Anna E. Waller

Unintentional injuries in the home in the United States: Part II: Morbidity

BACKGROUND Homes are an important setting for nonfatal unintentional injuries. The purpose of this study was to quantify and describe nonfatal, unintentional injuries in the United States, in which the injury took place at home. METHODS Data derived from the National Health Interview Survey, National Ambulatory Medical Care Survey, and National Hospital Ambulatory Medical Care Surveys for Outpatient and Emergency Departments. The nonfatal unintentional home injury rate and 95% confidence interval were computed for the United States overall (1998-1999), as well as by type of injury, gender, and age group. Weights were applied for each data set as designated by the National Center for Health Statistics. RESULTS In 1998, there were more than 12 million unintentional home injuries requiring some form of medical attention. Falls were the most common injury among all age groups, followed by cutting/piercing injuries, and injuries associated with being struck by or against an object or person. Injury rates were highest among the oldest and youngest age groups. There was inconsistency across data sets with regard to the presence of location information and definitions of the home environment, inclusion criteria, and the presence of external cause of injury and poisoning codes (E-codes). Depending on the data set, information was missing for 8% and 41% of cases on the location of injury, making it impossible to determine whether the injuries occurred in the home environment. CONCLUSIONS Falls are a significant problem, particularly among older adults. Additionally, data collection systems need to be improved so that location of injury data are routinely collected using consistent definitions so as to allow comparisons across data sets and over time.

Why Do Patients With Cancer Visit Emergency Departments? Results of a 2008 Population Study in North Carolina

PURPOSE Emergency departments (EDs) in the United States are used by patients with cancer for disease or treatment-related problems and unrelated issues. The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) collects information about ED visits through a statewide database. PATIENTS AND METHODS After approval by the institutional review board, 2008 NC DETECT ED visit data were acquired and cancer-related visits were identified. Descriptive statistics and logistic regressions were performed. Of 4,190,911 ED visits in 2008, there were 37,760 ED visits by 27,644 patients with cancer. RESULTS Among patients, 77.2% had only one ED visit in 2008, the mean age was 64 years, and there were slightly more men than women. Among visits, the payor was Medicare for 52.4% and Medicaid for 12.1%. More than half the visits by patients with cancer occurred on weekends or evenings, and 44.9% occurred during normal hours. The top three chief complaints were related to pain, respiratory distress, and GI issues. Lung, breast, prostate, and colorectal cancers were identified in 26.9%, 6.3%, 6%, and 7.7% of visits, respectively, with diagnosis. A total of 63.2% of visits resulted in hospital admittance. When controlling for sex, age, time of day, day of week, insurance, and diagnosis position, patients with lung cancer were more likely to be admitted than patients with other types of cancer. CONCLUSION To the best of our knowledge, this is the first study to provide a population-based snapshot of ED visits by patients with cancer in North Carolina. Efforts that target clinical problems and specific populations may improve delivery of quality cancer care and avoid ED visits.

Childhood injury deaths: National analysis and geographic variations

Twenty-three causes of injury mortality in children ages 0-14 in the United States were analyzed by age, race, sex, and state of residence for the years 1980-85. Motor vehicles caused 37 per cent of all injury-related deaths and were the leading cause of injury mortality in every group except children younger than one year, for whom homicide was the leading cause. Male death rates were at least four times female rates for suicide, unintentional firearm injury, and injuries related to farm machinery or motorcycles. The drowning rate among Whites was almost twice that of Blacks for ages 1-4, but in the 10-14 year age group the drowning rate for Blacks was over three times that of Whites. In general, the highest injury death rates were in the mountain states and the south. Between 1980 and 1985, the suicide rate in the 10-14 year age group more than doubled.

The New Zealand rugby injury and performance project. VI. A prospective cohort study of risk factors for injury in rugby union football

Objectives—Although the nature of rugby injury has been well documented, little is known about key risk factors. A prospective cohort study was undertaken to examine the association between potential risk factors and injury risk, measured both as an injury incidence rate and as a proportion of the playing season missed. The latter measure incorporates a measure of injury severity. Methods—A cohort of 258 male players (mean (SD) age 20.6 (3.7) years) were followed through a full competitive season. At a preseason assessment, basic characteristics, health and lifestyle patterns, playing experience, injury experience, training patterns, and anthropometric characteristics were recorded, and then a battery of fitness tests were carried out. Results—A multiple regression model identified grade and previous injury experience as risk factors for in season injury, measured as an injury incidence rate. A second model identified previous injury experience, hours of strenuous physical activity a week, playing position, cigarette smoking status, body mass index, years of rugby participation, stress, aerobic and anaerobic performance, and number of push ups as risk factors for in season injury, measured as proportion of season missed. Conclusions—The findings emphasise the importance of previous injury as a predictor of injury incidence and of missing play. They also show the importance of considering both the incidence rate and severity of injury when identifying risk factors for injury in sport.

The New Zealand Rugby Injury and Performance Project: II. Previous injury experience of a rugby-playing cohort.

The Rugby Injury and Performance Project (RIPP) is a prospective cohort study by a multidisciplinary research group. Rugby injuries constitute an important area for research because rugby union is New Zealands national sport and because of the considerable cost of all sports injury acknowledged by the Accident Rehabilitation and Compensation Insurance Corporation (ACC). The initial phase of data collection in the RIPP involved a pre-season questionnaire which, among other things, sought to establish variables relating to the past injury experience of players. The influence of previous injury, the use of safety equipment and the availability and significance of medical advice were among the variables identified by individual questionnaires. This paper analyses the responses to pre-season questions about injury experience in the previous 12 months. In so doing, it identifies baseline data which will be used to address a possible relationship between past injury experience and the prediction of injury during the season.

