[show abstract][hide abstract] ABSTRACT: The primary objective was evaluation of the injury pattern of children 14 years old or less involved in bicycle accidents and comparison of the differences between those wearing a helmet and not wearing a helmet.
This was a retrospective cohort study of all pediatric patients involved in bicycle crashes from 2008 through 2010 who were treated within the West Virginia Trauma System. A case was selected for further analysis if "bicycle" and "blunt cause of injury" were present in the Mechanism of Injury field and if age was 14 years old or less. Descriptive statistics were calculated on all variables. Differences between the helmeted and un-helmeted cohorts were tested using the Wilcoxon test or Fisher's exact test as appropriate. In all cases an alpha of 0.05 was selected as the threshold for statistical significance.
The helmeted group had a concussion rate of 19.4% while concussions were noted in 37.4% of the un-helmeted group (p = 0.0509). Additionally, there was a significant difference in the rate of skull fractures seen. Skull fractures occurred in 3.2% of the helmeted and 17.4% of the un-helmeted (p = 0.0408) riders. The rate of intra-cranial hemorrhage was 0% in helmeted riders and 17.4% in un-helmeted riders (p = 0.0079). Finally, perhaps the largest indicator of the effectiveness of helmets in the pediatric bicycle population is the mortality rate. While not statistically different, 100% (n = 2) of the deaths occurred in the un-helmeted group.
This study of the West Virginia pediatric population demonstrates findings similar to prior studies looking at the effectiveness of helmets in preventing injuries during a bicycle crash. Bicycle helmets were shown to significantly reduce the rates of both skull fractures and intracranial hemorrhage. Based on this, the expanded use of helmets within the pediatric population should continue to be encouraged both from an educational and legislative standpoint.
The West Virginia medical journal 01/2012; 108(3):78-81.
[show abstract][hide abstract] ABSTRACT: All-terrain vehicles (ATVs) are a popular source of outdoor activity in the United States, particularly in West Virginia. During the period of time from 1999 to 2007, deaths associated with ATVs in West Virginia increased by 28%. Helmet use among bicycle and motorcycle riders has been shown to decrease morbidity and mortality following trauma.
We performed a retrospective observational study to compare injury patterns, hospital course, and resource utilization of non-helmeted and helmeted riders involved in ATV accidents using data from the West Virginia Trauma Center System. Descriptive statistics were calculated for all study variables and comparisons were made between helmeted and non-helmeted riders.
In 2010, there were 1,059 patients aged 18 and over with traumas resulting from ATV accidents within the System. Riders involved in ATV trauma occurring on farms and streets were significantly more likely to be non-helmeted, while those using ATVs for recreational purposes were more likely to be helmeted. Non-helmeted riders were significantly more likely to arrive to the hospital via helicopter than helmeted riders, and were less likely to be discharged home from the ED compared to helmeted riders. Non-helmeted riders sustained significantly more head, neck, soft tissue injuries, concussions, intracranial hemorrhages, facial fractures, skull fractures, and thoracic spine fractures than helmeted riders.
The findings of the current study support previous studies documenting that helmet use is protective against intracranial injury and other injuries of the head and neck. ATV use continues to be a significant contribution to trauma morbidity and mortality in West Virginia.
Efforts that focus on increased helmet use have the potential to significantly reduce morbidity and mortality following ATV trauma. Enforcement of the current West Virginia ATV Law should be encouraged. Legislation expanding the mandatory use of safety equipment and rider training should be enacted in West Virginia.
The West Virginia medical journal 01/2012; 108(3):96-101.
[show abstract][hide abstract] ABSTRACT: Our study examines injury patterns, treatment implications, discharge disposition, and injury prevention for trauma patients with dementia. It is a retrospective observational study of trauma patients at the Jon Michael Moore Trauma Center at West Virginia University Hospitals. Causes of injury, injuries sustained, and discharge disposition were examined in 286 trauma patients with a pre-existing diagnosis of dementia and 5,865 trauma patients without dementia. All patients included in this study were 40 years of age or older. Injury data were compiled for patients with dementia. Causes of injury and discharge disposition were compared for the two groups.
The West Virginia medical journal 01/2011; 107(3):48-52.
