Overdosing in a Motor Vehicle: Examination of Human, Geographic, and Environmental Factors.

BACKGROUND: Fentanyl, a type of opioid, in impaired driving cases increased across cities in the United States. OBJECTIVES: No empirical studies have examined motor vehicle overdoses with fentanyl use. We investigated the magnitude of the motor vehicle overdose problem in Providence, RI, and the environmental, socioeconomic, and geographic conditions associated with motor vehicle overdose occurrence. METHODS: This was a retrospective observational study of emergency medical services data on all suspected opioid overdoses between January 1, 2017, and October 31, 2020. The data contain forced-choice fields, such as age and biological sex, and an open-ended narrative in which the paramedic documented clinical and situational information. The overdoses were geocoded, allowing for the extraction of sociodemographic data from the U.S. Census Bureau's American Community Survey. Seven other data sources were included in a logistic regression to understand key risk factors and spatial patterns of motor vehicle overdoses. RESULTS: Of the 1,357 opioid overdose cases in this analysis, 15.2% were defined as motor vehicle overdoses. In adjusted models, we found a 61% increase in the odds of a motor vehicle overdose involvement for men versus women, a 16.8% decrease in the odds of a motor vehicle overdose for a one-unit increase in distance to the nearest gas station, and a 10.7% decrease in the odds of a motor vehicle overdose for a one-unit increase in distance to a buprenorphine clinic. CONCLUSION: There is a need to understand the interaction between drug use in vehicles to design interventions for decreasing driving after illicit drug use.

Police narrative reports: Do they provide end-users with the data they need to help prevent bicycle crashes?

Bicycles gained significant popularity among Americans in 2020. Greater investment in adequate bicycle safety facilities will be needed. Crash data from police will undoubtedly play a role in decision-making. This research evaluated the data quality of text narratives in police reports on bicycle crashes. The aims were to identify situations in which police officers wrote more detail in the narrative text, investigate if longer reports translate to more in-depth crash descriptions, examine the extent to which narrative texts cover details useful for those charged with bicycle safety. This is a 4-year retrospective cohort study of vehicle-vs-bicycle crashes that occurred between January 1, 2009, and December 31, 2012, in Boston, Massachusetts (USA). Police reports were matched with the Pedestrian and Bicycle Crash Analysis Tool (PBCAT) to measure how much information was captured and when reports were more likely to capture more information. Police reports only captured most information in one area of the standardized form (Crash Typing), with average total missingness of over 75%. Longer reports did reduce the amount of missingness, and officers were more likely to write longer reports when they were on the crash site, when there was an injury, when the crash involved an extended car door, and during the day. A 100% increase in the report's words was associated with a four-percentage point reduction in PBCAT missingness. While longer reports result in less missingness when measured against the standardized crash form, the average report still misses most of the information that the form would capture. We recommend that police departments adopt a standardized form to facilitate information capture at the scene of bicycle-vehicle crashes.

Generating a city's first report on bicyclist safety: lessons from the field.

BACKGROUND: For cities aiming to create a useful surveillance system for bicycle injuries, a common challenge is that city crash reporting is scattered, faulty or non-existent. We document some of the lessons we learnt in helping the city of Boston, Massachusetts, USA, do the following: (1) Create a prototype for a comprehensive police crash data set (2) Produce the city's first cyclist safety report, (3) Make crash data available to the public and (4) Generate policy recommendations for both specific roadside improvements and for sustainable changes to the police department's crash reporting database. METHODS: We provided research and technical assistance to government partners to generate the report and used participant-observation field notes to generate the list of learnt lessons. RESULTS: After the release of the report, the city implemented immediate activities aimed at making an effort to prevent injuries, including: (1) Furnishing over 1800 taxis with stickers to prevent 'dooring,' (2) Adding pavement markings at trolley tracks to decrease the likelihood that cyclists would fall from getting their wheels lodged in the tracks, (3) Conducting targeted enforcement of traffic laws and (4) Working directly with state and federal agencies to fund a more comprehensive surveillance system. As of January of 2017, nearly 4 years after its public release, 19 170 users have viewed the crash data set 23 247 times. Some of the lessons include finding and using committed champions, prioritising the use of existing data, creating opportunities to bridge divisions between stakeholders, partnering with local universities for assistance with advanced analytics and using deliverables, such as a cyclist safety report, to advocate for sustainability. CONCLUSION: Providing an initial report on bicycle crashes in Boston served to identify specific problems, showed the value of a data system, and provided a blueprint for an improved data system. Building a useful surveillance system depends in no small part on the wise use of advocacy, group dynamics, and politics. Our hope is that the lessons learnt from our experience in Boston can help others do even better.

Using trauma center data to identify missed bicycle injuries and their associated costs.

