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Sample records for injury severity

  1. Age and injury severity.

    PubMed

    Brorsson, B

    1989-01-01

    This study aims at showing if and to what extent injury severity in frontal car crashes increases with the age of front seat occupants. Data on 2658 belted drivers and front seat passengers in Volvo private car series 140, 240 and 740/760, involved in frontal crashes were extracted from the Volvo Car Crash Register. The results show that the risk of injury resulting in "medical observation" does not increase systematically with age. However, the risk of fracture with any localization is more than three times higher among those aged 65-74 than in those aged 18-24, and the risk of fracture in the rib cage is nearly eleven times higher among the older than in the younger age group. It can be concluded that the incidence of specific types of injuries - as exemplified with fractures of any localization and fractures in the rib cage - increases with advancing age.

  2. Severe soccer injuries in amateurs

    PubMed Central

    Goga, I; Gongal, P

    2003-01-01

    Objectives: To ascertain the number and type of severe soccer injuries admitted to King Edward Hospital in South Africa over 42 months. Methods: This was a retrospective study of all patients admitted for treatment or observation to the orthopaedic unit only. Patients treated as outpatients, irrespective of severity, are also presented for comparison. Results: Thirty two patients were admitted with severe injuries. The injuries included 18 fractures of the tibial and femoral shaft. Two tibial shaft fractures were compound. Four tibial plateau fractures and five epiphyseal injuries were identified. One patient had a fracture-dislocation of the hip. One patient with a popliteal artery injury presented 48 hours after the injury had occurred. He had an above knee amputation. In the same period 122 patients were treated as outpatients. The types of injury in this group were similar to soccer injuries reported in other countries. Conclusions: Very serious injuries are sustained by casual soccer players in South Africa. Urgent measures need to be taken to prevent such injuries. PMID:14665587

  3. Memory and head injury severity.

    PubMed

    Dikmen, S; Temkin, N; McLean, A; Wyler, A; Machamer, J

    1987-12-01

    One hundred and two consecutive head injured patients were studied at 1 and 12 months after injury. Their performances were compared with a group of uninjured friends. The results indicate that impairment in memory depends on the type of task used, time from injury to testing, and on the severity of head injury (that is, degree of impaired consciousness). Head injury severity indices are more closely related to behavioural outcome early as compared with later after injury. At 1 year, only those with deep or prolonged impaired consciousness (as represented by greater than 1 day of coma, Glasgow Coma Scale of 8 or less, and post traumatic amnesia of 2 weeks or greater) are performing significantly worse than comparison subjects.

  4. Severe ocular self-injury.

    PubMed

    Field, H L; Waldfogel, S

    1995-05-01

    To further delineate the clinical characteristics of patients who deliberately, severely mutilate their eyes, we reviewed the medical records of a specialty eye hospital and found nine cases of intentional, severe, self-inflicted eye injuries. We identified two groups of patients. Most were young psychotic individuals with severe psychopathology often involving sexual and religious delusions, command hallucinations, and the propensity to act on delusions. The second group was comprised of patients with organic disabilities, either dementia or severe mental retardation, where a lack of impulse control and preexisting eye irritation or surgical operation may have contributed to the act. One patient was a recidivist. Two-thirds of the patients were confined at the time of the act. That self-mutilation may occur frequently in confined patients calls for active vigilance from caretakers; that it may recur calls for caution by the psychiatrist.

  5. Severe Brachial Plexus Injuries in American Football.

    PubMed

    Daly, Charles A; Payne, S Houston; Seiler, John G

    2016-11-01

    This article reports a series of severe permanent brachial plexus injuries in American football players. The authors describe the mechanisms of injury and outcomes from a more contemporary treatment approach in the form of nerve transfer tailored to the specific injuries sustained. Three cases of nerve transfer for brachial plexus injury in American football players are discussed in detail. Two of these patients regained functional use of the extremity, but 1 patient with a particularly severe injury did not regain significant function. Brachial plexus injuries are found along a spectrum of brachial plexus stretch or contusion that includes the injuries known as "stingers." Early identification of these severe brachial plexus injuries allows for optimal outcomes with timely treatment. Diagnosis of the place of a given injury along this spectrum is difficult and requires a combination of imaging studies, nerve conduction studies, and close monitoring of physical examination findings over time. Although certain patients may be at higher risk for stingers, there is no evidence to suggest that this correlates with a higher risk of severe brachial plexus injury. Unfortunately, no equipment or strengthening program has been shown to provide a protective effect against these severe injuries. Patients with more severe injuries likely have less likelihood of functional recovery. In these patients, nerve transfer for brachial plexus injury offers the best possibility of meaningful recovery without significant morbidity. [ Orthopedics. 2016; 39(6):e1188-e1192.].

  6. Duodenal organ injury severity (OIS) and outcome.

    PubMed

    Kline, G; Lucas, C E; Ledgerwood, A M; Saxe, J M

    1994-07-01

    The effect of organ injury severity on outcome was assessed in 101 patients treated for duodenal trauma. Most patients were men (89%) and victims of penetrating wounds (93%). Grade I is minor hematoma or incomplete perforation; Grade II is major hematoma or small complete perforation; Grade III is large perforation excluding ampulla; Grade IV is large perforation at ampulla; Grade V is duodenopancreatic crunch. The injuries were as follows: Grade I (5 patients), Grade II (31), Grade III (40), Grade IV (12), and Grade V (13). Fourteen patients exsanguinated from associated vessel injury; each had Grade IV or Grade V injury. All 36 patients with Grade I and Grade II injury had primary repair; the single death was due to liver necrosis. Most (31 patients) Grade III injuries and three Grade IV injuries were treated by primary repair alone; the three deaths were unrelated to the duodenal injury. Other major injuries were treated by duodenal exclusion (4 patients), duodenal diverticulization (6), or resection (4); the single death was unrelated to the duodenum. Primary closure is favored for minor injuries and most Grade III injuries. Severe injuries may require exclusion, diverticulization, or resection.

  7. [Assessment of concomitant floating knees injuries severity].

    PubMed

    Eone, Daniel Handy; Lamah, Léopold; Bayiha, Jean Emile; Ondoa, Danielle Larissa Essomba; Nonga, Bernadette Ngo; Ibrahima, Farikou; Bahebeck, Jean

    2016-01-01

    Floating knee is caused by high-energy trauma, whose genesis is suggestive of extensive locoregional and general damages. Referring to multiple trauma. The aim of our study was to collect data on all concomitant floating knee injuries in our practice environment and to evaluate their severity. We conducted a descriptive and retrospective study over a period of 14 years and 9 months. Our sample consisted of 75 floating knees, the average age was 35 years. Sixty six patients had an ISS≥16 (classified as polytrauma). Head traumas, chest and abdominal injuries associated with floating knee injuries require adequate resuscitation.

  8. [A man with severe traumatic brain injury].

    PubMed

    Oudeman, Eline A; Martins Jarnalo, Carine O; van Ouwerkerk, Willem J R

    2013-01-01

    We present a 41-year-old man with severe traumatic brain injury. Cranial imaging studies revealed cerebral contusion and a longitudinal fracture of the temporal bone. Several days later brain herniated into the left external auditory canal. Imaging studies showed the known skull fracture with a direct connection between the external acoustic meatus and the intracranial structures.

  9. Long term results after multiple injuries including severe head injury.

    PubMed

    Lehmann, U; Pape, H C; Seekamp, A; Gobiet, W; Zech, S; Winny, M; Molitoris, U; Regel, G

    1999-12-01

    To describe the long term results in patients with multiple injuries including severe head injury. Retrospective and prospective clinical study. Level I trauma centre, Germany. Patients aged 16-60 years who had been injured more than 2 years before, whose Injury Severity Score was over 20 and whose cranial Abbreviated Injury Score (AIS) was over 3. Glasgow Outcome Scale (GOS), functional, neuropsychological, vocational and social outcomes. 58 patients, median age 24 (range 16-53, interquartile range (IQR) 21-32) years were investigated 5 (3-9; IQR 4-7) years after their injury. Median ISS was 34 (21-57; IQR 26-41) and GCS 6 (3-8; IQR 4-7). Duration of coma was 10 (2-51; IQR 7-22) days and neurological rehabilitation lasted 169 (10-830; IQR 80-300) days. Movements of the elbow and ankle was most impaired by injury. All psychometric tests showed deficits, particularly in speed of processing, concentration, recent memory, and learning performance. The social environment had been changed in half and vocational rehabilitation was dependent on age. 24 (42%) returned to their former profession, 18 (31%) were retrained to another profession, 16 (27%) were unemployed or retired on a pension. 31 (53%) made a good recovery with moderate disability, 19 (33%) had severe disability, and 8 (14%) remained in a persistent vegetative state assessed by the GOS. Early and concentrated rehabilitation facilitates functional, social, and neuropsychological reintegration.

  10. Child and adolescent traumatic brain injury: correlates of injury severity.

    PubMed

    Max, J E; Lindgren, S D; Knutson, C; Pearson, C S; Ihrig, D; Welborn, A

    1998-01-01

    A record review focused on children and adolescents, with a history of traumatic brain injury, who were consecutively admitted to a brain injury clinic in which all new patients are psychiatrically evaluated. Significant correlates of severity of injury in the cognitive, education and communication domains of functioning included Performance IQ but not Verbal IQ nor standardized ratings of language or learning disability. Current organic personality syndrome (OPS) but not attention deficit hyperactivity disorder or oppositional defiant disorder/conduct disorder diagnostic status was significantly related to severity. In conclusion, the findings in this referred sample are similar to prospective studies indicating that Performance IQ appears sensitive in reflecting brain damage. The finding linking OPS to severity of injury is not surprising. This is because OPS is a diagnosis which is dependent on the clinician's judgment of the likelihood that the organic factor is etiologically related to a defined behavioural syndrome. The diagnosis therefore requires a clinical judgment that the threshold of severity of a presumed organic etiological factor has been reached.

  11. Regressive language in severe head injury.

    PubMed

    Thomsen, I V; Skinhoj, E

    1976-09-01

    In a follow-up study of 50 patients with severe head injuries three patients had echolalia. One patient with initially global aphasia had echolalia for some weeks when he started talking. Another patient with severe diffuse brain damage, dementia, and emotional regression had echolalia. The dysfunction was considered a detour performance. In the third patient echolalia and palilalia were details in a total pattern of regression lasting for months. The patient, who had extensive frontal atrophy secondary to a very severe head trauma, presented an extreme state of regression returning to a foetal-body pattern and behaving like a baby.

  12. A historical analysis of severe head injury.

    PubMed

    Boto, Gregorio R; Gómez, Pedro A; De la Cruz, Javier; Lobato, Ramiro D

    2009-07-01

    Severe head injury (SHI) is a significant health, social and economic concern rendering a worldwide health problem. This retrospective study was designed to describe the features and outcomes of patients with SHI treated in a single neurosurgical unit (Hospital "12 de Octubre", Madrid, Spain) over a period approaching 13 years. The subjects enrolled were 895 patients (15 years or older) with non-missile SHI treated over the period January 1987 to August 1999, in whom a computerised tomography scan had been performed within the first 6 h of injury. We considered epidemiological, clinical, analytical, radiological and therapeutic data along with final patient outcomes. The overall mortality rate was 46.8% (419 patients). Of these 419 deaths, 177 (42.2%) occurred within the first 48 h of injury rendering an early death rate of 19.8% (177/895 patients). Despite overall mortality showing a clear decreasing trend by the end of the 1990s, proportions of early deaths (within the first 48 h of injury) dramatically rose in the last 3 years of the study. As a whole, an unfavourable outcome was recorded in 62.6% (560 patients). Despite continued efforts to improve the outcome of patients with SHI, the results of our study are pessimistic in that high mortality and unfavourable outcome rates were recorded in this large series of patients. Although overall mortality has diminished over the years, the number of early deaths has increased.

  13. Predicting severe injury using vehicle telemetry data.

    PubMed

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

    2013-01-01

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

  14. Rehabilitation and outcome after severe head injury.

    PubMed Central

    Scott-Jupp, R; Marlow, N; Seddon, N; Rosenbloom, L

    1992-01-01

    After severe head injury, many children continue to experience major cognitive and behavioural problems and consequent educational difficulties, even after good physical recovery. Forty three children referred to the regional multidisciplinary head injury rehabilitation team are described. The clinical outcome at a median interval of 13 months after injury showed that 18 (42%) had persistent neurological impairment and 15 (35%) had an identified need for special educational support. Thirty seven children were further assessed for psychiatric morbidity, cognitive impairment, and classroom performance. Rutter behavioural questionnaires were sent to parents and teachers of head injured index cases and classmate controls matched for age and sex. Index parents scored their children significantly worse in both 'health' and 'habits' and more cases than controls had scores suggesting a psychiatric disorder. Teachers scored index cases significantly worse for five of the traits questioned, but discriminated cases from controls less decisively than parents. Index cases were significantly disadvantaged on teachers' assessments of classroom skills and performance. A need for improved support and training of staff who teach head injured children was identified. PMID:1543384

  15. Rehabilitation and outcome after severe head injury.

    PubMed

    Scott-Jupp, R; Marlow, N; Seddon, N; Rosenbloom, L

    1992-02-01

    After severe head injury, many children continue to experience major cognitive and behavioural problems and consequent educational difficulties, even after good physical recovery. Forty three children referred to the regional multidisciplinary head injury rehabilitation team are described. The clinical outcome at a median interval of 13 months after injury showed that 18 (42%) had persistent neurological impairment and 15 (35%) had an identified need for special educational support. Thirty seven children were further assessed for psychiatric morbidity, cognitive impairment, and classroom performance. Rutter behavioural questionnaires were sent to parents and teachers of head injured index cases and classmate controls matched for age and sex. Index parents scored their children significantly worse in both 'health' and 'habits' and more cases than controls had scores suggesting a psychiatric disorder. Teachers scored index cases significantly worse for five of the traits questioned, but discriminated cases from controls less decisively than parents. Index cases were significantly disadvantaged on teachers' assessments of classroom skills and performance. A need for improved support and training of staff who teach head injured children was identified.

  16. [Development of treatment of severe thoracic injuries].

    PubMed

    Le Brigand, H

    1975-11-01

    About 25 p. 100 of cases of closed trauma of the thorax may be classified as severe, for they rapidly endanger life. Their treatment has made considerable progress since the report of J. Dor and H. Le Brigand in 1960. However, when severe trauma is treated, the mortality has remained unchanged over the last ten years. The treatment of fractures of the sternum includes respiratory assistance and internal fixation of the fractured bones, these two methods together, when correctly applied, give good results. Endothoracic lesions are now better recognised. Hemothorax and pneumothorax are now treated by a well recognised method. Visceral lesions, such as bronchial rupture, or major vascular ruptures, e.g. aorta, and heart lesions may be diagnosed at an early stage and be operated on more often. On the other hand, it is now better recognised that diffuse pulmonary lesions, e.g. pulmonary contusions or "shock lung", which is usually treated by artificial respiration alone, still may have a poor prognosis in some cases. From this it results that many surgical teams have enlarged the indications for early thoracotomy in the same way as laparotomy is more often carried out in abdominal trauma. In fact, these indications require circumspection and thoracotomy should only be carried out in specialised thoracic surgery units. If this is not available, aspiration, drainage, tracheotomy, continuous extension, are still applicable, but it is also necessary for them to be carried out correctly; if not, failures and complications of these minor measures are frequent. The use of these methods has shown the existence of therapeutic failures, including major bilateral bony lesions, diffuse severe lung injuries with resistant anoxia, complex multiple injuries with thoracic involvement and, finally, combined thoracic and cranial lesions, the mortality of which is about 50 p. 100. These facts explain why treatment of severe thoracic trauma gives variable results. The mortality varies from

  17. [Severe craniocerebral injuries with a lucid interval].

    PubMed

    Vilalta, J; Rubio, E; Castaño, C H; Guitart, J M; Bosch, J

    1993-02-01

    Some variables were analyzed in 35 patients with severe cranioencephalic injuries following a lucid interval according to mortality. The variables analyzed were: age of less than 40 years, interval of time accident-admission (TAA), admission-operation (TAO), level of consciousness (Glasgow scale), associated extracranial lesions, type of intracranial lesion, and tomodensitometric signs of intracranial hypertension. The only variables demonstrating significant statistical differences (p < 0.05) were the level of consciousness (Glasgow scale < 6 points) and the presence of subdural hematoma. Twelve (70.5%) patients who died had less than 6 on the Glasgow scale and in contrast only 5 (27.7%) of the living. Eleven (64.7%) of the group who died and 4 (22.2%) of the living had subdural hematoma. These data suggest that the level of consciousness and the type of lesion are determining factors of the mortality in this type of patients. Early detection and energic treatment of secondary lesions contribute to prognostic improvement of cranioencephalic injuries.

  18. Severe Epistaxis from an Intracranial Vascular Bleed from Grenade Injury

    DTIC Science & Technology

    2008-09-01

    Severe Epistaxis from an Intracranial Vascular Bleed from Grenade Injury Radiology Corner Case 27 Severe Epistaxis from an Intracranial ...neck injuries. In particular, this case focuses on an intracranial vascular injury generated by a hand grenade with the diagnosis assisted by...4. TITLE AND SUBTITLE Severe Epistaxis from an Intracranial Vascular Bleed from Grenade Injury 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

  19. Systemic IL-17 after severe injuries.

    PubMed

    Frangen, Thomas M; Bogdanski, Denise; Schinkel, Christian; Roetman, Bernd; Kälicke, Thomas; Muhr, Gert; Köller, Manfred

    2008-04-01

    IL-17 is a cytokine produced by a newly identified T-cell subpopulation (THl7/THIL-17). It is a central mediator in inflammatory processes that connects T-cell stimulation with neutrophil mobilization. The role of IL-17 in the immune dysfunction after polytrauma is still not clarified. In a retrospective study, the systemic concentration of IL-17 and IL-6 of 71 polytraumatized patients were analyzed daily by enzyme-linked immunosorbent assay. The patients' collective consist of 55 men and 16 women (43 +/- 16 years; injury severity score, 33 +/- 13). In only 6% of the patients, an increase in systemic IL-17 was detected. In most patients (94%), no systemic IL-17 was detectable or the IL-17 concentrations in plasma were in the range of the healthy donor group. To identify a possible role of systemic IL-17 in the posttraumatic phase, the patients were divided into two groups. Group A (47 men, 15 women) consists of patients with IL-17 concentrations in the range of normal healthy donors. Group B (8 men, 1 woman) consists of patients with elevated (>45 pg ml(-1) on at least 3 consecutive days) systemic IL-17 concentrations. Three patients in group B showed highly increased systemic IL-17 concentrations (median, >200 pg mL(-1)). These patients were male and showed all blunt chest and abdominal trauma with lung contusion and pneumohemothorax. However, there was no conformity in other injury patterns, injury severity score, age, outcome, intensive care period, or clinical complications. After a period of 4 years, we were able to obtain a new blood sample from one patient with high IL-17 level. The systemic IL-17 value of this former patient was now less than the detection limit. However, stimulation of peripheral blood mononuclear cells from thlise patient revealed elevated numbers of cells with the capacity to produce IL-17 as determined by enzyme-linked immuno spot assay and flow cytometry compared with peripheral blood mononuclear cells obtained from current polytrauma

  20. Script knowledge after severe traumatic brain injury.

    PubMed

    Cazalis, F; Azouvi, P; Sirigu, A; Agar, N; Burnod, Y

    2001-11-01

    Severe diffuse traumatic brain injury (TBI) may impair the performance of daily-life complex activities. The aim of the present study was to assess whether these difficulties are related to a representational impairment of action knowledge. Two tasks requiring the manipulation of scripts were used. The first (script reconstitution) required subjects to sort cards describing actions belonging to 4 different scripts, presented in a random order. The second (script generation) required subjects to generate actions belonging to a given script. The results showed that TBI patients had preserved access to goal representation and action knowledge. However, they demonstrated (1) significant impairments when they had to deal with simultaneous competing sources of information and (2) a lack of inhibitory control on routine overlearned skills. Patients' performance was significantly correlated with behavioral modifications in everyday life. These data suggest that action impairment in severe TBI patients cannot be attributed to an impairment of action knowledge per se. As previously suggested by Schwartz et al., a restriction of limited-capacity processing resources may account for the observed deficits.

  1. Combat Blast Injuries: Injury Severity and Posttraumatic Stress Disorder Interaction on Career Outcomes in Male Servicemembers

    DTIC Science & Technology

    2013-01-01

    Naval Health Research Center Combat Blast Injuries: Injury Severity and Posttraumatic Stress Disorder Interaction on Career Outcomes in Male...injuries: Injury severity and posttraumatic stress disorder interaction on career outcomes in male servicemembers Susan L. Eskridge, PT, PhD;1...proportions were higher in those with posttraumatic stress disorder (PTSD) than in those without PTSD. There was a significant interaction between PTSD

  2. THE PATHOPHYSIOLOGIC RESPONSE TO SEVERE BURN INJURY

    PubMed Central

    Jeschke, Marc G; Chinkes, David L; Finnerty, Celeste C; Kulp, Gabriela; Suman, Oscar E; Norbury, William B; Branski, Ludwik K; Gauglitz, Gerd G; Mlcak, Ronald P; Herndon, David N

    2014-01-01

    Objective To improve clinical outcome and to determine new treatment options, we studied the pathophysiologic response postburn in a large prospective, single center, clinical trial. Summary Background Data A severe burn injury leads to marked hypermetabolism and catabolism, which are associated with morbidity and mortality. The underlying pathophysiology and the correlations between humoral changes and organ function have not been well delineated. Methods Two hundred forty-two severely burned pediatric patients [>30% total body surface area (TBSA)], who received no anabolic drugs, were enrolled in this study. Demographics, clinical data, serum hormones, serum cytokine expression profile, organ function, hypermetabolism, muscle protein synthesis, incidence of wound infection sepsis, and body composition were obtained throughout acute hospital course. Results Average age was 8 ± 0.2 years, and average burn size was 56 ± 1% TBSA with 43 ± 1% third-degree TBSA. All patients were markedly hypermetabolic throughout acute hospital stay and had significant muscle protein loss as demonstrated by a negative muscle protein net balance (−0.05% ± 0.007 nmol/100 mL leg/min) and loss of lean body mass (LBM) (−4.1% ± 1.9%); P < 0.05. Patients lost 3% ± 1% of their bone mineral content (BMC) and 2 ± 1% of their bone mineral density (BMD). Serum proteome analysis demonstrated profound alterations immediately postburn, which remained abnormal throughout acute hospital stay; P < 0.05. Cardiac function was compromised immediately after burn and remained abnormal up to discharge; P < 0.05. Insulin resistance appeared during the first week postburn and persisted until discharge. Patients were hyperinflammatory with marked changes in IL-8, MCP-1, and IL-6, which were associated with 2.5 ± 0.2 infections and 17% sepsis. Conclusions In this large prospective clinical trial, we delineated the complexity of the postburn pathophysiologic response and conclude that the postburn

  3. Leukocytosis as a Predictor of Severe Injury in Blunt Trauma

    PubMed Central

    Santucci, Claudia A.; Purcell, Thomas B.; Mejia, Carlo

    2008-01-01

    Objective The objective of this study was to determine if the white blood cell count can predict severity of injury in blunt trauma victims. Methods This was a retrospective study comparing two groups of blunt trauma victims by severity of injury, one with significant injury and one without significant injury, and comparing their initial WBC in the emergency department (ED). We also examined if WBC correlates with degree of injury using Injury Severity Score (ISS) in both groups combined. Further, we examined the WBC as a predictor of serious injury. Results Our study showed a difference in mean WBC between the two groups that was statistically significant (p<0.001). A positive relationship between ISS and WBC was found, although the association was weak (correlation coefficient = 0.369). While the WBC had moderate discriminatory capability for serious injury, it could not, in isolation, reliably rule in or out serious injury. Nevertheless, this study supports using WBC on presentation to the ED as an adjunct for making disposition decisions. Conclusion A significant elevation in WBC in a blunt trauma patient, even with minimal initial signs of severe injury, should heighten suspicion for occult injury. PMID:19561712

  4. Industrial distributions of severe occupational injuries among workers in Thailand.

    PubMed

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

    2014-01-01

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

  5. Rehabilitation of a person with severe traumatic brain injury.

    PubMed

    Burke, D; Alexander, K; Baxter, M; Baker, F; Connell, K; Diggles, S; Feldman, K; Horny, A; Kokinos, M; Moloney, D; Withers, J

    2000-05-01

    A case study report of a long and intensive rehabilitation programme for a young woman after she sustained a severe diffuse axonal injury in a motor vehicle accident is described in detail. The purpose of this paper is to encourage specialist brain injury rehabilitation services to offer extended rehabilitation programmes to patients, even with very severe injuries. Significant functional improvements and enhanced quality of life frequently reward the high cost and hard work involved.

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

    PubMed

    Mogaka, Eric Osoro; Ng'ang'a, Zipporah; Oundo, Joseph; Omolo, Jared; Luman, Elizabeth

    2011-01-01

    Road traffic injuries continue to exert a huge burden on the health care system in Kenya. Few studies on the severity of road traffic injuries have been conducted in Kenya. We carried out a cross-sectional study to determine factors associated with severity of road traffic injuries in a public hospital in Thika district, Kenya. Road crash victims attending the Thika district hospital, a 265-bed public hospital, emergency room were recruited consecutively between 10th August 2009 and 15th November 2009. Epidemiologic and clinical information was collected from medical charts and through interview with the victims or surrogates using a semi-structured questionnaire. Injuries were graded as severe or non-severe based on the Injury Severity Score (ISS). Independent factors associated with injury severity were assessed using multivariate logistic regression. The mean age of participants was 32.4 years, three quarters were between 20-49 years-old and 73% (219) were male. Nineteen percent (56/300) of the victims had severe injury. Five percent (15) had head injury while 38% (115) had fractures. Vulnerable road users (pedestrians and two-wheel users) comprised 33% (99/300) of the victims. Vulnerable road users (OR=2.0, 95%CI=1.0-3.9), road crashes in rainy weather (OR=2.9, 95%CI=1.3-6.5) and night time crashes (OR=2.0, 95%CI=-1.1-3.9) were independent risk factors for sustaining severe injury. Severe injury was associated with vulnerable road users, rainy weather and night time crashes. Interventions and measures such as use of reflective jackets and helmets by two wheel users and enhanced road visibility could help reduce the severity of road traffic injuries.

  7. Toddlers at risk for paper shredder injury in the home: easy access and severe injury.

    PubMed

    Warren, Ramona C; Foltin, George L

    2006-02-01

    A 2-year-old girl sustained severe injury to 2 fingers from a home paper shredder. This case illustrates the risk of injury from paper shredders, which are increasingly common household items. Toddlers are at risk of finger injury and amputation. The US Consumer Product Safety Commission performed an investigation of reported injuries and the characteristics of paper shredders that might have contributed to the injuries, and we summarize their findings.

  8. Frozen chips: an unusual cause of severe frostbite injury.

    PubMed

    Graham, C A; Stevenson, J

    2000-10-01

    A case of severe frostbite injury to the right foot is presented. This was caused by the inappropriate application of a bag of frozen chips to the foot in an attempt to ease non-specific pain. No specific acute traumatic injury was identified. As the patient was a teacher of physical education, the pain had initially been assumed to originate from a minor musculoskeletal injury. Full recovery ensued after surgical excision of necrotic tissue and split skin grafting. The danger of inappropriate overenthusiastic use of ice packs or other frozen material to treat soft tissue injuries is emphasised. The need for education to prevent similar future injuries is discussed.

  9. Weather impacts on single-vehicle truck crash injury severity.

    PubMed

    Naik, Bhaven; Tung, Li-Wei; Zhao, Shanshan; Khattak, Aemal J

    2016-09-01

    The focus of this paper is on illustrating the feasibility of aggregating data from disparate sources to investigate the relationship between single-vehicle truck crash injury severity and detailed weather conditions. Specifically, this paper presents: (a) a methodology that combines detailed 15-min weather station data with crash and roadway data, and (b) an empirical investigation of the effects of weather on crash-related injury severities of single-vehicle truck crashes. Random parameters ordinal and multinomial regression models were used to investigate crash injury severity under different weather conditions, taking into account the individual unobserved heterogeneity. The adopted methodology allowed consideration of environmental, roadway, and climate-related variables in single-vehicle truck crash injury severity. Results showed that wind speed, rain, humidity, and air temperature were linked with single-vehicle truck crash injury severity. Greater recorded wind speed added to the severity of injuries in single-vehicle truck crashes in general. Rain and warmer air temperatures were linked to more severe crash injuries in single-vehicle truck crashes while higher levels of humidity were linked to less severe injuries. Random parameters ordered logit and multinomial logit, respectively, revealed some individual heterogeneity in the data and showed that integrating comprehensive weather data with crash data provided useful insights into factors associated with single-vehicle truck crash injury severity. The research provided a practical method that combined comprehensive 15-min weather station data with crash and roadway data, thereby providing useful insights into crash injury severity of single-vehicle trucks. Those insights are useful for future truck driver educational programs and for truck safety in different weather conditions. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.

  10. Acute diabetes insipidus in severe head injury: a prospective study.

    PubMed

    Hadjizacharia, Pantelis; Beale, Elizabeth O; Inaba, Kenji; Chan, Linda S; Demetriades, Demetrios

    2008-10-01

    The incidence and risk factors for acute diabetes insipidus after severe head injury and the effect of this complication on outcomes have not been evaluated in any large prospective studies. We conducted a prospective study of all patients admitted to the surgical ICU of a Level I trauma center with severe head injury (head Abbreviated Injury Score [AIS] >or= 3). The following potential risk factors with p < 0.2 on bivariate analysis were included in a stepwise logistic regression to identify independent risk factors for diabetes insipidus and its association with mortality: age, mechanism of injury (blunt or penetrating), blood pressure, Glasgow Coma Scale, Injury Severity Score, head and other body area AIS, skull fracture, cerebral edema and shift, intracranial hemorrhage, and pneumocephaly. There were 436 patients (blunt injuries, 392; penetrating injuries, 44); 387 patients had isolated head injury. Diabetes insipidus occurred in 15.4% of all patients (blunt, 12.5%; penetrating, 40.9%; p < 0.0001) and in 14.7% of patients with isolated head injury (blunt, 11.8%; penetrating, 39.5%; p < 0.0001). The presence of major extracranial injuries did not influence the incidence of diabetes insipidus. Independent risk factors for diabetes insipidus in isolated head injury were Glasgow Coma Scale3. Diabetes insipidus was an independent risk factor for death (adjusted odds ratio, 3.96; 95% CI [1.65, 9.72]; adjusted p value = 0.002). The incidence of acute diabetes insipidus in severe head injury is high, especially in penetrating injuries. Independent risk factors for diabetes insipidus include a Glasgow Coma Scale3. Acute diabetes insipidus was associated with significantly increased mortality.

  11. Severity and Frequency of Proximal Tubule Injury Determines Renal Prognosis

    PubMed Central

    Takaori, Koji; Nakamura, Jin; Yamamoto, Shinya; Nakata, Hirosuke; Sato, Yuki; Takase, Masayuki; Nameta, Masaaki; Yamamoto, Tadashi; Economides, Aris N.; Kohno, Kenji; Haga, Hironori; Sharma, Kumar

    2016-01-01

    AKI increases the risk of developing CKD, but the mechanisms linking AKI to CKD remain unclear. Because proximal tubule injury is the mainstay of AKI, we postulated that proximal tubule injury triggers features of CKD. We generated a novel mouse model to induce proximal tubule–specific adjustable injury by inducing the expression of diphtheria toxin (DT) receptor with variable prevalence in proximal tubules. Administration of high-dose DT in mice expressing the DT receptor consistently caused severe proximal tubule–specific injury associated with interstitial fibrosis and reduction of erythropoietin production. Mild proximal tubule injury from a single injection of low-dose DT triggered reversible fibrosis, whereas repeated mild injuries caused sustained interstitial fibrosis, inflammation, glomerulosclerosis, and atubular glomeruli. DT–induced proximal tubule–specific injury also triggered distal tubule injury. Furthermore, injured tubular cells cocultured with fibroblasts stimulated induction of extracellular matrix and inflammatory genes. These results support the existence of proximal-distal tubule crosstalk and crosstalk between tubular cells and fibroblasts. Overall, our data provide evidence that proximal tubule injury triggers several features of CKD and that the severity and frequency of proximal tubule injury determines the progression to CKD. PMID:26701981

  12. The King's Outcome Scale for Childhood Head Injury and Injury Severity and Outcome Measures in Children with Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Calvert, Sophie; Miller, Helen E.; Curran, Andrew; Hameed, Biju; McCarter, Renee; Edwards, Richard J.; Hunt, Linda; Sharples, Peta Mary

    2008-01-01

    The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The…

  13. The King's Outcome Scale for Childhood Head Injury and Injury Severity and Outcome Measures in Children with Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Calvert, Sophie; Miller, Helen E.; Curran, Andrew; Hameed, Biju; McCarter, Renee; Edwards, Richard J.; Hunt, Linda; Sharples, Peta Mary

    2008-01-01

    The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The…

  14. Analyzing injury severity of bus passengers with different movements.

    PubMed

    Li, Duo; Zhao, Yifei; Bai, Qiang; Zhou, Bei; Ling, Hongbiao

    2017-07-04

    Though public transport vehicles are rarely involved in mass casualty accidents, when they are, the number of injuries and fatalities is usually high due to the high passenger capacity. Of the few studies that have been conducted on bus safety, the majority focused on vehicle safety features, road environmental factors, as well as driver characteristics. Nevertheless, few studies have attempted to investigate the underlying risk factors related to bus occupants. This article presents an investigation aimed at identifying the risk factors affecting injury severity of bus passengers with different movements. Three different passenger movement types including standing, seated, and boarding/alighting were analyzed individually using classification and regression tree (CART) method based on publicly available accident database of Great Britain. According to the results of exploratory analyses, passenger age and vehicle maneuver are associated with passenger injury severity in all 3 types of accidents. Moreover, the variable "skidding and overturning" is associated with injury severity of seated passengers and driver age is correlated with injury severity of standing and boarding/alighting passengers. The CART method shows its ability to identify and easily explain the complicated patterns affecting passenger injury severity. Several countermeasures to reduce bus passenger injury severity are recommended.

  15. Severe Brain Injury in Massachusetts: Assessing the Continuum of Care.

    PubMed

    Lorenz, Laura; Katz, Gabrielle

    2015-12-10

    Acquired brain injury (ABI) is a major public health problem in Massachusetts (Hackman et al, 2014) and includes traumatic brain injury (TBI), stroke, ABI-related infectious diseases, metabolic disorders affecting the central nervous system (brain and spinal cord), and brain tumor. Advances in emergency medical care and neurosurgery mean that more people are surviving severe traumatic brain injury (Trexler et al, 2014). Yet many patients with severe TBI in particular, are not receiving inpatient services after initial treatment (Hackman et al, 2014; CDC, 2014) or later that are known to be effective (Malec & Kean, 2015; Lewis & Horn, 2015; BI Commission, 2011; Kolakowsky-Hayner et al, 2000; Interviews). These services include post-acute rehabilitation, case management, and brain injury-specific community programming (CDC, 2014; BI Commission, 2011; Interviews). Governance and data for decision-making are also major gaps in the continuum of care for severe brain injury in MA (Interviews; NASHIA, 2005). The last two decades saw a surge in interest in the brain, with advances in neuroscience, diagnosis and measurement of brain injury, rehabilitation services, and brain theory (Boyle, 2001). Severe brain injury however is the new "hidden epidemic" in our society. For many, an injury to the brain is not a short-term event that can be "cured" but the beginning of a life-long disability (CDC, 2014; Langlois et al, 2006). Fortunately, even after a severe brain injury, when the right rehabilitation is provided at the right time, the "rest of life" journey can be a positive one for many (Marquez de la Plata, 2015; Langlois et al, 2006). Severe brain injury can lead to a "new normal" as patients regain skills, find new meaning and in life, and take on new family, volunteer, and work roles. Throughout this brief, the term "severe brain injury" refers to "severe acquired brain injury," or any injury to the brain that occurs after birth. This definition does not include

  16. Associations of distraction involvement and age with driver injury severities.

    PubMed

    Donmez, Birsen; Liu, Zishu

    2015-02-01

    This paper investigates the associations between the severity of injuries sustained by a driver who is involved in a two-vehicle crash, the existence and type of driver distraction as well as driver's age. Few studies investigated distraction as it relates to injury severity. Moreover, these studies did not consider driver age which is a significant factor related to driving behavior and the ability to respond in a crash situation. An ordered logit model was built to predict injury severity sustained by drivers using data from the U.S. National Automotive Sampling System's General Estimates System (2003 to 2008). Various factors (e.g., weather, gender, and speeding) were statistically controlled for, but the main focus was on the interaction of driver age and distraction type. The trends observed for young and mid-age drivers were similar. For these age groups, dialing or texting on the cell phone, passengers, and in-vehicle sources resulted in an increase in a likelihood of more severe injuries. Talking on the cell phone had a similar effect for younger drivers but was not significant for mid-age drivers. Inattention and distractions outside the vehicle decreased the odds of severe injuries. For older drivers, the highest odds of severe injuries were observed with dialing or texting on a cell phone, followed by in-vehicle sources and talking on the cell phone. All these sources were associated with an increased likelihood of injury severity. Similar to young and mid-age drivers, distractions outside the vehicle decreased the odds of severe injuries. Other distraction types did not have a significant effect for the older age group. The results support previous literature and extend our understanding of crash injury severity. The findings have implications for policy making and the design of distraction mitigation systems. Copyright © 2014 National Safety Council and Elsevier Ltd. All rights reserved.

  17. Severe rhabdomyolysis without renal injury associated with lightning strike.

    PubMed

    Navarrete, Norberto; Aldana, Norberto Navarrete

    2013-01-01

    Lightning strikes cause injuries in multiple systems and organs. Early recognition of lightning injury syndromes and anticipation of harmful complications can improve outcomes for these patients. The author has presented a case report of a patient who was struck by lightning and exhibited extensive soft tissue injury with myoglobinuria. He was treated with delayed fasciotomy and had evidence of severe muscle injury with markedly elevated creatine kinase levels that gradually improved with aggressive fluid infusion. The patient did not require alkalinization of urine, mannitol, or dialysis, and his renal function remained normal.

  18. [Injury severity and pattern at the scene. What is the influence of the mechanism of injury?].

    PubMed

    Frink, M; Zeckey, C; Haasper, C; Krettek, C; Hildebrand, F

    2010-05-01

    The mechanism of injury is the major cause for trauma team activation and emergency room resuscitation of trauma victims. To date, it remains unclear to what extent the injury mechanism influences injury pattern and severity. A comprehensive systematic literature search based on Medline was carried out. Only a limited number of studies are available which investigated the influence of injury mechanisms on injury patterns and severity. There are no specific mechanisms for traumatic brain and spine injuries. Injuries to the chest and abdomen most frequently resulted from motor vehicle accidents involving passengers sitting on the side of the impact. Steering wheel deformity correlated with the injury severity. Pelvic fractures occurred most frequently due to motor vehicle accidents. The highest mortality resulted from pedestrians being struck by a vehicle and additional loss of life in the same vehicle compartment. The systematic literature research showed inconsistent results regarding the influence of trauma mechanisms on the resulting injury. Therefore, a treatment algorithm for trauma patients should be independent of the mechanism which is represented in several training programs (e.g. ATLS and PHTLS). However, the mechanism of injury may increase the alertness of the trauma team with respect to injury distribution and severity.

  19. Frozen chips: an unusual cause of severe frostbite injury

    PubMed Central

    Graham, C.; Stevenson, J.

    2000-01-01

    A case of severe frostbite injury to the right foot is presented. This was caused by the inappropriate application of a bag of frozen chips to the foot in an attempt to ease non-specific pain. No specific acute traumatic injury was identified. As the patient was a teacher of physical education, the pain had initially been assumed to originate from a minor musculoskeletal injury. Full recovery ensued after surgical excision of necrotic tissue and split skin grafting. The danger of inappropriate overenthusiastic use of ice packs or other frozen material to treat soft tissue injuries is emphasised. The need for education to prevent similar future injuries is discussed. Key Words: cold injury; frostbite; ice pack; skin; necrosis PMID:11049150

  20. The neuropsychological similarities of mild and more severe head injury.

    PubMed

    Reitan, R M; Wolfson, D

    2000-07-01

    Reports in the literature have suggested that the neuropsychological effects of mild head injury are selective, represented by impairment of attention, information processing, and memory, and that evaluations with comprehensive and standard test batteries are likely to miss such deficits. The present study compared groups of individuals with mild head injuries, more severe head injuries, and non-brain-damaged controls using 19 tests from the Halstead-Reitan Battery. The results indicated that the group with mild head injuries performed significantly poorer than the controls, and that the group with more severe head injuries scored significantly more poorly than either of the other groups. Comparisons of the pattern of test scores for the two head-injured groups were remarkably similar across the 19 tests, yielding a rank difference correlation of 0.87. The findings yielded no evidence of selective or delimited impairment in the group with mild head injuries, but instead, showed them to have test results that were very similar, though showing less neuropsychological impairment, to the group of subjects with more severe head injuries. These findings suggest that a comprehensive neuropsychological test battery is necessary to detect the broad range of deficits that may result from mild head injury.

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

    PubMed

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

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

  2. Risk factors affecting injury severity determined by the MAIS score.

    PubMed

    Ferreira, Sara; Amorim, Marco; Couto, Antonio

    2017-07-04

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

  3. Injury severity, vehicle safety features, and intersection crashes.

    PubMed

    Obeng, K

    2008-01-01

    This article examines injury severity in crashes that occur within signalized intersections and identifies some factors that explain them. It uses a random effect ordered logit model and an unbalanced longitudinal panel data for 303 intersections for one medium-size city. Among its findings are 3% and 0.29% lower probabilities of sustaining evident and disabling injuries respectively when vehicle occupants wear three-point seat belts and corresponding 1.71% and 0.16% lower probabilities when they wear only shoulder belts. Also, the probabilities of sustaining evident and disabling injuries reduce by 0.87% and 0.08% when vehicles with airbags are involved in crashes. But, when front airbags deploy the probabilities of sustaining disabling, evident, and possible injuries increase by 1.3%, 11.93%, and 26.80%, respectively. Similarly, both side airbags deploying increases disabling and evident injuries by 1.8% and 15.53%, respectively. In addition, we find that the probability of sustaining severe injuries increases in head-on crashes. These results emphasize the effectiveness of seat belt use, especially three-point seat belts, the inclusion of airbags in all vehicles, increased awareness of possible injuries from airbags deploying, signalized intersection designs that include pedestrian crossing signals, and additional research to identify the predominant types of injuries associated with airbags deploying.

  4. A case of severe airbag related ocular alkali injury.

    PubMed

    Barnes, Shawn S; Wong, William; Affeldt, John C

    2012-08-01

    While airbags have saved many lives and are clearly beneficial overall, sodium hydroxide (NaOH) powder produced by the inflation reaction can cause significant alkali ocular injury if not irrigated promptly. Here we report a case of severe airbag related ocular alkali injury as a way to bring attention to the need for prompt ocular irrigation following motor vehicle accidents (MVA) with airbag deployment. A 47-year-old man was involved in a MVA with airbag deployment in a rural setting. Attention was paid to several other life-threatening traumatic injuries, however, ocular irrigation was not performed until some 6-7 hours after the MVA. Over the course of 6 months, airbag related alkali injury caused severe limbal ischemia, conjunctivalization of the cornea, corneal epithelial defects, cicatricial scarring, haze, and corneal/limbal vascularization despite amniotic membrane graft. Awareness of the importance of ocular irrigation following airbag deployment must be raised both in the ophthalmology and emergency medicine communities.

  5. Injury severity in ice skating: an epidemiologic analysis using a standardised injury classification system.

    PubMed

    Ostermann, Roman C; Hofbauer, Marcus; Tiefenböck, Thomas M; Pumberger, Matthias; Tiefenböck, Michael; Platzer, Patrick; Aldrian, Silke

    2015-01-01

    Although injuries sustained during ice skating have been reported to be more serious than other forms of skating, the potential injury risks are often underestimated by skating participants. The purpose of this study was to give a descriptive overview of injury patterns occurring during ice skating. Special emphasis was put on injury severity by using a standardised injury classification system. Over a six month period, all patients treated with ice-skating-related injuries at Europe's largest hospital were included. Patient demographics were collected and all injuries categorised according to the Abbreviated Injury Scale (AIS) 2005. A descriptive statistic and logistic regression analysis was performed. Three hundred and forty-one patients (134 M, 207 F) were included in this study. Statistical analysis revealed that age had a significant influence on injury severity. People > 50 years had a higher risk of sustaining a more severe injury according to the AIS compared with younger skaters. Furthermore, the risk of head injury was significantly lower for people aged between 18 and 50 years than for people < 18 years (p = 0.0007) and significantly higher for people > 50 years than for people aged between 18 and 50 years (p = 0.04). The severity of ice-skating injuries is associated with the patient's age, showing more severe injuries in older patients. Awareness should be raised among the public and physicians about the risks associated with this activity in order to promote further educational interventions and the use of protective gear.

