An interrupted time series analysis of trends in opioid-related emergency department visits from pre-COVID-19 pandemic to pandemic, from the Canadian Hospitals Injury Reporting and Prevention Program

Abstract Background Opioid-related emergency department (ED) visits in Canada increased during the COVID-19 pandemic, but how trends in volume and case severity changed from pre-pandemic times through the pandemic is not known. Trends in ED visits related to specific types of opioids also remain unclear. Our objective was to describe pre-pandemic trends and how they changed with the onset of COVID-19 and thereafter. Methods Based on data from the Canadian Hospitals Injury Reporting and Prevention Program, we identified opioid-related ED visits and constructed a time series from March 12, 2018 through March 7, 2021—two pre-COVID periods and one COVID period. We used an interrupted time series (ITS) analysis to examine trends in volume and case severity. We compared medians and means of monthly counts and percentages of severe cases between the periods, by sex, age, and opioid type. Results Before the pandemic, there was an increasing trend in fentanyl-related visits for males, females and 25- to 64-year-olds, and a decreasing trend in heroin-related visits for males and 18- to 64-year-olds. Fentanyl-related visits for 18- to 24-year-olds showed an immediate increase at the start of the pandemic and a decreasing trend during the pandemic. Heroin-related visits for 12- to 17-year-olds had an immediate increase at the start of the pandemic; for 18- to 24-year-olds and 45- to 64-year-olds, the prior decreasing pre-pandemic trend ceased. For pooled opioid-related visits, no significant trend in the percentage of severe cases was observed throughout the entire study period. Conclusion This study shows that an ITS approach in trend analysis is a valuable supplement to comparisons of before and after measures (with or without controlling seasonal effects). The findings provide evidence on how ED presentations for opioid use evolved in Canada from 2018 to 2021. The results can inform policies designed to reduce opioid-related harm in the context of a public health emergency

Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: A nationwide, population-based study.

This is an accepted manuscript of an article published by Lippincott Williams & Wilkins.BACKGROUND: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide.We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2011 using a nationwide, population based database that is mandatory for all hospitals in Canada. METHODS: Trends in hospitalization rates for all acute hospital separations in Canada were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression. RESULTS: Hospitalization rates remained stable for children and young adults but increased considerably among elderly adults (age Q65 years). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p = 0.01), while MVC-related hospitalization rates decreased by 18% (p = 0.03). Elderly adults were most vulnerable to falls and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages, 15Y24 years) were most at risk for MVCs but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends toward increasing age, injury severity, comorbidity, hospital length of stay, and rate of in-hospital mortality.However, multivariate regression showed that odds of death decreased over time after controlling for relevant factors. Injury severity, comorbidity, and advanced age were the most important predictors of in-hospital mortality for TBI inpatients. CONCLUSION: Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities. Although preventive strategies for MVC-related TBI are likely having some effects, there is a critical need for effective fall prevention strategies, especially among elderly adults.This research was supported by the Canadian Institutes of Health Research Strategic Team Grant in Applied Injury Research #TIR-103946, the Ontario Neurotrauma Foundation

Predictors of falls and mortality among elderly adults with traumatic brain injury: A nationwide, population-based study.

Elderly adults are at particular risk of sustaining a traumatic brain injury (TBI), and tend to suffer worse outcomes compared to other age groups. Falls are the leading cause of TBI among the elderly.We examined nationwide trends in TBI hospitalizations among elderly adults (ages 65 and older) between April 2006 and March 2011 using a population-based database that is mandatory for all hospitals in Canada. Trends in admission rates were analyzed using linear regression. Predictors of falls and in-hospital mortality were identified using logistic regression.Between 2006 and 2011, there were 43,823 TBI hospitalizations resulting in 6,939 deaths among elderly adults in Canada. Over the five-year study period, the overall rate of TBI admissions increased by an average of 6% per year from 173.2 to 214.7 per 100,000, while the rate of fall-related TBI increased by 7% annually from 138.6 to 179.2 per 100,000. There were significant trends towards increasing age and comorbidity level (p<0.001 and p = 0.002). Advanced age, comorbidity, and injury severity were independent predictors of both TBI-related falls and mortality on multivariate analysis.Prevention efforts should be targeted towards vulnerable demographics including the "older old" (ages 85 and older) and those with multiple medical comorbidities. Additionally, hospitals and long-term care facilities should be prepared to manage the burgeoning population of older patients with more complex comorbidities

Status report - The Canadian Hospitals Injury Reporting and Prevention Program: a dynamic and innovative injury surveillance system

This status report on the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), an emergency department-based injury and poisoning surveillance system, describes the result of migrating from a centralized data entry and coding process to a decentralized process, the web-based eCHIRPP system, in 2011. This secure system is improving the CHIRPP’s overall flexibility and timeliness, which are key attributes of an effective surveillance system. The integrated eCHIRPP platform enables near real-time data entry and access, has user-friendly data management and analysis tools, and allows for easier communication and connectivity across the CHIRPP network through an online collaboration centre. Current pilot testing of automated data monitoring and trend analysis tools—designed to monitor and flag incoming data according to predefined criteria (for example, a new consumer product)—is revealing eCHIRPP’s potential for providing early warnings of new hazards, issues and trends

Rapport d’étape – Le Système canadien hospitalier d’information et de recherche en prévention des traumatismes : un système de surveillance des blessures dynamique et novateur

