First EDition: News for and about the practice of Emergency Medicine
CDC updates guidance on protecting health care workers from Ebola; Malpractice reform failed to curb defensive medicine in the ED; New test will speed enterovirus D68 case confirmation from weeks to days; ED visits by young patients trended up in California; Pit bull bites are worse by several measures;Doubling of US heroin deaths spurs call for increased naloxone access; Opioid-poisoning deaths rose fastest in 55- to 64-year-olds.
“The divergence from older trends in ED use among youths may also reflect the increasingly central role of the ED in the US health care system, especially during a period of severe economic recession, and could signal an overall deterioration in access to primary care across payer groups, or that even privately insured youths with greater access to primary care physicians are being directed to the ED for care,” Dr Hsia and her associates said.
Pit bull bites are worse by several measures
By: Amy Karon
Vitals Key clinical point: Bites by pit bulls and other large dog breeds remain a serious threat to young children. Major finding: Pit bulls caused 42.4% of dog bites that required hospitalization. Data source: A retrospective chart review of 223 children presenting to an emergency department with dog bites. Disclosures: Dr Yeung did not report external funding sources and declared no financial conflicts. |
SAN DIEGO – Pit bulls caused 42% of dog bites for which children were hospitalized, a 4-year retrospective study showed.
Bites by pit bulls had a 40% greater odds of a full trauma team response, and were linked to a 3-day longer mean hospital stay, compared with bites by other dogs [4.2 days vs. 1.3 days], reported lead author Dr Claudia Yeung of Arizona Children’s Center and Maricopa Integrated Health System in Phoenix.
Of about 885,000 dog bites that need medical attention in the United States every year, half affect children, according to the Centers for Disease Control and Prevention. Dr Yeung and her colleagues reviewed the medical charts of 223 children and adolescents who presented with dog bites to the emergency department at Arizona Children’s Center from March 2010 through March 2014. Of the children who presented, 33 (15%) were hospitalized and 12 (5%) required the response of a full trauma team.
Hospitalized children in the study averaged 6 years of age, and almost 82% needed surgical intervention in the operating room. Children younger than age 5 years were more likely to sustain injuries to the face or neck than were older children (51% vs. 21%), she reported.
Besides pit bulls, the most commonly reported breeds associated with bites were German shepherds, Rottweilers, and Labrador retrievers, Dr Yeung said. A limitation of the study was that some medical records lacked data on the breed of the dog.
Doubling of US heroin deaths spurs call for increased naloxone access
By: M. Alexander Otto
Vitals Key clinical point: Heroin overdoses can be reduced by public education about the risks of prescription opioid abuse and by the distribution of intranasal naloxone kits to at-risk populations. Major finding: In a representative sample of 28 states from 2010 to 2012, heroin deaths climbed from 1,779 to 3,635, a rate increase from 1.0 to 2.1 per 100,000 population. Data source: Statistical analysis of state health records. Disclosures: The MMWR is published by the Centers for Disease Control and Prevention. |
Fatal heroin overdoses doubled in the United States from 2010 to 2012, according to a report in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention.
In a representative sample of 28 states, heroin deaths climbed from 1,779 to 3,635, a rate increase from 1.0 to 2.1 per 100,000 people. At the same time, deaths from prescription opioids fell from 10,427 to 9,869, a decrease from 6.0 to 5.6 per 100,000 people (MMWR2014;63:849-54).
In Northeastern states, fatal heroin overdoses increased 211%. Southern states had an increase of 181%, Midwestern states an increase of 62%, and Western states an increase of 91%, based on state health department data.
The report did not give numbers for individual states, only regions, but it did note that Kentucky reported a 279% increase in heroin deaths from 2010 to 2012, and Ohio had an increase of approximately 300% from 2007 to 2012.
The investigators found no statistically significant relationship between the increase in heroin deaths and the decrease in prescription opioid fatalities. However, they noted that about 75% of heroin users report using prescription opioids first, then switching to heroin, a cheaper, more readily available alternative that gives a more potent high.
Young adults are sometimes unaware that prescription pain pills are opioids and that their abuse can slip into heroin use. Particularly hard hit communities have reduced opioid fatalities by getting that message out through education campaigns, and also by distributing intranasal naloxone kits to the people most likely to need them: first responders, family members, and opioid abusers who might need to rescue a friend.
“State policies that increase access to naloxone, a drug that can reverse potentially fatal respiratory depression in persons who have overdosed from either OPRs [opioid pain relievers] or heroin, or policies that reduce or eliminate penalties when someone reports an overdose, are potentially useful strategies” to counter the problem, said the researchers, led by CDC statistician Rose A. Rudd.
