What factors have influence on persistence of neck pain after a whiplash?

PubMed

Cobo, Eulogio Pleguezuelos; Mesquida, M Engracia Pérez; Fanegas, Elisabet Palomera; Atanasio, Eva Moreno; Pastor, M Beatriz Samitier; Pont, Cristina Perucho; Prieto, Carlos Matarrubia; Gómez, Genoveva Reverón; Cano, Lluis Guirao

2010-04-20

Prospective longitudinal study. To identify prognosis factors that allow us to identify patients with risk of developing chronic symptoms and disabilities after a whiplash injury. The prognosis factors for poor recovery in acute whiplash are not conclusive. We included 557 patients who suffered whiplash injury after road traffic accident and visited the Department of Physical Medicine and Rehabilitation of Mataró Hospital (Spain) for medical evaluation and rehabilitation treatment. The variables were collected following a protocol designed for the study, and all patients were assessed through the Visual Analogue Scale (VAS) for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire (NPH) for cervical column functionality at initial evaluation and 6 months later. Factors related with VAS 6 months after the whiplash injury were women, age, number of days of cervical column immobilization, previous neck pain, self-employed workers, housewives, pensioners, students, presence of headache or dizziness, and VAS, Goldberg Depression and Anxiety scale, and NPH scores at initial evaluation. In multivaried analysis, it had been found that the variables that had influence on VAS 6 months after the whiplash injury were statistically significant for age, presence of dizziness, self-employed workers, and VAS and NPH scores at initial evaluation. Our findings indicate that factors that allow us to identify patients at risk for poor recovery are age, dizziness, and initial evaluation of neck pain with VAS and cervical column functionality with NPH.

Grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities?

PubMed Central

Dehner, Christoph; Elbel, Martin; Strobel, Philipp; Scheich, Matthias; Schneider, Florian; Krischak, Gert; Kramer, Michael

2009-01-01

Background In a majority of cases, whiplash injuries are a domain of conservative therapy. Nevertheless it remains unclear whether physical therapy is of medical or economic benefit in patients with whiplash injuries. Methods Seventy patients with acute Quebec Task Force (QTF) grade II whiplash injuries were randomized to two therapy groups and received either active (APT) or passive (PPT) physical therapy. Patients were compared with regard to pain and range of motion with data obtained in an earlier study from a group with grade II whiplash injuries in which the therapy recommendation had been "act as usual" (AAU; n = 20). The above-mentioned parameters were assessed at 24 hours and two months after the injury. Furthermore patients' period of disability was documented after two months. Results After two months, patients in both the APT and PPT groups showed significant improvement in the median period of disability (active: 14 days; passive: 14 days) compared to the AAU group (49 days). No group difference was observed with regard to median improvement in range of motion (active: 120°; passive: 108°; activity as usual: 70°). The median pain reduction was significantly greater in the APT group (50.5) than in the PPT (39.2) or AAU group (28.8). Conclusion Our data show that active physical therapy results in enhanced pain reduction and shortening of post-injury disability. Therefore, active physical therapy should be considered the treatment of choice in patients with QTF grade II whiplash injuries. Trial registration The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission. PMID:19149880

A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study

PubMed Central

Kasch, Helge; Kongsted, Alice; Qerama, Erisela; Bach, Flemming W; Bendix, Tom; Jensen, Troels Staehelin

2013-01-01

Objectives An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. Design The design was an observational prospective study of risk factors embedded in a randomised controlled study. Setting Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres. Participants During a 2-year inclusion period, acute consecutive whiplash-injured (age 18–70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I–III, symptoms within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability. Results The risk score and number of sick-listing days were related (Kruskal-Wallis, p<0.0001). In stratum 1, less than 4%, but in stratum 7, 68% were work-disabled after 1 year. Early work assessment (p<0.0001), impact of the event questionnaire (p<0.0006), psychophysical pain measures being McGill pain questionnaire parameters (p<0.0001), pressure pain algometry (p<0.0001) and palpation (p<0.0001) showed a significant relationship with risk stratification. Analysis Findings confirm previous studies reporting intense neck pain/headache and distress as predictors for work disability after whiplash. Neck-mobility was a strong predictor in this study; however, it was a more inconsistent predictor in other studies. Conclusions Application of the risk assessment score and use of the risk strata system may be beneficial in future studies and may be considered as a valuable tool to assess return-to-work following injuries; however, further studies are needed. PMID:23370009

Late whiplash syndrome: a clinical science approach to evidence-based diagnosis and management.

PubMed

Poorbaugh, Keith; Brismée, Jean-Michel; Phelps, Valerie; Sizer, Phillip S

2008-01-01

The purpose of this article is to narrow the gap that exists in the clinical application of scientific research and empiric evidence for the evaluation and management of late whiplash. Considering that 14% to 42% of patients are left with chronic symptoms following whiplash injury, it is unlikely that only minor self-limiting injuries result from the typical rear-end impact. As psychosocial issues play a role in the development of persistent whiplash symptoms, discerning the organic conditions from the biopsychosocial factors remains a challenge to clinicians. The term "whiplash" represents the multiple factors associated with the event, injury, and clinical syndrome that are the end-result of a sudden acceleration-deceleration trauma to the head and neck. However, contentions surround the nature of soft-tissue injuries that occur with most motor vehicle accidents and whether these injuries are significant enough to result in chronic pain and limitations. The stark contrast in litigation for whiplash that exists among industrialized nations and less developed countries suggests another factor that could influence one's interpretation of symptoms' chronicity associated with Late Whiplash Syndrome. There are no gold standard tests or imaging techniques that can objectify whiplash-associated disorders. A lack of supporting evidence and disparity in medico-legal issues have created distinct camps in the scientific interpretations and clinical management of late whiplash. It is likely that efforts in research and/or clinical practice will begin to explain the disparity between acute and chronic whiplash syndrome. Recent evidence suggests that Late Whiplash Syndrome should be considered from a different context. The purpose of this article is to expound on several of the significant findings in the literature and offer clinical applications for evaluation and management of Late Whiplash Syndrome.

Trunk sway measures of postural stability during clinical balance tests in patients with chronic whiplash injury symptoms.

PubMed

Sjöström, Henrik; Allum, John H J; Carpenter, Mark G; Adkin, Allan L; Honegger, Flurin; Ettlin, Thierry

2003-08-01

Trunk sway occurring during clinical stance and gait tasks was compared between a group of subjects with a chronic whiplash injury, resulting from an automobile collision, and a normal collective. To examine if population specific trunk sway patterns for stance and gait could be identified for chronic whiplash injury patients. Our previous work has established that it is possible to identify specific patterns of stance and gait deficits for vestibular loss (both acute and compensated) patients and those with Parkinson's disease. Our question was whether it was possible to use the same stance and gait tasks to identify patterns of trunk sway differences with respect to those of healthy subjects and individuals with a chronic whiplash injury. Twenty-five subjects with history of whiplash injury and 170 healthy age-matched control subjects participated in the study. Trunk sway angular displacements in chronic whiplash patients were assessed for a number of stance and gait tasks similar to those of the Tinetti and Clinical Test of Sensory Interaction and Balance (CTSIB) protocols. We used a lightweight, easy-to-attach, body-worn apparatus to measure trunk angular displacements and velocities in the roll (lateral) and the pitch (forward-backward) planes. Data analysis revealed several significant differences between the two groups. A pattern could be identified, showing greater trunk sway for stance tasks and for complex gait tasks that required task-specific gaze control such as walking up and down stairs. Trunk sway was less, however, for simple gait tasks that demanded large head movements but no task-specific gaze control, such as walking while rotating the head. Subjects who have a chronic whiplash injury show a characteristic pattern of trunk sway that is different from that of other patient groups with balance disorders. Balance was most unstable during gait involving task-specific head movements which possibly enhance a pathologic vestibulo-cervical interaction.

Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders [ISRCTN68653575

PubMed Central

Juan, Francisco J

2004-01-01

Background Whiplash associated disorder is commonly linked to motor vehicle accidents and sports injuries. Cervical injury is attributed to rapid extension followed by neck flexion. The exact pathophysiology of whiplash is uncertain but probably involves some degree of aberrant muscle spasms and may produce a wide range of symptoms. The most commonly prescribed pharmacological agents for initial treatment of whiplash-associated pain are oral muscle relaxants and nonsteroidal anti-inflammatory drugs. However, potential systemic adverse effects limit these agents. Physical interventions such as mobilization, manipulation, and exercises have proved beneficial for pain and dysfunction but only on a time-limited basis. Little evidence suggests that physical therapy specifically aimed at the musculature (e.g., transcutaneous electrical nerve stimulation, ultrasonography, heat, ice, and acupuncture) improves prognosis in acute whiplash associated disorder. A new approach to treatment is the use of botulinum toxin, which acts to reduce muscle spasms. Methods/design This is a prospective, randomized, controlled clinical trial and botulinum toxin-A (Botox®) injections will be compared with placebo injections. The primary objective is to determine the efficacy of Botox® in the management of musculoskeletal pain in whiplash associated disorders. Discussion Botulinum toxin type-A toxin has been studied in small trials on whiplash associated disorder patients and has generally been found to relieve pain and improve range of motion. Specifically, we seek to assess the efficacy of Botox® in reducing pain and to improve the cervical spine range of movement, during the 6-month trial period. PMID:15018625

Protocol for an economic evaluation alongside the University Health Network Whiplash Intervention Trial: cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario

PubMed Central

2011-01-01

Background Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD). A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the cost-effectiveness of: 1) physician-based education and activation, 2) a rehabilitation program developed by Aviva Canada (a group of property and casualty insurance providers), and 3) the legislated standard of care in the Canadian province of Ontario: the Pre-approved Framework Guideline for Whiplash developed by the Financial Services Commission of Ontario. Methods/Design The economic evaluation will use participant-level data from the University Health Network Whiplash Intervention Trial and will be conducted from the societal perspective over the trial's one-year follow-up. Resource use (costs) will include all health care goods and services, and benefits provided during the trial's 1-year follow-up. The primary health effect will be the quality-adjusted life year. We will identify the most cost-effective intervention using the incremental cost-effectiveness ratio and incremental net-benefit. Confidence ellipses and cost-effectiveness acceptability curves will represent uncertainty around these statistics, respectively. A budget impact analysis will assess the total annual impact of replacing the current legislated standard of care with each of the other interventions. An expected value of perfect information will determine the maximum research expenditure Canadian society should be willing to pay for, and inform priority setting in, research of WAD management. Discussion Results will provide health care decision makers with much needed economic evidence on common interventions for acute whiplash management. Trial Registration http://ClinicalTrials.gov identifier NCT00546806 [Trial registry date: October 18, 2007; Date first patient was randomized: February 27, 2008] PMID:21794155

StressModEx--Physiotherapist-led Stress Inoculation Training integrated with exercise for acute whiplash injury: study protocol for a randomised controlled trial.

PubMed

Ritchie, Carrie; Kenardy, Justin; Smeets, Rob; Sterling, Michele

2015-07-01

Whiplash associated disorders are the most common non-hospitalised injuries following a road traffic crash. Up to 50% of individuals who experience a whiplash injury will not fully recover and report ongoing pain and disability. Most recovery, if it occurs, takes place in the first 2-3 months post injury, indicating that treatment provided in the early stages is critical to long-term outcome. However, early management approaches for people with acute whiplash associated disorders are modestly effective. One reason may be that the treatments have been non-specific and have not targeted the processes shown to be associated with poor recovery, such as post-traumatic stress symptoms. Targeting and modulating these early stress responses in the early management of acute whiplash associated disorders may improve health outcomes. Early aggressive psychological interventions in the form of psychological debriefing may be detrimental to recovery and are now not recommended for management of early post-traumatic stress symptoms. In contrast, Stress Inoculation Training (SIT) is a cognitive behavioural approach that teaches various general problem-solving and coping strategies to manage stress-related anxiety (ie, relaxation training, cognitive restructuring and positive self-statements) and provides important information to injured individuals about the impact of stress on their physical and psychological wellbeing. While referral to a psychologist may be necessary in some cases where acute stress disorder or other more significant psychological reactions to stress are evident, in the case of acute whiplash injuries, it is neither feasible nor necessary for a psychologist to deliver the early stress modulation intervention to all injured individuals. The feasibility of using other specially trained health professionals to deliver psychological interventions has been explored in conditions such as chronic low back pain, chronic whiplash and cancer, but few trials have studied this approach in acute musculoskeletal conditions with the aim of preventing the development of chronic pain. As physiotherapy is the most common intervention received by individuals with a whiplash injury, physiotherapists are ideally placed to provide SIT in conjunction with standard physical rehabilitation. This study (StressModEx) will target individuals in the acute stage of injury and address the stress responses associated with the accident or injury (event-related distress) with the aim of improving both physical and mental health outcomes. Is SIT integrated with standard physiotherapy exercise and delivered by physiotherapists more effective than physiotherapy exercise alone in reducing neck pain and disability in individuals with acute whiplash associated disorders? Parallel randomised controlled trial with blinded outcome assessment. 100 individuals with grade II or III (no fracture/dislocation or neurological loss) acute whiplash associated disorder<4 weeks duration and at least moderate neck pain-related disability and hyper-arousal symptoms will be recruited for the study. Participants will be assessed via online surveys or in-person at a university research laboratory. Interventions will be provided at community physiotherapy practices in Brisbane, Gold Coast, Toowoomba and Mackay, Queensland, Australia. Clinical-guideline-recommended supervised physiotherapy exercise sessions (10 sessions) integrated with six (once per week) SIT sessions. Clinical-guideline-recommended supervised physiotherapy exercise sessions (10) only. Primary (Neck Disability Index) and secondary (Acute Stress Disorder Scale; Post-traumatic Stress Diagnostic Scale; Depression, Anxiety and Stress Scale; Pain Catastrophisingo Scale; Pain Self-Efficacy Questionnaire; Coping Strategies Questionnaire; Global impression of recovery; pain intensity; SF36) outcomes will be measured at baseline, 6 weeks, 6 months and 12 months after randomisation. Data analysis will be blinded and by intention to treat. Outcomes will be analysed using linear mixed and logistic regression models that will include baseline scores as covariates, participants as random effects and treatment conditions as fixed factors. This study will be the first to address early stress responses following acute whiplash injury through a novel intervention that integrates SIT and physiotherapy exercise. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study.

PubMed

Wiangkham, Taweewat; Duda, Joan; Haque, M Sayeed; Rushton, Alison

2016-09-14

To develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI. Modified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round. Online international survey. A purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form. 36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus. Experts suggested and agreed the underlying principles and treatment components of the ABPI for the management of acute WADII. The ABPI was underpinned by social cognitive theory focusing on self-efficacy enhancement prior to conducting a phase II trial. 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/

Therapy recommendation "act as usual" in patients with whiplash injuries QTF I°.

PubMed

Dehner, Christoph; Kraus, Michael; Schöll, Hendrik; Schneider, Florian; Richter, Peter; Kramer, Michael

2012-08-20

Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation "act as usual" has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation "act as usual" and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values < 2). This is consistent with a chronification rate of 3.1%. After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values < 1). The therapy recommendation "act as usual" in combination with an adapted pain treatment is sufficient. Usually patients with whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes.

The efficacy of patient education in whiplash associated disorders: a systematic review.

PubMed

Meeus, Mira; Nijs, Jo; Hamers, Veronique; Ickmans, Kelly; Oosterwijck, Jessica Van

2012-01-01

Until now, there is no firm evidence for conservative therapy in patients with chronic Whiplash Associated Disorders (WAD). While chronic WAD is a biopsychosocial problem, education may be an essential part in the treatment and the prevention of chronic WAD. However, it is still unclear which type of educative intervention has already been used in WAD patients and how effective such interventions are. This systematic literature study aimed at providing an overview of the literature regarding the currently existing educative treatments for patients with whiplash or WAD and their evidence. Systematic review of the literature. A systematic literature search was conducted in the following databases: Pubmed, Springerlink, and Web of Science using different keyword combinations. We included randomized controlled clinical trials (RCT) that encompass the effectiveness of education for patients with WAD. The included articles were evaluated on their methodological quality. Ten RCT's of moderate to good quality remained after screening. Both oral and written advice, education integrated in exercise programs and behavioral programs appear effective interventions for reducing pain and disability and enhancing recovery and mobility in patients with WAD. In acute WAD, a simple oral education session will suffice. In subacute or chronic patients broader (multidisciplinary) programs including education which tend to modulate pain behavior and activate patients seems necessary. Because of limited studies and the broad range of different formats and contents of education and different outcome measures, further research is needed before solid conclusions can be drawn regarding the use and the modalities of these educational interventions in clinical practice. Based on this systematic literature study is seems appropriate for the pain physician to provide education as part of a biopsychosocial approach of patients with whiplash. Such education should target removing therapy barriers, enhancing therapy compliance and preventing and treating chronicity. Still, more studies are required to provide firm evidence for the type, duration, format, and efficacy of education in the different types of whiplash patients.

Therapy Recommendation “Act as Usual” in Patients with Whiplash Injuries QTF I°

PubMed Central

Dehner, Christoph; Kraus, Michael; Schöll, Hendrik; Schneider, Florian; Richter, Peter; Kramer, Michael

2012-01-01

Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation “act as usual” has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation “act as usual” and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values < 2). This is consistent with a chronification rate of 3.1%. After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values < 1). The therapy recommendation “act as usual” in combination with an adapted pain treatment is sufficient. Usually patients with whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes. PMID:23121740

Managing Injuries of the Neck Trial (MINT): design of a randomised controlled trial of treatments for whiplash associated disorders

PubMed Central

Lamb, Sarah E; Gates, Simon; Underwood, Martin R; Cooke, Matthew W; Ashby, Deborah; Szczepura, Ala; Williams, Mark A; Williamson, Esther M; Withers, Emma J; Mt Isa, Shahrul; Gumber, Anil

2007-01-01

Background A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. Methods Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. Conclusion This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised. PMID:17257408

Isometric muscle fatigue of the paravertebral and upper extremity muscles after whiplash injury.

PubMed

Rastovic, Pejana; Gojanovic, Marija Definis; Berberovic, Marina; Pavlovic, Marko; Lesko, Josip; Galic, Gordan; Pandza, Maja

2017-01-01

Whiplash-associated disorders (WAD) result from injury of neck structures that most often occur during traffic accidents as a result of rapid acceleration-deceleration. The dominant symptoms manifest in the musculoskeletal system and include increased fatigue. Because of the frequency of whiplash injuries, a simple, cheap and useful diagnostic tool is needed to differentiate whiplash injury from healthy patients or those faking symptoms. To determine muscle fatigue in patients with whiplash injury in six body positions. Analytical cross-sectional study. Emergency center, university hospital. We studied patients with whiplash injury from vehicular traffic accidents who presented to the emergency center within 6 hours of sustaining the injury. We determined whiplash injury grade according to the Quebec Task Force (QTF) classification and measured isometric muscle endurance in six different body positions. Control subjects for each patient were matched by age, gender and anthropomorphic characteristics. Cut-off values were determined to distinguish patients with whiplash injury from controls and for determination of injury grade . QTF grade, time to muscle fatigue in seconds. From September 2013 to September 2016, we enrolled 75 patients with whiplash injury and 75 matching control subjects. In all six positions, the patients with whiplash injury felt muscle fatigue faster than equivalent controls (P < .05) and the time to onset of muscle fatigue decreased with increasing injury grades in all six positions. Assignment to the patient or control group and to injury grade could be predicted with more than 90% accuracy on the basis of time to muscle fatigue. The most efficient position was the highest injury grade, by which 99.9% of the patients were accurately categorized. Isometric muscle endurance correlated with whiplash injury grade in all six positions (P < .01). Under clinical conditions, muscle endurance and the appearance of isometric muscle fatigue during testing can be a useful indicator of whiplash injury and grade. The size of the sample was small. An objective parameter such as electromyography is needed to confirm isometric muscle fatigue.

Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials

PubMed Central

Wright, Chris; Heneghan, Nicola; Eveleigh, Gillian; Calvert, Melanie; Freemantle, Nick

2011-01-01

Objective To evaluate effectiveness of physiotherapy management in patients experiencing whiplash associated disorder II, on clinically relevant outcomes in the short and longer term. Design Systematic review and meta-analysis. Two reviewers independently searched information sources, assessed studies for inclusion, evaluated risk of bias and extracted data. A third reviewer mediated disagreement. Assessment of risk of bias was tabulated across included trials. Quantitative synthesis was conducted on comparable outcomes across trials with similar interventions. Meta-analyses compared effect sizes, with random effects as primary analyses. Data sources Predefined terms were employed to search electronic databases. Additional studies were identified from key journals, reference lists, authors and experts. Eligibility criteria for selecting studies Randomised controlled trials (RCTs) published in English before 31 December 2010 evaluating physiotherapy management of patients (>16 years), experiencing whiplash associated disorder II. Any physiotherapy intervention was included, when compared with other types of management, placebo/sham, or no intervention. Measurements reported on ≥1 outcome from the domains within the international classification of function, disability and health, were included. Results 21 RCTs (2126 participants, 9 countries) were included. Interventions were categorised as active physiotherapy or a specific physiotherapy intervention. 20/21 trials were evaluated as high risk of bias and one as unclear. 1395 participants were incorporated in the meta-analyses on 12 trials. In evaluating short term outcome in the acute/sub-acute stage, there was some evidence that active physiotherapy intervention reduces pain and improves range of movement, and that a specific physiotherapy intervention may reduce pain. However, moderate/considerable heterogeneity suggested that treatments may differ in nature or effect in different trial patients. Differences between participants, interventions and trial designs limited potential meta-analyses. Conclusions Inconclusive evidence exists for the effectiveness of physiotherapy management for whiplash associated disorder II. There is potential benefit for improving range of movement and pain short term through active physiotherapy, and for improving pain through a specific physiotherapy intervention. PMID:22102642

[Whiplash-associated disorders].

PubMed

Schmid, P

1999-09-25

Whiplash-associated disorders (WAD) represent a class of clinical complaints which commonly result from rear-end car accidents. An automobile collision can generate major forces which are transferred to the neck by an acceleration-deceleration mechanism (whiplash), resulting in bony or soft-tissue injuries (whiplash injury). Incidence of WAD is estimated to be 0.1 to 3.8/1000/year; WAD cost $29 billion a year in the USA. They can be classified clinically into 5 degrees of severity, namely WAD grades 0 to IV. Signs and symptoms typically crescendo during the first few days after an accident. Pathological findings (especially of musculo-skeletal or neurological types) must often be sought actively and should be documented at the earliest stage. Prevention of possible chronicity is the most important goal in clinical management of WAD. WAD grade IV patients are treated in the way their fracture or dislocation demands. Therapy of WAD grades I to III has three main aspects: non-narcotic analgesics, early active mobilisation (to the extent possible consistent with pain) and education of the patient. Soft collars should not be used (or only temporarily and sparingly). Most patients with WAD grades I-III feel well again relatively soon. Symptoms and signs that persist for longer than two months are important warning signs for imminent chronicity, which occurs at rates of 14-42%. In such cases, an interdisciplinary approach is recommended. Risk factors are accident severity, head position at the time of accident, age and pretraumatic existence of headache. Patients with chronic complaints can develop additional psychic and cognitive problems, which are caused by--and not the cause of--their chronic disorder. Therapy of chronic whiplash-associated disorders involves all the problems inherent in therapies of chronic pain. There are many therapeutic concepts, but little evidence that anything helps. Prevention of whiplash injuries is therefore very important in view of the lack of powerful treatment options. Although there is a substantial body of scientific literature about WAD, many unanswered questions remain. In particular the most important questions (how can patients with acute and chronic disorders be helped best) have no clear answer yet. Furthermore, there are many opinions and prejudices (especially concerning psycho-social factors of WAD) which have no scientific basis. Therefore, an intensive exchange of information between health care professionals, patients and the general public appears to be very important.

Trapped in the neutral zone: another symptom of whiplash-associated disorder?

PubMed

Klein, G N; Mannion, A F; Panjabi, M M; Dvorak, J

2001-04-01

Instability of the cervical spine following whiplash trauma has been demonstrated in a number of studies. We hypothesized that, in patients with whiplash-associated disorder, rotation of the head would be accompanied by an earlier onset of neck muscle activity to compensate for intrinsic instability. The aim of the study was to examine the range of motion (RoM) of the cervical spine and the onset and activity of the sternocleidomastoid (SCM) muscles during axial rotation, in healthy control subjects and in patients with chronic whiplash-associated disorder. Forty-eight control subjects (42% male) and 46 patients (33% male) with chronic whiplash-associated disorder (symptoms lasting longer than 3 months) were examined. Cervical axial RoM differed significantly (P = 0.0001) between the groups, with the whiplash patients showing lower values (83 degrees +/- 30 degrees) than the healthy controls (137 degrees +/- 19 degrees). The whiplash patient group showed no evidence of the predicted earlier activation of SCM muscles. Many patients never reached the point in the RoM where SCM muscle activity rises steeply, as it does in the healthy controls (the 'elastic zone'), and their movements remained mostly within the region of low muscle activity (the 'neutral zone'). The whiplash patients appeared either unable or unwilling to drive the cervical spine into this region of high muscle activity, possibly because they were restricted by existing pain or fear of pain.

Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies.

PubMed

Scholten-Peeters, Gwendolijne G M; Verhagen, Arianne P; Bekkering, Geertruida E; van der Windt, Daniëlle A W M; Barnsley, Les; Oostendorp, Rob A B; Hendriks, Erik J M

2003-07-01

We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However, there is some inconsistency in the literature and there have been no systematic attempts to analyze the level of evidence for prognostic factors in whiplash recovery. Studies were selected for inclusion following a comprehensive search of MEDLINE, EMBASE, CINAHL, the database of the Dutch Institute of Allied Health Professions up until April 2002 and hand searches of the reference lists of retrieved articles. Studies were selected if the objective was to assess prognostic factors associated with recovery; the design was a prospective cohort study; the study population included at least an identifiable subgroup of patients suffering from a whiplash injury; and the paper was a full report published in English, German, French or Dutch. The methodological quality was independently assessed by two reviewers. A study was considered to be of 'high quality' if it satisfied at least 50% of the maximum available quality score. Two independent reviewers extracted data and the association between prognostic factors and functional recovery was calculated in terms of risk estimates. Fifty papers reporting on twenty-nine cohorts were included in the review. Twelve cohorts were considered to be of 'high quality'. Because of the heterogeneity of patient selection, type of prognostic factors and outcome measures, no statistical pooling was able to be performed. Strong evidence was found for high initial pain intensity being an adverse prognostic factor. There was strong evidence that for older age, female gender, high acute psychological response, angular deformity of the neck, rear-end collision, and compensation not being associated with an adverse prognosis. Several physical (e.g. restricted range of motion, high number of complaints), psychosocial (previous psychological problems), neuropsychosocial factors (nervousness), crash related (e.g. accident on highway) and treatment related factors (need to resume physiotherapy) showed limited prognostic value for functional recovery. High initial pain intensity is an important predictor for delayed functional recovery for patients with whiplash injury. Often mentioned factors like age, gender and compensation do not seem to be of prognostic value. Scientific information about prognostic factors can guide physicians or other care providers to direct treatment and to probably prevent chronicity.

fMRI response during visual motion stimulation in patients with late whiplash syndrome.

PubMed

Freitag, P; Greenlee, M W; Wachter, K; Ettlin, T M; Radue, E W

2001-01-01

After whiplash trauma, up to one fourth of patients develop chronic symptoms including head and neck pain and cognitive disturbances. Resting perfusion single-photon-emission computed tomography (SPECT) found decreased temporoparietooccipital tracer uptake among these long-term symptomatic patients with late whiplash syndrome. As MT/MST (V5/V5a) are located in that area, this study addressed the question whether these patients show impairments in visual motion perception. We examined five symptomatic patients with late whiplash syndrome, five asymptomatic patients after whiplash trauma, and a control group of seven volunteers without the history of trauma. Tests for visual motion perception and functional magnetic resonance imaging (fMRI) measurements during visual motion stimulation were performed. Symptomatic patients showed a significant reduction in their ability to perceive coherent visual motion compared with controls, whereas the asymptomatic patients did not show this effect. fMRI activation was similar during random dot motion in all three groups, but was significantly decreased during coherent dot motion in the symptomatic patients compared with the other two groups. Reduced psychophysical motion performance and reduced fMRI responses in symptomatic patients with late whiplash syndrome both point to a functional impairment in cortical areas sensitive to coherent motion. Larger studies are needed to confirm these clinical and functional imaging results to provide a possible additional diagnostic criterion for the evaluation of patients with late whiplash syndrome.

Long-term functioning following whiplash injury: the role of social support and personality traits.

PubMed

Nijs, Jo; Inghelbrecht, Els; Daenen, Liesbeth; Hachimi-Idrissi, Said; Hens, Luc; Willems, Bert; Roussel, Nathalie; Cras, Patrick; Bernheim, Jan

2011-07-01

Transition from acute whiplash injury to either recovery or chronicity and the development of chronic whiplash-associated disorders (WAD) remains a challenging issue for researchers and clinicians. The roles of social support and personality traits in long-term functioning following whiplash have not been studied concomitantly. The present study aimed to examine whether social support and personality traits are related to long-term functioning following whiplash. One hundred forty-three subjects, who had experienced a whiplash injury in a traffic accident 10-26 months before the study took place, participated. The initial diagnoses were a 'sprain of the neck' (ICD-9 code 847.0); only the outcome of grades I-III acute WAD was studied. Long-term functioning was considered within the biopsychosocial model: it was expressed in terms of disability, functional status, quality of life and psychological well-being. Participants filled out a set of questionnaires to measure the long-term functioning parameters (i.e. the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being and the Symptom Checklist-90) and potential determinants of long-term functioning (the Dutch Personality Questionnaire and the Social Support List). The results suggest that social support (especially the discrepancies dimension of social support) and personality traits (i.e. inadequacy, self-satisfaction and resentment) are related to long-term functioning following whiplash injury (Spearman rho varied between 0.32 and 0.57; p < 0.01). Within the discrepancy dimension, everyday emotional support, emotional support during problems, appreciative support and informative support were identified as important correlates of long-term functioning. Future prospective studies are required to confirm the role of social support and personality traits in relation to long-term functioning following whiplash. For such studies, a broad view of long-term functioning within the biopsychological model should be applied.

Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries.

PubMed

Lamb, S E; Williams, M A; Williamson, E M; Gates, S; Withers, E J; Mt-Isa, S; Ashby, D; Castelnuovo, E; Underwood, M; Cooke, M W

2012-01-01

To examine the clinical effectiveness of a stepped care approach over a 12-month period after an acute whiplash injury; to estimate the costs and cost-effectiveness of each strategy including treatments and subsequent health-care costs; and to gain participants' perspective on experiencing whiplash injury, NHS treatment, and recovery within the context of the Managing Injuries of the Neck Trial (MINT). Two linked, pragmatic, randomised controlled trials. In Step 1, emergency departments (EDs) were cluster randomised to usual care advice (UCA) or The Whiplash Book advice (WBA)/active management advice. In Step 2, participants were individually randomised to either a single session of advice from a physiotherapist or a physiotherapy package of up to six sessions. An economic evaluation and qualitative study were run in parallel with the trial. Twelve NHS trusts in England comprising 15 EDs. People who attended EDs with an acute whiplash injury of whiplash-associated disorder grades I-III were eligible for Step 1. People who had attended EDs with whiplash injuries and had persistent symptoms 3 weeks after ED attendance were eligible for Step 2. In Step 1, the control intervention was UCA and the experimental intervention was a psycho-educational intervention (WBA/active management advice). In Step 2 the control treatment was reinforcement of the advice provided in Step 1 and the experimental intervention was a package of up to six physiotherapy treatments. The primary outcome was the Neck Disability Index (NDI), which measures severity and frequency of pain and symptoms, and a range of activities including self-care, driving, reading, sleeping and recreation. Secondary outcomes included the mental and physical health-related quality-of-life (HRQoL) subscales of the Short Form questionnaire-12 items (SF-12) and the number of work days lost. A total of 3851 patients were recruited to Step 1 of the trial. 1598 patients attending EDs were randomised to UCA, and 2253 were randomised to WBA/active management. Outcome data were obtained at 12 months for 70% and 80% of participants at Step 1 and Step 2, respectively. The majority of people recovered from the injury. Eighteen per cent of the Step 1 cohort had late whiplash syndrome. There was no statistically or clinically significant difference observed in any of the outcomes for participants attending EDs randomised to UCA or active management advice [difference in NDI 0.5, 95% confidence interval (CI) -1.8 to 2.8]. In Step 2 the physiotherapy package resulted in improvements in neck disability at 4 months compared with a single advice session, but these effects were small at the population level (difference in NDI -3.2, 95% CI -5.8 to -0.7). The physiotherapy package was accompanied by a significant reduction in the number of work days lost at 4-month follow-up (difference -40.2, 95% CI -44.3 to -35.8). MINT suggests that enhanced psycho-educational interventions in EDs are no more effective than UCA in reducing the burden of acute whiplash injuries. A physiotherapy package provided to people who have persisting symptoms within the first 6 weeks of injury produced additional short-term benefits in neck disability compared with a single physiotherapy advice session. However, from a health-care perspective, the physiotherapy package was not cost-effective at current levels of willingness to pay. Both experimental treatments were associated with increased cost with no discernible gain in health-related quality of life. However, an important benefit of the physiotherapy package was a reduction in work days lost; consequently, the intervention may prove cost-effective at the societal level. Current Controlled Trials ISRCTN33302125. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 49. See the HTA programme website for further project information.

Whiplash injuries: is there a role for imaging?

PubMed

Van Geothem, J W; Biltjes, I G; van den Hauwe, L; Parizel, P M; De Schepper, A M

1996-03-01

Whiplash describes the manner in which a head is moved suddenly to produce a sprain in the neck and typically occurs after rear-end automobile collisions. It is one of the most common mechanisms of injury to the cervical spine. Although considered by some to be a form of compensation neurosis, evidence suggests that whiplash injuries are real and that they are a potential cause of significant impairment. Symptoms of cervical whiplash injury include neck pain and stiffness, interscapular pain, arm pain and/or occipital headache, and many whiplash patients have persistent complaints. Cervical roentgenography and conventional or computed tomography (CT) may show dislocations, subluxations and fractures in severely traumatized patients, but often fail to determine or visualize the cause for a whiplash syndrome. Magnetic resonance imaging (MRI), however, is able to assess different types of soft-tissue lesions related to whiplash injuries. Dynamic imaging may show functional disturbances. More widespread use of flexion/extension views, high-resolution static MRI and especially dynamic MRI should improve the correlation between imaging findings and patients' complaints.

Modic changes of the cervical spine in patients with whiplash injury: a prospective 11-year follow-up study.

PubMed

Matsumoto, Morio; Ichihara, Daisuke; Okada, Eijiro; Toyama, Yoshiaki; Fujiwara, Hirokazu; Momoshima, Suketaka; Nishiwaki, Yuji; Takahata, Takeshi

2013-06-01

There are few studies on Modic changes of the cervical spine in patients suffering from whiplash. This study compared Modic changes seen in whiplash patients 10 years after the injury with those observed in asymptomatic volunteers. This is a follow-up study of 133 patients who suffered whiplash injuries in 1994-1996 and underwent MRI with a superconductive imager (63 men, 70 women, mean age 49.6±15.3 years, mean follow-up 11.4 years). In addition, 223 healthy volunteers who underwent MRI during the same period were included as controls (123 men, 100 women, mean age 50.5±15.0 years, mean follow-up 11.6 years). All participants underwent follow-up MRI. We examined all participants for Modic changes, and investigated relationships between Modic changes and clinical symptoms or potentially related factors. Modic changes were observed in 4 patients (3%) and at 7 intervertebral levels in the initial study, and in 17 patients (12.8%) and at 30 intervertebral levels at the follow-up. Modic Type 2 changes were the most prevalent in the whiplash patients in both the initial and follow-up studies. There was no significant difference in the percentage of whiplash patients versus control subjects with positive Modic changes, either at the initial study or at follow-up. Modic changes were not related to clinical symptoms present at follow-up, but were associated with preexisting disc degeneration. There was no association between Modic changes and the details of the car accident that caused the injury. While Modic changes became more common in whiplash patients in the 10-year period after the accident, they occurred with a similar frequency in control subjects. We did not find any association between Modic changes and the nature of the car accident in which the whiplash occurred. Modic changes found in whiplash patients may be a result of the physiological ageing process rather than pathological findings relating to the whiplash injury. Copyright © 2012 Elsevier Ltd. All rights reserved.

Prevalence of whiplash trauma in TMD patients: a systematic review.

PubMed

Häggman-Henrikson, B; Rezvani, M; List, T

2014-01-01

The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 8·4% to 70% (median 35%) in TMD populations, compared with 1·7-13% in the non-TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non-TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head-neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD. © 2014 John Wiley & Sons Ltd.

Are smooth pursuit eye movements altered in chronic whiplash-associated disorders? A cross-sectional study.

PubMed

Kongsted, A; Jørgensen, L V; Bendix, T; Korsholm, L; Leboeuf-Yde, C

2007-11-01

To evaluate whether smooth pursuit eye movements differed between patients with long-lasting whiplash-associated disorders and controls when using a purely computerized method for the eye movement analysis. Cross-sectional study comparing patients with whiplash-associated disorders and controls who had not been exposed to head or neck trauma and had no notable neck complaints. Smooth pursuit eye movements were registered while the subjects were seated with and without rotated cervical spine. Thirty-four patients with whiplash-associated disorders with symptoms more than six months after a car collision and 60 controls. Smooth pursuit eye movements were almost identical in patients with chronic whiplash-associated disorders and controls, both when the neck was rotated and in the neutral position. Disturbed smooth pursuit eye movements do not appear to be a distinct feature in patients with chronic whiplash-associated disorders. This is in contrast to results of previous studies and may be due to the fact that analyses were performed in a computerized and objective manner. Other possible reasons for the discrepancy to previous studies are discussed.

Cervical vertigo and dizziness after whiplash injury.

PubMed

Endo, Kenji; Ichimaru, Katsuji; Komagata, Mashashi; Yamamoto, Kengo

2006-06-01

Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. Vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. It is reported that vertebrobasilar artery insufficiency (VBI) leads to brainstem and cerebellar ischemia and infarction following cervical manipulation. Here we examined the correlation between vertigo or dizziness and the right and left side difference in vertebral arteries after whiplash injury using MRA. We studied 20 patients who complained of neck pain with vertigo or dizziness after whiplash injury and 13 healthy volunteers as a control. In the control group, abnormal MRA findings in the vertebral arteries such as occlusion, stenosis or slow blood flow were seen in 77% of the cases. In the patient group, abnormal MRA findings were seen in 60%. The side difference in blood flow was 3.5+/-2.5 cm/s in the control group and 6.1+/-3.0 cm/s in the patient group. Our findings suggest that some subjects with persistent vertigo or dizziness after whiplash injury are more likely to have VBI on MRA. VBI might be an important background factor to evoke cervical vertigo or dizziness after whiplash injury. The side difference between the two vertebral arteries could cause a circulation disorder in the vertebrobasilar system after whiplash injury. However, the VBI on MRA itself was also seen in the control group, and thus it is not clear whether it is due to whiplash injury in the patient group.

Do head-restraints protect the neck from whiplash injuries?

PubMed Central

Morris, F

1989-01-01

Over an 11-month period a study was made of all patients presenting to an accident and emergency department who had sustained whiplash as a result of rear-bumper impacts. The patients were analysed with respect to the presence of head-restraints in their vehicles. A significant increase in the incidence of whiplash was found in patients whose vehicles did not have head-restraints fitted. Legislation requiring all passenger cars to have head-restraints fitted as standard would have a major impact in reducing the number of whiplash injuries sustained in rear bumper impacts. PMID:2712983

Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders.

PubMed

Klobas, Luciano; Axelsson, Susanna; Tegelberg, Ake

2006-11-01

The aim of this study was to investigate the effect of a specific therapeutic jaw exercise on the temporomandibular disorders of patients with chronic whiplash-associated disorders. Ninety-four consecutive patients with whiplash-related conditions were referred to and accepted for a treatment period at a center for functional evaluation and rehabilitation during 2001-2002. The patients followed a program of physical therapy, occupational therapy, and pain management. At the start of their stay, they were examined by a physician specialized in rehabilitation medicine and also by a dentist who performed a functional examination of the stomatognathic system. Of the 93 patients who accepted participation in the study, 55 were diagnosed with temporomandibular disorders and chronic whiplash-associated disorders in accordance with the inclusion criteria. They were randomized into a jaw exercise group (n = 25), who performed specific therapeutic jaw exercises, and a control group (n = 30). Both groups undertook the whiplash rehabilitation program at the center. There were no inter- or intra-group differences in symptoms and signs of temporomandibular disorders at baseline, nor at the 3-week and 6-month follow-ups, except for an increase of maximum active mouth-opening capacity in the control group. In conclusion, the therapeutic jaw exercises, in addition to the regular whiplash rehabilitation program, did not reduce symptoms and signs of temporomandibular disorders in patients with chronic whiplash-associated disorders.

Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK)

PubMed Central

2012-01-01

Background Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. Methods Data from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45). Results Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05). The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash (r = 0.016, p = 0.032). Conclusions The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome. PMID:22935146

Characterization of postural control deficit in whiplash patients by means of linear and nonlinear analyses - A pilot study.

PubMed

Madeleine, Pascal; Nielsen, Mogens; Arendt-Nielsen, Lars

2011-04-01

The ability to maintain balance is diminished in patients suffering from a whiplash injury. The aim of this study was to characterize the variability of postural control in patients with chronic whiplash injury. For this purpose, we analyzed static postural recordings from 11 whiplash patients and sex- and age-matched asymptomatic healthy volunteers. Static postural recordings were performed randomly with eyes open, eyes closed, and eyes open and speaking (dual task). Spatial-temporal changes of the center of pressure displacement were analyzed to assess the amplitude and structure of postural variability by computing, respectively, the standard deviation/coefficient of variation and sample entropy/fractal dimension of the time series. The amplitude of variability of the center of pressure was larger among whiplash patients compared with controls (P<0.001) while fractal dimension was lower (P<0.001). The sample entropy increased during both eyes closed and a simple dual task compared with eyes open (P<0.05). The analysis of postural control dynamics revealed increased amplitude of postural variability and decreased signal dimensionality related to the deficit in postural stability found in whiplash patients. Linear and nonlinear analyses can thus be helpful for the quantification of postural control in normal and pathological conditions. Copyright © 2010 Elsevier Ltd. All rights reserved.

Cervicocephalic kinesthetic sensibility, active range of cervical motion, and oculomotor function in patients with whiplash injury.

PubMed

Heikkilä, H V; Wenngren, B I

1998-09-01

To investigate cervicocephalic kinesthetic sensibility, active range of cervical motion, and oculomotor function in patients with whiplash injury. A 2-year review of consecutive patients admitted to the emergency unit after whiplash injury. An otorhinolaryngology department. Twenty-seven consecutive patients with diagnosed whiplash injury (14 men and 13 women, mean age, 33.8yrs [range, 18 to 66yrs]). The controls were healthy subjects without a history of whiplash injury. Oculomotor function was tested at 2 months and at 2 years after whiplash injury. The ability to appreciate both movement and head position was studied. Active range of cervical motion was measured. Subjective intensity of neck pain and major medical symptoms were recorded. Active head repositioning was significantly less precise in the whiplash subjects than in the control group. Failures in oculomotor functions were observed in 62% of subjects. Significant correlations occurred between smooth pursuit tests and active cervical range of motion. Correlations also were established between the oculomotor test and the kinesthetic sensibility test. The results suggest that restricted cervical movements and changes in the quality of proprioceptive information from the cervical spine region affect voluntary eye movements. A flexion/extension injury to the neck may result in dysfunction of the proprioceptive system. Oculomotor dysfunction after neck trauma might be related to cervical afferent input disturbances.

Magnetic resonance imaging of the alar and transverse ligaments in acute whiplash-associated disorders 1 and 2: a cross-sectional controlled study.

PubMed

Vetti, Nils; Kråkenes, Jostein; Damsgaard, Eivind; Rørvik, Jarle; Gilhus, Nils Erik; Espeland, Ansgar

2011-03-15

Cross-sectional. To describe alar- and transverse-ligament magnetic resonance imaging (MRI) high-signal changes in acute whiplash-associated disorders (WAD) grades 1 and 2 in relation to the severity and mechanics of trauma, and to compare them with controls. The alar and transverse ligaments are important stabilizers at the craniovertebral junction. Acute injury of these ligaments should be detected as high-signal changes on high-resolution MRI. In the study, 114 consecutive acute WAD 1-2 patients and 157 noninjured controls underwent upper-neck high-resolution MRI, using proton-weighted sequences and Short Tau Inversion Recovery (STIR). Two blinded radiologists independently graded high-signal changes 0 to 3 on proton images and assessed ligament high-signal intensity on STIR. Image quality was evaluated as good, reduced, or poor (not interpretable). Multiple logistic regression was used for both within- and between-groups analyses. All proton and STIR images were interpretable. Interobserver agreement for grades 2 to 3 versus grades 0 to 1 changes was moderate to good (κ = 0.71 alar; and 0.54 transverse). MRI showed grades 2 to 3 alar ligament changes in 40 (35.1%) and grades 2 to 3 transverse ligament changes in 27 (23.7%) of the patients. Such changes were related to contemporary head injury (P = 0.041 alar), neck pain (P = 0.042 transverse), and sex (P = 0.033 transverse) but did not differ between patients and controls (P = 0.433 alar; and 0.254 transverse). STIR ligament signal intensity, higher than bone marrow, was found in only three patients and one control. This first study on high-resolution MRI of craniovertebral ligaments in acute WAD 1-2 indicates that such trauma does not induce high-signal changes. Follow-up studies are needed to find out whether pretraumatic high-signal changes imply reduced ligament strength and can predict chronic WAD.

What information do patients need following a whiplash injury? The perspectives of patients and physiotherapists.

PubMed

Maujean, Annick; Sterling, Joanna; Sterling, Michele

2018-05-01

The aims of the present study were to identify information that individuals with whiplash associated disorders (WAD) need to know in the early stages of recovery and to establish whether there is a difference between what physiotherapists and whiplash-injured patients perceive as important information. Forty-one participants were recruited (20 whiplash-injured patients, 21 physiotherapists). Participants were asked to provide five statements to one open-ended question about what they believe is the most important information individuals with WAD need to know in the early stages of recovery. Participants provided 182 statements which were reviewed independently and organised into themes by two of the authors. Six key themes emerged from the statements. These included general information about whiplash injury, treatment and recovery, reassurance, provision of poor information and patients' interaction with general practitioners, maintaining daily activities, and compensation claims and litigation. Both patients and physiotherapists agreed on the type of general whiplash information that should be provided however, major differences were found with regard to information pertaining to compensation claims and litigation and maintaining daily activities. The findings of this study provide some insight into the type of information that WAD individuals require in the early stages of recovery. Implications for Rehabilitation The provision of reassurance can be an effective communication tool to decrease patients concerns about their injury and help strengthen the patient-health practitioner relationship. Although clinical guidelines for the management of whiplash injuries recommend that individuals must remain physically active post-injury, statements from the patient group indicate that this information is not always provided and clearly explained to patients. Keeping in line with the patient centred care approach of being responsive to patient needs and values, it is essential for health practitioners to be attentive to patients' preferences regarding the level of participation in treatment decisions. Processes need to be developed to deliver individuals with WAD accurate information regarding compensation claims so that these factors do not distract from focusing on recovery.

Pregabalin versus placebo in targeting pro-nociceptive mechanisms to prevent chronic pain after whiplash injury in at-risk individuals - a feasibility study for a randomised controlled trial.

PubMed

Nikles, J; Keijzers, G; Mitchell, G; Schug, S; Ware, R; McLean, S A; Connelly, L; Gibson, S; Farrell, S F; Sterling, M

2018-01-17

Whiplash-associated disorders (WAD) are an enormous and costly burden to Australian society. Up to 50% of people who experience a whiplash injury will never fully recover. Whiplash is resistant to treatment and no early management approach has yet been shown to prevent chronic pain. The early presence of central sensitization is associated with poor recovery. Pregabalin's effects on central sensitization indicate the potential to prevent or modulate these processes after whiplash injury and to improve health outcomes, but this has not been investigated. This paper describes the protocol for a feasibility study for a randomised controlled trial of pregabalin plus evidence-based advice compared to placebo plus evidence-based advice for individuals with acute whiplash injury who are at risk of poor recovery. This double blind, placebo-controlled randomised feasibility study will examine the feasibility and potential effectiveness of pregabalin and evidence-based advice (intervention) compared to placebo and evidence-based advice (control) for individuals with acute whiplash injury at risk of poor recovery. Thirty participants (15 per group) aged 18-65 years with Grade II WAD, within 48 hours of injury and currently experiencing at least moderate pain (NRS: ≥ 5/10) will be recruited from Emergency Departments of public hospitals in Queensland, Australia. Pregabalin will be commenced at 75 mg bd and titrated up to 300 mg bd as tolerated for 4 weeks followed by 1 week of weaning. The feasibility of trial procedures will be tested, as well as the potential effect of the intervention on the outcomes. The primary outcome of neck pain intensity at 3 months from randomisation will be compared between the treatment groups using standard analysis of variance techniques. Feasibility and potential effectiveness data will inform an appropriately powered full trial, which if successful, will provide an effective and cost-effective intervention for a costly and treatment resistant condition. It will also have implications for the early management of other traumatic conditions beyond whiplash. Clinical Trials Primary Registry: Australian and New Zealand Clinical Trials Registry. ACTRN12617000059369 . Date of Registration: 11/01/2017. Primary Trial Sponsor: The University of Queensland, Brisbane QLD 4072 Australia.

Early coping strategies do not influence the prognosis after whiplash injuries.

PubMed

Kivioja, Jouko; Jensen, Irene; Lindgren, Urban

2005-08-01

This is a 1-year prospective study to investigate the prognostic value of coping strategies such as catastrophising for persistent pain after a whiplash injury. A consecutive series of 96 patients who were seen in the emergency room in the acute phase after the injury were followed prospectively for 1 year. Age, gender and whether or not pain in the neck preceded the accident was recorded. Cases involving fractures or dislocations of the cervical spine, head trauma or pre-existing neurological disorders were not included. The mean interval between the accident and the initial examination was 3+/-2(S.D.) days. Coping was measured using the Coping Strategies Questionnaire (CSQ). The outcome parameter was self-reported neck pain at 1 year after the motor vehicle accident. At 1 year, 34% of the patients had neck pain. Women developed chronic neck pain more often than men (71% versus 29%); they also had significantly higher coping activity, such as diverting attention, praying or hoping (p<0.05), catastrophising and increasing behavioural activities (p<0.0001). Women reported pain in the neck or shoulder more often before the accident and this was the only statistically significant predictor of chronic symptoms when analysed by logistic regression (odds ratio 4.5). To conclude, we found no evidence that the different coping patterns during the early phase after a whiplash injury influenced the prognosis.

Examination of the diagnostic validity of 'headache attributed to whiplash injury': a controlled, prospective study.

PubMed

Schrader, H; Stovner, L J; Obelieniene, D; Surkiene, D; Mickeviciene, D; Bovim, G; Sand, T

2006-11-01

Acute and chronic headache attributed to whiplash injury are new diagnostic entities in the International Classification of Headache Disorders, second edition. A main objective of the present study was to assess the validity of these nosologic entities by studying the headache pattern in an inception cohort of 210 rear-end car collision victims and in 210 matched controls. Consecutive drivers involved in rear-end collisions were identified from the daily records of the Traffic Police Department of Kaunas, Lithuania. A standard self-report questionnaire was sent to the drivers between 2 and 7 days after the collision, and their passengers were recruited as well. Headache and neck pain were evaluated within 7 days of the collision, at 2 months and 1 year after the collision. A control group of non-traumatized subjects received questionnaires at the time of the selection and 1 year later. Of the 75 collision victims who developed headache within the first 7 days of the collision, 37 had a clinical picture in accordance with the criteria for acute whiplash headache (i.e., concomitant neck pain) and 38 did not. For acute headache after collision, concomitant neck pain was of no relevance to the headache type or its course. In both these subgroups, migraine and tension-type headache could be diagnosed in similar proportions and the prognosis after 2 months and 1 year was also similar. Preexisting headache was a strong prognostic factor in both groups for both acute and chronic pain. Compared with the non-traumatized control group, the 1-year incidence of new or worsened headache, or of headache improvement, was the same. A likely interpretation of the data is that acute headaches after rear-end car collisions mainly represent episodes of a primary headache precipitated by the stress of the situation. We conclude that the nosologic validity of both acute and chronic whiplash headache is poor as the headaches, in accordance with the criteria lack distinguishing clinical features and have the same prognosis compared with headaches in a control group.

Physiotherapists' Beliefs About Whiplash-associated Disorder: A Comparison Between Singapore and Queensland, Australia.

PubMed

Ng, Tze Siong; Pedler, Ashley; Vicenzino, Bill; Sterling, Michele

2015-06-01

Healthcare providers' beliefs may play a role in the outcome of whiplash-associated disorders (WAD), a condition which is proposed to be culturally dependent. Clinical practice guidelines recommend an active approach for the management of WAD, which is often delivered by physiotherapists. However, there is no data on physiotherapists' whiplash beliefs. Our primary objective was to determine physiotherapists' beliefs from Queensland (Australia) and Singapore, two cultures with differing prevalence of chronic musculoskeletal pain and chronic WAD. A pen and paper survey of musculoskeletal physiotherapists practicing in Queensland and Singapore was conducted. Participants completed questionnaires consisting of patient vignettes and statements inquiring knowledge and attitudes towards WAD. Chi-square tests of significance were used to compare the responses of physiotherapists from both samples. Ninety-one (response rate 45%) Queensland-based and 94 (response rate 98%) Singapore-based physiotherapists participated in the study. The beliefs in the management strategies for the patient vignettes were generally consistent with practice guidelines. A higher proportion of Queensland-based physiotherapists expected permanent disabilities for the patient vignette depicting chronic WAD (Queensland: 55% Singapore: 28% Pearson chi-sq 18.76, p < 0.005).Up to 99% of the physiotherapists from both samples believed in encouragement of physical activity, the effectiveness of exercise and multimodal physiotherapy for WAD. Significantly higher proportions of Singapore-based physiotherapists believed in ordering radiographs for acute WAD (Pearson chi-sq 41.98, p < 0.001) and also believed in a psychogenic origin of chronic WAD (Pearson chi-sq 22.57, p  0.001). The majority of beliefs between physiotherapists in Queensland and Singapore were similar but there were specific differences. Physiotherapists' whiplash beliefs in Queensland and Singapore did not clearly reflect the difference in prevalence of chronic musculoskeletal pain or chronic WAD in Queensland and Singapore. Copyright © 2014 John Wiley & Sons, Ltd.

To What Degree Does Active Cervical Range of Motion Differ Between Patients With Neck Pain, Patients With Whiplash, and Those Without Neck Pain? A Systematic Review and Meta-Analysis.

PubMed

Stenneberg, Martijn S; Rood, Michiel; de Bie, Rob; Schmitt, Maarten A; Cattrysse, Erik; Scholten-Peeters, Gwendolijne G

2017-07-01

To quantify differences in active cervical range of motion (aCROM) between patients with neck pain and those without neck pain, in patients with whiplash-associated disorders (WADs) and nontraumatic neck pain, and in patients with acute complaints versus those with chronic complaints. Seven bibliographic databases were searched from inception to April 2015. In addition, a manual search was performed. Full articles on a numerical comparison of aCROM in patients with neck pain and asymptomatic control persons of similar ages were included. Two reviewers independently selected studies and assessed risk of bias. Two reviewers extracted the data. Pooled mean differences of aCROM were calculated using a random-effects model. The search yielded 6261 hits; 27 articles (2366 participants, 13 low risk of bias) met the inclusion criteria. The neck pain group showed less aCROM in all movement directions compared with persons without neck pain. Mean differences ranged from -7.04° (95% CI, -9.70° to -4.38°) for right lateral bending (11 studies) to -89.59° (95% CI, -131.67° to -47.51°) for total aCROM (4 studies). Patients with WADs had less aCROM than patients with nontraumatic neck pain. No conclusive differences in aCROM were found between patients with acute and patients with chronic complaints. Patients with neck pain have a significantly decreased aCROM compared with persons without neck pain, and patients with WADs have less aCROM than those with nontraumatic neck pain. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The notion of a “whiplash culture”: a review of the evidence

PubMed Central

Haneline, Michael T.

2009-01-01

Objective Most whiplash patients eventually recover, although some are left with ongoing pain and impairment. Why some develop long-term symptoms after whiplash, whereas others do not, is largely unknown. One explanation blames the cultural expectations of the population wherein the injury occurred, engendering the moniker whiplash culture. The purpose of this review was to locate and discuss studies that were used as a basis for developing the whiplash culture concept and to evaluate its plausibility. Methods The PubMed database was searched using combinations of the terms whiplash culture, whiplash OR WAD, and chronic OR late OR long term. Search dates spanned from 1950 to June 2008. Filters were set to only retrieve English-language citations. Articles that dealt with the whiplash culture were selected and examined to determine which studies had been used to create the concept. Results Nineteen articles discussed the cultural aspects of whiplash and were explored to determine which were used as a basis for the whiplash culture. Eight studies were found that met this final criterion. Conclusion There are many unanswered questions about the basis of chronic whiplash, and the notion of a whiplash culture is controversial. Chronic whiplash symptoms are surely not caused entirely by cultural issues, yet they are probably not entirely physical. Presumably, a tissue injury component exists in most chronic whiplash-associated disorder victims that becomes aggravated in those who are susceptible to biopsychosocial factors. As with many other controversial health care topics, the answer to the debate probably lies somewhere in the middle. PMID:19703667

Cervical range of motion discriminates between asymptomatic persons and those with whiplash.

PubMed

Dall'Alba, P T; Sterling, M M; Treleaven, J M; Edwards, S L; Jull, G A

2001-10-01

A comparative study of cervical range of motion in asymptomatic persons and those with whiplash. To compare the primary and conjunct ranges of motion of the cervical spine in asymptomatic persons and those with persistent whiplash-associated disorders, and to investigate the ability of these measures of range of motion to discriminate between the groups. Evidence that range of motion is an effective indicator of physical impairment in the cervical spine is not conclusive. Few studies have evaluated the ability to discriminate between asymptomatic persons and those with whiplash on the basis of range of motion or compared three-dimensional in vivo measures of range of motion in asymptomatic persons and those with whiplash-associated disorders. The study participants were 89 asymptomatic volunteers (41 men, 48 women; mean age 39.2 years) and 114 patients with persistent whiplash-associated disorders (22 men, 93 women; mean age 37.2 years) referred to a whiplash research unit for assessment of their cervical region. Range of cervical motion was measured in three dimensions with a computerized, electromagnetic, motion-tracking device. The movements assessed were flexion, extension, left and right lateral flexion, and left and right rotation. Range of motion was reduced in all primary movements in patients with persistent whiplash-associated disorder. Sagittal plane movements were proportionally the most affected. On the basis of primary and conjunct range of motion, age, and gender, 90.3% of study participants could be correctly categorized as asymptomatic or as having whiplash (sensitivity 86.2%, specificity 95.3%). Range of motion was capable of discriminating between asymptomatic persons and those with persistent whiplash-associated disorders.

Is temporomandibular pain in chronic whiplash-associated disorders part of a more widespread pain syndrome?

PubMed

Visscher, Corine; Hofman, Nico; Mes, Carola; Lousberg, Richel; Naeije, Machiel

2005-01-01

The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group. From 65 persons, a standardized oral history was taken, a physical examination of the neck and the masticatory system was performed, widespread pain was investigated by tender point palpation, and psychologic distress was measured with a questionnaire (SCL-90). Because the recognition of temporomandibular disorder pain and neck pain remains a matter of debate, 3 well-defined classification systems were used: one based on the oral history, a second on a combination of oral history and pain on active movements and palpation, and a third one based on a combination of oral history and function tests. Irrespective of the classification system used, the chronic whiplash-associated disorder pain group more often suffered from temporomandibular disorder pain (0.001

Responsiveness of pain and disability measures for chronic whiplash.

PubMed

Stewart, Mark; Maher, Christopher G; Refshauge, Kathryn M; Bogduk, Nikolai; Nicholas, Michael

2007-03-01

Cohort study. To evaluate the responsiveness of common pain and disability measures in a cohort of patients with chronic whiplash. Pain and disability are routinely measured in clinical practice and clinical research. However, to date, a head-to-head comparison of competing measures for whiplash patients has not been performed. Pain (pain intensity, bothersomeness, and SF-36 bodily pain score) and disability (Patient Specific Functional Scale, Neck Disability Index, Functional Rating Index, Copenhagen Scale, and SF-36 physical summary) measures were completed by 132 patients with chronic whiplash at baseline and then again after 6 weeks together with an 11-point global perceived effect scale. Internal responsiveness was evaluated by calculating effect sizes and standardized response means, and external responsiveness by correlating change scores with global perceived effect scores and by ROC curves. The ranking of responsiveness was consistent across the different analyses. Pain bothersomeness was more responsive than pain intensity, which was more responsive than the SF-36 pain measure. The Patient Specific Functional Scale was the most responsive disability measure, followed by the spine-specific measures, with the SF-36 physical summary measure the least responsive. Pain bothersomeness and the Patient Specific Functional Scale provide the most responsive measures of pain and disability, respectively, in patients with chronic whiplash.

Whiplash causes increased laxity of cervical capsular ligament

PubMed Central

Ivancic, Paul C.; Ito, Shigeki; Tominaga, Yasuhiro; Rubin, Wolfgang; Coe, Marcus P.; Ndu, Anthony B.; Carlson, Erik J.; Panjabi, Manohar M.

2009-01-01

Background Previous clinical studies have identified the cervical facet joint, including the capsular ligaments, as sources of pain in whiplash patients. The goal of this study was to determine whether whiplash caused increased capsular ligament laxity by applying quasi-static loading to whiplash-exposed and control capsular ligaments. Methods A total of 66 capsular ligament specimens (C2/3 to C7/T1) were prepared from 12 cervical spines (6 whiplash-exposed and 6 control). The whiplash-exposed spines had been previously rear impacted at a maximum peak T1 horizontal acceleration of 8 g. Capsular ligaments were elongated at 1 mm/s in increments of 0.05 mm until a tensile force of 5 N was achieved and subsequently returned to neutral position. Four pre-conditioning cycles were performed and data from the load phase of the fifth cycle were used for subsequent analyses. Ligament elongation was computed at tensile forces of 0, 0.25, 0.5, 0.75, 1.0, 2.5, and 5.0 N. Two factor, non-repeated measures ANOVA (P<0.05) was performed to determine significant differences in the average ligament elongation at tensile forces of 0 and 5 N between the whiplash-exposed and control groups and between spinal levels. Findings Average elongation of the whiplash-exposed capsular ligaments was significantly greater than that of the control ligaments at tensile forces of 0 and 5 N. No significant differences between spinal levels were observed. Interpretation Capsular ligament injuries, in the form of increased laxity, may be one component perpetuating chronic pain and clinical instability in whiplash patients. PMID:17959284

Jaw symptoms and signs and the connection to cranial cervical symptoms and post-traumatic stress during the first year after a whiplash trauma.

PubMed

Severinsson, Yvonne; Bunketorp, Olle; Wenneberg, Bengt

2010-01-01

To estimate the prevalence of jaw symptoms and signs during the first year after a neck sprain in a car collision. Further, to determine their relationships to the localisation and grade of the initial neck symptoms and signs, headache, post-traumatic stress and crash characteristics. One hundred and forty-six adult subjects and crash characteristics were prospectively investigated in an in-depth study during 1997-2001. Head, neck, and jaw symptoms and signs were recorded within 5 weeks and after 1 year. Acute post-traumatic stress was estimated with the Impact of Event Scale-Revised (IES-R). Jaw symptoms were initially reported by three men (5%) and three women (4%), and subsequently developed in eight women (10%) during the following year. Jaw signs were noted initially in 53 subjects (37%) and in 28 subjects (24%) after 1 year, without difference between sexes, and more often after low-speed impacts. Headache in females, cranial cervical symptoms, pronounced neck problems, post-traumatic stress and whiplash-associated disorders (WAD) grade II-III after rear-end impacts were related to jaw signs during the acute phase. After 1 year, jaw signs were related to residual neck problems, headache and post-traumatic stress. Jaw symptoms are seldom reported during the acute phase after a whiplash trauma. Women more often than men develop jaw symptoms during the first year. Jaw symptoms and signs may develop also after low-speed impacts, especially after rear-end collisions. Jaw symptoms and signs should be observed after whiplash trauma, especially in those with headache, pronounced neck problems, cranial neck symptoms and post-traumatic stress.

Symptoms, disabilities, and life satisfaction five years after whiplash injuries.

PubMed

Styrke, Johan; Sojka, Peter; Björnstig, Ulf; Stålnacke, Britt-Marie

2017-12-29

Background Chronic whiplash-associated disorders (WADs) are often associated with social functioning problems and decreased ability to perform previous activities. This may lead to decreased life satisfaction, which is insufficiently studied in the context of whiplash injuries. Symptoms included in chronic WAD are similar to symptoms frequently reported by persons who have sustained mild traumatic brain injury (MTBI)/concussion. In cases of MTBI, the severity and number of symptoms have been suggested to have a diagnostic value. The corresponding importance of symptoms in chronic WAD has not been documented. Most studies of whiplash injuries have focused on neck pain because this is the dominant complaint, while other symptoms are less studied. The frequency of long-term symptoms after whiplash injuries seems to vary. It is difficult to compare the long-term outcome since the follow-up after whiplash injury in most studies has been rather short. Therefore, the primary aim of this investigation was to study neck pain and other symptoms, disability, and life satisfaction five years after whiplash injury in a defined population and geographical area. Methods The study was carried out at a public hospital in northern Sweden and was a cross-sectional survey of patients five years after the injury event in a cohort of whiplash-injured patients. Five years after the emergency department visit, 186 persons aged 18-64 answered questionnaires on symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire, RHFUQ), and life satisfaction (LiSat-11). The answers were compared to those of a comparison cohort. Results The most common symptoms five years after whiplash injury were fatigue (41%), poor memory (39%), and headache (37%). Inability to sustain previous workload (44%) and fatigue at work (43%) were frequently reported disabilities. Only 39% were satisfied with their somatic health and 60% with their psychological health. Compared with healthy controls, the whiplash injured exhibited more symptoms and had lower life satisfaction. Women reported significantly higher pain intensity than men. Few significant differences between women and men regarding the other parameters were found. Conclusions This study shows that five years after a whiplash injury, patients reported symptoms that are typical of mild traumatic brain injury. Further, this study emphasizes the possibility of screening patients with chronic WAD for these symptoms as a complement to the assessment. Implications Untreated symptoms may negatively affect the outcome of pain rehabilitation. This implies that it might be clinically meaningful to quantify symptoms earlier in the rehabilitation process.

Initial healthcare and coping preferences are associated with outcome 1 year after whiplash trauma: a multicentre 1-year follow-up study

PubMed Central

Myrtveit, Solbjørg Makalani; Carstensen, Tina; Kasch, Helge; Ørnbøl, Eva; Frostholm, Lisbeth

2015-01-01

Objective Individuals exposed to whiplash collisions have to cope with the stressful event as well as early physical symptoms. As in other chronic pain conditions, coping has been associated with outcome after whiplash. In this study, our aim was to examine whether initial coping preferences were associated with the development of chronic whiplash. Design Prospective study. Setting Primary care. Methods 740 acute whiplash patients were recruited from emergency units and general practitioners after car collisions in Denmark. Within 10 days postinjury, participants were asked what they believed could help them get better. At 12-month follow-up, the level of neck pain and capability to work was obtained. Whether coping preferences (baseline) were associated with outcome was investigated using multiple regression analyses. Results Persistent neck pain was most strongly associated with preferring medications (mean difference=1.24 (95% CI 0.67 to 1.82)) and sickness absence (mean difference=1.18 (95% CI 0.53 to 1.82)). Reduced work capability was most strongly associated with preferring medications (OR=3.53 (95% CI 2.13 to 5.86)), sickness absence (OR=3.05 (95% CI 1.80 to 5.17)) and being referred to a physiotherapist/chiropractor (OR=3.03 (95% CI 1.33 to 6.91)). Active coping was associated with better outcomes: Participants preferring to change their lifestyle were protected against reduced work capability (OR=0.11 (95% CI 0.01 to 0.78)). Individuals who wanted to keep living as usual only (no other preference reported) were protected against neck pain (mean difference −1.62 (95% CI −2.39 to −0.84)) and reduced work capability (OR=0.09 (95% CI 0.01 to 0.64)). Conclusions A simple nine-item measure of coping preferences is associated with the development of chronic neck pain and reduced capability to work following whiplash trauma and may be used to identify individuals at risk of poor recovery. PMID:25795697

MRI analysis of the size and shape of the oropharynx in chronic whiplash.

PubMed

Elliott, James; Cannata, Emma; Christensen, Eric; Demaris, Joel; Kummrow, John; Manning, Erin; Nielsen, Elizabeth; Romero, Tomas; Barnes, Clifford; Jull, Gwendolen

2008-06-01

To quantify differences in the size/shape of the oropharynx between female subjects with whiplash and controls. Retrospective cohort. A total of 113 subjects (79 whiplash, 34 controls) were included. T1-weighted MRI was used to measure 1) cross-sectional area (CSA [mm(2)]) and 2) shape ratios for the oropharynx. Reliability data were established. Whiplash subjects had significantly smaller oropharynx CSAs (P < 0.001) and shape ratios (P < 0.001) compared with healthy controls. Self-reported levels of pain and disability and duration of symptoms were not associated with size and shape of the oropharynx in whiplash subjects (P = 0.75 and P = 0.99, respectively). Age and BMI did influence the size (P = 0.01) and shape of the oropharynx (P < 0.001) in the whiplash subjects, but only 20 to 30 percent of the variance could be explained by these factors. Significant difference in the size and shape of the oropharynx was noted in subjects with chronic whiplash compared with controls. Future studies are required to investigate the relationships between oropharynx morphometry and symptoms in patients with chronic whiplash.

No cash no whiplash?: Influence of the legal system on the incidence of whiplash injury.

PubMed

Represas, C; Vieira, D N; Magalhães, T; Dias, R; Frazão, S; Suárez-Peñaranda, J M; Rodríguez-Calvo, M S; Concheiro, L; Muñoz, J I

2008-08-01

Whiplash injury has been a continuous source of controversy due to its association with litigation. We studied the incidence of whiplash associated disorder (WAD) in two similar socioeconomic areas and carried out a retrospective study based on the hypothesis that the Spanish law 30/1995 might have an affect on the incidence and duration of cervical symptoms and the persistence of impairment. More than 10,000 patients injured in traffic accidents were studied over a period three years. Of these, only patients with an initial diagnosis of whiplash injury were included in the study. Patients with other injuries were excluded. The patients were classified into two groups: Galicia-Spain and North-Central Portugal (depending on where the accident took place and the medico-legal evaluation procedure in force). Statistical analysis was made using SPSS 13.0 and Statistix 8.0. We found a statistically significant difference between Spain and Portugal in the incidence of WAD and in the duration of symptoms. The incongruities caused by the compulsory application of Spanish law arise from the fact that evaluation on a points scale of impairment does not always reflect the functional state of the injured person.

[The drama of hyperextension trauma--chronic whiplash syndrome with its neuropsychological and psychiatric findings. An analysis of 80 cases from expert assessment].

PubMed

Kissel, W

1999-10-28

The problem "whiplash associated disorder" was studied in a multidisciplinary analysis of 80 patients who all had a "simple whiplash-accident", this means a whiplash-accident without concomitant head trauma apart from contact with the car seat and without unconsciousness. The opinions of a rheumatologist and of a psychiatrist were considered in each case, and in 47 patients, a neuropsychological expertise was present. 43% of the patients who had been neuropsychologically tested revealed specific cognitive deficits as they are described after mild traumatic brain injuries and after whiplash accidents. Symptoms related to a pretraumatic cognitive disease were not found in any of the cases. Most patients had been professionally active at the time of the accident, some performing activities requiring a high level of cognitive skill. 66% percent of the study group showed psychological disturbances reducing the working capacity. There was no evidence for preexisting traumatic psychiatric symptoms. In many cases the psychiatric disturbances were accident-related, either reactive to the cognitive deficiencies or resulting from chronic pain. We assume that the "simple whiplash-accident" can cause chronic disturbances of brain function. In the etiology, a mild traumatic brain damage must be considered, this means an organic damage and not only a functional brain disorder. These brain function disturbances are often masked by the pure psychiatric symptoms, therefore they must be carefully searched for. Injured patients, who do not regain their working capacity after the accident, should be explored in a neuropsychological as well as in a psychiatric mode as early as possible after the accident.

Expectancies mediate the relationship between perceived injustice and return to work following whiplash injury: A 1-year prospective study.

PubMed

Carriere, J S; Thibault, P; Adams, H; Milioto, M; Ditto, B; Sullivan, M J L

2017-08-01

Emerging evidence suggests that perceived injustice is a risk factor for work disability in individuals with whiplash injury. At present, however, little is known about the processes by which perceived injustice impacts on return to work. The purpose of this study was to examine whether expectancies mediated the relationship between perceived injustice and return to work in patients with whiplash injury. One hundred and fifty-two individuals (81 men, 71 women) with a primary diagnosis of whiplash injury completed self-report measures of pain intensity, perceived injustice and return-to-work expectancies following admission to a rehabilitation programme. Work status was assessed 1 year after discharge. Consistent with previous research, high scores on a measure of perceived injustice were associated with prolonged work disability. Results indicated that high perceptions of injustice were associated with low return-to-work expectancies. Causal mediation analyses revealed that expectancies fully mediated the relationship between perceived injustice and return to work. The findings suggest that intervention techniques designed to target expectancies could improve return-to-work outcomes in patients with whiplash injury. Discussion addresses the processes by which expectancies might impact on return-to-work outcomes and the manner in which negative return-to-work expectancies might be modified through intervention. The study confirms that expectancies are the mechanism through which perceived injustice impacts return to work following whiplash injury. The findings suggest that interventions designed to specifically target return-to-work expectancies might improve rehabilitation outcomes in patients with whiplash injury. © 2017 European Pain Federation - EFIC®.

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: speculations and facts.

PubMed

McKay, D C; Christensen, L V

1998-10-01

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.

Reduced head steadiness in whiplash compared with non-traumatic neck pain.

PubMed

Woodhouse, Astrid; Liljebäck, Pål; Vasseljen, Ottar

2010-01-01

While sensorimotor alterations have been observed in patients with neck pain, it is uncertain whether such changes distinguish whiplash-associated disorders from chronic neck pain without trauma. The aim of this study was to investigate head steadiness during isometric neck flexion in subjects with chronic whiplash-associated disorders (WAD), those with chronic non-traumatic neck pain and healthy subjects. Associations with fatigue and effects of pain and dizziness were also investigated. Head steadiness in terms of head motion velocity was compared in subjects with whiplash (n=59), non-traumatic neck pain (n=57) and healthy controls (n=57) during 2 40-s isometric neck flexion tests; a high load test and a low load test. Increased velocity was expected to reflect decreased head steadiness. The whiplash group showed significantly decreased head steadiness in the low load task compared with the other 2 groups. The difference was explained largely by severe levels of neck pain and dizziness. No group differences in head steadiness were found in the high load task. Reduced head steadiness during an isometric holding test was observed in a group of patients with whiplash-associated disorders. Decreased head steadiness was related to severe pain and dizziness.

Evaluation of electromagnetic fields in the treatment of pain in patients with lumbar radiculopathy or the whiplash syndrome.

PubMed

Thuile, Ch; Walzl, M

2002-01-01

Back pain and the whiplash syndrome are very common diseases involving tremendous costs and extensive medical effort. A quick and effective reduction of symptoms, especially pain, is required. In two prospective randomized studies, patients with either lumbar radiculopathy in the segments L5/S1 or the whiplash syndrome were investigated. Inclusion criteria were as follows: either clinically verified painful lumbar radiculopathy in the segments L5/S1 and a Laségue's sign of 30 degrees (or more), or typical signs of the whiplash syndrome such as painful restriction of rotation and flexion/extension. Exclusion criteria were prolapsed intervertebral discs, systemic neurological diseases, epilepsy, and pregnancy. A total of 100 patients with lumbar radiculopathy and 92 with the whiplash syndrome were selected and entered in the study following a 1:1 ratio. Both groups (magnetic field treatment and controls) received standard medication consisting of diclofenac and tizanidine, while the magnetic field was only applied in group 1, twice a day, for a period of two weeks. In patients suffering from radiculopathy, the average time until pain relief and painless walking was 8.2 +/- 0.5 days in the magnetic field group, and 11.7 +/- 0.5 days in controls p < 0.04). In patients with the whiplash syndrome, pain was measured on a ten-point scale. Pain in the head was on average 4.6 before and 2.1 after treatment in those receiving magnetic field treatment, and 4.2/3.5 in controls. Neck pain was on average 6.3/1.9 as opposed to 5.3/4.6, and pain in the shoulder/arm was 2.4/0.8 as opposed to 2.8/2.2 (p < 0.03 for all regions). Hence, magnetic fields appear to have a considerable and statistically significant potential for reducing pain in cases of lumbar radiculopathy and the whiplash syndrome.

Burnout in Patients with Chronic Whiplash-Associated Disorders

ERIC Educational Resources Information Center

Clementz, Gunilla; Borsbo, Bjorn; Norrbrink, Cecilia

2012-01-01

This study sought to assess burnout and its relation to pain, disability, mood and health-related quality of life in a group of patients with chronic whiplash-associated disorders (WAD). Forty-five patients with chronic WAD ([greater than or equal to] 3 months) referred to a multidisciplinary rehabilitation centre were included. A questionnaire…

Vestibular rehabilitation in a patient with whiplash-associated disorders.

PubMed

Tuo, Kwo-Shieng; Cheng, Yuan-Yang; Kao, Chung-Lan

2006-12-01

Whiplash-associated disorders are characterized by multiple physical complaints after a flexion-extension trauma to the neck. They are difficult to treat, and they often result in great impact on the patient's quality of life. In this paper, the comprehensive treatment of a patient with whiplash-associated disorders is presented. The purpose is to highlight the importance of accurate diagnosis and appropriate treatment plans to improve patients' quality of life. This 23-year-old woman experienced a traffic accident which caused severely painful neck disability, numbness over bilateral upper limbs, dizziness, double vision and loss of balance. Among these symptoms, dizziness was the problem that bothered the patient most. She received a comprehensive rehabilitation program including physical modalities, trigger point injections for relief of pain, as well as a vestibular rehabilitation program, which included exercises challenging and improving her balance function, head-eye coordination exercise, visual-ocular control exercise and sensory substitution-promoting exercises. She resumed her previous full-time work after 3 weeks of treatment. This successfully treated case illustrates the importance of correct diagnosis and appropriate treatment for patients who suffer from whiplash-associated disorders.

Magnetic Resonance Imaging-Based Prediction of the Relationship between Whiplash Injury and Temporomandibular Disorders.

PubMed

Lee, Yeon-Hee; Lee, Kyung Mi; Auh, Q-Schick; Hong, Jyung-Pyo

2017-01-01

Whiplash injury can cause internal derangement of the temporomandibular joint (TMJ) and lead to temporomandibular disorders (TMDs). Our aim was to evaluate whether the initial clinical findings in TMD patients with whiplash injury are correlated with their magnetic resonance imaging (MRI) characteristics. This case-control study involved 219 patients (135 women, 84 men; mean age: 37.84 years) who visited our orofacial pain clinic with TMD; TMD was diagnosed using the diagnostic criteria for TMD Axis I. Patients were categorized into three groups based on the presence and type of macrotrauma: in the "wTMD" group, patients had suffered whiplash injury; patients in the "pTMD" group had post-traumatic TMD; the "iTMD" group comprised patients who had presented with TMD symptoms and had sustained no macrotrauma. We investigated the presence of disk displacement, effusion, disk deformity, and condylar degeneration, and changes in the lateral pterygoid muscle (LPM). To evaluate the severity of TMD pain and objectively analyze symptoms, we used a visual analog scale (VAS), palpation index (PI), neck PI, dysfunction index, and craniomandibular index (CMI). The VAS scores, and the severity indexes of the TMD including PI, neck PI, and CMI were highest in the wTMD patients. Atrophy of the LPM was most commonly seen in the wTMD group, as was disk deformity. In wTMD patients only, VAS score was significantly correlated with stress; it was correlated with headache in wTMD and iTMD patients. The clinical symptoms of TMD were not correlated with MRI findings in the wTMD group. However, alterations in the LPM were strongly correlated with disk displacement. If clinicians recognize alterations in the LPM and disk displacement in the TMJ, they will better understand the clinical symptoms and pathophysiology of TMD with whiplash injury. Whiplash injury may lead to TMD via different mechanisms from other macrotraumas.

Case report: whiplash-associated disorder from a low-velocity bumper car collision: history, evaluation, and surgery.

PubMed

Duffy, Michael F; Stuberg, Wayne; DeJong, Stacey; Gold, Kurt V; Nystrom, N Ake

2004-09-01

Case report of a patient with a whiplash-associated disorder following a bumper car collision. Imaging studies failed to provide an anatomic explanation for the debilitating symptoms. To report a chronic, debilitating pain syndrome after a low-velocity bumper car collision while using complex range-of-motion data for the diagnosis, prognosis, and surgical indication in whiplash-associated disorder. The controversy of whiplash-associated disorder mainly concerns pathophysiology and collision dynamics. Although many investigations attempt to define a universal lesion or determine a threshold of force that may cause permanent injury, no consensus has been reached. Eight years after a low-velocity collision, the patient underwent surgical excision of multiple painful trigger points in the posterior neck. Computerized motion analysis was used for pre- and postoperative evaluations. Surgical treatment resulted in an increase in total active range of motion by 20%, reduced intake of pain medication, doubled the number of work hours, and generally led to a dramatic improvement in quality of life. This case of whiplash-associated disorder after a low-velocity collision highlights the difficulty in defining threshold of injury in regard to velocity. It also illustrates the value of computerized motion analysis in confirming the diagnosis of whiplash-associated disorder and in the evaluation of prognosis and treatment.

Whiplash and Whiplash Associated Disorder (WAS)

MedlinePlus

... Patient Education Committee The spine is a long chain of bones, discs, muscles and ligaments that extends ... is to perform an injection called "medial branch block (MBB)," which is discussed below. Disc injury can ...

[Postural control disorders in initial phases of whiplash].

PubMed

Pleguezuelos Cobo, Eulogio; García-Alsina, Joan; García Almazán, Concepción; Ortiz Fandiño, Javier; Pérez Mesquida, M Engracia; Guirao Cano, Lluis; Samitier Pastor, Beatriz; Perucho Pont, Cristina; Coll Serra, Estel; Matarrubias, Carlos; Reveron, Genoveva

2009-05-02

Dizziness of variable intensity is a frequent complaint in patients who suffered whiplash and largely documented balance disturbances. The objective of the study was to identify balance disorders in early stage of whiplash after road traffic accidents. Ninety nine women were included in the study. Fifty four women had suffered whiplash within two weeks and 45 were included in a healthy control group. Static posturography on a force platform was carried out in all study participants, by means of the Romberg test in four sequential phases, using the postural sway area (SA) as a dependent variable. Visual Analogic Scale (VAS) and Northwick Park Neck Pain Questionnaire (NPH) were used to evaluate pain and function. Postural sway area increased significantly in each of the consecutive phases in both groups. The differences of the means of the postural sway area were statistically significant in all Romberg phases (p=.009 to P=.000). No correlation was found between SA and VAS or NPH scores. There was a positive correlation between the postural sway area standing on a thick foam cushion placed over the plate with closed eyes and the number of days of transitory incapacity (r=0.414; P=.009). Patients with recent whiplash show a postural control disturbance revealed trough a sequential static posturography analysis. This suggests that the balance disorder is not only a consequence of late whiplash syndrome evolution. Therefore, we should promote early instauration of a specific therapeutic approach if and when the patient refers dizziness and related symptoms.

Cognitive function and distress after common whiplash injury.

PubMed

Smed, A

1997-02-01

In a prospective study 29 patients fulfilled the criteria of Whiplash-Associated Disorders grade III in the Quebec classification. One month postinjury, computerized neuropsychological tests, a clinical interview and the symptom checklist SCL-90-R were administered. Three whiplash scales were extrapolated from SCL-90-R: pain, subjective cognitive difficulties and sleep disorders. SCL-90-R was repeated 6 months later. One month after the accident, 85% of the patients had resumed work. Subjective cognitive disturbances, however, were frequent but unrelated to test performances, which were within the normal range. Patients reporting stressful life events unrelated to the injury had more symptoms and elevated levels of distress on all SCL-90-R syndrome scales. At follow-up their distress was unchanged, and subjective cognitive function had deteriorated. Stressful life events unrelated to the accident and a high level of distress 1 month postinjury may augment the risk of "late whiplash syndrome". Reassessment 3-6 weeks postinjury as recommended by the Quebec Task Force should include assessment of complicating social factors and a psychological symptom checklist.

