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OBJECTIVES: Identify the frequency of recurrent violence in cases reported in Espírito Santo and the associated factors. METHODS: Cross-sectional study. Which included data on violence in Espírito Santo from 2011 to 2018, from the Notifiable Diseases Information System, and, Statistical analyzes were performed using the chi-square test and Poisson regression. RESULTS: 54.2% (N:14.966) of reported cases of violence are repeated, and higher prevalences were associated with female sex (PR:1.54), child (PR: 1.29) or elderly victims (PR: 1.25), the presence of disabilities/disorders (PR:1.42) and occurrence in urban/peri-urban areas (PR: 1.10). Furthermore, there is a greater frequency of injuries caused by a single aggressor (PR: 1.20), man (PR: 1.28), aged 25 or over (PR: 1.09), known to the victim (PR: 2.81) and at home (PR: 1.69). CONCLUSION: The reported cases of violence showed a high frequency of recurrence, and were associated with the studied characteristics of the victim, the aggressor and the event.
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Recurrencia , Violencia , Humanos , Masculino , Estudios Transversales , Femenino , Adulto , Violencia/estadística & datos numéricos , Niño , Persona de Mediana Edad , Anciano , Adulto Joven , Adolescente , Brasil/epidemiología , Preescolar , Lactante , Prevalencia , Heridas y Lesiones/epidemiologíaRESUMEN
This cross-sectional study examines treatment received for falls from a section of the US-Mexico border wall with a focus on emergency medical services activation and type of treatment.
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Accidentes por Caídas , Humanos , Masculino , México/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Femenino , Adulto , Persona de Mediana Edad , Servicios Médicos de Urgencia/estadística & datos numéricos , Estados Unidos/epidemiología , Anciano , Adolescente , Adulto Joven , Heridas y Lesiones/epidemiologíaRESUMEN
INTRODUCTION: In high-income countries, quality improvement interventions and research are usually guided by trauma registries. In low- and middle-income countries, the implementation of trauma registries has been limited mainly for cost reasons. OBJECTIVE: To analyze the budgetary impact of the implementation of trauma registries in Argentina. METHODS: We estimated direct costs of implementing trauma registries in public hospitals located in cities with a population over 50,000 inhabitants. In large urban areas, we selected hospitals by estimating a minimum volume of 240 severe trauma admissions/year and using the NBATS-2 instrument with geolocation techniques. We estimated costs based on a micro-costing approach of a trauma registry developed by Fundación Trauma. Scenario analysis was carried out restricting the population to hospitals from bigger cities and/or with higher concentration of trauma patients' care. For the high budget impact threshold, we used the total health spending estimation, and alternatively the health spending of the public sector. RESULTS: For the base case, 139 hospitals from 104 cities were included, comprising 175,605 injury-related discharges and 13,707 severely injured patients/year. The average cost for the initial three years was USD 3,753,085 (21.4 USD/per patient), falling below the high budget impact thresholds. The scenarios analysis showed a significantly costs reduction. CONCLUSIONS: The implementation of trauma registries in Argentina would be affordable, and in consequence, it would improve the coordination, management and quality of care for this great public health issue.
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Hospitales Públicos , Sistema de Registros , Heridas y Lesiones , Humanos , Argentina/epidemiología , Heridas y Lesiones/economía , Heridas y Lesiones/terapia , Heridas y Lesiones/epidemiología , Hospitales Públicos/economía , Presupuestos , Centros Traumatológicos/economía , Mejoramiento de la Calidad/economía , Análisis Costo-Beneficio , Costos de la Atención en Salud/estadística & datos numéricosRESUMEN
High-energy trauma is defined as severe organic injuries resulting from events that generate a large amount of kinetic, electrical, or thermal energy. It represents a significant public health concern, accounting for 10% of global mortality. This article aims to describe the epidemiology of high-energy trauma in Chile. Specifically, it seeks to compare the mortality rate per 100 000 inhabitants among member countries of the World Health Organization (WHO), provide a descriptive analysis of notifications under the Explicit Health Guarantees (GES) for the health issue of polytraumatized patients, and analyze the trend in the mortality rate due to external causes in Chile. This study employs an ecological design using three open-access databases. First, the WHO database on deaths from traffic accidents in 2019 was used. Then, the GES database was consulted for the "Polytraumatized" issue between 2018 and 2022. Finally, the Chilean Department of Health Statistics database on causes of death between 1997 and 2020 was utilized. In 2019, Chile ranked in the middle regarding the mortality rate per 100 000 inhabitants due to traffic accidents. GES notifications for polytrauma predominantly involved men aged 20 to 40 years and those affiliated with the public health system, highlighting a primary focus for prevention efforts. Mortality from accidents showed a decreasing trend, with significant structural changes identified in 2000 and 2007.
