Seasonal Variation of Trauma in Western Massachusetts: Fact or Folklore?

background Previous studies have demonstrated a significant relationship between weather or seasons and total trauma admissions. We hypothesized that specific mechanisms such as penetrating trauma, motor vehicle crashes, and motorcycle crashes (MCCs) occur more commonly during the summer, while more falls and suicide attempts during winter. Methods A retrospective review of trauma admissions to a single Level I trauma center in Springfield, Massachusetts from 01/2010 through 12/2015 was performed. Basic demographics including age, Injury Severity Score (ISS), and length of stay were collected. Linear regression analysis was used to test the association between monthly admission rates and season, year, injury class, and mechanism of injury, and whether seasonal variation trends were different according to injury class or mechanism. results A total of 8886 admissions had a mean age of 44.6 and mean ISS of 11.9. Regression analysis showed significant seasonal variation in blunt compared with penetrating trauma (p<0.001), MCC (p<0.001), and falls (p=0.002). In addition, seasonal variation differed according to injury class or mechanism. There were significantly lower rates of MCCs in winter compared with all other seasons and conversely higher rates of total falls in winter compared with other seasons. Discussion A significant seasonal variation in blunt trauma, MCC, and falls was observed. This has potential ramifications for resource allocation, including trauma prevention programs geared toward mechanisms of injury with significant seasonal variation. Level of evidence Retrospective Review, Level IV. IntroDuctIon Trauma is the leading cause of death in persons under the age of 46 and third leading cause of death in all ages.1 According to the CDC, in 2010 combined fatal and nonfatal unintentional injury resulted in total medical costs greater than $73 billion, with an estimated $419 billion when accounting for loss of work.2 Community-based prevention programs have been shown to prevent injury-related morbidity and mortality and reduce healthcare costs.3 The American Association for the Surgery of Trauma suggests a 10-step process for developing an injury prevention program. The first step consists of gathering and analyzing data, while the second step is to target an injury and the population affected.4 In order to do this effectively and efficiently, it would be ideal to target the most ‘at risk’ population near the most ‘at risk’ time. Previous studies have demonstrated an association of increased overall trauma admissions with weather and temperature.5–7 Ho et al showed significant variation of penetrating trauma with changes in temperature.8 Bhattacharyya et al found individual weather changes such as maximum temperature and precipitation as independent predictors of trauma admissions.9 Studies have also reported that there is a high incidence of specific mechanisms of injury such as motor vehicle crashes (MVCs), falls, gunshot, stab, assault, and motorcycle crashes (MCCs).10 11 Similarly, these are the most common mechanisms at our institution. However, there are no studies that have evaluated seasonal variation with specific mechanisms of injury. The purpose of this study was to determine whether there is any seasonal variation in trauma admissions and whether this variation differs for specific mechanisms of injury that are either common (ie, MVCs, MCCs, falls, or penetrating trauma) and/or have historical data suggesting seasonal or temperate variation (suicide and elderly falls).12 13 We hypothesized that penetrating trauma, MVCs, and MCCs occur more commonly during the summer, while more falls and suicides attempts occur during winter. MethoDs After obtaining institutional review board exemption, all trauma patients admitted to a Level I trauma center in Springfield, Massachusetts between January 1, 2010 and December 31, 2015 were retrospectively reviewed. Basic demographic variables were collected to provide context of the type of patients seen which include: date of injury, age, gender, Injury Severity Score (ISS), hospital length of stay, and mechanism of injury, and injury class (blunt or penetrating). Penetrating injuries were defined as injuries resulting from gunshot, stab wounds, impalements defined by Abbreviated Injury Scale, while blunt trauma were all other mechanisms of injuries excluding burns and penetrating trauma. Data were subdivided based on months of the year as well as seasons: Winter (December to February), Spring (March to May), Summer (June to August), and Fall (September to November). Linear regression was used to analyze seasonal trends in mean monthly admissions across all patients by season, year and injury class (blunt or penetrating), or season, year, and mechanism of injury for selected mechanisms: motor vehicle collisions, motorcycle collisions, suicide attempts, falls, and falls in age greater than 65 years old. To Seasonal Variation of Trauma in Western Massachusetts: Fact or Folklore? Jeffry Nahmias,1,2 Shiva Poola,2 Andrew Doben,2 Jane Garb,2 Ronald I Gross2 to cite: Nahmias J, Poola S, Doben A, et al. Trauma Surg Acute Care Open 2017;2:1–5. 1Department of Surgery, University of California Irvine Medical Center, Orange, California, USA 2Department of General Surgery, Baystate Medical Center, Springfield, Massachusetts, USA correspondence to Dr Shiva Poola, Department of General Surgery, Baystate Medical Center, Springfield, Massachusetts, MA 01199, USA; shivapoola@ gmail. com Received 20 June 2017 Revised 9 August 2017 Accepted 11 August 2017 Original Article group.bmj.com on October 10, 2017 Published by http://tsaco.bmj.com/ Downloaded from