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...

Severe ocular injuries in Greek children.

Science.gov (United States)

Mela, Ephigenia K; Georgakopoulos, Constantinos D; Georgalis, Athanasios; Koliopoulos, John X; Gartaganis, Sotirios P

2003-02-01

To determine the epidemiological characteristics of severe eye injuries in childhood, in a mixed urban and rural Greek setting. Retrospective analysis of 95 cases (103 eyes) of eye injuries in children younger than 17 years of age admitted to the Department of Ophthalmology, University Hospital of Patras, Greece, during a five-year period. The data were analyzed with respect to age, sex, type, cause and mode of injury, method of management, duration of hospitalization and final visual deficit. The average age was 9.8 years and males were involved in 80% of the cases. The most common type of eye injury was mechanical closed-globe injury (71.8%). Mechanical open-globe injuries were found in 21.3% of the eyes, while burns comprised 6.7% of the injuries. Most injuries were agent-related, with blows and falls being responsible most often. Multiple operations were part of the treatment in 11.6% of the eyes; 14.5% of the eyes were blinded and 15.5% had significant final visual acuity loss. These hospital-based data suggest that there is a need for health education of both parents and children, since some injuries in children could easily have been prevented.

Effects of muscle injury severity on localized bioimpedance measurements

International Nuclear Information System (INIS)

Nescolarde, L; Rosell-Ferrer, J; Yanguas, J; Lukaski, H; Alomar, X; Rodas, G

2015-01-01

Muscle injuries in the lower limb are common among professional football players. Classification is made according to severity and is diagnosed with radiological assessment as: grade I (minor strain or minor injury), grade II (partial rupture, moderate injury) and grade III (complete rupture, severe injury). Tetrapolar localized bioimpedance analysis (BIA) at 50 kHz made with a phase-sensitive analyzer was used to assess damage to the integrity of muscle structures and the fluid accumulation 24 h after injury in 21 injuries in the quadriceps, hamstring and calf, and was diagnosed with magnetic resonance imaging (MRI). The aim of this study was to identify the pattern of change in BIA variables as indicators of fluid [resistance (R)] and cell structure integrity [reactance (Xc) and phase angle (PA)] according to the severity of the MRI-defined injury. The % difference compared to the non-injured contralateral muscle also measured 24-h after injury of R, Xc and PA were respectively: grade I (n = 11; −10.4, −17.5 and −9.0%), grade II (n = 8; −18.4, −32.9 and −16.6%) and grade III (n = 2; −14.1, −52.9 and −43.1%), showing a greater significant decrease in Xc (p < 0.001). The greatest relative changes were in grade III injuries. However, decreases in R, that indicate fluid distribution, were not proportional to the severity of the injury. Disruption of the muscle structure, demonstrated by the localized determination of Xc, increased with the severity of muscle injury. The most significant changes 24 h after injury was the sizeable decrease in Xc that indicates a pattern of disrupted soft tissue structure, proportional to the severity of the injury. (paper)

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

Science.gov (United States)

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.

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

DEFF Research Database (Denmark)

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...

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 ...

Trampoline-related injury in children.

Science.gov (United States)

Shankar, Amitabh; Williams, Kim; Ryan, Mary

2006-09-01

To quantify and describe trampoline-related injuries in children attending an urban pediatric emergency department. Retrospective cohort study of consecutive patients attending a children's emergency department with trampoline-related injuries over a 3-month period (May-July 2005). One hundred and sixty-eight children were treated for trampoline-related injuries during the period reviewed. Sixty-three percent were girls. Their age ranged between 4 months and 16 years (mean, 10.4 years [SD, 3 years and 10 months]). Lower limb injuries (51%) were more common overall. The most common injuries were to the ankle (31%), followed by foot (9.2%), and neck (8.4%). Sprain or soft tissue injuries (68%) were the most common type of injury, followed by fracture (12.2%). The most common mechanism of injury was inversion of the ankle on a trampoline (18.4%). Trampoline-related injuries represented 2.5% of morbidity from accidental trauma in children presenting to emergency department in our study. The rate and severity of injury has become a significant public health concern. It appears that current preventative strategies are inadequate in making children's carers aware of the potential risks of trampoline use, particularly when used recreationally.

Surfing-related ocular injuries.

Science.gov (United States)

Kim, J W; McDonald, H R; Rubsamen, P E; Luttrull, J K; Drouilhet, J H; Frambach, D A; Boyer, D S; Lambrou, F H; Hendrick, A; Weiss, J N; Engstrom, R E; Ing, M

1998-01-01

This report evaluates the clinical characteristics of surfing-related ocular trauma to learn the nature of such injuries and propose possible preventive measures. The authors reviewed 11 cases of surfing-related eye injuries caused by direct trauma from the surfboard, studying their mechanism of injury, the associated ocular complications, and the anatomic and visual outcomes of surgical repair. Surfing-related ocular injuries occurred exclusively in young males (mean age, 24.8 years; range, 14-37 years). The mechanism of injury most frequently responsible was impact with the sharp nose of the surfboard following a fall. Serious posterior segment complications were observed in all 11 patients, with nine patients suffering ruptured globes. Despite immediate medical attention, five patients did not recover ambulatory levels of visual acuity (>5/200). Surfing-related ocular trauma presenting to the retinal specialist typically leaves the patient with a permanent visual disability. Important factors contributing to these high-velocity injuries include the sharply pointed nose of the surfboard and the leash keeping the surfer in close proximity to the board following a fall. A simple modification in surfboard design such as blunting the sharp nose of the surfboard, or appropriate protective guards fitted over the surfboard nose, should lessen the severity of such injuries.

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.

A multivariate tobit analysis of highway accident-injury-severity rates.

Science.gov (United States)

Anastasopoulos, Panagiotis Ch; Shankar, Venky N; Haddock, John E; Mannering, Fred L

2012-03-01

Relatively recent research has illustrated the potential that tobit regression has in studying factors that affect vehicle accident rates (accidents per distance traveled) on specific roadway segments. Tobit regression has been used because accident rates on specific roadway segments are continuous data that are left-censored at zero (they are censored because accidents may not be observed on all roadway segments during the period over which data are collected). This censoring may arise from a number of sources, one of which being the possibility that less severe crashes may be under-reported and thus may be less likely to appear in crash databases. Traditional tobit-regression analyses have dealt with the overall accident rate (all crashes regardless of injury severity), so the issue of censoring by the severity of crashes has not been addressed. However, a tobit-regression approach that considers accident rates by injury-severity level, such as the rate of no-injury, possible injury and injury accidents per distance traveled (as opposed to all accidents regardless of injury-severity), can potentially provide new insights, and address the possibility that censoring may vary by crash-injury severity. Using five-year data from highways in Washington State, this paper estimates a multivariate tobit model of accident-injury-severity rates that addresses the possibility of differential censoring across injury-severity levels, while also accounting for the possible contemporaneous error correlation resulting from commonly shared unobserved characteristics across roadway segments. The empirical results show that the multivariate tobit model outperforms its univariate counterpart, is practically equivalent to the multivariate negative binomial model, and has the potential to provide a fuller understanding of the factors determining accident-injury-severity rates on specific roadway segments. Published by Elsevier Ltd.

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....

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

Science.gov (United States)

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.

Epidemiology of terror-related versus non-terror-related traumatic injury in children.

Science.gov (United States)

Aharonson-Daniel, Limor; Waisman, Yehezkel; Dannon, Yehuda L; Peleg, Kobi

2003-10-01

In the past 2 years hundreds of children in Israel have been injured in terrorist attacks. There is a paucity of data on the epidemiology of terror-related trauma in the pediatric population and its effect on the health care system. The objective of this study was to review the accumulated Israeli experience with medical care to young victims of terrorism and to use the knowledge obtained to contribute to the preparedness of medical personnel for future events. Data on all patients who were younger than 18 years and were hospitalized from October 1, 2000, to December 31, 2001, for injuries sustained in a terrorist attack were obtained from the Israel National Trauma Registry. The parameters evaluated were patient age and sex, diagnosis, type, mechanism and severity of injury, interhospital transfer, stay in intensive care unit, duration of hospitalization, and need for rehabilitation. Findings were compared with the general pediatric population hospitalized for non-terror-related trauma within the same time period. During the study period, 138 children were hospitalized for a terror-related injury and 8363 for a non-terror-related injury. The study group was significantly older (mean age: 12.3 years [standard deviation: 5.1] v 6.9 years [standard deviation: 5.3]) and sustained proportionately more penetrating injuries (54% [n = 74] vs 9% [n = 725]). Differences were also noted in the proportion of internal injuries to the torso (11% in the patients with terror-related trauma vs 4% in those with non-terror-related injuries), open wounds to the head (13% vs 6%), and critical injuries (Injury Severity Score of 25+; 25% vs 3%). The study group showed greater use of intensive care unit facilities (33% vs 8% in the comparison group), longer median hospitalization time (5 days vs 2 days), and greater need for rehabilitative care (17% vs 1%). Terror-related injuries are more severe than non-terror-related injuries and increase the demand for acute care in children.

Underestimation of Severity of Previous Whiplash Injuries

Science.gov (United States)

Naqui, SZH; Lovell, SJ; Lovell, ME

2008-01-01

INTRODUCTION We noted a report that more significant symptoms may be expressed after second whiplash injuries by a suggested cumulative effect, including degeneration. We wondered if patients were underestimating the severity of their earlier injury. PATIENTS AND METHODS We studied recent medicolegal reports, to assess subjects with a second whiplash injury. They had been asked whether their earlier injury was worse, the same or lesser in severity. RESULTS From the study cohort, 101 patients (87%) felt that they had fully recovered from their first injury and 15 (13%) had not. Seventy-six subjects considered their first injury of lesser severity, 24 worse and 16 the same. Of the 24 that felt the violence of their first accident was worse, only 8 had worse symptoms, and 16 felt their symptoms were mainly the same or less than their symptoms from their second injury. Statistical analysis of the data revealed that the proportion of those claiming a difference who said the previous injury was lesser was 76% (95% CI 66–84%). The observed proportion with a lesser injury was considerably higher than the 50% anticipated. CONCLUSIONS We feel that subjects may underestimate the severity of an earlier injury and associated symptoms. Reasons for this may include secondary gain rather than any proposed cumulative effect. PMID:18201501

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.

Targeted treatment of severe head injury

African Journals Online (AJOL)

injury is not a homogeneous concept and is poorly classified for the purposes of treatment.1 The separation of patients into 3 categories of severity (mild, moderate and severe) remains a blunt measure used to guide therapy in individual patients. Patients with severe traumatic brain injury (TBI), i.e. a Glasgow Coma Score ...

Paediatric ride-on mower related injuries and plastic surgical management.

LENUS (Irish Health Repository)

Laing, T A

2011-05-01

Lawnmower related injuries cause significant morbidity in children and young teenagers. The \\'ride-on\\' mowers which are more powerful than the \\'walk behind\\' mowers are becoming increasingly popular. The incidence and severity of injuries from either type of lawnmower appears to be steadily rising as is the burden placed on local plastic surgical and emergency services in managing the care of these patients. The aims of the study were to demonstrate changing trends in lawnmower-related injuries to children presenting to a single unit over a ten-year period and to identify any association between injury severity and machine subtype (\\'ride-on\\' versus \\'walk-behind\\'). Hospital databases, theatre records and medical case notes were reviewed retrospectively of all patients under the age of 16 treated for lawnmower related injuries over a 10 year period from July 1998 to June 2008. Data gathered included patient demographics, injury site and severity, management (type and number of surgical procedures), length of hospital stay and outcome. Injury severity score was also calculated for each case. Controlling for estimated regional population changes, there was a significant increase in the number of ride-on mower related accidents in the time period 2003-2008, compared to the time period 1998-2003. Ride-on injuries had significantly higher injury severity scores, longer hospital stays and were more likely to involve amputations as compared with walk-behind injuries. Children can sustain significant injuries with unsafe lawnmower use. The current study demonstrates the increasing incidence of ride-on mower related injuries in children and identifies a greater morbidity associated with such injuries. Such presentations place intense demands on local plastic surgical services.

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

Science.gov (United States)

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.

Model for predicting the injury severity score.

Science.gov (United States)

Hagiwara, Shuichi; Oshima, Kiyohiro; Murata, Masato; Kaneko, Minoru; Aoki, Makoto; Kanbe, Masahiko; Nakamura, Takuro; Ohyama, Yoshio; Tamura, Jun'ichi

2015-07-01

To determine the formula that predicts the injury severity score from parameters that are obtained in the emergency department at arrival. We reviewed the medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The injury severity score, age, mean blood pressure, heart rate, Glasgow coma scale, hemoglobin, hematocrit, red blood cell count, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, and fibrin degradation products, were examined in those patients on arrival. To determine the formula that predicts the injury severity score, multiple linear regression analysis was carried out. The injury severity score was set as the dependent variable, and the other parameters were set as candidate objective variables. IBM spss Statistics 20 was used for the statistical analysis. Statistical significance was set at P  Watson ratio was 2.200. A formula for predicting the injury severity score in trauma patients was developed with ordinary parameters such as fibrin degradation products and mean blood pressure. This formula is useful because we can predict the injury severity score easily in the emergency department.

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.

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.

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

Science.gov (United States)

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.

Incidence of severe work-related injuries among young adult workers in Brazil: analysis of compensation data.

Science.gov (United States)

Sousa Santana, Vilma; Villaveces, Andrés; Bangdwala, Shrikant L; Runyan, Carol W; Albuquerque Oliveira, Paulo Rogerio

2012-08-01

To obtain national estimates of the annual cumulative incidence and incidence density of severe non-fatal injuries using compensation benefits data from the Brazilian National Social Security Institute (INSS), and to describe their sociodemographic distribution among workers aged under 25 years. Data are records of health-related compensation benefits from the Ministry of Social Insurance's information system of compensation benefits of the INSS recorded in 2006. Injuries were cases classified under chapter XIX, ICD-10. The assessment of their relation with work was made by INSS's occupational physician experts. The study population comprised young workers aged 16-24 years. 59,381 workers received compensation benefits for injuries in the study year. Among them 14,491 (24.4%) were work related, 12,501 (86.3%) were male and 1990 were female workers (13.7%). The annual cumulative incidence rate of work-related injuries (ACI-WI) was 2.9×1000 workers, higher among men (4.2×1000) than women (1.0×1000). The incidence density rate (IDR-WI) was 0.7/1000 full-time equivalent (FTE), higher for men (0.97/1000 FTE) than women (0.24/1000 FTE). Both morbidity measures were higher in the younger group (16-19 years), and inversely related to wage, especially for women in the younger group. Logging, extraction, food/beverage and construction industries had higher ACI-WI and IDR-WI for adolescents and young adult workers of both sex groups. These findings suggest that the Brazilian labour laws limiting young adult workers in hazardous settings need to be expanded, adding occupations in other extractive industries and certain types of work in the food/beverage manufacturing industries. Social inequalities associated with sex need to be examined further with more detailed data.

Trampoline-related injuries to children.

Science.gov (United States)

Smith, G A; Shields, B J

1998-07-01

To describe the epidemiological features of trampoline-related injuries among children treated in an urban pediatric emergency department. A descriptive study of a consecutive series of patients. The emergency department of a large, urban, academic children's hospital. Children treated for trampoline-related injuries from May 1, 1995, through April 30, 1997. Two hundred fourteen children were treated for trampoline-related injuries during the study period, representing, on average, 1 child treated approximately every 3 days. Children ranged in age from 1 to 16 years (mean [SD], 9.4 [3.6] years). The area of the body most commonly injured was a lower extremity (36.0%), followed by an upper extremity (31.8%), the head (14.5%), the trunk (9.8%), and the neck (7.9%). The most common type of injury was a soft tissue injury (51.9%), followed by fracture (34.6%) and laceration (11.7%). Several patterns of trampoline-related injury were identified. Extremity fractures were more common in the upper extremities (P=.006; relative risk [RR]=1.64; 95% confidence interval [CI], 1.16-2.31); however, soft tissue injuries were more common in the lower extremities (P=.006; RR=1.66; 95% CI, 1.16-2.38). Lacerations were associated with injury to the head region (Ptrampoline was located in the backyard in 96% (119/124) of cases. Adult supervision was present at the time of injury for 55.6% (65/117) of children, including 73.3% (22/30) of children younger than 6 years. Parents reported that they had been aware of the potential dangers of trampolines before the injury event (73% [81/111]), that their child had previously attempted a flip on a trampoline (56.9% [66/116]), that this was not the child's first injury on a trampoline (10% [12/120]), and that their child continued to use a trampoline after the current injury event (54.8% [63/115]). Trampoline-related injuries to children treated in the emergency department are almost exclusively associated with the use of backyard trampolines

Geriatric fall-related injuries.

Science.gov (United States)

Hefny, Ashraf F; Abbas, Alaa K; Abu-Zidan, Fikri M

2016-06-01

Falls are the leading cause of geriatric injury. We aimed to study the anatomical distribution, severity, and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. All injured patients with an age ≥ 60 years who were admitted to Al-Ain Hospital or died in the Emergency Department due to falls were prospectively studied over a four year period. We studied 92 patients. Fifty six of them (60.9%) were females. The mean (standard deviation) of age was 72.2 (9.6) years. Seventy three (89%) of all incidents occurred at home. Eighty three patients (90.2%) fell on the same level. The median (range) ISS was 4 (1-16) and the median GCS (range) was 15 (12-15). The lower limb was the most common injured body region (63%). There were no statistical significant differences between males and females regarding age, ISS, and hospital stay (p = 0.85, p = 0.57, and p = 0.35 respectively). The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk factors for falls including home hazards is essential for prevention of geriatric fall-related injuries.

Work-related injuries: injury characteristics, survival, and age effect.

Science.gov (United States)

Konstantinidis, Agathoklis; Talving, Peep; Kobayashi, Leslie; Barmparas, Galinos; Plurad, David; Lam, Lydia; Inaba, Kenji; Demetriades, Demetrios

2011-06-01

Work-related injuries impose a significant burden on society. The goal of this study was to delineate the epidemiology and the effect of age on type and mortality after occupational injuries. Patients 16 years of age or older sustaining work-related injuries were identified from the National Trauma Databank 12.0. The study population was stratified into four age groups: 16 to 35, 36 to 55, 56 to 65, and older than 65 years old. The demographic characteristics, type of injury, mechanism of injury, setting of injury, use of alcohol or other illicit drugs, and mortality were analyzed and related to age strata. Overall 67,658 patients were identified. There were 27,125 (40.1%) patients in the age group 16 to 35 years, 30,090 (44.5%) in the group 36 to 55 years, 6,618 (9.8%) in the group 56 to 65 years, and 3,825 (5.7%) older than 65 years. The injury severity increased significantly with age. Elderly patients were significantly more likely to sustain intracranial hemorrhages, spinal, and other skeletal injuries. The overall mortality was 2.9 per cent (1938) with the latter increasing significantly in a stepwise fashion with progressing age, becoming sixfold higher in patients older than 65 years (OR, 6.18; 95% CI, 4.78 to 7.80; P < 0.001). Our examination illustrates the associations between occupational injury and significant mortality that warrant intervention for mortality reduction. There is a stepwise-adjusted increase in mortality with progressing age.

Occurrence and severity of agitated behavior after severe traumatic brain injury

DEFF Research Database (Denmark)

Moth Wolffbrandt, Mia; Poulsen, Ingrid; Engberg, Aase W

2013-01-01

To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS).......To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS)....

Seizure Severity Is Correlated With Severity of Hypoxic-Ischemic Injury in Abusive Head Trauma.

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Dingman, Andra L; Stence, Nicholas V; O'Neill, Brent R; Sillau, Stefan H; Chapman, Kevin E

2017-12-12

The objective of this study was to characterize hypoxic-ischemic injury and seizures in abusive head trauma. We performed a retrospective study of 58 children with moderate or severe traumatic brain injury due to abusive head trauma. Continuous electroencephalograms and magnetic resonance images were scored. Electrographic seizures (51.2%) and hypoxic-ischemic injury (77.4%) were common in our cohort. Younger age was associated with electrographic seizures (no seizures: median age 13.5 months, interquartile range five to 25 months, versus seizures: 4.5 months, interquartile range 3 to 9.5 months; P = 0.001). Severity of hypoxic-ischemic injury was also associated with seizures (no seizures: median injury score 1.0, interquartile range 0 to 3, versus seizures: 4.5, interquartile range 3 to 8; P = 0.01), but traumatic injury severity was not associated with seizures (no seizures: mean injury score 3.78 ± 1.68 versus seizures: mean injury score 3.83 ± 0.95, P = 0.89). There was a correlation between hypoxic-ischemic injury severity and seizure burden when controlling for patient age (r s =0.61, P interquartile range 0 to 0.23 on magnetic resonance imaging done within two days versus median restricted diffusion ratio 0.13, interquartile range 0.01 to 0.43 on magnetic resonance imaging done after two days, P = 0.03). Electrographic seizures are common in children with moderate to severe traumatic brain injury from abusive head trauma, and therefore children with suspected abusive head trauma should be monitored with continuous electroencephalogram. Severity of hypoxic-ischemic brain injury is correlated with severity of seizures, and evidence of hypoxic-ischemic injury on magnetic resonance imaging may evolve over time. Therefore children with a high seizure burden should be reimaged to evaluate for evolving hypoxic-ischemic injury. Published by Elsevier Inc.

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.

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...

Skateboarding injuries in Vienna: location, frequency, and severity.

