Firearm Injuries to the Wrist and Hand in Children and Adults: An Epidemiologic Study

Background: Gunshot wounds (GSWs) to the wrist and hand are a major health and economic burden in the United States. There are few studies examining the circumstances and epidemiological factors surrounding these injuries. This study assesses the epidemiological factors, as well as the shooting circumstances, injury details, and surgical management of wrist and hand GSWs in children and adults. Methods: Medical records and radiographs were reviewed for all patients with ballistic injury to the wrist or hand treated at an urban academic level 1 trauma center from 2016 to 2019. Fisher exact and Pearson χ2 tests were used to assess differences between groups. Results: Two hundred forty-nine victims (29 children, 220 adults) with complete documentation were identified. Among 180 victims with known shooting circumstances, 132 (70%) were shot by another person and 110 (65%) were injured by intentional gunfire. Eighty-seven victims (35%) suffered a concurrent GSW to another body region. Metacarpal fracture was the most commonly diagnosed bony injury (37%), followed by proximal phalanx fracture (25%). One hundred twenty-nine victims (52%) underwent surgery following their injuries. Nerve discontinuity was diagnosed in 27 victims (11%), while 20 victims (8%) had vascular disruption. There was no significant difference between children and adult victims’ type of fracture, concurrent injuries, rates of surgery, or in the most common fracture fixation method. Conclusions: Most wrist and hand GSW victims were injured due to intentional, non-self-inflicted gunfire. Most patients present with hand fractures, and fortunately, nerve and vascular disruptions are uncommon.

Download Full-text

Emergency Medical Services vs. Police: Impact of Pre-Hospital Transportation Method on Outcomes of Trauma Patients with Firearm Injuries

10.21203/rs.3.rs-103342/v1 ◽

2020 ◽

Author(s):

Christina Wohler ◽

Rachel Denneny ◽

Allegra Bermudez ◽

Robert Wilson ◽

Douglas Gouchoe ◽

...

Keyword(s):

Emergency Medical Services ◽

The United States ◽

Hospital Length Of Stay ◽

Medical Services ◽

Hospital Treatment ◽

Firearm Injuries ◽

Patient Demographics ◽

Emergency Medical ◽

Significant Difference ◽

The Impact

Abstract Background Firearms are a significant cause of morbidity and mortality in the United States. Few studies exist to investigate the impact of pre-hospital transportation methods on trauma patient outcomes. Methods Patients with firearm injuries were identified using an institutional trauma registry (2008 to 2017). Data on patient demographics, hospital transportation, treatments, and outcomes was collected and analyzed. Patient characteristics between Emergency Medical Services (EMS) vs. police transport groups were compared using Kruskal-Wallis, chi-square, or Fisher’s exact tests as appropriate. Results Of 224 patients identified, 147 (66%) were transported by EMS and 77 (34%) were transported by police. There was no significant difference in patient demographics between groups. Most patients were male (94.2%) and African American (69.2%), with a mean age of 27.1 years. 84.4% of patients suffered from an externally-inflicted gunshot wound, while 9.4% of patients had inflicted the wound themselves. Handguns were the weapon most commonly used. There was no significant difference in in-hospital treatments or mortality between patients transported by EMS vs. police. 44.1% of patients underwent surgery, and 34.8% required specialist consultation. The mean hospital length of stay for all patients was 1 day, and 27.7% of all patients expired during admission. Conclusions There is no difference in hospital treatment or mortality between firearm victims transported by EMS vs. police.

Download Full-text

Population-Based Analysis of Firearm Injuries among Young Children in the United States, 2010–2015

The American Surgeon ◽

10.1177/000313481908500518 ◽

2019 ◽

Vol 85 (5) ◽

pp. 449-455 ◽

Cited By ~ 1

Author(s):

Alan Cook ◽

David Hosmer ◽

Laurent Glance ◽

Bindu Kalesan ◽

Jordan Weinberg ◽

...

