1
|
Walker J, Madigan D, Friedman LS, Forst L. Injuries Among Hispanic/Latinx Agricultural Workers Seen in Illinois Hospitals. J Agromedicine 2024; 29:246-256. [PMID: 38108302 DOI: 10.1080/1059924x.2023.2293826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Agriculture is a dangerous industry, with evidence indicating a disproportionate burden among Hispanic/Latinx workers. There is a need to expand the utilization of different data systems to improve the surveillance of precarious workers within agriculture. This analysis describes inclusion criteria to identify farm-related injuries and illnesses in hospital data utilizing ICD-10 codes to better assess health equity issues involving Hispanic/Latinx workers and their associated costs. METHODS Discharge data of agriculture-related injuries and illnesses treated in Illinois hospitals and emergency departments from 2018 to 2021 were extracted using ICD-10 diagnosis and location of injury codes. Injury cause, nature, severity, and course of clinical care are stratified by ethnicity. Multivariable models were developed to assess differences in injury severity, level of care required, and cost of care. RESULTS We identified 3,745 farm-related injuries and illnesses treated in Illinois hospitals between 2018 and 2021, of which 196 involved Hispanic/Latinx individuals. Hispanic/Latinx patients were substantially younger and disproportionately covered by workers' compensation insurance or uninsured. Compared to non-Hispanic/Latinx individuals, Hispanic/Latinx patients suffered injuries from different mechanisms, particularly involving animals and cutting/piercing instruments. While non-Hispanic/Latinx individuals demonstrated more severe injuries based on the descriptive statistics, after controlling for confounding (particularly age), we did not observe ethnic disparities in injury severity or level of care required. However, the cost of care was equivalent to or higher among Hispanic/Latinx persons. CONCLUSION The case definition used for this analysis identified agriculture-related cases and provided insights on the course of clinical care by ethnicity. This strategy would likely yield valuable information in states with larger and more diverse agricultural workforces. More targeted research to appropriately scope the issue and inform interventions is needed to understand differential exposure and reduce agricultural workplace hazards and address the financial burden resulting from farm-related injuries.
Collapse
Affiliation(s)
- Jared Walker
- Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, IL, USA
| | - Dana Madigan
- Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, IL, USA
| | - Lee S Friedman
- Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, IL, USA
| | - Linda Forst
- Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, IL, USA
| |
Collapse
|
2
|
Beiter KJ, Knowles SM, Tedesco A, Leonardi C, Scharf PL, Chapman BM, Brown TA, Schoen JE, Stuke LE, Greiffenstein PP, Marr AB, Hunt JP, Smith AA. Discrepancies in Mass Shootings and Access to Trauma Care Across the United States, 2014-2018. Am Surg 2024:31348241241748. [PMID: 38520302 DOI: 10.1177/00031348241241748] [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: 03/25/2024]
Abstract
INTRODUCTION The United States has one of the highest rates of gun violence and mass shootings. Timely medical attention in such events is critical. The objective of this study was to assess geographic disparities in mass shootings and access to trauma centers. METHODS Data for all Level I and II trauma centers were extracted from the American College of Surgeons and the Trauma Center Association of America registries. Mass shooting event data (4+ individuals shot at a single event) were taken from the Gun Violence Archive between 2014 and 2018. RESULTS A total of 564 trauma centers and 1672 mass shootings were included. Ratios of the number of mass shootings vs trauma centers per state ranged from 0 to 11.0 mass shootings per trauma center. States with the greatest disparity (highest ratio) included Louisiana and New Mexico. CONCLUSION States in the southern regions of the US experience the greatest disparity due to a high burden of mass shootings with less access to trauma centers. Interventions are needed to increase access to trauma care and reduce mass shootings in these medically underserved areas.
Collapse
Affiliation(s)
- Kaylin J Beiter
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Stacey M Knowles
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alexandra Tedesco
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Claudia Leonardi
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Peter L Scharf
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Brett M Chapman
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tommy A Brown
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jonathan E Schoen
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Lance E Stuke
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patrick P Greiffenstein
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alan B Marr
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - John P Hunt
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alison A Smith
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
3
|
Abasilim C, Friedman LS, Karch L, Holloway-Beth A. Trends in non-fatal and fatal opioid overdoses during the first two years of the coronavirus disease-2019 pandemic. Ann Epidemiol 2024; 90:35-41. [PMID: 38501569 DOI: 10.1016/j.annepidem.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/19/2023] [Accepted: 10/26/2023] [Indexed: 03/20/2024]
Abstract
PURPOSE This study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems. METHODS We examined opioid-involved overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases. RESULTS The overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (β = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (β = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses. CONCLUSIONS We underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.