Science.gov (United States)

Keilani, Mohammad; Krall, Christoph; Lipowec, Lucas; Posch, Martin; Komanadj, Tanya Sedghi; Crevenna, Richard

2010-07-01

To describe injury patterns of skateboard-associated injuries (SAIs) and to assess the frequency and severity of SAIs depending on an athlete's skateboarding experience. Cross-sectional observation. Skating areas. A total of 100 Viennese skateboarders. No intervention. The participants filled in a questionnaire that was used to assess selected sociodemographic data; duration and frequency of skateboarding; "stance"; and localization, rate, as well as the severity of SAIs during the past 24 months. Skating behavior and sociodemographic data were compared with frequency and severity of SAIs. Response rate of questionnaires was 75% (n=75) of the participants. Duration of skateboarding was 8+/-5 years, and training time was 18+/-11 hours/week. A total of 97% (73) of the respondents reported at least one injury: in 52% (39) of the respondents the most serious injury was mild to moderate (laceration, contusion, strain/sprain, and bruise), whereas in 45% (34) it was severe (ligament rupture, fracture). A total of 33% (13) of participants experiencing only mild-to-moderate injuries consulted a physician compared with 94% (32) with at least one serious injury. The most severely affected regions were lower leg/ankle/foot in 32% (24) of all respondents who experienced at least one severe injury and forearm/wrist/hand in 16% (12) who experienced at least one severe injury. Only 13% (10) used protective equipment. Multivariate logistic regression for the occurrence of at least one severe injury with all socioeconomic and sport-relevant data investigated revealed significant positive correlations with weekly training time (P=.037) and years of experience (P=.021). However, after correcting for multiple testing (Bonferroni adjustment for 8 tests), no significances remained. More experienced skateboarders seem to have a greater risk of incurring severe SAIs, but sociodemographic factors seem to have no influence on injury risk in this population. Only a minority of skateboarders

The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?

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Brown, Joshua B; Gestring, Mark L; Leeper, Christine M; Sperry, Jason L; Peitzman, Andrew B; Billiar, Timothy R; Gaines, Barbara A

2017-06-01

The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS greater than 15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and Abbreviated Injury Scale (AIS) to predict mortality and define optimal thresholds of severe injury in pediatric trauma. Patients from the Pennsylvania trauma registry 2000-2013 were included. Children were defined as younger than 16 years. Logistic regression predicted mortality from ISS for children and adults. The optimal ISS cutoff for mortality that maximized diagnostic characteristics was determined in children. Regression also evaluated the association between mortality and maximum AIS in each body region, controlling for age, mechanism, and nonaccidental trauma. Analysis was performed in single and multisystem injuries. Sensitivity analyses with alternative outcomes were performed. Included were 352,127 adults and 50,579 children. Children had similar predicted mortality at ISS of 25 as adults at ISS of 15 (5%). The optimal ISS cutoff in children was ISS greater than 25 and had a positive predictive value of 19% and negative predictive value of 99% compared to a positive predictive value of 7% and negative predictive value of 99% for ISS greater than 15 to predict mortality. In single-system-injured children, mortality was associated with head (odds ratio, 4.80; 95% confidence interval, 2.61-8.84; p 0.05). For multisystem injury, all body region AIS scores were associated with mortality except extremities. Sensitivity analysis demonstrated ISS greater than 23 to predict need for full trauma activation, and ISS greater than 26 to predict impaired functional independence were optimal thresholds. An ISS greater than 25 may be a more appropriate definition of severe injury in children. Pattern of injury is important, as only head and chest injury drive mortality

Airbag deployment-related eye injuries.

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Koisaari, Tapio; Leivo, Tiina; Sahraravand, Ahmad; Haavisto, Anna-Kaisa; Sulander, Pekka; Tervo, Timo M T

2017-07-04

We studied the correlation between airbag deployment and eye injuries using 2 different data sets. The registry of the Finnish Road Accident (FRA) Investigation Teams was analyzed to study severe head- and eyewear-related injuries. All fatal passenger car or van accidents that occurred during the years 2009-2012 (4 years) were included (n = 734). Cases in which the driver's front airbag was deployed were subjected to analysis (n = 409). To determine the proportion of minor, potentially airbag-related eye injuries, the results were compared to the data for all new eye injury patients (n = 1,151) recorded at the Emergency Clinic of the Helsinki University Eye Hospital (HUEH) during one year, from May 1, 2011, to April 30, 2012. In the FRA data set, the unbelted drivers showed a significantly higher risk of death (odds ratio [OR] = 5.89, 95% confidence interval [CI], 3.33-10.9, P = 2.6E-12) or of sustaining head injuries (OR = 2.50, 95% CI, 1.59-3.97, P = 3.8E-5). Only 4 of the 1,151 HUEH patients were involved in a passenger car accident. In one of the crashes, the airbag operated, and the belted driver received 2 sutured eye lid wounds and showed conjunctival sugillation. No permanent eye injuries were recorded during the follow-up. The calculated annual airbag-related eye injury incidence was less than 1/1,000,000 people, 4/100,000 accidents, and 4/10,000 injured occupants. Airbag-related eye injuries occurred very rarely in car accidents in cases where the occupant survived and the restraint system was appropriately used. Spectacle use did not appear to increase the risk of eye injury in restrained occupants.

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.

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/

Comparing alertness and injury severity following motor vehicular ...

African Journals Online (AJOL)

Background: From casual observation of injury patterns in Motor Vehicular Accidents (MVAs), it was sometimes observed that if the victim had been more alert and reacts protectively, injury severity might be reduced. Protective response is often expected to minimize the severity of injuries. Objective: To determine the ...

Surviving severe traumatic brain injury in Denmark

DEFF Research Database (Denmark)

Odgaard, Lene; Poulsen, Ingrid; Kammersgaard, Lars Peter

2015-01-01

PURPOSE: To identify all hospitalized patients surviving severe traumatic brain injury (TBI) in Denmark and to compare these patients to TBI patients admitted to highly specialized rehabilitation (HS-rehabilitation). PATIENTS AND METHODS: Patients surviving severe TBI were identified from...... severe TBI were admitted to HS-rehabilitation. Female sex, older age, and non-working status pre-injury were independent predictors of no HS-rehabilitation among patients surviving severe TBI. CONCLUSION: The incidence rate of hospitalized patients surviving severe TBI was stable in Denmark...

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 description of the severity of equestrian-related injuries (ERIs) using clinical parameters and patient-reported outcomes.

Science.gov (United States)

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.

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...

Incidence, Mechanisms, and Severity of Match-Related Collegiate Men's Soccer Injuries on FieldTurf and Natural Grass Surfaces: A 6-Year Prospective Study.

Science.gov (United States)

Meyers, Michael C

2017-03-01

Numerous injuries have been attributed to playing on artificial turf. More recently, newer generations of artificial turf have been developed to duplicate the playing characteristics of natural grass. Although artificial turf has been deemed safer than natural grass in some studies, few long-term studies have been conducted comparing match-related collegiate soccer injuries between the 2 playing surfaces. Collegiate male soccer athletes do not experience any difference in the incidence, mechanisms, or severity of match-related injuries between FieldTurf and natural grass. Cohort study; Level of evidence, 2. Male soccer athletes from 11 universities were evaluated over 6 seasons. Demographic features and predictors included player position, cleat design, player weight, turf age, and environmental factors. Outcomes of interest included injury incidence, injury category, time loss, injury mechanism and situation, type of injury, injury grade and anatomic location, injury severity, head and lower extremity trauma, and elective medical procedures. All match-related injuries were evaluated by the attending head athletic trainer and team physicians on site and subsequently in the physician's office when further follow-up and treatment were deemed necessary. In sum, 765 collegiate games were evaluated for match-related soccer injuries sustained on FieldTurf or natural grass during 6 seasons. Overall, 380 team games (49.7%) were played on FieldTurf versus 385 team games (50.3%) played on natural grass. A total of 722 injuries were documented, with 268 (37.1%) occurring on FieldTurf and 454 (62.9%) on natural grass. Multivariate analysis per 10 team games indicated a significant playing surface effect: F 2,720 = 7.260, P = .001. A significantly lower total injury incidence rate (IIR) of 7.1 (95% CI, 6.6-7.5) versus 11.8 (95% CI, 11.3-12.2; P < .0001) and lower rate of substantial injuries, 0.7 (95% CI, 0.5-1.0) versus 1.9 (95% CI, 1.5-2.3; P < .03), were documented on Field

Morbidity associated with golf-related injuries among children: findings from a pediatric trauma center.

Science.gov (United States)

Vitale, Melissa A; Mertz, Kristen J; Gaines, Barbara; Zuckerbraun, Noel S

2011-01-01

To describe injuries due to golf-related activities among pediatric patients requiring hospital admission. We conducted a retrospective analysis of all sports-related injuries from 2000 to 2006 using a level 1 trauma center database. Of 1005 children admitted with sports-related injuries, 60 (6%) had golf-related injuries. The mean injury severity score was significantly higher for golf-related injuries (11.0) than that for all other sports-related injuries (6.8). Most golf-related injuries occurred in children younger than 12 years (80%), at home (48%), and by a strike from a club (57%) and resulted in trauma to the head or neck (68%). Golf-related injuries, although an infrequent cause of sports-related injuries, have the potential to result in severe injuries, especially in younger children. Preventive efforts should target use of golf clubs by younger children in the home setting.

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

Science.gov (United States)

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.

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.

Prognostic significance of specific injury patterns in casualties of traffic-related accidents.

Science.gov (United States)

Calosevic, Srdjan; Lovric, Zvonimir

2015-11-01

Fatal triad and ipsilateral dyad are patterns of pedestrian injuries related to significant mortality in traffic-related accidents. The aim of this research was to investigate the correlation between specific injury patterns and fatal outcome in other participants of traffic-related accidents. This was a retrospective study of traffic-related accidents in the broader area of the city of Osijek in a five-year period from 1995 to 1999. Autopsy results from the Institute of Pathology and Forensic Medicine of the Clinical Hospital Centre Osijek were analysed of individuals who died after their accident. The total severity of injuries was measured using the ISS. Logistic regression analysis was used for assessing the correlation between specific injury patterns and an early outcome from the severe injury. There were 213 individuals included in the study: 72 pedestrians and 141 other participants (drivers, assistant drivers, passengers, cyclists and motorcyclists). A total of129 individuals died on the spot and 84 died in the hospital during the first 48h. Femoral and pelvic fracture, fatal triad and both variants of ipsilateral dyad were related to higher ISS values. Ipsilateral fracture of upper and lower extremities (ipsilateral dyad 1) was associated with a 4.59 times higher risk of an immediate fatal outcome in the total sample. In pedestrians, the risk was 5.99 higher, and in other participants, the risk was 4.11 times higher. Specific skeletal injuries and injury patterns are a significant indicator for total injury severity and related poor prognosis for all participants of traffic-related injuries, not only for pedestrians. In this study, the ipsilateral fracture of upper and lower extremity was related to the largest total severity of injuries and the poorest prognosis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study.

Directory of Open Access Journals (Sweden)

Marc Hanschen

Full Text Available Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients.In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009, characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6, the revised injury severity score (RISC allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6 (2.3% of patients.Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%. The overall mortality rate was 13.9%, minor cardiac injury (AIS 1 and severe cardiac injury (AIS 2-6 are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6 is associated with a higher mortality (OR 2.79 and 4.89, respectively as compared to the predicted average mortality (OR 2.49 of the study collective.Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients' outcome is dependent on the severity of cardiac injury.

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

Directory of Open Access Journals (Sweden)

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.

Terrorism-related injuries versus road traffic accident-related trauma: 5 years of experience in Israel.

Science.gov (United States)

Peleg, Kobi; Savitsky, Bella

2009-12-01

Terrorism victims comprise the minority among trauma injured people, but this small population imposes a burden on the health care system. Thirty percent of the population injured in terrorist activities experienced severe trauma (injury severity score > or =16), more than half of them need a surgical procedure, and 25% of the population affected by terrorism had been admitted to intensive care. Furthermore, compared with patients with non-terrorism-related trauma, victims of terrorism often arrive in bulk, as part of a mass casualty event. This poses a sudden load on hospital resources and requires special organization and preparedness. The present study compared terrorism-related and road accident-related injuries and examined clinical characteristics of both groups of patients. This study is a retrospective study of all patients injured through terrorist acts and road traffic accidents from September 29, 2000 to December 31, 2005, and recorded in the Israel Trauma Registry. Data on the nature of injuries, treatment, and outcome were obtained from the registry. Medical diagnoses were extracted from the registry and classified based on International Classification of Diseases coding. Diagnoses were grouped to body regions, based on the Barell Injury Diagnosis Matrix. The study includes 2197 patients with terrorism-related injuries and 30,176 patients injured in road traffic accidents. All in all, 27% of terrorism-related casualties suffered severe to critical injuries, comparing to 17% among road traffic accident-related victims. Glasgow Coma Scale scores terrorism victims, in contrast with 7.4% among people injured on the roads. The terrorism victims had a significantly higher rate of use of intensive care facilities (24.2% vs 12.4%). The overall inpatient death rate was 6.0% among terrorism victims and 2.4% among those injured in road traffic accidents. Casualties from terrorist events are more severely injured and require more resources relative to casualties

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

Blunt splenic injury and severe brain injury: a decision analysis and implications for care

Science.gov (United States)

Alabbasi, Thamer; Nathens, Avery B.; Tien, Col Homer

2015-01-01

Background The initial nonoperative management (NOM) of blunt splenic injuries in hemodynamically stable patients is common. In soldiers who experience blunt splenic injuries with concomitant severe brain injury while on deployment, however, NOM may put the injured soldier at risk for secondary brain injury from prolonged hypotension. Methods We conducted a decision analysis using a Markov process to evaluate 2 strategies for managing hemodynamically stable patients with blunt splenic injuries and severe brain injury — immediate splenectomy and NOM — in the setting of a field hospital with surgical capability but no angiography capabilities. We considered the base case of a 40-year-old man with a life expectancy of 78 years who experienced blunt trauma resulting in a severe traumatic brain injury and an isolated splenic injury with an estimated failure rate of NOM of 19.6%. The primary outcome measured was life expectancy. We assumed that failure of NOM would occur in the setting of a prolonged casualty evacuation, where surgical capability was not present. Results Immediate splenectomy was the slightly more effective strategy, resulting in a very modest increase in overall survival compared with NOM. Immediate splenectomy yielded a survival benefit of only 0.4 years over NOM. Conclusion In terms of overall survival, we would not recommend splenectomy unless the estimated failure rate of NOM exceeded 20%, which corresponds to an American Association for the Surgery of Trauma grade III splenic injury. For military patients for whom angiography may not be available at the field hospital and who require prolonged evacuation, immediate splenectomy should be considered for grade III–V injuries in the presence of severe brain injury. PMID:26100770

Risk factors affecting injury severity determined by the MAIS score.

Science.gov (United States)

Ferreira, Sara; Amorim, Marco; Couto, Antonio

2017-07-04

Traffic crashes result in a loss of life but also impact the quality of life and productivity of crash survivors. Given the importance of traffic crash outcomes, the issue has received attention from researchers and practitioners as well as government institutions, such as the European Commission (EC). Thus, to obtain detailed information on the injury type and severity of crash victims, hospital data have been proposed for use alongside police crash records. A new injury severity classification based on hospital data, called the maximum abbreviated injury scale (MAIS), was developed and recently adopted by the EC. This study provides an in-depth analysis of the factors that affect injury severity as classified by the MAIS score. In this study, the MAIS score was derived from the International Classification of Diseases. The European Union adopted an MAIS score equal to or greater than 3 as the definition for a serious traffic crash injury. Gains are expected from using both police and hospital data because the injury severities of the victims are detailed by medical staff and the characteristics of the crash and the site of its occurrence are also provided. The data were obtained by linking police and hospital data sets from the Porto metropolitan area of Portugal over a 6-year period (2006-2011). A mixed logit model was used to understand the factors that contribute to the injury severity of traffic victims and to explore the impact of these factors on injury severity. A random parameter approach offers methodological flexibility to capture individual-specific heterogeneity. Additionally, to understand the importance of using a reliable injury severity scale, we compared MAIS with length of hospital stay (LHS), a classification used by several countries, including Portugal, to officially report injury severity. To do so, the same statistical technique was applied using the same variables to analyze their impact on the injury severity classified according to LHS

Supporting the long-term residential care needs of older homeless people with severe alcohol-related brain injury in Australia: the Wicking Project.

Science.gov (United States)

Rota-Bartelink, Alice; Lipmann, Bryan

2007-01-01

For years, community service providers have been frustrated with the lack in availability of long-term, specialized supported accommodation for older people, particularly older homeless people, with severe acquired brain injury (ABI) and challenging behaviors. Although the incidence of ABI (particularly alcohol-related brain injury) is far wider than being confined to the homeless population, it is frequently misdiagnosed and very often misunderstood Wintringham is an independent welfare company in Melbourne, Australia, that provides secure, affordable, long-term accommodation and high quality services to older homeless people. The high incidence of alcohol abuse among the resident population has led us to adapt our model ofcare to accommodate a complexity of need. However, there are some individuals with severely affected behaviors that continue to challenge Wintringham's capacity to provide adequate support. The deficiency in highly specialized, long-term supported accommodation for older people with severe alcohol-related brain injury (ARBI) is the driving force behind this project. We aim to further develop and improve the current Wintringham model of residential care to better support people with these complex care needs. We will report on the synthesis of this project which aims to test a specialized model that can be reproduced or adapted by other service providers to improve the life circumstances of these frequently forgotten people.

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...

Neuropsychiatric aspects of severe brain injuries

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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.

Effect of Fireworks Laws on Pediatric Fireworks-Related Burn Injuries.

Science.gov (United States)

Myers, John; Lehna, Carlee

Changes in U.S. fireworks laws have allowed younger children to purchase fireworks. In addition, the changes have allowed individuals to purchase more powerful fireworks. The purpose of this study is to examine the epidemiology of pediatric firework-related burn injuries among a nationally representative sample of the United States for the years 2006 to 2012. We examined inpatient admissions for pediatric firework-related burn patients from 2006 to 2012 using the nationwide inpatient sample and examined emergency department admissions using the nationwide emergency department sample. Both data sources are part of the Healthcare Cost and Utilization Project. Trajectories over time were evaluated. A total of 3193 injuries represented an estimated 90,257 firework-related injuries treated in the United States from 2006 to 2012. A majority of injuries were managed in the emergency department (n = 2008, 62.9%). The incidence generally increased over time; increasing from 4.28 per 100,000 population in 2006 to 5.12 per 100,000 population in 2012, P = .019. However, the proportion of injuries requiring inpatient admission (28.9% in 2006 to 50.0% in 2012, P fireworks laws may have had a modest effect on incidence of related injuries and the age of purchaser. However, it has had a dramatic effect on the severity of the related injuries, resulting in more inpatient admissions and longer length of stay in the hospital. Preventative methods should be taken to reduce the rate and severity of firework-related injuries among U.S. youths.

ED utilization trends in sports-related traumatic brain injury.

Science.gov (United States)

Hanson, Holly R; Pomerantz, Wendy J; Gittelman, Mike

2013-10-01

Emergency department (ED) visits for sports-related traumatic brain injuries (TBIs) have risen. This study evaluated how the number and severity of admissions have changed as ED visits for sports-related TBIs have increased. A retrospective study of children aged 0 to 19 years at a level 1 trauma center was performed. Patients from 2002 to 2011 with a primary or secondary diagnosis of TBI were identified from the hospital's inpatient and outpatient trauma registries. Frequencies were used to characterize the population, χ(2) analysis was performed to determine differences between groups, and regression analysis looked at relationship between year and injury severity score or length of stay. Sport was responsible for injury in 3878 (15.4%) cases during the study period; 3506 (90.4%) were discharged from the hospital, and 372 (9.6%) were admitted. Seventy-three percent were male patients and 78% Caucasian; mean age was 13 ± 3.5 years. ED visits for sports-related TBIs increased 92% over the study period, yet there was no significant change (χ(2) = 9.8, df = 9, P = .37) in the percentage of children admitted. Mean injury severity score for those admitted decreased from 7.8 to 4.8 (β = -0.46; P = .006); length of stay trended downward (β = -0.05; P = .05). The percentage of children being admitted from the ED with sports-related TBI has not changed over the past 10 years. The severity of admitted sports-related TBI is decreasing. Additional research is needed to correlate these trends with other TBI mechanisms.

Industrial distributions of severe occupational injuries among workers in Thailand.

Science.gov (United States)

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.

Science.gov (United States)

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.

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.

A comparison of wakeboard-, water skiing-, and tubing-related injuries in the United States, 2000-2007.

Science.gov (United States)

Baker, John I; Griffin, Russell; Brauneis, Paul F; Rue, Loring W; McGwin, Gerald

2010-01-01

The purpose of the study was to compare tubing-related injuries to wakeboarding- and water skiing-related injuries. Data was collected from the 2000-2007 National Electronic Injury Surveillance Survey for 1,761 individuals seeking care at an emergency department due to a tubing-, wakeboarding, or water skiing-related injury. Data included patient age and sex, as well as injury characteristics including body region injured (i.e., head and neck, trunk, shoulder and upper extremity, and hip and lower extremity) and diagnosis of injury (e.g., contusion, laceration, or fracture). Case narratives were reviewed to ensure that a tubing-, wakeboarding-, or water skiing-related injury occurred while the individual was being towed behind a boat. Severe injury (defined as an injury resulting in the individual being hospitalized, transferred, held for observation) was compared among the groups using logistic regression. Wakeboard- and tubing-related injuries more commonly involved the head and neck, while water skiing- related injuries were likely to involve the hip and lower extremity. Tubing-related injuries, compared to water skiing-related injuries, were more likely to be severe (OR 2.31, 95% CI 1.23-4. 33). Like wakeboarding and water skiing, tubing has inherent risks that must be understood by the participant. While tubing is generally considered a safer alternative to wakeboarding and water skiing, the results of the current study suggest otherwise. Both the number and severity of tubing- related injuries could be prevented through means such as advocating the use of protective wear such as helmets while riding a tube or having recommended safe towing speeds prominently placed on inner tubes. Key pointsIncrease annual injury rate trend in wakeboard injuries.Wakeboard- and tubing-related injuries more often to head and neck, waterskiing-related injuries more often to hip and lower extremity.Tubing-related injuries over 2-times as likely to be severe compared to

Exploring Driver Injury Severity at Intersection: An Ordered Probit Analysis

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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

DEFF Research Database (Denmark)

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...

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

Science.gov (United States)

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].

Science.gov (United States)

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.

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.

Predicting severe injury using vehicle telemetry data.

Science.gov (United States)

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.

Science.gov (United States)

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

Analysis of Severe Injuries Associated with Volleyball Activities.

