Drug use in Canadian patients with trauma after cannabis legalization

Background: The federal Cannabis Act came into force on Oct. 17, 2018, in Canada, making Canada only the second country in the world to legalize the cultivation, acquisition, possession and consumption of cannabis and its by-products. This provided a unique opportunity to evaluate the impact of this legislation on drug-related trauma. Methods: We performed a prospective observational study on the use of cannabis and other illicit drugs in the trauma population at a lead Canadian trauma centre in London, Ontario, in the 3 months before (July 1 to Sept. 30, 2018) and 3 months after (Nov. 1, 2018, to Jan. 31, 2019) the legalization of cannabis in Canada. We defined cannabis use as a positive cannabinoid screen result at the time of assessment by the trauma team. We also screened for opioids, amphetamines and cocaine. Results: A total of 210 patients were assessed by our trauma service between July 1 and Sept. 30, 2018, and 141 patients were assessed between Nov. 1, 2018, and Jan. 31, 2019. Motor vehicle collisions were the most common cause of trauma both before (101 [48.1%]) and after (67 [47.5%]) legalization. The mean Injury Severity Score was 17.6 (standard deviation [SD] 13.0) and 19.7 (SD 14.8), respectively. Drug screens were done in 88 patients (41.9%) assessed before legalization and 99 patients (70.2%) assessed after legalization. There was no difference in the rate of positive cannabinoid screen results before and after legalization (22 [25%] v. 22 [22%]). There was a trend toward higher rates of positive cannabinoid screen results (2/10 [20%] v. 5/8 [62%]) and positive toxicology screen results (5/10 [50%] v. 6/8 [75%]) after legalization among patients with penetrating trauma, but our sample was too small to achieve statistical significance. Conclusion: We found no difference in the rates of positive cannabinoid screen results among patients assessed at our trauma centre in the 3 months before and the 3 months after legalization of cannabis; however, there was a trend toward an increase in the rates of positive results of toxicology screens and cannabinoid screens among those with penetrating trauma. These preliminary single-centre data showing no increased rates of cannabis use in patients with trauma after legalization are reassuring.

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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

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000659 ◽

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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The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

Injury Epidemiology ◽

10.1186/s40621-021-00324-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Pedro E. Ruiz-Medina ◽

Ediel O. Ramos-Meléndez ◽

Kerwin X. Cruz-De La Rosa ◽

Antonio Arrieta-Alicea ◽

Lourdes Guerrios-Rivera ◽

...

Keyword(s):

Puerto Rico ◽

Injury Severity ◽

Negative Binomial ◽

Motor Vehicle ◽

Statistical Significance ◽

Control Period ◽

Hospital Length Of Stay ◽

Fisher Exact Test ◽

Trauma Centers ◽

The Impact

Abstract Background The COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease. Very little is known about the impact of these restrictions on trauma centers. Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient’s demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital. Methods An IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15, 2020 – June 15, 2020) with a control period (same period in 2017–2019). Comparisons were done using the Pearson’s chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate. A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods. Statistical significance was set at p < 0.05. Results A total of 308 subjects were admitted during the quarter of study for 2017; 323, for 2018; 347, for 2019; and 150, for 2020. The median (interquartile range) age of patients rose significantly from 40 (33) years to 49 (30) years (p < 0.001) for the lockdown period compared to the historical period. Almost all mechanisms of injury (i.e., motor vehicle accident, assault, pedestrian, burn, suicide attempt, other) had a slight non-significant reduction in the percentage of patients presenting with an injury. Instead, falls experienced an increase during the lockdown period (18.9% vs. 26.7%; p = 0.026). Moreover, the proportion of severe cases decreased, as measured by an injury severity score (ISS) > 15 (37.3% vs. 26.8%; p = 0.014); while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups. Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0.41; 95% CI 0.31–0.54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS. Conclusions Following periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns. Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances.

