Effectiveness of a Messenger RNA Vaccine Booster Dose Against Coronavirus Disease 2019 Among US Healthcare Personnel, October 2021-July 2022

BACKGROUND: Protection against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019 [COVID-19]) can limit transmission and the risk of post-COVID conditions, and is particularly important among healthcare personnel. However, lower vaccine effectiveness (VE) has been reported since predominance of the Omicron SARS-CoV-2 variant. METHODS: We evaluated the VE of a monovalent messenger RNA (mRNA) booster dose against COVID-19 from October 2021 to June 2022 among US healthcare personnel. After matching case-participants with COVID-19 to control-participants by 2-week period and site, we used conditional logistic regression to estimate the VE of a booster dose compared with completing only 2 mRNA doses \u3e150 days previously, adjusted for multiple covariates. RESULTS: Among 3279 case-participants and 3998 control-participants who had completed 2 mRNA doses, we estimated that the VE of a booster dose against COVID-19 declined from 86% (95% confidence interval, 81%-90%) during Delta predominance to 65% (58%-70%) during Omicron predominance. During Omicron predominance, VE declined from 73% (95% confidence interval, 67%-79%) 14-60 days after the booster dose, to 32% (4%-52%) ≥120 days after a booster dose. We found that VE was similar by age group, presence of underlying health conditions, and pregnancy status on the test date, as well as among immunocompromised participants. CONCLUSIONS: A booster dose conferred substantial protection against COVID-19 among healthcare personnel. However, VE was lower during Omicron predominance, and waning effectiveness was observed 4 months after booster dose receipt during this period. Our findings support recommendations to stay up to date on recommended doses of COVID-19 vaccines for all those eligible

Analysis of naturalistic driving videos of fleet services drivers to estimate driver error and potentially distracting behaviors as risk factors for rear-end versus angle crashes

<p><b>Objective</b>: The objective of this study was to estimate the prevalence and odds of fleet driver errors and potentially distracting behaviors just prior to rear-end versus angle crashes.</p> <p><b>Methods</b>: Analysis of naturalistic driving videos among fleet services drivers for errors and potentially distracting behaviors occurring in the 6 s before crash impact. Categorical variables were examined using the Pearson's chi-square test, and continuous variables, such as eyes-off-road time, were compared using the Student's <i>t</i>-test. Multivariable logistic regression was used to estimate the odds of a driver error or potentially distracting behavior being present in the seconds before rear-end versus angle crashes.</p> <p><b>Results</b>: Of the 229 crashes analyzed, 101 (44%) were rear-end and 128 (56%) were angle crashes. Driver age, gender, and presence of passengers did not differ significantly by crash type. Over 95% of rear-end crashes involved inadequate surveillance compared to only 52% of angle crashes (<i>P</i> < .0001). Almost 65% of rear-end crashes involved a potentially distracting driver behavior, whereas less than 40% of angle crashes involved these behaviors (<i>P</i> < .01). On average, drivers spent 4.4 s with their eyes off the road while operating or manipulating their cell phone. Drivers in rear-end crashes were at 3.06 (95% confidence interval [CI], 1.73–5.44) times adjusted higher odds of being potentially distracted than those in angle crashes.</p> <p><b>Conclusions</b>: Fleet driver driving errors and potentially distracting behaviors are frequent. This analysis provides data to inform safe driving interventions for fleet services drivers. Further research is needed in effective interventions to reduce the likelihood of drivers' distracting behaviors and errors that may potentially reducing crashes.</p

Risk Factors for Maternal Injuries in a Population-Based Sample of Pregnant Women

Background: The prevalence of injuries during pregnancy is largely underestimated, as previous research has focused on more severe injuries resulting in emergency department visits and hospitalizations. The objective of our study was to estimate the frequency, risk factors, and causes of injuries in a population-based sample of pregnant women. Methods: This article is an analysis of postpartum interviews among the control series from a case-control study (n=1,488). Maternal, pregnancy, and environmental characteristics associated with injury during pregnancy in control subjects were examined to identify population-based risk factors for injury. We collected data on self-reported injury during pregnancy, including the month of pregnancy, whether medical attention was sought, the mechanism of injury, and the number and location of bodily injuries. Logistic regression was used to calculate unadjusted and adjusted odds ratios (aORs) of injury. Results: Over 5% of women reported an injury during pregnancy, with falls being the most common mechanism of injury. Women at highest adjusted risk for injury had unintended pregnancies (aOR: 2.28 [1.40–3.70]) and no partner during pregnancy (aOR: 2.45 [1.16–5.17]) relative to women without injuries. Conclusions: Pregnant women with risk factors for many pregnancy-related complications are also at increased risk of injury during pregnancy. Further studies of pregnancy-related injuries are needed to consider environmental and maternal characteristics on risk of injury

