The contribution of the Israeli trauma system to the survival of road traffic casualties

Demographic and injury trends for car crash casualties hospitalized in Level I Trauma centers over two decades: data from the National Trauma Registry

BACKGROUND

During the past two decades, there have been many changes in automotive and medical technologies, road infrastructure, trauma systems, and demographic changes which may have influenced injury outcomes. The aim of this study was to examine injury trends among traffic casualties, specifically private car occupants, hospitalized in Level I Trauma Centers (TC).

METHODS

A retrospective cohort study was performed based on data from the Israel National Trauma Registry. The data included occupants of private cars hospitalized in all six Level I TC due to a traffic collision related injury between January 1, 1998 and December 31, 2019. Demographic, injury and hospitalization characteristics and in-hospital mortality were analyzed. Chi-squared (X2) test, multivariable logistic regression models and Spearman's rank correlation were used to analyze injury data and trends.

RESULTS

During the study period, 21,173 private car occupants (14,078 drivers, 4,527 front passengers, and 2,568 rear passengers) were hospitalized due to a traffic crash. The percentage of females hospitalized due to a car crash increased from 37.7% in 1998 to 53.7% in 2019. Over a twofold increase in hospitalizations among older adult drivers (ages 65+) was observed, from 6.5% in 1998 to 15.7% in 2018 and 12.6% in 2019. While no increase was observed for severe traumatic brain injury, a statistically significant increase in severe abdominal and thoracic injuries was observed among the non-Jewish population along with a constant decrease in in-hospital mortality.

CONCLUSIONS

This study provides interesting findings regarding injury and demographic trends among car occupants during the past two decades. Mortality among private car occupant casualties decreased during the study period, however an increase in serious abdominal and thoracic injuries was identified. The results should be used to design and implement policies and interventions for reducing injury and disability among car occupants.

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Severe trauma in Germany and Israel: are we speaking the same language? A trauma registry comparison

Background

Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU®, TR-DGU) and Israel (Israeli National Trauma Registry, INTR).

Methods

The present study was a retrospective analysis of data from the described above trauma registries in Israel and Germany. Adult patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, type, distribution, mechanism, and severity of injury, treatment delivered and length of stay (LOS) in the ICU and in the hospital were included in the analysis.

Results

Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic collisions were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 vs. 20), more patients were treated on an intensive care unit (92 vs. 32%), and mortality was higher (19.4 vs. 9.5%) as well.

Conclusion

Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most probably, this was caused by different recruitment strategies of both registries, like trauma team activation and need for intensive care in TR-DGU. More detailed analyses are needed to uncover similarities and differences of both trauma systems.

Do direct admissions to trauma centers have a survival benefit compared to inter-hospital transfers in severe trauma?

PURPOSE

To compare mortality among severe and critically injured patients who were directly admitted (DA) to level I trauma center (TCI) or level II trauma center (TCII) with those who were transferred to a TCI after being initially admitted to a TCII.

METHODS

A cohort study of severe and critically injured patients (Injury Severity Score 16-75) hospitalized between 2010 and 2019 using data from the National Program for Trauma Registration. Multivariate logistic regression models estimated mortality risk, including stratified analyses.

RESULTS

Of the 27,131 hospitalizations, 9.5% were transfers, 60.1% were DA to TCI and 30.4% were DA to TCII. Children ages ≤ 17 years, Non-Jews (minority), critical injuries (ISS 25-75), head injuries (AIS ≥ 3) and fall injuries were significantly more frequent among transfers, compared with the DA groups. Evacuation by emergency medical services was less frequent among transfers. After accounting for possible confounders, transfers had a greater risk of in-hospital mortality [DA to TCI vs transfer, OR (95% CI) 0.61 (0.52-0.72); DA to TCII vs transfer, OR (95% CI) 0.78 (0.65-0.94)]. In stratified analyses, these mortality differences persisted among the sub-group of patients who sustained critical injuries, among the patients with non-penetrating injuries, among the elderly ages ≥ 65 year and during the first 2 weeks of hospitalization.

