Thomas Duncan

Prevention of firearm-related injuries with restrictive licensing and concealed carry laws: an Eastern Association for the Surgery of Trauma systematic review

BACKGROUND In the past decade, more than 300,000 people in the United States have died from firearm injuries. Our goal was to assess the effectiveness of two particular prevention strategies, restrictive licensing of firearms and concealed carry laws, on firearm-related injuries in the US Restrictive Licensing was defined to include denials of ownership for various offenses, such as performing background checks for domestic violence and felony convictions. Concealed carry laws allow licensed individuals to carry concealed weapons. METHODS A comprehensive review of the literature was performed. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the data specific to our Population, Intervention, Comparator, Outcomes (PICO) questions. RESULTS A total of 4673 studies were initially identified, then seven more added after two subsequent, additional literature reviews. Of these, 3,623 remained after removing duplicates; 225 case reports, case series, and reviews were excluded, and 3,379 studies were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of 14 studies which merited inclusion for PICO 1 and 13 studies which merited inclusion for PICO 2. CONCLUSION PICO 1: We recommend the use of restrictive licensing to reduce firearm-related injuries. PICO 2: We recommend against the use of concealed carry laws to reduce firearm-related injuries. This committee found an association between more restrictive licensing and lower firearm injury rates. All 14 studies were population-based, longitudinal, used modeling to control for covariates, and 11 of the 14 were multi-state. Twelve of the studies reported reductions in firearm injuries, from 7% to 40%. We found no consistent effect of concealed carry laws. Of note, the varied quality of the available data demonstrates a significant information gap, and this committee recommends that we as a society foster a nurturing and encouraging environment that can strengthen future evidence based guidelines. LEVEL OF EVIDENCE Systematic review, level III.

Prevention of fall-related injuries in the elderly: an eastern association for the surgery of trauma practice management guideline

BACKGROUND Fall-related injuries among the elderly (age 65 and older) are the cause of nearly 750,000 hospitalizations and 25,000 deaths per year in the United States, yet prevention research is lagging. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the Eastern Association for the Surgery of Trauma produced this practice management guideline to answer the following injury prevention–related population, intervention, comparator, outcomes (PICO) questions: PICO 1: Should bone mineral–enhancing agents be used to prevent fall-related injuries in the elderly? PICO 2: Should hip protectors be used to prevent fall-related injuries in the elderly? PICO 3: Should exercise programs be used to prevent fall-related injuries in the elderly? PICO 4: Should physical environment modifications be used to prevent fall-related injuries in the elderly? PICO 5: Should risk factor screening be used to prevent fall-related injuries in the elderly? PICO 6: Should multiple interventions tailored to the population or individual be used to prevent fall-related injuries in the elderly? METHODS A comprehensive search and review of all the available literature was performed. We used the GRADE methodology to assess the breadth and quality of the data specific to our PICO questions. RESULTS We reviewed 50 articles that met our inclusion and exclusion criteria as they applied to our PICO questions. CONCLUSION Given the data constraints, we offer the following suggestions and recommendations: PICO 1: We conditionally recommend vitamin D and calcium supplementation for frail elderly individuals. PICO 2: We conditionally recommend hip protectors for frail elderly individuals, in the appropriate environment. PICO 3: We conditionally recommend evidence-based exercise programs for frail elderly individuals. PICO 4: We conditionally recommend physical environment modification for frail elderly people. PICO 5: We conditionally recommend frailty screening for the elderly. PICO 6: We strongly recommend risk stratification with targeted comprehensive risk-reduction strategies tailored to particular high-risk groups. LEVEL OF EVIDENCE Systematic review, level III.

Operation PeaceWorks: A community program with the participation of a Level II trauma center to decrease gang-related violence

BACKGROUND Gang-related violence is a major public health problem. A gang prevention program (Operation PeaceWorks) was developed in Ventura County, California, to help trauma patients who were gang members quit gang lifestyles. The purpose of this study was to determine the incidence of gang-related violence in the community before and after establishing Operation PeaceWorks. METHODS In Operation PeaceWorks, participating gang members were mentored, counseled, offered job training, and provided with opportunities to further their education or secure employment. Data about gang-related activity in the community were identified and recorded. The number of gang-related assaults (total), assaults involving firearms, and homicides were determined and compared before and after the start of the program. RESULTS During the 3 years after starting Operation PeaceWorks (2010–2012), the program had 3,430 interventions with 1,464 gang members (2.3 interventions per gang member). Three years after starting Operation PeaceWorks, there was a significant decrease in mean annual total gang assaults (−16%, p < 0.001), assaults with firearms (−32%, p < 0.001), and homicides (−47%, p = 0.05) compared with the 7 years before Operation PeaceWorks. CONCLUSION A multidisciplinary community gang prevention program, with the participation of the trauma center, may be effective in decreasing gang-related trauma. The experience with this program may contribute to the development of further evidence-based programs to decrease gang-related trauma. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.

Motor Vehicle Collision-Related Injuries in the Elderly: An Eastern Association for the Surgery of Trauma Evidence-Based Review of Risk Factors and Prevention.

