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1.
Medicine (Baltimore) ; 100(6): e24642, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578587

RESUMEN

ABSTRACT: Personal mobility devices (PMDs) have emerged as new factors in motor vehicle accidents, and related injuries are increasing. We aimed to describe the characteristics of PMD-related injuries presented to emergency departments (EDs) through a cross-sectional study for 7 years.This study is a multicenter cross-sectional study using the Emergency Department-based Injury In-Depth Surveillance database in South Korea. We identified all PMD-related injuries from 2011 to 2017 based on text searching. We categorized them into 3 groups based on their distinguishable characteristics: electric standing scooter (E-scooter), electric self-balancing wheel (E-wheel), and electronic board (E-board).A total of 448 PMD-related injuries were observed during the observation period. E-scooter-, E-wheel-, and E-board-related injuries occurred in 284, 138, and 26 cases, respectively. Most patients were between the ages of 19 and 59 years (69.2%), men (66.3%), and injured because of leisure activity (61.2%). The mechanism of injury was mostly traffic accidents (75.2%), but regarding injuries involving E-wheel and E-board, 25.4% and 30.8% of patients slipped from the device. The most commonly injured body part was the head, which accounted for 58.1% of E-scooter injuries, 38.4% of E-wheel injuries, and 53.9% of E-board injuries. Only 6 of all patients wore a helmet at the time of accident.PMD users and PMD-sharing programs are increasing, and more accidents are expected in the future. As PMDs are convenient to move and more people are willing to use them, proper riding and safety rules based on the type of PMD are needed to reduce the risk of injury. The results of this study can be used as basic data for developing safety policies.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Vehículos a Motor Todoterreno , Heridas y Traumatismos/epidemiología , Adolescente , Adulto , Factores de Edad , Niño , Estudios Transversales , Femenino , Dispositivos de Protección de la Cabeza , Humanos , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Heridas y Traumatismos/etiología , Adulto Joven
2.
Isr Med Assoc J ; 23(2): 82-86, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595211

RESUMEN

BACKGROUND: The novel coronavirus disease (COVID-19) pandemic changed medical environments worldwide. OBJECTIVES: To evaluate the impact of the COVID-19 pandemic on trauma-related visits to the emergency department (ED). METHODS: A single tertiary center retrospective study was conducted that compared ED attendance of patients with injury-related morbidity between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2018 and 2019. RESULTS: Overall, 6513 patients were included in the study. During the COVID-19 outbreak, the daily number of patients visiting the ED for acute trauma declined by 40% compared to the average in previous months (P < 0.01). A strong negative correlation was found between the number of trauma-related ED visits and the log number of confirmed cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Israel (Pearson's r = -0.63, P < 0.01). In the COVID-19 period there was a significant change in the proportion of elderly patients (7% increase, P = 0.002), admissions ratio (12% increase, P < 0.001), and patients brought by emergency medical services (10% increase, P < 0.001). The number of motor vehicle accident related injury declined by 45% (P < 0.01). CONCLUSIONS: A significant reduction in the number of trauma patients presenting to the ED occurred during the COVID-19 pandemic, yet trauma-related admissions were on the rise.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Estudios Transversales , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención Terciaria , Heridas y Traumatismos/terapia , Adulto Joven
3.
Rev Col Bras Cir ; 48: e20202875, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33605394

RESUMEN

The coronavirus pandemic led society to adopt measures to contain its spread that generate impacts in the social, economic and psychological spheres, mainly due to social isolation. Some authors point out that social changes have generated changes in the various forms of trauma and violence. For this study, data collection for the years 2019 and 2020 was carried out on DATASUS - TABNET and on the website of the Secretariat of Public Security - SSP, considering various types of trauma and violence, with subsequent correlation analysis using the Kendall coefficient and correlation test. There was statistical significance, allowing a correlation with the negative pandemic for the rates of body injury due to traffic accidents, gunshot injuries, stab wounds, sexual violence, bodily injuries and interpersonal violence. As factors possibly associated with a reduction in the incidence of these variables, the literature presents some changes resulting from the pandemic, such as adherence to isolation, with a reduction in the flow of people on the street, and a decrease in reports of violence. The present study indicates that the findings may serve as a warning for future changes and for the adoption of preventive measures, however they represent the initial situation of the pandemic in São Paulo and, therefore, further investigations must be carried out with the course of the pandemic, which still remains.


