Dick, Charles G; White, Simon; Bopf, Daniel
Competitive and recreational motocross is an increasingly popular sport in Australia and worldwide. Children as young as 4-year-old can participate in this activity. It is recognised that this is a high risk sport despite the use of protective equipment and developments in course design. Injuries sustained range from minor contusions and fractures to severe life threatening spine and head injuries in adults and the paediatric population. In addition organised events can generate a surge of trauma that can burden small local hospitals, resulting in an unpredicted increase in the workload with subsequent delays to treatment. We present the trauma workload generated in a district hospital following a single motocross event. All patients attending a district hospital emergency department with injuries sustained during a single motocross event were identified through hospital and ambulance records. The nature of their injuries and the treatment required, the length of hospital stay and operative theatre time generated by their injuries were obtained from hospital and theatre records. 14 patients attended the emergency department over a 24-hour period, requiring 5 ambulances from the scene. 7 patients required hospital admission with 7 operations performed, consuming 12.2 h of operating theatre time and 21 days of hospital beds. 2 patients sustained head injuries requiring observation, one of which was transferred to a spinal unit for management of their spinal injuries. Motocross is a popular sport and at times has unacceptable risks of injury in organised competitions, especially with regards to paediatric injuries. Better course design, restrictions on participant age and limitations in vehicle speeds may help reduce the number of severe injuries. These events can also generate a sudden trauma burden to local hospital facilities with knock on effects on waiting times for theatre and potentially compromising not only treatment of the injured participants but also
Kim, Jong-Eun; Kim, Il Hwan; Shum, Phillip C; Shih, Alan M; Pintar, Frank; Shen, Wei; Ma, Xiaoguang; Laud, Purushottam W; Heymsfield, Steven B; Allison, David B; Zhu, Shankuan
The objective of this study was to examine the role of body mass and subcutaneous fat in injury severity and pattern sustained by overweight drivers. Finite element models were created to represent the geometry and properties of subcutaneous adipose tissue in the torso with data obtained from reconstructed magnetic resonance imaging data-sets. The torso adipose tissue models were then integrated into the standard multibody dummy models together with increased inertial parameters and sizes of the limbs to represent overweight occupants. Frontal crash simulations were carried out considering a variety of occupant restraint systems and regional body injuries were measured. The results revealed that differences in body mass and fat distribution have an impact on injury severity and pattern. Even though the torso adipose tissue of overweight subjects contributed to reduce abdominal injury, the momentum effect of a greater body mass of overweight subjects was more dominant over the cushion effect of the adipose tissue, increasing risk of other regional body injuries except abdomen. Through statistical analysis of the results, strong correlations (p risks (p < 0.001) of head, thorax and lower extremity injury than observed in non-overweight males. The findings have important implications for improving the vehicle and occupant safety systems designed for the increasing global obese population.
Riese, H.; Hoedemaeker, M.; Brouwer, W.H.; Mulder, L.J.M.; Cremer, R.; Veldman, J.B.P.
In patients with very severe closed head injury (CHI), returning to work is often problematic. The present study focuses on a persistent complaint of these patients, viz. mental fatigue. To study this, the effect of sustained workload is assessed in a continuous dynamic divided attention task. Three
Riese, H; Hoedemaeker, M; Brouwer, WH; Mulder, LJM; Veldman, JBP
In patients with very severe closed head injury (CHI), returning to work is often problematic. The present study focuses on a persistent complaint of these patients, viz. mental fatigue. To study this, the effect of sustained workload is assessed in a continuous dynamic divided attention task. Three
Yamamoto, Hirotaka; Watanabe, Hiroaki; Mizushima, Yasuaki; Matsuoka, Tetsuya
A 30-year-old male involved in a traffic accident was brought to our hospital. He was in shock with a rigid abdomen, and a computed tomography scan showed severe pancreatoduodenal injury. He was successfully treated with damage control surgery consisting of peripancreatic packing at the initial surgery followed by a two-stage pancreaticoduodenectomy. The postoperative course was complicated by a hepatic abscess, but there were no pancreaticoduodenectomy-related complications. The patient was transferred to a local hospital on postoperative day 55. Three step strategy consisting of peripancreatic packing followed by a two-stage pancreaticoduodenectomy is an effective treatment strategy for severe pancreatoduodenal injury.
In automobile accidents, the "seatbelt syndrome" (SBS) consists of a constellation of injuries, predominantly involving thoraco-lumbar vertebral fractures and intraabdominal organ injury. A recent amendment to Irish legislation has made the wearing of seatbelts mandatory for all rear seated passengers in an effort to protect children. Whilst rear seatbelts result in a significant reduction in morbidity and mortality following road traffic accidents (RTA), we present a case in which the rear lap seatbelt caused severe abdominal injuries. It is evident that the current rear seat lapbelt system is an inferior design associated with a significant morbidity and mortality when compared to three-point harness system and consideration should be given to replacing them in all motor vehicles.
Daly, Charles A; Payne, S Houston; Seiler, John G
This article reports a series of severe permanent brachial plexus injuries in American football players. The authors describe the mechanisms of injury and outcomes from a more contemporary treatment approach in the form of nerve transfer tailored to the specific injuries sustained. Three cases of nerve transfer for brachial plexus injury in American football players are discussed in detail. Two of these patients regained functional use of the extremity, but 1 patient with a particularly severe injury did not regain significant function. Brachial plexus injuries are found along a spectrum of brachial plexus stretch or contusion that includes the injuries known as "stingers." Early identification of these severe brachial plexus injuries allows for optimal outcomes with timely treatment. Diagnosis of the place of a given injury along this spectrum is difficult and requires a combination of imaging studies, nerve conduction studies, and close monitoring of physical examination findings over time. Although certain patients may be at higher risk for stingers, there is no evidence to suggest that this correlates with a higher risk of severe brachial plexus injury. Unfortunately, no equipment or strengthening program has been shown to provide a protective effect against these severe injuries. Patients with more severe injuries likely have less likelihood of functional recovery. In these patients, nerve transfer for brachial plexus injury offers the best possibility of meaningful recovery without significant morbidity. [ Orthopedics. 2016; 39(6):e1188-e1192.]. Copyright 2016, SLACK Incorporated.
Rugby football is a fast growing physical contact sport that is known for its ruggedness and injuries. Tournament play tests the stamina of the individual players and may have a cumulative wear and tear effect that results in different types of injuries. This study was conducted to determine what body parts are injured in a rugby tournament and how serious those injuries are. Climatic conditions, mainly heat and humidity, were considered to be major factors. Heat-related injuries were the single most important cause for termination of play. This type of injury is very serious and may be reduced or prevented by following simple guidelines for play based on the temperature-humidity index. Most other injuries were strains, sprains, contusions, and several lacerations to the knee, thorax, head, and neck; none was catastrophic. The reputation that rugby football is brutal does not seem justified by the injuries sustained in this tournament. J Orthop Sports Phys Ther 1985;7(1):16-19.
The incidence of facial injuries in hurling has decreased since the introduction of helmets with facial protection. The aim of this study was to identify the incidence of facial and dental injuries sustained in hurling training or matches and compliance with wearing helmets, with or without modified or unmodified faceguards. This prospective study included all patients who attended the Mid Western Regional Hospital Limerick, with injuries sustained while playing hurling during 2007 and 2008 seasons. The study population included 70 patients. Forty two (60%) injuries occurred during practice and 28(40%) during matches. Fifty two players (75%) sustained facial injuries whilst no helmet was worn. Eighteen injuries (25%) were sustained by players wearing helmets. Th study demonstrates that 60% of injuries occur during training when players do not wear helmets. We support the recent introduction by the GAA making it compulsory to wear helmets with faceguard protection from January 1st 2010.
Sears, Jeanne M; Bowman, Stephen M; Hogg-Johnson, Sheilah
Hospitalization-based estimates of trends in injury incidence are also affected by trends in health care practices and payer coverage that may differentially impact minor injuries. This study assessed whether implementing a severity threshold would improve occupational injury surveillance. Hospital discharge data from four states and a national survey were used to identify traumatic injuries (1998-2009). Negative binomial regression was used to model injury trends with/without severity restriction, and to test trend divergence by severity. Trend estimates were generally biased downward in the absence of severity restriction, more so for occupational than non-occupational injuries. Restriction to severe injuries provided a markedly different overall picture of trends. Severity restriction may improve occupational injury trend estimates by reducing temporal biases such as increasingly restrictive hospital admission practices, constricting workers' compensation coverage, and decreasing identification/reporting of minor work-related injuries. Injury severity measures should be developed for occupational injury surveillance systems. © 2014 Wiley Periodicals, Inc.
Papadakaki, Maria; Ferraro, Ottavia Eleonora; Orsi, Chiara; Otte, Dietmar; Tzamalouka, Georgia; von-der-Geest, Marco; Lajunen, Timo; Özkan, Türker; Morandi, Anna; Sarris, Markos; Pierrakos, George; Chliaoutakis, Joannes
The current study aimed to follow-up a group of road crash survivors for one year and assesses the impact of injury on their psychological and physical condition. All crash survivors that were admitted to the intensive or sub-intensive care units of selected hospitals in Greece, Germany and Italy over one year period (2013-2014), were invited to participate in the study and were interviewed at three different time-points as follows: (a) at one month (baseline data), (b) at six months, and (c) at twelve months. The study used widely recommended classifications for injury severity (AIS, MAIS) and standardized health outcome measures such as the Disability Assessment Schedule II (WHODAS 2.0) to measure disability, "Impact of Event Scale" (IES-R) to measure Post-Traumatic Stress Disorder (PTSD), Center for Epidemiological Studies Depression Scale (CES-D Scale) to measure depression. A total of 120 patients were enrolled in the study in all the partner countries and 93 completed all follow up questionnaires. The risk of physical disability was 4.57 times higher [CI 1.98-2.27] at the first follow up and 3.43 times higher [CI 1.43-9.42] at the second follow up as compared with the time before the injury. There was a 79% and an 88% lower risk of depression at the first and the second follow up respectively, as compared with the baseline time. There was also a 72% lower risk of Post-Traumatic Stress at the second follow up as compared with the baseline time. A number of factors relevant to the individuals, the road crash and the injury, were shown to distinguish those at higher risk of long-lasting disability and psychological distress including age, marital status, type of road user, severity and type of the injury, past emotional reaction to distress. The study highlights the importance of a comprehensive and holistic understanding of the impact of injury on an individual and further underlines the importance of screening and treating psychological comorbidities in injury
Levati, A; Farina, M L; Vecchi, G; Rossanda, M; Marrubini, M B
The authors have analyzed retrospectively a series of 288 consecutive patients with severe head injury observed between January, 1977, and May, 1980. Seventy-three patients were excluded as not being compatible with those of the International Data Bank. The remaining 215 patients complied with the definition of coma given by Jennett. All patients, after appropriate cardiopulmonary resuscitation, diagnostic measures, and, when required, surgical treatment, were managed in the Neurosurgical Intensive Care Unit with endotracheal intubation, controlled hyperventilation, mild dehydration, dexamethasone in standard doses, and sedation. The mortality rate was 39.5%. Of the survivors, 59.2% made a good recovery, 18.4% remained moderately disabled, 6.1% were severely disabled, and 1.5% were in a persistent vegetative state. The most reliable predictive criteria were: absence of brain-stem reflexes, neurological status, abnormal motor patterns, arterial hypotension, and presence of mass lesions. It is concluded that no sign has an absolute prognostic value when considered independently of its time course.
Tanaka, Keiko; Tanabe, Katsuyuki; Nishii, Naoko; Takiue, Keiichi; Sugiyama, Hitoshi; Wada, Jun
Leptospirosis is frequently associated with acute kidney injury. Some survivors are known to progress to chronic kidney disease due to sustained tubulointerstitial inflammation. We present a case of severe leptospirosis with acute renal failure. Although antibiotic therapy resolved the infection, moderate renal dysfunction remained. A renal biopsy demonstrated marked inflammatory infiltration in the tubules and interstitium. Many of the inflammatory cells were CD68-positive monocytes/macrophages, predominantly M1 phenotype. An intermediate dose of oral corticosteroids normalized the patient's serum creatinine levels. We suggest that corticosteroid therapy may be a therapeutic option for some patients with sustained tubulointerstitial nephritis who survive severe leptospirosis.
Odgaard, Lene; Poulsen, Ingrid; Kammersgaard, Lars Peter
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...
Hagiwara, Shuichi; Oshima, Kiyohiro; Murata, Masato; Kaneko, Minoru; Aoki, Makoto; Kanbe, Masahiko; Nakamura, Takuro; Ohyama, Yoshio; Tamura, Jun'ichi
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.
Sandvall, Brinkley K; Jacobson, Lauren; Miller, Erin A; Dodge, Ryan E; Alex Quistberg, D; Rowhani-Rahbar, Ali; Vavilala, Monica S; Friedrich, Jeffrey B; Keys, Kari A
There is a paucity of clinical data on severe fireworks-related injuries, and the relationship between firework types, injury patterns, and magnitude of impairment is not well understood. Our objective was to describe the relationship between fireworks type, injury patterns, and impairment. Retrospective case series (2005-2015) of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or an operation at a Level 1 Trauma/Burn Center. Fireworks types, injury patterns (body region, injury type), operation, and permanent impairment were examined. Data from 294 patients 1 to 61years of age (mean 24years) were examined. The majority (90%) were male. 119 (40%) patients were admitted who did not undergo surgery, 163 (55%) patients required both admission and surgery, and 12 (5%) patients underwent outpatient surgery. The greatest proportion of injuries was related to shells/mortars (39%). There were proportionally more rocket injuries in children (44%), more homemade firework injuries in teens (34%), and more shell/mortar injuries in adults (86%). Brain, face, and hand injuries were disproportionately represented in the shells/mortars group. Seventy percent of globe-injured patients experienced partial or complete permanent vision loss. Thirty-seven percent of hand-injured patients required at least one partial or whole finger/hand amputation. The greatest proportion of eye and hand injuries resulting in permanent impairment was in the shells/mortars group, followed by homemade fireworks. Two patients died. Severe fireworks-related injuries from homemade fireworks and shells/mortars have specific injury patterns. Shells/mortars disproportionately cause permanent impairment from eye and hand injury. Published by Elsevier Inc.
Hefny, Ashraf F; Eid, Hani O; Abu-Zidan, Fikri M
The destructive potential of the tyre explosions has received little attention in the medical literature. Fatal and severely deforming injuries have been reported. These blasts mainly affect the personnel servicing big vehicle tyres such as trucks and buses. We aimed to review the relevant literature on tyre blast injuries so as to define the mechanism of injury, outcome, and its methods of prevention. A search of the English literature on tyre blast injuries was performed through Medline. Different studies were retrieved, analysed and combined together. A total of 763 patients were studied in the literature. Most of the patients were young aged male mechanics and the explosions usually occur during tyre servicing especially during inflation. Injury is caused by the pressure impact of the explosion or by direct hit of the rim. The head and face are the most commonly affected regions (48%) followed by the upper limbs (20%). About 25% of patients had multi-trauma. The overall mortality is high (19%) and is mainly caused by head injuries. Inflated large tyres contain a tremendous amount of potential energy. Tyre blast injuries during servicing have a high morbidity and mortality. Preventive occupational methods should be implemented.
Green, N.; Goldberg, H.; Goldman, H.; Lombardo, L.; Skaist, L.
Between 1970 and 1981, 348 patients underwent definitive irradiation. Of these patients 6 (1.7 per cent) sustained severe rectal injury as manifest by major rectal bleeding, rectal stricture, rectal mucosal slough and rectal ulceration. Severe rectal injury was observed in 0 of 13 patients (0 per cent) treated with 125iodine, 3 of 329 (1 per cent) treated with 6,400 to 6,800 rad external irradiation, 2 of 39 (5 per cent) treated with 7,000 to 7,300 rad external irradiation, and 1 of 7 (14 per cent) treated with 198gold and external irradiation. The impact of radiation dose, radiation therapy technique and surgical trauma was assessed. Rectal injury was managed by supportive measures in 2 patients and by diverting colostomy in 3 with benefit. One patient underwent abdominoperineal resection. A small bowel fistula and an intra-abdominal abscess developed, and the patient died.
O. S. Zaitsev
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.
Norup, Anne; Petersen, Janne; Lykke Mortensen, Erik
relatives of patients with severe brain injury. METHODS: The relatives were assessed on the anxiety and depression scales from the Symptom Checklist-90-Revised and latent variable growth curve models were used to model the trajectories. The effects of patient's age, patient's Glasgow Coma Score, level...... improvement. Higher initial level of symptoms of depression was seen in female relatives. Higher initial level of anxiety was associated with younger patient age, lower level of function and consciousness in the patient and the relative being female or the spouse. CONCLUSION: Future research and interventions......PRIMARY OBJECTIVE: To investigate trajectories and predictors of trajectories of anxiety and depression in relatives of patients with a severe brain injury during the first year after injury. RESEARCH DESIGN: A prospective longitudinal study with four repeated measurements. SUBJECTS: Ninety...
Delen, Dursun; Tomak, Leman; Topuz, Kazim; Eryarsoy, Enes
Investigation of the risk factors that contribute to the injury severity in motor vehicle crashes has proved to be a thought-provoking and challenging problem. The results of such investigation can help better understand and potentially mitigate the severe injury risks involved in automobile crashes and thereby advance the well-being of people involved in these traffic accidents. Many factors were found to have an impact on the severity of injury sustained by occupants in the event of an auto...
Birch, R; Misra, P; Stewart, M P M; Eardley, W G P; Ramasamy, A; Brown, K; Shenoy, R; Anand, P; Clasper, J; Dunn, R; Etherington, J
We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain. This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes.
Baath, J; Ells, A L; Kherani, A; Williams, R G
To determine the outcomes and circumstances of retinal injuries caused by blunt trauma from paintball pellet projectiles. Retrospective case series of all patients who presented with retinal injuries due to paintball-related trauma to 2 retina specialists in a clinical setting from 2004 to 2005. Patients were followed for a mean of 7.3 months, and retinal trauma was documented with retinal photographs and ocular coherence tomography as needed. Best corrected visual acuity (BCVA) was the main outcome measure. Three eyes of 3 patients suffered severe retinal injuries after blunt trauma from a paintball pellet. Together, the 3 eyes demonstrated extensive retinal findings, including commotio retinae, choroidal rupture, and macular hole. BCVA at last follow-up ranged from 20/80 to hand motions. Our small case series indicates that retinal trauma from paintball injuries is not uncommon and results in severe long-term visual morbidity. The sale of paintball guns and pellets should be strictly prohibited for minors, and adults should be educated about the need for appropriate ocular protection and the potentially serious consequences of the use of these guns outside of commercial settings.
Yoganandan, Narayan; Baisden, Jamie L; Maiman, Dennis J; Gennarelli, Thomas A; Guan, Yabo; Pintar, Frank A; Laud, Prakash; Ridella, Stephen A
Severe-to-fatal head injuries in motor vehicle environments were analyzed using the United States Crash Injury Research and Engineering Network database for the years 1997-2006. Medical evaluations included details and photographs of injury, and on-scene, trauma bay, emergency room, intensive care unit, radiological, operating room, in-patient, and rehabilitation records. Data were synthesized on a case-by-case basis. X-rays, computed tomography scans, and magnetic resonance images were reviewed along with field evaluations of scene and photographs for the analyses of brain injuries and skull fractures. Injuries to the parenchyma, arteries, brainstem, cerebellum, cerebrum, and loss of consciousness were included. In addition to the analyses of severe-to-fatal (AIS4+) injuries, cervical spine, face, and scalp trauma were used to determine the potential for head contact. Fatalities and survivors were compared using nonparametric tests and confidence intervals for medians. Results were categorized based on the mode of impact with a focus on head contact. Out of the 3178 medical cases and 169 occupants sustaining head injuries, 132 adults were in frontal (54), side (75), and rear (3) crashes. Head contact locations are presented for each mode. A majority of cases clustered around the mid-size anthropometry and normal body mass index (BMI). Injuries occurred at change in velocities (DeltaV) representative of US regulations. Statistically significant differences in DeltaV between fatalities and survivors were found for side but not for frontal impacts. Independent of the impact mode and survivorship, contact locations were found to be superior to the center of gravity of the head, suggesting a greater role for angular than translational head kinematics. However, contact locations were biased to the impact mode: anterior aspects of the frontal bone and face were involved in frontal impacts while temporal-parietal regions were involved in side impacts. Because head
Possley, Daniel R; Johnson, Anthony E
Participation in martial arts has grown over the past 15 years with an estimated 8 million participants. In 2004, the Chief of Staff of the Army directed that all Initial Military Training soldiers receive Modern Army Combatives (MAC) training. The mechanical differences between the various martial arts styles incorporated into mixed martial arts/MAC pose challenges to the medical professional. We report the incidence of musculoskeletal injuries by Level 1 and 2 trained active duty soldiers participating in MAC over a 3-year period. From June 1, 2005 to January 1, 2009, the Orthopaedic Surgery service treated and tracked all injuries in MAC. Data was analyzed using the Chi(2) method of analysis. (p injuries reported inability to perform their military occupation specialty duties. The knee was most frequently injured followed by shoulder. Surgical intervention was warranted 24% of the time. Participants in MAC reported injuries severe enough to impact occupational duties at 15.5%. Surgical intervention was warranted only 24% of the time. The knee and shoulder are the most frequently injured body parts. Labral repair was the most frequent surgical procedure.
Achenbach, Leonard; Krutsch, Volker; Weber, Johannes; Nerlich, Michael; Luig, Patrick; Loose, Oliver; Angele, Peter; Krutsch, Werner
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.
Ekstrand, Jan; Hägglund, Martin; Kristenson, Karolina; Magnusson, Henrik; Waldén, Markus
Limited information is available on the variation in injury rates over multiple seasons of professional football. To analyse time-trends in injury characteristics of male professional football players over 11 consecutive seasons. A total of 1743 players comprising 27 teams from 10 countries were followed prospectively between 2001 and 2012. Team medical staff recorded individual player exposure and time loss injuries. A total of 8029 time loss injuries were recorded. The match unavailability due to injury was 14% and constant over the study period. On average, a player sustained two injuries per season, resulting in approximately 50 injuries per team and season. The ligament injury rate decreased during the study period (R(2)=0.608, b=-0.040, 95% CI -0.065 to -0.016, p=0.005), whereas the rate of muscle injury (R(2)=0.228, b=-0.013, 95% CI -0.032 to 0.005, p=0.138) and severe injury (R(2)=0.141, b=0.015, 95% CI -0.013 to 0.043, p=0.255) did not change over the study period. In addition, no changes in injury rates over the 11-year period were found for either training (R(2)=0.000, b=0.000, 95% CI -0.035 to 0.034, p=0.988) or match play (R(2)=0.282, b=-0.015, 95% CI -0.032 to 0.003, p=0.093). The injury rate has decreased for ligament injuries over the last 11 years, but overall training, match injury rates and the rates of muscle injury and severe injury remain high.
Ayoung-Chee, Patricia; Mack, Christopher D; Kaufman, Robert; Bulger, Eileen
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
Hart, Tessa; Kozlowski, Allan; Whyte, John
functional levels received more treatment and more treatment was associated with slower recovery, presumably because treatment was allocated according to need. Thus, effects of treatment on outcome could not be disentangled from effects of case mix factors. CONCLUSIONS: FIM gain during inpatient recovery......OBJECTIVE: To examine person, injury, and treatment characteristics associated with recovery trajectories of people with severe traumatic brain injury (TBI) during inpatient rehabilitation. DESIGN: Observational prospective longitudinal study. SETTING: Two specialized inpatient TBI rehabilitation...... recovery was best modeled with linear, cubic, and quadratic components: relatively steep recovery was followed by deceleration of improvement, which attenuated prior to discharge. Slower recovery was associated with older age, longer coma, and interruptions to rehabilitation. Patients admitted at lower...
Full Text Available Many studies suggest that more crashes occur due to mixed traffic flow at unsignalized intersections. However, very little is known about the injury severity of these crashes. The objective of this study is therefore to investigate how contributory factors affect crash injury severity at unsignalized intersections. The dataset used for this analysis derived from police crash reports from Dec. 2006 to Apr. 2009 in Heilongjiang Province, China. An ordered probit model was developed to predict the probability that the injury severity of a crash will be one of four levels : no injury, slight injury, severe injury, and fatal injury. The injury severity of a crash was evaluated in terms of the most severe injury sustained by any person involved in the crash. Results from the present study showed that different factors had varying effects on crash injury severity. Factors found to resuit in the increased probability of serious injuries include adverse weather, sideswiping with pedestrians on poor surface, the interaction of rear-ends and the third-class highway, winter night without illumination, and the interaction between traffic signs or markings and the third-class highway. Although there are some limitations in the current study, this study provides more insights into crash injury severity at unsignalized intersections.
Carangan, M; Tham, K Y; Seow, E
Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED). Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of foreign workers, more (P workers, resulting in 2 out of 3 foreign workers death. Though the pattern of injuries was similar between foreign and local workers, foreign workers needed longer (P = 0.03) sick leave and more (P = 0.01) foreign workers were hospitalised, giving a ratio of 2 foreign workers for every 1 local worker hospitalised. Foreign workers had no difficulty accessing ED and hospital care for work-related injuries. The pattern and severity of injuries were similar between foreign and local workers but more foreign workers were hospitalised.
Spinal Cord Injury-Assessing Tolerability and Use of Combined Rehabilitation and NeuroAiD (SATURN Study): Protocol of An Exploratory Study In Assessing the Safety and Efficacy of NeuroAiD Amongst People Who Sustain Severe Spinal Cord Injury.
Kumar, Ramesh; Htwe, Ohnmar; Baharudin, Azmi; Ariffin, Mohammad Hisam; Abdul Rhani, Shaharuddin; Ibrahim, Kamalnizat; Rustam, Aishah; Gan, Robert
Spinal cord injury (SCI) is a devastating condition with limited therapeutic options despite decades of research. Current treatment options include use of steroids, surgery, and rehabilitation. Nevertheless, many patients with SCI remain disabled. MLC601 (NeuroAiD), a combination of natural products, has been shown to be safe and to aid neurological recovery after brain injuries and may have a potential role in improving recovery after SCI. The aim of this study is to evaluate the safety and efficacy of NeuroAiD amongst people who sustain SCI in the study setting. Spinal Cord Injury-Assessing Tolerability and Use of Combined Rehabilitation and NeuroAiD (SATURN) is a prospective cohort study of patients with moderately severe to severe SCI, defined as American Spinal Injury Association (ASIA) Impairment Scale (AIS) A and B. These patients will be treated with open-label NeuroAiD for 6 months in addition to standard care and followed for 24 months. Anonymized data will be prospectively collected at baseline and months 1, 3, 6, 12, 18, and 24 and will include information on demographics; main diagnostics; and neurological and functional state assessed by the Spinal Cord Independence Measure, ASIA-International Standard for Neurological Classification Spinal Cord Injury, and Short Form (SF-8) Health Survey. In addition, NeuroAiD treatment, compliance, concomitant therapies, and side effects, if any, will be collected. Investigators will use a secured online system for data entry. The study is approved by the ethics committee of Hospital University Kebangsaan Malaysia. The coprimary endpoints are safety, AIS grade, and improvement in ASIA motor score at 6 months. Secondary endpoints are AIS grade, ASIA motor scores and sensory scores, Spinal Cord Independence Measure (SCIM), SF-8 Health Survey, and compliance at other time points. SATURN investigates the promising role of NeuroAiD in SCI especially given its excellent safety profile. We described here the protocol and
Full Text Available Objective: The purpose of this study was to investigate the effect of prophylactic anticoagulation on the incidence of venous thromboembolic events (VTE in patients suffering from isolated severe traumatic brain injury (TBI. Materials and Methods: Retrospective matched case-control study in adult patients sustaining isolated severe TBI (head AIS ≥3, with extracranial AIS ≤2 receiving VTE prophylaxis while in the surgical intensive care unit from 1/2007 through 12/2009. Patients subjected to VTE prophylaxis were matched 1:1 by age, gender, glasgow coma scale (GCS score at admission, presence of hypotension on admission, injury severity score, and head abbreviated injury scale (AIS score, with patients who did not receive chemical VTE prophylaxis. The primary outcome measure was VTE. Secondary outcomes were SICU and hospital length of stay (HLOS, adverse effects of anticoagulation, and mortality. Results: After propensity matching, 37 matched pairs were analysed. Cases and controls had similar demographics, injury characteristics, rate of craniotomies/craniectomies, SICU LOS, and HLOS. The median time of commencement of VTE prophylaxis was 10 days. The incidence of VTE was increased 3.5-fold in the controls compared to the cases (95% CI 1.0-12.1, P=0.002. The mortality was higher in patients who did not receive anticoagulation (19% vs. 5%, P=0.001. No adverse outcomes were detected in the anticoagulated patients. Conclusion: Prophylactic anticoagulation decreases the overall risk for clinically significant VTE in patients with severe isolated TBI. Prospective validation of the timing and safety of chemical VTE prophylaxis in these instances is warranted.
Mohseni, Shahin; Talving, Peep; Lam, Lydia; Chan, Linda S; Ives, Crystal; Demetriades, Demetrios
The purpose of this study was to investigate the effect of prophylactic anticoagulation on the incidence of venous thromboembolic events (VTE) in patients suffering from isolated severe traumatic brain injury (TBI). Retrospective matched case-control study in adult patients sustaining isolated severe TBI (head AIS ≥3, with extracranial AIS ≤2) receiving VTE prophylaxis while in the surgical intensive care unit from 1/2007 through 12/2009. Patients subjected to VTE prophylaxis were matched 1:1 by age, gender, glasgow coma scale (GCS) score at admission, presence of hypotension on admission, injury severity score, and head abbreviated injury scale (AIS) score, with patients who did not receive chemical VTE prophylaxis. The primary outcome measure was VTE. Secondary outcomes were SICU and hospital length of stay (HLOS), adverse effects of anticoagulation, and mortality. After propensity matching, 37 matched pairs were analysed. Cases and controls had similar demographics, injury characteristics, rate of craniotomies/craniectomies, SICU LOS, and HLOS. The median time of commencement of VTE prophylaxis was 10 days. The incidence of VTE was increased 3.5-fold in the controls compared to the cases (95% CI 1.0-12.1, P=0.002). The mortality was higher in patients who did not receive anticoagulation (19% vs. 5%, P=0.001). No adverse outcomes were detected in the anticoagulated patients. Prophylactic anticoagulation decreases the overall risk for clinically significant VTE in patients with severe isolated TBI. Prospective validation of the timing and safety of chemical VTE prophylaxis in these instances is warranted.
Dekker, R; Kingma, J; Groothoff, JW; Eisma, WH; Ten Duis, HJ
Objective: To evaluate the severity of sports injuries in relation to the severity of injuries due to other causes and in relation to type of sport, using generally applied measures of injury severity. Subjects: A total of 12 403 patients, 4-50 years old, who were treated in the trauma department of
van der Sluis, CK; Timmer, HW; Eisma, WH; ten Duis, HJ
To evaluate the differences between the outcome of elderly patients with severe injuries and that of their contemporaries with a less severe injury, we reviewed 42 severely injured elderly patients and compared them with 76 patients with a femoral neck fracture. We analysed the influence of injury
V. V. Moroz
Full Text Available The purpose of the present investigation was to study the levels of triglycerides, cholesterol metabolism, a number of biochemical plasma parameters, and the elastic properties of the arterial wall in the late period in victims with severe mechanical injury (SMI and impaired hemodynamics.Material and methods. The investigation included 13 persons who had experienced SMI and blood loss with impaired hemodynamics. This involved three stages: 1 at the end of the first day; 2 on days 15—30 following injury; 3 1—5 years after SMI. The concentrations of triglycerides, total cholesterol, and high-density lipoprotein (HDL cholesterol and the activities of aspartate aminotransferase (AST, alanine aminotransferase (ALT, and alkaline phosphatase were determined. Very low-density lipoprotein and low-density lipoprotein (LDL cholesterols were calculated by the Friedwald formula. An oscillometric analyzer (APKO-8-RITs was used to record central hemodynamic parameters and vascular elastic properties.Results. There was a decrease in cholesterol levels and an increase in AST and ALT activities at the end of the first day. The activity of alkaline phosphatase was in the normal range. There was a reduction in AST and ALT on days 15—30 after injury. Enhanced alkaline phosphatase activity was observed at the same time. There was a considerable decrease in HDL cholesterol with the normal level of LDL cholesterol. The level of total cholesterol was in the normal range. The activities of AST and ALT were in the normal range at Stage 3 following 1—5 years after injury. At the same time, the activity of alkaline phosphatase remained increased. The content of HDL cholesterol having antiatherogenic properties remained lower although this parameter tended to become normal: there was an average increase by 33.9%. There was a decrease in arterial wall compliance and an increase in the speed of pulse wave propagation in the group of the examinees.Conclusion. The change
information on injury pattern, severity, provided care and outcome of injuries, which are essential data for planning injury- .... Sports/play area. 6. 1.1 ..... Profile of children with head injuries treated at the trauma unit of Red Cross War Memorial.
Watura, Christopher; Harries, William
A 42-year-old female nurse presented in March 2008 with a left proximal hamstring tendon injury sustained while playing hockey. At surgery, the proximal biceps femoris tendon and semitendonosus were found to be ruptured and were repaired. The patient made a good recovery but sustained a further hockey injury in January 2010 involving a complete tear and rupture of the biceps femoris tendon distally. This was managed conservatively and the patient was able to return to playing hockey 10 months...
Sandler, Gideon; Soundappan, Soundappan Sv; Manglick, Maria P; Fahy, Fiona E; Ross, Frank; Lam, Lawrence; Cass, Danny
This study aimed to describe the determinants of the severity and type of injuries sustained by children hurt in off-road vehicle (ORV) accidents. This was a retrospective clinical study for which data were obtained from the trauma database at the Children's Hospital at Westmead covering the 10-year period between January 1, 1998, and December 31, 2007. Data points collected included age, sex, Injury Severity Score (ISS), body region injured, type of vehicle, accident setting, mechanism of injury, estimated speed, position of the rider, use of a helmet and/or protective clothing, and hospital length of stay. The study end points were determinants of injury severity and type. Statistical analysis of the collected data was done with the standard statistical software package, SPSS. A total of 288 children (242 male [84%] and 46 female [16%] patients) presented for ORV-related trauma. Helmets significantly diminished the chance of sustaining a head injury occasioning a skull fracture. Jumping was associated with increased ISS and a higher chance of sustaining an abdominal and/or thoracic injury. Older children were more likely to sustain pelvic and spinal injures, be injured while traveling at high speed, and be injured while going over a jump. Mean ISS was significantly lower if trauma was sustained while riding a mini motorcyle in any setting and any ORV at home. Further research (prospective, federal, and multi-institutional) is needed with a view to optimizing training schedules, rules, regulations, and licensing requirements for pediatric ORV riders.
Gray, Shannon E.; Finch, Caroline F.
Purpose: The purpose of this study was to provide an epidemiological profile of injuries sustained by participants in fitness activities in Victoria, Australia, based on hospital admissions and emergency department (ED) presentations and to identify the most common types, causes, and sites of these injuries. Method: Hospital-treated fitness…
Mitchell, R J; Bambach, M R; Toson, Barbara
The risk of serious injury or death has been found to be reduced for some front compared to rear seat car passengers in newer vehicles. However, differences in injury severity between car occupants by seating position has not been examined. This study examines the injury severity risk for rear compared to front seat car passengers. A retrospective matched-cohort analysis was conducted of vehicle crashes involving injured rear vs front seat car passengers identified in linked police-reported, hospitalisation and emergency department (ED) presentation records during 2001-2011 in New South Wales (NSW), Australia. Odds ratios were estimated using an ordinal logistic mixed model and logistic mixed models. There were 5419 front and 4588 rear seat passengers in 3681 vehicles. There was a higher odds of sustaining a higher injury severity as a rear-compared to a front seat car passenger, with a higher odds of rear seat passengers sustaining serious injuries compared to minimal injuries. Where the vehicle occupant was older, travelling in a vehicle manufactured between 1990 and 1996 or after 1997, where the airbag deployed, and where the vehicle was driven where the speed limit was ≥70km/h there was a higher odds of the rear passenger sustaining a higher injury severity then a front seated occupant. Rear seat car passengers are sustaining injuries of a higher severity compared to front seat passengers travelling in the same vehicle, as well as when travelling in newer vehicles and where the front seat occupant is shielded by an airbag deployed in the crash. Rear seat occupant protective mechanisms should be examined. Pre-hospital trauma management policies could influence whether an individual is transported to a hospital ED, thus it would be beneficial to have an objective measure of injury severity routinely available in ED records. Further examination of injury severity between rear and front seat passengers is warranted to examine less severe non-fatal injuries by car
Objectives: To identify the aetiology and outcome of severe injuries. Method: A retrospective study of accidental injuries. Results: Over a consequtive 12 month period, 54 patients with severe injuries (ISS > 15) were seen. There were 35 males and 19 females with a mean age of 33 years and mean ISS of 21. The aetiology ...
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 ...
Aladelusi, Timothy; Akinmoladun, Victor; Olusanya, Adeola; Akadiri, Oladimeji; Fasola, Abiodun
The objective of this study was to determine the prevalence of road traffic crashes (RTC)–related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the
Aladelusi, Timothy; Akinmoladun, Victor; Olusanya, Adeola; Akadiri, Oladimeji; Fasola, Abiodun
The objective of this study was to determine the prevalence of road traffic crashes (RTC)-related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the
Kingery, Kathleen M; Narad, Megan E; Taylor, H Gerry; Yeates, Keith Owen; Stancin, Terry; Wade, Shari L
To examine the prevalence of academic need, academic service utilization, and unmet need as well as factors associated with academic service utilization 6.8 years after traumatic brain injury (TBI) in early childhood. Fifty-eight (16 severe, 14 moderate, 28 complicated mild) children with TBI and 72 children with orthopedic injury (OI) completed the long-term follow-up 6.8 years after injury in early childhood (ages 3-7 years). Injury group differences in rates of need for academic services, academic service utilization, and unmet need as well as factors associated with service utilization and unmet need were examined. Students with moderate and severe TBI had significantly greater rates of need than those with OI. A greater proportion of the severe TBI sample was receiving academic services at long-term follow-up than the OI and complicated mild groups however, among those with an identified need, injury group did not affect academic service utilization. Below average IQ/achievement scores was the only area of need predictive of academic service utilization. Rates of unmet need were high and similar across injury groups (46.2%-63.6%). The need for academic services among patients who sustained a TBI during early childhood remains high 6.8 years post injury. Findings underscore the importance of continued monitoring of behaviors and academic performance in students with a history of early childhood TBI. This may be especially true among children with less severe injuries who are at risk for being underserved.
Noaman, Farah; Lam, Lawrence T; Soundappan, S V; Browne, Gary J
To increase the evidence base by characterizing various features of pediatric sports-related abdominal injuries. A review of the trauma database at The Children's Hospital at Westmead was undertaken for all abdominal injuries presenting to the emergency department between 2001 and 2006. The Children's Hospital at Westmead is a tertiary-level pediatric trauma center servicing Sydney's west. It sees approximately 50,000 patients a year. Only those injuries occurring during an organized sport were included for analysis. Thirty-three of the original 513 patients were eligible for inclusion. The data collected included basic demographics, mechanism of injury, sport injury, time to presentation, length of stay, diagnoses, treatment, and complications. Injury severity scores were assigned retrospectively. Males sustained more injuries than females. Collisions and falls were the most common modes of injury. Rugby was the most common sport for injury. Most patients presented within 12 hours, and most presented with musculoskeletal injuries. Injury severity was usually mild; treatment, conservative; length of stay, short; and complications, uncommon. When characteristics were compared by sex, males had mostly collision injuries in high-impact/contact sports, with females having more falls in other sports. When characteristics were compared by age, the only statistically significant difference was in the organ injured: older children had more single solid organ injuries, and younger children had more multiple and hollow viscus injuries. Sports-related abdominal injuries in children are mostly minor and not as common as other injury mechanisms. Despite this, they can be serious, with early diagnosis often delayed because of their subtle nature. Sports-related abdominal injuries in children require a high index of suspicion in the part of the clinician if they are to be recognized early and managed effectively.
Hendricks, H.T.; Geurts, A.C.H.; Ginneken, B.C. van; Heeren, A.J.; Vos, P.E.
OBJECTIVE: To assess brain injury severity, autonomic dysregulation and systemic infection as risk factors for the occurrence of heterotopic ossification in patients with severe traumatic brain injury. DESIGN: Historic cohort study. SETTING: Radboud University Medical Centre. SUBJECTS: All
Barnes, Sean M; Russell, Leah M; Hostetter, Trisha A; Forster, Jeri E; Devore, Maria D; Brenner, Lisa A
This hypothesis-generating research describes the characteristics of traumatic brain injuries (TBIs) sustained among 229 Veterans seeking homeless services. Nearly all participants (83%) had sustained at least one TBI prior to their first episode of homelessness. Among participants with a TBI, assaults, transportation-related accidents, and falls were the most common causes of these injuries. Thirty percent of individuals sustained injuries with severity levels that would be expected to be associated with ongoing TBI-related deficits. Forty-three percent of the Veterans sustained at least one brain injury following their first episode of homelessness. Median lifetime number of TBIs was three. The severity of TBIs was similar among Veterans who sustained injuries before or after their first incident of homelessness. Findings suggest that future research should directly examine the potential bi-directional relationship between TBI and homelessness, as well as the impact of TBI-related deficits on Veterans' ability to benefit from homeless services and/or maintain stable housing.
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 ...
Patterns, Severity, and Management of Maxillofacial Injuries in a Suburban South Western Nigeria Tertiary Center. ... Nigerian Journal of Surgery ... Information about demographic data, types of maxillofacial and associated injury, etiology of injury, treatment received and complications were collected and analyzed. Results: ...
Jensen, Andrew R; Maciel, Robert C; Petrigliano, Frank A; Rodriguez, John P; Brooks, Adam G
Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise. A review of relevant publications using the search term mixed martial arts and each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar. Clinical review. Level 5. The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries. Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women. © 2016 The Author(s).
Weaver, Ashley A; Barnard, Ryan T; Kilgo, Patrick D; Martin, R Shayn; Stitzel, Joel D
The study purpose was to develop mortality-based metrics of injury severity for frequent motor vehicle crash (MVC) injuries. Injury severity was quantified with mortality-based metrics for 240 injuries comprising the top 95% most frequently occurring AIS 2+ injuries in the National Automotive Sampling System - Crashworthiness Data System (NASS-CDS) 2000-2011. Mortality risk ratios (MRRs) were computed by dividing the number of deaths by occurrences for each of the 240 injuries using National Trauma Data Bank Research Data System (NTDB-RDS) MVC cases. MRRMAIS was computed using only patients with a maximum AIS (MAIS) equal to the AIS severity of a given injury. Each injury had an associated MRR and MRRMAIS which ranged from zero (0% mortality representing low severity) to one (100% or universal mortality representing high severity). Injuries with higher MRR and MRRMAIS values are considered more severe because they resulted in a greater proportion of deaths among injured patients. The results illustrated an overall positive trend between AIS severity and the MRR and MRRMAIS values as expected, but showed large variations in MRR and MRRMAIS for some injuries of the same AIS severity. Mortality differences up to 83% (MRR) and 54% (MRRMAIS) were observed for injuries of the same AIS severity. The MRR-based measures of injury severity indicate that some lower AIS severity injuries may result in as many deaths as higher AIS severity injuries. This data-driven determination of injury severity using MRR and MRRMAIS provides a supplement or an alternative to AIS severity classification.
Davidson, Scott B; Blostein, Paul A; Schrotenboer, Andrew; Sloffer, Chris A; VandenBerg, Sheri L
The size, speed, and unpredictable nature of horses present a significant risk for injury in all equine-related activities. We sought to examine the mechanism, severity, frequency, body regions affected, surgical requirements, rehabilitation needs, safety equipment utilization, and outcomes of equine-related injured patients. Records of inpatients who sustained an equine-related injury from 2002-2011 with International Classification of Diseases, Ninth Revision codes E828 and E906 were retrospectively reviewed for pertinent data. Ninety patients, 70% female, age (mean ± SD) 37.3 ± 19.4 years, length of stay 3.7 ± 4.5 days, Injury Severity Score 12.9 ± 8.4. Predominant mechanism of injury was fall from horse (46.7%). The chest (23%) was most frequently injured, followed by brain/head (21.5%). Thirty patients (33%) required 57 surgical procedures. Twenty percent of patients required occupational therapy and 33.3% required physical therapy while hospitalized. Only 3% required rehabilitation, with 90% discharged directly home. Safety equipment was not used in 91.9% of patients. One patient sustained a cord injury. Six patients expired, all from extensive head injuries. The majority of equine-related injuries occur while pursuing recreational activities and are due to falls. Our patients experienced more severe injuries to the trunk and head and required more surgical intervention for pelvic, facial, and brain injuries than previously reported. Failure to use safety equipment contributes to the risk of severe injury. Education and injury prevention is essential. The need for complex surgical intervention by multiple specialties supports transfer to Level I trauma centers. Copyright © 2015 Elsevier Inc. All rights reserved.
Tee, Jason C; Klingbiel, Jannie F G; Collins, Robert; Lambert, Mike I; Coopoo, Yoga
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.
Lam, Kenneth C.; Snyder Valier, Alison R.; Valovich McLeod, Tamara C
Background: The inclusion of clinical practice factors, beyond epidemiologic data, may help guide medical coverage and care decisions. Hypothesis: Trends in injury and treatment characteristics of sport-specific injuries sustained by secondary school athletes will differ based on sport. Study Design: Retrospective analysis of electronic patient records. Level of evidence: Level 4. Methods: Participants consisted of 3302 boys and 2293 girls who were diagnosed with a sport-related injury or con...
Bederman, S Samuel; Murnaghan, Olivia; Malempati, Harsha; Lansang, Edward; Wilkinson, Marc; Johnston, Edward; Bronstein, Yigal; Finkelstein, Joel A; Yee, Albert J M
Patients who sustain major trauma experience multisystem injuries including those affecting the spine. We hypothesize that recovery after spinal injuries differs from those affecting other systems. The purpose of our study was to compare in-hospital mortality and surgical resource utilization in severely polytraumatized patient with and without spinal injury. We assembled a cohort of patients with severe polytrauma (Injury Severity Score [ISS]>15) and spinal injury and matched them to a cohort without spinal injury for age, gender, ISS, and mechanism of injury. In patients presenting to a Level I trauma center, we compared in-hospital patient mortality, the number of surgical procedures, and duration required for ventilatory support, intensive care unit (ICU) length of stay (LOS), and in-hospital LOS comparing matched groups. We performed a subanalysis of those who sustained severe fracture types and those with neurologic impairment. From 114 matched pairs, we found no significant differences in mortality rates or numbers of surgical procedures performed between the groups. Patients with spine injury, however, were observed to experience a prolonged duration of ventilation, ICU and in-hospital LOS compared with their matched cohort. Severe fracture patterns and the presence of neurologic involvement amplified the effect on these outcomes. In this study, we conclude that the presence of a spinal injury in the setting of severe polytrauma (ISS>15) is associated with a prolonged course of ventilatory support, ICU, and in-hospital LOS. Trauma hospitals treating patients with spinal fracture should be aware of differences in the use of health services for this patient population.
Naik, Bhaven; Tung, Li-Wei; Zhao, Shanshan; Khattak, Aemal J
The focus of this paper is on illustrating the feasibility of aggregating data from disparate sources to investigate the relationship between single-vehicle truck crash injury severity and detailed weather conditions. Specifically, this paper presents: (a) a methodology that combines detailed 15-min weather station data with crash and roadway data, and (b) an empirical investigation of the effects of weather on crash-related injury severities of single-vehicle truck crashes. Random parameters ordinal and multinomial regression models were used to investigate crash injury severity under different weather conditions, taking into account the individual unobserved heterogeneity. The adopted methodology allowed consideration of environmental, roadway, and climate-related variables in single-vehicle truck crash injury severity. Results showed that wind speed, rain, humidity, and air temperature were linked with single-vehicle truck crash injury severity. Greater recorded wind speed added to the severity of injuries in single-vehicle truck crashes in general. Rain and warmer air temperatures were linked to more severe crash injuries in single-vehicle truck crashes while higher levels of humidity were linked to less severe injuries. Random parameters ordered logit and multinomial logit, respectively, revealed some individual heterogeneity in the data and showed that integrating comprehensive weather data with crash data provided useful insights into factors associated with single-vehicle truck crash injury severity. The research provided a practical method that combined comprehensive 15-min weather station data with crash and roadway data, thereby providing useful insights into crash injury severity of single-vehicle trucks. Those insights are useful for future truck driver educational programs and for truck safety in different weather conditions. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.
Full Text Available Approximately 20% of caustic ingestions result in some degree of esophageal injury. Alkaline materials are the most frequent corrosive materials ingested. The physical form and PH of ingested materials play a critical role in the site and type of gastrointestinal injury (PH > 12 or PH < 1.5, crystalline drain cleaners. Unlike Alkaline solutions, strong acids are bitter, burn on contact and usually produce vomiting but when swallowed pass rapidly through the esophagus and damage the antrum of the stomach. I will present the results of 5 cases of gastric out let obstruction after acid ingestion (subtotal gastrectomy and billroth 1 and 4 patients with extensive esophageal damage and perforation ( Total esophagectomy and gastric pull up.
