Food Insecurity Predicts Urban Gun Violence.

INTRODUCTION: Food insecurity (FI), defined as inadequate access to affordable and quality nutrition, has negative health consequences. FI and violence share similar root causes. The aim of this study was to determine the association of FI with gunshot injury (GSI) incidence. METHODS: We performed a retrospective review of all patients from 2012 to 2018 who sustained a GSI. Food access data was abstracted from the US Department of Agriculture. We analyzed the impact of FI, low food access (LA), and low food access with no vehicle (LANV) on the incidence of GSI using Poisson regression. We also compared high-risk zip codes for GSI, FI, LA, and LANV using geospatial analysis. RESULTS: There were 1700 patients in our cohort from 33 different zip codes. The median incidence of GSI per zip code was 142 (85-164); 5 zip codes comprised 50% of all GSI events. FI (incidence rate ratio [IRR] 4.05, 95% CI 3.98-4.13, P < .0001), LA (IRR 2.97, 95% CI 2.92-3.03. P < .0001), and LANV (IRR 2.58, 95% CI 2.55-2.62, P < .0001) were significant predictors of GSI incidence. The FI model was superior to the LA and LANV models. Geospatial analysis demonstrated that both FI (P < .0001) and LANV (P < .0001) were significantly associated with GSI, while LA was not (P > .05). CONCLUSION: FI is an independent risk factor for GSI incidence. Additionally, a majority of GSI events occur in a minority of communities. These data provide a novel opportunity for social services to guide future violence prevention strategies.

Long-Term Functional Outcomes after Traumatic Thoracic and Lumbar Spine Fractures.

The incidence of thoracolumbar spine fractures in blunt trauma is 4 to 5 per cent. These fractures may lead to neurologic injury, chronic back pain, and disability. Most studies from United States trauma centers focus on neurologic sequelae and/or compare treatment modalities. However, most patients with spine fractures do not have a neurologic deficit. Our primary objective was to determine the long-term outcome of traumatic thoracolumbar spine fractures, specifically addressing quality of life, chronic pain, and employment using a validated patient outcome survey. A chart review of 138 adult blunt trauma patients who sustained a thoracolumbar spine fracture and were admitted to our Level I trauma center from 2008 to 2013 was performed. A phone interview based on the Short-Form 12®, a general health survey, was then conducted. Of the 134 patients who met the inclusion criteria, 46 (34%) completed the survey. The average Short-Form 12® scores were 51.0 for the physical health component score and 52.9 for the mental health component score. These did not differ significantly from the national norm. Furthermore, 83 per cent (38) of the survey respondents returned to work full-time at the same level as before their injury. Majority of the patients (76%) said they did not have pain two to seven years after injury. Despite a commonly held belief that back injury leads to chronic pain and disability, after sustaining a thoracic or lumbar fracture, patients are generally able to return to work and have a comparable quality of life to the general population. This knowledge may be useful in counseling patients regarding expectations for recovery from trauma.

Comparison of 3-Factor Prothrombin Complex Concentrate and Low-Dose Recombinant Factor VIIa for Warfarin Reversal.

INTRODUCTION: Prothrombin complex concentrate (PCC) and recombinant Factor VIIa (rFVIIa) have been used for emergent reversal of warfarin anticoagulation. Few clinical studies have compared these agents in warfarin reversal. We compared warfarin reversal in patients who received either 3 factor PCC (PCC3) or low-dose rFVIIa (LDrFVIIa) for reversal of warfarin anticoagulation. METHODS: Data were collected from medical charts of patients who received at least one dose of PCC3 (20 units/kg) or LDrFVIIa (1000 or 1200 mcg) for emergent warfarin reversal from August 2007 to October 2011. The primary end-points were achievement of an INR 1.5 or less for efficacy and thromboembolic events for safety. RESULTS: Seventy-four PCC3 and 32 LDrFVIIa patients were analyzed. Baseline demographics, reason for warfarin reversal, and initial INR were equivalent. There was no difference in the use of vitamin K or fresh frozen plasma. More LDrFVIIa patients achieved an INR of 1.5 or less (71.9% vs. 33.8%, p =0.001). The follow-up INR was lower after LDrFVIIa (1.25 vs. 1.75, p < 0.05) and the percent change in INR was larger after LDrFVIIa (54.1% vs. 38.8%, p = 0.002). There was no difference in the number of thromboembolic events (2 LDrFVIIa vs. 5 PCC3, p = 1.00), mortality, length of hospital stay, or cost. CONCLUSIONS: Based on achieving a goal INR of 1.5 or less, LDrFVIIa was more likely than PCC3 to reverse warfarin anticoagulation. Thromboembolic events were equivalent in patients receiving PCC3 and LDrFVIIa.