits and hospitalizations immediately after the onset of pandemic policies in Ontario. Following this, violence-related injuries increased, approaching pre-pandemic levels.

Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps.

Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.

Global burden of all cause-specific injuries among children and adolescents from 1990 to 2019: a prospective cohort study.

To assess the burden and change in incidence, death, and disability-adjusted life years (DALYs) for all-cause-specific injuries among children and adolescents in 204 countries and territories between 1990 and 2019. Data were extracted from the Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019). Global, regional, and country-level age-standardized rate (per 100000) of incidence (ASRI), mortality (ASRM), and DALYs (ASRD) with 95% uncertainty interval (95% UI) of injuries were estimated by age, sex, socio-demographic index (SDI), and all-cause-specific injuries from 1990 to 2019. Overall, the ASRI, ASRM, and ASRD of injury were 9006.18 (95% UI: 7459.74-10918.04), 23.04 (20.00-26.50), and 2020.19 (1759.47-2318.64) among children and adolescents worldwide in 2019, respectively. All the above indicators showed a downward trend from 1990 to 2019. In level 2 cause of injury, both the global transport injury and unintentional injury declined during the study years, while self-harm and interpersonal violence-related injury showed an increasing trend. High SDI regions had higher ASRI of injuries, but low SDI regions had higher ASRM and ASRD of injuries globally in 2019. Males had a higher burden of injuries than those in females. The ASRI of injuries is higher in adolescents aged 15-19 years, whereas the mortality and DALYs rate are higher among children under 5 years old. Moreover, adolescents aged 15-19 years and individuals living in Central Asia, Middle East, and Africa had higher ASRI, ASRM, and ASRD of injuries owing to self-harm and interpersonal violence. Generally, falls and road traffic injuries are the leading cause of injury among the population aged 0-19 years worldwide, but self-harm, interpersonal violence, and conflict and terrorism are also leading types of injuries in some regions, particularly in Low-Income Countries and Middle-Income Countries. Injury remains a major global public health problem among children and adolescents, although its burden at the worldwide level showed a decreasing trend from 1990 to 2019. Of concern, the burden of injuries caused by transport injuries, and unintentional injuries has shown a downward trend in most countries, while the burden caused by self-harm and interpersonal violence has shown an upward trend in most countries. These findings suggest that more targeted and specific strategies to prevent the burden of injuries should be reoriented, and our study provides important findings for decision-makers and healthcare providers to reduce injury burden among children and adolescents.

Rehabilitation and violence-related traumatic brain injury: A scoping review.

There is a dearth of reviews exploring rehabilitation for violence-related traumatic brain injury (TBI) despite its increasing rates and distinct risk factors and outcomes. The aim of this scoping review is to determine the extent to which rehabilitation is available to and accessed by people who sustain TBI from interpersonal violence. Electronic databases (i.e., MEDLINE, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Criminal Justice Abstracts, Applied Social Sciences Index and Abstracts, and Proquest Nursing and Allied Health) and grey literature (i.e., relevant organizations' websites) were systematically searched for peer-reviewed articles and reports that met eligibility criteria. To be included, articles had to report primary findings on rehabilitation interventions that included individuals who sustained a TBI through interpersonal violence. Articles based on the military population were excluded. Data were synthesized through a descriptive numerical summary and qualitative content analysis. Fifty-two primary research articles and five grey literature reports were included. Most (77.2%) of these articles described rehabilitation interventions that addressed TBI sequalae without consideration for violence as a mechanism of injury, beyond reporting sample characteristics. Only thirteen articles (22.4%) considered violence-related TBI by investigating the rehabilitation profile (13.8%) or designing programs specifically for survivors of violence-related TBI (8.6%). There was limited attention to social determinants of health across all studies. This is the first scoping review to our knowledge that explored the extent and nature of rehabilitation among persons who experience TBI through violence in civilian populations. Priorities for education, research, and practice are identified.

Overview of Occupational Injuries Among Registered Nurses in Washington State, 2007 to 2019.

Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs. Annual injury claims data covered under Washington State workers' compensation (WC) fund were analyzed over a 13-year period (2007-2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications. Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio [IRR]: 0.99, 95% confidence interval [CI] = [0.94, 1.05]). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts. To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.

Prevalence of use and impairment from drugs and alcohol among trauma patients: A national prospective observational study

BackgroundBeing under the influence of psychoactive substances increases the risk of involvement in and dying from a traumatic event. The study is a prospective population-based observational study that aims to determine the prevalence of use and likely impairment from psychoactive substances among patients with suspected severe traumatic injury. MethodThis study was conducted at 35 of 38 Norwegian trauma hospitals from 1 March 2019 to 29 February 2020. All trauma admissions for patients aged ≥ 16 years admitted via trauma team activation during the study period were eligible for inclusion. Blood samples collected on admission were analysed for alcohol, benzodiazepines, benzodiazepine-like hypnotics (Z-drugs), opioids, stimulants, and cannabis (tetrahydrocannabinol). ResultsOf the 4878 trauma admissions included, psychoactive substances were detected in 1714 (35 %) and in 771 (45 %) of these, a combination of two or more psychoactive substances was detected. Regarding the level of impairment, 1373 (28 %) admissions revealed a concentration of one or more psychoactive substances indicating likely impairment, and 1052 (22 %) highly impairment. Alcohol was found in 1009 (21 %) admissions, benzodiazepines and Z-drugs in 613 (13 %), opioids in 467 (10 %), cannabis in 352 (7 %), and stimulants in 371 (8 %). Men aged 27–43 years and patients with violence-related trauma had the highest prevalence of psychoactive substance use with respectively 424 (50 %) and 275 (80 %) testing positive for one or more compounds. ConclusionThe results revealed psychoactive substances in 35 % of trauma admissions, 80 % of which were likely impaired at the time of traumatic injury. A combination of several psychoactive substances was common, and younger males and patients with violence-related injuries were most often impaired. Injury prevention strategies should focus on high-risk groups and involve the prescription of controlled substances. We should consider toxicological screening in trauma admissions and incorporation of toxicological data into trauma registries.

Linking emergency care and police department data to strengthen timely information on violence-related paediatric injuries

BackgroundCombined ED and police department (PD) data have improved violence surveillance in the UK, enabling significantly improved prevention. We sought to determine if the addition of emergency medical service (EMS)...

Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 - 2020).

Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups. This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers. The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022. Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.