El trauma de alta energía se define como lesiones orgánicas graves resultantes de eventos que generan una gran cantidad de energía cinética, eléctrica o térmica. Constituye una importante preocupación de salud pública, representando el 10% de la mortalidad mundial. El objetivo de este artículo es describir la epidemiología del trauma de alta energía en Chile. Específicamente, se busca comparar la tasa de mortalidad por 100 000 habitantes entre los países miembros de la Organización Mundial de la Salud (OMS), realizar un análisis descriptivo de las notificaciones por Garantías Explícitas en Salud (GES) del problema de salud "politraumatizado", y analizar la tendencia de la tasa de fallecidos por causa externa en Chile. El presente estudio tiene un diseño ecológico, utilizando tres bases de datos de acceso abierto. Primero, se utilizó la base de datos de la OMS sobre fallecidos por accidentes automovilísticos en 2019. Luego, se consultó la base de datos del programa Garantías Explícitas en Salud para el problema "politraumatizado" entre los años 2018 y 2022. Finalmente, se utilizó la base de datos del Departamento de Estadísticas de Salud de Chile sobre causas de muerte entre 1997 y 2020. En 2019, Chile ocupó una posición intermedia en cuanto a la tasa de mortalidad por 100 000 habitantes debido a accidentes de tráfico. Las notificaciones el programa Garantías Explícitas en Salud por politraumatismo fueron predominantemente en hombres de entre 20 y 40 años, afiliados al sistema de salud pública. Por este motivo, el foco principal de prevención debe centrarse en este grupo. La mortalidad por accidentes mostró una tendencia decreciente, identificándose cambios estructurales significativos en los años 2000 y 2007.
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Accidentes de Tránsito , Bases de Datos Factuales , Traumatismo Múltiple , Sistema de Registros , Chile/epidemiología , Humanos , Accidentes de Tránsito/estadística & datos numéricos , Accidentes de Tránsito/mortalidad , Masculino , Adulto , Femenino , Adulto Joven , Persona de Mediana Edad , Traumatismo Múltiple/epidemiología , Traumatismo Múltiple/mortalidad , Heridas y Lesiones/epidemiología , Heridas y Lesiones/mortalidad , Salud Pública , Distribución por Sexo , Adolescente , Distribución por Edad , Organización Mundial de la Salud , AncianoRESUMEN
OBJECTIVE: The aim of this study was to conduct a detailed geospatial analysis of mobile phone signal coverage in the northwest macro-region of Paraná State, Brazil, seeking to identify areas where limitations in coverage may be related to lengthy travel times of the helicopter emergency medical service (HEMS) for the assistance of victims of road traffic injuries (RTIs). METHODS: An observational study was conducted to examine mobile phone signal coverage and HEMS travel times from 2017 to 2021. HEMS travel times were categorized into four groups: T1 (0-15 min), T2 (16-30 min), T3 (31-45 min), and T4 (over 45 min). Empirical Bayesian Kriging was used to map areas with low mobile signal coverage. The Kruskal-Wallis test and Dwass-Steel-Critchlow-Fligner comparative analyses were performed to explore how mobile signal coverage relates to HEMS travel times to RTI locations. RESULTS: There were 470 occurrences of RTIs attended by HEMS, of which 108 (23%) resulted in on-site fatalities. Among these deaths, 47 (26.85%) occurred in areas with low mobile phone signal coverage ("shadow areas"). Low mobile phone signal coverage identified at 175 (37.24%) RTIs locations, was unevenly distributed across the macro-region. The lowest medians of mobile signal quality were predominantly found in areas with HEMS travel times exceeding 30 min, corresponding to signal strength values of -98.44 (T3) and -100.75 (T4) dBm. This scenario represents a challenge for effective communication to activate HEMS. In the multiple comparison analysis among travel time groups, significant differences were observed between T1 and T2 (p < 0.001), T1 and T3 (p < 0.001), T1 and T4 (p < 0.001), and T2 and T3 (p < 0.001), indicating a potential association between lower mobile phone signal coverage and longer HEMS travel times. CONCLUSION: It can be concluded that poor mobile phone signals in remote areas can hinder HEMS activation, potentially delaying the start of treatment for RTIs. Identification of the shadow areas can help communication and health managers in designing and implementing the necessary changes to improve mobile phone signal coverage and consequently reduce delays in the initial response to RTIs.
