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Alho AM, Oliveira AP, Viegas S, Nogueira P. Effect of heatwaves on daily hospital admissions in Portugal, 2000-18: an observational study. Lancet Planet Health 2024; 8:e318-e326. [PMID: 38729671 DOI: 10.1016/s2542-5196(24)00046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Climate change has increased the frequency, intensity, and duration of heatwaves, posing a serious threat to public health. Although the link between high temperatures and premature mortality has been extensively studied, the comprehensive quantification of heatwave effects on morbidity remains underexplored. METHODS In this observational study, we assessed the relationship between heatwaves and daily hospital admissions at a county level in Portugal. We considered all major diagnostic categories and age groups (<18 years, 18-64 years, and ≥65 years), over a 19-year period from 2000 to 2018, during the extended summer season, defined as May 1, to Sept 30. We did a comprehensive geospatial analysis, integrating over 12 million hospital admission records with heatwave events indexed by the Excess Heat Factor (EHF), covering all 278 mainland counties. We obtained data from the Hospital Morbidity Database and E-OBS daily gridded meteorological data for Europe from 1950 to present derived from in-situ observations. To estimate the effect of heatwaves on hospital admissions, we applied negative binomial regression models at both national and county levels. FINDINGS We found a statistically significant overall increase in daily hospital admissions during heatwave days (incidence rate ratio 1·189 [95% CI 1·179-1·198]; p<0·0001). All age groups were affected, with children younger than 18 years being the most affected (21·7% [20·6-22·7] increase in admissions; p<0·0001), followed by the working-age (19·7% [18·7-20·7]; p<0·0001) and elderly individuals (17·2% [16·2-18·2]; p<0·0001). All 25 major disease diagnostic categories showed significant increases in hospital admissions, particularly burns (34·3% [28·7-40·1]; p<0·0001), multiple significant trauma (26·8% [22·2-31·6]; p<0·0001), and infectious and parasitic diseases (25·4% [23·5-27·3]; p<0·0001). We also found notable increases in endocrine, nutritional, and metabolic diseases (25·1% [23·4-26·8]; p<0·0001), mental diseases and disorders (23·0% [21·1-24·8]; p<0·0001), respiratory diseases (22·4% [21·2-23·6]; p<0·0001), and circulatory system disorders (15·8% [14·7-16·9]; p<0·0001). INTERPRETATION Our results provide statistically significant evidence of the association between heatwaves and increased hospitalisations across all age groups and for all major causes of disease. To our knowledge, this is the first study to estimate the full extent of heatwaves' impact on hospitalisations using the EHF index over a 19-year period, encompassing an entire country, and spanning 25 disease categories during multiple heatwave events. Our data offer crucial information to guide policy makers in effectively and efficiently allocating resources to address the profound health-care consequences resulting from climate change. FUNDING None.
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Affiliation(s)
- Ana Margarida Alho
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal; Public Health Unit USP Francisco George, ACES Lisboa Norte, Lisbon, Portugal; Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Ana Patrícia Oliveira
- CoLAB + ÂTLANTIC, IPL-ESTM, Peniche, Portugal; Centro de Estudos Geográficos, IGOT-Instituto de Geografia e Ordenamento do Território, University of Lisbon, Lisbon, Portugal
| | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Paulo Nogueira
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal; Instituto de Saúde Ambiental, Faculdade de Medicina Universidade de Lisboa, Lisbon, Portugal; Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas-TERRA, Lisbon, Portugal; CIDNUR-Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal
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Pflaum-Carlson J. Commentary on "Drop of Blood". ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:163. [PMID: 38294425 DOI: 10.1097/01.acm.0001006616.72921.3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Jacqueline Pflaum-Carlson
- J. Pflaum-Carlson is clinical assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Emergency Medicine, Wayne State University School of Medicine, Henry Ford Health System, Detroit, Michigan; ; Twitter: @CritCraftingMD; ORCID: http://orcid.org/0000-0002-0502-1826
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Le VTH, Berman JD, Wattenberg EV, Ngo TV, Tran QA, Alexander BH. Temperature-related emergency injury visits in Hanoi, Vietnam. Inj Prev 2024; 30:33-38. [PMID: 37863513 PMCID: PMC10850667 DOI: 10.1136/ip-2023-044946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/29/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The short-term association between increasing temperatures and injury has been described in high-income countries, but less is known for low-income and-middle-income countries, including Vietnam. METHODS We used emergency injury visits (EIV) data for 2017-2019 from 733 hospitals and clinics in Hanoi, Vietnam to examine the effects of daily temperature on EIV. Time-series analysis with quasi-Poisson models was used to estimate a linear relative risk increase (RRI) for overall populations and ones stratified by age and sex. Exposure-response curves estimated non-linear associations as an RR between daily temperature and injury. Models were adjusted for the day of week, holidays, daily relative humidity, daily particulate matter, and long-term and seasonal trends. RESULTS AND CONCLUSIONS A total of 39 313 EIV were recorded averaging 36 injuries daily. Injuries more likely occurred in males and those aged 15-44, and aged 44-60. For linear effects, a 5°C increase in same day mean temperature was associated with an overall increased EIV (RRI 4.8; 95% CI 2.3 to 7.3) with males (RRI 5.9; 95% CI 3.0 to 8.9) experiencing a greater effect than females (RRI 3.0; 95% CI -0.5 to 6.5). Non-linear effects showed an increase in EIV at higher temperatures compared with the threshold temperature of 15°C, with the greatest effect at 33°C (RR 1.3; 95% CI 1.2 to 1.6). Further research to investigate temperature-injury among different populations and by the cause of injury is warranted.
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Affiliation(s)
- Vu Thuy Huong Le
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Jesse D Berman
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Elizabeth V Wattenberg
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Toan Van Ngo
- Environmental Health Department, School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
| | - Quynh Anh Tran
- Environmental Health Department, School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
| | - Bruce H Alexander
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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Skladman R, Tadisina KK, Bettlach CR, Currie KB, Tanaka SA, Mackinnon SE, Fox IK, Sacks JM, Pet MA. The Yearly Periodicity of Operative Upper Extremity Trauma: A Retrospective Study of "Trauma Season". Plast Reconstr Surg 2024; 153:101e-111e. [PMID: 37189241 DOI: 10.1097/prs.0000000000010689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Upper extremity (UE) trauma requiring operative care increases during the summer and fall months, which the authors colloquially refer to as "trauma season." METHODS CPT databases were queried for codes related to acute UE trauma at a single level-1 trauma center. Monthly CPT code volume was tabulated for 120 consecutive months and average monthly volume was calculated. Raw data were plotted as a time series and transformed as a ratio to the moving average. Autocorrelation was applied to the transformed data set to detect yearly periodicity. Multivariable modeling quantified the proportion of volume variability attributable to yearly periodicity. Subanalysis assessed presence and strength of periodicity in four age groups. RESULTS A total of 11,084 CPT codes were included. Monthly trauma-related CPT volume was highest in July through October and lowest in December through February. Time-series analysis revealed yearly oscillation in addition to a growth trend. Autocorrelation revealed statistically significant positive and negative peaks at a lag of 12 and 6 months, respectively, confirming yearly periodicity. Multivariable modeling revealed R 2 attributable to periodicity of 0.53 ( P < 0.01). Periodicity was strongest in younger populations and weaker in older populations. R 2 was 0.44 for ages 0 to 17, 0.35 for ages 18 to 44, 0.26 for ages 45 to 64, and 0.11 for ages 65 and older. CONCLUSIONS Operative UE trauma volumes peak in the summer and early fall and reach a winter nadir. Periodicity accounts for 53% of trauma volume variability. The authors' findings have implications for allocation of operative block time and personnel and expectation management over the course of the year.
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Affiliation(s)
- Rachel Skladman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
| | - Kashyap K Tadisina
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
| | - Carrie R Bettlach
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
| | - Kelly B Currie
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
| | - Shoichiro A Tanaka
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
| | - Susan E Mackinnon
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
| | - Ida K Fox
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
| | - Justin M Sacks
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
| | - Mitchell A Pet
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University
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Segeroth M, Vosshenrich J, Breit HC, Wasserthal J, Heye T. Radiology weather forecast: A retrospective analysis of predictability of median daily polytrauma-CT occurrence based on weather data. Eur J Radiol 2024; 170:111269. [PMID: 38142572 DOI: 10.1016/j.ejrad.2023.111269] [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: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES Resource planning is a crucial component in hospitals, particularly in radiology departments. Since weather conditions are often described to correlate with emergency room visits, we aimed to forecast the amount of polytrauma-CTs using weather information. DESIGN All polytrauma-CTs between 01/01/2011 and 12/31/2022 (n = 6638) were retrieved from the radiology information system. Local weather data was downloaded from meteoblue.com. The data was normalized and smoothened. Daily polytrauma-CT occurrence was stratified into below median and above median number of daily polytrauma-CTs. Logistic regression and machine learning algorithms (neural network, random forest classifier, support vector machine, gradient boosting classifier) were employed as prediction models. Data from 2012 to 2020 was used for training, data from 2021 to 2022 for validation. RESULTS More polytrauma-CTs were acquired in summer compared with winter months, demonstrating a seasonal change (median: 2.35; IQR 1.60-3.22 vs. 2.08; IQR 1.36-3.03; p <.001). Temperature (rs = 0.45), sunshine duration (rs = 0.38) and ultraviolet light amount (rs = 0.37) correlated positively, wind velocity (rs = -0.57) and cloudiness (rs = -0.28) correlated negatively with polytrauma-CT occurrence (all p <.001). The logistic regression model for identification of days with above median number of polytrauma-CTs achieved an accuracy of 87 % on training data from 2011 to 2020. When forecasting the years 2021-2022 an accuracy of 65 % was achieved. A neural network and a support vector machine both achieved a validation accuracy of 72 %, whereas all classifiers regarded wind velocity and ultraviolet light amount as the most important parameters. CONCLUSION It is possible to forecast above or below median daily number of polytrauma-CTs using weather data. CLINCICAL RELEVANCE STATEMENT Prediction of polytrauma-CT examination volumes may be used to improve resource planning.
