Outcome of a hepatitis C outbreak among patients in a pain management clinic.

BACKGROUND AND AIMS: The aims of this study are to evaluate the natural history and response to therapy of patients following a hepatitis C outbreak in a pain management clinic. METHODS: A retrospective cohort study was conducted on patients who acquired hepatitis C virus (HCV) at a pain management clinic. Medical records were retrospectively reviewed for 77% of patients with hepatitis C included in the outbreak to obtain data regarding laboratory results, treatment, and outcomes. Chi-square, Fisher's exact, and Student's t-test were used to determine variables that were significantly associated with spontaneous clearance or sustained virologic response to therapy. RESULTS: Fifty Caucasian patients (31 women, 19 men; mean age 52 years) were included. Eleven of 50 (22%) patients cleared HCV spontaneously (clearers). The mean age of clearers was 47 years as compared with 57 years for nonclearers (P = 0.04). Liver biopsies were obtained by treating gastroenterologists in 31 patients with mean grade and stage of 2.1 and 1.7, respectively. Gastroenterologists treated 31 of 39 patients with pegylated interferon and ribavirin after a median of 354 (range 140-1,099) days post exposure. Sustained viral response (SVR) was observed in 65% (20/31) on an intention-to-treat basis. In patients who completed therapy, 91% (20/22) achieved SVR. Age, sex, weight, pretreatment alanine aminotransferase (ALT), and histologic parameters were not associated with SVR. CONCLUSIONS: In this large cohort of US immunocompetent patients with recent HCV infection, 22% resolved spontaneously. Younger age was the only predictor of spontaneous clearance. In patients with early chronic HCV, 65% achieved SVR.

Increasing aspirin use among persons at risk for cardiovascular events in Oklahoma.

BACKGROUND: Cardiovascular disease (CVD), including coronary heartdisease (CHD)and stroke, is the leading cause of death in the United States and in Oklahoma; Oklahoma ranks 48th worst in CVD deaths.This paper will present Oklahoma-specific data and review current recommendations regarding aspirin use for the prevention of CVD events. METHODS: Average annual age-adjusted death rates were calculated. Oklahoma Behavioral Risk Factor Surveillance System (BRFSS) data were used to determine past history of CHD, risk factors for CHD and stroke, and aspirin use among persons 45 years and older. A literature review of recommendations regarding aspirin use was conducted. RESULTS: Between 2005-2008, 14.8% of Oklahomans 45 years of age and older reported a history of coronary heart disease and 6.4% a history of stroke. Approximately 50% of Oklahomans 45 years and older reported a history of hypertension and hypercholesterolemia; 21.5% were current smokers and 16.0% had diabetes. Nearly 10,000 Oklahomans die annually from CHD or stroke. The United States Preventive Services Task Force recommends 81mg per day of aspirin for men 45 to 79 and women 55 to 79 years of age unless they are at risk for bleeding complications. Daily aspirin use in Oklahoma was 44-57% among those with risk factors but no history of CHD or stroke. Fewer than 50% of Oklahomans 45-79 years reported being counseled by a health professional to take aspirin. Among those persons without a history of CVD who were counseled by a healthcare professional regarding aspirin, 79% were taking daily aspirin compared to 18% among persons not counseled. Aspirin sales increased significantly in Stephens County following a multifaceted community-based aspirin campaign. CONCLUSION: Low-dose aspirin is being underutilized as a strategy for reducing the excessive numbers of cardiovascular events and deaths in Oklahoma. Health professionals play an important role in educating patients about appropriate use of low-dose aspirin. Community-based interventions can also be effective.

State-based surveillance to determine trends in meningococcal disease.

OBJECTIVES: Meningococcal disease (MD), is a leading cause of meningitis in the U.S. The purpose of this study was to determine the epidemiology of MD in Oklahoma, including trends, high-risk populations, and outcomes. METHODS: Cases from the statewide passive reporting system with disease onset between 1988 and 2004 were included; 2002-2004 cases were linked to hospital discharge data. We performed a multivariate logistic regression of variables predicting death. RESULTS: There were 545 total cases (mean annual incidence rate 1.0/100,000); 13% died. Rates were highest for children younger than 2 years of age; black males had rates two times higher than the state rate and a different age distribution than other race-gender groups. Mean length of hospital stay was 12 days and mean charges were $37,724. For every 10 years of age, the risk of death increased 13% (adjusted odds ratio 1.13, 95% confidence interval [CI] 1.05, 1.22). People younger than age 40 who developed MD between October and February were 68% more likely to die than those who developed it in other months (rate ratio [RR] 1.68, 95% CI 1.39, 2.05); an increased risk of death during these months was not statistically significant in people aged 40 and older (RR 1.19, 95% CI 0.83, 1.69). CONCLUSION: Using statewide public health surveillance data to characterize the epidemiology of MD is important to understand local trends and risk factors.

