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Trauma and Injury Prevention Section Newsletter - September 2010, Vol 14, #2

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circle_arrow Greetings from the Chair – Rebecca Cunningham, MD
circle_arrow Society for Advancement of Violence and Injury Research (SAVIR)
circle_arrow Update from Emory’s Center for Injury Control
circle_arrow University of Virginia Department of Emergency Medicine Awarded CIREN Center which will support new Trauma Research Fellowship 
circle_arrow Research on Interventions for Intimate Partner Violence
circle_arrow Hospitalizations from Prescription Drug Use at Record High
circle_arrow Focus on Pediatric/ Adolescent Injury
Research Projects: Traumatic Brain Injury in the Pediatric Population
circle_arrow CDC Funds Translational Study on SBIRT at Pediatric Trauma Centers
circle_arrow Weaving the Safety Net: Adolescent Behavioral Health Screening in the Children’s Hospital of Philadelphia Emergency Department
circle_arrow Adolescent dating abuse and alcohol consumption: Is there a connection? 
circle_arrow Emergency Medicine Foundation Awards Research Grant to Study Text-message Interventions Focused on Decreasing Adolescent Alcohol Consumption 
circle_arrow Opportunity to Participate in Trauma Documentary Series
circle_arrow Washington Update
circle_arrow Scientific Assembly 2010: Workplace Violence in the ED  
circle_arrow Meetings of Interest
circle_arrow Emergency Medicine Foundation Events during Scientific Assembly 
circle_arrow Register for this year's Injury Free conference! 


Newsletter Index


Trauma and Injury Prevention Section

Greetings from the Chair – Rebecca Cunningham, MD

CunninghamThe TIPS Section annual meeting at Scientific Assembly is scheduled for Wednesday, September 29th  9:00am - 11:00am in the Palm E Room. Our guest speaker, ACEP member Dr. Terry Kowalenko will address our section on Workplace Violence in Emergency Departments at 10 a.m.

The enormous clinical burden of caring for injuries has led to increased recognition of the importance of injury research among emergency care providers and represents an important opportunity for injury researchers and emergency medicine to develop partnerships that will advance the field.

This edition of the TIPS newsletter highlights recent work from several EM based Injury Prevention and Control centers including: Emory’s Center for Injury Control, Injury Prevention Center at RI Hospital, Injury Control Research Center West Virginia University, Injury Research Center at the Medical College of Wisconsin, Center for Injury Research and Prevention Research, Children’s Hospital of Philadelphia. The updates from these centers include trauma and injury prevention news on motor vehicle crash in the elderly, the rise of prescription drug mis-use and ED based interventions for intimate partner violence.

This fall newsletter adds a corner that focuses on pediatric injury prevention in EM, including Traumatic Brain Injury, SBIRT focused in Pediatric Trauma Centers, adolescent mental health/suicide screening, adolescent dating violence, and reaching adolescents at risk for alcohol misuse via text messaging. Too often, I find adult and pediatric injury researchers are working independently on similar issues and the TIPS section aims to broaden our section reach to our peds colleagues who are doing great work in Injury research and control. Finally the EM injury community is pleased to recognize Dr. Linda Degutis, the current Research Director for Yale Department of Emergency Medicine, and the director of the Yale Center for Public Health Preparedness who has been named as the new Director of CDC’s National Center for Injury Prevention and Control effective early November 2010.


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Society for Advancement of Violence and Injury Research (SAVIR)

Michael J. Mello, MD, MPH, FACEP
Injury Prevention Center at Rhode Island Hospital 
Department of Emergency Medicine, Alpert School of Medicine of Brown University 

As a long time member and former Chair of this section, I am very committed to ACEP and our section as well as keenly aware of its members’ dedication to injury prevention. Another organization I work with also shares this dedication to injury prevention and transcends many disciples including emergency medicine. The Society for Advancement of Violence and Injury Research (SAVIR) is dedicated to promoting scholarly activity in the prevention, control, acute care, and rehabilitation of intentional and unintentional injury. I have the honor of being the organization’s President this year and am working with colleagues from many clinical and academic disciplines. Several of our ACEP colleagues are part of this group and equally as stimulating is the opportunity to interact with individuals from other disciplines working in this field. Please consider joining SAVIR. It would augment the networking and interactions you have within this ACEP section to include the many non-emergency medicine physicians working within the field of injury and violence prevention. It is easy to join (go to savirweb.org) and when joining consider working on one of SAVIR’s committees where there is exciting ongoing projects. A description of SAVIR committees can be found at (http://www.savirweb.org/content/index.php?pid=19).

