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Last Updated: 10/02/01

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Analysis of Prior Health System Contacts as a Harbinger of Subsequent Fatal Injury in American Indians.


Sanddal, T.L.., Sanddal, N.D., Upchurch J., Esposito, T.E. (2000) Analysis of prior health system contacts as a harbinger of subsequent fatal injury in american indians. Annals of Emergency Medicine (Submitted for publication).

Objective: To identify and characterize any association between prior injury or alcohol-related acute care contacts with the Indian Health Service (IHS) and subsequent alcohol-related injury death that may suggest opportunities for mitigation.

Methods: All death certificates involving American Indians who died from injury (ICD-9-E 800999) in a rural IHS Area from 1/1/90-12/31/95 were obtained and linked to IHS acute care facility records. Linkage to toxicology reports performed on the deceased was also conducted. An association was sought between IHS facility contacts occurring within 24 months of a fatal injury. Deaths and prior IHS contacts were stratified by alcohol use as a contributing factor. Non-parametric chi square analyses were conducted.

Results: Of the 526 injury deaths involving American Indians in the IHS Area studied, 411 (78%) were successfully linked. Of these, 256 (63%) had IHS facility contact within the 24 months of death. Alcohol use at time of death (BAC 0.0) could be determined in 250 of 411 records (61%), 152 (59%) of these had a prior IHS facility contact. No difference in alcohol use at time of death between groups with and without prior IHS contact could be determined overall (81% vs 74% p = .21). In those decedents who had a prior IHS contact for injury without mention of alcohol, there was no association with subsequent alcohol-related injury fatality (p = .29). Prior injury visits with alcohol as a contributor were also shown not to be associated with subsequent alcohol-related injury fatality (p = .41). A statistically significant relationship was found between previous visits for acute or chronic alcohol treatment events and subsequent alcohol-related fatalities (p = .01).

Conclusion: In this population, prior health system contacts for any reason, including injury, do not appear to be associated with subsequent alcohol-related injury deaths unless alcohol use is a precipitating or co-morbid finding at the time of that contact. Based on these findings, injury prevention activities in the population studied should be initiated at the time of any health system contact in which alcohol use is identified. Intervention strategies should be developed that convey the immediate risk of death from injury in these patients using both traditional native and non-native materials and approaches.


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