Krista K. Wheeler

Costs, mortality likelihood and outcomes of hospitalized US children with traumatic brain injuries

Primary objective: To examine the hospitalization costs and discharge outcomes of US children with TBI and to evaluate a severity measure, the predictive mortality likelihood level. Research design: Data from the 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) were used to report the national estimates and characteristics of TBI-associated hospitalizations among US children ≤20 years of age. The percentage of children with TBI caused by motor vehicle crashes (MVC) and falls was calculated according to the predictive mortality likelihood levels (PMLL), death in hospital and discharge into long-term rehabilitation facilities. Associations with the PMLL, discharge outcomes and average hospital charges were examined. Results: In 2006, there were an estimated 58 900 TBI-associated hospitalizations among US children, accounting for

Undertriage of major trauma patients in the US emergency departments

2.56 billion in hospital charges. MVCs caused 38.9% and falls caused 21.2% of TBI hospitalizations. The PMLL was strongly associated with TBI type, length of hospital stay, hospital charges and discharge disposition. About 4% of children with fall or MVC related TBIs died in hospital and 9% were discharged into long-term facilities. Conclusion: The PMLL may provide a useful tool to assess characteristics and treatment outcomes of hospitalized TBI children, but more research is still needed.

Work-related non-fatal injuries among foreign-born and US-born workers: Findings from the U.S. National Health Interview Survey, 1997–2005

BACKGROUND There is evidence that regionalized trauma care and appropriate triage of major trauma patients improve patient outcomes. However, the national rate of undertriage and diagnoses of undertriaged patients are unknown. METHODS We used the 2010 Nationwide Emergency Department Sample to estimate the national rate of undertriage, identify the prevalent diagnoses, and conduct a simulation analysis of the capacity increase required for level I and II trauma centers (TCs) to accommodate undertriaged patients. Undertriaged patients were those with major trauma, injury severity score ≥ 16, who received definitive care at nontrauma centers (NTCs), or level III TCs. The rate of undertriage was calculated with those receiving definitive care at an NTC center or level III center as a fraction of all major trauma patients. RESULTS The estimated number of major trauma patient discharges in 2010 was 232448. Level of care was known for 197702 major trauma discharges, and 34.0% were undertriaged in emergency departments (EDs). Elderly patients were at a significantly higher risk of being undertriaged. Traumatic brain injury (TBI) was the most common diagnosis, 40.2% of the undertriaged patient diagnoses. To accommodate all undertriaged patients, level I and II TCs nationally would have to increase their capacity by 51.5%. CONCLUSIONS We found that more than one-third of US ED major trauma patients were undertriaged, and more than 40% of undertriaged diagnoses were TBIs. A significant capacity increase at level I and II TCs to accommodate these patients appears not feasible.

Paediatric patients with abusive head trauma treated in US Emergency Departments, 2006–2009

BACKGROUND Millions of foreign-born workers are employed in the US. Population-based surveys have value in describing the non-fatal work-related injuries that these workers suffer. METHODS Using data from the 1997-2005 National Health Interview Survey, we compared the rates of non-fatal work-related injuries among foreign-born and US-born adult workers. Logistic regression was used to produce work-related injury odds ratios (ORs) and 95% confidence intervals (95% CI) by nativity and years of residence while controlling for sex, age, race/ethnicity, education, poverty, family size, insurance status, delayed medical care, and alcohol use. Industry-specific rates were also compared. RESULTS Foreign-born workers reported a lower rate of work-related injuries than US-born workers, 50 per 10,000 foreign-born workers versus 89 per 10,000 US-born workers (P < 0.01). After controlling for confounding variables, the OR of work-related injuries for foreign-born workers as compared to US-born workers was 0.50 (95% CI = 0.38-0.66). The construction, agriculture/forestry and fisheries, and manufacturing industries had the highest work-related injury rates for both groups of workers. CONCLUSIONS Foreign-born workers had a lower overall rate of work-related injury when compared to US-born workers. Both US-born and foreign-born workers face significant injury risks, especially in certain industries. Interventions tailored with ethnic and cultural differences in mind are still warranted.

