Appendix 1: Presenting Complaints - Trauma history/signs of abuse or maltreatment abuse physical or mental
abuse physical, mental, high emotional physical or sexual assault >48 hours sexual assault + high risk mechanism sexual assault, low risk mechanism s.a. high risk mech +/-bbf exp s.a. low risk mechanism cardiac arrest (t)
cardiac arrest (traumatic) ear injury, lac'n require sutures ear injury, minor
ear injury, major amputation
ear injury, bleeding / open laceration major electrical injury
major electrical injury, lightning minor/moderate electrical injury eye tr, unable to visualize eye eye tr, high risk mech, visual chang eye trauma, high risk mechanism, eye trauma, minor no visual change eye trauma, unable to visualize eye anal/rectal tr, sev hemodynam comp anal/rectal trauma, mild pain
anal/rectal trauma, moderate pain anal/rectal trauma, severe
genital tr, sev hemodynamic comprom genital trauma, mild pain
genital trauma, moderate pain
genital trauma, severe + hemodynamic head injury, alt loc gcs <=9
head injury, alt loc gcs 10-13 head injury, history loc gcs 14-15 head injury, hx loc gcs 14-15
minor head injury/no loc, no vomiting head injury, altered loc gcs <9
head injury, altered loc gcs 10-13 facial tr, airway compromised facial tr, mod, low risk mechanism facial tr, severe, high risk mech facial trauma, airway compromised facial trauma, minor
facial trauma, moderate, low risk facial trauma, severe, high risk
neck trauma +/-mod resp distress neck trauma +/-neuro symptoms neck trauma, high risk mechanism +/- neck trauma, low risk mechanism neck trauma, severe resp distress neck trauma, severe respiratory neck trauma/pain
nasal tr, sev pain+/-active bleed nasal trauma, moderate pain nasal trauma, severe pain +/- active back trauma acute, mild pain back trauma acute, moderate pain back trauma acute, neuro deficit back trauma acute, neuro deficit +/- back trauma acute, severe pain head, neck or proximal extremity head, neck or prox extremity trauma, head, neck or proximal extremity trauma lower extremity injury, neurovascular lower extremity injury, no deformity lower extremity injury, obvious lower extremity injury, suggestive of lwr extrem inj, suggestive open fx lwr extrem inj, neurovascular comp lwr extrem inj + mod pain+/-deform lwr extrem inj + sev pain+/-deform lwr extrem injury, neurovascular comp lwr extrem injury, no deformity lwr extrem injury, obvious deformity lwr extrem injury, suggestive open fx minor/part amputation, distal digit minor/partial amputation, distal digit minor/partial amputation, distal digit traumatic amputation extremity traumatic amputation of digit up extrem inj, suggestive open fx up extrem inj, neurovascular comp up extrem inj + mod pain+/-deformity up extrem inj + sev pain+/-deformity up extrem injury, neurovascular comp up extrem injury, no deformity up extrem injury, obvious deformity up extrem injury, suggestive open fx upper extremity injury, neurovascular upper extremity injury, no deformity upper extremity injury, obvious
upper extremity injury, suggestive of head/neck/prox extrem penetrating tr abdominal tr, penetrating
abdominal tr, penetrating (any) abdominal tr, penetrating, shock abdominal trauma, penetrating (any) abdominal trauma, penetrating, shock chest tr, penetrating
chest tr, penetrating (any) chest trauma, penetrating (any) chest trauma, penetrating, severe chest tr, penetrating, sev resp distr major tr penetrating
major tr penetrating +shock
multisystem trauma, blunt, high risk multisystem trauma, blunt, low risk multisystem trauma, blunt, severe 2&3rd degree burn >1% bsa
2nd/3rd degree burns to hands, feet, burn <5% bsa
burn >25% bsa +/- potential airway burn 5-25% bsa
burn>25% bsa +/-pot. airway comp burn>25% bsa +/-potential airway comp direct burn to the eye
extensive / multiple abrasion laceration requiring pressure to laceration, controlled bleeding localized abrasion
sev. laceration, uncontrolled bleed severe burn, airway compromise severe, extensive laceration, uncontrol sevre, extensive laceration, uncontrol superficial lac'n/abrasn/contusn superficial laceration/abrasion/
abdominal tr, blunt, low risk mech abdominal tr, blunt, high risk mech abdominal tr, blunt, sev resp dist abdominal trauma, blunt severe abdominal trauma, blunt, high risk abdominal trauma, blunt, low risk ac dental avulsion, pt has tooth acute dental avulsion, patient has chest pain + minor chest inj chest pain + minor chest injury + chest tr, blunt, sev resp distress
chest tr, blunt, high risk mechanism chest tr, blunt, low risk mech inj chest trauma, blunt, high risk chest trauma, blunt, low risk chest trauma, blunt, severe fingertip avulsion
hand injury
human bite - superficial
human bite requir press ctrl bld human bite requiring pressure to human bite, controlled bleeding human bite, superficial
lac'n requiring pressure ctrl bld ms blunt tr, high risk mech of inj.
ms blunt tr, low risk mech of inj.
ms blunt tr, sev resp dist +/- shock
Appendix 1: CEDIS presenting complaint list for trauma visits. Complaints (including abbreviations), isolated from data extract and trauma-associated visits, were selected and reviewed by three reviewers (SB, MT, and JRB).
