Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness.

BACKGROUND: Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness. METHODS: PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences. RESULTS: Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences. CONCLUSION: Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.

Patterns and Trends of Gun Violence Against Women in the United States.

OBJECTIVE: To examine patterns and trends of firearm injuries in a nationally representative sample of US women. SUMMARY OF BACKGROUND DATA: Gun violence in the United States exceeds rates seen in most other industrialized countries. Due to the paucity of data little is known regarding demographics and temporal variations in firearm injuries among women. METHODS: Data were extracted from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (2001-2017) for women 18 years and older. Number of nonfatal firearm assaults and homicide per year were extracted and crude population-based injury rates were calculated. Sub-stratification by age-group and time period were performed. RESULTS: Between 2001 and 2017, there were 88,823 nonfatal firearm assaults involving women and 29,106 firearm homicides. There were 4116 victims of nonfatal firearm assault in 2001 (3.8 per 105) and 12,959 by 2017 (10.0 per 105). Homicide rates were 1.5 per 105 in 2001 and 1.7 per 105 in 2017. Sub-stratification by age-group and time period showed that there were no significant changes in nonfatal firearm assault rates between 2001 and 2010 (P-trend = 0.132 in 18-44 yo; 0.298 in 45-64 yo). However between 2011 and 2017, nonfatal assault rates increased from 7.10 per 105 to 19.24 per 105 in 18-44 yo (P-trend = 0.013) and from 1.48 per 105 to 3.93 per 105 in 45-64 yo (P-trend = 0.003). Similar trends were seen with firearm homicide among 18-44 yo (1.91 per 105 to 2.47 per 105 in 2011-2017, P-trend = 0.022). However, the trends among 45-64 yo were not significant in both time periods. CONCLUSIONS: Female victims of gun violence are increasing and more recent years have been marked with higher rates of firearm injuries, particularly among younger women. These data suggest that improved public health strategies and policies may be beneficial in reducing gun violence against US women.

Coronary Artery Bypass Grafting Among Older Adults: Patterns, Outcomes, and Trends.

INTRODUCTION: Although the numbers of older adults in the US are rapidly increasing, there is sparse recent data on the use and outcomes of coronary artery bypass grafting (CABG) among this population. We aimed to evaluate the characteristics and outcomes of older adults undergoing CABG and to measure temporal trends. MATERIALS AND METHODS: Using data from the National Inpatient Sample (2005-2014), patients aged 85 y and older who underwent CABG were selected. Demographic, clinical, and hospital characteristics were extracted. Outcomes measured were hospital mortality, hospital length of stay, discharge home, and operative complications. Patients were grouped by 2-year increments. Differences in clinical characteristics and outcomes over time were evaluated using trend analyses. RESULTS: There were 60,124 patients included in the cohort. The mean age was 86.8 y with majority being men (61%), white (88%), and treated in teaching hospitals (61%). Over the study period, the annual surgical volume decreased from 6689 in 2005/06 to 5150 in 2013/14. Mortality decreased from 8.5% to 5.5% (P-trend <0.001) and mean hospital length of stay decreased from 13.9 d to 12.0 d (P-trend <0.001), whereas the rate of discharge home remained stable (14.1% versus 11.6%, P-trend = 0.056). Compared with patients in 2005/06, those in 2013/14 had higher comorbidities [diabetes: 27.6% versus 17.3%; chronic kidney disease: 29.8% versus 9.2%; peripheral artery disease: 7.5% versus 6.0%; and hypertension: 83.7% versus 64.5% (all P-trend <0.001)]. CONCLUSIONS: CABG volumes are decreasing among older adults, and comorbidity burden is increasing, but outcomes are improving. These data may indicate improved preoperative optimization and better perioperative care processes.

Risk Factors Associated With Adverse Outcomes After Ventral Hernia Repair With Component Separation.