  6. Abstract thinking following severe traumatic brain injury.

    PubMed

    Scherzer, B P; Charbonneau, S; Solomon, C R; Lepore, F

    1993-01-01

    Abstract abilities were studied in a sample of 34 individuals with severe TBI and a control group. The results indicate that TBI interferes with performance on tests requiring individuals to process information into new categories. There appears to be a dissociation between verbal abstract abilities and visual-perceptual abstract abilities. There is evidence that Goldstein and Sheerer's [1] postulate of a general 'abstract attitude' was at least partially correct. This attitude does not appear to be related to a general verbal ideational process, as dysphasic subjects were only deficient on a purely verbal abstract task.

  7. Severely comminuted radius fracture presenting as a signature patterned injury.

    PubMed

    Jain, Saurabh; Rajan, Sunil; Srivastava, Abhishek

    2016-01-01

    Dilemma still prevails, regarding the exact management of mangled extremity injuries between limb salvage versus amputation, each having there own set of complications. We here present a case of severely comminuted fractures of radius (bag of bones) along with the multiple criss-cross shaped lacerated wounds on the forearm and wrist presenting as a "signature pattern injury" caused by entrapment of the limb in the concrete mixer. MESS score of patient was 8, a score valid for amputation, but contrary, we successfully salvaged the patient's limb with use of radio-carpal distracter. Management of mangled injuries should be individualized, with due consideration to the mechanism and force of injury, associated injuries, and the patient profile.

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

    PubMed

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

    2010-07-01

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

  9. Central diabetes insipidus in pediatric severe traumatic brain injury.

    PubMed

    Alharfi, Ibrahim M; Stewart, Tanya Charyk; Foster, Jennifer; Morrison, Gavin C; Fraser, Douglas D

    2013-02-01

    To determine the occurrence rate of central diabetes insipidus in pediatric patients with severe traumatic brain injury and to describe the clinical, injury, biochemical, imaging, and intervention variables associated with mortality. Retrospective chart and imaging review. Children's Hospital, level 1 trauma center. Severely injured (Injury Severity Score ≥ 12) pediatric trauma patients (>1 month and <18 yr) with severe traumatic brain injury (presedation Glasgow Coma Scale ≤ 8 and head Maximum Abbreviated Injury Scale ≥ 4) that developed acute central diabetes insipidus between January 2000 and December 2011. Of 818 severely injured trauma patients, 180 had severe traumatic brain injury with an overall mortality rate of 27.2%. Thirty-two of the severe traumatic brain injury patients developed acute central diabetes insipidus that responded to desamino-8-D-arginine vasopressin and/or vasopressin infusion, providing an occurrence rate of 18%. At the time of central diabetes insipidus diagnosis, median urine output and serum sodium were 6.8 ml/kg/hr (interquartile range = 5-11) and 154 mmol/L (interquartile range = 149-159), respectively. The mortality rate of central diabetes insipidus patients was 87.5%, with 71.4% declared brain dead after central diabetes insipidus diagnosis. Early central diabetes insipidus onset, within the first 2 days of severe traumatic brain injury, was strongly associated with mortality (p < 0.001), as were a lower presedation Glasgow Coma Scale (p = 0.03), a lower motor Glasgow Coma Scale (p = 0.01), an occurrence of fixed pupils (p = 0.04), and a prolonged partial thromboplastin time (p = 0.04). Cerebral edema on the initial computed tomography, obtained in the first 24 hrs after injury, was the only imaging finding associated with death (p = 0.002). Survivors of central diabetes insipidus were more likely to have intracranial pressure monitoring (p = 0.03), have thiopental administered to induce coma (p = 0.04) and have received a

  10. Fireworks type, injury pattern, and permanent impairment following severe fireworks-related injuries.

    PubMed

    Sandvall, Brinkley K; Jacobson, Lauren; Miller, Erin A; Dodge, Ryan E; Alex Quistberg, D; Rowhani-Rahbar, Ali; Vavilala, Monica S; Friedrich, Jeffrey B; Keys, Kari A

    2017-10-01

    There is a paucity of clinical data on severe fireworks-related injuries, and the relationship between firework types, injury patterns, and magnitude of impairment is not well understood. Our objective was to describe the relationship between fireworks type, injury patterns, and impairment. Retrospective case series (2005-2015) of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or an operation at a Level 1 Trauma/Burn Center. Fireworks types, injury patterns (body region, injury type), operation, and permanent impairment were examined. Data from 294 patients 1 to 61years of age (mean 24years) were examined. The majority (90%) were male. 119 (40%) patients were admitted who did not undergo surgery, 163 (55%) patients required both admission and surgery, and 12 (5%) patients underwent outpatient surgery. The greatest proportion of injuries was related to shells/mortars (39%). There were proportionally more rocket injuries in children (44%), more homemade firework injuries in teens (34%), and more shell/mortar injuries in adults (86%). Brain, face, and hand injuries were disproportionately represented in the shells/mortars group. Seventy percent of globe-injured patients experienced partial or complete permanent vision loss. Thirty-seven percent of hand-injured patients required at least one partial or whole finger/hand amputation. The greatest proportion of eye and hand injuries resulting in permanent impairment was in the shells/mortars group, followed by homemade fireworks. Two patients died. Severe fireworks-related injuries from homemade fireworks and shells/mortars have specific injury patterns. Shells/mortars disproportionately cause permanent impairment from eye and hand injury. Published by Elsevier Inc.

  11. Hemipelvectomy after severe pelvic injury in Factor VII deficiency toddler.

    PubMed

    Haim, Shtarker; Laufer, Yocheved; Leonid, Kogan; Daniel, Glikman; Yechiel, Sweed; Zeev, Zonis; Yury, Grozovsky; Asher, Kuperman Amir; Michal, Elboim-Gabyzon

    2015-01-01

    Traumatic hemipelvectomy is a lethal catastrophic injury. The reported average age of individuals surviving this trauma is 21 years old, suggesting the necessity of good physiological reserves to survive this type of injury. Dealing with this injury in children may call for special requirements throughout all the stages of diagnosis, treatment and rehabilitation. Experience in the resuscitation and subsequent treatment of individuals suffering from this traumatic condition in the paediatric population is even scarce. There are only several reported cases involving children and none of the paediatric cases suffered from comorbidities prior to their traumatic injury. The present report describes the successful management of a 16-month-old child with a medical history of a rare bleeding disorder a severe coagulation Factor VII deficiency who underwent right-sided traumatic hemipelvectomy.

  12. Injuries from combat explosions in Iraq: injury type, location, and severity.

    PubMed

    Eskridge, Susan L; Macera, Caroline A; Galarneau, Michael R; Holbrook, Troy L; Woodruff, Susan I; MacGregor, Andrew J; Morton, Deborah J; Shaffer, Richard A

    2012-10-01

    Explosions have caused a greater percentage of injuries in Iraq and Afghanistan than in any other large-scale conflict. Improvements in body armour and field medical care have improved survival and changed the injury profile of service personnel. This study's objective was to determine the nature, body region, and severity of injuries caused by an explosion episode in male service personnel. A descriptive analysis was conducted of 4623 combat explosion episodes in Iraq between March 2004 and December 2007. The Barell matrix was used to describe the nature and body regions of injuries due to a combat explosion. A total of 17,637 International Classification of Diseases, Ninth Revision (ICD-9) codes were assigned to the 4623 explosion episodes, with an average of 3.8 ICD-9 codes per episode. The most frequent single injury type was a mild traumatic brain injury (TBI; 10.8%). Other frequent injuries were open wounds in the lower extremity (8.8%) and open wounds of the face (8.2%), which includes tympanic membrane rupture. The extremities were the body regions most often injured (41.3%), followed by head and neck (37.4%) and torso (8.8%). The results of this study support previous observations of TBI as a pre-eminent injury of the wars in Iraq and Afghanistan, with mild TBI as the most common single injury in this large cohort of explosion episodes. The extremities had the highest frequency of injuries for any one body region. The majority of the explosion episodes resulted in more than one injury, and the variety of injuries across nearly every body region and injury type suggests a complex nature of explosion injuries. Understanding the constellation of injuries commonly caused by explosions will assist in the mitigation, treatment, and rehabilitation of the effects of these injuries. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Current guidelines for management of severe hand injuries.

    PubMed

    Stępień, Robert; Szczęsny, Grzegorz

    2014-06-18

    Severe, multitissue hand injuries constitute a serious problem of the modern world. Despite investing significant funds in their management these injuries often exclude young people from professional life. It is often due to improper management conducted by untrained personnel lacking appropriate instruments. The goal of this work is to review the literature on the problem and attempt to organize this information. A review of available literature on mutilating hand trauma, amputations in the hand region, replantation and scales used for assessment of the severity of injury and hand function, both in Poland and internationally. Hand injuries may be managed through three approaches: concomitant definitive, delayed and secondary. The best results are achieved through the first approach. However sometimes, due to the character of injury or lack of trained personnel, the team is forced to apply temporary dressing and, subsequently, initiate complex further management. HISS scale is a useful tool allowing for precise determination of the severity of injury and, used together with DASH questionnaire, prediction of long-term treatment outcome. Necessary changes need to be implemented in the healthcare system in order to achieve better results of treatment of severe hand injuries. Proper guidelines for everyday practice should be also introduced. Changes should encompass precise determination of competences of individual centers as well as the mode and indications for patient transport between them. Training of doctors should be modified in such way to ensure that at least one person in each center would be capable of performing proper immediate management of such injuries, making further treatment possible. At the same time, financing, as a strong motivator, should promote appropriate management.

  14. Advances in Surgical Care: Management of Severe Burn Injury

    DTIC Science & Technology

    2008-01-01

    tube is often initiated within 48 hrs after in- jury and is continued during flight using a paired nasogastric tube to ensure gas- tric decompression...Advances in surgical care : Management of severe burn injury Christopher E. White, MD, FACS; Evan M. Renz, MD, FACS I n the United States, 500,000 peo...States, most civilian burn patients can be transported from the site of injury to a definitive care facility within a few hours (4). In contrast to

  15. Mechanism of injury affects 6-month functional outcome in children hospitalized because of severe injuries.

    PubMed

    Macpherson, Alison K; Rothman, Linda; McKeag, Alexandra Moses; Howard, Andrew

    2003-09-01

    The burden of childhood injury is often described using vital statistics for mortality and hospital admissions as a measure of morbidity. Hospital admissions, however, reflect the process of care and do not directly measure children's functional disability. The purpose of this study was to determine the influence of mechanism of injury on the functional outcome 6 months after injury in children in an inpatient trauma unit of a pediatric referral hospital. A retrospective cohort of 357 children aged 2 to 15 with an Injury Severity Score (ISS) > 12 was studied to determine the relationship between mechanism of injury (based on International Classification of Diseases, Ninth Revision e-code) and functional outcome 6 months after hospital discharge. Wee Functional Independence Measure (WeeFIM) was used to assess functional outcome. Any child with a WeeFIM score less than the maximum (of 126) attainable was classed as requiring assistance, and the relative risk of requiring assistance at 6 months was calculated for each injury mechanism. Poisson regression analysis was used to assess the importance of mechanism of injury, after adjusting for age, gender, ISS, and a primary diagnosis of central nervous system (CNS) injury. Mechanism of injury had a significant effect on the functional outcome at 6 months: 72% of pedestrians, 64% of cyclists struck by cars, and 59% of injured motor vehicle occupants required assistance during daily activities. By contrast, only 27% of those injured playing sports and 22% of cyclists injured without motor vehicle involvement required assistance. The relative risk of children requiring assistance was similar with or without adjustment for age, gender, ISS, and CNS injury. Mechanism of injury is significantly associated with requiring assistance 6 months postdischarge, even after controlling for age, injury severity, and the presence of a CNS injury. These data are important both when discussing the prognosis for an individual patient and

  16. Occupant injury severity from lateral collisions: a literature review.

    PubMed

    Laberge-Nadeau, Claire; Bellavance, François; Messier, Stéphane; Vézina, Lyne; Pichette, Fernand

    2009-01-01

    Side impacts are a serious automotive injury problem; they represent about 30% of all fatalities for passenger vehicle occupants. This literature review focuses on occupant injuries resulting from real lateral collisions. It emphasizes the interaction between injury patterns and crash factors, taking into account type of injuries and their severity. It highlights what is known on the subject and suggests further studies. We reviewed papers identified by searches in two electronic databases for the 1996-2009 publication period, and in specific journals and conference proceedings. Studies on the Primary Direction of Force (PDOF) have revealed that fatal crashes occur most frequently when the PDOF is at 3 or 9 o'clock. The risk of serious injury is two to three times higher for the near-side occupant than for the far-side occupant. Head injuries predominate in oblique impacts and thoracic injuries in perpendicular ones. A few results are also reported on side airbag protection. This literature review presents an overall picture of the injuries caused by lateral collisions, though each of the papers or articles examined focuses mostly on some particular aspect of the problem. The incidence of specific injuries depends on the data source used. Very few population-based analyses of lateral collision injuries were found. New studies are needed to evaluate new protective devices (e.g., lateral airbags, inflatable curtains). Without interfering with their care duties, Emergency Medical Technicians could be systematically trained to observe the collision's specific characteristics and to report all their relevant observations to the emergency physicians to increase the likelihood of prompt diagnosis and proper care.

  17. Traumatic Brain Injury Severity Affects Neurogenesis in Adult Mouse Hippocampus.

    PubMed

    Wang, Xiaoting; Gao, Xiang; Michalski, Stephanie; Zhao, Shu; Chen, Jinhui

    2016-04-15

    Traumatic brain injury (TBI) has been proven to enhance neural stem cell (NSC) proliferation in the hippocampal dentate gyrus. However, various groups have reported contradictory results on whether TBI increases neurogenesis, partially due to a wide range in the severities of injuries seen with different TBI models. To address whether the severity of TBI affects neurogenesis in the injured brain, we assessed neurogenesis in mouse brains receiving different severities of controlled cortical impact (CCI) with the same injury device. The mice were subjected to mild, moderate, or severe TBI by a CCI device. The effects of TBI severity on neurogenesis were evaluated at three stages: NSC proliferation, immature neurons, and newly-generated mature neurons. The results showed that mild TBI did not affect neurogenesis at any of the three stages. Moderate TBI promoted NSC proliferation without increasing neurogenesis. Severe TBI increased neurogenesis at all three stages. Our data suggest that the severity of injury affects adult neurogenesis in the hippocampus, and thus it may partially explain the inconsistent results of different groups regarding neurogenesis following TBI. Further understanding the mechanism of TBI-induced neurogenesis may provide a potential approach for using endogenous NSCs to protect against neuronal loss after trauma.

  18. Incidence and severity of acute complications after spinal cord injury.

    PubMed

    Grossman, Robert G; Frankowski, Ralph F; Burau, Keith D; Toups, Elizabeth G; Crommett, John W; Johnson, Michele M; Fehlings, Michael G; Tator, Charles H; Shaffrey, Christopher I; Harkema, Susan J; Hodes, Jonathan E; Aarabi, Bizhan; Rosner, Michael K; Guest, James D; Harrop, James S

    2012-09-01

    The aim of this multicenter, prospective study was to determine the spectrum, incidence, and severity of complications during the initial hospitalization of patients with spinal cord injury. The study was conducted at 9 university-affiliated hospitals that comprise the clinical centers of the North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury. The study population comprised 315 patients admitted to NACTN clinical centers between June 25, 2005, and November 2, 2010, who had American Spinal Injury Association (ASIA) Impairment Scale grades of A-D and were 18 years of age or older. Patients were managed according to a standardized protocol. The study population was 79% male with a median age of 44 years. The leading causes of injury were falls (37%) and motor vehicle accidents (28%). The distribution of initial ASIA grades were A (40%), B (16%), C (15%), and D (29%). Fifty-eight percent of patients sustained 1 or more severe, moderate, or mild complications. Complications were associated with more severe ASIA grade: 84% of patients with Grade A and 25% of patients with Grade D had at least 1 complication. Seventy-eight percent of complications occurred within 14 days of injury. The most frequent types of severe and moderate complications were respiratory failure, pneumonia, pleural effusion, anemia, cardiac dysrhythmia, and severe bradycardia. The mortality rate was 3.5% and was associated with increased age and preexisting morbidity. Knowledge of the type, frequency, time of occurrence, and severity of specific complications that occur after spinal cord injury can aid in their early detection, treatment, and prevention. The data are of importance in evaluating and selecting therapy for clinical trials.

  19. Long-term outcome after severe head injury.

    PubMed Central

    Lewin, W; Marshall, T F; Roberts, A H

    1979-01-01

    From a consecutive series of 7000 patients with head injuries admitted to the regional accident service, Radcliffe Infirmary, Oxford between 10 and 24 years earlier, every patient was taken who had been amnesic or unconscious for one week or longer. Of these 479 patients, all but ten were traced, and either the cause of death was established or the survivors examined. Ten years after injury 4% were totally disabled, and 14% severely disabled to a degree precluding normal occupational or social life. Of the remainder, 49% had recovered, and the rest were dead. Additionally, a selected series of 64 patients whose unconsciousness had been prolonged for a month or more were studied. Forty of these had survived between three and 25 years after injury and were re-examined. On the basis of age at injury, the worst state of neurological responsiveness, and the duration of posttraumatic amnesia, the outcome of head injury can be predicted reliably in most cases. Patients and relatives need more reassurance and simple psychotherapeutic support, especially in the first few months after injury. Extrapolation from our figures suggests that each year in England and Wales 210 patients survive totally disabled and another 1500 are severely disabled. PMID:119567

  20. Severe-to-fatal head injuries in motor vehicle impacts.

    PubMed

    Yoganandan, Narayan; Baisden, Jamie L; Maiman, Dennis J; Gennarelli, Thomas A; Guan, Yabo; Pintar, Frank A; Laud, Prakash; Ridella, Stephen A

    2010-07-01

    Severe-to-fatal head injuries in motor vehicle environments were analyzed using the United States Crash Injury Research and Engineering Network database for the years 1997-2006. Medical evaluations included details and photographs of injury, and on-scene, trauma bay, emergency room, intensive care unit, radiological, operating room, in-patient, and rehabilitation records. Data were synthesized on a case-by-case basis. X-rays, computed tomography scans, and magnetic resonance images were reviewed along with field evaluations of scene and photographs for the analyses of brain injuries and skull fractures. Injuries to the parenchyma, arteries, brainstem, cerebellum, cerebrum, and loss of consciousness were included. In addition to the analyses of severe-to-fatal (AIS4+) injuries, cervical spine, face, and scalp trauma were used to determine the potential for head contact. Fatalities and survivors were compared using nonparametric tests and confidence intervals for medians. Results were categorized based on the mode of impact with a focus on head contact. Out of the 3178 medical cases and 169 occupants sustaining head injuries, 132 adults were in frontal (54), side (75), and rear (3) crashes. Head contact locations are presented for each mode. A majority of cases clustered around the mid-size anthropometry and normal body mass index (BMI). Injuries occurred at change in velocities (DeltaV) representative of US regulations. Statistically significant differences in DeltaV between fatalities and survivors were found for side but not for frontal impacts. Independent of the impact mode and survivorship, contact locations were found to be superior to the center of gravity of the head, suggesting a greater role for angular than translational head kinematics. However, contact locations were biased to the impact mode: anterior aspects of the frontal bone and face were involved in frontal impacts while temporal-parietal regions were involved in side impacts. Because head

  1. Severely comminuted radius fracture presenting as a signature patterned injury

    PubMed Central

    Jain, Saurabh; Rajan, Sunil; Srivastava, Abhishek

    2016-01-01

    Dilemma still prevails, regarding the exact management of mangled extremity injuries between limb salvage versus amputation, each having there own set of complications. We here present a case of severely comminuted fractures of radius (bag of bones) along with the multiple criss-cross shaped lacerated wounds on the forearm and wrist presenting as a “signature pattern injury” caused by entrapment of the limb in the concrete mixer. MESS score of patient was 8, a score valid for amputation, but contrary, we successfully salvaged the patient's limb with use of radio-carpal distracter. Management of mangled injuries should be individualized, with due consideration to the mechanism and force of injury, associated injuries, and the patient profile. PMID:27053813

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

    PubMed Central

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

    2015-01-01

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

  3. Maxillofacial injuries sustained during soccer: incidence, severity and risk factors.

    PubMed

    Papakosta, Veronica; Koumoura, Fanny; Mourouzis, Constantinos

    2008-04-01

    A very popular sport worldwide, soccer generates a great number of maxillofacial injuries, mainly fractures, resulting in esthetic or functional problems. The aim of this retrospective study was to contribute to the knowledge of soccer-related maxillofacial injuries, and call attention to the risk factors that favor these injuries. A total of 108 patients, who attended hospital because of maxillofacial injuries during soccer within a period of 8 years, were included in this study. The relationship of the patients with soccer, the type, the site, the severity, the mechanism of the injuries and the applied treatment were analyzed. The injured were all males, and were principally amateurs. Around 89.8% of the patients suffered maxillofacial fractures while 10.2% presented only soft tissue injuries; 13.9% had multiple fractures; 50% of the maxillofacial fractures concerned the zygomatic complex and 38.2% the mandible where the majority occurred at the angle. The prevailing mechanism was the direct impact of players. Head to head impact outnumbered. Elbow to head impact caused contusions of the temporomandibular joint. Kick to head impact was the main cause of multiple fractures. The treatment of fractures was mainly surgical (68.2%). These findings support the fact that maxillofacial injuries sustained during soccer tend to be severe, demanding surgical treatment. The mandibular angle is in danger due to the usual existence of impacted and semi-impacted third molars. There should be a preventive intervention on the above contributors, and mainly coaches and sports physicians should be properly informed about the specificity of the maxillofacial injuries.

  4. Complement activation and kidney injury molecule-1-associated proximal tubule injury in severe preeclampsia.

    PubMed

    Burwick, Richard M; Easter, Sarah Rae; Dawood, Hassan Y; Yamamoto, Hidemi S; Fichorova, Raina N; Feinberg, Bruce B

    2014-10-01

    Kidney injury with proteinuria is a characteristic feature of preeclampsia, yet the nature of injury in specific regions of the nephron is incompletely understood. Our study aimed to use existing urinary biomarkers to describe the pattern of kidney injury and proteinuria in pregnancies affected by severe preeclampsia. We performed a case-control study of pregnant women from Brigham and Women's Hospital from 2012 to 2013. We matched cases of severe preeclampsia (n=25) 1:1 by parity and gestational age to 2 control groups with and without chronic hypertension. Urinary levels of kidney injury molecule-1 and complement components (C3a, C5a, and C5b-9) were measured by enzyme-linked immunosorbent assay, and other markers (albumin, β2 microglobulin, cystatin C, epithelial growth factor, neutrophil gelatinase-associated lipocalin, osteopontin, and uromodulin) were measured simultaneously with a multiplex electrochemiluminescence assay. Median values between groups were compared with the Wilcoxon signed-rank test and correlations with Spearman correlation coefficient. Analysis of urinary markers revealed higher excretion of albumin and kidney injury molecule-1 and lower excretion of neutrophil gelatinase-associated lipocalin and epithelial growth factor in severe preeclampsia compared with chronic hypertension and healthy controls. Among subjects with severe preeclampsia, urinary excretion of complement activation products correlated most closely with kidney injury molecule-1, a specific marker of proximal tubule injury (C5a: r=0.60; P=0.001; and C5b-9: r=0.75; P<0.0001). Taken together, we describe a pattern of kidney injury in severe preeclampsia that is characterized by glomerular impairment and complement-mediated inflammation and injury, possibly localized to the proximal tubule in association with kidney injury molecule-1.

  5. Vehicle occupant injury severity on highways: an empirical investigation.

    PubMed

    Christoforou, Zoi; Cohen, Simon; Karlaftis, Matthew G

    2010-11-01

    Accident severity analysis is important to both researchers and practitioners because of its implications in accident cost estimation, external cost estimation and road safety. Although much research has been done to explore the factors influencing crash-injury severity, few studies have investigated the association between severity and traffic characteristics collected real-time during the time the accident occurred. We apply a random parameters ordered probit model to explore the influence of speed and traffic volume on the injury level sustained by vehicle occupants involved in accidents on the A4-A86 junction in the Paris region. Results indicate that increased traffic volume has a consistently positive effect on severity, while speed has a differential effect on severity depending on flow conditions. 2010. Published by Elsevier Ltd.

  6. Postmortem cytokine levels and severity of traumatic injuries.

    PubMed

    Mimasaka, Sohtaro; Ohtsu, Yuki; Tsunenari, Shigeyuki; Funayama, Masato

    2006-09-01

    The relationship between postmortem serum cytokine levels and severity of traumatic injuries was studied. The postmortem serum levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) of 131 victims who died from traumatic injury were measured by an enzyme-linked immunosorbent assay method and compared with scores of total abbreviated injury scale (total AIS) and injury severity score (ISS) calculated from detailed autopsy reports. A significant positive correlation was observed between IL-6 and total AIS (rs=0.4508, p<0.0001), between IL-6 and ISS (rs=0.3337, p<0.0001), between IL-8 and total AIS (rs=0.6593, p<0.0001), and between IL-8 and ISS (rs=0.5305, p<0.0001). The significant correlation between cytokine levels and anatomical traumatic severity indicated that the cytokine levels are useful objective indexes of traumatic severity. In addition, the total AIS is a suitable marker to evaluate traumatic severity as the coefficient of correlation between the cytokine levels and the total AIS was higher than that for the ISS values.

  7. Analyzing pedestrian crash injury severity under different weather conditions.

    PubMed

    Li, Duo; Ranjitkar, Prakash; Zhao, Yifei; Yi, Hui; Rashidi, Soroush

    2017-05-19

    Pedestrians are the most vulnerable road users due to the lack of mass, speed, and protection compared to other types of road users. Adverse weather conditions may reduce road friction and visibility and thus increase crash risk. There is limited evidence and considerable discrepancy with regard to impacts of weather conditions on injury severity in the literature. This article investigated factors affecting pedestrian injury severity level under different weather conditions based on a publicly available accident database in Great Britain. Accident data from Great Britain that are publicly available through the STATS19 database were analyzed. Factors associated with pedestrian, driver, and environment were investigated using a novel approach that combines a classification and regression tree with random forest approach. Significant severity predictors under fine weather conditions from the models included speed limits, pedestrian age, light conditions, and vehicle maneuver. Under adverse weather conditions, the significant predictors were pedestrian age, vehicle maneuver, and speed limit. Elderly pedestrians are associated with higher pedestrian injury severities. Higher speed limits increase pedestrian injury severity. Based on the research findings, recommendations are provided to improve pedestrian safety.

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

    PubMed

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

    2013-01-01

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

  9. Thenar flap for severe finger tip injuries in children.

    PubMed

    Fitoussi, F; Ghorbani, A; Jehanno, P; Frajman, J M; Penneçot, G F

    2004-04-01

    Twelve children aged between 18 months and 11 years old who had sustained a severe fingertip amputation with total or subtotal pulp loss were treated with a distal-based thenar flap. The injuries were palmar oblique amputations or avulsion injuries involving the pulp and the nail bed. The pedicles of the thenar flaps were divided after 18 to 25 days and none suffered any necrosis. At the final follow-up, no interphalangeal joint contractures were found, the average two point discrimination was 5mm, the thenar scar was asymptomatic and the subcutaneous tissue of the thenar flap was providing sufficient bulk to produce a rounded contour, like a normal fingertip. The thenar flap is a useful technique for use with severe fingertip injuries when local flaps cannot provide enough soft tissue and replantation is not possible.

  10. Do burns increase the severity of terror injuries?

    PubMed

    Peleg, Kobi; Liran, Alon; Tessone, Ariel; Givon, Adi; Orenstein, Arie; Haik, Josef

    2008-01-01

    The use of explosives and suicide bombings has become more frequent since October 2000. This change in the nature of terror attacks has marked a new era in the Israeli-Palestinian conflict. We previously reported that the incidence of thermal injuries has since risen. However, the rise in the incidence of burns among victims of terror was proportionate to the rise in the incidence of burns among all trauma victims. This paper presents data from the Israeli National Trauma Registry during the years 1997--2003, to compare the severity of injuries and outcome (mortality rates) in terror victims with and without burn injuries. We also compare the severity of injuries and outcome (mortality rates) for patients with terror-attack related burns to non terror-attack related burns during the same period. Data was obtained from the Israeli National Trauma Registry for all patients admitted to 8 to 10 hospitals in Israel between 1997 and 2003. We analyzed and compared demographic and clinical characteristics of 219 terror-related burn patients (terror/burn), 2228 terror patients with no associated burns (Terror/no-burn) and 6546 non terror related burn patients (burn/no-terror). Severity of injuries was measured using the injury severity score, and burn severity by total body surface percentage indices. Admission rates to Intensive Care Units (ICU) and total length of hospitalization were also used to measure severity of injuries. In-hospital mortality rates were used to indicate outcome. Of burn/terror patients, 87.2% suffered other accompanying injuries, compared with 10.4% of burn/no-terror patients. Of burn/terror patients, 49.8% were admitted to ICU compared with only 11.9% of burn/no-terror patients and 23.8% of no-burn/terror patients. Mean length of hospital stay was 18.5 days for the terror/burn group compared with 11.1 days for the burn/no-terror group and 9.5 days for the terror/no-burn group. Burn/terror patients had a significantly higher injury severity score

  11. Injury severity measures for predicting return-to-work after a traumatic brain injury.

    PubMed

    Chien, Ding-Kuo; Hwang, Hei-Fen; Lin, Mau-Roung

    2017-01-01

    This study compared the ability of five injury severity measures, namely the Abbreviated Injury Scale to the Head (AIS-H), Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), Extended Glasgow Outcome Scale (GOSE), and Injury Severity Score (ISS), to predict return-to-work after a traumatic brain injury (TBI). Furthermore, factors potentially associated with return-to-work were investigated. In total, 207 individuals aged ≤65 years newly diagnosed with a TBI and employed at the time of injury were recruited and followed-up for 1year by telephone every 3 months. A bivariate proportional hazards model analysis revealed that all five injury severity measures were significantly associated with return-to-work after a TBI. The AIS-H and non-head ISS explained 23.8% of the variation in the duration of returning to work from discharge after hospitalization for a TBI; similarly, the GCS, GOS, GOSE, and ISS respectively accounted for 4.7%, 21.4%, 12.9%, and 48.4% of the variation. A multivariable analysis revealed that individuals with higher injury severity as measured by the ISS (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.92-0.97), a lack of autonomy in transportation (HR, 2.55; 95% CI, 1.23-5.32), cognitive impairment (HR, 0.47; 95% CI, 0.28-0.79), and depression (HR, 0.97; 95% CI, 0.95-0.99) were significantly less likely to be employed after a TBI. In conclusion, of the five injury severity measures, the ISS may be the most capable measure of predicting return-to-work after a TBI. In addition to injury severity, autonomy in transportation, cognitive function, and the depressive status may also influence the employment status during the first year after a TBI.

  12. Insulin secretion after injuries of differing severity in the rat.

    PubMed Central

    Frayn, K. N.

    1976-01-01

    The effects on insulin secretion of injuries of differing severity have been studied in the rat. The injuries used were dorsal scalds to 20% and 40% of the body surface area, and a 4-h period of bilateral hind-limb ischaemia. These injuries resulted in 48 h mortality rates of 0/10, 7/10 and 5/10 respectively. Rats were studied 1-5-2 h after scalding or removal of tourniquets. The blood glucose concentration was markedly raised after all these injuries, and the plasma insulin concentration was also raised, so that the insulin to glucose ratio in any group did not differ significantly from that in non-injured controls. Injection of glucose (0-5 g/kg i.v.) induced a rise in insulin concentration in all groups, although the insulin to glucose ratio after the lethal 40% scald was lower than in control rats. It was concluded that in the rat normal insulin secretion is maintained even after lethal injuries, although some suppression of the insulin response to exogenous glucose may occur. Insulin resistance is more important in the rat than impairment of insulin secretion even at an early stage after injury. PMID:782499

  13. On scene injury severity prediction (OSISP) algorithm for car occupants.

    PubMed

    Buendia, Ruben; Candefjord, Stefan; Fagerlind, Helen; Bálint, András; Sjöqvist, Bengt Arne

    2015-08-01

    Many victims in traffic accidents do not receive optimal care due to the fact that the severity of their injuries is not realized early on. Triage protocols are based on physiological and anatomical criteria and subsequently on mechanisms of injury in order to reduce undertriage. In this study the value of accident characteristics for field triage is evaluated by developing an on scene injury severity prediction (OSISP) algorithm using only accident characteristics that are feasible to assess at the scene of accident. A multivariate logistic regression model is constructed to assess the probability of a car occupant being severely injured following a crash, based on the Swedish Traffic Accident Data Acquisition (STRADA) database. Accidents involving adult occupants for calendar years 2003-2013 included in both police and hospital records, with no missing data for any of the model variables, were included. The total number of subjects was 29128, who were involved in 22607 accidents. Partition between severe and non-severe injury was done using the Injury Severity Score (ISS) with two thresholds: ISS>8 and ISS>15. The model variables are: belt use, airbag deployment, posted speed limit, type of accident, location of accident, elderly occupant (>55 years old), sex and occupant seat position. The area under the receiver operator characteristic curve (AUC) is 0.78 and 0.83 for ISS>8 and ISS>15, respectively, as estimated by 10-fold cross-validation. Belt use is the strongest predictor followed by type of accident. Posted speed limit, age and accident location contribute substantially to increase model accuracy, whereas sex and airbag deployment contribute to a smaller extent and seat position is of limited value. These findings can be used to refine triage protocols used in Sweden and possibly other countries with similar traffic environments. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Severe and Catastrophic Neck Injuries Resulting from Tackle Football

    ERIC Educational Resources Information Center

    Torg, Joseph S.; And Others

    1977-01-01

    Use of the spring-loaded blocking and tackling devices should be discontinued due to severe neck injuries resulting from their use; employment of the head and helmet as the primary assault weapon in blocking, tackling, and head butting should be condemned for the same reason. (MJB)

  15. Severe and Catastrophic Neck Injuries Resulting from Tackle Football

    ERIC Educational Resources Information Center

    Torg, Joseph S.; And Others

    1977-01-01

    Use of the spring-loaded blocking and tackling devices should be discontinued due to severe neck injuries resulting from their use; employment of the head and helmet as the primary assault weapon in blocking, tackling, and head butting should be condemned for the same reason. (MJB)

  16. [Experience in the management of severe inhalation injury].

    PubMed

    Chen, B; Jia, C; Su, Y

    1999-11-01

    To summarize our clinical experiences in the treatment of severe inhalation injury accompanying extensive burn. Retrospective analysis of 30 cases of inhalation injury (1980-1996) was done, the cure rate, mortality, effective treatments and lessons of failure were summarized. As soon as the diagnosis was defined, tracheostomy should be done immediately, followed by oxygen therapy, tracheo-bronchial lavage, aspiration, and clearance of airway secretion. If there was pulmonary edema or severe bronchospasm, cortical hormone was used for a short time, in addition, the patients were encouraged to cough, breathe deeply, and change postures, as well as patted on the back and also positioned to facilitate posture drainage, etc. These measures were effective. In this series, there were thirty cases of severe inhalation injury. Fourteen patients(46.6%) were cured, sixteen patients died(53.3%). The result was basically satisfactory. It is possible to increase the cure rate of severe inhalation injury, and the treatment should be carried out conscientiously as early as possible, and great attention should be paid to prevent various complications.

  17. Evaluating Categorization Skills in Children Following Severe Brain Injury.

    ERIC Educational Resources Information Center

    Josman, Naomi; Berney, Tikva; Jarus, Tal

    2000-01-01

    The Toglia Category Assessment was used to evaluate the cognitive categorization ability and the capacity to switch conceptual sets of 30 children with severe brain injuries and 30 without impairments. Brain-injured children had significantly lower scores; awareness scores were significantly correlated with performance scores. (Contains 33…

  18. Severe traumatic head injury: prognostic value of brain stem injuries detected at MRI.

    PubMed

    Hilario, A; Ramos, A; Millan, J M; Salvador, E; Gomez, P A; Cicuendez, M; Diez-Lobato, R; Lagares, A

    2012-11-01

    Traumatic brain injuries represent an important cause of death for young people. The main objectives of this work are to correlate brain stem injuries detected at MR imaging with outcome at 6 months in patients with severe TBI, and to determine which MR imaging findings could be related to a worse prognosis. One hundred and eight patients with severe TBI were studied by MR imaging in the first 30 days after trauma. Brain stem injury was categorized as anterior or posterior, hemorrhagic or nonhemorrhagic, and unilateral or bilateral. Outcome measures were GOSE and Barthel Index 6 months postinjury. The relationship between MR imaging findings of brain stem injuries, outcome, and disability was explored by univariate analysis. Prognostic capability of MR imaging findings was also explored by calculation of sensitivity, specificity, and area under the ROC curve for poor and good outcome. Brain stem lesions were detected in 51 patients, of whom 66% showed a poor outcome, as expressed by the GOSE scale. Bilateral involvement was strongly associated with poor outcome (P < .05). Posterior location showed the best discriminatory capability in terms of outcome (OR 6.8, P < .05) and disability (OR 4.8, P < .01). The addition of nonhemorrhagic and anterior lesions or unilateral injuries showed the highest odds and best discriminatory capacity for good outcome. The prognosis worsens in direct relationship to the extent of traumatic injury. Posterior and bilateral brain stem injuries detected at MR imaging are poor prognostic signs. Nonhemorrhagic injuries showed the highest positive predictive value for good outcome.

  19. Energy expenditure in children after severe traumatic brain injury.

    PubMed

    Mtaweh, Haifa; Smith, Rebecca; Kochanek, Patrick M; Wisniewski, Stephen R; Fabio, Anthony; Vavilala, Monica S; Adelson, P David; Toney, Nicole A; Bell, Michael J

    2014-03-01

    To evaluate energy expenditure in a cohort of children with severe traumatic brain injury. A prospective observational study. A pediatric neurotrauma center within a tertiary care institution. Mechanically ventilated children admitted with severe traumatic brain injury (Glasgow Coma Scale < 9) with a weight more than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, antiseizure prophylaxis, and a tiered-based system for treating intracranial hypertension. Within the first week after injury, indirect calorimetry measurements were performed daily when the patient's condition permitted. Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure obtained from indirect calorimetry was compared with predicted resting energy expenditure calculated from Harris-Benedict equation. Overall, measured energy expenditure/predicted resting energy expenditure averaged 70.2% ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75% ± 4.5% vs 68.9% ± 4.7%, respectively, p = 0.273). Furthermore, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4% ± 6% vs 64.7% ± 4.7% for the unfavorable outcome, p = 0.13). Contrary to previous work from several decades ago that suggested severe pediatric traumatic brain injury is associated with a hypermetabolic response (measured energy expenditure/predicted resting energy expenditure > 110%), our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe traumatic brain injury is the first step in development of rational nutritional support goals that might lead to improvements in outcome.

  20. Severe Traumatic Head Injury Affects Systemic Cytokine Expression

    PubMed Central

    LaPar, Damien J; Rosenberger, Laura H; Walters, Dustin M; Hedrick, Traci L; Swenson, Brian R; Young, Jeffrey S; Dossett, Lesly A; May, Addison K; Sawyer, Robert G

    2012-01-01

    Background The neuroimmunologic effect of traumatic head injury remains ill-defined. This study aimed to characterize systemic cytokine profiles among traumatically injured patients to assess the effect of traumatic head injury on the systemic inflammatory response. Study Design Over five years, 1,022 patients were evaluated from a multi-institutional trauma immunomodulatory database (TIMD). Patients were stratified by presence of severe head injury (SHI, Head ISS ≥ 4, n=335) versus non-severe head injury (NHI, Head ISS ≤ 3, n=687). Systemic cytokine expression was quantified by ELISA within 72 hours of admission. Patient factors, outcomes, and cytokine profiles were compared by univariate analyses. Results SHI patients were more severely injured with higher mortality despite similar ICU infection and ventilator associated pneumonia (VAP) rates. Expression of early pro-inflammatory cytokines, IL-6 (p<0.001) and tumor necrosis factor (TNF)-α (p=0.02), were higher among NHI patients, while expression of immunomodulatory cytokines, interferon-γ (p=0.01) and IL-12 (p=0.003), was higher in SHI patients. High TNF-α levels in NHI patients were associated with mortality (p=0.01), increased mechanical ventilation (p=0.02), and development of VAP (p=0.01). Alternatively, among SHI patients, high IL-2 levels were associated with survival, decreased mechanical ventilation, and absence of VAP. Conclusions The presence of severe traumatic head injury significantly alters systemic cytokine expression and exerts an immunomodulatory effect. Early recognition of these profiles may allow for targeted intervention to reduce patient morbidity and mortality. PMID:22342787

  1. Dysprosody after severe closed head injury: an acoustic analysis

    PubMed Central

    Samuel, C; Louis-Dreyfus, A; Couillet, J; Roubeau, B; Bakchine, S; Bussel, B; Azouvi, P

    1998-01-01

    OBJECTIVES—Neurological speech disorders (dysarthria and dysprosody) are known to be frequent sequelae after severe closed head injury. These disorders may dramatically alter communicative intent and accentuate social isolation. The aim was to provide an instrumental evaluation for prosodic production in a group of patients with severe closed head injury and to determine the correlations between prosodic production and neurobehavioural status.
METHODS—Fifteen patients, at the subacute stage after severe closed head injury, were studied and compared with 11 controls, matched for age, sex, and duration of education. Each subject was required to read aloud a French sentence "Je m'en vais samedi matin" (I am leaving saturday morning) under six different prosodic intonations (neutral, affirmation, interrogation, happiness, sadness, anger). The recorded sentences were analysed using a sound signal analysis software (Signalyse) allowing the measurement of signal intensity and fundamental frequency. Statistical analyses were carried out using repeated measures analysis of variance (ANOVA).
RESULTS—Patients with closed head injury were significantly less able than controls to modulate speech output (pitch and intensity) according to prosodic context. This deficit was particularly pronounced for the intonation feature of anger, question, and statement. No consistent correlations could be found between prosodic production and cognitive or behavioural data.
CONCLUSIONS—Acoustic analysis of pitch and intensity may show impairments of prosodic production after severe closed head injury, which may be useful in rehabilitation planning. This impairment does not seem to reflect the eventual cognitive and behavioural deficits of the patients, but rather a specific disorder of modulation of speech output.

 PMID:9576539

  2. Effects of injury severity and cognitive exaggeration on olfactory deficits in head injury compensation claims.

    PubMed

    Green, P; Iverson, G L

    2001-01-01

    The purpose of this study was to examine the relationship between exaggeration and scores on a test of olfactory discrimination in patients being assessed in connection with a claim for financial benefits. Participants were 448 patients referred to a private practice in Edmonton, Alberta, Canada for psychological or neuropsychological assessment, related to evaluation of impairment and disability resulting from a work-related or non-work related accident. All patients were involved in some form of compensation claim at the time of their evaluation. All patients completed two tests designed to detect exaggerated cognitive deficits, the Computerized Assessment of Response Bias (CARB) and the Word Memory Test (WMT) as part of their evaluation. The diagnostic groups included 322 head injury cases, varying from very minor to very severe. Normative data for the smell test were derived from 126 patients with orthopedic injuries who passed both the CARB and the WMT. Patients with more severe traumatic brain injuries were 10-12 times more likely to have olfactory deficits than persons with trivial to mild head injuries. In a subgroup of patients who failed either the CARB or the WMT, there was no relationship between injury severity and total scores on the smell test. Therefore, the dose-response relationship between brain injury severity and olfactory deficits is severely attenuated when patients who are probably exaggerating their cognitive deficits are included in the analyses. Those patients with trivial to mild head injuries who demonstrated adequate effort on both the CARB and the WMT were no more likely to show olfactory deficits than the non-head-injured orthopedic control subjects. Therefore, anosmia following mild traumatic brain injury should not be concluded from self-reports or from tests of smell unless tests of effort have been passed. Effort should also be controlled in group studies of olfaction.

  3. Prevalence and predictors of personality change after severe brain injury.

    PubMed

    Norup, Anne; Mortensen, Erik Lykke

    2015-01-01

    To investigate the prevalence of personality change after severe brain injury; to identify predictors of personality change; and to investigate whether personality change is associated with distress in family members. A longitudinal study of personality change. Rehabilitation unit. The study sample was composed of 22 pairs of patients with traumatic brain injury or nontraumatic brain injury (N=22) and their significant others (SOs). Not applicable. An SO completed the observer version of the NEO Five Factor Inventory rating the patient at discharge from hospital and 1 year after injury. The SOs were also asked to complete the anxiety and depression scales of the Symptom Checklist-90-Revised, rating their own emotional condition and health-related quality of life (HRQOL) as assessed by the 4 mental scales of the Medical Outcomes Study 36-Item Short-Form Health Survey. Of the sample, 59.1% experienced personality change after acquired brain injury, and the most dominant changes were observed in the personality traits of neuroticism, extraversion, and conscientiousness. Changes in neuroticism were most often observed in patients with frontal or temporal lesions. Generally, personality changes in patients were not associated with more distress and lower HRQOL in family members; however, change in patient agreeableness was associated with lower HRQOL on the role limitations-emotional scale. Personality change was observed in most patients with severe brain injury. Change in neuroticism was associated with frontal and temporal lesions. Generally, personality change was not associated with more distress and lower HRQOL in SOs. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children.

