scholarly journals Association of mechanism of injury with overtriage of injured youth patients as trauma alerts

2019 ◽  
Vol 4 (1) ◽  
pp. e000300 ◽  
Author(s):  
Jessica Lynn Ryan ◽  
Etienne Pracht ◽  
Barbara Langland-Orban ◽  
Marie Crandall
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Pediatric Trauma ◽  
International Classification Of Diseases ◽  
Mechanism Of Injury ◽  
Level Of Evidence ◽  
Severe Injuries ◽  
Firearm Injuries ◽  
Field Triage ◽  
Classification Of Diseases

BackgroundTrauma alert criteria include physiologic and anatomic criteria, although field triage based on injury mechanism is common. This analysis evaluates injury mechanisms associated with pediatric trauma alert overtriage and estimates the effect of overtriage on patient care costs.MethodsFlorida’s Agency for Health Care Administration inpatient and financial data for 2012–2014 were used. The study population included mildly and moderately injured patients aged 5–15 years brought to a trauma center and had an International Classification of Diseases-based Injury Severity Score survival probability ≥0.90, a recorded mechanism of injury, no surgery, a hospital stay less than 24 hours, and discharged to home. Overtriaged patients were those who had a trauma alert. Logistic regression was used to analyze the odds of overtriage relative to mechanism of injury and multivariable linear regression was used to analyze cost of overtriage.ResultsTwenty percent of patients were overtriaged; yet these patients accounted for 37.2% of total costs. The mechanisms of injury related to firearms (OR 11.99) and motor vehicle traffic (2.25) were positively associated with overtriage as a trauma alert. Inpatient costs were 131.8% higher for overtriaged patients.DiscussionFirearm injuries and motor vehicle injuries can be associated with severe injuries. However, in this sample, a proportion of patients with this mechanism suffered minimal injuries. It is possible that further identifying relevant anatomic and physiologic criteria in youth may help decrease overtriage without compromising outcomes.Level of evidenceEconomic, level IV.

Prevalence and incidence of doctor-diagnosed Dupuytren’s disease: a population-based study

2017 ◽  
Vol 42 (7) ◽  
pp. 673-677 ◽  
Author(s):  
J. Nordenskjöld ◽  
M. Englund ◽  
C. Zhou ◽  
I. Atroshi
Keyword(s):  
General Population ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Dupuytren’S Disease ◽  
Level Of Evidence ◽  
Dupuytren's Disease ◽  
Population Based Study ◽  
Classification Of Diseases ◽  
First Time

The prevalence and incidence of doctor-diagnosed Dupuytren’s disease in the general population is unknown. From the healthcare register for Skåne region (population 1.3 million) in southern Sweden, we identified all residents aged ⩾20 years (on 31 December 2013), who 1998 to 2013 had consulted a doctor and received the diagnosis Dupuytren’s disease (International Classification of Diseases 10th Revision code M720). During the 16 years, 7207 current residents (72% men) had been diagnosed with Dupuytren’s disease; the prevalence among men was 1.35% and among women 0.5%. Of all people diagnosed, 56% had received treatment (87% fasciectomy). In 2013, the incidence of first-time doctor-diagnosed Dupuytren’s disease among men was 14 and among women five per 10,000. The annual incidence among men aged ⩾50 years was 27 per 10,000. Clinically important Dupuytren’s disease is common in the general population. Level of evidence: III

Hospitalizations Due to Firearm Injuries in Children and Adolescents

2017 ◽  
pp. 33-39
Author(s):  
John M. Leventhal ◽  
Julie R. Gaither ◽  
Robert Sege
Keyword(s):  
Children And Adolescents ◽  
Suicide Attempts ◽  
International Classification Of Diseases ◽  
The United States ◽  
Hospitalization Rate ◽  
Firearm Injuries ◽  
White Males ◽  
Classification Of Diseases ◽  
Weighted Number ◽  
Us Children

