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Sudri S, Shitrit S, Ben Amy DP, Dahoud WA, Laviv A, El-Naaj IA. Pediatric Trauma During COVID-19: What Have We Learned? J Oral Maxillofac Surg 2024; 82:546-553. [PMID: 38403270 DOI: 10.1016/j.joms.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND In December 2019, an outbreak of a novel pneumonia-like illness, COVID-19 (C-19), emerged in Wuhan, China. In March 2020, as the incidence of C-19 rose, the Israeli government, like that of other nations, declared a national state of emergency, and a full, general lockdown was announced. PURPOSE The purpose of this study is to determine the incidence and characteristics of pediatric maxillofacial trauma presentation during the 2020 C-19 lockdown restrictions and compare them to periods outside lockdown between 2019 and 2020 (pre-C-19). STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was conducted and included all pediatric patients (0-18 years) referred to the emergency department (ED) at Tzafon Medical Center, Israel, and diagnosed with maxillofacial injuries. Patients with missing demographic data and patients who did not complete the medical examination were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The exposure variable is the date of injury-2020 C-19 lockdown period compared to the previous year (pre-C-19). MAIN OUTCOME VARIABLE(S) The main outcome variable was the number of pediatric maxillofacial trauma ED arrivals out of total pediatric ED arrivals and out of total maxillofacial ED arrivals. COVARIATES Covariates included patient demographics, etiology, and place of injury. ANALYSES The association between categorical variables was tested using the Fisher exact test or χ2 test for binary variables with relative risk when appropriate, logistic regression model used to predict outcome variable. P values were 2-tailed and statistical significance was defined as P < .05. RESULTS The study sample comprised 1174 patients. Relative risk of presenting with oral and maxillofacial trauma out of all pediatric ED patients was 1.85 comparing C-19 period to pre-C-19 period (confidence interval [1.65; 2.073], P < .0001). Most of the injuries recorded during the C-19 restrictions occurred in the domestic environment (56.1% compared to 47.5% in pre-C-19, P < .001). Incidences necessitating treatment increased from 45.8 to 55% during C-19 (P = .002). CONCLUSION AND RELEVANCE During C-19, there was a higher rate of pediatric injuries compared to pre-C-19. The incidence of domestic oral and maxillofacial injuries increased despite the considered home safety.
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Affiliation(s)
- Shiran Sudri
- Resident, Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel.
| | - Shany Shitrit
- Dental Student at the Maurice & Gabriela Goldschlager School of Dental Medicine, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv; Senior Lecturer, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv
| | - Dalit Porat Ben Amy
- Head of Oral Medicine Unit, Oral Medicine Unit, Tzafon Medical Center, Affiliated with Azrieli Faculty of medicine, Bar Ilan University, Israel
| | - Wadie Abu Dahoud
- Head Department of Oral and Maxillofacial Surgery, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Statical Analysist, Research Institute, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Amir Laviv
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv
| | - Imad Abu El-Naaj
- Resident, Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel; Head Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel
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Jang KM, Jang JS. Weekend Admission and Mortality in Patients With Traumatic Brain Injury: A Meta-analysis. Korean J Neurotrauma 2023; 19:422-433. [PMID: 38222828 PMCID: PMC10782108 DOI: 10.13004/kjnt.2023.19.e61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Previous studies have reported the presence of a "weekend effect" with respect to mortality in serious emergency admissions, including cases of traumatic brain injury (TBI). However, the relationship between weekend hospitalization and TBI mortality has not been fully established. This study aimed to conduct a systematic review of available evidence and investigate differences in mortality among TBI patients between weekday and weekend admissions. Methods Electronic databases including PubMed, Cochrane Library, and Embase were used to obtain relevant articles. Mortality, as the primary outcome of interest, encompassed in-hospital or 30-day mortality. Mortality rates were compared between the 2 groups, weekend and weekday admissions. Additionally, meta-regression analysis was performed on potential confounders to verify and provide comparative results. Results A total of 7 studies involving 522,942 TBI patients were eligible for inclusion in the synthesis of the systematic review. Of these patients, 71.6% were admitted during weekdays, whereas 28.4% were hospitalized on weekends. The overall integrated mortality was 11.0% (57,286/522,942), with a mortality rate of 10.8% in the weekday group and 11.3% in the weekend group. Pooled analysis revealed no significant difference in mortality between the weekday and weekend groups (risk ratio, 0.99; 95% confidence interval, 0.90-1.09; p=0.78). Furthermore, the meta-regression analysis for sensitivity assessment showed no modifying effect on mortality (p=0.79). Conclusion This study found no difference in mortality rates between weekday and weekend admissions among TBI patients. Additional sensitivity analyses also demonstrated no significant increase in the risk of mortality in the weekend group.