    PubMed

    Allen, Kimberly A

    2016-02-01

    Traumatic brain injuries (TBIs) in children are a major cause of morbidity and mortality worldwide. Severe TBIs account for 15,000 admissions annually and a mortality rate of 24% in children in the United States. The purpose of this article is to explore pathophysiologic events, examine monitoring techniques, and explain current treatment modalities and nursing care related to caring for children with severe TBI. The primary injury of a TBI is because of direct trauma from an external force, a penetrating object, blast waves, or a jolt to the head. Secondary injury occurs because of alterations in cerebral blood flow, and the development of cerebral edema leads to necrotic and apoptotic cellular death after TBI. Monitoring focuses on intracranial pressure, cerebral oxygenation, cerebral edema, and cerebrovascular injuries. If abnormalities are identified, treatments are available to manage the negative effects caused to the cerebral tissue. The mainstay treatments are hyperosmolar therapy; temperature control; cerebrospinal fluid drainage; barbiturate therapy; decompressive craniectomy; analgesia, sedation, and neuromuscular blockade; and antiseizure prophylaxis.

  5. Treatment consent capacity in patients with traumatic brain injury across a range of injury severity

    PubMed Central

    Triebel, K.L.; Martin, R.C.; Novack, T.A.; Dreer, L.; Turner, C.; Pritchard, P.R.; Raman, R.

    2012-01-01

    Objective: To investigate medical decision-making capacity (MDC) in patients with acute traumatic brain injury (TBI) across a range of injury severity. Methods: We evaluated MDC cross-sectionally 1 month after injury in 40 healthy controls and 86 patients with TBI stratified by injury severity (28 mild [mTBI], 15 complicated mild [cmTBI], 43 moderate/severe [msevTBI]). We compared group performance on the Capacity to Consent to Treatment Instrument and its 5 consent standards (expressing choice, reasonable choice, appreciation, reasoning, understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, severe impairment) on the consent standards were also assigned to each participant with TBI using cut scores referenced to control performance. Results: One month after injury, the mTBI group performed equivalently to controls on all consent standards. In contrast, the cmTBI group was impaired relative to controls on the understanding standard. No differences emerged between the mTBI and cmTBI groups. The msevTBI group was impaired on almost all standards relative to both control and mTBI groups, and on the understanding standard relative to the cmTBI group. Capacity compromise (mild/moderate or severe impairment ratings) on the 3 clinically complex standards (understanding, reasoning, appreciation) occurred in 10%–30% of patients with mTBI, 50% of patients with cmTBI, and 50%–80% of patients with msevTBI. Conclusions: One month following injury, MDC is largely intact in patients with mTBI, but is impaired in patients with cmTBI and msevTBI. Impaired MDC is prevalent in acute TBI and is strongly related to injury severity. PMID:22496195

  6. Bone contusion progression from traumatic knee injury: association of rate of contusion resolution with injury severity

    PubMed Central

    Pedersen, Douglas R; El-Khoury, Georges Y; Thedens, Dan R; Saad-Eldine, Mothana; Phisitkul, Phinit; Amendola, Annunziato

    2017-01-01

    Background Bone contusions are frequently encountered in magnetic resonance imaging (MRI) evaluation of knee anterior cruciate ligament (ACL) injuries. Their role as indicators of injury severity remains unclear, primarily due to indeterminate levels of joint injury forces and to a lack of preinjury imaging. Purpose The purpose of this study was to 1) quantify bone contusion pathogenesis following traumatic joint injuries using fixed imaging follow-ups, and 2) assess the feasibility of using longitudinal bone contusion volumes as an indicator of knee injury severity. Study design Prospective sequential MRI follow-ups of a goat cohort exposed to controlled stifle trauma in vivo were compared to parallel clinical MRI follow-ups of a human ACL tear patient series. Methods Reproducible cartilage impact damage of various energy magnitudes was applied in a survival goat model, coupled with partial resection of anterior portions of medial menisci. Both emulate injury patterns to the knee osteochondral structures commonly encountered in human ACL injury imaging as well as instability from resultant ligament laxity. Longitudinal clinical MRI sequences portrayed stifle bone contusion evolution through 6 months after the inciting event. Results In the first 2 weeks, biological response variability dominated the whole-joint response with no apparent correlation to trauma severity. Control goats subjected to partial meniscectomy alone exhibited minimal bone response. Thereafter, 0.6 J impact bone contusions portrayed a faster rate of resolution than those induced by 1.2 J cartilage impacts. Conclusion Bone contusion sizes combined with time of persistence are likely better measures of joint injury severity than isolated bone contusion volume. PMID:28203112

  7. Advances in surgical care: management of severe burn injury.

    PubMed

    White, Christopher E; Renz, Evan M

    2008-07-01

    Management of combat casualties with severe burns and associated traumatic injuries requires a coordinated interaction of surgical, critical care, and evacuation assets. These patients present enormous challenges to the entire medical system as a result of the severity of injury combined with the great distance required for transport to definitive care. The objective of this study was to review and highlight some of the advances in burn critical care experienced during recent combat operations. This review focuses on initial resuscitation, respiratory support, care of the burn wound, and long range evacuation. The authors conducted a search of the MEDLINE database and manual review of published articles and abstracts from national and international meetings in addition to Institute of Surgical Research Burn Center registry. Fluid resuscitation during the first 24 to 48 hrs after injury remains a significant challenge for all who manage burn casualties. Guidelines have been developed in an effort to standardize fluid resuscitation during this time. These guidelines along with the standardization of burn wound care and continued provider education have resulted in decreased morbidity and mortality in severely burned patients returning from war zones. This system of care for severely burned patients facilitates the transfer of the burn casualty between healthcare providers and facilities and is now being integrated into the catchment area for the Institute of Surgical Research Burn Center.

  8. Motorcycle petrol tanks and their role in severe pelvic injuries.

    PubMed

    de Peretti, F; Cambas, P M; Hovorka, I; Veneau, B; Argenson, C

    1994-05-01

    Between 1985 and 1992, nine patients who sustained severe pelvic lesions as a result of motorcycle accidents were admitted to and treated in the authors' department. In six of these nine cases the petrol tank of the motorcycle was one of the wounding agents, and all six patients had the same kind of motorcycle with an oversized petrol tank. All six patients had unstable pelvic lesions. In addition, four had subperitoneal haematomas which required multiple transfusions; five had perineal and/or genital lesions, and one had a ruptured membranous urethra. Severe pelvic injuries are rare, but can have after-effects which jeopardize the social and family life of the patients. A national epidemiological study would be useful to evaluate the frequency of such injuries and to draw conclusions leading to improved safety for motorcyclists.

  9. Mosaic Decisionmaking and Reemergent Agency after Severe Brain Injury.

    PubMed

    Fins, Joseph J

    2017-09-18

    In this article, I will discuss the challenge posed by the reemergent agency of individuals with severe brain injury whose ability to communicate has been partially restored by neuroprosthetics, drugs, and rehabilitation. Instead of categorically distinguishing patients as either competent or incompetent, these technologies necessitate a more nuanced approach to intermediate states of decisionmaking capacity. This indeterminacy is addressed through a mosaic approach to decisionmaking, which seeks to achieve a proportionate and prudent balance between unbridled self-determination and conventional surrogate representation.

  10. A novel rodent model of severe renal ischemia reperfusion injury.

    PubMed

    Whalen, Henry; Shiels, Paul; Littlejohn, Marc; Clancy, Marc

    2016-11-01

    Renal ischemia reperfusion injury (IRI) is a major problem, currently without treatments in clinical use. This reflects the failure of animal models to mimic the severity of IRI observed in clinical practice. Most described models lack both the ability to inflict a permanent reduction in renal function and the sensitivity to demonstrate the protective efficacy of different therapies in vivo. To test novel cell-based therapies, we have developed a model of renal IRI in Fisher 344 rats. Animals were subjected to 120 min of unilateral warm ischemia, during which they underwent an intra-renal artery infusion of therapeutic agents or vehicle. At either 2 or 6 weeks post-surgery, animals underwent terminal glomerular filtration rate (GFR) studies by inulin clearance to most accurately quantify renal function. Harvested kidneys underwent histological analysis. Compared to sham operations, saline treated animals suffered a long-term reduction in GFR of ≈50%. Histology revealed short- and long-term disruption of renal architecture. Despite the injury severity, post-operative animal losses are <5%. This model produces a severe, consistent renal injury that closely replicates the pathological processes encountered in clinical medicine. Renal artery infusion mimics the route likely employed in clinical transplantation, where the renal artery is accessible. Inulin clearance characterizes GFR, allowing full assessment of therapeutic intervention. This model is useful for screening therapeutic agents prior to testing in a transplant model. This reduces animal numbers needed to test drugs for clinical transplantation and allows for refinement of dosing schedules.

  11. [Brain arousal dysfunction in severe craniocerebral injury treated with acupuncture].

    PubMed

    Tu, Xiao-Hua; He, Zeng-Yi; Fu, Xiao; Chen, Yan-Hua; Chen, You-Lin; Kang, Shao-Jun

    2010-12-01

    To explore the early rehabilitation effect of acupuncture on brain arousal in severe craniocerebral injury. One hundred and two cases of severe craniocerebral injury were randomly divided into an observation group and a control group, 51 cases in each one. Based on the conventional nursing care in neurological external medicine, in observation group, acupuncture was applied at Shuigou (GV 26), Neiguan (PC 6) and Sanyinjiao (SP 6) mainly. In control group, functional electric stimulation was applied at stimulate the affected muscles of the upper limbs. Thirty days later, the lucid rate from coma, lucid interval and clinical efficacy were compared between two groups. RESULTS; The lucid rate from coma was 82.4% (42/51) in observation group, which was higher than 56.9% (29/51) in control group (P < 0.01). The lucid interval in observation group was shortened remarkably as compared with control group (P < 0.01), and the clinical efficacy was superior apparently to that in control group (P < 0.01). On the basis of conventional treatment, acupuncture intervention at early stage can accelerate the recovery of brain arousal function in patients with severe craniocerebral injury.

  12. Analysis of Severe Injuries Associated with Volleyball Activities.

    ERIC Educational Resources Information Center

    Gerberich, Susan Goodwin; And Others

    1987-01-01

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

  13. Amputation: Not a failure for severe lower extremity combat injury.

    PubMed

    van Dongen, Thijs T C F; Huizinga, Eelco P; de Kruijff, Loes G M; van der Krans, Arie C; Hoogendoorn, Jochem M; Leenen, Luke P H; Hoencamp, Rigo

    2017-02-01

    The use of improvised explosive devices is a frequent method of insurgents to inflict harm on deployed military personnel. Consequently, lower extremity injuries make up the majority of combat related trauma. The wounding pattern of an explosion is not often encountered in a civilian population and can lead to substantial disability. It is therefore important to study the impact of these lower extremity injuries and their treatment (limb salvage versus amputation) on functional outcome and quality of life. All Dutch repatriated service members receiving treatment for wounds on the lower extremity sustained in the Afghan theater between august 2005 and August 2014, were invited to participate in this observational cohort study. We conducted a survey regarding their physical and mental health using the Short Form health survey 36, EuroQoL 6 dimensions and Lower Extremity Functional Scale questionnaires. Results were collated in a specifically designed electronic database combined with epidemiology and hospital statistics gathered from the archive of the Central Military Hospital. Statistical analyses were performed to identify differences between combat and non-combat related injuries and between limb salvage treatment and amputation. In comparison with non-battle injury patients, battle casualties were significantly younger of age, sustained more severe injuries, needed more frequent operations and clinical rehabilitation. Their long-term outcome scores in areas concerning well-being, social and cognitive functioning, were significantly lower. Regarding treatment, amputees experienced higher physical well-being and less pain compared to those treated with limb salvage surgery. Sustaining a combat injury to the lower extremity can lead to partial or permanent dysfunction. However, wounded service members, amputees included, are able to achieve high levels of activity and participation in society, proving a remarkable resilience. These long-term results demonstrate

  14. Kinetics of humoral responsiveness in severe thermal injury.

    PubMed Central

    Rapaport, F T; Bachvaroff, R J

    1976-01-01

    Severe thermal injury has the capacity to increase the rate of generation of antibody-forming cells in mice. The intensity of stimulation appears to be proportional to the extent of injury. The effect has been observed in animals burned within 1 hr before or after sensitization with test antigen(s), and persists up to 14 days after injury. Thereafter, the stimulatory effect wanes, and disappears by the 21st day after burning. Responses to T-cell (thymus derived lymphocytes) dependent antigens (sheep erythrocytes; sheep erythrocytes coupled to TNP) and to antigens not requiring T and B-cell (bone marrow derived lymphocytes) cooperation (DNP-Ficoll) appear to be equally affected by thermal injury. The mechanisms underlying this form of enhanced antibody response are not clear. The data, however, support the possibility that the burn wound may release factor(s) capable of enhancing humoral responsiveness in the injured animal. Such factor(s) do not appear to be endotoxins. PMID:945719

  15. [Recreational or professional participants in Nordic skiing. Differences in injury patterns and severity of injuries].

    PubMed

    Ketterl, R

    2014-01-01

    A total of 441 Nordic skiing injuries were observed and analysed for a period of two winter seasons. The data showed that athletes in squads (0.02/1000 days) or professional clubs (0.09/1000 days) have lower injury risks compared to those doing Nordic skiing in their leisure time (0.51/1000 days). Amongst recreational athletes, women (0.65/1000 days) sustain trauma more frequently than men (0.40/1000 days). In professional athletes, the upper limb is commonly injured, whereas there are fewer head and trunk injuries. Furthermore the injured in this group are younger and have less severe injuries. Recreational athletes more often injure their lower limb and 20 % have injuries to the head and trunk. Those injured in this group are older and have a higher percentage of overweight people, are not well trained and have more severe or complex injuries compared to professionals.

  16. The impact-acceleration model of head injury: injury severity predicts motor and cognitive performance after trauma.

    PubMed

    Beaumont, A; Marmarou, A; Czigner, A; Yamamoto, M; Demetriadou, K; Shirotani, T; Marmarou, C; Dunbar, J

    1999-12-01

    This study examines neuropsychological dysfunction after varying severities of the Impact Acceleration Model of diffuse traumatic brain injury. Adult rats (340 g-400 g) were divided into five groups, and exposed to varying degrees of Impact Acceleration Injury (1 m, 2 m, 2.1 m/500 g and second insult). After injury, animals were allowed to recover; acute neurological reflexes, beam walk score, beam balance score, inclined plane score, and Morris Water Maze score were then assessed at multiple time points. Injury of all severities caused significant motor and cognitive deficits. With milder injuries these effects were transient; however, with more severe injuries no recovery in function was seen. The addition of hypoxia and hypotension made a moderate injury worse than a severe injury. The acute neurological reflexes, the beam balance test and the inclined plane test distinguished between the more severely injured groups, but were affected less by mild injury. The beam walk test was sensitive to mild injury, but appeared unable to distinguish between the severe groups. The Morris Water Maze was sensitive for all injury groups, but appeared to adopt a different response profile with secondary insult. This study has for the first time characterized the degree of motor and cognitive deficits in rodents exposed to differing severities of Impact Acceleration Injury. These data confirm that the tests considered, and the Injury Model used, provide a useful system for the consideration of potential therapies which might ameliorate neuropsychological deficits in diffuse brain injury.

  17. Variation in seizure prophylaxis in severe pediatric traumatic brain injury.

    PubMed

    Ostahowski, Paige J; Kannan, Nithya; Wainwright, Mark S; Qiu, Qian; Mink, Richard B; Groner, Jonathan I; Bell, Michael J; Giza, Christopher C; Zatzick, Douglas F; Ellenbogen, Richard G; Boyle, Linda Ng; Mitchell, Pamela H; Vavilala, Monica S

    2016-10-01

    OBJECTIVE Posttraumatic seizure is a major complication following traumatic brain injury (TBI). The aim of this study was to determine the variation in seizure prophylaxis in select pediatric trauma centers. The authors hypothesized that there would be wide variation in seizure prophylaxis selection and use, within and between pediatric trauma centers. METHODS In this retrospective multicenter cohort study including 5 regional pediatric trauma centers affiliated with academic medical centers, the authors examined data from 236 children (age < 18 years) with severe TBI (admission Glasgow Coma Scale score ≤ 8, ICD-9 diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head Abbreviated Injury Scale score ≥ 3) who received tracheal intubation for ≥ 48 hours in the ICU between 2007 and 2011. RESULTS Of 236 patients, 187 (79%) received seizure prophylaxis. In 2 of the 5 centers, 100% of the patients received seizure prophylaxis medication. Use of seizure prophylaxis was associated with younger patient age (p < 0.001), inflicted TBI (p < 0.001), subdural hematoma (p = 0.02), cerebral infarction (p < 0.001), and use of electroencephalography (p = 0.023), but not higher Injury Severity Score. In 63% cases in which seizure prophylaxis was used, the patients were given the first medication within 24 hours of injury, and 50% of the patients received the first dose in the prehospital or emergency department setting. Initial seizure prophylaxis was most commonly with fosphenytoin (47%), followed by phenytoin (40%). CONCLUSIONS While fosphenytoin was the most commonly used medication for seizure prophylaxis, there was large variation within and between trauma centers with respect to timing and choice of seizure prophylaxis in severe pediatric TBI. The heterogeneity in seizure prophylaxis use may explain the previously observed lack of relationship between seizure prophylaxis and outcomes.

  18. Hemodynamic and Metabolic Correlates of Perinatal White Matter Injury Severity

    PubMed Central

    Riddle, Art; Maire, Jennifer; Cai, Victor; Nguyen, Thuan; Gong, Xi; Hansen, Kelly; Grafe, Marjorie R.; Hohimer, A. Roger; Back, Stephen A.

    2013-01-01

    Background and Purpose Although the spectrum of perinatal white matter injury (WMI) in preterm infants is shifting from cystic encephalomalacia to milder forms of WMI, the factors that contribute to this changing spectrum are unclear. We hypothesized that the variability in WMI quantified by immunohistochemical markers of inflammation could be correlated with the severity of impaired blood oxygen, glucose and lactate. Methods We employed a preterm fetal sheep model of in utero moderate hypoxemia and global severe but not complete cerebral ischemia that reproduces the spectrum of human WMI. Since there is small but measurable residual brain blood flow during occlusion, we sought to determine if the metabolic state of the residual arterial blood was associated with severity of WMI. Near the conclusion of hypoxia-ischemia, we recorded cephalic arterial blood pressure, blood oxygen, glucose and lactate levels. To define the spectrum of WMI, an ordinal WMI rating scale was compared against an unbiased quantitative image analysis protocol that provided continuous histo-pathological outcome measures for astrogliosis and microgliosis derived from the entire white matter. Results A spectrum of WMI was observed that ranged from diffuse non-necrotic lesions to more severe injury that comprised discrete foci of microscopic or macroscopic necrosis. Residual arterial pressure, oxygen content and blood glucose displayed a significant inverse association with WMI and lactate concentrations were directly related. Elevated glucose levels were the most significantly associated with less severe WMI. Conclusions Our results suggest that under conditions of hypoxemia and severe cephalic hypotension, WMI severity measured using unbiased immunohistochemical measurements correlated with several physiologic parameters, including glucose, which may be a useful marker of fetal response to hypoxia or provide protection against energy failure and more severe WMI. PMID:24416093

  19. Evidence to support mitochondrial neuroprotection, in severe traumatic brain injury.

    PubMed

    Gajavelli, Shyam; Sinha, Vishal K; Mazzeo, Anna T; Spurlock, Markus S; Lee, Stephanie W; Ahmed, Aminul I; Yokobori, Shoji; Bullock, Ross M

    2015-04-01

    Traumatic brain injury (TBI) is still the leading cause of disability in young adults worldwide. The major mechanisms - diffuse axonal injury, cerebral contusion, ischemic neurological damage, and intracranial hematomas have all been shown to be associated with mitochondrial dysfunction in some form. Mitochondrial dysfunction in TBI patients is an active area of research, and attempts to manipulate neuronal/astrocytic metabolism to improve outcomes have been met with limited translational success. Previously, several preclinical and clinical studies on TBI induced mitochondrial dysfunction have focused on opening of the mitochondrial permeability transition pore (PTP), consequent neurodegeneration and attempts to mitigate this degeneration with cyclosporine A (CsA) or analogous drugs, and have been unsuccessful. Recent insights into normal mitochondrial dynamics and into diseases such as inherited mitochondrial neuropathies, sepsis and organ failure could provide novel opportunities to develop mitochondria-based neuroprotective treatments that could improve severe TBI outcomes. This review summarizes those aspects of mitochondrial dysfunction underlying TBI pathology with special attention to models of penetrating traumatic brain injury, an epidemic in modern American society.

  20. Abbreviated Injury Scale: not a reliable basis for summation of injury severity in trauma facilities?

    PubMed

    Ringdal, Kjetil G; Skaga, Nils Oddvar; Hestnes, Morten; Steen, Petter Andreas; Røislien, Jo; Rehn, Marius; Røise, Olav; Krüger, Andreas J; Lossius, Hans Morten

    2013-05-01

    Injury severity is most frequently classified using the Abbreviated Injury Scale (AIS) as a basis for the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), which are used for assessment of overall injury severity in the multiply injured patient and in outcome prediction. European trauma registries recommended the AIS 2008 edition, but the levels of inter-rater agreement and reliability of ISS and NISS, associated with its use, have not been reported. Nineteen Norwegian AIS-certified trauma registry coders were invited to score 50 real, anonymised patient medical records using AIS 2008. Rater agreements for ISS and NISS were analysed using Bland-Altman plots with 95% limits of agreement (LoA). A clinically acceptable LoA range was set at ± 9 units. Reliability was analysed using a two-way mixed model intraclass correlation coefficient (ICC) statistics with corresponding 95% confidence intervals (CI) and hierarchical agglomerative clustering. Ten coders submitted their coding results. Of their AIS codes, 2189 (61.5%) agreed with a reference standard, 1187 (31.1%) real injuries were missed, and 392 non-existing injuries were recorded. All LoAs were wider than the predefined, clinically acceptable limit of ± 9, for both ISS and NISS. The joint ICC (range) between each rater and the reference standard was 0.51 (0.29,0.86) for ISS and 0.51 (0.27,0.78) for NISS. The joint ICC (range) for inter-rater reliability was 0.49 (0.19,0.85) for ISS and 0.49 (0.16,0.82) for NISS. Univariate linear regression analyses indicated a significant relationship between the number of correctly AIS-coded injuries and total number of cases coded during the rater's career, but no significant relationship between the rater-against-reference ISS and NISS ICC values and total number of cases coded during the rater's career. Based on AIS 2008, ISS and NISS were not reliable for summarising anatomic injury severity in this study. This result indicates a limitation in their use

  1. Metacognitive monitoring in moderate and severe traumatic brain injury.

    PubMed

    Chiou, Kathy S; Carlson, Richard A; Arnett, Peter A; Cosentino, Stephanie A; Hillary, Frank G

    2011-07-01

    The ability to engage in self-reflective processes is a capacity that may be disrupted after neurological compromise; research to date has demonstrated that patients with traumatic brain injury (TBI) show reduced awareness of their deficits and functional ability compared to caretaker or clinician reports. Assessment of awareness of deficit, however, has been limited by the use of subjective measures (without comparison to actual performance) that are susceptible to report bias. This study used concurrent measurements from cognitive testing and confidence judgments about performance to investigate in-the-moment metacognitive experiences after moderate and severe traumatic brain injury. Deficits in metacognitive accuracy were found in adults with TBI for some but not all indices, suggesting that metacognition may not be a unitary construct. Findings also revealed that not all indices of executive functioning reliably predict metacognitive ability.

  2. Learning people's names following severe closed-head injury.

    PubMed

    Milders, M

    1998-04-01

    Although problems remembering people's names rank highly among the subjective complaints of patients with closed-head injuries, very few studies have examined their memory for people's names by objective measurements. An experiment is reported in which patients with severe closed-head injuries and normal controls learned the same set of words, either as names or as possessions, for unfamiliar faces. Name learning proved to be impaired in the patients. Patient recall of meaningless names and possessions which were described by nonwords was equally poor. The patients, but not the controls, recalled significantly fewer names than possessions if these items were described by concrete nouns. This last finding suggests that the patients' problems with learning people's names can not be fully explained by a general verbal learning impairment.

  3. Injury severity related to overturn characteristics of tractors.

    PubMed

    Myers, Melvin L; Cole, Henry P; Westneat, Susan C

    2009-01-01

    Early studies of injuries associated with overturns indicate that more fatalities occurred when a tractor overturned beyond 90 degrees (continuous roll) relative to the impact plane. Recently, the principle of preventing continuous rolls has re-emerged for the protection of riding lawnmower operators. Related to tractors, a population-based study was conducted that compared the severity of fatal and nonfatal injuries between a 90 degrees and continuous roll for tractors equipped with rollover protective structures (ROPS) and not equipped with a ROPS (non- ROPS). In 2002, the Kentucky Farm Tractor Overturn Survey was administered to an 8% random sample (6,063) of Kentucky farm operators. The farmers responded to questions that differentiated between the types of overturns and operator injury outcomes for ROPS-equipped and non-ROPS tractors during overturn events. Overturn characteristics were collected that included 90 degrees to the side, beyond 90 degrees to the side, and to the rear for both ROPS-equipped and non-ROPS tractors. Of the 541 overturns reported in this study, 535 (99%) of the respondents reported the most recent overturn characteristics of the tractor: 92 (17%) were ROPS-equipped and 443 (83%) were non-ROPS. For side overturns, 67% of the rolls occurred with ROPS-equipped tractors, and 54% occurred with non-ROPS tractors. The percentages of deaths related to rolls to the side for ROPS-equipped and non-ROPS tractors were, respectively, 1.6% and 3.7%. There was one (2%) deaths related to 90 degrees rolls for ROPS-equipped tractors, whereas for continuous rolls there were 6.4% fatalities related to side overturns, 13% resulted in non-fatal injuries with an average of 1 day of hospitalization for ROPS-equipped tractors, and 39% resulted in non-fatal injuries with an average of 18 days of hospitalization for non-ROPS tractors. The results from this study indicated that a ROPS was more effective at stopping an overturn at 90 degrees than no ROPS, with an

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

    PubMed

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

    2013-01-01

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

  5. Pedestrian and Pedalcyclist Injury Costs in the United States by Age and Injury Severity

    PubMed Central

    Miller, Ted R.; Zaloshnja, Eduard; Lawrence, Bruce A.; Crandall, Jeff; Ivarsson, Johan; Finkelstein, A. Eric

    2004-01-01

    This paper estimates the incidence, unit costs, and annual costs of pedestrian and pedalcycle crash injuries in the United States. It includes medical care costs, household and wage work losses, and the value of pain, suffering, and lost quality of life. The estimates are broken down by body region and severity. They rely heavily on data from the health care system. Costs of pedestrian and pedalcycle injuries in 2000 will total $40 billion over the lifetimes of the injured. Most pedalcyclist injury costs and half of pedestrian injury costs do not involve motor vehicles. Youth ages 5–14 face greater annual risks when walking or driving their own pedaled vehicles than when being driven. Children under age 5 experience higher costs than their elders when injured as pedestrians. Our results suggest European and Japanese component tests used to design pedestrian injury countermeasures for motor vehicles are too narrow. Separate lower limb testing is needed for younger children. Testing for torso/vertebral column injury of adults also seems desirable. PMID:15319130

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  8. An analysis of fatal and non-fatal injuries and injury severity factors among electric power industry workers.

    PubMed

    Fordyce, Tiffani A; Leonhard, Megan J; Watson, Heather N; Mezei, Gabor; Vergara, Ximena P; Krishen, Lovely

    2016-11-01

    The electric power industry represents a unique subset of the U.S. workforce. We aimed to evaluate the relationships between occupational category, nature of injury, and injury severity among electric power industry workers. The Occupational Health and Safety Database (1995-2013) was used to calculate injury rates, assess patterns of injury severity, and identify at-risk occupations in this population. Over the surveillance period, a total of 63,193 injuries were reported. Overall, and severe injury rates were 3.20 and 0.52 per 100 employee-years, respectively. The fatal injury rate was 3.29 per 100,000 employee-years. Line workers experienced the highest risk for fatal injuries and second highest for non-fatal severe injuries, following meter readers. The most severe non-fatal injuries were hernia and rupture; multiple injuries; and CTD/RSI. Fatal injuries were most commonly associated with vehicle collisions and contact with electric current. Industry specific surveillance and interventions tailored to high-risk occupations are needed to further reduce severe injuries in this population. Am. J. Ind. Med. 59:948-958, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  9. Cannabis Use Has Negligible Effects Following Severe Traumatic Injury.

    PubMed

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

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

  10. Severe osteomyelitis caused by Myceliophthora thermophila after a pitchfork injury

    PubMed Central

    Destino, Lauren; Sutton, Deanna A; Helon, Anna L; Havens, Peter L; Thometz, John G; Willoughby, Rodney E; Chusid, Michael J

    2006-01-01

    Background Traumatic injuries occurring in agricultural settings are often associated with infections caused by unusual organisms. Such agents may be difficult to isolate, identify, and treat effectively. Case report A 4-year-old boy developed an extensive infection of his knee and distal femur following a barnyard pitchfork injury. Ultimately the primary infecting agent was determined to be Myceliophthora thermophila, a thermophilic melanized hyphomycete, rarely associated with human infection, found in animal excreta. Because of resistance to standard antifungal agents including amphotericin B and caspofungin, therapy was instituted with a prolonged course of terbinafine and voriconazole. Voriconazole blood levels demonstrated that the patient required a drug dosage (13.4 mg/kg) several fold greater than that recommended for adults in order to attain therapeutic blood levels. Conclusion Unusual pathogens should be sought following traumatic farm injuries. Pharmacokinetic studies may be of critical importance when utilizing antifungal therapy with agents for which little information exists regarding drug metabolism in children. PMID:16961922

  11. Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution.

    PubMed

    Esnault, Pierre; Cardinale, Mickaël; Boret, Henry; D'Aranda, Erwan; Montcriol, Ambroise; Bordes, Julien; Prunet, Bertrand; Joubert, Christophe; Dagain, Arnaud; Goutorbe, Philippe; Kaiser, Eric; Meaudre, Eric

    2016-07-29

    OBJECTIVE Blunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI. METHODS The authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation. RESULTS In total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9-34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7-80.9), cervical spine injury (OR 13.5, 95% CI 3.1-59.4), thoracic trauma (OR 7.3, 95% CI 1.1-51.2), and hepatic lesion (OR 13.3, 95% CI 2.1-84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication. CONCLUSIONS Blunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.

  12. Discourse macrolevel processing after severe pediatric traumatic brain injury.

    PubMed

    Chapman, Sandra Bond; Sparks, Garen; Levin, Harvey S; Dennis, Maureen; Roncadin, Caroline; Zhang, Lifang; Song, James

    2004-01-01

    The purpose of this study was to determine if discourse macrolevel processing abilities differed between children with severe traumatic brain injury (TBI) at least 2 years postinjury and typically developing children. Twenty-three children had sustained a severe TBI either before the age of 8 (n = 10) or after the age of 8 (n = 13). The remaining 32 children composed a control group of typically developing peers. The groups' summaries and interpretive lesson statements were analyzed according to reduction and transformation of narrative text information. Compared to the control group, the TBI group condensed the original text information to a similar extent. However, the TBI group produced significantly less transformed information during their summaries, especially those children who sustained early injuries. The TBI and control groups did not significantly differ in their production of interpretive lesson statements. In terms of related skills, discourse macrolevel summarization ability was significantly related to problem solving but not to lexical or sentence level language skills or memory. Children who sustain a severe TBI early in childhood are at an increased risk for persisting deficits in higher level discourse abilities, results that have implications for academic success and therapeutic practices.

  13. Management of severe spinal cord injury following hyperbaric exposure.

    PubMed

    Mathew, Bruce; Laden, Gerard

    2015-09-01

    management protocols are based largely on anecdote and transferred evidence from conventional cord trauma, as the low numbers and sporadic nature of DCI in divers makes RCTs nigh on impossible. Unfortunately even with best management, some patients are left with significant neurological deficit. The 'iceberg phenomenon', occurs when patients with DCI of the cord make a good neurological recovery but actually have profound cord damage as revealed in one case some four years later at post mortem and another example in a diver who developed late functional deterioration due to loss of neuronal reserve. This clinical evidence, together with animal study data, support the notion that even a modest preservation of spinal cord axons is associated with significant improvement in neurological outcome. In the light of the positive level two evidence in the vascular literature that CSF drainage limits 'secondary' injury thereby improving neurological outcome, we propose that centres with appropriate clinical experience consider using lumbar CSF drainage to normalise SCPP, as an adjunct to the conventional treatment of severe spinal cord DCI. Divers with severe spinal cord DCI are generally in the most productive years of their lives and, given the potentially devastating impact of this condition, should be given the benefit of any possible adjuvant treatment that may serve to improve long-term outcome.

  14. Inaccurate early assessment of neurological severity in head injury.

    PubMed

    Stocchetti, Nino; Pagan, Francesca; Calappi, Emiliana; Canavesi, Katia; Beretta, Luigi; Citerio, Giuseppe; Cormio, Manuela; Colombo, Angelo

    2004-09-01

    Intubation, which requires sedation and myorelaxants, may lead to inaccurate neurological evaluation of severely head-injured patients. Aims of this study were to describe the early clinical evolution of traumatic brain injured (TBI) patients admitted to intensive care unit (ICU), to identify cases of over-estimated neurological severity, and to quantify the risk factors for this over-estimation. A total of 753 TBI patients consecutively admitted to ICU of three academic neurosurgical hospitals (NSH) were assessed. Cases whose severity was potentially over-estimated were identified by four criteria and indicated as "mistakenly severe" (MS): (1) no surgical intracranial masses; (2) could not follow commands at neurological assessment; (3) were dismissed from the ICU in < or =3 days to a regular ward; and (4) had regained the ability to obey commands. A total of 675 patients were intubated and/or sedated-paralyzed at the post-stabilization evaluation. In all, 304 patients had surgically treated intracranial masses. Among the 449 non-surgical cases, 58 patients fulfilling the criteria for MS were identified. The main features distinguishing MS from truly severe cases were younger age, higher Glasgow Coma Scale (GCS) score at all time points, Marshall classification of Computerized Tomographic (CT) scan mostly Diffuse Injury I and II, fewer pupillary abnormalities, and a lower frequency of hypoxia, hypotension, and extra-cranial injuries. In a certain proportion of non-surgical TBI patients, mostly intubated and sedated, neurological examination is difficult and severity can be over-estimated. Risk factors for this inaccurate evaluation can be identified, and clinical decisions should be based on further examination.

  15. The Military Injury Severity Score (mISS): A better predictor of combat mortality than Injury Severity Score (ISS).

    PubMed

    Le, Tuan D; Orman, Jean A; Stockinger, Zsolt T; Spott, Mary Ann; West, Susan A; Mann-Salinas, Elizabeth A; Chung, Kevin K; Gross, Kirby R

    2016-07-01

    The Military Injury Severity Score (mISS) was developed to better predict mortality in complex combat injuries but has yet to be validated. US combat trauma data from Afghanistan and Iraq from January 1, 2003, to December 31, 2014, from the US Department of Defense Trauma Registry (DoDTR) were analyzed. Military ISS, a variation of the ISS, was calculated and compared with standard ISS scores.Receiver operating characteristic curve, area under the curve, and Hosmer-Lemeshow statistics were used to discriminate and calibrate between mISS and ISS. Wilcoxon-Mann-Whitney, t test and χ tests were used, and sensitivity and specificity calculated. Logistic regression was used to calculate the likelihood of mortality associated with levels of mISS and ISS overall. Thirty thousand three hundred sixty-four patients were analyzed. Most were male (96.8%). Median age was 24 years (interquartile range [IQR], 21-29 years). Battle injuries comprised 65.3%. Penetrating (39.5%) and blunt (54.2%) injury types and explosion (51%) and gunshot wound (15%) mechanisms predominated. Overall mortality was 6.0%.Median mISS and ISS were similar in survivors (5 [IQR, 2-10] vs. 5 [IQR, 2-10]) but different in nonsurvivors, 30 (IQR, 16-75) versus 24 (IQR, 9-23), respectively (p < 0.0001). Military ISS and ISS were discordant in 17.6% (n = 5,352), accounting for 56.2% (n = 1,016) of deaths. Among cases with discordant severity scores, the median difference between mISS and ISS was 9 (IQR, 7-16); range, 1 to 59. Military ISS and ISS shared 78% variability (R = 0.78).Area under the curve was higher in mISS than in ISS overall (0.82 vs. 0.79), for battle injury (0.79 vs. 0.76), non-battle injury (0.87 vs. 0.86), penetrating (0.81 vs. 0.77), blunt (0.77 vs. 0.75), explosion (0.81 vs. 0.78), and gunshot (0.79 vs. 0.73), all p < 0.0001. Higher mISS and ISS were associated with higher mortality. Compared with ISS, mISS had higher sensitivity (81.2 vs. 63.9) and slightly lower specificity (80.2 vs. 85

  16. Application of a facial injury severity scale in craniomaxillofacial trauma.

    PubMed

    Bagheri, Shahrokh C; Dierks, Eric J; Kademani, Deepak; Holmgren, Eric; Bell, R Bryan; Hommer, Louis; Potter, Bryce E

    2006-03-01

    To establish a Facial Injury Severity Scale (FISS) that correlates with patient outcome and provides a practical tool for communication between clinicians and healthcare personnel for management of facial trauma. All patients presenting to the Emergency Department (ED) at Legacy Emanuel Hospital (Level One Trauma Center) in Portland, Oregon between 01/1993 and 6/2003 with facial fractures with or without concomitant non-facial injuries where identified retrospectively. The diagnosis and treatment of all facial fractures were conducted by the Oral and Maxillofacial Surgery (OMFS) service. The following data were collected; age, gender, mechanism of injury, detailed diagnosis of facial fractures, disposition, and the length of hospital stay (LOS). The hospital operating room charges (ORC) for the treatment of each patient's facial fractures were also obtained. We designed the FISS to be a numeric value composed of the sum of the individual fractures and fracture patterns in a patient. Not all fractures of the face are weighted equally in the FISS because not all fracture patterns are equal in severity. Individual fracture points within the scale were optimized to result in the highest correlation. A total of 1,115 patient admissions to the ED with blunt or penetrating maxillofacial injuries were identified and reviewed. Full information on operating room charges (ORC) was available for 247 patients (average age: 32, SD +/- 17; range, 2 to 84; male:female, 3:1; blunt:penetrating, 232:15). The FISS scores were calculated for each patient (average FISS: 4.4, SD +/- 2.7; range, 1 to 13). Hospital ORC for the treatment of each patient's maxillofacial injuries were obtained from the hospital financial services (average ORC: 4,135 dollars, SD +/- 2,832 dollars; range, 845 dollars to 18,974 dollars). A significant correlation was identified between the FISS and the ORC (R value = .82). The length of stay was significantly associated with the FISS (t = 4.7, 245 degrees of

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

    PubMed

    Dénes, Zoltán

    2004-10-07

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

  18. Urban crash-related child pedestrian injury incidence and characteristics associated with injury severity.

    PubMed

    Koopmans, Joy M; Friedman, Lee; Kwon, Soyang; Sheehan, Karen

    2015-04-01

    Describe age-based urban pedestrian versus auto crash characteristics and identify crash characteristics associated with injury severity. Secondary analysis of the 2004-2010 National Highway and Traffic Safety Administration database for Illinois. All persons in Chicago crashes with age data who were listed as pedestrians (n=7175 child age ≤19 yo, n=16,398 adult age ≥20 yo) were included. Incidence and crash characteristics were analyzed by age groups and year. Main outcome measures were incidence, crash setting, and injury severity. Multivariate logistic regression analysis was performed to estimate injury severity by crash characteristics. Overall incidence was higher for child (146.6 per 100,000) versus adult (117.3 per 100,000) pedestrians but case fatality rate was lower (0.7% for children, 1.7% for adults). Child but not adult pedestrian injury incidence declined over time (trend test p<0.0001 for <5 yo, 5-9 yo, and 10-14 yo; p<0.05 for 15-19 yo, p=0.96 for ≥20 yo). Most crashes for both children and adults took place during optimal driving conditions. Injuries were more frequent during warmer months for younger age groups compared to older (χ(2)p<0.001). Midblock crashes increased as age decreased (p<0.0001 for trend). Most crashes occurred at sites with sub-optimal traffic controls but varied by age (p<0.0001 for trend). Crashes were more likely to be during daylight on dry roads in clear weather conditions for younger age groups compared to older (χ(2)p<0.001). Daylight was associated with less severe injury (child OR 0.93, 95% CI 0.87-0.98; adult OR 0.90, 95% CI 0.87-0.93). The incidence of urban pedestrian crashes declined over time for child subgroups but not for adults. The setting of pedestrian crashes in Chicago today varies by age but is similar to that seen in other urban locales previously. Injuries for all age groups tend to be less severe during daylight conditions. Age-based prevention efforts may prove beneficial. Copyright © 2015

  19. Thalamic and extrathalamic mechanisms of consciousness after severe brain injury.

    PubMed

    Lutkenhoff, Evan S; Chiang, Jeffrey; Tshibanda, Luaba; Kamau, Evelyn; Kirsch, Murielle; Pickard, John D; Laureys, Steven; Owen, Adrian M; Monti, Martin M

    2015-07-01

    What mechanisms underlie the loss and recovery of consciousness after severe brain injury? We sought to establish, in the largest cohort of patients with disorders of consciousness (DOC) to date, the link between gold standard clinical measures of awareness and wakefulness, and specific patterns of local brain pathology-thereby possibly providing a mechanistic framework for patient diagnosis, prognosis, and treatment development. Structural T1-weighted magnetic resonance images were collected, in a continuous sample of 143 severely brain-injured patients with DOC (and 96 volunteers), across 2 tertiary expert centers. Brain atrophy in subcortical regions (bilateral thalamus, basal ganglia, hippocampus, basal forebrain, and brainstem) was assessed across (1) healthy volunteers and patients, (2) clinical entities (eg, vegetative state, minimally conscious state), (3) clinical measures of consciousness (Coma Recovery Scale-Revised), and (4) injury etiology. Compared to volunteers, patients exhibited significant atrophy across all structures (p < 0.05, corrected). Strikingly, we found almost no significant differences across clinical entities. Nonetheless, the clinical measures of awareness and wakefulness upon which differential diagnosis rely were systematically associated with tissue atrophy within thalamic and basal ganglia nuclei, respectively; the basal forebrain was atrophied in proportion to patients' response to sensory stimulation. In addition, nontraumatic injuries exhibited more extensive thalamic atrophy. These findings provide, for the first time, a grounding in pathology for gold standard behavior-based clinical measures of consciousness, and reframe our current models of DOC by stressing the different links tying thalamic mechanisms to willful behavior and extrathalamic mechanisms to behavioral (and electrocortical) arousal. © 2015 American Neurological Association.

  20. Evaluation of motorcycle safety strategies using the severity of injuries.

    PubMed

    Jung, Soyoung; Xiao, Qin; Yoon, Yoonjin

    2013-10-01

    The growth of motorcycle fatalities in California has been especially prominent, specifically with regard to the 24 and under age group and those aged 45-54. This research quantitatively examined factors associated with motorcyclist fatalities and assessed strategies that could improve motorcyclist safety, specifically focusing on the two age groups mentioned above. Severity of injury was estimated separately for both age groups with multinomial logit models and pseudo-elasticity using motorcycle-related collision data that was collected between 2005 and 2009. The results were compared with motorcyclists aged 35-44, a group that shows a consistent trend of fatalities. This research found that lack or improper use of helmets, victim ejection, alcohol/drug effects, collisions (head-on, broadside, hit-object), and truck involvement were more likely to result in fatal injuries regardless of age group. Weekend and non-peak hour activity was found to have a strong effect in both the younger and older age groups. Two factors, movement of running off the road preceding a collision and multi-vehicle involvement, were found to be statistically significant factors in increasing older motorcyclist fatalities. Use of street lights in the dark was found to decrease the probability of severe injury for older motorcyclists. Driver type of victim, at-fault driver, local road, and speed violation were significant factors in increasing the fatalities of younger motorcyclists. Road conditions and collision location factors were not found to be statistically significant to motorcyclist fatalities. Based on the statistically significant factors identified in this research, the following safety strategies appear to be effective methods of reducing motorcyclist fatalities: public education of alcohol use, promoting helmet use, enforcing heavy vehicle and speed violations, improving roadway facilities, clearer roadway guidance and street lighting systems, and motorcyclist training.

  1. The King's Outcome Scale for Childhood Head Injury and injury severity and outcome measures in children with traumatic brain injury.

