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Background: Neighborhood location and its built environment are important social determinants of health that impact health outcomes. Older adults (OAs) represent the fastest growing population in the United States with many requiring emergency general surgery procedures (EGSPs). The aim of this study was to evaluate whether neighborhood location, represented by zip code, influences mortality and disposition in OAs undergoing EGSPs in Maryland. Methods: A retrospective review was undertaken of hospital encounters in the Maryland Health Services Cost Review Commission from 2014 to 2018 of OAs undergoing EGSPs. Older adults residing in the 50 most affluent (MANs) and 50 least affluent (LANs) neighborhoods based on zip codes were compared. Data collected included demographics, all patient-refined (APR)-severity of illness (SOI), APR-risk of mortality (ROM), Charlson Comorbidity Index, complications, mortality, and discharge to a higher level of care. Results: Of the 8661 OAs analyzed, 2362 (27.3%) resided in MANs and 6299 (72.7%) in LANs. Older adults in LANs were more likely to undergo EGSPs, had higher APR-SOI and APR-ROM, and experienced more complications, discharge to higher level of care, and mortality. Living in LANs was independently associated with discharge to higher level of care (OR 1.56, 95% CI: 1.38-1.77, P <.001) and increased mortality (OR 1.35, 95% CI: 1.07-1.71, P =.01). Discussion: Mortality and quality of life in OAs undergoing EGSPs are dependent on environmental factors likely determined by neighborhood location. These factors need to be defined and incorporated in predictive models of outcomes. Public health opportunities to improve outcomes for those who are socially disadvantaged are necessary. [ABSTRACT FROM AUTHOR]

Background: Older adults (OAs) ≥ 65 years of age, representing the fastest growing segment in the United States, are anticipated to require a greater percentage of emergency general surgery procedures (EGSPs) with an associated increase in health care costs. The aims of this study were to identify the frequency of EGSP and charges incurred by OA compared to their younger counterparts in the state of Maryland.Methods: A retrospective review of the Maryland Health Services Cost Review Commission from 2009 to 2018 was undertaken. Patients undergoing urgent or emergent ESGP were divided into 2 groups (18-64 years and ≥65 years). Data collected included demographics, APR-severity of illness (SOI), APR-risk of mortality (ROM), the EGSP (partial colectomy [PC], small bowel resection [SBR], cholecystectomy, operative management of peptic ulcer disease, lysis of adhesions, appendectomy, and laparotomy), length of stay (LOS), and hospital charges. P-values (P < .05) were significant.Results: Of the 181,283 patients included in the study, 55,401 (38.1%) were ≥65 years of age. Older adults presented with greater APR-SOI (major 37.7% vs 21.3%, extreme 5.2% vs 9.3%), greater APR-ROM (major 25.3% vs 8.7%, extreme 22.3% vs 5.3%), underwent PC (24.5% vs 10.9%) and SBR (12.8% vs 7.0%) more frequently, and incurred significantly higher median hospital charges for every EGSP, consistently between 2009 and 2018 due to increased LOS and complications when compared to those ≤65 years of age.Conclusion: These findings stress the need for validated frailty indices and quality improvement initiatives focused on the care of OAs in emergency general surgery to maximize outcomes and optimize cost. [ABSTRACT FROM AUTHOR]

Objectives. This study sought to determine the impact of Maryland's all-rider motorcycle helmet law (enacted on October 1, 1992) on preventing deaths and traumatic brain injuries among motorcyclists. Methods. Statewide motorcyclist fatalities occurring during seasonally comparable 33-month periods immediately preceding and following enactment of the law were compared. Results. The motorcyclist fatality rate dropped from 10.3 per 10000 registered motorcycles prelaw to 4.5 postlaw despite almost identical numbers of registered motorcycles. Motorcyclists wearing helmets had a lower risk of traumatic brain injury than those not wearing helmets (odds ratio=0.31, 95% confidence interval=0.14, 0.68). Conclusions. Maryland's controversial motorcycle helmet law appears to be an effective public health policy and may be responsible for saving many lives. (Am J Public Health. 2002;92:1352-1355) [ABSTRACT FROM AUTHOR]

