Michael Singleton

Factors Associated with Higher Levels of Injury Severity in Occupants of Motor Vehicles That Were Severely Damaged in Traffic Crashes in Kentucky, 2000-2001

Objectives: The majority of motor vehicle occupants who were killed or hospitalized in crashes in Kentucky in 2000–2001 occupied vehicles that were severely damaged in the crash. Even so, overall only a small percentage of all severely damaged vehicle occupants were killed or hospitalized. The purpose was to identify occupant, vehicle, crash, and roadway/environmental factors that were associated with increased risk of severe injury in crashes where the occupants vehicle was severely damaged. Methods: This study probabilistically linked Kentuckys statewide motor vehicle crash and inpatient hospital discharge data files for 2000 and 2001, and selected cases representing occupants of vehicles that were reported by police as having either “severe” or “very severe” damage. For occupants who were identified through data linkage as having been hospitalized, the Injury Severity Score (ISS) was calculated using ICDMAP-90 TM software, and the scores were stratified into the following categories: critical (> 24), severe (15–24), moderate (9–14), and mild (< 9). We then created an outcome variable, injury severity level, with five levels: killed; hospitalized with at least moderate injuries (ISS = critical, severe, or moderate); hospitalized with mild injuries (ISS = mild); injured according to the police report but not hospitalized; and no apparent injury according to the police report. We performed a stepwise, ordinal logistic regression of injury severity, using independent variables identified from the existing crash literature. Results: Occupant risk factors for higher levels of injury severity selected by the regression were age (risk increased with age, other factors being equal), female gender, restraint non-use, ejection from the vehicle, and driver impairment (by alcohol and/or drugs). Crash risk factors included head-on collision, collision with a fixed object, vehicle rollover, and vehicle fire. Roadway/environmental factors were federal- or state-maintained roadway and posted speed limit 89 kph (55 mph) or greater. Conclusions: Many of the identified risk factors are explicitly or implicitly mentioned in the strategic plans of key organizations involved in highway safety and injury prevention in Kentucky. Our analysis provides additional evidence of their importance, and confirms that their mitigation will reduce injury severity in crashes involving severe vehicle damage. Additionally, older occupants and female occupants showed increased risks of serious injury, but to our knowledge these factors are not currently addressed in any state plans. An opportunity exists to clarify the nature of these risks through further studies, which might lead to the identification of countermeasures specific to these populations.

Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance

BACKGROUND The study aims to describe recent changes in Kentuckys drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. METHODS The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky. RESULTS Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25-34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening. CONCLUSIONS The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records.

Surveillance of methadone-related poisonings in Kentucky using multiple data sources

The methadone poisoning death rate for Kentucky in the year 2005 was the sixth highest in the US and increased 17‐fold from 1999 to 2005. The purpose of this study was to identify and characterize methadone related poisonings in Kentucky using multiple data sources: inpatient hospitalization discharge data, poison control center data, vital statistics mortality data, and Kentucky All Schedule Prescription Electronic Reporting (KASPER) data.

Body mass index, asthma and exhaled nitric oxide in U.S. adults, 2007-2010.

Abstract Objective: Increases in asthma and obesity over the past three decades have led to speculation about a causal link between the two diseases. However, investigations of the relationship between body mass index (BMI) and fractional exhaled nitric oxide (FeNO) – a marker of eosinophilic airway inflammation – have produced mixed results. The purpose of this study was to evaluate the relationship between body mass index (BMI), asthma and FeNO in a sample of U.S. adults using data from the National Health and Nutrition Examination Surveys (NHANES) for 2007–2010. Methods: We assessed the relationship between FeNO and BMI in subjects with and without asthma using categorical and continuous models for BMI. All models controlled for age, gender, ethnicity, household income-to-poverty ratio, atopy and current smoking. Results: Adjusted asthma prevalence was positively associated with BMI, and subjects with asthma had higher adjusted FeNO levels than subjects without asthma. However, no association between FeNO and BMI was observed in either those with (β = 0.002, p = 0.74) or without (β = 0.0014, p = 0.51) asthma after adjusting for covariates. Conclusions: Our results suggest that in the U.S. adult population, BMI is not associated with eosinophilic airway inflammation.

