scholarly journals Driving under the influence: a multi-center evaluation of vehicular crashes in the era of cannabis legalization

2021 ◽  
Vol 6 (1) ◽  
pp. e000736
Author(s):  
Johanna Marie Borst ◽  
Todd W Costantini ◽  
Lindsay Reilly ◽  
Alan M Smith ◽  
Robert Stabley ◽  
...  
Keyword(s):  
Public Education ◽  
Trauma Center ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Driving Under The Influence ◽  
Driving Safety ◽  
Medical Examiner ◽  
Blood Alcohol ◽  
Level Of Evidence ◽  
Vehicular Crashes

BackgroundEleven states have instituted laws allowing recreational cannabis use leading to growing public health concerns surrounding the effects of cannabis intoxication on driving safety. We hypothesized that after the 2016 legalization of cannabis in California, the use among vehicular injury patients would increase and be associated with increased injury severity.MethodsSan Diego County’s five adult trauma center registries in were queried from January 2010 to June 2018 for motor vehicle or motorcycle crash patients with completed toxicology screens. Patients were stratified as toxicology negative (TOX−), positive for only THC (THC+), only blood alcohol >0.08% (ETOH+), THC+ETOH, or THC+ with any combination with methamphetamine or cocaine (M/C). County medical examiner data were reviewed to characterize THC use in those with deaths at the scene of injury.ResultsOf the 11,491 patients identified, there were 61.6% TOX−, 11.7% THC+, 13.7% ETOH+, 5.0% THC+ETOH, and 7.9% M/C. THC+ increased from 7.3% to 14.8% over the study period and peaked at 14.9% post-legalization in 2017. Compared with TOX− patients, THC+ patients were more likely to be male and younger. THC+ patients were also less likely to wear seatbelts (8.5% vs 14.3%, p<0.001) and had increased mean Injury Severity Score (8.4±9.4 vs 9.0±9.9, p<0.001) when compared with TOX− patients. There was no difference in in-hospital mortality between groups. From the medical examiner data of the 777 deaths on scene, 27% were THC+.DiscussionTHC+ toxicology screens in vehicular injury patients peaked after the 2016 legalization of cannabis. Public education on the risks of driving under the influence of cannabis should be a component of injury prevention initiatives.Level of evidenceIII, Prognostic

EXTENSIVE EPIDEMIOLOGICAL STUDY OF TRAUMATIC PNEUMOTHORAX IN SAUDI ARABIA’S POPULATION

2021 ◽  
pp. 32-34
Author(s):  
NASSER ALRASHIDI
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Demographic Data ◽  
Demographic Characteristics ◽  
Local Health ◽  
Common Cause ◽  
Traumatic Pneumothorax ◽  
Level 1 ◽  
Level 1 Trauma Center

Objectives: Traumatic pneumothorax is one of the causes of trauma mortality and morbidity. It is a problem for developing countries as many accidents can be avoided and there are few epidemiological data to support programs injury prevention. The main objective of the current study was to determine demographic characteristics, patterns, and severity of the injury, thoracic, and extra-thoracic related injuries in a Level 1 trauma center, Riyadh, Saudi Arabia (SA). Methods: This retrospective observational study used the King Abdulaziz Medical City Trauma Center’s trauma registry to review the data of traumatic pneumothorax patients admitted to the hospital from January 2001 to December 2018. Demographic characteristics, admission date and time, type and mechanism of injury, involved body area, and severity rates were analyzed. Results: A total of 708 patients of whom 92.3% were males. Blunt trauma (75.8%) is the most common cause of injury. Motor Vehicle Accidents (MVA) were the most common cause (57%) of traumatic pneumothorax. Rib fractures (36.5%), lung contusions (31.5%), and hemothorax (23.5%) were the most common clinical forms of chest injury associated with traumatic pneumothorax. On the other hand, the head injury (34.8%) was the most common extra thoracic part associated. The mean Injury Severity Score in the current study was found to be 20.1. Conclusion: This study showed the trends of traumatic pneumothorax injuries in a Level 1 trauma center, Riyadh, SA, showing MVA are the leading cause of traumatic pneumothorax in our region. These demographic data will be crucial for local health-care systems to be optimally resourced.

Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

2020 ◽  
Author(s):  
Nikathan Kumar ◽  
Kartik Prabhakaran ◽  
Matthew K. McIntyre ◽  
David J. Samson ◽  
Rifat Latifi
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Alcohol Intoxication ◽  
Blood Alcohol Concentration ◽  
Alcohol Ingestion ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Severity Scores ◽  
Severity Of Injury ◽  
Level 1

Abstract Background Previous studies show varied results regarding the protective effects of alcohol intoxication upon injury and mortality in the setting of trauma. Our study aimed to determine the effects of blood alcohol content (BAC) amongst trauma patients with alcohol ingestion, upon injury type and severity, as well as outcomes. Methods This 4-year retrospective study (2013–2017) used an institutional trauma database to capture all Level 1 and 2 trauma patients (≥14 years old) with BAC > 10 mg/dL presenting to the emergency department at a Level 1 trauma center. Demographic variables including mechanism of injury (MOI) were collected. Patients’ BAC was compared to their calculated injury severity scores (ISS) and abbreviated injury scale (AIS) scores. Analysis included linear regression, T-tests and ANOVAs with Tukey’s post-hoc analysis for continuous variables and Fisher’s exact test for binary variables. Multivariate regression analysis was performed to determine independent predictors of injury severity. Results 332 intoxicated patients were identified (mean BAC: 210.2±87.14 mg/dL, range 12.7–460.0; 74.1% male; median age 35; range: 16–90). The median ISS was 6 (range: 1–48). Patients in motor vehicle collisions had lower BACs (186.0±5.59 mg/dL) than those who fell (233.8±10.42 mg/dL, p = 0.0002), were assaulted (230.4±14.04 mg/dL, p = 0.0261), or were pedestrians struck (259.4±14.17 mg/dL, p = 0.004). Overall, patients with higher BAC had lower GCS, lower ISS, and shorter intensive care unit (ICU) length of stay, but no differences in hospital stay, or ventilator days. Conclusions Trauma patients with higher BAC have lower ISS, less severe chest injury, and shorter ICU stays. These findings suggest that higher levels of alcohol ingestion may portend a protective effect in the setting of trauma with respect to severity of injury that does not mitigate the importance of education and injury prevention but warrants further study into the physiology of alcohol and trauma.

“Nurse, I Only Had a Couple of Beers”: Validity of Self-reported Drinking Before Serious Vehicular Injury

2002 ◽  
Vol 11 (2) ◽  
pp. 106-114 ◽  
Author(s):  
Marilyn Sawyer Sommers ◽  
Janice M. Dyehouse ◽  
Steven R. Howe ◽  
Kathryn Wekselman ◽  
Michael Fleming
Keyword(s):  
Alcohol Consumption ◽  
Motor Vehicle ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Alcohol Intervention ◽  
Blood Alcohol ◽  
Traffic Crashes ◽  
The Mean ◽  
Reported Data ◽  
Vehicular Crashes

• Background Of the more than 40 000 Americans killed each year in vehicular crashes, 40% are involved in alcohol-related collisions. Although self-reported alcohol use has become an anchor for alcohol intervention after traffic crashes, clinicians are often skeptical about the truthfulness of self-reporting. • Objective To determine the validity of self-reported alcohol consumption of vehicular occupants hospitalized for a serious, alcohol-related injury. • Methods Non-alcohol–dependent subjects 18 years and older who were injured in motor vehicle crashes were interviewed. The self-reported number of standard drinks, time that drinking commenced, sex, and weight were used to calculate estimated blood alcohol concentration. This value was compared with the blood alcohol concentration measured at admission. • Results Of the 181 subjects, 60% provided sufficient data to calculate the estimated concentration. Seven men with admission concentrations of 10 mg/dL or more denied drinking. Among the 113 subjects with estimated concentrations who acknowledged drinking (excluding the 7 who denied drinking), the mean concentration at admission was 158.67 mg/dL, and mean estimated concentration was 83.81 mg/dL. According to multiple regression analyses, weight and number of drinks accounted for 3% of the variance in alcohol concentration at admission for women (R =0.174, F2,40 = 0.623, P = .54) and for 29% of the variance in men (R=0.543, F2,128 =26.71, P&lt; .001). • Conclusions Most persons who drink before vehicular injury acknowledge drinking. Self-reported data from men generally reflect the overall trend of alcohol consumption but with systematic underreporting. Reports from women are less predictable.