BACKGROUND: Over 350,000 surgeries are performed for ventral hernias (VHs) annually. Abdominal wall component separation has been more frequently used for the management of VHs. The goal of this study is to better understand factors associated with component separation complication rates. METHODS: The National Inpatient Sample (2005-2014) was used to identify all patients with an International Classification of Diseases ninth Revision diagnosis of VHs who underwent open VH repair with a pedicleor graft advancement flap. All cases included in this study were elective and not associated with additional procedures. Demographic, clinical, and hospital characteristics were extracted. Independent predictors of complications and outcomes were determined by multivariable regression analysis. RESULTS: Component separation was performed in 4346 patients. Mean age was 56; majority were female (55%) and white (80%). Most patients (73%) underwent surgery in an urban teaching hospital; mesh was used in 80% of cases and 11% were smokers. Hypertension was the most common comorbidity (50%), followed by obesity (26%), diabetes mellitus (DM) (23%), coronary artery disease (11%), and chronic obstructive pulmonary disease (COPD) (8%). Half of the patients (50%) had private insurance, and 35% had Medicare. Patients were distributed equally over household income quartiles. The mortality rate was 0.5%; median length of stay was 5 d. Overall complication rate was 25% (wound 11%, intraoperative 5%, infectious 11%, and pulmonary 8%). Mesh was associated with a lower rate of wound complications (10% versus 15%, P = 0.001). On multivariable analysis, patients with COPD (odds ratio: 2.02; 95% confidence interval: 1.58-2.59), obesity (1.37; 1.16-1.63), DM (1.3; 1.09-1.55), and those in the lowest income quartile (1.44; 1.06-1.96) had higher overall complication rates. CONCLUSIONS: Consistent with other studies, patients with COPD, Obesity, DM, and lower income status were associated with increased complications after component separation.

Trends in Firearm Injuries Among Children and Teenagers in the United States.

BACKGROUND: Gun violence among children and teenagers in the United States occurs at a magnitude many times that of other industrialized countries. The trends of injury in this age group relative to the adult population are not well studied. This study seeks to measure trends in pediatric firearm injuries in the United States. METHODS: Data from the National Trauma Data Bank (2010-2016) were used in selecting patients evaluated for firearm injury. Patients were classified as children and teenagers (<20 y) or adults (≥20 y). Changes in the proportion of firearm injuries among children and teenagers relative to the overall population (pediatric component) were determined using trend analyses. RESULTS: There were 240,510 firearm injuries with children and teenagers accounting for 45,075 of these injuries (pediatric component of 18.7%). Pediatric firearm injury was mostly among males (87.4%), Blacks (60.7%), and victims of assault (76.0%). The pediatric component of firearm injuries decreased from 21.7% in 2010 to 18.2% in 2016 (P-trend < 0.001). Although there was a decrease from 22.7% to 17.6% in the pediatric component of assault (P-trend < 0.001), there was an increase from 8.7% to 10.1% in the pediatric component of self-inflicted injuries (P-trend = 0.028). Substratification by race/ethnicity showed decrease in the pediatric component of firearm injuries among all groups (P-trend < 0.001) except Whites (P-trend = 0.847). CONCLUSIONS: Despite reductions in the pediatric component of firearm injuries, there remains a significant burden of injury in this group. Continued public health efforts are necessary to ensure safety and reduce firearm injuries among children and teenagers in the United States.

Assessment of the "Weekend Effect" in Lower Extremity Vascular Trauma.

BACKGROUND: Studies suggest that patients admitted on weekends may have worse outcomes as compared with those admitted on weekdays. Lower extremity vascular trauma (LEVT) often requires emergent surgical intervention and might be particularly sensitive to this "weekend effect." The objective of this study was to determine if a weekend effect exists for LEVT. METHODS: The National and Nationwide Inpatient Sample Database (2005-2014) was queried to identify all adult patients who were admitted with an LEVT diagnosis. Patient and hospital characteristics were recorded or calculated and outcomes including in-hospital mortality, amputation, length of stay (LOS), and discharge disposition were assessed. Independent predictors of outcomes were identified using multivariable regression models. RESULTS: There were 9,282 patients admitted with LEVT (2,866 weekend admissions vs. 6,416 weekday admissions). Patients admitted on weekends were likely to be younger than 45 years (68% weekend vs. 55% weekday, P < 0.001), male (81% weekend vs. 75% weekday, P < 0.001), and uninsured (22% weekend vs. 17% weekday, P < 0.001) as compared with patients admitted on weekdays. There were no statistically significant differences in mortality (3.8% weekend vs. 3.3% weekday, P = 0.209), amputation (7.2% weekend vs. 6.6% weekday, P = 0.258), or discharge home (57.4% weekend vs. 56.1% weekday, P = 0.271). There was no clinically significant difference in LOS (median 7 days weekend vs. 7 days weekday), P = 0.009. On multivariable regression analyses, there were no statistically significant outcome differences between the groups. CONCLUSIONS: This study did not identify a weekend effect in LEVT patients in the United States. This suggests that factors other than the day of admission may be important in influencing outcomes after LEVT.