Factors associated with injury severity in Oklahoma City bombing survivors.

BACKGROUND: Terrorist bombings are an increasing source of violent death and injury worldwide. Injuries in building bombings have been previously reported in descriptive studies, but no comparative analyses have quantitatively assessed factors influencing the severity of nonfatal bombing injuries. The objective of this study was to identify personal and environmental risk factors for injury severity in the Oklahoma City bombing, on April 19, 1995. METHODS: We conducted a retrospective comparative analysis of 509 nonfatally injured occupants of four buildings surrounding the detonation site. The source of data was the 1995 Oklahoma City Bombing database, a registry of all injuries and fatalities related to the bombing. Multivariable logistic regression was used to assess two outcomes: (1) medically-attended injury among injured occupants; and (2) hospital admission among occupants with medically attended injuries. RESULTS: Increased odds of sustaining medically attended injuries were associated with being struck by flying glass (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI], 1.9-14.8) and location above the first floor of buildings (OR, 4.0; 95% CI, 1.4-11.7) after adjustment for other factors. Adjusted odds of hospital admission were associated with location in the collapsed region (AOR, 43.4; 95% CI, 4.4-434.1), being blown by the blast wind (AOR, 5.3; 95% CI, 2.1-13.8), and being trapped (AOR, 3.1; 95% CI, 1.2-7.7). CONCLUSIONS: The severity of nonfatal injury in the Oklahoma bombing was primarily associated with structural and environmental factors. Improved architectural design may prevent many injuries in building bombings. These finding provide evidence for future injury prevention activities.

Unintentional motor vehicle-train collisions--Oklahoma, 1995-2003.

BACKGROUND: Rates of persons injured in motor vehicle (MV)-train collisions in the state of Oklahoma (1.13/100,000 population) are more than 2 times the United States rate (0.51/100,000 population). METHODS: To better understand and describe unintentional MV-train collisions in Oklahoma, we collected information on MV-train collisions during 1995-2003 from the United States Federal Railroad Administration and from statewide medical examiner reports. Intersections were classified into train-activated gates, train-activated flashing lights, and passive signage (crossbucks or stop signs). For each type of intersection, MV-train collisions were calculated as the average annual number of collisions/1,000,000 vehicles/100,000 trains. RESULTS: A total of 444 unintentional MV-train collisions occurred; 48% had at least one injury. The average annual intersection collision rate with passive signage (5.15) was eight and 37 times, respectively, the rate of train-activated lights (0.63) and train-activated gates (0.14). Of drivers involved in collisions at intersections with gates, 83% ignored the gate warning. Twenty-five percent of drivers were aged < 25 years, compared with 16% of registered drivers in Oklahoma (p = 0.0001); 74% of drivers were male, compared with 49% of registered drivers in Oklahoma (p < 0.0001). Of fatalities tested for the presence of alcohol, 22% were legally intoxicated. CONCLUSIONS: Increasing the number of intersections with active warnings and instituting structural changes (i.e., gates that close across both lanes of traffic) would likely reduce the number of MV-train collisions in Oklahoma and throughout the U.S.

Injury perceptions of bombing survivors--interviews from the Oklahoma City bombing.

INTRODUCTION: Bombings, including the 1995 Oklahoma City bombing, remain an important public health threat. However, there has been little investigation into the impressions of injury risk or protective factors of bombing survivors. OBJECTIVE: This study analyzes Oklahoma City bombing survivors' impressions of factors that influenced their risk of injury, and validates a hazard timeline outlining phases of injury risk in a building bombing. METHODS: In-depth, semi-structured interviews were conducted within a sample of Oklahoma City bombing survivors. Participants included 15 injured and uninjured survivors, who were located in three buildings surrounding the detonation site during the attack. RESULTS: Risk factor themes included environmental glass, debris, and entrapment. Protective factors included knowledge of egress routes, shielding behaviors to deflect debris, and survival training. Building design and health status were reported as risk and protective factors. The hazard timeline was a useful tool, but should be modified to include a lay rescue phase. The combination of a narrative approach and direct questioning is an effective method of gathering the perceptions of survivors. CONCLUSIONS: Investigating survivors' impressions of building bombing hazards is critical to capture injury exposures, behavior patterns, and decision-making processes during actual events, and to identify interventions that will be supported by survivors.

