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Open Access

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

Jeffry Nahmias, Shiva Poola, Andrew Doben, Jane Garb, Ronald I Gross
DOI: 10.1136/tsaco-2017-000120 Published 7 September 2017
Jeffry Nahmias
1 Department of Surgery, University of California Irvine Medical Center, Orange, California, USA
2 Department of General Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
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Shiva Poola
2 Department of General Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
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Andrew Doben
2 Department of General Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
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Jane Garb
2 Department of General Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
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Ronald I Gross
2 Department of General Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
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    Figure 1

    Trauma admissions by month and year. ISS, Injury Severity Score.

  • Figure 2
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    Figure 2

    Predicted mean monthly admissions by season and mechanism.

Tables

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  • Table 1

    Trauma demographics

    Total admissions8886
    Average age, years (range)44.6 (1–102)
    Average ISS (range)11.9 (1–75)
    LOS, days (range)5.2 (1–104)
    N%
    Gender
     Male592366.7
     Female296333.3
    Injury classN (%)
    Penetrating864 (9.7)
    Blunt8022 (90.3)
    Mechanism of injury (n=4444)(N, % of total)
     MVC1546 (17.4)
     Falls1389 (15.6)
     Falls aged >65898 (10.1)
     MCC430 (4.8)
     Suicide181 (2.0)
    • ISS, Injury Severity Score; LOS, length of stay; MCC, motorcycle crashes; MVC, motor vehicle crashes; N, count.

  • Table 2

    Regression on monthly admissions by season, injury class, and year

    CoefficientSEtp Value95% CI
    Season (vs Winter)*
     Spring6.74.41.50.129−2.0 to 15.4
     Summer5.64.41.30.205−3.1 to 14.3
     Fall2.64.40.60.562−6.2 to 11.3
    Injury class (vs Penetrating)
     Blunt—all seasons87.24.419.8<0.00178.5 to 95.9
    Season/Class (vs Winter/Blunt)
     Spring/Blunt5.26.20.80.403−7.1 to 17.5
     Summer/Blunt22.76.23.7<0.00110.4 to 35.0
     Fall/Blunt21.16.23.40.0018.7 to 33.4
    Year (vs 2013)
     201014.83.83.9<0.0017.3 to 22.4
     201114.33.83.7<0.0016.7 to 21.8
     20126.73.81.80.083−0.9 to 14.2
     20147.43.82.00.054−0.1 to 15.0
     201512.63.83.30.0015.0 to 20.1
    • *Total admissions.

  • Table 3

    Predicted mean monthly admissions

    Mean (95% CI)
    Season
     Winter51.9 (47.5 to 56.2)
     Spring61.2 (56.8 to 65.5)
     Summer68.8 (64.5 to 73.2)
     Fall64.9 (60.6 to 69.3)
    Class
     Penetrating12.0 (8.9 to 15.1)
     Blunt111.4 (108.3 to 114.5)
    Season/Class
     Winter/Penetrating8.3 (2.1 to 14.4)
     Spring/Penetrating15.0 (8.8 to 21.2)
     Summer/Penetrating13.9 (7.7 to 20.0)
     Fall/Penetrating10.8 (4.7 to 17.0)
     Winter/Blunt95.4 (89.3 to 101.6)
     Spring/Blunt107.4 (101.2 to 113.5)
     Summer/Blunt123.8 (117.6 to 129.9)
     Fall/Blunt119.1 (112.9 to 125.9)
    Year
     201067.3 (61.9 to 72.6)
     201166.7 (61.3 to 72.0)
     201259.1 (53.8 to 64.4)
     201352.4 (47.1 to 57.7)
     201459.8 (54.5 to 65.2)
     201565.0 (59.7 to 70.3)
  • Table 4

    Predicted mean monthly admissions

    MechanismSeasonMean (95% CI)Excess versus referencep Value
    SuicideSpring3.3 (1.1 to 5.5)1.70.273
    Winter*1.6 (−0.6 to 3.7)
    Summer3.0 (0.8 to 5.2)1.40.358
    Fall2.2 (0.0 to 4.4)0.70.671
    MVCSpring*19.1 (16.9 to 21.2)
    Winter22.2 (20.0 to 24.4)3.20.044
    Summer21.4 (19.2 to 23.6)2.30.138
    Fall23.2 (21.0 to 25.4)4.20.008
    MCCSpring†5.7 (3.5 to 7.8)5.20.001
    Winter*0.4 (−1.7 to 2.6)
    Summer†11.4 (9.3 to 13.6)11.0<0.001
    Fall†6.3 (4.2 to 8.5)5.9<0.001
    FallsSpring18.2 (16.0 to 20.3)0.50.75
    Winter†22.5 (20.3 to 24.7)4.80.002
    Summer*17.7 (15.5 to 19.8)
    Fall18.8 (16.7 to 21.0)1.20.458
    Falls>65Spring11.5 (9.3 to 13.7)0.10.972
    Winter15.3 (13.2 to 17.5)3.90.014
    Summer*11.4 (9.3 to 13.6)
    Fall11.6 (9.4 to 13.8)0.20.915
    • *Represents reference.

    • †Represents significance.

    • MCC, motorcycle crashes; MVC, motor vehicle crashes.

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Seasonal Variation of Trauma in Western Massachusetts: Fact or Folklore?
Jeffry Nahmias, Shiva Poola, Andrew Doben, Jane Garb, Ronald I Gross
Trauma Surg Acute Care Open Sep 2017, 2 (1) e000120; DOI: 10.1136/tsaco-2017-000120

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Seasonal Variation of Trauma in Western Massachusetts: Fact or Folklore?
Jeffry Nahmias, Shiva Poola, Andrew Doben, Jane Garb, Ronald I Gross
Trauma Surg Acute Care Open Sep 2017, 2 (1) e000120; DOI: 10.1136/tsaco-2017-000120
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Seasonal Variation of Trauma in Western Massachusetts: Fact or Folklore?
Jeffry Nahmias, Shiva Poola, Andrew Doben, Jane Garb, Ronald I Gross
Trauma Surgery & Acute Care Open Sep 2017, 2 (1) e000120; DOI: 10.1136/tsaco-2017-000120
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