Elevated [11C]-D-Deprenyl Uptake in Chronic Whiplash Associated Disorder Suggests Persistent Musculoskeletal Inflammation

PubMed Central

Linnman, Clas; Appel, Lieuwe; Fredrikson, Mats; Gordh, Torsten; Söderlund, Anne; Långström, Bengt; Engler, Henry

2011-01-01

There are few diagnostic tools for chronic musculoskeletal pain as structural imaging methods seldom reveal pathological alterations. This is especially true for Whiplash Associated Disorder, for which physical signs of persistent injuries to the neck have yet to be established. Here, we sought to visualize inflammatory processes in the neck region by means Positron Emission Tomography using the tracer 11C-D-deprenyl, a potential marker for inflammation. Twenty-two patients with enduring pain after a rear impact car accident (Whiplash Associated Disorder grade II) and 14 healthy controls were investigated. Patients displayed significantly elevated tracer uptake in the neck, particularly in regions around the spineous process of the second cervical vertebra. This suggests that whiplash patients have signs of local persistent peripheral tissue inflammation, which may potentially serve as a diagnostic biomarker. The present investigation demonstrates that painful processes in the periphery can be objectively visualized and quantified with PET and that 11C-D-deprenyl is a promising tracer for these purposes. PMID:21541010

"If I can get over that, I can get over anything"--understanding how individuals with acute whiplash disorders form beliefs about pain and recovery: a qualitative study.

PubMed

Williamson, Esther; Nichols, Vivien; Lamb, Sarah E

2015-06-01

Beliefs held by patients have been shown to influence outcomes in acute whiplash associated disorders (WAD). The aim was to identify beliefs about pain and recovery present in the narratives of individuals with WAD and to understand how and why individuals' came to hold these beliefs. A qualitative study. Interpretative Phenomenological Analysis of semi-structured interviews. Participants (n=20) were enrolled in a large, pragmatic randomised controlled trial of physiotherapy for acute WAD. Participants were interviewed after they completed their treatment. A range of beliefs were evident. These included beliefs about exercise and activity, ability to self-manage symptoms, expectations of recovery and competing priorities. Some beliefs appeared to be barriers to recovery despite all participants having consulted several health professionals. Health professionals were highly influential over how individuals' thought about and managed their injury. The pain experienced influenced how individuals thought and behaved as did past experiences of injury and illness. Competing priorities were a potential barrier to engaging with treatment. We identified examples of how beliefs and behaviour changed in response to information from health professionals and the pain they experienced. People with WAD hold a range of beliefs about pain and recovery and some appear unhelpful to recovery. Health professionals can influence these beliefs and encourage behaviours that aid recovery. Understanding how patients form beliefs may help health professionals to address unhelpful beliefs. It is important that advice and education provided is in line with the current evidenced based understanding of pain and recovery. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Measurement of cervical flexor endurance following whiplash.

PubMed

Kumbhare, Dinesh A; Balsor, Brad; Parkinson, William L; Harding Bsckin, Peter; Bedard, Michel; Papaioannou, Alexandra; Adachi, Jonathan D

2005-07-22

To investigate measurement properties of a practical test of cervical flexor endurance (CFE) in whiplash patients including inter-rater reliability, sensitivity to clinical change, criterion related validity against the Neck Disability Index (NDI), and discriminant validity for injured versus uninjured populations. Two samples were recruited, 81 whiplash patients, and a convenience sample of 160 subjects who were not seeking treatment and met criteria for normal pain and range of motion. CFE was measured using a stopwatch while the subject, in crook lying, held their head against gravity to fatigue. Inter-rater reliability in whiplash patients was in a range considered 'almost perfect' (Intraclass Correlation=0.96). CFE had greater inter-subject variability than the NDI or range of motion in any of three planes. However, the effect size for improvement in CFE over treatment was as large as the effect sizes for all of those measures. In multivariate regression, CFE changes accounted for changes on the NDI better than the three ranges of motion. CFE discriminated whiplash patients who were within six months of injury (n=71) from age and gender matched normals with high effect size (ES=1.5). These findings provide evidence of reliability and validity for CFE measurement, and demonstrate that CFE detects clinical improvements. Variance on CFE emphasizes the need to consider inter-, and intra-subject standard deviations to interpret scores.

Sex Differences in Patients with Chronic Pain Following Whiplash Injury: The Role of Depression, Fear, Somatization, Social Support, and Personality Traits.

PubMed

Malfliet, Anneleen; De Kooning, Margot; Inghelbrecht, Els; Hachimi-Idrissi, Said; Willems, Bert; Bernheim, Jan; Nijs, Jo

2015-11-01

Chronic whiplash-associated disorders (chronic WAD) cover a large variety of clinical manifestations that can occur after a whiplash injury. Women have an increased risk of developing chronic WAD, and it is suggested that psychosocial factors are related to long-term pain and functioning following whiplash injury and persistence of chronic pain. This leads to the question whether there are sex differences in psychosocial factors in chronic WAD. This study included 117 subjects who had experienced a whiplash injury at least 3 months before the start of the study (mean duration of pain: 67.29 ± 63.86 months, range: 297 months). They were selected as chronically symptomatic, by excluding those who had recovered from their whiplash injury. Psychosocial aspects (including depression, fear, somatization, social support, and personality traits) were assessed by validated questionnaires, and sex differences were tested using a univariate analysis of variance (ANCOVA), with age and time from whiplash injury as covariates. No differences in depression, fear, somatization, discrepancy in social support personality trait, Neck Disability Index scores, physical functioning, bodily pain, or general health were present between women and men with chronic WAD. Women with chronic WAD reported higher levels of emotional support in problem situations and social companionship. Except for emotional support in problem situations and social companionship, psychosocial factors do not differ between men and women with chronic WAD. These findings imply little to no risk for sex bias in studies investigating psychosocial issues in patients with chronic WAD. © 2014 World Institute of Pain.

Intracutaneous sterile water injections do not relieve pain in cervicogenic headache.

PubMed

Sand, T; Bovim, G; Helde, G

1992-11-01

Intracutaneous sterile water injections have been reported to relieve acute labor pain and cervical pain in whip-lash patients. A double blind cross-over trial has presently been conducted in 10 women with cervicogenic headache in order to investigate whether sterile water injections were effective in this disorder. No benefit was observed for either treatment (isotonic saline or sterile water), neither on pain during the first 14 days nor on neck mobility. We conclude that intracutaneous sterile water injections is not effective in cervicogenic headache.

The role of the cervical spine in post-concussion syndrome.

PubMed

Marshall, Cameron M; Vernon, Howard; Leddy, John J; Baldwin, Bradley A

2015-07-01

While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼ 10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function.

Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an Active Behavioural Physiotherapy Intervention in an insurance private setting

PubMed Central

Wiangkham, Taweewat; Duda, Joan; Haque, M Sayeed; Price, Jonathan; Rushton, Alison

2016-01-01

Introduction Whiplash-associated disorder (WAD) causes substantial social and economic burden internationally. Up to 60% of patients with WAD progress to chronicity. Research therefore needs to focus on effective management in the acute stage to prevent the development of chronicity. Approximately 93% of patients are classified as WADII (neck complaint and musculoskeletal sign(s)), and in the UK, most are managed in the private sector. In our recent systematic review, a combination of active and behavioural physiotherapy was identified as potentially effective in the acute stage. An Active Behavioural Physiotherapy Intervention (ABPI) was developed through combining empirical (modified Delphi study) and theoretical (social cognitive theory focusing on self-efficacy) evidence. This pilot and feasibility trial has been designed to inform the design of an adequately powered definitive randomised controlled trial. Methods and analysis Two parallel phases. (1) An external pilot and feasibility cluster randomised double-blind (assessor and participants), parallel two-arm (ABPI vs standard physiotherapy) clinical trial to evaluate procedures and feasibility. Six UK private physiotherapy clinics will be recruited and cluster randomised by a computer-generated randomisation sequence. Sixty participants (30 each arm) will be assessed at recruitment (baseline) and at 3 months postbaseline. The planned primary outcome measure is the neck disability index. (2) An embedded exploratory qualitative study using semistructured indepth interviews (n=3–4 physiotherapists) and a focus group (n=6–8 patients) and entailing the recruitment of purposive samples will explore perceptions of the ABPI. Quantitative data will be analysed descriptively. Qualitative data will be coded and analysed deductively (identify themes) and inductively (identify additional themes). Ethics and dissemination This trial is approved by the University of Birmingham Ethics Committee (ERN_15-0542). Trial registration number ISRCTN84528320. PMID:27412105

Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an Active Behavioural Physiotherapy Intervention in an insurance private setting.

PubMed

Wiangkham, Taweewat; Duda, Joan; Haque, M Sayeed; Price, Jonathan; Rushton, Alison

2016-07-13

Whiplash-associated disorder (WAD) causes substantial social and economic burden internationally. Up to 60% of patients with WAD progress to chronicity. Research therefore needs to focus on effective management in the acute stage to prevent the development of chronicity. Approximately 93% of patients are classified as WADII (neck complaint and musculoskeletal sign(s)), and in the UK, most are managed in the private sector. In our recent systematic review, a combination of active and behavioural physiotherapy was identified as potentially effective in the acute stage. An Active Behavioural Physiotherapy Intervention (ABPI) was developed through combining empirical (modified Delphi study) and theoretical (social cognitive theory focusing on self-efficacy) evidence. This pilot and feasibility trial has been designed to inform the design of an adequately powered definitive randomised controlled trial. Two parallel phases. (1) An external pilot and feasibility cluster randomised double-blind (assessor and participants), parallel two-arm (ABPI vs standard physiotherapy) clinical trial to evaluate procedures and feasibility. Six UK private physiotherapy clinics will be recruited and cluster randomised by a computer-generated randomisation sequence. Sixty participants (30 each arm) will be assessed at recruitment (baseline) and at 3 months postbaseline. The planned primary outcome measure is the neck disability index. (2) An embedded exploratory qualitative study using semistructured indepth interviews (n=3-4 physiotherapists) and a focus group (n=6-8 patients) and entailing the recruitment of purposive samples will explore perceptions of the ABPI. Quantitative data will be analysed descriptively. Qualitative data will be coded and analysed deductively (identify themes) and inductively (identify additional themes). This trial is approved by the University of Birmingham Ethics Committee (ERN_15-0542). ISRCTN84528320. 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/

Osteopathic manipulative treatment for facial numbness and pain after whiplash injury.

PubMed

Genese, Josephine Sun

2013-07-01

Whiplash injury is often caused by rear-end motor vehicle collisions. Symptoms such as neck pain and stiffness or arm pain or numbness are common with whiplash injury. The author reports a case of right facial numbness and right cheek pain after a whiplash injury. Osteopathic manipulative treatment techniques applied at the level of the cervical spine, suboccipital region, and cranial region alleviated the patient's facial symptoms by treating the right-sided strain of the trigeminal nerve. The strain on the trigeminal nerve likely occurred at the upper cervical spine, at the nerve's cauda, and at the brainstem, the nerve's point of origin. The temporal portion of the cranium played a major role in the strain on the maxillary.

Neck pain.

PubMed

Binder, Allan I

2008-08-04

Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration-deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy, physical treatments, postural techniques (yoga, pilates, Alexander technique), pulsed electromagnetic field (PEMF) treatment, soft collars and special pillows, spray and stretch, surgery, traction, and transcutaneous electrical nerve stimulation (TENS).

Recruitment bias in chronic pain research: whiplash as a model.

PubMed

Nijs, Jo; Inghelbrecht, Els; Daenen, Liesbeth; Hachimi-Idrissi, Said; Hens, Luc; Willems, Bert; Roussel, Nathalie; Cras, Patrick; Wouters, Kristien; Bernheim, Jan

2011-11-01

In science findings which cannot be extrapolated to other settings are of little value. Recruitment methods vary widely across chronic whiplash studies, but it remains unclear whether this generates recruitment bias. The present study aimed to examine whether the recruitment method accounts for differences in health status, social support, and personality traits in patients with chronic whiplash-associated disorders (WAD). Two different recruitment methods were compared: recruiting patients through a local whiplash patient support group (group 1) and local hospital emergency department (group 2). The participants (n=118) filled in a set of questionnaires: the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being, Symptom Checklist-90, Dutch Personality Questionnaire, and the Social Support List. The recruitment method (either through the local emergency department or patient support group) accounted for the differences in insufficiency, somatization, disability, quality of life, self-satisfaction, and dominance (all p values <.01). The recruitment methods generated chronic WAD patients comparable for psychoneurotism, social support, self-sufficiency, (social) inadequacy, rigidity, and resentment (p>.01). The recruitment of chronic WAD patients solely through patient support groups generates bias with respect to the various aspects of health status and personality, but not social support. In order to enhance the external validity of study findings, chronic WAD studies should combine a variety of recruitment procedures.

[Chronic whiplash syndrome--an overview].

PubMed

Schrader, Harald; Stovner, Lars Jacob; Ferrari, Robert

2002-05-20

In some countries a seemingly large number of patients suffer from chronic whiplash syndrome, whereas in other countries whiplash is not known or is considered to give only moderate symptoms over a brief period of time. In this paper, this discrepancy is accounted for by a biopsychosocial model, a central element of which is the existence of a large pool of spontaneously occurring symptoms in the population, among them head and neck pain. By the mechanisms of attribution, expectation ("nocebo") and reinforcement, common symptoms may be experienced by the patient as caused exclusively by a mild or moderate trauma. Inappropriate behaviour and harmful treatment may worsen and prolong symptoms. To this one should add the effects of conscious exaggeration of symptoms, under-performance in neuropsychological testing, and underreporting of pre-accident symptoms in a medico-legal context. When assessing litigation claims, it is emphasised that a causal relation between common whiplash injuries and chronic complaints has not been demonstrated; a causal relationship can be accepted in exceptional cases only if a set of minimal criteria are fulfilled.

Frequent jaw-face pain in chronic Whiplash-Associated Disorders.

PubMed

Häggman-Henrikson, Birgitta; Grönqvist, Johan; Eriksson, Per-Olof

2011-01-01

Chronic Whiplash-Associated Disorders (WAD) present with frequent pain in the neck, head and shoulder regions but the presence of frequent jaw-face pain is unclear. The aim of the study was to investigate the frequency of jaw-face pain, pain in other regions, and general symptoms in chronic WAD patients. Fifty whiplash-patients and 50 healthy age- and sex-matched controls were examined by questionnaire for pain in the jaw-face, pain in other regions and other symptoms. In contrast to healthy, a majority of the WAD patients (88%) reported frequent pain in the jaw-face, in addition to frequent pain in the neck (100%), shoulders (94%), head (90%) and back (72%). The WAD patients also reported stiffness and numbness in the jaw-face region, and frequent general symptoms such as balance problems, stress and sleep disturbances. The result suggests that frequent pain in the jaw-face can be part of the spectrum of symptoms in chronic WAD.The finding of self-reported numbness in the jaw-face indicates disturbed trigeminal nerve function and merits further investigation. We conclude that assessment of WAD should include pain in the jaw-face region. A multidisciplinary rehabilitation program including dentists, preferably specialized in the area of orofacial pain, should be advocated after whiplash injury.

Acupuncture treatment of whiplash injury.

PubMed

Fattori, Bruno; Ursino, Francesco; Cingolani, Cristina; Bruschini, Luca; Dallan, Iacopo; Nacci, Andrea

2004-01-01

We evaluated by computerized static posturography the postural changes after acupuncture treatment in a group of 27 patients (12 men and 15 women; mean age, 35.7+/-6.8 SD) having balance disorders caused by cervical torsion due to whiplash injury. Acupuncture was performed by piercing deeply and bilaterally acupuncture points bladder 10 and gall bladder 20 with steel needles that were twirled manually for 20 seconds. All patients underwent posturographic evaluations before and just after each session of acupuncture. The posturography was performed with open eyes (OE), closed eyes (CE), and closed eyes with retroflexed head (CER). The control group consisted of 25 patients complaining of the same symptoms as those recorded by the study group due to whiplash injury but treated with nonsteroidal anti-inflammatory drugs and myorelaxation or with physiotherapy only. The data presented in this study revealed a considerable difference between the two groups as regards the reduction of the CE and CER length of the statokinesigram just before each session of acupuncture; the frequency oscillation on the sagittal plane in CER was reduced in the study group, whereas we noticed a progressive increase of its values in the control group. The high percentage of positive results in whiplash injury patients leads us to advocate acupuncture for balance disorders due to cervical pathology.

[Characteristics of vertebral and muscular tonic syndromes in acute and remote periods of cervical whiplash injuries].

PubMed

Makarov, G V; Levin, O S

2004-01-01

The study elicited the peculiarities of vertebral and muscular tonic syndromes in acute and remote periods of whip cervical trauma (WCT). Forty patients in acute period of WCT (2nd-3rd degree of severity) and 30 patients in remote period of WCT, who experienced pain and other symptoms 6 months after the trauma (late whip syndrome--LWS) were examined. The control group included 30 patients with neck and arm pain due to cervical osteochondrosis. In WCT, comparing to cervical osteochondrosis, more marked movement restriction in sagittal plane, more frequent blockade of the lower cervical spine segments, stronger correlation between pain syndrome and movement restriction in the cervical segments, more frequent muscular tonic syndrome in the anterior neck muscles and deeper neck flexors were found. In LWS, in contrast to the acute period of WCT, dissociation between more restricted active and more preserved passive movements in the cervical segments, weaker correlation between emerging of pain syndrome and restriction of movement volume, more frequent blockade of the upper cervical segments, more frequent occurrence of supraspinal muscles and shoulder-scapular syndromes were detected. The data obtained revealed a complex mechanism of symptoms formation in WCT that should be taken into account in treatment planning for acute and remote periods of cervical trauma.

Serum C-reactive protein levels predict regional brain responses to noxious cold stimulation of the hand in chronic whiplash associated disorders.

PubMed

Sterling, Michele; Head, Jessica; Cabot, Peter J; Farrell, Michael

2016-04-01

Whiplash Associated Disorders (WAD) are a costly health burden. The condition is characterised by sensory disturbances such as widespread hyperalgesia likely indicative of central hyperexcitability. Recently elevated levels of pro-inflammatory biomarkers have also found in acute and chronic WAD. The aim of this cross-sectional study was to investigate the relationship between inflammatory biomarkers and pain processing in people with persistent whiplash associated disorders (WAD). Twenty one participants with chronic whiplash (>3 months) were recruited. Venous blood samples were collected and assays performed for C-reactive protein (CRP) and TNF-α. Blood oxygen level-dependent (BOLD) contrast images of the brain were acquired with a Siemens 1.5T MRI scanner during repeated 24s stimulus blocks of innocuous or painful stimuli (thumbnail pressure and cold stimulation of dorsum of hand) separated by 36s inter-stimulus intervals. Stimulus intensities used during scanning were at the level of participants' thresholds for moderate pain. Parameter estimates representing BOLD signal increases during painful events from each participant were tested for associations with inflammatory biomarkers. Clinically relevant levels of CRP and TNF-α were found in 33% and 38% of participants. Levels of CRP showed a positive correlation with levels of cold pain activation in brain regions including the anterior insula, posterior parietal cortex, caudate and thalamus (p corrected <0.05). Levels of TNF-α were not related to activation levels during either noxious pressure or cold. Pressure pain activations also did not show a relationship with CRP levels. Shared variance between inflammation and increased levels of regional pain-related activation in people with persistent whiplash symptoms is apparent for cold, but not pressure stimuli. The results highlight cold pain processing as an important aspect of whiplash chronicity, although the implications of this modality-specific effect are not readily apparent. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

Pain and Disability in the Jaw and Neck Region following Whiplash Trauma.

PubMed

Häggman-Henrikson, B; Lampa, E; Marklund, S; Wänman, A

2016-09-01

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain. © International & American Associations for Dental Research 2016.

Effects of Stress and Relaxation on Central Pain Modulation in Chronic Whiplash and Fibromyalgia Patients Compared to Healthy Controls.

PubMed

Coppieters, Iris; Cagnie, Barbara; Nijs, Jo; van Oosterwijck, Jessica; Danneels, Lieven; De Pauw, Robby; Meeus, Mira

2016-03-01

Compelling evidence has demonstrated that impaired central pain modulation contributes to persistent pain in patients with chronic whiplash associated disorders (WAD) and fibromyalgia (FM). However, there is limited research concerning the influence of stress and relaxation on central pain modulation in patients with chronic WAD and FM. The present study aims to investigate the effects of acute cognitive stress and relaxation on central pain modulation in chronic WAD and FM patients compared to healthy individuals. A randomized crossover design was employed. The present study took place at the University of Brussels, the University Hospital Brussels, and the University of Antwerp. Fifty-nine participants (16 chronic WAD patients, 21 FM, 22 pain-free controls) were enrolled and subjected to various pain measurements. Temporal summation (TS) of pain and conditioned pain modulation (CPM) were evaluated. Subsequently, participants were randomly allocated to either a group that received progressive relaxation therapy or a group that performed a battery of cognitive tests (= cognitive stressor). Afterwards, all pain measurements were repeated. One week later participant groups were switched. A significant difference was found between the groups in the change in TS in response to relaxation (P = 0.008) and cognitive stress (P = 0.003). TS decreased in response to relaxation and cognitive stress in chronic WAD patients and controls. In contrast, TS increased after both interventions in FM patients. CPM efficacy decreased in all 3 groups in response to relaxation (P = 0.002) and cognitive stress (P = 0.001). The obtained results only apply for a single session of muscle relaxation therapy and cognitive stress, whereby no conclusions can be made for effects on pain perception and modulation of chronic cognitive stress and long-term relaxation therapies. A single relaxation session as well as cognitive stress may have negative acute effects on pain modulation in patients with FM, while cognitive stress and relaxation did not worsen bottom-up sensitization in chronic WAD patients and healthy persons. However, endogenous pain inhibition, assessed using a CPM paradigm, worsened in chronic WAD and FM patients, as well as in healthy people following both interventions.

A narrative review on cervical interventions in adults with chronic whiplash-associated disorder

PubMed Central

Yeung, Euson; Tong, Tiffany; Reed, Nick

2018-01-01

Introduction Whiplash injuries are common in society, but clinical interventions are inconclusive on the most effective treatment. Research and reviews have been completed with the goal of determining clinical interventions that are effective for whiplash injuries and disorders, but literature has not recently been summarised on best practices for cervical spine interventions for adults with chronic whiplash. Purpose The objective of this narrative review is to update and expand on previous works, to provide recommendations for clinical interventions and future research in the area of cervical spine rehabilitation for adults with chronic whiplash-associated disorder. Method The Arskey and O’Malley methodology was used for this narrative review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched from 2003 to April 2017. Two reviewers screened titles and abstracts for relevance to the review, and content analysis summarised the study findings. A total of 14 citations were included in the final review. Findings Exercise-based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder (WAD). Invasive interventions still require more rigorous studies to deem their effectiveness for this population. Conclusion Further research is required to investigate and determine clinically relevant results for cervical spine intervention in patients with chronic WAD. PMID:29719724

Dynamic and functional balance tasks in subjects with persistent whiplash: a pilot trial.

PubMed

Stokell, Raina; Yu, Annie; Williams, Katrina; Treleaven, Julia

2011-08-01

Disturbances in static balance have been demonstrated in subjects with persistent whiplash. Some also report loss of balance and falls. These disturbances may contribute to difficulties in dynamic tasks. The aim of this study was to determine whether subjects with whiplash had deficits in dynamic and functional balance tasks when compared to a healthy control group. Twenty subjects with persistent pain following a whiplash injury and twenty healthy controls were assessed in single leg stance with eyes open and closed, the step test, Fukuda stepping test, tandem walk on a firm and soft surface, Singleton test with eyes open and closed, a stair walking test and the timed 10 m walk with and without head movement. Subjects with whiplash demonstrated significant deficits (p < 0.01) in single leg stance with eyes closed, the step test, tandem walk on a firm and soft surface, stair walking and the timed 10 m walk with and without head movement when compared to the control subjects. Specific assessment and rehabilitation directed towards improving these deficits may need to be considered in the management of patients with persistent whiplash if these results are confirmed in a larger cohort. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

High power laser therapy treatment compared to simple segmental physical rehabilitation in whiplash injuries (1° and 2° grade of the Quebec Task Force classification) involving muscles and ligaments

PubMed Central

Conforti, Maria; Fachinetti, Giorgio Paolo

2013-01-01

Summary Introduction: whiplash is a frequent post traumatic pathology caused by muscle, tendon and capsular elements over stretching. The authors conducted a short term prospective randomised study to test the effectiveness of a multi wave High Power Laser Therapy (HPLT) versus conventional simple segmental physical rehabilitation (PT) included in Italian tariff nomenclature performance physiotherapy Study Design: prospective randomised study (Level II). Material and methods: the authors identified 135 homogeneous patients with whiplash grade 1 – 2 of the Quebec Task Force classification (QTFC). INAIL, the Italian National Workers Insurance, based in Milan, was reliable source for identifying patients. All patients with whiplash injuries grade 1 or 2 QTFC, were eligible for the study, starting from April 28 2010 to September 30 2010. Patients referred to a Coordinator (C.M.) who applied the inclusion and exclusion criteria. Patients who agreed to participate were randomly assigned to one of the two treatment groups. Dates for initial treatment session were arranged, including cervical spine X-ray, and assessment. Each patient gave informed consent for participation and agreed to adopt only the study treatment for 6 weeks. Group A (84 patients) was treated with High Power Laser Therapy (HPLT), Group B (51 patients) received conventional simple segmental physical rehabilitation (PT). During the treatment period, no other electro-medical therapy, analgesics or anti-inflammatory drugs were allowed. All patients were assessed at baseline (T0) and at the end of the treatment period (T1) using a Visual Analogical Scale (VAS), (T2) the date of return to work was registered afterwards. Results: there was a reduction in VAS pain scores at T1. Group A (VAS = 20) Group B (VAS = 34,8) (p =0.0048). Laser treatment allowed quick recovery and return to work (T2). Group A after 48 days against 66 days of Group B (p=0.0005). Conclusions: results suggest that High Power Laser Therapy - is an effective treatment in patients with whiplash injury, compared to conventional simple segmental physical rehabilitation. PMID:23888293

High power laser therapy treatment compared to simple segmental physical rehabilitation in whiplash injuries (1° and 2° grade of the Quebec Task Force classification) involving muscles and ligaments.

PubMed

Conforti, Maria; Fachinetti, Giorgio Paolo

2013-04-01

whiplash is a frequent post traumatic pathology caused by muscle, tendon and capsular elements over stretching. The authors conducted a short term prospective randomised study to test the effectiveness of a multi wave High Power Laser Therapy (HPLT) versus conventional simple segmental physical rehabilitation (PT) included in Italian tariff nomenclature performance physiotherapy Study Design: prospective randomised study (Level II). the authors identified 135 homogeneous patients with whiplash grade 1 - 2 of the Quebec Task Force classification (QTFC). INAIL, the Italian National Workers Insurance, based in Milan, was reliable source for identifying patients. All patients with whiplash injuries grade 1 or 2 QTFC, were eligible for the study, starting from April 28 2010 to September 30 2010. Patients referred to a Coordinator (C.M.) who applied the inclusion and exclusion criteria. Patients who agreed to participate were randomly assigned to one of the two treatment groups. Dates for initial treatment session were arranged, including cervical spine X-ray, and assessment. Each patient gave informed consent for participation and agreed to adopt only the study treatment for 6 weeks. Group A (84 patients) was treated with High Power Laser Therapy (HPLT), Group B (51 patients) received conventional simple segmental physical rehabilitation (PT). During the treatment period, no other electro-medical therapy, analgesics or anti-inflammatory drugs were allowed. All patients were assessed at baseline (T0) and at the end of the treatment period (T1) using a Visual Analogical Scale (VAS), (T2) the date of return to work was registered afterwards. there was a reduction in VAS pain scores at T1. Group A (VAS = 20) Group B (VAS = 34,8) (p =0.0048). Laser treatment allowed quick recovery and return to work (T2). Group A after 48 days against 66 days of Group B (p=0.0005). results suggest that High Power Laser Therapy - is an effective treatment in patients with whiplash injury, compared to conventional simple segmental physical rehabilitation.

Persistent pseudomyopia following a whiplash injury in a previously emmetropic woman.

PubMed

Hughes, Fintan E; Treacy, Maxwell P; Duignan, Emma S; Mullaney, Paul B

2017-12-01

Accommodative spasm, which manifests as ciliary muscle spasm, convergent strabismus or miosis, is a recognised consequence of head trauma. In whiplash cases, cervical spine hyperextension poses a risk of contra-coup injury and brainstem trauma, and is known to affect the visual system. However, to date, no cases of accommodative spasm due to whiplash injury have been reported. We present the case of a 34-year-old female who developed sudden onset blurred distance vision after a rear impact car crash, having previously been emmetropic. Her unaided distance visual acuity was 20/70 in the right eye and 20/20 in the left. Best-corrected visual acuity in the right eye was 20/20 with a correction that progressed from -1.75 to -3.50 DS over the 12 months following the accident.This patient's sudden unilateral myopia, with unilaterally increased amplitude of accommodation suggests pseudomyopia due to accommodative spasm. Magnetic resonance imaging showed no evidence of injury to her brain stem, frontal lobes or oculomotor nerve. The patient is now well adjusted with a -3.50DS corrective lens for the right eye. The accommodation reflex is susceptible to injury at the occipital lobe, frontal eye fields, Edinger-Westphal nuclei and oculomotor nerves. As such it should be examined in patients who present with visual disturbances following whiplash injury.It is important that such cases are identified at presentation, as early intervention can improve outcomes in accommodative spasm and reduce the long term psychological effects often associated with whiplash injuries.

Simulated pain and cervical motion in patients with chronic disorders of the cervical spine.

PubMed

Dvir, Zeevi; Gal-Eshel, Noga; Shamir, Boaz; Pevzner, Evgeny; Peretz, Chava; Knoller, Nachshon

2004-01-01

The primary objective of the present study was to determine how simulated severe cervical pain affects cervical motion in patients suffering from two distinct chronic cervical disorders: whiplash (n=25) and degenerative changes (n=25). The second objective was to derive an index that would allow the differentiation of maximal from submaximal performances of cervical range of motion. Patients first performed maximal movement of the head (maximal effort) in each of the six primary directions and then repeated the test as if they were suffering from a much more intense level of pain (submaximal effort). All measurements were repeated within four to seven days. In both groups, there was significant compression of cervical motion during the submaximal effort. This compression was also highly stable on a test-retest basis. In both groups, a significantly higher average coefficient of variation was associated with the imagined pain and it was significantly different between the two clinical groups. In the whiplash group, a logistic regression model allowed the derivation of coefficient of variation-based cutoff scores that might, at selected levels of probability and an individual level, identify chronic whiplash patients who intentionally magnify their motion restriction using pain as a cue. However, the relatively small and very stable compression of cervical motion under pain simulation supports the view that the likelihood that chronic whiplash patients are magnifying their restriction of cervical range of motion using pain as a cue is very low.

A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims.

PubMed

Vikne, John; Oedegaard, Arit; Laerum, Even; Ihlebaek, Camilla; Kirkesola, Gitle

2007-04-01

Many patients with chronic whiplash-associated disorders have reduced neuromuscular control of the neck and head. It has been proposed that a new sling exercise therapy may promote neuromuscular control of the neck. To compare the effects of traditional physiotherapy vs traditional physiotherapy combined with a new sling exercise therapy on discomfort and function in patients with chronic whiplash-associated disorders who have unsettled compensation claims; and to investigate possible additional effects of guided, long-term home training. A randomized multi-centre trial with 4 parallel groups. A total of 214 patients were assigned randomly to 4 treatment groups, and received either traditional physiotherapy with or without home training, or new sling exercise therapy with or without home training. Outcome measures were pain, disability, psychological distress, sick leave and physical tests. A total of 171 patients (80%) completed the study. There were no important statistical or clinical differences between the groups after 4 months of treatment. There was a small statistically significant effect at 12-month follow-up in both groups with home training regarding pain during rest (p = 0.05) and reported fatigue in the final week (p = 0.02). No statistically significant differences were found between the traditional physiotherapy group and the new sling exercise group, with or without home training. Since the groups were not compared with a control group without treatment, we cannot conclude that the studied treatments are effective for patients with whiplash-associated disorder, only that they did not differ in our study.

[Discrimination between pain-induced head movement disturbances after whiplash injuries and their simulation].

PubMed

Berger, M; Lechner-Steinleitner, S; Hoffmann, F; Schönegger, J

1998-12-09

Neck pain after whiplash injury of the cervical spine often induces typical changes in head motion patterns (amplitude, velocity). These changes of kinematics may help to recognize malingerers. We investigated the hypothesis that malingerers are not able to reproduce their simulated head movement disturbances three times. The kinematics of head movements of 23 patients with neck pain after whiplash injury and of 22 healthy subjects trying to act as malingerers were compared. The healthy subjects were informed about the symptomatology of whiplash injury and were asked to simulate painful head movements. Two different kinds of head movements were registered and analyzed by Cervicomotography: (1) the slow free axial head rotation (yaw) and (2) the axial head rotation (yaw) tracking a moving visual target. Each experimental condition was presented three times, expecting the malingerers not to be able to produce as well as to reproduce the same head movement disturbances again and again. In patients, as a consequence of their distinct pain patterns, we expected less variance between the test repetitions. The statistical analysis showed significant differences of the calculated kinematic parameters between both groups and the inability of healthy subjects to simulate and to reproduce convincingly distinct pain patterns.

A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash).

PubMed

Freeman, Michael D; Rosa, Scott; Harshfield, David; Smith, Francis; Bennett, Robert; Centeno, Christopher J; Kornel, Ezriel; Nystrom, Ake; Heffez, Dan; Kohles, Sean S

2010-01-01

Chiari malformation is defined as herniation of the cerebellar tonsils through the foramen magnum, also known as cerebellar tonsillar ectopia (CTE). CTE may become symptomatic following whiplash trauma. The purpose of the present study was to assess the frequency of CTE in traumatic vs non-traumatic populations. Case-control. Cervical MRI scans for 1200 neck pain patients were reviewed; 600 trauma (cases) and 600 non-trauma (controls). Half of the groups were scanned in a recumbent position and half were scanned in an upright position. Two radiologists interpreted the scans for the level of the cerebellar tonsils. A total of 1195 of 1200 scans were read. CTE was found in 5.7% and 5.3% in the recumbent and upright non-trauma groups vs 9.8% and 23.3% in the recumbent and upright trauma groups (p = 0.0001). The results described in the present investigation are first to demonstrate a neuroradiographic difference between neck pain patients with and without a recent history of whiplash trauma. The results of prior research on psychosocial causes of chronic pain following whiplash are likely confounded because of a failure to account for a possible neuropathologic basis for the symptoms.

[Management of patients with simple cervical distortions].

PubMed

Foletti, G; Regli, F

1995-11-11

Common distortion of the cervical spine without evidence of neurological or osteoligamentary damage is a frequent consequence of indirect head and neck trauma. The mechanism of the injury (called "whiplash", "coup de lapin", or "Schleudertrauma") does not imply direct trauma to the head or neck. In the acute phase, common distortion of the cervical spine requires treatment. Rapid management may avoid or considerably reduce the chronic pain syndrome with the characteristic chronic tension-like headache. The chronic pain and the numerous associated functional disorders are not well understood: certain factors favour central and peripheral dysfunction and others emphasize the importance of extra-trauma phenomena. In our opinion, extra-trauma phenomena would explain the invalidating nature of pain in a small number of patients. Management of these chronic patients requires a multidisciplinary approach aimed at helping the patient overcome the inconveniences of this condition.

Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury - A prospective cohort study.

PubMed

Andersen, T E; Karstoft, K-I; Brink, O; Elklit, A

2016-09-01

Knowledge about the course of recovery after whiplash injury is important. Most valuable is identification of prognostic factors that may be reversed by intervention. The mutual maintenance model outlines how post-traumatic stress symptoms (PTSS) and pain may be mutually maintained by attention bias, fear, negative affect and avoidance behaviours. In a similar vein, the fear-avoidance model describes how pain-catastrophizing (PCS), fear-avoidance beliefs (FA) and depression may result in persistent pain. These mechanisms still need to be investigated longitudinally in a whiplash cohort. A longitudinal cohort design was used to assess patients for pain intensity and psychological distress after whiplash injury. Consecutive patients were all contacted within 3 weeks after their whiplash injury (n = 198). Follow-up questionnaires were sent 3 and 6 months post-injury. Latent Growth Mixture Modelling was used to identify distinct trajectories of recovery from pain. Five distinct trajectories were identified. Six months post-injury, 64.6% could be classified as recovered and 35.4% as non-recovered. The non-recovered (the medium stable, high stable and very high stable trajectories) displayed significantly higher levels of PTSS, PCS, FA and depression at all time points compared to the recovered trajectories. Importantly, PCS and FA mediated the effect of PTSS on pain intensity. The present study adds important knowledge about the development of psychological distress and pain after whiplash injury. The finding, that PCS and FA mediated the effect of PTSS on pain intensity is a novel finding with important implications for prevention and management of whiplash-associated disorders. WHAT DOES THIS STUDY ADD?: The study confirms the mechanisms as outlined in the fear-avoidance model and the mutual maintenance model. The study adds important knowledge of pain-catastrophizing and fear-avoidance beliefs as mediating mechanisms in the effect of post-traumatic stress on pain intensity. Hence, cognitive behavioural techniques targeting avoidance behaviour and catastrophizing may be beneficial preventing the development of chronic pain. © 2016 European Pain Federation - EFIC®

Active involvement and intervention in patients exposed to whiplash trauma in automobile crashes reduces costs: a randomized, controlled clinical trial and health economic evaluation.

PubMed

Rosenfeld, Mark; Seferiadis, Aris; Gunnarsson, Ronny

2006-07-15

To examine and compare the costs and consequences in a partial economic evaluation of two competing interventions in patients exposed to whiplash trauma in automobile crashes. The interventions were an active involvement and intervention using early mobilization and a standard intervention of rest, recommended short-term immobilization in a cervical collar and a cautious, gradual self-exercise program according to a leaflet. The study was randomized and controlled. The aim of the study was to compare the costs of an active involvement and intervention versus a standard intervention and to relate them to the clinical benefits in patients exposed to whiplash trauma in automobile crashes to facilitate decision-making regarding intervention and resource allocation. There is very little known about the health economic aspects of various interventions in the target treatment group of patients. Based on a prospective, randomized, clinical trial, data on clinical effectiveness and resources used for the active involvement and intervention and standard intervention were collected for a comparative analysis of the costs related to physical therapy treatment and sick leave. A cost-consequence analysis consisting of a modified cost-effectiveness analysis was used. The costs were significantly lower after 6 and 36 months with an active involvement and intervention as compared with the standard intervention. The active involvement and intervention were significantly superior in reducing experienced pain and reducing sick leave. For patients exposed to whiplash trauma in a motor vehicle collision, an active involvement and intervention were both less costly and more effective than a standard intervention.

Differential diagnosis and treatment of bilateral facial pain after whiplash: a case report.

PubMed

Peterson, Seth

2015-01-01

Clinical case report. Symptoms in the face and jaw are common after whiplash. Few studies have reported cervicogenic headache in a trigeminal nerve distribution, and no published studies could be found describing such symptoms experienced bilaterally after whiplash. The objective of the current case report was to detail the clinical reasoning and management of an uncommon patient presentation. The 41-year-old female patient of the current case complained of shooting pain in the jaw, cheek and forehead beginning 7 days after her accident. No imaging was performed, and examination ruled out serious pathology. The patient was treated primarily with deep neck flexor (DNF) and proprioceptive training for 10 visits over an 8-week period. The Numeric Pain Rating Scale improved from 2/10 to 0/10, the Neck Disability Index improved from 17/50 to 1/50, and the Neck Flexor Muscle Endurance Test improved from 13 to 30 s. The patient remained symptom-free at 4-month follow-up. The current case report describes a patient presentation unique to the literature. Significant changes were seen by week 3 with DNF and proprioceptive training. Additional research is required to determine the effectiveness of this intervention in similar presentations.

WHIPLASH INJURIES—Diagnosis and Treatment

PubMed Central

Huddleston, O. Leonard

1958-01-01

Whiplash injury may extend far beyond the neck, and may involve even the soft tissues of the pelvis. For permanent recovery, all the injuries must be evaluated and treated together. When impact from the rear snaps the head back and then forward, posterior subluxations in the cervical spine cause anterior-posterior narrowing of the intervertebral foramina, which may result in injury to the cervical nerve roots. Impact at the front, causing hyperflexion followed by hyperextension, has a similar effect although usually not as severe. Resulting symptoms may not appear until two or three weeks later, when irritative lesions have developed because of hemorrhage or swelling. Mild or progressive degenerative changes may cause no symptoms but may predispose the affected area to injury following some slight trauma. Capsular ligaments of the lateral intervertebral joints are especially liable to whiplash injury which may give rise to scars and adhesions that compress spinal nerves. Sympathetic system involvement may cause reflex and referred pain. Detailed neurologic, roentgen and electromyographic studies may be necessary for proper evaluation of injuries. Seemingly psychosomatic pain or disability is likely to have some physical basis in whiplash injuries. In 33 patients with whiplash injury, some recently injured and some chronically disabled with persistent symptoms, good results were observed following hydromassage, hot packs, joint mobilization exercises and, in a few, cervical or pelvic traction. PMID:13585155

Surgical fasciectomy of the trapezius muscle combined with neurolysis of the Spinal accessory nerve; results and long-term follow-up in 30 consecutive cases of refractory chronic whiplash syndrome

PubMed Central

2010-01-01

Background Chronic problems from whiplash trauma generally include headache, pain and neck stiffness that may prove refractory to conservative treatment modalities. As has previously been reported, such afflicted patients may experience significant temporary relief with injections of local anesthetic to painful trigger points in muscles of the shoulder and neck, or lasting symptomatic improvement through surgical excision of myofascial trigger points. In a subset of patients who present with chronic whiplash syndrome, the clinical findings suggest an affliction of the spinal accessory nerve (CN XI, SAN) by entrapment under the fascia of the trapezius muscle. The present study was undertaken to assess the effectiveness of SAN neurolysis in chronic whiplash syndrome. Methods A standardized questionnaire and a linear visual-analogue scale graded 0-10 was used to assess disability related to five symptoms (pain, headache, insomnia, weakness, and stiffness) before, and one year after surgery in a series of thirty consecutive patients. Results The preoperative duration of symptoms ranged from seven months to 13 years. The following changes in disability scores were documented one year after surgery: Overall pain decreased from 9.5 +/- 0.9 to 3.2 +/- 2.6 (p < 0.001); headaches from 8.2 +/- 2.9 to 2.3 +/- 2.8 (p < 0.001); insomnia from 7.5 +/- 2.4 to 3.8 +/- 2.8 (p < 0.001); weakness from 7.6 +/- 2.6 to 3.6 +/- 2.8 (p < 0.001); and stiffness from 7.0 +/- 3.2 to 2.6 +/- 2.7 (p < 0.001). Conclusions Entrapment of the spinal accessory nerve and/or chronic compartment syndrome of the trapezius muscle may cause chronic debilitating pain after whiplash trauma, without radiological or electrodiagnostic evidence of injury. In such cases, surgical treatment may provide lasting relief. PMID:20374624

The relationship of whiplash injury and temporomandibular disorders: a narrative literature review☆

PubMed Central

Fernandez, Charles E.; Amiri, Abid; Jaime, Joseph; Delaney, Paul

2009-01-01

Objective The purpose of this article is to offer a narrative review and discuss the possible relationship between temporomandibular disorders (TMDs) and whiplash injuries. Methods Databases from 1966 to present were searched including PubMed; Manual, Alternative, and Natural Therapy Index System; and Cumulative Index for Nursing and Allied Health Literature. Search terms used included whiplash injury, temporomandibular disorders and craniomandibular disorders. Inclusion criteria consisted of studies on orofacial pain of a musculoskeletal origin addressing the following topics: posttraumatic temporomandibular disorder (pTMD) incidence and prevalence, mechanism of injury, clinical findings and characteristics, prognosis (including psychologic factors). Excluded were studies of orofacial pain from nontraumatic origin, as well as nonmusculoskeletal causes including neurologic, vascular, neoplastic, or infectious disease. Results Thirty-two studies describing the effects of whiplash on TMD were reviewed based on inclusion/exclusion criteria. The best evidence from prospective studies indicates a low to moderate incidence and prevalence. Only 3 studies addressed mechanism of injury theories. Most studies focusing on clinical findings and characteristics suggest significant differences when comparing pTMD to idiopathic/nontraumatic patients. Regarding prognosis, most studies suggest a significant difference when comparing pTMD to idiopathic/nontraumatic TMD patients, with pTMD having a poorer prognosis. Conclusions There is conflicting evidence regarding the effects of whiplash on the development of TMD. Furthermore, because of lack of homogeneity in the study populations and lack of standardization of data collection procedures and outcomes measured, this review cannot conclusively resolve the controversies that exist concerning this relationship. This review of the literature is provided to clarify the issues and to provide useful clinical information for health care providers managing TMD such as doctors of chiropractic, physical therapists, dentists, and medical doctors. PMID:19948308

Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms.

PubMed

Williamson, Esther; Williams, Mark A; Gates, Simon; Lamb, Sarah E

2015-03-01

(1) To identify risk factors for chronic disability in people with acute whiplash associated disorders (WAD). (2) To estimate the impact of the numbers of risk factors present. Prospective cohort study. Data were collected, on average, 32 days after injury (SD=10.9) and 12 months later. Baseline measures of pain, disability, neck movement, psychological and behavioural factors were independent variables and chronic disability at 12 months was the dependent variable in a multivariable logistic regression analysis. National Health Service physiotherapy departments. Participants (n=599) with symptoms 3 weeks after injury, self-referred to physiotherapy as part of a randomised controlled trial. 430 (72%) participants provided complete data for this analysis. Chronic disability based on Neck Disability Index scores. 136 (30%) participants developed chronic disability. High baseline disability (OR 3.3, 95% CI 1.97 to 5.55), longer predicted recovery time (OR 2.4, 95% CI 1.45 to 3.87), psychological distress (OR 1.9, 95%CI 1.05 to 3.51), passive coping (OR 1.8, 95% CI 1.07 to 2.97) and greater number of symptoms (OR 1.7, 95% CI 1.07 to 2.78) were associated with chronic disability. One risk factor resulted in 3.5 times the risk (95% CI 1.04 to 11.45) of chronic disability but this risk increased to 16 times (95%CI 5.36 to 49.27) in those with four or five risk factors. Baseline disability had the strongest association with chronic disability but psychological and behavioural factors were also important. Treatment strategies should reflect this which may require a change to current physiotherapy approaches for acute WAD. The number of risk factors present should be considered when evaluating potential for poor outcome. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Does knowledge of seat design and whiplash injury mechanisms translate to understanding outcomes?

PubMed

Ivancic, Paul C

2011-12-01

Review of whiplash injury mechanisms and effects of anti-whiplash systems including active head restraint (AHR) and Whiplash Protection System (WHIPS). This article provides an overview of previous biomechanical and epidemiological studies of AHR and WHIPS and investigates whether seat design and biomechanical knowledge of proposed whiplash injury mechanisms translates to understanding outcomes of rear crash occupants. In attempt to reduce whiplash injuries, some newer automobiles incorporate anti-whiplash systems such as AHR or WHIPS. During a rear crash, mechanically based systems activate by occupant momentum pressing into the seatback whereas electronically based systems activate using crash sensors and an electronic control unit linked to the head restraint. To investigate the effects of AHR and WHIPS on occupant responses including head and neck loads and motions, biomechanical studies of simulated rear crashes have been performed using human volunteers, mathematical models, crash dummies, whole cadavers, and hybrid cadaveric/surrogate models. Epidemiological studies have evaluated the effects of AHR and WHIPS on reducing whiplash injury claims and lessening subjective complaints of neck pain after rear crashes. RESULTS.: Biomechanical studies indicate that AHR and WHIPS reduced the potential for some whiplash injuries but did not completely eliminate the injury risk. Epidemiological outcomes indicate reduced whiplash injury claims or subjective complaints of crash-related neck pain between 43 and 75% due to AHR and between 21% and 49% due to WHIPS as compared to conventional seats and head restraints. Yielding energy-absorbing seats aim to reduce occupant loads and accelerations whereas AHRs aim to provide early head support to minimize head and neck motions. Continued objective biomechanical and epidemiological studies of anti-whiplash systems together with industry, governmental, and clinical initiatives will ultimately lead to reduced whiplash injuries through improved prevention strategies.

Laypersons' expectations of recovery and beliefs about whiplash injury: a cross-cultural comparison between Australians and Singaporeans.

PubMed

Ng, T S; Bostick, G; Pedler, A; Buchbinder, R; Vicenzino, B; Sterling, M

2013-09-01

Beliefs and expectations are thought to influence outcome following whiplash injury. Studies have proposed a link between rates of chronic whiplash and laypersons' expectations about outcome following a motor vehicle accident. The prevalence of chronic whiplash is relatively high in Australia and apparently low in Singapore. This study's objectives were to compare laypersons' beliefs and expectations of recovery of whiplash injury in Brisbane and Singapore and to assess the effect of demographic factors on whiplash beliefs. A cross-sectional study using online surveys was conducted on adult Internet users in Brisbane (Australia) and Singapore. The 14-item whiplash beliefs questionnaire (WBQ) was used to evaluate whiplash beliefs. Two additional items assessed expectations of recovery. Individual items of WBQ, WBQ score and expectations of recovery were analysed. Stratified analysis was performed to adjust for sampling bias due to quota sampling. A total of 402 participants from Singapore and 411 participants from Brisbane, Australia, completed the survey. While participants from Singapore demonstrated slightly more negative whiplash beliefs than participants from Brisbane [t(811)  = -5.72; p < 0.0001], participants from both samples were similar in their expectations of quick recovery and return to normal activities following whiplash injury. Only gender had a significant effect on whiplash beliefs [estimated marginal means of WBQ score for men = 21.5; standard error (SE) = 0.20; women = 22.5; SE = 0.20; F(1,810)  = 11.2; p = 0.001]. Laypersons' expectations of recovery and beliefs about whiplash injury in Brisbane and Singapore were generally similar and mostly positive. Our results demonstrate that cultural differences reflected by laypersons' beliefs may not reflect the differences in prevalence of chronic whiplash between countries. © 2012 European Federation of International Association for the Study of Pain Chapters.

BAEP and E.M.G. changes from whiplash injuries.

PubMed

Serra, L L; Gallicchio, B; Serra, F P; Grillo, G; Ferrari, M

1994-12-01

The frequent negativity of neuroradiological changes after neck injury despite the constant complaints (neck pain and stiffness, limited neck movements, arm pains) experienced after a motor vehicle crash has led us to verify the diagnostic and prognostic validity of different neurophysiological tests in these patients. To this aim 120 young patients (67 females and 53 males) referred for a whiplash syndrome aged 18-31 years without neuroradiological abnormalities have been submitted to EMG and BAEP studies immediately after the traffic accident and after six months. Constant slowing of median MNCV and SNCV and ulnar SNCV without changes in morphology, amplitude and duration of MAP and SAP have been observed in 92 patients, with persistent abnormalities in 64 cases after six months. Increase in I-III or I-V interpeak interval of BAEP have been observed unilaterally in 45 patients and bilaterally in 32 ones without changes in absolute latencies and V/I amplitude ratio, with persistence of such abnormalities in 31 and 16 patients respectively after six months. Simultaneous abnormalities of all neurophysiological tests have been observed in 31 patients, with unmodified recordings after six months in 24 patients. The above findings could be accounted for subtle cerebral lesions and a possible damage to brain stem structures as claimed by Ettlin et al. (1992). The usefulness of the above proposed neurophysiological tests in assessment of asymptomatic dysfunction of central motor and sensory pathways in whiplash injuries is discussed.

How can animal models inform on the transition to chronic symptoms in whiplash?

PubMed Central

Winkelstein, Beth A.

2011-01-01

Study Design A non-systematic review of the literature. Objective The objective was to present general schema for mechanisms of whiplash pain and review the role of animal models in understanding the development of chronic pain from whiplash injury. Summary of Background Data Extensive biomechanical and clinical studies of whiplash have been performed to understand the injury mechanisms and symptoms of whiplash injury. However, only recently have animal models of this painful disorder been developed based on other pain models in the literature. Methods A non-systematic review was performed and findings were integrated to formulate a generalized picture of mechanisms by chronic whiplash pain develops from mechanical tissue injuries. Results The development of chronic pain from tissue injuries in the neck due to whiplash involves complex interactions between the injured tissue and spinal neuroimmune circuits. A variety of animal models are beginning to define these mechanisms. Conclusion Continued work is needed in developing appropriate animal models to investigate chronic pain from whiplash injuries and care must be taken to determine whether such models aim to model the injury event or the pain symptom. PMID:22020616

Influence of vestibular rehabilitation on neck pain and cervical range of motion among patients with whiplash-associated disorder: a randomized controlled trial.

PubMed

Hansson, Eva Ekvall; Persson, Liselott; Malmström, Eva Maj

2013-09-01

To describe how vestibular rehabilitation influences pain and range of motion among patients with whiplash-associated disorder and dizziness, and to describe whether pain or range of motion correlated with balance performance or self-perceived dizziness handicap. A total of 29 patients, 20 women and 9 men, age range 22-76 years. Patients with whiplash-associated disorder and dizziness were randomized to either intervention (vestibular rehabilitation) or control. Neck pain intensity, cervical range of motion (CROM), balance and self-perceived dizziness handicap were measured at baseline, 6 weeks and 3 months. There were no differences in neck pain intensity or CROM between the 2 groups either at baseline, 6 weeks or 3 months (p = 0.10-0.89). At baseline, neck pain intensity correlated with CROM (-0.406) and self-perceived dizziness handicap (0.492). CROM correlated with self-perceived dizziness handicap and with 1 balance measure (-0.432). Neck pain intensity did not correlate with balance performance (-0.188-0.049). Neck pain intensity and CROM was not influenced by vestibular rehabilitation. Importantly, the programme did not appear to increase pain or decrease neck motion, as initially thought. Neck pain intensity and CROM correlated with self-perceived dizziness handicap. CROM also correlated with 1 balance measure.

Neck ligament strength is decreased following whiplash trauma

PubMed Central

Tominaga, Yasuhiro; Ndu, Anthony B; Coe, Marcus P; Valenson, Arnold J; Ivancic, Paul C; Ito, Shigeki; Rubin, Wolfgang; Panjabi, Manohar M

2006-01-01

Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95) mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P < 0.05; trend: P < 0.1). The average physiological ligament elongation was determined using a mathematical model. Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the interspinous and supraspinous ligaments were most flexible. The whiplash-exposed ligaments had significantly lower (P = 0.036) failure force, 149.4 vs. 186.0 N, and a trend (P = 0.078) towards less energy absorption capacity, 308.6 vs. 397.0 J, as compared to the control data. Conclusion The present decreases in neck ligament strength due to whiplash provide support for the ligament-injury hypothesis of whiplash syndrome. PMID:17184536

Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients.

PubMed

Jull, G; Kristjansson, E; Dall'Alba, P

2004-05-01

There has been little investigation into whether or not differences exist in the nature of physical impairment associated with neck pain of whiplash and insidious origin. This study examined the neck flexor synergy during performance of the cranio-cervical flexion test, a test targeting the action of the deep neck flexors. Seventy-five volunteer subjects participated in this study and were equally divided between Group 1, asymptomatic control subjects, Group 2, subjects with insidious onset neck pain and Group 3, subjects with neck pain following a whiplash injury. The cranio-cervical flexion test was performed in five progressive stages of increasing cranio-cervical flexion range. Subjects' performance was guided by feedback from a pressure sensor inserted behind the neck which monitored the slight flattening of the cervical lordosis which occurs with the contraction of longus colli. Myoelectric signals (EMG) were detected from the muscles during performance of the test. The results indicated that both the insidious onset neck pain and whiplash groups had higher measures of EMG signal amplitude (normalized root mean square) in the sternocleidomastoid during each stage of the test compared to the control subjects (all P<0.05) and had significantly greater shortfalls from the pressure targets in the test stages (P<0.05). No significant differences were evident between the neck pain groups in either parameter indicating that this physical impairment in the neck flexor synergy is common to neck pain of both whiplash and insidious origin.

Health practitioners’ perceptions of adopting clinical prediction rules in the management of musculoskeletal pain: a qualitative study in Australia

PubMed Central

Kelly, Joan; Sterling, Michele; Rebbeck, Trudy; Bandong, Aila Nica; Leaver, Andrew; Mackey, Martin; Ritchie, Carrie

2017-01-01

Objectives To investigate health practitioners’ understanding and practice behaviours with regards to clinical prediction rules (CPRs) and explore their perceptions of adopting a new whiplash CPR. Design Qualitative study using six semistructured focus groups. Setting Primary and secondary care in New South Wales and Queensland, Australia. Participants Physiotherapists (n=19), chiropractors (n=6) and osteopaths (n=3) were purposively sampled to include health practitioners who provide routine treatment to people with whiplash-associated disorders. Methods Focus group discussions (n=6) were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Results Health practitioners’ understanding and use of CPRs were mixed. Clinicians considered components relating to acceptability (‘whether I agree with it’) and implementation (‘how I'll use it’) when deciding on whether to adopt a new CPR. Acceptability was informed by four themes: knowledge and understanding, CPR type, congruence and weighted value. Consideration of matters that promote implementation occurred once a CPR was deemed to be acceptable. Three themes were identified as potentially enhancing whiplash CPR implementation: the presence of an external driver of adoption, flexibility in how the CPR could be administered and guidance regarding communication of CPR output to patients. Conclusions Education on CPR purpose and fit with practice is needed to enhance the perceived acceptability of CPRs. Strategies that facilitate practitioner motivation, enable administrative flexibility and assist clinicians in communicating the results of the whiplash CPR could promote adoption of the whiplash CPR. PMID:28801412

Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs.

PubMed

Treleaven, Julia; Peterson, Gunnel; Ludvigsson, Maria Landén; Kammerlind, Ann-Sofi; Peolsson, Anneli

2016-04-01

Dizziness and unsteadiness are common symptoms following a whiplash injury. To compare the effect of 3 exercise programs on balance, dizziness, proprioception and pain in patients with chronic whiplash complaining of dizziness. A sub-analysis of a randomized study. One hundred and forty subjects were randomized to either a physiotherapist-guided neck-specific exercise (NSE), physiotherapist-guided neck-specific exercise, with a behavioural approach (NSEB) or prescription of general physical activity (PPA) group. Pre intervention, 3, 6 and 12 months post baseline they completed the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Visual Analogue Scales (VAS) for, dizziness at rest and during activity and physical measures (static and dynamic clinical balance tests and head repositioning accuracy (HRA)). There were significant time by group differences with respect to dizziness during activity and UCLA-Q favouring the physiotherapy led neck specific exercise group with a behavioural approach. Within group analysis of changes over time also revealed significant changes in most variables apart from static balance. Between and within group comparisons suggest that physiotherapist led neck exercise groups including a behavioural approach had advantages in improving measures of dizziness compared with the general physical activity group, although many still complained of dizziness and balance impairment. Future studies should consider exercises specifically designed to address balance, dizziness and cervical proprioception in those with persistent whiplash. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Neuromuscular control of the head in an isometric force reproduction task: comparison of whiplash subjects and healthy controls.

PubMed

Descarreaux, Martin; Mayrand, Nancy; Raymond, Jean

2007-01-01

A number of recent scientific publications suggest that patients suffering from whiplash-associated disorders (WADs) exhibit sensorimotor deficits in the control of head and neck movements. The main objective of the present study was to evaluate if subjects with WADs can produce isometric neck extension and flexion forces with precision, variability, and a mode of control similar to the values of healthy subjects. A control group study with repeated measures. Neck force production parameters and neuromuscular control were measured in 17 whiplash and 14 control subjects. The experimental group included subjects who had a history of persistent neck pain or disability after a motor vehicle accident. Pain levels were assessed on a standard 100-mm visual analog pain scale at the beginning and end of the experiment. Each whiplash subject completed the neck disability index and the short-form 36 health survey (SF-36) questionnaire before the experiment. All subjects were asked to exert flexion and extension forces against a fixed head harness. Kinetic variables included time to peak force, time to peak force variability, peak force variability, and absolute error in peak force. Surface electrodes were applied bilaterally over the sternocleidomastoideus and paraspinal muscles. Electromyography (EMG)-dependent variables included EMG burst duration and amplitude using numerical integrated techniques. The average time to peak force was significantly longer for whiplash subjects than for the healthy controls. A significant increase in peak force variability was also observed in the whiplash group, and no group differences were noted for absolute error. Heightened muscular activity was seen in both paraspinal muscles, even though it only reached statistical significance for the left paraspinal muscle. Our results show that the whiplash subjects involved in the study were able to produce isometric forces with spatial precision similar to healthy controls using a motor strategy in which the time to peak force is increased. This trade-off between spatial precision and time to peak force probably reflects an adaptation aimed at limiting pain and further injuries.

Whiplash: pathophysiology, diagnosis, treatment, and prognosis.

PubMed

Rodriquez, Arthur A; Barr, Karen P; Burns, Stephen P

2004-06-01

We have reviewed the literature relevant to pathophysiology, diagnosis, treatment, and prognosis of whiplash-associated disorder (WAD) since 1995 and provided a brief summary of literature pertaining to forces action on the head and neck during a motor vehicle accident. The scope of the current review is confined to the Quebec guidelines for WAD grades 1-3 but excludes grade 4 (neck complaints and fracture or dislocation). After excluding papers without scientific data and single case reports or case series with fewer than 20 patients, articles were reviewed for methodological quality. The diagnosis remains clinical. No imaging, physiological, or psychological study provides specific diagnostic criteria. In the acute period up to 2 weeks, soft collars or rest and work-leave do not shorten the duration of neck pain. Sick leave is reduced by high-dose methylprednisolone given within 8 h of injury, but confirmatory studies examining the cost-benefit relationship are needed. In the first 6 months, active as opposed to passive treatment results in improved outcomes. Specific exercise strategies have not been studied. For those with symptoms lasting more than 6 months, percutaneous radio-frequency neurotomy can provide pain relief for many months in those responding to blind local anesthetic facet blocks. Intra-articular corticosteroids are ineffective. Uncontrolled trials suggest that multimodal rehabilitation programs result in improved overall function. The overall prognosis for recovery has varied considerably across studies. Such variability is likely due to differences in case identification methods and whether outcome is assessed in terms of symptoms or the receipt of financial compensation for injury. The impact on prognosis of both collision- and patient-related factors is also reviewed.

[Current study and research progress of whiplash injury of cervical vertebrae].

PubMed

Guo, Ying; Jia, Lian-shun

2011-07-01

Whiplash injury is a common injures in our daily lives, but the mechanism of it and the best treatment is largely unknown. The development of chronic pain and disability following whiplash injury is not uncommon and results in substantial social and economic costs. Clinical manifestation and recovery time are difference, which make it difficult for doctor diagnosis and treatment. The current study have shown that the social class, severity of collision, compensation and lawsuit, physical and psychological factors were relevant predictors for the outcome of whiplash. This article is try to overview the status quo of the whiplash injury.

Analytical Prediction of Turbulent Heat Transfer Parameters.

DTIC Science & Technology

1985-04-01

responsible for the observed whiplash motion of turbulent jets. The buckling theory predicts correctly the natural frequency of the whiplash motion and...number increases frcm % 102 to 10 , the whiplash motion of jets evolves from a sinusoid to a helix and eventually to a train of axisymmetric waves... whiplash and fluctuating motion of turbulent jets. The period of this fluctua- tion scales with the buckling time t. = A/V , i.e., with the time of fluid

The effect of pre-injury physical fitness on the initial severity and recovery from whiplash injury, at six-month follow-up.

PubMed

Geldman, Mark; Moore, Ann; Cheek, Liz

2008-04-01

To evaluate the effect of pre-injury physical fitness on the initial severity and recovery of motor vehicle-induced neck injury (whiplash injury). A quantitative experimental design using both retrospective and prospective data. Metropolitan Police physiotherapy and rehabilitation department in the UK. One-hundred and two patients with neck pain following whiplash injury. Patients were divided into three groups based on pre-injury physical fitness (low, medium and high). Recovery was compared between the three groups initially then again at three and six months. Three measurement scales were used: the Neck Disability Index, the Problem Percentage, and the Physical Activity Scale. Pre-injury physical fitness had a marked effect on recovery at three and six months, with the medium and high fitness groups having significantly better recovery than the low fitness group. At three months the Neck Disability Index score for the low fitness group was 12 compared with 7 and 7.5 for the medium and high fitness groups respectively (P = 0.009). At six months the Neck Disability Index score was 9 for the low fitness group compared with 0 and 3 for the medium and high fitness groups (P = 0.002). In addition, the return to work rate was almost twice as high for individuals with medium/high fitness. Early recovery from whiplash injury was significantly more likely for individuals with medium to high levels of pre-injury physical fitness than for individuals with low levels of pre-injury physical fitness.

Cervical helical axis characteristics and its center of rotation during active head and upper arm movements-comparisons of whiplash-associated disorders, non-specific neck pain and asymptomatic individuals.

PubMed

Grip, Helena; Sundelin, Gunnevi; Gerdle, Björn; Stefan Karlsson, J

2008-09-18

The helical axis model can be used to describe translation and rotation of spine segments. The aim of this study was to investigate the cervical helical axis and its center of rotation during fast head movements (side rotation and flexion/extension) and ball catching in patients with non-specific neck pain or pain due to whiplash injury as compared with matched controls. The aim was also to investigate correlations with neck pain intensity. A finite helical axis model with a time-varying window was used. The intersection point of the axis during different movement conditions was calculated. A repeated-measures ANOVA model was used to investigate the cervical helical axis and its rotation center for consecutive levels of 15 degrees during head movement. Irregularities in axis movement were derived using a zero-crossing approach. In addition, head, arm and upper body range of motion and velocity were observed. A general increase of axis irregularity that correlated to pain intensity was observed in the whiplash group. The rotation center was superiorly displaced in the non-specific neck pain group during side rotation, with the same tendency for the whiplash group. During ball catching, an anterior displacement (and a tendency to an inferior displacement) of the center of rotation and slower and more restricted upper body movements implied a changed movement strategy in neck pain patients, possibly as an attempt to stabilize the cervical spine during head movement.

Quantitative posturography in altered sensory conditions: a way to assess balance instability in patients with chronic whiplash injury.

PubMed

Madeleine, Pascal; Prietzel, Hanne; Svarrer, Heine; Arendt-Nielsen, Lars

2004-03-01

To quantify neck mobility and posture with and without various postural perturbations. A multivariable 2-group study with repeated measures and treatments. A human performance laboratory. Eleven patients with chronic whiplash injury (mean age, 33.3+/-6.7 y; weight, 73.4+/-11.4 kg; height, 173.3+/-7.2 cm) with a sex- and age-matched control group (mean age, 33.1+/-6.8 y; weight, 68+/-12.5 kg; height, 171.5+/-6.3 cm). Neck mobility and the effects of postural perturbations affecting the visual, vestibular, cutaneous, proprioceptive, and nociceptive systems were measured. Active range of motion, neck position sense, and postural activity. We found significantly reduced neck mobility and increased postural activity in the patient group compared with the control group. In patients, there was significantly greater postural activity with eyes closed, eyes open and speaking, and eyes closed with Achilles' tendons vibrations compared with eyes open with no vibrations. In the controls, there was no significant effect of experimental muscle pain on postural activity. Patients with chronic whiplash injury had a protective response to neck movement and different tuning, sequencing, and execution of the postural synergies probably because of excessive reliance on visual input despite a possible deficit and altered vestibular and/or proprioceptive activity. In healthy volunteers, the pain induced by a single bolus injection of hypertonic saline was probably too limited in intensity and spreading to decrease postural stability.

Whiplash in individuals with known pre-accident, clinical neck status.

PubMed

Sjaastad, Ottar; Fredriksen, Torbjörn A; Båtnes, Jan; Petersen, Hans C; Bakketeig, Leiv S

2006-02-01

In whiplash studies, there may be interpretation difficulties: are post-whiplash findings, when present, a consequence of the whiplash trauma, or did they exist prior to trauma? In the Vågå headache epidemiology study (1995-1997), there was a headache history and detailed physical/neurological findings from the face/head/neck in 1838 18-65-year-old parishioners. In September 2001, four years after the Vågå study, a search through the Health Centre files divulged six cases with whiplash trauma in the intervening period. These parishioners could thus be their own controls. Two females did not develop new complaints. In the four parishioners with apparently new, subjective complaints, i.e., headache, neck pain, and a feeling of stiffness in the neck, there were corresponding findings as regards various parameters: shoulder area skin-roll test, changes in two, possible changes in two; range of motion, neck, changes in two, borderline changes in one; "features indicative of cervical abnormality" ("CF"), changes in all four; the mean, post-whiplash stage value was: 3.6+, against 1.6+ prior to accident (Vågå: only 0.93%, "CF" exceeding 3+). In the two without new complaints, the mean "CF" value was 1.0+. The number of cases is small, but the similarity of the symptoms--and signs--following whiplash injury may suggest an element of organic origin in the whiplash syndrome.

Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error.

PubMed

Treleaven, Julia; Jull, Gwendolen; Sterling, Michele

2003-01-01

Dizziness and/or unsteadiness are common symptoms of chronic whiplash-associated disorders. This study aimed to report the characteristics of these symptoms and determine whether there was any relationship to cervical joint position error. Joint position error, the accuracy to return to the natural head posture following extension and rotation, was measured in 102 subjects with persistent whiplash-associated disorder and 44 control subjects. Whiplash subjects completed a neck pain index and answered questions about the characteristics of dizziness. The results indicated that subjects with whiplash-associated disorders had significantly greater joint position errors than control subjects. Within the whiplash group, those with dizziness had greater joint position errors than those without dizziness following rotation (rotation (R) 4.5 degrees (0.3) vs 2.9 degrees (0.4); rotation (L) 3.9 degrees (0.3) vs 2.8 degrees (0.4) respectively) and a higher neck pain index (55.3% (1.4) vs 43.1% (1.8)). Characteristics of the dizziness were consistent for those reported for a cervical cause but no characteristics could predict the magnitude of joint position error. Cervical mechanoreceptor dysfunction is a likely cause of dizziness in whiplash-associated disorder.

Localized cervical facet joint kinematics under physiological and whiplash loading.

PubMed

Stemper, Brian D; Yoganandan, Narayan; Gennarelli, Thomas A; Pintar, Frank A

2005-12-01

Although facet joints have been implicated in the whiplash injury mechanism, no investigators have determined the degree to which joint motions in whiplash are nonphysiological. The purpose of this investigation was to quantify the correlation between facet joint and segmental motions under physiological and whiplash loading. Human cadaveric cervical spine specimens were exercise tested under physiological extension loading, and intact human head-neck complexes were exercise tested under whiplash loading to correlate the localized component motions of the C4-5 facet joint with segmental extension. Facet joint shear and distraction kinematics demonstrated a linear correlation with segmental extension under both loading modes. Facet joints responded differently to whiplash and physiological loading, with significantly increased kinematics for the same-segmental angulation. The limitations of this study include removal of superficial musculature and the limited sample size for physiological testing. The presence of increased facet joint motions indicated that synovial joint soft-tissue components (that is, synovial membrane and capsular ligament) sustain increased distortion that may subject these tissues to a greater likelihood of injury. This finding is supported by clinical investigations in which lower cervical facet joint injury resulted in similar pain patterns due to the most commonly reported whiplash symptoms.

Optimal designs for prediction studies of whiplash.

PubMed

Kamper, Steven J; Hancock, Mark J; Maher, Christopher G

2011-12-01

Commentary. To provide guidance for the design and interpretation of predictive studies of whiplash associated disorders (WAD). Numerous studies have sought to define and explain the clinical course and response to treatment of people with WAD. Design of these studies is often suboptimal, which can lead to biased findings and issues with interpreting the results. Literature review and commentary. Predictive studies can be grouped into four broad categories; studies of symptomatic course, studies that aim to identify factors that predict outcome, studies that aim to isolate variables that are causally responsible for outcome, and studies that aim to identify patients who respond best to particular treatments. Although the specific research question will determine the optimal methods, there are a number of generic features that should be incorporated into design of such studies. The aim of these features is to minimize bias, generate adequately precise prognostic estimates, and ensure generalizability of the findings. This paper provides a summary of important considerations in the design, conduct, and reporting of prediction studies in the field of whiplash.

Health practitioners' perceptions of adopting clinical prediction rules in the management of musculoskeletal pain: a qualitative study in Australia.

PubMed

Kelly, Joan; Sterling, Michele; Rebbeck, Trudy; Bandong, Aila Nica; Leaver, Andrew; Mackey, Martin; Ritchie, Carrie

2017-08-11

To investigate health practitioners' understanding and practice behaviours with regards to clinical prediction rules (CPRs) and explore their perceptions of adopting a new whiplash CPR. Qualitative study using six semistructured focus groups. Primary and secondary care in New South Wales and Queensland, Australia. Physiotherapists (n=19), chiropractors (n=6) and osteopaths (n=3) were purposively sampled to include health practitioners who provide routine treatment to people with whiplash-associated disorders. Focus group discussions (n=6) were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Health practitioners' understanding and use of CPRs were mixed. Clinicians considered components relating to acceptability ('whether I agree with it') and implementation ('how I'll use it') when deciding on whether to adopt a new CPR. Acceptability was informed by four themes: knowledge and understanding, CPR type, congruence and weighted value. Consideration of matters that promote implementation occurred once a CPR was deemed to be acceptable. Three themes were identified as potentially enhancing whiplash CPR implementation: the presence of an external driver of adoption, flexibility in how the CPR could be administered and guidance regarding communication of CPR output to patients. Education on CPR purpose and fit with practice is needed to enhance the perceived acceptability of CPRs. Strategies that facilitate practitioner motivation, enable administrative flexibility and assist clinicians in communicating the results of the whiplash CPR could promote adoption of the whiplash CPR. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis.

PubMed

Walton, David M; Macdermid, Joy C; Giorgianni, Anthony A; Mascarenhas, Joanna C; West, Stephen C; Zammit, Caroline A

2013-02-01

Systematic review and meta-analysis. To update a previous review and meta-analysis on risk factors for persistent problems following whiplash secondary to a motor vehicle accident. Prognosis in whiplash-associated disorder (WAD) has become an active area of research, perhaps owing to the difficulty of treating chronic problems. A previously published review and meta-analysis of prognostic factors included primary sources up to May 2007. Since that time, more research has become available, and an update to that original review is warranted. A systematic search of international databases was conducted, with rigorous inclusion criteria focusing on studies published between May 2007 and May 2012. Articles were scored, and data were extracted and pooled to estimate the odds ratio for any factor that had at least 3 independent data points in the literature. Four new cohorts (n = 1121) were identified. In combination with findings of a previous review, 12 variables were found to be significant predictors of poor outcome following whiplash, 9 of which were new (n = 2) or revised (n = 7) as a result of additional data. The significant variables included high baseline pain intensity (greater than 5.5/10), report of headache at inception, less than postsecondary education, no seatbelt in use during the accident, report of low back pain at inception, high Neck Disability Index score (greater than 14.5/50), preinjury neck pain, report of neck pain at inception (regardless of intensity), high catastrophizing, female sex, WAD grade 2 or 3, and WAD grade 3 alone. Those variables robust to publication bias included high pain intensity, female sex, report of headache at inception, less than postsecondary education, high Neck Disability Index score, and WAD grade 2 or 3. Three existing variables (preaccident history of headache, rear-end collision, older age) and 1 additional novel variable (collision severity) were refined or added in this updated review but showed no significant predictive value. This review identified 2 additional prognostic factors and refined the estimates of 7 previously identified factors, bringing the total number of significant predictors across the 2 reviews to 12. These factors can be easily identified in a clinical setting to provide estimates of prognosis following whiplash.

Early changes in somatosensory function in spinal pain: a systematic review and meta-analysis.

PubMed

Marcuzzi, Anna; Dean, Catherine M; Wrigley, Paul J; Hush, Julia M

2015-02-01

Alterations in sensory processing have been demonstrated in chronic low back and neck pain. However, it has not been yet systematically summarized how early these changes occur in spinal pain. This systematic review examines the available literature measuring somatosensory function in acute (<6 weeks) and subacute (6-12 weeks) spinal pain. The protocol for this review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO). An electronic search of 4 databases was conducted to retrieve studies assessing somatosensory function by quantitative sensory testing in adults with spinal pain of up to 12 weeks duration. Two reviewers independently screened the studies and assessed the risk of bias. Studies were grouped according to spinal pain condition (whiplash injury, idiopathic neck pain, and nonspecific low back pain), and, where possible, meta-analyses were performed for comparable results. Fifteen studies were included. Sources of bias included lack of assessor blinding, unclear sampling methods, and lack of control for confounders. We found that: (1) there is consistent evidence for thermal and widespread mechanical pain hypersensitivity in the acute stage of whiplash, (2) there is no evidence for pain hypersensitivity in the acute and subacute stage of idiopathic neck pain, although the body of evidence is small, and (3) hyperalgesia and spinal cord hyperexcitability have been detected in early stages of nonspecific low back pain, although evidence about widespread effects are conflicting. Future longitudinal research using multiple sensory modalities and standardized testing may reveal the involvement of somatosensory changes in the development and maintenance of chronic pain.

Anterior longitudinal ligament injuries in whiplash may lead to cervical instability.

PubMed

Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A; Rao, Raj D

2006-07-01

Although whiplash injuries account for a significant annual cost to society, the exact mechanism of injury and affected tissues remain unknown. Previous investigations documented injuries to the cervical anterior longitudinal ligament in whiplash. The present investigation implemented a comprehensively validated computational model to quantify level-dependent distraction magnitudes of this structure in whiplash. Maximum ligament distractions approached failure levels, particularly in middle to lower cervical levels, and occurred during the initial phase of head-neck kinematics. In particular, the C5-C6 anterior longitudinal ligament sustained distraction magnitudes as high as 2.6mm during the retraction phase, corresponding to 56% of distraction necessary to result in ligament failure. Present results demonstrated that anterior structures in the lower cervical spine may be susceptible to injury through excess distraction during the retraction phase of whiplash, which likely occurs prior to head restraint contact. Susceptibility of these structures is likely due to non-physiologic loading placed on the cervical spinal column as the head translates posteriorly relative to the thorax. Injury to anterior spinal structures can result in clinical indications including cervical instability in extension, axial rotation, and lateral bending modes. Mitigation of whiplash injury may be achieved by minimizing head retraction during initial stages of whiplash.

[Relevant factors in medico-legal prognosis of whiplash injury].

PubMed

Pujol, Amadeo; Puig, Luisa; Mansilla, Joaquina; Idiaquez, Itziar

2003-07-12

Whiplash injury (WI) is commonly evaluated in medico-legal practice. With the aim of knowing the determining factors of WI's medico-legal prognosis, a prospective and observational study was carried out. One hundred and twenty consecutive patients who were clinically observed and evaluated in the Medico-Legal Clinic of Barcelona were studied. Socio-demographic, clinical, radiographic and evolutive factors were analyzed. We included 120 patients with a mean age of 35.6 (14) years (range, 4-74), with a homogeneous male/female distribution. An earlier cervical pathology was detected in 10% of patients; none of them had previous psychiatric pathology. 95% corresponded to road-traffic accident cases and there were 5 aggression cases. Over 50% of cases involved a rear-end collision. All patients had neck pain, almost 25% had headache and 13% had paresthesia. According to the Whiplash Association Disorders clinical classification, distribution in grades (G) was: G I 51%, G II 32% and G III 17%. Patients reported recovery within a mean time of 71.6 (46) days (range, 4-244), with 51,2 (45) no working days (range, 0-180 days). The 52% of the patients rest with complains. According to the recovery time, the following medico-legal prognostic factors were identified: age (p < 0.001), being female (p = 0.001), clinical grade (p < 0.001) and abnormal cervical MRI exploration (p < 0.001). Patients with previous cervical pathology reported more complaints (p = 0.001). In our study, WI affected young people of both sex mainly during rear-end collision. Worst medico-legal prognostic factors were age, being females, severity of initial clinical symptoms, previous cervical pathology and abnormal cervical MRI/CT.

Kinematics of a Head-Neck Model Simulating Whiplash

NASA Astrophysics Data System (ADS)

Colicchia, Giuseppe; Zollman, Dean; Wiesner, Hartmut; Sen, Ahmet Ilhan

2008-02-01

A whiplash event is a relative motion between the head and torso that occurs in rear-end automobile collisions. In particular, the large inertia of the head results in a horizontal translation relative to the thorax. This paper describes a simulation of the motion of the head and neck during a rear-end (whiplash) collision. A head-neck model that qualitatively undergoes the same forces acting in whiplash and shows the same behavior is used to analyze the kinematics of both the head and the cervical spine and the resulting neck loads. The rapid acceleration during a whiplash event causes the extension and flexion of the cervical spine, which in turn can cause dislocated vertebrae, torn ligaments, intervertebral disc herniation, and other trauma that appear to be the likely causes of subsequent painful headache or neck pain symptoms. Thus, whiplash provides a connection between the dynamics of the human body and physics. Its treatment can enliven the usual teaching in kinematics, and both theoretical and experimental approaches provide an interesting biological context to teach introductory principles of mechanics.

Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study.

PubMed

Van Oosterwijck, Jessica; Nijs, Jo; Meeus, Mira; Truijen, Steven; Craps, Julie; Van den Keybus, Nick; Paul, Lorna

2011-01-01

Chronic whiplash is a debilitating condition characterized by increased sensitivity to painful stimuli, maladaptive illness beliefs, inappropriate attitudes, and movement dysfunctions. Previous work in people with chronic low back pain and chronic fatigue syndrome indicates that pain neurophysiology education is able to improve illness beliefs and attitudes as well as movement performance. This single-case study (A-B-C design) with six patients with chronic whiplash associated disorders (WAD) was aimed at examining whether education about the neurophysiology of pain is accompanied by changes in symptoms, daily functioning, pain beliefs, and behavior. Periods A and C represented assessment periods, while period B consisted of the intervention (pain neurophysiology education). Results showed a significant decrease in kinesiophobia (Tampa Scale for Kinesiophobia), the passive coping strategy of resting (Pain Coping Inventory), self-rated disability (Neck Disability Index), and photophobia (WAD Symptom List). At the same time, significantly increased pain pressure thresholds and improved pain-free movement performance (visual analog scale on Neck Extension Test and Brachial Plexus Provocation Test) were established. Although the current results need to be verified in a randomized, controlled trial, they suggest that education about the physiology of pain is able to increase pain thresholds and improve pain behavior and pain-free movement performance in patients with chronic WAD.

Headache and musculoskeletal complaints among subjects with self reported whiplash injury. The HUNT-2 study

PubMed Central

2011-01-01

Background To evaluate the life-time prevalence of self reported whiplash injury and the relationship to chronic musculoskeletal complaints (MSCs) and headache in a large unselected adult population. Methods Between 1995 and 1997, all inhabitants 20 years and older in Nord-Trondelag county in Norway were invited to a comprehensive health survey. Out of 92,936 eligible for participation, a total of 59,104 individuals (63.6%) answered the question about whiplash injury (whiplash). Among these, 46,895 (79.3%) responded to the questions of musculoskeletal complaints and headache. Results The total life-time prevalence of self reported whiplash injury was 2.9%, for women 2.7% and for men 3.0%. There was a significant association between self reported whiplash injury and headache (OR = 2.1; 95% CI 1.8-2.4), and chronic MSCs (OR = 3.3; 95% CI 2.8-3.8), evident for all ten anatomical sites investigated. The association was most pronounced for those with a combination of headache and chronic MSC for both men (OR = 4.8; 95% CI 3.6-6.2) and women (OR = 5.2; 95% CI 3.7-7.1). Conclusions Subjects with self reported whiplash injury had significantly more headache and musculoskeletal complaints than those without, and may in part be due to selective reporting. The causal mechanism remains unclear and cannot be addressed in the present study design. PMID:21651816

Energy-absorbing car seat designs for reducing whiplash.

PubMed

Himmetoglu, S; Acar, M; Bouazza-Marouf, K; Taylor, A J

2008-12-01

This study presents an investigation of anti-whiplash features that can be implemented in a car seat to reduce whiplash injuries in the case of a rear impact. The main emphasis is on achieving a seat design with good energy absorption properties. A biofidelic 50th percentile male multi-body human model for rear impact is developed to evaluate the performance of car seat design concepts. The model is validated using the responses of 7 volunteers from the Japanese Automobile Research Institute (JARI) sled tests, which were performed at an impact speed of 8 kph with a rigid seat and without head restraint and seatbelt. A generic multi-body car seat model is also developed to implement various seatback and recliner properties, anti-whiplash devices, and head restraints. Using the same driving posture and the rigid seat in the JARI sled tests as the basic configuration, several anti-whiplash seats are designed to allow different types of motion for the seatback and seat-pan. The anti-whiplash car seat design concepts limit neck internal motion successfully until the head-to-head restraint contact occurs and they exhibit low NIC(max) values (7 m(2)/s(2) on average). They are also effective in reducing neck compression forces and T1 forward accelerations. In principle, these car seat design concepts employ controlled recliner rotation and seat-pan displacement to limit the formation of S-shape. This is accomplished by using anti-whiplash devices that absorb the crash energy in such a way that an optimum protection is provided at different severities. The results indicate that the energy absorbing car seat design concepts all demonstrate good whiplash-reducing performances at the IIWPG standard pulse. Especially in higher severity rear impacts, two of the car seat design concepts reduce the ramping of the occupant considerably.

Kinematics of a Head-Neck Model Simulating Whiplash

ERIC Educational Resources Information Center

Colicchia, Giuseppe; Zollman, Dean; Wiesner, Hartmut; Sen, Ahmet Ilhan

2008-01-01

A whiplash event is a relative motion between the head and torso that occurs in rear-end automobile collisions. In particular, the large inertia of the head results in a horizontal translation relative to the thorax. This paper describes a simulation of the motion of the head and neck during a rear-end (whiplash) collision. A head-neck model that…

Retropharyngeal hematoma secondary to whiplash injury in childhood: a case report.

