Hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers.

BACKGROUND: Unintentional poisoning deaths have been increasing dramatically over the past decade, and the majority of this increase has resulted from overdoses of specific prescription drugs. Despite this trend, there are limited existing data examining hospitalizations for poisonings, both unintentional and intentional, associated with prescription drugs. A better understanding of these hospitalizations may help identify high-risk populations in need of intervention to prevent subsequent mortality. PURPOSE: This article aims to describe the incidence and characteristics of hospitalizations resulting from poisoning by prescription opioids, sedatives, and tranquilizers in the U.S. from 1999 to 2006 and make comparisons to hospitalizations for all other poisonings during this time period. METHODS: Hospitalizations for poisonings were selected from the Nationwide Inpatient Sample (NIS), a stratified, representative sample of approximately 8 million hospitalizations each year, according to the principal discharge diagnosis. Intentionality of the poisoning was determined by external cause of injury codes. SAS callable SUDAAN software was used to calculate weighted estimates of poisoning hospitalizations by type and intentionality. Demographic and clinical characteristics of poisoning cohorts were compared. Data were analyzed in 2009. RESULTS: From 1999 to 2006, U.S. hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers increased a total of 65%. This increase was double the increase observed in hospitalizations for poisoning by other drugs and substances. The largest increase in the number of hospitalized cases over the 7-year period was seen for poisonings by benzodiazepines, whereas the largest percentage increase was observed for methadone (400%). In comparison to patients hospitalized for poisoning from other substances, those hospitalized for prescription opioids, sedatives, and tranquilizers were more likely to be women, aged >34 years, and to present to a rural or urban nonteaching hospital. CONCLUSIONS: Prescription opioids, sedatives, and tranquilizers are an increasing cause of hospitalization. The hospital admission provides an opportunity to better understand the contextual factors contributing to these cases, which may aid in the development of targeted prevention strategies.

Rural-urban differences in injury hospitalizations in the U.S., 2004.

BACKGROUND: Despite prior research demonstrating higher injury-mortality rates among rural populations, few studies have examined the differences in nonfatal injury risk between rural and urban populations. The objective of this study was to compare injury-hospitalization rates between rural and urban populations using population-based national estimates derived from patient-encounter data. METHODS: A cross-sectional analysis of the 2004 Nationwide Inpatient Sample was conducted in 2007. Rural-urban classifications were determined based on residence. SUDAAN software and U.S. Census population estimates were used to calculate nationally representative injury-hospitalization rates. Injury rates between rural and urban categories were compared with rate ratios and 95% CIs. RESULTS: An estimated 1.9 million (95% CI=1,800,250-1,997,801) injury-related hospitalizations were identified. Overall, injury-hospitalization rates generally increased with increasing rurality; rates were 27% higher in large rural counties (95% CI=10%, 44%) and 35% higher in small rural counties (95% CI=16%, 55%). While hospitalization rates for assaults were highest in large urban counties, the rates for unintentional injuries from motor vehicle traffic, falls, and poisonings were higher in rural populations. Rates for self-inflicted injuries from poisonings, cuttings, and firearms were higher in rural counties. The total estimated hospital charges for injuries were more than $50 billion. On a per-capita basis, hospital charges were highest for rural populations. CONCLUSIONS: These findings highlight the substantial burden imposed by injury on the U.S. population and the significantly increased risk for those residing in rural locations. Prevention and intervention efforts in rural areas should be expanded and should focus on risk factors unique to these populations.

All-terrain vehicle-related hospitalizations in the United States, 2000-2004.

