Trends in hospitalization for firearm-related injury in Finland from 1990 to 2003

Epidemiology of trauma admissions in a level 1 trauma center in Northern Italy: a nine-year study

The aim of this study was to analyze the results of 9 years of trauma care and data collection in a level 1 urban trauma center in Northern Italy. Overall, 6065 patients have been included in the study; the number of patients managed yearly has doubled between 2011 and 2019. This rise mostly involved patients with injury severity score (ISS) < 16. Most injuries (94%) were blunt. Road traffic accidents, especially involving motorcycles, were the most common cause of injury. Self-inflicted injuries were responsible for less than 5% of trauma but they were severe in 56% of cases. The median age was 38 and it remained constant over the years; 43% of patients had 14-39 years of age. Different characteristics and patterns of injury were observed for each age group and gender. Males were more likely to be injured in the central years of life while females presented a trimodal pattern in the age distribution. Young adults (14-39 years old) were overall at higher risk of self-harm. Overall mortality was equal to 5.2%. Most deceased were male and ≥ 65 years of age.

Outcome and rational management of civilian gunshot injuries to the brain-retrospective analysis of patients treated at the Helsinki University Hospital from 2000 to 2012

Background

Treatment of gunshot wounds of the brain (GSWB) remains controversial and there is high variation in reported survival rates (from < 10 to > 90%) depending on the etiology and country. We retrospectively analyzed the outcome of a series of consecutive GSWB patients admitted alive to a level 1 trauma center in a safe high-income welfare country with a low rate of homicidal gun violence.

Methods

Patients admitted due to a GSWB to the HUS Helsinki University Hospital during 2000–2012 were identified from hospital discharge registry and log books of the emergency room and ICU. CT scans and medical records of these patients were reviewed. Univariate analysis and backward logistic regression were performed, and their results compared with that of a systematic literature review of factors related to the outcome of GSWB patients.

Results

Sixty-four patients admitted alive after GSWB were identified. Eighty percent had self-inflicted GSWB, 81% were contact shots, and 70% were caused by handguns. In-hospital mortality was 72%. Factors associated with mortality in our series were low GCS (≤ 8) at admission, transventricular bullet trajectory, and associated damage to deep brain structures, as reported before in the literature. Of the 64 patients admitted alive, 42% (27/64) were admitted to ICU, 34% (22/64) underwent surgery, and in 25% (16/64), craniotomy and hematoma evacuation was performed. Mortality in the surgically treated group was 32% but near 100% without surgery and ICU treatment. Median GOS in the surgically treated patients was 3 (range 1–5).

Conclusions

GSWB caused by contact shot from handguns has a high mortality rate, but can be survived with reasonable outcome if limited to lobar injury without significant damage to deep brain structures or brain stem. In such GSWB patients, initial aggressive resuscitation, ICU admission, and surgery seem indicated.

Electronic supplementary material

The online version of this article (10.1007/s00701-019-03952-y) contains supplementary material, which is available to authorized users.

Medico-legal evaluation of firearm injuries--an original study from India with review of literature

Firearm (FA) injuries pose great health burden and presents enormous challenge for health and national economies. This study was undertaken to analyze the characteristics of fatal gunshot injuries, their pattern, associated factors, and postmortem findings in central India, to provide data for such fatalities in this region, which has not been reported earlier. This is a descriptive, retrospective cross-sectional study carried out on the victims of FA injuries referred to the mortuary. Of the autopsies conducted during study, 2.09% were firearm-related deaths. Of the cases, males (92.42%) notably outnumbered females in a ratio of 12.2:1. Homicidal attacks were maximum, and unlicensed, illegal country-made weapons were the preferred choice. Suicides were least. Result signifies that illegal country-made weapons should be strictly limited to save the precious lives. A holistic approach encompassing public awareness, behavioral modification, and stringent management of law and order is the need of the hour.

Temporal variation in United States firearm injuries 1993-2008: results from a national data base

BACKGROUND

There are few studies that address temporal variation in firearm associated injuries. It was the purpose of this study to analyze the temporal variation in the types and patterns of injuries associated with firearm use from a national data base.

