Analysis of patients with bodyboarding injuries transported by physician-staffed emergency helicopter

The epidemiology, risk factors and impact of exposure on unintentional surfer and bodyboarder deaths

Surfing and bodyboarding (SAB) are popular activities, but not without risk. Limited SAB mortality and exposure risk explorations exist, so this cross-sectional study explores epidemiology and risk factors for SAB deaths (1 July, 2004-30 June,2020) in Australia: including decedent and incident profiles, causes of death, differences between fatalities during SAB and other coastal activities; and the impact of exposure on SAB mortality risk. Fatality data were sourced from the National Coronial Information System, incident and media reports. Tide-state data, population data and participation data were sourced from relevant authorities. Analyses included chi-square testing and simple logistic regression with odds ratios. There were 155 SAB deaths (80.6% surfing; 96.1% male; 36.8% aged 55+years; 0.04/100,000 residents; 0.63/100,000 surfers). Drowning was the most common cause of death (58.1%; n = 90), but higher in bodyboarding, with bodyboarders 4.62 times more likely to drown than surfers (95%CI: 1.66-12.82; p = 0.003). Almost half (44.5%; n = 69; χ22 = 9.802; p = 0.007) were with friends/family, and the largest proportion occurred during a rising tide (41.3%; n = 64; χ23 = 180.627; p<0.001) followed by a low tide (36.8%;n = 57). Australians surf 45.7 times each year, for 1.88 hours each visit equalling 86.1 'exposed' hours. With exposure-time considered, exposure-adjusted surfer mortality rate (0.06/1 million hours) is lower than other in-water activities (0.11/1 million hours). Younger surfers (14-34 years) surfed more yet had the lowest mortality rate (114.5 hours/year; 0.02/1 million hours). Older surfers (55+ years) had a lower SAB mortality rate (0.052) than the all-cause crude mortality rate of their average population counterparts (1.36). Cardiac conditions were identified in 32.9% (n = 69) of SAB deaths. SAB are relatively safe, with lower exposure mortality rates than other activities. Prevention should target older surfers, inland residents, and identification of surfers with risk factors for cardiac events.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Data quality of Glasgow Coma Scale and Systolic Blood Pressure in scientific studies involving physician-staffed emergency medical services: Systematic review

BACKGROUND

Emergency physicians on-scene provide highly specialized care to severely sick or injured patients. High-quality research relies on the quality of data, but no commonly accepted definition of EMS data quality exits. Glasgow Coma Score (GCS) and Systolic Blood Pressure (SBP) are core physiological variables, but little is known about the quality of these data when reported in p-EMS research. This systematic review aims to describe the quality of pre-hospital reporting of GCS and SBP data in studies where emergency physicians are present on-scene.

METHODS

A systematic literature search was performed using CINAHL, Cochrane, Embase, Medline, Norart, Scopus, SweMed + and Web of Science, in accordance with the PRISMA guidelines. Reported data on accuracy of reporting, completeness and capture were extracted to describe the quality of documentation of GCS and SBP. External and internal validity assessment was performed by extracting a set of predefined variables.

RESULTS

We included 137 articles describing data collection for GCS, SBP or both. Most studies (81%) were conducted in Europe and 59% of studies reported trauma cases. Reporting of GCS and SBP data were not uniform and may be improved to enable comparisons. Of the predefined external and internal validity data items, 26%-45% of data were possible to extract from the included papers.

CONCLUSIONS

Reporting of GCS and SBP is variable in scientific papers. We recommend standardized reporting to enable comparisons of p-EMS.

Correlation of history and physical examination with imaging in traumatic near-shore aquatic head and spinal injury

OBJECTIVE

It remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury.

METHODS

We conducted a multicenter retrospective comparative analysis of adult patients who were transported from the beach in Ocean City, Maryland, to three nearby emergency departments for possible spinal injury from 2006 through 2017. Patients suspected to have any spinal injury from beach activities were eligible. We excluded patients who could not verbalize their symptoms or with insufficient emergency department records. We compared components of each patient's HPI and PE with radiologic evidence of spinal injury. We calculated sensitivity, specificity, and negative and positive likelihood ratios (LRs).

