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Mandatory gunshot wound reporting laws have been enacted in much of Canada, yet there is a lack of evidence on whether these laws are effective in preventing firearm injuries. Our objective was to determine if the Gunshot Wounds Reporting Act in Nova Scotia had an effect on the number of firearm-related injuries in the province.Pre-post-study of major trauma patients in Nova Scotia who sustained a gunshot wound injury before and after enactment of the Gunshot Wounds Reporting Act (Bill 10) in 2008. Data were collected from the Nova Scotia Trauma Registry and the Nova Scotia Medical Examiner Service for a 6-year pre-period (2002-2007) and an 11-year post-period (2009-2019), allowing for a 1-year washout period. Patient characteristics in the pre- and post-periods were compared using t tests and Chi-square analysis. Gunshot wound traumas were analyzed as a time series using the AutoRegressive Integrated Moving Average (ARIMA) model.A total of 722 firearm injuries were observed during the study period (pre-period = 259, post-period = 463). Mean age was 45.2 ± 19.3 years with males accounting for 95.3% (688/722) of cases. The majority of injuries were self-inflicted (65.1%; 470/722). The mean overall annualized rate of firearm injuries was 4.61 per 100,000 population in the pre-period and 4.45 per 100,000 in the post-period (reduction of 3.4%). No linear trends in the annual number of firearm injuries were observed over the study period. ARIMA modelling was an extremely poor predictor for gunshot wound trauma (RAlthough our findings suggest that there is no association between the Gunshot Wounds Reporting Act and the incidence of firearm injury, it is difficult to draw firm conclusions due to the complexity of this topic. Physicians need to be aware of the legal requirements of mandatory reporting when they encounter patients with gunshot wounds.RéSUMé: OBJECTIF: Des lois obligatoires sur le signalement des blessures par balle ont été promulguées dans une grande partie du Canada, mais on manque de données probantes sur l'efficacité de ces lois pour prévenir les blessures par balle. Notre objectif était de déterminer si la Gunshot Wounds Reporting Act de la Nouvelle-Écosse a eu un effet sur le nombre de blessures liées aux armes à feu dans la province. MéTHODES: Étude pré-post des patients souffrant de traumatismes majeurs en Nouvelle-Écosse et ayant subi une blessure par balle avant et après la promulgation de la loi sur la déclaration des blessures par balle (projet de loi 10) en 2008. Les données ont été recueillies auprès du Nova Scotia Trauma Registry et du Nova Scotia Medical Examiner Service pour une période de 6 ans avant (2002–2007) et de 11 ans après (2009–2019), en tenant compte d'une période d'élimination d'un an. Les caractéristiques des patients avant et après les périodes ont été comparées à l’aide de tests- t et d’une analyse du chi-carré. Les traumatismes liés aux blessures par balle ont été analysés comme une série chronologique à l'aide du modèle ARIMA (AutoRegressive Integrated Moving Average). RéSULTATS: Au total, 722 blessures par arme à feu ont été observées au cours de la période d'étude (avant la période = 259, après la période = 463). L'âge moyen était de 45,2 ± 19,3 ans, les hommes représentant 95,3% (688/722) des cas. La majorité des blessures étaient auto-infligées (65,1%; 470/722). Le taux global moyen annualisé de blessures par arme à feu était de 4,61 pour 100 000 habitants pendant la période antérieure et de 4,45 pour 100 000 pendant la période postérieure (réduction de 3,4%). Aucune tendance linéaire du nombre annuel de blessures par arme à feu n'a été observée au cours de la période d'étude. Le modèle ARIMA s'est avéré être un très mauvais prédicteur des traumatismes liés aux blessures par balle (R2 = 0,012). CONCLUSIONS: Bien que nos résultats suggèrent qu'il n'y a pas de lien entre la loi sur le signalement des blessures par balle et l'incidence des blessures par arme à feu, il est difficile de tirer des conclusions définitives en raison de la complexité de ce sujet. Les médecins doivent être conscients des obligations légales de déclaration obligatoire lorsqu'ils rencontrent des patients présentant des blessures par balle.