Appendix 2: Mental Health and Substance-Related Presenting Complaints Mental Health and Psychological Issues:
aggressive/violent behaviour, acute anxiety, mild agitation
anxiety, moderate agitation
anxiety, sev agitation,+/-disrup behvr anxiety, severe agitation
anxiety, severe agitation+/-disruptive bizzare/paranoid behavior
bizzare/paranoid behavior, controlled bizzare/paranoid behaviour, chronic bizzare/paranoid behavr, cooperativ bizzare/paranoid behavr, uncontrol bizzare/paranoid behavr, uncontrolled bizzare/paranoid behavr, uncooperat conflict or unstable situation
depressed, no suicidal ideation hallucinations +/- severe agitation hallucinations +/- severe agitation/
hallucinations, chronic, pt stable hallucinations, mild agitation hallucinations, mild agitation, stable hallucinations, sev agitation, psychosis hallucinations, severe agitation homicidal / ++risk of eloping homicidal, active thoughts homicidal, passive thoughts homicidal/++risk of eloping, plans homicidal/++risk of eloping, plans &
mod anxiety/agitation, or with paranoia moderate anxiety or agitation
moderate anxiety or agitation, or with social issues
social issues, chronic
social issues, chronic, non-urgent suicidal ideation-specific plan/access suicidal ideation, no plan & access suicidal ideation, no plan & access suicidal ideation, no specific plan suicidal ideation, plans & access
suicidal ideation, specific plans &
suicidal, attempted + uncertain flight suicidal, attempted
suicidal, attempted, high risk elope unable to cope, situational crisis violent behavior, settled
violent behaviour - uncertain flight violent or homicidal ideation, no plan acute difficulties with others/
bizarre/paranoid behavior, harmless bizarre/paranoid behaviour,
bizarre/paranoid behaviour, chronic bizarre/paranoid behaviour, controlled bizarre/paranoid behaviour, harmless bizarre/paranoid behaviour, uncertain hyperventilation mild/mod resp distres hyperventilation, mild/moderate hyperventilation, mod resp distress hyperventilation, resolved
hyperventilation, moderate respiratory imminent harm to self or others unable to sleep
unable to sleep, acute
persistent, problematic behaviour Neurologic:
acute confusion + altered loc acute confusion no altered loc or altered loc gcs <=9
altered loc gcs <=9, unable btha-15 altered loc gcs <=9, unable to altered loc gcs 10-13
altered loc gcs 10-13 to ward at 1505 altered loc gcs 14-15
history altered loc gcs 15, symptoms hx altered loc gcs 15 s/s resolved overdose, altered loc gcs 10-13 +/- Substance Use:
withdrawal, mild pain, anxiety/tremor withdrawal, moderate pain, anxiety/
withdrawal, mod pain, anxiety/tremor withdrawal, sev pain, anxiety/tremor withdrawal, severe pain, anxiety/tremor
withdrawl, mild pain, anxiety/tremor od, high risk or unknown substance overdose, gcs 14-15
overdose, gcs 14-15 s.ideation overdose, high risk or unknown overdose, unconscious gcs <=9 unable substance misuse/intox, gcs <=9 substance misuse/intox, gcs 10-13 substance misuse/intox, gcs 14-15 substance misuse/intox, gcs 15
substance misuse/intox, uncons, gcs <=9 substance misuse/intox, unconscious substance misuse/intoxication, altered substance misuse/intoxication, gcs substance misuse/intoxication, gcs 15 od, alt loc gcs 10-13
od, gcs<=9,unprotected airway
od, uncons, gcs<=9,unprotected airway
Appendix 2: CEDIS presenting complaint list for mental health and substance-related visits. Complaints (including abbreviations), isolated from data extract and relevant complaints, were selected and reviewed by three reviewers (SB, MT, and JRB).
Appendix 3: Relative risk of trauma-related ED visits identified by presenting complaint
Appendix 3: Number of trauma-related ED visits identified by presenting complaint in cheque weeks and control weeks, stratified by prespecified subgroups of interest.
Includes N=146 cheque weeks and N=146 control weeks between January 2008 and April 2020. Cheque and control weeks in August 2019 and November 2019 were excluded due to missing data in the regional ED database.