CONCLUSION

This study has intervention implications that should be directed primarily at prehospital triage and the inter-hospital transfer processes. In addition, there may be a need to optimize the capabilities of regional trauma systems along with continuous performance evaluations and actions as required.

Gunshot casualties in Israel: A decade of violence

OBJECTIVE

The purpose of this study was to identify and characterize casualties hospitalized with assault (non-terror) related gunshot wounds (GSW) in Israel as a basis for determining the incidence, trends and at-risk population groups.

METHODS

This retrospective cohort study is based on data from the Israel National Trauma Registry. The data includes GSW casualties hospitalized between January 1, 2011 and December 31, 2020. Attempted suicide, unintentional injury, legal intervention, children (ages 0-9) and terror (Israeli-Arab conflict) related GSW were excluded. The remaining population was classified with an ICD-9-CM diagnosis code of 965.0-965.4.

RESULTS

The study population included 2,763 GSW admissions. A noticeable increase in GSW casualties was reported, from 206 hospitalization in 2011 to 456 in 2020. The proportion of Arab casualties increased from 73.3% of all GSW casualties in 2011 to 90.8% in 2020, far more than their proportion in the population (∼20%). The majority of the GSW casualties were males (95.8%) and between the ages of 20 and 29 (42.2%). Among severe/critical casualties, 19% of Arabs and 9.9% of Jews arrived by private car. Severe thoracic and abdominal injuries were the prominent injuries among fatal casualties (47.6 and 40.8, respectively). While the all-severity mortality rate was 5.6% (n = 147), 24.4% (n = 135) of severe/critical (ISS16+) casualties died, with no significant differences between Jews and Arabs. Forty percent of deaths occurred in the emergency department.

CONCLUSIONS

This study establishes that during the past decade in Israel, not only has there been a continuous increase in hospitalizations due to GSW, but also Arabs are at great risk of such related hospitalizations. Preventive strategies targeting at-risk groups are crucial for minimizing morbidity and mortality related to GSW in Israel.

Developing a National Set of Health Equity Indicators Using a Consensus Building Process

BACKGROUND

Considerable health inequities documented in Israel between communities, populations and regions, undermine the rights of all citizens to optimal health. The first step towards health equity is agreement on a set of national indicators, reflecting equity in healthcare provision and health outcomes, and allowing monitoring of the impact of interventions on the reduction of disparities. We describe the process of reaching a consensus on a defined set of national equity indicators.

METHODS

The study was conducted between January 2019 and June 2020, in a multistage design: (A) Identifying appropriate and available inequity measures via interviews with stakeholders. (B) Agreement on the screening criteria (public health importance; gap characteristics; potential for change; public interest) and relative weighting. (C) Constructing the consultation framework as an online, 3-round Delphi technique, with a range of experts recruited from the health, welfare and education sectors.

RESULTS

Participants were of diverse age, gender, geographic location, religion and ethnicity, and came from academia, healthcare provision, government ministries and patient representative groups. Thirty measures of inequity, presented to participants, represented the following domains: Health promotion (11 indicators), acute and chronic morbidity (11), life expectancy and mortality (2), health infrastructures and affordability of care (4), education and employment (2). Of the 77 individuals contacted, 75 (97%) expressed willingness to participate, and 55 (73%) completed all three scoring rounds. The leading ten indicators were: Diabetes care, childhood obesity, adult obesity, distribution of healthcare personnel, fatal childhood injuries, cigarette smoking, infant mortality, ability to afford care, access to psychotherapy and distribution of hospital beds. Agreement among raters, measured as intra-class correlation coefficient (ICC), was 0.75.

CONCLUSION

A diverse range of consultants reached a consensus on the most important national equity indicators, including both clinical and system indicators. Results should be used to guide governmental decision-making and inter-sectoral strategies, furthering the pursuit of a more equitable healthcare system.