Advancements in car and road safety in the US have led to a drop in the number of overall fatalities per million miles traveled in recent decades. However, elderly individuals (aged 65 and older) remain more likely to die or be severely injured due to motor vehicle collisions (MVCs) than younger people. As the elderly population continues to grow, the number of elderly injured by MVCs is also expected to increase. In this article, the authors investigate MVC-related injury prevention strategies aimed at elderly drivers and pedestrians. An evidence-based review of risk factors and prevention is conducted. The authors determine that injury prevention research is lagging and they recommend further research to strengthen future evidence-based guidelines.

Primary prevention of contact sports-related concussions in amateur athletes: a systematic review from the Eastern Association for the Surgery of Trauma

Background Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years. Our objective is to conduct a prospectively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions. Methods Using the Grading of Recommendations Assessment, Development, and Evaluation methodology, we performed a systematic review of the literature to answer seven population, intervention, comparator, and outcomes (PICO) questions regarding concussion education, head protective equipment, rules prohibiting high-risk activity and neck strengthening exercise for prevention of contact sports-related concussion in pediatric and adult amateur athletes. A query of MEDLINE, PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Embase was performed. Letters to the editor, case reports, book chapters, and review articles were excluded, and all articles reviewed were written in English. Results Thirty-one studies met the inclusion criteria and were applicable to our PICO questions. Conditional recommendations are made supporting preventive interventions concussion education and rules prohibiting high-risk activity for both pediatric and adult amateur athletes and neck strengthening exercise in adult amateur athletes. Strong recommendations are supported for head protective equipment in both pediatric and adult amateur athletes. Strong recommendations regarding newer football helmet technology in adult amateur athletes and rules governing the implementation of body-checking in youth ice hockey are supported. Conclusion Despite increasing scientific attention to sports-related concussion, studies evaluating preventive interventions remain relatively sparse. This systematic review serves as a call to focus research on primary prevention strategies for sports-related concussion. Level of evidence IV. PROSPERO registration number #42016043019.

Elder abuse: Paucity of data hampers evidence-based injury prevention.

B y 2050, 25% of the US population will consist of individuals older than age 65 compared to the 12.5% makeup in 2000. Wolf reported that in 2000, 4% to 6% of older people had been abused. Only a decade later, the US National Elder Mistreatment Study found that 1 in 10 people aged older than 60 has experienced some kind of mistreatment. While it is unclear if this represents an increase in abuse or an increase in reporting, it is certain that elder abuse is common and serious. The Injury Control and Violence Prevention Section of the Eastern Association for the Surgery of Trauma (EAST), the Practice Management Guidelines Section of EAST, the Injury Prevention Committee of the AmericanAssociation for the Surgery of Trauma (AAST), and the Geriatric Trauma Committee of AAST agree that such maltreatment of our elders must stop. The focus of this paper is to educate the trauma community about current literature on elder abuse prevention, encourage prevention initiatives, and direct future research.

The East’s Injury Control and Violence Prevention Committee’s Annual Distracted Driving Outreach Event: Evaluating attitude and behavior change in high school students

BACKGROUND The National Center for Statistics and Analysis reports at least eight deaths and 1,160 daily injuries due to distracted driving (DD) in the United States. Drivers younger than 20 years are most likely to incur a distraction-related fatal crash. We aimed to determine short- and long-term impact of a multimodal educational program including student-developed interventions, simulated driving experiences, and presentations by law enforcement and medical personnel. METHODS A single-day program aimed at teen DD prevention was conducted at a high school targeting students aged 15 years to 19 years old. Students were surveyed before, after, and at 6 weeks. We surveyed age, gender, knowledge, and experience regarding DD. Summary statistics were obtained at each survey time point. Bivariate and multivariable analysis were conducted to assess whether change in responses varied over time points. Multivariable models were adjusted for sex and urban and rural driving. RESULTS Preintervention, postintervention, and 6-week follow-up surveys were completed by 359, 272 (76%), and 331 (92%) students, respectively. At baseline and 6-week follow-up, the most frequent passenger-reported DD behaviors were cell phone (63% [63% at follow-up) and radio use (61% [63%]). Similarly, the most frequent driver-reported DD behaviors were cell phone (68% [72%]) and radio use (79% [80%]). When students were asked, “How likely are you to use your cell phone while driving?” they answered “never” 35%, 70%, and 46% on the preintervention, postintervention, and 6-week surveys. They were less likely to report consequences to be worse or change in attitude to a great extent at 6 weeks (p < 0.01). Gender and urban or rural driving were not significantly associated with responses. CONCLUSIONS While DD education may facilitate short-term knowledge and attitude changes, there appears to be no lasting effect. Research should be focused toward strategies for longer-term impact. LEVEL OF EVIDENCE Therapeutic study, level II.

Case Report of Situs Inversus Totalis and Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy (LC) in patients with situs inversus totalis (SIT) characterized by transposition of organs to the opposite side of the body can be technically challenging. A 43-year-old Hispanic woman presented with epigastric pain radiating to the chest and back, intermittently over 3 months, but worse on day of admission. During the cardiac workup, she was noted to have dextrocardia. The patient had a left-sided Murphys sign, propagating a workup that confirmed SIT, including an ultrasound showing cholelithiasis and normal ducts. The patient underwent an LC and was found to have choledocholithiasis. An endoscopic retrograde cholangiopancreatography cleared the common bile duct of a choledocholith. LC is the gold standard for cholecystitis. It is the second most common laparoscopic procedure conducted worldwide. When SIT is encountered, feasibility and technical difficulty in diagnosis and treatment of such cases pose challenges due to contralateral transposition of the visceral organs. Di...