Understanding the burden of traumatic injuries at the United States-Mexico border: A scoping review of the literature.

ABSTRACT: The US-Mexico border is the busiest land crossing in the world and faces continuously increasing numbers of undocumented border crossers. Significant barriers to crossing are present in many regions of the border, including walls, bridges, rivers, canals, and the desert, each with unique features that can cause traumatic injury. The number of patients injured attempting to cross the border is also increasing, but significant knowledge gaps regarding these injuries and their impacts remain. The purpose of this scoping literature review is to describe the current state of trauma related to the US-Mexico border to draw attention to the problem, identify knowledge gaps in the existing literature, and introduce the creation of a consortium made up of representatives from border trauma centers in the Southwestern United States, the Border Region Doing Research on Trauma Consortium. Consortium members will collaborate to produce multicenter up-to-date data on the medical impact of the US-Mexico border, helping to elucidate the true magnitude of the problem and shed light on the impact cross-border trauma has on migrants, their families, and the US health care system. Only once the problem is fully described can meaningful solutions be provided.

Morbidity and Mortality After Rib Fracture in Elderly Patients (>65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health.

BACKGROUND: Traumatic rib fracture is a major cause of morbidity and mortality. Recent studies highlight the inadequacy of age and the number of rib fractures (NRFs) to assess patients' care needs, which may unnecessarily increase the burden of intensive care unit (ICU) admissions. Therefore, we sought to clarify the clinical outcomes of patients admitted to a level I trauma center with multiple blunt-trauma rib fractures by age and fracture location. METHODS: We performed a retrospective cohort study of patients aged 18-95 admitted to Doctors Hospital at Renaissance Health with multiple rib fractures during 2017-2020. Patients with major vascular/cerebral injuries or emergency surgery from other injuries were excluded. The study population comprised 71 patients aged ≤65 and 53 patients aged >65 years. The primary study outcomes included mortality and non-home discharge. ICU length of stay (ICU-LOS), total hospital length of stay (HLOS), and days on the ventilator were the secondary outcomes. Study outcomes were also analyzed by stratifying patients by fracture location. RESULTS: Patients aged >65 years with multiple blunt-trauma rib fractures had lower mortality rates despite a higher prevalence of comorbidities but with higher rates of non-home discharges compared to younger patients. However, the mortality and non-home discharge odds ratios were not statistically significant. Also, median ICU-LOS and HLOS were numerically higher in geriatric patients but were not statistically significant. Nonetheless, younger patients required significantly more days of respiratory support than older patients. Similar differences were observed in the clinical outcome of patients ≤65 or >65 years when stratified by fracture locations. CONCLUSION: Young patients with blunt trauma rib fractures may have similar, if not worse, clinical outcomes than geriatric patients. These findings underscore the need for individual assessment of the patient's trauma severity independent of age, the number of rib fractures, or fracture location to reduce ICU burden.

Hearing hoofbeats? Think head and neck trauma: a 10-year NTDB analysis of equestrian-related trauma in the USA.

OBJECTIVE: There is a paucity of evidence about traumatic injuries and their sequelae sustained due to equestrian injuries nationally. METHODS: Retrospective study analyzing National Trauma Data Bank data from 2007 to 2016. Variables collected included age, sex, race, payer status, Injury Severity Score (ISS), hospital length of stay, Glasgow Coma Scale, systolic blood pressure (SBP) at presentation, discharge disposition, and mortality. Patient data were analyzed by anatomic region. RESULTS: The most frequent type of injury was in the thorax, but head and neck injuries produced the highest mortality. Increased ISS and an SBP of less than 90 mm Hg were also significant predictors of mortality. CONCLUSIONS: The risk of hospital admission from equestrian injuries is higher than football, motor vehicle racing, and skiing. Preventive measures and campaigns should be instituted to highlight safety practices and the use of personal protective equipment while on horseback either for sports, leisure, or work. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Racial inequality in the trauma of women: A disproportionate decade.

