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1.
J Surg Res ; 257: 370-378, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892133

RESUMO

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).


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Modelos Estatísticos , Readmissão do Paciente/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estados Unidos/epidemiologia
2.
J Surg Res ; 257: 92-100, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818790

RESUMO

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.


Assuntos
Transtornos Relacionados ao Uso de Álcool/sangue , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Concentração Alcoólica no Sangue , Transferrina/análogos & derivados , Ferimentos e Lesões/sangue , Acidentes de Trânsito , Adolescente , Adulto , Alcoolismo/sangue , Alcoolismo/epidemiologia , Bebedeira/sangue , Bebedeira/epidemiologia , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transferrina/análise , Resultado do Tratamento , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia , Ferimentos por Arma de Fogo/sangue , Adulto Jovem
3.
Scand J Trauma Resusc Emerg Med ; 28(1): 114, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33276799

RESUMO

BACKGROUND: COVID-19 outbreak lead to nationwide lockdown in Finland on the March 16th, 2020. Previous data regarding to the patient load in the emergency departments during pandemics is scarce. Our aim is to describe the effect of national lockdown and social distancing on the number and reasons for emergency department (ED) visits and inpatient admissions in three large volume hospitals prior to and after the outbreak of the COVID-19 epidemic in Finland. METHODS: Data for this register-based retrospective cohort study were collected from three large ED's in Finland, covering 1/6 of the Finnish population. All patients visiting ED's six weeks before and six weeks after the lockdown were included. Pediatric and gynecological patients were excluded. Numbers and reasons for ED visits and inpatient admissions were collected. Corresponding time period in 2019 was used as reference. RESULTS: A total of 40,653 ED visits and 12,226 inpatient admissions were analyzed. The total number of ED visits decreased 16% after the lockdown, whereas the number of inpatient admissions decreased 15% (p < 0.001). This change in inpatient admissions was similar in all participating hospitals. Visits due to back or limb pain decreased 31% and infectious diseases 28%. The visit rate and inpatient admissions due to acute myocardial infarction and strokes remained stable throughout the study period. Interestingly, the rate of inpatient admissions due to psychiatric diagnoses remained unchanged, although the ED visit rate decreased by 19%. The number of ED visits (n = 282) and inpatient admissions (n = 55) due to COVID-19 remained low in the participating hospitals. CONCLUSIONS: Changes in ED visits and inpatient admissions prior to and during the early phase of the COVID-19 outbreak were unpredictable, and our results may help hospitals and especially ED's focus their resources better. Surprisingly, there was a major decrease in the rate of ED visits due to back or limb pain and not so surprisingly in infectious diseases. Rates of acute myocardial infarctions and cerebral strokes remained stable. In summary, stabile resources for the treatment of patients with severe diseases will be needed in hospitals and ED's.


Assuntos
/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Quarentena/legislação & jurisprudência , Dor nas Costas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Finlândia/epidemiologia , Humanos , Transtornos Mentais/epidemiologia , Infarto do Miocárdio/epidemiologia , Pandemias , Admissão do Paciente/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Ferimentos e Lesões/epidemiologia
4.
BMC Psychol ; 8(1): 129, 2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33298173

RESUMO

BACKGROUND: Evidence of the relationship between serious physical injury and poor mental health among university students from low- and middle-income countries is limited. The aim of the study is to assess the association between serious physical injury and posttraumatic stress disorder (PTSD) and depressive symptoms in university students from low- and middle-income countries. METHODS: In a cross-sectional survey, 18,382 university students from 26 countries responded to a short screening scale for DSM-IV PTSD, Center for Epidemiologic Studies Depression Scale as well as questions on injury and sociodemographics. RESULTS: The overall prevalence of past 12-month serious physical injury was 24.7%. In adjusted logistic regression analysis, compared to having no past 12-month serious physical injury, having a past 12-month serious injury was associated with 1.35 (95% CI 1.18, 1.56) times higher odds for PTSD symptoms and 1.49 (95% CI 1.32, 1.67) times higher odds for depressive symptoms in university students. CONCLUSION: Compared to students who had not sustained a serious physical injury in the past 12 months, students with an injury had significantly higher PTSD and depressive symptoms. Mental health support of students who sustained physical injuries may prevent PTSD and depressive symptoms.


