Henry Xiang - Academia.edu (original) (raw)

Papers by Henry Xiang

Injury Epidemiology, 2015

Children with disabilities are thought to have an increased risk of unintentional injuries, but q... more Children with disabilities are thought to have an increased risk of unintentional injuries, but quantitative syntheses of findings from previous studies have not been done. We conducted a systematic review and meta-analysis to assess whether pre-existing disability can increase the risk of unintentional injuries among children when they are compared to children without disability. We searched 13 electronic databases to identify original research published between 1 January 1990 and 28 February 2013. We included those studies that reported on unintentional injuries among children with pre-existing disabilities compared with children without disabilities. We conducted quality assessments and then calculated pooled odds ratios of injury using random-effects models. Fifteen eligible studies were included from 24,898 references initially identified, and there was a total sample of 83,286 children with disabilities drawn from the eligible studies. When compared with children without disabilities, the pooled OR of injury was 1.86 (95 % CI 1.65-2.10) in children with disabilities. The pooled ORs of injury were 1.28, 1.75, and 1.86 in the 0-4 years, 5-9 years, and ≥10 years of age subgroups, respectively. Compared with children without disabilities, the pooled OR was 1.75 (95 % CI 1.26-2.43) among those with International Classification of Functioning (ICF) limitations. When disability was defined as physical disabilities, the pooled OR was 2.39 (95 % CI 1.43-4.00), and among those with cognitive disabilities, the pooled OR was 1.77 (95 % CI 1.49-2.11). There was significant heterogeneity in the included studies. Compared with peers without disabilities, children with disabilities are at a significantly higher risk of injury. Teens with disabilities may be an important subgroup for future injury prevention efforts. More data are needed from low-and middle-income countries.

medRxiv (Cold Spring Harbor Laboratory), Mar 21, 2024

The authors affirm that the methods used in the data analyses are suitably applied to their data ... more The authors affirm that the methods used in the data analyses are suitably applied to their data within their study design and context, and the statistical findings have been implemented and interpreted correctly. The authors agree to take responsibility for ensuring that the choice of statistical approach is appropriate and is conducted and interpreted correctly as a condition to submit to the Journal.

Opioids are the most frequently used pain medications by US burn centers to control severe proced... more Opioids are the most frequently used pain medications by US burn centers to control severe procedural pain during wound care. Concerns for long-term opioid use have prompted the exploration of non-pharmaceutical interventions, such as virtual reality (VR), for procedural pain management. The primary objective of this pilot study was to evaluate the feasibility and efficacy of VR pain alleviation treatment on reducing adult burn patients’ perceived pain during burn dressing changes. Adult patients aged 18-70 years were recruited from the inpatient unit of a single American Burn Association–verified burn center between May 2019 and February 2020 and randomly assigned to one of three arms. Active VR participants played four VR games; passive VR participants were immersed in the same VR environment without the interaction elements; and a standard of care control group. 71 patients were screened for eligibility and 33 were deemed eligible to approach for informed consent, with 14 agreein...

International Journal of Environmental Research and Public Health, Jun 5, 2018

Objective: To use the 2006-2013 Nationwide Emergency Department Sample (NEDS) database to describ... more Objective: To use the 2006-2013 Nationwide Emergency Department Sample (NEDS) database to describe trends of age-adjusted rates of pediatric traumatic brain injuries (TBI) treated in U.S. emergency departments. Methods: Time trend analysis was conducted on age-adjusted rates among children ≤17 years in the U.S. The annual percent change (APC) was calculated by fitting a least squares regression to the logarithm of the rates, using the calendar year as an independent variable. Results: In males, motor-vehicle-related trauma (APC −2.5%) and severe TBI (APC −3.6%) decreased over the study time period. Conversely, concussion (APC 5.1%), unspecified head injury (APC 6.6%), fall-related TBI (APC 7.1%), and mild TBI (APC 5.9%) increased. In females, severe TBI (APC −3.3%) decreased over the study time period and concussion (APC 6.5%), unspecified head injury (APC 7.2%), fall-related TBI (APC 7.6%), and mild TBI (APC 6.8%) increased. Conclusion: The overall age-adjusted rates of pediatric TBI-related emergency department (ED) visits increased from 2006 to 2013, which is largely caused by pediatric mild TBIs, especially unspecified injury to the head (ICD-9-CM code 959.01) and concussion. In comparison, age-adjusted rates of pediatric severe TBIs decreased. A major contributing factor might be a reduced number of traffic-related head trauma.