BACKGROUND: Recently, there has been a 58% increase in the number of observed cyclists in San Francisco. In 2009, 3.2% of commuters were traveling by bicycle in this city, which is well above the national average of less than 1%. Police reports are the industry standard for assessing transportation-related collisions and informing policies and interventions that address the issue. Previous studies have suggested that police reports miss a substantial portion of bicycle crashes not involving motor vehicles. No study to date has explored the health and economic impact of cyclist-only (CO) injuries for adults in the United States. Our objective was to use trauma registry data to investigate possible underrepresentation of certain cyclist injuries and characterize cost. METHODS: We reviewed hospital and police records for 2,504 patients treated for bicycle-related injuries at San Francisco General Hospital (SFGH). We compared incidence, injury severity, admission rate, and cost of injury for CO and auto-versus-bicycle (AVB) injuries treated at SFGH. We then calculated the cost of injury. RESULTS: Of all bicycle-related injuries at SFGH, 41.5% were CO injuries and 58.5% were AVB injuries. Those with CO injuries were more than four times as likely to be required of hospital admission compared with those with AVB injuries (odds ratio, 4.76; 95% confidence interval, 3.93-5.76; p < 0.0001). From 2000 to 2009, 54.5% of bicycle injuries treated at SFGH were not associated with a police report, revealing that bicycle crashes and injuries are underrecognized in San Francisco. Costs for care were significantly higher for AVB injuries and increased dramatically over time; total cost for CO and AVB injuries were $12.6 and $17.8 million. CONCLUSION: Based on this study, we conclude that trauma centers can play a key role in future collaborations to define issues and develop prevention strategies for CO crashes. LEVEL OF EVIDENCE: Epidemiologic study, level II.

Screening for mental illness in a trauma center: rooting out a risk factor for unintentional injury.

BACKGROUND: Injury prevention and screening efforts have long targeted risk factors for injury recurrence. In a retrospective study, our group found that mental illness is an independent risk factor for unintentional injury and reinjury. The purpose of this study was to administer a standard validated screening instrument and psychosocial needs assessment to admitted patients who suffer unintentional injury. We aimed to prospectively measure the prevalence of mental illness. We hypothesize that systematic screening for psychiatric disorders in trauma patients is feasible and identifies people with preexisting mental illness as a high-risk group for unintentional injury. METHODS: In this prospective study, we recruited patients admitted to our Level I trauma center for unintentional injury for a period of 18 months. A bedside structured interview, including the Mini International Neuropsychiatric Interview, and a needs assessment were performed by lay research personnel trained by faculty from the Department of Psychiatry. The validated needs assessment questions were from the Camberwell Assessment of Need Short Appraisal Schedule instrument. Psychiatric screening and needs assessment results, as well as demographic characteristics are reported as descriptive statistics. RESULTS: A total of 1,829 people were screened during the study period. Of the 854 eligible people, 348 were able to be approached by researchers before discharge with a positive response rate of 63% (N = 219 enrolled). Interviews took 35 minutes ± 12 minutes. Chi-squared analysis revealed no difference in mechanism in those with mental illness versus no mental illness. Men were significantly more likely to be found to have a mental health disorder but when substance abuse was excluded, no difference was found. Four-way diagnostic grouping revealed the prevalence of mental illness detected. CONCLUSIONS: This inpatient pilot screening program prospectively identified preexisting mental illness as a risk factor for unintentional injury. Implementation of validated psychosocial and mental health screening instruments is feasible and efficient in the acute trauma setting. Administration of a validated mental health screening instrument can be achieved by training college-level research assistants. This system of screening can lead to identification and treatment of mental illness as a strategy for unintentional injury prevention.

Cost-driven injury prevention: creating an innovative plan to save lives with limited resources.

BACKGROUND: Pedestrian injury costs >$20 billion annually. Countermeasures such as blinking crosswalks can be expensive but expectedly vital to injury prevention efforts. We aimed to create a new framework of cost-driven surveillance. The purpose of our study was to carry out a detailed analysis of the hospital cost and its relationship to location of pedestrian injury. Targeting identified "high cost areas" with effective countermeasures could save lives and be most cost-effective. Our hypothesis is that pedestrian injury creates a tremendous public funding burden and that hotspot sites can be mapped based on corresponding hospital costs. METHODS: We conducted a retrospective analysis of billing records of 694 auto versus pedestrian victims treated at Level I trauma center in our city in the sample year 2004. Total cost was computed using cost to charge ratios for hospital and ambulance fees and actual cost of professional fees. City district "price tags" were assigned per detailed patient cost data to corresponding spatial analysis of intersections. χ(2) analyses were conducted on demographic variables. Multiple regression analysis determined predictors of total cost. RESULTS: The total cost of injury was $9.8 million, whereas the total charge was $20.8 million. Ninety percent of victims resided in our City. Thirty-one percent were admitted and cost of their care accounted for 76% of the total. Admitted patients were older than nonadmitted patients (47 years vs. 38 years; t = 5.45; p = 0.00). Spatial analysis determined that of 11 city districts, three districts accounted for almost 50% of the total cost. Seventy-six percent of the total cost was publicly funded. The strongest predictors of cost were length of stay (â = 0.77; t(220) = 30.42; p = 0.000) and ventilator days (â = 0.51; t(220) = 6.69; p = 0.000). CONCLUSIONS: These findings provide a roadmap to target costly hot spots for city planning of preventive countermeasures. In a climate of limited resources, this kind of roadmap outlines the three regions that could most benefit from countermeasures from both an injury prevention and cost-containment standpoint. Cost-driven surveillance is useful in city strategic planning for cost-effective and life-saving pedestrian injury prevention.