Assuntos
Depressão/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estudantes/estatística & dados numéricos , Universidades , Ferimentos e Lesões/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Estudantes/psicologia , Adulto Jovem
5.
BMC Emerg Med ; 20(1): 97, 2020 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308165

RESUMO

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.


Assuntos
/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Algoritmos , Finlândia/epidemiologia , Humanos , Transtornos Mentais/epidemiologia , New York , Pandemias , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Fatores de Tempo , Universidades , Ferimentos e Lesões/epidemiologia
6.
S Afr Med J ; 0(0): 13183, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33334392

RESUMO

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.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Controle de Doenças Transmissíveis , Violência/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , /prevenção & controle , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Feminino , Humanos , Masculino , África do Sul/epidemiologia , Centros de Traumatologia/estatística & dados numéricos
7.
PLoS One ; 15(11): e0241276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33166300

RESUMO

BACKGROUND AND PURPOSE: Pressure injuries remain a significant health care issue in various settings. The purpose of this study was to examine the relationship between a pressure redistributing foam mattress (PRFM) and the development of pressure injuries. METHODS: This study employed an observational prospective cohort study design. We enrolled 254 participants from the intensive care unit who were at risk of developing pressure injuries. Participants were exposed to either a nonpressure redistributing foam mattress (NPRFM), which was the standard mattress used at the study site, or a PRFM made of viscoelastic, temperature-sensitive, polyurethane memory foam. The patients' assignment to either a PRFM or NPRFM was performed upon their admission, before the study eligibility screening. The relationship between the PRFM and the development of pressure injuries was studied using a logistic regression model. RESULTS: The overall incidence of pressure injuries was 5.9% (15/254) in our study, with 1.6% (2/127) for participants who used a PRFM and 10.2% (13/127) for those using a NPRFM. After adjusting for potential confounding variables, use of a PRFM was associated with an 88% reduced risk of pressure injury development (OR = 0.12, 95% CI: 0.03, 0.56, P = 0.007). The use of a PRFM also contributed to a postponed occurrence of pressure injuries by 4.2 days on average in comparison with that of a NPRFM (P = 0.041). CONCLUSIONS: A PRFM is associated with a significantly reduced incidence and postponed occurrence of pressure injuries. It is recommended to use a PRFM for patients at risk of developing pressure injuries.


Assuntos
Leitos , Pressão , Ferimentos e Lesões/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos
8.
Am J Emerg Med ; 38(10): 2049-2054, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33142173

RESUMO

OBJECTIVE: It remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury. METHODS: We conducted a multicenter retrospective comparative analysis of adult patients who were transported from the beach in Ocean City, Maryland, to three nearby emergency departments for possible spinal injury from 2006 through 2017. Patients suspected to have any spinal injury from beach activities were eligible. We excluded patients who could not verbalize their symptoms or with insufficient emergency department records. We compared components of each patient's HPI and PE with radiologic evidence of spinal injury. We calculated sensitivity, specificity, and negative and positive likelihood ratios (LRs). RESULTS: We analyzed 278 patients with suspected spinal injury. Midline spinal tenderness was associated with increased likelihood of thoracic (LR+ 2.6) and lumbar spinal fractures (LR+ 3.5). HPI complaints of paralysis (LR+ 13.9) and sensory loss (LR+ 5.8) had strong associations with spinal cord injuries. Weakness found through PE was also associated with spinal cord injury (LR+ 5.3). CONCLUSIONS: We identified several components of the clinical evaluation that had clinically significant association with spinal injuries from beach-related trauma. While prospective studies are needed to confirm our observations, clinicians may consider these high-risk features in patients with beach-related trauma and adjust testing and level of care appropriately.