Testing the efficacy of a hospital-based violence intervention programme: protocol and design.

INTRODUCTION: Hospital-based violence intervention programmes (HBVIPs) are a promising strategy to reduce trauma recidivism and promote safety among victims of violent injury. While previous studies have demonstrated cost-effectiveness and positive impact on the lives of victims, there are a number of key limitations in the study designs of this evidence base. This study seeks to address the methodological shortcomings of previous research, determine the efficacy of HBVIPs using a randomised control study design, and provide a better understanding of successful service allocation within an HBVIP. METHODS AND ANALYSIS: The current study is 1 of 12 demonstration projects being implemented around the country with the purpose of bolstering the ability to provide effective, culturally appropriate and trauma-informed services for boys and men harmed by violence. We propose a randomised control trial in which male victims of violence receive one of two interventions: treatment as usual versus enhanced services. The purpose is to determine which intervention leads to reductions in trauma recidivism over the period of 1 year from contact with the programme. Differences will also be monitored on measures of mental health, quality of life and attitudes towards violence. Analyses employed will include Kaplan-Meier analysis and Cox proportional hazards regression with death and recidivism being the outcomes of interest. ETHICS AND DISSEMINATION: Study procedures have been approved by the Institutional Review Boards of the University at Buffalo and four hospitals. Results will be submitted for publication in peer-reviewed journals.

Assessing surgical care delivery at facilities caring for higher volumes of minority children utilizing the pediatric quality indicator for perforated appendicitis: a propensity-matched analysis.

INTRODUCTION: The pediatric quality indicator (PDI) measures released by the Agency for Healthcare Research and Quality (AHRQ) provide an impetus for benchmarking quality of care in children. The PDI-17, aimed at studying perforation in appendicitis, is one such measure that this study aims to utilize to assess surgical care delivery and outcomes in children managed at majority-minority hospitals. METHODS: The Kid Inpatient Database (2000-2012) was queried for pediatric patients (< 18 years) with a diagnosis of appendicitis, with and without perforation. Facilities were categorized into tertiles based on rates of perforation (PDI-17). Similarly, tertiles were generated based on volume of minority patients (Black and Hispanic) treated at each facility. Multivariable regression analysis adjusted for demographic parameters, hospital-level characteristics, propensity score quintiles, clinically relevant outcomes, and tertiles of minority patients treated. RESULTS: Of the 322,805 patients with appendicitis 28.7% had perforated appendicitis. Patients presenting to facilities caring for a higher volume of perforated appendicitis were younger with public insurance or no insurance and, however, these patients were less likely to belong to a minority group (p < 0.05). Additionally, these patients were less likely to belong to the highest income quartile (OR [95% CI] 0.45 [0.39-0.52]). Hospitals treating the highest volume of minority patients [majority-minority hospitals (MMHs)] had an 87% (OR [95% CI] 1.87 [1.77-1.98]) increased likelihood of also treating the highest rates of perforated appendicitis. CONCLUSION: Hospitals treating a high volume of complicated appendicitis are less likely to care for minority groups. Additionally, MMHs lacking experience and volume in caring for complicated appendicitis have an increased likelihood of patients with perforations which is indicative of poor healthcare access.

The Violence Epidemic in the African American Community: A Call by the National Medical Association for Comprehensive Reform.