Members at any level of professional development- students, residents, junior or senior level faculty are welcome as members and on all of our committees. I also invite ACEP members to consider attending SAVIR’s national meeting next spring. SAVIR, Safe States Alliance, and the National Center for Injury Prevention and Control have joined forces to host this dynamic injury conference to be held in Iowa City, IA from April 6-8, 2011.


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Update from Emory’s Center for Injury Control

Deborah Houry, MD, MPH
Associate Professor, Emergency Medicine
Director, Emory Center for Injury Control

This has been a fantastic year for the Emory Center for Injury Control. We recently updated our five year strategic plan and have undergone a significant transformation from an inter-disciplinary unit based at a single university into an expansive multi-institution consortium. With this renewed growth and a compelling vision, we joined the ranks of the Centers for Disease Control and Prevention’s Injury Control Research Centers (ICRCs) as one of their new centers this year.

This fall we will be publishing our first special issue in Western Journal of Emergency Medicine highlighting our Center’s research and sending copies to academic injury centers as well as state public health departments. This goes hand in hand with our core mission to focus on the practice, implementation and evaluation of injury and violence interventions and their successful dissemination.

We have several active projects in various community settings on a wide range of injury topics including child maltreatment, motor vehicle crashes, and traumatic brain injury. As many of our Center leaders are in emergency medicine, our Center is currently supporting three emergency department-based studies including a behavioral intervention to prevent development of post traumatic stress disorder in trauma patients, development of a screen for or violent injury in high risk youth, and a translational study looking at best practices for kiosk screening for intimate partner violence. More information is on our website: www.emorycenterforinjurycontrol.org


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University of Virginia Department of Emergency Medicine Awarded CIREN Center which will support new Trauma Research Fellowship

University of Virginia Emergency Department awarded $2.5 million to study and prevent elderly drivers’ motor vehicle crash injuries.
Mark R. Sochor, MD, MS, FACEP, Past Chair TIPS

The University of Virginia and INOVA Fairfax Hospital received a grant of $2.5 million from the National Highway and Traffic Safety Administration to establish a joint Engineering Crash Injury Research and Engineering Network (CIREN) Center. A major initiative for this new CIREN Center will be studying elderly drivers and occupants.

A new two year Trauma Research Fellowship will be offered through the University of Virginia’s Department of Emergency Medicine. During this two year fellowship, the research fellow will gain clinical experience in the emergency department while gaining laboratory experience (including specimen prep) at the University of Virginia Center for Applied Biomechanics. In addition, the research fellow will obtain a Master’s of Science in Clinical Research or a Masters of Public Health from UVA’s School of Medicine Public Health Sciences. Please see website: http://www.medicine.virginia.edu/clinical/departments/emergency-medicine/forphysicians/fellowships/fellowship-in-trauma-research.html for more information.

The overall goal of the new research and engineering center is to reduce motor vehicle crash-related injuries and deaths and the related human and economic costs. The center will provide engineering and medical excellence in test subject enrollment, crash investigation, analysis of automobile crash data, impact biomechanics and research and community outreach.

Dr. Mark Sochor, Associate Professor of Emergency Medicine, will serve as Co-Principal Investigator. Jeff Crandall, Professor of Mechanical Engineering and Principal Investigator for this grant, is the Director of the University’s Center for Applied Biomechanics (CAB). The CAB is a collaborative research facility supported by the School of Engineering and Applied Science and the School of Medicine at the University of Virginia.

The CIREN Center will be housed in a new 4 million dollar facility located at the UVA North Fork Research Park. Through the CIREN Center activities, the UVA CAB will continue its studies on the biomechanics of aging as well as its investigations of future injury trends within the elderly occupant population. The CAB is a recognized authority in research related to crash injuries sustained by older vehicle occupants, occupants involved in frontal, side and rollover crashes and occupants who sustain extremity and thoracic injuries.

Alliances with AARP, The Hartford and the Insurance Institute for Highway Safety will expand both the research team’s expertise and their breadth of outreach. The AARP will provide a national outlet for dissemination of CIREN research findings relating to older drivers and passengers and to injury trends. Their outreach potential includes more than 38 million Americans.

The Hartford Advanced 50 Team, gerontologists with advanced degrees in aging-related field including the psychological, sociological and financial dimensions of aging, will serve as another partner in this initiative. The Insurance Institute for Highway Safety will provide both technical support and data for case reviews.