The Utility of the Shock Index for Predicting Survival, Function and Health Status Outcomes in Major Trauma Patients: A Registry-Based Cohort Study

The shock index (SI; heart rate/systolic blood pressure) has been found to predict mortality in trauma patients. The aims of this study were to establish whether the SI improved the prediction of an existing model for both mortality and longer-term outcomes in major trauma patients. In total, 29,574 adult (>15 years) major trauma patients were included from the Victorian State Trauma Registry with a date of injury from July 2009 to June 2019. Outcomes of interest were survival to hospital discharge and function and health status at 6 months post-injury. Survival and function were analysed using measures of discrimination and calibration, whereas health status was assessed with R2 and MRSE measures. The area under the receiver operating characteristic curve (AUC) of the VSTR survival model improved when the SI was added (AUC 0.797 (0.787–0.807) versus AUC 0.807 (0.797–0.816), p < 0.001). For the prediction of functional outcome 6 months post-injury, the inclusion of the SI increased the AUC marginally (AUC 0.795 (0.786–0.803) versus AUC 0.799 (0.791–0.807), p < 0.001). When predicting in-hospital mortality and health status 6 months post-injury, including the SI resulted in a slightly better fit to the registry-risk adjustment model. In the future, external validation and the exploration of other models to improve prediction outcomes are warranted.

Reduction of motorcycle-related deaths over 15 years in a developing country

BACKGROUND

There have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates.

METHODS

This is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle-injured patients who were admitted to Al-Ain Hospital for more than 24 h or died in the Emergency Department or after hospitalization were studied.

RESULTS

The incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in both prehospital and in-hospital trauma care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's exact test).

CONCLUSIONS

The incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle-injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention, and both prehospital and in-hospital trauma care.

Patterns and clinical outcomes of injuries related to two-wheeled vehicles (bicycle and motorcycle) in the geriatric population: a nationwide analysis in South Korea (2016-2018)

Background

South Korea has a rapidly ageing population. This study aimed to provide epidemiologic data and to identify the characteristics of the patterns and clinical outcomes of two-wheeled vehicle-related injuries (bicycle and motorcycle) in elderly riders.

Methods

This study retrospectively analyzed data from the National Emergency Department Information System from 2016 to 2018. Adult patients (≥ 20 years old) who were injured while using two-wheeled vehicles were included. Elderly patients were defined as being 65 years and older. The analysis was performed for 65,648 bicycle-related injuries (15,272 elderly patients) and 87,855 motorcycles-related injuries (17,292 elderly patients).

Results

In emergency departments (EDs), the average injury severity score (ISS) for motorcycle-related accidents was 9.8 ± 11.2 in the younger group and 14.1 ± 14.7 in the elderly group (p = 0.001). In addition, the average ISS of bicycle-related accidents was 7.1 ± 8.9 in the younger group and 10.5 ± 12.3 in the elderly group (p = 0.001). Two-wheeled vehicle accident mortality rates of elderly riders (0.9% for bicycle and 1.8% for motorcycle in the ED; 4.1% for bicycle and 3.8% for motorcycle in the hospital) were more than twice those of younger riders.

The elderly stayed in the hospital longer than younger patients (485.2 ± 543.0 h vs 336.8 ± 385.5 h, p = 0.001) for bicycle-related injuries. They also stayed longer for motorcycle-related injuries (529 ± 598.6 h vs 452.0 ± 543.55 h, p = 0.001).

The logistic regression analysis showed that age ≥ 65 years was an independent factor associated with severe trauma (ISS ≥ 16) for both bicycle-related injuries (adjusted odds ratio [OR] 2.185 [95% Confidence Interval (CI) 2.072–2.303]) and motorcycle-related injuries (adjusted OR 1.220 [95% CI 1.137–1.287]).

Conclusion

Two-wheeled vehicle-related injuries in the elderly were associated with higher ISS, length of hospital stay, and mortality than in younger riders. Analysing the characteristics of two-wheeled vehicle-related injuries in the elderly can be the basis for planning to reduce and prevent injuries in elderly riders.

The effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis

BACKGROUND

Traumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development.

METHOD

A systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI).