BACKGROUND AND OBJECTIVE Despite recent national attention on deaths from firearms, little information exists about children and adolescents who are hospitalized for firearm injuries. The objective was to determine the national frequency of firearm-related hospitalizations in the United States in children, compare rates by cause and demographics, and describe hospitalized cases. METHODS We used the 2009 Kids’ Inpatient Database to identify hospitalizations from firearm-related injuries in young people <20 years of age; International Classification of Diseases, Ninth Revision, Clinical Modification, and external-cause-of injury codes were used to categorize the injuries and the causes as follows: assault, suicide attempt, unintentional, or undetermined. Incidences were calculated by using the weighted number of cases and the intercensal population. Risk ratios compared incidences. RESULTS In 2009, 7391 (95% confidence interval [CI]: 6523–8259) hospitalizations were due to firearm-related injuries. The hospitalization rate was 8.87 (95% CI: 7.83–9.92) per 100 000 persons <20 years of age. Hospitalizations due to assaults were most frequent (n = 4559) and suicide attempts were least frequent (n = 270). Of all hospitalizations, 89.2% occurred in males; the hospitalization rate for males was 15.22 per 100 000 (95% CI: 13.41–17.03) and for females was 1.93 (95% CI: 1.66–2.20). The rate for black males was 44.77 (95% CI: 36.69–52.85), a rate more than 10 times that for white males. Rates were highest for those aged 15 to 19 years (27.94; 95% CI: 24.42–31.46). Deaths in the hospital occurred in 453 (6.1%); of those hospitalized after suicide attempts, 35.1% died. CONCLUSIONS On average, 20 US children and adolescents were hospitalized each day in 2009 due to firearm injuries. Public health efforts are needed to reduce this common source of childhood injury.

Does Alcohol Intoxication Protect Patients from Severe Injury and Reduce Hospital Mortality? The Association of Alcohol Consumption with the Severity of Injury and Survival in Trauma Patients

2013 ◽  
Vol 79 (12) ◽  
pp. 1289-1294 ◽  
Author(s):  
Chi-Hsun Hsieh ◽  
Li-Ting Su ◽  
Yu-Chun Wang ◽  
Chih-Yuan Fu ◽  
Hung-Chieh Lo ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Hospital Stay ◽  
Brain Injuries ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Length Of Hospital Stay ◽  
Trauma Patients ◽  
Prolonged Hospital Stay ◽  
Severe Injuries ◽  
Prolonged Hospital

Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. Blood alcohol concentration (BAC) was routinely measured for each patient on admission. Patients were divided into four groups based on their BAC level, which included nondrinking, BAC less than 100, BAC 100 to 200, and BAC 200 mg/dL or greater. Patient demographics, physical status and injury severity on admission, length of hospital stay, and outcome were compared between the groups. Odds ratios of having a severe injury, prolonged hospital stay, and mortality were estimated. Patients with a positive BAC had an increased risk of sustaining craniofacial and thoracoabdominal injuries. Odds ratios of having severe injuries (Injury Severity Score [ISS] 16 or greater) and a prolonged hospital stay were also increased. However, for those patients whose ISS was 16 or greater and who also had a brain injury, risk of fatality was significantly reduced if they were intoxicated (BAC 200 mg/dL or greater) before injury. Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.

scholarly journals Crash Telemetry-Based Injury Severity Prediction is Equivalent to or Out-Performs Field Protocols in Triage of Planar Vehicle Collisions

2019 ◽  
Vol 34 (04) ◽  
pp. 356-362 ◽  
Author(s):  
Katherine He ◽  
Peng Zhang ◽  
Stewart C. Wang
Keyword(s):  
At Risk ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Principal Direction ◽  
Trauma Centers ◽  
Sampling System ◽  
Vehicle Collisions ◽  
Field Triage ◽  
Severity Prediction ◽  
Patients At Risk

