Neuropsychiatric aspects of severe brain injuries

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O. S. Zaitsev

2012-01-01

Full Text Available The state-of-the-art of Russian neuropsychiatry and priority developments in different psychopathological syndromes in severe brain injuries are assessed. Many cognitive and emotional impairments are explained in terms of the idea on the organization of psychic activity over time. It is emphasized that to achieve the premorbid levels of an interhemispheric interaction and functional asymmetry of the cerebral hemispheres affords psychic activity recovery. The experience in investigating, classifying, and treating various mental disorders occurring after severe brain injuries is generalized. The basic principles of psychopharmacotherapy and rehabilitation of victims are stated.

Apoptosis-induced lymphopenia in sepsis and other severe injuries.

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Girardot, Thibaut; Rimmelé, Thomas; Venet, Fabienne; Monneret, Guillaume

2017-02-01

Sepsis and other acute injuries such as severe trauma, extensive burns, or major surgeries, are usually followed by a period of marked immunosuppression. In particular, while lymphocytes play a pivotal role in immune response, their functions and numbers are profoundly altered after severe injuries. Apoptosis plays a central role in this process by affecting immune response at various levels. Indeed, apoptosis-induced lymphopenia duration and depth have been associated with higher risk of infection and mortality in various clinical settings. Therapies modulating apoptosis represent an interesting approach to restore immune competence after acute injury, although their use in clinical practice still presents several limitations. After briefly describing the apoptosis process in physiology and during severe injuries, we will explore the immunological consequences of injury-induced lymphocyte apoptosis, and describe associations with clinically relevant outcomes in patients. Therapeutic perspectives targeting apoptosis will also be discussed.

Industrial distributions of severe occupational injuries among workers in Thailand.

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Yamakawa, Michiyo; Sithisarankul, Pornchai; Yorifuji, Takashi; Hengpraprom, Sarunya; Hiransuthikul, Narin; Doi, Hiroyuki; Takao, Soshi

2014-01-01

In industrializing countries, occupational safety and health have been affected by globalization. However, a lack of reliable data prevents evaluation of this situation. Therefore, we examined industrial distributions and risks of severe occupational injuries among workers in Thailand, which is one of the few industrializing countries that compiles nationwide data. Data on workers who made claims for occupational injuries from 2007 to 2009 were extracted from the Workmen's Compensation Fund records in Thailand. Among 501,334 claimants, we evaluated the industrial distributions of severe occupational injuries (i.e., permanent disability and death). We then examined the associations between industry and those injuries, using proportionate ratios (PRs) between each industrial category and the overall distribution of occupational injuries. The number of workers in manufacturing making claims for severe occupational injuries was the largest among all industrial categories (319,114/501,334 injuries), although the total number of occupational injuries recently declined. Additionally, workers in manufacturing experienced severe occupational injuries more often compared with the overall distribution of occupational injuries. The PRs (95% confidence interval) for manufacturing were 1.17 (1.14-1.20) in men and 1.33 (1.27-1.38) in women. After adjusting for individual characteristics, the results did not substantially change. Manufacturing seems to have the largest burden of occupational injuries in industrializing countries like Thailand.

Mobile health technology transforms injury severity scoring in South Africa.

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Spence, Richard Trafford; Zargaran, Eiman; Hameed, S Morad; Navsaria, Pradeep; Nicol, Andrew

2016-08-01

The burden of data collection associated with injury severity scoring has limited its application in areas of the world with the highest incidence of trauma. Since January 2014, electronic records (electronic Trauma Health Records [eTHRs]) replaced all handwritten records at the Groote Schuur Hospital Trauma Unit in South Africa. Data fields required for Glasgow Coma Scale, Revised Trauma Score, Kampala Trauma Score, Injury Severity Score (ISS), and Trauma Score-Injury Severity Score calculations are now prospectively collected. Fifteen months after implementation of eTHR, the injury severity scores were compared as predictors of mortality on three accounts: (1) ability to discriminate (area under receiver operating curve, ROC); (2) ability to calibrate (observed versus expected ratio, O/E); and (3) feasibility of data collection (rate of missing data). A total of 7460 admissions were recorded by eTHR from April 1, 2014 to July 7, 2015, including 770 severely injured patients (ISS > 15) and 950 operations. The mean age was 33.3 y (range 13-94), 77.6% were male, and the mechanism of injury was penetrating in 39.3% of cases. The cohort experienced a mortality rate of 2.5%. Patient reserve predictors required by the scores were 98.7% complete, physiological injury predictors were 95.1% complete, and anatomic injury predictors were 86.9% complete. The discrimination and calibration of Trauma Score-Injury Severity Score was superior for all admissions (ROC 0.9591 and O/E 1.01) and operatively managed patients (ROC 0.8427 and O/E 0.79). In the severely injured cohort, the discriminatory ability of Revised Trauma Score was superior (ROC 0.8315), but no score provided adequate calibration. Emerging mobile health technology enables reliable and sustainable injury severity scoring in a high-volume trauma center in South Africa. Copyright © 2016 Elsevier Inc. All rights reserved.

Relatives of patients with severe brain injury

DEFF Research Database (Denmark)

Norup, Anne; Petersen, Janne; Lykke Mortensen, Erik

2015-01-01

PRIMARY OBJECTIVE: To investigate trajectories and predictors of trajectories of anxiety and depression in relatives of patients with a severe brain injury during the first year after injury. RESEARCH DESIGN: A prospective longitudinal study with four repeated measurements. SUBJECTS: Ninety...... relatives of patients with severe brain injury. METHODS: The relatives were assessed on the anxiety and depression scales from the Symptom Checklist-90-Revised and latent variable growth curve models were used to model the trajectories. The effects of patient's age, patient's Glasgow Coma Score, level...... should focus not only on specific deficits in the patient, but also on how the emotional state and well-being of the relatives evolve, while trying to adjust and cope with a new life-situation....

Exploring Driver Injury Severity at Intersection: An Ordered Probit Analysis

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Yaping Zhang

2015-02-01

Full Text Available It is well known that intersections are the most hazardous locations; however, only little is known about driver injury severity in intersection crashes. Hence, the main goal of this study was to further examine the different factors contributing to driver injury severity involved in fatal crashes at intersections. Data used for the present analysis was from the US DOT-Fatality Analysis Reporting System (FARS crash database from the year 2011. An ordered probit model was employed to fit the fatal crash data and analyze the factors impacting each injury severity level. The analysis results displayed that driver injury severity is significantly affected by many factors. They include driver age and gender, driver ethnicity, vehicle type and age (years of use, crash type, driving drunk, speeding, violating stop sign, cognitively distracted driving, and seat belt usage. These findings from the current study are beneficial to form a solid basis for adopting corresponding measures to effectively drop injury severity suffering from intersection crash. More insights into the effects of risk factors on driver injury severity could be acquired using more advanced statistical models.

Safety of repair for severe duodenal injuries.

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Velmahos, George C; Constantinou, Constantinos; Kasotakis, George

2008-01-01

There is ongoing debate about the management of severe duodenal injuries (SDIs), and earlier studies have recommended pyloric exclusion. The objective of this study was to compare primary repair with pyloric exclusion to examine if primary repair can be safely used in SDIs. The medical records of 193 consecutive patients who were admitted between August 1992 and January 2004 with duodenal injuries were reviewed. After excluding early deaths (n = 50), low-grade duodenal injuries (n = 81), and pancreatoduodenectomies for catastrophic trauma (n = 12), a total of 50 patients with SDIs (grade III, IV, or V) were analyzed. Primary repair (PR--simple duodenorrhaphy or resection and primary anastomosis) was performed in 34 (68%) and pyloric exclusion (PE) in 16 (32%). Characteristics and outcomes of these two groups were compared. PE and PR patients were similar for age, injury severity score, abdominal abbreviated injury score, physiologic status on admission, time to operation, and most abdominal organs injured. PE patients had more pancreatic injuries (63% vs. 24%, p duodenum (79% vs. 42%, p = 0.02), and a nonsignificant trend toward more grade IV and V injuries (37% vs. 18%, p = 0.11). There was no difference in morbidity (including complications specific to the duodenal repair), mortality, and intensive care unit and hospital length of stay between the two groups. Pyloric exclusion is not necessary for all patients with SDIs, as previously suggested. Selected SDI patients can be safely managed by simple primary repair.

Examining Pedestrian Injury Severity Using Alternative Disaggregate Models

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Abay, Kibrom Araya

2013-01-01

This paper investigates the injury severity of pedestrians considering detailed road user characteristics and alternative model specification using a high-quality Danish road accident data. Such detailed and alternative modeling approach helps to assess the sensitivity of empirical inferences...... to the choice of these models. The empirical analysis reveals that detailed road user characteristics such as crime history of drivers and momentary activities of road users at the time of the accident provides an interesting insight in the injury severity analysis. Likewise, the alternative analytical...... specification of the models reveals that some of the conventionally employed fixed parameters injury severity models could underestimate the effect of some important behavioral attributes of the accidents. For instance, the standard ordered logit model underestimated the marginal effects of some...

Risk factors that predict severe injuries in university rugby sevens players.

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Mirsafaei Rizi, Rezvan; Yeung, Simon S; Stewart, Nathan J; Yeung, Ella W

2017-07-01

To investigate injury incidence and the influence of physical fitness parameters on the risk of severe injuries in players on rugby sevens university teams. Prospective cohort study. Rugby players from three universities (N=104; 90M:14F; 20.6±1.9years) were recruited before the beginning of the season. Players underwent pre-season assessments of power, strength, speed, agility, endurance, stability, and flexibility. Throughout the season, rugby-related injury and exposure data were collected. Potential predictor variables were analyzed using Cox proportional regression model to identify risk factors associated with severe injuries (time loss>28days). Thirty-one injuries occurred during the rugby season. The match and training injury incidence rates were 59.3 injuries and 3.3 injuries per 1000 player-hours, respectively. Lower limb injuries were most common and most severe. The ankle joint was the most prevalent site of injury, and ligamentous injury was most common (48.4%). Nine severe injuries were sustained resulting in an average time loss of 51.3±14.6days. Female (hazard ratio [HR]=8.35; 95% confidence intervals [CI]=2.01-34.8), slower (HR=3.51; 95% CI=1.17-10.5), and less agile (HR=2.22; 95% CI=1.26-3.92) players as well as those with hip flexors tightness (HR=1.12; 95% CI=1.00-1.25) were at significantly greater risk for sustaining severe injuries. Limited studies are available on risk factors associated with amateur rugby players in the Sevens version. The development of gender-specific injury prevention measures that emphasize speed and agility training, and improve hip flexor extensibility may be important to reduce the risk of severe injuries. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Neuromuscular exercises prevent severe knee injury in adolescent team handball players.

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Achenbach, Leonard; Krutsch, Volker; Weber, Johannes; Nerlich, Michael; Luig, Patrick; Loose, Oliver; Angele, Peter; Krutsch, Werner

2017-10-20

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players. Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury. Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01-0.90), p = 0.019. Other injuries to the lower extremities showed no significant difference between the two groups. Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

[Severe trampoline injuries and their risk factors among children and the young].

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Sinikumpu, Juha-Jaakko; Salokorpi, Niina; Suo-Palosaari, Maria; Pesälä, Juha; Serlo, Willy

2016-01-01

Although the majority of trampoline injuries in children are minor, severe injuries occur as well. We have analyzed the risk factors, treatment and outcome of severe trampoline injuries treated in the Oulu University Hospital in children and the young between April and November 2105. There was a total of eight severe injuries. Five injuries involved a danger of death. Almost all severe trampoline injuries resulted from an unsuccessful trick. A safety net was in use in half of the cases. All cervical spine injuries would have been avoided provided that the children would have refrained from doing a somersault on the trampoline.

Predicting severe injury using vehicle telemetry data.

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Ayoung-Chee, Patricia; Mack, Christopher D; Kaufman, Robert; Bulger, Eileen

2013-01-01

In 2010, the National Highway Traffic Safety Administration standardized collision data collected by event data recorders, which may help determine appropriate emergency medical service (EMS) response. Previous models (e.g., General Motors ) predict severe injury (Injury Severity Score [ISS] > 15) using occupant demographics and collision data. Occupant information is not automatically available, and 12% of calls from advanced automatic collision notification providers are unanswered. To better inform EMS triage, our goal was to create a predictive model only using vehicle collision data. Using the National Automotive Sampling System Crashworthiness Data System data set, we included front-seat occupants in late-model vehicles (2000 and later) in nonrollover and rollover crashes in years 2000 to 2010. Telematic (change in velocity, direction of force, seat belt use, vehicle type and curb weight, as well as multiple impact) and nontelematic variables (maximum intrusion, narrow impact, and passenger ejection) were included. Missing data were multiply imputed. The University of Washington model was tested to predict severe injury before application of guidelines (Step 0) and for occupants who did not meet Steps 1 and 2 criteria (Step 3) of the Centers for Disease Control and Prevention Field Triage Guidelines. A probability threshold of 20% was chosen in accordance with Centers for Disease Control and Prevention recommendations. There were 28,633 crashes, involving 33,956 vehicles and 52,033 occupants, of whom 9.9% had severe injury. At Step 0, the University of Washington model sensitivity was 40.0% and positive predictive value (PPV) was 20.7%. At Step 3, the sensitivity was 32.3 % and PPV was 10.1%. Model analysis excluding nontelematic variables decreased sensitivity and PPV. The sensitivity of the re-created General Motors model was 38.5% at Step 0 and 28.1% at Step 3. We designed a model using only vehicle collision data that was predictive of severe injury at

Patterns of severe injury in pediatric car crash victims: Crash Injury Research Engineering Network database.

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Brown, J Kristine; Jing, Yuezhou; Wang, Stewart; Ehrlich, Peter F

2006-02-01

Motor vehicle crashes (MVCs) account for 50% of pediatric trauma. Safety improvements are typically tested with child crash dummies using an in vitro model. The Crash Injury Research Engineering Network (CIREN) provides an in vivo validation process. Previous research suggest that children in lateral crashes or front-seat locations have higher Injury Severity Scale scores and lower Glasgow Coma Scale scores than those in frontal-impact crashes. However, specific injury patterns and crash characteristics have not been characterized. Data were collected from the CIREN multidisciplinary crash reconstruction network (10 pediatric trauma centers). Injuries were examined with regard to crash direction (frontal/lateral), restraint use, seat location, and change in velocity at impact (DeltaV). Injuries were limited to Abbreviated Injury Scale (AIS) scores of 3 or higher and included head, thoracic, abdominal, pelvic, spine, and long bone (orthopedic) injuries. Standard age groupings (0-4, 5-9, 10-14, and 15-18 years) were used. Statistical analyses used Fisher's Exact test and multiple logistic regressions. Four hundred seventeen MVCs with 2500 injuries were analyzed (males = 219, females = 198). Controlling for DeltaV and age, children in lateral-impact crashes (n = 232) were significantly more likely to suffer severe injuries to the head and thorax as compared with children in frontal crashes (n = 185), who were more likely to suffer severe spine and orthopedic injuries. Children in a front-seat (n = 236) vs those in a back-seat (n = 169) position had more injuries to the thoracic (27% vs 17%), abdominal (21% vs 13%), pelvic (11% vs 1%), and orthopedic (28% vs 10%) regions (P < .05 for all). Seat belts were protective for pelvic (5% vs 12% unbelted) and orthopedic (15% vs 40%) injuries (odds ratio = 3, P < .01 for both). A reproducible pattern of injury is noted for children involved in lateral-impact crashes characterized by head and chest injuries. The Injury Severity

Self-Reported Minimalist Running Injury Incidence and Severity: A Pilot Study.

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Ostermann, Katrina; Ridpath, Lance; Hanna, Jandy B

2016-08-01

Minimalist running entails using shoes with a flexible thin sole and is popular in the United States. Existing literature disagrees over whether minimalist running shoes (MRS) improve perceived severity of injuries associated with running in traditional running shoes (TRS). Additionally, the perceived injury patterns associated with MRS are relatively unknown. To examine whether injury incidence and severity (ie, degree of pain) by body region change after switching to MRS, and to determine if transition times affect injury incidences or severity with MRS. Runners who were either current or previous users of MRS were recruited to complete an Internet-based survey regarding self-reported injury before switching to MRS and whether self-reported pain from that injury decreased after switching. Questions regarding whether new injuries developed in respondents after switching to MRS were also included. Analyses were calculated using t tests, Wilcoxon signed rank tests, and Fischer exact tests. Forty-seven runners completed the survey, and 16 respondents reported injuries before switching to MRS. Among these respondents, pain resulting from injuries of the feet (P=.03) and knees (P=.01) decreased. Eighteen respondents (38.3%) indicated they sustained new injuries after switching to MRS, but the severity of these did not differ significantly from no injury. Neither time allowed for transition to MRS nor use or disuse of a stretching routine during this period was correlated with an increase in the incidence or severity of injuries. After switching to MRS, respondents perceived an improvement in foot and knee injuries. Additionally, respondents using MRS reported an injury rate of 38.3%, compared with the approximately 64% that the literature reports among TRS users. Future studies should be expanded to determine the full extent of the differences in injury patterns between MRS and TRS.

Factors associated with severity of road traffic injuries, Thika, Kenya ...

African Journals Online (AJOL)

Background: Road traffic injuries continue to exert a huge burden on the health care system in Kenya. Few studies on the severity of road traffic injuries have been conducted in Kenya. We carried out a cross-sectional study to determine factors associated with severity of road traffic injuries in a public hospital in Thika district ...

Pediatric Injuries at an Annual Motocross Competition: Rates and Severity.

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Williams, Brendan A; McFadden, James P; Teurlings, Tyler L; Blakemore, Laurel C

Pediatric motocross injuries occur frequently and with significant associated morbidity; however, data are limited regarding injury occurring during competition. North Central Florida hosts an annual motocross competition with numerous pediatric competitors. We sought to evaluate the rate and severity of injuries sustained at this event over a multiyear period. Our primary hypothesis was that motocross injury rates and severity in competition exceed that of other competitive sports in this age group. A retrospective review was performed to identify pediatric patients (17 and younger) presenting to a single Level 1 Trauma Center as a result of injury sustained at an annual motocross competition from 2009 to 2012. Demographic, diagnostic, and treatment data were collected including injuries, procedural interventions, and length of hospital stay. Rate, type, and severity of injury were evaluated and compared with established norms of other competitive sports in a similar age group. Over a 4-year period, 51 pediatric motocross competitors sustained 75 injuries. Injured riders were 14.2±2.51 years (range, 8 to 17 y) old and 92% (47/51) male. Forty (78%) patients sustained at least 1 orthopaedic injury and 17 (33%) patients suffered polytrauma. The majority of injuries occurred in the upper extremity (36%). Twenty-four (47%) patients required procedural intervention, 15 of which were operative. Thirty-nine (76%) patients necessitated surgical specialty care. Average injury severity score was 6.5 (1 to 75) and 1 death occurred. The injury rate for pediatric motocross riders in this study was 19.9 injuries per 1000 competitors. High rates of injury occur among pediatric patients in competitive motocross, exceeding those seen in other competitive sports in a comparable age group. Significant morbidity and at least 1 fatality were demonstrated in the group studied. The majority of patients suffer at least 1 orthopaedic injury and nearly all patients require pediatric

Intracranial Monitoring after Severe Traumatic Brain Injury

OpenAIRE

Donnelly, Joseph

2018-01-01

Intracranial monitoring after severe traumatic brain injury offers the possibility for early detection and amelioration of physiological insults. In this thesis, I explore cerebral insults due raised intracranial pressure, decreased cerebral perfusion pressure and impaired cerebral pressure reactivity after traumatic brain injury. In chapter 2, the importance of intracranial pressure, cerebral perfusion pressure and pressure reactivity in regulating the cerebral circulation is elucidated ...

Injury severity and seating position in accidents with German EMS helicopters.

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Hinkelbein, Jochen; Spelten, Oliver; Neuhaus, Christopher; Hinkelbein, Mandy; Özgür, Enver; Wetsch, Wolfgang A

2013-10-01

Accident rates and fatality rates for Helicopter Emergency Medical Service (HEMS) missions have been investigated recently, but none of these studies considered the influence of the seating position in the helicopter. The aim of the present descriptive and observational study was to analyze injury severity depending on the seating position during HEMS accidents in Germany. Data from the German Federal Agency for Flight Accident Investigation was gathered for a period of 40 years (from 1970 to 2009). The seating position in the aircraft during the accident and the resulting injury severity (i.e., 1=no; 2=slight; 3=severe; and 4=fatal) were recorded. Injury severity was compared using the Fisher's exact test. P values accidents were investigated (n=61 accidents did not lead to any injuries in the occupants, n=7 accidents resulted in minor, and n=6 in severe injuries, and lethal injuries resulted from n=15 accidents). The occupant in the "patient" position was most likely to suffer from deadly injuries (44.9%), followed by the HEMS crew member rear seat (25.0%), compared to lower lethality rates in the other seating positions (9.4-11.2%). Sitting on the HEMS crew member rear seat also was associated with the highest percentage of severe and minor injuries (12.5% each). In HEMS accidents, the patients' position and the HEMS crew member rear seat were found to be at the highest risk for fatal or severe injuries. These results support the urgent requirement of a large international data base for HEMS accidents as a basis for further studies to improve the safety in HEMS missions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Postmortem CT of severe head injuries

International Nuclear Information System (INIS)

Tamura, Masaru; Tsukahara, Yoshio; Nagaseki, Yoshishige; Horikoshi, Satoru; Yodonawa, Masahiko

1983-01-01

CT findings of fatal head injuries were analysed for the cause of death. Postmortem CT examinations were undertaken on 14 cases who died before reaching the hospital or shortly after arrival at the hospital (immediate death group). CT were also examined in non-operative 20 cases who were comatose and who died within 24 hours after severe head injuries (early death group). In the immediate death group, the following findings were demonstrated: a huge amount of free intracranial and intraventricular air in 8 cases; traumatic basal subarachnoid hemorrhage in 3 cases; a mixture of pneumocephalus and subarachnoid hemorrhage in 2 cases, and intracranial hematoma in 1 case. In the early death group: a mixture of pneumocephalus and subarachnoid hemorrhage in 2 cases; traumatic subarachnoid hemorrhage in 5 cases; intracranial hematoma in 11 cases, and brain contusion in 2 cases. The huge amount of intracranial free air due to the severe fracture of the skull base will make the CNS collapse immediately. Basal subarachnoid hemorrhage with signs of brain-stem injuries may result in instantaneous death. Acute subdural hematoma with contusion and edema in elderly patients was the most frequent cause of death in the early death group. (author)

Community integration 2 years after moderate and severe traumatic brain injury.

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Sandhaug, Maria; Andelic, Nada; Langhammer, Birgitta; Mygland, Aase

2015-01-01

The aim of this study was to examine community integration by the Community Integration Questionnaire (CIQ) 2 years after injury in a divided TBI sample of moderately and severely injured patients. The second aim was to identify social-demographic, injury-related and rehabilitation associated predictors of CIQ. A cohort study. Outpatient follow-up. Fifty-seven patients with moderate (n = 21) or severe (n = 36) TBI were examined with the Community Integration Questionnaire (CIQ) at 2 years after injury. Possible predictors were analysed in a regression model using CIQ total score at 2 years as the outcome measure. The Community Integration Questionnaire. At 2 years follow-up, there was significant difference between the moderately and severely injured patients in the productivity scores (p productivity level than the severely injured patients. Marital status, injury severity and rehabilitation after injury were associated with community integration 2 years after TBI.

The assessment of severity of lung injury in sepsis

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Arsenijević Ljubica

2004-01-01

Full Text Available Adult respiratory distress syndrome (ARDS is an acute and severe pulmonary dysfunction. It is clinically characterized by dyspnea and tachypnea, progressive hypoxemia (within 12-48 hours, reduction of pulmonary compliance and diffuse bilateral infiltrates seen on pulmonary radiogram. Etiological factors giving rise to development of the syndrome are numerous. The acute lung injury (AU is defined as the inflammation syndrome and increased permeability, which is associated with radiological and physiological disorders. Lung injury score (LIS, which is composed of four components, is used for making a distinction between two separate but rather similar syndromes. The study was aimed at the assessment of the severity of the lung injury in patients who had suffered from sepsis of the gynecological origin and its influence on the outcome of the disease. The total of 43 female patients was analyzed. Twenty patients (46.51% were diagnosed as having ARDS based on the lung injury score, while 23 patients (53.48% were diagnosed with acute lung injury. In our series, lung injury score ranged from 0.7 to 3.3 in ARDS patients, and lethal outcome ensued in 11 (55% cases in this group. As for the patients with the acute lung injury, the score values ranged from 0.3 to 1.3 and only one patient from this group died (4.34%. The obtained results indicate that high values of the lung injury score are suggestive of the severe respiratory dysfunction as well as that lethal outcome is dependent on LIS value.

Pedestrian injury risk functions based on contour lines of equal injury severity using real world pedestrian/passenger-car accident data.

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Niebuhr, Tobias; Junge, Mirko; Achmus, Stefanie

2013-01-01

Injury risk assessment plays a pivotal role in the assessment of the effectiveness of Advanced Driver Assistance Systems (ADAS) as they specify the injury reduction potential of the system. The usual way to describe injury risks is by use of injury risk functions, i.e. specifying the probability of an injury of a given severity occurring at a specific technical accident severity (collision speed). A method for the generation of a family of risk functions for different levels of injury severity is developed. The injury severity levels are determined by use of a rescaled version of the Injury Severity Score (ISS) namely the ISSx. The injury risk curves for each collision speed is then obtained by fixing the boundary conditions and use of a case-by-case validated GIDAS subset of pedestrian-car accidents (N=852). The resultant functions are of exponential form as opposed to the frequently used logistic regression form. The exponential approach in combination with the critical speed value creates a new injury risk pattern better fitting for high speed/high energy crashes. Presented is a family of pedestrian injury risk functions for an arbitrary injury severity. Thus, the effectiveness of an ADAS can be assessed for mitigation of different injury severities using the same injury risk function and relying on the internal soundness of the risk function with regard to different injury severity levels. For the assessment of emergency braking ADAS, a Zone of Effective Endangerment Increase (ZEEI), the speed interval in which a one percent speed increase results at least in a one percent of injury risk increase, is defined. The methodology presented is kept in such general terms that a direct adaption to other accident configurations is easily done.

Severe Hand Injuries Caused by a Mole Gun

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Serdar Düzgün

2017-10-01

Full Text Available Objective: Injuries by mole guns differ from other firearm injuries primarily because they are close-range, low-energy injuries that are highly contaminated owing to contact with contaminated surfaces and the presence of numerous residual foreign bodies within the wound. The aim of this article is to share our surgical experience regarding the repair of severe hand injuries caused by mole guns. Material and Methods: This retrospective study included 11 patients with hand injuries. Data obtained about the patients, including age, gender, dominant or non-dominant hand, injuries to all vital structures, and reconstructive procedures were assessed, categorized, and recorded. Results: Ten patients had defects in one or several common digital branches of the median nerve in areas ranging from the distal part of the carpal tunnel to the distal palmar crease. All patients had flexor and extensor tendon injuries in all fingers except for the first finger. Reconstruction of soft tissue and skin defects was carried out with an interpolation flap planned from a random-based subpectoral- paraumbilical region in five patients, a SCIA-based groin flap in four patients, a reverse-radial forearm flap in one patient, and an adipofascial flap planned from the forearm in one patient. Conclusion: Mole gun injuries typically include all structures of the hand, and repair procedures involve every anatomic structure of the hand. An early and effective surgical operation followed by prolonged and effective physical therapy protocols is vital for regaining the full spectrum of hand functions.

Aetiology and treatment outcome of severe traumatic brain injuries ...

African Journals Online (AJOL)

Background: Severe traumatic brain injury (TBI) is a major challenge to the patient, the relatives, the care givers, and the society in general. The primary and secondary injuries, and the high metabolism are formidable stages of the injury, each capable of taking the life of the patient. The objectives were to determine the ...

Effect of Posttraumatic Serum Thyroid Hormone Levels on Severity and Mortality of Patients with Severe Traumatic Brain Injury

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Forough Saki

2012-02-01

Full Text Available Traumatic brain injury (TBI is an important cause of death and disability in young adults ,and may lead to physical disabilities and long-term cognitive, behavioral psychological and social defects. There is a lack of definite result about the effect of thyroid hormones after traumatic brain injury in the severity and no data about their effect on mortality of the injury. The aim of this study is to evaluate the effect of thyroid hormones after traumatic brain injury in the severity and mortality and gain a clue in brain injury prognosis. In a longitudinal prospective study from February 2010 until February 2011, we checked serum levels of T3, T4, TSH and TBG of severely brain injured patients and compared the relationship of them with primary Glasgow Coma Scale (GCS score and mortality of patients. Statistical analysis used SPSS 11.5 software with using chi-square and Fisher exact test. Serum levels of T3 and T4 were decreased after brain trauma but not TSH and TBG. Mortality rates were higher in patients with lower T4 serum levels. The head injury was more severe in whom with low T3 and T4. Follow a severe brain injury a secondary hypothyroidism is happened due to pituitary dysfunction. Also, serum level of T3 and T4 on the first day admission affect on primary GCS score of patients which is an indicator of severity of brain injury. In addition, mortality rates of severely brain injured patients have a high correlation with the serum level of T4 in the first day admission.

Unintentional injuries among Chinese children with different types and severity of disability.

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Zhu, Huiping; Xiang, Huiyun; Xia, Xin; Yang, Xia; Li, Dan; Stallones, Lorann; Du, Yukai

2014-01-01

Little research has been done in China to study injury in individuals with disability. We investigated the impact of type and severity of disability on injury among children with disability in Hubei Province of China. A sample of 1201 children with disability were matched with 1201 healthy children on gender, age, and neighborhood. Disability type and severity were determined using the Chinese national standards. Caregivers were interviewed face-to-face about nonfatal unintentional injuries suffered by the child in the past 12 months before the interview. Univariate χ(2) test and logistic regression models were used to investigate association between disability type/severity and nonfatal unintentional injuries. Injury rate among children with disability was significantly higher than that among children without disability (10.2% vs. 4.4%; P disability and injury varied by type and severity of disability. The magnitude of the association between the presence or absence of disability in children and their risk of injury was large and significant, regardless of the type or severity of the children's disabilities. Copyright © 2014 Elsevier Inc. All rights reserved.

Severe blood-brain barrier disruption and surrounding tissue injury.

Science.gov (United States)

Chen, Bo; Friedman, Beth; Cheng, Qun; Tsai, Phil; Schim, Erica; Kleinfeld, David; Lyden, Patrick D

2009-12-01

Blood-brain barrier opening during ischemia follows a biphasic time course, may be partially reversible, and allows plasma constituents to enter brain and possibly damage cells. In contrast, severe vascular disruption after ischemia is unlikely to be reversible and allows even further extravasation of potentially harmful plasma constituents. We sought to use simple fluorescent tracers to allow wide-scale visualization of severely damaged vessels and determine whether such vascular disruption colocalized with regions of severe parenchymal injury. Severe vascular disruption and ischemic injury was produced in adult Sprague Dawley rats by transient occlusion of the middle cerebral artery for 1, 2, 4, or 8 hours, followed by 30 minutes of reperfusion. Fluorescein isothiocyanate-dextran (2 MDa) was injected intravenously before occlusion. After perfusion-fixation, brain sections were processed for ultrastructure or fluorescence imaging. We identified early evidence of tissue damage with Fluoro-Jade staining of dying cells. With increasing ischemia duration, greater quantities of high molecular weight dextran-fluorescein isothiocyanate invaded and marked ischemic regions in a characteristic pattern, appearing first in the medial striatum, spreading to the lateral striatum, and finally involving cortex; maximal injury was seen in the mid-parietal areas, consistent with the known ischemic zone in this model. The regional distribution of the severe vascular disruption correlated with the distribution of 24-hour 2,3,5-triphenyltetrazolium chloride pallor (r=0.75; P<0.05) and the cell death marker Fluoro-Jade (r=0.86; P<0.05). Ultrastructural examination showed significantly increased areas of swollen astrocytic foot process and swollen mitochondria in regions of high compared to low leakage, and compared to contralateral homologous regions (ANOVA P<0.01). Dextran extravasation into the basement membrane and surrounding tissue increased significantly from 2 to 8 hours of

Changes in the Severity and Injury Sources of Thoracic Aorta Injuries due to Vehicular Crashes.

Science.gov (United States)

Ryb, Gabriel; Dischinger, Patricia; Kerns, Timothy; Burch, Cynthia; Rabin, Joseph; Ho, Shiu

Research using the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) suggested a decreased adjusted risk of thoracic aorta injuries (TAI) for newer vehicles during near-side crashes and an increased adjusted TAI risk during frontal crashes. This study attempted to explore possible explanations of these findings. Adult front seat occupants in the Crash Injury Research and Engineering Network (CIREN) database through June 2012 were studied. TAI cases were compared with remaining cases in relation to crash and vehicular characteristics. TAI cases of later crash year (CY) (2004-2012) were compared to those in earlier CY (1996-2003) in relation to TAI severity (minor, moderate, severe and non-survivable). TAI cases in newer model year (MY) vehicles (1999-2012) were compared to those in older vehicles (1988-98) in relation to injury source (steering wheel, front, left, seat belt, air bag and other or unknown). Analysis was stratified by direction of impact (frontal and near-side) and the use of restraints. The similar TAI severity of earlier and later CY among frontal crashes suggests that the observed changes in the adjusted odds of injury seen in NASS-CDS are not due to an increase in injury detection. The decrease in TAI severity among newer vehicles in near-side crashes of later CY is consistent with a beneficial effect of crashworthiness improvements for this crash configuration. A shift of injury source in frontal crashes from the steering wheel in older vehicles to "front of vehicle structures", "seat belts" and "unknown and other" in newer vehicles should suggest potential sites for crashworthiness improvements.

How is the injury severity scored? a brief review of scoring systems

Directory of Open Access Journals (Sweden)

Mohsen Ebrahimi

2015-06-01

Full Text Available The management of injured patients is a critical issue in pre-hospital and emergency departments. Trauma victims are usually young and the injuries may lead to mortality or severe morbidities. The severity of injury can be estimated by observing the anatomic and physiologic evidences. Scoring systems are used to present a scale of describing the severity of the injuries in the victims.We reviewed the evidences of famous scoring systems, the history of their development, applications and their evolutions. We searched electronic database PubMed and Google scholar with keywords: (trauma OR injury AND (severity OR intensity AND (score OR scale.In this paper, we are going to present a definition of scoring systems and discuss the Abbreviated Injury Scale (AIS and Injury Severity Score (ISS, the most acceptable systems, their applications and their advantages and limitations.Several injury-scoring methods have been introduced. Each method has specific features, advantages and disadvantages. The AIS is an anatomical-based scoring system, which provides a standard numerical scale of ranking and comparing injuries. The ISS was established as a platform for trauma data registry. ISS is also an anatomically-based ordinal scale, with a range of 1-75. Several databases and studies are formed based on ISS and are available for trauma management research.Although the ISS is not perfect, it is established as the basic platform of health services and public health researches. The ISS registering system can provide many opportunities for the development of efficient data recording and statistical analyzing models.

Risk factors for severe injury following indoor and outdoor falls in geriatric patients.

Science.gov (United States)

Kim, Sun Hyu

2016-01-01

This study was performed to examine the characteristics of indoor and outdoor falls in older patients and the factors related to severe injury in the emergency department (ED). In total, 26,515 patients fell indoors and 19,581 outdoors. The general and clinical characteristics were compared between the two groups and factors associated with severe injury following the falls were evaluated. Younger males fell more frequently outdoors than indoors. The common activities during outdoor falls were sports and leisure activities. Environmental hazards lead to more outdoor falls than indoor falls. Factors associated with severe injury after indoor falls were transport to the ED by public ambulance or from another medical facility rather than individual transportation, fall from stairs rather than fell over, and a head and neck injury rather than a lower extremity injury. Factors related to severe injury after outdoor falls were male sex, transport to the ED by public ambulance or from another medical facility or by another method rather than individual transportation, state employed, fall from stairs rather than fell over, head and neck or thorax or abdomen injury rather than a lower extremity injury. Transport to the ED by public ambulance or from another medical facility, and head and neck injury were risks for severe injury following indoor and outdoor falls in elderly subjects. Efforts to identify the risk factors for severe injury and for falling itself are important to prevent and reduce fall injuries in elderly subjects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Severe injury in multiple impacts: Analysis of 1997-2015 NASS-CDS.

Science.gov (United States)

Viano, David C; Parenteau, Chantal S

2018-07-04

This is a descriptive study of the incidence and risk for severe injury in single-impact and multi-impact crashes by belt use and crash type using NASS-CDS. 1997-2015 NASS-CDS data were used to determine the distribution of crashes by the number of impacts and severe injury (Maximum Abbreviated Injury Score [MAIS] 4+F) to >15-year-old nonejected drivers by seat belt use in 1997+ MY vehicles. It compares the risk for severe injury in a single impact and in crashes involving 2, 3, or 4+ impacts in the collision with a focus on a frontal crash followed by other impacts. Most vehicle crashes involve a single impact (75.4% of 44,889,518 vehicles), followed by 2-impact crashes (19.6%), 3-impact crashes (5.0%) and 4+ impacts (2.6%). For lap-shoulder-belted drivers, the distribution of severe injury was 42.1% in a single impact, 29.3% in 2 impacts, 13.4% in 3 impacts, and 15.1% in 4+ impact crashes. The risk for a belted driver was 0.256 ± 0.031% in a single impact, 0.564 ± 0.079% in 2 impacts, 0.880 ± 0.125% in 3 impacts, and 2.121 ± 0.646% in 4+ impact. The increase in risk from a single crash to multi-impact collisions was statistically significant (P impact, 53.8% of belted drivers were in a frontal crashes, 22.4% in side crashes, 20% in rear crashes, and 1.7% in rollover crashes. The risk for severe injury was highest in a rollover at 0.677 ± 0.250%, followed by near-side impact at 0.467 ± 0.084% and far-side impact at 0.237 ± 0.071%. Seat belt use was 82.4% effective in preventing severe injury (MAIS 4+F) in a rollover, 47.9% in a near-side impact, and 74.8% in a far-side impact. In 2-impact crashes with a belted driver, the most common sequence was a rear impact followed by a frontal crash at 1,843,506 (21.5%) with a risk for severe injury of 0.100 ± 0.058%. The second most common was a frontal impact followed by another frontal crash at 1,257,264 (14.7%) with a risk of 0.401 ± 0.057%. The risk was 0.658 ± 0.271% in a frontal impact followed by a rear

Medical Management of the Severe Traumatic Brain Injury Patient.

Science.gov (United States)

Marehbian, Jonathan; Muehlschlegel, Susanne; Edlow, Brian L; Hinson, Holly E; Hwang, David Y

2017-12-01

Severe traumatic brain injury (sTBI) is a major contributor to long-term disability and a leading cause of death worldwide. Medical management of the sTBI patient, beginning with prehospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of sTBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care. Where appropriate, differences between the third and fourth editions of the Brain Trauma Foundation guidelines for the management of severe traumatic brain injury are highlighted.

The influence of severe malnutrition on rehabilitation in patients with severe head injury.

Science.gov (United States)

Dénes, Zoltán

2004-10-07

The purpose of the study was to evaluate the consequences of severe malnutrition in patients with severe head injury during rehabilitation. The data were collected from medical records of patients admitted to the neurorehabilitation unit over the last 5 years. Twenty of 1850 patients had severe malnutrition, the body mass index (BMI) of these patients were under 15 (10-14) kg/m2. The majority of patients suffered traumatic brain damage (17/20). Thirteen patients arrived with percutaneous endoscopic gastrotomy /PEG, three nasogastric tube in 3 cases we placed PEG. The nutritional strategy included a high-calorie diet, by means of bolus feeding five times during the day, continuous feeding during the night; the daily intake target being more than 2500 kcal. During rehabilitation treatment the majority of patients (13/20) revealed weight gain with a rate of 0.5-2 kg/week. The following complications were treated during the rehabilitation phase: 20 pressure sores, 20 contractures, 11 urinal infections, 6 cases of pneumonia, 2 of purulent bronchitis, 6 of sepsis, 1 penoscrotal abscess, epidydymitis, and 1 case of purulent arthritis. The patients required total assistance at the time of admission. At discharge 10 patients remained completely dependent, 6 patients needed minimal assistance, and 4 patients could perform daily activities independently. The average length of stay in our unit was 78/6-150/days. Patients with head injury suffering from severe malnutrition exhibit serious complications at the time of admission as well as during rehabilitation treatment. The patients were very difficult to mobilize. The length of stay at the rehabilitation unit was 28 days longer when complicated by malnutrition, than head injuries showing normal nutritional status. These findings underline the importance of adequate nutrition in patients with head injury in both the acute ward and in the rehabilitation unit.

Brain injury and severe eating difficulties at admission

DEFF Research Database (Denmark)

Kjærsgaard, Annette; Kaae Kristensen, Hanne

Objective: The objective of this pilot study was to explore and interpret the way that individuals with acquired brain injury, admitted to inpatient neurorehabilitation with severe eating difficulties, experienced eating nine to fifteen months after discharge. Methods: Four individuals with acqui......Objective: The objective of this pilot study was to explore and interpret the way that individuals with acquired brain injury, admitted to inpatient neurorehabilitation with severe eating difficulties, experienced eating nine to fifteen months after discharge. Methods: Four individuals...... with acquired brain injury were interviewed via qualitative semi-structured interviews. An explorative study was conducted to study eating difficulties. Qualitative content analysis was used. Results: Four main themes emerged from the analysis: personal values related to eating, swallowing difficulties, eating......-of-life. The preliminary findings provide knowledge regarding the patient perspective of adapting to and developing new strategies for activities related to eating, however, further prospective, longitudinal research in a larger scale and with repeated interviews is needed....

Ten Years of Equine-related Injuries: Severity and Implications for Emergency Physicians.

Science.gov (United States)

Davidson, Scott B; Blostein, Paul A; Schrotenboer, Andrew; Sloffer, Chris A; VandenBerg, Sheri L

2015-11-01

The size, speed, and unpredictable nature of horses present a significant risk for injury in all equine-related activities. We sought to examine the mechanism, severity, frequency, body regions affected, surgical requirements, rehabilitation needs, safety equipment utilization, and outcomes of equine-related injured patients. Records of inpatients who sustained an equine-related injury from 2002-2011 with International Classification of Diseases, Ninth Revision codes E828 and E906 were retrospectively reviewed for pertinent data. Ninety patients, 70% female, age (mean ± SD) 37.3 ± 19.4 years, length of stay 3.7 ± 4.5 days, Injury Severity Score 12.9 ± 8.4. Predominant mechanism of injury was fall from horse (46.7%). The chest (23%) was most frequently injured, followed by brain/head (21.5%). Thirty patients (33%) required 57 surgical procedures. Twenty percent of patients required occupational therapy and 33.3% required physical therapy while hospitalized. Only 3% required rehabilitation, with 90% discharged directly home. Safety equipment was not used in 91.9% of patients. One patient sustained a cord injury. Six patients expired, all from extensive head injuries. The majority of equine-related injuries occur while pursuing recreational activities and are due to falls. Our patients experienced more severe injuries to the trunk and head and required more surgical intervention for pelvic, facial, and brain injuries than previously reported. Failure to use safety equipment contributes to the risk of severe injury. Education and injury prevention is essential. The need for complex surgical intervention by multiple specialties supports transfer to Level I trauma centers. Copyright © 2015 Elsevier Inc. All rights reserved.

Severe traumatic brain injury managed with decompressive ...

African Journals Online (AJOL)

2012-05-29

May 29, 2012 ... Patients with severe taumatic brain injury may develop intractable raised ICP resulting in high mortality ... Glasgow coma score was 8/15 (E1V3M4) and he had left ... An emergency right fronto-temporo-parietal decompressive.

Patients with the most severe traumatic brain injury benefit from rehabilitation

DEFF Research Database (Denmark)

Poulsen, Ingrid; Norup, Anne; Liebach, Annette

2014-01-01

Patients with the most severe traumatic brain injury benefit from rehabilitation Ingrid Poulsen, Anne Norup, Annette Liebach, Lars Westergaard, Karin Spangsberg Kristensen, Tina Haren, & Lars Peter Kammersgaard Department for Neurorehabilitation, TBI Unit, Copenhagen University, Glostrup Hospital......., Hvidovre, Denmark Objectives: During the last couple of years, studies have indicated that even patients with the most severe traumatic brain injuries (TBI) benefit from rehabilitation despite what initially appears to be dismal prognosis. In Denmark, all patients with severe TBI have had an opportunity......-acute inpatient rehabilitation during a 12-year period followed an intensive interdisciplinary rehabilitation programme. Severity of injury was defined by Glasgow Coma Scale (GCS) score on rehabilitation admission and duration of post-traumatic amnesia (PTA). Patients were routinely measured...

Platelet-rich plasma (PRP) treatment of sports-related severe acute hamstring injuries.

Science.gov (United States)

Guillodo, Yannick; Madouas, Gwénaelle; Simon, Thomas; Le Dauphin, Hermine; Saraux, Alain

2015-01-01

hamstring injury is the most common musculoskeletal disorder and one of the main causes of missed sporting events. Shortening the time to return to play (TTRTP) is a priority for athletes and sports medicine practitioners. platelet-rich plasma (PRP) injection at the site of severe acute hamstring injury increases the healing rate and shortens the TTRTP. Cohort study. all patients with ultrasonography and MRI evidence of severe acute hamstring injury between January 2012 and March 2014 were offered PRP treatment. Those who accepted received a single intramuscular PRP injection within 8 days post-injury; the other patients served as controls. The same standardized rehabilitation program was used in both groups. A physical examination and ultrasonography were performed 10 and 30 days post-injury, then a phone interview 120 days post-injury, to determine the TTRTP at the pre-injury level. of 34 patients, 15 received PRP and 19 did not. Mean TTRTP at the pre-injury level was 50.9±10.7 days in the PRP group and 52.8±15.7 days in the control group. The difference was not statistically significant. a single intramuscular PRP injection did not shorten the TTRTP in sports people with severe acute hamstring injuries.

Use of Lactoferrin in the Treatment of Patients with Severe Concomitant Injury

Directory of Open Access Journals (Sweden)

V. M. Kapitonov

2009-01-01

Full Text Available Objective: to define the degree of activation of lipid peroxidation in patients with severe concomitant injury and to determine whether they could be corrected with the antioxidant agent Laprot. Subjects and methods. The time course of changes in lipid peroxidation parameters and clinical data was studied in 68 patients with severe concomitant injury, in 35 of whom Laprot (made by P. A. Herzen Moscow Oncological Research Institute, Russian Agency for Medical Technologies (Russia, was added to the standard treatment. Results. The significant activation of oxidative processes and lipid peroxi-dation, which was accompanied by antioxidant system imbalance, was ascertained to occur in severe concomitant injury. Key words: injury, lipid peroxidation, lactoferrin.

Caregiver burden in Danish family members of patients with severe brain injury

DEFF Research Database (Denmark)

Doser, Karoline; Norup, Anne

2016-01-01

OBJECTIVE: To investigate caregiver burden and factors associated with caregiver burden among family members of patients with severe brain injury in the chronic phase. Additionally, the study aimed at investigating differences in burden between parents and spouses. METHODS: Forty-four Danish...... caregivers of patients with severe brain injury were contacted 3-6 years post-injury and asked to complete a measure of caregiver burden. RESULTS: Medium, high and low levels of burden were observed in 45%, 16% and 39% of family members, respectively. Higher burden was seen in caregivers of patients...... with more severe injuries, who spent more time on caregiving and reported more unmet needs. Overall, spouses spent significantly more time taking care of their family member than parents and reported higher levels of burden. CONCLUSIONS: The findings emphasized the continuing consequences of brain injury...

Severe head injury in children - a preventable but forgotten epidemic

African Journals Online (AJOL)

Severe head injury in a child is a sociological disaster that crosses all sociological ... permanently disabled each year as a result of accidental injury." Over a ..... the daylight when transportation of the patient is more rapid; this results in some ...

Acute posterior cruciate ligament injuries: effect of location, severity, and associated injuries on surgical management.

Science.gov (United States)

Anderson, Mark A; Simeone, F Joseph; Palmer, William E; Chang, Connie Y

2018-06-01

To correlate MRI findings of patients with posterior cruciate ligament (PCL) injury and surgical management. A retrospective search yielded 79 acute PCL injuries (36 ± 16 years old, 21 F, 58 M). Two independent readers graded PCL tear location (proximal, middle, or distal third) and severity (low-grade or high-grade partial/complete) and evaluated injury of other knee structures. When available, operative reports were examined and the performed surgical procedure was compared with injury grade, location, and presence of associated injuries. The most commonly injured knee structures in acute PCL tears were posterolateral corner (58/79, 73%) and anterior cruciate ligament (ACL) (48/79, 61%). Of the 64 patients with treatment information, 31/64 (48%) were managed surgically: 12/31 (39%) had PCL reconstruction, 13/31 (42%) had ACL reconstruction, 10/31 (32%) had posterolateral corner reconstruction, 9/31 (29%) had LCL reconstruction, 8/31 (26%) had meniscectomy, and 8/31 (26%) had fixation of a fracture. Proximal third PCL tear and multiligamentous injury were more commonly associated with surgical management (P < 0.05). Posterolateral and posteromedial corner, ACL, collateral ligament, meniscus, patellar retinaculum, and gastrocnemius muscle injury, and fracture were more likely to result in surgical management (P < 0.05). Patients with high-grade partial/complete PCL tear were more likely to have PCL reconstruction as a portion of surgical management (P < 0.05). Location of PCL tear and presence of other knee injuries were associated with surgical management while high-grade/complete PCL tear grade was associated with PCL reconstruction. MRI reporting of PCL tear location, severity, and of other knee structure injuries is important for guiding clinical management.

Injury profiles related to mortality in patients with a low Injury Severity Score: a case-mix issue?

Science.gov (United States)

Joosse, Pieter; Schep, Niels W L; Goslings, J Carel

2012-07-01

Outcome prediction models are widely used to evaluate trauma care. External benchmarking provides individual institutions with a tool to compare survival with a reference dataset. However, these models do have limitations. In this study, the hypothesis was tested whether specific injuries are associated with increased mortality and whether differences in case-mix of these injuries influence outcome comparison. A retrospective study was conducted in a Dutch trauma region. Injury profiles, based on injuries most frequently endured by unexpected death, were determined. The association between these injury profiles and mortality was studied in patients with a low Injury Severity Score by logistic regression. The standardized survival of our population (Ws statistic) was compared with North-American and British reference databases, with and without patients suffering from previously defined injury profiles. In total, 14,811 patients were included. Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic injuries were significantly associated with mortality corrected for age, sex, and physiologic derangement in patients with a low injury severity. Odds ratios ranged from 2.42 to 2.92. The Ws statistic for comparison with North-American databases significantly improved after exclusion of patients with these injuries. The Ws statistic for comparison with a British reference database remained unchanged. Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic wall injuries are associated with increased mortality. Comparative outcome analysis of a population with a reference database that differs in case-mix with respect to these injuries should be interpreted cautiously. Prognostic study, level II.

Music therapy for children with severe burn injury

OpenAIRE

Edwards, Jane

1998-01-01

peer-reviewed Music therapy for children with severe burns is a developing field of practice and research interest in pediatric music therapy. The following article presents an overview of the nature of severe burn injury and provides a rationale for the use of music therapy in the Burn Unit. The application of song writing techniques to address needs of children receiving care for severe burns in a hospital setting is presented.

Validation of ICDPIC software injury severity scores using a large regional trauma registry.

Science.gov (United States)

Greene, Nathaniel H; Kernic, Mary A; Vavilala, Monica S; Rivara, Frederick P

2015-10-01

Administrative or quality improvement registries may or may not contain the elements needed for investigations by trauma researchers. International Classification of Diseases Program for Injury Categorisation (ICDPIC), a statistical program available through Stata, is a powerful tool that can extract injury severity scores from ICD-9-CM codes. We conducted a validation study for use of the ICDPIC in trauma research. We conducted a retrospective cohort validation study of 40,418 patients with injury using a large regional trauma registry. ICDPIC-generated AIS scores for each body region were compared with trauma registry AIS scores (gold standard) in adult and paediatric populations. A separate analysis was conducted among patients with traumatic brain injury (TBI) comparing the ICDPIC tool with ICD-9-CM embedded severity codes. Performance in characterising overall injury severity, by the ISS, was also assessed. The ICDPIC tool generated substantial correlations in thoracic and abdominal trauma (weighted κ 0.87-0.92), and in head and neck trauma (weighted κ 0.76-0.83). The ICDPIC tool captured TBI severity better than ICD-9-CM code embedded severity and offered the advantage of generating a severity value for every patient (rather than having missing data). Its ability to produce an accurate severity score was consistent within each body region as well as overall. The ICDPIC tool performs well in classifying injury severity and is superior to ICD-9-CM embedded severity for TBI. Use of ICDPIC demonstrates substantial efficiency and may be a preferred tool in determining injury severity for large trauma datasets, provided researchers understand its limitations and take caution when examining smaller trauma datasets. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Commercial truck crash injury severity analysis using gradient boosting data mining model.

