Sport and recreation-related head injuries treated in the emergency department.

OBJECTIVE: Head injury (HI) in sport is common and can have serious consequences. This study examines the epidemiology of sport/recreational (SR)-related HI presenting to the emergency department (ED). DESIGN: Retrospective review of medical records. SETTING: Five EDs in the Capital Health Region (Edmonton) located in the province of Alberta, Canada. PATIENTS: All persons in a 1-year period reporting to the EDs with an HI. HI was defined as IC9-CM coded skull fracture, loss of consciousness, or concussion. MAIN OUTCOME MEASURES: Hospitalization, utilization of diagnostic testing, and discharge destination. RESULTS: In total, 10,877 (3%) of 288,948 ED encounters were for sports and recreational injuries; 358 (3%) were for HI. Males (71%) were more frequently injured; patients < 20 years old were involved in 66% of all HI cases. The highest proportion of HI occurred during ice hockey (21%), cycling (13%), and playground-related activities (8%). 9% of HI were hospitalized (versus 4% admission rate for other SR injuries: p < 0.01). CONCLUSIONS: These results demonstrate the utility of an ED-based injury registry and indicate that patients with HI presenting to the ED from SR activities are common. These injuries appear to be more severe than other types of SR injuries treated in the ED.

Emergency staff survey on their role in pediatric injury prevention education-a pilot study.

A pilot study to survey the attitudes of emergency department (ED) personnel regarding their role in injury prevention education in children and parents was conducted at a tertiary care trauma center. The survey consisted of 14 statements, asking staff members their level of agreement (from strongly agree to strongly disagree) on a forced-choice four-point scale. These were followed by two questions asking staff members to rank schools, physician's offices, emergency departments, and public health units on their value in providing injury prevention information to children and parents. Before the intervention (an in-service training program on the importance of documenting the circumstances of injury on a patient's chart), a 50% randomly selected sample of ED staff members was asked in May 1997 to complete the survey. After the data collection prepilot (4 months later), the remaining 50% was asked in September 1997 to complete the same questionnaire. Administration of the preintervention survey resulted in 53 of 62 surveys being returned (85%). The postintervention survey was completed by 35 of the 41 staff members still eligible (85%), those who were employed in the ED during the entire pilot project. There was no statistically significant difference between the pre- and post-pilot groups on any demographic characteristics. Staff members agreed least with the statement that ED physicians and staff members could impact the severity of injuries to children by providing counseling to parents (68.1% preintervention and 64.5% postintervention agreement). Of most significance was the fact that a lower percentage of staff members agreed postintervention that almost all injuries to children were avoidable. The emergency department was the lowest ranked information dissemination venue for both parents and children.

Pilot intervention to improve the documentation of pediatric injuries in the emergency department, Critical care medicine as a subspecialty of emergency medicine.

OBJECTIVES: Our goal was to determine the effectiveness of an intervention aimed at improving the emergency department (ED) documentation of pediatric injuries. METHODS: All physicians and nursing staff in the ED of an urban teaching hospital and trauma centre underwent focused injury surveillance training and were instructed how to document 14 injury-specific data elements. Pocket reminder cards were provided, and pediatric injury charts were flagged. Subsequently, random samples of pediatric injury charts were analyzed from a 3-month period prior to the intervention and from the corresponding months after the intervention. Post-intervention documentation was compared to pre-intervention documentation for the 14 pre-defined data elements. RESULTS: Six of the 14 data elements were charted more frequently, and 2 less frequently during the post-intervention phase. Odds ratios ranged from 4.59 (95%CI, 3.40 to 6.19) for charting "the presence of an adult observer" to 0.09 (95%CI, 0.01 to 0.76) for charting "sports equipment related to the injury." The "flagging" of injury charts, as a visual reminder for clinicians to document injury data, seemed to be the most effective component of the intervention. CONCLUSION: A simple intervention, consisting of staff training, chart modification, and visual flagging of charts, can increase the amount of injury information documented by ED clinicians. Efforts to improve ED charting are most likely to succeed if they include visual prompts for clinicians.

A descriptive epidemiology of sport and recreation injuries in a population-based sample: results from the Alberta Sport and Recreation Injury Survey (ASRIS).

The 1996 Alberta Sport and Recreation Injury Survey is a retrospective study describing the annual incidence of injuries in the province of Alberta resulting from sport and recreational involvement. Data was collected by means of a telephone survey using random digit dialing techniques to obtain a representative sample of Albertans in the winter of 1995-96. The sample produced a total of 3,790 respondents from 1,478 households evenly split between genders, with an age range of 6 to 93 years. The survey asked information regarding medically attended, non-fatal injuries resulting from sport and recreational activities. Findings reveal an annual incidence of sport or recreational injuries of 11%. Among those reporting a sport or recreational injury, the most common types of injuries were a sprained/torn ligament (31%), strained/pulled muscle (19%), and fracture (13%). The most common bodily locations of injuries were the knees (21%) and the ankle (14%).