AbstractIntroduction:With the increasing availability of vehicle telemetry technology, there is great potential for Advanced Automatic Collision Notification (AACN) systems to improve trauma outcomes by detecting patients at-risk for severe injury and facilitating early transport to trauma centers.Methods:National Automotive Sampling System Crashworthiness Data System (NASS-CDS) data from 1999-2013 were used to construct a logistic regression model (injury severity prediction [ISP] model) predicting the probability that one or more occupants in planar, non-rollover motor vehicle collisions (MVCs) would have Injury Severity Score (ISS) 15+ injuries. Variables included principal direction of force (PDOF), change in velocity (Delta-V), multiple impacts, presence of any older occupant (≥55 years old), presence of any female occupant, presence of right-sided passenger, belt use, and vehicle type. The model was validated using medical records and 2008-2011 crash data from AACN-enabled Michigan (USA) vehicles identified from OnStar (OnStar Corporation; General Motors; Detroit, Michigan USA) records. To compare the ISP to previously established protocols, a literature search was performed to determine the sensitivity and specificity of first responder identification of ISS 15+ for MVC occupants.Results:The study population included 924 occupants in 836 crash events. The ISP model had a sensitivity of 72.7% (95% Confidence Interval [CI] 41%-91%) and specificity of 93% (95% CI 92%-95%) for identifying ISS 15+ occupants injured in planar MVCs. The current standard 2006 Field Triage Decision Scheme (FTDS) was 56%-66% sensitive and 75%-88% specific in identifying ISS 15+ patients.Conclusions:The ISP algorithm comparably is more sensitive and more specific than current field triage in identifying MVC patients at-risk for ISS 15+ injuries. This real-world field study shows telemetry data transmitted before dispatch of emergency medical systems can be helpful to quickly identify patients who require urgent transfer to trauma centers.

scholarly journals INCIDENCE OF ACUTE TRAUMA ON HAND AND WRIST: A RETROSPECTIVE STUDY

2017 ◽  
Vol 25 (6) ◽  
pp. 287-290 ◽  
Author(s):  
GIOVANNA DAMM RAPHAEL JUNQUEIRA ◽  
ANDRÉ LUIZ MACHADO LIMA ◽  
ROBISON BONI ◽  
JOELMAR CÉSAR DE ALMEIDA ◽  
RAFAEL SOUZA RIBEIRO ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Data Gathering ◽  
International Classification Of Diseases ◽  
Level Of Evidence ◽  
Correct Definition ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Definition Of ◽  
Epidemiological Profile

ABSTRACT Objectives: A retrospective statistical data gathering of wrist and hand complaints assisted over two years in the orthopedic emergency department of a regional referral hospital, seeking to know the profile of these patients. Methods: Information obtained by analysis of 31.356 orthopedic visits from May 2013 to April 2015, of which 6.754 related to hand complaints and/or wrist, at the Hospital Estadual Doutor Jayme dos Santos Neves (HDJSN) and analyzed by IBM SPSS Statistics software version 21. Results: The data revealed that the average age was 37,5 ± 15,7 years and the male gender was predominant (60,72%). Bruises (52,58%) and fractures (30,49%) were the most common diagnoses. Conclusion: The complaints of wrist and hand accounted for 21,44% of all orthopedic emergency room visits. Detailed data description and correct definition of the International Classification of Diseases (ICD-10) are needed to better define the epidemiological profile of patients seeking orthopedic emergency. Level of Evidence III, Retrospective Study.

Τραυματικοί θάνατοι στην Ελλάδα

2021 ◽  
Author(s):  
Λεωνίδας Ρουμελιώτης
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Abbreviated Injury Scale ◽  
Microsoft Access ◽  
Classification Of Diseases