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Accidentes de Tránsito , Ambulancias Aéreas , Teléfono Celular , Humanos , Brasil , Ambulancias Aéreas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Teléfono Celular/estadística & datos numéricos , Factores de Tiempo , Servicios Médicos de Urgencia/estadística & datos numéricos , Análisis Espacial , Masculino , Heridas y Lesiones/epidemiologíaAsunto(s)
Heridas y Lesiones , Humanos , México , Niño , Masculino , Femenino , Preescolar , Heridas y Lesiones/epidemiología , Estados Unidos/epidemiología , Adolescente , Lactante , Estudios RetrospectivosRESUMEN
INTRODUCTION: Direct transport from the scene of injury to a trauma centre reduces saves lives. In Ontario, paramedics use the field trauma triage standard (FTTS) to determine if a patient meets trauma bypass criteria. Recent studies have questioned the efficacy of the FTTS in identifying severely injured patients. The objective of this study was to determine the predictive performance of the FTTS on the need for trauma center care in patients who were transported to a trauma center. METHODS: This was a single-center health records study of patients transported by ambulance directly to a level 1 trauma center. Hospital based trauma center need and injury severity score-based need were defined. Bivariate associations with one or more FTTS criteria were tested using the Wilcoxon two-sample test for continuous variables, and the Chi-square or Fisher's exact test for categorical indicators. The sensitivity and specificity of each category of the FTTS were calculated. RESULTS: There were 1427 patients included in the study, with 76% men, mean age of 40, and 76% had a blunt mechanism. The overall sensitivity and specificity of the FTTS was 90.9% and 20.8% for hospital-based need and 91.6% and 20.3 for injury severity need. The most sensitive variable for hospital-based need was physiologic criteria (53.7). Mechanism of injury was the most sensitive criteria for injury severity need (54.8). Physiological criteria had the highest association with hospital-based and injury severity need (adjusted odds ratios 7.5 [95% CI 5.8-9.8] and 5.1 [95% CI 3.9-6.7]). CONCLUSIONS: The FTTS has fair performance in identifying the need for hospital-based and injury severity need. Systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (motor) less than 6, and falls greater than 6 m were most predictive of trauma center need. Improving prehospital trauma triage is critical to ensure timely transport to a trauma centre.
RéSUMé: INTRODUCTION: Le transport direct de la scène de la blessure à un centre de traumatologie permet de sauver des vies. En Ontario, les ambulanciers paramédicaux utilisent la norme de triage des traumatismes sur le terrain (FTTS) pour déterminer si un patient répond aux critères de pontage traumatique. Des études récentes ont remis en question l'efficacité du FTTS dans l'identification des patients gravement blessés. L'objectif de cette étude était de déterminer la performance prédictive du FTTS sur le besoin de soins en centre de traumatologie chez les patients qui ont été transportés dans un centre de traumatologie. MéTHODES: Il s'agissait d'une étude des dossiers médicaux d'un seul centre portant sur des patients transportés par ambulance directement à un centre de traumatologie de niveau 1. Les besoins des centres de traumatologie hospitaliers et les besoins basés sur le score de gravité des blessures ont été définis. Les associations bivariées avec un ou plusieurs critères FTTS ont été testées à l'aide du test à deux échantillons de Wilcoxon pour les variables continues et du test de Fisher pour les indicateurs catégoriels. La sensibilité et la spécificité de chaque catégorie du FTTS ont été calculées. RéSULTATS: Il y avait 1427 patients inclus dans l'étude, avec 76% d'hommes, âge moyen de 40, et 76% avaient un mécanisme émoussé. La sensibilité et la spécificité globales du FTTS étaient de 90,9 % et de 20,8 % pour les besoins hospitaliers et de 91,6 % et de 20,3 % pour les besoins de gravité des blessures. La variable la plus sensible pour les besoins hospitaliers était les critères physiologiques (53,7). Le mécanisme de blessure était le critère le plus sensible pour le besoin de gravité de la blessure (54,8). Les critères physiologiques étaient les plus associés aux besoins hospitaliers et aux besoins en matière de gravité des blessures (rapports de cotes ajustés de 7,5 [IC à 95 % 5,8-9,8] et 5,1 [IC à 95 % 3,9-6,7]). CONCLUSION: Le FTTS a un rendement équitable pour ce qui est de déterminer le besoin de soins hospitaliers et de gravité des blessures. La pression artérielle systolique inférieure à 90mmHg, l'échelle de coma de Glasgow (moteur) inférieure à 6 et les chutes supérieures à 6m étaient les plus prédictives des besoins du centre de traumatologie. L'amélioration du triage des traumatismes avant l'hospitalisation est essentielle pour assurer un transport rapide vers un centre de traumatologie.
