Efforts to control agricultural injuries have been underway for years. Yet, very little is known ... more Efforts to control agricultural injuries have been underway for years. Yet, very little is known about their trends over time. We examined trends in non-fatal agricultural injuries through analyzing injuries reported in a state trauma registry. Using Iowa Trauma Registry data collected by the Iowa Department of Public Health, we examined trends in non-fatal agricultural injuries reported by acute care hospitals accredited as Level I, II, and III Trauma Care Facilities from 2005 to 2013. Rate ratios and corresponding 95 % confidence intervals were used to examine the burden of non-fatal agricultural injuries across this period. Negative binomial regression was used to calculate the average annual change in agricultural injury rates over time. Joinpoint regression analysis was used to examine the average annual change in the number of injuries over time. Between 2005 and 2013, a total of 1238 agricultural injuries were reported to the trauma registry by Level I, II and III trauma faci...
Http Dx Doi Org 10 1089 Neu 2006 0196, Jul 4, 2007
The response of trauma systems in rural areas is uncertain since distances between injury scenes ... more The response of trauma systems in rural areas is uncertain since distances between injury scenes and trauma care are considerable. Timely arrival at definitive care is critical for persons with traumatic brain injury (TBI) since secondary damage can occur during the hours following injury. We evaluated how the implementation of a trauma system in a predominately rural state affected the triage of TBI patients and their risk for mortality. The Iowa System Trauma Registry Dataset was analyzed, and included patients evaluated before trauma system implementation, 1997-1998, and after implementation, 2002-2003. Patients were identified using ICD9-CM codes or AIS codes, and included 710 pre-system patients and 886 post-system patients. Multivariate logistic regression assessed the effect of the trauma system on survival while controlling for confounders. Following implementation of the trauma system, patients treated in Level I or II facilities were older (p = 0.019), more often had multiple injuries (p = 0.0002), and had more severe TBI (p = 0.008). After controlling for confounders, transferred patients and those directly admitted were less likely to die in 72 h in the post-system than the pre-system (odds ratio [OR] = 0.56, 95% confidence interval (CI) = 0.36, 0.88; OR = 0.50, 95% CI = 0.32, 0.79). Implementation of the Iowa trauma system seems to have led to more appropriate triage and transport for TBI patients, and this likely contributed to reduced in-hospital mortality.
Background: Fall-related injuries are a leading cause of non-fatal injury in Iowa with increasing... more Background: Fall-related injuries are a leading cause of non-fatal injury in Iowa with increasing occurrence, particularly with the aging population. Falls from the same level are also increasing in occurrence, particularly in females. Statewide trauma data was used in our analysis to examine the trends and variation in characteristics of same level falls by age and gender. Methods: The study population consisted of Iowa Trauma Registry patients from January 1, 2002 through December 31, 2006 that sustained a same level fall-related injury (n=6,235 patients). We examined demographic, injury event, injury type, severity, and outcome characteristics by age and gender. Results: Same level falls have increased by 47% from 2002 to 2006. In our examination of same level fall mechanisms, males Conclusions: Same level fall injuries differed by age and gender in the mechanism, primary injury type, and injury severity. The activity and/or velocity of same level falls coincide with injury sever...
Background/Purpose: Although trauma systems have been in place in the United States for over half... more Background/Purpose: Although trauma systems have been in place in the United States for over half a century, their usefulness in rural settings has remained controversial. The mostly rural State of Iowa implemented a trauma system in 2001. This study examines the impact the new system has had on the transfer patterns of patients with spinal cord injuries (SCI). Methods: We analyzed characteristics of spinal cord injury patients' pre-implementation (1997-1998) and post-implementation (2002-2004) and within those compared those who were transferred versus not transferred. Data were drawn from the State Trauma Registry of Iowa and spinal cord injuries were identified by ICD-9 and AIS codes. T, F, and Chi-square tests were performed to evaluate pre/post implementation and variables of transferred/not transferred, time, region where injury occurred, ISS, injury mechanism, risk of death, and level of spinal column injured. Results/Outcome: 635 subjects were included in the analysis (2...
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, Jan 29, 2015
Farm-related injuries are an important public health problem in agriculture because of their impa... more Farm-related injuries are an important public health problem in agriculture because of their impact on individuals, families, and farm operations. While surveillance programs such as the Census of Fatal Occupational Injuries is available to track fatal agricultural injuries, more work is needed to examine the burden of nonfatal agricultural injuries. Data involving agricultural injuries were collected from the Iowa Trauma Registry from January 1, 2005, through December 31, 2011. A total of 2,490 trauma patients were found to have been classified as having a farm-related injury. These nonfatal farm-related injuries were compared by work-relatedness, injury severity score, length of hospital stay, and hospital discharge status. Also reported are the age and gender of the trauma patients, as well as the population of the county in which the injury occurred. In our analysis, we found that work- versus nonwork-relatedness had little effect on injury severity, but that work-related injuri...