Το τραύμα αποτελεί μείζον υγειονομικό πρόβλημα σε παγκόσμια κλίμακα. Η αποτελεσματική πρόληψη και αντιμετώπισή του βασίζεται στην κατανόηση του προβλήματος μέσω κατάλληλων επιδημιολογικών και υψηλής ποιότητας ερευνητικών δεδομένων. Σε απάντηση αυτής της αναγκαιότητας, στις αναπτυγμένες χώρες ιδρύθηκαν και είναι σε λειτουργία εθνικές και τοπικές βάσεις καταγραφής δεδομένων τραύματος. Η λειτουργία τους είναι απαιτητική σε πόρους και οικονομικό κόστος. Στην Ελλάδα αντίστοιχες προσπάθειες συστηματικής εκτίμησης της ποιότητας αντιμετώπισης των τραυματιών αποδείχθηκαν περιορισμένες τόσο σε εύρος κάλυψης πληθυσμού όσο και σε διάρκεια σε βάθος χρόνου. Στην παρούσα μελέτη παρουσιάζεται η διαδικάσια ίδρυσης, λειτουργίας και απόδοσης μίας μη κρατικής βάσης δεδομένων τραύματος, που περιλαμβάνει δεδομένα από θανατηφόρους τραυματισμούς κυρίως από την ευρύτερη περιοχή της Αττικής, αξιοποιώντας το αρχείο της Ιατροδικαστικής Υπηρεσίας Αθηνών. Τα Ιατροδικαστικά αρχεία αποτελούν σημαντική και συνεχή πηγή πληροφοριών για τραυματικούς θανάτους σε εθνικό επίπεδο, αφού η Ελληνική νομοθεσία επιβάλλει τη διένεργεια Ιατροδικαστικής εξέτασης στο σύνολο αυτών των θυμάτων. Η βάση δεδομένων γνωστή ως Attica-Trauma Audit and Research Autopsy-Based Registry είναι μία ηλεκτρονική βάση Microsoft Access, όπου συγκεντρώθηκαν ανώνυμα στοιχεία 9.266 διαδοχικών τραυματικών θανάτων της δεκαετίας μεταξύ 1 Ιανουαρίου 1996 και 31 Δεκεμβρίου 2005. Από το υλικό της βάσης δεδομένων έχουν δημοσιευτεί μέχρι τώρα δέκα πλήρεις μελέτες σε διεθνή ιατρικά περιοδικά του Pubmed, καθώς και πλήθος περιλήψεων σε διεθνείς και Ελληνικές επιστημονικές εκδηλώσεις. Οι κατηγορίες των συλλεχθέντων πληροφοριών βασίστηκαν στη μεθοδολογία των διεθνών βάσεων καταγραφής τραύματος της ίδιας περιόδου. Πηγές πληροφοριών αποτελέσαν τα έγγραφα των Ιατροδικαστικών φακέλων. Χρησιμοποιήθηκε η International Classification of Diseases 9th Revision (ICD-9) για την περιγραφή των συνθηκών του τραυματισμού, και η Abbreviated Injury Scale 1990 Revision (AIS90) για την περιγραφή των ανατομικών κακώσεων και τον υπολογισμό του Injury Severity Score (ISS). Παρουσιάζεται το σύνολο των επιδημιολογικών στοιχείων της βάσης καταγραφής, ανά κατηγορία δεδομένων, και σύμφωνα με τα πρότυπα ανάλυσης και παρουσιάσης των αποτελεσμάτων των διεθνών βάσεων καταγραφής τραύματος. Ακολουθούν ειδικές αναλύσεις για τους συχνότερους μηχανισμούς τραυματισμού: ατυχήματα μέσων μεταφοράς, οδικά τροχαία ατυχήματα, πτώσεις, διατιτραίνοντες τραυματισμοί. Δύο επιπλέον ειδικές αναλύσεις, που έχουν παρουσιαστεί στην ιατρική κοινότητα, ολοκληρώνουν τη διαδικασία της απόδοσης των δεδομένων: 1) τα κατάγματα του μηριαίου ως δείκτης βαρύτητας του τραυματισμού από οδικά τροχαία ατυχήματα, 2) η επίπτωση, οι παράγοντες κινδύνου και ο πιθανός χρόνος επέλευσης της μετατραυματικής Πνευμονικής Εμβολής στους θανατηφόρους τραυματισμούς. Η πλειονότητα των θυμάτων ήταν άρρενες (73,7%) με διάμεση ηλικία τα 36 έτη. Η πλειοψηφία των θανάτων συνέβει ως αποτέλεσμα οδικών τροχαίων ατυχημάτων (54,4%), ακολουθούμενα από τα θύματα πτώσεων (20,8%) και αυτά των διατιτραίνοντων μηχανισμών (10,1%). Η διάμεση τιμή του ISS ήταν 35 και 94,3% των θυμάτων είχαν ISS≥16 (βαρύς τραυματισμός). Ο χρόνος επέλευσης του θανάτου ακολούθησε μία τρικόρυφη κατανομή και 58,8% των θανάτων συνέβησαν σε προνοσοκομειακό επίπεδο με διάμεσο χρόνο διακομιδής τα 40 λεπτά. Τα κατάγματα μηριαίου στα πλαίσια οδικών τροχαίων ατυχημάτων σχετίστηκαν με υψηλότερη βαρύτητα τραυματισμού, όπως εκφράστηκε στις υψηλότερες τιμές ISS και στον βραχύτερο χρόνο μετατραυματικής επιβίωσης, καθώς και με κακώσεις του θώρακα, των κοιλιακών σπλάγχνων και σκελετικές κακώσεις των άνω και κάτω άκρων και του πυελικού δακτυλίου. Η επίπτωση της μετατραυματικής Πνευμονικής Εμβολής ήταν 4,3%, με πιθανό χρόνο επέλευσης από 0,66 ημέρες έως 3,5 μήνες. Παράγοντες κινδύνου που σχετίστηκαν θετικά με την εμφάνιση μετατραυματικής Πνευμονικής Εμβολής ήταν οι Δευτερογενείς θάνατοι και οι σκελετικές κακώσεις του πυελικού δακτυλίου. Στο τελευταίο τμήμα της παρούσας μελέτης παρουσιάζεται η εμπειρία της ομάδας εργασίας από την ανάπτυξη και τη λειτουργία της βάσης καταγραφής, στα πλαίσια της πιθανής μελλοντικής δημιουργίας αντίστοιχων προγραμμάτων επιτήρησης τραυματικών θανάτων σε τοπικό ή εθνικό επίπεδο. Τα πνευματικά δικαιώματα που απορέουν από την Attica-Trauma Audit and Research Autopsy-Based Registry ανήκουν στον εμπνευστή και Ιδρυτή (Founder) της Βάσης, Καθηγητή Ιορδάνη Παπαδόπουλο.