Asunto(s)
Pandemias , Violencia , Heridas y Traumatismos/epidemiología , Brasil/epidemiología , Humanos
4.
JAMA Netw Open ; 4(2): e2037227, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33576819

RESUMEN

Importance: In early 2020, the United States declared a public health emergency in response to coronavirus disease 2019 (COVID-19) and implemented a variety of social distancing measures. The association between the COVID-19 pandemic and the number of pediatric admissions is unclear. Objective: To determine the changes in patterns of pediatric admissions in 2020 compared with the prior decade. Design, Setting, and Participants: This cross-sectional study included 49 US hospitals contributing to the Pediatric Health Information Systems database. Inpatient admissions were transformed into time-series data, and ensemble forecasting models were generated to analyze admissions across a range of diagnoses in 2020 compared with previous years. The setting was inpatient admissions. All patients discharged between January 1, 2010, and June 30, 2020, from an inpatient hospital encounter were included. Main Outcomes and Measures: Number of hospital admissions by primary diagnosis for each encounter. Results: Of 5 424 688 inpatient encounters among 3 372 839 patients (median [interquartile range] age, 5.1 [0.7-13.3] years; 2 823 748 [52.1%] boys; 3 171 224 [58.5%] White individuals) at 49 hospitals, 213 571 (3.9%) were between January 1, 2020, and June 30, 2020. There was a decrease in the number of admissions beginning in March 2020 compared with the period from 2010 to 2019. At the nadir, admissions in April 2020 were reduced 45.4% compared with prior years (23 798 in April 2020 compared with a median [interquartile range] of 43 550 [42 110-43 946] in April 2010-2019). Inflation-adjusted hospital charges decreased 27.7% in the second quarter of 2020 compared with prior years ($4 327 580 511 in 2020 compared with a median [interquartile range] of $5 983 142 102 [$5 762 690 022-$6 324 978 456] in 2010-2019). Seasonal patterns were evident between 2010 and 2019 for a variety of common pediatric conditions, including asthma, atrial septal defects, bronchiolitis, diabetic ketoacidosis, Kawasaki syndrome, mental health admissions, and trauma. Ensemble models were able to discern seasonal patterns in admission diagnoses and accurately predicted admission rates from July 2019 until December 2019 but not from January 2020 to June 2020. All diagnoses except for birth decreased below the model 95% CIs between January 2020 and June 2020. Conclusions and Relevance: In this cross-sectional study, pediatric admissions to US hospitals decreased in 2020 across an array of pediatric conditions. Although some conditions may have decreased in incidence, others may represent unmet needs in pediatric care during the COVID-19 pandemic.


Asunto(s)
Hospitalización , Hospitales Pediátricos , Pandemias , Estaciones del Año , Adolescente , Niño , Estudios Transversales , Cetoacidosis Diabética/epidemiología , Femenino , Defectos del Tabique Interatrial/epidemiología , Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Humanos , Masculino , Trastornos Mentales/epidemiología , Síndrome Mucocutáneo Linfonodular/epidemiología , Admisión del Paciente , Enfermedades Respiratorias/epidemiología , Estudios Retrospectivos , Estados Unidos/epidemiología , Heridas y Traumatismos/epidemiología
5.
Ann R Coll Surg Engl ; 103(2): 114-119, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33559558

RESUMEN

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.


Asunto(s)
Fracturas Óseas/epidemiología , Hospitalización/tendencias , Trastornos Mentales/epidemiología , Derivación y Consulta/tendencias , Intento de Suicidio/tendencias , Adulto , Alcoholismo/epidemiología , Trastornos de Ansiedad/epidemiología , Comorbilidad , Trastorno Depresivo/epidemiología , Femenino , Cuerpos Extraños/epidemiología , Cuerpos Extraños/cirugía , Fracturas Óseas/cirugía , Humanos , Luxaciones Articulares/epidemiología , Luxaciones Articulares/cirugía , Londres/epidemiología , Masculino , Trastornos Mentales/tratamiento farmacológico , Procedimientos Ortopédicos , Psicotrópicos/uso terapéutico , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/epidemiología , Traumatismos de los Tejidos Blandos/cirugía , Trastornos Relacionados con Sustancias/epidemiología , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/cirugía
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(1): 137-141, 2021 Jan 10.
Artículo en Chino | MEDLINE | ID: mdl-33503710