To determine the rate of recurrent major trauma (i.e., trauma recidivism) using a provincial population-based trauma registry. We compared outcomes between recidivists and non-recidivists, and assessed factors associated with recidivism and mortality.Review of all adult (gt;17 years) major trauma patients in Nova Scotia (2001-2015) using data from the Nova Scotia Trauma Registry. Outcomes of interest were mortality, duration of hospital stay, and in-hospital complications. Multiple regression was used to assess factors associated with recidivism and mortality.Of 9,365 major trauma patients, 2% (150/9365) were recidivists. Mean age at initial injury was 52 ± 21.5 years; 73% were male. The mortality rate for both recidivists and non-recidivists was 31%. However, after adjusting for potential confounders the likelihood of mortality was over 3 times greater for recidivists compared to non-recidivists (OR 3.67, 95% CI 2.06-6.54). Other factors associated with mortality included age, male gender, penetrating injury, Injury Severity Score, trauma team activation (TTA) and admission to the intensive care unit. The only variables associated with recidivism were age (OR 0.98, 95% CI 0.97-1.00) and TTA (OR 0.59, 95% CI 0.34-0.96).This is the first provincial investigation of major trauma recidivism in Canada. While recidivism was infrequent (2%), the adjusted odds of mortality were over three times greater for recidivists. Further research is warranted to determine the effectiveness of strategies for reducing rates of major trauma recidivism such as screening and brief intervention in cases of violence or substance abuse.L’étude visait à déterminer le taux de répétition (ou de récidive) de traumas graves à l'aide d'un registre provincial de traumas, fondé sur la population. Ont d'abord été comparés les résultats cliniques chez les « récidivistes » et les « non-récidivistes », puis évalués les facteurs associés aux répétitions et à la mortalité.L’étude consistait en un examen des dossiers de tous les adultes (17 ans) ayant subi un trauma grave en Nouvelle-Écosse (2001–2015), à l'aide de données tirées du registre Nova Scotia Trauma Registry. Les résultats cliniques d'intérêt étaient la mortalité, la durée de séjour à l'hôpital et les complications survenues à l'hôpital. Par ailleurs, il y a eu régression multiple afin d’évaluer les facteurs associés aux répétitions et à la mortalité.Sur 9365 patients ayant subi un trauma grave, 150 (2%) étaient des récidivistes. L’âge moyen au moment du premier accident était de 52 ± 21,5 ans, et 73% des patients étaient des hommes. Le taux de mortalité dans les deux groupes s’élevait à 31%. Toutefois, après rajustement du taux pour tenir compte de possibles facteurs parasites, les probabilités de mort étaient 3 fois plus élevées chez les récidivistes que chez les non-récidivistes (risque relatif approché [RRA] : 3,67; IC à 95% : 2,6–6,54). D'autres facteurs associés à la mortalité comprenaient l’âge, le sexe masculin, les blessures par pénétration, le score selon l'indice de gravité des blessures, l'appel à l’équipe de soins en traumatologie (EST) et l'admission au service de soins intensifs. Toutefois, seules deux variables ont été associées aux répétitions de traumas, soit l’âge (RRA : 0,98; IC à 95% : 0,97–1,00) et l'appel à l'EST (RRA : 0,59; IC à 95% : 0,34–0,96).Il s'agit là de la première étude sur les répétitions de traumas graves, menée à l’échelle provinciale, au Canada. Si le taux de répétition était faible (2%), les probabilités rajustées de mort chez les récidivistes étaient plus de 3 fois supérieures à celles enregistrées chez les non-récidivistes. Il faudrait donc approfondir le sujet afin de déterminer l'efficacité des stratégies de réduction du taux de répétition de traumas graves, telles que le dépistage et les interventions brèves dans les cas de violence ou d'un usage abusif d'alcool ou de drogues.

