The Costs and Characteristics of Occupational Injuries Admitted to a Trauma Unit

Abstract

Occupational injuries requiring admission to a trauma unit were examined to outline the events surrounding the injury and to examine the costs. Sixty-nine patients were admitted over a 12-month period, representing 4.30% of all work-related injuries attending the emergency department and 4.25% of all admissions to the trauma unit. Most were male (91%), working in skilled trade occupations (65%), with a mean age of 38.8 years. Personal protective equipment was used only by 46% of injured workers who should have been using it. Sixty-one percent of patients believed that their injury was preventable. Half of the injuries were to the upper limb, fall was the most frequent mechanism (25%) and the median duration of admission was 2 days. The direct hospital costs were estimated at over 300 000 GBP. Failure to use protective equipment and to follow health and safety guidelines suggests that opportunities exist for injury prevention.     

Reducing primary and secondary impact loads on the pelvis during side impact

OBJECTIVE: The objective of the study was to determine which vehicle factors are significantly related to pelvic injury in side impact collisions. Identification of relevant parameters could aid in the reduction of these injuries. METHOD: Side impact crashes from the CIREN database were separated into those in which the occupant sustained a pelvic fracture and those in which no pelvic fracture occurred, although all occupants had serious injuries. A multibody MADYMO model was created of a USDOT SINCAP (U.S. Department of Transportation Side Impact New Car Assessment Program) test of a vehicle with a large center console. RESULTS: From a study of 113 side impact crashes in the ciren database, nearside occupants with pelvic fractures (n = 78) had (i) more door intrusion (mean, 37 vs. 32 cm, p = 0.02) than those who had serious injuries, but not pelvic fractures (ii) a greater likelihood that the lower border of the door intruded more than the upper part (40% vs. 18%, p < 0.025); and (iii) a greater likelihood that their vehicle had a center console (47 vs. 17%, p < 0.005). Other parameters such as occupant age, weight, gender, vehicle weight, and struck vehicle speed change were not significantly different. MADYMO modeling showed that with a center console, an initial positive pelvic acceleration occurred at about 30 msec, followed at about 45 msec by a second acceleration peak in the opposite direction. Reducing console stiffness reduced the second acceleration but not the initial peak. Allowing the seat to translate laterally when contacted by the door reduced the initial pelvic acceleration by 50% and eliminated the second acceleration peak. CONCLUSIONS: Redesigning the center console using less stiff materials and allowing some lateral translation of the seat could aid in reducing pelvic injuries in side impact collisions.     

Emergency department visits by pediatric patients sustained as a passenger on a motorcycle

Objective: Currently only 5 out of the 50 states in the United States have laws restricting the age of passengers permitted to ride on a motorcycle. This study sought to characterize the visits by patients under the age of 16 to U.S. emergency departments (EDs) for injuries sustained as a passenger on a motorcycle.

Methods: In this retrospective cohort study, data were obtained from the Nationwide Emergency Department Sample (NEDS) for the years 2006 to 2011. Pediatric patients who were passengers on a motorcycle that was involved in a crash were identified using International Classification of Diseases, Ninth Revision (ICD-9) External Cause of Injury codes. We also examined gender, age, disposition, regional differences, common injuries, and charges.

Results: Between 2006 and 2011 there were an estimated 9,689 visits to U.S. EDs by patients under the age of 16 who were passengers on a motorcycle involved in a crash. The overall average patient age was 9.4 years, and they were predominately male (54.5%). The majority (85%) of these patients were treated and released. The average charges for discharged patients were $2,116.50 and amounted to roughly $17,500,000 during the 6 years. The average cost for admission was $51,446 per patient and totaled over $54 million. The most common primary injuries included superficial contusions; sprains and strains; upper limb fractures; open wounds of head, neck, and trunk; and intracranial injuries.

Conclusion: Although there were only about 9,700 visits to U.S. EDs for motorcycle crashes involving passengers less than 16 years old for 2006 to 2011, the total cost of visits that resulted in either ED discharge or hospital admission amounted to over $71 million.     

Social and hospital costs of patients admitted to a university hospital in Brazil due to motorcycle crashes

Objective: This study aimed to investigate the social and hospital costs of patients treated at a public hospital who were motorcycle crash victims.

Method: This prospective study was on 68 motorcycle riders (drivers or passengers), who were followed up from hospital admission to 6 months after the crash. A questionnaire covering quantitative and qualitative questions was administered.

