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BACKGROUND: COVID-19 challenged U.S. trauma centers to grapple with demands for expanded services with finite resources while also experiencing a concurrent increase in violent injuries. OBJECTIVE: The purpose of this study was to describe the impact of COVID-19 on the roles and duties of U.S. hospital-based injury prevention professionals. METHODS: This descriptive cross-sectional survey study of hospital-based injury prevention professionals was conducted between June 2021 and August 2021. Participants were recruited from six organizational members of the national Trauma Prevention Coalition, including the American Trauma Society, Emergency Nurses Association, Injury Free Coalition for Kids, Safe States Alliance, Society for Trauma Nurses, and Trauma Center Association of America. Results were analyzed using descriptive and inferential statistics. RESULTS: A total of 216 participants affiliated with 227 trauma centers responded. The following changes were reported during 2020: change in injury prevention position (range = 31%-88%); change in duties (range = 92%-100%); and change to hospital-based injury prevention programs (range = 75%-100%). Sixty-one (43%) single-center participants with a registered nurse license were reassigned to clinical duties compared with six (10%) nonlicensed participants (OR = 5.6; 95% CI [1.96, 13.57]; p < .001). Injury prevention programs at adult-only and combined adult and pediatric trauma centers had higher odds of suspension than pediatric-only trauma centers (OR = 3.6; 95% CI [1.26, 10.65]; p < .017). CONCLUSION: The COVID-19 response exposed the persistent inequity and limited prioritization of injury prevention programming as a key deliverable for trauma centers.
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COVID-19 , Ferimentos e Lesões , Adulto , Criança , Humanos , Estados Unidos/epidemiologia , Estudos Transversais , Centros de Traumatologia , Inquéritos e Questionários , Hospitais , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
Improper child passenger restraint use contributes to higher pediatric motor vehicle collision morbidity and mortality among cultural minority populations. Child passenger safety education improves caregiver knowledge of restraint use, but effective interventions require culturally specific programming. The purpose of this study was to evaluate the effectiveness of a child passenger safety education program culturally adapted through a pediatric trauma center's community partnerships. A nonexperimental observational cohort study using program evaluation data for the child passenger safety education programs during a 24-month period. Paired pretest/posttest self-reported survey responses measured changes in caregiver knowledge and self-efficacy of restraint use. Data were analyzed by class location and by caregiver language using a paired t test and Wilcoxon's signed ranks test. A total of 1,795 paired survey responses were collected in English, Spanish, or Russian. An increase in mean knowledge scores occurred overall, with a difference in mean of 0.565 (SE = 0.022, 95% CI [0.521, 0.607]). Stratification by class site and by language reflected significant increases in median scores, but findings were variable by study group. Pretest median scores for self-efficacy of restraint use were high for all groups, but the increases in posttest medians were also significant across groups (p ≤ .001). Caregiver knowledge and self-efficacy for child passenger restraint use increased after participation in the community classes. The pediatric trauma center's community partnerships facilitated uptake and adaption of the child passenger safety education programs and increased the injury prevention outreach to minority communities.
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Prevenção de Acidentes/métodos , Sistemas de Proteção para Crianças/estatística & dados numéricos , Seguridade Social , Centros de Traumatologia , California , Proteção da Criança , Pré-Escolar , Feminino , Educação em Saúde/organização & administração , Humanos , Lactente , Recém-Nascido , Disseminação de Informação , Relações Interinstitucionais , MasculinoRESUMO
Injury prevention initiatives are an effective strategy to reduce pediatric morbidity and mortality, but resource constraints can limit hospital-based prevention programs' capacity for carrying out such initiatives. Partnerships that leverage hospital leadership roles and promote collaborative outreach may provide a less resource-intensive means to expand prevention program capacity. One hospital piloted a collaborative helmet safety initiative, partnering with a nursing school and a local school district. The purpose of this study was to evaluate the effectiveness of the resulting student nurse-administered school helmet safety program in improving use, knowledge, and attitudes toward helmets among school-age children.
