Assault-related traumatic brain injury hospitalizations in Canada from 2010 to 2021: rates, trends and comorbidity.

BACKGROUND: Traumatic brain injury (TBI) is a major cause of morbidity and mortality globally. TBI is often associated with other physical or psychological issues resulting in high hospitalization costs. TBI incidence and recovery can vary with the external cause being intentional or unintentional. It is important to monitor the rates of TBI hospitalizations related to different external causes. This study examined the annual rate, comorbidity and length of stay associated with assault-related TBI hospitalizations and compare it with other external causes, by age and sex in Canada from 2010 to 2021. METHODS: Discharge Abstract Database was used to extract cases of TBI (2010-2021). ICD-10-CA codes were used to classify all cases with TBI as per assault and other external causes (falls; transport; sport, physical activity and recreation; struck by). Additional variables, including age, sex, comorbidity and length of stay, were examined. Time trends were quantified using Joinpoint regression. RESULTS: The average annual percent increase for all TBI hospitalizations from 2010 to 2021 was not significant at 0.1%. Females accounted for 35.8% of these TBI hospitalizations. From 2010 to 2021, assault-related TBI hospitalizations showed a significant annual decline of 4.1% for males and a significant increase of 1.2% for females. Increase in TBI hospitalizations related to falls showed an average annual percent increase of 1.4% for males and 2.2% for females. A significant decrease was observed for TBI hospitalizations related to the other three (transport, SPAR and struck by) external causes for both sexes from 2010 to 2021. Infants and children under 10 years of age had higher percentages of cases with comorbidities and higher length of stay for assault-related TBI hospitalizations. CONCLUSIONS: Assault-related TBI hospitalization rates decreased overall and among males, rates among females increased from 2010 to 2021. These results underscore the importance of targeted prevention efforts for TBI related to different external causes, age and sex, and continued surveillance to monitor the epidemiology of assault-related TBI.

Eating disorder hospitalizations among children and youth in Canada from 2010 to 2022: a population-based surveillance study using administrative data.

BACKGROUND: Eating disorders (EDs) are severe mental illnesses associated with significant morbidity and mortality. EDs are more prevalent among females and adolescents. Limited research has investigated Canadian trends of ED hospitalizations prior to the COVID-19 pandemic, however during the pandemic, rates of ED hospitalizations have increased. This study examined rates of ED hospitalizations among children and youth in Canada from 2010 to 2022, by sex, age, province/territory, length of stay, discharge disposition and ED diagnosis. METHODS: Cases of ED hospitalizations among children and youth, ages 5 to 17 years, were identified using available ICD-10 codes in the Discharge Abstract Database from the 2010/11 to 2022/23 fiscal years. The EDs examined in this study were anorexia nervosa (F50.0), atypical anorexia nervosa (F50.1), bulimia nervosa (F50.2), other EDs (F50.3, F50.8) and unspecified EDs (F50.9). Both cases of total and first-time ED hospitalizations were examined. Descriptive statistics and trend analyses were performed. RESULTS: Between 2010/11 and 2022/23, 18,740 children and youth were hospitalized for an ED, 65.9% of which were first-time hospitalizations. The most frequent diagnosis was anorexia nervosa (51.3%). Females had significantly higher rates of ED hospitalization compared to males (66.7/100,000 vs. 5.9/100,000). Youth had significantly higher rates compared to children. The average age of ED hospitalization was 14.7 years. Rates of ED hospitalizations were relatively stable pre-pandemic, however during the pandemic (2020-2021), rates increased. INTERPRETATION: Rates of pediatric ED hospitalizations in Canada increased significantly during the pandemic, suggesting that there may have been limited access to alternative care for EDs or that ED cases became more severe and required hospitalization. This emphasizes the need for continued surveillance to monitor how rates of ED hospitalizations evolve post-pandemic.

