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Article ; Online: Exploring Racialized Economic Segregation and Reinjury and Violence Perpetration Among Survivors of Violent Injuries.

Kotagal, Meera / Nehra, Deepika / Dicker, Rochelle

JAMA network open

2023 Volume 6, Issue 4, Page(s) e239548

MeSH term(s)	Humans ; Reinjuries ; Violence ; Aggression ; Survivors
Language	English
Publishing date	2023-04-03
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.9548
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Article ; Online: How Should a Surgeon and Anesthesiologist Cooperate During Intraoperative Cardiac Arrest?

Jolissaint, Joshua S / Nehra, Deepika

AMA journal of ethics

2020 Volume 22, Issue 4, Page(s) E291–297

Abstract: Surgeons and anesthesiologists each have a unique sense of duty and responsibility to patients throughout all phases of perioperative care. Intraoperative cardiac arrest during elective, noncardiac surgery is rare, with an incidence between 0.8 to 4.3 ... ...

Abstract	Surgeons and anesthesiologists each have a unique sense of duty and responsibility to patients throughout all phases of perioperative care. Intraoperative cardiac arrest during elective, noncardiac surgery is rare, with an incidence between 0.8 to 4.3 per 10 000 cases. Fortunately, patients who suffer cardiac arrest during surgery are more likely to survive than patients who suffer cardiac arrest in other settings. This article considers factors that have been shown to influence outcomes after intraoperative cardiac arrest and offers a framework for analyzing and discussing these clinically, ethically, and emotionally complex cases.
MeSH term(s)	Anesthesia ; Anesthesiologists ; Heart Arrest ; Humans ; Incidence ; Surgeons
Language	English
Publishing date	2020-04-01
Publishing country	United States
Document type	Journal Article
ISSN	2376-6980
ISSN (online)	2376-6980
DOI	10.1001/amajethics.2020.291
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Article ; Online: Association of Community Vulnerability and State Gun Laws With Firearm Deaths in Children and Adolescents Aged 10 to 19 Years.

Kwon, Eustina G / Rice-Townsend, Samuel E / Agoubi, Lauren L / Rowhani-Rahbar, Ali / Nehra, Deepika

JAMA network open

2023 Volume 6, Issue 5, Page(s) e2314863

Abstract: Importance: Firearm-related injuries are the leading cause of death among children and adolescents in the US. For youths aged 10 to 19 years, 64% of firearm-related deaths are due to assault. Understanding the association between the rate of death due ... ...

Abstract	Importance: Firearm-related injuries are the leading cause of death among children and adolescents in the US. For youths aged 10 to 19 years, 64% of firearm-related deaths are due to assault. Understanding the association between the rate of death due to assault-related firearm injury and both community-level vulnerability and state-level gun laws may inform prevention efforts and public health policy. Objective: To assess the rate of death due to assault-related firearm injury stratified by community-level social vulnerability and state-level gun laws in a national cohort of youths aged 10 to 19 years. Design, setting, and participants: This national cross-sectional study used the Gun Violence Archive to identify all assault-related firearm deaths among youths aged 10 to 19 years occurring in the US between January 1, 2020, and June 30, 2022. Exposure: Census tract-level social vulnerability (measured by the Centers for Disease Control and Prevention social vulnerability index [SVI]; categorized in quartiles as low [<25th percentile], moderate [25th-50th percentile], high [51st-75th percentile], or very high [>75th percentile]) and state-level gun laws (measured by the Giffords Law Center gun law scorecard rating; categorized as restrictive, moderate, or permissive). Main outcomes and measures: Youth death rate (per 100 000 person-years) due to assault-related firearm injury. Results: Among 5813 youths aged 10 to 19 years who died of an assault-related firearm injury over the 2.5-year study period, the mean (SD) age was 17.1 (1.9) years, and 4979 (85.7%) were male. The death rate per 100 000 person-years in the low SVI cohort was 1.2 compared with 2.5 in the moderate SVI cohort, 5.2 in the high SVI cohort, and 13.3 in the very high SVI cohort. The mortality rate ratio of the very high SVI cohort compared with the low SVI cohort was 11.43 (95% CI, 10.17-12.88). When further stratifying deaths by the Giffords Law Center state-level gun law scorecard rating, the stepwise increase in death rate (per 100 000 person-years) with increasing SVI persisted, regardless of whether the Census tract was in a state with restrictive gun laws (0.83 in the low SVI cohort vs 10.11 in the very high SVI cohort), moderate gun laws (0.81 in the low SVI cohort vs 13.18 in the very high SVI cohort), or permissive gun laws (1.68 in the low SVI cohort vs 16.03 in the very high SVI cohort). The death rate per 100 000 person-years was higher for each SVI category in states with permissive compared with restrictive gun laws (eg, moderate SVI: 3.37 vs 1.71; high SVI: 6.33 vs 3.78). Conclusions and relevance: In this study, socially vulnerable communities in the US experienced a disproportionate number of assault-related firearm deaths among youths. Although stricter gun laws were associated with lower death rates in all communities, these gun laws did not equalize the consequences on a relative scale, and disadvantaged communities remained disproportionately impacted. While legislation is necessary, it may not be sufficient to solve the problem of assault-related firearm deaths among children and adolescents.
MeSH term(s)	United States/epidemiology ; Humans ; Adolescent ; Child ; Male ; Female ; Cross-Sectional Studies ; Firearms ; Wounds, Gunshot ; Census Tract ; Centers for Disease Control and Prevention, U.S.
Language	English
Publishing date	2023-05-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.14863
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Article ; Online: Community-Level Social Vulnerability and Patterns of Adolescent Injury.

