1
|
Hanson HR, Formica M, Laraque-Arena D, Zonfrillo MR, Desai P, O'Neil JO, Unni P, Johnson EL, Cobb P, Agarwal M, Beckworth K, Schroter S, Strotmeyer S, Donnelly KA, Middelberg LK, Morse AM, Dodington J, Latuska RF, Anderson B, Lawson KA, Valente M, Levas MN, Kiragu AW, Monroe K, Ruest SM, Lee LK, Charyk Stewart T, Attridge MM, Haasz M, Jafri M, McIntire A, Rogers SC, Uspal NG, Blanchard A, Hazeltine MD, Riech T, Jennissen C, Model L, Fu Q, Clukies LD, Juang D, Ruda MT, Prince JM, Chao S, Yorkgitis BK, Pomerantz WJ. A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic. Inj Epidemiol 2023; 10:66. [PMID: 38093383 PMCID: PMC10717699 DOI: 10.1186/s40621-023-00476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. METHODS This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020. RESULTS The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019. CONCLUSIONS The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.
Collapse
Affiliation(s)
- Holly R Hanson
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Margaret Formica
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, New York, New York, USA
- Clinical Epidemiology and Pediatrics, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, Syracuse, NY, USA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Puja Desai
- Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph O O'Neil
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Purnima Unni
- Department of Pediatric Trauma, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Estell Lenita Johnson
- Department of Epidemiology, School of Public Health, Injury Free Coalition for Kids, Columbia University, New York City, NY, USA
| | - Patricia Cobb
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maneesha Agarwal
- Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristen Beckworth
- Center for Childhood Injury Prevention, Texas Children's Hospital, Houston, TX, USA
| | - Stephanie Schroter
- Department of Pediatric Emergency Medicine, University of California, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Stephen Strotmeyer
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Allegheny County Health Department, Pittsburgh, PA, USA
| | - Katie A Donnelly
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Leah K Middelberg
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amber M Morse
- Division of Pediatric Emergency Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | | | - Richard F Latuska
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brit Anderson
- Department of Pediatric Emergency Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Karla A Lawson
- Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Michael Valente
- Department of Pediatric Emergency Medicine, Children's Health Orange County, Orange, CA, USA
| | - Michael N Levas
- Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew Waititu Kiragu
- Department of Pediatrics, University of Minnesota and Children's Minnesota, Minneapolis, MN, USA
| | - Kathy Monroe
- Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephanie M Ruest
- Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Tanya Charyk Stewart
- Department of Paediatrics, University of Western Ontario and London Health Sciences Centre, London, ON, Canada
| | - Megan M Attridge
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maya Haasz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mubeen Jafri
- Department of Pediatric Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Alicia McIntire
- Department of Pediatric Surgery, Randall Children's Hospital at Emanuel Legacy, Portland, OR, USA
| | - Steven C Rogers
- Department of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Hospital, Hartford, CT, USA
| | - Neil G Uspal
- Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Ashley Blanchard
- Department of Emergency Medicine, Columbia University Medical Center, New York City, NY, USA
| | - Max D Hazeltine
- Department of Surgery, UMass Chan Medical School, Worcester, MA, USA
| | - Teresa Riech
- Department of Pediatric Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Charles Jennissen
- Department of Pediatrics, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Emergency Medicine, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Lynn Model
- Department of Pediatric Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Quinney Fu
- Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Lindsay D Clukies
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michelle T Ruda
- Department of Pediatrics, Children's Memorial Hermann Hospital, UTHealth Houston, Houston, TX, USA
| | - Jose M Prince
- Department of Pediatric Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Stephanie Chao
- Division of Pediatric Surgery, Stanford School of Medicine, Palo Alto, CA, USA
| | - Brian K Yorkgitis
- Department of Surgery, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Wendy J Pomerantz
- Division of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
2
|
Oral R, Coohey C, Zarei K, Conrad A, Nielsen A, Wibbenmeyer L, Segal R, Wojciak AS, Jennissen C, Peek-Asa C. Nationwide efforts for trauma-informed care implementation and workforce development in healthcare and related fields: a systematic review. Turk J Pediatr 2021; 62:906-920. [PMID: 33372429 DOI: 10.24953/turkjped.2020.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is building evidence that Adverse Childhood Experiences without early and proper intervention leads to subsequent short- and long-term behavioral, social, physical and mental health problems. Practitioners, researchers, and healthcare systems have been implementing trauma-informed care (TIC) in a variety of health and human services settings, resulting in improvements in clinical care and prevention of illness by identifying high risk populations. This has led to positive health outcomes including improved compliance, better access to mental health services and reduced health care costs. A systematic review was conducted of studies that focused on TIC implementation in healthcare settings, statewide TIC implementation, impact of adverse childhood experiences on health outcomes, impact of TIC on health outcomes, and evaluation of TIC implementation. A search was conducted in March 2019 to identify studies in PubMed, Medline, and other online literature. We limited our search to articles published in English after 2000. This article aims to review the components of TIC phases of implementation in healthcare settings, success stories across the nation to help the readers understand the importance of a paradigm shift to improve healthcare delivery and health outcomes and to prevent illness starting from childhood with a family centered care perspective.
