Previous research suggests that some racial/ethnic groups are at increased risk for poor health outcomes following a traumatic brain injury (TBI). Less is known about the extent to which TBI prevalence and incidence vary by race/ethnicity. This paper presents results of a systematic search and review of TBI prevalence and incidence among US racial and ethnic groups.
Studies were included if they were peer-reviewed, included any prevalence or incidence measure of head injury (TBI and concussion) in a US population, stratified by race and/or ethnicity and included data collected within the last 20 years. Estimates were synthesised and described based on study outcomes and population types.
TBI prevalence and incidence varied by race and ethnicity across a range of population and outcome types. Past year self-reported prevalence of sports-related or recreation-related concussion ranged from about 11% to 40% and was generally highest among American Indian/Alaska Native (AI/AN) high school students and lowest among Asian high school students. Similarly, rates of TBI-related deaths across the USA ranged from 7.7 per 100 000 population among Asian/Pacific Islanders to 29.0 among AI/AN individuals. Rates of abusive head trauma were generally higher among black children.
This review suggests the prevalence and incidence of TBI vary considerably by race/ethnicity and across different outcomes and populations examined. However, certain race/ethnicity groups, like AI/AN individuals, generally experience the highest frequency of TBI. Future research and interventions to help reduce TBIs among groups at increased risk for this injury may be warranted.
This study investigated the differences in injury profiles and safety device effectiveness among children with road traffic injuries (RTIs) involving passenger vehicles and school buses.
Using data from the Emergency Department-based Injury In-depth Surveillance database, this multicentre cross-sectional study investigated the injury profiles of 14 669 children aged 12 years old and younger who experienced RTIs from 2011–2021. Demographic factors, injury distribution, severity and effect of safety device use between RITs involving passenger vehicles and school buses were compared.
RTIs in children most frequently occurred between 12:00 and 18:00 hours (46.9%). School bus-related RTIs peaked during school commute hours, that is, from 06:00 to 12:00 hours, and were associated with a higher prevalence of head (63.1% vs 58.9%, p<0.05) and extremity injuries (upper extremity: 8.0% vs 6.4% and lower extremity: 11.1% vs 7.6 %, p<0.05) compared with those involving passenger vehicles. However, passenger vehicle crashes showed higher proportions of neck and chest injuries, along with injuries requiring hospitalisation and intensive care. Safety devices exhibited preventive effects against head and lower extremity injuries in both vehicle types. While safety devices showed effective in reducing hospital admissions and severe injuries in passenger vehicles, their effectiveness in school buses was not observed.
This study highlights the different epidemiology and injury profiles of RTIs among children involving passenger vehicles and school buses. Improved safety devices, particularly in school buses, are necessary to ensure the comprehensive protection of child passengers and reduce the risk of severe injuries during road traffic incidents.
Premature graduation to an adult seatbelt is common and detrimental to optimal crash protection. While there is an existing tool (the 5-step test) to support a parent’s decision to graduate their child, its effectiveness is unknown. The aim of this study was to evaluate the 5-step test.
A randomised controlled design was used. Participants were parents of children aged 7–12 years. After exposure to information about the 5-step test or control material, participants assessed belt fit in three seating conditions and ‘thought aloud’ while making their assessment. Seating conditions provided a good, poor and partially good seatbelt fit based on the child’s anthropometry. Participants were also assessed on their knowledge of good seatbelt fit criteria.
Participants exposed to the 5-step test (n=18) had significantly improved their knowledge of the criteria required to achieve good seatbelt with, on average, 1.0 higher score in the 6-point assessment (95% CI 0.23 to 1.7, p=0.012) than those in the control group. There was also a greater percentage of participants in this group (44.4% intervention vs 27.8% control) who made accurate decisions about seatbelt fit, but this difference did not reach significance (OR 2.08, 95% CI 0.52 to 8.34).
The results demonstrate that the 5-step test is effective in improving knowledge but are inconclusive about its effectiveness in promoting accurate decision-making. However, the proportion of participants making accurate decisions in the intervention group remained low. This suggests that parents may require greater assistance than what is currently provided.