Kwon, Eustina G / Herrera-Escobar, Juan P / Bulger, Eileen M / Rice-Townsend, Samuel E / Nehra, Deepika

Annals of surgery open : perspectives of surgical history, education, and clinical approaches

2023 Volume 4, Issue 2, Page(s) e287

Abstract: Objective: To describe adolescent injuries by the community-level social vulnerability, focusing on injuries related to interpersonal violence.: Background: The Center for Disease Control and Prevention's social vulnerability index (SVI) is a tool ... ...

Abstract	Objective: To describe adolescent injuries by the community-level social vulnerability, focusing on injuries related to interpersonal violence. Background: The Center for Disease Control and Prevention's social vulnerability index (SVI) is a tool used to characterize community-level vulnerability. Methods: Injured adolescent trauma patients (13-17 years old) cared for at a large Level I trauma center over a 10-year period were identified. Injuries were classified by intent as either intentional or unintentional. Census tract level SVI was calculated by composite score and for 4 subindex scores (socioeconomic, household composition/disability, minority/language, housing type/transportation). Patients were stratified by SVI quartile with the lowest quartile designated as low-, the middle two quartiles as average-, and the highest quartile as high vulnerability. The primary outcome was odds of intentional injury. Demographic and injury characteristics were compared by SVI and intent. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI. Results: A total of 1993 injured adolescent patients (1676 unintentional and 317 intentional) were included. The composite SVI was higher in the intentional injury cohort (mean, SD: 66.7, 27.8 vs. 50.5, 30.2; Conclusions: Adolescents living in the highest SVI areas experience significantly higher odds of intentional injury. SVI and SVI subindex details may provide direction for community-level interventions to decrease the impact of violent injury among adolescents.
Language	English
Publishing date	2023-05-31
Publishing country	United States
Document type	Journal Article
ISSN	2691-3593
ISSN (online)	2691-3593
DOI	10.1097/AS9.0000000000000287
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Article ; Online: Utilization of rehabilitation services in violent versus nonviolent traumatic spinal cord injury.

Barnett, Heather M / Wilson, Josh M / Kunapaisal, Thitikan / Nehra, Deepika / Vavilala, Monica S / Hoffman, Jeanne M / Crane, Deborah A

PM & R : the journal of injury, function, and rehabilitation

2023

Abstract: Background: Violence is the third leading cause of spinal cord injury (SCI) in the United States, and people with violence-related SCI have worse long-term outcomes compared to other traumatic SCI etiologies. Little is known, however, about the ... ...

Abstract	Background: Violence is the third leading cause of spinal cord injury (SCI) in the United States, and people with violence-related SCI have worse long-term outcomes compared to other traumatic SCI etiologies. Little is known, however, about the underlying reasons for these differences. Access to and utilization of rehabilitation services may differ in this population, but their outpatient care has not been previously investigated. Objective: To evaluate differences in utilization patterns of outpatient rehabilitation services between people with violence-related SCI and other traumatic SCI etiologies. Design: Retrospective cohort study. Setting: Academic tertiary care hospital system. Patients: A total of 41 patients with violence-related SCI residing in King County at the time of injury who completed inpatient rehabilitation (IPR) in our institution were identified from the hospital trauma registry and matched with 41 control patients with nonviolent traumatic SCI. Interventions: Not applicable. Main outcome measure(s): The number of appointments attended, canceled, and missed during the first year after discharge from IPR were obtained by chart review for physical medicine & rehabilitation (PM&R) physicians and therapy services. Results: People with violence-related SCI had decreased follow-up with outpatient rehabilitation services after IPR discharge compared to non-violent traumatic SCI, including PM&R (2.50 ± 2.44 vs. 3.76 ± 2.21 visits, β = -1.28, p = .017), physical therapy (8.91 ± 11.02 vs. 17.57 ± 15.26, β = -9.79, p = .009), occupational therapy (4.28 ± 7.90 vs. 10.04 ± 14.42, β = -6.18, p = .033), and recreational therapy (0.293 ± 0.955 vs. 1.37 ± 2.86, β = -1.07, p = .035). The rate of missed appointments was also higher among people with violence-related SCI compared to controls for PM&R (25.2% ± 28.5% vs. 9.9% ± 16.5%, β = 14.6%, p = .014) and physical therapy (26.0% ± 32.0% vs 4.2% ± 13.2%, β = 22.1%, p = .009). Conclusions: Individuals with violence-related SCI had fewer follow-up appointments with PM&R physicians and other allied health professionals and were more likely to miss scheduled appointments compared to other traumatic SCI etiologies. Decreased outpatient follow-up may affect long-term outcomes for people with violence-related SCI.
Language	English
Publishing date	2023-11-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2608988-9
ISSN	1934-1563 ; 1934-1482
ISSN (online)	1934-1563
ISSN	1934-1482
DOI	10.1002/pmrj.13105
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Article ; Online: Modification of Firearm Law-Firearm Injury Association by Economic Disadvantage.

