Hospital discharges for substance-related injuries before and during the COVID-19 pandemic: a descriptive surveillance study using administrative data.

BACKGROUND: The COVID-19 pandemic and associated behavioural changes have contributed to an increase in substance-related hospital discharges, and has altered the injury epidemiology landscape in Canada. We sought to evaluate hospital discharges for substance-related injuries during the pandemic compared with prepandemic and to identify subpopulations that have been greatly affected by substance-related injuries during the first year of the pandemic. METHODS: We compared data on hospital discharges in Canada from before the pandemic (March 2019-February 2020) with discharges during the first year of the pandemic (March 2020-February 2021) using the Discharge Abstract Database. We identified discharges for substance-related injuries using codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. We calculated percent changes, age-standardized rates and age-specific rates of discharges for substance-related injuries. RESULTS: Hospital discharges for substance-related injuries increased by 7.1% during the first year of the pandemic. Discharges for intentional injuries decreased by 6.3%, whereas unintentional substance-related injuries increased by 15.1% during this period. Male patients accounted for 95.6% of the increase in hospital discharges for substance-related injuries during the first year of the pandemic. We observed a percent increase among discharges for injuries related to alcohol, opioid, cannabinoid, hallucinogen, tobacco, volatile solvents, other psychoactive substances and polysubstance use. INTERPRETATION: We observed an increase in hospital discharges for substance-related injuries during the first year of the COVID-19 pandemic, compared with the same time period before the pandemic. This work will provide useful insight into the ongoing management of the COVID-19 pandemic, as well as future policy and health care planning related to substance use in Canada.

Chronic health effects associated with electronic cigarette use: A systematic review.

Introduction: Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report. Methods: Three bibliographic databases were searched to identify studies comparing the chronic health effects of e-cigarette users (ECU) to non-smokers (NS), smokers, and/or dual users indexed between 31 August 2017 and 29 January 2021. Two independent reviewers screened abstracts and full texts. Data were extracted by one reviewer and verified by a second one. Outcomes were synthesized in a narrative manner using counts and based on statistical significance and direction of the association stratified by study design and exposure type. Risk of bias and certainty of evidence was assessed. The protocol was prospectively registered on Open Science Framework https://osf.io/u9btp. Results: A total of 180 articles were eligible. This review focused on 93 studies for the 11 most frequently reported outcomes and from which 59 reported on daily e-cigarette use. The certainty of evidence for all outcomes was very low because of study design (84% cross-sectional) and exposure type (27% reported on exclusive ECU, i.e., never smoked traditional cigarettes). Overall, the summary of results for nearly all outcomes, including inflammation, immune response, periodontal and peri-implant clinical parameters, lung function, respiratory symptoms, and cardiovascular disease, suggested either non-significant or mixed results when daily ECU was compared to NS. This was also observed when comparing exclusive ECU to NS. The only notable exception was related to oral health where most (11/14) studies reported significantly higher inflammation among daily ECU vs. NS. Compared to the smokers, the exclusive-ECUs had no statistically significant differences in inflammation orperiodontal clinical parameters but had mixed findings for peri-implant clinical parameters. Conclusions: This review provides an update to the 2018 NASEM report on chronic health effects of e-cigarette use. While the number of studies has grown, the certainty of evidence remains very low largely because of cross-sectional designs and lack of reporting on exclusive e-cigarette exposure. There remains a need for higher quality intervention and prospective studies to assess causality, with a focus on exclusive e-cigarette use.

Strengthening surveillance of consumer products in Canada: the vaping example. / Renforcer la surveillance des produits de consommation au Canada : l'exemple du vapotage.

INTRODUCTION: The overall objective of this study was to demonstrate how information collected by the Consumer Product Safety Program ("the Program") can be used to identify emerging hazards. Specifically, this study characterized and quantified trends associated with vaping reports received by the Program over the past five years. METHODS: Data collated by the Program were extracted for the period from 1 January, 2015 to 30 September, 2019. The data were summarized using descriptive statistics and trends were quantified for annual percent change. In order to compare characteristics of vaping reports, the proportionate injury ratios (PIRs) and corresponding 95% CIs were used to compare vaping-related injuries to all other reports received by the Program. RESULTS: A total of 71 vaping-related reports were received between 1 January, 2015 and 30 September, 2019. During this period, the annual percent change increase in the number of reports received was approximately 73% annually (p < .05). Among the reported injuries, 41% were burn injuries. Proportionally, there were more vaping reports involving males (PIR = 1.89; 95% CI: 1.51-2.36) and individuals between the ages of 15 and 19 years (PIR = 11.53; 95 % CI: 4.95-26.8) as compared to all other reports submitted to the Program. CONCLUSIONS: While the number of reports relating to vaping products is small, the results of this analysis suggest that certain groups, including males and youth, are more likely to be the subject of a vaping-related incident.

Injuries and poisonings associated with e-cigarettes and vaping substances, electronic Canadian Hospitals Injury Reporting and Prevention Program, 2011-2019. / Traumatismes et intoxications associés à la cigarette électronique et aux substances de vapotage, base de données électronique du Système canadien hospitalier d'information et de recherche en prévention des traumatismes, 2011-2019.

Electronic cigarettes are devices that deliver nicotine to the user by heating an e-liquid. In Canada, the Tobacco and Vaping Products Act became law on May 23, 2018. The purpose of this study was to describe the cases of injuries and poisonings associated with e-cigarette and vaping substances that presented to Canadian emergency departments within the electronic Canadian Hospitals Injury Reporting and Prevention Program network between 2011 and 2019. A total of 68 cases were retrieved (54.4% males). Of the 68 cases, 8 occurred between 2011 and 2014, while 35 (51.5%) occurred in 2018 or 2019. Ingestions, inhalations and burns were observed.