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Affiliation(s)
- Martin Segeroth
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jan Vosshenrich
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Hanns-Christian Breit
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jakob Wasserthal
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Tobias Heye
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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Beiriger J, Lu L, Silver D, Brown JB. Impact of patient, system, and environmental factors on utilization of air medical transport after trauma. J Trauma Acute Care Surg 2024; 96:62-69. [PMID: 37789517 PMCID: PMC10841710 DOI: 10.1097/ta.0000000000004153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Air medical transport (AMT) improves outcomes for severely injured patients. The decision to fly patients is complex and must consider multiple factors. Our objective was to evaluate the interaction between geography, patient and environmental factors, and emergency medical services (EMS) system resources on AMT after trauma. We hypothesize that significant geographic variation in AMT utilization will be associated with varying levels of patient, environmental, and EMS resources. METHODS Patients transported by EMS in the Pennsylvania state trauma registry 2000 to 2017 were included. We used our previously developed Air Medical Prehospital Triage (AMPT; ≥2 points triage to AMT) score and Geographic Emergency Medical Services Index (GEMSI; higher indicates more system resources) as measures for patient factors and EMS resources, respectively. A mixed-effects logistic regression model determined the association of AMT utilization with patient, system, and environmental variables. RESULTS There were 195,354 patients included. Fifty-five percent of variation in AMT utilization was attributed to geographic differences. Triage to AMT by the AMPT score was associated with nearly twice the odds of AMT utilization (adjusted odds ratio, 1.894; 95% confidence interval, 1.765-2.032; p < 0.001). Each 1-point increase in GEMSI was associated with a 6.1% reduction in odds of AMT (0.939; 0.922-0.957; p < 0.001). Younger age, rural location, and more severe injuries were also associated with increased odds of AMT ( p < 0.05). When categorized by GEMSI level, the AMPT score and patient factors were more important for predicting AMT utilization in the middle tercile (moderate EMS resources) compared with the lower (low EMS resources) and higher tercile (high EMS resources). Weather, season, time-of-day, and traffic were all associated with AMT utilization ( p < 0.05). CONCLUSION Patient, system, and environmental factors are associated with AMT utilization, which varies geographically and by EMS/trauma system resource availability. A more comprehensive approach to AMT triage could reduce variation and allow more tailored efforts toward optimizing resource allocation and outcomes. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Jamison Beiriger
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
| | - Liling Lu
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
| | - David Silver
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
| | - Joshua B. Brown
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
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Vergouwen M, Tarcea A, Van Essen D, Sayre EC, White NJ. FROST 2.0: Factors Predicting Orthopaedic Trauma Volumes - A Validation Study. Injury 2023; 54:111111. [PMID: 37839917 DOI: 10.1016/j.injury.2023.111111] [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: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
The anecdotal relationship between weather, season, and orthopaedic trauma volumes is understood by patients and healthcare providers: when the winter ground is icy, people fall. Previous research established that winter and summer months as well as ice and snow were significant predictors of orthopaedic trauma and surges in volumes. The current study validates the previously established predictive model in one Canadian city; the original methods were repeated using a new, yet geographically similar dataset. The effect of month and ice were consistent, which suggests the proposed model has sufficient external validity to guide resource allocation and primary prevention strategies.
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Affiliation(s)
- Martina Vergouwen
- Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada.
| | - Adina Tarcea
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
| | - Darren Van Essen
- Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
| | - Eric C Sayre
- Arthritis Research Canada, 5591 Number 3 Rd, V6X 2C7 Richmond, BC Canada
| | - Neil J White
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
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Ghio M, Ghio C, Campbell A, Fleckman J, Theall K, Constans J, Tatum D, McGrew P, Duchesne J, Taghavi S. Tropical Storms and Hurricanes in New Orleans Lead to Increased Rates of Violent Injury. Disaster Med Public Health Prep 2023; 17:e473. [PMID: 37650226 DOI: 10.1017/dmp.2023.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The effects of named weather storms on the rates of penetrating trauma is poorly understood with only case reports of single events currently guiding public health policy. This study examines whether tropical storms and hurricanes contribute to trauma services and volume. METHODS This was a cross-sectional review of tropical storms/hurricanes affecting New Orleans, Louisiana, during hurricane seasons (June 1-November 30) from 2010-2021, and their association with the rate of penetrating trauma. Authors sought to determine how penetrating trauma rates changed during hurricane seasons and associate them with demographic variables. RESULTS There were 5531 penetrating injuries, with 412 (7.4%) occurring during landfall and 554 (10.0%) in the aftermath. Black/African Americans were the most affected. There was an increase in the rate of penetrating events during landfall (3.4 events/day) and aftermath (3.5 events/day) compared to the baseline (2.8 events/day) (P = < 0.001). Using multivariate analysis, wind speed was positively related to firearm injury, whereas the rainfall total was inversely related to firearm violence rates during landfall and aftermath periods. Self-harm was positively related to distance from the trauma center. CONCLUSIONS Cities at risk for named weather storms may face increasing gun violence in the landfall and aftermath periods. Black/African Americans are most affected, worsening existing disparities. Self-harm may also increase following these weather events.
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Affiliation(s)
- Michael Ghio
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Caroline Ghio
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alexandra Campbell
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Julia Fleckman
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Katherine Theall
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Joseph Constans
- School of Science and Engineering, Tulane University, New Orleans, LA, USA
| | - Danielle Tatum
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Patrick McGrew
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Juan Duchesne
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sharven Taghavi
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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The effect of weather and temporal factors on emergency hand trauma consultations. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04777-2. [PMID: 36705761 PMCID: PMC9881519 DOI: 10.1007/s00402-023-04777-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/08/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Fluctuations in the numbers of patient consultations in hand trauma emergency units are challenging in terms of both scheduling and the provision of sufficient resources. Trauma consultations in general are affected by both temporal and meteorological variables. As the genesis and epidemiology of hand trauma have their own characteristics, this study aimed to identify the influence of temporal and meteorological factors on hand trauma consultations. MATERIALS AND METHODS All patients treated for hand trauma in our level one trauma center in 2019 were included in the study population and the data were analyzed in retrospect. The daily weather data, including temperature, sunshine duration, precipitation, humidity and wind speed, as well as temporal factors such as time of day, weekday and public holidays were considered and correlated with patient consultations. Gender differences were studied as well. RESULTS We included 4787 hand trauma patients (66.4% male, mean age 38.4 ± 19.3 years, 31.7% occupational injuries). Significantly more consultations occurred on Saturdays as compared to weekdays (14.8 ± 0.6, n = 52 vs. 13.0 ± 0.2, n = 261; p = 0.028), and fewer occurred on official holidays (11.8 ± 0.5, n = 63 vs. 13.4 ± 0.2, n = 302; p = 0.0047). We found a significant positive correlation between daily consultations, sunshine duration (r = 0.14, p = 0.0056) and the mean temperature (r = 0.20, p < 0.0001); in contrast, a significant negative correlation between daily consultations and humidity (r = - 0.17, p = 0.001) was observed. Furthermore, fewer consultations were seen on days with precipitation (12.7 ± 0.3, n = 219 vs. 13.8 ± 0.3, n = 146; p = 0.009). The variation was considerably stronger in men. CONCLUSIONS Hand trauma consultations increased with increasing temperatures, duration of sunshine, and decreasing humidity. Peak admissions were seen on Fridays and Saturdays. These findings can assist in predicting days with peak admissions to allocate resources appropriately.
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Skladman R, Tadisina KK, Chi J, Nguyen DC, Patel K, Pet MA. Facial Trauma Operative Volume Demonstrates Consistent and Significant Yearly Periodicity. J Oral Maxillofac Surg 2022; 81:424-433. [PMID: 36587931 DOI: 10.1016/j.joms.2022.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Facial trauma requiring operative care increases during the summer and fall months, which is colloquially referred to as trauma season. The purpose of this study is to determine if there is a quantifiable and statistically significant yearly periodicity of operative facial trauma volume. MATERIALS AND METHODS To confirm the existence and quantify the magnitude of trauma season, we conducted a retrospective cohort study. The Plastic Surgery divisional billing database was queried for Current Procedural Terminology (CPT) codes related to acute facial trauma. The outcome variable is monthly CPT code volume and calendar month is the predictor. Monthly CPT volume was tabulated for 120 consecutive months. Raw data were plotted as a time series and transformed as a ratio to the moving average. Autocorrelation was applied to the transformed dataset to detect yearly periodicity. Multivariable modeling quantified the proportion of volume variability (R2) attributable to yearly periodicity. Subanalysis assessed presence and strength of periodicity in 4 age groups. Patient identifiers, demographic information, surgeon, and date of surgery were collected as covariates. RESULTS One thousand six hundred fifty eight CPT codes obtained through Plastic Surgery billing records were included. Mean age at presentation was 32.5 ± 16.3 years (range = 85.05). Monthly trauma-related CPT volume was highest in June-September and lowest in December-February. Time series analysis revealed yearly oscillation, in addition to a growth trend. Autocorrelation revealed statistically significant positive and negative peaks at a lag of 12 and 6 months, respectively, confirming the presence of yearly periodicity. Multivariable linear modeling revealed R2 attributable to periodicity of 0.23 (P = .008). Periodicity was strongest in younger populations and weaker in older populations. R2 = 0.25 for ages 0-17, R2 = 0.18 for ages 18-44, R2 = 0.16 for ages 45-64, and R2 = 0.034 for ages ≥ 65. CONCLUSION Operative facial trauma volumes peak in the summer and early fall and reach a winter nadir. This periodicity is statistically significant and accounts for 23% of overall trauma volume variability at our Level 1 trauma hospital. Younger patients drive the majority of this effect. Our findings have implications for operative block time and personnel allocation, in addition to expectation management over the course of the year.
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Affiliation(s)
- Rachel Skladman
- Post-Doctoral Research Fellow, Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO
| | - Kashyap K Tadisina
- Fellow, Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO
| | - John Chi
- Associate Professor, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Washington University, St. Louis, MO
| | - Dennis C Nguyen
- Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO
| | - Kamlesh Patel
- Associate Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO
| | - Mitchell A Pet
- Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO.
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Schöbel T, Hantusch G, Hennings R, Schleifenbaum S, Kleber C, Spiegl U. Risk factors for revision surgery in operative treatment of traumatic injuries of the olecranon and prepatellar bursa. BMC Musculoskelet Disord 2022; 23:1008. [PMID: 36419124 PMCID: PMC9685846 DOI: 10.1186/s12891-022-05980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Traumatic lacerations of the prepatellar (PB) and olecranon bursa (OB) are common injuries. The aim of this study was to gain descriptive data and to identify risk factors associated with complications that made revision surgery after primary bursectomy necessary. MATERIAL AND METHODS In this retrospective monocentric study at a level I trauma center, all patients with traumatic lacerations of the PB or OB who were treated with primary surgical bursectomy from 2015 to 2020 were analyzed. RESULTS 150 consecutive patients were included. In 44% of cases, the PB was affected (n = 66), in 56% the OB (n = 84). The reoperation rate after surgical bursectomy was 10.7% (n = 16). The main cause of reoperation was wound infection (50%; n = 8). The most common pathogen of postoperative infections was Staphylococcus aureus (87.5%). Several comorbidities have been identified as risk factors for reoperation after primary surgical bursectomy, such as heart diseases, arterial hypertension, the use of antihypertensives and anticoagulation. In contrast, surgical expertise, use of drains, postoperative immobilization, and postoperative antibiotics had no statistically significant effect. A significantly higher postoperative infection rate (17.6%) was observed in patients who were operated more than 48 h after initial trauma. CONCLUSIONS Given the limited recommendations for therapy of these common injuries, further investigations should focus on standardized therapeutic options for lacerations of the PB or OB. Delayed surgical interventions after trauma were associated with higher complication rates. Therefore, urgent surgery within 48 h after trauma may help to prevent revisions. LEVEL OF EVIDENCE Level of evidence IV.