Assuntos
Diagnóstico por Imagem/estatística & dados numéricos , Anamnese/métodos , Oceanos e Mares , Exame Físico/métodos , Ferimentos e Lesões/complicações , Adulto , Idoso , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Diagnóstico por Imagem/métodos , Feminino , Humanos , Masculino , Maryland/epidemiologia , Anamnese/estatística & dados numéricos , Pessoa de Meia-Idade , Exame Físico/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia , Estatísticas não Paramétricas , Ferimentos e Lesões/epidemiologia
9.
Isr Med Assoc J ; 11(22): 673-679, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33249785

RESUMO

BACKGROUND: As part of the effort to control the coronavirus disease-19 (COVID-19) outbreak, strict emergency measures, including prolonged national curfews, have been imposed. Even in countries where healthcare systems still functioned, patients avoided visiting emergency departments (EDs) because of fears of exposure to COVID-19. OBJECTIVES: To describe the effects of the COVID-19 outbreak on admissions of surgical patients from the ED and characteristics of urgent operations performed. METHODS: A prospective registry study comparing all patients admitted for acute surgical and trauma care between 15 March and 14 April 2020 (COVID-19) with patients admitted in the parallel time a year previously (control) was conducted. RESULTS: The combined cohort included 606 patients. There were 25% fewer admissions during the COVID-19 period (P < 0.0001). The COVID-19 cohort had a longer time interval from onset of symptoms (P < 0.001) and presented in a worse clinical condition as expressed by accelerated heart rate (P = 0.023), leukocyte count disturbances (P = 0.005), higher creatinine, and CRP levels (P < 0.001) compared with the control cohort. More COVID-19 patients required urgent surgery (P = 0.03) and length of ED stay was longer (P = 0.003). CONCLUSIONS: During the COVID-19 epidemic, fewer patients presented to the ED requiring acute surgical care. Those who did, often did so in a delayed fashion and in worse clinical condition. More patients required urgent surgical interventions compared to the control period. Governments and healthcare systems should emphasize to the public not to delay seeking medical attention, even in times of crises.


Assuntos
Doença Aguda , Serviço Hospitalar de Emergência , Tratamento de Emergência , Controle de Infecções , Procedimentos Cirúrgicos Operatórios , Ferimentos e Lesões/cirurgia , Doença Aguda/epidemiologia , Doença Aguda/terapia , /prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Inovação Organizacional , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Tempo para o Tratamento/tendências , Ferimentos e Lesões/epidemiologia
10.
Injury ; 51(12): 2834-2839, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33162012

RESUMO

INTRODUCTION: By May 2020, Peru was the country with the third most COVID-19 cases in the Americas. The current study's overall aim was to examine the impact of the current COVID-19 outbreak on the number of non-COVID-related patient presentations to a major national emergency traumatology/orthopedics referral center in Latin America. METHODS: An observational study was performed at one of Peru's main tertiary trauma referral centers, during the current COVID-19 pandemic. Numbers of non-follow-up patients presenting to the traumatology/ orthopedics service were counted and compared between January through April 2019 and January through April 2020; and between the month immediately prior to the Peruvian government's implementation of national lock-down measures (Feb 16-Mar 15; Period 1) and the month immediately following (Mar 16-Apr 15; Period 2). The number of surgery service hospitalizations also was compared pre- versus post lockdown initiation (Period 1 vs. 2), as were patient characteristics and outcomes, like age, sex, discharge disposition, mortality, indications for hospital admission, and COVID-19 status. RESULT: Comparing 2019 and 2020, no appreciable differences were detected in the number of patients seen in either January or February. However, relative to March and April 2019, the numbers of patients seen in March and April 2020 (the two months after the first Peruvian case of COVID-19 was detected) were reduced by 55.8 and 88.6%, respectively. Comparing the months immediately pre and post lockdown, the number of service patients declined by 79.9% in April, while the number of hospitalizations declined by 30.9%. The number of admissions for various surgical indications either remained stable or declined in parallel with the overall decline in admissions for all indications except for osteoporotic hip fractures and diabetic foot ulcers (both of which increased proportional to the overall number of admissions) and for hand and foot fractures, both of which decreased. CONCLUSION: At our hospital, not all indications for traumatology/orthopedics service utilization declined despite the national government's directive to reduce non-COVID-related consultations and admissions. Some disorders presented with even greater frequency, which must be considered when developing contingencies for the reallocation of healthcare resources during a pandemic.