International Journal of Environmental Research and Public Health

Exposure to high temperatures is detrimental to human health. As climate change is expected to in... more Exposure to high temperatures is detrimental to human health. As climate change is expected to increase the frequency of extreme heat events, and raise ambient temperatures, an investigation into the trend of heat-related emergency department (ED) visits over the past decade is necessary to assess the human health impact of this growing public health crisis. ED visits were examined using the Nationwide Emergency Department Sample. Visits were included if the diagnostic field contained an ICD-9-CM or ICD-10-CM code specific to heat-related emergency conditions. Weighted counts were generated using the study design and weighting variables, to estimate the national burden of heat-related ED visits. A total of 1,078,432 weighted visits were included in this study. The annual incidence rate per 100,000 population increased by an average of 2.85% per year, ranging from 18.21 in 2009, to 32.34 in 2018. The total visit burden was greatest in the South (51.55%), with visits increasing to the...

arXiv (Cornell University), Sep 8, 2020

Trauma mortality results from a multitude of non-linear dependent risk factors including patient ... more Trauma mortality results from a multitude of non-linear dependent risk factors including patient demographics, injury characteristics, medical care provided, and characteristics of medical facilities; yet traditional approach attempted to capture these relationships using rigid regression models. We hypothesized that a transfer learning-based machine learning algorithm could deeply understand a trauma patient's condition and accurately identify individuals at high risk for mortality without relying on restrictive regression model criteria. Anonymous patient visit data were obtained from years 2007-2014 of the National Trauma Data Bank. Patients with incomplete vitals, unknown outcome, or missing demographics data were excluded. All patient visits occurred in U.S. hospitals, and of the 2,007,485 encounters that were retrospectively examined, 8,198 resulted in mortality (0.4%). The machine intelligence model was evaluated on its sensitivity, specificity, positive and negative predictive value, and Matthews Correlation Coefficient. Our model achieved similar performance in age-specific comparison models and generalized well when applied to all ages simultaneously. While testing for confounding factors, we discovered that excluding fall-related injuries boosted performance for adult trauma patients; however, it reduced performance for children. The machine intelligence model described here demonstrates similar performance to contemporary machine intelligence models without requiring restrictive regression model criteria or extensive medical expertise.

Background: Virtual Reality (VR) gaming is considered a safe and effective alternative to standar... more Background: Virtual Reality (VR) gaming is considered a safe and effective alternative to standard pain alleviation in the hospital. This study will address the effectiveness and feasibility of a VR game that was developed by our research team for repeated at-home burn dressing changes. Methods: A randomized clinical trial was conducted among patients recruited from the outpatient burn clinic of a large American Burn Association–verified pediatric burn center between September 2019 and June 2021. We included English-speaking burn patients 5-17 years old requiring daily dressing changes for at least one week after first outpatient dressing change. One group played an interactive VR game during dressing changes, while the other utilized standard distraction techniques available in the home for up to a week. Both child and caretaker were asked to assess perceived pain on a scale of 1-10. For the VR group, patients were also asked to rate various aspects of the VR game on a scale of 1-1...