Collapse
Affiliation(s)
- Resmiye Oral
- Clinical Pediatrics, Carver College of Medicine, University of Iowa
| | | | | | | | - Anne Nielsen
- Stead Family Children's Hospital, University of Iowa
| | | | | | | | - Charles Jennissen
- Pediatrics and Emergency Medicine, Carver College of Medicine, University of Iowa
| | | |
Collapse
|
3
|
Jennissen C, Wetjen K, Hoogerwerf P, Mulford L, Harland K, Denning G. JA:2021-13. Recreational Off-Highway Vehicle Exposure, Safety Behaviors and Crash Experiences among Iowa FFA Members. J Agromedicine 2020. [DOI: 10.1080/1059924x.2020.1763743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Charles Jennissen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, Iowa, USA
| | - Kristel Wetjen
- Division of Pediatric Surgery, Department of Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Pam Hoogerwerf
- Injury Prevention and Community Outreach, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
| | - Lauren Mulford
- Injury Prevention and Community Outreach, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
| | - Karisa Harland
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, Iowa, USA
| | - Gerene Denning
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, Iowa, USA
| |
Collapse
|
4
|
Affiliation(s)
- Serap Gorucu
- Department of Agricultural and Biological Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Bryan Weichelt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Gerene Denning
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Charles Jennissen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | |
Collapse
|
5
|
Jennissen C, Stange N, Wymore C, Hooyer M, Hoogerwerf P, Mulford L, Denning G. JA:2021-12. How to Increase ATV Safe Riding Behaviors in Youth: FFA Members from across the Country Respond. J Agromedicine 2020. [DOI: 10.1080/1059924x.2020.1763742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Charles Jennissen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Nicholas Stange
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Cole Wymore
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Mitchell Hooyer
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Pam Hoogerwerf
- Injury Prevention and Community Outreach Program, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa, USA
| | - Lauren Mulford
- Injury Prevention and Community Outreach Program, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa, USA
| | - Gerene Denning
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| |
Collapse
|
6
|
Khorsandi F, Ayers P, Denning G, Jennissen C, Jepsen D, Myers M, Oesch S, Pate M, White DJ. Agricultural All-Terrain Vehicle Safety: Hazard Control Methods Using the Haddon Matrix. J Agromedicine 2020; 26:420-435. [PMID: 33169657 DOI: 10.1080/1059924x.2020.1837705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
All-terrain vehicle (ATV) crashes are one of the leading causes of death and injury in agriculture across the United States. Use of ATVs is highly prevalent in rural areas and has seen an increase in their application for a variety of agricultural work tasks. Empirical research on the use of these vehicles for agricultural tasks and associated injuries is limited, especially in the United States. Moreover, little is known about the risk factors associated with ATV-related injuries while doing farm work. A comprehensive review was conducted to evaluate the current injury burden of ATV use in agriculture, the need for future research, and possible solutions related to agricultural ATV safety. Potential injury prevention approaches are evaluated based on the hierarchy of control, including elimination or substitution (using side-by-side vehicles instead of ATVs or modifying ATV design), engineering control (operator protection devices), administrative authority (regulations and standards in the United States and around the world), training, and use of personal protective equipment. In addition, vehicle nomenclature, risk factors, and crash mechanisms are reviewed. Recommendations to decrease the likelihood of ATV crashes and injuries are provided.