Keyword(s):

United States ◽

Young Children ◽

Hospital Mortality ◽

Gunshot Wounds ◽

The United States ◽

Population Based ◽

Older Children ◽

Firearm Injuries ◽

One Year ◽

The Impact

Firearm violence in the United States knows no age limit. This study compares the survival of children younger than five years to children and adolescents of age 5–19 years who presented to an ED for gunshot wounds (GSWs) in the United States to test the hypothesis of higher GSW mortality in very young children. A study of GSW patients aged 19 years and younger who survived to reach medical care was performed using the Nationwide ED Sample for 2010–2015. Hospital survival and incidence of fatal and nonfatal GSWs in the United States were the study outcomes. A multilevel logistic regression model estimated the strength of association among predictors of hospital mortality. The incidence of ED presentation for GSW is as high as 19 per 100,000 population per year. Children younger than five years were 2.7 times as likely to die compared with older children (15.3% vs 5.6%). Children younger than one year had the highest hospital mortality, 33.1 per cent. The mortality from GSW is highest among the youngest children compared with older children. This information may help policy makers and the public better understand the impact of gun violence on the youngest and most vulnerable Americans.

Download Full-text

Childhood Firearm Injuries in the United States

10.1542/9781610022750-childhood ◽

2017 ◽

pp. 64-79

Author(s):

Katherine A. Fowler ◽

Linda L. Dahlberg ◽

Tadesse Haileyesus ◽

Carmen Gutierrez ◽

Sarah Bacon

Keyword(s):

United States ◽

Public Health Problem ◽

Gunshot Wounds ◽

The United States ◽

Vital Statistics ◽

Older Children ◽

Injury Surveillance System ◽

Important Public Health Problem ◽

Firearm Injuries ◽

Using Data

OBJECTIVES Examine fatal and nonfatal firearm injuries among children aged 0 to 17 in the United States, including intent, demographic characteristics, trends, state-level patterns, and circumstances. METHODS Fatal injuries were examined by using data from the National Vital Statistics System and nonfatal injuries by using data from the National Electronic Injury Surveillance System. Trends from 2002 to 2014 were tested using joinpoint regression analyses. Incident characteristics and circumstances were examined by using data from the National Violent Death Reporting System. RESULTS Nearly 1300 children die and 5790 are treated for gunshot wounds each year. Boys, older children, and minorities are disproportionately affected. Although unintentional firearm deaths among children declined from 2002 to 2014 and firearm homicides declined from 2007 to 2014, firearm suicides decreased between 2002 and 2007 and then showed a significant upward trend from 2007 to 2014. Rates of firearm homicide among children are higher in many Southern states and parts of the Midwest relative to other parts of the country. Firearm suicides are more dispersed across the United States with some of the highest rates occurring in Western states. Firearm homicides of younger children often occurred in multivictim events and involved intimate partner or family conflict; older children more often died in the context of crime and violence. Firearm suicides were often precipitated by situational and relationship problems. The shooter playing with a gun was the most common circumstance surrounding unintentional firearm deaths of both younger and older children. CONCLUSIONS Firearm injuries are an important public health problem, contributing substantially to premature death and disability of children. Understanding their nature and impact is a first step toward prevention.

Download Full-text

Protective Effectiveness of Long-Lasting Permethrin Impregnated Clothing Against Tick Bites in an Endemic Lyme Disease Setting: A Randomized Control Trial Among Outdoor Workers

Journal of Medical Entomology ◽

10.1093/jme/tjaa061 ◽

2020 ◽

Vol 57 (5) ◽

pp. 1532-1538

Author(s):

Cedar Mitchell ◽

Megan Dyer ◽

Feng-Chang Lin ◽

Natalie Bowman ◽

Thomas Mather ◽

...

Keyword(s):