Science.gov (United States)

Zheng, Zijian; Lu, Pan; Lantz, Brenda

2018-06-01

Truck crashes contribute to a large number of injuries and fatalities. This study seeks to identify the contributing factors affecting truck crash severity using 2010 to 2016 North Dakota and Colorado crash data provided by the Federal Motor Carrier Safety Administration. To fulfill a gap of previous studies, broad considerations of company and driver characteristics, such as company size and driver's license class, along with vehicle types and crash characteristics are researched. Gradient boosting, a data mining technique, is applied to comprehensively analyze the relationship between crash severities and a set of heterogeneous risk factors. Twenty five variables were tested and 22 of them are identified as significant variables contributing to injury severities, however, top 11 variables account for more than 80% of injury forecasting. The relative variable importance analysis is conducted and furthermore marginal effects of all contributing factors are also illustrated in this research. Several factors such as trucking company attributes (e.g., company size), safety inspection values, trucking company commerce status (e.g., interstate or intrastate), time of day, driver's age, first harmful events, and registration condition are found to be significantly associated with crash injury severity. Even though most of the identified contributing factors are significant for all four levels of crash severity, their relative importance and marginal effect are all different. For the first time, trucking company and driver characteristics are proved to have significant impact on truck crash injury severity. Some of the results in this study reinforce previous studies' conclusions. Findings in this study can be helpful for transportation agencies to reduce injury severity, and develop efficient strategies to improve safety. Copyright © 2018 National Safety Council and Elsevier Ltd. All rights reserved.

Severe bicycling injury risk factors in children and adolescents: a case-control study.

Science.gov (United States)

Hagel, Brent E; Romanow, Nicole T R; Enns, Nancy; Williamson, Jacqueline; Rowe, Brian H

2015-05-01

Bicycling is the most common cause of sports and recreation injury in children and adolescents; yet, there is limited evidence on the factors associated with severe bicycling injuries in youth. Case-control study of injured bicyclists less than 18 years old seen in seven emergency departments (EDs) from May 2008 to October 2010. Cases were bicyclists hospitalized after their ED visit (severe injury). Controls were bicyclists seen and discharged from the ED (non-severe injury). Personal, environmental, and crash characteristics were collected by interview. Injury data were collected from medical charts. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to estimate the odds of hospitalization associated with risk factors. Multiple imputation techniques were employed to address missing data. There were 1470 participants including 119 cases. Those ages 13-17 had the highest proportion (23%) of severe injuries resulting from motor vehicle [MV] collision. In models including age, sex and MV collision, being male (OR: 2.02; 95% CI: 1.21-3.38), not wearing a helmet (OR: 2.18; 95% CI: 1.43-3.31) and MV collision (OR: 3.91; 95% CI: 2.26-6.78) were significant risk factors for severe injury. Riding on a paved surface (OR: 0.63; 95% CI: 0.41-0.97) and utilitarian (school, work) bicycling (OR: 0.44; 95% CI: 0.2-0.94) decreased injury risk. Results were similar, apart from utilitarian bicycling (OR: 0.49; 95% CI: 0.22-1.06), after imputation for missing data. Bicycle-MV collisions increase severe injury risk in youth, and adolescents are often injured in these events. This suggests separating bicyclists from MVs or traffic calming strategies could improve safety. Copyright © 2015 Elsevier Ltd. All rights reserved.

Improving occupational injury surveillance by using a severity threshold: development of a new occupational health indicator.

Science.gov (United States)

Sears, Jeanne M; Bowman, Stephen M; Rotert, Mary; Blanar, Laura; Hogg-Johnson, Sheilah

2016-06-01

Hospital discharge data are used for occupational injury surveillance, but observed hospitalisation trends are affected by trends in healthcare practices and workers' compensation coverage that may increasingly impair ascertainment of minor injuries relative to severe injuries. The objectives of this study were to (1) describe the development of a severe injury definition for surveillance purposes and (2) assess the impact of imposing a severity threshold on estimated occupational and non-occupational injury trends. Three independent methods were used to estimate injury severity for the severe injury definition. 10 population-based hospital discharge databases were used to estimate trends (1998-2009), including the National Hospital Discharge Survey (NHDS) and State Inpatient Databases (SID) from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Negative binomial regression was used to model injury trends with and without severity restriction and to test trend divergence by severity. Trend estimates for occupational injuries were biased downwards in the absence of severity restriction, more so than for non-occupational injuries. Imposing a severity threshold resulted in a markedly different historical picture. Severity restriction can be used as an injury surveillance methodology to increase the accuracy of trend estimates, which can then be used by occupational health researchers, practitioners and policy-makers to identify prevention opportunities and to support state and national investments in occupational injury prevention efforts. The newly adopted state-based occupational health indicator, 'Work-Related Severe Traumatic Injury Hospitalizations', incorporates a severity threshold that will reduce temporal ascertainment threats to accurate trend estimates. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A spatial generalized ordered response model to examine highway crash injury severity.

Science.gov (United States)

Castro, Marisol; Paleti, Rajesh; Bhat, Chandra R

2013-03-01

This paper proposes a flexible econometric structure for injury severity analysis at the level of individual crashes that recognizes the ordinal nature of injury severity categories, allows unobserved heterogeneity in the effects of contributing factors, as well as accommodates spatial dependencies in the injury severity levels experienced in crashes that occur close to one another in space. The modeling framework is applied to analyze the injury severity sustained in crashes occurring on highway road segments in Austin, Texas. The sample is drawn from the Texas Department of Transportation (TxDOT) crash incident files from 2009 and includes a variety of crash characteristics, highway design attributes, driver and vehicle characteristics, and environmental factors. The results from our analysis underscore the value of our proposed model for data fit purposes as well as to accurately estimate variable effects. The most important determinants of injury severity on highways, according to our results, are (1) whether any vehicle occupant is ejected, (2) whether collision type is head-on, (3) whether any vehicle involved in the crash overturned, (4) whether any vehicle occupant is unrestrained by a seat-belt, and (5) whether a commercial truck is involved. Copyright © 2012 Elsevier Ltd. All rights reserved.

Family function and its relationship to injury severity and psychiatric outcome in children with acquired brain injury: a systematized review.

Science.gov (United States)

Lax Pericall, Maria Teresa; Taylor, Eric

2014-01-01

The psychological and psychiatric outcome of children with acquired brain injury is influenced by many variables. A review was undertaken to clarify the contribution of family function, how it relates to injury severity, and what particular aspects of family function influence psychological outcome in this group. A systematized review of the literature of studies published between 1970 and 2012 from OvidMedline, PsychoInfo, PsycARTICLES, and Cochrane was undertaken focusing on family function, injury severity, and psychiatric outcome. Thirty-six papers met the inclusion criteria. Injury severity was linked to the development of organic personality change. Family function before injury, measured by the Family Assessment Device or the Clinical Rating Scale, had a statistically significant effect on general psychological functioning in six out of eight studies. Family function had a significant effect for oppositional defiant disorder and secondary attention-deficit-hyperactivity disorder. The effects of family function may differ depending on the age of the child and the severity of the injury. Some styles of parenting moderated recovery. After injury, family function was related to the child's contemporaneous psychiatric symptoms. The level of evidence for these papers was 3 or 4 (Oxford Centre for Evidence-based Medicine criteria). Screening for some aspects of family functioning before injury and family function during the rehabilitation phase may identify children at risk of psychiatric disorders. © 2013 Mac Keith Press.

Severe street and mountain bicycling injuries in adults: a comparison of the incidence, risk factors and injury patterns over 14 years.

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Roberts, Derek J; Ouellet, Jean-Francois; Sutherland, Francis R; Kirkpatrick, Andrew W; Lall, Rohan N; Ball, Chad G

2013-06-01

Street and mountain bicycling are popular recreational activities and prevalent modes of transportation with the potential for severe injury. The purpose of this investigation was to compare the incidence, risk factors and injury patterns among adults with severe street versus mountain bicycling injuries. We conducted a retrospective cohort study using the Southern Alberta Trauma Database of all adults who were severely injured (injury severity score [ISS] ≥ 12) while street or mountain bicycling between Apr. 1, 1995, and Mar. 31, 2009. Among 11 772 severely injured patients, 258 (2.2%) were injured (mean ISS 17, hospital stay 6 d, mortality 7%) while street (n = 209) or mountain bicycling (n = 49). Street cyclists were often injured after being struck by a motor vehicle, whereas mountain bikers were frequently injured after faulty jump attempts, bike tricks and falls (cliffs, roadsides, embankments). Mountain cyclists were admitted more often on weekends than weekdays (61.2% v. 45.0%, p = 0.040). Injury patterns were similar for both cohorts (all p > 0.05), with trauma to the head (67.4%), extremities (38.4%), chest (34.1%), face (26.0%) and abdomen (10.1%) being common. Spinal injuries, however, were more frequent among mountain cyclists (65.3% v. 41.1%, p = 0.003). Surgical intervention was required in 33.3% of patients (9.7% open reduction internal fixation, 7.8% spinal fixation, 7.0% craniotomy, 5.8% facial repair and 2.7% laparotomy). With the exception of spine injuries, severely injured cyclists display similar patterns of injury and comparable outcomes, regardless of style (street v. mountain). Helmets and thoracic protection should be advocated for injury prevention.

Protection for Thorax Injury Severity in 90° Lateral Collision

Directory of Open Access Journals (Sweden)

Dimitrios Kallieris

1996-01-01

Full Text Available The thoracic trauma index (TTI and the viscous criterion (VC are injury criteria intended for the prediction of torso injury severity. The criteria were assessed in two series of experiments: 90° (lateral car to car collisions and controlled left trunk impacts against either a rigid or padded wall. Forty-two belt restrained human cadavers in the age range 18–65 years, located in the near-side front passenger seat, were used. The impact velocity was between 40 and 60 km/h. Left and right side impacts were simulated using standard or modified car side structures. With the second series of experiments, the left side of each subject was impacted under one of two different test conditions: 24 km/h rigid wall or 32 km/h padded wall. The thorax deformation was evaluated through the double integration of the accelerated difference at the fourth and eight ribs, near and far side. Deformation maxima of 6–138 mm (mean 69 mm, VC values of 0.3–4.7 m/s (mean 1.6 m/s, and TTI values of 85–252 (mean 63 occurred. Torso abbreviated injury severity (AIS values were between 0 and 5. Statistical analyses showed a stronger influence of age on injury severity than the injury criteria or biomechanical responses in the two series of experiments. The TTI showed the highest correlation with thoracic AIS and the number of rib fractures, while VC was the better predictor of abdominal AIS. The results are discussed critically and the strength and robustness of the injury criteria analyzed.

Risk Factors for Motorcycle-related Severe Injuries in a Medium-sized City in China

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Xiong, Lili; Zhu, Yao; Li, Liping

2016-01-01

Background Motorcycle vehicles are frequent in China, especially in the small and medium sized cities. Road traffic collisions involving motorcycles often result in severe injuries. We aimed to identify risk factors for severe injuries in inpatients sustaining motorcycle collisions. Methods Patients with road traffic injuries involving motorcycles who presented to the neurosurgery and orthopedic departments of three major comprehensive hospitals in Shantou city were reviewed from October 2012 to June 2013. Data from 349 patients was investigated. Crash and injury characteristics were documented by interviewing patients, their family members, and their doctors. Binary logistic regression was used to determine risk factors for severe injuries. Results There were 253 males (72.49%) and 96 females (27.51%), with a male to female ratio of 2.64:1. The mean age was 38.21±17.32 years. One-hundred and fifty patients were in the severe injury group with a mean injury severity score (ISS) of 15.34±9.13. The simple and multiple logistic model showed that males, lack of safeguards, morning and night hours, non-urban areas, collision of a motorcycle with a cycle, ambulance transportation to hospital, admission to a neurosurgery department, lack of traffic control, unobstructed traffic, and poor visibility were all the risk factors. Conclusions This research highlights some problems: less helmet wearing in motorcyclists and cyclists, rural injuries being more serious than urban ones, and head injuries being the main diagnosis in severe injuries. The result of this research is predictable. If the safety equipment is required to be used, such as helmets, and the traffic environment is improved, such as traffic flow, medical resources to injuries and deaths is seasonable, then traffic safety will be improved and accidents will be reduced. PMID:29546203

A joint econometric analysis of seat belt use and crash-related injury severity.

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Eluru, Naveen; Bhat, Chandra R

2007-09-01

This paper formulates a comprehensive econometric structure that recognizes two important issues in crash-related injury severity analysis. First, the impact of a factor on injury severity may be moderated by various observed and unobserved variables specific to an individual or to a crash. Second, seat belt use is likely to be endogenous to injury severity. That is, it is possible that intrinsically unsafe drivers do not wear seat belts and are the ones likely to be involved in high injury severity crashes because of their unsafe driving habits. The preceding issues are considered in the current research effort through the development of a comprehensive model of seat belt use and injury severity that takes the form of a joint correlated random coefficients binary-ordered response system. To our knowledge, this is the first instance of such a model formulation and application not only in the safety analysis literature, but in the econometrics literature in general. The empirical analysis is based on the 2003 General Estimates System (GES) data base. Several types of variables are considered to explain seat belt use and injury severity levels, including driver characteristics, vehicle characteristics, roadway design attributes, environmental factors, and crash characteristics. The results, in addition to confirming the effects of various explanatory variables, also highlight the importance of (a) considering the moderating effects of unobserved individual/crash-related factors on the determinants of injury severity and (b) seat belt use endogeneity. From a policy standpoint, the results suggest that seat belt non-users, when apprehended in the act, should perhaps be subjected to both a fine (to increase the chances that they wear seat belts) as well as mandatory enrollment in a defensive driving course (to attempt to change their aggressive driving behaviors).

Considering built environment and spatial correlation in modelling pedestrian injury severity

DEFF Research Database (Denmark)

Prato, Carlo G.; Kaplan, Sigal; Patrier, Alexandre

traffic calming measures, illumination solutions, road maintenance programs and speed limit reductions. Moreover, this study emphasises the role of the built environment, as shopping areas, residential areas, and walking traffic density are positively related to a reduction in pedestrian injury severity......This study looks at mitigating and aggravating factors that are associated with the injury severity of pedestrians when they have crashes with another road user and overcomes existing limitations in the literature by posing attention on the built environment and considering spatial correlation...... of pedestrians to sustain a severe or fatal injury conditional on the occurrence of a crash with another road user. This study confirms previous findings about older pedestrians and intoxicated pedestrians being the most vulnerable road users, and crashes with heavy vehicles and in roads with higher speed limits...

Considering built environment and spatial correlation in modelling pedestrian injury severity

DEFF Research Database (Denmark)

Prato, Carlo G.; Kaplan, Sigal; Patrier, Alexandre

2018-01-01

traffic calming measures, illumination solutions, road maintenance programs and speed limit reductions. Moreover, this study emphasises the role of the built environment, as shopping areas, residential areas, and walking traffic density are positively related to a reduction in pedestrian injury severity......This study looks at mitigating and aggravating factors that are associated with the injury severity of pedestrians when they have crashes with another road user and overcomes existing limitations in the literature by posing attention on the built environment and considering spatial correlation...... of pedestrians to sustain a severe or fatal injury conditional on the occurrence of a crash with another road user. This study confirms previous findings about older pedestrians and intoxicated pedestrians being the most vulnerable road users, and crashes with heavy vehicles and in roads with higher speed limits...

Neurosurgery for management of severe head injury

International Nuclear Information System (INIS)

Seitz, K.; Richter, H.P.

1998-01-01

Neurosurgery as a treatment of severe head injuries is not restricted to invasive surgery but also includes peri-operative intensive care medicine. Thanks to the technological progress and advanced diagnostic tools, especially drug treatments and their efficiency as well as risks can be far better monitored and analysed today. (orig./CB) [de

Hospital stay as a proxy indicator for severe injury in earthquakes: a retrospective analysis.

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Zhao, Lu-Ping; Gerdin, Martin; Westman, Lina; Rodriguez-Llanes, Jose Manuel; Wu, Qi; van den Oever, Barbara; Pan, Liang; Albela, Manuel; Chen, Gao; Zhang, De-Sheng; Guha-Sapir, Debarati; von Schreeb, Johan

2013-01-01

Earthquakes are the most violent type of natural disasters and injuries are the dominant medical problem in the early phases after earthquakes. However, likely because of poor data availability, high-quality research on injuries after earthquakes is lacking. Length of hospital stay (LOS) has been validated as a proxy indicator for injury severity in high-income settings and could potentially be used in retrospective research of injuries after earthquakes. In this study, we assessed LOS as an adequate proxy indicator for severe injury in trauma survivors of an earthquake. A retrospective analysis was conducted using a database of 1,878 injured patients from the 2008 Wenchuan earthquake. Our primary outcome was severe injury, defined as a composite measure of serious injury or resource use. Secondary outcomes were serious injury and resource use, analysed separately. Non-parametric receiver operating characteristics (ROC) and area under the curve (AUC) analysis was used to test the discriminatory accuracy of LOS when used to identify severe injury. An 0.7earthquake survivors. However, LOS was found to be a proxy for major nonorthopaedic surgery and blood transfusion. These findings can be useful for retrospective research on earthquake-injured patients when detailed hospital records are not available.

Motor vehicle and pedestrian collisions: burden of severe injury on major versus neighborhood roads.

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Rothman, Linda; Slater, Morgan; Meaney, Christopher; Howard, Andrew

2010-02-01

To determine whether the severity of injuries sustained by pedestrians involved in motor vehicle collisions varies by road type and age. All police-reported pedestrian motor vehicle collisions in the city of Toronto, Canada, between January 1, 2000, and December 31, 2005, were analyzed. Geographic Information Systems software was used to determine whether the collisions occurred on major or neighborhood roads. Age-specific estimates of the burden of pedestrian collisions are presented. Odds ratios and 95 percent confidence intervals were calculated to examine age-specific relationships between injury severity and road type. A second analysis comparing the distribution of severe injury location between age groups was also performed. The majority of collisions involved adults (68%), although elderly pedestrians were overrepresented in fatal collisions (49%). Severe and fatal collisions involving working-age and elderly adult pedestrians were more likely on major roads. Odds of severe injury occurring on a major road were 1.36 (95% CI: 1.17-1.57) times higher for adults ages 18 to 64, and 1.55 (95% CI: 1.22-1.99) times higher for elderly aged 65+. By contrast, severe injuries among children were more common on neighborhood roads, with odds of severe injury on a major road of 0.64 (95% CI: 0.37-1.1) for children aged 5 to 9. Among children under 9, 64-67 percent of hospitalized or fatal injuries occurred on neighborhood roads, a marked difference from the distribution of such injuries in adults or the elderly, for whom only 29-30 percent of hospitalized or fatal injuries occurred on neighborhood roads (chi-square = 52.6, p roads alone will not make child pedestrians safer. Pedestrian interventions specific to children and focused on neighborhood roads must be considered in urban centers like Toronto.

Osteo-Odonto-Keratoprosthesis in Severe Thermal and Chemical Injuries.

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Vasquez-Perez, Alfonso; Zarei-Ghanavati, Mehran; Avadhanam, Venkata; Liu, Christopher

2018-05-16

To report the results of osteo-odonto-keratoprosthesis (OOKP) surgery in patients who sustained severe chemical and thermal injuries. This is a noncomparative retrospective case series of 14 patients who underwent OOKP surgery between 2001 and 2016 at the Sussex Eye Hospital, Brighton, UK, because of severe chemical and thermal injuries RESULTS:: OOKP surgery was performed in 14 eyes of 14 patients. Eight patients (57%) sustained thermal injuries and 6 patients (43%) chemical injuries. Every eye had previously undergone adnexal or ocular surgery, including 2 cases that underwent synthetic keratoprosthesis implantation. One case had choroidal hemorrhage during stage 2. Laminar retention was observed in 11 cases (85%) at the end of the study. The Kaplan-Meier curve showed a probability of 81% of laminar retention at 5 years and a decrease at 15 years to 61%. Functional visual success was observed in only 7 patients (50%) because of end-stage glaucomatous optic neuropathy in 4 cases and macular scar in 1 case. Two cases developed endophthalmitis. Two cases required removal of laminae, one because of endophthalmitis, bone resorption and aqueous leak and the other because of development of a retroprosthetic membrane. Glaucoma was the most frequent complication (79%) and required surgical intervention with tube shunts in 5 cases. Six cases (43%) required buccal mucosal repair, which included two cases that developed endophthalmitis. Anatomic success was achieved in 11 of 13 cases in this series of OOKP surgery after severe chemical and thermal trauma; 8 of these cases had at least 5 years of follow-up and thus qualified as long-term.

Modeling the risk: innovative approaches to understand and quantify the risk of severe FB injury.

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Berchialla, Paola; Bellussi, Luisa; Castella, Annalisa; Snidero, Silvia; Passali, Desiderio; Gregori, Dario

2012-05-14

The entry of a small item into the respiratory or digestive tract is still one of the leading causes of injuries in children up to 14 years old. The aim of the paper is to provide a quantitative risk assessment analysis for identifying consumer product features which contribute to increase the risk of sustaining a severe injury. Data on foreign body injuries were collected in 28 European countries and one Pakistani hospital. A total of 7296 cases were classified according to ICD-9CM 931-935. Information about injuries included age and gender of the injured child, circumstances of the accident and foreign body features. A classification tree was set up in order to analyze the impact of the item features like volume shape and rigidity on the severity of the injury. Males are involved in severe injuries more often than females. Most severe injuries when the foreign body is localized in the ears were due to objects with volume lesser than 49 mm(3). Volume cut-off is slightly higher for foreign bodies that have been found in the nose (55 mm(3)). Objects with conforming rigidity pose children to higher risk of severe injury. The presence and supervision of an adult is crucial in reducing the risk for severe injuries both in pharynx and laryhnx and in mouth. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Patient Effort in Traumatic Brain Injury Inpatient Rehabilitation: Course and Associations With Age, Brain Injury Severity, and Time Postinjury

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Seel, Ronald T.; Corrigan, John D.; Dijkers, Marcel P.; Barrett, Ryan S.; Bogner, Jennifer; Smout, Randall J.; Garmoe, William; Horn, Susan D.

2016-01-01

Objective To describe patients' level of effort in occupational, physical, and speech therapy sessions during traumatic brain injury (TBI) inpatient rehabilitation and to evaluate how age, injury severity, cognitive impairment, and time are associated with effort. Design Prospective, multicenter, longitudinal cohort study. Setting Acute TBI rehabilitation programs. Participants Patients (N=1946) receiving 138,555 therapy sessions. Interventions Not applicable. Main Outcome Measures Effort in rehabilitation sessions rated on the Rehabilitation Intensity of Therapy Scale, FIM, Comprehensive Severity Index brain injury severity score, posttraumatic amnesia (PTA), and Agitated Behavior Scale (ABS). Results The Rehabilitation Intensity of Therapy Scale effort ratings in individual therapy sessions closely conformed to a normative distribution for all 3 disciplines. Mean Rehabilitation Intensity of Therapy Scale ratings for patients' therapy sessions were higher in the discharge week than in the admission week (Prehabilitation, differences in effort ratings (Pcognitive scores and over time. In linear mixed-effects modeling, age and Comprehensive Severity Index brain injury severity score at admission, days from injury to rehabilitation admission, days from admission, and daily ratings of PTA and ABS score were predictors of level of effort (Prehabilitation setting using the Rehabilitation Intensity of Therapy Scale. Patients who sustain TBI show varying levels of effort in rehabilitation therapy sessions, with effort tending to increase over the stay. PTA and agitated behavior are primary risk factors that substantially reduce patient effort in therapies. PMID:26212400

Young Children's Acute Stress After a Burn Injury: Disentangling the Role of Injury Severity and Parental Acute Stress.

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Haag, Ann-Christin; Landolt, Markus A

2017-09-01

Although injury severity and parental stress are strong predictors of posttraumatic adjustment in young children after burns, little is known about the interplay of these variables. This study aimed at clarifying mediation processes between injury severity and mother's, father's, and young child's acute stress. Structural equation modeling was used to examine the relationships between injury severity and parental and child acute stress. Parents of 138 burn-injured children (ages 1-4 years) completed standardized questionnaires on average 19 days postinjury. Sixteen children (11.7%) met Diagnostic and Statistical Manual of Mental Disorders, 5th edition, preschool criteria for posttraumatic stress disorder (excluding time criterion). The model revealed a significant mediation of maternal acute stress, with the effect of injury severity on a child's acute stress mediated by maternal acute stress. Paternal acute stress failed to serve as a mediating variable. Our findings confirm mothers' crucial role in the posttraumatic adjustment of young children. Clinically, mothers' acute stress should be monitored. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Railway train versus motor vehicle collisions: a comparative study of injury severity and patterns.

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Kligman, M D; Knotts, F B; Buderer, N M; Kerwin, A J; Rodgers, J F

1999-11-01

This study compares the demographics, injury severity, resource use, and injury patterns of patients involved in railway train-motor vehicle (RT-MV) to motor vehicle-motor vehicle (MV-MV) collisions. Retrospective trauma registry review of 74 RT-MV and 1,931 MV-MV consecutive patients, age more than 14 years, presenting to two Level I trauma centers, January of 1991 to May of 1998. Compared with MV-MV, RT-MV had significantly more males (72% vs. 54%), higher mortality (15% vs. 7%), higher Injury Severity Score (median, 20 vs. 9), longer intensive care unit length of stay (1.7 vs. 0.04 days), and longer hospital length of stay (7.5 vs. 4 days). RT-MV patients had a higher percentage of scalp/facial lacerations; intracranial hemorrhage; hemothorax and pneumothorax; fractures of the rib/sternum, upper extremity, skull, and face; and lung, splenic, and renal injuries. After adjusting for the difference in Injury Severity Score between groups, the only remaining significant group difference was the odds of a scalp/facial laceration. RT-MV collisions are a marker for more severe injuries, but not a different pattern of injury, compared with MV-MV collisions.

Bus accident severity and passenger injury: evidence from Denmark

DEFF Research Database (Denmark)

Prato, Carlo Giacomo; Kaplan, Sigal

2014-01-01

Purpose Bus safety is a concern not only in developing countries, but also in the U.S. and Europe. In Denmark, disentangling risk factors that are positively or negatively related to bus accident severity and injury occurrence to bus passengers can contribute to promote safety as an essential...... principle of sustainable transit and advance the vision “every accident is one too many”. Methods Bus accident data were retrieved from the national accident database for the period 2002–2011. A generalized ordered logit model allows analyzing bus accident severity and a logistic regression enables...... examining occurrence of injury to bus passengers. Results Bus accident severity is positively related to (i) the involvement of vulnerable road users, (ii) high speed limits, (iii) night hours, (iv) elderly drivers of the third party involved, and (v) bus drivers and other drivers crossing in yellow or red...

Injury severity assessment for car occupants in frontal impacts, using disability scaling.

Science.gov (United States)

Norin, H; Krafft, M; Korner, J; Nygren, A; Tingvall, C

1997-01-01

Injury classification and assessment is one of the most important fields of injury prevention. At present, injury assessment focuses primarily on the risk of fatalities, in spite of the fact that most people who are injured survive the trauma. The net result of a fatality-based approach is that safety and vehicle engineers must make decisions with an incomplete, and sometimes misleading, picture of the traffic safety problem. By applying disability scaling reflecting long-term consequences to injury data, the most significant disabling injuries can be identified. The priorities change with the level of disability used in the scaling. In this study, the risk of permanent medical disability due to different injuries was derived and linked to abbreviated injury scale (AIS) values for 24,087 different injured body regions. This material is based on insurance data. To study how the importance of different bodily injuries changes with different severity assessments in a realistic real-world injury distribution, Swedish insurance industry disability scaling was applied to 3066 cases of belted Volvo drivers involved in frontal collisions. Crash severity was included in the study by using equivalent barrier speed (EBS). When lower levels of disability are included, injuries to the neck and the extremities become the most important, while brain and skull injuries become the most prominent at higher levels of disability. The results presented in this article should be regarded as a contribution to the development of a suitable disability scaling method. The results can also be utilized to further injury research and vehicle design aimed at reducing injuries which have the most important long-term disability consequences.

The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury.

Science.gov (United States)

Alway, Yvette; Gould, Kate Rachel; McKay, Adam; Johnston, Lisa; Ponsford, Jennie

2016-05-01

Increasing evidence indicates that post-traumatic stress disorder (PTSD) may develop following traumatic brain injury (TBI), despite most patients having no conscious memory of their accident. This prospective study examined the frequency, timing of onset, symptom profile, and trajectory of PTSD and its psychiatric comorbidities during the first 4 years following moderate-to-severe TBI. Participants were 85 individuals (78.8% male) with moderate or severe TBI recruited following admission to acute rehabilitation between 2005 and 2010. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders (SCID-I), participants were evaluated for pre- and post-injury PTSD soon after injury and reassessed at 6 months, 12 months, 2 years, 3 years, and 4 years post-injury. Over the first 4 years post-injury, 17.6% developed injury-related PTSD, none of whom had PTSD prior to injury. PTSD onset peaked between 6 and 12 months post-injury. The majority of PTSD cases (66.7%) had a delayed-onset, which for a third was preceded by subsyndromal symptoms in the first 6 months post-injury. PTSD frequency increased over the first year post-injury, remained stable during the second year, and gradually declined thereafter. The majority of subjects with PTSD experienced a chronic symptom course and all developed one or more than one comorbid psychiatric disorder, with mood, other anxiety, and substance-use disorders being the most common. Despite event-related amnesia, post-traumatic stress symptoms, including vivid re-experiencing phenomena, may develop following moderate-to-severe TBI. Onset is typically delayed and symptoms may persist for several years post-injury.

Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates.

Science.gov (United States)

Beaulieu-Bonneau, Simon; Ouellet, Marie-Christine

2017-10-01

The objectives of this study were to document the evolution of fatigue in the first year after traumatic brain injury (TBI), and to explore correlates of fatigue. Participants were 210 adults who were hospitalised following a TBI. They completed questionnaires 4, 8, and 12 months post-injury, including the Multidimensional Fatigue Inventory (MFI). Participants with severe TBI presented greater mental and physical fatigue, and reduced activity compared to participants with moderate TBI. For all MFI subscales except reduced motivation, the general pattern was a reduction of fatigue levels over time after mild TBI, an increase of fatigue after severe TBI, and stable fatigue after moderate TBI. Fatigue was significantly associated with depression, insomnia, cognitive difficulties, and pain at 4 months; the same variables and work status at 8 months; and depression, insomnia, cognitive difficulties, and work status at 12 months. These findings suggest that injury severity could have an impact on the course of fatigue in the first year post-TBI. Depression, insomnia, and cognitive difficulties remain strong correlates of fatigue, while for pain and work status the association with fatigue evolves over time. This could influence the development of intervention strategies for fatigue, implemented at specific times for each severity subgroup.

Biomarkers for severity of spinal cord injury in the cerebrospinal fluid of rats.

Directory of Open Access Journals (Sweden)

Joanna M Lubieniecka

Full Text Available One of the major challenges in management of spinal cord injury (SCI is that the assessment of injury severity is often imprecise. Identification of reliable, easily quantifiable biomarkers that delineate the severity of the initial injury and that have prognostic value for the degree of functional recovery would significantly aid the clinician in the choice of potential treatments. To find such biomarkers we performed quantitative liquid chromatography-mass spectrometry (LC-MS/MS analyses of cerebrospinal fluid (CSF collected from rats 24 h after either a moderate or severe SCI. We identified a panel of 42 putative biomarkers of SCI, 10 of which represent potential biomarkers of SCI severity. Three of the candidate biomarkers, Ywhaz, Itih4, and Gpx3 were also validated by Western blot in a biological replicate of the injury. The putative biomarkers identified in this study may potentially be a valuable tool in the assessment of the extent of spinal cord damage.

Biomarkers for Severity of Spinal Cord Injury in the Cerebrospinal Fluid of Rats

Science.gov (United States)

Lubieniecka, Joanna M.; Streijger, Femke; Lee, Jae H. T.; Stoynov, Nikolay; Liu, Jie; Mottus, Randy; Pfeifer, Tom; Kwon, Brian K.; Coorssen, Jens R.; Foster, Leonard J.; Grigliatti, Thomas A.; Tetzlaff, Wolfram

2011-01-01

One of the major challenges in management of spinal cord injury (SCI) is that the assessment of injury severity is often imprecise. Identification of reliable, easily quantifiable biomarkers that delineate the severity of the initial injury and that have prognostic value for the degree of functional recovery would significantly aid the clinician in the choice of potential treatments. To find such biomarkers we performed quantitative liquid chromatography-mass spectrometry (LC-MS/MS) analyses of cerebrospinal fluid (CSF) collected from rats 24 h after either a moderate or severe SCI. We identified a panel of 42 putative biomarkers of SCI, 10 of which represent potential biomarkers of SCI severity. Three of the candidate biomarkers, Ywhaz, Itih4, and Gpx3 were also validated by Western blot in a biological replicate of the injury. The putative biomarkers identified in this study may potentially be a valuable tool in the assessment of the extent of spinal cord damage. PMID:21559420

Acute Respiratory Distress Syndrome in Severe Brain Injury

Directory of Open Access Journals (Sweden)

Yu. A. Churlyaev

2009-01-01

Full Text Available Objective: to study the development of acute respiratory distress syndrome (ARDS in victims with isolated severe brain injury (SBI. Subject and methods. 171 studies were performed in 16 victims with SBI. Their general condition was rated as very critical. The patients were divided into three groups: 1 non-ARDS; 2 Stage 1 ARDS; and 3 Stage 2 ARDS. The indicators of Stages 1 and 2 were assessed in accordance with the classification proposed by V. V. Moroz and A. M. Golubev. Intracranial pressure (ICP, extravascular lung water index, pulmonary vascular permeability, central hemodynamics, oxygenation index, lung anastomosis, the X-ray pattern of the lung and brain (computed tomography, and its function were monitored. Results. The hemispheric cortical level of injury of the brain with function compensation of its stem was predominantly determined in the controls; subcompensation and decompensation were ascertained in the ARDS groups. According to the proposed classification, these patients developed Stages 1 and 2 ARDS. When ARDS developed, there were rises in the level of extravascular lung fluid and pulmonary vascular permeability, a reduction in the oxygenation index (it was 6—12 hours later as compared with them, increases in a lung shunt and ICP; X-ray study revealed bilateral infiltrates in the absence of heart failure in Stage 2 ARDS. The correlation was positive between ICP and extravascular lung water index, and lung vascular permeability index (r>0.4;p<0.05. Conclusion. The studies have indicated that the classification proposed by V. V. Moroz and A. M. Golubev enables an early diagnosis of ARDS. One of its causes is severe brainstem injury that results in increased extravascular fluid in the lung due to its enhanced vascular permeability. The ICP value is a determinant in the diagnosis of secondary brain injuries. Key words: acute respiratory distress syndrome, extravascu-lar lung fluid, pulmonary vascular permeability, brain injury

Sorting variables for each case: a new algorithm to calculate injury severity score (ISS) using SPSS-PC.

Science.gov (United States)

Linn, S

One of the more often used measures of multiple injuries is the injury severity score (ISS). Determination of the ISS is based on the abbreviated injury scale (AIS). This paper suggests a new algorithm to sort the AISs for each case and calculate ISS. The program uses unsorted abbreviated injury scale (AIS) levels for each case and rearranges them in descending order. The first three sorted AISs representing the three most severe injuries of a person are then used to calculate injury severity score (ISS). This algorithm should be useful for analyses of clusters of injuries especially when more patients have multiple injuries.

Suspected alcohol and addictive narcotic use were more at risk to severe head injury

Directory of Open Access Journals (Sweden)

Woro Riyadina

2012-07-01

Full Text Available Latar belakang: Cedera kepala menyebabkan dampak seperti gangguan kognitif, perilaku dan keterbatasan fisik. Tujuan studi ini untuk menentukan faktor utama yang berkontribusi terhadap keparahan cedera kepala pada pasien yang dirawat inap di rumah sakit. Metode: Studi ini merupakan bagian dari penelitian “Pengembangan Database Registri Trauma sebagai Penunjang Sistem Surveilans Cedera”. Data dikumpulkan dengan cara abstraksi dari rekam medis oleh petugas terlatih dengan formulir registri pada pasien cedera yang dirawat inap di 3 rumah sakit dari bulan Januari – Agustus 2010. Keparahan cedera diklasifikasikan berdasarkan Glasgow Coma Scale (GCS dengan batasan nilai 3-9 mengalami cedera kepala berat, 10-12 cedera kepala sedang dan 13-15 cedera kepala ringan. Hasil: Dari 450 pasien cedera rawat inap terdapat 36 pasien (8% yang mengalami cedera kepala berat. Pasien dengan indikasi mengkonsumsi alkohol/narkotik mempunyai risiko hampir 5 kali mengalami cedera kepala berat [rasio odds suaian (ORa = 4,77; 95% interval kepercayaan (CI=1,04–21,75] dibanding tanpa indikasi. Pasien yang tidak dirujuk mempunyai risiko 5,5 kali  mengalami cedera kepala berat (ORa=5,50; 95% CI=2,28–13,27 dibanding pasien yang dirujuk. Pasien cedera karena kecelakaaan lalu lintas dibanding bukan kecelakaan lalu lintas mempunyai risiko 3 kali mengalami cedera kepala berat (ORa=3,43; 95% CI=1,14–10,32. Kesimpulan: Indikasi mengkonsumsi alkohol/narkotik berkontribusi paling besar terhadap keparahan cedera kepala. Kampanye anti alkohol/narkotik dan perlu dilakukan untuk mencegah cedera kepala berat. (Health Science Indones 2011;2:34-40   Abstract Background: The impact of head injuries were cognitive disorder, behavioral disorder and physical limitation. The objective of this study was to identify a major factor that contributes to head injury severity in hospitalized patients. Methods: This study was part of research "Development of Trauma Registry Databases as a

CONSEQUENCES OF SEVERE TRAUMATIC BRAIN INJURY IN CHILDREN AND THEIR TREATMENT

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N.N. Zavadenko

2006-01-01

Full Text Available Traumatic brain injury is one of the major causes for invalidization in children. The research purpose is an integrated study of consequences of severe and moderate closed traumatic brain injury in children and evaluation of their dynamics during therapy by means of a no tropic medication — cerebrolysin (Ebewe Pharma, Austria. The total of 283 children aged from 4 to 14 years were examined in the longaterm period of severe and moderate closed traumatic brain injury, from 6 months to 4 years after injury. Their neurological status was characterized by nona specific focal symptoms along with evident motor coordination disturbances, elements of dynamic and staticoloa comotory ataxia, reduction in execution speed of serial movements. Statistically significant differences with ageamatched controls were confirmed for measures of acousticaverbal memory and sustained attention. Posttraumatic epilepsy developed in 16 (5,7% patients with the onset of secondarily generalized seizures in 4–12 months following the injury. Effectiveness of the no tropic medication was evaluated in 60 patients aged from 7 to 12 years, who were distributed into 2 equal groups. The research has confirmed a positive effect of no tropic medication in the treatment of traumatic brain injury consequences manifested in the regression of headaches, fatigue, motor coordination disturbances along with improvements of memory, attention, intellectual performance rates, as well as EEG characteristics.Key words: traumatic brain injury, consequences, children, therapy, nootropic medications.

Nitric oxide as an indicator for severity of injury in polytrauma.

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Beitl, E; Banasova, A; Vlcek, M; Mikova, D; Hampl, V

2016-01-01

Patients with injuries to multiple organs or organ systems are in a serious risk of shock, multiorgan failure and death. Although there are scoring systems available to assess the extent of polytrauma and guide the prognosis, their usefulness is limited by their considerably subjective nature. As the production of nitric oxide (NO) by many cell types is elevated in tissue injury, we hypothesized that serum concentration of NO (and its oxidation products, NOx) represents a suitable marker of polytrauma correlating with prognosis. We wanted to prove that nitric oxide could serve as an indicator for severity of injury in polytrauma. We measured serum NOx and standard biochemical parameters in 93 patients with various degrees of polytrauma, 15 patients with minor injuries and 20 healthy volunteers. On admission, serum NOx was higher in patients with moderate polytrauma than both in controls and patients with minor injury, and it was even higher in patients with severe polytrauma. Surprisingly, NOx on admission was normal in the group of patients that required cardiopulmonary resuscitation or died within 48 hours after admission. In the groups, where it was elevated on admission, serum NOx dropped to normal values within 12 hours. Blood lactate levels on admission were elevated in proportion to the severity of subsequent clinical course. Elevated serum NOx and blood lactate in patients with polytrauma are markers of serious clinical course, while normal NOx combined with a very high lactate may signal a fatal prognosis (Fig. 4, Ref. 8).

Case Report - Severe traumatic brain injury managed with ...

African Journals Online (AJOL)

Patients with severe taumatic brain injury may develop intractable raised ICP resulting in high mortality and morbidity. This may be anticipated from the patient's clinical status and imaging findings even where intracranial monitoring is unavailable. Outcome may be improved by early and aggressive control of ICP and ...

Injuries observed in a prospective transition from traditional to minimalist footwear: correlation of high impact transient forces and lower injury severity.

Science.gov (United States)

Salzler, Matthew J; Kirwan, Hollie J; Scarborough, Donna M; Walker, James T; Guarino, Anthony J; Berkson, Eric M

2016-11-01

Minimalist running is increasing in popularity based upon a concept that it can reduce impact forces and decrease injury rates. The purpose of this investigation is to identify the rate and severity of injuries in runners transitioning from traditional to minimalist footwear. The secondary aims were to identify factors correlated with injuries. Fourteen habitually shod (traditional running shoes) participants were enrolled for this prospective study investigating injury prevalence during transition from traditional running shoes to 5-toed minimalist shoes. Participants were uninjured, aged between 22-41 years, and ran at least twenty kilometers per week in traditional running shoes. Participants were given industry recommended guidelines for transition to minimalist footwear and fit with a 5-toed minimalist running shoe. They completed weekly logs for identification of injury, pain using Visual Analogue Scale (VAS), injury location, and severity. Foot strike pattern and impact forces were collected using 3D motion analysis at baseline, 4 weeks, and 12 weeks. Injuries were scored according to a modified Running Injury Severity Score (RISS). Fourteen runners completed weekly training and injury logs over an average of 30 weeks. Twelve of 14 (86%) runners sustained injuries. Average injury onset was 6 weeks (range 1-27 weeks). Average weekly mileage of 23.9 miles/week prior to transition declined to 18.3 miles/week after the transition. The magnitude of the baseline impact transient peak in traditional shoes and in minimalist shoes negatively correlated with RISS scores (r = -0.45, p = 0.055 and r = -0.53, p = 0.026, respectively). High injury rates occurred during the transition from traditional to minimalist footwear. Non-compliance to transition guidelines and high injury rates suggest the need for improved education. High impact transient forces unexpectedly predicted lower modified RISS scores in this population.

A comprehensive overview of the frequency and the severity of injuries sustained by car occupants and subsequent implications in terms of injury prevention.

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Page, Yves; Cuny, Sophie; Hermitte, Thierry; Labrousse, Maxime

2012-01-01

The objective of the paper is to give an overview of the road injuries issues in France in the 2010's by determining the frequency and the severity of injuries sustained by car occupants, and to infer the implications in terms of vehicule safety. Three types of analysis are conducted. First, we present a time series analysis at a macro statistical level showing a dramatic decrease of injured and fatally injured occupants in passenger cars compared to other modes of road transport. Secondly, we propose a descriptive statistical analysis of the injuries (frequency and severity) sustained by car occupants, by body regions, using the AIS. Finally we propose some insights into the effectiveness of some safety features. French National crash census (BAAC) is used for a general overview of injury frequencies and raw severity scores (fatal, hospitalized, slighty injured) in car crashes. In-depth crash investigations data are used to specify the body regions and the severity of the injuries sustained by car occupants. Data show that car occupants mortality and morbidity decreased more over the last decade than other road modes: -58 % fatalities and -64 % hospitalized (compared to -39% and -55% for pedestrians, and -21% and -44% for motorcyclists for example). In crashes for which at least one person has been injured, 19 % of occupants are uninjured, 49 % of occupants sustain MAIS 1 injuries, 15 % MAIS2, 8% MAIS 3, and 9 % MAIS 4+. Regardless of seat belt use, the body regions most often injured are head, upper and lower extremities and thorax. However, at least two third up to 92% of involved persons sustain no injury at each of these body regions. The frequency of severe injuries is low, often less than 10 % and concern head and thorax mainly. Finally, the frequency and severity of injuries decrease for belted occupants in newer cars compared to older cars, whatever body regions. The frequency of severe injuries decreased by almost 50 % in these newer cars.

Comparison of Injury Severity Between Moped and Motorcycle Crashes: A Finnish Two-Year Prospective Hospital-Based Study.

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Airaksinen, N; Nurmi-Lüthje, I; Lüthje, P

2016-03-01

The coverage of the official statistics is poor in motorcycle and moped accidents. The aim of this study was to analyze the severity of motorcycle and moped crashes, and to define the degree of under-reporting in official statistics. All first attendances due to an acute motorcyclist or moped driver injury registered in the emergency department between June 2004 and May 2006 were analyzed. The severity of the injuries was classified using the Abbreviated Injury Scale score and the New Injury Severity Score. The hospital injury data were compared to the traffic accident statistics reported by the police and compiled and maintained by Statistics Finland. A total of 49 motorcyclists and 61 moped drivers were involved in crashes, leading to a total of 94 and 109 injuries, respectively. There were slightly more vertebral and midfoot fractures among motorcyclists than among moped drivers (p = 0.038 and 0.016, respectively). No significant differences were found between the severity (maximum Abbreviated Injury Scale and median New Injury Severity Scores) of the motorcycle and moped crashes. There was no in-hospital mortality. The degree of agreement (overlap) between the hospital dataset and the official statistics was 32%. The rate of under-reporting was 68%. According to the maximum Abbreviated Injury Scale and New Injury Severity Scores, the injury severity was equal for motorcycle and moped crashes. The degree of agreement between the hospital dataset and the official statistics was 32%. © The Finnish Surgical Society 2015.

Management of Severe Perineal Injuries in Major Pelvic Fractures

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A Jangjoo

2009-01-01

Full Text Available Introduction: Significant perineal injuries and major pelvic fractures resulting from blunt trauma manifest a high-energy injury. Open pelvic fractures (with perineal injury are associated with higher mortality rates of 40 to 60 %. Methods: This study was a review of patients with multiple traumas comprising of major pelvic fracture and severe perineal injuries (Shahid Kamyab hospital in Mashhad from 2002- 2005. A total of 11 patients, with pelvic fracture and perineal injuries (injury to urethra and anal canal were entered in the study. The data was gathered by a checklist and analyzed with SPSS software. Results: The population under study included 11 patients (9 male, 2 female with a mean age of 35years. Cause of trauma in all patients was motor vehicle accidents. All of the patients in the first 6 hours of admission received at least 4 liters of serum ringer lactate and 3 units of packed cells. The mean of packed cell received was 8 units and one patient needed 21 units of packed cells. All of patients were taken to the operating room for diverting colostomy, distal rectal washout, cystostomy and radical debridment and irrigation of devitalized tissue. Good results were achieved in 9 patients and there was one case of mortality and one morbidity (ARF. Conclusion: Open pelvic fractures and perineal injuries are associated with higher mortality rates. Prompt diagnosis and proper treatment (reanimation, colostomy, cystostomy, debridment and irrigation is the key to success.

Modeling crash injury severity by road feature to improve safety.

Science.gov (United States)

Penmetsa, Praveena; Pulugurtha, Srinivas S

2018-01-02

The objective of this research is 2-fold: to (a) model and identify critical road features (or locations) based on crash injury severity and compare it with crash frequency and (b) model and identify drivers who are more likely to contribute to crashes by road feature. Crash data from 2011 to 2013 were obtained from the Highway Safety Information System (HSIS) for the state of North Carolina. Twenty-three different road features were considered, analyzed, and compared with each other as well as no road feature. A multinomial logit (MNL) model was developed and odds ratios were estimated to investigate the effect of road features on crash injury severity. Among the many road features, underpass, end or beginning of a divided highway, and on-ramp terminal on crossroad are the top 3 critical road features. Intersection crashes are frequent but are not highly likely to result in severe injuries compared to critical road features. Roundabouts are least likely to result in both severe and moderate injuries. Female drivers are more likely to be involved in crashes at intersections (4-way and T) compared to male drivers. Adult drivers are more likely to be involved in crashes at underpasses. Older drivers are 1.6 times more likely to be involved in a crash at the end or beginning of a divided highway. The findings from this research help to identify critical road features that need to be given priority. As an example, additional advanced warning signs and providing enlarged or highly retroreflective signs that grab the attention of older drivers may help in making locations such as end or beginning of a divided highway much safer. Educating drivers about the necessary skill sets required at critical road features in addition to engineering solutions may further help them adopt safe driving behaviors on the road.

Incidence and severity of maxillofacial injuries during the Second Lebanon War among Israeli soldiers and civilians.

Science.gov (United States)

Levin, Liran; Zadik, Yehuda; Peleg, Kobi; Bigman, Galya; Givon, Adi; Lin, Shaul

2008-08-01

To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians. This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals. Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries. In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.

THE RELATIONSHIP BETWEEN INJURY SEVERITY AND INDIVIDUAL CHARACTERISTICS: A SURVEY IN SOUTHERN CHINA.

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Huang, Kaiyong; Liang, Wenjie; Han, Shanshan; Abdullah, Abu S; Yang, Li

2015-11-01

This study aimed to assess the relationships between road traffic injury severity and individual characteristics in Liuzhou, a city in southern China. Data for this study were collected from the Guangxi Public Security Bureau Traffic Police Corps. Multivariate ordinal logistic regression analysis was used. Of all 14,595 individuals involved in accidents, males, motor vehicle drivers, motorcyclists, and those aged 21-45 years accounted for the great proportion of all injuries. Children, the elderly, pedestrians, farmers and migrant workers, unemployed people, and novice drivers were at higher risk of serious injury in crashes. These findings suggest that individual characteristics (age, modes of transport, profession, driving experience) are strongly related to injury severity. To address road traffic related mortality and injuries, there is a need to develop policy strategies, strengthen road supervision, and improve public consciousness of road safety.

A comprehensive analysis of factors influencing the injury severity of large-truck crashes.

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Zhu, Xiaoyu; Srinivasan, Sivaramakrishnan

2011-01-01

Given the importance of trucking to the economic well being of a country and the safety concerns posed by the trucks, a study of large-truck crashes is critical. This paper contributes by undertaking an extensive analysis of the empirical factors affecting injury severity of large-truck crashes. Data from a recent, nationally representative sample of large-truck crashes are examined to determine the factors affecting the overall injury severity of these crashes. The explanatory factors include the characteristics of the crash, vehicle(s), and the driver(s). The injury severity was modeled using two measures. Several similarities and some differences were observed across the two models which underscore the need for improved accuracy in the assessment of injury severity of crashes. The estimated models capture the marginal effects of a variety of explanatory factors simultaneously. In particular, the models indicate the impacts of several driver behavior variables on the severity of the crashes, after controlling for a variety of other factors. For example, driver distraction (truck drivers), alcohol use (car drivers), and emotional factors (car drivers) are found to be associated with higher severity crashes. A further interesting finding is the strong statistical significance of several dummy variables that indicate missing data - these reflect how the nature of the crash itself could affect the completeness of the data. Future efforts should seek to collect such data more comprehensively so that the true effects of these aspects on the crash severity can be determined. Copyright © 2010 Elsevier Ltd. All rights reserved.

Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial.

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Okonkwo, David O; Shutter, Lori A; Moore, Carol; Temkin, Nancy R; Puccio, Ava M; Madden, Christopher J; Andaluz, Norberto; Chesnut, Randall M; Bullock, M Ross; Grant, Gerald A; McGregor, John; Weaver, Michael; Jallo, Jack; LeRoux, Peter D; Moberg, Dick; Barber, Jason; Lazaridis, Christos; Diaz-Arrastia, Ramon R

2017-11-01

A relationship between reduced brain tissue oxygenation and poor outcome following severe traumatic brain injury has been reported in observational studies. We designed a Phase II trial to assess whether a neurocritical care management protocol could improve brain tissue oxygenation levels in patients with severe traumatic brain injury and the feasibility of a Phase III efficacy study. Randomized prospective clinical trial. Ten ICUs in the United States. One hundred nineteen severe traumatic brain injury patients. Patients were randomized to treatment protocol based on intracranial pressure plus brain tissue oxygenation monitoring versus intracranial pressure monitoring alone. Brain tissue oxygenation data were recorded in the intracranial pressure -only group in blinded fashion. Tiered interventions in each arm were specified and impact on intracranial pressure and brain tissue oxygenation measured. Monitors were removed if values were normal for 48 hours consecutively, or after 5 days. Outcome was measured at 6 months using the Glasgow Outcome Scale-Extended. A management protocol based on brain tissue oxygenation and intracranial pressure monitoring reduced the proportion of time with brain tissue hypoxia after severe traumatic brain injury (0.45 in intracranial pressure-only group and 0.16 in intracranial pressure plus brain tissue oxygenation group; p injury after severe traumatic brain injury based on brain tissue oxygenation and intracranial pressure values was consistent with reduced mortality and increased proportions of patients with good recovery compared with intracranial pressure-only management; however, the study was not powered for clinical efficacy. Management of severe traumatic brain injury informed by multimodal intracranial pressure and brain tissue oxygenation monitoring reduced brain tissue hypoxia with a trend toward lower mortality and more favorable outcomes than intracranial pressure-only treatment. A Phase III randomized trial to assess

Correlation between crash avoidance maneuvers and injury severity sustained by motorcyclists in single-vehicle crashes.