Eating disorders disproportionally affect children and youth, however, literature investigating long-term trends of eating disorder hospitalizations among children and youth in Canada is limited. We conducted a retrospective surveillance study, examining eating disorder hospitalizations among children and youth in Canada, from 2010 to 2022, by sex, age group, geography and eating disorder diagnosis. More than half of eating disorder hospitalizations examined during our study period were first-time hospitalizations. The most common eating disorder diagnoses were anorexia nervosa, followed by unspecified eating disorders. Youth had higher rates of eating disorders compared to younger children and females had higher rates compared to males. In Canada, rates of pediatric eating disorder hospitalizations increased during the pandemic. These results emphasize the need for continued surveillance to monitor how ED hospitalizations evolve post-pandemic, as well as prioritizing early intervention and treatment to help reduce the number of children and youth requiring hospitalization.

Trends in cannabis-related emergency department visits and hospitalizations among children aged 0-11 years in Canada from 2015 to 2021: spotlight on cannabis edibles.

BACKGROUND: Cannabis poisonings among children are of public health concern. Existing evidence from the US and from four provinces in Canada (Quebec, Ontario, Alberta, British Columbia) indicate an increase in pediatric cannabis-related poisonings since the legalization of cannabis. This study evaluates trends in cannabis-related poisoning pediatric emergency department (ED) visits and hospitalizations in Canada and addresses a gap in literature by describing trends and context around cannabis edible-related poisoning cases using data from a Canadian sentinel surveillance system. METHODS: Mixed-methods using data from two administrative data sources and one injury/poisoning sentinel surveillance system to estimate age-specific rates of cannabis-related poisonings ED visits (Ontario and Alberta), edible-related events (sentinel surveillance Canada), and hospitalizations (Canada with the exception of Quebec) among children between the ages of 0 to 11 from 2015/2016 to 2021. Annual absolute changes were calculated to quantify the magnitude of change between each age-specific rate. Joinpoint regression was used for trend analysis. A thematic analysis was completed to gain a better understanding of cannabis edible-related poisoning cases in the ED. RESULTS: The pediatric age-specific rates for cannabis-related poisoning ED visits (average annual percent change (AAPC) Ontario: 98.2%, 95% CI: 79.1, 119.2; AAPC Alberta: 57.4%, 95% CI: 36.7, 81.2), hospitalizations (AAPC: 63.4%, 95% CI: 42.0, 87.9) and cannabis edible-related events (AAPC: 122.8%, 95% CI: 64.0, 202.6) increased significantly from 2015 to 2021. Almost half of all pediatric edible-related events involved gummy edible products (48.8%, n = 143). Based on the thematic analysis, 88% cannabis edible-related events were attributed to inadvertent ingestion due to access to such products or lack of safe storage practices. CONCLUSION: Age-specific rates of cannabis-related poisoning ED visits (Ontario and Alberta) and hospitalizations (Canada with the exception of Quebec) have increased since cannabis legalization, with the largest increase in rates occurring from 2019 to 2020. A similar increase in the rate of cannabis edible-related cases from sentinel surveillance data underscores the importance of monitoring this outcome. Public health messaging and national public health promotion strategies targeted towards raising awareness on the risks associated with consuming illegal cannabis and safe storage of cannabis could help mitigate cannabis poisonings among children.

An interrupted time series analysis of trends in opioid-related emergency department visits from pre-COVID-19 pandemic to pandemic, from the Canadian Hospitals Injury Reporting and Prevention Program.

