Emergency department visits vs. fatalities among substance-impaired underage youths involved in motor vehicle crashes

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019142842 .

Current trauma care system in Saudi Arabia: A scoping literature review

BACKGROUND

Trauma is one of the leading causes of death worldwide with millions of people dying each year, particularly in low or middle-income countries. This paper describes and evaluates the current trauma system (TS) in Saudi Arabia (SA).

METHODS

A scoping literature review was performed, incorporating an extensive search of Medline and Embase databases for refereed literature, as well as a search of grey literature to locate unpublished articles or reports in English or Arabic. All publications were assessed against the World Health Organization (WHO) Trauma System Maturity Index (TSMI) and American College of Surgeon's (ACS) criteria.

RESULTS

Despite local injury prevention efforts, Motor Vehicle Crashes (MVC) remain the primary cause of injuries in SA. Prehospital trauma care in SA aligns with level III care as described in the WHO TSMI classification system, based on the presence of formal emergency medical services and universal access to care. With respect to the ACS classification, no clear written guidelines, either for field triage or trauma destination protocols such as trauma bypass, were identified in prehospital trauma care. The role of secondary and tertiary facilities in treating trauma patients is unclear, with no clear referral linkages, suggesting a level I to III grading of SA's trauma care facilities. Currently, there is no national or regional electronic trauma registry, no quality assurance program, and active involvement in research projects related to injuries is limited.

CONCLUSION

The current SA TS has strengths but there are key features missing in comparison to other systems globally. As MVCs remain a leading cause of death/ disability, efforts to reduce the prevalence and impact of MVC burden in SA through development of a stronger national TS are warranted.

Use of multiple data sources to identify specific drugs and other factors associated with drug and alcohol screening of fatally injured motor vehicle drivers

OBJECTIVE

Drugged driving crashes have significantly increased over the past two decades. The objectives of this study were to identify and characterize the drugs present in motor vehicle driver fatalities using multiple surveillance data sources; assess concordance of the data sources in identifying drug presence; and identify demographic and crash factors associated with drug and alcohol screening in fatally injured motor vehicle drivers.

METHODS

Fatality Analysis Reporting System (FARS), Collision Report Analysis for Safer Highways (CRASH), and mortality data sets were linked; drug screening and positive drug screens were identified. Chi-square and conditional logistic regression were performed.

RESULTS

The use of FARS data identified the majority of positive drug screens in the linked data set. Supplementation of FARS data with death certificate and CRASH data increased identification of specific drugs and drug classes detected among fatally injured motor vehicle drivers, although there was a low concordance among the data sources. Alcohol and depressants such as alprazolam had the highest frequencies among fatally injured drivers. Speeding, lack of occupant restraints, young age, commercial truck drivers, and speeding were all factors associated with increased odds of the fatally injured driver being drug or alcohol screened.

CONCLUSIONS

These findings indicate that FARS drug information data may be strengthened through increased autopsy and consultation with medical examiners to better understand and interpret decedent toxicology testing results, and that states with low driver drug testing rates should consider mandatory driver drug testing in fatal crashes.

Impressions of "Evidence-Based Practice": A Direct-to-Consumer Survey of Caregivers Concerned about Adolescent Substance Use

National behavioral health organizations have recently started using direct-to-consumer (DTC) marketing strategies as a means of promoting increased utilization of evidence-based practice (EBP). Such strategies often encourage patients and caregivers to proactively seek out EBP, based on the assumptions that patients and caregivers understand the concept and view it favorably. We conducted a DTC marketing survey of caregivers concerned about their adolescents' substance use in order to explore how these caregivers define, value, and prefer to describe the EBP concept. We also examined whether caregiver perceptions of EBP vary by socio-demographic (race/ethnicity, income per capital, education level) and clinical (adolescent's history of therapy) characteristics. A total of 411 caregivers (86% women, 88% Non-Hispanic White) of adolescents age 12 to 19 (M age = 16.1, SD = 1.8, 82% Non-Hispanic White) completed an online survey. Caregivers answered a series of questions evaluating assumed definitions of EBP, underlying EBP principles, the appeal of EBP, and alternate terms to describe EBP. Chi-square analyses and multivariate logistic regressions were used to examine which variables were associated with the greatest likelihood of response selection. Results indicated that most parents defined EBP correctly, valued EBP principles, and found EBP appealing. However, caregivers from racial/ethnic minority groups, with lower income per capita, and lower education were more likely to define EBP incorrectly and have negative impressions of the concept. Education level was the strongest and most consistent predictor of caregiver perceptions. Clinical implications for the development of targeted, accessible marketing messages are discussed.

The odds of wrong-way crashes and resulting fatalities: A comprehensive analysis

The United States of America and other nations are grappling with the incidence of wrong-way driving (WWD). The issue is as important today (NTSB, 2012) as it was a half-century ago (Hulbert and Beers, 1966). In the absence of a comprehensive analysis, any effort to implement WWD countermeasures can be counterproductive. Hence, this effort began with the express intent to identify the factors that cause WWD crashes and fatalities. This work is sizeable in that it evaluated one million complete crash records from Florida. The methodology comprised (a) administering a survey on the perceptions about WWD; (b) developing binomial logistic models for computing the odds of WWD crashes, and of fatal crashes within the WWD space; (c) analyzing the contributing variables; and (d) comparing perceptions with crash analysis results. The study parameters included driver's age, gender, licensing state, physical defect, blood alcohol concentration, vehicle use, seatbelt compliance, day and time of crash, roadway lighting, facility type, weather conditions, road geometrics, and traffic volumes. Individual variable analysis of 23 parameters and the model development process included the determination of odds ratios and statistical tests for the predictive power and goodness-of-fit. The results of this work are generally consistent with expectation, yet surprising at times. This work concludes with decision-making inputs to the scientist, policy-maker and practitioner on the need for effectively engineering the roads, actively educating people about wrong-way driving, and strictly enforcing traffic laws, rules and regulations.