Mechanisms of Injury Among the Amish Population in Central Pennsylvania

2021 ◽  
pp. 000313482110505
Author(s):  
Larissa Whitney ◽  
Kelly Bonneville ◽  
Madison Morgan ◽  
Lindsey L. Perea
Keyword(s):  
Pediatric Population ◽  
Traumatic Injury ◽  
Age Groups ◽  
Geographic Location ◽  
Future Research ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Injury Patterns ◽  
Level Of Evidence

Background Individuals presenting with traumatic injury in rural populations have significantly different injury patterns than those in urban environments. With an increasing Amish population, totaling over 33 000 in our catchment area, their unique way of life poses additional factors for injury. This study aims to evaluate differences in mechanism of injury, location of injury, and demographic patterns within the Amish population. We hypothesize that there will be an increased incidence of agriculture-related mechanisms of injury. Methods All Amish trauma patients presenting to our level I trauma center over 20 years (1/2000-4/2020) were retrospectively analyzed. Mechanism and geographic location of injury were collected. Demographic and clinical variables were compared between the age groups. Results There were 1740 patients included in the study with 36.4% (n = 634) ≤ 14 years. Only 10% (n = 174) were ≥ 65 years. The most common mechanism across all ages was falls. However, when separating out the pediatric population ( ≤ 14 years), 27.8% (n = 60) fell from a height on average > 8-10 feet. The most common geographic location of injury was at home in all age groups, except for the 15-24 year group, which was roadways. Discussion The Amish population poses a unique set of mechanisms of injury and thus injury patterns to rural trauma centers. We have found the most common injuries to be falls, buggy accidents, animal-related injuries, and farming accidents across all age groups. Future research and collaboration with other rural trauma centers treating large Amish populations would be beneficial to maximize injury prevention in this population. Level of Evidence Level 3a, epidemiological.

scholarly journals Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures

2021 ◽  
Vol 6 (1) ◽  
pp. e000655
Author(s):  
Kristin Salottolo ◽  
Rachel Caiafa ◽  
Jalina Mueller ◽  
Allen Tanner ◽  
Matthew M Carrick ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Motor Vehicle ◽  
Traumatic Injury ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
Study Objective ◽  
Time Periods ◽  
Injury Causes

BackgroundThe COVID-19 pandemic resulted in nationwide social distancing and shelter-in-place orders meant to curb transmission of the SARS-CoV-2 virus. The effect of the pandemic on injury patterns has not been well described in the USA. The study objective is to determine the effect of the COVID-19 pandemic on the distribution and determinants of traumatic injuries.MethodsThis retrospective multi-institutional cohort study included all hospital admissions for acute traumatic injury at six community level I trauma centers. Descriptive statistics were used to compare injury causes, diagnoses and procedures over two similar time periods: prepandemic (March 11–June 30, 2019) and pandemic (March 11–June 30, 2020).ResultsThere were 7308 trauma patients included: 3862 (53%) prepandemic and 3446 (47%) during the pandemic. Cause of injury significantly differed by period (p<0.001). During the pandemic, there were decreases in motor vehicle crashes (from 17.0% to 14.0%, p<0.001), worksite injuries (from 5.2% to 4.1%, p=0.02), pedestrian injuries (from 3.0% to 2.2%, p=0.02) and recreational injuries (from 3.0% to 1.7%, p<0.001), while there were significant increases in assaults (6.9% to 8.5%, p=0.01), bicycle crashes (2.8% to 4.2%, p=0.001) and off-road vehicle injuries (1.8% to 3.0%, p<0.001). There was no change by study period in falls, motorcycle injuries, crush/strikes, firearm and self-inflicted injuries, and injuries associated with home-improvement projects. Injury diagnoses differed between time periods; during the pandemic, there were more injury diagnoses to the head (23.0% to 27.3%, p<0.001) and the knee/leg (11.7% to 14.9%, p<0.001). There were also increases in medical/surgical procedures (57.5% to 61.9%, p<0.001), administration of therapeutics/blood products (31.4% to 34.2%, p=0.01) and monitoring (11.0% to 12.9%, p=0.01).DiscussionCauses of traumatic injury, diagnoses, and procedures were significantly changed by the pandemic. Trauma centers must adjust to meet the changing demands associated with altered injury patterns, as they were associated with increased use of hospital resources.Level of evidenceIII (epidemiological).

scholarly journals Decreased adult trauma admission volumes and changing injury patterns during the COVID-19 pandemic at 85 trauma centers in a multistate healthcare system

2021 ◽  
Vol 6 (1) ◽  
pp. e000642
Author(s):  
Gina M Berg ◽  
Ransom J Wyse ◽  
Jennifer L Morse ◽  
John Chipko ◽  
Jeneva M Garland ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Trauma Network ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
Trauma Population ◽  
Absolute Decrease