Collapse
Affiliation(s)
- Farzaneh Khorsandi
- Agricultural Safety and Health Engineering Assistant Specialist in Cooperative Extension, Defpartment of Biological and Agricultural Engineering, University of California, Davis
| | - Paul Ayers
- Professor, Department of Biosystems Engineering and Soil Science, University of Tennessee, Knoxville
| | - Gerene Denning
- Emeritus Research Scientist in Emergency Medicine, Department of Emergency Medicine, University of Iowa Carver College of Medicine
| | - Charles Jennissen
- MD,Clinical Professor of Pediatrics and Emergency Medicine, Department of emergency medicine, University of Iowa Carver College of Medicine
| | - Dee Jepsen
- Associate Professor / State Agricultural Safety Leader, Department of Food, Agricultural and Biological Engineering, agricultural safety and health program, The Ohio State University
| | - Melvin Myers
- Associate Professor (Adjunct), Environmental Health, Emory University, Emory Rollins School of Public Health, Atlanta, Georgia
| | | | - Michael Pate
- Associate Professor, Applied Sciences, Technology & Education, Agricultural Systems Technology and Education program, Utah State University
| | - David J White
- PhD, Professor of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, School of Social and Behavioral Health Sciences and Extension 4-H Youth Development, Oregon State University
| |
Collapse
|
7
|
Fjeld A, Stange N, Denning G, Jennissen C. 293 The Dangers of Off-Road Vehicles to Youths: Not Something to Kid Around About. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
8
|
Wymore C, King R, Stange N, Wetjen K, Hoogerwerf P, Wood K, Shilyansky J, Mulford L, Jennissen C. 290 Rural Youth’s Exposure to Firearm-Related Injury and Death and Their Attitudes Regarding Firearms. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
9
|
Hooyer M, Wymore C, Stange N, Wetjen K, Hoogerwerf P, Wood K, Shilyansky J, Mulford L, Jennissen C. 291 Firearm Presence and Storage in Rural Youth Homes. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
10
|
Fjeld A, Sampson L, Stange N, Denning G, Jennissen C. 295 Roadway to Disaster: Adult All-Terrain Vehicle Crashes on Iowa Roads. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Jennissen C, Schaefer K, Denning G, Leonard S. JA:2021-11. Exposure, Crashes, and Deaths Related to the Use of All-Terrain Vehicles for Spraying. J Agromedicine 2020. [DOI: 10.1080/1059924x.2020.1763738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Charles Jennissen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, Iowa, USA
| | | | - Gerene Denning
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, Iowa, USA
| | - Stephanie Leonard
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
12
|
Abstract
Background Helmets prevent head trauma in both all-terrain vehicle (ATV) and bicycle crashes. This pilot study’s objective was to compare family helmet use and participant attitudes regarding helmets for ATVs versus bicycles. Methods A convenience sampling of adults attending a 2017 university-sponsored health fair who had at least one child < 18 years living at home were surveyed. Demographics, frequency of helmet use, and information about factors influencing helmet use were collected. Descriptive (frequencies) and bivariate (Fisher’s exact test) analyses were performed. Qualitative themes of written responses were also examined. Results Subjects (N = 98) were 26–57 years old (mean 40 years). Three-quarters (76%) were female. The percentage always wearing a helmet riding bicycles was 63% (subjects), 58% (spouses/partners), and 51% (children), compared to 11, 14 and 37% on ATVs, respectively. Moreover, the percentage never wearing a helmet while on an ATV was 68% for subjects, 71% for spouses, and 47% for children. Despite helmet use differences between bicycles and ATVs, the importance of children wearing a helmet on these vehicles was rated highly and equally important, 9.28 and 9.58 on a 1–10 scale, respectively. Higher proportions of subjects’ oldest children wore a bike helmet 100% of the time if at least one parent always wore a helmet (81%), compared to children whose parents both wore helmets < 100% of the time or didn’t ride (21%) (p < 0.0001). The proportion of children wearing ATV and bicycle helmets less than 100% of the time was significantly higher if parents reported barriers to effectively enforcing helmet use than if they did not (p = 0.04 and p = 0.004, respectively). Many reported a “strict no helmet, no bike/ATV riding rule” as being most effective in getting their children to always wear a helmet. Conclusions This study is the first to explore family helmet use while riding bicycles vs ATVs. Although parent’s belief in the importance of helmet use was high for both, helmet use was greater when riding bicycles. Further research is needed to better understand the social and environmental influences that shape parental helmet attitudes and practices in order to improve safety interventions for increasing pediatric helmet use.