To identify tractor-related injuries using data from a statewide trauma system, to characterize t... more To identify tractor-related injuries using data from a statewide trauma system, to characterize the mechanisms of nonfatal tractor-related injury, and to determine which injuries are associated with higher severity injury. A retrospective observational study was conducted using the Iowa State Trauma Registry to identify cases of nonfatal tractor-related injuries over an 11-year period from 2002 to 2012. Frequency of injury was reported by age, sex, severity, and nature. Injuries were classified by mechanism and a polytomous regression model was used to predict injury severity adjusting for sex and age. Five-hundred thirteen nonfatal tractor-related injuries were identified with 18% classified as severe. Injuries were most frequent among males and among those ≥45years of age. Rollovers were the most frequent mechanism of both total (25%) and severe injury (38%), although the frequency of injury mechanism varied by age. Falls were the next most frequent mechanism of injury (20%) but resulted in fewer high-severity injuries. Collision (adjOR=1.89, 95% CI=1.01-3.51), rollover (adjOR=2.03, 95% CI=1.21-3.40), and run over/rolled on (adjOR=2.06, 95% CI=1.17-3.62) injuries were significantly associated with higher injury severity. Advanced age was also a significant predictor of higher severity injury (adjOR=1.82, 95% CI=1.06-3.12). Mechanisms of nonfatal tractor-related injuries are heterogeneous, differ by age, and are associated with varying level of severity. This work shows the burden of nonfatal tractor injuries on a rural state trauma system. These findings also demonstrate the heterogeneous nature of nonfatal tractor injuries and underscore the need for a multi-level approaches to injury prevention.
Background/Purpose: Unintentional poisoning (UP) is a growing public health problem with steadily... more Background/Purpose: Unintentional poisoning (UP) is a growing public health problem with steadily rising number of deaths. From 2002-2011, deaths from UP have risen from 67 to 199 deaths (197% increase). The primary cause of death in 2011 was from illicit drugs, other medications, and alcohol. The purpose is to examine differences in rates and increased odds in UP deaths across age, gender, and population size by drug class. Methods: All UP deaths were obtained from Iowa Death Certificates (2009-2011). Main drug classes focused on included illicit drugs, other medications, and alcohol. Bivariate analyses of age, gender, and population size by drug class were performed. Rates of each drug class were calculated for covariates. Logistic regression was used to identify covariates associated with UP deaths among the three drug classes. Results/Outcomes: There were 462 UP deaths in Iowa. Rates were higher in males across drug class, ages 25-44 for illicit drugs and other medications, and ...
Background/Purpose: Intoxications and poisonings are among the most common diagnoses in Emergency... more Background/Purpose: Intoxications and poisonings are among the most common diagnoses in Emergency Departments. While childhood poisonings have been studied in high income countries for years, limited data are available for middle and low income countries. We are aware of no prior studies conducted in eastern Europe. This retrospective study identifies the distribution and major risk factors for childhood poisoning cases treated in the Emergency Department (ED) of a major children's hospital in Romania. Methods: A retrospective record review of children aged 0 19 who were admitted and treated for poisonings between January 1999 and December 2003 was conducted. Injury diagnoses and cause of injury were coded using ICD-10. Study variables used in this analyses included gender, age, injury diagnoses, source of poisoning, cause of injury, injury intent, and disposition. Results/Outcomes: Poisonings represent a high-percentage (37.3%) of pediatric injury-related ED visits. The most co...
Although prior research has established that school buses are a safe form of transportation, cras... more Although prior research has established that school buses are a safe form of transportation, crashes can produce catastrophic consequences. School buses have 2 types of routes: predictable, routine routes that take children to and from school and less predictable, nonroutine routes for school events. No studies have examined school bus crash incidence and characteristics by these route types. School bus crashes were identified from the Iowa Department of Transportation Crash Database from mid-2005 through mid-2010. Crash reports did not identify whether the bus was on a routine or nonroutine route, so a protocol to assign these based on day and time was developed. Bus mileage was provided by the Iowa Department of Education. The school bus crash rate was 2.1 times higher on nonroutine routes than on routine routes (95% CI = 1.8-2.3). Most crashes involved an improper action by the driver of another vehicle. In crashes attributed to improper actions of school buses, failure to yield ...
To identify the prevalence, characteristics, and risk markers for childhood poisonings treated in... more To identify the prevalence, characteristics, and risk markers for childhood poisonings treated in the emergency department of a large Romanian hospital. Trauma registry data using ICD-10 codes and case summaries were studied to identify poisonings among children aged 0-18. Multivariate logistic regression identified factors associated with hospital admission. Between 1999 and 2003, 1,173 pediatric trauma cases were seen in the emergency department; 437 (37.3%) were treated for poisoning, including medication (35%), alcohol (26%), chemical products (19%), and carbon monoxide (14%). Half of all poisonings were unintentional, primarily affecting children \ 10 years. Half were intentional, mainly affecting children 10-18. Females were three times more likely than males to have documented suicidal intent (P \ .0001). Over 30% of suicide attempts were among children ages 10-14 (P \ .0001). We report significantly increased adjusted odds ratios (P \ .05) of hospital admission for children 10-18, and for chemical substance poisoning, and suicidal intent. Pediatric poisoning is a serious public health issue in Romania, and we suggest these findings are relevant across other eastern European countries with limited resources. Poisonings result in morbidity and hospital admissions, yet there are few prevention resources available. Health education programs and consumer product safety policies are needed in Romania and eastern Europe.