While much progress has occurred since the civil rights act of 1964, minorities have continued to suffer disparate and discriminatory access to economic opportunities, education, housing, health care and criminal justice. The latest challenge faced by the physicians and public health providers who serve the African American community is the detrimental, and seemingly insurmountable, causes and effects of violence in impoverished communities of color. According to statistics from the Centers for Disease Control (CDC), the number one killer of black males ages 10-35 is homicide, indicating a higher rate of violence than any other group. Black females are four times more likely to be murdered by a boyfriend or girlfriend than their white counterparts, and although intimate partner violence has declined for both black and white females, black women are still disproportionately killed. In addition, anxiety and depression that can lead to suicide is on the rise among African American adolescents and adults. Through an examination of the role of racism in the perpetuation of the violent environment and an exploration of the effects of gang violence, intimate partner violence/child maltreatment and police use of excessive force, this work attempts to highlight the repercussions of violence in the African American community. The members of the National Medical Association have served the African American community since 1895 and have been advocates for the patients they serve for more than a century. This paper, while not intended to be a comprehensive literature review, has been written to reinforce the need to treat violence as a public health issue, to emphasize the effect of particular forms of violence in the African American community and to advocate for comprehensive policy reforms that can lead to the eradication of this epidemic. The community of African American physicians must play a vital role in the treatment and prevention of violence as well as advocating for our patients, family members and neighbors who suffer from the preventable effects of violence.

Trauma education in a state of emergency: a curriculum-based analysis.

BACKGROUND: Trauma is the leading cause of death from ages 1-44-y in the United States and the fifth leading cause of death overall, but there are few studies quantifying trauma education in medical school. This study reviews curriculum hours devoted to trauma education at a northeastern medical school. MATERIALS AND METHODS: We reviewed the preclinical curriculum at a northeastern medical school affiliated with three adult and two pediatric level I trauma centers verified by the American College of Surgeons. We reviewed curricular hours and we categorized them according to the leading ten causes of death in the United States. We also compared the number of educational hours devoted to trauma to other leading causes of death. RESULTS: The total amount of time devoted to trauma education in the first 2 y of medical school was 6.5 h. No lectures were given on the fundamentals of trauma management, traumatic brain injury, or chest or abdominal trauma. The most covered topic was heart disease (128 h), followed by chronic lower respiratory disease (80 h). Curricular time for heart disease, chronic lower respiratory disease, cancer, diabetes, renal disease, and influenza and pneumonia far exceeded that devoted to trauma, after adjusting for the mortality burden of these diseases (P < 0.05 for all). CONCLUSIONS: Our study demonstrates that trauma education at a northeastern medical school is nearly absent. With the large burden of trauma and rise in mass casualty incidence, the preclinical curriculum might not be sufficient to expose students to the fundamentals of trauma management. A broader multi-institutional study may shed more insight on these curricular deficiencies in trauma education and detect if these deficiencies are widespread nationally.

Analysis of the National Resident Matching Program for Surgical Critical Care Training in the United States: 2008-2022.

BACKGROUND: Few studies have assessed the pipeline for surgical intensivists despite projected shortages in the United States' critical care workforce. We had 3 primary objectives in analyzing the Surgical Critical Care Match: (1) understand growth in the number of applicants relative to training positions; (2) compare match rates for United States Allopathic Graduates versus non-United States Allopathic Graduates; and (3) analyze the number of unfilled training positions over time. METHODS: This was a national cohort study of Surgical Critical Care Match applicants (2008-2022). Annual match rates and applicant-to-training position ratios were calculated. Cochrane-Armitage tests elucidated temporal trends during the study period. RESULTS: There was a greater increase in the number of annual applicants (276% increase) relative to training positions (128% increase) during the study period (P < .001). The applicant-to-training position ratio increased (0.5-0.9, P < .001). Annual match rates increased for both United States Allopathic (92%-97%, P = .015) and non-United States Allopathic (81%-96%, P < .001) Graduates. Match rates for United States Allopathic Graduates exceeded those for non-United States Allopathic Graduates (P < .05) but were similar from 2020 to 2022 (P > .05). The percentage of applicants that matched at their top fellowship choice decreased from 69%-50% (P < .001). From 2008 to 2022, fewer available training positions went unfilled (52%-13%, P < .001). CONCLUSION: The pipeline for surgical intensivists in the United States appears to be increasing along with rising interest in Surgical Critical Care training. Future research is needed to understand disparities in match rates by applicant and fellowship program characteristics.

Trends in Suicides and Homicides in 21st Century America.

