The epidemiology of firework-related injuries in the United States: 2000–2010

IntroductionThe purpose of this study is to examine the epidemiology of firework-related injuries among an emergency department (ED) nationally representative population of the United States for the years 2000–2010, including whether the type of firework causing the injury is differential by patient demographics and whether the severity of injury is associated with the firework type.MethodsThe data analysed in this study was collected from the Consumer Product Safety Commission's (CPSC's) National Electronic Injury Surveillance System (NEISS).ResultsA total of 2812 injuries represented an estimated 97,562 firework-related injuries treated in emergency departments within the United States from 2000 to 2010. The incidence generally decreased over time. With respect to age, the rate was higher for children, with the highest rates being observed for 10–19 year olds (7.28 per 100,000 persons) and 0–9 year olds (5.45 per 100,000 persons). The injury rate was nearly three times higher for males compared to the female counterparts (4.48 vs. 1.57 per 100,000 persons). Females were less likely than males to severely injure themselves with all types of fireworks besides sparklers/novelty devices (OR 1.08, CI 0.26–4.38).DiscussionThe results from this suggest that firework-related injuries have decreased by nearly 30% over the 11-year period between 2000 and 2010. Moreover, there has been a decreasing trend in the type of firework causing injury for every firework type excluding the unspecified firework type. However, adolescents of 10–19 years old had the highest rate of injury for fireworks over the 11-year period. In addition odds of injury are differential by firework type.ConclusionUnderstanding the specific types of fireworks may lead to better preventative methods and regulations. Moreover, preventative methods should be taken to reduce the rate of firework-related injuries among U.S. youths [1], and possibly more regulations and enforcement of laws geared towards prohibiting novice use of fireworks.     

FRAX? probabilities and risk of major osteoporotic fracture in France

Summary

The incidence of hip fracture, death and the estimated incidence of major osteoporotic fracture in France were used to determine the lifetime and 10-year probability of fracture and incorporated into a probability model (FRAX?) calibrated to the French population.

Introduction

Fracture probabilities in the French population have not been determined. Our aim was to determine the incidence of hip fracture in France and the estimated 10-year probabilities of hip and major osteoporotic fractures.

Methods

The study population included adults over 50?years living in France in 2004. Incident hip fracture cases were identified from the French PMSI database. Incidence of the other major osteoporotic fractures was imputed from the relationship between hip fracture incidence and other major fracture in Sweden. These data were used to calculate population-based fracture probabilities according to age and BMD using cutoff values for femoral neck T-scores from the NHANES III data in Caucasian women. The probability model (FRAX?) calibrated to the French population was used to compute individual fracture probabilities according to specific clinical risk factors.

Results

We identified 15,434 men and 51,469 women with an incident hip fracture. The remaining lifetime probability of hip fracture at 50?years was approximately 10 and 30% respectively. With a femoral neck T-score of ?2 SD, one in two women and one in five men would sustain a major osteoporotic fracture in their lifetime. The 10-year probability of other major osteoporotic fractures increased with declining T-score and increasing age. Low body mass index and other clinical risk factors had an independent effect on fracture probability whether or not BMD was included in the FRAX? model.

Conclusion

This analysis provides detailed estimation on the risk of fracture in the French population and may help to define therapeutic guidelines.     

Does diabetes modify the effect of FRAX risk factors for predicting major osteoporotic and hip fracture?

Summary

In an observational study population of 62,413 individuals (6,455 [10 %] with diabetes), diabetes was independently associated with major osteoporotic fractures (MOFs) but did not significantly modify the effect of FRAX^TM risk factors or prior fracture site. However, the presence of diabetes exerted a much stronger effect on hip fracture risk in younger versus older individuals.

Introduction

Diabetes mellitus increases fracture risk independent of risk factors that comprise the WHO FRAX^TM tool. We explored whether diabetes modifies the effect of FRAX clinical risk factors on MOF and hip fracture risk.

Methods

Using a registry of clinical dual-energy X-ray absorptiometry (DXA) results for Manitoba, Canada, we identified women and men aged 40 years and older undergoing baseline DXA in 1996–2011. Health services data were used to identify diabetes diagnosis, FRAX risk factors and incident fractures using previously validated algorithms. Prior fracture was stratified as clinical vertebral, hip, humerus, forearm, pelvis and ‘other’. Cox proportional hazards models were used to test for statistical interactions of diabetes with FRAX clinical risk factors and prior fracture site.