Darrow, Cory J; Collins, Christy L; Yard, Ellen E; Comstock, R Dawn
Over 7 million students participate in high school athletics annually. Despite numerous health benefits, high school athletes are at risk for injury. Severe injury rates and patterns differ by gender and type of exposure. Study Design Descriptive epidemiology study. Sports-related injury data were collected during the 2005-2007 academic years from 100 nationally representative United States high schools via RIO (Reporting Information Online). Severe injury was defined as any injury that resulted in the loss of more than 21 days of sports participation. Participating certified athletic trainers (ATCs) reported 1378 severe injuries during 3 550 141 athlete-exposures (0.39 severe injuries per 1000 athletic exposures). Football had the highest severe injury rate (0.69), followed by wrestling (0.52), girls' basketball (0.34), and girls' soccer (0.33). The rate in all boys' sports (0.45) was higher than all girls' sports (0.26) (rate ratio [RR], 1.74; 95% confidence interval [CI], 1.54-1.98; P sports (soccer, basketball, and baseball/softball), girls sustained a higher severe injury rate (0.29) than boys (0.23) (RR, 1.28; 95% CI, 1.08-1.52; P = .006). More specifically, girls' basketball had a higher rate (0.34) than boys' basketball (0.24) (RR, 1.43; 95% CI, 1.10-1.86; P = .009). Differences between boys' and girls' soccer and baseball/softball were not statistically significant. The severe injury rate was greater in competition (0.79) than practice (0.24) (RR, 3.30; 95% CI, 2.97-3.67; P sports injuries, 0.3% resulted in medical disqualification for the athletes' career, and an additional 56.8% resulted in medical disqualification for the entire season. One in 4 (28.3%) severe injuries required surgery, with over half (53.9%) being knee surgeries. Severe injury rates and patterns varied by sport, gender, and type of exposure. Because severe injuries negatively affect athletes' health and often place an increased burden on the health care system, future research should
Full Text Available Background: Motorcycle vehicles are frequent in China, especially in the small and medium sized cities. Road traffic collisions involving motorcycles often result in severe injuries. We aimed to identify risk factors for severe injuries in inpatients sustaining motorcycle collisions. Methods: Patients with road traffic injuries involving motorcycles who presented to the neurosurgery and orthopedic departments of three major comprehensive hospitals in Shantou city were reviewed from October 2012 to June 2013. Data from 349 patients was investigated. Crash and injury characteristics were documented by interviewing patients, their family members, and their doctors. Binary logistic regression was used to determine risk factors for severe injuries. Results: There were 253 males (72.49% and 96 females (27.51%, with a male to female ratio of 2.64:1. The mean age was 38.21 ± 17.32 years. One-hundred and fifty patients were in the severe injury group with a mean injury severity score (ISS of 15.34 ± 9.13. The simple and multiple logistic model showed that males, lack of safeguards, morning and night hours, non-urban areas, collision of a motorcycle with a cycle, ambulance transportation to hospital, admission to a neurosurgery department, lack of traffic control, unobstructed traffic, and poor visibility were all the risk factors. Conclusions: This research highlights some problems: less helmet wearing in motorcyclists and cyclists, rural injuries being more serious than urban ones, and head injuries being the main diagnosis in severe injuries. The result of this research is predictable. If the safety equipment is required to be used, such as helmets, and the traffic environment is improved, such as traffic flow, medical resources to injuries and deaths is seasonable, then traffic safety will be improved and accidents will be reduced.
Weiler, Richard; Van Mechelen, Willem; Fuller, Colin; Verhagen, Evert
Fifteen percent of the world's population live with disability, and many of these individuals choose to play sport. There are barriers to sport participation for athletes with disability and sports injury can greatly impact on daily life, which makes sports injury prevention additionally important. The purpose of this review is to systematically review the definitions, methodologies and injury rates in disability sport, which should assist future identification of risk factors and development of injury prevention strategies. A secondary aim is to highlight the most pressing issues for improvement of the quality of injury epidemiology research for disability sport. A search of NICE, AMED, British Nursing Index, CINAHL, EMBASE and Medline was conducted to identify all publications up to 16 June 2015. Of 489 potentially relevant articles and reference searching, a total of 15 studies were included. Wide study sample heterogeneity prevented data pooling and meta-analysis. Results demonstrated an evolving field of epidemiology, but with wide differences in sports injury definition and with studies focused on short competitions. Background data were generally sparse; there was minimal exposure analysis, and no analysis of injury severity, all of which made comparison of injury risk and injury severity difficult. There is an urgent need for consensus on sports injury definition and methodology in disability sports. The quality of studies is variable, with inconsistent sports injury definitions, methodologies and injury rates, which prevents comparison, conclusions and development of injury prevention strategies. The authors highlight the most pressing issues for improvement of the quality in injury epidemiology research for disability sport.
Full Text Available Aims and Objectives: To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Materials and Methods: Patients with severe head injury (Glasgow coma score (GCS ≤8 presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS at 1 month post-injury or at death (whichever came earlier. Results: Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1% had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3-85 years. Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1-3 was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21 in patients with severe head injury without arterial infarct. Conclusions: A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-a-vis patient without these findings.
Gouttebarge, Vincent; Aoki, Haruhito; Ekstrand, Jan; Verhagen, Evert A L M; Kerkhoffs, Gino M M J
To explore the associations of severe musculoskeletal injuries (joint and muscles) and surgeries with symptoms of common mental disorders (distress, anxiety/depression, sleeping disturbance, adverse alcohol behaviour , smoking, adverse nutrition behaviour) among male European professional footballers. Cross-sectional analyses were conducted on electronic questionnaires completed by professional footballers recruited from the national players' unions of Finland, France, Norway, Spain or Sweden. The number of severe (time loss of more than 28 days) musculoskeletal injuries (total, joint, muscle) and surgeries during a professional football career was examined through four questions, while symptoms of common mental disorders were evaluated through validated scales. A total of 540 professional footballers (mean age of 27 years; 54 % playing in the highest leagues) participated in the study. Sixty-eight per cent of the participants had already incurred one or more severe joint injuries and 60 % one or more severe muscle injuries. Prevalence of symptoms of common mental disorders ranged from 3 % for smoking to 37 % for anxiety/depression and 58 % for adverse nutrition behaviour. The number of severe musculoskeletal injuries during a football career was positively correlated with distress, anxiety and sleeping disturbance, while the number of surgeries was correlated with adverse alcohol behaviour and smoking. Professional footballers who had sustained one or more severe musculoskeletal injuries during their career were two to nearly four times more likely to report symptoms of common mental disorders than professional footballers who had not suffered from severe musculoskeletal injuries. It can be concluded that the number of severe musculoskeletal injuries and surgeries during a career is positively correlated and associated with symptoms of common mental disorders among male European professional footballers. This study emphasises the importance of applying a
Lorenz, Laura; Katz, Gabrielle
Acquired brain injury (ABI) is a major public health problem in Massachusetts (Hackman et al, 2014) and includes traumatic brain injury (TBI), stroke, ABI-related infectious diseases, metabolic disorders affecting the central nervous system (brain and spinal cord), and brain tumor. Advances in emergency medical care and neurosurgery mean that more people are surviving severe traumatic brain injury (Trexler et al, 2014). Yet many patients with severe TBI in particular, are not receiving inpatient services after initial treatment (Hackman et al, 2014; CDC, 2014) or later that are known to be effective (Malec & Kean, 2015; Lewis & Horn, 2015; BI Commission, 2011; Kolakowsky-Hayner et al, 2000; Interviews). These services include post-acute rehabilitation, case management, and brain injury-specific community programming (CDC, 2014; BI Commission, 2011; Interviews). Governance and data for decision-making are also major gaps in the continuum of care for severe brain injury in MA (Interviews; NASHIA, 2005). The last two decades saw a surge in interest in the brain, with advances in neuroscience, diagnosis and measurement of brain injury, rehabilitation services, and brain theory (Boyle, 2001). Severe brain injury however is the new "hidden epidemic" in our society. For many, an injury to the brain is not a short-term event that can be "cured" but the beginning of a life-long disability (CDC, 2014; Langlois et al, 2006). Fortunately, even after a severe brain injury, when the right rehabilitation is provided at the right time, the "rest of life" journey can be a positive one for many (Marquez de la Plata, 2015; Langlois et al, 2006). Severe brain injury can lead to a "new normal" as patients regain skills, find new meaning and in life, and take on new family, volunteer, and work roles. Throughout this brief, the term "severe brain injury" refers to "severe acquired brain injury," or any injury to the brain that occurs after birth. This definition does not include
Nescolarde, L; Yanguas, J; Lukaski, H; Alomar, X; Rosell-Ferrer, J; Rodas, G
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 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.
Although problems remembering people's names rank highly among the subjective complaints of patients with closed-head injuries, very few studies have examined their memory for people's names by objective measurements. An experiment is reported in which patients with severe closed-head injuries and
Tainio, Marko; Olkowicz, Dorota; Teresiński, Grzegorz; de Nazelle, Audrey; Nieuwenhuijsen, Mark J
Health impact assessment (HIA) studies are increasingly predicting the health effects of mode shifts in traffic. The challenge for such studies is to combine the health effects, caused by injuries, with the disease driven health effects, and to express the change in the health with a common health indicator. Disability-adjusted life year (DALY) combines years lived disabled or injured (YLD) and years of life lost (YLL) providing practical indicator to combine injuries with diseases. In this study, we estimate the average YLDs for one person injured in a transport crash to allow easy to use methods to predict health effects of transport injuries. We calculated YLDs and YLLs for transport fatalities and injuries based on the data from the Swedish Traffic Accident Data Acquisition (STRADA). In STRADA, all the fatalities and most of the injuries in Sweden for 2007-2011 were recorded. The type of injury was recorded with the Abbreviated Injury Scale (AIS) codes. In this study these AIS codes were aggregated to injury types, and YLDs were calculated for each victim by multiplying the type of injury with the disability weight and the average duration of that injury. YLLs were calculated by multiplying the age of the victim with life expectancy of that age and gender. YLDs and YLLs were estimated separately for different gender, mode of transport and location of the crash. The average YLDs for injured person was 14.7 for lifelong injuries and 0.012 for temporal injuries. The average YLDs per injured person for lifelong injuries for pedestrians, cyclists and car occupants were 9.4, 12.8 and 18.4, YLDs, respectively. Lifelong injuries sustained in rural areas were on average 31% more serious than injuries in urban areas. The results show that shifting modes of transport will not only change the likelihood of injuries but also the severity of injuries sustained, if injured. The results of this study can be used to predict DALY changes in HIA studies that take into account
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
Formisano, Rita; Azicnuda, Eva; Sefid, Maryam Khan; Zampolini, Mauro; Scarponi, Federico; Avesani, Renato
Establish the best time to start rehabilitation by means of scientific evidence. Observational study in patients with a diagnosis of Severe Brain Injury who received intensive inpatient rehabilitation after acute care. 1470 subjects enrolled: 651 with Traumatic Brain Injury (TBI) and 819 with Non-TBI. Male gender was prevalent in the population study, but sex distribution was not different among groups, with a prevalence of male gender in both populations. This project involved 29 rehabilitation facilities for Severe ABI. The registry was an electronic database, remained active only during the period of data collection. The patients were divided into three different categories according to the time interval from brain injury to inpatient rehabilitation admission and demographic and clinical data were collected. Etiology, time interval from injury to inpatient rehabilitation, disability severity, the presence of tracheostomy at admission to the rehabilitation facility, rehabilitation length of stay and transfer back to acute care wards because of medical, surgical or neurosurgical complications. The interval from brain injury to rehabilitation facilities admission increases along with age, brain injury severity according to DRS scores, the presence of a tracheal tube and the percentage of transfers back to acute care wards from rehabilitation facilities, because of medical, surgical or neurosurgical complications. The better recovery and more positive outcomes, reported as resulting from early rehabilitation, may be due more to less severity of brain injury and fewer complications in the acute and post-acute phase than to when the rehabilitation starts.
Moth Wolffbrandt, Mia; Poulsen, Ingrid; Engberg, Aase W
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)....
Li, Zhibin; Liu, Pan; Wang, Wei; Xu, Chengcheng
The study presented in this paper investigated the possibility of using support vector machine (SVM) models for crash injury severity analysis. Based on crash data collected at 326 freeway diverge areas, a SVM model was developed for predicting the injury severity associated with individual crashes. An ordered probit (OP) model was also developed using the same dataset. The research team compared the performance of the SVM model and the OP model. It was found that the SVM model produced better prediction performance for crash injury severity than did the OP model. The percent of correct prediction for the SVM model was found to be 48.8%, which was higher than that produced by the OP model (44.0%). Even though the SVM model may suffer from the multi-class classification problem, it still provides better prediction results for small proportion injury severities than the OP model does. The research also investigated the potential of using the SVM model for evaluating the impacts of external factors on crash injury severities. The sensitivity analysis results show that the SVM model produced comparable results regarding the impacts of variables on crash injury severity as compared to the OP model. For several variables such as the length of the exit ramp and the shoulder width of the freeway mainline, the results of the SVM model are more reasonable than those of the OP model. Copyright © 2011 Elsevier Ltd. All rights reserved.
Jessula, Samuel; Murphy, Nadia; Yanchar, Natalie L
In 2004-2005, legislation restricting all-terrain vehicle (ATV) use by children and an extensive social marketing campaign intended to reduce pediatric ATV-related morbidity. The frequency, nature, and severity of pediatric ATV-associated trauma were compared before and after such interventions. A retrospective cohort study was performed for all pediatric ATV-related injuries that presented to the provincial level 1 pediatric trauma center from 1998 to 2014. National databases were queried for ATV-related injury hospitalizations (n=258), trauma center emergency department visits (n=342), and admissions (n=136) in Nova Scotia from 2002 to 2014. Admissions between 1998 and 2003 (n=68) and 2006-2014 (n=60) were compared using chi square analysis for age and gender distribution, length of stay, critical care admission, helmet use, mechanism, and severity of injury. Admissions, trauma center emergency room visits and admissions initially decreased following legislative and social marketing interventions and subsequently gradually increased. Interventions resulted in no significant difference in age or gender distribution, length of hospital stay, critical care admission, helmet use, and mechanism of injury. There was a significantly higher proportion of severe injuries post interventions. Legislation and social marketing interventions had a short-term decrease on the frequency of ATV-related injuries and no sustained effect on the frequency, nature, and severity of ATV-related injuries. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.
Norup, Anne; Mortensen, Erik Lykke
Objectives To investigate the prevalence of personality change after severe brain injury; to identify predictors of personality change; and to investigate whether personality change is associated with distress in family members. Design A longitudinal study of personality change. Setting Rehabilit...
Eva Esther Tejerina Alvarez
Increased intracranial pressure is associated with mortality and with unfavorable functional outcomes is patients with severe traumatic brain injury. The main clinical practice guidelines recommend using a number of staggered therapeutic measures. However, although these measures seem to be efficient in reducing intracranial pressure, this effect is not often translated into clinical improvement. This review describes the essential principles of the management of patients with severe traumatic brain injury in intensive care units.
Rushby, Jacqueline Ann; McDonald, Skye; Randall, Rebekah; de Sousa, Arielle; Trimmer, Emily; Fisher, Alana
Empathy deficits are widely-documented in individuals after severe traumatic brain injury (TBI). This study examined the relationship between empathy deficits and psychophysiological responsivity in adults with TBI to determine if impaired responsivity is ameliorated through repeated emotional stimulus presentations. Nineteen TBI participants (13 males; 41 years) and 25 control participants (14 males; 31 years) viewed five repetitions of six 2-min film clip segments containing pleasant, unpleasant, and neutral content. Facial muscle responses (zygomaticus and corrugator), tonic heart rate (HR) and skin conductance level (SCL) were recorded. Mean responses for each viewing period were compared to a pre-experiment 2-min resting baseline period. Self-reported emotional empathy was also assessed. TBI participants demonstrated identical EMG response patterns to controls, i.e. an initial large facial response to both pleasant and unpleasant films, followed by habituation over repetitions for pleasant films, and sustained response to unpleasant films. Additionally, an increase in both arousal and HR deceleration to stimulus repetitions was found, which was larger for TBI participants. Compared to controls, TBI participants self-reported lower emotional empathy, and had lower resting arousal, and these measures were positively correlated. Results are consistent with TBI producing impairments in emotional empathy and responsivity. While some normalisation of physiological arousal appeared with repeated stimulus presentations, this came at the cost of greater attentional effort. Copyright © 2013 Elsevier B.V. All rights reserved.
Ferreira, Sara; Amorim, Marco; Couto, Antonio
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
Sandvall, Brinkley K; Keys, Kari A; Friedrich, Jeffrey B
The purpose of this study was to characterize injury patterns and outcomes of fireworks-related hand injuries and determine if there was an association with certain fireworks types. A retrospective cohort study was conducted on patients treated at a trauma center between 2005 and 2015. A total of 105 patients sustaining operative hand injuries due to fireworks were identified. Medical records were reviewed to identify injury patterns, treatment outcomes, and fireworks types. Eighty-eight patients (84%) sustained 92 thumb and/or first web space injuries. There were 12 thumb soft tissue-only injuries (13%) and 80 thumb fractures/dislocations (87%). Of these, there were 52 thumb carpometacarpal (CMC) joint dislocations (57%) and 36 thumb fractures outside the thumb CMC joint (39%). Fifteen hands (16%) sustained both thumb CMC joint dislocations and additional thumb fractures. Twenty-three hands (25%) required thumb revision amputation. The number of surgeries for acute reconstruction ranged from 1 to 7, with 17 patients (19%) requiring 3 or more. Sixty-three hands had deep first web space injuries, and 11 (17%) required flaps acutely for first web space reconstruction. Six hands required secondary reconstruction of a first web space contracture. An external fixator was applied to 6 hands to maintain the first web space; none of these required secondary web reconstruction. Excluding isolated pin removals and dressing changes under anesthesia, 19 patients (22%) required later-stage surgeries. Shells/mortars (59%) were the most common fireworks type causing injury. Among operative hand injuries, fireworks most commonly fracture the thumb, destabilize the thumb CMC joint, and deeply damage the first web space. The first web space requires particular consideration because deep injury may result in adduction contracture and require secondary reconstruction if not prevented. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc
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.
Barnes, Shawn S; Wong, William; Affeldt, John C
While airbags have saved many lives and are clearly beneficial overall, sodium hydroxide (NaOH) powder produced by the inflation reaction can cause significant alkali ocular injury if not irrigated promptly. Here we report a case of severe airbag related ocular alkali injury as a way to bring attention to the need for prompt ocular irrigation following motor vehicle accidents (MVA) with airbag deployment. A 47-year-old man was involved in a MVA with airbag deployment in a rural setting. Attention was paid to several other life-threatening traumatic injuries, however, ocular irrigation was not performed until some 6-7 hours after the MVA. Over the course of 6 months, airbag related alkali injury caused severe limbal ischemia, conjunctivalization of the cornea, corneal epithelial defects, cicatricial scarring, haze, and corneal/limbal vascularization despite amniotic membrane graft. Awareness of the importance of ocular irrigation following airbag deployment must be raised both in the ophthalmology and emergency medicine communities.
Roberts, Darren C; Power, D M; Stapley, S A
Scapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel. All UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004-2014). Forty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (pmilitary personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united. Scapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss. © Article author(s) (or their
Alharfi, Ibrahim M; Stewart, Tanya Charyk; Foster, Jennifer; Morrison, Gavin C; Fraser, Douglas D
To determine the occurrence rate of central diabetes insipidus in pediatric patients with severe traumatic brain injury and to describe the clinical, injury, biochemical, imaging, and intervention variables associated with mortality. Retrospective chart and imaging review. Children's Hospital, level 1 trauma center. Severely injured (Injury Severity Score ≥ 12) pediatric trauma patients (>1 month and diabetes insipidus between January 2000 and December 2011. Of 818 severely injured trauma patients, 180 had severe traumatic brain injury with an overall mortality rate of 27.2%. Thirty-two of the severe traumatic brain injury patients developed acute central diabetes insipidus that responded to desamino-8-D-arginine vasopressin and/or vasopressin infusion, providing an occurrence rate of 18%. At the time of central diabetes insipidus diagnosis, median urine output and serum sodium were 6.8 ml/kg/hr (interquartile range = 5-11) and 154 mmol/L (interquartile range = 149-159), respectively. The mortality rate of central diabetes insipidus patients was 87.5%, with 71.4% declared brain dead after central diabetes insipidus diagnosis. Early central diabetes insipidus onset, within the first 2 days of severe traumatic brain injury, was strongly associated with mortality (p diabetes insipidus were more likely to have intracranial pressure monitoring (p = 0.03), have thiopental administered to induce coma (p = 0.04) and have received a decompressive craniectomy for elevated intracranial pressure (p = 0.04). The incidence of central diabetes insipidus in pediatric patients with severe traumatic brain injury is 18%. Mortality was associated with early central diabetes insipidus onset and cerebral edema on head computed tomography. Central diabetes insipidus nonsurvivors were less likely to have received intracranial pressure monitoring, thiopental coma and decompressive craniectomy.
Jain, Saurabh; Rajan, Sunil; Srivastava, Abhishek
Dilemma still prevails, regarding the exact management of mangled extremity injuries between limb salvage versus amputation, each having there own set of complications. We here present a case of severely comminuted fractures of radius (bag of bones) along with the multiple criss-cross shaped lacerated wounds on the forearm and wrist presenting as a "signature pattern injury" caused by entrapment of the limb in the concrete mixer. MESS score of patient was 8, a score valid for amputation, but contrary, we successfully salvaged the patient's limb with use of radio-carpal distracter. Management of mangled injuries should be individualized, with due consideration to the mechanism and force of injury, associated injuries, and the patient profile.
Zuccarello, M; Facco, E; Zampieri, P; Zanardi, L; Andrioli, G C
The outcome is reported in 62 children with severe head injuries following a road traffic accident. All patients were comatose for at least 6 h; all patients were graded using the Glasgow Coma Score (GCS) or the Children Coma Score (CCS). Fifty-four patients were comatose immediately after injury, 8 after a lucid interval. Thirty patients had isolated head injuries and 32 had associated injuries, either long bone fractures or rupture of an abdominal organ. Additional information concerning main brainstem reflexes, posture and respiration was included in the study. The overall mortality was 32%. The goal of the study was to identify those clinical features available soon after injury which are important indicators of treatment and outcome.
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...
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...
Rechel, Julie A; Yard, Ellen E; Comstock, R Dawn
More than 7 million US high school students play sports. To compare practice and competition injury rates and patterns in 5 boys' sports (football, soccer, basketball, wrestling, and baseball) and 4 girls' sports (soccer, volleyball, basketball, and softball) during the 2005-2006 school year. Prospective injury surveillance study. Injury data were collected from 100 nationally representative United States high schools via High School RIO (Reporting Information Online). Athletes from participating high schools injured while participating in a school-sanctioned practice or competition in one of the above sports. Practice and competition injury rates, body site, diagnosis, and severity. High school athletes participating in these 9 sports at participating schools sustained 4350 injuries during the 2005-2006 school year, which corresponds to an estimated 1 442 533 injuries nationally. The rate of injury per 1000 athlete-exposures was higher in competition (4.63) than in practice (1.69) (rate ratio [RR] = 2.73, 95% confidence interval [CI] = 2.58, 2.90). Of all sports, football had the highest competition (12.09) and practice (2.54) injury rates per 1000 athlete-exposures. Compared with injuries sustained during practice, higher proportions of competition injuries were head/face/neck injuries (proportion ratio [PR] = 1.61, 95% CI = 1.34, 1.94), particularly in boys' soccer (PR = 7.74, 95% CI = 2.53, 23.65) and girls' basketball (PR = 6.03, 95% CI = 2.39, 15.22). Competition injuries were more likely to be concussions (PR = 2.02, 95% CI = 1.56, 2.62), especially in boys' soccer (PR = 6.94, 95% CI = 2.01, 23.95) and girls' basketball (PR = 5.83, 95% CI = 2.06, 16.49). Higher proportions of competition injuries caused the athlete to miss more than 3 weeks of play (PR = 1.28, 95% CI = 1.08, 1.52), particularly in baseball (PR = 3.47, 95% CI = 1.48, 8.11) and volleyball (PR = 2.88, 95% CI = 1.01, 8.24). Rates and patterns of high school sport injuries differed between
Pollard Henry P
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.
M. A. Goldzon
Full Text Available Objective: to experimentally study cardiac functional and metabolic disturbances in the acute period of severe thermal injury. Material and methods. Experiments were carried out on 25 outbred male albino rats anesthesized with Nembutal (50 mg/kg intraperitoneally. Five-mm-thick copper plates heated up to 60°C were used to simulate thermal injury. Skin contact with the thermal agent lasted 15 seconds. Myocardial contractility and metabolism were examined using the specimen of the isolated isovolumically contracted heart. Results. Severe thermal injury was found to induce acute heart failure caused by cardiac bioenergy impairment, hypoxia, metabolic acidosis, and cardiomyocyte membrane destruction. Key words: thermal injury, cardiac contractility and metabolism.
Kostogloudis, Nikolaos; Demiri, Efterpi; Tsimponis, Antonios; Dionyssiou, Dimitrios; Ioannidis, Sotirios; Chatziioannidis, Ilias; Nikolaidis, Nikolaos
Extravasation injuries are a common and challenging problem in hospitalized newborns. Accidental infusion leakage into the surrounding tissues in immature infants may frequently result in skin necrosis, with significant risk of functional and cosmetic impairment. In the present study we reviewed 34 cases of severe extravasation injuries occurring in 1,409 neonates hospitalized in a single neonatal unit over 24 months (incidence 2.4%). Total parenteral nutrition solutions were involved in most cases. All patients were treated within 30 minutes after the injury was recorded using a flush-out technique with normal saline irrigation and occlusive paraffin dressings of the infiltrated area. The majority of injuries affected preterm, low-birthweight infants (mean gestation 32 wks + 6 days, mean birth weight 1,885 g), with a mean age at the time of injury of 11.6 days and a mean weight of 2,045 g. Neither gestational age (p = 0.87) or birthweight significantly affected (p = 0.07) the incidence of extravasation injuries, although the incidence of skin necrosis had a significant correlation with gestational age (p = 0.009) and birthweight (p injuries in extremely preterm and low-birthweight infants are more likely to lead to skin necrosis. Peripheral venous catheterization should be performed with caution in these patients to prevent such injuries. Immediate irrigation with normal saline is recommended to reduce toxic sequelae in the infiltrated area. © 2015 Wiley Periodicals, Inc.
Bhat, Pookala S.; Pardal, P. K.; Diwakar, M.
Self-mutilation, the deliberate destruction occurs in a variety of psychiatric disorders.Many methods of self-destructive behavior have been described in literature. Patients of schizophrenia are known to attempt self-harm due to command hallucination, catatonic excitement or because of associated depression, however severe glossal injury by biting has not been reported so far.Authors report case of self-harm of glossal injury by biting in schizophrenia. Treatment and management issues are discussed. PMID:23271870
Eskridge, Susan L; Macera, Caroline A; Galarneau, Michael R; Holbrook, Troy L; Woodruff, Susan I; MacGregor, Andrew J; Morton, Deborah J; Shaffer, Richard A
Explosions have caused a greater percentage of injuries in Iraq and Afghanistan than in any other large-scale conflict. Improvements in body armour and field medical care have improved survival and changed the injury profile of service personnel. This study's objective was to determine the nature, body region, and severity of injuries caused by an explosion episode in male service personnel. A descriptive analysis was conducted of 4623 combat explosion episodes in Iraq between March 2004 and December 2007. The Barell matrix was used to describe the nature and body regions of injuries due to a combat explosion. A total of 17,637 International Classification of Diseases, Ninth Revision (ICD-9) codes were assigned to the 4623 explosion episodes, with an average of 3.8 ICD-9 codes per episode. The most frequent single injury type was a mild traumatic brain injury (TBI; 10.8%). Other frequent injuries were open wounds in the lower extremity (8.8%) and open wounds of the face (8.2%), which includes tympanic membrane rupture. The extremities were the body regions most often injured (41.3%), followed by head and neck (37.4%) and torso (8.8%). The results of this study support previous observations of TBI as a pre-eminent injury of the wars in Iraq and Afghanistan, with mild TBI as the most common single injury in this large cohort of explosion episodes. The extremities had the highest frequency of injuries for any one body region. The majority of the explosion episodes resulted in more than one injury, and the variety of injuries across nearly every body region and injury type suggests a complex nature of explosion injuries. Understanding the constellation of injuries commonly caused by explosions will assist in the mitigation, treatment, and rehabilitation of the effects of these injuries. Copyright © 2012 Elsevier Ltd. All rights reserved.
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.
Barnes, J; Hassan, A; Cuerden, R; Cookson, R; Kohlhofer, J
The aim of this study is to investigate the differences in car occupant injury severity recorded in AIS 2005 compared to AIS 1990 and to outline the likely effects on future data analysis findings. Occupant injury data in the UK Cooperative Crash Injury Study Database (CCIS) were coded for the period February 2006 to November 2007 using both AIS 1990 and AIS 2005. Data for 1,994 occupants with over 6000 coded injuries were reviewed at the AIS and MAIS level of severities and body regions to determine changes between the two coding methodologies. Overall there was an apparent general trend for fewer injuries to be coded at the AIS 4+ severity and more injuries to be coded at the AIS 2 severity. When these injury trends were reviewed in more detail it was found that the body regions which contributed the most to these changes in severity were the head, thorax and extremities. This is one of the first studies to examine the implications for large databases when changing to an updated method for coding injuries. PMID:20184835
Hels, Tove; Lyckegaard, Allan; Bernhoft, Inger Marie
Driving with alcohol and other psychoactive substances imposes an increased risk of severe injury accidents. In a population-based case-control design, the relative risks of severe driver injury (MAIS ≥ 2) by driving with ten substance groups were approximated by odds ratios (alcohol, amphetamines...... (N = 2490) were collected from severely injured drivers of passenger cars or vans in selected hospitals in various regions of the countries. Control samples (N = 15,832) were sampled in a uniform sampling scheme stratified according to country, time, road type and season. Relative risks were...... driver injury with increasing age. It is concluded that among psychoactive substances alcohol still poses the largest problem in terms of driver risk of getting injured. © 2013 Elsevier Ltd. All rights reserved....
Abay, Kibrom Araya
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......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...
Garcia, Carolinna M; Cunningham, Sandra J
In adult patients with blunt trauma, severe mechanism of injury leads to routine pan-computed tomography (CT). Due to concerns about the risk of radiation, we sought to determine whether clinical suspicion could identify children requiring radiographic imaging. A prospective study was conducted in a pediatric emergency department of a Level 1 trauma center. Patients ≤14years presenting with blunt trauma due to predefined severe mechanisms were eligible. Physicians recorded their suspicions for clinically significant injury (CSI). Imaging was obtained at the physician's discretion. CSI was defined as injury requiring intervention or hospital admission ≥24h. Both admitted and discharged patients were contacted ≥2weeks after presentation to document undetected injuries. 837 patients were eligible; 753 were enrolled. 159 patients were excluded because the mechanism did not meet severity criteria. Follow-up was completed for 529/594 remaining patients. Physicians were suspicious of all injuries in 71/75 patients with CSI and had no suspicions in 382/454 without CSI. The 75 injured patients had 153 CSIs; positive suspicion of CSI was recorded for 149 injuries. The four patients who sustained unsuspected injuries had multiple other suspected injuries. Of the 594 patients, 42 received focused CT and 14 underwent pan-CT. No patient had previously undetected injuries on follow-up. In our study, clinical suspicion was able to identify children with CSI. If further studies support our findings, using clinical suspicion rather than mechanism alone to guide radiographic imaging may avoid unnecessary radiation exposure. Copyright © 2017. Published by Elsevier Inc.
Schellenberg, Morgan; Inaba, Kenji; Cho, Jayun; Tatum, James M; Barmparas, Galinos; Strumwasser, Aaron; Grabo, Daniel; Bir, Cynthia; Eastman, Alexander; Demetriades, Demetrios
Injuries sustained by civilians from interaction with police are a polarizing contemporary sociopolitical issue. Few comprehensive studies have been published using national hospital-based data. The aim of this study was to examine the epidemiology of these injuries to better understand this mechanism of injury. Patients entered into the National Trauma Data Bank (NTDB) (January 2007 to December 2012) with E-codes E970.0 to E976.0 (International Classification of Diseases, Ninth Revision, Clinical Modification), identifying injuries associated with law enforcement in the course of legal action, were enrolled. Patients' demographics, injury characteristics, procedures, and outcomes were collected and analyzed. Patients injured by other civilians (E960.0-E968.0) were used for comparison. Of 4,146,428 patients in the NTDB, 7,203 (0.17%) were injured during interaction with police. The numbers of patients in consecutive study years were 858, 1,103, 1,148, 1,274, 1,316, and 1,504. The incidence of these injuries was stable over time (0.17-0.18%) (p = 0.129). Patients had a median age of 31 years (range, 0-108), and 94.3% were male. Median injury severity score was 9 (interquartile range [IQR], 4-17). The most common mechanism of injury was gunshot wound (44%).Patients were white, 43%; black, 30%; Hispanic, 17%; Asian, 1%; and Other, 9%. As a proportion of the total race-specific NTDB trauma population, there was an average of 1.13 white patients, 2.71 Hispanic patients, and 3.83 black patients per 1,000. Mechanism, injury severity score, and outcomes did not vary by race. Compared to patients injured by civilians, patients injured by police are more likely to be white (43% vs 25%, p wounds (44% vs 32%, p trauma centers across the United States, the rate of injuries sustained during interactions with police has been stable over time. Gunshot wounds are the most common mechanism of injury. Proportionally, black patients are the most frequently injured race. When compared
Full Text Available Dilemma still prevails, regarding the exact management of mangled extremity injuries between limb salvage versus amputation, each having there own set of complications. We here present a case of severely comminuted fractures of radius (bag of bones along with the multiple criss-cross shaped lacerated wounds on the forearm and wrist presenting as a “signature pattern injury” caused by entrapment of the limb in the concrete mixer. MESS score of patient was 8, a score valid for amputation, but contrary, we successfully salvaged the patient's limb with use of radio-carpal distracter. Management of mangled injuries should be individualized, with due consideration to the mechanism and force of injury, associated injuries, and the patient profile.
Chaudhary, Sofia; Pomerantz, Wendy J; Miller, Beverly; Pan, Anqi; Agarwal, Maneesha
Injury is the leading cause of death in children. Although many pediatric hospitals and trauma centers provide injury prevention (IP) programming, there is no national standard. This study aims to identify characteristics of a sustainable and successful IP program by querying programs affiliated with the Injury Free Coalition for Kids (IFCK). The IFCK sites were sent a 30-question survey via e-mail. Questions focused on demographics, scope of IP activities, self-efficacy, and outcome measures including finances, academic productivity, and legislative advocacy. Counts and frequencies were calculated and compared using χ tests. The survey was completed by 38 (90.4%) of 42 sites. The majority were associated with a freestanding children's hospital (57.9%) and Level I pediatric trauma center (86.8%). Most programs (79%) had at least one dedicated full-time equivalent (FTE) staff. Research was most common on child passenger safety and teen driving. Nearly 30% of programs offered educational curricula to health care providers; these sites were more likely to have FTE support (p = 0.036). Steady sources of funding were identified for 60.5% of programs, with 47.8% citing their hospital as the primary source; 73% of respondents were confident in their program's capacity to sustain activities; these were more likely to be larger programs (p = 0.001) with steady sources of funding (p < 0.001). Despite 73.7% of sites having academic affiliations, 60.5% had 5 or fewer publications over the previous 5 years. In the prior 2 years, 55.3% of programs impacted legislative or policy changes. Funding, size of program, and FTE had no statistical correlation with research productivity or number of legislative/policy contributions. This study characterizes the variation among pediatric IP programs within IFCK sites, while highlighting the association between financial and FTE support from programs' institutions with sustainable IP programming. These results can assist programs in
Adesunkanmi, A R; Oginni, L M; Oyelami, O A; Badru, O S
The records of 324 children who were injured in road traffic accidents (RTA) between January 1992 and December 1995 were reviewed to determine the pattern, severity and outcome of their injuries. This represented 2% of all attendances at the emergency room. Pedestrians represented the largest group of patients. Head injuries were the most common injury, followed closely by limb trauma. Chest and abdominal trauma accounted for only 2.5 and 1.5% of patients, respectively. Eighty percent of abdominal injuries required a splenectomy, but most chest injuries were managed nonoperatively. In 306 children the ISS was 1-25 with no mortality but significant morbidity. Eighteen patients had an ISS of 26-54 with a 61% mortality rate (11 patients). The highest ISS were found in the group of patients who were passengers in a motor vehicle.
Alekseev, V S; Ivanov, V A; Alekseev, S V; Vaniukov, V P
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.
Full Text Available Abstract Background The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning. Methods This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL from the Head Injury Family Interview (HIFI. Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis. Results Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning. Conclusion This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.
vaginal rape being well documented — even in young infants under one year of age.3 These severe and brutal assaults can result in serious and sometimes life- threatening injury to the young child.4 A systematic approach to the care of these individuals is essential in order to achieve a satisfactory outcome. Traditionally.
Pan, Hong-Wei; Iakymenko, Stanislav; Xu, Jin-Tang; Hou, Guang-Hui; Sun, Bing-Ji; Zheng, A-Ning
To present the results of implantation of Iakymenko keratoprosthesis in five patients with vascularized corneal leukoma caused by severe ocular injury. Iakymenko keratoprosthesis was implanted into 5 eyes of 5 patients: 4 patients were suffered from chemical burns and 1 patient from explosive injury. The preoperative visual acuity ranged from light perception to hand motion. The implantation surgery was composed of two-stage procedures. The follow-up period was from 9 months to 11 years. The outcome measures were visual acuity, retention, and complications of the keratoprosthesis. Vision improvements were achieved in most patients. All keratoprosthesis were retained within the follow-up period. Corneal melting occurred in one patient and fibrous closure in another patient, both of which were successfully treated. Retinal detachment occurred in one patient after surgery. Iakymenko keratoprosthesis seems to be a promising alternative for the patients with severe corneal injury, but further investigation is needed to evaluate the role of Iakymenko keratoprosthesis.
Prato, Carlo Giacomo; Kaplan, Sigal
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...... light. Occurrence of injury to bus passengers is positively related to (i) the involvement of heavy vehicles, (ii) crossing intersections in yellow or red light, (iii) open areas, (iv) high speed limits, and (v) slippery road surface. Conclusions The findings of the current study provide a comprehensive......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...
Peleg, Kobi; Liran, Alon; Tessone, Ariel; Givon, Adi; Orenstein, Arie; Haik, Josef
The use of explosives and suicide bombings has become more frequent since October 2000. This change in the nature of terror attacks has marked a new era in the Israeli-Palestinian conflict. We previously reported that the incidence of thermal injuries has since risen. However, the rise in the incidence of burns among victims of terror was proportionate to the rise in the incidence of burns among all trauma victims. This paper presents data from the Israeli National Trauma Registry during the years 1997--2003, to compare the severity of injuries and outcome (mortality rates) in terror victims with and without burn injuries. We also compare the severity of injuries and outcome (mortality rates) for patients with terror-attack related burns to non terror-attack related burns during the same period. Data was obtained from the Israeli National Trauma Registry for all patients admitted to 8 to 10 hospitals in Israel between 1997 and 2003. We analyzed and compared demographic and clinical characteristics of 219 terror-related burn patients (terror/burn), 2228 terror patients with no associated burns (Terror/no-burn) and 6546 non terror related burn patients (burn/no-terror). Severity of injuries was measured using the injury severity score, and burn severity by total body surface percentage indices. Admission rates to Intensive Care Units (ICU) and total length of hospitalization were also used to measure severity of injuries. In-hospital mortality rates were used to indicate outcome. Of burn/terror patients, 87.2% suffered other accompanying injuries, compared with 10.4% of burn/no-terror patients. Of burn/terror patients, 49.8% were admitted to ICU compared with only 11.9% of burn/no-terror patients and 23.8% of no-burn/terror patients. Mean length of hospital stay was 18.5 days for the terror/burn group compared with 11.1 days for the burn/no-terror group and 9.5 days for the terror/no-burn group. Burn/terror patients had a significantly higher injury severity score
Ewing-Cobbs, Linda; Prasad, Mary R; Kramer, Larry; Cox, Charles S; Baumgartner, James; Fletcher, Stephen; Mendez, Donna; Barnes, Marcia; Zhang, Xiaoling; Swank, Paul
Although long-term neurological outcomes after traumatic brain injury (TBI) sustained early in life are generally unfavorable, the effect of TBI on the development of academic competencies is unknown. The present study characterizes intelligence quotient (IQ) and academic outcomes an average of 5.7 years after injury in children who sustained moderate to severe TBI prior to 6 years of age. Twenty-three children who suffered inflicted or noninflicted TBI between the ages of 4 and 71 months were enrolled in a prospective, longitudinal cohort study. Their mean age at injury was 21 months; their mean age at assessment was 89 months. The authors used general linear modeling approaches to compare IQ and standardized academic achievement test scores from the TBI group and a community comparison group (21 children). Children who sustained early TBI scored significantly lower than children in the comparison group on intelligence tests and in the reading, mathematical, and language domains of achievement tests. Forty-eight percent of the TBI group had IQs below the 10th percentile. During the approximately 5-year follow-up period, longitudinal IQ testing revealed continuing deficits and no recovery of function. Both IQ and academic achievement test scores were significantly related to the number of intracranial lesions and the lowest postresuscitation Glasgow Coma Scale score but not to age at the time of injury. Nearly 50% of the TBI group failed a school grade and/or required placement in self-contained special education classrooms; the odds of unfavorable academic performance were 18 times higher for the TBI group than the comparison group. Traumatic brain injury sustained early in life has significant and persistent consequences for the development of intellectual and academic functions and deleterious effects on academic performance.
Carrivick, Philip J W; Lee, Andy H; Yau, Kelvin K W; Stevenson, Mark R
Manual handling is the greatest contributor to non-fatal injury and disease in the workplace, commonly accounting for one-third of national injury counts. Interventional strategies that have focused on selecting or modifying the worker have been ineffective in reducing injury risk. In recent times, participatory ergonomics has been widely adopted as a process to reduce the risk of injury from manual handling but it is not well validated as an intervention. This study evaluated the effectiveness of a participatory ergonomics risk assessment approach in reducing the rate and severity of injuries from manual and non-manual handling sustained by a cohort of 137 cleaners within a hospital setting. The date of injury and the workers' compensation claim cost and hours lost from work were obtained for each injury incurred during the 4-year pre-intervention and 3-year intervention period. The age, gender and hours worked were ascertained for every cleaner whether injured or not. Using generalized linear mixed modelling analysis, reductions of rate of injury by two-thirds, workers' compensation claim costs by 62% and hours lost by 35% for manual handling injuries were found to be associated with the intervention period. Although the cleaners experienced a significant intervention period reduction in non-manual handling injury rate, the corresponding changes in severity of injury were not significant. The success of the intervention supports the adoption of a participatory ergonomics approach in reducing the rate and consequence of injuries in the workplace.
Youngblut, JoAnne M.; Caicedo, Carmen; Brooten, Dorothy
The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head injuries only, 20% had other fractures, 5% had organ damage, and 7% had all three. Injury severity was measured by head AIS and GCS scores. Treatments and procedures included tubes/lines, blood/blood products, and medications. Children with head injuries only had fewer hospital days, less severe head injuries, and near normal GCS scores. They were less likely to have tubes/lines and medications. Children were discharged with medications (61%) and medical equipment (14%). Five children were discharged to long-term care facilities, and five were discharged to rehabilitation facilities. Concordance of head AIS and GCS categories occurred for only 50 (28%) children. Although the GCS is the gold standard for identifying changes in neurological status, it was not as helpful in representing hospital care. Head AIS injury categories clustered children in more homogeneous groups and better represented hospital care. Head AIS categories are better indicators of injury severity and care provided than GCS. Head injury AIS score may be an important addition to GCS for guiding care. PMID:24640315
with severe head injuries to the trauma unit of Red Cross. War Memorial Hospital during the last 4 years. Our goal was ... biochemical monitoring, measurement of arterial oxygen and carbon dioxide, fluid restriction and anticonvulsant ... patients doomed to a poor quality of life. The results of this study were then analysed ...
Romanczyk, Raymond G.; Goren, Elizabeth R.
The long-term treatment program and follow-up of a case of chronic, severe, multiple self-injurious behavior is presented. Contingent electric shock and differential reinforcement of other behavior were the primary techniques utilized. Total suppression was achieved in the laboratory setting, but extending control to the natural environment proved…
A 34 year old woman involved in road traffic accident with severe anterior and posterior pelvic fractures with associated soft tissue injury was referred from Wa Regional Hospital 18 hours after the accident to Tania Specialist Hospital in Tamale. Emergency resuscitative measures such as catheterization and management of ...
Torg, Joseph S.; And Others
Use of the spring-loaded blocking and tackling devices should be discontinued due to severe neck injuries resulting from their use; employment of the head and helmet as the primary assault weapon in blocking, tackling, and head butting should be condemned for the same reason. (MJB)
Background: Thermal injuries are a major cause of morbidity and mortality in Kenya. Though a lot is known about burns, the morbidity patterns and mortality rates of burns in this country have not been established. This study was designed with the general objective of investigating the outcome of moderate and severe burns ...
Yasmin, Shamsunnahar; Eluru, Naveen
This paper focuses on the relevance of alternate discrete outcome frameworks for modeling driver injury severity. The study empirically compares the ordered response and unordered response models in the context of driver injury severity in traffic crashes. The alternative modeling approaches considered for the comparison exercise include: for the ordered response framework-ordered logit (OL), generalized ordered logit (GOL), mixed generalized ordered logit (MGOL) and for the unordered response framework-multinomial logit (MNL), nested logit (NL), ordered generalized extreme value logit (OGEV) and mixed multinomial logit (MMNL) model. A host of comparison metrics are computed to evaluate the performance of these alternative models. The study provides a comprehensive comparison exercise of the performance of ordered and unordered response models for examining the impact of exogenous factors on driver injury severity. The research also explores the effect of potential underreporting on alternative frameworks by artificially creating an underreported data sample from the driver injury severity sample. The empirical analysis is based on the 2010 General Estimates System (GES) data base-a nationally representative sample of road crashes collected and compiled from about 60 jurisdictions across the United States. The performance of the alternative frameworks are examined in the context of model estimation and validation (at the aggregate and disaggregate level). Further, the performance of the model frameworks in the presence of underreporting is explored, with and without corrections to the estimates. The results from these extensive analyses point toward the emergence of the GOL framework (MGOL) as a strong competitor to the MMNL model in modeling driver injury severity. Copyright © 2013 Elsevier Ltd. All rights reserved.
Stenroos, A; Handolin, L
During the last decade urban skiing and snowboarding has gained a lot of popularity. In urban skiing/snowboarding riders try to balance on handrails and jump off buildings. Previous studies in skiing and snowboarding accidents have mostly been conducted at hospitals located close to alpine terrain with big ski resort areas. The aim of this study is to evaluate the types and severity of traumatic brain injuries occurring in small, suburban hills and in urban environment, and to characterize injury patterns to find out the specific mechanisms of injuries behind. This study included all patients admitted to the Helsinki University Hospital Trauma Unit from 2006 to 2015 with a head injury (ICD 10 S06-S07) from skiing or snowboarding accidents in Helsinki capital area. Head injuries that did not require a CT-scan, and injuries older than 24 hours were excluded from this study. There were a total of 72 patients that met the inclusion criteria Mean length of stay in hospital was 2.95 days. According to the AIS classification, 30% had moderate, 14% had severe, and 10% had critical head injuries. Patients who got injured in terrain parks or on streets where more likely to be admitted to ICU than those injured on slopes. Based on GOS score at discharge, 78% were classified as having a good recovery from the injury, 13% had a moderate disability, 5% had a severe disability and 3% of the injuries were fatal. There were no statistically significant differences in decreased GOS between the accident sites. Head injuries occurring in small suburban hills and in urban environments can be serious and potentially fatal. The profile and severity of skiing injuries in urban environments and small, suburban hills is comparable to those on alpine terrain.
Pookala S Bhat
Full Text Available Self-mutilation, the deliberate destruction occurs in a variety of psychiatric disorders.Many methods of self-destructive behavior have been described in literature. Patients of schizophrenia are known to attempt self-harm due to command hallucination, catatonic excitement or because of associated depression, however severe glossal injury by biting has not been reported so far.Authors report case of self-harm of glossal injury by biting in schizophrenia.Treatment and management issues are discussed.
Bremare, A; Rapin, A; Veber, B; Beuret-Blanquart, F; Verin, E
The objective of this study was to determine the clinical characteristics of swallowing disorders in severe brain injury in the arousal phase after coma. Between December 1, 2013 and June 30, 2014, eleven patients with severe acquired brain injury who were admitted to rehabilitation center (Male 81.8 %; 40.7 ± 14.6 years) were included in the study. Evaluation of swallowing included a functional examination, clinical functional swallowing test, and naso-endoscopic swallowing test. All patients had swallowing disorders at admission. The first functional swallowing test showed oral (77.8 %) and pharyngeal (66.7 %) food bolus transport disorders; and alterations in airway protection mechanisms (80 %). Swallowing test under endoscopic control showed a disorder in swallowing coordination in 55.6 % of patients tested. Seven (63.6 %) patients resumed oral feeding within an average of 6 weeks after admission to rehabilitation center and 14 weeks after acquired brain injury. Six (85.7 %) of these seven patients continued to require modified solid and liquid textures. Swallowing disorders are a major concern in severe brain injury in the arousal phase. Early bedside assessment of swallowing is essential for detection of swallowing disorders to propose appropriate medical rehabilitation care to these patients in a state of altered consciousness.
Justis, E J; Moore, S V; LaVelle, D G
Woodworking equipment produces approximately 720,000 injuries per year often causing severe psychologic and functional impairment. Responses from 1000 injured woodworkers to a demographic survey revealed that 60.5% of injuries occurred to amateur woodworkers; 42% of injuries were caused by the table saw and 37% of respondents reported amputation of one or more digits. The most significant causal factor reported was failure to use properly installed guards, but personal factors, such as fatigue and postprandial somnolence were also implicated. Twenty-seven percent of respondents required hospitalization for an average of 3.7 days, and 22.8% were treated by hand surgeons. Hand surgeons need to become more aware of the dangers of specific types of woodworking equipment and the injuries produced by these tools to better treat and perhaps, prevent woodworking injuries.
Gordillo-Escobar, E; Egea-Guerrero, J J; Rodríguez-Rodríguez, A; Murillo-Cabezas, F
Severe head injuries have a great socioeconomic and public health impact. Despite progress in diagnosis and treatment, no sufficiently reliable predictive models have been established for developing clinical trials and promoting effective therapeutic strategies capable of improving the prognosis. In the last decades, several brain damage biomarkers have been studied as potential diagnostic and prognostic tools in traumatic brain injury. However, all of them have limitations that preclude their universalized application. The properties of the known biomarkers -both those traditionally shown to correlate with severity and prognosis, and those recently announced as promising options- should be analyzed. New studies are needed to define their properties, both isolatedly and in combined use. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
Howard, Travis M.; Ahn, Bumsoo; Ferreira, Leonardo F.