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Wang, Chen; Lu, Linjun; Lu, Jian; Wang, Tao

2016-01-01

In order to improve motorcycle safety, this article examines the correlation between crash avoidance maneuvers and injury severity sustained by motorcyclists, under multiple precrash conditions. Ten-year crash data for single-vehicle motorcycle crashes from the General Estimates Systems (GES) were analyzed, using partial proportional odds models (i.e., generalized ordered logit models). The modeling results show that "braking (no lock-up)" is associated with a higher probability of increased severity, whereas "braking (lock-up)" is associated with a higher probability of decreased severity, under all precrash conditions. "Steering" is associated with a higher probability of reduced injury severity when other vehicles are encroaching, whereas it is correlated with high injury severity under other conditions. "Braking and steering" is significantly associated with a higher probability of low severity under "animal encounter and object presence," whereas it is surprisingly correlated with high injury severity when motorcycles are traveling off the edge of the road. The results also show that a large number of motorcyclists did not perform any crash avoidance maneuvers or conducted crash avoidance maneuvers that are significantly associated with high injury severity. In general, this study suggests that precrash maneuvers are an important factor associated with motorcyclists' injury severity. To improve motorcycle safety, training/educational programs should be considered to improve safety awareness and adjust driving habits of motorcyclists. Antilock brakes and such systems are also promising, because they could effectively prevent brake lock-up and assist motorcyclists in maneuvering during critical conditions. This study also provides valuable information for the design of motorcycle training curriculum.

Neurocognitive Models of Medical Decision-Making Capacity in Traumatic Brain Injury Across Injury Severity.

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Triebel, Kristen L; Novack, Thomas A; Kennedy, Richard; Martin, Roy C; Dreer, Laura E; Raman, Rema; Marson, Daniel C

2016-01-01

To identify neurocognitive predictors of medical decision-making capacity (MDC) in participants with mild and moderate/severe traumatic brain injury (TBI). Academic medical center. Sixty adult controls and 104 adults with TBI (49 mild, 55 moderate/severe) evaluated within 6 weeks of injury. Prospective cross-sectional study. Participants completed the Capacity to Consent to Treatment Instrument to assess MDC and a neuropsychological test battery. We used factor analysis to reduce the battery test measures into 4 cognitive composite scores (verbal memory, verbal fluency, academic skills, and processing speed/executive function). We identified cognitive predictors of the 3 most clinically relevant Capacity to Consent to Treatment Instrument consent standards (appreciation, reasoning, and understanding). In controls, academic skills (word reading, arithmetic) and verbal memory predicted understanding; verbal fluency predicted reasoning; and no predictors emerged for appreciation. In the mild TBI group, verbal memory predicted understanding and reasoning, whereas academic skills predicted appreciation. In the moderate/severe TBI group, verbal memory and academic skills predicted understanding; academic skills predicted reasoning; and academic skills and verbal fluency predicted appreciation. Verbal memory was a predictor of MDC in controls and persons with mild and moderate/severe TBI. In clinical practice, impaired verbal memory could serve as a "red flag" for diminished consent capacity in persons with recent TBI.

Extreme' vasculobiliary injuries: association with fundus-down cholecystectomy in severely inflamed gallbladders

NARCIS (Netherlands)

Strasberg, Steven M.; Gouma, Dirk J.

2012-01-01

Objectives: Extreme vasculobiliary injuries usually involve major hepatic arteries and portal veins. They are rare, but have severe consequences, including rapid infarction of the liver. The pathogenesis of these injuries is not well understood. The purpose of this study was to elucidate the

Workshop for disabled survivors of severe head injury.

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London, P S

1973-08-18

Existing services for the disabled do not cater for the needs of lame-brain survivors of severe head injury who may be capable of productive work though they may never become employable. A grant from the Nuffield Provincial Hospitals Trust made it possible to set up in 1967 a special workshop in premises provided by the regional hospital board. The hospital management committee assumed financial responsibility for the centre after three years, and after five years the Department of Health and Social Security purchased adjoining premises, which will double the present accommodation for about 35 persons. Though 45% of the 101 patients attending the workshop have returned to work, no financial support has yet been received from the Department of Employment. A suitably staffed hostel is needed for patients who live too far away to travel daily to and from the workshop. This undertaking has shown a need for special facilities for some of the victims of severe head injury, who differ in many important ways from other disabled persons.

Decision model support of severity of injury traffic accident victims care by SAMU 192

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Rackynelly Alves Sarmento Soares

2013-01-01

Full Text Available Traffic accidents produce high morbidity and mortality in several countries, including Brazil. The initial care to victims of accidents, by a specialized team, has tools for evaluating the severity of trauma, which guide the priorities. This study aimed to develop a decision model applied to pre-hospital care, using the Abbreviated Injury Scale, to define the severity of the injury caused by the AT, as well to describe the features of accidents and their victims, occurred in Joao Pessoa, Paraiba. This is a descriptive epidemiological investigation, sectional, which analyzed all victims of traffic accidents attended by the SAMU 192, João Pessoa-PB, in January, April and June 2010. Data were collected in the medical regulation sheets of SAMU 192. Most of victims were male (76%, aged between 20 and 39 years (60%. Most injuries were classified as AIS1 (62.5%. The model of decision support implemented was the decision tree that managed to correctly classify 95.98% of the severity of injuries. By this model, it was possible to extract 29 rules of gravity classification of injury, which may be used for decision-making teams of the SAMU 192.

Injury severity in relation to seatbelt use in Cape Town, South Africa ...

African Journals Online (AJOL)

Background. Injuries and deaths from road traffic collisions present an enormous challenge to the South African (SA) healthcare system. The use of restraining devices is an important preventive measure. Objective. To determine the relationship between seatbelt use and injury severity in vehicle occupants involved in road ...

Assessing injury severity in bicyclists involved in traffic accidents to more effectively prevent fatal bicycle injuries in Japan.

Science.gov (United States)

Gomei, Sayaka; Hitosugi, Masahito; Ikegami, Keiichi; Tokudome, Shogo

2013-10-01

The objective of this study was to clarify the relationship between injury severity in bicyclists involved in traffic accidents and patient outcome or type of vehicle involved in order to propose effective measures to prevent fatal bicycle injuries. Hospital records were reviewed for all patients from 2007 to 2010 who had been involved in a traffic accident while riding a bicycle and were subsequently transferred to the Shock Trauma Center of Dokkyo Medical University Koshigaya Hospital. Patient outcomes and type of vehicle that caused the injury were examined. The mechanism of injury, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) of the patient were determined. A total of 115 patients' records were reviewed. The mean patient age was 47.1 ± 27.4 years. The average ISS was 23.9, with an average maximum AIS (MAIS) score of 3.7. The ISS, MAIS score, head AIS score, and chest AIS score were well correlated with patient outcome. The head AIS score was significantly higher in patients who had died (mean of 4.4); however, the ISS, MAIS score, and head AIS score did not differ significantly according to the type of vehicle involved in the accident. The mean head AIS scores were as high as 2.4 or more for accidents involving any type of vehicle. This study provides useful information for forensic pathologists who suspect head injuries in bicyclists involved in traffic accidents. To effectively reduce bicyclist fatalities from traffic accidents, helmet use should be required for all bicyclists.

Curative effect of ganglioside sodium for adjuvant therapy on acute severe craniocerebral injury

Directory of Open Access Journals (Sweden)

Yun-Liang Deng

2017-01-01

>Conclusions: The adjuvant therapy of ganglioside sodium in patients with severe craniocerebral injury can effectively reduce ICP, improve PbtO2 and alleviate the injuries of neurons and glial cells caused by oxidative stress.

Preseason Functional Movement Screen Component Tests Predict Severe Contact Injuries in Professional Rugby Union Players.

Science.gov (United States)

Tee, Jason C; Klingbiel, Jannie F G; Collins, Robert; Lambert, Mike I; Coopoo, Yoga

2016-11-01

Tee, JC, Klingbiel, JFG, Collins, R, Lambert, MI, and Coopoo, Y. Preseason Functional Movement Screen component tests predict severe contact injuries in professional rugby union players. J Strength Cond Res 30(11): 3194-3203, 2016-Rugby union is a collision sport with a relatively high risk of injury. The ability of the Functional Movement Screen (FMS) or its component tests to predict the occurrence of severe (≥28 days) injuries in professional players was assessed. Ninety FMS test observations from 62 players across 4 different time periods were compared with severe injuries sustained during 6 months after FMS testing. Mean composite FMS scores were significantly lower in players who sustained severe injury (injured 13.2 ± 1.5 vs. noninjured 14.5 ± 1.4, Effect Size = 0.83, large) because of differences in in-line lunge (ILL) and active straight leg raise scores (ASLR). Receiver-operated characteristic curves and 2 × 2 contingency tables were used to determine that ASLR (cut-off 2/3) was the injury predictor with the greatest sensitivity (0.96, 95% confidence interval [CI] = 0.79-1.0). Adding the ILL in combination with ASLR (ILL + ASLR) improved the specificity of the injury prediction model (ASLR specificity = 0.29, 95% CI = 0.18-0.43 vs. ASLR + ILL specificity = 0.53, 95% CI = 0.39-0.66, p ≤ 0.05). Further analysis was performed to determine whether FMS tests could predict contact and noncontact injuries. The FMS composite score and various combinations of component tests (deep squat [DS] + ILL, ILL + ASLR, and DS + ILL + ASLR) were all significant predictors of contact injury. The FMS composite score also predicted noncontact injury, but no component test or combination thereof produced a similar result. These findings indicate that low scores on various FMS component tests are risk factors for injury in professional rugby players.

Determinants of Glasgow outcome scale in patients with severe traumatic brain injury for better quality of life

Science.gov (United States)

Dharmajaya, R.; Sari, D. K.; Ganie, R. A.

2018-03-01

Primary and secondary brain injury may occur with severe traumatic brain injury. Secondary traumatic brain injury results in a more severe effect compared to primary traumatic brain injury. Therefore, prevention of secondary traumatic brain injury is necessary to obtain maximum therapeutic results and accurate determination of prognosis and better quality of life. This study aimed to determine accurate and noninvasive prognostic factors in patients with severe traumatic brain injury. It was a cohort study on 16 subjects. Intracranial pressure was monitored within the first 24 hours after traumatic brain injury. Examination of Brain-Derived Neurotrophic Factor (BDNF) and S100B protein were conducted four times. The severity of outcome was evaluated using Glasgow Outcome Scale (GOS) three months after traumatic brain injury. Intracranial pressure measurement performed 24 hours after traumatic brain injury, low S100B protein (6.16pg/ml) 48 hours after injury indicate good prognosis and were shown to be significant predictors (p<0.05) for determining the quality of GOS. The conclusion is patient with a moderate increase in intracranial pressure Intracranial pressure S100B protein, being inexpensive and non-invasive, can substitute BDNF and intracranial pressure measurements as a tool for determining prognosis 120 hours following traumatic brain injury.

Brain SPECT in severs traumatic head injury

International Nuclear Information System (INIS)

Beaulieu, F.; Eder, V.; Pottier, J.M.; Baulieu, J.L.; Fournier, P.; Legros, B.; Chiaroni, P.; Dalonneau, M.

2000-01-01

The aim of this work was to compare the results of the early brain scintigraphy in traumatic brain injury to the long term neuropsychological behavior. Twenty four patients had an ECD-Tc99m SPECT, within one month after the trauma; scintigraphic abnormalities were evaluated according to a semi-quantitative analysis. The neuropsychological clinical investigation was interpreted by a synthetic approach to evaluate abnormalities related to residual motor deficit, frontal behavior, memory and language disorders. Fourteen patients (58%) had sequela symptoms. SPECT revealed 80 abnormalities and CT scan only 31. Statistical analysis of uptake values showed significantly lower uptake in left basal ganglia and brain stem in patients with sequela memory disorders. We conclude that the brain perfusion scintigraphy is able to detect more lesions than CT and that it could really help to predict the neuropsychological behavior after severe head injury. Traumatology could become in the future a widely accepted indication of perfusion SPECT. (authors)

Follow-up CT myelography of severe cervical spinal cord injury

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Okada, Keiichi; Onoda, Kimio; Kawashima, Yasuhiro; Muto, Atsushi; Kobayashi, Yoichi

1987-11-01

There are many reports describing gross anatomical and microscopical findings of severely injured cervical cords in autopsy of the acute and chronic state, but no morphological findings of a severe cervical spinal cord injury in a chronic state by follow-up CT myelography have been found in the literature so far. The sagittal and transverse diameters of the cervical spinal cord and subarachnoid space of 9 out of 14 severe cervical spinal cord injury patients were measured with CT myelography within 7.5 years after the tranuma and their size compared with a control group which was made up of 29 patients with slight radiculopathy due to cervical spondylosis and whiplash injuries. Injured cord levels were C4 4 cases, C5 4 cases and C6 1 case. Remarkable spinal cord atrophy was recogniged in the sagittal diameter from C1 to C7 and in the transverse diameter below C4 and narrowing of the cervical subarachnoid space in the sagittal diameter from C2 to C5. The significance level was set at 1 - 5 %. From these fingings, we have concluded that atrophy appeared not only in the injured segment but also the whole cervical cord after the trauma. There was less cord atrophy in a good functional prognosis than in a poor prognosis.

Follow-up CT myelography of severe cervical spinal cord injury

International Nuclear Information System (INIS)

Okada, Keiichi; Onoda, Kimio; Kawashima, Yasuhiro; Muto, Atsushi; Kobayashi, Yoichi

1987-01-01

There are many reports describing gross anatomical and microscopical findings of severely injured cervical cords in autopsy of the acute and chronic state, but no morphological findings of a severe cervical spinal cord injury in a chronic state by follow-up CT myelography have been found in the literature so far. The sagittal and transverse diameters of the cervical spinal cord and subarachnoid space of 9 out of 14 severe cervical spinal cord injury patients were measured with CT myelography within 7.5 years after the tranuma and their size compared with a control group which was made up of 29 patients with slight radiculopathy due to cervical spondylosis and whiplash injuries. Injured cord levels were C4 4 cases, C5 4 cases and C6 1 case. Remarkable spinal cord atrophy was recogniged in the sagittal diameter from C1 to C7 and in the transverse diameter below C4 and narrowing of the cervical subarachnoid space in the sagittal diameter from C2 to C5. The significance level was set at 1 - 5 %. From these fingings, we have concluded that atrophy appeared not only in the injured segment but also the whole cervical cord after the trauma. There was less cord atrophy in a good functional prognosis than in a poor prognosis. (author)

Incidence, severity, aetiology and type of neck injury in men's amateur rugby union: a prospective cohort study

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Pollard Henry P

2010-07-01

Full Text Available Abstract Background There is a paucity of epidemiological data on neck injury in amateur rugby union populations. The objective of this study was to determine the incidence, severity, aetiology and type of neck injury in Australian men's amateur rugby union. Methods Data was collected from a cohort of 262 participants from two Australian amateur men's rugby union clubs via a prospective cohort study design. A modified version of the Rugby Union Injury Report Form for Games and Training was used by the clubs physiotherapist or chiropractor in data collection. Results The participants sustained 90 (eight recurrent neck injuries. Exposure time was calculated at 31143.8 hours of play (12863.8 hours of match time and 18280 hours of training. Incidence of neck injury was 2.9 injuries/1000 player-hours (95%CI: 2.3, 3.6. As a consequence 69.3% neck injuries were minor, 17% mild, 6.8% moderate and 6.8% severe. Neck compression was the most frequent aetiology and was weakly associated with severity. Cervical facet injury was the most frequent neck injury type. Conclusions This is the first prospective cohort study in an amateur men's rugby union population since the inception of professionalism that presents injury rate, severity, aetiology and injury type data for neck injury. Current epidemiological data should be sought when evaluating the risks associated with rugby union football.

[Consequence of secondary complications during the rehabilitation of patients with severe brain injury].

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Dénes, Zoltán

2009-01-25

Recovery from brain injury is not only determined by the primary injury, but a very important element is the development of secondary complications which have a major role in determining the possibility of the achievement of available maximal functional abilities and the quality of life of the patients and their family after rehabilitation. This is why during medical treatment the prevention of secondary complications is at least as important as the prevention of primary injury. Determination of the most important secondary complications after severe brain injury, and observation of these effects on the rehabilitation process. Retrospective study in the Brain Injury Rehabilitation unit of the National Institute for Medical Rehabilitation in Hungary. 166 patients were treated with brain injury; the mean age of the patients was 33 (8-83) years in 2004. The majority of patients suffered traumatic brain injury in traffic accidents (125/166), while the rest of them through falls or acts of violence. Sixty-four patients were admitted directly from an intensive care unit, 18 from a second hospital ward (traumatology, neurosurgery or neurology) and the rest of the patients were treated in several different units before they were admitted for rehabilitation. The time that has elapsed between injury and rehabilitation admission was 50 days (21-177). At the time of admission 27 patients were in a vegetative state, 38 patients in a minimal conscious state, and 101 patients had already regained consciousness. 83 patients were hemiparetic, 54 presented tetraparesis, and 1 paraparesis, but 28 patients were not paretic. The most frequent complications in patients with severe brain injury at admission in our rehabilitation unit were: contractures (47%), pressure sores (35%), respiratory (14%) and urinary (11%) tract infections, malnutrition (20%). The functional outcome was worse in the cases arriving with secondary complications during the same rehabilitation period. The length of

A hybrid clustering and classification approach for predicting crash injury severity on rural roads.

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Hasheminejad, Seyed Hessam-Allah; Zahedi, Mohsen; Hasheminejad, Seyed Mohammad Hossein

2018-03-01

As a threat for transportation system, traffic crashes have a wide range of social consequences for governments. Traffic crashes are increasing in developing countries and Iran as a developing country is not immune from this risk. There are several researches in the literature to predict traffic crash severity based on artificial neural networks (ANNs), support vector machines and decision trees. This paper attempts to investigate the crash injury severity of rural roads by using a hybrid clustering and classification approach to compare the performance of classification algorithms before and after applying the clustering. In this paper, a novel rule-based genetic algorithm (GA) is proposed to predict crash injury severity, which is evaluated by performance criteria in comparison with classification algorithms like ANN. The results obtained from analysis of 13,673 crashes (5600 property damage, 778 fatal crashes, 4690 slight injuries and 2605 severe injuries) on rural roads in Tehran Province of Iran during 2011-2013 revealed that the proposed GA method outperforms other classification algorithms based on classification metrics like precision (86%), recall (88%) and accuracy (87%). Moreover, the proposed GA method has the highest level of interpretation, is easy to understand and provides feedback to analysts.

Mesh wrapping for severe hepatic injury: a beneficial option in the trauma surgeon's armamentarium.

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Kennedy, Ryan; Brevard, Sidney B; Bosarge, Patrick; Simmons, Jon D; Frotan, Mohammed A; Baker, Jeremy A; Tuart, Lynda; Pritchett, Cindy; Gonzalez, Richard P

2015-03-01

The purpose of this study was to assess the efficacy of absorbable mesh wrapping (MW) versus perihepatic packing (HP) for severe hepatic injury. From January 2001 to December 2012, data were collected for MW patients with hepatic injury. Patients who underwent HP were matched with MW patients by injury mechanism, liver injury grade, Injury Severity Score, and age. Twenty-six MW and twenty-six HP patients were matched. Eighteen blunt and 8 penetrating injuries were present in each group. There were 9 (35%) mortalities in the MW group and 16 (62%) in the HP groups (P = .03). Average transfusions were 12.0 and 24.5 (P = .03) packed red blood cells in the MW and HP groups, respectively. Average laparotomies per survivors were 1.3 for the MW and 3.1 for the HP groups (P = .01). Average length of stay for survivors was 19 and 47 (P = .04) days in the MW and HP groups, respectively. MW for hepatic injuries can significantly decrease mortality, transfusions, laparotomies, and length of stay. Copyright © 2015 Elsevier Inc. All rights reserved.

Management of patients with severe lung injury : first, do no harm

NARCIS (Netherlands)

van der Werf, TS

Severe acute lung injury may result from many infectious and other insults. Although the initial insult may cause overwhelming tissue damage with subsequent gas exchange impairment and risk of death. several strategies of management may also add substantial toxicity. This review focuses on damage

Identification of vehicle components associated with severe thoracic injury in motor vehicle crashes: a CIREN and NASS analysis.

Science.gov (United States)

Nirula, R; Pintar, F A

2008-01-01

Thoracic trauma secondary to motor vehicle crashes (MVC) continues to be a major cause of morbidity and mortality. Specific vehicle features may increase the risk of severe thoracic injury when striking the occupant. We sought to determine which vehicle contact points were associated with an increased risk of severe thoracic injury in MVC to focus subsequent design modifications necessary to reduce thoracic injury. The National Automotive Sampling System (NASS) databases from 1993 to 2001 and the Crash Injury Research and Engineering Network (CIREN) databases from 1996 to 2004 were analyzed separately using univariate and multivariate logistic regression stratified by restraint use and crash direction. The risk of driver thoracic injury, defined as an abbreviated injury scale (AIS) of score > or =3, was determined as it related to specific points of contact between the vehicle and the driver. The incidence of severe chest injury in NASS and CIREN were 5.5% and 33%, respectively. The steering wheel, door panel, armrest, and seat were identified as contact points associated with an increased risk of severe chest injury. The door panel and arm rest were consistently a frequent cause of severe injury in both the NASS and CIREN data. Several vehicle contact points, including the steering wheel, door panel, armrest and seat are associated with an increased risk of severe thoracic injury when striking the occupant. These elements need to be further investigated to determine which characteristics need to be manipulated in order to reduce thoracic trauma during a crash.

Severe and fatal obstetric injury claims in relation to labor unit volume

DEFF Research Database (Denmark)

Milland, Maria; Mikkelsen, Kim L; Christoffersen, Jens K

2015-01-01

with decreasing annual delivery volume. Face value incidence rate ratios of approved severe injuries increased with decreasing labor unit volume, but the association did not reach statistical significance. CONCLUSION: High volume labor units appear associated with fewer approved and fewer fatal injury claims...... in labor units in 1995-2012. METHODS: Exposure information regarding the annual number of deliveries per labor unit was retrieved from the Danish National Birth Register. Outcome information was retrieved from the Danish Patient Compensation Association. Exposure was categorized in delivery volume...... quintiles as annual volume per labor unit: (10-1377), (1378-2016), (2017-2801), (2802-3861), (3862-6659). MAIN OUTCOME MEASURES: Five primary measures of outcome were used. Incidence rate ratios of (A) Submitted claims, (B) Approved claims, (C) Approved severe injury claims (120% degree of disability), (D...

Demographic profile of severe traumatic brain injury admissions to ...

African Journals Online (AJOL)

Background. Paediatric traumatic brain injury (PTBI) is a major public health problem. However, recent epidemiological data for PTBI in South Africa (SA) are lacking. Objectives. To establish a demographic profile of severe PTBI admissions to the Red Cross War Memorial Children's Hospital (RCWMCH) over a 5-year ...

Using acute kidney injury severity and scoring systems to predict outcome in patients with burn injury

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George Kuo

2016-12-01

Conclusion: Our results revealed that AKI stage has considerable discriminative power for predicting mortality. Compared with other prognostic models, AKI stage is easier to use to assess outcome in patients with severe burn injury.

Executive dysfunction, severity of traumatic brain injury, and IQ in workers with disabilities.

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Matheson, Leonard

2010-01-01

To study whether severity of traumatic brain injury and the intelligence quotient are related to executive dysfunction. Sixty-two adults with brain injury who were referred for a work capacity evaluation. Retrospective review of severity of traumatic brain injury, intelligence quotient from a previously-conducted neuropsychological evaluation, determination of executive function status from the neuropsychological evaluation, and both self-report and informant-report executive dysfunction scores from the Behavior Rating Inventory of Executive Function. Executive dysfunction and the intelligence quotient are related to severity of traumatic brain injury, but executive dysfunction and the intelligence quotient are not related to each other. Executive dysfunction as determined by a neuropsychological evaluation was not consistent with clients' self-reports but was consistent with informant-reported executive dysfunction. Five types of executive dysfunction were reported by knowledgeable informants, with significant elevations on the Shift, Plan/Organize, Task Monitor, Organization of Materials, and Working Memory BRIEF clinical scales. The intelligence quotient is not a useful indicator of executive dysfunction. Informant-report executive dysfunction is a reliable and potentially useful adjunct to a neuropsychological evaluation. Working memory is the most severe type of executive dysfunction and may not be adequately measured by current neuropsychological evaluation methods.

Pattern, severity, and management of cranio-maxillofacial soft-tissue injuries in Port Harcourt, Nigeria

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Akinbami Babatunde Olayemi

2013-01-01

Full Text Available Background: The pattern of craniofacial soft-tissue injuries occurring either in isolation or in association with fractures vary in different societies and is multiply influenced. The effects are enormous because of the prominence of the face; therefore, the purpose of this study was to document any changing pattern, severity and management of these craniofacial injuries in our center. Patients and Method: Cranio-maxillofacial region was classified into upper, middle and lower face. The cause, type, and site of the injuries were documented. Gunshot injuries were further categorized as penetrating, perforating or avulsions. Further, classification of injuries into mild, moderate, and severe was carried out based on multiple factors. Result: A total of 126 patients with soft-tissue injuries presented to our hospital out of which 85 (67.5% were males and 41 (32.5 were females. The age range of the patients was between 10 months and 90 years with a mean ± SD of 26.4 ± 15.5 years. Road traffic accident was the most common etiology of which vehicular accidents constituted 50 (54.9% and the motorcycle was 2 (2.2%. Assault contributed 16 (17.6% while cases due to gun shots were 13 (14.3%. A total of 19 (15.1% patients had associated head injuries, 11 (8.7% patients had craniofacial fractures involving any of the bones while 3 (2.4% patients had limb fractures and 2 (1.6% patients had rib fractures. There were 51 (41.8% cases classified as mild injuries, 37 (30.3% cases as moderate injuries and 24 (19.7% cases as severe injuries. Total of 126 cases managed, 121 (96.0% received primary closure of the wounds while 5 (4.0% received delayed closure under general anesthesia.

Distribution of Severity of Injury/Illness Index according to ICD-10 groups

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Dahl, Michael; Rostgaard-Knudsen, Martin

OBJECTIVE: In our area patients seen by the Prehospital Emergency Physician (PEP) are all classified according to the Severity of Injury/Illness Index (SIII) groups 0 to 7. This classification enables the evaluation of the optimal use of the PEP and focus on education. The PEP should only......, dispatches a PEP for major injury and severe medical conditions. For 72 months we extracted data regarding six main groups of diagnosis according to the ICD-10-system: Metabolic diseases, Diseases of the Central Nervous System (CNS), Diseases of the circulatory system, Diseases of the respiratory system...

Cannabis Use Has Negligible Effects Following Severe Traumatic Injury.

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AbdelFattah, Kareem R; Edwards, Courtney R; Cripps, Michael W; Minshall, Christian T; Phelan, Herb A; Minei, Joseph P; Eastman, Alexander L

Nearly half of all states have legalized medical marijuana or recreational-use marijuana. As more states move toward legalization, the effects on injured patients must be evaluated. This study sought to determine effects of cannabis positivity at the time of severe injury on hospital outcomes compared with individuals negative for illicit substances and those who were users of other illicit substances. A Level I trauma center performed a retrospective chart review covering subjects over a 2-year period with toxicology performed and an Injury Severity Score (ISS) of more than 16. These individuals were divided into the negative and positive toxicology groups, further divided into the marijuana-only, other drugs-only, and mixed-use groups. Differences in presenting characteristics, hospital length of stay, intensive care unit (ICU) stays, ventilator days, and death were compared. A total of 8,441 subjects presented during the study period; 2,134 (25%) of these had toxicology performed; 843 (40%) had an ISS of more than 16, with 347 having negative tests (NEG); 70 (8.3%) substance users tested positive only for marijuana (MO), 323 (38.3%) for other drugs-only, excluding marijuana (OD), and 103 (12.2%) subjects showed positivity for mixed-use (MU). The ISS was similar for all groups. No differences were identified in Glasgow Coma Scale (GCS), ventilator days, blood administration, or ICU/hospital length of stay when comparing the MO group with the NEG group. Significant differences occurred between the OD group and the NEG/MO/MU groups for GCS, ICU length of stay, and hospital charges. Cannabis users suffering from severe injury demonstrated no detrimental outcomes in this study compared with nondrug users.

Surgical correction of severe enophthalmos caused by bullet injury

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S M Balaji

2016-01-01

Full Text Available Ballistic injuries of oral and maxillofacial region are usually fatal due to close propinquity with the vital structures. The severity of injury depends on the caliber of the weapon used and distance from which the patient is shot. The preliminary care of facial ballistic wounds strictly adheres to the basics of trauma resuscitation. Early and appropriate surgical management has proved to be influential on the final outcome and esthetic result. Treatment of facial gunshot wounds should be planned and carried out carefully to avoid esthetic complications. It takes even multiple-staged corrections to achieve the targeted functional and esthetic treatment plan. Prevention and control of infection is one of the most important goals to achieve the success of the treatment. Herewith, we present a case of facial gunshot injury with fractures in the orbital floor, medial wall maxillary sinus, and buttress of the zygomatic bone causing deficit, which was successfully managed by surgical reconstruction.

Evaluation of the field relevance of several injury risk functions.

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Prasad, Priya; Mertz, Harold J; Dalmotas, Danius J; Augenstein, Jeffrey S; Diggs, Kennerly

2010-11-01

An evaluation of the four injury risk curves proposed in the NHTSA NCAP for estimating the risk of AIS>= 3 injuries to the head, neck, chest and AIS>=2 injury to the Knee-Thigh-Hip (KTH) complex has been conducted. The predicted injury risk to the four body regions based on driver dummy responses in over 300 frontal NCAP tests were compared against those to drivers involved in real-world crashes of similar severity as represented in the NASS. The results of the study show that the predicted injury risks to the head and chest were slightly below those in NASS, and the predicted risk for the knee-thigh-hip complex was substantially below that observed in the NASS. The predicted risk for the neck by the Nij curve was greater than the observed risk in NASS by an order of magnitude due to the Nij risk curve predicting a non-zero risk when Nij = 0. An alternative and published Nte risk curve produced a risk estimate consistent with the NASS estimate of neck injury. Similarly, an alternative and published chest injury risk curve produced a risk estimate that was within the bounds of the NASS estimates. No published risk curve for femur compressive load could be found that would give risk estimates consistent with the range of the NASS estimates. Additional work on developing a femur compressive load risk curve is recommended.

Analysis of factors associated with traffic injury severity on rural roads in Iran.

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Kashani, Ali Tavakoli; Shariat-Mohaymany, Afshin; Ranjbari, Andishe

2012-01-01

Iran is a country with one of the highest rates of traffic crash fatality and injury, and seventy percent of these fatalities happen on rural roads. The objective of this study is to identify the significant factors influencing injury severity among drivers involved in crashes on two kinds of major rural roads in Iran: two-lane, two-way roads and freeways. According to the dataset, 213569 drivers were involved in rural road crashes in Iran, over the 3 years from 2006 to 2008. The Classification And Regression Tree method (CART) was applied for 13 independent variables, and one target variable of injury severity with 3 classes of no-injury, injury and fatality. Some of the independent variables were cause of crash, collision type, weather conditions, road surface conditions, driver's age and gender and seat belt usage. The CART model was trained by 70% of these data, and tested with the rest. It was indicated that seat belt use is the most important safety factor for two-lane, two-way rural roads, but on freeways, the importance of this variable is less. Cause of crash, also turned out to be the next most important variable. The results showed that for two-lane, two-way rural roads, "improper overtaking" and "speeding", and for rural freeways, "inattention to traffic ahead", "vehicle defect", and "movement of pedestrians, livestock and unauthorized vehicles on freeways" are the most serious causes of increasing injury severity. The analysis results revealed seat belt use, cause of crash and collision type as the most important variables influencing the injury severity of traffic crashes. To deal with these problems, intensifying police enforcement by means of mobile patrol vehicles, constructing overtaking lanes where necessary, and prohibiting the crossing of pedestrians and livestock and the driving of unauthorized vehicles on freeways are necessary. Moreover, creating a rumble strip on the two edges of roads, and paying attention to the design consistency of

Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation

DEFF Research Database (Denmark)

Kammersgaard, Lars Peter; Linnemann, Mia; Tibæk, Maiken

2013-01-01

To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI).......To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI)....

Investigating the risk factors associated with pedestrian injury severity in Illinois.

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Pour-Rouholamin, Mahdi; Zhou, Huaguo

2016-06-01

Pedestrians are known as the most vulnerable road users, which means their needs and safety require specific attention in strategic plans. Given the fact that pedestrians are more prone to higher injury severity levels compared to other road users, this study aims to investigate the risk factors associated with various levels of injury severity that pedestrians experience in Illinois. Ordered-response models are used to analyze single-vehicle, single-pedestrian crash data from 2010 to 2013 in Illinois. As a measure of net change in the effect of significant variables, average direct pseudo-elasticities are calculated that can be further used to prioritize safety countermeasures. A model comparison using AIC and BIC is also provided to compare the performance of the studied ordered-response models. The results recognized many variables associated with severe injuries: older pedestrians (more than 65years old), pedestrians not wearing contrasting clothing, adult drivers (16-24), drunk drivers, time of day (20:00 to 05:00), divided highways, multilane highways, darkness, and heavy vehicles. On the other hand, crossing the street at crosswalks, older drivers (more than 65years old), urban areas, and presence of traffic control devices (signal and sign) are associated with decreased probability of severe injuries. The comparison between three proposed ordered-response models shows that the partial proportional odds (PPO) model outperforms the conventional ordered (proportional odds-PO) model and generalized ordered logit model (GOLM). Based on the findings, stricter rules to address DUI driving is suggested. Educational programs need to focus on older pedestrians given the increasing number of older people in Illinois in the upcoming years. Pedestrians should be educated to use pedestrian crosswalks and contrasting clothing at night. In terms of engineering countermeasures, installation of crosswalks where pedestrian activity is high seems a promising practice

The Epidemiology of Severe Injuries Sustained by National Collegiate Athletic Association Student-Athletes, 2009–2010 Through 2014–2015

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Kay, Melissa C.; Register-Mihalik, Johna K.; Gray, Aaron D.; Djoko, Aristarque; Dompier, Thomas P.; Kerr, Zachary Y.

2017-01-01

Context: Few researchers have described the incidence of the most severe injuries sustained by student-athletes at the collegiate level. Objective: To describe the epidemiology of severe injuries within 25 National Collegiate Athletic Association (NCAA) sports in the 2009–2010 through 2014–2015 academic years. Design: Descriptive epidemiology study. Setting: Aggregate injury and exposure data from 25 NCAA sports. Patients or Other Participants: Collegiate student-athletes in the 2009–2010 through 2014–2015 academic years. Main Outcome Measure(s): Injury data from the NCAA Injury Surveillance Program were analyzed. A severe injury (1) occurred during a sanctioned competition or practice, (2) required medical attention by an athletic trainer or physician, and (3) resulted in at least 21 days lost from sport activity or a premature end to the sport season. Injury counts, proportions, rates per 1000 athlete-exposures (AEs), rate ratios (RRs), and injury proportion ratios were reported with 95% confidence intervals (CIs). Results: A total of 3183 severe injuries were reported, for an injury rate of 0.66/1000 AEs. Wrestling had the highest severe injury rate (1.73/1000 AEs), followed by women's gymnastics (1.40/1000 AEs) and football (0.97/1000 AEs). Overall, the severe injury rate was higher in competition than in practice (RR = 4.25, 95% CI = 3.97, 4.56). Most severe injuries were reported during the regular season (69.3%, n = 2206); however, severe injury rates did not differ between the preseason and regular season (RR = 0.98, 95% CI = 0.91, 1.06). Common severely injured body parts were the knee (32.9%, n = 1047), lower leg/ankle/foot (22.5%, n = 715), and head/face/neck (11.2%, n = 358). Common severe injury diagnoses were sprains (32.9%, n = 1048), strains (16.9%, n = 538), and fractures (14.4%, n = 458). Common severe injury mechanisms were player contact (39.3%, n = 1251), noncontact (25.1%, n = 800), and surface contact (12.0%, n = 383). Conclusions

Employment Outcome Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study.

Science.gov (United States)

Grauwmeijer, Erik; Heijenbrok-Kal, Majanka H; Haitsma, Ian K; Ribbers, Gerard M

2017-09-01

The objective of this prospective cohort study was to evaluate the probability of employment and predictors of employment in patients with moderate- to- severe traumatic brain injury (TBI) over 10-year follow-up. One hundred nine patients (18-67 years) were included with follow-up measurements 3, 6, 12, 18, 24, and 36 months and 10 years post-TBI. Potential predictors of employment probability included patient characteristics, injury severity factors, functional outcome measured at discharge from the hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), Functional Independence Measure (FIM), and the Functional Assessment Measure (FAM). Forty-eight patients (42%) completed the 10-year follow-up. Three months post-TBI, 12% were employed, which gradually, but significantly, increased to 57% after 2-years follow-up (p employed persons had less-severe TBI, shorter length of hospital stay (LOS), and higher scores on the GOS, BI, FIM, and FAM at hospital discharge than unemployed persons. No significant differences in age, sex, educational level, living with partner/family or not, pre-injury employment, professional category, psychiatric symptoms, or discharge destination were found. Longitudinal multivariable analysis showed that time, pre-injury employment, FAM, and LOS were independent predictors of employment probability. We concluded that employment probability 10 years after moderate or severe TBI is related to injury severity and pre-injury employment. Future studies on vocational rehabilitation should focus on modifiable factors and take into consideration the effects of national legislation and national labor market forces.

Factors affecting mortality in severe traumatic brain injury in adults at ...

African Journals Online (AJOL)

Objective: To assess factors contributing to mortality of adult patients admitted to intensive care units for severe traumatic brain injury (TBI). Patients and methods: This is a retrospective, descriptive and analytical study. Included in the study were all adults patients admitted for severe TBI. From the hospital records, ...

78 FR 57486 - Eligibility of Disabled Veterans and Members of the Armed Forces With Severe Burn Injuries for...

Science.gov (United States)

2013-09-19

... Members of the Armed Forces With Severe Burn Injuries for Financial Assistance in the Purchase of an... ``severe burn injury (as determined pursuant to regulations prescribed by the Secretary)'' as one of the... severe burn injuries, the Chairman of the Senate Committee on Veterans' Affairs explained that, ``[d]ue...

77 FR 66419 - Eligibility of Disabled Veterans and Members of the Armed Forces With Severe Burn Injuries for...

Science.gov (United States)

2012-11-05

... Members of the Armed Forces With Severe Burn Injuries for Financial Assistance in the Purchase of an... the Armed Forces with Severe Burn Injuries for Financial Assistance in the Purchase of an Automobile... (U.S.C.), by reformatting the statute and adding ``severe burn injury (as determined pursuant to...

[Objective assessment of trauma severity in patients with spleen injuries].

Science.gov (United States)

Alekseev, V S; Ivanov, V A; Alekseev, S V; Vaniukov, V P

2013-01-01

The work presents an analysis of condition severity of 139 casualties with isolated and combined spleen injuries on admission to a surgical hospital. The assessment of condition severity was made using the traditional gradation and score scale VPH-SP. The degree of the severity of combined trauma of the spleen was determined by the scales ISS. The investigation showed that the scale ISS and VPH-SP allowed objective measurement of the condition severity of patients with spleen trauma. The score assessment facilitated early detection of the severe category of the patients, determined the diagnostic algorithm and the well-timed medical aid.

Oxidant-Antioxidant Balance in Severe Brain Injury

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N. N. Yepifantseva

2010-01-01

Full Text Available Objective: to study the time course of changes in oxidative status parameters and their relationship with inflammation mediators in the acute period of severe brain injury (SBI. Subjects and methods. One hundred and thirteen patients aged 17—67 years were examined. The injury was closed and open in 54 (47.8% and 59 (52.2% patients, respectively. Severe brain contusions were observed in 47 patients, diffuse axonal lesions were seen in 2, and intracranial hematomas were present in 64 patients. The Glasgow coma scores for admission consciousness loss were 6.8±0.25. A control group comprised 23 healthy individuals. The significance of differences was estimated by Student’s test, Wilcoxon-Mann-Whitney, test, Spearman’s correlation test. Venous blood samples were used to study total oxidative activity (TOA and total antioxidative activity (TAA, diene conjugates, lactic acid, albumin, transferrin (TF, ceruloplasmin, C-reactive protein, and lactoferrin (LF were measured in venous blood on disease days 1, 4, 7, 10, 14, and 21. The profile of plasma cytokines (IL-1j8, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, TNF-а, and IFN-y was studied by flow fluorometry on a Cytomics FC 500 cytofluorometer (Beckman Counlter, USA (reagents were from Bender Medsystems, Austria. Results. In SBI, there was an increase in oxidants, a reduction in antioxidant activity, and lipid peroxidation activation, which were closely related. The oxidation coefficient (TOA/TAA was 40 times greater than the normal values on days 7 to 10. The oxidation parameters were found to be associated with inflammation and cytokine-mediated immunological reactions. The time course of changes in the study proteins was characteristic for systemic inflammation and there was an association with oxidative processes only for ceruloplasm. TF was found to have an association with IL-5 and IL-10, which reflects its involvement in immunological reactions. The association with hypoxia was

Considering built environment and spatial correlation in modeling pedestrian injury severity.

Science.gov (United States)

Prato, Carlo G; Kaplan, Sigal; Patrier, Alexandre; Rasmussen, Thomas K

2018-01-02

This study looks at mitigating and aggravating factors that are associated with the injury severity of pedestrians when they have crashes with another road user and overcomes existing limitations in the literature by focusing attention on the built environment and considering spatial correlation across crashes. Reports for 6,539 pedestrian crashes occurred in Denmark between 2006 and 2015 were merged with geographic information system resources containing detailed information about the built environment and exposure at the crash locations. A linearized spatial logit model estimated the probability of pedestrians sustaining a severe or fatal injury conditional on the occurrence of a crash with another road user. This study confirms previous findings about older pedestrians and intoxicated pedestrians being the most vulnerable road users and crashes with heavy vehicles and in roads with higher speed limits being related to the most severe outcomes. This study provides novel perspectives by showing positive spatial correlations of crashes with the same severity outcomes and emphasizing the role of the built environment in the proximity of the crash. This study emphasizes the need for thinking about traffic calming measures, illumination solutions, road maintenance programs, and speed limit reductions. Moreover, this study emphasizes the role of the built environment, because shopping areas, residential areas, and walking traffic density are positively related to a reduction in pedestrian injury severity. Often, these areas have in common a larger pedestrian mass that is more likely to make other road users more aware and attentive, whereas the same does not seem to apply to areas with lower pedestrian density.

Rotational stiffness of American football shoes affects ankle biomechanics and injury severity.

Science.gov (United States)

Button, Keith D; Braman, Jerrod E; Davison, Mark A; Wei, Feng; Schaeffer, Maureen C; Haut, Roger C

2015-06-01

While previous studies have investigated the effect of shoe-surface interaction on injury risk, few studies have examined the effect of rotational stiffness of the shoe. The hypothesis of the current study was that ankles externally rotated to failure in shoes with low rotational stiffness would allow more talus eversion than those in shoes with a higher rotational stiffness, resulting in less severe injury. Twelve (six pairs) cadaver lower extremities were externally rotated to gross failure while positioned in 20 deg of pre-eversion and 20 deg of predorsiflexion by fixing the distal end of the foot, axially loading the proximal tibia, and internally rotating the tibia. One ankle in each pair was constrained by an American football shoe with a stiff upper, while the other was constrained by an American football shoe with a flexible upper. Experimental bone motions were input into specimen-specific computational models to examine levels of ligament elongation to help understand mechanisms of ankle joint failure. Ankles in flexible shoes allowed 6.7±2.4 deg of talus eversion during rotation, significantly greater than the 1.7±1.0 deg for ankles in stiff shoes (p = 0.01). The significantly greater eversion in flexible shoes was potentially due to a more natural response of the ankle during rotation, possibly affecting the injuries that were produced. All ankles failed by either medial ankle injury or syndesmotic injury, or a combination of both. Complex (more than one ligament or bone) injuries were noted in 4 of 6 ankles in stiff shoes and 1 of 6 ankles in flexible shoes. Ligament elongations from the computational model validated the experimental injury data. The current study suggested flexibility (or rotational stiffness) of the shoe may play an important role in both the severity of ankle injuries for athletes.

77 FR 70389 - Eligibility of Disabled Veterans and Members of the Armed Forces With Severe Burn Injuries for...

Science.gov (United States)

2012-11-26

... Members of the Armed Forces With Severe Burn Injuries for Financial Assistance in the Purchase of an... reformatting the statute and adding ``severe burn injury (as determined pursuant to regulations prescribed by...)(iv), VA proposes to amend 38 CFR 3.808 to define the term ``severe burn injury.'' In the proposed...

Development of Metabolic Indicators of Burn Injury: Very Low Density Lipoprotein (VLDL and Acetoacetate Are Highly Correlated to Severity of Burn Injury in Rats

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Maria-Louisa Izamis

2012-07-01

Full Text Available Hypermetabolism is a significant sequela to severe trauma such as burns, as well as critical illnesses such as cancer. It persists in parallel to, or beyond, the original pathology for many months as an often-fatal comorbidity. Currently, diagnosis is based solely on clinical observations of increased energy expenditure, severe muscle wasting and progressive organ dysfunction. In order to identify the minimum number of necessary variables, and to develop a rat model of burn injury-induced hypermetabolism, we utilized data mining approaches to identify the metabolic variables that strongly correlate to the severity of injury. A clustering-based algorithm was introduced into a regression model of the extent of burn injury. As a result, a neural network model which employs VLDL and acetoacetate levels was demonstrated to predict the extent of burn injury with 88% accuracy in the rat model. The physiological importance of the identified variables in the context of hypermetabolism, and necessary steps in extension of this preliminary model to a clinically utilizable index of severity of burn injury are outlined.

Maternal Pseudo-Bartter Syndrome Associated with Severe Perinatal Brain Injury.

Science.gov (United States)

Vora, Shrenik; Ibrahim, Thowfique; Rajadurai, Victor Samuel

2017-09-15

Maternal electrolyte imbalance is rarely reported as causative factor of severe perinatal brain injury. This case outlines a unique maternal and neonatal pseudo-Bartter syndrome presented with metabolic alkalosis and hypochloremia due to maternal severe vomiting. Neonatal MRI brain revealed extensive brain hemorrhages with porencephalic cysts. Subsequent investigation workup points towards maternal severe metabolic alkalosis as its cause. Careful medical attention should be paid to pregnant women with excessive vomiting to ensure a healthy outcome for both the mother and the baby.

The effect of helmet use on injury severity and crash circumstances in skiers and snowboarders.

Science.gov (United States)

Hagel, Brent; Pless, I Barry; Goulet, Claude; Platt, Robert; Robitaille, Yvonne

2005-01-01

The aim of this study was to examine the effect of helmet use on non-head-neck injury severity and crash circumstances in skiers and snowboarders. We used a matched case-control study over the November 2001 to April 2002 winter season. 3295 of 4667 injured skiers and snowboarders reporting to the ski patrol at 19 areas in Quebec with non-head, non-neck injuries agreed to participate. Cases included those evacuated by ambulance, admitted to hospital, with restriction of normal daily activities (NDAs) >6 days, with non-helmet equipment damage, fast self-reported speed, participating on a more difficult run than usual, and jumping-related injury. Controls were injured participants without severe injuries or high-energy crash circumstances and were matched to cases on ski area, activity, day, age, and sex. Conditional logistic regression was used to relate each outcome to helmet use. There was no evidence that helmet use increased the risk of severe injury or high-energy crash circumstances. The results suggest that helmet use in skiing and snowboarding is not associated with riskier activities that lead to non-head-neck injuries.

The trajectories of overall disability in the first 5 years after moderate and severe traumatic brain injury.

Science.gov (United States)

Forslund, Marit V; Roe, Cecilie; Perrin, Paul B; Sigurdardottir, Solrun; Lu, Juan; Berntsen, Svein; Andelic, Nada

2017-01-01

To assess longitudinal trajectories of overall disability after moderate-to-severe traumatic brain injury (TBI) and to examine whether those trajectories could be predicted by socio-demographic and injury characteristics. Demographics and injury characteristics of 105 individuals with moderate-to-severe TBI were extracted from medical records. At the 1-, 2-, and 5-year follow-ups, TBI-related disability was assessed by the GOSE. A hierarchical linear model (HLM) was used to examine functional outcomes up to 5 years following injury and whether those outcomes could be predicted by: time, gender, age, relationship, education, employment pre-injury, occupation, GCS, cause of injury, length of post-traumatic amnesia (PTA), CT findings and injury severity score, as well as the interactions between each of these predictors and time. Higher GOSE trajectories (lower disability) were predicted by younger age at injury and shorter PTA, as well as by the interaction terms of time*PTA and time*employment. Those who had been employed at injury decreased in disability over time, while those who had been unemployed increased in disability. The study results support the view that individual factors generally outweigh injury-related factors as predictors of disability after TBI, except for PTA.

Extracorporeal Detoxification in Victims with Severe Concomitant Injury

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S. Ye. Khoroshilov

2009-01-01

Full Text Available Objective: to improve the results of victims with massive crushes of soft tissues in severe concomitant injury (SCI, by applying extracorporeal detoxification techniques as soon as possible. Subjects and methods. The results of examination and treatment were studied in 41 victims with SCI treated at the N. N. Burdenko Main Military Clinical Hospital in 2006 to 2008. In the early posttraumatic period (on days 1—3, all the victims (n=41 were divided into 2 groups. Group 1 victims (n=19 underwent hemodiafiltration (HDF with replacement at 35 ml/kg/hr; Group 2 (n=22 had plasmapheresis. Results. Early HDF applied to Group 1 victims could achieve 32, 44, and 37% reductions in the elevated levels creatine phosphokinase, myoglobin, and middle-sized molecules, respectively. In Group 2, plasmapheresis showed a lower effect (19, 25, and 26% reductions. Furthermore, there was a decrease in total protein in Group 1, which was absent in Group 2. Conclusion. The timely use of extracorporeal detoxification techniques in victims with massive crushes of soft tissues in the early posttraumatic period prevents the development of fatal complications of SCI, at the same time HDF is more effective and safe than plasmapheresis. Key words: severe concomitant injury, rhabdomyolysis, myoglobin, plasmapheresis, hemodiafiltration.

Percutaneous dilatational tracheostomy for ICU patients with severe brain injury

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Guo Dongyuan

2014-12-01

Full Text Available 【Abstract】Objective: To sum up our experience in percutaneous dilatational tracheostomy (PDT in ICU patient with severe brain injury. Methods: Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, effi cacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results: The operations took 4-15 minutes (mean 9.1 minutes±4.2 minutes. Totally 4 cases suffered from complications in the operations: 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, or clinically signifi cant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion: Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in diffi cult airway management. Key words: Brain injuries; Percutaneous dilatational tracheostomy; ICU

Prevention of pressure ulcers in patients undergoing sub-acute rehabilitation after severe brain injury

DEFF Research Database (Denmark)

Sachs, Marianne Brostrup; Wolffbrandt, Mia Moth; Poulsen, Ingrid

2018-01-01

OBJECTIVE: The aim of this study was to uncover efforts made by healthcare professionals to prevent pressure ulcers (PUs) in patients with severe brain injury undergoing treatment at a sub-acute rehabilitation department. BACKGROUND: PUs is a major burden for patients and also generate considerable...... healthcare costs. PUs are, nevertheless, prevalent in both secondary and primary care. DESIGN: In this qualitative study, we performed 24-hour observation on four patients undergoing rehabilitation for severe brain injury. An observation guide was developed inspired by the Braden Scale and Spradley's theory...... that patients' rehabilitation days be planned in such a manner that activities, mobilisation and training are conducted throughout the day and evening. We also recommend that professional staff are encouraged to seek information about the former life of patients with severe brain injury. This article...