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Prevenção de Acidentes/instrumentação , Dispositivos de Proteção da Cabeça , Educação em Saúde/organização & administração , Ferimentos e Lesões/prevenção & controle , Prevenção de Acidentes/métodos , Adolescente , Ciclismo/lesões , California , Criança , Relações Comunidade-Instituição , Feminino , Humanos , Masculino , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Gestão da Segurança , Serviços de Saúde Escolar/organização & administraçãoRESUMO
BACKGROUND: Analysis of the costs associated with emergency department (ED) visits after discharge for violent injury could highlight subgroups for the development of cost-effective interventions to support healing and prevent treatment failures in violently injured patients. METHODS: A retrospective cohort review was conducted of all patients with return ED visits within 90 days of discharge after treatment for a violent injury occurring between July 1, 2016, and June 30, 2018. Hospital costs were calculated for each incidence and analyzed against demographic and injury type variables to identify trends. RESULTS: 218 return ED visits were identified. Hospital costs showed a high frequency of low-cost visits. For more complex visits, distinct cost patterns were observed for Black and LatinX males compared to White males as a function of age. CONCLUSIONS: Analysis of hospital cost per visit identified trends among different subgroups. Underlying etiologies presumably vary between groups, but hypothesis-driven further investigation and needs assessment is required. Understanding the driving forces behind these cost trends may aid in developing effective interventions.
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Serviço Hospitalar de Emergência , Alta do Paciente , Masculino , Humanos , Estudos Retrospectivos , Custos Hospitalares , IncidênciaRESUMO
For decades, the American College of Surgeons Committee on Trauma (ACSCOT) has published Resources for Optimal Care of the Injured Patient, which outlines specific criteria necessary to be verified by the college as a trauma center, including having an organized and effective approach to prevention of trauma. However, the document provides little public health-specific guidance to assist trauma centers with developing these approaches. An advisory panel was convened in 2017 with representatives from national trauma and public health organizations with the purpose of identifying strategies to support trauma centers in the development of a public health approach to injury and violence prevention and to better integrate these efforts with those of local and state public health departments. This panel developed the Standards and Indicators for Model Level I and II Trauma Center Injury and Violence Prevention Programs. The document outlines five, consensus-based core components of a model injury and violence prevention program: (1) leadership, (2) resources, (3) data, (4) effective interventions, and (5) partnerships. We think this document provides the missing public health guidance and is an essential resource to trauma centers for effectively addressing injury and violence in our communities. We recommend the Standards and Indicators be referenced in the injury prevention chapter of the upcoming revision of ACSCOT's Resources for Optimal Care of the Injured Patient as guidance for the development, implementation and evaluation of injury prevention programs and be used as a framework for program presentation during ACSCOT verification visits.
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OBJECTIVE: The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. METHODS: We applied a unidirectional case-crossover design to a retrospective analysis sample derived from healthcare administrative data from all non-federal licensed hospitals in the State of California. The analysis sample was comprised of California residents age 65 years or older with a record of treatment for injury fall occurring at home from January 1, 2014 to December 31, 2014. A conditional Poisson regression with fixed person effects and a robust estimator of variance was used to calculate the incidence rate ratio of acute care admissions during the 90 day period immediately preceding an injury fall, with the period of 360-271 days prior to index fall as reference. RESULTS: The rate of acute care admissions was 121% greater (IRR: 2.21; 95% CI 2.15-2.27) during the 90 days immediately preceding the index injury fall than 181-360 days prior. Period effects on rates of admissions were significantly higher in the acute care treatment subsample (IRR 2.63; 95% CI 2.51-2.76) than the emergency department treatment subsample (IRR 2.00; 95% CI 1.94-2.07). Discharge to post-acute care facilities; discharge to home health and Elixhauser comorbidity index all significantly modified period effects on acute care admissions. CONCLUSIONS: Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.
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Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Acidentes Domésticos/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Estudos Cross-Over , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Incidência , Vida Independente , Masculino , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
Participants read sentences presented one word at a time, half of which ended with a semantically incongruent ending. 1.5T functional magnetic resonance imaging data were collected from 11 participants, showing that the left posterior inferior temporal region, which has previously been termed the Language Formulation Area (LFA), responded to cloze probability. It is suggested, based on anatomical positioning and a literature review, that the responsiveness of the LFA to cloze probabilities may reflect a role in coordinating the lexical and non-lexical reading pathways. Finally, it is noted that previous studies have implicated this region in dyslexia and some speculations are made in this regard.