Skeletal muscle regeneration following injury is a highly coordinated process that involves transient muscle inflammation, removal of necrotic cellular debris and subsequent replacement of damaged myofibers through secondary myogenesis. However, the molecular mechanisms which coordinate these events are only beginning to be defined. In the current study we demonstrate that Heat shock protein 70 (Hsp70) is increased following muscle injury, and is necessary for the normal sequence of events following severe injury induced by cardiotoxin, and physiological injury induced by modified muscle use. Indeed, Hsp70 ablated mice showed a significantly delayed inflammatory response to muscle injury induced by cardiotoxin, with nearly undetected levels of both neutrophil and macrophage markers 24 hours post-injury. At later time points, Hsp70 ablated mice showed sustained muscle inflammation and necrosis, calcium deposition and impaired fiber regeneration that persisted several weeks post-injury. Through rescue experiments reintroducing Hsp70 intracellular expression plasmids into muscles of Hsp70 ablated mice either prior to injury or post-injury, we confirm that Hsp70 optimally promotes muscle regeneration when expressed during both the inflammatory phase that predominates in the first four days following severe injury and the regenerative phase that predominates thereafter. Additional rescue experiments reintroducing Hsp70 protein into the extracellular microenvironment of injured muscles at the onset of injury provides further evidence that Hsp70 released from damaged muscle may drive the early inflammatory response to injury. Importantly, following induction of physiological injury through muscle reloading following a period of muscle disuse, reduced inflammation in 3-day reloaded muscles of Hsp70 ablated mice was associated with preservation of myofibers, and increased muscle force production at later time points compared to WT. Collectively our findings indicate that
Fuller, Colin W; Dick, Randall W; Corlette, Jill; Schmalz, Rosemary
To compare the incidence, nature, severity and cause of training injuries sustained on new generation artificial turf and grass by male and female footballers. The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study involving American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all training injuries. The number of days lost from training and match play was used to define the severity of an injury. Training exposures (player hours) were recorded on a team basis. The overall incidence of training injuries for men was 3.34 injuries/1000 player hours on artificial turf and 3.01 on grass (incidence ratio 1.11; p = 0.21) and for women it was 2.60 injuries/1000 player hours on artificial turf and 2.79 on grass (incidence ratio 0.93; p = 0.46). For men, the mean severity of injuries that were not season ending injuries was 9.4 days (median 5) on artificial turf and 7.8 days (median 4) on grass and, for women, 10.5 days (median 4) on artificial turf and 10.0 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and muscle/tendon injuries to the lower limbs were the most common general categories of injury on artificial turf and grass for both male and female players. Most training injuries were acute (men: artificial turf 2.92, grass 2.63, p = 0.24; women: artificial turf 1.94, grass 2.23, p = 0.21) and resulted from player-to-player contact (men: artificial turf 1.08, grass 0.85, p = 0.10; women: artificial turf 0.47, grass 0.56; p = 0.45). There were no major differences between the incidence, severity, nature or cause of training injuries
Bahloul, Mabrouk; Ben Hamida, Chokri; Chelly, Hedi; Chaari, Adel; Kallel, Hatem; Dammak, Hassen; Rekik, Noureddine; Bahloul, Kamel; Ben Mahfoudh, Kheireddine; Hachicha, Mongia; Bouaziz, Mounir
To determine predictive factors of mortality among children after traumatic brain injury. A retrospective study over 8 years of 222 children with severe head injury (Glasgow Coma Scale score road traffic accident (75.7%). Mean Glasgow Coma Scale score was 6+/-1.5, mean Injury Severity Score (ISS) was 28.2+/-6.9, mean Paediatric Trauma Score (PTS) was 3.7+/-2.1 and mean Paediatric Risk of Mortality (PRISM) was 14.3+/-8.5; 54 children (24.3%) died. Univariate analysis showed that low PTS on admission, high ISS or PRISM, presence of shock or meningeal haemorrhage or bilateral mydriasis, and serum glucose > 10 mmol l(-1) were associated with mortality rate. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 20 and bilateral mydriasis on admission. In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic accidents. Short-term prognosis is poor, with a high mortality rate (24.3%), and is influenced by demographic, clinical, radiological and biological factors.
Seitz, H D
The sign of a traumatically caused alveolar hyperventilation in severe cranio-cerebral injury is a respiratory alcalosis as well as hypoxia and hypoxemia in the arterial as well in the cerebral veneous blood. The combination of decreased oxygen tension or saturation and hypocapnia can exist for several days and in a lethal course transform into a combined metabolic respiratory acidosis with increasing carbonic acid tension and so initiate the prefinal state. The extremely pathological blood gases are usually the first sign of shock-specific changes of the lung. The most impressing changes of the cerebrospinal fluid are the metabolic acidosis in combination with a diminished oxygen tension and tissue hypoxia of the brain. The acidosis of cerebrospinal fluid in severe brain injury is not only of prognostic but also of therapeutical importance. The treatment of the acidosis of cerebrospinal fluid by intrathecal administration of buffering substances in severe brain injuries and its sequelae can have a favourable influence on the cerebral circulation and brain metabolism.
Kaplan, Sigal; Vavatsoulas,, Konstantinos; Prato, Carlo Giacomo
severity on Danish roads by examining a comprehensive set of accidents involving a cyclist and a collision partner between 2007 and 2011. Method: This study estimates a generalized ordered logit model of the severity of cyclist injuries because of its ability to accommodate the ordered-response nature......Denmark is one of the leading cycling nations, where cycling trips constitute a large share of the total trips, and cycling safety assumes a top priority position in the agenda of policy makers. The current study sheds light on the aggravating and mitigating factors associated with cyclist injury......–80 km/h, slippery road surface, and location of the crash on road sections are aggravating infrastructure factors, while the availability of cycling paths and dense urban development are mitigating factors. Heavy vehicle involvement and conflicts between cyclists going straight or turning left and other...
Haleem, Kirolos; Abdel-Aty, Mohamed
This study presents multiple approaches to the analysis of crash injury severity at three- and four-legged unsignalized intersections in the state of Florida from 2003 until 2006. An extensive data collection process was conducted for this study. The dataset used in the analysis included 2,043 unsignalized intersections in six counties in the state of Florida. For the scope of this study, there were three approaches explored. The first approach dealt with the five injury levels, and an ordered probit model was fitted. The second approach was an aggregated one, and dealt with only the severe versus non-severe crash levels, and a binary probit model was used. The third approach dealt with fitting a nested logit model. Results from the three fitted approaches were shown and discussed, and a comparison between the three approaches was shown. Several important factors affecting crash severity at unsignalized intersections were identified. These include the traffic volume on the major approach, and the number of through lanes on the minor approach (surrogate measure for traffic volume), and among the geometric factors, the upstream and downstream distance to the nearest signalized intersection, left and right shoulder width, number of left turn movements on the minor approach, and number of right and left turn lanes on the major approach. As for driver factors, young and very young at-fault drivers were associated with the least fatal probability compared to other age groups. The analysis identified some countermeasures to reduce injury severity at unsignalized intersections. The spatial covariates showed the importance of including safety awareness campaigns for speeding enforcement. Also, having a 90-degree intersection design is the most appropriate safety design for reducing severity. Moreover, the assurance of marking stop lines at unsignalized intersections is very essential. 2010 Elsevier Ltd. All rights reserved.
P. Benson Ham
Full Text Available Perinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn.
Penmetsa, Praveena; Pulugurtha, Srinivas S
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.
Xie, Kun; Ozbay, Kaan; Yang, Hong
This study aims to investigate the contributing factors to secondary collisions and the effects of secondary collisions on injury severity levels. Manhattan, which is the most densely populated urban area of New York City, is used as a case study. In Manhattan, about 7.5% of crash events become involved with secondary collisions and as high as 9.3% of those secondary collisions lead to incapacitating and fatal injuries. Structural equation models (SEMs) are proposed to jointly model the presence of secondary collisions and injury severity levels and adjust for the endogeneity effects. The structural relationship among secondary collisions, injury severity, and contributing factors such as speeding, alcohol, fatigue, brake defects, limited view, and rain are fully explored using SEMs. In addition, to assess the temporal effects, we use time as a moderator in the proposed SEM framework. Due to its better performance compared with other models, the SEM with no constraint is used to investigate the contributing factors to secondary collisions. Thirteen explanatory variables are found to contribute to the presence of secondary collisions, including alcohol, drugs, inattention, inexperience, sleep, control disregarded, speeding, fatigue, defective brakes, pedestrian involved, defective pavement, limited view, and rain. Regarding the temporal effects, results indicate that it is more likely to sustain secondary collisions and severe injuries at night. This study fully investigates the contributing factors to secondary collisions and estimates the safety effects of secondary collisions after adjusting for the endogeneity effects and shows the advantage of using SEMs in exploring the structural relationship between risk factors and safety indicators. Understanding the causes and impacts of secondary collisions can help transportation agencies and automobile manufacturers develop effective injury prevention countermeasures.
Fuller, Colin W; Dick, Randall W; Corlette, Jill; Schmalz, Rosemary
To compare the incidence, nature, severity and cause of match injuries sustained on grass and new generation artificial turf by male and female footballers. The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study of American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all match injuries. The number of days lost from training and match play was used to define the severity of an injury. Match exposures (player hours) were recorded on a team basis. The overall incidence of match injuries for men was 25.43 injuries/1000 player hours on artificial turf and 23.92 on grass (incidence ratio 1.06; p = 0.46) and for women was 19.15 injuries/1000 player hours on artificial turf and 21.79 on grass (incidence ratio = 0.88; p = 0.16). For men, the mean severity of non-season ending injuries was 7.1 days (median 5) on artificial turf and 8.4 days (median 5) on grass and, for women, 11.2 days (median 5) on artificial turf and 8.9 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and contusion injuries to the lower limbs were the most common general categories of match injury on artificial turf and grass for both male and female players. Most injuries were acute (men: artificial turf 24.60, grass 22.91; p = 0.40; women: artificial turf 18.29, grass 20.64; p = 0.21) and resulted from player-to-player contact (men: artificial turf 14.73, grass 13.34; p = 0.37; women: artificial turf 10.72; grass 11.68; p = 0.50). There were no major differences in the incidence, severity, nature or cause of match injuries sustained on new generation artificial turf and
Gerberich, Susan Goodwin; And Others
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…
Yu. A. Gorodovikova
Full Text Available Objective: to determine the time and development rate of acute lung injury (ALI in severe brain injury (SBI complicated by aspiration of gastric contents or blood. Subjects and methods. Twenty-nine patients aged 19 to 70 years, who had isolated SBI, of whom there were 24 males and 5 females, were examined. The patients were divided into 2 groups: those with aspiration of gastric contents (n=9 or blood (n=10. A control group included 10 patients with SBI without aspiration. A PiCCO plus device was used to determine pulmonary extravascular fluid. ALI was diagnosed in accordance with the recommendations of the Research Institute of General Reanimatology, Russian Academy of Medical Sciences. Results. SBI patients with aspiration of gastric contents or blood were found to have significantly increased pulmonary extravascular water (p<0.01 and a lower oxygenation index (<300, which correlated with each other. ALI was recorded in the first hours after injury in about 50% of cases in both patients with gastric contents aspiration and those with blood aspiration. Conclusion. In patients with SBI complicated by aspiration of gastric contents or blood, pulmonary extravascular fluid accumulation concurrent with other signs of injury may be regarded as a criterion for acute lung injury. Key words: severe brain injury, aspiration, acute lung lesion.
Full Text Available BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Riddle, Art; Maire, Jennifer; Cai, Victor; Nguyen, Thuan; Gong, Xi; Hansen, Kelly; Grafe, Marjorie R; Hohimer, A Roger; Back, Stephen A
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.
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
Viano, David C; Parenteau, Chantal S
This is a descriptive study of the fatality risk by injury severity and time of death for lap-shoulder-belted drivers without ejection in modern vehicles. It also determined the body region for severe injuries experienced by belted drivers using the most recent federal crash data. 1997-2015 NASS-CDS data were evaluated for fatally injured lap-shoulder-belted drivers without ejection in light vehicles of 1997+ model year (MY). The severity of injuries sustained by belted drivers was assessed by the Maximum Abbreviated Injury Scale (MAIS) and individual injuries by Abbreviated Injury Scale (AIS) and body region. The change in fatality risk with MAIS was fit with a Logist function. Time of death was determined using the variable DEATH, which is reported hourly in unequal intervals up to 24 h and then daily up to 30 days after the crash. The fraction (f) and cumulative fraction (F) of the deaths are reported for each time period up to 30 days. A power or logarithmic curve was fit to the data using the trendline functions in Excel. The NASS-CDS sample included 20,610,000 belted drivers with 37,974 fatalities from 1997 to 2015. The fraction of driver deaths increased with maximum injury severity (MAIS). For example, 17.4% of drivers died within 30 days with MAIS 4 injury. Virtually all drivers (99.7%) died with MAIS 6 injury. The change in fatality risk with injury severity was r = [1 + exp(10.159 - 2.088MAIS)]-1, R2 = 0.950. Overall, there were 19,772 driver deaths with MAIS 4-6 injury and 13,059 with MAIS 0-3 injury. In addition, 44.7% of driver deaths occurred within 1.5 h of the crash, 56.7% within 2.5 h, and 64.6% within 4.5 h after the crash. The cumulative fraction of the deaths (F) up to 30 days was fit with a logarithmic function. It was F = 0.0739ln(t) + 0.5302, R2 = 0.976, for deaths after 3.5 h. There were 19,772 driver deaths with 52,130 AIS 4+ injuries. On average, the driver experienced 2.64 AIS 4+ injuries most commonly to the head (44.5%) and
Yan, Jun; Wang, Xiaolin; Chen, Shengli
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.
Gabbe, B J; Bailey, M; Cook, J L; Makdissi, M; Scase, E; Ames, N; Wood, T; McNeil, J J; Orchard, J W
To establish the relationship between the history of hip and groin injuries in elite junior football players prior to elite club recruitment and the incidence of hip and groin injuries during their elite career. Retrospective cohort study. Analysis of existing data. 500 Australian Football League (AFL) players drafted from 1999 to 2006 with complete draft medical assessment data. Previous history of hip/groin injury, anthropometric and demographic information. The number of hip/groin injuries resulting in > or =1 missed AFL game. Data for 500 players were available for analysis. 86 (17%) players reported a hip/groin injury in their junior football years. 159 (32%) players sustained a hip/groin injury in the AFL. Players who reported a previous hip or groin injury at the draft medical assessment demonstrated a rate of hip/groin injury in the AFL >6 times higher (IRR 6.24, 95% CI 4.43 to 8.77) than players without a pre-AFL hip or groin injury history. This study demonstrated that a hip or groin injury sustained during junior football years is a significant predictor of missed game time at the elite level due to hip/groin injury. The elite junior football period should be targeted for research to investigate and identify modifiable risk factors for the development of hip/groin injuries.
Gabbe, Belinda J.; Simpson, Pam M.; Lyons, Ronan A.; Ameratunga, Shanthi; Harrison, James E.; Derrett, Sarah; Polinder, Suzanne; Davie, Gabrielle; Rivara, Frederick P.
Objective To determine associations between the number of injuries sustained and three measures of disability 12-months post-injury for hospitalised patients. Methods Data from 27,840 adult (18+ years) participants, hospitalised for injury, were extracted for analysis from the Validating and Improving injury Burden Estimates (Injury-VIBES) Study. Modified Poisson and linear regression analyses were used to estimate relative risks and mean differences, respectively, for a range of outcomes (Glasgow Outcome Scale-Extended, GOS-E; EQ-5D and 12-item Short Form health survey physical and mental component summary scores, PCS-12 and MCS-12) according to the number of injuries sustained, adjusted for age, sex and contributing study. Findings More than half (54%) of patients had an injury to more than one ICD-10 body region and 62% had sustained more than one Global Burden of Disease injury type. The adjusted relative risk of a poor functional recovery (GOS-Einjuries in disability studies. Future studies should consider the impact of multiple injuries to avoid under-estimation of injury burden. PMID:25501651
Full Text Available Douglas R Pedersen,1 Georges Y El-Khoury,2 Dan R Thedens,3 Mothana Saad-Eldine,1 Phinit Phisitkul,1 Annunziato Amendola4 1Department of Orthopaedics and Rehabilitation, 2Department of Radiology, University of Iowa Hospitals and Clinics, 3Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, 4Department of Orthopaedics and Sports Medicine, Duke University Medical School, Durham, NC, USA Background: Bone contusions are frequently encountered in magnetic resonance imaging (MRI evaluation of knee anterior cruciate ligament (ACL injuries. Their role as indicators of injury severity remains unclear, primarily due to indeterminate levels of joint injury forces and to a lack of preinjury imaging.Purpose: The purpose of this study was to 1 quantify bone contusion pathogenesis following traumatic joint injuries using fixed imaging follow-ups, and 2 assess the feasibility of using longitudinal bone contusion volumes as an indicator of knee injury severity.Study design: Prospective sequential MRI follow-ups of a goat cohort exposed to controlled stifle trauma in vivo were compared to parallel clinical MRI follow-ups of a human ACL tear patient series.Methods: Reproducible cartilage impact damage of various energy magnitudes was applied in a survival goat model, coupled with partial resection of anterior portions of medial menisci. Both emulate injury patterns to the knee osteochondral structures commonly encountered in human ACL injury imaging as well as instability from resultant ligament laxity. Longitudinal clinical MRI sequences portrayed stifle bone contusion evolution through 6 months after the inciting event.Results: In the first 2 weeks, biological response variability dominated the whole-joint response with no apparent correlation to trauma severity. Control goats subjected to partial meniscectomy alone exhibited minimal bone response. Thereafter, 0.6 J impact bone contusions portrayed a faster rate of resolution
Corzillius, Michael; Storz, Christian; Gräsner, Jan-Thorsten
EMS is called to a construction worker with serious cutting injuries of the neck from an angle grinder. The patient was found on the upper floor of a construction building accessible only through a scaffolding with narrow ladders. Primary examination reveals severe hemorrhagic shock. The Fire Department is called for evacuation of the patient with a turntable ladder. Further examination in the hospital shows complete dissection of the left carotid artery and the left internal jugular vein. The history reveals alcohol abuse and depression. Attempted suicide appears to be the most likely cause of the injury. The case report further discusses proper coordination of medical and technical measures in rescue operations, recommended treatment of hemorrhagic shock, and the unusual finding of paradoxical bradycardia despite volume depletion.
Spinal Cord Injury (SCI) is a debilitating condition which causes neurological damage and can result in paralysis. SCI results in immediate mechanical damage to the spinal cord, but secondary injuries due to inflammation, oxidative damage, and activated biochemical pathways leading to apoptosis exacerbate the injury. The only currently available treatment, methylprednisolone, is controversial because there is no convincing data to support its therapeutic efficacy for SCI treatment. In the absence of an effective SCI treatment option, 17beta-estradiol has gained significant attention for its anti-oxidant, anti-inflammatory, and anti-apoptotic abilities, all events associated with secondary. Sadly, 17beta-estradiol is associated with systemic adverse effects preclude the use of free estrogen even for local administration due to short drug half-life in the body. Biodegradable nanoparticles can be used to increase half-life after local administration and to bestow sustained release. Sustained release using PEGylated biodegradable polymeric nanoparticles constructed from poly(lactic-co-glycolic acid) (PLGA) will endow a consistent, low, but effective dose to be delivered locally. This will limit systemic effects due to local administration and low dose, sustained release. PLGA was chosen because it has been used extensively for sustained release, and has a record of safety in humans. Here, we show the in vitro efficacy of PEGylated nanoparticles loaded with 17beta-estradiol for treatment of secondary SCI. We achieved a high loading efficiency and controlled release from the particles over a several day therapeutic window. The particles also show neuroprotection in two in vitro cell culture models. Both the dose and pretreatment time with nanoparticles was evaluated in an effort to translate the treatment into an animal model for further study.
Chai, Jia-ke; Li, Li-gen; Chen, Yue-xiu; Hu, Xiao-juan; Yang, Yong-ming
To explore a new method in estimating extent and degree of arterial injury in upper limbs sustaining high tension electric burns. Eighteen patients (twenty-four upper limbs) with high tension electricity injury were admitted from December 1998 to September 2002, The damaged limbs consisted of four parts: wrist wound part, 5 cm, 10 cm, 15 cm parts around wrist wound, where the radial and ulnar arteries were detected using B ultrasound and color WP Doppler examination. The changes of endangium, vessel diameter, thickness of the vessel wall and volume of blood flow were recorded respectively. The parameters of normal radial and ulnar arteries were also determined as normal control. B ultrasound and color WP Doppler examination showed that the endangium in radial and ulnar arteries become coarse, edema or exfoliation. The vessel wall was thicker than that of the normal control and the thickness was heterogeneity. The vessel wall could be necrosis in severe patient and the vessel cavity was stricture or beaded. Thrombosis or occlusion could occur at the site of severe injury area in vessel. The decrease in volume of blood flow was observed. The condition of the radial and ulnar arteries become well apart from 10 - 15 cm of wrist wound. The ultrasonography can be used to detect the changes in endangium, diameter, thickness of the vessel wall, blood flow volume in injury blood vessel caused by electric burn injury. It is helpful in judging the degree and extent of injury vessel and could be a safe, non-invasive diagnostic method and is worth popularizing.
Sinikumpu, Juha-Jaakko; Salokorpi, Niina; Suo-Palosaari, Maria; Pesälä, Juha; Serlo, Willy
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.
Quality-of-life (QoL) measures may be useful in quantifying the personal impact of an acquired brain injury and as an indicator of the effectiveness of service provision. This study investigated the validity of the patient generated index (PGI) as a measure of QoL with a sample of adults who had sustained a severe traumatic brain injury.
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.
Full Text Available Traumatic brain injury (TBI is a common cause of morbidity and mortality worldwide. There has been a constant search for therapeutic modalities in an attempt to reduce this burden, but till date, none of them have proved to have a significant clinical impact. The interest in whole-body hypothermia as a treatment modality for severe TBI arose from enthusiastic experiences with the patients having anoxic brain damage after cardiac arrest. However, despite numerous randomised controlled trials (RCTs and systematic reviews, its role in improving the outcomes after TBI are still far from being certain to warrant its clinical usage. The concept that hypothermia may be beneficial in improving the outcomes after TBI evolved with the discovery that the final neuronal injury pattern after an ischemic event could be lessened by cooling the brain. Several subsequent animal studies and clinical trials have now been conducted, which have led the Brain Trauma Foundation to issue a Level III recommendation for the use of primary therapeutic hypothermia in the management of TBI. Induced hypothermia should logically be useful in improving the mortality and neurologic outcome after severe TBI. However, the beneficial, effect of hypothermia only exists in high-quality trials, and presently, there is no Level I or Level II evidence. The relative scarcity of high-quality data in this setting entails well-designed large multicentric RCT′s to prove any association if it exists.
Prat, R; Calatayud-Maldonado, V
It is usually defficult in clinical practice to establish factors affecting final outcome in patients suffering severe diffuse brain injury (SDBI), due to the absence of specific semiology. We studied retrospectively 160 consecutive patients with criteria of SDBI. We performed a statistical analysis of epidemiological, clinical and radiological factors, and relationship with final outcome. 35% of patients with severe head injury presented SDBI. Sixty percent were 15-35 year old and 73% male. More than 45% of the patients presented GCS 3 or 4. On CT performed during the first 24 h, haemorrhagic lesions appeared in white matter in 35% and subarachnoid haemorrhage was observed in 28%. During the first 24 h., 66% of patients presented values of intracranial pressure (ICP) above 20 mm Hg and a 33% below 20 mm Hg. Twenty percent of the patients had ICP > 20 mm and no response to treatment. According to the Glasgow Outcome Scale (GOS), mortality of more than 50% and 25% of patients with persistent vegetative state or severe disability were observed. Clinical evaluation, early CT findings, ICP values and their response to medical treatment and clinical complications were found to be related (p < 0.05) to final outcome (GOS).
Hu, Feng; Lv, Donglai; Zhu, Jie; Fang, Jian
To explore the related risk factors of injuries caused by e-bike and bicycle crashes in Hefei, Anhui. Between June 2009 and June 2011, the records of injuries were triggered by e-bike and bicycle crashes in Hefei maintained by 105th Hospital of PLA. A form was designed to document patient age, gender, road user category (driver, passenger, pedestrian), safety factors (safety devices present, speed, traffic violations), environmental factors (time of trauma, light conditions, road surface), crash mode, impact type, and vehicle type. Of the 205 cases, 108 were female and 97 were male. One hundred forty-six patients suffered injuries due to e-bike accidents and 59 due to bicycle accident. The chi-squared test compared distribution of categorical variables suggested that age (P =.0250), road user category (P =.0278), traffic rule violations (P =.0132), crash mode (P =.0027), impact type (P =.0019), and vehicle type (P =.0219) are related to the severity of injuries caused by e-bike/bicycle crashes in Hefei. The multiple-factor nonconditional logistic regression analysis showed that injury severity is the most commonly sustained within the vehicle type (odds ratio [OR] = 14.418; 95% confidence interval [CI], 4.680-44.418), followed by crash mode (OR = 11.556; 95% CI, 4.430-30.142), traffic rule violations (OR = 4.735; 95% CI, 1.934-11.594), and age (OR = 2.910; 95% CI, 1.213-6.979). With the study of e-bike/bicycle crashes in Hefei, primary identification of the risk factors for the traffic injuries is obtained. These findings are important in decision making regarding preventive measures.
Mathew, Bruce; Laden, Gerard
management protocols are based largely on anecdote and transferred evidence from conventional cord trauma, as the low numbers and sporadic nature of DCI in divers makes RCTs nigh on impossible. Unfortunately even with best management, some patients are left with significant neurological deficit. The 'iceberg phenomenon', occurs when patients with DCI of the cord make a good neurological recovery but actually have profound cord damage as revealed in one case some four years later at post mortem and another example in a diver who developed late functional deterioration due to loss of neuronal reserve. This clinical evidence, together with animal study data, support the notion that even a modest preservation of spinal cord axons is associated with significant improvement in neurological outcome. In the light of the positive level two evidence in the vascular literature that CSF drainage limits 'secondary' injury thereby improving neurological outcome, we propose that centres with appropriate clinical experience consider using lumbar CSF drainage to normalise SCPP, as an adjunct to the conventional treatment of severe spinal cord DCI. Divers with severe spinal cord DCI are generally in the most productive years of their lives and, given the potentially devastating impact of this condition, should be given the benefit of any possible adjuvant treatment that may serve to improve long-term outcome.
Penn-Barwell, Jowan G; Sargeant, Ian D
Surgical treatment of high-energy gun-shot wounds (GSWs) to the extremities is challenging. Recent surgical doctrine states that wound tracts from high-energy GSWs should be laid open, however the experience from previous conflicts suggests that some of these injuries can be managed more conservatively. The aim of this study is to firstly characterise the GSW injuries sustained by UK forces, and secondly test the hypothesis that the likely severity of GSWs can be predicted by features of the wound. The UK Military trauma registry was searched for cases injured by GSW in the five years between 01 January 2009 and 31 December 2013: only UK personnel were included. Clinical notes and radiographs were then reviewed. Features associated with energy transfer in extremity wounds in survivors were further examined with number of wound debridements used as a surrogate marker of wound severity. There were 450 cases who met the inclusion criteria. 96 (21%) were fatally injured, with 354 (79%) surviving their injuries. Casualties in the fatality group had a median New Injury Severity Score (NISS) of 75 (IQR 75-75), while the median NISS of the survivors was 12 (IQR 4-48) with 10 survivors having a NISS of 75. In survivors the limbs were most commonly injured (56%). 'Through and through' wounds, where the bullet passes intact through the body, were strongly associated with less requirement for debridement (pwound debridements (p=0.0002), as there was if a bullet fractured a bone (p=0.0006). More complex wounds, as indicated by the requirement for repeated debridements, are associated with injuries where the bullet does not pass straight through the body, or where a bone is fractured. Gunshot wounds should be assessed according to the likely energy transferred, extremity wounds without features of high energy transfer do not require extensive exploration. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
Cicuendez, Marta; Castaño-León, Ana; Ramos, Ana; Hilario, Amaya; Gómez, Pedro A; Lagares, Alfonso
This study was performed to investigate the relationship between corpus callosum (CC) injury and prognosis in traumatic axonal injury (TAI). We retrospectively reviewed 264 patients with severe head trauma who underwent a conventional MR imaging in the first 60 days after injury. They were selected from a prospectively collected database of 1048 patients with severe head trauma admitted in our hospital. TAI lesions were defined as areas of increased signal intensity on T2 and FLAIR or areas of decreased signal on gradient-echo T2. We attempted to determine whether any MR imaging findings of TAI lesions at CC could be related to prognosis. Neurological impairment was assessed at 1 year after injury by means of GOS-E (good outcome being GOS-E 4/5 and bad outcome being GOS-E motor score at admission, and pupillary reactivity) and the Extended model (including CT information and second insults). We found 97 patients (37 %) with TAI at CC and 167 patients (63 %) without CC lesions at MR. A total of 62 % of the patients with CC lesions had poor outcome, whereas 38 % showed good prognosis. The presence of TAI lesions at the corpus callosum was associated with poor outcome 1 year after brain trauma (p CC lesions measured on T2 and FLAIR sequences was negatively correlated with the GOS-E after adjustment for independent prognostic factors (p = 0.01, OR 2.23, 95 % CI:1.17-4.26). Also the presence of lesions at splenium was statistically related to worse prognosis (p = 0.002, OR 8.1, 95 % CI: 2.2-29.82). We did not find statistical significance in outcome between hemorrhagic and non-hemorrhagic CC lesions. The presence of CC is associated with a poor outcome. The total volume of the CC lesion is an independent prognostic factor for poor outcome in severe head trauma.
Kathryn van Boom
Injuries to the face included 16 episodes of epistaxis, and five auricular hematomas. Return- to- play (RTP) times. Lower limb injuries were responsible for the longest time off play. The average RTP after injury was 7.7 weeks. Lower limb injuries included anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ...
In 2009, more than 746 000 injury cases were registered in the Ministry of Health hospitals in Egypt, with an injury rate of 1 004/100 000 population. Around 38% of all injuries occur among children and young adults less than 20 years of age. Furthermore, more than 20 000 people lose their lives to injuries every year ...
Oddo, Mauro; Levine, Joshua M; Kumar, Monisha; Iglesias, Katia; Frangos, Suzanne; Maloney-Wilensky, Eileen; Le Roux, Peter D
To investigate the relationship between hemoglobin (Hgb) and brain tissue oxygen tension (PbtO(2)) after severe traumatic brain injury (TBI) and to examine its impact on outcome. This was a retrospective analysis of a prospective cohort of severe TBI patients whose PbtO(2) was monitored. The relationship between Hgb-categorized into four quartiles (≤9; 9-10; 10.1-11; >11 g/dl)-and PbtO(2) was analyzed using mixed-effects models. Anemia with compromised PbtO(2) was defined as episodes of Hgb ≤ 9 g/dl with simultaneous PbtO(2) 11 g/dl as the reference level, and controlling for important physiologic covariates (CPP, PaO(2), PaCO(2)), Hgb ≤ 9 g/dl was the only Hgb level that was associated with lower PbtO(2) (coefficient -6.53 (95 % CI -9.13; -3.94), p < 0.001). Anemia with simultaneous PbtO(2) < 20 mmHg, but not anemia alone, increased the risk of unfavorable outcome (odds ratio 6.24 (95 % CI 1.61; 24.22), p = 0.008), controlling for age, GCS, Marshall CT grade, and APACHE II score. In this cohort of severe TBI patients whose PbtO(2) was monitored, a Hgb level no greater than 9 g/dl was associated with compromised PbtO(2). Anemia with simultaneous compromised PbtO(2), but not anemia alone, was a risk factor for unfavorable outcome, irrespective of injury severity.
Solbakk, Anne-Kristin; Reinvang, Ivar; Andersson, Stein
The purpose of the study was to examine the P3a and P3b components of the event-related brain potential (ERP) in patients sustaining moderate to severe brain injury. Electrophysiological and behavioral responses were recorded in brain injured (N = 18) and healthy control (N = 21) participants performance of an auditory 3-stimulus distractor paradigm. Auditory stimuli consisted of a series of repetitive standard tones (75 ms), occasionally interrupted by equiprobable target (25 ms) and distractor sounds (white noise). Tone duration discrimination accuracy was similar in patients and controls, but patients had prolonged reaction times to targets. The reaction time delay was paralleled by a prolongation of P3b latency to targets in the patient group relative to controls. The stimulus and task dependent modulation of ERP responses in the brain injury group was similar to that of controls in terms of the spatial distribution of ERPs over the scalp. However, the brain injury group had attenuated P3a and P3b amplitudes to distractor and target stimuli, respectively. The electrophysiological data suggest a deficit in the allocation of attentional resources to the processing of deviant stimuli in the brain injury group.
Examples of Injuries Assigned Various Abbreviated Injury Scale (Military Version) Scores Score Severity Example 1 Minor Isolated rib fracture 2...Moderate Testicular avulsion 3 Serious Simple hemothorax 4 Severe Below-knee traumatic amputation 5 Critical Femoral artery injury with >20% blood loss 6...Investigators AIS Region Injuries Recorded According to JTTR, No. Injuries Recorded by Investigators, No. Head 25 11 Face 23 14 Neck 0 1 Thorax 19
Alexander, C; Abzug, J M; Johnson, A J; Pensy, R A; Eglseder, W A; Paryavi, E
The purpose of this study was to investigate motorcycle crash thumb injury patterns. We hypothesized that ulnar collateral ligament injuries at the thumb metacarpophalangeal joint would be most common and there would be a side predilection due to the clutch and brake positions. Motorcyclist admissions following injury between 2002 and 2013 were reviewed, and phalangeal and metacarpal injuries treated acutely identified. Demographics, injury, and treatment characteristics were recorded. Association between laterality and injury type was assessed. Of 128 patients, 59 underwent acute treatment for thumb injuries. Eleven patients sustained thumb ulnar collateral ligament injuries; 27 sustained thumb carpometacarpal injuries. Most carpometacarpal injuries were fracture-dislocations (19/27). Thumb carpometacarpal injuries had no overall side predilection; ulnar collateral ligament injuries occurred more on the right. Carpometacarpal fractures and dislocations are the most frequent motorcycle crash thumb injury, probably due to the mechanics of gripping handlebars and the high-energy force directed into the palm and against the metacarpal base. Level IV. © The Author(s) 2015.
Goffus, Andrea M.; Anderson, Gail D; Hoane, Michael R.
Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral contr...
Goffus, Andrea M.; Anderson, Gail D; Hoane, Michael R.
Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral contr...
Mailhan, Laurence; Azouvi, Philippe; Dazord, Alice
To assess the relationships between life satisfaction and disability after a severe traumatic brain injury (TBI). Cross-sectional study, including 75 patients 2 years or more after a severe TBI. Life satisfaction was assessed with the Subjective Quality of Life Profile. Impairments, activities and participation were assessed with standardized tests. The satisfaction profile was flat, i.e. the majority of items obtained mean satisfaction scores close to 0, suggesting that participants felt indifferent to these items or in other words that they were neither satisfied nor unsatisfied. Patients were on average slightly dissatisfied with their cognitive functions, physical abilities and self-esteem. A factor analysis revealed three underlying factors. The main finding was that the relationships between life satisfaction and disability were not linear: the lowest satisfaction scores were reported by participants with moderate disability rated by the Glasgow Outcome Scale, while individuals with severe disability did not significantly differ from the good recovery group. Life satisfaction is not linearly related to disability after severe TBI.
Simmel, S; Bühren, V
Consequences of accidents are found not only in physical but also in psychological and social areas. The quality of life of severely injured patients is significantly reduced compared with the normal population even years after the trauma. Subjective experiences of severely injured patients during and after hospitalization have a major impact on the subsequent quality of life. Knowledge of these factors is essential for the planning, organization and implementation of rehabilitation after severe injury. The phase model of rehabilitation after trauma requires early initiation of therapy even during acute treatment as so-called early rehabilitation. After a specialized post-acute rehabilitation additional therapeutic options are often required. Besides pain management the focus lies especially in work-related rehabilitation and psychological support which is also decisive for the success of rehabilitation of accident victims. For severely injured patients it is important to provide sufficient support, e.g. through a case manager which does not end with discharge from the rehabilitation facility. The aim of all efforts is reintegration into the working and social environment and the best possible quality of life.
N. N. Yepifantseva
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
S. A. Svistunov
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
Chung, Younshik; Song, Tai-Jin; Yoon, Byoung-Jo
More than 56% of motorcycles in Korea are used for the purpose of delivering parcels and food. Since such delivery requires quick service, most motorcyclists commit traffic violations while delivering, such as crossing the centerline, speeding, running a red light, and driving in the opposite direction down one-way streets. In addition, the fatality rate for motorcycle crashes is about 12% of the fatality rate for road traffic crashes, which is considered to be high, although motorcycle crashes account for only 5% of road traffic crashes in South Korea. Therefore, the objective of this study is to analyze the injury severity of vehicle-to-motorcycle crashes that have occurred during delivery. To examine the risk of different injury levels sustained under all crash types of vehicle-to-motorcycle, this study applied an ordered probit model. Based on the results, this study proposes policy implications to reduce the injury severity of vehicle-to-motorcycle crashes during delivery. Copyright © 2013 Elsevier Ltd. All rights reserved.
the management of child rape victims has focused on the forensic, psychosocial ... management of the sexually abused child in the South African context. .... after the injury. Abdominal injuries. Injury to intra-abdominal organs is rarely a result of a sexual assault, but if not detected can cause death from blood loss or later ...
Shum, D H; Harris, D; O'Gorman, J G
The study aimed to clarify the effects of severe traumatic brain injury (TBI) on visual memory. Three groups of participants (14 late-recovery and 14 early-recovery TBI individuals and 18 controls) were administered the following: The Shum Visual Learning Test (SVLT), a test that measures the ability to remember visual patterns, an electronic maze test, a test that measures the ability to remember spatial positions, and the Rey Auditory Verbal Learning Test (RAVLT), a test of verbal memory and learning. The individuals with TBI (late- and early-recovery) were found to be impaired on the SVLT and the RAVLT but not on the electronic maze. Specifically, on the SVLT, they were found to learn at a slower rate and make more false-positive errors than the controls. The advantages of the SVLT over visual memory tests used in previous studies and the significance of findings of the present study were discussed.
Ma, Zhuanglin; Lu, Xi; Chien, Steven I-Jy; Hu, Dawei
Vehicle crashes that involve pedestrians at intersections have been reported occasionally. Pedestrian injury severity in these crashes is significantly related to driver and pedestrian attributes, vehicle characteristics, and the geometry of intersections. Identifying factors associated with pedestrian injury severity (PIS) is critical for reducing crashes and improving safety. For developing the proposed probit models, drivers involved in crashes are classified into 3 groups: young drivers (16 ≤ age ≤ 24), middle-aged drivers (25 ≤ age ≤ 64), and older drivers (age ≥ 65). This study determines that PIS is significantly but differently affected by these grouped drivers with different sets of explanatory variables. A total of 2,614 crash records (2011-2012) at intersections in Cook County, Illinois, were collected. An ordered probit modeling approach was employed to develop the proposed model and examine factors influencing PIS. The likelihood ratio test was used to assess model performance. Elasticity analysis was conducted to interpret the marginal effect of contributing factors on PIS associated with different driver groups by age. The results show that 4 independent variables, including pedestrian age, vehicle type, point of first contact, and weather condition, significantly affect PIS at intersections for all drivers. Two additional independent variables (i.e., number of vehicles and traffic type) affect PIS for young and middle-aged drivers, and 2 other variables (i.e., divided type and hit-and-run related) are significant to PIS for both young and older drivers. The independent variables significant to PIS at intersections for young, middle-aged, and older driver groups were identified and the marginal effect of each variable to the likelihood of PIS were assessed.
Muller, François; Simion, Audrey; Reviriego, Elsa; Galera, Cédric; Mazaux, Jean-Michel; Barat, Michel; Joseph, Pierre-Alain
Previous studies have reported a dissociation between social behavioral impairments after severe traumatic brain injury (TBI) and relatively preserved performances in traditional tasks that investigate cognitive abilities. Theory of mind (ToM) refers to the ability to make inferences about other's mental states and use them to understand and predict others' behavior. We tested a group of 15 patients with severe TBI and 15 matched controls on a series of four verbal and non-verbal ToM tasks: the faux pas test, the first-order and second-order false belief task, the character intention task and the Reading the Mind in the Eyes Test. Participants with severe TBI were also compared to controls on non-ToM inference tasks of indirect speech act from the Montreal Evaluation of Communication (M.E.C.) Protocol and empathy (Davis Interpersonal Reactivity Index - I.R.I.) and tests for executive functions. Subjects with TBI performed worse than control subjects on all ToM tasks, except the first-order false belief task. The findings converge with previous evidence for ToM deficit in TBI and dissociation between ToM and executive functions. We show that ToM deficit is probably distinct from other aspects of social cognition like empathy and pragmatic communication skills. Copyright © 2009 Elsevier Srl. All rights reserved.
The aim of this study was to determine the frequency, nature and risk factors of childhood injuries in the Suez Canal. University Hospital Emergency Department. The study included a total of 551 children of 12 years of age. The most common causes of injuries among those children were falls (60%), road traffic injuries ...
Corra, Stefano; Girardi, Paolo; de Giorgi, Franco; Braggion, Marco
Alpine skiing and snowboarding are popular winter sports. The practice of these sports is related to traumatic injuries, some of which are severe and/or life threatening. To identify the incidence, injury patterns and associated risk factors of severe and polytraumatic injuries in South Tyrol. During four consecutive winter seasons (2001-2005), data of every patient referred to our emergency department (Bolzano-Bozen) after a skiing or snowboarding accident were collected. One hundred and five patients with an Injury Severity Score of 16 or higher were identified (90 skiers, 15 snowboarders). Statistical descriptive analyses were carried out by producing frequency tables. Chi-square test was performed to verify possible association between injury severity and type of sport. Risk factors for severe injuries were evaluated using logistic regression with robust variance estimators. Traumatic brain injury was the most common injury observed (51 cases), followed by vertebral injury (45 cases); 63% of the patients reported two or more associated injuries. We observed significant associations between severe spine injuries and the following risk factors: snowboarders who reported more severe injuries than skiers [odds ratio=5.89, 95% confidence interval (CI)=1.31, 26.44], age classes of 40-50 years and over 60 years showed an OR of 8.10 (95% CI=1.87, 35.06) and 5.16 (95% CI=1.27, 21.01), respectively, with respect to age class (20-40 years). Severe traumatic injuries occur among skiers and snowboarders, and preventive measures such as the use of helmets and educational programs, are necessary.
Streit, Stephanie; Kavarana, Minoo; Scheurer, Mark A; Cina, Robert A
A 16-year-old adolescent male sustained combined injuries to the tricuspid valve and liver. This injury is exceptional due to the mechanism and the circumstances in which it took place: a flying pumpkin thrown from a sport utility vehicle. An echocardiogram demonstrated a flail chordal apparatus associated with the posterior leaflet of the tricuspid valve, creating substrate for severe tricuspid regurgitation with preserved right heart function. He was treated with non-operative management for the liver injury; he remained hemodynamically stable and was discharged home. He underwent successful repair of the tricuspid valve 17 days following the initial injury necessitating systemic anticoagulation and was discharged home two days later. The patient recovered fully without residual valvular pathology or hepatic sequelae. Copyright © 2013 Elsevier Inc. All rights reserved.
vascular endothelial growth factor gene transfer on wound healing after burn injury , Crit. Care Med. 31 (2003) 1017–1025. D.M. Burmeister et al. BBA...G.L. Su, D.G. Remick, S.C. Wang, S. Arbabi, Attenuating burn wound inflammatory signaling reduces systemic inflammation and acute lung injury , J...AWARD NUMBER: W81XWH-16-2-0041 TITLE: Resuscitation Strategies for Burn Injuries Sustained in Austere Environments to Improve Renal Perfusion
Lee, Yann-Leei L; Simmons, Jon D; Gillespie, Mark N; Alvarez, Diego F; Gonzalez, Richard P; Brevard, Sidney B; Frotan, Mohammad A; Schneider, Andrew M; Richards, William O
Achieving adequate perfusion is a key goal of treatment in severe trauma; however, tissue perfusion has classically been measured by indirect means. Direct visualization of capillary flow has been applied in sepsis, but application of this technology to the trauma population has been limited. The purpose of this investigation was to compare the efficacy of standard indirect measures of perfusion to direct imaging of the sublingual microcirculatory flow during trauma resuscitation. Patients with injury severity scores >15 were serially examined using a handheld sidestream dark-field video microscope. In addition, measurements were also made from healthy volunteers. The De Backer score, a morphometric capillary density score, and total vessel density (TVD) as cumulative vessel area within the image, were calculated using Automated Vascular Analysis (AVA3.0) software. These indices were compared against clinical and laboratory parameters of organ function and systemic metabolic status as well as mortality. Twenty severely injured patients had lower TVD (X = 14.6 ± 0.22 vs 17.66 ± 0.51) and De Backer scores (X = 9.62 ± 0.16 vs 11.55 ± 0.37) compared with healthy controls. These scores best correlated with serum lactate (TVD R(2) = 0.525, De Backer R(2) = 0.576, P trauma patients, and seems to provide real-time assessment of microcirculatory perfusion. This study suggests that in severe trauma, many indirect measurements of perfusion do not correlate with microvascular perfusion. However, visualized perfusion deficiencies do reflect a shift toward anaerobic metabolism.
Full Text Available OBJECTIVE: To reveal the expression and possible roles of aquaporin 9 (AQP9 in rat brain, after severe traumatic brain injury (TBI. METHODS: Brain water content (BWC, tetrazolium chloride staining, Evans blue staining, immunohistochemistry (IHC, immunofluorescence (IF, western blot, and real-time polymerase chain reaction were used. RESULTS: The BWC reached the first and second (highest peaks at 6 and 72 hours, and the blood brain barrier (BBB was severely destroyed at six hours after the TBI. The worst brain ischemia occurred at 72 hours after TBI. Widespread AQP9-positive astrocytes and neurons in the hypothalamus were detected by means of IHC and IF after TBI. The abundance of AQP9 and its mRNA increased after TBI and reached two peaks at 6 and 72 hours, respectively, after TBI. CONCLUSIONS: Increased AQP9 might contribute to clearance of excess water and lactate in the early stage of TBI. Widespread AQP9-positive astrocytes might help lactate move into neurons and result in cellular brain edema in the later stage of TBI. AQP9-positive neurons suggest that AQP9 plays a role in energy balance after TBI.
Aubert, S; Barat, M; Campan, M; Dehail, P; Joseph, P A; Mazaux, J-M
Discursive abilities of severe brain injured patient are always impaired: loss of flexibility, lack of cohesion and coherence, often more elliptic. We know few about nonverbal competencies during discourse. The objective is to verify nonverbal abilities of these patients by pragmatic analysis. Four men were examined more than 7 years after severe traumatic brain injury. Nonverbal Prutting and Kirchner Pragmatic Protocol (1987) were done allowing to a qualitative and quantitative measurement of paralinguistic behaviour: prosody and quality of speech, facial expression, posture, gaze, gesture. Two conditions were recorded: dual (descriptive discourse) and group (conversational discourse). Associated impairments such as cognitive and dysexecutive functioning were also investigated. Impoverishment (loss of ability) or impaired inadequacity was observed in all patients. Paralinguistic competences of conversational discourse was worse than descriptive one. Facial expression, gaze functioning, referential gesture were more often impaired. Maladjustment could be interpretated in reference with dysexecutive syndrome. In spite of the lack of information about the range of normal pragmatic behaviour, it seems that brain injured patients have shown poor nonverbal abilities during discourse. Rehabilitation training of communication skills would integrate this fact in order to improve interactivity and social relationship.
Lederer, R; Bennett, D; Parkin, T
Working dog owners in Scotland were invited to take part in an internet survey regarding the 2010/2011 shooting season, which was designed to estimate the prevalence of tail injuries; assess the risk of tail injuries in docked and undocked working dogs; and identify risk factors for owner-reported tail injuries. Of 2860 working dogs, 13.5 per cent sustained at least one tail injury during the 2010/2011 shooting season. Undocked spaniels and hunt point retrievers (HPRs) were at greatest risk of tail injury with 56.6 per cent of undocked spaniels and 38.5 per cent of undocked HPRs sustaining at least one tail injury during the season. There was no statistically significant difference in the risk of tail injury in dogs with tails docked by one-third, half or shorter. To prevent one tail injury in one shooting season, between two and 18 spaniels or HPRs would need to be docked as puppies. The authors believe that this work provides the best available evidence on which to base a consultation for changes to the legislation on tail docking in working dogs in Scotland. Docking the tails of HPRs and spaniels by one-third would significantly decrease the risk of tail injury sustained while working in these breeds.
Tojuola, Bayo D; Gu, Xiao; Littlejohn, Nathan R; Sharpe, John P; Williams, Mark A; Giel, Dana W
Blunt abdominal trauma can result in injury to genitourinary (GU) organs. Children may be more susceptible to some GU injuries due to anatomic differences compared to adults. Mechanism of injury (MOI) has been thought to relate to both the likelihood and severity of GU injury in children, although this has not definitively been proven. Our purpose was to determine if MOI has any correlation to the severity of GU injury in children treated at our institution. We reviewed records of all pediatric blunt trauma patients presenting to our institution from January 2005-December 2010 using the LeBonheur Children's Hospital Trauma Registry. All patients with GU injuries were included in this study. Data collected included demographic information, MOI, type and grade of GU injury, associated injuries, and clinical outcome. Continuous variables were tested with ANOVA and categorical variables were tested with chi-square test. Records of 5151 children with blunt trauma were reviewed; 76 patients were found to have GU organ injury. There were 47 males (61.8%) and 29 females (38.2%). Categories of MOI included motor vehicle accident, sports injury, bicycle accident, all-terrain vehicle accident (ATV), pedestrian struck accident, falls, and animal injury. MOI did not have any statistically significant association with the severity of GU organ injury (p = 0.5159). In addition, there was no association between MOI and either gender or side of injury. There was a statistically significant association between MOI and patient age (p = 0.04); older pediatric patients were more likely to experience GU injury due to sports injury and ATV accidents, where as younger patients were more likely to experience GU injury due to pedestrian struck, bicycle accidents or animal bite. Although specific MOI would seem to relate to presence and severity of injury in children, MOI alone does not correlate with the severity of GU organ injury in our pediatric trauma population. Age of pediatric
Full Text Available Traumatic Brain Injury (TBI is one of the leading causes of death among critically ill patients from the Intensive Care Units (ICU. After primary traumatic injuries, secondary complications occur, which are responsible for the progressive degradation of the clinical status in this type of patients. These include severe inflammation, biochemical and physiological imbalances and disruption of the cellular functionality. The redox cellular potential is determined by the oxidant/antioxidant ratio. Redox potential is disturbed in case of TBI leading to oxidative stress (OS. A series of agression factors that accumulate after primary traumatic injuries lead to secondary lesions represented by brain ischemia and hypoxia, inflammatory and metabolic factors, coagulopathy, microvascular damage, neurotransmitter accumulation, blood-brain barrier disruption, excitotoxic damage, blood-spinal cord barrier damage, and mitochondrial dysfunctions. A cascade of pathophysiological events lead to accelerated production of free radicals (FR that further sustain the OS. To minimize the OS and restore normal oxidant/antioxidant ratio, a series of antioxidant substances is recommended to be administrated (vitamin C, vitamin E, resveratrol, N-acetylcysteine. In this paper we present the biochemical and pathophysiological mechanism of action of FR in patients with TBI and the antioxidant therapy available.
Kampen, P.J. van; Martina, J.D.; Vos, P.E.; Hoedemaekers, C.W.E.; Hendricks, H.T.