    PubMed

    Calvert, Sophie; Miller, Helen E; Curran, Andrew; Hameed, Biju; McCarter, Renée; Edwards, Richard J; Hunt, Linda; Sharples, Peta Mary

    2008-06-01

    The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The male:female ratio was 1.8:1. The mean age was 11 years 10 months (SD 3.6, range 5-16y). Discharge KOSCHI categories were good (n=34), moderate (n=39), severe (n=6), and unclassifiable (n=2). KOSCHI category correlated strongly with admission Glasgow Coma Score, length of hospital stay, and post-traumatic amnesia. It also correlated significantly with Verbal IQ and Performance IQ (Wechsler); measures of attention; health status (Health Utilities Index [HUI]); health-related quality of life (Pediatric Quality of Life Inventory [PedsQL]); depressive symptoms (Birleson Depression Scale) assessed within 3 months postTBI; and with Verbal IQ, selective attention (map mission), and HUI and PedsQL domains assessed at least 6 months post-TBI discharge. KOSCHI did not correlate with behaviour or executive function. We conclude that the KOSCHI scored at hospital discharge correlates with severity of injury and some cognitive, health status, and HRQL outcomes early after TBI. It is not helpful at predicting later difficulties, or behavioural and emotional problems.

  2. Common Laundry Detergent Ingredient May Help Preserve Muscle Tissue After Severe Injury

    MedlinePlus

    ... historical) Common Laundry Detergent Ingredient May Help Preserve Muscle Tissue After Severe Injury A compound commonly found in household laundry detergents may help preserve muscle tissue after a severe injury, according to research ...

  3. Considering the Patient’s Perspective in the Injury Severity Score

    PubMed Central

    Geiger, Angie A.; Brasel, Karen J.; deRoon-Cassini, Terri

    2016-01-01

    Background The Injury Severity Score (ISS) is an assessment of anatomical threat to life, but does not correlate with severity perceived by the patient. The purpose of this study was to assess how and why patients assign perceived injury severity. Methods One hundred twenty consecutive patients were asked “Would you say your injury is mild, moderate, severe or very severe?” and “Why do you rate your injury that way?” Explanations were categorized and compared by age, perceived injury severity, and injury mechanism. Categories were pain, injury assessment, injury description, and all others. The two age groups used were <55 and ≥55 years old. Perceived injury severity and ISS were given a 1 to 4 value, and a difference score was generated. The data were analyzed with Wilcoxon Rank-Sum, Spearman’s correlation coefficient, and Mantel-Haenszel tests. Results The ISS was not significantly correlated with perceived injury severity scores (r2 =0.177, p=0.0535, Spearman’s correlation), and most patients reported a higher injury severity. The difference between perceived severity and ISS was statistically significant (p<0.001, Wilcoxon Rank Sum). Patients with penetrating injuries significantly overestimated their injury severity (p=0.014, Wilcoxon Rank Sum). Patients with mild and moderate injuries gave more assessment explanations, whereas patients with severe or very severe injuries gave more description explanations (p=0.0220, Mantel-Haenszel). Conclusions Patients based perceived severity on their injuries, but it did not correlate with ISS, likely because ISS considers injuries graded events, while the patient considers them all or none events. PMID:21550062

  4. [Monitoring intracranial pressure in severe traumatic brain injury].

    PubMed

    García-Lira, José Ramón; Zapata-Vázquez, Rita Esther; Alonzo-Vázquez, Felipe; Rodríguez-Ruz, Suemy Gabriela; Medina-Moreno, Manuel Rene; Torres-Escalante, Jose Luis

    Severe traumatic brain injury (TBI) is a serious condition. Intracranial pressure (ICP) monitoring can be used to direct treatment, which is of limited access in developing countries. To describe the clinical experience of pediatric patients with severe TBI. A clinical experience in patients with severe TBI was conducted. Age was 1-17 years, exclusion criteria were chronic illness and psicomotor retardation. Informed consent was obtained in each case. Two groups were formed based on the criterion of neurosurgeons: with and without intracraneal pressure (ICP) monitoring. PIC monitoring was performed through a 3PN Spiegelberg catheter and a Spiegelberg HDM 26 monitor. Patients were treated according international pediatric guides. The characteristics of both groups are described at 6 months of follow-up. Forty-two patients (CM=14 and SM=28). Those in the CM Group had lower Glasgow coma scale score and Marshall classification with poorer prognosis. Among them survival rate was lower, although the outcome was from moderate to good. No complications were reported with the use of the ICP catheter. Patients with ICP monitoring had greater severity at admission and an increased mortality; however, the outcome for the survivors was from moderate to good. It is necessary to conduct randomized clinical trials to define the impact of ICP monitoring on survival and quality of life in severe TBI patients. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

    DTIC Science & Technology

    2012-11-05

    Polytrauma injuries so severe as to prevent comprehensive treatment of CMF injuriesSevere traumatic brain injuries Based on these criteria, four...and Enduring Freedom (OIF/OEF explosion burns). Burns 2006;32; 853 857 5 Motamedi MH. Primary treatment of penetrating injuries to the face. J Oral...an algorithm for primary reconstruction. Plast Reconstr Surg 1996;98:583 601 7 Ueeck BA. Penetrating injuries to the face: delayed versus primary

  6. Comparison of fatal and severe nonfatal traumatic work-related injuries in Washington state.

    PubMed

    Alexander, B H; Franklin, G M; Fulton-Kehoe, D

    1999-08-01

    To compare fatal and hospitalized nonfatal work-related traumatic injuries by occupation and cause. Fatal and hospitalized nonfatal injuries occurring from 1991-1995 were identified from Washington State workers' compensation claims data. Nonfatal injuries were classified as severe if they had at least one of the following criteria: a brain or spinal cord injury, an Injury Severity Score of >/=16, or were hospitalized for more than 7 days. The frequency and rate of fatal and severe nonfatal injuries were then described by industrial risk class and cause. The study identified 335 fatal injuries and 4,405 hospitalized nonfatal injuries, of which 1,105 were classified as severe. Tree topping and pruning, carnival work, roofing, and metal siding and gutters risk classes had several severe nonfatal injuries, but few, if any, fatalities. Causes of fatal and severe nonfatal injuries were notably different for the roofing, restaurant, and orchard workers risk classes. The inclusion of severe hospitalized injuries in occupational injury surveillance systems will provide a broader view of high-risk occupations and profile of injury causation with which to direct occupational injury prevention efforts. Copyright 1999 Wiley-Liss, Inc

  7. Traumatic Brain Injury: Imaging Spectrum from Mild to Severe Closed Head Injury

    DTIC Science & Technology

    2008-11-01

    recent advances in TBI treatment. Decompressive Craniotomy has been a mainstay of severe penetrating head injury in current conflicts. It allows...immediate room for swelling while improving intracerebral bloodflow. An interesting surgical craniotomy technique was developed at the onset of the...for recovery and replacement later. This keeps the patient’s own bone viable. Stereolithography is now used to digitally reconstruct the patient’s

  8. Biomarkers Affected by Impact Severity during Osteochondral Injury.

    PubMed

    Waters, Nicole Poythress; Stoker, Aaron M; Pfeiffer, Ferris M; Cook, James L

    2015-06-01

    Osteochondral injury elevates the risk for developing posttraumatic osteoarthritis (PTOA). Therefore, our objective was to evaluate the relationship between impact severity during injury to cell viability and biomarkers possibly involved in PTOA. Osteochondral explants (6 mm, n = 72) were harvested from cadaveric femoral condyles (N = 6). Using a test machine, each explant (except for No Impact) was subjected to mechanical impact at a velocity of 100 mm/s to 0.25, 0.5, 0.75, 1.0, or 1.25 mm maximum compression corresponding to Low, Low-Moderate, Moderate, Moderate-High, or High impact groups. Cartilage cell viability, collagen content, and proteoglycan content were assessed at either day 0 or after 12 days of culture. Culture media were assessed for prostaglandin E2 (PGE2); nitric oxide; granulocyte macrophage colony-stimulating factor (GM-CSF); interferon gamma (IFNγ); interleukin (IL)-2, -4, -6, -7, -8, -10, -15, -18; interferon gamma-induced protein 10 (IP-10); keratinocyte-derived chemoattractant (KC); monocyte chemoattractant protein-1 (MCP-1); tumor necrosis factor alpha (TNFα); and matrix metalloproteinase-2, -3, -8, -9, -13. There was increased impact energy absorbed for the High group compared with the Moderate-High group, Moderate group, and Low-Moderate group (p = 0.011, 0.048, 0.008, respectively). At day 0, there was decreased area cell viability for the High group compared with the Low-Moderate group (p = 0.035). At day 1, PGE2 was increased for the High group compared with the Moderate, Low-Moderate, Low, and No Impact groups (p ≤ 0.01). Cumulative PGE2 was increased for the Moderate-High and High groups compared with the Moderate, Low-Moderate, Low, and No Impact groups (p ≤ 0.036). At day 1, MCP-1 was increased for the Moderate-High and High groups compared with the Low and No Impact groups (p ≤ 0.032). Impact to osteochondral explants resulted in multiple levels of severity. PGE2 was sensitive to impact

  9. Life satisfaction and disability after severe traumatic brain injury.

    PubMed

    Mailhan, Laurence; Azouvi, Philippe; Dazord, Alice

    2005-04-01

    To assess the relationships between life satisfaction and disability after a severe traumatic brain injury (TBI). Cross-sectional study, including 75 patients 2 years or more after a severe TBI. Life satisfaction was assessed with the Subjective Quality of Life Profile. Impairments, activities and participation were assessed with standardized tests. The satisfaction profile was flat, i.e. the majority of items obtained mean satisfaction scores close to 0, suggesting that participants felt indifferent to these items or in other words that they were neither satisfied nor unsatisfied. Patients were on average slightly dissatisfied with their cognitive functions, physical abilities and self-esteem. A factor analysis revealed three underlying factors. The main finding was that the relationships between life satisfaction and disability were not linear: the lowest satisfaction scores were reported by participants with moderate disability rated by the Glasgow Outcome Scale, while individuals with severe disability did not significantly differ from the good recovery group. Life satisfaction is not linearly related to disability after severe TBI.

  10. Transplanting Kidneys from Deceased Donors With Severe Acute Kidney Injury.

    PubMed

    Heilman, R L; Smith, M L; Kurian, S M; Huskey, J; Batra, R K; Chakkera, H A; Katariya, N N; Khamash, H; Moss, A; Salomon, D R; Reddy, K S

    2015-08-01

    Our aim was to determine outcomes with transplanting kidneys from deceased donors with acute kidney injury, defined as a donor with terminal serum creatinine ≥2.0 mg/dL, or a donor requiring acute renal replacement therapy. We included all patients who received deceased donor kidney transplant from June 2004 to October 2013. There were 162 AKI donor transplant recipients (21% of deceased donor transplants): 139 in the standard criteria donor (SCD) and 23 in the expanded criteria donor (ECD) cohort. 71% of the AKI donors had stage 3 (severe AKI), based on acute kidney injury network (AKIN) staging. Protocol biopsies were done at 1, 4, and 12 months posttransplant. One and four month formalin-fixed paraffin embedded (FFPE) biopsies from 48 patients (24 AKI donors, 24 non-AKI) underwent global gene expression profiling using DNA microarrays (96 arrays). DGF was more common in the AKI group but eGFR, graft survival at 1 year and proportion with IF/TA>2 at 1 year were similar for the two groups. At 1 month, there were 898 differentially expressed genes in the AKI group (p-value <0.005; FDR <10%), but by 4 months there were no differences. Transplanting selected kidneys from deceased donors with AKI is safe and has excellent outcomes.

  11. The Effect of Injury Severity on Behavior: A Phenotypic Study of Cognitive and Emotional Deficits after Mild, Moderate, and Severe Controlled Cortical Impact Injury in Mice

    PubMed Central

    Washington, Patricia M.; Forcelli, Patrick A.; Wilkins, Tiffany; Zapple, David N.; Parsadanian, Maia

    2012-01-01

    Abstract Traumatic brain injury (TBI) can cause a broad array of behavioral problems including cognitive and emotional deficits. Human studies comparing neurobehavioral outcomes after TBI suggest that cognitive impairments increase with injury severity, but emotional problems such as anxiety and depression do not. To determine whether cognitive and emotional impairments increase as a function of injury severity we exposed mice to sham, mild, moderate, or severe controlled cortical impact (CCI) and evaluated performance on a variety of neurobehavioral tests in the same animals before assessing lesion volume as a histological measure of injury severity. Increasing cortical impact depth successfully produced lesions of increasing severity in our model. We found that cognitive impairments in the Morris water maze increased with injury severity, as did the degree of contralateral torso flexion, a measure of unilateral striatal damage. TBI also caused deficits in emotional behavior as quantified in the forced swim test, elevated-plus maze, and prepulse inhibition of acoustic startle, but these deficits were not dependent on injury severity. Stepwise regression analyses revealed that Morris water maze performance and torso flexion predicted the majority of the variability in lesion volume. In summary, we find that cognitive deficits increase in relation to injury severity, but emotional deficits do not. Our data suggest that the threshold for emotional changes after experimental TBI is low, with no variation in behavioral deficits seen between mild and severe brain injury. PMID:22642287

  12. Posttraumatic tricuspid valve injury and severe tricuspid valve regurgitation.

    PubMed

    Gucuk Ipek, Esra

    2013-09-01

    A 66-year-old male was brought to our hospital following a car accident. He had subarachnoid hemorrhage, multiple rib fractures, and left hemopneumothorax. He was referred to the Cardiology Department for elevated troponin levels (42 ng/ml, reference 0-1 ng/ml). The electrocardiogram was free of ischemia, whereas the transthoracic echocardiography revealed dilated right heart chambers, enlarged tricuspid annulus and coaptation failure of the tricuspid valvular leaflets. There was rupture on the subvalvular apparatus of the anterior leaflet of the tricuspid valve with accompanying prolapse, causing severe tricuspid valvular regurgitation. The patient did not present right ventricular failure signs and symptoms; he was referred to surgery after the resolution of associated thoracic and cranial injuries.

  13. Awareness of memory loss after severe closed-head injury.

    PubMed

    Boake, C; Freeland, J C; Ringholz, G M; Nance, M L; Edwards, K E

    1995-04-01

    This study investigated unawareness of memory loss in 48 severe closed-head injury patients. Awareness was measured as the correlation of patients' memory test scores with their self-ratings on the Everyday Memory Questionnaire (EMQ). Patients who endorsed atypical memory failures on the EMQ were classified as invalid responders. Invalid responders had poorer memory test performances and a higher rate of focal left hemispheric lesions, but did not report greater emotional symptoms. Correlations between memory test scores and memory self-ratings were weaker among invalid responders or those classified as depressed, and stronger among valid responders, especially those classified as non-depressed. The results indicate that the validity of memory self-reports is influenced by both neurogenic and psychogenic factors, and suggest that invalid responding is an important problem with self-reports by brain-injured patients.

  14. Functional recovery after moderate/severe traumatic brain injury

    PubMed Central

    Sur, Sandeepa; Raymont, Vanessa; Duckworth, Josh; Kowalski, Robert G.; Efron, David T.; Hui, Xuan; Selvarajah, Shalini; Hambridge, Hali L.; Stevens, Robert D.

    2014-01-01

    Objective: To evaluate the hypothesis that educational attainment, a marker of cognitive reserve, is a predictor of disability-free recovery (DFR) after moderate to severe traumatic brain injury (TBI). Methods: Retrospective study of the TBI Model Systems Database, a prospective multicenter cohort funded by the National Institute on Disability and Rehabilitation Research. Patients were included if they were admitted for rehabilitation after moderate to severe TBI, were aged 23 years or older, and had at least 1 year of follow-up. The main outcome measure was DFR 1 year postinjury, defined as a Disability Rating Scale score of zero. Results: Of 769 patients included, 214 (27.8%) achieved DFR at 1 year. In total, 185 patients (24.1%) had <12 years of education, while 390 (50.7%) and 194 patients (25.2%) had 12 to 15 years and ≥16 years of education, respectively. DFR was achieved by 18 patients (9.7%) with <12 years, 120 (30.8%) with 12 to 15 years, and 76 (39.2%) with ≥16 years of education (p < 0.001). In a logistic regression model controlling for age, sex, and injury- and rehabilitation-specific factors, duration of education of ≥12 years was independently associated with DFR (odds ratio 4.74, 95% confidence interval 2.70–8.32 for 12–15 years; odds ratio 7.24, 95% confidence interval 3.96–13.23 for ≥16 years). Conclusion: Educational attainment was a robust independent predictor of 1-year DFR even when adjusting for other prognostic factors. A dose-response relationship was noted, with longer educational exposure associated with increased odds of DFR. This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI. PMID:24759845

  15. En-route care capability from point of injury impacts mortality after severe wartime injury.

    PubMed

    Morrison, Jonathan J; Oh, John; DuBose, Joseph J; O'Reilly, David J; Russell, Robert J; Blackbourne, Lorne H; Midwinter, Mark J; Rasmussen, Todd E

    2013-02-01

    The objective of this study is to characterize modern point-of-injury (POI) en-route care platforms and to compare mortality among casualties evacuated with conventional military retrieval (CMR) methods to those evacuated with an advanced medical retrieval (AMR) capability. Following a decade of war in Afghanistan, the impact of en-route care capabilities from the POI on mortality is unknown. Casualties evacuated from POI to one level III facility in Afghanistan (July 2008-March 2012) were identified from UK and US trauma registries. Groups comprised those evacuated by a medically qualified provider-led, AMR and those by a medic-led CMR capability. Outcomes were compared per incremental Injury Severity Score (ISS) bins. Most casualties (n = 1054; 61.2%) were in the low-ISS (1-15) bracket in which there was no difference in en-route care time or mortality between AMR and CMR. Casualties in the mid-ISS bracket (16-50) (n = 583; 33.4%) experienced the same median en-route care time (minutes) on AMR and CMR platforms [78 (58) vs 75 (93); P = 0.542] although those on AMR had shorter time to operation [110 (95) vs 117 (126); P < 0.001]. In this mid-ISS bracket, mortality was lower in the AMR than in the CMR group (12.2% vs 18.2%; P = 0.035). In the high-ISS category (51-75) (n = 75; 4.6%), time to operation was lower in the AMR than the CMR group (66 ± 77 vs 113 ± 122; P = 0.013) but there was no difference in mortality. This study characterizes en-route care capabilities from POI in modern combat. Conventional platforms are effective in most casualties with low injury severity. However, a definable injury severity exists for which evacuation with an AMR capability is associated with improved survival.

  16. Establishing the injury severity of thoracolumbar trauma: confirmation of the hierarchical structure of the AOSpine Thoracolumbar Spine Injury Classification System.

    PubMed

    Schroeder, Gregory D; Vaccaro, Alexander R; Kepler, Christopher K; Koerner, John D; Oner, F Cumhur; Dvorak, Marcel F; Vialle, Luiz R; Aarabi, Bizhan; Bellabarba, Carlo; Fehlings, Michael G; Schnake, Klaus J; Kandziora, Frank

    2015-04-15

    Survey of spine surgeons. To develop a validated regional and global injury severity scoring system for thoracolumbar trauma. The AOSpine Thoracolumbar Spine Injury Classification System was recently published and combines elements of both the Magerl system and the Thoracolumbar Injury Classification System; however, the injury severity of each fracture has yet to be established. A survey was sent to 100 AOSpine members from all 6 AO regions of the world (North America, South America, Europe, Africa, Asia, and the Middle East). Each respondent was asked to numerically grade the severity of each variable of the AOSpine Thoracolumbar Spine Injury Classification System including the morphology, neurological grade, and patient specific modifiers. A grade of zero was considered to be not severe at all, and a grade of 100 was the most severe injury possible. Seventy-four AOSpine surgeons from all 6 AO regions of the world numerically graded the severity of each variable of the AOSpine Thoracolumbar Spine Injury Classification System to establish the injury severity score. The reported fracture severity increased significantly (P < 0.0001) as the subtypes of fracture type A and type B increased, and a significant difference (P < 0.0001) in severity was established for burst fractures with involvement of 2 versus 1 endplates. Finally, no regional or experiential difference in severity or classification was identified. Development of a globally applicable injury severity scoring system for thoracolumbar trauma is possible. This study demonstrates no regional or experiential difference in perceived severity or thoracolumbar spine trauma. The AOSpine Thoracolumbar Spine Injury Classification System provides a logical approach to assessing these injuries and enables rational strategies for treatment. 4.

  17. Keratinocytes in the treatment of severe burn injury: an update.

    PubMed

    Lootens, Liesbeth; Brusselaers, Nele; Beele, Hilde; Monstrey, Stan

    2013-02-01

    Burns are among the most life-threatening physical injuries, in which fast wound closure is crucial. The surgical burn care has evolved considerably throughout the past decennia resulting in a shift of therapeutic goals. Therapies aiming to provide coverage of the burn have been replaced by treatments that have both functional as aesthetic outcomes. The standard in treating severe burns is still early excision followed by skin grafting. The use of cultured keratinocytes to cover extensive burn wounds appeared very promising at first, but the technique still has several limitations of which the long time to culture, the major costs, the risk of infection and the need for an adequate dermal layer limit clinical application. The introduction of dermal substitutes, composite grafts, tissue engineering based on stem cell application have been advocated. The aim of this review is to assess the use of cultured keratinocytes in terms of technical aspects, clinical application, limitations and future perspectives. Cultured keratinocytes are expected to keep playing a role in wound healing, especially in the field of chronic wounds. In severe burns, despite its limitations, keratinocytes can be beneficial if implemented as one of the elements in a broader wound management. © 2012 The Authors. International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

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

    PubMed

    Kuo, George; Yang, Shih-Yi; Chuang, Shiow-Shuh; Fan, Pei-Chun; Chang, Chih-Hsiang; Hsiao, Yen-Chang; Chen, Yung-Chang

    2016-12-01

    Acute kidney injury (AKI) is a frequent complication of severe burn injury and is associated with mortality. The definition of AKI was modified by the Kidney Disease Improving Global Outcomes Group in 2012. So far, no study has compared the outcome accuracy of the new AKI staging guidelines with that of the complex score system. Hence, we compared the accuracy of these approaches in predicting mortality. This was a post hoc analysis of prospectively collected data from an intensive care burn unit in a tertiary care university hospital. Patients admitted to this unit from July 2004 to December 2006 were enrolled. Demographic, clinical, and laboratory data and prognostic risk scores were used as predictors of mortality. A total of 145 adult patients with a mean age of 41.9 years were studied. Thirty-five patients (24.1%) died during the hospital course. Among the prognostic risk models, the Acute Physiology and Chronic Health Evaluation III system exhibited the strongest discriminative power and the AKI staging system also predicted mortality well (areas under the receiver operating characteristic curve: 0.889 vs. 0.835). Multivariate logistic regression analysis identified total burn surface area, ventilator use, AKI, and toxic epidermal necrolysis as independent risk factors for mortality. Our results revealed that AKI stage has considerable discriminative power for predicting mortality. Compared with other prognostic models, AKI stage is easier to use to assess outcome in patients with severe burn injury. Copyright © 2016. Published by Elsevier B.V.

  19. Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms.

    PubMed

    Nigrovic, Lise E; Lee, Lois K; Hoyle, John; Stanley, Rachel M; Gorelick, Marc H; Miskin, Michelle; Atabaki, Shireen M; Dayan, Peter S; Holmes, James F; Kuppermann, Nathan

    2012-04-01

    To determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms). Secondary analysis of a large prospective observational cohort study. Twenty-five emergency departments participating in the PECARN. Children with minor blunt head trauma and Glasgow Coma Scale scores of at least 14. Treating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori). Clinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms. Of the 42,412 patients enrolled in the overall study, 42,099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%). Children with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

  20. The risk of severity of limb injuries in racing thoroughbred horses.

    PubMed

    Mohammed, H O; Hill, T; Lowe, J

    1992-07-01

    A retrospective study was carried out to identify factors which predisposed Thoroughbred horses to severe injuries, as compared to less severe injuries, while racing on New York Racing Association (NYRA) tracks during the period of January 1986 to June 1988. A severe injury was defined as an injury which led to humane destruction of the horse. A less severe injury was defined as a horse which didn't race within 6 months following a muscular, ligament, tendon, or skeletal injury on the racetrack. The data were obtained from the Horse Identification Department records kept by the Chief Examining Veterinarian of NYRA and included 55 severely injured horses and 245 less severely injured horses. Multiple logistic regression analysis was used to identify factors associated with the risk of severe injuries compared to less severe injuries in those horses. There was a significant association between track and the risk of severe injury (horses raced on Belmont and Saratoga were more likely to develop a severe injury compared to horses raced on Aqueduct Main). The track surface was also associated with the risk of severe injury (horses raced on a firm turf had a significantly lower risk of severe injury associated with the track was significantly modified by the track condition (horses raced at Belmont when it was muddy had a significantly increased risk compared to Aqueduct dirt). Horses were more likely to experience severe injury in the early part of the race (less than or equal to 6 furlongs) than the latter part of the race (greater than 6 furlongs). The risk of severe injury decreased with the age of the horse.

  1. Comparison of the Ability to Predict Mortality between the Injury Severity Score and the New Injury Severity Score: A Meta-Analysis

    PubMed Central

    Deng, Qiangyu; Tang, Bihan; Xue, Chen; Liu, Yuan; Liu, Xu; Lv, Yipeng; Zhang, Lulu

    2016-01-01

    Background: Description of the anatomical severity of injuries in trauma patients is important. While the Injury Severity Score has been regarded as the “gold standard” since its creation, several studies have indicated that the New Injury Severity Score is better. Therefore, we aimed to systematically evaluate and compare the accuracy of the Injury Severity Score and the New Injury Severity Score in predicting mortality. Methods: Two researchers independently searched the PubMed, Embase, and Web of Science databases and included studies from which the exact number of true-positive, false-positive, false-negative, and true-negative results could be extracted. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies checklist criteria. The meta-analysis was performed using Meta-DiSc. Meta-regression, subgroup analyses, and sensitivity analyses were conducted to determine the source(s) of heterogeneity and factor(s) affecting the accuracy of the New Injury Severity Score and the Injury Severity Score in predicting mortality. Results: The heterogeneity of the 11 relevant studies (total n = 11,866) was high (I2 > 80%). The meta-analysis using a random-effects model resulted in sensitivity of 0.64, specificity of 0.93, positive likelihood ratio of 5.11, negative likelihood ratio of 0.27, diagnostic odds ratio of 27.75, and area under the summary receiver operator characteristic curve of 0.9009 for the Injury Severity Score; and sensitivity of 0.71, specificity of 0.87, positive likelihood ratio of 5.22, negative likelihood ratio of 0.20, diagnostic odds ratio of 24.74, and area under the summary receiver operating characteristic curve of 0.9095 for the New Injury Severity Score. Conclusion: The New Injury Severity Score and the Injury Severity Score have similar abilities in predicting mortality. Further research is required to determine the appropriate use of the Injury Severity Score or the New Injury Severity Score based on specific

  2. Severe burn injuries: acute and long-term treatment.

    PubMed

    Spanholtz, Timo A; Theodorou, Panagiotis; Amini, Peymaneh; Spilker, Gerald

    2009-09-01

    The physician that initially sees a patient with an extensive and deep dermal burn injury must be able to provide initial acute treatment and to make a well-founded decision whether to have the patient transported to a burn care center (BCC). Physicians from a variety of specialities will be involved in the management of long-term sequelae. This article provides an overview of the treatment of severe burns and their commonest complications. Special attention is paid to initial emergency treatment (first aid) and to late complications, because physicians from multiple specialties are often involved in these phases of treatment. The data and guidelines that are summarized here were obtained through a selective Medline search and supplemented by the authors' experience in their own burn care center. Analgesia, careful fluid balance, and early intubation are important elements of the initial emergency treatment. Long-term complications of burns, such as disfiguring scars on exposed areas of skin and functionally significant contractures, often require surgical treatment. Early measures for scar care may improve the outcome. The effective treatment of severe burns is interdisciplinary, involving general practitioners and emergency physicians as well as plastic surgeons and physicians of other specialties. Knowledge of the basic principles of treatment enables physicians to care for patients with burns appropriately both in the acute setting and in the long term.

  3. Visual selective attention after severe closed head injury.

    PubMed

    Schmitter-Edgecombe, M; Kibby, M K

    1998-03-01

    This study investigated the nature of selective attention deficits after severe closed head injury (CHI). Twenty participants with severe CHI (greater than 1 year postinjury) and 20 matched controls completed search and nonsearch visual selective attention tasks under conditions of low (Experiment 1) and high (Experiment 2) target-distractor similarity. In the search situations, participants searched visual displays that contained 1, 4, or 8 items for the targets. In the nonsearch situations, the location of the targets was visually cued with a peripheral arrow. The results revealed that in both the low and high target-distractor similarity search conditions. CHI participants required a longer time than controls to locate and identify the target. In contrast, in the nonsearch condition, CHI participants were able to successfully ignore irrelevant task information when target-distractor similarity was low. However, when target-distractor similarity was high, CHI participants had more difficulty than controls ignoring the irrelevant information. These results suggest that, in comparison to controls, CHI participants may be at a disadvantage in selective attention situations when visual search is required and when the discriminability between targets and distractors is difficult.

  4. [Non verbal communication abilities in severe traumatic brain injury].

    PubMed

    Aubert, S; Barat, M; Campan, M; Dehail, P; Joseph, P A; Mazaux, J-M

    2004-05-01

    Discursive abilities of severe brain injured patient are always impaired: loss of flexibility, lack of cohesion and coherence, often more elliptic. We know few about nonverbal competencies during discourse. The objective is to verify nonverbal abilities of these patients by pragmatic analysis. Four men were examined more than 7 years after severe traumatic brain injury. Nonverbal Prutting and Kirchner Pragmatic Protocol (1987) were done allowing to a qualitative and quantitative measurement of paralinguistic behaviour: prosody and quality of speech, facial expression, posture, gaze, gesture. Two conditions were recorded: dual (descriptive discourse) and group (conversational discourse). Associated impairments such as cognitive and dysexecutive functioning were also investigated. Impoverishment (loss of ability) or impaired inadequacity was observed in all patients. Paralinguistic competences of conversational discourse was worse than descriptive one. Facial expression, gaze functioning, referential gesture were more often impaired. Maladjustment could be interpretated in reference with dysexecutive syndrome. In spite of the lack of information about the range of normal pragmatic behaviour, it seems that brain injured patients have shown poor nonverbal abilities during discourse. Rehabilitation training of communication skills would integrate this fact in order to improve interactivity and social relationship.

  5. Built environment effects on cyclist injury severity in automobile-involved bicycle crashes.

    PubMed

    Chen, Peng; Shen, Qing

    2016-01-01

    This analysis uses a generalized ordered logit model and a generalized additive model to estimate the effects of built environment factors on cyclist injury severity in automobile-involved bicycle crashes, as well as to accommodate possible spatial dependence among crash locations. The sample is drawn from the Seattle Department of Transportation bicycle collision profiles. This study classifies the cyclist injury types as property damage only, possible injury, evident injury, and severe injury or fatality. Our modeling outcomes show that: (1) injury severity is negatively associated with employment density; (2) severe injury or fatality is negatively associated with land use mixture; (3) lower likelihood of injuries is observed for bicyclists wearing reflective clothing; (4) improving street lighting can decrease the likelihood of cyclist injuries; (5) posted speed limit is positively associated with the probability of evident injury and severe injury or fatality; (6) older cyclists appear to be more vulnerable to severe injury or fatality; and (7) cyclists are more likely to be severely injured when large vehicles are involved in crashes. One implication drawn from this study is that cities should increase land use mixture and development density, optimally lower posted speed limits on streets with both bikes and motor vehicles, and improve street lighting to promote bicycle safety. In addition, cyclists should be encouraged to wear reflective clothing.

  6. Psychosocial and executive function recovery trajectories one year after pediatric traumatic brain injury: the influence of age and injury severity.

    PubMed

    Keenan, Heather T; Clark, Amy E; Holubkov, RIchard; Cox, Charles S; Ewing-Cobbs, Linda

    2017-08-30

    Time since traumatic brain injury (TBI) and developmental stage at injury may affect the trajectory of outcomes associated with adjustment and school success. We prospectively enrolled a cohort of 519 children with either TBI or orthopedic injury (OI) aged 2.5 - 15 years to examine children's psychosocial and executive function outcomes at 3 and 12-months post-injury. Outcome measures included the Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire (SDQ) and Behavior Rating Inventory of Executive Function (BRIEF) ratings. Controlling for preinjury ratings and using the OI group as the reference, children with TBI, regardless of age or injury severity, had affective, anxiety and attention deficit hyperactivity (ADHD) problems on the CBCL. Symptom trajectories differed both by injury severity and age at injury. Children with mild and complicated mild TBI had a decreasing anxiety trajectory while children with severe TBI had increasing symptoms. Children 6 - 11 years of age had high ADHD and affective scores; however, the youngest children had increasing symptoms over time. On the SDQ, peer relationships and prosocial behaviors were not significantly affected by TBI but were associated with family environment. Children with severe TBI had the worst executive function scores; however, mild and complicated mild/moderate TBI groups had clinically important working memory deficits. Hispanic ethnicity and strong social capital were positively associated with multiple outcomes. Children's recovery trajectories differed by injury severity, time since injury, and developmental stage when injured. Schools need to reassess children's skills over time as new problems in behavior and learning may emerge.

  7. Seawater Immersion Aggravates Burn Injury Causing Severe Blood Coagulation Dysfunction.

    PubMed

    Yan, Hong; Mao, Qingxiang; Ma, Yongda; Wang, Li; Chen, Xian; Hu, Yi; Ge, Hengjiang

    2016-01-01

    This study aimed to investigate the endothelial function in a canine model of burn injury combined with seawater immersion. The model of burn injury was established. The dogs were randomly divided into four groups including dogs with burn injury (B group), or burn injury combined with seawater immersion (BI group), or only immersion in seawater (I group), or control animals with no injury or immersion (C group). The circulating endothelial cell (CEC) count and coagulation-fibrinolysis parameters were measured. The CEC count in B group increased at 4 h, 7 h, and 10 h after injury and then reduced, whereas it continuously increased to a greater extent in BI group (P < 0.05). The von Willebrand factor (vWF) activity, plasminogen activator inhibitor (PAI-1), and the ratio of thromboxane B2 (TXB2) to 6-keto-prostaglandin F1α (6-K-PGF1α ) in BI group had a marked increase after injury, and the tissue-type plasminogen activator (tPA) in the BI group decreased. Microscope observations revealed thrombus formation in lungs of the animals in BI group, but not in C, I, or B groups. Burn injury causes endothelial dysfunction, and seawater immersion lastingly aggravates this injury, leading to a higher risk of developing thrombosis.

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

    PubMed Central

    Hanschen, Marc; Kanz, Karl-Georg; Kirchhoff, Chlodwig; Khalil, Philipe N.; Wierer, Matthias; van Griensven, Martijn; Laugwitz, Karl-Ludwig; Biberthaler, Peter; Lefering, Rolf; Huber-Wagner, Stefan

    2015-01-01

    Background Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients. Methods In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009), characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6), the revised injury severity score (RISC) allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6) (2.3% of patients). Results Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%). The overall mortality rate was 13.9%, minor cardiac injury (AIS 1) and severe cardiac injury (AIS 2-6) are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6) is associated with a higher mortality (OR 2.79 and 4.89, respectively) as compared to the predicted average mortality (OR 2.49) of the study collective. Conclusion Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients’ outcome is dependent on the severity of cardiac injury. PMID:26136126

  9. Working memory after mild, moderate, or severe childhood closed head injury.

    PubMed

    Roncadin, Caroline; Guger, Sharon; Archibald, Jennifer; Barnes, Marcia; Dennis, Maureen

    2004-01-01

    Children with closed head injury (CHI) perform poorly on complex tasks requiring working memory (WM). It is unclear to what extent WM itself is compromised, and whether WM varies with factors related to the CHI, such as injury severity, age at injury, and time since injury. We studied verbal WM in 126 school-age children with CHI, divided into mild, moderate, and severe injury severity groups. WM distributions were significantly skewed toward lower scores in the moderate and severe groups, although the distribution in the mild group was normal. Age at injury and time since injury predicted WM components only for the moderate group. Survivors of moderate or severe childhood CHI have persisting WM deficits limiting the computational workspace required for many cognitive tasks.

  10. Impaired emotional contagion following severe traumatic brain injury.

    PubMed

    Rushby, Jacqueline Ann; McDonald, Skye; Randall, Rebekah; de Sousa, Arielle; Trimmer, Emily; Fisher, Alana

    2013-09-01

    Empathy deficits are widely-documented in individuals after severe traumatic brain injury (TBI). This study examined the relationship between empathy deficits and psychophysiological responsivity in adults with TBI to determine if impaired responsivity is ameliorated through repeated emotional stimulus presentations. Nineteen TBI participants (13 males; 41 years) and 25 control participants (14 males; 31 years) viewed five repetitions of six 2-min film clip segments containing pleasant, unpleasant, and neutral content. Facial muscle responses (zygomaticus and corrugator), tonic heart rate (HR) and skin conductance level (SCL) were recorded. Mean responses for each viewing period were compared to a pre-experiment 2-min resting baseline period. Self-reported emotional empathy was also assessed. TBI participants demonstrated identical EMG response patterns to controls, i.e. an initial large facial response to both pleasant and unpleasant films, followed by habituation over repetitions for pleasant films, and sustained response to unpleasant films. Additionally, an increase in both arousal and HR deceleration to stimulus repetitions was found, which was larger for TBI participants. Compared to controls, TBI participants self-reported lower emotional empathy, and had lower resting arousal, and these measures were positively correlated. Results are consistent with TBI producing impairments in emotional empathy and responsivity. While some normalisation of physiological arousal appeared with repeated stimulus presentations, this came at the cost of greater attentional effort.

  11. Disorders of consciousness after severe brain injury: therapeutic options.

    PubMed

    Schnakers, Caroline; Monti, Martin M

    2017-09-09

    Very few options exist for patients who survive severe traumatic brain injury but fail to fully recover and develop a disorder of consciousness (e.g. vegetative state, minimally conscious state). Among pharmacological approaches, Amantadine has shown the ability to accelerate functional recovery. Although with very low frequency, Zolpidem has shown the ability to improve the level of consciousness transiently and, possibly, also in a sustained fashion. Among neuromodulatory approaches, transcranial direct current stimulation has been shown to transiently improve behavioral responsiveness, but mostly in minimally conscious patients. New evidence for thalamic deep brain stimulation calls into question its cost/benefit trade-off. The growing understanding of the biology of disorders of consciousness has led to a renaissance in the development of therapeutic interventions for patients with disorders of consciousness. High-quality evidence is emerging for pharmacological (i.e. Amantadine) and neurostimulatory (i.e. transcranial direct current stimulation) interventions, although further studies are needed to delineate preconditions, optimal dosages, and timing of administration. Other exciting new approaches (e.g. low intensity focused ultrasound) still await systematic assessment. A crucial future direction should be the use of neuroimaging measures of functional and structural impairment as a means of tailoring patient-specific interventions.

  12. Brief compassion focused imagery for treatment of severe head injury.

    PubMed

    Campbell, Iain N; Gallagher, Melanie; McLeod, Hamish J; O'Neill, Brian; McMillan, Tom M

    2017-06-30

    To determine whether participants with severe head injury (SHI) allocated to a brief compassion focused imagery (CFI) intervention show greater change in compassion than those exposed to relaxation imagery (RI). Participants were exposed to a preparatory video to promote engagement and then randomly allocated to intervention. Pre- and post-preparatory measures were Motivation for Intervention and Fears of Compassion Scales, State-Trait Anxiety Inventory (STAI) and PANAS. Pre- and post-intervention self-report measures were the Empathy Quotient, Self-Compassion Scale, STAI and Relaxation Scale. Heart rate variability (HRV) was monitored throughout. Motivation for therapy increased after the preparatory video (z = 3.44, p = 0.001). Across the intervention, group differences were not found on self-report measures or HRV changes. When CFI and RI groups were pooled, improvement in relaxation (r = .41, p < 0.01) and state anxiety (r = .29, p < 0.05) were found across the intervention; these outcomes were not associated with changes in self-compassion or HRV. Brief CFI, a central aspect of compassion focused therapy, did not produce a reliable change in people with SHI. Enhanced motivation for psychological therapy after a brief preparatory video is relevant and underlines the need to understand mechanisms of action rather than the pursuing whole protocol approaches to therapy.

  13. Patterns of neuropsychological impairment after severe blunt head injury.

    PubMed

    Tate, R L; Fenelon, B; Manning, M L; Hunter, M

    1991-03-01

    A consecutive series of 100 subjects with severe blunt head injuries was followed up 6 years after trauma. Neuropsychological test performances of 82 subjects and of a noninjured control group were analyzed by two principal components analyses (PCAs). Each PCA extracted 15 factors relating to a range of cognitive impairments, as well as neuropsychological features consistent with posttraumatic personality changes. Measures identified by the PCAs were applied to 85 head-injured subjects in the series to examine the incidence of impairment in four neuropsychological areas: disorders of learning and memory, neuropsychological features consistent with posttraumatic personality change, slowness in rate of information processing, and a range of basic neuropsychological skills. Overall, impairments occurred in 70% of the series. Disorders of learning and memory were the most common type of deficit (56.5%), with disturbances in basic neuropsychological skills the least frequent (16.5%). Variability among subjects with respect to the types and combinations of neuropsychological impairments was a characteristic feature of this clinical group, but the largest proportion (one-third) demonstrated isolated impairments. The implications of the incidence and selectivity of neuropsychological impairments are discussed.

  14. Mental Trauma Experienced by Caregivers of patients with Diffuse Axonal Injury or Severe Traumatic Brain Injury

    PubMed Central

    Syed Hassan, Syed Tajuddin; Jamaludin, Husna; Abd Raman, Rosna; Mohd Riji, Haliza; Wan Fei, Khaw

    2013-01-01

    Context As with care giving and rehabilitation in chronic illnesses, the concern with traumatic brain injury (TBI), particularly with diffuse axonal injury (DAI), is that the caregivers are so overwhelmingly involved in caring and rehabilitation of the victim that in the process they become traumatized themselves. This review intends to shed light on the hidden and silent trauma sustained by the caregivers of severe brain injury survivors. Motor vehicle accident (MVA) is the highest contributor of TBI or DAI. The essence of trauma is the infliction of pain and suffering and having to bear the pain (i.e. by the TBI survivor) and the burden of having to take care and manage and rehabilitate the TBI survivor (i.e. by the TBI caregiver). Moreover many caregivers are not trained for their care giving task, thus compounding the stress of care giving and rehabilitating patients. Most research on TBI including DAI, focus on the survivors and not on the caregivers. TBI injury and its effects and impacts remain the core question of most studies, which are largely based on the quantitative approach. Evidence Acquisition Qualitative research can better assess human sufferings such as in the case of DAI trauma. While quantitative research can measure many psychometric parameters to assess some aspects of trauma conditions, qualitative research is able to fully reveal the meaning, ramification and experience of TBI trauma. Both care giving and rehabilitation are overwhelmingly demanding; hence , they may complicate the caregivers’ stress. However, some positive outcomes also exist. Results Caregivers involved in caring and rehabilitation of TBI victims may become mentally traumatized. Posttraumatic recovery of the TBI survivor can enhance the entire family’s closeness and bonding as well as improve the mental status of the caregiver. Conclusions A long-term longitudinal study encompassing integrated research is needed to fully understand the traumatic experiences of

  15. Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score.

    PubMed

    Vaccaro, Alexander R; Baron, Eli M; Sanfilippo, James; Jacoby, Sidney; Steuve, Jacob; Grossman, Eric; DiPaola, Matthew; Ranier, Paul; Austin, Luke; Ropiak, Ray; Ciminello, Michael; Okafor, Chuka; Eichenbaum, Matthew; Rapuri, Venkat; Smith, Eric; Orozco, Fabio; Ugolini, Peter; Fletcher, Mark; Minnich, Jonathan; Goldberg, Gregory; Wilsey, Jared; Lee, Joon Y; Lim, Moe R; Burns, Anthony; Marino, Ralph; DiPaola, Christian; Zeiller, Laura; Zeiler, Steven C; Harrop, James; Anderson, D Greg; Albert, Todd J; Hilibrand, Alan S

    2006-05-15

    Prospective study of 5 spine surgeons rating 71 clinical cases of thoracolumbar spinal injuries using the Thoracolumbar Injury Severity Score (TLISS) and then re-rating the cases in a different order 1 month later. To determine the reliability of the TLISS system. The TLISS is a recently introduced classification system for thoracolumbar spinal column injures designed to simplify injury classification and facilitate treatment decision making. Before being widely adopted, the reliability of the TLISS must be studied. A total of 71 cases of thoracolumbar spinal trauma were distributed on CD-ROM to 5 attending spine surgeons, including clinical/radiographic data, details of the TLISS, and a scoring sheet in which cases would be scored using the system. The surgeons were later assigned the task with the cases reordered. Intraobserver and interobserver reliability was calculated for TLISS components, total score, and surgeon's treatment decision using the Cohen unweighted kappa coefficients and Spearman rank-order correlation. Interrater reliability assessed by generalized kappa coefficients was 0.33 +/- 0.03 for injury mechanism, 0.91 +/- 0.02 for neurologic status, 0.35 +/- 0.03 for posterior ligamentous complex status, 0.29 +/- 0.02 for TLISS total, and 0.52 +/- 0.03 for treatment recommendation. Respective results using the Spearman correlation were 0.35 +/- 0.04, 0.94 +/- 0.01, 0.48 +/- 0.04, 0.65 +/- 0.03, and 0.51 +/- 0.04. Surgeons agreed with the TLISS recommendation 96.4% of the time. Intrarater kappa coefficients were 0.57 +/- 0.04 for injury mechanism, 0.93 +/- 0.02 for neurologic status, 0.48 +/- 0.04 for posterior ligamentous complex status, 0.46 +/- 0.03 for TLISS total, and 0.62 +/- 0.04 for treatment recommendation. Respective results using the Spearman correlation were 0.70 +/- 0.04, 0.95 +/- 0.02, 0.59 +/- 0.05, 0.77 +/- 0.04, and 0.59 +/- 0.05. The TLISS has good reliability and compares favorably to other contemporary thoracolumbar fracture

  16. Does alcohol intoxication protect patients from severe injury and reduce hospital mortality? The association of alcohol consumption with the severity of injury and survival in trauma patients.