OBJECTIVES: To estimate the incidence of all-terrain vehicle (ATV)-related injury hospitalizations in the United States from 2000 through 2004, and to describe the types of injuries and associated hospital costs for the entire population. METHODS: Data for 2000 through 2004 were obtained from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample--a stratified probability sample of 1004 community hospitals from 37 states. ATV injuries were defined by ICD-9-CM external cause of injury codes within E821. Variables included age, gender, primary diagnoses, patient disposition, primary payer, and hospital charges. Data were analyzed in 2007. RESULTS: There were an estimated 58,254 ATV-related hospitalizations, increasing 90% over the 5-year period. Eighty percent were men. Thirty percent of the cases involved youth under age 18, and 8% were over age 60. Passengers accounted for 9% of the hospitalizations. Eighty-five percent were routinely discharged to home while 13% required long-term rehabilitation or home health care. Payers included private insurance (62%), Medicaid/Medicare (19%), and self-pay (12%). Rural hospitals treated 23% of the cases and urban teaching hospitals 47%. Estimated total hospital charges were about $1.1 billion (20% paid from public funds) with an average charge per patient of $19,671. Leading injuries included fractures of lower limbs (22%; mean hospital charges of $19,626), other fractures (15%; $18,873), and intracranial injuries (14%; $26,906). The overall hospital admission rate was 4.4 per 100,000 population with variation by year, gender, and age. CONCLUSIONS: Voluntary industry and government safety efforts have had little impact on the increasing incidence and cost of ATV injuries. Renewed prevention efforts to making ATV riding safer are warranted.

Realities of disaster preparedness in rural hospitals.

Disaster preparedness has always been an area of major concern for the medical community, but recent world events have prompted an increased interest. The health care system must respond to disasters of all types, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored. This study examines the experiences of rural hospital emergency departments with threat preparedness. Data were gathered through a nationwide survey to describe emergency department experience with specific incidents, as well as the frequency of occurrence of these events. Expanding surge capacity of hospitals and developing a community-wide response to natural or human-made incidents is crucial in mitigating long-term effects on the health care system. Analysis of preparedness activities will help identify common themes to better prioritize preparedness activities and maximize a hospital's response capabilities.

Realities of rural emergency medical services disaster preparedness.

INTRODUCTION: Disaster preparedness is an area of major concern for the medical community that has been reinforced by recent world events. The emergency healthcare system must respond to all types of disasters, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored. PROBLEM: This study sought to answer several questions, including: (1) What are rural emergency medical services (EMS) organizations training for, compared to what they actually have seen during the last two years?; (2) What scale and types of events do they believe they are prepared to cope with?; and (3) What do they feel are priority areas for training and preparedness? METHODS: Data were gathered through a multi-region survey of 1801 EMS organizations in the US to describe EMS response experiences during specific incidents as well as the frequency with which these events occur. Respondents were asked a number of questions about local priorities. RESULTS: A total of 768 completed surveys were returned (43%). Over the past few years, training for commonly occurring types of crises and emergencies has declined in favor of terrorism preparedness. Many rural EMS organizations reported that events with 10 or fewer victims would overload them. Low priority was placed on interacting with other non-EMS disaster response agencies, and high priority was placed on basic staff training and retention. CONCLUSION: Maintaining viable, rural, emergency response capabilities and developing a community-wide response to natural or man-made events is crucial to mitigate long-term effects of disasters on a local healthcare system. The assessment of preparedness activities accomplished in this study will help to identify common themes to better prioritize preparedness activities and maximize the response capabilities of an EMS organization.

Matched analysis of parent's and children's attitudes and practices towards motor vehicle and bicycle safety: an important information gap.

The purpose of this study was to compare parents' and children's attitudes and habits towards use of bicycle helmets and car seat belts. We hypothesized that parental perception of their children's safety practices did not reflect actual behavior and further, that parental practices, rather than their beliefs about a particular safety practice, have a greater affect on their child's risk-taking behavior. The study population consisted of children in grades four and five and their parents/guardians. Participation in the cross-sectional study was voluntary and confidential anonymous questionnaires were used. In separate and independent surveys, children and parents were questioned in parallel about their knowledge, habits and attitudes toward bicycle helmet use and car safety practices. In the study, 731 students participated with 329 matched child-parent pairs. Ninety-five percent of the children own bicycles and 88% have helmets. Seventy percent of parents report their child always wears a helmet, while only 51% of children report always wearing one (p < 0.05). One-fifth of the children never wear a helmet, whereas parents think only 4% of their children never use one (p < 0.05). Parents report their children wear seat belts 92% of the time while 30% of children report not wearing one. Thirty-eight percent of children ride bicycles with their parents and wear their helmets more often than those who do not ride with their parents (p < 0.05). Parents who always wear a seat belt are more likely to have children who sit in the back seat and wear a seat belt (p < 0.05). Parents' perceptions of their children's safety practices may not be accurate and their actions do affect their children's. Injury prevention programs that target both parents and children may have a greater impact on reducing risk-taking behaviors than working with each group in isolation.

