Biomedical subjects

D Fife

Publications and source records attributed to D Fife.

At least 37 records · Page 2Linked to original sources

PubMed1989

Analyses of the relationship between blood alcohol and nasal breath alcohol concentrations: implications for assessment of trauma cases.

To prevent serious complications and facilitate efficient and effective management of patients admitted to the emergency department or intensive care settings, it is extremely important to differentiate, quickly, between elevated concentrations of alcohol in the blood and compromised neurological status due to brain injury or other pathology. This research analyzed the relationship between blood alcohol concentrations (BACs) estimated from venous blood samples and those estimated from breath samples that were obtained using the Alco-Sensor III device with an attached tube for passive nasal breath sampling. Blood and breath samples, as well as brief medical histories and demographic and environmental data, were obtained and recorded for 35 adult trauma patients admitted to two major urban emergency departments. Passively expired nasal breath provided an excellent estimate of BAC measured from venous blood (range, 0 to 0.32) as evidenced in the extremely high regression coefficient (r = 0.99; slope = 1.22; p less than 0.0001). BAC assessment and monitoring, through the application of passive nasal breath sampling, provides a means of rapidly estimating BAC, and thus can facilitate diagnosis and the initiation of appropriate management and treatment.

Adult↗

PubMed1989

Firearms' decreased role in New Jersey homicides after a mandatory sentencing law.

In 1981 New Jersey adopted a law requiring a mandatory minimum prison sentence for use or possession of a firearm in a variety of crimes. New Jersey firearms homicides as a per cent of all New Jersey homicides increased from 1974 to 1980 and decreased from 1981 through 1986. No similar change was observed for homicides in the balance of the U.S. or for suicides in New Jersey or the balance of the U.S. The findings suggest an effect of the mandatory minimum sentencing law on firearms homicides.

Firearms↗

PubMed1989

Blood alcohol tests, prevalence of involvement, and outcomes following brain injury.

We collected data on all residents of San Diego County, California who were hospitalized for or died from a brain injury in 1981. The objectives were to assess the frequency of blood alcohol concentration (BAC) testing and the associations of BAC prevalence with the external cause of the brain injury and case outcome. We found that high BAC levels were most frequent among brain-injured subjects between the ages of 25 and 44 and among those subjects involved in motor vehicle crashes and assaults. Contrary to expectations, injury severity and hospital mortality were inversely related to BAC level, controlling for other predictors. We believe that these inverse associations might be due to differential rates of BAC testing by severity. Among brain-injured survivors with more severe injuries, however, we found that BAC level was positively associated with the prevalence of physician-diagnosed neurological impairment at discharge and with the length of hospitalization.

Accidents↗

PubMed1988

Historical changes in motor vehicle death rates among the elderly.

Motor vehicle death rates among the elderly decreased substantially between 1940 and 1980, while the number of registered motor vehicles in the United States increased fourfold and death rates from motor vehicle injury changed little for the entire population. The annual death rate per 100,000 males aged 75-79 declined from 120 in 1940 to 41 in 1980. Much of the decrease can be attributed to reduced pedestrian deaths. Rates for other elderly age and sex groups showed similar patterns but the rates were lower and the changes smaller. Displaying age-specific motor vehicle death rates by birth cohort provides a graphic demonstration that these death rates have decreased markedly for all age groups 60 and older. Implications and possible causes of this decrease are discussed.

Accidents, Traffic↗

PubMed1988

Infection as a contributory cause of death in patients hospitalized for motor vehicle trauma.

The age and length-of-stay specific incidence of fatal infections and the percentage of deaths due to infection were determined in a population-based sample of patients hospitalized for more than 2 days for motor vehicle injuries. The percentage of deaths due to infection was determined from a statewide sample of death certificates, and the patient fatality rates for hospitalized motor vehicle crash injury patients were determined from statewide Professional Activities Study data. Fatal pulmonary infections were far more common than fatal nonpulmonary infections. The incidence rate of fatal pulmonary infection was highest among those with hospital stays of 7 to 28 days and among those 70 years of age or older. Incidence rates varied substantially by age and length of hospital stay from a low of 8 deaths per 100,000 patient-days for adult female patients with stays longer than 28 days to a high of 102 deaths per 100,000 patient-days for elderly men with stays of 7 to 28 days. The incidence rates documented in this study may improve the identification of blunt trauma patient groups with the greatest need for prophylactic antiinfective measures.

Accidents, Traffic↗

PubMed1987

What role do injuries play in the deaths of old people?

An injury event related to a person's death may be recorded on the death certificate as the underlying cause of death, as an event associated with death but not necessarily causing it, or both. Of the 5,882 deaths in Los Angeles during 1980 with a related injury event recorded on the death certificate, an injury event was identified as the underlying cause of death for more than 95 percent of those aged less than 55 and only 54 percent for those aged 65 or older. This finding suggests that injury may be underreported as a cause of death among old people. Deaths which were injury-related but for which there was no notation of injury could not be identified, but the numbers may be substantial. If so, considerably more attention should be given to injury care and prevention for the elderly.

Accidents↗

PubMed1987

Changing patterns in motor vehicle crash mortality: 1940-1980.