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Affiliation(s)
- T. Schöbel
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - G. Hantusch
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - R. Hennings
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - S. Schleifenbaum
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany ,ZESBO – Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstrasse 14, D-04103 Leipzig, Germany ,grid.461651.10000 0004 0574 2038Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, D-01187 Dresden, Germany
| | - C. Kleber
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - U. Spiegl
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
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12
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Jaques A, Hanrahan J, Islam S, Sofat R, Vella-Baldacchino M. Under the Weather: The Meteorological Effect on Orthopaedic Trauma in Hertfordshire. Cureus 2022; 14:e31146. [PMID: 36382318 PMCID: PMC9637454 DOI: 10.7759/cureus.31146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/07/2022] Open
Abstract
Background Effective and efficient use of operating theatres is essential to the smooth running of a trauma service. The paper aims to understand the effect of meteorological factors on the number of referrals and volume and nature of trauma operating cases within our local area. Methods Trauma data over two seasons were analysed in our database, a digital clinical platform that coordinates all admissions and trauma theatre activity. Data consisted of the number of referrals per day, patient age, mechanism of injury, and type of orthopaedic injury. Weather data were gathered from ‘Weather Underground’, https://www.wunderground.com/history, which records daily weather observations, located 12 miles away from our trauma unit. Results During the study period's last two seasons, 1160 consultations were analysed and 779 required operative intervention. The neck of femur fractures and ankle trauma were the two most common causes of trauma, accounting for 27% and 15%, respectively. The neck of femur fracture pathologies were not significantly correlated with any meteorological factor studied. On the contrary, ankle trauma was the only injury significantly correlating with temperature (p < 0.03) and dew point (p < 0.04). The most common mechanism of trauma was a ground-level fall (n = 590) whilst the least common was a motor vehicle accident (n = 39). Analysing the effect of weather and its effect on the age group of presentation, temperature (p < 0.01), sunlight (p < 0.002), and dew point (p < 0.03) were all significantly correlated with trauma in patients aged younger than 21 years of age. Conclusion The weather has no effect on the neck of femur fractures, the most common trauma pathology treated in our department. In all seasons, allocated specific trauma lists for the latter should be arranged irrelevant of the weather conditions. A strong correlation was identified between ankle trauma and weather. We identified that Tuesdays and Fridays received the highest referral rate and peaked between the months of October-November. These data lay the groundwork for local clinical directors to shape the future on-call trauma service.
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Robertson GAJ, Marsh AG, Gill SL, Martin D, Lowe DJ, Jamal B. The influence of heatwave temperatures on fracture patient presentation to hospital. Injury 2022; 53:3163-3171. [PMID: 35810044 DOI: 10.1016/j.injury.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/07/2022] [Accepted: 07/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As global warming continues at its current rate, heatwaves are likely to become an increasing phenomenon. At present, knowledge of the influence of heatwave temperatures on fracture patient presentation to hospital remains limited. METHODS This was a retrospective descriptive epidemiology study performed through hospital database review, linked to meteorological data. Emergency Department and Fracture Patient Presentation Data was obtained for the adult (16+) South Glasgow population (population count - 525,839) and the adult (16+) population covered by the West of Scotland Major Trauma Centre (population count - 2,218,326) from May 2021 to August 2021. This was combined with maximum temperature data, along with humidity and humidex data. Humidex is a measure which quantifies the temperature experienced by the patient, through a combined score incorporating both maximum temperature and humidity RESULTS: During the study period, there was one temperature heatwave (19th to 25th July), and four humidex heatwaves (27th June to 3rd July, 15th to 17th July, 19th to 27th July, 22nd to 26th August). During the temperature heatwave, there was a significantly higher incidence of orthopaedic polytrauma patient presentation (IRR 2.37: p < 0.027), as well as ED patient presentation (IRR 1.07: p < 0.036). The humidex heatwaves were associated with a significantly higher incidence of orthopaedic polytrauma patient presentation (IRR 2.31: p < 0.002) and overall fracture patient presentation (IRR 1.18: p < 0.002). Positive correlations were found between orthopaedic polytrauma patient presentation vs temperature (R=0.217: p < 0.016), ED patient presentation vs temperature (R=0.427: p < 0.001), fracture patient presentation vs temperature (R=0.394: p < 0.001), and distal radius fracture patient presentation vs temperature (R=0.246: p < 0.006). CONCLUSION This study finds that heatwave temperatures result in a significantly increased number of orthopaedic polytrauma patients presenting to a Major Trauma Centre. Given the significant resources these patients require for care, Major Trauma Centres should be aware of such findings, and consider staff and resources profiles in response.
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Affiliation(s)
- Greg A J Robertson
- Department of Orthopaedic Major Trauma Surgery, Orthopaedic post CCT Fellow, Queen Elizabeth University Hospital, 5/6 Gladstone Terrace, Glasgow, Edinburgh EH9 1LX, United Kingdom.
| | - Andrew G Marsh
- Consultant Orthopaedic Surgeon, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Sarah L Gill
- Consultant Orthopaedic Surgeon, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - David Martin
- Consultant Orthopaedic Surgeon, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - David J Lowe
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Bilal Jamal
- Consultant Orthopaedic Surgeon, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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14
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Marco C, Statt C, Bashir K, Repas SJ. Acute trauma: Seasonal and daily variations in injury patterns. Am J Emerg Med 2022; 61:230-232. [PMID: 35909064 DOI: 10.1016/j.ajem.2022.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Catherine Marco
- Department of Emergency Medicine, Penn State Health - Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, United States of America.
| | - Carin Statt
- Wright State University, Dayton, OH, United States of America
| | - Kiren Bashir
- Wright State University, Dayton, OH, United States of America
| | - Steven J Repas
- Wright State University, Dayton, OH, United States of America
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15
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Liang M, Min M, Guo X, Song Q, Wang H, Li N, Su W, Liang Q, Ding X, Ye P, Duan L, Sun Y. The relationship between ambient temperatures and road traffic injuries: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:50647-50660. [PMID: 35235122 DOI: 10.1007/s11356-022-19437-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
Traffic accidents cause considerable economic losses and injuries. Although the adverse effects of a change in ambient temperatures on human health have been widely documented, its effects on road traffic safety are still debated. This systematic review and meta-analysis was performed to synthesize available data on the association between ambient temperature and the risks of road traffic accidents (RTAs) and traffic accident injuries (TAIs). We searched 7 different databases to locate studies. The subgroup analyses were stratified by temperature type, temperature exposure, region, mean temperature, mortality, study period, statistical model, and source of injury data. This study was registered with PROSPERO under the number CRD42021264660. This is the first meta-analysis to investigate the association between ambient temperature and road traffic safety. A total of 34 high-temperature effect estimates were reported, and two additional studies reported the relationship between low temperatures and TAI risk. The meta-analysis results found a significant association between the high temperature and RTAs, and the pooled RR was 1.025 (95%CI 1.014, 1.035). The risk of TAI was also significantly associated with temperature increases. Subgroup analyses found that using daily mean temperatures, the RR value of road traffic accidents was 1.024 (95%CI 0.939, 1.116), and the RR value of road traffic injuries was 1.052 (95%CI 1.024, 1.080). Hourly temperatures significantly increased the risk of RTA, while the risk of TAI was not significantly increased by hourly temperature. The sensitivity analysis indicated that the results were stable, and no obvious publication bias was detected. The results of this systematic review and meta-analysis suggest that increases in ambient temperature are associated with an increased risk of RTAs and TAIs. These findings add to the evidence of the impact of ambient temperature on road traffic safety.
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Affiliation(s)
- Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Min Min
- Anhui Institute of Medical Information (Anhui Medical Association), No.15 Gongwan Road, Hefei, 230061, Anhui, People's Republic of China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Qiwei Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Pengpeng Ye
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, the Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Leilei Duan
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, the Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.
- Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.
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16
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Stanisce L, Fisher AH, Choi BY, Newman A, Wang JL, Koshkareva Y. How Did the COVID-19 Pandemic Affect Trends in Facial Trauma? Craniomaxillofac Trauma Reconstr 2022; 15:132-138. [PMID: 35633770 PMCID: PMC8941287 DOI: 10.1177/19433875211022574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Study Design: Retrospective cohort analysis. Objective: To examine the impact the COVID-19 pandemic and its accompanying societal measures had on the incidence, characteristics, and management of maxillofacial traumatic injuries. Methods: This cohort analysis compared facial trauma injuries presenting to the highest-volume Level I Trauma Center in New Jersey, USA from January 1 to July 31 in 2020 and 2019. Differences in demographics, mechanisms, and interventions were compared between the pandemic period (March 16–July 31, 2020) and the equivalent pre-pandemic date period in 2019 using X2, Fishers Exact, and Mann–Whitney U testing. Results: In total, 616 subjects were included. The daily incidence of facial trauma consults during the 2020 pandemic (1.81 ± 1.1) decreased compared to 2019 (2.15 ± 1.3) (p = 0.042). During the outbreak, there was an increase in the proportion of subjects with positive urine drug screens (21.5% vs. 12.2%; p = 0.011) and injuries related to domestic violence (10.2% vs. 4.5%; p = 0.023). Patients were 30% less likely to be transferred from local hospitals (RR, 0.70 [0.53–0.93]; p = 0.014). Although subjects had a 25% increased risk of presenting with injuries deemed procedural (RR, 1.25 [95% CI, 1.05–1.56]; p = 0.048), a greater proportion were discharged with operative procedures scheduled as outpatients (16.0% vs. 4.9%; p = 0.005). Conclusions: The COVID-19 pandemic has impacted both the epidemiology and management of maxillofacial traumatic injuries, perhaps secondary to modifications in personal and community behaviors or the effects on healthcare systems in our region.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology—Head and Neck Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Alec H. Fisher
- Division of Plastic and Reconstructive Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Bo Young Choi
- Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Andrew Newman
- Division of Plastic and Reconstructive Surgery, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Ju Lin Wang
- Cooper Medical School at Rowan University, Camden, NJ, USA
- Division of Trauma Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology—Head and Neck Surgery, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School at Rowan University, Camden, NJ, USA
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17
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Tobías A, Casals M, Saez M, Kamada M, Kim Y. Impacts of ambient temperature and seasonal changes on sports injuries in Madrid, Spain: a time-series regression analysis. BMJ Open Sport Exerc Med 2021; 7:e001205. [PMID: 34917395 PMCID: PMC8638454 DOI: 10.1136/bmjsem-2021-001205] [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] [Accepted: 11/17/2021] [Indexed: 11/08/2022] Open
Abstract
Objectives Recreational physical activity is an integral part of our society, and the injuries caused by sports activities are a concern for public health. We studied the effect of outdoor ambient temperature on hospital emergency department visits caused by sports injuries in Madrid, Spain, and accounted for its seasonal changes. Methods We used a time-series design. Data was analysed with quasi-Poisson regression models. We calculated the proportion of emergency visits attributable to seasonal changes before and after adjusting for daily ambient temperature. We modelled the association between emergency visits and temperature using distributed lag non-linear models. Results The proportion of emergency visits attributable to seasonal changes was 24.1% and decreased to 7.6% after adjusting for temperature. We found a high risk of emergency visits associated with cold and hot temperatures, whereas the risk was higher for heat. Conclusion Sports and recreational physical activity injuries are not rare events; therefore, appropriate healthcare decisions should consider the impact of outdoor ambient temperature and seasonal changes.
