1. Illinois Trauma Following the 9/11/01 Terrorist Attacks Scott A Miller, MD Edward P Sloan, MD, MPH University of Illinois at Chicago

2. Introduction: Clinical Issues  Sept 11 a significant day in history  USA seemed to come to standstill  Behavior of people altered significantly  Did the change in behavior affect trauma frequency?

3. Introduction: Prior Work on Sept 11  Johnston 2002: Fewer injuries, more CP after 9/11  Schlenger 2002: More PTSD months after 9/11  Galea 2002: More PTSD close to WTC  Silver 2002: More PTSD immediately after 9/11  Schuster 2001: Stress increased after 9/11  Cardenas 2002: More depression, ETOH, drugs  There was a change in psyche and behavior in the days following 9/11

4. Introduction: Study Questions  What was the impact of Sept 11 on trauma? Overall trauma? Overall trauma? Intentional vs. unintentional? Intentional vs. unintentional? Chicago vs. Non-Chicago? Chicago vs. Non-Chicago?  Was the weekly periodicity affected?

5. Methods: Data Collection  Illinois Department of Public Health trauma registry  Statewide data from Level I & II trauma centers - Traumatic injuries - Admitted, transferred, or DOA - Discharged patients not included in registry - External classification of disease (E-code) to determine type of trauma

6. Results: Mechanism of Injury Most trauma was blunt and unintentional

7. Results: Major Subgroup Comparison Chicago Non-Chicago Unintentional Intentional

8. Results: Time Periods  Week One Sept 5-11, 2000877  Week Two Sept 12-18, 2000859  Week Three Sept 4-10, 2001946  Week Four Sept 11-17, 2001792

9. Results: Overall Trauma Volume  2000 (Wk 1,2): 124/day  2001 (Wk 3): 135/day+9.0%p<.002  2001 (Wk 4): 113/day-8.8%p<.008  Despite greater trauma volume in 2001, it was reduced after 9/11

10. Results: Difference Between Weeks 2000 Wk 12000 Wk 22001 Wk 32001 Wk 4

11. Results: Difference Between Weeks Week 1 vs. 2 Down 2% in 2 NS Avg 1&2 vs. 3 Up 9% in 3 p=0.002 Avg 1&2 vs. 4 Down 9% in 4 p=0.008 Week 3 vs. 4 Down 16% in 4 p=0.001 Avg 1,2&3 vs. 4 Down 11% in 4 p=0.003

12. Results: Unintentional Trauma  2000 (Wk 1,2): 108/day  2001 (Wk 3): 117/day+10.0%p<.003  2001 (Wk 4): 97/day-9.8%p<.018  Unintentional trauma increased in 2001, with a significant decrease after 9/11

13. Results: Non-Chicago Trauma  2000 (Wk 1,2): 92/day  2001 (Wk 3): 106/day+13.4%p<.003  2001 (Wk 4): 88/day-9.2%p<.049  Trauma outside of Chicago was increased in 2001, but decreased after 9/11

14. Results: Other Comparisons  Intentional—no significant change  Chicago—no significant change  No trauma center specific data

15. Results: Week 4 Week 3 2000

16. Results: Comparison by day  Week 4 volume less for every day of week  Still a periodicity in week 4  Shape of curve similar to week 2, suggesting no significant difference in periodicity

17. Conclusions: Illinois Trauma After 9/11  Despite increasing in 2001, trauma volume significantly decreased after 9/11  Change was in unintentional trauma and outside of urban setting  Decrease implies less risky behavior by population  Weekly periodicity remained after 9/11 with increase of trauma on weekend

18. Recommendations: Trauma after 9/11  Future research should link each trauma to the corresponding hospital.  Analyze other major events (Oklahoma city bombing, other terrorist attacks)  Nationwide analysis

19. Implications: Trauma after 9/11  Potential to divert resources