RESUMO
BACKGROUND: Gunshot wounds (GSW) to the head are associated with the highest mortality of all gun-related injuries, with assault reported as the leading cause of penetrating GSW. Several studies have explored factors and trends related to assault and self-inflicted GSW separately. The aim of this study was to investigate epidemiological characteristics and racial differences collectively in patients with GSW to the head by examining associations to injury intent and survival. METHOD: A retrospective study was performed by accessing the hospital trauma registry at our regional Level 1 Trauma Center. A query of neurosurgery consults with penetrating trauma was completed from January 2008 to October 2013. Patients with penetrating intracranial GSW were included in the study. A chi-square test was used to evaluate association between patients' characteristics and intent of injury. Logistic regression analyses predicting intent of injury and survival were also conducted. RESULTS: Of 111 patients, the majority were male (87.4 %). Most were African American (57.7 %) and Caucasian (35.1 %). Compared to African Americans, Caucasian patients were more likely to inflict self-harm (odds ratio (OR) 16.369 (95 % confidence interval (CI) 5.633-47.571), p < 0.0001), while African Americans (OR 26.413 (95 % CI 8.957-77.890), p < 0.0001) were more likely to be victims of assault. Race and other demographic variables did not predict survival nor did intent of injury (p = 0.368). CONCLUSION: This study reports that there are racial disparities between assault GSW and self-inflicted GSW. However, neither race nor intent is a predictor of survival outcome. Targeted efforts are needed to reduce occurrence of cranial GSW events in order to decrease associated morbidity and mortality.
Assuntos
Negro ou Afro-Americano , Traumatismos Craniocerebrais/etnologia , Disparidades nos Níveis de Saúde , Ferimentos por Arma de Fogo/etnologia , Adulto , Feminino , Humanos , Masculino , Grupos Raciais , Sistema de Registros , Estudos Retrospectivos , Centros de TraumatologiaRESUMO
PURPOSE: While bicycle helmet use reduces bicycle-related head injury, few children wear them regularly. We aimed to describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles County (LAC) to help target groups for injury prevention programs. METHODS: A retrospective review of all pediatric patients involved in bicycle-related accidents in LAC between 2006 and 2011 was performed. Our primary analysis examined the association between helmet use and age, gender, insurance status, and race/ethnicity. We also evaluated the association between helmet use and the need for emergency surgery, mortality, and length of hospital stay (LOH), after adjusting for injury severity score (ISS), age, insurance status, and race/ethnicity. RESULTS: Of 1248 patients, 11.3% wore helmets, with decreased use among children 12years and older, minorities, and those without private insurance. Overall, 5.9% required an emergency operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7%. On multivariable analysis, higher ISS increased LOH, the risk for emergency surgery, and mortality. CONCLUSION: Nearly 90% of children involved in bicycle-related accidents were not wearing helmets. Helmet use was lower among older children, minorities, and those from a low socioeconomic status. Injury prevention programs targeting low-income middle and high schools and minority communities may help increase helmet use in children in LAC.
Assuntos
Ciclismo/lesões , Traumatismos Craniocerebrais/etnologia , Etnicidade , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Seguro Saúde , Adolescente , Criança , Pré-Escolar , Traumatismos Craniocerebrais/economia , Traumatismos Craniocerebrais/prevenção & controle , Feminino , Humanos , Incidência , Los Angeles/epidemiologia , Masculino , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
BACKGROUND: Ethnic disparities in trauma mortality outcomes have been demonstrated in the United States according to the US National Trauma Data Bank. The aim of this study was to determine the effect of race/ethnicity on trauma mortality in Singapore. METHODS: This was a retrospective review of patients aged 18-64 years with an injury severity score (ISS) ≥ 9 in the Trauma Registry of Tan Tock Seng Hospital, a 1,300-bed trauma center in Singapore, from 2006 to 2010. Chinese, Malay, and Indian patients were compared with patients of other ethnic groups. Multiple logistic regression analyses determined differences in survival rates after adjusting for demographics, anatomic and physiologic ISS and revised trauma score, mechanism or type of injury. RESULTS: A total of 4,186 patients (66.4 % of the database) met the inclusion criteria. Most patients were male (76.3 %) and young (mean age 40 years). Using Chinese as the reference group, we found no statistically significant differences in unadjusted or adjusted mortality rates among the ethnic groups. Independent predictors of mortality included age [odds ratio (OR) 1.05, 95 % confidence interval (CI) 1.03-1.06, p < 0.0001], presence of severe head injury (OR 1.75, 95 % CI 1.13-2.69, p = 0.012), and increasing ISS (p < 0.0001). CONCLUSIONS: Ethnicity is not an independent predictor of trauma mortality outcomes in the Singapore population. Our findings contrast with those from the United States, where race/ethnicity (Black and Hispanic) remains a strong independent risk factor for trauma mortality. This study attests to the success of the Singapore health care/trauma system in delivering the same quality of care regardless of ethnicity.