Risk Factors for Maternal Injuries in a Population-Based Sample of Pregnant Women

Background: The prevalence of injuries during pregnancy is largely underestimated, as previous research has focused on more severe injuries resulting in emergency department visits and hospitalizations. The objective of our study was to estimate the frequency, risk factors, and causes of injuries in a population-based sample of pregnant women. Methods: This article is an analysis of postpartum interviews among the control series from a case-control study (n=1,488). Maternal, pregnancy, and environmental characteristics associated with injury during pregnancy in control subjects were examined to identify population-based risk factors for injury. We collected data on self-reported injury during pregnancy, including the month of pregnancy, whether medical attention was sought, the mechanism of injury, and the number and location of bodily injuries. Logistic regression was used to calculate unadjusted and adjusted odds ratios (aORs) of injury. Results: Over 5% of women reported an injury during pregnancy, with falls being the most common mechanism of injury. Women at highest adjusted risk for injury had unintended pregnancies (aOR: 2.28 [1.40–3.70]) and no partner during pregnancy (aOR: 2.45 [1.16–5.17]) relative to women without injuries. Conclusions: Pregnant women with risk factors for many pregnancy-related complications are also at increased risk of injury during pregnancy. Further studies of pregnancy-related injuries are needed to consider environmental and maternal characteristics on risk of injury

Prevalence of alcohol impairment and odds of a driver injury or fatality in on-road farm equipment crashes

<p><b>Objective</b>: The objective of this article was to estimate the prevalence of alcohol impairment in crashes involving farm equipment on public roadways and the effect of alcohol impairment on the odds of crash injury or fatality.</p> <p><b>Methods</b>: On-road farm equipment crashes were collected from 4 Great Plains state departments of transportation during 2005–2010. Alcohol impairment was defined as an involved driver having blood alcohol content of ≥0.08 g/100 ml or a finding of alcohol impairment as a driver contributing circumstance recorded on the police crash report. Injury or fatality was categorized as (a) no injury (no and possible injury combined), (b) injury (nonincapacitating or incapacitating injury), and (c) fatality. Hierarchical multivariable logistic regression modeling, clustered on crash, was used to estimate the odds of an injury/fatality in crashes involving an alcohol-impaired driver.</p> <p><b>Results</b>: During the 5 years under study, 3.1% (61 of 1971) of on-road farm equipment crashes involved an alcohol-impaired driver. One in 20 (5.6%) injury crashes and 1 in 6 (17.8%) fatality crashes involved an alcohol-impaired driver. The non-farm equipment driver was significantly more likely to be alcohol impaired than the farm equipment driver (2.4% versus 1.1% respectively, <i>P</i> = .0012). After controlling for covariates, crashes involving an alcohol-impaired driver had 4.10 (95% confidence interval [CI], 2.30–7.28) times the odds of an injury or fatality. In addition, the non-farm vehicle driver was at 2.28 (95% CI, 1.92–2.71) times higher odds of an injury or fatality than the farm vehicle driver. No differences in rurality of the crash site were found in the multivariable model.</p> <p><b>Conclusion</b>: On-road farm equipment crashes involving alcohol result in greater odds of an injury or fatality. The risk of injury or fatality is higher among the non-farm equipment vehicle drivers who are also more likely to be alcohol impaired. Further studies are needed to measure the impact of alcohol impairment in on-road farm equipment crashes.</p

Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis

Introduction: Mental health and substance use disorder (MHSUD) patients in the emergency department (ED) have been facing increasing lengths of stay due to a shortage of inpatient beds. Previous research indicates mobile crisis outreach (MCO) reduces long ED stays for MHSUD patients. Our objective was to assess the impact of MCO contact on future ED utilization. Methods: We conducted a retrospective chart review of patients presenting to a large Midwest university ED with an MHSUD chief complaint from 2015–2018. We defined the exposure as those who had MCO contact and any MHSUD-related ED visit within 30 days of MCO contact. The MCO patients were 2:1 propensity score–matched by demographic data and comorbidities matched to patients with no MCO contact. Outcomes were all-cause and psychiatric-specific reasons for return to the ED within one year of the index ED visit. We report descriptive statistics and odds ratios (OR) to describe the difference between the two groups, and hazard ratios (HR) to estimate the risk of return ED visit.&nbsp; Results: The final sample included 106 MCO and 196 non-MCO patients. The MCO patients were more likely to be homeless (OR 14.8; 95% confidence interval [CI],1.87, 117), less likely to have adequate family or social support (OR 0.51; 95% CI, 0.31, 0.84), and less likely to have a hospital bed requested for them in the index visit by ED providers (OR 0.50; 95% CI, 0.29, 0.88). For those who returned to the ED, the median time for all-cause return to the ED was 28 days (interquartile range [IQR]: 6–93 days) for the MCO patients and 88 days (IQR: 20–164 days) for non-MCO patients. The risk of all-cause return to the ED was greater among MCO patients (67%) compared to non-MCO patients (49%) (adjusted HR: 1.66; 95% CI, 1.22, 2.27).&nbsp; Conclusion: The MCO patients had less family and social support; however, they were less likely to require hospitalization for each visit, likely due to MCO involvement. Patients with MCO contact presented to the ED more frequently than non-MCO patients, which implies a strong linkage between the ED and MCO in our community. An effective referral to community service from the ED and MCO and collaboration could be the next step to improve healthcare utilization

Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality

Introduction: National studies of largely urban populations showed increased risk of traumatic death among uninsured patients, as compared to those insured. No similar studies have been done for major trauma centers serving rural states. Methods: We performed retrospective analyses using trauma registry records from adult, non-burn patients admitted to a single American College of Surgeons-certified Level 1 trauma center in a rural state (2003-2010, n=13,680) and National Trauma Data Bank (NTDB) registry records (2002-2008, n=380,182). Risk of traumatic death was estimated using multivariable logistic regression analysis. Results: We found that 9% of trauma center patients and 27% of NTDB patients were uninsured. Overall mortality was similar for both (~4.5%). After controlling for covariates, uninsured trauma center patients were almost five times more likely to die and uninsured NTDB patients were 75% more likely to die than commercially insured patients. The risk of death among Medicaid patients was not significantly different from the commercially insured for either dataset. Conclusion: Our results suggest that even with an inclusive statewide trauma system and an emergency department that does not triage by payer status, uninsured patients presenting to the trauma center were at increased risk of traumatic death relative to patients with commercial insurance

Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality

Introduction: National studies of largely urban populations showed increased risk of traumatic death among uninsured patients, as compared to those insured. No similar studies have been done for major trauma centers serving rural states. Methods: We performed retrospective analyses using trauma registry records from adult, non-burn patients admitted to a single American College of Surgeons-certified Level 1 trauma center in a rural state (2003-2010, n=13,680) and National Trauma Data Bank (NTDB) registry records (2002-2008, n=380,182). Risk of traumatic death was estimated using multivariable logistic regression analysis. Results: We found that 9% of trauma center patients and 27% of NTDB patients were uninsured. Overall mortality was similar for both (~4.5%). After controlling for covariates, uninsured trauma center patients were almost five times more likely to die and uninsured NTDB patients were 75% more likely to die than commercially insured patients. The risk of death among Medicaid patients was not significantly different from the commercially insured for either dataset. Conclusion: Our results suggest that even with an inclusive statewide trauma system and an emergency department that does not triage by payer status, uninsured patients presenting to the trauma center were at increased risk of traumatic death relative to patients with commercial insurance

Outcomes Associated with Lower Doses of Ketamine by Emergency Medical Services for Profound Agitation

Introduction: Ketamine is commonly used to treat profound agitation in the prehospital setting. Early in ketamine’s prehospital use, intubation after arrival in the emergency department (ED) was frequent. We sought to measure the frequency of ED intubation at a Midwest academic medical center after prehospital ketamine use for profound agitation, hypothesizing that intubation has become less frequent as prehospital ketamine has become more common and prehospital dosing has improved. Methods: We conducted a retrospective cohort study of adult patients receiving ketamine in the prehospital setting for profound agitation and transported to a midwestern, 60,000-visit, Level 1 trauma center between January 1, 2017–- March 1, 2021. We report descriptive analyses of patient-level prehospital clinical data and ED outcomes. The primary outcome was proportion of patients intubated in the ED.&nbsp; Results: A total of 78 patients received ketamine in the prehospital setting (69% male, mean age 36 years). Of the 42 (54%) admitted patients, 15 (36% of admissions) were admissions to the intensive care unit. Overall, 12% (95% confidence interval [CI]), 4.5-18.6%)] of patients were intubated, and indications included agitation (n = 4), airway protection not otherwise specified (n = 4), and respiratory failure (n = 1).&nbsp; Conclusion: Endotracheal intubation in the ED after prehospital ketamine use for profound agitation in our study sample was found to be less than previously reported