Mary Pat McKay

Trauma Registries: History, Logistics, Limitations, and Contributions to Emergency Medicine Research

Trauma registries have been designed to serve a number of purposes, including quality improvement, injury prevention, clinical research, and policy development. Since their inception over 30 years ago, there are increasingly more institutions with trauma registries, many of which submit data to a national trauma registry. The goal of this review is to describe the history, logistics, and characteristics of trauma registries and their contribution to emergency medicine and trauma research. Discussed in this review are the limitations of trauma registries, such as variability in quality and type of the collected data, absence of data pertaining to long-term and functional outcomes, prehospital information, and complications as well as other methodologic obstacles limiting the utility of registry data in clinical and epidemiologic research.

Serious injuries related to the Segway® personal transporter: a case series.

STUDY OBJECTIVE We describe a case series of emergency department (ED) visits for injuries related to the Segway® personal transporter. METHODS This was a retrospective case review using a free-text search feature of an electronic ED medical record to identify patients arriving April 2005 through November 2008. Data were hand extracted from the record, and further information on admitted patients was obtained from the hospital trauma registry. RESULTS Forty-one cases were included. The median age was 50 years, and 30 patients (73.2%) were women. Twenty-nine (70.7%) of the patients resided outside the District of Columbia, Maryland, and Virginia, and 32 (78.1%) arrived between June and September. Seven (17.1%) patients had documented helmet use. Ten (24.4%) were admitted. Four patients (40% of admitted patients) required admission to the ICU. CONCLUSION The severity of trauma in this case series of patients injured by the use of the self-balancing personal transporter is significant. Further investigation into the risks of use, as well as the optimal length and type of training or practice, is warranted. A distinct E-code and Consumer Product Safety Commissions product code is needed to enable further investigation of injury risks for this mode of transportation.

The epidemiology of Mountain Bike Park injuries at the Whistler Bike Park, British Columbia (BC), Canada.

OBJECTIVE To describe the epidemiology of injuries sustained during the 2009 season at Whistler Mountain Bike Park. METHODS A retrospective chart review was performed of injured bike park cyclists presenting to the Whistler Health Clinic between May 16 and October 12, 2009. RESULTS Of 898 cases, 86% were male (median age, 26 years), 68.7% were Canadian, 19.4% required transport by the Whistler Bike Patrol, and 8.4% arrived by emergency medical services. Identification of 1759 specific injury diagnoses was made, including 420 fractures in 382 patients (42.5%). Upper extremity fractures predominated (75.4%), 11.2% had a traumatic brain injury, and 8.5% were transferred to a higher level of care: 7 by helicopter, 62 by ground, and 5 by personal vehicle. Two patients refused transfer. CONCLUSIONS Mountain bikers incurred many injuries with significant morbidity while riding in the Whistler Mountain Bike Park in 2009. Although exposure information is unavailable, these findings demonstrate serious risks associated with this sport and highlight the need for continued research into appropriate safety equipment and risk avoidance measures.

Mastitis and Methicillin-Resistant Staphylococcus Aureus (MRSA): The Calm Before the Storm?

BACKGROUND Post-partum mastitis is a common infection in breastfeeding women, with an incidence of 9.5-16% in recent literature. Over the past decade, community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant pathogen in soft-tissue infections presenting to the emergency department. The incidence of mastitis caused by MRSA is unknown at this time, but likely increasing. OBJECTIVES We review the data on prevention and treatment of mastitis and address recent literature demonstrating increases in MRSA infections in the post-partum population and how we should change our practices in light of this emerging pathogen. CASE REPORT We present a case of simple mastitis in a health care worker who failed to improve until treated with antibiotics appropriate for a MRSA infection. CONCLUSION Recent evidence suggests that just as MRSA has become the prominent pathogen in other soft-tissue infections, mastitis is now increasingly caused by this pathogen. Physicians caring for patients with mastitis need to be aware of this bacteriologic shift to treat appropriately.