Multiple anonymous reporting systems (ARS) have been implemented to prevent school violence and improve school climate. This study examines the facilitators and barriers to implementation and the role and usability of the Say Something Anonymous Reporting System (SS-ARS).
10 qualitative interviews with key staff and administrators from intervention schools in the Miami-Dade County School District were conducted between July and December 2020. Using a thematic framework analysis of interview transcripts, we identified major themes related to the SS-ARS.
Students used the SS-ARS to report issues related to violence, mental health and substance use. The SS-ARS provided training and safe reporting channels, enabling prompt responses from administrators. Successful anonymous reporting system implementation requires ongoing training for students and personnel, a multidisciplinary response team and integration into a comprehensive school safety effort.
Our study highlights key facilitators and barriers to implementing ARS in schools, offering three takeaways for practitioners: (1) include ongoing training for students and personnel, (2) establish a multidisciplinary team to respond to reports and integrate ARS into a comprehensive safety effort and (3) encourage reporting on a range of concerns. Interviews were conducted with school personnel, with findings primarily reflecting their perspectives, thereby limiting the ability to generalise the findings to students. Although conducted in schools within Miami-Dade County, an urban US county, the findings may be relevant for practitioners implementing ARS or similar initiatives in educational settings globally, given the ubiquity of violence and mental health issues among adolescents.
Given the high incidence and heavy burden of ankle sprains in recruits, large-scale, multifactorial investigations into potential risk factors are warranted. This study aimed to identify the incidence of ankle sprains and associated risk factors among new military recruits during their infantry training.
The study included 365 infantry recruits (aged 18–21 years), who were inducted into service in March 2022. These recruits were monitored for ankle sprains throughout their basicy and advanced infantry training by a physiotherapist. Preinduction smoking habits, physical fitness preparation and recurrent ankle sprains were recorded. Anthropometric measures, lower-extremity functional movement, Achilles tendon structure, perceived ankle instability, and mechanical ankle instability were assessed at the onset of both training periods.
Ankle sprains were diagnosed in 109 trainees (29.9%) during both the basic and the advanced training periods. Preinduction recurrent ankle sprains were reported by 28.2% of the participants. The relative risk of a recruit with preinduction ankle sprains suffering a subsequent sprain during training was 1.66 (p=0.001). Logistic regression analysis indicated that reduced proprioception ability (OR=0.002), higher body mass index (OR=1.08), preinduction recurrent sprains (OR=1.95) and lack of physical fitness preparation (OR=3.12) were related to ankle sprains throughout the complete basic-and-advanced training period. Preinduction recurrent ankle sprains (OR=3.37) and reduced Achilles tendon quality (OR=1.30) were associated with ankle sprains during the advanced training period.
Lower-extremity functional movement, body mass index, preinduction recurrent sprains, physical preparation and reduced Achilles tendon quality were associated with the risk of ankle sprains during training. These findings could contribute to developing prevention and intervention programmes for reducing ankle sprains in military trainees.
The Eastern Mediterranean Region suffers disproportionately from paediatric traffic-related injuries. Despite governmental laws, Lebanon—an eastern Mediterranean country—has low child restraint (CR) use prevalence. This study examined the impact of using car seat distribution, and child passenger safety education and awareness intervention to improve child passenger safety knowledge and practices among caregivers.
This study recruited Lebanese caregivers with one child or more, using a 4-wheel motor vehicle, and not using a car seat. The intervention comprised an educational session followed by a car seat or booster seat distribution and installation check by a certified child passenger safety technician. A baseline assessment questionnaire was used to identify reasons for prior CR non-use. A child passenger safety knowledge test was administered before, immediately after and 3 months postintervention to assess child passenger safety knowledge retention and compare it to the baseline using the conditional logit model for pre–post interventions.
Fifty-eight participants underwent the intervention. Affordability was identified as the primary reason for car seat non-use. Three months after the intervention, compliance with CRs use was reported at 100%, and correct responses on the knowledge test significantly increased (p<0.05) for all items except for harness tightness (p=0.673).