The New Zealand rugby injury and performance project. IV. Anthropometric and physical performance comparisons between positional categories of senior A rugby players.

OBJECTIVE--To describe the anthropometric and physical performance characteristics of a sample of senior A club rugby players and to highlight differences between the positional categories of the players within the forwards and backs. METHODS--94 senior A male rugby players were assessed on a number of anthropometric and physical performance assessments. The forwards were categorised into props, hookers, locks, and loose forwards. Backs were categorised into inside, midfield, and outside backs. Categories within the forwards were compared with each other, as were the categories within the backs. RESULTS--The anthropometric characteristics of forwards differed significantly between positional categories. Front row forwards (props and hookers) possessed highly endo-mesomorphic somatotypes, and typically rated very low for ectomorphy. Props possessed greater body mass than hookers. Locks and loose forwards were taller than the front row forwards. In terms of physical performance fewer differences were observed. Hookers performed better than props on an aerobic assessment. Locks and loose forwards were faster than the front row forwards on a 30 m sprint from a running start. The inside backs were shorter and lighter than the midfield and outside backs. CONCLUSIONS--The combination of anthropometric characteristics and physical performance attributes observed allows players to best meet the demands imposed on them by their position.

The New Zealand rugby injury and performance project. III. Anthropometric and physical performance characteristics of players.

OBJECTIVE: To investigate the anthropometric and physical performance characteristics of New Zealand rugby players of different ages and both sexes. METHODS: 356 rugby players (264 male, 92 female) took part in the study during a single season. Playing grade ranged from schoolboys and schoolgirls to senior men and women. Assessment of height, weight, neck circumference, and somatotype was performed before the competitive rugby season. A battery of six physical performance assessments was completed after the anthropometry. Analysis of variance was used to examine differences in these variables between field positions and grades. RESULTS: Significant differences between forwards and backs on anthropometric and physical performance variables were apparent at all grades assessed. In terms of anthropometric characteristics, forwards of a given grade were generally taller, possessed greater body mass, and were more endomorphic and less ectomorphic than backs of the same grade. The backs tended to perform better on physical performance measures than forwards, being more aerobically fit, faster, more agile, and possessing a higher degree of muscular endurance. Differences in anthropometry and physical performance attributes were also apparent between players from the various grades. The players at higher levels were generally larger, and performed better on tests of physical performance than the players at lower levels. These differences were found in both sexes. CONCLUSIONS: The greater body mass of the forwards allows them to obtain greater momentum than the backs when sprinting. The ability to obtain greater momentum is important in the body contact phases of the game. Forwards may compromise their aerobic fitness and speed to some extent in order to maintain a high body mass. The anthropometric and physical performance characteristics of players appear to reflect the demands placed on them by the sport.

Adult thermal injuries in New Zealand resulting in death and hospitalization

This paper provides an overview of thermal injury resulting in death or hospitalization in New Zealand adults, defined as age 15 years and over. For the 10-year period 1978-1987, there were 493 adult thermal injury deaths resulting in an overall rate of 2.1 per 100000 person-years (95%CI: 1.9-2.3). For the year 1988, there were 644 hospitalizations resulting in a rate of 25.1 per 100000 (95%CI: 23.2-27.1). The highest rates of death and hospitalization were observed in the elderly (65 years of age and over). Young males (15-29 years) also had a very high rate of hospitalization. Residential fire was the most common type of burn event resulting in death (44%), and smoking materials were the most common source of ignition in fatal residential fires (37%). Hot liquids were the most common source of thermal energy for the hospitalized injuries (34%). Typical scenarios involved burns from hot water expelled from automobile radiators, from hot water use in the workplace, from hot beverages, and from household hot tap-water. The epidemiology of the adult thermal injuries in New Zealand is similar to that reported in other developed countries. Opportunities and strategies for the prevention of these injuries are discussed.

The New Zealand Rugby Injury and Performance Project: I. Design and methodology of a prospective follow-up study.

Injury resulting from participation in sporting and physical recreational activities is a major contributor to the overall incidence of injury in the developed world. If sports injuries are to be reduced, a comprehensive approach must be taken to define the nature and magnitude of the problem, to establish models of relationships between risk factors, protective factors and injury experience, and to address injury through well designed intervention and evaluation programmes. The Rugby Injury and Performance Project (RIPP) is a prospective cohort study designed to examine the risk and protective factors for rugby injury. Data were collected on potential risk and protective factors from the RIPP cohort pre-season. Data on exposure to rugby, injury events and medical treatments were collected from the players each week during the season through telephone interviews. Pre-season measures were repeated post-season. A key feature of the design was that data were collected on both injured and non-injured players, allowing a longitudinal comparison of the injury experience of players with and without the factors of interest. A wealth of information was collected on each cohort member during the pre-season interview. A contact rate of 90% was achieved during the weekly follow-up phase. Post-season questionnaires were completed by 76% of the players and 88% of the coaches. Recommendations are made for the use of this methodology by other researchers and future directions for RIPP are described.

Reliability and Validity of the Emergency Severity Index for Pediatric Triage

OBJECTIVES The Emergency Severity Index (ESI) triage algorithm is a five-level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all-age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites. METHODS Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay. RESULTS Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi-square, p < 0.0001). Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs (odds ratio [OR] = 0.31, 95% CI = 0.14 to 0.67). CONCLUSIONS Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric-specific ESI educational materials to strengthen reliability and validity for pediatric triage.