Collapse
Affiliation(s)
- Chibuzor Abasilim
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Lee S Friedman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Lydia Karch
- Epidemiology Unit, Cook County Department of Public Health, Bridgeview, IL
| | - Alfreda Holloway-Beth
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL; Epidemiology Unit, Cook County Department of Public Health, Bridgeview, IL
| |
Collapse
|
4
|
Friedman LS, Abasilim C, Karch L, Jasmin W, Holloway-Beth A. Disparities in fatal and non-fatal opioid-involved overdoses among middle-aged non-Hispanic Black Men and Women. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01877-y. [PMID: 38048043 DOI: 10.1007/s40615-023-01877-y] [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: 07/13/2023] [Revised: 11/10/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
The gap in fatal opioid overdose rates has been closing between non-Hispanic Black and non-Hispanic White individuals. The rising opioid-involved mortality rates among non-Hispanic Black adults has been identified by SAMHSA as a critical public health issue. However, further research is needed that utilizes comprehensive surveillance data on both fatal and non-fatal opioid-involved overdoses to better assess the changing trends and evaluate factors contributing to changing disparities. We conducted an analysis of medical examiner and hospital data for years 2016-2021 from the largest county in Illinois (Cook) to (1) evaluate disparities in non-fatal and fatal opioid-involved overdoses between middle-aged non-Hispanic Black adults and Black adults of other age groups stratified by sex, (2) to assess if disparities exist across middle-aged adults of different race-ethnicities specifically non-Hispanic White and Hispanic-Latino adults, and (3) evaluate factors contributing to the disparities. Fatal opioid overdose rates among middle-aged Black men 45-64 years old were on average 5.3 times higher than Black men of other age groups, and 6.2 times higher than middle-aged non-Black men. Similarly, fatal opioid overdose rates among middle-aged Black women were on average 5.0 times higher than Black women of other age groups, and 4.9 times higher than middle-aged non-Black women. Hospital utilization rates for opioid-involved overdoses showed similar disparities between age groups and race-ethnicities. Findings indicate that stark disparities in rates of opioid-involved overdoses among middle-aged Black men and women are likely attributed to exposure to more lethal opioids, drug variability in local markets, differences in concurrent drug exposures, and lower access to harm reduction, emergent and preventative health services.
Collapse
Affiliation(s)
- Lee S Friedman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA.
| | - Chibuzor Abasilim
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Lydia Karch
- Cook County Department of Public Health, Chicago, IL, USA
| | | | | |
Collapse
|
5
|
Zheng N, Abram KM, Welty LJ, Aaby DA, Meyerson NS, Teplin LA. Nonfatal Firearm Injury and Firearm Mortality in High-risk Youths and Young Adults 25 Years After Detention. JAMA Netw Open 2023; 6:e238902. [PMID: 37083667 PMCID: PMC10122168 DOI: 10.1001/jamanetworkopen.2023.8902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Youths, especially Black and Hispanic males, are disproportionately affected by firearm violence. Yet, no epidemiologic studies have examined the incidence rates of nonfatal firearm injury and firearm mortality in those who may be at greatest risk-youths who have been involved with the juvenile justice system. Objectives To examine nonfatal firearm injury and firearm mortality in youths involved with the juvenile justice system and to compare incidence rates of firearm mortality with the general population. Design, Setting, and Participants The Northwestern Juvenile Project is a 25-year prospective longitudinal cohort study of 1829 youths after juvenile detention in Chicago, Illinois. Youths were randomly sampled by strata (sex, race and ethnicity, age, and legal status [juvenile or adult court]) at intake from the Cook County Juvenile Temporary Detention Center. Participants were interviewed at baseline (November 1995 to June 1998) and reinterviewed as many as 13 times over 16 years, through February 2015. Official records on mortality were collected through December 2020. Data analysis was conducted from November 2018 to August 2022. Main Outcomes and Measures Participants self-reported nonfatal firearm injuries. Firearm deaths were identified from county and state records and collateral reports. Data on firearm deaths in the general population were obtained from the Illinois Department of Public Health. Population counts were obtained from the US census. Results The baseline sample of 1829 participants included 1172 (64.1%) males and 657 (35.9%) females; 1005 (54.9%) Black, 524 (28.6%) Hispanic, 296 (16.2%) non-Hispanic White, and 4 (0.2%) from other racial and ethnic groups (mean [SD] age, 14.9 [1.4] years). Sixteen years after detention, more than one-quarter of Black (156 of 575 [27.1%]) and Hispanic (103 of 387 [26.6%]) males had been injured or killed by firearms. Males had 13.6 (95% CI, 8.6-21.6) times the rate of firearm injury or mortality than females. Twenty-five years after the study began, 88 participants (4.8%) had been killed by a firearm. Compared with the Cook County general population, most demographic groups in the sample had significantly higher rates of firearm mortality (eg, rate ratio for males, 2.8; 95% CI, 2.0-3.9; for females: 6.5; 95% CI, 3.0-14.1; for Black males, 2.5; 95% CI, 1.7-3.7; for Hispanic males, 9.6; 95% CI, 6.2-15.0; for non-Hispanic White males, 23.0; 95% CI, 11.7-45.5). Conclusions and Relevance This is the first study to examine the incidence of nonfatal firearm injury and firearm mortality in youths who have been involved with the juvenile justice system. Reducing firearm injury and mortality in high-risk youths and young adults requires a multidisciplinary approach involving legal professionals, health care professionals, educators, street outreach workers, and public health researchers.