Overall motor vehicle mortality rates in the United States varied little between 1940 (26 deaths per 100,000 per year) and 1980 (23 deaths per 100,000 per year). However, the distribution of motor vehicle deaths by age, sex, and road user status has changed considerably. Among the elderly there has been a substantial increase in motor vehicle death rates. The result of these changes, and of the altered age structure of the population, is that the number of years of life lost to motor vehicle crash injury before age 70 has increased 84 percent between 1940 and 1980.

Accidents, Traffic↗

PubMed1987

Time from injury to death (survival time) among fatally injured pedestrians.

This study examines the survival time after injury and its relationship to age and Injury Severity Score (ISS) among 322 fatally injured pedestrians. Long survival times were associated with older age and with lower ISS. The association of long survival time with older ages remained present after adjustment for ISS. People with untreatable severe injuries (as defined by the Abbreviated Injury Scale) and people who died of potentially survivable injuries had markedly different survival times. Therefore, in analyses of data relating to survival time, combining the two groups should be avoided.

Accidents, Traffic↗

PubMed1987

Injuries and deaths among elderly persons.

Injury related to a death may be recorded on the death certificate as the underlying cause of death or as a condition associated with death but not causing it. The present study uses the National Center for Health Statistics Multiple Cause of Death data for 1978 to determine the percentage of injury-related deaths for which injury was identified as the underlying cause of death and the variation of this percentage with age at death. Injury was identified as the underlying cause of death in 86% of all cases with injury recorded on the death certificate. The percentage with injury identified as the underlying cause varied with age: 93% for those in the first year of life, 97% for those aged 1-44 years, 87% for those aged 55-64, and 50% for those aged 75 or older. The percentage with injury identified as the underlying cause also varied by cause of injury. In all age groups, assault, suicide, and motor vehicle accidents were identified as the underlying cause of death in more than 90% of the cases in which they were mentioned. Causes other than motor vehicle accidents, assaults, and suicides, especially when occurring in the elderly, were less likely to be identified as the underlying cause of death. Cause of death tabulations based only on the underlying cause of death selectively underestimate the role of injury in the deaths of the elderly.

Adolescent↗

PubMed1987

Incidence, severity, and outcomes of brain injuries involving bicycles.

We performed a population-based study of bicycle-related brain injuries in San Diego, California, residents during 1981. Incidence rates among males were three times higher than for females and were highest at ages 10-14 years for males. Only one-third of bicycle-related brain injuries involved collision with a motor vehicle, and this proportion was independent of age or gender. Brain injuries from motor-vehicle collisions were more severe than those resulting from other causes. Over half the brain-injured bicyclists aged 15 and older who were blood alcohol tested were legally intoxicated.

Accidents, Traffic↗

PubMed1987

Head injury with and without hospital admission: comparisons of incidence and short-term disability.

All persons with head injuries (skull fracture or injury to the cranial contents resulting in a physician visit or at least one day of disability), regardless of treatment or hospital admission status, were identified from National Health Interview Survey data for the years 1977-81. Among those who reported such head injuries within the two weeks prior to interview, only 16 per cent were admitted to hospitals. Children, members of low-income families, and those injured at home, school, or in a recreational setting were less likely to be admitted to hospital than others. Among those who sustained a head injury in the previous three months and had some disability from that injury during the two weeks prior to interview, those not admitted to hospital included one-half of those with three to seven days of bed disability and one-third of those with more than seven days of bed disability; and they accounted for one-half of all disability days. These findings indicate that hospital-based head injury incidence data are incomplete and may contain substantial biases.

Adolescent↗

PubMed1987

Pediatric brain injuries: the nature, clinical course, and early outcomes in a defined United States' population.

Acute brain injury is the cause of approximately 100,000 pediatric hospital admissions per year in the United States. This report examines the nature of the brain injury, clinical diagnosis, hospital course, and discharge outcome of all pediatric cases in the population of San Diego County, California, for 1981 (N = 709). Brain-injured children were identified from hospital records, death certificates, and coroners' records. Severity of injury was determined using the Abbreviated Injury Scale and the Glasgow Coma Scale. Three percent of brain-injured children died at the accident site; an additional 3% died in the hospital. All in-hospital deaths occurred among the 5% of children with Glascow Coma Scale scores of 8 or less, and in this group the case fatality rate was 59%. Fractures of the skull, present in 23% of cases, seemed to be associated with excess mortality even after type of lesion was considered. Type of lesion, but not presence or absence of a skull fracture, had some predictive power for disability among survivors. Concussion was the most frequent diagnosis. Mildly brain-injured children accounted for 93% of all cases and about 90% of all hospital days.

Adolescent↗

PubMed1986

Incidence, severity, and external causes of pediatric brain injury.

The number of fatal brain injuries and hospital admissions for brain injuries in children up to 15 years old in San Diego County, California, were ascertained from emergency room and hospital records, coroners' reports, death certificates, and nursing home and extended-care records for 1981. The annual brain-injury rate per 100 000 children was 185 (235 for boys and 132 for girls). The major causes of pediatric brain injury were falls (35%), recreational activities (29%), and motor vehicle crashes (24%). The case-fatality ratio was six deaths per 100 injured children. Of those children admitted to a hospital alive, 88% had a mild brain injury and 44% had no evidence of loss of consciousness. Two thirds of children with mild brain injuries and one third of those with serious brain injuries were transported to a hospital in private nonemergency vehicles.

