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17 September 2001
The injured intoxicated driver: analysis of the conviction process.
Chang S, Cushman JG, Pasquale MD. J Trauma 2001; 51(3): 551-556.
Correspondence: Department of Surgery, Division of Trauma and Surgical Critical Care, Lehigh Valley Hospital, Allentown, Pennsylvania, USA. (email: unavailable).
BACKGROUND: The widespread nature of alcohol-related motor vehicle collisions suggests inadequacies in the system for deterring alcohol use when driving.
OBJECTIVES: This study was performed to determine whether hospitalization is a component in a 'system failure' that allows injured, alcohol-impaired drivers to escape arrest and conviction for driving under the influence (DUI).
METHODS: Retrospective review of medical and court records of intoxicated drivers injured in a motor vehicle collision who were transported to our Level I trauma center from January 1, 1997, through December 31, 1998.
RESULTS: Of the 213 intoxicated drivers in our study, 172 (81%) were followed up by law enforcement officials, and 156 (73.2%) were arrested for DUI. Of those who were arrested and completed court hearings, 135 (93.8%) were convicted for DUI.
CONCLUSIONS: These values are higher than those reported in previous studies and indicate that hospitalization does not 'protect' injured, intoxicated drivers in our community.
Trends in youth mortality in Israel, 1984-1995.
Wilf-Miron R, Nathan K, Sikron F, Barrell V. Isr Med Assoc J 2001; 3(8): 610-614.
Correspondence: Rachel Wilf-Miron, Division of Pediatrics and Health Services Research Unit, Sheba Medical Center, Tel-Hashomer, ISRAEL. (email: unavailable).
BACKGROUND: Investigation of causes of death can help inform intervention policy aimed at reducing preventable mortality.
OBJECTIVES: To assess mortality causes and trends over time and identify target groups with excessive mortality rates among Israeli youth aged 10-24, in order to formulate an intervention policy for prevention of adolescent mortality.
METHODS: Mortality data for Israeli residents aged 10-24 were extracted from the Central Bureau of Statistics computerized death certificate file for the period 1984-95. Trends were evaluated by cause of death and demographic characteristics.
RESULTS: The crude mortality rate among Israeli youth aged 10-24, during 1993-1995, was 39.6 per 100,000. Rates were 2.7 times higher among males, increased with age, and reached a peak among 18-21 year olds. Rates were 1.4 times higher among Arabs than among Jews. The sharp increase in mortality among Jewish males of military service age (18-21 years) was due mainly to motor vehicle crashes and suicide. Although overall mortality decreased by 9.4% from 1984-86 to 1993-95, the gap between the subgroups increased. MVC-related mortality increased over time by 100% among Arab males. The rate of completed suicide among Jewish males increased by 110%. Although injury-related mortality is lower in Israel compared with the U.S., similar demographic differentials and trends were found in both countries.
CONCLUSIONS: Suicide among Jewish males of military service age, as well as MVC fatalities among Arab males, present a growing public health issue. Intervention strategies should therefore be targeted towards these subgroups in order to minimize the rates of preventable death. Mortality among patients admitted to hospitals on weekends as compared with weekdays.
Bell CM, Redelmeier DA. New Engl J Med 2001; 345(9): 663-668.
Correspondence: Donald Redelmeier, Department of Medicine, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, ON, CANADA. (email: don.redelmeier@swchsc.on.ca).
BACKGROUND: The level of staffing in hospitals is often lower on weekends than on weekdays, despite a presumably consistent day-to-day burden of disease.
OBJECTIVE: To determine whether in-hospital mortality rates among patients with serious conditions differ according to whether they are admitted on a weekend or on a weekday.
METHODS: We analyzed all acute care admissions from emergency departments in Ontario, Canada, between 1988 and 1997 (a total of 3,789,917 admissions). We compared in-hospital mortality among patients admitted on a weekend with that among patients admitted on a weekday for three prespecified diseases: ruptured abdominal aortic aneurysm (5454 admissions), acute epiglottitis (1139), and pulmonary embolism (11,686) and for three control diseases: myocardial infarction (160,220), intracerebral hemorrhage (10,987), and acute hip fracture (59,670), as well as for the 100 conditions that were the most common causes of death (accounting for 1,820,885 admissions).