Collapse
Affiliation(s)
- Nanzi Zheng
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A Aaby
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nicholas S Meyerson
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
6
|
Shannon B, Abasilim C, Friedman LS. Trends in assault-related hospitalizations during the SARS-CoV-2 pandemic. Injury 2023; 54:1106-1112. [PMID: 36801070 PMCID: PMC9901223 DOI: 10.1016/j.injury.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Violence remains a priority issue in the United States (US) requiring public health input to discern the magnitude and impact of violence on the health system. Concerns over violence and the injuries resulting from violence have increased following the SARS-CoV-2 pandemic which exacerbated an array of individual and economic stressors related to violence including increased unemployment, alcohol intake, social isolation, anxiety and panic and decreased access to health services. The aim of this study was to analyze the trends in violence-related injuries in the state of Illinois during the SARS-CoV-2 lockdown periods and post-lockdown in order to inform future public health policy. MATERIAL AND METHODS Outpatient and inpatient assault related injuries treated in Illinois hospitals from 2016 through March 2022 were analyzed. Segmented regression models evaluating change in time trends were adjusted for seasonality, serial correlation, overall trend and economic variables. RESULTS The annual rate of assault related hospitalizations per one million Illinois residents decreased from 3857.8 pre-pandemic to 3458.7 pandemic period. However, during the pandemic there was an increase in deaths and in the proportion of injuries involving open wounds, internal injuries, and fractures, while there was a reduction in less serious injuries. Segmented regression time series models demonstrated significant increase in firearm violence in all four pandemic periods examined. Firearm violence increased particularly in subgroups including African-American victims, 15-34-year-olds, and Chicago residents. CONCLUSION During SARS-CoV-2, we saw an overall reduction in assault related hospitalization, however, findings demonstrated an increase in serious injuries which may be associated with social and economic stressors of the pandemic, increased gun-violence while decrease in less serious injuries may be linked to hospital avoidance for non-lethal injuries during the peak waves of the pandemic. Our findings have implications for ongoing surveillance, service planning and management of the increased gunshot and penetrating assault cases and further demonstrate the need for public health input into the violence epidemic in the US.
Collapse
Affiliation(s)
- Brett Shannon
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, United States.
| | - Chibuzor Abasilim
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, United States
| | - Lee S Friedman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, United States
| |
Collapse
|
7
|
Abstract
BACKGROUND Surveillance systems rely on death records to monitor the most severe outcome of the opioid epidemic. However, few studies have linked data from hospital systems with death records to determine potential undercount of opioid-involved deaths occurring in hospitals. This study describes characteristics of decedents less likely to have an autopsy following an opioid-involved death in hospitals and estimates the resulting undercount. METHODS A probabilistic data linkage of hospital and medical examiner data involving 4,936 opioid-involved deaths among residents of Cook County, Illinois, US from 2016 to 2019. We included only hospital deaths that met a national case definition and presented with clinical signs of opioid overdose. RESULTS Decedents had higher odds of not having an autopsy if they were 50+ years, admitted to the hospital (aOR = 3.7: 2.1, 6.5), hospitalized for 4+ days (aOR = 2.2: 1.5, 3.1), and had a comorbid diagnosis of malignant cancer (aOR = 4.3: 1.8, 10.1). However, decedents exposed to heroin and synthetic opioids (aOR = 0.39: 0.28, 0.55), and concurrent exposure to stimulants (aOR = 0.44: 0.31, 0.64) were more likely to have an autopsy). Compared to estimates from the US Centers for Disease Control and Prevention (CDC), we observed undercounts of opioid overdose deaths ranging from 6% to 15%. CONCLUSIONS Surveillance systems may undercount decedents that do not meet the typical profile of those more likely to have an autopsy, particularly older patients with chronic health conditions. Our undercount estimate likely exists in addition to the estimated 20%-40% undercount reported elsewhere. See video abstract at, http://links.lww.com/EDE/B990 .