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Research on Interventions for Intimate Partner Violence

Karin Rhodes MD, MS 
Director of the Division of Emergency Care Policy Research 
University of Pennsylvania 

As an emergency medicine resident, Dr. Rhodes designed a computer-based health risk assessment for the acute care setting and gathered pilot data on its effectiveness. Her RJW clinical scholar’s project was a large AHRQ-funded randomized control trial to assess the effectiveness of IPV screening on domestic violence communication outcomes between doctors and women patients. Articles from that study were published in the Annals of Internal Medicine, Archives of Internal Medicine, Annals of Emergency Medicine, the Journal of Sexually Transmitted Diseases, and received national publicity, including an article in the New York Times. She recently completed a NIMH-funded career development award designed to develop interventions for both male and female patients who self-disclose victimization and/or perpetration of IPV in a health care setting. As an EM faculty member, Rhodes has helped to mentor a number of prominent IPV researchers, to achieve NIH Career Development and other federal funding. For example, she was co-PI with Deborah Houry, MD, on a study assessing the safety of computer screening in an ED setting. Her collaborations with investigators from Social Policy and Criminal Justice, along with the community-based Kalamazoo Assault Intervention Project, led to funding by the National Institute of Justice to study the arrest outcomes of police calls for IPV and a larger NIJ grant using mixed quantitative and qualitative methods to assess whether female victim participation in prosecution improves her health and safety. The results include an integrated health and criminal justice database that is being used to address the effectiveness of criminal justice interventions for violence against women.

Since moving to U. Penn four years ago, Rhodes has been working with a local community-based organization, the Institute for Safe Families and the Philadelphia Department of Public Health to study low tech cost-effective methods of improving detection and response to IPV in Community Health Clinics, as well as in the HUP emergency department. This work lead to a recent successful Challenge grant Community Health Center Intervention for Intimate Partner Violence” that aims to test a multi-level intervention that combines: (1) a social health screening process that shifts the focus from provider screening to patient self-disclosure; (2) a social marketing campaign targeted at providers and staff to increase awareness and elevate clinician and staff confidence that something can be done to address IPV; and (3) specially trained Family Violence Social Workers trained in motivational counseling interventions for both male and female patients and 4) conduct a small randomized controlled intervention trial with 60 abused women to assess the acceptability, safety, and potential effectiveness of providing a community health worker social support system for abused women. Both studies are being conducted in four Philadelphia Department of Health community health centers serving approximately 50,000 low income urban patients. Her concern for improving community response to violence and abuse has also led Rhodes to serve as a member of the board of the Penn police and committee for the Philadelphia Collaborative Violence Prevention Center. 

Rhodes’ most recent funding success is “An RCT of Brief Intervention for Problem Drinking and Partner Violence”; a five-year randomized controlled trial with 600 women ED patients. Advised by international experts on gender and alcohol use and motivational enhancement therapy, Rhodes is leading a multidisciplinary group of investigators to assess whether a brief motivational intervention can decrease primary outcomes of episodes of heavy drinking and incidents of IPV. The analysis will also explore likely mediators and moderators of the intervention. The brief 25-minute manual-guided motivational intervention, which will be recorded and monitored for fidelity, will be delivered by trained social workers at the time of the ED visit, followed by a 15-minute phone booster at ten days, as this is a model that could be generalized to other acute health care settings.


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Hospitalizations from Prescription Drug Use at Record High

Jeffrey H. Coben, MD
 Director, Injury Control Research Center
 West Virginia University 
 

Poisoning-related hospitalizations increased by nearly two-thirds over seven years, according to research led by Injury Control Research Center Director Jeffrey Coben, M.D., that is attracting national media attention. 

From 1999 to 2006, hospitalizations from opioid, sedative, and tranquilizer poisonings increased by 65 percent, Coben and his co-investigators found in the study, which appeared in the May issue of the American Journal of Preventive Medicine. The study’s findings were reported by numerous national media outlets, including CNN, Scientific American, Reuters, US News and World Report, and KCRW, an affiliate of National Public Radio that broadcasts to stations nationwide. 

This drastic increase in prescription drug-related hospitalizations was double that associated with other drugs. Over the seven years studied, the class of tranquilizers known as benzodiazepines was associated with the largest increase in hospitalizations. At 400 percent, the synthetic narcotic methadone had the largest percentage increase in hospitalizations. 

Demographically, the patients hospitalized for prescription drug poisonings were more likely than those receiving treatment for other poisonings to be women and older than 34 years of age.

For this study, Coben and his team analyzed data from the Nationwide Inpatient Sample, which contains the diagnosis upon hospital discharge for a representative eight million patients each year. From these data, the investigators compared clinical and demographic characteristics of patients who had been poisoned, as well as whether the poisoning was intentional or unintentional.

While the recent prescription drug-related deaths of high profile celebrities like Michael Jackson and Heath Ledger made the news, people of all ages, professions, and socioeconomic groups are affected by abusing these drugs. 