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Affiliation(s)
- Kyoung Min Jang
- Department of Neurosurgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Ju Sung Jang
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Pines N, Bala M, Gross I, Ohana-Sarna-Cahan L, Shpigel R, Nama A, Asaf K, Rosenberg Bsc MP, Hashavya S. Changes in pediatric major trauma epidemiology, injury patterns, and outcome during COVID-19-associated lockdown. TRAUMA-ENGLAND 2023; 25:62-66. [PMID: 36883119 PMCID: PMC9982404 DOI: 10.1177/14604086211045359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The COVID-19 pandemic and its associated preventive measures such as national and regional lockdowns have dramatically changed the epidemiology of pediatric admissions to the emergency department. Nevertheless, there are scant data on the epidemiology and injury patterns of major pediatric trauma injuries during these lockdown periods. Methods A single-center retrospective study of data obtained from a tertiary level 1 trauma hospital trauma registry. The data included demographics, injury mechanisms, injury severity and type, treatment, and resource utilization in children aged 0-18 years who required trauma team activation upon arrival. The analysis compares the data from the 5-week lockdown period from March to May 2020 in Jerusalem, Israel, to its parallel periods in 2018-2019. Results A total of 187 trauma visits that required trauma team activation (TTA) were analyzed: 48 visits during the lockdown period vs. 139 in 2018-2019, corresponding to a 40% drop in TTA. There was a significant decrease of 34% in MVA-related injuries (p = 0.0001) but a significant increase of 14% in burns (p = 0.01) and a 16% increase in bicycle-related injuries (p = 0.001). No changes in ISS, injury patterns, admission rate, PICU utilization, or need for interventions were observed. Conclusion There was a significant decrease in the number of overall pediatric trauma visits during the 2020 lockdown, mainly in MVA-associated trauma, but an increase in burns and bicycle injuries. These findings can thus inform policy makers as to the need to formulate prevention awareness programs alerting the public to indoor hazards and the dangers of activities outside the home. Furthermore, it can inform hospital policy decision-making in future lockdowns. The fact that PICU admissions and the need for operating rooms stayed unchanged suggests that it is vital to maintain trauma team capabilities even during lockdowns.
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Affiliation(s)
- Naama Pines
- Department of Pediatric Emergency Medicine, Hadassah and Hebrew University Hospital, Jerusalem, Israel
| | - Miklosh Bala
- Department of Pediatric Emergency Medicine, Hadassah and Hebrew University Hospital, Jerusalem, Israel
| | - Itai Gross
- Department of Pediatric Emergency Medicine, Hadassah and Hebrew University Hospital, Jerusalem, Israel
| | - Lea Ohana-Sarna-Cahan
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ruth Shpigel
- Department of Emergency Medicine, Hadassah and Hebrew University Hospital, Jerusalem, Israel
| | - Ahmad Nama
- Department of Emergency Medicine, Hadassah and Hebrew University Hospital, Jerusalem, Israel
| | - Kedar Asaf
- Department of General Surgery, Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Saar Hashavya
- Department of Pediatric Emergency Medicine, Hadassah and Hebrew University Hospital, Jerusalem, Israel
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Khurana B, Prakash J, Loder RT. Assault related injury visits in US emergency departments: An analysis by weekday, month and weekday-by-month. Chronobiol Int 2022; 39:1068-1077. [PMID: 35535524 DOI: 10.1080/07420528.2022.2065285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study investigated the temporal variation (month and day) in assault-related injuries presenting to the US Emergency Departments (ED). An IRB exempt, retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System Database from 2005 to 2017 for six categories of assault-related injuries-altercation, sexual assault, robbery, intimate partner violence (IPV), other specified assaults and unknown assault types. National estimates of injuries and associated variables were obtained using SUDAAN software, followed by cosinor analyses for the variation of month and weekday of injury. Three-dimensional topographic representations for weekday-by-month analyses were also created. Over this 13-year time span, there were more than 21 million injury visits due to assault, accounting for 6.57% of all ED visits. While there was no change in the incidence of total number of assaults over the study period, there was a significant increase in the annual percentage incidence of IPV (1.17%; p = .0094) and robbery (2.56%; p = .0001). Cosinor analyses demonstrated a mid-summer peak for all assault types except for robberies (late summer). All assault types showed a weekend peak (late Saturday or early Sunday). Topographical contours exhibited a peak in July and August on early Sunday for all assaults, however the month varied by the type of assault, with weekend peaks in the spring and winter for IPV. This information can be used in prospective resource planning for management and prevention strategies.
