Trauma epidemiology in Puerto Rico: in-hospital morbidity and mortality from 2002 to 2011

Abstract

This study aimed to describe the distribution of injury mechanisms and to assess the impact of those mechanisms on the morbidity and mortality of trauma. All patients admitted to Puerto Rico Trauma Hospital (2002-2011) for road-traffic collisions (RTCs, 5,371), gunshot wounds (GSWs, 2,946), falls (2,319), pedestrian accidents (1,652), and stab wounds (SWs, 1,073) were selected. Gunshot victims were 1.19 (95%CI: 1.07-1.33) times as likely as road-traffic victims to have an ISS ≥25. Pedestrians were 1.76 (95%CI: 1.49-2.09) times more likely to have a GCS ≤8 than road-traffic victims were. The risk of dying was 2.64 (95%CI: 2.20-3.16) times higher for gunshot victims and 1.51 (95%CI: 1.23-1.86) times higher for pedestrians compared to patients who had had RTCs. Gunshot victims and pedestrians had the worst clinical outcomes. Accordingly, these patients should receive the most aggressive clinical management. Furthermore, it is imperative to develop public health campaigns on trauma prevention.

Unveiling the Natural History of Category 4 Tropical Cyclones: The Puerto Rico Trauma Hospital Experience after Hurricane Maria

“…Historically, GSWs have represented a highly prevalent mechanism at the PRTH, accounting for 20% of admissions. 33 The downward trend in GSWs during the first half of the post-Maria period could be partially explained by the nightly curfew that Puerto Rico's governor decreed for 4 wk in an attempt to avoid a rise in crime. 34 On the contrary, massive absences of police officers reported in December 2017 and January 2018, when roughly 2700 of 13,000 officers were calling in sick every day "to press demands for unpaid overtime," coincide with the upward trend in GSWs observed throughout the second half of the period.…”

Elderly Admission Trends at the Puerto Rico Trauma Hospital: A Time-Series Analysis

“…A previous study undertaken at our institution found that the pedestrian mechanism of injury is associated with higher ISSs, higher mortality rates, and worse outcomes, whereas patients admitted for falls usually presented the contrary. 25 Given the statistical relationship between mechanisms of injury and ISSs, the significant increase in fall-related admissions and the clear decline in those associated with pedestrians occurred in our hospital over time could potentially explain the observed decrease in ISSs. MV is the most common among elderly patients and patients admitted to the intensive care unit (ICU).…”

Morbidity and mortality of Hispanic trauma patients with diabetes mellitus

“…To estimate the statistical power (88%) of our study, we assumed an 11% trauma mortality rate for unexposed subjects [ 23 ] and an odds ratio (OR) of 1.46 [ 14 ], with a sample size of 1134 subjects in each cohort and a confidence level of 95%.…”