In the U.S., the death rate from unintentional poisoning has climbed steadily since 1990 to become the second leading cause of death from unintentional injury, according to the Centers for Disease Control and Prevention. In 2005, 23,618 people died from unintentional poisoning, and 95 percent of those deaths were attributed to drug overdoses. 

Despite this increase in deaths, little information was available about hospitalizations associated with prescription drug poisoning. The goal of this study was to clarify the link between this kind of drug abuse and hospitalization and, ultimately, to help develop interventions for at-risk individuals before drug abuse results in hospitalization and/or death. 

“It is essential that healthcare providers, pharmacists, insurance providers, state and federal agencies, and the general public all work together to address this crisis,” Coben said. “Prescription medications are just as powerful and dangerous as other notorious street drugs, and we need to ensure people are aware of these dangers and that treatment services are available for those with substance abuse problems.” 

Co-investigators on the study, called “Hospitalizations for Poisoning by Prescription Opioids, Sedatives, and Tranquilizers,” include Stephen M. Davis, M.P.A. M.S.W.; Paul M. Furbee, M.A.; Rosanna D. Sikora, M.D.; Roger D. Tillotson, M.D.; and Robert M. Bossarte, Ph.D.


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Focus on Pediatric/ Adolescent Injury
Research Projects: Traumatic Brain Injury in the Pediatric Population

Ann Christiansen, MPH, Assistant Director, Steven Hargarten, MD, 
Danny Thomas, MD
Injury Research Center at the Medical College of Wisconsin

Traumatic brain injury (TBI) is a significant problem in the pediatric population. The majority of patients with TBI are discharged home with the diagnosis of concussion. The accurate assessment and early outpatient management of concussion are critical for ensuring safe recovery. Research has shown that modifiable post injury risk factors play a role in recovery. Animal evidence has suggested that early cognitive and physical activity may worsen outcome following concussion. There is very little human data on the role of rest plays in concussion recovery. In 2010, the Injury Research Center at the Medical College of Wisconsin, through the College’s Advancing a Healthier Wisconsin program, funded a two-year research project to evaluate the association between rest and recovery from concussion. Danny Thomas, MD, a pediatrician who is board certified in pediatric emergency medicine is the Principal Investigator for the study.

The study is a randomized controlled trial of strict physical and academic rest in patients 11 to 22 years old with a diagnosis of concussion, presenting within 24 hours of a head injury to the Emergency Department / Trauma Center (EDTC) at Children’s Hospital of Wisconsin. Patients receive neuropsychological, symptom, and balance assessment in the EDTC. Patients are then randomized to either receive the standard of care or strict rest recommendations for the next 5 days. Study participants are instructed to complete a validated “Three-Day Activity Diary” and have in-home follow up neuropsychological, symptoms and balance assessment at three days and ten days after their EDTC visit. Patients receive incentives for completing each follow up appointment. Neuropsychological, symptoms and balance assessments recorded for study patients in the EDTC will be compared with assessments in follow-up later to determine clinical improvement and will be compared with exertion and activity calculated from the “Three-Day Activity Diary”. Differences between neurocognitive outcome and activity will be assessed between control and intervention group using intention to treat analysis.

In summary, we anticipate that this study will provide important evidence regarding the association between decreased early post-concussion activity and improved post-concussion outcomes. With these findings, we can work to modify and strengthen our discharge recommendations.


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CDC Funds Translational Study on SBIRT at Pediatric Trauma Centers

Michael J. Mello, MD, MPH, FACEP and Julie Bromberg, MPH 
Injury Prevention Center at RI Hospital 
Department of Emergency Medicine, Alpert School of Medicine of Brown University 

A recent requirement for trauma center certification by the American College of Surgeons is the requirement for level 1 trauma centers to have the capacity to identify risky alcohol use and provide interventions to trauma patients. Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based model used on those screening positive. To date, there has been a lack of consistent integration of evidence-based practices around this component of acute care, with even less successful implementation among pediatric trauma centers. For this reason, researchers at the Injury Prevention Center at Rhode Island Hospital enrolled seven pediatric trauma centers from across the country into a translational research project funded by the Centers for Disease Control. Study aims include: 1) examine the development of policy and protocol for adoption of adolescent SBIRT within participating pediatric level 1 trauma centers; 2) evaluate the implementation of a trauma center policy and protocol for adolescent SBIRT within participating pediatric level 1 trauma centers; 3) examine mechanisms for sustainability and maintenance of SBIRT services within participating pediatric level 1 trauma centers and 4) develop recommendations on implementing SBIRT within pediatric trauma care.