To determine how many Level 1 and Level 2 trauma centres in Canada have implemented a resuscitative endovascular balloon occlusion of the aorta (REBOA) program, and to identify facilitators and barriers to successful implementation of REBOA programs.An electronic survey was developed and administered in November 2019 (updated in July 2021) via email to directors at all 32 Level 1 and Level 2 trauma centres across Canada, and to the medical director in PEI (no Level 1 or Level 2 capacity). Survey responses were supplemented by an online search in PubMed and the grey literature. Responses were analyzed using simple descriptive statistics including frequencies and proportions.We received responses from directors at 22 sites (17 Level 1 trauma centres, 4 Level 2 trauma centres, PEI) for a response rate of 66.7%. There are 6 Level 1 trauma centres with REBOA programs; all were implemented between 2017 and 2019. One additional Level 1 trauma centre that did not respond was found to have a REBOA program; thus, 21.9% (7/32) of Canadian Level 1 and Level 2 trauma centres have an existing REBOA program. These programs are located in three provinces (British Columbia, Ontario, Quebec). Five other centres are planning on implementing a REBOA program in the next 2 years. The number of REBOA cases performed ranged from 0 to 30 (median 2). Factors contributing most to successful program implementation were having physician champions and patient populations with sufficient REBOA candidates, while cost and lack of expertise were the greatest barriers identified.As of July 2021, 21.9% (7/32) of Canadian Level 1 and Level 2 trauma centres have a REBOA program. Physician champions and a patient population with sufficient numbers of REBOA candidates were the most important factors contributing to successful implementation of these programs.RéSUMé: OBJECTIFS: Déterminer combien de centres de traumatologie de niveau 1 et de niveau 2 au Canada ont mis en œuvre un programme d'occlusion endovasculaire par ballonnet de l'aorte en réanimation (REBOA), et identifier les facilitateurs et les obstacles à la mise en œuvre réussie des programmes REBOA. MéTHODES: Un sondage électronique a été élaboré et administré en novembre 2019 (mis à jour en juillet 2021) par courriel aux directeurs des 32 centres de traumatologie de niveau 1 et 2 au Canada, ainsi qu'au directeur médical de l'Î.-P.-É. (aucune capacité de niveau 1 ou 2). Les réponses à l'enquête ont été complétées par une recherche en ligne dans PubMed et la littérature grise. Les réponses ont été analysées à l'aide de statistiques descriptives simples, y compris les fréquences et les proportions. RéSULTATS: Nous avons reçu des réponses des directeurs de 22 sites (17 centres de traumatologie de niveau 1, 4 centres de traumatologie de niveau 2, Î.-P.-É.), soit un taux de réponse de 66,7 %. Il existe 6 centres de traumatologie de niveau 1 avec des programmes REBOA ; tous ont été mis en œuvre entre 2017 et 2019. Un autre centre de traumatologie de niveau 1 qui n'a pas répondu s'est avéré avoir un programme de REBOA ; ainsi, 21,9 % (7/32) des centres de traumatologie canadiens de niveau 1 et de niveau 2 ont déjà un programme de REBOA. Ces programmes sont situés dans 3 provinces (Colombie-Britannique, Ontario, Québec). Cinq autres centres prévoient de mettre en place un programme REBOA dans les 2 prochaines années. Le nombre de cas de REBOA effectués allait de 0 à 30 (médiane 2). Les facteurs contribuant le plus à une mise en œuvre réussie du programme étaient le fait d'avoir des médecins champions et des populations de patients avec suffisamment de candidats au REBOA, tandis que le coût et le manque d'expertise étaient les plus grands obstacles identifiés. CONCLUSIONS: En juillet 2021, 21,9 % (7/32) des centres canadiens de traumatologie de niveau 1 et 2 disposent d'un programme de REBOA. Les médecins champions et une population de patients avec un nombre suffisant de candidats au REBOA ont été les facteurs les plus importants contribuant à la réussite de la mise en œuvre de ces programmes.

