Correction to: Influence of Cystic Fibrosis­Related Diabetes on Mental Health in Adults: A Single­Center Study.

The original version of this article unfortunately contained a mistake in one of the co-author name Prof. Don Hayes Jr. During production process, "Jr." was missed to add after the author name. The author name is corrected with this correction. The original article has been corrected.

Influence of Cystic Fibrosis-Related Diabetes on Mental Health in Adults: A Single-Center Study.

PURPOSE: People with cystic fibrosis (CF) are predisposed to chronic conditions, such as CF-related diabetes (CFRD). Recent attention has been focused on the addition of screening for anxiety and depression in the CF population. Independently, CFRD and mental health conditions are associated with worse clinical outcomes; however, research assessing the impact of both conditions together is limited. We aimed to characterize the association between CFRD and selected diagnoses of anxiety or depressive disorders on clinical outcomes in adults with CF. METHODS: A single-center, retrospective, cross-sectional study in adult patients with CF was performed. Group comparisons included selected diagnoses of depression, anxiety, and CFRD using two-sample t-tests or rank-sum tests for continuous variables, and Chi-square or Fisher's exact tests for categorical variables. RESULTS: A total of 209 adults were enrolled (mean age of 31.4 ± 11.4 years). Those with a selected diagnoses of depression had a significantly higher proportion of CFRD than those without depression (48% vs. 28%, respectively, p = 0.005), and CFRD was associated with increased odds of depression [OR (CI) = 2.33 (1.28, 4.26), p = 0.006]. We did not see a higher proportion of adults with CFRD and selected diagnoses of anxiety than those without anxiety (41% vs. 31% respectively, p = 0.12), nor an increased odds of anxiety in those with CFRD [OR (CI) = 1.58 (0.88, 2.84), p = 0.12]. CONCLUSION: We show a significant association between CFRD and selected diagnoses of depression in a cohort of adult patients.

Similarities Between Large Animal-Related and Motor Vehicle Crash-Related Injuries.

OBJECTIVE: Many Americans sustain large animal-related injuries (LARIs) from blunt trauma. We compare the injuries and management of LARI in our region of the United States with those of motor vehicle crashes (MVCs). METHODS: A 15-year retrospective study of trauma patients with LARI matched to MVC controls by Injury Severity Score (ISS), age, and sex was conducted. Values were statistically compared, and differences were considered statistically significant at P < .05. RESULTS: There were 156 LARI cases, of which 87% were related to horses, 8% to bulls, and the remainder to deer, mules, bison, cows, and rams. In the LARI group, the age was 42±18 years (mean±SD), ISS was 7±4, and 61% were females. The MVC group had a significantly longer length of hospital stay (5±5 vs 4±3 days) and blood alcohol concentration (35±84 vs 3±20 g/L). There were no significant differences in injury patterns between LARI and MVC; however, additional radiological studies (RS) were performed on MVC (9±6 vs 7±5). LARI patients were more often transferred from rural locations (39% vs 25%) and traveled further to our trauma center (40±32 vs 24±29 km) than did MVC patients. CONCLUSIONS: LARI has a similar pattern of injury to MVC, but fewer RS. LARI typically occurred further away, requiring transfer from rural areas to our institution. We recommend a similar approach for the evaluation of LARI and MVC.

Hospital outcomes and disposition of trauma patients who are intubated because of combativeness.

BACKGROUND: The purpose of this study was to determine whether trauma patients who are intubated because of combativeness, and not because of medical necessity, have more complications resulting in longer lengths of stay. METHODS: Data were retrospectively collected from 2001 through 2004 on trauma patients who were intubated because of combative behavior before hospital admission (group 1, N = 34). Cases were matched 1:2 by age, sex, injury severity score (ISS), and injury to controls each who were not intubated (group 2, N = 68). Additionally, there were 187 patients identified who were intubated because of medical necessity before hospital admission; these represented unmatched intubated controls and were divided based on ISS <15 (group 3, N = 58) and ISS >15 (group 4, N = 129). RESULTS: There were no significant differences between groups 1, 2, and 3 with regard to age, sex, or ISS. There was no significant difference between the groups 1 and 2 in frequency of head injuries as demonstrated by positive computed tomography (50 vs. 37%, p = 0.28); however, there was a significant difference in frequency of neurologic deficit at discharge (33 vs. 6%, p = 0.006). There was a significant difference in the frequency of head injuries between groups 1 and 3 (50 vs. 22%, p = 0.006); however, there was no significant difference in neurologic deficit at discharge (33 vs. 22%, p = 0.24). There was a significant difference in hospital length of stay between groups 1 and 2 (7.4 +/- 5.9 vs. 4.3 +/- 4.5 days, p = 0.0009). The incidence of pneumonia was significantly greater in group 1 than in group 2 (29 vs. 0%, p < 0.0001). The amount of lorazepam in average mg per day was also significantly greater in group 1 versus group 2 (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p < 0.0001). There was also a difference in the discharge status, with significantly fewer group 1 cases being discharged home compared with group 2 (56 vs. 91%, p < 0.0001). There was no significant difference between groups 1 and 3 with regard to length of stay, ventilator days, pneumonia, or discharge status. There was a significant difference between groups 1 and 3 in the amount of lorazepam per day (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p = 0.002). CONCLUSION: The results from this study indicate that trauma patients who are intubated because of combativeness, and not because of medical necessity, have longer lengths of stay, increased incidence of pneumonia, and poorer discharge status when compared with matched controls. The outcomes of this group are similar to that of patients who are intubated because of medical necessity.