Subgroup analysis of trauma visits by presenting complaint Presenting Complaint (N=146 weeks) Cheque Week
Visits
Control Week Visits
Relative Risk
(95% CI) P-value
All visits1 76,981 76,778 1.00 (0.97, 1.03) 0.86
Age (years)
≤ 16 7,684 7,908 0.97 (0.92, 1.03) 0.33
17 - 32 26,046 25,837 1.01 (0.97, 1.04) 0.64
33 - 48 16,153 16,058 1.01 (0.97, 1.04) 0.75
49 - 64 13,912 13,883 1.00 (0.96, 1.04) 0.92
≥ 65 13,186 13,092 1.01 (0.96, 1.06) 0.79
Sex
Male 43,657 43,524 1.00 (0.97, 1.03) 0.85
Female 33,322 33,244 1.00 (0.97, 1.04) 0.89
Unknown 2 10
Site
VGH 36,768 36,100 1.02 (0.99, 1.05) 0.28
UBCH 15,267 15,558 0.98 (0.95, 1.02) 0.33
RGH 24,946 25,120 0.99 (0.96, 1.03) 0.70
Appendix 4: Relative risk of trauma-related ED visits identified by mechanism of injury flag
Appendix 4: Number of trauma-related ED visits identified by mechanism of injury flag in cheque weeks and control weeks, stratified by prespecified subgroups of interest.
Includes N=146 cheque weeks and N=146 control weeks between January 2008 and April 2020. Cheque and control weeks in August 2019 and November 2019 were excluded due to missing data in the regional ED database.
Appendix 4: Relative risk of trauma-Related ED visits during cheque and control weeks Trauma-related ED visit
(N=146 weeks) Cheque Week
Visits
Control Week Visits
Relative Risk
(95% CI) P-value
All visits1 84,055 84,236 1.00 (0.97, 1.03) 0.90
Age (years)
≤ 16 7,030 7,361 0.96 (0.90, 1.02) 0.16
17 - 32 28,675 28,263 1.01 (0.98, 1.05) 0.45
33 - 48 18,850 18,840 1.00 (0.96, 1.04) 0.98
49 - 64 15,632 15,691 1.00 (0.96, 1.04) 0.86
≥ 65 13,868 14,081 0.98 (0.94, 1.03) 0.52
Sex
Male 47,760 47,590 1.00 (0.97, 1.04) 0.84
Female 36,292 36,636 0.99 (0.96, 1.02) 0.58
Unknown 3 10
Site
VGH 45,278 44,705 1.01 (0.98, 1.05) 0.48
UBCH 12,046 12,300 0.98 (0.92, 1.04) 0.51
RGH 26,731 27,231 0.98 (0.95, 1.02) 0.33
Trauma Type
Fall 25,450 25,545 1.00 (0.96, 1.04) 0.86
Sports 11,248 11,627 0.97 (0.91, 1.03) 0.31
Vehicle/Motorcycle 7,284 7,214 1.01 (0.95, 1.07) 0.75
Pedestrian/Bicycle 3,689 3,694 1.00 (0.91, 1.10) 0.98
Assault/Gunshot 3,099 2,923 1.06 (0.99, 1.13) 0.08
Industrial 2,137 2,146 1.00 (0.88, 1.13) 0.95
Other* 31,148 31,087 1.00 (0.96, 1.04) 0.92
Appendix 5: Relative risk of mental health and substance-related ED visits
Appendix 5: Number of trauma visits, identified by mechanism of trauma flag, or mental health and substance-related visits, in cheque weeks and control weeks.
*Burn/Crush/Electrocution/Stab/Cut/Hypothermia/Water-related/Other/Unknown
† Indicates relative risks significantly different than the null at p<0.05.
Includes N=146 cheque weeks and N=146 control weeks between January 2008 and April 2020. Cheque and control weeks in August 2019 and November 2019 were excluded due to missing data in the regional ED database.
