Prehospital Factors Associated with Refractory Traumatic Arrest

Objective. Identification of the prehospital factors associated with a poor prognosis of immediate traumatic arrest should help reduce unwarranted treatment. We aim to reveal the clinical factors related to death after traumatic arrest on the scene. Methods. We performed a multicenter (4 tertiary hospitals in urban areas of South Korea) retrospective study on consecutive adult patients with trauma arrest on scene who were transferred by fire ambulance from January 2016 to December 2018. Patients with death on arrival in the emergency room (ER) were excluded. Prehospital data were collected from first aid records, and information on each patient’s survival outcome in the ER was collected from an electronic database. Patients were divided into ER death and ER survival groups, and variables associated with prehospital trauma were compared. Results. A total of 145 (84.3%) and 27 (15.7%) patients were enrolled in the ER death and survival groups, respectively. Logistic regression analysis revealed that asystole (OR 4.033, 95% CI 1.342–12.115, p = 0.013) was related to ER death and that ROSC in the prehospital phase (OR 0.100, 95% CI 0.012–0.839, p = 0.034) was inversely related to ER death. In subgroup analysis of those who suffered fall injuries, greater height of fall was associated with ER death (15.0 (5.5–25.0) vs. 4.0 (2.0–7.5) meters, p = 0.001); the optimal height cutoff for prediction of ER death was 10 meters, with 66.1% sensitivity and 100% specificity. Conclusions. In cases of traumatic arrest, asystole, no prehospital ROSC, and falls from a greater height were associated with trauma death in the ER. Termination of resuscitation in traumatic arrest cases should be done on the basis of comprehensive clinical factors.

Conceptual Design and Analysis of a Hybrid Walking Cane

This work is aimed to design and analyze the staircase climbing aid, hybrid with the function of walking cane. The tremendous demand for living space increases the essentiality of staircase, corresponding to the escalation of fall injuries. The handrails complemented along with staircase had provided deficient safeguard for staircase user, particularly senior citizen and people with lower limb disability, who need staircase climbing aid to provide extra support during escalating or declining staircase.

Saving fall-injured older adults from depressive symptoms: The mediating role of social participation

Falls are the second primary cause of unintentional injury deaths globally. Prior studies found that fall incidences are associated with depressive symptoms among older adults, which could reversely lead to repeated fall incidences. However, few have investigated the role of social interventions in saving fall-injured older adults from experiencing depressive symptoms among older adults. Using the Chinese Health and Retirement Longitudinal Study (CHARLS) 2011-2018 data and multiple levels of fixed-effect analysis, this study examined the potential mediating role of social participation in alternating the effect of fall injuries on depressive symptoms. For the first time, this study specified the fall-injured older adults among those who had fall incidences. It also implemented the current literature by removing the bias caused by unobservable confounding variables at provincial and city levels. The descriptive results show that 22.2% and 20.6% of rural (n=4,972) and urban (n=3,258) older adults (65+), respectively, experienced fall incidences, among whom 45.1% needed one or more times of medical treatment. The fixed-effect results show that for urban older adults, social participation accounted for partial effects (17.2%) of fall injuries on their depressive symptoms. For rural older adults, fall injuries are significantly associated with more depressive symptoms, but social participation no longer functions as the mediator. Findings from this study emphasize the necessity of collecting efforts from multiple levels to improve the social engagement of urban older adults who had fall injuries. Future studies could further specify what types of social participation would be more helpful in buffering the intervention effects.

Persistent polypharmacy and fall injury risk: the Health, Aging and Body Composition Study

Background Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults. Methods The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in 4.6 ± 2.9 years) were defined as the initial claim with an ICD-9 fall E-code and non-fracture injury, or fracture code with/without a fall code from 1998/99 clinic visit to 12/31/08. Those without fall injury (N = 1219) were followed for 8.1 ± 2.6 years. Stepwise Cox models of fall injury risk with a time-varying variable for persistent polypharmacy (defined as ≥6 prescription medications at the two most recent consecutive clinic visits) were adjusted for demographics, lifestyle characteristics, chronic conditions, and functional ability. Sensitivity analyses explored if persistent polypharmacy both with and without fall risk increasing drugs (FRID) use were similarly associated with fall injury risk. Results Among 1764 participants, 636 (36%) had persistent polypharmacy over the follow-up period, and 1128 (64%) did not. Fall injury incidence was 38 per 1000 person-years. Persistent polypharmacy increased fall injury risk (hazard ratio [HR]: 1.31 [1.06, 1.63]) after adjusting for covariates. Persistent polypharmacy with FRID use was associated with a 48% increase in fall injury risk (95%CI: 1.10, 2.00) vs. those who had non-persistent polypharmacy without FRID use. Risks for persistent polypharmacy without FRID use (HR: 1.22 [0.93, 1.60]) and non-persistent polypharmacy with FRID use (HR: 1.08 [0.77, 1.51]) did not significantly increase compared to non-persistent polypharmacy without FRID use. Conclusions Persistent polypharmacy, particularly combined with FRID use, was associated with increased risk for treated fall injuries from inpatient and outpatient settings. Clinicians may need to consider medication management for FRID and other fall prevention strategies in community-dwelling older adults with persistent polypharmacy to reduce fall injury risk.

