title: Impact of a prison triage system on injuries seen in emergency departments.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A chart review.
  
  
  METHODS
  The catchment area surrounding 2 hospital-based EDs in Kingston, Ontario, which includes 8 federal and provincial prisons for adult males.
  
  
  METHODS
  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.
authors.affiliation: First-year resident in Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Kuzak
authors.forename: M
authors.initials: M
authors.lastname: O'connor
authors.forename: W
authors.initials: W
authors.lastname: Pickett
authors.forename: T
authors.initials: T
authors.lastname: O'brien
authors.forename: K
authors.initials: K
authors.lastname: Reid
authors.forename: M
authors.initials: M
authors.lastname: Pearson