A large, travel-associated outbreak of legionellosis among hotel guests: utility of the urine antigen assay in confirming Pontiac fever.

BACKGROUND: During March 2004, a large outbreak of legionnaires disease and Pontiac fever occurred among hotel guests in Oklahoma. An investigation was conducted to identify the source and evaluate the utility of the Legionella urine antigen assay and serologic testing for the identification of Pontiac fever. METHODS: A retrospective cohort investigation of hotel guests and employees and an environmental evaluation were performed. Participants were interviewed, and clinical specimens were collected from consenting individuals. RESULTS: Six cases of legionnaires disease and 101 cases of Pontiac fever were identified. Exposure to the indoor pool and hot tub area was associated with legionellosis (relative risk, 4.4; 95% confidence interval, 2.8-6.9). Specimens from the pool and hot tub tested positive for Legionella pneumophila serogroup 1 by polymerase chain reaction. For Pontiac fever, the sensitivity and positive predictive value were 35.7% and 100%, respectively, for the urine antigen assay, and 46.4% and 90%, respectively, for serologic testing. The specificity and negative predictive value were 100% and 47.8%, respectively, for the urine antigen assay, and 89.3% and 45.5%, respectively, for serologic testing. CONCLUSIONS: Urine antigen testing, with or without serologic testing, can be used to confirm outbreak-associated cases of Pontiac fever caused by L. pneumophila serogroup 1.

Non-fire carbon monoxide-related deaths, Oklahoma 1994-2003.

The purpose of this study was to determine the magnitude of non-fire carbon monoxide (CO)-related deaths and assess temporal trends, high-risk groups, and sources of CO resulting in deaths to Oklahoma residents from 1994-2003. Mortality data was collected from the Oklahoma Office of the Chief Medical Examiner. There were 281 non-fire, carbon monoxide-related deaths; 77% of CO deaths were suicides, 19% were unintentional, and 4% were unknown intent. The average annual death rate for males was nearly three times higher than females (12.0 vs. 4.7 per million population). Seventy-six percent of unintentional CO deaths in dwellings involved a furnace or heater. An audible CO detector in homes is the most promising technology available to prevent unintentional deaths, and there are several promising methods currently being researched to prevent suicides via CO exposure. Public and mental health authorities and health providers should educate the public regarding prevention of CO exposures.

Aspirin use in the prevention of cardiovascular events.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the United States and Oklahoma, and Oklahoma ranks 50th in CVD deaths. This paper will describe CVD and coronary heart disease (CHD) mortality in Oklahoma and review current recommendations regarding aspirin use for the prevention of CHD events. METHODS: The CDC Compressed Mortality File for 1999-2004 was accessed. Average annual age-adjusted or age-specific death rates per 100,000 population were calculated. A literature review of data and recommendations regarding aspirin use was conducted. RESULTS: From 1999-2004, there were 50,170 CHD deaths in Oklahoma (age-adjusted rate 232.1 per 100,000). Persons 75 years and older, males, and blacks had the highest death rates; the death rates declined for all persons except those aged 35-54 years. Aspirin use has been shown to be effective in reducing the number of nonfatal myocardial infarction (MI) and fatal CHD, though studies of aspirin effects in women have found a significant reduction in ischemic stroke but no significant effect on fatal or nonfatal MI or CVD death. Aspirin use slightly increases rates of gastrointestinal bleeding and hemorrhagic stroke. CONCLUSION: Continued commitment to counseling patients regarding tobacco cessation, nutrition and exercise, and treatment to reduce blood pressure, cholesterol, tobacco use, and blood sugar are essential. The Oklahoma State Medical Association Physicians Campaign for a Healthy Oklahoma has made it a priority to increase awareness of the risk and benefits of aspirin use among high-risk persons. Oklahoma physicians should assess patients at highest risk, such as healthy men older than 40 years, postmenopausal women (especially >or= 65 years), and younger people with risk factors for coronary heart disease (e.g., hypertension, hyperlipidemia, diabetes, or smoking) and discuss the potential benefits and harms of aspirin use.

Evaluation of death certificate-based surveillance for traumatic brain injury--Oklahoma 2002.

