Introduction: Asphyxiation or suffocation injuries can result in multi-organ damage and are a major cause of morbidity and mortality among different age groups. This study aims to describe characteristics of patients presenting with suffocation injuries to emergency departments (EDs) in the U.S and to identify factors associated with mortality in this population.

Methods: We conducted a retrospective cross-sectional study using the 2013 U.S National Emergency Department Sample database. ED visits with primary diagnoses of intentional or accidental suffocation injury, and injury by inhalation and aspiration of foreign bodies or food (ICD-9-CM codes) were included. We performed descriptive statistics to describe the study population. This was followed by multivariate analyses to identify factors associated with mortality.

Results: We included a total of 27,381 ED visits for suffocation injuries. Most suffered from either inhalation and ingestion of food causing obstruction of respiratory tract or suffocation (51.6%), or suicide and self-inflicted injury by hanging, strangulation, and suffocation (39.4%). Overall mortality was 10.9%. Over half (54.7%) of the patients were between 19 and 65 years old. Males were more common than females (59.1% vs. 40.9%). Over half of the patients (54.9%) were treated and released from the ED. Factors associated with increased mortality included male gender, young age (4-18 years), diseases of the cardiac, respiratory, genitourinary and neurologic systems, intentional self-harm, and self-payer status.

Conclusion: Mortality from suffocation injuries remains high with significant burden on children and adolescents and on patients with intentional injuries. Tailored initiatives targeting identified modifiable factors through implementation of behavioral and environmental change can reduce the risk of suffocation injury and improve clinical outcomes of affected victims.

Introduction: Firearm-related spinal cord injuries are commonly missed in the initial assessment as they are often obscured by concomitant injuries and emergent trauma management. These injuries, however, have a significant health and financial impact. The objective of this study was to examine firearm-related spinal cord injuries and identify predictors of presence of such injuries in adult trauma patients.

Methods: This retrospective cohort study examined adult trauma patients (≥16 years) with injuries from firearms included in the 2015 United States National Trauma Data Bank. We performed descriptive and bivariate analyses and compared two groups: patients with no spinal cord injury (SCI) or vertebral column injury (VCI); and patients with SCI and/or VCI. Predictors of SCI and/or VCI in patients with firearm-related injuries were identified using a multivariate logistic regression analysis.

Results: There were 34,898 patients who sustained a firearm-induced injury. SCI and/or VCI were present in 2768 (7.9%) patients. Patients with SCI and/or VCI had more frequently severe injuries, higher Injury Severity Score (ISS), lower mean systolic blood pressure, and lower Glasgow Coma Scale (GCS). The mortality rate was not significantly different between the two groups (14.7%, N = 407 in SCI and/or VCI vs 15.0%, N = 4,811 in no SCI or VCI group). Significant general positive predictors of presence of SCI and/or VCI were as follows: university hospital; assault; public or unspecified location of injury; drug use; air medical transport; and Medicaid coverage. Significant clinical positive predictors included fractures, torso injuries, blood vessel or internal organ injuries, open wounds, mild (13-15) and moderate GCS scores (9 – 12), and ISS ≥ 16.

Conclusion: Firearm-induced SCI and/or VCI injuries have a high burden on affected victims. The identified predictors for the presence of SCI and/or VCI injuries can help with early detection, avoiding management delays, and improving outcomes. Further studies defining the impact of each predictor are needed.

Introduction: The quality of care and patient outcome of out-of-hospital cardiac arrest (OHCA) are affected by different factors, one of which is the hospital teaching status. This study aims to assess the association between teaching status of hospitals and  survival rates.

Methods: This retrospective observational study utilized the Nationwide Emergency Department Sample (NEDS) database of the year 2014 (released in 2016). The study sample included OHCA 122,776 patients. Descriptive analysis was performed. Patients’ characteristics were compared according to the hospital teaching status. This was followed by a multivariate analysis to assess the impact of the hospital teaching status on the patients’ survival at hospital discharge after controlling for confounding factors.

Results: A total of 122,776 patients with OHCA were included in this study. The average age was 65.91 years with male predominance (61.7%). Around 62.1% of patients were admitted to metropolitan teaching hospitals. Overall survival to hospital discharge was 6.4%. Survival was higher in patients who were treated in a metropolitan teaching hospital in comparison with those who presented to a metropolitan non-teaching hospital (7.2 % versus 4.9%, p<0.001). After adjusting for confounders, patients’ survival to hospital discharge was similar in the two groups (teaching and non-teaching metropolitan hospitals) (OR=0.909, 95% CI 0.776 – 1.065).

Conclusion: In this study, there was no significant association between teaching status of US metropolitan hospitals and survival of OHCA patients. OHCA patients may be transferred to the nearest hospital regardless of teaching status in US metropolitan areas.

Introduction: Subarachnoid hemorrhage (SAH) is a life-threatening condition characterized by bleeding into the subarachnoid space. Most data regarding non-traumatic SAH is from the U.S. and Europe with a paucity of studies from the Middle East. Therefore, this study aims at assessing the characteristics of SAH patients and describing associated factors and outcomes in a sample of SAH patients presenting to an emergency department in a regional tertiary-care medical center in Lebanon.

Method: A  retrospective medical chart review was conducted on all patients presenting to the emergency department with non-traumatic SAH from September 2009 to September 2016 using hospital discharge diagnosis (ICD-9 code 430); descriptive analyses were carried out to map patients’ characteristics, clinical presentation and potential factors.

Results: Within the span of seven years, 94 patients presented with non-traumatic SAH with a mean age of 55 years and a predominance of female gender (62.8%). Most patients presented with headache (79.8%). Almost all patients underwent non-contrast computed tomography scan of the brain in the emergency department (95.7%), 95.6% of which had a positive finding. Etiology of SAH was mostly due to an aneurysm (66.0%), 75.8% of which were in the anterior cerebral circulation, followed by unknown causes (28.7%). In-hospital complications were found in 21.3% of patients and in-hospital mortality was 6.4%.

Conclusion: Subarachnoid hemorrhage is a debilitating medical condition which has not previously been described in the Lebanese population. Incidence and outcomes of SAH in this study are comparable to other regions including Europe and the United States.