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Affiliation(s)
- Aurelio Tobías
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Catalunya, Spain.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Martí Casals
- Sport and Physical Activity Studies Centre, Faculty of Medicine, Universitat de Vic - Universitat Central de Catalunya, Vic, Catalunya, Spain.,Physical Activity and Sport, Institut Nacional d'Educació Física de Catalunya, University of Barcelona, Barcelona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health, University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Masamitsu Kamada
- Department of Health Education and Health Sociology, The University of Tokyo, Bunkyo-ku, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, The University of Tokyo, Bunkyo-ku, Japan
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18
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Mazzolini K, Dzubnar J, Kwak H, Banks K, Mooney C, Tang A, Cohan C, Browder T. An Epidemic Within the Pandemic: The Rising Tide of Trauma DuringCOVID-19. J Surg Res 2021; 272:139-145. [PMID: 34971837 PMCID: PMC8654586 DOI: 10.1016/j.jss.2021.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 10/14/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
Background In the age of COVID-19 and enforced social distancing, changes in patterns of trauma were observed but poorly understood. Our aim was to characterize traumatic injury mechanisms and acuities in 2020 and compare them with previous years at our level I trauma center. Material and methods Patients with trauma triaged in 2016 through 2020 from January to May were reviewed. Patient demographics, level of activation (1 versus 2), injury severity score, and mechanism of injury were collected. Data from 2016 through 2019 were combined, averaged by month, and compared with data from 2020 using chi-squared analysis. Results During the months of interest, 992 patients with trauma were triaged in 2020 and 4311 in 2016-2019. The numbers of penetrating and level I trauma activations in January-March of 2020 were similar to average numbers for the same months during 2016 through 2019. In April 2020, there was a significant increase in the incidence of penetrating trauma compared with the prior 4-year average (27% versus 16%, P < 0.002). Level I trauma activations in April 2020 also increased, rising from 17% in 2016 through 2019 to 32% in 2020 (P < 0.003). These findings persisted through May 2020 with similarly significant increases in penetrating and high-level trauma. Conclusions In the months after the initial spread of COVID-19, there was a perceptible shift in patterns of trauma. The significant increase in penetrating and high-acuity trauma may implicate a change in population dynamics, demanding a need for thoughtful resource allocation at trauma centers nationwide in the context of a global pandemic.
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Affiliation(s)
- Kirea Mazzolini
- Department of Surgery, University of California San Francisco, San Francisco, California.
| | - Jessica Dzubnar
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Hyunjee Kwak
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kian Banks
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Colin Mooney
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Annie Tang
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Caitlin Cohan
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Timothy Browder
- Department of Surgery, University of California San Francisco, San Francisco, California
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19
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Ghada W, Estrella N, Ankerst DP, Menzel A. Universal thermal climate index associations with mortality, hospital admissions, and road accidents in Bavaria. PLoS One 2021; 16:e0259086. [PMID: 34788302 PMCID: PMC8598056 DOI: 10.1371/journal.pone.0259086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
When meteorological conditions deviate from the optimal range for human well-being, the risks of illness, injury, and death increase, and such impacts are feared in particular with more frequent and intense extreme weather conditions resulting from climate change. Thermal indices, such as the universal thermal climate index (UTCI), can better assess human weather-related stresses by integrating multiple weather components. This paper quantifies and compares the seasonal and spatial association of UTCI with mortality, morbidity, and road accidents in the federal state of Bavaria, Germany. Linear regression was applied to seasonally associate daily 56 million hospital admissions and 2.5 million death counts (1995-2015) as well as approximately 930,000 road accidents and 1.7 million people injured (2002-2015) with spatially interpolated same day- and lagged- (up to 14 days) average UTCI values. Additional linear regressions were performed stratifying by age, gender, region, and district. UTCI effects were clear in all three health outcomes studied: Increased UTCI resulted in immediate (1-2 days) rises in morbidity and even more strongly in mortality in summer, and lagged (up to 14 days) decreases in fall, winter, and spring. The strongest UTCI effects were found for road accidents where increasing UTCI led to immediate decreases in daily road accidents in winter but pronounced increases in all other seasons. Differences in UTCI effects were observed e.g. between in warmer north-western regions (Franconia, more districts with heat stress-related mortality, but hospital admissions for lung, heart and external reasons decreasing with summer heat stress), the touristic alpine regions in the south (immediate effect of increasing UTCI on road accidents in summer), and the colder south-eastern regions (increasing hospital admissions for lung, heart and external reasons in winter with UTCI). Districts with high percentages of elderly suffered from higher morbidity and mortality, particularly in winter. The influences of UTCI as well as the spatial and temporal patterns of this influence call for improved infrastructure planning and resource allocation in the health sector.
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Affiliation(s)
- Wael Ghada
- Department of Life Science Systems, Technical University of Munich, Freising, Germany
| | - Nicole Estrella
- Department of Life Science Systems, Technical University of Munich, Freising, Germany
| | - Donna P. Ankerst
- Department of Life Science Systems, Technical University of Munich, Freising, Germany
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Annette Menzel
- Department of Life Science Systems, Technical University of Munich, Freising, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
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COVID-19 orthopaedic trauma volumes: a Canadian experience during lockdown and staged reopening. OTA Int 2021; 4:e134. [PMID: 34746665 PMCID: PMC8568396 DOI: 10.1097/oi9.0000000000000134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 12/20/2022]
Abstract
Objectives: The aim of this study is to report the impact of public health measures (PHM), including their relaxation, on surgical orthopaedic trauma volumes. We hypothesize an initial reduction in orthopaedic trauma volumes during lockdown followed by a surge as Stages 1 and 2 of reopening progressed in Summer 2020. Methods: All unscheduled surgical orthopaedic trauma cases from March through August were retrospectively reviewed in Calgary, Alberta, Canada, from 2008 to 2020. Trauma volumes from 2008 to 2019 were used to model expected 2020 volumes, and multivariable Poisson regression was used to determine the effect of PHM on orthopaedic trauma volumes. Results: A total of 22,331 trauma orthopaedic surgeries were included. During lockdown, there was a significant decrease in trauma volume compared with expected (−14.2%, −25.7 to −10.5%, P < .001) and there were significantly fewer ankle fractures (−17.8%, −30.9 to −2.2%, P = .027). During reopening Stage 2, there was a significant increase in trauma volume (+8.9%, +2.2 to +16.1%, P = .009). There was no change in the incidence of polytrauma, hip fracture, or wrist fracture during the pandemic. Conclusions: This study provides the first report of a surge in trauma volumes as PHM are relaxed during the COVID-19 pandemic. The ability to predict decreases in trauma volumes with strict PHM and subsequent surges with reopening can help inform operating room time management and staffing in future waves of COVID-19 or infectious disease pandemics. Level of Evidence: Prognostic – Level III
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21
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Kim SH, Sul YH, Kim JS. Effect of weather variables on the incidence of trauma: A retrospective study at a single tertiary hospital center for 4 years. Medicine (Baltimore) 2021; 100:e27623. [PMID: 34713850 PMCID: PMC8556037 DOI: 10.1097/md.0000000000027623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/01/2021] [Indexed: 01/05/2023] Open
Abstract
The occurrence of trauma is associated with various factors, including weather. We aimed to elucidate the relationship between local weather factors and the incidence of trauma to effectively manage and treat patients in a community setting. A retrospective study was conducted at a single center from January 2016 to December 2019. The study participants were trauma patients in the Cheongju area where the regional trauma center is located. Weather data including average daily temperature (°C), rainfall duration (hours), amount of rainfall (mm), average relative humidity (%), wind speed (m/s), and total sunlight hours per day were collected. One-way analysis of variance, correlation analysis, and linear regression analysis were performed. The average age of the participants (n = 3352) was 52.69 years. As regards seasonal difference in the incidence of trauma, there were more patients in spring than in winter (2.42/day vs 2.06/day, P = .05). The highest number of average daily trauma incidents occurred from April to June, and the difference between this value and that from January to February was significant (F = 2.20, P = .01). According to the distributed lag nonlinear model (DLnM), the relative risk is greater than 1 when the mean temperature is high (>15°C) compared to when the temperature is low (<15°C). The trauma patient prevalence was the highest at high wind speed (4.5 m/s). When the total amount of sunlight was long (>Ref. 8 hours), the trauma patient prevalence was relatively higher than the median value (lag = 0). DLnM analysis results showed that the relative risk of trauma patients increased as the amount of precipitation increased, and the incidence of trauma increased when the relative humidity was 40% to 50%. Multiple linear regression analysis revealed that high average daily temperatures and long average daily total sunlight hours resulted in an increased incidence of trauma (F = 6.605, P < .001). An increase in temperature, an increase in the daily sunlight hours, an increase in rainfall, high wind speed, and relative humidity of 40% to 50% are associated with a relatively high risk of trauma.
