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Tatebe LC, Cone JT, Slidell MB, Chang G, Jonikas M, Stewart A, Doherty J, Arunkumar P, Schlanser V, Dennis AJ. When public health crises collide: 5 years of pediatric firearm injury prevention opportunities. Trauma Surg Acute Care Open 2023; 8:e001026. [PMID: 37303982 PMCID: PMC10254944 DOI: 10.1136/tsaco-2022-001026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Prior publications on pediatric firearm-related injuries have emphasized significant social disparities. The pandemic has heightened a variety of these societal stresses. We sought to evaluate how we must now adapt our injury prevention strategies. Patients and methods Firearm-related injuries in children 15 years old and under at five urban level 1 trauma centers between January 2016 and December 2020 were retrospectively reviewed. Age, gender, race/ethnicity, Injury Severity Score, situation, timing of injury around school/curfew, and mortality were evaluated. Medical examiner data identified additional deaths. Results There were 615 injuries identified including 67 from the medical examiner. Overall, 80.2% were male with median age of 14 years (range 0-15; IQR 12-15). Black children comprised 77.2% of injured children while only representing 36% of local schools. Community violence (intentional interpersonal or bystander) injuries were 67.2% of the cohort; 7.8% were negligent discharges; and 2.6% suicide. Median age for intentional interpersonal injuries was 14 years (IQR 14-15) compared with 12 years (IQR 6-14, p<0.001) for negligent discharges. Far more injuries were seen in the summer after the stay-at-home order (p<0.001). Community violence and negligent discharges increased in 2020 (p=0.004 and p=0.04, respectively). Annual suicides also increased linearly (p=0.006). 5.5% of injuries were during school; 56.7% after school or during non-school days; and 34.3% were after legal curfew. Mortality rate was 21.3%. Conclusions Pediatric firearm-related injuries have increased during the past 5 years. Prevention strategies have not been effective during this time interval. Prevention opportunities were identified specifically in the preteenage years to address interpersonal de-escalation training, safe handling/storage, and suicide mitigation. Efforts directed at those most vulnerable need to be reconsidered and examined for their utility and effectiveness. Level of evidence Level III; epidemiological study type.
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Affiliation(s)
- Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer T Cone
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Mark B Slidell
- Department of Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois, USA
| | - Grace Chang
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Meghan Jonikas
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Amy Stewart
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - James Doherty
- Department of Surgery, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Ponni Arunkumar
- Department of Pathology, Northwestern University, Chicago, Illinois, USA
| | | | - Andrew J Dennis
- Department of Trauma, Cook County Health, Chicago, Illinois, USA
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Ojima M, Ishida K, Katayama Y, Hirose T, Nakao S, Tachino J, Noda T, Umemura Y, Kiguchi T, Kiyohara K, Matsuyama T, Kitamura T, Oda J, Ohnishi M. Impact of the COVID-19 pandemic on epidemiology, treatment, and outcome of major trauma in Japan in 2020: a retrospective observational nationwide registry-based study. Acute Med Surg 2023; 10:e817. [PMID: 36698916 PMCID: PMC9849826 DOI: 10.1002/ams2.817] [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: 09/09/2022] [Accepted: 01/01/2023] [Indexed: 01/21/2023] Open
Abstract
Aim The nationwide impact of the coronavirus disease (COVID-19) pandemic on major trauma in Japan is unknown. The nationwide registry-based data of the Japanese Trauma Data Bank were analyzed to elucidate the impact of COVID-19 on the epidemiology, treatment, and outcomes of major trauma patients. Methods Among patients transported directly from the injury site by ambulance with an Injury Severity Score of ≥16, we compared patients managed from April to December in 2019 to those managed from April to December in 2020. Results In total, 9792 patients were included in this study (2019, n = 5194; 2020, n = 4598). There were no significant differences in age or sex, but there were significant differences between 2019 and 2020 in the rates of "self-injury (suicide)", "motor vehicle accident", "fall from height", "fall down", and "fall to the ground", which are factors associated with patient age. Injury severity in 2019 and 2020 did not differ to a statistically significant extent, but the rate of major spinal injury increased. The time of prehospital care significantly increased in 2020 compared to 2019. There was no noticeable change in hospital treatment or in-hospital mortality between 2019 and 2020. Conclusion This study suggests that the COVID-19 pandemic might have altered the injuries of major trauma; however, medical services for major trauma were well supplied in Japan in 2020.
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Affiliation(s)
- Masahiro Ojima
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care MedicineOsaka Metropolitan University School of MedicineOsakaJapan
| | - Yutaka Umemura
- Department of Emergency and Critical CareOsaka General Medical CenterOsakaJapan
| | - Takeyuki Kiguchi
- Department of Emergency and Critical CareOsaka General Medical CenterOsakaJapan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home EconomicsOtsuma Women's UniversityTokyoJapan
| | - Tasuku Matsuyama
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Mitsuo Ohnishi
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
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Plekhanov AN, Tovarshinov AI, Plekhanov NA. [Features of surgical patients of COVID-19 patients]. Khirurgiia (Mosk) 2023:51-56. [PMID: 37379405 DOI: 10.17116/hirurgia202307151] [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: 06/30/2023]
Abstract
The novel coronavirus pandemic has significantly increased the workload of surgical service worldwide. Restrictive measures led to postponement of elective surgical and diagnostic interventions and reduced the number of emergency manipulations around the world. Large-scale studies identified optimal period for postponing surgical procedures and advisability of this postponement. The authors present opinions of surgeons and their views on treatment strategy for various elective and emergency surgical interventions in abdominal surgery, traumatology-orthopedics and oncology. The main factors reducing perioperative mortality in patients with a new coronavirus infection are observance of anti-epidemic measures by patients and medical personnel, competent use of personal protective equipment, as well as adherence to protocols and algorithms for the treatment of these patients.