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Mapeamento Encefálico , Linguística , Imageamento por Ressonância Magnética , Lobo Temporal/irrigação sanguínea , Lobo Temporal/fisiologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Oxigênio/sangue , Probabilidade , LeituraAssuntos
Acidentes de Trânsito/legislação & jurisprudência , Intoxicação Alcoólica/diagnóstico , Enfermagem em Emergência/legislação & jurisprudência , Medicina Legal/legislação & jurisprudência , Responsabilidade Legal , Manejo de Espécimes/enfermagem , Intoxicação Alcoólica/enfermagem , Procedimentos Clínicos/normas , Enfermagem em Emergência/normas , Serviço Hospitalar de Emergência/legislação & jurisprudência , Serviço Hospitalar de Emergência/normas , Humanos , Manejo de Espécimes/normasRESUMO
INTRODUCTION: Conviction rates for drivers driving under the influence (DUI) and in motor vehicle collisions (MVC) presenting to trauma centers are based primarily on data from the 1990s. Our goal was to identify DUI conviction rates of intoxicated drivers in MVCs presenting to a trauma center and to identify factors associated with the failure to obtain a DUI conviction. METHODS: Retrospective study of adults (>18 years) presenting to a trauma center emergency department (ED) in 2007. Eligible subjects were drivers involved in a MVC with an ED blood alcohol level (BAL) ≥ 80mg/dL. Subjects were matched to their Department of Motor Vehicle (DMV) records to identify DUI convictions from the collision, the legal blood alcohol concentration (BAC), and arresting officer's impression of the driver's sobriety. We entered potential variables predictive of failure to obtain a DUI conviction into a regression model. RESULTS: The 241 included subjects had a mean age of 34.1 ± 12.8 years, and 185 (77%) were male. Successful DUI convictions occurred in 142/241 (58.9%, 95% CI 52.4, 65.2%) subjects. In a regression model, Injury Severity Score > 15 (odds ratio = 2.70 (95% CI 1.06, 6.85)) and a lower ED BAL from 80 to 200mg/dL (odds ratio = 5.03 (95% CI 1.69, 14.9) were independently associated with a failure to obtain a DUI conviction. CONCLUSION: Slightly more than half of drivers who present to an ED after a MVC receive a DUI conviction. The most severely injured subjects and those with lower BALs are least likely to be convicted of a DUI.
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Intoxicação Alcoólica/sangue , Condução de Veículo/legislação & jurisprudência , Centros de Traumatologia/normas , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Sistema de Registros , Estudos RetrospectivosRESUMO
BACKGROUND: A violence intervention program (VIP) developed at our trauma center resulted in a reduction of injury recidivism to 4% from a historical rate of 16%. Our aim was to investigate the feasibility of exporting our program to another trauma center by examining rates of and identifying potential barriers to recruitment, enrollment, and impact. We hypothesized that our VIP is feasible at another trauma center and successfully meets needs associated with risk reduction. METHODS: In January 2010, we introduced our VIP to another trauma center. To assess exportability of our program, we used a standard model of program evaluation for VIPs promoted by the Centers for Disease Control and Prevention. Specifically, the process and impact portions of the model evaluation were performed in this comparative analysis over a 1-year period. Recruitment, enrollment (process), and success at meeting risk reduction needs (impact) were our outcomes. This included patient and case manager characteristics in addition to rates at which eligible patients were approached and enrolled. These variables were compared using the Wilcoxon rank-sum and chi-square tests. RESULTS: During the study period, 155 patients were eligible for inclusion at the exported program compared with 119 at the original VIP. Rates at which eligible patients were approached at the exported program were significantly lower than the original program (44% vs 92%, P = .04). Rates at which approached patients were enrolled were also significantly lower (21% vs 55%, P = .002). The difference was associated with the time of injury and hospital length of stay because 40% of eligible patients were missed if injury occurred during a weekend and 70% were missed if the length of stay was less than or equal to 48 hours at the exported program. A cultural match between the client and case manager was assessed by race/ethnicity and language spoken; 2 of the 3 case managers at our site are Latino and bilingual and the other is black, whereas the 1 case manager at the exported program is black and monolingual. Cultural match was 91% versus 47%, respectively (P < .05). IMPACT: Both programs met more than 50% of identified client needs in several categories. CONCLUSIONS: Program exportation is based on the replication of both the program model and the program infrastructure. The data in our study support success of the program model (case management process) at our export site, but the actual program infrastructure was not successfully exported to this hospital.