RESUMEN

Objective: To understand the epidemiologic characteristics of fall in people aged 60 years and above in China from 2015 to 2018, and provide basis for the prevention of fall in old people and the development of related policies. Methods: Descriptive analysis was conducted on general information, injury occurrence information and injury clinical characteristics of fall cases in people aged 60 years and above by using the data from Chinese National Injury Surveillance System(NISS). Results: A total of 205 670 fall cases were reported to NISS from 2015 to 2018 with the male to female ratio of 1.37. Falls mainly occurred during 10:00-10:59 am (11.91%). The top three places where fall might occur were home (56.41%), road (17.24%) and public residence (14.36%). Leisure activity(37.56%), housework (24.20%) and walk (15.07%) were top three activities in which fall occurred. Bruise/scrape (42.17%), fracture (31.79%) and sprain/strain (14.62%) were the major injuries. The most common body parts involved were low limbs (31.38%), head (22.46%) and truncus(20.71%). Moderate and severe injuries accounted for 37.21% of all cases, and 22.49% of the elderly seeking medical care due to fall required hospitalization. Conclusions: The number of fall in people aged 60 years and above increased from 2015 to 2018. The elderly is a key population in the prevention and control of fall.


Asunto(s)
Accidentes por Caídas , Heridas y Traumatismos , Anciano , Grupo de Ascendencia Continental Asiática , China/epidemiología , Femenino , Humanos , Actividades Recreativas , Masculino , Persona de Mediana Edad , Heridas y Traumatismos/epidemiología
10.
Artículo en Inglés | MEDLINE | ID: mdl-33401486

RESUMEN

BACKGROUND: Research suggests that drivers tend to engage in risk-taking behaviours on public holidays. Studies that examined the association between holidays (or other special days) and fatal injuries are inconsistent. This study used UK STATS19 data to investigate the associations of nine public holidays on road crash casualties. METHODS: This retrospective study assessed UK STATS19 crash data for 1990-2017. All casualties from two vehicle crashes were initially considered; subsequently, casualties with missing data were excluded. Multiple logistic regression was estimated to explore the associations of potential risk factors with the likelihood of killed or seriously injured (KSI) casualties and to calculate adjusted odds ratios (AORs). RESULTS: In total, 3,751,998 casualties from traffic accidents in the United Kingdom during 1990-2017 were included in the final data set; among these, 410,299 (10.9%) were KSI casualties, and 3,341,699 (89.1%) were slight injuries. Crashes on public holidays were 16% (AOR = 1.16; 95% confidence interval [CI] = 1.13-1.19) more likely to involve KSI casualties than were crashes on non-holidays. With other factors controlled for, crashes during the Queen's 2002 Golden Jubilee and on New Year's Day were 48% (AOR = 1.48; 95% CI = 1.06-2.07) and 36% (AOR = 1.36; 1.26-1.48) more likely to lead to KSIs, respectively. CONCLUSIONS: The proportion of crashes resulting in KSI casualties on public holidays was higher than that on non-holidays. Furthermore, crashes during the Queen's 2002 Golden Jubilee had the highest risk of KSI casualties followed by New Year's Day.


Asunto(s)
Accidentes de Tránsito , Vacaciones y Feriados , Heridas y Traumatismos , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Vacaciones y Feriados/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiología , Heridas y Traumatismos/epidemiología , Adulto Joven
11.
J Surg Res ; 257: 370-378, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32892133

RESUMEN

BACKGROUND: Return visits within 72 h are an important metric in evaluating the performance of emergency rooms. This has not been well studied in the pediatric trauma population. We sought to determine novel risk factors for return visits to the emergency department (ED) after trauma that may assist in identifying patients most at risk of revisit. METHODS: We used the Cerner Health Facts Database to retrieve data from 34 EDs across the United States that care for pediatric trauma patients aged <15 y. The data consist of 610,845 patients and 816,571 ED encounters. We retrieved variables encompassing demographics, payor, current and past health care resource utilization, trauma diagnoses, other diagnoses/comorbidities, medications, and surgical procedures. We built a nested mixed effects logistic regression model to provide statistical inference on the return visits. RESULTS: Traumas resulting from burns and corrosion, injuries to the shoulder and arms, injuries to the hip and legs, and trauma to the head and neck are all associated with increased odds of returning to the ED. Patients suffering from poisoning relating to drugs and other biological substances and patients with trauma to multiple body regions have reduced odds of returning to the ED. Longer ED length of stay and prior health care utilization (ED or inpatient) are associated with increased odds of a return visit. The sex of the patient and payor had a statistically significant effect on the risk of a return visit to the ED within 72 h of discharge. CONCLUSIONS: Certain traumas expose patients to an increased risk for return visits to the ED and, as a result, provide opportunity for improved quality of care. Targeted interventions that include education, observation holds, or a decision to hospitalize instead of discharge home may help improve patient outcomes and decrease the rate of ED returns. LEVEL OF EVIDENCE: III (Prognostic and Epidemiology).


