Analgesic-Related Medication Errors Reported to US Poison Control Centers.

Objective: This study investigates the characteristics and trends of medication errors involving analgesic medications. Design and Methods: A retrospective analysis was conducted of analgesic-related medication errors reported to the National Poison Data System (NPDS) from 2000 through 2012. Results: From 2000 through 2012, the NPDS received 533,763 reports of analgesic-related medication errors, averaging 41,059 medication errors annually. Overall, the rate of analgesic-related medication errors reported to the NPDS increased significantly by 82.6% from 2000 to 2009, followed by a 5.7% nonsignificant decrease from 2009 to 2012. Among the analgesic categories, rates of both acetaminophen-related and opioid-related medication errors reported to the NPDS increased during 2000-2009, but the opioid error rate leveled off during 2009-2012, while the acetaminophen error rate decreased by 17.9%. Analgesic-related medication errors involved nonsteroidal anti-inflammatory drugs (37.0%), acetaminophen (35.5%), and opioids (23.2%). Children five years or younger accounted for 38.8% of analgesics-related medication errors. Most (90.2%) analgesic-related medication errors were managed on-site, rather than at a health care facility; 1.6% were admitted to a hospital, and 1.5% experienced serious medical outcomes, including 145 deaths. The most common type of medication error was inadvertently taking/given the medication twice (26.6%). Conclusion: Analgesic-related medication errors are common, and although most do not result in clinical consequences, they can have serious adverse outcomes. Initiatives associated with the decrease in acetaminophen-related medication errors among young children merit additional research and potential replication as a model combining government policy and multisectoral collaboration.

An evaluation of the effect of Ohio's graduated driver licensing law on motor vehicle crashes and crash outcomes involving drivers 16 to 20 years of age.

OBJECTIVE: Nationally, motor vehicle crashes are the leading cause of death among youth ages 16 to 20 years. Graduated driver licensing (GDL) laws have been implemented to reduce motor vehicle crashes among teen drivers. Studies have shown decreases in teen crash rates and crash-related fatality rates following enactment of GDL laws. However, GDL laws typically apply to teens only until their 18th birthday; therefore, the effect, if any, that GDL laws have on youth drivers ages 18 to 20 years and whether these programs should be extended to include these older youth warrant further study. The objective of this study was to evaluate the effects of Ohio's 2007 revised GDL law on motor vehicle crashes and crash-related injuries for crashes involving teen drivers ages 16 to 20 years, with a focus on the effects on crashes involving drivers ages 18 to 20 years. METHODS: Cross-sectional analysis of motor vehicle crashes involving drivers ages 16 to 20 years in Ohio in the pre-GDL (2004-2006) and post-GDL (2008-2010) periods was performed. Descriptive statistics and population-based crash rates for drivers and occupants ages 16 to 20 years were calculated, as well as rate ratios and 95% confidence intervals (CIs) comparing crashes in the pre-GDL and post-GDL periods. RESULTS: Compared with the pre-GDL period, the post-GDL period was associated with lower crash rates for drivers age 16 years (relative risk [RR] = 0.94; 95% CI, 0.90-0.98), age 17 years (RR = 0.90; 95% CI, 0.88-0.93), age 18 years (RR = 0.95; 95% CI, 0.92-0.97), and ages 16-17 years combined (RR = 0.92; 95% CI, 0.90-0.95). Crash rate was higher for the post-GDL period for drivers age 19 years (RR = 1.04; 95% CI, 1.01-1.07), age 20 years (RR = 1.09; 95% CI, 1.05-1.13), and ages 18-20 years combined (RR = 1.02; 95% CI, 1.00-1.03). CONCLUSIONS: Unlike previous studies, this investigation used linked data to evaluate the outcomes of all occupants in crashes involving drivers ages 16-20 years. The post-GDL period was associated with lower crash, injury crash, and fatal crash involvement among drivers and occupants ages 16-17 years but higher overall crash involvement for drivers and occupants ages 19 years, 20 years, and 18-20 years combined. These findings support extending GDL restrictions to novice drivers ages 18 through 20 years to reduce crashes in that group.

The impact of aggressive driving-related injuries in Ohio, 2004-2009.