Collapse
Affiliation(s)
- Cole Wymore
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Gerene Denning
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Pamela Hoogerwerf
- Injury Prevention and Community Outreach Program, University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, USA
| | - Kristel Wetjen
- Pediatric Trauma Program, University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, USA
| | - Charles Jennissen
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, USA. .,Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, USA.
| |
Collapse
|
13
|
Weichelt B, Gorucu S, Jennissen C, Denning G, Oesch S. Assessing the Emergent Public Health Concern of All-Terrain Vehicle Injuries in Rural and Agricultural Environments: Initial Review of Available National Datasets in the United States. JMIR Public Health Surveill 2020; 6:e15477. [PMID: 32469319 PMCID: PMC7293057 DOI: 10.2196/15477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/17/2020] [Accepted: 02/15/2020] [Indexed: 02/03/2023] Open
Abstract
Background Injuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural and agricultural environments. In the United States alone, ATVs have played a role in thousands of fatalities and millions of injuries in the recent decades. However, no known centralized federal surveillance system consistently captures these data. Traditional injury data sources include surveys, police reports, trauma registries, emergency department data, newspaper and online media reports, and state and federal agency databases. Objective The objectives of this study paper were to (1) identify published articles on ORV-related injuries and deaths that used large databases and determine the types of datasets that were used, (2) examine and describe several national US-based surveillance systems that capture ORV-related injuries and fatalities, and (3) promote and provide support for the establishment of a federally-funded agricultural injury surveillance system. Methods In this study, we examined several national United States–based injury datasets, including the web-based AgInjuryNews, the Fatality Analysis Reporting System, databases compiled by the US Consumer Product Safety Commission, and the National Fatality Review Case Reporting System. Results Our review found that these data sources cannot provide a complete picture of the incidents or the circumstantial details needed to effectively inform ORV injury prevention efforts. This is particularly true with regard to ORV-related injuries in agricultural production. Conclusions We encourage the establishment of a federally funded national agricultural injury surveillance system. However, in lieu of this, use of multiple data sources will be necessary to provide a more complete picture of ORV- and other agriculture-related injuries and fatalities.
