Which Method of Transportation Is Associated With Better Outcomes for Patients With Firearm Injuries to the Head and Neck?

BACKGROUND: In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. PURPOSE: The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). STUDY DESIGN, SETTING, SAMPLE: This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). MAIN OUTCOME VARIABLE(S): The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). COVARIATES: Patient, injury, and hospital-related covariates were collected. ANALYSES: Univariate analysis, χ2 test for categorical variables, and independent t test for continuous variables were calculated. Statistical significance was P < .05. RESULTS: Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007]. CONCLUSION AND RELEVANCE: HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.

Socioeconomic Profile is Associated with the Type of Firearm Injuries to the Head and Neck.

PURPOSE: Socioeconomic status (SES) describes social standing of an individual or a group. SES has been directly associated with violence. The purpose of this study is to measure the association between SES profiles and firearm injuries (FIs) to the head and neck. METHODS: This cross-sectional study reviewed patients at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to June 2021. The study included patients who sustained FIs to the head and neck. The primary predictor variable was Distressed Community Index as a surrogate for SES. The primary outcome variable was type of FI (assault-induced firearm injury [AFI] or self-inflicted firearm injury [SFI]). Covariates were patient characteristics, distribution, and severity of FI. Univariate and bivariate analyses were calculated. The χ2 test was used for categorical variables. Independent t test was used for continuous variables. Statistical significance was P < .05. RESULTS: Six hundred ninety-four patients met inclusion criteria. AFIs were statistically more frequent in young (AFI = 32.2; SFI = 42.2; P ≤ .001) and/or Black patients (AFI: n = 483, 86.3%; SFI: n = 40, 29.9%; P ≤ .001). Patients who sustained AFIs were statistically more likely to live in areas associated with high Distressed Community Index score (AFI: 64.8, range = 3.7 to 99.7; SFI: 54.4, range = 2.8 to 98; P ≤ .001). A statistically significant number of SFI patients presented with lower Glasgow Coma Scale score (AFI: 10.7, range = 3 to 15; SFI: 5.5, range = 3 to 15; P ≤ .001), and/or required tracheostomy (AFI: n = 56, 10%; SFI: n = 27, 20.1%; P = .005). CONCLUSIONS: Patients who lived in economically distressed areas were positively associated with AFIs to the head and neck. However, SFIs were statistically more sever. More studies on the impact of current gun prevention programs and how to be addressed to at-risk populations is needed.

Do Gender Differences Exist Among Victims of Head and Neck Injuries due to Intimate Partner Violence?

PURPOSE: The frequency of intimate partner violence (IPV) is much lower in males than females. Data regarding IPV-related injuries patterns and characteristics in males are scant. The purpose of this study was to characterize and compare patterns of IPV-related head and neck injuries between men and women. MATERIALS AND METHODS: This cross-sectional study reviewed cases of IPV at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to August 2019. The study sample was collected from electronic medical records by identifying IPV subjects using a natural language processing algorithm and then cross-referencing the trauma registry to identify patients who sustained head and neck injuries. The primary analyses of interest were to measure the association between gender and the following covariates: age, race, insurance status, setting of injury, day of injury, social history, report of physical abuse, mechanism of injury, injury location, brain injuries, soft tissue injuries, facial fractures, other associated injuries, Glasgow Coma Scale, Injury Severity Score, hospital length of stay, intensive care unit length of stay, and discharge status. Univariate and bivariate analyses were calculated. Statistical significance was P < .05. RESULTS: One hundred fifty six patients met inclusion criteria. There were 120 (76.9%) female patients with a mean age of 34.5 years (range, 16 to 67 years). There were 36 (23%) male patients with a mean age of 43.8 years (range, 18 to 77 years). Women were statistically more likely than men to have government-subsidized insurance (47 [39.2%] vs 7 [19.4%]; P = .03), positive alcohol exposure (27 [22.5%] vs 19 [52.8%]; P = .0001), positive illicit drugs toxicology screen (25 [20.8%] vs 13 [36.1%]; P < .02), report physical abuse (24 [20%] vs 0; P = .004), have subarachnoid hemorrhage (14 [11.7%] vs 0; P = .04), and/or lower extremity injuries (39 [32.5%] vs 5 [13.9%]; P = .03). CONCLUSION: Males tend not to report physical abuse; this behavior contributes to IPV under-reporting in males.

Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life?

PURPOSE: There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. METHODS: This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16 years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P < .05 significance). RESULTS: A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau = 0.390, P = .002), to not require pain medications (tau = 0.389, P = .002), to report larger maximum mouth opening (tau = 0.402, P = .0003), and to report better QOL (tau = 0.440, P = 7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P = .29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P = 3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P = .002). CONCLUSION: ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.

How Accurate Are Surgeons at Calculating Orbital Volumes?