    PubMed

    Hsieh, Chi-Hsun; Su, Li-Ting; Wang, Yu-Chun; Fu, Chih-Yuan; Lo, Hung-Chieh; Lin, Chiu-Hsiu

    2013-12-01

    Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. Blood alcohol concentration (BAC) was routinely measured for each patient on admission. Patients were divided into four groups based on their BAC level, which included nondrinking, BAC less than 100, BAC 100 to 200, and BAC 200 mg/dL or greater. Patient demographics, physical status and injury severity on admission, length of hospital stay, and outcome were compared between the groups. Odds ratios of having a severe injury, prolonged hospital stay, and mortality were estimated. Patients with a positive BAC had an increased risk of sustaining craniofacial and thoracoabdominal injuries. Odds ratios of having severe injuries (Injury Severity Score [ISS] 16 or greater) and a prolonged hospital stay were also increased. However, for those patients whose ISS was 16 or greater and who also had a brain injury, risk of fatality was significantly reduced if they were intoxicated (BAC 200 mg/dL or greater) before injury. Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.

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

    PubMed

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

    2017-07-01

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

  18. Increased insulin requirements are associated with pneumonia after severe injury.

    PubMed

    Martin, R Shayn; Smith, Judy S; Hoth, J Jason; Miller, Preston R; Meredith, J Wayne; Chang, Michael C

    2007-08-01

    Hyperglycemia after severe injury has been associated with an increased risk of infection and death. Strict glycemic control has been found to be valuable in select surgical populations. Varying amounts of insulin by infusion are required to maintain blood glucose levels within normal limits. Little is known about how insulin requirements are affected by the presence of infection, and therefore, the purpose of this study was to characterize this relationship. Medical records of all intubated, injured patients admitted to the intensive care unit during a 16-month period were reviewed. Patients were included if they were managed with an insulin infusion, and they had a single bronchoalveolar lavage (BAL) culture performed for presumed pneumonia between 48 hours and 8 days. Mean hourly and 24-hour insulin requirements were analyzed before BAL was performed and then compared with values after cultures were obtained. This difference was then compared between patients with and without pneumonia. Eighty-two patients met inclusion criteria during the 16-month study period. The hourly and 24-hour insulin requirements significantly increased from before to after BAL was performed in patients with pneumonia (n = 54) and not in those without (n = 28) (p = 0.008). The 24-hour insulin requirement increased by 26.2 units from before to after BAL in the pneumonia group versus 7.6 units in the nonpneumonia group (p = 0.029). A mean hourly insulin requirement increase of 1.2 units more than the pre-BAL level demonstrated an 86% positive predictive value and 89% specificity for pneumonia. An increase in insulin requirements at the time of obtaining pulmonary cultures is associated with the presence of pneumonia and may represent a valuable tool for earlier recognition.

  19. Premorbid prevalence of poor academic performance in severe head injury.

    PubMed Central

    Haas, J F; Cope, D N; Hall, K

    1987-01-01

    A study of 80 head injured patients revealed poor premorbid academic performance in up to 50% of the sample. Poor academic performance, as defined by diagnosis of learning disability, multiple failed academic subjects, or school dropout during secondary education, is not a previously cited risk factor for head injury. These findings have important implications in the identification of a high risk population and in the subsequent ability to reduce the incidence of head injury. PMID:3819755

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

    PubMed

    Lax Pericall, Maria Teresa; Taylor, Eric

    2014-01-01

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

  1. Perioperative Evaluation of Patient Outcomes after Severe Acid Corrosive Injury

    PubMed Central

    Wu, Ming-Ho; Wu, Han-Yun

    2015-01-01

    We reviewed 64 patients with perforation or full-thickness injury of the alimentary tract after acid ingestion. Based on our classification of laparotomy findings, there were class I (n = 15); class II (n = 13); class III (n = 16); and class IV (n = 20). Study parameters were preoperative laboratory data, gastric perforation, associated visceral injury, and extension of the injury. End points of the study were the patients' mortality and length of hospital stay. All these patients underwent esophagogastrectomy with (n = 16) or without (n = 24) concomitant resection, esophagogastroduodenojejunectomy with (n = 4) or without (n = 13) concomitant resection, and laparotomy only (n = 7). Concomitant resections were performed on the spleen (n = 10), colon (n = 2), pancreas (n = 1), gall bladder (n = 1), skipped areas of jejunum (n = 4), and the first portion of the duodenum (n = 4). The study demonstrates five preoperative risk factors, female gender, shock status, shock index, pH value, and base deficit, and four intraoperative risk factors, gastric perforation, associated visceral injury, injury beyond the pylorus, and continuous involvement of the jejunum over a length of 50 cm. The overall mortality rate was 45.3%, which increased significantly with advancing class of corrosive injury. PMID:26582190

  2. Effect of posttraumatic serum thyroid hormone levels on severity and mortality of patients with severe traumatic brain injury.

    PubMed

    Malekpour, Babak; Mehrafshan, Ali; Saki, Forough; Malekmohammadi, Zahed; Saki, Nasrin

    2012-01-01

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

  3. Severe Traumatic Brain Injury In Children: An Evidence-Based Review Of Emergency Department Management.

    PubMed

    Morrissey, Kirsten; Fairbrother, Hilary

    2016-10-01

    More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged < 14 years. Traumatic brain injury is a significant cause of morbidity and mortality in pediatric trauma patients. Early identification and management of severe traumatic brain injury is crucial in decreasing the risk of secondary brain injury and optimizing outcome. The main focus for early management of severe traumatic brain injury is to mitigate and prevent secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes. This issue discusses methods to maintain adequate oxygenation, maximize management of intracranial hypertension, and optimize blood pressure in the emergency department to improve neurologic outcomes following pediatric severe traumatic brain injury.

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

    PubMed

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

    2016-08-01

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

  5. Priorities of pedestrian protection--a real-life study of severe injuries and car sources.

    PubMed

    Fredriksson, Rikard; Rosén, Erik; Kullgren, Anders

    2010-11-01

    The aim of this study was to aid the optimisation of future, vehicle based, pedestrian injury countermeasures. The German In-Depth Accident Study (GIDAS) database was queried for pedestrians impacted by the front of a passenger car or van. A total of 1030 cases from 1998 to 2008 were studied including 161 severely (AIS3+) injured pedestrians. Considering the severe injuries, the most frequent injury mechanisms were "leg-to-front end", "head-to-windscreen area", "chest-to-bonnet area", and "chest-to-windscreen area". For children, a "head-to-bonnet area" impact was the second most common source of injury. With safety systems targeting these five injury mechanisms, 73% (95% confidence interval [CI], 65-81%) of the severely injured pedestrians would be provided protection from all of their vehicle-induced severe injuries. Omitting the windscreen area, this figure is decreased to 44% (CI, 36-53%). Furthermore, 31% of the surviving pedestrians were estimated to sustain a permanent medical impairment at any level. For more severe impairment, head was the dominating body region. The study shows that when developing countermeasures for the windscreen area to mitigate head injuries, attention should be paid to the structural parts of the windscreen area with a special focus on brain injuries. Finally, the incidence and risk of severe injury were derived as functions of impact speed for different body regions and injury sources. 2010 Elsevier Ltd. All rights reserved.

  6. Relationship between socioeconomic factors and severe childhood injuries.

    PubMed

    Pomerantz, W J; Dowd, M D; Buncher, C R

    2001-03-01

    The objective was to examine the relationship between injury rates and socioeconomic factors for children in Hamilton County, Ohio, using small-area analysis. The subjects were county residents less than 15 years old who were hospitalized or died of injuries between January 1, 1993, and December 31, 1995; they were identified through a population-based trauma registry. The census tract was the unit of analysis; the rate of injury per 100,000 population was the dependent variable. Risk factors included median income, level of education, percentage below the poverty level, percentage unemployment, percentage non-Caucasian, and percentage families headed by females. There were 2,437 children meeting the case definition; injuries per census tract ranged from 0 to 2,020.2 per 100,000 per year. Census tracts with higher injury rates had lower median incomes, more people with less than a high school education, more unemployment, more families headed by females, more people living below the poverty level, and more non-Caucasians than those with lower rates. In a regression model, percentage of people living below the poverty level, percentage of those who did not graduate from high school, and percentage unemployment were significant risk factors for injuries, P < .001. Since small-area analysis examines associations on an ecological level rather than an individual level, these studies should always be interpreted with caution because an association found at the level of the census tract may not apply at the individual level. Interventions to reduce injuries should target socioeconomically disadvantaged children living below the poverty level and those in areas with fewer high school graduates and more unemployment.

  7. Injuries from Combat Explosions in Iraq: Injury Type, Location, and Severity

    DTIC Science & Technology

    2012-01-01

    Institutional Review Board ( Protocol NHRC.2009.0023). Individual demographics (age, military rank, branch of service), injury circumstances (type of explosive...the ICD-9 codes that describe trauma, and constructs a matrix using 12 natures of injury (fractures, dislocations, sprains and strains, internal...versions were used in the analysis. The 11 of the 12 injury natures were collapsed into orthopaedic injuries (fractures, dislocations, sprains and strains

  8. Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability.

    PubMed

    Fitzgerald, Julie C; Basu, Rajit K; Akcan-Arikan, Ayse; Izquierdo, Ledys M; Piñeres Olave, Byron E; Hassinger, Amanda B; Szczepanska, Maria; Deep, Akash; Williams, Duane; Sapru, Anil; Roy, Jason A; Nadkarni, Vinay M; Thomas, Neal J; Weiss, Scott L; Furth, Susan

    2016-12-01

    The prevalence of septic acute kidney injury and impact on functional status of PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic acute kidney injury. Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study: acute kidney injury was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no acute kidney injury or stage 1 acute kidney injury ("no/mild acute kidney injury") were compared with those with stage 2 or 3 acute kidney injury ("severe acute kidney injury"). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher and increased by 1 from baseline. One hundred twenty-eight PICUs in 26 countries. Children with severe sepsis in the Sepsis PRevalence, OUtcomes, and Therapies study. None. One hundred two (21%) of 493 patients had severe acute kidney injury. More than twice as many patients with severe acute kidney injury died or developed new moderate disability compared with those with no/mild acute kidney injury (64% vs 30%; p < 0.001). Severe acute kidney injury was independently associated with death or new moderate disability (adjusted odds ratio, 2.5; 95% CI, 1.5-4.2; p = 0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score. In a multinational cohort of critically ill children with severe sepsis and high mortality rates, septic acute kidney injury is independently associated with further increased death or new disability.

  9. Incidence and Severity of Foot and Ankle Injuries in Men’s Collegiate American Football

    PubMed Central

    Lievers, W. Brent; Adamic, Peter F.

    2015-01-01

    Background: American football is an extremely physical game with a much higher risk of injury than other sports. While many studies have reported the rate of injury for particular body regions or for individual injuries, very little information exists that compares the incidence or severity of particular injuries within a body region. Such information is critical for prioritizing preventative interventions. Purpose: To retrospectively analyze epidemiological data to identify the most common and most severe foot and ankle injuries in collegiate men’s football. Study Design: Descriptive epidemiology study. Methods: Injury data were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for all foot and ankle injuries during the 2004-2005 to 2008-2009 seasons. Injuries were analyzed in terms of incidence and using multiple measures of severity (time loss, surgeries, medical disqualifications). This frequency and severity information is summarized in tabular form as well as in a 4 × 4 quantitative injury risk assessment matrix (QIRAM). Results: The rate of foot and ankle injuries was 15 per 10,000 athletic exposures (AEs). Five injuries were found to be responsible for more than 80% of all foot and ankle injuries: lateral ankle ligament sprains, syndesmotic (high ankle) sprains, medial ankle ligament sprains, midfoot injuries, and first metatarsophalangeal joint injuries. Ankle dislocations were found to be the most severe in terms of median time loss (100 days), percentage of surgeries (83%), and percentage of medical disqualifications (94%), followed by metatarsal fractures (38 days, 36%, and 49%, respectively) and malleolus fractures (33 days, 41%, and 59%, respectively). Statistical analysis suggests that the 3 measures of severity are highly correlated (r > 0.94), thereby justifying the use of time loss as a suitable proxy for injury severity in the construction of the QIRAM. Conclusion: Based on the QIRAM analysis

  10. Investigation of mortality and morbidity associated with severe self-injurious behavior.

    PubMed

    Wieseler, N A; Hanson, R H; Nord, G

    1995-07-01

    A retrospective study was conducted to determine whether severe self-injurious behavior was associated with shortened lengths of life or greater sensory impairments for Minnesota Regional Treatment Center residents with developmental disabilities. The client records of 209 institutionalized individuals who died between January 1, 1980, and December 31, 1989, were reviewed. The data revealed that the 29 clients who exhibited severe self-injury did not live significantly shorter lives compared to matched cohorts without self-injury. However, those clients with severe self-injury were found to have a significantly higher incidence of vision and hearing impairments than did the matched cohorts. Implications of these findings were discussed.

  11. [Injuries in emergency rooms of urban areas in Mexico: prevalence and severity].

    PubMed

    Avila-Burgos, Leticia; Ventura-Alfaro, Carmelita Elizabeth; Hidalgo-Solórzano, Elisa del Carmen; Hijar-Medina, Martha; Aracena-Genao, Belkis; Celis-de la Rosa, Alfredo de Jesús

    2012-01-01

    To identify frequency and severity of injuries by type of external cause in people attending emergency services for medical attention. Cross-sectional study held in the cities of Guadalajara, Colima and Mexico City, from September 2007 to February 2008. All people requiring emergency medical attention due to injuries were included. sex, age, anatomical area of the injury, type of injury, external cause, type of aggressor and severity according to the abbreviated injury scale. Statistical analysis was univariate simple and multivariate. 26.3% of the emergency medical attention was due to injuries, with the main cause being falls (49.3%). Individuals from 15 to 44 years (55.8%) reported a higher frequency, while those over 60 years presented the most serious injuries. Associated variables to severity were interpersonal aggression (OR 6.7, IC 95% 4.20-10.69) and road traffic injuries (OR 3.00, IC 95% 1.72-5.23). Conclusions. Accidental and intentional injuries represent an important demand of emergency medical attention; with interpersonal aggression and road traffic injuries being responsible for the highest number of serious injuries.

  12. A cause of severe thigh injury: Battery explosion.

    PubMed

    Görgülü, Tahsin; Torun, Merve; Olgun, Abdulkerim

    2016-02-01

    In parallel with technological improvements, humankind encounter with equipments/devices transforming chemical energy to electrical energy. Especially automobile batteries, watch and mobile phone batteries are the most encountered ones. In the literature, there are mainly facial burn cases due to mobile phone battery explosion. On the other hand very few examples of serious lower limb. injury is present. 12-year-old female patient referred to emergency room with skin and soft tissue injuries on bilateral anteromedial thigh area as a result of battery explosion. The widest axis of skin defect was approximately 16 × 8 cm on the right side, and 17 × 4 cm on the left side. In addition, there were tattooing caused by chemical injury and multiple pin-point like lesions extending to dermal level on anterior region of thigh. Chemically dirty and necrotized dermal and subdermal tissues were debrided and foreign materials were removed from regions with multiple tattooing. Left thigh was closed primarily. In order to close the defect on right anterior thigh, skin flap from right medial thigh is advanced in Y-V fashion. Battery explosion causing lower extremity tissue defect is a type of injury that is rarely seen in the literature. Regardless of battery size and energy level, they should be considered as potential explosive material and protector masks, clothing should be worn during contact with this type of material.

  13. A cause of severe thigh injury: Battery explosion

    PubMed Central

    Görgülü, Tahsin; Torun, Merve; Olgun, Abdulkerim

    2015-01-01

    Introduction In parallel with technological improvements, humankind encounter with equipments/devices transforming chemical energy to electrical energy. Especially automobile batteries, watch and mobile phone batteries are the most encountered ones. In the literature, there are mainly facial burn cases due to mobile phone battery explosion. On the other hand very few examples of serious lower limb. injury is present. Presentation of case 12-year-old female patient referred to emergency room with skin and soft tissue injuries on bilateral anteromedial thigh area as a result of battery explosion. The widest axis of skin defect was approximately 16 × 8 cm on the right side, and 17 × 4 cm on the left side. In addition, there were tattooing caused by chemical injury and multiple pin-point like lesions extending to dermal level on anterior region of thigh. Chemically dirty and necrotized dermal and subdermal tissues were debrided and foreign materials were removed from regions with multiple tattooing. Left thigh was closed primarily. In order to close the defect on right anterior thigh, skin flap from right medial thigh is advanced in Y–V fashion. Discussion Battery explosion causing lower extremity tissue defect is a type of injury that is rarely seen in the literature. Regardless of battery size and energy level, they should be considered as potential explosive material and protector masks, clothing should be worn during contact with this type of material. PMID:26862395

  14. Thoracic injuries sustained by severely injured front-seat passengers and drivers: injury patterns and their relationship to crash characteristics.

    PubMed

    Stübig, Timo; Brand, Stephan; Zeckey, Christian; Beltran, Michael J; Otte, Dietmar; Krettek, Christian; Haasper, Carl

    2013-01-01

    Thoracic injuries are common in vehicle crashes, but only a few studies thus far have analysed the relationship between injury characteristics and collision details and discussed the possible implications for future vehicle design and prevention. In this study, the crash details were prospectively collected at the scene of injury between 2004 and 2009 for severely injured patients. The collected data included the type of collision, angle of impact and change of velocity on impact as well as injury characteristics and patient demographics, including abbreviated injury scale (AIS) and injury severity score (ISS).There were 5998 accidents involving 8830 patients over this five-year period; 31 met the inclusion criteria (23 males and eight females). The mean ISS was 37 ± 12.68, the mean AIS Thorax was 4.0. Lung contusions were found in 90% of the patients, pneumothoraces in 58% and rib fractures in 81%. There was a significant relationship between accident deceleration speed (ΔV), AIS Thorax (p = 0.02) and the incidence of pneumothoraces (p = 0.046). The analysis showed a high overall incidence of thoracic injuries in car passengers. Future improvements in automobile safety and design should seek to reduce the incidence of thoracic injuries by uniform vehicle deformation and further implementation of side airbags.

  15. Brief Report: Parental Report of Sleep Behaviors Following Moderate or Severe Pediatric Traumatic Brain Injury*

    PubMed Central

    Beebe, Dean W.; Krivitzky, Lauren; Wells, Carolyn T.; Wade, Shari L.; Taylor, H. Gerry; Yeates, Keith Owen

    2014-01-01

    Objective Determine the effect of moderate and severe traumatic brain injuries (TBI) on the sleep of school-aged children. Methods A concurrent cohort-prospective design compared children aged 6–12 years who sustained moderate TBI (baseline n=56), severe TBI (n= 53), or only orthopedic injuries (n= 80). Retrospective parental report of pre-injury sleep was collected about 3 weeks post-injury. Post-injury assessments occurred prospectively a mean of 6, 12, and 48 months later. Results Growth curve analyses compared the groups over time. The moderate TBI group had worse pre-injury sleep than the other groups. The moderate TBI and orthopedic injury groups displayed a small decline in sleep problems from pre- to post-injury. Children with severe TBI displayed increased post-injury sleep problems. Conclusions Children who sustain severe TBI are at elevated risk for post-injury sleep problems. Because sleep problems may result in daytime impairments and family distress, additional clinical and research attention is warranted. PMID:17442693

  16. Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics

    PubMed Central

    Cripton, Peter A; Shen, Hui; Brubacher, Jeff R; Chipman, Mary; Friedman, Steven M; Harris, M Anne; Winters, Meghan; Reynolds, Conor C O; Cusimano, Michael D; Babul, Shelina; Teschke, Kay

    2015-01-01

    Objective To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics. Methods Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics. Results Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission). Conclusions In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians. PMID:25564148

  17. Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics.

    PubMed

    Cripton, Peter A; Shen, Hui; Brubacher, Jeff R; Chipman, Mary; Friedman, Steven M; Harris, M Anne; Winters, Meghan; Reynolds, Conor C O; Cusimano, Michael D; Babul, Shelina; Teschke, Kay

    2015-01-05

    To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics. Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics. Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission). In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians. Published by the BMJ Publishing Group Limited. For permission to use (where

  18. Injury risk for matched front and rear seat car passengers by injury severity and crash type: An exploratory study.

    PubMed

    Mitchell, R J; Bambach, M R; Toson, Barbara

    2015-09-01

    The risk of serious injury or death has been found to be reduced for some front compared to rear seat car passengers in newer vehicles. However, differences in injury severity between car occupants by seating position has not been examined. This study examines the injury severity risk for rear compared to front seat car passengers. A retrospective matched-cohort analysis was conducted of vehicle crashes involving injured rear vs front seat car passengers identified in linked police-reported, hospitalisation and emergency department (ED) presentation records during 2001-2011 in New South Wales (NSW), Australia. Odds ratios were estimated using an ordinal logistic mixed model and logistic mixed models. There were 5419 front and 4588 rear seat passengers in 3681 vehicles. There was a higher odds of sustaining a higher injury severity as a rear-compared to a front seat car passenger, with a higher odds of rear seat passengers sustaining serious injuries compared to minimal injuries. Where the vehicle occupant was older, travelling in a vehicle manufactured between 1990 and 1996 or after 1997, where the airbag deployed, and where the vehicle was driven where the speed limit was ≥70km/h there was a higher odds of the rear passenger sustaining a higher injury severity then a front seated occupant. Rear seat car passengers are sustaining injuries of a higher severity compared to front seat passengers travelling in the same vehicle, as well as when travelling in newer vehicles and where the front seat occupant is shielded by an airbag deployed in the crash. Rear seat occupant protective mechanisms should be examined. Pre-hospital trauma management policies could influence whether an individual is transported to a hospital ED, thus it would be beneficial to have an objective measure of injury severity routinely available in ED records. Further examination of injury severity between rear and front seat passengers is warranted to examine less severe non-fatal injuries by car

  19. Neuroendocrine dysfunction in acute phase of moderate-to-severe traumatic brain injury: a prospective study.

    PubMed

    Prasanna, K L; Mittal, R S; Gandhi, Ashok

    2015-01-01

    Most of the retrospective studies have demonstrated that traumatic brain injury mediated hypopituitarism could be more frequent than previously known. Therefore, this study has prospectively investigated pituitary function and their correlation with severity, pressure effect and Glasgow Outcome Scale in the acute phase of moderate-to-severe traumatic brain injury. One hundred consecutive moderate-to-severe traumatic brain injury patients from August 2012 to November 2013 formed the study group. Apart from clinical assessment, non-contrast computed tomography of the head was performed on all patients on admission. The hormonal analysis (fT3, fT4, TSH, GH, Cortisol, Prolactin) was performed within 24 hours of traumatic brain injury and was repeated on the 7th day amongst the patients who survived. Growth hormone was the most common hormone to decrease. Cortisol was the most common hormone to increase. Risk of pituitary insufficiency was increased in patients with severe traumatic brain injury, patients with increased intracranial pressure and who had low Glasgow Outcome Scale. Neuroendocrine dysfunction occurs often in the acute phase of moderate-to-severe traumatic brain injury, more commonly in patients with severe traumatic brain injury, patients with pressure effects and low Glasgow Outcome Scale. Hormonal analysis should be considered in patients with moderate-to-severe traumatic brain injury, so that appropriate hormonal replacement can be done to optimize the clinical outcome.

  20. Incidence and severity of reported acute sports injuries in 35 sports using insurance registry data.

    PubMed

    Åman, M; Forssblad, M; Henriksson-Larsén, K

    2016-04-01

    Acute injuries in sport are still a problem where limited knowledge of incidence and severity in different sports at national level exists. In Sweden, 80% of the sports federations have their mandatory injury insurance for all athletes in the same insurance company and injury data are systematically kept in a national database. The aim of the study was to identify high-risk sports with respect to incidence of acute and severe injuries in 35 sports reported to the database. The number and incidences of injuries as well as injuries leading to permanent medical impairment (PMI) were calculated during 2008-2011. Each year approximately 12,000 injuries and 1,162,660 licensed athletes were eligible for analysis. Eighty-five percent of the injuries were reported in football, ice hockey, floorball, and handball. The highest injury incidence as well as PMI was in motorcycle, handball, skating, and ice hockey. Females had higher risk of a PMI compared with males in automobile sport, handball, floorball, and football. High-risk sports with numerous injuries and high incidence of PMI injuries were motorcycle, handball, ice hockey, football, floorball, and automobile sports. Thus, these sports ought to be the target of preventive actions at national level.

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

    PubMed

    Abakumov, A A; Lebedev, N V; Maliarchuk, B I

    2001-01-01

    The work presents an analysis of using scales VPH-P(MT) and VPH-P(SP) on the basis of a retrospective investigation of results of treatment of 268 patients with a combined injury of the abdomen. A conclusion is made that these scales have reserves for an improvement. The authors propose to supplement the scale VPH-P(SP) with the index of the patient's age, and the scale VPH-P(MT)--with an index of the blood loss volume.

  2. Metoprolol-induced Severe Liver Injury and Successful Management with Therapeutic Plasma Exchange

    PubMed Central

    Paramaguru, Rajaguru; Mahadevan, Pushpa; Ravindranath, Jayasurya; Augustine, Philip

    2017-01-01

    Liver injury caused by metoprolol is very rare with current reports limited to an isolated elevation in transaminases. We report the first case of severe icteric liver injury leading to hepatic encephalopathy secondary to metoprolol use in a patient diagnosed with coronary heart disease. We also describe the histopathology of metoprolol-related liver injury, discuss mechanisms of injury with new insights on the immunological phenomenon, and shed light on the successful utility of early plasmapheresis as a salvage therapy in metoprolol-induced severe liver damage. PMID:28589058

  3. Metoprolol-induced Severe Liver Injury and Successful Management with Therapeutic Plasma Exchange.

    PubMed

    Philips, Cyriac; Paramaguru, Rajaguru; Mahadevan, Pushpa; Ravindranath, Jayasurya; Augustine, Philip

    2017-05-02

    Liver injury caused by metoprolol is very rare with current reports limited to an isolated elevation in transaminases. We report the first case of severe icteric liver injury leading to hepatic encephalopathy secondary to metoprolol use in a patient diagnosed with coronary heart disease. We also describe the histopathology of metoprolol-related liver injury, discuss mechanisms of injury with new insights on the immunological phenomenon, and shed light on the successful utility of early plasmapheresis as a salvage therapy in metoprolol-induced severe liver damage.

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

    PubMed

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

    2012-03-01

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

  5. Helmet use and injury severity among pediatric skiers and snowboarders in Colorado.

    PubMed

    Milan, Melissa; Jhajj, Sandeep; Stewart, Camille; Pyle, Laura; Moulton, Steven

    2017-02-01

    Skiing and snowboarding are popular winter recreational activities that are commonly associated with orthopedic type injuries. Unbeknownst to most parents, however, are the significant but poorly described risks for head, cervical spine and solid organ injuries. Although helmet use is not mandated for skiers and snowboarders outside of resort sponsored activities, we hypothesized that helmet use is associated with a lower risk of severe head injury, shorter ICU stay and shorter hospital length of stay. The trauma registry at a level I pediatric trauma center in the state of Colorado was queried for children ages 3-17years, who sustained an injury while skiing or snowboarding from 1/1/1999 to 12/31/2014. Injury severity was assessed by Abbreviated Injury Severity (AIS) score, injury severity score (ISS) and admission location. Head injury was broadly defined as any trauma to the body above the lower border of the mandible. Regression analysis was used to test associations of variables with injury severity. 549 children sustained snow sport related injuries during the 16year study period. The mean patient age was11±3years, most were male (74%) and the majority were Colorado residents (54%). The overall median ISS was 9 (IQR 4-9) and 78 children (14%) were admitted to the ICU. Colorado residents were nearly twice as likely to be wearing a helmet at the time of injury, compared to visitors from out-of-state (adjusted OR 1.86, 95% CI 1.24-2.76, p=0.002). In a multivariate analysis injury severity was significantly associated with injury while skiing (p=0.026), helmet use (p=0.0416), and sustaining a head injury (p<0.0001). In a separate multivariate analysis ICU admission was associated with head injury (p<0.0001) and wearing a helmet (p=0.0257); however, those wearing a helmet and admitted to the ICU had significantly lower ISS (p=0.007) and head AIS (p=0.011) scores than those who were not wearing a helmet at the time of injury. Visitors from out of state were less

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

    PubMed

    Linn, S

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

  7. Injury severity, sex, and transfusion volume, but not transfusion ratio, predict inflammatory complications after traumatic injury.

    PubMed

    Jones, Allison R; Bush, Heather M; Frazier, Susan K

    Blood component (packed red blood cells [PRBC], fresh frozen plasma [FFP], platelets [PLT]) ratios transfused in a 1:1:1 fashion are associated with survival after trauma; the relationship among blood component ratios and inflammatory complications after trauma is not fully understood. To evaluate the relationship among blood component ratios (1:1 vs other for PRBC:FFP and PRBC:PLT) and inflammatory complications (primary outcome) in patients with major trauma. Secondary analysis of a multi-institution database (N = 1538). Survival methods were used to determine the relationship among blood component ratios and inflammatory complications. Patients were primarily male (68%), Caucasians (89%), aged 39 ± 14 years, involved in a motor vehicle collision (53%). Eighty-six percent of patients developed an inflammatory complication; 76% developed organ failure, 27% ventilator-associated pneumonia, and 24% acute respiratory distress syndrome. Injury severity, sex, and total PRBC transfusion volume, not blood component ratio, predicted inflammatory complications. Increased understanding of factors associated with inflammation after trauma and PRBC transfusion is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Non‐firearm weapon use and injury severity: priorities for prevention

    PubMed Central

    Brennan, I R; Moore, S C; Shepherd, J P

    2006-01-01

    Objectives To test the hypothesis that weapon‐related violence (excluding firearms) results in more severe injury relative to the use of body parts (fists, feet and other body parts), and to rank order of injury severity by assault mechanism. Design Retrospective cohort study. Participants 24 660 patients who were treated in a UK emergency department for violence‐related injury. Main outcome measure Score on the Manchester Triage Scale. Results The use of a weapon resulted in significantly more serious injury (adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI) 1.00 to 1.28). However, of all mechanisms of violent injury, the use of feet resulted in most severe injury (AOR 1.41, 95% CI 1.17 to 1.70), followed by blunt objects (AOR 1.35, 95% CI 1.14 to 1.58), other body parts (AOR 1.22, 95% CI 1.06 to 1.40) and sharp objects (AOR 1.09, 95% CI 0.91 to 1.5), compared with use of fists. Conclusions Use of weapons resulted in more severe injury than use only of body parts. The use of feet caused the most serious injuries, whereas the use of fists caused the least severe injuries. Injury severity varied by number of assailants and age of the patient—peaking at 47 years—but not by number of injuries. Preventing the use of feet in violence, and preventing group violence should be major priorities. PMID:17170189

  9. Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types.

    PubMed

    Sandvall, Brinkley K; Keys, Kari A; Friedrich, Jeffrey B

    2017-05-01

    The purpose of this study was to characterize injury patterns and outcomes of fireworks-related hand injuries and determine if there was an association with certain fireworks types. A retrospective cohort study was conducted on patients treated at a trauma center between 2005 and 2015. A total of 105 patients sustaining operative hand injuries due to fireworks were identified. Medical records were reviewed to identify injury patterns, treatment outcomes, and fireworks types. Eighty-eight patients (84%) sustained 92 thumb and/or first web space injuries. There were 12 thumb soft tissue-only injuries (13%) and 80 thumb fractures/dislocations (87%). Of these, there were 52 thumb carpometacarpal (CMC) joint dislocations (57%) and 36 thumb fractures outside the thumb CMC joint (39%). Fifteen hands (16%) sustained both thumb CMC joint dislocations and additional thumb fractures. Twenty-three hands (25%) required thumb revision amputation. The number of surgeries for acute reconstruction ranged from 1 to 7, with 17 patients (19%) requiring 3 or more. Sixty-three hands had deep first web space injuries, and 11 (17%) required flaps acutely for first web space reconstruction. Six hands required secondary reconstruction of a first web space contracture. An external fixator was applied to 6 hands to maintain the first web space; none of these required secondary web reconstruction. Excluding isolated pin removals and dressing changes under anesthesia, 19 patients (22%) required later-stage surgeries. Shells/mortars (59%) were the most common fireworks type causing injury. Among operative hand injuries, fireworks most commonly fracture the thumb, destabilize the thumb CMC joint, and deeply damage the first web space. The first web space requires particular consideration because deep injury may result in adduction contracture and require secondary reconstruction if not prevented. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc

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

    PubMed Central

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

    2014-01-01

    Purpose Little research has been done in China to study injury in individuals with disability. We investigated impact of type and severity of disability on injury among children with disability in Hubei Province of China. Methods A sample of 1201 children with disability were matched with 1201 healthy children on gender, age, and neighborhood. Disability type and severity were determined using the Chinese national standards. Caregivers were interviewed face-to-face about nonfatal unintentional injuries suffered by the child in the past 12 months prior to the interview. Univariate Chi-square test and logistic regression models were used to investigate association between disability type/severity and nonfatal unintentional injuries. Results Injury rate among children with disability was significantly higher than that among children without disability (10.2% vs. 4.4%; P <.001). Children with multiple disabilities had the highest risk of injury after controlling for confounding variables (OR=4.54; 95% CI=2.82, 7.30; P<.001). The magnitude of the association between disability and injury varied by type and severity of disability. Conclusions The magnitude of the association between the presence or absence of disability in children and their risk of injury was large and significant, regardless of the type or severity of the children's disabilities. PMID:24331162

  11. Analysis of driver injury severity in single-vehicle crashes on rural and urban roadways.

    PubMed

    Wu, Qiong; Zhang, Guohui; Zhu, Xiaoyu; Liu, Xiaoyue Cathy; Tarefder, Rafiqul

    2016-09-01

    This study analyzes driver injury severities for single-vehicle crashes occurring in rural and urban areas using data collected in New Mexico from 2010 to 2011. Nested logit models and mixed logit models are developed in order to account for the correlation between severity categories (No injury, Possible injury, Visible injury, Incapacitating injury and fatality) and individual heterogeneity among drivers. Various factors, such as crash and environment characteristics, geometric features, and driver behavior are examined in this study. Nested logit model and mixed logit model reveal similar results in terms of identifying contributing factors for driver injury severities. In the analysis of urban crashes, only the nested logit model is presented since no random parameter is found in the mixed logit model. The results indicate that significant differences exist between factors contributing to driver injury severity in single-vehicle crashes in rural and urban areas. There are 5 variables found only significant in the rural model and six significant variables identified only in the urban crash model. These findings can help transportation agencies develop effective policies or appropriate strategies to reduce injury severity resulting from single-vehicle crashes.

  12. Severe Head Injury May Raise Dementia Risk Years Later

    MedlinePlus

    ... moderate-to-severe TBI [were] diagnosed with a neurodegenerative disease [such as dementia] later in life," said study ... persons with mild TBI were diagnosed with a neurodegenerative disease," Raj added, placing moderate-to-severe TBI patients ...

  13. Analysis of Road Traffic Crashes–Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan

    PubMed Central

    Aladelusi, Timothy; Akinmoladun, Victor; Olusanya, Adeola; Akadiri, Oladimeji; Fasola, Abiodun

    2014-01-01

    The objective of this study was to determine the prevalence of road traffic crashes (RTC)–related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the

  14. Analysis of Road Traffic Crashes-Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan.

    PubMed

    Aladelusi, Timothy; Akinmoladun, Victor; Olusanya, Adeola; Akadiri, Oladimeji; Fasola, Abiodun

    2014-12-01

    The objective of this study was to determine the prevalence of road traffic crashes (RTC)-related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the

  15. Severe injury to near- and far-seated occupants in side impacts by crash severity and belt use.

    PubMed

    Viano, David C; Parenteau, Chantal S

    2010-02-01

    This study investigated the risk of severe-to-fatal injury (MAIS 4+F) to near- and far-seated front occupants in side impacts by belt use and crash severity (delta V). 1993-2007 NASS-CDS was analyzed for front-seat occupants in side impacts while they were either the near-side or far-side occupant by belt use. Light vehicles were included with model year 1994+. Injury severity was subdivided into MAIS 0-2, 3, and 4+F. The risk for MAIS 4+F injury was determined by dividing the number of MAIS 4+F by the number of exposed occupants with known injuries. Individual NASS-CDS cases were downloaded from the 1997-2007 electronic data to evaluate injury patterns causing high relative risks. In 35+ mph side-impact delta Vs, the risk for MAIS 4+F injury was 75.4 +/- 41.0% for unbelted near-side and 48.1 +/- 14.6% for unbelted far-side occupants. The risk was 51.8 +/- 14.8% for belted near-side and 30.9 +/- 8.2% for far-side occupants. Seat belt use was 81.4% effective in preventing MAIS 4+F injury for near-side occupants and 93.5% for far-side occupants. The relative risk (RR) for unbelted compared to belted occupants was 35.9 for far-side occupants in 10-15 mph delta V crashes. The relative risk was 35.1 for near-side occupants in < 10 mph delta V side impacts. The high relative risks were associated with complex, high-speed multi-collision crashes often with occupant impacts on the windshield, steering wheel, or other frontal components and ejection. Seat belt use was more effective in preventing severe injury (MAIS 4+F) to far-side occupants than near-side occupants in < 25 mph delta V impacts. High relative risk for unbelted occupants in low-speed side impacts was explained by the fact that the accidents were high-speed, multi-impact collisions. Severe injury was caused by ejection, impact with the side interior, or impact with the frontal components where airbags sometimes deployed.

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

    PubMed

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

    2015-01-01

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

  17. Child Outcomes and Family Characteristics 1 Year After Severe Inflicted or Noninflicted Traumatic Brain Injury

    PubMed Central

    Keenan, Heather T.; Runyan, Desmond K.; Nocera, Maryalice

    2008-01-01

    OBJECTIVE To assess outcomes 1 year after severe traumatic brain injury (TBI) among young children and to compare outcomes between children with inflicted versus noninflicted injuries. STUDY DESIGN Prospective cohort study. METHODS All North Carolina-resident children who were hospitalized between January 2000 and December 2001 in any of the state’s 9 PICUs and who survived a severe TBI that occurred on or before their second birthday were eligible to participate. Child health status, child use of ancillary medical resources, and family characteristics were determined through maternal caregiver interviews ~1 year after injury. Comparisons were made between family characteristics and child outcomes according to injury type. RESULTS Seventy-two interviews of maternal caregivers were completed among 112 survivors (64.3%). Children with inflicted injuries (n = 41) had worse outcomes than did children with noninflicted injuries (n = 31), as measured with the Pediatric Outcome Performance Category and Stein-Jessup Functional Status II (Revised) tools. However, ~50% of children with inflicted injuries had only mild deficits or better. Children with inflicted injuries had a higher use of ancillary medical resources. Families caring for the children did not differ substantively, with a large proportion of single, working, minority mothers. CONCLUSIONS Children with inflicted TBIs had worse outcomes than did children with other TBIs 1 year after injury. However, outcomes for these children were better than those reported previously. Many families caring for children after severe TBI are socially disadvantaged. Interventions to improve child outcomes may include enhanced family support. PMID:16452349

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

    PubMed Central

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

    2015-01-01

    Summary Purpose hamstring injury is the most common musculoskeletal disorder and one of the main causes of missed sporting events. Shortening the time to return to play (TTRTP) is a priority for athletes and sports medicine practitioners. Hypothesis platelet-rich plasma (PRP) injection at the site of severe acute hamstring injury increases the healing rate and shortens the TTRTP. Study design Cohort study. Methods all patients with ultrasonography and MRI evidence of severe acute hamstring injury between January 2012 and March 2014 were offered PRP treatment. Those who accepted received a single intramuscular PRP injection within 8 days post-injury; the other patients served as controls. The same standardized rehabilitation program was used in both groups. A physical examination and ultrasonography were performed 10 and 30 days post-injury, then a phone interview 120 days post-injury, to determine the TTRTP at the pre-injury level. Results of 34 patients, 15 received PRP and 19 did not. Mean TTRTP at the pre-injury level was 50.9±10.7 days in the PRP group and 52.8±15.7 days in the control group. The difference was not statistically significant. Conclusion a single intramuscular PRP injection did not shorten the TTRTP in sports people with severe acute hamstring injuries. PMID:26958537

  19. Child outcomes and family characteristics 1 year after severe inflicted or noninflicted traumatic brain injury.

    PubMed

    Keenan, Heather T; Runyan, Desmond K; Nocera, Maryalice

    2006-02-01

    To assess outcomes 1 year after severe traumatic brain injury (TBI) among young children and to compare outcomes between children with inflicted versus noninflicted injuries. Prospective cohort study. All North Carolina-resident children who were hospitalized between January 2000 and December 2001 in any of the state's 9 PICUs and who survived a severe TBI that occurred on or before their second birthday were eligible to participate. Child health status, child use of ancillary medical resources, and family characteristics were determined through maternal caregiver interviews approximately 1 year after injury. Comparisons were made between family characteristics and child outcomes according to injury type. Seventy-two interviews of maternal caregivers were completed among 112 survivors (64.3%). Children with inflicted injuries (n = 41) had worse outcomes than did children with noninflicted injuries (n = 31), as measured with the Pediatric Outcome Performance Category and Stein-Jessup Functional Status II (Revised) tools. However, approximately 50% of children with inflicted injuries had only mild deficits or better. Children with inflicted injuries had a higher use of ancillary medical resources. Families caring for the children did not differ substantively, with a large proportion of single, working, minority mothers. Children with inflicted TBIs had worse outcomes than did children with other TBIs 1 year after injury. However, outcomes for these children were better than those reported previously. Many families caring for children after severe TBI are socially disadvantaged. Interventions to improve child outcomes may include enhanced family support.

  20. A Geospatial Analysis of Severe Firearm Injuries Compared to Other Injury Mechanisms: Event Characteristics, Location, Timing, and Outcomes.

    PubMed

    Newgard, Craig D; Sanchez, Brittany J; Bulger, Eileen M; Brasel, Karen J; Byers, Adam; Buick, Jason E; Sheehan, Kellie L; Guyette, Frank X; King, Richard V; Mena-Munoz, Jorge; Minei, Joseph P; Schmicker, Robert H

    2016-05-01

    Relatively little is known about the context and location of firearm injury events. Using a prospective cohort of trauma patients, we describe and compare severe firearm injury events to other violent and nonviolent injury mechanisms regarding incident location, proximity to home, time of day, spatial clustering, and outcomes. This was a secondary analysis of a prospective cohort of injured children and adults with hypotension or Glasgow Coma Scale score ≤ 8, injured by one of four primary injury mechanisms (firearm, stabbing, assault, and motor vehicle collision [MVC]) who were transported by emergency medical services to a Level I or II trauma center in 10 regions of the United States and Canada from January 1, 2010, through June 30, 2011. We used descriptive statistics and geospatial analyses to compare the injury groups, distance from home, outcomes, and spatial clustering. There were 2,079 persons available for analysis, including 506 (24.3%) firearm injuries, 297 (14.3%) stabbings, 339 (16.3%) assaults, and 950 (45.7%) MVCs. Firearm injuries resulted in the highest proportion of serious injuries (66.3%), early critical resources (75.3%), and in-hospital mortality (53.5%). Injury events occurring within 1 mile of a patient's home included 53.9% of stabbings, 49.2% of firearm events, 41.3% of assaults, and 20.0% of MVCs; the non-MVC events frequently occurred at home. While there was geospatial clustering, 94.4% of firearm events occurred outside of geographic clusters. Severe firearm events tend to occur within a patient's own neighborhood, often at home, and generally outside of geospatial clusters. Public health efforts should focus on the home in all types of neighborhoods to reduce firearm violence. © 2016 by the Society for Academic Emergency Medicine.