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Affiliation(s)
- Se Heon Kim
- Department of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Young Hoon Sul
- Department of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Korea
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Joong Suck Kim
- Department of Trauma Surgery, Cheju Halla General Hospital, Jeju, Korea
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FROST: Factors Predicting Orthopaedic Trauma Volumes. Injury 2021; 52:2871-2878. [PMID: 33678462 DOI: 10.1016/j.injury.2021.02.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/07/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Orthopaedic surgeons often speculate weather and season impact the nature and volume of surgical trauma. Little evidence exists to support this. We aimed to identify the relationship between weather conditions, time of year, surgical orthopaedic trauma volumes, after-hours surgery, and surgical wait times. METHODS Unscheduled surgical orthopaedic cases were retrospectively reviewed at major adult hospitals in Calgary, Alberta, Canada, over an eleven-year period (2008-2018). Weather variables were gathered and a predictive model for ice was generated. Multivariable Poisson regression was used to determine the effect of weather and time of year on orthopaedic trauma volumes and after-hours surgery. Linear regression was used to investigate surgical wait times. RESULTS 41,421 unscheduled orthopaedic trauma surgeries were analyzed against daily weather patterns. 49% of all surgery performed was for hip (26.4%) or ankle fractures (22.6%). Same day snow (p=0.002) and ice for two days prior (p=0.031; p=0.003) were significantly associated with increased overall trauma volumes. Same day snow (p<0.001) and ice (p=0.002), as well as ice two days prior (p=0.001), predicted a significant increase in ankle fracture volumes. There was no correlation between weather patterns and hip fracture volumes. Independent of weather, time of year was highly predictive of large swings in orthopaedic trauma volumes and increased wait times. Generally, when patient volumes increased so did after-hours surgery. CONCLUSION Winter and summer months as well as ice and daily snow contributed to the most significant increases in overall orthopaedic trauma volumes. On a snowy day in February with ice present for three consecutive days, trauma volumes increased as much as 71%. Despite this, resources dedicated to orthopaedic trauma are consistent throughout the year, which highlights the need to allocate resources for orthopaedic trauma surgery based on seasonal demands. We suggest our predictive model be used to guide the amount of operating room time reserved for orthopaedic trauma to better reflect expected volumes. This contrasts the current system which relies on after-hours surgeries and increased patient wait-times to compensate for increased orthopaedic trauma volumes. Since orthopaedic trauma can be predicted by weather patterns, interventions should aim to decrease weather-related orthopaedic trauma and reduce the burden prolonged wait times have on our system.
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Bedada AG, Tarpley MJ, Tarpley JL. The characteristics and outcomes of trauma admissions to an adult general surgery ward in a tertiary teaching hospital. Afr J Emerg Med 2021; 11:303-308. [PMID: 33996419 PMCID: PMC8095126 DOI: 10.1016/j.afjem.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/01/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Traumatic injuries are proportionally higher in low- and middle-income countries (LMICs) than high-income counties. Data on trauma epidemiology and patients' outcomes are limited in LMICs. Methods A retrospective review of medical records was performed for trauma admissions to the Princess Marina Hospital general surgical (GS) wards from August 2017 to July 2018. Data on demographics, mechanisms of injury, body parts injured, Revised Trauma Score, surgical procedures, hospital stay, and outcomes were analysed. Results During the study period, 2610 patients were admitted to GS wards, 1307 were emergency admissions. Trauma contributed 22.1% (576) of the total and 44.1% of the emergency admissions. Among the trauma admissions, 79.3% (457) were male. The median[interquartile range(IQR)](range) age in years was 30[24–40](13–97). The main mechanisms of injury were interpersonal violence (IPV), 53.1% and road traffic crashes (RTCs), 23.1%. More females than males suffered animal bites (5.9% vs. 0.9%), and burns (8.4% vs. 4.2%), while more males than females were affected by IPV (57.8% vs. 35.3%) and self-harm (5.5% vs. 3.4%). Multiple body parts were injured in 6.6%, mainly by RTCs. Interpersonal violence (IPV) and RTCs resulted in significant numbers of head and neck injuries, 57.3% and 22.2% respectively. More females than males had multiple body-parts injury 34.5% vs. 18.5%. Revised Trauma Score (RTS) of ≤11 was recorded in IPV, 38.4% and RTCs, 33.6%. Surgical procedures were performed on 44.4% patients. The most common surgical procedures were laparotomy (27.8%), insertion of chest tube (27.8%), and craniotomy/burr hole(25.1%). Complications were recorded in 10.1% of the patients(58) including 39 deaths, 6.8% of the 576. Conclusion Trauma contributed significantly to the total GS and emergency admissions. The most common mechanism of injury was IPV with head and neck the most frequently injured body part. Further studies on IPV and trauma admissions involving paediatric and orthopaedic patients are warranted.
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Affiliation(s)
- Alemayehu Ginbo Bedada
- Department of Surgery, Faculty of Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Corresponding author.
| | - Margaret J. Tarpley
- Department of Medical Education, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - John L. Tarpley
- Department of Surgery, Faculty of Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
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Abstract
Aims This observational study examines the effect of the COVID-19 pandemic upon the paediatric trauma burden of a district general hospital. We aim to compare the nature and volume of the paediatric trauma during the first 2020 UK lockdown period with the same period in 2019. Methods Prospective data was collected from 23 March 2020 to 14 June 2020 and compared with retrospective data collected from 23 March 2019 to 14 June 2019. Patient demographics, mechanism of injury, nature of the injury, and details of any surgery were tabulated and statistically analyzed using the independent-samples t-test for normally distributed data and the Mann-Whitney-U test for non-parametric data. Additionally, patients were contacted by telephone to further explore the mechanism of injury where required, to gain some qualitative insight into the risk factors for injury. Results The 2020 lockdown resulted in 30% fewer paediatric trauma presentations (441 vs 306), but no significant change in the number of patients requiring surgery (47 vs 51; p = 0.686). Trampolining injuries increased in absolute numbers by 168% (p < 0.001), almost four times more common when considered as percentage of all injuries observed in 2020 vs 2019. There was a decrease in high energy trauma from road traffic accidents and falls from height (21.5% decrease, p < 0.001). Despite a shift towards more conservative treatment options, trampolining injuries continued to require surgery in similar proportions (19.4 vs 20%; p = 0.708). Qualitative investigation revealed that the most common risk factor for trampolining injury was concurrent usage, especially with an older child. Conclusion COVID-19 lockdown has resulted in a decrease in paediatric orthopaedic presentations and high energy trauma. However, due to a marked increase in home trampolining injuries, and their unchanged requirement for surgery, there has been no change in the requirement for surgery during the lockdown period. As home exercise becomes more prevalent, a duty of public health falls upon clinicians to advise parents against trampoline usage. Cite this article: Bone Jt Open 2021;2(2):86–92.
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Affiliation(s)
- Yahya Ibrahim
- Orthopaedic Department, Broomfield Hospital, Mid Essex Hospital NHS Trust, Chelmsford, UK
| | - Sumon Huq
- Orthopaedic Department, Broomfield Hospital, Mid Essex Hospital NHS Trust, Chelmsford, UK
| | | | - Helen Gille
- Orthopaedic Department, Broomfield Hospital, Mid Essex Hospital NHS Trust, Chelmsford, UK
| | - Pranai Buddhdev
- Orthopaedic Department, Broomfield Hospital, Mid Essex Hospital NHS Trust, Chelmsford, UK
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Murphy T, Akehurst H, Mutimer J. Impact of the 2020 COVID-19 pandemic on the workload of the orthopaedic service in a busy UK district general hospital. Injury 2020; 51:2142-2147. [PMID: 32654849 PMCID: PMC7338859 DOI: 10.1016/j.injury.2020.07.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/21/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The COVID -19 outbreak has had a profound effect on the management of healthcare service provision in the UK. Orthopaedic departments have been no exception to this and have needed to adapt to the changing circumstances by releasing resources and focusing on 'essential' activity. The aim of this study is to quantify the reduction in trauma and, in addition, describe any changes in the type of referrals to the trust which may have been affected by the pandemic itself and the social distancing measures employed by the UK government. METHODS The study was performed in a UK District Hospital which is also a Trauma Unit providing trauma and orthopaedic care to a population of 625,000 people. The trust based electronic database of trauma referrals was used to compare the numbers of, and types of referral to our trauma service during the COVID-19 pandemic and the corresponding time periods in the previous 3 years. RESULTS The mean number of referrals per week to the service reduced by 33% in the time period following the confirmation of the outbreak as a pandemic (p<0.0001). Number of operations performed per week reduced by 26% (p = 0.001). There was no change in the number of referrals relating to domestic abuse or non-accidental injury. In addition, numbers of hip fractures, periprosthetic fractures and prosthetic joint dislocations were unchanged. There was a significant reduction in the number of referrals for simple fractures, native joint dislocations, wounds and soft tissue injuries. Within the paediatric population, similarly, a reduction in simple fracture referrals was demonstrated. DISCUSSION An association between the outbreak of the pandemic and a reduction in referral numbers to our department has been demonstrated. The direct cause of this may be multifactorial but proposing that it is, in part, due to the social distancing measures introduced by the government is certainly conceivable. The patterns of injury would reflect this also with low energy and fragility trauma persisting whilst injuries associated with younger people have reduced. We would suggest that information such as this could be useful in healthcare planning and resource allocation in future pandemic situations.
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Hind J, Lahart IM, Jayakumar N, Athar S, Fazal MA, Ashwood N. Seasonal variation in trauma admissions to a level III trauma unit over 10 years. Injury 2020; 51:2209-2218. [PMID: 32703642 DOI: 10.1016/j.injury.2020.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Major trauma centres have improved morbidity and mortality for moderate and severely injured patients. Less injured patients may be treated in facilities less resourced for trauma care. In these units, understanding the variations in injury presentation and treatment over time allows service delivery to be tailored to demand. This study set out to describe seasonal variations in trauma over a 10-year period at a level III trauma unit. MATERIALS AND METHODS Patient demographics, admission frequency, site of injury, season of admission, management, complications, onward transfers, and length of stay were extracted on consecutive patients admitted with traumatic injuries between January 2009 and December 2018 and recorded on a prospectively maintained database. Analysis was undertaken to determine if there were reproducible patterns in trauma presentation across seasons, based on the patient's age and gender, type of injury, management and length of stay. RESULTS There were 13,007 'first admissions' over 10 years, with a mean (SD) age of 55.6 (27.7) years. Admissions were higher in summer (27%) and lower in winter (23.6%) and patients were on average younger in the summer (52.8 years) and older in winter (59.2 years). The proportion of female and male patients remained relatively constant across seasons (CV=6% and 8%, respectively). There was seasonal variation in the incidence of forearm (36%) elbow (19%), and multi-sites injuries (17%) compared with hip and wrist injuries (CV=5% for both). A lower proportion of patients underwent operations in summer (72%) compared with other seasons with winter having the highest at 77%. More patients aged less than 60 years stayed in hospital during winter than summer (13.2% vs. 11.6-12.4%) although often for a day. Patients aged 60 years stayed longer in spring and winter. CONCLUSION The results of this study demonstrate trends in the admission and management of trauma patients to a level III trauma unit. Some of the patterns in admission, treatment and length of stay had not been identified previously. The results can be used to enhance patient care and minimise health care costs by reducing unwarranted variations and enabling service delivery to match the demand in all trauma units.