PubMed

Nurata, Hakan; Yilmaz, Muhammet Bahadır; Borcek, Alp Ozgun; Oner, Ali Yusuf; Baykaner, M Kemali

2012-01-01

Whiplash Associated Disorders (WAD) has been reported as an adult phenomenon. Whiplash injury has classically been described as a cervical soft tissue hyperextension- flexion injury after a trauma such as a rear end impact car crash, contact sport injuries, blows to the head from a falling object or a punch and shaken baby syndrome and is mostly seen in adults . It is important as it may cause severe disability due to spinal cord injury, decrease work productivity and even retropharyngeal hematoma resulting airway obstruction and mortality due to bleeding amongst deep cervical fascias. We describe a case of retropharyngeal hematoma after whiplash injury in a childhood.

From railway spine to whiplash--the recycling of nervous irritation.

PubMed

Ferrari, Robert; Shorter, Edward

2003-11-01

The search for a specific structural basis for chronic whiplash and other chronic pain and fatigue syndromes has been in progress for decades, and yet currently there remains no "structural" solution to these enigmata. In light of the failure of research to identify the chronic "damage" or pathology as lying in a muscular, bony, or "connective tissue" sites for many chronic pain syndromes like whiplash, fibromyalgia, et cetera, more recent attention has been paid to nervous system structures. Nerve irritation has been implicated as the basis for the pain and other symptoms that are common to many chronic disability syndromes. We postulate here, however, that the concept of nervous irritation has been prostituted for centuries whenever more concrete structural explanations for chronic pain and other controversial illness have been untenable. We suggest that, after each cycle of nervous irritation as a disease, and subsequent dismissal of the notion, the doctrine of irritation as a disease was too good to go away. First, with the hypersthenic and asthenic diseases of the nineteenth century, then railway spine, whiplash, thoracic outlet syndrome, and now brachial plexus irritation, we detect the same pattern: patients with symptoms, but no objective evidence of nerve disease. Nervous irritation has repeatedly served this purpose for the last 200 years. It is our intent that bringing an understanding of this trend will encourage current clinicians and researchers to appreciate the need to abandon this form of speculation without historical insight when dealing with today's controversial syndromes.

Do "whiplash" victims with neck pain differ from those with neck pain and other symptoms?

PubMed

Tencer, A F; Mirza, S; Cummings, P

2001-01-01

Studying 432 patients with "whiplash" neck pain after a low speed rear-end crash, we determined whether those who reported associated symptoms (arm or low back pain) differed from those with neck pain only. Exposure variables were: age, gender, height, weight, surprised by impact, rotated position of the head, and pre-existing cervical or lumbar spinal degeneration. Immediate symptoms were considered. Odds ratios (OR) were derived from logistic regression. Only pre-existing lumbar spinal degeneration was associated with having arm symptoms (OR = 9.6, CI = 1.1, 83.6) or low back pain (OR = 23.3, CI = 2.6, 206.7) along with neck pain.

Whiplash evokes descending muscle recruitment and sympathetic responses characteristic of startle

PubMed Central

Mang, Daniel WH; Siegmund, Gunter P; Blouin, Jean-Sébastien

2014-01-01

Whiplash injuries are the most common injuries following rear-end collisions. During a rear-end collision, the human muscle response consists of both a postural and a startle response that may exacerbate injury. However, most previous studies only assessed the presence of startle using data collected from the neck muscles and head/neck kinematics. The startle response also evokes a descending pattern of muscle recruitment and changes in autonomic activity. Here we examined the recruitment of axial and appendicular muscles along with autonomic responses to confirm whether these other features of a startle response were present during the first exposure to a whiplash perturbation. Ten subjects experienced a single whiplash perturbation while recording electromyography, electrocardiogram, and electrodermal responses. All subjects exhibited a descending pattern of muscle recruitment, and increasing heart rate and electrodermal responses following the collision. Our results provide further support that the startle response is a component of the response to whiplash collisions. PMID:24932015

Whiplash Syndrome Reloaded: Digital Echoes of Whiplash Syndrome in the European Internet Search Engine Context.

PubMed

Noll-Hussong, Michael

2017-03-27

In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many less wealthy countries, there may be limited access to care and no insurance or compensation system. The purpose of this infodemiology study was to investigate the global pattern of evolving Internet usage in countries with and without insurance and the corresponding compensation systems for whiplash injury. We used the Internet search engine analytics via Google Trends to study the health information-seeking behavior concerning whiplash injury at national population levels in Europe. We found that the search for "whiplash" is strikingly and consistently often associated with the search for "compensation" in countries or cultures with a tort system. Frequent or traumatic painful injuries; diseases or disorders such as arthritis, headache, radius, and hip fracture; depressive disorders; and fibromyalgia were not associated similarly with searches on "compensation." In this study, we present evidence from the evolving viewpoint of naturalistic Internet search engine analytics that the expectations for receiving compensation may influence Internet search behavior in relation to whiplash injury. ©Michael Noll-Hussong. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 27.03.2017.

Cervical radiofrequency neurotomy reduces central hyperexcitability and improves neck movement in individuals with chronic whiplash.

PubMed

Smith, Ashley Dean; Jull, Gwendolen; Schneider, Geoff; Frizzell, Bevan; Hooper, Robert Allen; Sterling, Michele

2014-01-01

This study aims to determine if cervical medial branch radiofrequency neurotomy reduces psychophysical indicators of augmented central pain processing and improves motor function in individuals with chronic whiplash symptoms. Prospective observational study of consecutive patients with healthy control comparison. Tertiary spinal intervention centre in Calgary, Alberta, Canada. Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2); 30 healthy controls. Measures were made at four time points: two prior to radiofrequency neurotomy, and 1- and 3-months post-radiofrequency neurotomy. Measures included: comprehensive quantitative sensory testing (including brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement, superficial neck flexor activity during the craniocervical flexion test). Self-report pain and disability measures were also collected. One-way repeated measures analysis of variance and Friedman's tests were performed to investigate the effect of time on the earlier measures. Differences between the whiplash and healthy control groups were investigated with two-tailed independent samples t-test or Mann-Whitney tests. Following cervical radiofrequency neurotomy, there were significant early (within 1 month) and sustained (3 months) improvements in pain, disability, local and widespread hyperalgesia to pressure and thermal stimuli, nociceptive flexor reflex threshold, and brachial plexus provocation test responses as well as increased neck range of motion (all P < 0.0001). A nonsignificant trend for reduced muscle activity with the craniocervical flexion test (P > 0.13) was measured. Attenuation of psychophysical measures of augmented central pain processing and improved cervical movement imply that these processes are maintained by peripheral nociceptive input. Wiley Periodicals, Inc.

The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders.

PubMed

Bernhoff, Gabriella; Landén Ludvigsson, Maria; Peterson, Gunnel; Bertilson, Bo Christer; Elf, Madeleine; Peolsson, Anneli

2016-01-01

The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. This cross-sectional study included data collected in a randomized controlled study. Two hundred and sixteen patients with chronic (≥6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa =0.11, 95% CI: -0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa =0.64, 95% CI: 0.53 to 0.76). The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.

Psychological Care, Patient Education, Orthotics, Ergonomics and Prevention Strategies for Neck Pain: An Systematic Overview Update as Part of the ICON§ Project

PubMed Central

Gross, Anita R.; Kaplan, Faith; Huang, Stacey; Khan, Mahweesh; Santaguida, P. Lina; Carlesso, Lisa C.; MacDermid, Joy C.; Walton, David M.; Kenardy, Justin; Söderlund, Anne; Verhagen, Arianne; Hartvigsen, Jan

2013-01-01

Objectives: To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1⁰/2⁰ neck pain prevention for adults with acute-chronic neck pain. Search Strategy: Computerized databases and grey literature were searched (2006-2012). Selection Criteria: Systematic reviews of randomized controlled trials (RCTs) on pain, function/disability, global perceived effect, quality-of-life and patient satisfaction were retrieved. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias using AMSTAR tool and extracted data. The GRADE tool was used to evaluate the body of evidence and an external panel to provide critical review. Main Results: We retrieved 30 reviews (5-9 AMSTAR score) reporting on 75 RCTs with the following moderate GRADE evidence. For acute whiplash associated disorder (WAD), an education video in emergency rooms (1RCT, 405participants] favoured pain reduction at long-term follow-up thus helping 1 in 23 people [Standard Mean Difference: -0.44(95%CI: -0.66 to -0.23)). Use of a soft collar (2RCTs, 1278participants) was not beneficial in the long-term. For chronic neck pain, a mind-body intervention (2RCTs, 1 meta-analysis, 191participants) improved short-term pain/function in 1 of 4 or 6 participants. In workers, 2-minutes of daily scapula-thoracic endurance training (1RCT, 127participants) over 10 weeks was beneficial in 1 of 4 participants. A number of psychosocial interventions, workplace interventions, collar use and self-management educational strategies were not beneficial. Reviewers' Conclusions: Moderate evidence exists for quantifying beneficial and non-beneficial effects of a limited number of interventions for acute WAD and chronic neck pain. Larger trials with more rigorous controls need to target promising interventions PMID:24133554

Whiplash (image)

MedlinePlus

The pain of whiplash may not appear right away after an accident, but sometimes may take hours to weeks to develop. Symptoms include dizziness, headache, pain or stiffness in the neck, jaw, shoulders, or arms.

Bioengineering Study of Basic Physical Measurements Related to Susceptibility to Cervical Hyperextension-Hyperflexion Injury

DTIC Science & Technology

1975-09-01

34 whiplash " phenomenon, little information has been published concerning variation in head mass, center of gravity in the seated position, and neck...which occur in head -on collisions (i.e., an abrupt flexion of the neck followed by a recoil in extension). While " whiplash " may occur in this manner...Jackson) or rear impact with the occupant’s head turned. The term " whiplash " has been widely misused in the literature to denote a medical

A Literature Review of Musculoskeletal Injuries to the Human Neck and the Effects of Head-Supported Mass Worn by Soldier

DTIC Science & Technology

2005-10-01

in whiplash -type injury studies (Table 1). At the time it was the most sophisticated head - neck model available. This model uses a series of rigid...phase of rear-end whiplash loading (i.e. the extension phase). In this initial phase, the head translates backward, putting the upper spine in local...work to characterize neck response in impact scenarios has been performed, the effect of musculature on head -neck whiplash -type response is still

Addition of posttraumatic stress and sensory hypersensitivity more accurately estimates disability and pain than fear avoidance measures alone after whiplash injury.

PubMed

Pedler, Ashley; Kamper, Steven J; Sterling, Michele

2016-08-01

The fear avoidance model (FAM) has been proposed to explain the development of chronic disability in a variety of conditions including whiplash-associated disorders (WADs). The FAM does not account for symptoms of posttraumatic stress and sensory hypersensitivity, which are associated with poor recovery from whiplash injury. The aim of this study was to explore a model for the maintenance of pain and related disability in people with WAD including symptoms of PTSD, sensory hypersensitivity, and FAM components. The relationship between individual components in the model and disability and how these relationships changed over the first 12 weeks after injury were investigated. We performed a longitudinal study of 103 (74 female) patients with WAD. Measures of pain intensity, cold and mechanical pain thresholds, symptoms of posttraumatic stress, pain catastrophising, kinesiophobia, and fear of cervical spine movement were collected within 6 weeks of injury and at 12 weeks after injury. Mixed-model analysis using Neck Disability Index (NDI) scores and average 24-hour pain intensity as the dependent variables revealed that overall model fit was greatest when measures of fear of movement, posttraumatic stress, and sensory hypersensitivity were included. The interactive effects of time with catastrophising and time with fear of activity of the cervical spine were also included in the best model for disability. These results provide preliminary support for the addition of neurobiological and stress system components to the FAM to explain poor outcome in patients with WAD.

Is Traumatic and Non-Traumatic Neck Pain Associated with Brain Alterations? - A Systematic Review.

PubMed

DePauw, Robby; Coppieters, Iris; Meeus, Mira; Caeyenberghs, Karen; Danneels, Lieven; Cagnie, Barbara

2017-05-01

Chronic neck pain affects 50% - 85% of people who have experienced an acute episode. This transition and the persistence of chronic complaints are believed to be mediated by brain alterations among different central mechanisms. This study aimed to systematically review and critically appraise the current existing evidence regarding structural and functional brain alterations in patients with whiplash associated disorders (WAD) and idiopathic neck pain (INP). Additionally, associations between brain alterations and clinical symptoms reported in neck pain patients were evaluated. Systematic review. The present systematic review was performed according to the PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were searched. First, the obtained articles were screened based on title and abstract. Secondly, the screening was based on the full text. Risk of bias in included studies was investigated. Twelve studies met the inclusion criteria. Alterations in brain morphology and function, including perfusion, neurotransmission, and blood oxygenation level dependent-signal, were demonstrated in chronic neck pain patients. There is some to moderate evidence for both structural and functional brain alterations in patients with chronic neck pain. In contrast, no evidence for structural brain alterations in acute neck pain patients was found. Only 12 articles were included, which allows only cautious conclusions to be drawn. Brain alterations were observed in both patients with chronic WAD and chronic INP. Furthermore, more evidence exists for brain alterations in chronic WAD, and different underlying mechanisms might be present in both pathologies. In addition, pain and disability were correlated with the observed brain alterations. Accordingly, morphological and functional brain alterations should be further investigated in patients with chronic WAD and chronic INP with newer and more sensitive techniques, and associative clinical measurements seem indispensable in future research.

Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON§ Project

PubMed Central

Peloso, Paul M; Khan, Mahweesh; Gross, Anita R; Carlesso, Lisa; Santaguida, Lina; Lowcock, Janet; MacDermid, Joy C; Walton, Dave; Goldsmith, Charlie H; Langevin, Pierre; Shi, Qiyun

2013-01-01

Objectives: To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain. Search Strategy: Computerized databases and grey literature were searched from 2006 to 2012. Selection Criteria: Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review. Main Results: We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of: a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; andno long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability; Reviewers' Conclusions: While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain. PMID:24155805

PubMed Central

NACCI, A.; FERRAZZI, M.; BERRETTINI, S.; PANICUCCI, E.; MATTEUCCI, J.; BRUSCHINI, L.; URSINO, F.; FATTORI, B.

2011-01-01

SUMMARY Vertigo and postural instability following whiplash and/or minor head injuries is very frequent. According to some authors, post-whiplash vertigo cannot be caused by real injury to vestibular structures; other authors maintain that vestibular damage is possible even in the case of isolated whiplash, with vascular or post-traumatic involvement. Furthermore, many of the balance disorders reported after trauma can be justified by post-traumatic modification to the cervical proprioceptive input, with consequent damage to the vestibular spinal reflex. The aim of this study was to evaluate the vestibular condition and postural status in a group of patients (Group A, n = 90) affected with balance disorders following whiplash, and in a second group (Group B, n = 20) with balance disorders after minor head injury associated with whiplash. Both groups were submitted to videonystagmography (VNG) and stabilometric investigation (open eyes – O E, closed eyes – CE, closed eyes with head retroflexed – CER) within 15 days of their injuries and repeated within 10 days after conclusion of cervical physiotherapy treatment. The VNG tests revealed vestibulopathy in 19% of cases in Group A (11% peripheral, 5% central, 3% in an undefined site) and in 60% of subjects in Group B (50% peripheral, 10% central). At the follow-up examination, all cases of non-compensated labyrinth deficit showed signs of compensation, while there were two cases (2%) in Group A and one case (5%) in Group B of PPV. As far as the altered posturographic recordings are concerned, while there was no specific pattern in the two groups, they were clearly pathologic, especially during CER. Both in OE and in CE there was an increase in the surface values and in those pertaining to shifting of the gravity centre on the sagittal plane, which was even more evident during CER. In Group A, the pre-post-physiotherapy comparison of CER results showed that there was a statistically significant improvement in the majority of the parameters after treatment. Moreover, in Group B there was frequent lateral shifting of the centre of gravity that was probably linked with the high percentage of labyrinth deficits. The comparison between the first and second stabilometric examinations was statistically significant only in those parameters referring to gravity centre shifting on the frontal plane, which was probably due to the progressive improvement in the associated vestibulopathy rather than to the physiotherapy treatment performed for the cervical damage. Hence, our study confirms that only in a minority of cases can whiplash cause central or peripheral vestibulopathy, and that this is more probable after minor head injury associated with whiplash. In addition, our data confirm that static stabilometry is fundamental for assessing postural deficits following a cervical proprioceptive disorder. In these cases, in fact, analysis of the different parameters and the indices referring to cervical interference not only permits evaluation of altered postural performance, but also detects and quantifies destabilisation activity within the cervical proprioceptive component. PMID:22323849

An Investigation of Fat Infiltration of the Multifidus Muscle in Patients With Severe Neck Symptoms Associated With Chronic Whiplash-Associated Disorder.

PubMed

Karlsson, Anette; Leinhard, Olof Dahlqvist; Åslund, Ulrika; West, Janne; Romu, Thobias; Smedby, Örjan; Zsigmond, Peter; Peolsson, Anneli

2016-10-01

Study Design Cross-sectional study. Background Findings of fat infiltration in cervical spine multifidus, as a sign of degenerative morphometric changes due to whiplash injury, need to be verified. Objectives To develop a method using water/fat magnetic resonance imaging (MRI) to investigate fat infiltration and cross-sectional area of multifidus muscle in individuals with whiplash-associated disorders (WADs) compared to healthy controls. Methods Fat infiltration and cross-sectional area in the multifidus muscles spanning the C4 to C7 segmental levels were investigated by manual segmentation using water/fat-separated MRI in 31 participants with WAD and 31 controls, matched for age and sex. Results Based on average values for data spanning C4 to C7, participants with severe disability related to WAD had 38% greater muscular fat infiltration compared to healthy controls (P = .03) and 45% greater fat infiltration compared to those with mild to moderate disability related to WAD (P = .02). There were no significant differences between those with mild to moderate disability and healthy controls. No significant differences between groups were found for multifidus cross-sectional area. Significant differences were observed for both cross-sectional area and fat infiltration between segmental levels. Conclusion Participants with severe disability after a whiplash injury had higher fat infiltration in the multifidus compared to controls and to those with mild/moderate disability secondary to WAD. Earlier reported findings using T1-weighted MRI were reproduced using refined imaging technology. The results of the study also indicate a risk when segmenting single cross-sectional slices, as both cross-sectional area and fat infiltration differ between cervical levels. J Orthop Sports Phys Ther 2016;46(10):886-893. Epub 2 Sep 2016. doi:10.2519/jospt.2016.6553.

Cervical neuro-muscular syndrome: discovery of a new disease group caused by abnormalities in the cervical muscles.

PubMed

Matsui, Takayoshi; Ii, Kunio; Hojo, Shuntaro; Sano, Keiji

2012-01-01

Our previous study of whiplash injury found that abnormalities in the cervical muscles cause autonomic dystonia. Further research has found that abnormalities in the cervical muscles cause headache, chronic fatigue syndrome, vertigo, and dizziness. We named this group of diseases cervical neuro-muscular syndrome. Patients treated within a 2-year period from April 1, 2002 to March 31, 2004 reported good outcomes in 83.8% for headache, 88.4% for vertigo and dizziness, 84.5% for chronic fatigue syndrome, 88.0% for autonomic dystonia, and 83.7% for whiplash-associated disorder. A large number of outpatients present with general malaise, including many general physical complaints without identifiable cause. We propose that treatment of the cervical muscle is effective for general malaise.

Whiplash Syndrome Reloaded: Digital Echoes of Whiplash Syndrome in the European Internet Search Engine Context

PubMed Central

2017-01-01

Background In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many less wealthy countries, there may be limited access to care and no insurance or compensation system. Objective The purpose of this infodemiology study was to investigate the global pattern of evolving Internet usage in countries with and without insurance and the corresponding compensation systems for whiplash injury. Methods We used the Internet search engine analytics via Google Trends to study the health information-seeking behavior concerning whiplash injury at national population levels in Europe. Results We found that the search for “whiplash” is strikingly and consistently often associated with the search for “compensation” in countries or cultures with a tort system. Frequent or traumatic painful injuries; diseases or disorders such as arthritis, headache, radius, and hip fracture; depressive disorders; and fibromyalgia were not associated similarly with searches on “compensation.” Conclusions In this study, we present evidence from the evolving viewpoint of naturalistic Internet search engine analytics that the expectations for receiving compensation may influence Internet search behavior in relation to whiplash injury. PMID:28347974

Head repositioning accuracy to neutral: a comparative study of error calculation.

PubMed

Hill, Robert; Jensen, Pål; Baardsen, Tor; Kulvik, Kristian; Jull, Gwendolen; Treleaven, Julia

2009-02-01

Deficits in cervical proprioception have been identified in subjects with neck pain through the measure of head repositioning accuracy (HRA). Nevertheless there appears to be no general consensus regarding the construct of measurement of error used for calculating HRA. This study investigated four different mathematical methods of measurement of error to determine if there were any differences in their ability to discriminate between a control group and subjects with a whiplash associated disorder. The four methods for measuring cervical joint position error were calculated using a previous data set consisting of 50 subjects with whiplash complaining of dizziness (WAD D), 50 subjects with whiplash not complaining of dizziness (WAD ND) and 50 control subjects. The results indicated that no one measure of HRA uniquely detected or defined the differences between the whiplash and control groups. Constant error (CE) was significantly different between the whiplash and control groups from extension (p<0.05). Absolute errors (AEs) and root mean square errors (RMSEs) demonstrated differences between the two WAD groups in rotation trials (p<0.05). No differences were seen with variable error (VE). The results suggest that a combination of AE (or RMSE) and CE are probably the most suitable measures for analysis of HRA.

Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey.

PubMed

Carlesso, Lisa C; Macdermid, Joy C; Gross, Anita R; Walton, David M; Santaguida, P Lina

2014-03-24

Clinical practice guidelines on the management of neck pain make recommendations to help practitioners optimize patient care. By examining the practice patterns of practitioners, adherence to CPGs or lack thereof, is demonstrated. Understanding utilization of various treatments by practitioners and comparing these patterns to that of recommended guidelines is important to identify gaps for knowledge translation and improve treatment regimens. To describe the utilization of interventions in patients with neck pain by clinicians. A cross-sectional international survey was conducted from February 2012 to March 2013 to determine physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain. The survey was international (19 countries) with Canada having the largest response (38%). Results were analyzed by usage amongst physical therapists (38%) and chiropractors (31%) as they were the predominant respondents. Within these professions, respondents were male (41-66%) working in private practice (69-95%). Exercise and manual therapies were consistently (98-99%) used by both professions but tests of subgroup differences determined that physical therapists used exercise, orthoses and 'other' interventions more, while chiropractors used phototherapeutics more. However, phototherapeutics (65%), Orthoses/supportive devices (57%), mechanical traction (55%) and sonic therapies (54%) were not used by the majority of respondents. Thermal applications (73%) and acupuncture (46%) were the modalities used most commonly. Analysis of differences across the subtypes of neck pain indicated that respondents utilize treatments more often for chronic neck pain and whiplash conditions, followed by radiculopathy, acute neck pain and whiplash conditions, and facet joint dysfunction by diagnostic block. The higher rates of usage of some interventions were consistent with supporting evidence (e.g. manual therapy). However, there was moderate usage of a number of interventions that have limited support or conflicting evidence (e.g. ergonomics). This survey indicates that exercise and manual therapy are core treatments provided by chiropractors and physical therapists. Future research should address gaps in evidence associated with variable practice patterns and knowledge translation to reduce usage of some interventions that have been shown to be ineffective.

Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey

PubMed Central

2014-01-01

Background Clinical practice guidelines on the management of neck pain make recommendations to help practitioners optimize patient care. By examining the practice patterns of practitioners, adherence to CPGs or lack thereof, is demonstrated. Understanding utilization of various treatments by practitioners and comparing these patterns to that of recommended guidelines is important to identify gaps for knowledge translation and improve treatment regimens. Aim To describe the utilization of interventions in patients with neck pain by clinicians. Methods A cross-sectional international survey was conducted from February 2012 to March 2013 to determine physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain. Results The survey was international (19 countries) with Canada having the largest response (38%). Results were analyzed by usage amongst physical therapists (38%) and chiropractors (31%) as they were the predominant respondents. Within these professions, respondents were male (41-66%) working in private practice (69-95%). Exercise and manual therapies were consistently (98-99%) used by both professions but tests of subgroup differences determined that physical therapists used exercise, orthoses and ‘other’ interventions more, while chiropractors used phototherapeutics more. However, phototherapeutics (65%), Orthoses/supportive devices (57%), mechanical traction (55%) and sonic therapies (54%) were not used by the majority of respondents. Thermal applications (73%) and acupuncture (46%) were the modalities used most commonly. Analysis of differences across the subtypes of neck pain indicated that respondents utilize treatments more often for chronic neck pain and whiplash conditions, followed by radiculopathy, acute neck pain and whiplash conditions, and facet joint dysfunction by diagnostic block. The higher rates of usage of some interventions were consistent with supporting evidence (e.g. manual therapy). However, there was moderate usage of a number of interventions that have limited support or conflicting evidence (e.g. ergonomics). Conclusions This survey indicates that exercise and manual therapy are core treatments provided by chiropractors and physical therapists. Future research should address gaps in evidence associated with variable practice patterns and knowledge translation to reduce usage of some interventions that have been shown to be ineffective. PMID:24661461

Special issue : neck injuries and rear-end crashes

DOT National Transportation Integrated Search

1999-05-22

Research has indicated that head restraints could prevent whiplash injuries in rear-end crashes, but so far the existing head restraints do not satisfactorily prevent whiplash injuries. This special issue of 'Status Report' first provides a snapshot ...

Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion

PubMed Central

Huang, H.; Nightingale, R. W.

2018-01-01

Objectives Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. Methods A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Results Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Conclusion Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28–35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1. PMID:29330341

Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study.

PubMed

Huang, H; Nightingale, R W; Dang, A B C

2018-01-01

Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t -test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article : H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28-35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1. © 2018 Huang et al.

The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial.

PubMed

Ludvigsson, Maria L; Peterson, Gunnel; O'Leary, Shaun; Dedering, Åsa; Peolsson, Anneli

2015-04-01

The aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA). A total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months. The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the 2 NSE groups (29% to 48%) compared with the PPA group (5%) at 3 months. At 6 months 39% to 44% of the patients in the 2 neck-specific groups and 28% in the PPA group reported substantial pain reduction. Reduction of disability was also larger in the 2 neck-specific exercise groups at both 3 and 6 months (P<0.02). Self-efficacy was only improved in the NSE group without a behavioral approach (P=0.02). However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups. NSE resulted in superior outcomes compared with PPA in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.

The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders

PubMed Central

Peterson, Gunnel; O’Leary, Shaun; Dedering, Åsa; Peolsson, Anneli

2015-01-01

Objectives: The aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA). Materials and Methods: A total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months. Results: The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the 2 NSE groups (29% to 48%) compared with the PPA group (5%) at 3 months. At 6 months 39% to 44% of the patients in the 2 neck-specific groups and 28% in the PPA group reported substantial pain reduction. Reduction of disability was also larger in the 2 neck-specific exercise groups at both 3 and 6 months (P<0.02). Self-efficacy was only improved in the NSE group without a behavioral approach (P=0.02). However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups. Discussion: NSE resulted in superior outcomes compared with PPA in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive. PMID:24918474

The role of tissue damage in whiplash associated disorders: Discussion paper 1

PubMed Central

Bogduk, Nikolai; Ivancic, Paul C.; McLean, Samuel A.; Siegmund, Gunter P.; Winkelstein, Beth

2011-01-01

STUDY DESIGN Non-systematic review of cervical spine lesions in whiplash-associated disorders (WAD). OBJECTIVE To describe whiplash injury models in terms of basic and clinical science, to summarize what can and cannot be explained by injury models, and to highlight future research areas to better understand the role of tissue damage in WAD. SUMMARY OF BACKGROUND DATA The frequent lack of detectable tissue damage has raised questions about whether tissue damage is necessary for WAD and what role it plays in the clinical context of WAD. METHODS Non-systematic review. RESULTS Lesions of various tissues have been documented by numerous investigations conducted in animals, cadavers, healthy volunteers and patients. Most lesions are undetected by imaging techniques. For zygapophysial (facet) joints, lesions have been predicted by bioengineering studies and validated through animal studies; for zygapophysial joint pain, a valid diagnostic test and a proven treatment are available. Lesions of dorsal root ganglia, discs, ligaments, muscles and vertebral artery have been documented in biomechanical and autopsy studies, but no valid diagnostic test is available to assess their clinical relevance. The proportion of WAD patients in whom a persistent lesion is the major determinant of ongoing symptoms is unknown. Psychosocial factors, stress reactions and generalized hyperalgesia have also been shown to predict WAD outcomes. CONCLUSION There is evidence supporting a lesion-based model in WAD. Lack of macroscopically identifiable tissue damage does not rule out the presence of painful lesions. The best available evidence concerns zygapophysial joint pain. The clinical relevance of other lesions needs to be addressed by future research. PMID:22020601

Lack of Gender and Age Differences in Pain Measurements Following Exercise in People with Chronic Whiplash-Associated Disorders.

PubMed

Ickmans, Kelly; Malfliet, Anneleen; De Kooning, Margot; Goudman, Lisa; Hubloue, Ives; Schmitz, Tom; Goubert, Dorien; Aguilar-Ferrandiz, Maria Encarnacion

2017-09-01

Individuals with chronic whiplash associated disorders (WAD) present persistent pain in the absence of structural pathology. In these people, altered central pain processing and central sensitization are observed. The role of personal factors, such as gender and age, on pain processing mechanisms in chronic WAD, however, is still unclear. This study investigated possible gender- and age-related differences in self-reported and experimental pain measurements in people with chronic WAD. Besides the exercise-induced response on pain measurements between gender and age subgroups was recorded. Case-control study. University Hospital, Brussels. Self-reported pain and experimental pain measurements (pressure pain thresholds [PPT], occlusion cuff pressure, temporal summation, and conditioned pain modulation) were performed in 52 individuals (26 chronic WAD patients and 26 healthy controls), before and after a submaximal cycle exercise. Lower PPTs and occlusion cuff pressures were shown in chronic WAD in comparison with healthy controls. No gender and age differences regarding PPTs, occlusion cuff pressures and conditioned pain modulation were found in chronic WAD. Within the chronic WAD group, men showed higher self-reported pain compared to women and younger adults showed enhanced generalized pain facilitation compared to older adults. In addition, chronic WAD patients are able to inhibit exercise-induced hyperalgesia, but no gender and age differences in pain response following exercise were found. This study was sufficiently powered to detect differences between the chronic WAD and control group. However, a sufficient power was not reached when patients were divided in age and gender groups. Furthermore, only mechanical stimuli were included in the experimental pain measurements. Besides, psychosocial factors were not taken into account. Some alterations of altered pain processing are present in chronic WAD patients, however not in response to exercise. No gender and age differences in pain measurements were observed in people with chronic WAD.Key words: Neck pain, whiplash associated disorders, chronic pain, personal factors, age, gender, central sensitization, exercise induced hyperalgesia, pressure pain thresholds, self reported pain.

Investigation of whiplash injuries in the upper cervical spine using a detailed neck model.

PubMed

Fice, Jason B; Cronin, Duane S

2012-04-05

Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location. In this study, a detailed and validated explicit finite element model of a 50th percentile male cervical spine in a seated posture was used to investigate upper cervical spine response and the potential for whiplash injury resulting from vehicle crash scenarios. This model was previously validated at the segment and whole spine levels for both kinematics and soft tissue strains in frontal and rear impact scenarios. The model predicted increasing upper cervical spine ligament strain with increasing impact severity. Considering all upper cervical spine ligaments, the distractions in the apical and alar ligaments were the largest relative to their failure strains, in agreement with the clinical findings. The model predicted the potential for injury to the apical ligament for 15.2 g frontal or 11.7 g rear impacts, and to the alar ligament for a 20.7 g frontal or 14.4 g rear impact based on the ligament distractions. Future studies should consider the effect of initial occupant position on ligament distraction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders.

PubMed

Elert, J; Kendall, S A; Larsson, B; Månsson, B; Gerdle, B

2001-06-01

To investigate if muscle tension according to the surface electromyogram (EMG) of the shoulder flexors is increased in consecutive patients with fibromyalgia (FM) or chronic whiplash associated disorders (WAD). A total of 59 consecutive patients with FM (n = 36) or chronic WAD (n = 23) performed 100 maximal isokinetic contractions combined with surface electromyography of the trapezius and infraspinatus. A randomized group of pain-free female (n = 27) subjects served as control group. Peak torque initially (Pti) and absolute and relative peak torque at endurance level (PTe, PTer) were registered as output variables, together with the EMG level of unnecessary muscle tension, i.e., the signal amplitude ratio (SAR). The patient groups had a higher level of unnecessary tension initially and at the endurance level. The patients had lower absolute output (PTi and PTe), but the relative levels (PTer) did not differ comparing all 3 groups. Subjects with FM had significantly higher body mass index (BMI) than the other groups. BMI did not influence the SAR but correlated positively with PTi. The results confirmed earlier findings that groups of patients with chronic pain have increased muscle tension and decreased output during dynamic activity compared to pain-free controls. However, the results indicated there is heterogeneity within groups of patients with the same chronic pain disorder and that not all patients with chronic pain have increased muscle tension.

Flagellate dermatitis after consumption of Shiitake mushrooms

PubMed Central

Kreft, Burkhard; Marsch, Wolfgang Ch.

2014-01-01

Flagellate dermatitis occurs in patients who have eaten Shiitake mushrooms. We are reporting on a 55-year-old man, who developed whiplash-striped, severely itching efflorescences on the trunk 3 days after eating Lentinula edodes. Flagellate dermatitis is also known as a cutaneous side effect of bleomycin therapy. PMID:25097492

A small group Whiplash-Associated-Disorders (WAD) patients with central neck pain and movement induced stabbing pain, the painful segment determined by mechanical provocation: Fusion surgery was superior to multimodal rehabilitation in a randomized trial.

PubMed

Nyström, Bo; Svensson, Elisabeth; Larsson, Svante; Schillberg, Birgitta; Mörk, Ann; Taube, Adam

2016-07-01

The majority of patients suffering from a whiplash injury will recover, but some will have symptoms (Whiplash Associated Disorders, WAD) for years despite conservative treatment. Some of these patients perceive neck pain that might come from a motion segment, possibly the disc. In comprehensive reviews no evidence has been found that fusion operations have a positive treatment effect on neck pain in WAD patients. Our aim was to evaluate the possibility of (a) selecting a subgroup of chronic WAD patients based on specified symptoms possibly indicating segmental pain, and (b) treating said segmental pain through fusion operation based on non-radiological segment localization. The hypothesis was that fusion operation in this selected subgroup of chronic WAD patients could alleviate perceived neck pain. Eligible patients for the study had a traffic accident as the origin for their neck pain, and no previous neck symptoms. Neck pain should be the predominant symptom and the pain origin reported to be in the midline, being dull, aching in character and at sudden movements combined by a stabbing pain in the same area. Forty-nine patients with these specified symptoms were identified among a large number of chronic WAD patients. Those selected had pronounced symptoms for a median of around 50 months and had previously been investigated and fully treated within the ordinary healthcare system without success. No neurological abnormalities were to be found at clinical examination and no specific changes to be seen on X-ray and MRI. The patients were randomized to either cervical fusion operation or multimodal rehabilitation. By using a mechanical provocation test the level/s to be fused were identified. In all but one patient the surgery was performed anteriorly using microsurgical technique and a right-sided Smith-Pedersen approach and plate fixation. The multimodal rehabilitation at the Clinic of Medical Rehabilitation, Karolinska Hospital, Stockholm, included outpatient treatment for four days a week for six weeks and included treatment by physician, physiotherapists, occupational therapist, psychologists, social-service worker and nurses. Perceived change in neck pain was assessed using the Balanced Inventory for Spinal Disorders questionnaire at the 2-year-follow-up. Mean age of the patients was 38 and 40 years (surgery and rehabilitation groups, respectively), the most common type of accident being rear-end collision. At clinical examination muscle tenderness was not an outstanding sign. In most patients the mid-cervical region appeared to be the painful area but one patient localized the pain to C1. At follow-up 67% of the patients in the surgery group and 23% in the rehabilitation group assessed improvements in the ITT analysis. Corresponding proportions in the per protocol analysis were 83% and 12%, respectively. The results support the supposition that among patients with central neck pain for long periods of time following a whiplash injury there are some in whom the neck pain emanates from a motion segment, probably the disc, a situation suitable for fusion surgery. Thorough individual symptom evaluation in patients with chronic WAD may identify patients who will benefit from cervical fusion surgery. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders.

PubMed

Peterson, Gunnel; Nilsson, David; Trygg, Johan; Falla, Deborah; Dedering, Åsa; Wallman, Thorne; Peolsson, Anneli

2015-10-16

Chronic whiplash-associated disorder (WAD) is common after whiplash injury, with considerable personal, social, and economic burden. Despite decades of research, factors responsible for continuing pain and disability are largely unknown, and diagnostic tools are lacking. Here, we report a novel model of mechanical ventral neck muscle function recorded from non-invasive, real-time, ultrasound measurements. We calculated the deformation area and deformation rate in 23 individuals with persistent WAD and compared them to 23 sex- and age-matched controls. Multivariate statistics were used to analyse interactions between ventral neck muscles, revealing different interplay between muscles in individuals with WAD and healthy controls. Although the cause and effect relation cannot be established from this data, for the first time, we reveal a novel method capable of detecting different neck muscle interplay in people with WAD. This non-invasive method stands to make a major breakthrough in the assessment and diagnosis of people following a whiplash trauma.

[New diagnostic approach can improve treatment of whiplash injuries. Functional magnetic resonance tomography makes visualization of the injuries possible].

PubMed

Bergholm, Ulla; Johansson, Bengt H

2003-11-20

Patients suffering from chronic pain and dysfunction after acceleration/deceleration trauma to the cervical spine often present reliability problems. This is partly due to inadequate possibilities of diagnosing of the soft tissue structures in this area. A new diagnostic method--functional magnetic resonance imaging (fMRI) has made it possible to detect injuries in ligaments and capsules at the craniocervical junction. Not only do these structures stabilize the head during rotation movements, but they also contain receptors of the central nervous system, and thus have the most important function in position perception (i.e. proprioception) and movement control. The late onset of symptoms in this patient group can now be explained by the functional stenosis of the spinal cord and brainstem due to scar formation around the dens axis after injury. Modern neurophysiology can now explain the background of the generalized and complex picture of chronic pain and muscular and cognitive dysfunction. This new knowledge has prepared the way for more specific therapy in patients suffering from craniocervical instability symptoms and pain from disks and facet joints in the cervical spine after whiplash trauma.

Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder

PubMed Central

2010-01-01

Background There is little qualitative insight into how persons with chronic Whiplash-Associated Disorder cope on a day to day basis. This study seeks to identify the symptoms persons with Whiplash-Associated Disorder describe as dominating and explore their self-initiated coping strategies. Methods Qualitative study using focus groups interviews. Fourteen Norwegian men and women with Whiplash-Associated Disorder (I or II) were recruited to participate in two focus groups. Data were analyzed according to a phenomenological approach, and discussed within the model of Cognitive Activation Theory of Stress (CATS). Results Participants reported neck and head pain, sensory hypersensitivity, and cognitive dysfunction following their whiplash injury. Based on the intensity of symptoms, participants divided everyday life into good and bad periods. In good periods the symptoms were perceived as manageable. In bad periods the symptoms intensified and took control of the individual. Participants expressed a constant notion of trying to balance their three main coping strategies; rest, exercise, and social withdrawal. In good periods participants experienced coping by expecting good results from the strategies they used. In bad periods they experienced no or negative relationships between their behavioral strategies and their complaints. Conclusions Neck and head pain, sensory hypersensitivity, and cognitive dysfunction were reported as participants' main complaints. A constant notion of balancing between their three main coping strategies; rest, exercise, and social withdrawal, was described. PMID:20626855

Head eye co-ordination and gaze stability in subjects with persistent whiplash associated disorders.

PubMed

Treleaven, Julia; Jull, Gwendolen; Grip, Helena

2011-06-01

Symptoms of dizziness, unsteadiness and visual disturbances are frequent complaints in persons with persistent whiplash associated disorders. This study investigated eye, head co-ordination and gaze stability in subjects with persistent whiplash (n = 20) and asymptomatic controls (n = 20). Wireless motion sensors and electro-oculography were used to measure: head rotation during unconstrained head movement, head rotation during gaze stability and sequential head and eye movements. Ten control subjects participated in a repeatability study (two occasions one week apart). Between-day repeatability was acceptable (ICC > 0.6) for most measures. The whiplash group had significantly less maximal eye angle to the left, range of head movement during the gaze stability task and decreased velocity of head movement in head eye co-ordination and gaze stability tasks compared to the control group (p < 0.01). There were significant correlations (r > 0.55) between both unrestrained neck movement and neck pain and head movement and velocity in the whiplash group. Deficits in gaze stability and head eye co-ordination may be related to disturbed reflex activity associated with decreased head range of motion and/or neck pain. Further research is required to explore the mechanisms behind these deficits, the nature of changes over time and the tests' ability to measure change in response to rehabilitation. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder.

PubMed

Krohne, Kariann; Ihlebaek, Camilla

2010-07-13

There is little qualitative insight into how persons with chronic Whiplash-Associated Disorder cope on a day to day basis. This study seeks to identify the symptoms persons with Whiplash-Associated Disorder describe as dominating and explore their self-initiated coping strategies. Qualitative study using focus groups interviews. Fourteen Norwegian men and women with Whiplash-Associated Disorder (I or II) were recruited to participate in two focus groups. Data were analyzed according to a phenomenological approach, and discussed within the model of Cognitive Activation Theory of Stress (CATS). Participants reported neck and head pain, sensory hypersensitivity, and cognitive dysfunction following their whiplash injury. Based on the intensity of symptoms, participants divided everyday life into good and bad periods. In good periods the symptoms were perceived as manageable. In bad periods the symptoms intensified and took control of the individual. Participants expressed a constant notion of trying to balance their three main coping strategies; rest, exercise, and social withdrawal. In good periods participants experienced coping by expecting good results from the strategies they used. In bad periods they experienced no or negative relationships between their behavioral strategies and their complaints. Neck and head pain, sensory hypersensitivity, and cognitive dysfunction were reported as participants' main complaints. A constant notion of balancing between their three main coping strategies; rest, exercise, and social withdrawal, was described.

Function in patients with cervical radiculopathy or chronic whiplash-associated disorders compared with healthy volunteers.

PubMed

Peolsson, Anneli; Ludvigsson, Maria Landén; Wibault, Johanna; Dedering, Åsa; Peterson, Gunnel

2014-05-01

The purposes of this study were to examine whether any differences in function and health exist between patients with cervical radiculopathy (CR) due to disk disease scheduled for surgery and patients with chronic whiplash-associated disorders (WADs) and to compare measures of patients' physical function with those obtained from healthy volunteers. This is a cross-sectional study of patients with CR (n = 198) and patients with chronic WAD (n = 215). Patient data were compared with raw data previously obtained from healthy people. Physical measures included cervical active range of motion, neck muscle endurance, and hand grip strength. Self-rated measures included pain intensity (visual analog scale), neck disability (Neck Disability Index), self-efficacy (Self-Efficacy Scale), and health-related quality of life (EuroQol 5-dimensional self-classifier). Patient groups exhibited significantly lower performance than the healthy group in all physical measures (P < .0005) except for neck muscle endurance in flexion for women (P > .09). There was a general trend toward worse results in the CR group than the WAD group, with significant differences in neck active range of motion, left hand strength for women, pain intensity, Neck Disability Index, EuroQol 5-dimensional self-classifier, and Self-Efficacy Scale (P < .0001). Patients had worse values than healthy individuals in almost all physical measures. There was a trend toward worse results for CR than WAD patients. Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): protocol of a randomised, controlled trial.

PubMed

Rebbeck, Trudy; Leaver, Andrew; Bandong, Aila Nica; Kenardy, Justin; Refshauge, Kathryn; Connelly, Luke; Cameron, Ian; Mitchell, Geoffrey; Willcock, Simon; Ritchie, Carrie; Jagnoor, Jagnoor; Sterling, Michele

2016-04-01

Whiplash-associated disorders (WAD) are a huge worldwide health and economic burden. The propensity towards developing into chronic, disabling conditions drives the rise in health and economic costs associated with treatment, productivity loss and compulsory third party insurance claims. Current treatments fail to address the well-documented heterogeneity of WAD and often result in poor outcomes. A novel approach is to evaluate whether the care provided according to the estimated risk of poor prognosis improves health outcomes while remaining cost-effective. (1) Does a guideline-based clinical pathway of care improve health outcomes after whiplash injury compared to usual care? (2) Does risk of recovery have a differential effect on health outcomes for the clinical pathway of care? (3) Is the clinical pathway of care intervention cost-effective? (4) What are the variations in professional practice between usual care and the clinical pathway of care? Multi-centre, randomised, controlled trial conducted over two Australian states: Queensland and New South Wales. 236 people with WAD (grade I-III, within 6 weeks of injury) and their primary healthcare providers. A clinical pathway of care, with care matched to the predicted risk of poor recovery. Participants at low risk of ongoing pain and disability (hence, predicted to fully recover) will receive up to three sessions of guideline-based advice and exercise with their primary healthcare provider. Participants at medium/high risk of developing ongoing pain and disability will be referred to a specialist (defined as a practitioner with expertise in whiplash) who will conduct a more in-depth physical and psychological assessment. As a result, the specialist will liaise with the original primary healthcare provider and determine one of three further pathways of care. Usual care provided by the primary healthcare provider that is based on clinical judgment. Primary (global rating of change and neck-related disability) and secondary (self-efficacy, pain intensity, general health and disability and psychological health) outcomes will be collected using validated scales. Direct (eg, professional care, transportation costs, time spent for care, co-payments) and indirect (eg, lost economic productivity) costs will be obtained through an electronic cost diary. Health and cost outcomes will be assessed at baseline, 3, 6 and 12 months after randomisation. Professional practice outcomes will be evaluated through questionnaires completed by healthcare providers and their patients at 3 months. Potential participants (patients) will be identified through emergency departments, primary health clinics and advertisements. Eligible participants will complete baseline assessments and will be categorised into low or medium/high risk of poor recovery using a clinical prediction rule. After this assessment, participants will be randomly allocated to either a control group (n=118) or intervention group (n=118), stratified by risk subgroup and treatment site. The participants' nominated primary healthcare providers will be informed of their involvement in the trial. Consent will be obtained from the primary healthcare providers to participate and to obtain information about professional practice. Participants in the intervention group will additionally have access to an interactive website that provides information about whiplash and recovery relative to their risk category. Analysis will be conducted on an intention-to-treat basis. Outcomes will be analysed independently through cross-sectional analyses using generalised linear models methods, with an appropriate link function, to test for an intervention effect, adjusted for the baseline values. The risk category will be tested for its association with treatment effect by adding risk group to the regression equation. Cost-effectiveness will be calculated using utility weights and the resulting measure will be cost per quality-adjusted life year (QALY) saved. Professional practice outcomes will be analysed using descriptive statistics. This research is significant as it will be the first study to address the heterogeneity of whiplash by implementing a clinical pathway of care that matches evidence-based interventions to projected risk of poor recovery. The results of this trial have the potential to change clinical practice for WAD, thereby maximising treatment effects, improving patient outcomes, reducing costs and maintaining the compulsory third party system. Copyright © 2016. Published by Elsevier B.V.

[Medical and legal considerations in whiplash injury].

PubMed

Castillo-Chávez, Miguel Angel

2013-01-01

Whiplash injury usually occurs in people who suffered an automobile accident, but also occurs as a result of physical assault and other mechanisms. Diagnosis and initial management of the patient by the emergency physician or orthopedist, and prescribing indications, are taken into account by two forensic intervention specialists. One of these is the medical officer, who, through analysis of the injury mechanism, establishes a cause-effect relationship and concludes whether the accident suffered by a worker it is related to work or not, determines how long the worker will remain disabled and if the injury caused permanent disability under Federal Labor Law. The medical examiner by injury classification assists the Public Ministry so that it can frame the crime of injury to the Criminal Code of Federal District. For these reasons a review of medical information about the mechanism of injury, diagnosis, treatment and healing time was performed to help both specialists to standardize their approach in their daily activities.

[Whiplash lesions and temporomandibular joint disorders].

PubMed

Gola, R; Richard, O; Guyot, L; Cheynet, F

2004-11-01

Attributing dysfunction of the temporomandibular joint (TMJ) to whiplash injury is a difficult problem to solve. TMJ disorders do not seem to be secondary to direct articular trauma but rather caused by a postural disorder of the cervical spine. Occlusal disorders and stress further complicate the picture. Four clinical cases illustrate a new hypothetical approach.

Positive Cervical Artery Testing in a Patient with Chronic Whiplash Syndrome: Clinical Decision-Making in the Presence of Diagnostic Uncertainty

PubMed Central

Graziano, David L.; Nitsch, Wanda; Huijbregts, Peter A.

2007-01-01

This case report describes the diagnosis and management of a 43-year-old female patient who had sustained an injury to her neck in a motor-vehicle accident two years earlier. The major symptoms described by the patient included headache and neck pain, but history and examination also revealed signs and symptoms potentially indicative of cervical artery compromise. Physical therapy management initially consisted of soft tissue and non-thrust joint manipulation of the lower cervical and thoracic spine, specific exercise prescription, and superficial heat. Cervical vascular compromise was re-evaluated by way of the sustained extension-rotation test. When at the fifth visit this test no longer produced symptoms potentially indicative of vascular compromise, upper cervical diagnosis and management consisting of soft tissue and non-thrust joint manipulation was added. A positive outcome was achieved both at the impairment level and with regard to limitations in activities, the latter including increased performance at work, a return to previous reading activities, improved length and quality of sleep, and greater comfort while driving. At discharge, the patient reported only occasional pain and mild limitations in activities. This report describes the positive outcomes in a patient with chronic whiplash syndrome; however, its main emphasis lies in the discussion and critical evaluation of clinical reasoning in the presence of diagnostic uncertainty with regard to cervical artery compromise. PMID:19066653

Conservative treatment of a patient with previously unresponsive whiplash-associated disorders using clinical biomechanics of posture rehabilitation methods.

PubMed

Ferrantelli, Joseph R; Harrison, Deed E; Harrison, Donald D; Stewart, Denis

2005-01-01

To describe the treatment of a patient with chronic whiplash-associated disorders (WADs) previously unresponsive to multiple physical therapy and chiropractic treatments, which resolved following Clinical Biomechanics of Posture (CBP) rehabilitation methods. A 40-year-old man involved in a high-speed rear-impact collision developed chronic WADs including cervicothoracic, shoulder, and arm pain and headache. The patient was diagnosed with a confirmed chip fracture of the C5 vertebra and cervical and thoracic disk herniations. He was treated with traditional chiropractic and physical therapy modalities but experienced only temporary symptomatic reduction and was later given a whole body permanent impairment rating of 33% by an orthopedic surgeon. The patient was treated with CBP mirror-image cervical spine adjustments, exercise, and traction to reduce forward head posture and cervical kyphosis. A presentation of abnormal head protrusion resolved and cervical kyphosis returned to lordosis posttreatment. His initial neck disability index was 46% and 0% at the end of care. Verbal pain rating scales also improved for neck pain (from 5/10 to 0/10). A patient with chronic WADs and abnormal head protrusion, cervical kyphosis, and disk herniation experienced an improvement in symptoms and function after the use of CBP rehabilitation protocols when other traditional chiropractic and physical therapy procedures showed little or no lasting improvement.

German translation, cross-cultural adaptation and validation of the whiplash disability questionnaire.

PubMed

Schuster, Corina; McCaskey, Michael; Ettlin, Thierry

2013-03-14

The Australian Whiplash Disability Questionnaire (WDQ) was cross-culturally translated, adapted, and tested for validity to be used in German-speaking patients. The self-administered questionnaire evaluates actual pain intensity, problems in personal care, role performance, sleep disturbances, tiredness, social and leisure activities, emotional and concentration impairments with 13 questions rated on an 11-point rating scale from zero to ten. In a first part, the Australian-based WDQ was forward and backward translated. In a consensus conference with all translators and health care professionals, who were experts in the treatment of patients with a whiplash associated disorder (WAD), formulations were refined. Original authors were contacted for clarification and approval of the forward-backward translated version. The German version (WDQ-G) was evaluated for comprehensiveness and clarity in a pre-study patient survey by a random sample of German-speaking patients after WAD and four healthy twelve to thirteen year old teenagers. In a second part, the WDQ-G was evaluated in a patient validation study including patients affected by a WAD. Inpatients had to complete the WDQ-G, the North American Spine Society questionnaire (NASS cervical pain), and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) at entry in the rehabilitation centre. In the pre-study patient survey (response rate 31%) patients rated clarity for title 9.6 ± 0.9, instruction 9.3 ± 1.4 and questions 9.6 ± 0.7, and comprehensiveness for title 9.6 ± 0.7, instruction 9.3 ± 1.4 and questions 9.8 ± 0.4. Time needed to fill in was 13.7 ± 9.0 minutes. In total, 70 patients (47 females, age = 43.4 ± 12.5 years, time since injury: 1.5 ± 2.6 years) were included in the validation study. WDQ-G total score was 74.0 ± 21.3 points (range between 15 and 117 points). Time needed to fill in was 6.7 ± 3.4 minutes with data from 22 patients. Internal consistency was confirmed with Cronbachs's α = 0.89. Concurrent validity showed a highly significant correlation with subscale pain and disability (NASS) at r = 0.74 and subscale pain (SF-36) at r = 0.71. The officially translated and adapted WDQ-G can be used in German-speaking patients affected by a WAD to evaluate patients' impairments in different domains. The WDQ-G is a self-administered outcome measure showing a high internal consistency and good concurrent validity.

Do Subjects with Whiplash-Associated Disorders Respond Differently in the Short-Term to Manual Therapy and Exercise than Those with Mechanical Neck Pain?

PubMed

Castaldo, Matteo; Catena, Antonella; Chiarotto, Alessandro; Fernández-de-Las-Peñas, César; Arendt-Nielsen, Lars

2017-04-01

To compare the short-term effects of manual therapy and exercise on pain, related disability, range of motion, and pressure pain thresholds between subjects with mechanical neck pain and whiplash-associated disorders. Twenty-two subjects with mechanical neck pain and 28 with whiplash-associated disorders participated. Clinical and physical outcomes including neck pain intensity, neck-related disability, and pain area, as well as cervical range of motion and pressure pain thresholds over the upper trapezius and tibialis anterior muscles, were obtained at baseline and after the intervention by a blinded assessor. Each subject received six sessions of manual therapy and specific neck exercises. Mixed-model repeated measures analyses of covariance (ANCOVAs) were used for the analyses. Subjects with whiplash-associated disorders exhibited higher neck-related disability ( P  = 0.021), larger pain area ( P  = 0.003), and lower pressure pain thresholds in the tibialis anterior muscle ( P  = 0.009) than those with mechanical neck pain. The adjusted ANCOVA revealed no between-group differences for any outcome (all P  > 0.15). A significant main effect of time was demonstrated for clinical outcomes and cervical range of motion with both groups experiencing similar improvements (all P  < 0.01). No changes in pressure pain thresholds were observed in either group after treatment ( P  > 0.222). The current clinical trial found that subjects with mechanical neck pain and whiplash-associated disorders exhibited similar clinical and neurophysiological responses after a multimodal physical therapy intervention, suggesting that although greater signs of central sensitization are present in subjects with whiplash-associated disorders, this does not alter the response in the short term to manual therapy and exercises. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

The Effectiveness of Conservative Management for Acute Whiplash Associated Disorder (WAD) II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

PubMed Central

Wiangkham, Taweewat; Duda, Joan; Haque, Sayeed; Madi, Mohammad; Rushton, Alison

2015-01-01

Objective To evaluate the effectiveness of conservative management (except drug therapy) for acute Whiplash Associated Disorder (WAD) II. Design Systematic review and meta-analysis of Randomised Controlled Trials (RCTs) using a pre-defined protocol. Two independent reviewers searched information sources, decided eligibility of studies, and assessed risk of bias (RoB) of included trials. Data were extracted by one reviewer and checked by the other. A third reviewer mediated any disagreements throughout. Qualitative trial and RoB data were summarised descriptively. Quantitative syntheses were conducted across trials for comparable interventions, outcome measures and assessment points. Meta-analyses compared effect sizes with random effects, using STATA version 12. Data Sources PEDro, Medline, Embase, AMED, CINAHL, PsycINFO, and Cochrane Library with manual searching in key journals, reference lists, British National Bibliography for Report Literature, Center for International Rehabilitation Research Information & Exchange, and National Technical Information Service were searched from inception to 15th April 2015. Active researchers in the field were contacted to determine relevant studies. Eligibility Criteria for Selecting Studies RCTs evaluating acute (<4 weeks) WADII, any conservative intervention, with outcome measures important to the International Classification of Function, Disability and Health. Results Fifteen RCTs all assessed as high RoB (n=1676 participants) across 9 countries were included. Meta-analyses enabled 4 intervention comparisons: conservative versus standard/control, active versus passive, behavioural versus standard/control, and early versus late. Conservative intervention was more effective for pain reduction at 6 months (95%CI: -20.14 to -3.38) and 1-3 years (-25.44 to -3.19), and improvement in cervical mobility in the horizontal plane at <3 months (0.43 to 5.60) compared with standard/control intervention. Active intervention was effective for pain alleviation at 6 months (-17.19 to -3.23) and 1-3 years (-26.39 to -10.08) compared with passive intervention. Behavioural intervention was more effective than standard/control intervention for pain reduction at 6 months (-15.37 to -1.55), and improvement in cervical movement in the coronal (0.93 to 4.38) and horizontal planes at 3-6 months (0.43 to 5.46). For early (<4 days) versus late (>10 days) interventions, there were no statistically significant differences in all outcome measures between interventions at any time. Conclusions Conservative and active interventions may be useful for pain reduction in patients with acute WADII. Additionally, cervical horizontal mobility could be improved by conservative intervention. The employment of a behavioural intervention (e.g. act-as-usual, education and self-care including regularly exercise) could have benefits for pain reduction and improvement in cervical movement in the coronal and horizontal planes. The evidence was evaluated as low/very low level according to the Grading of Recommendations Assessment, Development and Evaluation system. PMID:26196127

Whiplash-type neck distortion in restrained car drivers: frequency, causes and long-term results.

PubMed

Richter, M; Otte, D; Pohlemann, T; Krettek, C; Blauth, M

2000-04-01

An analysis was made of 1176 whiplash-type neck distortions taken from a total of 3838 restrained car driver incident reports. The percentage of whiplash-type neck distortion among injured drivers increased from less than 10% in 1985 to over 30% in 1997. Most occurred in head-on crashes or crashes with multiple collisions; only 15% occurred in rear-end collisions. More than 1,000 questionnaires were sent to the injured to find out about the duration and type of complaints caused by their cervical spine injury. Although only 138 (12%) returned the questionnaire, which may not be a representative sample, a further analysis was carried out. Of the 138, 121 (88%) indicated that they had suffered or were still suffering from their symptoms. The percentages of the various complaints were as follows: pain (74%), tension (6%) and stiffness (5%) in the head (27%), neck (55%) and shoulder (8%). The duration of the complaints was longest after multiple collisions and when the onset of complaints was longer than 24 h after trauma. Women and elderly persons predominated slightly in the group with longer duration of complaints. A correlation between the severity of the accompanying injuries and duration of complaints was found. Lack of adequate follow-up for patients with less severe injuries posed considerable difficulties for this retrospective study. In order to better evaluate this problem, prospective studies are necessary, with documentation including diagnosis, treatments, complaint duration and type.

The Relation between the Fear-Avoidance Model and Constructs from the Social Cognitive Theory in Acute WAD.

PubMed

Sandborgh, Maria; Johansson, Ann-Christin; Söderlund, Anne

2016-01-01

In the fear-avoidance (FA) model social cognitive constructs could add to explaining the disabling process in whiplash associated disorder (WAD). The aim was to exemplify the possible input from Social Cognitive Theory on the FA model. Specifically the role of functional self-efficacy and perceived responses from a spouse/intimate partner was studied. A cross-sectional and correlational design was used. Data from 64 patients with acute WAD were used. Measures were pain intensity measured with a numerical rating scale, the Pain Disability Index, support, punishing responses, solicitous responses, and distracting responses subscales from the Multidimensional Pain Inventory, the Catastrophizing subscale from the Coping Strategies Questionnaire, the Tampa Scale of Kinesiophobia, and the Self-Efficacy Scale. Bivariate correlational, simple linear regression, and multiple regression analyses were used. In the statistical prediction models high pain intensity indicated high punishing responses, which indicated high catastrophizing. High catastrophizing indicated high fear of movement, which indicated low self-efficacy. Low self-efficacy indicated high disability, which indicated high pain intensity. All independent variables together explained 66.4% of the variance in pain disability, p < 0.001. Results suggest a possible link between one aspect of the social environment, perceived punishing responses from a spouse/intimate partner, pain intensity, and catastrophizing. Further, results support a mediating role of self-efficacy between fear of movement and disability in WAD.

Chemokines and their receptors in whiplash injury: elevated RANTES and CCR-5.

PubMed

Kivioja, J; Rinaldi, L; Ozenci, V; Kouwenhoven, M; Kostulas, N; Lindgren, U; Link, H

2001-07-01

The human sufferings and socioeconomic burden due to whip-lash-associated disorders (WAD) are obvious but the pathogenesis of WAD is obscure. The possible involvement of the immune system during the disease process in WAD is not known. Effector molecules including chemokines and their receptors could play a role in WAD. In a prospective study using flow cytometry, we examined percentages of blood mononuclear cells (MNC) expressing the chemokines RANTES, MCP-1, MIP-1alpha, MIP-1beta, and IL-8, the chemokine receptor CCR-5, the T cell activation marker CD25, and the T cell chemoattractant IL-16 in patients with WAD and, for reference, in healthy controls. Higher percentages of RANTES-expressing blood MNC and T cells were observed in patients with WAD examined within 3 days compared to 14 days after the whiplash injury and, likewise, compared with healthy controls. The patients with WAD examined within 3 days after the accident also had higher percentages of CCR-5-expressing blood MNC, T cells, and CD45RO+ T cells compared to healthy controls. In contrast, there were no differences for any of these variables between patients with WAD examined 14 days after injury and healthy controls. In conclusion, WAD is associated with a systemic but transient dysregulation in percentages of RANTES and CCR-5 expressing MNC and T cells.

Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma

PubMed Central

Tenenbaum, Artur; Nordeman, Lena; Sunnerhagen, Katharina S.; Gunnarsson, Ronny

2017-01-01

Objective The aim was to study gender differences in care-seeking behavior and treatment provided immediately after whiplash trauma. Methods Participants were residents from a defined geographical area, Skaraborg County in the southwestern part of Sweden. A cohort of 3,368 persons exposed to whiplash trauma and attending a healthcare facility immediately after the trauma between 1999 and 2008 were identified in a database. Information about gender, age, time elapsed prior to seeking care, type of healthcare contact, initial treatment provided and eventual hospitalization time was retrieved. Results Women sought care later than men (p = 0.00074). Women consulted primary healthcare first more often than men, who more often first sought hospital care (p = 0.0060). There were no gender differences regarding the type of treatment after trauma. Women had longer hospital admission than men (p = 0.022), indicating their injuries were at least similar to or worse than men’s. Conclusion Women sought healthcare later than men after whiplash trauma. Although not directly investigated in this study, it raises the question if this may reduce their probability of getting financial compensation compared to men. PMID:28441465

Laterality judgments are not impaired in patients with chronic whiplash associated disorders.

PubMed

Pedler, Ashley; Motlagh, Helena; Sterling, Michele

2013-02-01

Impaired integration of the body schema with motor processes may contribute to painful and/or restricted movement in chronic pain. Laterality judgment tasks assess this integration of the body schema with motor processes. The purpose of this study was to assess if patients with chronic whiplash associated disorders (WAD) are impaired on laterality judgment tasks. Accuracy (ACC) and reaction time (RT) for foot and neck laterality tasks were assessed in 64 (35 female) patients with chronic (>6 months) WAD and 24 (14 female) asymptomatic subjects. Pain characteristics, post-traumatic stress symptoms, cold pain thresholds (CPT) and pressure pain thresholds (PPT) were collected for patients with WAD. The effect of WAD and body part on laterality task performance was assessed. For patients with WAD, the correlations between neck task performance and pain characteristics, post-traumatic stress symptoms and pain thresholds were assessed. There was no effect of group on laterality performance. Subjects showed better RT (p < 0.001) and ACC (p = 0.001) on the neck task in comparison to the foot task. There was a significant correlation between CPT and ACC (r = 0.33) and RT (r = -0.33) on the neck laterality task in patients with WAD. Cervical spine PPT were significantly correlated with accuracy (r = 0.36) and RT (r = 0.29) in patients with WAD. These findings suggest that patients with chronic WAD are not impaired on neck or foot laterality judgment tasks. Laterality training is not indicated in the management of chronic WAD. Copyright © 2012 Elsevier Ltd. All rights reserved.

Whiplash and the compensation hypothesis.

PubMed

Spearing, Natalie M; Connelly, Luke B

2011-12-01

Review article. To explain why the evidence that compensation-related factors lead to worse health outcomes is not compelling, either in general, or in the specific case of whiplash. There is a common view that compensation-related factors lead to worse health outcomes ("the compensation hypothesis"), despite the presence of important, and unresolved sources of bias. The empirical evidence on this question has ramifications for the design of compensation schemes. Using studies on whiplash, this article outlines the methodological problems that impede attempts to confirm or refute the compensation hypothesis. Compensation studies are prone to measurement bias, reverse causation bias, and selection bias. Errors in measurement are largely due to the latent nature of whiplash injuries and health itself, a lack of clarity over the unit of measurement (specific factors, or "compensation"), and a lack of appreciation for the heterogeneous qualities of compensation-related factors and schemes. There has been a failure to acknowledge and empirically address reverse causation bias, or the likelihood that poor health influences the decision to pursue compensation: it is unclear if compensation is a cause or a consequence of poor health, or both. Finally, unresolved selection bias (and hence, confounding) is evident in longitudinal studies and natural experiments. In both cases, between-group differences have not been addressed convincingly. The nature of the relationship between compensation-related factors and health is unclear. Current approaches to testing the compensation hypothesis are prone to several important sources of bias, which compromise the validity of their results. Methods that explicitly test the hypothesis and establish whether or not a causal relationship exists between compensation factors and prolonged whiplash symptoms are needed in future studies.

Smooth Pursuit Eye Movement Deficits in Patients With Whiplash and Neck Pain are Modulated by Target Predictability.

PubMed

Janssen, Malou; Ischebeck, Britta K; de Vries, Jurryt; Kleinrensink, Gert-Jan; Frens, Maarten A; van der Geest, Jos N

2015-10-01

This is a cross-sectional study. The purpose of this study is to support and extend previous observations on oculomotor disturbances in patients with neck pain and whiplash-associated disorders (WADs) by systematically investigating the effect of static neck torsion on smooth pursuit in response to both predictably and unpredictably moving targets using video-oculography. Previous studies showed that in patients with neck complaints, for instance due to WAD, extreme static neck torsion deteriorates smooth pursuit eye movements in response to predictably moving targets compared with healthy controls. Eye movements in response to a smoothly moving target were recorded with video-oculography in a heterogeneous group of 55 patients with neck pain (including 11 patients with WAD) and 20 healthy controls. Smooth pursuit performance was determined while the trunk was fixed in 7 static rotations relative to the head (from 45° to the left to 45° to right), using both predictably and unpredictably moving stimuli. Patients had reduced smooth pursuit gains and smooth pursuit gain decreased due to neck torsion. Healthy controls showed higher gains for predictably moving targets compared with unpredictably moving targets, whereas patients with neck pain had similar gains in response to both types of target movements. In 11 patients with WAD, increased neck torsion decreased smooth pursuit performance, but only for predictably moving targets. Smooth pursuit of patients with neck pain is affected. The previously reported WAD-specific decline in smooth pursuit due to increased neck torsion seems to be modulated by the predictability of the movement of the target. The observed oculomotor disturbances in patients with WAD are therefore unlikely to be induced by impaired neck proprioception alone. 3.

A combination of gestalt therapy, Rosen Body Work, and Cranio Sacral therapy did not help in chronic whiplash-associated disorders (WAD)--results of a randomized clinical trial.

PubMed

Ventegodt, Søren; Merrick, Joav; Andersen, Niels Jørgen; Bendix, Tom

2004-12-10

The chronic state of whiplash-associated disorder (WAD) might be understood as a somatization of existential pain. Intervention aimed to improve quality of life (QOL) seemed to be a solution for such situations. The basic idea behind the intervention was holistic, restoring quality of life and relationship with self, in order to diminish tension in the locomotion system, especially the neck. A psychosomatic theory for WAD is proposed. Our treatment was a short 2-day course with teachings in philosophy of life, followed by 6-10 individual sessions in gestalt psychotherapy and body therapy (Rosen therapy and Cranio Sacral therapy), followed by a 1-day course approximately 2 months later, closing the intervention. Two independent institutions did the intervention and the assessments. In a randomized, clinically controlled setting, 87 chronic WAD patients were included with a median duration of 37 months from their whiplash accidents. One patient never started. Forty-three had the above intervention (female/male = 36/7, ages 22-49, median 37 years) and another 43 were assigned to a nontreated control group (female/male = 35/8, ages 18-48, median 38). Six had disability pension and 27 had pending medicolegal issues in each group. Effect variables were pain in neck, arm, and/or head; measures of quality of life and daily activities; as well as general physical or mental health. Wilcoxon test for between-groups comparisons with intention-to-treat analyses was conducted; the square curve paradigm testing for immediate improvements of health and quality of life was also used. The groups were comparable at baseline. From the intervention group, 11 dropped out during the intervention (4 of those later joined the follow-up investigation), 22 of the remaining 32 graduated the course, and 35 of the 43 controls did as well. Approximately 3 months later, we found no clinically relevant or significant increase in any effect measure. The above version of a quality of life intervention based on alternative therapy had no effect on patients with chronic WAD.

Irregular head movement patterns in whiplash patients during a trajectory task.

PubMed

Woodhouse, Astrid; Stavdahl, Øyvind; Vasseljen, Ottar

2010-03-01

Patients with whiplash associated disorders (WAD) have shown less accuracy in trajectory head motion compared to asymptomatic controls, which comply with clinical observations. The aim of this study was to investigate whether a trajectory head movement task can differ between WAD patients, chronic non-traumatic neck pain (CNP) patients and asymptomatic controls. Study groups included subjects with WAD (n = 35) with persistent neck pain after a car accident, CNP (n = 45), and asymptomatic controls (n = 48). Head motion was recorded from an unsupported standing position using a 3D Fastrak device. A laser pointer was attached to the head and by moving the head the subjects were asked to trace a figure of eight displayed on the wall at three different paces (slow, moderate and fast). The motion signal was decomposed into 1 Hz frequency bands and angular velocity (deg/s) within each frequency band was calculated. Significantly higher angular RMS velocity was found in the WAD group compared to the two other groups for the slow paced test (3-4 and 4-5 Hz frequency bands) and the moderate paced test (3-4 Hz frequency band) indicating irregular and uncoordinated movements. Angular RMS velocity was associated with pain and dizziness, but only with severe symptom levels. In conclusion, irregular head movements during a complex task were found in the WAD group, indicating altered central sensorimotor processing. The irregularities were found within frequency levels observable to clinicians.

Acute lion's mane jellyfish, Cyanea capillata (Cnideria: Scyphozoa), exposure to Atlantic salmon (Salmo salar L.).

PubMed

Powell, M D; Åtland, Å; Dale, T

2018-05-01

Jellyfish-induced gill pathology relies upon occasional diagnostic observations yet the extent and impact of jellyfish blooms on aquaculture may be significant. Idiopathic gill lesions are often observed in apparently healthy fish. This study exposed Atlantic salmon (Salmo salar L.) smolts to macerated Cyanea capillata at 2.5 and 5 g/L for 2 hr under controlled laboratory conditions. Blood chemistry and gill histopathology were examined over a subsequent 4-week period. Fish showed an acute response to the presence of jellyfish, including characteristic external "whiplash" discoloration of the skin and acute increases in blood electrolytes and CO 2 concentration; however, these were resolved within 4 days after exposure. Histopathologically, gills showed first an acute oedema with epithelial separation followed by focal haemorrhage and thrombus formation, and then progressive inflammatory epithelial hyperplasia that progressively resolved over the 4 weeks post-exposure. Results were consistent with the envenomation of gills with cytotoxic neurotoxins and haemolysins known to be produced by C. capillata. This study suggests that many focal hyperplastic lesions on gills, especially those involving focal thrombi, may be the result of jellyfish stings. Thus, the presence of jellyfish and their impact may be severe and understated in terms of marine fish aquaculture and fish welfare. © 2018 John Wiley & Sons Ltd.

Case series on chronic whiplash related neck pain treated with intraarticular zygapophysial joint regeneration injection therapy.

PubMed

Hooper, R Allen; Frizzell, J Bevan; Faris, Peter

2007-03-01

Although in clinical use, there is only 1 published case report on the efficacy of intraarticular regeneration injection therapy (RIT) (a.k.a. prolotheraphy). This report supports a rationale for future clinical trials of this technique. To assess the efficacy of intraarticular zygapophysial joint RIT in patients with chronic whiplash related neck pain that failed other conservative and interventional procedures. Patients were treated with intraarticular RIT and reassessed over 1 year. Retrospective case review of prospective data. Eighteen consecutive patients were treated with intraarticular prolotherapy by placing 0.5 - 1mL of 20% dextrose solution into each zygapophysial joint, after confirmation of intraarticular location with radiographic contrast, using 25-gauge spinal needles and fluoroscopic guidance. Solution was prepared by diluting D50W with 1% lidocaine. Fifteen patients completed treatment. Three patients had bilateral treatment, leaving 18 sides for analysis. Mean Neck Disability Index (NDI) pre-treatment was 24.71 and decreased post-treatment to 14.21 (2 months), 13.45 (6 months), 10.94 (12 months). Average change NDI=13.77 (p<0.0001) baseline versus 12 months. Symptoms for 14 patients were from motor vehicle accident, of which 13 were in litigation. Patients attending physiotherapy over the course of treatment had better outcomes than those without physiotherapy. Women needed more injections (5.4) than men (3.2) p=0.0003. Intraarticular RIT improved pain and function in this case series. The procedure appears safe, more effective than periarticular RIT, and lasted as long, or longer, than those patients with previous radiofrequency neurotomy. Concurrent physiotherapy helped reduce post-procedure neck stiffness. Future trials should consider gender when deciding how many treatments to administer. Litigation was not a barrier to recovery.

[The diagnosis of so-called whiplash injury of the cervical vertebrae. A case report].

PubMed

Ludolph, E; Meindl, U

1990-08-01

The acceleration injury of the cervical spine (so-called whip-lash injury) is a common traumatic mechanism in traffic accident. Severe damages are possible. Scepticism is necessary, if several hours or days are symptom-free. Radiological results which seem to prove an injury should be controlled. Severe injuries are in consideration of the symptom-free course incredible. This is demonstrated with a description of a case.

Reliability and safety of functional capacity evaluation in patients with whiplash associated disorders.

PubMed

Trippolini, M A; Reneman, M F; Jansen, B; Dijkstra, P U; Geertzen, J H B

2013-09-01

Whiplash-associated disorders (WAD) are a burden for both individuals and society. It is recommended to evaluate patients with WAD at risk of chronification to enhance rehabilitation and promote an early return to work. In patients with low back pain (LBP), functional capacity evaluation (FCE) contributes to clinical decisions regarding fitness-for-work. FCE should have demonstrated sufficient clinimetric properties. Reliability and safety of FCE for patients with WAD is unknown. Thirty-two participants (11 females and 21 males; mean age 39.6 years) with WAD (Grade I or II) were included. The FCE consisted of 12 tests, including material handling, hand grip strength, repetitive arm movements, static arm activities, walking speed, and a 3 min step test. Overall the FCE duration was 60 min. The test-retest interval was 7 days. Interclass correlations (model 1) (ICCs) and limits of agreement (LoA) were calculated. Safety was assessed by a Pain Response Questionnaire, observation criteria and heart rate monitoring. ICCs ranged between 0.57 (3 min step test) and 0.96 (short two-handed carry). LoA relative to mean performance ranged between 15 % (50 m walking test) and 57 % (lifting waist to overhead). Pain reactions after WAD FCE decreased within days. Observations and heart rate measurements fell within the safety criteria. The reliability of the WAD FCE was moderate in two tests, good in five tests and excellent in five tests. Safety-criteria were fulfilled. Interpretation at the patient level should be performed with care because LoA were substantial.

Cognitive Performance Is Related to Central Sensitization and Health-related Quality of Life in Patients with Chronic Whiplash-Associated Disorders and Fibromyalgia.

PubMed

Coppieters, Iris; Ickmans, Kelly; Cagnie, Barbara; Nijs, Jo; De Pauw, Robby; Noten, Suzie; Meeus, Mira

2015-01-01

A growing body of research has demonstrated that impaired central pain modulation or central sensitization (CS) is a crucial mechanism for the development of persistent pain in chronic whiplash-associated disorders (WAD) and fibromyalgia (FM) patients. Furthermore, there is increasing evidence for cognitive dysfunctions among these patients. In addition, chronic WAD and FM patients often report problems with health-related quality of life (QoL). Yet, there is limited research concerning the interrelations between cognitive performance, indices of CS, and health-related QoL in these patients. (1) Examining the presence of cognitive impairment, CS, and limitations on health-related QoL in patients with chronic WAD and FM compared to healthy controls. (2) Examining interrelations between performance-based cognitive functioning, CS, and self-reported health-related QoL in these 3 study groups. A case-control study was conducted. The present study took place at the University Hospital Brussels, the University of Brussels, and the University of Antwerp. Fifty-nine patients (16 chronic WAD patients, 21 FM patients, and 22 pain-free volunteers) filled out the Short Form 36 item Health Survey (SF-36), a self-reported psychosocial questionnaire, to assess health-related QoL. Next, they were subjected to various pain measurements (pressure hyperalgesia, deep-tissue hyperalgesia, temporal summation [TS], and conditioned pain modulation [CPM]). Finally, participants completed a battery of performance-based cognitive tests (Stroop task, psychomotor vigilance task [PVT], and operation span task [OSPAN]). Significant cognitive impairment, bottom-up sensitization, and decreased health-related QoL were demonstrated in patients with chronic WAD and FM compared to healthy controls (P < 0.017). CPM was comparable between the 3 groups. Cognitive performance was significantly related to central pain modulation (deep-tissue hyperalgesia, TS, CPM) as well as to self-reported health-related QoL (P < 0.05). Decreased cognitive performance was related to deficient central pain modulation in healthy controls. Further, significant correlations between decreased cognitive performance and reduced health-related QoL were revealed among all study groups. Additionally, FM patients showed correlations between cognitive impairment and increased health-related QoL. Remarkably, impaired selective attention and working memory were related to less TS, whereas impaired sustained attention was correlated with dysfunctional CPM in FM patients. Based on the current cross-sectional study no firm conclusions can be drawn on the causality of the relations. In conclusion, this paper has demonstrated significant cognitive deficits, signs of CS, and reduced health-related QoL in chronic WAD and FM patients compared to healthy individuals. Significant relations between cognitive performance and CS as well as health-related QoL were demonstrated. These results provide preliminary evidence for the clinical importance of objectively measured cognitive deficits in patients with chronic WAD and FM. Chronic pain, fibromyalgia, whiplash, central sensitization, conditioned pain modulation, temporal summation, cognition, quality of life.

Persistent post-traumatic headache, postconcussion syndrome, and whiplash injuries: the evidence for a non-traumatic basis with an historical review.

PubMed

Evans, Randolph W

2010-04-01

There has been intense controversy about postconcussion syndrome since Erichsen's publication in 1866 on railway brain and railway spine. The fascinating history of this debate will be reviewed and then the non-organic explanations for postconcussion syndrome, headaches after head injury, and chronic whiplash injuries and headaches will be explored including the following: psychogenic, psychosocial, sociocultural, base rate misattribution, chronic pain, compensation and litigation, and malingering.

Responsiveness of the cervical Northern American Spine Society questionnaire (NASS) and the Short Form 36 (SF-36) in chronic whiplash.

PubMed

Angst, Felix; Verra, Martin L; Lehmann, Susanne; Gysi, Françoise; Benz, Thomas; Aeschlimann, André

2012-02-01

To determine and compare the sensitivity to change of the condition-specific cervical Northern American Spine Society (NASS) and the generic Short Form 36 (SF-36). Prospective cohort study. One hundred and seventy five patients after whiplash injury. Four-week inpatient interdisciplinary pain management programme. MAIN MEASURES, ANALYSIS: Responsiveness of the NASS and the SF-36 was quantified by effect size and standardized response mean and compared within the same construct by the modified Jacknife test. Ability to detect improvement was compared using sensitivities determined from receiver operating characteristics curves. In pain, the NASS was comparable responsive to the SF-36 at the one-month follow-up (n = 175): effect sizes: 0.62 (NASS) versus 0.61 (SF-36), P = 0.914. The NASS was less responsive than the SF-36 in function: 0.23 versus 0.63, P < 0.001 and in pain+function: 0.35 versus 0.58 (P = 0.001). These relationships remained consistent using standardized response means, at the six-month follow-up (n = 103), and in the comparison of the sensitivities. Sensitivities at one month, pain: 70% (NASS) versus 62% (SF-36), P = 0.234; function: 65% versus 80%, P = 0.002; pain+function: 68% versus 78%, P = 0.035. The six-month data were similar. The generic SF-36 was more responsive in function and equally responsive in pain when compared to the condition-specific NASS. The SF-36 can be recommended as a responsive instrument for measurement of pain and function in chronic whiplash syndrome.

Biomechanical analyses of whiplash injuries using an experimental model.

PubMed

Yoganandan, Narayan; Pintar, Frank A; Cusick, Joseph F

2002-09-01

Neck pain and headaches are the two most common symptoms of whiplash. The working hypothesis is that pain originates from excessive motions in the upper and lower cervical segments. The research design used an intact human cadaver head-neck complex as an experimental model. The intact head-neck preparation was fixed at the thoracic end with the head unconstrained. Retroreflective targets were placed on the mastoid process, anterior regions of the vertebral bodies, and lateral masses at every spinal level. Whiplash loading was delivered using a mini-sled pendulum device. A six-axis load cell and an accelerometer were attached to the inferior fixation of the specimen. High-speed video cameras were used to obtain the kinematics. During the initial stages of loading, a transient decoupling of the head occurs with respect to the neck exhibiting a lag of the cranium. The upper cervical spine-head undergoes local flexion concomitant with a lag of the head while the lower column is in local extension. This establishes a reverse curvature to the head-neck complex. With continuing application of whiplash loading, the inertia of the head catches up with the neck. Later, the entire head-neck complex is under an extension mode with a single extension curvature. The lower cervical facet joint kinematics demonstrates varying local compression and sliding. While the anterior- and posterior-most regions of the facet joint slide, the posterior-most region of the joint compresses more than the anterior-most region. These varying kinematics at the two ends of the facet joint result in a pinching mechanism. Excessive flexion of the posterior upper cervical regions can be correlated to headaches. The pinching mechanism of the facet joints can be correlated to neck pain. The kinematics of the soft tissue-related structures explain the mechanism of these common whiplash associated disorders.

Sincerity of effort versus feigned movement control of the cervical spine in patients with whiplash-associated disorders and asymptomatic persons: a case-control study.

PubMed

Oddsdóttir, Gudny Lilja; Kristjansson, Eythor; Gislason, Magnus Kjartan

2015-01-01

Cross-sectional design. To investigate whether the Fly Test can be used to differentiate patients with whiplash-associated disorders (WAD) from asymptomatic persons who deliberately feign symptoms and from WAD patients exaggerating symptoms. The lack of valid clinical tests makes it difficult to detect a justifiable cause for compensation claims in traumatic neck-pain disorders. The Fly Test recorded the accuracy of neck movements in patients with WAD (n = 34) and asymptomatic persons (n = 31). The participants followed a moving "Fly" on a computer screen with a cursor from sensors mounted on the head. Two conditions were tested, sincere versus feigned efforts. In the former, the participants moved their neck as accurately as possible. In the latter, a short text was presented describing a fictitious accident (asymptomatic group) or imagining more intense pain/suffering (WAD group), and the test was performed as affected by these more serious conditions. Amplitude accuracy (AA), time on target (ToT) and jerk index (JI) were compared across patterns, conditions and groups. The sincere effort in the WAD group was significant compared to the feigned effort of the asymptomatic group (p < 0.001). For AA, correct categorization of 81.5% of the performances was made, where a mean score above 5.5 mm differentiated feigned versus sincere efforts in asymptomatic and WAD groups (sensitivity 79.4%, specificity 67.7%). For ToT, score above 11% indicated correctly categorized WAD patients (sensitivity 82.4%, specificity 64.5%). The Fly Test can provide clinicians a clue when patients with mild to moderate pain/disability are feigning or exaggerating symptoms.

Rapid neck muscle adaptation alters the head kinematics of aware and unaware subjects undergoing multiple whiplash-like perturbations.