BACKGROUND: Violent deaths, including suicides and homicides, pose a significant public health challenge in the United States. Understanding the trends and identifying associated risk factors is crucial for targeted intervention strategies. AIM: To examine the trends in suicides and homicides over the past two decades and identify demographic and contextual predictors using the Center for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System online database. METHODS: A retrospective analysis of mortality records from 2000 to 2020 was conducted, utilizing multivariate regression analyses. Covariates included age, race, sex, education, mental health conditions, and time period. Age-adjusted rates were employed to assess trends. RESULTS: Over the 20 years, there was an upward trajectory in suicide rates, increasing from approximately 10/100,000 to over 14/100,000 individuals, which is a notable increase among American Indians (100.8% increase) and individuals aged 25 years and younger (45.3% increase). Homicide rates, while relatively stable, exhibited a significant increase in 2019-2020, with African Americans consistently having the highest rates and a significant increase among American Indians (73.2% increase). In the multivariate regression analysis, Individuals with advanced education (OR= 1.74, 95% CI= 1.70 - 1.78), depression (OR = 13.47, 95% CI = 13.04 - 13.91), and bipolar disorder (OR = 2.65, 95% CI = 2.44 - 2.88) had higher odds of suicide. Risk factors for homicide include African Americans (OR = 4.15, 95% CI = 4.08 - 4.23), Latinx (OR = 2.31, 95% CI = 2.26 - 2.37), people aged 25 years and younger, and those with lower educational attainment. CONCLUSION: This study highlights the changing demographic pattern in suicides and homicides in the United States and the need for targeted public health responses. Means restriction, universal suicide screening, addressing mental health stigma, and implementing broad interventions that modify societal attitudes toward suicide and homicides are essential components of a comprehensive strategy.

Adherence Rate to Alliance for Clinical Trials in Oncology Z0011 Trial Based on Breast Cancer Subtype.

BACKGROUND: The American College of Surgeons Oncology Group Z0011 (ACOSOG Z0011 or Z11) trial demonstrated no survival advantage with completion axillary lymph node dissection (ALND) for patients with T1-2 breast cancer, 1 to 2 positive SLNs who received adjuvant chemoradiation therapy. More than 70% of the cohort had estrogen receptor (ER)+ tumors. There is paucity of data on the adherence rate to Z11, as well as a dearth of data on the applicability of Z11 for the different subtypes. We conducted a large hospital-based study to evaluate the adherence rate to Z11 based on subtypes. STUDY DESIGN: The National Cancer Database was queried to evaluate 33,859 patients diagnosed with T1-2, N1, and M0 breast cancer treated with lumpectomy with negative margins, and adjuvant chemoradiation therapy between 2012 and 2018. Patients were classified into 3 groups: (1) ER+/HER2-, (2) ER-/HER2-, and (3) HER2+ regardless of ER status. The revised Scope of the Regional Lymph Node Surgery 2012 was used to classify patients into those who underwent an SLN or ALND. Differences in use of ALND by subtypes were compared. The Kaplan-Meier method and log-rank test were used to compare overall survival (OS). A p value of <0.05 was considered statistically significant. RESULTS: For ER+/human epidermal growth factor receptor 2 (HER2)-, ER-/HER2-, and HER2+ tumors, the rate of ALND was 43.6%, 50.2%, and 47.8%, respectively. The 5-year OS for SLN and ALND for the entire cohort was 94.0% and 93.1% (p = 0.0004); for ER+/HER2-, it was 95.4% and 94.7% (p = 0.04); for ER-/HER2-, it was 84.1% and 84.3% (p = 0.41); for HER2+, it was 94.2% and 93.2% (p = 0.20). Multivariable cox proportional hazard regression analysis demonstrated no significant survival differences between SLN and ALND (p = 0.776). CONCLUSIONS: Z11 is applicable for women with early N1 disease, regardless of subtypes. ALND did not confer a survival advantage over SLN. Despite this, up to 50% of patients who fit Z11 criteria continue to undergo ALND.

Early Cholecystectomy in Patients with Sickle Cell Disease with Uncomplicated Cholelithiasis Is Associated with Better Outcomes.