scholarly journals Is Blood Alcohol Level a Good Predictor for Injury Severity Outcomes in Motor Vehicle Crash Victims?

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Bikaramjit Mann ◽  
Ediriweera Desapriya ◽  
Takeo Fujiwara ◽  
Ian Pike
Keyword(s):  
Hospital Stay ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Experimental Studies ◽  
Length Of Hospital Stay ◽  
Motor Vehicle Crash ◽  
Blood Alcohol Level ◽  
Blood Alcohol ◽  
High Alcohol ◽  
Alcohol Group

Experimental studies in animals suggest that alcohol may influence pathophysiologic response to injury mechanisms. However, biological evidence for the alcohol-injury severity relationship provides conflicting results. The purpose of our retrospective cross-sectional study in 2,323 people was to assess whether blood alcohol level (BAC) adversely influences injury severity in victims of motor vehicle collisions (MVCs). We found no difference in mortality OR 1.09 (0.73–1.62), or length of hospital stay, and a trend for lower ISS score was found in the high-alcohol group (P=0.052). Furthermore, the high-alcohol group demonstrated a lower adjusted rate of severe head injury OR 0.65 (0.48–0.87), chest injury OR 0.58 (0.42–0.80), and serious extremity injury OR 0.10 (0.01–0.76). The findings of our study do not demonstrate a dose-response relationship between alcohol consumption and injury severity in MVCs. This study implies that higher BAC may lead to less severe injuries, without impacting mortality or length of hospital stay, however, further research is required to elucidate the nature of this relationship.

scholarly journals Hearing hoofbeats? Think head and neck trauma: a 10-year NTDB analysis of equestrian-related trauma in the USA

2021 ◽  
Vol 6 (1) ◽  
pp. e000728
Author(s):  
Kevin Mutore ◽  
Jiyun Lim ◽  
Demba Fofana ◽  
Annelyn Torres-Reveron ◽  
Jeffrey J Skubic
Keyword(s):  
Retrospective Study ◽  
Head And Neck ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Data Bank ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Level Of Evidence ◽  
Discharge Disposition ◽  
The Usa

ObjectiveThere is a paucity of evidence about traumatic injuries and their sequelae sustained due to equestrian injuries nationally.MethodsRetrospective study analyzing National Trauma Data Bank data from 2007 to 2016. Variables collected included age, sex, race, payer status, Injury Severity Score (ISS), hospital length of stay, Glasgow Coma Scale, systolic blood pressure (SBP) at presentation, discharge disposition, and mortality. Patient data were analyzed by anatomic region.ResultsThe most frequent type of injury was in the thorax, but head and neck injuries produced the highest mortality. Increased ISS and an SBP of less than 90 mm Hg were also significant predictors of mortality.ConclusionsThe risk of hospital admission from equestrian injuries is higher than football, motor vehicle racing, and skiing. Preventive measures and campaigns should be instituted to highlight safety practices and the use of personal protective equipment while on horseback either for sports, leisure, or work.Level of evidenceLevel IV. Retrospective study.

