State injury prevention policies and variation in death from injury

National evaluation of the association between stay-at-home orders on mechanism of injury and trauma admission volume

BACKGROUND

The COVID-19 pandemic had numerous negative effects on the US healthcare system. Many states implemented stay-at-home (SAH) orders to slow COVID-19 virus transmission. We measured the association between SAH orders on the injury mechanism type and volume of trauma center admissions during the first wave of the COVID-19 pandemic.

METHODS

All trauma patients aged 16 years and older who were treated at the American College of Surgeons Trauma Quality Improvement Program participating centers from January 2018-September 2020. Weekly trauma patient volume, patient demographics, and injury characteristics were compared across the corresponding SAH time periods from each year. Patient volume was modeled using harmonic regression with a random hospital effect.

RESULTS

There were 166,773 patients admitted in 2020 after a SAH order and an average of 160,962 patients were treated over the corresponding periods in 2018-2019 in 474 centers. Patients presenting with a pre-existing condition of alcohol misuse increased (13,611 (8.3%) vs. 10,440 (6.6%), p <0.001). Assault injuries increased (19,056 (11.4%) vs. 15,605 (9.8%)) and firearm-related injuries (14,246 (8.5%) vs. 10,316 (6.4%)), p<0.001. Firearm-specific assault injuries increased (10,748 (75.5%) vs. 7,600 (74.0%)) as did firearm-specific unintentional injuries (1,318 (9.3%) vs. 830 (8.1%), p<0.001. In the month preceding the SAH orders, trauma center admissions decreased. Within a week of SAH implementation, hospital admissions increased (p<0.001) until a plateau occurred 10 weeks later above predicted levels. On regional sub-analysis, admission volume remained significantly elevated for the Midwest during weeks 11-25 after SAH order implementation, (p<0.001).

Demographics and Incident Location of Traumatic Injuries at a Single Level I Trauma Center

Introduction

Traumatic injuries are preventable and understanding determinants of injury, such as socio-economic and environmental factors, is vital. This study evaluated traumatic injuries and identified areas of high trauma incidence.

Methods

A retrospective review was conducted of all patients 14 years or older who were admitted with a traumatic injury to a Level I trauma center between 2016 and 2017. Descriptive analyses were presented and maps of high injury areas were generated.

Results

The most frequent mechanisms of injury were falls (58.3%), motor vehicle crashes (22.3%), and motorcycle crashes (5.7%). Fall patients were more likely to be female (59.6%) and were the oldest age group (72.1 ± 17.2) compared to motor vehicle and motorcycle crash patients. Severe head (22.1%, p = 0.007) and extremity (35.7%, p = 0.001) injuries were most frequent among fall patients, however, more motorcycle crash patients required mechanical ventilation (16.1%, p < 0.001) and experienced the longest intensive care unit length of stay (5.3 ± 6.8 days, p < 0.001) and mechanical ventilation days (6.6 ± 8.5, p < 0.036). Motorcycle crash patients also had the greatest number of deaths (7.5%, p < 0.001). The generated maps of all traumas suggested that most injuries occur near our hospital and are located in several of the most population-dense zip codes.

Conclusion

Patient demographics, injury severity, and hospital outcomes varied by mechanisms of injury. Traumatic injuries occurred near our hospital and were located in several of the most populationdense zip codes. Injury prevention efforts should target high incident areas.

Association of designated open water swim area regulations and open water drowning rates

BACKGROUND

Although most persons over 5 years of age drown in open water, few laws have sought to regulate open water swim sites. We examined the association between regulations for designated open water swim sites and open water drowning death rates by state.

METHODS

Using International Classification of Disease (ICD)-10 codes in the CDC Web-based Injury Statistics Query and Reporting System (WISQARS), we identified and calculated open water drowning deaths involving all ages from 2012 to 2017 for 50 states and calculated open water drowning death rates. We then identified and categorised types of state regulations (lifeguards, water quality, rescue equipment, tracking/planning/reporting and signage) for open water swim sites in place in 2017 for a sample of 30 states (20 high-drowning, 10 low-drowning). Analyses evaluated associations between open water drowning rates in three groups (overall, youth and non-white) and the total number and types of state regulations.