BackgroundReports indicate social distancing guidelines and other effects of the COVID-19 pandemic impacted trauma patient volumes and injury patterns. This report is the first analysis of a large trauma network describing the extent of these impacts. The objective of this study was to describe the effects of the COVID-19 pandemic on patient volumes, demographics, injury characteristics, and outcomes.MethodsFor this descriptive, multicenter study from a large, multistate hospital network, data were collected from the system-wide centralized trauma registry and retrospectively reviewed to retrieve patient information including volume, demographics, and outcomes. For comparison, patient data from January through May of 2020 and January through May of 2019 were extracted.ResultsA total of 12 395 trauma patients (56% men, 79% white, mean age 59 years) from 85 trauma centers were included. The first 5 months of 2020 revealed a substantial decrease in volume, which began in February and continued into June. Further analysis revealed an absolute decrease of 32.5% in patient volume in April 2020 compared with April 2019 (4997 from 7398; p<0.0001). Motor vehicle collisions decreased 49.7% (628 from 1249). There was a statistically significant increase in injury severity score (9.0 vs. 8.3; p<0.001). As a proportion of the total trauma population, blunt injuries decreased 3.1% (87.3 from 90.5) and penetrating injuries increased 2.7% (10.0 from 7.3; p<0.001). A significant increase was found in the proportion of patients who did not survive to discharge (3.6% vs. 2.8%; p=0.010; absolute decrease: 181 from 207).DiscussionEarly phases of the COVID-19 pandemic were associated with a 32.5% decrease in trauma patient volumes and altered injury patterns at 85 trauma centers in a multistate system. This preliminary observational study describes the initial impact of the COVID-19 pandemic and warrants further investigation.Level of evidenceLevel II (therapeutic/care management).

An Overview of Amish Mortalities at a Level I Trauma Center

2021 ◽  
pp. 000313482110472
Author(s):  
Madison E. Morgan ◽  
Catherine Ting Brown ◽  
Larissa Whitney ◽  
Kelly Bonneville ◽  
Lindsey L. Perea
Keyword(s):  
Trauma Center ◽  
Chart Review ◽  
Trauma Registry ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
Trauma Mortality ◽  
Level I

Background The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors. Methods All Amish trauma patients who presented and were captured by the trauma registry at our Level I trauma center over 20 years (1/2000-2004/2020) were analyzed. A retrospective chart review was subsequently performed. Patients who died were of interest to this study. Demographic and clinical variables were analyzed for the mortalities. Mortalities were then compared to Amish patients who survived. Results There were 1827 Amish trauma patients during the study period and, of these, 32 (1.75%) were mortalities. The top 3 mechanisms of injury leading to mortality were falls (34.4%), pedestrian struck (21.9%), and farming accidents (15.6%). Pediatric (age ≤ 14y) (25%) and geriatric (age ≥ 65y) (28.1%) had the highest percentage of mortalities. Mortalities in the Amish population were significantly older (mean age: 39 years vs 27 years, P = .003) and had significantly higher ISS (mean ISS: 29 vs 10, P < .001) compared to Amish patients who survived. Discussion The majority of mortalities occurred in the pediatric and geriatric age groups and were falls. Further intervention and outreach in the Amish population should be done to highlight this particular cause of mortality. Level of Evidence Level III, epidemiological.

Children and Terror Casualties Receive Preference in ICU Admissions

2012 ◽  
Vol 6 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Kobi Peleg ◽  
Michael Rozenfeld ◽  
Eran Dolev ◽  
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Age Groups ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Severe Injuries ◽  
Level I ◽  
Hospital Emergency Departments ◽  
Trauma Type

ABSTRACTObjective: Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events.Methods: Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry.Results: All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU.Conclusions: Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.(Disaster Med Public Health Preparedness. 2012;6:14–19)

scholarly journals Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature

2020 ◽  
Vol 9 (06) ◽  
pp. 458-464
Author(s):  
Rachana Tataria ◽  
Jeannette Ting ◽  
Andrea Jester ◽  
Tommy R. Lindau ◽  
Kerstin Oestreich
Keyword(s):  
Pediatric Population ◽  
Age Groups ◽  
Case Series ◽  
Final Diagnosis ◽  
Scaphoid Bone ◽  
Age Group ◽  
Level Of Evidence ◽  
Scaphoid Fractures ◽  
Fractures In Children ◽  
Common Location