Blunt hepatic and splenic trauma in children: correlation of a CT injury severity scale with clinical outcome

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Ruess, L. [Dept. of Diagnostic Imaging and Radiology, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States); Sivit, C.J. [Dept. of Diagnostic Imaging and Radiology, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States)]|[Dept. of Pediatrics, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States); Eichelberger, M.R. [Dept. of Pediatrics, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States)]|[Dept. of Surgery, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences Washington, DC (United States); Taylor, G.A. [Dept. of Diagnostic Imaging and Radiology, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States); Bond, S.J. [Dept. of Surgery, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences Washington, DC (United States)

1995-07-01

The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P = 0.002 by {chi}{sup 2}-test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P = 0.41 by {chi}{sup 2}-test) or amount (P = 0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury. (orig.)

Blunt hepatic and splenic trauma in children: correlation of a CT injury severity scale with clinical outcome

International Nuclear Information System (INIS)

Ruess, L.; Sivit, C.J.; Eichelberger, M.R.; Taylor, G.A.; Bond, S.J.

1995-01-01

The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P = 0.002 by χ 2 -test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P = 0.41 by χ 2 -test) or amount (P = 0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury. (orig.)

Factors influencing pediatric Injury Severity Score and Glasgow Coma Scale in pediatric automobile crashes: results from the Crash Injury Research Engineering Network.

Science.gov (United States)

Ehrlich, Peter F; Brown, J Kristine; Sochor, Mark R; Wang, Stewart C; Eichelberger, Martin E

2006-11-01

Motor vehicle crashes account for more than 50% of pediatric injuries. Triage of pediatric patients to appropriate centers can be based on the crash/injury characteristics. Pediatric motor vehicle crash/injury characteristics can be determined from an in vitro laboratory using child crash dummies. However, to date, no detailed data with respect to outcomes and crash mechanism have been presented with a pediatric in vivo model. The Crash Injury Research Engineering Network is comprised of 10 level 1 trauma centers. Crashes were examined with regard to age, crash severity (DeltaV), crash direction, restraint use, and airbag deployment. Multiple logistic regression analysis was performed with Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) as outcomes. Standard age groupings (0-4, 5-9, 10-14, and 15-18) were used. The database is biases toward a survivor population with few fatalities. Four hundred sixty-one motor vehicle crashes with 2500 injuries were analyzed (242 boys, 219 girls). Irrespective of age, DeltaV > 30 mph resulted in increased ISS and decreased GCS (eg, for 0-4 years, DeltaV 30: ISS = 19.5, GCS = 10.6; P 15) injuries than did backseat passengers (odds ratio, 1.7; 95% confidence interval, 0.7-3.4). A trend was noted for children younger than 12 years sitting in the front seat to have increased ISS and decreased GCS with airbag deployment but was limited by case number. A reproducible pattern of increased ISS and lower GCS characterized by high severity, lateral crashes in children was noted. Further analysis of the specific injuries as a function and the crash characteristic can help guide management and prevention strategies.

Analysis of factors associated with traffic injury severity on rural roads in Iran

Directory of Open Access Journals (Sweden)

Andishe Ranjbari

2012-01-01

Full Text Available BACKGROUND: Iran is a country with one of the highest rates of traffic crash fatality and injury, and seventy percent of these fatalities happen on rural roads. The objective of this study is to identify the significant factors influencing injury severity among drivers involved in crashes on two kinds of major rural roads in Iran: two-lane, two-way roads and freeways. METHODS: According to the dataset, 213569 drivers were involved in rural road crashes in Iran, over the 3 years from 2006 to 2008. The Classification And Regression Tree method (CART was applied for 13 independent variables, and one target variable of injury severity with 3 classes of no-injury, injury and fatality. Some of the independent variables were cause of crash, collision type, weather conditions, road surface conditions, driver's age and gender and seat belt usage. The CART model was trained by 70% of these data, and tested with the rest. RESULTS: It was indicated that seat belt use is the most important safety factor for two-lane, two-way rural roads, but on freeways, the importance of this variable is less. Cause of crash, also turned out to be the next most important variable. The results showed that for two-lane, two-way rural roads, "improper overtaking" and "speeding", and for rural freeways, "inattention to traffic ahead", "vehicle defect", and "movement of pedestrians, livestock and unauthorized vehicles on freeways" are the most serious causes of increasing injury severity. CONCLUSIONS: The analysis results revealed seat belt use, cause of crash and collision type as the most important variables influencing the injury severity of traffic crashes. To deal with these problems, intensifying police enforcement by means of mobile patrol vehicles, constructing overtaking lanes where necessary, and prohibiting the crossing of pedestrians and livestock and the driving of unauthorized vehicles on freeways are necessary. Moreover, creating a rumble strip on the two edges of

Medical management of severe local radiation injury after acute X-ray exposure

International Nuclear Information System (INIS)

Bushmanov, A.; Nadezhina, N.; Kretov, A.

2008-01-01

Medical management during acute period in a case of severe local radiation injury after acute X-ray exposure includes 3 stages. During the fist stage patient got conservative treatment according to the common pathogenetic mechanisms of LRI (dis aggregating therapy, stimulation of regeneration, dis intoxication therapy, antibiotic therapy, pain relief therapy, Local anti-burn therapy-specific non-adhesive bandage with antiseptic and anti-burn medicaments); estimation of severity, deepness and area of injury by clinical picture and dates of instrumental methods of examining; defining necessity and volume of surgical treatment; preparing arrangements for surgical treatment. This stage ends with forming of demarcation line of a very hard severity of a Local Radiation Injure. The second stage includes necrectomy of the area of a very hard severity with microsurgical plastic by re vascularized flap and auto dermoplastic. The third stage - adaptation of re vascularized flap and total epithelization of injured area. (author)

The relation between persistent coma and brain ischemia after severe brain injury.

Science.gov (United States)

Cheng, Quan; Jiang, Bing; Xi, Jian; Li, Zhen Yan; Liu, Jin Fang; Wang, Jun Yu

2013-12-01

To investigate the relation between brain ischemia and persistent vegetative state after severe traumatic brain injury. The 66 patients with severe brain injury were divided into two groups: The persistent coma group (coma duration ≥10 d) included 51 patients who had an admission Glasgow Coma Scale (GCS) of 5-8 and were unconscious for more than 10 d. There were 15 patients in the control group, their admission GCS was 5-8, and were unconscious for less than 10 d. The brain areas, including frontal, parietal, temporal, occipital lobes and thalamus, were measured by Single Photon Emission Computed Tomography (SPECT). In the first SPECT scan, multiple areas of cerebral ischemia were documented in all patients in both groups, whereas bilateral thalamic ischemia were presented in all patients in the persistent coma group and were absented in the control group. In the second SPECT scan taken during the period of analepsia, with an indication that unilateral thalamic ischemia were persisted in 28 of 41 patients in persistent coma group(28/41,68.29%). Persistent coma after severe brain injury is associated with bilateral thalamic ischemia.

Clinical significance of percutaneous endoscopic gastrostomy for patients with severe craniocerebral injury

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Du Hanggen

2014-12-01

Full Text Available Objective: To investigate the application of percutaneous endoscopic gastrostomy (PEG to patients with severe craniocerebral injury for the purpose of nutritional support therapy and pulmonary infection prevention. Methods: A total of 43 patients with severe craniocerebral injury admitted to our department from January 2008 to December 2012 received PEG followed by nutritional therapy. There were other 82 patients who were prescribed nasal-feeding nutrition. Nutrition status was evaluated by comparing serum albumin levels, and the incidence of pulmonary infection 1 week before and 2 weeks after operation was identifi ed and compared. Results: Both PEG and nasal-feeding nutrition therapies have significantly levated serum albumin levels (P<0.05. Serum albumin levels before and after nutritional therapies showed no significant difference between the two groups (P>0.05. The incidence of pulmonary infection in PEG group was significantly decreased compared with that in nasal-feeding nutrition group (P<0.05. Conclusion: PEG is an effective method for severe craniocerebral injury patients. It can not only provide enteral nutrition but also prevent pulmonary infection induced by esophageal refl ux. Key words: Gastrostomy; Craniocerebral trauma; Enteral nutrition

Aggravating andmitigating factors associated with cyclist injury severity in Denmark

DEFF Research Database (Denmark)

Kaplan, Sigal; Vavatsoulas,, Konstantinos; Prato, Carlo Giacomo

2014-01-01

severity on Danish roads by examining a comprehensive set of accidents involving a cyclist and a collision partner between 2007 and 2011. Method: This study estimates a generalized ordered logit model of the severity of cyclist injuries because of its ability to accommodate the ordered-response nature...... of severity while relaxing the proportional odds assumption. Results: Model estimates show that cyclist fragility (children under 10 years old and elderly cyclists over 60 years of age) and cyclist intoxication are aggravating individual factors,while helmet use is a mitigating factor. Speed limits above 70...

Pediatric patients with severe head injury in Japan Neurotrauma Data Bank. Analysis of the prognostic factors

International Nuclear Information System (INIS)

Miki, Tamotsu; Haraoka, Jo

2009-01-01

The purpose of this study is to evaluate the clinical characteristics of the pediatric patients in the Japan Neurotrauma Data Bank: Project 2004. Project 2004 consisted of severe head injury patients with a Glasgow Coma Scale (GCS) score of 8 or less on admission or during course and patients who were operated for traumatic intracranial lesion between 2004-2006. The subjects were 101 pediatric patients aged 15 years old or less (mean: 7.8 y/o). We retrospectively examined the patients' age, GCS, cause of injury, duration and time of patient transfer, pupillary abnormality, body temperature, serum glucose level, Injury Severity Score (ISS) excluding cranio-cervical score, skull fracture, CT classification of the Traumatic Coma Data Bank (TCDB), main lesion of focal brain injury on CT, and traumatic subarachnoid hemorrhage (SAH) on CT. The mortality rate in children is lower than in adults: 18.8% vs. 39.7%. The factors that correlated to the poor outcome in pediatric patients are lower GCS score on admission, pupillary abnormality, hyperglycemia (more than 200 mg/dl), complications of severe other organ injury, diffuse injury III according to classification of CT, acute subdural hematoma and SAH. Pathophysiologically pediatric patients are not miniatures of adult patients. The data of Project 2004 is extremely significant and indicates the profile of one general view of pediatric patients with severe head injury in Japan. However, further collection of data and careful analysis are necessary for standardizing pediatric head trauma care. (author)

Case Study: Severe Self-Injurious Behavior in Comorbid Tourette's Disorder and OCD

Science.gov (United States)

Hood, Korey K.; Baptista-Neto, Lourival; Beasley, Pamela J.; Lobis, Robert; Pravdova, Iva

2004-01-01

This case report describes the successful treatment of severe self-injurious behavior in a 16-year-old adolescent with Tourette's disorder and obsessive-compulsive disorder. Treatment is described from initial presentation to the emergency department for severe self-inflicted oral lacerations through discharge from the inpatient psychiatric…

11.361 sports injuries in a 15-year survey of a Level I emergency trauma department reveal different severe injury types in the 6 most common team sports.

Science.gov (United States)

Krutsch, Werner; Krutsch, Volker; Hilber, Franz; Pfeifer, Christian; Baumann, Florian; Weber, Johannes; Schmitz, Paul; Kerschbaum, Maximilian; Nerlich, Michael; Angele, Peter

2018-06-01

 Severe sports-related injuries are a common affliction treated in Level I trauma departments. Detailed knowledge on injury characteristics from different medical settings is essential to improve the development of injury prevention strategies in different team sports.  Team sport injuries were retrospectively analysed in a Level I trauma department registry over 15 years. Injury and treatment data were compared with regard to competition and training exposure. Injury data such as "time of visitation", "type of injury", "multiple injured body regions" and "immediate hospitalisation" helped to define the severity level of each team sports injury.  At the Level I trauma department, 11.361 sports-related injuries were seen over 15 years, of which 34.0 % were sustained during team sports. Soccer injuries were the most common injuries of all team sports (71.4 %). The lower extremity was the most affected body region overall, followed by the upper extremity. Head injuries were mainly seen in Ice hockey and American football and concussion additionally frequently in team handball. Slight injuries like sprains or contusions occurred most frequently in all team sports. In soccer and team handball, injuries sustained in competition were significantly more severe (p team sports, injury prevention strategies should address competitive as well as training situations, whichmay need different strategies. © Georg Thieme Verlag KG Stuttgart · New York.

Application of the Mandible Injury Severity Score to Pediatric Mandibular Fractures.

Science.gov (United States)

Swanson, Edward W; Susarla, Srinivas M; Ghasemzadeh, Ali; Mundinger, Gerhard S; Redett, Richard J; Tufaro, Anthony P; Manson, Paul N; Dorafshar, Amir H

2015-07-01

The Mandible Injury Severity Score (MISS) has been used to evaluate adult mandibular fractures. The purpose of this study was to evaluate the MISS in a cohort of pediatric patients. This was a retrospective study of pediatric patients treated for mandibular fractures over a 20-year period. Patients were included if they had computed tomographic imaging available for review and had at least 1 post-treatment visit. The primary predictor variable was the MISS. Secondary predictors were demographic and injury-associated factors. The outcome was treatment-associated complications. Descriptive, bivariate, and multiple logistic regression statistics were computed. One hundred sixteen patients with mandibular fractures were identified; 73 (62.9%) met the inclusion criteria. The sample's mean age was 8.5 ± 4.1 years; 44% were girls. Motor vehicle collisions (60%) and falls (15.1%) were the most common mechanisms. More than 50% of patients had an extra-mandibular injury. The mean MISS was 13.5 ± 7.8. Forty-five percent of the sample underwent open reduction and internal fixation. Complications were noted in 20.5% of patients, of which malocclusion was the most common (8.2%). Increasing MISS was associated with complications (P pediatric patients with mandibular fractures, increased severity of injury is associated with complications, even after controlling for the effects of multiple confounders, including open treatment. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Clinical value of computerized tomography scanning in severe head injury

International Nuclear Information System (INIS)

Kobayashi, Shiro; Yano, Masami; Otsuka, Toshibumi; Nakazawa, Shozo

1982-01-01

Serial computerized tomography (SCT) was performed on 138 patients suffering from severe head injuries (8 or less on the Glasgow Coma Scale). Standard practice called for scans to be done upon admission (within hours of the injury), and after 1, 3, 7 days and 1 month. Subsequent CT's depended on the patient's condition. Clinical results at the time of discharge were graded according to the Glasgow Outcome Scale. Patients who died, were in a persistent vegetative state, or were severely disabled were considered to have a ''bad outcome''. On the other hand, patients who were somewhat disabled or made good recoveries were considered to have a ''good outcome''. During the serial CT scan, there were new findings (not visualized on the initial CT but appearing on subsequent ones) in 91 of the 138 patients. These new findings were classified as follows; 1) decreased density collection in the subdural space (DDC), 2) ventricular dilation (VD), 3) intracerebral hematoma (ICH), 4) intraventricular hemorrhage (IVH), 5) extracerebral hematoma (ECH), 6) edema (E), 7) infarction (I). We defined ICH, IVH, ECH, E and I as new lesions. Of the 60 patients with new lesions 12 had good outcomes and 48 had poor outcomes. There were 78 patients who did not have any new lesions, 60 with good outcomes and 18 with poor outcomes. A significant correlation was found between good outcomes and the absence of new lesions, and between bad outcomes and the development of new lesions (p 2 = 44.038). We conclude that SCT can help predict the outcome with severe head injury patients and may be very important in their examination and care. (J.P.N.)

Hemodynamic and metabolic correlates of perinatal white matter injury severity.

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Art Riddle

Full Text Available Although the spectrum of perinatal white matter injury (WMI in preterm infants is shifting from cystic encephalomalacia to milder forms of WMI, the factors that contribute to this changing spectrum are unclear. We hypothesized that the variability in WMI quantified by immunohistochemical markers of inflammation could be correlated with the severity of impaired blood oxygen, glucose and lactate.We employed a preterm fetal sheep model of in utero moderate hypoxemia and global severe but not complete cerebral ischemia that reproduces the spectrum of human WMI. Since there is small but measurable residual brain blood flow during occlusion, we sought to determine if the metabolic state of the residual arterial blood was associated with severity of WMI. Near the conclusion of hypoxia-ischemia, we recorded cephalic arterial blood pressure, blood oxygen, glucose and lactate levels. To define the spectrum of WMI, an ordinal WMI rating scale was compared against an unbiased quantitative image analysis protocol that provided continuous histo-pathological outcome measures for astrogliosis and microgliosis derived from the entire white matter.A spectrum of WMI was observed that ranged from diffuse non-necrotic lesions to more severe injury that comprised discrete foci of microscopic or macroscopic necrosis. Residual arterial pressure, oxygen content and blood glucose displayed a significant inverse association with WMI and lactate concentrations were directly related. Elevated glucose levels were the most significantly associated with less severe WMI.Our results suggest that under conditions of hypoxemia and severe cephalic hypotension, WMI severity measured using unbiased immunohistochemical measurements correlated with several physiologic parameters, including glucose, which may be a useful marker of fetal response to hypoxia or provide protection against energy failure and more severe WMI.

Severe road traffic injuries in Kenya, quality of care and access ...

African Journals Online (AJOL)

Severe road traffic injuries in Kenya, quality of care and access. ... hospitals were interviewed on availability of emergency care and resources. ... Training of motorists and general public in first aid should be considered in RTI control initiatives.

A Long-Term Follow-Up of Treatment for Severe Self-Injury.

Science.gov (United States)

Williams, Don E.; And Others

1994-01-01

Treatment of a woman with severe mental retardation with the Self-Injurious Behavior Inhibiting System (SIBIS) resulted in significant reductions in SIB behavior which generalized to the natural environment and the brief follow-up sessions. (Author/DB)

Medical aspects of pediatric rehabilitation after moderate to severe traumatic brain injury.

Science.gov (United States)

Cantore, Lisa; Norwood, Kenneth; Patrick, Peter

2012-01-01

Recovery from severe traumatic brain injury (TBI) is prolonged, complicated and challenging. Medical rehabilitation is the bridge from acute medical care and stabilization to community reintegration. The process of caring for the recovering brain introduces unknown challenges of neural plasticity with demands to restore and to also move the child and family back to the developmental trajectory they once knew. While the ongoing focus is to maintain and advance medical stability, co- morbid conditions are addressed, and a plan for ongoing health is established. While no one manuscript can cover all of the medical aspects, this article will present in a "systems review" manner the most challenging and demanding medical conditions that children may confront following severe brain injury.

Analysis of Severe Injuries Associated with Volleyball Activities.

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Gerberich, Susan Goodwin; And Others

1987-01-01

Evaluation of 106 persons treated for injuries related to volleyball revealed that nearly 90 percent of injuries were concentrated in the lower extremities. Knee injuries accounted for 59 percent of injuries and ankle injuries accounted for about 23 percent of injuries. The mechanisms of jumping, landing, or twisting upon impact were highly…

Melatonin Secretion Is Increased in Children with Severe Traumatic Brain Injury.

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Marseglia, Lucia; D'Angelo, Gabriella; Manti, Sara; Rulli, Immacolata; Salvo, Vincenzo; Buonocore, Giuseppe; Reiter, Russel J; Gitto, Eloisa

2017-05-13

Traumatic brain injury (TBI) is a leading cause of death and disability in children. Oxidative stress plays a significant role in brain damage and melatonin exhibits both direct and indirect antioxidant effects. The primary aim of the present study was to evaluate serum melatonin levels in children with severe TBI in comparison to critically ill children admitted to the Pediatric Intensive Care Unit for conditions other than TBI. Twenty-four children were evaluated, equally divided into severe TBI and no-TBI. Blood samples for serum melatonin analysis were collected at 22:00, 01:00, 03:00, 05:00, 08:00, and 12:00. Mean serum melatonin peaks in children of the TBI group were higher compared to the values of no-TBI critically ill children (495 ± 102 vs. 294 ± 119 pg/mL, p = 0.0002). Furthermore, the difference was even more significant in comparison to values reported in literature for healthy age-matched children (495 ± 102 vs. 197 ± 71 pg/mL, p melatonin levels dramatically increase in children after severe TBI. This elevation is likely to represent a response to oxidative stress and/or inflammation due to severe head injury.

Cytoprotective effect of cytoflavinum in the treatment of thermal injuries of various severity levels

Directory of Open Access Journals (Sweden)

Alexey J. Bozhedomov

2012-12-01

Full Text Available The research aimed to conduct studying of cytoprotective effect of cytoflavinum in thermal traumas of various severity levels. Material and methods – 169 patients were included into the research with thermal burns and with a favorable outcome and the severity of a thermal injury from 30 to 170 points according Frank index. 28 patients received cytoflavinum in a complex therapy in a standard dosage. Results – During the cytoflavinum usage in patients with the severity of a thermal injury more than 60 points by Frank there had been fixed: the decrease of a systemic inflammatory response syndrome (SIRS, reduction of stab neutrophils content, slower decrease of erythrocytes, smaller activation of thrombopoiesis, decrease of concentration of the vascular endothelial growth factor. In the group of patients with thermal injuries less than 60 points who had been receiving cytoflavinum there had not positive effects been fixed. Conclusion – Cytoflavinum is the most effective when the severity of a thermal trauma is more than 60 points by Frank.

Deafferentation in thalamic and pontine areas in severe traumatic brain injury.

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Laouchedi, M; Galanaud, D; Delmaire, C; Fernandez-Vidal, S; Messé, A; Mesmoudi, S; Oulebsir Boumghar, F; Pélégrini-Issac, M; Puybasset, L; Benali, H; Perlbarg, V

2015-07-01

Severe traumatic brain injury (TBI) is characterized mainly by diffuse axonal injuries (DAI). The cortico-subcortical disconnections induced by such fiber disruption play a central role in consciousness recovery. We hypothesized that these cortico-subcortical deafferentations inferred from diffusion MRI data could differentiate between TBI patients with favorable or unfavorable (death, vegetative state, or minimally conscious state) outcome one year after injury. Cortico-subcortical fiber density maps were derived by using probabilistic tractography from diffusion tensor imaging data acquired in 24 severe TBI patients and 9 healthy controls. These maps were compared between patients and controls as well as between patients with favorable (FO) and unfavorable (UFO) 1-year outcome to identify the thalamo-cortical and ponto-thalamo-cortical pathways involved in the maintenance of consciousness. Thalamo-cortical and ponto-thalamo-cortical fiber density was significantly lower in TBI patients than in healthy controls. Comparing FO and UFO TBI patients showed thalamo-cortical deafferentation associated with unfavorable outcome for projections from ventral posterior and intermediate thalamic nuclei to the associative frontal, sensorimotor and associative temporal cortices. Specific ponto-thalamic deafferentation in projections from the upper dorsal pons (including the reticular formation) was also associated with unfavorable outcome. Fiber density of cortico-subcortical pathways as measured from diffusion MRI tractography is a relevant candidate biomarker for early prediction of one-year favorable outcome in severe TBI. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Incidence and severity of ocular and adnexal injuries during the Second Lebanon War among Israeli soldiers and civilians.

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Barak, Adiel; Elhalel, Amir; Pikkel, Joseph; Krauss, Eli; Miller, Benjamin

2011-12-01

To analyze the incidence and severity of ocular and adnexal injuries in the Second Lebanon War among Israeli soldiers and civilians. Retrospective cohort study. All patients recorded in the Israeli National Trauma Registry during the Second Lebanon War (July-August, 2006). Retrieval of all data relevant to ocular and adnexal injuries sustained during the study period, and differentiation between those associated with combat/terrorist and other events. Analysis of data according to the severity of trauma , anatomical location of the injury, and whether the patients were military personnel or civilians. A total of 69 war-related ocular trauma patients (58 military personnel and 11 civilians) were registered during the 34 days of war. The injuries involved the anterior segment injury (n = 25), posterior segment (n = 29) and the periocular region (n = 15, all severe). Twenty-seven of the patients had open-globe injuries, of which 18 involved intraocular foreign bodies, and 27 patients had closed-globe injuries. The rate of ocular injuries was 7% among all registered wounded military personnel and 1.2% among all injured civilians. The incidence and severity of ocular and adnexal injuries among military personnel during the Second Lebanon War were consistent with previous reports from American sources of ocular injuries sustained in Iraq and Afghanistan. The rates of ocular injury associated with wartime events sustained by civilians has not been investigated before, and it was relatively low, probably as a result of stringent government-mandated building regulations for passive defense that are discussed.

Severe Traumatic Brain Injury

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... TBI Online Concussion Training Press Room Guide to Writing about TBI in News and Social Media Living with TBI HEADS UP to Brain Injury Awareness Get Email Updates To receive email updates about this topic, ...

Serum concentration of ubiquitin c-terminal hydrolase-L1 in detecting severity of traumatic brain injury

Science.gov (United States)

Siahaan, A. M. P.; Japardi, I.; Hakim, A. A.

2018-03-01

One of the main problems with ahead injury is assessing the severity. While physical examination and imaging had limitations, neuronal damage markers, ubiquitin C-terminal hydrolase-L1 (UCH-L1), released in theblood may provide valuable information about diagnosis the traumatic brain injury (TBI).Analyzing the concentrations of serum ubiquitin C-terminal hydrolase-L1 (UCH-L1), there must have a neuronal injury biomarker, in theTBI patients serum and their association with clinical characteristics and outcome. There were 80 TBI subjects, and there are mild, moderate, and severe involved in this study of case- control. By using ELISA, we studied the profile of serum UCH-L1 levels for TBI patients. TheUCH-L1 serum level of moderate and severe head injury is higher than in mild head injury (pinjury patients. There is no particular correlation found between serum UCH-L1 level and outcome. Serum levels of UCH-L1 appear to have potential clinical utility in diagnosing TBI but do not correlate with outcome.

Patient Effort in Traumatic Brain Injury Inpatient Rehabilitation: Course and Associations With Age, Brain Injury Severity, and Time Postinjury.

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Seel, Ronald T; Corrigan, John D; Dijkers, Marcel P; Barrett, Ryan S; Bogner, Jennifer; Smout, Randall J; Garmoe, William; Horn, Susan D

2015-08-01

To describe patients' level of effort in occupational, physical, and speech therapy sessions during traumatic brain injury (TBI) inpatient rehabilitation and to evaluate how age, injury severity, cognitive impairment, and time are associated with effort. Prospective, multicenter, longitudinal cohort study. Acute TBI rehabilitation programs. Patients (N=1946) receiving 138,555 therapy sessions. Not applicable. Effort in rehabilitation sessions rated on the Rehabilitation Intensity of Therapy Scale, FIM, Comprehensive Severity Index brain injury severity score, posttraumatic amnesia (PTA), and Agitated Behavior Scale (ABS). The Rehabilitation Intensity of Therapy Scale effort ratings in individual therapy sessions closely conformed to a normative distribution for all 3 disciplines. Mean Rehabilitation Intensity of Therapy Scale ratings for patients' therapy sessions were higher in the discharge week than in the admission week (Prehabilitation, differences in effort ratings (Prehabilitation admission, days from admission, and daily ratings of PTA and ABS score were predictors of level of effort (Prehabilitation setting using the Rehabilitation Intensity of Therapy Scale. Patients who sustain TBI show varying levels of effort in rehabilitation therapy sessions, with effort tending to increase over the stay. PTA and agitated behavior are primary risk factors that substantially reduce patient effort in therapies. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The clinical implications of severe low rib fracture in the management of diaphragm injury: A Case Control Study.

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Kim, Seongyup; Choi, Woo Jin; Lee, Kawng Ho; Byun, Chun Sung; Bae, Keum Seok; Park, Il Hwan

2017-06-01

The objective of this study was to analyze the differences in clinical presentation and characteristics with regard to diaphragmatic injury between blunt trauma patients with severe low rib fractures and those without severe low rib fractures. The medical records of all patients with diaphragmatic injuries who were surgically treated at this level I trauma center, between January 2004 and December 2016 were reviewed. Patient notes, radiologic findings, and operative reports were evaluated. All of the diaphragmatic injuries were confirmed based on the operative findings. Rib fracture with displacement between the ends of the fracture of more than half the width of the fractured rib on computed tomography was classified as 'severe rib fracture'. Patients were categorized into 2 groups and analyzed: those who had more than one severe rib fracture in low ribs on the ipsilateral side of the diaphragm injury (Severe group), and those with no severe rib fracture (Non-severe group). Delayed diagnosis of diaphragmatic injury was more frequent in the Severe group than in the Non-severe group (81.8% vs 36.8%, p-value = 0.026). With regard to initial indications for operation, intrathoracic visceral herniation was more frequent in the Non-severe group (78.9% vs 18.2%, p-value = 0.002), while hemothorax was more frequent in the Severe group (63.6% vs 5.3%, p-value = 0.001). Central type diaphragmatic laceration was more frequent in the Non-severe group than in the Severe group (78.9% vs 18.2%, p-value = 0.002). The diameter of diaphragmatic injury was larger in the Non-severe group than in the Severe group (9.70 ± 4.10 cm vs 4.80 ± 3.60 cm, p-value = 0.004). The results of this study imply that a low threshold for thoracotomy or laparotomy should be considered in blunt trauma patients with severe low rib fractures for the purpose of hidden diaphragmatic injury detection and management. Copyright © 2017. Published by Elsevier Ltd.

Severe burn injuries caused by bioethanol-design fireplaces-an overview on recreational fire threats.

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Kraemer, Robert; Knobloch, Karsten; Lorenzen, Johan; Breuing, Karl H; Koennecker, Soeren; Rennekampff, Hans-Oliver; Vogt, Peter M

2011-01-01

Commercially available bioethanol-fueled fireplaces have become increasingly popular additions for interior home decoration in Europe and more recently in the United States. These fireplaces are advertised as smokeless, ecologically friendly, and do not require professional installation, formal gas lines, or venting. Although manufacturers and businesses promote their safety, recent presentations of injuries have alerted the authors to the relevant danger bioethanol fireplaces can pose for the incautious user. Are bioethanol fireplaces going to become the future threat in domestic burn accidents beside common barbeque burns? A Medline literature search on barbeque and domestic fireplace accidents was performed to compare and stratify the injury patterns reported and to identify a risk profile for contemporary bioethanol-fueled fireplaces. To exemplify, two representative clinical cases of severe burn accidents caused by bioethanol-fueled fireplaces, both treated in the burn unit of the authors, are being presented. Design fireplaces are being recognized as an increasing source of fuel and fire-related danger in the home. This risk may be underestimated by the uninformed customer, resulting in severe burn injuries. Because bioethanol-fueled fireplaces have become more commonplace, they may overtake barbecue-related injury as the most common domestic burn injury.

Symptomatic heterotopic ossification after very severe traumatic brain injury in 114 patients: incidence and risk factors

DEFF Research Database (Denmark)

Simonsen, Louise Lau; Sonne-Holm, Stig; Krasheninnikoff, Michael

2007-01-01

The incidence of heterotopic ossification (HO) among patients with traumatic brain injury (TBI) varies in the literature from 11 to 73.3%. The aim of this study was to determine the incidence of HO among patients with very severe TBI treated in a new established intensive rehabilitation Brain...... Injury Unit and to list some of the risk-predicting features. The study comprised an approximately complete, consecutive series of 114 adult patients from a well-defined geographical area, and with a posttraumatic amnesia period of at least 28 days, i.e. very severe TBI. Demographic and functional data...... as well as data about trauma severity and hospital stay of these patients have been registered prospectively in a database (Danish National Head Injury database) at the Brain Injury Unit where the sub acute rehabilitation took place. The present study was based retrospectively on this database, combined...

Impact of Posttraumatic Stress Disorder and Injury Severity on Recovery in Children with Traumatic Brain Injury

Science.gov (United States)

Kenardy, Justin; Le Brocque, Robyne; Hendrikz, Joan; Iselin, Greg; Anderson, Vicki; McKinlay, Lynne

2012-01-01

The adverse impact on recovery of posttraumatic stress disorder (PTSD) in mild traumatic brain injury (TBI) has been demonstrated in returned veterans. The study assessed this effect in children's health outcomes following TBI and extended previous work by including a full range of TBI severity, and improved assessment of PTSD within a…

Treatment for unstable pulmonary sequestration injury in patient with severe blunt trauma: A case report.

Science.gov (United States)

Hiraki, Sakiko; Okada, Yohei; Arai, Yusuke; Ishii, Wataru; Iiduka, Ryoji

2017-08-01

Pulmonary sequestration is a congenital malformation characterized by nonfunctioning tissue not communicating with the tracheobronchial tree. As the blood pressure in the artery feeding the sequestrated lung tissue is higher than that in the normal pulmonary artery, the risk of massive hemorrhage in pulmonary sequestration is high. We herein present the first case of a severe blunt trauma patient with unstable pulmonary sequestration injury. The mechanism of pulmonary sequestration injury is vastly different than that of injury to normal lung. We suggest that proximal feeding artery embolization should be performed before surgical intervention in patients with massive hemorrhage of pulmonary sequestration due to severe chest trauma.

The application of a mathematical model linking structural and functional connectomes in severe brain injury

Directory of Open Access Journals (Sweden)

A. Kuceyeski

2016-01-01

Full Text Available Following severe injuries that result in disorders of consciousness, recovery can occur over many months or years post-injury. While post-injury synaptogenesis, axonal sprouting and functional reorganization are known to occur, the network-level processes underlying recovery are poorly understood. Here, we test a network-level functional rerouting hypothesis in recovery of patients with disorders of consciousness following severe brain injury. This hypothesis states that the brain recovers from injury by restoring normal functional connections via alternate structural pathways that circumvent impaired white matter connections. The so-called network diffusion model, which relates an individual's structural and functional connectomes by assuming that functional activation diffuses along structural pathways, is used here to capture this functional rerouting. We jointly examined functional and structural connectomes extracted from MRIs of 12 healthy and 16 brain-injured subjects. Connectome properties were quantified via graph theoretic measures and network diffusion model parameters. While a few graph metrics showed groupwise differences, they did not correlate with patients' level of consciousness as measured by the Coma Recovery Scale — Revised. There was, however, a strong and significant partial Pearson's correlation (accounting for age and years post-injury between level of consciousness and network diffusion model propagation time (r = 0.76, p < 0.05, corrected, i.e. the time functional activation spends traversing the structural network. We concluded that functional rerouting via alternate (and less efficient pathways leads to increases in network diffusion model propagation time. Simulations of injury and recovery in healthy connectomes confirmed these results. This work establishes the feasibility for using the network diffusion model to capture network-level mechanisms in recovery of consciousness after severe brain injury.

Exploratory multinomial logit model-based driver injury severity analyses for teenage and adult drivers in intersection-related crashes.

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Wu, Qiong; Zhang, Guohui; Ci, Yusheng; Wu, Lina; Tarefder, Rafiqul A; Alcántara, Adélamar Dely

2016-05-18

Teenage drivers are more likely to be involved in severely incapacitating and fatal crashes compared to adult drivers. Moreover, because two thirds of urban vehicle miles traveled are on signal-controlled roadways, significant research efforts are needed to investigate intersection-related teenage driver injury severities and their contributing factors in terms of driver behavior, vehicle-infrastructure interactions, environmental characteristics, roadway geometric features, and traffic compositions. Therefore, this study aims to explore the characteristic differences between teenage and adult drivers in intersection-related crashes, identify the significant contributing attributes, and analyze their impacts on driver injury severities. Using crash data collected in New Mexico from 2010 to 2011, 2 multinomial logit regression models were developed to analyze injury severities for teenage and adult drivers, respectively. Elasticity analyses and transferability tests were conducted to better understand the quantitative impacts of these factors and the teenage driver injury severity model's generality. The results showed that although many of the same contributing factors were found to be significant in the both teenage and adult driver models, certain different attributes must be distinguished to specifically develop effective safety solutions for the 2 driver groups. The research findings are helpful to better understand teenage crash uniqueness and develop cost-effective solutions to reduce intersection-related teenage injury severities and facilitate driver injury mitigation research.

Relationship of mechanical impact magnitude to neurologic dysfunction severity in a rat traumatic brain injury model.

Directory of Open Access Journals (Sweden)

Tsung-Hsun Hsieh

Full Text Available Traumatic brain injury (TBI is a major brain injury type commonly caused by traffic accidents, falls, violence, or sports injuries. To obtain mechanistic insights about TBI, experimental animal models such as weight-drop-induced TBI in rats have been developed to mimic closed-head injury in humans. However, the relationship between the mechanical impact level and neurological severity following weight-drop-induced TBI remains uncertain. In this study, we comprehensively investigated the relationship between physical impact and graded severity at various weight-drop heights.The acceleration, impact force, and displacement during the impact were accurately measured using an accelerometer, a pressure sensor, and a high-speed camera, respectively. In addition, the longitudinal changes in neurological deficits and balance function were investigated at 1, 4, and 7 days post TBI lesion. The inflammatory expression markers tested by Western blot analysis, including glial fibrillary acidic protein, beta-amyloid precursor protein, and bone marrow tyrosine kinase gene in chromosome X, in the frontal cortex, hippocampus, and corpus callosum were investigated at 1 and 7 days post-lesion.Gradations in impact pressure produced progressive degrees of injury severity in the neurological score and balance function. Western blot analysis demonstrated that all inflammatory expression markers were increased at 1 and 7 days post-impact injury when compared to the sham control rats. The severity of neurologic dysfunction and induction in inflammatory markers strongly correlated with the graded mechanical impact levels.We conclude that the weight-drop-induced TBI model can produce graded brain injury and induction of neurobehavioral deficits and may have translational relevance to developing therapeutic strategies for TBI.

Family needs in the chronic phase after severe brain injury in Denmark

DEFF Research Database (Denmark)

Doser, Karoline; Norup, Anne

2014-01-01

Abstract Objective: This preliminary study aimed at investigating (1) changes in the status of family members between time of injury and follow-up in the chronic phase and (2) the most important needs within the family in the chronic phase and whether the needs were perceived as met. Participants......: The sample comprised 42 relatives (76% female, mean age = 53 years) of patients with severe brain injury, who had received intensive sub-acute rehabilitation. The relatives were contacted in the chronic phase after brain injury. Outcome measure: A set of questions about demographics and time spent caregiving...... for the patient was completed. The relatives completed the revised version of the Family Needs Questionnaire, a questionnaire consisting of 37 items related to different needs following brain injury. Results: Significant changes in status were found in employment (z = -3.464, p = 0.001) and co-habitation (z = -3...

Analysis of the injury severity of crashes by considering different lighting conditions on two-lane rural roads.

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Jafari Anarkooli, A; Hadji Hosseinlou, M

2016-02-01

Many studies have examined different factors contributing to the injury severity of crashes; however, relatively few studies have focused on the crashes by considering the specific effects of lighting conditions. This research investigates lighting condition differences in the injury severity of crashes using 3-year (2009-2011) crash data of two-lane rural roads of the state of Washington. Separate ordered-probit models were developed to predict the effects of a set of factors expected to influence injury severity in three lighting conditions; daylight, dark, and dark with street lights. A series of likelihood ratio tests were conducted to determine if these lighting condition models were justified. The modeling results suggest that injury severity in specific lighting conditions are associated with contributing factors in different ways, and that such differences cannot be uncovered by focusing merely on one aggregate model. Key differences include crash location, speed limit, shoulder width, driver action, and three collision types (head-on, rear-end, and right-side impact collisions). This paper highlights the importance of deploying street lights at and near intersections (or access points) on two-lane rural roads because injury severity highly increases when crashes occur at these points in dark conditions. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.

[Experimental model of severe local radiation injuries of the skin after X-rays].

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Kotenko, K V; Moroz, B B; Nasonova, T A; Dobrynina, O A; LIpengolz, A A; Gimadova, T I; Deshevoy, Yu B; Lebedev, V G; Lyrschikova, A V; Eremin, I I

2013-01-01

The experimental model of severe local radiation injuries skin under the influence of a relatively soft X-rays on a modified device RAP 100-10 produced by "Diagnostica-M" (Russia) was proposed. The model can be used as pre-clinical studies in small experimental animals in order to improve the treatment of local radiation injuries, especially in the conditions of application of cellular therapy.

Influence of prayer and prayer habits on outcome in patients with severe head injury.

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Vannemreddy, Prasad; Bryan, Kris; Nanda, Anil

2009-01-01

The objective of the study is to evaluate the effect of prayers on the recovery of the unconscious patients admitted after traumatic brain injury. A retrospective study of patients with severe head injury was conducted. The Glasgow Coma Scale and Glasgow Outcome Scale scores were examined along with age, gender, smoking, and alcohol intake. There were 13 patients who received prayer and 13 who did not receive prayer during the hospital stay with almost identical mean Glasgow Coma Scale score. The prayer group stayed in the hospital for more days (P = .03). On multivariate analysis, patients' age (P = .01), admission Glasgow Coma Scale score (P = .009), and prayer habits (P = .007) were significant factors. Patients with prayers habits recovered better following severe head injury. The role of intercessory prayer needs further studies in larger groups.

[Clinical analysis of acute encephalocele during operation in 21 patients with severe craniocerebral injury].

Science.gov (United States)

Zhuang, Qiang; Qu, Chun-cheng; Liang, Wen-zhi; Qin, Hao; Yu, Rui

2011-03-08

To analyze the clinical features of acute intra-operative encephalocele and the proper prophylactic-therapeutic measures for severe craniocerebral injury. The clinical data were collected and analyzed for 21 patients with severe head injuries who suffered acute intra-operative encephalocele from June 2008 to May 2010. There were 12 males and 9 females with an age range of 18 - 69 years old. Among these patients, 6 died with a mortality rate of 28.5%. It was lower than that reported in literatures. One patient died post-operatively of severe brain swelling and intracranial infection secondary to leakage of cerebrospinal fluid. Four patients died of severe craniocerebral injury, brain swelling and brain stem failure. And 1 patient died after his guardian abandoned the treatment. The follow-up period for the remaining 15 surviving patients was 3 - 6 months. According to the Glasgow outcome score (GOS), there were a favorable prognosis (n = 9), moderate disabilities (n = 5) and severe disability (n = 1). The probability of acute intra-operative encephalocele may be predicted in advance with a combination of clinical features and computed tomographic scans. The therapeutic success rate of acute encephalocele will be boosted by taking protective and therapeutic measures pre- and intra-operatively.

Tracheostomy risk factors and outcomes after severe traumatic brain injury.

Science.gov (United States)

Humble, Stephen S; Wilson, Laura D; McKenna, John W; Leath, Taylor C; Song, Yanna; Davidson, Mario A; Ehrenfeld, Jesse M; Guillamondegui, Oscar D; Pandharipande, Pratik P; Patel, Mayur B

2016-01-01

To determine risk factors associated with tracheostomy placement after severe traumatic brain injury (TBI) and subsequent outcomes among those who did and did not receive a tracheostomy. This retrospective cohort study compared adult trauma patients with severe TBI (n = 583) who did and did not receive tracheostomy. A multivariable logistic regression model assessed the associations between age, sex, race, insurance status, admission GCS, AIS (Head, Face, Chest) and tracheostomy placement. Ordinal logistic regression models assessed tracheostomy's influence on ventilator days and ICU LOS. To limit immortal time bias, Cox proportional hazards models assessed mortality at 1, 3 and 12-months. In this multivariable model, younger age and private insurance were associated with increased probability of tracheostomy. AIS, ISS, GCS, race and sex were not risk factors for tracheostomy placement. Age showed a non-linear relationship with tracheostomy placement; likelihood peaked in the fourth decade and declined with age. Compared to uninsured patients, privately insured patients had an increased probability of receiving a tracheostomy (OR = 1.89 [95% CI = 1.09-3.23]). Mortality was higher in those without tracheostomy placement (HR = 4.92 [95% CI = 3.49-6.93]). Abbreviated injury scale-Head was an independent factor for time to death (HR = 2.53 [95% CI = 2.00-3.19]), but age, gender and insurance were not. Age and insurance status are independently associated with tracheostomy placement, but not with mortality after severe TBI. Tracheostomy placement is associated with increased survival after severe TBI.

Procedural discourse performance in adults with severe traumatic brain injury at 3 and 6 months post injury.

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Stubbs, Elin; Togher, Leanne; Kenny, Belinda; Fromm, Davida; Forbes, Margaret; MacWhinney, Brian; McDonald, Skye; Tate, Robyn; Turkstra, Lyn; Power, Emma

2018-01-01

There is limited research on communicative recovery during the early stages after a severe traumatic brain injury (TBI) in adults. In the current study 43 people with severe TBI described a simple procedure at 3 and 6 months post injury and this was compared to the description provided by 37 healthy speakers. Linguistic productivity and the presence of macrostructural discourse elements were analysed. No change occurred in productivity in the TBI group between the two time points. There was increased use of relevant information (macrostructure) over time for the TBI group, reflecting improvement. People with TBI differed from controls in speech rate and in two out of three macrostructural categories at both time points, indicating difficulties even after 12 weeks of recovery. Overall, the quality, rather than the quantity of discourse was disordered for participants with TBI. Findings indicate that procedural discourse is sensitive to discourse deficits of people with TBI and can be used to map recovery during the sub-acute phase.

Injury severity in delivery-motorcycle to vehicle crashes in the Seoul metropolitan area.

Science.gov (United States)

Chung, Younshik; Song, Tai-Jin; Yoon, Byoung-Jo

2014-01-01

More than 56% of motorcycles in Korea are used for the purpose of delivering parcels and food. Since such delivery requires quick service, most motorcyclists commit traffic violations while delivering, such as crossing the centerline, speeding, running a red light, and driving in the opposite direction down one-way streets. In addition, the fatality rate for motorcycle crashes is about 12% of the fatality rate for road traffic crashes, which is considered to be high, although motorcycle crashes account for only 5% of road traffic crashes in South Korea. Therefore, the objective of this study is to analyze the injury severity of vehicle-to-motorcycle crashes that have occurred during delivery. To examine the risk of different injury levels sustained under all crash types of vehicle-to-motorcycle, this study applied an ordered probit model. Based on the results, this study proposes policy implications to reduce the injury severity of vehicle-to-motorcycle crashes during delivery. Copyright © 2013 Elsevier Ltd. All rights reserved.

Correlation Between Euro NCAP Pedestrian Test Results and Injury Severity in Injury Crashes with Pedestrians and Bicyclists in Sweden.

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Strandroth, Johan; Sternlund, Simon; Lie, Anders; Tingvall, Claes; Rizzi, Matteo; Kullgren, Anders; Ohlin, Maria; Fredriksson, Rikard

2014-11-01

Pedestrians and bicyclists account for a significant share of deaths and serious injuries in the road transport system. The protection of pedestrians in car-to-pedestrian crashes has therefore been addressed by friendlier car fronts and since 1997, the European New Car Assessment Program (Euro NCAP) has assessed the level of protection for most car models available in Europe. In the current study, Euro NCAP pedestrian scoring was compared with real-life injury outcomes in car-to-pedestrian and car-tobicyclist crashes occurring in Sweden. Approximately 1200 injured pedestrians and 2000 injured bicyclists were included in the study. Groups of cars with low, medium and high pedestrian scores were compared with respect to pedestrian injury severity on the Maximum Abbreviated Injury Scale (MAIS)-level and risk of permanent medical impairment (RPMI). Significant injury reductions to both pedestrians and bicyclists were found between low and high performing cars. For pedestrians, the reduction of MAIS2+, MAIS3+, RPMI1+ and RPMI10+ ranged from 20-56% and was significant on all levels except for MAIS3+ injuries. Pedestrian head injuries had the highest reduction, 80-90% depending on level of medical impairment. For bicyclist, an injury reduction was only observed between medium and high performing cars. Significant injury reductions were found for all body regions. It was also found that cars fitted with autonomous emergency braking including pedestrian detection might have a 60-70% lower crash involvement than expected. Based on these results, it was recommended that pedestrian protection are implemented on a global scale to provide protection for vulnerable road users worldwide.

Prevalence and Predictors of Personality Change After Severe Brain Injury

DEFF Research Database (Denmark)

Norup, Anne; Mortensen, Erik Lykke

2015-01-01

of the Medical Outcomes Study 36-Item Short-Form Health Survey. Results Of the sample, 59.1% experienced personality change after acquired brain injury, and the most dominant changes were observed in the personality traits of neuroticism, extraversion, and conscientiousness. Changes in neuroticism were most......Objectives To investigate the prevalence of personality change after severe brain injury; to identify predictors of personality change; and to investigate whether personality change is associated with distress in family members. Design A longitudinal study of personality change. Setting...... often observed in patients with frontal or temporal lesions. Generally, personality changes in patients were not associated with more distress and lower HRQOL in family members; however, change in patient agreeableness was associated with lower HRQOL on the role limitations-emotional scale. Conclusions...

New onset obsessive-compulsive symptoms in children and adolescents with severe traumatic brain injury.

Science.gov (United States)

Grados, Marco A; Vasa, Roma A; Riddle, Mark A; Slomine, Beth S; Salorio, Cynthia; Christensen, James; Gerring, Joan

2008-01-01

Traumatic brain injury (TBI) constitutes a major source of psychiatric morbidity and disability. This study examines new onset of obsessions and compulsions (OCS) within 1 year of severe pediatric TBI. Eighty children and adolescents ages 6-18 years with severe TBI were interviewed by a child psychiatrist using the Diagnostic Interview for Children and Adolescents-Revised to diagnose OCS and comorbidities. A brain magnetic resonance imaging used a 1.5 T scanner 3 months after injury with a T1-weighted spoiled gradient-recalled-echo sequence to provide high spatial resolution and T1- and T2(*)-contrast sensitivity. Race, sex, socioeconomic status, psychosocial adversity, and injury severity were used to predict new onset OCS. Psychiatric comorbidities and brain lesion volumes in orbitofrontal, mesial prefrontal, temporal lobe, basal ganglia, and thalamus were examined in relation to new onset OCS. Twenty-one children (21/72, 29.2%) had OCS after TBI. Most common were worries about disease, cleanliness, and inappropriate actions as well as excessive cleaning, doing things a certain way and ordering. Anxiety disorders, mania, dysthymia, depressive symptoms, and posttraumatic stress disorder were significantly associated with new onset OCS. Injury severity was not associated with new onset OCS. Greater psychosocial adversity (P=0.009), and being female (P=0.005) were associated with OCS while mesial prefrontal and temporal lobe lesions were associated with new onset obsessions (P<0.05). OCS are common after severe pediatric TBI and are associated with greater comorbidities. New onset obsessions are associated with female sex, psychosocial adversity, and mesial prefrontal and temporal lesions. Published 2007 Wiley-Liss, Inc.

A comparative injury severity analysis of motorcycle at-fault crashes on rural and urban roadways in Alabama.

Science.gov (United States)

Islam, Samantha; Brown, Joshua

2017-11-01

The research described in this paper explored the factors contributing to the injury severity resulting from the motorcycle at-fault accidents in rural and urban areas in Alabama. Given the occurrence of a motorcycle at-fault crash, random parameter logit models of injury severity (with possible outcomes of fatal, major, minor, and possible or no injury) were estimated. The estimated models identified a variety of statistically significant factors influencing the injury severities resulting from motorcycle at-fault crashes. According to these models, some variables were found to be significant only in one model (rural or urban) but not in the other one. For example, variables such as clear weather, young motorcyclists, and roadway without light were found significant only in the rural model. On the other hand, variables such as older female motorcyclists, horizontal curve and at intersection were found significant only in the urban model. In addition, some variables (such as, motorcyclists under influence of alcohol, non-usage of helmet, high speed roadways, etc.) were found significant in both models. Also, estimation findings showed that two parameters (clear weather and roadway without light) in the rural model and one parameter (on weekend) in the urban model could be modeled as random parameters indicating their varying influences on the injury severity due to unobserved effects. Based on the results obtained, this paper discusses the effects of different variables on injury severities resulting from rural and urban motorcycle at-fault crashes and their possible explanations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Able or unable to work? Life trajectory after severe occupational injury.

Science.gov (United States)

Kulmala, Jarna; Luoma, Arto; Koskinen, Lasse

2018-04-24

To study the probabilities and permanence of return to work, inability to work and rehabilitation, and to explore the connection between these life situations and later working after a severe occupational injury. A historical cohort of Finnish workers with a severe occupational injury during 2008 (N = 11,585) were followed up annually on the outcomes of return to work over a 5-year observation period. We examined transition probabilities from one life situation to another with Markov chain analysis, and applied logistic regression with generalized estimating equations to assess the effect of register-based determinants on return to work. Within the five anniversaries, 85% of the injured were working, 9% were unable to work (fully or partly) and 2% received rehabilitation. Age, gross annual income, type of work, injured body part, injury type and the injured's annual condition subsequent to the work injury were significant determinants of return to work. The probability of return to work decreased with time, but, on average, one-fifth of the injured workers succeeded in return to work after being unable to work on the previous anniversary, which indicates that it is worthwhile to conduct efforts for this target group in order to promote return to work. Implications for Rehabilitation The current life situation of the injured should be taken into account when promoting return to work, as it is a strong predictor of later working after a serious occupational injury. Rehabilitation and return to work programs should start in time due to declining return to work rates as the disability continues. Return to work on a part-time basis could be a good option during the early phases of recovery, since a notable proportion of those partly unable to work on the first anniversary returned later to full-time workers. The probability of recovery is relatively high even for those with long-term disabilities, so the promotion of return to work is highly recommended also for

Tube pancreatico-duodenostomy for management of a severe penetrating pancreaticoduodenal injury.

