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Impact of a prison triage system on injuries seen in emergency departments

Published online by Cambridge University Press:  21 May 2015

Nick Kuzak ,
Michael O’Connor ,
William Pickett ,
Terry O’Brien ,
Ken Reid  and
Mary Pearson
Nick Kuzak
Affiliation:
First-year resident in Emergency Medicine, University of British Columbia, Vancouver, BC.
Michael O’Connor*
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont
William Pickett
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont Department of Community Health and Epidemiology, Queen’s University, Kingston, Ont
Terry O’Brien
Affiliation:
Residency Emergency Medicine Program Director, Queen’s University, Kingston, Ont
Ken Reid
Affiliation:
Department of Cardiothoracic Surgery, Queen’s University, Kingston, Ont
Mary Pearson
Affiliation:
Department of Family Medicine, Queen’s University, Kingston, Ont
*
Professor and Head, Department of Emergency Medicine, Queen’s University, Kingston General Hospital, 76 Stuart St., Kingston ON K7L 2V7; 613 548-2368, fax 613 548-1374, oconnorh@kgh.kari.net

Abstract

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Objectives:

1) To describe injuries experienced by the male prisoner population in the Kingston, Ontario area, and to compare them with those observed in the general population; and 2) to compare the incidence and patterns of prisoner injuries seen in emergency departments (EDs) before and after the introduction of a prison injury triage system.

Design:

A chart review.

Setting:

The catchment area surrounding 2 hospital-based EDs in Kingston, Ontario, which includes 8 federal and provincial prisons for adult males.

Observations:

Injuries to male prisoners (ages 18–75 years) who were treated in the ED during 1996–98 were compared with injuries to the general male population of the same age range. An on-site emergency care triage system was introduced to area prisons in 1993. Prisoner injuries seen in the ED during 1996–98 were compared with those seen during a similar period prior to the introduction of the triage system (1981–84). Available comparators included patient demographics, disposition, intent and nature of injury, the need for surgery, and lengths of hospital stay.

Results:

148 prisoner injuries were identified for 1996–98. Prisoner injuries seen in the ED were relatively severe when compared with the general male population, as indicated by the higher frequency of fractures (31.8% prisoner vs. 13.4% general, p < 0.001), blunt head injuries (10.1% vs. 2.2%, p < 0.001), hospital admissions (42.6% vs. 4.1%, p < 0.001) and deaths (2.7% vs. 0.6%, p < 0.001). Since the introduction of the triage system there has been a reduction in the rate of prisoner injuries seen in local hospital EDs (6.1/100/yr [before] vs. 1.6/100/yr [after], p < 0.001). There has been an increase in the relative severity of prisoner injuries seen in the EDs as indicated by the increased hospital admission rate (42.6% vs. 22.7%, p < 0.001), increased rate of surgical intervention (27.7% vs. 12.1%, p < 0.001), and increased length of hospital stay (4.0 days vs. 2.1 days, p < 0.05). The mortality rate has remained low and unchanged (0.7% vs. 1.1%, p = 0.99).

Conclusions:

The introduction of the new triage system appeared to be associated with a decrease in the total number of ED visits by prisoners. The relative acuity of prisoner injuries seen in the EDs appeared to increase following introduction of the triage system.

Type
EM Advances • Progrès de la MU
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 3 , July 2001 , pp. 199 - 204
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

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