PURPOSE: Bilateral orbital volume (OV) symmetry is imperative for successful orbital reconstruction to prevent complications such as enophthalmos, diplopia, and orbital dystopia. The purpose of this study was to determine the accuracy of surgeon-led in-house OV calculation for reconstructed orbits after orbital floor fracture. MATERIALS AND METHODS: This is a retrospective cross-sectional observational study of maxillofacial computed tomography scans for patients undergone orbital fracture repair by Emory Oral and Maxillofacial service at Grady Memorial Hospital (Atlanta, Georgia) from 2018 to 2020.The primary predictor variable was OV calculation approach (outsourced vs surgeon-led in-house approach). The primary outcome variable was OV. Secondary variables were age, gender, and race. Interobserver reliability was calculated with a 2-way mixed-effects model, intraclass correlation coefficients, 95% confidence intervals, and P values. Differences between OV (in-house and outsourced) were calculated using student t-test. Statistical significance was determined at P < .05. RESULTS: During the study period, 172 patients sustained orbital floor fracture. Of them, 49 patients (31 male, 18 females; 98 orbits) with the mean age of 41.3 years (range, 19 to 89 years) met inclusion criteria. Subjects with incomplete medical records and inadequate computed tomography scans were excluded from the study. The racial distribution in descending order was 87.8% African American, 8.2% Caucasian, 2% Hispanic, and 2% Asian. There was excellent inter-rater reliability for calculating uninjured OV (OV-U, P < .0001) and reconstructed OV (OV-R, P < .0001). The mean OV difference of outsourced approach was 0.8 cm3and for surgeon-led in-house approach was 0.07 cm3. There was no significant difference in OV difference between outsourced and in-house approach (P = .16). CONCLUSIONS: In conclusion, using open-source 3-dimensional imaging software is a reliable and a predictable method at calculating reconstructed OV in patients who underwent open reduction and internal fixation of orbital fractures. By having this software in our personal computers and laptops, one can easily calculate OVs in an efficient manner.

Pediatric head and neck burns increased during early COVID-19 pandemic.

OBJECTIVE: The purpose of this study was to describe patterns of burns to the head and neck in children during the early COVID-19 pandemic. STUDY DESIGN: This cross-sectional study reviewed pediatric patients in the Burn Care Quality Platform Registry. Patients were included if they were ≤17.9 years old and had sustained burns to the head and neck. Patients were separated into the following groups: March 13 to September 13, 2019 (before COVID-19 pandemic, BC) or March 13 to September 13, 2020 (during the initial 6 months of the COVID-19 pandemic, C19). The study team collected patient-related variables, details regarding burn injury, burn severity, and hospital course. Univariate and bivariate analyses were calculated. The chi-squared test was used for categorical variables. Statistical significance was P < .05. RESULTS: Fifty-five children with head and neck burn injuries were included. There was a 200% increase in burns to the head and neck region in children in April 2021 compared with previous year. Burns to head and neck in White children occurred more often during C19 (P = .03). The study revealed differences in timing of presentation (time of burn injury to emergency department admission) in different racial groups during (White children [P = .05]), and after the pandemic (African American children [P = .02]). CONCLUSIONS: There was a transient increase in burns to the head and neck region in children during the early pandemic compared with the historic cohort.

The Potential Impact of Food Insecurity in an Urban Trauma Population.

BACKGROUND: Food insecurity (FI) has been defined as a lack of consistent access to enough food for a healthy active lifestyle. As of 12.7% of the United States are suffering from FI, which has been correlated with increased hospital costs and poorer health outcomes. Currently, limited data exists examining the relationship between trauma populations and FI despite both having similar root causes. We sought to determine this and validate a screening tool for FI in this population. METHODS: A cross-sectional survey study of trauma patients was conducted at a level 1 trauma center in Atlanta, Georgia. Survey questions included the first two items of the Core Food Security Module. Zip codes were used to determine FI, defined by the USDA Food Access Research and compared to individual participant survey responses. Binary classification test metrics were calculated to validate the two items as a screening tool in this population. RESULTS: The cohort included 136 patients, of which the majority were black (60.3%) and male (60.3%). Thirty-one respondents affirmed food security (22.8%) despite over half (51.5%) living in a food insecure community. The sensitivity and specificity for this screening to predict FI were 25 and 80%, respectively. CONCLUSION: Although the specificity is high, this screening tool has a low sensitivity, accuracy, NPV, and PPV to determine food insecurity in this population. Community-level statistics suggests that food insecurity is a significant public problem amongst trauma patients. Prevention efforts should, therefore, aim to address both issues simultaneously.

Comprehensive analysis of patients with failure of mandibular hardware.

OBJECTIVE: The purpose of the study was to characterize patients who had failure of mandibular hardware (FMH). STUDY DESIGN: This retrospective cohort study consisted of patients with mandible fractures (MFs) that required surgical intervention from 2012 to 2020. Patients were included when mandibular hardware failed. Descriptive variables were collected. RESULTS: During the study period, 57 patients (47 male, average age 38.7 years) met the inclusion criteria. Incidence of FMH was 7.4%. Most patients were African American (n = 45, 78.9%) with American Society of Anesthesiologists classification II (n = 40, 70.2%). Tobacco use (n = 31, 54.4%) and/or alcohol (n = 33, 57.9%). The most common etiology was assault (n = 28, 49.1%). The most common location was the angle of the mandible. Most mandibles had fracture at 1 location (n = 31, 54.4%) and a tooth was involved in the fracture line (n = 44, 77.2%). More than half of patients were treated with transoral surgical approach (n = 35, 61.4%). The majority of patients received preoperative antibiotics (n = 51, 89.4%). Patients had varying levels of compliance with postoperative care, and most were not compliant. Infection (n = 45) was the most common presentation of FMH. CONCLUSION: High American Society of Anesthesiologists score, smoking, excessive alcohol use, parafunctional habits, and compliance with postoperative instructions may affect surgical outcome.