The relationship between psychiatric medication and course of hospital stay among intoxicated trauma patients.

INTRODUCTION: The purpose of this study was to determine whether trauma patients requiring psychiatric medication who were admitted with positive alcohol or drug screen require more pain medications or sedation resulting in longer length of stay. METHODS: Data were retrospectively collected from 1997 through 2003 on patients with positive alcohol or drug screen who also received psychiatric medication during their hospital stay in a trauma center. Patients were matched by age, injury severity score, and injury to controls who had negative alcohol and toxicology screens and no psychiatric medication. An additional group consisted of positive alcohol or drug-screen trauma patients without psychiatric medication during hospitalization. Each group had 25 patients. RESULTS: No significant differences between the three groups regarding comorbidities or pain-medication doses given per day were found. The patients with positive alcohol and with psychiatric medication were more likely to have respiratory complications such as pneumonia or respiratory failure requiring ventilator support (36 versus 4%, P=0.005), to develop other infections (8 versus 0%), or other complications (26 versus 4%, P=0.0007) compared with the controls. A significant difference in hospital length of stay between the group with positive toxicity and psychiatric medication and that with negative toxicity and psychiatric medication (mean: 12.8 and 5.5 days, respectively; P=0.01) was found. CONCLUSION: Psychiatric medication and positive drug or alcohol screens are associated with longer length of stay and increased respiratory complications. Factors influencing these outcomes need more clarification and prospective studies.

The effect of bicycle helmet legislation on pediatric injury.

BACKGROUND: Research supports the use of a correctly fitted bicycle helmet to reduce the risk of bicycle-related head injury. Although parents believe bicycle helmets work, a large percentage of children do not wear helmets while riding. PURPOSE: The purpose of this study was to track pediatric bicycle-related injuries presenting to a pediatric trauma center 1 year before and 5 years after 2001 bicycle helmet legislation aimed to protect children 0 to 16 years. METHODS: Prospective data collection of pedal cycle injury e-code 826.1 from hospital discharge data set from January 1, 2000, through December 31, 2005. Bicycle-related injuries among children 0 to 16 years were grouped by injury type (head, extremity, and other), age, and gender. RESULTS: For years reviewed (2000-2005), bicycle-related injuries were highest in the period May through August. Bicycle-related injury rates per 100,000 for this population were 1,452 a year before legislation. The injury rate decreased 27% (1,054/100,000) one year later. Overall, bicycle-related injury per 100,000 continues to be down by 24%. Data show that extremity injury is greater than head and other injury categories in both male (24% greater) and female (27% greater) children 0 to 16 years one year before legislation. Data show extremity injury rates per 100,000 is greater than head and other injury categories in both male (24% greater) and female (38% greater) categories 5 years later. Bicycle-related injury rates per 100,000 in boys were greater than girls for all years reported. Male extremity injury was 45% higher for 10- to 16-year-old boys than for 5- to 9-year-old boys a year before legislation and continued to rise to 58% in 2005. Male head injury rates per 100,000 were higher in 5- to 9-year-old boys (598/100,000) than in 10- to 16- year-old boys (354/100,000) one year before legislation. In 2005, the bicycle-related head injury rates per 100,000 dropped to 485 for 5- to 9-year-old vs 223 for the 10- to 16-year-old boys. Female extremity injury rate per 100,000 for 5- to 9-year-old girls in 2000 was 367, exceeding the 10- to 16-year category rate of 213 per 100,000. In 2005, female extremity injury per 100,000 was 299 for the 5- to 9-year-old girls and rose 16% to 250 for 10- to 16-year-old girls. Head injury rates per 100,000 for 5- to 9-year-old girls in 2000 were 325, ending with a rate of 254 per 100,000 in 2005. Head injury rates per 100,000 for 10- to 16-year-old girls in 2000 were 93, ending in 2005 with a rate of 91 per 100,000. CONCLUSION: The greatest reduction in injury occurred 1 year after legislation, suggesting that promoting bicycle helmet use in the community is effective in reducing injury. The overall rate of bicycle-related injury in the population studied continues to be down 24%, suggesting bicycle helmet legislation for children is an effective adjunct in reducing injury. Extremity injury rates were greater than head injury in both male and female populations, suggesting that future bicycle safety initiatives address extremity injury. Female head injury rates in the 10- to 16-year-old population changed very little from baseline and would benefit from further investigation of female riding habits and perceived barriers to bicycle helmet use.

Preinjury warfarin and geriatric orthopedic trauma patients: a case-matched study.

BACKGROUND: This study examined the hypothesis that patients on warfarin before sustaining orthopedic injuries will have increased morbidity and mortality compared with matched control patients not on warfarin. METHODS: Records of consecutive trauma patients on warfarin with orthopedic fractures who presented from January 1997 to June 2002 to a Level I trauma center were retrospectively analyzed. Data were evaluated using the chi and Student's t tests and nonparametric tests when appropriate; values of p < 0.05 were considered significant. RESULTS: A study group of 53 patients was available for review. In comparison with the control group, significant differences were found in time delay from admission to surgery (p = 0.005), hospital length of stay (p = 0.03), total units of blood transfused (p = 0.03), and discharge disposition (p < 0.0003). No difference was found in number of intensive care unit days, complications, or mortality. CONCLUSION: Preinjury warfarin impacts outcomes of geriatric trauma patients sustaining orthopedic injuries.