Comparison of Demographics Across the Burn, Spinal Cord Injury, and Traumatic Brain Injury Model Systems.

OBJECTIVE: To analyze the demographic profiles of participants in the traumatic brain injury, burn injury, and spinal cord injury model systems databases. DESIGN: Data from the Burn Model System (BMS), Traumatic Brain Injury Model System (TBIMS), and Spinal Cord Injury Model System (SCIMS) National Databases were analyzed from 1994-2020. SETTING: Not applicable. PARTICIPANTS: The study included participants aged ≥16 years (N=42,407) with available data in selected variables, totaling 4807 burn injury, 19,127 TBI, and 18,473 SCI participants. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Variables including age, race, ethnicity, sex, education level, primary payor source, family income level, employment status at 1 year postinjury, etiology, and mortality at 1 year postinjury were analyzed across the database. RESULTS: Median ages at injury for BMS (40.4y), TBIMS (40y), and SCIMS (38y) National Database participants were comparable. Men constituted approximately 75% of participants in the BMS, TBIMS, and SCIMS datasets, with approximately 75% having a high-school education or less. The proportion of participants funded by Medicare during initial hospital care varied across the BMS (14%), TBIMS (15.6%), and SCIMS (10.2%). For family income (data available for BMS and SCIMS), approximately 30% of these participants reported a family income <$25,000. Etiology data indicated 49.0% of traumatic brain injury and 40.7% of spinal cord injury cases resulted from vehicular incidents. CONCLUSIONS: An overlapping at-risk population for these injuries appears to be middle-aged men with lower education levels and family incomes who have access to vehicles. This underscores the need for preventive initiatives tailored to this identified population to mitigate the risk of these injuries.

Modernization of a Large Spinal Cord Injuries and Disorders Registry: The Veterans Administration Experience.

Since the 1990s, Veterans Health Administration (VHA) has maintained a registry of Veterans with Spinal Cord Injuries and Disorders (SCI/Ds) to guide clinical care, policy, and research. Historically, methods for collecting and recording data for the VHA SCI/D Registry (VSR) have required significant time, cost, and staffing to maintain, were susceptible to missing data, and caused delays in aggregation and reporting. Each subsequent data collection method was aimed at improving these issues over the last several decades. This paper describes the development and validation of a case-finding and data-capture algorithm that uses primary clinical data, including diagnoses and utilization across 9 million VHA electronic medical records, to create a comprehensive registry of living and deceased Veterans seen for SCI/D services since 2012. A multi-step process was used to develop and validate a computer algorithm to create a comprehensive registry of Veterans with SCI/D whose records are maintained in the enterprise wide VHA Corporate Data Warehouse. Chart reviews and validity checks were used to validate the accuracy of cases that were identified using the new algorithm. An initial cohort of 28,202 living and deceased Veterans with SCI/D who were enrolled in VHA care from 10/1/2012 through 9/30/2017 was validated. Tables, reports, and charts using VSR data were developed to provide operational tools to study, predict, and improve targeted management and care for Veterans with SCI/Ds. The modernized VSR includes data on diagnoses, qualifying fiscal year, recent utilization, demographics, injury, and impairment for 38,022 Veterans as of 11/2/2022. This establishes the VSR as one of the largest ongoing longitudinal SCI/D datasets in North America and provides operational reports for VHA population health management and evidence-based rehabilitation. The VSR also comprises one of the only registries for individuals with non-traumatic SCI/Ds and holds potential to advance research and treatment for multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and other motor neuron disorders with spinal cord involvement. Selected trends in VSR data indicate possible differences in the future lifelong care needs of Veterans with SCI/Ds. Future collaborative research using the VSR offers opportunities to contribute to knowledge and improve health care for people living with SCI/Ds.

Applications of Direct Injection Soft Chemical Ionisation-Mass Spectrometry for the Detection of Pre-blast Smokeless Powder Organic Additives.

Analysis of smokeless powders is of interest from forensics and security perspectives. This article reports the detection of smokeless powder organic additives (in their pre-detonation condition), namely the stabiliser diphenylamine and its derivatives 2-nitrodiphenylamine and 4-nitrodiphenylamine, and the additives (used both as stabilisers and plasticisers) methyl centralite and ethyl centralite, by means of swab sampling followed by thermal desorption and direct injection soft chemical ionisation-mass spectrometry. Investigations on the product ions resulting from the reactions of the reagent ions H3O+ and O2+ with additives as a function of reduced electric field are reported. The method was comprehensively evaluated in terms of linearity, sensitivity and precision. For H3O+, the limits of detection (LoD) are in the range of 41-88 pg of additive, for which the accuracy varied between 1.5 and 3.2%, precision varied between 3.7 and 7.3% and linearity showed R2 ≥ 0.9991. For O2+, LoD are in the range of 72 to 1.4 ng, with an accuracy of between 2.8 and 4.9% and a precision between 4.5 and 8.6% and R2 ≥ 0.9914. The validated methodology was applied to the analysis of commercial pre-blast gun powders from different manufacturers. Graphical Abstract.

Suicide mortality after spinal cord injury in the United States: injury cohorts analysis.

OBJECTIVES: To compare 12-year suicide-specific mortalities of 3 different injury cohorts, identify the risk factors for suicide mortality after spinal cord injury (SCI), and investigate whether suicide mortality is higher among those with SCI than in the general population. DESIGN: Retrospective cohort study. SETTING: United States hospitals (n=28) designated as SCI Model Systems. PARTICIPANTS: Participants (N=31,339) injured between January 1, 1973, and December 31, 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Suicide death after SCI. RESULTS: The crude annual suicide mortality rate during the first 12 years after SCI was 91 per 100,000 person-years for 1973 to 1979 injury cohort, 69 per 100,000 person-years for 1980 to 1989 injury cohort, and 46 per 100,000 person-years for 1990 to 1999 injury cohort. Suicide mortality was associated with race, injury severity, and years since injury. The standardized mortality ratios for the 3 cohorts were 5.2, 3.7, and 3.0, respectively. CONCLUSIONS: Suicide mortality among those with SCI decreased over 3 injury cohorts, but it still remained 3 times higher than that of the general population.