OBJECTIVE: This study describes the medical and financial impact (hospital charges) of aggressive driving-related injuries in Ohio. METHODS: Statewide crash and hospital databases were probabilistically linked for 2004 through 2009. Descriptive analyses and multivariate regression modeling of multiply-imputed data on motor vehicle occupants involved in aggressive driving-related crashes were performed. RESULTS: There were 821,136 motor vehicle occupants involved in aggressive driving-related crashes in Ohio from 2004 through 2009; injuries were sustained by 15.0%. The rate of aggressive driving-related crashes was highest among drivers ages 16 to 19 years (3787.1 crashes per 100,000 licensed drivers). Aggressive driving-related inpatients accrued more than $250.8 million in hospital charges and 28,366 inpatient days of treatment in 2004 through 2009. Occupants ages 16 to 19 years had higher odds of sustaining injury when involved in aggressive driving-related crashes (OR = 1.10; 95% CI = 1.07, 1.12; p < 0.001), but lower odds of death, inpatient admission, ISS ≥ 16, and rehabilitation. DISCUSSION: Aggressive driving-related injuries have a substantial medical and financial impact in Ohio. PRACTICAL APPLICATIONS: Compared with other highway safety issues, prevention efforts aimed specifically at aggressive driving are lacking. Targeted enforcement and public awareness campaigns are needed.

Nonfatal choking on food among children 14 years or younger in the United States, 2001-2009.

OBJECTIVE: The objective of this study was to investigate the epidemiology of nonfatal choking on food among US children. METHODS: Using a nationally representative sample, nonfatal pediatric choking-related emergency department (ED) visits involving food for 2001 through 2009 were analyzed by using data from the National Electronic Injury Surveillance System-All Injury Program. Narratives abstracted from the medical record were reviewed to identify choking cases and the types of food involved. RESULTS: An estimated 111,914 (95% confidence interval: 83,975-139,854) children ages 0 to 14 years were treated in US hospital EDs from 2001 through 2009 for nonfatal food-related choking, yielding an average of 12,435 children annually and a rate of 20.4 (95% confidence interval: 15.4-25.3) visits per 100,000 population. The mean age of children treated for nonfatal food-related choking was 4.5 years. Children aged ≤ 1 year accounted for 37.8% of cases, and male children accounted for more than one-half (55.4%) of cases. Of all food types, hard candy was most frequently (15.5% [16,168 cases]) associated with choking, followed by other candy (12.8% [13,324]), meat (12.2% [12,671]), and bone (12.0% [12,496]). Most patients (87.3% [97,509]) were treated and released, but 10.0% (11,218) were hospitalized, and 2.6% (2911) left against medical advice. CONCLUSIONS: This is the first nationally representative study to focus solely on nonfatal pediatric food-related choking treated in US EDs over a multiyear period. Improved surveillance, food labeling and redesign, and public education are strategies that can help reduce pediatric choking on food.

The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio.

INTRODUCTION: The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system. METHOD: The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law. RESULTS: Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt. SUMMARY AND IMPACT ON INDUSTRY: Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.

Pediatric pedestrian injuries and associated hospital resource utilization in the United States, 2003.

BACKGROUND: The objective was to calculate national estimates of pedestrian-related hospitalizations and associated use of healthcare resources among children or=16. A traffic-related event was the cause of 92.7% of hospitalizations. Older age, higher injury severity, urban and Western hospital location, children's hospital type, and longer LOS were significantly associated with higher total hospital charges. Older age and higher injury severity were significantly associated with longer LOS. CONCLUSION: Pediatric pedestrian injuries contribute substantially to the healthcare resource burden in the United States, accounting for approximately 45,000 days of hospitalization and >USD 290 million in inpatient charges annually.

Pediatric traumatic amputations and hospital resource utilization in the United States, 2003.