Collapse
|
8
|
Abstract
OBJECTIVES To describe individuals coded as homeless in state-level data comprising of outpatient and inpatient cases over a multi-year period to provide public health surveillance data on the health care utilization and needs of this population. RESEARCH DESIGN In this cross-sectional study, outpatient and inpatient visits coded for homelessness were identified from the Illinois Hospital Discharge Database from January 1, 2011 through December 31, 2018. Demographic characteristics, primary diagnosis and comorbid conditions, and hospital course of treatment were described. Predictors of discharge to a health care facility versus routine discharge to home or self-care were evaluated using multivariable logistic regression. RESULTS There were 154,173 patient visits predominantly involving males, those aged 25-64 years, and non-Hispanic Whites and African Americans. The majority had comorbidities of depression, psychosis, and/or substance abuse (70.2%) and a routine discharge to home or self-care (81.9%). Discharge to home or self-care relative to another health care institution was associated with having charity coverage and being Black/African American. CONCLUSIONS Those experiencing homelessness experience a high burden of health concerns. Hospital billing records can be used to prioritize the distribution of limited public health resources for health care programs and interventions among those experiencing homelessness.
Collapse
Affiliation(s)
- Dana Madigan
- University of Illinois at Chicago, School of Public Health, Division of Environmental and Occupational Health Sciences, 1603 W. Taylor St, Chicago, Illinois 60612
- National University of Health Sciences, 200 E Roosevelt Rd, Lombard, Illinois 60148
| | - Lee S. Friedman
- University of Illinois at Chicago, School of Public Health, Division of Environmental and Occupational Health Sciences, 1603 W. Taylor St, Chicago, Illinois 60612
| |
Collapse
|
9
|
Moriscot A, Miyabara EH, Langeani B, Belli A, Egginton S, Bowen TS. Firearms-related skeletal muscle trauma: pathophysiology and novel approaches for regeneration. NPJ Regen Med 2021; 6:17. [PMID: 33772028 PMCID: PMC7997931 DOI: 10.1038/s41536-021-00127-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
One major cause of traumatic injury is firearm-related wounds (i.e., ballistic trauma), common in both civilian and military populations, which is increasing in prevalence and has serious long-term health and socioeconomic consequences worldwide. Common primary injuries of ballistic trauma include soft-tissue damage and loss, haemorrhage, bone fracture, and pain. The majority of injuries are of musculoskeletal origin and located in the extremities, such that skeletal muscle offers a major therapeutic target to aid recovery and return to normal daily activities. However, the underlying pathophysiology of skeletal muscle ballistic trauma remains poorly understood, with limited evidence-based treatment options. As such, this review will address the topic of firearm-related skeletal muscle injury and regeneration. We first introduce trauma ballistics and the immediate injury of skeletal muscle, followed by detailed coverage of the underlying biological mechanisms involved in regulating skeletal muscle dysfunction following injury, with a specific focus on the processes of muscle regeneration, muscle wasting and vascular impairments. Finally, we evaluate novel approaches for minimising muscle damage and enhancing muscle regeneration after ballistic trauma, which may have important relevance for primary care in victims of violence.
Collapse
Affiliation(s)
- Anselmo Moriscot
- grid.11899.380000 0004 1937 0722Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Elen H. Miyabara
- grid.11899.380000 0004 1937 0722Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Antonio Belli
- grid.6572.60000 0004 1936 7486NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Stuart Egginton
- grid.9909.90000 0004 1936 8403School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - T. Scott Bowen
- grid.9909.90000 0004 1936 8403School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
10
|
Wood N, Straw S, Scalabrin M, Roberts LD, Witte KK, Bowen TS. Skeletal muscle atrophy in heart failure with diabetes: from molecular mechanisms to clinical evidence. ESC Heart Fail 2021; 8:3-15. [PMID: 33225593 PMCID: PMC7835554 DOI: 10.1002/ehf2.13121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
Two highly prevalent and growing global diseases impacted by skeletal muscle atrophy are chronic heart failure (HF) and type 2 diabetes mellitus (DM). The presence of either condition increases the likelihood of developing the other, with recent studies revealing a large and relatively poorly characterized clinical population of patients with coexistent HF and DM (HFDM). HFDM results in worse symptoms and poorer clinical outcomes compared with DM or HF alone, and cardiovascular-focused disease-modifying agents have proven less effective in HFDM indicating a key role of the periphery. This review combines current clinical knowledge and basic biological mechanisms to address the critical emergence of skeletal muscle atrophy in patients with HFDM as a key driver of symptoms. We discuss how the degree of skeletal muscle wasting in patients with HFDM is likely underpinned by a variety of mechanisms that include mitochondrial dysfunction, insulin resistance, inflammation, and lipotoxicity. Given many atrophic triggers (e.g. ubiquitin proteasome/autophagy/calpain activity and supressed IGF1-Akt-mTORC1 signalling) are linked to increased production of reactive oxygen species, we speculate that a higher pro-oxidative state in HFDM could be a unifying mechanism that promotes accelerated fibre atrophy. Overall, our proposal is that patients with HFDM represent a unique clinical population, prompting a review of treatment strategies including further focus on elucidating potential mechanisms and therapeutic targets of muscle atrophy in these distinct patients.