  1. Risk factors associated with the severity of injury outcome for paediatric road trauma.

    PubMed

    Mitchell, R J; Bambach, M R; Foster, K; Curtis, K

    2015-05-01

    Road trauma is one of the most common causes of injury for children. Yet risk factors associated with different levels of injury severity for childhood road trauma have not been examined in-depth. This study identifies crash and injury risk factors associated with the severity of non-fatal injury outcome for paediatric road trauma. A retrospective analysis was conducted of paediatric road trauma identified in linked police-reported and hospitalisation records during 1 January 2001 to 31 December 2011 in New South Wales (NSW), Australia. The linkage rate was 54%. Injury severity was calculated from diagnosis classifications in hospital records using the International Classification of Disease Injury Severity Score. Univariate and multi-variable logistic regression was conducted. There were 2412 car occupants, 1701 pedestrians and 612 pedal cyclists hospitalised where their hospital record linked to a police report. For car occupants, unauthorised vehicle drivers had twice the odds (OR: 2.21, 95%CI 1.47-3.34) and learner/provisional drivers had one and a half times higher odds (OR: 1.54, 95%CI 1.15-2.07) of a child car occupant sustaining a serious injury compared to a minor injury. For pedal cyclists and pedestrians, there were lower odds of a crash occurring during school commuting time and higher odds of a crash occurring during the weekend or on a dry road for children who sustained a serious versus a minor injury. Injury prevention initiatives, such as restraint and helmet use, that should reduce injury and/or crash severity are advocated. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Long-term consequences of severe closed head injury on episodic memory.

    PubMed

    Zec, R F; Zellers, D; Belman, J; Miller, J; Matthews, J; Femeau-Belman, D; Robbs, R

    2001-10-01

    This is the first systematic investigation of the very long-term effects of severe closed head injury (CHI) on objective measures of memory, and the first to employ both a normal control group and an 'other injury' control group consisting of spinal cord injury (SCI) patients. The CHI group displayed significantly poorer performance on every memory measure, and the effect sizes were large. This impairment in episodic memory is neither due to pre-injury nor post-injury differences between CHI and normal control subjects because the same differences were found when the CHI group was compared to a group of SCI patients. The findings demonstrate severe impairment in learning and retention many years after sustaining a severe CHI, which is likely in part due to the bilateral hippocampal damage shown in neuropathological studies. This life-long memory impairment needs to be addressed by community service programs.

  3. Exploring factors contributing to crash injury severity on rural two-lane highways.

    PubMed

    Ma, Zhuanglin; Zhao, Wenjing; Chien, Steven I-Jy; Dong, Chunjiao

    2015-12-01

    Crash injury results from complex interaction among factors related to at-fault driver's behavior, vehicle characteristics, and road conditions. Identifying the significance of these factors which affect crash injury severity is critical for improving traffic safety. A method was developed to explore the relationship based on crash data collected on rural two-lane highways in China. There were 673 crash records collected on rural two-lane highways in China. A partial proportional odds model was developed to examine factors influencing crash injury severity owing to its high ability to accommodate the ordered response nature of injury severity. An elasticity analysis was conducted to quantify the marginal effects of each contributing factor. The results show that nine explanatory variables, including at-fault driver's age, at-fault driver having a license or not, alcohol usage, speeding, pedestrian involved, type of area, weather condition, pavement type, and collision type, significantly affect injury severity. In addition to alcohol usage and pedestrian involved, others violate the proportional odds assumption. At-fault driver's age of 25-39years, alcohol usage, speeding, pedestrian involved, pavement type of asphalt, and collision type of angle are found to be increased crash injury severity. The developed logit model has demonstrated itself efficient in identifying the effect of contributing factors on the crash injury severity. Copyright © 2015 Elsevier Ltd and National Safety Council. All rights reserved.

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

    PubMed

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

    1997-01-01

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

  5. Fatal and severe injury: scooter and moped crashes in California, 1985.

    PubMed Central

    Salatka, M; Arzemanian, S; Kraus, J F; Anderson, C L

    1990-01-01

    Fatal and severe injury crashes for scooters and mopeds in California for 1985 were compared with those for motorcycles during the same year. Scooters had more than twice the injury crash rate of mopeds but one-half the rate of motorcycles. Age of injured drivers and crash patterns for scooters, mopeds, and motorcycles varied significantly. PMID:2382755

  6. Continuous Venovenous Hemofiltration in Severely Burned Patients with Acute Kidney Injury: A Cohort Study

    DTIC Science & Technology

    2009-05-01

    FiO2: fraction of inspired oxygen; IHD: intermittent hemodialysis ; IQR: interquartile range; ISS: injury severity score; MODS: multiple organ...were compared. Definitions During the period after November 2005 our staff intensivists utilized the RIFLE (Risk, Injury, Failure, Loss, End-stage...for acute renal fail- ure which included: fluid resuscitation, minimization of nephro- toxic agents, and utilization of hemodialysis if classic

  7. A Comparison of Shock Intensity in the Treatment of Longstanding and Severe Self-Injurious Behavior.

    ERIC Educational Resources Information Center

    Williams, Don E.; And Others

    1993-01-01

    The severe self-injurious behavior of a woman with profound mental retardation was treated with 3.5 milliamps of shock combined with reinforcement and extinction techniques, with minimal results. Treatment with the Hot Shot Power Mite, which delivers 18.5 milliamps, combined with reinforcement for compliance and extinction of self-injurious escape…

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

    Treesearch

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

    2004-01-01

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

  9. Exploring the impact of access designs on crash injury severity on multilane highways.

    PubMed

    Wang, Zhenyu; Huang, Bing; Lu, Jian; Zhao, Jianyou; Zhang, Yu

    2014-01-01

    Access design is a critical factor that influences the safety and mobility of urban/suburban multilane highways due to the interactions between access movements and through traffic. An effective way for improving the safety and mobility of multilane highways is to control access maneuvers by implementing appropriate access designs. Understanding the impact of access designs on crash injury severity is beneficial for implementing effective countermeasures to mitigate crash injury at access points. Thus, the objectives of this article are to investigate the impact of access designs on crash injury severity and identify contributing factors of crash injury severity at access points of multilane highways. A total of 1830 crash records were collected at 149 access points with different access designs for a period of 3 years (2008-2010) in Florida. A heterogeneous logit model, relaxing the constraint of identical variances across observations in the traditional ordered choice models, was developed to evaluate the impact of access designs on crash injury severity and identify contributing factors. The marginal effects of the developed model were used to interpret the impact of access designs and other contributing factors. At 4-leg access points, given that a crash has occurred, replacing full median openings with closed medians will reduce the probability of severe injury (fatality, incapacitating injury, or nonincapacitating injury) by 9.73 percent; substituting full median openings with directional median openings will reduce the probability of severe injury by 11.02 percent. At 3-leg access points, given that a crash has occurred, closed medians significantly experience a lower risk of severe injury than full median openings; however, there is no evidence that directional median openings are similarly effective. Other contributing factors of crash injury severity at access points were identified as number of lanes, shoulder width, median width, driveway density, left

  10. Rehabilitation outcome of brain damaged patients after severe head injury.

    PubMed

    Najenson, T; Groswasser, Z; Mendelson, L; Hackett, P

    1980-01-01

    The multidisciplinary team approach to the prolonged treatment of head injured patients in widely discussed. The rehabilitation process of the 147 subjects of this paper started while they were comatose and continued throughout the various stages of their progress towards full integration into society; the assessment of this process was carried out by testing their reintegration into work according to their capacities. Brain damage is classified in four categories: Physical-locomotor, communicative, cognitive and behavioural. The gap between the team's expectations and the patients' factual functioning within the community was found to be proportional to the extent of damage caused by the original injury. Treatment procedures and the influence of various factors on the factual functional state are discussed at length.

  11. Incidence, severity and correlates of bicycling injuries in a sample of cyclists in Queensland, Australia.

    PubMed

    Heesch, Kristiann C; Garrard, Jan; Sahlqvist, Shannon

    2011-11-01

    Bicycle injuries, particularly those resulting from single bicycle crashes, are underreported in both police and hospital records. Data on cyclist characteristics and crash circumstances are also often lacking. As a result, the ability to develop comprehensive injury prevention policies is hampered. The aim of this study was to examine the incidence, severity, cyclist characteristics, and crash circumstances associated with cycling injuries in a sample of cyclists in Queensland, Australia. A cross-sectional study of Queensland cyclists was conducted in 2009. Respondents (n=2056) completed an online survey about their cycling experiences, including cycling injuries. Logistic regression modelling was used to examine the associations between demographic and cycling behaviour variables with experiencing cycling injuries in the past year, and, separately, with serious cycling injuries requiring a trip to a hospital. Twenty-seven percent of respondents (n=545) reported injuries, and 6% (n=114) reported serious injuries. In multivariable modelling, reporting an injury was more likely for respondents who had cycled <5 years, compared to ≥ 10 years (p<0.005); cycled for competition (p=0.01); or experienced harassment from motor vehicle occupants (p<0.001). There were no gender differences in injury incidence, and respondents who cycled for transport did not have an increased risk of injury. Reporting a serious injury was more likely for those whose injury involved other road users (p<0.03). Along with environmental and behavioural approaches for reducing collisions and near-collisions with motor vehicles, interventions that improve the design and maintenance of cycling infrastructure, increase cyclists' skills, and encourage safe cycling behaviours and bicycle maintenance will also be important for reducing the overall incidence of cycling injuries. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    PubMed Central

    2009-01-01

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

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

    PubMed

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

    2015-11-01

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

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

    PubMed

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

    2016-05-01

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

  15. [Advances in the research of pathogenesis and treatment of severe smoke inhalation injury].

    PubMed

    Feng, Shengjuan; Jia, Chiyu; Liu, Zhen; Lyu, Xiaowu

    2016-02-01

    Among the fire victims, respiratory tract injury resulted from smoke inhalation is the major cause of death. Particulate substances in smoke, toxic and harmful gas, and chemical substances act together would rapidly induce the occurrence of dramatic pathophysiologic reaction in the respiratory tract, resulting in acute injury to the respiratory tract, thus inducing serious injury to it and acute respiratory distress syndrome, leading to death of the victims. In recent years, the pathophysiologic mechanism of severe smoke inhalation injury has been gradually clarified, thus appreciable advances in its treatment have been achieved. This paper is a brief review of above-mentioned aspects.

  16. Predictive value of bronchoscopy in assessing the severity of inhalation injury.

    PubMed

    Mosier, Michael J; Pham, Tam N; Park, David R; Simmons, Jill; Klein, Matthew B; Gibran, Nicole S

    2012-01-01

    Inhalation injury is associated with severe pulmonary complications as inhaled products of combustion cause lung inflammation and loss of natural defenses. A bronchoscopic grading for inhalation injury has been proposed but has not yet been validated in burn patients. In this study, the authors evaluated whether bronchoscopic grading of injury clinically correlated with indices of gas exchange over the first 72 hours or predicted differences in hospitalization outcomes. They conducted a single-center retrospective review of all mechanically ventilated adults with suspected inhalation injury and thermal injury over an 18-month period. All recorded bronchoscopy examinations were reviewed and categorized injury according to the published abbreviated injury score (AIS 0: no injury, 1: mild, 2: moderate, 3: severe, and 4: massive injury). They also compared changes in oxygenation, airway pressures, chest radiograph findings, fluid administration, and early development of pneumonia and organ failure, by severity of inhalation injury according to the AIS. Thirty-two adult patients met inclusion criteria over the study period. This cohort was 69% male with a mean age of 44.5 ± 14 years and a mean % TBSA burn of 33.9 ± 17%. Of these 32 patients, 11 patients (34%) were classified as grade 0, 9 patients (28%) were classified as grade 1, 7 patients (22%) were classified as grade 2, and 5 patients (16%) were classified as grade 3. Measured carboxyhemoglobin levels increased significantly with higher AIS grade. Oxygenation indices were worse as grade worsened by 24, 48, and 72 hours. The incidence of acute respiratory distress syndrome increased by grade of injury: 0, 22, 57, and 80%, respectively, at 24 hours (P < .01), and remained statistically different at 48 and 72 hours. After adjustment for age, % TBSA burn, and full-thickness component, severe inhalation injury (grades 2 and 3) was associated with an increased risk of acute respiratory distress syndrome at 24 and 72

  17. The impact of blood ethanol concentration on the classification of head injury severity in traumatic brain injury.

    PubMed

    Rønning, Pål; Gunstad, Per Ole; Skaga, Nils-Oddvar; Langmoen, Iver Arne; Stavem, Knut; Helseth, Eirik

    2015-01-01

    Traumatic brain injury (TBI) is classified into mild, moderate and severe, based on the Glasgow Coma Score (GCS). However, TBI patients are often influenced by ethanol, which in itself can attenuate the level of consciousness. This study investigated the effect of ethanol on the GCS group classification in TBI patients. The Oslo University Hospital trauma database was searched for all patients admitted with a head injury where the blood ethanol concentration (BEC) had been measured (n = 1004). The effect of BEC on GCS groups was analysed using multivariate ordinal logistic regression. This study identified 546, 142 and 316 patients in the mild, moderate and severe groups, respectively. Increasing BEC by 1 g kg(-1) and pre-hospital intubation had OR = 1.34 and 16.34 for being in a more severe GCS group, respectively. Increasing head abbreviated injury scale (head-AIS) was significantly associated with being in a more severe GCS group. The modelled probability of detecting a head-AIS of 4 or 5 in a patient with BEC of 2.0 g kg(-1) was 20%, 38% and 65% in the mild, moderate and severe groups, respectively. Increasing BEC was associated with increasing odds of being in a more severe GCS group. However, because the modelled probability of significant brain injury was high in patients with high levels of BEC, a reduced level of consciousness in intoxicated patients mandates further radiological investigations.

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

    PubMed

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

    2010-02-01

    To determine whether the severity of injuries sustained by pedestrians involved in motor vehicle collisions varies by road type and age. All police-reported pedestrian motor vehicle collisions in the city of Toronto, Canada, between January 1, 2000, and December 31, 2005, were analyzed. Geographic Information Systems software was used to determine whether the collisions occurred on major or neighborhood roads. Age-specific estimates of the burden of pedestrian collisions are presented. Odds ratios and 95 percent confidence intervals were calculated to examine age-specific relationships between injury severity and road type. A second analysis comparing the distribution of severe injury location between age groups was also performed. The majority of collisions involved adults (68%), although elderly pedestrians were overrepresented in fatal collisions (49%). Severe and fatal collisions involving working-age and elderly adult pedestrians were more likely on major roads. Odds of severe injury occurring on a major road were 1.36 (95% CI: 1.17-1.57) times higher for adults ages 18 to 64, and 1.55 (95% CI: 1.22-1.99) times higher for elderly aged 65+. By contrast, severe injuries among children were more common on neighborhood roads, with odds of severe injury on a major road of 0.64 (95% CI: 0.37-1.1) for children aged 5 to 9. Among children under 9, 64-67 percent of hospitalized or fatal injuries occurred on neighborhood roads, a marked difference from the distribution of such injuries in adults or the elderly, for whom only 29-30 percent of hospitalized or fatal injuries occurred on neighborhood roads (chi-square = 52.6, p < or =.001). Targeting interventions toward the adult pedestrian burden on major roads alone will not make child pedestrians safer. Pedestrian interventions specific to children and focused on neighborhood roads must be considered in urban centers like Toronto.

  19. Child and Adult Pedestrian Impact: The Influence of Vehicle Type on Injury Severity

    PubMed Central

    Henary, Basem Y.; Crandall, Jeff; Bhalla, Kavi; Mock, Charles N.; Roudsari, Bahman S.

    2003-01-01

    In the United States, the vehicle fleet is shifting from predominantly passenger cars (automobiles) to SUVs, light trucks, and vans (LTV). This study investigates how pedestrian severe injury and mortality are associated with vehicle type and pedestrian age. The Pedestrian Crash Data Study (PCDS) database for years 1994–1998 was used for a cross-sectional study design. Outcome measures were Injury Severity Score, Maximum Abbreviated Injury Score, Abbreviated Injury Scale, Pedestrian Mortality, Functional Capacity Index and Life Years Lost to Injury. Compared to children, adult pedestrians were more likely to sustain severe injury (OR = 2.81; 95% CI: 1.56–5.06) or mortality (OR = 2.91; 95% CI: 1.10–7.74) when examining all vehicle types. However, after adjusting for vehicle type and impact speed, this association was not statistically significant at p < 0.05. Compared to passenger cars, pedestrians struck by LTV were more likely to have severe injuries (OR = 1.31; 95% CI: 0.88–1.94) or mortality (OR = 1.40; 95% CI: 0.84–2.34) for all pedestrians. Adjusting for pedestrian age, this association was more obvious and significant at lower impact speeds (≤ 30 km/h); odds ratios of severe injury and mortality were 3.34 (p< 0.01) and 1.87 (p= 0.07), respectively. Adults hit by LTV had the highest risk of injury and mortality. These findings indicate that pedestrian age, vehicle engineering design and impact speed are highly contributing to risks of pedestrian injury and mortality. PMID:12941221

  20. Hospital Stay as a Proxy Indicator for Severe Injury in Earthquakes: A Retrospective Analysis

    PubMed Central

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

    2013-01-01

    Introduction Earthquakes are the most violent type of natural disasters and injuries are the dominant medical problem in the early phases after earthquakes. However, likely because of poor data availability, high-quality research on injuries after earthquakes is lacking. Length of hospital stay (LOS) has been validated as a proxy indicator for injury severity in high-income settings and could potentially be used in retrospective research of injuries after earthquakes. In this study, we assessed LOS as an adequate proxy indicator for severe injury in trauma survivors of an earthquake. Methods A retrospective analysis was conducted using a database of 1,878 injured patients from the 2008 Wenchuan earthquake. Our primary outcome was severe injury, defined as a composite measure of serious injury or resource use. Secondary outcomes were serious injury and resource use, analysed separately. Non-parametric receiver operating characteristics (ROC) and area under the curve (AUC) analysis was used to test the discriminatory accuracy of LOS when used to identify severe injury. An 0.7severe injury in earthquake survivors. However, LOS was found to be a proxy for major nonorthopaedic surgery and blood transfusion. These findings can be useful for retrospective research on earthquake-injured patients when detailed hospital records are not available. PMID:23585897

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

    PubMed

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

    2013-01-01

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

  2. [Severe open-globe eye injuries: socio-demographic aspects and risk factors].

    PubMed

    Puodziuviene, Edita; Paunksnis, Alvydas

    2007-01-01

    To evaluate sociodemographic aspects and risk factors of severe open-globe ocular injuries. We present data from prospective study of 315 patients with severe open-globe ocular injuries, meeting inclusion criteria. The patients in our series were predominantly male (92.70%). The male to female ratio was 12.7:1. Almost 27% of the patients were from the age group of 30-39 years. Home (53.65%), streets and highways (19.05%) were the most common place of injury, followed by industrial premises (11.11%), agricultural activities (8.25%), recreation and sports (5.40%); 15.56% of cases were work-related. Sharp objects (43.17%) and hammering on metal (24.44%) were the two major causes of injury. Alcohol intoxication was observed in 13.65% of cases. Severe open-globe eye injuries were classified into four categories: penetrating injuries (56.83%), perforating injuries (2.54%), globe ruptures (12.38 %), and IOFB injuries (28.25%). Males suffered significantly more often than females in the age of 20-29 (OR=1.39+/-95% CI 1.10-1.75, P<0.01) and 30-39-year (OR=1.75+/-95% PI 1.45-2.22, P<0.01). Risk factors of severe open-globe eye injuries for male gender were living in urban setting (P=0.001), alcohol use (P=0.001), occupation--unemployed (P=0.001) and retired persons (P=0.011). Risk factors for male gender to sustain severe open-globe eye injury were living in urban setting, alcohol use, and occupation (unemployed and retired persons).

  3. Biomechanical evaluation of injury severity associated with patient falls from bed.

    PubMed

    Bowers, Bonnie; Lloyd, John; Lee, W; Powell-Cope, G; Baptiste, A

    2008-01-01

    This study investigated the severity of injuries associated with falling from bed and the effectiveness of injury-prevention strategies. Injury criteria were calculated for head- and feet-first falls from six bed heights onto a tiled surface and floor mat. These values indicated a 25% chance of experiencing a serious head injury as a result of falling feet-first from a bed height of 97.5 cm onto a tiled surface. Risk of injury increased to 40% when extrapolated for the height added by bedrails. Using a floor mat decreased this risk to less than 1% for bedrail height for feet-first falls. Calculated impact forces indicated a risk of skull fracture when hitting the tiled surface. Floor mats and height-adjustable beds positioned to the lowest height should be used to decrease the risk of injury associated with falling from bed.

  4. TLR9 Mediates Remote Liver Injury following Severe Renal Ischemia Reperfusion.

    PubMed

    Bakker, Pieter J; Scantlebery, Angelique M; Butter, Loes M; Claessen, Nike; Teske, Gwendoline J D; van der Poll, Tom; Florquin, Sandrine; Leemans, Jaklien C

    2015-01-01

    Ischemia reperfusion injury is a common cause of acute kidney injury and is characterized by tubular damage. Mitochondrial DNA is released upon severe tissue injury and can act as a damage-associated molecular pattern via the innate immune receptor TLR9. Here, we investigated the role of TLR9 in the context of moderate or severe renal ischemia reperfusion injury using wild-type C57BL/6 mice or TLR9KO mice. Moderate renal ischemia induced renal dysfunction but did not decrease animal well-being and was not regulated by TLR9. In contrast, severe renal ischemia decreased animal well-being and survival in wild-type mice after respectively one or five days of reperfusion. TLR9 deficiency improved animal well-being and survival. TLR9 deficiency did not reduce renal inflammation or tubular necrosis. Rather, severe renal ischemia induced hepatic injury as seen by increased plasma ALAT and ASAT levels and focal hepatic necrosis which was prevented by TLR9 deficiency and correlated with reduced circulating mitochondrial DNA levels and plasma LDH. We conclude that TLR9 does not mediate renal dysfunction following either moderate or severe renal ischemia. In contrast, our data indicates that TLR9 is an important mediator of hepatic injury secondary to ischemic acute kidney injury.

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

    PubMed

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

    2014-11-01

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

  6. Partial proportional odds model-an alternate choice for analyzing pedestrian crash injury severities.

    PubMed

    Sasidharan, Lekshmi; Menéndez, Mónica

    2014-11-01

    The conventional methods for crash injury severity analyses include either treating the severity data as ordered (e.g. ordered logit/probit models) or non-ordered (e.g. multinomial models). The ordered models require the data to meet proportional odds assumption, according to which the predictors can only have the same effect on different levels of the dependent variable, which is often not the case with crash injury severities. On the other hand, non-ordered analyses completely ignore the inherent hierarchical nature of crash injury severities. Therefore, treating the crash severity data as either ordered or non-ordered results in violating some of the key principles. To address these concerns, this paper explores the application of a partial proportional odds (PPO) model to bridge the gap between ordered and non-ordered severity modeling frameworks. The PPO model allows the covariates that meet the proportional odds assumption to affect different crash severity levels with the same magnitude; whereas the covariates that do not meet the proportional odds assumption can have different effects on different severity levels. This study is based on a five-year (2008-2012) national pedestrian safety dataset for Switzerland. A comparison between the application of PPO models, ordered logit models, and multinomial logit models for pedestrian injury severity evaluation is also included here. The study shows that PPO models outperform the other models considered based on different evaluation criteria. Hence, it is a viable method for analyzing pedestrian crash injury severities.

  7. Copula-based regression modeling of bivariate severity of temporary disability and permanent motor injuries.

    PubMed

    Ayuso, Mercedes; Bermúdez, Lluís; Santolino, Miguel

    2016-04-01

    The analysis of factors influencing the severity of the personal injuries suffered by victims of motor accidents is an issue of major interest. Yet, most of the extant literature has tended to address this question by focusing on either the severity of temporary disability or the severity of permanent injury. In this paper, a bivariate copula-based regression model for temporary disability and permanent injury severities is introduced for the joint analysis of the relationship with the set of factors that might influence both categories of injury. Using a motor insurance database with 21,361 observations, the copula-based regression model is shown to give a better performance than that of a model based on the assumption of independence. The inclusion of the dependence structure in the analysis has a higher impact on the variance estimates of the injury severities than it does on the point estimates. By taking into account the dependence between temporary and permanent severities a more extensive factor analysis can be conducted. We illustrate that the conditional distribution functions of injury severities may be estimated, thus, providing decision makers with valuable information.

  8. Role of hyperbaric oxygen therapy in severe head injury in children.

    PubMed

    Prakash, Advait; Parelkar, Sandesh V; Oak, Sanjay N; Gupta, Rahul K; Sanghvi, Beejal V; Bachani, Mitesh; Patil, Rajashekhar

    2012-01-01

    A brain injury results in a temporary or permanent impairment of cognitive, emotional, and/or physical function. Predicting the outcome of pediatric brain injury is difficult. Prognostic instruments are not precise enough to reliably predict individual patient's mortality and long-term functional status. The purpose of this article is to provide a guide to the strengths and limitations of the use of hyperbaric oxygen therapy (HBOT) in treating pediatric patients with severe brain injury. We studied total 56 patients of head injury. Out of them 28 received HBOT. Only cases with severe head injury [Glasgow Coma Scale (GCS) < 8] with no other associated injury were included in the study group. After an initial period of resuscitation and conservative management (10-12 days), all were subjected to three sessions of HBOT at 1-week interval. This study group was compared with a control group of similar severity of head injury (GCS < 8). The study and control groups were compared in terms of duration of hospitalization, GCS, disability reduction,and social behavior. Patients who received HBOT were significantly better than the control group on all the parameters with decreased hospital stay, better GCS, and drastic reduction in disability. In children with traumatic brain injury, the addition of HBOT significantly improved outcome and quality of life and reduced the risk of complications.

  9. A BCI-based Environmental Control System for Patients with Severe Spinal Cord Injuries.

    PubMed

    Zhang, Rui; Wang, Qihong; Li, Kai; He, Shenghong; Qin, Si; Feng, Zhenghui; Chen, Yang; Song, Pingxia; Yang, Tingyan; Zhang, Yuandong; Yu, Zhuliang; Hu, Yaohua; Shao, Ming; Li, Yuanqing

    2017-01-09

    This study proposes an event-related potential (ERP) BCI-based environmental control system that integrates household electrical appliances, a nursing bed, and an intelligent wheelchair to provide daily assistance to paralyzed patients with severe spinal cord injuries (SCIs).

  10. Treatment of severe self-injurious and aggressive biting.

    PubMed

    Altmeyer, B K; Williams, D E; Sams, V

    1985-06-01

    The treatment of a 16-year-old severely mentally retarded and blind female client exhibiting severe biting of self and others consisted of the contingent application of an aversive gustatory stimulus (Tabasco Sauce), brief timeout, DRO, and contingent restraint against biting while in time-out. This is the first use of Tabasco as the aversive stimulus against biting. Deceleration of biting was rapid and maintained for 20 months after initiation of treatment.

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

    PubMed

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

    2015-11-01

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

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

    PubMed

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

    2015-05-01

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

  13. Assessment of impulsivity after moderate to severe traumatic brain injury.

    PubMed

    Rochat, Lucien; Beni, Catia; Billieux, Joël; Azouvi, Philippe; Annoni, Jean-Marie; Van der Linden, Martial

    2010-10-01

    The aim of the study was to develop and validate a short questionnaire assessing four dimensions of impulsivity (urgency, lack of premeditation, lack of perseverance, sensation seeking) in patients with traumatic brain injury (TBI). To this end, 82 patients with TBI and their caregivers completed a short questionnaire adapted from the UPPS Impulsive Behavior Scale designed to assess impulsivity changes after TBI. Confirmatory factor analyses (CFAs) performed on the version of the scale completed by the relatives revealed that a hierarchical model holding that lack of premeditation and lack of perseverance are facets of a higher order construct (lack of conscientiousness), with urgency and sensation seeking as separate correlated factors, fit the data best. Urgency, lack of premeditation, and lack of perseverance increased after the TBI, whereas sensation seeking decreased. CFA failed to reveal a satisfactory model in the version of the scale completed by the patients. The psychological processes related to these impulsivity changes and the discrepancy observed between self-report and informant-report are discussed. This short questionnaire opens up interesting prospects for better comprehension and assessment of behavioural symptoms of TBI.

  14. All-terrain vehicle and bicycle crashes in children: epidemiology and comparison of injury severity.

    PubMed

    Brown, Rebeccah L; Koepplinger, Matthew E; Mehlman, Charles T; Gittelman, Michael; Garcia, Victor F

    2002-03-01

    Despite statements by the American Academy of Pediatrics (AAP) and the US Consumer Product Safety Commission (CPSC) against the use of all-terrain vehicles (ATVs) by children under the age of 16 years, nearly half of ATV-related injuries and over 35% of all ATV-related deaths continue to occur in this age group. Because ATV and bicycle crashes have been associated with serious injury in children, the authors compared the demographics, mechanism of injury, injury severity, and outcome of children with ATV- and bicycle-related injuries. Further, the authors sought to identify whether ATV-related injuries elicited changes in risk-taking behavior. A retrospective, comparative analysis of 109 children admitted for ATV-related injuries and 994 children admitted for bicycle-related injuries to a level 1 pediatric trauma center between January 1991 and June 2000 was performed. A phone survey was conducted to determine self-reported changes in safety behaviors or use patterns after ATV injury. Mean age was 11.1 plus minus 3.5 years (range, 2 to 18 years) for ATV crashes versus 9.4 plus minus 3.3 years (range, 1 to 17 years) for bicycle crashes (P <.05). Ninety-three percent of ATV crashes occurred in children less than 16 years of age; 31% in children less-than-or-equal10 years of age; and 7% in children less-than-or-equal5 years of age. Male-to-female ratio was about 3:1 for both groups. White race accounted for 97% of ATV injuries compared with 79% of bicycle injuries (P <.05). Falls from ATVs or bicycles were the most common mechanism of injury (41% v 59%, respectively). Collisions with motor vehicles were more common for bicyclists (32% v 10%), whereas collisions with stationary objects were more common among ATV riders (27% v 9%). Sixteen percent of ATV crashes were caused by a roll-over mechanism. Mean injury severity score (ISS) were significantly higher for victims of ATV crashes (8.3 ATV v 6.7 bicycle; P <.05). ATV-related trauma was associated with multiple

  15. Injury severity in pediatric all-terrain vehicle-related trauma in Nova Scotia.

    PubMed

    Jessula, Samuel; Murphy, Nadia; Yanchar, Natalie L

    2017-05-01

    In 2004-2005, legislation restricting all-terrain vehicle (ATV) use by children and an extensive social marketing campaign intended to reduce pediatric ATV-related morbidity. The frequency, nature, and severity of pediatric ATV-associated trauma were compared before and after such interventions. A retrospective cohort study was performed for all pediatric ATV-related injuries that presented to the provincial level 1 pediatric trauma center from 1998 to 2014. National databases were queried for ATV-related injury hospitalizations (n=258), trauma center emergency department visits (n=342), and admissions (n=136) in Nova Scotia from 2002 to 2014. Admissions between 1998 and 2003 (n=68) and 2006-2014 (n=60) were compared using chi square analysis for age and gender distribution, length of stay, critical care admission, helmet use, mechanism, and severity of injury. Admissions, trauma center emergency room visits and admissions initially decreased following legislative and social marketing interventions and subsequently gradually increased. Interventions resulted in no significant difference in age or gender distribution, length of hospital stay, critical care admission, helmet use, and mechanism of injury. There was a significantly higher proportion of severe injuries post interventions. Legislation and social marketing interventions had a short-term decrease on the frequency of ATV-related injuries and no sustained effect on the frequency, nature, and severity of ATV-related injuries. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2015-10-01

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

  17. [Analysis of the risk factors for early death in acute severe traumatic cervical spinal cord injury].

    PubMed

    Leng, Yu-xin; Nie, Chun-yan; Yao, Zhi-yuan; Zhu, Xi

    2013-05-01

    To survey the risk factors for early death of patients with acute severe traumatic cervical spinal cord injury. A retrospective analysis of data of consecutive patients with acute severe traumatic cervical spinal cord injury admitted from January 1st 1994 to October 1st 2012 were made. The patients died within 30 days or not were allocated for death group or survival group. The risk factors for early death were analyzed through univariate analysis and logistic analysis. Among 1093 patients with acute traumatic cervical spinal cord injury, 352 patients with severe injury were included, and the early death rate was 14.49% (51/352). The leading causes of spinal cord injury were vehicle accidents (153 cases) and falls (117 cases). The main causes of early death were respiratory failure (16 cases), multiple organ failure (MOF, 14 cases) and gastrointestinal bleeding (11 cases). Combining the results of univariate and logistic analysis, it was found that high acute physiology and chronic health evaluation II(APACHEII) score [>15, odds ratio (OR)=11.595, P=0.000], high damage level (OR=3.519, P=0.032), hyponatremia (OR=6.316, P=0.000), neurogenic shock (OR=6.209, P=0.000), pulmonary infection (OR=14.627, P=0.000) and tracheostomy (OR=8.983, P=0.000) were risk factors for early death of patients with acute severe traumatic cervical spinal cord injury, however, the impact of gender, age, surgery, fracture and dislocation, high central fever, and administration of steroids on early death of patients with acute severe traumatic cervical spinal cord injury were uncertain. The factors reflecting disease severity and occurrence of related complications were more important in predicting the early death among patients with acute severe traumatic cervical spinal cord injury, while the influence of age, surgical manipulation etc. were minor factors.

  18. An evaluation of the association between vehicle type and the source and severity of pedestrian injuries.

    PubMed

    Roudsari, Bahman S; Mock, Charles N; Kaufman, Robert

    2005-06-01

    To evaluate the effect of vehicle type (passenger vehicle vs. light truck vehicle) on crash trajectory and on the consequent source and severity of pedestrian injury, we analyzed data from the Pedestrian Crash Data Study (PCDS), conducted by National Highway Traffic Safety Administration (NHTSA) from 1994 to 1998. While 62% of the adults in PV (passenger vehicle)-related crashes were carried by the vehicle, such pedestrian-vehicle interaction was observed only in 28% of LTV (light truck vehicle)-adult crashes. Being thrown forward or knocked down were the most common (65%) type of pedestrian-vehicle interactions for LTV-adult crashes. For children, 93% of those struck by LTVs and 46% of those struck by PVs were thrown forward or knocked down. For adults, LTVs were more likely than PVs to cause thorax (37% vs. 20%) and abdomen injuries (33% vs. 18%). For children, LTVs were more likely than PVs to cause injuries to the upper extremity (71% vs. 56%) and abdomen (14% vs. 8%). For adults struck by PVs the most common sources of injury were windshield for head injuries (63%), hood surface for thorax (67%), abdomen (58%), spine (30%), and upper extremity (36%) injuries, and bumper for the lower extremity injuries (60%). The leading causes of injury for adult-LTV crashes were ground for head (39%) and upper extremity (37%) injuries, hood edge for thorax (48%) and abdomen (56%) injuries, hood surface for spine injuries (36%), and bumper for lower extremity injuries (45%). For child-PV crashes, ground was the most common source of face (37%) abdomen (83%), spine (43%), and upper extremity injuries (54%). For children hit by LTVs, 52% of face, 67% of abdomen, 100% of spine, and 60% of upper extremity injuries were attributed to ground contacts. Altogether, the major sources of injury were hood surface and windshield for PV-pedestrian crashes and hood surface and hood edge for LTV-pedestrian crashes. Changes in design, such as altering the geometry and stiffness of front

  19. The epidemiology of vasospasm in children with moderate-to-severe traumatic brain injury.

    PubMed

    O'Brien, Nicole F; Maa, Tensing; Yeates, Keith O

    2015-03-01

    To gain a description of the prevalence and time course of vasospasm in children suffering moderate-to-severe traumatic brain injury. A prospective, observational study was performed. Children with a diagnosis of traumatic brain injury, a Glasgow Coma Score less than or equal to 12, and abnormal head imaging were enrolled. Transcranial Doppler ultrasound was performed to identify and follow vasospasm. Diagnostic criteria included flow velocity elevation more than or equal to 2 sd above age and gender normal values for the middle cerebral and basilar arteries. Additional criteria required for vasospasm diagnosis in the middle cerebral artery was a ratio of flow in the middle cerebral artery to extracranial internal carotid artery more than or equal to 3. None. Sixty-nine children were included. The prevalence of middle cerebral artery vasospasm in children with moderate traumatic brain injury (Glasgow Coma Score, 9-12) was 8.5% and was 33.5% in those with severe traumatic brain injury (Glasgow Coma Score, ≤ 8). The prevalence of basilar artery vasospasm in children with moderate traumatic brain injury was 3% and with severe traumatic brain injury was 21%. Mean time to onset of vasospasm was 4 days (± 2 d) in the middle cerebral arteries and 5 days (± 2.5 d) in the basilar artery. Mean duration of vasospasm in the middle cerebral artery was 2 days (± 2 d) and 1.5 days (± 1 d) in the basilar artery. Children in whom vasospasm developed were more likely to have been involved in motor vehicle accidents, had higher Injury Severity Scores, had fever at admission, and had lower Glasgow Coma Score scores. Good neurologic outcome (Glasgow Outcome Score Extended Pediatric version of ≥ 4) at 1 month from injury was seen in 76% of those with moderate traumatic brain injury without vasospasm and in 40% of those with vasospasm. In those with severe traumatic brain injury, good neurologic outcome was seen in 29% of those children without vasospasm and in 15% of those with

  20. The effect of alcohol on incidence, pattern, severity and outcome from traumatic brain injury.

    PubMed

    Gururaj, G

    2004-03-01

    Alcohol consumption is known to be a major contributing factor for the occurrence of traumatic brain injuries (TBIs) in both developed and developing countries. It also influences diagnosis, management and recovery from TBIs, subsequent to injury occurrence. The present report examines the association of alcohol in injury occurrence, and its impact on severity and outcome from TBIs. Subjects were identified from 7 major hospitals in the city of Bangalore, India with data collection undertaken by standardised methods. Alcohol users (n = 243) and non-users (n = 1310) were compared on various characteristics and injury details. Sixteen per cent of the injured patients were intoxicated at the time of hospital registration. While the incidence of road traffic injuries was similar in both the groups, falls were higher in the alcohol user group. Evening-and night-time consumption of alcohol was a major risk factor for injuries. Drivers and occupants of motorised two wheeler vehicles, and pedestrians were involved in crashes to a greater extent among alcohol users. Severity of brain injuries (based on Glasgow coma scale), duration of hospital stay, death and post-traumatic disabilities among alcohol users were significantly higher compared with non-users. With the emergence of injuries and alcohol as twin major public health problems, immediate efforts are required to reduce the burden in developing societies. Legislative and enforcement strategies along with education developed on epidemiological, clinical and public health research need to be co-ordinated, target oriented, visible and with stiffer penalties for achieving desired results.

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

    PubMed

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

    2013-10-01

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

  2. Utility of magnetic resonance imaging in diagnosing cervical spine injury in children with severe traumatic brain injury.

    PubMed

    Qualls, David; Leonard, Jeffrey R; Keller, Martin; Pineda, Jose; Leonard, Julie C

    2015-06-01

    Evaluation of children for cervical spine injuries (CSIs) after blunt trauma is complicated, particularly if the patient is unresponsive because of severe traumatic brain injury. Plain radiography and computed tomography (CT) are commonly used, but CT combined with magnetic resonance imaging (MRI) is still considered the gold standard in CSI detection. However, MRI is expensive and can delay cervical clearance. The purpose of this study is to determine the added benefit of MRI as an adjunct to CT in the clearance of children with severe head trauma. We performed a retrospective chart review of pediatric head trauma patients admitted to the pediatric intensive care unit at St. Louis Children's Hospital from 2002 to 2012. Patients who received both cervical spine CT and MRI and presented with a Glasgow Coma Scale score of 8 or lower were included in the study. Imaging was analyzed by two pediatric trauma subspecialists and classified as demonstrating "no injury," "stable injury," or "unstable injury." Results were compared, and discrepancies between CT and MRI findings were noted. A total of 1,196 head-injured children were admitted to the pediatric intensive care unit between January 2002 and December 2012. Sixty-three children underwent CT and MRI and met Glasgow Coma Scale criteria. Seven children were identified with negative CT and positive MRI findings, but none of these injuries were considered unstable by our criteria. Five children were determined to have unstable injuries, and all were detected on CT. The results of this study suggest that MRI does not detect unstable CSIs in the setting of negative CT imaging. Given the limited patient population for this study, further and more extensive studies investigating the utility of MRI in the head-injured pediatric patient are warranted. Diagnostic and care management study, level IV.

  3. A model for estimating level and net severity of spinal cord injuries.

    PubMed

    Holford, T R; Bracken, M B

    1992-06-30

    Objective and detailed neurological assessments are essential in studies of the treatment and the epidemiology of acute spinal cord injuries. In practice, investigators use the expanded score, found by taking the total of the individual determinations, but this summary obscures important detail as to the level and the overall severity of injury. To address this issue, we present a method for estimating level and net severity of injury that makes use of isotonic regression and the Spearman-Kärber estimator. We describe the method for both sensory and motor assessments of neurologic function. In the special case where one gives an identical weight to the response at each level, these estimators algebraically partition the expanded score into separate contributions due to level and net severity. We provide a numerical example using data from the first National Acute Spinal Cord Injury Study, and we present a summary of the distribution of these parameters for this population.

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

    PubMed Central

    Olayemi, Akinbami Babatunde; Adeniyi, Akadiri Oladimeji; Samuel, Udeabor; Emeka, Obiechina Ambrose

    2013-01-01

    Background: The pattern of craniofacial soft-tissue injuries occurring either in isolation or in association with fractures vary in different societies and is multiply influenced. The effects are enormous because of the prominence of the face; therefore, the purpose of this study was to document any changing pattern, severity and management of these craniofacial injuries in our center. Patients and Method: Cranio-maxillofacial region was classified into upper, middle and lower face. The cause, type, and site of the injuries were documented. Gunshot injuries were further categorized as penetrating, perforating or avulsions. Further, classification of injuries into mild, moderate, and severe was carried out based on multiple factors. Result: A total of 126 patients with soft-tissue injuries presented to our hospital out of which 85 (67.5%) were males and 41 (32.5) were females. The age range of the patients was between 10 months and 90 years with a mean ± SD of 26.4 ± 15.5 years. Road traffic accident was the most common etiology of which vehicular accidents constituted 50 (54.9%) and the motorcycle was 2 (2.2%). Assault contributed 16 (17.6%) while cases due to gun shots were 13 (14.3%). A total of 19 (15.1%) patients had associated head injuries, 11 (8.7%) patients had craniofacial fractures involving any of the bones while 3 (2.4%) patients had limb fractures and 2 (1.6%) patients had rib fractures. There were 51 (41.8%) cases classified as mild injuries, 37 (30.3%) cases as moderate injuries and 24 (19.7%) cases as severe injuries. Total of 126 cases managed, 121 (96.0%) received primary closure of the wounds while 5 (4.0%) received delayed closure under general anesthesia. PMID:24339654

  5. Variation and significance of NKT cell and its subset in patients with severe multiple injuries.

    PubMed

    Chen, Guo-bing; Tang, Zhao-hui; Bai, Xiang-jun

    2009-12-01

    To observe the variation and significance of natural killer T (NKT) cells in patients with severe multiple injuries. Peripheral blood was drawn from 30 patients with severe multiple injuries and 20 healthy individuals. NKT cells and the subsets of NKT cells were stained and analyzed on fluorescence activated cell sorter (FACS) using Cellquest software. The level of IL-4 and IFN-gamma in blood serum was detected by ELISA. The proportion of NKT cells was significantly increased. CD4+ NKT cells was increased (t equal to -3.11, P less than 0.01) and CD4+CD8+NKT (double negative NKT, DN NKT) cells decreased in patients with severe multiple injuries compared with healthy controls (t equal to 2.99, P less than 0.01). There was a positive correlation between the proportion of NKT cells and injury severity score (ISS) by Spearman correlation analysis (r equal to 0.70, P less than 0. 01). The level of IFN-gamma was significantly decreased and the level of IL-4 significantly increased in patients with severe multiple injuries. We demonstrate that human NKT cells are increased in trauma patients. Most significantly, there is an association between ISS and NKT cells. The increased CD4+NKT cells may contribute to the reduction of Th1 cytokine production and the growth of Th2 cytokine production, leading to the suppression of immunity after injury.

  6. Contractures and involuntary muscle overactivity in severe brain injury.

    PubMed

    Pohl, Marcus; Mehrholz, Jan; Rockstroh, Günter; Rückriem, Stefan; Koch, Rainer

    2007-04-01

    The aim of the present study was to evaluate the association of contractures with an increase or reduction of non-spastic muscle overactivity due to severe cerebral damage. Forty-five patients with tetraparesis after severe cerebral damage were investigated. Three groups were defined based on the presence of spasticity (revealed as resistance to passive stretch (= hypertonia)), and the presence of contracture of the relevant knee joint: Group(s) (17 patients with hypertonia without contracture), Group(s+c) (20 patients with hypertonia and contracture), and Group(c) (eight patients without hypertonia and with contracture). In all groups spontaneous involuntary muscle activity was assessed continuously over a 12-hour period through isometric measurement of knee joint flexion torque. A mathematical algorithm differentiated an hourly muscle activity spectrum (PI(h)). The frequency of peaks (peaks(h)) from the activity spectrum was determined. We revealed that Group(s) had higher PI(h) and more frequent peaks(h) compared with Group(s+c) and Group(c) (p<0.05). Group(c) had comparable PI(h) and peaks(h) compared with Group(s+c) (p>0.05). The presence of contractures was associated with lower involuntary muscle overactivity in terms of lower PI(h) and less frequent peaks(h), indicating that contractures may be associated with reduced non-spastic positive features of the upper motor neurone syndrome in patients with severe brain damage.