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Modelos Estadísticos , Readmisión del Paciente/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estados Unidos/epidemiología
12.
J Surg Res ; 257: 92-100, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32818790

RESUMEN

BACKGROUND: Alcohol use remains abundant in patients with traumatic injury. Previous studies have suggested that serum carbohydrate-deficient transferrin (%dCDT) levels, relative to blood alcohol levels (BALs), may better differentiate episodic binge drinkers from sustained heavy consumers in admitted patients with traumatic injury. We characterized %dCDT levels and BAL levels to differentiate binge drinkers from sustained heavy consumers in admitted trauma patients and their associations with outcomes. METHODS: This prospective, cross-sectional, observational study assessed %dCDT and BAL levels in admitted male and female patients with traumatic injury (≥18 y) at an American College of Surgeons Committee on Trauma level-1 center from July 2014 to June 2016. We designated patients with %dCDT levels ≥1.7% (CDT+) as chronic alcohol users and dichotomized acutely intoxicated patients using three different BAL-level thresholds. Primary outcomes included in-hospital complications, along with prolonged ventilation and intensive care unit length of stay, both defined as the top decile. Secondary outcomes included rates of drug or alcohol withdrawal and all-cause mortality. Analyses were adjusted for clinical factors. RESULTS: We studied 715 patients (77.5% men, 60.6% ≤ 40 y of age, median Injury Severity Score: 14, 41.7% motor vehicle crashes, 17.9% gunshot wounds, 11.1% falls). While 31.0% were CDT+, 48.7% were BAL>0. After adjusting for CDT levels, BAL levels >0, >100, or >200 were not associated with adverse outcomes. However, CDT+ relative to patients with CDT were associated with complications (adjusted odds ratio: 1.96 [1.24-3.09]), prolonged ventilation days (3.23 [1.08-9.65]), and prolonged intensive care unit stays (2.83 [1.20-6.68]). CONCLUSIONS: In this 2-year prospective, cross-sectional, and observational study, we found that %dCDT levels, relative to BAL levels, may better stratify admitted patients with traumatic injury into acute versus chronic alcohol users, identifying those at higher risk for in-hospital complications.


Asunto(s)
Trastornos Relacionados con Alcohol/sangre , Trastornos Relacionados con Alcohol/epidemiología , Nivel de Alcohol en Sangre , Transferrina/análogos & derivados , Heridas y Traumatismos/sangre , Accidentes de Tránsito , Adolescente , Adulto , Alcoholismo/sangre , Alcoholismo/epidemiología , Borrachera/sangre , Borrachera/epidemiología , Estudios Transversales , Diagnóstico Diferencial , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Transferrina/análisis , Resultado del Tratamiento , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/terapia , Heridas por Arma de Fuego/sangre , Adulto Joven
13.
J Urol ; 205(1): 30-35, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33053308

RESUMEN

PURPOSE: The authors of this guideline reviewed the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. MATERIALS AND METHODS: The Panel amended the Guideline in 2020 to reflect additional literature published through February 2020. When sufficient evidence existed, the Panel assigned the body of evidence a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, the Panel provided additional information as Clinical Principles and Expert Opinions (See table 1[Table: see text]). RESULTS: The Panel updated a total of six existing statements on renal, ureteral, bladder, urethra, and genital trauma. Additionally, four new statements were added based on literature released since the 2017 amendment. Statement 5b was added based on new evidence for treatment of hemodynamically unstable patients with renal trauma. Statement 20b was added based on new literature for percutaneous or open suprapubic tube placement following pelvic fracture urethral injury. Statements 30a and 30b were also added to provide guidance on ultrasonography for blunt scrotal injuries suggestive of testicular rupture and for performing surgical exploration with repair or orchiectomy for penetrating scrotal injuries respectively. CONCLUSIONS: These evidence-based updates to the AUA Guidelines further inform the treatment of urotrauma.