Do Racial Differences in Orbital Volume Influence the Reconstruction of Orbital Trauma.

PURPOSE: Successful orbital reconstruction relies on an accurate restoration of orbital volume (OV). The purpose of this study was to determine if the OV of African American (AA) subjects differs from that of Caucasian subjects. METHODS: The authors implemented a retrospective observational study of successive subjects who received a maxillofacial computed tomography (CT) scan at a level I trauma center between 2017 and 2020. The primary predictor variable was race (AA/Caucasian). The primary outcome variable was orbital volume. Two independent examiners calculated OV with an open access OsiriX MD software version 10.0.5 (Pixmeo, Switzerland). Inter-rater reliability was calculated. Differences between races, genders, and sides were tested using independent samples t test with a significance of P < .05. RESULTS: Sixty subjects (120 orbits) were included in the study. The mean age was 36.7 (SD ± 13.2) years with a range of 22 to 78 years. Gender distribution was equal with 30 male (50%) and 30 female (50%) subjects. Inter-examiner reliability was 0.973. The mean OV of AA and Caucasians was 22.38 and 23.23 cm3, respectively (P = .07). The mean OV of AA and Caucasian males was 23.92, and 24.17cm3, respectively (P = .71). The mean OV in AA and Caucasian females was 20.84 and 22.28cm3, respectively (P = .013). CONCLUSIONS: African-American female subjects appear to have a smaller OV when compared with Caucasians which may influence orbital reconstruction. Laterality does not appear to be associated with any differences in OV.

Frequency of Firearm Injuries to Head and Neck Increased During Covid-19 Pandemic.

PURPOSE: During coronavirus disease-19 (COVID-19) pandemic, hospitals faced challenges which were different than previous years. The purpose this study was to report frequency of firearm injuries (FI) to head and neck during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study reviewed patients in the Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, GA. Patients were included if they sustained FI to head and neck, were listed in TR, and were treated at GMH. Patients were stratified according to date of injury into 1) before COVID-19 pandemic, (BC19) or 2) during initial 5 months of COVID-19 pandemic, (C19). Variables were patient demographics, illegal substance use, etiology, place of injury, distressed communities index, location of injury, Glasgow Coma scale on arrival, cardiopulmonary resuscitation in Emergency Department (ED), shock on admission, disposition from ED, length of stay, days on mechanical ventilation and discharge status. Descriptive, univariate, and bivariate analysis were completed. Chi square test was used for categorical variables. Statistical significance was P < .05. RESULTS: There were 215 patients who met inclusion criteria. There were 96 patients (78 males) with a mean age of 31.5 years old during BC19. There were 119 patients (101 males) with a mean age 32.7 years old during C19. There was a 10.4% increase in FI to head and neck during COVID-19. Our data showed that alcohol use was associated with FI during C19 (P≤ .0001). FI to base of skull occurred 34.5% more often during C19 (P = .002). Cranial injuries occurred 26% more often during BC19 (P = .03). During BC19, 85.4% of the patients arrived alive to GMH, but only 16% arrived alive during C19 (P ≤ .0001). CONCLUSIONS: There were more FI to head and neck during COVID-10 pandemic than during the previous time period.

Profile Of Head And Neck Burns During COVID-19 Pandemic.

Coronavirus disease 2019 (COVID- 19) affected daily activities since December 2019. Burn injuries to head and neck can result in cosmetic and functional deformities. The purpose of this study was to characterize patients with burns to head and neck during the pandemic. This cross-sectional study reviewed patients in Burn Care Quality Platform Registry. Patients were included if they were age 18 years of age or older, and sustained burns to head and neck. Patients were stratified according to date of injury into: (1) March 13 to September 13, 2019 (i.e., before COVID-19 pandemic, BC19) or (2) March 13 to September 13, 2020. March 13, 2020 was chosen because (1) COVID-19 was announced as a national emergency on that date and (2) it was the last day of in-person schools in state of Georgia. Data collection included patient demographics, admission details, burn details, and hospital related variables were documented. During the study period, 157 patients had burn to head and neck (BC-19; 70, C-19; 71). Our data showed a 375% increase in March following the announcement of the pandemic (BC19; 4, C19;19). Admissions from another facility were statistically more than in C19 group (p=<0.0001). For C19 group, there were 53% more admissions from ED than BC19 (p=0.001). Additionally, in BC19 group patients presented with concomitant inhalation injuries significantly more than C19 group (p=0.04). In conclusion, the total number of burns is the same during BC and C19, however there was a significant spike in number of cases in March 2020.