Comparative analysis of injury identification using KABCO and ISS in linked North Carolina trauma registry and crash data.

Objective: The purpose of this study was to examine differences between police-reported injury severity and trauma registry data among persons with linked records in North Carolina and quantify the degree of alignment.

Methods: We analyzed linked North Carolina trauma registry and motor vehicle crash data from 2018. Injury severity identification was assessed using police-reported 5-point scale KABCO from crash data and Injury Severity Score (ISS) from trauma records.

Injury Patterns, Imaging Usage, and Disparities Associated With Car Restraint Use in Children.

Background: Motor vehicle collision (MVC) is a leading cause of accidental death in children. Despite effective forms of child safety restraint (eg, car seat and booster seat), studies demonstrate poor compliance with guidelines. The goal of this study was to delineate injury patterns, imaging usage, and potential demographic disparities associated with child restraint use following MVC.

Impact of COVID-related policies on gunshot wound assault hospitalizations in the United States: a statewide time series analysis.

Background: The CDC recently reported that firearm homicide rates in the United States increased in 2020, particularly among Black/African American individuals and men 25-44 years old. It is unclear whether firearm hospitalizations also increased, and more importantly, what impact the COVID-19 pandemic and COVID-related policies had. Using the North Carolina Trauma Registry, a statewide registry of trauma admissions to eighteen North Carolina hospitals, we calculated weekly GSW hospitalization rates from 1/2019 to 12/2020, overall and stratified by race-ethnicity, age, and sex.

Shelter in Place and an Alarming Increase in Penetrating Trauma in Children and Concerning Decrease in Child Abuse.

Background: On March 14, 2020, schools across North Carolina (NC) closed in response to Covid-19, forcing completion of the school year at home. Most pediatric trauma occurs at home with a higher prevalence when children are out of school. We queried the state trauma database to assess if the 2020 "shelter in place" was associated with an increase in pediatric trauma statewide.

Effect of Stay-at-Home orders and other COVID-related policies on trauma hospitalization rates and disparities in the USA: a statewide time-series analysis.

Background: To combat the coronavirus pandemic, states implemented several public health policies to reduce infection and transmission. Increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. The goal of this study was to determine the impact of a statewide Stay-at-Home order and other COVID-related policies on trauma hospitalizations, stratified by race/ethnicity, age, and sex.

Effect of Stay-at-Home Orders and Other COVID-Related Policies on Trauma Hospitalization Rates and Disparities in the United States: A Statewide Time-Series Analysis.

Background: To combat the coronavirus pandemic, states implemented several public health policies to reduce infection and transmission. Increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. The goal of this study was to determine the impact of a statewide Stay-at-Home and other COVID-related policies on trauma hospitalizations, stratified by race/ethnicity, age, and sex.

Estimated Cost-Effectiveness of Implementing a Statewide Tranexamic Acid Protocol for the Management of Suspected Hemorrhage in the Prehospital Setting.

Introduction: Hemorrhage is responsible for up to 40% of all traumatic deaths. The seminal CRASH-2 trial demonstrated a reduction in overall mortality following early tranexamic acid (TXA) administration to bleeding trauma patients. Following publication of the trial results, TXA has been incorporated into many prehospital trauma protocols.

Database selection matters: A case study in child restraint use and injury patterns using North Carolina motor vehicle traffic crash report and trauma registry data.

Objective: While proper restraint use is protective against motor traffic vehicle crash (MVTC)-associated morbidity and mortality, it is inconsistently measured across health and MVTC data sources. This project addresses this gap by assessing differences in child restraint measures between two North Carolina (NC) datasets and comparing the utility of these sources to evaluate patterns of child restraint use and associated health outcomes.

Methods: We analyzed 2018 NC MVTC and NC Trauma Registry (NCTR) data for children ≤15 years old, both separately and as linked MVTC-NCTR records.

Causes of death following discharge after trauma in North Carolina.

Background: While a "fourth peak" of delayed trauma mortality has been described, limited data describe the causes of death (CODs) for patients in the years following an injury. This study investigates the difference in COD statewide for patients with and without a recent trauma admission.

Methods: This retrospective cohort study compared COD for trauma and nontrauma patients in North Carolina.

Prolonged Emergency Department Stay at Referring Facilities: A Poor Trauma Performance Improvement Tool.

Background: Delays in the transfers of injured patients are perceived to increase morbidity and mortality and drive initiatives to limit the emergency department length of stay (LOS) at referring facilities (RF). RF LOS >4 hours is used for performance improvement (PI) with a large review burden with few improvement opportunities.

Methods: A statewide trauma registry 2013-2018 was used.

Evaluation of statewide utilization of helicopter emergency medical services for interfacility transfer.

Background: Helicopter emergency medical services (HEMSs) are used with increasing frequency for the transportation of injured patients from the scene and from treatment facilities to higher levels of care. Improved outcomes have been difficult to establish, and reports of overutilization and financial harm have been published. Our study was performed to evaluate statewide utilization for interfacility transfers (IFTs).