RESULTS

Swim site regulations and open water drowning death rates for 10 839 victims were associated in all regression models. States with more types of regulations had lower open water drowning death rates in a dose-response relationship. States lacking regulations compared with states with all five types of regulations had open water drowning death rates 3.02 times higher among youth (95% CI 1.82 to 4.99) and 4.16 times higher among non-white residents (95% CI 2.46 to 7.05). Lifeguard and tracking/planning/reporting regulations were associated with a 33% and 45% reduction in open water drowning rates overall and among those aged 0-17 years.

CONCLUSION

States' open water swim area regulations, especially addressing tracking/planning/reporting and lifeguards, were associated with lower open water drowning death rates.

Comparison of Secular Trends in Road Injury Mortality in China and the United States: An Age-Period-Cohort Analysis

This study aimed to identify and compare the mortality trends for road injuries in China and the United States, and evaluate the contributions of age, period, and cohort effects to the trends from 1990 to 2014. Using the 2016 Global Burden of Disease Study database, the mortality trends were analyzed by joinpoint regression and age-period-cohort modeling. Overall, the mortality for road injuries was higher in China than in the United States. The mortality in China increased from 1992 to 2002 (annual percent change [APC] was 1.9%), and then decreased from 2002 to 2015 (APC_2002–2009 was 1.5%; APC_2009–2015 was 3.5%). For the United States, the mortality decreased from 1990 to 2010 (APC_1990–1997 was 1.8%; APC_1997–2005 was 0.7%; APC_2005–2010 was 4.2%). Age-period-cohort modeling revealed significant period and cohort effects. Compared with the period 2002–2004, the period risk ratios (RRs) in 2010–2014 period declined by 14.62% for China and 18.86% for the United States. Compared with the 1955–1959 birth cohort, the cohort RRs for China and the United States in the 2010–2014 cohort reduced by 47.60% and 75.94%, respectively. Period and cohort effects could not be ignored for reducing road injury mortalities.

An analysis of the characteristics of road traffic injuries and a prediction of fatalities in China from 1996 to 2015

OBJECTIVES

This study analyzed the characteristics and burdens of road traffic injuries (RTIs) from the 3 perspectives of time, space, and population in China and predicted traffic fatalities using 2 models.

METHODS

By extracting data from the China Statistical Yearbooks and GBD 2015 (Global Health Data Exchange), we described the change in the time trend of traffic crashes and economic losses associated with the rate of motorization in China from 1996 to 2015; analyzed the geographical distribution of these events by geographic information system; and evaluated the age-, sex-, and cause-specific death rate, disability-adjusted life year (DALY) rate, years of life lost (YLL) rate, and years lost due to disability (YLD) rate lost from RTIs from 1990 to 2015. In addition, we predicted the traffic fatality (per population or vehicles) trend using the log-linear model derived from Smeed's and Borsos' models.

RESULTS

From 1996 to 2015, the motorization rate showed rapid growth, increasing from 0.023 to 0.188. With the growth in the motorization rate, the time trends of traffic crashes and economic losses in China changed, showing a tendency to first increase and then later decrease. The crashes and losses were closely correlated and mainly distributed in some of the economically developed provinces, including Zhejiang, Jiangsu, Anhui, Sichuan, and Guangdong provinces. The health burden of RTIs presented a time trend similar to that of the economic burden, and it was higher among males than females. The death rate among older pedestrians was higher. The DALY rate and YLL rate among young and middle-aged pedestrians were higher. The YLD rate among older motor vehicle drivers was higher. In addition, the fatalities per 10,000 vehicles continued to decline, and Borsos's model was better fitted to the reported traffic fatalities than Smeed's model.

CONCLUSIONS

Although the burden of RTIs in China has declined, the burden of RTIs is still heavy. Hence, RTIs remain a universal problem of great public health concern in China, and we need to work hard to reduce them.