Weekend Emergency Department Visits in Nebraska: Higher Utilization, Lower Acuity

BACKGROUND We know very little about differences in Emergency Department (ED) utilization and acuity on weekends compared with weekdays. Understanding such differences may help elucidate the role of the ED in the health care delivery system. STUDY OBJECTIVE To compare patterns of ED use on weekends with weekdays and analyze the differences between these two groups. METHODS The Health Care Utilization Project (HCUP) is a national state-by-state billing database from acute-care, non-federal hospitals. Data from Nebraska in 2004 was used to compare ED-only patient visits (patients discharged home or transferred to another health care facility) and ED-admitted visits (patients admitted to the same hospital after an ED visit) for weekend vs. weekday frequency, billed charges, sex, age, and primary payer. RESULTS Of all non-admitted patients who visited the ED, 34.5% came in on weekends. This yielded ED utilization rates of 25 visits/1,000 people on weekdays and 33 visits/1,000 people on weekends, an increase of 32% on weekends. Weekend-only ED patients of all ages and payer categories were charged lower hospital facility fees than weekday-only ED patients; USD 777 vs. USD 921, respectively (p < 0.001). Weekend ED patients were less likely to be admitted and less likely to die while in the ED (2 deaths/1000 ED visits for weekend-only patients vs. 3 deaths/1000 ED visits for weekday-only [p < 0.001]). CONCLUSIONS In Nebraska, EDs care for a greater number of low-acuity patients on weekends than on weekdays. This highlights the important role EDs play within the ambulatory care delivery system.

Exceeding the speed limit: prevalence and determinants in Iran

Speeding is one of the most common risk behaviours associated with crashes causing signficant injury. The objective of this study is to explore the prevalence and determinants of speeding on a road between Tehran and Hamadan, Iran. In a cross-sectional study in 2009, stretches of the road were studied including three groups of posted speed limits: < 50 km/h, 50–100 km/h and > 100 km/h. Each stretch was evaluated both in daylight and dark. Randomly identified drivers speed was checked by a handheld speed camera and then the driver was invited to participate in a survey. Statistical analysis was performed using Chi-Square, crude and adjusted odds ratio, 95% confidence interval and multiple logistic regression models. Overall, 52.8% of the drivers were travelling more than 10 km/h above the posted limit. Where limits were < 50 km/h, 74.6% of drivers were speeding. This declined to 46.9% for sections with limits between 50 and 100 km/h and to 36.9% for sections posted more than 100 km/h. Finally, more than half the drivers were observed to be speeding. Driving more than the posted limit was far more likely on the areas with the lowest posted speed limits, personal passenger vehicles, modern vehicles not using seat belts, and male drivers.

Analysis of emergency medical services activations in Shenandoah National Park from 2003 to 2007.

Abstract Background. Wilderness activities continue to be popular in the United States, but may lead to both direct injuries and exacerbations or complications from chronic diseases. Appropriate response planning requires information on the type and location of emergency medical services (EMS) activations in large outdoor areas with many visitors. Objectives. To describe EMS calls in Shenandoah National Park in Virginia and explore the resultant implications for EMS resources and staging, medical provider training, and potential public health interventions in similar wilderness recreation areas. Methods. A retrospective, descriptive review was conducted of all park EMS activations in Shenandoah National Park from 2003 to 2007. Results. There were 335 EMS activations within the park over the study period. Both call volume and call rate increased during the study period. There were 197 calls (58.8%%) for injuries and 138 (41.2%%) for illnesses. Weakness/dizziness was the most frequent illness complaint, and lower extremity injury was the most frequent injury. Those with illnesses were more likely to be seen by EMS at a lodge, tended to be female, and were more likely to require emergency transportation to a hospital. Chronic medical problems were reported for twice as many of the illness patients as for those who were injured. Conclusions. EMS runs in Shenandoah are increasing and the majority of calls from 2003 to 2007 were for injuries. A notable number of patients with both injuries and illnesses reported chronic medical conditions. These data may be used to help with EMS support availability planning, provider education, and safety planning within the park, and provide baseline data for future public-safety interventions.