Science.gov (United States)

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…

Elderly Taiwanese's Intrinsic Risk Factors for Fall-related Injuries

OpenAIRE

In-Fun Li; Yvonne Hsiung; Hui-Fen Hsing; Mei-Yu Lee; Te-Hsin Chang; Ming-Yuan Huang

2016-01-01

Background: As a vital issue in geriatric research, risk factors for falls were concluded to be multifactorial, and prevention has been mostly aimed at decreasing situational and environmental risks that cause and aggravate fall-related injuries, particularly within the institutions. While knowledge is limited about older patients' intrinsic determinants, the purpose of this study was to explore elderly Taiwanese's intrinsic risk factors associated with severe fall-related injuries. Method...

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 ...

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)

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

Science.gov (United States)

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

"Heely"-related injuries in children.

Science.gov (United States)

Thing, J; Wade, D; Clark, H

2008-09-01

"Heelys", or shoes with an integral wheel embedded into the heel, are becoming increasingly popular among children in the UK. Despite the manufacturer's claims about their safety, increasing numbers of patients are attending the emergency department with "Heely"-related injuries. To assess the number and type of "Heely"-related injuries seen in the emergency department in a busy district general hospital and to assess the number of school days lost as a result of these injuries as a secondary measure of the impact on education and lifestyle. Medical staff working in the emergency department completed proformas for all children attending the department with "Heely"-related injuries between 26 December and 26 April 2007. Data collected included age, sex, mechanism of injury, diagnosis and number of days off school as a result of the injury. 35 patients with "Heely"-related injuries of mean age 9.6 years (range 6-15) were identified during the study period. The most common mechanism of injury was a fall onto an outstretched hand (20/35, 57%). Other mechanisms of injury identified were lateral upper limb injury (7/35), traumatic lower limb injury (2/35), rotational lower limb injury (2/35), head injury (2/35) and back injury (2/35). The most common diagnosis was fracture of the distal radius (10/35), two of which had an associated distal ulna fracture. Two tibial fractures and one nasal fracture were also seen. The average number of days off school was 4.5 days (range 0-20). None of the children included in this study were using safety equipment at the time of the injury. The number of "Heely"-related injuries seen in one department over a 4-month period suggests a much higher incidence of injuries than the 46/100,000 found by the manufacturers based on Consumer Product Safety Commission data in the USA. The discrepancy is almost certainly due to the reluctance of UK children to use safety equipment and to follow the manufacturer's safety advice. Larger scale studies

Scarf-related injuries at a major trauma center in northern India

Directory of Open Access Journals (Sweden)

Pritish Singh

2017-04-01

Conclusion: Scarf-related injuries constitute a sizable proportion of trauma, with varying degrees of severity. Devastating consequences in significant proportion of cases dictate the call for a prevention plan comprising both educational and legislative measures. Urgent preventive measures targeting scarf-related injuries will help reduce mortality and morbidity.

Geriatric fall-related injuries.

African Journals Online (AJOL)

Conclusion: The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk fac- tors for falls including home hazards is essential for prevention of geriatric fall-related injuries. Keywords: Accidental fall, geriatrics, injury, trauma registry. DOI: http://dx.doi.org/10.4314/ahs.v16i2.24.

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 ...

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.

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

Science.gov (United States)

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.

What are the Main Risk Factors for Running-Related Injuries?

NARCIS (Netherlands)

Saragiotto, B.T.; Yamato, T.P.; Hespanhol, L.C.; Rainbow, M.J.; Davis, I.S.; Lopes, A.D.

2014-01-01

Background: Despite several studies that have been conducted on running injuries, the risk factors for running-related injuries are still not clear in the literature. Objective: The aim of this study was to systematically review prospective cohort studies that investigated the risk factors for

High-grade renal injuries are often isolated in sports-related trauma.

Science.gov (United States)

Patel, Darshan P; Redshaw, Jeffrey D; Breyer, Benjamin N; Smith, Thomas G; Erickson, Bradley A; Majercik, Sarah D; Gaither, Thomas W; Craig, James R; Gardner, Scott; Presson, Angela P; Zhang, Chong; Hotaling, James M; Brant, William O; Myers, Jeremy B

2015-07-01

Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III-V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma. We identified patients with AAST grades III-V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into "Sport" or "Non-sport" related groups. Outcomes included rates of hypotension (systolic blood pressure 110bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury. 320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p=0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p=0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, pinjury scale scores. Sports related trauma was more likely to be isolated without other significant injury (69% vs. 39% (psports and non-sports renal injuries (p=0.30). Sports injuries had lower transfusion (7% vs. 47%, psports vs. 18% non-sports, p=0.95). High-grade sports-related blunt renal trauma is more likely to occur in isolation without other abdominal or thoracic injuries and clinicians must have a high suspicion of renal injury with significant blows to the flank during sports activities. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

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

Science.gov (United States)

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.

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)

Sports-related injuries in athletes with disabilities.

Science.gov (United States)

Fagher, K; Lexell, J

2014-10-01

The number of athletes with disabilities participating in organized sports and the popularity of the Paralympic Games is steadily increasing around the world. Despite this growing interest and the fact that participation in sports places the athlete at risk for injury, there are few studies concerning injury patterns, risk factors, and prevention strategies of injuries in disabled athletes. In this systematic literature search and critical review, we summarize current knowledge of the epidemiology of sports-related injuries in disabled athletes and describe their characteristics, incidence, prevalence, and prevention strategies. The outcomes of interest were any injury, either an acute trauma or an overuse event. PubMed, EMBASE, CINAHL, and Google Scholar were systematically searched and 25 of 605 identified studies met the inclusion criteria. Lower extremity injuries were more common in walking athletes, whereas upper extremity injuries were more prevalent in wheelchair athletes. The methodologies and populations varied widely between the studies. Few studies were sports or disability specific, which makes it difficult to determine specific risk factors, and few studies reported injury severity and prevention of injuries. Further longitudinal, systematic sports and disability specific studies are needed in order to identify and prevent injuries in athletes with disabilities. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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...

The assessment of severity of lung injury in sepsis

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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.

[Boxing-related cranial injury in children: a case report].

Science.gov (United States)

Timsit, S; Rougeau, T; Grevent, D; Chéron, G

2012-11-01

No pediatric recommendations exist in France on the exercise of boxing by children and adolescents despite the risk of traumatic injury, sometimes serious. We report the case of a 15-year-old boy who participated in amateur boxing and had a subdural hematoma. Brain injuries and concussions are frequent and multiple. Severity is not always correlated with the intensity of the blows. There are age-related features. Several international medical organizations oppose boxing for children and adolescents. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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

Science.gov (United States)

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.

A COMPARISON OF WAKEBOARD-, WATER SKIING-, AND TUBING-RELATED INJURIES IN THE UNITED STATES, 2000-2007

Directory of Open Access Journals (Sweden)

John I. Baker

2010-03-01

Full Text Available The purpose of the study was to compare tubing-related injuries to wakeboarding- and water skiing-related injuries. Data was collected from the 2000-2007 National Electronic Injury Surveillance Survey for 1,761 individuals seeking care at an emergency department due to a tubing-, wakeboarding, or water skiing-related injury. Data included patient age and sex, as well as injury characteristics including body region injured (i.e., head and neck, trunk, shoulder and upper extremity, and hip and lower extremity and diagnosis of injury (e.g., contusion, laceration, or fracture. Case narratives were reviewed to ensure that a tubing-, wakeboarding-, or water skiing-related injury occurred while the individual was being towed behind a boat. Severe injury (defined as an injury resulting in the individual being hospitalized, transferred, held for observation was compared among the groups using logistic regression. Wakeboard- and tubing-related injuries more commonly involved the head and neck, while water skiing- related injuries were likely to involve the hip and lower extremity. Tubing-related injuries, compared to water skiing-related injuries, were more likely to be severe (OR 2.31, 95% CI 1.23-4. 33. Like wakeboarding and water skiing, tubing has inherent risks that must be understood by the participant. While tubing is generally considered a safer alternative to wakeboarding and water skiing, the results of the current study suggest otherwise. Both the number and severity of tubing- related injuries could be prevented through means such as advocating the use of protective wear such as helmets while riding a tube or having recommended safe towing speeds prominently placed on inner tubes

Severe Hand Injuries Caused by a Mole Gun

Directory of Open Access Journals (Sweden)

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.

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

Science.gov (United States)

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.

Injury patterns and mortality rates of motorcycle-related head injuries ...

African Journals Online (AJOL)

Background: Motorcycles are an emerging means of public transportation in many developing countries and has a poor safety record when compared to other road users. Subsequently, motorcycle injuries have been on the rise and head injuries are the leading cause of death, severe injury and disability globally.

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

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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.

Cow-related trauma: a 10-year review of injuries admitted to a single institution.

LENUS (Irish Health Repository)

Murphy, Colin G

2012-02-01

INTRODUCTION: Bovine-related injuries to farmers are common in rural communities. Many injuries are significant requiring hospital admission and surgery. We reviewed all cattle-related injuries admitted to a regional trauma centre over 10 years and detail the nature of the injuries. METHOD: A retrospective review was undertaken, using hospital inpatient coding system (HIPE) to identify patients admitted following cow-related trauma for the last 10 years. From retrieved charts mechanism of injury was identified, demographics recorded and Injury Severity Score (ISS) and Trauma Injury Severity Score (TRISS) calculated based on the injuries sustained. RESULTS: 47 patients were identified, with a median age of 53 years. 4 injuries occurred in children, and 12 in patients over 65 years old. Three-quarters of those injured were male. Kicking was the most common mechanism of injury (n=21), but charge\\/head-butt injuries and trampling injuries were associated with more serious injury scores. 72% of patients were admitted under Orthopaedics as their primary care team, 25% under General Surgeons, with one patient admitted medically. Mean ISS score was 6.9 (range 1-50). 41 operative interventions were performed on 30 patients during their admission. 6.3% of patients required admission to Intensive Care with a mean length of stay of 12.3 days (range 2-21 days). There was no mortality. CONCLUSION: Cow-related trauma is a common among farming communities and is a potentially serious mechanism of injury that appears to be under-reported in a hospital context. Bovine-related head-butt and trampling injuries should be considered akin to high-velocity trauma.

Trampoline related injuries in adults.

Science.gov (United States)

Arora, Varun; Kimmel, Lara A; Yu, Kathy; Gabbe, Belinda J; Liew, Susan M; Kamali Moaveni, Afshin

2016-01-01

Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria. A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes. There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12. Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

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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.

The work-related fatal injury study: numbers, rates and trends of work-related fatal injuries in New Zealand 1985-1994.

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Feyer, A M; Langley, J; Howard, M; Horsburgh, S; Wright, C; Alsop, J; Cryer, C

2001-01-26

To determine the number and rates of work-related fatal injuries by employment status, occupation, industry, age and gender in New Zealand 1985-1994. Potential cases of work-related injury deaths of persons aged 15-84 years were identified from the national electronic mortality data files. Main exclusions were deaths due to suicide and deaths due to motor vehicle crashes. The circumstances of the deaths of each fatal incident meeting inclusion criteria were then reviewed directly from coronial files to determine work-relatedness. The rate of work-related fatal injury in New Zealand was 5.03/100000 workers per year for the study period. There was a significant decline in crude rate over the study period. However, this was in substantial part accounted for by changes in occupation and industry mix. Older workers, male workers, self-employed workers, and particular occupational groups, all had substantially elevated rates. Agricultural and helicopter pilots, forestry workers and fishery workers had the highest rates. Farmers, forestry workers, and fishery workers also had high numbers of deaths, together accounting for nearly 40% of all deaths. This study has demonstrated that work-related fatal injury remains a pressing problem for New Zealand. Several areas in urgent need of prevention efforts were highlighted.

Boxing-related head injuries.

Science.gov (United States)

Jayarao, Mayur; Chin, Lawrence S; Cantu, Robert C

2010-10-01

Fatalities in boxing are most often due to traumatic brain injury that occurs in the ring. In the past 30 years, significant improvements in ringside and medical equipment, safety, and regulations have resulted in a dramatic reduction in the fatality rate. Nonetheless, the rate of boxing-related head injuries, particularly concussions, remains unknown, due in large part to its variability in clinical presentation. Furthermore, the significance of repeat concussions sustained when boxing is just now being understood. In this article, we identify the clinical manifestations, pathophysiology, and management of boxing-related head injuries, and discuss preventive strategies to reduce head injuries sustained by boxers.

War-related penile injuries in Libya: Single-institution experience.

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Etabbal, Abdalla M; Hussain, Fathi F; Benkhadoura, Mohamed O; Banni, Abdalla M

2018-06-01

To report on our initial experience in the management of war-related penile injuries; proper diagnosis and immediate treatment of penile injuries is essential to gain satisfactory results. Besides treating primary wounds and restoring penile function, the cosmetic result is also an important issue for the surgeon. The study was conducted in the Department of Urology at Benghazi Medical Center and comprised all patients who presented with a shotgun, gunshot or explosive penile injury between February 2011 and August 2017. The patient's age, cause of injury, site and severity of injuries, management, postoperative complications, and hospital stay, were recorded. In all, 29 males with war-related penile injuries were enrolled in the study. The mean (SD) age of these patients was 31.3 (10.5) years. The glans, urethra, and corporal bodies were involved in four (13.7%), 10 (34.4%), and 20 (68.9%) of the patients, respectively. According to the American Association for the Surgery of Trauma Penis Injury Scale, Grade III penile injuries were the most common (11 patients, 37.9%). The most common post-intervention complications were urethral stricture with or without proximal urethrocutaneous fistula (eight patients, 27.5%), followed by permanent erectile dysfunction (five patients, 17.2%). In patients who sustain war-related penile injuries the surgeon's efforts should not only be directed to restoring normal voiding and erectile function but also on the cosmetic appearance of the penis.

Severe blood-brain barrier disruption and surrounding tissue injury.

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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

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

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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.

Injury-related fear-avoidance and symptoms of posttraumatic stress in parents of children with burns.

Science.gov (United States)

Willebrand, M; Sveen, J

2016-03-01

Parents of children with burns experience a range of psychological reactions and symptoms, and parents' health is known to impact children's health. So far, there is little research into potential mechanisms that maintain parents' symptoms. The aim was to investigate parental injury-related fear-avoidance, and its associations with injury severity and health measures. Parents (n=107) of children aged 0.4-18 years that sustained burns 0.1-9.0 years previously completed questionnaires on fear-avoidance, posttraumatic stress, and health of the child. Analyses showed that the average level of fear-avoidance was low and positively associated with measures of injury severity and parents' symptoms of posttraumatic stress, and negatively associated with parents' ratings of their child's health. In two separate multiple regressions with parents' symptoms of PTSD and the child's health as dependent variables, fear-avoidance made the largest contribution in both models while injury severity was non-significant. Results were not related to comorbid conditions of the child, scarring, or parent-related socio-demographic variables. In summary, injury-related fear-avoidance is more likely among parents whose children sustain more severe burns. In turn, fear-avoidance contributes significantly to parents' symptoms of PTSD and to poorer health ratings regarding the child, irrespective of injury severity or child comorbidity. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

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.

Mind the gap: 11 years of train-related injuries at the Royal London Hospital Major Trauma Centre.

Science.gov (United States)

Virdee, J; Pafitanis, G; Alamouti, R; Brohi, K; Patel, H

2018-06-18

Introduction This study presents an extensive retrospective database of patients with polytrauma following train-related injuries and highlights the key lessons learnt in this rare clinical presentation. Materials and methods We retrospectively collected data from 127 patients who presented to Royal London Hospital after sustaining train related trauma. We analysed demographics, accident report data, aetiologies and clinical management interventions. All data were screened and injuries were mapped to various anatomical regions. The revised trauma score, injury severity score and new injury severity scores were used to quantify injury extent. Results Mean patient age was 41 years (range 16-81 years) with a 73% to 27% male to female ratio. Deliberate injuries occurred in 71% of patients, with accidental injury accounting for 29%. The mean new injury severity score was 26.48 (range 1-75), with the most common injuries sustained to the chest and the extremities. Pneumothorax, haemothorax or tension pneumothorax occurred in 44% of patients, with 11% suffering a flail chest injury. Traumatic amputations occurred in 33% of patients and 56% of patients required admission to intensive care. Total mortality rates were 19%, with 12% of patients dying at day 0 and 18% at day 7, respectively. Conclusions This study demonstrated the significant impact of train-related polytrauma and provided a comprehensive injury patterns. It was observed that deliberate polytrauma is related to psychiatric deliberate harm but there is no significant difference in the patterns of injuries between accidental and deliberately caused injuries. Overall injuries to the thorax and extremities were the most severe, demonstrating the highest mean injury scores.

Percutaneous dilatational tracheostomy for ICU patients with severe brain injury

Directory of Open Access Journals (Sweden)

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

Alcohol-related hand injuries: an unnecessary social and economic cost.

OpenAIRE

Marston, R. A.

1992-01-01

Severe hand injuries constitute the largest number of acute referrals to this plastic surgery unit, the admission of these patients often displacing routine admissions due to bed shortages, thus increasing waiting list time. This study showed that a high percentage of these injuries were alcohol-related and were therefore preventable. The economic cost to the unit is discussed.

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.

Diagnosis of climbing related overuse injuries

International Nuclear Information System (INIS)

Klauser, A.; Frauscher, F.; Helweg, G.; Nedden, D. zur; Hochholzer, T.; Kramer, J.

2002-01-01

Sport climbing shows an enormous increase in participation, evolving to more popularity, including even school sport activity on high standards. Therefore the number of climbing related injuries is increasing and becomes a more frequently encountered medical problem. Typical climbing associated injuries involve predominantly the upper limb. Overuse injuries are the most common climbing related injuries.The clinical examination is the first line investigation, which is often limited especially in the acute phase. However, an exact diagnosis is desireable for therapeutic management. Imaging modalities have shown to be capable for detection of climbing related injuries. An overview about the current use of x-ray, ultrasound and magnetic resonance imaging in different climbing related overuse injuries is presented. (orig.) [de

Fatal lawn mower related projectile injury.

Science.gov (United States)

Colville-Ebeling, Bonnie; Lynnerup, Niels; Banner, Jytte

2014-06-01

Fatal lawn mower related injuries are a relatively rare occurrence. In a forensic setting, the primary aim is to reconstruct the injury mechanism and establish the cause of death. A relatively rare, but characteristic type of injury is a so-called projectile or missile injury. This occurs when the operator or a bystander is impacted by an object mobilized from the grass by the rotating mower blades. This type of injury often leaves only modest external trauma, which increases the risk of overlooking an entry wound. In this paper we present a case of a fatal lawn mower related projectile injury which was initially overlooked, later interpreted as a possible gunshot homicide, and finally identified as a lawn mower related projectile injury when autopsy revealed a piece of metal thread in the main bronchus to the right middle lobe, hemopericardium, and right-sided hemothorax. To our knowledge, this injury mechanism has not previously been reported as a cause of death. This case illustrates the importance of postmortem radiological imaging and interdisciplinary cooperation when establishing manner and cause of death in unusual cases.

Computer-Related Repetitive Stress Injuries

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... Staying Safe Videos for Educators Search English Español Computer-Related Repetitive Stress Injuries KidsHealth / For Parents / Computer-Related Repetitive Stress Injuries What's in this article? ...

[Clinical epidemiological assessments on 3521 patients suffering from road traffic injuries, in relation with trauma localisation and severity, assisted in "Sf. Ioan" Emergency Unit, during 2002-2009].

Science.gov (United States)

Manole, M; Ciuhodaru, T; Zanoschi, Georgeta; Manole, Alina; Ivan, A

2011-01-01

The aim of study was to assess road traffic injuries in relation with their localisation and severity. A sample of 3521 patients suffering from road traffic injuries and assisted in "Sf. Ioan" Emergency Unit, Iaşi, Romania was assess regarding age group, sex and residence area, type of lesions and ther localisation and severity, between 2002-2009. Data were collected using a special epidemiological inquiry and processed using SPSS and MS Excel statistical softs. The incidence of road traffic injuries increased during the last decade, with a report men/women of 1.5, urban and 21-30 age group predominance. The most frequent were leg fractures (16.7%) and thoracal contusions (19.1%), cranial and facial trauma (32.4%), with open injuries (10.5%). Prevention programmes with a high efficiency at the national level, as well as a concret identification of risk factors with a multidisciplinar approach of road traffic accidents, are needed.

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

Maxillofacial injuries due to work-related accidents in the North West of Italy.

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Roccia, Fabio; Boffano, Paolo; Bianchi, Francesca Antonella; Gerbino, Giovanni

2013-09-01

The aim of this study was to assess the incidence and patterns of work-related maxillofacial injuries, identifying worker categories with a high risk of injury. From a systematic computer-assisted database that has continuously recorded patients hospitalized with maxillofacial fractures, only patients with work-related injuries were considered. Occupation, mechanism of injury, and demographic and clinical data were analyzed. Work-related facial injuries represented the fifth most common cause of injury, with a percentage of 6.3 %. Maxillofacial fractures were most often seen in construction workers (37.9 %). The middle third was involved in 67 % of the cases; the mandible was the most frequently injured site. Work-related maxillofacial trauma is rare, but it is often complex and challenging as Facial Injury Severity Scale values show. In agreement with the few published reports, construction workers, together with farm and forestry workers, are at the highest risk of injuries, mainly because of struck by a thrown, projected, or falling object.

Patterns in deer-related traffic injuries over a decade: the Mayo clinic experience

Directory of Open Access Journals (Sweden)

Smoot Dustin L

2010-08-01

Full Text Available Abstract Background Our American College of Surgeons Level 1 Trauma Center serves a rural population. As a result, there is a unique set of accidents that are not present in an urban environment such as deer related motor vehicle crashes (dMVC. We characterized injury patterns between motorcycle/all-terrain vehicles (MCC and automobile (MVC crashes related to dMVC (deer motor vehicle crash with the hypotheses that MCC will present with higher Injury Severity Score (ISS and that it would be related to whether the driver struck the deer or swerved. Methods The records of 157 consecutive patients evaluated at our institution for injury related to dMVC from January 1st, 1997 to December 31st, 2006 were reviewed from our prospectively collected trauma database. Demographic, clinical, and crash specific parameters were abstracted. Injury severity was analyzed by the Abbreviated Injury Scale score for each body region as well as the overall Injury Severity Score (ISS. Results Motorcycle crashes presented with a higher median ISS than MVCs (14 vs 5, p Within the MVC group, there was no difference between swerving and hitting the deer in any AIS group. Forty-seven percent of drivers were not wearing seat belts which resulted in similar median ISS (6 vs 5 and AIS of all body regions. Conclusions Motorcycle operators suffered higher ISS. There were no significant differences in median ISS if a driver involved in a deer-related motor vehicle crash swerved rather than collided, was helmeted, or restrained.