 The research team offered several technical assistance components (online, in person workshops and conference calls) throughout the first grant year aimed at developing SBIRT policies and procedures. Now as the grant enters its second year, sites will begin to implement these policies and procedures and will receive technical assistance components related to implementation. The sites will focus on maintenance of their SBIRT policies in the third year of the grant. Change in adoption, implementation and maintenance among sites will be measured by self report of project site leaders and other key informants as well as retrospective blinded medical chart review of adolescent trauma patients. This study will allow researchers to better understand best practices for the dissemination and adoption of alcohol screening and brief intervention within pediatric trauma centers.


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Weaving the Safety Net: Adolescent Behavioral Health Screening in the Children’s Hospital of Philadelphia Emergency Department

Joel Fein, MD, MPH
Center for Injury Research and Prevention Research,
Children's Hospital of Philadelphia

Investigators at Children’s Hospital of Philadelphia (CHOP) have developed and validated a web-based behavioral health screening tool (the BHS) for adolescent ambulatory medical settings. With EMSC Targeted Issues grant funding, they implemented the tool as standard of care for non-critical adolescents in the CHOP Emergency Department (ED).

Medical settings provide key opportunities for the early identification of psychiatric illness in youth. Research at Cincinnati Children’s Hospital Emergency Department has shown that 40 percent of teens who come in exhibit symptoms of mental illness severe enough to impact daily activities.

During the screening process, adolescents ages 14 and older sit with headphones at a computer in his or her ED treatment room and complete a web-based instrument that assesses depression, suicidal ideation, post-traumatic stress, and substance use. Nurses or ED technicians initiate the process by signing the patient into the web-based, password-protected system. The web-based program then scores the data and generates a report for providers to review before meeting with the patient. Answers that are of concern are addressed by the clinical team and often involve social workers and psychiatrists as dictated by standard ED procedures. The unique nature of this system is that it is delivered by clinical staff instead of research staff, and is fully translated to the end user.

In a feasibility study in the CHOP ED, nurses and medical technicians were trained to administer the BHS-ED. After research staff support was removed, one-third of eligible ED patients were approached by clinical staff for the BHS-ED. Even with this rate of screening the intent to treat analysis still revealed a doubling of the rate of identification and assessment of mental illness during the implementation period. For patients who actually participated in the screening process this rate of identification increased five-fold. 

The BHS initiatives are run by Joel Fein, M.D., M.P.H., a pediatric emergency medicine physician at CHOP and director of the Philadelphia Collaborative Violence Prevention Center, and Guy Diamond, Ph.D., a clinical psychologist and director of CHOP’s Center for Family Intervention Science. The BHS-ED was adapted as a shorter version of a BHS tool designed by Diamond and colleagues and is currently being used in primary care clinics in Pennsylvania.

The full BHS adds medical, school, family, safety, sexuality, nutrition and eating, anxiety, and psychosis. Dr. Diamond and colleagues have validated the BHS in clinical outpatient settings.

To reach full potential,” said Dr. Fein. There has to be system-wide change. Mental health screening needs to become a billable, standard of care. Widespread implementation can help reduce stigma and increase quality of care.”

Next steps for BHS include developing engagement strategies that will increase successful referrals and expanding the technology to assist with cross system communication between medical and behavioral health providers. Several published papers describe the validity and usage of the BHS.

For more information on CHOP’s BHS program, contact: Dr. Fein  and/or Dr. Diamond

References:

  1. Pailler, ME, Fein JA. Computerized behavioral health screening in the emergency department. Pediatric Annals 2009;38:156-160.
  2. Pailler ME, Cronholm PF, Barg FK, Wintersteen M, Diamond GS, Fein JA. Adolescents’ and Caregivers’ Beliefs about Depression Screening and Referral in the Emergency Department. Pediatric Emergency Care 2009;25(11):721-727.
  3. Cronholm PF, Barg FK, Pailler ME, Wintersteen MB, Diamond GS, Fein JA. Adolescent Depression: Views of Health Care Providers in a Pediatric Emergency Department. Pediatric Emergency Care.26(2):111-117.
  4. Diamond G, Levy S, Bevans KB, Fein JA, Wintersteen M, Tien A, Creed T. Development, Validation and Utility of the Web-based, Behavioral Health Screen for Adolescents in Ambulatory Care. Pediatrics 2010;126 e163-e170.
  5. Fein JA, Pailler M, Diamond G, Wintersteen M, Tien A, Hayes K, Barg F. Self-administered, Computerized Assessment of Adolescent Mental Illness in the Pediatric ED. Archives of Pediatric and Adolescent Medicine, in press.

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Adolescent dating abuse and alcohol consumption: Is there a connection?