Collapse
Affiliation(s)
- Nathanael Wood
- Faculty of Biomedical SciencesUniversity of LeedsLeedsLS2 9JTUK
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | | | - Lee D. Roberts
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Klaus K. Witte
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | | |
Collapse
|
11
|
McGaha P, Stewart K, Garwe T, Johnson J, Sarwar Z, Letton RW. Is it time for firearm injury to be a separate activation criteria in children? An assessment of penetrating pediatric trauma using need for surgeon presence. Am J Surg 2020; 221:21-24. [PMID: 32546370 DOI: 10.1016/j.amjsurg.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Penetrating injury independently predicts the need for surgeon presence (NSP) upon arrival. Penetrating injury is often used as a trauma triage indicator, however, it includes a wide range of specific mechanisms of injury. We sought to compare firearm-related and non-firearm related pediatric penetrating injuries with respect to NSP, ISS and mortality. METHODS Patients <18 from the 2016 National Trauma Quality Improvement Program Database were included. Penetrating injury was identified and grouped using ICD-10 mechanism codes into firearm and non-firearm related injury. NSP, ISS, and mortality were compared between the two groups. RESULTS A total of 1715 (4.2%) patients with penetrating injury were; 832 firearm-related and 883 non-firearm. No deaths occurred among the non-firearm group compared to 94 (11.3%) among firearm-related patients. Among non-firearm patients, 22.7% had a NSP indicator compared to 51.2% of patients injured by a firearm. CONCLUSION There is a significantly higher proportion of severe injury and mortality with firearm penetrating injury when compared to non-firearm pediatric penetrating injury. Consideration should be given to dividing it into firearm and non-firearm penetrating injury.
Collapse
Affiliation(s)
- Paul McGaha
- McGaha, Stewart, Garwe, Johnson, and Sarwar Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.
| | - Kenneth Stewart
- McGaha, Stewart, Garwe, Johnson, and Sarwar Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.
| | - Tabitha Garwe
- McGaha, Stewart, Garwe, Johnson, and Sarwar Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.
| | - Jeremy Johnson
- McGaha, Stewart, Garwe, Johnson, and Sarwar Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.
| | - Zoona Sarwar
- McGaha, Stewart, Garwe, Johnson, and Sarwar Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.
| | - Robert W Letton
- Letton Nemours Children's Specialty Care Jacksonville, FL, USA.
| |
Collapse
|
12
|
Madigan D, Forst L, Friedman LS. Comparison of State Hospital Visits With Housing and Urban Development Estimates of Homeless: Illinois, 2011-2018. Am J Public Health 2020; 110:391-393. [PMID: 31944841 DOI: 10.2105/ajph.2019.305492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess the value of hospital records in augmenting information on homelessness counts at a state level.Methods. We used data from the Illinois Hospital Discharge Database (2011-2018) to identify outpatients and inpatients identified as affected by homelessness. We used probabilistic linkage methodology to estimate unique individuals rather than visits and compared them with US Department of Housing and Urban Development annual estimates of homelessness based on point-in-time counts.Results. Department of Housing and Urban Development point-in-time estimates indicate a substantial decline of approximately 24% in homelessness in Illinois; however, estimates of unique individuals visiting the hospital with a code for homelessness more than doubled in this same period.Conclusions. Other data sources, such as hospital records, are increasingly able to identify and report information related to homelessness. Using these additional data sources may help to augment the Department of Housing and Urban Development point-in-time estimates to provide more accurate estimates of homelessness that are used to direct resources and assess policy and support services for those affected by homelessness.
