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Objective: While proper restraint use is protective against motor traffic vehicle crash (MVTC)-associated morbidity and mortality, it is inconsistently measured across health and MVTC data sources. This project addresses this gap by assessing differences in child restraint measures between two North Carolina (NC) datasets and comparing the utility of these sources to evaluate patterns of child restraint use and associated health outcomes., Methods: We analyzed 2018 NC MVTC and NC Trauma Registry (NCTR) data for children ≤15 years old, both separately and as linked MVTC-NCTR records. We calculated mean and standard deviation for continuous variables and frequency and proportion for categorical variables. Among linked records, we compared reported restraint use and performed age-adjusted logistic regression to estimate associations between restraint use and severe injury., Results: A lower proportion of pediatric MVTC victims were reported as unrestrained in the MVTC (14.7%) versus NCTR (25.8%) data. Among linked MVTC-NCTR records, only 41.3% featured perfect concordance of restraint information between datasets. Among linked records, child restraint was reported for 31.3% of children, while the NCTR data allowed more granular coding of child restraint (30.3% overall), including child booster seat (13.5%), child car seat (8.7%), infant car seat (4.8%), and unrestrained in child car seat (3.4%). Age-adjusted regression analyses of the linked data revealed that lap/shoulder seatbelt use was significantly associated with lower likelihood of severe injury compared to being unrestrained whether informed by MVTC (OR = 0.39; 95% CI: 0.16, 0.93) or NCTR (OR = 0.38; 95% CI: 0.15, 0.96) data. While the association between reported use of a child car seat and severe injury was not statistically significant in the MVTC data (OR = 0.50; 95% CI: 0.19, 1.32), child car seat use reported in the NCTR data revealed a significant association (OR = 0.16; 95% CI: 0.03, 0.93)., Conclusions: Linked crash and trauma center data allow for identifying important patterns of restraint use among pediatric passengers in MVTCs. Dataset-dependent differences in measuring restraint use have critical public health implications and illustrate the importance of careful dataset selection prior to analysis, as the use of different data sources may impact overall study conclusions.

Context: The global COVID-19 pandemic has had a major impact on the utilization of healthcare services; however, the impact on population-level emergency department (ED) utilization patterns for the treatment of acute injuries has not been fully characterized., Objective: This study examined the frequency of North Carolina (NC) EDs visits for selected injury mechanisms during the first eleven months of the COVID-19 pandemic., Methods: Data were obtained from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC's legislatively mandated statewide syndromic surveillance system for the years 2019 and 2020. Frequencies of January - November 2020 NC ED visits were compared to frequencies of 2019 visits for selected injury mechanisms, classified according to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) injury diagnosis and mechanism codes., Results: In 2020, the total number of injury-related visits declined by 19.5% (N = 651,158) as compared to 2019 (N = 809,095). Visits related to motor vehicle traffic crashes declined by a greater percentage (29%) and falls (19%) declined by a comparable percentage to total injury-related visits. Visits related to assault (15%) and self-harm (10%) declined by smaller percentages. Medication/drug overdose visits increased (10%), the only injury mechanism studied to increase during this period., Conclusion: Both ED avoidance and decreased exposures may have contributed to these declines, creating implications for injury morbidity and mortality. Injury outcomes exacerbated by the pandemic should be addressed by timely public health responses., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Over the last several years, pedestrian fatalities have increased in North Carolina; however, fatalities represent a small proportion of the total number of nonfatally injured pedestrians. Therefore, we linked statewide motor vehicle crash (MVC) and emergency department (ED) visit data to better understand the circumstances and characteristics of pedestrians treated in North Carolina emergency departments (EDs) for injuries related to crashes., Methods: We linked information for pedestrians and bicyclists from 2017 North Carolina police-reported MVCs to population-based ED visit data using hierarchical deterministic methods., Results: We linked 45% of pedestrian crash records to ED visit records (N = 1383 incident ED visits). The rate of pedestrians treated in North Carolina EDs for their injuries was 13.6 ED visits per 100,000 person years. For pedestrian injuries treated in North Carolina EDs, rates (per 100,000 person years in parentheses) were higher among men (15.5) and Black pedestrians (22.7) than women (10.6) and White pedestrians (8.2). Sociodemographic characteristics associated with serious injuries included age, sex, race/ethnicity, and expected source of payment for the ED visit. Crash characteristics associated with serious injuries included posted speed limit, ambient light, number of lanes, and striking vehicle type., Limitations: The study involved the use of secondary data, not collected specifically for pedestrian injury surveillance., Conclusions: Pedestrian injuries and fatalities place a considerable burden on the population of North Carolina, especially among persons of color and older adults. Injury prevention programs are actively addressing this problem, but more needs to be done., (©2021 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Objective: The objective of this study was to describe pedestrian demographic characteristics, crash characteristics, selected health outcomes, and injury patterns by age using linked North Carolina (NC) crash-emergency department (ED) visit data for the period October 1, 2010, to September 30, 2015., Methods: This was a descriptive epidemiologic study. To examine both crash and health outcomes, NC pedestrian crash records were linked to statewide NC ED visit records using hierarchical deterministic methods. Pearson chi-square tests were used to compare the frequencies of pedestrians treated in NC EDs by sex, race/ethnicity, crash location, rurality, estimated driver speed at impact, ambient light, hospitalization/death, location of injury, and nature of injury, stratified by the following age groups: 0-14, 15-24, 25-64, and ≥65 years., Results: Most pedestrians treated in NC EDs were male (57.5%), except among adults ≥65 years old (47.5%). Over half of all injured pedestrians aged 0-14 (52.6%) and 15-24 (50.5%) years were Black/African American, and 70.8% of injured pedestrians ≥65 years were white. Among pedestrians aged 25-64 years, no single racial/ethnic group was the majority. Though most pedestrians were injured on trafficways (71.7%) and at speeds ≤35 mph (80.1%), adults ≥65 years were less likely to be involved in on-trafficway crashes (51.0%) and pedestrians aged 15-24 years were more likely to be involved in >35 mph crashes (22.9%) compared to other age groups. Most pedestrians were injured under daylight conditions (56.9%). Regarding selected health outcomes, the highest frequency of hospitalization/death was for pedestrians aged ≥65 years (26.3%), compared to those aged 0-14 years (18.8%) and 15-64 years (12.4%). In terms of location of injury, 0- to 14-year-olds had the highest proportion of head injuries (39.5%), and adults ≥65 years of age had the highest proportion of spinal column/vertebral column (12.6%) and upper extremity injuries (33.2%). For nature of injury, 0- to 14-year-olds had the highest proportion of traumatic brain injuries (11.4%) and superficial wounds and contusions (62.8%). Adults aged ≥65 years had the highest proportion of open wounds/amputations and fractures (16.1%). Adults aged 25-64 years had the highest proportion of strains/sprains/dislocations (18.7%)., Conclusions: There were considerable differences in demographic characteristics, crash characteristics, frequency of hospitalization/death, and injury patterns by age group. It is important to design streets and implement transportation policies and programs that improve safety for all pedestrians.