Alcohol Consumption and Work-Related Injuries Among Farmers in Heilongjiang Province, People's Republic of China

Abstract Objective: To study characteristics and outcomes of paediatric patients with abusive head trauma (AHT) treated in emergency departments. Methods: Nationwide Emergency Department Sample (NEDS) data were analysed. The CDC recommended AHT definition was used to classify children ≤ 4 years with head trauma into AHT and non-AHT groups. Outcomes were compared between patients with AHT and patients with non-AHT. Logistic models were fitted to identify risk factors. Results: An estimated 10 773 paediatric patients with AHT were treated in EDs in 2006–2009. The average annual rate was 12.83 per 100 000 for children ≤ 4 years. Children < 1 year of age accounted for most AHT cases (60.6%) and males had a significantly higher AHT rate than females. Medicaid was the primary payer for 66.1% of AHT injuries and 40.3% of non-AHT injuries. The case mortality rate was 53.9 (95% CI = 41.0–66.7) per 1000 patients with AHT compared with 1.6 (95% CI = 1.4–1.9) per 1000 patients with non-AHT. Conclusions: Child caregivers should be educated about the serious consequences of AHT and proper techniques for caring for infants. Unbiased and accurate documentation of AHT by physicians and medical coders is crucial for monitoring AHT injuries.

Immigrants as crime victims: Experiences of personal nonfatal victimization

BACKGROUND Alcohol consumption has been found to be associated with work-related injuries among workers around the world, but this association has not well been studied among agricultural workers in China. METHODS This population-based survey aimed to study the association between alcohol use and work-related agricultural injury. Farmers in a northeastern province of China were questioned about work-related injury in the past year (May 2007-April 2008), alcohol use, farming practices, and sociodemographic factors. The Chi-square test and logistic regression analyses were used to investigate the role of alcohol drinking in agricultural injuries. RESULTS Among 2,050 farmers who completed the survey, the 12-month prevalence of work-related injury was 12.2%. The leading external cause of injury was exposure to mechanical force. The odds of injury among farmers with past month drinking, who drank distilled spirits, and reported intoxication were respectively 1.77 (95% CI = 1.27-2.47), 1.89 (95% CI = 1.35-2.66), 2.12 (95% CI = 1.42-3.11). The odds of injury also significantly increased with greater average amounts of pure alcohol per day, with increased frequency of drinking per week, and with greater reported years of drinking. Each alcohol use variable was associated with injury in logistic regression models while controlling for sex, age, years of farm work, months of farm work in the past 12 months, driving a motor vehicle, and agricultural machinery use. CONCLUSIONS We found a significant association between alcohol consumption and work-related injuries among farmers. Our findings stress the need for culturally appropriate interventions which affect alcohol use and prevent injuries among Chinese farmers.

Back Pain among Farmers in A Northern Area of China

BACKGROUND Immigrants to the United States are disproportionately victims of homicide mortality in and outside the workplace. Examining their experiences with nonfatal victimization may be helpful in understanding immigrant vulnerability to violence. METHODS We compared the annual prevalence of nonfatal personal victimization experienced by immigrant and US-born adults by sociodemographics, employment, occupation, industry, smoking, alcohol and drug use using data from Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS The prevalence of victimization among immigrants was comparable to that among US-born adults [3.84% (95% CI: 3.18-4.63) vs. 4.10% (95% CI: 3.77-4.44)]. Lower percentages of victimization experienced by immigrants were seen among the unmarried, those age 30-44 years, and among residents of central city areas as compared to those groups among the US-born. For immigrants entering the US as youth, the victimization prevalence declines with greater years of residency in US. Multivariate logistic regression models suggest that, the odds of victimization was significantly associated with age, family income, marital status, central city residency, smoking, and drug use while employment status was not a significant factor. Immigrant workers with farming/forestry occupations might face a higher risk of being victims of violence than their US-born counterparts. CONCLUSIONS The prevalence of victimization among immigrants was comparable to that among US-born adults. Employment status and industry/occupation overall were not significant risk factors for becoming victims of violence.