Our child passenger safety intervention resulted in improved knowledge and increased self-reported use of CRs in a caregivers’ cohort in Lebanon. Further efforts should address sociocultural and economic barriers and the lack of local child passenger safety technicians to mitigate the region’s paediatric road traffic injury and death toll.
Head-on-head impacts are a risk factor for concussion, which is a concern for sports. Computer vision frameworks may provide an automated process to identify head-on-head impacts, although this has not been applied or evaluated in rugby.
This study developed and evaluated a novel computer vision framework to automatically classify head-on-head and non-head-on-head impacts. Tackle events from professional rugby league matches were coded as either head-on-head or non-head-on-head impacts. These included non-televised standard-definition and televised high-definition video clips to train (n=341) and test (n=670) the framework. A computer vision framework consisting of two deep learning networks, an object detection algorithm and three-dimensional Convolutional Neural Networks, was employed and compared with the analyst-coded criterion. Sensitivity, specificity and positive predictive value were reported.
The overall performance evaluation of the framework to classify head-on-head impacts against manual coding had a sensitivity, specificity and positive predictive value (95% CIs) of 68% (58% to 78%), 84% (78% to 88%) and 0.61 (0.54 to 0.69) in standard-definition clips, and 65% (55% to 75%), 84% (79% to 89%) and 0.61 (0.53 to 0.68) in high-definition clips.
The study introduces a novel computer vision framework for head-on-head impact detection. Governing bodies may also use the framework in real time, or for retrospective analysis of historical videos, to establish head-on-head rates and evaluate prevention strategies. Future work should explore the application of the framework to other head-contact mechanisms and also the utility in real time to identify potential events for clinical assessment.
Although cycling is a healthy, ecological and practical way of transportation, it is not without risk. The effect of bicycle helmets to prevent head injuries on crashing has been extensively investigated. Nonetheless, the overall use of helmets by adolescents remains low. While various interventions to increase helmet use have been adopted, adolescents’ perspectives on these interventions have not been extensively explored. In our study, we aim to understand the facilitators and barriers to bicycle helmet use by adolescents and their perspectives on injury prevention campaigns.
A qualitative methodology was selected. A convenience sample of three schools in Belgium was selected for participation. 12 focus groups were conducted with a total of 84 adolescents aged 12–17 years in the second, third or fourth year of secondary school.
Four key themes regarding adolescents’ views on safe cycling practices emerged from the analysis: external motivation, internal motivation, factors specific to the helmet and the cycling environment. The main barriers to bicycle helmet use identified by adolescents were peer pressure, appearance and discomfort. The perceived risks of cycling without a helmet among adolescents were low. Mandatory bicycle helmet laws and non-legislative programmes were considered to be an effective strategy by the study participants. Parental strategies, including strict parental rules and parental helmet use, further contributed to wear a bicycle helmet.
The results of this qualitative study add to the literature by expanding the understanding of motivation for bicycle helmet use and should be considered when designing interventions to promote bicycle helmet use.
Armed conflicts are likely to have implications for the welfare and safety of children, potentially leading to increased rates of unintentional childhood injuries.
We examine data from Israel concerning the relationship between emergencies and childhood mortality due to unintentional injuries using the media-based database of Beterem Safe Kids Israel to analyse seven events: 2008 Gaza War, 2014 Gaza War, first COVID-19 Lockdown, second COVID-19 Lockdown (September 2020), third COVID-19 Lockdown (December 2020), 2021 Israel–Palestine crisis and 2023 Israel–Gaza War. These events are categorised into Emergency Periods (EPs) and Emergency Routine Periods (periods during which an emergency extends and normalises into a stable routine; ERPs). For each EP we selected a comparable Routine Period (RP).