Collapse
Affiliation(s)
- Dana Madigan
- Dana Madigan is with National University of Health Sciences and the Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Linda Forst and Lee S. Friedman are with the Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Linda Forst
- Dana Madigan is with National University of Health Sciences and the Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Linda Forst and Lee S. Friedman are with the Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Lee S Friedman
- Dana Madigan is with National University of Health Sciences and the Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Linda Forst and Lee S. Friedman are with the Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago
| |
Collapse
|
13
|
Mohan D, Wallace DJ, Kerti SJ, Angus DC, Rosengart MR, Barnato AE, Yealy DM, Fischhoff B, Chang CC, Kahn JM. Association of Practitioner Interfacility Triage Performance With Outcomes for Severely Injured Patients With Fee-for-Service Medicare Insurance. JAMA Surg 2019; 154:e193944. [PMID: 31642889 PMCID: PMC6813581 DOI: 10.1001/jamasurg.2019.3944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022]
Abstract
Importance Despite evidence that treatment of severely injured patients at trauma centers is associated with reduced mortality, nearly half of all such patients are treated at nontrauma centers (undertriaged). Little is known about whether interfacility undertriage occurs because of practitioner decision-making or institutional and regional factors. Objectives To assess the associations between variation in triage practitioners at nontrauma centers and between practitioner-level variation and patient outcomes after injury. Design, Setting, and Participants This retrospective cohort study used Medicare claims data from severely injured patients presenting to nontrauma centers and the practitioners who evaluated them in the emergency department from January 1, 2010, to October 15, 2015. Data analysis was performed from January 15, 2018, to March 21, 2019. Main Outcomes and Measures Proportion of variation in undertriage associated with practitioners, practitioner rates of undertriage, practitioner characteristics associated with undertriage, and 30-day case-fatality rate. Results A total of 124 008 severely injured patients (mean [SD] age, 81 [8.4] years; 67 253 [54.2%] female) and the 25 376 practitioners (5564 [21.9%] female) who evaluated the patients in the emergency department of nontrauma centers were included in the study. Undertriage occurred among 85 403 patients (68.9%), with 40.6% of total variation associated with practitioners, 37.8% with hospitals, and 6.7% with regions. Compared with physicians with National Provider Identification (NPI) enumeration before 2007, those with an NPI enumerated between 2007 and 2010 had an undertriage risk ratio (RR) of 0.98 (95% CI, 0.97-0.99), and those with an NPI enumerated after 2010 had an undertriage RR of 0.96 (95% CI, 0.94-0.99). Hospitals with neurosurgeons had an undertriage RR of 1.51 (95% CI, 1.45-1.57) compared with those that did not; hospitals with spine surgeons had an undertriage RR of 1.10 (95% CI, 1.06-1.13); hospitals with general surgeons had an undertriage RR of 1.13 (95% CI, 1.09-1.17). Compared with practitioners who undertriaged 25% or less of patients, a statistically significant increase was found in the odds of death for patients treated by practitioners with a triage rate of less than 25% to 50% (odds ratio [OR], 1.08; 95% CI, 1.05-1.20) and less than 50% to 75% undertriage (OR, 1.12; 95% CI, 1.09-1.26) but not undertriage at greater than 75% (OR, 1.03, 95% CI, 1.00-1.18). In sensitivity analyses to adjust for unmeasured confounding, the association between triage practices and the case fatality rate became monotonic; compared with patients treated by practitioners with an undertriage rate of 25% or less, the odds of case fatality were 1.13 (95% CI, 1.05-1.21; P = .001) among patients treated by practitioners with undertriage rates less than 25% to 50%, 1.22 (95% CI, 1.13-1.32; P < .001) for patients treated by practitioners with undertriage rates less than 50% to 75%, and 1.20 (95% CI, 1.10-1.30; P < .001) for patients treated by practitioners with undertriage rates greater than 75%. Conclusions and Relevance The findings suggest that individual practitioner practices are an important source of variation in triage and represent a potential locus of intervention to reduce preventable deaths after injury.
Collapse
Affiliation(s)
- Deepika Mohan
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David J. Wallace
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samantha J. Kerti
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek C. Angus
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew R. Rosengart
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amber E. Barnato
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Donald M. Yealy
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Baruch Fischhoff
- Department of Engineering and Environmental Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Chung-Chou Chang
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeremy M. Kahn
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
14
|
Moise IK, de Joya E, Silva VO, Moise V, Farmer DB, Orantia A. Patient-level factors are more salient than a legislation prohibiting minors in bars in predicting unintentional injury hospitalizations. BMC Public Health 2019; 19:1010. [PMID: 31357967 PMCID: PMC6664708 DOI: 10.1186/s12889-019-7327-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 07/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol related homicide, suicide and aggravated assault represent the largest costs for the state of Illinois. Previous research has examined the impact of some alcohol-related policies on youth alcohol use and alcohol-related harm in the United States but findings have been mixed. To our knowledge, no study has provided a detailed epidemiology of the relationship between the impacts of alcohol policies on unintentional injury in Illinois. Therefore, the purpose of this study is to determine whether a legislation that prohibit minors under 21 years old in establishments that serve alcohol is more salient than individual level factors in predicting hospitalization for traumatic unintentional injuries. Methods A retrospective observational study of data abstracted from 6,139 patients aged 10 to 19 hospitalized in Illinois Level I and Level II trauma centers. Patient data from 2006 to 2015 was linked with the city-level alcohol-related legislation (n = 514 cities). The response variable was whether a patient tested positive or negative for blood alcohol concentration (BAC) at the time of admission. Mixed-effects logistic regression analyses were conducted to model the patient and city level legislation effect of having a positive BAC test result on hospitalizations after adjusting for the legislation and patient factors. Results After adjustment, patients aged 15 to 19 and white patients who tested positive for BAC at the time of admission had the greater odds of hospitalization for traumatic alcohol-related unintentional injuries compared to patients who had a negative BAC test result. However, odds of hospitalization decreased for female patients and for those with private insurance, and over time, but a significant decrease in such hospitalizations occurred during 2010, 2014 and 2015. The alcohol-related legislation of interest was not a significant predictor of traumatic alcohol-related unintentional injury hospitalization. Conclusions Patient-level covariates were significant predictors of traumatic alcohol-related unintentional injury hospitalization; an alcohol-related legislation may not reduce hospitalizations for young patients aged 10 to 19. Therefore, to prevent underage drinking and consequences, interventions should target sex/gender, race/ethnicity and focus on both individual and environmental strategies. Electronic supplementary material The online version of this article (10.1186/s12889-019-7327-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Imelda K Moise
- Department of Geography, University of Miami, 1300 Campo Sano Ave, Coral Gables, FL, 33124, USA.