Emily Rothman, ScD
Boston University

A research team from the Boston University School of Public Health has been investigating the relationship between alcohol use and adolescent dating abuse in a sample of pediatric emergency department patients. Results were presented at the Research Society on Alcoholism’s 2010 conference.

Dating violence (DV) is a common adolescent health problem with serious public health consequences. As many as 21-32% of U.S. adolescents report having been physically or sexually hurt by a partner, and of these, 9% have gone to an emergency department for it. And, it’s not just a few who are responsible; 15-40% of teens report having used violence against a partner.

There is now substantial evidence that alcohol use can elevate adults’ risk of partner violence perpetration, and that alcohol treatment may reduce partner violence perpetration among adults who are alcohol dependent. However, there is no evidence that adolescent alcohol use elevates risk for adolescent dating violence perpetration. Importantly, adolescents are different from adults in at least two ways that could affect the alcohol-dating violence link: (1) the majority of adolescents who drink tend to engage in heavy episodic drinking rather than daily drinking, and (2) the nature of teen dating relationships is markedly different from most marriages or cohabitation partnerships—teens don’t typically share bank accounts or residences, for example—so it is usually more difficult for them to terrorize a partner, although they may use physical violence frequently.

Our research team sought to determine whether adolescents’ drinking style was associated with increased risk of dating violence perpetration or victimization. We did this by conducting two studies. The first entailed collecting self-report survey data from 472 pediatric emergency department patients between the ages of 14-21. We collected data on (1) the frequency and amount of alcohol consumption, (2) patients’ expectancies about whether they tend to behave violently when drinking, (3) motivations for drinking, (4) tendency to become uninhibited when drinking, and (5) tendency to use alcohol as an excuse for bad behavior. We also collected data about adverse childhood experiences, mental health problems, and anti-social behavior. The second study entailed interviewing these same patients using a standard technique that records drinking events and dating violence events retrospectively over a six month period.

The results of our first study were that drinking style was strongly and significantly related to both dating violence victimization and perpetration, in both males and females, in a simple model. When we added childhood abuse victimization, other childhood adverse experiences, and problem behaviors to the model, these added variables attenuated the relationship between drinking style and dating abuse victimization and perpetration. In other words, drinking style was related to dating violence, and we also saw evidence that childhood victimization and problem behavior tendencies may be “upstream” of that association.

The results of our second study were that dating violence perpetration and victimization were each more likely to occur on a day when a patient reported that they had been drinking as compared to a day when he/she had not been drinking. In other words, in our sample, having one or more drinks of alcohol on a given day was associated with an increased likelihood that a dating violence event would also occur on that day.

From the results, we have concluded that in our sample there was a significant relationship between alcohol use and likelihood of dating violence involvement. However, we need more clarity about the days when adolescents drink and experience a dating violence event: are they drinking first, and becoming violent (or being assaulted) second? Or are they using or experiencing violence, and then using alcohol to cope? Or both? We intend to collect additional data that will allow us to pinpoint the temporal order of events on days when both alcohol use and dating violence occur.  Ultimately, a complete understanding of whether and how alcohol influences adolescents’ propensity for dating violence will allow us to develop interventions with the aim of reducing violent injury. 

References:

  1. Field C, Caetano R, Nelson S. Alcohol and violence related cognitive risk factors associated with the perpetration of intimate partner violence. Journal of Family Violence. 2004;19:249-253
  2. Foshee VA, Linder GF, Bauman KE, et al. The safe dates project: Theoretical basis, evaluation design, and selected baseline findings. American Journal of Preventive Medicine. 1996;12(5):39-47
  3. Foshee VA, Ennett ST, Bauman KE, Suchindran C. The association between family violence and adolescent dating violence onset does it vary by race, socioeconomic status, and family structure? Journal of Early Adolescence. 2005;25(3):317-344
  4. Leonard K, Senchak M. Alcohol and premarital aggression among newlywed couples. J Stud Alcohol Suppl. 1993;11:96-108
  5. Malik S, Sorenson SB, Aneshensel CS. Community and dating violence among adolescents: Perpetration and victimization. Journal of Adolescent Health. 1997;21(5):291-302

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Emergency Medicine Foundation Awards Research Grant to Study Text-message Interventions Focused on Decreasing Adolescent Alcohol Consumption

Brian Suffoletto, MD MS
University of Pittsburgh 
EMF grant recipient 

Hazardous alcohol consumption (binge drinking) occurs in 45% of young adults, results in frequent injury, and costs the health care system $22 billion per year. Young adults are in a critical period where they can be influenced to avoid a trajectory of high-risk drinking and harmful outcomes in the later adult years. Unfortunately, young adults rarely have contact with a health care provider to receive screening, brief interventions and referral to treatment (SBIRT). The Emergency Department might offer a unique opportunity to reach young adults, if an easy to implement SBIRT were available.

