Introduction Previous studies illustrate significant increases in pelvic fracture incidence; however, there is a paucity of information on the incidence of osteoporotic pelvic ring injuries based on large-scale examinations of geographically and ethnically diverse populations. This study addresses the epidemiology of osteoporotic pubic ramus fractures in the United States and details differences in incidence rates with respect to age, gender, and race. Materials and Methods National Electronic Injury Surveillance System (NEISS) data between 2002 and 2019 was gathered for individuals aged 60 and above presenting to U.S. emergency departments with ramus fractures. Incidence rates for ramus injuries were calculated using adjusted U.S. Census Bureau estimates of population. Fracture incidences were calculated for age, gender, and race strata. Results The overall incidence rate of pubic ramus fractures in the United States between 2002 and 2019 was 13.47 per 1,000,000 people 60 years and older (95% confidence limit: 9.92-17.01). The incidence of pubic ramus fractures for females in the US was 21.71 (16.08-27.34). Rates of ramus fracture increased overall ( P < .001) and for both genders between the ages of 60 and 100, though the rate increase was significantly greater in females than in males ( P < .001). In terms of race, incidence was highest Asian females and lowest in Native American and Pacific Islander men. Discussion/Conclusion : As the first national study addressing the epidemiology of ramus injuries in the United States, this work reveals these injuries comprise a significant fracture risk in the elderly. In addition, it highlights gender and ethnic strata that are more susceptible to these injuries.
<p class="abstract">A high prevalence of thrombotic events is observed in coronavirus-2019 (COVID-19). Optimal anticoagulation becomes a critical part of treatment and higher-dose prophylactic anticoagulation is being practiced. Prospective evidence to confirm the safety and efficacy of these regimens is lacking. We performed a systematic review of existing studies of anticoagulation in COVID-19. The ClinicalTrials.gov registry, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the EU Clinical Trials Register (EudraCT) were searched from inception to September 1, 2020. PRISMA guidelines were followed. Qualitative and quantitative analysis were performed. We identified 36 clinical studies involving anticoagulation in COVID-19. Most common study location was the United States (n=12, 33%). Thirty studies were randomized-controlled (83%) of which 22 were open-label. Median sample size was 309 (IQR 139-952) and study duration was 233 days (IQR 174-357). Most common study setting was critical and non-critical care (n=21, 58%). Most common single primary outcome was all-cause mortality (n=15, 42%) but thrombotic events represent the overall most common primary outcome (n=28, 77%). Low molecular weight heparin (LMWH) was the most common agent studied (n=25, 69%) followed by unfractionated heparin (UFH) (n=14, 38.8%) and factor Xa antagonists (n=8, 22.2%). Therapeutic-intensity prophylaxis was the most common dosage regimen studied in comparison to routine thromboprophylaxis dose in 76% and 86% of studies with LMWH and UFH respectively. Five studies (14%) used intermediate-dose prophylaxis. Bleeding is studied as an outcome variable in 19 studies (53%). Our review identifies studies of anticoagulation in COVID-19 and the pharmacological agents used, dosage intensities, and the outcomes analyzed.</p><p class="abstract"> </p>
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