RESULTS

A total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69-0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10-1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37-1.55]; p < 0.001).

CONCLUSION

The present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019142842 .

Perioperative cardiac arrest and mortality in trauma patients: A systematic review of observational studies

STUDY OBJECTIVE

Factors that influence the occurrence of perioperative cardiac arrest (CA) and its outcomes in trauma patients are not well known. The novelty of our study lies in the performance of a systematic review conducted worldwide on the occurrence of perioperative CA and/or mortality in trauma patients.

DESIGN

A systematic review was performed to identify observational studies that reported the occurrence of CA and/or mortality due to trauma and CA and/or mortality rates in trauma patients up to 24 h postoperatively. We searched the MEDLINE, EMBASE, LILACS and SciELO databases through January 29, 2020.

SETTING

Perioperative period.

MEASUREMENTS

The primary outcomes evaluated were data on the epidemiology of perioperative CA and/or mortality in trauma patients.

MAIN RESULTS

Nine studies were selected, with the first study being published in 1994 and the most recent being published in 2019. Trauma was an important factor in perioperative CA and mortality, with rates of 168 and 74 per 10,000 anesthetic procedures, respectively. The studies reported a higher proportion of perioperative CA and mortality in trauma patients who were males, young adults and adults, patients with American Society of Anesthesiologists (ASA) physical status ≥ III, patients undergoing general anesthesia, and in abdominal or neurological surgeries. Uncontrolled hemorrhage was the main cause of perioperative CA and mortality after trauma. Survival rates after perioperative CA were low.

CONCLUSIONS

Trauma is an important factor in perioperative CA and mortality, especially in young adult and adult males and in patients classified as having an ASA physical status ≥ III mainly due to uncontrollable bleeding after blunt and perforating injuries. Trauma is a global public health problem and has a strong impact on perioperative morbidity and mortality.

Comparison between traumatic brain injury with and without concomitant injuries: an analysis based on a national trauma registry 2008-2016

Objective: To compare demographic, injury and hospitalization characteristics and mortality between Isolated and Non-Isolated traumatic brain injury.Methods: A retrospective study based on the Israeli National Trauma Registry of patients hospitalized for traumatic brain injury (TBI) between 2008 and 2016. Isolated TBI was defined as no other anatomic region was having concomitant injury with AIS ≥2. X2 test and multivariate logistic regression analysis were used for data analysis.Results: Of the 23566-study population, 40.4% were admitted for isolated TBI. Isolated TBI was significantly more frequent in elderly aged ≥65 years, female, Jews, and injuries sustained at home or in residential institution. The Non-isolated TBI was greater in road traffic injuries, particularly among pedestrians and motor cyclists, and in violence injuries. The Non-isolated TBI group had greater injury severity and hospital resource utilization. In-hospital mortality was higher in the patients with Non-isolated TBI [OR: 1.56(95% CI: 1.33-1.83)], particularly in patients with GCS 13-15; elderly aged 65+ years; and patients with concomitant injuries to abdomen, spine or external body regions.Conclusion: In a patient with TBI, concomitant injuries with AIS ≥2 matter, and awareness of the identified factors has relevance for guiding injury prevention efforts and indeed for potentially improving care and outcome.

Comparison of traffic collision victims between older and younger drivers in South Korea: Epidemiologic characteristics, risk factors and types of collisions

Objective

This study aimed to show the epidemiological characteristics and the difference in the risk factors and types of collision between older and younger drivers in Korea.

Methods

We collected data from the Emergency Department-based Injury In-depth Surveillance retrieved by the Korea Centers for Disease Control and Prevention from 2011 to 2015. We included injured drivers aged ≥ 18 years who were registered in the database, who were limited to drivers of four-wheeled vehicles. The enrolled patients were divided according to age into older (≥ 65 years) and younger (< 65 years) drivers. The total number of enrolled drivers was 37,511; 2,361 (6.3%) of them were older drivers. The epidemiological characteristics (e.g., age, sex, fatality rate) of traffic collision victims for 5 years were determined, and the risk factors (e.g., seat belt use) and types of collision (single- vs. multi-vehicle) between the two groups were compared.