Results

During a mean follow-up of 6 years, there were 4,218 MOF and 1,108 hip fractures. Diabetes was a significant independent risk factor for MOF adjusted for FRAX risk factors including bone mineral density (BMD) (adjusted hazard ratio [aHR] 1.32 [95 % confidence interval (CI) 1.20–1.46]). No significant interactions of FRAX risk factors or prior fracture site with diabetes were identified in analyses of MOF. For predicting hip fractures, age significantly modified the effect of diabetes (aHR age <60, 4.67 [95 % CI 2.76–7.89], age 60–69, 2.68 [1.77–4.04], age 70–79, 1.57 [1.20–2.04], age >80, 1.42 [1. 10–1.99]; pinteraction <0.001).

Conclusions

Diabetes is an independent risk factor for MOFs and does not significantly modify the effect of FRAX risk factors or prior fracture site. However, diabetes exerts a much stronger effect on hip fracture risk in younger than older individuals which needs to be considered in hip fracture prediction.     

Antipsychotic use and the risk of hip/femur fracture: a population-based case–control study

Summary  This case–control study showed that current use of conventional antipsychotics, but not atypical antipsychotics, seems to be associated with an increased risk of a hip/femur fracture, possibly related to the pharmacological properties of conventional antipsychotics. Furthermore, no evidence for a dose effect was found. Introduction  The aim of this study was to assess the risk of hip/femur fracture associated with antipsychotic use, with particular reference to any difference in risk with conventional versus atypical antipsychotics, dose, and pharmacological properties. Methods  A case–control study was conducted using data from the PHARMO Record Linkage System among individuals aged 18 years and older between 1991 and 2002. Cases had a record of a hip or femur fracture, while controls had no evidence of ever having sustained any fracture. Results  Most cases were elderly (77.6% aged ≥70 years). We found an increased risk for hip/femur fracture associated with the use of antipsychotic drugs. The risk for current users (OR_adj 1.68 [1.43, 1.99]) was significantly greater than with past use (OR_adj 1.33 [1.14, 1.56]; p = 0.036). Current use of conventional antipsychotics (OR_adj 1.76 [1.48, 2.08]) but not atypical antipsychotics (OR_adj 0.83 [0.42, 1.65]) was associated with an increased risk. We did not find evidence for a dose effect. Conclusion  The use of conventional, but not atypical antipsychotics, seems to be associated with an increased risk of hip/femur fracture, possibly related to the pharmacological properties of conventional antipsychotics. However, the numbers of atypical antipsychotic users were small, and therefore this observation needs further attention in other study populations.     

Trends in the incidence of hip fracture in Japan, 1987–1997: The third nationwide survey

The third nationwide survey for hip fracture incidence was conducted in 1997 following the first such survey in 1987 and the second in 1992. The purpose of this study was to investigate the trends in the incidence and regional distribution of this disease during 10 years. Of 10 271 orthopedic institutions in Japan, 4503 were selected as subjects for the study using the optimum allocation method. Questionnaires concerning new patients with hip fracture were mailed. The replies were obtained from 2930 institutions by the end of December 1998; the response rate was 65.1%. The number of new patients was estimated to be 89 900–94 900 [mean, 92 400; 20 100–21 400 (20 800) men and 69 600–73 600 (71 600) women]. The number of cases in 1997 was about 1.7 times higher than that in the first survey and 1.2 times higher than that in the second survey. The age-specific incidence (per 10 000 per year) in men and women in 1997 was 0.30 and 0.13, respectively, for age under 40 years; 0.91 and 0.60, 40–49 years; 2.00 and 2.39, 50–59 years; 5.12 and 9.07, 60–69 years; 17.3 and 40.8, 70–79 years; 57.4 and 147.8, 80–89 years; and 128.9 and 281.0, for age over 90 years. The incidence was increased compared with that of the first survey, and similar to the second survey, excepting that of women aged 80 years or older. Concerning regional differences, hip fracture incidence was relatively low in the eastern area compared to the western area in Japan, which was a trend identical to that in the previous nationwide surveys. Received: Aug. 7, 1999 / Accepted: Oct. 12, 1999     

Severity of vertebral fracture and risk of hip fracture: a nested case�Ccontrol study

Summary  

Severe vertebral fractures strongly predicted subsequent hip fracture in this population-based study. Such high-risk patients should be provided with clinical evaluation and care for osteoporosis.     