Motorcycle helmet effectiveness in reducing head, face and brain injuries by state and helmet law

Background Despite evidence that motorcycle helmets reduce morbidity and mortality, helmet laws and rates of helmet use vary by state in the U.S. Methods We pooled data from eleven states: five with universal laws requiring all motorcyclists to wear a helmet, and six with partial laws requiring only a subset of motorcyclists to wear a helmet. Data were combined in the Crash Outcome Data Evaluation System’s General Use Model and included motorcycle crash records probabilistically linked to emergency department and inpatient discharges for years 2005-2008. Medical outcomes were compared between partial and universal helmet law settings. We estimated adjusted relative risks (RR) and 95 % confidence intervals (CIs) for head, facial, traumatic brain, and moderate to severe head/facial injuries associated with helmet use within each helmet law setting using generalized log-binomial regression. Results Reported helmet use was higher in universal law states (88 % vs. 42 %). Median charges, adjusted for inflation and differences in state-incomes, were higher in partial law states (emergency department

Comparison of incidence of hospital utilization for poisoning and other injury types

1987 vs.

ECONOMIC COSTS OF LOW SAFETY BELT USAGE IN MOTOR VEHICLE CRASHES IN KENTUCKY

1443; inpatient

Concordance of motor vehicle crash, emergency department, and inpatient hospitalization data sets in the identification of drugs in injured drivers.

31,506 vs.

Establishment of a comprehensive drug overdose fatality surveillance system in Kentucky to inform drug overdose prevention policies, interventions and best practices

25,949). Injuries to the head and face, including traumatic brain injuries, were more common in partial law states. Effectiveness estimates of helmet use were higher in partial law states (adjusted-RR (CI) of head injury: 2.1 (1.9-2.2) partial law single vehicle; 1.4 (1.2, 1.6) universal law single vehicle; 1.8 (1.6-2.0) partial law multi-vehicle; 1.2 (1.1-1.4) universal law multi-vehicle). Conclusions Medical charges and rates of head, facial, and brain injuries among motorcyclists were lower in universal law states. Helmets were effective in reducing injury in both helmet law settings; lower effectiveness estimates were observed in universal law states.

Differential protective effects of motorcycle helmets against head injury

Objectives. We investigated the incidence of hospital utilization for injuries and compared poisoning with other forms of injury. Previous studies have suggested poison control centers reduce health-care costs by decreasing hospital utilization. Methods. We conducted a one-year retrospective study involving patients treated for injuries at acute-care hospitals in Kentucky in 2008. We also compared inpatient discharges with discharges directly from the emergency department (ED) to determine hospitalization rates. The primary data sources were the Kentucky Hospital Billing database and the Kentucky Regional Poison Control Center (KRPCC) database. Results. In 2008, there were 377,642 hospital encounters for injuries in Kentucky. The most common mechanisms of injury were falls, struck by/against, motor vehicle traffic crashes, and overexertion. Three causes of injury were greater than one standard deviation above the mean in percentage of inpatient admissions: poisoning (41.3%), firearms (38.4%), and drowning (22.4%). During this same year, KRPCC reported 46,258 poisonings, with 76.5% of patients managed outside of a health-care facility, 11.4% of patients treated and released from the ED, 7.1% of patients admitted to inpatient care, 2.3% of patients admitted to psychiatric care, and 2.7% lost to follow-up. Conclusions. Three causes of injury had the greatest percentage of patients admitted for inpatient medical care—poisoning, firearms, and drowning—suggesting a high level of severity in these injuries presenting to the ED. We believe availability and use of a poison control center reduced hospital utilization for poisoning primarily by managing a large number of low-severity patients outside of the hospital system.