To perform a province-wide evaluation of adult major traumas and determine the proportion of patients who met clinical and/or anatomical criteria for resuscitative endovascular balloon occlusion of the aorta (REBOA).This is a retrospective analysis of all major trauma patients (age 16) presenting to the sole adult level 1 trauma centre in Nova Scotia over a 5-year period (2012-2017). Data were collected from the Nova Scotia Trauma Registry and medical charts. We identified potential REBOA candidates using either: (1) clinical criteria (primary survey, Focused Assessment with Sonography for Trauma, pelvic/chest X-ray); or (2) anatomical criteria (ICD-10-CA codes). Potential candidates with persistent hypotension were considered true REBOA candidates.Overall 2885 patients were included in the analysis, of whom 248 (8.6%) patients were in shock (including 106 transfer patients) and had their charts reviewed. A total of 137 patients met clinical criteria for REBOA; 44 (1.5%) had persistent hypotension 10-20 min into resuscitation and were considered true REBOA candidates. There were 59 patients who met anatomical criteria for REBOA, of whom 15 (0.5%) patients had persistent hypotension and were true REBOA candidates. The 15 REBOA candidates based on anatomical criteria also met clinical criteria for REBOA.In this registry-based retrospective analysis, 1.5% of adult major trauma patients Nova Scotia were REBOA candidates based on resuscitative clinical presentation, while 0.5% were candidates based on post hoc anatomical injury patterns. Our findings suggest that using clinical findings and bedside imaging modalities as criteria may overestimate the number of candidates for REBOA.RéSUMé: OBJECTIFS: Effectuer une évaluation à l'échelle de la province des traumatismes majeurs chez l'adulte et déterminer la proportion de patients qui répondaient aux critères cliniques et/ou anatomiques de l’occlusion endovasculaire par ballonnet de réanimation de l'aorte (REBOA). LES MéTHODES: Analyse rétrospective de tous les patients ayant subi un traumatisme majeur (âge16 ans) qui se sont présentés au seul centre de traumatologie de niveau 1 pour adultes en Nouvelle-Écosse sur une période de 5 ans (2012-2017). Les données ont été recueillies à partir du registre des traumatismes de la Nouvelle-Écosse et des dossiers médicaux. Nous avons identifié des candidats potentiels à la REBOA en utilisant l'un ou l'autre : 1) des critères cliniques (enquête primaire, évaluation ciblée avec échographie pour les traumatismes, radiographie pelvienne/du thorax) ; ou 2) des critères anatomiques (codes CIM-10-CA). Les candidats potentiels présentant une hypotension persistante étaient considérés comme de véritables candidats au REBOA. RéSULTATS: Au total, 2 885 patients ont été inclus dans l'analyse, dont 248 (8,6 %) étaient en état de choc (dont 106 patients transférés) et ont vu leur dossier révisé. Au total, 137 patients répondaient aux critères cliniques pour la REBOA ; 44 (1,5 %) présentaient une hypotension persistante de 10 à 20 minutes en réanimation et étaient considérés comme de véritables candidats à la REBOA. Il y avait 59 patients qui répondaient aux critères anatomiques pour le REBOA, dont 15 (0,5 %) avaient une hypotension persistante et étaient de véritables candidats au REBOA. Les 15 candidats REBOA basés sur des critères anatomiques répondaient également aux critères cliniques de REBOA. CONCLUSIONS: Dans cette analyse rétrospective basée sur un registre, 1,5 % des patients adultes ayant subi un traumatisme majeur en Nouvelle-Écosse étaient des candidats au REBOA sur la base d'une présentation clinique de réanimation, tandis que 0,5 % étaient des candidats sur la base de modèles de blessures anatomiques post-hoc. Nos conclusions suggèrent que l'utilisation des résultats cliniques et des modalités d'imagerie au chevet du patient comme critères peut surestimer le nombre de candidats à la REBOA.

ObjectivesWhile the use of formal trauma teams is widely promoted, the literature is not clear that this structure provides improved outcomes over emergency physician delivered trauma care. The goal of this investigation was to examine if a trauma team model with a formalized, specialty-based trauma team, with specific activation criteria and staff composition, performs differently than an emergency physician delivered model. Our primary outcome was survival to discharge or 30 days.MethodsAn observational registry-based study using aggregate data from both the New Brunswick and Nova Scotia trauma registries was performed with data from April 1, 2011 to March 31, 2013. Inclusion criteria included patients 16 years-old and older who had an Injury Severity Score greater than 12, who suffered a kinetic injury and arrived with signs of life to a level-1 trauma centre.Results266 patients from the trauma team model and 111 from the emergency physician model were compared. No difference was found in the primary outcome of proportion of survival to discharge or 30 days between the two systems (0.88, n=266 vs. 0.89, n=111; p=0.8608).ConclusionsWe were unable to detect any difference in survival between a trauma team and an emergency physician delivered model.