United States ◽

Rhode Island ◽

The United States ◽

Amblyomma Americanum ◽

Adverse Outcomes ◽

Control Group ◽

Tick Bites ◽

Outdoor Workers ◽

Significant Difference ◽

Protective Effectiveness

Abstract Tick-borne diseases are a growing threat to public health in the United States, especially among outdoor workers who experience high occupational exposure to ticks. Long-lasting permethrin-impregnated clothing has demonstrated high initial protection against bites from blacklegged ticks, Ixodes scapularis Say (Acari: Ixodidae), in laboratory settings, and sustained protection against bites from the lone star tick, Amblyomma americanum (L.) (Acari: Ixodidae), in field tests. However, long-lasting permethrin impregnation of clothing has not been field tested among outdoor workers who are frequently exposed to blacklegged ticks. We conducted a 2-yr randomized, placebo-controlled, double-blinded trial among 82 outdoor workers in Rhode Island and southern Massachusetts. Participants in the treatment arm wore factory-impregnated permethrin clothing, and the control group wore sham-treated clothing. Outdoor working hours, tick encounters, and bites were recorded weekly to assess protective effectiveness of long-lasting permethrin-impregnated garments. Factory-impregnated clothing significantly reduced tick bites by 65% in the first study year and by 50% in the second year for a 2-yr protective effect of 58%. No significant difference in other tick bite prevention method utilization occurred between treatment and control groups, and no treatment-related adverse outcomes were reported. Factory permethrin impregnation of clothing is safe and effective for the prevention of tick bites among outdoor workers whose primary exposure is to blacklegged ticks in the northeastern United States.

Download Full-text

Trans-metacarpal Screw Fixation for Extra-articular Proximal Phalangeal Base Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s021881041750006x ◽

2017 ◽

Vol 22 (01) ◽

pp. 35-38 ◽

Cited By ~ 1

Author(s):

Eichi Itadera ◽

Takahiro Yamazaki

Keyword(s):

Screw Fixation ◽

Proximal Phalanx ◽

Metacarpophalangeal Joint ◽

Fixation Method ◽

Compression Screw ◽

Metacarpal Head ◽

Headless Compression Screw ◽

Articular Fractures ◽

Intramedullary Canal ◽

Cannulated Drill

We developed a new internal fixation method for extra-articular fractures at the base of the proximal phalanx using a headless compression screw to achieve rigid fracture fixation through a relatively easy technique. With the metacarpophalangeal joint of the involved finger flexed, a smooth guide-pin is inserted into the intramedullary canal of the proximal phalanx through the metacarpal head and metacarpophalangeal joint. Insertion tunnels are made over the guide-pin using a cannulated drill. Then, a headless cannulated screw is placed into the proximal phalanx. All of five fractures treated by this procedure obtained satisfactory results.

Download Full-text

Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas

Journal of Endocrinological Investigation ◽

10.1007/s40618-021-01584-7 ◽

2021 ◽

Author(s):

T. J. Marini ◽

S. L. Weiss ◽

A. Gupta ◽

Y. T. Zhao ◽

T. M. Baran ◽

...

Keyword(s):

Thyroid Nodule ◽

Standard Of Care ◽

The United States ◽

Epidemiological Studies ◽

Thyroid Ultrasound ◽

Target Region ◽

Experienced Radiologist ◽

Significant Difference ◽

Size Evaluation

Abstract Purpose Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. Methods The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. Results Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen’s kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. Conclusion Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.

Download Full-text

338. Analysis of Etiologies of Aseptic Meningitis within a Nation-Wide Hospital Network

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.533 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S239-S239

Author(s):

Arunmozhi S Aravagiri ◽

Scott Kubomoto ◽

Ayutyanont Napatkamon ◽

Sarah Wilson ◽

Sudhakar Mallela

Keyword(s):