Results

The median age and interquartile range (IQR; 25^th and 75^th percentiles) of all drivers were 41.0 (IQR, 32.0–52.0), and 24,544 (65.4%) of them were men. The median age increased from 40.0 (IQR, 31.0–50.0) to 43.0 (IQR, 33.0–54.0) between 2010 and 2015 (P < 0.001). The proportion of older drivers increased from 5.0% to 8.4% annually during the study period (P < 0.001). Between 2010 and 2015, the fatality rate decreased from 3.1% to 1.2% (P = 0.287) for older drivers and from 0.9% to 0.5% (P = 0.009) for younger drivers. The proportion of single-vehicle collision (25.9% vs. 20.3%) was higher in older than in younger drivers (P < 0.001). Older drivers had a lower rate of seat-belt use than younger drivers (79.0% vs. 83.0%, P < 0.001).

Conclusions

The proportion of older drivers increased annually during the study period, and older drivers experienced more single-vehicle collision and used seat belt less frequently than younger drivers. A national policy support to reduce traffic collision in older drivers and public relation activities to enhance their seat belt use should be strengthened in the future.

Minorities and foreign born are disproportionately affected by injuries due to violence: an analysis based on a National Trauma Registry 2008-2017

BACKGROUND

Populations of different ethnicity and country of origin living in the same country may possess particular features of violence-related injuries. This study aims to compare violence-related injury characteristics and circumstances, hospital resource utilization and in-hospital mortality among the major ethnic groups in Israel.

METHODS

A study based on the Israeli National Trauma Registry database of patients hospitalized due to violence-related injuries between 2008 and 2017. Data included demographic, injury and hospitalization characteristics and in-hospital mortality. Statistical analysis included χ2-test and multiple logistic regression.

RESULTS

During the study period, 16,151 violence related-hospitalizations were reported, of which; 46.1% were Arab Israelis (AI), 3.2% were Israelis born in Ethiopia (IBE), 12.7% were Israelis born in the former Soviet Union (IBFSU) and 38.0% were all other Israelis (AOI). The proportion of violence-related hospitalizations among AI, IBE and IBFSU was greater than their respective proportion in the Israeli population. In comparison to the other groups, stab injuries were significantly greater among IBE (30% vs 39%); unarmed brawl-related injuries were greater among IBFSU (22-41% vs 49%) and firearm injuries were greatest among AI (2-8% vs 23%). These differences in violence mechanism persisted even after accounting for age, gender, injury place and time differences. The foreign born groups had higher rates for injuries sustained on the street/road (58% for IBE, 54% for IBFSU vs 46% for AI and AOI, each), with IBE also showing higher rates for weekend and weeknight injuries compared to the other groups (83% vs 71-75%). IBE were more likely to suffer from severe and critical injuries (19% vs 12-16%), to be admitted to the intensive care unit (17% vs 9-11%) and to have prolonged hospital stays of seven days or more (20% vs 16-17%), with no significant difference in in-hospital mortality between the comparison groups.

CONCLUSIONS

Characteristics of violence-related casualties differed significantly among diverse ethnic populations living in the same country. Each population group showed specific attributes regarding injury mechanism, circumstances, severity and hospital utilization. Violence prevention programs should be culturally adapted and take into account ethnicity and country of origin of the target population.

The epidemiology of wrist and hand injury in two hospitals in Jerusalem: substantial differences between population subgroups

Background

Wrist and hand injuries are common and constitute a major economic burden. General injury prevention programs have failed to demonstrate a decrease in injury rates. We hypothesized that there are differences in injury patterns in culturally diverse subpopulations of a metropolitan area treated within the same medical system, which may partly explain the difficulties associated with injury prevention.

Methods

We conducted a survey of patients admitted to emergency departments of two hospitals in Jerusalem for wrist and hand injuries during a 3 month period. Patients were asked to complete a questionnaire regarding demographic data, injury type and mechanism. Injury type and mechanism were then compared for age, gender, level of education and degree of religiosity.