Agoubi, Lauren L / Banks, Samantha N / Kwon, Eustina G / Rowhani-Rahbar, Ali / Nehra, Deepika / Rivara, Frederick P

American journal of preventive medicine

2023 Volume 66, Issue 2, Page(s) 291–298

Abstract: Introduction: Firearm-related injuries in the U.S. have risen 37% since 2015. Understanding how the association between firearm incidents and state-level firearm restrictiveness is modified by community-level distress and economic connectedness (EC) may ...

Abstract	Introduction: Firearm-related injuries in the U.S. have risen 37% since 2015. Understanding how the association between firearm incidents and state-level firearm restrictiveness is modified by community-level distress and economic connectedness (EC) may inform upstream injury prevention efforts. Methods: A national cross-sectional study of firearm incidents (interpersonal and unintentional firearm events) occurring between 1/2015 and 12/2021 was performed using the Gun Violence Archive. The exposures were community distress (Distressed Communities Index, DCI), EC, and year-state-level firearm restrictiveness. The primary outcome was mean annual urban firearm incidence rate per ZIP Code Tabulation Area. Generalized linear mixed models were fit to evaluate the modification of the firearm law-firearm incident association by DCI and EC. Data analyses took place in 2022. Results: About 266,020 firearm incidents were included. The mean rate was higher with each DCI tertile, with a RR of 3.18 (95% CI: 3.06, 3.30) in high versus low distress communities. Low EC was associated with over 1.8 times greater rate of firearm-related injury. The least restrictive firearm laws were associated with 1.20 times higher risk of firearm incidents (95% CI: 1.12, 1.28). The association between restrictive laws and lower incidence rates was strongest in low and medium distress and high EC communities. Conclusions: Stricter firearm laws are associated with lower rate of firearm incidents. The magnitude of this association is smallest for communities experiencing the greatest economic disadvantage.
MeSH term(s)	Humans ; United States/epidemiology ; Firearms ; Homicide ; Wounds, Gunshot/epidemiology ; Wounds, Gunshot/prevention & control ; Cross-Sectional Studies ; Gun Violence/prevention & control
Language	English
Publishing date	2023-09-14
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2023.09.007
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Article ; Online: The association between childhood opportunity index and pediatric hospitalization for firearm injury or motor vehicle crash.

Kwon, Eustina G / Nehra, Deepika / Hall, Matthew / Herrera-Escobar, Juan P / Rivara, Frederick P / Rice-Townsend, Samuel E

Surgery

2023 Volume 174, Issue 2, Page(s) 356–362

Abstract: Background: Community-level factors can profoundly impact children's health, including the risk of violent injury. This study's objective was to understand the relationship between the Childhood Opportunity Index and pediatric firearm injury owing to ... ...