Objectives Trauma systems have been widely implemented across Canada, but access to trauma care remains a challenge for much of the population. This study aims to develop and validate a model to quantify the accessibility of definitive care within one provincial trauma system and identify populations with poor access to trauma care. Methods A geographic information system (GIS) was used to generate models of pre-scene and post-scene intervals, respectively. Models were validated using a population-based trauma registry containing data on prehospital time intervals and injury locations for Nova Scotia (NS). Validated models were then applied to describe the population-level accessibility of trauma care for the NS population as well as a cohort of patients injured in motor vehicle collisions (MVCs). Results Predicted post-scene intervals were found to be highly correlated with documented post-scene intervals (β 1.05, p Conclusion GIS models can be used to identify populations with poor access to care and inform service planning in Canada. Although only 43% of the provincial population has access to Level I care within 60 minutes, the majority of the population of NS has access to Level III trauma care.

ObjectivesVarious medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians.MethodsA clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail. The survey was distributed to Canadian emergency medicine (EM) and intensive care unit (ICU) physicians using web-based and postal methods. Physicians were asked questions based on three scenarios (trauma; pneumonia; heart failure) and responded using a 5-point scale ranging from “always” to “never” to capture usual practice.ResultsThe survey response rate was 50.2% (882/1,758). Most physicians indicated a Macintosh blade with direct laryngoscopy would “always/often” be their first choice of intubation device in the three scenarios (mean 85% [79%-89%]) followed by video laryngoscopy (mean 37% [30%-49%]). The most common backup device chosen was an extraglottic device (mean 59% [56%-60%]). The medications most physicians would “always/often” administer were fentanyl (mean 45% [42%-51%]) and etomidate (mean 38% [25%-50%]). EM physicians were more likely than ICU physicians to paralyze patients for EETI (adjusted odds ratio 3.40; 95% CI 2.90-4.00).ConclusionsMost EM and ICU physicians utilize direct laryngoscopy with a Macintosh blade as a primary device for EETI and an extraglottic device as a backup strategy. This survey highlights variation in Canadian practice patterns for some aspects of intubation in critically ill patients.

ObjectivesThe objective of this study was to systematically review the published literature for risk factors associated with adverse outcomes in older adults sustaining blunt chest trauma.MethodsEMBASE and MEDLINE were searched from inception until March 2017 for prognostic factors associated with adverse outcomes in older adults sustaining blunt chest trauma using a pre-specified search strategy. References were independently screened for inclusion by two reviewers. Study quality was assessed using the Quality in Prognostic Studies tool. Where appropriate, descriptive statistics were used to evaluate study characteristics and predictors of adverse outcomes.ResultsThirteen cohort studies representing 79,313 patients satisfied our selection criteria. Overall, 26 prognostic factors were examined across studies and were reported for morbidity (8 studies), length of stay (7 studies), mortality (6 studies), and loss of independence (1 study). No studies examined patient quality of life or emergency department recidivism. Prognostic factors associated with morbidity and mortality included age, number of rib fractures, and injury severity score. Although age and rib fractures were found to be associated with adverse outcomes in more than 3 studies, meta-analysis was not performed due to heterogeneity amongst included studies in how these variables were measured.ConclusionsWhile blunt chest wall trauma in older adults is relatively common, the literature on prognostic factors for adverse outcomes in this patient population remains inadequate due to a paucity of high quality studies and lack of consistent reporting standards.