BACKGROUND: Heterotopic ossification (HO) is a frequent complication after traumatic brain injury (TBI). The current preliminary study is intended to provide additional data on the potential roles that brain injury severity, concomitant orthopaedic trauma, and specific intensive care complicating
Full Text Available Abstract Background Data on the incidence, nature, severity and cause of match football injuries sustained on dirt field are scarce. The objectives of this study was to compare the incidence, nature, severity and cause of match injuries sustained on dirt field and artificial turf field by amateur male football players. Methods A prospective two-cohort design was employed. Participants were 252 male football players (mean age 27 years, range 18-43 in 14 teams who participated in a local championship carried on a dirt field and 216 male football players (mean age 28 years, range 17-40 in 12 teams who participated in a local championship carried on a artificial turf field in the same zone of the city. Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Results The overall incidence of match injuries for men was 36.9 injuries/1000 player hours on dirt field and 19.5 on artificial turf (incidence rate ratio 1.88; 95% CI 1.19-3.05. Most common injured part on dirt field was ankle (26.7% and on artificial turf was knee (24.3%. The most common injury type in the dirt field was skin injuries (abrasion and laceration and in the artificial turf was sprain and ligament injury followed by haematoma/contusion/bruise. Most injuries were acute (artificial turf 89%, dirt field 91% and resulted from player-to-player contact (artificial turf 59.2%, dirt field 51.4%. Most injuries were slight and minimal in dirt field cohort but in artificial turf cohort the most injuries were mild. Conclusions There were differences in the incidence and type of football match injuries sustained on dirt field and artificial turf.
Goffus, Andrea M; Anderson, Gail D; Hoane, Michael
Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral controlled cortical impact (CCI) injuries or sham procedures and divided into three groups: CCI-NAM, CCI-vehicle, and sham. Thirty minutes following CCI, Alzet osmotic mini-pumps were implanted subcutaneously. NAM was delivered at a rate of 50 mg/kg/day for 7 days immediately post-CCI. On day 7 following injury, the pumps were removed and blood draws were collected for serum NAM and nicotinamide adenine dinucleotide (NAD+) analyses. Starting on day 2 post-CCI, animals were tested on a battery of sensorimotor tests (bilateral tactile adhesive removal, locomotor placing, and limb-use asymmetry). Continuous infusion of NAM resulted in a significant serum elevation in NAM, but not NAD+. Statistical analyses of the tactile removal and locomotor placing data revealed that continuous administration of NAM significantly reduced the initial magnitude of the injury deficit and improved overall recovery compared to the vehicle-treated animals. NAM treatment also significantly decreased limb-use asymmetries compared to vehicle-treated animals. The overall extent of the cortical damage was also reduced by NAM treatment. No detrimental effects were seen following continuous infusion. The present results suggest that NAM delivered via a clinically relevant therapeutic regimen may truncate behavioral damage following TBI. Thus our results offer strong support for translation into the clinical population.
Andrea M. Goffus
Full Text Available Previously, we have demonstrated that nicotinamide (NAM, a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI. However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral controlled cortical impact (CCI injuries or sham procedures and divided into three groups: CCI-NAM, CCI-vehicle and sham. Thirty minutes following CCI, Alzet osmotic mini-pumps were implanted subcutaneously. NAM was delivered at a rate of 50 mg/kg/day for 7 days immediately post-CCI. On day 7 following injury, the pumps were removed and blood draws were collected for serum NAM and nicotinamide adenine dinucleotide (NAD+ analyses. Starting on day 2 post-CCI, animals were tested on a battery of sensorimotor tests (bilateral tactile adhesive removal, locomotor placing and limb-use asymmetry. Continuous infusion of NAM resulted in a significant serum elevation in NAM, but not NAD+. Statistical analyses of the tactile removal and locomotor placing data revealed that continuous administration of NAM significantly reduced the initial magnitude of the injury deficit and improved overall recovery compared to the vehicle-treated animals. NAM treatment also significantly decreased limb-use asymmetries compared to vehicle-treated animals. The overall extent of the cortical damage was also reduced by NAM treatment. No detrimental effects were seen following continuous infusion. The present results suggest that NAM delivered via a clinically relevant therapeutic regimen may truncate behavioral damage following TBI. Thus our results offer strong support for translation into the clinical population.
Santosa, Sigit Puji; Mahyuddin, Andi Isra; Sunoto, Febrianto Guntur
There has been a steady increase in traffic accidents with major injuries in Indonesia over the last 10 years, especially those with a score higher than 3 on the Abbreviated Injury Scale (AIS). Frontal, side, and rear collisions, as well as pedestrian impact are modes of accident that contribute to the majority of injuries or fatalities. Based on age classification, the 16-30 age group are the most vulnerable road users in Indonesia. Traffic accidents in Indonesia are dominated by motorcycles...
Assimacopoulos, Evangelia M; Liao, Junlin; Heard, Jason P; Kluesner, Karen M; Wilson, Jeffrey; Wibbenmeyer, Lucy A
Considerable risk of burn injury exists for those patients on home oxygen therapy (HOT) who continue to smoke. In this study, the authors sought to establish the national incidence of burns incurred while smoking on HOT and to determine the resource utilization and sequelae of these injuries. A retrospective review of the American Burn Association's National Burn Repository was conducted to identify patients burned while on HOT during the years 2002 to 2011. Duplicate entries, as well as records of follow-up visits and readmissions, were removed. Univariate analysis was used to compare the differences between patients sustaining burn injuries related to HOT and patients with other mechanisms of injury. Multivariate analysis provided odds ratios for mortality controlling for all significant variables. The frequency of burns sustained on HOT significantly increased during the 10-year period reviewed and were associated with increased comorbidities and certain complications. Compared with non-HOT injuries, HOT injuries had higher incidence of inhalation injury and mortality. Inhalation injury was the strongest predictor of mortality in HOT burn injuries. The likelihood of poor prognosis was even more pronounced in patients who required intubation. Smoking was responsible for 83% of the HOT burn injuries described here. Therefore, smoking cessation counseling and treatment should be mandatory in all patients prescribed HOT.
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.
Hanschen, Marc; Kanz, Karl-Georg; Kirchhoff, Chlodwig; Khalil, Philipe N; Wierer, Matthias; van Griensven, Martijn; Laugwitz, Karl-Ludwig; Biberthaler, Peter; Lefering, Rolf; Huber-Wagner, Stefan
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.
Hanschen, Marc; Kanz, Karl-Georg; Kirchhoff, Chlodwig; Khalil, Philipe N.; Wierer, Matthias; van Griensven, Martijn; Laugwitz, Karl-Ludwig; Biberthaler, Peter; Lefering, Rolf; Huber-Wagner, Stefan
Background 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. Methods 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). Results 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. Conclusion 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. PMID:26136126
Kim, Sun Hyu
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.
McDonald, Skye; Fisher, Alana; Flanagan, Sharon; Honan, Cynthia A
People with a severe traumatic brain injury (TBI) often experience problems understanding non-literal utterances such as sarcasm and lies in dyadic exchanges. This study aimed to investigate whether these problems extend to settings where speakers vary in their degree of sincerity and whether such problems are associated with deficits in social cognitive abilities (emotion perception, theory of mind, and self-reported empathy) or cognitive abilities (abstract reasoning, working memory, processing speed, attentional switching). Thirty-one adults with severe TBI (24 males) and 25 demographically matched controls (20 males) participated. They watched video vignettes depicting four actors volunteering for additional duties. Each speaker made a limited verbal response which literally suggested a willingness to be involved, but the sincerity with which the response was made was tempered by the actor's emotional demeanour. Participants rated each speaker in the vignettes for degree of sincerity (0-100%). Standardized measures of cognitive and social cognitive function were also taken. Control participants had excellent agreement (α = .90) in their rankings of actors according to sincerity. TBI participants were less consistent (α = .65). Overall, they were sensitive to decreasing sincerity but generally less accurate than control participants. They were poorer at differentiating between levels of sincerity and rated insincere expressions as more sincere, although they rated sincere expressions similarly. Poorer working memory and poorer social cognition were associated with poorer sincerity/sarcasm detection in the participants with TBI, but only social cognition was uniquely associated. Some adults with TBI have difficulty assessing the level of sincerity of speakers. Moreover, poorer social cognition abilities are associated with this difficulty. © 2015 The British Psychological Society.
Schrieff, Leigh E; Thomas, Kevin G F; Dollman, Aimee K; Rohlwink, Ursula K; Figaji, Anthony A
Paediatric traumatic brain injury (PTBI) is a major public health problem. However, recent epidemiological data for PTBI in South Africa (SA) are lacking. To establish a demographic profile of severe PTBI admissions to the Red Cross War Memorial Children's Hospital (RCWMCH) over a 5-year period, by investigating trends in annual admissions, age, sex, language, time and day of injury, and aetiology. Methods. This retrospective, descriptive, quantitative study included children admitted to the RCWMCH with severe traumatic brain injury (TBI) between June 2006 and April 2011, who required intracranial monitoring. We used the Division of Paediatric Neurosurgery's TBI database to identify cases for inclusion in the study and to gather demographic and injury information. Descriptive statistics suggested that: (i) the number of annual admissions did not vary substantially across the study period; (ii) the peak admission age was 6 years; (iii) more boys than girls were admitted; (iv) the major mechanism of injury was pedestrian road traffic accidents; and (v) most injuries occurred on weekends. These results are discussed against the backdrop of international research on PTBI and reflect the extent to which epidemiological findings on TBI in high-income countries compare with those from low- and middle-income countries such as SA. The identification of aetiological factors and the description of demographic profiles of children sustaining TBI constitutes a basis for preventative policy administration and intervention strategies in SA.
Aimee K. Dollman
Full Text Available Background: Children who have sustained severe traumatic brain injuries (TBIs demonstrate a range of post-injury neurocognitive and behavioral sequelae, which may have adverse effects on their academic and behavioral outcomes and interfere with school re-entry, educational progress, and quality of life. These post-TBI sequelae are exacerbated within the context of a resource-poor country like South Africa (SA where the education system is in a somewhat precarious state especially for those from disadvantaged backgrounds.Objectives: To describe behavioral and academic outcomes of a group of school-aged SA children following severe TBI.Methods: The sample included 27 school-age children who were admitted to the Red Cross War Memorial Children's Hospital (RXH, SA, between 2006 and 2011 for closed severe TBI and who received intracranial monitoring. We collected behavioral data using the Child Behavior Checklist (CBCL and the Behavior Rating Inventory of Executive Function (BRIEF and academic information sourced from the BRIEF, CBCL, medical folders, and caregivers. Analyses include descriptive statistics and bivariate correlation matrices.Results: The descriptive results show that (1 more than half of the participants experienced clinically-significant behavioral problems across the CBCL scales, (2 the working memory BRIEF subscale appeared to be the most problematic subdomain, (3 two thirds of the sample were receiving some form of, or were in the process of being placed in, special needs education, (4 there was a three-fold increase in the use of special education services from pre- to post-injury, and (5 more than half (n = 16 of the sample repeated at least one grade after returning to school post-injury. Correlation analyses results suggest that children with increased externalizing behavioral problems and executive dysfunction are more likely to repeat a grade post-injury; and that children with executive dysfunction post-TBI are more likely
Dollman, Aimee K.; Figaji, Anthony A.; Schrieff-Elson, Leigh E.
Background: Children who have sustained severe traumatic brain injuries (TBIs) demonstrate a range of post-injury neurocognitive and behavioral sequelae, which may have adverse effects on their academic and behavioral outcomes and interfere with school re-entry, educational progress, and quality of life. These post-TBI sequelae are exacerbated within the context of a resource-poor country like South Africa (SA) where the education system is in a somewhat precarious state especially for those from disadvantaged backgrounds. Objectives: To describe behavioral and academic outcomes of a group of school-aged SA children following severe TBI. Methods: The sample included 27 school-age children who were admitted to the Red Cross War Memorial Children's Hospital (RXH), SA, between 2006 and 2011 for closed severe TBI and who received intracranial monitoring. We collected behavioral data using the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) and academic information sourced from the BRIEF, CBCL, medical folders, and caregivers. Analyses include descriptive statistics and bivariate correlation matrices. Results: The descriptive results show that (1) more than half of the participants experienced clinically-significant behavioral problems across the CBCL scales, (2) the working memory BRIEF subscale appeared to be the most problematic subdomain, (3) two thirds of the sample were receiving some form of, or were in the process of being placed in, special needs education, (4) there was a three-fold increase in the use of special education services from pre- to post-injury, and (5) more than half (n = 16) of the sample repeated at least one grade after returning to school post-injury. Correlation analyses results suggest that children with increased externalizing behavioral problems and executive dysfunction are more likely to repeat a grade post-injury; and that children with executive dysfunction post-TBI are more likely to
Severe injury involvements on arterial roads account for a quarter of the total severe injuries reported statewide. Crash severity analysis was conducted and consisted of six road entity models and twenty crash type models. The data preparation and s...
Weiss, Harold B.; Kaplan, Sigal; Prato, Carlo Giacomo
one 15–24year-old driver in New Zealand between 2002 and 2011 that resulted in minor, serious or fatal injuries. A mixed logit model accounting for heterogeneity and heteroscedasticity in the propensity to injury severity outcomes and for correlation between serious and fatal injuries proved a better...
Riddle, Art; Maire, Jennifer; Cai, Victor; Nguyen, Thuan; Gong, Xi; Hansen, Kelly; Grafe, Marjorie R; Hohimer, A Roger; Back, Stephen A
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...
Maryn, Youri; Roy, Nelson
Auditory-perceptual evaluation of dysphonia may be influenced by the type of speech/voice task used to render judgements during the clinical evaluation, i.e., sustained vowels versus continuous speech. This study explored (a) differences in listener dysphonia severity ratings on the basis of speech/voice tasks, (b) the influence of speech/voice task on dysphonia severity ratings of stimuli that combined sustained vowels and continuous speech, and (c) the differences in inter-rater reliability of dysphonia severity ratings between both speech tasks. Five experienced listeners rated overall dysphonia severity in sustained vowels, continuous speech and concatenated speech samples elicited by 39 subjects with various voice disorders and degrees of hoarseness. Data confirmed that sustained vowels are rated significantly more dysphonic than continuous speech. Furthermore, dysphonia severity in concatenated speech samples is least determined by the sustained vowel. Finally, no significant difference was found in inter-rater reliability between dysphonia severity ratings of sustained vowels versus continuous speech. Based upon the results, both types of speech/voice tasks (i.e., sustained vowel and continuous speech) should be elicited and judged by clinicians in the auditory-perceptual rating of dysphonia severity.
Jagger, Robert G; Abbasbhai, Ali; Patel, Dilan; Jagger, Daryll C; Griffiths, Alex
The aim of the study was to determine the prevalence of dental, orofacial and head injuries and of mouthguard use among schoolboy rugby players. All members of the first and second XV rugby squads at three secondary schools (two in England and one in Australia) were included in the study. All participants answered a questionnaire that sought information regarding dental, orofacial and head injuries. Statistical differences between groups were determined using chi-square tests for categorical variables and Kruskal-Wallis tests for discrete (count) variables. One hundred and seventy-eight completed questionnaires were returned (100% response rate). One hundred and twenty-five (70%) players reported having sustained at least one injury (range 1-4). Facial injuries were common. Dental injuries were the most prevalent injury: 46 (26%) were reported. Fractured teeth were reported by 20 (11%) players, and avulsed teeth by 7 (4%). There was evidence of a difference between schools in the prevalence of injured players (P=0.014), but among those reporting injuries, there was no difference between schools in the number of injuries (P=0.95). All players said that they used a mouthguard regularly. Dental, orofacial and head injuries were commonly reported. Dental injuries were the most prevalent type of injury. All players used mouthguards regularly.
Pomerantz, W J; Dowd, M D; Buncher, C R
The objective was to examine the relationship between injury rates and socioeconomic factors for children in Hamilton County, Ohio, using small-area analysis. The subjects were county residents less than 15 years old who were hospitalized or died of injuries between January 1, 1993, and December 31, 1995; they were identified through a population-based trauma registry. The census tract was the unit of analysis; the rate of injury per 100,000 population was the dependent variable. Risk factors included median income, level of education, percentage below the poverty level, percentage unemployment, percentage non-Caucasian, and percentage families headed by females. There were 2,437 children meeting the case definition; injuries per census tract ranged from 0 to 2,020.2 per 100,000 per year. Census tracts with higher injury rates had lower median incomes, more people with less than a high school education, more unemployment, more families headed by females, more people living below the poverty level, and more non-Caucasians than those with lower rates. In a regression model, percentage of people living below the poverty level, percentage of those who did not graduate from high school, and percentage unemployment were significant risk factors for injuries, P graduates and more unemployment.
Chung, Kevin K; Juncos, , Luis A; Wolf, Steven E; Mann, Elizabeth E; Renz, Evan M; White, Christopher E; Barillo, David J; Clark, Richard A; Jones, John A; Edgecombe, Harcourt P
.... We wondered whether early use of continuous renal replacement therapy (CRRT) changes outcomes in severely burned military casualties with predetermined criteria for acute kidney injury. Methods...
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.
Lax Pericall, Maria Teresa; Taylor, Eric
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.
Schroeder, Gregory D.; Vaccaro, Alexander R.; Kepler, Christopher K.; Koerner, John D.; Oner, F. Cumhur; Dvorak, Marcel F.; Vialle, Luiz R.; Aarabi, Bizhan; Bellabarba, Carlo; Fehlings, Michael G.; Schnake, Klaus J.; Kandziora, Frank
Study Design. Survey of spine surgeons. Objective. To develop a validated regional and global injury severity scoring system for thoracolumbar trauma. Summary of Background Data. The AOSpine Thoracolumbar Spine Injury Classification System was recently published and combines elements of both the
Sidaros, Annette; Skimminge, Arnold Jesper Møller; Liptrot, Matthew George
Traumatic brain injury (TBI) results in neurodegenerative changes that progress for months, perhaps even years post-injury. However, there is little information on the spatial distribution and the clinical significance of this late atrophy. In 24 patients who had sustained severe TBI we acquired 3D...... T1-weighted MRIs about 8 weeks and 12 months post-injury. For comparison, 14 healthy controls with similar distribution of age, gender and education were scanned with a similar time interval. For each subject, longitudinal atrophy was estimated using SIENA, and atrophy occurring before the first...... scan time point using SIENAX. Regional distribution of atrophy was evaluated using tensor-based morphometry (TBM). At the first scan time point, brain parenchymal volume was reduced by mean 8.4% in patients as compared to controls. During the scan interval, patients exhibited continued atrophy...
Hu, Jia; Guo, Ying-Qiang; Zhang, Er-Yong; Tan, Jin; Shi, Ying-Kang
The goal of this study was to analyze the patterns, therapeutic modalities, and short-term outcomes of patients with chest injuries in the aftermath of the Wen-Chuan earthquake, which occurred on May 12, 2008 and registered 8.0 on the Richter scale. Of the 1522 patients who were referred to the West China Hospital of Sichuan University from May 12 to May 27, 169 patients (11.1%) had suffered major chest injuries. The type of injury, the presence of infection, Abbreviated Injury Score (AIS 2005), New Injury Severity Score (NISS), treatment, and short-term outcome were all documented for each case. Isolated chest injuries were diagnosed in 129 patients (76.3%), while multiple injuries with a major chest trauma were diagnosed in 40 patients (23.7%). The mean AIS and the median NISS of the hospitalized patients with chest injuries were 2.5 and 13, respectively. The mortality rate was 3.0% (5 patients). Most of the chest injuries were classified as minor to moderate trauma; however, coexistent multiple injuries and subsequent infection should be carefully considered in medical response strategies. Coordinated efforts among emergency medical support groups and prior training in earthquake preparedness and rescue in earthquake-prone areas are therefore necessary for efficient evacuation and treatment of catastrophic casualties.
Background Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery. Methods We designed a “virtually minimal” approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks. Results The interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next. Conclusions Interactive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing. PMID:23938101
Dvorkin, Assaf Y; Ramaiya, Milan; Larson, Eric B; Zollman, Felise S; Hsu, Nancy; Pacini, Sonia; Shah, Amit; Patton, James L
Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery. We designed a "virtually minimal" approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks. The interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next. Interactive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing.
column injury except for cervical vertebral column, trunk, back and buttocks, upper extremity unspecified, hip , upper leg and thigh, knee, other...the ICD-9 codes that describe trauma, and constructs a matrix using 12 natures of injury ( fractures , dislocations, sprains and strains, internal...versions were used in the analysis. The 11 of the 12 injury natures were collapsed into orthopaedic injuries ( fractures , dislocations, sprains and strains
Koelmeyer, T D; Beer, B; Mullins, P R
A computer-based analysis of the injury patterns sustained by victims in the DC-10 aircraft that crashed into Mt. Erebus, Antarctica, On November 28, 1979, is presented. The distribution of these injury patterns supports the hypothesis that at impact the plane was in a nose-high attitude with respect to the slope and the impact point was the underside of the rear section of the fuselage.
Franz, T; Hasler, R M; Benneker, L; Zimmermann, H; Siebenrock, K A; Exadaktylos, A K
To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe spinal injuries related to alpine skiing and snowboarding. A six-year review of all adult patients with severe spinal injuries sustained from alpine skiing or snowboarding. Tertiary trauma centre in Bern, Switzerland. All adult patients (over 16 years of age) admitted to a tertiary trauma centre from 1 July 2000, through 30 June 2006, were reviewed using a computerised database. From these records, a total of 728 patients injured from snow sports were identified. Severe spinal injuries (defined as spinal fractures, subluxations, dislocations or concomitant spinal cord injuries) were found in 73 patients (17 female, 56 male). The clinical features of these patients were reviewed with respect to epidemiological factors, mechanism of injury, fracture pattern, and neurological status. The majority of severe spinal injuries (n = 63) were related to skiing. Fatal central-nervous injuries and transient or persistent neurological symptoms occurred in 28 patients (23 skiers, 5 snowboarders). None of the snowboarders suffered from persistent neurological sequelae. Snowboarders with severe spinal injuries (n = 10) were all male (p<0.05), and were significantly younger than skiers (p<0.001). The most commonly affected site was the lumbar spine. However, 39 patients (53.4%) suffered from injury pattern at two or more levels. With advances in technology and slope maintenance, skiers and snowboarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in snow sports, but until recently very little attention has been given to spinal injury prevention on the slopes. Suggestions for injury prevention include the use of spine protectors, participation on appropriate runs for ability level, proper fit and adjustment of equipment, and taking lessons with the goal of increasing ability and learning
From 18 July 2003 to 1 August 2003 (the first three weeks after the June/July holidays), 25 injuries occurred. Conclusion Our findings were similar to those of other studies in certain respects but differed in others. Further research should investigate the effect of coaching techniques, fitness levels, protective gear and first aid ...
Errington, Gail; Evans, Catrin; Watson, Michael C
Sustaining public health programmes in the long-term is key to ensuring full manifestation of their intended benefits. Although an increasing interest in sustainability is apparent within the global literature, empirical studies from within the European setting are few. The factors that influence sustainability are generally conceptualized at three levels: programme level, the immediate context and the wider environment. To-date attention has focused primarily on the former two. Using a community-based child injury prevention programme in England as an exemplar, this paper explores the concept of sustainability within the wider policy environment, and considers the impact of this on local programmes. A content review of global and UK national public health policies (1981-2014) relevant to child safety was undertaken. Interviews were held with senior representatives of global and UK agencies involved in developing child safety policy. Forty-nine policies were reviewed. The term 'sustain', or its derivatives, featured in 36 (73%) of these. Its' use however, related primarily to conservation of resources rather than continued programme operation. Potential mechanisms for supporting programme sustainability featured within some documents; however, the approach to sustainability was inconsistent between policies and over time. Policy stakeholders identified programme sustainability as relevant to their core business, but its' conceptualization varied according to individual interpretation. Programme sustainability is poorly addressed within global and UK-based public health policy. Strengthening a national and international policy focus on sustainability and incorporating sustainability into public health planning frameworks may create a more supportive environment for local programmes.
AWARD NUMBER: W81XWH-16-2-0046 TITLE: The Epidemiology of Epilepsy and Traumatic Brain Injury: Severity, Mechanism, and Outcomes PRINCIPAL...COVERED 30 Sep 2016 – 29 SEP 2017 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER The Epidemiology of Epilepsy and Traumatic Brain Injury: Severity...previous research has found that Post-9/11 Veterans with any kind of traumatic brain injury (TBI) were more likely to develop epilepsy than those without
Results from this prospective cohort study were compared to a similar study done in the United States of America (USA). An injury was defined as any damage to an athlete's body that needed the attention of the ringside physician. Statistical analyses included descriptive statistics and a stepwise logistic regression. Odds of ...
Sollid, S.; Sundstrom, T.; Kock-Jensen, C.
. Evidence-based guidelines already exist that focus on all steps in the process. In the present article members of the Scandinavian Neurotrauma Committee present recommendations on prehospital management of traumatic brain injury adapted to the infrastructure of the Nordic region Udgivelsesdato: 2008/6/26...
2 School of Child and Adolescent Health, Division of Neurosurgery, Department of Surgery, Red Cross War Memorial Children's Hospital,. Cape Town, South Africa. Corresponding author: L E Schrieff (firstname.lastname@example.org). Background. Paediatric traumatic brain injury (PTBI) is a major public health problem. However ...
Kathryn van Boom
concussions include soccer, basketball, skiing, lacrosse, baseball, basketball, snowboarding, skateboarding and motocross. Many head injuries in athletes are the result of improper playing techniques and this can be reduced in. African athletes through the teaching of proper skills and enforcing safety promoting rules..
Kjærsgaard, Annette; Kaae Kristensen, Hanne
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...
Yewlin E. Chee
Conclusions and importance: Poor presenting acuity is a known risk factor for poor visual outcome after open globe injury. We hypothesize this remarkable visual recovery could be attributable to the presence of a massive choroidal hemorrhage and limited intraocular hemorrhage elsewhere. In rare cases, vision can improve from the no light perception level after secondary vitreoretinal surgery.
The changing etiological factors and patterns of maxillofacial injuries reported from different regions at different times is largely modulated by prevailing socioeconomic, cultural, environmental and legislative factors, as well as location of the trauma center.[4‑6] Recently, published literature shows that assault.
African Safety Promotion: A Journal of Injury and Violence Prevention. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 2 (2012) >. Log in or Register to get access to full text downloads.
de Roulet, Amory; Inaba, Kenji; Strumwasser, Aaron; Chouliaras, Konstantinos; Lam, Lydia; Benjamin, Elizabeth; Grabo, Daniel; Demetriades, Demetrios
Injuries after skiing and snowboarding accidents lead to an estimated 7,000 hospital admissions annually and present a significant burden to the health care system. The epidemiology, injury patterns, hospital resource utilization, and outcomes associated with these severe injuries need further characterization. The National Trauma Data Bank was queried for the period 2007 to 2014 for admissions with Injury Severity Score > 15 and International Classification of Diseases Codes-9th Revision codes 885.3 (fall from skis, n = 1,353) and 885.4 (fall from snowboard, n = 1,216). Demographics, emergency department data, diagnosis and procedure codes, and outcomes were abstracted from the database. Severe (Injury Severity Score > 15) ski-associated and snowboard-associated injuries differed with respect to age distribution (median age, 38; interquartile range, 19-59 for skiers and median age, 20; interquartile range, 16-25 for snowboarders; p snowboarders, p snowboarders. Severe injuries after ski and snowboard accidents are associated with significant morbidity and mortality. Differences in injury patterns, risk factors for severe injury, and resource utilization require further study. Increased resource allocation to alpine trauma systems is warranted. Prognostic/epidemiologic, level III.
Cripton, Peter A; Shen, Hui; Brubacher, Jeff R; Chipman, Mary; Friedman, Steven M; Harris, M Anne; Winters, Meghan; Reynolds, Conor C O; Cusimano, Michael D; Babul, Shelina; Teschke, Kay
To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics. Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics. Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission). In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians. Published by the BMJ Publishing Group Limited. For permission to use (where
Cripton, Peter A; Shen, Hui; Brubacher, Jeff R; Chipman, Mary; Friedman, Steven M; Harris, M Anne; Winters, Meghan; Reynolds, Conor C O; Cusimano, Michael D; Babul, Shelina; Teschke, Kay
Objective To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics. Methods Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics. Results Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission). Conclusions In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians. PMID:25564148
Bena, Antonella; Pasqualini, O; Tomaino, A; Mamo, C; Costa, G
The indicators of severity commonly used for studying workplace injuries are somewhat limited. It is possible to use RIDIT Analysis (Relative to an Identified Distribution) as an alternative method To order occupations in Italy by severity of workplace injuries and discuss the methodological problems and the outcomes from available administrative data. The database included injuries defined by INAIL (National Institute for Insurance against Occupational Accidents and Diseases) in Italy in the period 1995-99 in the industrial and artisan sectors (1,647,220 events). RIDIT Analysis was applied using Bross analysis of ordinal data. A distribution of injuries in Italy for the same period on a six-level scale of severity was used as a reference. The RIDIT value for each occupation was calculated and stratified by age, sex, and occupational sector. Among men, the occupations in which injuries were more severe than the average in Italy were construction, transport, woodworking, and mining. Above-average injury severity among women was found in transport drivers, postwomen, messengers, and workers in performing arts, the food industry, and tourism. A positive relationship between age and severity of injury was observed in all occupations in both sexes. Average severity was higher among artisans. The method used allows ranking of occupations according to injury severity and should be systematically introduced into existing systems of surveillance so that data can be used to foster prevention and workplace safety.
Viano, David C; Parenteau, Chantal S
This study investigated the risk of severe-to-fatal injury (MAIS 4+F) to near- and far-seated front occupants in side impacts by belt use and crash severity (delta V). 1993-2007 NASS-CDS was analyzed for front-seat occupants in side impacts while they were either the near-side or far-side occupant by belt use. Light vehicles were included with model year 1994+. Injury severity was subdivided into MAIS 0-2, 3, and 4+F. The risk for MAIS 4+F injury was determined by dividing the number of MAIS 4+F by the number of exposed occupants with known injuries. Individual NASS-CDS cases were downloaded from the 1997-2007 electronic data to evaluate injury patterns causing high relative risks. In 35+ mph side-impact delta Vs, the risk for MAIS 4+F injury was 75.4 +/- 41.0% for unbelted near-side and 48.1 +/- 14.6% for unbelted far-side occupants. The risk was 51.8 +/- 14.8% for belted near-side and 30.9 +/- 8.2% for far-side occupants. Seat belt use was 81.4% effective in preventing MAIS 4+F injury for near-side occupants and 93.5% for far-side occupants. The relative risk (RR) for unbelted compared to belted occupants was 35.9 for far-side occupants in 10-15 mph delta V crashes. The relative risk was 35.1 for near-side occupants in ejection. Seat belt use was more effective in preventing severe injury (MAIS 4+F) to far-side occupants than near-side occupants in ejection, impact with the side interior, or impact with the frontal components where airbags sometimes deployed.
Kocamer Şimşek, Betül; Dokur, Mehmet; Uysal, Erdal; Çalıker, Necdet; Gökçe, Oruç Numan; Deniz, İbrahim Kürşat; Uğur, Murat; Geyik, Murat; Kaya, Mehmet; Dağlı, Güner
During a war, many civilians are severely injured by firearms, bombs, and shrapnel. The triage of war injuries involves difficult and complicated processes requiring surgical procedures and patient monitoring in the Intensive Care Unit (ICU) of hospitals. In this study, we examine the demographic, traumatic, and critical care characteristics of cases injured during the civil war in Syria and requiring emergency surgery. Electronic data of the traumatic, surgical, and ICU monitoring features of 707 patients admitted to Kilis Public Hospital between March 2012 and January 2013 were analyzed retrospectively RESULTS: Most of the patients reported having been injured due to firearms (83.75%). Of the 707 cases studied in this work, 93.2% was male. Male patients reported a mean age of 26.1±12.1 years, while pediatric cases reported a mean age of 11.7±3.41 years. The most frequently injured region of the body was the head-neck region (52.7%). The New Injury Severity Score (NISS) of the cases was 42.5±11.2 and their American Society of Anesthesiologists (ASA) score was 3.2±0.7. The number of cases with intraoperative exitus was 7, while the number of cases who had undergone damage control surgery was 204. The number of cases hospitalized in the ICU during the postoperative period was 233, and the average hospitalization duration in the ICU was 4.67±1.32 days. Among survivor patients, the first 24-hour invasive measurements (i.e., pH, hemoglobin, body temperature, and mean arterial blood pressure) and international normalized ratio were found to be high. The number of blood products used for surviving patients was fewer relative to that used for non-surviving patients, and these NISS of these patients was 29.7±10.1. The mortality rate of all patients followed up in the ICU after emergency surgery was 45%, and neurosurgical cases showed the lowest level of survival (24.1%). The results of this study indicated that head-neck, chest-abdomen, and multiple body injuries are
Ye. A. Spiridonova; S. A. Rumyantsev; F. G. Sharshov; D. V. Prometnoy; A. V. Chernozubenko
Objective: to study stepwise differences in the severity and pattern of severe traumatic injuries due to road traffic accidents in patients during the qualified and specialized stages of medical care in the age...
load (51). Also, with arm movements the upper trapezius and the levator scapulae become involved and resist neck movement, thus directly and...proper diet and weight control; 2. Regular strength and aerobic training with stretching and functional respiration training; 3. Massage, sauna and...physical warm-up including stretching neck muscles immediately before taking off while the pilot is in the cockpit. 39 CHAPTER 10 CERVICAL INJURY AND
Schoenfeld, Andrew J; Dunn, John C; Bader, Julia O; Belmont, Philip J
Previous studies regarding combat wounding have a limited translational capacity due to inclusion of soldiers from all military branches and occupational specialties as well as a lack of information regarding soldiers who died in theater. A search was performed of the Department of Defense Trauma Registry and Armed Forces Medical Examiner data set for the years 2003 to 2011 to identify all injured personnel with the military specialty 19D (cavalry scout). A manual search was conducted for each record identified, and age, rank, location and manner of injury, mechanism of injury, Injury Severity Score (ISS), and extent of wounding were abstracted. The incidence of injuries by body region and rates for specific types of wounds were determined. Statistically significant associations between rank, location of injury, manner of injury, body region involved, and injury mechanism were assessed using χ2 analysis. Associations between ISS, rank, manner of injury, and survival were evaluated by t test with Satterthwaite correction. A total of 701 casualties were identified with 3,189 distinct injuries. Mean (SD) age of injured personnel was 25.9 (6.0) years. Thirty-five percent of the cohort was composed of soldiers who died in theater. Explosions were the most common mechanism of injury (70%), while 18% of wounds occurred owing to gunshot. Extremity wounds and injuries to the head and neck represented 34% of casualty burden. Thoracic trauma occurred in 16%, and abdominal injuries occurred in 17%. Wounds with a frequency exceeding 5% included skin, extremity, facial, brain, and gastrointestinal injuries. Vascular injury occurred in 4%. Gunshot wounds were a greater cause of injury in Afghanistan (p = 0.001) and resulted in a higher percentage of thoracic injuries (p trauma sustained by combat-specific personnel seems to be different from that experienced by all soldiers deployed to a war zone.
Lippa, Sara M; Brickell, Tracey A; Bailie, Jason M; French, Louis M; Kennedy, Jan E; Lange, Rael T
Examine effects of diagnostically relevant posttraumatic stress disorder (PTSD) symptoms, mild traumatic brain injury (TBI) severity, and associated bodily injury severity on postconcussion symptom reporting in female service members (SM) compared with a matched sample of male SM. Six US military medical treatment facilities. A total of 158 SM (79 females, 79 males) evaluated within 30 months after mild TBI. Men and women were matched by age, days postinjury, PTSD symptom status, mild TBI severity, and bodily injury severity. All passed a measure of symptom validity. Compare reported postconcussion symptoms for men and women stratified by PTSD diagnostic symptoms (present/absent), mild TBI severity (alteration of consciousness/loss of consciousness), and bodily injury severity (mild/moderate-severe). Neurobehavioral Symptom Inventory, PTSD Checklist, Abbreviated Injury Scale. Overall postconcussion symptom reporting increased with PTSD but did not significantly differ based on severity of mild TBI or associated bodily injury. Females reported more somatosensory and/or vestibular symptoms than males under some circumstances. Females in the PTSD-Present group, Alteration of Consciousness Only group, and Moderate-Severe Bodily Injury group reported more somatosensory symptoms than males in those groups. Females in the Alteration of Consciousness Only group and Minor Bodily Injury group reported more vestibular symptoms than males in those groups. Diagnostically relevant PTSD symptoms, mild TBI severity, and bodily injury severity differentially impact somatosensory and vestibular postconcussion symptom reporting for male and female SM after mild TBI. Controlling for PTSD and symptom validity resulted in fewer gender-based differences in postconcussive symptoms than previously demonstrated in the literature.
allow for standardisation , but careful selection of the model and methodolo- gies are important to ensure they are relevant to the clinical problem under...which K wires are passed to fix the implant to the femur. This produces a standardised and reproducible bone defect which will not heal spontaneously...for examination as it was believed there was an obvious potential for use in contami- nated combat injuries. When tested in the contaminated rat femur
... HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Required Documentation To Be Deemed... to establish that a smallpox vaccine recipient or vaccinia contact sustained a covered injury, a... records, including the admission history and physical examination, the discharge summary, all physician...
Anastasopoulos, Panagiotis Ch; Shankar, Venky N; Haddock, John E; Mannering, Fred L
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.
Helak, Kelsey; Jehle, Dietrich; McNabb, Daniel; Battisti, Amanda; Sanford, Steward; Lark, Mary Claire
In 2014, 726 bicyclists were killed and an additional 50,000 were injured in crashes with motor vehicles. The number of cyclists in the United States is increasing, and as a result there has been a call for more bike lanes. We examined the difference in the severity of injury of bicyclists involved in motor vehicle crashes when riding in the traffic lane compared with riding in a bike lane or on a paved shoulder. We also controlled for other safety factors, including alcohol use, travel speed, posted speed, helmet usage, and lighting conditions to determine their impact on bicyclist safety. Single-year National Automotive Sampling System-General Estimates System files were used to analyze data regarding the bike lanes, and multiyear data were used to analyze the additional factors. Univariate and multiple regression analyses controlling for confounders were performed on the data. When adjusting for speed limit, alcohol use by driver, weather conditions, time of day, and helmet use, the cyclist's position had no significant effect on the severity of injury (P = 0.57). The severity of injury was significantly greater when the driver or bicyclist had been drinking alcohol (P bike lane or a paved shoulder, does not reduce the severity of injuries sustained when a crash with a motor vehicle takes place. Cyclist safety could be improved by implementing changes that affect vehicle speed, alcohol use by drivers, and lighting conditions. Moreover, emergency physicians should be aware that when they receive a report of a cyclist being struck by a car in a bike lane, they should prepare to treat injuries of severity similar to those received by a bicyclist hit by a vehicle in traffic.
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
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.
V. V. Moroz
Full Text Available Objective. To study the mechanisms of posttraumatic changes in the blood cells, by investigating DNA damages associat ed with hypoxia caused by massive blood loss (BL in severe injury.Subjects and methods. Ninetyfive patients aged 40.6±16.5 years (from 20 to 79 years who had sustained severe mechanical injury with different BL volumes (BLV (from 100 to 4000 ml and hemodynamic disorders were examined to study DNA damages and white blood cell necrotic and apop totic processes. In terms of the victims' weight, the mean BL was 21.5±16.5 ml/kg (from 1.4 to 61.5 ml/kg. The victimswere divided into 4 groups according to BLV: 1 26 victims whose BLV was less than 750 ml (5.93±2.41 ml/kg (grade I BL; 2 23 victims whose BLV was 750—1500 ml (11.5±1.5 ml/kg (grade 2 BL; 3 23 victims whose BLV was 1500—2000 ml (23.8±4.0 ml/kg (grade 3 BL; 4 23 victims whose BLV was over 2000 ml (45.6±10.1 ml/kg (grade 4 BL, according to the type of injury: 1 severe skeletal injury (SSI (n=17; 2 brain injury (BI (n=43; 3 a concurrence of SSI and BI (SSI+BI (n=35; according to the development of infectious complications: 1 69 victims who developed infectious com plications on days 5—7 postinjury; 2 26 victims who did not. To evaluate the impact of hypoxia on DNA damages, white blood cell apoptotic and necrotic processes, the victims were divided into 2 groups: 1 hypoxia (18 of the 95 victims who had 4 altered indicators, such as capillary blood pO2, plasma lactate levels, pH, and BE; 2 no hypoxia (10 of the 95 victims whose indicators were within the normal range. DNA damages and necrotic and apoptotic changes in the white blood cells were assessed by the DNA comet assay. The plasma concentration of extracellular DNA was fluorometrically determined using a QuantiTTM HS DNA Assay Kit (Invitrogen, USA. That of 8hydroxy2deoxyguanosine was estimated by enzyme immunoassay employing an 8hydroxy2deoxyGuanosine EIA Kit (Cayman Chemical, USA. The levels of cas
defined as motor or sensory dysfunction involving the peroneal or tibial nerve distal to the popliteal fossa. Surveillance cultures were obtained during...rates after open fractures sustained during combat range from 1% to 50% and may be influenced by injury inclusion criteria and infection definitions
Brooks, M Alison; Evans, Michael D; Rivara, Frederick P
This study compares skiing and snowboarding injuries in terrain parks versus slopes at two ski areas, 2000-05. A total of 3953 (26.7%) injuries occurred in terrain parks, predominantly among young male snowboarders. Terrain park injuries were more likely to be severe, involving head (RR 1.31, 95% CI 1.16 to 1.48) or back (RR 1.96, 95% CI 1.67 to 2.29).
Norup, Anne; Siert, Lars; Lykke Mortensen, Erik
31 primary relatives of patients with severe brain injury. The participants were recruited at admission to Traumatic Brain Injury Unit, Copenhagen University Hospital, Glostrup. All relatives completed the depression and anxiety scales from SCL-90-R (Symptom Checklist) and the Role Emotional, Social...... of life and symptoms of anxiety and depression at the time of admission. Future research should focus on developing and evaluating interventions in the acute phase....... Function, Mental Health and Vitality scale of the SF-36 approximately 36 days after injury. Data concerning severity of injury, the patients' level of consciousness and function was also collected. MAIN OUTCOME AND RESULTS: The participants had significantly lower scores on all quality of life scales (p...
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.
Ye. A. Spiridonova
Full Text Available Objective: to study stepwise differences in the severity and pattern of severe traumatic injuries due to road traffic accidents in patients during the qualified and specialized stages of medical care in the age groups of 1 month to 18 years in the Rostov Region. Material and methods. The 2004—2009 case reports were used to make a retrospective comparative assessment of the condition of victims with severe road traffic injury at care stages in 2 groups: 1 one-month- to 18-year-old children who had been primarily admitted to the qualified-stage intensive care units (n=61; 2 one-month-to 18-year-old patients from the intensive care unit of the Regional Children’s Hospital, referred from the qualified-stage intensive care units (n=133. Results. The number of specialized-stage children in grave and extremely extensive grave condition at the specialized stage was 14.7% more than that at the qualified stage (100 and 85.3%, espectively. Concomitant injury was encountered more frequently (by 13% in the specialized-stage patients (73.7 and 60.7%, respectively. The severity of road traffic injury was determined mainly by brain injuries at the qualified irnd specialized stages (96.7 and 96.1%, by skeletal injuries (11.6% more frequently and thoracic ones (9.8% more frequently at the specialized stage. The prevalence of abdominal injuries at the qualified stage was 9.8% higher. The pattern of brain injury in the specialized-stage patients showed a preponderance of brain contusion and epidural hematomas by 18.5 and 6.5%, respectively. Conclusion. Severe thoracic and brain injuries (craniocerebral injuries, brain contusion, and intracranial hematomas are an indication for patient referral to the specialized care stage in order to perform high-technological diagnostic and therapeutic methods. Key words: children, road traffic accidents, severe injury, medical care stages.
Edlow, Brian L; Chatelle, Camille; Spencer, Camille A; Chu, Catherine J; Bodien, Yelena G; O'Connor, Kathryn L; Hirschberg, Ronald E; Hochberg, Leigh R; Giacino, Joseph T; Rosenthal, Eric S; Wu, Ona
See Schiff (doi:10.1093/awx209) for a scientific commentary on this article. Patients with acute severe traumatic brain injury may recover consciousness before self-expression. Without behavioural evidence of consciousness at the bedside, clinicians may render an inaccurate prognosis, increasing the likelihood of withholding life-sustaining therapies or denying rehabilitative services. Task-based functional magnetic resonance imaging and electroencephalography techniques have revealed covert consciousness in the chronic setting, but these techniques have not been tested in the intensive care unit. We prospectively enrolled 16 patients admitted to the intensive care unit for acute severe traumatic brain injury to test two hypotheses: (i) in patients who lack behavioural evidence of language expression and comprehension, functional magnetic resonance imaging and electroencephalography detect command-following during a motor imagery task (i.e. cognitive motor dissociation) and association cortex responses during language and music stimuli (i.e. higher-order cortex motor dissociation); and (ii) early responses to these paradigms are associated with better 6-month outcomes on the Glasgow Outcome Scale-Extended. Patients underwent functional magnetic resonance imaging on post-injury Day 9.2 ± 5.0 and electroencephalography on Day 9.8 ± 4.6. At the time of imaging, behavioural evaluation with the Coma Recovery Scale-Revised indicated coma (n = 2), vegetative state (n = 3), minimally conscious state without language (n = 3), minimally conscious state with language (n = 4) or post-traumatic confusional state (n = 4). Cognitive motor dissociation was identified in four patients, including three whose behavioural diagnosis suggested a vegetative state. Higher-order cortex motor dissociation was identified in two additional patients. Complete absence of responses to language, music and motor imagery was only observed in coma patients. In patients with behavioural evidence
V. V. Moroz
Full Text Available Early changes in the parameters of central hemodynamics and pulmonary extravascular fluid were studied in patients who had sustained a severe concomitant injury in combination with acute massive blood loss. Early postoperative monitoring of these parameters by a «Pulsion Picco Plus» invasive monitoring apparatus was ascertained to verify the early stages on non-cardiogenic pulmonary edema, to assess a risk for acute lung lesion and acute respiratory distress syndrome in the phase of reperfusion lesions, and to perform an adequate correction of therapy.
Stender, Johan; Mortensen, Kristian Nygaard; Thibaut, Aurore
Differentiation of the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS) is a persistent clinical challenge . Based on positron emission tomography (PET) studies with [18F]-fluorodeoxyglucose (FDG) during sleep and anesthesia, the global cerebral metabolic rate...... changes in brain metabolism . We here used FDG-PET to measure resting state brain glucose metabolism in 131 DOC patients to identify objective quantitative metabolic indicators and predictors of awareness. Quantitation of images was performed by normalizing to extracerebral tissue. We show that 42......, associated with the reemergence of consciousness after brain injury. Our data further revealed that regional variations relative to the global resting metabolic level reflect preservation of specific cognitive or sensory modules, such as vision and language comprehension. These findings provide a simple...
Holm, Sara; Schönberger, Michael; Poulsen, Ingrid
was low compared to other studies using the EBIQ. Furthermore, the effects of injury severity and general level of functioning had limited impact on the subjective experience of difficulties. Implications of these findings, specifically as they pertain to the sub-acute stage are discussed Udgivelsesdato......The present study aimed to (1) identify the difficulties most frequently reported by individuals with severe traumatic brain injury (TBI) at the time of discharge from a sub-acute rehabilitation brain injury unit as well as difficulties reported by their relatives, (2) compare patients......' and relatives' reports of patient difficulties, and (3) explore the role of injury severity, disability and other factors on subjective experience of difficulties. The primary measure was the European Brain Injury Questionnaire (EBIQ) administered to patients and to one of their close relatives at discharge...
Doser, Karoline; Norup, Anne
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...
Newgard, Craig D; Sanchez, Brittany J; Bulger, Eileen M; Brasel, Karen J; Byers, Adam; Buick, Jason E; Sheehan, Kellie L; Guyette, Frank X; King, Richard V; Mena-Munoz, Jorge; Minei, Joseph P; Schmicker, Robert H
Relatively little is known about the context and location of firearm injury events. Using a prospective cohort of trauma patients, we describe and compare severe firearm injury events to other violent and nonviolent injury mechanisms regarding incident location, proximity to home, time of day, spatial clustering, and outcomes. This was a secondary analysis of a prospective cohort of injured children and adults with hypotension or Glasgow Coma Scale score ≤ 8, injured by one of four primary injury mechanisms (firearm, stabbing, assault, and motor vehicle collision [MVC]) who were transported by emergency medical services to a Level I or II trauma center in 10 regions of the United States and Canada from January 1, 2010, through June 30, 2011. We used descriptive statistics and geospatial analyses to compare the injury groups, distance from home, outcomes, and spatial clustering. There were 2,079 persons available for analysis, including 506 (24.3%) firearm injuries, 297 (14.3%) stabbings, 339 (16.3%) assaults, and 950 (45.7%) MVCs. Firearm injuries resulted in the highest proportion of serious injuries (66.3%), early critical resources (75.3%), and in-hospital mortality (53.5%). Injury events occurring within 1 mile of a patient's home included 53.9% of stabbings, 49.2% of firearm events, 41.3% of assaults, and 20.0% of MVCs; the non-MVC events frequently occurred at home. While there was geospatial clustering, 94.4% of firearm events occurred outside of geographic clusters. Severe firearm events tend to occur within a patient's own neighborhood, often at home, and generally outside of geospatial clusters. Public health efforts should focus on the home in all types of neighborhoods to reduce firearm violence. © 2016 by the Society for Academic Emergency Medicine.
Meyers, Michael C
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: F2,720 = 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 soccer. The findings of this study, however, may not be generalizable to other levels of competition or to other artificial surfaces.