Medical Management of the Severe Traumatic Brain Injury Patient.

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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.

Further Reductions in Road-Related Deaths and Injuries in Irish Children

LENUS (Irish Health Repository)

Garry, E

2018-04-01

The aim was to study road-related injuries and fatalities in under 15-year-olds in three time periods (1996-2000, 2004-2008 and 2009 -2013 respectively) to assess whether progress has been made via cross-sectoral efforts (legislation, public awareness campaigns and police enforcement) to reduce this injury toll in Ireland. For road traffic collisions where an injury has occurred, police assistance is required and at the time a detailed CT 68 form is completed by the attending police officer and sent to the Road Safety Authority for analysis. Details regarding the severity of injury, light and road conditions and safety measures such as seat belt or car restraint use, seat position and helmet use if a cyclist is involved are recorded. Injuries were sub-classified as fatalities, serious (detained in hospital, fractures, severe head injury, severe internal injuries or shock requiring treatment) or minor. All data for the three time periods was entered onto an SPSS database. A concerted national campaign re road safety media campaign allied to random breath testing, penalty points for driving offences, on the spot fines for speeding and greater police enforcement took place over the 17-year timeframe and continues to this day. When results were compared between the three cohorts, total injuries dropped from 5928 (1996-2000) to 3903 (2009-2013).Fatal injuries dropped from 163 to 43 with car occupant fatalities fell from 69 to 17 between 1996-2000 and 2009-2013. Serious injuries dropped from 347 in the first cohort to 201 in the third cohort. Minor injuries fell from 5,063 to 3,659 between first and last cohort. Pedestrian injuries dropped from 1719 to 1258 with pedestrian fatalities decreased from 61 (1996-2000) to 21 (2009-2013) and serious pedestrian injuries decreased from 261 down to 129. Cyclist fatalities saw the most significant fall (76%) with a dramatic reduction in fatalities from 25 down to 6. A national road safety campaign, greater police enforcement and a

How important is resilience among family members supporting relatives with traumatic brain injury or spinal cord injury?

Science.gov (United States)

Simpson, Grahame; Jones, Kate

2013-04-01

To investigate the relationship between resilience and affective state, caregiver burden and caregiving strategies among family members of people with traumatic brain or spinal cord injury. An observational prospective cross-sectional study. Inpatient and community rehabilitation services. Convenience sample of 61 family respondents aged 18 years or older at the time of the study and supporting a relative with severe traumatic brain injury (n = 30) or spinal cord injury (n= 31). Resilience Scale, Positive And Negative Affect Schedule, Caregiver Burden Scale, Functional Independence Measure, Carer's Assessment of Managing Index. Correlational analyses found a significant positive association between family resilience scores and positive affect (r(s) = 0.67), and a significant negative association with negative affect (r(s) = -0.47) and caregiver burden scores (r(s) = -0.47). No association was found between family resilience scores and their relative's severity of functional impairment. Family members with high resilience scores rated four carer strategies as significantly more helpful than family members with low resilience scores. Between-groups analyses (families supporting relative with traumatic brain injury vs. spinal cord injury) found no significant differences in ratings of the perceived helpfulness of carer strategies once Bonferroni correction for multiple tests was applied. Self-rated resilience correlated positively with positive affect, and negatively with negative affect and caregiver burden. These results are consistent with resilience theories which propose that people with high resilience are more likely to display positive adaptation when faced by significant adversity.

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.

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

The epidemiology of firework-related injuries in the United States: 2000-2010.

Science.gov (United States)

Moore, Justin Xavier; McGwin, Gerald; Griffin, Russell L

2014-11-01

The purpose of this study is to examine the epidemiology of firework-related injuries among an emergency department (ED) nationally representative population of the United States for the years 2000-2010, including whether the type of firework causing the injury is differential by patient demographics and whether the severity of injury is associated with the firework type. The data analysed in this study was collected from the Consumer Product Safety Commission's (CPSC's) National Electronic Injury Surveillance System (NEISS). A total of 2812 injuries represented an estimated 97,562 firework-related injuries treated in emergency departments within the United States from 2000 to 2010. The incidence generally decreased over time. With respect to age, the rate was higher for children, with the highest rates being observed for 10-19 year olds (7.28 per 100,000 persons) and 0-9 year olds (5.45 per 100,000 persons). The injury rate was nearly three times higher for males compared to the female counterparts (4.48 vs. 1.57 per 100,000 persons). Females were less likely than males to severely injure themselves with all types of fireworks besides sparklers/novelty devices (OR 1.08, CI 0.26-4.38). The results from this suggest that firework-related injuries have decreased by nearly 30% over the 11-year period between 2000 and 2010. Moreover, there has been a decreasing trend in the type of firework causing injury for every firework type excluding the unspecified firework type. However, adolescents of 10-19 years old had the highest rate of injury for fireworks over the 11-year period. In addition odds of injury are differential by firework type. Understanding the specific types of fireworks may lead to better preventative methods and regulations. Moreover, preventative methods should be taken to reduce the rate of firework-related injuries among U.S. youths [1], and possibly more regulations and enforcement of laws geared towards prohibiting novice use of fireworks. Published

Interventions to prevent softball related injuries: a review of the literature

Science.gov (United States)

Pollack, K; Canham-Chervak, M; Gazal-Carvalho, C; Jones, B; Baker, S

2005-01-01

Objectives: To examine the published evidence on interventions to prevent softball related injuries among adults, and to encourage more epidemiologic research as a foundation for future softball injury prevention efforts. Methods: The authors reviewed literature identified from six electronic databases for studies on softball related injuries. The search was limited to studies written in the English language, published between 1970 and 2002, and involving adult populations. Research was excluded that evaluated baseball ("hard ball") related injuries or was aimed at injury treatment. Identified studies were categorized by study design. Intervention/prevention papers were evaluated further and described in detail. Results: The search strategy identified 39 studies specifically related to softball. Most studies were case reports/case series (n = 13) or descriptive studies (n = 11); only four were analytic or intervention/prevention studies. Studies collected data in a variety of ways, often without denominator data to permit calculation of injury rates. Studies also did not differentiate between slow or fast pitch softball activities and most did not mention the type of softball that was used. Conclusions: Surprisingly few studies exist on interventions to reduce injuries during softball, one of the most popular recreational sports in the US. Of the existing literature, much attention has been on sliding related injuries, which comprise only a segment of softball injuries. Basic epidemiologic studies describing the nature, severity, and risk factors for softball injuries in a variety of populations are needed, followed by additional intervention evaluation studies aimed at modifiable risk factors. PMID:16203835

Outcome of pregnancy related acute kidney injury requiring ...

African Journals Online (AJOL)

Background: Pregnancy related acute kidney injury (AKI) severe enough to require dialysis is now rare in developed countries but is still a significant cause of maternal mortality in many resource constrained countries. However, there is scanty information from many sub-Saharan countries about outcomes of patient who ...

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

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...

Oxidant-Antioxidant Balance in Severe Brain Injury

Directory of Open Access Journals (Sweden)

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

Severe cervical spinal cord injuries related to rugby union and league football in New South Wales, 1984-1996.

Science.gov (United States)

Rotem, T R; Lawson, J S; Wilson, S F; Engel, S; Rutkowski, S B; Aisbett, C W

1998-04-20

To determine the frequency and circumstances of serious cervical cord injuries associated with rugby union and league football in New South Wales. Retrospective review of patients with rugby football-related cervical spinal cord injuries. The two central spinal units in NSW, from January 1984 to July 1996. Admission to spinal units; injury resulting in permanent tetraplegia. During the review period, 115 rugby football players (56 union and 59 league) were admitted to the spinal units because of cervical spinal cord injuries. 49 patients had resultant permanent neurological deficits (complete tetraplegia [quadriplegia])--26 associated with rugby union and 23 with rugby league. Two patients died of injury sequelae within two weeks of admission. There was no significant change in the rate of football-related admissions to spinal units for either code. There was a small decline in the number (from 15 in 1984 to 1987 to 7 in 1992 to 1996) and incidence (from 1.2 to 0.5 per 10,000 participants) of patients with tetraplegia associated with rugby union. When this decline was tested as a trend over the years, it was found to be statistically significant (P = 0.06). No significant trend was found in the tetraplegia data associated with rugby league. Cervical spinal cord injuries leading to complete tetraplegia were most commonly associated with scrum-like plays in union and with tackles in league. Serious cervical spinal injuries associated with both codes of rugby continue to occur in NSW. Rugby football in its various forms is still an inherently dangerous game.

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

Science.gov (United States)

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

Visual and anatomic outcomes of golf ball-related ocular injuries.

Science.gov (United States)

Park, S J; Park, K H; Heo, J W; Woo, S J

2014-03-01

To investigate the characteristics and prognoses of golf ball-related ocular injuries (GROIs) using standardized terminology, classification, and scoring systems. Twenty-two GROI patients were assessed using the Birmingham Eye Trauma Terminology, Ocular Trauma Classification Group (OTCG) classification, and Ocular Trauma Score. Globe preservation and final visual acuity (FVA) were assessed according to the injury severity categorical designation. Fourteen patients were injured on golf courses and eight on driving ranges. Nine patients (40.9%) had open-globe injuries (five ruptures (22.7%), four penetrating injuries (18.2%)). All rupture cases required enucleation, whereas penetrating injury cases did not (the FVA ranged from 20/100 to no light perception). In open-globe injuries, wearing glasses protected against rupture (P=0.008). Thirteen patients sustained closed-globe injuries that were accompanied by lens subluxation (38.5%), choroidal rupture (30.8%), macular commotio retinae (38.5%), and traumatic optic neuropathy (7.7%). Twelve (54.5%) patients had orbital wall fractures. The mean number of related surgeries required was 1.5±1.7 across all patients. Eyes with GROIs had devastating FVA and globe preservation status, especially those with open-globe injuries. Observing golf rules and improving driving-range facilities are essential for preventing GROIs. Protective eyewear may reduce ocular damage from GROIs, especially globe rupture.

Health-related quality of life two years after injury due to terrorism.

Science.gov (United States)

Tuchner, Maya; Meiner, Zeev; Parush, Shula; Hartman-Maeir, Adina

2010-01-01

During the past few decades, terrorist acts have been an unfortunate reality worldwide. There is a striking paucity of research investigating the multitude of long-term outcomes after severe physical injury due to terrorist attacks, a unique subgroup of trauma patients. The purpose of this study was to provide a profile of the long-term health-related quality of life (HR-QOL) after injury due to terrorist attacks and to explore the relationships between Post Traumatic Stress Disorder (PTSD), occupational status and injury severity with HR-QOL. We included 35 survivors of terrorist attacks living in the community, two years on average after the injury, mean age at follow-up = 32.1 (±13.8), mean Injury Severity Score (ISS) = 27 (±14.2). The subjects were recruited from consecutive admissions to a rehabilitation department in a tertiary care center between September 2000 - June 2004. Most of the subjects suffered multiple trauma. The main outcome measures were the Short-Form Health Survey (SF-36), Post Traumatic Diagnostic Scale and return to work rates. The mean scores on 6/8 of the SF-36 subscales were significantly lower among the survivors compared to normative population norms. Post Traumatic Stress Disorder (PTSD) was found in 39% of the sample and 43% did not resume their main occupation two years after the injury. Multivariate analysis of variance of PTSD and occupational status (returned vs. did not return to work) on quality of life scores revealed significant main effects for both PTSD (p=. 000) and occupational status (p=. 005) with no interaction effect (p=. 476). No significant correlations were found between injury severity and the SF-36 scores. This study demonstrated the long-term impact of injury due to terrorism. Results showed independent effects of PTSD and occupational status on health related quality of life, two years after injury. These findings suggest that this group may benefit from intervention focusing on their emotional and

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.

Gymnastic Formation-related Injury to Children in Physical Education.

Science.gov (United States)

Araki, Takashi; Miyauchi, Masato; Suzaki, Makoto; Wakakuri, Taro; Kirinoki, Sonoko; Onodera, Naoko; Saigusa, Taro; Takana, Akihiro; Hyodo, Hideya; Ohara, Toshihiko; Kawai, Makoto; Yasutake, Masahiro; Yokota, Hiroyuki

2015-01-01

Current data indicate that the rate of trauma in children during gymnastic formation is increasing, especially while creating a structure with a certain height, such as the human pyramid. The goal of the present study was to clarify the clinical characteristics of these injuries. In this single-institution review, all children treated for a gymnastic formation-related injury at Nippon Medical School Hospital from 2013 through 2015 were identified through the institution's registry. The injury mechanism was classified, and injury severity, interventions, and outcome were examined. Eight children were treated for a gymnastic formation-related injury. They were 7 boys and 1 girl aged 10 to 15 years (mean age, 13.1±1.8 years). Neurotrauma ranging from concussion to spinal cord injury without radiographic abnormality occurred in 6 patients (75%). No intracranial hemorrhagic lesions were detected. The Glasgow Coma Scale score on arrival was 15 in all 8 patients, and neurological deficits were present in 1 patient. No patient required surgical intervention. All patients made a full recovery after discharge from the hospital. No patients died. The average follow-up period was 2.1±0.9 weeks. Neurotrauma is a frequent result of gymnastic formation accidents in children. Healthcare workers and teachers should recognize this type of injury, and public education that targets parents should be introduced.

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 ...

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

Science.gov (United States)

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.

Progress in reducing road-related deaths and injuries in Irish children.

LENUS (Irish Health Repository)

Donnelly, J

2012-04-01

The aim was to study road-related injuries and fatalities in under 15 year olds in two time periods (1996-2000 and 2004-2008 inclusive) to assess whether progress has been made via cross-sectoral efforts to reduce this injury toll in Ireland. For pedestrian and car-related accidents, police assistance is required and at the time a detailed CT 68 form is completed by the attending officer and sent to the Road Safety Authority for analysis. Details re the severity of injury, light and road conditions and safety measures such as seat belt or car restraint use, seat position and helmet use if a cyclist were recorded. Injuries were sub-classified as fatalities, serious (detained in hospital, fractures, severe head injury, severe internal injuries or shock requiring treatment) or minor. All data for the two time periods was entered onto an SPSS database. A concerted national campaign re road safety media campaign allied to random breath testing, penalty points for driving offences, on the spot fines for speeding and far greater police enforcement took place between the two time frames and continues to this day. When looked at as most likely estimates of death ratios the results were found to be statistically significant with an overall p value of < 0.0001 CI [0.39, 0.69]. When broken down into specific age ranges all were significant apart from the 0-3 age range with a p value of 0.69 CI [0.26, 1.1]. The most significant changes were found in the 7-9 years, 10-12 and 13-15 year age ranges with p values of < 0.0001, 0.0002 and 0.0007 respectively. When results were compared between the two cohorts, car occupant fatalities between both groups dropped by 36%. Pedestrian injuries dropped from 1719 to 1232, pedestrian fatalities decreased by almost 50% as did serious pedestrian injuries from 261 down to 129. Cyclist fatalities saw the most significant fall (76%) with a dramatic reduction in cyclist injuries from 25 down to 6 (63%). The 13-15 year old age group had the highest

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.

[Trampoline-related injuries in children: an increasing problem].

Science.gov (United States)

Königshausen, M; Gothner, M; Kruppa, C; Dudda, M; Godry, H; Schildhauer, T A; Seybold, D

2014-06-01

The sales of recreational trampolines have increased during the past few years. Severe injuries are associated in part with trampoline sport in the domestic setting. Therefore, this study was conducted to confirm the hypothesis of an increase in trampoline-related injuries in conjunction with the increasing sales of recreational trampolines and to find out what kind of injuries are most frequent in this context. Between 01/1999 and 09/2013 all trampoline-related injuries of children (0-16 years of age) were assessed retrospectively. Only those cases were evaluated which described with certainty a trampoline-associated trauma. The fractures were considered separately and assigned to specific localisations. Additionally, accidents at home were differentiated from institutional accidents. Within the past 13 years and 9 months trampoline-related injuries were seen in 195 infants. Fractures were present in 83 cases (42 %). The average age was 10 ± 3.4 years (range: 2-16 years). Within first half of the observed time period (7½ years; 01/1999 to 06/2006) 73 cases were detected with a significantly increasing number of injuries up to 122 cases between 07/2006 and 09/2013 (7 years, 3 months), which corresponds to an increase of 67 % (p = 0,028). The vast majority of these injuries happened in the domestic setting (90 %, n = 175), whereas only 10 % (n = 20) of the traumas occurred in public institutions. In 102 children (52 %) the lower extremity was affected and in 51 patients (26 %) the upper extremity was involved (head/spine/pelvis: n = 42, 22 %). The upper extremity was primarily affected by fractures and dislocations (n = 38, 76 %). At the upper extremity there were more injuries requiring surgery in contrast to the lower extremity (n = 11) or cervical spine (n = 1). The underlying data show a significant increase of trampoline-related injuries within the past years. The upper extremity is the second most affected

Hemodynamic and metabolic correlates of perinatal white matter injury severity.

Directory of Open Access Journals (Sweden)

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.

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

Directory of Open Access Journals (Sweden)

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.

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.

Adult sports-related traumatic brain injury in United States trauma centers.

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Winkler, Ethan A; Yue, John K; Burke, John F; Chan, Andrew K; Dhall, Sanjay S; Berger, Mitchel S; Manley, Geoffrey T; Tarapore, Phiroz E

2016-04-01

OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories-fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to

Cytokine Profiles of Severe Influenza Virus-Related Complications in Children

OpenAIRE

Andrew Fiore-Gartland; Angela Panoskaltsis-Mortari; Anna A. Agan; Anushay J. Mistry; Paul G. Thomas; Michael A. Matthay; Michael A. Matthay; PALISI PICFlu Investigators; Tomer Hertz; Tomer Hertz; Tomer Hertz; Adrienne G. Randolph; Adrienne G. Randolph; Adrienne G. Randolph; Ronald C. Sanders

2017-01-01

RationaleEffective immunomodulatory therapies for children with life-threatening “cytokine storm” triggered by acute influenza infection are lacking. Understanding the immune profiles of children progressing to severe lung injury and/or septic shock could provide insight into pathogenesis.ObjectivesTo compare the endotracheal and serum cytokine profiles of children with influenza-related critical illness and to identify their associations with severe influenza-associated complications.Methods...

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.

Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: A longitudinal study

DEFF Research Database (Denmark)

Sidaros, A.; Engberg, A.W.; Sidaros, K.

2008-01-01

of longitudinal studies on TBI that follow DTI changes over time and correlate findings with long-term clinical outcome. We performed a prospective longitudinal study of 30 adult patients admitted for subacute rehabilitation following severe traumatic brain injury. DTI and conventional MRI were acquired at mean 8......Diffusion tensor imaging (DTI) has been proposed as a sensitive biomarker of traumatic white matter injury, which could potentially serve as a tool for prognostic assessment and for studying microstructural changes during recovery from traumatic brain injury (TBI). However, there is a lack...... weeks (5-11 weeks), and repeated in 23 of the patients at mean 12 months (9-15 months) post-trauma. Using a region-of-interest-based approach, DTI parameters were compared to those of healthy matched controls, scanned during the same time period and rescanned with a similar interval as that of patients...

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.

Clobazam-Treated Patients with Lennox Gastaut Syndrome Experienced Fewer Seizure-Related Injuries than Placebo Patients During Trail OV-1012

Science.gov (United States)

2016-08-19

severe seizure- related AEs occurred in the placebo group, with three patients experiencing one severe AE each (fall, contusion, or jaw fracture ). In all...only one non–seizure- related injury, and therefore no evidence to suggest that the drug was associated with injuries. The analysis also helps to...Clobazam-treated patients with Lennox-Gastaut syndrome experienced fewer seizure- related injuries than placebo patients during trial OV-1012 *Jouko

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

Science.gov (United States)

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.

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.

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.

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

Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality.

Science.gov (United States)

Daneshvar, Parham; Roffey, Darren M; Brikeet, Yasser A; Tsai, Eve C; Bailey, Chris S; Wai, Eugene K

2013-08-01

Spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population. To determine the mortality rate of elderly patients with SCIs related to C-spine fractures and identify factors that contribute toward a higher risk for negative outcomes. Retrospective cohort study at two Level 1 trauma centers. Thirty-seven consecutive patients aged 60 years and older who had SCIs related to C-spine fractures. Level of injury, injury severity, preinjury medical comorbidities, treatment (operative vs. nonoperative), and cause of death. Hospital medical records were reviewed independently. Baseline radiographs and computed tomography or magnetic resonance imaging scans were examined to permit categorization according to the mechanistic classification by Allen and Ferguson of subaxial C-spine injuries. Univariate logistic regression analyses were performed to identify factors related to in-hospital mortality and ambulation at discharge. There were no funding sources or potential conflicts of interest to disclose. The in-hospital mortality rate was 38%. Respiratory failure was the leading cause of death. Preinjury medical comorbidities, age, and operative versus nonoperative treatment did not affect mortality. Injury level at or above C4 was associated with a 7.1 times higher risk of mortality compared with injuries below C4 (p=.01). Complete SCI was associated with a 5.1 times higher risk of mortality compared with incomplete SCI (p=.03). Neurological recovery was uncommon. Apart from severity of initial SCI, no other factor was related to ambulatory disposition at discharge. In this elderly population, neurological recovery was poor and the in-hospital mortality rate was high. The strongest risk factors for mortality were injury level and severity of SCI. Although each case of SCI

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

Science.gov (United States)

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.

A successful therapy for severe malaria accompanied by malaria-related acute kidney injury (MAKI) complications: a case report

Science.gov (United States)

Syahputra, A.; Siregar, M. L.; Jamil, K. F.