Background: Previous research has identified teenage drivers as having an increased risk for moto... more Background: Previous research has identified teenage drivers as having an increased risk for motor-vehicle crash injury compared with older drivers, and rural roads as having increased crash severity compared with urban roads. Few studies have examined incidence and characteristics of teen driver-involved crashes on rural and urban roads. Methods: All crashes involving a driver aged 10 through 18 were identified from the Iowa Department of Transportation crash data from 2002 through 2008. Rates of overall crashes and fatal or severe injury crashes were calculated for urban, suburban, rural, and remote rural areas. The distribution of driver and crash characteristics were compared between rural and urban crashes. Logistic regression was used to identify driver and crash characteristics associated with increased odds of fatal or severe injury among urban and rural crashes. Results: For younger teen drivers (age 10 through 15), overall crash rates were higher for more rural areas, although for older teen drivers (age 16 through 18) the overall crash rates were lower for rural areas. Rural teen crashes were nearly five times more likely to lead to a fatal or severe injury crash than urban teen crashes. Rural crashes were more likely to involve single vehicles, be late at night, involve a failure to yield the right-of-way and crossing the center divider. Conclusions: Intervention programs to increase safe teen driving in rural areas need to address specific risk factors associated with rural roadways. Impact on Industry: Teen crashes cause lost work time for teen workers as well as their parents. Industries such as safety, health care, and insurance have a vested interest in enhanced vehicle safety, and these efforts should address risks and injury differentials in urban and rural roadways.
The response of trauma systems in rural areas is uncertain since distances between injury scenes ... more The response of trauma systems in rural areas is uncertain since distances between injury scenes and trauma care are considerable. Timely arrival at definitive care is critical for persons with traumatic brain injury (TBI) since secondary damage can occur during the hours following injury. We evaluated how the implementation of a trauma system in a predominately rural state affected the triage of TBI patients and their risk for mortality. The Iowa System Trauma Registry Dataset was analyzed, and included patients evaluated before trauma system implementation, 1997-1998, and after implementation, 2002-2003. Patients were identified using ICD9-CM codes or AIS codes, and included 710 pre-system patients and 886 post-system patients. Multivariate logistic regression assessed the effect of the trauma system on survival while controlling for confounders. Following implementation of the trauma system, patients treated in Level I or II facilities were older (p = 0.019), more often had multiple injuries (p = 0.0002), and had more severe TBI (p = 0.008). After controlling for confounders, transferred patients and those directly admitted were less likely to die in 72 h in the post-system than the pre-system (odds ratio [OR] = 0.56, 95% confidence interval (CI) = 0.36, 0.88; OR = 0.50, 95% CI = 0.32, 0.79). Implementation of the Iowa trauma system seems to have led to more appropriate triage and transport for TBI patients, and this likely contributed to reduced in-hospital mortality.
Burn injuries sustained during residential trash, brush, and grass burning cause significant morb... more Burn injuries sustained during residential trash, brush, and grass burning cause significant morbidity and mortality in rural areas. To further prevention efforts, we surveyed individuals who incurred injuries from residential burning. Thirty-six individuals injured while burning trash, brush, or grass from June 2003 through September 2005 were asked to respond to a self-administered written survey. Injury related questions revealed that the majority of those injured were burning brush (21 of 35, 60.0%) in an open space (19 of 35, 54.2%) with the addition of accelerants (27 of 36, 75%). Survey questions regarding usual burning practices revealed almost two-thirds burned either brush or a mixture of brush and trash (23 of 36, 63.9%). Eighty percent of those who were injured desired to change their behavior (25 of 35, 80%). Approximately two-thirds would consider asking for help with burning if it were provided (22 of 34, 64.7%). Our survey shows that acceptable alternatives to burning varied depending on the material that was burned. As the majority of respondents usually burned brush or a mixture of brush and trash, an acceptable trash removal system should also include brush pickup. As residential burning continues presently, injury prevention efforts are essential and should focus on the misuse of gasoline, uniform safety standards for gasoline cans, and dissemination of safe burning practices.