• A new casino in suburban Maryland changed the characteristics of nearby crashes. • Crashes were more likely to occur near the casino after it opened (OR 1.23). • Crashes were more likely to occur on weekends (OR 1.39, 95 % CI: 1.15–1.67). • Drivers <40 years old were more likely to crash within a mile of the casino (OR 1.74). • Neither gender (OR 0.86) nor time of day (OR = 1.13) were significant. Many states have legalized casino gambling, and casinos create increased vehicle traffic, but the strength of the association between casino construction and vehicle crashes is unknown. Retrospective analyses of motor vehicle crashes (MVCs) occurring within Anne Arundel County, Maryland (2010–2014) were conducted. The ratio of crashes within one mile of the casino's location after it was opened were compared to the ratio occurring in the same area before it was opened to determine how the incidence of MVCs near the casino changed with time. Logistic regression was used to determine how crash characteristics may have influenced the incidence of MVCs near the casino after it opened. 101,860 persons were involved in 43,328 MVCs in Anne Arundel County during the study period; 29,476 (68.0 %) had an at-fault driver ≥21 years of age and complete data. MVCs proximal to the casino occurred most commonly during the day (N = 421, 76.6 %) and involved drivers <40 years of age (N = 366, 66.6 %) and male (N = 316, 57.4 %). After adjustment for impairment and day of the week, there was a significant association with crashes close to the casino after it opened (OR Adjusted = 1.23, 95 % CI: 1.04–1.46, p = 0.02). Crashes occurring close to the casino, after it opened, involved drivers <40 years of age (OR = 1.74, 95 % CI:1.45–2.08) and occurred on weekends (OR = 1.39, 95 %CI:1.15–1.67). In this single-site study the opening of a casino was associated with an increase in crashes nearby. The generalizability of this finding should be confirmed with analysis of MVC data near other gambling venues. [ABSTRACT FROM AUTHOR]

Background: Older adults (OAs; ≥ 65 years) comprise a growing population in the United States and are anticipated to require an increasing number of emergency general surgery procedures (EGSPs). The aims of this study were to identify the frequency of EGSPs and compare cost of care in OAs managed at teaching hospitals (THs) vs nonteaching hospitals (NTHs).Methods: A retrospective review of data from the Maryland Health Services Cost Review Commission database from 2009 to 2018 for OAs undergoing EGSPs was undertaken. Data collected included demographics, all patient-refined (APR)-severity of illness (SOI), APR-risk of mortality (ROM), Charlson Comorbidity Index (CCI), EGSPs (partial colectomy (PC), small bowel resection, cholecystectomy, operative management of peptic ulcers, lysis of adhesions, appendectomy, and laparotomy, categorized hospital charges, length of stay (LOS), and mortality.Results: Of the 55,401 OAs undergoing EGSPs in this study, 28,575 (51.6%) were treated at THs and 26,826 (48.4%) at NTHs. OAs at THs presented with greater APR-ROM (major 25.6% vs 24.9%, extreme 22.6% vs 22.0%, P=.01), and CCI (3.1±3 vs 2.7±2.8, P<.001) compared to NTHs. Lysis of adhesions, cholecystectomy, and PC comprised the overall most common EGSPs. Older adults at THs incurred comparatively higher median hospital charges for every EGSP due to increased room charges and LOS. Mortality was higher at THs (6.13% vs 5.33%, P<.001).Conclusion: While acuity of illness appears similar, cost of undergoing EGSPs for OAs is higher in THs vs NTHs due to increased LOS. Future work is warranted to determine and mitigate factors that increase LOS at THs. [ABSTRACT FROM AUTHOR]

Hospitalizations for peptic ulcer disease (PUD) have decreased since the advent of specific medical therapy in the 1980s. The authors' clinical experience at a tertiary center, however, has been that procedures to treat PUD complications have not declined. This study tested the hypothesis that despite decreases in PUD hospitalizations, the volume of procedures for PUD complications has remained consistent. The study population included all inpatient encounters in the state of Maryland from 2009 to 2014 with a primary ICD-9 diagnosis code for PUD. Data on annual patient volume, demographics, anatomic location, procedures, complications, and outcomes were collected, and PUD prevalence rates were calculated. The study population consisted of the state's entire population, not a sample; statistical analysis was not applied. Hospitalizations for PUD declined from 2,502 in 2009 to 2,101 in 2014, whereas the percentage of hospitalizations with procedures increased from 27.1 to 31.5 per cent. Endoscopy was performed in 19.8 per cent of hospitalizations, operation in 9.4 per cent, and angiography in 1.3 per cent. Of 13,974 inpatient encounters, 30 per cent had at least one inhospital complication. Overall inpatient mortality was 2.2 per cent. PUD hospitalizations are declining in Maryland, mirroring national trends. A subset of patients continue to need urgent procedures for PUD complications, including nearly 10 per cent needing operation. Inpatient mortality among patients admitted for PUD was 2.2 per cent, congruent with other studies. Despite the efficacy of modern medical therapy, these data underscore the importance of teaching surgical residents the cognitive and operative skills necessary to manage PUD complications. [ABSTRACT FROM AUTHOR]

