Significant Injury in Cruise Ship Passengers A Case Series Vishal Bansal, MD, Dale Fortlage, BA, Jeanne G. Lee, MD, Linda L. Hill, MD, Bruce Potenza, MD, Raul Coimbra, MD, PhD, FACS Background: The attention placed on cruise ship infectious epidemics has helped create important preventive strategies in improving food handling, sanitation, and overall cruise ship medical care. However, the incidence of serious injury in cruise ship passengers has never been fully described. In 2006, there was an increase in the number of cruise ship passengers receiving medical care at a Level I trauma center. This report provides a case series analysis of eight patients identified as suffering from significant cruise ship-related injuries. Methods: A retrospective, descriptive study design was used. Data on trauma patients transported directly from cruise ships and admitted to a university Level I trauma center in 2003–2006 were reviewed. Results: A total of 2132 patients were admitted as major trauma resuscitations in 2006. Eight were identified as being injured on a major cruise ship compared to an average of 1.7 patients/year in the preceding 3 years. All but one patient was female. Three patients had significant medical comorbidities. All eight patients suffered injuries from falls, five of which were in stairwells. Concussions were the most common injury. Five patients were discharged to home, two to extended rehabilitation facilities, and one died. Conclusions: In this case series, falls were the sole cause of major injury among cruise ship passengers. Improved surveillance and characterization of injuries among cruise ship passengers is needed to inform safety policies and develop programs to prevent passenger injury. (Am J Prev Med 2007;33(3):219 –221) © 2007 American Journal of Preventive Medicine Introduction T he increasing popularity of cruise ships has heightened awareness of infectious epidemics, mostly consisting of viral dysentery and respira- tory infections. The establishment of the Vessel Sanita- tion Program in 1975 and the aggressive implementa- tion of inspection and food preparation cleanliness has significantly decreased passenger outbreaks of viral epidemics; however, very little attention has been placed on cruise ship injuries. 1,2 Non-epidemic illnesses are frequently encountered by cruise ship physicians but infrequently described secondarily due to the mi- nor nature of these conditions. 3 In 1999, Peake et al described the epidemiologic results of 7147 medical consultations on board four cruise ships in a one-year period. Injuries consisted of 18.2% of all visits to the cruise ship infirmary. 4 However, the majority of injuries were minor (sprains and superficial wounds), and most were treated on board without transfer to a trauma center. Only four vessels of one major cruise line were described, therefore, the complete epidemiology of cruise ship injuries remains unknown. San Diego, California harbors a large number of cruise liners with a consistent increase in yearly passen- ger traffic from an estimated 92,000 in 2003 to over 235,000 in 2005, and a continued expected increase in 2006. 5 In 2006, an increase in the number of severe cruise ship–related injuries that received medical care in a university Level I trauma center was noted. This report presents a case series of eight injured passengers from cruise ships in 2006 that were transferred to a Level I trauma center in hopes of identifying factors involved in cruise ship–related injury. Methods The records of all trauma patients admitted to the University of California San Diego Trauma Center from 2003 to 2006 were analyzed. Medical records and registry data for all patients that were transported directly from cruise ships were identified. In-hospital data collection included age, gender, From the University of California San Diego, Department of Surgery, Division of Trauma, Burns and Critical Care (Bansal, Fortlage, Lee, Potenza, Coimbra), San Diego, California and the University of California San Diego, Department of Family and Preventative Medi- cine (Hill), La Jolla, California Address correspondence and reprint requests to: Raul Coimbra, MD, PhD, FACS, Division of Trauma, Surgical Critical Care, and Burns, 200 W Arbor Drive #8896, San Diego CA 92103. E-mail: rcoimbra@ucsd.edu. 219 Am J Prev Med 2007;33(3) 0749-3797/07/$–see front matter © 2007 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2007.05.004