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Puntaje de Gravedad del Traumatismo , Centros Traumatológicos , Triaje , Heridas y Lesiones , Humanos , Triaje/métodos , Triaje/normas , Masculino , Estudios Retrospectivos , Femenino , Adulto , Ontario , Heridas y Lesiones/terapia , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/epidemiología , Persona de Mediana Edad , Servicios Médicos de Urgencia/normas , Servicios Médicos de Urgencia/organización & administraciónRESUMEN
To describe the sociodemographic data of injured pedestrians, temporal patterns of injury, injury patterns, and the independent predictors of hospital admission. A two year cross-sectional study was conducted at the Saint Ann's Bay Regional Hospital in pedestrians with injuries post collision with a motor vehicle. A census was performed in all patients who received either emergency room treatment, hospital admission, or surgical intervention. A 30-item interviewer questionnaire was administered to collect the data. A logical regression model was used to determine independent predictors for hospital admission. Ninety pedestrians were included. Age range: 6-86 years old (Mean=39.9). Males were 63.3%, 75.6% were employed, 31% had a chronic illness and 27% reported marijuana use. Most injuries occurred in April, lowest injury rates occurred in August and September. Twenty two percent of collisions occurred on Saturdays. Most injuries occurred at 5pm and 3pm. Many (54.4%) had a fracture, 73.5% were closed. Approximately 32% had contusions and 6.7% had lacerations. Independent predictors of admission were history of marijuana use and having a fracture. Those with history of marijuana use were 4.21 times more likely to be admitted. Those with fractures were 7.10 times more likely to be admitted. Injury patterns spanned a wide age range. They often involved a high energy mechanism of injury as evidenced by the frequency of fractures, hospital admission and surgery intervention rates. The data also suggests a need to implement marijuana testing programmes in our road users.
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Accidentes de Tránsito , Peatones , Heridas y Lesiones , Humanos , Estudios Transversales , Masculino , Peatones/estadística & datos numéricos , Niño , Adolescente , Adulto , Accidentes de Tránsito/estadística & datos numéricos , Femenino , Persona de Mediana Edad , Adulto Joven , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiología , Anciano , Jamaica/epidemiología , Anciano de 80 o más Años , Hospitalización/estadística & datos numéricosRESUMEN
Nine in 10 road traffic deaths occur in low- and middle-income countries (LMICs). Despite this disproportionate burden, few studies have examined built environment correlates of road traffic injury in these settings, including in Latin America. We examined road traffic collisions in Bogotá, Colombia, occurring between 2015 and 2019, and assessed the association between neighborhood-level built environment features and pedestrian injury and death. We used descriptive statistics to characterize all police-reported road traffic collisions that occurred in Bogotá between 2015 and 2019. Cluster detection was used to identify spatial clustering of pedestrian collisions. Adjusted multivariate Poisson regression models were fit to examine associations between several neighborhood-built environment features and rate of pedestrian road traffic injury and death. A total of 173,443 police-reported traffic collisions occurred in Bogotá between 2015 and 2019. Pedestrians made up about 25% of road traffic injuries and 50% of road traffic deaths in Bogotá between 2015 and 2019. Pedestrian collisions were spatially clustered in the southwestern region of Bogotá. Neighborhoods with more street trees (RR, 0.90; 95% CI, 0.82-0.98), traffic signals (0.89, 0.81-0.99), and bus stops (0.89, 0.82-0.97) were associated with lower pedestrian road traffic deaths. Neighborhoods with greater density of large roads were associated with higher pedestrian injury. Our findings highlight the potential for pedestrian-friendly infrastructure to promote safer interactions between pedestrians and motorists in Bogotá and in similar urban contexts globally.