JAMA Network Open, 2021

IMPORTANCE It is unknown whether smartphone-based virtual reality (VR) games are effective in red... more IMPORTANCE It is unknown whether smartphone-based virtual reality (VR) games are effective in reducing pain among pediatric patients in real-world burn clinics. OBJECTIVE To evaluate the efficacy of a smartphone VR game on dressing pain among pediatric patients with burns. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included children aged 6 to 17 years who seen in the outpatient clinic of a large American Burn Association-verified pediatric burn center and level I pediatric trauma center between

BMJ Health & Care Informatics, 2021

ObjectivesTo develop and evaluate a machine learning model for predicting patient with trauma mor... more ObjectivesTo develop and evaluate a machine learning model for predicting patient with trauma mortality within the US emergency departments.MethodsThis was a retrospective prognostic study using deidentified patient visit data from years 2007 to 2014 of the National Trauma Data Bank. The predictive model intelligence building process is designed based on patient demographics, vital signs, comorbid conditions, arrival mode and hospital transfer status. The mortality prediction model was evaluated on its sensitivity, specificity, area under receiver operating curve (AUC), positive and negative predictive value, and Matthews correlation coefficient.ResultsOur final dataset consisted of 2 007 485 patient visits (36.45% female, mean age of 45), 8198 (0.4%) of which resulted in mortality. Our model achieved AUC and sensitivity-specificity gap of 0.86 (95% CI 0.85 to 0.87), 0.44 for children and 0.85 (95% CI 0.85 to 0.85), 0.44 for adults. The all ages model characteristics indicate it gen...

Archives of Physical Medicine and Rehabilitation, 2021

Postural stability is an important indicator of balance and is commonly evaluated in neurorehabil... more Postural stability is an important indicator of balance and is commonly evaluated in neurorehabilitation. We proposed a system based on a virtual reality (HTC Vive) system with a tracker at the lumbar area. The position data of the tracker were obtained through detection of the sensors on the tracker by the VR system. The reliability and validity of these sway parameters to measure postural stability were evaluated. Twenty healthy adults had their postural sway measured with this system and a force platform system under four stance conditions, with wide-or narrow-stance and eyes open or closed. The path data from both systems were computed to obtain the following parameters: the mean distance and the mean velocity in the medial-lateral and anterior-posterior directions and the 95% confidence ellipse area. The reliability of the Vive-based sway measures was tested with intraclass correlation coefficients (ICCs). The convergent validity was tested against the center of pressure (COP) parameters from the force platform system. Finally, the discriminative validity was tested for the above four conditions. The results indicated that the Vive-based sway parameters had moderate to high reliability (ICCs: 0.56~0.90) across four conditions and correlated moderately to very highly with the COP parameters (r=0.420~0.959). Bland-Altman plotting showed generally good agreement, with negative offset for the Vive-based sway parameters. The sway parameters obtained by the Vive-based system also discriminated well among the tasks. In conclusion, the results support this system as a simple and easy-to-use tool to evaluate postural stability with acceptable reliability and validity.

Objective: Our aims were to determine which day(s) during the holiday had highest motor vehicle f... more Objective: Our aims were to determine which day(s) during the holiday had highest motor vehicle fatality risk compared to non-holiday travel and to identify potential risk factors. Results: Of 43,457 traffic fatalities studied, 15,292 (35%) occurred during the holiday, with Saturday being deadliest but Monday having highest odds. Both sexes, all years, age <65, drivers and passengers, rural and urban, and all regions in the United States were at increased risk during the holiday versus non-holiday periods.