RESULTS: Weekend admissions were associated with significantly higher in-hospital mortality rates than were weekday admissions among patients with ruptured abdominal aortic aneurysms (42 percent vs. 36 percent, P < 0.001), acute epiglottitis (1.7 percent vs. 0.3 percent, P=0.04), and pulmonary embolism (13 percent vs. 11 percent, P=0.009). The differences in mortality persisted for all three diagnoses after adjustment for age, sex, and coexisting disorders. There were no significant differences in mortality between weekday and weekend admissions for the three control diagnoses. Weekend admissions were also associated with significantly higher mortality rates for 23 of the 100 leading causes of death and were not associated with significantly lower mortality rates for any of these conditions.
CONCLUSIONS: Patients with some serious medical conditions are more likely to die in the hospital if they are admitted on a weekend than if they are admitted on a weekday.
Substances used in deliberate self-poisoning 1985-1997: trends and associations with age, gender, repetition and suicide intent.
Townsend E, Hawten K, Harriss L, Bale E, Bond A. Int J Res Social and Genetic Epidemiol Mental Health Serv 2001; 36(5): 228-234.
Correspondence: Keith Hawton, Centre for Suicide Research, Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX, UK. (email: keith.hawton@psych.ox.ac.uk).
BACKGROUND: Rates of deliberate self-poisoning have increased in recent years. While over-the-counter availability and prescribing patterns may influence trends in substances used in overdose, these may also be related to clinical characteristics of patients.
OBJECTIVE: To investigate trends in substances used for self-poisoning and the influence of age, gender, suicidal intent and repetition status on the substances used.
METHODS: Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends and patterns of self-poisoning between 1985 and 1997.
RESULTS: There were substantial increases in self-poisoning with paracetamol and antidepressants. While the increase in antidepressant self-poisoning closely paralleled local prescribing figures during 1995-97, SSRI antidepressant overdoses occurred somewhat more often than expected compared with tricyclic overdoses. Paracetamol overdoses were more common in first-timers and young people, whereas overdoses of antidepressants and tranquillizers were more common in repeaters and older people. Self-poisoning with gas and non-ingestible poisons was associated with high suicidal intent.
CONCLUSIONS: There have been marked changes in the substances used for self-poisoning, which seem primarily to reflect availability, as do the influences of age and repeater status on choice of substances used. Degree of suicidal intent may also influence choice of method of self-poisoning.
Seat belt use before and after motor vehicle trauma.
Passman C, McGwin GJ, Taylor AJ, Rue LW. J Trauma 2001; 51(1): 105-109.
Correspondence: Gerald McGwinn, Jr., Center for Injury Sciences, Division of General Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, 700 South 18th Street
Birmingham, AL 35294, USA. (email: mcgwin@eyes.uab.edu).
BACKGROUND: Motor vehicle crashes cause significant morbidity and mortality annually. Seat belt use has partially been associated with a decreased risk of morbidity and mortality among those involved in motor vehicle crashes. Persons injured in motor vehicle crashes and not wearing seat belts have an increased risk of admission to trauma centers for motor vehicle crash-related injury.
OBJECTIVES: The purpose of this study was to measure changes in seat belt use after discharge among patients admitted to a Level I trauma center for injuries sustained in motor vehicle crashes.
METHODS: Patients admitted to a Level I trauma center for injuries sustained in motor vehicle crashes during 1998 were eligible for participation. A telephone interview was conducted with a random sample of 136 eligible patients regarding patterns of seat belt use before and after their collision. Demographic data and clinical characteristics were also collected. The frequency of seat belt use before and after crash involvement was compared for all patients and stratified by age, gender, race, and Injury Severity Score (ISS).
RESULTS: Slightly over half (54%) of patients reported 'always' wearing a seat belt before their collision compared with 85% afterward. Younger age groups, male subjects, and whites had the largest increases in the frequency of seat belt use after collision (45%, 37%, and 44% increases, respectively). With respect to injury severity, the largest increase in the frequency of seat belt use was among those with ISS of 15 to 25 (82% increase). Significant concordance between patient- and emergency medical service-reported use of seat belts was observed. Among subjects reported by emergency medical service personnel to have been restrained, nearly 90% reported belt use at the time of the telephone interview. The most frequently cited occasion for failure to use seat belts (30%) was when taking short trips. Other reported reasons were forgetting to fasten belts (29%), discomfort (10%), being in a rush (8%), riding in the back seat (4%), and that seat belts were unnecessary when riding with a good driver (3%).
CONCLUSION: Involvement in a motor vehicle crash results in increased seat belt use. Prevention efforts should be directed toward those patients who report infrequent use. Patient 'converts' to seat belt use after collisions may be useful in public awareness and prevention campaigns. The effects of age on accident severity and outcome in Irish road traffic accident patients.