Vitamin A intake and the risk of hip fracture in postmenopausal women: the Iowa Women’s Health Study

Excessive intake of vitamin A is postulated to have a detrimental effect on bone by inducing osteoporosis. This may lead to an increased risk of fracture, particularly in persons who are already at risk of osteoporosis. However, few studies have specifically examined the association of vitamin A intake through diet and supplement use, with fractures in a cohort of older, community-dwelling women. We prospectively followed a cohort of 34,703 postmenopausal women from the Iowa Womens Health Study to determine if high levels of vitamin A and retinol intake through food and supplement use were associated with an increased risk of hip or all fractures. A semiquantitative food frequency questionnaire was used to obtain the participants baseline vitamin A and retinol intake. Participants were followed for a mean duration of 9.5 years for incident self-reported hip and nonhip fractures. After multivariate adjustment, it was revealed that users of supplements containing vitamin A had a 1.18-fold increased risk of incident hip fracture (n=525) compared with nonusers (95% CI, 0.99 to 1.41), but there was no evidence of an increased risk of all fractures (n=6,502) among supplement users. There was also no evidence of a dose-response relationship in hip fracture risk with increasing amounts of vitamin A or retinol from supplements. Furthermore, our results showed no association between vitamin A or retinol intake from food and supplements, or food only, and the risk of hip or all fractures. In conclusion, we found little evidence of an increased risk of hip or all fractures with higher intakes of vitamin A or retinol among a cohort of older, postmenopausal women.     

Functional improvement of self-care in the elderly after hip fracture: is age a factor?

Introduction

The aging population is growing rapidly in Asia resulting in an increased number of hip fractures being managed surgically. Though there is evidence of improved quality of patient care and outcomes with well-established models of care, we do not know if the functional recovery in activities of daily living among this group of patients is also dependant on age. We hypothesize that there will be a difference in Modified Barthel Index (MBI) scores between the ‘older old’ (>85 years) and the ‘younger old’ (<85 years).

Patient and methods

Hip fracture patients (>60 years) treated surgically were divided into Group A (below 85 years) and Group B (above 85 years). Demographic data, Charlson’s Comorbidity Index (CCI) score, time to surgery and length of stay (LOS) were recorded. To assess the recovery in activities of daily living, the MBI scores were measured for the following intervals; pre-fall, at discharge, at 6-month and at 1-year follow-up.

Results

The mean age for Group A (n = 120) was 77 years (60–85) and the mean age for Group B (n = 59) was 91.8 years (86–108). There was no significant difference in the mean CCI (A: 1.14, B: 1.24), mean time to surgery (A: 72.3 h, B: 79.9 h) and mean LOS (A: 10.8 days, B: 10.3 days). The MBI scores were significantly different (P < 0.05) for the pre-injury scores (A = 91.5, B = 84.4); however, there was no significant difference for scores measured at discharge (A = 57.5, B = 52.7), at 6 months (A = 74.6, B = 69.3) and at 1 year (A = 82.2, B = 73.2). Though there was a significant improvement, the scores at 1 year were significantly lower than the pre-injury score for both groups.

Conclusion

We conclude that age is not a factor in determining functional recovery with regard to activities of daily living in an integrated model of care for geriatric hip fracture patients.     

Do hip protectors decrease the risk of hip fracture in institutional and community-dwelling elderly? A systematic review and meta-analysis of randomized controlled trials