Smoke alarms are one of the most promoted prevention strategies to reduce residential fire deaths... more Smoke alarms are one of the most promoted prevention strategies to reduce residential fire deaths, and they can reduce residential fire deaths by half. Smoke alarm function can be measured by two tests: the smoke alarm button test and the chemical smoke test. Using results from a randomized trial of smoke alarms, we compared smoke alarm response to the button test and the smoke test. The smoke alarms found in the study homes at baseline were tested, as well as study alarms placed into homes as part of the randomized trial. Study alarms were tested at 12 and 42 months postinstallation. The proportion of alarms that passed the button test but not the smoke test ranged from 0.5 to 5.8% of alarms; this result was found most frequently among ionization alarms with zinc or alkaline batteries. These alarms would indicate to the owner (through the button test) that the smoke alarm was working, but the alarm would not actually respond in the case of a fire (as demonstrated by failing the smoke test). The proportion of alarms that passed the smoke test but not the button test ranged from 1.0 to 3.0%. These alarms would appear nonfunctional to the owner (because the button test failed), even though the alarm would operate in response to a fire (as demonstrated by passing the smoke test). The general public is not aware of the potential for inaccuracy in smoke alarm tests, and burn professionals can advocate for enhanced testing methods. The optimal test to determine smoke alarm function is the chemical smoke test.
Parents play a fundamental role in teaching their children safe driving skills to reduce risk of ... more Parents play a fundamental role in teaching their children safe driving skills to reduce risk of motor vehicle crashes, the leading cause of death for teens. Steering Teens Safe is a new parent-based intervention that equips parents with communication skills to talk about, demonstrate, and practice safe driving behaviors and skills with their teens. This implementation evaluation focuses on a sample of 83 parents who delivered Steering Teens Safe to their teens. One-, 2- and 3-month follow-up assessments were conducted with intervention parents to evaluate the self-reported quantity and quality of talking about, demonstrating, and practicing safe driving goals with teens; perceived success and benefit of the program; and barriers to implementation. Over 3 months of follow-up, parents discussed driving goals with their teens for a median of 101.5 minutes. The most frequently addressed topics were general safety principles, including distracted driving, driving in bad weather, wearing a seat belt, and being a safe passenger. Parents spent a median of 30 minutes practicing safe driving skills such as changing lanes. Sixty-seven percent of parents talked to their children about rural road safety, but just 36% demonstrated and half practiced these skills with their teens. Barriers to implementation include time and opportunity barriers and resistant attitudes of their teens. However, barriers neither affected frequency of engagement nor parents' perceived benefit and comfort in delivering the program. Parents with time/opportunity barriers also had higher practice and demonstration times than parents without these barriers. Findings indicate high acceptability among parent implementers and promise for real-world delivery. Future studies are needed to assess intervention impact.
Childhood injury rates are higher in low and middle-income countries than in high-income countrie... more Childhood injury rates are higher in low and middle-income countries than in high-income countries. Childhood injuries have not been widely studied in Romania, a middle-income country, because data sources are lacking. This study presents the first surveillance data of nonfatal childhood injuries from a large children's hospital in Cluj, a major city of Romania. This retrospective study included review of medical records of injured children of 0-18 years of age treated in a major city pediatric emergency department from 1999 to 2003. In the 5-year study period, 1179 childhood injuries were treated in the emergency department, for an average of 236 patients per year. For the county of Cluj, this represents an annual average injury incidence of 197 per 100,000 children younger than 5 years, 140 per 100 000 children aged 5-14 years, and 135 per 100 000 for children aged 15-18 years. Unintentional injuries represented 77.8% of cases, 18% were self-harm and suicide attempts, and 4.3% were assaults. These trends, among the first reported from Romania, can help identify priority prevention areas.
season, and 2/7th -or 28.57% -of ED visits would occur on weekends. We define a surge as any incr... more season, and 2/7th -or 28.57% -of ED visits would occur on weekends. We define a surge as any increase above this assumption of randomness. All statistical analyses were performed using SPSS.
Background: This randomized trial presents fındings from the longest follow-up study of smoke ala... more Background: This randomized trial presents fındings from the longest follow-up study of smoke alarm and battery function to date.
Background: Although the use of smoke alarms is widely recommended, little guidance is available ... more Background: Although the use of smoke alarms is widely recommended, little guidance is available on the types of alarms and batteries that function best. This study examined smoke alarm and battery function 12 months after installation in rural residential households.
Crashes are the leading cause of death for teens, and parent-based interventions are a promising ... more Crashes are the leading cause of death for teens, and parent-based interventions are a promising approach. We assess the effectiveness of Steering Teens Safe, a parent-focused program to increase safe teen driving. Steering Teens Safe aimed to improve parental communication with teens about safe driving using motivational interviewing techniques in conjunction with 19 safe driving lessons. A randomized controlled trial involved 145 parent-teen dyads (70 intervention and 75 control). Intervention parents received a 45-minute session to learn the program with four follow-up phone sessions, a DVD, and a workbook. Control parents received a standard brochure about safe driving. Scores were developed to measure teen-reported quantity and quality of parental communication about safe driving. The main outcome measure was a previously validated Risky Driving Score reported by teens. Because the Score was highly skewed, a generalized linear model based on a gamma distribution was used for an...