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Affiliation(s)
- A N Plekhanov
- Dorzhi Banzarov Buryat State University, Ulan-Ude, Russia
- Irkutsk Research Center for Surgery and Traumatology, Irkutsk, Russia
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Thomas AC, Campbell BT, Subacius H, Orlas CP, Bulger E, Stewart RM, Stey AM, Jang A, Hamad D, Bilimoria KY, Nathens AB. National evaluation of the association between stay-at-home orders on mechanism of injury and trauma admission volume. Injury 2022; 53:3655-3662. [PMID: 36167686 PMCID: PMC9467931 DOI: 10.1016/j.injury.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/11/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic had numerous negative effects on the US healthcare system. Many states implemented stay-at-home (SAH) orders to slow COVID-19 virus transmission. We measured the association between SAH orders on the injury mechanism type and volume of trauma center admissions during the first wave of the COVID-19 pandemic. METHODS All trauma patients aged 16 years and older who were treated at the American College of Surgeons Trauma Quality Improvement Program participating centers from January 2018-September 2020. Weekly trauma patient volume, patient demographics, and injury characteristics were compared across the corresponding SAH time periods from each year. Patient volume was modeled using harmonic regression with a random hospital effect. RESULTS There were 166,773 patients admitted in 2020 after a SAH order and an average of 160,962 patients were treated over the corresponding periods in 2018-2019 in 474 centers. Patients presenting with a pre-existing condition of alcohol misuse increased (13,611 (8.3%) vs. 10,440 (6.6%), p <0.001). Assault injuries increased (19,056 (11.4%) vs. 15,605 (9.8%)) and firearm-related injuries (14,246 (8.5%) vs. 10,316 (6.4%)), p<0.001. Firearm-specific assault injuries increased (10,748 (75.5%) vs. 7,600 (74.0%)) as did firearm-specific unintentional injuries (1,318 (9.3%) vs. 830 (8.1%), p<0.001. In the month preceding the SAH orders, trauma center admissions decreased. Within a week of SAH implementation, hospital admissions increased (p<0.001) until a plateau occurred 10 weeks later above predicted levels. On regional sub-analysis, admission volume remained significantly elevated for the Midwest during weeks 11-25 after SAH order implementation, (p<0.001).
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Affiliation(s)
- Arielle C. Thomas
- Medical College of Wisconsin, Milwaukee, WI, USA,American College of Surgeons, Chicago, IL, USA,Corresponding author at: Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brendan T. Campbell
- American College of Surgeons, Chicago, IL, USA,Department of Pediatric Surgery, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford, CT, USA
| | - Haris Subacius
- American College of Surgeons, Chicago, IL, USA,Society of Thoracic Surgeons, Chicago, IL, USA
| | - Claudia P. Orlas
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eileen Bulger
- American College of Surgeons, Chicago, IL, USA,Department of Surgery, University of Washington, Seattle, WA, USA
| | - Ronald M. Stewart
- American College of Surgeons, Chicago, IL, USA,Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anne M. Stey
- Medical College of Wisconsin, Milwaukee, WI, USA,American College of Surgeons, Chicago, IL, USA
| | - Angie Jang
- Northwestern University, Chicago, IL, USA
| | - Doulia Hamad
- Department of Surgery, Sunnybrook Health Sciences Center and the University of Toronto, Canada
| | - Karl Y. Bilimoria
- Medical College of Wisconsin, Milwaukee, WI, USA,American College of Surgeons, Chicago, IL, USA
| | - Avery B. Nathens
- American College of Surgeons, Chicago, IL, USA,Department of Surgery, Sunnybrook Health Sciences Center and the University of Toronto, Canada
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Sheppard DM, Hayman J, Allen TJ, Berecki-Gisolf J. Improving injury surveillance data quality: a study based on hospitals contributing to the Victorian Emergency Minimum Dataset. Aust N Z J Public Health 2022; 46:401-406. [PMID: 35238429 DOI: 10.1111/1753-6405.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE In this paper, we describe the design and baseline data of a study aimed at improving injury surveillance data quality of hospitals contributing to the Victorian Emergency Minimum Dataset (VEMD). METHODS The sequential study phases include a baseline analysis of data quality, direct engagement and communication with each of the emergency department (ED) hospital sites, collection of survey and interview data and ongoing monitoring. RESULTS In 2019/20, there were 371,683 injury-related ED presentations recorded in the VEMD. Percentage unspecified, the indicator of (poor) data quality, was lowest for 'body region' (2.7%) and 'injury type' (7.4%), and highest for 'activity when injured' (29.4%). In the latter, contributing hospitals ranged from 3.0-99.9% unspecified. The 'description of event' variable had a mean word count of 10; 16/38 hospitals had a narrative word count of <5. CONCLUSIONS Baseline hospital injury surveillance data vary vastly in data quality, leaving much room for improvement and justifying intervention as described. Implications for public health: Hospital engagement and feedback described in this study is expected to have a marked effect on data quality from 2021 onwards. This will ensure that Victorian injury surveillance data can fulfil their purpose to accurately inform injury prevention policy and practice.
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Affiliation(s)
- Dianne M Sheppard
- The Victorian Injury Surveillance Unit (VISU), Monash University Accident Research Centre, Monash University, Victoria
| | - Jane Hayman
- The Victorian Injury Surveillance Unit (VISU), Monash University Accident Research Centre, Monash University, Victoria
| | - Trevor J Allen
- The Victorian Injury Surveillance Unit (VISU), Monash University Accident Research Centre, Monash University, Victoria
| | - Janneke Berecki-Gisolf
- The Victorian Injury Surveillance Unit (VISU), Monash University Accident Research Centre, Monash University, Victoria
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