Hip fractures are an important cause of morbidity and mortality in the elderly. Hip protectors are padded undergarments designed to decrease the impact of a fall on the hip. We systematically reviewed randomized controlled trials of hip protectors to determine if they reduce hip fractures in the elderly. Analyses were pooled according to participant residence—community or institutional (the latter, included nursing homes, residential group homes or seniors hostels). We included individually randomized and statistically adjusted cluster randomized trials. Seven trials of 12- to 28-month duration were included. The Safehip brand of hip protector was used in most studies. Compliance rates in the treatment groups varied from 31 to 68%. In four trials including a total of 5,696 community-dwelling seniors, the hip fracture rates in control groups ranged from 1.1 to 7.4%, and the pooled risk difference with hip protector allocation was 0% [95% confidence intervals (CI), –1%, +1%), with a relative risk of 1.07 (0.81, 1.42). In three trials including 1,188 institutionalized elderly participants, hip fracture rates in the control groups varied from 8 to 19.4%, and the pooled risk difference for sustaining one or more hip fractures with hip protector allocation was –3.7% (95% CI, –7.4%, 0.1%), with a relative risk of 0.56 (0.31, 1.01) (with statistically significant heterogeneity of treatment effect). In a post-hoc subgroup analysis of two trials comprised of exclusively nursing home residents, the risk difference with hip protector allocation was –4.4% (–8.09, –0.76) with a relative risk of 0.50 (0.28, 0.91) ( n =1,014). Thus, there is little evidence to support the use of hip protectors outside the nursing home setting. The potential benefit of hip protectors in reducing hip fractures in nursing home residents requires further confirmation.     

Sister’s fracture history may be associated with perimenopausal bone fragility and modifies the predictability of fracture risk

Summary  The present study investigated the effects of first degree relatives’ fractures on fracture incidence after the menopause. Sister’s, but not other relatives’, wrist or hip fracture history was associated with increased risk of fragility fractures after the menopause. This suggests genetic predisposition to bone fragility among postmenopausal women. Objective  The aim of the present study was to investigate the association between first degree relatives’ fractures and perimenopausal bone fragility. Materials and methods  The study sample of 971 perimenopausal women was extracted from randomly selected Kuopio Osteoporosis Risk Factor and Prevention cohort and measured with dual X-ray absorptiometry in femoral neck (FN) in baseline (1989–1991), in 5 years (1994–97), and in 10 years (1999–2001). All low-trauma energy fractures during the 10-year follow-up were recorded based on self-reports and validated from medical records. First degree relatives’ history of life-time hip and wrist fractures (exact classification or trauma energy not specified) was questioned by postal inquiries. Results  There was a significant correlation between fathers’ vs. brothers’ and mothers’ vs. sisters’ fractures (p < 0.01 in Pearson bivariate correlations). Sister’s, but not mother’s, father’s, or brother’s wrist and hip fractures were associated with significantly lowered 10-year fragility fracture-free survival rate (HR = 0.56, p = 0.006). Sisters’ or other relatives’ fractures were not associated with FN bone loss rate or bone mineral density (BMD) in the follow-up measurements (p = NS in ANCOVA). The predictive power of BMD for fragility fractures differed according to sisters’ fracture history: Baseline FN T score predicted fracture-free survival only among women without sisters’ fracture history (HR 0.62, p < 0.001 vs. women with sisters’ fracture in Cox regression). Conclusions  In conclusion, sisters’ fracture history is associated with 10-year fracture-free survival in perimenopausal women but not with BMD or its changes. Predictability of fragility fracture risk with BMD may depend on sister’s fracture history. This may indirectly suggest genetic predisposition to bone fragility independently of BMD.     

Does time of surgery and complication have any correlation in the management of hip fracture in elderly and can early surgery affect the outcome?

Objective

Hip fractures in the elderly are usually associated with a high rate of morbidity and mortality and affect quality of life. On review of published data, the current guidelines in the literature indicate that early surgery should be performed within 24 h of injury because it is associated with better functional outcomes and lower rates of perioperative complications and mortality. The aim of this study was to evaluate whether any correlation exists between early surgical intervention and functional outcomes.

Methods

In a retrospective study, we analyzed the records between January 2010 and December 2016 and 550 elderly patients between the age group of 65–95 were included.

Results

The results of early surgery were promising, 451 (82%) patients did not have any complication, 42 (7.6%) has developed bed sore, 23 (4%) developed a hospital-acquired infection, 13 (2.3%) developed wound infection, 08 (1.4%) developed DVT, 04 (0.7%) developed implant failure, and 09 (01%) died of some or other complications.

Conclusion

Still, there is conflicting evidence in the published data that early surgery would improve mortality and function. However, early surgery definitively improves outcome and reduces morbidity, bed sores, infection, and the length of hospital stay could be improved by reducing the waiting time of hip surgery following fracture. We concluded that it is beneficial to the elderly patients to receive surgical treatment as early as possible.

     

The Faltering Solid Organ Donor Pool in the United States (2001–2010)

Background

Organ shortage is the greatest challenge facing the field of organ transplantation today. Use of more organs of marginal quality has been advocated to address the shortage.