Results

The questionnaire was completed by 799 patients (response rate 62%; 75% male; average age 27). Thirty-one percent reported they were injured at work, 33% at home and 36% during leisure activities. Data analysis showed that several subpopulations were found to be at risk as compared to their corresponding groups and relative proportion in the overall population of the city. These included contusions after falls in non-ultra-Orthodox Jewish women aged 65 years and over, crush injuries in ultra-Orthodox Jews under the age of 10 (53% vs. 14% for non ultra-Orthodox Jews, respectively) and Muslim teens. Muslims were injured more, especially at work, in comparison to their relative proportion in the population as a whole.

Conclusion

Different subpopulations at risk and different injury patterns of wrist and hand injuries were found in this culturally heterogeneous population. Awareness of these differences may be the first step when designing specific injury prevention programs in a culturally diverse population. A combined effort of community leaders and government agencies is needed to deal with the specific populations at risk, although legislation may be needed to limit some of the risks such as teens and specific work related hazards and exposures.

Injury patterns in road traffic victims comparing road user categories: Analysis of 811 consecutive cases in the emergency department of a level I institution in a low-income country

Background:

More than a million people die every day on world's roads and according to current estimates traffic related injuries will become the 5th highest killer in the world by 2030. Low and middle-income countries carry over 90% of this burden with substantial socio-economic consequences. Policies to reduce this burden are currently centered on preventive measures and the care of the injured is still neglected. This study aims at describing the crash characteristics and pattern of injuries in an urban area of a middle-income country with particular emphasis on the differential analysis of various road user categories.

Methods:

in this prospective cohort analysis conducted over a period of 5 months in the casualty department of the largest hospital in the city of Douala in Cameroon, all patients admitted after sustaining a traffic related injury were analyzed for crash characteristics, pattern and severity of injury and final outcome after a maximum follow-up period of 1 week. The analysis compared various user categories for different variables.

Results:

a total of 811 cases could be analyzed. These included 586 (72.2%) males for a sex-ratio of 2.6/1. Motorized two-wheelers and pedestrians represented overall over 80% of all victims and the most frequent collision involved a motorcycle and a tourist car. Over 95% of victims did not use a protective device. Most patients sustained external soft tissue lesions frequently involving the limbs and face. A total of 280 patients (34.52%) sustained a limb fracture. The most frequently fractured bones were the tibia, fibula and femur. Most injury cases were minor or moderate and collision between a motorcycle and a truck resulted in a significantly more severe injury. Motorized two-wheelers and pedestrian were significantly more exposed to external injuries while car occupants were more exposed to chest and spine injuries.

Conclusion:

crash characteristics in Douala are greatly influenced by the popularization of motorized two-wheelers who are exposed to collision with tourist cars. Victims mostly tend to develop external lesions resulting in minor injuries. However, there is need to emphasize on the need to associate to current preventive measures an appropriate policy of management of the injured.

Highlights:

Regionalisation of trauma care in England

AIMS

We aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England.

PATIENTS AND METHODS

An observational study was undertaken using the Trauma Audit and Research Network (TARN), Hospital Episode Statistics (HES) and national death registrations. The outcome measures were indicators of the quality of trauma care, such as treatment by a senior doctor and clinical outcomes, such as mortality in hospital.

RESULTS AND CONCLUSION

A total of 20 181 major trauma cases were reported to TARN during the study period, which was 270 days before and after each hospital became a Major Trauma Centre. Following regionalisation of trauma services, all indicators of the quality of care improved, fewer patients required secondary transfer between hospitals and a greater proportion were discharged with a Glasgow Outcome Score of "good recovery". In this early post-implementation analysis, there were a number of apparent process improvements (e.g. time to CT) but no differences in either crude or adjusted mortality. The overall number of deaths following trauma in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggests that further benefits may become apparent after a period of maturing of the trauma system. Cite this article: Bone Joint J 2016;98-B:1253-61.