State Medical Board Policy and Opioid Prescribing: A Controlled Interrupted Time Series.

Introduction: In March 2016, the Centers for Disease Control and Prevention issued opioid prescribing guidelines for chronic noncancer pain. In response, in April 2016, the North Carolina Medical Board launched the Safe Opioid Prescribing Initiative, an investigative program intended to limit the overprescribing of opioids. This study focuses on the association of the Safe Opioid Prescribing Initiative with immediate and sustained changes in opioid prescribing among all patients who received opioid and opioid discontinuation and tapering among patients who received high-dose (>90 milligrams of morphine equivalents), long-term (>90 days) opioid therapy.

Risks and Realities of Delayed Splenic Bleeding.

Delayed splenic bleeding (DSB) is a poorly understood complication of blunt splenic injury. Treatment for splenic bleeding may involve splenectomy, but angioembolization is becoming a widely used adjuvant for management. Using the North Carolina Trauma Registry, this study aimed to evaluate the incidence, mortality, and risk factors for DSB in North Carolina.

Trauma system resource preservation: A simple scene triage tool can reduce helicopter emergency medical services overutilization in a state trauma system.

Background: Helicopter emergency medical services improve survival in some injured patients but current utilization leads to significant overtriage with considerable numbers of transported patients discharged home from the emergency department or found to have non-time-sensitive injuries. Current triage models for utilization are complex and untested.

Methods: Data from a state trauma registry were reviewed from 1987 to 1993 and from 2013 to 2015 and compared.

Prescribing of Opioids and Benzodiazepines Among Patients With History of Overdose.

Objectives: Addiction and overdose related to prescription drugs continues to be a leading cause of morbidity and mortality in the United States. We aimed to characterize the prescribing of opioids and benzodiazepines to patients who had previously presented with an opioid or benzodiazepine overdose.

Methods: This was a retrospective chart review of patients who were prescribed an opioid or benzodiazepine in a 1-month time-period in 2015 (May) and had a previous presentation for opioid or benzodiazepine overdose at a large healthcare system.

Opioid Prescribing in the Pediatric Orthopaedic Trauma Population.

The purpose of this article is to describe opioid prescribing patterns for children with orthopaedic injuries. A retrospective chart review was conducted on pediatric orthopaedic trauma patients (n = 124) who were discharged from the hospital or emergency department or had a clinic visit during a 1-month period. Patient demographics, prescription specifics, injury details, and fracture fixation information were collected.

Simulation-Based Training in Cardiac Surgery.

Background: Operating room surgical training has significant limitations. This study hypothesized that some skills could be learned efficiently and safely by using simulation with component task training, deliberate practice, progressive complexity, and experienced coaching to produce safer cardiac surgeons.

Methods: Training modules included cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, massive air embolism, acute intraoperative aortic dissection, and sudden deterioration in cardiac function.

The use of a prescription drug monitoring program to develop algorithms to identify providers with unusual prescribing practices for controlled substances.

The misuse, abuse and diversion of controlled substances have reached epidemic proportion in the United States. Contributing to this problem are providers who over-prescribe these substances. Using one state's prescription drug monitoring program, we describe a series of metrics we developed to identify providers manifesting unusual and uncustomary prescribing practices.

Injury prevention: North Carolina's challenge and capacity to respond.

North Carolina has worked to develop an infrastructure and identify priorities to reduce the high morbidity and mortality from injuries. Findings of the North Carolina Institute of Medicine (NCIOM) Task Force on Adolescent Health and the NCIOM Task Force on Prevention, combined with the North Carolina Division of Public Health strategic plan and the Injury and Violence Prevention State Advisory Council, have laid the path toward this goal.

Patterns of finger amputation and replantation in the setting of a rapidly growing immigrant population.

To determine the incidence of finger amputation and replantation in North Carolina (NC) and to identify patterns of injury by race and immigration status. Finger amputation injury data were obtained from the NC hospital discharge database. Hospital discharge data were linked to 2000 US Census data by zip code of residence to estimate median income, the percentage of Hispanics, and the percent foreign-born.

Homicide among pregnant and postpartum women in the United States: a review of the literature.

Eighteen articles that examined the extent of homicide among pregnant and/or postpartum women in the United States are reviewed, documenting the studies' methods and findings. Results from proportional mortality analyses (studies that examined only deaths, rather than deaths within a larger population of living individuals) showed a modicum of support for the contention that homicide may account for a greater proportion of the deaths among pregnant/postpartum women than among other women of reproductive age. However, results from more comprehensive analyses that estimated homicide risks/rates (studies that examined deaths within the context of living populations) did not find any evidence to suggest that pregnant/postpartum women experience a greater risk/rate of homicide compared to other women of reproductive age.