Appendix 5: Relative risk of Mental Health and Substance-Related ED visits during cheque and control weeks Mental Health and Substance-related ED visit (N=146 weeks)
Cheque Week Visits
Control Week Visits
Relative Risk
(95% CI) P-value
All visits1 27,272 25,450 1.07 (1.03, 1.11)† 0.0006
Age (years)
≤ 16 358 388 0.92 (0.78, 1.09) 0.3320
17 - 32 9,718 9,115 1.07 (1.01, 1.13)† 0.0199
33 - 48 7,451 6,900 1.08 (1.04, 1.13)† 0.0003
49 - 64 5,506 5,010 1.10 (1.04, 1.16)† 0.0007
≥ 65 4,239 4,037 1.05 (0.98, 1.13) 0.1786
Sex
Male 15,190 13,854 1.10 (1.05, 1.15)† 0.0001
Female 12,077 11,594 1.04 (1.00, 1.08)† 0.0476
Unknown 5 2
Site
VGH 20,071 18,610 1.08 (1.04, 1.12)† 0.0001
UBCH 606 633 0.96 (0.84, 1.09) 0.5198
RGH 6,595 6,207 1.06 (1.01, 1.12)† 0.0246
Complaint Type Mental Health and
Psychological Issues 16,098 15,662 1.03 (0.99, 1.06) 0.1248
Neurologic 4,815 4,520 1.07 (1.00, 1.14) 0.0630
Substance Use 6,359 5,268 1.21 (1.13, 1.29)† <0.0001
Appendix 6: Relative risk of trauma or mental health and substance-related ED visits, by weekday Appendix 6a: Trauma by mechanism of injury flag
Analysis Cheque
week
Control week
Relative Risk P- value (count) (count) (95% CI)
Primary analysis
Week 84,055 84,236 1.00 (0.97, 1.03) 0.90 Weekday
WW (Wed) 11,835 11,591 1.02 (0.98, 1.07) 0.37 WW+1 (Thu) 11,716 11,850 0.99 (0.95, 1.03) 0.60 WW+2 (Fri) 11,686 11,866 0.98 (0.94, 1.03) 0.47 WW+3 (Sat) 12,482 12,474 1.00 (0.96, 1.04) 0.98 WW+4 (Sun) 12,747 12,748 1.00 (0.96, 1.04) 1.00 WW+5 (Mon) 11,937 12,004 0.99 (0.95, 1.04) 0.81 WW+6 (Tue) 11,652 11,703 1.00 (0.95, 1.04) 0.85 Outside
Cheque Week
WW-2 (Mon)2 11,901 11,987 0.99 (0.95, 1.04) 0.74 WW-1 (Tues)2 11,661 11,613 1.00 (0.96, 1.05) 0.85
11
Social Assistance Timing and Emergency Visits Version 8 (October 31st, 2020) Appendix 6b: Trauma by presenting complaint Analysis
Cheque week
Control
week Relative Risk P-
value (count) (count) (95% CI)
Primary analysis
Week 76,981 76,778 1.00 (0.97, 1.03) 0.86 Weekday
WW (Wed) 10,867 10,338 1.05 (1.01, 1.10)† 0.02 WW+1 (Thu) 10,611 10,734 0.99 (0.95, 1.03) 0.58 WW+2 (Fri) 10,795 10,909 0.99 (0.95, 1.03) 0.61 WW+3 (Sat) 11,754 11,631 1.01 (0.97, 1.05) 0.61 WW+4 (Sun) 11,466 11,656 0.98 (0.95, 1.02) 0.41 WW+5 (Mon) 10,973 11,006 1.00 (0.96, 1.04) 0.89 WW+6 (Tue) 10,515 10,504 1.00 (0.96, 1.04) 0.96 Outside
Cheque Week
WW-2 (Mon)2 10,788 11,102 0.97 (0.93, 1.01) 0.15 WW-1 (Tues)2 10,585 10,495 1.01 (0.97, 1.05) 0.69 Appendix 6c: Mental health and substance-related visits
Analysis Cheque
week
Control week
Relative Risk
P-value (count) (count) (95% CI)
Primary analysis
Week 27,272 25,450 1.07 (1.03, 1.11)† 0.0006
Weekday
WW (Wed) 3,979 3,718 1.07 (1.02, 1.13)† 0.01 WW+1 (Thu) 3,918 3,638 1.08 (1.02, 1.14)† 0.01 WW+2 (Fri) 4,257 3,816 1.12 (1.06, 1.18)† <0.0001 WW+3 (Sat) 3,969 3,540 1.12 (1.05, 1.19)† 0.0004 WW+4 (Sun) 3,638 3,384 1.08 (1.01, 1.14)† 0.02 WW+5 (Mon) 3,651 3,642 1.00 (0.94, 1.06) 0.93 WW+6 (Tue) 3,860 3,712 1.04 (0.98, 1.10) 0.17 Outside
Cheque Week
Appendix 6a, 6b, & 6c: Number of trauma and mental health and substance-related ED visits in cheque weeks and control weeks, stratified by weekday.
† Indicates relative risks significantly different than the null at p<0.05.
2 Due to holiday timing of cheque issue date in December 2010, control dates for outside of cheque week analysis overlapped with cheque disbursement in the previous month. Outside of cheque week analysis for December 2010 was excluded.
Appendix 7: Trauma and Mental Health and Substance-related ED Visits from 2008 to 2020.
Appendix 7: Average trauma-related and mental health and substance-related ED visits in cheque weeks and control weeks. Legend: Plot showing the average number of 1.) trauma-related ED visits, identified by
presenting complaint, and 2.) mental health and substance-related ED visits in cheque and control weeks, 2008-2020.