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Accidentes de Tránsito , Entorno Construido , Peatones , Características de la Residencia , Heridas y Lesiones , Humanos , Colombia/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Accidentes de Tránsito/mortalidad , Estudios Transversales , Adulto , Masculino , Femenino , Peatones/estadística & datos numéricos , Adulto Joven , Persona de Mediana Edad , Heridas y Lesiones/epidemiología , Adolescente , Características de la Residencia/estadística & datos numéricos , Niño , Preescolar , Anciano , Planificación AmbientalRESUMEN
OBJECTIVE: To prospectively determine injury recovery time in the medical-legal examinations of non-fatal injuries and their associated factors, carried out by the National Institute of Legal Medicine and Forensic Sciences of Colombia to create a multivariate analysis. METHODS: A prospective medical-legal assessment of non-fatal injuries was carried out on 281 individuals with complete follow-up, in which the observational unit of analysis was the most serious injury. Variables, such as sex, circumstances of the injury, the mechanism that caused the injury, medical certificate of incapacity to work, among others were related to the injury recovery time, measured in days. The Kruskal Wallis (K-W) ANOVA and a multivariate analysis using the ordinal regression model were applied. RESULTS: In the multivariate analysis, the factors most associated with longer recovery time were the extent of joint damage (CR95%:1.47-5.94,p = 0.0001) and bone damage (CR95%:2.92-7.42,p < 0.001). In terms of circumstances of the injury, traffic accidents (CR95%:1.03-2.96,p < 0.001), medical-legal impairments (CR95%:0.34-2.19,p = 0.007), and complications of the primary injury (CR95%: 1.18-2.57,p < 0.001) had the greatest impact on recovery time. Others factors that significantly impacted injury recovery time are surgical treatments (IC95%: 0.33-3.26,p = 0.0164) and delayed treatment (CR95%:1.41-4.72,p < 0.001). A direct correlation (significant and moderately strong) was found between the recovery time of the injury and the days of incapacity for work (r = 0.802, p < 0.001). CONCLUSION: This prospective analysis determined which variables were most strongly related to the medical-legal assessment of non-fatal injuries and the recovery time of said injuries. Further studies aimed at improving the strategies to help individuals complete the legal process are required.
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Medicina Legal , Heridas y Lesiones , Humanos , Accidentes de Tránsito , Colombia , Análisis Multivariante , Heridas y Lesiones/epidemiología , Masculino , FemeninoRESUMEN
OBJECTIVE: In this study, we aim to identify social typologies of pedestrian crashes considering demographics, health impacts, involved vehicle, temporality of the collision, and place of impact in Hermosillo, Mexico. METHODS: A socio-spatial analysis was performed by using local urban planning information and vehicles-pedestrian crashes records collected by the police department (N = 950) between 2014 and 2017. Multiple Correspondence Analysis and Hierarchical Cluster Analysis were used to determine typologies. Geographical distribution of typologies was obtained with spatial analysis techniques. RESULTS: The results suggest there are four typologies, which portray the physical vulnerability of pedestrians, which reflect the vulnerability to collisions associated to the variables age, gender, and street speed limits. Findings show that children are more likely to be injured during weekends in residential zones (Typology 1), while older females are more likely to be injured during the first three days of the week (Monday - Wednesday) in the downtown area (Typology 2). Injured males during the afternoon in arterial streets represented the most frequent cluster (Typology 3). Also, males were likely to be severely injured by heavy trucks during nighttime in peri-urban areas (Typology 4). These findings indicate that vulnerability and risk exposure vary according to the type of pedestrian involved in the crash, which are linked to the types of places they visit. CONCLUSIONS: The design of the built environment plays a major role in the number of pedestrian injuries particularly when it favors motor vehicles over pedestrians or non-motorized vehicles. Because traffic crashes are considered preventable events, cities must embrace a diversity of mobility modes and incorporate the appropriate infrastructures that safeguard the lives of all their travelers, especially pedestrians.
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Peatones , Heridas y Lesiones , Masculino , Niño , Femenino , Humanos , Accidentes de Tránsito , Ciudades , México/epidemiología , Vehículos a Motor , Heridas y Lesiones/epidemiologíaRESUMEN
PURPOSE: The study aimed to verify the association between in-hospital complications and characterization and clinical variables including hospital care and trauma severity. METHODS: This analysis with the prospective cohort data was conducted at a municipal hospital in São Paulo, Brazil, and included participants aged 14 years or older, with traumatic injuries from traffic accidents. Data was collected from January 2015 to July 2016 and included demographics variables, type of traumatic event, clinical parameters, length of stay in the Emergency department and in the Intensive Care Unit, length of hospital stay, survival probability, trauma severity and mortality. RESULTS: Of the 327 patients, 25.1% had in-hospital complications and their occurrence was statistically associated with higher mean age, run-overs and higher trauma severity. The length of stay in the emergency room, hospital stay, ICU stay, percentage of deaths, and hospital readmission were higher in patients with complications. The number of complications was correlated with trauma severity, ICU stay, and mortality. CONCLUSION: Complications were associated with older age, run-overs, greater trauma severity, length of stay and readmission after hospital discharge.