PubMed

Siegmund, Gunter P; Sanderson, David J; Myers, Barry S; Inglis, J Timothy

2003-04-01

To examine whether habituation confounds the study of whiplash injury using human subjects, we quantified changes in the magnitude and temporal development of the neck muscle electromyogram and peak linear and angular head/torso kinematics of subjects exposed to sequential whiplash-like perturbations. Forty-four seated subjects (23F, 21M) underwent 11 consecutive forward horizontal perturbations (peak sled acceleration=1.5 g). Electromyographic (EMG) activity was recorded over the sternocleidomastoid (SCM) and cervical paraspinal (PARA) muscles with surface electrodes, and head and torso kinematics were measured using linear and angular accelerometers and a 3D motion analysis system. EMG onset occurred at reflex latencies (67-75 ms in SCM) and did not vary with repeated perturbations. EMG amplitude was significantly attenuated by the second perturbation in PARA muscles and by the third perturbation in SCM muscles. The mean decrement in EMG amplitude between the first trial and the mean of the last five trials was between 41% and 64%. Related kinematic changes ranged from a 21% increase in head extension angle to a 29% decrease in forward acceleration at the forehead, and were also significantly different by the second exposure in some variables. Although a wider range of perturbation intensities and inter-perturbation intervals need to be studied, the significant changes observed in both muscle and kinematic variables by the second perturbation indicated that habituation was a potential confounder of whiplash injury studies using repeated perturbations of human subjects.

Head repositioning accuracy in patients with whiplash-associated disorders.

PubMed

Feipel, Veronique; Salvia, Patrick; Klein, Helene; Rooze, Marcel

2006-01-15

Controlled study, measuring head repositioning error (HRE) using an electrogoniometric device. To compare HRE in neutral position, axial rotation and complex postures of patients with whiplash-associated disorders (WAD) to that of control subjects. The presence of kinesthetic alterations in patients with WAD is controversial. In 26 control subjects and 29 patients with WAD (aged 22-74 years), head kinematics was sampled using a 3-dimensional electrogoniometer mounted using a harness and a helmet. All tasks were realized in seated position. The repositioning tasks included neutral repositioning after maximal flexion-extension, eyes open and blindfolded, repositioning at 50 degrees of axial rotation, and repositioning at 50 degrees of axial rotation combined to 20 degrees of ipsilateral bending. The flexion-extension, ipsilateral bending, and axial rotation components of HRE were considered. A multiple-way repeated-measures analysis of variance was used to compare tasks and groups. The WAD group displayed a reduced flexion-extension range (P = 1.9 x 10(-4)), and larger HRE during flexion-extension and repositioning tasks (P = 0.009) than controls. Neither group nor task affected maximal motion velocity. Neutral HRE of the flexion-extension component was larger in blindfolded condition (P = 0.03). Ipsilateral bending and axial rotation HRE components were smaller than the flexion-extension component (P = 7.1 x 10(-23)). For pure rotation repositioning, axial rotation HRE was significantly larger than flexion-extension and ipsilateral bending repositioning error (P = 3.0 x 10(-23)). Ipsilateral bending component of HRE was significantly larger combined tasks than for pure rotation tasks (P = 0.004). In patients with WAD, range of motion and head repositioning accuracy were reduced. However, the differences were small. Vision suppression and task type influenced HRE.

An energy-absorbing sliding seat for reducing neck injury risks in rear impact--analysis for prototype built.

PubMed

Zhang, Xiaowei; Zhou, Qing

2016-01-01

This study investigated overall performance of an energy-absorbing sliding seat concept for whiplash neck injury prevention. The sliding seat allows its seat pan to slide backward for some distance under certain restraint force to absorb crash energy in rear impacts. A numerical model that consisted of vehicle interior, seat, seat belt, and BioRID II dummy was built in MADYMO to evaluate whiplash neck injury in rear impact. A parametric study of the effects of sliding seat parameters, including position and cushion stiffness of head restraint, seatback cushion stiffness, recliner characteristics, and especially sliding energy-absorbing (EA) restraint force, on neck injury criteria was conducted in order to compare the effectiveness of the sliding seat concept with that of other existing anti-whiplash mechanisms. Optimal sliding seat design configurations in rear crashes of different severities were obtained. A sliding seat prototype with bending of a steel strip as an EA mechanism was fabricated and tested in a sled test environment to validate the concept. The performance of the sliding seat under frontal and rollover impacts was checked to make sure the sliding mechanism did not result in any negative effects. The protective effect of the sliding seat with EA restraint force is comparable to that of head restraint-based and recliner stiffness-based anti-whiplash mechanisms. EA restraint force levels of 3 kN in rear impacts of low and medium severities and 6 kN in impacts of high severity were obtained from optimization. In frontal collision and rollover, compared to the nonsliding seat, the sliding seat does not result in any negative effects on occupant protection. The sled test results of the sliding seat prototype have shown the effectiveness of the concept for reducing neck injury risks. As a countermeasure, the sliding seat with appropriate restraint forces can significantly reduce whiplash neck injury risk in rear impacts of low, medium, and high severities with no negative effects on other crash load cases.

Treatment of whiplash associated neck pain [corrected] with botulinum toxin-A: a pilot study.

PubMed

Freund, B J; Schwartz, M

2000-02-01

Up to 87% of patients with whiplash associated disorder (WAD) have some degree of muscle spasm that is contributory to both pain and dysfunction. Botulinum toxin A (BTX-A) produces prolonged muscle relaxation that is dose-dependent and can be easily targeted to affected muscles. BTX-A therapy may be an effective form of therapy offering an alternative or adjunct to conventional modalities. We investigated BTX-A as therapy in patients with WAD. This randomized, double blind, placebo controlled study compares outcome measures in 26 patients with chronic neck pain (WAD-II chronic) subsequent to a motor vehicle accident. One-half of the patients received 100 units BTX-A, diluted in 1 ml saline, while the other half received just saline (1 ml). Five trigger points received 0.2 ml each of injectant via a 30 gauge needle. Outcome measures included total subjective neck, shoulder, and head pain based on visual analog scales; objective total range of neck motion (ROM), and the Vernon-Mior subjective function index. Followup assessments were carried out at 2 and 4 weeks post-treatment. Fourteen subjects receiving BTX-A and 12 receiving saline completed the study. The treatment group showed a trend toward improvement in ROM and reduction in pain at 2 weeks post-injection. At 4 weeks post-injection the treatment group was significantly improved from preinjection levels (p < 0.01). The placebo group showed no statistically significant changes at any post-treatment time. The Vernon-Mior scale revealed a trend to improvement for both groups. BTX-A treatment of subjects with chronic WAD II neck pain resulted in a significant (p < 0.01) improvement in ROM and subjective pain compared to a placebo group, but only a trend to improvement in subjective functioning.

Do the key prognostic factors for non-specific neck pain have moderation effects? - A study protocol.

PubMed

Balasundaram, Arun Prasad; Robinson, Hilde Stendal; Vøllestad, Nina Køpke

2018-05-01

Neck pain is one of the common musculoskeletal conditions prevalent in the general population in Norway. Patients with neck pain, seek treatment from different health professionals such as general practitioners, physiotherapists, chiropractors and alternative medicine practitioners. The interventions for neck pain are typically provided in a primary care or specialised healthcare setting depending on the general practitioners' referral patterns. Clinicians are interested to know the various prognostic factors that can explain the recovery from neck pain. In order to know this, studies have explored and reported on a range of prognostic factors that contribute to the outcomes in patients with neck pain. This information is currently available only for neck pain following whiplash injury that has a traumatic origin. There is limited information on the role of prognostic factors specifically for non-specific neck pain without a traumatic episode. Moreover, there is a lack of data on whether there are interactions (moderation effects) between the prognostic factors. Therefore, we propose a hypothesis to elucidate whether the same set of prognostic factors found in neck pain associated with whiplash injuries are also identified in patients with neck pain without trauma. Additionally, we hypothesize that the association between a prognostic factor and the outcome variable (s) would be dependent on the third variable, thereby confirming the moderation effects. Clinicians could make informed decisions in the clinical management of neck pain with the knowledge of prognostic factors that explain the outcomes. It could also be used for the development of new interventions or for modifying the existing ones. Copyright © 2018 Elsevier Ltd. All rights reserved.

Multivariate analysis of ultrasound-recorded dorsal strain sequences: Investigation of dynamic neck extensions in women with chronic whiplash associated disorders.

PubMed

Peolsson, Anneli; Peterson, Gunnel; Trygg, Johan; Nilsson, David

2016-08-03

Whiplash Associated Disorders (WAD) refers to the multifaceted and chronic burden that is common after a whiplash injury. Tools to assist in the diagnosis of WAD and an increased understanding of neck muscle behaviour are needed. We examined the multilayer dorsal neck muscle behaviour in nine women with chronic WAD versus healthy controls during the entire sequence of a dynamic low-loaded neck extension exercise, which was recorded using real-time ultrasound movies with high frame rates. Principal component analysis and orthogonal partial least squares were used to analyse mechanical muscle strain (deformation in elongation and shortening). The WAD group showed more shortening during the neck extension phase in the trapezius muscle and during both the neck extension and the return to neutral phase in the multifidus muscle. For the first time, a novel non-invasive method is presented that is capable of detecting altered dorsal muscle strain in women with WAD during an entire exercise sequence. This method may be a breakthrough for the future diagnosis and treatment of WAD.

Multivariate analysis of ultrasound-recorded dorsal strain sequences: Investigation of dynamic neck extensions in women with chronic whiplash associated disorders

PubMed Central

Peolsson, Anneli; Peterson, Gunnel; Trygg, Johan; Nilsson, David

2016-01-01

Whiplash Associated Disorders (WAD) refers to the multifaceted and chronic burden that is common after a whiplash injury. Tools to assist in the diagnosis of WAD and an increased understanding of neck muscle behaviour are needed. We examined the multilayer dorsal neck muscle behaviour in nine women with chronic WAD versus healthy controls during the entire sequence of a dynamic low-loaded neck extension exercise, which was recorded using real-time ultrasound movies with high frame rates. Principal component analysis and orthogonal partial least squares were used to analyse mechanical muscle strain (deformation in elongation and shortening). The WAD group showed more shortening during the neck extension phase in the trapezius muscle and during both the neck extension and the return to neutral phase in the multifidus muscle. For the first time, a novel non-invasive method is presented that is capable of detecting altered dorsal muscle strain in women with WAD during an entire exercise sequence. This method may be a breakthrough for the future diagnosis and treatment of WAD. PMID:27484361

Multivariate analysis of ultrasound-recorded dorsal strain sequences: Investigation of dynamic neck extensions in women with chronic whiplash associated disorders

NASA Astrophysics Data System (ADS)

Peolsson, Anneli; Peterson, Gunnel; Trygg, Johan; Nilsson, David

2016-08-01

Whiplash Associated Disorders (WAD) refers to the multifaceted and chronic burden that is common after a whiplash injury. Tools to assist in the diagnosis of WAD and an increased understanding of neck muscle behaviour are needed. We examined the multilayer dorsal neck muscle behaviour in nine women with chronic WAD versus healthy controls during the entire sequence of a dynamic low-loaded neck extension exercise, which was recorded using real-time ultrasound movies with high frame rates. Principal component analysis and orthogonal partial least squares were used to analyse mechanical muscle strain (deformation in elongation and shortening). The WAD group showed more shortening during the neck extension phase in the trapezius muscle and during both the neck extension and the return to neutral phase in the multifidus muscle. For the first time, a novel non-invasive method is presented that is capable of detecting altered dorsal muscle strain in women with WAD during an entire exercise sequence. This method may be a breakthrough for the future diagnosis and treatment of WAD.

Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study.

PubMed

Ozegovic, Dejan; Carroll, Linda J; David Cassidy, J

2009-06-01

To determine the association between expectations to return to work and self-assessed recovery. Positive expectations predict better outcomes in many health conditions, but to date the relationship between expecting to return to work after traffic-related whiplash-associated disorders and actual recovery has not been reported. We assessed early expectations for return to work in a cohort of 2,335 individuals with traffic-related whiplash injury to the neck. Using multivariable Cox proportional hazard analysis we assessed the association between return to work expectations and self-perceived recovery during the first year following the event. After adjusting for the effects of sociodemographic characteristics, initial pain and symptoms, post-crash mood, prior health status and collision-related factors, those who expected to return to work reported global recovery 42% more quickly than those who did not have positive expectations (HRR = 1.42, 95% CI 1.26-1.60). Knowledge of return to work expectation provides an important prognostic tool to clinicians for recovery.

Seat design principles to reduce neck injuries in rear impacts.

PubMed

Viano, David C

2008-12-01

In the 1990s, research was conducted at General Motors R&D Center on seat safety in rear impacts. It led to the development of high retention seats and an active head restraint to improve occupant safety. This article provides an overview of the design principles found from that research and focuses on seat characteristics that lower whiplash risks. Sled and quasistatic seat testing showed how occupants interact with the seat in rear impacts and what seat characteristics improve occupant retention, energy management, and support of the head-neck, lowering injury risks. Neck displacements, moments, and forces were used to assess whiplash and more severe injury risks. A QST test was developed to quasi-statically push a dummy rearward into the seat to determine seat stiffness (k), frame strength (j), and peak bending moment (M(Hpt)). These parameters were related to neck displacements associated with whiplash. Sled tests were run with in-position and out-of-position male and female Hybrid III dummies to assess performance. A high retention seat and active head restraint were developed and put into production in 1997. High retention seats have 2.3 times greater moment, develop 2.2 times greater load, but have the same stiffness as earlier yielding seats. Seat stiffness was found to be a principle characteristic related to neck displacements associated with whiplash. The combination of a stronger frame, yielding seatback, and high-forward head restraint in the high retention seat provides early head support and low neck displacements in rear impacts. Larger reductions in neck displacement were obtained by adding an active head restraint that moves the head restraint forward and upward by occupant penetration into the seatback. This substantially reduces head contact time, neck displacements, and loads. Whiplash risks are related to seat stiffness, the position of the head restraint, and frame strength. Low seat stiffness allows the occupant to move into the seatback without high loads on the torso until the head-neck is supported by the head restraint. A strong seat frame reduces early seatback rotation that increases the gap to the head restraint and drops it in relation to the occupant's head. A high and forward head restraint provides support of the head and neck. Large forces can be applied to the occupant once the head, neck, and torso are supported by the seat and head restraint without adverse loading of the spine. The addition of an active head restraint closes the gap behind the head before significant load develops on the neck. The movement provides a more upward trajectory of the head restraint. Low-speed rear crashes are not just a matter of whiplash; older occupants, some with cervical stenosis, are at risk for paralyzing spinal cord injury.

Prediction models of health-related quality of life in different neck pain conditions: a cross-sectional study.

PubMed

Beltran-Alacreu, Hector; López-de-Uralde-Villanueva, Ibai; Calvo-Lobo, César; La Touche, Roy; Cano-de-la-Cuerda, Roberto; Gil-Martínez, Alfonso; Fernández-Ayuso, David; Fernández-Carnero, Josué

2018-01-01

The main aim of the study was to predict the health-related quality of life (HRQoL) based on physical, functional, and psychological measures in patients with different types of neck pain (NP). This cross-sectional study included 202 patients from a primary health center and the physiotherapy outpatient department of a hospital. Patients were divided into four groups according to their NP characteristics: chronic (CNP), acute whiplash (WHIP), chronic NP associated with temporomandibular dysfunction (NP-TMD), or chronic NP associated with chronic primary headache (NP-PH). The following measures were performed: Short Form-12 Health Survey (SF-12), Neck Disability Index (NDI), visual analog scale (VAS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BECK), and cervical range of movement (CROM). The regression models based on the SF-12 total HRQoL for CNP and NP-TMD groups showed that only NDI was a significant predictor of the worst HRQoL (48.9% and 48.4% of the variance, respectively). In the WHIP group, the regression model showed that BECK was the only significant predictor variable for the worst HRQoL (31.7% of the variance). Finally, in the NP-PH group, the regression showed that the BECK, STAI, and VAS model predicted the worst HRQoL (75.1% of the variance). Chronic nonspecific NP and chronic NP associated with temporomandibular dysfunction were the main predictors of neck disability. In addition, depression, anxiety, and pain were the main predictors of WHIP or primary headache associated with CNP.

[Whiplash injury of the neck from concepts to facts].

PubMed

Revel, M

2003-04-01

To focus on a topic of traumatology and rehabilitation becoming recently a much debated public health problem. A references search from Medline database with whiplash as keyword was carried out. Were selected articles with abstracts in french or english and focusing on accidentology, biomechanics, demonstrated lesions, epidemiology and treatments. From 1664 references found, 232 were reviewed. The usual mechanism of crash is a rear-end collision inducing in the occupants of the bumped vehicle a sudden lower cervical spine extension with upper flexion followed by a global flexion. In nearly 50% of the cases, the stress occurring in the collision is comparable to that observed in bumper cars. The velocity changes are seldom up to 15 km/h. A headrest at the level of the center of gravity of the head restrict significantly the extension of the neck. Every structure of the cervical spine could be damaged and mainly the facet joints but the lesions were only demonstrated in severes traumatisms. The discrepancies in incidence among the different countries could be related to their medicolegal system. Although subjectives, the early symptoms are rather similar among patients suggesting true anatomical or functional disorders but the chronicity seems to be mainly related to social and psychological factors. The association of: no posterior midline cervical tenderness, no intoxication, normal alertness, no focal neurological deficit and no painful distracting injuries has a good predictive value of the lack of osteo-articular lesion on X-rays. Except the grade IV of the Quebec task Force (0, no symptom; 1, pain and stiffness; 2, neck complaint and physical signs; 3, neck complaint and neurological signs; 4, fracture or dislocation) the use of a collar should be avoided and the cervical spine should be mobilized. In most whiplash injuries, the mildness should be early stated, mobilization encouraged, and procedures of compensation shortened.

Variations in the axis of motion during head repositioning--a comparison of subjects with whiplash-associated disorders or non-specific neck pain and healthy controls.

PubMed

Grip, Helena; Sundelin, Gunnevi; Gerdle, Björn; Karlsson, J Stefan

2007-10-01

The ability to reproduce head position can be affected in patients after a neck injury. The repositioning error is commonly used as a measure of proprioception, but variations in the movement might provide additional information. The axis of motion and target performance were analyzed during a head repositioning task (flexion, extension and side rotations) for 24 control subjects, 22 subjects with whiplash-associated disorders and 21 with non-specific neck pain. Questionnaires regarding pain intensity and fear avoidance were collected. Head position and axis of motion parameters were calculated using a helical axis model with a moving window of 4 degrees . During flexion the whiplash group had a larger constant repositioning error than the control group (-1.8(2.9) degrees vs. 0.1(2.4) degrees , P=0.04). The axis was more inferior in both neck pain groups (12.0(1.6)cm vs. 14.5(2.0)cm, P<0.05) indicating movement at a lower level in the spine. Including pain intensity from shoulder and neck region as covariates showed an effect on the axis position (P=0.03 and 0.04). During axial rotation to the left there was more variation in axis direction for neckpain groups as compared with controls (4.0(1.7) degrees and 3.7(2.4) degrees vs. 2.3(1.9) degrees , P=0.01 and 0.05). No significant difference in fear avoidance was found between the two neck pain groups. Measuring variation in the axis of motion together with target performance gives objective measures on proprioceptive ability that are difficult to quantify by visual inspection. Repositioning errors were in general small, suggesting it is not sufficient as a single measurement variable in a clinical situation, but should be measured in combination with other tests, such as range of motion.

A comparison of physical and psychological features of responders and non-responders to cervical facet blocks in chronic whiplash

PubMed Central

2013-01-01

Background Cervical facet block (FB) procedures are often used as a diagnostic precursor to radiofrequency neurotomies (RFN) in the management of chronic whiplash associated disorders (WAD). Some individuals will respond to the FB procedures and others will not respond. Such responders and non-responders provided a sample of convenience to question whether there were differences in their physical and psychological features. This information may inform future predictive studies and ultimately the clinical selection of patients for FB procedures. Methods This cross-sectional study involved 58 individuals with chronic WAD who responded to cervical FB procedures (WAD_R); 32 who did not respond (WAD_NR) and 30 Healthy Controls (HC)s. Measures included: quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test); nociceptive flexion reflex (NFR); motor function (cervical range of movement (ROM); activity of the superficial neck flexors during the cranio-cervical flexion test (CCFT). Self-reported measures were gained from the following questionnaires: neuropathic pain (s-LANSS); psychological distress (General Health Questionnaire-28), post-traumatic stress (PDS) and pain catastrophization (PCS). Individuals with chronic whiplash attended the laboratory once the effects of the blocks had abated and symptoms had returned. Results Following FB procedures, both WAD groups demonstrated generalized hypersensitivity to all sensory tests, decreased neck ROM and increased superficial muscle activity with the CCFT compared to controls (p < 0.05). There were no significant differences between WAD groups (all p > 0.05). Both WAD groups demonstrated psychological distress (GHQ-28; p < 0.05), moderate post-traumatic stress symptoms and pain catastrophization. The WAD_NR group also demonstrated increased medication intake and elevated PCS scores compared to the WAD_R group (p < 0.05). Conclusions Chronic WAD responders and non-responders to FB procedures demonstrate a similar presentation of sensory disturbance, motor dysfunction and psychological distress. Higher levels of pain catastrophization and greater medication intake were the only factors found to differentiate these groups. PMID:24188899

Kinetics of the head-neck complex in low-speed rear impact.

PubMed

Stemper, Brian D; Yoganandan, Naryan; Pintar, Frank A

2003-01-01

A comprehensive characterization of the biomechanics of the cervical spine in rear impact will lead to an understanding of the mechanisms of whiplash injury. Cervical kinematics have been experimentally described using human volunteers, full-body cadaver specimens, and isolated and intact head-neck specimens. However, forces and moments at the cervico-thoracic junction have not been clearly delineated. An experimental investigation was performed using ten intact head-neck complexes to delineate the loading at the base of the cervical spine and angular acceleration of the head in whiplash. A pendulum-minisled apparatus was used to simulate whiplash acceleration of the thorax at four impact severities. Lower neck loads were measured using a six-axis load cell attached between the minisled and head-neck specimens, and head angular motion was measured with an angular rate sensor attached to the lateral side of the head. Shear and axial force, extension moment, and head angular acceleration increased with impact severity. Shear force was significantly larger than axial force (p < 0.0001). Shear force reached its maximum value at 46 msec. Maximum extension moment occurred between 7 and 22 msec after maximum shear force. Maximum angular acceleration of the head occurred 2 to 18 msec later. Maximum axial force occurred last (106 msec). All four kinetic components reached maximum values during cervical S-curvature, with maximum shear force and extension moment occurring before the attainment of maximum S-curvature. Results of the present investigation indicate that shear force and extension moment at the cervico-thoracic junction drive the non-physiologic cervical S-curvature responsible for whiplash injury and underscore the importance of understanding cervical kinematics and the underlying kinetics.

Musculotendon and fascicle strains in anterior and posterior neck muscles during whiplash injury.

PubMed

Vasavada, Anita N; Brault, John R; Siegmund, Gunter P

2007-04-01

A biomechanical neck model combined with subject-specific kinematic and electromyographic data were used to calculate neck muscle strains during whiplash. To calculate the musculotendon and fascicle strains during whiplash and to compare these strains to published muscle injury thresholds. Previous work has shown potentially injurious musculotendon strains in sternocleidomastoid (SCM) during whiplash, but neither the musculotendon strains in posterior cervical muscles nor the fascicle strains in either muscle group have been examined. Experimental human subject data from rear-end automobile impacts were integrated with a biomechanical model of the neck musculoskeletal system. Subject-specific head kinematic data were imposed on the model, and neck musculotendon and fascicle strains and strain rates were computed. Electromyographic data from the sternocleidomastoid and the posterior cervical muscles were compared with strain data to determine which muscles were being eccentrically contracted. SCM experienced lengthening during the retraction phase of head/neck kinematics, whereas the posterior muscles (splenius capitis [SPL], semispinalis capitis [SEMI], and trapezius [TRAP]) lengthened during the rebound phase. Peak SCM fascicle lengthening strains averaged (+/-SD) 4% (+/-3%) for the subvolumes attached to the mastoid process and 7% (+/-5%) for the subvolume attached to the occiput. Posteriorly, peak fascicle strains were 21% (+/-14%) for SPL, 18% (+/-16%) for SEMI, and 5% (+/-4%) for TRAP, with SPL strains significantly greater than calculated in SCM or TRAP. Fascicle strains were, on average, 1.2 to 2.3 times greater than musculotendon strains. SCM and posterior muscle activity occurred during intervals of muscle fascicle lengthening. The cervical muscle strains induced during a rear-end impact exceed the previously-reported injury threshold for a single stretch of active muscle. Further, the larger strains experienced by extensor muscles are consistent with clinical reports of pain primarily in the posterior cervical region following rear-end impacts.

Long-term follow-up of whiplash injuries reported to insurance companies: a cohort study on patient-reported outcomes and impact of financial compensation.

PubMed

Rydman, Eric; Ponzer, Sari; Brisson, Rosa; Ottosson, Carin; Pettersson-Järnbert, Hans

2018-06-01

The long-term outcome of Whiplash-associated disorder (WADs) has been reported to be poor in populations from medical settings. However, no trials have investigated the long-term prognosis of patients from medico-legal environment. For this group, the "compensation hypothesis" suggests financial compensation being associated with worsened outcome. The aims of this study were to describe long-term (2-4 years) non-recovery rates in participants with WAD recruited from insurance companies and to investigate the association between self-reported non-recovery and financial compensation. 144 participants, reporting neck pain after a motor vehicle accident, were recruited from two major insurance companies in Sweden. Self-reported recovery was measured at 6 months and 2-4 years. Those who received financial compensation from an insurance company were compared with those who received no compensation. The overall non-recovery rate after 2-4 years was 55.9% (66/118). In the non-compensated group, the non-recovery rate was 51.0% (25/49) and in the compensated group 73% (27/37) (p = 0.039). Adjusted OR was 4.33 (1.37-13.66). High level of pain at baseline was a strong predictor of non-recovery [OR 46 (4.7-446.0)]. However, no association was found between pain level at baseline and financial compensation. The non-recovery rate among patients making insurance claims is high, especially among those receiving financial compensation even if causal relationship cannot be determined based on this study. However, lack of association between baseline level of pain and compensation supports the compensation hypothesis.

Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study.

PubMed

Van Oosterwijck, Jessica; Nijs, Jo; Meeus, Mira; Van Loo, Michel; Paul, Lorna

2012-03-01

A controlled experimental study was performed to examine the efficacy of the endogenous pain inhibitory systems and whether this (mal)functioning is associated with symptom increases following exercise in patients with chronic whiplash-associated disorders (WAD). In addition, 2 types of exercise were compared. Twenty-two women with chronic WAD and 22 healthy controls performed a submaximal and a self-paced, physiologically limited exercise test on a cycle ergometer with cardiorespiratory monitoring on 2 separate occasions. Pain pressure thresholds (PPT), health status, and activity levels were assessed in response to the 2 exercise bouts. In chronic WAD, PPT decreased following submaximal exercise, whereas they increased in healthy subjects. The same effect was established in response to the self-paced, physiologically limited exercise, with exception of the PPT at the calf which increased. A worsening of the chronic WAD symptom complex was reported post-exercise. Fewer symptoms were reported in response to the self-paced, physiologically limited exercise. These observations suggest abnormal central pain processing during exercise in patients with chronic WAD. Submaximal exercise triggers post-exertional malaise, while a self-paced and physiologically limited exercise will trigger less severe symptoms, and therefore seems more appropriate for chronic WAD patients. The results from this exercise study suggest impaired endogenous pain inhibition during exercise in people with chronic WAD. This finding highlights the fact that one should be cautious when evaluating and recommending exercise in people with chronic WAD, and that the use of more individual, targeted exercise therapies is recommended. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

Lack of evidence for central sensitization in idiopathic, non-traumatic neck pain: a systematic review.

PubMed

Malfliet, Annaleen; Kregel, Jeroen; Cagnie, Barbara; Kuipers, Mandy; Dolphens, Mieke; Roussel, Nathalie; Meeus, Mira; Danneels, Lieven; Bramer, Wichor M; Nijs, Jo

2015-01-01

Chronic neck pain is a common problem with a poorly understood pathophysiology. Often no underlying structural pathology can be found and radiological imaging findings are more related to age than to a patient's symptoms. Besides its common occurrence, chronic idiopathic neck pain is also very disabling with almost 50% of all neck pain patients showing moderate disability at long-term follow-up. Central sensitization (CS) is defined as "an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity," "increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input," or "an augmentation of responsiveness of central neurons to input from unimodal and polymodal receptors." There is increasing evidence for involvement of CS in many chronic pain conditions. Within the area of chronic idiopathic neck pain, there is consistent evidence for the presence and clinical importance of CS in patients with traumatic neck pain, or whiplash-associated disorders. However, the majority of chronic idiopathic neck pain patients are unrelated to a traumatic injury, and hence are termed chronic idiopathic non-traumatic neck pain. When comparing whiplash with idiopathic non-traumatic neck pain, indications for different underlying mechanisms are found. The goal of this article was to review the existing scientific literature on the role of CS in patients with chronic idiopathic non-traumatic neck pain. Systematic review. All selected studies were case control studies. A systematic search of existing, relevant literature was performed via the electronic databases Medline, Embase, Web of Science, Cinahl, PubMed, and Google Scholar. All titles and abstracts were checked to identify relevant articles. An article was considered eligible if it met following inclusion criteria: (1) participants had to be human adults (> 18 years) diagnosed with idiopathic non-traumatic chronic (present for at least 3 months) neck pain; (2) papers had to report outcomes related to CS; and (3) articles had to be full-text reports or original research (no abstracts, case-reports, reviews, meta-analysis, letters, or editorials). Six articles were found eligible after screening the title, abstract and - when necessary - the full text for in- and exclusion criteria. All selected studies were case-control studies. Overall, results regarding the presence of CS were divergent. While the majority of patients with chronic traumatic neck pain (i.e. whiplash) are characterized by CS, this is not the case for patients with chronic idiopathic neck pain. The available evidence suggests that CS is not a major feature of chronic idiopathic neck pain. Individual cases might have CS pain, but further work should reveal how they can be characterized. Very few studies available. Literature about CS in patients with chronic idiopathic non-traumatic neck pain is rare and results from the available studies provide an inconclusive message. CS is not a characteristic feature of chronic idiopathic and non-traumatic neck pain, but can be present in some individuals of the population. In the future a subgroup with CS might be defined, but based on current knowledge it is not possible to characterize this subgroup. Such information is important in order to provide targeted treatment.

An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders

PubMed Central

Graham, Nadine; Gross, Anita R; Carlesso, Lisa C; Santaguida, P. Lina; MacDermid, Joy C; Walton, Dave; Ho, Enoch

2013-01-01

Introduction: Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited. Purpose: To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain. Methods: A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus. Results: Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up. Conclusions: The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research. PMID:24155804

Increasing climate whiplash in 21st century California

NASA Astrophysics Data System (ADS)

Swain, D. L.; Langenbrunner, B.; Neelin, J. D.; Hall, A. D.

2017-12-01

Temperate "Mediterranean" climate regimes across the globe are particularly susceptible to wide swings between drought and flood—of which California's rapid transition from record multi-year dryness between 2012-2016 to extreme wetness during 2016-2017 provides a dramatic example. The wide-ranging human and environmental impacts of this recent "climate whiplash" event in a highly-populated, economically critical, and biodiverse region highlight the importance of understanding weather and climate extremes at both ends of the hydroclimatic spectrum. Previous studies have examined the potential contribution of anthropogenic warming to recent California extremes, but findings to date have been mixed and primarily drought-focused. Here, we use specific historical California flood and drought events as thresholds for quantifying long-term changes in precipitation extremes using a large ensemble of multi-decadal climate model simulations (CESM-LENS). We find that greenhouse gas emissions are already responsible for a detectable increase in both wet and dry extremes across portions of California, and that increasing 21st century "climate whiplash" will likely yield large increases in the frequency of both rapid "dry-to-wet" transitions and severe flood events over a wide range of timescales. This projected intensification of California's hydrological cycle would seriously challenge the region's existing water storage, conveyance, and flood control infrastructure—even absent large changes in mean precipitation.

The effect of neck torsion on postural stability in subjects with persistent whiplash.

PubMed

Yu, Li-Ju; Stokell, Raina; Treleaven, Julia

2011-08-01

Dysfunction of cervical receptors in neck disorders has been shown to lead to disturbances in postural stability. The neck torsion manoeuvre used in the smooth pursuit neck torsion (SPNT) test is thought to be a specific measure of neck afferent dysfunction on eye movement in those with neck pain. This study aimed to determine whether neck torsion could change balance responses in those with persistent whiplash-associated disorders (WADs). Twenty subjects with persistent WAD and 20 healthy controls aged between 18 and 50 years stood on a computerised force plate with eyes closed in comfortable stance under 5 conditions: neutral head, head turned to left and right and neck torsion to left and right. Root mean square (rms) amplitude of sway was measured in the anterior-posterior (AP) and medial-lateral (ML) directions. The whiplash group had significantly greater rms amplitude in the AP direction following neck torsion compared to the control group (p < 0.03). The results show that the neck torsion manoeuvre may lead to greater postural deficits in individuals with persistent WAD and provides further evidence of neck torsion to identify abnormal cervical afferent input, as an underlying cause of balance disturbances in WAD. Further research is warranted. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Head and neck control varies with perturbation acceleration but not jerk: implications for whiplash injuries

PubMed Central

Siegmund, Gunter P; Blouin, Jean-Sébastien

2009-01-01

Recent studies have proposed that a high rate of acceleration onset, i.e. high jerk, during a low-speed vehicle collision increases the risk of whiplash injury by triggering inappropriate muscle responses and/or increasing peak head acceleration. Our goal was to test these proposed mechanisms at realistic jerk levels and then to determine how collision jerk affects the potential for whiplash injuries. Twenty-three seated volunteers (8 F, 15 M) were exposed to multiple experiments involving perturbations simulating the onset of a vehicle collision in eyes open and eyes closed conditions. In the first experiment, subjects experienced five forward and five rearward perturbations to look for the inappropriate muscle responses and ‘floppy’ head kinematics previously attributed to high jerk perturbations. In the second experiment, we independently varied the jerk (∼125 to 3 000 m s−3) and acceleration (∼0.65 to 2.6 g) of the perturbation to assess their effect on the electromyographic (EMG) responses of the sternocleidomastoid (SCM), scalene (SCAL) and cervical paraspinal (PARA) muscles and the kinematic responses of the head and neck. In the first experiment, we found neither inappropriate muscle responses nor floppy head kinematics when subjects had their eyes open, but observed two subjects with floppy head kinematics with eyes closed. In the second experiment, we found that about 70% of the variations in the SCM and SCAL responses and about 95% of the variations in head/neck kinematics were explained by changes in perturbation acceleration in both the eyes open and eyes closed conditions. Less than 2% of the variation in the muscle and kinematic responses was explained by changes in perturbation jerk and, where significant, response amplitudes diminished with increasing jerk. Based on these findings, collision jerk appears to have little or no role in the genesis of whiplash injuries in low-speed vehicle crashes. PMID:19237420

Altered motor control patterns in whiplash and chronic neck pain.

PubMed

Woodhouse, Astrid; Vasseljen, Ottar

2008-06-20

Persistent whiplash associated disorders (WAD) have been associated with alterations in kinesthetic sense and motor control. The evidence is however inconclusive, particularly for differences between WAD patients and patients with chronic non-traumatic neck pain. The aim of this study was to investigate motor control deficits in WAD compared to chronic non-traumatic neck pain and healthy controls in relation to cervical range of motion (ROM), conjunct motion, joint position error and ROM-variability. Participants (n = 173) were recruited to three groups: 59 patients with persistent WAD, 57 patients with chronic non-traumatic neck pain and 57 asymptomatic volunteers. A 3D motion tracking system (Fastrak) was used to record maximal range of motion in the three cardinal planes of the cervical spine (sagittal, frontal and horizontal), and concurrent motion in the two associated cardinal planes relative to each primary plane were used to express conjunct motion. Joint position error was registered as the difference in head positions before and after cervical rotations. Reduced conjunct motion was found for WAD and chronic neck pain patients compared to asymptomatic subjects. This was most evident during cervical rotation. Reduced conjunct motion was not explained by current pain or by range of motion in the primary plane. Total conjunct motion during primary rotation was 13.9 degrees (95% CI; 12.2-15.6) for the WAD group, 17.9 degrees (95% CI; 16.1-19.6) for the chronic neck pain group and 25.9 degrees (95% CI; 23.7-28.1) for the asymptomatic group. As expected, maximal cervical range of motion was significantly reduced among the WAD patients compared to both control groups. No group differences were found in maximal ROM-variability or joint position error. Altered movement patterns in the cervical spine were found for both pain groups, indicating changes in motor control strategies. The changes were not related to a history of neck trauma, nor to current pain, but more likely due to long-lasting pain. No group differences were found for kinaesthetic sense.

Altered motor control patterns in whiplash and chronic neck pain

PubMed Central

Woodhouse, Astrid; Vasseljen, Ottar

2008-01-01

Background Persistent whiplash associated disorders (WAD) have been associated with alterations in kinesthetic sense and motor control. The evidence is however inconclusive, particularly for differences between WAD patients and patients with chronic non-traumatic neck pain. The aim of this study was to investigate motor control deficits in WAD compared to chronic non-traumatic neck pain and healthy controls in relation to cervical range of motion (ROM), conjunct motion, joint position error and ROM-variability. Methods Participants (n = 173) were recruited to three groups: 59 patients with persistent WAD, 57 patients with chronic non-traumatic neck pain and 57 asymptomatic volunteers. A 3D motion tracking system (Fastrak) was used to record maximal range of motion in the three cardinal planes of the cervical spine (sagittal, frontal and horizontal), and concurrent motion in the two associated cardinal planes relative to each primary plane were used to express conjunct motion. Joint position error was registered as the difference in head positions before and after cervical rotations. Results Reduced conjunct motion was found for WAD and chronic neck pain patients compared to asymptomatic subjects. This was most evident during cervical rotation. Reduced conjunct motion was not explained by current pain or by range of motion in the primary plane. Total conjunct motion during primary rotation was 13.9° (95% CI; 12.2–15.6) for the WAD group, 17.9° (95% CI; 16.1–19.6) for the chronic neck pain group and 25.9° (95% CI; 23.7–28.1) for the asymptomatic group. As expected, maximal cervical range of motion was significantly reduced among the WAD patients compared to both control groups. No group differences were found in maximal ROM-variability or joint position error. Conclusion Altered movement patterns in the cervical spine were found for both pain groups, indicating changes in motor control strategies. The changes were not related to a history of neck trauma, nor to current pain, but more likely due to long-lasting pain. No group differences were found for kinaesthetic sense. PMID:18570647

Thoracic dysfunction in whiplash associated disorders: A systematic review

PubMed Central

Smith, Richard; Tyros, Isaak; Falla, Deborah; Rushton, Alison

2018-01-01

Background Research investigating Whiplash Associated Disorder (WAD) has largely focused on the cervical spine yet symptoms can be widespread. Thoracic spine pain prevalence is reported ~66%; perhaps unsurprising given the forceful stretch/eccentric loading of posterior structures of the spine, and the thoracic spine’s contribution to neck mobility/function. Approximately 50% WAD patients develop chronic pain and disability resulting in high levels of societal and healthcare costs. It is time to look beyond the cervical spine to fully understand anatomical dysfunction in WAD and provide new directions for clinical practice and research. Purpose To evaluate the scope and nature of dysfunction in the thoracic region in patients with WAD. Methods A systematic review and data synthesis was conducted according to a pre-defined, registered (PROSPERO, CRD42015026983) and published protocol. All forms of observational study were included. A sensitive topic-based search strategy was designed from inception to 1/06/16. Databases, grey literature and registers were searched using a study population terms and key words derived from scoping search. Two reviewers independently searched information sources, assessed studies for inclusion, extracted data and assessed risk of bias. A third reviewer checked for consistency and clarity. Extracted data included summary data: sample size and characteristics, outcomes, and timescales to reflect disorder state. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were tabulated to allow enabling a semi-qualitative comparison and grouped by outcome across studies. Strength of the overall body of evidence was assessed using a modified GRADE. Results Thirty eight studies (n>50,000) which were conducted across a range of countries were included. Few authors responded to requests for further data (5 of 9 contacted). Results were reported in the context of overall quality and were presented for measures of pain or dysfunction and presented, where possible, according to WAD severity and time point post injury. Key findings include: 1) high prevalence of thoracic pain (>60%); higher for those with more severe presentations and in the acute stage, 2) low prevalence of chest pain (<22%), 3) evidence of thoracic outlet syndrome, with some association to and involvement of the brachial plexus, 4) muscle dysfunction in the form of heightened activity of the sternocleidomastoid or delayed onset of action of the serratus anterior, 5) high prevalence of myofascial pain and trigger points in the scalene muscles, sternocleidomastoid and mid/lower fibres of trapezius muscle (48–65%), and 6) inconclusive evidence of altered thoracic posture or mobility. Conclusions Considerable evidence supports thoracic pain and dysfunction in patients with WAD, involving primarily nerves and muscles. Notwithstanding the low/very low level of evidence from this review, our findings do support a more extensive clinical evaluation of patients presenting with WAD. Additional high quality research is required to further characterise dysfunction across other structures in the thoracic region, including but not limited to the thoracic spine (mobility and posture) and thoracic muscles (stiffness, activation patterns). In turn this may inform the design of clinical trials targeting such dysfunction. PMID:29570722

The clinical course over the first year of whiplash associated disorders (WAD): pain-related disability predicts outcome in a mildly affected sample.

PubMed

Åsenlöf, Pernilla; Bring, Annika; Söderlund, Anne

2013-12-21

Different recovery patterns are reported for those befallen a whip-lash injury, but little is known about the variability within subgroups. The aims were (1) to compare a self-selected mildly affected sample (MILD) with a self-selected moderately to severely affected sample (MOD/SEV) with regard to background characteristics and pain-related disability, pain intensity, functional self-efficacy, fear of movement/(re)injury, pain catastrophising, post-traumatic stress symptoms in the acute stage (at baseline), (2) to study the development over the first year after the accident for the above listed clinical variables in the MILD sample, and (3) to study the validity of a prediction model including baseline levels of clinical variables on pain-related disability one year after baseline assessments. The study had a prospective and correlative design. Ninety-eight participants were consecutively selected. Inclusion criteria; age 18 to 65 years, WAD grade I-II, Swedish language skills, and subjective report of not being in need of treatment due to mild symptoms. A multivariate linear regression model was applied for the prediction analysis. The MILD sample was less affected in all study variables compared to the MOD/SEV sample. Pain-related disability, pain catastrophising, and post-traumatic stress symptoms decreased over the first year after the accident, whereas functional self-efficacy and fear of movement/(re)injury increased. Pain intensity was stable. Pain-related disability at baseline emerged as the only statistically significant predictor of pain-related disability one year after the accident (Adj r² = 0.67). A good prognosis over the first year is expected for the majority of individuals with WAD grade I or II who decline treatment due to mild symptoms. The prediction model was not valid in the MILD sample except for the contribution of pain-related disability. An implication is that early observations of individuals with elevated levels of pain-related disability are warranted, although they may decline treatment.

TMJ disorders

MedlinePlus

... conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial ... Garza I, Schwedt TJ, Robertson CE, Smith JH. Headache and other craniofacial pain. In: Daroff RB, Jankovic ...

Whiplash

MedlinePlus

... Strategy Current Research Research Funded by NINDS Basic Neuroscience Clinical Research Translational Research Research at NINDS Focus ... Diversity Resources Jobs at NINDS Director, Division of Neuroscience Director, NIH BRAIN Initiative® Health Scientist Administrator Channels ...

Nonimpact brain injury: neuropsychological and behavioral correlates with consideration of physiological findings.

PubMed

Henry, G K; Gross, H S; Herndon, C A; Furst, C J

2000-01-01

This retrospective clinical study investigated the neuropsychological, physiological, and behavioral functioning of 32 adult outpatients up to 65 months following nonimpact brain injury (i.e., whiplash). All participants were administered a flexible battery of cognitive tests, and some underwent neurodiagnostic procedures and sleep studies. Compared with published norms, neuropsychological data revealed significant and persistent age-adjusted cognitive deficits, primarily in the area of executive functioning. Participants frequently complained of problems with behavioral control, sleep, and sexuality. Although structural neuroimaging was not sensitive in detecting brain pathology, quantitative electroencephalography was abnormal in all the participants evaluated, showing frontocentral slowing and increased spike wave activity. We propose that whiplash injury can produce wide-ranging circuitry dysfunction and that test selection is critical in identifying cognitive deficits.

Radiofrequency Neurotomy

MedlinePlus

... Radiofrequency neurotomy might also be recommended to treat neck pain associated with whiplash. Risks Common side effects include: ... isn't a permanent fix for back or neck pain. Studies on the success of treatment have been ...

EXERCISE, MANUAL THERAPY AND POSTURAL RE-EDUCATION FOR UNCONTROLLED EAR TWITCHING AND RELATED IMPAIRMENTS AFTER WHIPLASH INJURY: A CASE REPORT.

PubMed

Flanders, Kelsey; Feldner, Heather

2017-10-01

Whiplash Associated Disorders and the interventions used to remediate them are well documented in physical therapy literature. However, specific interventions for spasms of the neck musculature that also involve constant ear twitching have yet to be addressed. The purpose of this case report is twofold. First, to describe comprehensive physical therapy management and outcomes for a subject with uncontrolled ear twitching and related musculoskeletal impairments, and second, to discuss the physical therapist's approach to evidence-based care when faced with a paucity of literature addressing physical therapy interventions for subjects with uncontrolled ear twitching. The subject was a 14-year-old female who sustained a right anterolateral whiplash injury when struck in the head by a volleyball seven months prior to physical therapy. Beginning five months after that injury, she experienced uncontrolled and constant superior/inferior movement of her right ear (hereafter described in this report as a twitch) in addition to facial and cervical pain from her initial injury. She was unable to participate in high school athletics due to her pain. A multimodal treatment approach including exercise, manual therapy, and postural reeducation was utilized during the subject's episode of care. After eight treatment sessions, the subjects's cervical range of motion and upper extremity strength improved. The reported frequency of ear twitching decreased, as did reports of neck and shoulder pain. In addition, her Neck Disability Index improved from a score of 22, indicating moderate disability, to 9, indicating mild disability and she was able to return to sport activity. With limited research to direct intervention, clinical reasoning was utilized to formulate an effective therapeutic intervention. A combination of manual therapy, exercise, and postural reeducation intervention was effective for this subject and could assist in guiding interventions for similarly unique clinical presentations in the future. Further research is needed to examine the etiology of ear twitching caused by muscle spasm and to develop additional evidence-based interventions for Whiplash Associated Disorders. Level 4.

Classification of neck movement patterns related to whiplash-associated disorders using neural networks.

PubMed

Grip, Helena; Ohberg, Fredrik; Wiklund, Urban; Sterner, Ylva; Karlsson, J Stefan; Gerdle, Björn

2003-12-01

This paper presents a new method for classification of neck movement patterns related to Whiplash-associated disorders (WAD) using a resilient backpropagation neural network (BPNN). WAD are a common diagnosis after neck trauma, typically caused by rear-end car accidents. Since physical injuries seldom are found with present imaging techniques, the diagnosis can be difficult to make. The active range of the neck is often visually inspected in patients with neck pain, but this is a subjective measure, and a more objective decision support system, that gives a reliable and more detailed analysis of neck movement pattern, is needed. The objective of this study was to evaluate the predictive ability of a BPNN, using neck movement variables as input. Three-dimensional (3-D) neck movement data from 59 subjects with WAD and 56 control subjects were collected with a ProReflex system. Rotation angle and angle velocity were calculated using the instantaneous helical axis method and motion variables were extracted. A principal component analysis was performed in order to reduce data and improve the BPNN performance. BPNNs with six hidden nodes had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88, which are very promising results. This shows that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD, even though further evaluation of the method is needed.

Neck pain

MedlinePlus

... injuries, such as vertebral fractures, whiplash, blood vessel injury, and even paralysis. Other causes include: Medical conditions, such as fibromyalgia Cervical arthritis or spondylosis Ruptured disk Small fractures to the spine from osteoporosis Spinal stenosis (narrowing of the spinal ...

Risk of cervical injuries in mixed martial arts.

PubMed

Kochhar, T; Back, D L; Mann, B; Skinner, J

2005-07-01

Mixed martial arts have rapidly succeeded boxing as the world's most popular full contact sport, and the incidence of injury is recognised to be high. To assess qualitatively and quantitatively the potential risk for participants to sustain cervical spine and associated soft tissue injuries. Four commonly performed manoeuvres with possible risks to the cervical spine were analysed with respect to their kinematics, and biomechanical models were constructed. Motion analysis of two manoeuvres revealed strong correlations with rear end motor vehicle impact injuries, and kinematics of the remaining two suggested a strong risk of injury. Mathematical models of the biomechanics showed that the forces involved are of the same order as those involved in whiplash injuries and of the same magnitude as compression injuries of the cervical spine. This study shows that there is a significant risk of whiplash injuries in this sport, and there are no safety regulations to address these concerns.

Are people who claim compensation "cured by a verdict"? A longitudinal study of health outcomes after whiplash.

PubMed

Spearing, Natalie M; Gyrd-Hansen, Dorte; Pobereskin, Louis H; Rowell, David S; Connelly, Luke B

2012-09-01

This study examines whether the lure of injury compensation prompts whiplash claimants to overstate their symptoms. Claim settlement is the intervention of interest, as it represents the point at which there is no further incentive to exaggerate symptoms, and neck pain at 24 months is the outcome of interest. Longitudinal data on neck pain scores and timing of claim settlement were regressed, controlling for the effect of time on recovery, to compare outcomes in claimants who had and had not settled their compensation claims. The results show clearly that removing the financial incentive to over-report symptoms has no effect on self-reported neck pain in a fault-based compensation scheme, and this finding concurs with other studies on this topic. Policy decisions to limit compensation in the belief that claimants systematically misrepresent their health status are not supported empirically Claimants do not appear to be "cured by a verdict".

Risk of cervical injuries in mixed martial arts

PubMed Central

Kochhar, T; Back, D; Mann, B; Skinner, J

2005-01-01

Background: Mixed martial arts have rapidly succeeded boxing as the world's most popular full contact sport, and the incidence of injury is recognised to be high. Objective: To assess qualitatively and quantitatively the potential risk for participants to sustain cervical spine and associated soft tissue injuries. Methods: Four commonly performed manoeuvres with possible risks to the cervical spine were analysed with respect to their kinematics, and biomechanical models were constructed. Results: Motion analysis of two manoeuvres revealed strong correlations with rear end motor vehicle impact injuries, and kinematics of the remaining two suggested a strong risk of injury. Mathematical models of the biomechanics showed that the forces involved are of the same order as those involved in whiplash injuries and of the same magnitude as compression injuries of the cervical spine. Conclusions: This study shows that there is a significant risk of whiplash injuries in this sport, and there are no safety regulations to address these concerns. PMID:15976168

Disturbed jaw behavior in whiplash-associated disorders during rhythmic jaw movements.

PubMed

Häggman-Henrikson, B; Zafar, H; Eriksson, P-O

2002-11-01

As shown previously, "functional jaw movements" are the result of coordinated activation of jaw as well as neck muscles, leading to simultaneous movements in the temporomandibular, atlanto-occipital, and cervical spine joints. In this study, the effect of neck trauma on natural jaw function was evaluated in 12 individuals suffering from whiplash-associated disorders (WAD). Spatiotemporal characteristics of mandibular and concomitant head movements were evaluated for three different modes of rhythmic jaw activities: self-paced continuous maximal jaw-opening/-closing movements, paced continuous maximal jaw-opening/-closing movements at 50 cycles/minute, and unilateral chewing. Compared with healthy subjects, the WAD group showed smaller magnitude and altered coordination pattern (a change in temporal relations) of mandibular and head movements. In conclusion, these results show that neck trauma can derange integrated jaw and neck behavior, and underline the functional coupling between the jaw and head-neck motor systems.

Experimentally induced central sensitization in the cervical spine evokes postural stiffening strategies in healthy young adults.

PubMed

Huntley, Andrew H; Srbely, John Z; Zettel, John L

2015-02-01

Dysequilibrium of cervicogenic origin can result from pain and injury to cervical paraspinal tissues post-whiplash; however, the specific physiological mechanisms still remain unclear. Central sensitization is a neuradaptive process which has been clinically associated with conditions of chronic pain and hypersensitivity. Strong links have been demonstrated between pain hypersensitivity and postural deficits post-whiplash; however, the precise mechanisms are still poorly understood. The purpose of this study was to explore the mechanisms of cervicogenic disequilibrium by investigating the effect of experimentally induced central sensitization in the cervical spine on postural stability in young healthy adults. Sixteen healthy young adults (7 males (22.6±1.13 years) and 9 females (22±2.69 years)) performed 30-s full-tandem stance trials on an AMTI force plate under normal and centrally sensitized conditions. The primary outcome variables included the standard deviation of the center of pressure (COP) position in medio-lateral (M-L) and antero-posterior (A-P) directions; sway range of the COP in M-L and A-P directions and the mean power frequency (MPF) of the COP and horizontal ground shear forces. Variability and sway range of the COP decreased with experimental induction of central sensitization, accompanied by an increase in MPF of COP displacement in both M-L and A-P directions, suggesting an increase in postural stiffening post-sensitization versus non-sensitized controls. Future studies need to further explore this relationship in clinical (whiplash, chronic pain) populations. Copyright © 2015 Elsevier B.V. All rights reserved.

The clinical course over the first year of Whiplash Associated Disorders (WAD): pain-related disability predicts outcome in a mildly affected sample

PubMed Central

2013-01-01

Background Different recovery patterns are reported for those befallen a whip-lash injury, but little is known about the variability within subgroups. The aims were (1) to compare a self-selected mildly affected sample (MILD) with a self-selected moderately to severely affected sample (MOD/SEV) with regard to background characteristics and pain-related disability, pain intensity, functional self-efficacy, fear of movement/(re)injury, pain catastrophising, post-traumatic stress symptoms in the acute stage (at baseline), (2) to study the development over the first year after the accident for the above listed clinical variables in the MILD sample, and (3) to study the validity of a prediction model including baseline levels of clinical variables on pain-related disability one year after baseline assessments. Methods The study had a prospective and correlative design. Ninety-eight participants were consecutively selected. Inclusion criteria; age 18 to 65 years, WAD grade I-II, Swedish language skills, and subjective report of not being in need of treatment due to mild symptoms. A multivariate linear regression model was applied for the prediction analysis. Results The MILD sample was less affected in all study variables compared to the MOD/SEV sample. Pain-related disability, pain catastrophising, and post-traumatic stress symptoms decreased over the first year after the accident, whereas functional self-efficacy and fear of movement/(re)injury increased. Pain intensity was stable. Pain-related disability at baseline emerged as the only statistically significant predictor of pain-related disability one year after the accident (Adj r2 = 0.67). Conclusion A good prognosis over the first year is expected for the majority of individuals with WAD grade I or II who decline treatment due to mild symptoms. The prediction model was not valid in the MILD sample except for the contribution of pain-related disability. An implication is that early observations of individuals with elevated levels of pain-related disability are warranted, although they may decline treatment. PMID:24359208

Use of muscle functional magnetic resonance imaging to compare cervical flexor activity between patients with whiplash-associated disorders and people who are healthy.

PubMed

Cagnie, Barbara; Dolphens, Mieke; Peeters, Ian; Achten, Eric; Cambier, Dirk; Danneels, Lieven

2010-08-01

Chronic whiplash-associated disorders (WAD) have been shown to be associated with motor dysfunction. Increased electromyographic (EMG) activity in neck and shoulder girdle muscles has been demonstrated during different tasks in participants with persistent WAD. Muscle functional magnetic resonance imaging (mfMRI) is an innovative technique to evaluate muscle activity and differential recruitment of deep and superficial muscles following exercise. The purpose of this study was to compare the recruitment pattern of deep and superficial neck flexors between patients with WAD and controls using mfMRI. A cross-sectional design was used. The study was conducted in a physical and rehabilitation medicine department. The participants were 19 controls who were healthy (10 men, 9 women; mean [+/-SD] age=22.2+/-0.6 years) and 16 patients with WAD (5 men, 11 women; mean [+/-SD] age=32.9+/-12.7 years). The T2 values were calculated for the longus colli (Lco), longus capitis (Lca), and sternocleidomastoid (SCM) muscles at rest and following cranio-cervical flexion (CCF). In the overall statistical model for T2 shift, there was a significant main effect for muscle (F=3.906, P=.033) but not for group (F=2.855, P=.101). The muscle x group interaction effect was significant (F=3.618, P=.041). Although not significant, there was a strong trend for lesser Lco (P=.061) and Lca (P=.060) activity for the WAD group compared with the control group. Although the SCM showed higher T2 shifts, this difference was not significant (P=.291). Although mfMRI is an innovative and useful technique for the evaluation of deep cervical muscles, consideration is required, as this method encompasses a postexercise evaluation and is limited to resistance types of exercises. Muscle functional magnetic resonance imaging demonstrated a difference in muscle recruitment between the Lco, Lca, and SCM during CCF in the control group, but failed to demonstrate a changed activity pattern in the WAD group compared with the control group. The mild symptoms in the WAD group and the wide variability in T2 values may explain the lack of significance.

[Rupture of the Achilles tendon].

PubMed

Ulmar, B; Simon, S; Eschler, A; Mittlmeier, T

2014-10-01

The rupture of the Achilles tendon is the most frequent tendon rupture in humans and it is associated with increasing incidence. The main risk factor is intrinsic degeneration of the tendon. During the rupture the person feels a whiplash or dagger thrust-like pain, followed by restricted walking ability and decreased plantar flexion of the ankle. The positive Simmond/Thompson test and a palpable dent above the tendon rupture are pathognomical. Diagnostically, ultrasound of the tendon and lateral x-ray of the calcaneus (bony pull-out of the tendon insertion) are necessary. Regarding correct indication and treatment modalities, most established conservative and surgical therapies realize optimal functional results. Surgical treatment promises better primary stability and slightly earlier better functional results, but there is the potential for surgical complications. Conservative therapy is associated with higher rates of re-rupture and healing of the tendon under elongation. Therefore, therapy planning in Achilles tendon rupture should be determined based on each patient. We recommend surgical treatment in patients with higher sporting demands and in younger patients (< 50 years).

[CSF enzyme activities in patients with head injury--especially on GOT, GPT, LDH, and CPK (AUTHOR'S TRANSL)].

PubMed

Nakamura, H; Mizuno, T; Kawamura, K; Kamino, T

1976-08-01

In our studies on patients with head injury, it was noted that there are some correlations between their clinical courses and the urinary excretion of creatine (cr), creatinine (Crn), 17-ketosteroid and 17-hydroxycorticosteroid. We observed the high urinary excretion of Cr in patients with severe head injury while almost negative in a mild case. We reported those facts in 1974. Also noted in patients with head injury is the relationship between the enzyme-activities (GOT, GPT, LDH and CPK) in the cerebrospinal fluid and their clinical courses. In this paper, we reported 34 cases of head injured patients (simple type: 2, concussion: 9, contusion: 8, acute intracranial hematoma: 7 and chronic intra-cranial hematoma: 8). The control values of CSF enzyme-activities were determined in these 14 cases (simple head injury, whip-lash injury and osteoma of the skull) as GOT less that 15, GPT less than 7, LDH less than 12 and CPK less than 8 units. In the moderate cases, a slight increase in activities of 4 enzymes in CSF were observed, while in severe or comatose cases, the enzyme-activities (especially LDH and CPK) were greater than in the controls. In the dead cases these values were five times as high as the normal case. In the patients recovering from a serious stage, these activities decreased to normal. High CSF enzyme-levels tend to indicate a poor prognosis and low levels a favorable progrosis. In the patients with a significant elevation of CSF enzymes, a high urinary excretion of Cr [normal range: 0-150 (ca. 50)mg/day] was often observed. There was no apparent correlation between the enzyme level in CSF and that in serum and the increase or decrease of these 4 enzymes are not always proprotionate with each other. As reported by Green (1958) and Lending (1961), cerebral cell necrosis and increased permeability of BLB, BBB or cerebral cell membrane can be related to the increase of enzymeactivities. With these observations, it can be considered that severe head injury gives influence on metabolic function in the hypothalamus and may cause in the levels of CSF enzymes and/or the urinary excretions of Cr, Crn and corticosteroids. And the examinations of enzyme activities in the patients with head injury may become a useful aid to make an outlook of their clinical coure and prognosis.

Widespread pain following whiplash-associated disorders: incidence, course, and risk factors.

PubMed

Holm, Lena W; Carroll, Linda J; Cassidy, J David; Skillgate, Eva; Ahlbom, Anders

2007-01-01

To investigate the incidence and course of widespread pain (WP) subsequent to localized pain in subjects with whiplash-associated disorders (WAD); and to investigate the influence of depressive symptoms, neck pain intensity, number of whiplash-associated symptoms, and number of painful body areas on such conditions. From a large prospective cohort of injury claimants who reported WAD after motor vehicle collision (MVC; n = 7462), we identified a subgroup with only localized head/neck/back pain, and who responded to one or more followup questionnaires mailed at 6 weeks and 4, 6, and 12 months after the MVC (n = 266). Pain drawings were distributed at the followup, and we defined WP as having 9 or more painful areas, including posterior neck, at any of these occasions. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale and pain intensity with on a visual analog scale (VAS). The cumulative incidence of WP was 21%, and it occurred early after the injury. Continuous WP over the 12 months was rare. The odds for developing WP were greater in those with depressive symptoms (OR 3.2, 95% CI 1.6-6.3), VAS pain intensity 55-100 (OR 3.2, 95% CI 1.3-8.0), reporting > or = 3 pain-associated symptoms (OR 1.9, 95% CI 0.9-3.8), and those reporting 4 or 5 painful body areas (OR 2.6, 95% CI 1.3-5.4). WP occurred early in the course. Even though the cumulative incidence was 21%, continuous WP was rare. Subjects with WAD who report early depressive symptoms and more severe neck injury symptoms are at risk of developing WP after MVC.

Report on a membership audit of the Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT).

PubMed

Berry, Gunnel; Svarovska, Beth

2014-08-01

Reflex Therapy (RT), akin to reflexology, is a non-invasive physiotherapy modality approved by the UK Chartered Society of Physiotherapists. One hundred members of the Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT) participated in an audit to establish a baseline of practice. Findings indicate that experienced therapists use RT in conjunction with their professional skills to induce relaxation (95%) and reduce pain (86%) for patients with conditions including whiplash injury and chronic pain. According to 68% of respondents, RT is "very good," "good" or "as good as" orthodox physiotherapy practices. Requiring minimal equipment, RT may be as cost effective as orthodox physiotherapy with regards to duration and frequency of treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluating the Epidemiology of Inflicted Traumatic Brain Injury in Infants of U.S. Military Families

DTIC Science & Technology

2008-01-01

subdural hematoma and whiplash injuries. Caffey3 in 1972 theorized that shaking was responsible for retinal hemorrhages and subdural or subarachnoid...and contusion 852.xx Subarachnoid, subdural , and extradural hemorrhage after injury 853.xx Other and unspecified intracranial hemorrhage following

Anthropometric specifications, development, and evaluation of EvaRID--a 50th percentile female rear impact finite element dummy model.

PubMed

Carlsson, Anna; Chang, Fred; Lemmen, Paul; Kullgren, Anders; Schmitt, Kai-Uwe; Linder, Astrid; Svensson, Mats Y

2014-01-01

Whiplash-associated disorders (WADs), or whiplash injuries, due to low-severity vehicle crashes are of great concern in motorized countries and it is well established that the risk of such injuries is higher for females than for males, even in similar crash conditions. Recent protective systems have been shown to be more beneficial for males than for females. Hence, there is a need for improved tools to address female WAD prevention when developing and evaluating the performance of whiplash protection systems. The objective of this study is to develop and evaluate a finite element model of a 50th percentile female rear impact crash test dummy. The anthropometry of the 50th percentile female was specified based on literature data. The model, called EvaRID (female rear impact dummy), was based on the same design concept as the existing 50th percentile male rear impact dummy, the BioRID II. A scaling approach was developed and the first version, EvaRID V1.0, was implemented. Its dynamic response was compared to female volunteer data from rear impact sled tests. The EvaRID V1.0 model and the volunteer tests compared well until ∼250 ms of the head and T1 forward accelerations and rearward linear displacements and of the head rearward angular displacement. Markedly less T1 rearward angular displacement was found for the EvaRID model compared to the female volunteers. Similar results were received for the BioRID II model when comparing simulated responses with experimental data under volunteer loading conditions. The results indicate that the biofidelity of the EvaRID V1.0 and BioRID II FE models have limitations, predominantly in the T1 rearward angular displacement, at low velocity changes (7 km/h). The BioRID II model was validated against dummy test results in a loading range close to consumer test conditions (EuroNCAP) and lower severity levels of volunteer testing were not considered. The EvaRID dummy model demonstrated the potential of becoming a valuable tool when evaluating and developing seats and whiplash protection systems. However, updates of the joint stiffness will be required to provide better correlation at lower load levels. Moreover, the seated posture, curvature of the spine, and head position of 50th percentile female occupants needs to be established and implemented in future models.

Maximal voluntary isometric neck strength deficits in adults with whiplash-associated disorders and association with pain and fear of movement.

PubMed

Pearson, Isabelle; Reichert, Alison; De Serres, Sophie J; Dumas, Jean-Pierre; Côté, Julie N

2009-03-01

Controlled laboratory study using a cross-sectional, repeated-measures design. To quantify maximal voluntary isometric neck forces in healthy subjects and individuals with whiplash-associated disorder (WAD), using an objective measurement system to evaluate the test-retest properties of these strength measurements and to assess the links between neck strength, pain, kinesiophobia, and catastrophizing in patients with WAD. The prognosis of WAD is difficult to predict due to a lack of objective measurement methods and to our limited understanding of the role of psychological factors in the development of chronic WAD symptoms. Fourteen subjects with chronic WAD grade I or II and an age-matched, healthy group (n = 28) participated in this study. Cervical strength was measured with the Multi-Cervical Unit (MCU) in 6 directions, and pain was measured with a visual analog scale. Individuals in the WAD group completed the Neck Disability Index (NDI), the Tampa Scale for Kinesiophobia (TSK), and the Pain Catastrophizing Scale (PCS). Significant deficits in strength were observed for the individuals in the WAD group compared to the healthy group, particularly in extension, retraction, and left lateral flexion (P<.05). The MCU demonstrated good intratester reliability for the healthy group (ICC = 0.80-0.92) and the WAD group (ICC = 0.85-0.98), and small standard errors of measurement for both groups. No significant association was found between neck strength and NDI, TSK, and PCS. The MCU demonstrated good test-retest properties for healthy subjects and individuals with WAD. Cervical strength was lower in individuals with WAD; however, the strength deficits were not clearly linked with psychological factors.

What Are the Predictors of Altered Central Pain Modulation in Chronic Musculoskeletal Pain Populations? A Systematic Review.

PubMed

Clark, Jacqui; Nijs, Jo; Yeowell, Gillian; Goodwin, Peter Charles

2017-09-01

Altered central pain modulation is the predominant pain mechanism in a proportion of chronic musculoskeletal pain disorders and is associated with poor outcomes. Although existing studies predict poor outcomes such as persistent pain and disability, to date there is little consensus on what factors specifically predict altered central pain modulation. To review the existing literature on the predictive factors specifically for altered central pain modulation in musculoskeletal pain populations. This is a systematic review in accordance with supplemented PRISMA guidelines. A systematic search was performed by 2 mutually blinded reviewers. Relevant articles were screened by title and abstract from Medline, Embase, PubMed, CINAHL, and Web of Science electronic databases. Alternative sources were also sought to locate missed potential articles. Eligibility included studies published in English, adults aged 18 to 65, musculoskeletal pain, baseline measurements taken at the pre-morbid or acute stage, > 3-month follow-up time after pain onset, and primary outcome measures specific to altered central pain modulation. Studies were excluded where there were concurrent diseases or they were non-predictive studies. Risk of bias was assessed using the quality in prognostic studies (QUIPS) tool. Study design, demographics, musculoskeletal region, inclusion/exclusion criteria, measurement timelines, predictor and primary outcome measures, and results were extracted. Data were synthesized qualitatively and strength of evidence was scored using the grading of recommendations, assessment, development, and evaluations (GRADE) scoring system. Nine eligible articles were located, in various musculoskeletal populations (whiplash, n = 2; widespread pain, n = 5; temporomandibular disorder, n = 2). Moderate evidence was found for 2 predictive factors of altered central pain modulation: 1) high sensory sensitivity (using genetic testing or quantitative sensory tests), and 2) psychological factors (somatization and poor self-expectation of recovery), at a pre-morbid or acute stage baseline. At the times of the article publications, the current definitions and clinical guidelines for identifying altered central pain modulation were not yet available. Careful interpretation of the information provided using current knowledge and published guidelines was necessary to extract information specific to altered central pain modulation in some of the studies, avoiding unwarranted assumptions. Premorbid and acute stage high sensory sensitivity and/or somatization are the strongest predictors of altered central pain modulation in chronic musculoskeletal pain to date. This is the first systematic review specifically targeting altered central pain modulation as the primary outcome in musculoskeletal pain populations. Early identification of people at risk of developing chronic pain with altered central pain modulation may guide clinicians in appropriate management, diminishing the burden of persistent pain on patients and heath care providers alike. Systematic Review Registration no.: PROSPERO 2015:CRD42015032394.Key words: Predictive factors, pre-morbid and acute stage baselines, altered central pain modulation, chronic musculoskeletal pain, sensory processing, somatization.

General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care.

PubMed

Brijnath, Bianca; Bunzli, Samantha; Xia, Ting; Singh, Nabita; Schattner, Peter; Collie, Alex; Sterling, Michele; Mazza, Danielle

2016-07-20

In Australia, general practitioners (GPs) see around two-thirds of people injured in road traffic crashes. Road traffic crash injuries are commonly associated with diverse physical and psychological symptoms that may be difficult to diagnose and manage. Clinical guidelines have been developed to assist in delivering quality, consistent care, however the extent to which GPs knowledge and practice in diagnosing and managing road traffic crash injuries concords with the guidelines is unknown. This study aimed to explore Australian GPs knowledge, attitudes and practices regarding the diagnosis and management of road traffic crash injuries, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD). A cross-sectional survey of 423 GPs across Australia conducted between July and December 2014. We developed a questionnaire to assess their knowledge of WAD and PTSD, confidence in diagnosing and managing WAD and PTSD, frequency of referral to health providers, barriers to referral, and attitudes towards further education and training. Factor analysis, Spearman's correlation, and multiple ordered logistic regressions were performed. Overall, GPs have good level knowledge of WAD and PTSD; only 9.6 % (95 % CI: 7.1 %, 12.8 %) and 23.9 % (95 % CI: 20.8 %, 28.2 %) of them were deemed to have lower level knowledge of WAD and PTSD respectively. Key knowledge gaps included imaging indicators for WAD and indicators for psychological referral for PTSD. GPs who were male, with more years of experience, working in the urban area and with higher knowledge level of WAD were more confident in diagnosing and managing WAD. Only GPs PTSD knowledge level predicted confidence in diagnosing and managing PTSD. GPs most commonly referred to physiotherapists and least commonly to vocational rehabilitation providers. Barriers to referral included out-of-pocket costs incurred by patients and long waiting times. Most GPs felt positive towards further education on road traffic crash injury management. This study has enhanced understanding of the knowledge skills and attitudes of GPs towards road traffic crash injury care in Australia, and has identified areas for further education and training. If delivered, this training has the potential to reduce unnecessary imaging for WAD and optimise the early referral of patients at risk of delayed recovery following a road traffic crash.

Measurement of intervertebral cervical motion by means of dynamic x-ray image processing and data interpolation.

PubMed

Bifulco, Paolo; Cesarelli, Mario; Romano, Maria; Fratini, Antonio; Sansone, Mario

2013-01-01

Accurate measurement of intervertebral kinematics of the cervical spine can support the diagnosis of widespread diseases related to neck pain, such as chronic whiplash dysfunction, arthritis, and segmental degeneration. The natural inaccessibility of the spine, its complex anatomy, and the small range of motion only permit concise measurement in vivo. Low dose X-ray fluoroscopy allows time-continuous screening of cervical spine during patient's spontaneous motion. To obtain accurate motion measurements, each vertebra was tracked by means of image processing along a sequence of radiographic images. To obtain a time-continuous representation of motion and to reduce noise in the experimental data, smoothing spline interpolation was used. Estimation of intervertebral motion for cervical segments was obtained by processing patient's fluoroscopic sequence; intervertebral angle and displacement and the instantaneous centre of rotation were computed. The RMS value of fitting errors resulted in about 0.2 degree for rotation and 0.2 mm for displacements.

Are psychological interventions effective for the management of neck pain and whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

PubMed

Shearer, Heather M; Carroll, Linda J; Wong, Jessica J; Côté, Pierre; Varatharajan, Sharanya; Southerst, Danielle; Sutton, Deborah A; Randhawa, Kristi A; Yu, Hainan; Mior, Silvano A; van der Velde, Gabrielle M; Nordin, Margareta C; Stupar, Maja; Taylor-Vaisey, Anne L

2016-12-01

In 2008, the lack of published evidence prevented the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force [NPTF]) from commenting on the effectiveness of psychological interventions for the management of neck pain. This study aimed to update findings of the NPTF and evaluate the effectiveness of psychological interventions for the management of neck pain and associated disorders (NAD) or whiplash-associated disorders (WAD). This study used systematic review and best-evidence synthesis. Randomized controlled trials, cohort studies, and case-control studies comparing psychological interventions to other non-invasive interventions or no intervention were the samples used in this study. The outcome measures are (1) self-rated recovery; (2) functional recovery; (3) clinical outcomes; (4) administrative outcomes; and (5) adverse effects. We searched six databases from 1990 to 2015. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers used the Scottish Intercollegiate Guidelines Network criteria to critically appraise eligible studies. Studies with a low risk of bias were synthesized following best evidence synthesis principles. This study was funded by the Ontario Ministry of Finance. We screened 1,919 articles, 19 were eligible for critical appraisal and 10 were judged to have low risk of bias. We found no clear evidence supporting relaxation training or cognitive behavioral therapy (CBT) for persistent grades I-III NAD for reducing pain intensity or disability. Similarly, we did not find evidence to support the effectiveness of biofeedback or relaxation training for persistent grade II WAD, and there is conflicting evidence for the use of CBT in this population. However, adding a progressive goal attainment program to functional restoration physiotherapy may benefit patients with persistent grades I-III WAD. Furthermore, Jyoti meditation may help reduce neck pain intensity and bothersomeness in patients with persistent NAD. We did not find evidence for or against the use of psychological interventions in patients with recent onset NAD or WAD. We found evidence that a progressive goal attainment program may be helpful for the management of persistent WAD and that Jyoti meditation may benefit patients with persistent NAD. The limited evidence of effectiveness for psychological interventions may be due to several factors, such as interventions that are ineffective, poorly conceptualized, or poorly implemented. Further methodologically rigorous research is needed. Copyright © 2015 Elsevier Inc. All rights reserved.

Willow establishment in relation to cattle grazing on an eastern Oregon stream

Treesearch

Nancy L. Shaw; Warren P. Clary

1996-01-01

Natural regeneration and growth of coyote willow (Salix exigua Nutt. ssp. exigua) and whiplash willow (S. lasiandra Bemth. var. caudata [Nutt.] Sudw.) were monitored from 1987 to 1993 on a low-elevation eastern Oregon stream degraded by more than a century of heavy livestock grazing. Treatments were no grazing, moderate spring grazing, moderate fall grazing, and...

Changes in Dorsal Neck Muscle Function in Individuals with Chronic Whiplash-Associated Disorders: A Real-Time Ultrasound Case-Control Study.

PubMed

Peterson, Gunnel; Nilsson, David; Peterson, Simon; Dedering, Åsa; Trygg, Johan; Wallman, Thorne; Peolsson, Anneli

2016-05-01

Impaired neck muscle function leads to disability in individuals with chronic whiplash-associated disorder (WAD), but diagnostic tools are lacking. In this study, deformations and deformation rates were investigated in five dorsal neck muscles during 10 arm elevations by ultrasonography with speckle tracking analyses. Forty individuals with chronic WAD (28 women and 12 men, mean age = 37 y) and 40 healthy controls matched for age and sex were included. The WAD group had higher deformation rates in the multifidus muscle during the first (p < 0.04) and 10th (only women, p < 0.01) arm elevations compared with the control group. Linear relationships between the neck muscles for deformation rate (controls: R(2) = 0.24-0.82, WAD: R(2) = 0.05-0.74) and deformation of the deepest muscles (controls: R(2) = 0.61-0.32, WAD: R(2) = 0.15-0.01) were stronger for women in the control group versus women with WAD, indicating there is altered interplay between dorsal neck muscles in chronic WAD. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Factors influencing neck pain intensity in whiplash-associated disorders.

PubMed

Holm, Lena W; Carroll, Linda J; Cassidy, J David; Ahlbom, Anders

2006-02-15

Cohort study of subjects with whiplash-associated disorders (WAD). To assess the association between preinjury factors and neck pain intensity within 30 days after a motor vehicle collision. Neck pain is the main symptom in WAD. There are studies of nonspecific musculoskeletal pain suggesting that pain intensity can be modified by psychologic, personal, or social factors, but, to our knowledge, no studies have investigated the association between such factors and neck pain intensity in WAD. The subjects (n = 5970) either filed a claim or were treated for neck pain within 30 days after a collision. Neck pain intensity was measured on the visual analog scale. Fair or poor health before the collision was associated with severe neck pain in females (odds ratio 4.0, 95% confidence interval 1.8-8.9). Other associated factors in females included low education and prior neck pain. Low family income was associated with severe neck pain in males (odds ratio 2.3, 95% confidence interval 1.5-3.4), as was prior headache and being unaware of the head position at the time of collision. The results suggest that neck pain intensity in WAD seems to be influenced by several factors other than characteristics related to the injury event itself.

Occipital Neuralgia Diagnosis and Treatment: The Role of Ultrasound.

PubMed

Narouze, Samer

2016-04-01

Occipital neuralgia is a form of neuropathic type of pain in the distribution of the greater, lesser, or third occipital nerves. Patients with intractable occipital neuralgia do not respond well to conservative treatment modalities. This group of patients represents a significant therapeutic challenge and may require interventional or invasive therapeutic approaches. Occipital neuralgia frequently occurs as a result of nerve entrapment or irritation by a tight muscle or vascular structure, or nerve trauma during whiplash injury. Although the entrapment theory is most commonly accepted, it lacks strong clinical evidence to support it. Accordingly, the available interventional approaches have been targeting the accessible part of the occipital nerve rather than the entrapped part. Bedside sonography is an excellent imaging modality for soft tissue structures. Ultrasound not only allows distinguishing normal from abnormal entrapped occipital nerves, it can identify the level and the cause of entrapment as well. Ultrasound guidance allows precise occipital nerve blocks and interventions at the level of the "specific" entrapment location rather than into the site of "presumed" entrapment. © 2016 American Headache Society.

Clinical presentation and manual therapy for upper quadrant musculoskeletal conditions

PubMed Central

Isabel de-la-Llave-Rincón, Ana; Puentedura, Emilio J; Fernández-de-las-Peñas, César

2011-01-01

In recent years, increased knowledge of the pathogenesis of upper quadrant pain syndromes has translated to better management strategies. Recent studies have demonstrated evidence of peripheral and central sensitization mechanisms in different local pain syndromes of the upper quadrant such as idiopathic neck pain, lateral epicondylalgia, whiplash-associated disorders, shoulder impingement, and carpal tunnel syndrome. Therefore, a treatment-based classification approach where subjects receive matched interventions has been developed and, it has been found that these patients experience better outcomes than those receiving non-matched interventions. There is evidence suggesting that the cervical and thoracic spine is involved in upper quadrant pain. Spinal manipulation has been found to be effective for patients with elbow pain, neck pain, or cervicobrachial pain. Additionally, it is known that spinal manipulative therapy exerts neurophysiological effects that can activate pain modulation mechanisms. This paper exposes some manual therapies for upper quadrant pain syndromes, based on a nociceptive pain rationale for modulating central nervous system including trigger point therapy, dry needling, mobilization or manipulation, and cognitive pain approaches. PMID:23115473

Cervicogenic headache: a critical review of the current diagnostic criteria.

PubMed

Leone, M; D'Amico, D; Grazzi, L; Attanasio, A; Bussone, G

1998-10-01

Opinions are divided on the use of the term cervicogenic headache (CGH) in cases with no evidence of cervical damage. According to Sjaastad et al. (1990), CGH is diagnosed from three features: (1) unilateral headache triggered by head/neck movements or posture; (2) unilateral headache triggered by pressure on the neck; (3) unilateral headache spreading to the neck and the homolateral shoulder/arm. Other characteristics are not essential for CGH diagnosis, including pain improvement after greater occipital nerve (GON)/C2 block. However, other authors give different definitions of CGH, and this may explain why reported frequencies for this headache vary so widely. In this paper we critically review the major diagnostic criteria of Sjaastad et al. for CGH in the light of clinical studies conducted at our institute and other literature findings. In a study of 500 headaches we found only two patients with unilateral headache triggered by head/ neck movements or posture, and no cases of neck pressure-induced headache. No clear-cut criteria are given in the literature for differentiating CGH trigger points from myofascial trigger points. In another study of 440 primary headache patients we found that in the unilateral long-lasting headache group (64 migraines and 10 tension-type headaches), a pain involving the occiput/neck was present in 30 migraine and seven tension headache patients; thus, according to the CGH major criteria, 10% (30/307) of 'migraines' and 7% (7/96) of 'tension headaches' could be diagnosed as CGH. However, one cannot exclude that the association of unilateral pain with posterior irradiation is due to the high prevalence of migraine, tension-type headache and chronic neck pain. The relation between CGH and whip-lash injury has been put in doubt by a recent study which found no difference in headache frequency between trauma and control groups and reported no specific headache pattern in the trauma group. Other reports suggest that, when it occurs, CGH usually disappears within a year of whip-lash, throwing doubt on the appropriateness of surgery for post-traumatic CGH. The lack of specificity of GON/C2 block as a treatment for CGH adds further difficulties to the diagnosis of this headache. We conclude that, although neck structures play a role in the pathophysiology of some headaches, clinical patterns indicating a neck-headache relationship have still not been adequately defined. We believe that further rigorous studies are needed to definitively confirm the validity of CGH as a nosological entity.

A Multidisciplinary Evaluation of Traumatic Brain Injury: Early Predictors of Outcome

DTIC Science & Technology

2007-04-01

undergoing an acceleration/deceleration movement (i.e., whiplash ) without direct external trauma to the head . Computed tomography (CT...mild head injury. J Neurol Neurosurg Psychiatry. 1985;48:137-140. Geurts ACH , Ribbers GM, Knoop JA, van Limbeek J. Identification of static and...boney) Injury 30 Facial Injury 13 Skull Fracture/ Head CT Findings 7 Symptoms (i.e. dizziness, nausea, vomiting) 10 Past Medical History 6 The NBM

A description of neck motor performance, neck pain, fatigue, and mental effort while driving in a sample with chronic whiplash-associated disorders.

PubMed

Takasaki, Hiroshi; Treleaven, Julia; Johnston, Venerina; Van den Hoorn, Wolbert; Rakotonirainy, Andry; Jull, Gwendolen

2014-08-01

Individuals with chronic whiplash-associated disorders (WADs) often note driving as a difficult task. This study's aims were to (1) compare, while driving, neck motor performance, mental effort, and fatigue in individuals with chronic WAD against healthy controls and (2) investigate the relationships of these variables and neck pain to self-reported driving difficulty in the WAD group. This study involved 14 participants in each group (WAD and control). Measures included self-reported driving difficulty and measures of neck pain intensity, overall fatigue, mental effort, and neck motor performance (head rotation and upper trapezius activity) while driving a simulator. The WAD group had greater absolute path of head rotation in a simulated city area and used greater mental effort (P = 0.04), but there were no differences in other measures while driving compared with the controls (all P ≥ 0.05). Self-reported driving difficulty correlated moderately with neck pain intensity, fatigue level, and maximum velocity of head rotation while driving in the WAD group (all P < 0.05). Individuals with chronic WAD do not seem to have impaired neck motor performance while driving yet use greater mental effort. Neck pain, fatigue, and maximum head rotation velocity could be potential contributors to self-reported driving difficulty in this group.

Simulation of Blast on Porcine Head

DTIC Science & Technology

2015-07-01

human cadaver heads (Wayne State Tolerance Curve), and concussive data from animals as well as long-duration human sled experiments have led to the...99% probability of producing concussion in Rhesus monkeys (whiplash injury on the sagittal plane) (Ommaya et al. 1967). However, since a single...correlated to brain injury—the critical rotation velocity ωcr = 42.1 rad/s and the critical acceleration αcr = 363 krad/ s2 for college football data

Models of Cerebral System Mechanics.

DTIC Science & Technology

1986-07-20

Hirsch, A.E. (1971) Tolerances for cerebral concussion from head impact and whiplash in primates. J. Biomech. 4:13-21. Pamidi, M.R. and Advani, S.H. (1978...elastic element (PAMIDI and ADVANI, 1978). In the literature on the mechanics of head impacts, the skull was ide- alized to be a rigid sphere with an...of the living cranium. J. Amer. Osteo. Assoc., 70, 928-945. GOLDSMITH, W. (1972) Biomechanics of head injuries. In Biomechanics: Its Foundations and

Hypnotizability in acute stress disorder.