2018-03-01

Indonesia is an endemic malaria country with high levels of morbidity and mortality. In Aceh, by the end of 2016, based on the data from Annual Parasite Incidence, the incidence rate was 0.1 per 1.000 population at risk of malaria. One of severe malaria complications is malaria-related acute kidney injury(MAKI). The death increasesthreefold by the presence of MAKI. A 56 years old male farmer was a resident in Buketmeuh village, Meukek, South Aceh, Indonesia, which was an endemic malaria area. He hadfever for seven days, chills, sweating, joint pain, headache, nausea, vomit, yellow eyes and raved. Concentrated tea-colored urineduring four days before hospital admission with a small amount of urine of 200 cc in 24 hours. The diagnosis established based on the Plasmodium vivax trophozoite finding in the blood smear examination, and the severe malaria clinical descriptions such as black water fever (BWF)with MAKI complications. Artemether injection therapy followed by oral primaquine, dihydroartemisinin and piperaquine phosphate (DHP) and hemodialysis provide a good outcome.

A systematic review of prognostic factors for return to work following work-related traumatic hand injury.

Science.gov (United States)

Shi, Qiyun; Sinden, Kathryn; MacDermid, Joy C; Walton, David; Grewal, Ruby

2014-01-01

Systematic review. Traumatic hand injuries are frequent cause of work related injuries and can result in prolonged durations of time loss from work. To systematically review available evidence to determine which prognostic factors predict return-to-work (RTW) following work-related traumatic hand injuries. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and PsycINFO from 1980 to September 2013 and reference lists of articles. Studies investigating any prognostic factors of RTW after traumatic hand injury were included. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Identified factors were grouped into conceptual prognostic factor categories. We assessed 8 studies, which addressed 11 potential prognostic factors (i.e., sociodemographic factors, occupation, work compensation status, treatment related factors, impairment severity, location of injury, etc.). The quality of the studies was low to moderate. Across all included studies, RTW (original or modified work) occurred in over 60% of individuals by 6 months. There was consistent low-moderate quality evidence that individuals with more severe impairments and lower pre-injury income were less likely to RTW, and low-moderate quality evidence that age, gender and level of education had no impact on RTW. Evidence on other commonly cited prognostic factors were limited in the literature. Impairment severity and lower pre-injury income showed a consistent association with RTW following occupational hand injury, while other factors demonstrated no or variable effects across studies. Additional high-quality studies are warranted toward improving our understanding of the complex factors that mediate RTW following a traumatic work-related hand injury. 2a. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

How many work-related injuries requiring hospitalization in British Columbia are claimed for workers' compensation?

Science.gov (United States)

Alamgir, Hasanat; Koehoorn, Mieke; Ostry, Aleck; Tompa, Emile; Demers, Paul A

2006-06-01

Workplace compensation claims datasets represent an important source of information on work-related injuries. This study investigated the concordance between hospital discharge records and workers' compensation records for work-related serious injuries among a cohort of sawmill workers in British Columbia (BC), Canada. It also examined the extent to which workers' compensation capturing patterns varied by cause, severity of injuries, and demographic characteristics of workers. Work-related injuries were identified in hospitalization records between April 1989 and December 1998, and were matched by dates and description of injury to compensation records. The agreement between the hospital records and compensation records was good (kappa = 0.84, P < 0.01). A lower claim reporting rate for work-related hospitalization was observed for older and non-white workers. More serious injuries defined by longer length of stay and emergency admissions were more likely to be reported. Falls, struck against, and overexertion injuries had lower reporting rates; whereas, machinery-related, cutting/piercing, and caught in/between injuries had higher reporting rates. When compared with hospital discharge records, the compensation agency underreported incidents of serious work-related injuries by 10-15% among the sawmill workers.

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.

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

Science.gov (United States)

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.

Systematic review of military motor vehicle crash-related injuries.

Science.gov (United States)

Krahl, Pamela L; Jankosky, Christopher J; Thomas, Richard J; Hooper, Tomoko I

2010-01-01

Motor vehicle crashes account for nearly one third of U.S. military fatalities annually. The objective of this review is to summarize the published evidence on injuries due specifically to military motor vehicle (MMV) crashes. A search of 18 electronic databases identified English language publications addressing MMV crash-related injuries between 1970 and 2006 that were available to the general public. Documents limited in distribution to military or government personnel were not evaluated. Relevant articles were categorized by study design. The search identified only 13 studies related specifically to MMV crashes. Most were case reports or case series (n=8); only one could be classified as an intervention study. Nine of the studies were based solely on data from service-specific military safety centers. Few studies exist on injuries resulting from crashes of military motor vehicles. Epidemiologic studies that assess injury rates, type, severity, and risk factors are needed, followed by studies to evaluate targeted interventions and prevention strategies. Interventions currently underway should be evaluated for effectiveness, and those proven effective in the civilian community, such as graduated driver licensing, should be considered for implementation and evaluation in military populations. Published by Elsevier Inc.

Burden of motorcycle-related injury in Malaysia

OpenAIRE

Rahman, Nik Hisamuddin NA; Baharuddin, Kamarul A; Mohamad, Syarifah Mastura S

2015-01-01

Background Road traffic injury (RTI) contributes to major morbidity and mortality in both developed and developing countries. Most of the injuries are caused by road-related injuries that specifically relate to motorcycle crash. We attempted to conduct a short survey to determine the magnitude of burden related to motorcycle-related RTIs in Malaysia. We hypothesize that motorcycle-related RTI in Malaysia contributes significantly to the health burden in the country. Methods The cross-sectiona...

Woodworking injuries: a comparative study of work-related and hobby-related accidents.

Science.gov (United States)

Loisel, F; Bonin, S; Jeunet, L; Pauchot, J; Tropet, Y; Obert, L

2014-10-01

The primary objective of this study was to describe the injury characteristics and demographics of patients injured during woodworking activities, upon their arrival to the emergency department in a regional of France where this industry is prevalent. The secondary objective was to compare patient and injury characteristics for work-related and hobby-related accidents. A cohort of 87 patients who had suffered a woodworking accident over a two-year period was evaluated; 79 were available for follow-up. The context and circumstances of the accident, nature and location of the injuries and patient demographics were recorded. Hobby-related accidents accounted for two-thirds of the accidents (51/79). Most of the injured workers were either loggers (35%) or carpenters (46%). The hand was injured in 53 cases (67%). Work-related accidents resulted in significantly more serious consequences in terms of hospital stay, work stoppage, resumption of work or retraining than hobby-related accidents. For the workplace accidents, 86% occurred on new machines; more than 25% of the machines involved in accidents at home were over 15 years. Sixty-eight per cent of workers were wearing their safety gear, while only 31% of those injured during recreational woodworking wore the appropriate gear. Several elements of prevention should be improved: information about the need to maintain the equipment, protect the worker with suitable clothing, and learn which maneuvers are considered hazardous. Safety gear should be regularly inspected in the workplace. Copyright © 2014. Published by Elsevier SAS.

Lawn mower-related projectile injury.

Science.gov (United States)

McNamara, William F; Yamout, Sani Z; Escobar, Mauricio A; Glick, Philip L

2009-07-01

Lawn mower injuries are a potentially devastating, yet preventable cause of morbidity and mortality in the pediatric population. The sequelae to these injuries can become even worse if the initial presentation goes unsuspected by medical staff, leading to a delay in treatment. The authors report the case of a lawn mower-related penetrating missile injury, where the extent of injury was not appreciated by the patient until signs and symptoms of a soft-tissue infection developed, prompting the patient to seek medical attention the next day.

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

Science.gov (United States)

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.

Science.gov (United States)

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

Science.gov (United States)

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

Systematic review of severe acute liver injury caused by terbinafine.

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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.

Mountain biking-related injuries treated in emergency departments in the United States, 1994-2007.

Science.gov (United States)

Nelson, Nicolas G; McKenzie, Lara B

2011-02-01

Injury research on mountain biking has been mostly limited to examining professional riders and off-road biking. Mountain bikes represent the largest segment of bike sales in the United States. Recreational mountain bike use is popular and understudied. To describe the scope, distribution, and trends of mountain bike-related injuries treated in US emergency departments. Descriptive epidemiologic study. A retrospective analysis was conducted with data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for patients aged ≥ 8 years from 1994 through 2007. Sample weights provided by the system were used to calculate national estimates of mountain bike-related injuries based on 4624 cases. Bivariate comparisons between categorical variables were assessed with injury proportion ratios and 95% confidence intervals. Nationwide, an estimated 217 433 patients were treated for mountain bike-related injuries in US emergency departments from 1994 to 2007, an average of 15 531 injuries per year. The annual number of injuries decreased 56%, from a high of 23 177 in 1995 to 10 267 in 2007 (P bike-related injuries decreased from 1994 to 2007. Upper extremity fractures were the most common injury. Girls and women may be more likely than boys and men to sustain more severe injuries requiring hospitalization. Despite the decline over the past decade, more can be done to improve safety and reduce injuries in this popular recreational activity.

Firework-related injuries in Tehran's Persian Wednesday Eve Festival (Chaharshanbe Soori).

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Tavakoli, Hassan; Khashayar, Patricia; Amoli, Hadi Ahmadi; Esfandiari, Khalil; Ashegh, Hossein; Rezaii, Jalal; Salimi, Javad

2011-03-01

Fireworks are the leading cause of injuries such as burns and amputations during the Persian Wednesday Eve Festival (Chaharshanbeh Soori). This study was designed to explore the age of the high-risk population, the type of fireworks most frequently causing injury, the pattern of injury, and the frequency of permanent disabilities. This cohort study was performed by Tehran Emergency Medical Services at different medical centers all around Tehran, Iran, in individuals referred due to firework-related injuries during 1 month surrounding the festival in the year 2007. The following information was extracted from the patients' medical records: demographic data, the type of fireworks causing injury, the pattern and severity of the injury, the pre-hospital and hospital care provided for the patient, and the patient's condition at the time of discharge. In addition, information on the severity of the remaining disability was recorded 8 months after the injury. There were 197 patients enrolled in the study with a mean age of 20.94 ± 11.31 years; the majority of them were male. Fuse-detonated noisemakers and homemade grenades were the most frequent causes of injury. Hand injury was reported in 39.8% of the cases. Amputation and long-term disability were found in 6 and 12 cases, respectively. None of the patients died during the study period. The fireworks used during a Chaharshanbe Soori ceremony were responsible for a considerable number of injuries to different parts of the body, and some of them led to permanent disabilities. Copyright © 2011 Elsevier Inc. All rights reserved.

Tribal motor vehicle injury prevention programs for reducing disparities in motor vehicle-related injuries.

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West, Bethany A; Naumann, Rebecca B

2014-04-18

A previous analysis of National Vital Statistics System data for 2003-2007 that examined disparities in rates of motor vehicle-related death by race/ethnicity and sex found that death rates for American Indians/Alaska Natives were two to four times the rates of other races/ethnicities. To address the disparity in motor vehicle-related injuries and deaths among American Indians/Alaska Natives, CDC funded four American Indian tribes during 2004-2009 to tailor, implement, and evaluate evidence-based road safety interventions. During the implementation of these four motor vehicle-related injury prevention pilot programs, seat belt and child safety seat use increased and alcohol-impaired driving decreased. Four American Indian/Alaska Native tribal communities-the Tohono O'odham Nation, the Ho-Chunk Nation, the White Mountain Apache Tribe, and the San Carlos Apache Tribe-implemented evidence-based road safety interventions to reduce motor vehicle-related injuries and deaths. Each community selected interventions from the Guide to Community Preventive Services and implemented them during 2004-2009. Furthermore, each community took a multifaceted approach by incorporating several strategies, such as school and community education programs, media campaigns, and collaborations with law enforcement officers into their programs. Police data and direct observational surveys were the main data sources used to assess results of the programs. Results included increased use of seat belts and child safety seats, increased enforcement of alcohol-impaired driving laws, and decreased motor vehicle crashes involving injuries or deaths. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion as an example of a program that might be effective for reducing motor vehicle-related injury disparities in the United States. The Guide to Community Preventive Services recognizes these selected interventions as effective; this report examines the

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.

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

Science.gov (United States)

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.

Factors related to child maltreatment in children presenting with burn injuries.

Science.gov (United States)

Wibbenmeyer, Lucy; Liao, Junlin; Heard, Jason; Kealey, Lyn; Kealey, Gerald; Oral, Resmiye

2014-01-01

The underpinnings of maltreatment in children presenting with burn injuries are necessary to discern as detection and prevention rest on a clear delineation of factors associated with maltreatment. Inaccurate identification of child victims can result in perpetuation of the maltreatment and its attendant neuropsychological sequela. The authors sought to determine factors associated with maltreatment in children presenting with burn injuries, which would guide the burn team in assessing the likelihood of maltreatment. All consenting children admitted with burn injuries were surveyed regarding their injury mechanism and current sociodemographic status. Suspicious injuries were referred by the burn team to the multidisciplinary review team (MRT). The MRT reported injuries with signs of physical abuse, supervision neglect, neglect of other basic needs, or sexual abuse. These children constituted the cases in our study. Variables related to maltreatment were entered into stepwise logistic regression to identify independent predicting variables. Pmaltreatment. Risk factors related to suspicions of maltreatment included: young age, large burns, tap water injury, immersion lines, delay in care, absence of a two-parent family (unconventional family structure), young parents, inconsistent history, and injury pattern. In this single-center prospective study, the authors identified several factors that, when present in injuries with initial suspicion of maltreatment, should trigger a child maltreatment workup. Burn clinicians have an important role as advocates for children and their families. It is important to continue to further the knowledge of maltreatment detection and prevention among children presenting with burn injuries.

Hospitalization due to horse-related injuries: has anything changed? A 25 year survey.

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Abu-Kishk, Ibrahim; Klin, Baruch; Gilady-Doron, Nataly; Jeroukhimov, Igor; Eshel, Gideon

2013-04-01

Horse riding and horse handling are dangerous. There is a lack of knowledge concerning the incidence of hospitalization due to horse-related injuries and types of injuries in Israel. During the last two decades we have observed an increasing incidence of hospitalizations due to horse-related injuries at our medical center as well as the frequent involvement of pediatric patients. To investigate these injuries with respect to type, incidence and modes of prevention. We conducted a retrospective study of medical records for all patients admitted to Assaf Harofeh Medical Center due to horse-related injury between January 1984 and December 2008. A telephone questionnaire was used to complete the data. Eighty-nine subjects (267 injuries) were included in the study. Most of them were not professional horse riders or horse handlers. Helmet use was reported in only 28% of the participants. The number of subjects with horse-related injuries and the percentage of pediatric involvement increased during the study period. Falling from a horse was the most frequent cause of injury (60.67%), followed by being kicked (13.4%). Head and extremities were the most affected areas. On admission, 33.7% had a potential severe injury score. Forty-two participants (47%) had underlying fractures, mostly in the upper extremities. In the pediatric population, 16.2% (vs. 0% adults) rode horses for therapeutic reasons. Seventeen subjects reported having long-term consequences. The findings are similar to those described in other parts of the world. Horseback riding-related injuries are increasing, which emphasizes the need for safety education programs in Israel.

Age-related patterns in work-related injury claims from older New Zealanders, 2009-2013: Implications of injury for an aging workforce.

Science.gov (United States)

Lilley, Rebbecca; Jaye, Chrystal; Davie, Gabrielle; Keeling, Sally; Waters, Debra; Egan, Richard

2018-01-01

This study describes the incidence, nature and cause of work-related injuries in older New Zealand workers to understand the risks of work-related injury in this rapidly aging population. Data for the period 2009-2013 from 25,455 injured workers aged 55-79 years, extracted from national work-related injury entitlement claims, were stratified by age group and analysed by sex, industry, injury type and cause. Age-specific claims rates were calculated by year, sex and ethnicity. Patterns of injury differed by age: 70-79 year olds had the highest injury rates and proportion of claims due to falls (45%), for the self-employed (32%), for the agriculture sector (24%), and for fatal injuries (5%). The burden of work-related injuries in older workers, particularly in those aged over 70, will increase with their increasing participation in work. Workplace injury prevention strategies and interventions need to consider the specific characteristics and vulnerabilities of older workers. 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

Effect of built environment on tsunami related injuries

Directory of Open Access Journals (Sweden)

SD Dharmarathne

2013-10-01

Full Text Available Background Built environment is a major determinant in injuries and deaths during natural disasters. Purpose of the present paper was to study the effect of built environment on tsunami injuries.Methods A retrospective residential cohort was constructed one month after the tsunami, based on the cross sectional household survey. Household structure was categorised as a binary variable based on the definition used department of census and statistics for the census.Results The constructed cohort consisted of 4178 individuals, 2143 (51.3% males and 2034 (48.7% females from 1047 households. Mean age of the study sample was 25 years with a standard deviation of 17 years. Out of the 4178 study units studied, 43 (1.1% died during the acute incidence and 19(0.5% died later due to complications. Twenty eight (0.7% people were reported missing at the time of data collection. Moderate to severe injuries were reported by 508 individuals (12.5%. To investigate the injury incidence all tsunami related deaths, missing personals and injuries were classified in to a single group as injuries. Reported number of injuries were 302 (14.4%, and 296 (14.9% among males and females respectively. In multivariate analysis, living in a temporary shelter (OR=0.259, 95% CI 0.351-0.797 shown a protective effect on injuries whereas, residing within the 100 meter boundary from sea (OR 1.43, 95% CI 1.1-1.8 and destruction of house (OR 1.53 95% CI 1.14-2.07 were predictors of injuries.Conclusion Policies on building construction in coastal areas should be done considering these findings to mitigate the effect of future disasters.

Clinical analysis of firework-related ocular injuries during Spring Festival 2009.

Science.gov (United States)

Jing, Yuan; Yi-qiao, Xing; Yan-ning, Yang; Ming, Ai; An-huai, Yang; Lian-hong, Zhou

2010-03-01

To document the clinical features, management and visual outcome of fireworks-related ocular injuries during the Spring Festival. A retrospective analysis of all patients with fireworks-related ocular injuries attending the Department of Ophthalmology in Renmin Hospital of Wuhan University from January 20 to February 10, 2009. Age, gender, laterality, type of fireworks, location of incident, initial best-corrected visual acuity (BCVA), diagnosis, management, and final BCVA at last follow-up were documented. Relevant clinical features and visual outcome were evaluated. We observed 25 eyes in 24 patients. Injuries were more frequent in children (ten, 41.7%), males (19, 79.2%), and as open globe injury (15, 62.5%). The most common pyrotechnical products causing accidents were firecrackers (12, 50%). Rural residents had significantly higher rates of injury compared to urban residents (P = 0.023). Of 25 eyes, the most common injuries were corneal/scleral/corneoscleral open globe trauma (15, 60%), traumatic cataract (14, 56%), vitreous hemorrhage (seven, 28%) and retinal detachment (seven, 28%). Most eyes (23, 92%) received surgical intervention, including one (4%) eye enucleation. Vitrectomy was the most surgical treatment. After management, visual outcomes showed statistically significant improvement (P = 0.008). Initial BCVA correlated strongly with final BCVA (P = 0.010). Fireworks-related ocular injuries occur mainly in children, males and rural settings, are frequently severe and visually devastating. Therefore, preventive measures should be strengthened, including public education and legal restriction on the sale and use of fireworks.

Training errors and running related injuries

DEFF Research Database (Denmark)

Nielsen, Rasmus Østergaard; Buist, Ida; Sørensen, Henrik

2012-01-01

The purpose of this systematic review was to examine the link between training characteristics (volume, duration, frequency, and intensity) and running related injuries.......The purpose of this systematic review was to examine the link between training characteristics (volume, duration, frequency, and intensity) and running related injuries....

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.

Science.gov (United States)

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.

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

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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.

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.

Epidemiology of Muay Thai fight-related injuries.

Science.gov (United States)

Strotmeyer, Stephen; Coben, Jeffrey H; Fabio, Anthony; Songer, Thomas; Brooks, Maria

2016-12-01

Muay Thai is a combat sport of Thailand that uses stand-up striking along with various clinching techniques. Currently, little is known about the injuries and risk factors for injuries among Muay Thai fighters. Gaining more insight into the nature and frequency of injury in this sport provides part of the overall sports injury picture, within the larger burden of injury as a public health issue. Generating this information is a critical first step toward the broader goal of improving the health and safety of Muay Thai fighters engaged in competition. This study is based upon a survey of 195 Muay Thai fighters. Participants were asked to complete a retrospective web survey on fight-related injuries. Regression analyses were conducted to determine whether injuries during sanctioned fights were related to factors such as fight experience, use of protective equipment, and injury history. Participants were aged 18 to 47 years old (median 26), predominantly male (85.9%), and white (72.3%). Respondents were professional (n = 96, 49.2%) and amateur (n = 99, 50.8%). Fighters reported a mean fight experience of 15.8 fights. Of the 195 respondents, 108 (55.4%) reported sustaining an injury during the most recent fight. The primary body region injured was the extremities (58%) versus the head, with a lower amount of self-reported concussions (5.4%). Nearly 2/3 (66.7%) of all injured fighters reported that the injury did not interfere with the bout outcome. Nearly 25% reported they missed no training time as a result of the injury. Injuries were related to professional fighter status (OR = 2.5, 95% CI = 1.4-4.5), fight experience (OR = 2.7, 95% CI = 1.5-4.9), weight class (OR = 0.923 heavy versus light, 95% CI = .86-.99), age (OR = 0.90 > 26 versus ≤26, 95% CI = .85-.95), use of protective equipment (OR = .46, 95% CI = .26-.82) and previous injury (OR = 1.81, 95% CI = .98-3.3). Lighter, younger, and more experienced

Firework related injury in New Zealand.

Science.gov (United States)

Clarke, J A; Langley, J D

1994-10-26

In March 1992 a private members Bill was introduced into parliament which sought to place tighter restrictions on the sale of fireworks. The primary purpose of this research was to document the nature and extent of firework related injury in New Zealand for the purpose of preparing a submission on this Bill. Firework related injuries were examined in relation to the legislative history of fireworks control in New Zealand to ascertain if existing regulations had been effective in reducing firework injuries and whether there was justification for greater control. Between 1979 and 1992 (inclusive) 237 persons were admitted to hospital for treatment of injuries related to fireworks. The overall incidence rate for this period was 0.52 per 100,000 persons per year. Eighty five percent of all events involved males. Children (fireworks (as is proposed in the Bill). The current legislation could well be supported though, by extending the ban on the types of fireworks publicly available to include skyrockets.