Asunto(s)
Medicina Basada en la Evidencia/normas , Sistema Urogenital/lesiones , Urología/normas , Heridas y Traumatismos/terapia , Medicina Basada en la Evidencia/métodos , Humanos , Sociedades Médicas/normas , Estados Unidos/epidemiología , Urología/métodos , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/epidemiología
14.
Artículo en Inglés | MEDLINE | ID: mdl-33374262

RESUMEN

Trauma records in Egyptian hospitals are widely suspected to be inadequate for developing a practical and useful trauma registry, which is critical for informing both primary and secondary prevention. We reviewed archived paper records of trauma patients admitted to the Beni-Suef University Hospital in Upper Egypt for completeness in four domains: demographic data including contact information, administrative data tracking patients from admission to discharge, clinical data including vital signs and Glasgow Coma Scale scores, and data describing the causal traumatic event (mechanism of injury, activity at the time of injury, and location/setting). The majority of the 539 medical records included in the study had significant deficiencies in the four reviewed domains. Overall, 74.3% of demographic fields, 66.5% of administrative fields, 55.0% of clinical fields, and just 19.9% of fields detailing the causal event were found to be completed. Critically, oxygen saturation, arrival time, and contact information were reported in only 7.6%, 25.8%, and 43.6% of the records, respectively. Less than a fourth of the records provided any details about the cause of trauma. Accordingly, the current, paper-based medical record system at Beni-Suef University Hospital is insufficient for the development of a practical trauma registry. More efforts are needed to develop efficient and comprehensive documentation of trauma data in order to inform and improve patient care.


Asunto(s)
Servicio de Urgencia en Hospital , Registros Médicos , Heridas y Traumatismos , Adulto , Egipto/epidemiología , Hospitales Universitarios , Humanos , Sistema de Registros , Estudios Retrospectivos , Heridas y Traumatismos/epidemiología
15.
BMC Emerg Med ; 20(1): 97, 2020 12 11.
Artículo en Inglés | MEDLINE | ID: mdl-33308165

RESUMEN

BACKGROUND: Emergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain. METHODS: We acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified using localized New York University Emergency Department Algorithm (NYU-EDA) to evaluate changes in presentations with different acuity levels. RESULTS: A total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23% (from 113 to 87, p < .001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42% (from 18 to 10, p < .001). Emergent presentations were reduced by 19 to 28% depending on the subgroup (p < .001). Number of injuries were reduced by 25% (from 27 to 20, p < .001). The NYU-EDA distribution changed statistically significantly with 4% point reduction in Non-Emergent visits (from 16 to 12%, p < .001) and 0.9% point increase in Alcohol-related visits (from 1.6 to 2.5%, p < .001). CONCLUSIONS: We observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Algoritmos , Finlandia/epidemiología , Humanos , Trastornos Mentales/epidemiología , New York , Pandemias , Estudios Retrospectivos , Centros de Atención Secundaria/estadística & datos numéricos , Factores de Tiempo , Universidades , Heridas y Traumatismos/epidemiología
16.
S Afr Med J ; 0(0): 13183, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-33334392

RESUMEN

BACKGROUND: In response to the coronavirus pandemic, lockdown restrictions and a ban on alcohol sales were introduced in South Africa. Objectives. To investigate the impact of lockdown measures on the number of patients who visited a tertiary urban trauma centre. Methods. The period of investigation was from 1 February to 30 June 2020 and was segmented into three intervals: pre-lockdown (February and March 2020), hard lockdown (April and May 2020) and immediately post lockdown (June 2020). The electronic HECTIS health record registry was interrogated for the total number of patients that were seen per month. These were further categorised according to mechanism of injury (stab, gunshot, blunt assault and road traffic injuries). Penetrating (stab and gunshot) and blunt assault victims were collectively grouped as violent trauma. Results. The mean total number of patients seen decreased by 53% during the hard lockdown period. There was a moderate reduction (15%) in patients with gunshot injuries seen during the hard lockdown phase, but there was an 80% increase in the post-lockdown period. The proportion of patients injured in road traffic collisions pre lockdown, hard lockdown and immediate post lockdown was 16.4%, 8.9% and 11.1%, respectively. Patients injured in road traffic collisions decreased by 74% during the hard lockdown period and maintained a reduction of 32% during the immediate post-lockdown period. The mean total number of patients who visited the trauma unit returned to pre-lockdown levels in June. Conclusions. There was an overall trend of reduced number of patients who visited the trauma unit during the hard lockdown period; however, these numbers returned to pre-lockdown levels during the immediate post-lockdown period. The number of road traffic injury admissions remained reduced during all three phases of lockdown, while the number of gunshot victims increased substantially during the post-lockdown period.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Control de Enfermedades Transmisibles , Violencia/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Heridas por Arma de Fuego/epidemiología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , /prevención & control , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Femenino , Humanos , Masculino , Sudáfrica/epidemiología , Centros Traumatológicos/estadística & datos numéricos
17.
Artículo en Inglés | MEDLINE | ID: mdl-33374643