Objective: Seat belt usage has increased substantially since the 1960s, yet driver use continues to affect passenger usage. Recent observational restraint use findings for Maryland will examine the relationship between driver and passenger usage, including adults and children in the rear seat., Methods: Analyses were based on observational front and rear seat studies administered in parallel from 2016 to 2019. A statistically rigorous front seat project yielded weighted results among drivers and outboard passengers. A study of adults and children in the rear seat was based on a convenience sample of vehicles. Restraint usage results were presented as frequencies and proportions among occupants with known belt use, along with the 95% confidence interval for overall rates., Results: Overall restraint usage rates averaged 90.9% in the front seat study and 81.1% in the rear seat sample. In vehicles with two front seat occupants and a belted driver, the proportion of belted passengers averaged 93.0% over four years. However, among unbelted drivers, only 41.6% of passengers were belted on average. In the rear seat study, an average of 82.7% were belted in vehicles driven by a restrained driver, differing for children (92.0%) versus adults (70.4%). Analysis of vehicles with an unbelted driver revealed an average of 45.0% of belted rear seat occupants, with a considerable difference for children (65.0%) compared with adults (21.0%)., Conclusions: Observational seat belt studies in Maryland in recent years have shown that, despite overall rates above 80%, passenger use in both the front and rear seats is associated with driver restraint use.

Purpose: To describe predictors of PTSD after motor vehicle crashes (MVC)., Methods: MVC patients were interviewed during their hospitalization and at 6 and 12 months post-injury. Interviews included information about behavioral factors, circumstances around the crash, recovery and PTSD screening. PTSD was defined as the development of 3 or more of 7 PTSD symptoms. Association of risk factors with PTSD development at 6 and 12 months was analyzed using contingency tables. Multiple regression models were built for the prediction of PTSD., Results: 367 and 317 patients completed the 6 and 12 month interviews respectively. PTSD developed in 27.5 % (n=101) and 24.3 % (n=77) of the population at 6 and 12 months respectively. PTSD occurred more frequently among females, those with a previous history of depression, violent injury, or other traumatic events, and those whose crashes involved a fatality. Those who were culpable for the crash, age<30, and sustained brain injuries were less likely to develop PTSD at 6 months. Occupant position, education, marital status, alcohol problems, injury severity, heart rate, and blood alcohol + status did not show any significant association with PTSD. In the multiple logistic regression, female gender, history of depression, culpability, prior violent injury, and a fatality in the crash were associated with PTSD at 6 months. Only prior violent injury, and a death in same crash were predictors at one year., Conclusion: PTSD occurs frequently after MVCs. Female gender, prior violent injury, death of another occupant and history of depression are associated with PTSD development.

Objective: To compare injury patterns and outcomes of near- and far-side collisions., Methods: Near- and far-side occupants in the Crash Injury Research and Engineering Network (CIREN) were compared for mortality and the occurrence of severe injuries (maximum abbreviated injury scale [MAIS] 3+). Regression models, adjusting for confounders, examined death and MAIS 3+ injuries as outcomes and near- or far-side position as an independent variable. CIREN findings were compared with those of the Crash Outcome Data Evaluation System (CODES), and the Maryland Automated Accident Reporting System., Results: Of the 380 cases, 72% were in the near and 28% in the far position. Mortality was similar between groups within CIREN. Near-side occupants experienced a higher frequency of MAIS 3+ injuries for the thorax, abdomen, and lower extremities, and fewer MAIS 3+ head injuries than far-side occupants (35% vs. 46%, p = 0.06). Regression models revealed similar risk of MAIS 3+ head injuries among near- and far-side occupants. The most common structures contacting the head in far-side crashes (N = 62) were opposite side structures (52%) and other occupants (13%). Similar risks of head injuries among near- and far-side occupants were observed for the CODES data; however, lower risks of death were present among far-side drivers involved in crashes, based on CODES and Maryland Automated Accident Reporting System., Conclusions: Despite a lower incidence of thoracic, abdominal, and lower extremity injuries, far-side occupants experienced a similar risk of head injuries to that of near-side occupants. Contact patterns suggest that restraint systems fail to keep far-side occupants' heads from striking opposite side structures or other occupants.