United States ◽

West Nile Virus ◽

Aseptic Meningitis ◽

Epidemiologic Study ◽

The United States ◽

Positive Test ◽

Diagnostic Tools ◽

West Nile ◽

Varicella Zoster ◽

The Us

Abstract Background Aseptic meningitis can be caused by an array of microorganisms, both bacterial and non-bacterial, as well as non-infectious conditions. Some etiologies of aseptic meningitis require treatment with antibiotics, antiviral, antifungals, anti-parasitic agents, immunosuppressants, and or chemotherapy. There are limited diagnostic tools for diagnosing certain types of aseptic meningitis, therefore knowing the differential causes of aseptic meningitis, and their relative percentages may assist in diagnosis. Review of the literature reveals that there are no recent studies of etiologies of aseptic meningitis in the United States (US). This is an epidemiologic study to delineate etiologies of aseptic meningitis in a large database of 185 HCA hospitals across the US. Methods Data was collected from January 2016 to December 2019 on all patients diagnosed with meningitis. CSF PCR studies, and CSF antibody tests were then selected for inclusion. Results Total number of encounters were 3,149 hospitalizations. Total number of individual labs analyzed was 10,613, and of these 262 etiologies were identified. 23.6% (62) of cases were due to enterovirus, 18.7% (49) due to HSV-2, 14.5% (38) due to West Nile virus, 13.7% (36) due to Varicella zoster (VZV), 10.5% (27) due to Cryptococcus. Additionally, we analyzed the rate of positive test results by region. Nationally, 9.7% of tests ordered for enterovirus were positive. In contrast, 0.5% of tests ordered for HSV 1 were positive. The southeastern United States had the highest rate of positive tests for HSV 2 (7% of tests ordered for HSV 2 were positive). The central United States had the highest rate of positive test for West Nile virus (11% of tests ordered for West Nile were positive). The northeastern region and the highest rate of positive tests for varicella zoster (18%). Table 1: Percentage of positive CSF tests (positive tests/tests ordered) Table 2: Lists the number of HIV patients and transplant patients that had positive CSF PCR/serologies Figure 1: Percentage of positive CSF tests in each region Conclusion Approximately 40% of aseptic meningitis population had treatable etiologies. A third of the Cryptococcus meningitis population had HIV. Furthermore, enteroviruses had the majority of cases within the US, which are similar to studies done in other parts of the world. Disclosures All Authors: No reported disclosures

Download Full-text

Assessing Diazinon Pollution in the Three Major Rivers Flowing into the Caspian Sea (Iran)

Water ◽

10.3390/w13030335 ◽

2021 ◽

Vol 13 (3) ◽

pp. 335

Author(s):

Reza Dahmardeh Behrooz ◽

Abbas Esmaili-sari ◽

Magdalena Urbaniak ◽

Paromita Chakraborty

Keyword(s):

High Risk ◽

Organophosphorus Pesticides ◽

Aquatic Organisms ◽

The United States ◽

The Caspian Sea ◽

Worst Case ◽

Pollution Levels ◽

Haraz River ◽

Significant Difference ◽

Medium Risk

The aim of this study was to investigate the seasonal and spatial variations in the concentrations of a widely used organophosphorous pesticide (OPP), diazinon, and the associated risk posed by this OPP in the surface water from the three largest rivers located in the northern province of Iran: the Haraz, the Talar and the Babolrood rivers. These rivers are located in the agriculture province of Mazandaran, and are exposed to high doses of organophosphorus pesticides, especially diazinon. The concentration of diazinon was determined using gas chromatography, while the potential risk posed by diazinon was elucidated using a Risk Quotient (RQ) calculated for general (RQm) and worst-case (RQex) scenarios. The obtained results demonstrated that the average diazinon concentrations ranged from 41 ± 76 ng/L in the Talar River and 57 ± 116 ng/L in the Haraz River, to 76.5 ± 145 ng/L in the Babolrood River, with a significant difference noted between summer and autumn seasons for all three rivers. For some stations, the concentration of diazinon is higher than the standard guidelines of Australian/New Zealand Guidelines for Fresh and Marine Water Quality (FMWQ) and the United States Criteria Maximum Concentration (CMC). The calculated RQs indicated a medium risk of diazinon, RQm = 0.73 and RQex = 2.27, in the Talar River; RQm = 1.02 and RQex = 2.49 in the Haraz River; and RQm = 1.35 and RQex = 4.54 in the Babolrood River. The overall exposure of diazinon was defined to have a high risk (RQm and RQex > 1); however, the summer sampling revealed a high risk (RQm and RQex > 1), while the autumn had a medium risk (RQm and RQex < 1). The obtained results revealed not only elevated concentrations of diazinon in the studied rivers but most importantly the high risk posed by this OPP for the aquatic organisms and the wellbeing of the whole river ecosystem. The current study showed that development and implementation of appropriate standards and regulations toward diazinon in countries such as Iran are required to reduce the pollution levels and risks related to elevated concentrations of the studied pesticide.