BACKGROUND: Opioid-related emergency department (ED) visits in Canada increased during the COVID-19 pandemic, but how trends in volume and case severity changed from pre-pandemic times through the pandemic is not known. Trends in ED visits related to specific types of opioids also remain unclear. Our objective was to describe pre-pandemic trends and how they changed with the onset of COVID-19 and thereafter. METHODS: Based on data from the Canadian Hospitals Injury Reporting and Prevention Program, we identified opioid-related ED visits and constructed a time series from March 12, 2018 through March 7, 2021-two pre-COVID periods and one COVID period. We used an interrupted time series (ITS) analysis to examine trends in volume and case severity. We compared medians and means of monthly counts and percentages of severe cases between the periods, by sex, age, and opioid type. RESULTS: Before the pandemic, there was an increasing trend in fentanyl-related visits for males, females and 25- to 64-year-olds, and a decreasing trend in heroin-related visits for males and 18- to 64-year-olds. Fentanyl-related visits for 18- to 24-year-olds showed an immediate increase at the start of the pandemic and a decreasing trend during the pandemic. Heroin-related visits for 12- to 17-year-olds had an immediate increase at the start of the pandemic; for 18- to 24-year-olds and 45- to 64-year-olds, the prior decreasing pre-pandemic trend ceased. For pooled opioid-related visits, no significant trend in the percentage of severe cases was observed throughout the entire study period. CONCLUSION: This study shows that an ITS approach in trend analysis is a valuable supplement to comparisons of before and after measures (with or without controlling seasonal effects). The findings provide evidence on how ED presentations for opioid use evolved in Canada from 2018 to 2021. The results can inform policies designed to reduce opioid-related harm in the context of a public health emergency.

Self-reported concussions in Canada: A cross-sectional study.

Background: Traumatic brain injuries (TBIs) are a major public health concern impacting the lives of many Canadians. Among all TBIs, concussions are the most common. However, to date, the incidence of concussions among the Canadian population, has remained unknown. To address this data surveillance gap, this study presents national estimates on the percentage of Canadians aged 12 years or older (excluding those living in the territories) who sustained one or more concussions in 2019. Data and methods: This study used data collected from the Traumatic Brain Injury Rapid Response (TBIRR) module of the 2020 Canadian Community Health Survey, a cross-sectional health survey. Descriptive statistics and logistic regressions were conducted to summarize the information in the TBIRR module. Results: This study found that approximately 1.6% of Canadians aged 12 years or older reported sustaining one or more concussions in 2019. Age was significantly associated with concussion incidence after controlling for sex and annual household income, and the locations and activities surrounding respondents' most serious concussions varied by age group. Over one-third of respondents sustained multiple concussions. Interpretation: The results suggest that certain populations, particularly younger individuals, may be more affected by concussions. While circumstances surrounding concussions vary by age group, the most important contributing factors were sports or physical activities among youth and falls among the adult population. Monitoring concussions among the national population is an important activity in injury surveillance, as it can help evaluate the efficacy of injury prevention intervention and better understand knowledge gaps and the burden of this injury.

Impact of substance-related harms on injury hospitalizations in Canada, from 2010 to 2020. / Incidence des méfaits liés à une consommation de substances sur les hospitalisations pour blessures au Canada, 2010-2020.

INTRODUCTION: Injuries continue to be a leading cause of death and contribute significantly to hospitalizations each year in Canada. Substance use has been associated with an increase in intentional and unintentional injuries, resulting in hospitalizations. This study examines trends in injury hospitalizations with a co-occurring substance diagnosis, to quantify the burden of injuries and identify at risk populations. METHODS: We analyzed Discharge Abstract Database data between 2010/11 and 2020/21, for clinical and demographic information about hospital discharges across Canada. We used ICD-10 codes to identify injury hospitalizations with co-occurring substance diagnostic codes, by injury intent and substance type. Rates, proportions, age-specific rates and age-standardized rates were calculated, trends quantified using average annual percent change and results stratified by sex and age group. RESULTS: From 2010/11 to 2020/21, unintentional injuries accounted for over half of all substance-related injury hospitalizations. Substance-related injuries accounted for 12% of total injury hospitalizations over this period. Overall, substance-related injury hospitalizations with co-occurring use of stimulants, opioids, cannabinoids and alcohol increased significantly among males and females. Unintentional substance-related, injury hospitalizations were more common later in life, and intentional substancerelated injuries were more common among adolescents and young adults. CONCLUSION: These results highlight key demographic groups with higher rates of substance-related injury hospitalizations that would benefit from targeted prevention efforts.