scholarly journals Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank

2020 ◽  
Vol 5 (1) ◽  
pp. e000441 ◽  
Author(s):  
Jesse Peek ◽  
Yassine Ochen ◽  
Noelle Saillant ◽  
Rolf H H Groenwold ◽  
Loek P H Leenen ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Flail Chest ◽  
Ventilatory Support ◽  
Data Bank ◽  
International Classification Of Diseases ◽  
Rib Fractures ◽  
Severe Injury ◽  
Level Of Evidence ◽  
National Trauma ◽  
National Trauma Data Bank

BackgroundIn recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogeneity among patients with traumatic rib fractures, there is insufficient literature reporting on the outcomes of different subgroups.MethodsA retrospective cohort study using the National Trauma Data Bank was performed. All adult patients with one or more traumatic rib fractures or flail chest who were admitted to a hospital between January 2010 and December 2016 were identified by the International Classification of Diseases Ninth Revision diagnostic codes.ResultsOf the 564 798 included patients with one or more rib fractures, 44.9% (n=2 53 564) were patients with polytrauma. Two per cent had open rib fractures (n=11 433, 2.0%) and flail chest was found in 4% (n=23 388, 4.1%) of all cases. Motor vehicle accidents (n=237 995, 51.6%) were the most common cause of rib fractures in patients with polytrauma and flail chest. Blunt chest injury accounted for 95.5% (n=5 39 422) of rib fractures. Rib fractures in elderly patients were predominantly caused by high and low energy falls (n=67 675, 51.9%). Ultimately, 49.5% (n=2 79 615) of all patients were admitted to an intensive care unit, of whom a quarter (n=146 191, 25.9%) required invasive mechanical ventilatory support. The overall mortality rate was 5.6% (n=31 524).DiscussionTraumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. Worse outcomes were predominantly observed among patients with polytrauma and flail chest. Future studies should recognize these differences and treatment should be evaluated accordingly.Level of evidenceII/III.