| | - Evan de Joya
- Department of Geography, University of Miami, 1300 Campo Sano Ave, Coral Gables, FL, 33124, USA
| | | | - Vanji Moise
- Eastern University, 1300 Eagle Road, St Davids, PA, 19087, UK
| | | | - Adelisa Orantia
- Illinois Department of Public Health, Division of EMS and Highway Safety, Springfield, IL, 62701, USA
| |
Collapse
|
15
|
Renson A, Schubert FD, Gabbe LJ, Bjurlin MA. Interfacility Transfer is Associated With Lower Mortality in Undertriaged Gunshot Wound Patients. J Surg Res 2019; 236:74-82. [PMID: 30694782 DOI: 10.1016/j.jss.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/01/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Treatment at a Level I trauma center yields better outcomes for patients with moderate-to-severe injury as compared with treatment in nontrauma centers. We examined the association between interfacility transfer to a level I or II trauma center and mortality for gunshot wound patients, among patients initially transported to a lower level or undesignated facility. MATERIALS AND METHODS This retrospective cohort study included all patients from the National Trauma Data Bank (2010-2015) with firearm as the external cause of injury, who met CDC criteria for emergency medical services triage to a higher level (American College of Surgeons [ACS] Level II or above) trauma center. We compared outcomes between patients (a) treated in an ACS level III or below facility and not transferred versus (b) transferred to an ACS level II or above facility, adjusting for confounders using inverse probability of treatment weights. RESULTS Of the total 62,277 patients, 10,968 (17.6%) were transferred to a level II center or above, and 51,309 (82.4%) were treated at a level III or below or undesignated center. In adjusted analysis comparing transferred versus not transferred patients, risk was lower for mortality (risk ratio [RR] 0.81, 95% confidence interval [CI] 0.70 to 0.95 P = 0.011) but similar for any complication (RR 1.02, 95% CI 0.83 to 1.25 P = 0.87) and the five most common complications. Results were consistent when accounting for data missing at random, and when including state trauma center designations in the definition of Level II or greater versus III and below. CONCLUSIONS Our study found lower mortality but similar complication risk associated with interfacility transfer for undertriaged gunshot wound patients. This suggests that transfer to a higher level center is warranted among these patients, with improved care potentially outweighing potential harms because of transfer.
Collapse
Affiliation(s)
- Audrey Renson
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York; Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, New York.
| | - Finn D Schubert
- Department of Clinical Research, New York University Langone Hospital - Brooklyn, Brooklyn, New York
| | - Laura J Gabbe
- Department of Clinical Research, New York University Langone Hospital - Brooklyn, Brooklyn, New York
| | - Marc A Bjurlin
- Department of Urology, New York University Langone Hospital - Brooklyn, Brooklyn, New York
| |
Collapse
|
16
|
Mohan D, Fischhoff B, Angus DC, Rosengart MR, Wallace DJ, Yealy DM, Farris C, Chang CCH, Kerti S, Barnato AE. Serious games may improve physician heuristics in trauma triage. Proc Natl Acad Sci U S A 2018; 115:9204-9209. [PMID: 30150397 PMCID: PMC6140476 DOI: 10.1073/pnas.1805450115] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Trauma triage depends on fallible human judgment. We created two "serious" video game training interventions to improve that judgment. The interventions' central theoretical construct was the representativeness heuristic, which, in trauma triage, would mean judging the severity of an injury by how well it captures (or "represents") the key features of archetypes of cases requiring transfer to a trauma center. Drawing on clinical experience, medical records, and an expert panel, we identified features characteristic of representative and nonrepresentative cases. The two interventions instantiated both kinds of cases. One was an adventure game, seeking narrative engagement; the second was a puzzle-based game, emphasizing analogical reasoning. Both incorporated feedback on diagnostic errors, explaining their sources and consequences. In a four-arm study, they were compared with an intervention using traditional text-based continuing medical education materials (active control) and a no-intervention (passive control) condition. A sample of 320 physicians working at nontrauma centers in the United States was recruited and randomized to a study arm. The primary outcome was performance on a validated virtual simulation, measured as the proportion of undertriaged patients, defined as ones who had severe injuries (according to American College of Surgeons guidelines) but were not transferred. Compared with the control group, physicians exposed to either game undertriaged fewer such patients [difference = -18%, 95% CI: -30 to -6%, P = 0.002 (adventure game); -17%, 95% CI: -28 to -6%, P = 0.003 (puzzle game)]; those exposed to the text-based education undertriaged similar proportions (difference = +8%, 95% CI: -3 to +19%, P = 0.15).