Background: Few studies have examined alcohol use in the older trauma population. The purpose of the present study was to examine blood alcohol level testing and results among older trauma patients., Methods: All patients aged 65 years or older directly admitted from the injury scene and entered into the Maryland Trauma Registry during a 6-year period were reviewed., Results: The annual proportion of directly admitted patients of age 65 or older increased by 44% from 1996 to 2000. Blood alcohol concentration (BAC) was measured for 66% of older patients; 9% were alcohol positive, and 81% had BAC > or = 80 mg/dL. Mean BAC was 165 mg/dL for all alcohol-positive patients. The highest mean BAC was noted in patients with fall-related injuries, followed by pedestrians struck, then by those in a motor vehicle crash. The most common cause of injury was motor vehicle crash (47%). Among all injury causes, patients with fall-related injuries had the greatest proportional increase from 28% in 1996 to 44% in 2000. Alcohol positive status was most frequent (13%) and mean BAC was highest among patients admitted because of fall-related injuries., Conclusion: Identifying and addressing alcohol use problems remains an important injury prevention measure for the older trauma population.

Objective: This study aimed to determine whether a persuasive educational intervention could increase licensure among motorcycle owners. Unlicensed motorcycle operators appear to be disproportionately involved in police-reported motorcycle crashes in Maryland, accounting for about 27% of motorcycle operators in police-reported crashes, although unlicensed owners comprise 17% of primary motorcycle owners., Methods: A randomized controlled trial was conducted among unlicensed owners. Linking Maryland records of registered motorcycles with license files, 8,499 unlicensed owners who had no licensed co-owners were identified. Half were randomized to receive a persuasive educational mailing in early June 2005 from Maryland Motor Vehicle Administration (MVA). Motorcycle licenses can be attained by passing an accredited motorcycle training class or passing knowledge and skills tests administered by the state driver licensing agency. Licensure rates and motorcycle class enrollment were followed for 6 months post-intervention., Results: As of December 16, 2005, 280 intervention group owners had obtained Class M motorcycle licenses and 158 had obtained Class R motorcycle learner's permits. The comparison group obtained 209 M licenses and 122 R permits. The overall success rate in the intervention group, defined as obtaining Class M or R, was 10.4% compared with 7.9% in the comparison group (licensure ratio (LR) = 1.33; 95% confidence interval (CI) = 1.16-1.52). The intervention was most successful among men, whose LR for obtaining M licenses was 1.45 (95% CI = 1.21-1.75). LRs were higher among owners ages 40-48 and 49+ receiving the intervention compared with younger groups. Motorcycle training class enrollment rates were higher in the intervention group, particularly among those taking a course for riders with intermediate skills (enrollment ratio = 2.24; 95% CI = 1.41-3.55)., Conclusion: The intervention appeared to increase licensure, yet the licensure rate remained low among the intervention group. Potential risks and benefits of increasing the percentage of motorcyclists who are licensed need to be studied.

Twenty years ago the American Medical Association reported the relationship between blood alcohol concentration (BAC) and crash causation. This study addresses culpability, age, gender and BAC in a population of drivers injured in motor vehicle crashes. Five years of hospital and crash data were linked, using probabilistic techniques. Trends in culpability were analyzed by BAC category. Given BAC level, the youngest and oldest drivers were more likely to have caused their crash. Women drivers had significantly higher odds of culpability at the highest BAC levels. Seatbelt use was also associated with culpability, perhaps as a marker for risk-taking among drinkers.

Objectives: To describe the epidemiology of traumatic brain injury (TBI) among children in Maryland and to examine factors that influence hospital admission., Methods: Statewide mortality, hospital discharge, and ambulatory care data were used to identify all TBI-related emergency department (ED) visits, hospitalizations, and deaths that occurred in 1998 to children aged 0-19 years according to the Centers for Disease Control and Prevention's standard case definition and protocol. Inpatient admission was modeled as a function of patient, injury, and hospital characteristics., Results: The overall incidence of pediatric TBI (i.e., ED visits, hospitalizations, and deaths) in 1998 was 670/100,000. After controlling for injury severity and other factors, uninsured children were 40% less likely to be hospitalized (95% CI = 0.43 to 0.82) and children with Medicaid were 90% more likely to be hospitalized (95% CI = 1.42 to 2.54) than were those with private insurance. The presence of a major associated injury significantly influenced the likelihood of hospitalization, especially among children with a minor (OR = 8.8) to moderate (OR = 11.6) TBI. Children who presented to a trauma center hospital were significantly more likely to be hospitalized than children treated at a non-trauma center hospital, although this varied depending on income (OR = 1.8 for high versus low) and hospital volume (OR = 2.6 for a small hospital and OR = 29.0 for a large hospital)., Conclusions: After adjusting for TBI severity and the presence of associated injuries, significant differences in hospitalization rates may exist among different patient subgroups and hospitals for children who sustain TBIs.