Science.gov (United States)

Hatzigeorgiadis, Anestis; Boulas, Konstantinos A; Barettas, Nikolaos; Papageorgiou, Irene; Blouhos, Konstantinos

2014-05-27

Optimal management of penetrating pancreaticoduodenal injuries and better outcomes are associated with simple, fast damage control surgery and shorter operative time. The performance of pyloric exclusion and tube duodenostomy has markedly decreased. However, there is still a trend toward their performance in cases of delay duodenal repair or severe pancreaticoduodenal injury. The present report describes a case of a hemodynamically stable patient with a single penetrating gunshot trauma causing an AAST-OIS grade III pancreatic head injury and grade IV injury of the second portion of the duodenum. The patient was treated in our Level IV rural trauma center and submitted to primary closure of the posterolateral duodenal wall (the laceration of the contralateral inner medial duodenal wall could not be repaired), external duodenal and pancreatic drainage, and duodenal decompression by tube pancreatico-duodenostomy (insertion of a 18 Fr Foley catheter through the laceration of the pancreatic head toward the duodenal lumen), tube cholangiostomy, and pyloric exclusion accompanied with a feeding jejunostomy. Tube pancreatico-duodenostomy, which is described for the first time in the literature, turned out to be effective and can be considered as an option in pancreaticoduodenal trauma when the inner medial duodenal wall cannot be repaired.

Optimized hyperventilation preserves 2,3-diphosphoglycerate in severe traumatic brain injury

OpenAIRE

Torres,Rayne Borges; Terzi,Renato Giuseppe Giovanni; Falcão,Antônio Luís Eiras; Höehr,Nelci Fenalti; Dantas Filho,Venâncio Pereira

2007-01-01

INTRODUCTION: The concentration of 2,3-diphosphoglycerate (2,3-DPG/Hct) increases as a physiological occurrence to pH increase and hyperventilation. This response was tested in patients with severe traumatic brain injury (TBI). METHOD: The concentration of 2,3-DPG/Hct was measured daily for six days in eleven patients with severe TBI in need of optimized hyperventilation because of intracranial hypertension. RESULTS:There was correlation between pH and the concentration of DPG/Hct. The concen...

Association of Lectin Pathway Protein Levels and Genetic Variants Early after Injury with Outcomes after Severe Traumatic Brain Injury: A Prospective Cohort Study.

Science.gov (United States)

Osthoff, Michael; Walder, Bernhard; Delhumeau, Cécile; Trendelenburg, Marten; Turck, Natacha

2017-09-01

The lectin pathway of the complement system has been implicated in secondary ischemic/inflammatory injury after traumatic brain injury (TBI). However, previous experimental studies have yielded conflicting results, and human studies are scarce. In this exploratory study, we investigated associations of several lectin pathway proteins early after injury and single-nucleotide polymorphisms (SNP) with outcomes after severe TBI (mortality at 14 days [primary outcome] and consciousness assessed with the Glasgow Coma Scale [GCS] at 14 days, disability assessed with the Glasgow Outcome Scale Extended [GOSE] at 90 days). Forty-four patients with severe TBI were included. Plasma levels of lectin pathway proteins were sampled at 6, 12, 24, and 48 h after injury and eight mannose-binding lectin (MBL) and ficolin (FCN)2 SNPs were analyzed by enzyme-linked immunosorbent assay (ELISA) and genotyping, respectively. Plasma protein levels were stable with only a slight increase in mannose-binding protein-associated serine protease (MASP)-2 and FCN2 levels after 48 h (p GOSE 1-4) at 90 days (p GOSE score < 4 at 90 days after adjustment (odds ratio 3.46 [95% confidence interval 1.12-10.68] per 100 ng/mL increase, p = 0.03). No association was observed between the lectin pathway of the complement system and 14 day mortality or 14 day consciousness. However, higher plasma FCN2, FCN3, and, in particular, MASP-2 levels early after injury were associated with an unfavorable outcome at 90 days (death, vegetative state, and severe disability) which may be related to an increased activation of the lectin pathway.

Treatment for unstable pulmonary sequestration injury in patient with severe blunt trauma: A case report

Directory of Open Access Journals (Sweden)

Sakiko Hiraki

2017-08-01

Full Text Available Case: Pulmonary sequestration is a congenital malformation characterized by nonfunctioning tissue not communicating with the tracheobronchial tree. As the blood pressure in the artery feeding the sequestrated lung tissue is higher than that in the normal pulmonary artery, the risk of massive hemorrhage in pulmonary sequestration is high. We herein present the first case of a severe blunt trauma patient with unstable pulmonary sequestration injury. Outcome and conclusion: The mechanism of pulmonary sequestration injury is vastly different than that of injury to normal lung. We suggest that proximal feeding artery embolization should be performed before surgical intervention in patients with massive hemorrhage of pulmonary sequestration due to severe chest trauma. Keywords: Blunt trauma, Coil embolization, Massive hemorrhage, Pulmonary sequestration

Cognitive activity limitations one year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury

DEFF Research Database (Denmark)

Sommer, Jens Bak; Norup, Anne; Poulsen, Ingrid

2013-01-01

Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub-acute re......Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub......-acute rehabilitation in the Eastern part of Denmark during a 5-year period from 2005 to 2009. Methods: Level of consciousness was assessed consecutively during rehabilitation and at 1 year post-trauma. Severity of traumatic brain injury was classified according to duration of post-traumatic amnesia. The cognitive...... subscale of Functional Independence MeasureTM (Cog-FIM) was used to assess cognitive activity limitations. Multivariate logistic regression analyses were performed to identify predictors of an independent level of functioning. Results: The majority of patients progressed to a post-confusional level...

Loss of the inducible Hsp70 delays the inflammatory response to skeletal muscle injury and severely impairs muscle regeneration.

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Sarah M Senf

Full Text Available Skeletal muscle regeneration following injury is a highly coordinated process that involves transient muscle inflammation, removal of necrotic cellular debris and subsequent replacement of damaged myofibers through secondary myogenesis. However, the molecular mechanisms which coordinate these events are only beginning to be defined. In the current study we demonstrate that Heat shock protein 70 (Hsp70 is increased following muscle injury, and is necessary for the normal sequence of events following severe injury induced by cardiotoxin, and physiological injury induced by modified muscle use. Indeed, Hsp70 ablated mice showed a significantly delayed inflammatory response to muscle injury induced by cardiotoxin, with nearly undetected levels of both neutrophil and macrophage markers 24 hours post-injury. At later time points, Hsp70 ablated mice showed sustained muscle inflammation and necrosis, calcium deposition and impaired fiber regeneration that persisted several weeks post-injury. Through rescue experiments reintroducing Hsp70 intracellular expression plasmids into muscles of Hsp70 ablated mice either prior to injury or post-injury, we confirm that Hsp70 optimally promotes muscle regeneration when expressed during both the inflammatory phase that predominates in the first four days following severe injury and the regenerative phase that predominates thereafter. Additional rescue experiments reintroducing Hsp70 protein into the extracellular microenvironment of injured muscles at the onset of injury provides further evidence that Hsp70 released from damaged muscle may drive the early inflammatory response to injury. Importantly, following induction of physiological injury through muscle reloading following a period of muscle disuse, reduced inflammation in 3-day reloaded muscles of Hsp70 ablated mice was associated with preservation of myofibers, and increased muscle force production at later time points compared to WT. Collectively our

Vehicular crash data used to rank intersections by injury crash frequency and severity

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Yi Liu

2016-09-01

Full Text Available This article contains data on research conducted in “A double standard model for allocating limited emergency medical service vehicle resources ensuring service reliability” (Liu et al., 2016 [1]. The crash counts were sorted out from comprehensive crash records of over one thousand major signalized intersections in the city of Chicago from 2004 to 2010. For each intersection, vehicular crashes were counted by crash severity levels, including fatal, injury Types A, B, and C for major, moderate, and minor injury levels, property damage only (PDO, and unknown. The crash data was further used to rank intersections by equivalent injury crash frequency. The top 200 intersections with the highest number of crash occurrences identified based on crash frequency- and severity-based scenarios are shared in this brief. The provided data would be a valuable source for research in urban traffic safety analysis and could also be utilized to examine the effectiveness of traffic safety improvement planning and programming, intersection design enhancement, incident and emergency management, and law enforcement strategies.

Ischemic Retinopathy and Neovascular Proliferation Secondary to Severe Head Injury

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Muge Coban-Karatas

2014-01-01

Full Text Available We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma.

Objective Assessment of the Severity of Patients Suffering from Fall from Height with Combined Injuries of the Abdominal Parenchymal Organs

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Abdukhakim Khadjibaev

2015-06-01

Full Text Available In recent years, fall from a height (FFH has been a relatively frequent cause of injury and death in the urban environment. The purpose of this study was to optimize the risk stratification of FFH victims with combined injuries of the abdominal organs by using Injury Severity Score (ISS scale. The study included 111 patients (aged between 15 and 80 years injured by FFH. All the falls were accidental and occurred mainly among males (82%. The height of the fall ranged from 2 to 5 meters. Combined injuries were found in 98 patients and isolated injuries in 13 patients. The combination of the 6 injured body regions was identified in 5 patients, 5 regions in 17, 4 in 35, 3 in 23, and 2 in 18. The abdomen trauma was most commonly associated with the following injured body regions: head and neck-chest-extremities and pelvis (13.3%, head and neck-chest-extremities (12.2%, and head and neck-chest-pelvis (9.2%. Among the combined injuries of the abdomen, ruptures of parenchymal organs (liver, spleen and kidneys were predominant. To assess the severity of the injury, the ISS scale was applied. The injuries of abdominal parenchymal organs were evaluated according to the AAST (American Association for the Surgery of Trauma classification. Comparative analysis of the assessment of the severity of a patient's condition according to the traditional scale and the ISS scale showed that the ISS scale promotes the active and timely detection of the extremely severe and terminal condition in patients with injuries due to FFH with combined trauma of the abdominal organs. Objective assessment of the severity of trauma and the dominant injury region allows determining the optimal treatment algorithm and predicting the outcome of the injury.

Statistical analysis plan for the Erythropoietin in Traumatic Brain Injury trial: a randomised controlled trial of erythropoietin versus placebo in moderate and severe traumatic brain injury.

LENUS (Irish Health Repository)

Presneill, Jeffrey

2014-01-01

The Erythropoietin in Traumatic Brain Injury (EPO-TBI) trial aims to determine whether the administration of erythropoietin to patients with moderate or severe traumatic brain injury improves patient-centred outcomes.

Determining the Prevalence and Assessing the Severity of Injuries in Mixed Martial Arts Athletes

Science.gov (United States)

2009-01-01

Background Mixed martial arts (MMA) is currently the fastest growing sport in the United States and has recently surpassed boxing as the most popular full contact sport. Due to the physical nature of the sport, MMA is associated with various types of injuries. Objective The purpose of this study was aimed at identifying prevalence and assessing the severity, location, and type of injuries in MMA athletes sustained during MMA related activities in the twelve month period prior to the survey. Methods A total of fifty-five subjects between the ages of 18 to 39 participated in the study. Participants were given a two-part questionnaire to collect demographic and injury data. Results Two hundred seven injuries were reported in the study. Low belt ranks had significantly more injuries more than any other belt rank, resulting in more than two times higher injury rate. Professional fighters had significantly more injuries than amateur fighters, resulting in three times higher injury rate. The most common body region injured was the head/neck/face (38.2%), followed by the lower extremities (30.4%), upper extremities (22.7%), torso (8.2%), and groin (0.5%). Injuries to the nose (6.3%), shoulder (6.3%), and toe (6.3%) were the most common. The most common type of injury was contusions (29.4%), followed by strains (16.2%), sprains (14.9%), and abrasions (10.1%). Conclusion Injury prevention efforts should consider the prevalence and distribution of injuries and focus on reducing or preventing injuries to the head/neck/face in MMA related activities. Preventative measures should focus on improving protective equipment during training, and possible competition rule modifications to further minimize participant injury. PMID:21509103

Diffusion-weighted MR and apparent diffusion coefficient in the evaluation of severe brain injury

International Nuclear Information System (INIS)

Nakahara, M.; Ericson, K.; Bellander, B.M.

2001-01-01

Purpose: To study apparent diffusion coefficient (ADC) maps in severely brain-injured patients. Material and Methods: Four deeply comatose patients with severe brain injury were investigated with single-shot, diffusion-weighted, spin-echo echo planar imaging. The tetrahedral diffusion gradient configuration and four iterations of a set of b-values (one time of 0 mm2/s, and four times of 1000 mm2/s) were used to create isotropic ADC maps with high signal-to-noise ratio. ADC values of gray and white matter were compared among patients and 4 reference subjects. Results: one patient was diagnosed as clinically brain dead after the MR examination. The patient's ADC values of gray and white matter were significantly lower than those of 3 other brain-injured patients. In addition the ADC value of white matter was significantly lower than that of gray matter. Conclusion: The patient with fatal outcome shortly after MR examination differed significantly from other patients with severe brain injury but non-fatal outcome, with regard to ADC values in gray and white matter. This might indicate a prognostic value of ADC maps in the evaluation of traumatic brain injury

The Impact of Selected Individual and External Factors on the Occurrence of Severe Injuries: Case Study of Slovenia

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Polona Tominc

2015-08-01

Full Text Available The purpose of this paper is to contribute to the understanding of the importance of different determinants and their impact on the severity of injuries of individuals in road traffic accidents, so that measures that are supposed to prevent or reduce severe injury consequences can be developed. In this paper three research models have been built. Model I was built to study the impact of demographic factors (gender and age on the individual’s likelihood to wear a seat-belt while Model II to study the impact of demographic factors (gender and age and the impact of wearing a seat belt on the likelihood that fatal injuries of individuals in road traffic accidents occur. Model III was formed to study the impact of several environmental factors on the likelihood that the accident involves severe or fatal injuries of road traffic accident participants. Altogether our study revealed that middle-aged individuals (over 25 years and up to 65 years old are less likely to wear a seat belt and at the same time more likely to suffer fatal injuries in road traffic accidents. This is the result that implies that the targeted policy measures to the population between 25 and 65 years of age are needed to reduce the fatal injuries occurrence in Slovenia.

Chest Injuries Associated with Head Injury

African Journals Online (AJOL)

Traumatic brain injury (TBI) is a common cause of mortality and severe morbidity. Although there have been significant advances in management, associated severe injuries, in particular chest injuries, remain a major challenge. Extracranial injuries, especially chest injuries increase mortality in patients with TBI in both short.

Analyzing injury severity factors at highway railway grade crossing accidents involving vulnerable road users: A comparative study.

Science.gov (United States)

Ghomi, Haniyeh; Bagheri, Morteza; Fu, Liping; Miranda-Moreno, Luis F

2016-11-16

The main objective of this study is to identify the main factors associated with injury severity of vulnerable road users (VRUs) involved in accidents at highway railroad grade crossings (HRGCs) using data mining techniques. This article applies an ordered probit model, association rules, and classification and regression tree (CART) algorithms to the U.S. Federal Railroad Administration's (FRA) HRGC accident database for the period 2007-2013 to identify VRU injury severity factors at HRGCs. The results show that train speed is a key factor influencing injury severity. Further analysis illustrated that the presence of illumination does not reduce the severity of accidents for high-speed trains. In addition, there is a greater propensity toward fatal accidents for elderly road users compared to younger individuals. Interestingly, at night, injury accidents involving female road users are more severe compared to those involving males. The ordered probit model was the primary technique, and CART and association rules act as the supporter and identifier of interactions between variables. All 3 algorithms' results consistently show that the most influential accident factors are train speed, VRU age, and gender. The findings of this research could be applied for identifying high-risk hotspots and developing cost-effective countermeasures targeting VRUs at HRGCs.

Type, severity, management and outcome of ocular and adnexal firework-related injuries: the Rotterdam experience.

Science.gov (United States)

Frimmel, Sonja; de Faber, J Tjeerd; Wubbels, Rene J; Kniestedt, Christoph; Paridaens, Dion

2018-03-13

To study the type, severity, management and outcome of firework-related adnexal and ocular injuries during New Year's Eve festivities. A retrospective analysis of 123 injured patients (143 eyes) treated at the Rotterdam Eye Hospital between 2009 and 2013. All ages were included and analysed according to age, gender, active participant or bystander, laterality, location, dimension and severity of injury. Outcome parameter was the final best-corrected visual acuity. The mean age was 22 ± 13 years with 87% males and 53% bystanders. 52% were ≤18 years. There was a higher number of female than male bystanders (63% versus 51%, p = 0.30). 50% of the eyes sustained mild, 13% moderate and 37% severe trauma. Adults suffered more from severe injuries compared to children (42% versus 31%). The most frequent intervention was gunpowder removal (20%), followed by traumatic cataract surgery (12%) and amniotic membrane grafting (8%). 76% of patients were followed over 1 year. At the end of follow-up, 88 (61.5%) eyes had recovered fully, while 55 (38.5%) eyes suffered from persistent complications with reduced vision ≤0.8 in 30% of injured eyes. 15 patients (12%, 10 adults, five children) were considered legally blind (vision ≤0.1). Three (2%) eyes were subject to evisceration. Every year, around New Year's Eve 30-45 victims were referred to the Rotterdam Eye Hospital; 50% sustained moderate-to-severe trauma. In severe firework injuries, patients required multiple treatments that may not prevent permanent blindness and/or functional/cosmetic disfigurement. The majority was bystander and younger than 18 years. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

The autopsy-correlation of computed tomography in acute severe head injuries

International Nuclear Information System (INIS)

Tomita, Shin; Kim, Hong; Mikabe, Toshio; Karasawa, Hideharu; Watanabe, Saburo

1981-01-01

We discuss the importance of Contrast-Enhanced CT (C.E.CT) in establishing the variety of the intracranial pathological process in acute severe head injuries. During a two-and-a-half-year period (June, 1977 - December, 1979) thirty-three patients with acute severe head injuries were autopsied, all of whom had been scanned on admission. Among them, 14 patients had undergone both plain CT and C.E.CT on admission. Brain slices were examined macroscopically in three categories; brain contusion, subarachnoid hemorrhage, and intracerebral hemorrhage. Each category was then compared retrospectively with the plain CT and C.E.CT findings. C.E.CT was found to correspond much better to the autopsy finding than plain CT in the following three points: (1) C.E.CT clearly enhances the contusion areas and reveals occult contusion areas. (2) C.E.CT enhances the areas corresponding to the subarachnoid space due to the breakdown of brain-surface blood vessels. (3) C.E.CT reveals the enlargement and formation of the intracerebral hematoma by the extravasation of the intravenous contrast material from injured arterial vessels. (author)

Functional level during the first 2 years after moderate and severe traumatic brain injury.

Science.gov (United States)

Sandhaug, Maria; Andelic, Nada; Langhammer, Birgitta; Mygland, Aase

2015-01-01

Long-term outcomes after TBI are examined to a large extent, but longitudinal studies with more than 1-year follow-up time after injury have been fewer in number. The course of recovery may vary due to a number of factors and it is still somewhat unclear which factors are contributing. The aim of this study was to describe the functional level at four time points up to 24 months after traumatic brain injury (TBI) and to evaluate the predictive impact of pre-injury and injury-related factors. A cohort study. Outpatient. Sixty-five patients with moderate (n = 21) or severe (n = 44) TBI. The patients with TBI were examined with Functional Independence Measure (FIM) and Glasgow Outcome Scale Extended (GOSE) at 3 months, 12 months and 24 months after injury. Possible predictors were analysed in a regression model using FIM total score at 24 months as the outcome measure. FIM scores improved significantly from rehabilitation unit discharge to 24 months after injury, with peak levels at 3 and 24 months after injury (p GOSE scores for the whole group and the moderate group improved significantly over time, but the severe group did not. FIM at admission to the rehabilitation unit and GCS score at admission to the rehabilitation unit were closest to being significant predictors of FIM total scores 24 months after injury (B = 0.265 and 2.883, R(2 )= 0.39, p = 0.073, p = 0.081). FIM levels improved during the period from rehabilitation unit discharge to 3 months follow-up; thereafter, there was a 'plateauing' of recovery. In contrast, GOSE 'plateauing' of recovery was at 12 months. The study results may indicate that two of the most used outcome measures in TBI research are more relevant for assessment of the functional recovery in a sub-acute phase than in later stages of TBI recovery.

Emotional distress and quality of life in relatives of patients with severe brain injury: the first month after injury

DEFF Research Database (Denmark)

Norup, Anne; Siert, Lars; Lykke Mortensen, Erik

2010-01-01

PRIMARY OBJECTIVE: To investigate emotional distress and quality of life in a sample of Danish relatives of patients with severe brain injury at admission to intensive rehabilitation in the sub-acute phase. RESEARCH DESIGN: Clinical convenience sample. METHODS AND PROCEDURES: Participants included...

Social Cognition Impairments in Relation to General Cognitive Deficits, Injury Severity, and Prefrontal Lesions in Traumatic Brain Injury Patients

NARCIS (Netherlands)

Spikman, Jacoba M.; Timmerman, Marieke E.; Milders, Maarten V.; Veenstra, Wencke S.; van der Naalt, Joukje

2012-01-01

Impairments in social behavior are frequently found in moderate to severe traumatic brain injury (TBI) patients and are associated with an unfavorable outcome with regard to return to work and social reintegration. Neuropsychological tests measuring aspects of social cognition are thought to be

Establishment of quantitative severity evaluation model for spinal cord injury by metabolomic fingerprinting.

Directory of Open Access Journals (Sweden)

Jin Peng

Full Text Available Spinal cord injury (SCI is a devastating event with a limited hope for recovery and represents an enormous public health issue. It is crucial to understand the disturbances in the metabolic network after SCI to identify injury mechanisms and opportunities for treatment intervention. Through plasma 1H-nuclear magnetic resonance (NMR screening, we identified 15 metabolites that made up an "Eigen-metabolome" capable of distinguishing rats with severe SCI from healthy control rats. Forty enzymes regulated these 15 metabolites in the metabolic network. We also found that 16 metabolites regulated by 130 enzymes in the metabolic network impacted neurobehavioral recovery. Using the Eigen-metabolome, we established a linear discrimination model to cluster rats with severe and mild SCI and control rats into separate groups and identify the interactive relationships between metabolic biomarkers in the global metabolic network. We identified 10 clusters in the global metabolic network and defined them as distinct metabolic disturbance domains of SCI. Metabolic paths such as retinal, glycerophospholipid, arachidonic acid metabolism; NAD-NADPH conversion process, tyrosine metabolism, and cadaverine and putrescine metabolism were included. In summary, we presented a novel interdisciplinary method that integrates metabolomics and global metabolic network analysis to visualize metabolic network disturbances after SCI. Our study demonstrated the systems biological study paradigm that integration of 1H-NMR, metabolomics, and global metabolic network analysis is useful to visualize complex metabolic disturbances after severe SCI. Furthermore, our findings may provide a new quantitative injury severity evaluation model for clinical use.

Age and pedestrian injury severity in motor-vehicle crashes: a heteroskedastic logit analysis.

Science.gov (United States)

Kim, Joon-Ki; Ulfarsson, Gudmundur F; Shankar, Venkataraman N; Kim, Sungyop

2008-09-01

This research explores the injury severity of pedestrians in motor-vehicle crashes. It is hypothesized that the variance of unobserved pedestrian characteristics increases with age. In response, a heteroskedastic generalized extreme value model is used. The analysis links explanatory factors with four injury outcomes: fatal, incapacitating, non-incapacitating, and possible or no injury. Police-reported crash data between 1997 and 2000 from North Carolina, USA, are used. The results show that pedestrian age induces heteroskedasticity which affects the probability of fatal injury. The effect grows more pronounced with increasing age past 65. The heteroskedastic model provides a better fit than the multinomial logit model. Notable factors increasing the probability of fatal pedestrian injury: increasing pedestrian age, male driver, intoxicated driver (2.7 times greater probability of fatality), traffic sign, commercial area, darkness with or without streetlights (2-4 times greater probability of fatality), sport-utility vehicle, truck, freeway, two-way divided roadway, speeding-involved, off roadway, motorist turning or backing, both driver and pedestrian at fault, and pedestrian only at fault. Conversely, the probability of a fatal injury decreased: with increasing driver age, during the PM traffic peak, with traffic signal control, in inclement weather, on a curved roadway, at a crosswalk, and when walking along roadway.

A review of the number and severity of injuries sustained following a single motocross event.

Science.gov (United States)

Dick, Charles G; White, Simon; Bopf, Daniel

2014-03-01

Competitive and recreational motocross is an increasingly popular sport in Australia and worldwide. Children as young as 4-year-old can participate in this activity. It is recognised that this is a high risk sport despite the use of protective equipment and developments in course design. Injuries sustained range from minor contusions and fractures to severe life threatening spine and head injuries in adults and the paediatric population. In addition organised events can generate a surge of trauma that can burden small local hospitals, resulting in an unpredicted increase in the workload with subsequent delays to treatment. We present the trauma workload generated in a district hospital following a single motocross event. All patients attending a district hospital emergency department with injuries sustained during a single motocross event were identified through hospital and ambulance records. The nature of their injuries and the treatment required, the length of hospital stay and operative theatre time generated by their injuries were obtained from hospital and theatre records. 14 patients attended the emergency department over a 24-hour period, requiring 5 ambulances from the scene. 7 patients required hospital admission with 7 operations performed, consuming 12.2 h of operating theatre time and 21 days of hospital beds. 2 patients sustained head injuries requiring observation, one of which was transferred to a spinal unit for management of their spinal injuries. Motocross is a popular sport and at times has unacceptable risks of injury in organised competitions, especially with regards to paediatric injuries. Better course design, restrictions on participant age and limitations in vehicle speeds may help reduce the number of severe injuries. These events can also generate a sudden trauma burden to local hospital facilities with knock on effects on waiting times for theatre and potentially compromising not only treatment of the injured participants but also

Abnormalities of Microcirculation and Intracranial and Cerebral Perfusion Pressures in Severe Brain Injury

Directory of Open Access Journals (Sweden)

Yu. A. Churlyaev

2008-01-01

Full Text Available Objective: to evaluate the states of microcirculation, cerebral perfusion intracranial pressures in patients with isolated severe brain injury (SBI and to determine their possible relationships. Subjects and methods. 148 studies were performed in 16 victims with SBI. According to the outcome of brain traumatic disease, the patients were divided into two groups: 1 those who had a good outcome (n=8 and 2 those who had a fatal outcome (n=8. Microcirculation was examined by skin laser Doppler flowmetry using a LAKK-01 capillary blood flow laser analyzer (LAZMA Research-and-Production Association, Russian Federation. All the victims underwent surgical interventions to remove epi-, subdural, and intracerebral hematomas. A Codman subdural/intraparenchymatous intracranial pressure (ICD sensor (Johnson & Johnson, United Kingdom was intraoperatively inserted in the victims. Cerebral perfusion pressure (CPP was calculated using the generally accepted formula: CPP = MBP (mean blood pressure — ICD. ICD, CPP, and microcirculation were studied on postoperative days 1, 3, 5, and 7. Their values were recorded simultaneously. Ninety and 58 studies were conducted in the group of patients with good and fatal outcomes, respectively. Results. No correlation between the changes in MBP, ICD, and microcirculatory parameters suggested that the value of ICD was determined by the nature of brain damage and it was the leading and determining indicator in the diagnosis and treatment of secondary cerebral lesions. The amplitude of low-frequency fluctuations directly correlated with ICD, which indicated that they might be used to evaluate cerebral perfusion and impaired cerebral circulation indirectly in victims with severe brain injury. Conclusion. The laser Doppler flowmetric technique makes it possible not only to qualitatively, but also quantitatively determine changes in the tissue blood flow system in severe brain injury. With this technique, both the local and central

Role of Intravenous Levetiracetam in Seizure Prophylaxis of Severe Traumatic Brain Injury Patients

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BATOOL F. KIRMANI

2013-11-01

Full Text Available Traumatic brain injury (TBI can cause seizures and the development of epilepsy. The incidence of seizures varies from 21% in patients with severe brain injuries to 50% in patients with war-related penetrating TBI. In the acute and sub-acute periods following injury, seizures can lead to increased intracranial pressure and cerebral edema, further complicating TBI management. Anticonvulsants should be used for seizure prophylaxis and treatment. Phenytoin is the most widely prescribed anticonvulsant in these patients. Intravenous levetiracetam, made available in 2006, is now being considered as an alternative to phenytoin in acute care settings. When compared with phenytoin, levetiracetam has fewer side-effects and drug-drug interactions. In the following, the role of levetiracetam in TBI care and the supporting evidence is discussed.

Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.

LENUS (Irish Health Repository)

Ghori, Kamran A

2012-02-03

BACKGROUND: Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome. DESIGN: 28 patients with severe head injury (Glasgow Coma Score <9) who required sedation and ventilation were randomly assigned to receive midazolam (n =15) or propofol (n = 13) based sedation. Blood samples were drawn daily for 5 days for estimation of S100beta and NO concentrations. Neurological outcome was assessed 3 months later as good (Glasgow Outcome Score [GOS], 4-5) or poor (GOS, 1-3). RESULTS: A good neurological outcome was observed in 8\\/15 patients (53%) in the midazolam group and 7\\/13 patients (54%) in the propofol group. Patients with a poor outcome had higher serum S100beta concentrations on ICU admission and on Days 1-4 in the ICU than those with a good outcome (mean [SD] on Day 1, 0.99 [0.81] v 0.41 [0.4] microg\\/L; Day 2, 0.80 [0.81] v 0.41 [0.24] microg\\/L; Day 3, 0.52 [0.55] v 0.24 [0.25] microg\\/L; and Day 4, 0.54 [0.43] v 0.24 [0.35] microg\\/L; P<0.05). There was no significant difference on Day 5. Plasma NO concentrations were not associated with outcome. In subgroup analysis, there was no difference in S100beta and NO concentrations between patients with a good outcome versus those with a poor outcome in either the midazolam or propofol group. CONCLUSIONS: Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.

Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

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P. Benson Ham

2015-05-01

Full Text Available Perinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn.

Renalase as a Novel Biomarker for Evaluating the Severity of Hepatic Ischemia-Reperfusion Injury

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Huili Li

2016-01-01

Full Text Available Hepatic ischemia-reperfusion (I/R injury is a serious complication in clinical practice. However, no efficient biomarkers are available for the evaluation of the severity of I/R injury. Recently, renalase has been reported to be implicated in the I/R injury of various organs. This protein is secreted into the blood in response to increased oxidative stress. To investigate the responsiveness of renalase to oxidative stress, we examined the changes of renalase in cell and mouse models. We observed a significant increase of renalase expression in HepG2 cells in a time- and dose-dependent manner when treated with H2O2. Renalase expression also increased significantly in liver tissues that underwent the hepatic I/R process. The increased renalase levels could be efficiently suppressed by antioxidants in vitro and in vivo. Furthermore, serum renalase levels were significantly increased in the mouse models and also efficiently suppressed by antioxidants treatment. The variation trends are consistent between renalase and liver enzymes in the mouse models. In conclusion, renalase is highly sensitive and responsive to oxidative stress in vitro and in vivo. Moreover, renalase can be detected in the blood. These properties make renalase a highly promising biomarker for the evaluation of the severity of hepatic I/R injury.

Text-to-Speech and Reading While Listening: Reading Support for Individuals with Severe Traumatic Brain Injury

Science.gov (United States)

Harvey, Judy

2013-01-01

Individuals with severe traumatic brain injury (TBI) often have reading challenges. They maintain or reestablish basic decoding and word recognition skills following injury, but problems with reading comprehension often persist. Practitioners have the potential to accommodate struggling readers by changing the presentational mode of text in a…

An analysis of the relationship between bodily injury severity and fall height in victims of fatal falls from height

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Grzegorz Teresiński

2017-03-01

Full Text Available Aim of the study : One of the basic issues discussed in forensic literature regarding falls from a height is determination of fall heights and differentiation between suicidal and accidental falls. The aim of the study was to verify the usefulness of the available methods for the purposes of forensic expertises. Material and methods : The study encompassed fatalities of falls from a height whose autopsies were performed in the Department of Forensic Medicine in Lublin. Results : Similarly to other authors, the severity of injuries was assessed using the Abbreviated Injury Scale (AIS and injury severity score (ISS. The study findings demonstrated a statistically significant correlation between the fall height and the severity of injuries according to ISS and a statistically significant difference in fall heights between the groups of accidents and suicides.

Abdominal Muscle Activity during Mechanical Ventilation Increases Lung Injury in Severe Acute Respiratory Distress Syndrome.

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Xianming Zhang

Full Text Available It has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS, but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS.Eighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAPSB and abdominal muscle paralysis group (BIPAPAP. All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH2O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO2 of 35-60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment.For the comparable ventilator setting, as compared with BIPAPSB group, the BIPAPAP group presented higher EELV (427±47 vs. 366±38 ml and oxygenation index (293±36 vs. 226±31 mmHg, lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7 and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9 in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAPAP group (22.5±2.0 vs. 25.2±2.1.Abdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.

Abdominal Muscle Activity during Mechanical Ventilation Increases Lung Injury in Severe Acute Respiratory Distress Syndrome.

Science.gov (United States)

Zhang, Xianming; Wu, Weiliang; Zhu, Yongcheng; Jiang, Ying; Du, Juan; Chen, Rongchang

2016-01-01

It has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS), but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS. Eighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAPSB) and abdominal muscle paralysis group (BIPAPAP). All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH2O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO2 of 35-60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV) and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL)-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment. For the comparable ventilator setting, as compared with BIPAPSB group, the BIPAPAP group presented higher EELV (427±47 vs. 366±38 ml) and oxygenation index (293±36 vs. 226±31 mmHg), lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml) and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml) in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7) and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9) in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAPAP group (22.5±2.0 vs. 25.2±2.1). Abdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.

MICROBIOLOGICAL METHODS APPLICATION EXPERIENCE IN THE SEVERE INJURIES INFECTIOUS COMPLICATIONS

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S. A. Svistunov

2016-01-01

Full Text Available Modern clinical medicine and surgery problems are associated with infections complications after medical care. In recent years, surgery has made substantial progress related to the new organizational approaches and medical technology specialized medical care to the wounded and injured. However, these gains are offset by a high rate of infectious complications that require finding effective measures emerging infectious complications timely diagnosis and their prevention. Clinical manifestations are often nosocomial in patients with severe injuries and are largely determined by the influence of clinical and pathogenetic risk factors. Such infectious complications require a comprehensive assessment, including microbiological testing. The main causative agents of infectious complications in surgical hospitals are S. aureus, K. pneumoniae, P. aeruginosa, Acinetobacter spp., which can cause bloodstream infections, soft tissue, respiratory and urinary tract infections, especially in debilitated and immunocompromised patients and patients in intensive care units. These micro organisms are dangerous to patients and medical staff, as they can survive for a long time in the hospital environment, as well as to spread from patient to patient in violation of isolation restrictive measures and requirements for hygiene of medical workers hands. Clinical patterns of infection associated with medical care for severe injuries are to the possibility of serial and parallel development, both in different and in the same time frame of local, visceral and generalized infection with prevalence of combined forms of patients surgical hospital with a high risk of nosocomial infection against the background of factors, diagnostic and treatment process and hospital environment, introduction of the agent. Early etiological diagnosis allows timely assign empirical causal treatment and arrange for infection control to prevent the spread of microorganisms in the hospital. The

Systematic review of severe acute liver injury caused by terbinafine.

Science.gov (United States)

Yan, Jun; Wang, Xiaolin; Chen, Shengli

2014-08-01

Terbinafine is an effective antimicrobial agent against dermatophytes, cryptococcus and other fungi. It is the preferred drug to treat onychomycosis. However, severe acute hepatitis from oral terbinafine administration has been recently reported. To describe a representative case, and review the literature regarding the best evidence on treatment and prognosis of severe acute hepatitis caused by oral terbinafine. The literature was searched for publications on severe hepatitis caused by terbinafine using MEDLINE, China Biology Medicine Disc, and the VIP Medical Information Resource System. Related references were searched manually. Seventeen English and three Chinese references of case reports were included after eliminating duplicate publications. No randomized control studies were found. Liver enzyme levels were found to have been increased significantly. Abdominal ultrasound demonstrated cholestasis. Severe acute liver injury is a known, but unusual complication of terbinafine exposure. The prognosis is often good with appropriate treatment. Liver function assessment before treatment and periodic monitoring 4-6 weeks after initiation of treatment is recommended.

Outcome of severe traumatic brain injury at a critical care unit: a ...

African Journals Online (AJOL)

Factors that were associated with poor outcome on univariate analysis were Glasgow coma scale of less than 5, diffuse axonal injury and intracerebral mass lesions and blood sugar greater than 10mmol / L. CONCLUSION: Severe TBI is a frequent cause of hospital admission to critical care units among young men with a ...

[International multicenter studies of treatment of severe traumatic brain injury].

Science.gov (United States)

Talypov, A E; Kordonsky, A Yu; Krylov, V V

2016-01-01

Despite the introduction of new diagnostic and therapeutic methods, traumatic brain injury (TBI) remains one of the leading cause of death and disability worldwide. Standards and recommendations on conservative and surgical treatment of TBI patients should be based on concepts and methods with proven efficacy. The authors present a review of studies of the treatment and surgery of severe TBI: DECRA, RESCUEicp, STITCH(TRAUMA), CRASH, CRASH-2, CAPTAIN, NABIS: H ll, Eurotherm 3235. Important recommendations of the international group IMPACT are considered.

[Severe Eyeball and Facial Skeletal Injuries Caused by Firefighting Sport].

Science.gov (United States)

Rusňák, Š; Maranová, Z; Kasl, Z; Hecová, L; Voigt, E; Raiskup, F

2017-07-01

The aim of this work is to draw attention to possible injuries of the eye and the facial skeleton caused by firefighting sport. There was a group of 9 patients presented who were treated from 2006 to 2015 in the Department of Ophthalmology at the University Hospital in Pilsen and diagnosed with severe eyeball contusion after being hit by a jet of water and/or a water pipe. Three cases are presented in detail. Georg Thieme Verlag KG Stuttgart · New York.

Relation between both oxidative and metabolic-osmotic cell damages and initial injury severity in bombing casualties

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Vučeljić Marina

2006-01-01

Full Text Available Background/Aim. We have recently reported the development of oxidative cell damages in bombing casualties within a very early period after the initial injury. The aim of this study, was to investigate malondialdehyde (MDA, as an indicator of lipid peroxidation, and osmolal gap (OG, as a good indicator of metabolic cell damages and to assess their relationship with the initial severity of the injury in bombing casualties. Methods. The study included the males (n = 52, injured during the bombing with the Injury Severity Score (ISS ranging from 3 to 66. The whole group of casualties was devided into a group of less severely (ISS < 25, n = 24 and a group of severely (ISS ≥ 26, n = 28 injured males. The uninjured volunteers (n = 10 were the controls. Osmolality, MDA, sodium, glucose, urea, creatinine, total bilirubin and total protein levels were measured in the venous blood, sampled daily, within a ten-day period. Results. In both groups of casualties, MDA and OG levels increased, total protein levels decreased, while other parameters were within the control limits. MDA alterations correlated with ISS (r = 0.414, p < 0.01, while a statistically significant correlation between OG and ISS was not obtained. Interestingly, in spite of some differences in MDA and OG trends, at the end of the examined period they were at the similar level in both groups. Conclusion. The initial oxidative damages of the cellular membrane with intracellular metabolic disorders contributed to the gradual development of metabolic-osmotic damages of cells, which, consequently caused the OG increase. In the bombing casualties, oxidative cell damages were dependent on the initial injury severity, while metabolic-osmotic cell damages were not.

Progesterone treatment shows benefit in a pediatric model of moderate to severe bilateral brain injury.

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Rastafa I Geddes

Full Text Available Controlled cortical impact (CCI models in adult and aged Sprague-Dawley (SD rats have been used extensively to study medial prefrontal cortex (mPFC injury and the effects of post-injury progesterone treatment, but the hormone's effects after traumatic brain injury (TBI in juvenile animals have not been determined. In the present proof-of-concept study we investigated whether progesterone had neuroprotective effects in a pediatric model of moderate to severe bilateral brain injury.Twenty-eight-day old (PND 28 male Sprague Dawley rats received sham (n = 24 or CCI (n = 47 injury and were given progesterone (4, 8, or 16 mg/kg per 100 g body weight or vehicle injections on post-injury days (PID 1-7, subjected to behavioral testing from PID 9-27, and analyzed for lesion size at PID 28.The 8 and 16 mg/kg doses of progesterone were observed to be most beneficial in reducing the effect of CCI on lesion size and behavior in PND 28 male SD rats.Our findings suggest that a midline CCI injury to the frontal cortex will reliably produce a moderate TBI comparable to what is seen in the adult male rat and that progesterone can ameliorate the injury-induced deficits.

Patients with severe acquired brain injury show increased arousal in tilt-table training

DEFF Research Database (Denmark)

Riberholt, Christian G; Thorlund, Jonas Bloch; Mehlsen, Jesper

2013-01-01

Patients with severe acquired brain injury (ABI) are often mobilised using a tilt-table. Complications such as orthostatic intolerance have been reported. The primary objective of this study was to investigate if using a tilt-table was feasible for mobilising patients with severe ABI admitted...... for sub-acute rehabilitation. We also investigated change in arousal, treatment duration before termination due to orthostatic reactions and change in muscle tone....

Classification of the severe trauma patient with the Abbreviated Injury Scale: degree of correlation between versions 98 and 2005 (2008 update).

Science.gov (United States)

Abajas Bustillo, Rebeca; Leal Costa, César; Ortego Mate, María Del Carmen; Zonfrillo, Mark R; Seguí Gómez, María; Durá Ros, María Jesús

2018-02-01

To explore differences in severity classifications according to 2 versions of the Abbreviated Injury Scale (AIS): version 2005 (the 2008 update) and the earlier version 98. To determine whether possible differences might have an impact on identifying severe trauma patients. Descriptive study and cross-sectional analysis of a case series of patients admitted to two spanish hospitals with out-of-hospital injuries between February 2012 and February 2013. For each patient we calculated the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the AIS scores according to versions 98 and 2005. The sample included 699 cases. The mean Severity (SD) age of patients was 52.7 (29.2) years, and 388 (55.5%) were males. Version 98 of the AIS correlated more strongly with both the ISS (2.6%) and the NISS (2.9%). The 2008 update of the AIS (version 2005) classified fewer trauma patients than version 98 at the severity levels indicated by the ISS and NISS.

Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury.

Science.gov (United States)

Howard, Jerry Lee; Cipolle, Mark D; Anderson, Meredith; Sabella, Victoria; Shollenberger, Daniele; Li, P Mark; Pasquale, Michael D

2008-08-01

Using decompressive craniectomy as part of the treatment regimen for severe traumatic brain injury (STBI) has become more common at our Level I trauma center. This study was designed to examine this practice with particular attention to long-term functional outcome. A retrospective review of prospectively collected data was performed for patients with STBI admitted from January 1, 2003 to December 31, 2005. Our institution manages patients using the Brain Trauma Foundation Guidelines. Data collected from patients undergoing decompressive craniectomy included: age, Injury Severity Score, admission and follow-up Glasgow Coma Score, timing of, and indication for decompressive craniectomy, and procedure-related complications. The Extended Glasgow Outcome Scale (GOSE) was performed by a experienced trauma clinical research coordinator using a structured phone interview to assess long-term outcome in the survivors. Student's t test and chi2 were used to examine differences between groups. Forty STBI patients were treated with decompressive craniectomy; 24 were performed primarily in conjunction with urgent evacuation of extra-axial hemorrhage and 16 were performed primarily in response to increased intracranial pressure with 4 of these after an initial craniotomy. Decompressive craniectomy was very effective at lowering intracranial pressure in these 16 patients (35.0 mm Hg +/- 13.5 mm Hg to 14.6 mm Hg +/- 8.7 mm Hg, p = 0.005). Twenty-two decompressive craniectomy patients did not survive to hospital discharge, whereas admission Glasgow Coma Score and admission pupil size and reactivity correlated with outcome, age, and Injury Severity Score did not. At a mean of 11 months (range, 3-26 months) after decompressive craniectomy, 6 survivors had a poor functional outcome (GOSE 1-4), whereas 12 survivors had a good outcome (GOSE 5-8). Therefore, 70% of these patients had an unfavorable outcome (death or severe disability), and 30% had a favorable long-term functional outcome

Prognosis in moderate and severe traumatic brain injury: External validation of the IMPACT models and the role of extracranial injuries

NARCIS (Netherlands)

Lingsma, Hester; Andriessen, Teuntje M. J. C.; Haitsema, Iain; Horn, Janneke; van der Naalt, Joukje; Franschman, Gaby; Maas, Andrew I. R.; Vos, Pieter E.; Steyerberg, Ewout W.

2013-01-01

BACKGROUND: Several prognostic models to predict outcome in traumatic brain injury (TBI) have been developed, but few are externally validated. We aimed to validate the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) prognostic models in a recent unselected patient

Successful Use of Extracorporeal Life Support after Double Traumatic Tracheobronchial Injury in a Patient with Severe Acute Asthma

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Xavier Valette

2011-01-01

Full Text Available We report the case of an asthmatic patient with blunt trachea and left main bronchus injuries who developed acute severe asthma after surgical repair. Despite medical treatment and ventilatory support, asthma persisted with high airway pressures and severe respiratory acidosis. We proposed venovenous extracorporeal life support for CO2 removal which allowed arterial blood gas normalization and airway pressures decrease. Extracorporeal life support was removed on day five after medical treatment of acute severe asthma. So we report the successful use of extracorporeal life support for operated double blunt tracheobronchial injury with acute severe asthma.

Changes in Plasma Sex Hormone Levels in Women with Severe Concomitant Injury

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K. N Yezhova

2010-01-01

Full Text Available Objective: to perform a complex study of the plasma levels of 11 sex hormones and their functional values in women with severe concomitant injury (SCI. Subjects and methods. The study enrolled 16 women aged 18—45 years who had SCI. Admission APACHE II scores were 18.9±1.3. According to the outcome of a posttraumatic period, all the patients were divided into 2 groups: A survivors; B deceased subjects. The normal values were used to comparatively analyze the concentrations of reproductive hormones. The time course of changes in hormone concentration was studied on postoperative days 1, 3, and 7. The hormone profile was examined by BSL test kits (USA on a STAT Fax 2100 enzyme immunoanalyzer (Awareness Technology Inc., USA. The content of prolactin, luteinizing hormone, follicle-stimulating hormone, progesterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate (DHEA-S, androstendione (A, testosterone (T, dihydrotestosterone, estrone, and estradiol (E were measured. Results. The complex study of changes in the profile of 11 plasma sex hormones was first conducted in women in the posttraumat-ic period. Moreover, the typical plasma hormonal changes were elevated prolactin levels, a decrease in the concentrations of gonadotropins, and increases in some androgens, A, T, and E. The deceased women showed lower concentrations of DHEA-S and T. Analysis revealed an inverse correlation between the plasma concentration of DHEA-S and the injury severity. This change seems to suggest that an adrenal adaptation reaction is exhausted. The changes revealed in hormonal levels are of significance in understanding the pathogenesis of SCT. This may serve as a basis for the development of new therapy modalities using reproductive hormones in the postresuscitative period. Key words: severe concomitant injury, sex hormones, prolactin, luteinizing hormone, follicle-stimulating hormone, progesterone, 17-hydroxyprogesterone, androgens, estrogens.

[Two cases of severe eye and cranial injuries due to firework explosions].

Science.gov (United States)

Saunte, J P; Trojaborg, N S; Nielsen, O A; Thygesen, J

1999-12-20

Two patients who sustained serious facial, cranial and eye trauma secondary to recreational fireworks injuries are reported. Initial assessment included axial and coronary computerized tomography, control of haemorrhage, debridement of wound and brain, and in one patient bilateral excenteration of the globe. Both patients suffered from intracranial haemorrhage, but both recovered without severe neurological sequelae.

Implicit and explicit memory outcome in children who have sustained severe traumatic brain injury: impact of age at injury (preliminary findings).

Science.gov (United States)

Lah, Suncica; Epps, Adrienne; Levick, Wayne; Parry, Louise

2011-01-01

To examine implicit and explicit memory outcome in children who had sustained severe traumatic brain injury (TBI) through childhood. Opposite patterns of impairments were expected: (i) impaired implicit memory in children with early TBI (TBI-EC, explicit memory in children with late TBI (TBI-LC, ≥ 6 years). Children who had sustained severe TBI more then 1 year ago were assessed. Fourteen children who had sustained severe TBI (TBI-EC, n = 10 and TBI-LC, n = 4) between 8 months and 13 years 7 months of age and 13 non-injured control subjects (NC) participated. Implicit (repetition priming and skill learning) and explicit verbal memory were examined. The TBI group performed worse on implicit (repetition priming) and explicit memory tasks compared to the NC group. Moreover, impairments were found in implicit and explicit memory in the TBI-EC, but not in the TBI-LC group. This study has shown, for the first time, that severe childhood TBI may compromise not only explicit, but also implicit memory. Nevertheless, instead of a selective implicit memory impairment, it was found that children who sustained injuries in early childhood present with impairments in both memory systems.

Identifying depression severity risk factors in persons with traumatic spinal cord injury.

Science.gov (United States)

Williams, Ryan T; Wilson, Catherine S; Heinemann, Allen W; Lazowski, Linda E; Fann, Jesse R; Bombardier, Charles H

2014-02-01

Examine the relationship between demographic characteristics, health-, and injury-related characteristics, and substance misuse across multiple levels of depression severity. 204 persons with traumatic spinal cord injury (SCI) volunteered as part of screening efforts for a randomized controlled trial of venlafaxine extended release for major depressive disorder (MDD). Instruments included the Patient Health Questionnaire-9 (PHQ-9) depression scale, the Alcohol Use Disorders Identification Test (AUDIT), and the Substance Abuse in Vocational Rehabilitation-Screener (SAVR-S), which contains 3 subscales: drug misuse, alcohol misuse, and a subtle items scale. Each of the SAVR-S subscales contributes to an overall substance use disorder (SUD) outcome. Three proportional odds models were specified, varying the substance misuse measure included in each model. 44% individuals had no depression symptoms, 31% had mild symptoms, 16% had moderate symptoms, 6% had moderately severe symptoms, and 3% had severe depression symptoms. Alcohol misuse, as indicated by the AUDIT and the SAVR-S drug misuse subscale scores were significant predictors of depression symptom severity. The SAVR-S substance use disorder (SUD) screening outcome was the most predictive variable. Level of education was only significantly predictive of depression severity in the model using the AUDIT alcohol misuse indicator. Likely SUD as measured by the SAVR-S was most predictive of depression symptom severity in this sample of persons with traumatic SCI. Drug and alcohol screening are important for identifying individuals at risk for depression, but screening for both may be optimal. Further research is needed on risk and protective factors for depression, including psychosocial characteristics. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Perceived difficulty in use of everyday technology in persons with acquired brain injury of different severity: a comparison with controls.

Science.gov (United States)

Fallahpour, Mandana; Kottorp, Anders; Nygård, Louise; Lund, Maria Larsson

2014-07-01

To compare the perceived difficulty in use of everyday technology in persons with acquired brain injury with different levels of severity of disability with that of controls. This comparison study recruited 2 samples of persons with acquired brain injury and controls, comprising a total of 161 participants, age range 18-64 years. The long and short versions of the Everyday Technology Use Questionnaire and the Extended Glasgow Outcome Scale were used to evaluate participants. Persons with acquired brain injury demonstrated lower mean levels of perceived ability in use of everyday technology than controls (F = 21.84, degrees of freedom = 1, p technology between persons with severe disability and good recovery, between persons with severe disability and controls, and between persons with moderate disability and controls. No significant mean difference was found between persons with severe disability and moderate disability, between persons with moderate disability and good recovery, and between persons with good recovery and controls. Perceived difficulty in using everyday technology is significantly increased among persons with acquired brain injury with severe to moderate disability compared with controls. Rehabilitation services should consider the use of everyday technology in order to increase participation in everyday activities after acquired brain injury.

Social skills treatment for people with severe, chronic acquired brain injuries: a multicenter trial.