Journal of pediatric surgery, Jan 12, 2017

In adults, shock index (SI; heart rate/systolic blood pressure) >0.9 predicts injury severity ... more In adults, shock index (SI; heart rate/systolic blood pressure) >0.9 predicts injury severity and trauma outcomes. However, age-adjusted shock index (SIPA) out-performs SI in blunt trauma patients 4-16years old. We sought to confirm these findings and expand this tool to include penetrating trauma and children aged 1-4years. We developed cutoff values for patients 1-3years old using age-based vital signs and queried the 2014 Pediatric Trauma Quality Improvement Program (TQIP) database for patients aged 1-16years sustaining blunt or penetrating trauma. Outcomes measured included injury severity, transfusion within 24h, intensive care unit (ICU) and hospital length of stay (LOS), and mortality. SI and SIPA were compared using Student's t-test and chi-square tests. We identified 22,344 blunt and 613 penetrating trauma patients. SI was elevated in 41.3% and 40.0% of these groups, respectively, whereas SIPA was elevated in 15.6% and 19.4% of patients. SIPA was a significantly bett...

The Journal of adolescent health : official publication of the Society for Adolescent Medicine, Jan 17, 2018

Determine the prevalence and explore individual- and state-level factors associated with texting/... more Determine the prevalence and explore individual- and state-level factors associated with texting/emailing while driving (TWD) among adolescent drivers in the United States. Data from 35 states that administered the 2015 state Youth Risk Behavior Survey were analyzed. We used Poisson regression models with robust error variance to estimate prevalence ratios (PRs) for TWD. Among the 101,397 high school students aged ≥ 14 years who had driven a vehicle during the past 30 days, 38% reported TWD at least once. TWD prevalence ranged from 26% in Maryland to 64% in South Dakota. TWD prevalence was higher in states with a lower minimum learner's permit age and in states where a larger percentage of students drove. Multivariable analyses revealed that the likelihood of TWD increased substantially with age, and white students were more likely to engage in TWD than students of all other races/ethnicities. Infrequent seatbelt users were 21% more likely to engage in TWD compared with frequent...

International journal of environmental research and public health, Jan 5, 2018

The journal of trauma and acute care surgery, Jan 2, 2018

An accurate injury severity measurement is essential for the evaluation of pediatric trauma care ... more An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted injury severity scoring (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS. The weights and wISS were generated using the National Trauma Data Bank (NTDB). The Nationwide Emergency Department Sample (NEDS) was used to validate our main results. Pediatric blunt trauma patients less than 16 years were included, and mortality was the outcome. Discrimination (areas under the receiver operating characteristic curve, sensitivi...

Clinical Pediatrics, 2017

Although trauma undertriage has been widely discussed in the literature, undertriage in the pedia... more Although trauma undertriage has been widely discussed in the literature, undertriage in the pediatric trauma population remains understudied. Using the 2009-2013 Nationwide Emergency Department Sample, we assessed the national undertriage rate in pediatric major trauma patients (age ≤16 years and injury severity score [ISS] >15), and identified factors associated with pediatric trauma undertriage. Nationally, 21.7% of pediatric major trauma patients were undertriaged. Children living in rural areas were more likely to be undertriaged ( P = .02), as were those without insurance ( P = .00). Children with life-threatening injuries were less likely to be undertriaged ( P < .0001), as were those with chronic conditions ( P < .0001). Improving access to specialized pediatric trauma care through innovative service delivery models may reduce undertriage and improve outcomes for pediatric major trauma patients.

Clinical Toxicology, 2017

Context: Pharmaceutical drug poisonings, especially those that are intentional, are a serious pro... more Context: Pharmaceutical drug poisonings, especially those that are intentional, are a serious problem for adolescents and young adults. Poison control center data is a viable tool to track intentional drug poisonings in near real-time. Objective: To determine intentional drug poisoning rates among adolescents and young adults in Ohio using poison control center data. Methods: We analyzed data from 2002 to 2014 obtained by Ohio's three poison control centers. Inclusion variables were calls made to the centers that had appropriate subject age (10-29 years old), subject sex, involved substance (all drug classes), and medical outcome (no effect, minor effect, moderate effect, major effect, and death). Intentional drug poisoning reports were also separated into subgroups to compare suspected suicide reports to misuse and abuse reports. Finally, resident population estimates were used to generate 2014 intentional drug poisoning rates for each county in Ohio. Results: The most common age group for intentional drug poisonings was 18-24. Females reported more suspected suicide drug poisonings while males reported more misuse/abuse drug poisonings. The most reported drug class across all ages was analgesics. Of the 88 counties in Ohio, Hamilton, Williams, Washington, and Guernsey counties had the highest rates of intentional drug poisonings. Conclusions: The high report rate of suspected suicides and analgesic class drugs demonstrates the need for preventative measures for adolescents and young adults in Ohio. Any interventions, along with legislative changes, will need to take place in our local communities.