Efforts to control agricultural injuries have been underway for years. Yet, very little is known ... more Efforts to control agricultural injuries have been underway for years. Yet, very little is known about their trends over time. We examined trends in non-fatal agricultural injuries through analyzing injuries reported in a state trauma registry. Using Iowa Trauma Registry data collected by the Iowa Department of Public Health, we examined trends in non-fatal agricultural injuries reported by acute care hospitals accredited as Level I, II, and III Trauma Care Facilities from 2005 to 2013. Rate ratios and corresponding 95 % confidence intervals were used to examine the burden of non-fatal agricultural injuries across this period. Negative binomial regression was used to calculate the average annual change in agricultural injury rates over time. Joinpoint regression analysis was used to examine the average annual change in the number of injuries over time. Between 2005 and 2013, a total of 1238 agricultural injuries were reported to the trauma registry by Level I, II and III trauma faci...
Http Dx Doi Org 10 1089 Neu 2006 0196, Jul 4, 2007
The response of trauma systems in rural areas is uncertain since distances between injury scenes ... more The response of trauma systems in rural areas is uncertain since distances between injury scenes and trauma care are considerable. Timely arrival at definitive care is critical for persons with traumatic brain injury (TBI) since secondary damage can occur during the hours following injury. We evaluated how the implementation of a trauma system in a predominately rural state affected the triage of TBI patients and their risk for mortality. The Iowa System Trauma Registry Dataset was analyzed, and included patients evaluated before trauma system implementation, 1997-1998, and after implementation, 2002-2003. Patients were identified using ICD9-CM codes or AIS codes, and included 710 pre-system patients and 886 post-system patients. Multivariate logistic regression assessed the effect of the trauma system on survival while controlling for confounders. Following implementation of the trauma system, patients treated in Level I or II facilities were older (p = 0.019), more often had multiple injuries (p = 0.0002), and had more severe TBI (p = 0.008). After controlling for confounders, transferred patients and those directly admitted were less likely to die in 72 h in the post-system than the pre-system (odds ratio [OR] = 0.56, 95% confidence interval (CI) = 0.36, 0.88; OR = 0.50, 95% CI = 0.32, 0.79). Implementation of the Iowa trauma system seems to have led to more appropriate triage and transport for TBI patients, and this likely contributed to reduced in-hospital mortality.
Background: Fall-related injuries are a leading cause of non-fatal injury in Iowa with increasing... more Background: Fall-related injuries are a leading cause of non-fatal injury in Iowa with increasing occurrence, particularly with the aging population. Falls from the same level are also increasing in occurrence, particularly in females. Statewide trauma data was used in our analysis to examine the trends and variation in characteristics of same level falls by age and gender. Methods: The study population consisted of Iowa Trauma Registry patients from January 1, 2002 through December 31, 2006 that sustained a same level fall-related injury (n=6,235 patients). We examined demographic, injury event, injury type, severity, and outcome characteristics by age and gender. Results: Same level falls have increased by 47% from 2002 to 2006. In our examination of same level fall mechanisms, males Conclusions: Same level fall injuries differed by age and gender in the mechanism, primary injury type, and injury severity. The activity and/or velocity of same level falls coincide with injury sever...
Background/Purpose: Although trauma systems have been in place in the United States for over half... more Background/Purpose: Although trauma systems have been in place in the United States for over half a century, their usefulness in rural settings has remained controversial. The mostly rural State of Iowa implemented a trauma system in 2001. This study examines the impact the new system has had on the transfer patterns of patients with spinal cord injuries (SCI). Methods: We analyzed characteristics of spinal cord injury patients' pre-implementation (1997-1998) and post-implementation (2002-2004) and within those compared those who were transferred versus not transferred. Data were drawn from the State Trauma Registry of Iowa and spinal cord injuries were identified by ICD-9 and AIS codes. T, F, and Chi-square tests were performed to evaluate pre/post implementation and variables of transferred/not transferred, time, region where injury occurred, ISS, injury mechanism, risk of death, and level of spinal column injured. Results/Outcome: 635 subjects were included in the analysis (2...
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, Jan 29, 2015
Farm-related injuries are an important public health problem in agriculture because of their impa... more Farm-related injuries are an important public health problem in agriculture because of their impact on individuals, families, and farm operations. While surveillance programs such as the Census of Fatal Occupational Injuries is available to track fatal agricultural injuries, more work is needed to examine the burden of nonfatal agricultural injuries. Data involving agricultural injuries were collected from the Iowa Trauma Registry from January 1, 2005, through December 31, 2011. A total of 2,490 trauma patients were found to have been classified as having a farm-related injury. These nonfatal farm-related injuries were compared by work-relatedness, injury severity score, length of hospital stay, and hospital discharge status. Also reported are the age and gender of the trauma patients, as well as the population of the county in which the injury occurred. In our analysis, we found that work- versus nonwork-relatedness had little effect on injury severity, but that work-related injuri...