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Accidentes de Tránsito , Heridas y Lesiones , Humanos , Estudios Prospectivos , Brasil/epidemiología , Tiempo de Internación , Unidades de Cuidados Intensivos , Hospitales , Heridas y Lesiones/complicaciones , Heridas y Lesiones/epidemiología , Heridas y Lesiones/terapia , Estudios RetrospectivosRESUMEN
BACTERKGROUND: There is debate on whether cannabis affects road traffic injuries (RTIs) separately from the effects of alcohol. Our goals are to report the possible increase in risk of an RTI among alcohol and cannabis users by type of exposure (biological, self-reported and combined) and the possible interaction of alcohol and cannabis in patients with an RTI in an emergency department in Mexico City. METHODS: A case-crossover study with 433 cases of RTI (as a pedestrian, driver or passenger) during the period January-April 2022. A breath sample, an oral sample for cannabis detection and self-reported alcohol and cannabis use 6 hours prior to the RTI and in two control periods were used. We report ORs and 95% CIs from conditional logistic regressions for the case-crossover estimates. RESULTS: Alcohol alone increased the risk of an RTI (OR=6.02, 95% CI 3.29 to 10.99) for most RTIs, regardless of whether we used information from self-reports or a breath sample in the hazard period. Conversely, cannabis only increased the RTI when we added information in the hazard period from self-reports or oral samples. Nevertheless, this increase in risk disappeared (OR=2.06, 95% CI 0.90 to 4.70) among those who only used cannabis. We also found no evidence of interaction between alcohol and cannabis in the risk of an RTI. CONCLUSIONS: Alcohol is the most commonly used substance in Mexico and a high-risk factor for RTI in Mexico City. Although cannabis alone was not associated with an RTI, continuous monitoring of its effects is required.
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Cannabis , Heridas y Lesiones , Humanos , Accidentes de Tránsito/prevención & control , Cannabis/efectos adversos , México/epidemiología , Estudios Cruzados , Factores de Riesgo , Heridas y Lesiones/epidemiologíaRESUMEN
Trauma-related injuries in traffic-accident victims can be quite serious. Evaluating the factors contributing to traffic accidents is critical for the effective design of programs aimed at reducing traffic accidents. Therefore, this study identified which factors related to traffic accidents are associated with injury severity in hospitalized victims. Factors related to traffic accidents, injury severity, disability and data collected from blood toxicology were evaluated, along with associated severity and disability indices with data collected from toxicology on victims of traffic accidents at the largest tertiary hospital in Latin America. One hundred and twenty-eight victims of traffic accidents were included, of whom the majority were young adult men, motorcyclists, and pedestrians. The most frequent injuries were traumatic brain injury and lower-limb fractures. Alcohol use, hit-and-run victims, and longer hospital stays were shown to lead to greater injury severity. Women, elderly individuals, and pedestrians tend to suffer greater disability post-injury. Therefore, traffic accidents occur more frequently among young male adults, motorcyclists, and those who are hit by a vehicle, with trauma to the head and lower limbs being the most common injury. Injury severity is greater in pedestrians, elderly individuals and inebriated individuals. Disability was higher in older individuals, in women, and in pedestrians.