Factors associated with survival in Adult Patients with Traumatic Arrest: A Retrospective Cohort Study from US Trauma Centers

2020 ◽  
Author(s):  
Abdel-Badih Ariss ◽  
Rana Bachir ◽  
Mazen El Sayed
Keyword(s):  
Cohort Study ◽  
Hospital Discharge ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Age Group ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Factors Associated

Abstract Background: Traumatic arrests (TA) increasingly affect young adults worldwide with low reported survival rates. This study examines factors associated with survival (to hospital discharge) in traumatic arrests transported to US trauma centers. Methods: This retrospective cohort study used the US National Trauma Databank 2015 dataset and included patients who presented to trauma centers with “no signs of life”. Univariate and bivariate analyses were done. Factors associated with survival were identified using multivariate regression analyses. Results: The study included 5,980 patients with traumatic arrests. Only 664 patients (11.1%) survived to hospital discharge. Patients were predominantly in age group 16-64 (84.6%), were mostly males (77.8%) and white (55.1%). Most were admitted to Level I (55.5%) or Level II trauma centers (31.6%). Injuries were mostly blunt (56.7%) or penetrating (39.3%). Mean ISS was 23.71 (± 20.79). Factors associated with decreased survival included: Age group ≥65 (Ref: 16-24), male gender, self-inflicted and other or undetermined types of injuries (Ref: assault), injuries to head & neck, injuries to torso and injury severity score (ISS) ≥ 16 (Ref: <16). While factors associated with increased survival included: All injury mechanisms (with the exception of Motor Vehicle Transportation (MVT)) (Ref: firearm), injuries to extremities or spine & back and all methods of coverage (Ref: self-pay).Conclusion: Patients with traumatic arrests have poor outcomes with only 11.1 % surviving to hospital discharge. Factors associated with survival in traumatic arrests were identified. These findings are important for devising injury prevention strategies and help guide trauma management protocols to improve outcomes in traumatic arrests. Level of evidence: Level III

Does Level of Blood Alcohol Content Affect Clinical Outcomes After Trauma in Older Adult Patients?

2020 ◽  
Vol 86 (9) ◽  
pp. 1106-1112
Author(s):  
Mary K. Bryant ◽  
Katherine Reynolds ◽  
Connor Brittain ◽  
Zachery Patel ◽  
Trista D.S. Reid ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Older Patients ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Matched Cohort ◽  
Poor Outcomes

Introduction Preinjury alcohol use and older age have independently been associated with poor outcomes. This study examined whether higher levels of blood alcohol concentration (BAC) correlated with an increased likelihood of poor outcomes in older trauma patients. Methods This was a retrospective cohort study of injured patients ≥65 years with BAC testing presenting to a Level 1 trauma center between 2015 and 2018. Patients were stratified by BAC at 4 thresholds of intoxication: BAC ≧10 mg/dL, BAC ≧80 mg/dL, BAC ≧150 mg/dL, and BAC ≧200 mg/dL. Propensity score matching using inverse probability of treatment weighting was used to estimate outcomes. Logistic and Poisson regression models were performed for each threshold of the BAC level with the matched cohort to assess clinical outcomes. Results Of all older patients (n = 3112), 32.5% (n = 1012) had BAC testing. In the matched cohort of 883 patients (76.7 ± 8.2 years; 48.1% female), 111 (12.5%) had BAC ≧10 mg/dL, 83 (74.8%) had BAC ≧80 mg/dL, 60 (54.1%) had BAC ≧150 mg/dL, and 37 (33.3%) had BAC ≧200 mg/dL. Falls (60.5%) and motor vehicle crashes (28.9%) were the most common mechanisms of injury. Median (IQR) of Injury Severity Score (ISS) was 5 (1-10). The risk of severe injury (ISS ≧15) was similar between alcohol-positive and alcohol-negative patients (9.9% vs 15.0%, P = .151). BAC ≧10 g/dL was not associated with length of stay, intensive care unit admission, or in-hospital complication, nor was any of the other 3 analyzed BAC thresholds. Conclusion Overall, any detectable BAC along and increasing thresholds of BAC was not associated with poor in-hospital outcomes of older patients after trauma. Alcohol screening was low in this population, and intoxication may bias injury assessment, leading to mistriage of older trauma patients.