BACKGROUND: Up to 85% of patients with sickle cell disease (SCD) will develop gallstones by their third decade. Cholecystectomy is the most commonly performed procedure in these patients. Cholecystectomy is recommended for patients with SCD with symptomatic cholelithiasis and leads to lower morbidity. No contemporary large studies have evaluated this recommendation or associated clinical outcomes. This study evaluates clinical outcomes after cholecystectomy in patients with SCD and cholelithiasis with specific advanced clinical presentations. STUDY DESIGN: The Nationwide Inpatient Sample was queried for patients with SCD and gallbladder disease between 2006 and 2015. Patients were divided into groups based on their disease presentation, including uncomplicated cholelithiasis, acute and chronic cholecystitis, and gallstone pancreatitis. Clinical outcomes associated with disease presentation were analyzed. Statistical analysis was performed using the Student's t -test, chi-square test, ANOVA, and logistic regression. RESULTS: There were 6,662 patients with SCD who presented with cholelithiasis. Median age was 20 (interquartile range 16 to 34) years and 54% were female patients. Cholecystectomy was performed in 1,779 patients with SCD with the most common indication being chronic cholecystitis (44%), followed by uncomplicated cholelithiasis (27%), acute cholecystitis (21%), and choledocholithiasis or gallstone pancreatitis (8%). On multivariable regression, advanced clinical presentation was the strongest predictor of perioperative vaso-occlusive crisis, which was the most common complication. Patients undergoing cholecystectomy for uncomplicated cholelithiasis were at lower risk than those with acute cholecystitis (odds ratio [OR] 2.37; 95% CI 1.64 to 3.41), chronic cholecystitis (OR 1.74; 95% CI 1.26 to 2.4), and choledocholithiasis or gallstone pancreatitis (OR 2.24; 95% CI 1.41 to 3.57). CONCLUSIONS: Seventy-three percent of patients with SCD have advanced clinical presentation at the time of their cholecystectomy. After cholecystectomy, perioperative vaso-occlusive events were significantly increased in patients with advanced clinical presentation. These data support screening abdominal ultrasounds and early cholecystectomy for cholelithiasis in patients with SCD.

Race, Insurance, and Socioeconomic Influences on Outcomes Following Roux-En-Y Gastric Bypass.

The effectiveness of Roux-en-Y gastric bypass (RYGB) might be shadowed by disparities in outcomes related to patient race and insurance type. We determine the influence of patient race/ethnicity and insurance types on complications following RYGB. We performed a retrospective analysis using data sourced from the National Inpatient Sample Database (2010 to 2019). A multivariate analysis was employed to determine the relationship between patient race/ethnicity and insurance type on RYGB complications. The analysis determined the interaction between race/ethnicity and insurance type on RYGB outcomes. We analyzed 277714 patients who underwent RYGB. Most of these patients were White (64.5%) and female (77.3%), with a median age of 46 years (IQR 36-55). Medicaid beneficiaries displayed less favorable outcomes than those under private insurance: Extended hospital stay (OR = 1.68; 95% CI 1.58-1.78), GIT Leak (OR = 1.83; 95% CI 1.35-2.47), postoperative wound infection (OR = 1.88; 95% CI 1.38-2.55), and in-hospital mortality (OR = 2.74; 95% CI 1.90-3.95).

Disfiguring Firearm Injuries in Children in the United States.

Firearms are a leading cause of injury and death among children in the United States. Most gun violence studies highlight mortality, but few have examined the morbidity in disfiguring injuries suffered by children. Using National Trauma Data Bank 2007-2015, children who suffered gunshot injuries and underwent procedures with lasting physical disfigurement formed the cohort of this study. We identified 28 593 children as victims of firearm injuries. Most were aged 13-18 (84%). There was a preponderance of male gender (86%) and black race/ethnicity (57%). Total mortality was 3774 (13%), and 1500 (5.4%) were identified with one or more disfigurements: 220 amputations, 191 craniectomy, 100 enucleation, 533 ileostomy/colostomy, and 557 tracheostomies. This report highlights the large toll firearm injuries take on American children, specifically in non-concealable disfigurements. These injuries are very impactful to their education and overall socialization and therefore must be a part of the discussion of gun violence in the United States.

The Distressed Communities Index: A Measure of Community-Level Economic Deprivation and Rate of Firearm Injuries in Maryland.

