Road hazard: a systematic review of traffic injuries following recreational cannabis legalization.

PURPOSE: Acute cannabis use is associated with impaired driving performance and increased risk of motor vehicle crashes. Following the Canadian Cannabis Act's implementation, it is essential to understand how recreational cannabis legalization impacts traffic injuries, with a particular emphasis on Canadian emergency departments. This study aims to assess the impact of recreational cannabis legalization on traffic-related emergency department visits and hospitalizations in the broader context of North America. METHODS: A systematic review was conducted according to best practices and reported using PRISMA 2020 guidelines. The protocol was registered on July 5, 2022 (PROSPERO CRD42022342126). MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), and Scopus were searched without language or date restrictions up to October 12, 2023. Studies were included if they examined cannabis-related traffic-injury emergency department visits and hospitalizations before and after recreational cannabis legalization. The risk of bias was assessed. Meta-analysis was not possible due to heterogeneity. RESULTS: Seven studies were eligible for the analysis. All studies were conducted between 2019 and 2023 in Canada and the United States. We found mixed results regarding the impact of recreational cannabis legalization on emergency department visits for traffic injuries. Four of the studies included reported increases in traffic injuries after legalization, while the remaining three studies found no significant change. There was a moderate overall risk of bias among the studies included. CONCLUSIONS: This systematic review highlights the complexity of assessing the impact of recreational cannabis legalization on traffic injuries. Our findings show a varied impact on emergency department visits and hospitalizations across North America. This underlines the importance of Canadian emergency physicians staying informed about regional cannabis policies. Training on identifying and treating cannabis-related impairments should be incorporated into standard protocols to enhance response effectiveness and patient safety in light of evolving cannabis legislation.

RéSUMé: OBJECTIF: La consommation aiguë de cannabis est associée à une conduite avec facultés affaiblies et à un risque accru d'accidents de la route. À la suite de la mise en œuvre de la Loi canadienne sur le cannabis, il est essentiel de comprendre l'incidence de la légalisation du cannabis à des fins récréatives sur les blessures de la route, en mettant l'accent sur les services d'urgence canadiens. Cette étude vise à évaluer l'impact de la légalisation du cannabis à des fins récréatives sur les visites et les hospitalisations aux urgences liées à la circulation dans le contexte plus large de l'Amérique du Nord. MéTHODES: Une revue systématique a été menée selon les meilleures pratiques et a été rapportée en utilisant les directives PRISMA 2020. Le protocole a été enregistré le 5 juillet 2022 (PROSPERO CRD42022342126). MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost) et Scopus ont été fouillés sans restriction de langue ou de date jusqu'au 12 octobre 2023. Des études ont été incluses si elles examinaient les visites aux urgences et les hospitalisations avant et après la légalisation du cannabis à des fins récréatives. Le risque de biais a été évalué. La méta-analyse n'était pas possible en raison de l'hétérogénéité. RéSULTATS: Sept études étaient admissibles à l'analyse. Toutes les études ont été menées entre 2019 et 2023 au Canada et aux États-Unis. Nous avons trouvé des résultats mitigés concernant l'impact de la légalisation du cannabis récréatif sur les visites aux urgences pour les blessures de la route. Quatre des études incluaient une augmentation des accidents de la route après la légalisation, tandis que les trois autres études n'ont révélé aucun changement significatif. Le risque global de biais était modéré parmi les études incluses. CONCLUSIONS: Cet examen systématique met en évidence la complexité de l'évaluation de l'impact de la légalisation du cannabis récréatif sur les blessures de la route. Nos résultats montrent un impact varié sur les visites aux urgences et les hospitalisations en Amérique du Nord. Cela souligne l'importance pour les médecins d'urgence canadiens de se tenir informés des politiques régionales sur le cannabis. La formation sur l'identification et le traitement des déficiences liées au cannabis devrait être intégrée aux protocoles normalisés afin d'améliorer l'efficacité de l'intervention et la sécurité des patients à la lumière de l'évolution de la législation sur le cannabis.

Rethinking cervical spine clearance in obtunded trauma patients: An updated systematic review and meta-analysis.

BACKGROUND: Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma. METHODS: A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology. RESULTS: 744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity. CONCLUSIONS: Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma. IMPLICATIONS OF KEY FINDINGS: Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.