Science.gov (United States)

McDonald, Skye; Tate, Robyn; Togher, Leanne; Bornhofen, Cristina; Long, Esther; Gertler, Paul; Bowen, Rebecca

2008-09-01

To determine whether social skills deficits including unskilled, inappropriate behavior, problems reading social cues (social perception), and mood disturbances (such as depression and anxiety) could be remediated after severe traumatic brain injuries. Randomized controlled trial comparing a social skills program with social activity alone or with waitlist control. Several participants were reassigned after randomization. Hospital outpatient and community facilities. Fifty-one outpatients from 3 brain injury units in Sydney, Australia, with severe, chronic acquired brain injuries were recruited. A total of 39 people (13 in skills training, 13 in social activity, 13 in waitlist) completed all phases of the study. Twelve-week social skills treatment program encompassing weekly 3-hour group sessions focused on shaping social behavior and remediating social perception and 1-hour individual sessions to address psychologic issues with mood, self-esteem, etc. Primary outcomes were: (1) social behavior during encounters with a confederate as rated on the Behaviorally Referenced Rating System of Intermediary Social Skills-Revised (BRISS-R), (2) social perception as measured by The Awareness of Social Inference Test, and (3) depression and anxiety as measured by the Depression, Anxiety and Stress Scale. Secondary outcomes were: relative report on social behavior and participation using: the Katz Adjustment Scale-R1; the Social Performance Survey Schedule; the La Trobe Communication Questionnaire; and the Sydney Psychosocial Reintegration Scale (both relative and self-report). Repeated-measures analysis of variance indicated that social activity alone did not lead to improved performance relative to waitlist (placebo effect) on any outcome variable. On the other hand, the skills training group improved differentially on the Partner Directed Behavior Scale of the BRISS-R, specifically the self-centered behavior and partner involvement behavior subscales. No treatment effects

Macrophage-expressed IFN-β contributes to apoptotic alveolar epithelial cell injury in severe influenza virus pneumonia.

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Katrin Högner

2013-02-01

Full Text Available Influenza viruses (IV cause pneumonia in humans with progression to lung failure and fatal outcome. Dysregulated release of cytokines including type I interferons (IFNs has been attributed a crucial role in immune-mediated pulmonary injury during severe IV infection. Using ex vivo and in vivo IV infection models, we demonstrate that alveolar macrophage (AM-expressed IFN-β significantly contributes to IV-induced alveolar epithelial cell (AEC injury by autocrine induction of the pro-apoptotic factor TNF-related apoptosis-inducing ligand (TRAIL. Of note, TRAIL was highly upregulated in and released from AM of patients with pandemic H1N1 IV-induced acute lung injury. Elucidating the cell-specific underlying signalling pathways revealed that IV infection induced IFN-β release in AM in a protein kinase R- (PKR- and NF-κB-dependent way. Bone marrow chimeric mice lacking these signalling mediators in resident and lung-recruited AM and mice subjected to alveolar neutralization of IFN-β and TRAIL displayed reduced alveolar epithelial cell apoptosis and attenuated lung injury during severe IV pneumonia. Together, we demonstrate that macrophage-released type I IFNs, apart from their well-known anti-viral properties, contribute to IV-induced AEC damage and lung injury by autocrine induction of the pro-apoptotic factor TRAIL. Our data suggest that therapeutic targeting of the macrophage IFN-β-TRAIL axis might represent a promising strategy to attenuate IV-induced acute lung injury.

Two-vehicle injury severity models based on integration of pavement management and traffic engineering factors.

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Jiang, Ximiao; Huang, Baoshan; Yan, Xuedong; Zaretzki, Russell L; Richards, Stephen

2013-01-01

The severity of traffic-related injuries has been studied by many researchers in recent decades. However, the evaluation of many factors is still in dispute and, until this point, few studies have taken into account pavement management factors as points of interest. The objective of this article is to evaluate the combined influences of pavement management factors and traditional traffic engineering factors on the injury severity of 2-vehicle crashes. This study examines 2-vehicle rear-end, sideswipe, and angle collisions that occurred on Tennessee state routes from 2004 to 2008. Both the traditional ordered probit (OP) model and Bayesian ordered probit (BOP) model with weak informative prior were fitted for each collision type. The performances of these models were evaluated based on the parameter estimates and deviances. The results indicated that pavement management factors played identical roles in all 3 collision types. Pavement serviceability produces significant positive effects on the severity of injuries. The pavement distress index (PDI), rutting depth (RD), and rutting depth difference between right and left wheels (RD_df) were not significant in any of these 3 collision types. The effects of traffic engineering factors varied across collision types, except that a few were consistently significant in all 3 collision types, such as annual average daily traffic (AADT), rural-urban location, speed limit, peaking hour, and light condition. The findings of this study indicated that improved pavement quality does not necessarily lessen the severity of injuries when a 2-vehicle crash occurs. The effects of traffic engineering factors are not universal but vary by the type of crash. The study also found that the BOP model with a weak informative prior can be used as an alternative but was not superior to the traditional OP model in terms of overall performance.

Transport Time and Preoperating Room Hemostatic Interventions Are Important: Improving Outcomes After Severe Truncal Injury.

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Holcomb, John B

2018-03-01

Experience in the ongoing wars in Iraq and Afghanistan confirm that faster transport combined with effective prehospital interventions improves the outcomes of patients suffering hemorrhagic shock. Outcomes of patients with hemorrhagic shock and extremity bleeding have improved with widespread use of tourniquets and early balanced transfusion therapy. Conversely, civilian patients suffering truncal bleeding and shock have the same mortality (46%) over the last 20 years. To understand how to decrease this substantial mortality, one must first critically evaluate all phases of care from point of injury to definitive hemorrhage control in the operating room. Limited literature review. The peak time to death after severe truncal injury is within 30 minutes of injury. However, when adding prehospital transport time, time spent in the emergency department, followed by the time in the operating room, it currently takes 2.1 hours to achieve definitive truncal hemorrhage control. This disparity in uncontrolled truncal bleeding and time to hemorrhage control needs to be reconciled. Prehospital and emergency department whole blood transfusion and temporary truncal hemorrhage control are now possible. The importance of rapid transport, early truncal hemorrhage control and whole blood transfusion is now widely recognized. Prehospital temporary truncal hemorrhage control and whole blood transfusion should offer the best possibility of improving patient outcomes after severe truncal injury.

The early IL-6 and IL-10 response in trauma is correlated with injury severity and mortality

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Stensballe, J; Christiansen, M; Tønnesen, E

2009-01-01

BACKGROUND: Trauma has previously been shown to influence interleukin (IL)-6 and IL-10 levels, but the association of injury severity and mortality with IL-6 and IL-10 responses in the early phase of accidental trauma remains to be investigated. We wished to describe serum levels of IL-6 and IL-10...... in the first 24 h after trauma and to assess the relationship with severity of injury and mortality. METHODS: Prospective, descriptive cohort study in a Level 1 trauma centre, Copenhagen, Denmark. We included 265 consecutive adult trauma patients admitted directly from the accident scene during an 18-month...... period. Serum levels of IL-6 and IL-10 were measured upon arrival and at 6, 12, and 24 h after admittance using an enzyme-linked immunosorbent assay. Correlation analysis was used to assess the relationship between Injury Severity Score (ISS) and levels of IL-6 and IL-10. Analysis of variance was used...

Ubiquinol treatment for TBI in male rats: Effects on mitochondrial integrity, injury severity, and neurometabolism.

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Pierce, Janet D; Gupte, Raeesa; Thimmesch, Amanda; Shen, Qiuhua; Hiebert, John B; Brooks, William M; Clancy, Richard L; Diaz, Francisco J; Harris, Janna L

2018-06-01

Following traumatic brain injury (TBI), there is significant secondary damage to cerebral tissue from increased free radicals and impaired mitochondrial function. This imbalance between reactive oxygen species (ROS) production and the effectiveness of cellular antioxidant defenses is termed oxidative stress. Often there are insufficient antioxidants to scavenge ROS, leading to alterations in cerebral structure and function. Attenuating oxidative stress following a TBI by administering an antioxidant may decrease secondary brain injury, and currently many drugs and supplements are being investigated. We explored an over-the-counter supplement called ubiquinol (reduced form of coenzyme Q10), a potent antioxidant naturally produced in brain mitochondria. We administered intra-arterial ubiquinol to rats to determine if it would reduce mitochondrial damage, apoptosis, and severity of a contusive TBI. Adult male F344 rats were randomly assigned to one of three groups: (1) Saline-TBI, (2) ubiquinol 30 minutes before TBI (UB-PreTBI), or (3) ubiquinol 30 minutes after TBI (UB-PostTBI). We found when ubiquinol was administered before or after TBI, rats had an acute reduction in brain mitochondrial damage, apoptosis, and two serum biomarkers of TBI severity, glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1). However, in vivo neurometabolic assessment with proton magnetic resonance spectroscopy did not show attenuated injury-induced changes. These findings are the first to show that ubiquinol preserves mitochondria and reduces cellular injury severity after TBI, and support further study of ubiquinol as a promising adjunct therapy for TBI. © 2018 Wiley Periodicals, Inc.

A New Weighted Injury Severity Scoring System: Better Predictive Power for Pediatric Trauma Mortality.

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Shi, Junxin; Shen, Jiabin; Caupp, Sarah; Wang, Angela; Nuss, Kathryn E; Kenney, Brian; Wheeler, Krista K; Lu, Bo; Xiang, Henry

2018-05-02

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, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration (Hosmer-Lemeshow statistic) were compared between the wISS and ISS. The areas under the receiver operating characteristic curves from the wISS and ISS are 0.88 vs. 0.86 in ISS=1-74 and 0.77 vs. 0.64 in ISS=25-74 (ppredictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration (smaller Hosmer-Lemeshow statistic) than the ISS (11.6 versus 19.7 for ISS=1-74 and 10.9 versus 12.6 for ISS= 25-74). The wISS showed even better discrimination with the NEDS. By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.Level of Evidence and study typeLevel IV Prognostic/Epidemiological.

Longitudinal Trajectories of Health Related Quality of Life in Danish Family Members of Individuals with Severe Brain Injury

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Norup, Anne; Snipes, Daniel J.; Siert, Lars

2013-01-01

– Emotional scores were higher when patients had high Rancho Los Amigos Scale scores at admission to early intensive rehabilitation in hospital. These results suggest that the acute and sub-acute periods after brain injury are an extremely difficult time psychologically for many families, and family......Scant research has examined health-related quality of life (HRQoL) in family members of patients with severe brain injury, even less has been done in Scandinavian countries, and none has examined this construct longitudinally. The current study therefore used multilevel modelling to investigate...... the trajectories of HRQoL in 94 Danish family members of patients with severe brain injury at five time points, beginning at the patient's stay in a neuro intensive care unit through one year after injury. The family members’ HRQoL scores significantly and strongly increased over time, and Role Limitations...

Severe red spruce winter injury in 2003 creates unusual ecological event in the northeastern United States

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Brynne E. Lazarus; Paul G. Schaberg; Donald H. DeHayes; Gary J. Hawley

2004-01-01

Abundant winter injury to the current-year (2002) foliage of red spruce (Picea rubens Sarg.) became apparent in the northeastern United States in late winter of 2003. To assess the severity and extent of this damage, we measured foliar winter injury at 28 locations in Vermont and surrounding states and bud mortality at a subset of these sites. Ninety percent of all...

DNA Damages and White Blood Cell Death Processes in Victims with Severe Injury

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V. V. Moroz

2014-01-01

Full Text Available Objective. To study the mechanisms of posttraumatic changes in the blood cells, by investigating DNA damages associat ed with hypoxia caused by massive blood loss (BL in severe injury.Subjects and methods. Ninetyfive patients aged 40.6±16.5 years (from 20 to 79 years who had sustained severe mechanical injury with different BL volumes (BLV (from 100 to 4000 ml and hemodynamic disorders were examined to study DNA damages and white blood cell necrotic and apop totic processes. In terms of the victims' weight, the mean BL was 21.5±16.5 ml/kg (from 1.4 to 61.5 ml/kg. The victimswere divided into 4 groups according to BLV: 1 26 victims whose BLV was less than 750 ml (5.93±2.41 ml/kg (grade I BL; 2 23 victims whose BLV was 750—1500 ml (11.5±1.5 ml/kg (grade 2 BL; 3 23 victims whose BLV was 1500—2000 ml (23.8±4.0 ml/kg (grade 3 BL; 4 23 victims whose BLV was over 2000 ml (45.6±10.1 ml/kg (grade 4 BL, according to the type of injury: 1 severe skeletal injury (SSI (n=17; 2 brain injury (BI (n=43; 3 a concurrence of SSI and BI (SSI+BI (n=35; according to the development of infectious complications: 1 69 victims who developed infectious com plications on days 5—7 postinjury; 2 26 victims who did not. To evaluate the impact of hypoxia on DNA damages, white blood cell apoptotic and necrotic processes, the victims were divided into 2 groups: 1 hypoxia (18 of the 95 victims who had 4 altered indicators, such as capillary blood pO2, plasma lactate levels, pH, and BE; 2 no hypoxia (10 of the 95 victims whose indicators were within the normal range. DNA damages and necrotic and apoptotic changes in the white blood cells were assessed by the DNA comet assay. The plasma concentration of extracellular DNA was fluorometrically determined using a QuantiTTM HS DNA Assay Kit (Invitrogen, USA. That of 8hydroxy2deoxyguanosine was estimated by enzyme immunoassay employing an 8hydroxy2deoxyGuanosine EIA Kit (Cayman Chemical, USA. The levels of cas

Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series

DEFF Research Database (Denmark)

Baguley, Ian J; Heriseanu, Roxana E; Gurka, Joseph A

2007-01-01

The pharmacological management of dysautonomia, otherwise known as autonomic storms, following acute neurological insults, is problematic and remains poorly researched. This paper presents six subjects with dysautonomia following extremely severe traumatic brain injury where gabapentin controlled...

Utility of the Croatian translation of the community integration questionnaire-revised in a sample of adults with moderate to severe traumatic brain injury.

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Tršinski, Dubravko; Tadinac, Meri; Bakran, Žarko; Klepo, Ivana

2018-02-23

To examine the utility of the Community Integration Questionnaire-Revised, translated into Croatian, in a sample of adults with moderate to severe traumatic brain injury. The Community Integration Questionnaire-Revised was administered to a sample of 88 adults with traumatic brain injury and to a control sample matched by gender, age and education. Participants with traumatic brain injury were divided into four subgroups according to injury severity. The internal consistency of the Community Integration Questionnaire-Revised was satisfactory. The differences between the group with traumatic brain injury and the control group were statistically significant for the overall Community Integration Questionnaire-Revised score, as well as for all the subscales apart from the Home Integration subscale. The community Integration Questionnaire-Revised score varied significantly for subgroups with different severity of traumatic brain injury. The results show that the Croatian translation of the Community Integration Questionnaire-Revised is useful in assessing participation in adults with traumatic brain injury and confirm previous findings that severity of injury predicts community integration. Results of the new Electronic Social Networking scale indicate that persons who are more active on electronic social networks report better results for other domains of community integration, especially social activities. Implications for rehabilitation The Croatian translation of the Community Integration Questionnaire-Revised is a valid tool for long-term assessment of participation in various domains in persons with moderate to severe traumatic brain injury Persons with traumatic brain injury who are more active in the use of electronic social networking are also more integrated into social and productivity domains. Targeted training in the use of new technologies could enhance participation after traumatic brain injury.

Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents.

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Kaiser, Radek; Waldauf, Petr; Haninec, Pavel

2012-07-01

Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively(1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail. Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper,22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents(63.2%) followed by car accidents (23.5%), bicycle accidents(10.7%) and pedestrian collisions (3.1%) (paccidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (paccidents (9.3%,paccidents),significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%). Study results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is important to consider the

Severity of injuries in different modes of transport, expressed with disability-adjusted life years (DALYs).

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Tainio, Marko; Olkowicz, Dorota; Teresiński, Grzegorz; de Nazelle, Audrey; Nieuwenhuijsen, Mark J

2014-07-29

Health impact assessment (HIA) studies are increasingly predicting the health effects of mode shifts in traffic. The challenge for such studies is to combine the health effects, caused by injuries, with the disease driven health effects, and to express the change in the health with a common health indicator. Disability-adjusted life year (DALY) combines years lived disabled or injured (YLD) and years of life lost (YLL) providing practical indicator to combine injuries with diseases. In this study, we estimate the average YLDs for one person injured in a transport crash to allow easy to use methods to predict health effects of transport injuries. We calculated YLDs and YLLs for transport fatalities and injuries based on the data from the Swedish Traffic Accident Data Acquisition (STRADA). In STRADA, all the fatalities and most of the injuries in Sweden for 2007-2011 were recorded. The type of injury was recorded with the Abbreviated Injury Scale (AIS) codes. In this study these AIS codes were aggregated to injury types, and YLDs were calculated for each victim by multiplying the type of injury with the disability weight and the average duration of that injury. YLLs were calculated by multiplying the age of the victim with life expectancy of that age and gender. YLDs and YLLs were estimated separately for different gender, mode of transport and location of the crash. The average YLDs for injured person was 14.7 for lifelong injuries and 0.012 for temporal injuries. The average YLDs per injured person for lifelong injuries for pedestrians, cyclists and car occupants were 9.4, 12.8 and 18.4, YLDs, respectively. Lifelong injuries sustained in rural areas were on average 31% more serious than injuries in urban areas. The results show that shifting modes of transport will not only change the likelihood of injuries but also the severity of injuries sustained, if injured. The results of this study can be used to predict DALY changes in HIA studies that take into account

The correlation between pedestrian injury severity in real-life crashes and Euro NCAP pedestrian test results.

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Strandroth, Johan; Rizzi, Matteo; Sternlund, Simon; Lie, Anders; Tingvall, Claes

2011-12-01

The aim of the present study was to estimate the correlation between Euro NCAP pedestrian rating scores and injury outcome in real-life car-to-pedestrian crashes, with special focus on long-term disability. Another aim was to determine whether brake assist (BA) systems affect the injury outcome in real-life car-to-pedestrian crashes and to estimate the combined effects in injury reduction of a high Euro NCAP ranking score and BA. In the current study, the Euro NCAP pedestrian scoring was compared with the real-life outcome in pedestrian crashes that occurred in Sweden during 2003 to 2010. The real-life crash data were obtained from the data acquisition system Swedish Traffic Accident Data Acquisition (STRADA), which combines police records and hospital admission data. The medical data consisted of International Classification of Diseases (ICD) diagnoses and Abbreviated Injury Scale (AIS) scoring. In all, approximately 500 pedestrians submitted to hospital were included in the study. Each car model was coded according to Euro NCAP pedestrian scores. In addition, the presence or absence of BA was coded for each car involved. Cars were grouped according to their scoring. Injury outcomes were analyzed with AIS and, at the victim level, with permanent medical impairment. This was done by translating the injury scores for each individual to the risk of serious consequences (RSC) at 1, 5, and 10 percent risk of disability level. This indicates the total risk of a medical disability for each victim, given the severity and location of injuries. The mean RSC (mRSC) was then calculated for each car group and t-tests were conducted to falsify the null hypothesis at p ≤ .05 that the mRSC within the groups was equal. The results showed a significant reduction of injury severity for cars with better pedestrian scoring, although cars with a high score could not be studied due to lack of cases. The reduction in RSC for medium-performing cars in comparison with low-performing cars

Predicting renal recovery after liver transplant with severe pretransplant subacute kidney injury: The impact of warm ischemia time.

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Laskey, Heather L; Schomaker, Nathan; Hung, Kenneth W; Asrani, Sumeet K; Jennings, Linda; Nydam, Trevor L; Gralla, Jane; Wiseman, Alex; Rosen, Hugo R; Biggins, Scott W

2016-08-01

Identifying which liver transplantation (LT) candidates with severe kidney injury will have a full recovery of renal function after liver transplantation alone (LTA) is difficult. Avoiding unnecessary simultaneous liver-kidney transplantation (SLKT) can optimize the use of scarce kidney grafts. Incorrect predictions of spontaneous renal recovery after LTA can lead to increased morbidity and mortality. We retrospectively analyzed all LTA patients at our institution from February 2002 to February 2013 (n = 583) and identified a cohort with severe subacute renal injury (n = 40; creatinine <2 mg/dL in the 14-89 days prior to LTA and not on renal replacement therapy [RRT] yet, ≥2 mg/dL within 14 days of LTA and/or on RRT). Of 40 LTA recipients, 26 (65%) had renal recovery and 14 (35%) did not. The median (interquartile range) warm ischemia time (WIT) in recipients with and without renal recovery after LTA was 31 minutes (24-46 minutes) and 39 minutes (34-49 minutes; P = 0.02), respectively. Adjusting for the severity of the subacute kidney injury with either Acute Kidney Injury Network or Risk, Injury, Failure, Loss, and End-Stage Kidney Disease criteria, increasing WIT was associated with lack of renal recovery (serum creatinine <2 mg/dL after LTA, not on RRT), with an odds ratio (OR) of 1.08 (1.01-1.16; P = 0.03) and 1.09 (1.01-1.17; P = 0.02), respectively. For each minute of increased WIT, there was an 8%-9% increase in the risk of lack of renal recovery after LTA. In a separate cohort of 98 LTA recipients with subacute kidney injury, we confirmed the association of WIT and lack of renal recovery (OR, 1.04; P = 0.04). In LT candidates with severe subacute renal injury, operative measures to minimize WIT may improve renal recovery potentially avoiding RRT and the need for subsequent kidney transplant. Liver Transplantation 22 1085-1091 2016 AASLD. © 2016 American Association for the Study of Liver Diseases.

Artesunate Protects Against the Organ Injury and Dysfunction Induced by Severe Hemorrhage and Resuscitation.

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Sordi, Regina; Nandra, Kiran K; Chiazza, Fausto; Johnson, Florence L; Cabrera, Claudia P; Torrance, Hew D; Yamada, Noriaki; Patel, Nimesh S A; Barnes, Michael R; Brohi, Karim; Collino, Massimo; Thiemermann, Christoph

2017-02-01

To evaluate the effects of artesunate on organ injury and dysfunction associated with hemorrhagic shock (HS) in the rat. HS is still a common cause of death in severely injured patients and is characterized by impairment of organ perfusion, systemic inflammatory response, and multiple organ failure. There is no specific therapy that reduces organ injury/dysfunction. Artesunate exhibits pharmacological actions beyond its antimalarial activity, such as anticancer, antiviral, and anti-inflammatory effects. Rats were submitted to HS. Mean arterial pressure was reduced to 30 mm Hg for 90 minutes, followed by resuscitation. Rats were randomly treated with artesunate (2.4 or 4.8 mg/kg i.v.) or vehicle upon resuscitation. Four hours later, parameters of organ injury and dysfunction were assessed. Artesunate attenuated the multiple organ injury and dysfunction caused by HS. Pathway analysis of RNA sequencing provided good evidence to support an effect of artesunate on the Akt-survival pathway, leading to downregulation of interleukin-1 receptor-associated kinase 1. Using Western blot analysis, we confirmed that treatment of HS rats with artesunate enhanced the phosphorylation (activation) of Protein kinase B (Akt) and endothelial nitric oxide synthase and the phosphorylation (inhibition) of glycogen synthase kinase-3β (GSK-3β). Moreover, artesunate attenuated the HS-induced activation of nuclear factor kappa B and reduced the expression of proinflammatory proteins (inducible nitric oxide synthase, tumor necrosis factor-α, and interleukin 6). Artesunate attenuated the organ injury/dysfunction associated with HS by a mechanism that involves the activation of the Akt-endothelial nitric oxide synthase survival pathway, and the inhibition of glycogen synthase kinase-3β and nuclear factor kappa B. A phase II clinical trial evaluating the effects of good manufacturing practice-artesunate in patients with trauma and severe hemorrhage is planned.

Increasing number of fractured ribs is not predictive of the severity of splenic injury following blunt trauma: an analysis of a National Trauma Registry database.

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Boris, Kessel; Forat, Swaid; Itamar, Ashkenazi; Oded, Olsha; Kobi, Peleg; Adi, Givon; Igor, Jeroukhimov; Ricardo, Alfici

2014-05-01

Association between rib fractures and incidence of abdominal solid organs injury is well described. However, the correlation between the number of fractured ribs and severity of splenic injury is not clear. The purpose of this study was to assess whether an increasing number of rib fractures predicts the severity of splenic injury in blunt trauma patients. A retrospective cohort study involving blunt trauma patients with concomitant splenic injuries and rib fractures, between the years 1998 and 2012, registered in the Israeli National Trauma Registry. Of 321,618 patients with blunt mechanism of trauma, 57,130 had torso injuries, and of these 14,651 patients sustained rib fractures, and 3691 patients suffered from splenic injury. Concomitant splenic injury occurred in 1326 of the patients with rib fractures (9.1%), as compared to 2365 patients sustaining splenic injury without rib fractures (5.6%). The incidence of splenic injury among patients sustaining 5 or more rib fractures was significantly higher compared to patients suffering from 1 to 4 rib fractures. Among patients with splenic injury, the tendency to sustain associated rib fractures increased steadily with age. Patients with concomitant rib fractures had higher Injury Severity Score (ISS), but similar mortality rates, compared to patients with splenic injury without rib fractures. Among patients with concomitant rib fractures and splenic injury, there was no relation between the number of fractured ribs and the severity of splenic injury, neither as a whole group, nor after stratification according to the mechanism of injury. Although the presence of rib fractures increases the probability of splenic injury in blunt torso trauma, there is no relation between the number of fractured ribs and splenic injury severity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Symptom severity and life satisfaction in brain injury: The mediating role of disability acceptance and social self-efficacy.

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Ditchman, Nicole; Sung, Connie; Easton, Amanda B; Johnson, Kristina S; Batchos, Elisabeth

2017-01-01

Although the negative impact of symptom severity on subjective well-being outcomes has been established among individuals with brain injury, the mediating and protective role that positive human traits might have on this relationship has not been adequately explored. The purpose of this study was to examine the impact of social self-efficacy and disability acceptance on the relationship between symptom severity and life satisfaction among individuals with brain injury. Hierarchical regression analysis and correlation techniques were used to test a hypothesized dual-mediation model of life satisfaction in a sample of 105 adults with acquired brain injury. Results indicated that social self-efficacy and disability acceptance fully mediated the relationship between symptom severity and life satisfaction, lending support for a dual-mediation model with disability acceptance being the strongest contributor. These findings suggest there may be considerable value for rehabilitation providers to develop strengths-based service strategies and/or specialized intervention programs that focus on capitalizing these positive human traits to promote life satisfaction and well-being for clients with brain injury. Implications for clinical practice and future research direction are also discussed.

Several issues regarding evaluation of renal injury and renal insufficiency in patients with liver disease

Directory of Open Access Journals (Sweden)

HAO Kunyan

2016-07-01

Full Text Available In patients with liver disease such as viral hepatitis and liver cirrhosis, renal injury and renal insufficiency can be generally classified as acute kidney injury (AKI, chronic kidney disease, and acute-on-chronic nephropathy. AKI can be classified as stage 1 (risk stage, stage 2 (injury stage, and stage 3 (failure stage. Traditionally hepatorenal syndrome is classified as types Ⅰ and Ⅱ, and in recent years, type Ⅲ hepatorenal syndrome with organic renal injury has been proposed. Hepatorenal disorder(HRD is used to describe any renal disease which occurs in patients with liver cirrhosis. At present, sensitive and accurate biochemical parameters used to evaluate renal function in patients with liver disease in clinical practice include estimated glomerular filtration rate, increase in serum creatinine within unit time, and serum cystatin C level, and urinary microalbumin level also plays an important role in the early diagnosis of nephropathy. Causes of liver disease, severity, complications including infection, nutritional status, therapeutic drugs, and underlying nephropathy may be associated with renal injury and renal insufficiency in patients with liver disease and should be differentiated.

Tracheostomy is associated with decreased hospital mortality after moderate or severe isolated traumatic brain injury.

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Baron, David Marek; Hochrieser, Helene; Metnitz, Philipp G H; Mauritz, Walter

2016-06-01

Data regarding the impact and timing of tracheostomy in patients with isolated traumatic brain injury (TBI) are ambiguous. Our goal was to evaluate the impact of tracheostomy on hospital mortality in patients with moderate or severe isolated TBI. We performed a retrospective cohort analysis of data prospectively collected at 87 Austrian intensive care units (ICUs). All patients continuously admitted between 1998 and 2010 were evaluated for the study. In total, 4,735 patients were admitted to ICUs with isolated TBI. Of these patients, 2,156 had a moderate or severe TBI (1,603 patients were endotracheally intubated only, 553 patients underwent tracheostomy). Epidemiological data (trauma severity, treatment, and outcome) of the two groups were compared. Patients with moderate or severe isolated TBI undergoing tracheostomy had a similar Glasgow Coma Scale score, median (interquartile range): 6 (3-8) vs 6 (3-8); p = 0.90, and Simplified Acute Physiology Score II, 45 (37-54) vs 45 (35-56); p = 0.86, compared with intubated patients not undergoing tracheostomy. Furthermore, patients undergoing tracheostomy exhibited higher Abbreviated Injury Scale Head scores and had a longer ICU stay for survivors, 30 (22-42) vs 9 (3-17) days; p tracheostomy compared with patients who remained intubated, observed-to-expected mortality ratio (95 % confidence interval): 0.62 (0.53-0.72) vs 1.00 (0.95-1.05) respectively. Despite the greater severity of head injury, patients with isolated TBI who underwent tracheostomy had a lower risk-adjusted mortality than patients who remained intubated. Reasons for this difference in outcome may be multifactorial and require further investigation.

Elastin: a possible genetic biomarker for more severe ligament injuries in elite soccer. A pilot study

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Artells, Rosa; Pruna, Ricard; Dellal, Alexandre; Maffulli, Nicola

2016-01-01

Summary Background The study of new genetic biomarkers in genes related to connective tissue repair and regeneration may help to identify individuals with greater predisposition to injury, who may benefit from targeted preventive measures, and those who require longer recovery time following a muscle, ligament or tendon injury. The present study investigated whether single nucleotide polymorphisms of the Elastin gene could be related to MCL injury. Methods 60 top class football players were studied to identify single nucleotide polymorphisms for the Elastin (ELN) gene using Allelic Discrimination analysis. Each player was followed for 7 seasons, and each MCL injury was noted. Results Ligament injury rate, severity and recovery time are related to specific genotypes observed in the elastin gene, especially the ELN-AA (16 MCL) and the ELN-AG (3 MCL). Players with the ELN-GG genotype sustained no MCL injury during the 7 seasons of the study. Conclusions The identification of polymorphisms in the ELN gene may be used as a novel tool to better define an athlete’s genotype, and help to plan training and rehabilitation programmes to prevent or minimize MCL ligament injuries, and optimize the therapeutic and rehabilitation process after soft tissue injuries, and manage the workloads during trainings and matches. PMID:27900291

Sodium butyrate protects against severe burn-induced remote acute lung injury in rats.

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Xun Liang

Full Text Available High-mobility group box 1 protein (HMGB1, a ubiquitous nuclear protein, drives proinflammatory responses when released extracellularly. It plays a key role as a distal mediator in the development of acute lung injury (ALI. Sodium butyrate, an inhibitor of histone deacetylase, has been demonstrated to inhibit HMGB1 expression. This study investigates the effect of sodium butyrate on burn-induced lung injury. Sprague-Dawley rats were divided into three groups: 1 sham group, sham burn treatment; 2 burn group, third-degree burns over 30% total body surface area (TBSA with lactated Ringer's solution for resuscitation; 3 burn plus sodium butyrate group, third-degree burns over 30% TBSA with lactated Ringer's solution containing sodium butyrate for resuscitation. The burned animals were sacrificed at 12, 24, and 48 h after burn injury. Lung injury was assessed in terms of histologic changes and wet weight to dry weight (W/D ratio. Tumor necrosis factor (TNF-α and interleukin (IL-8 protein concentrations in bronchoalveolar lavage fluid (BALF and serum were measured by enzyme-linked immunosorbent assay, and HMGB1 expression in the lung was determined by Western blot analysis. Pulmonary myeloperoxidase (MPO activity and malondialdehyde (MDA concentration were measured to reflect neutrophil infiltration and oxidative stress in the lung, respectively. As a result, sodium butyrate significantly inhibited the HMGB1 expressions in the lungs, reduced the lung W/D ratio, and improved the pulmonary histologic changes induced by burn trauma. Furthermore, sodium butyrate administration decreased the TNF-α and IL-8 concentrations in BALF and serum, suppressed MPO activity, and reduced the MDA content in the lungs after severe burn. These results suggest that sodium butyrate attenuates inflammatory responses, neutrophil infiltration, and oxidative stress in the lungs, and protects against remote ALI induced by severe burn, which is associated with inhibiting HMGB1

Severity of upper-limb panga injuries and infection rates associated ...

African Journals Online (AJOL)

The injuries sustained included 32 flexor tendon injuries, 14 extensor tendon injuries, 9 fractures and 21 peripheral nerve injuries. Results. Of the patients, 17 underwent early primary repair (within 24 h), 19 delayed primary repair, and 13 delayed repair following primary washout. Wounds were assessed postoperatively ...

Moderate to severe injuries in football: a one-year prospective study of twenty-four female and male amateur teams.

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Lion, Alexis; Theisen, Daniel; Windal, Thierry; Malisoux, Laurent; Nührenbörger, Christian; Huberty, Robert; Urhausen, Axel; Seil, Romain

2014-01-01

This study aimed to realize a prospective follow-up of the injuries occurring in female and male football players involved in the highest league in the Grand-Duchy of Luxembourg. Data concerning anthropometric characteristics and football activities were gathered in 125 female and 243 male football players via questionnaires at the beginning of the study. Then, a follow-up of moderate to severe injuries (> 15 days of interruption in football practice) was performed throughout the season 2013-2014. Sixteen injuries (injury incidence = 0.7 injuries/1000 h of exposure) were observed in 13 female football players (10.4%). These injuries concerned mainly the knee (n = 7; 43.7%), with capsules and ligaments being the most often concerned tissues (n = 7; 43.7%). In male football players, 41 severe injuries (injury incidence = 0.6 injuries/1000 h of exposure) were observed in 36 players (14.8%). These injuries concerned mainly the thighs (n = 12; 29.3%) and the muscles and tendons were the most often concerned tissues (n = 18; 43.9%). Injuries in football are predominantly located at the lower limbs, particularly the knees in female football players. The predominant muscle and tendon lesions of the thighs occurring in males could reveal that physical preparation is insufficient or inadequate for a number of players. Regarding these results, it is necessary to implement an injury prevention strategy. The "FIFA 11+" programme could be used as the basic method, but should be personalized according to sex. The injury collection methodology could be optimized with the use of an electronic database, such as the Training and Injury Prevention Platform for Sports (TIPPS). Beside the systematic recording of injury data (as well as the training load) by the players or the medical staff, this system allows to share of important information between stakeholders, follow-up the players, provide risk factor warnings and increase the awareness of the injury problem.

The Effect of Blood Loss in the Presence and Absence of Severe Soft Tissue Injury on Hemodynamic and Metabolic Parameters; an Experimental study

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Ali Mohammad Moradi

2014-09-01

Full Text Available Introduction: The effect of severe soft tissue injury on the severity of hemorrhagic shock is still unknown. Therefore, the present study was aimed to determine hemodynamic and metabolic changes in traumatic/hemorrhagic shock in an animal model. Methods: Forty male rats were randomly divided into 4 equal groups including sham, hemorrhagic shock, soft tissue injury, and hemorrhagic shock + soft tissue injury groups. The changes in blood pressure, central venous pressure (CVP level, acidity (pH, and base excess were dynamically monitored and comparedsented. Results: Mean arterial blood pressure decreased significantly in hemorrhagic shock (df: 12; F=10.9; p<0.001 and severe soft tissue injury + hemorrhagic shock (df: 12; F=11.7; p<0.001 groups 15 minutes and 5 minutes after injury, respectively. A similar trend was observed in CVP in severe soft tissue injury + hemorrhagic shock group (df: 12; F=8.9; p<0.001. After 40 minutes, pH was significantly lower in hemorrhagic shock (df: 12; F=6.8; p=0.009 and severe soft tissue injury + hemorrhagic shock (df: 12; F=7.9; p=0.003 groups. Base excess changes during follow ups have a similar trend. (df: 12; F=11.3; p<0.001. Conclusion: The results of this study have shown that the effect of hemorrhage on the decrease of mean arterial blood pressure, CVP, pH, and base excess is the same in the presence or absence of soft tissue injury.

Severe Aplastic Anemia following Acute Hepatitis from Toxic Liver Injury: Literature Review and Case Report of a Successful Outcome

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Kamran Qureshi

2014-01-01

Full Text Available Hepatitis associated aplastic anemia (HAAA is a rare syndrome in which severe aplastic anemia (SAA complicates the recovery of acute hepatitis (AH. HAAA is described to occur with AH caused by viral infections and also with idiopathic cases of AH and no clear etiology of liver injury. Clinically, AH can be mild to fulminant and transient to persistent and precedes the onset SAA. It is assumed that immunologic dysregulation following AH leads to the development of SAA. Several observations have been made to elucidate the immune mediated injury mechanisms, ensuing from liver injury and progressing to trigger bone marrow failure with the involvement of activated lymphocytes and severe T-cell imbalance. HAAA has a very poor outcome and often requires bone marrow transplant (BMT. The findings of immune related myeloid injury implied the use of immunosuppressive therapy (IST and led to improved survival from HAAA. We report a case of young male who presented with AH resulting from the intake of muscle building protein supplements and anabolic steroids. The liver injury slowly resolved with supportive care and after 4 months of attack of AH, he developed SAA. He was treated with IST with successful outcome without the need for a BMT.

Tensor-Based Morphometry Reveals Volumetric Deficits in Moderate=Severe Pediatric Traumatic Brain Injury.

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Dennis, Emily L; Hua, Xue; Villalon-Reina, Julio; Moran, Lisa M; Kernan, Claudia; Babikian, Talin; Mink, Richard; Babbitt, Christopher; Johnson, Jeffrey; Giza, Christopher C; Thompson, Paul M; Asarnow, Robert F

2016-05-01

Traumatic brain injury (TBI) can cause widespread and prolonged brain degeneration. TBI can affect cognitive function and brain integrity for many years after injury, often with lasting effects in children, whose brains are still immature. Although TBI varies in how it affects different individuals, image analysis methods such as tensor-based morphometry (TBM) can reveal common areas of brain atrophy on magnetic resonance imaging (MRI), secondary effects of the initial injury, which will differ between subjects. Here we studied 36 pediatric moderate to severe TBI (msTBI) participants in the post-acute phase (1-6 months post-injury) and 18 msTBI participants who returned for their chronic assessment, along with well-matched controls at both time-points. Participants completed a battery of cognitive tests that we used to create a global cognitive performance score. Using TBM, we created three-dimensional (3D) maps of individual and group differences in regional brain volumes. At both the post-acute and chronic time-points, the greatest group differences were expansion of the lateral ventricles and reduction of the lingual gyrus in the TBI group. We found a number of smaller clusters of volume reduction in the cingulate gyrus, thalamus, and fusiform gyrus, and throughout the frontal, temporal, and parietal cortices. Additionally, we found extensive associations between our cognitive performance measure and regional brain volume. Our results indicate a pattern of atrophy still detectable 1-year post-injury, which may partially underlie the cognitive deficits frequently found in TBI.

Quetiapine Induced Acute Dystonia in a patient with History of severe Head Injury

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Robert G. Bota

2010-01-01

Full Text Available A patient with a history of severe head injury 10 years ago regained ability to walk after years of being bound to a wheelchair. During the last psychiatric hospitalization, quetiapine was increased to therapeutic dose using a normal titration. As a result the patient developed dystonia of multiple muscle groups requiring 4 days of hospitalization for remittance of symptoms. In this paper, we take a close look at the literature concerning extrapiramidal symptoms (EPS in this context, and we suggest that in patients with a history of head injury, it is warranted to consider a slower titration of antipsychotic medications, including ones that are considered having a lower risk of EPS such as quetiapine.

Cardiopulmonary bypass after severe blunt hepatic injury: management of multi-system blunt trauma in an adolescent.

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Streit, Stephanie; Kavarana, Minoo; Scheurer, Mark A; Cina, Robert A

2013-06-01

A 16-year-old adolescent male sustained combined injuries to the tricuspid valve and liver. This injury is exceptional due to the mechanism and the circumstances in which it took place: a flying pumpkin thrown from a sport utility vehicle. An echocardiogram demonstrated a flail chordal apparatus associated with the posterior leaflet of the tricuspid valve, creating substrate for severe tricuspid regurgitation with preserved right heart function. He was treated with non-operative management for the liver injury; he remained hemodynamically stable and was discharged home. He underwent successful repair of the tricuspid valve 17 days following the initial injury necessitating systemic anticoagulation and was discharged home two days later. The patient recovered fully without residual valvular pathology or hepatic sequelae. Copyright © 2013 Elsevier Inc. All rights reserved.

Translational research to improve the treatment of severe extremity injuries.

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Brown, Kate V; Penn-Barwell, J G; Rand, B C; Wenke, J C

2014-06-01

Severe extremity injuries are the most significant injury sustained in combat wounds. Despite optimal clinical management, non-union and infection remain common complications. In a concerted effort to dovetail research efforts, there has been a collaboration between the UK and USA, with British military surgeons conducting translational studies under the auspices of the US Institute of Surgical Research. This paper describes 3 years of work. A variety of studies were conducted using, and developing, a previously validated rat femur critical-sized defect model. Timing of surgical debridement and irrigation, different types of irrigants and different means of delivery of antibiotic and growth factors for infection control and to promote bone healing were investigated. Early debridement and irrigation were independently shown to reduce infection. Normal saline was the most optimal irrigant, superior to disinfectant solutions. A biodegradable gel demonstrated superior antibiotic delivery capabilities than standard polymethylmethacrylate beads. A polyurethane scaffold was shown to have the ability to deliver both antibiotics and growth factors. The importance of early transit times to Role 3 capabilities for definitive surgical care has been underlined. Novel and superior methods of antibiotic and growth factor delivery, compared with current clinical standards of care, have been shown. There is the potential for translation to clinical studies to promote infection control and bone healing in these devastating injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy

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Pagnozzi, Alex M.; Fiori, Simona; Boyd, Roslyn N.; Guzzetta, Andrea; Doecke, James; Rose, Stephen; Dowson, Nicholas; Gal, Yaniv

2016-01-01

Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach. (orig.)

Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy.

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Pagnozzi, Alex M; Fiori, Simona; Boyd, Roslyn N; Guzzetta, Andrea; Doecke, James; Gal, Yaniv; Rose, Stephen; Dowson, Nicholas

2016-02-01

Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach.

Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy

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Pagnozzi, Alex M. [Royal Brisbane and Women' s Hospital, CSIRO Digital Productivity and Services Flagship, The Australian e-Health Research Centre, Herston, QLD (Australia); The University of Queensland, School of Medicine, Brisbane (Australia); Fiori, Simona [Stella Maris Scientific Institute, Pisa (Italy); Boyd, Roslyn N. [The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Brisbane (Australia); Guzzetta, Andrea [Stella Maris Scientific Institute, Pisa (Italy); University of Pisa, Department of Clinical and Experimental Medicine, Pisa (Italy); Doecke, James; Rose, Stephen; Dowson, Nicholas [Royal Brisbane and Women' s Hospital, CSIRO Digital Productivity and Services Flagship, The Australian e-Health Research Centre, Herston, QLD (Australia); Gal, Yaniv [The University of Queensland, Centre for Medical Diagnostic Technologies in Queensland, Brisbane (Australia)

2016-02-15

Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach. (orig.)

Severe Traumatic Brain Injury, Frontal Lesions, and Social Aspects of Language Use: A Study of French-Speaking Adults

Science.gov (United States)

Dardier, Virginie; Bernicot, Josie; Delanoe, Anaig; Vanberten, Melanie; Fayada, Catherine; Chevignard, Mathilde; Delaye, Corinne; Laurent-Vannier, Anne; Dubois, Bruno

2011-01-01

The purpose of this study was to gain insight into the social (pragmatic) aspects of language use by French-speaking individuals with frontal lesions following a severe traumatic brain injury. Eleven participants with traumatic brain injury performed tasks in three areas of communication: production (interview situation), comprehension (direct…

Etiology of Infectious Complications and Antibiotic-Resistance of Major Causative Agents in Victims with Severe Injury

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T. A. Vasina

2007-01-01

Full Text Available Objective: to analyze the spectrum of major pathogens of infectious complications in patients with concomitant injury.Materials and methods. 560 biological samples taken from 331 patients were bacteriologically studied. A significant reduction in the isolation frequency of Pseudomonas aeruginosa and an increase in etiological role of Staphylococcus aureus were ascertained in victims with severe injury and concomitant infectious complications during long-term 1982—1984 and 2002—2004 follow-ups.Results. The significant pathogens of infectious complications in concomitant injuries are Staphylococcus aureus, Klebsiella and Escherichia coli. Vancomycin, imipenem/cilastatin, and amikacin are shown to be the most effective drugs for early antibiotic therapy. Thus, the findings reflect structural changes in the leading causative agents of infectious complications in victims with severe injury. If their principal pathogen was Pseudomonas aeruginosa in the 1990s, Staphylococcus aureus and representatives in the colibacillus group prevail today. This supports and generates a need for continuous microbiological monitoring of the causative agents of pyoin-flammatory complications in intensive care units wherein patients with immunosuppression are also present. Pathogen monitoring makes it possible to apply of a well-grounded and rational package of preventive and therapeutic measures and to perform early target antibiotic therapy. 

A comprehensive picture of 4-year outcome of severe brain injuries. Results from the PariS-TBI study.

Science.gov (United States)

Jourdan, C; Bayen, E; Pradat-Diehl, P; Ghout, I; Darnoux, E; Azerad, S; Vallat-Azouvi, C; Charanton, J; Aegerter, P; Ruet, A; Azouvi, P

2016-04-01

Survivors of severe traumatic brain injury have a great variety of impairments and participation restrictions. Detailed descriptions of their long-term outcome are critical. We aimed to assess brain injury outcome for subjects with traumatic brain injury in terms of the International classification of functioning, disability and health. Four-year follow-up of an inception cohort of adults with severe traumatic brain injury by using face-to-face interviews with patients and proxies. Among 245 survivors at 4 years, 147 were evaluated (80% male, mean age: 32.5±14.2 years at injury); 46 (32%) presented severe disability, 58 (40%) moderate disability, and 40 (28%) good recovery. Most frequent somatic problems were fatigue, headaches, other pain, and balance. One quarter of subjects had motor impairments. Rates of cognitive complaints ranged from 25 to 68%, the most frequent being memory, irritability, slowness and concentration. With the Hospital Anxiety and Depression Scale, 43% had anxiety and 25% depression. Overall, 79% were independent in daily living activities and 40 to 50% needed help for outdoor or organizational activities on the BICRO-39. Most had regular contacts with relatives or close friends but few contacts with colleagues or new acquaintances. Subjects spent little time in productive activities such as working, studying, looking after children or voluntary work. Quality of life on the QOLIBRI scale was associated with disability level (Plife. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The association of functional oral intake and pneumonia in patients with severe Traumatic Brain Injury

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Schow, Trine; Larsen, Klaus; Engberg, Aase Worså

Abstract Objective(s): This study investigates the incidence and onset time of pneumonia for patients with severe Traumatic Brain Injury (TBI) in the early phase of rehabilitation, and identifies parameters associated with the risk of pneumonia. Design: Observational retrospective cohort study....... Setting: A subacute rehabilitation department, university hospital, Denmark. Participants: One-hundred and seventy-three patients aged 16-65 years with severe TBI admitted over a 5-year period. Patients are transferred to the Brain Injury Unit (BIU) as soon as they ventilate spontaneously. Intervention......: None Main Outcome Measure(s): Pneumonia. Results: Twenty-seven percent (27%) of the patients admitted to the BIU were in treatment for pneumonia and 12% developed pneumonia during rehabilitation, all but one within 19 days of admission. Of these patients, 81% received nothing by mouth. Three factors...

Analysis of factors associated with injury severity in crashes involving young New Zealand drivers

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Weiss, Harold B.; Kaplan, Sigal; Prato, Carlo Giacomo

2014-01-01

measures within youth-oriented road safety programs. The current study estimates discrete choice models of injury severity of crashes involving young drivers conditional on these crashes having occurred. The analysis examined a comprehensive set of single-vehicle and two-vehicle crashes involving at least...

Depression, anxiety and quality-of-life among relatives of patients with severe brain injury

DEFF Research Database (Denmark)

Norup, Anne; Welling, Karen-Lise; Qvist, Jesper

2012-01-01

Primary objective: To investigate the emotional well-being of relatives of patients with a severe brain injury in the acute setting, as well as risk factors associated with high anxiety and depression scores and impaired quality-of-life. Research design: Clinical convenience sample. Methods...

Temporal Profile of Microtubule-Associated Protein 2: A Novel Indicator of Diffuse Brain Injury Severity and Early Mortality after Brain Trauma.

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Papa, Linda; Robicsek, Steven A; Brophy, Gretchen M; Wang, Kevin K W; Hannay, H Julia; Heaton, Shelley; Schmalfuss, Ilona; Gabrielli, Andrea; Hayes, Ronald L; Robertson, Claudia S

2018-01-01

This study compared cerebrospinal fluid (CSF) levels of microtubule-associated protein 2 (MAP-2) from adult patients with severe traumatic brain injury (TBI) with uninjured controls over 10 days, and examined the relationship between MAP-2 concentrations and acute clinical and radiologic measures of injury severity along with mortality at 2 weeks and over 6 months. This prospective study, conducted at two Level 1 trauma centers, enrolled adults with severe TBI (Glasgow Coma Scale [GCS] score ≤8) requiring a ventriculostomy, as well as controls. Ventricular CSF was sampled from each patient at 6, 12, 24, 48, 72, 96, 120, 144, 168, 192, 216, and 240 h following TBI and analyzed via enzyme-linked immunosorbent assay for MAP-2 (ng/mL). Injury severity was assessed by the GCS score, Marshall Classification on computed tomography (CT), Rotterdam CT score, and mortality. There were 151 patients enrolled-130 TBI and 21 control patients. MAP-2 was detectable within 6 h of injury and was significantly elevated compared with controls (p < 0.001) at each time-point. MAP-2 was highest within 72 h of injury and decreased gradually over 10 days. The area under the receiver operating characteristic curve for deciphering TBI versus controls at the earliest time-point CSF was obtained was 0.96 (95% CI 0.93-0.99) and for the maximal 24-h level was 0.98 (95% CI 0.97-1.00). The area under the curve for initial MAP-2 levels predicting 2-week mortality was 0.80 at 6 h, 0.81 at 12 h, 0.75 at 18 h, 0.75 at 24 h, and 0.80 at 48 h. Those with Diffuse Injury III-IV had much higher initial (p = 0.033) and maximal (p = 0.003) MAP-2 levels than those with Diffuse Injury I-II. There was a graded increase in the overall levels and peaks of MAP-2 as the degree of diffuse injury increased within the first 120 h post-injury. These data suggest that early levels of MAP-2 reflect severity of diffuse brain injury and predict 2-week mortality in TBI patients. These

Using personality traits to construct linear growth models of mental health in family members of individuals with severe brain injury.

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Trujillo, Michael; Perrin, Paul B; Doser, Karoline; Norup, Anne

2016-11-01

No studies have examined the impact of personality traits on mental health among caregivers of individuals with severe brain injury. Therefore, the purpose of the current study was to construct linear growth models to examine whether the personality traits of family members of individuals with severe brain injury could predict the trajectories of their own mental health-related quality of life (HRQoL), anxiety, and depression beginning in a neurointensive care unit through 1 year after injury. Danish family members of individuals with severe brain injury (n = 52) completed the Short Form-36 assessing mental HRQoL (vitality, social functioning, role limitations-emotional, mental health), anxiety, and depression across 5 time points during the 1st year after injury. The measure of personality was administered 3 months after the patients' discharge. All mental HRQoL, anxiety, and depression variables improved significantly over time. Caregivers who were less neurotic and less conscientious had higher vitality, social functioning, and mental health over time, whereas caregivers who were more agreeable had higher social functioning over time. Caregivers with lower neuroticism had lower anxiety and depression over time, as well as a more accelerated decrease in anxiety and depression. Caregivers' personality traits were strongly associated over time with mental HRQoL, anxiety, and depression, with neuroticism being especially important for trajectories of anxiety and depression. These results suggest that personality assessments for caregivers of individuals with severe brain injury could help identify those most at risk for poor mental health over the course of rehabilitation. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children-An analysis of 52 type IIIB open fractures.