Injuries among Canadian children and youth: an analysis using the 2019 Canadian Health Survey on Children and Youth. / Blessures chez les enfants et les jeunes canadiens : analyse reposant sur les données de l'Enquête canadienne sur la santé des enfants et des jeunes de 2019.

This work provides an overview of injury patterns in Canadian children and youth aged 1 to 17 years. Self-reported data from the 2019 Canadian Health Survey on Children and Youth were used to calculate estimates for the percentage of Canadian children and youth who experienced a head injury or concussion, broken bone or fracture, or serious cut or puncture within the last 12 months, overall and by sex and age group. Head injuries and concussions (4.0%) were the most commonly reported, but the least likely to be seen by a medical professional. Injuries most frequently occurred while engaging in sports, physical activity or playing.

Overall, head injuries or concussions were the most commonly reported injury (4.0%), among the types of injuries surveyed. Serious cuts and punctures were most common among young children (aged 1 to 4 years), fractures were most common among children aged 10 to 14 years and head injuries or concussions were most common in youth aged 15 to 17 years. The most common activities that children and youth were partaking in when the injury occurred were playing and engaging in sports or physical activity. The majority of self-reported injuries led to a consultation.

Dans l'ensemble, les traumatismes crâniens ou les commotions c érébrales ont constitué les blessures les plus fréquemment déclarées (4,0 %) parmi les types de blessures recensées. Les blessures les plus fréquentes étaient les coupures et les perforations graves chez les jeunes enfants de 1 à 4 ans, les fractures chez les 10 à 14 ans, et les traumatismes crâniens et commotions cérébrale s chez les jeunes de 15 à17 ans,. Les activités les plus courantes auxquelles s'adonnaient les enfants et les jeunes au moment de la blessure étaient le jeu, le sport ou l'activité physique. La majorité des blessures autodéclarées ont mené à la consultation d'un professionnel de la santé.

Fatal and non-fatal firearm-related injuries in Canada, 2016-2020: a population-based study using three administrative databases.

BACKGROUND: Firearms are a substantial cause of injury-related morbidity and mortality in Canada and globally, though evidence from contexts other than the USA is relatively limited. We examined deaths, hospitalizations and emergency department (ED) visits due to firearm-related injuries in Canada to identify population groups at increased risk of fatal and non-fatal outcomes. METHODS: We conducted a population-based study using three national administrative databases on deaths, hospitalizations, and ED visits. ICD-10 codes were used to identify firearm-related injuries from January 1, 2016, through December 31, 2020. Fatal and non-fatal firearm injuries were classified as suicide/self-harm, homicide/assault, unintentional, undetermined or legal intervention injuries. We analyzed the data with counts, rates and proportions, stratified by sex, age group, province/territory, and year. RESULTS: Over the 5-year period, we identified 4005 deaths, 3169 hospitalizations, and 2847 ED visits related to firearm injuries in various jurisdictions in Canada. Males comprised the majority of fatal and non-fatal injury cases. The highest rates of fatal and non-fatal firearm injuries were among 20- to 34-year-olds. The leading cause of fatal firearm injuries was self-harm (72.3%). For non-fatal firearm hospitalizations and ED visits, assault (48.8%) and unintentional injuries (62.8%) were the leading causes of injury. Rates varied by province and territory. CONCLUSIONS: Our results showed that males comprised the majority of fatal and non-fatal firearm injuries in Canada. The rates of both fatal and non-fatal firearm injuries were highest among the 20- to 34-year-old age group. This comprehensive overview of the epidemiology of firearm injuries in Canada provides baseline data for ongoing surveillance and policy evaluation related to public health interventions.

Self-harm emergency department visits in Canada during the COVID-19 pandemic: evidence from a sentinel surveillance system.