Introduction: Long-term immobility has detrimental effects for critically ill patients admitted to the intensive care unit (ICU) including ICU-acquired weakness. Early mobilization of patients admitted to ICU has been demonstrated to be a safe, feasible and effective strategy to improve patient outcomes. The optimal mobilization of trauma ICU patients has not been extensively studied. Our objective was to determine the impact of an early mobilization protocol on outcomes among trauma patients admitted to the ICU. Methods: We analyzed all adult trauma patients ( > 18 years old) admitted to ICU over a 2-year period prior to and following implementation of an early mobilization protocol, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared patient characteristics and outcomes (mortality, length of stay [LOS], ventilator days) between the pre- and post-implementation groups. Associations between early mobilization and clinical outcomes were estimated using binary and linear regression models. Results: Overall, there were 526 patients included in the analysis (292 pre-implementation, 234 post-implementation). The study population ranged in age from 18 to 92 years (mean age 49.0 ± 20.4 years) and 74.3% of all patients were male. The pre- and post-implementation groups were similar in age, sex, and injury severity. In-hospital mortality was reduced in the post-implementation group (25.3% vs. 17.5%; p = 0.031). In addition, there was a reduction in ICU mortality in the post-implementation group (21.6% vs. 12.8%; p = 0.009). We did not observe any difference in overall hospital LOS, ICU LOS, or ventilator days between the two groups. Compared to the pre-implementation period, trauma patients admitted to the ICU following protocol implementation were less likely to die in-hospital (OR = 0.52, 95% CI 0.30-0.91; p = 0.021) or in the ICU (OR = 0.40, 95% CI 0.21- 0.76, p = 0.005). Results were similar following a sensitivity analysis limited to patients with blunt or penetrating injuries. There was no difference between the pre- and post-implementation groups with respect to in-hospital LOS, ICU LOS, or the number of ventilator days. Conclusion: We found that trauma patients admitted to ICU during the post-implementation period had decreased odds of in-hospital mortality and ICU mortality. Ours is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.

Introduction: Hypotension is known to be associated with increased mortality in severe traumatic brain injury (TBI) patients. Systolic blood pressure (SBP) of Methods: Retrospective cohort study of patients with severe TBI (Abbreviated Injury Scale Head score ≥3) admitted to ICU at the QEII Health Sciences Centre (Halifax, Canada) between 2002 and 2013. Patients were grouped by SBP on ED arrival ( Results: A total of 1233 patients sustained a severe TBI and were admitted to the ICU during the study period. The mean age was 43.4 ± 23.9 years and most patients were male (919/1233; 74.5%). The most common mechanism of injury was motor vehicle collision (491/1233; 41.2%) followed by falls (427/1233; 35.8%). Mean length of stay in the ICU was 6.1 ± 6.4 days, and the overall mortality rate was 22.7%. SBP on arrival was available for 1182 patients. The Conclusion: While we found that TBI patients with a SBP

Introduction: Previous systematic reviews suggest early mobilization in the intensive care unit (ICU) population is feasible, safe, and may improve outcomes. Only one review investigated mobilization specifically in trauma ICU patients and failed to identify any relevant articles. The objective of the present systematic review was to conduct an up-to-date search of the literature to assess the effect of early mobilization in adult trauma ICU patients on mortality, length of stay (LOS) and duration of mechanical ventilation. Methods: We performed a systematic search of four electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. To be included, studies must have compared early mobilization to delayed or no mobilization among trauma patients admitted to the ICU. Meta-analysis was performed to determine the effect of early mobilization on mortality, hospital LOS, ICU LOS, and duration of mechanical ventilation. Results: The search yielded 2,975 records from the 4 databases and 7 records from grey literature and bibliographic searches; of these, 9 articles met all eligibility criteria and were included in the analysis. There were 7 studies performed in the United States, 1 study from China and 1 study from Norway. Study populations included neurotrauma (3 studies), blunt abdominal trauma (2 studies), mixed injury types (2 studies) and burns (1 study). Cohorts ranged in size from 15 to 1,132 patients (median, 63) and varied in inclusion criteria. Most studies used some form of stepwise progressive mobility protocol. Two studies used simple ambulation as the mobilization measure, and 1 study employed upright sitting as their only intervention. Time to commencement of the intervention was variable across studies, and only 2 studies specified the timing of mobilization initiation. We did not detect a difference in mortality with early mobilization, although the pooled risk ratio (RR) was reduced (RR 0.90, 95% CI 0.74 to 1.09). Hospital LOS and ICU LOS were decreased with early mobilization, though this difference did not reach significance. Duration of mechanical ventilation was significantly shorter in the early mobilization group (mean difference −1.18. 95% CI −2.17 to −0.19). Conclusion: Our review identified few studies that examined mobilization of critically ill trauma patients in the ICU. On meta-analysis, early mobilization was found to reduce duration of mechanical ventilation, but the effects on mortality and LOS were not significant.