RESUMEN

Although motor vehicle collisions (MVCs) are a worldwide public health concern due to their high injury, mortality, and fatality rates, few studies have addressed the epidemiologic behavior of MVCs in Latin American youth. Thus, this study was aimed at describing and comparing the characteristics of MVCs involving 0 to 14-year-olds in Costa Rica, Guatemala, and Panama. A secondary aim was to estimate the crude MVC-related injury, fatality, and mortality rates and their trends over time. We conducted a descriptive, retrospective study using publicly available data for Costa Rica, Panama, and Guatemala between 2012 and 2015. We examined the reported MVC cases and calculated the crude injury, fatality, and mortality rates and their trends over time (α = 0.05). Publicly available data reported 12,020 MVC-related injuries and 431 MVC-related deaths involving 0 to 14-year-olds. The most frequent mechanisms involved 0 to 14-year-olds as passengers or pedestrians in MVCs (>85% of all cases). The highest crude MVC-related injury and mortality rates were reported for Panama (119.35 and 2.14 per 100,000 population, respectively, in 0 to 14-years-olds), while Guatemala had the highest median MVC-related fatality rate (8.84 per 100,000 events; χ2 [2] = 377.8; p < 0.001) with a statistically significant trend increasing over time (r = 0.947; p = 0.027). Although several factors play a role in the prevention of MVCs among 0 to 14-year-olds, we found that Costa Rica was the only country that implemented a policy on child restraint systems resulting in the lowest rates of MVC-related injury, mortality, and fatality. These results could be used by decision makers from the aforementioned Central American countries to develop adequate policies addressing MVC preventative strategies to protect Central American infants and children.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Adolescente , Niño , Preescolar , Costa Rica/epidemiología , Guatemala/epidemiología , Humanos , Lactante , Recién Nacido , Panamá/epidemiología , Estudios Retrospectivos
18.
Medicina (Kaunas) ; 56(10)2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33019514

RESUMEN

Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February -31 March) in the last three years (2018-2019-2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pandemias , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Servicio de Urgencia en Hospital/tendencias , Oftalmopatías/epidemiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades Otorrinolaringológicas/epidemiología , Admisión del Paciente/tendencias , Estudios Retrospectivos , Enfermedades Torácicas/epidemiología , Enfermedades Urológicas/epidemiología , Heridas y Traumatismos/epidemiología , Adulto Joven
19.
Neurology ; 95(19): e2605-e2609, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33004606

RESUMEN

OBJECTIVE: Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS: A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS: A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS: We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.


Asunto(s)
Ansiedad/epidemiología , Traumatismos Craneocerebrales/epidemiología , Depresión/epidemiología , Cefalea/epidemiología , Refugiados/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Violencia/estadística & datos numéricos , Adolescente , Adulto , Ansiedad/psicología , Conmoción Encefálica/epidemiología , Conmoción Encefálica/psicología , Traumatismos Craneocerebrales/psicología , Estudios Transversales , Depresión/psicología , El Salvador/etnología , Femenino , Guatemala/etnología , Haití/etnología , Cefalea/psicología , Honduras/etnología , Humanos , Masculino , Trastornos de la Memoria/epidemiología , Trastornos de la Memoria/psicología , México/etnología , Nicaragua/etnología , Oportunidad Relativa , Cuestionario de Salud del Paciente , Prevalencia , Trauma Psicológico/epidemiología , Trauma Psicológico/psicología , Refugiados/psicología , Estudios Retrospectivos , Distribución por Sexo , Delitos Sexuales/psicología , Delitos Sexuales/estadística & datos numéricos , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos por Estrés Postraumático/psicología , Inconsciencia/epidemiología , Inconsciencia/psicología , Estados Unidos/epidemiología , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/psicología , Adulto Joven
20.
Lancet ; 396(10258): 1135-1159, 2020 10 17.
Artículo en Inglés | MEDLINE | ID: mdl-33069324

RESUMEN

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.


Asunto(s)
Prestación de Atención de Salud/economía , Carga Global de Enfermedades/economía , Salud Global/tendencias , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Tasa de Natalidad , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Carga Global de Enfermedades/tendencias , Humanos , Masculino , Enfermedades no Transmisibles/epidemiología , Evaluación de Resultado en la Atención de Salud/tendencias , Factores de Riesgo , Factores Socioeconómicos , Heridas y Traumatismos/epidemiología
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