Unintentional childhood mortality rates are lower during EPs, compared with RPs. Conversely, there is an increase in unintentional mortality rates during ERPs. EPs and ERPs occurring during armed conflicts exhibit higher unintentional mortality rates compared with health-related EPs and ERPs. Furthermore, military-related ERPs show higher unintentional mortality rates compared with the corresponding RPs. Unintentional mortality rates are notably higher among Arab children compared with Jewish children, particularly during ERPs. Unintentional childhood mortality also differs as a function of socioeconomic ranking, with widening gaps between municipalities of low socioeconomic ranking and municipalities of medium to high socioeconomic ranking, during EPs and ERPs.
We hypothesise that parents’ emotional availability declines during EPs and ERPs associated with military conflicts, coinciding with socioeconomic aspects, impacting families’ well-being and children’s safety.
Injury is a major challenge to global public health. Analysing the trend of injury incidence in China from 1990 to 2019 and predicting future trends in incidence can provide a theoretical basis for injury prevention and control in China.
We collected age-standardised incidence rates of injuries in China from 1990 to 2019 from the Global Burden of Disease 2019 study. We analysed trends using joinpoint regression and age–period–cohort models. A prediction study was conducted using the Bayesian age-period-cohort model.
From 1990 to 2019, there was an increasing trend in transport injuries, a decreasing trend in unintentional injuries and a decreasing trend in self-harm and interpersonal violence. The high-risk age for transport injuries, unintentional injuries and self-harm and interpersonal violence were 20–69 years (relative risk (RR)>1), ≤14 and ≥80 years (RR>1) and 20–24 years (RR=2.311, 95% CI 2.296 to 2.326), respectively. Projections indicate that by 2030, the incidence of transport and unintentional injuries will increase, whereas the incidence of self-harm and interpersonal violence will decrease.
The age group with the highest risk of transport injuries, unintentional injuries and self-harm and interpersonal violence were the 20–69 years, ≤ 14 and ≥80 years and 20–24 years age groups, respectively. Transport injuries and unintentional injuries will increase in 2020–2030, while self-harm and interpersonal violence will decrease. These can serve as a basis for developing measures to prevent and manage the impact of injuries.
Missing and Murdered Indigenous People is a historic and contemporary issue that has gained national attention. In 2021, homicide was the eighth leading cause of death among American Indian/Alaska Native (AIAN) persons aged between 1 and 54 years old, and homicide is the sixth leading cause of death among all AIAN males aged 1–54 years old.
These data will build knowledge around AIAN homicides and to identify circumstances that can aid in comprehensive Missing and Murdered Indigenous People prevention efforts.
AIAN homicide data came from Centers for Disease Control and Prevention’s National Violent Death Reporting System, a state/jurisdiction-based surveillance system that collects detailed information about characteristics and circumstances of violent deaths. We examined data from 2003 to 2020 (all available years) from participating states/jurisdictions. We also assessed sociodemographic characteristics of victims and suspects, incident characteristics and differences across dichotomised urban/rural status. The study was conducted in 2022.
The National Violent Death Reporting System provided data on 2959 AIAN homicides from 2003 to 2020 (54.2% urban and 45.8% rural). Significant differences based on the two locations included type of weapon used, the location of the injury, race of the primary suspect, the victim’s relationship to the suspect and select circumstances precipitating the homicide including crimes precipitating the homicide and homicides stemming from intimate partner violence.
These findings provide crucial information to strengthen public health efforts for prevention.
Drowning is a leading cause of death for young children and knowing what puts a child at risk helps efforts across the spectrum of prevention. The purpose of this study was to identify risk and protective factors associated with hospital admission and mortality following paediatric drowning from a large level-1 paediatric trauma centre.
Children (ages 0–17) who presented at an emergency department or were admitted for a drowning event between 2017 and 2023 were included in this retrospective cohort study (n=698). This study examined differences between patients who were admitted compared with not admitted, and those who survived compared with those who did not survive.
Participants who had adult supervision at the time of their drowning were significantly less likely to be admitted (OR=0.31, 95% CI 0.22 to 0.43, p<0.001) and significantly more likely to survive (OR=6.9, 95% CI 3.2 to 15.4, p<0.001). The environment also played a significant role in drowning outcomes. Children who drowned in a pool compared with other bodies of water were significantly more likely to survive (OR=3.0, 95% CI 1.6 to 5.5, p<0.001). Children from communities with higher child opportunity compared with those from very low opportunity were both simultaneously more likely to be admitted (IRR=1.7–2.4, 95% CI 1.3 to 3.3, p<0.001) and more often survived (IRR=1.7–3.0, 95% CI 1.3 to 3.5, p<0.001).