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Lesiones Traumáticas del Encéfalo , Fracturas Óseas , Heridas y Lesiones , Adulto Joven , Humanos , Masculino , Femenino , Anciano , Accidentes de Tránsito , Motocicletas , Extremidad Inferior , Heridas y Lesiones/epidemiologíaRESUMEN
BACKGROUND: Mexico City implemented the Pasos Seguros programme to prevent pedestrian injuries and deaths at dangerous road intersections, which included street-level design changes, such as visible pedestrian crossings, sidewalk widening, refuge islands, lane reductions, pedestrian signals and adjustment of traffic light timing at these intersections. Few studies in low and middle-income countries (LMICs) have evaluated the effect of such interventions on pedestrian safety. AIM: Assess the effectiveness of the Pasos Seguros programme at reducing total, injury and fatal pedestrian-motor vehicle crashes. METHODS: Two-group quasi-experimental design. Monthly pedestrian crashes were obtained from the road incident database from Mexico City's Citizen Contact Center. The programme's effectiveness was evaluated by comparing 12 months preintervention to 12 months postintervention implementation using a negative binomial regression with random intercept with a difference-in-difference estimation. A qualitative comparative analysis was used to find the configuration of intersection characteristics and programme components associated with a decrease in pedestrian crashes. RESULTS: Total pedestrian crashes were reduced by 21% (RR 0.79; 95% CI 0.62 to 0.99) after implementation of Pasos Seguros programme. This reduction was observed for pedestrian injury crashes (RR 0.79; 95% CI 0.62 to 1.00) and for fatal crashes (RR 0.61; 95% CI 0.13 to 2.92) although not statistically significant for the latter. A decrease in pedestrian crashes was found at the most complex intersections where more of the programme components was implemented. CONCLUSION: The Pasos Seguros programme successfully decreased total and injury pedestrian crashes. Similar interventions may improve walking safety in other LMIC cities.
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Peatones , Heridas y Lesiones , Humanos , Accidentes de Tránsito/prevención & control , Ciudades , México/epidemiología , Caminata , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & controlRESUMEN
BACKGROUND: Mexico City approved new road safety policies in 2015, which included lower speed limits and higher fines for traffic offences. In 2019, economic fines were replaced by a point penalty system among other changes. This study evaluates these policies on road traffic collisions, injuries and deaths. METHODS: Collisions data came from insurance collision claims (January 2015 to December 2019) and road traffic deaths from vital registrations (January 2013 to December 2019). We conducted an interrupted time series analysis for each outcome using negative binomial regression models with an offset of insured vehicles (collisions) or total population (deaths). Then, we classified the 16 municipalities in the city into enforcement and no-enforcement groups based on presence or absence of automated traffic enforcement devices and conducted a controlled interrupted time series analysis. RESULTS: The 2015 road safety policies had no effect on total collisions and collisions resulting in injury but were associated with a 0.2% (95% CI -0.3 to 0.0) decline in the mortality trend. The 2019 policies had no effect on total collisions but were associated with a 1.5% increase in the trend of collisions resulting in injuries and with a 2.7% (95% CI 1.0 to 4.5) increase in the mortality trend. Postpolicy trends in enforcement versus no-enforcement municipalities were not significantly different. CONCLUSION: Policies that included high economic penalties for speeding and dangerous behaviours were effective in decreasing traffic mortality while removing economic penalties and replacing them with a point penalty system were associated with an increase in collisions, resulting in injury and mortality.
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Accidentes de Tránsito , Heridas y Lesiones , Humanos , Ciudades/epidemiología , Análisis de Series de Tiempo Interrumpido , México/epidemiología , Accidentes de Tránsito/prevención & control , Políticas , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & controlRESUMEN
Pedestrians are vulnerable road users that are directly exposed to road traffic crashes with high odds of resulting in serious injuries and fatalities. Therefore, there is a critical need to identify the risk factors associated with injury severity in pedestrian crashes to promote safe and friendly walking environments for pedestrians. This study investigates the risk factors related to pedestrian, crash, and built environment characteristics that contribute to different injury severity levels in pedestrian crashes in Santiago, Chile from a spatial and statistical perspective. First, a GIS kernel density technique was used to identify spatial clusters with high concentrations of pedestrian crash fatalities and severe injuries. Subsequently, partial proportional odds models were developed using the crash dataset for the whole city and the identified spatial clusters to examine and compare the risk factors that significantly affect pedestrian crash injury severity. The model results reveal higher increases in the fatality probability within the spatial clusters for statistically significant contributing factors related to drunk driving, traffic signage disobedience, and imprudence of the pedestrian. The findings may be utilized in the development and implementation of effective public policies and preventive measures to help improve pedestrian safety in Santiago.