Accidents, Traffic↗

PubMed1986

Motor vehicle trauma in northeastern Ohio. I: Incidence and outcome by age, sex, and road-use category.

Hospital emergency department visits for motor vehicle trauma occurring in a midwestern metropolitan region (Cleveland and Lorain-Elyria, Ohio Standard Metropolitan Statistical Areas; 2.2 million population) were analyzed to determine the incidence and outcome by age, sex, and road-use category. A 50% incidence sample (n = 20,752) of motor vehicle trauma events to residents of this region was identified from the emergency department records of 41 participating hospitals for a one-year period, 1977. These hospitals accounted for 98% of all emergency department cases in the region. The annual motor vehicle trauma incidence rate per 100,000 population was 1,871. The highest annual incidence rate (4,462) was for ages 20-24; the lowest rates were for infants under one year (837) and for the elderly over 74 years (667). Incidence rate rank-ordered road-use categories were as follows: passenger car occupant, motorized cycle rider, other enclosed vehicle occupant, pedestrian, and pedal cyclist. Above age 4, age-specific male incidence rates significantly exceeded female incidence rates for most road-use categories. There were 80 admissions and 7 fatalities per 1,000 motor vehicle trauma incidence cases. Case-admission ratios were highest for pedestrians (266), riders of motorized cycles (184), and pedal cyclists (115); they were lowest for occupants of partially or fully enclosed vehicles (65). Case-fatality ratios per 1,000 cases were also highest for pedestrians (43) and riders of motorized cycles (11). Male case-fatality ratios exceeded female ratios for each road-use category in nearly all age groups, and male case-admission ratios exceeded those for females ages 10-54. For ages 75 and over, the admission ratios and fatality ratios were nearly twice as high as in any other age group.

Accidents, Traffic↗

PubMed1986

Northeastern Ohio Trauma Study: V. Burn injury.

Burn injury cases were identified from a population-based sample of trauma visits to hospital emergency departments in northeastern Ohio during 1977. The 199 cases represented 2.4% of all trauma incidence visits by residents of the five-county study region. Ninety-five per cent of the burn cases were released from the emergency department directly after treatment. The annual incidence rate of emergency department-treated burns was 4.7 per 1,000 population. Incidence rates for males were twice those for females. The age groups with the highest annual incidence rates were those under 5 years of age and 25-34 years (seven and eight cases per 1,000 population, respectively). Most burns occurred at home or the workplace. The youngest employed age group sustained the highest rate of work-related burns. Hot or corrosive substances caused two thirds of all burns; fire and flames caused one fourth.

Accidents, Home↗

PubMed1986

The relationship of family income to the incidence, external causes, and outcomes of serious brain injury, San Diego County, California.

Among residents of San Diego County, California the incidence and external causes of serious brain injury were related to the median family income of the census tract of residency. Low income tracts had high incidence rates--a finding not changed by adjustment for age and race/ethnicity. For those injured, the type of emergency transport, time from injury to treatment, and outcome of treatment were not related to the median income of the census tract of residency.

Brain Injuries↗

PubMed1986

Incidence and outcome of hospital-treated head injury in Rhode Island.

Hospital discharge summary data were used to identify and study all 2,870 Rhode Island residents hospitalized in-state with head injuries during 1979 and 1980. The overall hospitalized incidence rate was 152 per 100,000 of population per year with age and sex variations similar to those found in other studies. This is consistent with the observation that fatal injury rates in Rhode Island are only 75 per cent of the United States average. Hospitalized incidence rates of head injury for the census tracts in the lowest decile of median income were twice those for census tracts in the highest decile. Smaller increases were also observed with increasing population density. Length of hospital stay increased with age. Discharge to chronic care facilities plus in-hospital deaths increased 20-fold with increasing age. In each age group, in-hospital deaths and discharge to chronic care facilities were associated with long hospital stays.

Accidents, Traffic↗

PubMed1985

Discrepancies in vehicular crash injury reporting: Northeastern Ohio Trauma Study. IV.

People injured in motor vehicle traffic crashes were identified from a population-representative incidence sample of hospital emergency department visits. Matched police reports of crashes were sought in official state records of motor vehicle traffic crashes. Of the emergency department cases, 55% had matched police reports. The frequency of matched reports was highest for drivers (74%), people transported to the hospital by emergency vehicle (69%), and those requiring hospital admission (74%). The frequency was lowest for people younger than 16 years (28%), people injured as occupants of vehicles other than passenger cars (24%), medicaid recipients (33%), and nonresidents of the study region (40%). Motor vehicle traffic injuries are undercounted in police-reported statistics. For many groups, police reporting is less than 50% of the cases identified through emergency departments. The likelihood that a case of motor vehicle traffic injury will have a matched police report depends on demographic, social and crash factors as well as on injury severity.

Accidents, Traffic↗