Abstract	Background: Community-level factors can profoundly impact children's health, including the risk of violent injury. This study's objective was to understand the relationship between the Childhood Opportunity Index and pediatric firearm injury owing to interpersonal violence compared with a motor vehicle crash. Methods: All pediatric patients (<18 years) who presented with an initial encounter with a firearm injury or motor vehicle crash between 2016 to 2021 were identified from 35 children's hospitals included in the Pediatric Health Information System database. The child-specific community-level vulnerability was determined by the Childhood Opportunity Index, a composite score of neighborhood opportunity level data specific to pediatric populations. Results: We identified 67,407 patients treated for injuries related to motor vehicle crashes (n = 61,527) or firearms (n = 5,880). The overall cohort had a mean age of 9.3 (standard deviation 5.4) years; 50.0% were male patients, 44.0% non-Hispanic Black, and were 60.8% publicly insured. Compared with motor vehicle crash injuries, patients with firearm-related injuries were older (12.2 vs 9.0 years), more likely to be male patients (77.7% vs 47.4%), non-Hispanic Black (63.5% vs 42.1%), and had public insurance (76.4 vs 59.3%; all P < .001). In multivariable analysis, children living in communities with lower Childhood Opportunity Index levels were more likely to present with firearm injury than those living in communities with a very high Childhood Opportunity Index. The odds increased as the Childhood Opportunity Index level decreased (odds ratio 1.33, 1.60, 1.73, 2.00 for high, moderate, low, and very low Childhood Opportunity Index, respectively; all P ≤ .001). Conclusion: Children from lower-Childhood Opportunity Index communities are disproportionately impacted by firearm violence, and these findings have important implications for both clinical care and public health policy.
MeSH term(s)	Child ; Humans ; Male ; Female ; Accidents, Traffic ; Firearms ; Wounds, Gunshot/epidemiology ; Wounds, Gunshot/therapy ; Retrospective Studies ; Hospitalization ; Motor Vehicles
Language	English
Publishing date	2023-05-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.04.011
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Article ; Online: Injury-related emergency department visits and unplanned readmissions are associated with worse long-term mental and physical health.

Orlas, Claudia P / Herrera-Escobar, Juan P / Moheb, Mohamad El / Velmahos, Andriana / Sanchez, Sabrina E / Kaafarani, Haytham Ma / Salim, Ali / Nehra, Deepika

Injury

2023 Volume 54, Issue 9, Page(s) 110881

Abstract: Background: The risk factors for unplanned emergency department (ED) visits and readmission after injury and the impact of these unplanned visits on long-term outcomes are not well understood. We aim to: 1) describe the incidence of and risk factors for ...

Abstract	Background: The risk factors for unplanned emergency department (ED) visits and readmission after injury and the impact of these unplanned visits on long-term outcomes are not well understood. We aim to: 1) describe the incidence of and risk factors for injury-related ED visits and unplanned readmissions following injury and, 2) explore the relationship between these unplanned visits and mental and physical health outcomes 6-12 months post-injury. Methods: Trauma patients with moderate-to-severe injury admitted to one of three Level-I trauma centers were asked to complete a phone survey to assess mental and physical health outcomes at 6-12 months. Patient reported data on injury-related ED visits and readmissions was collected. Multivariable regression analyses were performed controlling for sociodemographic and clinical variables to compare subgroups. Results: Of 7,781 eligible patients, 4675 were contacted and 3,147 completed the survey and were included in the analysis. 194 (6.2%) reported an unplanned injury-related ED visit and 239 (7.6%) reported an injury-related readmission. Risk factors for injury-related ED visits included: younger age, Black race, a lower level of education, Medicaid insurance, baseline psychiatric or substance abuse disorder and penetrating mechanism. Risk factors for unplanned injury-related readmission included younger age, male sex, Medicaid insurance, substance abuse disorder, greater injury severity and penetrating mechanism of injury. Injury-related ED visits and readmissions were associated with significantly higher rates of PTSD, chronic pain and new injury-related functional limitations in addition to lower SF-12 mental and physical composite scores. Conclusions: Injury-related ED visits and unplanned readmissions are common after hospital discharge following treatment of moderate-severe injury and are associated with worse mental and physical health outcomes.
MeSH term(s)	United States/epidemiology ; Humans ; Male ; Patient Readmission ; Retrospective Studies ; Emergency Service, Hospital ; Hospitalization ; Trauma Centers
Language	English
Publishing date	2023-06-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.110881
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Article ; Online: Patterns in Location of Death From Firearm Injury in the US.

Agoubi, Lauren L / Duan, Ning / Rowhani-Rahbar, Ali / Nehra, Deepika / Sakran, Joseph V / Rivara, Frederick P

JAMA surgery

2023 Volume 158, Issue 6, Page(s) 669–670

MeSH term(s)	Humans ; United States/epidemiology ; Firearms ; Wounds, Gunshot ; Hospice Care ; Nursing Homes
Language	English
Publishing date	2023-04-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2022.8380
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Article ; Online: Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers.

Nguyen, Jefferson / Whiteside, Lauren K / Bulger, Eileen M / Veach, Laura / Moloney, Kathleen / Russo, Joan / Nehra, Deepika / Wang, Jin / Zatzick, Douglas F

Trauma surgery & acute care open

2022 Volume 7, Issue 1, Page(s) e000913

Abstract: Background: Questions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy ... ...

Abstract	Background: Questions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients. Methods: This investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity. Results: The frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity. Discussion: This multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities. Level of evidence: Level II (epidemiological investigation of untreated controls from a multisite randomized clinical trial). Trial registration number: NCT02655354.
Language	English
Publishing date	2022-08-04
Publishing country	England
Document type	Journal Article
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2022-000913
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