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Study on Crash Injury Severity Prediction of Autonomous Vehicles for Different Emergency Decisions Based on Support Vector Machine Model

Electronics ◽

10.3390/electronics7120381 ◽

2018 ◽

Vol 7 (12) ◽

pp. 381 ◽

Cited By ~ 6

Author(s):

Yaping Liao ◽

Junyou Zhang ◽

Shufeng Wang ◽

Sixian Li ◽

Jian Han

Keyword(s):

Support Vector Machine ◽

Autonomous Vehicles ◽

Injury Severity ◽

Prediction Models ◽

Motor Vehicle ◽

Support Vector ◽

Severity Prediction ◽

Emergency Decision ◽

The Impact ◽

Crash Injury Severity

Motor vehicle crashes remain a leading cause of life and property loss to society. Autonomous vehicles can mitigate the losses by making appropriate emergency decision, and the crash injury severity prediction model is the basis for autonomous vehicles to make decisions in emergency situations. In this paper, based on the support vector machine (SVM) model and NASS/GES crash data, three SVM crash injury severity prediction models (B-SVM, T-SVM, and BT-SVM) corresponding to braking, turning, and braking + turning respectively are established. The vehicle relative speed (REL_SPEED) and the gross vehicle weight rating (GVWR) are introduced into the impact indicators of the prediction models. Secondly, the ordered logit (OL) and back propagation neural network (BPNN) models are established to validate the accuracy of the SVM models. The results show that the SVM models have the best performance than the other two. Next, the impact of REL_SPEED and GVWR on injury severity is analyzed quantitatively by the sensitivity analysis, the results demonstrate that the increase of REL_SPEED and GVWR will make vehicle crash more serious. Finally, the same crash samples under normal road and environmental conditions are input into B-SVM, T-SVM, and BT-SVM respectively, the output results are compared and analyzed. The results show that with other conditions being the same, as the REL_SPEED increased from the low (0–20 mph) to middle (20–45 mph) and then to the high range (45–75 mph), the best emergency decision with the minimum crash injury severity will gradually transition from braking to turning and then to braking + turning.

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Functional Status after Injury: A Longitudinal Study of Geriatric Trauma

The American Surgeon ◽

10.1177/000313481007601006 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1055-1058 ◽

Cited By ~ 8

Author(s):

Lorraine Kelley-Quon ◽

Lillian Min ◽

Eric Morley ◽

Jonathan R. Hiatt ◽

Henry Cryer ◽

...

Keyword(s):

Functional Status ◽

Injury Severity ◽

Living Arrangement ◽

Statistical Significance ◽

Functional Decline ◽

Traumatic Injury ◽

Community Dwelling ◽

Geriatric Trauma ◽

Trauma Patients ◽

Trauma Population

We evaluated self-rated functional status measured longitudinally in the year after injury in a geriatric trauma population. The longitudinal (L) group included 37 of 60 eligible trauma patients aged 65 years or older admitted December 2006 to November 2007 for greater than 24 hours who completed a Short Functional Status questionnaire (SFS) at 3, 6, and 12 months after injury. The SFS yields scores of 0 to 5 (5 = independent in all five activities of daily living [ADLs]) and has been validated among community-dwelling elders. The control (C) group included 63 trauma patients aged 65 years or older admitted December 2007 to July 2009 for greater than 24 hours who reported their preinjury functional status using the SFS at hospital admission. We used characteristics and scores of the C group to impute preinjury ADL scores for the L group. The groups were similar in baseline characteristics (age, ethnicity, Injury Severity Score, Charlson Comorbidity Index, and living arrangement; P > 0.05). For the C group, the preinjury ADL score was 4.6 (SD = 0.9). For the L group, ADL scores declined at all intervals reaching statistical significance at 12 months. We conclude that in the year after traumatic injury, geriatric patients lost the equivalent of approximately one ADL, increasing their risk of further functional decline, loss of independence, and death.

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Did Amendments to the Ontario Highway Traffic Act in 2009-2010 Affect the Proportion of Alcohol-Related Motor Vehicle Collisions Seen at a Level I Trauma Centre over a 10-year Period?

CJEM ◽

10.1017/cem.2016.343 ◽

2016 ◽

Vol 19 (2) ◽

pp. 106-111

Author(s):

Meghan Garnett ◽

Tanya Charyk Stewart ◽

Michael R Miller ◽

Rodrick Lim ◽

Kristine Van Aarsen ◽

...

