Hospitalization and readmission after single-level fall: a population-based sample.

BACKGROUND: Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older. METHODS: We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge. RESULTS: Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually. CONCLUSIONS: SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation.

Agricultural Injury Surveillance Using a Regional Trauma Registry.

BACKGROUND: The burden of traumatic injury among workers in agriculture is substantial. Surveillance can inform injury prevention efforts to reduce farmworkers' risk. We posited that the regional trauma registry can provide surveillance for agricultural injury requiring trauma-center care. METHODS: The Northeast Texas regional trauma registry was queried for patients injured in agricultural settings during 2016-2019 occurring in the 23,580 square mile study area subdivided into 219 US Census Zip Code Tract Area (ZCTA). Population at risk was estimated from the 2017 Census of Agriculture. Kuldorff's SaTScan identified case hot spots. A multivariable, geographically weighted regression model was fit for cases/1000 workers. RESULTS: In total, 273 cases occurred, (mean 68 cases per year [95% confidence interval 55.1-80.9]) among 96 ZCTA. The mean injury rate was 3.9 (95% confidence interval 3.4-4.3) cases per 1000 farmworkers. Animals and farm machinery were the most common injury mechanisms, 52.0% and 20.9%, respectively. Trauma ZCTA demonstrated more farms (median 170 versus 95.5, P < 0.001), greater farm acreage (53,900 acres versus 32,800, P = 0.004), and higher median total product sales ($6.5 million versus $3.9 million, P < 0.001). Six hot spots were identified with relative risks from 2.85 to 5.31. The multivariable model of cases/1000 workers demonstrated significant associations with workers per ZCTA (a mean ß-coefficient of 0.004 with P values <0.05 in 145 of 219 [66.5%] ZCTA) and percent rural population (ß = -6.62, P values <0.05 in 76.1% of ZCTA). CONCLUSIONS: Regional trauma registry data, combined with census data and spatial analyses, can identify actionable geographic areas of high agriculture-related injury risk.

Testicle ischemia resulting from an inguinal hernia.

BACKGROUND: Scrotal pain in the emergency department (ED) should be evaluated rapidly for sources that may cause irreversible testicular ischemia. OBJECTIVES: This case report discusses a patient presenting with a large inguinal hernia causing testicle ischemia. CASE REPORT: A 48-year-old man with a 1-year history of a large right-sided indirect inguinal hernia was transferred to the ED from the ultrasound laboratory after the patient experienced acute onset of severe right-sided testicular pain. The radiologist urgently called the attending emergency physician to notify him of ultrasound findings that showed compromised vascular flow to the right testicle. Urology and General Surgery were consulted immediately. The patient was placed in a supine position and reduction of the large hernia was attempted. After approximately 15 min of manual pressure, the herniated bowel was reduced back into the abdominal cavity and the patient experienced immediate relief of his symptoms. CONCLUSIONS: Scrotal ultrasound was repeated, and vascular flow to his right testicle was found to be re-established. This case highlights a rare presentation of acute onset of testicular ischemia caused by vascular compression from a large indirect inguinal hernia in an adult male.

Chemical colitis from a hydrogen peroxide enema.

BACKGROUND: Constipation is a common complaint seen in the emergency department for which patients will try many different remedies. OBJECTIVES: This case report discusses the outcome of a patient who developed a chemical colitis after using a hydrogen peroxide enema to relieve his constipation. CASE REPORT: A 43-year-old male with a history of chronic constipation presented to the Emergency Department (ED) with complaints of abdominal pain and hematochezia after self-administering a commercial sodium phosphate/sodium biphosphate enema mixed with hydrogen peroxide. The patient began to have left-sided abdominal cramping pain afterwards. He also began to have bowel movements mixed with bright red blood every 30 minutes. An abdominal computed tomography scan showed moderate to severe bowel wall thickening consistent with colitis involving the rectum extending to the distal one-third of the transverse colon. The patient was admitted to the internal medicine service for further monitoring. Gastroenterology was consulted for further management. CONCLUSIONS/SUMMARY: The abdominal pain and hematochezia resolved and the patient was discharged the next day without complications.