[show abstract][hide abstract] ABSTRACT: One previous study found that healthlines affiliated with academic neurology programs recommended non-emergent treatment for a hypothetical stroke scenario almost one quarter of the time, which could contribute to patients presenting too late for time dependent stroke therapies. We assessed the treatment advice given in a hypothetical stroke scenario by primary care physician offices across the United States.
We obtained a national listing of United States primary care physician offices from Yellowpages.com, and selected a systematic random sample of numbers to call. The respondent answering the phone was presented with a standardized, scripted stroke patient scenario, and asked to choose one of four responses that could be provided (wait for symptom resolution, attempt to schedule an office appointment later in the day, schedule an office visit within two days, call 911 for ambulance transport to a hospital).
Forty-two respondents completed the survey (average age = 43 years; 88% female), with 29% (95% CI 17%-44%) recommending scheduling an appointment later in the day if symptoms do not resolve. The remaining respondents recommended calling 911. When presented with a heart attack scenario, 100% of respondents recommended calling 911.
Almost one third of the primary care physician offices recommended scheduling an appointment later in the day for a hypothetical stroke case, despite always giving the correct answer of call 911 for a classic heart attack scenario. These results suggest that stroke education with specific emphasis on the need to call 911 may be needed for primary care physician office receptionists.
The West Virginia medical journal 01/2011; 107(2):24, 26-8.
[show abstract][hide abstract] ABSTRACT: Acute stroke is a time-dependent emergency in which patients often arrive outside of the therapeutic treatment windows. To determine the role that healthlines may have in promoting early presentation, this study evaluated patterns of healthline triage of potential stroke patients.
Phone numbers of healthlines at 82 United States hospitals with neurology residencies were acquired. Each healthline was called and the operator was presented with a standardized scripted stroke patient scenario. The operator was asked to choose 1 of 4 responses that could be given to the patient (wait for symptom resolution, contact a primary care physician, drive to a local urgent care center, call 911 for ambulance transport). The operator was then asked to name common signs and symptoms of stroke. If the operator transferred the call, the process was repeated.
Forty-six healthlines participated, with 22% recommending that the patient contact a primary care physician. The remaining 78% recommended calling 911. Calls were transferred at least once in 18 cases, and 24% of the operators could not name 1 sign or symptom of stroke.
Nearly one-quarter of potential stroke patients were routed away from emergent treatment for the described scenario. By diverting patients away from emergency therapy, patients are in jeopardy of "falling" out of the windows for therapy. Improved stroke education for healthline personnel may result in stroke patients arriving at an emergency department more urgently.
[show abstract][hide abstract] ABSTRACT: Falls are the number one cause of injury-related morbidity and mortality in West Virginia senior citizens. Poor outcomes following falls are exacerbated by numerous comorbidities which are prevalent in the elderly population in West Virginia. This study describes the injury patterns, resource utilization and dispositions of WV seniors injured in a fall.
This is a descriptive retrospective cohort study utilizing the West Virginia State Trauma System registry; which collects trauma data from 33 acute care facilities in West Virginia.
Data from 5498 cases were reviewed for patients enrolled in the Registry in 2010. Fall victims aged 65 and older were included. Most falls occurred in the home (75.2%) or in a residential institution (11.3%). Femur fractures (36.3%) and intracranial hemorrhages (8.2%) were the most common injury diagnoses. Disposition back home declined from 58.6% in the 60-65 age group to 20.9% returning home following falls in the age 90-94 group. Conversely, disposition to a skilled nursing facility rose from 20.1% in the age 60-65 group to 49.1% in the age 90-94 group. The case fatality rate for all the seniors enrolled in the trauma system was 3.3%.
Fall was the mechanism of injury for 83.3% of traumatic injuries in persons over the age of 65 enrolled in the WV trauma system. Older West Virginians suffer from numerous comorbidities that increase the risk of fall as well as the severity of injuries from a fall.
In West Virginia, there is a correlation between increasing age and less desirable outcomes and dispositions from trauma centers for senior citizens after a fall. West Virginia patients, families and care providers must frequently face complicated treatment dilemmas, especially as the related risk of falling and the co-morbid conditions are commonly seen in older West Virginians. Multi-modal fall prevention programs can reduce the risk of falls in senior citizens.