Assuntos
/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Idoso , Idoso de 80 Anos ou mais , /prevenção & controle , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Peru/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
11.
Am Surg ; 86(10): 1230-1237, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33167696

RESUMO

BACKGROUND: Intimate partner violence (IPV) refers to physical or sexual violence, stalking, and psychological aggression by an intimate partner. The present study aims to examine the incidence, injury patterns, and outcomes using a representative nationwide data set. STUDY DESIGN: The Nationwide Emergency Department Sample database was queried from 2010 to 2014 to identify IPV in adult patients by injury code E967.3. Demographics, diagnoses, and injury mechanisms were captured. Primary outcome was mortality, and logistic regression analyses were used to compare the baselines and outcomes. RESULTS: 132 806 IPV emergency visits were identified, with 5.1% of patients requiring hospitalization. Most patients were female (92.6%). The most common injury mechanisms were unintentional injury (36%) and striking (22.0%). Contusions of face/scalp/neck (13.2%) and unspecified head injury (6.9%) were the most common diagnoses. Males were significantly older [median and interquartile range of 39 (30, 50)] than females [33 (26, 43)], and were more frequently hospitalized (6.7% vs. 5.0%, P = .002) with more injuries with injury severity score ≥ 15 (.7% vs. .4%, P = .004) than females. Overall, IPV-related mortality was .06%, .26% in males and .05% in females (P = .003). Older age (odds ratio (OR) = 1.053) and male gender (OR = 3.102) were significantly associated with mortality. The annual incidence rate decreased from 9.7 in 2010 to 8.2/100 000 US population in 2014 (R2 = .659). CONCLUSIONS: Young women are more likely to be victims of IPV, whereas men are more likely to be older and hospitalized with more severe injuries and worse outcomes.


Assuntos
Violência por Parceiro Íntimo/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estados Unidos
12.
BMC Geriatr ; 20(1): 417, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087050

RESUMO

BACKGROUND: With the ageing population, the number of older trauma patients has increased. The aim of this study was to assess non-surgical health care costs of older trauma patients and to identify which characteristics of older trauma patients were associated with high health care costs. METHODS: Trauma patients aged ≥65 years who were admitted to a hospital in Noord-Brabant, the Netherlands, were included in the Brabant Injury Outcome Surveillance (BIOS) study. Non-surgical in-hospital and up to 24- months post-hospital health care use were obtained from hospital registration data and collected with the iMTA Medical Consumption Questionnaire which patients completed 1 week and 1, 3, 6, 12 and 24 months after injury. Log-linked gamma generalized linear models were used to identify cost-driving factors. RESULTS: A total of 1910 patients were included in the study. Mean total health care costs per patient were €12,190 ranging from €8390 for 65-69 year-olds to €15,550 for those older than 90 years. Main cost drivers were the post-hospital costs due to home care and stay at an institution. Falls (72%) and traffic injury (15%) contributed most to the total health care costs, although costs of cause of trauma varied with age and sex. In-hospital costs were especially high in patients with high injury severity, frailty and comorbidities. Age, female sex, injury severity, frailty, having comorbidities and having a hip fracture were independently associated with higher post-hospital health care costs. CONCLUSIONS: In-hospital health care costs were chiefly associated with high injury severity. Several patient and injury characteristics including age, high injury severity, frailty and comorbidity were associated with post-hospital health care costs. Both fall-related injuries and traffic-related injuries are important areas for prevention of injury in the older population.


Assuntos
Custos de Cuidados de Saúde , Ferimentos e Lesões , Feminino , Custos Hospitalares , Humanos , Tempo de Internação , Países Baixos/epidemiologia , Estudos Prospectivos , Inquéritos e Questionários , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
13.
J Hosp Infect ; 106(4): 673-677, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33011308

RESUMO

We assessed infection control efforts by comparing data collected over 20 weeks during a pandemic under a dual-track healthcare system. A decline in non-COVID-19 patients visiting the emergency department by 37.6% (P<0.01) was observed since admitting COVID-19 cases. However, patients with acute myocardial infarction (AMI), stroke, severe trauma and acute appendicitis presenting for emergency care did not decrease. Door-to-balloon time (34.3 (± 11.3) min vs 22.7 (± 8.3) min) for AMI improved significantly (P<0.01) while door-to-needle time (55.7 (± 23.9) min vs 54.0 (± 18.0) min) in stroke management remained steady (P=0.80). Simultaneously, time-sensitive care involving other clinical services, including patients requiring chemotherapy, radiation therapy and haemodialysis did not change.


Assuntos
/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Doença Aguda , Apendicite/epidemiologia , Apendicite/terapia , /transmissão , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Controle de Infecções/organização & administração , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Pandemias/prevenção & controle , Seul/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento/tendências , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
14.
Lancet ; 396(10258): 1135-1159, 2020 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-33069324

RESUMO

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.