The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is a near-real-time database of emergency department (ED) visits automatically extracted from hospital information system(s) in the state of North Carolina. The National Hospital Ambulatory Medical Care Survey (NHAMCS) is a retrospective probability sample survey of visits to U.S. hospital EDs. This report compares data from NC DETECT (2006) with NHAMCS (2005) ED visit data to determine if the two data sets are consistent. Proportions, rates, and confidence intervals (CIs) were calculated for ED visits by age and gender; arrival method and age; expected source of payment; disposition; hospital admissions; NHAMCS top 20 diagnosis groups and top five primary diagnoses by age group; International Classifications of Disease, 9th revision, Clinical Modification (ICD-9-CM) primary diagnosis codes; and cause of injury. North Carolina DETECT captured 79% of statewide ED visits. Twenty-eight persons for every 100 North Carolina residents visited a North Carolina ED that reports to NC DETECT at least once in 2006, compared to 20% nationally. Twenty-seven percent of ED visits in North Carolina had private insurance as the expected payment source, compared with 40% nationwide. The proportion of injury-related ED visits in North Carolina is 25%, compared to 36.4% nationally. Rates and proportions of disease groups are similar. Similarity of NC DETECT rates and proportions to NHAMCS provides support for the face and content validity of NC DETECT. The development of statewide near-real-time ED databases is an important step toward the collection, aggregation, and analysis of timely, population-based data by state, to better define the burden of illness and injury for vulnerable populations.

Twenty-three causes of injury mortality in children ages 0-14 in the United States were analyzed by age, race, sex, and state of residence for the years 1980-85. Motor vehicles caused 37 per cent of all injury-related deaths and were the leading cause of injury mortality in every group except children younger than one year, for whom homicide was the leading cause. Male death rates were at least four times female rates for suicide, unintentional firearm injury, and injuries related to farm machinery or motorcycles. The drowning rate among Whites was almost twice that of Blacks for ages 1-4, but in the 10-14 year age group the drowning rate for Blacks was over three times that of Whites. In general, the highest injury death rates were in the mountain states and the south. Between 1980 and 1985, the suicide rate in the 10-14 year age group more than doubled.