BACKGROUND: This study aimed to investigate the relationship between community-level economic deprivation, as measured by the Distressed Communities Index (DCI) and ED visits on account of firearm injuries (assaults and unintentional). METHODS: A retrospective analysis was conducted using the Maryland State Emergency Department Databases (SEDD) from January 2019 to December 2020 to explore the association between the DCI and ED visits because of firearm injuries (assaults and unintentional). The DCI utilizes 7 variables, based on zip codes, generating 5 levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In a multivariate analysis, we adjusted for age, sex, mental conditions, alcohol addiction, substance abuse, smoking, race/ethnicity, insurance type, and median income. RESULTS: Of the 2725 ED visits for firearm injuries, 84.5% were Black and 88.5% male. The median age was 27 (21-35) years, and the mortality rate was 17.7%. A statistically significant association was found between economic deprivation and ED visits for firearm injuries. Compared to prosperous communities, the odds ratios (ORs) were comfortable (OR = 1.33, 95% CI 1.04-1.71, P = .03), mid-tier (OR = 1.69, 95% CI 1.33-2.15, P < .001), at-risk (OR = 1.53, 95% CI 1.17-1.99, P < .001), and distressed (OR = 2.65, 95% CI 2.11-3.33, P < .001). DISCUSSION: The study highlights the significant association between community-level economic deprivation, as measured by the Distressed Communities Index, and the incidence of firearm injuries in Maryland. The findings underscore the importance of addressing socioeconomic disparities and implementing targeted interventions to reduce firearm-related injuries in economically distressed communities.

The Impact of Obesity on Early Complications Following Tracheostomy: An Evaluation of a Nationwide Registry.

INTRODUCTION: The obesity epidemic is an important public health problem in the United States. Previous studies have revealed the association between obesity and various surgical complications. Tracheostomy which is an important lifesaving procedure may prove technically challenging in an obese patient. This study sought to evaluate the association between obesity and early complications following standard tracheostomy using a national registry. METHODS: Adult patients who underwent tracheostomy from 2007 to 2017 were analyzed using the Nationwide Inpatient Sample (NIS). The population was stratified into obese and non-obese groups. Early complications following standard tracheostomy were identified and compared between the two groups. Multivariable logistic regression analyses were performed to assess the association between obesity and early complications following tracheostomy. RESULTS: Data pertaining to 205 032 adult patients were evaluated. Obese patients accounted for 12.1% (n = 21 816) of the entire cohort. The most common complication in the cohort was perioperative bleeding (4316 [2.1%]). A total of 1382 (0.67%), 949 (0.46%), and 134 (0.07%) patients developed pneumothorax/pneumomediastinum, stoma/surgical site infection, and tracheal injury following standard tracheostomy, respectively. There was no difference in the odds of tracheal injury, perioperative bleeding, and pneumomediastinum/pneumothorax following standard tracheostomy in the obese and non-obese group in multivariable analysis. However, obesity was associated with 60% increased odds of developing stoma/surgical site infection following standard tracheostomy (OR 1.60 [1.33-1.92], P < 0.01). CONCLUSION: Obesity is associated with an increased risk of developing stoma/surgical site infection following standard tracheostomy. This adds to the growing need for measures to help curb the obesity epidemic in a bid to improve surgical outcomes.

Predictors of Completed Suicides Among Emergency Department Visits for Attempted Suicides.

BACKGROUND: The objective of this study was to identify predictors of mortality among patients presenting to the emergency department (ED) with attempted suicides. METHODS: We analyzed data on emergency department (ED) visits for attempted suicides from the Nationwide Emergency Department Sample (NEDS) database from January 2010 to December 2017. The predictors of mortality were determined in multivariate analysis including age, sex, insurance, annual income, region of the country, mechanism of injury, mental health conditions (schizophrenia; depression; and anxiety, bipolar, and personality disorders), chronic illnesses (hypertension, diabetes, obesity, and dementia), and social risk factors such as alcohol addiction, smoking, and substance abuse. RESULTS: From 2010 to 2017, there were 979,383 ED visits for attempted suicides in the NEDS database. Among these patients, 10,301 (1.1%) died. Of these completed suicides, 73.9% were male with the median age of 43 years (IQR, 30) while the unsuccessful suicide attempt group had a median age of 30 years (IQR, 24) and were 42.7% male. The most common mechanisms of suicide attempt were poisoning (58.8%) and cut injury (25.6%). Gunshot was the most lethal mechanism accounting 40.3% of the completed suicides despite representing 1.3% of the attempts who came to ED. After controlling for common risk factors for attempted suicide, significant predictors of completed suicide include higher income status, uninsured status, male sex, and higher age. DISCUSSION: Among US patients presenting to the ED following attempted suicide, factors associated with suicide completion include increasing age, male sex, higher income, gunshot injuries, and uninsured status.