Keyword(s):

Injury Severity ◽

Trauma Registry ◽

Motor Vehicle ◽

Trauma Centre ◽

Trauma Patients ◽

Highway Traffic ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Level I ◽

Legislative Amendments

AbstractObjectivesTo determine if changes to the Ontario Highway Traffic Act (OHTA) in 2009 and 2010 had an effect on the proportion of alcohol-related motor vehicle collisions (MVCs) presenting to a trauma centre over a 10-year period.MethodsA retrospective review of the trauma registry at a Level I trauma centre in southwestern Ontario was undertaken. The trauma registry is a database of all trauma patients with an injury severity score (ISS) ≥12 and/or who had trauma team activation. Descriptive statistics were calculated. Interrupted time series analyses with ARIMA modeling were performed on quarterly data from 2004-2013.ResultsA total of 377 drivers with a detectable serum ethanol concentration (SEC) were treated at our trauma centre over the 10-year period, representing 21% of all MVCs. The majority (330; 88%) were male. The median age was 31 years, median SEC was 35.3 mmol/L, and median ISS was 21. A total of 29 (7.7%) drinking drivers died from their injuries after arriving to hospital. There was no change in the proportion of drinking drivers after the 2009 amendment, but there was a significant decline in the average SEC of drinking drivers after changes to the law. There was no difference in the proportion of drinking drivers ≤21 years after introduction of the 2010 amendment for young and novice drivers.ConclusionsThere was a significance decline in the average SEC of all drinking drivers after the 2009 OHTA amendment, suggesting that legislative amendments may have an impact on drinking before driving behaviour.

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Disruption of paediatric orthopaedic hospital services due to the COVID-19 pandemic in a region with minimal COVID-19 illness

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200140 ◽

2020 ◽

Vol 14 (4) ◽

pp. 245-251 ◽

Cited By ~ 2

Author(s):

Fui Lin Wong ◽

Georgia Antoniou ◽

Nicole Williams ◽

Peter J. Cundy

Keyword(s):

Hospital Admissions ◽

Elective Surgery ◽

Statistical Significance ◽

Tertiary Hospital ◽

Trauma Centre ◽

Level Of Evidence ◽

Orthopaedic Hospital ◽

Retrospective Audit ◽

Paediatric Orthopaedic ◽

The Impact

Purpose This study was designed to evaluate the impact of the COVID-19 pandemic on paediatric orthopaedic services in a paediatric tertiary hospital in South Australia. Methods A retrospective audit was conducted of orthopaedic activity at a major paediatric tertiary hospital with a Level 1 paediatric trauma centre, where no patients were admitted with COVID-19 illness. Orthopaedic Emergency Department (ED) presentations, outpatient clinics and hospital admissions for the period between 16 March 2020 to 26 April 2020 were studied and compared with the same period in 2019 (18 March 2019 to 28 April 2019). Chi-square tests were performed with p < 0.05 indicating statistical significance. Results In total, 621 patients presented to the ED with orthopaedic complaints during the pandemic (versus 997 in 2019). However, there was minimal change in the number of ED presentations requiring admission (110 in 2020 versus 116 in 2019). Among patients discharged directly from ED, 27.3% received hospital outpatient referral (versus 39.1% in 2019), with the remaining patients referred to community health services or discharged directly. There was a 509.8% increase in telehealth (video and phone) outpatient consultations compared to 2019 and a 60.6% decline in face-to-face appointments. There was a total of 144 orthopaedic admissions (elective and emergency) compared to 184 in 2019. Admissions for children under seven remained unchanged (32.5% reduction in children aged seven and above). Conclusion Despite an overall decline in all paediatric orthopaedic hospital activity, the number of emergency admissions for musculoskeletal conditions did not change. Elective surgery numbers for children aged under seven were also unchanged. Appropriate planning and hospital resources allocation are necessary to meet this service requirement in future pandemics. Level of evidence IV

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Examining the Effect of Social Influence on Young Drivers’ Behavior

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1541931218621318 ◽

2018 ◽

Vol 62 (1) ◽

pp. 1394-1398 ◽

Cited By ~ 1

Author(s):