Cunningham C, Howard D, Walsh J, Coakley D, O'Neill D. Ir Med J 2001; 94(6): 169-171.
Correspondence: Conal Cunningham, Mercer's Institute for Research in Ageing, St James' Hospital, Dublin, IRELAND. (email: ccunningham@stjames.ie).
BACKGROUND: Road traffic crashes (RTC's) are the leading cause of fatal trauma in Ireland. Although older drivers are the safest group of drivers in the population, once involved in a crash they are more likely to sustain a severe injury or death. The experiences of Irish elderly RTC victims has not been previously documented.
METHODS: The authors studied older RTC patients admitted to two Irish trauma centers in 1995. Of 525 patients, 39 (7%) were aged over 65. They compared 38 patients aged 16-64 years for comparison and reviewed the notes in detail.
RESULTS: Elderly patients were mostly pedestrians (23/38 - 61%) though 21% (8/38) were drivers with 8% (3/38) on public transport. Younger patients were mostly drivers (14/37 - 38%), cyclists (9/37 - 24%) or motorcyclists (7/37 - 19%). Older patients had a higher median Injury Severity Score, p < 0.05, were more likely to be female (p < 0.01), involved in RTC's between 9am-5pm (p < 0.05) and have pre-existing medical conditions (p < 0.01). The following were significantly increased in older patients: surgical, medical, and therapist workload, complications, and length of stay. Less elderly were discharged directly to home (p < 0.001).
CONCLUSIONS: Strategies to reduce the mortality and morbidity associated with RTC in the elderly should emphasize a) older pedestrians during daytime hours, b) attention to safety in public transport. Treatment must ensure adequate medical and therapist input to anticipate higher complication rates.
Influence of Homicide on Racial Disparity in Life Expectancy --- United States, 1998.
Potter L, National Center for Injury Prevention and Control, National Center for Health Statistics. MMWR 2001; 50(36): 780-783.
Correspondence: Lloyd Potter, Children's Safety Network, 55 Chapel Street, Newton, MA 02458-1060, USA
(email: lpotter@edc.org).
BACKGROUND: Life expectancy (LE) is an important indicator of the health of populations. Since the early 1900s, when estimates of LE began to be tabulated in the United States, the LE of blacks has been lower than that of whites. Homicide, which disproportionately affects blacks, particularly young males, contributes to this difference in LE.
OBJECTIVE: To examine the associations between homicide, LE, and race.
METHODS: US National Center for Health Statistics mortality files for 1998 and the multiple-decrement life table were used to examine differences between whites and blacks. These methods were used to partition the contribution to LE at birth by selected causes of death using the International Classification of Diseases, Ninth Revision, (ICD-9) codes for the four major race-sex groups (black-males, black-females, white-males, white-females) in the United States. The contribution in years for each cause of death to the black/white differential and statistical tests of difference (Z-scores) were determined using Survival software, with whites as the referent group. Causes of death used were based on the leading causes of death in 1998 for the total population and for both racial populations. Other causes of death were categorized as 'all other causes.'
RESULTS: In the United States during 1998, whites lived 6.2 years longer than blacks. Among the leading causes of death that contributed to the difference were heart disease (1.7 years; 27.4%), cancer (1.2 years; 19.4%), homicide (0.6 years; 9.7%), stroke (0.5 years; 8.1%), and 'all other causes' (1.9 years; 30.6%). The LE differential was 6.4 years for males and 4.4 years for females. Among males, some of the leading causes of death that contributed to the LE differential were heart disease (1.2 years; 19.0%), cancer (1.0 years; 15.6%), and homicide (0.9 years; 14.1%), and among females were heart disease (1.2 years; 27.3%), cancer (0.5 years; 11.4%), and perinatal disease (e.g., birth trauma, birth asphyxia, ectopic pregnancy, and maternal death) (0.4 years; 9.1%). Stroke and human immunodeficiency virus (HIV) accounted for 0.3 years (6.8%) and 0.3 years (6.8%), respectively, of the LE differential among females and 0.4 years (6.3%) and 0.6 years (9.4%), respectively, among males. Homicide among black females contributed 0.2 years (4.5%) to the LE differential.
CONCLUSION: Homicide accounted for approximately 10% of the LE differential. This finding suggests that causes of death that rank low for the total population may be important targets to address in attempting to eliminate the LE gap between these populations.
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Rev. 15-Sep-2001 at 05:42 hours.
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