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Affiliation(s)
- Jamie Hind
- University Hospital of Derby and Burton (Queens Hospital), Belvedere Road, Burton on Trent, DE13 0RB, United Kingdom.
| | - Ian M Lahart
- Faculty of Education, Health, and Wellbeing, University of Wolverhampton, Gorway Road, Walsall, WS1 3BD, United Kingdom
| | - Nithish Jayakumar
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom
| | - Sajjad Athar
- University Hospital of Derby and Burton (Queens Hospital), Belvedere Road, Burton on Trent, DE13 0RB, United Kingdom
| | | | - Neil Ashwood
- University Hospital of Derby and Burton (Queens Hospital), Belvedere Road, Burton on Trent, DE13 0RB, United Kingdom
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Tverdal C, Aarhus M, Andelic N, Skaansar O, Skogen K, Helseth E. Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway. Inj Epidemiol 2020; 7:45. [PMID: 32867838 PMCID: PMC7461333 DOI: 10.1186/s40621-020-00269-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background The vast majority of hospital admitted patients with traumatic brain injury (TBI) will have intracranial injury identified by neuroimaging, requiring qualified staff and hospital beds. Moreover, increased pressure in health care services is expected because of an aging population. Thus, a regular evaluation of characteristics of hospital admitted patients with TBI is needed. Oslo TBI Registry – Neurosurgery prospectively register all patients with TBI identified by neuroimaging admitted to a trauma center for southeast part of Norway. The purpose of this study is to describe this patient population with respect to case load, time of admission, age, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival. Methods Data for 5 years was extracted from Oslo TBI Registry – Neurosurgery. Case load, time of admission, age, sex, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival was compiled and compared. Results From January 1st, 2015 to December 31st, 2019, 2153 consecutive patients with TBI identified by neuroimaging were registered. The admission rate of TBI of all severities has been stable year-round since 2015. Mean age was 52 years (standard deviation 25, range 0–99), and 68% were males. Comorbidities were common; 28% with pre-injury ASA score of ≥3 and 25% used antithrombotic medication. The dominating cause of injury in all ages was falls (55%) but increased with age. Upon admission, the head injury was classified as mild TBI in 46%, moderate in 28%, and severe (Glasgow coma score ≤ 8) in 26%. Case load was stable without seasonal variation. Majority of patients (68%) were admitted during evening, night or weekend. 68% was admitted to intensive care unit. Length of hospital stay was 4 days (median, interquartile range 3–9). 30-day survival for mild, moderate and severe TBI was 98, 94 and 69%, respectively. Conclusions The typical TBI patients admitted to hospital with abnormal neuroimaging were aged 50–79 years, often with significant comorbidity, and admitted outside ordinary working hours. This suggests the necessity for all-hour presence of competent health care professionals.
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Affiliation(s)
- Cathrine Tverdal
- Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Mads Aarhus
- Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ola Skaansar
- Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karoline Skogen
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures During the COVID-19 Pandemic. J Pediatr Orthop 2020; 40:373-379. [PMID: 32433260 DOI: 10.1097/bpo.0000000000001600] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, public health measures to encourage social distancing have been implemented, including cancellation of school and organized sports. A resulting change in pediatric fracture epidemiology is expected. This study examines the impact of the COVID-19 pandemic on fracture incidence and characteristics. METHODS This is a retrospective cohort study comparing acute fractures presenting to a single level I pediatric trauma hospital during the COVID-19 pandemic with fractures during a prepandemic period at the same institution. The "pandemic" cohort was gathered from March 15 to April 15, 2020 and compared with a "prepandemic" cohort from the same time window in 2018 and 2019. RESULTS In total, 1745 patients presenting with acute fractures were included. There was a significant decrease in the incidence of fractures presenting to our practice during the pandemic (22.5±9.1/d vs. 9.6±5.1/d, P<0.001). The presenting age for all fractures decreased during the pandemic (7.5±4.3 vs. 9.4±4.4 y, P<0.001) because of decreased fracture burden among adolescents. There were also a decrease in the number of fractures requiring surgery (2.2±1.8/d vs. 0.8±0.8/d, P<0.001). During the pandemic, there was an increase in the proportion of injuries occurring at home (57.8% vs. 32.5%, P<0.001) or on bicycles (18.3% vs. 8.2%, P<0.001), but a decrease in those related to sports (7.2% vs. 26.0%, P<0.001) or playgrounds (5.2% vs. 9.0%, P<0.001). There was no increase in time-to-presentation. Patients with distal radius torus fractures were more likely to receive a velcro splint during the pandemic (44.2% vs. 25.9%, P=0.010). CONCLUSIONS Pediatric fracture volume has decreased 2.5-fold during the COVID-19 pandemic, partially because of cessation of organized sports and decreased playground use. In endemic regions, lower trauma volume may allow redeployment of orthopaedic surgeons and staff to other clinical arenas. Given the rising proportion of bicycling injuries, an emphasis on basic safety precautions could improve public health. An observed increase in the prescription of velcro splints for distal radius fractures highlights an opportunity for simplified patient care during the pandemic. LEVEL OF EVIDENCE Level III.
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Greve F, Kanz KG, Zyskowski M, von Matthey F, Biberthaler P, Muthers S, Matzarakis A, Lefering R, Huber-Wagner S. The influence of foehn winds on the incidence of severe injuries in southern Bavaria - an analysis of the TraumaRegister DGU®. BMC Musculoskelet Disord 2020; 21:568. [PMID: 32825813 PMCID: PMC7442979 DOI: 10.1186/s12891-020-03572-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background Foehn describes a wind which occurs in areas with close proximity to mountains. The presence of foehn wind is associated with worsening health conditions. This study analyzes the correlation between a foehn typical circulation and the incidence for suffering a severe trauma. Methods This is a retrospective, multicentre observational register study. The years from 2013 to 2016 were analyzed for the presence of foehn winds. A logistic regression analysis with the number of daily admitted trauma patients as the primary target value was performed in dependence of foehn winds. Southern Bavaria is a typical foehn wind region. Individuals were treated in 37 hospitals of Southern Bavaria which participate in the TraumaRegister DGU®, an international register that includes all severe trauma patients, mainly in Germany. We analyzed patients with an Injury Severity Score (ISS) of at least nine with admission to intensive care units or prior death in the emergency room. Results 6215 patients were enrolled in this study. A foehn-typical circulation was present on 65 days (4.5%). 301 patients (5%) suffered a trauma with an ISS ≥ 9 on a foehn day. The mean ISS was 20.2 (9–75). On average, 4.3 patients (0–15 patients) were admitted on a daily basis due to a severe trauma. The multivariate regression analysis revealed a daily increase of 0.87 individuals (p = 0.004; 95% CI 0.23–1.47) on foehn days. During spring 1.07 patients (p = < 0.001; 95% CI 0.72–1.42), in summer 1.98 patients (p = < 0.001; 95% CI 1.63–2.32), in fall 0.63 (p = < 0.001; 95% CI 0.28–0.97) and on Saturdays, 0.59 patients (p = < 0.001; 95% CI 0.24–0.93) were additionally admitted due to severe trauma. Conclusion Foehn winds are significantly associated with severe trauma in trauma centers of the TraumaNetzwerk DGU®.
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Affiliation(s)
- Frederik Greve
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Karl-Georg Kanz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Francesca von Matthey
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stefan Muthers
- Research Centre Human Biometeorology, German Meteorological Service, Stefan-Maier-Straße 4, 79104, Freiburg, Germany
| | - Andreas Matzarakis
- Research Centre Human Biometeorology, German Meteorological Service, Stefan-Maier-Straße 4, 79104, Freiburg, Germany
| | - Rolf Lefering
- Faculty of Health, IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Trauma Surgery, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Germany
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Cignarella A, Redley B, Bucknall T. Organ donation within the intensive care unit: A retrospective audit. Aust Crit Care 2020; 33:167-174. [DOI: 10.1016/j.aucc.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/18/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022] Open
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Malik NS, Munoz B, de Courcey C, Imran R, Lee KC, Chernbumroong S, Bishop J, Lord JM, Gkoutos G, Bowley DM, Foster MA. Violence-related knife injuries in a UK city; epidemiology and impact on secondary care resources. EClinicalMedicine 2020; 20:100296. [PMID: 32300742 PMCID: PMC7152819 DOI: 10.1016/j.eclinm.2020.100296] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The incidence of knife-related injuries is rising across the UK. This study aimed to determine the spectrum of knife-related injuries in a major UK city, with regards to patient and injury characteristics. A secondary aim was to quantify their impact on secondary care resources. METHODS Observational study of patients aged 16+ years admitted to a major trauma centre following knife-related injuries resulting from interpersonal violence (May 2015 to April 2018). Patients were identified using Emergency Department and discharge coding, blood bank and UK national Trauma Audit and Research prospective registries. Patient and injury characteristics, outcome and resource utilisation were collected from ambulance and hospital records. FINDINGS 532 patients were identified; 93% male, median age 26 years (IQR 20-35). Median injury severity score was 9 (IQR 3-13). 346 (65%) underwent surgery; 133 (25%) required intensive care; 95 (17·9%) received blood transfusion. Median length of stay was 3·3 days (IQR 1·7-6·0). In-hospital mortality was 10/532 (1·9%). 98 patients (18·5%) had previous attendance with violence-related injuries. 24/37 females (64·9%) were injured in a domestic setting. Intoxication with alcohol (19·2%) and illicit drugs (17·6%) was common. Causative weapon was household knife in 9%, knife (other/unspecified) in 38·0%, machete in 13·9%, small folding blade (2·8%) and, unrecorded in 36·3%. INTERPRETATION Knife injuries constitute 12·9% of trauma team workload. Violence recidivism and intoxication are common, and females are predominantly injured in a domestic setting, presenting opportunities for targeted violence reduction interventions. 13·9% of injuries involved machetes, with implications for law enforcement strategies.