Abstract Background Scaphoid fractures are relatively uncommon in children, especially below the age of 10 due to the ossification of the scaphoid bone, which starts around 4 to 6 years of age and continues until 13 to 15 years of age, where pediatric scaphoid fractures peak. This makes the diagnoses challenging in this age group. Methods The primary aim of this study was to analyze prospectively collected data in managing scaphoid fractures. All cases in children up to the age of 10 years, treated in a tertiary pediatric hand and upper limb from January 2014 to June 2018 were included. Parameters studied were patient demographics, clinical presentation, mechanism of injury, investigations, type of fracture, associated injuries, treatment offered, outcomes and complications. The secondary aim was to review the literature due to the limited knowledge about these fractures in these low age groups. Results A total of 23 patients with documented scaphoid fractures in children up to the age of 10 years were found. Final diagnosis in all these patients was done with magnetic resonance imaging (MRI). The mean age was 9.8 years, with female preponderance. Scaphoid waist was the most common location. Five patients had associated fractures of the capitate and one patient had associated second metacarpal base fracture. All patients were managed nonoperatively. The average time of immobilization was 6.6 weeks (range: 4–10 weeks). A majority of patients had minor symptoms after the fracture, most likely due to the immobilization time. Conclusion Scaphoid fractures are rare in the pediatric population up to the age of 10. MRI is most often needed to confirm diagnosis. Nonoperative management of most scaphoid fractures in this age group is safe and feasible with no significant long-term morbidity. Surgical management of scaphoid fractures might be required in very selected cases. Level of Evidence This is a Level IV study.

scholarly journals A living systematic review protocol for COVID-19 clinical trial registrations

2020 ◽  
Vol 5 ◽  
pp. 60 ◽  
Author(s):  
Brittany J. Maguire ◽  
Philippe J. Guérin
Keyword(s):  
Systematic Review ◽  
Clinical Trial ◽  
Clinical Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Geographic Location ◽  
Diagnostic Methods ◽  
Future Research ◽  
Strong Response ◽  
Level Of Evidence

Since the coronavirus disease 2019 (COVID-19) outbreak was identified in December 2019 in Wuhan, China, a strong response from the research community has been observed with the proliferation of independent clinical trials assessing diagnostic methods, therapeutic and prophylactic strategies. While there is no intervention for the prevention or treatment of COVID-19 with proven clinical efficacy to date, tools to distil the current research landscape by intervention, level of evidence and those studies likely powered to address future research questions is essential. This living systematic review aims to provide an open, accessible and frequently updated resource summarising the characteristics of COVID-19 clinical trial registrations. Weekly search updates of the WHO International Clinical Trials Registry Platform (ICTRP) and source registries will be conducted. Data extraction by two independent reviewers of trial characteristic variables including categorisation of trial design, geographic location, intervention type and targets, level of evidence and intervention adaptability to low resource settings will be completed. Descriptive and thematic synthesis will be conducted. A searchable and interactive visualisation of the results database will be created, and made openly available online. Weekly results from the continued search updates will be published and made available on the Infectious Diseases Data Observatory (IDDO) website (COVID-19 website). This living systematic review will provide a useful resource of COVID-19 clinical trial registrations for researchers in a rapidly evolving context. In the future, this sustained review will allow prioritisation of research targets for individual patient data meta-analysis.

scholarly journals Minor change in initial PEEP setting decreases rates of ventilator-associated events in mechanically ventilated trauma patients

2020 ◽  
Vol 5 (1) ◽  
pp. e000455
Author(s):  
Ethan Ferrel ◽  
Kristina M Chapple ◽  
Liviu Gabriel Calugaru ◽  
Jennifer Maxwell ◽  
Jessica A Johnson ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Injury Severity ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Mechanically Ventilated ◽  
Change In Practice ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center

BackgroundSurveillance of ventilator-associated events (VAEs) as defined by the National Healthcare Safety Network (NHSN) is performed at many US trauma centers and considered a measure of healthcare quality. The surveillance algorithm relies in part on increases in positive end-expiratory pressure (PEEP) to identify VAEs. The purpose of this cohort study was to evaluate the effect of initiating mechanically ventilated trauma patients at marginally higher PEEP on incidence of VAEs.MethodsAnalysis of level-1 trauma center patients mechanically ventilated 2+ days from 2017 to 2018 was performed after an institutional ventilation protocol increased initial PEEP setting from 5 (2017) to 6 (2018)cm H2O. Incidence of VAEs per 1000 vent days was compared between PEEP groups. Logistic regression modelling was performed to evaluate the impact of the PEEP setting change adjusted to account for age, ventilator days, injury mechanism and injury severity.Results519 patients met study criteria (274 PEEP 5 and 245 PEEP 6). Rates of VAEs were significantly reduced among patients with initial PEEP 5 versus 6 (14.61 per 1000 vent days vs. 7.13 per 1000 vent days; p=0.039). Logistic regression demonstrated that initial PEEP 6 was associated with 62% reduction in VAEs.ConclusionsOur data suggest that an incrementally increased baseline PEEP setting was associated with a significantly decreased incidence of VAEs among trauma patients. This minor change in practice may have a major impact on a trauma center’s quality metrics.Level of evidenceIV.