PubMed

Bryant, R A; Guthrie, R M; Moulds, M L

2001-04-01

This study investigated the relationship between acute dissociative reactions to trauma and hypnotizability. Acutely traumatized patients (N=61) with acute stress disorder, subclinical acute stress disorder (no dissociative symptoms), and no acute stress disorder were administered the Stanford Hypnotic Clinical Scale within 4 weeks of their trauma. Although patients with acute stress disorder and patients with subclinical acute stress disorder displayed comparable levels of nondissociative psychopathology, acute stress disorder patients had higher levels of hypnotizability and were more likely to display reversible posthypnotic amnesia than both patients with subclinical acute stress disorder and patients with no acute stress disorder. The findings may be interpreted in light of a diathesis-stress process mediating trauma-related dissociation. People who develop acute stress disorder in response to traumatic experience may have a stronger ability to experience dissociative phenomena than people who develop subclinical acute stress disorder or no acute stress disorder.

Whiplash injury: cases with a long period of sick leave need biomechanical assessment.

PubMed

Schmitt, K-U; Walz, F; Vetter, D; Muser, M

2003-06-01

A total of 668 cases of cervical spine disorders (CSD) sustained in automotive collisions were analysed. All cases had a minimum sick leave duration of 4 weeks. To evaluate these cases a scheme was developed that takes into account technical, medical, and biomechanical aspects. For each case, the delta-v value of the underlying collision was estimated, the medical files were analysed, and a QTF (Québec Task Force) grade was assigned. In addition, the medical history of the patient was reviewed. It was found that the QTF grade for patients with pre-existing damage of the neck or pre-existing signs differed significantly from those patients without such a history. The overall assessment, which stated the extent to which the symptoms claimed could be explained by the impact, was also found to be significantly influenced by a history of neck injury. The results of the study showed that in about 50% of the cases where the technical analysis alone would not suggest that the symptoms shown could be explained by the impact, those symptoms could be explained when patient history and the collision circumstances were taken into consideration. It also found that medical evaluation based on a QTF grade alone cannot assess the explicability of claimed CSD without taking into account the collision circumstances. Therefore, the assessment of critical individual relevant biomechanical factors is necessary.

Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

PubMed

Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

2015-12-01

Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to the head and neck induced by a sudden braking event in a commonly experienced non-collision traffic incident. The likely mechanism of injury resulted from interaction between the occupant and the 3-point seat belt. These findings indicate that ICA dissections are substantially more likely to be associated with SAH following head and neck trauma, regardless of the magnitude of the traumatic event or whether an impact was involved.

PTSD-8: A Short PTSD Inventory

PubMed Central

Hansen, Maj; Andersen, Tonny Elmose; Armour, Cherie; Elklit, Ask; Palic, Sabina; Mackrill, Thomas

2010-01-01

Traumatic events pose great challenges on mental health services in scarcity of specialist trauma clinicians and services. Simple short screening instruments for detecting adverse psychological responses are needed. Several brief screening instruments have been developed. However, some are limited, especially in relation to reflecting the posttraumatic stress disorder (PTSD) diagnosis. Recently, several studies have challenged pre-existing ideas about PTSD’s latent structure. Factor analytic research currently supports two four factor models. One particular model contains a dysphoria factor which has been associated with depression and anxiety. The symptoms in this factor have been hailed as less specific to PTSD. The scope of this article is therefore to present a short screening instrument, based on this research; Posttraumatic Stress Disorder (PTSD) – 8 items. The PTSD-8 is shown to have good psychometric properties in three independent samples of whiplash patients (n=1710), rape victims (n=305), and disaster victims (n=516). Good test-rest reliability is also shown in a pilot study of young adults from families with alcohol problems (n=56). PMID:21253461

PTSD-8: A Short PTSD Inventory.

PubMed

Hansen, Maj; Andersen, Tonny Elmose; Armour, Cherie; Elklit, Ask; Palic, Sabina; Mackrill, Thomas

2010-09-28

Traumatic events pose great challenges on mental health services in scarcity of specialist trauma clinicians and services. Simple short screening instruments for detecting adverse psychological responses are needed. Several brief screening instruments have been developed. However, some are limited, especially in relation to reflecting the posttraumatic stress disorder (PTSD) diagnosis. Recently, several studies have challenged pre-existing ideas about PTSD's latent structure. Factor analytic research currently supports two four factor models. One particular model contains a dysphoria factor which has been associated with depression and anxiety. The symptoms in this factor have been hailed as less specific to PTSD. The scope of this article is therefore to present a short screening instrument, based on this research; Posttraumatic Stress Disorder (PTSD) - 8 items. The PTSD-8 is shown to have good psychometric properties in three independent samples of whiplash patients (n=1710), rape victims (n=305), and disaster victims (n=516). Good test-rest reliability is also shown in a pilot study of young adults from families with alcohol problems (n=56).

Parameterization of Injury Victim Condition as a Function of Time

DTIC Science & Technology

1976-05-01

degree burns. HEAD AND NECK --- Cerebral injury with headache; dizziness; no loss of consciousness. --- " Whiplash " complaint with no anatomical or...34Probability of Survival Tables", was derived for three injury categories: Compound and Comminuted Fractures of the Head , 4.4 [-44 0 N. >w 044 Ci2V ri) w...Commuklity Injury Category Ambulance Helicopter No Facilitie. Head Injuries .36 .34 (no treatment) Face Injuries .19 .15 Extremity Injuries .16 .13 No

Mild Head Trauma and Chronic Headaches in Returning US Soldiers

DTIC Science & Technology

2009-04-01

incidence and types of head or neck trauma among a cohort of US soldiers evaluated for chronic head - aches at a military neurology clinic following a...29.1 years. Head or neck trauma occurred during deployment in 33 of 81 (41%) of the soldiers referred to our clinic for head - aches . The causes of...consciousness. Ten soldiers also experienced a whiplash or neck injury while deployed. Multiple head or neck inju- Fig—Mechanism of head or neck

Anthropometry. A Bibliography with Abstracts

DTIC Science & Technology

1975-08-01

nces fro signific e shirt- (Author) o US per ach ions wea ed. angu obta m t ant slee AF pilots sonal p en velone : d) s ring com...side measured bility. s of the human neck which may influence a person’s • whiplash ’ injury during lateral impact have oeen mal subjects. Subjects...group of lb subjects Deing n average stature close to the both ptrcentile tor data include: measures of head , neck and body anding and normal

Whiplash injury is more than neck pain: a population-based study of pain localization after traffic injury.

PubMed

Hincapié, Cesar A; Cassidy, J David; Côté, Pierre; Carroll, Linda J; Guzmán, Jaime

2010-04-01

To describe the distribution of bodily pain and identify common patterns of pain localization after traffic injury. Cross-sectional analysis of a population-based cohort of 6481 Saskatchewan residents who were treated or filed an auto insurance claim within 30 days of traffic injury or both. The prevalence of pain in each of 13 body areas was calculated and compared with pain confined exclusively to each of these areas. Principal component analysis was used to identify the main patterns of pain localization after traffic injury. Irrespective of pain in other areas, 86% of respondents reported posterior neck pain, 72% indicated head pain, and 60% noted lumbar back pain. Ninety-five percent of claimants reported some pain within the posterior trunk region, comprising the posterior neck, shoulder, mid-back, lumbar, and buttock areas. Only 0.4% of respondents reported posterior neck pain only. Four main patterns accounted for 60% of the variance in pain localization: 1) upper anterior trunk and upper extremity pain; 2) head, posterior neck, and upper posterior trunk pain; 3) low back pain; and 4) lower anterior trunk and lower extremity pain. Pain after traffic injury is most commonly reported in multiple body areas; isolated neck pain is extremely rare. These results have implications for clinical management of traffic injuries and interpretation of whiplash-related trials.

Outcome of Acute Pancreatic and Peripancreatic Collections Occurring in Patients With Acute Pancreatitis.

PubMed

Manrai, Manish; Kochhar, Rakesh; Gupta, Vikas; Yadav, Thakur Deen; Dhaka, Narendra; Kalra, Naveen; Sinha, Saroj K; Khandelwal, Niranjan

2018-02-01

To study the outcome of acute collections occurring in patients with acute pancreatitis BACKGROUND:: There are limited data on natural history of acute collections arising after acute pancreatitis (AP). Consecutive patients of AP admitted between July 2011 and December 2012 were evaluated by imaging for development of acute collections as defined by revised Atlanta classification. Imaging was repeated at 1 and 3 months. Spontaneous resolution, evolution, and need for intervention were assessed. Of the 189 patients, 151 patients (79.9%) had acute collections with severe disease and delayed hospitalization being predictors of acute collections. Thirty-six patients had acute interstitial edematous pancreatitis, 8 of whom developed acute peripancreatic fluid collections, of which 1 evolved into pseudocyst. Among the 153 patients with acute necrotizing pancreatitis, 143 (93.4%) developed acute necrotic collection (ANC). Twenty-three of 143 ANC patients died, 21 had resolved collections, whereas 84 developed walled-off necrosis (WON), with necrosis >30% (P = 0.010) and Computed Tomographic Severity Index score ≥7 (P = 0.048) predicting development of WON. Of the 84 patients with WON, 8 expired, 53 patients required an intervention, and 23 were managed conservatively. Independent predictors of any intervention among all patients were Computed Tomographic Severity Index score ≥7 (P < 0.001) and interval between onset of pain to hospitalization >7 days (P = 0.04). Patients with severe AP and delayed hospitalization more often develop acute collections. Pancreatic pseudocysts are a rarity in acute interstitial pancreatitis. A majority of patients with necrotising pancreatitis will develop ANC, more than half of whom will develop WON. Delay in hospitalization and higher baseline necrosis score predict need for intervention.

Use of high-resolution 3.0-T magnetic resonance imaging to characterize atherosclerotic plaques in patients with cerebral infarction

PubMed Central

XU, PENG; LV, LULU; LI, SHAODONG; GE, HAITAO; RONG, YUTAO; HU, CHUNFENG; XU, KAI

2015-01-01

The present study aimed to evaluate the utility of high-resolution magnetic resonance imaging (MRI) in the characterization of atherosclerotic plaques in patients with acute and non-acute cerebral infarction. High-resolution MRI of unilateral stenotic middle cerebral arteries was performed to evaluate the degree of stenosis, the wall and plaque areas, plaque enhancement patterns and lumen remodeling features in 15 and 17 patients with acute and non-acute cerebral infarction, respectively. No significant difference was identified in the vascular stenosis rate between acute and non-acute patients. Overall, plaque eccentricity was observed in 29 patients, including 13 acute and 16 non-acute cases, with no significant difference identified between these groups. The wall area of stenotic arteries and the number of cases with plaque enhancement were significantly greater in the acute patients, but no significant difference in plaque or lumen area was identified between the 2 patient groups. Lumen remodeling patterns of stenotic arteries significantly differed between the acute and non-acute patients; the former predominantly demonstrated positive remodeling, and the latter group demonstrated evidence of negative remodeling. In conclusion, patients with acute and non-acute cerebral infarction exhibit specific characteristics in stenotic arteries and plaques, which can be effectively evaluated by high-resolution MRI. PMID:26668651

Balance performance and self-perceived handicap among dizzy patients in primary health care.

PubMed

Hansson, Eva Ekvall; Månsson, Nils-Ove; Håkansson, Anders

2005-12-01

To study the diagnostic panorama at a primary health care centre where the physiotherapist is specialized in dizziness. To study balance measures of dizzy patients as well as measures of self-perceived handicap and to analyse whether these measures correlate. Retrospective study of computerized medical records. A primary health care centre in Malmö, Sweden. A total of 119 patients with dizziness, 73 women and 46 men, aged from 22 to 90 years. Diagnoses according to specified criteria. Four balance measures: tandem standing, standing on one leg, walking in a figure of eight, and walking heel to toe on a line. The Dizziness Handicap Inventory (DHI). Six different groups of diagnoses were found: multisensory dizziness, peripheral vestibular disorder, dizziness as a symptom caused by whiplash-associated disorder, unspecific dizziness, phobic postural vertigo, and dizziness of cervical origin. The group with multisensory dizziness performed poorer on the balance measures than the other groups. The group with phobic postural vertigo had the highest total scores on DHI, while the vestibular group had the lowest total score. Subjects over 65 years old had more disturbances in balance, but a lower level of self-perceived handicap, than subjects aged 65 or younger. DHI did not correlate with any of the balance measures. Self-perceived handicap, measured with DHI, and disturbed balance measured with clinical methods, do not necessarily correlate. Elderly patients with dizziness seem to have more disturbances in balance than younger patients but a lower level of self-perceived handicap.

Acute Respiratory Failure in Cardiac Transplant Recipients.

PubMed

Komurcu, Ozgur; Ozdemirkan, Aycan; Camkiran Firat, Aynur; Zeyneloglu, Pinar; Sezgin, Atilla; Pirat, Arash

2015-11-01

This study sought to evaluate the incidence, risk factors, and outcomes of acute respiratory failure in cardiac transplant recipients. Cardiac transplant recipients >15 years of age and readmitted to the intensive care unit after cardiac transplant between 2005 and 2015 were included. Thirty-nine patients were included in the final analyses. Patients with acute respiratory failure and without acute respiratory failure were compared. The most frequent causes of readmission were routine intensive care unit follow-up after endomyocardial biopsy, heart failure, sepsis, and pneumonia. Patients who were readmitted to the intensive care unit were further divided into 2 groups based on presence of acute respiratory failure. Patients' ages and body weights did not differ between groups. The groups were not different in terms of comorbidities. The admission sequential organ failure assessment scores were higher in patients with acute respiratory failure. Patients with acute respiratory failure were more likely to use bronchodilators and n-acetylcysteine before readmission. Mean peak inspiratory pressures were higher in patients in acute respiratory failure. Patients with acute respiratory failure developed sepsis more frequently and they were more likely to have hypotension. Patients with acute respiratory failure had higher values of serum creatinine before admission to intensive care unit and in the first day of intensive care unit. Patients with acute respiratory failure had more frequent bilateral opacities on chest radiographs and positive blood and urine cultures. Duration of intensive care unit and hospital stays were not statistically different between groups. Mortality in patients with acute respiratory failure was 76.5% compared with 0% in patients without acute respiratory failure. A significant number of cardiac transplant recipients were readmitted to the intensive care unit. Patients presenting with acute respiratory failure on readmission more frequently developed sepsis and hypotension, suggesting a poorer prognosis.

The Olson method for detection of acute myocardial ischemia in patients with coronary occlusion.

PubMed

Lindow, Thomas; Olson, Charles W; Swenne, Cees A; Man, Sumche; Pahlm, Olle

An automated ECG-based method may provide diagnostic support in the management of patients with acute coronary syndrome. The Olson method has previously proved to accurately identify the culprit artery in patients with acute coronary occlusion. The Olson method was applied to 360 patients without acute myocardial ischemia and 52 patients with acute coronary occlusion. This study establishes the normal variation of the Olson wall scores in patients without acute myocardial ischemia, which provides the basis for implementation of the Olson method for triage of patients with acute coronary syndrome. All patients with acute occlusion had Olson wall scores above the upper limit of normal. The Olson method can be used for ischemia detection with very high sensitivity. Future studies are needed to explore specificity in patients with non-ischemic ST elevation. Copyright © 2016 Elsevier Inc. All rights reserved.

Is further evaluation for growth hormone (GH) deficiency necessary in fibromyalgia patients with low serum insulin-like growth factor (IGF)-I levels?

PubMed

Yuen, Kevin C J; Bennett, Robert M; Hryciw, Cheryl A; Cook, Marie B; Rhoads, Sharon A; Cook, David M

2007-02-01

Fibromyalgia (FM) is characterized by diffuse pain, fatigue, and sleep disturbances; symptoms that resemble the adult growth hormone (GH) deficiency syndrome. Many FM patients have low serum GH levels, with a hypothesized aetiology of dysregulated GH/insulin-like growth factor (IGF)-I axis. The aim of this study was to assess the GH reserve in FM patients with low serum IGF-I levels using the GH-releasing hormone (GHRH)-arginine test. We retrospectively reviewed the GHRH-arginine data of 77 FM patients with low serum IGF-I levels referred to our tertiary unit over a 4-year period. Of the 77 FM patients, 13 patients (17%) failed the GHRH-arginine test. Further evaluation with pituitary imaging revealed normal pituitary glands (n=7), coincident microadenomas (n=4), empty sella (n=1) and pituitary cyst (n=1), and relevant medical histories such as previous head injury (n=4), Sheehan's syndrome (n=1), and whiplash injury (n=1). In contrast, the remaining 64 patients (83%) that responded to the GHRH-arginine test demonstrated higher peak GH levels compared to age and BMI-matched controls (n=24). Our data shows that a subpopulation of FM patients with low serum IGF-I levels will fail the GHRH-arginine test. We, thus, recommend that the GH reserve of these patients should be evaluated further, as GH replacement may potentially improve the symptomatology of those with true GH deficiency. Additionally, the increased GH response rates to GHRH-arginine stimulation in the majority of FM patients with low serum IGF-I levels further supports the hypothesis of a dysregulated GH/IGF-I axis in the pathophysiology of FM.

Understanding the Effects of Blast Wave on the Intracranial Pressure and Traumatic Brain Injury in Rodents and Humans Using Experimental Shock Tube and Numerical Simulations

DTIC Science & Technology

2014-07-01

common mechanism of injury responsible for 52% TBI cases overall [24]. The analysis also showed that intracranial injuries, particularly concussions ...about the same time Ommaya and his collegues developed scaling relations (based on Holbourn’s theory) to scale experimental concussion data on sub-human...primates to concussion threshold in man [86]. The primates were subjected to head impact and whiplash in order to produce concussions in them [87

Intracutaneous sterile water for back pain in labour.

PubMed Central

Reynolds, J. L.

1994-01-01

Intracutaneous sterile water appears to be a simple, effective, and harmless technique for relieving back pain. This technique has been used to relieve pain of renal colic, whiplash, and back pain in labour. Family doctors often practise obstetrics in small or isolated units that have limited options for pain relief in labour. This technique is simple, is easy to learn, and appears effective for relieving back pain, which complicates about one third of all labours. Images Figures 1-2 Figures 3-4 PMID:7950471

Tearing at the Fabric - A Spiritual Journey Through Crisis and Trauma,

DTIC Science & Technology

1995-05-01

we find ourselves caught up in empathetic whiplash and sympathetic traction. Our intention is that you find this sampler of crisis and trauma...not immunize us from gnashing our teeth at the horrible sights and stories in Cook County Hospital’s Trauma and Burn Units. Heads smashed to pulp like...and paddle before heading up life’s Crisis Creek. Before any crisis occurs, determine what you are about in ministry and how you shall pattern your

Systemic classification for a new diagnostic approach to acute abdominal pain in children.

PubMed

Kim, Ji Hoi; Kang, Hyun Sik; Han, Kyung Hee; Kim, Seung Hyo; Shin, Kyung-Sue; Lee, Mu Suk; Jeong, In Ho; Kim, Young Sil; Kang, Ki-Soo

2014-12-01

With previous methods based on only age and location, there are many difficulties in identifying the etiology of acute abdominal pain in children. We sought to develop a new systematic classification of acute abdominal pain and to give some helps to physicians encountering difficulties in diagnoses. From March 2005 to May 2010, clinical data were collected retrospectively from 442 children hospitalized due to acute abdominal pain with no apparent underlying disease. According to the final diagnoses, diseases that caused acute abdominal pain were classified into nine groups. The nine groups were group I "catastrophic surgical abdomen" (7 patients, 1.6%), group II "acute appendicitis and mesenteric lymphadenitis" (56 patients, 12.7%), group III "intestinal obstruction" (57 patients, 12.9%), group IV "viral and bacterial acute gastroenteritis" (90 patients, 20.4%), group V "peptic ulcer and gastroduodenitis" (66 patients, 14.9%), group VI "hepatobiliary and pancreatic disease" (14 patients, 3.2%), group VII "febrile viral illness and extraintestinal infection" (69 patients, 15.6%), group VIII "functional gastrointestinal disorder (acute manifestation)" (20 patients, 4.5%), and group IX "unclassified acute abdominal pain" (63 patients, 14.3%). Four patients were enrolled in two disease groups each. Patients were distributed unevenly across the nine groups of acute abdominal pain. In particular, the "unclassified abdominal pain" only group was not uncommon. Considering a systemic classification for acute abdominal pain may be helpful in the diagnostic approach in children.

Systemic Classification for a New Diagnostic Approach to Acute Abdominal Pain in Children

PubMed Central

Kim, Ji Hoi; Kang, Hyun Sik; Han, Kyung Hee; Kim, Seung Hyo; Shin, Kyung-Sue; Lee, Mu Suk; Jeong, In Ho; Kim, Young Sil

2014-01-01

Purpose With previous methods based on only age and location, there are many difficulties in identifying the etiology of acute abdominal pain in children. We sought to develop a new systematic classification of acute abdominal pain and to give some helps to physicians encountering difficulties in diagnoses. Methods From March 2005 to May 2010, clinical data were collected retrospectively from 442 children hospitalized due to acute abdominal pain with no apparent underlying disease. According to the final diagnoses, diseases that caused acute abdominal pain were classified into nine groups. Results The nine groups were group I "catastrophic surgical abdomen" (7 patients, 1.6%), group II "acute appendicitis and mesenteric lymphadenitis" (56 patients, 12.7%), group III "intestinal obstruction" (57 patients, 12.9%), group IV "viral and bacterial acute gastroenteritis" (90 patients, 20.4%), group V "peptic ulcer and gastroduodenitis" (66 patients, 14.9%), group VI "hepatobiliary and pancreatic disease" (14 patients, 3.2%), group VII "febrile viral illness and extraintestinal infection" (69 patients, 15.6%), group VIII "functional gastrointestinal disorder (acute manifestation)" (20 patients, 4.5%), and group IX "unclassified acute abdominal pain" (63 patients, 14.3%). Four patients were enrolled in two disease groups each. Conclusion Patients were distributed unevenly across the nine groups of acute abdominal pain. In particular, the "unclassified abdominal pain" only group was not uncommon. Considering a systemic classification for acute abdominal pain may be helpful in the diagnostic approach in children. PMID:25587522

Spontaneous Recanalization After Carotid Artery Dissection: The Case for an Ultrasound-Only Monitoring Strategy

PubMed Central

Lumsden, Sarah; Rosta, Gabor; Bismuth, Jean; Lumsden, Alan B.; Garami, Zsolt

2017-01-01

Dissection of the internal carotid artery (ICA) accounts for 5% to 25% of ischemic strokes in young adults. We report a case of spontaneous recanalization of a traumatic ICA dissection in which carotid duplex (CDU) and transcranial color-coded duplex ultrasound (TCCD) were used. A 47-year-old male presented with intermittent episodes of headache, blurry vision, anisocoria, and loss of taste sensation following a whiplash injury while body surfing. Magnetic resonance angiogram (MRA) of the neck revealed absent flow in the cavernous ICA and a clot at the skull base. Carotid duplex, used to further evaluate flow, demonstrated reverberating color Doppler and spectrum signal. A TCCD showed ICA occlusion and smaller-caliber intracranial ICA. The patient reported for follow-up after 1 month on anticoagulation therapy. Upon his return, CDU and TCCD were normal and the ICA showed normal color and spectrum signals. Computed tomography angiogram confirmed ultrasound findings of a dramatic improvement of ICA patency. Additionally, the patient reported that his headaches had resolved. Extracranial CDU and TCCD are useful for monitoring patient progress in cases of spontaneous recanalization following carotid artery dissection. These inexpensive and noninvasive imaging modalities proved to be critical in the initial and follow-up evaluations of the extracranial and intracranial vascular system, providing a strong alternative to expensive magnetic resonance imaging and invasive angiograms and offering more hemodynamic information than “static” MRA. PMID:29744017

Treatment of central sensitization in patients with 'unexplained' chronic pain: what options do we have?

PubMed

Nijs, Jo; Meeus, Mira; Van Oosterwijck, Jessica; Roussel, Nathalie; De Kooning, Margot; Ickmans, Kelly; Matic, Milica

2011-05-01

Central sensitization accounts for chronic 'unexplained' pain in a wide variety of disorders, including chronic whiplash-associated disorders, temporomandibular disorders, chronic low back pain, osteoarthritis, fibromyalgia, chronic fatigue syndrome and chronic tension-type headache among others. Given the increasing evidence supporting the clinical significance of central sensitization in those with unexplained chronic pain, the awareness is growing that central sensitization should be a treatment target in these patients. This article provides an overview of the treatment options available for desensitizing the CNS in patients with chronic pain due to central sensitization. It focuses on those strategies that specifically target pathophysiological mechanisms known to be involved in central sensitization. In addition, pharmacological options, rehabilitation and neurotechnology options are discussed. Acetaminophen, serotonin-reuptake inhibitor drugs, selective and balanced serototin and norepinephrine-reuptake inhibitor drugs, the serotonin precursor tryptophan, opioids, N-methyl-d-aspartate (NMDA)-receptor antagonists, calcium-channel alpha(2)delta (a2δ) ligands, transcranial magnetic stimulation, transcutaneous electric nerve stimulation (TENS), manual therapy and stress management each target central pain processing mechanisms in animals that - theoretically - desensitize the CNS in humans. To provide a comprehensive treatment for 'unexplained' chronic pain disorders characterized by central sensitization, it is advocated to combine the best evidence available with treatment modalities known to target central sensitization. © 2011 Informa UK, Ltd

Comparing the Clinical Features and Outcomes of Acute Hepatitis E Viral Infections with Those of Acute Hepatitis A, B, and C Infections in Korea.

PubMed

Oh, Hye Won; Cha, Ra Ri; Lee, Sang Soo; Lee, Chang Min; Kim, Wan Soo; Jo, Yun Won; Kim, Jin Joo; Lee, Jae Min; Kim, Hong Jun; Ha, Chang Yoon; Kim, Hyun Jin; Kim, Tae Hyo; Jung, Woon Tae; Lee, Ok Jae

2017-01-01

This study investigated the etiology of acute viral hepatitis and compared the clinical features of hepatitis E virus (HEV) infections with those of other acute viral hepatitis infections in Korea. This study included 2,357 consecutive patients who were diagnosed with acute hepatitis, based on acute illness with jaundice or elevated alanine aminotransferase levels (>100 IU/L), between January 2007 and January 2016. Acute viral infections were observed in 23 (19.8%) patients with HEV, 49 (42.2%) patients with hepatitis A virus, 28 (24.1%) patients with hepatitis B virus, and 16 (13.8%) patients with hepatitis C virus. The incidence of acute HEV infection was higher among older patients (median age: 49 years) and male patients (69.6%), and was associated with the consumption of undercooked or uncooked meat (43.5%). Half of the acute HEV infections involved underlying liver disease, such as alcoholic liver disease, chronic hepatitis B, common bile duct stones, and autoimmune hepatitis. Two HEV-infected patients were diagnosed with Guillain-Barré syndrome, although no patients developed fulminant hepatitis. Our findings indicate that HEV infection in Korea is frequently transmitted through the consumption of raw meat and may cause acute or chronic liver disease. © 2017 S. Karger AG, Basel.

Can the dissociative PTSD subtype be identified across two distinct trauma samples meeting caseness for PTSD?

PubMed

Hansen, Maj; Műllerová, Jana; Elklit, Ask; Armour, Cherie

2016-08-01

For over a century, the occurrence of dissociative symptoms in connection to traumatic exposure has been acknowledged in the scientific literature. Recently, the importance of dissociation has also been recognized in the long-term traumatic response within the DSM-5 nomenclature. Several studies have confirmed the existence of the dissociative posttraumatic stress disorder (PTSD) subtype. However, there is a lack of studies investigating latent profiles of PTSD solely in victims with PTSD. This study investigates the possible presence of PTSD subtypes using latent class analysis (LCA) across two distinct trauma samples meeting caseness for DSM-5 PTSD based on self-reports (N = 787). Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in a dissociative compared with a non-dissociative PTSD class. The results of LCA revealed a two-class solution with two highly symptomatic classes: a dissociative class and a non-dissociative class across both samples. Increased emotion-focused coping increased the probability of individuals being grouped into the dissociative class across both samples. Social support reduced the probability of individuals being grouped into the dissociative class but only in the victims of motor vehicle accidents (MVAs) suffering from whiplash. The results are discussed in light of their clinical implications and suggest that the dissociative subtype can be identified in victims of incest and victims of MVA suffering from whiplash meeting caseness for DSM-5 PTSD.

Cervico-ocular coordination during neck rotation is distorted in people with whiplash-associated disorders.

PubMed

Bexander, Catharina S M; Hodges, Paul W

2012-03-01

People with whiplash-associated disorders (WAD) not only suffer from neck/head pain, but commonly report deficits in eye movement control. Recent work has highlighted a strong relationship between eye and neck muscle activation in pain-free subjects. It is possible that WAD may disrupt the intricate coordination between eye and neck movement. Electromyographic activity (EMG) of muscles that rotate the cervical spine to the right (left sternocleidomastoid, right obliquus capitis inferior (OI), right splenius capitis (SC) and right multifidus (MF)) was recorded in nine people with chronic WAD. Cervical rotation was performed with five gaze conditions involving different gaze directions relative to cervical rotation. The relationship between eye position/movement and neck muscle activity was contrasted with previous observations from pain-free controls. Three main differences were observed in WAD. First, the superficial muscle SC was active with both directions of cervical rotation in contrast to activity only with right rotation in pain-free controls. Second, activity of OI and MF varied between directions of cervical rotation, unlike the non-direction-specific activity in controls. Third, the effect of horizontal gaze direction on neck muscle EMG was augmented compared to controls. These observations provide evidence of redistribution of activity between neck muscles during cervical rotation and increased interaction between eye and neck muscle activity in people with WAD. These changes in cervico-ocular coordination may underlie clinical symptoms reported by people with WAD that involve visual deficits and changes in function during cervical rotation such as postural control.

Deranged jaw-neck motor control in whiplash-associated disorders.

PubMed

Eriksson, Per-Olof; Zafar, Hamayun; Häggman-Henrikson, Birgitta

2004-02-01

Recent findings of simultaneous and well coordinated head-neck movements during single as well as rhythmic jaw opening-closing tasks has led to the conclusion that 'functional jaw movements' are the result of activation of jaw as well as neck muscles, leading to simultaneous movements in the temporomandibular, atlanto-occipital and cervical spine joints. It can therefore be assumed that disease or injury to any of these joint systems would disturb natural jaw function. To test this hypothesis, amplitudes, temporal coordination, and spatiotemporal consistency of concomitant mandibular and head-neck movements during single maximal jaw opening-closing tasks were analysed in 25 individuals suffering from whiplash-associated disorders (WAD) using optoelectronic movement recording technique. In addition, the relative durations for which the head position was equal to, leading ahead of, or lagging behind the mandibular position during the entire jaw opening-closing cycle were determined. Compared with healthy individuals, the WAD group showed smaller amplitudes, and changed temporal coordination between mandibular and head-neck movements. No divergence from healthy individuals was found for the spatiotemporal consistency or for the analysis during the entire jaw opening-closing cycle. These findings in the WAD group of a 'faulty', but yet consistent, jaw-neck behavior may reflect a basic importance of linked control of the jaw and neck sensory-motor systems. In conclusion, the present results suggest that neck injury is associated with deranged control of mandibular and head-neck movements during jaw opening-closing tasks, and therefore might compromise natural jaw function.

Impaired positioning of the gape in whiplash-associated disorders.

PubMed

Zafar, Hamayun; Nordh, Erik; Eriksson, Per-Olof

2006-01-01

We have previously introduced a new concept for natural jaw function suggesting that "functional jaw movements" are the result of coordinated jaw and neck muscle activation, leading to simultaneous movements in the temporomandibular, atlanto-occipital and cervical spine joints. Thus, jaw function requires a healthy state of both the jaw and the neck motor systems. The aim of this study was to examine the positioning of the gape in space during maximal jaw opening at fast and slow speed in healthy as well as whiplash-associated disorders (WAD) individuals. A wireless optoelectronic technique for three-dimensional movement recording was used. Subjects were seated in an upright position, with back support up to the mid-scapular level without headrest. The position of the gape in space was defined as the vertical midpoint position of the gape at maximal jaw opening (MP). In healthy, the MP generally coincided with the reference position at the start of jaw opening. In the WAD group, the MP was significantly lower than the reference position. No sex or speed related differences were found. The results suggest that both the width and orientation of the gape in space relies on coordinated jaw and neck muscle activation and mandibular and head-neck movements. This study also suggests an association between neck pain and dysfunction following trauma, and reduced width and impaired positioning of the gape in space. Finally, the MP seems to be a useful marker in evaluation of the functional state of the jaw-neck motor system.

Neck pain with radiculopathy.

PubMed

Bhagawati, Dimpu; Gwilym, Stephen

2015-12-23

Non-specific neck pain has a postural or mechanical basis and affects about two-thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration-deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of surgical treatments for neck pain with radiculopathy? What are the effects of injection treatments for neck pain with radiculopathy? What are the effects of drug treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). At this update, searching of electronic databases retrieved 368 studies. After deduplication and removal of conference abstracts, 226 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 142 studies and the further review of 41 full publications. Of the 41 full articles evaluated, four systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for three PICO combinations. In this systematic overview, we categorised the efficacy for three interventions based on information about the effectiveness and safety of drug treatments, injection treatments, and surgical treatments.

Symptoms of acute myocardial infarction: A correlational study of the discrepancy between patients' expectations and experiences.

PubMed

Abed, Mona A; Ali, Raeda M Abu; Abu Ras, Motaz M; Hamdallah, Faten O; Khalil, Amani A; Moser, Debra K

2015-10-01

Patients' responses to acute myocardial infarction symptoms are affected by symptom incongruence, which is the difference between the symptoms they expect to experience and the symptoms they actually experienced during an acute myocardial infarction. To examine the relationship of patients' demographics, clinical characteristics and sources of information about acute myocardial infarction with their symptom expectations, actual experiences and symptom incongruence. Descriptive correlational study. Patients were recruited from ten hospitals in the two most populated cities in Jordan (Amman and Al Zarqa). Jordanian patients with acute myocardial infarction were recruited. Inclusion criteria were age 18 years or older, diagnosis of acute myocardial infarction, oriented, mentally competent and fluent in Arabic. Exclusion criteria were experiencing acute myocardial infarction during a hospitalization or having severe psychiatric illnesses. The Morgan Incongruence of Heart Attack Symptoms Index was used to quantify symptom incongruence and identify patients' expected and experienced acute myocardial infarction symptoms. Patients' information sources about acute myocardial infarction and demographic and clinical characteristics were collected by interview and medical chart review. Patients (N=299) were mostly males (80%) and married (92%). The average age was 56±12.3 years. Patients expected a limited number of acute myocardial infarction symptoms and these expectations were largely confined to typical symptoms and matched their experiences. Patients who were female, elderly, nonsmokers, poorly educated, with low income, and those who were normolipidemic, had no personal or family cardiac history, and were informed about acute myocardial infarction by relatives expected fewer symptoms (mostly typical and atypical) than their counterparts. Elderly patients and those with hyperlipidemia experienced fewer typical symptoms than their counterparts. Patients with ST-elevation myocardial infarction or previous myocardial infarction experienced more symptoms than their counterparts, yet only the former had more typical complaints. Characteristics that improved patients' awareness of AMI symptoms were mostly similar to those that decreased symptom incongruence. Patients' expected and experienced acute myocardial infarction symptoms and symptom incongruence varied according to their demographic and clinical characteristics. Information sources that patients used to learn about acute myocardial infarction may contribute to symptom incongruence. Copyright © 2015 Elsevier Ltd. All rights reserved.

Fundamentals of acute burn care and physical therapy management.

PubMed

Wright, P C

1984-08-01

The purpose of this paper is to discuss general treatment guidelines for treating patients with acute burns and to review pathophysiology of acute burn injuries. I will discuss skin composition briefly, give a review of acute burn pathophysiology and medical treatment, outline the psychological factors physical therapists should consider when working with these patients, and discuss physical therapy for the patient with acute burns. Physical therapy for patients with burns has become a specialty as knowledge of burn injuries increases. I have attempted to review physical therapy burn knowledge for inexperienced clinicians beginning to treat patients with acute burns.

Coronary heart disease is not significantly linked to acute kidney injury identified using Acute Kidney Injury Group criteria.

PubMed

Yayan, Josef

2012-01-01

Patients with unstable angina or myocardial infarction are at risk of acute kidney injury, which may be aggravated by the iodine-containing contrast agent used during coronary angiography; however, the relationship between these two conditions remains unclear. The current study investigated the relationship between acute kidney injury and coronary heart disease prior to coronary angiography. All patients were evaluated after undergoing coronary angiography in the cardiac catheterization laboratory of the Vinzentius Hospital in Landau, Germany, in 2011. The study group included patients with both acute coronary heart disease and acute kidney injury (as defined according to the classification of the Acute Kidney Injury Group); the control group included patients without acute coronary heart disease. Serum creatinine profiles were evaluated in all patients, as were a variety of demographic and health characteristics. Of the 303 patients examined, 201 (66.34%) had coronary artery disease. Of these, 38 (18.91%) also had both acute kidney injury and acute coronary heart disease prior to and after coronary angiography, and of which in turn 34 (16.91%) had both acute kidney injury and acute coronary heart disease only prior to the coronary angiography. However, the occurrence of acute kidney injury was not significantly related to the presence of coronary heart disease (P = 0.95, Chi-square test). The results of this study indicate that acute kidney injury is not linked to acute coronary heart disease. However, physicians should be aware that many coronary heart patients may develop kidney injury while hospitalized for angiography.

Reciprocal Risk of Acute Kidney Injury and Acute Respiratory Distress Syndrome in Critically Ill Burn Patients.

PubMed

Clemens, Michael S; Stewart, Ian J; Sosnov, Jonathan A; Howard, Jeffrey T; Belenkiy, Slava M; Sine, Christy R; Henderson, Jonathan L; Buel, Allison R; Batchinsky, Andriy I; Cancio, Leopoldo C; Chung, Kevin K

2016-10-01

To evaluate the association between acute respiratory distress syndrome and acute kidney injury with respect to their contributions to mortality in critically ill patients. Retrospective analysis of consecutive adult burn patients requiring mechanical ventilation. A 16-bed burn ICU at tertiary military teaching hospital. Adult patients more than 18 years old requiring mechanical ventilation during their initial admission to our burn ICU from January 1, 2003, to December 31, 2011. None. A total 830 patients were included, of whom 48.2% had acute kidney injury (n = 400). These patients had a 73% increased risk of developing acute respiratory distress syndrome after controlling for age, gender, total body surface area burned, and inhalation injury (hazard ratio, 1.73; 95% CI, 1.18-2.54; p = 0.005). In a reciprocal multivariate analysis, acute respiratory distress syndrome (n = 299; 36%) demonstrated a strong trend toward developing acute kidney injury (hazard ratio, 1.39; 95% CI, 0.99-1.95; p = 0.05). There was a 24% overall in-hospital mortality (n = 198). After adjusting for the aforementioned confounders, both acute kidney injury (hazard ratio, 3.73; 95% CI, 2.39-5.82; p < 0.001) and acute respiratory distress syndrome (hazard ratio, 2.16; 95% CI, 1.58-2.94; p < 0.001) significantly contributed to mortality. Age, total body surface area burned, and inhalation injury were also significantly associated with increased mortality. Acute kidney injury increases the risk of acute respiratory distress syndrome in mechanically ventilated burn patients, whereas acute respiratory distress syndrome similarly demonstrates a strong trend toward the development of acute kidney injury. Acute kidney injury and acute respiratory distress syndrome are both independent risks for subsequent death. Future research should look at this interplay for possible early interventions.

Cervical spine dysfunctions in patients with chronic subjective tinnitus.

PubMed

Michiels, Sarah; De Hertogh, Willem; Truijen, Steven; Van de Heyning, Paul

2015-04-01

To assess, characterize, and quantify cervical spine dysfunction in patients with cervicogenic somatic tinnitus (CST) compared to patients suffering from other forms of chronic subjective non-pulsatile tinnitus. Cross-sectional study. Tertiary referral center. Consecutive adult patients suffering from chronic subjective non-pulsatile tinnitus were included. Ménière's disease, middle ear pathology, intracranial pathology, cervical spine surgery, whiplash trauma, temporomandibular dysfunction. Assessment comprises medical history, ENT examination with micro-otoscopy, audiometry, tinnitus assessment, temporomandibular and cervical spine investigation, and brain MRI. Patients were classified into CST and non-CST population. Cervical spine dysfunction was investigated using the Neck Bournemouth Questionnaire (NBQ) and clinical tests of the cervical spine, containing range of motion, pain provocation (adapted Spurling test, AST), and muscle tests (tenderness via trigger points, strength and endurance of deep neck flexors). Between-group analysis was performed. The prevalence of cervical spine dysfunction was described for the total group and for CST and non-CST groups. In total, 87 patients were included, of which 37 (43%) were diagnosed with CST. In comparison with the non-CST group, the CST group demonstrated a significantly higher prevalence of cervical spine dysfunction. In the CST group, 68% had a positive manual rotation test, 47% a positive AST, 49% a positive score on both, and 81% had positive trigger points. In the non-CST group, these percentages were 36, 18, 10, and 50%, respectively. Furthermore, 79% of the CST group had a positive NBQ versus 40% in the non-CST group. Significant differences between the both groups were found for all the aforementioned variables (all p < 0.005). Although a higher prevalence of neck dysfunction was found in the CST group, neck dysfunction is often in non-CST patients.

Validation of the harmless acute pancreatitis score in predicting nonsevere course of acute pancreatitis.

PubMed

Oskarsson, V; Mehrabi, M; Orsini, N; Hammarqvist, F; Segersvärd, R; Andrén-Sandberg, A; Sadr Azodi, O

2011-01-01

The Harmless Acute Pancreatitis Score (HAPS) is a scoring algorithm to identify patients with nonsevere acute pancreatitis. The aim of this study was to evaluate the reproducibility of HAPS outside its original study setting. Baseline information of all hospitalized patients with acute pancreatitis at Karolinska University Hospital, Stockholm, Sweden, between 2004 and 2009 was collected. The parameters constituting HAPS were signs of peritonitis, hematocrit and serum creatinine levels. Since hematocrit was not available in all patients, complete sample analysis was performed by replacing hematocrit with hemoglobin (strongly correlated with hematocrit; r = 0.86). In total, 531 patients with a first-time or a recurrent attack of acute pancreatitis were included. Among 353 patients with complete information on parameters constituting HAPS, 79 patients were predicted to have a nonsevere course, of whom 1 patient developed severe acute pancreatitis. The specificity of HAPS in predicting a nonsevere course of acute pancreatitis was 96.3% (95% CI: 81.0-99.9) with a corresponding positive predictive value of 98.7% (95% CI: 93.1-100). Complete sample analysis replacing hematocrit with hemoglobin level predicted a nonsevere course in 182 patients, of whom 2 patients had severe acute pancreatitis (94.3% specificity and 98.9% positive predictive value). HAPS is a highly specific scoring algorithm that predicts a nonsevere course of acute pancreatitis. Therefore, HAPS might be an additional tool in the clinical assessment of acute pancreatitis where early screening is important to treat the patients at an optimal level of care. Copyright © 2011 S. Karger AG, Basel.

Practice Safe Driving.

PubMed

2017-07-01

More than 30,000 people die in motor vehicle collisions each year in the United States. Distracted, drowsy, and drunk driving cause most motor vehicle collision injuries and deaths. An editorial published in the October 2016 issue of JOSPT identified the global need for effective strategies to reduce, if not eliminate, preventable injuries, including whiplash-associated disorders and deaths from distracted driving. This is a call to action for everyone who gets behind the wheel of a car. J Orthop Sports Phys Ther 2017;47(7):449. doi:10.2519/jospt.2017.0506.

2017 JOSPT Award Recipients.

PubMed

Simoneau, Guy G

2018-05-01

During the American Physical Therapy Association's Combined Sections Meeting in New Orleans, LA in February 2018, JOSPT recognized the authors of the most outstanding research and clinical practice manuscripts published in JOSPT during 2017. The 2017 George J. Davies-James A. Gould Excellence in Clinical Inquiry Award was presented to Noa Ben-Ami, PT, PhD; Gabriel Chodick, MHA, PhD; Yigal Mirovsky, MD; Tamar Pincus, MPhil, MSc, PhD; and Yair Shapiro, MD, PhD, for their February 2017 article "Increasing Recreational Physical Activity in Patients With Chronic Low Back Pain: A Pragmatic Controlled Clinical Trial." The 2017 JOSPT Excellence in Research Award was presented to Sanneke Don, PT, MPT; Margot de Kooning, PT, PhD; Lennard Voogt, PT, MT, PhD; Kelly Ickmans, PT, PhD; Liesbeth Daenen, PT, PhD; and Jo Nijs, PT, MT, PhD, for their March 2017 article "The Effect of Visual Feedback of the Neck During Movement in People With Chronic Whiplash-Associated Disorders: An Experimental Study." J Orthop Sports Phys Ther 2018;48(5):348. doi:10.2519/jospt.2018.0104.

Determining level of care appropriateness in the patient journey from acute care to rehabilitation

PubMed Central

2011-01-01

Background The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer. Methods Cohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients. Results There were 696 episodes of care (7189 bed days). Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients) and 33% (other patients, from the time of referral). Most inappropriate days in acute care were due to delays in processes/scheduling (45%) or being more appropriate for rehabilitation or lower level of care (30%). On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively). From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable. Conclusions A high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of care, including rehabilitation. The rehabilitation team was the most accurate in determining ongoing medical stability, but at the cost of a longer acute stay. To avoid inpatients remaining in acute care in a state of 'terra nullius', clinical models which provide rehabilitation within acute care, and more efficient movement to a rehabilitation setting, is required. Utilization review could have a decision support role in the determination of medical stability. PMID:22040281

Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of patients from minority groups

PubMed Central

Pulte, Dianne; Redaniel, Maria Theresa; Jansen, Lina; Brenner, Hermann; Jeffreys, Mona

2013-01-01

The survival of younger patients with acute leukemia has improved in the early 21st century, but it is unknown whether people of all ethnic and racial backgrounds have benefited equally. Using cancer registry data from the Surveillance, Epidemiology and End Results Program, we assessed trends in 5-year relative survival for patients aged 15 years or more with acute lymphoblastic leukemia and acute myeloblastic leukemia divided by racial and ethnic group, including non-Hispanic whites, African-Americans, Hispanics, and Asian-Pacific Islanders in the 1990s and the early 21st century. Modeled period analysis was used to obtain the most up-to-date estimates of survival. Overall, the 5-year survival increased from 31.6% in 1997-2002 to 39.0% in 2003-2008 for patients with acute lymphoblastic leukemia and from 15.5% in 1991-1996 to 22.5% in 2003-2008 for those with acute myeloblastic leukemia. Nevertheless, among patients with acute lymphoblastic leukemia, age-adjusted 5-year relative survival rates remained lower for African-Americans and Hispanics than for non-Hispanic whites. Among patients with acute myeloblastic leukemia, the increase in survival was greatest (from 32.6% in 1991-1996 to 47.1% in 2003-2008) for younger patients (15-54 years), and was more pronounced for non-Hispanic whites (+16.4% units) than for other patients (+10.8% units). Increases in survival are observed in all ethnic or racial groups. Nevertheless, among patients with acute leukemias, disparities in survival persist between non-Hispanic white people and people of other ethnic or racial groups. Disparities are increasing in younger patients with acute myeloblastic leukemia. Improvements in access to treatment, especially for minority patients, may improve outcomes. PMID:22929974

Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis.

PubMed

Jamal Talabani, A; Endreseth, B H; Lydersen, S; Edna, T-H

2017-01-01

The study investigated the capability of clinical findings, temperature, C-reactive protein (CRP), and white blood cell (WBC) count to discern patients with acute colonic diverticulitis from all other patients admitted with acute abdominal pain. The probability of acute diverticulitis was assessed by the examining doctor, using a scale from 0 (zero probability) to 10 (100 % probability). Receiver operating characteristic (ROC) curves were used to assess the clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain. Of 833 patients admitted with acute abdominal pain, 95 had acute colonic diverticulitis. ROC curve analysis gave an area under the ROC curve (AUC) of 0.95 (CI 0.92 to 0.97) for ages <65 years, AUC = 0.86 (CI 0.78 to 0.93) in older patients. Separate analysis showed an AUC = 0.83 (CI 0.80 to 0.86) of CRP alone. White blood cell count and temperature were almost useless to discriminate acute colonic diverticulitis from other types of acute abdominal pain, AUC = 0.59 (CI 0.53 to 0.65) for white blood cell count and AUC = 0.57 (0.50 to 0.63) for temperature, respectively. This prospective study demonstrates that standard clinical evaluation by non-specialist doctors based on history, physical examination, and initial blood tests on admission provides a high degree of diagnostic precision in patients with acute colonic diverticulitis.

US Army Institute of Surgical Research Annual Research Progress Report for Fiscal Year 1986

DTIC Science & Technology

1987-10-01

Acute myocardial infarctions were seen in four patients and acute pulmonary emboli in four patients. Inhalation injury was identified in 76 patients (38.6...had inhalation injury as a primary or contributing cause of death. Three patients died with acute myocardial infarctions , one with acute phenol...may have been made in patients with complications (sepsis, hypotension, myocardial infarction , aminoglycoside antibiotic therapy, etc.) which depress

Predicting kidney disease progression in patients with acute kidney injury after cardiac surgery.

PubMed

Mizuguchi, K Annette; Huang, Chuan-Chin; Shempp, Ian; Wang, Justin; Shekar, Prem; Frendl, Gyorgy

2018-06-01

The study objective was to identify patients who are likely to develop progressive kidney dysfunction (acute kidney disease) before their hospital discharge after cardiac surgery, allowing targeted monitoring of kidney function in this at-risk group with periodic serum creatinine measurements. Risks of progression to acute kidney disease (a state in between acute kidney injury and chronic kidney disease) were modeled from acute kidney injury stages (Kidney Disease: Improving Global Outcomes) in patients undergoing cardiac surgery. A modified Poisson regression with robust error variance was used to evaluate the association between acute kidney injury stages and the development of acute kidney disease (defined as doubling of creatinine 2-4 weeks after surgery) in this observational study. Acute kidney disease occurred in 4.4% of patients with no preexisting kidney disease and 4.8% of patients with preexisting chronic kidney disease. Acute kidney injury predicted development of acute kidney disease in a graded manner in which higher stages of acute kidney injury predicted higher relative risk of progressive kidney disease (area under the receiver operator characteristic curve = 0.82). This correlation persisted regardless of baseline kidney function (P < .001). Of note, development of acute kidney disease was associated with higher mortality and need for renal replacement therapy. The degree of acute kidney injury can identify patients who will have a higher risk of progression to acute kidney disease. These patients may benefit from close follow-up of renal function because they are at risk of progressing to chronic kidney disease or end-stage renal disease. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Expectations for Recovery Important in the Prognosis of Whiplash Injuries

PubMed Central

Holm, Lena W; Carroll, Linda J; Cassidy, J. David; Skillgate, Eva; Ahlbom, Anders

2008-01-01

Background Individuals' expectations on returning to work after an injury have been shown to predict the duration of time that a person with work-related low back pain will remain on benefits; individuals with lower recovery expectations received benefits for a longer time than those with higher expectations. The role of expectations in recovery from traumatic neck pain, in particular whiplash-associated disorders (WAD), has not been assessed to date to our knowledge. The aim of this study was to investigate if expectations for recovery are a prognostic factor after experiencing a WAD. Methods and Findings We used a prospective cohort study composed of insurance claimants in Sweden. The participants were car occupants who filed a neck injury claim (i.e., for WAD) to one of two insurance companies between 15 January 2004 and 12 January 2005 (n = 1,032). Postal questionnaires were completed shortly (average 23 d) after the collision and then again 6 mo later. Expectations for recovery were measured with a numerical rating scale (NRS) at baseline, where 0 corresponds to “unlikely to make a full recovery” and 10 to “very likely to make a full recovery.” The scale was reverse coded and trichotomised into NRS 0, 1–4, and 5–10. The main outcome measure was self-perceived disability at 6 mo postinjury, measured with the Pain Disability Index, and categorised into no/low, moderate, and high disability. Multivariable polytomous logistic regression was used for the analysis. There was a dose response relationship between recovery expectations and disability. After controlling for severity of physical and mental symptoms, individuals who stated that they were less likely to make a full recovery (NRS 5–10), were more likely to have a high disability compared to individuals who stated that they were very likely to make a full recovery (odds ratio [OR] 4.2 [95% confidence interval (CI) 2.1 to 8.5]. For the intermediate category (NRS 1–4), the OR was 2.1 (95% CI 1.2 to 3.2). Associations between expectations and disability were also found among individuals with moderate disability. Conclusions Individuals' expectations for recovery are important in prognosis, even after controlling for symptom severity. Interventions designed to increase patients' expectations may be beneficial and should be examined further in controlled studies. PMID:18479182

Acute on chronic gastrointestinal bleeding: a unique clinical entity.

PubMed

Rockey, Don C; Hafemeister, Adam C; Reisch, Joan S

2017-06-01

Gastrointestinal bleeding is defined in temporal-spatial terms-as acute or chronic, and/or by its location in the gastrointestinal tract. Here, we define a distinct type of bleeding, which we have coined 'acute on chronic' gastrointestinal bleeding. We prospectively identified all patients who underwent endoscopic evaluation for any form of gastrointestinal bleeding at a University Hospital. Acute on chronic bleeding was defined as the presence of new symptoms or signs of acute bleeding in the setting of chronic bleeding, documented as iron deficiency anemia. Bleeding lesions were categorized using previously established criteria. We identified a total of 776, 254, and 430 patients with acute, chronic, or acute on chronic bleeding, respectively. In patients with acute on chronic gastrointestinal bleeding, lesions were most commonly identified in esophagus (28%), colon and rectum (27%), and stomach (21%) (p<0.0001 vs locations for acute or chronic bleeding). In those specifically with acute on chronic upper gastrointestinal bleeding (n=260), bleeding was most commonly due to portal hypertensive lesions, identified in 47% of subjects compared with 29% of acute and 25% of chronic bleeders, (p<0.001). In all patients with acute on chronic bleeding, 30-day mortality was less than that after acute bleeding alone (2% (10/430) vs 7% (54/776), respectively, p<0.001). Acute on chronic gastrointestinal bleeding is common, and in patients with upper gastrointestinal bleeding was most often a result of portal hypertensive upper gastrointestinal tract pathology. Reduced mortality in patients with acute on chronic gastrointestinal bleeding compared with those with acute bleeding raises the possibility of an adaptive response. Copyright © 2017 American Federation for Medical Research.

Traumatic hyphaema: a report of 472 consecutive cases.

PubMed

Ashaye, Adeyinka O

2008-11-26

Strategies for prevention of eye injuries require knowledge of the cause of the injuries. This study was done to determine the patient characteristics, the cause of injury, and where cases of traumatic hyphaema that necessitated admission to a tertiary hospital occurred. This may enable an appropriate intervention in the prevention of such injuries. Retrospective case analysis of 472 patients with traumatic hyphaema admitted to the University College Hospital, Ibadan between January 1997 and December 2006. The home was the single most frequent place of injury for all cases and for 75% of cases in children aged 0-10 years. Injuries that occurred at school comprised about one-fifth of cases. Sport-related injuries were uncommon. The most common activities preceding injuries were play, corporal punishment and assault. Stones, sticks and whiplash were the agents that caused traumatic hyphaema. Occupational-related hyphaema that caused injuries was mostly in farmers and artisans, few of whom used protective goggles. The majority of patients were males. Children and young adults aged

Patient dissatisfaction with acute stroke care.

PubMed

Asplund, Kjell; Jonsson, Fredrik; Eriksson, Marie; Stegmayr, Birgitta; Appelros, Peter; Norrving, Bo; Terént, Andreas; Asberg, Kerstin Hulter

2009-12-01

Riks-Stroke, the Swedish Stroke Register, was used to explore patient characteristics and stroke services as determinants of patient dissatisfaction with acute in-hospital care. All 79 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. During 2001 to 2007, 104,876 patients (87% of survivors) responded to a follow-up questionnaire 3 months after acute stroke; this included questions on satisfaction with various aspects of stroke care. The majority (>90%) were satisfied with acute in-hospital stroke care. Dissatisfaction was closely associated with outcome at 3 months. Patient who were dependent regarding activities of daily living, felt depressed, or had poor self-perceived general health were more likely to be dissatisfied. Dissatisfaction with global acute stroke care was linked to dissatisfaction with other aspects of care, including rehabilitation and support by community services. Patients treated in stroke units were less often dissatisfied than patients in general wards, as were patients who had been treated in a small hospital (vs medium or large hospitals) and patient who had participated in discharge planning. In multivariate analyses, the strongest predictor of dissatisfaction with acute care was poor outcome (dependency regarding activities of daily living, depressed mood, poor self-perceived health). Dissatisfaction with in-hospital acute stroke care is part of a more extensive complex comprising poor functional outcome, depressive mood, poor self-perceived general health, and dissatisfaction not only with acute care but also with health care and social services at large. Several aspects of stroke care organization are associated with a lower risk of dissatisfaction.

Phase II trial of vindesine in patients with acute leukemia.

PubMed

Sklaroff, R B; Arlin, Z; Young, C W

1979-01-01

Vindesine was administered to 18 patients with acute leukemia who had failed conventional chemotherapy. Each course of therapy consisted of an iv bolus infusion at a dose of 1-2 mg/m2 given daily x 5-10 days. Of 13 patients with acute lymphoblastic leukemia, two had partial remissions which lasted 2 and 3 months and five had minor responses. One of three patients with acute nonlymphoblastic leukemia and one of two patients with blastic crisis of chronic myelogenous leukemia each had a minor response. The data suggest that vindesine has activity in the treatment of acute leukemia.

Exploring how nurses assess, monitor and manage acute pain for adult critically ill patients in the emergency department: protocol for a mixed methods study.

PubMed

Varndell, Wayne; Fry, Margaret; Elliott, Doug

2017-08-01

Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but also as a consequence of delivering care whilst stabilising the patient. Emergency nurses are increasingly responsible for the safety and wellbeing of critically ill patients, which includes assessing, monitoring and managing acute pain. How emergency nurses manage acute pain in critically ill adult patients is unknown. The objective of this study is to explore how emergency nurses manage acute pain in critically ill patients in the Emergency Department. In this paper, we provide a detailed description of the methods and protocol for a multiphase sequential mixed methods study, exploring how emergency nurses assess, monitor and manage acute pain in critically ill adult patients. The objective, method, data collection and analysis of each phase are explained. Justification of each method and data integration is described. Synthesis of findings will generate a comprehensive picture of how emergency nurses' perceive and manage acute pain in critically ill adult patients. The results of this study will form a knowledge base to expand theory and inform research and practice.

Trisomy/tetrasomy 13 in seven cases of acute leukemia.

PubMed

Sreekantaiah, C; Baer, M R; Morgan, S; Isaacs, J D; Miller, K B; Sandberg, A A

1990-11-01

We report the clinical presentation and the morphologic, histochemical, and immunophenotypic characteristics of seven patients with acute leukemia who had trisomy/tetrasomy 13 as the sole cytogenetic abnormality in their leukemia. Five patients had trisomy 13 at diagnosis of acute leukemia. All five of these patients had undifferentiated leukemias. The sixth patient, who had French-American-British (FAB) type M2 acute nonlymphocytic leukemia (ANLL), and the seventh patient with biphenotypic acute leukemia developed the trisomic clone as a new abnormality late in the course of their disease. A review of the literature revealed 28 previously reported hematologic malignancies with trisomy 13 or tetrasomy 13q as a solitary cytogenetic abnormality. Trisomy 13 appears to represent another rare but nonrandom cytogenetic abnormality in acute leukemia. In our series trisomy 13 is largely associated with acute leukemia with little myeloid or lymphoid differentiation.

Does chronic hepatitis B infection affect the clinical course of acute hepatitis A?

PubMed

Shin, Su Rin; Moh, In Ho; Jung, Sung Won; Kim, Jin Bae; Park, Sang Hoon; Kim, Hyoung Su; Jang, Myung Kuk; Lee, Myung Seok

2013-01-01

The impact of chronic hepatitis B on the clinical outcome of acute hepatitis A remains controversial. The aim of present study was to evaluate the clinical characteristics of acute hepatitis A in cases with underlying chronic hepatitis B compared to cases of acute hepatitis A alone. Data on 758 patients with acute hepatitis A admitted at two university-affiliated hospitals were reviewed. Patients were classified into three groups: group A, patients with both acute hepatitis A and underlying chronic hepatitis B (n = 27); group B, patients infected by acute hepatitis A alone whose sexes and ages were matched with patients in group A (n  = 54); and group C, patients with acute hepatitis A alone (n = 731). None of the demographic features of group A were significantly different from those of group B or C, except for the proportion of males and body weight, which differed from group C. When comparing to group B, clinical symptoms were more frequent, and higher total bilirubin and lower albumin levels were observed in group A. When comparing to group C, the albumin levels were lower in group A. There were no differences in the duration of hospital stay, occurrence of acute kidney injury, acute liver failure, prolonged cholestasis, or relapsing hepatitis. This study revealed that clinical symptoms and laboratory findings were less favorable for patients with acute hepatitis A and chronic hepatitis B compared to those with acute hepatitis A alone. However, there were no differences in fatal outcomes or serious complications. Copyright © 2012 Wiley Periodicals, Inc.

The Association Between Ventriculo-Peritoneal Shunt and Acute Appendicitis in Patients with Traumatic Brain Injury: A 14-Year, Population-Based Study.

PubMed

Lim, Sher-Wei; Ao, Kam-Hou; Ho, Chung-Han; Tseng, Chien-Jen; Wang, Jhi-Joung; Chio, Chung-Ching; Kuo, Jinn-Rung

2017-07-01

The association between preexisting ventriculoperitoneal (VP) shunt and the risk of new-onset acute appendicitis in patients with traumatic brain injury (TBI) is not well established. The aim of the present study was to determine the relationships between VP shunt and acute appendicitis in patients with TBI. A longitudinal cohort study matched by a propensity score in patients with TBI with (4781 patients) or without (9562 patients) VP shunt was conducted using the National Health Insurance Research Database in Taiwan between January 1993 and December 2013. The main outcome studied was diagnosis of acute appendicitis. The cumulative probability of acute appendicitis was not different between these 2 groups (P = 0.6244). A Cox model showed central nervous system (CNS) infection to be an independent predictor of acute appendicitis with an adjusted hazard ratio of 2.98. Patients with TBI with both a VP shunt and a CNS infection had a greater risk of developing new-onset acute appendicitis (hazard ratio 4.25; 95% confidence interval 1.84-9.81) compared patients with TBI without a VP shunt or CNS infection. We concluded that VP shunt is not a risk factor in the development of appendicitis in patients with TBI. Patients with TBI with a shunt and a CNS infection may have a greater risk of developing acute appendicitis. Therefore, care in avoiding CNS infection is a key for the prevention acute appendicitis in this patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

Electrocardiogram Changes with Acute Alcohol Intoxication: A Systematic Review.

PubMed

Raheja, Hitesh; Namana, Vinod; Chopra, Kirti; Sinha, Ankur; Gupta, Sushilkumar Satish; Kamholz, Stephan; Moskovits, Norbert; Shani, Jacob; Hollander, Gerald

2018-01-01

Acute alcohol intoxication has been associated with cardiac arrhythmias but the electrocardiogram (ECG) changes associated with acute alcohol intoxication are not well defined in the literature. Highlight the best evidence regarding the ECG changes associated with acute alcohol intoxication in otherwise healthy patients and the pathophysiology of the changes. A literature search was carried out; 4 studies relating to ECG changes with acute alcohol intoxication were included in this review. Of the total 141 patients included in the review, 90 (63.8%) patients had P-wave prolongation, 80 (56%) patients had QTc prolongation, 19 (13.5%) patients developed T-wave abnormalities, 10 (7%) patients had QRS complex prolongation, 3 (2.12%) patients developed ST-segment depressions. The most common ECG changes associated with acute alcohol intoxication are (in decreasing order of frequency) P-wave and QTc prolongation, followed by T-wave abnormalities and QRS complex prolongation. Mostly, these changes are completely reversible.

How Does Cholecystectomy Influence Recurrence of Idiopathic Acute Pancreatitis?

PubMed

Stevens, Claire L; Abbas, Saleh M; Watters, David A K

2016-12-01

Idiopathic acute pancreatitis is diagnosed in approximately 10-30 % of cases of acute pancreatitis. While there is evidence to suggest that the cause in many of these patients is microlithiasis, this fact has not been translated into a resource efficient treatment strategy that is proven to reduce recurrence rates. The aim of this study was to examine the value of prophylactic cholecystectomy following an episode of acute pancreatitis in patients with no history of alcohol abuse and no stones found on ultrasound. This was a retrospective study of 2236 patients who presented to a regional Australian hospital. Patients were included when diagnosed with acute pancreatitis with no confirmed cause. Recurrence of acute pancreatitis was compared between those that did and did not undergo cholecystectomy. One hundred ninety-five consecutive patients met the study definition of "idiopathic" acute pancreatitis. 33.8 % (66/195) underwent cholecystectomy. The patients who had cholecystectomy had a recurrence rate of 19.7 % (13/66) whereas, of those managed expectantly, 42.8 % (68/159) had at least one recurrence of acute pancreatitis (P = 0.001). Following an episode of acute pancreatitis with no identifiable cause, in patients fit for surgery, cholecystectomy should be considered to reduce the risk of recurrent episodes of pancreatitis.

Frequency, pattern and management of acute abdomen in dengue fever in Karachi, Pakistan.

PubMed

Shamim, Muhammad

2010-07-01

This study aimed to determine the frequency, pattern and management of acute abdomen in patients with dengue fever. This descriptive case series is a prospective analysis of acute abdomen in dengue fever that was performed at three secondary care hospitals in Karachi, Pakistan from June 1, 2005 to December 31, 2008. The inclusion criterion was all patients with confirmed diagnosis of dengue fever. Patients with incomplete laboratory, ultrasound or histopathology data were excluded. Among 357 patients with dengue fever, 43 (12.04%) had acute abdomen. There were 15 men and 28 women, with a median age of 29 years. These included 26 cases of acute cholecystitis, 7 cases of acute appendicitis, 7 cases of nonspecific peritonitis, and 3 cases of acute pancreatitis. Dengue hemorrhagic fever/shock syndrome was found in acute pancreatitis, and two of these patients died. Emergency surgery was required in eight patients (5 appendectomy and 3 open cholecystectomy). Substantial transfusion of blood and its components was required in eight patients who underwent emergency surgery. Early diagnosis and prompt conservative management of dengue acute abdomen is necessary to avoid mortality and emergency surgery-related morbidity. However, if needed, surgery can be performed with acceptable morbidity. Copyright © 2010 Asian Surgical Association. Published by Elsevier B.V. All rights reserved.

Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia.

PubMed

Ford, Clyde D; Lopansri, Bert K; Haydoura, Souha; Snow, Greg; Dascomb, Kristin K; Asch, Julie; Bo Petersen, Finn; Burke, John P

2015-01-01

OBJECTIVE To determine the frequency, risk factors, and outcomes for vancomycin-resistant Enterococcus (VRE) colonization and infection in patients with newly diagnosed acute leukemia. DESIGN Retrospective clinical study with VRE molecular strain typing. SETTING A regional referral center for acute leukemia. PATIENTS Two hundred fourteen consecutive patients with newly diagnosed acute leukemia between 2006 and 2012. METHODS All patients had a culture of first stool and weekly surveillance for VRE. Clinical data were abstracted from the Intermountain Healthcare electronic data warehouse. VRE molecular typing was performed utilizing the semi-automated DiversiLab System. RESULTS The rate of VRE colonization was directly proportional to length of stay and was higher in patients with acute lymphoblastic leukemia. Risk factors associated with colonization include administration of corticosteroids (P=0.004) and carbapenems (P=0.009). Neither a colonized prior room occupant nor an increased unit colonization pressure affected colonization risk. Colonized patients with acute myelogenous leukemia had an increased risk of VRE bloodstream infection (BSI, P=0.002). Other risk factors for VRE BSI include severe neutropenia (P=0.04) and diarrhea (P=0.008). Fifty-eight percent of BSI isolates were identical or related by molecular typing. Eighty-nine percent of bloodstream isolates were identical or related to stool isolates identified by surveillance cultures. VRE BSI was associated with increased costs (P=0.0003) and possibly mortality. CONCLUSIONS VRE colonization has important consequences for patients with acute myelogenous leukemia undergoing induction therapy. For febrile neutropenic patients with acute myelogenous leukemia, use of empirical antibiotic regimens that avoid carbapenems and include VRE coverage may be helpful in decreasing the risks associated with VRE BSI.

Prospective investigation of pituitary functions in patients with acute infectious meningitis: is acute meningitis induced pituitary dysfunction associated with autoimmunity?

PubMed

Tanriverdi, F; De Bellis, A; Teksahin, H; Alp, E; Bizzarro, A; Sinisi, A A; Bellastella, G; Paglionico, V A; Bellastella, A; Unluhizarci, K; Doganay, M; Kelestimur, F

2012-12-01

Previous case reports and retrospective studies suggest that pituitary dysfunction may occur after acute bacterial or viral meningitis. In this prospective study we assessed the pituitary functions, lipid profile and anthropometric measures in adults with acute bacterial or viral meningitis. Moreover, in order to investigate whether autoimmune mechanisms could play a role in the pathogenesis of acute meningitis-induced hypopituitarism we also investigated the anti-pituitary antibodies (APA) and anti-hypothalamus antibodies (AHA) prospectively. Sixteen patients (10 males, 6 females; mean ± SD age 40.9 ± 15.9) with acute infectious meningitis were included and the patients were evaluated in the acute phase, and at 6 and 12 months after the acute meningitis. In the acute phase 18.7% of the patients had GH deficiency, 12.5% had ACTH and FSH/LH deficiencies. At 12 months after acute meningitis 6 of 14 patients (42.8%) had GH deficiency, 1 of 14 patients (7.1%) had ACTH and FSH/LH deficiencies. Two of 14 patients (14.3%) had combined hormone deficiencies and four patients (28.6%) had isolated hormone deficiencies at 12 months. Four of 9 (44.4%) hormone deficiencies at 6 months were recovered at 12 months, and 3 of 8 (37.5%) hormone deficiencies at 12 months were new-onset hormone deficiencies. At 12 months there were significant negative correlations between IGF-I level vs. LDL-C, and IGF-I level vs. total cholesterol. The frequency of AHA and APA positivity was substantially high, ranging from 35 to 50% of the patients throughout the 12 months period. However there were no significant correlations between AHA or APA positivity and hypopituitarism. The risk of hypopituitarism, GH deficiency in particular, is substantially high in the acute phase, after 6 and 12 months of the acute infectious meningitis. Moreover we found that 6th month after meningitis is too early to make a decision for pituitary dysfunction and these patients should be screened for at least 12 months. In addition, the occurrence of AHA and APA positivity due to acute infectious meningitis was demonstrated for the first time. Further longer-term prospective investigations need to be carried out on a larger cohort of patients to understand the role of autoimmunity in the pathogenesis of late hypopituitarism after acute infectious meningitis.

Statistical analysis of 4 types of neck whiplash injuries based on classical meridian theory.

PubMed

Chen, Yemeng; Zhao, Yan; Xue, Xiaolin; Li, Hui; Wu, Xiuyan; Zhang, Qunce; Zheng, Xin; Wang, Tianfang

2015-01-01

As one component of the Chinese medicine meridian system, the meridian sinew (Jingjin, (see text), tendino-musculo) is specially described as being for acupuncture treatment of the musculoskeletal system because of its dynamic attributes and tender point correlations. In recent decades, the therapeutic importance of the sinew meridian has become revalued in clinical application. Based on this theory, the authors have established therapeutic strategies of acupuncture treatment in Whiplash-Associated Disorders (WAD) by categorizing four types of neck symptom presentations. The advantage of this new system is to make it much easier for the clinician to find effective acupuncture points. This study attempts to prove the significance of the proposed therapeutic strategies by analyzing data collected from a clinical survey of various WAD using non-supervised statistical methods, such as correlation analysis, factor analysis, and cluster analysis. The clinical survey data have successfully verified discrete characteristics of four neck syndromes, based upon the range of motion (ROM) and tender point location findings. A summary of the relationships among the symptoms of the four neck syndromes has shown the correlation coefficient as having a statistical significance (P < 0.01 or P < 0.05), especially with regard to ROM. Furthermore, factor and cluster analyses resulted in a total of 11 categories of general symptoms, which implies syndrome factors are more related to the Liver, as originally described in classical theory. The hypothesis of meridian sinew syndromes in WAD is clearly supported by the statistical analysis of the clinical trials. This new discovery should be beneficial in improving therapeutic outcomes.

Altered ventral neck muscle deformation for individuals with whiplash associated disorder compared to healthy controls - a case-control ultrasound study.

PubMed

Peterson, Gunnel; Dedering, Åsa; Andersson, Erika; Nilsson, David; Trygg, Johan; Peolsson, Michael; Wallman, Thorne; Peolsson, Anneli

2015-04-01

Previous studies have shown altered neck muscle function in individuals with chronic whiplash associated disorder (WAD). However, we lack real-time investigations with non-invasive methods that can distinguish between the different ventral neck muscle layers. This study investigated deformations and deformation rates in the sternocleidomastoid (SCM), longus capitis (Lcap), and longus colli (Lco) muscles with real-time ultrasonography. Twenty-six individuals with WAD were compared with 26 controls, matched for age and sex. Ultrasound imaging of the SCM, Lcap, and Lco were recorded during 10 repetitive arm elevations. The first and tenth arm elevations were post-process analyzed with speckle tracking. There were few significant differences in the deformations or deformation rates in the SCM, Lcap, and Lco between the WAD and control group. In controls, deformations and deformation rates showed linear positive relationships between SCM/Lcap, SCM/Lco, and Lcap/Lco which increased from the first arm elevation (R(2) = 0.14-0.70); to the tenth arm elevation (R(2) = 0.51-0.71). The WAD group showed similar or weaker linear relationship (R(2) < 0.19) during the tenth compared to the first (R(2) < 0.44) arm elevation except for deformations in Lcap/Lco (R(2) = 0.13-0.57). This result indicated that deformations and deformation rates in one muscle were correlated by similar deformations and deformation rates in other neck muscles in the control group, but this interplay between muscles was not found in the WAD group. Copyright © 2014 Elsevier Ltd. All rights reserved.

Complexities in understanding the role of compensation-related factors on recovery from whiplash-associated disorders: discussion paper 2.

PubMed

Carroll, Linda J; Connelly, Luke B; Spearing, Natalie M; Côté, Pierre; Buitenhuis, Jan; Kenardy, Justin

2011-12-01

Focused discussion. To present some of the complexities in conducting research on the role of compensation and compensation-related factors in recovery from whiplash-associated disorders (WAD) and to suggest directions for future research. There is divergence of opinion, primary research findings, and systematic reviews on the role of compensation and/or compensation-related factors in WAD recovery. The topic of research of compensation/compensation-related factors was discussed at an international summit meeting of 21 researchers from diverse fields of scientific enquiry. This article summarizes the main points raised in that discussion. Traffic injury compensation is a complex sociopolitical construct, which varies widely across jurisdictions. This leads to conceptual and methodological challenges in conducting and interpreting research in this area. It is important that researchers and their audiences be clear about what aspect of the compensation system is being addressed, what compensation-related variables are being studied, and what social/economic environment the compensation system exists in. In addition, summit participants also recommended that nontraditional, sophisticated study designs and analysis strategies be employed to clarify the complex causal pathways and mechanisms of effects. Care must be taken by both researchers and their audiences not to overgeneralize or confuse different aspects of WAD compensation. In considering the role of compensation/compensation-related factors on WAD and WAD recovery, it is important to retain a broad-based conceptualization of the range of biological, psychological, social, and economic factors that combine and interact to define and determine how people recover from WAD.

The role of fear of movement in subacute whiplash-associated disorders grades I and II.

PubMed

Robinson, James P; Theodore, Brian R; Dansie, Elizabeth J; Wilson, Hilary D; Turk, Dennis C

2013-03-01

Fear and avoidance of activity may play a role in fostering disability in whiplash-associated disorders (WAD). This study examined the role of fear after WAD and assessed the effectiveness of 3 treatments targeting fear. People still symptomatic from WAD grade I-II injuries approximately 3months previously (n=191) completed questionnaires (eg, Neck Disability Index [NDI]) and were randomized to 1 of the treatments: (1) informational booklet (IB) describing WAD and the importance of resuming activities, (2) IB+didactic discussions (DD) with clinicians reinforcing the booklet, and (3) IB+imaginal and direct exposure desensitization (ET) to feared activities. DD and ET participants received three 2-hour treatment sessions. Absolute improvements in NDI were in predicted direction (ET=14.7, DD=11.9, IB=9.9). ETs reported significantly less posttreatment pain severity compared with the IB (Mean=1.5 vs 2.3, P<.001, d=0.6) and DD (M=1.5 vs 2.0, P=.039, d=0.6) groups. Reduction in fear was the most important predictor of improvement in NDI (β=0.30, P<.001), followed by reductions in pain (β=0.20, P=.003) and depression (β=0.18, P=.004). The mediational analysis confirmed that fear reduction significantly mediated the effect of treatment group on outcome. Results highlight the importance of fear in individuals with subacute WAD and suggest the importance of addressing fear via exposure therapy and/or educational interventions to improve function. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Exercise and Cognitive Functioning in People With Chronic Whiplash-Associated Disorders: A Controlled Laboratory Study.

PubMed

Ickmans, Kelly; Meeus, Mira; De Kooning, Margot; De Backer, Annabelle; Kooremans, Daniëlle; Hubloue, Ives; Schmitz, Tom; Van Loo, Michel; Nijs, Jo

2016-02-01

Controlled laboratory study. In addition to persistent pain, people with chronic whiplash-associated disorders (WAD) commonly deal with cognitive dysfunctions. In healthy individuals, aerobic exercise has a positive effect on cognitive performance, and preliminary evidence in other chronic pain conditions reveals promising results as well. However, there is evidence that people with chronic WAD may show a worsening of the symptom complex following physical exertion. To examine postexercise cognitive performance in people with chronic WAD. People with chronic WAD (n = 27) and healthy, inactive, sex- and age-matched controls (n = 27) performed a single bout of an incremental submaximal cycling exercise. Before and after the exercise, participants completed 2 performance-based cognitive tests assessing selective and sustained attention, cognitive inhibition, and simple and choice reaction time. At baseline, people with chronic WAD displayed significantly lower scores on sustained attention and simple reaction time (P<.001), but not on selective attention, cognitive inhibition, and choice reaction time (P>.05), compared with healthy controls. Postexercise, both groups showed significantly improved selective attention and choice reaction time (chronic WAD, P = .001; control, P<.001), while simple reaction time significantly increased (P = .037) only in the control group. In both groups, no other significant changes in sustained attention, cognitive inhibition, pain, and fatigue were observed (P>.05). In the short term, postexercise cognitive functioning, pain, and fatigue were not aggravated in people with chronic WAD. However, randomized controlled trials are required to study the longer-term and isolated effects of exercise on cognitive functioning.

Changes in head and neck position have a greater effect on elbow joint position sense in people with whiplash-associated disorders.

PubMed

Knox, Joanna Joy; Beilstein, Darren Jay; Charles, Scott Darren; Aarseth, Geir Arne; Rayar, Shivanthi; Treleaven, Julia; Hodges, Paul William

2006-01-01

It has been shown that perception of elbow joint position is affected by changes in head and neck position. Further, people with whiplash-associated disorders (WAD) present with deficits in upper limb coordination and movement. This study is aimed to determine whether the effect of changes in head position on elbow joint position error (JPE) is more pronounced in people with WAD, and to determine whether this is related to the participant's pain and anxiety levels. Nine people with chronic and disabling WAD and 11 healthy people participated in this experiment. The ability to reproduce a position at the elbow joint was assessed after changes in the position of the head and neck to 30 degrees , and with the head in the midline. Pain was monitored in WAD participants. Absolute elbow JPE with the head in neutral was not different between WAD and control participants (P=0.5). Changes in the head and neck position increased absolute elbow JPE in the WAD group (P<0.05), but did not affect elbow JPE in the control group (P=0.4). There was a connection between pain during testing and the effect of changes in head position on elbow JPE (P<0.05). Elbow JPE is affected by movement of the head and neck, with smaller angles of neck rotation in people with WAD than in healthy individuals. This observation may explain deficits in upper limb coordination in people with WAD, which may be due to the presence of pain or reduced range of motion in this population.

Measures of central hyperexcitability in chronic whiplash associated disorder--a systematic review and meta-analysis.

PubMed

Stone, Andrew M; Vicenzino, Bill; Lim, Edwin C W; Sterling, Michele

2013-04-01

To synthesise the evidence for central hyperexcitability in Chronic WAD (whiplash associated disorders) with meta-analysis, and review test protocols. Chronic WAD was compared to healthy controls. Studies were eligible if they used measures of central hyperexcitability with standardised procedure. Meta-analyses (where possible) were conducted. The search yielded 27 trials of good quality and 13 were suitable for meta-analyses. Individuals with chronic WAD showed heightened sensitivity to the following tests (p < 0.05): Pressure Pain Thresholds at Head/Neck/Upper Thoracic area (H/N/UT) (SMD (Standardised mean differences) -1.36, 95% CI (confidence intervals) -1.89 to -0.82), Upper Limb (UL) (-1.33, 95% CI -2.50 to -0.16), Lower Limb (LL) (-1.01, 95% CI -1.70 to -0.33), flexor withdrawal (-0.73, 95% CI -1.11 to -0.35), Cold Pain Threshold at H/N/UT (0.91, 95% CI 0.66-1.17) and UL (0.66, 95% CI 0.37-0.94), Heat Pain Threshold at H/N/UT (-0.58, 95% CI -0.88 to -0.28), Electrocutaneous Stimulation at H/N/UT (-1.04, 95% CI -1.63 to -0.45) and LL (-0.85, 95% CI -1.67 to -0.03), and elbow extension with the Brachial Plexus Provocation Test (SMD -0.55, 95% CI -0.76 to -0.35). There is compelling evidence for central hyperexcitability in chronic WAD. This should be considered in the management of chronic WAD. Copyright © 2012 Elsevier Ltd. All rights reserved.

Increased risk of acute pancreatitis in patients with chronic hemodialysis: a 4-year follow-up study.

PubMed

Hou, Sheng-Wen; Lee, Yi-Kung; Hsu, Chen-Yang; Lee, Ching-Chih; Su, Yung-Cheng

2013-01-01

The risk of acute pancreatitis in patients on long-term peritoneal dialysis is higher as compared to the general population. However, the relationship between long-term hemodialysis and acute pancreatitis has never been established. We investigated the incidence of acute pancreatitis among patients on long-term hemodialysis in Taiwan to evaluate if there is a higher risk of acute pancreatitis in comparison to the general population. We utilized a National Health Insurance (NHI) claims data sample containing one million beneficiaries. We followed all adult beneficiaries from January 1, 2007 until December 31, 2010 to see if they had been hospitalized for acute pancreatitis during this period. We further identified patients on chronic hemodialysis and compared their risk of acute pancreatitis with the general population. This study included 2603 patients with long-term hemodialysis and 773,140 patients without hemodialysis. After controlling for age, gender, Charlson Comorbidity Index Score, geographic region, socioeconomic status and urbanization level, the adjusted hazard ratio was 3.44 (95% Confidence interval, 2.5-4.7). The risk of acute pancreatitis in patients on long-term hemodialysis is significantly higher in comparison to the general population.

Investigation of pituitary functions in patients with acute meningitis: a pilot study.

PubMed

Tanriverdi, F; Alp, E; Demiraslan, H; Dokmetas, H S; Unluhizarci, K; Doganay, M; Casanueva, F F; Kelestimur, F

2008-06-01

Although long-term pituitary consequences of tuberculous meningitis are well documented in the literature, there have been few case reports of pituitary dysfunction after acute bacterial or viral meningitis. In this preliminary study, we have assessed the pituitary functions in adult patients who had acute bacterial or viral meningitis. Fourteen patients (8 men, 6 women; mean age 35.3+/-13.3) were included in the study. The diagnosis of bacterial and viral meningitis was proven by clinical findings, cerebrospinal fluid (CSF) examination, gram staining, and blood and CSF cultures. Pituitary functions were evaluated ranging from 6 to 48 months (mean 20 months) after acute meningitis. GH deficiency was investigated by the GHRH+arginine stimulation test. Four of 14 patients (28.6%) had isolated GH deficiency. In GH-deficient patients, the earliest duration was 6 months and the latest duration was 48 months after the diagnosis of acute meningitis. Three of the GH-deficient patients had acute bacterial meningitis and 1 patient had acute viral meningitis. Pituitary magnetic resonance imaging revealed normal pituitary gland in the patients with GH deficiency. This is the first systematic study evaluating the anterior pituitary function long term after the diagnosis of acute meningitis. Based on the present study, it is tempting to speculate that pituitary dysfunction is a more common sequel of acute bacterial or viral meningitis than hitherto reported. Studies with high numbers of patients are warranted to ascertain the prevalence of meningitis-induced hypopituitarism.

The incidence of acute oxaliplatin-induced neuropathy and its impact on treatment in the first cycle: a systematic review.

