The impact of the COVID-19 pandemic on the utilization of emergency department services for the treatment of injuries

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

Comparative analysis of pedestrian injuries using police, emergency department, and death certificate data sources in North Carolina, U.S., 2007–2012

Pedestrian safety programs are needed to address the rising incidence of pedestrian fatalities. Unfortunately, most communities lack comprehensive information on the circumstances of pedestrian crashes and resulting injuries that could help guide decision-making for prevention program development and implementation. This study aimed to evaluate how three commonly available data sources (police-reported pedestrian crashes, emergency department [ED] visits, and death certificates) define and capture pedestrian injury data, and to compare the distribution of pedestrian injuries and fatalities across these data sources. Existing state-wide data sources in North Carolina, U.S.A.,—police-reported pedestrian crashes, ED visits, and death certificates—were used to perform a descriptive analysis of temporal and demographic pedestrian injury severity distributions for a 6-year period (2007–2012). After excluding non-relevant cases, there were 12,646 police-reported pedestrian crashes, 17,369 pedestrian-injury-related ED visits, and 993 pedestrian-related death certificate cases. Pedestrian injury distributions appeared similar across the three data sets in relation to pedestrian sex, age, and temporality. Police data (which represented crashes rather than all pedestrians involved in a crash) likely underrepresented pedestrian injury incidence, while ED data (which represented ED visits, with multiple visits per person possible) likely overrepresented pedestrian injury incidence. The study provides a better understanding of the discrepancies between pedestrian injury data sources and key considerations when using police, ED, and death certificate data for surveillance or injury prevention efforts

Opioid overdose mortality among former North Carolina inmates: 2000-2015

Objectives. To examine differences in rates of opioid overdose death (OOD) between former North Carolina (NC) inmates and NC residents and evaluate factors associated with postrelease OOD. Methods. We linked NC inmate release data to NC death records, calculated OOD standardized mortality ratios to compare former inmates with NC residents, and calculated hazard ratios to identify predictors of time to OOD. Results. Of the 229 274 former inmates released during 2000 to 2015, 1329 died from OOD after release. At 2-weeks, 1-year, and complete follow-up after release, the respective OOD risk among former inmates was 40 (95% confidence interval [CI] = 30, 51), 11 (95% CI = 9.5, 12), and 8.3 (95% CI = 7.8, 8.7) times as high as general NC residents; the corresponding heroin overdose death risk among former inmates was 74 (95% CI = 43, 106), 18 (95% CI = 15, 21), and 14 (95% CI = 13, 16) times as high as general NC residents, respectively. Former inmates at greatest OOD risk were those within the first 2 weeks after release, aged 26 to 50 years, male, White, with more than 2 previous prison terms, and who received in-prison mental health and substance abuse treatment. Conclusions. Former inmates are highly vulnerable to opioids and need urgent prevention measures

Opioid Overdose Deaths among Formerly Incarcerated Persons and the General Population: North Carolina, 2000–2018

Objectives. To compare opioid overdose death (OOD) rates among formerly incarcerated persons (FIPs) from 2016 to 2018 with the North Carolina population and with OOD rates from 2000 to 2015. Methods. We performed a retrospective cohort study of 259 861 North Carolina FIPs from 2000 to 2018 linked with North Carolina death records. We used indirectly standardized OOD mortality rates and ratios and present 95% confidence intervals (CIs). Results. From 2017 to 2018, the OOD rates in the North Carolina general population decreased by 10.1% but increased by 32% among FIPs. During 2016 to 2018, the highest substance-specific OOD rate among FIPs was attributable to synthetic narcotics (mainly fentanyl and its analogs), while OOD rates for other opioids were half or less than that from synthetic narcotics. During 2016 to 2018, the OOD risk for FIPs from synthetic narcotics was 50.3 (95% CI 5 30.9, 69.6), 20.2 (95% CI 5 17.3, 23.2), and 18.2 (95% CI 5 15.9, 20.5) times as high as that for the North Carolina population at 2-week, 1-year, and complete follow-up after release, respectively. Conclusions. While nationwide OOD rates declined from 2017 to 2018, OOD rates among North Carolina FIPs increased by about a third, largely from fentanyl and its analogs