ObjectivesA small proportion of pediatric sport- and recreation-related injuries are serious enough to be considered “major trauma.” However, the immediate and long-term consequences in cases of pediatric major trauma are significant and potentially life-threatening. The objective of this study was to describe the incidence and outcomes of pediatric major traumas related to sport and recreational activities in Nova Scotia.MethodsThis study was a retrospective case series. Data on major pediatric traumas related to sport and recreational activities on a provincial scope were extracted from the Nova Scotia Trauma Program Registry between 2000 and 2013. We evaluated frequency, type, severity, and outcomes of major traumas. Outcomes assessed included length of hospital stay, admission to a special care unit (SCU), and mortality.ResultsOverall, 107 children aged three to 18 years sustained a major trauma (mean age 12.5 [SD 3.8]; 84% male). Most injuries were blunt traumas (97%). The greatest proportion were from cycling (59, 53%), followed by hockey (8, 7%), skateboarding (7, 7%) and skiing (7, 7%). The Nova Scotia Pediatric Trauma Team was activated in 27% of cases. Mean in-hospital length of stay was five days (SD 5.6), and nearly half (49%) of patients required SCU admission. Severe traumatic brain injury occurred in 52% of cases, and mortality in five cases.ConclusionsOver a 13-year period, the highest incidence of pediatric major trauma related to sport and recreational activities was from cycling, followed by hockey. Severe traumatic brain injury occurred in over half of pediatric major trauma patients.

Introduction: Recurrent admission to a hospital or trauma centre for separate incidents of traumatic injury is known as trauma recidivism. Although use of alcohol is a known risk factor for injury and associated with trauma recidivism, the scale of alcohol-related trauma recidivism has not been well described. The purpose of this review was to search the published literature for studies that evaluated the prevalence of alcohol use among trauma recidivists. Our primary objective was to determine the proportion of trauma recidivism related to alcohol use. The association between alcohol and trauma recidivism was evaluated as a secondary objective. Methods: Four electronic databases (MEDLINE, Embase, CINAHL, Web of Science) were searched from inception until December 2015 for all articles that might provide evidence on the proportion of trauma recidivism related to use of alcohol. After removal of duplicates, the search strategy yielded 2470 records for screening. Only primary studies that reported on repeated admissions to a hospital or trauma center for traumatic injuries specifically related to alcohol use were included. Descriptive statistics were used to assess study characteristics and the prevalence of trauma recidivism related to alcohol use. An aggregate weighted estimate of alcohol-related trauma recidivism was calculated. Results: A total of 12 studies met all inclusion criteria. Studies were published between 1989 and 2014. Overall, there were 3386 trauma recidivists among included studies. The proportion of trauma recidivists with evidence of alcohol use on admission ranged from 26.7% to 76.9% (median 46.4%). The aggregated sample produced a weighted estimate of 41.0% (1388/3386) for alcohol-related trauma recidivism. In four studies, the association between alcohol and trauma recidivism was examined; all four found a positive association between alcohol use and repeated admission for traumatic injury. Studies varied considerably in design, trauma populations, periods for evaluating recidivism, definitions for positive alcohol on admission, and methods used to determine alcohol use. Conclusion: Evidence from current literature suggests that 41.0% of trauma recidivism is related to use of alcohol. Due to methodological limitations among the studies included for review, this may underestimate the actual prevalence of alcohol-related trauma recidivism.