Understanding the burden of traumatic injuries at the United States-Mexico border: A scoping review of the literature.

ABSTRACT: The US-Mexico border is the busiest land crossing in the world and faces continuously increasing numbers of undocumented border crossers. Significant barriers to crossing are present in many regions of the border, including walls, bridges, rivers, canals, and the desert, each with unique features that can cause traumatic injury. The number of patients injured attempting to cross the border is also increasing, but significant knowledge gaps regarding these injuries and their impacts remain. The purpose of this scoping literature review is to describe the current state of trauma related to the US-Mexico border to draw attention to the problem, identify knowledge gaps in the existing literature, and introduce the creation of a consortium made up of representatives from border trauma centers in the Southwestern United States, the Border Region Doing Research on Trauma Consortium. Consortium members will collaborate to produce multicenter up-to-date data on the medical impact of the US-Mexico border, helping to elucidate the true magnitude of the problem and shed light on the impact cross-border trauma has on migrants, their families, and the US health care system. Only once the problem is fully described can meaningful solutions be provided.

Penetrating trauma in children on the United States-Mexico border: Hispanic ethnicity is not a risk factor.

INTRODUCTION: The United States-Mexico border is perceived as dangerous by the media and current political leaders. Hispanic ethnicity, low socioeconomic status, male gender and adolescent age have previously been identified as risk factors for penetrating trauma (PT). METHODS: A retrospective review of PT was performed in a border region. Children 0-17 years old, admitted to the region's only level I trauma center between 2001 and 2016 were included. Standardized morbidity ratio was used to compare observed to expected morbidity. RESULTS: There were 417 PT admissions. 197 (47%) were non-accidental, 34 (8%) suicide attempts and 186 (45%) accidental. There were 12 homicides, 7 suicides and no accidental deaths. The region contains over 280,000 children, thus yielding a homicide rate of 0.26 per 100,000. The U.S. pediatric homicide rate was 2.6-4.0 over this period. Adolescents 13-17 years old accounted for 237 (57%) admissions, 152 (78%) of non-accidental admissions and 12 (63%) deaths. Most admissions (N = 321, 77%) and 15 of the deaths (79%) were males. Non-accidental injuries were more frequent in ZIP codes associated with low incomes. Hispanic patients accounted for 173 (88%) of non-accidental trauma. However, 40 (20%) non-accidental injuries occurred in Mexico and 157 (80%) injuries occurred in an 82% Hispanic region. Therefore, the standardized morbidity ratio for Hispanic ethnicity was 1.048 (CL 0.8-1.2, P = 0.6). CONCLUSION: On the United States-Mexico border, the pediatric homicide rate was less than 1/10 the national average. Male adolescents are at risk for non-accidental PT. In a Hispanic majority population, Hispanic ethnicity was not a risk factor for PT. It is possible that economic disparity, rather than race/ethnicity, is a risk factor for PT.

Injuries sustained after falls from bridges across the United States-Mexico border at El Paso.

OBJECTIVE: To compare demographics and motivations for falls from bridges at the United States-Mexico border and in El Paso County, Texas, and to analyze injuries and injury patterns to support intentionality and to provide treatment recommendations. METHODS: A retrospective observational review was conducted of hospital admissions to a trauma center after falls from bridges from 1995 to 2009. Statistical methods used were chi-square testing, T-test for means comparison, univariate correlations, and regression analysis. RESULTS: Of the 97 evaluated patients, 81.4% fell from U.S.-Mexico border bridges, including one patient who fell from a railway bridge; 74.7% of those falling from border bridges had a non-U.S. address, contrasting with 22.2% of those who fell within the United States. Falls over the border were associated with more immigration-related motivations and fewer suicide attempts. Injuries included lower extremities in 76 (78.4%) and thoracolumbar spine in 27 (27.8%) patients; 16 patients with a thoracolumbar spine fracture (59.3%) also had a lower extremity injury. Mean hospital length of stay was 7.2 days. Mean injury severity score was 8.45 (range 1-43). Age, injury severity score, and pelvic fracture increased the hospital length of stay. CONCLUSIONS: Patients fell while emigrating-immigrating based on residence and motivating factors. A dyad of lower extremity and thoracolumbar spine injuries coincided in 59.3% of those with a thoracolumbar spine injury; thoracolumbar spine imaging of patients evaluated after falls from bridges is recommended. Proposed prevention strategies include posting signs on bridges and installing catch-net safety barriers.

