Tom, Andy

Background/objectives: Falls are a leading cause of traumatic injury and hospitalization for adults over the age of 65. While common, bed-related falls are relatively understudied when compared to ambulatory falls. The aim of this study is to characterize the risk factors for the hospitalization of older adults presenting to U.S. emergency departments (EDs) after a fall from bed. Methods: This was a cross-sectional study using publicly available data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) from 2014 to 2023, including all adults over the age of 65 presenting to the NEISS’s participating EDs with bed-related fall injuries. We identified fall injuries using a keyword search of the NEISS narratives and determined how the fall occurred by manually reviewing a randomized 3% sample of the narratives. We summarized demographics and injury patterns with descriptive statistics. We constructed a multivariable logistic regression model to identify risk factors for hospitalization and used Poisson regression to assess temporal trends in fall incidence and hospital admissions. Results: An estimated average of 320,751 bed-related fall injuries presented to EDs annually from 2014 to 2023. ED visits increased by 2.85% per year, while hospital admissions rose by 5.67% per year (p < 0.001). The most common injury patterns were superficial injuries (contusions, abrasions, lacerations, avulsions, and punctures) (28.6%), fractures (21.7%), and internal injuries (including concussions) (21.6%). Most of the falls occurred while transitioning into or out of bed (34.4%) or falling out of bed (56.8%). Hospitalization was required in 34.1% of cases and was associated with male sex, medication use at time of injury, and fracture injuries. Conclusions: Bed-related falls and associated hospitalizations are increasing among older adults. ED providers should understand risk factors for hospitalization in these common injuries such as male sex, medication use at time of injury, and high-risk injury patterns. Additionally, prevention efforts should focus on helping older adults remain safely in bed and then assisting with transitions into or out of bed.

Abstract Firework injuries remain a significant public health concern, with an estimated 9700 injuries reported in 2023. This study examines trends in pediatric facial injuries from fireworks over the past decade using the National Electronic Injury Surveillance System. Pediatric cases from 2014 to 2023 were identified using the fireworks consumer code (1313) and filtered for facial injuries (body part code 76). Data was analyzed using chi-square tests to assess significance and logistic regression to evaluate trends. An estimated 4625 pediatric facial injuries from fireworks presented to emergency departments nationwide from 2014 to 2023. Among cases (n = 177), 68.4% were male and 31.6% were female. Thermal burns (60.5%), lacerations (15.3%), and contusions/abrasions (11.9%) were the most common injuries. Males were more likely to be injured than females (P-value: &lt; .001). Overall, 17.5% of injuries required hospitalization or transfer. Older children were significantly more likely to sustain injuries requiring hospitalization (Odds Ratio [OR]: 1.13, 95% CI, 1.04-1.23, P = .005). Younger children had higher odds of sparkler-related injuries, although the risk rapidly decreased with age (OR: 0.76, 95% CI, 0.68-0.86, P &lt; .001). Our results show fireworks continue to cause significant pediatric facial injuries, with thermal burns being the most common diagnosis, and nearly one in 5 facial injuries from fireworks requiring hospitalization. Efforts to reduce facial injuries from fireworks should focus on minimizing the risk of injury in younger children while ensuring safety protocols are in place to address more significant injuries in older children.

Objectives/Goals: Undergraduate Medical Education (UME) may apply Just-in-Time training (JITT) to provide medical students with learning experiences closely aligned with real-time clinical needs. The purpose of this scoping review is to offer an overview of the implementation of JITT training in UME. Methods/Study Population: Following the five-stage framework by Arksey and O’Malley to methodically collect and analyze studies on JITT in UME, five electronic databases were searched, and a supplemental search for grey literature was conducted. Studies exploring the integration of JITT principles into UME clinical training and their time to follow-up after training were included. Bloom’s Taxonomy was used to assess educational goals of JITT interventions. Results/Anticipated Results: The review yielded 21 studies across 4 countries. The majority were cohort studies (13) and randomized control trials (5). Assessment definitions and use of JITT varied widely. Most studies focused on short-term outcomes, defined by being measured immediately after JITT session (15) or at the end of JITT-based rotation or clerkship (3). Three studies evaluated outcomes at a period longer than 2 weeks after completion of session or clerkship. Attitudes (9), followed by skills (8) were the most common educational goals of intervention. The efficacy and utility of JITT in improving educational goal acquisition was demonstrated in 90% (17/19) of the studies with reported outcomes. Discussion/Significance of Impact: The introduction of JITT in UME has been shown to meet the immediate needs of healthcare environments; however, evidence is limited in the evaluation of longer-term outcomes. Further research to determine the impact of JITT on long-term learning retention and education goal acquisition in UME is merited.