Assuntos
Etnicidade/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Escala de Gravidade do Ferimento , Ferimentos e Lesões/etnologia , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Fatores Etários , China/etnologia , Traumatismos Craniocerebrais/etnologia , Traumatismos Craniocerebrais/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Índia/etnologia , Malásia/etnologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Singapura/epidemiologia , Taxa de Sobrevida , Adulto JovemRESUMO
We aimed to explore the causes of higher than expected rates of Indigenous emergency department (ED) seizure presentations. A questionnaire was administered to adult patients presenting with seizure to an ED in Far North Queensland. Over 15 months, among 260 presentations with seizure (22% Indigenous), 50% non-Indigenous patients, and 45% Indigenous patients completed the questionnaire. Risk factors for alcohol misuse were common in both groups (50% Indigenous, 43% non-Indigenous; p = 0.50), as were rates of reported head injury (50% Indigenous, 44% non-Indigenous; p = 0.50). However, 47% Indigenous patients, compared to 19% non-Indigenous patients (p < 0.05) reported missing anti-epileptic tablets at least twice weekly, representing clinically relevant medication non-adherence. This was the first reported seizure presentation for 12% Indigenous patients and 26% non-Indigenous patients. We conclude that among ED seizure presentations, alcohol excess and prior head injury are commonly observed, in both Indigenous and non-Indigenous patients. However, Indigenous patients have higher rates of anti-convulsant non-adherence, likely contributing to ED presentations.
Assuntos
Alcoolismo/epidemiologia , Anticonvulsivantes/administração & dosagem , Traumatismos Craniocerebrais/epidemiologia , Epilepsia/epidemiologia , Disparidades nos Níveis de Saúde , Grupos Populacionais , Convulsões/epidemiologia , Adulto , Alcoolismo/etnologia , Comorbidade/tendências , Traumatismos Craniocerebrais/etnologia , Epilepsia/tratamento farmacológico , Epilepsia/etnologia , Feminino , Humanos , Masculino , Grupos Populacionais/psicologia , Convulsões/tratamento farmacológico , Convulsões/prevenção & controleRESUMO
PURPOSE OF REVIEW: The purpose of this review is to highlight recent advances in understanding the epidemiology of pediatric trauma and the impact of health disparities on care of the injured child. RECENT FINDINGS: Recent studies examining outcomes for injury in children consistently demonstrate worse clinical and functional outcomes for minority children compared with white children, with African-American race being an independent predictor of mortality. Despite controlling for injury severity and insurance status (as a surrogate of socioeconomic status), these disparities persist. Significant racial differences in mortality were also identified when national data were compared with local institutional data for children with traumatic brain injury. Studies examining the effect of insurance status on care of the injured child have similarly uncovered unsettling inequities. Disparities in delivery of pediatric trauma care have been identified based on access to pediatric trauma centers. Other studies have sought to reduce disparities by use of guidelines. Finally, prevention studies have demonstrated racial disparities in the use of motor vehicle restraints, with improved restraint use in minority populations after implementation of culturally tailored prevention programs. SUMMARY: The cause of disparities in childhood trauma appears to be multifactorial and may include race, socioeconomic factors, insurance status, access, and healthcare provider biases. Multiple studies have confirmed that disparities exist, but it is difficult to tease out the reasons why they exist. Further work is necessary to identify causes of such disparities and formulate strategies to eliminate them.
Assuntos
Disparidades em Assistência à Saúde , Grupos Raciais/estatística & dados numéricos , Ferimentos e Lesões/etnologia , Ferimentos e Lesões/epidemiologia , Adolescente , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etnologia , Humanos , Lactente , Cobertura do Seguro/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Fatores Socioeconômicos , Índices de Gravidade do Trauma , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: To continually improve quality of care, it is important for centers caring for children with head injury to evaluate their overall outcome and that among diverse patient groups. METHODS: Data on children with head injuries were extracted from the National Trauma Data Bank of the American College of Surgeons and our local trauma registry. Unadjusted mortality, as well as stratified analysis and logistic regression modeling, was used to evaluate overall and race-specific mortality. RESULTS: There were 13,363 children in the National Trauma Data Base and 3111 in our database included. Our overall mortality rate compared favorably with the national data (3.2% vs 6.8%, P < .05). Our local data, however, showed a significant difference in mortality between white and African American (AA) children (2.2% vs 5.3%, P < .05), which was not identified in the national data. After stratification, the disparities by race persisted. Finally, multivariate regression modeling revealed that AA race was an independent predictor of mortality among our patient population, with an odds ratio of 3.1 (95% confidence interval, 1.2-7.8). CONCLUSION: Despite excellent outcomes for children with head injuries, we have uncovered unsettling inequities between AA and white children. These findings support the need to evaluate outcomes among specific groups to identify disparities that require further careful investigation.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Traumatismos Craniocerebrais/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , População Branca/estatística & dados numéricos , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Criança , Pré-Escolar , Traumatismos Craniocerebrais/mortalidade , Bases de Dados Factuais , Feminino , Escala de Coma de Glasgow , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Cobertura do Seguro/estatística & dados numéricos , Masculino , Ohio/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Índices de Gravidade do Trauma , Estados Unidos/epidemiologiaAssuntos
Serviços Médicos de Emergência/organização & administração , Roma (Grupo Étnico) , Gestão da Qualidade Total/organização & administração , Assistência ao Convalescente/organização & administração , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/etnologia , Traumatismos Craniocerebrais/terapia , Enfermagem em Emergência/organização & administração , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Avaliação em Enfermagem , Alta do Paciente , Roma (Grupo Étnico)/etnologia , Roma (Grupo Étnico)/estatística & dados numéricos , Migrantes/psicologia , Migrantes/estatística & dados numéricos , Incontinência Urinária/diagnóstico , Incontinência Urinária/etnologia , Incontinência Urinária/terapiaRESUMO
Serious nonaccidental head trauma (NHT) can leave permanent neurological damage in children who survive abuse. This study reports on child welfare's handling of NHT cases compared with cases of physical abuse and head trauma due to neglect with regard to placement in foster care, reunification with family, and safety issues. The results show that workers placed children with NHT in foster care immediately after the abuse but treated them no differently than other physically abused children regarding reunification.