BACKGROUND: Self-harm is a leading cause of morbidity and mortality globally, though the prevalence tends to be highest among adolescents. As an indicator in suicide surveillance, the incidence of self-harm is useful because it is sensitive to social, environmental, and economic conditions. During the COVID-19 pandemic, the epidemiology of self-harm has varied across contexts. This study aims to investigate the changes in self-harm emergency department visits in 2020 compared to a pre-pandemic period in 2018-2019. METHODS: Self-harm emergency department visits were extracted from the Canadian Hospitals Injury Reporting and Prevention Program database from 2018 to 2020. We compared the data in 2020 with the pre-pandemic baseline in 2018-2019. We examined the changes in volume, the percentages of self-harm cases among all intentional injuries by sex, age group, and the proportions of self-harm cases by method of injury. We also quantified the time trends of the percentages of self-harm cases among all intentional injuries using Joinpoint regression. RESULTS: The overall volume of emergency visits related to self-harm was higher in 2020 during weeks 24-51 compared to the average volumes for the same weeks of 2018-2019. Percentage of self-harm among all intentional injury emergency department visits was significantly higher by 6.1% among females (p < 0.05) and by 5.3% among males in 2020 than in 2018-2019 (p < 0.05). The 11-to-18-year age group showed an increase in the percentage of self-harm among all intentional injury emergency department visits by 7.4% in 2020 when compared to 2018-2019. Time trend analyses showed that the percentages of self-harm among all intentional injury emergency department visits were higher during weeks 4-52 in 2020 than in 2018-2019, for both males and females. CONCLUSIONS: The percentage of emergency department visits related to self-harm among all intentional injury visits were higher during 2020 than in 2018-2019. These results underscore the importance of continued surveillance of self-harm in Canada to better understand the sociodemographic factors affecting self-harm and to inform the prevention strategies and policies.

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.

Characteristics of outdoor motorized scooter-related injuries: analysis of data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). / Caractéristiques des traumatismes causés par l'utilisation à l'extérieur d'une trottinette motorisée : analyse des données de la plate­forme électronique du Système canadien hospitalier d'information et de recherche en prévention des traumatismes (eSCHIRPT).

INTRODUCTION: The use of motorized scooters is gaining popularity in Canada and elsewhere. This study aims to summarize characteristics of injuries related to use of motorized scooters using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) and to analyze trends. The eCHIRPP collects information associated with the injury event and clinical information related to treatment (the injured body part, the nature of the injury, injury intent and treatment received) from 11 pediatric and 9 general hospitals across Canada. RESULTS: A free-text search using keywords identified 523 cases related to motorized scooter injuries between January 2012 and December 2019. Most of the injuries reported were among males (62.7%). Fracture/dislocation was the most frequent injury (36.9%), and 14.3% of all patients were admitted to hospital. Joinpoint regression showed a statistically significant increase in injuries related to motorized scooter use between 2012 and 2017 (annual percent change of 18.4%). CONCLUSION: Study findings indicate the need for continued preventive efforts and improved educational messages on safe riding and the importance of the use of protective equipment to prevent injuries among riders.

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.

Sentinel surveillance of injuries and poisonings associated with cocaine and other substance use: results from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). / Surveillance sentinelle des blessures et des intoxications liées à la consommation de cocaïne et d'autres substances : résultats du Système canadien hospitalier d'information et de recherche en prévention des traumatismes (SCHIRPT).

INTRODUCTION: Consumption of cocaine can lead to numerous injuries and poisoning. However, only a limited number of studies have explored cocaine-related injuries. This study examined a wide range of injuries and poisonings related to cocaine only and in combination with other substances in Canada using sentinel surveillance data captured by the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). METHODS: Injuries and poisonings related to the use of cocaine only or in combination with other substances were identified in the eCHIRPP database between January 2012 and December 2019 for all ages. Descriptive analyses were performed to investigate the distribution of demographic and injury characteristics in poisoning and injury records related to the use of cocaine only and in combination with other substances. Statistical analyses were conducted to find the proportion of cocaine-related injuries per 100000 eCHIRPP records. Cocaine-related injury trends were assessed using annual percent change (APC) Results: Cocaine-related injuries and poisonings were observed in 123 records per 100 000 eCHIRPP records. Of the 1482 patients who presented to emergency departments of CHIRPP sites with this type of injury or poisoning, the majority involved cocaine use in combination with one or more substances (80.0%; n = 1186), whereas cocaine-only use was the minority (20.0%; n = 296). Among all cocaine-related records, poisoning was the leading diagnosis (62.7%; n = 930) and most injuries and poisonings were unintentional (73.5%; n = 1090). Overall, the trend of cocaine-related eCHIRPP records for all age groups increased over the study period from 2012 to 2019 (APC [total] = 47.8%, p < 0.05). CONCLUSION: Our findings of a higher proportion of cocaine-related injuries and poisonings among adolescents and young adults, as well as the co-consumption of cocaine with other substances, demonstrate the importance of extensive surveillance of cocainerelated injuries and poisonings and the implementation of evidence-based public health interventions.