Health services have begun to use text messaging to collect health behavior information and deliver treatments to people in their everyday lives in natural settings, but its application to young adults with hazardous drinking behavior identified in the ED has not been explored. Therefore, researchers at the University of Pittsburgh are investigating the feasibility and accuracy of ED-initiated and outpatient-continued assessment of drinking behavior in young adults using a computer-driven text messaging platform. Based on the subject's response to weekly assessments, the computer platform will send personalized motivational messages in real-time.

Our research experience with automated assessments of drinking behavior and text-message interventions for young adults with hazardous drinking from three local urban EDs will provide the basis for larger multisite, randomized controlled trials. In the future, novel forms of communication may provide cost-effective solutions to EDs to modify behavior to reduce hazardous alcohol use and injury in at-risk patients. 


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Opportunity to Participate in Trauma Documentary Series

Forwarded by: Mark R. Sochor, MD, MS, FACEP, Past Chair TIPS 

Dragonfly Film & Television Productions, a London based production company specializes in high end documentaries. Since its founding in 2005, Dragonfly has established itself as one of the UK’s leading producers of science television, with a distinguished and award-winning track record of bold and innovative programmes. Last year we won a British Association of Film & Television Award with our sensitive and ground breaking series One Born Every Minute, which was set in a hospital maternity unit. To find out more: www.dragonfly.tv.

Dragonfly is currently developing a major new UK documentary series, provisionally titled Kevin Fong: Medicine Impossible. Over the course of five programmes we will explore the incredible work of a number of Emergency and Trauma teams around the world, looking at the science behind treating critically injured patients. The series will see Kevin Fong immersing himself in the world of the doctors who deal with serious injuries to give the viewers an understanding of the skill and dedication it takes to save lives. It will be a positive and educational series in which we will highlight the exceptional abilities and commitment of the doctors, and showcase the cutting edge medical technology that is utilized in treating patients. The key to the series is finding the right doctors and units to film. If you are interested in your level I or II ED being considered, contact: 

Tanya Winston
Producer/Director
Tel: 01144 207 033 2258
Mobile: 001144 7775 841 248 

Dragonfly Film and Television Productions Ltd 120 - 124 Curtain Road London EC2A 3SQ United Kingdom


 

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Washington Update

New Director of the CDC National Center for Injury Prevention and Control

LindaDegutisCDC

Dr. Linda Degutis, DrPH, MSN, has been named as the Director of CDC’s National Center for Injury Prevention and Control effective early November. Linda is a longtime friend of the trauma and injury prevention community and a world class injury researcher. She leaves her position as Associate Professor in the Department of Emergency Medicine and School of Public Health, and Associate Clinical Professor of Nursing at Yale University.

At Yale, Linda was the Research Director for Emergency Medicine, and the director of the Yale Center for Public Health Preparedness. She has served as the Director of the New Haven Regional Injury Prevention and Control Program, chair of the American Public Health Association’s Injury Control and Emergency Health Services Section, and as President of the APHA.

Dr. Degutis’ research interests have centered on issues related to alcohol and injury, with a particular focus on interventions and policy issues. She is known internationally for her work in public health, injury, substance abuse and policy, and has served as the principal investigator or co-investigator for grants on a wide range of topics including: alcohol interventions; screening, brief intervention, and referral to treatment (SBIRT); public health preparedness; public health workforce training; public health systems research; and interventions for opioid addiction.

CDC releases (finally) its 2009 Annual Emergency Department Survey -2007 data

Barbara Tomar, ACEP Federal Affairs Director 

  • Roughly 117 million people visited the America’s EDs in 2007 with nearly 40 million injury were for injury related visits. CDC also released overall visit rates for 2008 which have grown to 124 m, the highest number ever recorded.
  • 66% of injury related visits are due to unintentional falls. 

To review the report see: CDC National Health Statistic`s Reports

ACEP Collaborates with CDC on diagnosis and treatment of Traumatic Brain Injury 

In collaboration with the Center for Injury Prevention and Control Heads Up series, ACEP has contributed clinical policy in “Neuroimaging and Decision-making in Adult Mild Traumatic Brain Injury in the Acute Setting and is available for both clinicians and patients at Heads Up to Clinicians.

The Government Accountability Office (GAO) released a study of All Terrain Vehicles

An increase in injuries among children using All Terrain Vehicles (ATV) has sparked concerns with the Consumer Product Safety Commission because ATVs are primarily adult designed. Statistics show roughly 134,900 ATV related injuries were treated in emergency rooms in 2008 compared with 81,800 in 1999, a 65% increase. The GAO is required under the Consumer Product Safety Improvement Act to report on the use and advantages of ATVs and discovered several dealers aware of a child’s use.