Collapse
Affiliation(s)
- Deepika Mohan
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA 15213;
- Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261
| | | | - David J Wallace
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | | | - Chung-Chou H Chang
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261
| | - Samantha Kerti
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261
| | - Amber E Barnato
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766
| |
Collapse
|
17
|
van Rein EA, van der Sluijs R, Houwert RM, Gunning AC, Lichtveld RA, Leenen LP, van Heijl M. Effectiveness of prehospital trauma triage systems in selecting severely injured patients: Is comparative analysis possible? Am J Emerg Med 2018; 36:1060-1069. [DOI: 10.1016/j.ajem.2018.01.055] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 10/18/2022] Open
|
18
|
Mohan D, Farris C, Fischhoff B, Rosengart MR, Angus DC, Yealy DM, Wallace DJ, Barnato AE. Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial. BMJ 2017; 359:j5416. [PMID: 29233854 PMCID: PMC5725983 DOI: 10.1136/bmj.j5416] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. DESIGN Randomized clinical trial. SETTING Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. PARTICIPANTS 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. INTERVENTIONS Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. MAIN OUTCOME MEASURES Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. RESULTS 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively, completed reassessment at six months. The mean age was 40 (SD 8.9), 283 (96%) were trained in emergency medicine, and 207 (70%) were ATLS (advanced trauma life support) certified. Physicians exposed to the game under-triaged fewer severely injured patients than those exposed to didactic education (316/596 (0.53) v 377/592 (0.64), estimated difference 0.11, 95% confidence interval 0.05 to 0.16; P<0.001). Cognitive load did not influence under-triage (161/308 (0.53) v 155/288 (0.54) in the game arm; 197/300 (0.66) v 180/292 (0.62) in the traditional educational apps arm; P=0.66). At six months, physicians exposed to the game remained less likely to under-triage patients (146/256 (0.57) v 172/232 (0.74), estimated difference 0.17, 0.09 to 0.25; P<0.001). No physician reported side effects. The sample might not reflect all emergency medicine physicians, and a small set of cases was used to assess performance. CONCLUSIONS Compared with apps based on traditional didactic education, exposure of physicians to a theoretically grounded video game improved triage decision making in a validated virtual simulation. Though the observed effect was large, the wide confidence intervals include the possibility of a small benefit, and the real world efficacy of this intervention remains uncertain. TRIAL REGISTRATION clinicaltrials.gov; NCT02857348 (initial study)/NCT03138304 (follow-up).
Collapse
Affiliation(s)
- Deepika Mohan
- Scaife Hall, 3550 Terrace St, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Coreen Farris
- 4570 Fifth Avenue, Suite 600, RAND Corporation, Pittsburgh, PA 15213, USA
| | - Baruch Fischhoff
- Porter Hall 219E, 5000 Forbes Avenue, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Matthew R Rosengart
- F1266 Presbyterian Hospital, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Derek C Angus
- Scaife Hall, 3550 Terrace St, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Donald M Yealy
- 3600 Meyran Avenue, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - David J Wallace
- Scaife Hall, 3550 Terrace St, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Amber E Barnato
- The Dartmouth Institute, Williamson Translational Building, 5th Floor, One Medical Center Drive, Lebanon, NH 03756, USA
| |
Collapse
|
19
|
Gani F, Sakran JV, Canner JK. Emergency Department Visits For Firearm-Related Injuries In The United States, 2006–14. Health Aff (Millwood) 2017; 36:1729-1738. [DOI: 10.1377/hlthaff.2017.0625] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Faiz Gani
- Faiz Gani is a postdoctoral research fellow in the Department of Surgery, Johns Hopkins University School of Medicine, in Baltimore, Maryland
| | - Joseph V. Sakran
- Joseph V. Sakran is an assistant professor in the Department of Surgery, Johns Hopkins University School of Medicine
| | - Joseph K. Canner
- Joseph K. Canner is acting codirector of the Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine
| |
Collapse
|