To identify tractor-related injuries using data from a statewide trauma system, to characterize t... more To identify tractor-related injuries using data from a statewide trauma system, to characterize the mechanisms of nonfatal tractor-related injury, and to determine which injuries are associated with higher severity injury. A retrospective observational study was conducted using the Iowa State Trauma Registry to identify cases of nonfatal tractor-related injuries over an 11-year period from 2002 to 2012. Frequency of injury was reported by age, sex, severity, and nature. Injuries were classified by mechanism and a polytomous regression model was used to predict injury severity adjusting for sex and age. Five-hundred thirteen nonfatal tractor-related injuries were identified with 18% classified as severe. Injuries were most frequent among males and among those ≥45years of age. Rollovers were the most frequent mechanism of both total (25%) and severe injury (38%), although the frequency of injury mechanism varied by age. Falls were the next most frequent mechanism of injury (20%) but resulted in fewer high-severity injuries. Collision (adjOR=1.89, 95% CI=1.01-3.51), rollover (adjOR=2.03, 95% CI=1.21-3.40), and run over/rolled on (adjOR=2.06, 95% CI=1.17-3.62) injuries were significantly associated with higher injury severity. Advanced age was also a significant predictor of higher severity injury (adjOR=1.82, 95% CI=1.06-3.12). Mechanisms of nonfatal tractor-related injuries are heterogeneous, differ by age, and are associated with varying level of severity. This work shows the burden of nonfatal tractor injuries on a rural state trauma system. These findings also demonstrate the heterogeneous nature of nonfatal tractor injuries and underscore the need for a multi-level approaches to injury prevention.
Background/Purpose: Unintentional poisoning (UP) is a growing public health problem with steadily... more Background/Purpose: Unintentional poisoning (UP) is a growing public health problem with steadily rising number of deaths. From 2002-2011, deaths from UP have risen from 67 to 199 deaths (197% increase). The primary cause of death in 2011 was from illicit drugs, other medications, and alcohol. The purpose is to examine differences in rates and increased odds in UP deaths across age, gender, and population size by drug class. Methods: All UP deaths were obtained from Iowa Death Certificates (2009-2011). Main drug classes focused on included illicit drugs, other medications, and alcohol. Bivariate analyses of age, gender, and population size by drug class were performed. Rates of each drug class were calculated for covariates. Logistic regression was used to identify covariates associated with UP deaths among the three drug classes. Results/Outcomes: There were 462 UP deaths in Iowa. Rates were higher in males across drug class, ages 25-44 for illicit drugs and other medications, and ...
Background/Purpose: Intoxications and poisonings are among the most common diagnoses in Emergency... more Background/Purpose: Intoxications and poisonings are among the most common diagnoses in Emergency Departments. While childhood poisonings have been studied in high income countries for years, limited data are available for middle and low income countries. We are aware of no prior studies conducted in eastern Europe. This retrospective study identifies the distribution and major risk factors for childhood poisoning cases treated in the Emergency Department (ED) of a major children's hospital in Romania. Methods: A retrospective record review of children aged 0 19 who were admitted and treated for poisonings between January 1999 and December 2003 was conducted. Injury diagnoses and cause of injury were coded using ICD-10. Study variables used in this analyses included gender, age, injury diagnoses, source of poisoning, cause of injury, injury intent, and disposition. Results/Outcomes: Poisonings represent a high-percentage (37.3%) of pediatric injury-related ED visits. The most co...
Although prior research has established that school buses are a safe form of transportation, cras... more Although prior research has established that school buses are a safe form of transportation, crashes can produce catastrophic consequences. School buses have 2 types of routes: predictable, routine routes that take children to and from school and less predictable, nonroutine routes for school events. No studies have examined school bus crash incidence and characteristics by these route types. School bus crashes were identified from the Iowa Department of Transportation Crash Database from mid-2005 through mid-2010. Crash reports did not identify whether the bus was on a routine or nonroutine route, so a protocol to assign these based on day and time was developed. Bus mileage was provided by the Iowa Department of Education. The school bus crash rate was 2.1 times higher on nonroutine routes than on routine routes (95% CI = 1.8-2.3). Most crashes involved an improper action by the driver of another vehicle. In crashes attributed to improper actions of school buses, failure to yield ...
To identify the prevalence, characteristics, and risk markers for childhood poisonings treated in... more To identify the prevalence, characteristics, and risk markers for childhood poisonings treated in the emergency department of a large Romanian hospital. Trauma registry data using ICD-10 codes and case summaries were studied to identify poisonings among children aged 0-18. Multivariate logistic regression identified factors associated with hospital admission. Between 1999 and 2003, 1,173 pediatric trauma cases were seen in the emergency department; 437 (37.3%) were treated for poisoning, including medication (35%), alcohol (26%), chemical products (19%), and carbon monoxide (14%). Half of all poisonings were unintentional, primarily affecting children \ 10 years. Half were intentional, mainly affecting children 10-18. Females were three times more likely than males to have documented suicidal intent (P \ .0001). Over 30% of suicide attempts were among children ages 10-14 (P \ .0001). We report significantly increased adjusted odds ratios (P \ .05) of hospital admission for children 10-18, and for chemical substance poisoning, and suicidal intent. Pediatric poisoning is a serious public health issue in Romania, and we suggest these findings are relevant across other eastern European countries with limited resources. Poisonings result in morbidity and hospital admissions, yet there are few prevention resources available. Health education programs and consumer product safety policies are needed in Romania and eastern Europe.