Collapse
Affiliation(s)
- Bryan Weichelt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, United States
| | - Serap Gorucu
- Department of Agricultural and Biological Engineering, Penn State University, University Park, PA, United States
| | - Charles Jennissen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Gerene Denning
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | | |
Collapse
|
14
|
Peterson C, Jennissen C. 397 Snowmobile-related injuries in U.S. Emergency Departments 2001–2013. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
15
|
Denning G, Jennissen C. 186 U.S. recreational off-highway vehicle crashes; an emerging health and safety concern. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
16
|
Denning G, Chau J, Harland K, Jennissen C. 361 A population-based study of all-terrain vehicle exposure in a rural county. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
17
|
Jennissen C, Waters J, Denning G, Robinson E, Baranow E, Johnson B, Johnson N, Wetjen K, Hoogerwerf P, Harland K. 663 Regulations and enforcement in off-highway vehicle parks is associated with safer riding behaviours. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
18
|
Jennissen C, Godding J, Harland K, Denning G. 24 The effect of passengers on all-terrain vehicle crash mechanisms and injuries. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041654.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
19
|
Jennissen C, Godding J, Harland K, Denning G. 40 Why the need for speed? – ATVS, speed and brain injuries. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041654.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
20
|
Jennissen C, Godding J, Denning G. 19 Mechanisms and contributing factors of side-by-side vehicle crashes. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041654.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
21
|
Jennissen C, Wilkinson B, Denning G. 11 Off-road vehicle regulation enforcement at IOWA off-highway vehicle parks. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041654.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
22
|
Jennissen C, Robinson E, Baranow E, Greene G, Denning G. 57 Methodology validation of using motion-activated cameras to estimate off-highway vehicle park census data and evaluate rider safety behaviours. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041654.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
23
|
Denning G, Jennissen C, Harland K, Ellis D, Buresh C. All-terrain vehicles (ATVs) on the road: a serious traffic safety and public health concern. Traffic Inj Prev 2013; 14:78-85. [PMID: 23259522 DOI: 10.1080/15389588.2012.675110] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES On-road all-terrain vehicle (ATV) crashes are frequent occurrences that disproportionately impact rural communities. These crashes occur despite most states having laws restricting on-road ATV use. A number of overall risk factors for ATV-related injuries have been identified (e.g., lack of helmet, carrying passengers). However, few studies have determined the relative contribution of these and other factors to on-road crashes and injuries. The objective of our study was to determine whether there were differences between on- and off-road ATV crashes in their demographics and/or mechanisms and outcomes of injuries. METHODS Data were derived from our statewide ATV injury surveillance database (2002-2009). Crash location and crash and injury mechanisms were coded using a modification of the Department of Transportation (DOT) coding system. Descriptive analyses and statistical comparisons (chi-square test) of variables were performed. Multivariate logistic regression analysis was used to determine relative risk. RESULTS 976 records were included in the final analysis, with 38 percent of the injured individuals from on-road crashes. Demographics were similar for crashes at each location, with approximately 80 percent males, 30 percent under the age of 16, and 15 percent passengers. However, females and youths under 16 were over 4 times more likely to be passengers (P ≤ 0.0001), regardless of crash location. Compared to those off-road, on-road crash victims were approximately 10 times more likely to be involved in a vehicle-vehicle collision (P < 0.001), 3 times more likely to have a severe brain injury (P < 0.001), and twice as likely to have suffered major trauma (P < 0.001). Adult operators in on-road crashes were also twice as likely to test positive for alcohol as those off-road (P < 0.05). Helmet use significantly reduced the odds of sustaining a brain injury and on-road victims were only half as likely to be helmeted (P < 0.01). CONCLUSIONS More than 1 in 3 on-road crashes involved a collision with another vehicle, suggesting that ATVs on the road represent a potential traffic safety concern. Of note, helmets were associated with reduced risk for the number and severity of brain injuries, providing further support for the importance of helmet use. Finally, even controlling for helmet use, on-road crash victims suffered more major trauma and severe brain injuries than those off-road. Overall, our data reinforce the importance of laws restricting ATV road use and the need for effective enforcement, as well as the need to increase user education about ATV road-use laws and the dangers of riding on the roads.