Our analysis revealed significant differences in drowning risk related to adult supervision, location of drowning and where a child lives. These findings can help drowning prevention strategies mitigate the severity of drowning by enhancing educational messages, resources and policy.
Road safety authorities in high-income countries use geospatial motor vehicle collision data for planning hazard reduction and intervention targeting. However, low-income and middle-income countries (LMICs) rarely conduct such geospatial analyses due to a lack of data. Since 1991, Ghana has maintained a database of all collisions and is uniquely positioned to lead data-informed road injury prevention and control initiatives.
We identified and mapped geospatial patterns of hotspots of collisions, injuries, severe injuries and deaths using a well-known injury severity index with geographic information systems statistical methods (Getis-Ord Gi*).
We identified specific areas (4.66% of major roads in urban areas and 6.16% of major roads in rural areas) to target injury control. Key roads, including National Road 1 (from the border of Cote D’Ivoire to the border of Togo) and National Road 6 (from Accra to Kumasi), have a significant concentration of high-risk roads.
A few key road sections are critical to target for injury prevention. We conduct a collaborative geospatial study to demonstrate the importance of addressing data and research gaps in LMICs and call for similar future research on targeting injury control and prevention efforts.
To quantify the unintentional injuries associated with housing elements among older adults treated in US hospital emergency departments (EDs). To identify modifiable home hazards.
The National Electronic Injury Surveillance System (NEISS) coding manual was reviewed to identify all codes associated with housing elements that were permanently attached to a home. We queried the 2020 NEISS data for older adults (aged 65 and older) to determine the number of injuries associated with each element. The 10 elements involved in the most hospitalisations and the most ED visits were each tabulated by the number of records in the NEISS sample and national estimate, yielding two separate lists of 10 housing elements. A review of case narratives was conducted on a random selection constituting 10% of all records or a minimum of 100 records to determine common precipitating factors and prevention recommendations.
From the two lists, we identified 11 housing elements most commonly associated with housing-related injuries, resulting in ED visits or hospitalisations. The housing element most associated with housing-related injuries was floor, leading to 929 937 ED visits. Subsequent case narrative review yielded prevention recommendations, including modifications that support balance and fall recovery, reduce the need to reach and improve visibility.
Housing element-related injuries affect hundreds of thousands of older adults. Case narratives reveal falls, tripping/slipping and sliding injuries that can potentially be prevented with home modification. NEISS is a valuable tool to identify injury risks in the home.
Training characteristics, such as volume and duration, have been studied in relation to running-related injury (RRI) risk, with mixed findings in adult runners. There is a lack of research assessing how training characteristics relate to RRI in youth runners, despite the high RRI rates observed in this population.
To prospectively determine associations between (1) total weekly running volume and duration and (2) week-to-week changes in running volume, duration, intensity and training stress with in-season RRI among high school cross-country runners.
Runners completed a preseason demographics and injury history survey and daily surveys regarding training distance, duration, intensity and current RRI. Values were summed weekly and change scores were calculated relative to the prior week. Runners completing ≥75% of daily surveys were analysed; sensitivity analyses for those completing ≥50% and ≥90% were conducted. Generalised estimating equations assessed associations between change in each predictor, including interactions with sex and RRI within the subsequent week, controlling for year in school, prior RRI and repeated observations.
434 runners enrolled in the study; 161 (37%) completed ≥75% of daily surveys. No associations between total volume, total duration or week-to-week change in training characteristics and in-season RRI were observed (p≥0.54). Sensitivity analyses did not detect any significant associations.
Total weekly running volume and duration and weekly changes in training were not associated with RRI. RRI are multifactorial and assessing the interaction between training characteristics and other lifestyle factors is likely necessary for determining RRI risk in youth runners.