  7. Severe burns due to biofuel heater injury: A case series.

    PubMed

    Heald, Alicia; Muller, Michael

    2016-03-01

    Biofuel heaters are a new form of flame heating for indoor and outdoor use. Fuelled by methylated spirits, they are simple structures with few safety features, and can be associated with severe burn. We report five cases of severe burns in adults that occurred when refilling these heaters. We undertook a retrospective audit of all adults presenting to the Royal Brisbane and Women's Hospital (RBWH) with a biofuel heater-related burn between 20 and 30th June 2014. Five patients required admission for management of their burns. Three were admitted to ICU for greater than 3 weeks, and remained inpatients for up to 78 days. Two did not require ICU and were managed in the burns unit. Average total body surface area (TBSA) burned was 24.7%, and patients went to theatre up to seven times for debridement and skin grafting. Average length of stay was 41.8 days. Biofuel heaters are easily accessible yet there is no Australian Standard to ensure they are safe or perform in the way they were intended. As such, people using them are at undue risk of severe burn, even when following the operating instructions. These products should be removed from the market to prevent further harm and potential mortality. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  8. Neurodevelopmental outcome after severe traumatic brain injury in very young children: role for subcortical lesions.

    PubMed

    Bonnier, Christine; Marique, Patricia; Van Hout, Anne; Potelle, Dominique

    2007-05-01

    Traumatic brain injury is a major cause of mortality and morbidity in children younger than 15 years of age. To evaluate the role of subcortical lesions on neurodevelopmental outcomes, long-term outcomes of 50 children with severe traumatic brain injury before 4 years of age (accidental injury, n = 21, nonaccidental injury, n = 29) were reviewed retrospectively and compared with late magnetic resonance imaging (MRI) findings: no visible lesions, cortical lesions, or subcortical lesions. Subcortical lesions occurred in both accidental and nonaccidental traumatic brain injuries. Traumatic brain injury severity (initial Glasgow Coma Scale or coma duration) was significantly associated with subcortical lesions. Long-term motor or visual deficiencies occurred in one third of patients and cognitive deficiencies in 52.1%. Although deficiencies occurred without visible MRI lesions, global outcome scores, motor delay, visual impairment, head growth slowing, global intellectual quotients, and planning performances were significantly worse in patients with subcortical lesions. An alarming deterioration in intellectual quotient over time was noted. It was concluded that neurodevelopmental outcomes are worrisome after severe traumatic brain injury in young children, and subcortical lesions affect the prognosis.

  9. Injury severity of pedestrians, bicyclists and motorcyclists resulting from crashes with reversing cars.

    PubMed

    Decker, Sebastian; Otte, Dietmar; Cruz, Dana Leslie; Müller, Christian Walter; Omar, Mohamed; Krettek, Christian; Brand, Stephan

    2016-09-01

    Pedestrians, bicyclists and motorcyclists can suffer serious injury in road traffic crashes. To date, no studies examine the injury severity within this vulnerable cohort following collisions with reversing cars. Our institution prospectively maintains a database including medical and technical information regarding traffic accidents in our area, including urban and suburban regions. In a retrospective review of this database, the authors describe the injury severity of pedestrians, bicyclists and motorcyclists following traffic crashes involving reversing cars. Injury severity was described using the abbreviated injury scale (AIS) as well as the maximum abbreviated injury scale (MAIS). This study included 234 crashes occurring between 1999 and 2012. The lower extremity was injured most often while also suffering more severe injuries with a median AIS of 1 compared to 0 in all other documented body regions. The upper extremity was injured second most often. AIS ranging from 4 to 6 were infrequent. AIS 3 however, was documented for the legs in 4.3% of patients. MAIS 0, 1, 2, 3, 5 and 9 were found in 1, 164, 46, 14, 1, and 8 patients in the study cohort, respectively. Pedestrians and motorcyclists were seriously injured in 9.1% and 9.6% of cases, respectively. In contrast, no bicyclists suffered serious injuries. As to the zone of impact, most collisions occurred at the rear center of the vehicle (35%) followed by rear left (26%), rear right (20%), side rear (11%), side center (4%) and side front (3%). 204 (87.2%) collisions occurred during the day, 19 (8.1%) at night and 11 (4.7%) at twilight. Speed was similar in crashes involving pedestrians, bicyclists and motorcyclists, being as high as 7.0±3.6, 7.0±4.0 and 7.9±4.2km/h respectively. This is the first study that analyzes injury severity among these vulnerable road users following collisions with reversing vehicles. The majority of collisions occur at low impact speed during the day. Most injuries resulting

  10. Severe injuries associated with skiing and snowboarding: A national trauma data bank study.

    PubMed

    de Roulet, Amory; Inaba, Kenji; Strumwasser, Aaron; Chouliaras, Konstantinos; Lam, Lydia; Benjamin, Elizabeth; Grabo, Daniel; Demetriades, Demetrios

    2017-04-01

    Injuries after skiing and snowboarding accidents lead to an estimated 7,000 hospital admissions annually and present a significant burden to the health care system. The epidemiology, injury patterns, hospital resource utilization, and outcomes associated with these severe injuries need further characterization. The National Trauma Data Bank was queried for the period 2007 to 2014 for admissions with Injury Severity Score > 15 and International Classification of Diseases Codes-9th Revision codes 885.3 (fall from skis, n = 1,353) and 885.4 (fall from snowboard, n = 1,216). Demographics, emergency department data, diagnosis and procedure codes, and outcomes were abstracted from the database. Severe (Injury Severity Score > 15) ski-associated and snowboard-associated injuries differed with respect to age distribution (median age, 38; interquartile range, 19-59 for skiers and median age, 20; interquartile range, 16-25 for snowboarders; p < 0.001) and sex (78.9% and 86.4% males, respectively, p < 0.001). Traumatic brain injury was common for both sports (56.8% of skiers vs. 46.6% of snowboarders, p < 0.001). Injuries to the spine (28.9%), chest (37.6%), and abdomen (35.0%) were also common. Eighty percent of patients used emergency medical services (50% ambulance, 30% helicopter) with a median emergency medical services transport time of 84 minutes. 50.8% of patients required interhospital transport. 43.2% of injuries required surgical intervention (21.3% orthopedic, 12.5% neurosurgical, 10.5% thoracic, 7.8% abdominal). Median hospital length of stay was 5.0 days. 60.0% of patients required intensive care unit admission with median intensive care unit length of stay 3.0 days. Overall mortality was 4.0% for skiers and 1.9% for snowboarders. Severe injuries after ski and snowboard accidents are associated with significant morbidity and mortality. Differences in injury patterns, risk factors for severe injury, and resource utilization require further study. Increased

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

    PubMed

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

    2015-08-01

    To describe patients' level of effort in occupational, physical, and speech therapy sessions during traumatic brain injury (TBI) inpatient rehabilitation and to evaluate how age, injury severity, cognitive impairment, and time are associated with effort. Prospective, multicenter, longitudinal cohort study. Acute TBI rehabilitation programs. Patients (N=1946) receiving 138,555 therapy sessions. Not applicable. Effort in rehabilitation sessions rated on the Rehabilitation Intensity of Therapy Scale, FIM, Comprehensive Severity Index brain injury severity score, posttraumatic amnesia (PTA), and Agitated Behavior Scale (ABS). The Rehabilitation Intensity of Therapy Scale effort ratings in individual therapy sessions closely conformed to a normative distribution for all 3 disciplines. Mean Rehabilitation Intensity of Therapy Scale ratings for patients' therapy sessions were higher in the discharge week than in the admission week (P<.001). For patients who completed 2, 3, or 4 weeks of rehabilitation, differences in effort ratings (P<.001) were observed between 5 subgroups stratified by admission FIM cognitive scores and over time. In linear mixed-effects modeling, age and Comprehensive Severity Index brain injury severity score at admission, days from injury to rehabilitation admission, days from admission, and daily ratings of PTA and ABS score were predictors of level of effort (P<.0001). Patients' level of effort can be observed and reliably rated in the TBI inpatient rehabilitation setting using the Rehabilitation Intensity of Therapy Scale. Patients who sustain TBI show varying levels of effort in rehabilitation therapy sessions, with effort tending to increase over the stay. PTA and agitated behavior are primary risk factors that substantially reduce patient effort in therapies. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

    PubMed Central

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

    2016-01-01

    Objective To describe patients' level of effort in occupational, physical, and speech therapy sessions during traumatic brain injury (TBI) inpatient rehabilitation and to evaluate how age, injury severity, cognitive impairment, and time are associated with effort. Design Prospective, multicenter, longitudinal cohort study. Setting Acute TBI rehabilitation programs. Participants Patients (N=1946) receiving 138,555 therapy sessions. Interventions Not applicable. Main Outcome Measures Effort in rehabilitation sessions rated on the Rehabilitation Intensity of Therapy Scale, FIM, Comprehensive Severity Index brain injury severity score, posttraumatic amnesia (PTA), and Agitated Behavior Scale (ABS). Results The Rehabilitation Intensity of Therapy Scale effort ratings in individual therapy sessions closely conformed to a normative distribution for all 3 disciplines. Mean Rehabilitation Intensity of Therapy Scale ratings for patients' therapy sessions were higher in the discharge week than in the admission week (P<.001). For patients who completed 2, 3, or 4 weeks of rehabilitation, differences in effort ratings (P<.001) were observed between 5 subgroups stratified by admission FIM cognitive scores and over time. In linear mixed-effects modeling, age and Comprehensive Severity Index brain injury severity score at admission, days from injury to rehabilitation admission, days from admission, and daily ratings of PTA and ABS score were predictors of level of effort (P<.0001). Conclusions Patients' level of effort can be observed and reliably rated in the TBI inpatient rehabilitation setting using the Rehabilitation Intensity of Therapy Scale. Patients who sustain TBI show varying levels of effort in rehabilitation therapy sessions, with effort tending to increase over the stay. PTA and agitated behavior are primary risk factors that substantially reduce patient effort in therapies. PMID:26212400

  13. Aberrant sensory responses are dependent on lesion severity after spinal cord contusion injury in mice

    PubMed Central

    Hoschouer, Emily L.; Basso, D. Michele; Jakeman, Lyn B.

    2010-01-01

    Following spinal cord injury (SCI), individuals lose normal sensation and often develop debilitating neuropathic pain. Basic research has helped to elucidate many of the underlying mechanisms, but unanswered questions remain concerning how sensation changes after SCI and potential negative consequences of regenerative therapies. Mouse models provide an opportunity to explore these questions using genetic markers and manipulations. However, despite the increasing use of mice in pain and sensory research, the responses to sensory stimuli after SCI are poorly characterized in this species. This study evaluated behavioral responses to mechanical and nociceptive stimuli applied to the hindlimbs and the dorsal trunk in C57BL/6 mice after mid-thoracic SCI. Adult mice were subjected to laminectomy, contusion injuries of different severities, or complete transections to test the hypothesis that the patterns of sensory pathology depend on the extent of tissue damage at the injury site. In the hind paws, hyper-responsiveness to a heat stimulus developed independent of injury severity, while mechanical sensitivity decreased, except after the most severe contusion injuries sparing less than 2% of the white matter at the injury site, when enhanced sensitivity was observed. On the trunk, mechanical and pin prick testing revealed diminished sensitivity at and below the injury level, while responses above the level of the injury were unchanged. The contrast in injury severity threshold for thermal and mechanical hypersensitivity in the hind paws suggests that these responses have different underlying mechanisms. These results establish essential baseline information for murine studies of pain and changes in sensation after SCI. PMID:20022699

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

    PubMed

    Eluru, Naveen; Bhat, Chandra R

    2007-09-01

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

  15. Acute injuries in recreational and competitive surfers: incidence, severity, location, type, and mechanism.

    PubMed

    Furness, James; Hing, Wayne; Walsh, Joe; Abbott, Allan; Sheppard, Jeremy M; Climstein, Mike

    2015-05-01

    There are an estimated 37 million surfers worldwide, with 2.5 million recreational surfers in Australia. The recreational activity and sport of surfing has grown dramatically since the 1960s, but scientific research has been poorly mirrored in comparison with most other mainstream sports. To identify the incidence, severity, location, type, and mechanism of acute injuries in recreational and competitive surfers over a 12-month period. Descriptive epidemiology study. An online survey using an open-source survey application was utilized. The survey consisted of 2 primary sections: Section 1 included demographic information and participation levels (age, height, weight, hours surfed, competitive level); section 2 incorporated injury type, mechanism, severity, and injury management. A total of 1348 participants (91.3% males; 43.1% competitive surfers) were included in data analysis. A total of 512 acute injuries were classified as major, providing an incidence proportion of 0.38 (CI, 0.35-0.41) acute injuries per year. The incidence rate was calculated to be 1.79 (CI, 1.67-1.92) major injuries per 1000 hours of surfing. The shoulder, ankle, and head/face regions had the highest frequencies of acute injury, representing 16.4%, 14.6%, and 13.3%, respectively. Injuries were predominantly of muscular, joint, and skin origin, representing 30.3%, 27.7%, and 18.9%, respectively. Skin injuries were primarily a result of direct trauma, while joint and muscular injuries were mainly a result of maneuvers performed and repetitive actions. Key risk factors that increased the incidence of sustaining an acute injury included competitive status, hours surfed (>6.5 hours/week), and the ability to perform aerial maneuvers. The incidence proportion for surfers completing aerial maneuvers was calculated to be 0.48 (CI, 0.39-0.58) major injuries per year, this being the highest incidence proportion irrespective of competitive status. This is the largest surfing-specific survey that

  16. Analysis of traffic accident injury severity on Spanish rural highways using Bayesian networks.

    PubMed

    de Oña, Juan; Mujalli, Randa Oqab; Calvo, Francisco J

    2011-01-01

    Several different factors contribute to injury severity in traffic accidents, such as driver characteristics, highway characteristics, vehicle characteristics, accidents characteristics, and atmospheric factors. This paper shows the possibility of using Bayesian Networks (BNs) to classify traffic accidents according to their injury severity. BNs are capable of making predictions without the need for pre assumptions and are used to make graphic representations of complex systems with interrelated components. This paper presents an analysis of 1536 accidents on rural highways in Spain, where 18 variables representing the aforementioned contributing factors were used to build 3 different BNs that classified the severity of accidents into slightly injured and killed or severely injured. The variables that best identify the factors that are associated with a killed or seriously injured accident (accident type, driver age, lighting and number of injuries) were identified by inference. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. Maternal reporting of behaviour following very severe blunt head injury.

    PubMed Central

    Kinsella, G; Packer, S; Olver, J

    1991-01-01

    Mothers of 40 very severely head injured male subjects rated their son's behaviour on the Current Behaviour Scale and their ratings were compared with mothers' ratings of 40 control male subjects. The scale was able to discriminate the two groups, by utilising two factors--loss of emotional control and loss of motivation. The mothers' level of emotional distress was closely related to their reporting of loss of emotional control in their sons, but reporting of loss of motivation, or lowered arousal, was strongly predicted by the functional disability of the son. The utility of refining the measurement of post-trauma behaviour is discussed. PMID:1865205

  18. Altered Cognitive Control Activations after Moderate-to-Severe Traumatic Brain Injury and Their Relationship to Injury Severity and Everyday-Life Function

    PubMed Central

    Olsen, Alexander; Brunner, Jan Ferenc; Indredavik Evensen, Kari Anne; Finnanger, Torun Gangaune; Vik, Anne; Skandsen, Toril; Landrø, Nils Inge; Håberg, Asta Kristine

    2015-01-01

    This study investigated how the neuronal underpinnings of both adaptive and stable cognitive control processes are affected by traumatic brain injury (TBI). Functional magnetic resonance imaging (fMRI) was undertaken in 62 survivors of moderate-to-severe TBI (>1 year after injury) and 68 healthy controls during performance of a continuous performance test adapted for use in a mixed block- and event-related design. Survivors of TBI demonstrated increased reliance on adaptive task control processes within an a priori core region for cognitive control in the medial frontal cortex. TBI survivors also had increased activations related to time-on-task effects during stable task-set maintenance in right inferior parietal and prefrontal cortices. Increased brain activations in TBI survivors had a dose-dependent linear positive relationship to injury severity and were negatively correlated with self-reported cognitive control problems in everyday-life situations. Results were adjusted for age, education, and fMRI task performance. In conclusion, evidence was provided that the neural underpinnings of adaptive and stable control processes are differently affected by TBI. Moreover, it was demonstrated that increased brain activations typically observed in survivors of TBI might represent injury-specific compensatory adaptations also utilized in everyday-life situations. PMID:24557637

  19. Altered Cognitive Control Activations after Moderate-to-Severe Traumatic Brain Injury and Their Relationship to Injury Severity and Everyday-Life Function.

    PubMed

    Olsen, Alexander; Brunner, Jan Ferenc; Indredavik Evensen, Kari Anne; Finnanger, Torun Gangaune; Vik, Anne; Skandsen, Toril; Landrø, Nils Inge; Håberg, Asta Kristine

    2015-08-01

    This study investigated how the neuronal underpinnings of both adaptive and stable cognitive control processes are affected by traumatic brain injury (TBI). Functional magnetic resonance imaging (fMRI) was undertaken in 62 survivors of moderate-to-severe TBI (>1 year after injury) and 68 healthy controls during performance of a continuous performance test adapted for use in a mixed block- and event-related design. Survivors of TBI demonstrated increased reliance on adaptive task control processes within an a priori core region for cognitive control in the medial frontal cortex. TBI survivors also had increased activations related to time-on-task effects during stable task-set maintenance in right inferior parietal and prefrontal cortices. Increased brain activations in TBI survivors had a dose-dependent linear positive relationship to injury severity and were negatively correlated with self-reported cognitive control problems in everyday-life situations. Results were adjusted for age, education, and fMRI task performance. In conclusion, evidence was provided that the neural underpinnings of adaptive and stable control processes are differently affected by TBI. Moreover, it was demonstrated that increased brain activations typically observed in survivors of TBI might represent injury-specific compensatory adaptations also utilized in everyday-life situations.

  20. Revascularization of immature permanent incisors after severe extrusive luxation injury.

    PubMed

    Cehreli, Zafer C; Sara, Sezgi; Aksoy, Burak

    2012-07-01

    Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth.

  1. Revascularization of immature permanent incisors after severe extrusive luxation injury.

    PubMed

    Cehreli, Zafer C; Sara, Sezgi; Aksoy, Burak

    2012-01-01

    Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-Year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 Months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth.

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

    PubMed Central

    Niebuhr, Tobias; Junge, Mirko; Achmus, Stefanie

    2013-01-01

    Injury risk assessment plays a pivotal role in the assessment of the effectiveness of Advanced Driver Assistance Systems (ADAS) as they specify the injury reduction potential of the system. The usual way to describe injury risks is by use of injury risk functions, i.e. specifying the probability of an injury of a given severity occurring at a specific technical accident severity (collision speed). A method for the generation of a family of risk functions for different levels of injury severity is developed. The injury severity levels are determined by use of a rescaled version of the Injury Severity Score (ISS) namely the ISSx. The injury risk curves for each collision speed is then obtained by fixing the boundary conditions and use of a case-by-case validated GIDAS subset of pedestrian-car accidents (N=852). The resultant functions are of exponential form as opposed to the frequently used logistic regression form. The exponential approach in combination with the critical speed value creates a new injury risk pattern better fitting for high speed/high energy crashes. Presented is a family of pedestrian injury risk functions for an arbitrary injury severity. Thus, the effectiveness of an ADAS can be assessed for mitigation of different injury severities using the same injury risk function and relying on the internal soundness of the risk function with regard to different injury severity levels. For the assessment of emergency braking ADAS, a Zone of Effective Endangerment Increase (ZEEI), the speed interval in which a one percent speed increase results at least in a one percent of injury risk increase, is defined. The methodology presented is kept in such general terms that a direct adaption to other accident configurations is easily done. PMID:24406954

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

    PubMed

    Weiss, Harold B; Kaplan, Sigal; Prato, Carlo G

    2014-04-01

    Young people are a risk to themselves and other road users, as motor vehicle crashes are the leading cause of their death. A thorough understanding of the most important factors associated with injury severity in crashes involving young drivers is important for designing well-targeted restrictive measures within youth-oriented road safety programs. The current study estimates discrete choice models of injury severity of crashes involving young drivers conditional on these crashes having occurred. The analysis examined a comprehensive set of single-vehicle and two-vehicle crashes involving at least one 15-24 year-old driver in New Zealand between 2002 and 2011 that resulted in minor, serious or fatal injuries. A mixed logit model accounting for heterogeneity and heteroscedasticity in the propensity to injury severity outcomes and for correlation between serious and fatal injuries proved a better fit than a binary and a generalized ordered logit. Results show that the young drivers' behavior, the presence of passengers and the involvement of vulnerable road users were the most relevant factors associated with higher injury severity in both single-vehicle and two-vehicle crashes. Seatbelt non-use, inexperience and alcohol use were the deadliest behavioral factors in single-vehicle crashes, while fatigue, reckless driving and seatbelt non-use were the deadliest factors in two-vehicle crashes. The presence of passengers in the young drivers' vehicle, and in particular a combination of males and females, dramatically increased the probability of serious and fatal injuries. The involvement of vulnerable road users, in particular on rural highways and open roads, considerably amplified the probability of higher crash injury severity.

  4. An Analysis of Beta-Blocker Administration Pre-and Post-Traumatic Brain Injury with Subanalyses for Head Injury Severity and Myocardial Injury.

    PubMed

    Edavettal, Mathew; Gross, Brian W; Rittenhouse, Katelyn; Alzate, James; Rogers, Amelia; Estrella, Lisa; Miller, Jo Ann; Rogers, Frederick B

    2016-12-01

    A growing body of literature indicates that beta-blocker administration after traumatic brain injury (TBI) is cerebroprotective, limiting secondary injury; however, the effects of preinjury beta blocker status remain poorly understood. We sought to characterize the effects of pre- and postinjury beta-blocker administration on mortality with subanalyses accounting for head injury severity and myocardial injury. In a Level II trauma center, all admissions of patients ≥18 years with a head Abbreviated Injury Scale Score ≥2, Glasgow Coma Scale ≤13 from May 2011 to May 2013 were queried. Demographic, injury-specific, and outcome variables were analyzed using univariate analyses. Subsequent multivariate analyses were conducted to determine adjusted odds of mortality for beta-blocker usage controlling for age, Injury Severity Score, head Abbreviated Injury Scale, arrival Glasgow Coma Scale, ventilator use, and intensive care unit stay. A total of 214 trauma admissions met inclusion criteria: 112 patients had neither pre- nor postinjury beta-blocker usage, 46 patients had preinjury beta-blocker usage, and 94 patients had postinjury beta-blocker usage. Both unadjusted and adjusted odds ratios of preinjury beta-blocker were insignificant with respect to mortality. However, postinjury in-hospital administration of beta blockers was found to significantly in the decrease of mortality in both univariate (P = 0.002) and multivariate analyses (P = 0.001). Our data indicate that beta-blocker administration post-TBI in hospital reduces odds of mortality; however, preinjury beta-blocker usage does not. Additionally, myocardial injury is a useful indicator for beta-blocker administration post-TBI. Further research into which beta blockers confer the best benefits as well as the optimal period of beta-blocker administration post-TBI is recommended.

  5. Risk factors for the severity of injury incurred in crashes involving on-duty police cars.

    PubMed

    Chu, Hsing-Chung

    2016-07-03

    This article explores the risk factors associated with police cars on routine patrol and/or on an emergency run and their effects on the severity of injuries in crashes. The binary probit model is used to examine the effects of important factors on the risk of injuries sustained in crashes involving on-duty police cars. Several factors significantly increase the probability of crashes that cause severe injuries. Among those causes are police officers who drive at excessive speeds, traffic violations during emergency responses or pursuits, and driving during the evening (6 to 12 p.m.) or in rainy weather. Findings also indicate some potential issues associated with an increase in the probability of crashes that cause injuries. Younger police drivers were found to be more likely to be involved in crashes causing injuries than middle-aged drivers were. Distracted driving by on-duty police officers as well as civilian drivers who did not pull over to let a police car pass in emergency situations also caused serious crashes. Police cars are exempted from certain traffic laws under emergency circumstances. However, to reduce the probability of being involved in a crash resulting in severe injuries, officers are still obligated to drive safely and follow safety procedures when responding to emergencies or pursuing a car. Enhancement of training techniques for emergency situations or driving in pursuit of an offender and following the safety procedures are essential for safety in driving during an emergency run by police.

  6. Severity and treatment of "occult" intra-abdominal injuries in blunt trauma victims.

    PubMed

    Parreira, José G; Oliari, Camilla B; Malpaga, Juliano M D; Perlingeiro, Jacqueline A G; Soldá, Silvia C; Assef, José C

    2016-01-01

    to assess the severity and treatment of "occult" intra-abdominal injuries in blunt trauma victims. Retrospective analysis of charts and trauma register data of adult blunt trauma victims, admitted without abdominal pain or alterations in the abdominal physical examination, but were subsequently diagnosed with intra-abdominal injuries, in a period of 2 years. The severity was stratified according to RTS, AIS, OIS and ISS. The specific treatment for abdominal injuries and the complications related to them were assessed. Intra-abdominal injuries were diagnosed in 220 (3.8%) out of the 5785 blunt trauma victims and 76 (34.5%) met the inclusion criteria. The RTS and ISS median (lower quartile, upper quartile) were 7.84 (6.05, 7.84) and 25 (16, 34). Sixty seven percent had a GCS≥13 on admission. Injuries were identified in the spleen (34), liver (33), kidneys (9), intestines (4), diaphragm (3), bladder (3) and iliac vessels (1). Abdominal injuries scored AIS≥3 in 67% of patients. Twenty-one patients (28%) underwent laparotomy, 5 of which were nontherapeutic. The surgical procedures performed were splenectomy (8), suturing of the diaphragm (3), intestines (3), bladder (2), kidneys (1), enterectomy/anastomosis (1), ligation of the common iliac vein (1), and revascularization of the common iliac artery (1). Angiography and embolization of liver and/or spleen injuries were performed in 3 cases. Three patients developed abdominal complications, all of which were operatively treated. There were no deaths directly related to the abdominal injuries. Severe "occult" intra-abdominal injuries, requiring specific treatment, may be present in adult blunt trauma patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Interobserver Variability in Injury Severity Scoring After Combat Trauma: Different Perspectives, Different Values?

    PubMed

    Smith, Iain M; Naumann, David N; Guyver, Paul; Bishop, Jonathan; Davies, Simon; Lundy, Jonathan B; Bowley, Douglas M

    2015-01-01

    Anatomic measures of injury burden provide key information for studies of prehospital and in-hospital trauma care. The military version of the Abbreviated Injury Scale [AIS(M)] is used to score injuries in deployed military hospitals. Estimates of total trauma burden are derived from this. These scores are used for categorization of patients, assessment of care quality, and research studies. Scoring is normally performed retrospectively from chart review. We compared data recorded in the UK Joint Theatre Trauma Registry (JTTR) and scores calculated independently at the time of surgery by the operating surgeons to assess the concordance between surgeons and trauma nurse coordinators in assigning injury severity scores. Trauma casualties treated at a deployed Role 3 hospital were assigned AIS(M) scores by surgeons between 24 September 2012 and 16 October 2012. JTTR records from the same period were retrieved. The AIS(M), Injury Severity Score (ISS), and New Injury Severity Score (NISS) were compared between datasets. Among 32 matched casualties, 214 injuries were recorded in the JTTR, whereas surgeons noted 212. Percentage agreement for number of injuries was 19%. Surgeons scored 75 injuries as "serious" or greater compared with 68 in the JTTR. Percentage agreement for the maximum AIS(M), ISS, and NISS assigned to cases was 66%, 34%, and 28%, respectively, although the distributions of scores were not statistically different (median ISS: surgeons: 20 [interquartile range (IQR), 9-28] versus JTTR: 17.5 [IQR, 9-31.5], p = .7; median NISS: surgeons: 27 [IQR, 12-42] versus JTTR: 25.5 [IQR, 11.5-41], p = .7). There are discrepancies in the recording of AIS(M) between surgeons directly involved in the care of trauma casualties and trauma nurse coordinators working by retrospective chart review. Increased accuracy might be achieved by actively collaborating in this process. 2015.

  8. Progesterone Treatment Shows Benefit in a Pediatric Model of Moderate to Severe Bilateral Brain Injury

    PubMed Central

    Geddes, Rastafa I.; Sribnick, Eric A.; Sayeed, Iqbal; Stein, Donald G.

    2014-01-01

    Purpose Controlled cortical impact (CCI) models in adult and aged Sprague-Dawley (SD) rats have been used extensively to study medial prefrontal cortex (mPFC) injury and the effects of post-injury progesterone treatment, but the hormone's effects after traumatic brain injury (TBI) in juvenile animals have not been determined. In the present proof-of-concept study we investigated whether progesterone had neuroprotective effects in a pediatric model of moderate to severe bilateral brain injury. Methods Twenty-eight-day old (PND 28) male Sprague Dawley rats received sham (n = 24) or CCI (n = 47) injury and were given progesterone (4, 8, or 16 mg/kg per 100 g body weight) or vehicle injections on post-injury days (PID) 1–7, subjected to behavioral testing from PID 9–27, and analyzed for lesion size at PID 28. Results The 8 and 16 mg/kg doses of progesterone were observed to be most beneficial in reducing the effect of CCI on lesion size and behavior in PND 28 male SD rats. Conclusion Our findings suggest that a midline CCI injury to the frontal cortex will reliably produce a moderate TBI comparable to what is seen in the adult male rat and that progesterone can ameliorate the injury-induced deficits. PMID:24489882

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

    PubMed Central

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

    2016-01-01

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

  10. Trauma with Injury Severity Score of 75: Are These Unsurvivable Injuries?

    PubMed

    Peng, Jin; Wheeler, Krista; Shi, Junxin; Groner, Jonathan Ira; Haley, Kathryn Jo; Xiang, Huiyun

    2015-01-01

    Trauma patients with an ISS=75 have been deliberately excluded from some trauma studies because they were assumed to have "unsurvivable injuries." This study aimed to assess the true mortality among patients with an ISS=75, and to examine the characteristics and primary diagnoses of these patients. Retrospective review of the 2006-2010 U.S. Nationwide Emergency Department Sample (NEDS) generated 2,815 patients with an ISS=75 for analysis, representing an estimated 13,569 patients in the country. Dispositions from the emergency department and hospital for these patients were tabulated by trauma center level. Survivors and non-survivors were compared using Pearson's chi-square test. Primary diagnosis codes of these patients were tabulated by mortality status. Overall, about 48.6% of patients with an ISS=75 were discharged alive, 25.8% died and 25.6% had unknown mortality status. The mortality risks of these patients did not vary significantly across different levels of trauma centers (15.6% vs. 13.0%, P = 0.16). Non-survivors were more likely than survivors to: be male (81.2% vs. 74.4%, P < 0.0001), be over 65 years (20.3% vs. 10.2%, P < 0.0001), be uninsured (33.8% vs. 19.1%), have at least one chronic condition (58.0% vs. 43.7%, P <0.0001), sustain life-threatening injuries (79.2% vs. 49.4%, P<0.0001), sustain penetrating injuries (42.0% vs. 25.9%, P<0.0001), and have injuries caused by motor vehicle crashes (32.9% vs. 21.1%, P<0.0001) or firearms (21.9% vs. 4.4%, P<0.0001). The most frequent diagnosis code was 862.8 (injury to multiple and unspecified intrathoracic organs, without mention of open wound into cavity). Our results revealed that at least half of patients with an ISS=75 survived, demonstrating that the rationale for excluding patients with an ISS=75 from analysis is not always justified. To avoid bias and inaccurate results, trauma researchers should examine the mortality status of patients with an ISS=75 before exclusion, and explicitly describe their

  11. Trauma with Injury Severity Score of 75: Are These Unsurvivable Injuries?

    PubMed Central

    Peng, Jin; Wheeler, Krista; Shi, Junxin; Groner, Jonathan Ira; Haley, Kathryn Jo; Xiang, Huiyun

    2015-01-01

    Trauma patients with an ISS=75 have been deliberately excluded from some trauma studies because they were assumed to have "unsurvivable injuries." This study aimed to assess the true mortality among patients with an ISS=75, and to examine the characteristics and primary diagnoses of these patients. Retrospective review of the 2006-2010 U.S. Nationwide Emergency Department Sample (NEDS) generated 2,815 patients with an ISS=75 for analysis, representing an estimated 13,569 patients in the country. Dispositions from the emergency department and hospital for these patients were tabulated by trauma center level. Survivors and non-survivors were compared using Pearson's chi-square test. Primary diagnosis codes of these patients were tabulated by mortality status. Overall, about 48.6% of patients with an ISS=75 were discharged alive, 25.8% died and 25.6% had unknown mortality status. The mortality risks of these patients did not vary significantly across different levels of trauma centers (15.6% vs. 13.0%, P = 0.16). Non-survivors were more likely than survivors to: be male (81.2% vs. 74.4%, P < 0.0001), be over 65 years (20.3% vs. 10.2%, P < 0.0001), be uninsured (33.8% vs. 19.1%), have at least one chronic condition (58.0% vs. 43.7%, P <0.0001), sustain life-threatening injuries (79.2% vs. 49.4%, P<0.0001), sustain penetrating injuries (42.0% vs. 25.9%, P<0.0001), and have injuries caused by motor vehicle crashes (32.9% vs. 21.1%, P<0.0001) or firearms (21.9% vs. 4.4%, P<0.0001). The most frequent diagnosis code was 862.8 (injury to multiple and unspecified intrathoracic organs, without mention of open wound into cavity). Our results revealed that at least half of patients with an ISS=75 survived, demonstrating that the rationale for excluding patients with an ISS=75 from analysis is not always justified. To avoid bias and inaccurate results, trauma researchers should examine the mortality status of patients with an ISS=75 before exclusion, and explicitly describe their

  12. The validity of the mangled extremity severity score in the assessment of upper limb injuries.

    PubMed

    Togawa, S; Yamami, N; Nakayama, H; Mano, Y; Ikegami, K; Ozeki, S

    2005-11-01

    The Mangled Extremity Severity Score (MESS) may be used to decide whether to perform amputation in patients with injuries involving a limb. A score of 7 points or higher indicates the need for amputation. We have treated three patients with a MESS of 7 points or higher, in two of which the injured limb was salvaged. This scoring system was originally devised to assess injuries to the lower limb. However, a MESS of 7 points as a justification for amputation does not appear appropriate when assessing injuries to the major vessels in the upper limb.

  13. Return to work within the first seven years of severe head injury.

    PubMed

    Brooks, N; McKinlay, W; Symington, C; Beattie, A; Campsie, L

    1987-01-01

    The rate and prediction of return to work was examined in 98 severely head injured patients during the first seven years after injury. The employment rate dropped from 86% before injury to 29% after. Younger patients, and those with technical/managerial jobs before injury were more likely to return to work than those over 45 years of age, or in unskilled occupations. Physical deficits were not related to return to work, but the presence of cognitive, behavioural, and personality changes was significantly related to a failure to return to work.

  14. Impact of Injury Severity on Dynamic Inflammation Networks Following Blunt Trauma.

    PubMed

    Almahmoud, Khalid; Namas, Rami A; Abdul-Malak, Othman; Zaaqoq, Akram M; Zamora, Ruben; Zuckerbraun, Brian S; Sperry, Jason; Peitzman, Andrew B; Billiar, Timothy R; Vodovotz, Yoram

    2015-08-01

    Clinical outcomes following trauma depend on the extent of injury and the host's response to injury, along with medical care. We hypothesized that dynamic networks of systemic inflammation manifest differently as a function of injury severity in human blunt trauma. From a cohort of 472 blunt trauma survivors studied following institutional review board approval, three Injury Severity Score (ISS) subcohorts were derived after matching for age and sex: mild ISS (49 patients [33 males and 16 females, aged 42 ± 1.9 years; ISS 9.5 ± 0.4]); moderate ISS (49 patients [33 males and 16 females, aged 42 ± 1.9; ISS 19.9 ± 0.4]), and severe ISS (49 patients [33 males and 16 females, aged 42 ± 2.5 years; ISS 33 ± 1.1]). Multiple inflammatory mediators were assessed in serial blood samples. Dynamic Bayesian Network inference was utilized to infer causal relationships based on probabilistic measures. Intensive care unit length of stay, total length of stay, days on mechanical ventilation, Marshall Multiple Organ Dysfunction score, prevalence of prehospital hypotension and nosocomial infection, and admission lactate and base deficit were elevated as a function of ISS. Multiple circulating inflammatory mediators were significantly elevated in severe ISS versus moderate or mild ISS over both the first 24 h and out to 7 days after injury. Dynamic Bayesian Network suggested that interleukin 6 production in severe ISS was affected by monocyte chemotactic protein 1/CCL2, monokine inducible by interferon γ (MIG)/CXCL9, and IP-10/CXCL10; by monocyte chemotactic protein 1/CCL2 and MIG/CXCL9 in moderate ISS; and by MIG/CXCL9 alone in mild ISS over 7 days after injury. Injury Severity Score correlates linearly with morbidity, prevalence of infection, and early systemic inflammatory connectivity of chemokines to interleukin 6.

  15. Treatment with low-dose methamphetamine improves behavioral and cognitive function after severe traumatic brain injury.

    PubMed

    Rau, Thomas F; Kothiwal, Aakriti S; Rova, Annela R; Brooks, Diane M; Poulsen, David J

    2012-08-01

    Methamphetamine increases the release and blocks the reuptake of dopamine. The moderate activation of dopamine receptors may elicit neuroprotective effects. We have recently demonstrated that low doses of methamphetamine reduce neuronal loss after ischemic injury. On the basis of this finding, we hypothesized that methamphetamine could also prevent neuronal loss and improve functional behavior after severe traumatic brain injury (TBI). The rat lateral fluid percussion injury model was used to generate severe TBI. Three hours after injury, animals were treated with saline or methamphetamine. Neurological severity scores and foot fault assessments were used to determine whether treatment enhanced recovery after injury. The potential for methamphetamine treatment to improve cognitive function was assessed using the Morris water maze. Forty-eight hours after injury, paraffin-embedded brain sections were TUNEL stained to measure apoptotic cell death. Sections were also stained with antibody to doublecortin to quantify immature neurons within the dentate gyrus. Treatment with low-dose methamphetamine significantly reduced both behavioral and cognitive dysfunction after severe TBI. Methamphetamine-treated animals scored significantly lower on neurological severity scores and had significantly less foot faults after TBI compared with saline-treated control rats. Furthermore, methamphetamine treatment restored learning and memory function to near normal ability after TBI. At 48 hours after injury, apoptotic cell death within the hippocampus was significantly reduced, and the presence of immature neurons was significantly increased in methamphetamine-treated rats compared with saline-treated controls. Treatment with low-dose methamphetamine after severe TBI elicits a robust neuroprotective response resulting in significant improvements in behavioral and cognitive functions.

  16. The association between repetitive, self-injurious and aggressive behavior in children with severe intellectual disability.

    PubMed

    Oliver, Chris; Petty, Jane; Ruddick, Loraine; Bacarese-Hamilton, Monique

    2012-06-01

    We evaluated the independent association between adaptive behavior, communication and repetitive or ritualistic behaviors and self-injury, aggression and destructive behavior to identify potential early risk markers for challenging behaviors. Data were collected for 943 children (4-18 years, M = 10.88) with severe intellectual disabilities. Odds ratio analyses revealed that these characteristics generated risk indices ranging from 2 to 31 for the presence and severity of challenging behaviors. Logistic regressions revealed that high frequency repetitive or ritualistic behavior was associated with a 16 times greater risk of severe self-injury and a 12 times greater risk of showing two or more severe challenging behaviors. High frequency repetitive or ritualistic behaviors independently predict challenging behavior and have the potential to be early risk markers for self-injury and aggression of clinical significance.

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2015-05-01

    To assess possible association between the incidence of approved claims for severe and fatal obstetric injuries and delivery volume in Denmark. A nationwide panel study of labor units. Claimants seeking financial compensation due to injuries occurring in labor units in 1995-2012. Exposure information regarding the annual number of deliveries per labor unit was retrieved from the Danish National Birth Register. Outcome information was retrieved from the Danish Patient Compensation Association. Exposure was categorized in delivery volume quintiles as annual volume per labor unit: (10-1377), (1378-2016), (2017-2801), (2802-3861), (3862-6659). Five primary measures of outcome were used. Incidence rate ratios of (A) Submitted claims, (B) Approved claims, (C) Approved severe injury claims (120% degree of disability), (D) Approved fatal injury claims, and (C+D) Combined. 1 151 734 deliveries in 51 labor units and 1872 submitted claims were included. The incidence rate ratios of approved claims overall, of approved fatal injury claims, and of approved severe and fatal injuries combined increased significantly with decreasing annual delivery volume. Face value incidence rate ratios of approved severe injuries increased with decreasing labor unit volume, but the association did not reach statistical significance. High volume labor units appear associated with fewer approved and fewer fatal injury claims compared with units with less volume. The findings support the development towards consolidation of units in Denmark. A suggested option would be to tailor obstetric patient safety initiatives according to the delivery volume of individual labor units. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. Early and Late Acute Kidney Injury in Severely Burned Patients

    PubMed Central

    Witkowski, Wojciech; Kawecki, Marek; Surowiecka-Pastewka, Agnieszka; Klimm, Wojciech; Szamotulska, Katarzyna; Niemczyk, Stanisław

    2016-01-01

    Background This study evaluated factors influencing early and late occurrence of AKI in severely burned patients and assessed the relationship between time of occurrence of AKI and mortality of AKI patients. Material/Methods Renal function was evaluated at 3 time points: at admission, at the critical point or middle point of hospitalization, and at the endpoint for which death or a discharge from the center was considered. AKI criteria were: decrease in GFR of less than 60 ml/min at admission, decrease in GFR of more than 75% compared to baseline, and decrease in the daily diuresis of less than 500 ml/24 h. Results At admission, 15.1% of the patients had eGFR <60 ml/min. AKI occurred in 38.5% of cases. The occurrence of AKI was associated with: elderly age (p<0.001), female sex (p=0.017), overweight and obesity (p=0.055); extent and depth of burns, respiratory failure, low protein concentration (for all p<0.001), low blood pressure (p=0.014), and high WBC (p=0.010). Early AKI was detected in 28% of patients. Mortality was 100% with the initial GFR ≥60, 100% with the initial GFR <60 and early deterioration of renal function, 80% with the initial GFR <60 and late worsening, and 60% with the initial GFR <60 and no worsening. Late AKI was observed in 10% of patients and mortality in this group was 79.2%. Mortality in the entire group with AKI was 88.0% versus 24.5%. Conclusions The frequent occurrence of AKI, especially early, worsens the prognosis for survival. Assessment of renal function should be included in the prognostic scales for burned patients. PMID:27746455

  20. A Computerized Test Battery Sensitive to Mild and Severe Brain Injury

    PubMed Central

    Gualtieri, C. Thomas; Johnson, Lynda G.

    2008-01-01

    Objective Computerized neurocognitive testing (CNT) appears to be suited to measure relatively mild degrees of neurocognitive impairment in circumstances where speed, efficiency, and low cost are important. Computerized tests are used in the evaluation and management of patients who have had mild brain injuries; the objective is to determine if computerized testing is equally reliable and valid in the evaluation of patients who have had more severe brain injuries. Design A cross-sectional, naturalistic study of brain injury patients compared with normal controls. Setting An outpatient neuropsychiatry clinic. Participants 141 patients, aged 18–65 years, who had sustained traumatic brain injuries (TBIs): 13 patients with postconcussion syndrome; 15 who had recovered from mild brain injuries; 85 patients who had had severe brain injuries, but who had recovered, and were living independently; and 28 severe brain injury patients who were unable to live without assistance; compared with 145 normal controls. Interventions Not applicable. Main Outcome Measures The CNS Vital Signs (CNS VS) battery is a PC-based system that includes tests of verbal and visual memory, psychomotor speed, complex attention, reaction time, and cognitive flexibility. Results Performance on the CNS VS battery was related to severity of brain injury and degree of recovery. Tests of psychomotor speed and cognitive flexibility were the most relevant to TBI status. Patients who had recovered from mild brain injuries scored almost as well as normal controls. The Neurocognition Index (NCI), a summary score based on performance on all the tests in the battery, was 100 for normal controls and 98 for recovered mild brain injury patients. Postconcussive patients scored 82 on the MCI, and severe brain injury patients scored 66 on the NCI if they were living independently and 47 if they were not. Conclusions Computerized tests like CNS VS allow clinicians the advantage of precise neurocognitive measurement

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  3. Improving access to pediatric neurorehabilitation for patients with moderate and severe head injuries.