Asunto(s)
Peatones , Heridas y Lesiones , Accidentes de Tránsito , Entorno Construido , Chile/epidemiología , Humanos , Factores de Riesgo , Heridas y Lesiones/epidemiologíaRESUMEN
Introducción: El trauma es la pandemia que cada año cobra muchas vidas, los avances tecnológicos no han podido detenerla, sin embargo, estos han ayudado en la evaluación más efectiva de los pacientes. La ecografía realizada por médicos no radiólogos se ha convertido en una herramienta necesaria en la evaluación del paciente traumatizado. Objetivo: Describir los conocimientos que debe adquirir el cirujano general para realizar ecografía en la evaluación del trauma. Método: Se realizó una revisión bibliográfica del tema en las bases de datos PubMed, BVS-BIREME y Cochrane. Se describió los elementos que tiene que conocer el cirujano general para realizar ecografía en la evaluación del trauma. Se consideraron en la búsqueda todo tipo de estudios publicados desde enero de 1971 hasta diciembre de 2019 a los cuales se tuvo acceso y se realizó la evaluación de la validez interna de la evidencia, así como de su calidad global. Los idiomas utilizados en la búsqueda fueron el español e inglés. Desarrollo: La mayoría de los estudios aceptan a la ecografía como herramienta de evaluación en el trauma y su utilización sistemática por médicos no radiólogos. Conclusiones: Los principios básicos de la ecografía en el trauma tienen que ser parte de las herramientas de un cirujano general del siglo xxi. Los errores más frecuentes, responden a la no realización sistemática y a la falta de entrenamiento. Cada vez son menos las contraindicaciones de la ecografía en el trauma, pero sí es marcada la dependencia del operador(AU)
Introduction: Trauma is the pandemic that every year claims many lives; technological advances have not been able to stop it, but have contributed with the more effective assessment of patients. Ultrasound performed by non-radiologists physicians has become a necessary tool in the assessment of the trauma patient. Objective: To describe the knowledge that the general surgeon should acquire to perform ultrasound for assessing trauma. Methods: A bibliographic review of the subject was carried out in the PubMed, BVS-BIREME and Cochrane databases. The elements that the general surgeon must know in order to perform ultrasound in the assessment of trauma were described. The search considered all types of studies published from January 1971 to December 2019 and that could be accessed; the internal validity of the evidence was assessed, together with its overall quality. The languages used in the search were English and Spanish. Development: Most studies accept ultrasound as an assessment tool in trauma and its systematic use by non-radiologist physicians. Conclusions: The basic principles of ultrasound in trauma have to be part of the tools of a general surgeon of the twenty-first century. The most frequent errors are due to lack of systematic use and lack of training. Contraindications of ultrasound in trauma are progressively less frequent, but there is a marked dependence on the person who operates(AU)
Asunto(s)
Humanos , Heridas y Lesiones/epidemiología , Ultrasonografía/métodos , Literatura de Revisión como Asunto , Bases de Datos Bibliográficas , Urgencias MédicasRESUMEN
OBJECTIVE: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. METHODS: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. RESULTS: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01).The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). CONCLUSION: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.
OBJETIVO: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. MÉTODOS: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. RESULTADOS: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01).O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). CONCLUSÃO: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.
Asunto(s)
Cavidad Nasal , Ventilación no Invasiva , Peso al Nacer , Humanos , Incidencia , Recién Nacido , Recien Nacido Prematuro , Máscaras , Cavidad Nasal/lesiones , Ventilación no Invasiva/efectos adversos , Ventilación no Invasiva/métodos , Estudios Retrospectivos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & controlRESUMEN
BACKGROUND: Maritime transportation is an activity of vital importance for societies. The Mar Grande-Salvador crossing is an intercity waterway transport line in Brazil that transports 3,500 passengers/day, including residents and tourists. In 2017, an accident on this crossing was considered to be the biggest maritime tragedy in Bahia in the last decade. OBJECTIVE: To describe the clinical and epidemiology characteristics of victims of this maritime accident, with analysis on bodily injuries, causes of death and means/instruments that caused the fatal injuries. DESIGN AND SETTING: Case-series study at the Forensic Medical Institute of Bahia, Brazil. METHODS: Reports on 73 victims who were examined for bodily injury or were necropsied by the Forensic Medical Institute were analyzed. This study was approved by the institution's Research Ethics Committee (protocol 04012218.1.0000.5032). RESULTS: The victims' mean age was 33.0 years [95% confidence interval, CI, 26.3-47.0]. The mean age of those who died was 43.0 years [95% CI, 30.5-53.5]. Bodily injuries were found in 74% of the victims. The most frequent bodily injuries were ecchymoses among females (69.7%) and abrasions among males (76.2%). Blunt instruments produced most bodily injuries (85.2%). Among the victims who died, 68.4% were female. Mechanical asphyxiation through drowning was the leading cause of death (89.4%). The overall lethality rate was 26%, and this was higher among females (28.2%). CONCLUSION: Women were the main victims of this maritime accident. Bodily injuries occurred more frequently than death, but these injuries proved to be quite significant, thus demonstrating the importance of measures to improve the safety of navigation.