BACKGROUND: Historically, women have been largely underrepresented in the body of medical research. Given the paucity of data regarding race and trauma in women, we aimed to evaluate the most common types of traumas incurred by women and analyze temporal racial differences. METHODS: A 10-year review (2007-2016) of the National Trauma Data Bank was conducted to identify common mechanisms of injuries among women. Trends of race, intent of injury, and firearm-related assaults were assessed using the Cochran-Armitage Trend test. Multivariable multinomial logistic regressions were utilized to examine the association between race and trauma subtypes. RESULTS: Of the 2,082,768 women identified as a trauma during this study period, the majority presented due to an unintentional intent (94.5%), whereas fewer presented secondary to an assault (4.4%) or self-inflicted injury (1.1%). While racioethnic minority women encompassed a small percentage of total traumas (19%), they accounted for roughly three fifths of assault-related traumas (p < 0.001). Though total assaults decreased by 20.8% during the study period, black and Hispanic women saw a disproportionately smaller decrease of 15.1% and 15.8%, respectively. On regression analysis, compared with white women, black women had more than four times the odds of being an assault-related trauma compared with unintentional trauma (odds ratio, 4.48; 95% confidence interval, 4.41-4.55). On subset analysis, firearm-related assault was 17.3 times more prevalent among black women (white, 0.3% vs. black: 5.2%; p < 0.001). In fact, history of alcohol abuse was found to be an effect modifier of the association of race/ethnicity and firearm-related trauma. CONCLUSION: Compelling data highlight a disproportionate trend in the assault-related trauma of minority women. Specifically, minority women, especially those with a history of alcohol abuse, were at increased risk of being involved in a firearm assault. Further studies are essential to help mitigate disparities and subsequently develop preventative services for this diverse population. LEVEL OF EVIDENCE: Epidemiological, Level III.

Detecting Invasive Fungal Disease in Surgical Patients: Utility of the (13)- ß-d-Glucan Assay.

Background: The specificity and sensitivity of the (13)-ß-d-glucan (BDG) assay in surgical patients needs further investigation. We hypothesized that the BDG assay would have lower sensitivity/specificity compared with that of medical patients. Methods: We reviewed patients who had undergone laparotomy, gastrectomy, hepatectomy, or colectomy and had a BDG assay post-operatively. Results: A total of 71 patients met study criteria. There were 29 (40.8%) who had proven/probable invasive fungal infection. Sensitivity for BDG level ≥80 diagnosed within one week of the assay draw was 77.3% (95% confidence interval [CI], 54.6-92.2%), and specificity was 44.9% (95% CI, 30.7-59.8). The positive predictive value was 38.6% (95% CI, 31.0-46.9%), and negative predictive value was 82.5% (95% CI, 65.7-91.0%). A BDG assay result of 149 pg/mL had a classification rate of 63.4%. Therefore, a BDG assay result ≥150 pg/mL has a sensitivity of 78.6% and a specificity of 41.4%. Conclusion: A BDG assay can be useful for ruling out invasive fungemia in post-operative patients.

Emergency general surgery in pregnancy.

It is often that the acute care surgeon will be called on to evaluate the pregnant patient with abdominal pain. Most of the diagnostic and management decisions regarding pregnant patients will follow the usual tenets of surgery; however, there are important differences in the pregnant patient to be aware of to avoid pitfalls which can lead to complications for both mother and fetus. This review hopes to describe the most common emergencies facing the surgeon caring for the pregnant patient and the latest management options.

Association of insurance status with health outcomes following traumatic injury: statewide multicenter analysis.