Ten-Year Trends of Adult Trauma Patients in Denmark from 2010 to 2019: A Retrospective Cohort Study

Background: Trauma causes a considerable economic and societal burden and the trauma patient population and its prognosis changes over time. The aim of this study is to analyze ten-year trends of trauma patients at a major trauma center in Denmark. Methods: 5366 patients aged ≥ 16 years with Injury Severity Score (ISS) > 0 admitted by trauma team activation at Aarhus University Hospital Trauma Center between January 1, 2010 and December 31, 2019 were included. Descriptive statistics, incidence rate calculation, parametric and non-parametric test were used. An annual percent change with 95% confidence interval was used to estimate trend in mechanism of injuries. Multiple logistic regression with mortality as outcome were adjusted for age, sex and ISS. Results: The median age increased from 37 in 2010 to 49 in 2019 and the proportion of patients aged ≥ 65 doubled. The incidence of minor injuries (ISS 1-15) decreased from 181.3/105 inhabitants in 2010 to 112.7/105 in 2019 corresponding to an incidence rate ratio between 2019 and 2010 of 0.62 (95% CI: 0.54 to 0.72). Severe injuries (ISS > 15) increased from 10.1/105 inhabitants in 2010 to 13.6/105 in 2019 corresponding to an incidence rate ratio between 2019 and 2010 of 1.35 (95% CI: 1.04 to 1.76). The proportion of patients with ISS > 15 increased from 18.1% in 2010 to 31.1% in 2019. Multivariable logistic regression showed lower 30-day mortality for all trauma patients with ISS > 0 over the study period when adjusting for age, sex and ISS (Odds ratio: 0.94, 95% CI: 0.90 to 0.99). The 30-day mortality for severely injured patients with ISS > 15 decreased during the study period when adjusting for age, sex and ISS (Odds ratio: 0.92, 95% CI: 0.87 to 0.97). Fall injuries increased with an annual percent change of 4.1% (95% CI: 2.3% to 6.1%). Conclusions: Ten-year trends of trauma patients in Central Denmark Region show an increasing median age, injury severity and number of fall injuries. The 30-day mortality of trauma patients decreased for both minor injuries and severe injuries when adjusting for age, sex and injury severity. Trial registration: Not applicable.

Can we prevent falls in older individuals?

Falls are a major public health problem globally. Each year, 2.8 million elderly people (defined as those aged ≥65) are treated in emergency departments for fall injuries. A questionnaire containing 15 questions, prepared by researchers, was provided to patients who visited the emergency department due to falls and were aged ≥65. Patients who had fallen on the ground were included in the study group and were categorized using the following criteria: age, gender, education, socioeconomic status, life spots, falling location, chronic illnesses, previous falling episodes, cause of falls, medications used, hospital procedures undergone and the outcome of those procedures. A questionnaire was given to 159 patients that visited our emergency department as a result off all. When those patients that did not respond to the questionnaires, those who had high falls, and those who did not remember their traumas were excluded, there were 119 remaining. There were 83 female participants (69.7%) and 79.87 (SD, 7.98) were participants in the study. In our study, 21 (17.6%) patients were identified as having had previous falls. Age, gender, education status, living environment, number of drugs used, diseases and p values were compared according to old operative emoticons: 0.434, 0.855, 0.607, 0.502, 0.778, 0.324and 0.384, and there are no significant statistical differences between them. Despite the challenges mentioned above, educating people about the benefits of healthy ageing, and taking preventive measures will likely help to reduce negative outcomes in the future.

Deaths and Injuries from Unintentional Falls: An Analysis of Nepal Police Records

Falls are a major cause of unintentional injury-related global mortality and morbidity. The actual mortality and morbidity from falls in Nepal have been overlooked and not systematically studied. This study, therefore, aims to present the national status of fall-related deaths and injuries. The study analyzed the fall incidents recorded by Nepal Police for five fiscal years (17 July 2014 to 16 July 2019). These incident recordings were in the form of narratives, and possible variables were extracted for the analysis. In five years, 4,714 people were injured or died from falls in Nepal. The average age of the fall victim was 35.6 years (SD=19.94); the mean age of the person who died from falls was slightly lower (30.9 years) than the injured person (40.4 years). The analysis showed that the fall cases were remarkably greater for males than females. This study found that Bagmati Province, where the capital city was located has the highest death and injury rates from falls, followed by Gandaki Province and Province 1. The study identified 11 different locations of falls. These findings revealed that Nepal has a considerable burden of fall deaths and injuries. However, the actual burden of fall injuries might be higher due to the under-reporting of the incidents through the Nepal Police data recording system.