Injuries sustained after falls from bridges across the United State - Mexico border at El Paso / Traumatismos por caídas desde puentes que atraviesan la frontera entre México y los Estados Unidos en El Paso

Objective. To compare demographics and motivations for falls from bridges at the UnitedStates–Mexico border and in El Paso County, Texas, and to analyze injuries and injury patternsto support intentionality and to provide treatment recommendations.Methods. A retrospective observational review was conducted of hospital admissions to atrauma center after falls from bridges from 1995 to 2009. Statistical methods used were chisquaretesting, T-test for means comparison, univariate correlations, and regression analysis.Results. Of the 97 evaluated patients, 81.4% fell from U.S.–Mexico border bridges, includingone patient who fell from a railway bridge; 74.7% of those falling from border bridges hada non–U.S. address, contrasting with 22.2% of those who fell within the United States. Fallsover the border were associated with more immigration-related motivations and fewer suicideattempts. Injuries included lower extremities in 76 (78.4%) and thoracolumbar spine in 27(27.8%) patients; 16 patients with a thoracolumbar spine fracture (59.3%) also had a lowerextremity injury. Mean hospital length of stay was 7.2 days. Mean injury severity score was8.45 (range 1–43). Age, injury severity score, and pelvic fracture increased the hospital lengthof stay.Conclusions. Patients fell while emigrating–immigrating based on residence and motivatingfactors. A dyad of lower extremity and thoracolumbar spine injuries coincided in 59.3% ofthose with a thoracolumbar spine injury; thoracolumbar spine imaging of patients evaluatedafter falls from bridges is recommended. Proposed prevention strategies include posting signson bridges and installing catch-net safety barriers.

Objetivo. Comparar la información demográfica y las motivaciones relacionadascon las caídas desde puentes que atraviesan la frontera entre México y los EstadosUnidos en el condado de El Paso, Texas; analizar las lesiones y los patrones de lesionesque avalan la intencionalidad; y proporcionar recomendaciones terapéuticas.Métodos. Se llevó a cabo un examen retrospectivo observacional de las internacionesen un centro traumatológico debidas a caídas desde puentes que tuvieron lugarentre 1995 y el 2009. Los métodos estadísticos usados fueron la prueba de ji al cuadrado,la prueba T de comparación de medias, correlaciones de una sola variable y elanálisis de regresión.Resultados. De los 97 pacientes evaluados, 81,4% cayeron desde puentes ubicadosen la frontera México–Estados Unidos, incluido un paciente que cayó desde unpuente ferroviario; 74,7% de las personas que cayeron desde puentes fronterizostenían un domicilio no residente, en comparación con 22,2% en las personas que cayerondesde puentes ubicados en el interior de los Estados Unidos. Las caídas desdelos puentes fronterizos estaban asociadas con más motivaciones relacionadas con lainmigración y con menos intentos de suicidio. Las lesiones afectaban las extremidadesinferiores en 76 pacientes (78,4%) y la columna vertebral toracolumbar en 27 (27,8%);16 pacientes con fractura de la columna toracolumbar (59,3%) también presentabanlesión de las extremidades inferiores. La duración media de la hospitalización fue 7,2días. La puntuación media de gravedad de la lesión fue 8,45 (rango 1 a 43). Una mayoredad, una puntuación alta en la escala de gravedad de la lesión y la fractura pelvianaaumentaron la duración de la hospitalización.Conclusiones. Los pacientes cayeron durante un intento de emigración o inmigraciónrelacionado con la residencia y otros factores motivadores. En 59,3% de lospacientes con lesión de la columna vertebral toracolumbar esta coexistía con lesiónde las extremidades inferiores; al evaluar a pacientes con lesiones por caídas desdepuentes se recomienda efectuar estudios de imágenes de la columna vertebral toracolumbar.Las estrategias de prevención propuestas comprenden la colocación deseñales en los puentes y la instalación de redes de seguridad.

Study of methicillin-resistant Staphylococcus aureus on the U.S./Mexico border.

BACKGROUND: El Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S./Mexico border population. METHODS: Bacterial samples were collected from two hospitals in El Paso and two in Ciudad Juarez and transported to a reference microbiology laboratory in El Paso for microbial identification and antimicrobial susceptibility testing according to NCCLS standards. The presence of the MecA gene, and the prevalence of both the SSCmec IV element and the Panton-Valentine leukocidin were investigated by PCR in all MRSA isolates. RESULTS: A total of 201 isolates in El Paso and 128 in Ciudad Juarez of Staphylococcus aureus were identified, of those, MRSA were significantly more prevalent in El Paso than in Ciudad Juarez [89 (44.3%) versus 10 (7.8%) respectively (p<0.0001)]. Thirty one (35%) of MRSA strains isolated in El Paso were community associated. CONCLUSION: Significantly higher prevalence of MRSA infections was documented in El Paso compared to Ciudad Juarez.