OBJECTIVES: Death certificate data are used to estimate state and national incidence of traumatic brain injury (TBI)-related deaths. This study evaluated the accuracy of this estimate in Oklahoma and examined the case characteristics of those persons who experienced a TBI-related death but whose death certificate did not reflect a TBI. METHODS: Data from Oklahoma's vital statistics multiple-cause-of-death database and from the Oklahoma Injury Surveillance System database were analyzed for TBI deaths that occurred during 2002. Cases were defined using the Centers for Disease Control and Prevention (CDC) ICD-10 code case definition. In multivariate analysis using a logistic regression model, we examined the association of case characteristics and the absence of a death certificate for persons who experienced a TBI-related death. RESULTS: Overall, sensitivity of death certificate-based surveillance was 78%. The majority (62%) of missed cases were due to listing "multiple trauma" as the cause of death. Death certificate surveillance was more likely to miss TBI-related deaths among traffic crashes, falls, and persons aged > or = 65 years. After adding missed cases to cases captured by death certificate surveillance, traffic crashes surpassed firearm fatalities as the leading external cause of TBI-related death. CONCLUSIONS: Death certificate surveillance underestimated TBI-related death in Oklahoma and might lead to national underreporting. More accurate and detailed completion of death certificates would result in better estimates of the burden of TBI-related death. Educational efforts to improve death certificate completion could substantially increase the accuracy of mortality statistics.

Rapid needs assessment of Hurricane Katrina evacuees-Oklahoma, September 2005.

INTRODUCTION: On 04 September 2005, 1,589 Hurricane Katrina evacuees from the New Orleans area arrived in Oklahoma. The Oklahoma State Department of Health conducted a rapid needs assessment of the evacuees housed at a National Guard training facility to determine the medical and social needs of the population in order to allocate resources appropriately. METHODS: A standardized questionnaire that focused on individual and household evacuee characteristics was developed. Households from each shelter building were targeted for surveying, and a convenience sample was used. RESULTS: Data were collected on 197 households and 373 persons. When compared with the population of Orleans Parish, Louisiana, the evacuees sampled were more likely to be male, black, and 45-64 years of age. They also were less likely to report receiving a high school education and being employed pre-hurricane. Of those households of > 1 persons, 63% had at least one missing household member. Fifty-six percent of adults and 21% of children reported having at least one chronic disease. Adult women and non-black persons were more likely to report a pre-existing mental health condition. Fourteen percent of adult evacuees reported a mental illness that required medication pre-hurricane, and eight adults indicated that they either had been physically or sexually assaulted after the hurricane. Approximately half of adults reported that they had witnessed someone being severely injured or dead, and 10% of persons reported that someone close to them (family or friend) had died since the hurricane. Of the adults answering questions related to acute stress disorder, 50% indicated that they suffered at least one symptom of the disorder. CONCLUSIONS: The results from this needs assessment highlight that the evacuees surveyed predominantly were black, of lower socio-economic status, and had substantial, pre-existing medical and mental health concerns. The evacuees experienced multiple emotional traumas, including witnessing grotesque scenes and the disruption of social systems, and had pre-existing psychopathologies that predisposed this population to post-traumatic stress disorder (PTSD). When disaster populations are displaced, mental health and social service providers should be available immediately upon the arrival of the evacuees, and should be integrally coordinated with the relief response. Because the displaced population is at high risk for disaster-related mental health problems, it should be monitored closely for persons with PTSD. This displaced population will likely require a substantial re-establishment of financial, medical, and educational resources in new communities or upon their return to Louisiana.

Fatal necrotizing colitis following a foodborne outbreak of enterotoxigenic Clostridium perfringens type A infection.

BACKGROUND: Enterotoxigenic Clostridium perfringens type A is the third leading cause of foodborne disease in the United States, resulting annually in an estimated 250,000 cases of a typically mild, self-limiting gastrointestinal illness. METHODS: A retrospective cohort study was conducted to determine the cause of a small cluster of cases of gastrointestinal illness, which included cases of severe necrotizing colitis. Participants in the study consisted of residents and staff of a residential care facility for the mentally ill in Oklahoma (n = 20). An inspection of food preparation and food storage areas of the residential care facility was conducted as part of an environmental investigation. The investigation included extensive microbiological and molecular testing of the C. perfringens isolates and tissue specimens collected at autopsy. RESULTS: A total of 7 (3 confirmed and 4 probable) cases of foodborne enterotoxigenic C. perfringens type A were identified (attack rate, 35%) after the consumption of high-risk foods. Three residents developed acute necrotizing colitis; 2 of them died. Each patient with confirmed infection presented with evidence of constipation or fecal impaction. C. perfringens enterotoxin (CPE)-positive C. perfringens type A was cultured on samples from each patient with necrotizing colitis. Although statistical analyses failed to implicate a food source, the isolates carried a chromosomal cpe gene, which supports a foodborne origin. CONCLUSIONS: This study confirms that foodborne CPE-positive C. perfringens type A can affect the colon, resulting in potentially fatal necrotizing colitis. Drug-induced constipation and fecal impaction, resulting in prolonged exposure of the colonic mucosal tissue to C. perfringens type A toxins, contributed to the development of necrotizing colitis.