Mexico is among the countries with the highest mortality rates by firearms worldwide. We aimed to analyse the trend in the burden of firearm violence (FV) by age and sex in Mexico at a national and subnational level, and the association between this burden and the Sociodemographic Index.
We used estimates from the Global Burden of Disease (GBD)-2019 study for the analysis of FV mortality, premature mortality and disability for all available age-groups and by sex. The GBD data separates FV into three categories—interpersonal violence from firearms, unintentional injuries from firearms and self-harm from firearms. We used a joinpoint regression analysis to analyse the temporal trends of the FV burden.
FV exhibited a non-significant increase. By cause, there was a significant increase in the burden of interpersonal violence from firearms, a non-significant decrease in the burden of self-harm from firearms and a significant decrease in the burden of unintentional injuries from firearms. Most of the FV burden is attributed to interpersonal violence from firearms. Almost the entirety of the burden of FV results from premature mortality. The incidence of FV disability adjusted life years (DALYs) was significantly higher among males than females, and was most concentrated in males aged 20–44 and females aged 15–49. Significant heterogeneity in FV DALY trends was observed at the subnational level.
These results may help to better understand the burden of FV and help the design and implementation of national and local preventive policies.
Verification of the completion of supervised practice driving hours for teenagers is challenging. Electronic logbooks could provide an objective alternative to paper logbooks. Factors influencing the adoption of electronic logbooks are poorly understood. We conducted a survey of a nationally representative sample of teenagers and parents in the USA to address these gaps in understanding.
The survey was fielded to teenagers who were currently learning to drive or had a full driver’s licence, and parents of teenager with a learner’s permit or a driver’s licence. We measured (1) support for supervised practice driving requirements and logbook requirements, (2) preferences between paper and electronic logbooks and (3) features that would make an electronic logbook useful.
Most parents and teenagers supported both supervised practice driving and logbook requirements. The overwhelming majority of teenagers and parents preferred an electronic logbook over paper. Electronic logbooks that provide (1) summary information about completed drives, (2) parent certification of drives and (3) automatic trip detection were features that were rated most useful by respondents.
This is the first study to measure teen and parent support for the logbook format to track supervised practice driving. Public support for electronic logbooks is high, suggesting that policy makers could consider adding an electronic logbook requirement to graduated driver licensing systems to objectively measure completed practice driving hours. Driver educators could also promote the use electronic logbooks to track practice and calibrate behind-the-wheel lessons to the amount of practice driving that has been completed.
Adolescents with acquired brain injuries are at risk for additional injuries after hospital discharge. We asked healthcare providers to identify and prioritise urgent hazards in the home setting for this population.
We used a convergent mixed methods approach. Healthcare providers who do discharge planning and community re-integration for adolescent patients with brain injury were recruited from hospitals in the US Midwest. Participants completed two structured surveys, semi-structured interviews and a Hazard Prioritisation Matrix Activity. We analysed quantitative data via descriptive statistics and qualitative data via inductive thematic analysis to identify hazards, urgency, interactive themes and generate a conceptual model.
All participants validated four preidentified hazards in the surveys and the interviews: slippery objects on the floor, large furniture/objects in the path of travel, unattended open flames and inappropriate use of cooking appliances. 59 hazards were self-identified during the Hazard Priority Matrix Activity and assigned an urgency rating, with 12 (20.3%) urgent, 20 (33.9%) major, 19 (32.2%) moderate and 8 (13.6%) minor risks. We identified seven interactive themes about hazard factors: hazardous activities, hazardous situations, hazardous objects, hazardous others, hazardous spaces, harms and client factors. A conceptual model for home safety concerns links hazards, risks and harms.
Adolescents with acquired brain injuries need healthcare providers to recognise unique and complex hazards in their homes that could lead to harm. Mitigating home hazards may prevent additional unintentional injury for these adolescents. More research is needed to generalise this information for this population across clinical settings.
The need for evidence to inform interventions to prevent mass shootings (MS) in the USA has never been greater.