Krasny-Pacini, Agata; Chevignard, Mathilde; Lancien, Sabine; Escolano, Sylvie; Laurent-Vannier, Anne; De Agostini, Maria; Meyer, Philippe
Executive function (EF) impairment is a major predictor of overall outcome after traumatic brain injury (TBI). TBI severity is a factor of poor outcome, but most studies include a majority of children with mild and moderate TBI. The aims of this study were to estimate EF impairment after severe childhood TBI and to explore factors predicting EF outcome. The secondary aim was to compare recovery trajectories by age-at-injury groups. This was a prospective longitudinal study of children with severe TBI who were tested for EFs by performance-based tests and questionnaires at 3, 12 and 24 months. Children with TBI (n=65) showed significant impairment in working memory, inhibition, attention and global EF, with little or no recovery at 24 months. For flexibility and performance-based EF score, children were impaired at 3 months only and showed normal scores by 12 months. No impairment was found in planning. At 3 and 24 months, Glasgow Coma Scale score and parental education predicted global EF. Coma length was not a significant predictor of outcome. Age at injury predicted progress in EF, but the relationship was not linear; children 10-12 years old at injury showed better outcome than older and younger children. EFs are impaired after severe TBI in childhood. The relationship between age at injury and outcome is not linear. Relying on only performance-based EF tests can underestimate EF impairment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Haller, Chiara S; Delhumeau, Cecile; De Pretto, Michael; Schumacher, Rahel; Pielmaier, Laura; Rebetez, Marie My Lien; Haller, Guy; Walder, Bernhard
The objective was to investigate disability and health-related quality-of-life (HRQoL) 3, 6 and 12 months after traumatic brain injury (TBI) in non-geriatric (≤ 65 years) and geriatric patients (> 65 years). Patients ≥ 16 years who sustained a severe TBI (Abbreviated Injury Scale of the head region > 3) were included in this prospective, multi-centre study. Outcome measures were Glasgow Outcome Scale Extended (GOSE; disability), SF-12 (HRQoL). Mixed linear model analyses were performed. Three hundred and fifty-one patients (median age = 50 years; interquartile range (IQR) = 27-67) were included; 73.2% were male and 27.6% were geriatric patients. Median GOSE at 3, 6 and 12 months was 5 (IQR = 3-7), 6 (IQR = 4-8) and 7 (IQR = 5-8); this increase (slopetime = 0.22, p geriatric patients this improvement was relevant for HRQoL only.
Alway, Yvette; Gould, Kate Rachel; McKay, Adam; Johnston, Lisa; Ponsford, Jennie
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.
de Koning, Myrthe E; Scheenen, Myrthe E; van der Horn, Harm J; Timmerman, Marieke E; Hageman, Gerard; Roks, Gerwin; Spikman, Jacoba M; van der Naalt, Joukje
To study return to work (RTW) after mild traumatic brain injury (mTBI) at several intervals after injury and to predict RTW on the basis of occupational factors in addition to demographic, personality, and injury-related factors at 6 and 12 months after injury. This was a prospective cohort study (UPFRONT study, n = 1,151) of patients with mTBI admitted to the emergency department. Patients received questionnaires at 2 weeks and 3, 6, and 12 months after injury. RTW was divided into 3 levels: complete (cRTW), partial (pRTW), and no RTW. Rates of cRTW increased from 34% at 2 weeks to 77% at 12 months after injury, pRTW varied from 8% to 16% throughout the year. Logistic regression (complete vs incomplete RTW) demonstrated that apart from previously identified predictors such as demographics (e.g., age and education) and injury characteristics (e.g., cause and severity of injury) and indicators of psychological distress, occupational factors were of influence on work resumption after 6 months (area under the curve [AUC] = 0.82), At 12 months, however, the model was based solely on the presence of extracranial injuries and indicators of maladaptation after injury (AUC = 0.81). RTW after mTBI is a gradual process, with varying levels of RTW throughout the first year after injury. Different predictors were relevant for short- vs long-term work resumption, with occupational factors influencing short-term RTW. However, for both short- and long-term RTW, posttraumatic complaints and signs of psychological distress early after injury were relevant predictors, allowing early identification of patients at risk for problematic work resumption. © 2017 American Academy of Neurology.
Smidt, Helle Rønn; Pallesen, Hanne; Buhl, Inge
Early neurorehabilitation is an interdisciplinary field. Thus, in order to eliminate unnecessary barriers for individuals with severe acquired brain injury in early rehabilitation, we need rehabilitation science that supports both quantitative and qualitative research methods. Participation can...
The impact of seat‑belts in limiting the severity of injuries in patients presenting to a university hospital in the developing world. Olumuyiwa Joshua Ogundele, Adeleke O Ifesanya, Sylvester A Adeyanju, Samuel O Ogunlade ...
Poulsen, Ingrid; Norup, Anne; Liebach, Annette
-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...
Baguley, Ian J; Heriseanu, Roxana E; Gurka, Joseph A
The pharmacological management of dysautonomia, otherwise known as autonomic storms, following acute neurological insults, is problematic and remains poorly researched. This paper presents six subjects with dysautonomia following extremely severe traumatic brain injury where gabapentin controlled...
Strandroth, Johan; Sternlund, Simon; Lie, Anders; Tingvall, Claes; Rizzi, Matteo; Kullgren, Anders; Ohlin, Maria; Fredriksson, Rikard
Pedestrians and bicyclists account for a significant share of deaths and serious injuries in the road transport system. The protection of pedestrians in car-to-pedestrian crashes has therefore been addressed by friendlier car fronts and since 1997, the European New Car Assessment Program (Euro NCAP) has assessed the level of protection for most car models available in Europe. In the current study, Euro NCAP pedestrian scoring was compared with real-life injury outcomes in car-to-pedestrian and car-tobicyclist crashes occurring in Sweden. Approximately 1200 injured pedestrians and 2000 injured bicyclists were included in the study. Groups of cars with low, medium and high pedestrian scores were compared with respect to pedestrian injury severity on the Maximum Abbreviated Injury Scale (MAIS)-level and risk of permanent medical impairment (RPMI). Significant injury reductions to both pedestrians and bicyclists were found between low and high performing cars. For pedestrians, the reduction of MAIS2+, MAIS3+, RPMI1+ and RPMI10+ ranged from 20-56% and was significant on all levels except for MAIS3+ injuries. Pedestrian head injuries had the highest reduction, 80-90% depending on level of medical impairment. For bicyclist, an injury reduction was only observed between medium and high performing cars. Significant injury reductions were found for all body regions. It was also found that cars fitted with autonomous emergency braking including pedestrian detection might have a 60-70% lower crash involvement than expected. Based on these results, it was recommended that pedestrian protection are implemented on a global scale to provide protection for vulnerable road users worldwide.
Leeper, Christine M; Neal, Matthew D; McKenna, Christine J; Gaines, Barbara A
To trend fibrinolysis after injury and determine the influence of traumatic brain injury (TBI) and massive transfusion on fibrinolysis status. Admission fibrinolytic derangement is common in injured children and adults, and is associated with poor outcome. No studies examine fibrinolysis days after injury. Prospective study of severely injured children at a level 1 pediatric trauma center. Rapid thromboelastography was obtained on admission and daily for up to 7 days. Standard definitions of hyperfibrinolysis (HF; LY30 ≥3), fibrinolysis shutdown (SD; LY30 ≤0.8), and normal (LY30 = 0.9-2.9) were applied. Antifibrinolytic use was documented. Outcomes were death, disability, and thromboembolic complications. Wilcoxon rank-sum and Fisher exact tests were performed. Exploratory subgroups included massively transfused and severe TBI patients. In all, 83 patients were analyzed with median (interquartile ranges) age 8 (4-12) and Injury Severity Score 22 (13-34), 73.5% blunt mechanism, 47% severe TBI, 20.5% massively transfused. Outcomes were 14.5% mortality, 43.7% disability, and 9.8% deep vein thrombosis. Remaining in or trending to SD was associated with death (P = 0.007), disability (P = 0.012), and deep vein thrombosis (P = 0.048). Median LY30 was lower on post-trauma day (PTD)1 to PTD4 in patients with poor compared with good outcome; median LY30 was lower on PTD1 to PTD3 in TBI patients compared with non-TBI patients. HF without associated shutdown was not related to poor outcome, but extreme HF (LY30 >30%, n = 3) was lethal. Also, 50% of massively transfused patients in hemorrhagic shock demonstrated SD physiology on admission. All with HF (fc31.2%) corrected after hemostatic resuscitation without tranexamic acid. Fibrinolysis shutdown is common postinjury and predicts poor outcomes. Severe TBI is associated with sustained shutdown. Empiric antifibrinolytics for children should be questioned; thromboelastography-directed selective use should be considered for
Turgeon, Alexis F; Lauzier, François; Zarychanski, Ryan; Fergusson, Dean A; Léger, Caroline; McIntyre, Lauralyn A; Bernard, Francis; Rigamonti, Andrea; Burns, Karen; Griesdale, Donald E; Green, Robert; Scales, Damon C; Meade, Maureen O; Savard, Martin; Shemilt, Michèle; Paquet, Jérôme; Gariépy, Jean-Luc; Lavoie, André; Reddy, Kesh; Jichici, Draga; Pagliarello, Giuseppe; Zygun, David; Moore, Lynne
Severe traumatic brain injury is a significant cause of morbidity and mortality in young adults. Assessing long-term neurological outcome after such injury is difficult and often characterised by uncertainty. The objective of this feasibility study was to establish the feasibility of conducting a large, multicentre prospective study to develop a prognostic model of long-term neurological outcome in critically ill patients with severe traumatic brain injury. A prospective cohort study. 9 Canadian intensive care units enrolled patients suffering from acute severe traumatic brain injury. Clinical, biological, radiological and electrophysiological data were systematically collected during the first week in the intensive care unit. Mortality and functional outcome (Glasgow Outcome Scale extended) were assessed on hospital discharge, and then 3, 6 and 12 months following injury. The compliance to protocolised test procedures was the primary outcome. Secondary outcomes were enrolment rate and compliance to follow-up. We successfully enrolled 50 patients over a 12-month period. Most patients were male (80%), with a median age of 45 years (IQR 29.0-60.0), a median Injury Severity Score of 38 (IQR 25-50) and a Glasgow Coma Scale of 6 (IQR 3-7). Mortality was 38% (19/50) and most deaths occurred following a decision to withdraw life-sustaining therapies (18/19). The main reasons for non-enrolment were the time window for inclusion being after regular working hours (35%, n=23) and oversight (24%, n=16). Compliance with protocolised test procedures ranged from 92% to 100% and enrolment rate was 43%. No patients were lost to follow-up at 6 months and 2 were at 12 months. In this multicentre prospective feasibility study, we achieved feasibility objectives pertaining to compliance to test, enrolment and follow-up. We conclude that the TBI-Prognosis prospective multicentre study in severe traumatic brain injury patients in Canada is feasible. Published by the BMJ
Ye. A. Kameneva; S. S. Koval; Ye. V Grigoryev; A. S. Razumov; O N Yegorova
Objective: to enhance the efficiency of intensive therapy and prevention of pyoseptic complications (PSC) of severe concomitant injury. Subjects and methods: A hundred patients who were divided into three groups were examined. A control group consisted of 30 apparently healthy individuals (donors). A study group comprised 38 patients to whom the standard of intensive care and prevention of PSC of severe concomitant injury was applied. A comparison group included 32 patients who received speci...
van Delft-Schreurs, C.C.; van Bergen, J.; de Jongh, M.A.; van de Sande, P.; Verhofstad, M.H.; de Vries, J.
Background Former studies have demonstrated that health-related quality of life is decreased in severely injured patients. However, in those studies patients were asked about their functioning and not about their (dis)contentment concerning their functioning. Little is known about how severely
Held, Manuel; Medved, Fabian; Rothenberger, Jens; Rahmanian-Schwarz, Afshin; Schaller, Hans-Eberhard
Methyl iodide (iodomethane) is a monohalomethane that is mainly used as an intermediate in the manufacturing of different pharmaceuticals and pesticides. Until now, only 13 cases of methyl iodide poisoning have been described in the literature. The authors present the first case of severe chemical burn injury due to methyl iodide exposure in a 36-year-old Caucasian man who suffered superficial to partial-thickness burn injuries over 75% of his BSA and developed neurological malfunctions and prolonged respiratory insufficiency. Human poisoning with methyl iodide is very rare. In addition to the already described neurological symptoms and respiratory insufficiency, severe chemical burn injury can cause a life-threatening medical emergency.
Amantini, A; Fossi, S; Grippo, A; Innocenti, P; Amadori, A; Bucciardini, L; Cossu, C; Nardini, C; Scarpelli, S; Roma, V; Pinto, F
To monitor acute brain injury in the neurological intensive care unit (NICU), we used EEG and somatosensory evoked potentials (SEP) in combination to achieve more accuracy in detecting brain function deterioration. Sixty-eight patients (head trauma and intracranial hemorrhage; GCSSEP and intracranial pressure monitoring (ICP). Fifty-five patients were considered "stable" or improving, considering the GCS and CT scan: in this group, SEP didn't show significant changes. Thirteen patients showed neurological deteriorations and, in all patients, cortical SEP showed significant alterations (amplitude decrease>50% often till complete disappearance). SEP deterioration anticipated ICP increase in 30%, was contemporary in 38%, and followed ICP increase in 23%. Considering SEP and ICP in relation to clinical course, all patients but one with ICP less than 20 mmHg were stable, while the three patients with ICP greater than 40 mmHg all died. Among the 26 patients with ICP of 20-40 mmHg, 17 were stable, while nine showed clinical and neurophysiological deterioration. Thus, there is a range of ICP values (20-40 mmHg) were ICP is scarcely indicative of clinical deterioration, rather it is the SEP changes that identify brain function deterioration. Therefore, SEP have a twofold interest with respect to ICP: their changes can precede an ICP increase and they can constitute a complementary tool to interpret ICP trends. It has been very important to associate SEP and EEG: about 60% of our patients were deeply sedated and, because of their relative insensitivity to anesthetics, only SEP allowed us to monitor brain damage evolution when EEG was scarcely valuable. We observed 3% of nonconvulsive status epilepticus compared to 18% of neurological deterioration. If the aim of neurophysiological monitoring is to "detect and protect", it may not be limited to detecting seizures, rather it should be able to identify brain deterioration, so we propose the combined monitoring of EEG with SEP.
The estimated glomerular filtration rate (eGFR) was calculated using the modified Schwartz equation. Results: AKI occurred in 32 of 960 patients with severe malaria giving a prevalence of 3.3%. They were aged 8 months to 9 years with majority (84.4%) less than 60 months. There were more males with a male: female ratio ...
Almutawa, M; Scott, M; George, K P; Drust, B
To compare the incidence, severity and nature of injuries sustained by Saudi National Team footballers during match-play and training on natural grass and 3rd generation (3G) artificial turf. Injury data was collected on all Saudi National Team players competing at the Gulf Cup (Yemen December 2010: 3G) and the Asian Cup (Qatar January 2011; grass). A total of 49 players were studied (mean ± SD; Age 27 ± 4 yr; body mass 71.4 ± 6.7 kg; height 176.8 ± 6.3 cm; professional playing experience 9 ± 3 yr) of which 31 competed at the Gulf Cup, 32 at the Asian Cup (14 at both). A prospective cohort design was used to investigate the incidence, nature and severity of injuries sustained with data collected using a standardised injury questionnaire. All data were collected by the team physiotherapist with the definition of injury set at any injury that required player and clinician contact. Injury and exposure data were collected and reported for games, training and all football activity. A total of 82 injuries [incidence - 56.1 per 1000 h total game and training exposure] were recorded at the Asian Cup (grass) and 72 injuries [incidence - 37.9 per 1000 h total game and training exposure] were recorded at the Gulf Cup (3G). Incidence data for training, game and all football exposure injury rates were higher when playing on grass. The vast majority of injuries on both surfaces were very minor that, whilst requiring medical attention, did not result in loss of match/training exposure. Injuries that resulted in 1-3 days absence from training or game play had similar incidence rates (Grass: 7.4 vs. 3G: 7.4 injuries per 1000 h exposure). More severe injuries were less frequent but with a higher incidence when playing on grass. Lower limb injuries were the most common in both tournaments with a higher incidence on grass (Grass: 14.2 vs. 3G: 7.9 injuries per 1000 h exposure). Muscle injuries were the most frequent of all injuries with similar incidence rates on
Brouwer, W; Riese, H; Hoedemaeker, M; Mulder, B; Veldman, H; Withaar, F
After severe concussion, return to work is often problematic. Our study focuses on a persistent complaint of these patients, namely mental fatiguableness. To study mental fatiguableness the effect of sustained work load is assessed in a continuous divided attention task at two levels of workload, 50
Riberholt, Christian Gunge; Olesen, Niels Damkjær; Thing, Mira
mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P frequency domain revealed lower magnitudes of ∼0.......1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury.......Early mobilization is of importance for improving long-term outcome for patients after severe acquired brain injury. A limiting factor for early mobilization by head-up tilt is orthostatic intolerance. The purpose of the present study was to examine cerebral autoregulation in patients with severe...
Simonsen, Louise Lau; Sonne-Holm, Stig; Krasheninnikoff, Michael
The incidence of heterotopic ossification (HO) among patients with traumatic brain injury (TBI) varies in the literature from 11 to 73.3%. The aim of this study was to determine the incidence of HO among patients with very severe TBI treated in a new established intensive rehabilitation Brain...... as well as data about trauma severity and hospital stay of these patients have been registered prospectively in a database (Danish National Head Injury database) at the Brain Injury Unit where the sub acute rehabilitation took place. The present study was based retrospectively on this database, combined...... with X-rays obtained for symptoms of HO and/or as fracture control. Clinically significant HO was found in 7.9% of the patients. Logistic regression showed an independent significant positive correlation between HO, the female gender and a high Injury Severity Score. The low incidence of HO might...
V. M. Kapitonov
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.
Gartland, Sam; Malik, Mohammad Hammad; Lovell, Martyn
To investigate prospectively the type and rate of injuries sustained during amateur Muay Thai competition. Prospective cohort study collection of data following clinical examination. Amateur Muay Thai competitions in the United Kingdom organized by the International Amateur Muay Thai Federation. Amateur Muay Thai boxers. Both sexes. Lightweight to super heavyweight. There were 92 participants, 12 females and 82 males. The average age was 17.3 years, and the average previous number of bouts was 3.9. A total of 588.5 minutes of competition time was assessed during a total of 10 events. Injury rates were 1.3 injuries per 100 minutes of competition in the lightweight category, 2.25 per 100 minutes of competition in the middleweight category, 30 per 100 minutes of competition in the heavyweight category, and 2.54 per 100 minutes of competition in the super heavyweight category. Compared with other reported martial arts, the injury rates are higher in Muay Thai. The head was shown to be the most common site of injury in amateur fighters, but there was an almost complete absence of lower limb injuries, which again is at variance with reported figures for other martial arts.
Akinbami Babatunde Olayemi
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.
Hanrahan, Robert B; Layde, Peter M; Zhu, Shankuan; Guse, Clare E; Hargarten, Stephen W
To quantify the association of driver's age with the risk of being injured, dying, and experiencing injuries of different severity when involved in a motor vehicle crash. Data from the Wisconsin Crash Outcome Data Evaluation System (CODES) from 2002 to 2004 were used to study 602,964 drivers of a car or truck who were involved in a motor vehicle crash. Odds ratios (OR) or relative risk ratios (RRR) and their 95 percent confidence intervals (CIs) were calculated for age groups, in relation to the outcomes of injury, fatality, and injury severity using logistic regression models, which controlled for sex, alcohol use, urban/rural location, seat belt use, ejection, airbag deployment, vehicle type, and highway class. Increasing age was strongly associated the risk of dying or experiencing severe injuries for drivers involved in motor vehicle crashes with the greatest risk in drivers 85 years and older. Compared to drivers aged 25-44, drivers 85 years and older had the highest risks for moderate injury (ISS = 9-15; RRR = 5.44, 95% CI: 3.97-7.47), severe injury (ISS = 16-74; (RRR = 4.32, 95% CI: 2.73-6.84), and fatality (OR = 10.93, 95% CI: 7.76-15.38). In contrast, drivers 85 years and older had no increase in risk for minor injury (ISS = 1-8; OR = 0.94, 95% CI: 0.84-1.05). The oldest drivers involved in motor vehicle crashes had the highest risk for severe injury and fatality. In light of the increasing number of the oldest drivers and their poor outcomes from severe trauma, substantial morbidity can be expected to occur in the oldest drivers. Evidence-based measures to reduce the risks to older drivers should continue to be developed, evaluated, and implemented.
Viano, David C; Parenteau, Chantal S
This study investigates the risk for severe-to-fatal injury (Maximum Abbreviated Injury Scale [MAIS] 4+F) to drivers in two-vehicle crashes involving front impacts into the rear of another vehicle. 1995-2009 National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) was analyzed for driver injuries in front-to-rear crashes without rear occupants in either vehicle. The study involved 13+-year-old front outboard occupants in model year (MY) 1995+ light vehicles. Injury severity was subdivided into MAIS 0+6 and MAIS 4+F to assess the risk of severe-to-fatal injury (MAIS 4+F/MAIS 0+6). Injury risks were determined using weighted data for the drivers by impact type. Standard errors were calculated in SAS to determine ±95 percent confidence intervals. An in-depth analysis was made of individual cases with severely injured drivers in the front and rear impacts. There were 215,163 drivers in the 15 years of NASS-CDS with known injuries in front-to-rear two-vehicle collisions; 624 were severely injured (MAIS 4+F) in the rear impacts and 124 in the front impacts. The risk for severe-to-fatal driver injury was 0.290 ± 0.241 percent in rear impacts and 0.058 ± 0.057 percent in front impacts. The difference was not statistically significant (P > .05). There were 13 unweighted cases with MAIS 4+F driver injury in rear impacts. Most (77%) involved intrusion in the vicinity of the driver's seating area with the seat supported upright or deformed forward. There were 5 unweighted cases with severely injured drivers in frontal impacts. Three (60%) involved intrusion due to offset frontal loading. There was only one crash where both drivers were severely injured. In front-to-rear crashes with two vehicles, typically one driver was severely injured, not both. The risk of severe injury was not significantly different for drivers in the front or rear impacts. The risk was higher in rear impacts due to intrusion into the driver's seating area that supported or pushed
Dvorkin, Assaf Y; Ramaiya, Milan; Larson, Eric B; Zollman, Felise S; Hsu, Nancy; Pacini, Sonia; Shah, Amit; Patton, James L
.... We designed a "virtually minimal" approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task...
Eluru, Naveen; Bhat, Chandra R
This paper formulates a comprehensive econometric structure that recognizes two important issues in crash-related injury severity analysis. First, the impact of a factor on injury severity may be moderated by various observed and unobserved variables specific to an individual or to a crash. Second, seat belt use is likely to be endogenous to injury severity. That is, it is possible that intrinsically unsafe drivers do not wear seat belts and are the ones likely to be involved in high injury severity crashes because of their unsafe driving habits. The preceding issues are considered in the current research effort through the development of a comprehensive model of seat belt use and injury severity that takes the form of a joint correlated random coefficients binary-ordered response system. To our knowledge, this is the first instance of such a model formulation and application not only in the safety analysis literature, but in the econometrics literature in general. The empirical analysis is based on the 2003 General Estimates System (GES) data base. Several types of variables are considered to explain seat belt use and injury severity levels, including driver characteristics, vehicle characteristics, roadway design attributes, environmental factors, and crash characteristics. The results, in addition to confirming the effects of various explanatory variables, also highlight the importance of (a) considering the moderating effects of unobserved individual/crash-related factors on the determinants of injury severity and (b) seat belt use endogeneity. From a policy standpoint, the results suggest that seat belt non-users, when apprehended in the act, should perhaps be subjected to both a fine (to increase the chances that they wear seat belts) as well as mandatory enrollment in a defensive driving course (to attempt to change their aggressive driving behaviors).
Cehreli, Zafer C; Sara, Sezgi; Aksoy, Burak
Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-Year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 Months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth.
Cehreli, Zafer C; Sara, Sezgi; Aksoy, Burak
Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth.
The Erythropoietin in Traumatic Brain Injury (EPO-TBI) trial aims to determine whether the administration of erythropoietin to patients with moderate or severe traumatic brain injury improves patient-centred outcomes.
Clay, Fiona J; Perry, Luke A; Hicks, Amelia J; Batty, Rachel; Tufanaru, Catalin; Jayaram, Mahesh; Ponsford, Jennie; Hopwood, Malcolm
The objective of this systematic review is to synthesize the current evidence on the effectiveness and harms of pharmacotherapy in the management of depression in adults who have sustained a traumatic brain injury.
Weiss, Harold B; Kaplan, Sigal; Prato, Carlo G
Young people are a risk to themselves and other road users, as motor vehicle crashes are the leading cause of their death. A thorough understanding of the most important factors associated with injury severity in crashes involving young drivers is important for designing well-targeted restrictive measures within youth-oriented road safety programs. The current study estimates discrete choice models of injury severity of crashes involving young drivers conditional on these crashes having occurred. The analysis examined a comprehensive set of single-vehicle and two-vehicle crashes involving at least one 15-24 year-old driver in New Zealand between 2002 and 2011 that resulted in minor, serious or fatal injuries. A mixed logit model accounting for heterogeneity and heteroscedasticity in the propensity to injury severity outcomes and for correlation between serious and fatal injuries proved a better fit than a binary and a generalized ordered logit. Results show that the young drivers' behavior, the presence of passengers and the involvement of vulnerable road users were the most relevant factors associated with higher injury severity in both single-vehicle and two-vehicle crashes. Seatbelt non-use, inexperience and alcohol use were the deadliest behavioral factors in single-vehicle crashes, while fatigue, reckless driving and seatbelt non-use were the deadliest factors in two-vehicle crashes. The presence of passengers in the young drivers' vehicle, and in particular a combination of males and females, dramatically increased the probability of serious and fatal injuries. The involvement of vulnerable road users, in particular on rural highways and open roads, considerably amplified the probability of higher crash injury severity. Copyright © 2014 Elsevier Ltd. All rights reserved.
dʼHeurle, Albert; Archdeacon, Michael T; Hiratzka, Shannon; Casstevens, Christopher; Finnan, Ryan; McCoy, Brett
To determine the relationship between injury severity surrogates and other patient factors with the development and severity of heterotopic ossification (HO) following open reduction internal fixation of acetabular fractures treated with a posterior approach. Retrospective review. Academic level 1 trauma center. Two hundred forty-one patients who were treated through a posterior approach with a minimum of 6-month radiographic follow-up were identified from an acetabular fracture database. None. The occurrence and severity (Brooker Grade III/IV) of HO 6 months postsurgery. Length of stay (LOS) in the intensive care unit (ICU), non-ICU LOS >10 days, and HO prophylaxis with external radiation beam therapy (XRT) were significantly associated with the development of HO in a multivariate model [ICU LOS: 1-2 days, odds ratio (OR) = 4.33, 95% confidence interval (CI): 1.03-18.25; 3-6 days, OR = 4.1, 95% CI, 1.27-13.27; >6 days, OR = 11.7, 95% CI, 3.24-42.22; non-ICU LOS >10 days (vs. 0-6 days): OR = 7.6, 95% CI, 2.6-22.25; XRT HO prophylaxis: OR = 0.29, 95% CI, 0.10-0.85]. Other variables evaluated in multivariate modeling not significantly associated with development and severity of HO included age, gender, mechanism of injury, injury severity score, presence of neurologic injury, Letournel fracture type, occurrence of hip dislocation, interval from injury to surgery, operative time, and estimated blood loss. Surrogates of injury severity, including days in the ICU and non-ICU hospital LOS >10 days, were associated with the development of HO in our cohort of acetabular fracture patients. Prophylaxis with XRT was significantly protective against the development of HO, and the ability to provide prophylaxis is very likely related to the severity of injury. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Driedger, Michael R; Gupta, Arjun; Wells, Bryan; Dixon, Elijah; Ball, Chad G
Falls are an increasingly common source of severe traumatic injury. They now account for approximately 40% of both overall trauma volumes and injury-related deaths within Canada. In northern climates, the risk of all types of falls may increase during the fall/winter months when conditions become increasingly dangerous. The purpose of this study was to define the injury and patient demographics of severe trauma that occurs during falls associated with the installation of Christmas lights. All patients who were admitted to a referral level 1 trauma center (2002-2012) with severe injuries (ISS≥12) caused during Christmas light installation were retrospectively reviewed. Standard statistical methodology was utilised (pChristmas lights. Injuries included: neurologic (68%), thoracic (68%), spinal (43%), extremity (40%), and multiple other sites. Fall mechanisms were: ladder (65%), roof (30%), ground (3%) and railing (3%). Interventions included intubation and critical care (20%), as well as orthopaedic and neurosurgical operative repairs (30%). The median length of hospital stay was 15.6 days (range: 2-165). The fall-related morbidity (28%) and mortality (5%) were significant with a total of 12.5% patients requiring transfer to a long-term care or rehabilitation facility. Falls while installing Christmas lights during the fall/winter seasons can result in severe life-altering injuries with considerable morbidity and mortality. Caution should be employed when installing lights at any height. Copyright © 2015 Elsevier Ltd. All rights reserved.
Christian Gunge Riberholt
Full Text Available Early mobilization is of importance for improving long-term outcome for patients after severe acquired brain injury. A limiting factor for early mobilization by head-up tilt is orthostatic intolerance. The purpose of the present study was to examine cerebral autoregulation in patients with severe acquired brain injury and a low level of consciousness. Fourteen patients with severe acquired brain injury and orthostatic intolerance and fifteen healthy volunteers were enrolled. Blood pressure was evaluated by pulse contour analysis, heart rate and RR-intervals were determined by electrocardiography, middle cerebral artery velocity was evaluated by transcranial Doppler, and near-infrared spectroscopy determined frontal lobe oxygenation in the supine position and during head-up tilt. Cerebral autoregulation was evaluated as the mean flow index calculated as the ratio between middle cerebral artery mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P < 0.001. Spectral analysis of heart rate variability in the frequency domain revealed lower magnitudes of ~0.1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury.
Schöffl, Volker R; Hoffmann, Georg; Küpper, Thomas
injuries sustained, suggesting indoor climbing has a low risk of acute injury per 1000 hours of participation. The injuries were of minor to moderate injury severity, and no fatalities occurred. Several injuries could have been avoided, and further injury-prevention concepts should be developed. Wilderness Medical Society.
Quddus, Mohammed A; Noland, Robert B; Chin, Hoong Chor
Motorcycles constitute about 19% of all motorized vehicles in Singapore and are generally overrepresented in traffic accidents, accounting for 40% of total fatalities. In this paper, an ordered probit model is used to examine factors that affect the injury severity of motorcycle accidents and the severity of damage to the vehicle for those crashes. Nine years of motorcycle accident data were obtained for Singapore through police reports. These data included categorical assessments of the severity of accidents based on three levels. Damage severity to the vehicle was also assessed and categorized into four levels. Categorical data of this type are best analyzed using ordered probit models because they require no assumptions regarding the ordinality of the dependent variable, which in this case is the severity score. Various models are examined to determine what factors are related to increased injury and damage severity of motorcycle accidents. Factors found to lead to increases in the probability of severe injuries include the motorcyclist having non-Singaporean nationality, increased engine capacity, headlight not turned on during daytime, collisions with pedestrians and stationary objects, driving during early morning hours, having a pillion passenger, and when the motorcyclist is determined to be at fault for the accident. Factors leading to increased probability of vehicle damage include some similar factors but also show some differences, such as less damage associated with pedestrian collisions and with female drivers. In addition, it was also found that both injury severity and vehicle damage severity levels are decreasing over time.
Azouvi, Philippe; Couillet, Josette; Leclercq, Michel; Martin, Yves; Asloun, Sybille; Rousseaux, Marc
The aim of this study was to assess dual-task performance in TBI patients, under different experimental conditions, with or without explicit emphasis on one of two tasks. Results were compared with measurement of the subjective mental effort required to perform each task. Forty-three severe TBI patients at the subacute or chronic phase performed two tasks under single- and dual-task conditions: (a) random generation; (b) visual go-no go reaction time task. Three dual-task conditions were given, requiring either to consider both tasks as equally important or to focus preferentially on one of them. Patients were compared to matched controls. Subjective mental effort was rated on a visual analogic scale. TBI patients showed a disproportionate increase in reaction time in the go-no go task under the dual-task condition. However, they were just as able as controls to adapt performance to the specific instructions about the task to be emphasised. Patients reported significantly higher subjective mental effort, but the variation of mental effort according to task condition was similar to that of controls. These results suggest that the divided attention deficit of TBI patients is related to a reduction in available processing resources rather than an impairment of strategic processes responsible for attentional allocation and switching. The higher level of subjective mental effort may explain why TBI patients frequently complain of mental fatigue, although this subjective complaint seems to be relatively independent of cognitive impairment.
Parreira, José G; Oliari, Camilla B; Malpaga, Juliano M D; Perlingeiro, Jacqueline A G; Soldá, Silvia C; Assef, José C
to assess the severity and treatment of "occult" intra-abdominal injuries in blunt trauma victims. Retrospective analysis of charts and trauma register data of adult blunt trauma victims, admitted without abdominal pain or alterations in the abdominal physical examination, but were subsequently diagnosed with intra-abdominal injuries, in a period of 2 years. The severity was stratified according to RTS, AIS, OIS and ISS. The specific treatment for abdominal injuries and the complications related to them were assessed. Intra-abdominal injuries were diagnosed in 220 (3.8%) out of the 5785 blunt trauma victims and 76 (34.5%) met the inclusion criteria. The RTS and ISS median (lower quartile, upper quartile) were 7.84 (6.05, 7.84) and 25 (16, 34). Sixty seven percent had a GCS≥13 on admission. Injuries were identified in the spleen (34), liver (33), kidneys (9), intestines (4), diaphragm (3), bladder (3) and iliac vessels (1). Abdominal injuries scored AIS≥3 in 67% of patients. Twenty-one patients (28%) underwent laparotomy, 5 of which were nontherapeutic. The surgical procedures performed were splenectomy (8), suturing of the diaphragm (3), intestines (3), bladder (2), kidneys (1), enterectomy/anastomosis (1), ligation of the common iliac vein (1), and revascularization of the common iliac artery (1). Angiography and embolization of liver and/or spleen injuries were performed in 3 cases. Three patients developed abdominal complications, all of which were operatively treated. There were no deaths directly related to the abdominal injuries. Severe "occult" intra-abdominal injuries, requiring specific treatment, may be present in adult blunt trauma patients. Copyright © 2015 Elsevier Ltd. All rights reserved.
Edavettal, Mathew; Gross, Brian W; Rittenhouse, Katelyn; Alzate, James; Rogers, Amelia; Estrella, Lisa; Miller, Jo Ann; Rogers, Frederick B
A growing body of literature indicates that beta-blocker administration after traumatic brain injury (TBI) is cerebroprotective, limiting secondary injury; however, the effects of preinjury beta blocker status remain poorly understood. We sought to characterize the effects of pre- and postinjury beta-blocker administration on mortality with subanalyses accounting for head injury severity and myocardial injury. In a Level II trauma center, all admissions of patients ≥18 years with a head Abbreviated Injury Scale Score ≥2, Glasgow Coma Scale ≤13 from May 2011 to May 2013 were queried. Demographic, injury-specific, and outcome variables were analyzed using univariate analyses. Subsequent multivariate analyses were conducted to determine adjusted odds of mortality for beta-blocker usage controlling for age, Injury Severity Score, head Abbreviated Injury Scale, arrival Glasgow Coma Scale, ventilator use, and intensive care unit stay. A total of 214 trauma admissions met inclusion criteria: 112 patients had neither pre- nor postinjury beta-blocker usage, 46 patients had preinjury beta-blocker usage, and 94 patients had postinjury beta-blocker usage. Both unadjusted and adjusted odds ratios of preinjury beta-blocker were insignificant with respect to mortality. However, postinjury in-hospital administration of beta blockers was found to significantly in the decrease of mortality in both univariate (P = 0.002) and multivariate analyses (P = 0.001). Our data indicate that beta-blocker administration post-TBI in hospital reduces odds of mortality; however, preinjury beta-blocker usage does not. Additionally, myocardial injury is a useful indicator for beta-blocker administration post-TBI. Further research into which beta blockers confer the best benefits as well as the optimal period of beta-blocker administration post-TBI is recommended.
Williams, Anthony J; Ling, Geoffrey S F; Tortella, Frank C
Penetrating ballistic brain injury (PBBI) is a high-energy transfer wound causing direct damage to the cerebrum. Outcome is directly related to the ballistic's anatomical path and degree of energy transfer. In this study we evaluated differences in outcome induced by altering the 'projectile' paths and severity levels of a simulated bullet wound using a newly characterized rat model of PBBI. Severity levels (5, 10, and 15%) were compared across three distinct injury paths: (1) unilateral 'frontal', (2) 'bilateral' hemispheric, and (3) unilateral 'caudal' (including cerebellum/midbrain). Outcome was assessed by differences in mortality rate and motor dysfunction (e.g. neurological and balance beam deficits). Results indicated that outcome was dependent not only on the severity level of PBBI (Pbrain regions injured (Pdamage associated with PBBI.
Mohammadzadeh, Mahdi; Paravar, Mohammad; Mirzadeh, Azadeh Sadat; Mohammadzadeh, Javad; Mahdian, Soroush
Road traffic accidents (RTAs) are the main public health problems in Iran. The seat belts, which are vehicle safety devices, are imperative to reduce the risk of severe injuries and mortality. The aim of the study was to evaluate injury patterns, severity and outcome among belted and unbelted car occupants who were injured in car accidents. This cross-sectional prospective study was performed on all car occupants injured in RTAs (n = 822) who were transported to hospital and hospitalized for more than 24 hours from March 2012 to March 2013. Demographic profile of the patients, including age, gender, position in the vehicle, the use of seat belts, type of car crashes, injured body regions, revised trauma score (RTS), Glasgow coma score (GCS), duration of hospital stay and mortality rate were analyzed by descriptive analysis, chi-square and independent t-test. P seat belts (68.1%). The unbelted occupants were younger (28 years vs. 38 years) and had more frequently sustained head, abdomen and multiple injuries (P = 0.01, P = 0.01 and P = 0.009, respectively). Also, these patients had significantly lower GCS and elongated hospitalization and higher death rate (P = 0.001, P = 0.001 and P = 0.05, respectively). Tendency of severe head trauma and low RTS and death were increased in unbelted occupants in car rollover accident mechanisms (P = 0.001, P = 0.01 and P = 0.008, respectively). During car crashes, especially car rollover, unbelted occupants are more likely to sustain multiple severe injuries and death. Law enforcement of the seat belt usage for all occupants (front and rear seat) is obligatory to reduce severe injuries sustained as a result of car accidents, especially in vehicles with low safety.
Luca Loredana; Rogobete Alexandru Florin; Bedreag Ovidiu Horea
Traumatic Brain Injury (TBI) is one of the leading causes of death among critically ill patients from the Intensive Care Units (ICU). After primary traumatic injuries, secondary complications occur, which are responsible for the progressive degradation of the clinical status in this type of patients. These include severe inflammation, biochemical and physiological imbalances and disruption of the cellular functionality. The redox cellular potential is determined by the oxidant/antioxidant rat...
Doser, Karoline; Poulsen, Ingrid; Wuensch, Alexander
OBJECTIVES: Young individuals surviving severe traumatic brain injury (TBI) frequently experience a wide range of cognitive, emotional and behavioural consequences. This cross-sectional follow-up study investigated psychological outcome of young survivors in the chronic phase, and whether psychol...... of injury, which may hinder complete reintegration and participation in society. Larger functional improvement during sub-acute rehabilitation seemed to be associated with less psychological problems in the chronic phase....
Canham-Chervak, Michelle; Hooper, Tomoko I; Brennan, Fred H; Craig, Stephen C; Girasek, Deborah C; Schaefer, Richard A; Barbour, Galen; Yew, Kenneth S; Jones, Bruce H
To sustain progress toward injury reduction and other health promotion goals, public health organizations need a systematic approach based on data and an evaluation of existing scientific evidence on prevention. This paper describes a process and criteria developed to systematically and objectively define prevention program and policy priorities. Military medical surveillance data were obtained and summarized, and a working group of epidemiology and injury experts was formed. After reviewing the available data, the working group used predefined criteria to score leading military unintentional injury causes on five main criteria that assessed factors contributing to program and policy success: (1) importance of the problem, (2) effectiveness of existing prevention strategies, (3) feasibility of establishing programs and policies, (4) timeliness of implementation and results, and (5) potential for evaluation. Injury problems were ranked by total median score. Causes with the highest total median scores were physical training (34 points), military parachuting (32 points), privately-owned vehicle crashes (31 points), sports (29 points), falls (27 points), and military vehicle crashes (27 points). Using a data-driven, criteria-based process, three injury causes (physical training, military parachuting, and privately owned-vehicle crashes) with the greatest potential for successful program and policy implementation were identified. Such information is useful for public health practitioners and policymakers who must prioritize among health problems that are competing for limited resources. The process and criteria could be adapted to systematically assess and prioritize health issues affecting other communities. Published by Elsevier Inc.
Abstract. 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, ...
Twenty nine percent of patients had persistent vegetative state or severe disability. Factors that were associated with poor outcome on univariate analysis were Glasgow coma scale of less than 5, diffuse axonal injury and intracerebral mass lesions and blood sugar greater than 10mmol / L. CONCLUSION: Severe TBI is a ...
Riberholt, Christian Gunge; Thorlund, Jonas Bloch; Mehlsen, Jesper
Patients with severe acquired brain injury (ABI) are often mobilised using a tilt-table. Complications such as orthostatic intolerance have been reported. The primary objective of this study was to investigate if using a tilt-table was feasible for mobilising patients with severe ABI admitted...
van der Sluis, C.K.; Eisma, W.H.; Groothoff, J.W.; Ten Duis, H.J.
This 6 year follow-up study was designed to evaluate the long-term physical, psychological and social outcomes of severely injured patients (Injury Severity Score of greater than or equal to 16). Patients were treated at the University Hospital Groningen, the Netherlands, between January 1989 and
Full Text Available Introduction: In this retrospective study, we decided to determine the death causes and severity of injuries in traffic accidents according to reports of the forensic medical center of Yazd. Methods: A total of 251 fatalities due to traffic accidents that had undergone autopsy examinations at the Yazd forensic medicine center from2006 till 2008 were included in the study by census method. Data regarding gender, road user type, type of vehicle (car, motorcycle, autobus or minibus, consciousness level, and intensive care unit (ICU admission was gathered. For evaluation of injury severity, we used Injury Severity Score (ISS. Results: The population under study consisted of 202 men (80.5% and 49 women (19.5% with an average age of 34.1 years (range: 1-89 years. Motorcycle-pedestrian accidents were the most common type of injury (100, 39.8%. Head (220, 87.6% and face (169, 67.3% were the two most common sites of injuries. Mean (±SD of ISS was 23.2 (±10.4. According to autopsy records, the main cause of death was head trauma (146, 58.1%. Conclusion: Public awareness in terms of primary prevention of road accidents should be considered important. Also, regarding the high prevalence of brain injuries and complications associated with skull fractures, accessibility to neurosurgeons and availability of imaging devices have an important role in decreasing the mortality rate of traffic accidents.
Sasidharan, Lekshmi; Menéndez, Mónica
The conventional methods for crash injury severity analyses include either treating the severity data as ordered (e.g. ordered logit/probit models) or non-ordered (e.g. multinomial models). The ordered models require the data to meet proportional odds assumption, according to which the predictors can only have the same effect on different levels of the dependent variable, which is often not the case with crash injury severities. On the other hand, non-ordered analyses completely ignore the inherent hierarchical nature of crash injury severities. Therefore, treating the crash severity data as either ordered or non-ordered results in violating some of the key principles. To address these concerns, this paper explores the application of a partial proportional odds (PPO) model to bridge the gap between ordered and non-ordered severity modeling frameworks. The PPO model allows the covariates that meet the proportional odds assumption to affect different crash severity levels with the same magnitude; whereas the covariates that do not meet the proportional odds assumption can have different effects on different severity levels. This study is based on a five-year (2008-2012) national pedestrian safety dataset for Switzerland. A comparison between the application of PPO models, ordered logit models, and multinomial logit models for pedestrian injury severity evaluation is also included here. The study shows that PPO models outperform the other models considered based on different evaluation criteria. Hence, it is a viable method for analyzing pedestrian crash injury severities. Copyright © 2014 Elsevier Ltd. All rights reserved.
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.
Lustenberger, Thomas; Inaba, Kenji; Barmparas, Galinos; Talving, Peep; Plurad, David; Lam, Lydia; Konstantinidis, Agathoklis; Demetriades, Demetrios
The aim of this study was to determine the impact of ethanol (ETOH) on the incidence of severe traumatic brain injury (sTBI)-associated coagulopathy and to examine the effect of ETOH on in-hospital outcomes in patients sustaining sTBI. Patients admitted to the surgical intensive care unit from June 2005 through December 2008 following sTBI, defined as a head Abbreviated Injury Scale (AIS) score ≥3, were retrospectively identified. Patients with a chest, abdomen, or extremity AIS score >3 were excluded to minimize the impact of extracranial injuries. Criteria for sTBI-associated coagulopathy included thrombocytopenia and/or elevated International Normalized Ratio (INR) and/or prolonged activated partial thromboplastin time (aPTT). The incidence of admission coagulopathy, in-hospital complications, and mortality were compared between patients who were ETOH positive [ETOH (+)] and ETOH negative [ETOH (-)]. During the study period, there were 439 patients with ETOH levels available for analysis. Overall, 46.5% (n=204) of these patients were ETOH (+), while 53.5% (n=235) were ETOH (-). Coagulopathy was significantly less frequent in the ETOH (+) patients compared to their ETOH (-) counterparts (5.4% versus 15.3%; adjusted pintoxication is associated with a significantly lower incidence of early coagulopathy and in-hospital mortality. Further research to establish the pathophysiologic mechanisms underlying any potential beneficial effect of ETOH on the coagulation system following sTBI is warranted.
Talmor, Daniel; Thompson, Kimberly M; Legedza, Anna T R; Nirula, Ram
Motor vehicle crashes (MVC) are a leading public health problem. Improving notification times and the ability to predict which crashes will involve severe injuries may improve trauma system utilization. This study was undertaken to develop and validate a model to predict severe head injury following MVC using information readily incorporated into an automatic crash notification system. A cross-sectional study with derivation and validation sets was performed. The cohort was drawn from drivers of vehicles involved in MVC obtained from the National Automotive Sampling System (NASS). Independent multivariable predictors of severe head injury were identified. The model was able to stratify drivers according to their risk of severe head injury indicating its validity. The areas under the receiver-operating characteristic (ROC) curves were 0.7928 in the derivation set and 0.7940 in the validation set. We have developed a prediction model for head injury in MVC. As the development of automatic crash notification systems improves, models such as this one will be necessary to permit triage of what would be an overwhelming increase in crash notifications to pre-hospital responders.
The occurrence and outcome of traffic crashes have long been recognized as complex events involving interactions between many factors, including the roadway, driver, traffic characteristics, and the environment. This study is concerned with the outcome of the crash. Driver injury severity levels are analyzed using the ordered probit modeling methodology. Models were developed for roadway sections, signalized intersections, and toll plazas in Central Florida. All models showed the significance of driver's age, gender, seat belt use, point of impact, speed, and vehicle type on the injury severity level. Other variables were found significant only in specific cases. A driver's violation was significant in the case of signalized intersections. Alcohol, lighting conditions, and the existence of a horizontal curve affected the likelihood of injuries in the roadway sections' model. A variable specific to toll plazas, vehicles equipped with Electronic Toll Collection (ETC), had a positive effect on the probability of higher injury severity at toll plazas. Other variables that entered into some of the models were weather condition, area type, and some interaction factors. This study illustrates the similarities and the differences in the factors that affect injury severity between different locations.
Rackynelly Alves Sarmento Soares
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.
Brown, M; Traber, D L; Herndon, D N; Oldham, K T; Traber, L D
Smoke inhalation injury now represents the most frequent cause of death in burn patients, and accounts for 20-80 per cent of overall mortality. We have studied the use of extracorporeal membrane oxygenation (ECMO) to support sheep which have received lethal pulmonary smoke damage. The animals (n = 19) received inhalation injury induced by insufflation with smoke derived from burning cotton delivered with a bee smoker. The treatment group, those placed on ECMO at the time of injury (n=6), were systemically heparinized and placed on a venovenous perfusion circuit consisting of a roller pump, membrane oxygenator and heat exchanger. Blood flow rate in the circuit approximated 20-25 per cent of cardiac output. The animals remained on partial venovenous bypass until the termination of the experiment 96 h after injury. All animals in the treatment group survived. The control sheep (n = 7) received inhalation injury alone and had a 100 per cent mortality (P = 0.0015 ECMO vs. control). Ventilatory management of treatment and control groups followed an identical protocol. We have also studied a third group (n = 6) composed of animals receiving inhalation injury with systemic heparinization but not ECMO. This group had a 66 per cent mortality at 96 h. These studies suggest that partial venovenous ECMO may be a valuable form of adjunctive treatment in severe inhalation injury.
Pangilinan, Percival H; Hornyak, Joseph E
Various guidelines have been proposed for returning to sport after concussion or mild TBI. However, no such guidelines exist for severe TBI. This study presents three cases of athletes who sustained severe TBIs and returned to competition. The rational for their clearance will be discussed.
Full Text Available Traumatic brain injury (TBI is a major brain injury type commonly caused by traffic accidents, falls, violence, or sports injuries. To obtain mechanistic insights about TBI, experimental animal models such as weight-drop-induced TBI in rats have been developed to mimic closed-head injury in humans. However, the relationship between the mechanical impact level and neurological severity following weight-drop-induced TBI remains uncertain. In this study, we comprehensively investigated the relationship between physical impact and graded severity at various weight-drop heights.The acceleration, impact force, and displacement during the impact were accurately measured using an accelerometer, a pressure sensor, and a high-speed camera, respectively. In addition, the longitudinal changes in neurological deficits and balance function were investigated at 1, 4, and 7 days post TBI lesion. The inflammatory expression markers tested by Western blot analysis, including glial fibrillary acidic protein, beta-amyloid precursor protein, and bone marrow tyrosine kinase gene in chromosome X, in the frontal cortex, hippocampus, and corpus callosum were investigated at 1 and 7 days post-lesion.Gradations in impact pressure produced progressive degrees of injury severity in the neurological score and balance function. Western blot analysis demonstrated that all inflammatory expression markers were increased at 1 and 7 days post-impact injury when compared to the sham control rats. The severity of neurologic dysfunction and induction in inflammatory markers strongly correlated with the graded mechanical impact levels.We conclude that the weight-drop-induced TBI model can produce graded brain injury and induction of neurobehavioral deficits and may have translational relevance to developing therapeutic strategies for TBI.
McLean, Susan F; Tyroch, Alan H
To compare demographics and motivations for falls from bridges at the United States-Mexico border and in El Paso County, Texas, and to analyze injuries and injury patterns to support intentionality and to provide treatment recommendations. A retrospective observational review was conducted of hospital admissions to a trauma center after falls from bridges from 1995 to 2009. Statistical methods used were chi-square testing, T-test for means comparison, univariate correlations, and regression analysis. Of the 97 evaluated patients, 81.4% fell from U.S.-Mexico border bridges, including one patient who fell from a railway bridge; 74.7% of those falling from border bridges had a non-U.S. address, contrasting with 22.2% of those who fell within the United States. Falls over the border were associated with more immigration-related motivations and fewer suicide attempts. Injuries included lower extremities in 76 (78.4%) and thoracolumbar spine in 27 (27.8%) patients; 16 patients with a thoracolumbar spine fracture (59.3%) also had a lower extremity injury. Mean hospital length of stay was 7.2 days. Mean injury severity score was 8.45 (range 1-43). Age, injury severity score, and pelvic fracture increased the hospital length of stay. Patients fell while emigrating-immigrating based on residence and motivating factors. A dyad of lower extremity and thoracolumbar spine injuries coincided in 59.3% of those with a thoracolumbar spine injury; thoracolumbar spine imaging of patients evaluated after falls from bridges is recommended. Proposed prevention strategies include posting signs on bridges and installing catch-net safety barriers.