Feasibility of screening and intervention for alcohol problems among young adults in the ED.

This study evaluates the feasibility of screening and brief intervention (SBI) for alcohol problems among young adults (18-39 years) in a rural, university ED. Research staff screened a convenience sample of patients waiting for medical treatment with the Alcohol Use Disorders Identification Test (AUDIT), used motivational interviewing techniques to counsel screen-positive patients (AUDIT >/= 6) during the ED visit, and referred patients to off-site alcohol treatment as appropriate. Patients were interviewed again at 3 months. Eighty-seven percent of age-eligible drinkers (2,067 of 2,371) consented to participate. Forty-three percent (894 of 2,067) screened positive, of which 94% were counseled. Forty percent of those counseled set a goal to decrease or stop drinking and 4% were referred for further treatment. Median times for obtaining consent, screening, and intervention were 4, 4, and 14 minutes, respectively. Project staff reported that 3% of patients screened or counseled were uncooperative. Seventy percent of 519 patients who participated in follow-up interviews agreed the ED is a good place to help patients with alcohol problems. High rates of informed consent and acceptance of counseling confirmed this protocol's acceptability to patients and indicated patients were comfortable divulging alcohol-related risk behavior. The modest times required for the process enhanced acceptability to patients as well as ED staff. The high prevalence of alcohol problems and the broad acceptance of SBI in this sample provide evidence of the ED's promise as a venue for this clinical preventive service.

Screening and brief intervention for alcohol problems among college students treated in a university hospital emergency department.

The authors evaluated a protocol to screen and provide brief interventions for alcohol problems to college students treated at a university hospital emergency department (ED). Of 2,372 drinkers they approached, 87% gave informed consent. Of those, 54% screened positive for alcohol problems (Alcohol Use Disorders Identification Test score < or = 6). One half to two thirds of the students who screened positive drank 2 to 3 times a week, drank 7 or more drinks per typical drinking day, or had experienced alcohol dependence symptoms within the past year. Ninety-six percent of screen-positive students accepted counseling during their ED visit. Three quarters of those questioned at 3-month follow-up reported that counseling had been helpful and that they had decreased their alcohol consumption. The prevalence of alcohol problems, high rates of informed consent and acceptance of counseling, and improved outcomes suggest that the ED is an appropriate venue for engaging students at high risk for alcohol problems.

Alcohol problems among young adult emergency department patients: making predictions using routine sociodemographic information.

OBJECTIVES: The study aims were to explore the process of identifying young adult Emergency Department (ED) patients at risk for alcohol problems, examine the sociodemographic predictors of patient alcohol problems, and determine differences between patients who screened positive and those who screened negative for alcohol problems. Implications for ED practice are discussed. METHOD: As part of a larger study, the Alcohol Use Disorders Identification Test was administered to consenting patients ages 18 to 29. A score of greater than 5 (out of 40) was considered a positive screen for alcohol problems. Sociodemographic information was collected from a generic Individual Information Form. RESULTS: Approximately 48% (1855 of 3890) of patients screened positive for alcohol problems. Among screen-positive patients, 91% (1689) had scores that corresponded to mild to moderate alcohol problems. Compared with screen-negative patients, screen-positive patients were almost 3 times more likely to be men (odds ratio [OR] = 2.70); 2.5 times more likely to use tobacco (OR = 2.43); 2 times more likely to be single (OR = 2.03); and 1.5 times more likely to have some college education (OR = 1.41), be an 18- to 20-year-old adult (OR = 1.61), be a college student (OR = 1.60), be unemployed (OR = 1.39), and cohabitate with friends (OR = 1.19). Screen-positive patients also were more likely to have made at least one past attempt to change their drinking behavior (OR = 3.21). CONCLUSION: Routine patient information presented an accurate risk profile for alcohol problems among patients in this study. If ED-based health care professionals routinely screened patients for alcohol problems or could predict potential alcohol problems by using routinely collected information, then intervention or referral for additional services may increase.