Nonoccupational and Occupational Injuries to US Workers With Disabilities

Study Design. This was a population-based survey conducted in 2008 in a northern area of China. Objective. To investigate back pain prevalence and to examine the associations between potential risk factors and back pain among Chinese farmers. Summary of Background Data. Few studies have investigated back pain and its associated risk factors among farmers in low-income and developing nations. Methods. Farmers ages 15 years and older were chosen from 800 families in Heilongjiang province of the Peoples Republic of China using cluster sampling methods. Complete survey data were obtained from 2045 farmers. The prevalence of self-reported back pain during the previous 3 months was reported. Associations between back pain and potential risk factors, which included age, gender, education levels, perceived stress, main farm activities, smoking, and drinking status, were examined in logistic regression models. Results. A total of 786 (38.4%) farmers reported back pain. Two-thirds of those with back pain (66.0%) reported that back pain affected work quantity and quality. The adjusted odds ratios of reporting back pain increased with advancing age. Females and farmers who experienced stress regularly were also more likely to report back pain. Conclusion. Back pain is a common problem among Chinese farmers and is reported more frequently by females. Significant positive associations of gender, age, and perceived stress with back pain warrant additional study.

An Evaluation of Comparability between NEISS and ICD-9-CM Injury Coding

OBJECTIVES We examined medically treated injuries among US workers with disability. METHODS Using 2006-2010 National Health Interview Survey data, we compared 3-month rates of nonoccupational and occupational injuries to workers with disability (n = 7729) and without disability (n = 175 947). We fitted multivariable logistic regression models to calculate odds ratios and 95% confidence intervals of injuries by disability status, controlling for sociodemographic variables. We also compared leading causes of injuries by disability status. RESULTS In the 3-month period prior to the survey, workers with disability were more likely than other workers to have nonoccupational injuries (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 2.04, 2.71) and occupational injuries (OR = 2.39; 95% CI = 1.89, 3.01). For both groups, the leading cause was falls. CONCLUSIONS Disability status was strongly associated with risk of nonoccupational and occupational injuries among US workers. The safety issues facing US workers with disability in the workplace warrant future research. Federal agencies with an interest in the employment of workers with disability and their safety in the workplace should take a lead in further assessing injury risk and in promoting a safe working environment for workers with disability.

Chronic conditions and outcomes of pediatric trauma patients.

Objective To evaluate the National Electronic Injury Surveillance System’s (NEISS) comparability with a data source that uses ICD-9-CM coding. Methods A sample of NEISS cases from a children’s hospital in 2008 was selected, and cases were linked with their original medical record. Medical records were reviewed and an ICD-9-CM code was assigned to each case. Cases in the NEISS sample that were non-injuries by ICD-9-CM standards were identified. A bridging matrix between the NEISS and ICD-9-CM injury coding systems, by type of injury classification, was proposed and evaluated. Results Of the 2,890 cases reviewed, 13.32% (n = 385) were non-injuries according to the ICD-9-CM diagnosis. Using the proposed matrix, the comparability of the NEISS with ICD-9-CM coding was favorable among injury cases (κ = 0.87, 95% CI: 0.85–0.88). The distribution of injury types among the entire sample was similar for the two systems, with percentage differences ≥1% for only open wounds or amputation, poisoning, and other or unspecified injury types. Conclusions There is potential for conducting comparable injury research using NEISS and ICD-9-CM data. Due to the inclusion of some non-injuries in the NEISS and some differences in type of injury definitions between NEISS and ICD-9-CM coding, best practice for studies using NEISS data obtained from the CPSC should include manual review of case narratives. Use of the standardized injury and injury type definitions presented in this study will facilitate more accurate comparisons in injury research.