Download Full-text

Ampicillin-Ceftriaxone vs Ampicillin-Gentamicin for Definitive Therapy of Enterococcus faecalis Infective Endocarditis: A Propensity Score–Matched, Retrospective Cohort Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab102 ◽

2021 ◽

Vol 8 (4) ◽

Author(s):

Niyati H Shah ◽

Kathleen A Shutt ◽

Yohei Doi

Keyword(s):

Infective Endocarditis ◽

Propensity Score ◽

Adverse Events ◽

Cohort Analysis ◽

Hospital Readmissions ◽

Length Of Hospital Stay ◽

The United States ◽

Aminoglycoside Resistance ◽

Definitive Therapy ◽

Significant Difference

Abstract Background Ampicillin-ceftriaxone (AC) has emerged as an alternative antibiotic regimen for enterococcal infective endocarditis (EIE) with reduced toxicity compared with ampicillin-gentamicin (AG), but evidence regarding its success in reducing EIE-associated death in the United States is limited. Methods We conducted a retrospective, propensity score–matched cohort analysis of EIE patients treated with AC or AG between 2010 and 2017 at 3 hospitals in Pittsburgh, Pennsylvania. We assessed all-cause 90-day mortality as the primary outcome and in-hospital mortality, length of hospital stay, hospital readmissions, adverse events, and relapse of bacteremia as the secondary outcomes. Results A total of 190 patients with EIE (100 treated with AC and 90 with AG) were included. Ninety-day mortality was significantly higher with AC than AG (21% vs 8%; P = .02). After propensity score matching, 56 patients in each group remained for the outcomes analysis. Documented aminoglycoside resistance, presence of annular or aortic abscess, and complete pacemaker removal were the significantly different variables between the 2 matched cohorts. We observed no statistically significant difference in 90-day mortality between the 2 treatment groups (11% vs 7%; P = .55). Adverse events were more common in patients treated with AG (25 vs 39; P = .0091), and more patients in the propensity score–matched AG cohort switched antibiotic regimens than in the AC group (10% vs 49%; P < .0001). Conclusions Patients treated with AC demonstrate no significant differences in mortality, treatment failure, or bacteremia relapse compared with AG in a propensity score–matched EIE cohort.

Download Full-text

Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/21925682211030873 ◽

2021 ◽

pp. 219256822110308

Author(s):

Andrew Platt ◽

Mostafa H. El Dafrawy ◽

Michael J. Lee ◽

Martin H. Herman ◽

Edwin Ramos

Keyword(s):

Systematic Review ◽

Random Effects ◽

Surgical Intervention ◽

Meta Analysis ◽

Gunshot Wounds ◽

Operative Management ◽

Operative Intervention ◽

Lumbosacral Spine ◽

Random Effects Model ◽

Significant Difference

Study Design: Systematic review and meta-analysis. Objectives: Indications for surgical decompression of gunshot wounds to the lumbosacral spine are controversial and based on limited data. Methods: A systematic review of literature was conducted to identify studies that directly compare neurologic outcomes following operative and non-operative management of gunshot wounds to the lumbosacral spine. Studies were evaluated for degree of neurologic improvement, complications, and antibiotic usage. An odds ratio and 95% confidence interval were calculated for dichotomous outcomes which were then pooled by random-effects model meta-analysis. Results: Five studies were included that met inclusion criteria. The total rate of neurologic improvement was 72.3% following surgical intervention and 61.7% following non-operative intervention. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 1.07; 95% CI 0.45, 2.53; P = 0.88). In civilian only studies, a random-effects model meta-analysis failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 0.75; 95% CI 0.21, 2.72; P = 0.66). Meta-analysis further failed to show a statistically significant difference in the rate of neurologic improvement between patients with either complete (OR 4.13; 95% CI 0.55, 30.80; P = 0.17) or incomplete (OR 0.38; 95% CI 0.10, 1.52; P = 0.17) neurologic injuries who underwent surgical and non-operative intervention. There were no significant differences in the number of infections and other complications between patients who underwent surgical and non-operative intervention. Conclusions: There were no statistically significant differences in the rate of neurologic improvement between those who underwent surgical or non-operative intervention. Further research is necessary to determine if surgical intervention for gunshot wounds to the lumbosacral spine, including in the case of retained bullet within the spinal canal, is efficacious.

Download Full-text