ABSTRACT
BACKGROUND: The number of commercial cruise ship passengers continues to rise and is projected to reach 27.2 million passengers worldwide in 2018. Accidental injury aboard these ships can result in serious morbidity and mortality. This study examines the injury mechanisms, patterns, demographics, and outcomes of these injuries which are serious enough to require hospitalisation in order to facilitate administrative, financial, and medical decision making to aid in injury prevention and treatment. MATERIALS AND METHODS: This is a cross-sectional, retrospective, registry-based study of adult patients sustaining injury while on a cruise ship admitted to a Level I Trauma Centre in the United States over a 2-year period. Data on demographics, injury type and severity, surgical management, hospital charges, length of stay, mortality, and discharge disposition were recorded. RESULTS: Sixty seven patients were identified and included in the analysis. 70.1% of patients were 65 or older and a majority were female (59.7%). The most common mechanism of injury was a ground level fall (79.1%), and the most common injury encountered was a femur fracture (52.2%) which involved the acetabulo-femoral joint in 85.7% of cases. Traumatic brain injuries were uncommon occurring in 7.5% of cases. There were no fatalities in this series. CONCLUSIONS: The most common injuries aboard cruise ships requiring hospitalisation occur in the geriatric population as a result of a ground level fall. Most commonly, the injuries are long bone fractures, with femur fractures occurring most frequently and accounting for over half of all injuries sustained. Resources and protocols for pre-hospital management of cruise ship injuries should prioritise these patients, and fall prevention measures for this demographic should be mandatory aboard all cruise ships.
Subject(s)
Ships , Wounds and Injuries/epidemiology , Accidental Falls/statistics & numerical data , Adolescent , Adult , Aged , Brain Injuries, Traumatic/epidemiology , Cross-Sectional Studies , Female , Femoral Fractures/epidemiology , Femoral Fractures/etiology , Florida , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , Trauma Centers , Travel , Wounds and Injuries/etiologyABSTRACT
OBJECTIVE: To describe recent epidemiological trends in concussion diagnosis within the United States (US) population. METHODS: We conducted a retrospective review of PearlDiver, a private-payor insurance database. Our search included International Classification of Disease, Ninth Revision codes for sports-related concussions spanning 2010 through 2014. Overall study population included patients aged 5 to 39 with subgroup analysis performed on Cohort A (Youth), children and adolescents aged 5 to 19, and Cohort B (Adults), adults aged 20 to 39. Incidence was defined as the number of individuals diagnosed normalized to the number of patients in the database for each demographic. RESULTS: Our search returned 1,599 patients diagnosed during the study period. The average (±SD) annual rate was 4.14 ± 1.42 per 100,000 patients for the overall population. Youth patients were diagnosed at a mean annual rate of 3.78 ± 1.30 versus 0.36 ± 0.16 per 100,000 in Adults. Concussion normalized incidence significantly increased from 2.47 to 3.87 per 100,000 patients (57%) in the Youth cohort (p = 0.048). In Adults, rate grew from 0.34 to 0.44 per 100,000 patients (29%) but was not statistically significant (p = 0.077). Four-year compound annual growth rates for Youth and Adults were 26.3% and 20.4%, respectively. Youth patients comprised 1,422/1,599 (90.18%) of all concussion diagnoses and were predominantly male (75%). Adults also constituted 138/1,599 (8.63%) of the sample and were also largely male (80%). Midwestern states had highest diagnostic rates (Cohort A:19 per 100,000 and Cohort B:1.8 per 100,000). Both cohorts had the most total diagnoses made in the fourth quarter followed by the second quarter. CONCLUSION: Sports-related concussion diagnostic rates have grown significantly in the youth population. Quarterly, regional and gender distributions appear consistent with participation in concussion-prone sports. Utilization of individualized and multifaceted approaches are recommended to advance diagnosis, assessment and management of concussions in the U.S.