BACKGROUND: Despite the severity of consequences associated with traumatic amputation, little is known about the epidemiology or healthcare resource burden of amputation injuries, and even less is known about these injuries in the pediatric population. METHODS: An analysis of patients aged < or =17 years hospitalized with traumatic amputations using the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database was performed. National estimates of amputation-associated hospitalizations, rates, resource use, and demographics were calculated. Potentially significant covariate associations were studied using hospital charges and length of stay (LOS). RESULTS: In 2003, 956 cases of traumatic amputations among children aged < or =17 years resulted in 21.6 million dollars (standard deviation [SD] = 2.2 million dollars) in inpatient charges and 3,967 days (SD = 354) of hospitalization in the United States. Finger and/or thumb amputations accounted for the majority of injuries (64.0%). Mean (SD) hospital charges and LOS were 23,157 dollars (49,018 dollars) and 4.1 (7.4) days, respectively. Traumatic leg amputations incurred the highest mean hospital charges (120,275 dollars) and longest mean LOS (18.5 days). Older children (15-17 years) experienced a higher hospitalization rate (1.84/100,000) than other age groups. Older age, amputation caused by a motorized vehicle, urban hospital location, children's hospital type, and longer LOS were associated with higher total charges. Amputation caused by lawn mower, motorized vehicle or explosives/fireworks, and children's hospital type were associated with longer LOS. CONCLUSIONS: Pediatric traumatic amputations contribute substantially to the health resource burden in the United States, resulting in 21 million dollars in inpatient charges annually. More effective interventions to prevent these costly injuries among children must be implemented.

The contribution of traumatic brain injury to the medical and economic outcomes of motor vehicle-related injuries in Ohio.

OBJECTIVE: To describe traumatic brain injury (TBI) among injured roadway users. Aim 1 assessed the association of age, gender, alcohol/drug use, safety equipment use, type of roadway user, metropolitan area, and primary payer with motor vehicle-related TBI outcome. Aim 2 assessed the relationship of motor vehicle-related TBI and risk/protective factors with medical and economic outcomes. METHODS: Population-level hospital and trauma databases from the Ohio Hospital Association and Ohio Department of Public Safety, respectively, were probabilistically linked for 2003 through 2006. Injured roadway users (motor vehicle occupants, motorcyclists, bicyclists, pedestrians, and others) were assessed for TBI, ventilator use, intensive care unit (ICU) admission, injury severity score (ISS), need for rehabilitation, death, and total hospital charges. RESULTS: The odds of a motor vehicle-related TBI were greater among those not using safety equipment (OR=1.56). The interactions of alcohol/drug use by gender and of alcohol/drug use by location were significant. Sustaining a TBI increased the odds of requiring ventilation (OR=3.66), being admitted to the ICU (OR=2.51), having a high ISS (OR=4.24), requiring rehabilitation (OR=2.22), or death (OR=2.52). When compared with a non-TBI, total hospital charges increased by a factor of 1.35 for a TBI. Hospital charges were $46,441 on average for individuals who sustained a TBI, whereas mean hospital charges were $32,614 for patients with a non-TBI. CONCLUSIONS: Among injured roadway users, individuals who sustain a TBI are more likely to require extensive medical care and have injuries resulting in death. IMPACT ON INDUSTRY: Prevention strategies aimed at reducing alcohol use and increasing safety device use should be encouraged to reduce the burden of TBI.

Injuries From furniture tip-overs among children and adolescents in the United States, 1990-2007.

OBJECTIVE: To describe the epidemiology of pediatric injuries associated with furniture tip-overs in the United States. METHODS: Data from the National Electronic Injury Surveillance System were analyzed for patients < or =17 years treated in emergency departments for a furniture tip-over-related injury from 1990 through 2007. RESULTS: An estimated 264 200 furniture tip-over-related injuries occurred during the study period, yielding an average of 14 700 injuries annually, or 20.7 per 100 000 population per year. There was a significant increase in the number and rate of these injuries during the 18-year period. Three-quarters of injuries were to children < or =6 years. Televisions were the item most commonly involved (47.4%). Head/neck injuries were the most common (42.2%) injury type among children 0 to 9 years of age. CONCLUSIONS: The number and rate of injuries to children associated with furniture tip-overs are increasing. Pediatricians and caregivers should be aware of this important source of pediatric injury and the strategies for prevention.

Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio.

PROBLEM: Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio. METHOD: Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study. RESULTS: There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS >/=16 (95% CI: 1.03, 9.88; p=0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p=0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p=0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p=0.005). Higher ISS was associated with both higher total charges (p<0.001) and longer LOS (p<0.001). DISCUSSION: This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact. IMPACT ON INDUSTRY: Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.