Background: Previous research has identified teenage drivers as having an increased risk for moto... more Background: Previous research has identified teenage drivers as having an increased risk for motor-vehicle crash injury compared with older drivers, and rural roads as having increased crash severity compared with urban roads. Few studies have examined incidence and characteristics of teen driver-involved crashes on rural and urban roads. Methods: All crashes involving a driver aged 10 through 18 were identified from the Iowa Department of Transportation crash data from 2002 through 2008. Rates of overall crashes and fatal or severe injury crashes were calculated for urban, suburban, rural, and remote rural areas. The distribution of driver and crash characteristics were compared between rural and urban crashes. Logistic regression was used to identify driver and crash characteristics associated with increased odds of fatal or severe injury among urban and rural crashes. Results: For younger teen drivers (age 10 through 15), overall crash rates were higher for more rural areas, although for older teen drivers (age 16 through 18) the overall crash rates were lower for rural areas. Rural teen crashes were nearly five times more likely to lead to a fatal or severe injury crash than urban teen crashes. Rural crashes were more likely to involve single vehicles, be late at night, involve a failure to yield the right-of-way and crossing the center divider. Conclusions: Intervention programs to increase safe teen driving in rural areas need to address specific risk factors associated with rural roadways. Impact on Industry: Teen crashes cause lost work time for teen workers as well as their parents. Industries such as safety, health care, and insurance have a vested interest in enhanced vehicle safety, and these efforts should address risks and injury differentials in urban and rural roadways.
The response of trauma systems in rural areas is uncertain since distances between injury scenes ... more The response of trauma systems in rural areas is uncertain since distances between injury scenes and trauma care are considerable. Timely arrival at definitive care is critical for persons with traumatic brain injury (TBI) since secondary damage can occur during the hours following injury. We evaluated how the implementation of a trauma system in a predominately rural state affected the triage of TBI patients and their risk for mortality. The Iowa System Trauma Registry Dataset was analyzed, and included patients evaluated before trauma system implementation, 1997-1998, and after implementation, 2002-2003. Patients were identified using ICD9-CM codes or AIS codes, and included 710 pre-system patients and 886 post-system patients. Multivariate logistic regression assessed the effect of the trauma system on survival while controlling for confounders. Following implementation of the trauma system, patients treated in Level I or II facilities were older (p = 0.019), more often had multiple injuries (p = 0.0002), and had more severe TBI (p = 0.008). After controlling for confounders, transferred patients and those directly admitted were less likely to die in 72 h in the post-system than the pre-system (odds ratio [OR] = 0.56, 95% confidence interval (CI) = 0.36, 0.88; OR = 0.50, 95% CI = 0.32, 0.79). Implementation of the Iowa trauma system seems to have led to more appropriate triage and transport for TBI patients, and this likely contributed to reduced in-hospital mortality.
Burn injuries sustained during residential trash, brush, and grass burning cause significant morb... more Burn injuries sustained during residential trash, brush, and grass burning cause significant morbidity and mortality in rural areas. To further prevention efforts, we surveyed individuals who incurred injuries from residential burning. Thirty-six individuals injured while burning trash, brush, or grass from June 2003 through September 2005 were asked to respond to a self-administered written survey. Injury related questions revealed that the majority of those injured were burning brush (21 of 35, 60.0%) in an open space (19 of 35, 54.2%) with the addition of accelerants (27 of 36, 75%). Survey questions regarding usual burning practices revealed almost two-thirds burned either brush or a mixture of brush and trash (23 of 36, 63.9%). Eighty percent of those who were injured desired to change their behavior (25 of 35, 80%). Approximately two-thirds would consider asking for help with burning if it were provided (22 of 34, 64.7%). Our survey shows that acceptable alternatives to burning varied depending on the material that was burned. As the majority of respondents usually burned brush or a mixture of brush and trash, an acceptable trash removal system should also include brush pickup. As residential burning continues presently, injury prevention efforts are essential and should focus on the misuse of gasoline, uniform safety standards for gasoline cans, and dissemination of safe burning practices.