Results: Motorcycle crash victims were responsible for 12% of the institution's hospital admissions; 54.4% were young (18–28 years of age); 92.6% were the drivers; 91.2% were male; and 50% used their motorcycles as daily means of transportation. Six months afterward, 94.1% needed help from someone; 83.8% had changed their family dynamics; and 73.5% had not returned to their professional activities. Among the injuries, 94.7% had some type of fracture, of which 53.5% were exposed fractures; 35.3% presented temporary sequelae; and 32.4% presented permanent sequelae. They used the surgical center 2.53 times on average, with a mean hospital stay of 18 days. The per capita hospital cost of these victims’ treatment was US$17,481.50.

Conclusion: The social and hospital costs were high, relative to the characteristics of a public institution. Temporary or permanent disability caused changes to family dynamics, as shown by the high numbers of patients who were still away from their professional activities more than 6 months afterward.     

Personal injury recovery cost of pedestrian–vehicle collisions in New South Wales,Australia

Background: There is a need for routine estimates of injury recovery costs from pedestrian collisions using hospital separation records for economic evaluations.

Objective: To estimate the cost of injury recovery following pedestrian–vehicle collisions using the personal injury recover cost (PIRC) equation using key demographic and injury characteristics.

Method: An estimation of the costs of on-road pedestrian–vehicle collisions involving individuals who were injured and hospitalized in New South Wales (NSW), Australia, from 2002 to 2011 using the PIRC equation. The PIRC estimates individual injury recovery costs and does not include costs associated with property damage, vehicle repair, or rescue services. Individual recovery costs associated with severe traumatic brain injury (TBI) were estimated. The injured individual's mean, median, and total injury recovery costs are described for key demographic, injury, and crash characteristics.

Results: There were 9,781 pedestrians who were injured, costing an estimated total of $2.4 billion in personal injury recovery costs, an annual cost of $243 million. Males had a total injury recovery cost 1.7 times higher than females. The median injury recovery cost decreased with increasing age. TBI ($248,491) and spinal cord and vertebral column injuries ($264,103) had the highest median injury recovery costs for the body region of the most severe injury. TBI accounted for 22.6% of the total injury recovery costs for the most severe injury sustained. Just over one third of pedestrians sustained 4 or more injuries, with a median cost of $243,992, which was 1.6 times higher than the cost for a pedestrian who sustained a single injury ($153,682).

Conclusions: Personal injury recovery costs following pedestrian–vehicle collisions where a pedestrian is injured are substantial in NSW. The PIRC equation enables the economic cost burden of road traffic injury to be calculated using hospital separation data. The PIRC enables comprehensive personal injury recovery costs to be estimated and would aid in economic evaluations of preventive strategies in road safety.     

Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar

Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.

Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive.

Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49–2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31–7.38, P = .001) was significantly greater among unrestrained passengers.

Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.     

Nationwide risk factors for hospital readmission for subsequent injury after motor vehicle crashes

Abstract

Objective: Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital.

Methods: The Nationwide Readmissions Database for 2010–2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash–related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (P < .05) variables on univariate analysis. Results were weighted for national estimates.

Results: During the study period, 1,008,991 patients were admitted for motor vehicle–related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR]?=?1.32; 95% confidence interval [CI], 1.20–1.45; P < .01) and a higher ISS (OR?=?1.38; 95% CI, 1.27–1.49; P < .01). Motorcyclists were more likely to suffer subsequent injury (OR?=?1.39; 95% CI, 1.32–1.46; P < .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR?=?2.49; 95% CI, 1.73–3.59; P < .01). Alcohol abuse was associated with subsequent injury (OR?=?1.12; 95% CI, 1.07–1.18; P < .01).

Conclusions: Nearly a third of patients suffering subsequent motor vehicle crash–related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements.     

Motorcycle helmets and spinal cord injury: helmet usage and type

The objective of this study was to assess the role of helmets and helmet type in relation to injury to the cervical spinal cord. It was based on a consecutive series of 110 motorcyclists with neurological damage to the spinal cord admitted alive (referred to as acute survivors) to a specialist spinal cord injuries unit at an Australian hospital. Cases were those with injury to the cervical spinal cord and controls were those with injury to the cord of other segments of the spine. The study showed that there was no significant difference in the odds of cervical spinal cord injury among unhelmeted and helmeted motorcyclist acute survivors. In addition, it confirmed the findings of a recently published Australian fatality study demonstrating no difference in the odds of cervical spinal cord injury among full-face and open-face helmet wearers. These results contrasted with the findings of earlier studies. In consideration of the limitations of existing research on the role of helmets in spinal cord injury, further study is required based on a larger series or a series having a higher proportion of non-wearers and open-face helmet wearers, including both survivors and those killed, and including assessment of cord and non-cord spinal injuries separately, helmet type, head impact, and helmet retention.     