Sentinel surveillance of substance-related self-harm in Canadian emergency departments, 2011 - 19.

INTRODUCTION: Self-harm is a public health concern that can result in serious injury or death. This study provides an overview of emergency department (ED) visits for patients presenting with substance-related self-harm. METHODS: Cases of self-harm in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database were extracted (April 2011 to September 2019; N = 15,682), using various search strategies to identify substance-related self-harm cases for patients 10 years and older. Cases involving alcohol, cannabis, illicit drugs, or medications (or any combinations of these) were included. Additional variables, including age and sex, location and the severity of injury (hospital admission) were examined. Proportionate injury ratios (PIR) were used to compare emergency department outcomes of self-harm and unintentional injuries involving substance use. Time trends were quantified using Joinpoint regression. For cases requiring hospital admission, text fields were analyzed for contextual factors. RESULTS: A total of 9470 substance-related self-harm cases were reported (28.1% of all intentional injury cases), representing 820.0 records per 100,000 eCHIRPP records. While age patterns for both sexes were similar, the number of cases for females was significantly higher among 15-19 year olds. Over half (55%) of cases that identified substance type involved medications, followed by multi-type substance use (19.8%). In the ED, there were proportionally more treatments, observations, and admissions presenting with substance-related self-harm compared to substance-related unintentional injury cases. Among those aged 20+ years, a statistically significant increasing trend of 15.9% per year was observed, while among those aged 10-19 years a significant annual percent change of 16.9% was noted (2011 to 2019). Text field analysis demonstrated suicide attempt or ideation was a reoccurring theme among all age groups. Poor mental health status or conflict with family or an intimate partner were reported stressors, depending on age group. Additional self-harming injuries, such as cutting, were reported among all age groups. CONCLUSION: Our study found that hospital admission for substance-related self-harm was highest for patients aged 15-19 years, especially females, and that they were more likely to use medications. The statistically significant increasing trend of cases found between 2011 and 2019 is notable. Patients showed multiple types of adversities, demonstrating the complexity of this issue.

Associations between meteorological factors and emergency department visits for unintentional falls during Ontario winters. / Associations entre facteurs météorologiques et nombre de visites aux services d'urgence en raison de chutes accidentelles pendant les hivers ontariens.

INTRODUCTION: Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets. METHODS: We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex. RESULTS: We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05-1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16-1.19). The OR for fall-related ED visits on cold days (less than -9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex. CONCLUSION: Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment.

A population-based study of fall-related traumatic brain injury identified in older adults in hospital emergency departments.