Data were abstracted from the Gun Violence Archive, an independent online database of US gun violence incidents. Descriptive analyses consisted of individual-level epidemiology of victims, suspected shooters and weapons involved, trends and county-level choropleths of population-level incident and fatality rates. Counties with and without state-level assault weapons bans (AWB) were compared, and we conducted a multivariable negative binomial model controlling for county-level social fragmentation, median age and number of gun-related homicides for the association of state-level AWB with aggregate county MS fatalities.
73.3% (95% CI 72.1 to 74.5) of victims and 97.2% (95% CI 96.3 to 98.3) of shooters were males. When compared with incidents involving weapons labelled ‘handguns’, those involving a weapon labelled AR-15 or AK-47 were six times more likely to be associated with case-fatality rates greater than the median (OR=6.1, 95% CI 2.3 to 15.8, p<0.00001). MS incidents were significantly more likely to occur on weekends and during summer months. US counties in states without AWB had consistently higher MS rates throughout the study period (p<0.0001), and the slope for increase over time was significantly lower in counties with AWB (beta=–0.11, p=0.01). In a multivariable negative binomial model, counties in states with AWB were associated with a 41% lower incidence of MS fatalities (OR=0.58, 95% CI 0.37 to 0.97, p=0.02).
Counties located in states with AWB were associated with fewer MS fatalities between 2014 and 2022.
Paediatric drowning is an injury associated with significant morbidity and mortality.
The objective is to describe drowning trends, including associations with inpatient hospitalisation or fatality, in a state-wide paediatric cohort to inform prevention strategies.
In this retrospective cohort study using the Health Services Cost Review Commission database, we used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify patients aged 0–19 years with an outpatient (including emergency department) or inpatient medical encounter following a non-fatal or fatal drowning event between 2016 and 2019. Descriptive statistics and logistic regression were used to summarise the data and evaluate associations with inpatient hospitalisation or fatality.
There were 541 medical encounters for drowning events, including 483 non-fatal outpatient encounters, 42 non-fatal inpatient encounters and 16 fatal cases. Overall, most patients were boys, 0–4 years, white and lived in urban settings. White children accounted for 66% of encounters among those aged 0–4 years, whereas non-white children accounted for 62% of visits among those aged 10–19 years. Non-white children were more likely than white children to experience a fatal drowning (OR 3.6, 95% CI: 1.2 to 11.5). Adolescents were more likely than younger children to be hospitalised (OR 3.1, 95% CI: 1.6 to 6.5) and had higher charges in outpatient (p=0.002) and inpatient settings (p=0.003).
Our study revealed high fatality rates among non-white children and high admission rates among adolescents.
Commotio cordis is a rare event that occurs following blunt, non-penetrating trauma to the chest, precipitating a ventricular arrhythmia. Commotio cordis requires immediate medical attention through cardiopulmonary resuscitation and defibrillation, often resulting in death. Commotio cordis is most common condition among young male athletes. The purpose of this study was to describe the incidents and patterns of commotio cordis among young athletes participating in organised sports in the USA from academic years 1982-1983 through 2022-2023.
This was a retrospective, descriptive epidemiology study using surveillance data from the National Center for Catastrophic Sport Injury Research. The study included all commotio cordis incidents captured in the database. We calculated descriptive statistics (counts and proportions) overall and stratified by outcome and athlete sport.
Over the study period, 64 incidents of commotio cordis were captured. The majority occurred among males (n=60) and were caused by contact with an object/apparatus (n=39) or contact with another player (n=20). The most common sports were baseball (n=20), lacrosse (n=17) and football (n=13). Over half of these incidents resulted in death (n=34), although survival from commotio cordis increased over the study period. A higher proportion of fatal incidents occurred among football athletes and were caused by contact with another player.
Commotio cordis remains most common among young male athletes who participate in organised baseball, lacrosse and football. Although survival has improved over time, greater awareness and emergency preparedness for commotio cordis in an organised sport are needed to facilitate prompt recognition and intervention.