Holiday ornament-related injuries in children.

Science.gov (United States)

Kimia, Amir; Lee, Lois; Shannon, Michael; Capraro, Andrew; Mays, Donald; Johnston, Patrick; Hummel, David; Shuman, Margot

2009-12-01

Holiday ornament injuries in children have not been well documented in the medical literature. Our aim was to investigate the patterns of injuries sustained from these ornaments as a first measure toward prevention. This was a retrospective cohort analysis of all patients examined in an urban pediatric emergency department over a 13-year period ending in March 2008 for holiday ornament-related injuries. Cases were identified using a computer-assisted text query followed by a manual chart review. Data collected from each chart included the child's age, sex, injury characteristics, physical examination findings, radiographic imaging, interventions, and disposition. To analyze injury rates over the years, we used a multiplicative Poisson model allowing varying exposures. Over the study period, we identified 76 eligible patients. The median age was 2 years (interquartile range, 1.17-3.3 years); 44.7% were female. Forty-three of the 76 cases (53.9%) involved ingestions: 35 were of holiday ornaments, and 8 were of light bulbs. All but one of these ornaments were made of glass. In 28%, there was an associated bleed either from the mouth or as a delayed gastrointestinal bleed. Other patients experienced lacerations (27.6%), eye injuries (5.1%), and minor electrocution injury (2.5%). Imaging was performed in 85%. A subspecialty consult was obtained in 23%, primarily addressing a foreign body ingestion or removal after skin exploration. The incidence rate has not changed over the years. Holiday ornament-related injuries primarily involve foreign body ingestions and glass-related injuries. Over half of the injuries involved small light bulbs and ornaments made of glass placed at the level a toddler can reach. Pediatricians are advised to discuss these points with families during holiday season.

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

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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

Seat belt-related injuries: A surgical perspective

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Tahir Masudi

2017-01-01

Full Text Available Introduction: Legislation making seatbelt use mandatory is considered to have reduced fatal and serious injuries by 25%, with UK government estimates predicting more than 50,000 lives saved since its introduction. However, whilst the widespread use of seatbelts has reduced the incidence of major traumatic injury and death from road-traffic collisions (RTCs, their use has also heralded a range of different injuries. The first ever seatbelt related injury was described in 1956, and since then clear patterns of seatbelt-related injuries have been recognised. Methodology and Findings: This review of the published literature demonstrates that the combination of airbags and three-point seatbelts renders no part of the body free from injury. Serious injuries can, and do, occur even when passengers are properly restrained and attending clinicians should have a high index of suspicion for overt or covert intra-abdominal injuries when patients involved in RTCs attend the Emergency Department. Bruising to the trunk and abdomen in a seatbelt distribution is an obvious sign that suggests an increased risk of abdominal and thoracic injury, but bruising may not be apparent and its absence should not be falsely reassuring. A high index of suspicion should be retained for other subtler signs of injury. Children and pregnant women represent high-risk groups who are particularly vulnerable to injuries. Conclusion: In this review we highlight the common patterns of seatbelt-related injuries. A greater awareness of the type of injuries caused by seatbelt use will help clinicians to identify and treat overt and covert injuries earlier, and help reduce the rates of morbidity and mortality following RTCs.

Preventing Paraffin-Related Injury

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Dehran Swart

2009-07-01

Full Text Available Paraffin (called kerosene in North America and other parts of the world is the most commonly used fuel in ‎non-electrified dwellings worldwide. It is especially popular in Africa and South Asia. Although paraffin ‎offers many advantages – especially its comparatively low cost to produce – it poses two major risks of ‎injury. First, paraffin poisoning is common, either through ingestion or through inhalation of smoke and ‎fumes. Second, paraffin is highly flammable, and poses fire risk through multiple causes. This commentary ‎discusses strategies to prevent paraffin-related injury. Prevention of paraffin-related injury must be through ‎multiple strategies, and should include policy-oriented change, changes to the safety of home environments, ‎and behavioral changes targeting how individuals store and use paraffin and paraffin appliances. We review ‎successful prevention strategies in each of these domains and discuss appropriate research and community ‎initiatives that should be implemented to improve paraffin safety among at-risk populations.‎

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

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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.

Epidemiology of work-related injuries among construction workers of ilam (Western iran) during 2006 - 2009.

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Moradinazar, Mehdi; Kurd, Nematullah; Farhadi, Rozita; Amee, Vahid; Najafi, Farid

2013-10-01

Work-related injuries are the most important cause of work absence, disability, retirement, mutilation, and even mortality. In Iran a great number of work-related injuries are occurred in construction industry. However, less than 12% of total workers are active in the construction sector. This study aimed to determine the incidence rate of work-related injuries, the type of injuries, and its other determinants among the construction workers of Ilam (Iran). The participants were the workers and staffs working in the construction activities of Ilam in Western Iran. All the recorded injuries and deaths related to the construction workers of Ilam from 2006-2009 were collected from the Bureau of Labor and Social Affairs and then analyzed by the statistical package of SPSS (version 19, for Windows). During 2006 - 2009 in Ilam, 387workers encountered the building accidents. Their mean age was 34.3 years (SD = 12.4). The average annual incidence of work-related injuries among the workers was 8.2 per 1000 workers. Fracture with 275 cases (71%) was the most common outcome of injuries, and slipping and falling with 77 cases (36%) were the most important events and exposures. The most important factor related to injuries was the lack of surveillance by employers which was also related with the severity of accident-induced injuries (P constructive workers.

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.

Acute Respiratory Distress Syndrome in Severe Brain Injury

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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

Work-related ocular injuries in Johor Bahru, Malaysia

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Nyo Nyo Min

2016-03-01

Full Text Available AIM:To describe the epidemiology of work-related ocular injuries and its visual outcome in tertiary hospital in southern Malaysia. METHODS:Retrospective review of medical records of patients diagnosed as work-related ocular injuries who attended to the eye casualty of Hospital Sultan Ismail in Johor Bahru, Malaysia from Jan. 2011 to Dec. 2013. Data for clinical presentation, types of injuries, use of eye protective device(EPDand visual outcome were collected using a standardized proforma.RESULTS: A total of 935 ocular injuries attended to Hospital Sultan Ismail during 3y period. Among them 440 cases were work-related ocular injuries and included in the study. There was significant male preponderance(98.19%and commonest age group affected was 21 to 30y(45%. The most common type of injury was superficial injuries(70.91%, followed by chemical(11.13%, open globe(8.41%, closed globe(6.83%and thermal(2.72%. Although Malays are commonly involved in work-related ocular injury accounted for 78.47%, two-thirds of open globe injuries were seen in foreign workers. Only 59 patients(13.41%reported that they wore EPD at the time of incident. Generally, 89.86%(n=399had good vision, 5.45%(n=24had moderate vision and 3.86%(n=17poor vision. Visual outcome related to specific types of injuries showed that poor outcome was higher in open globe injuries groups compared with closed globe injuries \\〖odd ratio(OR=3.33, 95% confidence interval(CI=0.68 to 16.33\\〗. Overall hospital attendance rate of work-related ocular trauma ranged from 20.7 to 51.9 per 1000 new cases and decline of approximately 1.5% per year(PCONCLUSION: Work-related ocular trauma is important cause of ocular morbidity in working forces particularly young men. Malay males between 21 to 40y have higher risk. Majority of work-related ocular trauma seen in our hospital are generally of superficial injuries and potentially preventable. This study indicates they need to improve safety measures to

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

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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

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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.

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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.

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

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Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

2015-01-01

We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.

Cytokine Profiles of Severe Influenza Virus-Related Complications in Children

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Andrew Fiore-Gartland

2017-11-01

Full Text Available RationaleEffective immunomodulatory therapies for children with life-threatening “cytokine storm” triggered by acute influenza infection are lacking. Understanding the immune profiles of children progressing to severe lung injury and/or septic shock could provide insight into pathogenesis.ObjectivesTo compare the endotracheal and serum cytokine profiles of children with influenza-related critical illness and to identify their associations with severe influenza-associated complications.MethodsChildren with influenza-related critical illness were enrolled across 32 hospitals in development (N = 171 and validation (N = 73 cohorts (December 2008 through May 2016. Concentrations of 42 cytokines were measured in serum and endotracheal samples and clustered into modules of covarying cytokines. Relative concentrations of cytokines and cytokine modules were tested for associations with acute lung injury (ALI, shock requiring vasopressors, and death/ECMO.Measurements and main resultsModules of covarying cytokines were more significantly associated with disease severity than individual cytokines. In the development cohort, increased levels of a serum module containing IL6, IL8, IL10, IP10, GCSF, MCP1, and MIP1α [shock odds ratio (OR = 3.37, family-wise error rate (FWER p < 10−4], and decreased levels of a module containing EGF, FGF2, SCD40L, and PAI-1 (shock OR = 0.43, FWER p = 0.002, were both associated with ALI, shock, and death-ECMO independent of age and bacterial coinfection. Both of these associations were confirmed in the validation cohort. Endotracheal and serum cytokine associations differed markedly and were differentially associated with clinical outcomes.ConclusionWe identified strong positive and negative associations of cytokine modules with the most severe influenza-related complications in children, providing new insights into the pathogenesis of influenza-related critical illness in children. Effective

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.

Imagining the future in children with severe traumatic brain injury.

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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.

Deficits in Visual System Functional Connectivity after Blast-Related Mild TBI are Associated with Injury Severity and Executive Dysfunction

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2016-08-24

W. Jung. 2003. Long-term potentiation in visual cortical projections to the medial prefrontal cortex of the rat . Neuroscience 120:283–289. Kim, J., J...functional connec- tivity (FC) of four key nodes within the visual system: lateral geniculate nucleus (LGN), primary visual cortex (V1), lateral...related TBI may be accompanied by involvement of the visual system through optic nerve injury, diffuse or focal cerebral injury, or ocular motor

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.

[Health-related quality of life of people with severe traumatic injury: a longitudinal study using the SF-36 health survey].

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Bauer, J; Beck, B; Wandl, U

2013-06-01

Even though 85 percent of those who have been severely injured in an accident in Germany survive, complex and serious long-term consequences are still a major problem not only for health and care insurance providers but also for the accident victims themselves because their quality of life is affected permanently. Therefore the aim of the current study is to identify factors that significantly improve the quality of life after a severe traumatic injury and to investigate whether the support by a reintegration service has a positive effect on the victims' quality of life. The sample consisted of severely injured accident victims who were supported by a reintegration service. The data collection comprised three data points. At every data point the SF-36 questionnaire was used to assess the participants' quality of life. The results indicate that an individual medical-vocational support by a reintegration service has the potential to significantly and stably improve the physical aspects of quality of life, even if the accident dates back several years. Furthermore it appears to be important to support the independence of the accident victims because assistance by a third person correlates with a lower degree of physical quality of life, regardless of severity or type of injury. Moreover it becomes clear that it is important to pay more attention to the treatment of psychological consequences of severe accidents.

Descriptive epidemiology of serious work-related injuries in British Columbia, Canada.

Directory of Open Access Journals (Sweden)

Jonathan Fan

Full Text Available OBJECTIVE: This study examined the rates and distribution of serious work-related injuries by demographic, work and injury characteristics in British Columbia, Canada from 2002-2008, using population-based data. METHODS: Claims for workers with a serious injury were extracted from workers' compensation data. Serious injuries were defined by long duration, high cost, serious medical diagnosis, or fatality. Workforce estimates were used to calculate stratum-specific rates. Rate-ratios (RR and 95% CIs were calculated using negative binomial regression for the comparison of rates, adjusting for gender, age and occupation. RESULTS: Women had a lower overall serious injury rate compared to men (RR: 0.93, 95% CI: 0.87-0.99. The 35-44 age group had the highest overall rate compared to the youngest age group. The rate for severe strains/sprains was similarly high for men and women in the 35-44 age group, although there was a differential pattern by gender for other injury types: the rate of fracture was similar across age groups for men, but increased with age for women (RR: 2.7, 95% CI: 2.2-3.3; and the rate of severe falls increased with age for men and women, with a larger three-fold increase for older women (men: RR: 1.8, 95% CI: 1.7-2.1; women: RR: 3.2, 95% CI: 2.7-3.7. CONCLUSIONS: The risk of serious injuries is higher among specific age groups with different patterns emerging for men and women. Variations persisted within similar injury types and occupation groups in our adjusted models. These results provide evidence for the burden of serious injuries and a basis for future analytic research. Given projected demographic shifts and increasing workforce participation of older workers, intervention programs should be carefully implemented with consideration to demographic groups at risk for serious injuries in the workplace.

Modeling crash injury severity by road feature to improve safety.

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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.

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

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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.

A step towards understanding the mechanisms of running-related injuries.

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Malisoux, Laurent; Nielsen, Rasmus Oestergaard; Urhausen, Axel; Theisen, Daniel

2015-09-01

To investigate the association between training-related characteristics and running-related injury using a new conceptual model for running-related injury generation, focusing on the synergy between training load and previous injuries, short-term running experience or body mass index (> or running training characteristics (weekly distance, frequency, speed), other sport participation and injuries on a dedicated internet platform. Weekly volume (dichotomized into running-related injury. Non-training-related characteristics were included in Cox regression analyses as effect-measure modifiers. Hazard ratio was the measure of association. The size of effect-measure modification was calculated as the relative excess risk due to interaction. One hundred sixty-seven runners reported a running-related injury. Crude analyses revealed that weekly volume running-related injury is influenced by body mass index and previous injury. These results show the importance to distinguish between confounding and effect-measure modification in running-related injury research. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Soccer-Related Injuries Treated in Emergency Departments: 1990-2014.

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Smith, Nicholas A; Chounthirath, Thiphalak; Xiang, Huiyun

2016-10-01

To investigate the epidemiology of youth soccer-related injuries treated in emergency departments in the United States. A retrospective analysis was conducted of soccer-related injuries among children 7 through 17 years of age from 1990 through 2014 with data from the National Electronic Injury Surveillance System. Injury rates were calculated from soccer participation data. An estimated 2 995 765 (95% confidence interval [CI], 2 309 112-3 682 418) children 7 through 17 years old were treated in US emergency departments for soccer-related injuries during the 25-year study period, averaging 119 831 (95% CI, 92 364-147 297) annually. The annual injury rate per 10 000 soccer participants increased significantly, by 111.4%, from 1990 to 2014. Patients 12 to 17 years old accounted for 72.7% of injuries, 55.5% of patients were male, and most injuries occurred in a place of sport or recreation (68.5%) or school (25.7%). Struck by (38.5%) and fell (28.7%) were the leading mechanisms of injury. Injuries most commonly were diagnosed as sprain or strain (34.6%), fracture (23.2%), and soft tissue injury (21.9%), and occurred to the upper extremity (20.7%), ankle (17.8%), and head or neck (17.7%). Concussions or other closed head injuries accounted for 7.3% of the injuries, but the annual rate of concussions/closed head injuries per 10 000 participants increased significantly, by 1595.6%, from 1990 to 2014. This study is the first to comprehensively investigate soccer-related injuries and calculate injury rates based on soccer participation data among children at the national level. The increasing number and rate of pediatric soccer-related injuries, especially soccer-related concussions/closed head injuries, underscore the need for increased efforts to prevent these injuries. Copyright © 2016 by the American Academy of Pediatrics.

Airbag Related Ocular Injuries: A Short Case Series

African Journals Online (AJOL)

Department of Ophthalmology, Guinness Eye Centre, Lagos University Teaching Hospital, Idi-Araba, PMB 12003, Lagos, Nigeria ... Type of injury was grouped as either open globe or .... An assessment of closed globe injury RE and severe.

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

Science.gov (United States)

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.

Science.gov (United States)

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.

Lawn mower-related injuries to children.

Science.gov (United States)

Vollman, David; Khosla, Kimberly; Shields, Brenda J; Beeghly, B Christine; Bonsu, Bema; Smith, Gary A

2005-09-01

Despite current prevention efforts, approximately 9,400 children younger than 18 years continue to receive emergency care for lawn mower-related injuries each year in the United States. In this study, we analyzed data from a consecutive series of children treated for lawn mower-related injuries during a 53-consecutive-month period in the emergency department of a large, academic children's hospital. The objective of this study was to describe the epidemiology of lawn mower-related injuries to these children and to investigate the beliefs of parents regarding lawn mower use. There were 85 children treated for lawn mower-related injuries during the study period. The mean age was 7.6 years (SD, 4.3 years; median, 5 years), and 65% were boys. Thirty-four patients (40.0%) were admitted to the hospital, including 3 (3.5%) to the pediatric intensive care unit, and 30 (35.3%) required surgical intervention in the operating room. There were 25 children with lacerations (29.4%), 22 with fractures (25.9%), 18 with amputations (21.2%), and 10 with burns (11.8%). The most common body region injured was the lower extremity, accounting for 57.6% (49 of 85) of injuries, including 33 injuries (38.8%) to the foot/toe and 16 injuries (18.8%) to the leg. The hand/finger and head/neck regions each accounted for another 18.8% of injuries. The leading mechanism of injury was run-over/back-over (22.4%), followed by other blade contact (17.6%), thrown object (12.9%), burn (10.6%), and a fall off the mower (7.0%). Lacerations accounted for 68.8% (11 of 16) of injuries to the head/neck compared with 20.3% (14 of 69) to other body regions (p lawn mower safety standard American National Standards Institute/Outdoor Power Equipment Institute B71.1-2003 should be revised to include more rigorous performance provisions regarding prevention of penetration of feet and toes under the mower and into the path of the blades, shielding of hot mower parts from access by young children, and equipping all

A theoretical perspective on running-related injuries.

Science.gov (United States)

Gallant, Jodi Lynn; Pierrynowski, Michael Raymond

2014-03-01

The etiology of running-related injuries remains unknown; however, an implicit theory underlies much of the conventional research and practice in the prevention of these injuries. This theory posits that the cause of running-related injuries lies in the high-impact forces experienced when the foot contacts the ground and the subsequent abnormal movement of the subtalar joint. The application of this theory is seen in the design of the modern running shoe, with cushioning, support, and motion control. However, a new theory is emerging that suggests that it is the use of these modern running shoes that has caused a maladaptive running style, which contributes to a high incidence of injury among runners. The suggested application of this theory is to cease use of the modern running shoe and transition to barefoot or minimalist running. This new running paradigm, which is at present inadequately defined, is proposed to avoid the adverse biomechanical effects of the modern running shoe. Future research should rigorously define and then test both theories regarding their ability to discover the etiology of running-related injury. Once discovered, the putative cause of running-related injury will then provide an evidence-based rationale for clinical prevention and treatment.

The epidemiology of sports-related injuries in older adults: a central European epidemiologic study.

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Kammerlander, Christian; Braito, Matthias; Kates, Stephen; Jeske, Christian; Roth, Tobias; Blauth, Michael; Dallapozza, Christian

2012-10-01

The population is rapidly aging and remaining more active over the age of 65. An increasing number of sports related injuries in individuals 65 and older are thus anticipated. The aim of this study is to analyze the epidemiology of sports injuries in the age group aged 65 and older. Data from the medical records of adults aged 65 years and older who were treated for sports-related injuries at a level one trauma center between December 1994 and February 2008 was collected and statistically analyzed. A total of 2635 patients met our inclusion criteria. There were 1647 men (62.5%) and 988 women (37.5%) with a mean age of 70.9 years. The yearly number of injuries doubled during the study period (1996-2007). The most common mechanism of injury was a simple fall from standing height (69%). Nearly 75% of all injuries occurred during alpine skiing, cycling or mountain climbing. The median Injury Severity Score was 4. Minor injuries and wounds (40%) were recorded most commonly followed by fractures (27%), sprains, ligament injuries (19%) and injuries of muscles and tendons (6%). The most frequent diagnoses were minor injuries to the head and ligament injuries around the knee joint. Injuries to the upper extremities occurred in 33.7%, injuries to the lower extremities in 29.4% and injuries to the head occurred in 20% of the patients. Women sustained substantially more fractures than men. Adults aged 65 and older are remaining active in sports, which results in higher numbers of sports related injuries in this age group. Identification of type, mechanism and distribution of the injuries can help with the recognition of risk factors for injury. This may enable us to develop appropriate preventative measures to reduce the incidence, and morbidity of such injuries.

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.

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.

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

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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.

What are the main risk factors for running-related injuries?

Science.gov (United States)

Saragiotto, Bruno Tirotti; Yamato, Tiê Parma; Hespanhol Junior, Luiz Carlos; Rainbow, Michael J; Davis, Irene S; Lopes, Alexandre Dias

2014-08-01

Despite several studies that have been conducted on running injuries, the risk factors for running-related injuries are still not clear in the literature. The aim of this study was to systematically review prospective cohort studies that investigated the risk factors for running injuries in general. We conducted electronic searches without restriction of language on EMBASE (1980 to Dec 2012), PUBMED (1946 to Dec 2012), CINAHL (1988 to Dec 2012) SPORTDiscus (1977 to Dec 2012), Latin American and Caribbean Centre on Health Sciences Information (1985 to Dec 2012) and Scientific Electronic Library Online (1998 to Dec 2012) databases, using subject headings, synonyms, relevant terms and variant spellings for each database. Only prospective cohort studies investigating the risk factors for running-related musculoskeletal injuries were included in this review. Two independent reviewers screened each article and, if they did not reach a consensus, a third reviewer decided whether or not the article should be included. Year of publication, type of runners, sample size, definition of running-related musculoskeletal injury, baseline characteristics, reported risk factors and the statistical measurement of risk or protection association were extracted from the articles. A scale adapted by the authors evaluated the risk of bias of the articles. A total of 11 articles were considered eligible in this systematic review. A total of 4,671 pooled participants were analysed and 60 different predictive factors were investigated. The main risk factor reported was previous injury (last 12 months), reported in 5 of the 8 studies that investigated previous injuries as a risk factor. Only one article met the criteria for random selection of the sample and only six articles included a follow-up of 6 months or more. There was no association between gender and running injuries in most of the studies. It is possible that eligible articles for this review were published in journals that were

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.

