Trauma Surgeon-Led and Funded Injury Prevention Program Decreases Number of All-Terrain Vehicle-Related Admissions.

BACKGROUND: All-terrain vehicle (ATV) laws regarding helmet use, alcohol involvement, and roadway riding are poorly enforced or largely ignored. We hypothesized that direct surgeon funding and leadership in injury prevention would decrease ATV crashes. To focus prevention efforts, we reviewed a rural level 1 trauma center 11-year experience with ATV crashes comparing helmeted and unhelmeted rider outcomes. METHODS: For the latter 6 years of the study period, a trauma surgeon sponsored an injury prevention fund promoting ATV safety using simulators and discussions for area high school students. Helmet use, alcohol avoidance, and safe ATV operating were emphasized. A trauma registry review of ATV admissions from 2009 through 2020 examined demographics, helmet use, and clinical outcomes using chi-square, t-test, and regression analysis. RESULTS: Unhelmeted ATV riders suffered more severe head and neck injuries (OR 19, CI 1.5-1.8, P < .001), worse overall Injury Severity Score (ISS), (OR 25, CI 12.1-14.2, P < .001), and higher mortality rates (OR 4.0, CI .02-.05, P < .001). Helmet use corresponded with an average decrease in AIS and increase in GCS status. Although only 15% of riders were helmeted, ATV crash admissions have decreased in the last 5 years (P < .001). DISCUSSION: All-terrain vehicle trauma and mortality is still frequent, especially in unhelmeted riders. The recent decrease in area ATV crashes is encouraging. Trauma surgeons have an opportunity to make a difference in public awareness and education through comprehensive physician-funded and directed injury prevention and research efforts.

Midlevel Providers Focusing on Geriatrics Improve Care and Outcomes of Fall-Related Injuries Among the Elderly.

BACKGROUND: A rural level 1 trauma center underwent a consolidation to level III status in a new trauma network system. A dedicated group of midlevel practitioners emphasizing early mobilization, a geriatric care model, and fall prevention replaced surgical residents in the level 3 center. We hypothesized that outcomes of elderly fall-related injuries may be enhanced with midlevel providers using a geriatric-focused care model. METHODS: An IRB-approved trauma registry review of patients over 65 years of age with a fall-related injury admitted to a rural trauma center 1 year prior to and 1 year following a trauma center consolidation from level 1 to level III designation evaluated demographics, anticoagulant use, comorbidities, and clinical outcomes. Statistical analysis included t-test and regression analysis. RESULTS: 327 patients injured by falls were seen over a 2-year study period. The number of patients admitted with a fall-related injury and the injury severity were similar over the study period. Increasing age and anticoagulant use increased length of stay and mortality (both with P < .05). Mortality rates and patient level of independence on discharge were improved in the later period involving midlevel practitioners (both with P < .05). DISCUSSION: Trauma centers and trauma system networks face increasing challenges to provide resources and providers of care for patients injured by falls, especially for the growing elderly population. Midlevel providers focusing on geriatric clinical issues and goals may enhance care and outcomes of elderly fall-related injuries.

Trauma Surgeon-Led and Funded Injury Prevention Program Decreases Admission for Motorcycle Crash Injuries.

BACKGROUND: Unhelmeted motorcyclists injured in states with lax or poorly enforced helmet safety laws are frequently seen in rural trauma centers. A trauma surgeon started a comprehensive injury prevention and research fund with outreach to a three-state trauma center catchment area promoting injury prevention at area high schools and local communities. We hypothesized that unhelmeted riders would have more severe head injuries and fatalities than helmeted riders. METHODS: A trauma registry review of 708 injured motorcycle riders over an 11-year period examined demographics, helmet use, and clinical outcomes of helmeted and unhelmeted riders. A full-time injury prevention coordinator collaborating with law enforcement provided electronic and mechanical simulations with discussions regarding helmet use, alcohol avoidance, and responsible motorcycle riding for area high school students. This program coincided with the second half of our 11-year study. Multiple regression analysis evaluated predictors for head injury and death. RESULTS: Unhelmeted motorcyclists suffered worse head injuries, (OR 8.8, CI 1.6-2.4, P < .001), more severe overall injury (OR 10, CI 12.7-18.6, P < .001), and higher mortality (OR 2.7, CI .02-.15, P < .001). Local motorcycle-related trauma center admissions and deaths have stabilized in recent years while statewide motorcycle crashes have increased (P < .05). DISCUSSION: Unhelmeted motorcyclists suffer worse head injuries and mortality rates. Physician-led outreach efforts for injury prevention may be effective. Trauma surgeons have ongoing opportunities to promote responsible motorcycle riding for schools and local communities.