Smoke alarms are one of the most promoted prevention strategies to reduce residential fire deaths... more Smoke alarms are one of the most promoted prevention strategies to reduce residential fire deaths, and they can reduce residential fire deaths by half. Smoke alarm function can be measured by two tests: the smoke alarm button test and the chemical smoke test. Using results from a randomized trial of smoke alarms, we compared smoke alarm response to the button test and the smoke test. The smoke alarms found in the study homes at baseline were tested, as well as study alarms placed into homes as part of the randomized trial. Study alarms were tested at 12 and 42 months postinstallation. The proportion of alarms that passed the button test but not the smoke test ranged from 0.5 to 5.8% of alarms; this result was found most frequently among ionization alarms with zinc or alkaline batteries. These alarms would indicate to the owner (through the button test) that the smoke alarm was working, but the alarm would not actually respond in the case of a fire (as demonstrated by failing the smoke test). The proportion of alarms that passed the smoke test but not the button test ranged from 1.0 to 3.0%. These alarms would appear nonfunctional to the owner (because the button test failed), even though the alarm would operate in response to a fire (as demonstrated by passing the smoke test). The general public is not aware of the potential for inaccuracy in smoke alarm tests, and burn professionals can advocate for enhanced testing methods. The optimal test to determine smoke alarm function is the chemical smoke test.
Parents play a fundamental role in teaching their children safe driving skills to reduce risk of ... more Parents play a fundamental role in teaching their children safe driving skills to reduce risk of motor vehicle crashes, the leading cause of death for teens. Steering Teens Safe is a new parent-based intervention that equips parents with communication skills to talk about, demonstrate, and practice safe driving behaviors and skills with their teens. This implementation evaluation focuses on a sample of 83 parents who delivered Steering Teens Safe to their teens. One-, 2- and 3-month follow-up assessments were conducted with intervention parents to evaluate the self-reported quantity and quality of talking about, demonstrating, and practicing safe driving goals with teens; perceived success and benefit of the program; and barriers to implementation. Over 3 months of follow-up, parents discussed driving goals with their teens for a median of 101.5 minutes. The most frequently addressed topics were general safety principles, including distracted driving, driving in bad weather, wearing a seat belt, and being a safe passenger. Parents spent a median of 30 minutes practicing safe driving skills such as changing lanes. Sixty-seven percent of parents talked to their children about rural road safety, but just 36% demonstrated and half practiced these skills with their teens. Barriers to implementation include time and opportunity barriers and resistant attitudes of their teens. However, barriers neither affected frequency of engagement nor parents' perceived benefit and comfort in delivering the program. Parents with time/opportunity barriers also had higher practice and demonstration times than parents without these barriers. Findings indicate high acceptability among parent implementers and promise for real-world delivery. Future studies are needed to assess intervention impact.
Childhood injury rates are higher in low and middle-income countries than in high-income countrie... more Childhood injury rates are higher in low and middle-income countries than in high-income countries. Childhood injuries have not been widely studied in Romania, a middle-income country, because data sources are lacking. This study presents the first surveillance data of nonfatal childhood injuries from a large children's hospital in Cluj, a major city of Romania. This retrospective study included review of medical records of injured children of 0-18 years of age treated in a major city pediatric emergency department from 1999 to 2003. In the 5-year study period, 1179 childhood injuries were treated in the emergency department, for an average of 236 patients per year. For the county of Cluj, this represents an annual average injury incidence of 197 per 100,000 children younger than 5 years, 140 per 100 000 children aged 5-14 years, and 135 per 100 000 for children aged 15-18 years. Unintentional injuries represented 77.8% of cases, 18% were self-harm and suicide attempts, and 4.3% were assaults. These trends, among the first reported from Romania, can help identify priority prevention areas.
season, and 2/7th -or 28.57% -of ED visits would occur on weekends. We define a surge as any incr... more season, and 2/7th -or 28.57% -of ED visits would occur on weekends. We define a surge as any increase above this assumption of randomness. All statistical analyses were performed using SPSS.
Background: This randomized trial presents fındings from the longest follow-up study of smoke ala... more Background: This randomized trial presents fındings from the longest follow-up study of smoke alarm and battery function to date.
Background: Although the use of smoke alarms is widely recommended, little guidance is available ... more Background: Although the use of smoke alarms is widely recommended, little guidance is available on the types of alarms and batteries that function best. This study examined smoke alarm and battery function 12 months after installation in rural residential households.
Crashes are the leading cause of death for teens, and parent-based interventions are a promising ... more Crashes are the leading cause of death for teens, and parent-based interventions are a promising approach. We assess the effectiveness of Steering Teens Safe, a parent-focused program to increase safe teen driving. Steering Teens Safe aimed to improve parental communication with teens about safe driving using motivational interviewing techniques in conjunction with 19 safe driving lessons. A randomized controlled trial involved 145 parent-teen dyads (70 intervention and 75 control). Intervention parents received a 45-minute session to learn the program with four follow-up phone sessions, a DVD, and a workbook. Control parents received a standard brochure about safe driving. Scores were developed to measure teen-reported quantity and quality of parental communication about safe driving. The main outcome measure was a previously validated Risky Driving Score reported by teens. Because the Score was highly skewed, a generalized linear model based on a gamma distribution was used for an...
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