scholarly journals The Protective Effect of Breast Implants in Penetrating Trauma

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Christopher J Pannucci ◽  
Nicole M Kurnik ◽  
Mark Brzezienski ◽  
K Kye Higdon ◽  
Alanna M Rebecca
Keyword(s):  
Chest Trauma ◽  
Breast Implant ◽  
Traumatic Injury ◽  
Penetrating Trauma ◽  
Breast Implants ◽  
Future Research ◽  
Level Of Evidence ◽  
Substantial Impact ◽  
Penetrating Chest Trauma

Abstract Breast implants are typically placed for cosmetic or reconstructive purposes, and are recognized to have a substantial impact on aesthetics and quality of life. In addition, the presence of a breast implant on the chest wall has a potential benefit of force diffusion or force absorption in traumatic injury. This article reports a series of three patients with preexisting breast implants who suffered penetrating chest trauma. In each case, the presence of a breast implant was potentially lifesaving. We describe the cases in detail, provide a conceptual discussion, and discuss directions for future research. Level of Evidence: 5

Older people and major trauma

2009 ◽  
Vol 19 (2) ◽  
pp. 77-85 ◽  
Author(s):  
Elaine Cole ◽  
Antonia Lynch ◽  
Jackie Bridges ◽  
Anita West
Keyword(s):  
Older People ◽  
Major Trauma ◽  
Traumatic Injury ◽  
Psychological Impact ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Practice Research ◽  
Trauma Patients ◽  
Policy Practice ◽  
Research And Education

SummaryMajor traumatic injury is a leading cause of death in younger age groups, but increasingly older people are affected also. Adverse outcomes, both physical and psychological, are associated with injury in the older population. This review aims to locate and describe the evidence relating to older people and major trauma in order to inform policy, practice, research and education. The published research and systematic reviews fall into three main topics: mechanism of traumatic injury in older people, the effects of co-morbidities on older trauma patients and outcomes following serious traumatic injury in older people. The psychological impact of traumatic injury and the resulting functional alteration cannot be underestimated in this group of patients.

scholarly journals The effect of Covid-19 on the willingness to use video consultations among orthopedic and trauma outpatients: a multi-center survey in 1400 outpatients

2021 ◽  
Author(s):  
Julian Scherer ◽  
David A. Back ◽  
Friedrich Thienemann ◽  
Ernest Kaufmann ◽  
Valentin Neuhaus ◽  
...  
Keyword(s):  
Age Groups ◽  
Physical Contact ◽  
Online Video ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Trauma Centers ◽  
Advantages And Disadvantages ◽  
Video Consultation ◽  
The Difference ◽  
Willingness To Use

Abstract Introduction Due to the Covid-19 pandemic, making more use of remote medical solutions has been advertised. The purpose of this study was to assess the willingness of orthopedic trauma patients to conduct an online video consultation (OVC) during the coronavirus pandemic compared to before. Methods A survey amongst orthopedic and trauma outpatients from three European trauma centers was conducted via paper-based questionnaires, composed of participants’ demographics and five open and closed questions between June and November 2019 and between April and July 2020 during Covid-19. The main outcome was the difference between the cohorts regarding the willingness to use an OVC, reasons for and against usage as well as advantages and disadvantages. Sub-analysis was performed for gender, participants’ occupation and three age groups (≤ 30 years; 31–55 years; > 55 years). Results 1400 participants (780 preCovid-19 and 620 Covid-19) were included. There was no difference in willingness to conduct an OVC between the cohorts (57.6% versus 63.9%; p = 0.053). The highest disposition towards an OVC in both cohorts was seen in patients below 30 years of age, followed by 31–55 years and over 55 years. Women were significantly more likely in the Covid-19-group than in the preCovid-19-group to conduct an OVC (p = 0.032). Use of the OVC for “personal questions to the physician” was more often stated in the Covid-19-cohort (p = 0.007). “No danger of an infection” (p = 0.001) and “availability from anywhere” (p = 0.032) as advantages of an OVC were more often stated in the Covid-19-cohort. “No direct contact with the doctor” (p = 0.001) and “relationship to the doctor could change” (p = 0.024) as disadvantages of the OVC were less often stated in the Covid-19-cohort. Conclusion The majority of the assessed outpatients would use an OVC. Fear of infections have increased, and direct physical contact is less important since the Covid-19 pandemic, but have not increased the disposition for an OVC significantly.

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