Ce rapport d’étape sur le Système canadien hospitalier d’information et de recherche en prévention des traumatismes (SCHIRPT), un système de surveillance des blessures et des empoisonnements utilisé par les services d’urgence, décrit le résultat de la migration d’un processus d’entrée et de codage des données centralisé vers le processus décentralisé de l’eSCHIRPT, réalisée en 2011. Ce système sécurisé accroît la souplesse et la rapidité globales du SCHIRPT, attributs clés d’un système de surveillance efficace. La plate-forme intégrée de l’eSCHIRPT permet une entrée de données et un accès aux données en temps quasi réel, comprend des outils conviviaux de gestion et d’analyse des données et facilite la communication et la connectivité au sein du réseau du SCHIRPT grâce à un centre de collaboration en ligne. L’essai pilote mené actuellement sur les outils automatisés de contrôle de données et d’analyse des tendances – destinés à surveiller et à mettre en évidence les données d’entrée à partir de critères prédéfinis (par exemple un nouveau produit de consommation) – révèle le potentiel de détection rapide des nouveaux dangers, enjeux et tendances que possède l’eSCHIRPT

Le suicide et les hospitalisations associées à des blessures auto-infligées au Canada (1979 à 2014-2015)

Introduction : Cette étude a pour objet de décrire, à l’aide de données administratives canadiennes, les tendances et les caractéristiques des blessures auto-infligées entre 1979 et 2014-2015, afin d’orienter et d’améliorer les mesures de prévention du suicide. Méthodologie : Les données sur la mortalité par suicide et sur les congés des patients ont été extraites des fonds de données de l’Agence de la santé publique du Canada (ASPC) provenant de la Base canadienne de données sur l’état civil – Décès (BCDEC-D) de Statistique Canada (1979 à 2012), du Système canadien d’information socioéconomique (CANSIM 2011, 2012), de la Base de données sur la morbidité hospitalière (BDMH, 1994- 1995 à 2010-2011) et de la Base de données sur les congés des patients (BDCP, 2011-2012 à 2014-2015). Le nombre de cas et les taux de décès et d’hospitalisation ont été répartis par sexe, tranche d’âge de 5 ans et méthode. Résultats : Le taux de suicide au Canada (hommes et femmes confondus, tous âges, et taux normalisé selon l’âge et le sexe) a diminué, passant de 14,4/100 000 (n = 3 355) en 1979 à 10,4/100 000 (n = 3 926) en 2012, soit une variation annuelle en pourcentage (VAP) de –1,2 % (IC à 95 % : –1,3 à –1,0). Cependant, cette tendance n’a pas été observée chez les deux sexes : chez les femmes, les taux de suicide se sont stabilisés vers les années 1990, tandis que chez les hommes, ils ont continué de décliner au fil du temps – malgré le fait que les suicides chez les hommes constituent toujours 75,7 % de tous les suicides en 2012. La suffocation (pendaison et strangulation) était en 2012 la principale méthode de suicide (46,9 %) chez les Canadiens de tous âges, suivie de l’intoxication (23,3 %). Au cours de l’exercice 2014-2015, il y a eu 13 438 hospitalisations au Canada (à l’exclusion du Québec) associées à des blessures auto-infligées – ce qui représente plus de trois fois le nombre de suicides. Au fil du temps, les femmes ont systématiquement présenté des taux d’hospitalisation plus élevés pour des blessures auto-infligées que les hommes, soit 63 % du total. L’intoxication a été la méthode la plus fréquemment déclarée de préjudice autoinfligé au cours de l’exercice 2014-2015, constituant 86 % de toutes les hospitalisations. Conclusion : Les suicides et les blessures auto-infligées demeurent un problème de santé publique grave – mais évitable – qui exige une surveillance constante

Suicide and self-inflicted injury hospitalizations in Canada (1979 to 2014/15)

Introduction: The purpose of this paper is to describe the trends and patterns of self-inflicted injuries, available from Canadian administrative data between 1979 and 2014/15, in order to inform and improve suicide prevention efforts. Methods: Suicide mortality and hospital separation data were retrieved from the Public Health Agency of Canada (PHAC) holdings of Statistics Canada's Canadian Vital Statistics: Death Database (CVS:D) (1979 to 2012); Canadian Socio-Economic Information Management System (CANSIM 2011, 2012); the Hospital Morbidity Database (HMDB) (1994/95 to 2010/11); and the Discharge Abstract Database (2011/12 to 2014/15). Mortality and hospitalization counts and rates were reported by sex, 5-year age groups and method. Results: The Canadian suicide rate (males and fe­males combined, all ages, age-sex standardized rate) has decreased from 14.4/100 000 (n = 3355) in 1979 to 10.4/100 000 (n = 3926) in 2012, with an annual percent change (APC) of ­ 1.2% (95% CI: ­1.3 to ­1.0). However, this trend was not observed in both sexes: female suicide rates stabilized around 1990, while male rates continued declining over time—yet males still accounted for 75.7% of all suicides in 2012. Suffocation (hanging and strangulation) was the primary method of suicide (46.9%) among Canadians of all ages in 2012, followed by poisoning at 23.3%. In the 2014/15 fiscal year, there were 13 438 hospitalizations in Canada (excluding Quebec) associated with self-in­flicted injuries—over 3 times the number of suicides. Over time females have displayed con­sistently higher rates of hospitalization for self-inflicted injury than males, with 63% of the total. Poisoning was reported as the most frequent means of self-inflicted harm in the fiscal year 2014/15, at 86% of all hospitalizations. Conclusion: Suicides and self-inflicted injuries continue to be a serious—but preventable—public health problem that requires ongoing surveillance