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Venkatadass, K; Grandhi, Tarani Sai Prasanth; Rajasekaran, S

2017-11-01

Open injuries in children are rare compared to adults. In children with major open injuries, there is no specific scoring system to guide when to amputate or salvage the limb. The use of available adult scoring systems may lead to errors in management. The role of Ganga Hospital Open Injury Severity Scoring (GHOISS) for open injuries in adults is well established and its applicability for pediatric open injuries has not been studied. This study was done to analyse the usefulness of GHOISS in pediatric open injuries and to compare it with MESS(Mangled Extremity Severity Score). All children (0-18 years) who were admitted with Open type IIIB injuries of lower limbs between January 2008 and March 2015 were included. MESS and GHOISS were calculated for all the patients. There were 50 children with 52 type IIIB Open injuries of which 39 had open tibial fractures and 13 had open femur fractures. Out of 52 type IIIB open injuries, 48 were salvaged and 4 were amputated. A MESS score of 7 and above had sensitivity of 25% for amputation while GHOISS of 17 and above was found to be more accurate for determining amputation with sensitivity of 75% and specificity of 93.75%. GHOISS is a reliable predictor of injury severity in type IIIB open fractures in children and can be used as a guide for decision-making. The use of MESS score in children has a lower predictive value compared to GHOISS in deciding amputation versus salvage. A GHOISS of 17 or more has the highest sensitivity and specificity to predict amputation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk Factors for Acute Kidney Injury in Severe Rhabdomyolysis

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Rodríguez, Eva; Soler, María J.; Rap, Oana; Barrios, Clara; Orfila, María A.; Pascual, Julio

2013-01-01

Background Acute kidney injury (AKI) is a life-threatening complication of severe rhabdomyolysis. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction. Methods Retrospective observational cohort study with a 9-year follow-up, carried out in an acute-care teaching-affiliated hospital. A total of 126 patients with severe rhabdomyolysis defined as serum creatine kinase (CK) > 5,000 IU/L fulfilled the inclusion criteria. Univariate and logistic regression analyses were performed to determine risk factors for AKI. Based on the values obtained for each variable, a risk score and prognostic probabilities were estimated to establish the risk for developing AKI. Results The incidence of AKI was 58%. Death during hospitalization was significantly higher among patients with AKI, compared to patients without AKI (19.2% vs 3.6%, p = 0.008). The following variables were independently associated with AKI: peak CK (odds ratio [OR] 4.9, 95%CI 1.4-16.8), hypoalbuminemia (rhabdomyolysis may be useful in clinical practice, particularly to implement early preventive measures. PMID:24367578

Early endocrine alterations reflect prolonged stress and relate to one year functional outcome in patients with severe brain injury

DEFF Research Database (Denmark)

Marina, Djordje; Klose, Marianne; Nordenbo, Annette

2015-01-01

OBJECTIVE: Severe brain injury poses a risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective was to assess the pattern and prevalence...

Patterns of triangular fibrocartilage complex (TFCC) injury associated with severely dorsally displaced extra-articular distal radius fractures.

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Scheer, Johan H; Adolfsson, Lars E

2012-06-01

The aim of the study was to examine triangular fibrocartilage (TFCC) injury patterns associated with unstable, extra-articular dorsally displaced distal radius fractures. Twenty adult patients with an Arbeitsgemeinschaft für Osteosynthesefragen (AO), type A2 or A3, distal radius fracture with an initial dorsal angulation greater than 20° were included. Nine had a tip fracture (distal to the base) of the ulnar styloid and 11 had no such fracture. They were all openly explored from an ulnopalmar approach and TFCC injuries were documented. Eleven patients also underwent arthroscopy and intra-articular pathology was recorded. All patients had TFCC lesions of varying severity, having an extensor carpi ulnaris subsheath avulsion in common. Eighteen out of 20 also displayed deep foveal radioulnar ligament lesions, with decreasingly dorsal fibres remaining. The extent of this foveal injury could not be appreciated by radiocarpal arthroscopy. Severe displacement of an extra-articular radius fracture suggests an ulnar-sided ligament injury to the TFCC. The observed lesions concur with findings in a previous cadaver study. The lesions follow a distinct pattern affecting both radioulnar as well as ulnocarpal stabilisers. Copyright © 2012 Elsevier Ltd. All rights reserved.

Tensor-Based Morphometry Reveals Volumetric Deficits in Moderate=Severe Pediatric Traumatic Brain Injury

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Hua, Xue; Villalon-Reina, Julio; Moran, Lisa M.; Kernan, Claudia; Babikian, Talin; Mink, Richard; Babbitt, Christopher; Johnson, Jeffrey; Giza, Christopher C.; Thompson, Paul M.; Asarnow, Robert F.

2016-01-01

Abstract Traumatic brain injury (TBI) can cause widespread and prolonged brain degeneration. TBI can affect cognitive function and brain integrity for many years after injury, often with lasting effects in children, whose brains are still immature. Although TBI varies in how it affects different individuals, image analysis methods such as tensor-based morphometry (TBM) can reveal common areas of brain atrophy on magnetic resonance imaging (MRI), secondary effects of the initial injury, which will differ between subjects. Here we studied 36 pediatric moderate to severe TBI (msTBI) participants in the post-acute phase (1–6 months post-injury) and 18 msTBI participants who returned for their chronic assessment, along with well-matched controls at both time-points. Participants completed a battery of cognitive tests that we used to create a global cognitive performance score. Using TBM, we created three-dimensional (3D) maps of individual and group differences in regional brain volumes. At both the post-acute and chronic time-points, the greatest group differences were expansion of the lateral ventricles and reduction of the lingual gyrus in the TBI group. We found a number of smaller clusters of volume reduction in the cingulate gyrus, thalamus, and fusiform gyrus, and throughout the frontal, temporal, and parietal cortices. Additionally, we found extensive associations between our cognitive performance measure and regional brain volume. Our results indicate a pattern of atrophy still detectable 1-year post-injury, which may partially underlie the cognitive deficits frequently found in TBI. PMID:26393494

Internal vacuum-assisted closure device in the swine model of severe liver injury

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Everett Christopher B

2012-12-01

Full Text Available Abstract Objectives The authors present a novel approach to nonresectional therapy in major hepatic trauma utilizing intraabdominal perihepatic vacuum assisted closure (VAC therapy in the porcine model of Grade V liver injury. Methods A Grade V injury was created in the right lobe of the liver in a healthy pig. A Pringle maneuver was applied (4.5 minutes total clamp time and a vacuum assisted closure device was placed over the injured lobe and connected to suction. The device consisted of a perforated plastic bag placed over the liver, followed by a 15 cm by 15cm VAC sponge covered with a nonperforated plastic bag. The abdomen was closed temporarily. Blood loss, cardiopulmonary parameters and bladder pressures were measured over a one-hour period. The device was then removed and the animal was euthanized. Results Feasibility of device placement was demonstrated by maintenance of adequate vacuum suction pressures and seal. VAC placement presented no major technical challenges. Successful control of ongoing liver hemorrhage was achieved with the VAC. Total blood loss was 625 ml (20ml/kg. This corresponds to class II hemorrhagic shock in humans and compares favorably to previously reported estimated blood losses with similar grade liver injuries in the swine model. No post-injury cardiopulmonary compromise or elevated abdominal compartment pressures were encountered, while hepatic parenchymal perfusion was maintained. Conclusion These data demonstrate the feasibility and utility of a perihepatic negative pressure device for the treatment of hemorrhage from severe liver injury in the porcine model.

Patellofemoral Instability in Children: Correlation Between Risk Factors, Injury Patterns, and Severity of Cartilage Damage.

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Kim, Hee Kyung; Shiraj, Sahar; Kang, Chang Ho; Anton, Christopher; Kim, Dong Hoon; Horn, Paul S

2016-06-01

The purpose of this study was to compare MRI findings between groups with and without patellofemoral instability and to correlate the MRI findings with the severity of patellar cartilage damage. Fifty-three children with patellofemoral instability and 53 age- and sex-matched children without patellofemoral instability (15.9 ± 2.4 years) were included. Knee MRI with T2-weighted mapping was performed. On MR images, femoral trochlear dysplasia, patellofemoral malalignment, medial retinaculum injury, and bone marrow edema were documented. The degree of patellar cartilage damage was evaluated on MR images by use of a morphologic grading scale (0-4) and on T2 maps with mean T2 values at the medial, central, and lateral facets. MRI findings were compared between the two groups. In cases of patellofemoral instability, MRI findings were correlated with the severity of cartilage damage at each region. Trochlear structure and alignment were significantly different between the two groups (Wilcoxon p patellofemoral instability, a high-riding patella was associated with central patellar cartilage damage with a higher morphologic grade and T2 value (Spearman p patellofemoral instability have significantly different trochlear structure and alignment than those who do not, and these differences are known risk factors for patellofemoral instability. However, the only risk factors or injury patterns that directly correlated with the severity of patellar cartilage damage were patella alta, medial stabilizer injury, and bone marrow edema.

Evaluation of Microvascular Perfusion and Resuscitation after Severe Injury.

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Lee, Yann-Leei L; Simmons, Jon D; Gillespie, Mark N; Alvarez, Diego F; Gonzalez, Richard P; Brevard, Sidney B; Frotan, Mohammad A; Schneider, Andrew M; Richards, William O

2015-12-01

Achieving adequate perfusion is a key goal of treatment in severe trauma; however, tissue perfusion has classically been measured by indirect means. Direct visualization of capillary flow has been applied in sepsis, but application of this technology to the trauma population has been limited. The purpose of this investigation was to compare the efficacy of standard indirect measures of perfusion to direct imaging of the sublingual microcirculatory flow during trauma resuscitation. Patients with injury severity scores >15 were serially examined using a handheld sidestream dark-field video microscope. In addition, measurements were also made from healthy volunteers. The De Backer score, a morphometric capillary density score, and total vessel density (TVD) as cumulative vessel area within the image, were calculated using Automated Vascular Analysis (AVA3.0) software. These indices were compared against clinical and laboratory parameters of organ function and systemic metabolic status as well as mortality. Twenty severely injured patients had lower TVD (X = 14.6 ± 0.22 vs 17.66 ± 0.51) and De Backer scores (X = 9.62 ± 0.16 vs 11.55 ± 0.37) compared with healthy controls. These scores best correlated with serum lactate (TVD R(2) = 0.525, De Backer R(2) = 0.576, P trauma patients, and seems to provide real-time assessment of microcirculatory perfusion. This study suggests that in severe trauma, many indirect measurements of perfusion do not correlate with microvascular perfusion. However, visualized perfusion deficiencies do reflect a shift toward anaerobic metabolism.

Predicting motorcycle crash injury severity using weather data and alternative Bayesian multivariate crash frequency models.

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Cheng, Wen; Gill, Gurdiljot Singh; Sakrani, Taha; Dasu, Mohan; Zhou, Jiao

2017-11-01

Motorcycle crashes constitute a very high proportion of the overall motor vehicle fatalities in the United States, and many studies have examined the influential factors under various conditions. However, research on the impact of weather conditions on the motorcycle crash severity is not well documented. In this study, we examined the impact of weather conditions on motorcycle crash injuries at four different severity levels using San Francisco motorcycle crash injury data. Five models were developed using Full Bayesian formulation accounting for different correlations commonly seen in crash data and then compared for fitness and performance. Results indicate that the models with serial and severity variations of parameters had superior fit, and the capability of accurate crash prediction. The inferences from the parameter estimates from the five models were: an increase in the air temperature reduced the possibility of a fatal crash but had a reverse impact on crashes of other severity levels; humidity in air was not observed to have a predictable or strong impact on crashes; the occurrence of rainfall decreased the possibility of crashes for all severity levels. Transportation agencies might benefit from the research results to improve road safety by providing motorcyclists with information regarding the risk of certain crash severity levels for special weather conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Rehabilitation after severe brain injury: a follow-up study of a behaviour modification approach.

OpenAIRE

Eames, P; Wood, R

1985-01-01

Twenty four patients with severe brain injury who had disturbed behaviours preventing rehabilitation or care in ordinary settings were treated in a token economy. This long-term follow-up study indicates that post-traumatic behaviour disorders can be lastingly improved, and that lengthy rehabilitation can have surprisingly good effects.

The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

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Haghbayan, Hourmazd; Boutin, Amélie; Laflamme, Mathieu; Lauzier, François; Shemilt, Michèle; Moore, Lynne; Zarychanski, Ryan; Douville, Vincent; Fergusson, Dean; Turgeon, Alexis F

2017-12-01

Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury. MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015. Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale. Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation. We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01-3.15; I = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72-3.58; I = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06-5.69; I = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias. MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well

Academic and Behavioral Outcomes in School-Age South African Children Following Severe Traumatic Brain Injury

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Aimee K. Dollman

2017-12-01

Full Text Available Background: Children who have sustained severe traumatic brain injuries (TBIs demonstrate a range of post-injury neurocognitive and behavioral sequelae, which may have adverse effects on their academic and behavioral outcomes and interfere with school re-entry, educational progress, and quality of life. These post-TBI sequelae are exacerbated within the context of a resource-poor country like South Africa (SA where the education system is in a somewhat precarious state especially for those from disadvantaged backgrounds.Objectives: To describe behavioral and academic outcomes of a group of school-aged SA children following severe TBI.Methods: The sample included 27 school-age children who were admitted to the Red Cross War Memorial Children's Hospital (RXH, SA, between 2006 and 2011 for closed severe TBI and who received intracranial monitoring. We collected behavioral data using the Child Behavior Checklist (CBCL and the Behavior Rating Inventory of Executive Function (BRIEF and academic information sourced from the BRIEF, CBCL, medical folders, and caregivers. Analyses include descriptive statistics and bivariate correlation matrices.Results: The descriptive results show that (1 more than half of the participants experienced clinically-significant behavioral problems across the CBCL scales, (2 the working memory BRIEF subscale appeared to be the most problematic subdomain, (3 two thirds of the sample were receiving some form of, or were in the process of being placed in, special needs education, (4 there was a three-fold increase in the use of special education services from pre- to post-injury, and (5 more than half (n = 16 of the sample repeated at least one grade after returning to school post-injury. Correlation analyses results suggest that children with increased externalizing behavioral problems and executive dysfunction are more likely to repeat a grade post-injury; and that children with executive dysfunction post-TBI are more likely

First rib fractures as an indicator of injury severity in major trauma

OpenAIRE

Sammy, I.A.; Chatha, H.; Lecky, F.; Bouamra, O.; Fragoso Iniguez, M.; Sattout, A.; Hickey, M.

2016-01-01

Introduction First rib fractures are traditionally considered indicators of increased morbidity and mortality in major trauma. However, this relationship has not been definitively proven. With an increase in computed tomography in major trauma, and the likely increase in detection of first rib fractures, this study re-evaluates whether first rib fractures are an indicator of injury severity. Discussion This study suggests that major trauma patients with first rib fractures have increased ISS ...

Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong.

Science.gov (United States)

Taw, Benedict B T; Lam, Alan C S; Ho, Faith L Y; Hung, K N; Lui, W M; Leung, Gilberto K K

2012-07-01

Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We aim to review the outcome of severely head-injured patients after discharge from acute care at a designated trauma center in Hong Kong. This is a retrospective study of prospectively collected data of patients admitted with severe head injuries between 2004 and 2008. Patients' functional status post-discharge was assessed using the Extended Glasgow Outcome Score (GOSE). Of a total of 1565 trauma patients, 116 had severe head injuries and 41 of them survived acute hospital care. Upon the last follow-up, 23 (56.1%) of the acute-care survivors had improvements in their GOSE, six (11.8%) experienced deteriorations, and 12 (23.5%) did not exhibit any change. The greatest improvement was observed in patients with GOSE of 5 and 6 upon discharge, but two of the 16 patients with GOSE 2 or 3 also had a good recovery. On logistic regression analysis, old age and prolonged acute hospital stay were found to be independent predictors of poor functional outcome after a mean follow-up duration of 42 months. Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery. Copyright © 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.

Spatial patterns of progressive brain volume loss after moderate-severe traumatic brain injury

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Jolly, Amy; de Simoni, Sara; Bourke, Niall; Patel, Maneesh C; Scott, Gregory; Sharp, David J

2018-01-01

Abstract Traumatic brain injury leads to significant loss of brain volume, which continues into the chronic stage. This can be sensitively measured using volumetric analysis of MRI. Here we: (i) investigated longitudinal patterns of brain atrophy; (ii) tested whether atrophy is greatest in sulcal cortical regions; and (iii) showed how atrophy could be used to power intervention trials aimed at slowing neurodegeneration. In 61 patients with moderate-severe traumatic brain injury (mean age = 41.55 years ± 12.77) and 32 healthy controls (mean age = 34.22 years ± 10.29), cross-sectional and longitudinal (1-year follow-up) brain structure was assessed using voxel-based morphometry on T1-weighted scans. Longitudinal brain volume changes were characterized using a novel neuroimaging analysis pipeline that generates a Jacobian determinant metric, reflecting spatial warping between baseline and follow-up scans. Jacobian determinant values were summarized regionally and compared with clinical and neuropsychological measures. Patients with traumatic brain injury showed lower grey and white matter volume in multiple brain regions compared to controls at baseline. Atrophy over 1 year was pronounced following traumatic brain injury. Patients with traumatic brain injury lost a mean (± standard deviation) of 1.55% ± 2.19 of grey matter volume per year, 1.49% ± 2.20 of white matter volume or 1.51% ± 1.60 of whole brain volume. Healthy controls lost 0.55% ± 1.13 of grey matter volume and gained 0.26% ± 1.11 of white matter volume; equating to a 0.22% ± 0.83 reduction in whole brain volume. Atrophy was greatest in white matter, where the majority (84%) of regions were affected. This effect was independent of and substantially greater than that of ageing. Increased atrophy was also seen in cortical sulci compared to gyri. There was no relationship between atrophy and time since injury or age at baseline. Atrophy rates were related to memory performance at the end of the

A case of severe acute kidney injury by near-drowning.

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Seong, Eun Young; Rhee, Harin; Lee, Naria; Lee, Sung Jun; Song, Sang Heon; Lee, Dong Won; Lee, Soo Bong; Sol, Mee Young; Kwak, Ihm Soo

2012-02-01

Acute kidney injury (AKI) secondary to near-drowning is rarely described and poorly understood. Only few cases of severe isolated AKI resulting from near-drowning exist in the literature. We report a case of near-drowning who developed to isolated AKI due to acute tubular necrosis (ATN) requiring dialysis. A 21-yr-old man who recovered from near-drowning in freshwater 3 days earlier was admitted to our hospital with anuria and elevated level of serum creatinine. He needed five sessions of hemodialysis and then renal function recovered spontaneously. Renal biopsy confirmed ATN. We review the existing literature on near-drowning-induced AKI and discuss the possible pathogenesis.

Early Autologous Cranioplasty after Decompressive Hemi-Craniectomy for Severe Traumatic Brain Injury

International Nuclear Information System (INIS)

Qasmi, S. A.; Ghaffar, A.; Hussain, Z.; Mushtaq, J.

2015-01-01

Objective: To evaluate the outcome of early replacement of autologous bone flap for decompressive hemicraniectomy in severe traumatic brain injury patients. Methods: The observational cross-sectional prospective study was conducted at the Neurosurgical Unit of the Combined Military Hospital, Rawalpindi, Pakistan, from July 2011, to June 2014, and comprised patients who underwent cranioplasty after decompressive hemicraniectomy for trauma. Patients over 20 years of age and of either gender were included. Cranioplasty was timed in all these patients using native bone flap preserved in the abdominal wall after decompressive craniectomy. Parameters recorded were mortality, wound infection, subdural collection, wound dehiscence, ventriculomegaly, bone resorption, cosmetic deformity and neurological outcome. SPSS 17 was used for data analysis. Results: Of the 30 patients in the study, 28(93.3 percent) were males. The overall mean age was age 32.03±8.01 years (range: 20-48 years). Mean cranioplasty time was 66.2±11.50 days (range: 44-89 days). Major infection necessitating bone flap removal was found in 1(3.33 percent) patient, while minor scalp wound infections, treated with antibiotics and dressings were found in 2(6.66 percent). Cosmetic18 deformity was seen in 3(10 percent). Improved neurological outcome was noted in 21(70 percent) patients; 6(20 percent) survived with a moderate to severe disability and 3(10 percent) remained in a vegetative state. No mortality was found after the procedure. Conclusion: Early autologous bone replacement for decompressive hemicraniectomy in severe traumatic brain injury patients offered cost-effective, acceptable surgical and improve dneurological outcome. (author)

MENTAL ACTIVITY RESTORATION PECULIARITIES IN CHILDREN WITH SEVERE TRAUMATIC BRAIN INJURY AT THE EARLY STAGE OF REHABILITATION

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A. V. Zakrepina

2013-01-01

Full Text Available The article is concerned with rehabilitation issues of children with severe traumatic brain injury (STBI. It gives the results of the study which was aimed at analyzing the psychophysical health restoration dynamics in children with STBI and determining the pedagogic typology of deviant development at traumatic brain injury in order to devise a training-organizational work plan for children being on the stages of complex rehabilitation.

Gender-Based Violence Causing Severe Multiple Injuries; a Case Report

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Adalard Falschung

2018-04-01

Full Text Available Introduction: Gender-based violence (GBV against women has been identified as a global health and development issue. We reported a case of GBV causing sever, multiple injuries in a middle-aged female. Case report: A 47-year-old woman presented to emergency room with disturbed level of consciousness, shortness of breath and multiple patches of skin discoloration. On examination, the patient was semi-conscious, with multiple ecchymosis and bilateral decreased air entry. Computed tomography scan of the neck and chest showed six rib fractures on the left side, and eight rib fractures on the right side, sternal fracture, manubriosternal dislocation, bilateral hemothorax, fracture of body of eleventh thoracic vertebra, and fracture of cervical spine of fifth and seventh vertebrae. The patient was intubated and admitted to intensive care unit. She was discharged with good health condition after 23 days of hospital admission. Conclusion: GBV is still a cause of severe trauma that puts the patient’s life at risk.

How bicycle level of traffic stress correlate with reported cyclist accidents injury severities: A geospatial and mixed logit analysis.

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Chen, Chen; Anderson, Jason C; Wang, Haizhong; Wang, Yinhai; Vogt, Rachel; Hernandez, Salvador

2017-11-01

Transportation agencies need efficient methods to determine how to reduce bicycle accidents while promoting cycling activities and prioritizing safety improvement investments. Many studies have used standalone methods, such as level of traffic stress (LTS) and bicycle level of service (BLOS), to better understand bicycle mode share and network connectivity for a region. However, in most cases, other studies rely on crash severity models to explain what variables contribute to the severity of bicycle related crashes. This research uniquely correlates bicycle LTS with reported bicycle crash locations for four cities in New Hampshire through geospatial mapping. LTS measurements and crash locations are compared visually using a GIS framework. Next, a bicycle injury severity model, that incorporates LTS measurements, is created through a mixed logit modeling framework. Results of the visual analysis show some geospatial correlation between higher LTS roads and "Injury" type bicycle crashes. It was determined, statistically, that LTS has an effect on the severity level of bicycle crashes and high LTS can have varying effects on severity outcome. However, it is recommended that further analyses be conducted to better understand the statistical significance and effect of LTS on injury severity. As such, this research will validate the use of LTS as a proxy for safety risk regardless of the recorded bicycle crash history. This research will help identify the clustering patterns of bicycle crashes on high-risk corridors and, therefore, assist with bicycle route planning and policy making. This paper also suggests low-cost countermeasures or treatments that can be implemented to address high-risk areas. Specifically, with the goal of providing safer routes for cyclists, such countermeasures or treatments have the potential to substantially reduce the number of fatalities and severe injuries. Published by Elsevier Ltd.

Randomized, placebo-controlled trial of acetaminophen for the reduction of oxidative injury in severe sepsis: the Acetaminophen for the Reduction of Oxidative Injury in Severe Sepsis trial.

Science.gov (United States)

Janz, David R; Bastarache, Julie A; Rice, Todd W; Bernard, Gordon R; Warren, Melissa A; Wickersham, Nancy; Sills, Gillian; Oates, John A; Roberts, L Jackson; Ware, Lorraine B

2015-03-01

This trial evaluated the efficacy of acetaminophen in reducing oxidative injury, as measured by plasma F2-isoprostanes, in adult patients with severe sepsis and detectable plasma cell-free hemoglobin. Single-center, randomized, double-blind, placebo-controlled phase II trial. Medical ICU in a tertiary, academic medical center. Critically ill patients 18 years old or older with severe sepsis and detectable plasma cell-free hemoglobin. Patients were randomized 1:1 to enteral acetaminophen 1 g every 6 hours for 3 days (n = 18) or placebo (n = 22) with the same dosing schedule and duration. F2-Isoprostanes on study day 3, the primary outcome, did not differ between acetaminophen (30 pg/mL; interquartile range, 24-41) and placebo (36 pg/mL; interquartile range, 25-80; p = 0.35). However, F2-isoprostanes were significantly reduced on study day 2 in the acetaminophen group (24 pg/mL; interquartile range, 19-36) when compared with placebo (36 pg/mL; interquartile range, 23-55; p = 0.047). Creatinine on study day 3, a secondary outcome, was significantly lower in the acetaminophen group (1.0 mg/dL; interquartile range, 0.6-1.4) when compared with that in the placebo (1.3 mg/dL; interquartile range, 0.83-2.0; p = 0.039). There was no statistically significant difference in hospital mortality (acetaminophen 5.6% vs placebo 18.2%; p = 0.355) or adverse events (aspartate aminotransferase or alanine aminotransferase > 400; acetaminophen 9.5% vs placebo 4.3%; p = 0.599). In adults with severe sepsis and detectable plasma cell-free hemoglobin, treatment with acetaminophen within 24 hours of ICU admission may reduce oxidative injury and improve renal function. Additional study is needed to confirm these findings and determine the effect of acetaminophen on patient-centered outcomes.

Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity.

Science.gov (United States)

Xiao, Nianzhou; Devarajan, Prasad; Inge, Thomas H; Jenkins, Todd M; Bennett, Michael; Mitsnefes, Mark M

2015-06-01

To assess subclinical kidney injury in adolescents with severe obesity by measuring biomarkers of early kidney disease and to assess changes in the levels of these biomarkers following bariatric procedures. Twenty-two adolescents undergoing bariatric surgery with no microalbuminuria and normal kidney function were selected. Urinary NGAL, IL-18, and KIM-1 were measured at baseline, 6 and 12 months postoperatively. Biomarker levels were compared to 44 age-gender-matched lean controls. Subjects with obesity had a mean baseline BMI of 48 kg/m(2) that decreased by 34% at 1-year follow-up. Urine NGAL, IL-18, and KIM-1 were significantly elevated in subjects with obesity compared to lean controls at baseline. The obese cohort had a further significant increase in NGAL and KIM-1 at 6 months, followed by decline at 1 year. The overall change in levels of all three biomarkers through 1 year after surgery, however, was not significant compared to baseline. Adolescent severe obesity is associated with increased urinary excretion of novel biomarkers of kidney injury, despite no microalbuminuria or decreased kidney function. This subclinical kidney injury persists 1 year after significant weight loss induced by bariatric surgery, suggesting that close, long-term follow-up of kidney status is warranted in these adolescents. © 2015 The Obesity Society.

Changes in emotional empathy, affective responsivity, and behavior following severe traumatic brain injury.

Science.gov (United States)

de Sousa, Arielle; McDonald, Skye; Rushby, Jacqueline

2012-01-01

This study was designed to examine the relationship between deficits in empathy, emotional responsivity, and social behavior in adults with severe traumatic brain injury (TBI). A total of 21 patients with severe TBI and 25 control participants viewed six film clips containing pleasant, unpleasant, and neutral content whilst facial muscle responses, skin conductance, and valence and arousal ratings were measured. Emotional empathy (the Balanced Emotional Empathy Scale, BEES: self-report) and changes in drive and control in social situations (The Current Behaviour Scale, CBS: relative report) were also assessed. In comparison to control participants, those in the TBI group reported less ability to empathize emotionally and had reduced facial responding to both pleasant and unpleasant films. They also exhibited lowered autonomic arousal, as well as abnormal ratings of valence and arousal, particularly to unpleasant films. Relative reported loss of emotional control was significantly associated with heightened empathy, while there was a trend to suggest that impaired drive (or motivation) may be related to lower levels of emotional empathy. The results represent the first to suggest that level of emotional empathy post traumatic brain injury may be associated with behavioral manifestations of disorders of drive and control.

Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study.

Science.gov (United States)

Kaul, Rahul; Chhabra, Harvinder Singh; Vaccaro, Alexander R; Abel, Rainer; Tuli, Sagun; Shetty, Ajoy Prasad; Das, Kali Dutta; Mohapatra, Bibhudendu; Nanda, Ankur; Sangondimath, Gururaj M; Bansal, Murari Lal; Patel, Nishit

2017-05-01

The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries. Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation. Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems. Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not

Divided attention years after severe closed head injury : The effect of dependencies between the subtasks

NARCIS (Netherlands)

Brouwer, W; Verzendaal, M; van der Naalt, J; Smit, J; van Zomeren, E

2001-01-01

Lesions of white matter which connects distant brain areas are characteristic for closed head injury (CHI). It was predicted that this impairs divided attention only if dependent subtasks are used which require communication between corresponding brain processes. Fourteen chronic severe CHI patients

Gas Exchange and Mechanical Properties of the Lung in Miners with Severe Concomitant Injury

Directory of Open Access Journals (Sweden)

V. V. Moroz

2007-01-01

Full Text Available Objective: to study the specific features of pulmonary gas exchange and mechanical properties in various manifestations of respiratory failure in miners with severe concomitant injury, who have a service length of 10 years or more, in order to optimize respiratory support.Subjects and methods. Pulmonary gas exchange and mechanical properties were studied over time in the presence of respiratory failure (acute lung injury/acute respiratory distress syndrome in 34 miners and 36 victims (a control group with severe concomitant injury who had no underground service length. Both groups were matched in age, severity and nature of traumatic lesions and surgical interventions. Pulmonary gas exchange and mechanical properties were evaluated by the following indices: oxygen fraction in an inspired gas mixture; hemoglobin saturation and partial arterial blood oxygen and carbon dioxide tension with the alveolar-arterial gradient being calculated by the oxygen level; oxygenation index; intrapulmonary shunting; statistical compliance and airways resistance.Results. The studies demonstrated that the miners, as compared with the controls, had more pronounced gas exchange changes within 5—7 post-traumatic days; later on (days 7—9 the above differences were undetectable. Impaired pulmonary mechanical properties in the miners persisted throughout the study while in the control group, their recovery started just on day 3. The course of respiratory failure in the miners was attributable to the baseline external respiratory function. Their respiratory support was performed during 14.5±1.4 days versus 9.5±1.9 days in the controls. In the miners, the mean bed-days at an intensive care unit were 18.5±2.2 whereas in the controls those were 12.3±2.1.Conclusion. More significant impairments of pulmonary gas exchange and mechanical properties are seen in the miners due to the background changes in external respiratory function in the development of respiratory

Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury.

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Brown, Joshua B; Stassen, Nicole A; Cheng, Julius D; Sangosanya, Ayodele T; Bankey, Paul E; Gestring, Mark L

2010-08-01

The mortality of traumatic brain injury (TBI) continues to decline, emphasizing functional outcomes. Trauma center designation has been linked to survival after TBI, but the impact on functional outcomes is unclear. The objective was to determine whether trauma center designation influenced functional outcomes after moderate and severe TBI. Trauma subjects presenting to an American College of Surgeons (ACS) Level I or II trauma center with a Glasgow Coma Score (GCS) independence (FI) defined as a modified functional independence measure (FIM) of 12, and independent expression (IE) defined as a FIM component of 4. These were compared between Level I and Level II centers in subjects with both moderate (GCS 9-12) and severe (GCS injuries, and comorbidities. Analysis identified 25,170 subjects (72% severe TBI). After adjusting for covariates, ACS Level I designation was associated with FI (odds ratio: 1.16; confidence interval: 1.07-1.24, p < 0.01) and IE (1.10; 1.03-1.17, p < 0.01) after severe TBI. Trauma center designation was not associated with FI or IE after moderate TBI. ACS trauma center designation is significantly associated with FI and IE after severe, but not moderate TBI. Prospective study is warranted to verify and explore factors contributing to this discrepancy.

Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge.

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Kesinger, Matthew Ryan; Kumar, Raj G; Wagner, Amy K; Puyana, Juan Carlos; Peitzman, Andrew P; Billiar, Timothy R; Sperry, Jason L

2015-02-01

Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Limited information exists regarding the significance of infectious complications on long-term outcomes after TBI. We sought to characterize risks associated with HAP on outcomes 5 years after TBI. This study involved data from the merger of an institutional trauma registry and the Traumatic Brain Injury Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale [AIS] score ≥ 4) who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scale-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into low (GOSE score GOSE score ≥ 6). Logistic regression was used to determine adjusted odds of low GOSE score associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS) score, ventilation days, and other important confounders. A general estimating equation model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS score. Logistic regression demonstrated that HAP was independently associated with low GOSE scores at follow-up (1 year: odds ratio [OR], 6.39; 95% confidence interval [CI], 1.76-23.14; p = 0.005) (2 years: OR, 7.30; 95% CI, 1.87-27.89; p = 0.004) (5-years: OR, 6.89; 95% CI, 1.42-33.39; p = 0.017). Stratifying by GCS score of 8 or lower and early intubation, HAP remained a significant independent predictor of low GOSE score in all strata. In the general estimating equation model, HAP continued to be an independent

Incidence and severity of head and neck injuries in victims of road traffic crashes: In an economically developed country.

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Bener, Abdulbari; Rahman, Yassir S Abdul; Mitra, Biswadev

2009-01-01

Head and neck injuries following the road traffic crashes (RTCs) are the most common cause of morbidity and mortality in most developed and developing countries and may also result in temporary or permanent disability. The aim of this study was to determine the incidence pattern of head and neck injuries, investigate its trend and identify the severity of injuries involved with road traffic crashes (RTCs) during the period 2001-2006. This is a retrospective descriptive hospital based study. The patients with head and neck injuries were seen and treated in the Accident and Emergency Department of the Hamad General Hospital and other Trauma Centers of the Hamad Medical Corporation following the road traffic crashes during the period 2001-2006. This study is a retrospective analysis of 6709 patients attended and treated at the Accident and Emergency and Trauma centers for head and neck injuries over a 6 year period. Head and neck injuries were determined according to the ICD 10 criteria. Of these, 3013 drivers, 2502 passengers, 704 pedestrians and 490 two wheel riders (motor bike and cyclists). Details of all the road traffic crash patients were compiled in the database of the Emergency Medical Services (EMS), and the data of patients with head and neck injuries were extracted from this database. A total of 6709 patients with head and neck injuries was reported during the study period. Majority of the victims were non-Qataris (68.7%), men (85.9%) and in the age group 20-44 years (68.5%). There were statistical significant differences in relation to age, nationality, gender, and accident during week ends for head and neck injuries (pQatar from road traffic crashes. The incidence of head and neck injuries is still very high in Qatar, but the severity of injury was mild in most of the victims. The findings of the study highlighted the need for taking urgent steps for safety of people especially drivers and passengers.

How Do Intensity and Duration of Rehabilitation Services Affect Outcomes from Severe Traumatic Brain Injury?

DEFF Research Database (Denmark)

Hart, Tessa; Whyte, John; Poulsen, Ingrid

2016-01-01

OBJECTIVE: Determine effects of inpatient and outpatient treatment intensity on functional and emotional well-being outcomes at 1 year post severe traumatic brain injury (TBI). DESIGN: Prospective, quasi-experimental study comparing outcomes in a US TBI treatment center with those in a Denmark (DK...

Reduction of hyperthermia in pediatric patients with severe traumatic brain injury: a quality improvement initiative.

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Lovett, Marlina E; Moore-Clingenpeel, Melissa; Ayad, Onsy; O'Brien, Nicole

2018-02-01

OBJECTIVE Severe traumatic brain injury remains a leading cause of morbidity and mortality in the pediatric population. Providers focus on reducing secondary brain injury by avoiding hypoxemia, avoiding hypotension, providing normoventilation, treating intracranial hypertension, and reducing cerebral metabolic demand. Hyperthermia is frequently present in patients with severe traumatic brain injury, contributes to cerebral metabolic demand, and is associated with prolonged hospital admission as well as impaired neurological outcome. The objective of this quality improvement initiative was to reduce the duration of hyperthermia for pediatric patients with severe traumatic brain injury during the initial 72 hours of admission to the pediatric intensive care unit. METHODS A retrospective chart review was performed to evaluate the incidence and duration of hyperthermia within a preintervention cohort. The retrospective phase was followed by three 6-month intervention periods (intervention Phase 1, the maintenance phase, and intervention Phase 2). Intervention Phase 1 entailed placement of a cooling blanket on the bed prior to patient arrival and turning it on once the patient's temperature rose above normothermia. The maintenance phase focused on sustaining the results of Phase 1. Intervention Phase 2 focused on total prevention of hyperthermia by initiating cooling blanket use immediately upon patient arrival to the intensive care unit. RESULTS The median hyperthermia duration in the preintervention cohort (n = 47) was 135 minutes. This was reduced in the Phase 1 cohort (n = 9) to 45 minutes, increased in the maintenance phase cohort (n = 6) to 88.5 minutes, and decreased again in the Phase 2 cohort (n = 9) to a median value of 0 minutes. Eight percent of patients in the intervention cohorts required additional sedation to tolerate the cooling blanket. Eight percent of patients in the intervention cohorts became briefly hypothermic while on the cooling blanket. No

Spatial patterns of progressive brain volume loss after moderate-severe traumatic brain injury.

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Cole, James H; Jolly, Amy; de Simoni, Sara; Bourke, Niall; Patel, Maneesh C; Scott, Gregory; Sharp, David J

2018-01-04

Traumatic brain injury leads to significant loss of brain volume, which continues into the chronic stage. This can be sensitively measured using volumetric analysis of MRI. Here we: (i) investigated longitudinal patterns of brain atrophy; (ii) tested whether atrophy is greatest in sulcal cortical regions; and (iii) showed how atrophy could be used to power intervention trials aimed at slowing neurodegeneration. In 61 patients with moderate-severe traumatic brain injury (mean age = 41.55 years ± 12.77) and 32 healthy controls (mean age = 34.22 years ± 10.29), cross-sectional and longitudinal (1-year follow-up) brain structure was assessed using voxel-based morphometry on T1-weighted scans. Longitudinal brain volume changes were characterized using a novel neuroimaging analysis pipeline that generates a Jacobian determinant metric, reflecting spatial warping between baseline and follow-up scans. Jacobian determinant values were summarized regionally and compared with clinical and neuropsychological measures. Patients with traumatic brain injury showed lower grey and white matter volume in multiple brain regions compared to controls at baseline. Atrophy over 1 year was pronounced following traumatic brain injury. Patients with traumatic brain injury lost a mean (± standard deviation) of 1.55% ± 2.19 of grey matter volume per year, 1.49% ± 2.20 of white matter volume or 1.51% ± 1.60 of whole brain volume. Healthy controls lost 0.55% ± 1.13 of grey matter volume and gained 0.26% ± 1.11 of white matter volume; equating to a 0.22% ± 0.83 reduction in whole brain volume. Atrophy was greatest in white matter, where the majority (84%) of regions were affected. This effect was independent of and substantially greater than that of ageing. Increased atrophy was also seen in cortical sulci compared to gyri. There was no relationship between atrophy and time since injury or age at baseline. Atrophy rates were related to memory performance at the end of the follow

Sequential computerized tomography changes and related final outcome in severe head injury patients

International Nuclear Information System (INIS)

Lobato, R.D.; Gomez, P.A.; Alday, R.

1997-01-01

The authors analyzed the serial computerized tomography (CT) findings in a large series of severely head injured patients in order to assess the variability in gross intracranial pathology through the acute posttraumatic period and determine the most common patterns of CT change. A second aim was to compare the prognostic significance of the different CT diagnostic categories used in the study (Traumatic Coma Data Bank CT pathological classification) when gleaned either from the initial (postadmission) or the control CT scans, and determine the extent to which having a second CT scan provides more prognostic information than only one scan. 92 patients (13.3 % of the total population) died soon after injury. Of the 587 who survived long enough to have at least one control CT scan 23.6 % developed new diffuse brain swelling, and 20.9 % new focal mass lesions most of which had to be evacuated. The relative risk for requiring a delayed operation as related to the diagnostic category established by using the initial CT scans was by decreasing order: diffuse injury IV (30.7 %), diffuse injury III (30.5 %), non evacuated mass (20 %), evacuated mass (20.2 %), diffuse injury II (12.1 %), and diffuse injury I (8.6 %). Overall, 51.2 % of the patients developed significant CT changes (for worse or better) occurring either spontaneously or following surgery, and their final outcomes were more closely related to the control than to the initial CT diagnoses. In fact, the final outcome was more accurately predicted by using the control CT scans (81.2 % of the cases) than by using the initial CT scans (71.5 % of the cases only). Since the majority of relevant CT changes developed within 48 hours after injury a pathological categorization made by using an early control CT scan seems to be most useful for prognostic purposes. Prognosis associated with the CT pathological categories used in the study was similar independently of the moment of the acute posttraumatic period at which

Parents and teachers reporting on a child's emotional and behavioural problems following severe traumatic brain injury (TBI): the moderating effect of time.

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Silberg, Tamar; Tal-Jacobi, Dana; Levav, Miriam; Brezner, Amichai; Rassovsky, Yuri

2015-01-01

Gathering information from parents and teachers following paediatric traumatic brain injury (TBI) has substantial clinical value for diagnostic decisions. Yet, a multi-informant approach has rarely been addressed when evaluating children at the chronic stage post-injury. In the current study, the goals were to examine (1) differences between parents' and teachers' reports on a child's emotional and behavioural problems and (2) the effect of time elapsed since injury on each rater's report. A sample of 42 parents and 42 teachers of children following severe TBI completed two standard rating scales. Receiver Operating Characteristic (ROC) curves were used to determine whether time elapsed since injury reliably distinguished children falling above and below clinical levels. Emotional-behavioural scores of children following severe TBI fell within normal range, according to both teachers and parents. Significant differences were found between parents' reports relatively close to the time of injury and 2 years post-injury. However, no such differences were observed in teachers' ratings. Parents and teachers of children following severe TBI differ in their reports on a child's emotional and behavioural problems. The present study not only underscores the importance of multiple informants, but also highlights, for the first time, the possibility that informants' perceptions may vary across time.

Early detection of consciousness in patients with acute severe traumatic brain injury.

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Edlow, Brian L; Chatelle, Camille; Spencer, Camille A; Chu, Catherine J; Bodien, Yelena G; O'Connor, Kathryn L; Hirschberg, Ronald E; Hochberg, Leigh R; Giacino, Joseph T; Rosenthal, Eric S; Wu, Ona

2017-09-01

See Schiff (doi:10.1093/awx209) for a scientific commentary on this article. Patients with acute severe traumatic brain injury may recover consciousness before self-expression. Without behavioural evidence of consciousness at the bedside, clinicians may render an inaccurate prognosis, increasing the likelihood of withholding life-sustaining therapies or denying rehabilitative services. Task-based functional magnetic resonance imaging and electroencephalography techniques have revealed covert consciousness in the chronic setting, but these techniques have not been tested in the intensive care unit. We prospectively enrolled 16 patients admitted to the intensive care unit for acute severe traumatic brain injury to test two hypotheses: (i) in patients who lack behavioural evidence of language expression and comprehension, functional magnetic resonance imaging and electroencephalography detect command-following during a motor imagery task (i.e. cognitive motor dissociation) and association cortex responses during language and music stimuli (i.e. higher-order cortex motor dissociation); and (ii) early responses to these paradigms are associated with better 6-month outcomes on the Glasgow Outcome Scale-Extended. Patients underwent functional magnetic resonance imaging on post-injury Day 9.2 ± 5.0 and electroencephalography on Day 9.8 ± 4.6. At the time of imaging, behavioural evaluation with the Coma Recovery Scale-Revised indicated coma (n = 2), vegetative state (n = 3), minimally conscious state without language (n = 3), minimally conscious state with language (n = 4) or post-traumatic confusional state (n = 4). Cognitive motor dissociation was identified in four patients, including three whose behavioural diagnosis suggested a vegetative state. Higher-order cortex motor dissociation was identified in two additional patients. Complete absence of responses to language, music and motor imagery was only observed in coma patients. In patients with behavioural evidence

Computed tomography and clinical outcome in patients with severe traumatic brain injury.

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Stenberg, Maud; Koskinen, Lars-Owe D; Jonasson, Per; Levi, Richard; Stålnacke, Britt-Marie

2017-01-01

To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI). Initial CT (CT i ) and CT 24 hours post-trauma (CT 24 ) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated. Thirty-seven patients were included. Marshall CT i and CT 24 were significantly correlated with RLAS-R at three months. Rotterdam CT 24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year. Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.

Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries.

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Ball, Chad G; Ball, Jill E; Kirkpatrick, Andrew W; Mulloy, Robert H

2007-05-01

Horseback riding is more dangerous than motorcycle riding, skiing, football, and rugby. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with severe equestrian trauma. All patients with major equestrian injuries (injury severity score > or = 12) admitted between 1995 and 2005 were reviewed. A 46-question survey outlining potential rider, animal, and environmental risk factors was administered. Among 7941 trauma patients, 151 (2%) were injured on horseback (mean injury severity score, 20; mortality rate, 7%). Injuries included the chest (54%), head (48%), abdomen (22%), and extremities (17%). Forty-five percent required surgery. Survey results (55%) indicated that riders and horses were well trained, with a 47% recidivism rate. Only 9% of patients wore helmets, however, 64% believed the accident was preventable. Chest trauma previously has been underappreciated. This injury pattern may be a result of significant rider experience. Helmet and vest use will be targeted in future injury prevention strategies.

A novel Drosophila injury model reveals severed axons are cleared through a Draper/MMP-1 signaling cascade

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Purice, Maria D; Ray, Arpita; Münzel, Eva Jolanda; Pope, Bernard J; Park, Daniel J; Speese, Sean D; Logan, Mary A

2017-01-01

Neural injury triggers swift responses from glia, including glial migration and phagocytic clearance of damaged neurons. The transcriptional programs governing these complex innate glial immune responses are still unclear. Here, we describe a novel injury assay in adult Drosophila that elicits widespread glial responses in the ventral nerve cord (VNC). We profiled injury-induced changes in VNC gene expression by RNA sequencing (RNA-seq) and found that responsive genes fall into diverse signaling classes. One factor, matrix metalloproteinase-1 (MMP-1), is induced in Drosophila ensheathing glia responding to severed axons. Interestingly, glial induction of MMP-1 requires the highly conserved engulfment receptor Draper, as well as AP-1 and STAT92E. In MMP-1 depleted flies, glia do not properly infiltrate neuropil regions after axotomy and, as a consequence, fail to clear degenerating axonal debris. This work identifies Draper-dependent activation of MMP-1 as a novel cascade required for proper glial clearance of severed axons. DOI: http://dx.doi.org/10.7554/eLife.23611.001 PMID:28825401

Prevalence, source and severity of work-related injuries among "foreign" construction workers in a large Malaysian organisation: a cross-sectional study.

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Zerguine, Haroun; Tamrin, Shamsul Bahri Mohd; Jalaludin, Juliana

2018-02-02

Malaysian construction sector is regarded as critical in the field of health because of the high rates of accidents and fatalities. This research aimed to determine the prevalence, sources and severity of injuries and its association with commitment to safety among foreign construction workers. A cross-sectional study was conducted among 323 foreign construction workers from six construction projects of a large organization in Malaysia, using a simple random sampling method. Data was collected using a structured questionnaire to assess work-related injuries and safety commitment. The collected data was analysed by SPSS 22.0 using descriptive statistics and chi-square test. The prevalence of work-related injuries in a one year period was 22.6%, where most of the injuries were of moderate severity (39.7%) and falls from heights represented the main source (31.5%). The majority of the foreign construction workers had perceived between moderate and high safety commitment, which was significantly associated with work-related injuries. The results also showed a significant association of work-related injuries with the company\\'s interest in Safety and Health, Safety and Health training, and safety equipment. Thus, the implementation of new procedures and providing relevant trainings and safety equipment; will lead to a decrease in injury rates in construction sites.

Early rehabilitation and participation in focus - a Danish perspective on patients with severe acquired brain injury

DEFF Research Database (Denmark)

Smidt, Helle Rønn; Pallesen, Hanne; Buhl, Inge

2016-01-01

Early neurorehabilitation is an interdisciplinary field. Thus, in order to eliminate unnecessary barriers for individuals with severe acquired brain injury in early rehabilitation, we need rehabilitation science that supports both quantitative and qualitative research methods. Participation can b...

Severe pediatric ocular injury due to explosion of a firecracker inside a soda bottle

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Tarek A Shazly

2010-10-01

Full Text Available Tarek A ShazlyDepartment of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USAAbstract: This case report describes a penetrating ocular injury, followed by endophthalmitis, in a four-year-old girl, resulting from explosion of a small K0201 match-cracker inside a soda bottle. The patient presented with two corneal lacerations, ruptured crystalline lens, multiple intraocular foreign bodies, and hyphema of the right eye, for which immediate surgical exploration and repair was performed. The patient developed aggressive endophthalmitis that led to atrophy of the eye within a few weeks. Severe ocular injuries can result from small, relatively “safe” firecrackers. Therefore, this type of firework should not be used, especially by minors.Keywords: pediatric trauma, endophthalmitis, firecracker

Family functioning in severe brain injuries: correlations with caregivers' burden, perceived social support and quality of life.

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Tramonti, Francesco; Bonfiglio, Luca; Di Bernardo, Carolina; Ulivi, Chiara; Virgillito, Alessandra; Rossi, Bruno; Carboncini, Maria Chiara

2015-01-01

Severe brain injuries have long-term consequences on functional status and psychosocial functioning. Family life can be greatly influenced as well, and features of high caregiver burden can emerge. Although the data on caregivers' distress are constantly increasing, less information is available about the role of family functioning. Thirty caregivers of hospitalised patients with severe brain injuries received questionnaires for the evaluation of caregiver burden, family functioning and perceived social support. A semi-structured interview was performed for the evaluation of quality of life. Family cohesion and adaptability positively correlated with caregivers' quality of life and perceived social support. Partner caregivers' scores were significantly higher on the time-dependent burden than those of sons and daughters, whereas the latter scored higher on the emotional burden.

[Definition of hospital discharge, serious injury and death from traffic injuries].

Science.gov (United States)

Pérez, Katherine; Seguí-Gómez, María; Arrufat, Vita; Barberia, Eneko; Cabeza, Elena; Cirera, Eva; Gil, Mercedes; Martín, Carlos; Novoa, Ana M; Olabarría, Marta; Lardelli, Pablo; Suelves, Josep Maria; Santamariña-Rubio, Elena

2014-01-01

Road traffic injury surveillance involves methodological difficulties due, among other reasons, to the lack of consensus criteria for case definition. Police records have usually been the main source of information for monitoring traffic injuries, while health system data has hardly been used. Police records usually include comprehensive information on the characteristics of the crash, but often underreport injury cases and do not collect reliable information on the severity of injuries. However, statistics on severe traffic injuries have been based almost exclusively on police data. The aim of this paper is to propose criteria based on medical records to define: a) "Hospital discharge for traffic injuries", b) "Person with severe traffic injury", and c) "Death from traffic injuries" in order to homogenize the use of these sources. Copyright © 2014. Published by Elsevier Espana.

THE INJURY SEVERITY RATE DIFFERENCES IN PASSENGER CARS AND PICK UP TRUCKS RELATED TWO VEHICLE INVOLVED MOTOR VEHICLE CRASHES IN BRITISH COLUMBIA, CANADA

Directory of Open Access Journals (Sweden)

E.B.R. DESAPRIYA

2004-01-01

Full Text Available The effect of large vehicle involvement on motor vehicle crash (MVC rates and severity has long been a concern in MVC analysis literature. Injuries in drivers and occupants are related to several key factors: the mass of the case vehicle and mass of its collision partner and speed of case vehicle and collision partner at the time of the crash. Objective: To evaluate the relative risk of injury occurrence in collisions between picks up trucks (PU and passenger sedan cars (PS. Methods: Data from the Insurance Corporation of British Columbia (ICBC crash data base was used to determine MVC rates and injury occurrence. Descriptive characteristics of the injury location and injury type were analyzed comparing the Odds Ratios and chi-squares. Results: PS occupants received more injuries; Odds Ratio was 2.49 (95% confidence interval: 2.15–2.88. Conclusion: Occupants in PS which collide with PU were at twice the risk of injuries. Concussion, whiplash, lacerations and abrasion were more frequent in PS drivers and occupants than in PU drivers and occupants. Overall, PS drivers/occupants experienced greater injuries than PU drivers/occupants in PU-PS collisions. In this paper, results are shown as odds ratios comparing occupants injuries in PS (case group with occupant injuries in PU (control group.

Long-term global and regional brain volume changes following severe traumatic brain injury: A longitudinal study with clinical correlates

DEFF Research Database (Denmark)

Sidaros, Annette; Skimminge, Arnold Jesper Møller; Liptrot, Matthew George

2009-01-01

with percent brain volume change (%BVC) ranging between − 0.6% and − 9.4% (mean − 4.0%). %BVC correlated significantly with injury severity, functional status at both scans, and with 1-year outcome. Moreover, %BVC improved prediction of long-term functional status over and above what could be predicted using......Traumatic brain injury (TBI) results in neurodegenerative changes that progress for months, perhaps even years post-injury. However, there is little information on the spatial distribution and the clinical significance of this late atrophy. In 24 patients who had sustained severe TBI we acquired 3D...... scan time point using SIENAX. Regional distribution of atrophy was evaluated using tensor-based morphometry (TBM). At the first scan time point, brain parenchymal volume was reduced by mean 8.4% in patients as compared to controls. During the scan interval, patients exhibited continued atrophy...