METHODS

The database used was the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2008. Emergency department visits associated with firearm use were analyzed for month and day of the week for various demographic variables. Statistical analyses were performed using SUDAAN 10™ software to give national estimates. Temporal variation by month or day was assessed using histograms, circular distributions, and cosinor analyses. Variation by month and day combined were analyzed using three dimensional contours.

RESULTS

There were an estimated 1,841,269 injuries. Circular analyses demonstrated a non-uniform distribution for all parameters for both month and day of injury (p less than 0.001). The overall peak was September 15 with several exceptions. Injuries from BB guns had a peak on May 22, a diagnosis of a foreign body on July 11, and patients aged 10 to 14 years on April 9.The peak day was always Saturday/Sunday when significant variation existed. There were many different patterns for month and day combined. Some were "a rapidly rising high mountain starting at sea level" (hunting), or others a "series of mountain ranges starting from a high plain or steppe" (hospital admissions).

CONCLUSIONS

This study provides altogether new information regarding temporal variation for injuries associated with firearms in the USA. These results can be used to assist medical resource allocation and prevention campaigns. Education campaigns can be emphasized before the peaks for which prevention is desired (eg. BB gun prevention campaigns should be concentrated in March, prior to the April/May peak).

Swedish hunters' safety behaviour and experience of firearm incidents

Since any firearm injury is potentially lethal, it is of great interest to prevent firearm incidents. This study investigated such incidents during hunting and Swedish hunters' safety behaviour. A 48-item questionnaire was posted to a random sample of 1000 members of the Swedish Association for Hunting and Wildlife Management. The questions considered demographics, hunting experience/hunting habits/safety behaviour/attitudes and experience of careless weapon handling, hunters' weapons and safety behaviour relating to weapons, health status, firearm incidents and their preventability, and personal comments on the questionnaire. The response rate was almost 50%. The mean age of the responders was 54 years; 5% were females. Almost none (1%) reported hunting under the influence of alcohol. Young age and male sex were positively associated with risk behaviour, although the presence of multiple risk behaviours in the same responder was not common. A very high degree of compliance with Swedish laws regarding weapon storage was reported. One-quarter of the responders had witnessed a firearm incident caused by another hunter, which in most situations did not result in human injury or death. An unsafetied weapon was the most common reported "cause" of these incidents. Experience of a firearm incident was not uncommon and the majority of the responders considered the incident in question to be preventable. This study provides a picture of the possible risk behaviour among hunters and the results suggest that future prevention work should target safer weapon handling.

Adolescent risk factors for poisonings - a prospective cohort study

AIM

This study assessed whether adolescents' socioeconomic background, health and health behaviours are associated with later risk of poisoning hospitalization.

METHODS

A prospective cohort of 54,169 Finns aged 14-18 years was followed for an average of 10.6 years. The end-point of the study was poisoning hospitalization, death or termination of follow-up in 2001. The relationships of socioeconomic background, health and health behaviour characteristics with poisoning hospitalization were studied with adjusted Cox's proportional hazard model.

RESULTS

We identified 443 persons (0.8%) with a diagnosed poisoning leading to hospital admission. The mean age at the time of the poisoning hospitalization was 22.7 years. The strongest risk factors for poisoning hospitalization in males were more than three stress symptoms weekly (HR 1.9), poor school success (HR 1.9) and not living with both of the parents in adolescence (HR 1.8). In females, the strongest risk factors were more than three stress symptoms weekly (HR 2.1), poor school success (HR 2.2) and recurring drunkenness as drinking style (HR 1.7).

CONCLUSION

Poor school performance, health and health-compromising behaviour adopted in adolescence are associated with a poisoning hospitalization risk in adulthood. Daily smoking and recurring drunkenness were strongly associated with a later poisoning hospitalization.

Trauma systems and early management of severe injuries in Scandinavia: review of the current state

INTRODUCTION

Scandinavian countries face common challenges in trauma care. It has been suggested that Scandinavian trauma system development is immature compared to that of other regions. We wanted to assess the current status of Scandinavian trauma management and system development.