Both the multiplicative and single-worst-injury International Classification of Diseases Injury Severity Score underperform in urban Indian hospitals

Trauma ◽  
2018 ◽  
Vol 21 (4) ◽  
pp. 301-309
Author(s):  
Mattias Sterner ◽  
Jonatan Attergrim ◽  
Alice Claeson ◽  
Vineet Kumar ◽  
Monty Khajanchi ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Trauma Care ◽  
Severity Score ◽  
Injury Severity ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Operating Characteristics ◽  
Trauma Severity ◽  
Classification Of Diseases

Introduction Trauma accounts for 9% of all deaths worldwide, killing almost five million people annually. As India accounts for more than one million of these deaths, research on local trauma care is of great importance. A key aspect of such research is outcome comparisons between contexts. One tool to adjust these comparisons for trauma severity is the International Classification of Diseases Injury Severity Score. The aim was to assess two versions of this score in India. Methods The data used were from the project Towards Improved Trauma Care Outcomes in India. Published survival risk ratios were used to calculate multiplicative-International Classification of Diseases Injury Severity Score and single-worst-injury-International Classification of Diseases Injury Severity Score for the 200 most recent non-surviving patients and the surviving patients during the same period. Score performance was measured in discrimination and calibration. Results The 30-day prediction single-worst-injury-International Classification of Diseases Injury Severity Score discriminated best with an area under the receiver operating characteristics curve of 0.668 (95% CI 0.645–0.690) and a calibration slope of 0.830 (95% CI 0.708–0.940). Conclusions The single-worst-injury-International Classification of Diseases Injury Severity Score applied on 30-day mortality was the only score to calibrate on a satisfactory level. None of the scores had an acceptable discrimination. In interpreting these findings, we see that none of the tested scores can currently be implemented in the studied hospitals.

scholarly journals Major trauma patients are not who you might think they are: a linked data study

2019 ◽  
Vol 16 ◽  
Author(s):  
Elizabeth Brown ◽  
Hideo Tohira ◽  
Paul Bailey ◽  
Daniel Fatovich ◽  
Judith Finn
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
High Energy ◽  
Categorical Variables ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Continuous Variables ◽  
Mechanism Of Injury ◽  
Young Males

IntroductionMajor trauma patients are often perceived as being young males injured by high energy transfer mechanisms. The aim of this study was to describe the demographics of major trauma patients who were transported to hospital by ambulance.MethodsThis is a retrospective cohort study of adult major trauma (injury severity score >15) patients transported to hospital by St John Western Australia emergency ambulance in metropolitan Perth, between 1 January 2013 and 31 December 2016. To describe the cohort, median and interquartile range (IQR) were used for continuous variables and counts and percentages for categorical variables. Differences between mechanism of injury groups were assessed using the Kruskal-Wallis test. Trauma deaths were defined as early (declared deceased within 24 hours) or late (declared deceased within 30 days). ResultsA total of 1625 patients were included. The median age was 51 years (IQR 30-75) and 1158 (71%) were male. Falls from standing were the most common mechanism of injury (n=460, 28%) followed by motor vehicle crashes (n=259, 16%). Falls from standing were responsible for the majority of early (n=45/175, 26%) and late deaths (n=69/158, 44%). A large number of early deaths also resulted from motorbike crashes (n=32/175, 18%) with a median age of 34 years (IQR 21-46, p<0.001). ConclusionMajor trauma is not only a disease of the young. More than half of the cohort was more than 51 years of age and the most common cause was a fall from standing. Pre-hospital care must evolve to address the needs of a changing trauma patient demographic.

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