Epidemiology of soccer-related injuries among male high school ...

African Journals Online (AJOL)

Soccer in Rwandan high schools can expose players to the risk of injury warranting prevention programmes. The aim of this study was to determine the type, causes, severity and management of injuries among high school soccer players in Rwanda, in order to obtain baseline data for injury prevention programmes.

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.

MICROBIOLOGICAL METHODS APPLICATION EXPERIENCE IN THE SEVERE INJURIES INFECTIOUS COMPLICATIONS

Directory of Open Access Journals (Sweden)

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

Impact of CrossFit-Related Spinal Injuries.

Science.gov (United States)

Hopkins, Benjamin S; Cloney, Michael B; Kesavabhotla, Kartik; Yamaguchi, Jonathon; Smith, Zachary A; Koski, Tyler R; Hsu, Wellington K; Dahdaleh, Nader S

2017-11-16

Exercise-related injuries (ERIs) are a common cause of nonfatal emergency department and hospital visits. CrossFit is a high-intensity workout regimen whose popularity has grown rapidly. However, ERIs due to CrossFit remained under investigated. All patients who presented to the main hospital at a major academic center complaining of an injury sustained performing CrossFit between June 2010 and June 2016 were identified. Injuries were classified by anatomical location (eg, knee, spine). For patients with spinal injuries, data were collected including age, sex, body mass index (BMI), CrossFit experience level, symptom duration, type of symptoms, type of clinic presentation, cause of injury, objective neurological examination findings, imaging type, number of clinic visits, and treatments prescribed. Four hundred ninety-eight patients with 523 CrossFit-related injuries were identified. Spine injuries were the most common injuries identified, accounting for 20.9%. Among spine injuries, the most common location of injury was the lumbar spine (83.1%). Average symptom duration was 6.4 months ± 15.1, and radicular complaints were the most common symptom (53%). A total of 30 (32%) patients had positive findings on neurologic examination. Six patients (6.7%) required surgical intervention for treatment after failing an average of 9.66 months of conservative treatment. There was no difference in age, sex, BMI, or duration of symptoms of patients requiring surgery with those who did not. CrossFit is a popular, high-intensity style workout with the potential to injure its participants. Spine injuries were the most common type of injury observed and frequently required surgical intervention.

Health-related quality of life after mild, moderate and severe traumatic brain injury: patterns and predictors of suboptimal functioning during the first year after injury.

Science.gov (United States)

Scholten, A C; Haagsma, J A; Andriessen, T M J C; Vos, P E; Steyerberg, E W; van Beeck, E F; Polinder, S

2015-04-01

The Glasgow Outcome Scale Extended (GOSE) is the established functional outcome scale to assess disability following traumatic brain injury (TBI), however does not capture the patient's subjective perspective. Health-related quality of life (HRQL) does capture the individual's perception of disability after TBI, and has therefore been recognized as an important outcome in TBI. In contrast to GOSE, HRQL enables comparison of health outcome across various disease states and with healthy individuals. We aimed to assess functional outcome, HRQL, recovery, and predictors of 6 and 12-month outcome in a comprehensive sample of patients with mild, moderate or severe TBI, and to examine the relationship between functional impairment (GOSE) and HRQL. A prospective cohort study was conducted among a sample of 2066 adult TBI patients who attended the emergency department (ED). GOSE was determined through questionnaires or structured interviews. Questionnaires 6 and 12 months after ED treatment included socio-demographic information and HRQL measured with Short-Form Health Survey (SF-36; reflecting physical, mental and social functioning) and Perceived Quality of Life Scale (PQoL; measuring degree of satisfaction with functioning). 996 TBI survivors with mild, moderate or severe TBI completed the 6-month questionnaire. Functional outcome and HRQL after moderate or severe TBI was significantly lower than after mild TBI. Patients with moderate TBI showed greatest improvement. After one year, the mild TBI group reached outcomes comparable to population norms. TBI of all severities highly affected SF-36 domains physical and social functioning, and physical and emotional role functioning. GOSE scores were highly related to all SF-36 domains and PQoL scores. Female gender, older age, co-morbidity and high ISS were strongest independent predictors of decreased HRQL at 6 and 12 months after TBI. HRQL and recovery patterns differ for mild, moderate and severe TBI. This study indicates

Fishing gear-related injury in California marine wildlife.

Science.gov (United States)

Dau, Brynie Kaplan; Gilardi, Kirsten V K; Gulland, Frances M; Higgins, Ali; Holcomb, Jay B; Leger, Judy St; Ziccardi, Michael H

2009-04-01

We reviewed medical records from select wildlife rehabilitation facilities in California to determine the prevalence of injury in California Brown Pelicans (Pelecanus occidentalis), gulls (Larus spp.), and pinniped species (Zalophus californianus, Mirounga angustirostris, and Phoca vitulina) due to fishing gear entanglement and ingestion from 2001 to 2006. Of 9,668 Brown Pelican, gull, and pinniped cases described during the 6-yr study period (2001-06), 1,090 (11.3%) were fishing gear-related. Pelican injuries caused by fishing gear were most common in the Monterey Bay region, where 59.6% of the pelicans rescued in this area and admitted to a rehabilitation center were injured by fishing gear over the 6-yr period. The highest prevalence of fishing gear-related injury in gulls was documented in the Los Angeles/Orange County region (16.1%), whereas the highest prevalences in pinnipeds were seen in the San Diego region (3.7%). Despite these higher prevalences of gull and pinniped fishing gear-related injuries in these specific regions, there was no statistical significance in these trends. Juvenile gulls and pinnipeds were more commonly injured by fishing gear than adults (gulls: P = 0.03, odds ratio = 1.29; pinnipeds: P = 0.01, odds ratio = 2.07). Male pinnipeds were twice as likely to be injured by fishing gear as females (P gear-related injury cases that were successfully rehabilitated and released (percentage of cases successfully rehabilitated to the point of release out of the total number of fishing gear-related injury cases) was high in all three species groups (pelicans: 63%; gulls: 54%; pinnipeds: 70%). Fishing gear-related injuries in Brown Pelicans and gulls were highest in the fall, but there was only a significant difference between seasons for fishing gear-related injuries in pelicans. Fishing gear-related injuries in pinnipeds most commonly occurred in summer; however, a statistical difference was not detected between seasons for pinnipeds. Derelict

Follow-up CT myelography of severe cervical spinal cord injury

Energy Technology Data Exchange (ETDEWEB)

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)

Work-related traumatic dental injuries: Prevalence, characteristics and risk factors.

Science.gov (United States)

Ugolini, Alessandro; Parodi, Giovanni Battista; Casali, Claudia; Silvestrini-Biavati, Armando; Giacinti, Flavio

2018-02-01

The prevalence of work-related oral trauma is underestimated because minor dental injuries are often not reported in patients with several injuries in different parts of the body. In addition, little data are available regarding their characteristics. The aim of this epidemiological study was to determine the prevalence, types, and characteristics of occupational traumatic dental injuries (TDIs) in a large working community. Work-related TDIs that occurred during the period between 2011 and 2013 in the District of Genoa (Northwest of Italy, 0.86 million inhabitants) were analyzed. Patients' data were obtained from the National Institute for Insurance against Accidents at Work database. During the 2 year period, 112 TDIs (345 traumatized teeth) were recorded. The prevalence was 5.6‰ of the total amount of occupational trauma. The highest prevalence was found in the fourth and fifth decades of life (OR=3.6, P construction/farm/factory workers and craftsmen were 48%. TDIs involved only teeth and surrounding tissue in 66% of cases, or in combination with another maxillofacial injury in 34%. They were statistically associated with construction/farm/factory workers group (Chi squared P cases, subluxation/luxation in 10.7%, avulsion in 9%, root fracture in 3.8%, and concussion in 3.5%. Thirty-two subjects (28.6%, 133 teeth, OR=4.3, P < .001) presented at least 1 traumatized tooth with previous dental treatment. Among 212 (61.4%) traumatized teeth, 67.5% were upper incisors, 17.5% were lower incisors, 3.3% were upper canines, 1.9% were lower canines, and 9.9% were bicuspids and molars. Work-related TDIs had a low overall prevalence, and fractures were the most frequent dental injury. Age, gender, and preexisting dental treatments represented risk factors for work-related TDIs. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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...

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

Directory of Open Access Journals (Sweden)

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.

Seizure-related injuries in children and adolescents with epilepsy.

Science.gov (United States)

Lagunju, IkeOluwa A; Oyinlade, Alexander O; Babatunde, Olubusayo D

2016-01-01

Children with epilepsy are reported to be at a greater risk of injuries compared with their peers who do not have epilepsy. We set out to determine the frequency and pattern of seizure-related injuries in children with epilepsy seen at the University College Hospital (UCH), Ibadan, Nigeria. Consecutive cases of epilepsy seen at the pediatric neurology clinic of the UCH, Ibadan over a period of 6months were evaluated for injuries in the preceding 12months using a structured questionnaire. These were compared with age- and sex-matched controls. A total of 125 children with epilepsy and 125 age- and sex-matched controls were studied. Injuries occurred more frequently in children with epilepsy than in their peers (p=0.01, OR 1.935, 95% CI 1.142-3.280). Epilepsy was generalized in 80 (64.0%), and localization-related in 45 (36.0%). Idiopathic epilepsy accounted for 74 (59.2%), and the remaining 51 (40.8%) had remote symptomatic epilepsy. Fifty-seven (45.6%) children had suffered seizure-related injuries with multiple injuries in 31 (24.8%). The most frequent were skin/soft tissue lacerations (26.4%), injuries to the tongue and soft tissues of the mouth (19.2%), minor head injuries (15.2%), and dental injuries with tooth loss (8.0%). There was a statistically significant association between seizure frequency and seizure-related injuries (p=0.002). Children on polytherapy had a significantly higher frequency of seizure-related injuries (pEpilepsy is a major risk factor for injuries in childhood. High seizure frequency increases the risk of multiple injuries in children with epilepsy. Copyright © 2015 Elsevier Inc. All rights reserved.

[Epidemiology of work-related eye injuries].

Science.gov (United States)

Zghal-Mokni, Imen; Nacef, Leila; Kaoueche, Mourad; Letaief, Imen; Bouguila, Hedi; Jeddi, Amel; Ayed, Saida

2007-07-01

Occupational injury represents 7,7 at 69,9% of the total ocular traumatisms. They can be a major source of visuel loss and blindness. The aim is to study the epidemiology of work-related ocular injuries: objects frequencies,works most exposed. We performed a prospective study that interest 78 patients having a work-related ocular traumatism during a 4 months period. They were admitted at ocular emergeney All patients underwent an ophtalmologic examination completed with orbital radiography and echography. A medical and/or chirurgical appropriate treatment was institued. Occupationnal injury frequency was 9% of the whole ocular traumatisms in the same period. The mean age was 31 years. 55% of cases were under 30 years. 91% were male. Most exposed works were industrial and mecanical sectors In 70,5% of cases work-related eye injuries were caused by projectile objects. Most common lesion was corneal superficial foreign body (58%). Open globe injury was noted in 8%. 95% of patients had no eye protection at the time of the accident. 13% were blind or unilateral partially sighted (according to the OMS classification). The authors discussed the importance and different prevention strategies to prevent the risk of blindness and socio-economical cost of occupationnal accidents. There is a need for systematic periodic sensibilization to reduce these accidents and blindness.

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

Directory of Open Access Journals (Sweden)

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.

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

Science.gov (United States)

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

Prevalence of work-related injuries among workers of bottling ...

African Journals Online (AJOL)

Prevalence of work-related injuries among workers of bottling industries in Benin city, ... job descriptions and activities which constitute health hazards for the individual. ... with the major work-related injuries and illness being physical injuries.

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

Science.gov (United States)

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.

Science.gov (United States)

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.

Role of physical activity in the occurrence of falls and fall-related injuries in community-dwelling adults over 50 years old.

Science.gov (United States)

Pereira, Catarina L N; Baptista, Fátima; Infante, Paulo

2014-01-01

This study examined the effect of the type, level and amount of physical activity in falls and fall-related injuries. Participants were 506 community-dwelling adults aged >50 years (390 women: 67.7 ± 6.8 years and 116 men: 69.6 ± 6.6 years). Falls, fall-related injuries (slight and severe), and physical activity (type, level and energy expenditure) were evaluated by questionnaires. Confounders included co-morbidities, fear of falling, environmental hazards and physical fitness. After adjustment for confounders, logistic analysis revealed that the likelihood of falling decreased by 2% for each 100 metabolic expenditure (MET-min/week) of total physical activity and increased by 5% for each 100 MET-min/week of vigorous-intensity physical activity; total physical activity >1125 MET-min/week and vigorous physical activity physical activity level, increased physical activity levels diminished the likelihood of the occurrence of severe fall-related injuries by 76% (moderate) and 58% (high; p active, especially sufficiently active, reduces fall-related injuries by decreasing falls and by safeguarding against severe injuries when falls occur. At least 1125 MET-min/week of total physical activity including >500 MET-min/week of vigorous intensity seems to prevent falls and, therefore, fall-related injuries.

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

Science.gov (United States)

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.

Distinct features of trampoline-related orthopedic injuries in children aged under 6 years.

Science.gov (United States)

Choi, Eun Seok; Hong, Jin Heon; Sim, Jae Ang

2018-02-01

Concern has been growing about trampoline-related injuries among young children. Several published policy statements have repeatedly recommended that children younger than 6 years should not use trampolines. However, few studies have investigated the injuries caused by trampoline-related accidents among young children. This study aimed to identify the distinct features of trampoline-related orthopedic injuries in children younger than 6 years. We retrospectively reviewed the medical records of pediatric patients aged between 0 and 16 years who visited our regional emergency center due to trampoline-related orthopedic injuries between 2012 and 2015. Patients were divided into two groups: a preschool group (younger than 6 years) and a school group (older than 6 years). We compared the features of the injuries in the two groups. Among 208 patients, 108 (52%) were male and 100 (48%) were female. The mean age was 5.4 years. The preschool group accounted for 66%. There were no seasonal variations. Fractures were sustained in 96 patients (46%). The anatomical locations of injuries differed significantly between the two age groups. Proximal tibia fractures were more frequent in the preschool group than the school group (34% and 6%, respectively). Distal tibia fractures were more prevalent in the school group than the preschool group (44% vs. 13%, respectively). Surgical treatment was needed more frequently in the school group (p = 0.035, hazard ratio 2.52, 95% confidence interval: 1.03-6.17). Most of the injuries (82%) occurred at trampoline parks. The anatomical locations of trampoline-related orthopedic injuries differed significantly between age groups. Fractures were more common around the knee in younger children and the ankle in older children. Copyright © 2017 Elsevier Ltd. All rights reserved.

High velocity missile-related colorectal injuries: In-theatre application of injury scores and their effects on ostomy rates.

Science.gov (United States)

Kaymak, Şahin; Ünlü, Aytekin; Harlak, Ali; Ersöz, Nail; Şenocak, Rahman; Coşkun, Ali Kağan; Zeybek, Nazif; Lapsekili, Emin; Kozak, Orhan

2016-03-01

Treatment of colorectal injuries (CRIs) remains a significant cause of morbidity and mortality. The aim of the present study was to analyze treatment trends of Turkish surgeons and effects of the American Association for the Surgery of Trauma (AAST), Injury Severity (ISS), and Penetrating Abdominal Trauma Index (PATI) scoring systems on decision-making processes and clinical outcomes. Data regarding high velocity missile (HVM)-related CRIs were retrospectively gathered. Four patient groups were included: Group 1 (stoma), Group 2 (no stoma in primary surgery), Group 2a (conversion to stoma in secondary surgery), and Group 2b (remaining Group 2 patients). Groups 1, 2, 2a, and 2b included 39 (66%), 20 (34%), 6 (30%), and 14 (70%) casualties, respectively. Ostomies were performed in casualties with significantly higher AAST scores (pcolon/rectum injury scores.

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

Weather warnings predict fall-related injuries among older adults.

Science.gov (United States)

Mondor, Luke; Charland, Katia; Verma, Aman; Buckeridge, David L

2015-05-01

weather predictions are a useful tool for informing public health planning and prevention strategies for non-injury health outcomes, but the association between winter weather warnings and fall-related injuries has not been assessed previously. to examine the association between fall-related injuries among older adults and government-issued winter weather warnings. using a dynamic cohort of individuals ≥65 years of age who lived in Montreal between 1998 and 2006, we identified all fall-related injuries from administrative data using a validated set of diagnostic and procedure codes. We compared rates of injuries on days with freezing rain or snowstorm warnings to rates observed on days without warnings. We also compared the incidence of injuries on winter days to non-winter days. All analyses were performed overall and stratified by age and sex. freezing rain alerts were associated with an increase in fall-related injuries (incidence rate ratio [IRR] = 1.20, 95% confidence interval [CI]: 1.08-1.32), particularly among males (IRR = 1.31, 95% CI: 1.10-1.56), and lower rates of injuries were associated with snowstorm alerts (IRR = 0.89, 95% CI: 0.80-0.99). The rate of fall-related injuries did not differ seasonally (IRR = 1.00, 95% CI: 0.97-1.03). official weather warnings are predictive of increases in fall-related injuries among older adults. Public health agencies should consider using these warnings to trigger initiation of injury prevention strategies in advance of inclement weather. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Elevator-related injuries to older adults in the United States, 1990 to 2006.

Science.gov (United States)

Steele, Gregory K; O'Neil, Joseph; Huisingh, Carrie; Smith, Gary A

2010-01-01

Elevators remain one of the safest forms of transportation; however, they are still associated with deaths and injuries. This study describes the epidemiology of elevator-related injuries among adults aged 65 years and older in the United States between 1990 and 2006, through a retrospective analysis of data from the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission. Proportions with 95% confidence intervals were calculated by age group for cause of injury, injured body region, injury type, and locale. Rate ratios with 95% confidence interval were calculated to determine any association between the body region injured, type of injury, and cause of injury categories. There were an estimated 44,870 elevator-related injuries in older adults. The mean age was 79.5 years, and approximately 75% were women. More than half of the injuries (51.4%) were caused from a slip, trip, or fall. Soft-tissue injuries were the most common injury type (48.0%). The upper extremities were the most commonly injured body region (26.2%). Almost 15% (14.5%) of those injured required hospital admission. Of those admitted, more than 40% were for a fractured hip. Injuries associated with passenger elevators occur fairly frequently among older adults, are often associated with slip, trip or falls, and can be severe enough to require hospital admission. Older adults should use caution when stepping on or off an elevator. Awareness of the risk and the circumstances leading to falls allows for better direction of intervention strategies.

Fatal lawn mower related projectile injury

DEFF Research Database (Denmark)

Colville-Ebeling, Bonnie; Lynnerup, Niels; Banner, Jytte

2014-01-01

was initially overlooked, later interpreted as a possible gunshot homicide, and finally identified as a lawn mower related projectile injury when autopsy revealed a piece of metal thread in the main bronchus to the right middle lobe, hemopericardium, and right-sided hemothorax. To our knowledge, this injury...

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 ...

Female Service Members and Symptom Reporting after Combat and Non-Combat-Related Mild Traumatic Brain Injury.

Science.gov (United States)

Brickell, Tracey A; Lippa, Sara M; French, Louis M; Kennedy, Jan E; Bailie, Jason M; Lange, Rael T

2017-01-15

Females are often excluded from military-related mild traumatic brain injury (mTBI) research because of its relatively low prevalence in this population. The purpose of this study was to focus on outcome from mTBI in female service members, compared with males. Participants were 172 United States military service members selected from a larger sample that had sustained an mTBI, and were evaluated within 24 months of injury (Age: mean = 28.9, SD = 8.1) at one of six military medical centers. Eighty-six women were matched to 86 men on nine key variables: TBI severity, mechanism of injury, bodily injury severity, days post-injury, age, number of deployments, theater where wounded, branch of service, and rank. Participants completed the Neurobehavioral Symptom Inventory (NSI) and the Posttraumatic Stress Disorder Checklist (PCL-C). There were no meaningful gender differences across all demographic and injury-related variables (p > 0.05). There were significant group differences and medium effect sizes for the NSI total score and all four NSI cluster scores. Symptoms most affected related to nausea, sensitivity to light, change in taste/smell, change in appetite, fatigue, and poor sleep. There were significant group differences and small-medium effect sizes for the PCL-C total score and two of the three PCL-C cluster scores. Symptoms most affected related to poor concentration, trouble remembering a stressful event, and disturbing memories/thoughts/images. Females consistently experienced more symptoms than males. As females become more active in combat-related deployments, it is critical that future studies place more emphasis on this important military population.

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

Directory of Open Access Journals (Sweden)

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.

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

Directory of Open Access Journals (Sweden)

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.

Patterns of post-acute health care utilization after a severe traumatic brain injury: Results from the PariS-TBI cohort.

Science.gov (United States)

Jourdan, Claire; Bayen, Eleonore; Darnoux, Emmanuelle; Ghout, Idir; Azerad, Sylvie; Ruet, Alexis; Vallat-Azouvi, Claire; Pradat-Diehl, Pascale; Aegerter, Philippe; Weiss, Jean-Jacques; Azouvi, Philippe

2015-01-01

To assess brain injury services utilization and their determinants using Andersen's model. Prospective follow-up of the PariS-TBI inception cohort. Out of 504 adults with severe traumatic brain injury (TBI), 245 survived and 147 received a 4-year outcome assessment (mean age 33 years, 80% men). Provision rates of medical, rehabilitation, social and re-entry services and their relations to patients' characteristics were assessed. Following acute care discharge, 78% of patients received physiotherapy, 61% speech/cognitive therapy, 50% occupational therapy, 41% psychological assistance, 63% specialized medical follow-up, 21% community re-entry assistance. Health-related need factors, in terms of TBI severity, were the main predictors of services. Provision of each therapy was significantly associated with corresponding speech, motor and psychological impairments. However, care provision did not depend on cognitive impairments and cognitive therapy was related to pre-disposing and geographical factors. Community re-entry assistance was provided to younger and more independent patients. These quantitative findings illustrate strengths and weaknesses of late brain injury care provision in urban France and highlight the need to improve treatment of cognitive impairments.