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Affiliation(s)
- Nabeela S. Malik
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- College of Medical and Dental Sciences, Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom
- 212 Field Hospital (Volunteers), Encliffe Hall, Endcliffe Vale Road, Sheffield S10 3EU, United Kingdom
- Corresponding author at: NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom.
| | - Beau Munoz
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- Uniformed Services University (USU) Surgical Critical Care Initiative (SC2i), Walter Reed National Military Medical Center (WRNMMC), Bethesda 20889, Maryland, United States
| | - Cynthia de Courcey
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Rizwana Imran
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Kwang C. Lee
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Saisakul Chernbumroong
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Jonathan Bishop
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
| | - Janet M. Lord
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- College of Medical and Dental Sciences, Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - George Gkoutos
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, United Kingdom
- MRC Health Data Research UK (HDR UK), United Kingdom
| | - Douglas M. Bowley
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Mark A. Foster
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
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Dennis BM, Stonko DP, Callcut RA, Sidwell RA, Stassen NA, Cohen MJ, Cotton BA, Guillamondegui OD. Artificial neural networks can predict trauma volume and acuity regardless of center size and geography: A multicenter study. J Trauma Acute Care Surg 2020; 87:181-187. [PMID: 31033899 DOI: 10.1097/ta.0000000000002320] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Trauma has long been considered unpredictable. Artificial neural networks (ANN) have recently shown the ability to predict admission volume, acuity, and operative needs at a single trauma center with very high reliability. This model has not been tested in a multicenter model with differing climate and geography. We hypothesize that an ANN can accurately predict trauma admission volume, penetrating trauma admissions, and mean Injury Severity Score (ISS) with a high degree of reliability across multiple trauma centers. METHODS Three years of admission data were collected from five geographically distinct US Level I trauma centers. Patients with incomplete data, pediatric patients, and primary thermal injuries were excluded. Daily number of traumas, number of penetrating cases, and mean ISS were tabulated from each center along with National Oceanic and Atmospheric Administration data from local airports. We trained a single two-layer feed-forward ANN on a random majority (70%) partitioning of data from all centers using Bayesian Regularization and minimizing mean squared error. Pearson's product-moment correlation coefficient was calculated for each partition, each trauma center, and for high- and low-volume days (>1 standard deviation above or below mean total number of traumas). RESULTS There were 5,410 days included. There were 43,380 traumas, including 4,982 penetrating traumas. The mean ISS was 11.78 (SD = 6.12). On the training partition, we achieved R = 0.8733. On the testing partition (new data to the model), we achieved R = 0.8732, with a combined R = 0.8732. For high- and low-volume days, we achieved R = 0.8934 and R = 0.7963, respectively. CONCLUSION An ANN successfully predicted trauma volumes and acuity across multiple trauma centers with very high levels of reliability. The correlation was highest during periods of peak volume. This can potentially provide a framework for determining resource allocation at both the trauma system level and the individual hospital level. LEVEL OF EVIDENCE Care Management, level IV.
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Affiliation(s)
- Bradley M Dennis
- From the Division of Trauma and Surgical Critical Care, (B.M.D., O.D.G.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery (D.P.S.), The Johns Hopkins Hospital, Baltimore, Maryland; Department of Surgery (R.A.C.), University of California San Francisco, San Francisco, California; Department of General Surgery, Iowa Methodist Medical Center (R.A.S.), Des Moines, Iowa; Division of Acute Care Surgery, Department of Surgery, University of Rochester Medical Center (N.A.S.), Rochester, New York; Department of Surgery, Denver Health Medical Center (M.J.C.), Denver, Colorado; and Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Memorial Hermann Hospital/Texas Medical Center (B.A.C.), Houston, Texas
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Kropelnicki A, Ali AM, Popat R, Sarraf KM. Paediatric supracondylar humerus fractures. Br J Hosp Med (Lond) 2020; 80:312-316. [PMID: 31180787 DOI: 10.12968/hmed.2019.80.6.312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article gives a practical guide to the management of supracondylar fractures of the humerus in paediatric patients, from initial presentation to definitive treatment. It reviews the optimal management of this common and serious injury based on current evidence including the British Orthopaedic Association Standards for Trauma (BOAST) 11 standard.
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Affiliation(s)
- Anna Kropelnicki
- Specialist Trainee in Trauma and Orthopaedics, Department of Trauma and Orthopaedics, The Hillingdon Hospitals NHS Trust, London UB8 3NN
| | - Adam M Ali
- Specialist Trainee in Trauma and Orthopaedics, Department of Trauma and Orthopaedics, The Hillingdon Hospitals NHS Trust, London UB8 3NN
| | - Ravi Popat
- Specialist Trainee in Trauma and Orthopaedics, Department of Trauma and Orthopaedics, The Hillingdon Hospitals NHS Trust, London UB8 3NN
| | - Khaled M Sarraf
- Consultant Trauma and Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London
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Abstract
Objective: This mixed methods study analyzed the factors that led to a fall in a cohort of patients with distal radius fracture (DRF). Methods: A sample of 1,453 patients (430 men; 1,023 women; age range: 18-89 years) supplemented by new interview data from 29 patients (19 women) were examined. Chi-square and descriptive analysis of quantitative data and descriptive thematic analysis of qualitative data were compared to determine data convergence and divergence. Results: A higher number of DRF were observed in the 45- to 64-year-old group (44%), employed people (48%), in winter months (41%), and in low-energy fractures (75%). Themes emerged from qualitative data on the cause of the fracture, including environmental factors, behavioral factors, physical factors, and sports activities. Conclusion: Reasons for DRF are multifactorial. Preventive strategies with an emphasis on environmental and behavioral factor modifications are likely to decrease the number of DRF.
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Logistics of air medical transport: When and where does helicopter transport reduce prehospital time for trauma? J Trauma Acute Care Surg 2019; 85:174-181. [PMID: 29787553 DOI: 10.1097/ta.0000000000001935] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma is a time sensitive disease. Helicopter emergency medical services (HEMS) have shown benefit over ground emergency medical services (GEMS), which may be related to reduced prehospital time. The distance at which this time benefit emerges depends on many factors that can vary across regions. Our objective was to determine the threshold distance at which HEMS has shorter prehospital time than GEMS under different conditions. METHODS Patients in the Pennsylvania trauma registry 2000 to 2013 were included. Distance between zip centroid and trauma center was calculated using straight-line distance for HEMS and driving distance from geographic information systems network analysis for GEMS. Contrast margins from linear regression identified the threshold distance at which HEMS had a significantly lower prehospital time than GEMS, indicated by nonoverlapping 95% confidence intervals. The effect of peak traffic times and adverse weather on the threshold distance was evaluated. Geographic effects across EMS regions were also evaluated. RESULTS A total of 144,741 patients were included with 19% transported by HEMS. Overall, HEMS became faster than GEMS at 7.7 miles from the trauma center (p = 0.043). Helicopter emergency medical services became faster at 6.5 miles during peak traffic (p = 0.025) compared with 7.9 miles during off-peak traffic (p = 0.048). Adverse weather increased the distance at which HEMS was faster to 17.1 miles (p = 0.046) from 7.3 miles in clear weather (p = 0.036). Significant variation occurred across EMS regions, with threshold distances ranging from 5.4 to 35.3 miles. There was an inverse but non-significant relationship between urban population and threshold distance across EMS regions (ρ, -0.351, p = 0.28). CONCLUSION This is the first study to demonstrate that traffic, weather, and geographic region significantly impact the threshold distance at which HEMS are faster than GEMS. Helicopter emergency medical services was faster at shorter distances during peak traffic while adverse weather increased this distance. The threshold distance varied widely across geographic region. These factors must be considered to guide appropriate HEMS triage protocols. LEVEL OF EVIDENCE Therapeutic, level IV.
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[Impact of weather, time of day and season on the admission and outcome of major trauma patients]. Unfallchirurg 2019; 121:10-19. [PMID: 27778061 DOI: 10.1007/s00113-016-0267-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES The potential association of external factors such as time of day, lunar phases or specific weather conditions on the daily management and outcome of trauma emergencies remains under debate. We undertook this trauma centre investigation to detect possible worthwhile factors of influence in order to optimize the organizational structure of trauma admissions. MATERIALS AND METHODS Retrospective cohort analysis over the years 2010-2013, including all emergency trauma admissions with a new injury severity score (NISS) ≥8 (major trauma) treated in a teaching hospital in the lowland of Switzerland (uni- and multivariable analysis; p < 0.05). RESULTS During the study period, 1178 major trauma patients were admitted to the hospital. The mean age of trauma victims was 53 ± 23 and the average ISS was 14 ± 8. More patients arrived within the summer months than during the rest of the year (p < 0.001). Higher energy trauma was found to correlate with higher daytime temperature, longer duration of sunshine (each p < 0.001), and change in weather conditions (p = 0.008). In contrast, snowfall and lunar phases did not demonstrate any association with the number or characteristics of trauma admissions. Multivariable analysis demonstrated that altogether longer sunshine, higher minimum daytime temperature and lower air humidity, compared to the previous day, accounted for 31 % of major trauma admissions. We could not find any impact of the investigated external factors on the outcome of patients. CONCLUSIONS The study shows a significant relationship between specific weather conditions, such as higher daytime temperature or change in circulation, and the admission of major trauma patients. Due to the small effect in our setting, our results do not implicate any according change in the management of resources. Nevertheless, for hospitals in other geographic or more exposed weather regions, such effects could indeed be relevant and therefore should be tested.
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Stonko DP, Dennis BM, Callcut RA, Betzold RD, Smith MC, Medvecz AJ, Guillamondegui OD. Identifying temporal patterns in trauma admissions: Informing resource allocation. PLoS One 2018; 13:e0207766. [PMID: 30507930 PMCID: PMC6277067 DOI: 10.1371/journal.pone.0207766] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Increased knowledge of the temporal patterns in the distribution of trauma admissions could be beneficial to staffing and resource allocation efforts. However, little work has been done to understand how this distribution varies based on patient acuity, trauma mechanism or need for intervention. We hypothesize that temporal patterns exist in the distribution of trauma admissions, and that deep patterns exist when traumas are analyzed by their type and severity. STUDY DESIGN We conducted a cross-sectional observational study of adult patient flow at a level one trauma center over three years, 7/1/2013-6/30/2016. Primary thermal injuries were excluded. Frequency analysis was performed for patients grouped by ED disposition and mechanism against timing of admission; in subgroup analysis additional exclusion criteria were imposed. RESULTS 10,684 trauma contacts were analyzed. Trauma contacts were more frequent on Saturdays and Sundays than on weekdays (p<0.001). Peak arrival time was centered around evening shift change (6-7pm), but differed based on ED disposition: OR and ICU or Step-Down admissions (p = 0.0007), OR and floor admissions (p<0.0001), and ICU or Step-Down and floor admissions (p<0.0001). Step-Down and ICU arrival times (p = 0.42) were not different. Penetrating injuries peaked later than blunt (p<0.0001). Trauma varies throughout the year; we establish a high incidence trauma season (April to late October). Different mechanisms have varying dependence upon season; Motorcycle crashes (MCCs) have the greatest dependence. CONCLUSION We identify new patterns in the temporal and seasonal variation of trauma and of specific mechanisms of injury, including the novel findings that 1) penetrating trauma tends to present at later times than blunt, and 2) critically ill patients requiring an OR tend to present later than those who are less acute and require an ICU or Step-Down unit. These patients present later than those who are admitted to the floor. Penetrating trauma patients arriving later than blunt may be the underlying reason why operative patients arrive later than other patients.