PubMed

Gebremedhn, Endale Gebreegziabher; Shortland, Peter John; Mahns, David Anthony

2018-04-12

Although acute oxaliplatin-induced neuropathy (OXIPN) is frequently regarded to be transient, recent studies have reported prolongation of infusion times, dose reduction and treatment cessation following the first dose of oxaliplatin in quarter of patients. Acute OXIPN is also a well-established risk factor for chronic neuropathy. However, there is underreporting of these parameters during the acute phase (≤ 14 days). This paper systematically reviews the incidence of acute OXIPN and its impact on treatment in the first cycle. A systematic literature search was performed using PubMed and Medline. Published original articles were included if they described details about prevalence of oxaliplatin-induced acute neuropathy. Fourteen studies, comprised of 6211 patients were evaluated. The majority of patients were treated with oxaliplatin in combination with leucovorin and fluorouracil (FOLFOX). Most studies used the National Cancer Institute Common Toxicity Criteria to assess acute neuropathy. Acute neuropathy (Grades 1-4) was the most common event with prevalence ranging from 4-98%, followed by haematological (1.4-81%) and gastrointestinal (1.2-67%) toxicities, respectively. Drug regimens, starting dose of oxaliplatin and neuropathy assessment tools varied across studies. In addition, moderate to severe toxicities were common in patients that received a large dose of oxaliplatin (> 85 mg/m 2 ) and/ or combined drugs. The majority of studies did not report the factors affecting acute neuropathy namely the range (minimal) doses required to evoke acute neuropathy, patient and clinical risk factors. In addition, there was no systematic reporting of the number of patients subjected to prolonged infusion, dose reduction, treatment delay and treatment cessation during the acute phase. Despite the heterogeneity of studies regarding oxaliplatin starting dose, drug regimen, neuropathy assessment tools and study design, a large number of patients developed acute neuropathy. To develop a better preventive and therapeutic guideline for acute/chronic neuropathy, a prospective study should be conducted in a large cohort of patients in relation to drug regimen, starting/ranges (minimal) of doses producing acute neuropathy, treatment compliance, patient and clinical risk factors using a standardised neuropathy assessment tool.

Patterns, evolution, and severity of striatal injury in insidious- versus acute-onset glutaric aciduria type 1.

PubMed

Boy, Nikolas; Garbade, Sven F; Heringer, Jana; Seitz, Angelika; Kölker, Stefan; Harting, Inga

2018-05-02

Striatal injury in patients with glutaric aciduria type 1 (GA1) results in a complex, predominantly dystonic, movement disorder. Onset may be acute following acute encephalopathic crisis (AEC) or insidious without apparent acute event. We analyzed clinical and striatal magnetic resonance imaging (MRI) findings in 21 symptomatic GA1 patients to investigate if insidious- and acute-onset patients differed in timing, pattern of striatal injury, and outcome. Eleven patients had acute and ten had insidious onset, two with later AEC (acute-on-insidious). The median onset of dystonia was 10 months in both groups, and severity was greater in patients after AEC (n = 8 severe, n = 5 moderate) than in insidious onset (n = 4 mild, n = 3 moderate, n = 1 severe). Deviations from guideline-recommended basic metabolic treatment were identified in six insidious-onset patients. Striatal lesions were extensive in all acute-onset patients and restricted to the dorsolateral putamen in eight of ten insidious-onset patients. After AEC, the two acute-on-insidious patients had extensive striatal changes superimposed on pre-existing dorsolateral putaminal lesions. Two insidious-onset patients with progressive dystonia without overt AEC also had extensive striatal changes, one with sequential striatal injury revealed by diffusion-weighted imaging. Insidious-onset patients had a latency phase of 3.5 months to 6.5 years between detection and clinical manifestation of dorsolateral putaminal lesions. Insidious-onset type GA1 is characterized by dorsolateral putaminal lesions, less severe dystonia, and an asymptomatic latency phase, despite already existing lesions. Initially normal MRI during the first months and deviations from guideline-recommended treatment in a large proportion of insidious-onset patients substantiate the protective effect of neonatally initiated treatment.

Evaluating the Performance of the Pediatric Acute Lung Injury Consensus Conference Definition of Acute Respiratory Distress Syndrome.

PubMed

Parvathaneni, Kaushik; Belani, Sanjay; Leung, Dennis; Newth, Christopher J L; Khemani, Robinder G

2017-01-01

The Pediatric Acute Lung Injury Consensus Conference has developed a pediatric-specific definition of acute respiratory distress syndrome, which is a significant departure from both the Berlin and American European Consensus Conference definitions. We sought to test the external validity and potential impact of the Pediatric Acute Lung Injury Consensus Conference definition by comparing the number of cases of acute respiratory distress syndrome and mortality rates among children admitted to a multidisciplinary PICU when classified by Pediatric Acute Lung Injury Consensus Conference, Berlin, and American European Consensus Conference criteria. Retrospective cohort study. Tertiary care, university-affiliated PICU. All patients admitted between March 2009 and April 2013 who met inclusion criteria for acute respiratory distress syndrome. None. Of 4,764 patients admitted to the ICU, 278 (5.8%) met Pediatric Acute Lung Injury Consensus Conference pediatric acute respiratory distress syndrome criteria with a mortality rate of 22.7%. One hundred forty-three (32.2% mortality) met Berlin criteria, and 134 (30.6% mortality) met American European Consensus Conference criteria. All patients who met American European Consensus Conference criteria and 141 (98.6%) patients who met Berlin criteria also met Pediatric Acute Lung Injury Consensus Conference criteria. The 137 patients who met Pediatric Acute Lung Injury Consensus Conference but not Berlin criteria had an overall mortality rate of 13.1%, but 29 had severe acute respiratory distress syndrome with 31.0% mortality. At acute respiratory distress syndrome onset, there was minimal difference in mortality between mild or moderate acute respiratory distress syndrome by both Berlin (32.4% vs 25.0%, respectively) and Pediatric Acute Lung Injury Consensus Conference (16.7% vs 18.6%, respectively) criteria, but higher mortality for severe acute respiratory distress syndrome (Berlin, 43.6%; Pediatric Acute Lung Injury Consensus Conference, 37.0%). Twenty-four hours after acute respiratory distress syndrome onset, the presence of severe acute respiratory distress syndrome (using either Berlin or Pediatric Acute Lung Injury Consensus Conference) was associated with nearly 50% mortality. Applying the Pediatric Acute Lung Injury Consensus Conference definition of acute respiratory distress syndrome has the potential to significantly increase the number of acute respiratory distress syndrome patients identified, with a lower overall mortality rate. However, severe acute respiratory distress syndrome is associated with extremely high mortality, particularly if present at 24 hours after initial diagnosis.

Post-traumatic stress disorder symptoms in family caregivers of adult patients with acute leukemia from a dyadic perspective.

PubMed

Jia, Mutian; Li, Jie; Chen, Chunyan; Cao, Fenglin

2015-12-01

Acute leukemia is a fatal disease in adults that not only affects the patients who suffer from it but also their family caregivers. No studies have investigated post-traumatic stress disorder symptoms (PTSS) in family caregivers of adult patients with acute leukemia using a matched sample. The current study examined PTSS in adult patients with acute leukemia and their family caregivers and investigated the factors associated with caregivers' PTSS. A total of 163 patient-caregiver dyads completed questionnaires assessing their PTSS, psychological resilience, and perceived social support. Hierarchical linear regression was used to explore the related factors of caregivers' PTSS. More caregivers than patients met caseness criteria for PTSS (36.8% vs. 18.4%, p < 0.001). Among caregivers, being more closely related to the patients (e.g., spouses and parents), having patients with higher PTSS and having lower psychological resilience were independently associated with more severe PTSS. Caregivers of acute leukemia patients had significantly more severe PTSS than did their patients. This study is the first to investigate PTSS among family caregivers of adult patients with acute leukemia and its related factors in a matched sample. More attention should be paid to the caregivers of patients with acute leukemia to minimize their PTSS and thus improve mental health of caregivers and reduce potential negative consequences for the patients themselves. Copyright © 2015 John Wiley & Sons, Ltd.

Acute abdominal conditions in people with sickle cell disease: a 10-year experience in Port Harcourt, Nigeria.

PubMed

Jebbin, N J; Adotey, J M

2011-01-01

Abdominal crises (vaso-occlusive) are not infrequent in patients with sickle cell anemia. They usually present as acute abdomen. These patients none the less present with other causes of acute abdomen like others without hemoglobinopathy. Six cases of surgical acute abdomen in sickle cell disease patients treated in the University of Port Harcourt Teaching Hospital (UPTH) are presented. Six sickle cell anaemia patients presenting with acute abdominal conditions from 1999 to 2008 (inclusive) in the University of Port Harcourt Teaching Hospital were studied retrospectively (two patients) and prospectively (four patients). After initial resuscitation, appropriate surgical procedures, namely, appendicectomy (2), cholecystectomy (1), open drainage of splenic abscess (1), and release of adhesive band (1) were performed. Six cases were treated (female/male ratio 2:1). Four patients were in the 11-20 year age group. Two patients had appendicectomy and two presented with acute cholecystitis/cholelithiasis, one of whom had open cholecystectomy. One young girl had drainage of splenic abscess and a 42-year-old male had division of obstructive adhesive band at laparotomy. There were two complications, namely, postoperative haemorrhage (in cholecystectomy patient) and acute chest syndrome (in one appendicectomy patient). These were successfully managed with blood transfusion and antibiotic/oxygen therapy, respectively. There was no mortality. Sickle cell anaemia patients are not exempt from acute abdominal conditions requiring surgery. A high index of suspicion coupled with repeated clinical examination is needed for early diagnosis and appropriate treatment.

Does the Intestinal Parasite Enterobius vermicularis Cause Acute Appendicitis?

PubMed

Pirhan, Yavuz; Özen, Fatma Zeynep; Kılınç, Çetin; Güçkan, Rıdvan

2017-06-01

Although intestinal parasitic infections rarely cause acute appendicitis, they are common public health problems in undeveloped and developing countries. Parasitic infections should be kept in mind in patients clinically suspected of having acute appendicitis, and treatment procedures should be adopted according to the etiology. Herein we presented the cases of four patients with clinical findings of acute appendicitis. Patients were clinically suspected of having acute appendicitis, and Enterobius vermicularis was detected in the pathological examinations of specimens. Pinworm infections are common parasitic infections that may mimic appendicitis. The pathology of the four cases was noted when the file of 186 patients aged between 4 and 72 years who underwent surgery for acute appendicitis in my hospital was retrospectively reviewed. When the appendectomy specimen was examined histopathologically it was understood that acute appendicitis was caused by Enterobius vermicularis parasite. In Enterobius infections, performing systemic therapy for patients and their family members is sufficient. To prevent unnecessary appendectomy, this type of infection should be made to ask in the history and clinical findings of patients.

[Study of 3D-pcASL in differentiation of acute cerebral infarction and acute encephalitis].

PubMed

Mao, Chuanwan; Fu, Yuchuan; Ye, Xinjian; Wu, Aiqin; Yan, Zhihan

2015-06-16

To investigate the value of three-dimentional pseudo-continuous arterial spin labeling (ASL) perfusion imaging in differentiating acute cerebral infarction from acute encephalitis. From September 2013 to September 2014, 42 patients with actue stroke onset and 20 healthy volunteers underwent conventional brain MRI DWI and 3D-ASL Perfusion Imaging in our hospital. Only 20 patients whose lesions located in the middle cerebral artery (MCA) territory were enrolled in this study. Of these cases, 12 cases were diagnosed with acute cerebral infarction, 8 were diagnosed with encephalitis. First, we analyzed the imaging features of the 20 patients and 20 volunteers. Then, CBF values of the lesions in the 20 patients and the gray matter of MCA territory in the 20 volunteers were measured on 3D-pcASL images. Third, the difference of mean CBF values between patients and volunteers were analyzed. Out of 20 study group, 19 patients whose lesions presented high signal intensity on DWI images, 12 cases were acute cerebral infarction and 8 were encephalitis. All the lesions of 20 cases showed abnormal perfusion on 3D-pcASL images. 3D-pcASL has good consistency with DWI in diagnostic capabilities (χ² = 0.565, P = 0.01). On 3D-pcASL, 11 acute cerebral infarction patients presented perfusion defects or low perfusion, 1 acute cerebral infarction patients showed high perfusion, 8 encephalitis patients showed inhomogeneous perfusion. The mean value of CBF was (17 ± 6) ml · min⁻¹ · 100 g⁻¹ in 12 acute cerebral infarction patients, (136 ± 69) ml · min⁻¹ · 100 g⁻¹ in 8 encephalitis patients and (68 ± 12) ml · min⁻¹ · 100 g⁻¹ three in 20 healthy volunteers. The difference in mean value of CBF among the three groups was statistically significant (P < 0.01). Acute cerebral infarction often shows low perfusion and acute encephalitis shows high perfusion on 3D-pcASL images, which has a higher application value in diagnosis and differentiation of acute cerebral infarction and encephalitis.

Reinduction therapy for adult acute leukemia with adriamycin, vincristine, and prednisone: a Southwest Oncology Group study.

PubMed

Elias, L; Shaw, M T; Raab, S O

1979-08-01

In an attempt to improve remissions and survivals in previously treated patients with adult acute leukemia, we gave Adriamycin, vincristine, and prednisone for induction therapy, followed by 6-mercaptopurine and methotrexate for maintenance therapy to patients attaining complete remission (CR). The study group consisted of 18 patients with acute myeloblastic leukemia (AML), ten with acute lymphoblastic leukemia, and one with acute undifferentiated leukemia. Only one patient had previously received Adriamycin. Overall, there were ten CRs and two partial remissions. The five CRs and one partial remission in patients with AML occurred among those with one prior induction attempt; none of the eight AML patients with more than one prior induction attempt responded. The actuarial median duration of CR was 15 weeks and was similar for AML and acute lymphoblastic leukemia patients. Responders had a longer median survival (30 weeks) than nonresponders (9 weeks). Thus, although a reasonable number of responses in previously treated patients were obtained with this program, improvements in maintenance therapy are clearly needed.

Intestinal Microbial Community Differs between Acute Pancreatitis Patients and Healthy Volunteers.

PubMed

Zhang, Xi Mei; Zhang, Zheng Yu; Zhang, Chen Huan; Wu, Jing; Wang, You Xin; Zhang, Guo Xin

2018-01-01

A case control study including 45 acute pancreatitis and 44 healthy volunteers was performed to investigate the association between intestinal microbial community and acute pancreatitis. High-throughput 16S rRNA gene amplicon sequencing was used to profile the microbiological composition of the samples. In total, 27 microbial phyla were detected and the samples of pancreatitis patients contained fewer phyla. Samples from acute pancreatitis patients contained more Bacteroidetes and Proteobacteria and fewer Firmicutes and Actinobacteria than those from healthy volunteers. PCoA analyses distinguished the fecal microbial communities of acute pancreatitis patients from those of healthy volunteers. The intestinal microbes of acute pancreatitis patients are different from those of healthy volunteers. Modulation of the intestinal microbiome may serve as an alternative strategy for treating acute pancreatitis. Copyright © 2018 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Identification of acute self-limited hepatitis B among patients presenting with hepatitis B virus-related acute hepatitis: a hospital-based epidemiological and clinical study.

PubMed

Han, Y-N

2009-01-01

This study aimed to identify acute self-limited hepatitis B (ASL-HB) among patients presenting with hepatitis B virus (HBV)-related acute hepatitis. Data were available for 220 patients diagnosed with HBV-related acute hepatitis, of whom 164 had acute hepatitis B (AHB). Of these, 160 were confirmed as ASL-HB: three (1.9%) evolved to chronic hepatitis B and one (0.6%) developed fulminant hepatitis and died. Comparisons were also made between AHB and acute infections with hepatitis A (HA) and hepatitis E (HE) viruses. During the study period, the number of patients with AHB exceeded the sum of those with acute HA and acute HE infections. There was no distinct seasonal peak for AHB infection, whereas both acute HA and acute HE infections occurred more frequently in the spring. Clinical symptoms and physical signs were similar for all three types of hepatitis, but significant differences were seen in some biochemical parameters. In conclusion, this study suggests that symptomatic AHB is not rare in China but it seldom evolves to chronic hepatitis B.

A single-center retrospective clinicopathologic study of endomyocardial biopsies after heart transplant at Baskent University Hospital in Ankara, 1993-2014.

PubMed

Terzi, Ayşen; Sezgin, Atilla; Tunca, Zeynep; Deniz, Ebru; Ayva, Ebru Şebnem; Haberal Reyhan, Nihan; Müderrisoğlu, Haldun; Özdemir, Binnaz Handan

2015-04-01

The purpose of this study was to investigate the frequency and prognostic importance of acute cellular rejection after heart transplant. All 84 heart transplant patients at our center from January 1993 to January 2014, including all 576 endomyocardial biopsies, were evaluated with retrospective review of clinical records and endomyocardial biopsies. Routine and clinically indicated endomyocardial biopsies after heart transplant were graded for acute cellular rejection (2005 International Society for Heart and Lung Transplantation Working Formulation). Survival analysis was performed using Kaplan-Meier method. There were 61 male (73%) and 23 female recipients. Median age at heart transplant was 29 years (range, 1-62 y). Posttransplant early mortality rate was 17.9% (15 patients). In the other 69 patients, 23 patients died and 46 patients (66.7%) were alive at mean 69.3 ± 7.2 months after heart transplant. Mean follow-up was 35.4 ± 29.8 months (range, 0.07-117.5 mo). Mean 8.4 ± 4.2 endomyocardial biopsies (range, 1-19 biopsies) were performed per patient. Median first biopsy time was 7 days (range, 1-78 d). The frequency of posttransplant acute cellular rejection was 63.8% (44 of 69 patients) by histopathology; 86% patients experienced the first episode of acute cellular rejection within 6 months after transplant. There were 18 patients with acute cellular rejection ≥ grade 2R on ≥ 1 endomyocardial biopsy in 44 patients with acute cellular rejection. No significant difference was observed between survival rates of patients with grade 1R or ≥ grade 2R acute cellular rejection, or between survival rates of patients with or without diagnosis of any grade of acute cellular rejection. Acute cellular rejection was not related to any prognostic risk factor. Acute cellular rejection had no negative effect on heart recipient long-term survival, but it was a frequent complication after heart transplant, especially within the first 6 months.

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center.

PubMed

Ploumis, A; Kolli, S; Patrick, M; Owens, M; Beris, A; Marino, R J

2011-03-01

Retrospective database review. To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital. Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital. Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n=78) and from non-SCI centers (n=131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared. Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P=0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (P<0.001). Acute care in organized SCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.

Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit.

PubMed

Fu, Jack B; Lee, Jay; Shin, Ben C; Silver, Julie K; Smith, Dennis W; Shah, Jatin J; Bruera, Eduardo

2017-06-01

Pancytopenia, immunosuppression, and other factors may place patients with multiple myeloma at risk for medical complications. These patients often require inpatient rehabilitation. No previous studies have looked at risk factors for return to the primary acute care service of this patient population. To determine the percentage of and factors associated with return to the primary acute care service of multiple myeloma rehabilitation inpatients. Retrospective review. Acute inpatient rehabilitation unit within a National Cancer Institute Comprehensive Cancer Center. All patients with multiple myeloma admitted to the inpatient rehabilitation unit between March 1, 2004, and February 28, 2015. Return to the primary acute care service was analyzed with demographic information, multiple myeloma characteristics, medications, laboratory values, and hospital admission characteristics. One hundred forty-three inpatient rehabilitation admissions were found during the study period. After we removed multiple admissions of the same patients and planned transfers to the primary acute care service, 122 admissions were analyzed. Thirty-two (26%) patients transferred back to the primary acute care service for unplanned reasons. Multivariate analysis revealed male gender and thrombocytopenia as significantly associated with return to the primary acute care service. The median survival of patients who transferred back to the inpatient primary acute care service was 180 days versus 550 days for those who did not (P < .001). Because of their medical fragility, clinicians caring for rehabilitation inpatients with multiple myeloma should maintain close contact with the primary oncology service. Factors associated with an increased risk of transfer back to the primary acute care service include male gender and thrombocytopenia. IV. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Respiratory Viruses in Invasively Ventilated Critically Ill Patients-A Prospective Multicenter Observational Study.

PubMed

van Someren Gréve, Frank; Juffermans, Nicole P; Bos, Lieuwe D J; Binnekade, Jan M; Braber, Annemarije; Cremer, Olaf L; de Jonge, Evert; Molenkamp, Richard; Ong, David S Y; Rebers, Sjoerd P H; Spoelstra-de Man, Angelique M E; van der Sluijs, Koenraad F; Spronk, Peter E; Verheul, Kirsten D; de Waard, Monique C; de Wilde, Rob B P; Winters, Tineke; de Jong, Menno D; Schultz, Marcus J

2018-01-01

The presence of respiratory viruses and the association with outcomes were assessed in invasively ventilated ICU patients, stratified by admission diagnosis. Prospective observational study. Five ICUs in the Netherlands. Between September 1, 2013, and April 30, 2014, 1,407 acutely admitted and invasively ventilated patients were included. None. Nasopharyngeal swabs and tracheobronchial aspirates were collected upon intubation and tested for 14 respiratory viruses. Out of 1,407 patients, 156 were admitted because of a severe acute respiratory infection and 1,251 for other reasons (non-severe acute respiratory infection). Respiratory viruses were detected in 28.8% of severe acute respiratory infection patients and 17.0% in non-severe acute respiratory infection (p < 0.001). In one third, viruses were exclusively detected in tracheobronchial aspirates. Rhinovirus and human metapneumovirus were more prevalent in severe acute respiratory infection patients (9.6% and 2.6% vs 4.5 and 0.2%; p = 0.006 and p < 0.001). In both groups, there were no associations between the presence of viruses and the number of ICU-free days at day 28, crude mortality, and mortality in multivariate regression analyses. Respiratory viruses are frequently detected in acutely admitted and invasively ventilated patients. Rhinovirus and human metapneumovirus are more frequently found in severe acute respiratory infection patients. Detection of respiratory viruses is not associated with worse clinically relevant outcomes in the studied cohort of patients.

Premature chromosome condensation studies in human leukemia. I. Pretreatment characteristics.

PubMed

Hittelman, W N; Broussard, L C; McCredie, K

1979-11-01

The phenomenon of premature chromosome condensation (PCC) was used to compare the bone marrow proliferation characteristics of 163 patients with various forms of leukemia prior to the initiation of new therapy. The proliferative potential index (PPI, or fraction of G1 cells in late G1 phase) and the fraction of cells in S phase was determined and compared to the type of disease and the bone marrow blast infiltrate for each patient. Previously untreated patients with acute leukemia exhibited an average PPI value three times that of normal bone marrow (37.5% for acute myeloblastic leukemia [AML], acute monomyeloblastic leukemia [AMML], or acute promyelocytic leukemia [APML] and 42% for acute lymphocytic leukemia [ALL] or acute undifferentiated leukemia [AUL]). Untreated chronic myelogenous leukemia (CML) patients showed intermediate PPI values (25.2%), whereas CML patients with controlled disease exhibited nearly normal PPI values (14.6%). On the other hand, blastic-phase CML patients exhibited PPI values closer to that observed in patients with acute leukemia (35.4%). Seven patients with chronic lymphocytic leukemia (CLL) exhibited even higher PPI values. No correlations were observed between PPI values, fraction of cells in S phase, and marrow blast infiltrate. For untreated acute disease patients, PPI values were prognostic for response only at low and high PPI values. These results suggest that the PCC-determined proliferative potential is a biologic reflection of the degree of malignancy within the bone marrow.

Steroid Exposure, Acute Coronary Syndrome, and Inflammatory Bowel Disease: Insights into the Inflammatory Milieu

PubMed Central

Deaño, Roderick C.; Basnet, Sandeep; Onandia, Zurine Galvan; Gandhi, Sachin; Tawakol, Ahmed; Min, James K.; Truong, Quynh A.

2014-01-01

Background Steroids are anti-inflammatory agents commonly used to treat inflammatory bowel disease. Inflammation plays a critical role in the pathophysiology of both inflammatory bowel disease and acute coronary syndrome. We examined the relationship between steroid use in patients with inflammatory bowel disease and acute coronary syndrome. Methods In 177 patients with inflammatory bowel disease (mean age 67, 75% male, 44% Crohn's disease, 56% ulcerative colitis), we performed a 1:2 case-control study matched for age, sex and inflammatory bowel disease type and compared 59 patients with inflammatory bowel disease with acute coronary syndrome to 118 patients with inflammatory bowel disease without acute coronary syndrome. Steroid use was defined as current or prior exposure. Acute coronary syndrome was defined as myocardial infarction or unstable angina, confirmed by cardiac biomarkers and coronary angiography. Results In patients with inflammatory bowel disease, 34% with acute coronary syndrome had exposure to steroids versus 58% without acute coronary syndrome (p<0.01). Steroid exposure reduced the adjusted odds of acute coronary syndrome by 82% (odds ratio [OR] 0.39, 95% CI 0.20-0.74; adjusted OR 0.18, 95% CI 0.06-0.51) in patients with inflammatory bowel disease, 77% in Crohn's disease (OR 0.36, 95% CI 0.14-0.92; adjusted OR 0.23, 95% CI 0.06-0.98), and 78% in ulcerative colitis (OR 0.41, 95% CI 0.16-1.04; adjusted OR 0.22, 95% CI 0.06-0.90). There was no association between other inflammatory bowel disease medications and acute coronary syndrome. Conclusions In patients with inflammatory bowel disease, steroid use significantly reduces the odds of acute coronary syndrome. These findings provide further mechanistic insight into the inflammatory processes involved in inflammatory bowel disease and acute coronary syndrome. PMID:25446295

Acute computed tomography findings in patients with acute confusion of non-traumatic aetiology.

PubMed

West, W M; Ali, A; West, K P; Stultz, R

2011-10-01

A retrospective review was undertaken of all patients referred for computed tomography (CT) scans of the head for acute onset of confusion, not consequent on head trauma, during the period June 1, 2004 to May 31, 2007. Data were obtained by Microsoft Word search of the reports of the Radiology Department of the University Hospital of the West Indies, Kingston, Jamaica. Two hundred and twenty-one patients were reviewed: 103 men and 118 women. The mean age of the sample was 64 years; 168 patients (76%) were 50 years old or older. Computed tomography scans were reported normal in 170 (76.9%) patients; 45 patients (20.4%) had definite acute intracranial CT findings. Findings were equivocal in three patients (1.4%) and unavailable for three (1.4%); 23.2% and 15.6% of patients above and below the age of 50 years respectively showed acute abnormalities on CT The most common acute finding on CT scan was an ischaemic infarct (68%). Other abnormalities included intracerebral haemorrhage and metastases 6.2% each, toxoplasmosis and primary brain tumour 4.2% each and subdural haematoma and meningitis 2.1% each. The diagnoses of toxoplasmosis were made based on appearances typical of toxoplasmosis on CT scans in patients whose request stated that they were HIV positive. In the sample reviewed, most patients who presented with acute confusion were above the age of 50 years. Overall, 20.4% of patients from all age groups had acute abnormalities on CT with a relative higher proportion, 23.2% versus 15.6% of those over 50 years, having acute pathology. The most common abnormality was an ischaemic infarct. This finding is similar to that in developed countries and unlike that seen in other developing countries where infectious aetiologies predominate.

Anticoagulant therapy and outcomes in patients with prior or acute heart failure and acute coronary syndromes: Insights from the APixaban for PRevention of Acute ISchemic Events 2 trial.

PubMed

Cornel, Jan H; Lopes, Renato D; James, Stefan; Stevens, Susanna R; Neely, Megan L; Liaw, Danny; Miller, Julie; Mohan, Puneet; Amerena, John; Raev, Dimitar; Huo, Yong; Urina-Triana, Miguel; Gallegos Cazorla, Alex; Vinereanu, Dragos; Fridrich, Viliam; Harrington, Robert A; Wallentin, Lars; Alexander, John H

2015-04-01

Clinical outcomes and the effects of oral anticoagulants among patients with acute coronary syndrome (ACS) and either a history of or acute heart failure (HF) are largely unknown. We aimed to assess the relationship between prior HF or acute HF complicating an index ACS event and subsequent clinical outcomes and the efficacy and safety of apixaban compared with placebo in these populations. High-risk patients were randomly assigned post-ACS to apixaban 5.0 mg or placebo twice daily. Median follow-up was 8 (4-12) months. The primary outcome was cardiovascular death, myocardial infarction, or stroke. The main safety outcome was thrombolysis in myocardial infarction major bleeding. Heart failure was reported in 2,995 patients (41%), either as prior HF (2,076 [28%]) or acute HF (2,028 [27%]). Patients with HF had a very high baseline risk and were more often managed medically. Heart failure was associated with a higher rate of the primary outcome (prior HF: adjusted hazard ratio [HR] 1.73, 95% CI 1.42-2.10, P < .0001, acute HF: adjusted HR 1.65, 95% CI 1.35-2.01, P < .0001) and cardiovascular death (prior HF: HR 2.54, 95% CI 1.82-3.54, acute HF: adjusted HR 2.52, 95% CI 1.82-3.50). Patients with acute HF also had significantly higher rates of thrombolysis in myocardial infarction major bleeding (prior HF: adjusted HR 1.22, 95% CI 0.65-2.27, P = .54, acute HF: adjusted HR 1.78, 95% CI 1.03-3.08, P = .04). There was no statistical evidence of a differential effect of apixaban on clinical events or bleeding in patients with or without prior HF; however, among patients with acute HF, there were numerically fewer events with apixaban than placebo (14.8 vs 19.3, HR 0.76, 95% CI 0.57-1.01, interaction P = .13), a trend that was not seen in patients with prior HF or no HF. In high-risk patients post-ACS, both prior and acute HFs are associated with an increased risk of subsequent clinical events. Apixaban did not significantly reduce clinical events and increased bleeding in patients with and without HF; however, there was a tendency toward fewer clinical events with apixaban in patients with acute HF. Copyright © 2015 Elsevier Inc. All rights reserved.

Antibiotic prophylaxia in patients with severe acute pancreatitis.

PubMed

Zhou, Yan-Ming; Xue, Zuo-Liang; Li, Yu-Min; Zhu, You-Quan; Cao, Nong

2005-02-01

The prophylactic use of antibiotics in patients with severe acute pancreatitis remains contentious. This study was undertaken to review the current studies on antibiotic prophylaxis in patients with severe acute pancreatitis. All papers found by a Medline search were relevant to human trials of antibiotic prophylaxis in patients with severe acute pancreatitis. In the 1970s, three small randomized studies of prophylactic ampicillin in the treatment of acute pancreatitis showed no effect on mortality or morbidity, but the inclusion of patients at low risk for infection and the use of an ineffective antibiotic were insufficient to detect any differences. From 1993 to 2001, eight prospective clinical trials of antibiotic prophylaxis were conducted in patients with severe acute pancreatitis (SAP). Seven of the 8 trials showed significant effect of the prophylaxis in prevention of pancreatic infections, and one showed significant improvement of clinical course documented by the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Only two trials did demonstrate the significance of the prophylaxis in lowering the mortality rate. Despite variations in drug agents, study size and patient selection, duration of treatment, and methodology (None of the studies was double-blinded), a meta-analysis showed the positive effect of antibiotics in reducing the mortality. We suggested that antibiotic prophylaxis with proven efficacy in necrotic pancreatic tissues should be given to all patients with acute necrotizing pancreatitis. In recent years, however, the first double-blind, placebo-controlled multicenter study from Germany detected no benefit of antibiotic prophylaxis with respect to the risk of developing infected pancreatic necrosis. Prophylactic antibiotics for severe acute pancreatitis is still a matter of discussion and further studies are required to provide adequate data to answer many questions and to define the role of antibiotic prophylaxis in patients with severe acute pancreatitis.

Association between in-hospital acute hypertensive episodes and outcomes in older trauma patients.

PubMed

Saliba, Lina; Stawicki, Stanislaw Peter; Thongrong, Cattleya; Bergese, Sergio Daniel; Papadimos, Thomas John; Gerlach, Anthony Thomas

2014-08-01

Although chronic hypertension is associated with long-term complications, few studies directly examine the effects of in-hospital acute hypertensive episodes in trauma patients. The aim was to determine whether there is an association between in-hospital acute hypertension and morbidity. We included trauma patients between 45 and 89 years who presented to a level I trauma center between January and September 2008. Patients were classified as either experiencing or not experiencing acute hypertensive episode(s) as defined by systolic blood pressure ≥180, or diastolic blood pressure ≥110 mmHg, or at least two readings of systolic blood pressure ≥160 or diastolic blood pressure ≥100 mmHg. The primary outcome was a composite endpoint of myocardial infarction, stroke, venous thromboembolism, new-onset atrial fibrillation, or acute kidney injury. At least one acute hypertensive episode occurred in 42.6% (69/162) of patients. A total of 10.5% patients developed the composite endpoint, 17.4% in the acute hypertensive episode group compared to 5.4% in the non-hypertensive group, p = 0.012. Patients in the acute hypertensive group were more likely to require an intensive care unit admission compared to the non-hypertensive group (33.3 versus 14.0%, p = 0.004). Of the 17 patients who developed an acute hypertensive episode and met the primary endpoint, 10 were on home antihypertensive medications. Of those, four were restarted on all medications initially, three on some, two were started on new medications, and one was not resumed on home medications. Development of acute hypertensive episode(s) in older trauma patients was associated with an increase in the composite endpoint. Prospective studies are needed.

Utilization of Post-Acute Care following Distal Radius Fracture among Medicare Beneficiaries

PubMed Central

Zhong, Lin; Mahmoudi, Elham; Giladi, Aviram M.; Shauver, Melissa; Chung, Kevin C.; Waljee, Jennifer F.

2016-01-01

Purpose To examine the utilization and cost of post-acute care following isolated distal radius fractures (DRF) among Medicare beneficiaries. Methods We examined utilization of post-acute care among Medicare beneficiaries who experienced an isolated DRF (n=38,479) during 2007 using 100% Medicare claims data. We analyzed the effect of patient factors on hospital admission following DRF and the receipt of post-acute care delivered by skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), home healthcare agencies (HHAs), and outpatient OT/PT for the recovery of DRF. Results In this cohort of isolated DRF patients, 1,694 (4.4%) were admitted to hospitals following DRF, and 20% received post-acute care. Women and patients with more comorbid conditions were more likely to require hospital admission. The utilization of post-acute care was higher among women, patients who resided in urban areas, and patients of higher socioeconomic status. The average cost per patient of post-acute care services from IRFs and SNFs ($15,888/patient) was significantly higher than the average cost other aspects of DRF care and accounted for 69% of the total DRF-related expenditure among patients who received inpatient rehabilitation. Conclusions Sociodemographic factors, including sex, socioeconomic status, and age, were significantly correlated with the use of post-acute care following isolated DRFs, and post-acute care accounted for a substantial proportion of the total expenditures related to these common injuries among the elderly. Identifying patients who will derive the greatest benefit from post-acute care can inform strategies to improve the cost-efficiency of rehabilitation and optimize scarce healthcare resources. Level of evidence Therapeutic, III PMID:26527599

Frequency of cancer in patients operated on for acute peripheral arterial thrombosis and the impact on prognosis.

PubMed

Nicolajsen, Chalotte Winther; Dickenson, Maja Holch; Budtz-Lilly, Jacob; Eldrup, Nikolaj

2015-12-01

Little is known about acute peripheral arterial thrombosis in patients with concomitant cancer. Small studies suggest that revascularization in this patient group is associated with thrombosis and increased risk of amputation and death. We investigated the frequency of cancer in patients operated on for acute peripheral arterial thrombosis and the long-term risk of amputation, mortality, myocardial infarction, and stroke in a national cohort. This was a prospective case/noncase study comprising all Danish citizens undergoing vascular surgery for acute arterial thrombosis from 1986 to 2012 with up to 26 years of follow-up. A total of 7840 patients were treated surgically for acute arterial thrombosis; 2384 (30.4%) were previously diagnosed with cancer or developed cancer during the observation period. Risk of amputation was not significantly different in patients with or without cancer, except in patients with cancer diagnosed <24 months before acute limb ischemia (hazard ratio, 2.0). Mortality was significantly greater in all patients having or developing cancer within 24 months after surgery (hazard ratio, 1.2-2.2). The frequencies of myocardial infarction and stroke were similar to those among patients without cancer. One of five patients operated on for acute limb ischemia has a diagnosis of cancer, and a further 3.4% will develop cancer within 24 months. The data further show that patients with acute limb ischemia and concomitant cancer can be successfully revascularized and that the majority of these patients preserve their limb. Cancer should therefore not contravene interventional treatment. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Prone Positioning Improves Oxygenation in Adult Burn Patients with Severe Acute Respiratory Distress Syndrome

DTIC Science & Technology

2012-01-01

Prone positioning improves oxygenation in adult burn patients with severe acute respiratory distress syndrome Diane F. Hale, MD, Jeremy W. Cannon, MD...Kevin K. Chung, MD, San Antonio, Texas BACKGROUND: Prone positioning (PP) improves oxygenation and may provide a benefit in patients with acute... positioning improves oxygenation in adult burn patients with severe acute respiratory distress syndrome 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

The Association Between Unhealthy Alcohol Use and Acute Care Expenditures in the 30 Days Following Hospital Discharge Among Older Veterans Affairs Patients with a Medical Condition.

PubMed

Chavez, Laura J; Liu, Chuan-Fen; Tefft, Nathan; Hebert, Paul L; Devine, Beth; Bradley, Katharine A

2017-10-01

Hospital readmissions and emergency department (ED) visits within 30 days of discharge are costly. Heavy alcohol use could predict increased risk for post-discharge acute care. This study assessed 30-day acute care utilization and expenditures for different categories of alcohol use. Veterans Affairs (VA) patients age ≥65 years with past-year alcohol screening, hospitalized for a medical condition, were included. VA and Medicare health care utilization data were used. Two-part models adjusted for patient demographics. Among 416,050 hospitalized patients, 25% had 30-day acute care use. Nondrinking patients (n = 267,746) had increased probability of acute care use, mean utilization days, and expenditures (difference of $345; 95% CI $268-$423), relative to low-risk drinkers (n = 105,023). High-risk drinking patients (n = 5,300) had increased probability of acute care use and mean utilization days, but not expenditures. Although these patients did not have greater acute care expenditures than low-risk drinking patients, they may nevertheless be vulnerable to poor post-discharge outcomes.

[Metabolic disturbances and ways of their pharmacological correction in acute poisoning with ethanol in patients with chronic alcoholism].

PubMed

Livanov, G A; Lodyagin, A N; Lubsanova, S V; Kovalenko, A L; Batotsyrenov, B V; Sergeev, O A; Loladze, A T; Andrianov, A Yu

2015-01-01

To study an influence of chronic alcoholism on the clinical course and severity of metabolic disturbances in patients with acute poisoning with ethanol and to improve the treatment. Authors examined 93 patients stratified into three groups (acute poisoning with ethanol in patients with chronic alcoholism, without chronic alcoholism and those treated with reamberin). The presence of chronic alcoholism significantly augmented metabolic disturbances and influenced the disturbance of oxygen-transport function and free-radical processes in patients with acute intoxication with ethanol. Using of reamberin in the complex intensive therapy led to the decrease in metabolic disorders, which improved the clinical course of acute poisoning with ethanol in patients with chronic alcoholism.

Early identification of ‘acute-onset’ chronic inflammatory demyelinating polyneuropathy

PubMed Central

Sung, Jia-Ying; Tani, Jowy; Park, Susanna B.; Kiernan, Matthew C.

2014-01-01

Distinguishing patients with acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy prior to relapse is often challenging at the onset of their clinical presentation. In the present study, nerve excitability tests were used in conjunction with the clinical phenotype and disease staging, to differentiate between patients with acute-onset chronic inflammatory demyelinating polyneuropathy and patients with acute inflammatory demyelinating polyneuropathy at an early stage, with the aim to better guide treatment. Clinical assessment, staging and nerve excitability tests were undertaken on patients initially fulfilling the diagnostic criteria of acute inflammatory demyelinating polyneuropathy soon after symptom onset and their initial presentation. Patients were subsequently followed up for minimum of 12 months to determine if their clinical presentations were more consistent with acute-onset chronic inflammatory demyelinating polyneuropathy. Clinical severity as evaluated by Medical Research Council sum score and Hughes functional grading scale were not significantly different between the two cohorts. There was no difference between the time of onset of initial symptoms and nerve excitability test assessment between the two cohorts nor were there significant differences in conventional nerve conduction study parameters. However, nerve excitability test profiles obtained from patients with acute inflammatory demyelinating polyneuropathy demonstrated abnormalities in the recovery cycle of excitability, including significantly reduced superexcitability (P < 0.001) and prolonged relative refractory period (P < 0.01), without changes in threshold electrotonus. In contrast, in patients with acute-onset chronic inflammatory demyelinating polyneuropathy, a different pattern occurred with the recovery cycle shifted downward (increased superexcitability, P < 0.05; decreased subexcitability, P < 0.05) and increased threshold change in threshold electrotonus in both hyperpolarizing and depolarizing directions [depolarizing threshold electrotonus (90–100 ms) P < 0.005, hyperpolarizing threshold electrotonus (10–20 ms), P < 0.01, hyperpolarizing threshold electrotonus (90–100 ms), P < 0.05], perhaps suggesting early hyperpolarization. In addition, using excitability parameters superexcitability, subexcitability and hyperpolarizing threshold electrotonus (10–20 ms), the patients with acute inflammatory demyelinating polyneuropathy and acute-onset chronic inflammatory demyelinating polyneuropathy could be clearly separated into two non-overlapping groups. Studies of nerve excitability may be able to differentiate acute from acute-onset chronic inflammatory demyelinating polyneuropathy at an early stage. Characteristic nerve excitability parameter changes occur in early acute-onset chronic inflammatory demyelinating polyneuropathy, to match the clinical phenotype. Importantly, this pattern of change was strikingly different to that shown by patients with acute inflammatory demyelinating polyneuropathy, suggesting that nerve excitability techniques may be useful in distinguishing acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy at the initial stage. PMID:24983276

Heart failure in patients admitted for acute coronary syndromes: A report from a large national registry.

PubMed

Jeger, Raban V; Pfister, Otmar; Radovanovic, Dragana; Eberli, Franz R; Rickli, Hans; Urban, Philip; Pedrazzini, Giovanni; Stauffer, Jean-Christophe; Nossen, Jörg; Erne, Paul

2017-10-01

Data on temporal trends of heart failure (HF) in acute coronary syndrome (ACS) are scarce. Improved treatment options may have led to lower case-fatality rates (CFRs) during the last years in ACS complicated by HF. Patients of the nationwide Acute Myocardial Infarction in Switzerland (AMIS)-Plus ACS registry were analyzed from 2000 to 2014. Of 36 366 ACS patients, 3376 (9.3%) had acute or chronic HF, 2111 (5.8%) de novo acute HF (AHF), 964 (2.7%) chronic HF (CHF), and 301 (0.8%) acute decompensated CHF (ADCHF). In-hospital CFRs were highest in patients with ADCHF (32.6%) and de novo AHF (29.7%), followed by patients with CHF (12.9%) and without HF (3.2%, P < 0.001). Although in-hospital CFRs gradually decreased in CHF patients (14.3% to 4.5%, P = 0.003) and patients without HF (3.5% to 2.2%, P < 0.001), they remained high in patients with ADCHF (36.4% to 40.0%, P = 0.45) and de novo AHF (50.0% to 29.4%, P = 0.37). Although there was an increase in specific ACS therapies in the cohort over time, ACS patients with HF received significantly less pharmacological and interventional ACS therapies than patients without HF. There was no significant change in HF medication rates except less frequent use of β-blockers and diuretics in de novo AHF patients in recent years. HF is present in 1 out of 10 patients presenting with ACS and is associated with high in-hospital CFRs, particularly in acute HF. Although advances in ACS therapy improved in-hospital CFRs in patients with no HF or CHF, CFRs remained unchanged and high in patients with acute HF and ACS over the last decade. © 2017 Wiley Periodicals, Inc.

Troponin I degradation in serum of patients with acute ischemic stroke.

PubMed

Jensen, Jesper K; Hallén, Jonas; Lund, Terje; Madsen, Lene Helleskov; Grieg, Zanina; Januzzi, James L; Atar, Dan

2011-02-01

Although troponin is a cornerstone biomarker in the assessment and management of patients with acute coronary syndrome, much remains to be learned about the biology of this widely used biomarker, including its post-release modification. Degradation of troponin following release in patients with acute coronary syndrome has been described; however whether such post-release modification occurs in other non-acute coronary syndrome states remains unknown. The aim of this study was to define troponin degradation in patients with acute ischemic stroke. Troponin I (cTnI) was measured daily during the first 5 days of admission in 244 patients with acute ischemic stroke. Western blot analysis was performed using anti-cTnI antibodies and compared with serum concentrations of cTnI in seven patients and one patient with myocardial infarction (positive control). Elevated levels of troponin were detected in 25 (10%) patients; in all, both intact cTnI and cTnI degradation products were detected, with up to seven degradation fragments found. Samples with the highest total cTnI levels gave the strongest and most numerous western-blotting bands. All fragments were comparable with the degradation pattern of the positive control in terms of position. Immunoblotting of blood samples from patients with acute ischemic stroke reveals similar degradation patterns of cTnI as has been described in patients with acute myocardial infarction. The biological ramification and potential clinical impact of this finding bears further scrutiny.

Aldosterone, mortality, and acute ischaemic events in coronary artery disease patients outside the setting of acute myocardial infarction or heart failure.

PubMed

Ivanes, Fabrice; Susen, Sophie; Mouquet, Frédéric; Pigny, Pascal; Cuilleret, François; Sautière, Karine; Collet, Jean-Philippe; Beygui, Farzin; Hennache, Bernadette; Ennezat, Pierre Vladimir; Juthier, Françis; Richard, Florence; Dallongeville, Jean; Hillaert, Marieke A; Doevendans, Pieter A; Jude, Brigitte; Bertrand, Michel; Montalescot, Gilles; Van Belle, Eric

2012-01-01

Recent studies have demonstrated that aldosterone levels measured in patients with heart failure or acute myocardial infarction (MI) are associated with long-term mortality, but the association with aldosterone levels in patients with coronary artery disease (CAD) outside these specific settings remains unknown. In addition, no clear mechanism has been elucidated to explain these observations. The present study was designed to evaluate the relationship between the level of aldosterone and the risk of death and acute ischaemic events in CAD patients with a preserved left ventricular (LV) function and no acute MI. In 799 consecutive CAD patients referred for elective coronary angioplasty measurements were obtained before the procedure for: aldosterone (median = 25 pg/mL), brain natriuretic peptide (BNP) (median = 35 pg/mL), hsC-reactive protein (median = 4.17 mg/L), and left ventricular ejection fraction (mean = 58%). Patients with acute MI or coronary syndrome (ACS) who required urgent revascularization were not included in the study. The primary endpoint, cardiovascular death, occurred in 41 patients during a median follow-up period of 14.9 months. Secondary endpoints-total mortality, acute ischaemic events (acute MI or ischaemic stroke), and the composite of death and acute ischaemic events-were observed in 52, 54, and 94 patients, respectively. Plasma aldosterone was found to be related to BMI, hypertension and NYHA class, and inversely related to age, creatinine clearance, and use of beta-blockers. Multivariate Cox model analysis demonstrated that aldosterone was independently associated with cardiovascular mortality (P = 0.001), total mortality (P = 0.001), acute ischaemic events (P = 0.01), and the composite of death and acute ischaemic events (P = 0.004). Reclassification analysis, using integrated discrimination improvement (IDI) and net reclassification improvement (NRI), demonstrated incremental predictive value of aldosterone (P < 0.0001). Our results demonstrate that, in patients with CAD but without heart failure or acute MI, the level of aldosterone is strongly and independently associated with mortality and the occurrence of acute ischaemic events.

Predictors of acute and persisting ischemic brain lesions in patients randomized to carotid stenting or endarterectomy.

PubMed

Rostamzadeh, Ayda; Zumbrunn, Thomas; Jongen, Lisa M; Nederkoorn, Paul J; Macdonald, Sumaira; Lyrer, Philippe A; Kappelle, L Jaap; Mali, Willem P Th M; Brown, Martin M; van der Worp, H Bart; Engelter, Stefan T; Bonati, Leo H

2014-02-01

We investigated predictors for acute and persisting periprocedural ischemic brain lesions among patients with symptomatic carotid stenosis randomized to stenting or endarterectomy in the International Carotid Stenting Study. We assessed acute lesions on diffusion-weighted imaging 1 to 3 days after treatment in 124 stenting and 107 endarterectomy patients and lesions persisting on fluid-attenuated inversion recovery after 1 month in 86 and 75 patients, respectively. Stenting patients had more acute (relative risk, 8.8; 95% confidence interval, 4.4-17.5; P<0.001) and persisting lesions (relative risk, 4.2; 95% confidence interval, 1.6-11.1; P=0.005) than endarterectomy patients. Acute lesion count was associated with age (by trend), male sex, and stroke as the qualifying event in stenting; high systolic blood pressure in endarterectomy; and white matter disease in both groups. The rate of conversion from acute to persisting lesions was lower in the stenting group (relative risk, 0.4; 95% confidence interval, 0.2-0.8; P=0.007), and was only predicted by acute lesion volume. Stenting caused more acute and persisting ischemic brain lesions than endarterectomy. However, the rate of conversion from acute to persisting lesions was lower in the stenting group, most likely attributable to lower acute lesion volumes. Clinical Trial Registration -URL: www.isrctn.org. Unique identifier: ISRCTN25337470.

Clinical and microbiological characteristics of spontaneous acute prostatitis and transrectal prostate biopsy-related acute prostatitis: Is transrectal prostate biopsy-related acute prostatitis a distinct acute prostatitis category?

PubMed

Kim, Jong Wook; Oh, Mi Mi; Bae, Jae Hyun; Kang, Seok Ho; Park, Hong Seok; Moon, Du Geon

2015-06-01

This study aimed to compare the clinical and microbiological characteristics between acute bacterial prostatitis and transrectal biopsy-related acute prostatitis. We retrospectively reviewed the records of 135 patients hospitalized for acute prostatitis in three urological centers between 2004 and 2013. Acute bacterial prostatitis was diagnosed according to typical symptoms, findings of physical examination, and laboratory test results. Clinical variables, laboratory test results, and anti-microbial susceptibility results were reviewed. Patients were classified into the spontaneous acute prostatitis group (S-ABP) or biopsy-related acute prostatitis (Bx-ABP) for comparison of their clinical, laboratory, and microbiological findings. The mean age of all patients was 61.7 ± 12.9 years. Compared with S-ABP patients, Bx-ABP patients were significantly older, had larger prostate volumes, higher PSA values, higher peak fever temperatures, and higher incidence of septicemia and antibiotic-resistant bacteria. Overall, of the 135 patients, 57.8% had positive bacterial urine and/or blood cultures. Bx-ABP patients had a higher incidence of bacterial (urine and/or blood) positive cultures compared to S-ABP patients (66.7% versus 55.6%). Escherichia coli was the predominant organism in both groups, but it was more common in Bx-ABP (88.9%) than in S-ABP (66.7%). Extended spectrum beta-lactamase -producing bacteria accounted for 64.7% of culture-positive patients in the Bx-ABP group compared to 13.3% in the S-ABP group. Bx-ABP patients showed a higher incidence of septicemia and antibiotic-resistant bacteria than S-ABP patients. These results have important implications for the management and antimicrobial treatment of Bx-ABP, which may well deserve to be considered a distinct prostatitis category. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?

PubMed

Kisacik, Bunyamin; Kalyoncu, Umut; Erol, M Fatih; Karadag, Omer; Yildiz, Mustafa; Akdogan, Ali; Kaptanoglu, Bugra; Hayran, Mutlu; Ureten, Kemal; Ertenli, Ihsan; Kiraz, Sedat; Calguneri, Meral

2007-12-01

This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6 +/- 8.1 years (range 2-33 years) and all were on colchicine therapy with a mean colchicine dosage of 1.2 +/- 0.4 mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93 ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12 +/- 0.96] vs 0.095 [0.01-0.80] p < 0.001, respectively). PCT levels higher than 0.5 ng/ml were found in 11% (3/28) of FMF patients compared to 62% (18/29) of acute appendicitis patients (p < 0.001). Our results suggest that PCT could be a useful test in the differentiation of abdominal FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.

Epidemiology and outcomes of acute respiratory distress syndrome in children according to the Berlin definition: a multicenter prospective study.

PubMed

Barreira, Eliane R; Munoz, Gabriela O C; Cavalheiro, Priscilla O; Suzuki, Adriana S; Degaspare, Natalia V; Shieh, Huei H; Martines, João A D S; Ferreira, Juliana C; Lane, Christianne; Carvalho, Werther B; Gilio, Alfredo E; Precioso, Alexander R

2015-05-01

In 2012, a new acute respiratory distress syndrome definition was proposed for adult patients. It was later validated for infants and toddlers. Our objective was to evaluate the prevalence, outcomes, and risk factors associated with acute respiratory distress syndrome in children up to 15 years according to the Berlin definition. A prospective, multicenter observational study from March to September 2013. Seventy-seven PICU beds in eight centers: two private hospitals and six public academic hospitals in Brazil. All children aged 1 month to 15 years admitted to the participating PICUs in the study period. None. All children admitted to the PICUs were daily evaluated for the presence of acute respiratory distress syndrome according to the American-European Consensus Conference and Berlin definitions. Of the 562 patients included, acute respiratory distress syndrome developed in 57 patients (10%) and 58 patients (10.3%) according to the Berlin definition and the American-European Consensus Conference definition, respectively. Among patients with acute respiratory distress syndrome according to the Berlin definition, nine patients (16%) were mild, 21 (37%) were moderate, and 27 (47%) were severe. Compared with patients without acute respiratory distress syndrome, patients with acute respiratory distress syndrome had significantly higher severity scores, longer PICU and hospital length of stay, longer duration of mechanical ventilation, and higher mortality (p < 0.001). The presence of two or more comorbidities and admission for medical reasons were associated with development of acute respiratory distress syndrome. Comparisons across the three the Berlin categories showed significant differences in the number of ventilator-free days (21, 20, and 5 d, p = 0.001) and mortality for severe acute respiratory distress syndrome (41%) in comparison with mild (0) and moderate (15%) acute respiratory distress syndrome(p = 0.02). No differences in PICU or hospital stay were observed across the groups. The Berlin definition can identify a subgroup of patients with distinctly worse outcomes, as shown by the increased mortality and reduced number of ventilator-free days in pediatric patients with severe acute respiratory distress syndrome.

External validation of a six simple variable model of stroke outcome and verification in hyper-acute stroke.

PubMed

Reid, J M; Gubitz, G J; Dai, D; Reidy, Y; Christian, C; Counsell, C; Dennis, M; Phillips, S J

2007-12-01

We aimed to validate a previously described six simple variable (SSV) model that was developed from acute and sub-acute stroke patients in our population that included hyper-acute stroke patients. A Stroke Outcome Study enrolled patients from 2001 to 2002. Functional status was assessed at 6 months using the modified Rankin Scale (mRS). SSV model performance was tested in our cohort. 538 acute ischaemic (87%) and haemorrhagic stroke patients were enrolled, 51% of whom presented to hospital within 6 h of symptom recognition. At 6 months post-stroke, 42% of patients had a good outcome (mRS < or = 2). Stroke patients presenting within 6 h of symptom recognition were significantly older with higher stroke severity. In our Stroke Outcome Study dataset, the SSV model had an area under the curve of 0.792 for 6 month outcomes and performed well for hyper-acute or post-acute stroke, age < or > or = 75 years, haemorrhagic or ischaemic stroke, men or women, moderate and severe stroke, but poorly for mild stroke. This study confirms the external validity of the SSV model in our hospital stroke population. This model can therefore be utilised for stratification in acute and hyper-acute stroke trials.

Value of initial radiological investigations in patients admitted to hospital with appendicitis, acute gallbladder disease or acute pancreatitis.

PubMed

Bhangu, Aneel; Richardson, Charlotte; Winter, Hannah; Bleetman, Anthony

2010-10-01

To determine the value of abdominal radiography (AXR) for investigating patients attending hospital with a first episode of appendicitis (requiring appendicectomy), acute gallbladder disease or acute pancreatitis, and to identify if early (within 18 h) ultrasound or CT scanning reduces the use of AXR. Setting Two acute teaching hospitals during August-September 2008 and February-March 2009. Audit of 355 patients (179 patients (50%) who underwent appendicectomy, 128 (36%) admitted with acute gallbladder disease and 48 (14%) with acute pancreatitis). AXR was performed in 53 patients (30%) who underwent appendicectomy, 73 (57%) with acute gallstone disease and 38 (78%) with acute pancreatitis. The useful abnormality pick-up rate was low; 9% (n=5), 5% (n=4) and 0% (n=0), respectively. When used, ultrasound confirmed the diagnosis in 84% (140/166) and CT scanning (either after AXR or as first line) in 97% (34/35). 42 patients underwent early ultrasound (n=27) or CT scanning (n=15), which together reduced the rate of AXR usage by 34% (14/42 early vs 107/159 delayed, p<0.001). AXR does not aid diagnosis of these conditions but is still performed. Early ultrasound or CT scanning reduces the use of AXR and are more sensitive; methods of providing these should be explored.

Temporomandibular Joint Disorder Complaints in Tinnitus: Further Hints for a Putative Tinnitus Subtype

PubMed Central

Vielsmeier, Veronika; Strutz, Jürgen; Kleinjung, Tobias; Schecklmann, Martin; Kreuzer, Peter Michael; Landgrebe, Michael; Langguth, Berthold

2012-01-01

Objective Tinnitus is considered to be highly heterogeneous with respect to its etiology, its comorbidities and the response to specific interventions. Subtyping is recommended, but it remains to be determined which criteria are useful, since it has not yet been clearly demonstrated whether and to which extent etiologic factors, comorbid states and interventional response are related to each other and are thus applicable for subtyping tinnitus. Analyzing the Tinnitus Research Initiative Database we differentiated patients according to presence or absence of comorbid temporomandibular joint (TMJ) disorder complaints and compared the two groups with respect to etiologic factors. Methods 1204 Tinnitus patients from the Tinnitus Research Initiative (TRI) Database with and without subjective TMJ complaints were compared with respect to demographic, tinnitus and audiological characteristics, questionnaires, and numeric ratings. Data were analysed according to a predefined statistical analysis plan. Results Tinnitus patients with TMJ complaints (22% of the whole group) were significantly younger, had a lower age at tinnitus onset, and were more frequently female. They could modulate or mask their tinnitus more frequently by somatic maneuvers and by music or sound stimulation. Groups did not significantly differ for tinnitus duration, type of onset (gradual/abrupt), onset related events (whiplash etc.), character (pulsatile or not), hyperacusis, hearing impairment, tinnitus distress, depression, quality of life and subjective ratings (loudness etc.). Conclusion Replicating previous work in tinnitus patients with TMJ complaints, classical risk factors for tinnitus like older age and male gender are less relevant in tinnitus patients with TMJ complaints. By demonstrating group differences for modulation of tinnitus by movements and sounds our data further support the notion that tinnitus with TMJ complaints represents a subgroup of tinnitus with clinical features that are highly relevant for specific therapeutic management. PMID:22723902

Visuo-proprioceptive interactions in degenerative cervical spine diseases requiring surgery.

PubMed

Freppel, S; Bisdorff, A; Colnat-Coulbois, S; Ceyte, H; Cian, C; Gauchard, G; Auque, J; Perrin, P

2013-01-01

Cervical proprioception plays a key role in postural control, but its specific contribution is controversial. Postural impairment was shown in whiplash injuries without demonstrating the sole involvement of the cervical spine. The consequences of degenerative cervical spine diseases are underreported in posture-related scientific literature in spite of their high prevalence. No report has focused on the two different mechanisms underlying cervicobrachial pain: herniated discs and spondylosis. This study aimed to evaluate postural control of two groups of patients with degenerative cervical spine diseases with or without optokinetic stimulation before and after surgical treatment. Seventeen patients with radiculopathy were recruited and divided into two groups according to the spondylotic or discal origin of the nerve compression. All patients and a control population of 31 healthy individuals underwent a static posturographic test with 12 recordings; the first four recordings with the head in 0° position: eyes closed, eyes open without optokinetic stimulation, with clockwise and counter clockwise optokinetic stimulations. These four sensorial situations were repeated with the head rotated 30° to the left and to the right. Patients repeated these 12 recordings 6weeks postoperatively. None of the patients reported vertigo or balance disorders before or after surgery. Prior to surgery, in the eyes closed condition, the herniated disc group was more stable than the spondylosis group. After surgery, the contribution of visual input to postural control in a dynamic visual environment was reduced in both cervical spine diseases whereas in a stable visual environment visual contribution was reduced only in the spondylosis group. The relative importance of visual and proprioceptive inputs to postural control varies according to the type of pathology and surgery tends to reduce visual contribution mostly in the spondylosis group. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

Protocol for a prospective collaborative systematic review and meta-analysis of individual patient data from randomized controlled trials of vasoactive drugs in acute stroke: The Blood pressure in Acute Stroke Collaboration, stage-3.

PubMed

Sandset, Else Charlotte; Sanossian, Nerses; Woodhouse, Lisa J; Anderson, Craig; Berge, Eivind; Lees, Kennedy R; Potter, John F; Robinson, Thompson G; Sprigg, Nikola; Wardlaw, Joanna M; Bath, Philip M

2018-01-01

Rationale Despite several large clinical trials assessing blood pressure lowering in acute stroke, equipoise remains particularly for ischemic stroke. The "Blood pressure in Acute Stroke Collaboration" commenced in the mid-1990s focussing on systematic reviews and meta-analysis of blood pressure lowering in acute stroke. From the start, Blood pressure in Acute Stroke Collaboration planned to assess safety and efficacy of blood pressure lowering in acute stroke using individual patient data. Aims To determine the optimal management of blood pressure in patients with acute stroke, including both intracerebral hemorrhage and ischemic stroke. Secondary aims are to assess which clinical and therapeutic factors may alter the optimal management of high blood pressure in patients with acute stroke and to assess the effect of vasoactive treatments on hemodynamic variables. Methods and design Individual patient data from randomized controlled trials of blood pressure management in participants with ischemic stroke and/or intracerebral hemorrhage enrolled during the ultra-acute (pre-hospital), hyper-acute (<6 h), acute (<48 h), and sub-acute (<168 h) phases of stroke. Study outcomes The primary effect variable will be functional outcome defined by the ordinal distribution of the modified Rankin Scale; analyses will also be carried out in pre-specified subgroups to assess the modifying effects of stroke-related and pre-stroke patient characteristics. Key secondary variables will include clinical, hemodynamic and neuroradiological variables; safety variables will comprise death and serious adverse events. Discussion Study questions will be addressed in stages, according to the protocol, before integrating these into a final overreaching analysis. We invite eligible trials to join the collaboration.

[The etiological aspects of acute abdominal pain in children].

PubMed

Dinu, C A; Moraru, D

2011-01-01

The study of the etiological aspects of acute abdominal pain in children, in order to perceive the clinical-etiological correlations and the disorders distribution related to age, gender and the origin of the patients. The criteria for including patients were age (between 0 and 18 years) and the presence of acute abdominal pain before or during the consultation with the physician. The research on acute abdominal pain in children was performed on the level of the Surgery and Pediatrics II clinical departments of the "Sf. Ioan" Children's Emergency Clinical Hospital in Galati, between 01.01.2009 - 01.01.2011. The clinical study performed on the patients registered in the studied groups focused on the identification, the evaluation of the symptoms of acute abdominal pain in children, diagnosing and treating it. The criteria for excluding patients were an age older than 18 years or the absence of acute abdominal pain as a symptom before or during the examination. The statistical analysis used the descriptive and analytical methods. The data was centralized and statistically processed in M.S.EXCEL and S.P.S.S. databases. The patients with acute abdominal pain represent a percentage of 92.9% (2358 cases) of the total number of patients who suffer from abdominal pain (N=2537). The highest frequency of cases is represented by acute appendicitis (1056 cases - 44.8%). In the 5-18 years age group, acute appendicitis, mesenteric lymphadenitis, ovarian follicular cysts, acute pyelenophritis and salpingitis are predominant. In the 0-4 years age group gastroenteritis, acute pharyngitis, reactive hepatitis and lower digestive bleeding are predominant. In females, acute appendicitis, gastroenteritis, gastroduodenitis and cystitis are predominant, whereas in males, peritonitis, sepsis through E. coli, the contusion of the abdominal wall and acute pharyngitis are predominant.

Impact of obstructive sleep apnea on cardiac organ damage in patients with acute ischemic stroke.

PubMed

Mattaliano, Paola; Lombardi, Carolina; Sangalli, Davide; Faini, Andrea; Corrà, Barbara; Adobbati, Laura; Branzi, Giovanna; Mariani, Davide; Silani, Vincenzo; Parati, Gianfranco

2018-06-01

Both obstructive sleep apnea (OSA) and cardiac organ damage have a crucial role in acute ischemic stroke. Our aim is to explore the relationship between OSA and cardiac organ damage in acute stroke patients. A total of 130 consecutive patients with acute ischemic stroke were enrolled. Patients underwent full multichannel 24-h polysomnography for evaluation of OSA and echocardiography to evaluate left ventricle (LV) mass index (LV mass/BSA, LV mass/height), thickness of interventricular septum (IVS) and posterior wall (LVPW), LV ejection fraction and left atrium enlargement. Information on occurrence of arterial hypertension and its treatment before stroke was obtained from patients' history. 61.9% (70) of patients, mostly men (67.1%), with acute stroke had OSA (AHI > 10). Patients with acute stroke and OSA showed a significant increase (P < 0.05) of LV mass index, IVS and LVPW thickness and a significant left atrial enlargement as compared with patients without OSA. LV ejection fraction was not significantly different in stroke patients with and without OSA and was within normal limits. No relationship was found among cardiac alterations, occurrence of OSA and history of hypertension. Acute stroke patients with OSA had higher LV mass and showed greater left atrial enlargement than patients without OSA. This study confirms the high prevalence of OSA in stroke patients, suggesting also an association between OSA and cardiac target organ damage. Our finding of structural LV abnormalities in acute stroke patients with OSA suggests a potential role of OSA as contributing factor in determining both cerebrovascular and cardiac damage, even in absence of clear link with a history of blood pressure elevation.

Pretransplant thymic function predicts acute rejection in antithymocyte globulin-treated renal transplant recipients.

PubMed

Bamoulid, Jamal; Courivaud, Cécile; Crepin, Thomas; Carron, Clémence; Gaiffe, Emilie; Roubiou, Caroline; Laheurte, Caroline; Moulin, Bruno; Frimat, Luc; Rieu, Philippe; Mousson, Christiane; Durrbach, Antoine; Heng, Anne-Elisabeth; Rebibou, Jean-Michel; Saas, Philippe; Ducloux, Didier

2016-05-01

Lack of clear identification of patients at high risk of acute rejection hampers the ability to individualize immunosuppressive therapy. Here we studied whether thymic function may predict acute rejection in antithymocyte globulin (ATG)-treated renal transplant recipients in 482 patients prospectively studied during the first year post-transplant of which 86 patients experienced acute rejection. Only CD45RA(+)CD31(+)CD4(+) T cell (recent thymic emigrant [RTE]) frequency (RTE%) was marginally associated with acute rejection in the whole population. This T-cell subset accounts for 26% of CD4(+) T cells. Pretransplant RTE% was significantly associated with acute rejection in ATG-treated patients (hazard ratio, 1.04; 95% confidence interval, 1.01-1.08) for each increased percent in RTE/CD4(+) T cells), but not in anti-CD25 monoclonal (αCD25 mAb)-treated patients. Acute rejection was significantly more frequent in ATG-treated patients with high pretransplant RTE% (31.2% vs. 16.4%) or absolute number of RTE/mm(3) (31.7 vs. 16.1). This difference was not found in αCD25 monclonal antibody-treated patients. Highest values of both RTE% (>31%, hazard ratio, 2.50; 95% confidence interval, 1.09-5.74) and RTE/mm(3) (>200/mm(3), hazard ratio, 3.71; 95% confidence interval, 1.59-8.70) were predictive of acute rejection in ATG-treated patients but not in patients having received αCD25 monoclonal antibody). Results were confirmed in a retrospective cohort using T-cell receptor excision circle levels as a marker of thymic function. Thus, pretransplant thymic function predicts acute rejection in ATG-treated patients. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome.

PubMed

Villar, Jesús; Ambrós, Alfonso; Soler, Juan Alfonso; Martínez, Domingo; Ferrando, Carlos; Solano, Rosario; Mosteiro, Fernando; Blanco, Jesús; Martín-Rodríguez, Carmen; Fernández, María Del Mar; López, Julia; Díaz-Domínguez, Francisco J; Andaluz-Ojeda, David; Merayo, Eleuterio; Pérez-Méndez, Lina; Fernández, Rosa Lidia; Kacmarek, Robert M

2016-07-01

Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis. A prospective, multicenter, observational, descriptive, and validation study. A network of multidisciplinary ICUs. Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation. None. Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort. A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.

Influence of Acute Kidney Injury Defined by the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score on the Clinical Course of PICU Patients.

PubMed

Cabral, Felipe Cezar; Ramos Garcia, Pedro Celiny; Mattiello, Rita; Dresser, Daiane; Fiori, Humberto Holmer; Korb, Cecilia; Dalcin, Tiago Chagas; Piva, Jefferson Pedro

2015-10-01

To evaluate the predictive value of the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria for disease course severity in patients with or without acute kidney injury admitted to a PICU. Retrospective cohort study. A 12-bed PICU at a tertiary referral center in Southern Brazil. All patients admitted to the study unit over a 1-year period. A database of all eligible patients was analyzed retrospectively. Patients were classified by pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score at admission and worst pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score during PICU hospitalization. The outcomes of interest were length of PICU stay, duration of mechanical ventilation, duration of vasoactive drug therapy, and mortality. The Pediatric Index of Mortality 2 was used to assess overall disease severity at the time of PICU admission. Of 375 patients, 169 (45%) presented acute kidney injury at the time of admission and 37 developed acute kidney injury during PICU stay, for a total of 206 of 375 patients (55%) diagnosed with acute kidney injury during the study period. The median Pediatric Index of Mortality 2 score predicted a mortality rate of 9% among non-acute kidney injury patients versus a mortality rate of 16% among acute kidney injury patients (p = 0.006). The mortality of patients classified as pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease F was double that predicted by Pediatric Index of Mortality 2 (7 vs 3.2). Patients classified as having severe acute kidney injury (pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease I + F) exhibited higher mortality (14.1%; p = 0.001) and prolonged PICU length of stay (median, 7 d; p = 0.001) when compared with other patients. Acute kidney injury is a very frequent occurrence among patients admitted to PICUs. The degree of acute kidney injury severity, as assessed by the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria, is a good predictor of morbidity and mortality in this population. Pediatric Index of Mortality 2 tends to underestimate mortality in pediatric patients with severe acute kidney injury.

Accuracy of ultrasound in the diagnosis of acute cholecystitis with coexistent acute pancreatitis.

PubMed

Pereira, J; Afonso, A C; Constantino, J; Matos, A; Henriques, C; Zago, M; Pinheiro, L

2017-02-01

Acute cholecystitis and pancreatitis are acute forms of cholecystolithiasis. The presence of acute cholecystitis can lead to important changes in therapy in the early course of acute pancreatitis. The aim of this study was to identify the accuracy of ultrasonography in diagnosing acute cholecystitis with coexistent acute pancreatitis. Subjects were all those patients admitted to our hospital with a diagnosis of acute pancreatitis between 1998 and 2015 who underwent cholecystectomy within 15 days of the ultrasonography performed on admittance. Patient data were analyzed retrospectively to compare the ultrasound findings with the pathological findings of the resected gallbladders. Patients were allocated to two groups according to the signs of acute cholecystitis on ultrasonography: group 1 negative and group 2 positive. One hundred and twenty patients were enrolled in the study: 77 in group 1 and 43 in group 2. Similar results were found for the two groups with respect to the pathological diagnosis of acute cholecystitis, i.e., 31.2 % for group 1 and 27.9 % for group 2. Analysis indicated that there was no correlation between the ultrasonography data and pathological findings (p = 0.708). On the basis of our study, ultrasound findings alone cannot be used to accurately diagnose acute cholecystitis in the setting of acute pancreatitis.

Whiplash following rear end collisions: a prospective cohort study.

PubMed

Pobereskin, L H

2005-08-01

The purpose of this study was to investigate the factors which predict neck pain initially and at 1 year following a rear end collision. All people who reported a rear end collision to the Devon and Cornwall Constabulary were identified and formed the basis of the cohort. People were excluded if they were under 18 years of age or had suffered a head injury. The main outcome measures were neck pain lasting for more than a week after the accident and neck pain at least 1 day a week at 1 year. Logistic regression was used to investigate associations between demographic and accident related variables and outcomes. A total of 1147 people reported rear end collisions to the police during the study period and 503 (44%) agreed to take part in the study. Of the respondents, 78% had neck pain lasting for more than a week and 52% still had pain at 1 year. Age (odds ratio, 95% confidence interval: 0.957, 0.942-0.972) and prior history of neck pain (8.32, 2.89-23.89) were the most important predictors of early neck pain. The most important predictors of pain at 1 year were the initial neck visual analogue scale (VAS) score (1.03, 1.01-1.05) and the presence of a compensation claim (4.09, 1.62-10.32). There was only weak evidence that measures of the severity of the impact were associated with outcomes. Demographic variables and the presence of a compensation suit show the strongest correlation with acute and chronic neck pain following rear end collisions.

Seroprevalence of acute dengue in a Malaysian tertiary medical centre

PubMed Central

Ding, Chuan Hun; Rashid, Zetti Zainol; Rahman, Md. Mostafizur; Khang, NanFeng; Low, Wan Ngor; Hussin, Nurabrar; Marzuki, Melissa Iqlima; Jaafar, Alyaa Nadhira; Roslan, Nurul Ain’ Nabilla; Chandrasekaran, Terukumar

2016-01-01

Objectives: The aims of this study were to determine the seroprevalence of acute dengue in Universiti Kebangsaan Malaysia (UKM) Medical Centre and its correlation with selected haematological and biochemical parameters. Methods: This cross-sectional study was conducted from January to June 2015. A patient was serologically diagnosed with acute dengue if the dengue virus IgG, IgM or NS-1 antigen was reactive. Results: Out of 1,774 patients suspected to have acute dengue, 1,153 were serologically diagnosed with the infection, resulting in a seroprevalence of 64.9%. Dengue-positive patients had a lower mean platelet count (89 × 109/L) compared to the dengue-negative patients (171 × 109/L) (p<0.0001). The mean total white cell count was also lower in the dengue-positive cases (4.7 × 109/L vs. 7.2 × 109/L; p<0.0001). The mean haematocrit was higher in patients with acute dengue (42.5% vs. 40.0%; p<0.0001). Likewise, the serum alanine transaminase level was also higher in patients with acute dengue (108 U/L vs. 54 U/L; p<0.0001). Conclusions: Dengue is very prevalent in UKM Medical Centre as most patients suspected to have acute dengue had serological evidence of the infection. The platelet count was the single most likely parameter to be abnormal (i.e. low) in patients with acute dengue. PMID:27182269

Aircrew Automated Escape Systems (AAES) In-Service Usage Data Analyses. Volume 2. Papers Presented at the Annual SAFE Symposium (21st), San Antonio, Texas, 5,6,7,8 November 1983.

DTIC Science & Technology

1983-11-05

PILOT OF HIS INJURY AND PILOT RETURNED TO BASE RIO SUSTAINED MINIMAL ( WHIPLASH ) INJURY CAUSE WEIGHT OF HELMET AND MASK ON RiO’S HEAD WHILE IN...John Vetter (ESA-31 Division Head ). As has most unfortunately, despite the best of intentions of the team members to, for once, present the drafts...WARMINSTER NAVAIRTESTCEN (SY-70) PAXRIV NAVWPNCEN (64) CHINA LAKE NAVORDSTA (51) INDIAN HEAD NAVSAFECEN NORFOLK AFISC/SEL NORTON AFB,CA PACMISTESTCEN 1131 U.S

The Science of Change: The Importance of Methodology in Leading Change in the Army

DTIC Science & Technology

2007-05-24

the institution. The scope of these changes is unprecedented and the potential for “organizational whiplash ” is extremely high. Therefore, the...D eve lop s tra teg ies fo r ach iev ing tha t v is ion 4 . C o m m u n ic a te th e ch an g e v is io n • U se eve ry veh ic le poss...right people across the stratum of the organization for the team, and avoiding including only the ‘usual suspects’ such as departmental heads

Acute erythroid leukemia as defined in the World Health Organization classification is a rare and pathogenetically heterogeneous disease.

PubMed

Kasyan, Armen; Medeiros, L Jeffrey; Zuo, Zhuang; Santos, Favio P; Ravandi-Kashani, Farhad; Miranda, Roberto; Vadhan-Raj, Saroj; Koeppen, Hartmut; Bueso-Ramos, Carlos E

2010-08-01

The diagnostic criteria for acute erythroid leukemia have been controversial since this disease was initially described. Using the current World Health Organization classification criteria, we retrospectively reviewed cases of acute myeloid leukemia or myelodysplastic syndrome in which erythroid precursors were >or=50% of the bone marrow nucleated cell population and the diagnosis of erythroleukemia was considered using older classification schemes. We collected 90 cases and separated them into four diagnostic groups: acute erythroid leukemia, erythroleukemia or erythroid/myeloid type (n=20); acute myeloid leukemia with myelodysplasia-related changes (n=22); therapy-related acute myeloid leukemia (n=32); and refractory anemia with excess blasts and preceding or concurrent history of erythropoietin therapy for anemia (n=16). Patients with acute erythroid leukemia were the youngest patient group and had the best overall survival. There was a statistically significant difference in overall survival between patients with acute erythroid leukemia versus acute myeloid leukemia with myelodysplasia-related changes (P=0.003) and between patients with acute erythroid leukemia versus therapy-related acute myeloid leukemia (P<0.0001). The presence of complex cytogenetic abnormalities (>3) was the only statistically significant independent variable that adversely affected survival in the acute erythroid leukemia group. Monosomy 5/del(5q) and monosomy 7/del(7q) were overrepresented in the context of complex chromosomal abnormalities. Our data suggest that acute erythroid leukemia, as currently defined in the World Health Organization classification, has become a rare disease. A majority of the cases reported previously as erythroleukemia are now classified as other entities. In addition, our data suggest that the current definition of acute erythroid leukemia, erythroleukemia type remains heterogeneous. One subset of acute erythroid leukemia patients has relatively low blast counts and are diploid. The prognosis of this patient subset is relatively good. The other subset has cytogenetic abnormalities similar to those in myelodysplastic syndromes and a poor prognosis.

Epidural analgesia is infrequently used in patients with acute pancreatitis : a retrospective cohort study.

PubMed

Sasabuchi, Y; Yasunaga, H; Matsui, H; Lefor, A K; Fushimi, K; Sanui, M

2017-01-01

Epidural analgesia is an option for pain control in patients with acute pancreatitis. The aim of this study is to describe characteristics, morbidity and mortality of patients with acute pancreatitis treated with epidural analgesia. Data was extracted from a national inpatient database in Japan on patients hospitalized with acute pancreatitis between July 2010 and March 2013. A total of 44,146 patients discharged from acute care hospitals were included in this retrospective cohort study. The patient background, timing and duration of epidural analgesia, complications (epidural hematoma or abscess), surgery (for cholelithiasis / cholecystitis or complications) and mortality were verified. Epidural analgesia was used in 307 patients (0.70 %). The mean age was 64.0 years (standard deviation, 15.4 years) and 116 (37.8%) of the patients were female. The median duration of epidural analgesia was four days (interquartile range, 3-5 days). No patient underwent surgery for epidural hematoma or abscess. Six (2.0%) patients died during hospitalization. Most likely causes of death were pulmonary embolism, multiple organ failure, sepsis, and methicillin-resistant staphylococcus aureus enterocolitis. The responsible physician for 250 of the patients (81.4%) was a gastroenterological surgeon. Epidural analgesia was started on the day of surgery in 278 (90.6%) patients. Epidural analgesia is rarely used in patients with acute pancreatitis. None of the patients included in the study required surgery for epidural hematoma or abscess. Further research to evaluate the efficacy and safety of epidural analgesia in patients with acute pancreatitis is warranted. © Acta Gastro-Enterologica Belgica.

Appropriate treatment of acute sigmoid volvulus in the emergency setting

PubMed Central

Lou, Zheng; Yu, En-Da; Zhang, Wei; Meng, Rong-Gui; Hao, Li-Qiang; Fu, Chuan-Gang

2013-01-01

AIM: To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting. METHODS: A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery, Changhai Hospital, Shanghai from January 2001 to July 2012 was performed. Following the diagnosis of acute sigmoid volvulus, an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis. RESULTS: Of the 28 patients with acute sigmoid volvulus, 19 (67.9%) were male and 9 (32.1%) were female. Their mean age was 63.1 ± 22.9 years (range, 21-93 years). Six (21.4%) patients had a history of abdominal surgery, and 17 (60.7%) patients had a history of constipation. Abdominal radiography or computed tomography was performed in all patients. Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8% (26/28). Emergency surgery was required in the other two patients. Of the 26 successfully treated patients, seven (26.9%) had recurrent volvulus. CONCLUSION: Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus. Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful, or in those with peritonitis. PMID:23946604

[The acute (surgical) abdomen - epidemiology, diagnosis and general principles of management].

PubMed

Grundmann, R T; Petersen, M; Lippert, H; Meyer, F

2010-06-01

This review comments on epidemiology, diagnosis and general principles of surgical management in patients with acute abdomen. DEFINITION AND EPIDEMIOLOGY: The most common cause of acute abdominal pain is non-specific abdominal pain (24 - 44.3 % of the study populations), followed by acute appendicitis (15.9 - 28.1 %), acute biliary disease (2.9 - 9.7 %) and bowel obstruction or diverticulitits in elderly patients. Acute appendicitis represents the cause of surgical intervention in two-thirds of the children with acute abdomen. A standardised physical examination combined with ultrasonography (US) represents the initial investigation in patients with acute abdominal pain. Due to the risk associated with radiation and due to the costs, a selective use of CT imaging is recommended. The work-flow given in this paper restricts the use of CT imaging to less than 50 % of patients with acute abdominal pain. Diagnostic laparoscopy should be considered in patients without a specific diagnosis after appropriate imaging and as an alternative to active clinical observation which is the current practice in patients with non-specific abdominal pain. Acute small bowel obstruction has previously been considered as a relative contraindication for laparoscopic management, but it has been shown in the meantime that laparoscopic treatment is an elegant tool for the management of simple band small bowel obstruction. Bedside diagnostic laparoscopy is recommended in intensive care unit (ICU) patients with acute abdomen or sepsis of unknown origin, in suspicion of acute cholecystitis, diffuse gut hypoperfusion and mesenteric ischaemia or in refractory lactic acidosis, especially after cardiac surgery. Early administration of analgesia to patients with acute abdominal pain in the emergency department will reduce the patient's discomfort without impairing clinically important diagnostic accuracy and is recommended on the basis of some prospective randomised trials. However, the impact on diagnostic accuracy depends on dosage, kind of application and cause of acute abdominal pain. A practice of judicious provision of analgesia therefore appears safe. There are significant differences between the knowledge of the current literature and the routine practice of providing analgesia as a survey has shown demonstrating that less than 50 % of paediatric emergency physicians and paediatric surgeons are usually willing to provide analgesia before definitive diagnosis. Georg Thieme Verlag KG Stuttgart. New York.

Prognostic and diagnostic significance of mid-regional pro-atrial natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 Study.

PubMed

Pervez, Mohammad Osman; Winther, Jacob A; Brynildsen, Jon; Strand, Heidi; Christensen, Geir; Høiseth, Arne Didrik; Myhre, Peder L; Røysland, Ragnhild; Lyngbakken, Magnus Nakrem; Omland, Torbjørn; Røsjø, Helge

2018-05-07

To compare the diagnostic and prognostic value of mid-regional pro-ANP (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea. MR-proANP and NT-proBNP were measured with commercial immunoassays at hospital admission (n = 313), on day 2 (n = 234), and before discharge (n = 91) and compared for diagnosing acute heart failure (HF; n = 143) and to predict mortality among patients with acute HF and acute exacerbation of chronic obstructive pulmonary disease (AECOPD; n = 84) separately. The correlation coefficient between MR-proANP and NT-proBNP was 0.89 (p < 0.001) and the receiver-operating area under the curve was 0.85 (95% CI 0.81-0.89) for MR-proANP and 0.86 (0.82-0.90) for NT-proBNP to diagnose acute HF. During a median follow-up of 816 days, mortality rates were 46% in acute HF patients and 42% in AECOPD patients. After adjustment for other risk variables by multivariate Cox regression analysis, MR-proANP and NT-proBNP concentrations were associated with mortality in patients with acute HF, but only MR-proANP were associated with mortality among patients with AECOPD: hazard ratio ( ln MR-proANP) 1.98 (95% CI 1.17-3.34). MR-proANP and NT-proBNP concentrations provide similar diagnostic and prognostic information in patients with acute HF. In contrast to NT-proBNP, MR-proANP measurements also provided independent prognostic information in AECOPD patients.

Late Intensive Care Unit Admission in Liver Transplant Recipients: 10-Year Experience.