The Centers for Disease Control and Prevention’s Drug Overdose Surveillance and Epidemiology (DOSE) system captures non-fatal overdose data from health departments’ emergency department (ED) and inpatient hospitalisation discharge data; however, these data have not been compared with other established state-level surveillance systems, which may lag by several years depending on the state. This analysis compared non-fatal overdose rates from DOSE discharge data with rates from the Healthcare Cost and Utilization Project (HCUP) in order to compare DOSE data against an established dataset.
DOSE discharge data case definitions (ie, International Classification of Diseases, 10th revision, Clinical Modification codes) for non-fatal unintentional/undetermined intent all drug, all opioid-involved, heroin-involved and stimulant-involved overdoses were applied to HCUP’s 2018–2020 State Emergency Department Databases (SEDD) and State Inpatient Databases (SID). Quarterly crude rates (per 100 000 population) and rate differences of four overdose categories were calculated for ED and inpatient data sources across 18 states included in DOSE and HCUP datasets for at least 2 consecutive years. Joinpoint regression models examined trends from 2018 through 2020, estimating average quarterly percentage change (AQPC) and 95% CIs.
Quarterly crude rate differences between DOSE ED and SEDD data (across 12 states) and DOSE inpatient and SID data (across 16 states) indicated that 82% and 93% of rates, respectively, were within ±0.5 non-fatal overdoses per 100 000 population of each other. AQPC across states and drug categories were similar between the two data sources for both ED and inpatient data.
Non-fatal overdose surveillance through DOSE discharge data may be a valid and timely source for estimating non-fatal overdoses at the state level.
George Floyd’s death in 2020 galvanised large protests around the country, including the emergence of the Capitol Hill Autonomous Zone (CHAZ) in Seattle, Washington, a non-policed, organised protest region that may have differing injury risks than other regions. We sought to quantitatively describe characteristics of injuries related to protests documented at visits to two nearby major emergency departments, including the only Level 1 trauma centre in the state.
Using the International Classification of Diseases, 10th Revision code inclusion criteria, we identified 1938 unique patient visits across the two emergency departments from 29 May 2020 and 1 July 2020. We reviewed provider notes to identify keywords to determine if the visit was related to the CHAZ protest. We quantitatively described demographics and injury characteristics.
We identified 48 injury visits related to the protest, with 25 from assault, 11 from crowd-control weapons and 8 from ground-level falls. Crowd-control weapons consisted of five visits from pepper spray, five from tear gas and a smaller number from flash-bang grenades, rubber bullets or other projectiles or a baton. In terms of body region injuries, 23 involved the head, 13 involved the knee and lower leg and 11 involved the thorax. Five patients required transfer to the operating room for surgery and admission and two died.
The demonstrations during the CHAZ in Seattle in 2020 resulted in several violent injuries. Given the high proportion of assault and head injuries, these injury patterns can help prepare healthcare workers and first responders to plan care needs during protests.
Firearm secure storage (ie, storing firearms unloaded and locked) is recommended to reduce unintentional injuries and suicides. However, the relationship between psychological states, such as social isolation, and firearm secure storage practices is under-researched.
Data are from 7136 individuals with firearms in their households from the 2022 Behavioral Risk Factor Surveillance System. Multinomial logistic regression was used to explore the relationship between social isolation and firearm storage.
Among respondents, 71.6% reported storing firearms unloaded, 14.2% stored firearms loaded and locked and 14.2% stored firearms loaded and unlocked. Most respondents reported feeling ‘never’ (40.7%) or ‘rarely’ (33.3%) socially isolated, with 18.7% reporting ‘sometimes’, 4.3% ‘usually’ and 3.0% ‘always’ feeling socially isolated. Covariate-adjusted multinomial logistic regression analysis revealed that respondents who felt ‘always’ socially isolated had an over threefold greater risk of storing firearms loaded and unlocked (relative risk ratio=3.733, 95% CI 1.443 to 9.662, p=0.007) compared with unloaded.
Results suggest a link between feelings of social isolation and unsecured firearm storage. Public health strategies should address both firearm safety education and the underlying issue of social isolation.