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
Shuker, Sabri T
Interrami intraoral Kirschner wire fixation technique is presented for the reduction, stabilization, and immobilization of a pulverized and avulsed lower jaw caused by rifle fragmented bullet injuries. This indirect mandibular war injury fixation technique was tolerated by the patients and tissue more than any indirect external fixation. In addition, it is easier than open reduction using large bone plates for disrupted ballistics mandibular injury defects. An interrami intraoral fixation is appropriate for severely disrupted mandibular hard and soft tissues, and has been adapted in cases of mass casualties and limited resources. Benefits of use include limited hospital beds and fewer follow-up visits. Rifle fragmented bullet injuries need more attention for several reasons: not only because of the higher mortality and devastating nature of the injuries, but also because these injuries are responsible for an unreported type of bullet biomechanism wounding in the craniofacial region. In turn, this necessitates specialized victim management. The survival rates depend on immediate proper execution of airway, breathing, and circulation, which become more complicated as it relates to airway compromise and oropharyngeal hemorrhage resuscitation. Survival is predicated on the implementation of feasible, sensible, life-saving techniques that are applied at the appropriate time.
Karr, Catherine J; Rivara, Frederick P; Cummings, Peter
The authors' anecdotal experience at a regional Level I trauma center was that Hispanic children were overrepresented among burn patients, particularly among children with burns due to scalding from hot food. This study describes injury incidence and severity among Hispanic and non-Hispanic white infants, children, and adolescents with serious traumatic injuries in Washington State. Data from the Washington State Trauma Registry for 1995-1997 were used to identify injured individuals aged injury incidence rates for Hispanic children relative to non-Hispanic white children were calculated using denominator estimates derived from U.S. Census Bureau population data. Hispanic children and non-Hispanic white children were also compared on several measures of severity of injury. In 1995-1997, serious traumatic injuries were reported to the Registry for 231 Hispanic children aged white children (56 per 100,000 person-years), yielding an overall rate ratio (RR) of 1.0 (95% confidence interval [CI] 0.8, 1.1). Motor vehicle crashes and falls accounted for one-third to one-half of the injuries for each group. Infants, children, and adolescents identified as Hispanic had higher rates of injuries related to hot objects (i.e., burns) (RR=2.3; 95% CI 1.3, 4.1), guns (RR=2.2; 95% CI 1.5 to 3.3), and being cut or pierced (RR=3.5; 95% CI 2.2 to 5.5). The Hispanic group had a lower injury rate for motor vehicle accidents (RR=0.7; 95% CI 0.5, 0.9). Mortality rates were similar (RR=1.1; 95% CI 0.7, 1.7). The mean length of hospital stay was 5.5 days for the Hispanic group and 8.8 days for the non-Hispanic white group (difference=3.3 days; 95% CI -0.7, 7.4). The study found little difference between Hispanic and non-Hispanic white infants, children, and adolescents in the burden of traumatic pediatric injury. However, burns, guns, drowning, and being pierced/cut appeared to be particularly important mechanisms of injury for Hispanic children. More specific investigations targeted toward
Anson, Kate; Segedin, Elizabeth; Jones, Peter
Primary: To ascertain how many New Zealand (NZ) children are being injured or killed as the result of all-terrain vehicle (ATV) injuries and to define the nature and severity of their injuries. Secondary: to examine the effect of age, weight, helmet use, and ATV size on injury severity and to compare the demographics of injury in NZ to other countries. A retrospective review was undertaken of 643 cases of children less than 16 years old hospitalised between 2000-2006 due to possible ATV-related injury. New Zealand Health Information Statistics (NZHIS) identified the cases through discharge information, supplemented by a search of Auckland's Paediatric Intensive Care trauma database. Only confirmed ATV injuries were included. Records were unavailable for 150 cases (26%). There were 218 confirmed cases of ATV injury. Mechanisms of injury were: a fall from the ATV, 105 cases (48%), a collision, 59 cases (31%), rolling 31 cases (14%). Mean age was 9.9 years (SD 3.9) with 133 (61%) under 12 years, and 32 (15%) 5 years and under. The child was the driver in 116 cases (53%) and the passenger in 61 cases (28%). Male to female ratio was 2:1. Mean injury severity score was 7.9 (SD 5.2). Median (IQR) length of stay was 2 days (1-4). Helmet use not stated in 62%, with only 30 cases (14%) identified as wearing helmets. The majority of injuries were orthopaedic, soft tissue injuries and head injuries. Multiple injuries occurred in 74 cases (34%). One hundred and eleven children (51%) required a general anaesthetic. Seventeen (7.8%) children required admission to intensive care. Six (2.8%) children were left with a permanent disability. Sixteen children died. There was no correlation between ISS and age or weight (Rho=-0.089, p=0.08 and Rho=0.49, p=0.79 respectively). The observed differences in ISS between helmet users and non-users, ATV drivers and passengers and size of ATV were not statistically significant. There was a trend towards reduced risk of head injury with helmet
Schow, Trine; Larsen, Klaus; Engberg, Aase Worså
identified patients at highest risk of pneumonia: Glasgow Coma score (GCS) ...Abstract Objective(s): This study investigates the incidence and onset time of pneumonia for patients with severe Traumatic Brain Injury (TBI) in the early phase of rehabilitation, and identifies parameters associated with the risk of pneumonia. Design: Observational retrospective cohort study....... Setting: A subacute rehabilitation department, university hospital, Denmark. Participants: One-hundred and seventy-three patients aged 16-65 years with severe TBI admitted over a 5-year period. Patients are transferred to the Brain Injury Unit (BIU) as soon as they ventilate spontaneously. Intervention...
McCallister, Adrienne; Brown, Christopher; Smith, Michael; Ettlinger, Hugh; Baltazar, Gerard A
Somatic dysfunction caused by traumatic brain injury (TBI) may be managed by osteopathic manipulative treatment (OMT). In this case report, the authors describe 2 patients with severe TBI who were each treated with OMT in a level-1 regional trauma center. Both patients received OMT beginning in the acute care phase of injury. Somatic dysfunction improved during the course of treatment, and no adverse effects of OMT were noted. More comprehensive research may clarify the efficacy and adverse effects of OMT as part of multimodal acute care of patients with severe TBI.
Schwellnus, Martin P; Thomson, Alan; Derman, Wayne; Jordaan, Esme; Readhead, Clint; Collins, Rob; Morris, Ian; Strauss, Org; Van der Linde, Ewoudt; Williams, Arthur
Professional Rugby Union is a contact sport with a high risk of injury. To document the incidence and nature of time-loss injuries during the 2012 Super Rugby tournament. Prospective cohort study. 2012 Super Rugby tournament (Australia, New Zealand, South Africa). 152 players from 5 South African teams. Team physicians collected daily injury data through a secure, web-based electronic platform. Data included size of the squad, type of day, main player position, training or match injury, hours of play (training and matches), time of the match injury, mechanism of injury, main anatomical location of the injury, specific anatomical structure of the injury, the type of injury, the severity of the injury (days lost). The proportion (%) of players sustaining a time-loss injury during the tournament was 55%, and 25% of all players sustained >1 injury. The overall incidence rate (IR/1000 player-hours) of injuries was 9.2. The IR for matches (83.3) was significantly higher than for training (2.1) and the IR was similar for forwards and backs. Muscle/tendon (50%) and joint/ligament (32.7%) injuries accounted for >80% of injuries. Most injuries occurred in the lower (48.1%) and upper limb (25.6%). 42% of all injuries were moderate (27.5%) or severe (14.8%), and tackling (26.3%) and being tackled (23.1%) were the most common mechanisms of injury. The IR of injuries was unrelated to playing at home compared with away (locations ≥6 h time difference). 55% of all players were injured during the 4-month Super Rugby tournament (1.67 injuries/match). Most injuries occurred in the lower (knee, thigh) or upper limb (shoulder, clavicle). 42% of injuries were severe enough for players to not play for >1 week. 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.
Lazovic, Ranko; Radojevic, Nemanja; Curovic, Ivana
Among various reasons, colon injuries may be caused by low- or high-energy firearm bullets, with the latter producing a temporary cavitation phenomenon. The available treatment options include primary repair and two-stage management, but recent studies have shown that primary repair can be widely used with a high success rate. This paper investigates the differences in performance of primary repair on these two types of colon injuries. Two groups of patients who sustained colon injuries due to single gunshot wounds, were retrospectively categorized based on the type of bullet. Primary colon repair was performed in all patients selected based on the inclusion and exclusion criteria (Stone and Fabian's criteria). An almost absolute homogeneity was attained among the groups in terms of age, latent time before surgery, and four trauma indexes. Only one patient from the low-energy firearm projectile group (4%) developed a postsurgical complication versus nine patients (25.8%) from the high-energy group, showing statistically significant difference (p = 0.03). These nine patients experienced the following postsurgical complications: pneumonia, abscess, fistula, suture leakage, and one multiorgan failure with sepsis. Previous studies concluded that one-stage primary repair is the best treatment option for colon injuries. However, terminal ballistics testing determined the projectile's path through the body and revealed that low-energy projectiles caused considerably lesser damage than their high-energy counterparts. Primary colon repair must be performed definitely for low-energy short firearm injuries but very carefully for high-energy injuries. Given these findings, we suggest that the treatment option should be determined based not only on the bullet type alone but also on other clinical findings. PMID:26874437
Balazs, George C; Hanley, M G; Pavey, G J; Rue, J-Ph
Lisfranc injuries are relatively uncommon midfoot injuries disproportionately affecting young, active males. Previous studies in civilian populations have reported relatively good results with operative treatment. However, treatment results have not been specifically examined in military personnel, who may have higher physical demands than the general population. The purpose of this study was to examine rates of return to military duty following surgical treatment of isolated Lisfranc injuries. Surgical records and radiographic images from all active duty US military personnel treated for an isolated Lisfranc injury between January 2005 and July 2014 were examined. Demographic information, injury data, surgical details and subsequent return to duty information were recorded. The primary outcome was ability to return to unrestricted military duty following treatment. The secondary outcome was secondary conversion to a midfoot arthrodesis following initial open reduction internal fixation. Twenty-one patients meeting inclusion criteria were identified. Median patient age was 23 years, and mean follow-up was 43 months. Within this cohort, 14 patients were able to return to military service, while seven required a disability separation from the armed forces. Of the 18 patients who underwent initial fixation, eight were subsequently revised to midfoot arthrodesis for persistent pain. Military personnel sustaining Lisfranc injuries have high rates of persistent pain and disability, even after optimal initial surgical treatment. Military surgeons should counsel patients on the career-threatening nature of this condition and high rates of secondary procedures. 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/.
Wagner, Amy K; Fabio, Anthony; Puccio, Ava M; Hirschberg, Ronald; Li, Wei; Zafonte, Ross D; Marion, Donald W
Female sex hormones appear to be neuroprotective after traumatic brain injury by attenuating multiple mechanisms of secondary insult, including excitotoxicity and ischemia. The purpose of this study was to evaluate associations between gender and cerebrospinal fluid glutamate and lactate/pyruvate production and the role of hypothermia with gender in attenuating these markers. Prospectively collected data were analyzed for adult patients with severe traumatic brain injury. Gender comparisons for cerebrospinal fluid glutamate and lactate/pyruvate production were determined using ventricular samples obtained over the first 48 hrs postinjury. University-based level I trauma center. There were 123 patients, male n = 93 and female n = 30 (n = 686 cerebrospinal fluid samples), with severe traumatic brain injury (Glasgow Coma Scale score fluid glutamate production for males compared with females (p = .0023) and a significant interaction between glutamate concentration, gender, and time (p = .0035) by 24 hrs postinjury. Females had lower lactate/pyruvate ratios than males (p = .0006), and there was a significant interaction between lactate/pyruvate, gender, and time (p = .0045) throughout the first 48 hrs postinjury. Hypothermia attenuated glutamate levels, particularly for males, over the time course studied. These data suggest significant gender differences with glutamate and lactate/pyruvate production after severe traumatic brain injury. Gender- and hormone-mediated differences in central nervous system pathophysiology should be considered with clinical trials in traumatic brain injury.
Hasheminejad, Seyed Hessam-Allah; Zahedi, Mohsen; Hasheminejad, Seyed Mohammad Hossein
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.
Kim, Myeonghyeon; Kho, Seung-Young; Kim, Dong-Kyu
The high percentage of fatalities in pedestrian-involved crashes is a critical social problem. The purpose of this study is to investigate factors influencing injury severity in pedestrian crashes by examining the demographic and socioeconomic characteristics of the regions where crashes occurred. To understand the correlation between the unobserved characteristics of pedestrian crashes in a defined region, we apply a hierarchical ordered model, in which we set crash characteristics as lower-level variables and municipality characteristics as upper-level. Pedestrian crash data were collected and analyzed for a three-year period from 2011 to 2013. The estimation results show the statistically significant factors that increase injury severity of pedestrian crashes. At the crash level, the factors associated with increased severity of pedestrian injury include intoxicated drivers, road-crossing pedestrians, elderly pedestrians, heavy vehicles, wide roads, darkness, and fog. At the municipality level, municipalities with low population density, lower level of financial independence, fewer doctors, and a higher percentage of elderly residents experience more severe pedestrian crashes. Municipalities ranked as having the top 10% pedestrian fatality rate (fatalities per 100,000 residents) have rates 7.4 times higher than municipalities with the lowest 10% rate of fatalities. Their demographic and socioeconomic characteristics also have significant differences. The proposed model accounts for a 7% unexplained variation in injury severity outcomes between the municipalities where crashes occurred. To enhance the safety of vulnerable pedestrians, considerable investments of time and effort in pedestrian safety facilities and zones should be made. More certain and severe punishments should be also given for the traffic violations that increase injury severity of pedestrian crashes. Furthermore, central and local governments should play a cooperative role to reduce pedestrian
John, Mike T
Facial trauma: how dangerous are skiing and snowboarding?. Tuli T, Haechl O, Berger N, Laimer K, Jank S, Kloss F, Brandstätter A, Gassner R. J Oral Maxillofac Surg 2010;68(2):293-9. REVIEWER NAME: Mike T. John, DDS, MPH, PhD. To compare the prevalence of maxillofacial injury types in individuals who sustained snowboarding and skiing accidents. Information not available. Retrospective case series. Level 2: Limited-quality, patient-oriented evidence. Not applicable. Copyright © 2010 Elsevier Inc. All rights reserved.
Yak, Ryan Siqi; Lundin, Anna Carin; Peng, Yeong Pin; Sebastin, Sandeep Jacob
We report a patient that sustained a severe hand injury following a python bite. Python bite injuries are rare and we were unable to find guidelines in literature regarding the management of this injury...
Milland, Maria; Mikkelsen, Kim L; Christoffersen, Jens K
OBJECTIVE: To assess possible association between the incidence of approved claims for severe and fatal obstetric injuries and delivery volume in Denmark. DESIGN AND SETTING: A nationwide panel study of labor units. POPULATION: Claimants seeking financial compensation due to injuries occurring...... 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...
Jiang, Ximiao; Huang, Baoshan; Zaretzki, Russell L; Richards, Stephen; Yan, Xuedong; Zhang, Hongwei
The severity of traffic-related injuries has been studied by many researchers in recent decades. However, previous research has seldom accounted for the effects of curbed outside shoulders on traffic-related injury severity. This study applies the zero-inflated ordered probit (ZIOP) model to evaluate the influences of curbed outside shoulders, speed limit change, as well as other traditional factors on the injury severity of single-vehicle crashes. Crash data from 2003 to 2007 in the Illinois Highway Safety Database were employed in this study. The ZIOP model assumes that injury severity comes from two distinct sources: injury propensity and injury severity when this crash falls into the injury prone category. The modeling results show that on one hand, single-vehicle crashes that occurring on roadways with curbed outside shoulders are more likely to be injury prone. On the other hand, the existence of a curb decreases the likelihood of severe injury if the crash was in the injury prone category. As a result, the marginal effect analysis implies that the presence of curbs is associated with a higher likelihood of no injury and minor injury involved crashes, but a lower likelihood of incapacitating injury and fatality involved crashes. In addition, in the presence of curbed outside shoulders, the change of speed limit adds no significant impact to the injury severity of single-vehicle crashes. Moreover, the modeling results also highlight some interesting effects caused by vehicle type, light and weather conditions, and drivers' characteristics, as well as crash type and location. Through a comprehensive evaluation of the modeling results, the authors find that the ZIOP model performs well relative to the traditional ordered probit (OP) model, and can serve as an alternative in future studies of crash injury severity. Copyright © 2013 Elsevier Ltd. All rights reserved.
Tohira, Hideo; Jacobs, Ian; Matsuoka, Tetsuya; Ishikawa, Kazuo
The Abbreviated Injury Scale (AIS) was updated in 2008 (AIS 2008). We aimed to investigate the impact of AIS 2008 on the characterization of injury severity and quality assessment of trauma care. We identified all blunt trauma patients in the Japan Trauma Data Bank. First, we converted AIS 98 codes to AIS 2008 codes using a mapping table. Next, we compared Injury Severity Scores (ISSs) and New ISSs (NISSs) based on AIS 98 and AIS 2008. We compared the proportion of major trauma (ISS >15) between the two AISs. We derived risk-adjusted models using the two AISs and separately ranked hospitals according to the observed-to-expected death (OE) ratio. We counted the number of performance outliers for the two rankings. We analyzed the association between the percent change in OE ratios and the proportion of NISS outliers (change in NISS of ISSs and NISSs based on AIS 2008 were significantly less than those based on AIS 98. The proportion of major trauma was 46.3% and 38.9% for AIS 98 and AIS 2008, respectively (p < 0.001). The numbers of performance outliers were different between the two rankings. There was a significant positive linear relationship between the percent change in the OE ratio and the proportion of NISS outliers. The use of different AIS versions influenced the selection of major trauma patients and affected the quality assessment of the trauma care. Researchers should be aware of these findings when selecting the version of the AIS.
Du, Yanli; Li, Yu; Lan, Qing
Evaluation of the degree of severity of injury, coma duration, and prediction of outcome are integral parts of present-day management of severe traumatic brain injury (TBI). To investigate whether evaluation and prediction of outcome in early phase after severe TBI is possible by means of single-voxel proton magnetic resonance spectroscopy ( 1 H-MRS). Proton spectra were acquired from the posterior part of normal-appearing frontal lobes having predominantly white matter in 72 patients with severe TBI within a few days of trauma, mean 9.5 days and also in 30 controls. 1 H-MRS studies revealed lower ratios of N-acetylaspartate (NAA)/Choline (Cho) and NAA/ Creatine (Cr) and higher ratios of Cho/Cr in patients with TBI when compared to the control group. In patients with severe TBI, NAA/Cr, NAA/Cho and Cho/Cr ratios were significantly correlated with the initial Glasgow Coma Scale score (GCS) (P=0.004, r =0.439, P=0.018, r =0.364, P=0.004, r = -0.762, respectively), and with the clinical outcome, Glasgow Outcome Scores (GOS) (P=0.006, r =0.414; P=0.007, r =0.412; P=0.016, r = -0.775, respectively). An equation including clinical and spectroscopic variables, which can predict coma duration fairly accurately, was also obtained. 1 H-MRS may be a novel method of assessing brain function, estimating coma duration, and predicting outcome in patients with severe TBI.
Kim, Joon-Ki; Ulfarsson, Gudmundur F; Shankar, Venkataraman N; Kim, Sungyop
This research explores the injury severity of pedestrians in motor-vehicle crashes. It is hypothesized that the variance of unobserved pedestrian characteristics increases with age. In response, a heteroskedastic generalized extreme value model is used. The analysis links explanatory factors with four injury outcomes: fatal, incapacitating, non-incapacitating, and possible or no injury. Police-reported crash data between 1997 and 2000 from North Carolina, USA, are used. The results show that pedestrian age induces heteroskedasticity which affects the probability of fatal injury. The effect grows more pronounced with increasing age past 65. The heteroskedastic model provides a better fit than the multinomial logit model. Notable factors increasing the probability of fatal pedestrian injury: increasing pedestrian age, male driver, intoxicated driver (2.7 times greater probability of fatality), traffic sign, commercial area, darkness with or without streetlights (2-4 times greater probability of fatality), sport-utility vehicle, truck, freeway, two-way divided roadway, speeding-involved, off roadway, motorist turning or backing, both driver and pedestrian at fault, and pedestrian only at fault. Conversely, the probability of a fatal injury decreased: with increasing driver age, during the PM traffic peak, with traffic signal control, in inclement weather, on a curved roadway, at a crosswalk, and when walking along roadway.
O. V. Oliynyk
Full Text Available Background. Respiratory support is a vital method for temporary compensation of external breathing function in patients with severe traumatic brain injury. However, it is not always possible to deal with severe respiratory dysfunction even with the usage of up-to-date respiratory technologies. This work is aimed to find an answer how different pattern of mechanical ventilation influence on a treatment of patients with severe traumatic brain injury. Objective. The influence of respiratory support, as a main method for temporary compensation of external breathing function, on treatment result for patients with severe traumatic brain injury. Methods. Treatment results of 253 patients with severe traumatic brain injury of Ternopil University Hospital were evaluated due to the type of respiratory support used. The results were separately evaluated in alive and dead patients. Results. Mortality rate of patients depended on the type of mechanical ventilation that was used. The highest mortality (58.69 % was in the group, when a patient was transferred to forced ventilation a volume control. The mortality rate was decreasing by 51.78% in case of adding PEEP. The strategy of using accessory lung ventilation patterns CPAP and BiPAP caused significant (in 1.48 times decrease of mortality in this group of patients. Conclusion The survival of patients with severe traumatic brain injury, who were ventilated by the method of consistent combination of forced ventilation with pressure control (CРV and 2 patterns of accessory lung ventilation: Constant Positive Airway Pressure (CPAP and Biphasic positive airway pressure (BiPAP, is reliably higher than in the case of forced ventilation with volume control with Positive end-expiratory pressure.
Al-Bdairi, Nabeel Saleem Saad; Hernandez, Salvador
In recent years, there has been an increasing interest in understanding the contributory factors to run-off-road (ROR) crashes in the US, especially those where large trucks are involved. Although there have been several efforts to understand large-truck crashes, the relationship between crash factors, crash severity, and ROR crashes is not clearly understood. The intent of this research is to develop statistical models that provide additional insight into the effects that various contributory factors related to the person (driver), vehicle, crash, roadway, and environment have on ROR injury severity. An ordered random parameter probit was estimated to predict the likelihood of three injury severity categories using Oregon crash data: severe, minor, and no injury. The modeling approach accounts for unobserved heterogeneity (i.e., unobserved factors). The results showed that five parameter estimates were found to be random and normally distributed, and varied across ROR crash observations. These were factors related to crashes that occurred between January and April, raised median type, loss of control of a vehicle, the indicator variable of speed not involved, and the indicator variable of two vehicles or more involved in the crashes. In contrast, eight variables were found to be fixed across ROR observations. Looking more closely at the fixed parameter results, large-truck drivers who are not licensed in Oregon have a higher probability of experiencing no injury ROR crash outcomes, and human related factor, fatigue, increases the probability of minor injury. The modeling framework presented in this work offers a flexible methodology to analyze ROR crashes involving large trucks while accounting for unobserved heterogeneity. This information can aid safety planners and the trucking industry in identifying appropriate countermeasures to help mitigate the number and severity of large-truck ROR crashes. Copyright © 2017 Elsevier Ltd. All rights reserved.
Cosio, M Q
Fifteen male patients, 15 to 24 years of age, sustained injuries after rocking soda machines. The machines fell onto the victims, resulting in a variety of injuries. Three were killed. The remaining 12 required hospitalization for their injuries. Unless changes are made to safeguard these machines, people will continue to suffer severe and possibly fatal injuries from what are largely preventable accidents.
Simonsen, Louise Lau; Sonne-Holm, Stig; Krasheninnikoff, Michael
The incidence of heterotopic ossification (HO) among patients with traumatic brain injury (TBI) varies in the literature from 11 to 73.3%. The aim of this study was to determine the incidence of HO among patients with very severe TBI treated in a new established intensive rehabilitation Brain...
Allain, P.; Fasotti, L.; Roy, A.; Chauvire, V.; Etcharry-Bouyx, F.; Gall, D. le
The aim of the present study was to examine the syntactic and semantic dimensions of script representation in patients with structural damage within the cerebral cortex following a severe traumatic brain injury (TBI). Forty TBI patients and 38 healthy control subjects (HC) were asked to sort cards
Hansen, T.S.; Larsen, K.; Engberg, Anders
rehabilitation department in a university hospital in Denmark. PARTICIPANTS: Patients (N=173) aged 16 to 65 years with severe TBI who were admitted during a 5-year period. Patients are transferred to the brain injury unit as soon as they ventilate spontaneously. INTERVENTIONS: Not applicable. MAIN OUTCOME...
Eames, P; Wood, R.
Twenty four patients with severe brain injury who had disturbed behaviours preventing rehabilitation or care in ordinary settings were treated in a token economy. This long-term follow-up study indicates that post-traumatic behaviour disorders can be lastingly improved, and that lengthy rehabilitation can have surprisingly good effects.
Norup, Anne; Welling, Karen-Lise; Qvist, Jesper
Primary objective: To investigate the emotional well-being of relatives of patients with a severe brain injury in the acute setting, as well as risk factors associated with high anxiety and depression scores and impaired quality-of-life. Research design: Clinical convenience sample. Methods and p....... Conclusions: The majority of the relatives had severely impaired quality-of-life and symptoms of anxiety and depression during the patient's NICU stay. Future research is required to explore stressors and evaluate effects of psychological intervention in the acute setting.......Primary objective: To investigate the emotional well-being of relatives of patients with a severe brain injury in the acute setting, as well as risk factors associated with high anxiety and depression scores and impaired quality-of-life. Research design: Clinical convenience sample. Methods...... and procedures: Participants included 45 relatives of patients with severe brain injury recruited at a NICU. All relatives completed selected scales from the SCL-90-R and SF-36 ~ 14 days after injury. Data concerning the condition of the patient were also collected. Main outcome and results: Of the relatives, 51...
14.58) while three quarters of the patients were males. The age and sex profiles of the admitted patients did not change with the enforcement of the Traffic Act. Conclusion: The enforcement of the Traffic Act did not have any effect on injury severity among admitted PSV crash victims. Measures to lessen the burden of road ...
Teasdale, E.; Cardoso, E.; Galbraith, S; Teasdale, G
CT scan findings, clinical features and intracranial pressure were studied in patients with severe diffuse head injury. Compression of the 3rd ventricle and basal cisterns closely correlated with an intracranial pressure greater than 20 mmHg, with clinical signs of midbrain dysfunctions and worse prognosis. These CT scan findings can indicate whether intracranial pressure monitoring is appropriate.
Hansen, Trine Schow; Larsen, Klaus; Engberg, Aase Worså
OBJECTIVES: To investigate the incidence and onset time of pneumonia for patients with severe traumatic brain injury (TBI) in the early phase of rehabilitation and to identify parameters associated with the risk of pneumonia. DESIGN: Observational retrospective cohort study. SETTING: Subacute reh...
Radler, Gary A.; And Others
Intervention for self-injurious behavior (SIB) in a 14-year-old severely retarded institutionalized female involved contingent restraint, reinforcement of alternative behaviors, and changes in school activities. A clinically significant reduction in SIB in both the subject's living unit and school was associated with the intervention program. The…
Bagshaw, Sean M.; Uchino, Shigehiko; Kellum, John A.; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Etienne; Gibney, Noel; Tolwani, Ashita; Oudemans-van Straaten, Heleen M.; Ronco, Claudio; Bellomo, Rinaldo
To evaluate the characteristics and outcomes of critically ill patients with severe acute kidney injury (AKI) treated and not treated with renal replacement therapy (RRT). Secondary analysis of a multi-centre cohort study. Primary exposure was RRT. Primary outcome was propensity and multi-variable
Nielsen, Niels Dalsgaard; Dahl, Michael; Rostgaard-Knudsen, Martin
, 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...
Campbell, Thomas F.; Dollaghan, Christine; Janosky, Janine; Rusiewicz, Heather Leavy; Small, Steven L.; Dick, Frederic; Vick, Jennell; Adelson, P. David
Purpose: The authors sought to describe longitudinal changes in Percentage of Consonants Correct--Revised (PCC-R) after severe pediatric traumatic brain injury (TBI), to compare the odds of normal-range PCC-R in children injured at older and younger ages, and to correlate predictor variables and PCC-R outcomes. Method: In 56 children injured…
Warden, Craig; Sahni, Ritu; Newgard, Craig
To determine clusters of trauma incidents with high injury severity and resource utilization and to test their association with census demographic information. Using "trauma band" unique identifiers and probabilistic linkage for unmatched cases, we matched injury location information collected from a centralized regional trauma communications center to the state trauma system registry for patients directly transported to two level I trauma centers for the years 2001-2003 in a three-county area. The injury locations were aggregated at the census tract level using a geographic information system (GIS). Moran's I analysis was used to determine clusters of census tracts that had a high incidence of either total trauma injuries, Injury Severity Scores (ISSs) >15, or high resource use (in-hospital mortality, admission to the intensive care unit, or major nonorthopedic surgery). These clusters were then tested for association with census tract demographics using logistic regression. Eight thousand seven hundred fifty-one injured persons were directly transported from the tricounty area to a trauma center during the study period. The mean (+/- standard deviation) age was 37 +/- 21 years, 67.4% were male, 18.9% had ISSs >15, and 29.8% had a high-resource-use indicator. Moran's I analysis demonstrated a single large cluster of incidents for total injuries, ISS >15, and occurrence of a high-resource-use indictor that overlapped except for one small census tract. Logistic regression revealed that the high-risk cluster was associated with a higher prevalence of nonwhite population and vacant housing and a lower prevalence of foreign-born residents and family housing. GIS cluster analysis demonstrated high-risk census tracts for trauma incidents and associated population demographics. Geospatial analyses may assist injury prevention interventions and emergency medical services deployment strategies for trauma.
Murgatroyd, Darnel; Harris, Ian A; Chen, Jian Sheng; Adie, Sam; Mittal, Rajat; Cameron, Ian D
Compensation related factors have been repeatedly associated with poor recovery following orthopaedic trauma. There is limited research into the factors associated with seeking financial compensation. Further understanding of these factors could facilitate injury recovery by purposeful compensation scheme design. The aim of this study was to investigate the predictors of seeking financial compensation, namely making a claim and seeking legal representation, following motor vehicle related orthopaedic trauma. The study was conducted in New South Wales (NSW), Australia, in motor vehicle crash and workers' compensation schemes. Participants were patients admitted with upper or lower extremity factures following a motor vehicle crash to two trauma hospitals. Data were collected at baseline within two weeks of injury. Participants were followed up at six months. Analysis involved: descriptive statistics for baseline characteristics; comparison of compensable and non-compensable participants with Analysis of Variance (ANOVA) and chi-squared tests; and logistic regression for predictor models. The cohort consisted of 452 participants with a mean age 40 years; 75% male; 74% working pre-injury; 30% in excellent pre-injury health; 56% sustained serious injuries with an Injury Severity Score (ISS) 9-15; 61% had a low-middle range household income; and 35% self-reported at fault in the crash. There was no significant difference in pre-injury/baseline health between compensable and non-compensable participants. Follow up data was available for 301 (67%) participants. The significant predictor of claiming compensation in the adjusted analysis was higher body mass index (BMI) (overweight Odds Ratio [OR] 3.05, 95% Confidence Interval [CI] 1.63-5.68; obese OR 1.63, 95% CI 0.83-3.20). Participants less likely to claim were: involved in a motorcycle crash (OR 0.47, 95% CI 0.28-0.82); socioeconomically less disadvantaged (OR 0.37, 95% CI 0.17-0.82) or least disadvantaged (OR 0.39, 95
Franco-Koehrlen, Celine Alicia; Iglesias-Leboreiro, José; Bernárdez-Zapata, Isabel; Rendón-Macías, Mario Enrique
The main goal of this article was to evaluate if the decision to perform cranial computed tomography (CT) in children with minor head injury is determined by the presence or absence of the physician during assessment in the emergency room. Clinical files of 92 patients from 8 months to 4 years of age were selected. Those children were evaluated at the emergency department of the Spanish Hospital of Mexico due to non-severe traumatic brain injury. Glasgow Coma Scale (GCS) score was determined in all patients. Groups of patients were compared: 1) patients having CT, 2) patients with a physician who attended the initial assessment, 3) patients whose attending physician did not arrive to assess the patient and 4) patients assessed by the emergency room staff. 38% of patients with non-severe brain injury underwent CT, 8.6% had a brain injury visible on the CT. Moderate intensity impacts were greater in patients with CT. Regarding the ECG, it was found that most children scored 15 points (p=0.03). In patients without a physician, a greater trend was demonstrated for performing CT. Patients with minor head injury but without neurological signs should undergo a detailed clinical evaluation in order to avoid unwarranted CT. Copyright © 2015. Publicado por Masson Doyma México S.A.
The aim of the present investigation was to prospectively study injuries sustained by a cohort of junior players at all levels in a typical tennis club with respect to gender, anatomic location of injuries, type of injuries, and their degree of severity as well as cause of injuries, injury occasion and time of the year when injured. A further aim was to evaluate potential intrinsic as well as extrinsic injury risk factors in the same junior tennis players. All 12-18 year...
Peng, Jin; Wheeler, Krista; Shi, Junxin; Groner, Jonathan Ira; Haley, Kathryn Jo; Xiang, Huiyun
Trauma patients with an ISS=75 have been deliberately excluded from some trauma studies because they were assumed to have "unsurvivable injuries." This study aimed to assess the true mortality among patients with an ISS=75, and to examine the characteristics and primary diagnoses of these patients. Retrospective review of the 2006-2010 U.S. Nationwide Emergency Department Sample (NEDS) generated 2,815 patients with an ISS=75 for analysis, representing an estimated 13,569 patients in the country. Dispositions from the emergency department and hospital for these patients were tabulated by trauma center level. Survivors and non-survivors were compared using Pearson's chi-square test. Primary diagnosis codes of these patients were tabulated by mortality status. Overall, about 48.6% of patients with an ISS=75 were discharged alive, 25.8% died and 25.6% had unknown mortality status. The mortality risks of these patients did not vary significantly across different levels of trauma centers (15.6% vs. 13.0%, P = 0.16). Non-survivors were more likely than survivors to: be male (81.2% vs. 74.4%, P wound into cavity). Our results revealed that at least half of patients with an ISS=75 survived, demonstrating that the rationale for excluding patients with an ISS=75 from analysis is not always justified. To avoid bias and inaccurate results, trauma researchers should examine the mortality status of patients with an ISS=75 before exclusion, and explicitly describe their method of generating ISS scores.
Paffrath, Thomas; Lefering, Rolf; Flohé, Sascha
Multiple injured patients, polytrauma or severely injured patients are terms used as synonyms in international literature describing injured patients with a high risk of mortality and cost consuming therapeutic demands. In order to advance the definition of these terms, we analysed a large trauma registry. In detail, we compared critically ill trauma patients first specified on a pure anatomical base according to the ISS or NISS, second in the original "polytrauma definition" with two body regions affected and finally all of them combined with a physiological component. Records that were collected in the TraumaRegister DGU(®) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU) between 1993 and 2011 (92,479 patients) were considered for this study. All patients with primary admission from scene with a minimum hospital stay of 48 h and an Injury Severity Score (ISS)≥ 16 were included. Pre-hospital and early admission data were used to determine physiological risk factors and calculate individual risk of death using the Revised Injury Severity Classification (RISC). 45,350 patients met inclusion criteria. The overall hospital mortality rate was 20.4%. The predicted mortality according to the RISC-Score was 21.6%. 36,897 patients (81.4%) had injuries in several body regions. The prevalence of the five physiological risk factors varied between 17% (high age) and 34% (unconsciousness). There were 17,617 patients (38.8%) without any risk factor present on admission, while 30.6% (n=13,890) of the patients had one and 30.5% (n=13,843) had two or more factors present. Patients with ISS ≥ 16 but no physiological risk factor present had a very low mortality rate of 3.1% (542 of 17,617). With an increasing number of physiological factors there was an almost linear increase in mortality up to an 86% rate in patients with all five factors present. The 'polytrauma' definition of Butcher and colleagues with AIS ≥ 3 in at least two different body
Sala, Nathalie; Suys, Tamarah; Zerlauth, Jean-Baptiste; Bouzat, Pierre; Messerer, Mahmoud; Bloch, Jocelyne; Levivier, Marc; Magistretti, Pierre J; Meuli, Reto; Oddo, Mauro
Growing evidence suggests that endogenous lactate is an important substrate for neurons. This study aimed to examine cerebral lactate metabolism and its relationship with brain perfusion in patients with severe traumatic brain injury (TBI). A prospective cohort of 24 patients with severe TBI monitored with cerebral microdialysis (CMD) and brain tissue oxygen tension (PbtO2) was studied. Brain lactate metabolism was assessed by quantification of elevated CMD lactate samples (>4 mmol/L); these ...
Riberholt, Christian G; Thorlund, Jonas Bloch; Mehlsen, Jesper
Patients with severe acquired brain injury (ABI) are often mobilised using a tilt-table. Complications such as orthostatic intolerance have been reported. The primary objective of this study was to investigate if using a tilt-table was feasible for mobilising patients with severe ABI admitted for...... for sub-acute rehabilitation. We also investigated change in arousal, treatment duration before termination due to orthostatic reactions and change in muscle tone....
Riberholt, Christian Gunge; Thorlund, Jonas Bloch; Mehlsen, Jesper
Patients with severe acquired brain injury (ABI) are often mobilised using a tilt-table. Complications such as orthostatic intolerance have been reported. The primary objective of this study was to investigate if using a tilt-table was feasible for mobilising patients with severe ABI admitted...... for sub-acute rehabilitation. We also investigated change in arousal, treatment duration before termination due to orthostatic reactions and change in muscle tone....
Very little research has been done on the effect of dancing on the rehabilitation of patients having a severe brain injury. In addition to motor problems, the symptom picture of the sequelae of severe brain injuries often involves strong fatigability, reduced physiological arousal, disturbances of coordination of attention, difficulties of emotional control and impairment of memory. This review deals with the neural foundation of dancing and the possibilities of dancing in the rehabilitation of severe brain injuries.
Full Text Available Objective: To study the effect of adjuvant therapy of ganglioside sodium on intracranial pressure (ICP, partial pressure of brain tissue oxygen (PbtO2, nerve injury molecules, nerve protection molecules and indexes of oxidative stress in patients with acute severe craniocerebral injury. Methods: Forty-seven patients with severe craniocerebral injury treated in the emergency department of our hospital during the period time from December 2012 to October 2015 were selected for retrospective analyses. They were divided into the ganglioside group and the normal treatment group according to the usage of ganglioside sodium in the process of the emergency treatment. At days 1, 3, 5 and 7 before and after treatment, the ICP and PbtO2 in patients of the two groups were measured. After 7 days of treatment, the nerve injury molecules, nerve protection molecules and the indexes of oxidative stress in serum of the patients of the two groups were determined. Results: At days 1, 3, 5 and 7 before and after treatment, the ICP in patients of the ganglioside group were all significantly lower than those of the normal treatment group, while the PbtO2 were all significantly higher than those of normal treatment group. After 7 days of treatment, the contents of serum methane dicarboxylic aldehyde, advanced oxidation protein products, 8-hydroxy-2'-deoxyguanosine urine, S100β, glial fibrillary acidic portein, neuron specific enolase, myelin basic protein, neuroglobin and ubiquitin carboxyl-terminal hydrolase L1 in patients of the ganglioside group were notably lower than those of the normal treatment group, while the contents of superoxidase dismutase, glutathione peroxidase, catalase, nerve growth factor and brain derived neurotrophic factor were significantly higher than those of the normal treatment group. Conclusions: The adjuvant therapy of ganglioside sodium in patients with severe craniocerebral injury can effectively reduce ICP, improve PbtO2 and alleviate
Aadal, Lena; Kirkevold, Marit
During intensive neurorehabilitation, it is a professional challenge that patients with severe traumatic brain injury may have changed abilities to learn. To develop, initially test, and evaluate a model for neurorehabilitation aimed at systematizing and facilitating professionals' efforts of promoting patients' participation and learning. Qualitative study inspired by action research. Empirical data were analyzed by a theoretical framework of "didactic relation model," "situated learning theory," and neurophysiologic/neuropsychological categories of learning premises. Our findings indicate that the model for neurorehabilitation expands and systematizes the professional's reflections and interventions aimed at facilitating learning among patients with traumatic brain injury.
Haleem, Kirolos; Gan, Albert
This study identifies and compares the factors that contribute to injury severity on urban freeways and arterials and recommends potential countermeasures to enhance the safety of both facilities. The study makes use of an extensive data set from the State of Florida in the United States. To obtain a more complete picture, this study explores both traditional and nontraditional severity predictors. Some traditional predictors include traffic volume, speed limit, and road surface condition. The nontraditional predictors are comprised of those rarely explored in previous severity studies, including crash distance to the nearest ramp location, detailed vehicle types, and lighting and weather conditions. The analysis was conducted using the ordered and binary probit models, which are well suited for the inherently ordered property of injury severity. An important finding is the significance of the distance of crash to the nearest ramp junction/access point, for which the increase in the distance yielded a severity increase at both facilities. Other significant factors included traffic volume, speed limit, at-fault driver's age, road surface condition, alcohol and drug involvement, and left and right shoulder widths. In comparing both facilities, sport utility vehicles (SUVs) and pickup trucks showed a fatality/severity increase on freeways and a decrease on arterials. Furthermore, the detailed list of variables such as crash time provided pertinent severity trend information that showed that, compared to the other periods, the afternoon peak period had the highest reduction in fatality/severity. Both probit models succeeded in identifying significant severity predictors for each facility. The binary probit model outperformed the ordered probit model based on the higher elasticities (marginal effects) for the fatality/severity probability change, as well as the goodness of fit. As such, this study provides the guidelines for assessing the impact of important roadway and
Prieto-Valderrey, F; Muñiz-Montes, J R; López-García, J A; Villegas-Del Ojo, J; Málaga-Gil, J; Galván-García, R
To describe the apparent diffusion coefficient (ADC) in a series of severe traumatic brain injuries, their clinical and outcome features, and possible implications. A descriptive, observational case-series study was carried out. Patients with severe traumatic brain injuries (TBIs) admitted to the ICU were subjected to MRI study using a 1.5 T scanner. Diffusion-weighted images (DWMR) were obtained using the following echo-planar pulse sequence: TR 10000 ms, TE 126.9 ms, with b values 1000 s/mm2 in the three spatial dimensions. Combining the three sets of images, an isotropic image conforming a map of the mean ADCs was obtained. DWMR was performed in 23 patients with severe TBI admitted to the ICU between 2001 and 2004. In the MR images we selected 26 regions of interest (ROIs) where ADC was recorded. We observed a clear increase in diffusion in non-treated space-occupying lesions versus other types of injuries and the normal values. A poorer outcome was recorded in patients with lower ADC values. Mean ADC in the lesions was greater than the normal values and greater in contusions than in other types of injuries, as an expression of extracellular edema. ADCs were decreased in patients with a poor outcome, suggesting an association between ischemia and the patient prognosis. Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.
Hao, Wei; Kamga, Camille
Based on the Federal Railway Administration (FRA) database, there were 25,945 highway-rail crossing accidents in the United States between 2002 and 2011. With an extensive research, analysis results showed that there were substantial differences between rural and urban areas at highway-rail grade crossings. However, there is no published study specific on driver's injury severity at highway-rail grade crossings classified by area types. Using an ordered probit modelling approach, the study explores the determinants of driver-injury severity at rural highway-rail grade crossings compared with urban highway-rail grade crossings. The analysis found that motor vehicle driver's injury level at rural highway-rail grade crossing is extremely higher than urban area. Compared to collisions at urban area, collisions happened at rural area tend to result in more severe injuries. These crashes were more prevalent if vehicle drivers are driving at a high speed or the oncoming trains are high-speed. Moreover, highway-rail grade crossing accidents were more likely to occur at rural area without pavement and lighting.
Curia, Giulia; Levitt, Michael; Fender, Jason S.; Miller, John W.; Ojemann, Jeffrey
Human posttraumatic epilepsy (PTE) is highly heterogeneous, ranging from mild remitting to progressive disabling forms. PTE results in simple partial, complex partial, and secondarily generalized seizures with a wide spectrum of durations and semiologies. PTE variability is thought to depend on the heterogeneity of head injury and patient's age, gender, and genetic background. To better understand the role of these factors, we investigated the seizures resulting from calibrated fluid percussion injury (FPI) to adolescent male Sprague–Dawley rats with video electrocorticography. We show that PTE incidence and the frequency and severity of chronic seizures depend on the location and severity of FPI. The frontal neocortex was more prone to epileptogenesis than the parietal and occipital, generating earlier, longer, and more frequent partial seizures. A prominent limbic focus developed in most animals, regardless of parameters of injury. Remarkably, even with carefully controlled injury parameters, including type, severity, and location, the duration of posttraumatic apnea and the age and gender of outbred rats, there was great subject-to-subject variability in frequency, duration, and rate of progression of seizures, indicating that other factors, likely the subjects' genetic background and physiological states, have critical roles in determining the characteristics of PTE. PMID:21112931
Kalwerisky, Kevin; Davies, Brett; Mihora, Lisa; Czyz, Craig N; Foster, Jill A; DeMartelaere, Sheri
To report the use of the Boston Ocular Surface Prosthesis (BOSP) in patients with severe periorbital thermal injuries. Retrospective, interventional case series. Patients with severe periorbital thermal injuries treated with the BOSP. Chart review of 10 consecutive patients (16 eyes) who sustained severe periorbital thermal injuries during combat missions in Iraq and Afghanistan and were treated for exposure keratopathy with the BOSP, a Food and Drug Administration-approved gas-permeable, scleral contact lens. Corneal epithelial defect healing, uncorrected and best-corrected visual acuity, and BOSP wear time. Exposure keratopathy occurred after severe periorbital thermal injuries and followed a predictable course of scar contracture. In all patients, vision-threatening ocular surface disease developed as a result of chronic ocular exposure. Rehabilitation of the ocular surface was accomplished using the BOSP, with 10 of the 16 treated eyes achieving a corrected visual acuity of 20/70 or better. Five eyes achieved a best-corrected visual acuity of 20/40 or better. The BOSP also was used as a drug-delivery vehicle to treat corneal ulcers successfully in 6 eyes. The only eye that required penetrating keratoplasty was an early intervention believed to be a direct sequelae of the original thermal burn, rather than a failure of the BOSP regimen. The mean BOSP wear time was 16 hours per day. The BOSP can play an important role in rehabilitation of the ocular surface for patients with severe periorbital thermal injuries and resultant exposure keratopathy. Use of the BOSP should be considered as a treatment option for these difficult cases of severe periorbital thermal injuries. Copyright Â© 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
BATOOL F. KIRMANI
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.
Walker, William C; Pickett, Treven C
Neuromotor impairment is a common sequela of severe traumatic brain injury (TBI) but has been understudied relative to neurocognitive outcomes. This multicenter cohort study describes the longitudinal course of neurological examination-based motor abnormalities after severe TBI. Subjects were enrolled from the four lead Department of Veterans Affairs and Defense and Veterans Brain Injury Center sites. The study cohort consisted of 102 consecutive patients (active duty, veteran, or military dependent) with severe TBI who consented during acute rehabilitation for data collection and completed all follow-up evaluations. Paresis, ataxia, and postural instability measures showed a pattern of improvement over time, with the greatest improvement occurring between the inpatient (baseline) and 6-month follow-up assessments. Involuntary movement disorders were rare at all time points. Two years following acute rehabilitation, more than one-third of subjects continued to display a neuromotor abnormality on basic neurological examination. Persistence of tandem gait abnormality was particularly common.
Lilia de Souza Nogueira
Full Text Available The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS and the New Injury Severity Score (NISS. Databases were searched using the keyword NISS, with 42 articles, 23 of which didn't compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.
Kaiser, Radek; Waldauf, Petr; Haninec, Pavel
Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively(1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail. Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper,22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents(63.2%) followed by car accidents (23.5%), bicycle accidents(10.7%) and pedestrian collisions (3.1%) (pcar accidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (pcar accidents (9.3%,pcar and motorcycle accidents),significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%). Study results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is
Full Text Available In patients with liver disease such as viral hepatitis and liver cirrhosis, renal injury and renal insufficiency can be generally classified as acute kidney injury (AKI, chronic kidney disease, and acute-on-chronic nephropathy. AKI can be classified as stage 1 (risk stage, stage 2 (injury stage, and stage 3 (failure stage. Traditionally hepatorenal syndrome is classified as types Ⅰ and Ⅱ, and in recent years, type Ⅲ hepatorenal syndrome with organic renal injury has been proposed. Hepatorenal disorder(HRD is used to describe any renal disease which occurs in patients with liver cirrhosis. At present, sensitive and accurate biochemical parameters used to evaluate renal function in patients with liver disease in clinical practice include estimated glomerular filtration rate, increase in serum creatinine within unit time, and serum cystatin C level, and urinary microalbumin level also plays an important role in the early diagnosis of nephropathy. Causes of liver disease, severity, complications including infection, nutritional status, therapeutic drugs, and underlying nephropathy may be associated with renal injury and renal insufficiency in patients with liver disease and should be differentiated.
Everett Christopher B
Full Text Available Abstract Objectives The authors present a novel approach to nonresectional therapy in major hepatic trauma utilizing intraabdominal perihepatic vacuum assisted closure (VAC therapy in the porcine model of Grade V liver injury. Methods A Grade V injury was created in the right lobe of the liver in a healthy pig. A Pringle maneuver was applied (4.5 minutes total clamp time and a vacuum assisted closure device was placed over the injured lobe and connected to suction. The device consisted of a perforated plastic bag placed over the liver, followed by a 15 cm by 15cm VAC sponge covered with a nonperforated plastic bag. The abdomen was closed temporarily. Blood loss, cardiopulmonary parameters and bladder pressures were measured over a one-hour period. The device was then removed and the animal was euthanized. Results Feasibility of device placement was demonstrated by maintenance of adequate vacuum suction pressures and seal. VAC placement presented no major technical challenges. Successful control of ongoing liver hemorrhage was achieved with the VAC. Total blood loss was 625 ml (20ml/kg. This corresponds to class II hemorrhagic shock in humans and compares favorably to previously reported estimated blood losses with similar grade liver injuries in the swine model. No post-injury cardiopulmonary compromise or elevated abdominal compartment pressures were encountered, while hepatic parenchymal perfusion was maintained. Conclusion These data demonstrate the feasibility and utility of a perihepatic negative pressure device for the treatment of hemorrhage from severe liver injury in the porcine model.
