Biomedical subjects
Publications and source records attributed to L R Salmi.
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Explore the source record for details and available documents.
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The medical and psychological consequences of terrorism were assessed through an epidemiologic survey of 254 survivors of terrorist attacks (TA) that occurred in public places in France between 1982 and 1987 (20 bombings and 1 machine-gun attack). Physical lesions were typical of bombings (blast syndrome, burn, coma), but amputations were rare. Post-traumatic stress disorder (PTSD) was present in 10.5% of uninjured victims, 8.3% of moderately injured and 30.7% of severely injured ones. Major depression was found in 13.3% of all victims, with no difference according to the level of the injury. Prevalence rates were not different in males and females, nor did they vary with age of the victim. The prevalence of PTSD was not associated with the delay between TA and questionnaire completion. These findings suggest the need for including psychiatric assistance in the initial care of TA victims, especially severely injured ones.
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This paper focuses on the appropriateness of outcome measures to evaluate trauma care. The preventable death rate (PDR), based on the study of deceased patients only, has been the traditional measure of the impact of trauma care on improving the survival of patients with severe trauma. Another measure frequently used in other ares of evaluation research is the effectiveness rate--i.e. the survival rate in the total population of severe trauma patients. Because both the PDR and the effectiveness rate vary with the proportion of patients who would die even under conditions of optimal care, these two measures can be misleading. We illustrate their inadequacy by using published data on the impact of regionalization of trauma care. We propose the use of a third outcome measure of the impact of trauma care on survival, the efficacy rate--i.e. the survival rate among severe trauma patients with a potential for survival. Evaluation of trauma care should also measure outcomes other than survival and need not be restricted to patients with the most severe trauma. Evaluation of trauma care therefore requires outcome measures, such as the efficacy rate, which are based on the population at risk of manifesting the outcome of interest.
Hazardous roadway locations can be identified by monitoring the distribution of collisions on roads or by community concern following spectacular collisions. An in-depth investigation of collisions at a suspected high-risk site can allow engineers to conclude about causative factors. Expensive roadway investigations and modifications, however, should be undertaken only after an excess risk is demonstrated. We suggest using standard analytic cohort study methods for assessing suspected high-risk locations. The proposed approach complements the traditional approach of engineers, but differs from other epidemiologic studies of roadway hazards. This new application of standard techniques could help optimize the allocation of resources.
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This paper compares three methods to increase validity of case-control studies when two imperfect measurement tools are available to assess exposure. From simulated data, we show that point estimates of the relative risk, using only concordant dual responses, are always less biased than any other estimate. Because of the loss of power due to discarding discordant responses, the concordant response design is not efficient and is expensive. We show that a series response estimation, whereby all information is used but only dual positive responses are considered exposed, can be used to complement the interpretation of the less biased estimates. This approach is more interesting when exposure is rare and measuring it expensive.
In a regional study of the effect of the 1979 French seat-belt law, the nature and severity of car occupants' injuries were recorded for all car crashes during the same 3-month period in 1976, 1977, 1978 (before the law), and in 1979 (after the law). A trend analysis of data from all 4 years showed a slight decrease in the total injury rate, and significant decreases in the frequency of hospital admissions, and of head, face, arm, and leg injuries. Moderate pelvic and leg injuries, and serious head injuries were also less than expected in 1979. There was also a significant increase in the frequency of thoraco-lumbar spine injuries and of serious cervical spine injuries, but the absolute increase in these injuries was less than the absolute decrease in other injuries. These changes are compatible with the biomechanical effects of increased seat belt use, and thus suggest a beneficial effect of the law.
Death certificate data concerning farm-related injury deaths among children 0 to 9 years of age in Wisconsin and Illinois for the period of 1979 to 1985 were reviewed. Average annual farm-related injury death rates were 3.2 per 100,000 rural children in Wisconsin (62 deaths) and 1.5 per 100,000 in Illinois (32 deaths). Rates were three times higher among boys than girls. The occurrence of two harvest-related peaks and the absence of fatality in children less than 1 year of age suggest that presence of children on the farm when supervision is diminished is a key factor in farm-related fatalities. Moving machinery (tractors, wagons, and trucks) was the source of injury in approximately 55% of all deaths. Drowning accounted for 15% of all farm-related deaths. Two fatalities related to gravity box wagons could have easily been prevented with simple safety devices. These findings suggest a need for developing environmental interventions in farms. This will require the allocation of more resources to farm safety programs and a revision of current farm safety legislation.
We compared effectiveness (E), the proportion of severely injured patients who were salvageable and survived, to the preventable death rate (PDR) over three consecutive 1-year periods. Severely injured patients were those with at least one injury with an Abbreviated Injury Score (AIS) of greater than or equal to 4. Those with one fatal injury (AIS greater than or equal to 6), a critical head injury (AIS greater than or equal to 5) apart from acute epidural hematoma, or massive multiple injuries (Injury Severity Score greater than 59) were considered nonsalvageable; the remainder were considered salvageable. In the first year, six of 74 salvageable patients died, in the second year five of 76, and in the third year one of 69. The PDR rates were 0.32 (6/19), 0.23 (5/22), and 0.06 (1/17), respectively. There was no significant difference in the E of our trauma program over the 3 years. The apparent improvement in PDR in the second and third years resulted from an increased number of deaths among nonsalvageable patients and fewer deaths among salvageable patients. This finding demonstrates that PDR is sensitive to case mix and not just quality of care, and confirms the superiority of E over PDR for assessing a trauma program.
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The injury experience related to motor vehicle crashes on four bridges and one tunnel in Montreal, Quebec, Canada, from 1978 to 1982, are described. Particular attention is given to the Jacques Cartier Bridge, publicly perceived as being excessively dangerous. Data from the Quebec Automobile Insurance Board and police reports confirm an excess of deaths (19/34; rate ratio = 4.5) and severe injuries (69/109; rate ratio = 6.2) on the Jacques Cartier Bridge, and the association of 74 per cent of the fatalities and 64 per cent of the severe-injury cases on this bridge with a single curve. Crashes follow a consistent pattern; vehicles fail to negotiate the curve and strike vehicles moving in the opposite direction. The demonstrated association between crashes and design factors provides a basis for identifying effective remedial and preventive measures.