Objectives: The hazardous environmental conditions hurricanes create might increase injury incidence almost 7 times. Therefore, a cohort study was performed at the Puerto Rico Trauma Hospital to compare morbidity and mortality patterns of patients after Hurricane Maria with a control period. Methods: Admissions from September 20, 2017, through January 20, 2018, constituted the post-Maria period (473 patients); the corresponding months of the previous year comprised the pre-Maria period (439 patients). Comparisons were done using Pearson’s chi-square or Mann-Whitney U-tests, as appropriate. A logistic regression was performed to assess the association between mortality and the study period. Results: Postlandfall admissions among patients aged 40-64 y increased by 6.6%, while among subjects between ages 18 and 39 y dropped by 7.0% (P = 0.03). Falls, gunshots, and burns were the injury mechanisms that varied the most across the exposure period. The median Injury Severity Score (13 vs 12; P = 0.05) and the frequency of Glasgow Coma Scale scores ≤8 (17.1% vs 10.9%; P = 0.03) were higher among poststorm patients. Moreover, a 2-fold (odds ratio = 1.93; 95% CI: 1.07-3.47) increase in mortality was observed after Maria, when adjusting for covariates. Conclusions: Following a hurricane, trauma centers might expect an older population, with more severe injuries and a 2-fold increased mortality risk.

Background: Hurricanes are among the most devastating natural disasters, playing a significant role in public health. Currently, the epidemiology of fall-related injuries after the occurrence of a tropical storm is not well described. This study aims to compare the demographical patterns, clinical profile, hospital course, and costs of patients admitted to the Puerto Rico Trauma Hospital before and after Hurricane Maria. Methods: A retrospective study was performed to compare fall-related injuries after the hurricane (September 20, 2017-January 20, 2018) with a control period (same period in 2014-2016). Comparison between the groups was done using chi-square, Mann-Whitney test, and logistical regression. Results: After the hurricane, there was an increase in the proportion of fall-related admissions in subjects aged 40-64 years (39.2% vs. 50.6%) and a decrease among those aged 18-39 years (16.0% vs. 5.9%), when compared with the previous years. A greater proportion of patients presented with work related injuries (3.9% vs. 9.4%). No significant differences were identified for sex, Glasgow Coma Scale, Injury Severity Score, and hospital outcomes (hospital and intensive care unit days, mechanical ventilation, and mortality). Intracranial injuries were marginally higher post-Maria (p = 0.06). In multivariate analysis, during the post-Maria period, an increased risk of fall-related injuries was observed among subjects ≥40 years (OR: 3.20) and injuries related to recovery work (OR: 2.64) (p < 0.05). Conclusions: Our study shows that there is an increased risk of fall-related injuries among middle-aged individuals after a hurricane, causing significant changes in epidemiology. This study helps to elucidate the health consequences of falls and, in doing so, improves healthcare preparedness, interventions, and planning for future natural disasters.

Purpose Substance misuse has long been recognized as a major predisposing risk factor for traumatic injury. However, there still exists no clear scientific consensus regarding the impact of drug use on patient outcomes. Therefore, this study aims to evaluate the demographic profile, hospital-course factors, and outcomes of trauma patients based on their toxicology. Methods This is a non-concurrent cohort study of 3709 patients treated at the Puerto Rico Trauma Hospital during 2002–2018. The sample was divided into four groups according to their toxicology status. Statistical techniques used included Pearson’s chi-square test, Spearman correlation, and negative binomial and logistic regressions. Results Admission rates for marijuana (rho = 0.87) and marijuana and cocaine positive (rho = 0.68) patients increased. Positive toxicology patients underwent surgery more often than negative testing patients (marijuana: 68.7%, cocaine: 65.6%, marijuana & cocaine: 69.8%, negative: 57.0%). Among patients with non-penetrating injuries, a positive toxicology for cocaine or marijuana was linked to a 48% and 42% increased adjusted risk of complications, 37% and 27% longer TICU LOS, and 32% and 18% longer hospital LOS, respectively. Conclusion Our results show an association between positive toxicology for either marijuana, cocaine, or both with higher need for surgery. Additionally, our results show an increase in complications, TICU LOS, and hospital LOS among non-penetrating trauma patients testing positive for marijuana or cocaine. Therefore, this study provides valuable information on the clinical profile of patients with positive toxicology, suggesting they might benefit from more aggressive management.

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