Of 68 cases of injury or poisoning due to e-cigarette use or vaping between 2011 and 2019, 54.4% involved males. Of the 68 cases, 8 occurred between 2011 and 2014 while 35 (51.5%) occurred in 2018 or 2019. The annual percent change (APC) was 50.7% (95% CI: 15.9­96.1). Children under 5 years of age who either ingested the e-juice or vaping liquid or inhaled from the device accounted for 52.9% of incidents. In two cases, the device's battery exploded in the pocket of an adult male, causing a burn to the thigh. There were 3 traumatic brain injuries as a result of a fall subsequent to vaping.

Parmi les 68 cas de traumatisme ou d'intoxication causés par l'usage de la cigarette électronique ou le vapotage entre 2011 et 2019, 54,4 % concernaient des patients de sexe masculin. Parmi les 68 cas, 8 dataient de 2011 à 2014 et 35 (51,5 %) de 2018 et 2019. La variation annuelle en pourcentage (VAP) a été de 50,7 % (IC à 95 % : 15,9 à 96,1). Des enfants de moins de 5 ans ayant ingéré ou inhalé du liquide à vapoter à même le dispositif comptent pour 52,9 % des incidents. Dans deux cas, la pile du dispositif a explosé dans la poche d'un adulte, provoquant une brûlure à la cuisse. Trois traumatismes cérébraux se sont produits en raison d'une chute survenue à la suite d'une activité de vapotage.

The lows of getting high: sentinel surveillance of injuries associated with cannabis and other substance use.

OBJECTIVES: Cannabis is a widely used illicit substance that has been associated with acute injuries. This study seeks to provide near real-time injury estimates related to cannabis and other substance use from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database. METHODS: Data from the eCHIRPP database, years 2011 to 2016, were analyzed via data mining, descriptive, logistic regression, and sensitivity analyses. Drug use trends over time for cannabis and/or other substances (alcohol, illicit drugs, and medications) were assessed. Descriptive statistics (intent, external cause, and nature of injury) and proportionate injury ratios (PIR) associated with cannabis use are presented. RESULTS: Cannabis use was observed in 184 cases/100,000 eCHIRPP cases, and related injuries were mostly identified as unintentional (66.8%). Poisoning (68.5%) and intoxication (69.4%) were the external cause and nature of injury most associated with these events, and hospitalization was recorded for 14.3% of cases. Per 100,000 eCHIRPP cases, cannabis was used alone in 72.4 cases, and in combination with alcohol, illicit drugs, or medications in 74.6 cases, 11.3 cases, and 7.9 cases, respectively. Relative to non-use, the PIR of hospitalization was not significant for cannabis-only users of either sex (males: PIR 1.0, 95% CI 0.6-1.7, females: PIR 0.9, 95% CI: 0.5-1.7). CONCLUSION: Cannabis use injuries are rare, but can occur when cannabis is used with or without other substances. As Canada considers legislative changes, our finding of cases related to unintentional injury, poisoning, and intoxication suggests areas that might benefit from health literacy efforts.

Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: A nationwide, population-based study.

BACKGROUND: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide.We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2011 using a nationwide, population based database that is mandatory for all hospitals in Canada. METHODS: Trends in hospitalization rates for all acute hospital separations in Canada were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression. RESULTS: Hospitalization rates remained stable for children and young adults but increased considerably among elderly adults (age Q65 years). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p = 0.01), while MVC-related hospitalization rates decreased by 18% (p = 0.03). Elderly adults were most vulnerable to falls and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages, 15Y24 years) were most at risk for MVCs but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends toward increasing age, injury severity, comorbidity, hospital length of stay, and rate of in-hospital mortality.However, multivariate regression showed that odds of death decreased over time after controlling for relevant factors. Injury severity, comorbidity, and advanced age were the most important predictors of in-hospital mortality for TBI inpatients. CONCLUSION: Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities. Although preventive strategies for MVC-related TBI are likely having some effects, there is a critical need for effective fall prevention strategies, especially among elderly adults.

Neck and spine injuries in Canadian cheerleaders: An increasing trend.

BACKGROUND/PURPOSE: Cheerleading, now increasingly practiced in Canada, has a high propensity to cause traumatic neck and spine injuries. We aimed to evaluate the importance of neck and spine injuries in the practice of cheerleading and their occurrence mechanisms in order to propose preventive measures. METHODS: A retrospective cohort study of cheerleading injuries extracted from the Canadian Hospitals Injury Reporting and Prevention Program database between 1990 and 2010 was performed. RESULTS: Overall, there were 1496 cases of injuries documented secondary to cheerleading (median age 15, 4 (IQR=2, 2) years; 1410 women (94%)). Of those, 125 cases (8%) were neck and spine injuries. The most frequent injury was a sprain/strain (47%). More severe injuries included fractures (4%), muscle or tendon injury (3%), dislocation (1%), and nerve injury (1%). Over half of these injuries were caused by either falling from (26%) or basing/spotting a stunt from height (26%). Other mechanisms include being thrown/falling from a high toss (10%) and falling from a pyramid (8%). Of the 125 cases, 3 (2, 4%) were admitted to hospital. CONCLUSIONS: Most neck and spine injuries were related to stunts. Although the proportion of serious injury is low, the increasing trend for the practice of cheerleading calls for preventive measures.