Fangda Zhang ◽

Shashank Mehrotra ◽

Shannon C. Roberts

Keyword(s):

Social Influence ◽

Motor Vehicle ◽

Statistical Significance ◽

Influence Factors ◽

Driver Distraction ◽

Crash Risk ◽

Novice Drivers ◽

Young Drivers ◽

Study Participants ◽

The Impact

Motor vehicle crashes are the leading cause of death for 15 to 20-year olds. Young/novice drivers have long been thought to be vulnerable to the impact of peer passengers, and thus have a higher crash risk. It has been proven that perceived risky behavior of close friends was the best psychosocial predictor of risk. Additionally, young drivers (18-20 years) have the highest involvement in distraction-related crashes. The goal of this study was to examine the effect of social influence and driver distraction on young drivers’ behavior. Twenty-four pairs of participants took part in the study. Participants drove in pairs and by themselves while completing four distraction tasks. Results showed that the presence of a passenger did not show statistical significance related to drivers’ behavior. However, other social influence factors did significantly impact drivers’ behavior, including stimulating companionship, type of friendship, and their interactions.

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Impact of Multiprofessional Rounds on Critical Care Outcomes in the Surgical Trauma Intensive Care Unit

The American Surgeon ◽

10.1177/000313481908500108 ◽

2019 ◽

Vol 85 (1) ◽

pp. 15-22

Author(s):

Michael R. Nahouraii ◽

Colleen H. Karvetski ◽

Rita A. Brintzenhoff ◽

Gaurav Sachdev ◽

Susan L. Evans ◽

...

Keyword(s):

Injury Severity ◽

Statistical Significance ◽

Outcome Data ◽

Surgical Trauma ◽

Trauma Patients ◽

Linear Regression Models ◽

Icu Length Of Stay ◽

Severity Scores ◽

Mortality Difference ◽

The Impact

Multiprofessional rounds (MPR) represent a mechanism for the coordination of care in critically ill patients. Herein, we examined the impact of MPR on ventilator days (Vent-day), ICU length of stay (LOS), hospital LOS (HLOS), and mortality. A team developed guidelines for MPR, which began in February 2016. Patients admitted between November 2015 and March 2017 with Acute Physiology and Chronic Health Evaluation (APACHE) IV and injury severity scores were included. Outcome data consisted of Vent-day, Vent-day observed/expected ratio (O/E), ICU LOS, ICU LOS O/E, HLOS, HLOS-O/E, and mortality. Linear regression models are constructed to assess statistical significance. A total of 3372 patients were included. Among surgical patients (n = 343 pre-MPR, n = 1675 post-MPR), MPR was associated with decreases in Vent-day O/E (0.74 pre, 0.59 post, P = 0.03), ICU LOS O/E (0.67 pre, 0.61 post, P = 0.01), and HLOS-O/E (1.47 pre, 1.22 post, P = 0.0005). No mortality difference was observed. For trauma patients (n = 221 pre, n = 1133 post), MPR resulted in a reduction in Vent-days (2.2 days pre, 1.6 days post, P = 0.05). However, no differences were observed for Vent-day O/E, ICU LOS O/E, HLOS-O/E, and mortality. Implementation of MPR was associated with improved outcomes for surgical trauma ICU patients. Sustainability of MPR remains a challenge and requires education and engagement.

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A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0181 ◽

2016 ◽

Vol 98 (7) ◽

pp. 488-495 ◽

Cited By ~ 7

Author(s):

AS Madsen ◽

GL Laing ◽

JL Bruce ◽

DL Clarke

Keyword(s):