RESULTS

We analyzed 278 patients with suspected spinal injury. Midline spinal tenderness was associated with increased likelihood of thoracic (LR+ 2.6) and lumbar spinal fractures (LR+ 3.5). HPI complaints of paralysis (LR+ 13.9) and sensory loss (LR+ 5.8) had strong associations with spinal cord injuries. Weakness found through PE was also associated with spinal cord injury (LR+ 5.3).

CONCLUSIONS

We identified several components of the clinical evaluation that had clinically significant association with spinal injuries from beach-related trauma. While prospective studies are needed to confirm our observations, clinicians may consider these high-risk features in patients with beach-related trauma and adjust testing and level of care appropriately.

Prospective analysis of surfing and bodyboard injuries

Objective

To assess the differences in the types of injuries sustained by surfboard and bodyboard riders and to identify common mechanisms of injury.

Methods

Subjects were prospectively recruited to the study on presentation to one of the six hospital emergency departments. Consented subjects completed a questionnaire while in the emergency departments. Data regarding radiological investigations undertaken and their findings were collected retrospectively.

Results

A total of 224 males and 28 females in the surfing group and 14 males in the bodyboard group were recruited. In surfers, the most common injured body parts were the head/face (115; 45.6%) and lower limb (69; 27.4%). Surfers were most commonly injured by a surfboard, either their own (178; 70.6%) or someone else’s (18; 7.1%). Unfortunately, the small number of subjects recruited to the bodyboard group precluded meaningful comparison with the surfing group.

Conclusions

The most common body part injured in surfers is the head/face compared with the lower limbs in bodyboard riders. Contact with a surfer’s board (most commonly their own) is the most common cause of injury. Significant spinal fractures/injuries are sustained when the surfer (usually their head) strikes the seafloor. Head and facial fractures occur when the surfer is struck by their own board. Future research into surfboard design which incorporates softer compounds into the deck, rail, and fins is recommended. The need for local authorities and surf lifesavers to disseminate information relating to specific beaches to the general public regarding surf conditions, water depth, and the nature of the seafloor is also essential for injury prevention.

An Analysis of Intoxicated Patients Transported by a Doctor Helicopter

OBJECTIVE

We retrospectively investigated all of the intoxicated patients who were transported by a doctor helicopter (DH) in eastern Shizuoka between April 2004 and December 2015 to determine when air medical transport was used in cases of toxic exposure.

METHODS

Subjects were divided into 2 groups: an outpatient group of subjects who went home after receiving a medical evaluation and treatment and an admission group.

RESULTS

The outpatient and admission groups included 17 and 31 subjects, respectively. The ratio of dispatching the DH to the scene and the median Glasgow Coma Scale score in the outpatient group were greater, and the shock index in the outpatient group was significantly smaller than in the admission group. The duration from exposure of intoxicated agents to contact by staffs of the DH in the outpatient group was also smaller than in the admission group.

CONCLUSION

The level of consciousness and shock index may be important factors dictating whether or not to dispatch the DH in order to prevent secondary damage induced by unstable circulation.

Characteristics of patients who fell into open drains: a report from a single emergency center in East Shizuoka: Epidemiology of patients who fell into open drains in East Shizuoka

Aim

To clarify the characteristics of injuries caused by falling into an open drain.

Methods

A medical chart review was retrospectively carried out of all patients in East Shizuoka, Japan, who were injured due to falling into an open drain, and who were subsequently transported to hospital by ambulance or a physician-staffed helicopter, between January 2013 and December 2014. The patients were divided into two groups, those treated as outpatients and those who were admitted to hospital.

Results

During the investigation period, there were 33 patients who had accidentally fallen into an open drain. The ages of the subjects ranged from 10 to 90 years, with an average age of 58.8 years. The average age of the subjects, the ratio of female patients, and the average injury severity score in the admission group were higher than that of the outpatient group. One patient in the admission group who had cardiac arrest due to a cervical cord injury eventually died.

Conclusion

Falls into open drains are especially frequent in elderly people and female patients, and older patients tend to more frequently require admission due to severe injury. To prevent injuries of this type, some measures are required to improve the safety of open drains.