Assuntos
Assistência à Saúde/economia , Carga Global da Doença/economia , Saúde Global/tendências , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Coeficiente de Natalidade , Assistência à Saúde/estatística & dados numéricos , Feminino , Carga Global da Doença/tendências , Humanos , Masculino , Doenças não Transmissíveis/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/tendências , Fatores de Risco , Fatores Socioeconômicos , Ferimentos e Lesões/epidemiologia
15.
Medicina (Kaunas) ; 56(10)2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33019514

RESUMO

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.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência/tendências , Oftalmopatias/epidemiologia , Feminino , Gastroenteropatias/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Otorrinolaringopatias/epidemiologia , Admissão do Paciente/tendências , Estudos Retrospectivos , Doenças Torácicas/epidemiologia , Doenças Urológicas/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
16.
Neurology ; 95(19): e2605-e2609, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33004606

RESUMO

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.


Assuntos
Ansiedade/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Depressão/epidemiologia , Cefaleia/epidemiologia , Refugiados/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Violência/estatística & dados numéricos , Adolescente , Adulto , Ansiedade/psicologia , Concussão Encefálica/epidemiologia , Concussão Encefálica/psicologia , Traumatismos Craniocerebrais/psicologia , Estudos Transversais , Depressão/psicologia , El Salvador/etnologia , Feminino , Guatemala/etnologia , Haiti/etnologia , Cefaleia/psicologia , Honduras/etnologia , Humanos , Masculino , Transtornos da Memória/epidemiologia , Transtornos da Memória/psicologia , México/etnologia , Nicarágua/etnologia , Razão de Chances , Questionário de Saúde do Paciente , Prevalência , Trauma Psicológico/epidemiologia , Trauma Psicológico/psicologia , Refugiados/psicologia , Estudos Retrospectivos , Distribuição por Sexo , Delitos Sexuais/psicologia , Delitos Sexuais/estatística & dados numéricos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inconsciência/epidemiologia , Inconsciência/psicologia , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/psicologia , Adulto Jovem
17.
Online braz. j. nurs. (Online) ; 19(3)set. 2020. tab
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1129159

RESUMO

OBJETIVO: identificar a prevalência e os fatores associados à lesão por fricção em idosos internados em uma unidade de terapia intensiva. MÉTODO: estudo transversal, com amostra de 133 idosos internados em um hospital de ensino, entre julho de 2017 a julho de 2018. A coleta de dados contemplou consulta ao prontuário para levantamento sociodemográfico e clínico, exame físico de pele para avaliação de Skin tears. Os dados foram analisados pelo software Stata® versão12. RESULTADO: constatou-se prevalência de lesão por fricção em 10,5% dos idosos, com associação significativa ao índice de massa corpórea (p=0,003). CONCLUSÃO: Acredita-se que os resultados do presente estudo possam contribuir para sensibilizar o enfermeiro e sua equipe, quanto à realização de ações efetivas de prevenção e de cuidado às lesões por fricção, com o objetivo de melhorar a qualidade de assistência prestada aos idosos.


OBJETIVO: identificar la prevalencia y los factores asociados con la lesión por fricción en pacientes de edad avanzada internados en una unidad de cuidados intensivos. MÉTODO: estudio transversal, con una muestra de 133 personas mayores internadas en un hospital universitario, entre julio de 2017 y julio de 2018. La recopilación de datos incluyó la consulta de registros médicos para encuestas sociodemográficas y clínicas, un examen físico de la piel para evaluar Skin tears. Los datos se analizaron utilizando el software Stata® versión 12. RESULTADO: Se encontró una prevalencia de lesión por fricción en el 10,5% de los ancianos, con una asociación significativa con el índice de masa corporal (p = 0,003). CONCLUSIÓN: Se cree que los resultados del presente estudio pueden colaborar hacia sensibilizar al enfermero y su equipo, con respecto a la realización de acciones efectivas de prevención y atención para lesiones por fricción, con el objetivo de mejorar la calidad de la atención brindada a los ancianos.