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.

Science.gov (United States)

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

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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.

Epidemiology of pediatric holiday-related injuries presenting to US emergency departments.

Science.gov (United States)

D'Ippolito, Anthony; Collins, Christy L; Comstock, R Dawn

2010-05-01

The objective of this study was to calculate injury rates and describe the epidemiology of holiday-related injuries among children who were aged holiday-related injuries obtained from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System were analyzed. From 1997 through 2006, an estimated 5,710,999 holiday-related injuries sustained by children who were aged holidays were classified as sports and recreation-related. In addition, home structure-related and home furnishing-related injuries were prevalent. Injuries that were associated with fireworks were more likely to occur on the Fourth of July than any other holiday, yet fireworks accounted for only a small proportion of Fourth of July injuries. Most injuries that were sustained on holidays and required ED treatment were not holiday-specific but were associated with more general activities. Parents should be aware that holidays present a risk not only for holiday-specific injuries but also for more general, "everyday" injuries.

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

Science.gov (United States)

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

Water tubing-related injuries treated in US emergency departments, 1991-2009.

Science.gov (United States)

Heinsimer, Kevin R; Nelson, Nicolas G; Roberts, Kristin J; McKenzie, Lara B

2013-02-01

The objective was to describe the patterns and mechanisms of water tubing-related injuries treated in U.S. emergency departments. The National Electronic Injury Surveillance System was used to examine cases of water tubing-related injuries. Sample weights were used to calculate national estimates of water tubing-related injuries. Analyses were conducted in 2010. From 1991-2009 an estimated 69,471 injuries were treated in US emergency departments for water tubing-related injuries. The annual number of cases increased 250% over the 19-year study period (P tubing-related injuries differ for children and adults. Research is needed to determine how best to reduce these injuries.

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)....

Fall Risk Assessment Predicts Fall-Related Injury, Hip Fracture, and Head Injury in Older Adults.

Science.gov (United States)

Nilsson, Martin; Eriksson, Joel; Larsson, Berit; Odén, Anders; Johansson, Helena; Lorentzon, Mattias

2016-11-01

To investigate the role of a fall risk assessment, using the Downton Fall Risk Index (DFRI), in predicting fall-related injury, fall-related head injury and hip fracture, and death, in a large cohort of older women and men residing in Sweden. Cross sectional observational study. Sweden. Older adults (mean age 82.4 ± 7.8) who had a fall risk assessment using the DFRI at baseline (N = 128,596). Information on all fall-related injuries, all fall-related head injuries and hip fractures, and all-cause mortality was collected from the Swedish Patient Register and Cause of Death Register. The predictive role of DFRI was calculated using Poisson regression models with age, sex, height, weight, and comorbidities as covariates, taking time to outcome or end of study into account. During a median follow-up of 253 days (interquartile range 90-402 days) (>80,000 patient-years), 15,299 participants had a fall-related injury, 2,864 a head injury, and 2,557 a hip fracture, and 23,307 died. High fall risk (DFRI ≥3) independently predicted fall-related injury (hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 1.39-1.49), hip fracture (HR = 1.51, 95% CI =1.38-1.66), head injury (HR = 1.12, 95% CI = 1.03-1.22), and all-cause mortality (HR = 1.39, 95% CI = 1.35-1.43). DFRI more strongly predicted head injury (HR = 1.29, 95% CI = 1.21-1.36 vs HR = 1.08, 95% CI = 1.04-1.11) and hip fracture (HR = 1.41, 95% CI = 1.30-1.53 vs HR = 1.08, 95% CI = 1.05-1.11) in 70-year old men than in 90-year old women (P Fall risk assessment using DFRI independently predicts fall-related injury, fall-related head injury and hip fracture, and all-cause mortality in older men and women, indicating its clinical usefulness to identify individuals who would benefit from interventions. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

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

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

Science.gov (United States)

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

Science.gov (United States)

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

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

Directory of Open Access Journals (Sweden)

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

Compliant flooring to prevent fall-related injuries: a scoping review protocol.

Science.gov (United States)

Lachance, Chantelle C; Jurkowski, Michal P; Dymarz, Ania C; Mackey, Dawn C

2016-08-16

Fall-related injuries can have serious consequences for older adults, including increased risk of dependence in daily activities and mortality. Compliant flooring is a passive intervention that may reduce the incidence and severity of fall-related injuries in healthcare settings, including acute and long-term care, but few sites have implemented compliant flooring, in part because synthesised evidence about key performance aspects has not been available. We will conduct a scoping review to address the question: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries? We will conduct a comprehensive and systematic literature search of academic databases (AgeLine, CINAHL, EBM Reviews, MEDLINE (Ovid), SportDiscus and Web of Science) and grey literature (clinical trial registries, theses/dissertations, abstracts/conference proceedings and relevant websites). 2 team members will independently screen records (first titles and abstracts, then full text) and extract data from included records. Numerical and narrative analyses will be presented by theme (biomechanical efficacy, clinical effectiveness, cost-effectiveness, workplace safety). This scoping review responds to the information needs of healthcare decision-makers tasked with preventing fall-related injuries. This review will summarise evidence about compliant flooring as a potential intervention for preventing fall-related injuries in older adults and identify gaps in evidence and new avenues for research. Results will be especially useful in long-term care, but also applicable in acute care, assisted living and home care. We will disseminate the review's findings via open-access publications, conference presentations, a webinar, a Stakeholder Symposium and a Knowledge-to-Action Report. Published by the BMJ Publishing Group Limited. For permission to use (where not

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, ...

Four-wheeled walker related injuries in older adults in the Netherlands.

Science.gov (United States)

van Riel, K M M; Hartholt, K A; Panneman, M J M; Patka, P; van Beeck, E F; van der Cammen, T J M

2014-02-01

With ageing populations worldwide, mobility devices are used more than ever. In the current literature there is no consensus whether the available mobility devices safely improve the mobility of their users. Also, evidence is lacking concerning the risks and types of injuries sustained while using a four-wheeled walker. To assess injury risks and injury patterns in older adults (≥65 years) who presented at Emergency Departments (ED) in the Netherlands with an injury due to using a four-wheeled walker. In this study, the Dutch Injury Surveillance System was used to obtain a national representative sample of annual ED visits in the Netherlands in the adult population (≥65 years) sustaining an injury while using a four-wheeled walker. The numbers of four-wheeled walker users in the Netherlands were obtained from the national insurance board. The numbers of ED visits were divided by the numbers of four-wheeled walker users to calculate age- and sex-specific injury risks. Annually 1869 older adults visited an ED after sustaining an injury while using a four-wheeled walker. Falls were the main cause of injury (96%). The injury risk was 3.1 per 100 users of four-wheeled walkers. Women (3.5 per 100 users) had a higher risk than men (2.0 per 100 users). Injury risk was the highest in women aged 85 years and older (6.2 per 100 users). The majority of injuries were fractures (60%) with hip fracture (25%) being the most common injury. Nearly half of all four-wheeled walker related injuries required hospitalisation, mostly due to hip fractures. Healthcare costs per injury were approximately €12 000. This study presents evidence that older adults experiencing a fall while using a four-wheeled walker are at high risk to suffer severe injuries.

Injuries to children in the United States related to trampolines, 1990-1995: a national epidemic.

Science.gov (United States)

Smith, G A

1998-03-01

To describe the epidemiology of trampoline-related injuries among children in the United States. A retrospective analysis of data for children 18 years old and younger from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990 through 1995. There were an estimated 249 400 trampoline-related injuries [95% confidence interval (CI), 166 300-332 500] to children 18 years old and younger treated in hospital emergency departments in the United States during the 6-year study period. The number of injuries increased by 98% from 29 600 in 1990 to 58 400 in 1995, with an average of 41 600 (95% CI, 27 700-55 500) injuries per year, or 59.4 injuries per 100 000 United States children per year (95% CI, 39.6-79.3). The median age of injured children was 10 years, and 50% were males. Ninety-three percent of injuries occurred at home. Injuries to the extremities predominated among children of all ages and accounted for more than 70% of all injuries. This study identified several age-specific injury patterns. There was an inverse relationship between age versus the relative frequency of upper extremity injuries, and fractures and dislocations; and there was a direct relationship between age versus lower extremity injuries and soft tissue injury. There was also an inverse relationship between age versus facial injuries, head and neck injuries, and lacerations. Annually, an estimated 1400 children (95% CI, 800-2000), or 2.0 per 100 000 United States children (95% CI, 1. 1-2.9), required hospital admission or interhospital transfer because of a trampoline-related injury. This represented 3.3% of all children with a trampoline-associated injury. Fractures or dislocations accounted for 83% of injuries among admitted or transferred children, and children with a fracture or dislocation were more likely to be admitted or transferred to another hospital (8.4%) than children with other types of injury (relative risk, 10.80; 95% CI

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.

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.

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

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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.

Imaging of sports-related hip and groin injuries.

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Lischuk, Andrew W; Dorantes, Thomas M; Wong, William; Haims, Andrew H

2010-05-01

A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries.

Ultrasound imaging of sports-related musculoskeletal injuries

International Nuclear Information System (INIS)

Craig, J.G.; Holsbeek, M.T. van; Gauthier, T.P.; Cook, W.J.

2006-01-01

Sports-related injuries of the musculoskeletal system affect millions of individuals every year. Integrating high-frequency Tissue Harmonic Imaging ultrasound with MRI and CT gives the greatest opportunity for diagnosing specific injuries. (orig.)

Risk of Fall-Related Injury due to Adverse Weather Events, Philadelphia, Pennsylvania, 2006-2011.

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Gevitz, Kathryn; Madera, Robbie; Newbern, Claire; Lojo, José; Johnson, Caroline C

Following a surge in fall-related visits to local hospital emergency departments (EDs) after a severe ice storm, the Philadelphia Department of Public Health examined the association between inclement winter weather events and fall-related ED visits during a 5-year period. Using a standardized set of keywords, we identified fall-related injuries in ED chief complaint logs submitted as part of Philadelphia Department of Public Health's syndromic surveillance from December 2006 through March 2011. We compared days when falls exceeded the winter fall threshold (ie, "high-fall days") with control days within the same winter season. We then conducted matched case-control analysis to identify weather and patient characteristics related to increased fall-related ED visits. Fifteen high-fall days occurred during winter months in the 5-year period. In multivariable analysis, 18- to 64-year-olds were twice as likely to receive ED care for fall-related injuries on high-fall days than on control days. The crude odds of ED visits occurring from 7:00 am to 10:59 am were 70% higher on high-fall days vs control days. Snow was a predictor of a high-fall day: the adjusted odds of snow before a high-fall day as compared with snow before a control day was 13.4. The association between the number of fall-related ED visits and weather-related fall injuries, age, and timing suggests that many events occurred en route to work in the morning. Promoting work closures or delaying openings after severe winter weather would allow time for better snow or ice removal, and including "fall risk" in winter weather advisories might effectively warn morning commuters. Both strategies could help reduce the number of weather-related fall injuries.

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

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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.

Thoracic Injuries in earthquake-related versus non-earthquake-related trauma patients: differentiation via Multi-detector Computed Tomography

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Zhi-hui Dong

2011-01-01

Full Text Available PURPOSE: Massive earthquakes are harmful to humankind. This study of a historical cohort aimed to investigate the difference between earthquake-related crush thoracic traumas and thoracic traumas unrelated to earthquakes using a multi-detector Computed Tomography (CT. METHODS: We retrospectively compared an earthquake-exposed cohort of 215 thoracic trauma crush victims of the Sichuan earthquake to a cohort of 215 non-earthquake-related thoracic trauma patients, focusing on the lesions and coexisting injuries to the thoracic cage and the pulmonary parenchyma and pleura using a multi-detector CT. RESULTS: The incidence of rib fracture was elevated in the earthquake-exposed cohort (143 vs. 66 patients in the non-earthquake-exposed cohort, Risk Ratio (RR = 2.2; p<0.001. Among these patients, those with more than 3 fractured ribs (106/143 vs. 41/66 patients, RR=1.2; p<0.05 or flail chest (45/143 vs. 11/66 patients, RR=1.9; p<0.05 were more frequently seen in the earthquake cohort. Earthquake-related crush injuries more frequently resulted in bilateral rib fractures (66/143 vs. 18/66 patients, RR= 1.7; p<0.01. Additionally, the incidence of non-rib fracture was higher in the earthquake cohort (85 vs. 60 patients, RR= 1.4; p<0.01. Pulmonary parenchymal and pleural injuries were more frequently seen in earthquake-related crush injuries (117 vs. 80 patients, RR=1.5 for parenchymal and 146 vs. 74 patients, RR = 2.0 for pleural injuries; p<0.001. Non-rib fractures, pulmonary parenchymal and pleural injuries had significant positive correlation with rib fractures in these two cohorts. CONCLUSIONS: Thoracic crush traumas resulting from the earthquake were life threatening with a high incidence of bony thoracic fractures. The ribs were frequently involved in bilateral and severe types of fractures, which were accompanied by non-rib fractures, pulmonary parenchymal and pleural injuries.

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

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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.

Civil engineering airman at increased risk for injuries and injury-related musculoskeletal disorders.

Science.gov (United States)

Webb, Timothy S; Wells, Timothy S

2011-03-01

With the advent of electronic records, the opportunity to conduct research on workplace-related injuries and musculoskeletal disorders has increased dramatically. The purpose of this study was to examine the United States Air Force Civil Engineering career field to determine if they are negatively impacted by their work environment. Specifically, the objective of this study was to determine if enlisted Civil Engineering Airmen (n = 25,385) were at increased risk for injury or injury-related musculoskeletal disorders compared to enlisted Information Management/Communications Airmen (n = 28,947). Using an historical prospective design, electronic data were assembled and analyzed using Cox's proportional hazards modeling. Models were stratified by gender and adjusted for race/ethnicity, marital status, birth year, and deployment status. Male Civil Engineers were observed to be at greater risk for both inpatient injury-related musculoskeletal disorders (HR = 1.86; 95% CI = 1.54-2.26) and injuries (HR = 1.77; 95% CI = 1.48-2.11), while female Civil Engineers were more than double the risk for both inpatient injury-related musculoskeletal disorders (HR = 2.18; 95% CI = 1.28-3.73) and injuries (HR = 2.22; 95% CI = 1.27-3.88) compared to Information Management/Communications Airmen. Although analyses do not allow exploration of specific causes, they highlight the utility of using electronic data to identify occupations for further evaluation. Based on these results, additional resources were allocated to survey Civil Engineers on their physical work demands and job requirements to identify key problem areas for further study and mitigation. Copyright © 2010 Wiley-Liss, Inc.

Life goals and social identity in people with severe acquired brain injury: an interpretative phenomenological analysis.

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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.

College Sports-Related Injuries - United States, 2009-10 Through 2013-14 Academic Years.

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Kerr, Zachary Y; Marshall, Stephen W; Dompier, Thomas P; Corlette, Jill; Klossner, David A; Gilchrist, Julie

2015-12-11

Sports-related injuries can have a substantial impact on the long-term health of student-athletes. The National Collegiate Athletic Association (NCAA) monitors injuries among college student-athletes at member schools. In academic year 2013-14, a total of 1,113 member schools fielded 19,334 teams with 478,869 participating student-athletes in NCAA championship sports (i.e., sports with NCAA championship competition) (1). External researchers and CDC used information reported to the NCAA Injury Surveillance Program (NCAA-ISP) by a sample of championship sports programs to summarize the estimated national cumulative and annual average numbers of injuries during the 5 academic years from 2009-10 through 2013-14. Analyses were restricted to injuries reported among student-athletes in 25 NCAA championship sports. During this period, 1,053,370 injuries were estimated to have occurred during an estimated 176.7 million athlete-exposures to potential injury (i.e., one athlete's participation in one competition or one practice). Injury incidence varied widely by sport. Among all sports, men's football accounted for the largest average annual estimated number of injuries (47,199) and the highest competition injury rate (39.9 per 1,000 athlete-exposures). Men's wrestling experienced the highest overall injury rate (13.1 per 1,000) and practice injury rate (10.2 per 1,000). Among women's sports, gymnastics had the highest overall injury rate (10.4 per 1,000) and practice injury rate (10.0 per 1,000), although soccer had the highest competition injury rate (17.2 per 1,000). More injuries were estimated to have occurred from practice than from competition for all sports, with the exception of men's ice hockey and baseball. However, injuries incurred during competition were somewhat more severe (e.g., requiring ≥7 days to return to full participation) than those acquired during practice. Multiple strategies are employed by NCAA and others to reduce the number of injuries in

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.

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).

Changes in motorcycle-related injuries and deaths after mandatory motorcycle helmet law in a district of Vietnam.

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Ha, Ninh Thi; Ederer, David; Vo, Van Anh Ha; Pham, An Van; Mounts, Anthony; Nolen, Leisha D; Sugerman, David

2018-01-02

Our study measured the change in head injuries and deaths among motorcycle users in Cu Chi district, a suburban district of Ho Chi Minh City. Hospital records for road traffic injuries (RTIs) were collected from the Cu Chi Trauma Centre and motorcycle-related death records were obtained from mortality registries in commune health offices. Head injury severity was categorized using the Abbreviated Injury Score (AIS). Rate ratios (RRs) were used to compare rates pre- and post-law (2005/2006-2009/2010). Cu Chi's population, stratified by year, age, and sex, was used as the denominator. Of records identifying the transportation mode at the time of injury, motorcyclists accounted for most injuries (3,035, 87%) and deaths (238, 90%). Head injuries accounted for 70% of motorcycle-related hospitalizations. Helmet use was not recorded in any death records and not in 97% of medical records. Males accounted for most injuries (73%) and deaths (88%). The median age was 28 years and 32 years for injuries and deaths, respectively. Compared to the pre-law period, rates of motorcycle injuries (RR = 0.53; 95% confidence interval [CI], 0.49-0.58), head injuries (RR = 0.35; 95% CI, 0.31-0.39), severe head injuries (RR = 0.47; 95% CI, 0.34-0.63), and deaths (RR = 0.69; 95% CI, 0.53-0.89) significantly decreased in the post-law period. Rates of head injuries and deaths among motorcycle riders decreased significantly after implementation of the mandatory helmet law in Vietnam. To further examine the impact of the motorcycle helmet law, including compliance and helmet quality, further emphasis should be placed on gathering helmet use data from injured motorcyclists.

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

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Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

2015-01-01

PURPOSE We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. METHODS Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTS The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. CONCLUSION Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury. PMID:26081719

Parenting style is related to executive dysfunction after brain injury in children.

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Potter, Jennifer L; Wade, Shari L; Walz, Nicolay C; Cassedy, Amy; Stevens, M Hank; Yeates, Keith O; Taylor, H Gerry

2011-11-01

The goal of this study was to examine how parenting style (authoritarian, authoritative, permissive) and family functioning are related to behavioral aspects of executive function following traumatic brain injury (TBI) in young children. Participants included 75 children with TBI and 97 children with orthopedic injuries (OI), ages 3-7 years at injury. Pre-injury parenting behavior and family functioning were assessed shortly after injury, and postinjury executive functions were assessed using the Behavior Rating Inventory of Executive Functioning (BRIEF; Gioia & Isquith, 2004) at 6, 12, and 18 months postinjury. Mixed model analyses, using pre-injury executive functioning (assessed by the BRIEF at baseline) as a covariate, examined the relationship of parenting style and family characteristics to executive functioning in children with moderate and severe TBI compared to OI. Among children with moderate TBI, higher levels of authoritarian parenting were associated with greater executive difficulties at 12 and 18 months following injury. Permissive and authoritative parenting styles were not significantly associated with postinjury executive skills. Finally, fewer family resources predicted more executive deficits across all of the groups, regardless of injury type. These findings provide additional evidence regarding the role of the social and familial environment in emerging behavior problems following childhood TBI.

Parenting Style Is Related to Executive Dysfunction After Brain Injury in Children

Science.gov (United States)

Potter, Jennifer L.; Wade, Shari L.; Walz, Nicolay C.; Cassedy, Amy; Yeates, Keith O.; Stevens, M. Hank; Taylor, H. Gerry

2013-01-01

Objective The goal of this study was to examine how parenting style (authoritarian, authoritative, permissive) and family functioning are related to behavioral aspects of executive function following traumatic brain injury (TBI) in young children. Method Participants included 75 children with TBI and 97 children with orthopedic injuries (OI), ages 3–7 years at injury. Pre-injury parenting behavior and family functioning were assessed shortly after injury, and postinjury executive functions were assessed using the Behavior Rating Inventory of Executive Functioning (BRIEF; Gioia & Isquith, 2004) at 6, 12, and 18 months postinjury. Mixed model analyses, using pre-injury executive functioning (assessed by the BRIEF at baseline) as a covariate, examined the relationship of parenting style and family characteristics to executive functioning in children with moderate and severe TBI compared to OI. Results Among children with moderate TBI, higher levels of authoritarian parenting were associated with greater executive difficulties at 12 and 18 months following injury. Permissive and authoritative parenting styles were not significantly associated with postinjury executive skills. Finally, fewer family resources predicted more executive deficits across all of the groups, regardless of injury type. Conclusion These findings provide additional evidence regarding the role of the social and familial environment in emerging behavior problems following childhood TBI. PMID:21928918

Relation between patients' and physicians' severity assessment of occupational hand eczema

DEFF Research Database (Denmark)

Cvetkovski, Rikke Skoet; Jensen, H; Olsen, J

2005-01-01

BACKGROUND: Severity assessment of occupational hand eczema (OHE) is important not only in clinical settings but also in research. Questionnaires with self-rated assessment of severity may be an attractive tool for assessing severity because of their cost efficiency in comparison with expensive...... clinical examinations. OBJECTIVES: To evaluate the relation between self-rated severity and severity assessment based on standardized medical certificates issued by dermatologists in a population of patients with OHE. METHODS: Between October 2001 and November 2002 (58 weeks) we identified all new cases...... of recognized OHE from the Danish National Board of Industrial Injuries (DNBII) registry. Each patient was examined by a dermatologist, who issued a standardized medical certificate. The severity assessment in the DNBII registry was based on this medical certificate, which comprised information on morphology...