Objectives The authors present a novel approach to nonresectional therapy in major hepatic trauma utilizing intraabdominal perihepatic vacuum assisted closure (VAC) therapy in the porcine model of Grade V liver injury. Methods A Grade V injury was created in the right lobe of the liver in a healthy pig. A Pringle maneuver was applied (4.5 minutes total clamp time) and a vacuum assisted closure device was placed over the injured lobe and connected to suction. The device consisted of a perforated plastic bag placed over the liver, followed by a 15 cm by 15cm VAC sponge covered with a nonperforated plastic bag. The abdomen was closed temporarily. Blood loss, cardiopulmonary parameters and bladder pressures were measured over a one-hour period. The device was then removed and the animal was euthanized. Results Feasibility of device placement was demonstrated by maintenance of adequate vacuum suction pressures and seal. VAC placement presented no major technical challenges. Successful control of ongoing liver hemorrhage was achieved with the VAC. Total blood loss was 625 ml (20ml/kg). This corresponds to class II hemorrhagic shock in humans and compares favorably to previously reported estimated blood losses with similar grade liver injuries in the swine model. No post-injury cardiopulmonary compromise or elevated abdominal compartment pressures were encountered, while hepatic parenchymal perfusion was maintained. Conclusion These data demonstrate the feasibility and utility of a perihepatic negative pressure device for the treatment of hemorrhage from severe liver injury in the porcine model. PMID:23217091
Full Text Available Lene Odgaard,1 Ingrid Poulsen,2 Lars Peter Kammersgaard,2 Søren Paaske Johnsen,3 Jørgen Feldbæk Nielsen,1 1Hammel Neurorehabilitation Center and University Research Clinic, Aarhus University, Aarhus, Denmark; 2Department of Neurorehabilitation, TBI and Research Unit on Brain injury rehabilitation (RUBRIC, Glostrup Hospital, Copenhagen University, Copenhagen, Denmark; 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark 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 The Danish National Patient Registry and The Danish Head Trauma Database. Overall incidence rates of surviving severe TBI and incidence rates of admission to HS-rehabilitation after severe TBI were estimated and compared. Patient-related predictors of no admission to HS-rehabilitation among patients surviving severe TBI were identified using multivariable logistic regression. Results: The average incidence rate of surviving severe TBI was 2.3 per 100,000 person years. Incidence rates of HS-rehabilitation were generally stable around 2.0 per 100,000 person years. Overall, 84% of all patients surviving 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 and the majority of the patients were admitted to HS-rehabilitation. However, potential inequity in access to HS-rehabilitation may still be present despite a health care system based on equal access for all citizens. Keywords: database, health care disparities, registries, validity
Cox, Charles S; Hetz, Robert A; Liao, George P; Aertker, Benjamin M; Ewing-Cobbs, Linda; Juranek, Jenifer; Savitz, Sean I; Jackson, Margaret L; Romanowska-Pawliczek, Anna M; Triolo, Fabio; Dash, Pramod K; Pedroza, Claudia; Lee, Dean A; Worth, Laura; Aisiku, Imoigele P; Choi, Huimahn A; Holcomb, John B; Kitagawa, Ryan S
Preclinical studies using bone marrow derived cells to treat traumatic brain injury have demonstrated efficacy in terms of blood-brain barrier preservation, neurogenesis, and functional outcomes. Phase 1 clinical trials using bone marrow mononuclear cells infused intravenously in children with severe traumatic brain injury demonstrated safety and potentially a central nervous system structural preservation treatment effect. This study sought to confirm the safety, logistic feasibility, and potential treatment effect size of structural preservation/inflammatory biomarker mitigation in adults to guide Phase 2 clinical trial design. Adults with severe traumatic brain injury (Glasgow Coma Scale 5-8) and without signs of irreversible brain injury were evaluated for entry into the trial. A dose escalation format was performed in 25 patients: 5 controls, followed 5 patients in each dosing cohort (6, 9, 12 ×10 6 cells/kg body weight), then 5 more controls. Bone marrow harvest, cell processing to isolate the mononuclear fraction, and re-infusion occurred within 48 hours after injury. Patients were monitored for harvest-related hemodynamic changes, infusional toxicity, and adverse events. Outcome measures included magnetic resonance imaging-based measurements of supratentorial and corpus callosal volumes as well as diffusion tensor imaging-based measurements of fractional anisotropy and mean diffusivity of the corpus callosum and the corticospinal tract at the level of the brainstem at 1 month and 6 months postinjury. Functional and neurocognitive outcomes were measured and correlated with imaging data. Inflammatory cytokine arrays were measured in the plasma pretreatment, posttreatment, and at 1 and 6 month follow-up. There were no serious adverse events. There was a mild pulmonary toxicity of the highest dose that was not clinically significant. Despite the treatment group having greater injury severity, there was structural preservation of critical regions of interest
Falchook, Adam D; Porges, Eric C; Nadeau, Stephen E; Leon, Susan A; Williamson, John B; Heilman, Kenneth M
In most right-handed people, the left hemisphere is dominant for programming the temporal and spatial "how" (praxis) aspects of purposeful skilled movements, and the right hemisphere is dominant for control of the intentional "when" aspects of actions that mediate initiation, persistence, termination, and inhibition. Since the interhemispheric axons of the corpus callosum are especially susceptible to shearing from torsional forces during traumatic brain injury (TBI), the goal of this study was to learn whether participants with a history of severe traumatic brain injury demonstrate three types of cognitive-motor impairments that may result from callosal injury: ideomotor apraxia of the left hand, limb kinetic apraxia of the left hand, and hypokinesia of the right hand in response to left hemispatial stimuli. Nine participants with severe TBI and nine healthy control participants were studied for the presence of ideomotor apraxia, limb kinetic apraxia, and hypokinesia. When compared to the control participants, the participants with TBI revealed ideomotor apraxia and limb kinetic apraxia of the left hand and hypokinesia in response to left-sided visual stimuli when tested with the right hand. TBI appears to cause unilateral disorders of cognitive-motor functions. Future research is needed to understand how these cognitive-motor disorders are related to interhemispheric disconnection most likely induced by injury to the corpus callosum.
Stefanidou, Styliani; Kotsiou, Maria; Mesimeris, Theodore
Open fractures with severe soft-tissue injury and critical local ischaemia of the lower limbs are usually difficult to treat and require a multidisciplinary approach. A 33-year-old Caucasian female with crush injury of the right foot (Gustillo IIIC) was admitted to hospital after a car accident. Despite surgical interventions, a persistent state of hypoxia was present because of the severe vessel injury, and amputation was suggested. Seventy-two hours after admission she was referred to the hyperbaric medicine unit for hyperbaric oxygen treatment (HBOT) to define the limits of viable tissues prior to amputation. After six sessions, clinical improvement was so obvious that the decision to amputate was rejected and she underwent a total of 32 HBOT in addition to frequent debridement and administration of antibiotics. After the HBOT course, she underwent successful surgical reconstruction with a vascularised cutaneous flap. Full healing was achieved. Given the fact that hyperbaric oxygen mechanisms of action target the pathophysiology of crush injuries it should be considered not only for the definition of viable tissue limits but also to enhance viability, even in the most serious situations. HBOT may prove a valuable supplement in the therapeutic armamentarium of these patients.
Full Text Available Hepatic ischemia-reperfusion (I/R injury is a serious complication in clinical practice. However, no efficient biomarkers are available for the evaluation of the severity of I/R injury. Recently, renalase has been reported to be implicated in the I/R injury of various organs. This protein is secreted into the blood in response to increased oxidative stress. To investigate the responsiveness of renalase to oxidative stress, we examined the changes of renalase in cell and mouse models. We observed a significant increase of renalase expression in HepG2 cells in a time- and dose-dependent manner when treated with H2O2. Renalase expression also increased significantly in liver tissues that underwent the hepatic I/R process. The increased renalase levels could be efficiently suppressed by antioxidants in vitro and in vivo. Furthermore, serum renalase levels were significantly increased in the mouse models and also efficiently suppressed by antioxidants treatment. The variation trends are consistent between renalase and liver enzymes in the mouse models. In conclusion, renalase is highly sensitive and responsive to oxidative stress in vitro and in vivo. Moreover, renalase can be detected in the blood. These properties make renalase a highly promising biomarker for the evaluation of the severity of hepatic I/R injury.
Törnqvist, Björn; Waage, Anne; Zheng, Zongli; Ye, Weimin; Nilsson, Magnus
Acute cholecystitis is a common complication to gallstone disease. The relation between the severity of acute cholecystitis and risk of bile duct injury during cholecystectomy has not yet been addressed and is the main focus of this study. All cases with iatrogenic bile duct injury during cholecystectomy, within the Lake Mälaren region, Sweden, were identified through ICD procedure codes for biliary reconstruction within the Swedish Inpatient Register and matched to non-injured cholecystectomized controls. Information regarding perioperative variables was collected through medical record review. After review, 158 cases and 623 controls remained for analyses. Adjusted risk of bile duct injury was doubled among patients with acute cholecystitis (OR 1.97 95 % CI 1.05-3.72), whereas a mild acute cholecystitis (Tokyo grade I) did not affect the risk of bile duct injury (OR 0.96 95 % CI 0.41-2.25), a moderate (Tokyo grade II) more than doubled the risk (OR 2.41 95 % CI 1.21-4.80). Severe cholecystitis (Tokyo grade III) had a close to significant eightfold increase in risk (OR 8.43 95 % CI 0.97-72.9). The intention to use intraoperative cholangiography reduced injury risk by 52 % (OR 0.48, 95 % CI 0.29-0.81). Patients with on-going acute cholecystitis had twice the risk of sustaining a biliary lesion compared to patients without acute cholecystitis. There was a relation between the Tokyo guidelines severity grading of acute cholecystitis and injury risk and the intention to use intraoperative cholangiography halved the risk of reconstructed bile duct injury during cholecystectomy.
Yang, Hao; Cohen, Mitchell Jay; Chen, Wei; Sun, Ming-Wei; Lu, Charles Damien
Spinal cord injury (SCI) is a devastating event with a limited hope for recovery and represents an enormous public health issue. It is crucial to understand the disturbances in the metabolic network after SCI to identify injury mechanisms and opportunities for treatment intervention. Through plasma 1H-nuclear magnetic resonance (NMR) screening, we identified 15 metabolites that made up an “Eigen-metabolome” capable of distinguishing rats with severe SCI from healthy control rats. Forty enzymes regulated these 15 metabolites in the metabolic network. We also found that 16 metabolites regulated by 130 enzymes in the metabolic network impacted neurobehavioral recovery. Using the Eigen-metabolome, we established a linear discrimination model to cluster rats with severe and mild SCI and control rats into separate groups and identify the interactive relationships between metabolic biomarkers in the global metabolic network. We identified 10 clusters in the global metabolic network and defined them as distinct metabolic disturbance domains of SCI. Metabolic paths such as retinal, glycerophospholipid, arachidonic acid metabolism; NAD–NADPH conversion process, tyrosine metabolism, and cadaverine and putrescine metabolism were included. In summary, we presented a novel interdisciplinary method that integrates metabolomics and global metabolic network analysis to visualize metabolic network disturbances after SCI. Our study demonstrated the systems biological study paradigm that integration of 1H-NMR, metabolomics, and global metabolic network analysis is useful to visualize complex metabolic disturbances after severe SCI. Furthermore, our findings may provide a new quantitative injury severity evaluation model for clinical use. PMID:24727691
Peng, Jin; Zeng, Jun; Cai, Bin; Yang, Hao; Cohen, Mitchell Jay; Chen, Wei; Sun, Ming-Wei; Lu, Charles Damien; Jiang, Hua
Spinal cord injury (SCI) is a devastating event with a limited hope for recovery and represents an enormous public health issue. It is crucial to understand the disturbances in the metabolic network after SCI to identify injury mechanisms and opportunities for treatment intervention. Through plasma 1H-nuclear magnetic resonance (NMR) screening, we identified 15 metabolites that made up an "Eigen-metabolome" capable of distinguishing rats with severe SCI from healthy control rats. Forty enzymes regulated these 15 metabolites in the metabolic network. We also found that 16 metabolites regulated by 130 enzymes in the metabolic network impacted neurobehavioral recovery. Using the Eigen-metabolome, we established a linear discrimination model to cluster rats with severe and mild SCI and control rats into separate groups and identify the interactive relationships between metabolic biomarkers in the global metabolic network. We identified 10 clusters in the global metabolic network and defined them as distinct metabolic disturbance domains of SCI. Metabolic paths such as retinal, glycerophospholipid, arachidonic acid metabolism; NAD-NADPH conversion process, tyrosine metabolism, and cadaverine and putrescine metabolism were included. In summary, we presented a novel interdisciplinary method that integrates metabolomics and global metabolic network analysis to visualize metabolic network disturbances after SCI. Our study demonstrated the systems biological study paradigm that integration of 1H-NMR, metabolomics, and global metabolic network analysis is useful to visualize complex metabolic disturbances after severe SCI. Furthermore, our findings may provide a new quantitative injury severity evaluation model for clinical use.
Full Text Available Spinal cord injury (SCI is a devastating event with a limited hope for recovery and represents an enormous public health issue. It is crucial to understand the disturbances in the metabolic network after SCI to identify injury mechanisms and opportunities for treatment intervention. Through plasma 1H-nuclear magnetic resonance (NMR screening, we identified 15 metabolites that made up an "Eigen-metabolome" capable of distinguishing rats with severe SCI from healthy control rats. Forty enzymes regulated these 15 metabolites in the metabolic network. We also found that 16 metabolites regulated by 130 enzymes in the metabolic network impacted neurobehavioral recovery. Using the Eigen-metabolome, we established a linear discrimination model to cluster rats with severe and mild SCI and control rats into separate groups and identify the interactive relationships between metabolic biomarkers in the global metabolic network. We identified 10 clusters in the global metabolic network and defined them as distinct metabolic disturbance domains of SCI. Metabolic paths such as retinal, glycerophospholipid, arachidonic acid metabolism; NAD-NADPH conversion process, tyrosine metabolism, and cadaverine and putrescine metabolism were included. In summary, we presented a novel interdisciplinary method that integrates metabolomics and global metabolic network analysis to visualize metabolic network disturbances after SCI. Our study demonstrated the systems biological study paradigm that integration of 1H-NMR, metabolomics, and global metabolic network analysis is useful to visualize complex metabolic disturbances after severe SCI. Furthermore, our findings may provide a new quantitative injury severity evaluation model for clinical use.
Sobhani, Amir; Young, William; Logan, David; Bahrololoom, Sareh
An important part of any model of vehicle crashes is the development of a procedure to estimate crash injury severity. After reviewing existing models of crash severity, this paper outlines the development of a modelling approach aimed at measuring the injury severity of people in two-vehicle road crashes. This model can be incorporated into a discrete event traffic simulation model, using simulation model outputs as its input. The model can then serve as an integral part of a simulation model estimating the crash potential of components of the traffic system. The model is developed using Newtonian Mechanics and Generalised Linear Regression. The factors contributing to the speed change (ΔV(s)) of a subject vehicle are identified using the law of conservation of momentum. A Log-Gamma regression model is fitted to measure speed change (ΔV(s)) of the subject vehicle based on the identified crash characteristics. The kinetic energy applied to the subject vehicle is calculated by the model, which in turn uses a Log-Gamma Regression Model to estimate the Injury Severity Score of the crash from the calculated kinetic energy, crash impact type, presence of airbag and/or seat belt and occupant age. Copyright © 2010 Elsevier Ltd. All rights reserved.
Discussion: Urinary NGAL levels measured 2 to 3 hours after surgery were able to distinguish the kinetics of creatinine (sustained AKI vs. transient AKI over the subsequent week. Transient AKI is an easily reversible state that is likely not associated with substantial tubular injury and therefore NGAL release. Using AKIN criteria, both transient and sustained AKI are classified as AKI even though our data demonstrate that they are possibly different entities.
Welch, Timothy P; Wallendorf, Michael J; Kharasch, Evan D; Leonard, Jeffrey R; Doctor, Allan; Pineda, Jose A
To evaluate the clinical effectiveness of bolus-dose fentanyl and midazolam to treat episodic intracranial hypertension in children with severe traumatic brain injury. Retrospective cohort. PICU in a university-affiliated children's hospital level I trauma center. Thirty-one children 0-18 years of age with severe traumatic brain injury (Glasgow Coma Scale score of ≤ 8) who received bolus doses of fentanyl and/or midazolam for treatment of episodic intracranial hypertension. None. The area under the curve from high-resolution intracranial pressure-time plots was calculated to represent cumulative intracranial hypertension exposure: area under the curve for intracranial pressure above 20 mm Hg (area under the curve-intracranial hypertension) was calculated in 15-minute epochs before and after administration of fentanyl and/or midazolam for the treatment of episodic intracranial hypertension. Our primary outcome measure, the difference between predrug and postdrug administration epochs (Δarea under the curve-intracranial hypertension), was calculated for all occurrences. We examined potential covariates including age, injury severity, mechanism, and time after injury; time after injury correlated with Δarea under the curve-intracranial hypertension. In a mixed-effects model, with patient as a random effect, drug/dose combination as a fixed effect, and time after injury as a covariate, intracranial hypertension increased after administration of fentanyl and/or midazolam (overall aggregate mean Δarea under the curve-intracranial hypertension = +17 mm Hg × min, 95% CI, 0-34 mm Hg × min; p = 0.04). The mean Δarea under the curve-intracranial hypertension increased significantly after administration of high-dose fentanyl (p = 0.02), low-dose midazolam (p = 0.006), and high-dose fentanyl plus low-dose midazolam (0.007). Secondary analysis using age-dependent thresholds showed no significant impact on cerebral perfusion pressure deficit (mean Δarea under the curve
Hansen, Christian Riberholt; Olesen, Niels; Thing, Mira
) and the CBFV were lower in the patients (p increase in the Mxc index during head-up tilt pointing at impaired autoregulation (p = 0.001). Spectral analysis of HR variability in the frequency domain revealed significant lower magnitudes of ~ 0.1 Hz spectral power......Objectives: Upright tilt is an important tool for early mobilization of patients after severe acquired brain injury (ABI). Early mobilization is considered to be of importance for increasing awareness, in the prevention of contractures and pulmonary infections and to improve long-term outcome....... A challenge for early mobilization is orthostatic instability that is often observed during heap-up tilt, which could lead to decreased cerebral blood flow velocity (CBFV) and decreased long-term outcome. We examined cerebral blood flow autoregulation in patients with severe brain injury and impaired...
Cummins, Justin S; Koval, Kenneth J; Cantu, Robert V; Spratt, Kevin F
We studied National Trauma Data Bank data to determine the effectiveness of car safety devices in reducing mortality and injury severity in 184,992 patients between 1988 and 2004. Safety device variables were seat belt used plus air bag deployed; only seat belt used; only air bag deployed; and, as explicitly coded, no device used. Overall mortality was 4.17%. Compared with the no-device group, the seat-belt-plus-air-bag group had a 67% reduction in mortality (adjusted odds ratio [AOR], 0.33; 99% confidence interval [CI], 0.28-0.39), the seatbelt- only group had a 51% mortality reduction (AOR, 0.49; 99% CI, 0.45-0.52), and the air-bag-only group had a 32% mortality reduction (AOR, 0.68, 99% CI, 0.57-0.80). Injury Severity Scores showed a similar pattern.
Full Text Available Recent studies have suggested that endogenous angiogenesis inhibitor endostatin/collagen XVIII might play an important role in the secondary brain injury following traumatic brain injury (TBI. In this study, we measured endostatin/collagen XVIII concentrations serially for 1 week after hospitalization by using the enzyme-linked immunosorbent assay method in the cerebrospinal fluid (CSF of 30 patients with TBI and a Glasgow Coma Scale (GCS score of 8 or less on admission. There was a significant trend toward increased CSF levels of endostatin after TBI versus control from 72 h after injury. In patients with GCS score of 3–5, CSF endostatin concentration was substantially higher at 72 h after injury than that in patients with GCS score of 6–8 (P<0.05 and peaked rapidly at day 5 after injury, but decreased thereafter. The CSF endostatin concentration in 12 patients with an unfavorable outcome was significantly higher than that in 18 patients with a favorable outcome at day 5 (P=0.043 and day 7 (P=0.005 after trauma. Receiver operating characteristic curve analysis suggested a reliable operating point for the 7-day CSF endostatin concentration predicting poor prognosis to be 67.29 pg/mL. Our preliminary findings provide new evidence that endostatin/collagen XVIII concentration in the CSF increases substantially in patients with sTBI. Its dynamic change may have some clinical significance on the judgment of brain injury severity and the assessment of prognosis. This trial is registered with the ClinicalTrials.gov Identifier: NCT01846546.
...'' as severe burn injuries. We believe that VA's definition of severe burn injury for purposes of... consistent with congressional intent. This definition generally reflects the purpose found at 38 U.S.C. 3901... in a rule that may: (1) Have an annual effect on the economy of $100 million or more or adversely...
Jiang, Ximiao; Huang, Baoshan; Yan, Xuedong; Zaretzki, Russell L; Richards, Stephen
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.
Shi, Yan; Zhang, Xiong; Huang, Bo-Gao; Wang, Wen-Kui; Liu, Yan
The management of serious burn injuries during pregnancy is an unsolved clinical problem because of the low incidence of this disease. Although it has been documented that the effect of burns on fetal and maternal survival is detrimental, there have been conflicting reports among the different burn centers regarding the mortality of burned pregnant women and the management of burn patients during pregnancy. We report a case of severe burn in late pregnancy treated at our burn center. Addition...
Goldhaber, Gerald M.
A survey was conducted to determine the level of awareness among parents of high school football players about the risk of severe brain injury. A national sample of 1007 randomly selected households was interviewed by telephone during February, 1992. All interviewees were parents of high school football players who either were currently playing football or had played within the previous 5 years. Survey questions measured the extent to which parents were aware both of the risks associated with...
Dvorkin, Assaf Y; Ramaiya, Milan; Eric B Larson; Zollman, Felise S; Hsu, Nancy; Pacini, Sonia; Shah, Amit; Patton, James L.
Background Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery. Methods We designed a ?virtually minimal? approach using robot-rendered haptics in a virtual enviro...
Maggiore, Umberto; Picetti, Edoardo; Antonucci, Elio; Parenti, Elisabetta; Regolisti, Giuseppe; Mergoni, Mario; Vezzani, Antonella; Cabassi, Aderville; Fiaccadori, Enrico
Introduction The study was aimed at verifying whether the occurrence of hypernatremia during the intensive care unit (ICU) stay increases the risk of death in patients with severe traumatic brain injury (TBI). We performed a retrospective study on a prospectively collected database including all patients consecutively admitted over a 3-year period with a diagnosis of TBI (post-resuscitation Glasgow Coma Score ? 8) to a general/neurotrauma ICU of a university hospital, providing critical care ...
Full Text Available It has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS, but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS.Eighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAPSB and abdominal muscle paralysis group (BIPAPAP. All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH2O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO2 of 35-60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment.For the comparable ventilator setting, as compared with BIPAPSB group, the BIPAPAP group presented higher EELV (427±47 vs. 366±38 ml and oxygenation index (293±36 vs. 226±31 mmHg, lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7 and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9 in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAPAP group (22.5±2.0 vs. 25.2±2.1.Abdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.
Full Text Available Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS. However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method, injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months. In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11 and 9.24 (range 6–11, respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7 and 5.19 (range 3–8, respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS
Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac
Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6-32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6-11) and 9.24 (range 6-11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4-7) and 5.19 (range 3-8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative
Zhang, Xianming; Wu, Weiliang; Zhu, Yongcheng; Jiang, Ying; Du, Juan; Chen, Rongchang
Objective It has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS), but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS. Methods Eighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAPSB) and abdominal muscle paralysis group (BIPAPAP). All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH2O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO2 of 35–60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV) and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL)-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment. Results For the comparable ventilator setting, as compared with BIPAPSB group, the BIPAPAP group presented higher EELV (427±47 vs. 366±38 ml) and oxygenation index (293±36 vs. 226±31 mmHg), lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml) and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml) in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7) and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9) in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAPAP group (22.5±2.0 vs. 25.2±2.1). Conclusion Abdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury. PMID:26745868
Cheng, Quan; Jiang, Bing; Xi, Jian; Li, Zhen Yan; Liu, Jin Fang; Wang, Jun Yu
To investigate the relation between brain ischemia and persistent vegetative state after severe traumatic brain injury. The 66 patients with severe brain injury were divided into two groups: The persistent coma group (coma duration ≥10 d) included 51 patients who had an admission Glasgow Coma Scale (GCS) of 5-8 and were unconscious for more than 10 d. There were 15 patients in the control group, their admission GCS was 5-8, and were unconscious for less than 10 d. The brain areas, including frontal, parietal, temporal, occipital lobes and thalamus, were measured by Single Photon Emission Computed Tomography (SPECT). In the first SPECT scan, multiple areas of cerebral ischemia were documented in all patients in both groups, whereas bilateral thalamic ischemia were presented in all patients in the persistent coma group and were absented in the control group. In the second SPECT scan taken during the period of analepsia, with an indication that unilateral thalamic ischemia were persisted in 28 of 41 patients in persistent coma group(28/41,68.29%). Persistent coma after severe brain injury is associated with bilateral thalamic ischemia.
Full Text Available Objective: To investigate the application of percutaneous endoscopic gastrostomy (PEG to patients with severe craniocerebral injury for the purpose of nutritional support therapy and pulmonary infection prevention. Methods: A total of 43 patients with severe craniocerebral injury admitted to our department from January 2008 to December 2012 received PEG followed by nutritional therapy. There were other 82 patients who were prescribed nasal-feeding nutrition. Nutrition status was evaluated by comparing serum albumin levels, and the incidence of pulmonary infection 1 week before and 2 weeks after operation was identifi ed and compared. Results: Both PEG and nasal-feeding nutrition therapies have significantly levated serum albumin levels (P<0.05. Serum albumin levels before and after nutritional therapies showed no significant difference between the two groups (P>0.05. The incidence of pulmonary infection in PEG group was significantly decreased compared with that in nasal-feeding nutrition group (P<0.05. Conclusion: PEG is an effective method for severe craniocerebral injury patients. It can not only provide enteral nutrition but also prevent pulmonary infection induced by esophageal refl ux. Key words: Gastrostomy; Craniocerebral trauma; Enteral nutrition
Yan, Xinping; Ma, Ming; Huang, Helai; Abdel-Aty, Mohamed; Wu, Chaozhong
This research presents a comprehensive analysis of motor vehicle-bicycle crashes using 4 years of reported crash data (2004-2007) in Beijing. The interrelationship of irregular maneuvers, crash patterns and bicyclist injury severity are investigated by controlling for a variety of risk factors related to bicyclist demographics, roadway geometric design, road environment, etc. Results show that different irregular maneuvers are correlated with a number of risk factors at different roadway locations such as the bicyclist age and gender, weather and traffic condition. Furthermore, angle collisions are the leading pattern of motor vehicle-bicycle crashes, and different irregular maneuvers may lead to some specific crash patterns such as head-on or rear-end crashes. Orthokinetic scrape is more likely to result in running over bicyclists, which may lead to more severe injury. Moreover, bicyclist injury severity level could be elevated by specific crash patterns and risk factors including head-on and angle collisions, occurrence of running over bicyclists, night without streetlight, roads without median/division, higher speed limit, heavy vehicle involvement and older bicyclists. This study suggests installation of median, division between roadway and bikeway, and improvement of illumination on road segments. Reduced speed limit is also recommended at roadway locations with high bicycle traffic volume. Furthermore, it may be necessary to develop safety campaigns aimed at male, teenage and older bicyclists. Copyright © 2011 Elsevier Ltd. All rights reserved.
Full Text Available Childhood maltreatment is associated with attention deficits. We examined the effect of childhood abuse and abuse-by-gene (5-HTTLPR, MAOA, FKBP5 interaction on functional brain connectivity during sustained attention in medication/drug-free adolescents. Functional connectivity was compared, using generalised psychophysiological interaction (gPPI analysis of functional magnetic resonance imaging (fMRI data, between 21 age-and gender-matched adolescents exposed to severe childhood abuse and 27 healthy controls, while they performed a parametrically modulated vigilance task requiring target detection with a progressively increasing load of sustained attention. Behaviourally, participants exposed to childhood abuse had increased omission errors compared to healthy controls. During the most challenging attention condition abused participants relative to controls exhibited reduced connectivity, with a left-hemispheric bias, in typical fronto-parietal attention networks, including dorsolateral, rostromedial and inferior prefrontal and inferior parietal regions. Abuse-related connectivity abnormalities were exacerbated in individuals homozygous for the risky C-allele of the single nucleotide polymorphism rs3800373 of the FK506 Binding Protein 5 (FKBP5 gene. Findings suggest that childhood abuse is associated with decreased functional connectivity in fronto-parietal attention networks and that the FKBP5 genotype moderates neurobiological vulnerability to abuse. These findings represent a first step towards the delineation of abuse-related neurofunctional connectivity abnormalities, which hopefully will facilitate the development of specific treatment strategies for victims of childhood maltreatment.
Yoon, Jin-Ha; Roh, Jaehoon; Kim, Chi-Nyon; Won, Jong-Uk
The aim of this study was to examine the relationship between noise exposure and risk of occupational injury. Korean National Health and Nutrition Examination Survey was used for the current study. Self-report questionnaires were used to investigate occupational injury and exposure to noise, chemicals, and machines and equipments. In separate analyses for occupation and occupational hazard, the proportion of occupational injuries increased according to severity of noise exposure (all P exposure group, the respective odds ratio (95% confidence intervals) for occupational injury was 1.39 (1.07-1.80) and 1.67 (1.13-2.46) in the mild and severe noise exposure groups, after controlling for age, gender, sleep hours, work schedule (shift work), and exposure status to hazardous chemicals and hazardous machines and equipments. The current study highlights the association between noise exposure and risk of occupational injury. Furthermore, risk of occupational injury increased according to severity of noise exposure.
Zhang, X L; Chai, J K; Li, B L; Ma, L; Yin, K N; Zhang, D H; Feng, R
To explore the role of mitochondrial apoptosis on pulmonary fibrosis in rats with severe scald injury. According to the random digital table, a total number of 32 Wistar rats were divided into 4 groups: sham burn (group A), burn group (group B), 12-week post burn recovery group (group C), and 12-week post burn recovery plus a second burn injury group (group D). In group A and group B, lung tissues were harvested on post burn day 4. After received first burn injury 12 weeks, the group C and group D received separately a second sham burn injury and burn injury. Lung tissues were harvested on post burn day 4 after the second burn injury. All tissues were examined for cells apoptosis by Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling (TUNEL). Pulmonary fibrosis was assessed by Masson trichrome staining and Sirius red staining. The protein expression levels of cleaved Caspase-3, Bax and Bcl-2 were assessed by Western blot. Both Masson trichrome staining and Sirius red staining showed obvious pulmonary fibrosis in group C and group D. The apoptosis rates of group B, C and D were significantly higher than that in group A ((15.50±3.30)%, (7.88±3.10)%, (15.88±3.23)% vs (2.10±1.07)%, all P<0.05). Compared to group A, cleaved Caspase-3 levels were significantly higher in group B, C and D ((0.59±0.11), (0.33±0.08), (0.73±0.13) vs (0.16±0.05), all P<0.05). The ratio of Bax/Bcl-2 in group B, C and D also increased significantly ((2.08±0.30), (0.83±0.09), (1.54±0.12) vs (0.64±0.05), all P<0.05). Severe burn injury can induce pulmonary fibrosis and mitochondrial apoptosis may play an important role in the development of pulmonary fibrosis.
Villar, Jesús; Pérez-Méndez, Lina; Espinosa, Elena; Flores, Carlos; Blanco, Jesús; Muriel, Arturo; Basaldúa, Santiago; Muros, Mercedes; Blanch, Lluis; Artigas, Antonio; Kacmarek, Robert M.
Background There is a need for biomarkers insuring identification of septic patients at high-risk for death. We performed a prospective, multicenter, observational study to investigate the time-course of lipopolysaccharide binding protein (LBP) serum levels in patients with severe sepsis and examined whether serial serum levels of LBP could be used as a marker of outcome. Methodology/Principal Findings LBP serum levels at study entry, at 48 hours and at day-7 were measured in 180 patients with severe sepsis. Data regarding the nature of infections, disease severity, development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), and intensive care unit (ICU) outcome were recorded. LBP serum levels were similar in survivors and non-survivors at study entry (117.4±75.7 µg/mL vs. 129.8±71.3 µg/mL, P = 0.249) but there were significant differences at 48 hours (77.2±57.0 vs. 121.2±73.4 µg/mL, P<0.0001) and at day-7 (64.7±45.8 vs. 89.7±61.1 µg/ml, p = 0.017). At 48 hours, LBP levels were significantly higher in ARDS patients than in ALI patients (112.5±71.8 µg/ml vs. 76.6±55.9 µg/ml, P = 0.0001). An increase of LBP levels at 48 hours was associated with higher mortality (odds ratio 3.97; 95%CI: 1.84–8.56; P<0.001). Conclusions/Significance Serial LBP serum measurements may offer a clinically useful biomarker for identification of patients with severe sepsis having the worst outcomes and the highest probability of developing sepsis-induced ARDS. PMID:19718443
Kaski, Diego; Buttell, Joseph; Greenwood, Richard
To further understand the mechanisms underlying gait impairment following traumatic brain injury. A 58-year-old man presented with marked unsteadiness and motion sensitivity following a severe traumatic brain injury. He underwent a 6-week inpatient rehabilitation program focused on re-weighting and subsequently re-integrating ascending interoceptive information, by gradual reduction of maladaptive visual fixation techniques. We report clinical neurological outcomes and measures of functional outcome, as well as an objective assessment of visual dependency (the rod and disk test) at baseline and after the rehabilitation. Clinically, the patient had gait unsteadiness exacerbated by visual motion. A significant reduction in visual dependency occurred with tailored multi-disciplinary rehabilitation via gradual removal of visual fixation strategies that the patient had developed to maintain balance (t-test; p visual dependency in the generation of maladaptive gait strategies following brain injury. Our data suggest assessing and treating visual dependency to be an important component of gait rehabilitation after traumatic brain injury. Implications for rehabilitation Whilst gait disturbance in TBI is multifactorial, abnormal visual dependency may be important but under-recognised component of the disorder. Visual dependency can be easily and objectively assessed by the bedside in patients using a dynamic rod and disc test. Tailored rehabilitation with gradual reduction of maladaptive visual fixation can reduce visual dependency and contribute to improved gait and balance following TBI.
Yoong, W; Sanchez-Crespo, J; Rob, J; Parikh, M; Melendez, J; Pillai, R; Opriou, D
Backache is a common cause of morbidity among doctors and 50% of the obstetricians and gynaecologists suffering from this attribute it to work practice and posture. Occupational injuries remain poorly studied among obstetricians and gynaecologists and we have therefore tried to assess the extent and demographics of work-related injuries sustained during training by sending an eight-item questionnaire to 418 Registrar grade trainees in the London area. A low 23.2% response rate (97/418) was obtained, despite second questionnaires being sent to initial non-responders. Out of the 97 responders, 28 (28.7%) had suffered injuries at work at least once throughout their career. There was female preponderance in those reporting injuries, with a female to male ratio of 3:1. Of the 28 positive responders, 11 were UK graduates, 7 EU and the remaining 10 from Colombia, West Indies, India and Sudan. The mean age was 32.5 +/- 4.2 years, with 21 of the 28 (75%) being senior trainees (post-MRCOG). The injuries reported were: forearm (4); wrist (7); thumb (3); hands (1) shoulder and neck (9), ankle (1) and lower back (6). Of these, 18 sought medical help and received treatment for these injuries, which included long-term physiotherapy, although no-one required surgery. Eight were forced to take time off work, with a cumulative total of 80 days; one had to prolong her training by 3 months. Seven trainees sustained their injuries (e.g. ligamentous strain of wrist and scaphoid fracture) while performing caesarean sections, while forceps deliveries were the cause of six occupational injuries (e.g. ligamentous strain of sacroiliac joint). Work-related injuries can have adverse effects on training and workforce. Awareness of correct surgical techniques and adoption of ergonomic posture when performing procedures may help to minimise the risk of a work-related injury.
Ogundele, Olumuyiwa Joshua; Ifesanya, Adeleke O; Adeyanju, Sylvester A; Ogunlade, Samuel O
Road traffic injuries are major public health problems and a leading cause of death and injury around the world. Approximately 1.2 million people are killed each year in road crashes worldwide, with up to 50 million more injured. Over 95% of these deaths and injuries occur in the low- and middle-income countries of the world. The aim of this study is to evaluate the impact of the use of seat-belts in reducing the severity of injuries from road traffic crashes and to determine the compliance and awareness of the importance of the use of seat-belts among Nigerian motorists. The injury patterns and outcome of care in 140 patients who were seen at the emergency department of our tertiary hospital were evaluated. Initial care and resuscitation was carried out on all patients using the advanced trauma life support protocol. A total of 81 (57%) patients used seat-belts, while 59 (42.1%) did not. Nineteen (13.6%) patients died as a result of their injuries; 4 (21.1%) of these had used seat-belts, while 15 (79%) had not (P = 0.001). The mortality rate of 79% for patients who did not use seat-belt was statistically significant. The seat-belt is an effective safety tool that not only saves lives, but also significantly reduces the severity of the injury that a vehicle occupant may have sustained if they were not wearing the device. More public enlightenment is needed to increase the awareness and compliance of use of seat-belts among Nigerian motorists.
Bumbasirevic, Marko; Lesic, Aleksandar; Bumbasirevic, Vesna; Zagorac, Slavisa; Milosevic, Ivan; Simic, Marko; Markovic-Denic, Ljiljana
The objective of this study is to describe severe road traffic injuries (RTIs) in the population under 18 years in Belgrade, the capital of Serbia. We analysed both severe non-fatal and fatal RTIs in children and adolescents under 18 years old in the Belgrade area, during the period 2008-2011. Data sources were the official statistics of the Public Health Institute in Belgrade and forensic-medical records from two paediatric university hospitals and five university hospitals for adults. Using descriptive statistical methods, demographic characteristics, mechanism, type and time of injuries, surgical treatment procedures, injury severity scores (ISS), length of stay and outcome were evaluated. The admission and mortality rates were calculated. Among the total of 379 injured, 256 (67.5%) were male; the average age was 13.0 ± 4.7 (range: 0-18 years). The annual hospital admission rate of RTIs for both sexes decreased in average by 12.6% (95% CI = 9.3%-15.9%). The mean percentage of annual changes of mortality rates was 2.0 %; 95% CI = 1.3%-5.3% (5.7 per 100,000 in 2008, 5.6 in 2009, 4.7 in 2010 and 5.9 in 2011). The highest admission rates and mortality rates were for pedestrians, followed by passengers and cyclists. Accidents occurred most commonly on Monday (18.7%). Among children hospitalised for traffic injuries, 57.8% had head and neck trauma, 30.6% extremity fractures, 5% abdominal injuries, 4.2% chest and 2.4% multiple injuries. The average ISS was 22.4 (SD = 20.4), ranging from 1 to 75. Alcohol in blood was confirmed in 7.4% males and 3.3% females (p > 0.05). The average time of hospital stay was 8.8 days (SD = 16.7), ranging from 1 to 14. The increased rates require implementation of a well-defined national strategy in our country.
Hassan Naqvi, Syed Abid; Malik, Sidra; Zulfiqaruddin, Syed; Anwar, Syeda Birjees; Nayyar, Shahzad
Objective: To determine the etiology and severity of various forms of ocular war injuries in patients presenting at an Army Hospital in Pakistan. Methods: This cross sectional study was conducted at the Department of Ophthalmology, Combined Military Hospital, Peshawar over four years period from June 2012 through March 2016, Two hundred ten consecutive soldiers who presented with ocular war injuries were included for analysis after taking written informed consent. A predesigned proforma was used to record patient’s demographic details along with the cause, side, type and severity of injury, ocular trauma score was also recorded at presentation. Results: The mean age of the patients was 29.34±5.35 years. All of them were males. Left side was more frequently involved (n=126, 60.0%) and the most frequent underlying cause was IED blast injury (n=114, 54.3%). Closed globe injuries were more frequent and were recorded in 120 (57.1%) patients. Upon assigning Ocular Trauma Score, Grade-V (28.6%) injuries were the most frequent followed by Grade-I (25.7%), Grade III (25.7%), Grade II (11.4%) and Grade IV (8.6%). When stratified for the type of injury, OTS Grade I injuries were highest (60.0%) among patients with open globe injuries, hence poorer prognosis, while OTS Grade V injuries were highest (50.0%) among patients with closed globe injuries (p=0.000). Conclusion: IED blast injuries are most frequently encountered ocular war injuries often involving soldiers in the age group 20-30 years. These open globe injuries had worst clinical presentation to begin with and poorer prognosis than closed globe injuries. PMID:28083061
Yamauchi, Koun; Wakahara, Kazuhiko; Fukuta, Masashi; Matsumoto, Kazu; Sumi, Hiroshi; Shimizu, Katsuji; Miyamoto, Kei
Little epidemiological research on characteristics of upper extremity injuries resulting from snowboarding has been conducted, particularly in relation to snowboarding stance, falling direction, and the side of the body where the injury occurs. Snowboarding stance and the direction of the fall may influence the frequency of the side or the location of the upper extremity injury. Descriptive epidemiology study. This study analyzed the information obtained from 1918 patients with fractures or dislocations of the upper extremity (excluding the fingers and scapula) sustained during snowboarding/sliding between 2000 and 2008. Diagnosis, injured part and side, stance (regular or goofy), and falling directions were prospectively analyzed. Associations among these parameters were also analyzed. As characterized by skill level, patients were beginners (57.9%), intermediates (38.0%), and experts (4.0%). Eighty-eight percent had not received instruction from licensed instructors. Diagnoses included wrist fractures (53.7%), upper arm fractures (16.8%), shoulder dislocations (11.5%), and elbow dislocations (9.8%). In sum, 1742 (90.8%) patients were in regular stance when they fell, whereas 176 (9.2%) were in goofy stance. There was a significant difference in the prevalence of the injured side between the 2 stances. When the injured sides were classified according to the sliding direction, wrist fractures (61.7%) occurred on the side opposite the sliding direction, whereas shoulder dislocations (65.6%), upper arm fractures (82.9%), and elbow dislocations (79.8%) occurred on the same side as the sliding direction. When the injured sides were classified according to the falling direction, wrist fractures (68.1%) and elbow dislocations (63.5%) occurred because of backward falls, and shoulder dislocations (68.9%) and upper arm fractures (60.7%) occurred because of forward falls. Two snowboarding stances as well as 2 falling directions had a significant influence on the frequency of
Krasny-Pacini, Agata; Francillette, Leila; Toure, Hanna; Brugel, Dominique; Laurent-Vannier, Anne; Meyer, Philippe; Evans, Jonathan; Chevignard, Mathilde
To investigate the long-term outcome in prospective memory (PM), seven years after childhood severe traumatic brain injury (TBI), in a prospective longitudinal cohort. 76 young individuals (aged 7-22 years): 39 patients with a severe accidental TBI included prospectively seven years earlier, aged 0-15 years at injury, and 37 controls individually matched on age, gender and parental education. Three novel short PM tasks varying in the delay, motivation and context (ecological versus paper and pencil task). Individuals with severe TBI showed significantly poorer PM than matched controls in the two low-motivation PM tasks: (1) the ecological long-delay task consisting of sending a letter on a rainy day (p=0.047, odds ratio = 2.6); (2) the non-ecological short-delay task consisting of taking off post-its while identifying facial emotions (p=0.004, r=0.34). Differences in PM on the high motivation were not significant. PM is impaired several years post severe TBI.
Ng, D K K; Cherk, S W W; Yu, W L; Lau, M Y; Ho, J C S; Chau, C K W
To study the injury pattern of children admitted for management of severe trauma or thermal injury. Retrospective review. Paediatric intensive care unit of a regional hospital, Hong Kong. Twenty-eight children were admitted under this category from July 1996 to December 1999. Mechanisms, severity, and circumstances of injury. Road traffic accident was the most common cause of admission, followed by thermal injury, accidental fall, and non-accidental injury. However, children with non-accidental injury were admitted in a significantly more severe condition, as measured by the paediatric risk of mortality score, than those admitted for the other three reasons. Non-accidental injury was also associated with significantly higher morbidity and mortality than the other causes of admission. During the 42-month study period, trauma and thermal injury accounted for 7% of all admissions to the paediatric intensive care unit. Road traffic accident was the most common reason, while non-accidental injury accounted for the most serious injury. Detailed analysis of these cases identified certain preventable risk factors.
Four drivers sustained severe injuries when run down by their own automatic cars while adjusting the carburettor or throttle linkages. The transmission had been left in the "Drive" position and the engine was idling. This accident is easily avoidable.
Marc G Jeschke
Full Text Available BACKGROUND: Main contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury. It is currently unknown how long these conditions persist beyond the acute phase post-injury. The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions. METHODOLOGY/PRINCIPAL FINDINGS: PATIENTS: Nine-hundred seventy-seven severely burned pediatric patients with burns over 30% of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned, non-injured children. Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn. Statistical analysis was performed using One-way ANOVA, Student's t-test with Bonferroni correction where appropriate with significance accepted at p<0.05. Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05. Along with increased hypermetabolism, significant elevation of cortisol, catecholamines, cytokines, and acute phase proteins indicate that burn patients are in a hyperinflammatory state for up to three years post-burn p<0.05. CONCLUSIONS: Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown. Given the tremendous adverse events associated with the hypermetabolic and hyperinflamamtory responses, we now identified
Alharfi, Ibrahim M; Stewart, Tanya Charyk; Kelly, Shawn H; Morrison, Gavin C; Fraser, Douglas D
Acquired hypernatremia in hospitalized patients is often associated with poorer outcomes. Our aim was to evaluate the relationship between acquired hypernatremia and outcome in children with severe traumatic brain injury (sTBI). We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ≥12) with sTBI (Glasgow Coma Scale [GCS] ≤8 and Maximum Abbreviated Injury Scale [MAIS] ≥4) admitted to a Pediatric Critical Care Unit ([PCCU]; 2000-2009). In a cohort of 165 patients, 76% had normonatremia (135-150 mmol/L), 18% had hypernatremia (151-160 mmol/L), and 6% had severe hypernatremia (>160 mmol/L). The groups were similar except for lower GCS (p=0.002) and increased incidence of fixed pupil(s) on admission in both hypernatremia groups (phypernatremia and severe hypernatremia, respectively (phypernatremia had greater PCCU (p=0.001) and hospital (p=0.031) lengths of stays and were less frequently discharged home (p=0.008). Logistic regression analyses of patient characteristics and sTBI interventions demonstrated that hypernatremia was independently associated with the presence of fixed pupil(s) on admission (odds ratio [OR] 5.38; p=0.003); administration of thiopental (OR 8.64; p=0.014), and development of central diabetes insipidus (OR 5.66; p=0.005). Additional logistic regression analyses demonstrated a significant association between hypernatremia and mortality (OR 6.660; p=0.034). In summary, acquired hypernatremia appears to signal higher risk of mortality in pediatric sTBI and is associated with a higher discharge level of care in sTBI survivors.
Lam, Kenneth C; Snyder Valier, Alison R; Valovich McLeod, Tamara C
The inclusion of clinical practice factors, beyond epidemiologic data, may help guide medical coverage and care decisions. Trends in injury and treatment characteristics of sport-specific injuries sustained by secondary school athletes will differ based on sport. Retrospective analysis of electronic patient records. Level 4. Participants consisted of 3302 boys and 2293 girls who were diagnosed with a sport-related injury or condition during the study years. Injury (sport, body part, diagnosis via ICD-9 codes) and treatment (type, amount, and duration of care) characteristics were grouped by sport and reported using summary statistics. Most injuries and treatments occurred in football, girls' soccer, basketball, volleyball, and track and field. Sprain or strain of the ankle, knee, and thigh/hip/groin and concussion were the most commonly documented injuries across sports. The injury pattern for boys' wrestling differed from other sports and included sprain or strain of the elbow and neck and general medical skin conditions. The most frequently reported service was athletic training evaluation/reevaluation treatment, followed by hot/cold pack, therapeutic exercise, manual therapy techniques, electrical stimulation, and strapping of lower extremity joints. Most sports required 4 to 5 services per injury. With the exception of boys' soccer and girls' softball, duration of care ranged from 10 to 14 days. Girls' soccer and girls' and boys' track and field reported the longest durations of care. Injury and treatment characteristics are generally comparable across sports, suggesting that secondary school athletic trainers may diagnose and treat similar injuries regardless of sport. Subtle sport trends, including skin conditions associated with boys' wrestling and longer duration of care for girls' soccer, are important to note when discussing appropriate medical coverage and care.
V. V. Unzhakov
Full Text Available Objective: to study the impact of various sedation methods on lipid peroxidation in patients with acute severe brain injury. Subjects and methods. For this, 44 victims with this condition were examined. According the option of posttraumatic sedation therapy, the victims were divided into 3 groups: 1 12 patients in whom sodium oxybutyrate was used for sedation; 2 12 received thiopental sodium; 3 20 patients were given propofol. The lipid peroxidation and antioxidant system were judged from the serum levels of fatty acid hydroperoxides and secondary lipid peroxidation products (malonic dialdehyde and from the content of the endogenous antioxidant a-tocopherol. Results. The study performed indicated that the highest concentrations of fatty acid hydroperoxides were observed in Groups 1 and 2 within the first 24 posttraumatic hours. In Group 3 where propofol was used for sedation, the concentration of the hydroperoxides remained in the normal range although there was a tendency for their rise. Conclusion. Thus, propofol is the agent of choice for sedation that prevents the activation of lipid peroxidation and stabilizes some indices of the antioxidant system in patients with acute severe brain injury. Key words: brain injury, lipid peroxidation, sedation, sodium oxybutyrate, thiopental sodium, propofol.
Full Text Available This article contains data on research conducted in “A double standard model for allocating limited emergency medical service vehicle resources ensuring service reliability” (Liu et al., 2016 . The crash counts were sorted out from comprehensive crash records of over one thousand major signalized intersections in the city of Chicago from 2004 to 2010. For each intersection, vehicular crashes were counted by crash severity levels, including fatal, injury Types A, B, and C for major, moderate, and minor injury levels, property damage only (PDO, and unknown. The crash data was further used to rank intersections by equivalent injury crash frequency. The top 200 intersections with the highest number of crash occurrences identified based on crash frequency- and severity-based scenarios are shared in this brief. The provided data would be a valuable source for research in urban traffic safety analysis and could also be utilized to examine the effectiveness of traffic safety improvement planning and programming, intersection design enhancement, incident and emergency management, and law enforcement strategies.