PubMed

Atar, Funda; Gedik, Ender; Kaplan, Şerife; Zeyneloğlu, Pınar; Pirat, Arash; Haberal, Mehmet

2015-11-01

We evaluated late intensive care unit admission in liver transplant recipients to identify incidences and causes of acute respiratory failure in the postoperative period and to compare these results with results in patients who did not have acute respiratory failure. We retrospectively screened the data of 173 consecutive adult liver transplant recipients from January 2005 through March 2015 to identify patients with late admission (> 30 d posttransplant) to an intensive care unit. Patients were divided into 2 groups: patients with and without acute respiratory failure. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or need for noninvasive or invasive mechanical ventilation. Demographic, laboratory, clinical, and respiratory data were collected. Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores; lengths of intensive care unit and hospital stays; and hospital mortality were assessed. Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P = .003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P = .041). Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.

Expression of HER2/Neu in B-Cell Acute Lymphoblastic Leukemia.

PubMed

Rodriguez-Rodriguez, Sergio; Pomerantz, Alan; Demichelis-Gomez, Roberta; Barrera-Lumbreras, Georgina; Barrales-Benitez, Olga; Aguayo-Gonzalez, Alvaro

2016-01-01

The expression of HER2/neu in B-cell acute lymphoblastic leukemia has been reported in previous studies. The objective of this research was to study the expression of HER2/neu on the blasts of patients with acute leukemia from the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. From June 2015 to February 2016, a HER2/neu monoclonal antibody was added to the panel of antibodies that we routinely use in patients with acute leukemia. An expression of ≥ 30% was considered positive. We studied 33 patients: 19 had de novo leukemia (57.6%), three (9.1%) were in relapse, and in 11 (33.3%) their status could not be specified. Seventeen patients (51.5%) were classified as B-cell acute lymphoblastic leukemia with a median expression of HER2/neu of 0.3% (range 0-90.2). Three patients with B-cell acute lymphoblastic leukemia were positive for HER2/neu: 89.4%, 90.9%, and 62.4%. The first and third patient had de novo B-cell acute lymphoblastic leukemia. The second patient was in second relapse after allogeneic stem cell transplant. All three patients were categorized as high-risk at the time of diagnosis. In the studied Mexican population, we found a positive expression of HER2/neu in 17% of the B-cell acute lymphoblastic leukemia patients, similar to previous studies in which the expression was found in 15-50%.

Analysis of Surgical Success in Preventing Recurrent Acute Exacerbations in Chronic Pancreatitis

PubMed Central

Nealon, William H.; Matin, Sina

2001-01-01

Objective To determine whether surgical intervention prevents recurrent acute exacerbations in chronic pancreatitis (CP). Summary Background Data The primary goal of surgical intervention in the treatment of CP has been relief of chronic unrelenting abdominal pain. A subset of patients with CP have intermittent acute exacerbations, often with increasing frequency and often unrelated to ongoing ethanol abuse. Little data exist regarding the effectiveness of surgery to prevent acute attacks. Methods From 1985 to 1999, all patients identified with a diagnosis of CP were recruited to participate in an ongoing program of serial clinic visits and functional and clinical evaluations. Patients were offered surgery using standard criteria. Data were gathered regarding ethanol abuse, pain, narcotic use, and recurrent acute exacerbations requiring hospital admission before and after surgery. Patients were broadly categorized as having severe unrelenting pain alone (group 1), severe pain with intermittent acute exacerbations (group 2), and intermittent acute exacerbations only (group 3). Results Two hundred fifty-nine patients were recruited. One hundred eighty-five patients underwent 199 surgical procedures (124 modified Puestow procedure [LPJ], 29 distal pancreatectomies [DP], and 46 pancreatic head resections [PHR; 14 performed after failure of LPJ]). There were no deaths. The complication rate was 4% for LPJ, 15% for DP, and 27% for PHR. Ethanol abuse was causative in 238 patients (92%). Mean follow-up was 81 months. There were 104 patients in group 1 (86 who underwent surgery), 71 patients in group 2 (64 who underwent surgery), and 84 in group 3 (49 who underwent surgery). No patient without surgery had spontaneous resolution of symptoms. Postoperative pain relief (freedom from narcotic analgesics) was achieved in 153 of 185 patients (83%) overall: 106 of 124 (86%) for LPJ, 19 of 29 (67%) for DP, and 42 of 46 (91%) for PHR. The mean rate of acute exacerbations was 6.3 ± 2.1 events per year before surgery in group 2 and 7.8 ± 1.8 events per year in group 3. After surgery, no acute exacerbations occurred in 42 of 64 (66%) group 2 patients and in 40 of 49 (82%) group 3 patients. The mean number of episodes of acute exacerbation after surgery was 1.6 ± 2.3 events in group 2 and 1.1 ± 1.9 events in group 3. Only four patients in group 2 and one patient in group 3 had an equal or increased frequency of attacks after surgery. Preventing attacks was most effective with LPJ (58/64, 91%) and least effective for DP (6/18, 33%). Conclusions Surgical intervention prevents recurrent acute exacerbations. The overall frequency of events was reduced in nearly all patients. Therefore, surgical intervention is indicated in patients with CP whose disease is characterized by recurrent acute exacerbations. PMID:11371738

Analysis of surgical success in preventing recurrent acute exacerbations in chronic pancreatitis.

PubMed

Nealon, W H; Matin, S

2001-06-01

To determine whether surgical intervention prevents recurrent acute exacerbations in chronic pancreatitis (CP). The primary goal of surgical intervention in the treatment of CP has been relief of chronic unrelenting abdominal pain. A subset of patients with CP have intermittent acute exacerbations, often with increasing frequency and often unrelated to ongoing ethanol abuse. Little data exist regarding the effectiveness of surgery to prevent acute attacks. From 1985 to 1999, all patients identified with a diagnosis of CP were recruited to participate in an ongoing program of serial clinic visits and functional and clinical evaluations. Patients were offered surgery using standard criteria. Data were gathered regarding ethanol abuse, pain, narcotic use, and recurrent acute exacerbations requiring hospital admission before and after surgery. Patients were broadly categorized as having severe unrelenting pain alone (group 1), severe pain with intermittent acute exacerbations (group 2), and intermittent acute exacerbations only (group 3). Two hundred fifty-nine patients were recruited. One hundred eighty-five patients underwent 199 surgical procedures (124 modified Puestow procedure [LPJ], 29 distal pancreatectomies [DP], and 46 pancreatic head resections [PHR; 14 performed after failure of LPJ]). There were no deaths. The complication rate was 4% for LPJ, 15% for DP, and 27% for PHR. Ethanol abuse was causative in 238 patients (92%). Mean follow-up was 81 months. There were 104 patients in group 1 (86 who underwent surgery), 71 patients in group 2 (64 who underwent surgery), and 84 in group 3 (49 who underwent surgery). No patient without surgery had spontaneous resolution of symptoms. Postoperative pain relief (freedom from narcotic analgesics) was achieved in 153 of 185 patients (83%) overall: 106 of 124 (86%) for LPJ, 19 of 29 (67%) for DP, and 42 of 46 (91%) for PHR. The mean rate of acute exacerbations was 6.3 +/- 2.1 events per year before surgery in group 2 and 7.8 +/- 1.8 events per year in group 3. After surgery, no acute exacerbations occurred in 42 of 64 (66%) group 2 patients and in 40 of 49 (82%) group 3 patients. The mean number of episodes of acute exacerbation after surgery was 1.6 +/- 2.3 events in group 2 and 1.1 +/- 1.9 events in group 3. Only four patients in group 2 and one patient in group 3 had an equal or increased frequency of attacks after surgery. Preventing attacks was most effective with LPJ (58/64, 91%) and least effective for DP (6/18, 33%). Surgical intervention prevents recurrent acute exacerbations. The overall frequency of events was reduced in nearly all patients. Therefore, surgical intervention is indicated in patients with CP whose disease is characterized by recurrent acute exacerbations.

A prospective study of radionuclide biliary scanning in acute pancreatitis.

PubMed Central

Neoptolemos, J. P.; Fossard, D. P.; Berry, J. M.

1983-01-01

Early surgery for biliary pancreatitis has resulted in a need for an accurate method of gallstone detection in acute pancreatitis. Fifty patients with acute pancreatitis were studied prospectively to assess the diagnostic value of Radionuclide Biliary Scanning (RBS) performed within 72 hours of an attack. To assess the general accuracy of RBS a further 154 patients with suspected acute cholecystitis or biliary colic were similarly studied. There were 34 patients with biliary pancreatitis and 18 (53%) had a positive scan (no gallbladder seen). There were 16 patients with non-biliary pancreatitis and 5 (31%) had a positive scan. All 51 patients with acute cholecystitis had a positive scan, as did 82% of the 51 patients with biliary colic. There were 52 patients with no biliary or pancreatic disease and none of these had a positive scan. RBS is highly accurate in confirming a diagnosis of acute cholecystitis or biliary colic. However, it cannot be relied on to differentiate between biliary and non-biliary pancreatitis and should certainly not be used as the basis for biliary surgery in these patients. PMID:6859781

Multislice coronary computed tomographic angiography in emergency department presentations of unsuspected acute myocardial infarction.

PubMed

Hecht, Harvey S; Bhatti, Tandeep

2009-01-01

Coronary computed tomographic angiography (CCTA) is not indicated in the setting of acute myocardial infarction in the emergency department (ED). Nonetheless, acute coronary syndromes may have atypical presentations, and CCTA may be inadvertently performed in this setting. This study was designed to determine the frequency and characteristics of CCTA imaging of unsuspected acute myocardial infarction in the ED. All CCTAs performed in the ED at Lenox Hill Hospital were reviewed for clinical indications and subsequent course; patients with documented acute myocardial infarction were identified. Of the 500 CCTAs performed on ED patients in the Lenox Hill laboratory, 5 patients (1%) were imaged during the initial phase of an unsuspected acute myocardial infarction; in all cases the CCTAs were key to the diagnosis. The imaging characteristics were (1) total or subtotal occlusion and (2) transmural hypodensity in the infarct area. Although acute myocardial infarction on CCTA in ED patients is an infrequent event, proper and prompt recognition is critical for appropriate patient care, particularly as applications to the ED increase.

Drug induced acute pancreatitis: incidence and severity.

PubMed Central

Lankisch, P G; Dröge, M; Gottesleben, F

1995-01-01

To determine the incidence and severity of drug induced acute pancreatitis, data from 45 German centres of gastroenterology were evaluated. Among 1613 patients treated for acute pancreatitis in 1993, drug induced acute pancreatitis was diagnosed in 22 patients (incidence 1.4%). Drugs held responsible were azathioprine, mesalazine/sulfasalazine, 2',3'-dideoxyinosine (ddI), oestrogens, frusemide, hydrochlorothiazide, and rifampicin. Pancreatic necrosis not exceeding 33% of the organ was found on ultrasonography or computed tomography, or both, in three patients (14%). Pancreatic pseudocysts did not occur. A decrease of arterial PO2 reflecting respiratory insufficiency, and an increase of serum creatinine, reflecting renal insufficiency as complications of acute pancreatitis were seen in two (9%) and four (18%) patients, respectively. Artificial ventilation was not needed, and dialysis was necessary in only one (5%) case. Two patients (9%) died of AIDS and tuberculosis, respectively; pancreatitis did not seem to have contributed materially to their death. In conclusion, drugs rarely cause acute pancreatitis, and drug induced acute pancreatitis usually runs a benign course. PMID:7489946

Study on the treatment of acute thallium poisoning.

PubMed

Zhang, Hong-Tao; Qiao, Bao-Ping; Liu, Bao-Ping; Zhao, Xian-Guo

2014-05-01

Acute thallium poisoning rarely occurs but is a serious and even fatal medical condition. Currently, patients with acute thallium poisoning are usually treated with Prussian blue and blood purification therapy. However, there are few studies about these treatments for acute thallium poisoning. Nine patients with acute thallium poisoning from 1 family were treated successfully with Prussian blue and different types of blood purification therapies and analyzed. Prussian blue combined with sequential hemodialysis, hemoperfusion and/or continuous veno-venous hemofiltration were effective for the treatment of patients with acute thallium poisoning, even after delayed diagnosis. Blood purification therapies help in the clearance of thallium in those with acute thallium poisoning. Prussian blue treatment may do the benefit during this process.

The management of acute appendicitis in liver transplant patients: How effective is the Alvarado score?

PubMed

Ince, Volkan; Barut, Bora; Ozdemir, Fatih; Ersan, Veysel; Kutluturk, Koray; Gonultas, Fatih; Onur, Asim; Isik, Burak; Kutlu, Ramazan; Yilmaz, Sezai

2017-01-01

The incidence of acute appendicitis after liver transplantation (LT) is extremely low, reported to be 0.09% to 0.49%, but the efficacy of the Alvarado score in this patient group has not been studied. This study was an investigation of the clinical management of patients who developed acute appendicitis after LT and the usefulness of the Alvarado score in the diagnosis. The study was performed using the data of 7 patients treated for acute appendicitis who were among 1990 patients who underwent LT between March 2002 and July 2017. The Alvarado score of the patients was calculated and reliability was analyzed. In this study, the incidence of acute appendicitis in LT patients was 0.35%. All of the patients were in the adult age group; 86% were male. The mean age was 46.4±10.7 years and the timeframe for the development of appendicitis after transplantation was a median of 12 months (range: 4-101 months). The median Alvarado score was 7 (range: 5-9). All of the patients had an Alvarado score above 5 and 71% had a score of 7 or more. Acute appendicitis is very rare in LT patients. As with non-transplant patients, Alvarado scoring can be safely performed in LT patients.

The management of acute appendicitis in liver transplant patients: How effective is the Alvarado score?

PubMed Central

Ince, Volkan; Barut, Bora; Ozdemir, Fatih; Ersan, Veysel; Kutluturk, Koray; Gonultas, Fatih; Onur, Asim; Isik, Burak; Kutlu, Ramazan; Yilmaz, Sezai

2017-01-01

OBJECTIVE: The incidence of acute appendicitis after liver transplantation (LT) is extremely low, reported to be 0.09% to 0.49%, but the efficacy of the Alvarado score in this patient group has not been studied. This study was an investigation of the clinical management of patients who developed acute appendicitis after LT and the usefulness of the Alvarado score in the diagnosis. METHODS: The study was performed using the data of 7 patients treated for acute appendicitis who were among 1990 patients who underwent LT between March 2002 and July 2017. The Alvarado score of the patients was calculated and reliability was analyzed. RESULTS: In this study, the incidence of acute appendicitis in LT patients was 0.35%. All of the patients were in the adult age group; 86% were male. The mean age was 46.4±10.7 years and the timeframe for the development of appendicitis after transplantation was a median of 12 months (range: 4-101 months). The median Alvarado score was 7 (range: 5-9). All of the patients had an Alvarado score above 5 and 71% had a score of 7 or more. CONCLUSION: Acute appendicitis is very rare in LT patients. As with non-transplant patients, Alvarado scoring can be safely performed in LT patients. PMID:29270576

Microbiological Characteristics of Acute Prostatitis After Transrectal Prostate Biopsy

PubMed Central

Bang, Jun-Ho; Choe, Hyun-Sop; Lee, Dong-Sup; Lee, Seung-Ju

2013-01-01

Purpose We aimed to identify microbiological characteristics in patients with acute prostatitis after transrectal prostate biopsy to provide guidance in the review of prevention and treatment protocols. Materials and Methods A retrospective analysis of medical records was performed in 1,814 cases who underwent prostate biopsy at Seoul St. Mary's Hospital and St. Vincent's Hospital over a 5 year period from 2006 to 2011. Cases in which acute prostatitis occurred within 7 days after the biopsy were investigated. Before starting treatment with antibiotics, sample collections were done for culture of urine and blood. Culture and drug susceptibility was identified by use of a method established by the Clinical and Laboratory Standards Institute. Results A total of 1,814 biopsy procedures were performed in 1,541 patients. For 1,246 patients, the procedure was the first biopsy, whereas for 295 patients it was a repeat biopsy. Twenty-one patients (1.36%) were identified as having acute bacterial prostatitis after the biopsy. Fifteen patients (1.2%) had acute prostatitis after the first biopsy, and 6 patients (2.03%) experienced acute prostatitis after a repeat biopsy. Even though the incidence of acute bacterial prostatitis was higher after repeat biopsy than that after the first biopsy, there was no statistically significant intergroup difference in terms of incidence (χ2=1.223, p=0.269). When the collected urine and blood samples were cultured, Escherichia coli was found in samples from 15 patients (71.4%), Klebsiella pneumoniae in 3 patients (14.3%), Enterobacter intermedius in 1 patient (4.8%), E. aerogenes in 1 patient (4.8%), and Pseudomonas aeruginosa in 1 patient (4.8%). A fluoroquinolone-resistant strain was confirmed in 5 cases (23.8%) in total. Three cases of E. coli and 1 case of Klebsiella had extended-spectrum β-lactamase activity. Conclusions Empirical treatment of acute prostatitis should be done with consideration of geographical prevalence and drug resistance. This study will provide meaningful information for the management of acute prostatitis after transrectal prostate biopsy. PMID:23550205

THERAPY-RELATED T/MYELOID MIXED PHENOTYPE ACUTE LEUKEMIA IN A PATIENT TREATED WITH CHEMOTHERAPY FOR CUTANEOUS DIFFUSE LARGE B CELL LYMPHOMA.

PubMed

Roberts, Evans; Oncale, Melody; Safah, Hana; Schmieg, John

2016-01-01

Mixed-phenotype acute leukemia is a rare form of leukemia that is associated with a poor prognosis. Most cases of mixed-phenotype acute leukemia are de novo. However, therapy-related mixed-phenotype acute leukemia can occur, and are often associated with exposure to topoisomerase-II inhibitors and alkylating agents. There are no known treatment guidelines for therapy-related mixed-phenotype acute leukemia. We present a patient with T/myeloid mixed-phenotype acute leukemia secondary to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma. The patient's leukemic cells express CD34, an immaturity marker, CD3, a T-cell marker, and myeloperoxidase, a myeloid marker, and her history of chemotherapy for previous lymphoma supports the diagnosis of therapy-related T/myeloid mixed phenotype acute leukemia. Clinicians should be aware that this entity could be associated with R-CHOP chemotherapy. Given the complexity in diagnosis, and lack of treatment guidelines, a further understanding of the pathological and genetic principles of therapy-related mixed-phenotype acute leukemia will assist in future efforts to treat and categorize these patients. Mixed phenotype acute leukemia is a rare entity that accounts for two to five percent of all acute leukemias. Therapy- related mixed phenotype acute leukemia is an exceedingly rare hematological neoplasm that accounts for less than one percent of acute leukemias. We describe a case of therapy-related T/myeloid mixed phenotype acute leukemia following rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma DLBCL. The patient is a 63-year-old female who presented with several cutaneous nodules diagnosed as primary cutaneous DLBCL. The patient received R-CHOP chemotherapy and achieved remission. She remained in remission for four years until she presented with dyspnea, night sweats, weakness, and diffuse lymphadenopathy. Her presentation was initially concerning for recurrent lymphoma; however, a bone marrow biopsy and aspirate and a lymph node biopsy revealed a distinct blast population consistent with T/myeloid mixed phenotype acute leukemia T/M-MPAL. Given the patient's history of previous chemotherapy exposure, our patient represents a case of therapy-related T/myeloid mixed phenotype acute leukemia t-MPAL.

Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg.

PubMed

Westerbeek, R E; Van Rooden, C J; Tan, M; Van Gils, A P G; Kok, S; De Bats, M J; De Roos, A; Huisman, M V

2008-07-01

Accurate diagnosis of acute recurrent deep vein thrombosis (DVT) is relevant to avoid improper diagnosis and unnecessary life-long anticoagulant treatment. Compression ultrasound has high accuracy for a first episode of DVT, but is often unreliable in suspected recurrent disease. Magnetic resonance direct thrombus imaging (MR DTI) has been shown to accurately detect acute DVT. The purpose of this prospective study was to determine the MR signal change during 6 months follow-up in patients with acute DVT. This study was a prospective study of 43 consecutive patients with a first episode of acute DVT demonstrated by compression ultrasound. All patients underwent MR DTI. Follow-up was performed with MR-DTI and compression ultrasound at 3 and 6 months respectively. All data were coded, stored and assessed by two blinded observers. MR direct thrombus imaging identified acute DVT in 41 of 43 patients (sensitivity 95%). There was no abnormal MR-signal in controls, or in the contralateral extremity of patients with DVT (specificity 100%). In none of the 39 patients available at 6 months follow-up was the abnormal MR-signal at the initial acute DVT observed, whereas in 12 of these patients (30.8%) compression ultrasound was still abnormal. Magnetic resonance direct thrombus imaging normalizes over a period of 6 months in all patients with diagnosed DVT, while compression ultrasound remains abnormal in a third of these patients. MR-DTI may potentially allow for accurate detection in patients with acute suspected recurrent DVT, and this should be studied prospectively.

Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study.

PubMed

Jangland, Eva; Kitson, Alison; Muntlin Athlin, Åsa

2016-04-01

To explore how patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode. Acute abdominal pain is one of the most common conditions to present in the acute care setting. Little is known about how patients' fundamental care needs are managed from presentation to post discharge. A multi-stage qualitative case study using the Fundamentals of Care framework as the overarching theoretical and explanatory mechanism. Repeated reflective interviews were conducted with five adult patients over a 6-month period in 2013 at a university hospital in Sweden. The interviews (n = 14) were analysed using directed content analysis. Patients' experiences across the acute care episode are presented as five patient narratives and synthesized into five descriptions of the entire hospital journey. The patients talked about the fundamentals of care and had vivid accounts of what they meant to them. The experiences of each of the patients were influenced by the extent to which they felt engaged with the health professionals. The ability to engage or build a rapport was identified as a central component across the fundamental care elements, but it varied in visibility. Consistent pain management, comfort, timely and accurate information, choice and dignity and relationships were identified as essential fundamental care needs of patients experiencing acute abdominal pain regardless of setting, diagnosis, or demographic variables. These were variously achieved and the patients' narratives raised areas for improvement in several areas. © 2016 John Wiley & Sons Ltd.

Laparoscopic Cholecystectomy for Acute Cholecystitis in Elderly Patients

PubMed Central

Filho, Euler de Medeiros Ázaro; Galvão, Thales Delmondes; Ettinger, João Eduardo Marques de Menezes; Silva Reis, Jadson Murilo; Lima, Marcos; Fahel, Edvaldo

2006-01-01

Background: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. Method: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. Results: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (≤65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P=1). Conclusion: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age. PMID:17575761

Amylase, Lipase, and Acute Pancreatitis in People With Type 2 Diabetes Treated With Liraglutide: Results From the LEADER Randomized Trial.

PubMed

Steinberg, William M; Buse, John B; Ghorbani, Marie Louise Muus; Ørsted, David D; Nauck, Michael A

2017-07-01

To evaluate serum amylase and lipase levels and the rate of acute pancreatitis in patients with type 2 diabetes and high cardiovascular risk randomized to liraglutide or placebo and observed for 3.5-5.0 years. A total of 9,340 patients with type 2 diabetes were randomized to either liraglutide or placebo (median observation time 3.84 years). Fasting serum lipase and amylase were monitored. Acute pancreatitis was adjudicated in a blinded manner. Compared with the placebo group, liraglutide-treated patients had increases in serum lipase and amylase of 28.0% and 7.0%, respectively. Levels were increased at 6 months and then remained stable. During the study, 18 (0.4% [1.1 events/1,000 patient-years of observation] [PYO]) liraglutide-treated and 23 (0.5% [1.7 events/1,000 PYO]) placebo patients had acute pancreatitis confirmed by adjudication. Most acute pancreatitis cases occurred ≥12 months after randomization. Liraglutide-treated patients with prior history of pancreatitis ( n = 147) were not more likely to develop acute pancreatitis than similar patients in the placebo group ( n = 120). Elevations of amylase and lipase levels did not predict future risk of acute pancreatitis (positive predictive value <1.0%) in patients treated with liraglutide. In a population with type 2 diabetes at high cardiovascular risk, there were numerically fewer events of acute pancreatitis among liraglutide-treated patients (regardless of previous history of pancreatitis) compared with the placebo group. Liraglutide was associated with increases in serum lipase and amylase, which were not predictive of an event of subsequent acute pancreatitis. © 2017 by the American Diabetes Association.

The impact of an "acute dialysis start" on the mortality attributed to the use of central venous catheters: a retrospective cohort study.

PubMed

Tennankore, Karthik K; Soroka, Steven D; Kiberd, Bryce A

2012-07-30

Central venous catheters (CVCs) are associated with early mortality in dialysis patients. However, some patients progress to end stage renal disease after an acute illness, prior to reaching an estimated glomerular filtration rate (eGFR) at which one would expect to establish alternative access (fistula/peritoneal dialysis catheter). The purpose of this study was to determine if exclusion of this "acute start" patient group alters the association between CVCs and mortality. We conducted a retrospective cohort study of 406 incident dialysis patients from 1 Jan 2006 to 31 Dec 2009. Patients were classified as acute starts if 1) the eGFR was >25 ml/min/1.73 m2, ≤ 3 months prior to dialysis initiation and declined after an acute event (n = 45), or 2) in those without prior eGFR measurements, there was no supporting evidence of chronic kidney disease on history or imaging (n = 12). Remaining patients were classified as chronic start (n = 349). 98 % and 52 % of acute and chronic starts initiated dialysis with a CVC. There were 148 deaths. The adjusted mortality hazard ratio (HR) for acute vs. chronic start patients was 1.84, (95 % CI [1.19-2.85]). The adjusted mortality HR for patients dialyzing with a CVC compared to alternative access was 1.19 (95 % CI [0.80-1.77]). After excluding acute start patients, the adjusted HR fell to 1.03 (95 % CI [0.67-1.57]). A significant proportion of early dialysis mortality occurs after an acute start. Exclusion of this population attenuates the mortality risk associated with CVCs.

Diagnosis of Acute Appendicitis by Endoscopic Retrograde Appendicitis Therapy (ERAT): Combination of Colonoscopy and Endoscopic Retrograde Appendicography.

PubMed

Li, Yingchao; Mi, Chen; Li, Weizhi; She, Junjun

2016-11-01

Acute appendicitis is the most common abdominal emergency, but the diagnosis of appendicitis remains a challenge. Endoscopic retrograde appendicitis therapy (ERAT) is a new and minimally invasive procedure for the diagnosis and treatment of acute appendicitis. To investigate the diagnostic value of ERAT for acute appendicitis by the combination of colonoscopy and endoscopic retrograde appendicography (ERA). Twenty-one patients with the diagnosis of suspected uncomplicated acute appendicitis who underwent ERAT between November 2014 and January 2015 were included in this study. The main outcomes, imaging findings of acute appendicitis including colonoscopic direct-vision imaging and fluoroscopic ERA imaging, were retrospectively reviewed. Secondary outcomes included mean operative time, mean hospital stay, rate of complication, rate of appendectomy during follow-up period, and other clinical data. The diagnosis of acute appendicitis was established in 20 patients by positive ERA (5 patients) or colonoscopy (1 patient) alone or both (14 patients). The main colonoscopic imaging findings included mucosal inflammation (15/20, 75 %), appendicoliths (14/20, 70 %), and maturation (5/20, 25 %). The key points of ERA for diagnosing acute appendicitis included radiographic changes of appendix (17/20, 85 %), intraluminal appendicoliths (14/20, 70 %), and perforation (1/20, 5 %). Mean operative time of ERAT was 49.7 min, and mean hospital stay was 3.3 days. No patient converted to emergency appendectomy. Perforation occurred in one patient after appendicoliths removal was not severe and did not require invasive procedures. During at least 1-year follow-up period, only one patient underwent laparoscopic appendectomy. ERAT is a valuable procedure of choice providing a precise yield of diagnostic information for patients with suspected acute appendicitis by combination of colonoscopy and ERA.

Effect of formoterol/budesonide combination on arterial blood gases in patients with acute exacerbation of COPD.

PubMed

Cazzola, M; Noschese, P; De Michele, F; D'Amato, G; Matera, M G

2006-02-01

Patients with severe chronic airway obstruction might suffer dangerous hypoxemia after administration of a beta-agonist despite bronchodilation. We first compared the acute effects on gas exchange of two doses of formoterol Turbuhaler (9 and 18 microg) in 10 patients with acute exacerbation of COPD. Afterwards, we compared the acute effects of formoterol Turbuhaler 9 microug with those of formoterol/budesonide combination in a single inhaler (Turbuhaler) 9/320 microg in 10 other patients with acute exacerbation of COPD. Finally, we compared the changes in PaO(2) induced by formoterol Turbuhaler 9 microg or formoterol/budesonide combination in a single inhaler (Turbuhaler) 9/320 microg with those in FEV(1) in 10 other patients with acute exacerbation of COPD. Each agent was given on separate days, and the patients' arterial blood gases were measured at baseline and at intervals of 120 min. Small but statistically significant declines in PaO(2) were found after administration of both formoterol 9 and 18 microg. In the second group of patients, formoterol 9 microg alone again induced a significant decrease in PaO(2). However, the simultaneous administration of budesonide 320 microg significantly reduced the acute effect of formoterol on PaO(2). In a third group of 10 patients we confirmed a small but significant decrease in PaO(2) after formoterol alone and the reduction of this effect when budesonide was administered simultaneously. Moreover, we also documented that addition of budesonide amplified the fast onset of action of formoterol. These results suggest that when treating patients suffering from acute exacerbation of COPD with formoterol, it is prudent to check their arterial blood gases. In any case, combined administration of formoterol and budesonide reduces the potential for acute effects of formoterol on blood-gas tensions.

Acute Cholecystitis in Patients with Scrub Typhus.

PubMed

Lee, Hyun; Ji, Misuk; Hwang, Jeong-Hwan; Lee, Ja-Yeon; Lee, Ju-Hyung; Chung, Kyung Min; Lee, Chang-Seop

2015-11-01

Acute cholecystitis is a rare complication of scrub typhus. Although a few such cases have been reported in patients with scrub typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The scrub typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub typhus should be kept in mind as a rare etiology of acute cholecystitis in endemic areas because the typical signs of scrub typhus such as skin rash and eschar can present after the abdominal pain.

An Immunoassay to Rapidly Measure Acetaminophen Protein Adducts Accurately Identifies Patients with Acute Liver Injury or Failure

PubMed Central

Roberts, Dean W.; Lee, William M.; Hinson, Jack A.; Bai, Shasha; Swearingen, Christopher J.; Stravitz, R. Todd; Reuben, Adrian; Letzig, Lynda; Simpson, Pippa M.; Rule, Jody; Fontana, Robert J.; Ganger, Daniel; Reddy, K. Rajender; Liou, Iris; Fix, Oren; James, Laura P.

2017-01-01

Background & Aims A rapid, reliable point-of-care assay to detect acetaminophen protein adducts in serum of patients with acute liver injury could improve diagnosis and management. AcetaSTAT is a competitive immunoassay used to measure acetaminophen protein adducts formed by toxic metabolites in serum samples from patients. We compared the accuracy of AcetaSTAT vs high-pressure liquid chromatography with electrochemical detection (HPLC-EC, a sensitive and specific quantitative analytical assay) to detect acetaminophen protein adducts. Methods We collected serum samples from 19 healthy individuals (no liver injury, no recent acetaminophen use), 29 patients without acetaminophen-associated acute liver injury, and 33 patients with acetaminophen-associated acute liver injury participating in the Acute Liver Failure Study Group registry. Each serum sample was analyzed by AcetaSTAT (reported as test band amplitude) and HPLC-EC (the reference standard). We also collected data on patient age, sex, weight, level of alanine aminotransferase on test day and peak values, concentration of acetaminophen, diagnoses (by site investigator and causality review committee), and outcome after 21 days. Differences between groups were analyzed using Fisher’s Exact for categorical variables and Kruskal-Wallis Test or Rank-Sum test for continuous variables. Results AcetaSTAT discriminated between patients with and without acetaminophen-associated acute liver injury; the median (and range) AcetaSTAT test band amplitude for patients with acetaminophen-associated acute liver injury was 584 (range, 222–1027) vs 3678 (range, 394–8289) for those without (P<.001). AcetaSTAT identified patients with acetaminophen-associated acute liver injury with 100% sensitivity, 86.2% specificity, a positive-predictive value of 89.2%, and a negative-predictive value of 100%. Results from AcetaSTAT were positive in 4 subjects who received a causality review committee diagnosis of non-acetaminophen–associated acute liver injury; HPLC-EC and biochemical profiles were consistent with acetaminophen-associated acute liver injury in 3 of these cases. Conclusion The competitive immunoassay AcetaSTAT demonstrates a high degree of concordance with HPLC-EC results in identifying patients with acetaminophen-associated acute liver injury. This rapid and simple assay could increase early detection of this disorder and aid clinical management. PMID:27641661

Early identification of 'acute-onset' chronic inflammatory demyelinating polyneuropathy.

PubMed

Sung, Jia-Ying; Tani, Jowy; Park, Susanna B; Kiernan, Matthew C; Lin, Cindy Shin-Yi

2014-08-01

Distinguishing patients with acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy prior to relapse is often challenging at the onset of their clinical presentation. In the present study, nerve excitability tests were used in conjunction with the clinical phenotype and disease staging, to differentiate between patients with acute-onset chronic inflammatory demyelinating polyneuropathy and patients with acute inflammatory demyelinating polyneuropathy at an early stage, with the aim to better guide treatment. Clinical assessment, staging and nerve excitability tests were undertaken on patients initially fulfilling the diagnostic criteria of acute inflammatory demyelinating polyneuropathy soon after symptom onset and their initial presentation. Patients were subsequently followed up for minimum of 12 months to determine if their clinical presentations were more consistent with acute-onset chronic inflammatory demyelinating polyneuropathy. Clinical severity as evaluated by Medical Research Council sum score and Hughes functional grading scale were not significantly different between the two cohorts. There was no difference between the time of onset of initial symptoms and nerve excitability test assessment between the two cohorts nor were there significant differences in conventional nerve conduction study parameters. However, nerve excitability test profiles obtained from patients with acute inflammatory demyelinating polyneuropathy demonstrated abnormalities in the recovery cycle of excitability, including significantly reduced superexcitability (P < 0.001) and prolonged relative refractory period (P < 0.01), without changes in threshold electrotonus. In contrast, in patients with acute-onset chronic inflammatory demyelinating polyneuropathy, a different pattern occurred with the recovery cycle shifted downward (increased superexcitability, P < 0.05; decreased subexcitability, P < 0.05) and increased threshold change in threshold electrotonus in both hyperpolarizing and depolarizing directions [depolarizing threshold electrotonus (90-100 ms) P < 0.005, hyperpolarizing threshold electrotonus (10-20 ms), P < 0.01, hyperpolarizing threshold electrotonus (90-100 ms), P < 0.05], perhaps suggesting early hyperpolarization. In addition, using excitability parameters superexcitability, subexcitability and hyperpolarizing threshold electrotonus (10-20 ms), the patients with acute inflammatory demyelinating polyneuropathy and acute-onset chronic inflammatory demyelinating polyneuropathy could be clearly separated into two non-overlapping groups. Studies of nerve excitability may be able to differentiate acute from acute-onset chronic inflammatory demyelinating polyneuropathy at an early stage. Characteristic nerve excitability parameter changes occur in early acute-onset chronic inflammatory demyelinating polyneuropathy, to match the clinical phenotype. Importantly, this pattern of change was strikingly different to that shown by patients with acute inflammatory demyelinating polyneuropathy, suggesting that nerve excitability techniques may be useful in distinguishing acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy at the initial stage. © The Author (2014). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Severe asthma exacerbation: role of acute Chlamydophila pneumoniae and Mycoplasma pneumoniae infection.

PubMed

Cosentini, Roberto; Tarsia, Paolo; Canetta, Ciro; Graziadei, Giovanna; Brambilla, Anna Maria; Aliberti, Stefano; Pappalettera, Maria; Tantardini, Francesca; Blasi, Francesco

2008-05-30

Chlamydophila pneumoniae and Mycoplasma pneumoniae are associated with acute exacerbation of bronchial asthma (AEBA). The aim of this study was to evaluate the correlation between these acute bacterial infections and the severity of AEBA. We prospectively analysed consecutive patients admitted to the Emergency Department with acute asthma exacerbation. In every patient peak expiratory flow (PEF) measurement was performed on admission, and spirometry during follow-up. Serology for Chlamydophila and Mycoplasma pneumoniae was performed on admission and after 4-8 weeks. Fifty-eight patients completed the study. Acute atypical infections (AAI) was observed in 22/58 cases; we found single acute C. pneumoniae in 19 cases, single acute M. pneumoniae in 2 cases, and double acute infection in one case. Functional impairment on admission was greater in patients with AAI than in patients without AAI (PEF 205 +/- 104 L/min vs 276 +/- 117 p = 0.02) and persisted until visit 2 (FEV1% 76.30 +/- 24.54 vs FEV1% 92.91 +/- 13.89, p = 0.002). Moreover, the proportion of patients who presented with severe AEBA was significantly greater in the group with AAI than in the group without AAI (15/22 vs 12/36, p = 0.01; OR 4.29, 95% CI 1.38-13.32). Our data suggest an association between acute atypical infection and a more severe AEBA.

Severe asthma exacerbation: role of acute Chlamydophila pneumoniae and Mycoplasma pneumoniae infection

PubMed Central

Cosentini, Roberto; Tarsia, Paolo; Canetta, Ciro; Graziadei, Giovanna; Brambilla, Anna Maria; Aliberti, Stefano; Pappalettera, Maria; Tantardini, Francesca; Blasi, Francesco

2008-01-01

Background Chlamydophila pneumoniae and Mycoplasma pneumoniae are associated with acute exacerbation of bronchial asthma (AEBA). The aim of this study was to evaluate the correlation between these acute bacterial infections and the severity of AEBA. Methods We prospectively analysed consecutive patients admitted to the Emergency Department with acute asthma exacerbation. In every patient peak expiratory flow (PEF) measurement was performed on admission, and spirometry during follow-up. Serology for Chlamydophila and Mycoplasma pneumoniae was performed on admission and after 4–8 weeks. Results Fifty-eight patients completed the study. Acute atypical infections (AAI) was observed in 22/58 cases; we found single acute C. pneumoniae in 19 cases, single acute M. pneumoniae in 2 cases, and double acute infection in one case. Functional impairment on admission was greater in patients with AAI than in patients without AAI (PEF 205 ± 104 L/min vs 276 ± 117 p = 0.02) and persisted until visit 2 (FEV1% 76.30 ± 24.54 vs FEV1% 92.91 ± 13.89, p = 0.002). Moreover, the proportion of patients who presented with severe AEBA was significantly greater in the group with AAI than in the group without AAI (15/22 vs 12/36, p = 0.01; OR 4.29, 95% CI 1.38–13.32). Conclusion Our data suggest an association between acute atypical infection and a more severe AEBA. PMID:18513407

Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis

PubMed Central

Jeon, Tae Joo; Park, Ji Young

2017-01-01

AIM To investigated the prognostic value of the neutrophil-lymphocyte ratio (NLR) in patients with acute pancreatitis and determined an optimal cut-off value for the prediction of adverse outcomes in these patients. METHODS We retrospectively analyzed 490 patients with acute pancreatitis diagnosed between March 2007 and December 2012. NLRs were calculated at admission and 24, 48, and 72 h after admission. Patients were grouped according to acute pancreatitis severity and organ failure occurrence, and a comparative analysis was performed to compare the NLR between groups. RESULTS Among the 490 patients, 70 had severe acute pancreatitis with 31 experiencing organ failure. The severe acute pancreatitis group had a significantly higher NLR than the mild acute pancreatitis group on all 4 d (median, 6.14, 6.71, 5.70, and 4.00 vs 4.74, 4.47, 3.20, and 3.30, respectively, P < 0.05). The organ failure group had a significantly higher NLR than the group without organ failure on all 4 d (median, 7.09, 6.72, 6.27, and 6.24 vs 4.85, 4.49, 3.35, and 2.34, respectively, P < 0.05). The optimal cut-off value for baseline NLR was 4.76 in predicting severity and 4.88 in predicting organ failure in acute pancreatitis. CONCLUSION Elevated baseline NLR correlates with severe acute pancreatitis and organ failure. PMID:28638228

Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis.

PubMed

Jeon, Tae Joo; Park, Ji Young

2017-06-07

To investigated the prognostic value of the neutrophil-lymphocyte ratio (NLR) in patients with acute pancreatitis and determined an optimal cut-off value for the prediction of adverse outcomes in these patients. We retrospectively analyzed 490 patients with acute pancreatitis diagnosed between March 2007 and December 2012. NLRs were calculated at admission and 24, 48, and 72 h after admission. Patients were grouped according to acute pancreatitis severity and organ failure occurrence, and a comparative analysis was performed to compare the NLR between groups. Among the 490 patients, 70 had severe acute pancreatitis with 31 experiencing organ failure. The severe acute pancreatitis group had a significantly higher NLR than the mild acute pancreatitis group on all 4 d (median, 6.14, 6.71, 5.70, and 4.00 vs 4.74, 4.47, 3.20, and 3.30, respectively, P < 0.05). The organ failure group had a significantly higher NLR than the group without organ failure on all 4 d (median, 7.09, 6.72, 6.27, and 6.24 vs 4.85, 4.49, 3.35, and 2.34, respectively, P < 0.05). The optimal cut-off value for baseline NLR was 4.76 in predicting severity and 4.88 in predicting organ failure in acute pancreatitis. Elevated baseline NLR correlates with severe acute pancreatitis and organ failure.

Prospective investigation of the hypothalamo-pituitary-adrenal axis in patients with tularemia.

PubMed

Demiraslan, Hayati; Şimşek, Yasin; Tanriverdi, Fatih; Doğanay, Mehmet; Keleştemur, Hasan Fahrettin

2015-01-01

To investigate prospectively the hypothalamo-pituitary-adrenal (HPA) axis by adrenocorticotropic hormone (ACTH) stimulation test. Tularemia was diagnosed according to guidelines. An ACTH stimulation test (1 µg) and a dexamethasone suppression test (DST; 1 mg) were performed in patients in the acute phase of tularemia before antibiotic treatment and in the chronic phase. Nineteen patients (mean age: 41.0 ± 13.2 years; 57.9% female) with tularemia were enrolled in the study in 2011 and 2012. Cortisol response to ACTH stimulation test was sufficient in all patients during the acute phase. After the DST, the cortisol was not suppressed during the acute phase in only one patient. The median control time of 11 patients after acute tularemia was 13 months. During the chronic phase, cortisol response to ACTH stimulation was normal in all patients, and after DST cortisol was suppressed in all patients. The peak cortisol level after the ACTH stimulation test in the acute phase was higher than that in the chronic phase, but the difference was not statistically significant. The HPA axis of patients with tularemia was not significantly affected in the acute and chronic phases.

Increased ICU resource needs for an academic emergency general surgery service*.

PubMed

Lissauer, Matthew E; Galvagno, Samuel M; Rock, Peter; Narayan, Mayur; Shah, Paulesh; Spencer, Heather; Hong, Caron; Diaz, Jose J

2014-04-01

ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients. Retrospective database review. Academic, tertiary care, nontrauma surgical ICU. All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012. None. Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all p< 0.01). Ventilator usage, defined by percentage of total ICU days patients required mechanical ventilation, was significantly higher for acute care emergency surgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p < 0.01). Continuous renal replacement therapy usage, defined as percent of patients requiring this service, was significantly higher in acute care emergency surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p < 0.01). Acute care emergency surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p < 0.001 for each) and more likely required emergent surgery (13.7% vs 6.7% and 3.5%, all p < 0.001). Chronic comorbidities were similar between acute care emergency surgery and general surgery, whereas transplant had fewer. Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs will allow for better deployment of hospital resources.

Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands1

PubMed Central

Krijger, Elmer; Delsing, Corine E.; Sprong, Tom; Nabuurs-Franssen, Marrigje H.; Bleeker-Rovers, Chantal P.

2015-01-01

Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case–control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower respiratory tract symptoms, or fever and hepatitis, but had negative serologic results for Q fever. Patients with acute Q fever were younger and had higher C-reactive protein levels but lower leukocyte counts. However, a large overlap was found. In patients with an indication for prophylaxis, chronic Q fever did not develop after patients received prophylaxis but did develop in 50% of patients who did not receive prophylaxis. Differentiating acute Q fever from other respiratory infections, fever, or hepatitis is not possible without serologic testing or PCR. If risk factors for chronic Q fever are present, prophylactic treatment is advised. PMID:26196955

Emergency Medicine Management of Sickle Cell Disease Complications: An Evidence-Based Update.

PubMed

Simon, Erica; Long, Brit; Koyfman, Alex

2016-10-01

Sickle cell disease (SCD) affects approximately 100,000 individuals in the United States. Due to alterations in the structural conformation of hemoglobin molecules under deoxygenated conditions, patients with SCD are predisposed to numerous sequelae, many of which require acute intervention. Our aim was to provide emergency physicians with an evidence-based update regarding the diagnosis and management of SCD complications. SCD patients experience significant morbidity and mortality secondary to cerebrovascular accident, acute chest syndrome, acute vaso-occlusive pain crises, SCD-related multi-organ failure, cholecystitis, acute intrahepatic cholestasis, acute sickle hepatic crisis, acute hepatic sequestration, priapism, and renal disease. Emergency physicians must recognize acute manifestations of SCD in order to deliver timely management and determine patient disposition. A comprehensive review of the emergency department management of acute SCD complications is provided. Comprehensive understanding of these aspects of SCD can assist physicians in expediting patient evaluation and treatment, thus decreasing the morbidity and mortality associated with this hemoglobinopathy. Copyright © 2016 Elsevier Inc. All rights reserved.

Studying Physician-Patient Communication in the Acute Care Setting: The Hospitalist Rapport Study

PubMed Central

Anderson, Wendy G.; Winters, Kathryn; Arnold, Robert M.; Puntillo, Kathleen A.; White, Douglas B.; Auerbach, Andrew D.

2010-01-01

Objective To assess the feasibility of studying physician-patient communication in the acute care setting. Methods We recruited hospitalist physicians and patients from two hospitals within a university system and audio-recorded their first encounter. Recruitment, data collection, and challenges encountered were tracked. Results Thirty-two physicians consented (rate 91%). Between August 2008 and March 2009, 441 patients were referred, 210 (48%) were screened, and 119 (66% of 179 eligible) consented. We audio-recorded encounters of 80 patients with 27 physicians. Physicians’ primary concern about participation was interference with their workflow. Addressing their concerns and building the protocol around their schedules facilitated participation. Challenges unique to the acute care setting were: 1) extremely limited time for patient identification, screening, and enrollment during which patients were ill and busy with clinical care activities, and 2) little advance knowledge of when physician-patient encounters would occur. Employing a full-time study coordinator mitigated these challenges. Conclusion Physician concerns for participating in communication studies are similar in ambulatory and acute care settings. The acute care setting presents novel challenges for patient recruitment and data collection. Practice Implications These methods should be used to study provider-patient communication in acute care settings. Future work should test strategies to increase patient enrollment. PMID:20444569

The dyspnea-anxiety-dyspnea cycle--COPD patients' stories of breathlessness: "It's scary /when you can't breathe".

PubMed

Bailey, Patricia H

2004-07-01

Dyspnea, the major symptom associated with acute exacerbation events of chronic obstructive pulmonary disease (COPD), is a subjective experience. Extensive research has been done on the pathophysiology and affective components of dyspnea; however, the precise physical mechanism of breathlessness remains elusive. One purpose of this narrative research was to explore the affective component of dyspnea/anxiety as described by patients living with COPD characterized by acute illness events. Ten patient-family units participated in interviews during an acute episode of the patient's lung disease. They described their understanding of acute dyspnea as an experience inextricably related to anxiety and emotional functioning. Their stories suggest that given the absence of clear objective measures of illness severity, patient-reported anxiety might provide an important marker during acute exacerbation events. Health care providers need to recognize anxiety as an important and potentially measurable sign of invisible dyspnea for end-stage patients with COPD in acute respiratory distress.

Klinefelter syndrome and acute basophilic leukaemia--case report.

PubMed

Ljubić, Nives; Lang, Nada; Skelin, Ika Kardum; Lasan, Ruzica; Dominis, Mara; Perković, Leila; Zupanić-Krmek, Dubraka; Grgurević-Batinica, Anita

2010-06-01

Patients with 47, XXY karyotype (Klinefelter syndrome) appear to have increased risk of developing cancer, especially male breast cancer, germ cell tumours and non Hodgkin lymphomas, but rarely acute myeloid leukaemia. We report a patient with acute basophilic leukaemia with 47, XXY karyotype in both the tumour and constitutional cells. Acute basophilic leukaemia is very rare disease comprising less than 1% of all acute myeloid leukaemias. Morphological characteristic of leukaemic blast cells is moderately basophilic cytoplasm containing a variable number of coarse basophilic granules. The most characteristic cytochemical reaction is metachromatic positivity with toluidine blue. Blast are myeloperoxidase negative. Also leukemic blasts express myeloid and monocyte markers. There is no consistent chromosomal abnormality identified in this leukaemia. This is the first reported case of acute basophilic leukaemia in patient with Klinefelter syndrome. In this article the medical history of the patient is given and the possible connection between Klinefelter syndrome and acute myeloid leukaemia is discussed.

Individual patient data meta-analysis of organ failure in acute pancreatitis: protocol of the PANCREA II study.

PubMed

Das, Stephanie L M; Papachristou, George I; De Campos, Tercio; Panek, Jozefa; Poves Prim, Ignasi; Serrablo, Alejandro; Parks, Rowan W; Uomo, Generoso; Windsor, John A; Petrov, Maxim S

2013-09-10

Organ failure is a major determinant of mortality in patients with acute pancreatitis. These patients usually require admission to high dependency or intensive care units and consume considerable health care resources. Given a low incidence rate of organ failure and a lack of large non-interventional studies in the field of acute pancreatitis, the characteristics of organ failure that influence outcomes of patients with acute pancreatitis remain largely unknown. Therefore, the Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA) aims to conduct a meta-analysis of individual patient data from prospective non-interventional studies to determine the influence of timing, duration, sequence, and combination of different organ failures on mortality in patients with acute pancreatitis. Pancreatologists currently active with acute pancreatitis clinical research will be invited to contribute. To be eligible for inclusion patients will have to meet the criteria of acute pancreatitis, develop at least one organ failure during the first week of hospitalization, and not be enrolled into an intervention study. Raw data will then be collated and checked. Individual patient data analysis based on a logistic regression model with adjustment for confounding variables will be done. For all analyses, corresponding 95% confidence intervals and P values will be reported. This collaborative individual patient data meta-analysis will answer important clinical questions regarding patients with acute pancreatitis that develop organ failure. Information derived from this study will be used to optimize routine clinical management and improve care strategies. It can also help validate outcome definitions, allow comparability of results and form a more accurate basis for patient allocation in further clinical studies.

Differences in disease features between childhood-onset and adult-onset systemic lupus erythematosus patients presenting with acute abdominal pain.

PubMed

Tu, Yu-Ling; Yeh, Kuo-Wei; Chen, Li-Chen; Yao, Tsung-Chieh; Ou, Liang-Shiou; Lee, Wen-I; Huang, Jing-Long

2011-04-01

Abdominal pain in systemic lupus erythematosus (SLE) patients has rarely been analyzed in pediatric populations. We planned to investigate the potential differences between childhood-onset and adult-onset SLE patients who were hospitalized because of acute abdominal pain. A retrospective study including 23 childhood-onset SLE patients with 38 admissions and 88 adult-onset SLE patients with 108 admissions from 1999 to 2008 were conducted in our hospital. All of them had the chief complaint of diffuse abdominal pain. The etiologies of acute abdominal pain in adult-onset SLE patients were more diverse than childhood-onset SLE patients. The most common cause of acute abdominal pain in SLE patients was lupus mesenteric vasculitis (LMV) (18.5%), followed by acute gastroenteritis (14.4%), pancreatitis (10.3%), appendicitis (7.5%), and cholecystitis (6.2%). Compared with adults, children were admitted more often due to LMV (31.6% versus 13.9%; P = 0.016), had more frequently recurrent episodes (39.1% versus 14.8%; P = 0.009), and were more often treated with immunosuppressive agents (31.6% versus 7.4%; P < 0.001) at the time of admission. The overall case fatality rate of acute abdomen in SLE patients was 9.4%. The extra-gastrointestinal symptoms, laboratory evaluation, disease activity, and organ damage measured by the SLE Disease Activity Index and outcomes were comparable between children and adults. Various etiologies of acute abdominal pain should be considered in SLE patients. LMV is the most common cause of acute abdomen in childhood-onset SLE patients with low mortality and morbidity provided by prompt diagnosis and timely administration of high-dose intravenous corticosteroids after excluding real surgical abdomen. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

Epidemiology and characteristics of acute poisoning treated at an emergency center.

PubMed

Chen, Feng; Wen, Jun-Ping; Wang, Xiao-Ping; Lin, Qing-Ming; Lin, Cai-Jing

2010-01-01

Acute poisoning is frequently encountered at emergency department. This study was to investigate the epidemiology and characteristics of patients with acute poisoning who were treated at the Emergency Center, Fujian Provincial Hospital, China. We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients. Altogether 2867 patients with acute poisoning were treated from January 2004 to December 2009. The ratio of male to female was 1:1.04, and their average age was 33.8 years. Of the 2867 patients, 76.39% were between 18 and 40 years old. The incidence of acute poisoning was as high as 11.33% in January each year. The incidence of poisoning was in a descending order: alcohol poisoning (54.55%), medication poisoning (25.95%), pesticide poisoning (5.65%), and drug poisoning (4.88%). Most (56.44%) of the patients with drug poisoning were under 25 years and their mean age was significantly lower than that of patients with medication poisoning or alcohol poisoning (P < 0.01). Approximately 69.54% of the patients were followed up after emergency treatment, 30.39% were hospitalized, and four patients died. Acute poisoning is largely alcohol poisoning and medication poisoning in a city. The emergency green channel "pre-hospital emergency care-emergency department-hospital treatment" can significantly improve the survival rate of patients with acute poisoning.

[Successful endoscopic dilatation of a stenosis in relation to an ileorectal anastomosis by acute ileus].

PubMed

Kjærgaard, Jane Christensen; Hendel, Jakob; Gügenur, Ismail

2014-02-17

Endoscopic dilatation is a treatment option for patients with Crohns disease suffering from stenosis in relation to an ileorectal anastomosis. We present a case of a patient with Crohns disease who was admitted with acute obstructive symptoms due to a stensosis of the ileorectal anastomosis. The patient was septic. We performed a successful endoscopic dilatation in the acute phase and the patient was discharged few days after an uneventful recovery. Endoscopic dilatation of an ileorectal anastomsis in patients with Crohns disease is a treatment option in the acute setting when performed by experienced endoscopists.

Case Studies in Cardiac Dysfunction After Acute Aneurysmal Subarachnoid Hemorrhage

PubMed Central

Hamilton, Jason C.; Korn-Naveh, Lauren; Crago, Elizabeth A.

2015-01-01

Patients with acute aneurysmal subarachnoid hemorrhage (SAH) often present with more than just neurological compromise. A wide spectrum of complicating cardiopulmonary abnormalities have been documented in patients with acute SAH, presenting additional challenges to the healthcare providers who attempt to treat and stabilize these patients. The patients described in this article presented with both acute aneurysmal SAH and cardiopulmonary compromise. Education and further research on this connection is needed to provide optimal care and outcomes for this vulnerable population. Nurses play a key role in balancing the critical and diverse needs of patients presenting with these symptoms. PMID:18856247

The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning.

PubMed

Kim, Y S; Cha, Y S; Kim, M S; Kim, H J; Lee, Y S; Youk, H; Kim, H I; Kim, O H; Cha, K-C; Kim, H; Lee, K H; Hwang, S O

2018-06-01

Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). No previous study has determined whether early use of diffusion-weighted magnetic resonance imaging (DWI) can predict which patients will develop DNS in the acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 17-month period. All included patients with acute CO poisoning underwent DWI to evaluate brain injury within 72 h after CO exposure. DWI was evaluated as follows: (1) presence of pathology, (2) number of pathologies, (3) asymmetry, and (4) location of pathology. Patients were divided into two groups. The DNS group was composed of patients with delayed sequelae, while the non-DNS group included patients with no sequelae. A total of 102 patients with acute CO poisoning were finally enrolled in this study. DNS developed in 10 patients (9.8%). Between the DNS group and the non-DNS group, presence of pathology on DWI and initial Glasgow Coma Scale (GCS) showed significant difference. There was also a statistical difference between the non-DNS group and DNS group in terms of CO exposure time, troponin I, rhabdomyolysis, acute kidney injury, and pneumonia. The presence of pathology in DWI and initial GCS (cutoff: <12) at the emergency department served as an early predictors of DNS.

Prevalence and impact of active and passive cigarette smoking in acute respiratory distress syndrome.

PubMed

Hsieh, S Jean; Zhuo, Hanjing; Benowitz, Neal L; Thompson, B Taylor; Liu, Kathleen D; Matthay, Michael A; Calfee, Carolyn S

2014-09-01

Cigarette smoke exposure has recently been found to be associated with increased susceptibility to trauma- and transfusion-associated acute respiratory distress syndrome. We sought to determine 1) the incidence of cigarette smoke exposure in a diverse multicenter sample of acute respiratory distress syndrome patients and 2) whether cigarette smoke exposure is associated with severity of lung injury and mortality in acute respiratory distress syndrome. Analysis of the Albuterol for the Treatment of Acute Lung Injury and Omega Acute Respiratory Distress Syndrome Network studies. Acute Respiratory Distress Syndrome Network hospitals. Three hundred eighty-one patients with acute respiratory distress syndrome. None. 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol, a validated tobacco-specific marker, was measured in urine samples from subjects enrolled in two National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network randomized controlled trials. Urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels were consistent with active smoking in 36% of acute respiratory distress syndrome patients and with passive smoking in 41% of nonsmokers (vs 20% and 40% in general population, respectively). Patients with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels in the active smoking range were younger and had a higher incidence of alcohol misuse, fewer comorbidities, lower severity of illness, and less septic shock at enrollment compared with patients with undetectable 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels. Despite this lower severity of illness, the severity of lung injury did not significantly differ based on biomarker-determined smoking status. Cigarette smoke exposure was not significantly associated with death after adjusting for differences in age, alcohol use, comorbidities, and severity of illness. In this first multicenter study of biomarker-determined cigarette smoke exposure in acute respiratory distress syndrome patients, we found that active cigarette smoke exposure was significantly more prevalent among acute respiratory distress syndrome patients compared to population averages. Despite their younger age, better overall health, and lower severity of illness, smokers by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol had similar severity of lung injury as patients with undetectable 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol. These findings suggest that active cigarette smoking may increase susceptibility to acute respiratory distress syndrome in younger, healthier patients.

Hypodermoclysis therapy. In a chronic care hospital setting.

PubMed

Worobec, G; Brown, M K

1997-06-01

Occasionally, elderly patients experience acute, episodic incidents of illness that result in dehydration or a high potential for dehydration (e.g., flu, diarrhea). At times, patients may be unable, or refuse, to take fluids orally. Enteral routes via a nasogastric tube or enteral stomach tube may also not be available. In the past, these patients often had to be transferred from home or long-term care facilities to an acute care hospital for intravenous therapy. A transfer of the acutely ill elderly patient to an acute care hospital is often very stressful to the patient and his/her family and is costly to the health care delivery system. Hypodermoclysis, the process of rehydrating a patient by providing isotonic fluids into the subcutaneous tissues over a short time period, provides an alternative method to deal with acute, short-term fluid deficit problems in the elderly. Hypodermoclysis therapy can be administered in a chronic care setting thus potentially decreasing the need to transfer the elderly client to an acute care hospital. The purpose of this study was to investigate the use of hypodermoclysis therapy in solving acute, or potentially acute fluid deficit problems, that were anticipated to be both reversible and short term in nature. This was carried out in an elderly population that resided in a 284-bed chronic care hospital in southern Ontario.

Clinical correlates of acute pulmonary events in children and adolescents with sickle cell disease*

PubMed Central

Paul, Rabindra; Minniti, Caterina P.; Nouraie, Mehdi; Luchtman-Jones, Lori; Campbell, Andrew; Rana, Sohail; Onyekwere, Onyinye; Darbari, Deepika S.; Ajayi, Olaid; Arteta, Manuel; Ensing, Gregory; Sable, Craig; Dham, Niti; Kato, Gregory J.; Gladwin, Mark T.; Castro, Oswaldo L.; Gordeuk, Victor R.

2013-01-01

Objectives We aimed to identify risk factors for acute pulmonary events in children and adolescents in the Pulmonary Hypertension and the Hypoxic Response in SCD (PUSH) study. Methods Patients with hemoglobin SS (n=376) and other sickle cell genotypes (n=127) aged 3-20 years were studied at four centers in a cross-sectional manner. A sub-group (n=293) was followed for a median of 21 months (range 9-35). Results A patient-reported history of one or more acute pulmonary events, either acute chest syndrome (ACS) or pneumonia, was obtained in 195 hemoglobin SS patients (52%) and 51 patients with other genotypes (40%). By logistic regression, history of acute pulmonary events was independently associated with patient-reported history of asthma (p<0.0001), older age (p=0.001), >3 severe pain episodes in the preceding 12 months (p=0.002), higher tricuspid regurgitation velocity (TRV) (p=0.028), and higher white blood cell (WBC) count (p=0.043) among hemoglobin SS patients. History of acute pulmonary events was associated with >3 severe pain episodes (p=0.009) among patients with other genotypes. During follow-up, 43 patients (15%) had at least one new ACS episode including 11 without a baseline history of acute pulmonary events. History of acute pulmonary events (odds ratio 5.4; p<0.0001) and younger age (odds ratio 0.9; p=0.010) were independently associated with developing a new episode during follow-up. Conclusions Asthma history, frequent pain and higher values for TRV and WBC count were independently associated with history of acute pulmonary events in hemoglobin SS patients and frequent pain was associated in those with other genotypes. Measures to reduce pain episodes and control asthma may help to decrease the incidence of acute pulmonary events in SCD. PMID:23560516

Active acute leukaemia: should transplant be offered to all patients?

PubMed

Avni, Batia; Shapira, Michael Y; Resnick, Igor B; Stepensky, Polina; Or, Reuven; Grisariu, Sigal

2017-12-01

The probability of achieving long term remission for patients with refractory acute leukaemia is very low. Allogeneic stem cell transplantation (SCT) is offered to these patients in order to improve their dismal outcome. We retrospectively analyzed 361 acute leukaemia patients, who underwent allogeneic SCT in the Hadassah's bone marrow transplantation department between the years 2005 and 2012 and identified 84 patients with active leukaemia at transplantation. Median age was 34 years. Sixty four patients were diagnosed with acute myeloid leukaemia (AML), 18 patients with acute lymphoblastic leukaemia and two with biphenotypic leukaemia. The majority of patients were diagnosed with de-novo AML and transplanted at relapse. In the surviving patients, median follow up was 15 months. One year OS was 20%. At time of last follow up, 13 patients were alive (15.5%): ten patients with AML and two patients with acute lymphoblastic leukaemia. In the univariate analysis, factors associated with significantly better overall survival were as follows: matched unrelated donor (p = 0.006), matched donor (p = 0.014) and occurrence of acute graft-versus-host disease (aGVHD) (p = 0.019). Karnofsky performance score at SCT and occurrence of cGVHD were found to be borderline significant. Only matched unrelated donor and aGVHD were found to affect overall survival significantly in the multivariate analysis. Other than performance score at SCT, none of the pretransplant patients' characteristics were found to influence survival. In conclusion, as none of the pretransplant characteristics were found to influence the ability to select the patients that will benefit from HSC transplantation, this work supports offering HSCT to all active leukaemia eligible patients with reasonable performance status. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Survival after acute hemodialysis in Pennsylvania, 2005-2007: a retrospective cohort study.

PubMed

Ramer, Sarah J; Cohen, Elan D; Chang, Chung-Chou H; Unruh, Mark L; Barnato, Amber E

2014-01-01

Little is known about acute hemodialysis in the US. Here we describe predictors of receipt of acute hemodialysis in one state and estimate the marginal impact of acute hemodialysis on survival after accounting for confounding due to illness severity. This is a retrospective cohort study of acute-care hospitalizations in Pennsylvania from October 2005 to December 2007 using data from the Pennsylvania Health Care Cost Containment Council. Exposure variable is acute hemodialysis; dependent variable is survival following acute hemodialysis. We used multivariable logistic regression to determine propensity to receive acute hemodialysis and then, for a Cox proportional hazards model, matched acute hemodialysis and non-acute hemodialysis patients 1∶5 on this propensity. In 2,131,248 admissions of adults without end-stage renal disease, there were 6,657 instances of acute hemodialysis. In analyses adjusted for predicted probability of death upon admission plus other covariates and stratified on age, being male, black, and insured were independent predictors of receipt of acute hemodialysis. One-year post-admission mortality was 43% for those receiving acute hemodialysis, compared to 13% among those not receiving acute hemodialysis. After matching on propensity to receive acute hemodialysis and adjusting for predicted probability of death upon admission, patients who received acute hemodialysis had a higher risk of death than patients who did not over at least 1 year of follow-up (hazard ratio 1·82, 95% confidence interval 1·68-1·97). In a populous US state, receipt of acute hemodialysis varied by age, sex, race, and insurance status even after adjustment for illness severity. In a comparison of patients with similar propensity to receive acute hemodialysis, those who did receive it were less likely to survive than those who did not. These findings raise questions about reasons for lack of benefit.

Wireless capsule endoscopy for diagnosis of acute intestinal graft-versus-host disease.

PubMed

Neumann, Susanne; Schoppmeyer, Konrad; Lange, Thoralf; Wiedmann, Marcus; Golsong, Johannes; Tannapfel, Andrea; Mossner, Joachim; Niederwieser, Dietger; Caca, Karel

2007-03-01

The small intestine is the most common location of intestinal graft-versus-host disease (GVHD). EGD with duodenal biopsies yields the highest diagnostic sensitivity, but the jejunum and ileum are not accessible by regular endoscopy. In contrast, wireless capsule endoscopy (WCE) is a noninvasive imaging procedure offering complete evaluation of the small intestine. The objective was to compare the diagnostic value of EGD, including biopsies, with the results of WCE in patients with acute intestinal symptoms who received allogeneic blood stem cell transplantation and to analyze the appearance and distribution of acute intestinal GVHD lesions in these patients. An investigator-blinded, single-center prospective study. Patients with acute intestinal symptoms after allogeneic stem cell transplantation underwent both EGD and WCE within 24 hours. Clinical data were recorded during 2 months of follow-up. Fourteen consecutive patients with clinical symptoms of acute intestinal GVHD were recruited. In 1 patient, the capsule remained in the stomach and was removed endoscopically. In 7 of 13 patients who could be evaluated, acute intestinal GVHD was diagnosed by EGD with biopsies, but 3 of these would have been missed by EGD alone. In all 7 patients with histologically confirmed acute intestinal GVHD, WCE revealed typical signs of GVHD. Lesions were scattered throughout the small intestine, but were most accentuated in the ileum. This study had a small number of patients. WCE, which is less invasive than EGD with biopsies, showed a comparable sensitivity and a high negative predictive value for diagnosing acute intestinal GVHD. It may be helpful to avoid repeated endoscopic procedures in patients who have undergone stem cell transplantation.

Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial.

PubMed

Kacmarek, Robert M; Villar, Jesús; Sulemanji, Demet; Montiel, Raquel; Ferrando, Carlos; Blanco, Jesús; Koh, Younsuck; Soler, Juan Alfonso; Martínez, Domingo; Hernández, Marianela; Tucci, Mauro; Borges, Joao Batista; Lubillo, Santiago; Santos, Arnoldo; Araujo, Juan B; Amato, Marcelo B P; Suárez-Sipmann, Fernando

2016-01-01

The open lung approach is a mechanical ventilation strategy involving lung recruitment and a decremental positive end-expiratory pressure trial. We compared the Acute Respiratory Distress Syndrome network protocol using low levels of positive end-expiratory pressure with open lung approach resulting in moderate to high levels of positive end-expiratory pressure for the management of established moderate/severe acute respiratory distress syndrome. A prospective, multicenter, pilot, randomized controlled trial. A network of 20 multidisciplinary ICUs. Patients meeting the American-European Consensus Conference definition for acute respiratory distress syndrome were considered for the study. At 12-36 hours after acute respiratory distress syndrome onset, patients were assessed under standardized ventilator settings (FIO2≥0.5, positive end-expiratory pressure ≥10 cm H2O). If Pao2/FIO2 ratio remained less than or equal to 200 mm Hg, patients were randomized to open lung approach or Acute Respiratory Distress Syndrome network protocol. All patients were ventilated with a tidal volume of 4 to 8 ml/kg predicted body weight. From 1,874 screened patients with acute respiratory distress syndrome, 200 were randomized: 99 to open lung approach and 101 to Acute Respiratory Distress Syndrome network protocol. Main outcome measures were 60-day and ICU mortalities, and ventilator-free days. Mortality at day-60 (29% open lung approach vs. 33% Acute Respiratory Distress Syndrome Network protocol, p = 0.18, log rank test), ICU mortality (25% open lung approach vs. 30% Acute Respiratory Distress Syndrome network protocol, p = 0.53 Fisher's exact test), and ventilator-free days (8 [0-20] open lung approach vs. 7 [0-20] d Acute Respiratory Distress Syndrome network protocol, p = 0.53 Wilcoxon rank test) were not significantly different. Airway driving pressure (plateau pressure - positive end-expiratory pressure) and PaO2/FIO2 improved significantly at 24, 48 and 72 hours in patients in open lung approach compared with patients in Acute Respiratory Distress Syndrome network protocol. Barotrauma rate was similar in both groups. In patients with established acute respiratory distress syndrome, open lung approach improved oxygenation and driving pressure, without detrimental effects on mortality, ventilator-free days, or barotrauma. This pilot study supports the need for a large, multicenter trial using recruitment maneuvers and a decremental positive end-expiratory pressure trial in persistent acute respiratory distress syndrome.

An analysis of clinical outcomes and costs of a long term acute care hospital.

PubMed

Votto, John J; Scalise, Paul J; Barton, Randall W; Vogel, Cristine A

2011-01-01

Compare clinical outcomes and costs in a study group of long-term acute care hospital (LTCH) patients with a control group of LTCH-eligible patients in an acute care hospital. LTCHs were created to provide post-acute care services not available at other post-acute settings. This is based on the premise that these patients would otherwise have stayed at acute care hospitals as high-cost outliers. The LTCH hospital is intended to deliver care to patients more efficiently, however, there are little documented clinical and financial data regarding the comparative clinical outcomes and costs for patients. Retrospective medical and billing record review of patients from the following groups: (1) LTCH study comprising patients admitted directly from an acute care hospital to the study LTCH and discharged from the LTCH from September 2004 through August 2006; (2) a control group of LTCH-eligible, medically complex patients treated and discharged from an acute care hospital in FY 2002. The control group was selected from approximately 500 patients who had at least one of the ten most common principle diagnosis DRGs of the study LTCH with >30-day length of stay at the referring hospital and met NALTH admitting guidelines. Discharge disposition is an important outcome measure of the quality of care of medically complex patients. The in-hospital mortality rate trended lower and home discharge was 3 times higher for the LTCH study group than for the control group. As a possible result, SNF discharge of LTCH patients was approximately half that of the control group. Both mean patient cost per day and mean total cost per patient were significantly higher in the control group than in the LTCH study group. The patients in the LTCH study group had both better clinical outcomes and lower cost of care than the control group.

A potential biomarker for fatigue: Oxidative stress and anti-oxidative activity.

PubMed

Fukuda, Sanae; Nojima, Junzo; Motoki, Yukari; Yamaguti, Kouzi; Nakatomi, Yasuhito; Okawa, Naoko; Fujiwara, Kazumi; Watanabe, Yasuyoshi; Kuratsune, Hirohiko

2016-07-01

We sought to determine whether oxidative stress and anti-oxidative activity could act as biomarkers that discriminate patients with chronic fatigue syndrome (CFS) from healthy volunteers at acute and sub-acute fatigue and resting conditions. We calculated the oxidative stress index (OSI) from reactive oxygen metabolites-derived compounds (d-ROMs) and the biological antioxidant potential (BAP). We determined changes in d-ROMs, BAP, and OSI in acute and sub-acute fatigue in two healthy groups, and compared their values at rest between patients with CFS (diagnosed by Fukuda 1994 criteria) and another group of healthy controls. Following acute fatigue in healthy controls, d-ROMs and OSI increased, and BAP decreased. Although d-ROMs and OSI were significantly higher after sub-acute fatigue, BAP did not decrease. Resting condition yielded higher d-ROMs, higher OSI, and lower BAP in patients with CFS than in healthy volunteers, but lower d-ROMs and OSI when compared with sub-acute controls. BAP values did not significantly differ between patients with CFS and controls in the sub-acute condition. However, values were significantly higher than in the resting condition for controls. Thus, measured of oxidative stress (d-ROMS) and anti-oxidative activity (BAP) might be useful for discriminating acute, sub-acute, and resting fatigue in healthy people from patients with CFS, or for evaluating fatigue levels in healthy people. Copyright © 2016 Elsevier B.V. All rights reserved.

The Value of Secretin-Enhanced MRCP in Patients With Recurrent Acute Pancreatitis.

PubMed

Sandrasegaran, Kumar; Tahir, Bilal; Barad, Udaykamal; Fogel, Evan; Akisik, Fatih; Tirkes, Temel; Sherman, Stuart

2017-02-01

The purpose of this study is to assess the additional value of secretin-enhanced MRCP over conventional (non-secretin-enhanced) MRCP in diagnosing disease in patients with recurrent acute pancreatitis. A retrospective review of a radiology database found 72 patients with recurrent acute pancreatitis who had secretin-enhanced MRCP and ERCP correlation within 3 months of each other between January 2007 and December 2011. Of these patients, 54 had no history of pancreatic tumor or surgery and underwent MRI more than 3 months after an episode of acute pancreatitis. In addition, 57 age- and sex-matched control subjects with secretin-enhanced MRCP and ERCP correlation and without a diagnosis of recurrent acute pancreatitis or chronic pancreatitis were enrolled as the control group. All studies were anonymized, and secretin-enhanced MRCP images (image set A) were separated from conventional 2D and 3D MRCP and T2-weighted images (image set B). Image sets A and B for each patient were assigned different and randomized case numbers. Two blinded reviewers independently assessed both image sets for ductal abnormalities and group A image sets for exocrine response to secretin. There were statistically significantly more patients with recurrent acute pancreatitis with reduced exocrine function compared with patients in the control group (32% vs 9%; p < 0.01) on secretin-enhanced images. Patients with recurrent acute pancreatitis were more likely to have side branch dilation (p = 0.02; odds ratio, 3.6), but not divisum, compared with the control group. Secretin-enhanced images were superior to non-secretin-enhanced images for detecting ductal abnormalities in patients with recurrent acute pancreatitis, with higher sensitivity (76% vs 56%; p = 0.01) and AUC values (0.983 vs 0.760; p < 0.01). Up to one-third of patients with recurrent acute pancreatitis showed exocrine functional abnormalities. Secretin-enhanced MRCP had a significantly higher yield for ductal abnormalities than did conventional MRI and should be part of the MRCP protocol for investigation of patients with recurrent acute pancreatitis.

The Value of Secretin-Enhanced MRCP in Patients With Recurrent Acute Pancreatitis

PubMed Central

Sandrasegaran, Kumar; Tahir, Bilal; Barad, Udaykamal; Fogel, Evan; Akisik, Fatih; Tirkes, Temel; Sherman, Stuart

2017-01-01

OBJECTIVE The purpose of this study is to assess the additional value of secretin-enhanced MRCP over conventional (non–secretin-enhanced) MRCP in diagnosing disease in patients with recurrent acute pancreatitis. MATERIALS AND METHODS A retrospective review of a radiology database found 72 patients with recurrent acute pancreatitis who had secretin-enhanced MRCP and ERCP correlation within 3 months of each other between January 2007 and December 2011. Of these patients, 54 had no history of pancreatic tumor or surgery and underwent MRI more than 3 months after an episode of acute pancreatitis. In addition, 57 age- and sex-matched control subjects with secretin-enhanced MRCP and ERCP correlation and without a diagnosis of recurrent acute pancreatitis or chronic pancreatitis were enrolled as the control group. All studies were anonymized, and secretin-enhanced MRCP images (image set A) were separated from conventional 2D and 3D MRCP and T2-weighted images (image set B). Image sets A and B for each patient were assigned different and randomized case numbers. Two blinded reviewers independently assessed both image sets for ductal abnormalities and group A image sets for exocrine response to secretin. RESULTS There were statistically significantly more patients with recurrent acute pancreatitis with reduced exocrine function compared with patients in the control group (32% vs 9%; p < 0.01) on secretin-enhanced images. Patients with recurrent acute pancreatitis were more likely to have side branch dilation (p = 0.02; odds ratio, 3.6), but not divisum, compared with the control group. Secretin-enhanced images were superior to non–secretin-enhanced images for detecting ductal abnormalities in patients with recurrent acute pancreatitis, with higher sensitivity (76% vs 56%; p = 0.01) and AUC values (0.983 vs 0.760; p < 0.01). CONCLUSION Up to one-third of patients with recurrent acute pancreatitis showed exocrine functional abnormalities. Secretin-enhanced MRCP had a significantly higher yield for ductal abnormalities than did conventional MRI and should be part of the MRCP protocol for investigation of patients with recurrent acute pancreatitis. PMID:27824485

Relationship Between Acute Benzodiazepine Poisoning and Acute Pancreatitis Risk

PubMed Central

Liaw, Geng-Wang; Hung, Dong-Zong; Chen, Wei-Kung; Lin, Cheng-Li; Lin, I-Ching; Kao, Chia-Hung

2015-01-01

Abstract We designed a population-based retrospective cohort study to investigate the association between the event of benzodiazepine (BZD) poisoning and the risk of acute pancreatitis. In the present study, 12,893 patients with BZD poisoning during 2000 to 2011 were enrolled and matched with 4 comparison patients according to mean age and sex. We determined the cumulative incidences and adjusted hazard ratios of acute pancreatitis. A significant association was observed between BZD poisoning and acute pancreatitis. After adjustment for potential risk factors, the patients with BZD poisoning had a 5.33-fold increased risk of acute pancreatitis compared with the controls without BZD poisoning (HR = 5.33, 95% CI = 2.26–12.60). The results revealed that acute pancreatitis in patients with BZD poisoning occurred in a follow-up time of ≤1 month (HR = 50.0, P < .001), and the risk of acute pancreatitis was no different between the patients with and without BZD poisoning when the follow-up time was >1 month (HR = 1.07, P > .05). This population-based study revealed the positive correlation between the event of BZD poisoning and an increased risk of acute pancreatitis. The findings warrant further large-scale and in-depth investigation. PMID:26717383

Effectiveness of multifaceted interventions on rational use of antibiotics for patients with upper respiratory tract infections and acute diarrhea.

PubMed

Boonyasiri, Adhiratha; Thamlikitkul, Visanu

2014-03-01

To implement multifaceted interventions to promote rational use of antibiotics for out-patients with upper respiratory tract infection (URI) and acute diarrhea. The present study was conducted at ambulatory care facility for patients under Social Security Healthcare Benefit Scheme and Universal Health Coverage Scheme of Siriraj Hospital from January to April 2012. Multifaceted interventions were: Training responsible healthcare personnel on rational use of antibiotics, Clinical practice guidelines, Preprinted medical record forms for patients, Throat swab or stool culture to be taken from the patients (if responsible physicians needed these); and provision of brochures containing causes, necessity and harm of antibiotics for URI and acute diarrhea to patients as well as their relatives while waiting for receiving care. Pre-printed medical records were collected every day. Each patient was called on day 3 after receiving care by an investigator to determine clinical responses. There were 1,241 episodes of URI and 210 episodes of acute diarrhea during the study period. Rates of antibiotic prescriptions were 13.0% for URI and 19.1% for acute diarrhea. Throat swab cultures recovered group A beta-hemolytic streptococci in 3.8% of URI patients and non-typhoidal Salmonella spp. in 14.6% of acute diarrhea patients. Clinical responses of the patients on day 3 after receiving care revealed that more than 97% of the patients who received antibiotics and who did not receive antibiotics were cured or improved. Multifaceted interventions are very effective for promoting rational use of antibiotics for out-patients with URI and acute diarrhea at Siriraj Hospital.

Endovascular treatment of patients with types A and B thoracic aortic dissection using Relay thoracic stent-grafts: results from the RESTORE Patient Registry.

PubMed

Zipfel, Burkhart; Czerny, Martin; Funovics, Martin; Coppi, Gioacchino; Ferro, Carlo; Rousseau, Hervé; Berti, Sergio; Tealdi, Domenico G; Riambau, Vincent; Mangialardi, Nicola; Sassi, Carlo

2011-04-01

To evaluate the safety and performance of Relay stent-grafts in patients with acute or chronic aortic dissections. Patients with types A or B aortic dissections suitable for treatment with Relay stent-grafts and followed for 2 years after thoracic endovascular aortic repair (TEVAR) were identified from a company-sponsored registry database established in January 2006. Ninety-one consecutive patients (69 men; mean age 65 years) underwent TEVAR with Relay stent-grafts for dissection. Most patients (76, 84%) had type B dissections; 61 of all patients were classified as chronic and 30 as acute. The technical success rate was 95% (97% in acute, 95% in chronic, and 93% in type B dissections). The type I endoleak rate was 7% (7% in acute and 8% in chronic dissections); all occurred in patients with type B dissections. Paraplegia, paraparesis, and stroke occurred in 4, 1, and 2 patients, respectively; 2 cases of paraplegia occurred in patients with acute type B dissections. Thirty-day mortality was 8% (13% in acute and 5% in chronic dissections); all deaths occurred in patients with type B dissections. The 2-year survival rate was 82% in the overall population and 84% in patients with type B dissections. The combination of Relay's features, such as stent conformability, radial force, atraumatic design, and controlled deployment and fixation, may contribute to the safety of the Relay stent-grafts for the treatment of thoracic aortic dissections, including acute and chronic type B dissections.

Patent foramen ovale increases the risk of acute ischemic stroke in patients with acute pulmonary embolism leading to right ventricular dysfunction.

PubMed

Goliszek, Sylwia; Wiśniewska, Małgorzata; Kurnicka, Katarzyna; Lichodziejewska, Barbara; Ciurzyński, Michał; Kostrubiec, Maciej; Gołębiowski, Marek; Babiuch, Marek; Paczynska, Marzanna; Koć, Marcin; Palczewski, Piotr; Wyzgał, Anna; Pruszczyk, Piotr

2014-11-01

Patent foramen ovale (PFO) is an established risk factor for ischemic stroke. Since acute right ventricular dysfunction (RVD) observed in patients with PE can lead to right-to-left inter-atrial shunt via PFO, we hypothesized that PFO is a risk factor for ischemic stroke in PE with significant right ventricular dysfunction. 55 patients (31 F, 24M), median age 49 years (range 19-83 years) with confirmed PE underwent echocardiography for RVD and PFO assessment. High risk acute PE was diagnosed in 3 (5.5%) patients, while 16 (29%) hemodynamically stable with RVD patients formed a group with intermediate-risk PE. PFO was diagnosed in 19 patients (34.5%). Diffusion-weighted MRI of the brain for acute ischemic stroke (AIS) was performed in all patients 4.91 ± 4.1 days after admission. AIS was detected by MRI in 4 patients (7.3%). Only one stroke was clinically overt and resulted in hemiplegia. All 4 AIS occurred in the PFO positive group (4 of 19 patients), and none in subjects without PFO (21.0% vs 0%, p=0.02). Moreover, all AIS occurred in patients with RVD and PFO, and none in patients with PFO without RVD (50% vs 0%, p=0.038). Our data suggest that acute pulmonary embolism resulting in right ventricular dysfunction may lead to acute ischemic stroke in patients with patent foramen ovale. However, the clinical significance of such lesions remains to be determined. Copyright © 2014 Elsevier Ltd. All rights reserved.

Rate of recurrence in Indian patients presenting with acute pancreatitis and identification of chronicity on follow up: Possible risk factors for progression.

PubMed

Kalaria, Rishikesh; Abraham, Philip; Desai, Devendra C; Joshi, Anand; Gupta, Tarun

2018-03-01

To study the profile and long-term outcome of Indian patients presenting with acute pancreatitis and the possible risk factors for progression. Consecutive patients with acute or recurrent acute pancreatitis seen in our department during July 2013 to December 2014 were included. Details of past episodes were collected and patients were followed up till March 2015. In the 97 patients included (mean age 47.2 [SD 16.9] years; 74 men), gallstones (37 [38.1%]) and alcohol (19 [19.6%]) were the major identified etiologies; the idiopathic (31 [32%]) group constituted a third of patients. Recurrences were more common with idiopathic etiology (14 patients out of 30 had recurrences [46.7%]) as compared to alcoholic (5 out of 19 [26.3%]) and biliary (4 out of 37 [10.8%]) pancreatitis and with mild index episode. Following the episode of acute pancreatitis, identification of chronic pancreatitis was more common with alcoholic (6 out of 18 [33%]) and idiopathic (9 out of 30 [30%]) etiology as compared to other etiologies. Longer duration of follow up, but not number of recurrent episodes, was associated with identification of chronicity in patients presenting as acute pancreatitis. Out of 97 patients with acute pancreatitis, 27 (27.8%) developed recurrences with risk factors being idiopathic etiology and mild index episode. Eighteen of 97 (18.6%) patients had evidence of chronic pancreatitis on follow up, risk factors being the alcoholic and idiopathic varieties, and longer duration of follow up.