METHODS

An extensive search of the Medline/Pubmed, EMBASE and SweMed+ databases was conducted. Wide coverage was prioritized over systematic search strategies. Scandinavian publications from the last decade pertaining to trauma epidemiology, trauma systems and early trauma management were included.

RESULTS

The incidence of severe injury ranged from 30 to 52 per 100,000 inhabitants annually, with about 90% due to blunt trauma. Parts of Scandinavia are sparsely populated with long pre-hospital distances. In accordance with other European countries, pre-hospital physicians are widely employed and studies indicate that this practice imparts a survival benefit to trauma patients. More than 200 Scandinavian hospitals receive injured patients, increasingly via multidisciplinary trauma teams. Challenges remain concerning pre-hospital identification of the severely injured. Improved triage allows for a better match between patient needs and the level of resources available. Trauma management is threatened by the increasing sub-specialisation of professions and institutions. Scandinavian research is leading the development of team- and simulation-based trauma training. Several pan-Scandinavian efforts have facilitated research and provided guidelines for clinical management.

CONCLUSION

Scandinavian trauma research is characterised by an active collaboration across countries. The current challenges require a focus on the role of traumatology within an increasingly fragmented health care system. Regional networks of predictable and accountable pre- and in-hospital resources are needed for efficient trauma systems. Successful development requires both novel research and scientific assessment of imported principles of trauma care.

Secular trends in poisonings leading to hospital admission among Finnish children and adolescents between 1971 and 2005

OBJECTIVE

To investigate the secular trends in childhood poisonings leading to hospitalization in Finland.

STUDY DESIGN

All children and adolescents age 0 to 19 years hospitalized in Finland with the primary diagnosis of poisoning between 1971 and 2005 were identified using the International Classification of Diseases.

RESULTS

During the study period, there were 41 862 hospitalizations with 96 427 hospital bed days for poisoning in 38 582 children and adolescents. The incidence of hospitalization declined from 91.3 admissions per 100 000 person-years in boys and 105.2 per person-years in girls in 1971 to 64.8 in boys and 83.5 in girls in 2005. In the 0- to 4-year age group, admissions declined by 51%. Hospitalizations for alcohol poisoning increased 1.7-fold (95% confidence interval = 1.4 to 2.2) in boys and 2.4-fold (95% confidence interval = 1.8 to 3.3) in girls. Alcohol poisoning was the primary diagnosis in 53% of those in the 10- to 14-year age group.

CONCLUSIONS

Poisoning remains an important cause of morbidity in Finnish children and adolescents despite the decreased overall incidence of poisonings leading to hospitalization between 1971 and 2005. The increasing trend of hospital admissions for alcohol poisoning, especially in 10- to 14-year-olds, is noteworthy. Effective primary prevention programs and adult supervision should be targeted at reducing alcohol consumption and alcohol-related poisonings in youth.

Paediatric poisonings treated in one Finnish main university hospital between 2002 and 2006

AIM

Acute poisonings are a major cause of morbidity among children. This study aims to describe the incidence and nature of emergency visits for acute paediatric poisoning among Finnish children.

METHODS

All patients younger than 16 years admitted to the Tampere University Hospital's emergency department with a diagnosis of poisoning during 2002-2006 were identified from the Hospital Information System using the International Classification of Diseases (ICD-10).

RESULTS

Altogether 369 emergency visits were diagnosed with poisoning, the overall incidence being 8.1 per 10 000 person-years (95% CI 7.3-9.0). A majority of patients were adolescents aged 10-15 years (48%) and children under 5 years (45%). Boys represented 55% of the cases. Nonpharmaceutical agents were suspected to be the cause in 60.4% and pharmaceuticals in 30.6% of the intoxications. Multiple agents were involved in 8.4% of the cases. Ethanol was the agent in 30.9% of the poisonings. Most patients (78.9%) were hospitalized (median length of stay 1 day). Overall mortality was 0.3%.

CONCLUSION

Acute paediatric poisonings represent a relatively frequent problem in Finland, and remain a life-threatening problem. The high proportion of alcohol poisonings highlights the necessity to develop more effective primary prevention programs.