Full Text Available Background: Patients with head injury continue to improve over time and a minimum follow-up of six months is considered necessary to evaluate outcome. However, this may be difficult to assess due to lack of follow-up. It is also well known that operated patients who return for cranioplasty usually have the best outcome. Aims and Objectives: To assess the outcome following severe head injury using cranioplasty as a surrogate marker for good outcome. Materials and Methods: This was a retrospective study carried out from January 2009 to December 2010. All patients with severe head injury who underwent decompressive craniectomy (DC in the study period were included. Patients who came back for cranioplasty in the same period were also included. Case records, imaging and follow up visit data from all patients were reviewed. Glasgow Coma Score (GCS on admission and Glasgow Outcome Score (GOS at discharge were assessed. Observations and Results: Of the 273 patients, 84.25% (n=230 were males and 15.75% (n= 43 were females. The mean age was 34.3 years (range 2-81 years, SD 16.817. The mean GCS on admission was 5.615 (range 3-8, SD 1.438. The in-hospital mortality was 54% (n=149. Good outcome (GOS of 4 or 5 at discharge was attained in 22% (n=60 patients. Sixty five patients returned for cranioplasty (with a GOS of 4 or 5 during the study period. There was no statistical difference in the number of patients discharged with good outcome and those coming back for cranioplasty in the study period (P>0.5. Patients who came back for cranioplasty were younger in age (mean age 28.815 years SD 13.396 with better admission GCS prior to DC (mean GCS 6.32 SD1.39. Conclusions: In operated severe head injury patients significant number of patients (24% in our study have excellent outcome. However, insignificant number of patients had further improvement to GOS 4 or 5 (good outcome from the time of initial discharge. This suggests that due to lack of intensive
Full Text Available Background: Severe injury often results in substantial bleeding and mortality. Injury provokes cellular activation and release of extracellular vesicles. Circulating microvesicles (MVs are predominantly platelet-derived and highly procoagulant. They support hemostasis and vascular function. The roles of MVs in survival after severe injury are largely unknown. We hypothesized that altered MV phenotypes would be associated with transfusion requirements and poor outcomes. Methods: This single-centre study was approved by the Institutional Review Board. The study cohort consisted of patients with major trauma requiring blood product transfusion and 26 healthy controls. Plasma samples for MVs were collected upon admission to the emergency department (n=169 and post-resuscitation (n=42, and analysed by flow cytometry for MV counts and cellular origin: platelet (PMV, erythrocyte (RMV, leukocyte (LMV, endothelial (EMV, tissue factor (TFMV, and annexin V (AVMV. Twenty-four hour mortality is the outcome measurement used to classify survivors versus non-survivors. Data were compared over time and analysed with demographic and clinical data. Results: The median age was 34 (IQR 23, 51, 72% were male, Injury Severity Score was 29 (IQR 19, 36, and 24 h mortality was 13%. MV levels and phenotypes differed between patients and controls. Elevated admission EMVs were found both in survivors (409/µL and non-survivors (393/µL compared to controls (23/µL, p<0.001 and persisted over time. Admission levels of PMV, AVMV, RMV, and TFMV were significantly lower in patients who died compared to survivors, but were not independently associated with the 24 h mortality rate. Patients with low MV levels at admission received the most blood products within the first 24 h. AVMV and PMV levels either increased over time or stabilized in survivors but decreased in non-survivors, resulting in significantly lower levels at intensive care unit admission in non-survivors (1,048 vs
This paper reports two scenarios whereby goring injury sustained by a Bunaji bull and a Yankasa lamb were managed by pastoralists before the cases were presented to the Large Animal Clinic Unit of the Veterinary Teaching Hospital, Ahmadu Bello University, Zaria. Anamnesis of the cases presented was that the bull ...
Rushby, Jacqueline A; McDonald, Skye; Fisher, Alana C; Kornfeld, Emma J; De Blasio, Frances M; Parks, Nicklas; Piguet, Olivier
Severe traumatic brain injury (TBI) often leads to deficits in physiological arousal and empathy, which are thought to be linked. This study examined whether injury-related brain volume loss in key limbic system structures is associated with these deficits. Twenty-four adults with TBI and 24 matched Controls underwent MRI scans to establish grey matter volumes in the amygdala, thalamus, and hippocampus. EEG and skin conductance levels were recorded to index basal physiological arousal. Self-report emotional empathy levels were also assessed. The TBI group had reduced brain volumes, topographic alpha differences, and lower emotional empathy compared to Controls. Regional brain volumes were differentially correlated to arousal and self-report empathy. Importantly, lower volume in pertinent brain structures correlated with lower empathy, for participants with and without TBI. Overall we provide new insights into empathic processes after TBI and their relationship to brain volume loss.
Tarek A Shazly
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
Jacqueline A. Rushby
Full Text Available Severe traumatic brain injury (TBI often leads to deficits in physiological arousal and empathy, which are thought to be linked. This study examined whether injury-related brain volume loss in key limbic system structures is associated with these deficits. Twenty-four adults with TBI and 24 matched Controls underwent MRI scans to establish grey matter volumes in the amygdala, thalamus, and hippocampus. EEG and skin conductance levels were recorded to index basal physiological arousal. Self-report emotional empathy levels were also assessed. The TBI group had reduced brain volumes, topographic alpha differences, and lower emotional empathy compared to Controls. Regional brain volumes were differentially correlated to arousal and self-report empathy. Importantly, lower volume in pertinent brain structures correlated with lower empathy, for participants with and without TBI. Overall we provide new insights into empathic processes after TBI and their relationship to brain volume loss.
Norup, Anne; Svendsen, Susanne Wulff; Doser, Karoline
OBJECTIVE: To investigate the prevalence and severity of fatigue in adolescents and young adults with acquired brain injury (ABI) compared with healthy controls (HCs) and to examine associations between fatigue and gender, age and level of education. METHODS: This cross-sectional study included 15...... patterns of associations were evident with gender and level of education. ABBREVIATIONS: ABI: acquired brain injury; CI: confidence interval; GF: general fatigue; GOSE: Glasgow Outcome Scale Extended; HC: healthy control; MANCOVA: multivariate analysis of covariance; MF: mental fatigue; MFI-20...... prevalence of pathological fatigue (73% versus 29%), PPRadj 2.7 (95% confidence interval 2.1-3.5). Female patients experienced more fatigue than males on the "General Fatigue" and "Reduced Activity" subscales, while no gender differences were found in the HC group. Patients and HCs with elementary education...
Shaath, M K; Koury, K L; Gibson, P D; Lelkes, V M; Hwang, J S; Ippolito, J A; Adams, M R; Sirkin, M S; Reilly, M C
The purpose of this study was to review pelvic fractures and concomitant orthopaedic injuries in children who have a patent triradiate cartilage (TRO) compared with children whose triradiate cartilage has closed (TRC). We hypothesise that these injuries will differ, leading to correlated alterations in management. Using a database, we retrospectively reviewed patients aged below 18 years with pelvic fractures presenting to our Level 1 trauma center. Radiographs and CT scans were reviewed to identify orthopaedic injuries and categorise pelvic injuries using the modified Torode classification between the two groups. A total of 178 patients met inclusion criteria (60 TRO and 118 TRC). Mean age ± SD for TRO and TRC groups were 8 ± 4 years and 16 ± 2 years, respectively. TRO patients were more likely to present as a pedestrian struck by a vehicle (odds ratio (OR) 6.0; p < 0.001) and less likely to present after a motor vehicle collision (OR 0.2; p < 0.001). TRO patients were more likely to sustain rami fractures (OR 2.1; p = 0.020) and Torode IIIA injuries (OR 3.6; p < 0.001). They were less likely to sustain acetabular fractures (OR 0.5; p = 0.042), sacral fractures (OR 0.4; p = 0.009), hip dislocations (p = 0.002) and Torode IV injuries (OR 0.4; p = 0.004). TRO patients were less likely to be treated operatively for their pelvic (OR 0.3; p = 0.013) and orthopaedic injuries (OR 0.4; p = 0.006). We suggest that patients with open triradiate cartilage are unique. Their pelvic injuries may be treated more conservatively as they have a greater potential for periosteal healing and bone remodelling. Patients with closed triradiate cartilage should be treated similarly to adults, as they share a similar mechanism of injury and need for operative fixation.
Full Text Available High-mobility group box 1 protein (HMGB1, a ubiquitous nuclear protein, drives proinflammatory responses when released extracellularly. It plays a key role as a distal mediator in the development of acute lung injury (ALI. Sodium butyrate, an inhibitor of histone deacetylase, has been demonstrated to inhibit HMGB1 expression. This study investigates the effect of sodium butyrate on burn-induced lung injury. Sprague-Dawley rats were divided into three groups: 1 sham group, sham burn treatment; 2 burn group, third-degree burns over 30% total body surface area (TBSA with lactated Ringer's solution for resuscitation; 3 burn plus sodium butyrate group, third-degree burns over 30% TBSA with lactated Ringer's solution containing sodium butyrate for resuscitation. The burned animals were sacrificed at 12, 24, and 48 h after burn injury. Lung injury was assessed in terms of histologic changes and wet weight to dry weight (W/D ratio. Tumor necrosis factor (TNF-α and interleukin (IL-8 protein concentrations in bronchoalveolar lavage fluid (BALF and serum were measured by enzyme-linked immunosorbent assay, and HMGB1 expression in the lung was determined by Western blot analysis. Pulmonary myeloperoxidase (MPO activity and malondialdehyde (MDA concentration were measured to reflect neutrophil infiltration and oxidative stress in the lung, respectively. As a result, sodium butyrate significantly inhibited the HMGB1 expressions in the lungs, reduced the lung W/D ratio, and improved the pulmonary histologic changes induced by burn trauma. Furthermore, sodium butyrate administration decreased the TNF-α and IL-8 concentrations in BALF and serum, suppressed MPO activity, and reduced the MDA content in the lungs after severe burn. These results suggest that sodium butyrate attenuates inflammatory responses, neutrophil infiltration, and oxidative stress in the lungs, and protects against remote ALI induced by severe burn, which is associated with inhibiting HMGB1
Roberts, Derek J.; Ouellet, Jean-Francois; Sutherland, Francis R.; Kirkpatrick, Andrew W.; Lall, Rohan N.; Ball, Chad G.
Background 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. Methods 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. Results 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). Conclusion 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. PMID:23706856
Roberts, Derek J; Ouellet, Jean-Francois; Sutherland, Francis R; Kirkpatrick, Andrew W; Lall, Rohan N; Ball, Chad G
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.
Hicks, A J; Gould, K R; Hopwood, M; Kenardy, J; Krivonos, I; Ponsford, J L
Behaviours of Concern (BoC) following traumatic brain injury (TBI) have a significant negative impact on the daily functioning and quality of life for the individual and their family. However, there has been limited research examining the nature and severity of BoC beyond the acute recovery period, including the perspective of the individual with TBI as well as close others (COs). Eighty-nine individuals with predominantly severe TBI, at a mean of 11.4 years' post-injury, were identified through a no-fault accident compensation system database. Structured interviews were completed with 65 individuals with TBI, and 62 COs. Current BoC were documented using the Overt Behaviour Scale (OBS). 70.5% of participants exhibited BoC on the OBS, with an average of 3 behaviours. Verbal aggression and socially inappropriate behaviour were the most common BoC. Self-report of behaviour change was endorsed by 81% of the sample. There was generally poor concordance between the perspectives of the individual with the TBI and their CO. Severe BoC, across multiple behaviour types, may be evident many years following predominantly severe TBI. There is a need to provide long-term behaviour support for these individuals.
Martin, Rachelle; Levack, William M M; Sinnott, K Anne
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.
Bauer, Andrea S; Shen, Peter Y; Nidecker, Anna E; Lee, Paul S; James, Michelle A
Which infants with brachial plexus birth palsy (BPBP) should undergo microsurgical plexus reconstruction remains controversial. The current gold standard for the decision for plexus reconstruction is serial clinical examinations, but this approach obviates the possibility of early surgical treatment. We hypothesize that a new technique using 3-dimensional volumetric proton density magnetic resonance imaging (MRI) without sedation can evaluate the severity of BPBP injury earlier than serial clinical examinations. Infants were prospectively enrolled prior to 12 weeks of age and imaged using 3 Tesla MRI without sedation. Clinical scores were collected at all visits. The imaging findings were graded based on the number of injured levels and the severity of each injury, and a radiological score was calculated. All infants were followed at least until the decision for surgery was made based on clinical examination. Nine infants completed the MRI scan and clinical follow-up. The average Toronto score at presentation was 4.4 out of 10 (range, 0-8.2); the average Active Movement Scale score was 50 out of 105 (range, 0-86). Four infants required surgery: 2 because of a flail limb and Horner syndrome and 2 owing to failure to recover antigravity elbow flexion by age 6 months. Radiological scores ranged from 0 to 18 out of a maximum score of 25. The average radiological score for those infants who required surgery was 12 (range, 6.5-18), whereas the average score for infants who did not require surgery was 3.5 (range, 0-8). Three-dimensional proton density MRI can evaluate spinal nerve roots in infants without the need for radiation, contrast agents, or sedation. These data suggest that MRI can help determine the severity of injury earlier than clinical examination in infants with BPBP, although further study of a larger sample of infants with varying severity of disease is necessary. Diagnostic II. Copyright © 2017 American Society for Surgery of the Hand. Published by
Olivera, Anlys; Lejbman, Natasha; Jeromin, Andreas; French, Louis M; Kim, Hyung-Suk; Cashion, Ann; Mysliwiec, Vincent; Diaz-Arrastia, Ramon; Gill, Jessica
Approximately one-third of military personnel who deploy for combat operations sustain 1 or more traumatic brain injuries (TBIs), which increases the risk for chronic symptoms of postconcussive disorder, posttraumatic stress disorder, and depression and for the development of chronic traumatic encephalopathy. Elevated concentrations of tau are observed in blood shortly following a TBI, but, to our knowledge, the role of tau elevations in blood in the onset and maintenance of chronic symptoms after TBI has not been investigated. To assess peripheral tau levels in military personnel exposed to TBI and to examine the relationship between chronic neurological symptoms and tau elevations. Observational assessment from September 2012 to August 2014 of US military personnel at the Madigan Army Medical Center who had been deployed within the previous 18 months. Plasma total tau concentrations were measured using a novel ultrasensitive single-molecule enzyme-linked immunosorbent assay. Classification of participants with and without self-reported TBI was made using the Warrior Administered Retrospective Casualty Assessment Tool. Self-reported symptoms of postconcussive disorder, posttraumatic stress disorder, and depression were determined by the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist Military Version, and the Quick Inventory of Depressive Symptomatology, respectively. Group differences in tau concentrations were determined through analysis of variance models, and area under the receiver operating characteristic curve determined the sensitivity and specificity of tau concentrations in predicting TBI and chronic symptoms. Seventy participants with self-reported TBI on the Warrior Administered Retrospective Casualty Assessment Tool and 28 control participants with no TBI exposure were included. Concentration of total tau in peripheral blood. Concentrations of plasma tau were significantly elevated in the 70 participants with self
Leow, Jeffrey J; Lingam, Pravin; Lim, Vanessa W; Go, Karen TS; Chiu, Ming Terk; Teo, Li Tserng
INTRODUCTION In Singapore, as strict laws are a strong deterrent against armed violence, little is known about the epidemiology of penetrating stab wound injuries. Our study aimed to investigate the epidemiology of stab wound injuries at a major trauma centre in Singapore and determine if there was a difference in severity between self-inflicted stab wound (SI) injuries and those inflicted by others (IO). METHODS We retrospectively reviewed all penetrating injuries at Tan Tock Seng Hospital, and identified and categorised all stab wound injuries as SI or IO. Basic demographic information, injury severity characteristics and outcome data were compared between these two groups. A review of all mortalities was performed, including recording the causes of death. RESULTS Between 2005 and 2010, there were a total of 149 stab wound injuries, of which 24 (16.1%) were SI and 125 (83.9%) were IO injuries. Patients tended to be young (mean age 34.1 ± 14.2 years). The mean Injury Severity Score was significantly different between the SI and IO groups (8.8 ± 6.5 vs. 12.3 ± 8.1; p = 0.03). In both groups, the majority underwent an operative procedure (83.3% vs. 85.6%) and had an average hospital stay of four days. CONCLUSION The study confirms our hypothesis that SI injuries tend to be less severe than IO injuries and are more likely to occur at home rather than at a public area. This finding may be useful in the triage of patients with stab wound injuries. PMID:26831311
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.
Hart, Tessa; Whyte, John; Poulsen, Ingrid
OBJECTIVE: Determine effects of inpatient and outpatient treatment intensity on functional and emotional well-being outcomes at 1 year post severe traumatic brain injury (TBI). DESIGN: Prospective, quasi-experimental study comparing outcomes in a US TBI treatment center with those in a Denmark (DK...... treatments were estimated per discipline using a structured interview administered to patients and/ or caregivers at 12 months. MAIN OUTCOME MEASURES: FIM, Glasgow Outcome Scale- Extended, Disability Rating Scale, Participation Assessment with Recombined Tools-Objective, Perceived Quality of Life, SF-12....... CONCLUSIONS: Contrary to expectation, DK patients who received significantly more rehabilitation services during the year following severe TBI did not differ in outcome from their less intensively treated US counterparts, after adjusting for initial severity. The negative association of functional treatment...
K. N Yezhova
Full Text Available Objective: to perform a complex study of the plasma levels of 11 sex hormones and their functional values in women with severe concomitant injury (SCI. Subjects and methods. The study enrolled 16 women aged 18—45 years who had SCI. Admission APACHE II scores were 18.9±1.3. According to the outcome of a posttraumatic period, all the patients were divided into 2 groups: A survivors; B deceased subjects. The normal values were used to comparatively analyze the concentrations of reproductive hormones. The time course of changes in hormone concentration was studied on postoperative days 1, 3, and 7. The hormone profile was examined by BSL test kits (USA on a STAT Fax 2100 enzyme immunoanalyzer (Awareness Technology Inc., USA. The content of prolactin, luteinizing hormone, follicle-stimulating hormone, progesterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate (DHEA-S, androstendione (A, testosterone (T, dihydrotestosterone, estrone, and estradiol (E were measured. Results. The complex study of changes in the profile of 11 plasma sex hormones was first conducted in women in the posttraumat-ic period. Moreover, the typical plasma hormonal changes were elevated prolactin levels, a decrease in the concentrations of gonadotropins, and increases in some androgens, A, T, and E. The deceased women showed lower concentrations of DHEA-S and T. Analysis revealed an inverse correlation between the plasma concentration of DHEA-S and the injury severity. This change seems to suggest that an adrenal adaptation reaction is exhausted. The changes revealed in hormonal levels are of significance in understanding the pathogenesis of SCT. This may serve as a basis for the development of new therapy modalities using reproductive hormones in the postresuscitative period. Key words: severe concomitant injury, sex hormones, prolactin, luteinizing hormone, follicle-stimulating hormone, progesterone, 17-hydroxyprogesterone, androgens, estrogens.
Wallisch, Jessica S; Simon, Dennis W; Bayır, Hülya; Bell, Michael J; Kochanek, Patrick M; Clark, Robert S B
Inflammasome-mediated neuroinflammation may cause secondary injury following traumatic brain injury (TBI) in children. The pattern recognition receptors NACHT domain-, Leucine-rich repeat-, and PYD-containing Protein 1 (NLRP1) and NLRP3 are essential components of their respective inflammasome complexes. We sought to investigate whether NLRP1 and/or NLRP3 abundance is altered in children with severe TBI. Cerebrospinal fluid (CSF) from children (n = 34) with severe TBI (Glasgow coma scale score [GCS] ≤8) who had externalized ventricular drains (EVD) placed for routine care was evaluated for NLRP1 and NLRP3 at 0-24, 25-48, 49-72, and >72 h post-TBI and was compared to infection-free controls that underwent lumbar puncture to rule out CNS infection (n = 8). Patient age, sex, initial GCS, mechanism of injury, treatment with therapeutic hypothermia, and 6-month Glasgow outcome score were collected. CSF NLRP1 was undetectable in controls and detected in 2 TBI patients at only NLRP3 levels were increased in TBI patients compared with controls at all time points, p NLRP3 levels versus patients >4 (15.50 [3.65-25.71] vs. 3.04 [1.52-8.87] ng/mL, respectively; p = 0.048). Controlling for initial GCS in multivariate analysis, peak NLRP3 >6.63 ng/mL was independently associated with poor outcome at 6 months. In the first report of NLRP1 and NLRP3 in childhood neurotrauma, we found that CSF NLRP3 is elevated in children with severe TBI and independently associated with younger age and poor outcome. Future studies correlating NLRP3 with other markers of inflammation and response to therapy are warranted.
Full Text Available Neurological and neuropsychological examination of 104 patients (58 boys and 46 girls 12–19 years old who had closed moderate or severe craniocerebral injury (CCI (cerebral contusion, diffusive axonal injury 6 months — 5 years before inclusion to this study. Authors analyzed differences in clinical symptoms of CCI in adolescents compared to previously published data for pediatric patients. CCI consequences in adolescents are prolonged; they can be accompanied with disorders of movement coordination, high psychical functions, behavior and social adaptation. Obvious disorders can be hidden in adolescents experienced CCI until they are back to school education, though they reveal decrease of ability to education. Peptidergic nootropic drug Cerebrolysin proved its effectiveness for correction of disorders of behavior, high psychical (memory, attention, controlling functions and motor (coordination functions, and speed of cognitive and motor operations.Key words: adolescents, craniocerebral injury, consequences, therapy, nootropic drugs, cerebrolysin.(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(4:57-67
Williams, Ryan T; Wilson, Catherine S; Heinemann, Allen W; Lazowski, Linda E; Fann, Jesse R; Bombardier, Charles H
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.
Hotz, Gillian A; Castelblanco, Andrea; Lara, Isabel M; Weiss, Alyssa D; Duncan, Robert; Kuluz, John W
To investigate the effects of Snoezelen therapy on physiological, cognitive and behavioural changes in children recovering from severe traumatic brain injury (TBI). An observational study was conducted to assess the physiological, cognitive and behavioural changes of children recovering from severe TBI while receiving Snoezelen therapy. Fifteen subjects completed the pre- and post-Snoezelen treatment measurements computed over 10 consecutive sessions. Physiological, cognitive and behavioural measures were administered. Data was collected prospectively on each session in the Snoezelen room and were analysed by calculating the difference between pre- and post-treatment measurements for each Snoezelen session. Results revealed significant changes on physiological measures. Heart rates decreased for each subject in each treatment session and were found to be significant (p = 0.032). Muscle tone was decreased in all the affected extremities (right upper extremity p = 0.009, left upper extremity p = 0.020, right lower extremity p = 0.036 and left lower extremity p = 0.018). Agitation levels decreased over time and the overall cognitive outcome measures showed significant improvement when comparing the beginning of treatment with the end. This study revealed a beneficial use of Snoezelen therapy with children recovering from severe brain injury. However, there continues to be a critical need for evidenced-based research for this patient population and others in this multi-sensory environment.
Reinert, Michael; Andres, Robert H; Fuhrer, Martin; Müller, Alexander; Schaller, Benoit; Widmer, HansRuedi
Determination of relevant clinical monitoring parameters for helping guide the intensive care therapy in patients with severe head injury, is one of the most demanding issues in neurotrauma research. New insights into cerebral autoregulation and metabolism have revealed that a rigid cerebral perfusion pressure (CPP) regimen might not be suitable for all severe head injured patients. We thus developed an online analysis technique to monitor the correlation (AI rho) between the spontaneous fluctuations of the mean arterial blood pressure (MABP) and the intracranial pressure (ICP). In addition, brain tissue oxygen (PtiO2) and metabolic microdialysate measures including glucose and lactate were registered. We found that in patients with good outcome, the AI rho values were significantly lower as compared with patients with poor outcome. Accordingly, microdialysate glucose and lactate were significantly higher in the good outcome group. We conclude that online determination of AI rho offers a valuable additional and technically easily performable tool for guidance of therapy in patients with severe head injury.
Dardier, Virginie; Bernicot, Josie; Delanoe, Anaig; Vanberten, Melanie; Fayada, Catherine; Chevignard, Mathilde; Delaye, Corinne; Laurent-Vannier, Anne; Dubois, Bruno
The purpose of this study was to gain insight into the social (pragmatic) aspects of language use by French-speaking individuals with frontal lesions following a severe traumatic brain injury. Eleven participants with traumatic brain injury performed tasks in three areas of communication: production (interview situation), comprehension (direct…
The therapeutic rehabilitation of patients with traumatic brain injury (TBI) has a limited evidence-based foundation. The current rehabilitation approaches have been developed mainly through clinical practice. They often consist of many components that are defined in incomplete ways, making...... with severe TBI admitted for subacute rehabilitation (93%), pneumonia was found in 12%. The many components of FOTT are defined in a treatment manual; we developed and tested a method that can measure whether therapist uses FOTT appropriately. In addition, we developed and validated a FOTT clinical evaluation...
Candefjord, Stefan; Buendia, Ruben; Fagerlind, Helen; Bálint, András; Wege, Claudia; Sjöqvist, Bengt Arne
The aim of this study is to develop an on-scene injury severity prediction (OSISP) algorithm for truck occupants using only accident characteristics that are feasible to assess at the scene of the accident. The purpose of developing this algorithm is to use it as a basis for a field triage tool used in traffic accidents involving trucks. In addition, the model can be valuable for recognizing important factors for improving triage protocols used in Sweden and possibly in other countries with similar traffic environments and prehospital procedures. The scope is adult truck occupants involved in traffic accidents on Swedish public roads registered in the Swedish Traffic Accident Data Acquisition (STRADA) database for calendar years 2003 to 2013. STRADA contains information reported by the police and medical data on injured road users treated at emergency hospitals. Using data from STRADA, 2 OSISP multivariate logistic regression models for deriving the probability of severe injury (defined here as having an Injury Severity Score [ISS] > 15) were implemented for light and heavy trucks; that is, trucks with weight up to 3,500 kg and ⩾ 16,500 kg, respectively. A 10-fold cross-validation procedure was used to estimate the performance of the OSISP algorithm in terms of the area under the receiver operating characteristic curve (AUC). The rate of belt use was low, especially for heavy truck occupants. The OSISP models developed for light and heavy trucks achieved cross-validation AUC of 0.81 and 0.74, respectively. The AUC values obtained when the models were evaluated on all data without cross-validation were 0.87 for both light and heavy trucks. The difference in the AUC values with and without use of cross-validation indicates overfitting of the model, which may be a consequence of relatively small data sets. Belt use stands out as the most valuable predictor in both types of trucks; accident type and age are important predictors for light trucks. The OSISP models
Zhang, Feng; Zhao-peng MENG
This paper aims to compare the effect on early prognosis of post-traumatic early enteral nutrition therapy and central venous catheterization parenteral nutrition therapy in patients with severe traumatic brain injury (sTBI). The results showed that on 7 and 14 d, serum total protein [(62.04 ± 2.09) and 66.04 ± 2.27) g/L], albumin [(37.75 ± 2.86) and (43.43 ± 2.37) g/L] and prealbumin [(177.87 ± 13.89) and (199.43 ± 11.01) mg/L] in patients treated with early enteral nutrition were all ...
Sumowski, James F; Coyne, Julia; Cohen, Amanda; Deluca, John
To investigate whether retrieval practice (RP) improves delayed recall after short and long delays in survivors of severe traumatic brain injury (TBI) relative to massed restudy (MR) and spaced restudy (SR). 3(learning condition: MR, SR, RP)×2(delayed recall: 30min, 1wk) within-subject experiment. Nonprofit medical rehabilitation research center. Memory-impaired (memory impairment engenders confidence that this strategy would work outside the laboratory to improve memory in real-life settings. Future randomized controlled trials of RP training are needed. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Warden, D L; Salazar, A M; Martin, E M; Schwab, K A; Coyle, M; Walter, J
We have recently reported the results of a prospective controlled randomized trial comparing home versus inpatient cognitive rehabilitation for patients with moderate to severe head injury. That study showed no overall difference in outcomes between the two groups.(1) In this article, we provide further details of the home program arm of the study. All patients in the home program received medical treatment as needed, a multidisciplinary in-hospital evaluation, and TBI counseling before entering the eight-week home program, which then included guidance on home activities, as well as weekly telephone calls from a psychiatric nurse.
Signals from fat after injury: Plasma adipokines and ghrelin concentrations in the severely burnedq Charles E. Wade a,⇑, Alejandra G. Mora b, Beth A...samples were collected for measurement of leptin, adiponectin, resistin, ghrelin , insulin, and cortisol by ELISA. For comparison, samples from 15 healthy...vs. 17 ± 10.2 ng/ml), and ghrelin (0.37 ± 0.14 ng/ml vs.0.56 ± 0.26 ng/ml). Conclusion: Patients with burns, who are characteristically hypermetabolic
Emily L. Dennis
Full Text Available Traumatic brain injury (TBI is the leading cause of death and disability in children and can lead to a wide range of impairments. Brain imaging methods such as DTI (diffusion tensor imaging are uniquely sensitive to the white matter (WM damage that is common in TBI. However, higher-level analyses using tractography are complicated by the damage and decreased FA (fractional anisotropy characteristic of TBI, which can result in premature tract endings. We used the newly developed autoMATE (automated multi-atlas tract extraction method to identify differences in WM integrity. 63 pediatric patients aged 8–19 years with moderate/severe TBI were examined with cross sectional scanning at one or two time points after injury: a post-acute assessment 1–5 months post-injury and a chronic assessment 13–19 months post-injury. A battery of cognitive function tests was performed in the same time periods. 56 children were examined in the first phase, 28 TBI patients and 28 healthy controls. In the second phase 34 children were studied, 17 TBI patients and 17 controls (27 participants completed both post-acute and chronic phases. We did not find any significant group differences in the post-acute phase. Chronically, we found extensive group differences, mainly for mean and radial diffusivity (MD and RD. In the chronic phase, we found higher MD and RD across a wide range of WM. Additionally, we found correlations between these WM integrity measures and cognitive deficits. This suggests a distributed pattern of WM disruption that continues over the first year following a TBI in children.
Meulenbroek, Peter; Turkstra, Lyn S.
Purpose Communication deficits may play a critical role in maintaining employment after traumatic brain injury (TBI), but links between specific communication deficits and employment outcomes have not been determined. This study identified communication measures that distinguished stably employed versus unstably employed adults with TBI. Methods Participants were 31 adults with moderate-severe TBI who were employed full-time for at least 12 consecutive months before injury in skilled jobs and had attempted return to skilled jobs after injury. Sixteen had achieved stable employment (SE) post-injury, defined as full-time employment for ≥12 consecutive months; and 15 had unstable (UE) employment. Participants completed a battery of communication tests identified in a prior qualitative study of communication skills required for skilled work. Results Measures of spoken language comprehension, verbal reasoning, social inference, reading, and politeness in spoken discourse significantly discriminated between SE and UE groups. Two nested models were completed and compared. The first model excluded discourse data because of missing data for two UE and one SE participant. This model revealed that measures of verbal reasoning speed (β = −0.18, p = 0.05) and social inference (β = 0.19, p = 0.05) were predictive independent of the overall model. The second model included discourse data and was a better overall predictor of group membership (Likelihood ratio test, Model 1: 3.824, Model 2: 2.865). Conclusion Communication measures were positively associated with stable employment in skilled jobs after TBI. Clinicians should include assessment of communication for adults attempting return to work after TBI, paying specific attention to social inference and speed of verbal reasoning skills. PMID:25958999
Full Text Available Background and Aims: Literature from medical and health sciences indicated that sensory stimulation had a positive effect on traumatic brain injury patients. The present study was aimed to find out the effectiveness of a specific sensory stimulation (4 modalities in comparison with another sensory stimulation (5 modalities on recovery in comatose patients following severe traumatic brain injury. Methods: The study design was experimental, repeated measured with three groups. Two sensory stimulation models were compared with one control group. Forty-five participants with traumatic brain injury were recruited from surgical wards at Maharaj Nakhon Sri Thammarat Hospital, Thailand. The participants were randomly assigned to three groups, each group of 15 participants. Outcomes of the program were recovery determined by the Coma Recovery Scale-Revised (CRS-R. Inter rater agreement of the CRS-R was 0.85. Descriptive statistics, Fisher’s exact test, repeated measure analysis of variance, and post hoc comparison were used for data analysis. Results: All the patients were equally comparable regarding their baseline characteristics, and basic recovery determined by CRS-R. Recovery scores of the three groups were improved. However, those who received the sensory stimulation program (4 modalities had significantly higher CRS-R scores (P<0.001 after 5 days when compared to the two other groups. Conclusion: The sensory stimulation therapy had positive effects on traumatic brain injury patients. Application of the program required few stimuli materials which could be stored at the patient’s bedside making them accessible to care providers. However, monitoring physiologic parameters should be done before, during and after the stimulation.
Jiang, Lijun; Feng, Huizhen; Chen, Xiaofan; Liang, Kaifeng; Ni, Chengyao
Total liquid ventilation (TLV) is an alternative treatment for severe lung injury. High tidal volume is usually required for TLV to maintain adequate CO2 clearance. However, high tidal volume may cause alveolar barotrauma. We aim to investigate the effect of low tidal volume on pulmonary inflammation in piglets with lung injury and under TLV. After the establishment of acute lung injury model by infusing lipopolysaccharide, 12 piglets were randomly divided into two groups, TLV with high tidal volume (25 mL/kg) or with low tidal volume (6 mL/kg) for 240 min, respectively. Extracorporeal CO2 removal was applied in low tidal volume group to improve CO2 clearance and in high tidal volume group as sham control. Gas exchange and hemodynamic status were monitored every 30 min during TLV. At the end of the study, pulmonary mRNA expression and plasmatic concentration of interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured by collecting lung tissue and blood samples from piglets. Arterial blood pressure, PaO2 , and PaCO2 showed no remarkable difference between groups during the observation period. Compared with high tidal volume strategy, low tidal volume resulted in 76% reduction of minute volume and over 80% reduction in peak inspiratory pressure during TLV. In addition, low tidal volume significantly diminished pulmonary mRNA expression and plasmatic level of IL-6 and IL-8. We conclude that during TLV, low tidal volume reduces lung inflammation in piglets with acute lung injury without compromising gas exchange. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
Brooks, M Alison; Peterson, Kaitlin; Biese, Kevin; Sanfilippo, Jennifer; Heiderscheit, Bryan C; Bell, David R
Previous studies have identified abnormalities in brain and motor functioning after concussion that persist well beyond observed clinical recovery. Recent work suggests subtle deficits in neurocognition may impair neuromuscular control and thus potentially increase risk of lower extremity musculoskeletal injury after concussion. To determine the odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play from concussion in a cohort of National Collegiate Athletic Association (NCAA) Division I collegiate athletes. Cohort study; Level of evidence, 3. Included in this study were 87 cases of concussion among 75 athletes (58 men; 17 women) participating in NCAA Division I football, soccer, hockey, softball, basketball, wrestling, or volleyball at a single institution from 2011 to 2014. The 90-day period after return to play for each case of concussion was reviewed for acute noncontact lower extremity musculoskeletal injury. Each 90-day period after return to play was matched to the same 90-day period in up to 3 controls. Control athletes without a history of concussion in the previous year were matched to concussed athletes by sport team/sex, games played, and position. A total of 182 control (136 men; 46 women) 90-day periods were reviewed for acute injury. Conditional logistic regression was used to assess the association between concussion and subsequent risk of acute lower extremity musculoskeletal injury. The incidence of acute lower extremity musculoskeletal injury was higher among recently concussed athletes (15/87; 17%) compared with matched controls (17/182; 9%). The odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play were 2.48 times higher in concussed athletes than controls during the same 90-day period (odds ratio, 2.48; 95% CI, 1.04-5.91; P = .04). Concussed athletes have increased odds of sustaining an acute lower extremity musculoskeletal
Schoenfeld, Andrew J; Newcomb, Ronald L; Pallis, Mark P; Cleveland, Andrew W; Serrano, Jose A; Bader, Julia O; Waterman, Brian R; Belmont, Philip J
This study sought to characterize spine injuries among soldiers killed in Iraq or Afghanistan whose autopsy results were stored by the Armed Forces Medical Examiner System. The Armed Forces Medical Examiner System data set was queried to identify American military personnel who sustained a spine injury in conjunction with wounds that resulted in death during deployment in Iraq or Afghanistan from 2003 to 2011. Demographic and injury-specific characteristics were abstracted for each individual identified. The raw incidence of spinal injuries was calculated and correlations were drawn between the presence of spinal trauma and military specialty, mechanism and manner of injury, and wounds in other body regions. Significant associations were also sought for specific injury patterns, including spinal cord injury, atlantooccipital injury, low lumbar vertebral fractures, and lumbosacral dissociation. Statistical calculations were performed using χ statistic, z test, t test with Satterthwaite correction, and multivariate logistic regression. Among 5,424 deceased service members, 2,089 (38.5%) were found to have sustained at least one spinal injury. Sixty-seven percent of all fatalities with spinal injury were caused by explosion, while 15% occurred by gunshot. Spinal fracture was the most common type of injury (n = 2,328), while spinal dislocations occurred in 378, and vertebral column transection occurred in 223. Fifty-two percent sustained at least one cervical spine injury, and spinal cord injury occurred in 40%. Spinal cord injuries were more likely to occur as a result of gunshot (p injuries (p spinal injury risk and the periods 2003 to 2007 and 2008 to 2011, although atlantooccipital injuries and spinal cord injury were significantly reduced beginning in 2008 (p spinal trauma in modern warfare seems to be higher than previously reported. Epidemiologic study, level III.
Coelli, Stefania; Barbieri, Riccardo; Reni, Gianluigi; Zucca, Claudio; Bianchi, Anna Maria
The aim of this study is to assess the ability of EEG-based indices in providing relevant information about cognitive engagement level during the execution of a clinical sustained attention (SA) test in healthy volunteers and DAI (diffused axonal injury)-affected patients. We computed three continuous power-based engagement indices (P β /P α , 1/P α , and P β / (P α + P θ )) from EEG recordings in a control group (n = 7) and seven DAI-affected patients executing a 10-min Conners' "not-X" continuous performance test (CPT). A correlation analysis was performed in order to investigate the existence of relations between the EEG metrics and behavioral parameters in both the populations. P β /P α and 1/P α indices were found to be correlated with reaction times in both groups while P β / (P α + P θ ) and P β /P α also correlated with the errors rate for DAI patients. In line with previous studies, time course fluctuations revealed a first strong decrease of attention after 2 min from the beginning of the test and a final fading at the end. Our results provide evidence that EEG-derived indices extraction and evaluation during SA tasks are helpful in the assessment of attention level in healthy subjects and DAI patients, offering motivations for including EEG monitoring in cognitive rehabilitation practice. Graphical abstract Three EEG-derived indices were computed from four electrodes montages in a population of seven healthy volunteers and a group of seven DAI-affected patients. Results show a significant correlation between the time course of the indices and behavioral parameters, thus demonstrating their usefulness in monitoring mental engagement level during a sustained attention task.
Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study.
Kaul, Rahul; Chhabra, Harvinder Singh; Vaccaro, Alexander R; Abel, Rainer; Tuli, Sagun; Shetty, Ajoy Prasad; Das, Kali Dutta; Mohapatra, Bibhudendu; Nanda, Ankur; Sangondimath, Gururaj M; Bansal, Murari Lal; Patel, Nishit
The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries. Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation. Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems. Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not
Luoma, Suvi; Hakko, Helinä; Marttunen, Mauri; Taanila, Anja; Lindeman, Sari
Adolescents who later develop schizophrenia are likely to have problems with motor coordination and many adolescents with schizophrenia have self-injurious behaviour before treatment of first psychosis but association between injuries in adolescence and onset of psychotic disorder is unknown. The aim of this study was to describe what type of injuries psychotic individuals had during adolescence and in which age these injuries occurred. The study population consists of 155 members of the Northern Finland 1966 Birth Cohort with diagnosis of schizophrenia spectrum disease and 620 matched controls. All injuries which had occurred before onset of psychosis were extracted from Finnish Hospital Discharge Register. Individuals with psychotic disorder were more likely to have a history of severe injury. During the age 12-19, 11% of psychotic subjects and 5.3% of healthy controls had an injury (z=2.38; P=0.017) and the most common type of injury was fractures. Our findings suggest that severe injury in adolescence may be a predictor of psychosis. Copyright (c) 2010 Elsevier B.V. All rights reserved.
Chen, Cong; Zhang, Guohui; Tarefder, Rafiqul; Ma, Jianming; Wei, Heng; Guan, Hongzhi
Rear-end crash is one of the most common types of traffic crashes in the U.S. A good understanding of its characteristics and contributing factors is of practical importance. Previously, both multinomial Logit models and Bayesian network methods have been used in crash modeling and analysis, respectively, although each of them has its own application restrictions and limitations. In this study, a hybrid approach is developed to combine multinomial logit models and Bayesian network methods for comprehensively analyzing driver injury severities in rear-end crashes based on state-wide crash data collected in New Mexico from 2010 to 2011. A multinomial logit model is developed to investigate and identify significant contributing factors for rear-end crash driver injury severities classified into three categories: no injury, injury, and fatality. Then, the identified significant factors are utilized to establish a Bayesian network to explicitly formulate statistical associations between injury severity outcomes and explanatory attributes, including driver behavior, demographic features, vehicle factors, geometric and environmental characteristics, etc. The test results demonstrate that the proposed hybrid approach performs reasonably well. The Bayesian network reference analyses indicate that the factors including truck-involvement, inferior lighting conditions, windy weather conditions, the number of vehicles involved, etc. could significantly increase driver injury severities in rear-end crashes. The developed methodology and estimation results provide insights for developing effective countermeasures to reduce rear-end crash injury severities and improve traffic system safety performance. Copyright © 2015 Elsevier Ltd. All rights reserved.
Li, M; Hu, Y H; Chen, G
To investigate the relationship between severity of hypernatremia and the risk of death for patients with traumatic brain injury (TBI) who have been admitted to the neurosurgical intensive care unit (NICU). A total of 1044 patients with TBI were admitted to our NICU from January 2005 to January 2010. Of these patients, 881 were included in this study. Based on blood serum sodium level in the NICU the 881 patients were divided into four groups: 614 had normal serum sodium (Nahypernatremia (Na 150-hypernatremia (Na 155-160mmol/L) and 167 had severe hypernatremia (Na≥160mmol/L). The mortality rates for the mild, moderate, and severe hypernatremia groups were 20.6%, 42.4%, and 86.8%, respectively; the mortality rate for the normal group was 2.0%. In multivariable analysis, mild, moderate, and severe hypernatremia were independent risk factors for mortality; compared with the normal group the odds ratios of mild, moderate, and severe hypernatremia were 9.50, 4.34, and 29.35, respectively. Severe hypernatremia is an independent risk factor with extremely high odds ratio for death in patients with TBI who are admitted to the NICU. Copyright © 2012 Elsevier Ltd. All rights reserved.
Introduction Proteinuria in burn patients is common, and may be associated with acute kidney injury (AKI) and adverse outcomes. We evaluated the incidences, outcomes, characteristics and determinants of proteinuria and its influence on AKI and outcomes in burn patients. Methods This retrospective study was carried out in a hospital's burn department. The study population consisted of patients with burn injuries admitted during a five-year period. Positive urine dipstick readings were defined as mild (± or 1+) or heavy (≥ 2+) proteinuria, and AKI was diagnosed and staged according to the Risk, Injury, Failure, Loss, End Stage (RIFLE) classification system. Patient characteristics, management and outcomes were evaluated for associations with proteinuria using nonparametric tests, chi-square (χ2) tests and binary logistic regression. Results Of the patients admitted to the burn unit during the study period (n = 2,497), 865 (34.64%) were classified as having proteinuria. In the patients whose total burn surface areas (TBSA) were > 30% (n = 396), 271 patients (68.43%) had proteinuria and 152 of these patients (56.09%) met AKI criteria. No patients without proteinuria developed AKI. Intensive care unit (ICU) mortality rates were 0.8%, 16.67% and 30.77% (P proteinuria, respectively. Logistic regression analysis identified proteinuria (OR 4.48; 95% CI, 2.824 to 7.108; P proteinuria in patients with severe burns (> 30% TBSA). Severely burned patients with proteinuria had a high risk of developing AKI and a poor prognosis for survival. This suggests that proteinuria should be used for identifying burn patients at risk of developing AKI. PMID:23021407
Fuller, Gordon; Bouamra, Omar; Woodford, Maralyn; Jenks, Tom; Patel, Hirin; Coats, Timothy J; Oakley, Peter; Mendelow, A David; Pigott, Tim; Hutchinson, Peter J; Lecky, Fiona
Head injury is the leading cause of death in trauma. UK national guidelines have recommended that all patients with severe head injury (SHI) should be treated in neuroscience centers. The aim of this study was to investigate the effect of specialist neuroscience care on mortality after SHI. We conducted a cohort study using prospectively recorded data from the largest European trauma registry, for adult patients presenting with blunt trauma between 2003 and 2009. Mortality and unadjusted odds of death were compared for patients with SHI treated in neuroscience units (NSU) versus nonspecialist centers. To control for confounding, odds of death associated with non-NSU care were calculated using propensity score-adjusted multivariate logistic regression (explanatory covariates: age, Glasgow Coma Score, Injury Severity Score, treatment center). Sensitivity analyses were performed to study possible bias arising from selective enrollment, from loss to follow-up, and from hidden confounders. 5411 patients were identified with SHI between 2003 and 2009, with 1485 (27.4%) receiving treatment entirely in non-NSU centers. SHI management in a non-NSU was associated with a 11% increase in crude mortality (P<0.001) and 1.72-fold (95% confidence interval: 1.52-1.96) increase in odds of death. The case mix adjusted odds of death for patients treated in a non-NSU unit with SHI was 1.85 (95% confidence interval: 1.57-2.19). These results were not significantly changed in sensitivity analyses examining selective enrollment or loss to follow-up, and were robust to potential bias from unmeasured confounders. Our data support current national guidelines and suggest that increasing transfer rates to NSUs represents an important strategy in improving outcomes in patients with SHI.
Full Text Available The article discusses the burn encephalopathy as a manifestation of organ dysfunction. Purpose: to determine the impact of the systemic inflammatory response to the development of encephalopathy in thermal injury. The study involved 104 patients, who were divided into two groups depending on the severity of the burn injury. The development of SIRS in patients was confirmed by high levels of IL-6 during the whole period of observation. The level of IL-6 did not affect the development, timing and duration of sleep disorders in both groups. The level of LII on the day 1 affects the development of sleep disorders in group 1 (R=0.499, p=0.041. Development of insomnia correlated with the shift of leukocyte formula to the left in group 2 on the day 5 (R=0.349, p=0.020. We found a relationship between the development of delirium, its duration and the level of young forms of neutrophils in patients of 1 (R=0.563, p=0.001 and 2 (R=0.3488, p=0.003 groups. Development of delirium, its timing and duration correlated with the level of IL-6 on day 3 (R=0.812, p=0,049, R=0.5903, p=0.079 and R=0.615, p=0.059, respectively in the group 2. The extent of the inflammatory reaction determined the disorders of thought (R=-0.545, p=0.036, memory (R=-0.547, p=0.023 and the dynamic of the recovery of cognitive functions in patients of group 1. Cognitive deficit correlated with the level of IL-6 (R=0.760, p=0.079 and the level of young forms of neutrophils (R=-0.603, p=0,013 in group 2. Thus, SIRS is a defining moment in the development of nervous system dysfunction in severe thermal injury.
Forgus, S; Delva, W; Hauptfleisch, C; Govender, S; Blitz, J
Community assault (CA) or vigilantism is widespread in the township of Khayelitsha, Cape Town, South Africa (SA). Anecdotal evidence suggests that victims of CA are worse off than other assault cases. However, scientific data on the rate and severity of CA cases are lacking for SA. To contribute to CA prevention and management strategies by estimating the rate of CA among adults in Khayelitsha and comparing the injury severity and survival probability between cases of CA and other assault (non-CA) cases. We studied four healthcare centres in Khayelitsha during July - December 2012. A consecutive case series was conducted to capture all CA cases during this period. A retrospective folder review was performed on all cases of CA and on a control group of non-CA cases to compare injury severity and estimate survival probability. A total of 148 adult cases of CA occurred (case rate 1.1/1 000 person-years) over the study period. The Injury Severity Scores (ISSs) in the CA group were significantly higher than in the non-CA group (p < 0.001), with a median (interquartile range) ISS of 3 (2 - 6) in CA cases v. 1 (1 - 2) in non-CA cases. Comparison between the CA v. non-CA groups showed that a Glasgow Coma Scale < 15 (20.1% v. 5.4%, respectively), referral to the tertiary hospital (33.8% v. 22.6%, respectively), and crush syndrome (25.7% v. 0.0%, respectively) were all more common in CA cases. Survival probabilities were similar in both groups (CA v. non-CA 99.2% v. 99.3%, respectively). The rate of CA among adults in Khayelitsha is high, and the severity of injuries sustained by CA victims is substantially higher than in other assault cases.
Chandran, Avinash; Barron, Mary J; Westerman, Beverly J; DiPietro, Loretta
A number of sociocultural and environmental changes have occurred over the past several decades that may affect the risk of injury among young athletes playing soccer. To identify trends in injury incidence and severity between 2 time periods (1990-1996 and 2004-2009) in both male and female National Collegiate Athletic Association (NCAA) soccer players in the United States. Descriptive epidemiology study. Data were analyzed from the NCAA Injury Surveillance System. The rate ratio (RR), along with the 95% Wald CI, compared incidence density in 2004-2009 relative to that in 1990-1996. Overall sex-pooled injury rates were significantly lower in the 2004-2009 cohort compared with the 1990-1996 cohort (RR = 0.88; 95% CI = 0.86-0.91), and this was true for almost every category of injury studied. We observed only 1 significant sex difference between the time periods with regard to noncontact injuries, as men experienced a significant increase in rate of noncontact injuries between 1990-1996 and 2004-2009 (RR = 1.09; 95% CI = 1.02-1.17), whereas women experienced a significant decrease (RR = 0.70; 95% CI = 0.67-0.75). These surveillance data show decreasing trends in collegiate soccer injuries. Whether these decreases are attributable to greater resources being allocated toward athlete health, injury management, or the safety of the playing environment cannot be determined. Given the prominence of soccer play in the United States, public health efforts should promote the use of this surveillance system to better inform and evaluate injury prevention practices and policies directed toward player safety. © 2016 The Author(s).