Factors related to injury of shiftworking fire fighters in the Northeastern United States

Fire fighters, who provide society with an essential and life-saving service, are subjected to the effects of shiftwork and to the demands (physical and mental) and dangers of their profession, all of which can contribute to injuries. To identify factors involved in injuries to fire fighters, the timing, frequency, types, and places of occurrence of injuries sustained by fire fighters in three different municipal fire departments were examined. Data was obtained from analysis of Workers' Compensation forms. The most frequent injuries involved inhalation of hazardous materials and lacerations. Ninety-two percent of the injuries occurred at the fire scene, and their causes were related to fire fighting duties, such as rescue, extinguishment and overhaul. Although only 54% of fire alarms nationwide occurred from 12:00 to 16:00 and from 18:00 to 24:00 (42% of a 24 hour day), 68% of the injuries sustained by the fire fighters studied occurred during these time periods. Per alarm, at meal time or on the night shift fire fighters were more likely to be injured. Serious injuries were more prevalent at standardly accepted meal-times. The timing of the highest frequencies of injuries suggests that, due to the shiftwork nature of firefighting, both disruption of eating patterns and fatigue increase the risk of work-related injury to fire fighters. By understanding the contribution of factors, especially human ones, such as altered metabolism (due to disruption) and fatigue (due to time elapsed since awakening, alteration/disruption of sleep-wake pattern, or hypoglycaemia), interventions can be developed, which should decrease the incidence of injuries to fire fighters.     

The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio

Introduction

The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system.

Method

The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law.

Results

Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt.

Summary and Impact on Industry

Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.     

The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study

Objective: The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated.

Methods: An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury.

Results: Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury.

Conclusions: These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.     

Sharps injury prevention for hospital workers

Objectives. The purpose of this study was to collect data on self-reported sharps injuries to develop best practices to reduce them. Methods. Data on sharps injuries were collected for the period of January-October 2008 using Adverse Event Notification Forms already in use at Sema Hospital. Results. On average, 0.2% of all self-reported injuries were sharps injuries averaging one injury per month. Housekeeping staff sustained 64% of such injuries, nurses sustained 36% (5 incidents). Outpatient clinics experienced the most injuries at 28%, followed by the Internal Diseases Inpatient Unit with 21% and the Medical Waste Room with 14%. Injuries often occurred during contact with medical waste bags (28%) and while replacing full sharp-boxes (14%). Conclusion. In summary, reducing needle stick injuries is an important component of the occupational and patient safety program at Sema Hospital. The research described in this study allowed the hospital to provide targeted interventions to increase awareness of the risks of needle stick injuries and reduce such injuries. The steps used in the study can be used in any health care organization in the world to design a customized improvement plan to reduce risk and injury.     

Protective effect of different types of bicycle helmets

The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21-0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41-1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58-1.41) among users of hard shell helmets, and 1.87 (CI = 1.03-3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling.     

Protective Effect of Different Types of Bicycle Helmets

The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21–0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41–1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58–1.41) among users of hard shell helmets, and 1.87 (CI = 1.03–3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling.     

Road traffic injuries among riders of electric bike/electric moped in southern China

Objective: Electric bike/moped-related road traffic injuries have become a burgeoning public health problem in China. The objective of this study was to identify the prevalence and potential risk factors of electric bike/moped-related road traffic injuries among electric bike/moped riders in southern China.

Methods: A cross-sectional study was used to interview 3,151 electric bike/moped riders in southern China. Electric bike/moped-related road traffic injuries that occurred from July 2014 to June 2015 were investigated. Data were collected by face-to-face interviews and analyzed between July 2015 and June 2017.

Results: The prevalence of electric bike/moped-related road traffic injuries among the investigated riders was 15.99%. Electric bike/moped-related road traffic injuries were significantly associated with category of electric bike (adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI], 1.01–1.82), self-reported confusion (AOR = 1.77, 95% CI, 1.13–2.78), history of crashes (AOR = 6.14, 95% CI, 4.68–8.07), running red lights (AOR = 3.57, 95% CI, 2.42–5.25), carrying children while riding (AOR = 1.96, 95% CI, 1.37–2.85), carrying adults while riding (AOR = 1.68, 95% CI, 1.23–2.28), riding in the motor lane (AOR = 2.42, 95% CI, 1.05–3.93), and riding in the wrong traffic direction (AOR = 1.63, 95% CI, 1.13–2.35). In over 77.58% of electric bike/moped-related road traffic crashes, riders were determined by the police to be responsible for the crash. Major crash-causing factors included violating traffic signals or signs, careless riding, speeding, and riding in the wrong lane.

Conclusion: Traffic safety related to electric bikes/moped is becoming more problematic with growing popularity compared with other 2-wheeled vehicles. Programs need to be developed to prevent electric bike/moped-related road traffic injuries in this emerging country.     

