Jeffrey H. Coben

Driving Patterns and Medical Conditions in Older Women

OBJECTIVES: To describe driving patterns (e.g., driving frequency) in older women drivers and to evaluate the impact of medical conditions and comorbidity on driving patterns.

Identification of Fall Risk Factors in Older Adult Emergency Department Patients

OBJECTIVESnFalls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED).nnnMETHODSnThis was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence.nnnRESULTSnA total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut ones own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55).nnnCONCLUSIONSnFalls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non-fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping ones own toenails, and previous falls are all associated with falls after ED discharge.

Correlates of injury to women with partners enrolled in batterer treatment programs.

OBJECTIVESnThis study examined correlates of injury in a cohort of women who were partners of men enrolled in batterer treatment programs.nnnMETHODSnCross-sectional data of 670 pairs of battered women and their partners were analyzed. Prevalence rates of womens self-reports of injury due to their partners abusive behavior were computed and compared by couples demographic and behavioral characteristics.nnnRESULTSnMens use of severe tactics of abuse was the characteristic most significantly associated with injury (odds ratio = 15.47; 95% confidence interval = 9.02, 26.55).nnnCONCLUSIONSnOur findings underscore the need to obtain information on the specific tactics used by couples to settle their disputes during universal screening by practitioners.

Identifying homes with inadequate smoke detector protection from residential fires in Pennsylvania

With data from the Center for Disease Controls Behavioral Risk Factor Surveillance System, we estimated the prevalence of homes with inadequate smoke detector protection from residential fires in Pennsylvania and identified the characteristics of these homes in an effort to identify useful prevention strategies for Pennsylvania and other regions with similar characteristics. Homes with inadequate smoke detector protection from residential fires were defined on three levels. Eight percent (95% CL = 6.8, 8.6) of homes lacked any installed smoke detectors, 14% (95% CL = 12.8, 15) lacked smoke detectors installed on the same floor where they slept, and 28% (95% CL = 26.6, 29.6) were found to engage in unsafe smoke detector practices. The strong predictors of unsafe smoke detector practices determined from logistic regression included black, non-Hispanic homes (OR = 1.53), homes with annual household income of less than +20,000 (OR = 1.29), and those with no children younger than 5 years old (OR = 1.55). These findings should assist policy makers in planning residential fire prevention programs for Pennsylvania, which has yet to meet the Healthy People 2000 objective regarding fire prevention.

Firearm ownership and storage practices in Pennsylvania homes.

OBJECTIVE: To determine the household prevalence of firearms in Pennsylvania, and describe the storage practices for these weapons. DESIGN: A statewide telephone survey of 3,620 Pennsylvania adults selected from households by random digit dialing in 1994. MAIN OUTCOME MEASURES: Firearm ownership and storage practices were computed by household characteristics using logistic regression. RESULTS: The prevalence of firearm ownership was 37% (95% confidence interval = 35.4 to 38.6). Ownership of firearms was significantly higher for white residents, households with annual income of

Evaluation of the Emergency Department Logbook for Population-Based Surveillance of Firearm-Related Injury

20,000 or more, those in rural counties, and those with children and adolescents. Of the households with firearms, 23% contained a single firearm, the majority of which were handguns (40%) or rifles (40%); 76% had two or more firearms, with 57% reporting one handgun or more and 83% reporting one rifle or more. Storage of firearms in 72% of households involved two or more of these barriers: (1) taken apart; (2) trigger lock applied; (3) kept in a locked place; (4) unloaded; (5) no other ammunition; (6) locked ammunition; 6% stored at least one of their firearms with none of these barriers. The strongest predictor of storing a firearm with fewer than two protective barriers was households with no children or adolescents. CONCLUSIONS: Firearms are present in a large number of Pennsylvania homes. Many of these homes also contain children. To reduce the potential risks of firearms, optimal methods of storage of firearms in the home need to be determined.

Injury surveillance: a statewide survey of emergency department data collection practices

STUDY OBJECTIVEnTo evaluate existing emergency department logbooks as a source of population-based data on firearm-related injuries.nnnMETHODSnWe examined the logbooks of the 24 acute care and specialty-hospital EDs in Allegheny County, Pennsylvania, to determine the number and type of data variables each contained and the completeness of reporting of each variable for selected firearm-related cases. The amount of missing data for certain variables was determined and the cause for the missing data described.nnnRESULTSnLogbooks from 18 of the 24 eligible hospitals were reviewed. We identified 785 cases of firearm-related injury recorded between January 1, 1992, and December 31, 1993. Of the variables we selected for analysis, only date (100%), chief complaint or diagnosis (100%), name (98%), and time of admission (97%) were consistently documented. In 37% of cases the patients county of residence could not be determined. Similarly incomplete data were found for body part injured (31%), race (28%), age (26%), sex (22%), and mode of arrival (21%). The factor most responsible for the high percentage of incomplete data was the considerable variation in the data elements contained in the different hospitals logbooks.nnnCONCLUSIONnMissing data resulting from inconsistencies in the variables contained in different EDs logbooks and errors of omission prevent ED logbooks, in their current state, from providing population-based data for surveillance of firearm-related injury. Standardization of such variables in ED logbooks would yield a more useful source of information for injury and disease surveillance. In lieu of standardized logbooks, multiple sources of data are necessary to establish a more comprehensive and useful system of surveillance of firearm-related injury.

Incidence of Dog Bite Injuries Treated in Emergency Departments

STUDY OBJECTIVEnTo assess current emergency department data collection practices in Pennsylvania and determine whether existing data sources can be used as part of a statewide injury surveillance system.nnnMETHODSnSeparate survey questionnaires requesting information on current ED patient data collection practices and attitudes were mailed to all directors of medical records, billing, and EDs in Pennsylvania (N = 212).nnnRESULTSnOf the medical records department respondents, 92% indicated that ED registration data are retained in a computerized information system; 94% of respondents from billing departments reported that their ED patient registration system is integrated with an ED billing system. A total of 36% of EDs surveyed use a computerized ED patient logbook, and another 27% plan to begin a computerized log within 2 years. Dictation and transcription services that permit electronic retrieval of text are being used by 26% of EDs for patient medical records.nnnCONCLUSIONnMany elements for building a statewide ED injury surveillance system are in place in Pennsylvania, but they are as yet incomplete. Future studies should examine the feasibility of integrating existing ED data systems into statewide injury surveillance systems.