Injuria renal aguda en la sepsis grave Acute kidney injury in severe sepsis

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Hernán Trimarchi

2009-06-01

Full Text Available La sepsis afecta al 40% de los pacientes críticos, siendo su mortalidad de aproximadamente un 30% en el caso de la sepsis grave, y de 75% con injuria renal aguda, la cual sucede en el 20-51% de los casos. Se realizó un estudio prospectivo, observacional, longitudinal, en 80 pacientes sépticos graves en el lapso de 1 año para determinar el desarrollo de injuria renal aguda y su relación con la mortalidad; correlacionar antecedentes clínicos y variaciones del laboratorio con la mortalidad; determinar la tasa de mortalidad de la sepsis grave; relacionar óbito y foco séptico primario; evaluar la predictibilidad de mortalidad según niveles de creatinina de ingreso y sus variaciones finales. Se definieron dos grupos: Obito (n = 25 y No-óbito (n = 55. Analizados según la creatinina de ingreso, 39 tenían valores normales de creatinina (10 óbitos y 41 la presentaban elevada (15 óbitos; según la creatinina de egreso, 48 presentaron creatinina normal y fallecieron 7, mientras que 32 tenían daño renal agudo, de los cuales 18 fallecieron. De los 25 pacientes fallecidos, el 72% presentaron daño renal. De éstos, 7 pacientes vivos y 2 fallecidos requirieron hemodiálisis. El foco primario más frecuente fue el respiratorio (26.4%. El desarrollo de daño renal es un alto predictor de mortalidad en la sepsis, independientemente de los valores iniciales de creatinina. Edad más avanzada, hipertensión arterial, score APACHE más elevado, anemia más grave, hipoalbuminemia, hiperfosfatemia e hiperkalemia se asociaron a mayor mortalidad. La mortalidad global fue 31.3%. La imposibilidad de identificar el foco séptico primario se asoció a mayor mortalidad. El foco respiratorio se relacionó a mayor riesgo de requerir hemodiálisis.Sepsis affects 40% of critically ill patients, with a reported mortality of approximately 30% in severe sepsis, raising to 75% when acute kidney injury ensues, which occurs in about 20-51% of cases. The present study

Outcome of decompressive craniectomy (DC) for severe traumatic brain injury (stbi) in adults

International Nuclear Information System (INIS)

Qasmi, S.A.; Ghaffar, A.; Akram, M.

2015-01-01

To evaluate the outcomes of decompressive craniectomy (DC) in adults with severe traumatic brain injury (STBI). Study Design: Observational cross-sectional. Place and Duration of Study: Neurosurgical unit CMH Rawalpindi from July, 2011 to June 2014. Material and Methods: Total of 39 patients who underwent DC for STBI were included in the study. Patients of both sexes and of age range 20 - 48 (32.03 +- 8.01) years were included in the study. The DC was performed within 24 and after 24 hours. Parameters recorded were mortality, neurological outcome / complications like brain herniation, wound dehiscence, cerebrospinal fluid (CSF) leak, contusion expansion, sinking flap syndrome, subdural hygromas and hydrocephalus. Data was analyzed by using SPSS version 17 and descriptive statistics, frequency, rate and percentage was computed for presentation of qualitative outcomes. Results: Favourable neurological outcome was seen in 21 patients (53.85%) where as 6 patients (15.38%) had moderate to severe disability and 3 patients (7.69%) were vegetative respectively. Patients operated within 24 hours and with Glasgow coma scale (GCS) range 6-8 had better outcome. Overall 9 patients (23.08%) did not survive the injury and procedure. Conclusion: As high mortality is associated with STBI, DC is an effective option to lower down the refractory intracranial hypertension with an acceptable surgical outcome. (author)

[Predictive quality of the injury severity score in the systematic use of cranial MRI].

Science.gov (United States)

Woischneck, D; Lerch, K; Kapapa, T; Skalej, M; Firsching, R

2010-09-01

The ABBREVIATED INJURY SCORE (AIS) for the head is mostly coded on the basis of cranial computed tomography (CT). It defines, to a large extent, the predictive potency of the INJURY SEVERITY SCORE (ISS). The present study investigates whether the predictive capacity of the ISS can be improved by the systematic use of data from cranial MRI. 167 patients, who had been in a coma for at least 24 hours following trauma, underwent an MRI examination within 8 days. All had been found to have an intracranial injury on initial CT. 49 % had also suffered extracranial injuries. The GLASGOW OUTCOME SCALE (GOS) was determined 6 months post trauma. AIS, ISS and GOS values were rated as ordinal measurements. A contingency table was used as the statistical method of analysis, with a significance assumed as p RISC) score was improved by use of adapted MRI data. If visible brain stem lesions on MRI were coded according to the AIS guidelines, there was a significant increase in the ISS which correlated significantly to the GOS. If the AIS coding was adjusted to the prognostic significance of individual brain stem lesions, there was a further improvement in the prognostic potency of the ISS. The study encourages the inclusion of data obtained from MRI diagnostics in the ISS calculation. There are alternative ways. © Georg Thieme Verlag KG Stuttgart · New York.

MR imaging in severe upper cervical spinal cord injury in childhood

International Nuclear Information System (INIS)

Robertson, H.J.; Steele, N.; Tilton, A.; Bodin, R.A.

1990-01-01

This paper demonstrates that MR imaging of the cervical spine in patients with upper cervical spinal cord injury can accurately define the extent of cord injury for prognostic and rehabilitative purpose. Seven patients, ages newborn to 11 y, had acute upper cervical spinal cord injury and required continuous respiratory assistance. All patients had cervical spine radiography initially, but the extent of injuries precluded transport for early MR imaging. One or more MR imaging studies were done when the acute injury phase subsided. Manual ventilatory support by Ambu bag with oxygen was combined with careful respiratory and cardiac monitoring during imaging

Restoration of Function With Acupuncture Following Severe Traumatic Brain Injury: A Case Report

OpenAIRE

Wolf, Jacob; Sparks, Linda; Deng, Yong; Langland, Jeffrey

2015-01-01

This case report illustrates the improvement of an acupuncture-treated patient who incurred a severe traumatic brain injury (TBI) from a snowboarding accident. Over 4 years, the patient progressed from initially not being able to walk, having difficulty with speech, and suffering from poor eyesight to where he has now regained significant motor function, speech, and vision and has returned to snowboarding. A core acupuncture protocol plus specific points added to address the patient's ongoing...

Drug-refractory aggression, self-injurious behavior, and severe tantrums in autism spectrum disorders: a chart review study.

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Adler, Benjamin A; Wink, Logan K; Early, Maureen; Shaffer, Rebecca; Minshawi, Noha; McDougle, Christopher J; Erickson, Craig A

2015-01-01

Aggression, self-injurious behavior, and severe tantrums are impairing symptoms frequently experienced by individuals with autism spectrum disorders. Despite US Food and Drug Administration approval of two atypical antipsychotics targeting these symptoms in youth with autistic disorder, they remain frequently drug refractory. We define drug-refractory aggression, self-injurious behavior, and severe tantrums in people with autism spectrum disorders as behavioral symptoms requiring medication adjustment despite previous trials of risperidone and aripiprazole or previous trials of three psychotropic drugs targeting the symptom cluster, one of which was risperidone or aripiprazole. We reviewed the medical records of individuals of all ages referred to our clinic for autism spectrum disorder diagnostic evaluation, as well as pharmacotherapy follow-up notes for all people meeting autism spectrum disorder criteria, for drug-refractory symptoms. Among 250 consecutively referred individuals, 135 met autism spectrum disorder and enrollment criteria, and 53 of these individuals met drug-refractory symptom criteria. Factors associated with drug-refractory symptoms included age 12 years or older (p diagnosis of autistic disorder (p = 0.0139), and presence of intellectual disability (p = 0.0273). This pilot report underscores the significance of drug-refractory aggression, self-injurious behavior, and severe tantrums; suggests the need for future study clarifying factors related to symptom development; and identifies the need for focused treatment study of this impairing symptom domain. © The Author(s) 2014.

Hospital Acquired Pneumonia is an Independent Predictor of Poor Global Outcome in Severe Traumatic Brain Injury up to 5 Years after Discharge

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Kesinger, Matthew R.; Kumar, Raj G.; Wagner, Amy K.; Puyana, Juan C.; Peitzman, Andrew P.; Billiar, Timothy R.; Sperry, Jason L.

2016-01-01

Objectives Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Little information exists regarding the significance of infectious complications on long-term outcomes post-TBI. We sought to characterize risks associated with HAP on outcomes 5 years post-TBI. Methods Ddata from the merger of an institutional trauma registry and the TBI Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale≥4), who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scaled-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into LOW (GOSEGOSE≥6). Logistic regression was utilized to determine adjusted odds of LOW-GOSE associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS), ventilation days, and other important confounders. A general estimating equation (GEE) model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. Results A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS. Logistic regression demonstrated that HAP was independently associated with LOW-GOSE scores at follow-up (1year: OR=6.39, 95%CI: 1.76-23.14, p=0.005; 2-years: OR=7.30, 95%CI 1.87-27.89, p=0.004; 5-years: OR=6.89, 95%CI: 1.42-33.39, p=0.017). Stratifying by GCS≤8 and early intubation, HAP remained a significant independent predictor of LOW-GOSE in all strata. In the GEE model, HAP continued to be an independent predictor of LOW-GOSE (OR: 4.59; 95%CI: 1.82-11.60′ p=0.001). Conclusion HAP is independently associated with poor outcomes in severe-TBI extending 5

Functional outcome and health-related quality of life 10 years after moderate-to-severe traumatic brain injury.

Science.gov (United States)

Andelic, N; Hammergren, N; Bautz-Holter, E; Sveen, U; Brunborg, C; Røe, C

2009-07-01

To describe the functional outcome and health-related quality of life (HRQL) 10 years after moderate-to-severe traumatic brain injury (TBI). A retrospective, population-based study of 62 survivors of working-age with moderate-to-severe TBI injured in 1995/1996, and hospitalized at the Trauma Referral Center in Eastern Norway. Functional status was measured by the Glasgow Outcome Scale-Extended (GOS-E). HRQL was assessed by the SF-36 questionnaire. The mean current-age was 40.8 years. The frequency of epilepsy was 19% and the depression rate 31%. A majority had good recovery (48%) or moderate disability (44%). Employment rate was 58%. Functional and employment status were associated with initial injury severity in contrast to HRQL. Study patients had significantly lower scores in all SF-36 dimensions when compared with the general Norwegian population. At 10-years follow-up, our study population is still in their most productive years and affected domains should be considered in long-term follow-up and intervention programs.

Early tracheostomy in severe traumatic brain injury: evidence for decreased mechanical ventilation and increased hospital mortality

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Dunham, C Michael; Cutrona, Anthony F; Gruber, Brian S; Calderon, Javier E; Ransom, Kenneth J; Flowers, Laurie L

2014-01-01

Objective: In the past, the authors performed a comprehensive literature review to identify all randomized controlled trials assessing the impact of early tracheostomy on severe brain injury outcomes. The search produced only two trials, one by Sugerman and another by Bouderka. Subjects and methods: The current authors initiated an Institutional Review Board-approved severe brain injury randomized trial to evaluate the impact of early tracheostomy on ventilator-associated pneumonia rates, intensive care unit (ICU)/ventilator days, and hospital mortality. Current study results were compared with the other randomized trials and a meta-analysis was performed. Results: Early tracheostomy pneumonia rates were Sugerman-48.6%, Bouderka-58.1%, and current study-46.7%. No early tracheostomy pneumonia rates were Sugerman-53.1%, Bouderka-61.3%, and current study-44.4%. Pneumonia rate meta-analysis showed no difference for early tracheostomy and no early tracheostomy (OR 0.89; p = 0.71). Early tracheostomy ICU/ventilator days were Sugerman-16 ± 5.9, Bouderka-14.5 ± 7.3, and current study-14.1 ± 5.7. No early tracheostomy ICU/ventilator days were Sugerman-19 ± 11.3, Bouderka-17.5 ± 10.6, and current study-17 ± 5.4. ICU/ventilator day meta-analysis showed 2.9 fewer days with early tracheostomy (p = 0.02). Early tracheostomy mortality rates were Sugerman-14.3%, Bouderka-38.7%, and current study-0%. No early tracheostomy mortality rates were Sugerman-3.2%, Bouderka-22.6%, and current study-0%. Randomized trial mortality rate meta-analysis showed a higher rate for early tracheostomy (OR 2.68; p = 0.05). Because the randomized trials were small, a literature assessment was undertaken to find all retrospective studies describing the association of early tracheostomy on severe brain injury hospital mortality. The review produced five retrospective studies, with a total of 3,356 patients. Retrospective study mortality rate meta-analysis demonstrated a larger mortality for early

Imagining the future in children with severe traumatic brain injury.

Science.gov (United States)

Lah, Suncica; Gott, Chloe; Epps, Adrienne; Parry, Louise

2018-03-22

Imagining the future events is thought to rely on re-combination and integration of past episodic memory traces into future events. Future and past events contain episodic and non-episodic details. Children with severe traumatic brain injury (TBI) were found to have impaired recall of past episodic (but not semantic) event details. Here we examined whether severe TBI impairs construction of future events. Cross-sectional. Children with severe TBI (n = 14) and healthy controls (NC; n = 33) (i) completed tests of anterograde (narrative and relational) memory and executive skills, (ii) recalled past events and generated future events, and (iii) rated events' phenomenological qualities. Events were scored for episodic (internal) and non-episodic (external) details. The groups did not differ in generating details of future events although children with TBI recalled significantly fewer past internal (but not external) events' details relative to NCs. Moreover, the number of past internal details relative to future internal details was significantly higher in the NC group, but not in the TBI groups. Significant correlations between past and future were found for (i) episodic details in both groups, and (ii) semantic details in the NC group. The TBI group rated their events as being less significant than did the NC group. The groups did not differ on ratings of visual intensity and rehearsal. Children who have sustained severe TBI had impoverished recall of past, but not generation of future events. This unexpected dissociation between past and future event construction requires further research.

Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome.

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Skandsen, Toril; Kvistad, Kjell Arne; Solheim, Ole; Strand, Ingrid Haavde; Folvik, Mari; Vik, Anne

2010-09-01

In this prospective cohort study the authors examined patients with moderate to severe head injuries using MR imaging in the early phase. The objective was to explore the occurrence of diffuse axonal injury (DAI) and determine whether DAI was related to level of consciousness and patient outcome. One hundred and fifty-nine patients (age range 5-65 years) with traumatic brain injury, who survived the acute phase, and who had a Glasgow Coma Scale (GCS) score of 3-13 were admitted between October 2004 and August 2008. Of these 159 patients, 106 were examined using MR imaging within 4 weeks postinjury. Patients were classified into 1 of 3 stages of DAI: Stage 1, in which lesions were confined to the lobar white matter; Stage 2, in which there were callosal lesions; and Stage 3, in which lesions occurred in the dorsolateral brainstem. The outcome measure used 12 months postinjury was the Glasgow Outcome Scale-Extended (GOSE). Diffuse axonal injury was detected in 72% of the patients and a combination of DAI and contusions or hematomas was found in 50%. The GCS score was significantly lower in patients with "pure DAI" (median GCS Score 9) than in patients without DAI (median GCS Score 12; p GOSE score of 7, and patients without DAI had a median GOSE score of 8 (p = 0.10). Outcome was better in patients with DAI Stage 1 (median GOSE Score 8) and DAI Stage 2 (median GOSE Score 7.5) than in patients with DAI Stage 3 (median GOSE Score 4; p < 0.001). Thus, in patients without any brainstem injury, there was no difference in good recovery between patients with DAI (67%) and patients without DAI (66%). Diffuse axonal injury was found in almost three-quarters of the patients with moderate and severe head injury who survived the acute phase. Diffuse axonal injury influenced the level of consciousness, and only in patients with DAI was GCS score related to outcome. Finally, DAI was a negative prognostic sign only when located in the brainstem.

Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): results from the PariS-TBI study.

Science.gov (United States)

Jourdan, C; Bosserelle, V; Azerad, S; Ghout, I; Bayen, E; Aegerter, P; Weiss, J J; Mateo, J; Lescot, T; Vigué, B; Tazarourte, K; Pradat-Diehl, P; Azouvi, P

2013-01-01

To assess outcome and predicting factors 1 year after a severe traumatic brain injury (TBI). Multi-centre prospective inception cohort study of patients aged 15 or older with a severe TBI in the Parisian area, France. Data were collected prospectively starting the day of injury. One-year evaluation included the relatives-rating of the Dysexecutive Questionnaire (DEX-R), the Glasgow Outcome Scale-Extended (GOSE) and employment. Univariate and multivariate tests were computed. Among 257 survivors, 134 were included (mean age 36 years, 84% men). Good recovery concerned 19%, moderate disability 43% and severe disability 38%. Among patients employed pre-injury, 42% were working, 28% with no job change. DEX-R score was significantly associated with length of education only. Among initial severity measures, only the IMPACT prognostic score was significantly related to GOSE in univariate analyses, while measures relating to early evolution were more significant predictors. In multivariate analyses, independent predictors of GOSE were length of stay in intensive care (LOS), age and education. Independent predictors of employment were LOS and age. Age, education and injury severity are independent predictors of global disability and return to work 1 year after a severe TBI.

The Effect of Sharrows, Painted Bicycle Lanes and Physically Protected Paths on the Severity of Bicycle Injuries Caused by Motor Vehicles.

Science.gov (United States)

Wall, Stephen P; Lee, David C; Frangos, Spiros G; Sethi, Monica; Heyer, Jessica H; Ayoung-Chee, Patricia; DiMaggio, Charles J

2016-01-01

We conducted individual and ecologic analyses of prospectively collected data from 839 injured bicyclists who collided with motorized vehicles and presented to Bellevue Hospital, an urban Level-1 trauma center in New York City, from December 2008 to August 2014. Variables included demographics, scene information, rider behaviors, bicycle route availability, and whether the collision occurred before the road segment was converted to a bicycle route. We used negative binomial modeling to assess the risk of injury occurrence following bicycle path or lane implementation. We dichotomized U.S. National Trauma Data Bank Injury Severity Scores (ISS) into none/mild (0-8) versus moderate, severe, or critical (>8) and used adjusted multivariable logistic regression to model the association of ISS with collision proximity to sharrows (i.e., bicycle lanes designated for sharing with cars), painted bicycle lanes, or physically protected paths. Negative binomial modeling of monthly counts, while adjusting for pedestrian activity, revealed that physically protected paths were associated with 23% fewer injuries. Painted bicycle lanes reduced injury risk by nearly 90% (IDR 0.09, 95% CI 0.02-0.33). Holding all else equal, compared to no bicycle route, a bicycle injury nearby sharrows was nearly twice as likely to be moderate, severe, or critical (adjusted odds ratio 1.94; 95% confidence interval (CI) 0.91-4.15). Painted bicycle lanes and physically protected paths were 1.52 (95% CI 0.85-2.71) and 1.66 (95% CI 0.85-3.22) times as likely to be associated with more than mild injury respectively.

The Effect of Sharrows, Painted Bicycle Lanes and Physically Protected Paths on the Severity of Bicycle Injuries Caused by Motor Vehicles

Directory of Open Access Journals (Sweden)

Stephen P. Wall

2016-12-01

Full Text Available We conducted individual and ecologic analyses of prospectively collected data from 839 injured bicyclists who collided with motorized vehicles and presented to Bellevue Hospital, an urban Level-1 trauma center in New York City, from December 2008 to August 2014. Variables included demographics, scene information, rider behaviors, bicycle route availability, and whether the collision occurred before the road segment was converted to a bicycle route. We used negative binomial modeling to assess the risk of injury occurrence following bicycle path or lane implementation. We dichotomized U.S. National Trauma Data Bank Injury Severity Scores (ISS into none/mild (0–8 versus moderate, severe, or critical (>8 and used adjusted multivariable logistic regression to model the association of ISS with collision proximity to sharrows (i.e., bicycle lanes designated for sharing with cars, painted bicycle lanes, or physically protected paths. Negative binomial modeling of monthly counts, while adjusting for pedestrian activity, revealed that physically protected paths were associated with 23% fewer injuries. Painted bicycle lanes reduced injury risk by nearly 90% (IDR 0.09, 95% CI 0.02–0.33. Holding all else equal, compared to no bicycle route, a bicycle injury nearby sharrows was nearly twice as likely to be moderate, severe, or critical (adjusted odds ratio 1.94; 95% confidence interval (CI 0.91–4.15. Painted bicycle lanes and physically protected paths were 1.52 (95% CI 0.85–2.71 and 1.66 (95% CI 0.85–3.22 times as likely to be associated with more than mild injury respectively.

Life goals and social identity in people with severe acquired brain injury: an interpretative phenomenological analysis.

Science.gov (United States)

Martin, Rachelle; Levack, William M M; Sinnott, K Anne

2015-01-01

While there is a growing body of literature exploring life goals in rehabilitation, little research has been undertaken that includes the voice of the end-user. This study examined the views and experiences of people with severe acquired brain injury regarding the place of "life goals" in residential rehabilitation. Interpretative phenomenological analysis was used to collect and analyze data from five semi-structured interviews with participants in a residential rehabilitation setting. Three inter-related themes emerged from this study. Social connectedness (being 'part of things') emerged as a life goal of central importance for all participants (Theme 1). However, in order to achieve this sense of belonging, the participants needed to tentatively balance the opportunities arising within their environmental milieu (Theme 2) with the interpersonal factors relating to their unchanged, changed and changing self-identity (Theme 3). This study suggests that social identity and social connectedness ought to be primary foci of rehabilitation rather than matters only of secondary concern. Consideration needs to be given to both the environmental contexts and the intrapersonal strategies that support people who require residential rehabilitation services to achieve social connection, and thus their life goals, following a severe acquired brain injury. Implications for Rehabilitation There is a need to better support people with severe acquired brain injury (ABI) in terms of their social relationships and social identity during the delivery of person-centered rehabilitation services. Within the clinical setting there should be regular, in depth and open dialogue in which the individuals' values and preferences are discovered. A focus on the coherence between daily activities and the person's life goals is required for people with severe ABI. Clinicians need to consider how life goals for individual people change or are re-prioritized over the life span.

Diagnostic and treatment challenges in traumatic brain injury patients with severe neuropsychiatric symptoms: insights into psychiatric practice

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Lauterbach MD

2015-07-01

Full Text Available Margo D Lauterbach,1 Paula L Notarangelo,1 Stephen J Nichols,2 Kristy S Lane,1 Vassilis E Koliatsos11The Neuropsychiatry Program at Sheppard Pratt, Sheppard Pratt Health System, Baltimore, MD, 2Department of Emergency Medicine, The University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USAAbstract: Traumatic brain injury (TBI causes a variety of neuropsychiatric problems that pose diagnostic and treatment challenges for providers. In this report, we share our experience as a referral neuropsychiatry program to assist the general psychiatrist when adult TBI patients with psychiatric symptoms present for evaluation and treatment. We completed a retrospective study of patients with moderate-to-severe TBI and severe neuropsychiatric impairments. We collected information on demographics, nature of injury, symptomatology, diagnoses, and treatments. Data analysis indicates that mood stabilization was a key concern, often requiring aggressive pharmacological management. Cognitive dysfunction was a problem for the majority of patients, but was only medicated in a third, due to poor efficacy or behavioral side effects. The co-occurrence of multiple TBI-related symptoms and diagnoses in this patient cohort emphasizes the need for individualized psychopharmacological approaches and interventions.Keywords: traumatic brain injury, neurobehavioral, treatment

Quetiapine Induced Acute Dystonia in a patient with History of severe Head Injury

OpenAIRE

Robert G. Bota; Joanne W. Witkowski

2010-01-01

A patient with a history of severe head injury 10 years ago regained ability to walk after years of being bound to a wheelchair. During the last psychiatric hospitalization, quetiapine was increased to therapeutic dose using a normal titration. As a result the patient developed dystonia of multiple muscle groups requiring 4 days of hospitalization for remittance of symptoms. In this paper, we take a close look at the literature concerning extrapiramidal symptoms (EPS) in this context, and we ...

Vehicular crash data used to rank intersections by injury crash frequency and severity

OpenAIRE

Liu, Yi; Li, Zongzhi; Liu, Jingxian; Patel, Harshingar

2016-01-01

This article contains data on research conducted in “A double standard model for allocating limited emergency medical service vehicle resources ensuring service reliability” (Liu et al., 2016) [1]. The crash counts were sorted out from comprehensive crash records of over one thousand major signalized intersections in the city of Chicago from 2004 to 2010. For each intersection, vehicular crashes were counted by crash severity levels, including fatal, injury Types A, B, and C for major, modera...

Optimized hyperventilation preserves 2,3-diphosphoglycerate in severe traumatic brain injury.

Science.gov (United States)

Torres, Rayne Borges; Terzi, Renato Giuseppe Giovanni; Falcão, Antônio Luís Eiras; Höehr, Nelci Fenalti; Dantas Filho, Venâncio Pereira

2007-09-01

The concentration of 2,3-diphosphoglycerate (2,3-DPG/Hct) increases as a physiological occurrence to pH increase and hyperventilation. This response was tested in patients with severe traumatic brain injury (TBI). The concentration of 2,3-DPG/Hct was measured daily for six days in eleven patients with severe TBI in need of optimized hyperventilation because of intracranial hypertension. There was correlation between pH and the concentration of DPG/Hct. The concentration of 2,3-DPG/Hct remained predominantly within normal levels with slight increase in the sixth day of the study. The concentration of 2,3-DPG/Hct correlated significantly with measured partial pressure of oxygen that saturates 50% the hemoglobin of the blood (P50st), confirming the consistency of our data. The expected physiological response of a progressive increase in concentration of 2,3-DPG/Hct to hyperventilation was not observed. This fact may be explained by the intermittent and not sustained hyperventilation as dictated by the protocol of optimized ventilation.

Oxidative Stress and Antioxidant Therapy in Critically Ill Polytrauma Patients with Severe Head Injury

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Luca Loredana

2015-05-01

Full Text Available Traumatic Brain Injury (TBI is one of the leading causes of death among critically ill patients from the Intensive Care Units (ICU. After primary traumatic injuries, secondary complications occur, which are responsible for the progressive degradation of the clinical status in this type of patients. These include severe inflammation, biochemical and physiological imbalances and disruption of the cellular functionality. The redox cellular potential is determined by the oxidant/antioxidant ratio. Redox potential is disturbed in case of TBI leading to oxidative stress (OS. A series of agression factors that accumulate after primary traumatic injuries lead to secondary lesions represented by brain ischemia and hypoxia, inflammatory and metabolic factors, coagulopathy, microvascular damage, neurotransmitter accumulation, blood-brain barrier disruption, excitotoxic damage, blood-spinal cord barrier damage, and mitochondrial dysfunctions. A cascade of pathophysiological events lead to accelerated production of free radicals (FR that further sustain the OS. To minimize the OS and restore normal oxidant/antioxidant ratio, a series of antioxidant substances is recommended to be administrated (vitamin C, vitamin E, resveratrol, N-acetylcysteine. In this paper we present the biochemical and pathophysiological mechanism of action of FR in patients with TBI and the antioxidant therapy available.

The first description of severe anemia associated with acute kidney injury and adult minimal change disease: a case report

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Qian Yimei

2009-01-01

Full Text Available Abstract Introduction Acute kidney injury in the setting of adult minimal change disease is associated with proteinuria, hypertension and hyperlipidemia but anemia is usually absent. Renal biopsies exhibit foot process effacement as well as tubular interstitial inflammation, acute tubular necrosis or intratubular obstruction. We recently managed a patient with unique clinical and pathological features of minimal change disease, who presented with severe anemia and acute kidney injury, an association not previously reported in the literature. Case presentation A 60-year-old Indian-American woman with a history of hypertension and diabetes mellitus for 10 years presented with progressive oliguria over 2 days. Laboratory data revealed severe hyperkalemia, azotemia, heavy proteinuria and progressively worsening anemia. Urine eosinophils were not seen. Emergent hemodialysis, erythropoietin and blood transfusion were initiated. Serologic tests for hepatitis B, hepatitis C, anti-nuclear antibodies, anti-glomerular basement membrane antibodies and anti-neutrophil cytoplasmic antibodies were negative. Complement levels (C3, C4 and CH50 were normal. Renal biopsy unexpectedly displayed 100% foot process effacement. A 24-hour urine collection detected 6.38 g of protein. Proteinuria and anemia resolved during six weeks of steroid therapy. Renal function recovered completely. No signs of relapse were observed at 8-month follow-up. Conclusion Adult minimal change disease should be considered when a patient presents with proteinuria and severe acute kidney injury even when accompanied by severe anemia. This report adds to a growing body of literature suggesting that in addition to steroid therapy, prompt initiation of erythropoietin therapy may facilitate full recovery of renal function in acute kidney injury.

Effect of methylphenidate on ICU and hospital length of stay in patients with severe and moderate traumatic brain injury.

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Moein, Houshang; Khalili, Hossein A; Keramatian, Kamyar

2006-09-01

Traumatic brain injury is one of the major causes of death and disability among young people. Methylphenidate, a neural stimulant and protective drug, which has been mainly used for childhood attention deficit/hyperactivity disorder, has shown some benefits in late psychosocial problems in patients with traumatic brain injury. Its effect on arousal and consciousness has been also revealed in the sub-acute phase of traumatic brain injury. We studied its effect on the acute phase of moderate and severe traumatic brain injury (TBI) in relation to the length of ICU and hospital admission. Severely and moderately TBI patients (according to inclusion and exclusion criteria) were randomized to treatment and control groups. The treatment group received methylphenidate 0.3mg/kg per dose PO BID by the second day of admission until the time of discharge, and the control group received a placebo. Admission information and daily Glasgow Coma Scale (GCS) were recorded. Medical, surgical, and discharge plans for patients were determined by the attending physician, blinded to the study. Forty patients with severe TBI (GCS = 5-8) and 40 moderately TBI patients (GCS = 9-12) were randomly divided into treatment and control groups on the day of admission. In the severely TBI patients, both hospital and ICU length of stay, on average, were shorter in the treatment group compared with the control group. In the moderately TBI patients while ICU stay was shorter in the treatment group, there was no significant reduction of the period of hospitalization. There were no significant differences between the treatment and control groups in terms of age, sex, post resuscitation GCS, or brain CT scan findings, in either severely or moderately TBI patients. Methylphenidate was associated with reductions in ICU and hospital length of stay by 23% in severely TBI patients (P = 0.06 for ICU and P = 0.029 for hospital stay time). However, in the moderately TBI patients who received methylphenidate

The study of lymphocytes glucocorticoid receptor in severe head injury

International Nuclear Information System (INIS)

Li Dapei; Wang Haodan; Zhao Qihuang

1994-01-01

Glucocorticoid receptors (GCR) of peripheral lymphocytes from 14 patients with severe head injury and 11 normal volunteers are studied by means of single point method of radioligand binding assay. All these patients receive surgical therapy and glucocorticoid of routine dosage. The results show that the GCR level of these patients is lower than that of the normal, while the plasma cortisol level is much higher. These changes correlate closely to the patients' clinical outcome. It is indicated that the GCR level can reflect the degree of stress of these patients and their response to glucocorticoid therapy. Using peripheral lymphocytes instead of the brain biopsy for the measurement of GCR can reflect the GCR changes of brain tissue, it's more convenient to get the sample and more acceptable to the patients

A Study of Emotionalism in Patients Undergoing Rehabilitation following Severe Acquired Brain Injury

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Joanna McGrath

2000-01-01

Full Text Available The present study describes the phenomenon of emotionalism in a sample of brain injured patients of mixed aetiology, with a view to identifying issues relevant to clinical management, and possible causal factors. 82 subjects with severe acquired brain injury undergoing rehabilitation participated in a structured interview in which they were asked to report the presence/absence of emotionalism and degree of distress associated with it. Their overt crying behaviour was also observed and recorded. Independent variables that predicted crying during the interview were identified using a multiple logistic regression procedure. Prevalence rates of emotionalism-tearfulness were high in this sample (52% self-report, 36–41% Emotionalism-laughter was much less common (13% Emotionalism-tearfulness was usually accompanied by negative affect, occurred in response to identifiable precipitants, and was often controllable. It was associated with major personal distress in about half the subjects who reported it. Independent variables which predicted crying behaviour were female gender and focal damage to the right cerebral hemisphere. It is concluded that an increased readiness to cry is common in people with severe acquired brain injury of mixed aetiology. The behaviour is meaningful, though not always distressing. The intensity of the behaviour is variable, and it may be most appropriate to regard emotionalism as a dimension rather than a syndrome. Implications for clinical management are discussed.

Evaluation of the patient generated index as a measure of quality-of-life in people with severe traumatic brain injury.

LENUS (Irish Health Repository)

Hogan, Mark

2013-01-01

Quality-of-life (QoL) measures may be useful in quantifying the personal impact of an acquired brain injury and as an indicator of the effectiveness of service provision. This study investigated the validity of the patient generated index (PGI) as a measure of QoL with a sample of adults who had sustained a severe traumatic brain injury.

Neuropsychological support to relatives of patients with severe traumatic brain injury in the sub-acute phase

DEFF Research Database (Denmark)

Norup, Anne; Kristensen, Karin Spangsberg; Siert, Lars

2011-01-01

as characteristics related to the patient: Glasgow Coma Scale, Injury Severity Score, Early Functional Abilities, Functional Independence Measure, Rancho Los Amigos; and to the relative: symptoms of anxiety and depression (SCL-90-R), quality of life (SF-36) and amount and number of sessions of neuropsychological...

Successful treatment of inverted Takotsubo cardiomyopathy after severe traumatic brain injury with milrinone after dobutamine failure.

Science.gov (United States)

Mrozek, Ségolène; Srairi, Mohamed; Marhar, Fouad; Delmas, Clément; Gaussiat, François; Abaziou, Timothée; Larcher, Claire; Atthar, Vincent; Menut, Rémi; Fourcade, Olivier; Geeraerts, Thomas

2016-01-01

Takotsubo cardiomyopathy can occur at the early phase of severe acute brain injuries. In the case of cardiac output decrease or shock, the optimal treatment is still a matter of debate. Due to massive stress hormone release, the infusion of catecholamines may have limited effects and may even aggravate cardiac failure. Other inotropic agents may be an option. Levosimendan has been shown to have potential beneficial effects in this setting, although milrinone has not been studied. We report a case of a young female presenting with inverted Takotsubo cardiomyopathy syndrome after severe traumatic brain injury. Due to hemodynamic instability and increasing levels of infused norepinephrine, dobutamine infusion was begun but rapidly stopped due to tachyarrhythmia. Milrinone infusion stabilized the patient's hemodynamic status and improved cardiac output without deleterious effects. Milrinone could be a good alternative when inotropes are required in Takotsubo cardiomyopathy and when dobutamine infusion is associated with tachyarrhythmia. Copyright © 2016 Elsevier Inc. All rights reserved.

A description of the severity of equestrian-related injuries (ERIs) using clinical parameters and patient-reported outcomes.

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Papachristos, Alexander; Edwards, Elton; Dowrick, Adam; Gosling, Cameron

2014-09-01

Despite a number of injury prevention campaigns and interventions, horse riding continues to be a dangerous activity, resulting in more accidents per hour than motorcycling, skiing and football. Injuries are often serious, with one in four patients requiring admission to hospital. This study aims to describe the severity of equestrian-related injuries (ERIs) using both clinical parameters and patient-reported outcomes. A retrospective study of all patients aged ≥18 years admitted to The Alfred Hospital between January 2003 and January 2008 with an ERI was performed. Specific clinical data were extracted from the medical record. In addition, a questionnaire was conducted identifying the details of the accident, the required recovery time and levels of ongoing pain and physical disability. During the study period 172 patients met the inclusion criteria. There were three deaths (2%). Eighty-two patients (48%) suffered head injuries. Forty-one patients (24%) were admitted to the ICU and 31 patients (18%) required mechanical ventilation. On discharge, 41 patients (24%) required transfer to a sub-acute rehabilitation facility. One-hundred-and-twenty-four patients (72%) completed the questionnaire. Thirty-nine respondents (31%) were not wearing a helmet. Among patients injured for more than 6 months, 38 (35%) still experienced moderate or severe pain or disability. Ninety-five patients had returned to work at the time of review, among which 47(50%) required longer than 6 months to recover, and 40 (42%) returned at a reduced capacity. The clinical and patient-reported outcomes of ERIs requiring hospital admission are poor. Persistent pain and disability are common, even up to 5 years post-injury. A large proportion of patients required longer than 6 months to return to work and many return at a reduced capacity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Aging causes collateral rarefaction and increased severity of ischemic injury in multiple tissues

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Faber, James E.; Zhang, Hua; Lassance-Soares, Roberta M.; Prabhakar, Pranay; Najafi, Amir H.; Burnett, Mary Susan; Epstein, Stephen E.

2011-01-01

Objective Aging is a major risk factor for increased ischemic tissue injury. Whether collateral rarefaction and impaired remodeling contribute to this is unknown. We quantified the number and diameter of native collaterals, and their remodeling in 3-, 16-, 24-, and 31-months-old mice. Methods and Results Aging caused an “age-dose-dependent” greater drop in perfusion immediately after femoral artery ligation, followed by a diminished recovery of flow and increase in tissue injury. These effects were associated with a decline in collateral number, diameter and remodeling. Angiogenesis was also impaired. Mechanistically, these changes were not accompanied by reduced recruitment of T-cells or macrophages to remodeling collaterals. However, eNOS signaling was dysfunctional, as indicated by increased protein nitrosylation and less phosphorylated eNOS and VASP in collateral wall cells. The cerebral circulation exhibited a similar age-dose-dependent loss of collateral number and diameter and increased tortuosity, resulting in an increase in collateral resistance and infarct volume (e.g., 6- and 3-fold, respectively, in 24-months-old mice) after artery occlusion. This was not associated with rarefaction of similarly-sized arterioles. Collateral remodeling was also reduced. Conclusions Our findings demonstrate that aging causes rarefaction and insufficiency of the collateral circulation in multiple tissues, resulting in more severe ischemic tissue injury. PMID:21617137

Diagnostic and treatment challenges in traumatic brain injury patients with severe neuropsychiatric symptoms: insights into psychiatric practice.

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Lauterbach, Margo D; Notarangelo, Paula L; Nichols, Stephen J; Lane, Kristy S; Koliatsos, Vassilis E

2015-01-01

Traumatic brain injury (TBI) causes a variety of neuropsychiatric problems that pose diagnostic and treatment challenges for providers. In this report, we share our experience as a referral neuropsychiatry program to assist the general psychiatrist when adult TBI patients with psychiatric symptoms present for evaluation and treatment. We completed a retrospective study of patients with moderate-to-severe TBI and severe neuropsychiatric impairments. We collected information on demographics, nature of injury, symptomatology, diagnoses, and treatments. Data analysis indicates that mood stabilization was a key concern, often requiring aggressive pharmacological management. Cognitive dysfunction was a problem for the majority of patients, but was only medicated in a third, due to poor efficacy or behavioral side effects. The co-occurrence of multiple TBI-related symptoms and diagnoses in this patient cohort emphasizes the need for individualized psychopharmacological approaches and interventions.

Olfactory identification and its relationship to executive functions, memory, and disability one year after severe traumatic brain injury.

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Sigurdardottir, Solrun; Andelic, Nada; Skandsen, Toril; Anke, Audny; Roe, Cecilie; Holthe, Oyvor Oistensen; Wehling, Eike

2016-01-01

To explore the frequency of posttraumatic olfactory (dys)function 1 year after severe traumatic brain injury (TBI) and determine whether there is a relationship between olfactory identification and neuropsychological test performance, injury severity and TBI-related disability. A population-based multicenter study including 129 individuals with severe TBI (99 males; 16 to 85 years of age) that could accomplish neuropsychological examinations. Olfactory (dys)function (anosmia, hyposmia, normosmia) was assessed by the University of Pennsylvania Smell Identification Test (UPSIT) or the Brief Smell Identification Test (B-SIT). Three tests of the Delis-Kaplan Executive Function System (D-KEFS) were used to assess processing speed, verbal fluency, inhibition and set-shifting, and the California Verbal Learning Test-II was used to examine verbal memory. The Glasgow Outcome Scale-Extended (GOSE) was used to measure disability level. Employing 2 different smell tests in 2 equal-sized subsamples, the UPSIT sample (n = 65) classified 34% with anosmia and 52% with hyposmia, while the B-SIT sample (n = 64) classified 20% with anosmia and 9% with hyposmia. Individuals classified with anosmia by the B-SIT showed significantly lower scores for set-shifting, category switching fluency and delayed verbal memory compared to hyposmia and normosmia groups. Only the B-SIT scores were significantly correlated with neuropsychological performance and GOSE scores. Brain injury severity (Rotterdam CT score) and subarachnoid hemorrhage were related to anosmia. Individuals classified with anosmia demonstrated similar disability as those with hyposmia/normosmia. Different measures of olfaction may yield different estimates of anosmia. Nevertheless, around 1 third of individuals with severe TBI suffered from anosmia, which may also indicate poorer cognitive outcome. (c) 2015 APA, all rights reserved).

Symptomatic heterotopic ossification after very severe traumatic brain injury in 114 patients: incidence and risk factors

DEFF Research Database (Denmark)

Simonsen, Louise Lau; Sonne-Holm, Stig; Krasheninnikoff, Michael

2007-01-01

Injury Unit and to list some of the risk-predicting features. The study comprised an approximately complete, consecutive series of 114 adult patients from a well-defined geographical area, and with a posttraumatic amnesia period of at least 28 days, i.e. very severe TBI. Demographic and functional data...

The impact of combined use of fall-risk medications and antithrombotics on injury severity and intracranial hemorrhage among older trauma patients.

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Hohmann, Natalie; Hohmann, Lindsey; Kruse, Michael

2014-01-01

Use of fall-risk medications (medications that increase risk of falling in the elderly as defined by Beers criteria, STOPP/START criteria, and other literature) or antithrombotics is common in the elderly, and the impact of their concomitant use should be assessed in regards to fall injuries. The primary objective of this study is to assess the simultaneous outpatient use of fall-risk medications and antithrombotics in elderly fall-patients, and secondarily to analyze the injury severity score and occurrence of intracranial hemorrhage. Consecutive chart review at a level 2 trauma center in California, USA from August 01, 2009 to October 31, 2010. Records included 112 patients at least 65 years of age admitted with an outpatient fall. Fisher's exact and Student's t-tests were used (alpha 0.05, two-tailed) to examine prescribing patterns, intracranial hemorrhage occurrence, and injury severity score. Regression adjusted for antithrombotic and fall-risk medication type and number, opiate use, co-morbidities, age, and gender. Thirty-nine percent (44/112) of outpatients were prescribed antithrombotics plus fall-risk medications. The mean injury severity score (ISS) was 13.3 (range 1-26, standard deviation 7.2) for patients taking both medication classes versus 9.7 (range 1-25, standard deviation 7.5) for patients taking antithrombotics alone (p = 0.027). Additionally, in patients over 80 years of age, intracranial hemorrhage occurred more frequently with the use of antithrombotics plus fall-risk medications versus antithrombotics alone (18/29 = 62.1% versus 7/24 = 29.2%, p = 0.027, odds ratio = 3.974, 95% confidence interval = 1.094-15.010). Multivariate analyses showed an independent relationship between intracranial hemorrhage occurrence and type of therapy, as well as injury severity score and simultaneous therapy with fall-risk medications and antithrombotics. Simultaneous prescribing of antithrombotics and fall-risk medications is common. For

Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries.

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Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J

2015-01-01

We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Rib fracture patients have increased risk for truncal injuries and adverse outcomes. Adverse outcomes are independently associated with rib cage fracture burden. Severity of head, abdominal, and lung injuries also influence rib fracture outcomes.

Brain Injury and Severe Eating Difficulties at Admission-Patient Perspective Nine to Fifteen Months after Discharge

DEFF Research Database (Denmark)

Kjærsgaard, Annette

2017-01-01

The purpose of this pilot study was to explore and interpret the way that individuals with acquired brain injury, admitted to inpatient neurorehabilitation with severe eating difficulties, experienced eating nine to fifteen months after discharge. Four individuals with acquired brain injury were ...... the patient perspective of adapting to and developing new strategies for activities related to eating, however, further prospective, longitudinal research in a larger scale and with repeated interviews is needed....... interviewed via qualitative semi-structured interviews. An explorative study was conducted to study eating difficulties. Qualitative content analysis was used. Four main themes emerged from the analysis: personal values related to eating, swallowing difficulties, eating and drinking, meals and social life...... the ability to eat reduced or lost completely, even temporarily, was unexpected and difficult, and caused strong emotional reactions, even 18 months after injury. Time spent using a feeding tube had a negative, but not persistent, impact on quality-of-life. The preliminary findings provide knowledge regarding...

Improving the timeliness and accuracy of injury severity data in road traffic accidents in an emerging economy setting.

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Lam, Carlos; Chen, Chang-I; Chuang, Chia-Chang; Wu, Chia-Chieh; Yu, Shih-Hsiang; Chang, Kai-Kuo; Chiu, Wen-Ta

2018-05-18

Road traffic injuries (RTIs) are among the leading causes of injury and fatality worldwide. RTI casualties are continually increasing in Taiwan; however, because of a lack of an advanced method for classifying RTI severity data, as well as the fragmentation of data sources, road traffic safety and health agencies encounter difficulties in analyzing RTIs and their burden on the healthcare system and national resources. These difficulties lead to blind spots during policy-making for RTI prevention and control. After compiling classifications applied in various countries, we summarized data sources for RTI severity in Taiwan, through which we identified data fragmentation. Accordingly, we proposed a practical classification for RTI severity, as well as a feasible model for collecting and integrating these data nationwide. This model can provide timely relevant data recorded by medical professionals and is valuable to healthcare providers. The proposed model's pros and cons are also compared to those of other current models.

Social communication features in children following moderate to severe acquired brain injury: a cross-sectional pilot study.

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Breau, Lynn M; Clark, Brenda; Scott, Ori; Wilkes, Courtney; Reynolds, Shawn; Ricci, Florencia; Sonnenberg, Lyn; Zwaigenbaum, Lonnie; Rashid, Marghalara; Goez, Helly R

2015-04-01

We compared the social communication deficits of children with moderate to severe acquired brain injury or autism spectrum disorder, while accounting for the role of attention-deficit hyperactivity disorder (ADHD) symptoms. Parents of 20 children aged 6 to 10 years (10 acquired brain injury; 10 autism spectrum disorder) completed the Social Communication Questionnaire, and Conners 3 Parent Short. A multivariate analysis of covariance revealed significant differences between groups in Social Communication Questionnaire restricted repetitive behavior scores, but not reciprocal social interaction or social communication. Multiple linear regressions indicated diagnosis did not predict reciprocal social interaction or social communication scores and that Conners 3 Parent Short Form hyperactivity scores were the strongest predictor of Social Communication Questionnaire reciprocal social interaction scores after accounting for age and Intelligence Quotient. The lack of difference in social communication deficits between groups may help in understanding the pathophysiology underlying the behavioral consequences of acquired brain injury. The link between hyperactivity and reciprocal interaction suggests that targeting hyperactivity may improve social outcomes in children following acquired brain injury. © The Author(s) 2014.

Translational Research in Enteral and Parenteral Nutrition Support for Patients with Severe Head Injury

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Fa-liang LIN

2015-12-01

Full Text Available Abstract Objective: To explore the key points of the translational research in enteral and pareenteral nutrition support for patients with severe head injury (SHI, and to analyze the influence of different nutritional support routes on the prognosis of SHI patients. Methods: Totally 141 patients with severe craniocerebral injury were selected as study subjects, 47 cases for each group, and were given early enteral nutrition (EEN, delayed enteral nutrition (DEN, and parenteral nutrition (PN, respectively. The effect of different nutritional support routes on SHI patients was observed. Results: After 14 d of treatment, Glasgow coma scale (GCS scores of 3 groups were higher than treatment before (P<0.01, and with statistical differences among groups (P<0.05, or P<0.01. The levels of serum albumin, total serum protein and hemoglobin were higher in EEN group than the other groups (P<0.01. The level of serum albumin was lower in PN group than in DEN group (P<0.05. There were statistical differences in the incidence of complications among three groups (χ2=9.2487, P=0.0098. Conclusion: EEN support is more conductive to the improvement of the nutrition status, reduction of the incidence of complications, and promotion of the prognosis of SHI patients than DEN and PN.

The Evidence for Brain Injury in Whiplash Injuries

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Michael P. Alexander

2003-01-01

Full Text Available The evidence that brain damage can occur in injuries that produce whiplash is reviewed. The clinical phenomena for the two injuries are the same. Pure whiplash injury implies no, or minimal head contact, but many patients also have head contact against a head rest or the steering wheel or windshield. The relative severity of the neck injury and the head injury distinguishes whiplash from mild closed head injury. If there is brain injury is some patients with whiplash, it, by definition, falls at the mildest end of the concussion spectrum. The relationship between these two injuries is examined.

Effect of systemic inflammatory response in the development of encephalopathy in severe thermal injury

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Sorokina O.Y.

2015-11-01

Full Text Available The article discusses the burn encephalopathy as a manifestation of organ dysfunction. Purpose: to determine the impact of the systemic inflammatory response to the development of en­cephalopathy in thermal injury. The study involved 104 patients, who were divided into two groups depending on the severity of the burn injury. The development of SIRS in patients was confirmed by high levels of IL-6 during the whole period of observation. The level of IL-6 did not affect the development, timing and duration of sleep disorders in both groups. The level of LII on the day 1 affects the development of sleep disorders in group 1 (R=0.499, p=0.041. Development of insomnia correlated with the shift of leukocyte formula to the left in group 2 on the day 5 (R=0.349, p=0.020. We found a relationship between the development of delirium, its duration and the level of young forms of neutrophils in patients of 1 (R=0.563, p=0.001 and 2 (R=0.3488, p=0.003 groups. Development of delirium, its timing and duration correlated with the level of IL-6 on day 3 (R=0.812, p=0,049, R=0.5903, p=0.079 and R=0.615, p=0.059, respectively in the group 2. The extent of the inflammatory reaction determined the disorders of thought (R=-0.545, p=0.036, memory (R=-0.547, p=0.023 and the dynamic of the recovery of cognitive functions in patients of group 1. Cognitive deficit correlated with the level of IL-6 (R=0.760, p=0.079 and the level of young forms of neutrophils (R=-0.603, p=0,013 in group 2. Thus, SIRS is a defining moment in the development of nervous system dysfunction in severe thermal injury.

Changes in the Plasma Sex Hormone Profile in Males with Severe Concomitant Injury

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K. N Yezhova

2009-01-01

Full Text Available Objective: to perform a complex study of typical plasma sex hormone changes and their functional significance in males with severe concomitant injury (SCI. Subjects and methods. Fifty-nine males aged 18—49 years who had SCI were enrolled in the study. The admission severity was an APACHE II score of 18.6±2.4. According to the outcome of the disease, all the patients were divided into 2 groups: A survivors; B deceased persons. A control comprised 12 healthy male donors aged 19-36 years, in whom the levels of 8 sex steroids were measured. The standard procedures were used to comparatively analyze the concentrations of pituitary reproductive hormones and aldosterone. Hormonal concentrations were studied over time on posttraumatic days 1, 3, 5, 7, 10, and 15. The plasma hormone profile was examined by test kits (BSL, USA on a Stat Fax 2100 device (Awareness Technology Inc., USA for enzyme immunoassay. Prolactin, luteinizing hormone (LH, follicle-stimulating hormone (FSH, progesterone (P, 17-hydroxyprogesterone (17-OH-P, dehydroepiandrosterone sulfate (DHEA-S, androstendione (A, testosterone (T, dihydrotestosterone (DHT, estrone (E1, estradiol (E2, and aldosterone were determined. Results. The complex study of phasic changes in the profile of 11 plasma sex hormones was first conducted in males in the posttraumatic period. Moreover, the typical plasma hormonal changes were elevated prolactin levels and their phasic variations, normal LH and FSH levels with a tendency for further phasic LH changes and FSH reduction. After the injury, the plasma concentration of P was increased and that of 17-OH-P was decreased. The levels of A and DHEA-S varied in the normal range with a tendency for DHEA-S to be lower during the process. In the posttraumatic period, the plasma content of T and DHT was substantially reduced and that of E1 and E2 was increased. The deceased patients generally showed higher levels of A, DHEA-S, and estrogens as a reflection of

Comparative analysis of cervical spine management in a subset of severe traumatic brain injury cases using computer simulation.