Elevated Blood Alcohol Level May be Protective of Trauma Patient Mortality

2009 ◽  
Vol 75 (10) ◽  
pp. 950-953 ◽  
Author(s):  
Arezou Yaghoubian ◽  
Amy Kaji ◽  
Brant Putnam ◽  
Nicholas De Virgilio ◽  
Christian De Virgilio
Keyword(s):  
Blunt Trauma ◽  
Trauma Center ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Blood Alcohol Level ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Confounding Variables ◽  
Level I

To determine whether a positive blood alcohol level (BAL) affects morbidity and mortality at a Level I trauma center, a retrospective review of trauma patients 18 years of age and older was performed. There were 7985 trauma patients and 8 per cent (645) had a positive BAL. BAL(+) patients had lower Injury Severity Score (ISS) (8 vs 11, P < 0.01), lower rate of penetrating injury (9 vs 25%, P < 0.01), and were older (38 vs 32 years, P = 0.01). Overall there were 559 deaths (7%); (1% mortality in BAL(+) patients and 7% in BAL(-) patients; P < 0.0001). There were 352 (4.4%) complications with similar rates among BAL(-) and (+) patients. On univariate analysis, a positive BAL was inversely associated with death (OR, 0.17) as was blunt trauma (OR, 0.29), whereas older age (OR 1.009) and increased ISS (OR 1.13) were associated with death. On multivariable analysis, after adjusting for age, ISS, and mechanism of injury, a positive BAL remained protective against death (OR 0.35) as did blunt trauma (OR 0.2). Age (OR 1.04) and increased ISS (OR 1.19) were associated with mortality. In conclusion, a positive BAL was associated with a decreased mortality risk in trauma patients, which persisted after adjusting for multiple confounding variables.

scholarly journals Impact of COVID-19 pandemic on injury prevalence and pattern in the Washington, DC Metropolitan Region: a multicenter study by the American College of Surgeons Committee on Trauma, Washington, DC

2021 ◽  
Vol 6 (1) ◽  
pp. e000659
Author(s):  
Marc Chodos ◽  
Babak Sarani ◽  
Andrew Sparks ◽  
Brandon Bruns ◽  
Shailvi Gupta ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Trauma Center ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Motor Vehicle Crash ◽  
Metropolitan Region ◽  
Washington Dc ◽  
Mechanism Of Injury ◽  
The Impact

BackgroundThe COVID-19 pandemic has had far-reaching effects on healthcare systems and society with resultant impact on trauma systems worldwide. This study evaluates the impact the pandemic has had in the Washington, DC Metropolitan Region as compared with similar months in 2019.DesignA retrospective multicenter study of all adult trauma centers in the Washington, DC region was conducted using trauma registry data between January 1, 2019 and May 31, 2020. March 1, 2020 through May 31, 2020 was defined as COVID-19, and January 1, 2019 through February 28, 2020 was defined as pre-COVID-19. Variables examined include number of trauma contacts, trauma admissions, mechanism of injury, Injury Severity Score, trauma center location (urban vs. suburban), and patient demographics.ResultsThere was a 22.4% decrease in the overall incidence of trauma during COVID-19 compared with a 3.4% increase in trauma during pre-COVID-19. Blunt mechanism of injury decreased significantly during COVID-19 (77.4% vs. 84.9%, p<0.001). There was no change in the specific mechanisms of fall from standing, blunt assault, and motor vehicle crash. The proportion of trauma evaluations for penetrating trauma increased significantly during COVID-19 (22.6% vs. 15.1%, p<0.001). Firearm-related and stabbing injury mechanisms both increased significantly during COVID-19 (11.8% vs. 6.8%, p<0.001; 9.2%, 6.9%, p=0.002, respectively).Conclusions and relevanceThe overall incidence of trauma has decreased since the arrival of COVID-19. However, there has been a significant rise in penetrating trauma. Preparation for future pandemic response should include planning for an increase in trauma center resource utilization from penetrating trauma.Level of evidenceEpidemiological, level III.

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