INTRODUCTION: Recognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population. Our objective was to understand the relationship between patients' insurance status and trauma outcomes. METHODS: We collected data on all patients involved in traumatic injury from eight Level I and 15 Level IV trauma centers, and four non-designated hospitals through Arizona State Trauma Registry between January 1, 2008 and December 31, 2011. Of 109,497 records queried, we excluded 29,062 (26.5%) due to missing data on primary payer, sex, race, zip code of residence, injury severity score (ISS), and alcohol or drug use. Of the 80,435 cases analyzed, 13.3% were self-pay, 38.8% were Medicaid, 13% were Medicare, and 35% were private insurance. We evaluated the association between survival and insurance status (private insurance, Medicare, Medicaid, and self-pay) using multiple logistic regression analyses after adjusting for race/ethnicity (White, Black/African American, Hispanic, and American Indian/Alaska Native), age, gender, income, ISS and injury type (penetrating or blunt). RESULTS: The self-pay group was more likely to suffer from penetrating trauma (18.2%) than the privately insured group (6.0%), p<0.0001. There were more non-White (53%) self-pay patients compared to the private insurance group (28.3%), p<0.0001. Additionally, the self-pay group had significantly higher mortality (4.3%) as compared to private insurance (1.9%), p<0.0001. A simple logistic regression revealed higher mortality for self-pay patients (crude OR= 2.32, 95% CI [2.07-2.67]) as well as Medicare patients (crude OR= 2.35, 95% CI [2.54-3.24]) as compared to private insurance. After adjusting for confounding, a multiple logistic regression revealed that mortality was highest for self-pay patients as compared to private insurance (adjusted OR= 2.76, 95% CI [2.30-3.32]). CONCLUSION: These results demonstrate that after controlling for confounding variables, self-pay patients had a significantly higher risk of mortality following a traumatic injury as compared to any other insurance-type groups. Further research is warranted to understand this finding and possibly decrease the mortality rate in this population.

Impact of speed cameras on trauma centers.

BACKGROUND: While studies, mostly from Europe and Australia, have examined the effect of speed cameras on motor vehicle collisions, limited data exist regarding their impact on charges and number of patients taken to Level 1 trauma centers (L1TCs). Because of conflicting perceptions and data on their value, speed cameras were implemented along select Arizona highways in 2008 but then removed in 2010. The hypotheses of our study were twofold. (1) Speed cameras reduce admissions to L1TCs, and (2) speed cameras reduce crash kinetic energy, resulting in lower Injury Severity Score (ISS), mortality, hospital costs, and length of stay (LOS). METHODS: A retrospective review of all patients admitted to L1TCs who were injured in motor vehicle crashes along a 26-mile segment of interstate I-10 in urban Phoenix was performed. Patients were identified using both the Arizona State Trauma Registry and the Arizona Department of Transportation collision data for 2009 to 2011. This specific 26-mile segment of I-10 was selected because it contained at least one speed camera within 1 mile along its entire length from October 2008 to October 2010. Two time frames were evaluated: January 1 to December 31, 2009, when cameras were in place (2009 camera group) and January 1 to December 31, 2011, when no cameras were in place (2011 no-camera group). Variables analyzed include number of collisions, number of injuries, on-scene mortality, trauma center admissions, number of collisions with admissions, in-hospital mortality, ISS, hospital charges, LOS, age, sex, race, and ethnicity. Five confounding variables were eliminated. Analysis was performed using Fisher's exact test and linear regression. RESULTS: Camera removal was associated with a twofold increase in L1TC admissions as well as increased resource use. There were no significant differences between the two time frames for ISS, mortality, median charges, or median LOS. CONCLUSION: In this study, removal of speed cameras resulted in increased trauma center admissions and resource use. LEVEL OF EVIDENCE: Care management study, level IV.

Do speed cameras reduce collisions?

We investigated the effects of speed cameras along a 26 mile segment in metropolitan Phoenix, Arizona. Motor vehicle collisions were retrospectively identified according to three time periods - before cameras were placed, while cameras were in place and after cameras were removed. A 14 mile segment in the same area without cameras was used for control purposes. Five cofounding variables were eliminated. In this study, the placement or removal of interstate highway speed cameras did not independently affect the incidence of motor vehicle collisions.