Differences in Long-term Medical Consequences Depending on Impact Direction Involving Passenger Cars

Objective: There is limited knowledge of the long-term medical consequences for occupants injured in car crashes in various impact directions. Thus, the objective was to evaluate whether injuries leading to permanent medical impairment differ depending on impact direction.

Methods: In total, 36,743 injured occupants in car crashes that occurred between 1995 and 2011 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. Injured car occupants were followed for at least 3 years to assess permanent medical impairment. The data were divided into different groups according to impact direction and levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to AIS.

Results: It was found that almost 12% of all car occupants sustained a permanent medical impairment. Given an injury, car occupants involved in rollover crashes had the highest overall risk to sustain a permanent medical impairment. Half of the head injuries leading to long-term consequences occurred in frontal impacts. Far-side occupants had almost the same risk as near-side occupants. Occupants who sustained a permanent medical impairment from cervical spine injuries had similar risk in all impact directions (13%) except from rollover (17%). However, these injuries occurred more often in rear crashes. Most of the injuries leading to long-term consequences were classified as minor injuries by AIS for all impact directions.

Conclusions: Studying crash data from a perspective of medical impairment is important to identify injuries that might not be prioritized only considering the AIS but might lead to lower quality of life for the occupant and also costs for society. These results can be used for road transport system strategies and for making priority decisions in vehicle design.     

Physical,psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries

Introduction: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. Methods: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), “Impact of Event Scale” (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of ‘Direct’ and ‘Indirect’ costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results: A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50–64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65 + and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50–64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. Conclusions: There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. Practical implications: A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.     

Severity of e-scooter rider injuries associated with trip characteristics

Introduction: E-scooter rider injuries have been growing, but little is known about how trip and incident characteristics contribute to their severity. Method: We enrolled 105 adults injured while riding e-scooters who presented to an emergency department in Washington, DC, during 2019. Enrolled participants completed an interview during the emergency department visit, and their charts were abstracted to document their injuries and treatment. Logistic regression examined the association of incident location and circumstances with the likelihood of sustaining an injury on the Abbreviated Injury Scale (AIS) ≥ 2, while controlling for rider characteristics. Results: The most common locations of e-scooter injuries in our study sample occurred on the sidewalk (58%) or road (23%). Accounting for other trip and rider attributes, e-scooter riders injured on the road were about twice as likely as those injured elsewhere to sustain AIS ≥ 2 injuries (RR, 1.96; 95% CI, 1.23–2.36) and those who rode at least weekly more often sustained AIS ≥ 2 injuries compared with less frequent riders (RR, 1.86; 95% CI, 1.11–2.32). Conclusions: Greater injury severity for riders injured on the road may reflect higher travel speeds. Practical applications: Injury severity associated with riding in the road is one factor that jurisdictions can consider when setting policy on where e-scooters should be encouraged to ride, but the risk of any crash or fall associated with facilities should also be examined. Although injuries are of lower severity on sidewalks, sharing sidewalks with slower moving pedestrians could potentially lead to more conflicts.     

National estimates of U.S. residential fire-related injuries: An improved procedure

This study compared fire-related injuries from two ongoing data systems to determine how to combine them to provide improved estimates of U.S. residential fire-related injuries. National estimates and characteristics of patients treated in hospital emergency rooms for fire-related injuries were compared with injuries in a database of fires attended by the fire service. National estimates, age, and diagnosis distributions of injuries seen by both a hospital and the fire service were very similar in the two systems, indicating that the systems overlapped for this segment of injuries. Each system also contained a segment of fire-related injuries that was not included in the other. Combining the overlapping segment of injuries with segments that did not overlap resulted in an estimate of 45,000–47,000 U.S. fire-related injuries, the most com-prehensive estimate of U.S. residential fire-related injuries available to date.     

State helmet laws and helmet use among fatally injured moped riders in the United States, 2011–2015

Objective: Research has found that mandatory motorcycle helmet laws increase helmet use and reduce motorcycle-related fatalities. However, the association between state moped helmet laws and helmet use in the United States has not been examined. This study investigated this association among a census of fatally injured moped riders in the United States.

Methods: A logistic regression model was constructed to analyze data extracted from the Fatality Analysis Reporting System (FARS) to examine risk factors for helmet nonuse among 572 moped riders fatally injured between 2011 and 2015.

Results: Fatally injured moped riders in states with universal helmet laws had 69 times the odds of wearing a helmet (P < .001).

Conclusions: Findings suggest that universal moped helmet laws increase helmet use. However, additional research is needed to examine helmet laws and use among nonfatally injured moped riders.