Method

We examined the pattern of donation and organ use in the United States as shown in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database of individuals who were consented for and progressed to organ donation between January 2001 and December 2010.

Results

There were 66,421 living donors and 73,359 deceased donors, including 67,583 (92.1 %) identified as donation after brain death and 5,776 (7.9 %) as donation after circulatory death (DCD). Comparing two periods, era 1 (01/2001–12/2005) and era 2 (01/2006–12/2010), the number of deceased donors increased by 20.3 % from 33,300 to 40,059 while there was a trend for decreasing living donation. The DCD subgroup increased from 4.9 to 11.7 % comparing the two eras. A significant increase in cardiovascular/cerebrovascular disease as a cause of death was also noted, from 38.1 % in era 1 to 56.1 % in era 2 (p < 0.001), as was a corresponding decrease in the number of deaths due to head trauma (48.8 vs. 34.9 %). The overall discard rate also increased from 13,411 (11.5 %) in era 1 to 19,516 (13.7 %) in era 2. This increase in discards was especially prominent in the DCD group [440 (20.9 %) in era 1 vs. 2,089 (24.9 %) in era 2].

Conclusions

We detect a significant change in pattern of organ donation and use in the last decade in the United States. The transplant community should consider every precaution to prevent the decay of organ quality and to improve the use of marginal organs.     

Consent for regional anaesthesia in the United Kingdom: what is material risk?

Legal principles that apply to the process of informed consent have changed in recent years. Patients should now be given the information that they wish to receive, not the information that health professionals may consider reasonable for them. In obstetric practice informed consent is especially important as young, fit patients may request and receive non-essential but potentially life-threatening interventions. The quantity and detail of information parturients desire do not remain static. They vary over time and from country to country. Our paper examines current opinion amongst parturients in the United Kingdom. We asked 100 obstetric patients to choose the complications of regional anaesthesia that they would like to learn about during informed consent. Nearly all women (82-94%) wished to know about common, less severe side effects. A substantial majority (70-77%) also wished to know about rarer but more severe complications, such as permanent neurological deficit, meningitis and high spinal block. Despite the availability of information for patients from sources such as the Obstetric Anaesthetists' Association and the National Electronic Library for Health, there remains little consensus amongst anaesthetists about what information to provide. Frequently some complications that patients would consider important are not discussed. Changing legal and public expectations demand that we adapt our current practice and improve the accuracy and timing of information provided.     

Dopaminergic drugs and the risk of hip or femur fracture: a population-based case�Ccontrol study

Summary

The effect of dopaminergic medication on the risk of hip/femur fractures is not clear. Our results showed a nearly twofold increased risk of hip/femur fractures in current dopaminergic drug users. Concomitant use of antidepressants further increased this risk. Fracture risk assessment may be warranted in elderly users of dopaminergic drugs.

Introduction

Dopaminergic drugs, often used in the treatment of Parkinson??s disease, have several pharmacological effects that may increase or decrease the risk of falling and fractures. Thus, the effect of dopaminergic medication on the risk of hip/femur fractures is not clear. The objective of the study was to examine the effect of dopaminergic medication and concomitant use of psychotropics on the risk of hip/femur fractures taking into account the timing of dopaminergic drug use.

Methods

A population-based case?Ccontrol study in the PHARMO database was conducted for the period 1991 to 2002. Cases were patients aged 18?years and older with a first hip or femur fracture and matched to four control patients by year of birth, sex and geographical region.

Results

The study population included 6,763 cases and 26,341 controls. Current use of dopaminergic drugs (1?C30?days before the index date) was associated with an increased risk of hip/femur fractures compared to never use (OR_adj 1.76, 95% CI?=?1.39?C2.22), but this excess risk rapidly dropped to baseline levels when treatment had been discontinued >1?year ago. Concomitant use of antidepressants among current dopaminergic drug users further increased the risk of hip/femur fractures (OR_adj 3.51, 95% CI?=?2.10?C5.87) while there was no additional risk with concomitant use of other psychotropics.

Conclusions

Although the observed association between dopaminergic drugs and fracture risk may not be entirely causal, due to absence of information on the (severity of the) underlying disease, fracture risk assessment may be warranted in elderly users of dopaminergic drugs.