Collapse
Affiliation(s)
- Gerene Denning
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
| | | | | | | | | |
Collapse
|
24
|
Jennissen C. THE SAFETY INFORMATION AND GUIDANCE PROVIDED TO PARENTS BY ALL-TERRAIN VEHICLE DEALERS AND SALES REPRESENTATIVES. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580a.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
25
|
Jennissen C, Buresh C, Harland K, Ellis D, Denning G. All-terrain vehicles on the road: a serious traffic safety concern. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590s.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
26
|
Denning G, Harland K, Ellis D, Jennissen C. 384 All-Terrain Vehicles: Deadly On and Off the Road. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
27
|
Denning G, Jennissen C, Harland K, Ellis D, Buresh C. 368 Off-Highway Vehicle Parks: Do Increased Regulations and Enforcement Improve All-Terrain Vehicle Safety? Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Jennissen C, Marsico J, Steffen J, Schnell T, McGehee D, Denning G. OPTIMISING SEAT LENGTH DESIGN TO MINIMISE EXTRA PASSENGERS ON ALL-TERRAIN VEHICLES. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580a.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
29
|
Jennissen C, Price M, Harland K, Denning G. A picture is worth a thousand words: utilising social media to better understand all-terrain vehicle crash mechanisms of real patients. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590s.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
30
|
Jennissen C, Harland K, Ellis D, Denning G. All-terrain vehicles: deadly on and off the road. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590s.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
31
|
Kleiber C, Jennissen C, McCarthy AM, Ansley T. Evidence-Based Pediatric Pain Management in Emergency Departments of a Rural State. The Journal of Pain 2011; 12:900-10. [DOI: 10.1016/j.jpain.2011.02.349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/11/2011] [Accepted: 02/15/2011] [Indexed: 11/25/2022]
|
32
|
Jennissen C, Wallace J, Donham K, Rendell D, Brumby S. Unintentional Needlestick Injuries in Livestock Production: A Case Series and Review. J Agromedicine 2010; 16:58-71. [DOI: 10.1080/1059924x.2011.534045] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
33
|
Jacobson P, El-Massah SF, Rogosheske J, Kerr A, Long-Boyle J, DeFor T, Jennissen C, Brunstein C, Wagner J, Tomblyn M, Weisdorf D. Comparison of two mycophenolate mofetil dosing regimens after hematopoietic cell transplantation. Bone Marrow Transplant 2009; 44:113-20. [PMID: 19151792 DOI: 10.1038/bmt.2008.428] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mycophenolic acid (MPA) is the active component of mycophenolate mofetil (MMF). Low MPA exposure is associated with a higher incidence of acute GVHD and possibly worse engraftment. Therapeutic plasma targets have been proposed in hematopoietic cell transplantation (HCT), however, are difficult to achieve in adult patients with MMF doses of 2 g/day. Mycophenolate pharmacokinetics was prospectively studied in adults undergoing nonmyeloablative HCT who received MMF 3 g/day with CYA. The first 15 individuals received 1.5 g every 12 h and the second 15 received 1 g every 8 h. Sampling was performed in each patient with i.v. and oral administration. There were no differences in total or unbound MPA 24-h cumulative area under the curves (AUCs), concentrations at steady state (Css) or troughs between the two dosing regimens (all P>0.01). The previously proposed total MPA Css target of 3 microg/ml and trough >or=1 micro/ml were achieved in only 13-27% and 20-53% of patients, respectively, on 3 g/day. However, the 3 g/day regimens readily achieved satisfactory unbound 24-h cumulative AUC targets of 0.600 microg(*)h/ml in 87-100% of subjects. There appears to be no significant difference in daily MPA exposure when MMF of 3 g/day is divided into two or three equal doses.
Collapse
Affiliation(s)
- P Jacobson
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Graber MA, Randles BD, Monahan J, Ely JW, Jennissen C, Peters B, Anderson D. What questions about patient care do physicians have during and after patient contact in the ED? The taxonomy of gaps in physician knowledge. Emerg Med J 2007; 24:703-6. [PMID: 17901270 PMCID: PMC2658437 DOI: 10.1136/emj.2007.050674] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To categorise questions that emergency department physicians have during patient encounters. METHODS An observational study of 26 physicians at two institutions. All physicians were followed for at least two shifts. All questions that arose during patient care were recorded verbatim. These questions were then categorised using a taxonomy of clinical questions. RESULTS Physicians had 271 questions in the course of the study. The most common questions were about drug dosing (35), what drug to use in a particular case (28), "what are the manifestations of disease X" (23), and what laboratory test to do in a situation (21). Notably lacking were questions about medication costs, administrative questions, questions about services in the community, and pathophysiology questions. CONCLUSIONS Emergency department physicians tend to have questions that cluster around practical issues such as diagnosis and treatment. In routine practice they have fewer epidemiologic, pathophysiologic, administrative, and community services questions.
Collapse
Affiliation(s)
- Mark A Graber
- Department of Emergency Medicine, University of Iowa Carver College Medicine, Iowa City, Iowa 52242, USA.
| | | | | | | | | | | | | |
Collapse
|