OBJECTIVE: The purpose of this study was to examine the population-based trends and factors associated with hospitalization of patients with traumatic brain injury (TBI) treated in the Emergency Department (ED) among those 65 years and older. The implications of these trends for neurosurgery and the broader society are discussed. METHOD: With a national, mandatory reporting system of ED visits, the authors used Poisson regression controlling for age and sex to analyze trends in fall-related TBI of those aged 65 years and older between 2002 and 2017. RESULTS: The overall rate of ED visits for TBI increased by 78%-from 689.51 per 100,000 (95% CI 676.5-702.8) to 1229 per 100,000 (95% CI 1215-1243) between 2002 and 2017. Females consistently experienced higher rates of fall-related TBI than did males. All age groups 65 years and older experienced significant increases in fall-related TBI rate over the study period; however, the highest rates occurred among the oldest individuals (90+ and 85-89 years). The hospital admission rate increased with age and Charlson Comorbidity Index. Males experienced both a higher admission rate and a greater percentage change in admission rate than females. CONCLUSIONS: Rates of ED visits for fall-related TBI, hospitalization, and in-ED mortality in those aged 65 years and older are increasing for both sexes. The increasing hospital admission rate is related to more advanced comorbidities, male sex, and increasing age. These findings have significant implications for neurosurgical resources; they emphasize that health professionals should work proactively with patients, families, and caregivers to clarify goals of care, and they also outline the need for more high-level and, preferably, randomized evidence to support outcomes-based decisions. Additionally, the findings highlight the urgent need for improved population-based measures for prevention in not only this age demographic but in younger ones, and the need for changes in the planning of health service delivery and long-term care.

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.

Child injuries in land vehicles that do not require restraints.

The goal of this study was to determine the injury profiles of Canadian children who presented to the Emergency Department from 1990 to 2016 due to an injury caused while traveling in a form of land transportation that did not require child restraint. A case series was conducted using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). Children who were injured while travelling on land transportation for which child restraint is not required, who presented to a Canadian Emergency Department that participates in eCHIRPP between April 1, 1990 to August 29, 2016, were included. Overall, 1856 children sustained 2139 injuries (mean age: 9.8 years (SD 4.5), 45.5% male). The majority of children were injured on a school bus (49.3%). The most commonly injured body part was the head or neck (52.6%). The most common type of injury was a superficial or open wound (33.1%), followed by traumatic brain injury (19.3%). Overall, 39.4% of injuries required no treatment in hospital. Overall, approximately 70 children presented to eCHIRPP EDs per year on a land transportation vehicle that does not require restraints. Biomechanical studies are needed to improve safety on land transportation vehicles that do not require seatbelts.

Surveillance from the high ground: sentinel surveillance of injuries and poisonings associated with cannabis. / Surveillance de niveau supérieur : surveillance par sentinelle des blessures et des intoxications associées au cannabis.

INTRODUCTION: In October 2018, Canada legalized the nonmedical use of cannabis for adults. The aim of our study was to present a more recent temporal pattern of cannabis-related injuries and poisonings found in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database and provide a descriptive summary of the injury characteristics of cannabis-related cases captured in a nine-year period. METHODS: We conducted a search for cannabis-related cases in the eCHIRPP database reported between April 2011 and August 2019. The study population consisted of patients between the ages of 0 and 79 years presenting to the 19 selected emergency departments across Canada participating in the eCHIRPP program. We calculated descriptive estimates examining the intentionality, external cause, type and severity of cannabis-related cases to better understand the contextual factors of such cases. We also conducted time trend analyses using Joinpoint software establishing the directionality of cannabis-related cases over the years among both children and adults. RESULTS: Between 1 April 2011, and 9 August, 2019, there were 2823 cannabis-related cases reported in eCHIRPP, representing 252.3 cases/100 000 eCHIRPP cases. Of the 2823 cannabis-related cases, a majority involved cannabis use in combination with one or more substances (63.1%; 1780 cases). There were 885 (31.3%) cases that involved only cannabis, and 158 cases (5.6%) that related to cannabis edibles. The leading external cause of injury among children and adults was poisoning. A large proportion of cannabis-related cases were unintentional in nature, and time trend analyses revealed that cannabis-related cases have recently been increasing among both children and adults. Overall, 15.1% of cases involved serious injuries requiring admission to hospital. CONCLUSION: Cannabis-related cases in the eCHIRPP database are relatively rate, a finding that may point to the fact that mental and behavioural disorders resulting from cannabis exposure are not generally captured in this surveillance system and the limited number of sites found across Canada. With Canada's recent amendments to cannabis regulations, ongoing surveillance of the health impacts of cannabis will be imperative to help advance evidence to protect the health of Canadians.