OBJECTIVE: to identify the prevalence and factors associated with friction injury in elderly patients admitted to an intensive care unit. METHOD: cross-sectional study, with a sample of 133 elderly people admitted to a teaching hospital, between July 2017 and July 2018. Data collection included consulting medical records for sociodemographic and clinical surveys, physical examination of the skin to assess Skin tears. The data were analyzed using the Stata® version 12 software. RESULT: a prevalence of friction injuries was found in 10.5% of the elderly, with a significant association with the body mass index (p = 0.003). CONCLUSION: It is believed that the results of the present study may contribute to sensitize the nurse and his team, regarding the realization of effective prevention and care actions for friction injuries, with the aim of improving the quality of care provided to the elderly.


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Pele/patologia , Ferimentos e Lesões/epidemiologia , Saúde do Idoso , Pacientes Internados , Unidades de Terapia Intensiva , Comportamentos Relacionados com a Saúde , Envelhecimento da Pele , Demografia , Estudos Transversais , Hospitais Universitários , Estilo de Vida
18.
Pan Afr Med J ; 36: 152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874416

RESUMO

Introduction: fall injuries constitute a major public health concern worldwide, contributing to over 646,000 deaths every year. The aim of this study was to determine the nature and severity of fall injuries at a tertiary hospital in the Kingdom of Saudi Arabia (KSA). Methods: we conducted a cross-sectional study at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al Kharj. We recruited the patients and followed them through the triage, admission and discharge processes. We analyzed the participant´s clinical notes on the electronic health record (EHR) to obtain information relevant to the study, including the nature, cause, mechanism of injury, demographic characteristics and prognostic factors captured through the injury severity score (ISS), the Glasgow coma scale (GCS) and the presence or absence of shock. Results: of 264 patients, most of the patients were children under the age of ten (25.7%), followed by young adults between the ages of twenty-one and thirty (18.2%). The ISS was associated with severe head, chest, skull, brain, scalp, rib, abdominal, pelvic and lower limb injuries. The GCS was associated with severe the head, chest, skull, brain and rib injuries (p<0.005). The degree of shock was also significantly associated with pelvic, head, chest, skull, brain, scalp, abdominal and upper limb injuries (p<0.05). Conclusion: fall injuries in our setting are severe. Training of staff should prioritize head, chest, skull, brain, abdominal and rib injury management. As a reference hospital, minor injuries are more likely to be managed at lower levels of care.


Assuntos
Acidentes por Quedas , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Arábia Saudita/epidemiologia , Choque/epidemiologia , Choque/etiologia , Centros de Atenção Terciária , Índices de Gravidade do Trauma , Ferimentos e Lesões/patologia , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-32942714

RESUMO

There is a worrisome increase in the reporting of medically attended injuries in Slovak adolescents. The aim of this study is to examine the relationships between socio-economic factors, physical fighting, and physical activity with frequency of medically attended injuries among this population group. Data from 8902 adolescents participating in the Health Behavior in School-Aged Children study were used (mean age 13.37; 50.9% boys). The effects of family affluence, registered unemployment rate, average nominal monthly earnings of employees, physical fighting, and physical activity on frequency of medically attended injury were explored using linear regression analysis. Pearson's correlation was used to describe the associations between all selected variables. The selected model of linear regression explained 15.8% of the variance in the frequency of medically attended injuries. All variables except the registered unemployment rate showed linear positive relationships with medically attended injuries. The correlation analysis confirmed linear positive associations between medically attended injuries and physical fighting, family affluence, physical activity, and average nominal monthly earnings of employees. Further research on these variables is needed in the Slovak context. This may include analyses of the nature of the relationships between socio-economic factors and medically attended injuries, as well as systematic evaluation of applied physical fighting and physical-activity-related injury interventions to support evidence-based policy making.


Assuntos
Comportamento do Adolescente , Agressão , Ferimentos e Lesões , Adolescente , Exercício Físico , Feminino , Humanos , Masculino , Fatores de Risco , Instituições Acadêmicas , Eslováquia , Fatores Socioeconômicos , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
20.
Health Promot Chronic Dis Prev Can ; 40(11-12): 336-341, 2020 12 09.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-32924925

RESUMO

INTRODUCTION: Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic. METHODS: Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity. RESULTS: The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years. CONCLUSION: As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term.


Assuntos
/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Traumatismos em Atletas/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Fatores de Proteção , Quebeque/epidemiologia , Ferimentos e Lesões/etiologia
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