National assessment of validity of coding of acute mastoiditis: a standardised reassessment of 1966 records.

PubMed

Stalfors, J; Enoksson, F; Hermansson, A; Hultcrantz, M; Robinson, Å; Stenfeldt, K; Groth, A

2013-04-01

To investigate the internal validity of the diagnosis code used at discharge after treatment of acute mastoiditis. Retrospective national re-evaluation study of patient records 1993-2007 and make comparison with the original ICD codes. All ENT departments at university hospitals and one large county hospital department in Sweden. A total of 1966 records were reviewed for patients with ICD codes for in-patient treatment of acute (529), chronic (44) and unspecified mastoiditis (21) and acute otitis media (1372). ICD codes were reviewed by the authors with a defined protocol for the clinical diagnosis of acute mastoiditis. Those not satisfying the diagnosis were given an alternative diagnosis. Of 529 records with ICD coding for acute mastoiditis, 397 (75%) were found to meet the definition of acute mastoiditis used in this study, while 18% were not diagnosed as having any type of mastoiditis after review. Review of the in-patients treated for acute media otitis identified an additional 60 cases fulfilling the definition of acute mastoiditis. Overdiagnosis was common, and many patients with a diagnostic code indicating acute mastoiditis had been treated for external otitis or otorrhoea with transmyringeal drainage. The internal validity of the diagnosis acute mastoiditis is dependent on the use of standardised, well-defined criteria. Reliability of diagnosis is fundamental for the comparison of results from different studies. Inadequate reliability in the diagnosis of acute mastoiditis also affects calculations of incidence rates and statistical power and may also affect the conclusions drawn from the results. © 2013 Blackwell Publishing Ltd.

Percutaneous imaging-guided interventions for acute biliary disorders in high surgical risk patients

PubMed Central

Donkol, Ragab Hani; Latif, Nahed Abdel; Moghazy, Khaled

2010-01-01

AIM: To evaluate the efficacy of percutaneous imaging-guided biliary interventions in the management of acute biliary disorders in high surgical risk patients. METHODS: One hundred and twenty two patients underwent 139 percutaneous imaging-guided biliary interventions during the period between January 2007 to December 2009. The patients included 73 women and 49 men with a mean age of 61 years (range 35-90 years). Fifty nine patients had acute biliary obstruction, 26 patients had acute biliary infection and 37 patients had abnormal collections. The procedures were performed under computed tomography (CT)- (73 patients), sonographic- (41 patients), and fluoroscopic-guidance (25 patients). Success rates and complications were determined. The χ2 test with Yates’ correction for continuity was applied to compare between these procedures. A P value < 0.05 was considered significant. RESULTS: The success rates for draining acute biliary obstruction under CT- , fluoroscopy- or ultrasound-guidance were 93.3%, 62.5% and 46.1%, respectively with significant P values (P = 0.026 and 0.002, respectively). In acute biliary infection, successful drainage was achieved in 22 patients (84.6%). The success rates in patients drained under ultrasound- and CT-guidance were 46.1% and 88.8%, respectively and drainage under CT-guidance was significantly higher (P = 0.0293). In 13 patients with bilomas, percutaneous drainage was successful in 11 patients (84.6%). Ten out of 12 cases with hepatic abscesses were drained with a success rate of 83.3%. In addition, the success rate of drainage in 12 cases with pancreatic pseudocysts was 83.3%. The reported complications were two deaths, four major and seven minor complications. CONCLUSION: Percutaneous imaging-guided biliary interventions help to promptly diagnose and effectively treat acute biliary disorders. They either cure the disorders or relieve sepsis and jaundice before operations. PMID:21160698

Temporomandibular joint injury potential imposed by the low-velocity extension-flexion maneuver.

PubMed

Howard, R P; Hatsell, C P; Guzman, H M

1995-03-01

It has been proposed that significant temporomandibular joint injury can occur as a result of rapid extension-flexion motion of the neck (whip-lash). This motion, which is experienced by passengers in vehicles that undergo rear-end collisions, has been described as causing rapid protrusion and opening of the mandible. It has been speculated that this relative motion between the mandible and the cranium produces forces at the temporomandibular joint (TMJ) that injure the articular elements. The objective of this study was to measure these forces by an experimental method. Accelerometer sensor and high-speed cinematographic data were obtained from the kinematic responses of live human test subjects positioned as occupants in motor vehicles that underwent staged low-velocity rear-end collisions. Linear and moment forces generated at the TMJs were obtained from the resultant acceleration pulse at the craniomandibular complex, estimation of the mass properties of the mandible and its appended soft tissues, and the application of Newton's Second Law of motion. The maximum linear forces generated at the TMJ in a rear-end collision resulting in a velocity change of the test subject of 8 km/h (5 mph) were in the 7 to 10 N (1.6 to 2.2 lb) range. Moment forces at the joint peaked briefly at 0.55 N.m (4.81 lb-in). These force magnitudes generated at the TMJ constitute a minor fraction of the forces experienced at the joint during normal physiologic function. It is a conclusion of this study that injuries to the TMJ attributed to low-velocity "whiplash" cannot be accounted for by the joint forces produced by this maneuver.

Mechanical properties of the trapezius during scapular elevation in people with chronic whiplash associated disorders--A case-control ultrasound speckle tracking analysis.

PubMed

Landén Ludvigsson, Maria; Peterson, Gunnel; Jull, Gwendolen; Trygg, Johan; Peolsson, Anneli

2016-02-01

Approximately 50% of people with Whiplash Associated Disorders (WAD) report longstanding symptoms. The upper trapezius is commonly painful yet its mechanical properties are not fully understood. This study examined the deformation of different depths of the upper trapezius muscle during a scapular elevation task (shoulder shrugging) before and following loaded arm abduction. A cross-sectional case-control study of 36 people (26 female and 10 male, mean age 38 (SD 11)) with chronic WAD and 36 controls, matched for age and gender. Real-time ultrasound recordings of upper trapezius were taken during both scapular elevation tasks. Post-process speckle tracking analysis was undertaken of three different sections of the upper trapezius muscle (superficial, middle, deep). The WAD group had lower deformation of the superficial section of the upper trapezius compared to the control group in both concentric and eccentric phases of scapular elevation (p < 0.05) especially before the loaded arm abduction. After arm abduction, the deformation of the trapezius was reduced in both groups but only significantly in the WAD-group (p = 0.03). Within-group analysis revealed that the control group least engaged the deep section of upper trapezius during the task (p < 0.01). This study, measuring mechanical deformation of the upper trapezius during a scapular elevation task indicates that persons with WAD may display different patterns in engagement of the muscle sections than those in the control group. Further research is needed to replicate and understand the reasons for and implications of this possible change in motor strategy within upper trapezius. Clinical Trials.gov, Number: NCT01547624. Copyright © 2015 Elsevier Ltd. All rights reserved.

Associations with duration of compensation following whiplash sustained in a motor vehicle crash.

PubMed

Casey, Petrina P; Feyer, Anne Marie; Cameron, Ian D

2015-09-01

Continued exposure to compensation systems has been reported as deleterious to the health of participants. Understanding the associations with time to claim closure could allow for targeted interventions aimed at minimising the time participants are exposed to the compensation system. To identify the associations of extended time receiving compensation benefits with the aim of developing a prognostic model that predicts time to claim closure. Prospective cohort study in people with whiplash associated disorder. Time to claim closure, in a privately underwritten fault based third party traffic crash insurance scheme in New South Wales, Australia. Cox proportional hazard regression modelling. Of the 246 participants, 25% remained in the compensation system longer than 24 months with 15% remaining longer than three years. Higher initial disability (Functional Rating Index≥25 at baseline) (HRR: 95% CI, 1.916: 1.324-2.774, p<0.001); and lower initial mental health as measured by SF-36 Mental Component Score (HRR: 95% CI, 0.973: 0.960-0.987, p<0.001) were significantly and independently associated with an increased time-to-claim closure. Shorter time to claim closure was associated with having no legal involvement (HRR: 95% CI, 1.911: 1.169-3.123, p=0.009); and, not having a prior claim for compensation (HRR: 95% CI, 1.523: 1.062-2.198, p=0.022). Health and insurance related factors are independently associated with time to claim closure. Both factors need to be considered by insurers in their assessment of complexity of claims. Interventions aimed at minimising the impact of these factors could reduce claimants' exposure to the compensation system. In turn insurers can potentially reduce claims duration and cost, while improving the health outcomes of claimants. Copyright © 2015 Elsevier Ltd. All rights reserved.

Does injury compensation lead to worse health after whiplash? A systematic review.

PubMed

Spearing, Natalie M; Connelly, Luke B; Gargett, Susan; Sterling, Michele

2012-06-01

One might expect that injury compensation would leave injured parties better off than they would otherwise have been, yet many believe that compensation does more harm than good. This study systematically reviews the evidence on this "compensation hypothesis" in relation to compensable whiplash injuries. PubMed, CINAHL, EMBASE, PEDro, PsycInfo, CCTR, Lexis, and EconLit were searched from the date of their inception to April 2010 to locate longitudinal studies, published in English, comparing the health outcomes of adults exposed/not exposed to compensation-related factors. Studies concerning serious neck injuries, using claimants only, or using proxy measures of health outcomes were excluded. Eleven studies were included. These examined the effect of lawyer involvement, litigation, claim submission, or previous claims on pain and other health outcomes. Among the 16 results reported were 9 statistically significant negative associations between compensation-related factors and health outcomes. Irrespective of the compensation-related factor involved and the health outcome measured, the quality of these studies was similar to studies that did not find a significant negative association: most took some measures to address selection bias, confounding, and measurement bias, and none resolved the potential for reverse causality bias that arises in the relationship between compensation-related factors and health. Unless ambiguous causal pathways are addressed, one cannot draw conclusions from statistical associations, regardless of their statistical significance and the extent of measures to address other sources of bias. Consequently, there is no clear evidence to support the idea that compensation and its related processes lead to worse health. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Contributions of physical and cognitive impairments to self-reported driving difficulty in chronic whiplash-associated disorders.

PubMed

Takasaki, Hiroshi; Treleaven, Julia; Johnston, Venerina; Jull, Gwendolen

2013-08-15

Cross-sectional. To conduct a preliminary analysis of the physical, cognitive, and psychological domains contributing to self-reported driving difficulty after adjusting for neck pain, dizziness, and relevant demographics in chronic whiplash-associated disorders (WAD) using hierarchical regression modeling. Pain is a risk factor for car crashes, and dizziness may affect fitness to drive. Both symptoms are common in chronic WAD and difficulty driving is a common complaint in this group. Chronic WAD is often accompanied by physical, cognitive, and psychological impairments. These impairments may contribute to self-reported driving difficulty beyond neck pain, dizziness, and relevant demographics. Forty individuals with chronic WAD participated. Dependent variables were the magnitude of self-reported driving difficulty assessed in the strategic, tactical, and operational levels of the Neck Pain Driving Index. Three models were developed to assess the contributions of independent variables (physical, cognitive, and psychological domains) to each of the 3 dependent variables after adjusting for neck pain intensity, dizziness, and driving demographics. The measures included were: physical domain-range and maximum speed of head rotation, performances during gaze stability, eye-head coordination, and visual dependency tests; cognitive domain-self-reported cognitive symptoms including fatigue and the trail making tests; and psychological domain-general stress, traumatic stress, depression, and fear of neck movements and driving. Symptom duration was relevant to driving difficulty in the strategic and tactical levels. The cognitive domain increased statistical power to estimate the strategic and operational levels (P < 0.1) beyond other contributors. The physical domain increased statistical power to estimate the tactical level (P < 0.1) beyond other contributors. Physical and cognitive impairments independently contributed to self-reported driving difficulty in chronic WAD beyond neck pain, dizziness, and symptom duration. 3.

The Effect of Soft and Rigid Cervical Collars on Head and Neck Immobilization in Healthy Subjects.

PubMed

Barati, Kourosh; Arazpour, Mokhtar; Vameghi, Roshanak; Abdoli, Ali; Farmani, Farzad

2017-06-01

Whiplash injury is a prevalent and often destructive injury of the cervical column, which can lead to serious neck pain. Many approaches have been suggested for the treatment of whiplash injury, including anti-inflammatory drugs, manipulation, supervised exercise, and cervical collars. Cervical collars are generally divided into two groups: soft and rigid collars. The present study aimed to compare the effect of soft and rigid cervical collars on immobilizing head and neck motion. Many studies have investigated the effect of collars on neck motion. Rigid collars have been shown to provide more immobilization in the sagittal and transverse planes compared with soft collars. However, according to some studies, soft and rigid collars provide the same range of motion in the frontal plane. Twenty-nine healthy subjects aged 18-26 participated in this study. Data were collected using a three-dimensional motion analysis system and six infrared cameras. Eight markers, weighing 4.4 g and thickened 2 cm 2 were used to record kinematic data. According to the normality of the data, a paired t -test was used for statistical analyses. The level of significance was set at α=0.01. All motion significantly decreased when subjects used soft collars ( p <0.01). According to the obtained data, flexion and lateral rotation experienced the maximum (39%) and minimum (11%) immobilization in all six motions using soft collars. Rigid collars caused maximum immobilization in flexion (59%) and minimum immobilization in the lateral rotation (18%) and limited all motion much more than the soft collar. This study showed that different cervical collars have different effects on neck motion. Rigid and soft cervical collars used in the present study limited the neck motion in both directions. Rigid collars contributed to significantly more immobilization in all directions.

Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia.

PubMed

Sundararajan, Krishnaswamy; Schoeman, Tom; Hughes, Lara; Edwards, Suzanne; Reddi, Benjamin

2017-04-01

To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia. A retrospective single-centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2. Eighty-seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients' age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P < 0.0001), vasopressor support (85.7 vs 33.8% in survivors; P < 0.0001) or renal replacement therapy (60 vs 16.9% in survivors; P < 0.002). BISAP score surpasses Ranson's and Acute Physiological and Chronic Health Examination (APACHE) II scores in discriminating between survivors and non-survivors among unselected patients with acute pancreatitis admitted to ICU, whereas APACHE II discriminates better in the cohort admitted from ED. Severe acute pancreatitis is associated with high mortality. Aetiology and comorbidity did not predict adverse outcomes in this population. BISAP score is non-inferior to APACHE II score as a prognostic tool in critically ill patients with acute pancreatitis and could be used to triage admission. Evidence of persistent organ dysfunction and requirements for organ support reliably identify patients at high-risk of death. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II.

PubMed

Bettger, Janet Prvu; Li, Zixiao; Xian, Ying; Liu, Liping; Zhao, Xingquan; Li, Hao; Wang, Chunxue; Wang, Chunjuan; Meng, Xia; Wang, Anxin; Pan, Yuesong; Peterson, Eric D; Wang, Yilong; Wang, Yongjun

2017-04-01

Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p < 0.05) included disability prior to stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

[Monoclonal antibodies ICO-02 to blast cell antigens in patients with chronic myeloleukemia in blast crisis].

PubMed

Baryshnikov, A Iu

1984-01-01

Mice were immunized with blood cells of a patient with chronic granulocytic leukemia, and their cells were subsequently used for the preparation of hybridoma ICO-02. This hybridoma is continuously producing monoclonal antibodies which reacted with cells in 4 out of 13 patients with blastic crisis of chronic granulocytic leukemia and in 6 out of 38 patients with acute lymphoblastic leukemia. Antibodies reacted with blast cells in 2 out of 3 patients with undifferentiated blastic crisis of chronic myelocytic leukemia and in 2 out of 5 patients with lymphoid variant of blastic crisis of chronic granulocytic leukemia. Cells of 6 patients with acute lymphoblastic leukemia which reacted with the monoclonal antibodies had immunological markers of T lymphocytes bone-marrow precursors. Monoclonal antibodies did not react with cells of blood and bone marrow from healthy people and from patients with chronic lymphocytic leukemia, acute myeloblastic leukemia, acute myelomonocytic leukemia, acute monoblastic leukemia and lymphosarcoma.

Acute bacterial prostatitis and abscess formation.

PubMed

Lee, Dong Sup; Choe, Hyun-Sop; Kim, Hee Youn; Kim, Sun Wook; Bae, Sang Rak; Yoon, Byung Il; Lee, Seung-Ju

2016-07-07

The purpose of this study was to identify risk factors for abscess formation in acute bacterial prostatitis, and to compare treatment outcomes between abscess group and non-abscess group. This is a multicenter, retrospective cohort study. All patients suspected of having an acute prostatic infection underwent computed tomography or transrectal ultrasonography to discriminate acute prostatic abscesses from acute prostatitis without abscess formation. A total of 31 prostate abscesses were reviewed among 142 patients with acute prostatitis. Univariate analysis revealed that symptom duration, diabetes mellitus and voiding disturbance were predisposing factors for abscess formation in acute prostatitis. However, diabetes mellitus was not related to prostate abscess in multivariate analysis. Patients with abscesses <20 mm in size did not undergo surgery and were cured without any complications. In contrast, patients with abscesses >20 mm who underwent transurethral resection had a shorter duration of antibiotic treatment than did those who did not have surgery. Regardless of surgical treatment, both the length of hospital stay and antibiotic treatment were longer in patients with prostatic abscesses than they were in those without abscesses. However, the incidence of septic shock was not different between the two groups. A wide spectrum of microorganisms was responsible for prostate abscesses. In contrast, Escherichia coli was the predominant organism responsible for acute prostatitis without abscess. Imaging studies should be considered when patients with acute prostatitis have delayed treatment and signs of voiding disturbance. Early diagnosis is beneficial because prostatic abscesses require prolonged treatment protocols, or even require surgical drainage. Surgical drainage procedures such as transurethral resection of the prostate were not necessary in all patients with prostate abscesses. However, surgical intervention may have potential merits that reduce the antibiotic exposure period and enhance voiding function in patients with prostatic abscess.

Asian patients with Hinchey Ia acute diverticulitis: a condition for the ambulatory setting?

PubMed

Chan, Dedrick Kok Hong; Tan, Ker-Kan

2018-01-01

Diverticulitis in Asians is a different disease entity from Western counterparts. Few Asian studies have evaluated the management of acute Hinchey Ia diverticulitis with consideration for outpatient management. The purpose of this study was to evaluate the outcomes of Asian patients with Hinchey Ia acute diverticulitis. A retrospective review of all patients who were treated for Hinchey Ia acute colonic diverticulitis between 2012 and 2014 was performed. All patients were diagnosed on computed tomography (CT). There were 129 patients with Hinchey Ia acute diverticulitis. Fifty-five (42.6%) patients were male, and the median age was 54 years (range, 30-86). Eighty-seven (67.4%) patients had right-sided diverticulitis. Most patients were treated empirically with intravenous ceftriaxone and metronidazole (89.1%). They were then discharged with oral antibiotics. Only 6.1% of patients had a positive blood culture. The median length of stay in the hospital was 4 (range, 3-4) days. Only three (2.3%) patients were readmitted for acute diverticulitis within 30 days. They were managed with antibiotics and discharged well. The repeated CT scans reconfirmed Hinchey Ia diverticulitis. No patients required emergency surgery, and there were no 30-day mortalities. Asian patients with Hinchey Ia diverticulitis recovered well with conservative management and could be amenable to outpatient therapy. Future prospective studies should be performed amongst Asians to evaluate managing this condition in an ambulatory setting.

Procalcitonin cannot be used as a biomarker of infection in heart surgery patients with acute kidney injury.

PubMed

Heredia-Rodríguez, María; Bustamante-Munguira, Juan; Fierro, Inmaculada; Lorenzo, Mario; Jorge-Monjas, Pablo; Gómez-Sánchez, Esther; Álvarez, Francisco J; Bergese, Sergio D; Eiros, José María; Bermejo-Martin, Jesús F; Gómez-Herreras, José I; Tamayo, Eduardo

2016-06-01

We intended to assess how acute kidney injuy impacts on procalcitonin levels in cardiac surgery patients, with or without infection, and whether procalcitonin might be used as a biomarker of infection in acute kidney injuy. A case-control study was designed which included patients that had had cardiac surgery between January 2011 and January 2015. Every patient developing severe sepsis or septic shock (n = 122; 5.5%) was enrolled. In addition, consecutive cardiac surgery patients during 2013 developing systemic inflammatory response syndrome (n = 318) were enrolled. Those recruited 440 patients were divided into 2 groups, according to renal function. Median procalcitonin levels were significantly higher during the 10 postoperative days in the acute kidney injury patients. Regression analysis showed that postoperatory day, creatinine, white blood cells and infection were significantly (P < .0001) associated to serum procalcitonin level. In patients with creatinine ≥2, median procalcitonin levels were similar in infected and non-infected patients. Only when creatinine was less than 2 mg/L, the median procalcitonin levels were significantly higher in patients with infection, as compared to those with no infection. In acute kidney injuy patients, high procalcitonin levels are a marker of acute kidney injuy but will not be able to differentiate infected from non-infected patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Selected clinical aspects of acute intoxication with baclofen.

PubMed

Sein Anand, Jacek; Chodorowski, Zygmunt; Burda, Piotr

2005-01-01

Baclofen is a lipophilic analogue of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in central nervous system. The aim of the study was to evaluate some clinical aspects of acute intoxication with baclofen. Fifty two patients (37 females and 15 males) aged from 14 to 58 (mean 30.6 +/- 13.7) years were analyzed. Patients were admitted to the Clinic of Internal Diseases and Acute Poisonings Medical University of Gdańsk and the Centre of Acute Poisonings of Praski Hospital in Warszawa during the years 1996-2004 because of suicidal intoxication with baclofen. The doses of baclofen varied from 100 to 1500 (mean 444.8 +/- 317.8) mg. There were twenty eight patients (53.8%) in deep coma (III and IV grade of Matthew scale). Acute respiratory failure which required mechanical ventilation was observed in 18 cases (34.6%). Cardiac abnormalities included bradycardia (36.5%), hypertension (32.7%) and hypotension (3.8%). Toxic psychoses were observed in 6 cases (11.5%). The dosage of baclofen in patients with acute respiratory failure (ARF) was significantly higher than in patients without ARF. Treatment of patients with acute baclofen intoxication should take place in hospitals appropriately equipped which can provide artificial respiration.

The natural history of acute hepatitis C: clinical presentation, laboratory findings, and treatment outcomes

PubMed Central

Loomba, R.; Rivera, M. M.; McBurney, R.; Park, Y.; Haynes-Williams, V.; Rehermann, B.; Alter, H. J.; Herrine, S. K.; Liang, T. J.; Hoofnagle, J. H.; Heller, T.

2017-01-01

Summary Background Acute hepatitis C has variable modes of presentation and frequently results in chronic infection. Its optimal management has yet to be defined. Aims To establish natural history and complications of treatment of acute hepatitis C. Methods Data from all patients presenting with acute hepatitis C to the National Institutes of Health between 1994 and 2007 were reviewed. Results Twenty-five patients were identified. Symptoms were reported by 80% and jaundice by 40%. Aminotransferase levels and HCV RNA levels fluctuated greatly; 18% of patients were intermittently negative for HCV RNA. Five patients recovered spontaneously whereas 20 developed chronicity or received interferon-based therapy during the acute phase. Among 15 patients treated during the acute phase with peginterferon with or without ribavirin for 24 weeks, all became HCV RNA negative within 4 to 8 weeks, and all except two (HIV-positive) achieved a sustained virological response. Side effects (particularly psychiatric) were common and limited treatment in 30%. Conclusion Thus, among 25 patients with acute HCV infection, fluctuating illness was common and spontaneous recovery occurred in only 20%. Antiviral treatment with a 24-week course of peginterferon and ribavirin was highly effective but marked by frequent and severe side effects. PMID:21198704

Noninvasive ventilation for patients with acute lung injury or acute respiratory distress syndrome.

PubMed

Nava, Stefano; Schreiber, Ania; Domenighetti, Guido

2011-10-01

Few studies have been performed on noninvasive ventilation (NIV) to treat hypoxic acute respiratory failure in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The outcomes of these patients, for whom endotracheal intubation is not mandatory, depend on the degree of hypoxia, the presence of comorbidities and complications, and their illness severity. The use of NIV as an alternative to invasive ventilation in severely hypoxemic patients with ARDS (ie, P(aO(2))/F(IO(2)) < 200) is not generally advisable and should be limited to hemodynamically stable patients who can be closely monitored in an intensive care unit by highly skilled staff. Early NIV application may be extremely helpful in immunocompromised patients with pulmonary infiltrates, in whom intubation dramatically increases the risk of infection, pneumonia, and death. The use of NIV in patients with severe acute respiratory syndrome and other airborne diseases has generated debate, despite encouraging clinical results, mainly because of safety issues. Overall, the high rate of NIV failure suggests a cautious approach to NIV use in patients with ALI/ARDS, including early initiation, intensive monitoring, and prompt intubation if signs of NIV failure emerge.

Detection of hepatitis E virus RNA in saliva for diagnosis of acute infection.

PubMed

Rivero-Juarez, A; Frias, M; Lopez-Lopez, P; Martinez-Peinado, A; Risalde, M Á; Brieva, T; Machuca, I; Camacho, Á; García-Bocanegra, I; Gomez-Villamandos, J C; Rivero, A

2018-04-16

Diagnosis of acute hepatitis E virus (HEV) infection is established by detection of anti-HEV IgM antibodies by ELISA or by amplification of serum viral RNA. Here, we evaluate the diagnostic value of testing HEV RNA in saliva to identify patients with acute HEV infection. Prospective proof-of-concept study including patients with acute hepatitis. Whole blood and neat saliva samples were obtained from all patients. Saliva samples were processed and analysed for HEV RNA by RT-PCR within 2 hr after collection. A total of 34 patients with acute hepatitis and 12 healthy donors were included in the study. HEV RNA in serum was confirmed by RT-PCR in eight of these patients (23.5%; 95% CI: 12.2%-40.2%). HEV was isolated in the saliva of eight of 34 patients (23.5%; 95% CI: 12.2%-40.2%). All patients with HEV RNA amplified in saliva had detectable HEV RNA in serum. HEV was isolated neither in the saliva of any of the 26 patients without detectable HEV RNA in serum nor in healthy donors. Our study suggests that acute HEV infection could be diagnosed by assessing viral load in saliva. © 2018 Blackwell Verlag GmbH.

[Prediction of mortality in patients with acute hepatic failure].

PubMed

Eremeeva, L F; Berdnikov, A P; Musaeva, T S; Zabolotskikh, I B

2013-01-01

The article deals with a study of 243 patients (from 18 to 65 years old) with acute hepatic failure. Purpose of the study was to evaluate the predictive capability of severity scales APACHE III, SOFA, MODS, Child-Pugh and to identify mortality predictors in patients with acute hepatic failure. Results; The best predictive ability in patients with acute hepatic failure and multiple organ failure had APACHE III and SOFA scales. The strongest mortality predictors were: serum creatinine > 132 mmol/L, fibrinogen < 1.4 g/L, Na < 129 mmol/L.

Acute exogenous lipoid pneumonia caused by accidental kerosene ingestion in an elderly patient with dementia: a case report.

PubMed

Gotanda, Hiroshi; Kameyama, Yumi; Yamaguchi, Yasuhiro; Ishii, Masaki; Hanaoka, Yoko; Yamamoto, Hiroshi; Ogawa, Sumito; Iijima, Katsuya; Akishita, Masahiro; Ouchi, Yasuyoshi

2013-01-01

Acute exogenous lipoid pneumonia is an uncommon condition caused by aspiration of oil-based substances, occurring mainly in children. Here, we report the case of an 83-year-old patient with Alzheimer's disease who presented with coughing and hypoxia. The diagnosis of acute exogenous lipoid pneumonia caused by accidental kerosene ingestion was made on the basis of the patient's clinical history, and typical radiological and cytological findings. The patient's cognitive impairment and an unsafe environment, in which the patient's 91-year-old husband stored kerosene in an old shochu bottle, were responsible for the accidental ingestion. Acute exogenous lipoid pneumonia should be considered in the differential diagnosis for acute respiratory disorders in the rapidly aging population. © 2013 Japan Geriatrics Society.

[Identifying the severe acute pancreatitis].

PubMed

Acevedo Tizón, Anais; Targarona Modena, Javier; Málaga Rodríguez, Germán; Barreda Cevasco, Luis

2011-01-01

To compare patients with acute necrotizing pancreatitis without any additional complications during their hospital stay (Group A) versus patients with Acute Necrotizing Pancreatitis with additional complications during their hospital stay (Group B). Data obtained from a pre-existing base from hospitalized patients with diagnosis of acute necrotizing pancreatitis in the specialized unit of "Unidad de Pancreatitis Aguda Grave del Hospital Nacional Edgardo Rebagliati Martins" between 2000 and 2010. Data included patients with diagnosis of acute necrotizing pancreatitis, of ages 18 and over. Data from 215 patients with acute necrotizing pancreatitis was included. Patients from Group A represented 32% (68) and from Group B 68% (147). Group A had a average of 39 hospitalized days and Group B had an average of 56 days (p=0.01). From Group A 22% had more than 50% of necrosis while 43% of Group B had this extension of necrosis (p <0.05, OR 3.4, IC (1.12-10)). Of the 14 deaths of the population, all part of Group B, 12 of them had more than 50% of necrosis. Not every patient classified as severe acute pancreatitis, based on the presence of necrosis, behave likewise. It is an extended necrosis, described as more than 50% of pancreatic necrosis, and not the presence itself which will determine additional complications during the course of disease and a greater mortality.

Critically Ill Patients With the Middle East Respiratory Syndrome: A Multicenter Retrospective Cohort Study.

PubMed

Arabi, Yaseen M; Al-Omari, Awad; Mandourah, Yasser; Al-Hameed, Fahad; Sindi, Anees A; Alraddadi, Basem; Shalhoub, Sarah; Almotairi, Abdullah; Al Khatib, Kasim; Abdulmomen, Ahmed; Qushmaq, Ismael; Mady, Ahmed; Solaiman, Othman; Al-Aithan, Abdulsalam M; Al-Raddadi, Rajaa; Ragab, Ahmed; Al Mekhlafi, Ghaleb A; Al Harthy, Abdulrahman; Kharaba, Ayman; Ahmadi, Mashael Al; Sadat, Musharaf; Mutairi, Hanan Al; Qasim, Eman Al; Jose, Jesna; Nasim, Maliha; Al-Dawood, Abdulaziz; Merson, Laura; Fowler, Robert; Hayden, Frederick G; Balkhy, Hanan H

2017-10-01

To describe patient characteristics, clinical manifestations, disease course including viral replication patterns, and outcomes of critically ill patients with severe acute respiratory infection from the Middle East respiratory syndrome and to compare these features with patients with severe acute respiratory infection due to other etiologies. Retrospective cohort study. Patients admitted to ICUs in 14 Saudi Arabian hospitals. Critically ill patients with laboratory-confirmed Middle East respiratory syndrome severe acute respiratory infection (n = 330) admitted between September 2012 and October 2015 were compared to consecutive critically ill patients with community-acquired severe acute respiratory infection of non-Middle East respiratory syndrome etiology (non-Middle East respiratory syndrome severe acute respiratory infection) (n = 222). None. Although Middle East respiratory syndrome severe acute respiratory infection patients were younger than those with non-Middle East respiratory syndrome severe acute respiratory infection (median [quartile 1, quartile 3] 58 yr [44, 69] vs 70 [52, 78]; p < 0.001), clinical presentations and comorbidities overlapped substantially. Patients with Middle East respiratory syndrome severe acute respiratory infection had more severe hypoxemic respiratory failure (PaO2/FIO2: 106 [66, 160] vs 176 [104, 252]; p < 0.001) and more frequent nonrespiratory organ failure (nonrespiratory Sequential Organ Failure Assessment score: 6 [4, 9] vs 5 [3, 7]; p = 0.002), thus required more frequently invasive mechanical ventilation (85.2% vs 73.0%; p < 0.001), oxygen rescue therapies (extracorporeal membrane oxygenation 5.8% vs 0.9%; p = 0.003), vasopressor support (79.4% vs 55.0%; p < 0.001), and renal replacement therapy (48.8% vs 22.1%; p < 0.001). After adjustment for potential confounding factors, Middle East respiratory syndrome was independently associated with death compared to non-Middle East respiratory syndrome severe acute respiratory infection (adjusted odds ratio, 5.87; 95% CI, 4.02-8.56; p < 0.001). Substantial overlap exists in the clinical presentation and comorbidities among patients with Middle East respiratory syndrome severe acute respiratory infection from other etiologies; therefore, a high index of suspicion combined with diagnostic testing is essential component of severe acute respiratory infection investigation for at-risk patients. The lack of distinguishing clinical features, the need to rely on real-time reverse transcription polymerase chain reaction from respiratory samples, variability in viral shedding duration, lack of effective therapy, and high mortality represent substantial clinical challenges and help guide ongoing clinical research efforts.

Diagnosis of haematological disease using anti-i. II. Distinction between acute myeloblastic and acute lymphoblastic leukaemia.

PubMed

Shumak, K H; Rachkewich, R A; Beldotti, L E

1979-03-01

Leukaemic blast cells were obtained from the blood of six patients with acute lymphoblastic leukaemia (ALL) and 15 patients with acute myeloblastic leukaemia (AML). The blasts were compared with lymphocytes from normal subjects in cytotoxicity and 125I-labelled antibody binding tests using several examples of anti-i. As much i antigen was detected on ALL blasts as on normal lymphocytes; much less i antigen was detected on AML blasts. Studies of three patients with morphologically undifferentiated acute leukaemia suggest that, in tests with anti-i, blasts from such patients react either like lymphoblasts or myeloblasts despite the absence of the corresponding morphological features.

The diagnostic accuracy of the mediastinal width on supine anteroposterior chest radiographs with nontraumatic Stanford type A acute aortic dissection.

PubMed

Funakoshi, Hiraku; Mizobe, Michiko; Homma, Yosuke; Nakashima, Yoshiyuki; Takahashi, Jin; Shiga, Takashi

2018-03-01

Nontraumatic Stanford type A acute aortic dissection is a life-threatening condition; thus, the ability to make a precise diagnosis of nontraumatic Stanford type A acute aortic dissection is essential for the emergency physician. Several reports have shown that the mediastinal widening on a chest radiograph is useful for the diagnosis of nontraumatic Stanford type A acute aortic dissection; however, the exact cutoff value of the mediastinal width on plain radiographs is rarely defined. A single-center retrospective case-control study was conducted between October 1, 2013, and March 31, 2015. We evaluated the maximal mediastinal width of the anteroposterior chest X-ray at the level of the aortic knob in the supine position between patient groups with and without nontraumatic Stanford type A acute aortic dissection. We enrolled 72 patients (36 patients with nontraumatic Stanford type A acute aortic dissection and 36 patients without nontraumatic Stanford type A acute aortic dissection). The median mediastinal width of patients with nontraumatic Stanford type A acute aortic dissection was significantly larger than that of patients without nontraumatic Stanford type A acute aortic dissection (100.7 mm vs 77.7 mm, P  < .01). The optimal cutoff level was 87 mm (sensitivity, 81%; specificity, 89%). Using multivariable logistic regression, the odds ratio of a mediastinal width of >87 mm for a diagnosis nontraumatic Stanford type A acute aortic dissection was 57.1 (95% confidence interval, 11.2-290.2). A mediastinal width of >87 mm showed high sensitivity in the diagnosis of probable nontraumatic Stanford type A acute aortic dissection.

Clinical value of rapid urine trypsinogen-2 test strip, urinary trypsinogen activation peptide, and serum and urinary activation peptide of carboxypeptidase B in acute pancreatitis

PubMed Central

Sáez, Jesús; Martínez, Juan; Trigo, Celia; Sánchez-Payá, José; Compañy, Luis; Laveda, Raquel; Griñó, Pilar; García, Cristina; Pérez-Mateo, Miguel

2005-01-01

AIM: To assess the usefulness of urinary trypsinogen-2 test strip, urinary trypsinogen activation peptide (TAP), and serum and urine concentrations of the activation peptide of carboxypeptidase B (CAPAP) in the diagnosis of acute pancreatitis. METHODS: Patients with acute abdominal pain and hospitalized within 24 h after the onset of symptoms were prospectively studied. Urinary trypsinogen-2 was considered positive when a clear blue line was observed (detection limit 50 μg/L). Urinary TAP was measured using a quantitative solid-phase ELISA, and serum and urinary CAPAP by a radioimmunoassay method. RESULTS: Acute abdominal pain was due to acute pancreatitis in 50 patients and turned out to be extrapancreatic in origin in 22 patients. Patients with acute pancreatitis showed significantly higher median levels of serum and urinary CAPAP levels, as well as amylase and lipase than extrapancreatic controls. Median TAP levels were similar in both groups. The urinary trypsinogen-2 test strip was positive in 68% of patients with acute pancreatitis and 13.6% in extrapancreatic controls (P<0.01). Urinary CAPAP was the most reliable test for the diagnosis of acute pancreatitis (sensitivity 66.7%, specificity 95.5%, positive and negative predictive values 96.6% and 56.7%, respectively), with a 14.6 positive likelihood ratio for a cut-off value of 2.32 nmol/L. CONCLUSION: In patients with acute abdominal pain, hospitalized within 24 h of symptom onset, CAPAP in serum and urine was a reliable diagnostic marker of acute pancreatitis. Urinary trypsinogen-2 test strip showed a clinical value similar to amylase and lipase. Urinary TAP was not a useful screening test for the diagnosis of acute pancreatitis. PMID:16437625

Practice of Acute and Maintenance Electroconvulsive Therapy in the Psychiatric Clinic of a University Hospital from Turkey: between 2007 and 2013

PubMed Central

Sengul, Melike Ceyhan Balci; Kenar, Ayse Nur Inci; Hanci, Ezgi; Sendur, İbrahim; Sengul, Cem; Herken, Hasan

2016-01-01

Objective Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or maintenance ECT according to the process of administration. We report our 7 years’ observation with acute and maintenance ECT in a university hospital in Turkey. Methods The medical records of the hospitalized patients treated with acute or maintenance ECT between the years 2007 and 2013 was retrospectively analyzed. The sociodemographic characteristics, diagnosis, data of ECT and the co-administered psychotropic drugs were recorded. The frequency of ECT was calculated by identifying the total number of the hospitalized patients during the study period from the hospital records. Results A total number of 1,432 female and 1,141 male patients hospitalized in a period of 7 years, with a total number of 111 patients treated with ECT. The ratio of ECT was 4%, maintenance/acute ECT 11%. For acute ECT, affective disorders (65.3%) and psychotic disorders (21.6%) were among the leading diagnoses. Maintenance ECT, the diagnosis was; 6 affective disorders, 4 psychotic disorders and 1 obsessive compulsive disorder. There was a significant difference between the patients receiving acute and maintenance ECT in terms of age, duration of illness, and number of previous hospitalizations and ECTs. Conclusion The percentage of patients treated with acute ECT is lower in our institution than that in many other institutions from our country. Acute and maintenance ECT should be considered as an important treatment option particularly for patients with long disease duration, a high number of hospitalizations and a history of benefiting from previous ECTs. PMID:26792041

Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure: a retrospective cohort study.

PubMed

Caironi, Pietro; Carlesso, Eleonora; Cressoni, Massimo; Chiumello, Davide; Moerer, Onner; Chiurazzi, Chiara; Brioni, Matteo; Bottino, Nicola; Lazzerini, Marco; Bugedo, Guillermo; Quintel, Michael; Ranieri, V Marco; Gattinoni, Luciano

2015-04-01

The Berlin definition of acute respiratory distress syndrome has introduced three classes of severity according to PaO2/FIO2 thresholds. The level of positive end-expiratory pressure applied may greatly affect PaO2/FIO2, thereby masking acute respiratory distress syndrome severity, which should reflect the underlying lung injury (lung edema and recruitability). We hypothesized that the assessment of acute respiratory distress syndrome severity at standardized low positive end-expiratory pressure may improve the association between the underlying lung injury, as detected by CT, and PaO2/FIO2-derived severity. Retrospective analysis. Four university hospitals (Italy, Germany, and Chile). One hundred forty-eight patients with acute lung injury or acute respiratory distress syndrome according to the American-European Consensus Conference criteria. Patients underwent a three-step ventilator protocol (at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure). Whole-lung CT scans were obtained at 5 and 45 cm H2O airway pressure. Nine patients did not fulfill acute respiratory distress syndrome criteria of the novel Berlin definition. Patients were then classified according to PaO2/FIO2 assessed at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure. At clinical positive end-expiratory pressure (11±3 cm H2O), patients with severe acute respiratory distress syndrome had a greater lung tissue weight and recruitability than patients with mild or moderate acute respiratory distress syndrome (p<0.001). At 5 cm H2O, 54% of patients with mild acute respiratory distress syndrome at clinical positive end-expiratory pressure were reclassified to either moderate or severe acute respiratory distress syndrome. In these patients, lung recruitability and clinical positive end-expiratory pressure were higher than in patients who remained in the mild subgroup (p<0.05). When patients were classified at 5 cm H2O, but not at clinical or 15 cm H2O, lung recruitability linearly increases with acute respiratory distress syndrome severity (5% [2-12%] vs 12% [7-18%] vs 23% [12-30%], respectively, p<0.001). The potentially recruitable lung was the only CT-derived variable independently associated with ICU mortality (p=0.007). The Berlin definition of acute respiratory distress syndrome assessed at 5 cm H2O allows a better evaluation of lung recruitability and edema than at higher positive end-expiratory pressure clinically set.

The acute monocytic leukemias: multidisciplinary studies in 45 patients.

PubMed

Straus, D J; Mertelsmann, R; Koziner, B; McKenzie, S; de Harven, E; Arlin, Z A; Kempin, S; Broxmeyer, H; Moore, M A; Menendez-Botet, C J; Gee, T S; Clarkson, B D

1980-11-01

The clinical and laboratory features of 37 patients with variants of acute monocytic leukemia are described. Three of these 37 patients who had extensive extramedullary leukemic tissue infiltration are examples of true histiocytic "lymphomas." Three additional patients with undifferentiated leukemias, one patient with refractory anemia with excess of blasts, one patient with chronic myelomonocytic leukemia, one patient with B-lymphocyte diffuse "histiocytic" lymphoma and one patient with "null" cell, terminal deoxynucleotidyl transferase-positive lymphoblastic lymphoma had bone marrow cells with monocytic features. Another patient had dual populations of lymphoid and monocytoid leukemic cells. The true monocytic leukemias, acute monocytic leukemia (AMOL) and acute myelomonocytic leukemia (AMMOL), are closely related to acute myelocytic leukemia (AML) morphologically and by their response to chemotherapy. like AML, the leukemic cells from the AMMOL and AMOL patients form leukemic clusters in semisolid media. Cytochemical staining of leukemic cells for nonspecific esterases, presence of Fc receptor on the cell surface, phagocytic ability, low TdT activity, presence of surface "ruffles" and "ridges" on scanning EM, elevations of serum lysozyme, and clinical manifestations of leukemic tissue infiltration are features which accompanied monocytic differentiation in these cases.

Frequency, Severity, and Risk Factors for Acute Pancreatitis After Percutaneous Transhepatic Biliary Stent Placement Across the Papilla of Vater.

PubMed

Sugawara, Shunsuke; Arai, Yasuaki; Sone, Miyuki; Katai, Hitoshi

2017-12-01

To clarify the frequency, severity, and risk factors for acute pancreatitis after percutaneous biliary stent placement across the papilla of Vater for malignant biliary obstruction. This retrospective study included 95 patients who underwent percutaneous biliary metallic stent placement (64 [67.4%] bare stents and 31 [32.6%] covered stents) across the papilla of Vater for malignant biliary obstruction between January 2010 and December 2012. The incidence of acute pancreatitis (Atlanta classification of acute pancreatitis) and its severity (Common Terminology Criteria for Adverse Events, version 4) were reviewed. Additionally, the characteristics of the patients and biliary stents, and the computed tomography findings of the pancreas were evaluated. Grade 3 acute pancreatitis was observed in 23 patients (24.2%); acute pancreatitis of grade 4 or higher was not observed. The incidence of acute pancreatitis was lower in patients with atrophic pancreas than in those with non-atrophic pancreas (7.5 vs. 36.4%, p = 0.004). It was also lower in patients with main pancreatic duct (MPD) obstruction than in those without MPD obstruction (12.5 vs. 36.2%, p = 0.026). There was no difference in the incidence of acute pancreatitis between bare and covered stents. Percutaneous biliary stent placement across the papilla of Vater for malignant biliary stricture caused acute pancreatitis requiring medication in 24.2% of patients. Atrophy of the pancreas and the presence of a dilated MPD may be associated with a decreased risk of acute pancreatitis. Level 4, Case Series.

Elevated troponin I levels in acute liver failure: is myocardial injury an integral part of acute liver failure?

PubMed

Parekh, Nimisha K; Hynan, Linda S; De Lemos, James; Lee, William M

2007-06-01

Although rare instances of cardiac injury or arrhythmias have been reported in acute liver failure (ALF), overall, the heart is considered to be spared in this condition. Troponin I, a sensitive and specific marker of myocardial injury, may be elevated in patients with sepsis and acute stroke without underlying acute coronary syndrome, indicating unrecognized cardiac injury in these settings. We sought to determine whether subclinical cardiac injury might also occur in acute liver failure. Serum troponin I levels were measured in 187 patients enrolled in the US Acute Liver Failure Study Group registry, and correlated with clinical variables and outcomes. Diagnoses were representative of the larger group of >1000 patients thus far enrolled and included 80 with acetaminophen-related injury, 26 with viral hepatitis, 19 with ischemic injury, and 62 others. Overall, 74% of patients had elevated troponin I levels (>0.1 ng/ml). Patients with elevated troponin I levels were more likely to have advanced hepatic coma (grades III or IV) or to die (for troponin I levels >0.1 ng/ml, odds ratio 3.88 and 4.69 for advanced coma or death, respectively). In acute liver failure, subclinical myocardial injury appears to occur more commonly than has been recognized, and its pathogenesis in the context of acute liver failure is unclear. Elevated troponin levels are associated with a significant increase in morbidity and mortality. Measurement of troponin I levels may be helpful in patients with acute liver failure, to detect unrecognized myocardial damage and as a marker of unfavorable outcome.

BPC 157 therapy to detriment sphincters failure-esophagitis-pancreatitis in rat and acute pancreatitis patients low sphincters pressure.

PubMed

Petrovic, I; Dobric, I; Drmic, D; Sever, M; Klicek, R; Radic, B; Brcic, L; Kolenc, D; Zlatar, M; Kunjko, K; Jurcic, D; Martinac, M; Rasic, Z; Boban Blagaic, A; Romic, Z; Seiwerth, S; Sikiric, P

2011-10-01

Possibly, acute esophagitis and pancreatitis cause each other, and we focused on sphincteric failure as the common causative key able to induce either esophagitis and acute pancreatitis or both of them, and thereby investigate the presence of a common therapy nominator. This may be an anti-ulcer pentadecapeptide BPC 157 (tested for inflammatory bowel disease, wound treatment) affecting esophagitis, lower esophageal and pyloric sphincters failure and acute pancreatitis (10 μg/kg, 10 ng/kg intraperitoneally or in drinking water). The esophagitis-sphincter failure procedure (i.e., insertion of the tubes into the sphincters, lower esophageal and pyloric) and acute pancreatitis procedure (i.e., bile duct ligation) were combined in rats. Esophageal manometry was done in acute pancreatitis patients. In rats acute pancreatitis procedure produced also esophagitis and both sphincter failure, decreased pressure 24 h post-surgery. Furthermore, bile duct ligation alone immediately declines the pressure in both sphincters. Vice versa, the esophagitis-sphincter failure procedure alone produced acute pancreatitis. What's more, these lesions (esophagitis, sphincter failure, acute pancreatitis when combined) aggravate each other (tubes into sphincters and ligated bile duct). Counteraction occurred by BPC 157 therapies. In acute pancreatitis patients lower pressure at rest was in both esophageal sphincters in acute pancreatitis patients. We conclude that BPC 157 could cure esophagitis/sphincter/acute pancreatitis healing failure.

Anti-inflammatory effects of Simvastatin in patients with acute intracerebral hemorrhage in an intensive care unit

PubMed Central

Zhou, Xiurong; Chen, Jiafeng; Wang, Chengdong; Wu, Lili

2017-01-01

Intracerebral hemorrhage is one of the most common types of cerebrovascular disease in humans and often causes paralysis, a vegetative state and even death. Patients with acute intracerebral hemorrhage are frequently monitored in intensive care units (ICUs). Spontaneous intracerebral hemorrhage is associated with a higher rate of mortality and morbidity than other intracephalic diseases. The expression levels of inflammatory factors have important roles in inflammatory responses indicative of changes in a patient's condition and are therefore important in the monitoring and treatment of affected patients at the ICU as well as the development of therapeutic strategies for acute cerebral hemorrhage. The present study investigated the anti-inflammatory effects of Simvastatin in patients with acute intracerebral hemorrhage at an ICU, and inflammatory factors and cellular changes were systematically analyzed. The plasma concentrations of inflammatory factors, including interleukin (IL)-4, IL-6, IL-8 and IL-10, were evaluated by ELISAs. The plasma concentrations of inflammatory cellular changes were detected by using flow cytometry. The results demonstrated that after Simvastatin treatment of patients with acute cerebral hemorrhage at the ICU, the plasma concentrations of IL-4, IL-6, IL-8 and IL-10 were downregulated compared with those in placebo-treated controls. In addition, Simvastatin treatment at the ICU decreased lymphocytes, granulocytes and mononuclear cells in patients with acute cerebral hemorrhage. The levels of inflammatory factors were associated with brain edema in patients with acute cerebral hemorrhage treated at the ICU. In addition, the amount of bleeding was reduced in parallel with the inflammatory cell plasma concentration of lymphocytes, granulocytes and mononuclear cells. Importantly, Simvastatin treatment produced beneficial outcomes by improving brain edema and reducing the amount of bleeding. In conclusion, the present study demonstrated the efficacy of Simvastatin in treating acute intracerebral hemorrhage and evidenced the association between inflammatory responses and the progress of affected patients at the ICU, thereby providing insight for applying effective therapies for patients with acute intracerebral hemorrhage. PMID:29285177

Mesenchymal stem cells transplantation in hematological patients with acute graft-versus-host disease: characteristics and risk factors for infectious complications.

PubMed

Stoma, Igor; Karpov, Igor; Krivenko, Svetlana; Iskrov, Igor; Milanovich, Natalia; Koritko, Alla; Uss, Anatoly

2018-05-01

The role of MSCs in infection prevention and treatment is still discussed in transplant and hematological patients. The spectrum and risk factors for infections after MSCs transplantation in patients with acute GVHD have not been studied before. To determine the risk factors and spectrum of infectious complications in patients received mesenchymal stem cell transplantation as a treatment for acute GVHD. A prospective observational study was performed to evaluate the risk factors and characteristics of infectious complications after MSCs transplantation in adult patients having acute GVHD. Thirty-four episodes of MSCs transplantation in patients with acute GVHD after allogeneic HSCT were enrolled in the study. MSCs were given at a median dose of 1.32 (interquartile range 0.87-2.16) mln cells/kg per infusion at 91 days (interquartile range 31-131 days) after HSCT. Data relating to age, gender, date, and type of transplantation, characteristics of MSCs, infectious agents, and antimicrobial therapy and prevention regimens were prospectively collected in all of the enrolled patients. The episode of proven infectious complication was set as a primary outcome. There were totally 68 patients with acute GVHD in the study; among them there were 34 cases of MSCs transplantation performed. Among the registered infectious episodes were viral infections (CMV-associated disease, EBV-associated disease), invasive pulmonary aspergillosis, bacterial bloodstream infections, and pneumonia. MSCs transplantation has shown no statistically significant association with risk of infectious complications in patients with acute GVHD in a performed multivariate analysis. Among the most frequent infections in acute GVHD, we have described CMV, invasive aspergillosis, and bacterial infections (bloodstream infections or pneumonia). Among risk factors for infectious complications in patients with acute GVHD with/without MSCs transplantation are progression of main disease and neutropenia below 500 cells/mm 3 (for aspergillosis) and unrelated HSCT in the past history and progression of main disease (for bacterial bloodstream infections and pneumonia).

Monitoring and treatment of acute gastrointestinal bleeding.

PubMed

Lenjani, Basri; Zeka, Sadik; Krasniqi, Salih; Bunjaku, Ilaz; Jakupi, Arianit; Elshani, Besni; Xhafa, Agim

2012-01-01

Acute gastrointestinal bleeding-massive acute bleeding from gastrointestinal section is one of the most frequent forms of acute abdomen. The mortality degree in emergency surgery is about 10%. It's very difficult to identify the place of bleeding and etiology. The important purpose of this research is to present the cases of acute gastrointestinal bleeding from the patients which were monitored and treated at The University Clinical Center of Kosova-Emergency Center in Pristina. These inquests included 137 patients with acute gastrointestinal bleeding who were treated in emergency center of The University Clinical Center in Pristina for the period from January 2005 until December 2006. From 137 patients with acute gastrointestinal bleeding 41% or 29% was female and 96% or 70.1% male. Following the sex we gained a high significant difference of statistics (p < 0.01). The gastrointestinal bleeding was two times more frequent in male than in female. Also in the age-group we had a high significant difference of statistics (p < 0.01) 63.5% of patients were over 55 years old. The mean age of patients with an acute gastrointestinal bleeding was 58.4 years SD 15.8 age. The mean age for female patients was 56.4 age SD 18.5 age. The patients with arterial systolic pressure under 100 mmHg have been classified as patients with hypovolemic shock. They participate with 17.5% in all prevalence of acute gastrointestinal bleeding. From the number of prevalence 2 {1.5%} patients have been diagnosed with peptic ulcer, 1 {0.7%} as gastric perforation and 1 {0.7%} with intestine ischemia. Abdominal Surgery and Intensive Care 2 or 1.5% died, 1 at intensive care unit and 1 at nephrology. As we know the severe condition of the patients with gastrointestinal bleeding and etiology it is very difficult to establish, we need to improve for the better conditions in our emergency center for treatment and initiation base of clinic criteria.

The Australian National Sub-Acute and Non-Acute Patient casemix classification.

PubMed

Eagar, K

1999-01-01

The Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) Version 1 casemix classification was completed in 1997. AN-SNAP is designed for the classification of sub-acute and non-acute care provided in both inpatient and ambulatory settings and is intended to be useful for both funding and clinical management purposes. The National Sub-Acute and Non-Acute Casemix Classification study has produced the first version of a national classification of sub-acute and non-acute care. Ongoing refinement (leading to Version 2) will be possible through further analysis of the existing data set in combination with analysis of the results of a carefully planned and phased implementation.

Examination of the Use of Healing Touch by Registered Nurses in the Acute Care Setting.

PubMed

Anderson, Joel G; Friesen, Mary Ann; Swengros, Diane; Herbst, Anna; Mangione, Lucrezia

2017-03-01

Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.

A RETROSPECTIVE ANALYSIS OF ACUTE APPENDICITIS, RUPTURED APPENDICITIS AND THE LEVEL OF LEUKOCYTOSIS IN PAEDIATRIC SURGICAL PATIENTS OF NELSON MANDELA CENTRAL HOSPITAL.

PubMed

Mtimba, L; Dhaffala, A; Molaoa, S Z

2017-06-01

Appendicectomy is the most commonly performed operation worldwide. The diagnosis is predominantly based on clinical findings. Some patients will clinically be unclear if ruptured or acute inflamed appendicitis; the level of white cell count has been used as the predictor for ruptured appendicitis. This was a retrospective chart review of paediatric surgical patients admitted at Nelson Mandela Central Hospital, Mthatha South Africa. A total of 214 patients with a diagnosis of acute appendicitis. Overall, the ruptured appendicitis was 62% and 38% were inflamed appendicitis. Nature of the acute appendicitis: White cell count, Inflamed, Ruptured, Total p-value < 9.9 21 30 51 0.075, 10-14.9 28 54 82 0.0, 15-19.9 17 29 46 0.012, 20-29.9 5 26 31 0.0 > 30 0 4 4. This study has demonstrated that in patients who are diagnosed with acute appendicitis clinically, the normal white cell count does not necessarily rule out ruptured acute appendicitis. But the risks of ruptured acute appendicitis increase with the increase level of white cell count.

Clinical presentation and course of acute hepatitis C infection in HIV-infected patients.

PubMed

Luetkemeyer, Annie; Hare, C Bradley; Stansell, John; Tien, Phyllis C; Charlesbois, Edwin; Lum, Paula; Havlir, Diane; Peters, Marion

2006-01-01

Hepatitis C virus (HCV) has become a significant source of morbidity and mortality in HIV-infected patients. However, little is known about the clinical presentation and course of acute HCV infection in this population. This study reports the outcomes of acute HCV infection in 9 HIV-infected men. Sex with men was the only reported risk factor for HCV infection in 6 of the subjects. Clinical presentation of acute HCV ranged from incidentally discovered elevated transaminases to severe liver dysfunction requiring hospitalization. At the time of HCV diagnosis, 8 of 9 patients had CD4+ counts >250 cells/mm(3), and 6 had HIV viral loads of < or =5000 copies/mL. Eight patients were receiving antiretroviral therapy. Outcome of these acute HCV infections varied. Five patients experienced virologic clearance, 2 in whom virus cleared spontaneously and 3 who were treated with pegylated interferon and ribavirin. Four patients developed chronic infection, one of whom had a relapse during HCV treatment and 3 of whom were untreated. All 4 patients to whom HCV therapy was administered experienced significant anemia or neutropenia, necessitating dose reduction or support with growth factors. Prompt recognition of acute HCV infection may minimize antiretroviral treatment interruption and will allow early treatment, which may improve virologic clearance. Unexplained transaminase elevations in HIV-infected patients, including men who have sex with men, should trigger an evaluation for acute HCV infection.

Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China.

PubMed

Yin, Xiaoxv; Yang, Tingting; Gong, Yanhong; Zhou, Yanfeng; Li, Wenzhen; Song, Xingyue; Wang, Mengdie; Hu, Bo; Lu, Zuxun

2016-03-01

Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China. A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization. Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients' stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used. A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China. Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke. © 2016 American Heart Association, Inc.

Effects of total body irradiation-based conditioning on allogeneic stem cell transplantation for pediatric acute leukemia: a single-institution study

PubMed Central

Park, Jongmoo; Choi, Eun Kyung; Kim, Jong Hoon; Lee, Sang-wook; Song, Si Yeol; Yoon, Sang Min; Kim, Young Seok; Kim, Su Ssan; Park, Jin-hong; Park, Jaehyeon

2014-01-01

Purpose To evaluate the effects of total body irradiation (TBI), as a conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT), in pediatric acute leukemia patients. Materials and Methods From January 2001 to December 2011, 28 patients, aged less than 18 years, were treated with TBI-based conditioning for allo-SCT in our institution. Of the 28 patients, 21 patients were diagnosed with acute lymphoblastic leukemia (ALL, 75%) and 7 were diagnosed with acute myeloid leukemia (AML, 25%). TBI was completed 4 days or 1 day before stem cell infusion. Patients underwent radiation therapy with bilateral parallel opposing fields and 6-MV X-rays. The Kaplan-Meier method was used to calculate survival outcomes. Results The 2-year event-free survival and overall survival rates were 66% and 56%, respectively (71.4% and 60.0% in AML patients vs. 64.3% and 52.4% in ALL patients, respectively). Treatment related mortality rate were 25%. Acute and chronic graft-versus-host disease was a major complication; other complications included endocrine dysfunction and pulmonary complications. Common complications from TBI were nausea (89%) and cataracts (7.1%). Conclusion The efficacy and toxicity data in this study of TBI-based conditioning to pediatric acute leukemia patients were comparable with previous studies. However, clinicians need to focus on the acute and chronic complications related to allo-SCT. PMID:25324992

Prevalence of colorectal cancer in acute uncomplicated diverticulitis and the role of the interval colonoscopy.

PubMed

Soh, Nicholas Yock Teck; Chia, Daryl Kai Ann; Teo, Nan Zun; Ong, Calvin Jian Ming; Wijaya, Ramesh

2018-04-16

Although computed tomography (CT) is the imaging modality of choice for diagnosing colonic diverticulitis today, there remains a risk of colorectal cancer mimicking diverticulitis due to overlapping imaging features. Current practice guidelines recommend interval colonoscopy after diverticulitis to exclude occult malignancy. Some authors have suggested that this may be unnecessary in patients with uncomplicated diverticulitis. The aim of our study was to examine the prevalence of occult colorectal cancer in patients with CT-proven acute uncomplicated diverticulitis in an Asian population. This was a retrospective study of all patients admitted for CT-proven acute uncomplicated diverticulitis between 2007 and 2011 in a single institution. Colonoscopy and histopathology reports were reviewed for patients who underwent interval colonic evaluation. For patients who defaulted follow-up, national health records were reviewed for any subsequent diagnoses of colorectal cancer. The primary outcome was prevalence of colorectal cancer in the cohort. Secondary outcome was prevalence of advanced adenomas. A total of 227 patients with acute uncomplicated diverticulitis were included in our study. One hundred and thirty-five patients (59.5%) underwent follow-up colonic evaluation. The overall prevalence of colorectal cancer was 1.8%, with half these patients presenting with acute colonic obstruction after defaulting follow-up evaluation. Of the patients, 1.5% who underwent colonoscopy had advanced adenomas. Prevalence of colorectal cancer in patients with CT-proven acute uncomplicated diverticulitis may not be as low as previously suggested. We recommend that patients with acute uncomplicated diverticulitis continue to be offered interval colonoscopy until larger studies demonstrate the safety of omission.

Assessment of the usefulness of magnetic resonance brain imaging in patients presenting with acute seizures.

PubMed

Olszewska, D A; Costello, D J

2014-12-01

Magnetic Resonance Imaging (MRI) is increasingly available as a tool for assessment of patients presenting to acute services with seizures. We set out to prospectively determine the usefulness of early MRI brain in a cohort of patients presenting with acute seizures. We examined the MR imaging studies performed in patients admitted solely because of acute seizures to Cork University Hospital over a 12-month period. The main aim of the study was to determine if the MRI established the proximate cause for the patient's recent seizure. We identified 91 patients who underwent MRI brain within 48 h of admission for seizures. Of the 91 studies, 51 were normal (56 %). The remaining 40 studies were abnormal as follows: microvascular disease (usually moderate/severe) (n = 19), post-traumatic gliosis (n = 7), remote symptomatic lesion (n = 6), primary brain tumour (n = 5), venous sinus thrombosis (n = 3), developmental lesion (n = 3), post-surgical gliosis (n = 3) and single cases of demyelination, unilateral hippocampal sclerosis, lobar haemorrhage and metastatic malignant melanoma. Abnormalities in diffusion-weighted sequences that were attributable to prolonged ictal activity were seen in nine patients, all of who had significant ongoing clinical deficits, most commonly delirium. Of the 40 patients with abnormal MRI studies, seven patients had unremarkable CT brain. MR brain imaging revealed the underlying cause for acute seizures in 44 % of patients. CT brain imaging failed to detect the cause of the acute seizures in 19 % of patients in whom subsequent MRI established the cause. This study emphasises the importance of obtaining optimal imaging in people admitted with acute seizures.

Acute nutritional axonal neuropathy.

PubMed

Hamel, Johanna; Logigian, Eric L

2018-01-01

This study describes clinical, laboratory, and electrodiagnostic features of a severe acute axonal polyneuropathy common to patients with acute nutritional deficiency in the setting of alcoholism, bariatric surgery (BS), or anorexia. Retrospective analysis of clinical, electrodiagnostic, and laboratory data of patients with acute axonal neuropathy. Thirteen patients were identified with a severe, painful, sensory or sensorimotor axonal polyneuropathy that developed over 2-12 weeks with sensory ataxia, areflexia, variable muscle weakness, poor nutritional status, and weight loss, often with prolonged vomiting and normal cerebrospinal fluid protein. Vitamin B6 was low in half and thiamine was low in all patients when obtained before supplementation. Patients improved with weight gain and vitamin supplementation, with motor greater than sensory recovery. We suggest that acute or subacute axonal neuropathy in patients with weight loss or vomiting associated with alcohol abuse, BS, or dietary deficiency is one syndrome, caused by micronutrient deficiencies. Muscle Nerve 57: 33-39, 2018. © 2017 Wiley Periodicals, Inc.

Burn unit care of Stevens Johnson syndrome/toxic epidermal necrolysis: A survey.

PubMed

Le, Hong-Gam; Saeed, Hajirah; Mantagos, Iason S; Mitchell, Caroline M; Goverman, Jeremy; Chodosh, James

2016-06-01

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a systemic disease that can be associated with debilitating acute and chronic complications across multiple organ systems. As patients with acute SJS/TEN are often treated in a burn intensive care unit (BICU), we surveyed burn centers across the United States to determine their approach to the care of these patients. The goal of our study was to identify best practices and possible variations in the care of patients with acute SJS/TEN. We demonstrate that the method of diagnosis, use of systemic therapies, and involvement of subspecialists varied significantly between burn centers. Beyond supportive care provided to every patient, our data highlights a lack of standardization in the acute care of patients with SJS/TEN. A comprehensive guideline for the care of patients with acute SJS/TEN is indicated. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

[Management of Acute Cholecystitis].

PubMed

Lee, Seung Ok; Yim, Sung Kyun

2018-05-25

Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered. In those with high operational risks, gall bladder drainage can be performed as an alternative. Currently percutaneous and endoscopic drainage are available and show clinical success in most cases. After recovering from acute cholecystitis, the patients who have undergone drainage should be considered for cholecystectomy as a definitive treatment. However, in elderly patients or patients with significant comorbidity, operational risks may still be high, making cholecystectomy inappropriate. In these patients, gallstone removal using the percutaneous tract or endoscopy may be considered.

Frequency of Acute Hepatitis Following Acute Paraphenylene Diamine Intoxication.

PubMed

Ishtiaq, Rizwan; Shafiq, Sadaf; Imran, Ali; Masroor Ali, Qazi; Khan, Raheel; Tariq, Hassan; Ishtiaq, Daniyal

2017-04-21

Paraphenylene diamine (PPD) ingestion is manifesting as one of the more common ways of committing suicide in Southern Punjab, Pakistan, especially Bahawalpur. PPD is an ingredient of a compound commonly known "Kala Pathar" which means "Black Stone" in Urdu. It is readily available in the market at low cost and is used to dye hair and fur. Its intoxication inhibits cellular oxidation and affects the muscles causing rhabdomyolysis. This leads to myoglobinuria followed by renal failure and edema of face and throat resulting in respiratory difficulty. Very little is known about the impact of PPD intoxication on liver tissue. The purpose of the study was to find out the frequency of acute hepatitis following PPD intoxication. We reviewed the medical records of 109 patients with PPD intoxication admitted to Medical Unit-2, Bahawalpur Victoria Hospital from January 1, 2015, to June 30, 2015, in a descriptive, cross-sectional study. We noted the frequency of acute hepatitis and other complications, and we recorded the demographic features, clinical features, and outcomes of these patients. Our study included 32 men (29%) and 77 women (71%). The mean age was 22 ± 3.4 years, and most patients were young women aged 15 to 24 years. Suicidal ingestion was the leading cause of admission for 101 patients (93%). The most common clinical presentation was cervicofacial edema (95%), throat pain (88%), dysphonia (95%), cola-colored urine (100%), and oliguria (95%). Rhabdomyolysis (86%), acute hepatitis (51%), and acute renal failure (63%) were the most common clinical conditions following poisoning. Overall mortality was noted in 39 patients (36%) while all other patients achieved complete clinical recovery (64%). In patients with mortality, 20 of 39 (51%) developed acute hepatitis. Most patients (95%) in our study underwent tracheostomy. The frequency of acute hepatitis in PPD intoxication is high in this population, especially in young women. Measures need to be instituted regarding the management of acute hepatitis in PPD intoxication to improve patient outcomes. Workups in patients with PPD poisoning should include regular monitoring of aspartate aminotransferase and alanine aminotransferase to observe any damages to the liver so that acute hepatitis can be managed in a timely fashion.

Bacteriology of aspiration pneumonia in patients with acute coma.

PubMed

Lauterbach, Enise; Voss, Frederik; Gerigk, Roland; Lauterbach, Michael

2014-12-01

Loss of protective airway reflexes in patients with acute coma puts these patients at risk of aspiration pneumonia complicating the course of the primary disease. Available data vary considerably with regard to bacteriology, role of anaerobic bacteria, and antibiotic treatment. Our objective was to research the bacteriology of aspiration pneumonia in acute coma patients who were not pre-treated with antibiotics or hospitalized within 30 days prior to the event. We prospectively analyzed 127 patient records from adult patients admitted, intubated and ventilated to a tertiary medical intensive care unit with acute coma. Bacteriology and antibiotic resistance testing from tracheal aspirate sampled within 24 h after admission, blood cultures, ICU scores (APACHE II, SOFA), hematology, and clinical chemistry were assessed. Patients were followed up until death or hospital discharge. The majority of patients with acute coma suffered from acute cardiovascular disorders, predominantly myocardial infarction, followed by poisonings, and coma of unknown cause. In a majority of our patients, microaspiration resulted in overt infection. Most frequently S. aureus, H. influenzae, and S. pneumoniae were isolated. Anaerobic bacteria (Bacteroides spec., Fusobacteria, Prevotella spec.) were isolated from tracheal aspirate in a minority of patients, and predominantly as part of a mixed infection. Antibiotic monotherapy with a 2nd generation cephalosporin, or a 3rd generation gyrase inhibitor, was most effective in our patients regardless of the presence of anaerobic bacteria.

[Necrotic acute pancreatitis in the intensive care unit: a comparison between conservative and surgical medical treatment].

PubMed

Milian J, William; Portugal S, José; Laynez Ch, Richard; Rodríguez A, Cesar; Targarona, Javier; Barreda C, Luis

2010-01-01

To determine the prognosis of patients with necrotic acute pancreatitis receiving medical and surgical treatments. The severe acute pancreatitis treatment is multidisciplinary and requires a daily evaluation of the patient that will allow to observe changes and apply therapy in due time. The treatment includes: Admission in the ICU, fluids, nutrition and antibiotics, as well as other life supports for high-risk patients. Thus, patients undergo conservative treatment or, if it is necessary, surgery. A retrospective study of patients with necrotic acute pancreatitis admitted to the ICU between January 2004 and August 2006. The patients with necrotic acute pancreatitis without signs of sepsis underwent a conservative medical treatment, while fine needle punction-aspiration was performed in all patients who were suffering from necrotic acute pancreatitis and persistent sepsis four weeks after their admission and after discarding and eradicating every non-pancreatic focus of infection. All Gram stain or culture positive patients underwent surgery immediately. Seventy patients with necrotic acute pancreatitis were included in the study. Thirty-six patients (51%) suffered acute pancreatitis with sterile necrosis and underwent a conservative treatment, while 34 patients (49%) developed acute pancreatic with infected necrosis and underwent surgery. The average age was 55.19 vs. 57.65 (p=0.57). The average amylase was 1421.74 vs. 1402.45. (p=0.96). The tomography severity index was 8.47 vs. 8.79 (p=0.36). The Apache II was 8.22 vs. 9 (p=0.46). The average number of failed organs was 0.39 vs. 0.68. (p=0.19). The ICU stay was 10.75 vs. 26.5 days (p<0.05) while the total hospital stay was 46.47 vs. 57.26 days (p<0.05). The mortality rate was (3/36) 8.3% vs. (9/34) 26.5% (p<0.05) for conservative medical treatment vs. surgical treatment, respectively. Between the first and the twelfth month the evaluated patients who attended consultation, after discharge, showed: pancreatic pseudocyst 9/36 (25%) vs. 8/34(23.5%); recurring abdominal pain 3/36 (8.3%) vs. 4/34 (11.8%); and relapsing acute pancreatitis 3/36 (8.3%) vs. 2/34 (5.8%); while 4/36 (11.1%) vs. 3/34 (8.8%) did not show any problem. There were not significant differences between the conservative and the surgical medical treatment, respectively. Patients suffering acute pancreatitis with sterile necrosis can undergo conservative medical treatment which will result in a lower mortality rate, while the hospital stay, in comparison with acute pancreatitis with infected necrosis, will not be affected.

Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting

PubMed Central

2012-01-01

Background Rapid and accurate diagnosis and management can be lifesaving for patients with acute dyspnea. However, making a differential diagnosis and selecting early treatment for patients with acute dyspnea in the emergency setting is a clinical challenge that requires complex decision-making in order to achieve hemodynamic balance, improve functional capacity, and decrease mortality. In the present study, we examined the screening potential of rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating acute heart failure syndromes (AHFS) from primary pulmonary disease in patients with acute dyspnea in the emergency setting. Methods Between March 2011 and March 2012, 90 consecutive patients (45 women, 78.1 ± 9.9 years) admitted to the emergency room of our hospital for acute dyspnea were enrolled. Within 30 minutes of admission, all patients underwent conventional physical examination, rapid ultrasound (lung-cardiac-inferior vena cava [LCI] integrated ultrasound) examination with a hand-held device, routine laboratory tests, measurement of brain natriuretic peptide, and chest X-ray in the emergency room. Results The final diagnosis was acute dyspnea due to AHFS in 53 patients, acute dyspnea due to pulmonary disease despite a history of heart failure in 18 patients, and acute dyspnea due to pulmonary disease in 19 patients. Lung ultrasound alone showed a sensitivity, specificity, negative predictive value, and positive predictive value of 96.2, 54.0, 90.9, and 75.0%, respectively, for differentiating AHFS from pulmonary disease. On the other hand, LCI integrated ultrasound had a sensitivity, specificity, negative predictive value, and positive predictive value of 94.3, 91.9, 91.9, and 94.3%, respectively. Conclusions Our study demonstrated that rapid evaluation by LCI integrated ultrasound is extremely accurate for differentiating acute dyspnea due to AHFS from that caused by primary pulmonary disease in the emergency setting. PMID:23210515

Clinical characteristics of acute encephalopathy with acute brain swelling: A peculiar type of acute encephalopathy.

PubMed

Nukui, Megumi; Kawawaki, Hisashi; Inoue, Takeshi; Kuki, Ichiro; Okazaki, Shin; Amo, Kiyoko; Togawa, Masao; Ishikawa, Junichi; Rinka, Hiroshi; Shiomi, Masashi

2018-06-07

Acute encephalopathy has been observed with acute brain swelling (ABS) that is characterized by rapid progression to whole-brain swelling. The objective of this study was to describe the clinical characteristics of ABS. We encountered four patients with ABS and retrospectively investigated their clinical data with a medical chart review. Three patients had seizure clustering or status epilepticus in the clinical course. Signs of elevated intracranial pressure (ICP) appeared 3-9 h after the first convulsive attack in three patients. In all patients, signs of brainstem involvement appeared 1-8 h after signs of elevated ICP. Mild hyponatremia that progressed after signs of elevated ICP appeared was noted in three patients. Brain CT revealed mild brain swelling in the initial phase, which rapidly progressed to whole-brain swelling. No focal abnormalities were detected on brain MRI in one patient. Continuous electroencephalography was initially normal, but in two patients, high-amplitude slow waves appeared with rapid changes before signs of brainstem involvement. Although recovery was achieved without sequelae in two patients, outcome was fatal for the other two. The pathogenesis of ABS has yet to be clarified, but clinical features in our patients are not consistent with any established subtypes of acute encephalopathy. Therefore, we believe that ABS should be recognized as a new type of acute encephalopathy. Copyright © 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

The threatened stomach: management of the acute gastric volvulus.

PubMed

Light, D; Links, D; Griffin, M

2016-05-01

Acute presentation of gastric volvulus is a rare condition with a high mortality for acute ischaemia. This study was undertaken to investigate the acute management, diagnosis, and long-term outcomes of patients presenting with acute gastric volvulus. Cases were reviewed retrospectively from 2004 to 2014. Patients presenting as an emergency admission with acute gastric volvulus were included. Thirty-six patients were included, five of whom had previous surgery. The mean age was 71 years old. All patients presented with vomiting and chest/epigastric pain. CT was diagnostic in all 26 patients. Barium swallow was diagnostic in two/four patients. OGD was diagnostic in 9 of 20 patients. All patients had an NG tube placed, and eight patients were treated conservatively and made a full recovery. Twenty-nine patients proceeded to surgery. Nine had a laparoscopic repair with two open conversions. Four patients had gastric necrosis, and all had open surgery with resection. Three patients had a mediastinal perforation, and one patient required an additional thoracotomy. All patients with viable stomach had a hiatal repair (where appropriate), 11 had a gastropexy, and 11 had a fundoplication. Mortality for gastric necrosis/perforation was 30 %. Mean postoperative stay was 4 days for laparoscopic repair and 8 days for uncomplicated open surgery. Nine of twenty-nine had transient dysphagia postoperatively. Three of eight patients treated conservatively had an elective procedure subsequently. Acute paraoesophageal hiatus hernia requires early resuscitation and diagnosis. CT should be favoured in assessment, and an NG tube placed promptly. A conservative management may be considered safely in stable patients. Surgical management should be prompt for unstable patients. Gastric ischaemia or perforation has a mortality of 30 %. Laparoscopic repair has a shorter postoperative stay, but has a higher recurrence rate. Surgery for patients without gastric ischaemia has good long-term outcomes with minimal morbidity.

The expression and activation of the AIM2 inflammasome correlates with inflammation and disease severity in patients with acute pancreatitis.

PubMed

Algaba-Chueca, Francisco; de-Madaria, Enrique; Lozano-Ruiz, Beatriz; Martínez-Cardona, Claudia; Quesada-Vázquez, Noé; Bachiller, Victoria; Tarín, Fabián; Such, José; Francés, Rubén; Zapater, Pedro; González-Navajas, José M

Acute pancreatitis is an inflammatory disorder of the pancreas that is responsible for significant morbidity and mortality. The inflammasome pathway has acquired significant relevance in the pathogenesis of many inflammatory disorders, but its role in patients with acute pancreatitis still awaits clarification. We performed a prospective study in which 27 patients with acute pancreatitis and 16 healthy controls were included. We isolated peripheral blood mononuclear cells (PBMCs) and we assessed the expression and activation of different inflammasomes as well as their association with the clinical course of the disease. Our results show that PBMCs from patients with acute pancreatitis have elevated expression of several components of the inflammasome complex, including the inflammasome-forming receptor absent in melanoma 2 (AIM2), early during the onset of the disease. Activation of the AIM2 or NLRP3 inflammasomes in PBMCs from patients with acute pancreatitis results in exacerbated IL-1β and IL-18 production compared with PBMCs from healthy controls. Furthermore, both AIM2 mRNA expression and AIM2-mediated production of IL-1β by PBMCs correlated with increased systemic inflammation in these patients. Last, AIM2 expression was further increased in those patients that developed transient or persistent organ failure (moderate or severe acute pancreatitis). Our data demonstrates that AIM2 inflammasome expression and activation is increased early during the course of acute pancreatitis, and suggests that AIM2 activation may affect systemic inflammation and organ failure in these patients. Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Incidence and Risk Factors for Acute Kidney Injury Following Mannitol Infusion in Patients With Acute Stroke

PubMed Central

Lin, Shin-Yi; Tang, Sung-Chun; Tsai, Li-Kai; Yeh, Shin-Joe; Shen, Li-Jiuan; Wu, Fe-Lin Lin; Jeng, Jiann-Shing

2015-01-01

Abstract Mannitol, an osmotic diuretic, is commonly used to treat patients with acute brain edema, but its use also increases the risk of developing acute kidney injury (AKI). In this study, we investigated the incidence and risk factors of mannitol-related AKI in acute stroke patients. A total of 432 patients (ischemic stroke 62.3%) >20 years of age who were admitted to the neurocritical care center in a tertiary hospital and received mannitol treatment were enrolled in this study. Clinical parameters including the scores of National Institutes of Health Stroke Scale (NIHSS) at admission, vascular risk factors, laboratory data, and concurrent nephrotoxic medications were registered. Acute kidney injury was defined as an absolute elevation in the serum creatinine (Scr) level of ≥0.3 mg/dL from the baseline or a ≥50% increase in Scr. The incidence of mannitol-related AKI was 6.5% (95% confidence interval, 4.5%–9.3%) in acute stroke patients, 6.3% in patients with ischemic stroke, and 6.7% in patients with intracerebral hemorrhage. Multivariate analysis revealed that diabetes, lower estimated glomerular filtration rate at baseline, higher initial NIHSS score, and concurrent use of diuretics increased the risk of mannitol-related AKI. When present, the combination of these elements displayed an area under the receiver operating characteristic curve of 0.839 (95% confidence interval, 0.770–0.909). In conclusion, mannitol-related AKI is not uncommon in the treatment of acute stroke patients, especially in those with vulnerable risk factors. PMID:26632702

Incidence and Risk Factors for Acute Kidney Injury Following Mannitol Infusion in Patients With Acute Stroke: A Retrospective Cohort Study.

PubMed

Lin, Shin-Yi; Tang, Sung-Chun; Tsai, Li-Kai; Yeh, Shin-Joe; Shen, Li-Jiuan; Wu, Fe-Lin Lin; Jeng, Jiann-Shing

2015-11-01

Mannitol, an osmotic diuretic, is commonly used to treat patients with acute brain edema, but its use also increases the risk of developing acute kidney injury (AKI). In this study, we investigated the incidence and risk factors of mannitol-related AKI in acute stroke patients.A total of 432 patients (ischemic stroke 62.3%) >20 years of age who were admitted to the neurocritical care center in a tertiary hospital and received mannitol treatment were enrolled in this study. Clinical parameters including the scores of National Institutes of Health Stroke Scale (NIHSS) at admission, vascular risk factors, laboratory data, and concurrent nephrotoxic medications were registered. Acute kidney injury was defined as an absolute elevation in the serum creatinine (Scr) level of ≥0.3 mg/dL from the baseline or a ≥50% increase in Scr.The incidence of mannitol-related AKI was 6.5% (95% confidence interval, 4.5%-9.3%) in acute stroke patients, 6.3% in patients with ischemic stroke, and 6.7% in patients with intracerebral hemorrhage. Multivariate analysis revealed that diabetes, lower estimated glomerular filtration rate at baseline, higher initial NIHSS score, and concurrent use of diuretics increased the risk of mannitol-related AKI. When present, the combination of these elements displayed an area under the receiver operating characteristic curve of 0.839 (95% confidence interval, 0.770-0.909). In conclusion, mannitol-related AKI is not uncommon in the treatment of acute stroke patients, especially in those with vulnerable risk factors.

Risk-Based Classification System of Patients With Newly Diagnosed Acute Lymphoblastic Leukemia

ClinicalTrials.gov

2018-02-22

Adult B Acute Lymphoblastic Leukemia; Adult T Acute Lymphoblastic Leukemia; Childhood B Acute Lymphoblastic Leukemia; Childhood T Acute Lymphoblastic Leukemia; Untreated Adult Acute Lymphoblastic Leukemia; Untreated Childhood Acute Lymphoblastic Leukemia

Acute viral hepatitis E presenting with haemolytic anaemia and acute renal failure in a patient with glucose-6-phosphate dehydrogenase deficiency.

PubMed

Tomar, Laxmikant Ramkumarsingh; Aggarwal, Amitesh; Jain, Piyush; Rajpal, Surender; Agarwal, Mukul P

2015-10-01

The association of acute hepatitis E viral (HEV) infection with glucose-6-phosphate dehydrogenase (G6PD) deficiency leading to extensive intravascular haemolysis is a very rare clinical entity. Here we discuss such a patient, who presented with acute HEV illness, developed severe intravascular haemolysis and unusually high levels of bilirubin, complicated by acute renal failure (ARF), and was later on found to have a deficiency of G6PD. The patient recovered completely with haemodialysis and supportive management. © The Author(s) 2014.

Frequency and predictors of acute ischaemic lesions on brain magnetic resonance imaging in young patients with a clinical diagnosis of transient ischaemic attack.

PubMed

Tanislav, C; Grittner, U; Fazekas, F; Thijs, V; Tatlisumak, T; Huber, R; von Sarnowski, B; Putaala, J; Schmidt, R; Kropp, P; Norrving, B; Martus, P; Gramsch, C; Giese, A K; Rolfs, A; Enzinger, C

2016-07-01

Acute lesions in patients with transient ischaemic attack (TIA) are important as they are associated with increased risk for recurrence. Characteristics associated with acute lesions in young TIA patients were therefore investigated. The sifap1 study prospectively recruited a multinational European cohort (n = 5023) of patients aged 18-55 years with acute cerebrovascular event. The detection of acute ischaemic lesions was based on diffusion-weighted imaging (DWI). The frequency of DWI lesions was assessed in 829 TIA patients who met the criteria of symptom duration <24 h and their association with demographic, clinical and imaging variables was analysed. The median age was 46 years (interquartile range 40-51 years); 45% of the patients were female. In 121 patients (15%) ≥1 acute DWI lesion was detected. In 92 patients, DWI lesions were found in the anterior circulation, mostly located in cortical-subcortical areas (n = 63). Factors associated with DWI lesions in multiple regression analysis were left hemispheric presenting symptoms [odds ratio (OR) 1.92, 95% confidence interval (CI) 1.27-2.91], dysarthria (OR 2.17, 95% CI 1.38-3.43) and old brain infarctions on MRI (territories of the middle and posterior cerebral artery: OR 2.43, 95% CI 1.42-4.15; OR 2.41, 95% CI 1.02-5.69, respectively). In young patients with a clinical TIA 15% demonstrated acute DWI lesions on brain MRI, with an event pattern highly suggestive of an embolic origin. Except for the association with previous infarctions there was no clear clinical predictor for acute ischaemic lesions, which indicates the need to obtain MRI in young individuals with TIA. © 2016 EAN.