Journal of Burn Care & Research, 2017

Pediatric burn patients are at risk of both acute and delayed complications. Unscheduled readmiss... more Pediatric burn patients are at risk of both acute and delayed complications. Unscheduled readmissions are included in the top 10 list of complications in the 2016 National Burn Repository (NBR) report for both scald and electrical injuries. 1 Readmissions are increasingly being used as a quality improvement metric 2-4 and as an outcome of interest in comparative effectiveness research. 5-8 Burn patient readmissions have been described in a small number of studies, 9-13 but only 1 study includes pediatric patients. 11 Distinguishing between planned and unplanned readmissions was not always possible in these studies, and most were single institution studies that did not account for readmissions at different hospitals. In a study of older adults, Housley et al 9 reported that 11.1% of their hospital's burn patients had readmissions within 30 days of their index visit. Another older adult burn patient study looking at readmissions across a statewide cohort described 30-day and 2-year readmission rates of 4.6% and 45.1%, respectively. 10 In a 2005 to 2012 retrospective review of 250 burn patients seen at a regional burn center, 6.8% of patients with TBSA > 15% burned had unplanned readmissions over an unreported time frame. 11 The authors reported that each percentage increase in TBSA was associated with a 5% increase in the likelihood of being

International journal of environmental research and public health, Apr 13, 2017

Our goal in this paper was to use the 2006-2013 Nationwide Emergency Department Sample (NEDS) dat... more Our goal in this paper was to use the 2006-2013 Nationwide Emergency Department Sample (NEDS) database to describe trends of annual patient number, patient demographics and hospital characteristics of pediatric traumatic brain injuries (TBI) treated in U.S. emergency departments (EDs); and to use the same database to estimate the available sample sizes for various clinical trials of pediatric TBI cases. National estimates of patient demographics and hospital characteristics were calculated for pediatric TBI. Simulation analyses assessed the potential number of pediatric TBI cases from randomly selected hospitals for inclusion in future clinical trials under different scenarios. Between 2006 and 2013, the NEDS database estimated that of the 215,204,932 children who visited the ED, 6,089,930 (2.83%) had a TBI diagnosis. During the study period in the US EDs, pediatric TBI patients increased by 34.1%. Simulation analyses suggest that hospital EDs with annual TBI ED visits >1000, Lev...

American Journal of Lifestyle Medicine, 2018

Objective. Pediatric traumatic brain injury (TBI) is associated with physical and psychobehaviora... more Objective. Pediatric traumatic brain injury (TBI) is associated with physical and psychobehavioral impairment in children. Effective rehabilitation programs postinjury are critical for children with TBI. Virtual reality (VR) has been increasingly adopted for brain injury rehabilitation. However, scientific synthesis is lacking in evaluating its effectiveness in pediatric TBI rehabilitation. This article aimed to conduct a systematic review on the effectiveness of VR-based pediatric TBI rehabilitation. Methods. A systematic literature search was conducted in PubMed, PsycInfo, SCOPUS, CENTRAL, BioMed Central, CiNAHL, and Web of Science through November 2015. Personal libraries and relevant references supplemented the search. Two authors independently reviewed the abstracts and/or full text of 5824 articles. Data extraction and qualitative synthesis was conducted along with quantitative assessment of research quality by 2 authors. Results. A positive impact was found for VR-based inter...