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Affiliation(s)
- David P. Stonko
- The Johns Hopkins Hospital, Department of Surgery, Baltimore, MD, United States of America
| | - Bradley M. Dennis
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
| | - Rachael A. Callcut
- Department of Surgery, University of California, San Fransisco, San Fransisco, CA, United States of America
| | - Richard D. Betzold
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
| | - Michael C. Smith
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
| | - Andrew J. Medvecz
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
| | - Oscar D. Guillamondegui
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
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The Effect of Season and Weather on Orthopaedic Trauma: Consult Volume Is Significantly Correlated with Daily Weather. Adv Orthop 2018; 2018:6057357. [PMID: 30245890 PMCID: PMC6139230 DOI: 10.1155/2018/6057357] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction On-call orthopedic clinicians have long speculated that daily consult volume is closely correlated with weather. While prior studies have demonstrated a relationship between weather and certain fracture types, the effect of weather on total orthopaedic consult volume has not yet been examined. The aim of this study was to investigate this relationship. Methods We retrospectively reviewed orthopaedic consult data from 405 consecutive days at an urban, level one trauma center. The number, mechanism of injury, and type of consult were collected, along with daily weather data (temperature, wind, and precipitation). Statistical analysis was then performed to determine the relationship between weather and orthopaedic trauma consults. Results A total of 4543 consults were received during the study period. There was a significant difference in total number of consults between months of the year (p<0.001). A post hoc analysis revealed that this was due to increased volume in the summer months relative to the winter months (i.e., August 13.7 consults/day; January 9.3 consults/day). Average daily temperature and consult volume were also positively correlated (p<0.001, r= 0.30). While there was no significant association between precipitation and total consult volume, when there was over 0.25 inches of rain, there were less penetrating trauma (p=0.034) and motorcycle collision consults (p=0.013). Conclusion Weather parameters, specifically average temperature and precipitation, were found to be associated with daily orthopedic consult type and volume. Additionally, consult volume varies significantly between months of the year. Because trauma centers are often resource scarce, this is an important relationship to understand for proper resource allocation.
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Artificial intelligence can predict daily trauma volume and average acuity. J Trauma Acute Care Surg 2018; 85:393-397. [DOI: 10.1097/ta.0000000000001947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Ramirez DA, Porco TC, Lietman TM, Keenan JD. Ocular Injury in United States Emergency Departments: Seasonality and Annual Trends Estimated from a Nationally Representative Dataset. Am J Ophthalmol 2018; 191:149-155. [PMID: 29750945 DOI: 10.1016/j.ajo.2018.04.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine whether ocular trauma occurs more frequently in the summer months. DESIGN Retrospective, cross-sectional study. METHODS The Nationwide Emergency Department Sample (NEDS) is a large, publicly available administrative database that provides nationally representative estimates of emergency department (ED) visits in the United States. Billing codes from NEDS from 2006 to 2013 were used to identify all cases of ocular trauma, and the United States decennial census was used to estimate the population at risk for visiting an ED. The main outcome measures were the seasonal and annual trends in the incidence of ED-diagnosed eye trauma. RESULTS Eye trauma was the primary diagnosis for an estimated 5 615 532 ED encounters over the 8-year study period. Those with an eye trauma encounter were predominantly male (66%) and under 60 years of age (91%). The most common ocular trauma presentations were superficial injury of eye and adnexa (101 ED-diagnosed cases per 100 000 population), extraocular foreign body (54 per 100 000 population), contusion of eye and adnexa (27 per 100 000 population), and ocular adnexal open wound (26 per 100 000 population). Each exhibited a statistically significant annual cycle, with a mean annual peak between May and July (P < .01 for each, Edwards test). Eye trauma visits decreased by an average of 4% per year over the study period, with a similar pattern of decline during each calendar month (incidence rate ratio 0.96, 95% confidence interval 0.94-0.98). CONCLUSIONS Eye trauma, although decreasing in incidence, is a seasonal condition. Prevention efforts would likely be most effective if implemented in the spring or summer months. Further study to identify other individual-level or regional-level factors that would most benefit from public health efforts is warranted.
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Lemon DJ, Partridge R. Is weather related to the number of assaults seen at emergency departments? Injury 2017; 48:2438-2442. [PMID: 28870621 DOI: 10.1016/j.injury.2017.08.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/17/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is often suggested that the weather can effect behaviour, increasing the likelihood of assaults and resulting in increased admissions to emergency departments (ED). Therefor a better understanding of the effect of climatic conditions could be useful to help EDs in capacity planning. Whilst other studies have looked at this, none have used data collected specifically to look at ED attendance for assaults or have taken account of potential behaviour modifiers. METHODS We use data from our ED violence surveillance system, the Cardiff Model (CM), married to daily meteorological data to construct negative-binomial regression models. The models are used to estimate changes in the assault rate with changes in temperature, adjusting for day of the week and alcohol consumption. RESULTS We find that there is 1% increase in the assault rate for every degree increase in the maximum daily temperature (IRR=1.01, P-value=0.033). Additionally, different patterns in alcohol consumption at weekends also provide a significant contribution. However, when we generalise this model to represent temperature in terms of factors of standard deviation from the mean temperature, the IRR relationship changes, plateauing at unusually high temperatures (±1.5 SD above the mean). CONCLUSIONS The results presented here suggest that whilst temperature does increase the risk of assaults in Dorset, there may be a limit to its effect. This implies the 'curve-linear' relationship for temperature as suggested by others.
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Affiliation(s)
- D J Lemon
- Public Health Dorset, United Kingdom.
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- Public Health Dorset, United Kingdom
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Sinikumpu JJ, Pokka T, Hyvönen H, Ruuhela R, Serlo W. Supracondylar humerus fractures in children: the effect of weather conditions on their risk. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:243-250. [DOI: 10.1007/s00590-016-1890-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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Livingston KS, Miller PE, Lierhaus A, Matheney TH, Mahan ST. Does Weather Matter? The Effect of Weather Patterns and Temporal Factors on Pediatric Orthopedic Trauma Volume. Open Orthop J 2016; 10:550-558. [PMID: 27990193 PMCID: PMC5120380 DOI: 10.2174/1874325001610010550] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/14/2016] [Accepted: 10/20/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives: Orthopaedists often speculate how weather and school schedule may influence pediatric orthopedic trauma volume, but few studies have examined this. This study aims to determine: how do weather patterns, day, month, season and public school schedule influence the daily frequency of pediatric orthopedic trauma consults and admissions? Methods: With IRB approval, orthopedic trauma data from a level 1 pediatric trauma center, including number of daily orthopedic trauma consults and admissions, were collected from July 2009 to March 2012. Historical weather data (high temperatures, precipitation and hours of daylight), along with local public school schedule data were collected for the same time period. Univariate and multivariate regression models were used to show the average number of orthopedic trauma consults and admissions as a function of weather and temporal variables. Results: High temperature, precipitation, month and day of the week significantly affected the number of daily consults and admissions. The number of consults and admissions increased by 1% for each degree increase in temperature (p=0.001 and p<0.001, respectively), and decreased by 21% for each inch of precipitation (p<0.001, p=0.006). Daily consults on snowy days decreased by an additional 16% compared to days with no precipitation. November had the lowest daily consult and admission rate, while September had the highest. Daily consult rate was lowest on Wednesdays and highest on Saturdays. Holiday schedule was not independently significant. Conclusion: Pediatric orthopedic trauma consultations and admissions are highly linked to temperature and precipitation, as well as day of the week and time of year.
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Affiliation(s)
- Kristin S Livingston
- Department of Orthopaedics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | - Travis H Matheney
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan T Mahan
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
BACKGROUND/PURPOSE It has been suggested that hospital admission during weekends poses a risk for adverse outcomes and increased patient mortality, the so-called 'weekend effect'. We undertook an evaluation of the impact of weekend admissions to the management of polytraumatised patients, in a Level I Major Trauma Centre (MTC) in the UK. MATERIALS AND METHODS A retrospective review of prospectively documented data of polytrauma patients (injury severity score (ISS)>15), admitted between April 2013 and August 2015 was performed. Exclusion criteria included patients initially assessed in other institutions. All patients were initially managed at the emergency department (ED) according to ATLS® principles and underwent a trauma computed tomography (CT) scan, unless requiring immediate surgical intervention. RESULTS During the study period 1735 patients (pts) were admitted under the care of the MTC. Four hundred and five pts were excluded as they were transferred from other institutions and 300 pts were excluded as their ISS was less than 16. Overall 1030 patients met the inclusion criteria, out of which 731 were males. Comparing the two groups (Group A: weekday admissions (670), Group B: weekend admissions (360)), there was no difference in pts gender, mechanism of injury, GCS at presentation, need for intubation and time to CT. Patients admitted over the weekend were younger (p<0.01) and presented with haemodynamic instability more frequently (p=0.02). Time to operating room was also lower during the weekend, but this did not reach statistical significance (p=0.08). Mortality was lower in Group B: 39/360 pts (10.8%) compared to Group A: 100/670 pts (14.9%) (p=0.07). The relative risk (RR) of weekend mortality was calculated as 0.726 (95% CI: 0.513-1.027). DISCUSSION/CONCLUSION Weekend polytrauma patients appear to be younger, more severely injured and present with a higher incidence of haemodynamic instability (shock). Overall, we failed to identify a "weekend effect" in relation to mortality, time to CT and time to operating room. On the contrary, a lower risk of mortality was noted for patents admitted during the weekend.
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Affiliation(s)
- Vasileios Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK
| | - Michalis Panteli
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK.
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Otte im Kampe E, Kovats S, Hajat S. Impact of high ambient temperature on unintentional injuries in high-income countries: a narrative systematic literature review. BMJ Open 2016; 6:e010399. [PMID: 26868947 PMCID: PMC4762150 DOI: 10.1136/bmjopen-2015-010399] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Given the likelihood of increased hot weather due to climate change, it is crucial to have prevention measures in place to reduce the health burden of high temperatures and heat waves. The aim of this review is to summarise and evaluate the evidence on the effects of summertime weather on unintentional injuries in high-income countries. DESIGN 3 databases (Global Public Health, EMBASE and MEDLINE) were searched by using related keywords and their truncations in the title and abstract, and reference lists of key studies were scanned. Studies reporting heatstroke and intentional injuries were excluded. RESULTS 13 studies met our inclusion criteria. 11 out of 13 studies showed that the risk of unintentional injuries increases with increasing ambient temperatures. On days with moderate temperatures, the increased risk varied between 0.4% and 5.3% for each 1 °C increase in ambient temperature. On extreme temperature days, the risk of injuries decreased. 2 out of 3 studies on occupational accidents found an increase in work-related accidents during high temperatures. For trauma hospital admissions, 6 studies reported an increase during hot weather, whereas 1 study found no association. The evidence for impacts on injuries by subgroups such as children, the elderly and drug users was limited and inconsistent. CONCLUSIONS The present review describes a broader range of types of unintentional fatal and non-fatal injuries (occupational, trauma hospital admissions, traffic, fire entrapments, poisoning and drug overdose) than has previously been reported. Our review confirms that hot weather can increase the risk of unintentional injuries and accidents in high-income countries. The results are useful for injury prevention strategies.
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Affiliation(s)
- Eveline Otte im Kampe
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Sari Kovats
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Shakoor Hajat
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
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