Vascular Injury ◽

Injury Severity ◽

Gunshot Wounds ◽

Anatomical Site ◽

Cervical Injury ◽

Stab Wounds ◽

Emergency Airway ◽

Trauma Service ◽

Penetrating Neck Injury ◽

The Impact

Introduction The aim of this comparative study of gunshot wounds (GSWs) and stab wounds (SWs) to the neck was to quantify the impact of the mechanism of injury on the outcome and management of penetrating neck injury (PNI). Methods A prospective trauma registry was interrogated retrospectively. Data were analysed pertaining to demographics and injury severity score (ISS), physiology on presentation, anatomical site of wounds and injuries sustained, investigations, management, outcome and complications. Results There were 452 SW and 58 GSW cases over the 46 months of the study. Patients with GSWs were more likely to have extracervical injuries than those with SWs (69% vs 63%). The incidence of a ‘significant cervical injury’ was almost twice as high in the GSW cohort (55% vs 31%). For patients with transcervical GSWs, this increased to 80%. The mean ISS was 17 for GSW and 11 for SW patients. Those in the GSW cohort presented with threatened airways and a requirement for an emergency airway three times as often as patients with SWs (24% vs 7% and 14% vs 5% respectively). The incidence among GSW and SW patients respectively was 5% and 6% for airway injuries, 12% and 8% for injuries to the digestive tract, 21% and 16% for vascular injuries, 59% and 10% for associated cervical injuries, 36% and 14% for maxillofacial injuries, 16% and 9% for injuries to the head, and 35% and 45% for injuries to the chest. In the GSW group, 91% underwent computed tomography angiography (CTA), with 23% of these being positive for a vascular injury. For SWs, 74% of patients underwent CTA, with 17% positive for a vascular injury. Slightly more patients with GSWs required operative intervention than those with SWs (29% vs 26%). Conclusions Patients with GSWs to the neck have a worse outcome than those with injuries secondary to SWs. However, the proportion of neck injuries actually requiring direct surgical intervention is not increased and most cases with PNI secondary to GSWs can be managed conservatively with a good outcome. Imaging should be performed for all GSWs to the neck.

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P008: Evaluation of outcomes after implementation of a provincial prehospital bypass standard for trauma patients – an Eastern Ontario experience

CJEM ◽

10.1017/cem.2019.199 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S65-S66

Author(s):

M. Austin ◽

J. Sinclair ◽

S. Leduc ◽

S. Duncan ◽

J. Rouleau ◽

...

Keyword(s):

Injury Severity ◽

Univariate Analysis ◽

Vital Signs ◽

Trauma Centre ◽

Trauma Patients ◽

Level Of Consciousness ◽

Orthopedic Operation ◽

Eastern Ontario ◽

Record Review ◽

The Impact

Introduction: Trauma and injury play a significant role in the population's burden of disease. Limited research exists evaluating the role of trauma bypass protocols. The objective of this study was to assess the impact and effectiveness of a newly introduced prehospital field trauma triage (FTT) standard, allowing paramedics to bypass a closer hospital and directly transport to a trauma centre (TC) provided transport times were within 30 minutes. Methods: We conducted a 12-month multi-centred health record review of paramedic call reports and emergency department health records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness, step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as an urgent transport to hospital, that met one of the 4 steps of the FTT standard and would allow for a bypass consideration. We developed and piloted a standardized data collection tool and obtained consensus on all data definitions. The primary outcome was the rate of appropriate triage to a TC, defined as any of the following: injury severity score ≥12, admitted to an intensive care unit, underwent non-orthopedic operation, or death. We report descriptive and univariate analysis where appropriate. Results: 570 adult patients were included with the following characteristics: mean age 48.8, male 68.9%, attended by Advanced Care Paramedic 71.8%, mechanisms of injury: MVC 20.2%, falls 29.6%, stab wounds 10.5%, median initial GCS 14, mean initial BP 132, prehospital fluid administered 26.8%, prehospital intubation 3.5%, transported to a TC 74.6%. Of those transported to a TC, 308 (72.5%) had bypassed a closer hospital prior to TC arrival. Of those that bypassed a closer hospital, 136 (44.2%) were determined to be “appropriate triage to TC”. Bypassed patients more often met the step 1 or step 2 of the standard (186, 66.9%) compared to the step 3 or step 4 (122, 39.6%). An appropriate triage to TC occurred in 104 (55.9%) patients who had met step 1 or 2 and 32 (26.2%) patients meeting step 3 or 4 of the FTT standard. Conclusion: The FTT standard can identify patients who should be bypassed and transported to a TC. However, this is at a cost of potentially burdening the system with poor sensitivity. More work is needed to develop a FTT standard that will assist paramedics in appropriately identifying patients who require a trauma centre.

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