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Affiliation(s)
- Bharti Khurana
- Department of Radiology and Medicine, Radiology, Harvard Medical School, Trauma Imaging Research and Innovation Center, Boston, Massachusetts, USA
| | - Jaya Prakash
- Harvard Medical School, Trauma Imaging Research and Innovation Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Randall T Loder
- Orthopedic Surgery, Indiana University School of Medicine, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Schellenberg M, Inaba K, Love BE, Warriner Z, Forestiere MJ, Benjamin E, Lam L, Demetriades D. Trauma Team Activation at a Level I Trauma Center in Southern California: Time of Day Matters. Am Surg 2020. [DOI: 10.1177/000313481908501014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC1USC (January 2008–July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23–53]. The median Injury Severity Score was 4 [1–10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.
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Affiliation(s)
- Morgan Schellenberg
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Bryan E. Love
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Zachary Warriner
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Matthew J. Forestiere
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Elizabeth Benjamin
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Lydia Lam
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
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Aizpuru M, Farley KX, Rojas JC, Crawford RS, Moore TJ, Wagner ER. Motorized scooter injuries in the era of scooter-shares: A review of the national electronic surveillance system. Am J Emerg Med 2019; 37:1133-1138. [PMID: 30952603 DOI: 10.1016/j.ajem.2019.03.049] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There has been a spike in recent news regarding motorized scooter injuries due to the expansion of scooter sharing companies. Given the paucity of literature on this topic, the purpose of our study was to describe and quantify emergency department encounters associated with motorized scooter related injuries. METHODS The National Electronic Injury Surveillance System (NEISS) was queried for motorized scooter related injuries from 2013 to 2017. Patient demographics, diagnosis, injury location, narrative description of incident, and disposition data were collected from emergency department encounters. RESULTS There were an estimated 32,400 motorized scooter injuries from 2013 to 2017. The estimated incidence did not change significantly over time with 1.9 cases per 100,000 in 2013 and 2.6 cases per 100,000 in 2017. A 77.0% increase in scooter injuries was noted for millennials from 2016 to 2017. Head injuries were the most common body area injured (27.6%). Fractures or dislocations (25.9%) were the most common diagnosis. The most common site of fracture was the wrist and lower arm (35.4%). There were no deaths. Major orthopaedic injury and concussion were the strongest independent predictors of hospital admission. CONCLUSIONS Head injuries were the most commonly injured body part, while fractures or dislocations were the most common diagnosis. These results highlight the importance of using protective equipment while riding motorized scooters, and lay a foundation for future policies requiring helmet use.
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Affiliation(s)
- Matthew Aizpuru
- Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kevin X Farley
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, GA, United States of America
| | - Jaimie C Rojas
- New York Medical College, Valhalla, NY, United States of America
| | - Robert S Crawford
- Emory University School of Medicine, Department of Surgery, Vascular Division, Atlanta, GA, United States of America
| | - Thomas J Moore
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, GA, United States of America
| | - Eric R Wagner
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, GA, United States of America.
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