As a result, the Commission will engage in preventing the sale of adult sized ATVs for children’s use. Click to view the All Terrain Vehicle Report to Congressional Committees .

Brendan G. Carr, MD is the new Section Chair

Dr. Carr is currently the Associate Director of the Division of Emergency Care Policy Research in the Department of Emergency Medicine, University of Pennsylvania School of Medicine. He has been the principal investigator on AHRQ and NIH grants and has participated in several Institute of Medicine studies. A long-standing member of the ACEP’s Research Committee, he has become a well-published clinical researcher, most recently with a July 2010 article in Annals of Emergency Medicine. Welcome Dr. Carr.

Many thanks to Rebecca Cunningham, MD, outgoing chair of TIPS

Dr. Cunningham led the Section for the past two years and has re-energized a small, but dedicated and influential group of members to better define and prioritize Section issues, and initiate plans for submission of a didactic course proposal for SA.

As always, we welcome more active participation in Section activities and hope you can join us on the 29th..


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Scientific Assembly 2010: Workplace Violence in the ED

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Trauma and Injury Prevention Section
2010 Annual Meeting

Guest Speaker: Terry Kowalenko, MD, FACEP

Topic: ED Workplace Violence

When: Wednesday, September 29th 10:30am - 11:00 am

Where: Palm E Room – MBCC South 

Dr. Kowalenko will share his research on violence in the emergency department and is currently studying the effects of interventions.


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Meetings of Interest

The Society for Advancement of Violence and Injury Research (SAVIR), Safe States Alliance, and the National Center for Injury Prevention and Control have joined forces to host a dynamic injury conference to be held in Iowa City, IA from April 6-8, 2011. 

European Society for Suicide & Suicide Behavior Meeting will be held in Rome, Sept 1-4, 2010. We are having a symposium on Emergency Medicine and Suicide Prevention 

World Suicide Prevention Press Conference will be held at the UN in New York City and Washington, D.C. September 10, 2010.

World Injury Meeting will take place September 21st – 24th in London with many presentations from ACEP members.


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 Emergency Medicine Foundation Events during Scientific Assembly

The Emergency Medicine Foundation has many events planned during Scientific Assembly to promote their research grants and raise funds.  Please attend as many EMF as you can!  

An Evening with EMF

EMF: It's a Sure Bet!

Tuesday, September 28th/ 6:00 pm - 7:30 pm

MB Ballroom H, Mandalay Bay Hotel, Las Vegas

Skip the expensive lobby bar and join EMF for “THE PARTY” before the Opening Party!

  • Wine
  • Beer
  • Hors d'oevres
  • Live music by the Humanities Section
  • Book Signings by William Wesley Fields, MD, FACEP for Ghost Dancing and James, Fleming, MD for Tengo Sed
  • Special Presentations
  • Picis Photo Booth
  • Art Auction in Conjunction with the Section of Medical Humanities

Admission is $20 with proceeds from the evening benefitting the Emergency Medicine Foundation research grants. Proudly underwritten by Blue Jay Consulting and Emergency Medical Associates.

Research Forum

Tuesday, September 28th / 7:00 am - 6:30 pm

Wednesday, September 29th / 7:00 am - 6:30 pm 

See the results of EMF funded research by visiting the Research Forum. Look for the EMF Grant Winner ribbons on the posters. Learn how EMF is making a difference in your practice. Also, visit the EMF table with the announcement of the new grant categories for 2011-2012 funding cycle.

Go to a Movie Premiere in Las Vegas!: 21 and a Wakeup

Wednesday, September 29th/ 6:00 pm showing and 8:15 pm showing

United Artists Theater at the MGM Grand Hotel

In the final days of the war, one Hospital stood between life and death for the last valiant soldiers in Vietnam. Based on the experiences of Dr. Marvin Wayne and Director Chris McIntyre. The movie includes: Amy Acker, JC Chasez, Danica McKellar, Fay Dunaway, Tom Sizemore, just to name a few.

“Real, Profane, and Heartbreaking…this is truly the way it was…” Major Marvin Wayne, MD, FACEP

“The Spirit that Drove the Founding of Emergency Medicine.” Gregory Henry, MD, FACEP

Suggested donation is $20 benefitting the Emergency Medicine Foundation research grants.

Free Buses to the show from the Mandalay Bay. Go by Booth #625 for more information.


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Register for this year's Injury Free conference!

Use this link to register for this year's Injury Free conference   
www.ipc.rhodeislandhospital.org


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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.

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