Get off the bus: sound strategy for injury prevention during a tornado?

INTRODUCTION: On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the "F Scale") struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris. METHODS: A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck. RESULTS: Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate = 79.2%). While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were less severe (median injury severity score (ISS) 1 versus 4). CONCLUSION: For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.

All-terrain vehicle-related central nervous system injuries in Oklahoma.

OBJECTIVE: Determine the statewide, population-based incidence and epidemiology of all-terrain vehicle (ATV)-related severe central nervous system (CNS) injuries in Oklahoma. METHODS: Hospitalized and fatal traumatic brain injuries and spinal cord injuries are reportable conditions in Oklahoma. Professionally trained staff reviewed all medical examiner and hospital medical records. RESULTS: From 1992 through 2002 there were 391 persons hospitalized (n=353) or died (n=38) from an ATV-related neurologic injury (average annual rate 1.1/100,000 population), including 369 traumatic brain injuries and 18 spinal cord injuries and 4 persons with both injuries. These accounted for 1% of total CNS injuries in Oklahoma. Forty-five percent of persons who died were under 16 years of age. An average of 23 ATV-related injuries per year occurred before 1998; the number of cases doubled in 1999 and 2000 (mean=46) and tripled in 2002 and 2003 (mean=69). Rates were highest among males 15-24 (4.1/100,000) and 5-14 (3.8/100,000) and among whites (1.2/100,000). Persons who collided with a stationary or moving object were significantly more likely to suffer a fatal traumatic brain injury than those in non-collision events (OR 3.0, 95% CI 1.4, 6.8). Rollover of the ATV occurred in 38% of ATV incidents, and in 28% of traumatic brain injury fatalities, it occurred without a preceding collision. CONCLUSIONS: ATV use can result in significant neurologic morbidity and mortality, especially among children and young adults. Heightened public awareness and parental education on the dangers of these vehicles is imperative. State legislation restricting the use of ATVs among children under the age of 16 years is recommended. Vehicle design changes such as lowering the center of gravity and installing rollover protective structures should be considered.

A large nosocomial outbreak of hepatitis C and hepatitis B among patients receiving pain remediation treatments.

BACKGROUND AND OBJECTIVE: In August 2002, the Oklahoma State Department of Health received a report of six patients with unexplained hepatitis C virus (HCV) infection treated in the same pain remediation clinic. We investigated the outbreak's extent and etiology. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective cohort study of clinic patients, including a serologic survey, interviews of infected patients, and reviews of medical records and staff infection control practices. Patients received outpatient pain remediation treatments one afternoon a week in a clinic within a hospital. Cases were defined as HCV or hepatitis B virus (HBV) infections among patients who reported no prior diagnosis or risk factors for disease or reported previous risk factors but had evidence of acute infection. RESULTS: Of 908 patients, 795 (87.6%) were tested, and 71 HCV-infected patients (8.9%) and 31 HBV-infected patients (3.9%) met the case definition. Multiple HCV genotypes were identified. Significantly higher HCV infection rates were found among individuals treated after an HCV-infected patient during the same visit (adjusted odds ratio [AOR], 6.2; 95% confidence interval [CI95], 2.4-15.8); a similar association was observed for HBV (AOR, 2.9; CI95, 1.3-6.5). Review of staff practices revealed the nurse anesthetist had been using the same syringe-needle to sequentially administer sedation medications to every treated patient each clinic day. CONCLUSIONS: Reuse of needles-syringes was the mechanism for patient-to-patient transmission of HCV and HBV in this large nosocomial outbreak. Further education and stricter oversight of infection control practices may prevent future outbreaks.

Blood alcohol content (BAC)-negative victims in alcohol-involved injury incidents.

