Delaware coast Delaware surf zone injury demographics

Patterns and predictors of serious surf-related injuries in Hawaii

Introduction

Surfing is a popular leisure activity with inherent risk of injury that many participants fail to mitigate. There is a paucity of literature reporting severe surf-related trauma and associated risk factors.

Methods

A retrospective observational study of registry data from Honolulu’s main trauma center assessing surf-related injuries and risk factors for severe injury was performed between January 1, 2014 and December 31, 2018.

Results

Spine (35.1%), face (17.5%), and head (12.3%) injuries were the most common injuries identified in this cohort. A number of predictors for severe injury as well as serious spine injury were identified. Major risk factors for severe injury and serious spine injury included location of injury on Maui (Severe injury: OR 6.79, 95%CI 1.43–40.35, p = 0.0217; serious spine injury: OR 7.27, 95%CI 1.39–58.24, p = 0.0308) and being from one of the 48 contiguous states (severe injury: OR 3.33, 95%CI 1.10–10.98, p = 0.0388; serious spine injury: OR 2.95, 95%CI 1.08–8.46, p = 0.0379).

Conclusion

Understanding the nature of surf-related injuries and who is at risk can help to inform safety interventions that may prevent severe, sometimes irreversible injury. Efforts should be made to increase public awareness to the potential risk of surf-related activities.

Predictors associated with inappropriate transport of near shore spinal injuries

PURPOSE

Spinal injuries resulting in neurological damage cause significant morbidity. Swift neurosurgical intervention can mitigate negative outcomes. However, variable mechanisms of injury may be associated with inappropriate transport (IAT), which may delay necessary surgical interventions. Patients with near shore spinal injuries (NSSI) presented with unique mechanisms, so we investigated factors associated with IAT in patients with NSSI.

METHODS

We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006 - 2017. We excluded patients transferred to other facilities, and those not injured in the water. Primary outcome was IAT, defined as patients with NSSI requiring transfer to another trauma center. To avoid heterogeneity in our analysis, we further excluded patients without NSSI who were inappropriately transported to a level I trauma center. We used multivariable logistic regression to assess association of independent variables (such as demographic, environmental, and clinical factors) with outcome.

RESULTS

We analyzed 278 patients with suspected NSSI, and found 14 (5.0%) had IAT. Compared to appropriately transported patients, diving was associated with higher percentages of IAT (28.6% vs. 3.9%, p = 0.014) and more were transported by air (50.0% vs. 20.6%, p = 0.01). In multivariable regression, patients' oxygenation saturation (odds ratio [OR] = 0.8, 95% confidence intervals [CI]: 077-0.98) and diving (OR = 7.5, 95% CI: 1.2-46) were significantly associated with IAT.

CONCLUSION

Rate of IAT for patients with NSSI was low. However, first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.

A scoping review of female drowning: an underexplored issue in five high-income countries

BACKGROUND

Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning.

METHODS

A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines.

RESULTS

The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females).

CONCLUSION

Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

Early Predictors of Near-Shore Spinal Injuries Among Emergency Department Patients

BACKGROUND

Spinal injuries (SIs) can pose a significant burden to patients and family; delayed surgical intervention, associated with interhospital transfer, results in worse outcomes.

OBJECTIVE

This study aimed to identify early patient-centered factors associated with risk for near-shore SIs to assist clinicians with expeditious medical decision-making.

METHODS

We performed a multicenter retrospective study of all adults transported from Ocean City, Maryland to two emergency departments (EDs) and one regional trauma center for evaluation of suspected SIs from 2006 to 2017. Outcomes were any SI and any spinal cord injury (SCI). Multivariable logistic regression was performed for association of environmental and clinical factors with outcomes.

RESULTS

We analyzed 278 records, 102 patients (37%) were diagnosed with any SI and 41 (15%) were diagnosed with SCIs. Compared with patients without SI, patients with SI were more likely to be older (48 vs. 39 years), male (90% vs. 70%), with pre-existing spinal condition (62% vs. 33%), and injury caused by diving (11% vs. 2%). Multivariable logistic regression showed age (odd ratio [OR] 1.07; 95% confidence interval [CI] 1.04-1.11), diving (OR 3.5; 95% CI 3-100+), and wave height (OR 4.5; 95% CI 1.35-15.2) were associated with any SI, and a chief complaint of extremity numbness or tingling (OR 5.73; 95% CI 1.2-27.9) was associated with SCI.

CONCLUSIONS

We identified older age, diving, and higher wave height as risk factors for any SI and symptoms of numbness and tingling were associated with SCIs. Clinicians should consider expediting these patients' transfers to a trauma center with neurosurgical capability.