AIMS: To understand better how often BAC-negative victims suffer fatal and non-fatal alcohol-involved injuries. DESIGN: We analyzed 1988-1993 data from Oklahoma surveillance systems that track all people killed or hospitalized due to burns, submersions and spinal cord injuries (SCIs) and investigate alcohol use by victims and any others who contributed to their injuries. MEASUREMENTS: Percentage of victims BAC-positive and percentage of victims BAC-negative in alcohol-involved incidents. FINDINGS: Of 5107 cases studied, alcohol involvement was known for 4773 (93%), 1882 fire burns (93%), 1560 scald and other burns (97%), 698 submersions (92%) and 967 spinal cord injuries (89%). By type of injuries, BAC-negative victims were 4%, 13%, 6% and 8% of alcohol-involved cases, respectively. CONCLUSION: A sizeable number of BAC-negative victims suffer alcohol-involved injuries. Although alcohol is not the cause of some of these injuries, alcohol policy changes probably could avert others.

Injuries among Hispanics in the United States: implications for research.

The purpose of this article is to provide a brief overview of U.S. injury mortality among Hispanics, of past research, and of recommended research needs in the field of injury prevention and control. U.S. mortality data from the National Center for Health Statistics from 1990 to 1998 were accessed and summarized. It was found that injuries were the third leading cause of death among Hispanics and the leading cause for those 1 to 44 years of age. There were 119,314 injury deaths resulting in more than 5,000,000 years of potential life lost. Death rates from drugs and/or poisonings and falls increased 23% and 3%, respectively, whereas rates declined for all other causes. There are many gaps in published research focusing on injuries in Hispanic populations. Further research initiatives must be a priority because injuries clearly result in a disproportionate share of Hispanic mortality.

Spinal cord injuries due to falls from hunting tree stands in Oklahoma, 1988-1999.

Serious injuries resulting in paralysis or death have been shown to occur to hunters who have sustained falls from tree stands. A total of sixteen spinal cord injuries or deaths among Oklahoma hunters falling from tree stands were reported between 1987 and 1999. The mean height of the falls was 16.4 feet. Three (18.8%) of the cases were related to substance use. None of the patients were using a safety restraint. Nearly 90% of the injuries resulted in paraplegia/paresis; two (12.5%) of the injuries resulted in death. Forty-four percent of the spinal injuries occurred at the thoraco-lumbor junction (T12 or L1). Burst fractures were the most common fracture pattern. Hospitalizations averaged 19.6 days (range 3 to 73 days) and eight (50%) were discharged to inpatient rehabilitation facilities. Falls from tree stands can result in serious injuries or death. Hunter education and the use of safety harnesses for prevention of injuries related to tree stands are paramount.

The magnitude of major trauma in Oklahoma.

BACKGROUND: Injuries are the third leading cause of death in Oklahoma and the leading cause of death and disability among persons 1-44 years. In 2001, participation in the Oklahoma trauma system became mandatory, and all licensed acute care hospitals were required to submit data to the Oklahoma Trauma Registry (OTR). The objective of this study was to describe the magnitude of major trauma occurring in Oklahoma from 2001-2002. METHODS: Data were collected from all licensed acute care hospitals in Oklahoma. Only patients meeting the major trauma criteria were included in the study. Mortality was used as the main outcome measure. RESULTS: A total of 5760 major trauma patients were reported. The mean age was 38 years (range: 5 days-100 years). Over two-thirds of major trauma cases were male. Blacks had the highest rate of injury (89.5/100,000 population). The leading cause of injury was motor vehicle crashes among persons < 65 years and falls among persons 65 years or older. Overall mortality was 16%; after controlling for age, males were significantly more likely to die than females (O.R 1.3; CI 1.1-1.5). Persons injured by firearms were nearly 5 times more likely to die (CFR=42%) than persons injured by all other causes (CFR=14%) (Odds Ratio 4.5; CI 3.6, 5.5). Excluding deaths in the emergency department (ED), patients were hospitalized an average of 9 days (median: 5 days; range 1-204 days). Over two-thirds (69%) of survivors were discharged home and 14% were discharged to a rehabilitation facility. CONCLUSION: There are noted demographic and etiological differences in the burden of major trauma. Understanding these differences may be useful in enhancing existing prevention practices in Oklahoma and for generating new research to lower this burden. The OTR is relatively new and still maturing; hence, further studies will be required to increase understanding of other factors that influence the incidence and outcome of trauma.