    PubMed

    Lodh, Rajib; Siddell, Poppy; Jones, Jonathan; Morrall, Matthew C H J

    2017-10-01

    The majority of severely injured children in England have a significant head injury and will be seen in Major Trauma Centers (MTCs). The period following brain injury represents an opportunity to influence recovery of neurological function. The study sought to determine whether children who had sustained a head injury were referred for neurorehabilitation. The study was conducted over one year at one center. Children sustaining a moderate or severe head injury were identified and compared to those referred for neurorehabilitation. A total of 41 patients were identified; 16/41 (39%) were referred for neurorehabilitation. Group comparison revealed significant associations between referral status and age (X(2)(3) = 8.35, p = 0.039), injury mechanism (X(2)(1) = 8.12, p = 0.017), injury severity (X(2)(1) = 21.3, p < 0.000), and imaging findings (X(2)(1) = 11.71, p = 0.001). Data reveal concerns for access to neurorehabilitation. Improved access to neurorehabilitation permitting long-term follow-up is required. The establishment of MTCs provides an opportunity to enact this.

  4. Pediatric "off-road vehicle" trauma: determinants of injury severity and type.

    PubMed

    Sandler, Gideon; Soundappan, Soundappan Sv; Manglick, Maria P; Fahy, Fiona E; Ross, Frank; Lam, Lawrence; Cass, Danny

    2012-12-01

    This study aimed to describe the determinants of the severity and type of injuries sustained by children hurt in off-road vehicle (ORV) accidents. This was a retrospective clinical study for which data were obtained from the trauma database at the Children's Hospital at Westmead covering the 10-year period between January 1, 1998, and December 31, 2007. Data points collected included age, sex, Injury Severity Score (ISS), body region injured, type of vehicle, accident setting, mechanism of injury, estimated speed, position of the rider, use of a helmet and/or protective clothing, and hospital length of stay. The study end points were determinants of injury severity and type. Statistical analysis of the collected data was done with the standard statistical software package, SPSS. A total of 288 children (242 male [84%] and 46 female [16%] patients) presented for ORV-related trauma. Helmets significantly diminished the chance of sustaining a head injury occasioning a skull fracture. Jumping was associated with increased ISS and a higher chance of sustaining an abdominal and/or thoracic injury. Older children were more likely to sustain pelvic and spinal injures, be injured while traveling at high speed, and be injured while going over a jump. Mean ISS was significantly lower if trauma was sustained while riding a mini motorcyle in any setting and any ORV at home. Further research (prospective, federal, and multi-institutional) is needed with a view to optimizing training schedules, rules, regulations, and licensing requirements for pediatric ORV riders.

  5. Oxidation-Reduction Potential as a Biomarker for Severity and Acute Outcome in Traumatic Brain Injury

    PubMed Central

    Levy, Stewart; Carrick, Matthew; Mains, Charles W.; Slone, Denetta S.

    2016-01-01

    There are few reliable markers for assessing traumatic brain injury (TBI). Elevated levels of oxidative stress have been observed in TBI patients. We hypothesized that oxidation-reduction potential (ORP) could be a potent biomarker in TBI. Two types of ORP were measured in patient plasma samples: the static state of oxidative stress (sORP) and capacity for induced oxidative stress (icORP). Differences in ORP values as a function of time after injury, severity, and hospital discharge were compared using ANOVAs with significance at p ≤ 0.05. Logit regression analyses were used to predict acute outcome comparing ORP, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS). Antioxidant capacity (icORP) on day 4 was prognostic for acute outcomes (p < 0.05). An odds ratio of 4.08 was associated with poor acute outcome when icORP > 7.25 μC. IcORP was a better predictor than ISS, AIS, or GCS scores. sORP increased in those with the highest ISS values (p < 0.05). Based on these findings ORP is useful biomarker for severity and acute outcome in TBI patients. Changes in ORP values on day 4 after injury were the most prognostic, suggesting that patients' response to brain injury over time is a factor that determines outcome. PMID:27642494

  6. Parallel Metabolomic Profiling of Cerebrospinal Fluid and Serum for Identifying Biomarkers of Injury Severity after Acute Human Spinal Cord Injury

    PubMed Central

    Wu, Yiman; Streijger, Femke; Wang, Yining; Lin, Guohui; Christie, Sean; Mac-Thiong, Jean-Marc; Parent, Stefan; Bailey, Christopher S.; Paquette, Scott; Boyd, Michael C.; Ailon, Tamir; Street, John; Fisher, Charles G.; Dvorak, Marcel F.; Kwon, Brian K.; Li, Liang

    2016-01-01

    Suffering an acute spinal cord injury (SCI) can result in catastrophic physical and emotional loss. Efforts to translate novel therapies in acute clinical trials are impeded by the SCI community’s singular dependence upon functional outcome measures. Therefore, a compelling rationale exists to establish neurochemical biomarkers for the objective classification of injury severity. In this study, CSF and serum samples were obtained at 3 time points (~24, 48, and 72 hours post-injury) from 30 acute SCI patients (10 AIS A, 12 AIS B, and 8 AIS C). A differential chemical isotope labeling liquid chromatography mass spectrometry (CIL LC-MS) with a universal metabolome standard (UMS) was applied to the metabolomic profiling of these samples. This method provided enhanced detection of the amine- and phenol-containing submetabolome. Metabolic pathway analysis revealed dysregulations in arginine-proline metabolism following SCI. Six CSF metabolites were identified as potential biomarkers of baseline injury severity, and good classification performance (AUC > 0.869) was achieved by using combinations of these metabolites in pair-wise comparisons of AIS A, B and C patients. Using the UMS strategy, the current data set can be expanded to a larger cohort for biomarker validation, as well as discovering biomarkers for predicting neurologic outcome. PMID:27966539

  7. Risk factors for severe intimate partner violence and violence-related injuries among women in India.

    PubMed

    Sabri, Bushra; Renner, Lynette M; Stockman, Jamila K; Mittal, Mona; Decker, Michele R

    2014-01-01

    Relying on an ecological framework, we examined risk factors for severe physical intimate partner violence (IPV) and related injuries among a nationally representative sample of women (N = 67,226) in India. Data for this cross-sectional study were derived from the 2005-2006 India National Family Health Survey, a nationally representative household-based health surveillance system. Logistic regression analyses were used to generate the study findings. We found that factors related to severe physical IPV and injuries included low or no education, low socioeconomic status, rural residence, greater number of children, and separated or divorced marital status. Husbands' problem drinking, jealousy, suspicion, control, and emotionally and sexually abusive behaviors were also related to an increased likelihood of women experiencing severe IPV and injuries. Other factors included women's exposure to domestic violence in childhood, perpetration of IPV, and adherence to social norms that accept husbands' violence. Practitioners may use these findings to identify women at high risk of being victimized by severe IPV or injuries for prevention and intervention strategies. Policies and programs that focus on empowering abused women and holding perpetrators accountable may protect women at risk for severe IPV or injuries that may result in death.

  8. Factors influencing injury severity of motor vehicle-crossing pedestrian crashes in rural Connecticut.

    PubMed

    Zajac, Sylvia S; Ivan, John N

    2003-05-01

    The ordered probit model was used to evaluate the effect of roadway and area type features on injury severity of pedestrian crashes in rural Connecticut. Injury severity was coded on the KABCO scale and crashes were limited to those in which the pedestrians were attempting to cross two-lane highways that were controlled by neither stop signs nor traffic signals. Variables that significantly influenced pedestrian injury severity were clear roadway width (the distance across the road including lane widths and shoulders, but excluding the area occupied by on-street parking), vehicle type, driver alcohol involvement, pedestrian age 65 years or older, and pedestrian alcohol involvement. Seven area types were identified: downtown, compact residential, village, downtown fringe, medium-density commercial, low-density commercial, and low-density residential. Two groups of these area types were found to experience significantly different injury severities. Downtown, compact residential, and medium- and low-density commercial areas generally experienced lower pedestrian injury severity than village, downtown fringe, and low-density residential areas.

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

    PubMed

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

    2013-03-01

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

  10. Differences in injury severities between 2-vehicle and 3-vehicle crashes.

    PubMed

    Jiang, Xinguo; Zheng, Haitao; Qiu, Yanjun; Fan, Wenbo

    2015-01-01

    In traditional injury severity-related studies, 2-vehicle and 3-vehicle crashes are typically considered in a combinatory manner and thus the injury casual factors for these 2 crash types are implicitly assumed to be the same. This article attempts to investigate the potential discrepancy between 2- and 3-vehicle crash severities with the aid of a continuation ratio logit model with the property of partial proportional odds. The modeling results show that there are a number of significant differences between 2- and 3-vehicle crash injury severities in terms of the contributing factors, the magnitude of impact, and even the direction of effects. The research illustrates that a series of environmental and crash factors (e.g., rear-end straight crashes, urban roadways, alcohol usage, and different driving cohorts) are statistically significant in interpreting the disparity of coefficients between 2- and 3-vehicle crash injury severity models. It raises awareness that the combined analysis of 2- and 3-vehicle crashes should be exercised with caution, particularly when safety research targets crashes with less severe injuries.

  11. A hybrid finite mixture model for exploring heterogeneous ordering patterns of driver injury severity.

    PubMed

    Ma, Lu; Wang, Guan; Yan, Xuedong; Weng, Jinxian

    2016-04-01

    Debates on the ordering patterns of crash injury severity are ongoing in the literature. Models without proper econometrical structures for accommodating the complex ordering patterns of injury severity could result in biased estimations and misinterpretations of factors. This study proposes a hybrid finite mixture (HFM) model aiming to capture heterogeneous ordering patterns of driver injury severity while enhancing modeling flexibility. It attempts to probabilistically partition samples into two groups in which one group represents an unordered/nominal data-generating process while the other represents an ordered data-generating process. Conceptually, the newly developed model offers flexible coefficient settings for mining additional information from crash data, and more importantly it allows the coexistence of multiple ordering patterns for the dependent variable. A thorough modeling performance comparison is conducted between the HFM model, and the multinomial logit (MNL), ordered logit (OL), finite mixture multinomial logit (FMMNL) and finite mixture ordered logit (FMOL) models. According to the empirical results, the HFM model presents a strong ability to extract information from the data, and more importantly to uncover heterogeneous ordering relationships between factors and driver injury severity. In addition, the estimated weight parameter associated with the MNL component in the HFM model is greater than the one associated with the OL component, which indicates a larger likelihood of the unordered pattern than the ordered pattern for driver injury severity.

  12. Elevated serum uric acid after injury correlates with the early acute kidney in severe burns.

    PubMed

    Liang, Juan; Zhang, Ping; Hu, Xinlei; Zhi, Lizhu

    2015-12-01

    Early acute kidney injury (AKI) is one of the most serious and common complications in the early stage of severe burns, but the pathological mechanisms still need to be elucidated. High uric acid (UA) has been found to be correlated with renal dysfunction in some experimental and clinical studies; however, the study of the dynamic correlation between AKI and UA in severe burns is still lacking. The diagnosis and classification of AKI were performed according to RIFLE criteria, UA, serum creatinine (Scr), estimated glomerular filtration rate (eGFR), C-reactive protein (CRP) and lactic acid (LA) were dynamically monitored within 2 days after injury in 59 severely burned patients. Within 2 days after injury, AKI occurred in 23 of 59 patients (risk in 12 cases, injury in seven cases and failure in four cases), UA level in AKI patients was significantly higher than that in No-AKI patients, and referring to the cutoff level of UA (375.5 μmol/l) from ROC curve for predicting AKI, the abnormal increase of UA levels was earlier than acute deterioration of renal function in most of the AKI patients after injury. Among AKI patients, the Scr/eGFR levels were closely related to UA levels for 2 days after injury. Moreover, UA level in cases with severe grade of AKI was significantly higher than that in those with less severe grade of AKI. Furthermore, there was a positive correlation between UA and CRP for 2 days after injury in AKI patients, and a significant correlation between CRP and Scr/eGFR was found 1 day after injury. The positive correlation was also found between LA and UA after injury in AKI patients. The results suggest that elevated serum UA after injury due to hypoxia is closely correlated with early AKI after severe burns, and UA-related aberrant inflammation also appears to be one of the pathogenic factors, providing the useful information for potential therapy. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  13. Injury severities of truck drivers in single- and multi-vehicle accidents on rural highways.

    PubMed

    Chen, Feng; Chen, Suren

    2011-09-01

    In adverse driving conditions, such as inclement weather and/or complex terrain, trucks are often involved in single-vehicle (SV) accidents in addition to multi-vehicle (MV) accidents. Ten-year accident data involving trucks on rural highway from the Highway Safety Information System (HSIS) is studied to investigate the difference in driver-injury severity between SV and MV accidents by using mixed logit models. Injury severity from SV and MV accidents involving trucks on rural highways is modeled separately and their respective critical risk factors such as driver, vehicle, temporal, roadway, environmental and accident characteristics are evaluated. It is found that there exists substantial difference between the impacts from a variety of variables on the driver-injury severity in MV and SV accidents. By conducting the injury severity study for MV and SV accidents involving trucks separately, some new or more comprehensive observations, which have not been covered in the existing studies can be made. Estimation findings indicate that the snow road surface and light traffic indicators will be better modeled as random parameters in SV and MV models respectively. As a result, the complex interactions of various variables and the nature of truck-driver injury are able to be disclosed in a better way. Based on the improved understanding on the injury severity of truck drivers from truck-involved accidents, it is expected that more rational and effective injury prevention strategy may be developed for truck drivers under different driving conditions in the future. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Injury pattern, hospital triage, and mortality of 1250 patients with severe traumatic brain injury caused by road traffic accidents.

    PubMed

    Leijdesdorff, Henry A; van Dijck, Jeroen T J M; Krijnen, Pieta; Vleggeert-Lankamp, Carmen L A M; Schipper, Inger B

    2014-03-01

    This epidemiological study analyzed the incidence, risk factors, hospital triage, and outcome of patients with severe traumatic brain injuries (sTBIs) caused by road traffic accidents (RTAs) admitted to hospitals in the Trauma Center West-Netherlands (TCWN) region. Trauma registry data were used to identify TBI in all RTA victims admitted to hospitals in the mid-West region of the Netherlands from 2003 to 2011. Type of head injury and severity were classified using the Abbreviated Injury Scale (AIS). Head injuries with AIS severity scores ≥ 3 were considered sTBI. Ten percent of all 12,503 hospital-admitted RTA victims sustained sTBI, ranging from 5.4% in motorcyclists, 7.4% in motorists, 9.6% in cyclists, and 12.7% in moped riders to 15.1% in pedestrians (p<0.0001). Among RTA victims admitted to hospital, sTBI was most prevalent in pedestrians (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.78-2.86) and moped riders (OR, 1.86; 95% CI, 1.51-2.30). Injury patterns differed between road user groups. Incidence of contusion ranged from 46.6% in cyclists to 74.2% in motorcyclists, whereas basilar and open-skull fractures were least common in motorcyclists (22.6%) and most common in moped riders (51.5%). Hemorrhage incidence ranged from 44.9% (motorists) to 63.6% (pedestrians). Subdural and -arachnoid bleedings were most frequent. Age, Glasgow Coma Scale, and type of hemorrhage were independent prognostic factors for in-hospital mortality after sTBI. In-hospital mortality ranged from 4.2% in moped riders to 14.1% in motorists. Pedestrians have the highest risk to sustain sTBI and, more specifically, intracranial hemorrhage. Hemorrhage and contusion both occur in over 50% of patients with sTBI. Specific brain injury patterns can be distinguished for specific road user groups, and independent prognostic risk factors for sTBI were identified. This knowledge may be used to improve vigilance for particular injuries in specific patient groups and stimulate

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

    PubMed Central

    Kuceyeski, A.; Shah, S.; Dyke, J.P.; Bickel, S.; Abdelnour, F.; Schiff, N.D.; Voss, H.U.; Raj, A.

    2016-01-01

    Following severe injuries that result in disorders of consciousness, recovery can occur over many months or years post-injury. While post-injury synaptogenesis, axonal sprouting and functional reorganization are known to occur, the network-level processes underlying recovery are poorly understood. Here, we test a network-level functional rerouting hypothesis in recovery of patients with disorders of consciousness following severe brain injury. This hypothesis states that the brain recovers from injury by restoring normal functional connections via alternate structural pathways that circumvent impaired white matter connections. The so-called network diffusion model, which relates an individual's structural and functional connectomes by assuming that functional activation diffuses along structural pathways, is used here to capture this functional rerouting. We jointly examined functional and structural connectomes extracted from MRIs of 12 healthy and 16 brain-injured subjects. Connectome properties were quantified via graph theoretic measures and network diffusion model parameters. While a few graph metrics showed groupwise differences, they did not correlate with patients' level of consciousness as measured by the Coma Recovery Scale — Revised. There was, however, a strong and significant partial Pearson's correlation (accounting for age and years post-injury) between level of consciousness and network diffusion model propagation time (r = 0.76, p < 0.05, corrected), i.e. the time functional activation spends traversing the structural network. We concluded that functional rerouting via alternate (and less efficient) pathways leads to increases in network diffusion model propagation time. Simulations of injury and recovery in healthy connectomes confirmed these results. This work establishes the feasibility for using the network diffusion model to capture network-level mechanisms in recovery of consciousness after severe brain injury. PMID:27200264

  16. Moderate-to-Severe Traumatic Brain Injury in Children: Complications and Rehabilitation Strategies

    PubMed Central

    Popernack, Myra L.; Gray, Nicola; Reuter-Rice, Karin

    2015-01-01

    Traumatic brain injury (TBI) is the leading cause of death in children in the United States. Each year 37,200 children sustain a severe TBI, with up to 1.3 million life-years potentially adversely affected. Severe pediatric TBI is associated with significant mortality and morbidity. Of the children who survive their injury, more than 50% experience unfavorable outcomes 6 months after the injury. Although TBI-associated death rates decreased between 1997–2007, disabilities for TBI survivors continue to have both a direct and indirect impact on the economic and human integrity of our society. The degree of disability varies with the severity and mechanism of the injury, but a realm of physical and emotional deficits may be evident for years after the injury occurs. This article describes the pathophysiology of moderate to severe TBI, its associated complications, and opportunities to improve patient outcomes through use of acute management and rehabilitation strategies. To address the many challenges for TBI survivors and their families, including significant financial and emotional burdens, a collaborative effort is necessary to help affected children transition seamlessly from acute care through long-term rehabilitation. PMID:25449002

  17. Risk factors for severe injury in cyclists involved in traffic crashes in Victoria, Australia.

    PubMed

    Boufous, Soufiane; de Rome, Liz; Senserrick, Teresa; Ivers, Rebecca

    2012-11-01

    This study examines the impact of cyclist, road and crash characteristics on the injury severity of cyclists involved in traffic crashes reported to the police in Victoria, Australia between 2004 and 2008. Logistic regression analysis was carried out to identify predictors of severe injury (serious injury and fatality) in cyclist crashes reported to the police. There were 6432 cyclist crashes reported to the police in Victoria between 2004 and 2008 with 2181 (33.9%) resulting in severe injury of the cyclist involved. The multivariate analysis found that factors that increase the risk of severe injury in cyclists involved in traffic crashes were age (50 years and older), not wearing a helmet, riding in the dark on unlit roads, riding on roads zoned 70 km/h or above, on curved sections of the road, in rural locations and being involved in head-on collisions as well as off path crashes, which include losing control of vehicle, and on path crashes which include striking the door of a parked vehicle. While this study did not test effectiveness of preventative measures, policy makers should consider implementation of programs that address these risk factors including helmet programs and environmental modifications such as speed reduction on roads that are frequented by cyclists.

  18. Predicting severe head injury after light motor vehicle crashes: implications for automatic crash notification systems.

    PubMed

    Talmor, Daniel; Thompson, Kimberly M; Legedza, Anna T R; Nirula, Ram

    2006-07-01

    Motor vehicle crashes (MVC) are a leading public health problem. Improving notification times and the ability to predict which crashes will involve severe injuries may improve trauma system utilization. This study was undertaken to develop and validate a model to predict severe head injury following MVC using information readily incorporated into an automatic crash notification system. A cross-sectional study with derivation and validation sets was performed. The cohort was drawn from drivers of vehicles involved in MVC obtained from the National Automotive Sampling System (NASS). Independent multivariable predictors of severe head injury were identified. The model was able to stratify drivers according to their risk of severe head injury indicating its validity. The areas under the receiver-operating characteristic (ROC) curves were 0.7928 in the derivation set and 0.7940 in the validation set. We have developed a prediction model for head injury in MVC. As the development of automatic crash notification systems improves, models such as this one will be necessary to permit triage of what would be an overwhelming increase in crash notifications to pre-hospital responders.

  19. Elderly patients with severe head injury in coma from the outset--has anything changed?

    PubMed

    Ushewokunze, S; Nannapaneni, R; Gregson, B A; Stobbart, L; Chambers, I R; Mendelow, A D

    2004-12-01

    Advancing age is known to be a determinant of outcome in head injury. We have sought to discover whether there has been any change in the outcome of elderly patients with severe head injury in Newcastle, where these patients have continued to be treated with maximum intervention. A review of prospectively collected data from the Newcastle Head Injury Database for the period 1990 to 2000 was carried out. All patients aged 70 years and above who had sustained a severe head injury (Glasgow Coma Score of 8 or less from the outset) were included. The Glasgow Outcome Score (GOS) was determined at 6 months. Seventy-one patients were identified. Fifty-seven (80%) died and 2 (3%) were in a vegetative state, 11 (16%) had severe disability, 1 (1%) had moderate disability and no patients made a good recovery. The natural history of this condition remains unchanged and due consideration should be given to this when evaluating interventions for elderly patients with a severe head injury.

  20. T-wave inversion after a severe head injury without ischemic heart disease.

    PubMed

    La Rocca, Roberto; Materia, Valeria; Pasquini, Annalisa; La Rosa, Felice Carmelo; Marte, Filippo; Patanè, Salvatore

    2011-09-01

    Electrocardiographic changes mimicking an acute coronary event with T-wave inversion have been reported in the resting electrocardiogram in patients without ischemic heart disease but with acute ischemic stroke, or subarachnoid hemorrhage, or intracerebral hemorrhage, or a severe head injury. We present a case of T-wave inversion in a 73-year-old Italian woman admitted to the Emergency Department following a severe head injury. Pericarditis, pericardial effusion, and acute coronary event were excluded. Ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage were also excluded. Also this case focuses attention on T-wave inversion after a severe head injury without ischemic heart disease. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  1. Spinal Cord Injury: How Can We Improve the Classification and Quantification of Its Severity and Prognosis?

    PubMed Central

    Krishna, Vibhor; Andrews, Hampton; Varma, Abhay; Mintzer, Jacobo

    2014-01-01

    Abstract The preservation of functional neural tissue after spinal cord injury (SCI) is the basis for spontaneous neurological recovery. Some injured patients in the acute phase have more potential for recovery than others. This fact is problematic for the construction of clinical trials because enrollment of subjects with variable recovery potential makes it difficult to detect effects, requires large sample sizes, and risks Type II errors. In addition, the current methods to assess injury and recovery are non-quantitative and not sensitive. It is likely that therapeutic combinations will be necessary to cause substantially improved function after SCI, thus we need highly sensitive techniques to evaluate changes in motor, sensory, autonomic and other functions. We review several emerging neurophysiological techniques with high sensitivity. Quantitative methods to evaluate residual tissue sparing after severe acute SCI have not entered widespread clinical use. This reduces the ability to correlate structural preservation with clinical outcome following SCI resulting in enrollment of subjects with varying patterns of tissue preservation and injury into clinical trials. We propose that the inclusion of additional measures of injury severity, pattern, and individual genetic characteristics may enable stratification in clinical trials to make the testing of therapeutic interventions more effective and efficient. New imaging techniques to assess tract injury and demyelination and methods to quantify tissue injury, inflammatory markers, and neuroglial biochemical changes may improve the evaluation of injury severity, and the correlation with neurological outcome, and measure the effects of treatment more robustly than is currently possible. The ability to test such a multimodality approach will require a high degree of collaboration between clinical and research centers and government research support. When the most informative of these assessments is determined, it may

  2. Correlation between expectations of recovery and injury severity perception in whiplash-associated disorders

    PubMed Central

    Ferrari, Robert; Louw, Deon

    2011-01-01

    Objective: To assess the correlation between expectations of recovery and whiplash patients’ perceptions of injury severity using a simplified instrument. Expectations of recovery have been shown to predict rate of recovery from whiplash injury in population-based studies. The perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse prognosis. Methods: Consecutive patients with whiplash-associated disorder grade 1 or 2, presenting in the acute stage to a primary care centre, were asked “do you think that your injury will…” with response options “get better soon; get better slowly; never get better; don’t know.” Injury severity perception (ISP) was measured with a numerical rating scale which ranged from 0–10, on which subjects were asked to rate how severe (in terms of damage) they thought their injury was. The anchors were labeled “no damage” (0) and “severe, and maybe permanent damage” (10). The primary outcome measure was the correlation between the subject’s ISP score and expectation of recovery. Results: A total of 94 subjects (34 males, 60 females, and mean age (40.6±10.0) years, range 19–60 years) were included. The initial responses to expectation of recovery were: get better soon (29/94); get better slowly (22/94); never get better (11/94); don’t know (32/94). The mean ISP score was 4.9±1.7 (range 2–9 out of 10). There was a high correlation between expectations and ISP scores (Spearman’s rank correlation coefficient 0.68). Those who expected to recover soon and those who expected to get better slowly had the lowest ISP scores. Conclusions: The more slowly whiplash patients expect to recover, or the less sure they are of recovery, the more severe their initial perceptions of injury. PMID:21796810

  3. Correlation between expectations of recovery and injury severity perception in whiplash-associated disorders.

    PubMed

    Ferrari, Robert; Louw, Deon

    2011-08-01

    To assess the correlation between expectations of recovery and whiplash patients' perceptions of injury severity using a simplified instrument. Expectations of recovery have been shown to predict rate of recovery from whiplash injury in population-based studies. The perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse prognosis. Consecutive patients with whiplash-associated disorder grade 1 or 2, presenting in the acute stage to a primary care centre, were asked "do you think that your injury will…" with response options "get better soon; get better slowly; never get better; don't know." Injury severity perception (ISP) was measured with a numerical rating scale which ranged from 0-10, on which subjects were asked to rate how severe (in terms of damage) they thought their injury was. The anchors were labeled "no damage" (0) and "severe, and maybe permanent damage" (10). The primary outcome measure was the correlation between the subject's ISP score and expectation of recovery. A total of 94 subjects (34 males, 60 females, and mean age (40.6 ± 10.0) years, range 19-60 years) were included. The initial responses to expectation of recovery were: get better soon (29/94); get better slowly (22/94); never get better (11/94); don't know (32/94). The mean ISP score was 4.9 ± 1.7 (range 2-9 out of 10). There was a high correlation between expectations and ISP scores (Spearman's rank correlation coefficient 0.68). Those who expected to recover soon and those who expected to get better slowly had the lowest ISP scores. The more slowly whiplash patients expect to recover, or the less sure they are of recovery, the more severe their initial perceptions of injury.

  4. The Effect of Hemoglobin Levels on Mortality in Pediatric Patients with Severe Traumatic Brain Injury.

    PubMed

    Yee, Kevin F; Walker, Andrew M; Gilfoyle, Elaine

    2016-01-01

    Objective. There is increasing evidence of adverse outcomes associated with blood transfusions for adult traumatic brain injury patients. However, current evidence suggests that pediatric traumatic brain injury patients may respond to blood transfusions differently on a vascular level. This study examined the influence of blood transfusions and anemia on the outcome of pediatric traumatic brain injury patients. Design. A retrospective cohort analysis of severe pediatric traumatic brain injury (TBI) patients was undertaken to investigate the association between blood transfusions and anemia on patient outcomes. Measurements and Main Results. One hundred and twenty patients with severe traumatic brain injury were identified and included in the analysis. The median Glasgow Coma Scale (GCS) was 6 and the mean hemoglobin (Hgb) on admission was 115.8 g/L. Forty-three percent of patients (43%) received at least one blood transfusion and the mean hemoglobin before transfusion was 80.1 g/L. Multivariable regression analysis revealed that anemia and the administration of packed red blood cells were not associated with adverse outcomes. Factors that were significantly associated with mortality were presence of abusive head trauma, increasing PRISM score, and low GCS after admission. Conclusion. In this single centre retrospective cohort study, there was no association found between anemia, blood transfusions, and hospital mortality in a pediatric traumatic brain injury patient population.

  5. Differential Activation of Infiltrating Monocyte-Derived Cells After Mild and Severe Traumatic Brain Injury.

    PubMed

    Trahanas, Diane M; Cuda, Carla M; Perlman, Harris; Schwulst, Steven J

    2015-03-01

    Microglia are the resident innate immune cells of the brain. Although embryologically and functionally distinct, they are morphologically similar to peripheral monocyte-derived cells, resulting in a poor ability to discriminate between the two cell types. The purpose of this study was to develop a rapid and reliable method to simultaneously characterize, quantify, and discriminate between whole populations of myeloid cells from the brain in a murine model of traumatic brain injury. Male C57BL/6 mice underwent traumatic brain injury (n = 16) or sham injury (n = 14). Brains were harvested at 24 h after injury. Multiparameter flow cytometry and sequential gating analysis were performed, allowing for discrimination between microglia and infiltrating leukocytes as well as for the characterization and quantification of individual subtypes within the infiltrating population. The proportion of infiltrating leukocytes within the brain increased with the severity of injury, and the predominant cell types within the infiltrating population were monocyte derived (P = 0.01). In addition, the severity of injury altered the overall makeup of the infiltrating monocyte-derived cells. In conclusion, we describe a flow cytometry-based technique for gross discrimination between infiltrating leukocytes and microglia as well as the ability to simultaneously characterize and quantify individual myeloid subtypes and their maturation states within these populations.

  6. Underreporting in traffic accident data, bias in parameters and the structure of injury severity models.

    PubMed

    Yamamoto, Toshiyuki; Hashiji, Junpei; Shankar, Venkataraman N

    2008-07-01

    Injury severities in traffic accidents are usually recorded on ordinal scales, and statistical models have been applied to investigate the effects of driver factors, vehicle characteristics, road geometrics and environmental conditions on injury severity. The unknown parameters in the models are in general estimated assuming random sampling from the population. Traffic accident data however suffer from underreporting effects, especially for lower injury severities. As a result, traffic accident data can be regarded as outcome-based samples with unknown population shares of the injury severities. An outcome-based sample is overrepresented by accidents of higher severities. As a result, outcome-based samples result in biased parameters which skew our inferences on the effect of key safety variables such as safety belt usage. The pseudo-likelihood function for the case with unknown population shares, which is the same as the conditional maximum likelihood for the case with known population shares, is applied in this study to examine the effects of severity underreporting on the parameter estimates. Sequential binary probit models and ordered-response probit models of injury severity are developed and compared in this study. Sequential binary probit models assume that the factors determining the severity change according to the level of the severity itself, while ordered-response probit models assume that the same factors correlate across all levels of severity. Estimation results suggest that the sequential binary probit models outperform the ordered-response probit models, and that the coefficient estimates for lap and shoulder belt use are biased if underreporting is not considered. Mean parameter bias due to underreporting can be significant. The findings show that underreporting on the outcome dimension may induce bias in inferences on a variety of factors. In particular, if underreporting is not accounted for, the marginal impacts of a variety of factors appear

  7. Analysis of injury severity and vehicle occupancy in truck- and non-truck-involved accidents.

    PubMed

    Chang, L Y; Mannering, F

    1999-09-01

    The impact that large trucks have on accident severity has long been a concern in the accident analysis literature. One important measure of accident severity is the most severely injured occupant in the vehicle. Such data are routinely collected in state accident data files in the U.S. Among the many risk factors that determine the most severe level of injury sustained by vehicle occupants, the number of occupants in the vehicle is an important factor. These effects can be significant because vehicles with higher occupancies have an increased likelihood of having someone seriously injured. This paper studies the occupancy/injury severity relationship using Washington State accident data. The effects of large trucks, which are shown to have a significant impact on the most severely injured vehicle occupant, are accounted for by separately estimating nested logit models for truck-involved accidents and for non-truck-involved accidents. The estimation results uncover important relationships between various risk factors and occupant injury. In addition, by comparing the accident characteristics between truck-involved accidents and non-truck-involved accidents, the risk factors unique to large trucks are identified along with the relative importance of such factors. The findings of this study demonstrate that nested logit modeling, which is able to take into account vehicle occupancy effects and identify a broad range of factors that influence occupant injury, is a promising methodological approach.

  8. ATV (quad bike) injuries in New Zealand children: their extent and severity.

    PubMed

    Anson, Kate; Segedin, Elizabeth; Jones, Peter

    2009-09-11

    Primary: To ascertain how many New Zealand (NZ) children are being injured or killed as the result of all-terrain vehicle (ATV) injuries and to define the nature and severity of their injuries. Secondary: to examine the effect of age, weight, helmet use, and ATV size on injury severity and to compare the demographics of injury in NZ to other countries. A retrospective review was undertaken of 643 cases of children less than 16 years old hospitalised between 2000-2006 due to possible ATV-related injury. New Zealand Health Information Statistics (NZHIS) identified the cases through discharge information, supplemented by a search of Auckland's Paediatric Intensive Care trauma database. Only confirmed ATV injuries were included. Records were unavailable for 150 cases (26%). There were 218 confirmed cases of ATV injury. Mechanisms of injury were: a fall from the ATV, 105 cases (48%), a collision, 59 cases (31%), rolling 31 cases (14%). Mean age was 9.9 years (SD 3.9) with 133 (61%) under 12 years, and 32 (15%) 5 years and under. The child was the driver in 116 cases (53%) and the passenger in 61 cases (28%). Male to female ratio was 2:1. Mean injury severity score was 7.9 (SD 5.2). Median (IQR) length of stay was 2 days (1-4). Helmet use not stated in 62%, with only 30 cases (14%) identified as wearing helmets. The majority of injuries were orthopaedic, soft tissue injuries and head injuries. Multiple injuries occurred in 74 cases (34%). One hundred and eleven children (51%) required a general anaesthetic. Seventeen (7.8%) children required admission to intensive care. Six (2.8%) children were left with a permanent disability. Sixteen children died. There was no correlation between ISS and age or weight (Rho=-0.089, p=0.08 and Rho=0.49, p=0.79 respectively). The observed differences in ISS between helmet users and non-users, ATV drivers and passengers and size of ATV were not statistically significant. There was a trend towards reduced risk of head injury with helmet

  9. Functional neuroimaging after severe anoxic brain injury in children may reveal preserved, yet covert, cognitive function.

    PubMed

    Owen, Adrian M

    2017-10-01

    A growing body of evidence has confirmed that, after severe brain injury in adults, motoric and task-dependent factors that are essential for reliable communication, frequently interfere with an accurate assessment of cognitive status. In the current study, resting state functional magnetic resonance imaging (fMRI) in children who have sustained an anoxic brain injury following a near drowning incident suggests a similar pattern; preserved cognition amidst severe motoric impairment that effectively precludes accurate clinical diagnosis at the bedside. Hum Brain Mapp 38:4832-4833, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  10. [High-pressure injection injury of the hand. Underestimation of injury severity].

    PubMed

    Beirer, M; Deiler, S; Neu, J

    2015-01-01

    A 44-year-old man sustained a high-pressure injection injury of the left index finger with hot hydraulic oil in an occupational accident. On presentation to the occupational physician 4 h later the wound was irrigated and cleaned. At this time X-ray diagnostics, wound revision, administration of antibiotics and immobilization were not performed. The following day the patient presented to a hospital with painful swelling and reddening of the left index finger where an emergency surgical wound revision, administration of antibiotics and immobilization of the finger were performed due to a phlegmon of the flexor tendon. Despite subsequent revision operations, necrosis of the flexor tendon sheath occurred with a skin subcutis defect necessitating a full thickness skin transplantation and ultimately operative fusion of the distal interphalangeal joint of the index finger. After a total period of treatment of 9 months the patient still presented with local soft tissue swelling and paresthesia as well as a limited range of motion of the proximal interphalangeal joint. The patient filed a complaint for wrong treatment of the high-pressure injection injury in terms of an inaccurate examination and lack of administration of antibiotics at the first presentation. The expert opinion of the arbitration board ascertained medical malpractice at the first presentation. An emergency surgical wound revision had already been indicated at the first presentation and the revision procedures would have been less extensive and it was highly probability that surgical fusion of the distal interphalangeal joint could have been avoided. The arbitration furthermore concluded that iatrogenic maltreatment led to a phlegmon of the flexor tendon with the need for subsequent revision operations including surgical fusion of the distal interphalangeal joint which resulted in an affected grip control. The delay in surgical treatment must be considered as the reason for the much worse initial situation

  11. Cervical Injury Risk Resulting From Rotary Wing Impact: Assessment of Injury Based Upon Aviator Size, Helmet Mass Properties and Impact Severity

    DTIC Science & Technology

    2004-10-21

    NAWCADPAX/TR-2004/86 CERVICAL INJURY RISK RESULTING FROM ROTARY WING IMPACT: ASSESSMENT OF INJURY BASED UPON AVIATOR SIZE, HELMET MASS...DEPARTMENT OF THE NAVY NAVAL AIR WARFARE CENTER AIRCRAFT DIVISION PATUXENT RIVER, MARYLAND NAWCADPAX/TR-2004/86 21 October 2004 CERVICAL ... Cervical Injury Risk Resulting From Rotary Wing Impact: Assessment of Injury Based Upon Aviator Size, Helmet Mass Properties and Impact Severity 5b

  12. Analyzing pedestrian crash injury severity at signalized and non-signalized locations.

    PubMed

    Haleem, Kirolos; Alluri, Priyanka; Gan, Albert

    2015-08-01

    This study identifies and compares the significant factors affecting pedestrian crash injury severity at signalized and unsignalized intersections. The factors explored include geometric predictors (e.g., presence and type of crosswalk and presence of pedestrian refuge area), traffic predictors (e.g., annual average daily traffic (AADT), speed limit, and percentage of trucks), road user variables (e.g., pedestrian age and pedestrian maneuver before crash), environmental predictors (e.g., weather and lighting conditions), and vehicle-related predictors (e.g., vehicle type). The analysis was conducted using the mixed logit model, which allows the parameter estimates to randomly vary across the observations. The study used three years of pedestrian crash data from Florida. Police reports were reviewed in detail to have a better understanding of how each pedestrian crash occurred. Additionally, information that is unavailable in the crash records, such as at-fault road user and pedestrian maneuver, was collected. At signalized intersections, higher AADT, speed limit, and percentage of trucks; very old pedestrians; at-fault pedestrians; rainy weather; and dark lighting condition were associated with higher pedestrian severity risk. For example, a one-percent higher truck percentage increases the probability of severe injuries by 1.37%. A one-mile-per-hour higher speed limit increases the probability of severe injuries by 1.22%. At unsignalized intersections, pedestrian walking along roadway, middle and very old pedestrians, at-fault pedestrians, vans, dark lighting condition, and higher speed limit were associated with higher pedestrian severity risk. On the other hand, standard crosswalks were associated with 1.36% reduction in pedestrian severe injuries. Several countermeasures to reduce pedestrian injury severity are recommended. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Undirected compensatory plasticity contributes to neuronal dysfunction after severe spinal cord injury.

    PubMed

    Beauparlant, Janine; van den Brand, Rubia; Barraud, Quentin; Friedli, Lucia; Musienko, Pavel; Dietz, Volker; Courtine, Grégoire

    2013-11-01

    Severe spinal cord injury in humans leads to a progressive neuronal dysfunction in the chronic stage of the injury. This dysfunction is characterized by premature exhaustion of muscle activity during assisted locomotion, which is associated with the emergence of abnormal reflex responses. Here, we hypothesize that undirected compensatory plasticity within neural systems caudal to a severe spinal cord injury contributes to the development of neuronal dysfunction in the chronic stage of the injury. We evaluated alterations in functional, electrophysiological and neuromorphological properties of lumbosacral circuitries in adult rats with a staggered thoracic hemisection injury. In the chronic stage of the injury, rats exhibited significant neuronal dysfunction, which was characterized by co-activation of antagonistic muscles, exhaustion of locomotor muscle activity, and deterioration of electrochemically-enabled gait patterns. As observed in humans, neuronal dysfunction was associated with the emergence of abnormal, long-latency reflex responses in leg muscles. Analyses of circuit, fibre and synapse density in segments caudal to the spinal cord injury revealed an extensive, lamina-specific remodelling of neuronal networks in response to the interruption of supraspinal input. These plastic changes restored a near-normal level of synaptic input within denervated spinal segments in the chronic stage of injury. Syndromic analysis uncovered significant correlations between the development of neuronal dysfunction, emergence of abnormal reflexes, and anatomical remodelling of lumbosacral circuitries. Together, these results suggest that spinal neurons deprived of supraspinal input strive to re-establish their synaptic environment. However, this undirected compensatory plasticity forms aberrant neuronal circuits, which may engage inappropriate combinations of sensorimotor networks during gait execution.

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

    PubMed

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

    2015-06-01

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

  15. Characteristics of maxillofacial injuries and safety of in-theater facial fracture repair in severe combat trauma.

    PubMed

    Keller, Matthew W; Han, Peggy P; Galarneau, Michael R; Gaball, Curtis W

    2015-03-01

    The study objectives were to characterize maxillofacial injuries and assess the safety of in-theater facial fracture repair in U.S. military personnel with severe combat trauma from Iraq and Afghanistan. We performed a retrospective chart review of the Expeditionary Medical Encounter Database from 2004 to 2010. 1,345 military personnel with combat-related maxillofacial injuries were identified. Injury severity was quantified with the Abbreviated Injury Scale and Injury Severity Score. Service members with maxillofacial injury and severe combat trauma (Injury Severity Score ≥ 16) were included. The distribution of facial fractures, types, and outcomes of surgical repairs, incidence of traumatic brain injury, concomitant head and neck injuries, burn rate/severity, and rates of Acinetobacter baumannii colonization and surgical site infection were analyzed. The prevalence of maxillofacial injury in the Expeditionary Medical Encounter Database was 22.7%. The most common mechanism of injury was improvised explosive device (65.7%). Midface trauma and facial burns were common. Approximately 64% of the study sample sustained traumatic brain injury. Overall, 45.6% (109/239) had at least one facial bone fracture. Of those with facial fractures, 64.2% (n = 70) underwent surgical repair. None of the service members who underwent in-theater facial fracture repair developed A. baumannii facial wound infection or implant extrusion. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  16. The impact of child restraint legislation on the incidence of severe paediatric injury in Chile.

    PubMed

    Nazif-Muñoz, J Ignacio; Gariépy, Geneviève; Falconer, James; Gong, Annie; Macpherson, Alison

    2017-10-01

    The objective of this study is to determine the association between Chile's 2005 child restraint legislation (CRL) and the incidence of severe paediatric motor vehicle-related injury. We analysed motor vehicle injury data from Chile's Road Safety Commission from 2000 to 2012 to determine the association between Chile's 2005 CRL and severe paediatric injury. Using Poisson time-series models we assessed the effect of the law on two outcome variables: (1) severely injured children per vehicle fleet; and (2) severely injured children per population. Chile's 2005 CRL is significantly associated with a 24% reduction in severely injured children per vehicle, and 19% reduction in severely injured children per population in the 1st year of its enactment. In 2007 this law is also significantly associated with a 17% decrease in severely injured children per vehicle, and with an 11% decrease in severely injured children per population. However, this legislation had a short-term effect since no reductions in severely injured children per vehicle were observed after 2009 and no reductions for severely injured children per population were registered after 2008. This is the first study to examine the association between CRL and severe paediatric injury in a Latin-American country. This study suggests that Chile's CRL was only effective in the short term. To support this type of reforms in the long term, other measures such as police enforcement, public information campaigns and involvement of public health professionals in educating parents about the benefits of using child restraints should be considered. 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/.

  17. Hospital Qualities Related to Return to Work from Occupational Injury after Controlling for Injury Severity as Well as Occupational Characteristics.

    PubMed

    Won, Jong-Uk; Seok, Hongdeok; Rhie, Jeongbae; Yoon, Jin-Ha

    2016-05-01

    We examined associations between hospital quality in the workers' compensation system and injured patients' return to work after controlling for injury severity, occupational factors, and demographic factors. Return to work data of injured workers were constructed from 2 datasets: 23,392 patients injured in 2009-2011 from the Korea Workers' Compensation & Welfare Service and return to work data from Korea Employment Information Services. After de-identifying the data, quality scores were matched for each hospital that cared for injured patients. Injury severity was measured by Abbreviated Injury Scales. Relative risk and 95% confidence interval were calculated using log binomial regression models. After adjusting for age, sex, injury severity, occupation, factory size, city, and hospital type, the relative risk (95% confidence interval) for the total score was 1.04 (1.02-1.06), 1.06 (1.04-1.09), and 1.07 (1.05-1.10) in the 2(nd), 3(rd), and 4(th) quartiles, respectively, compared to the 1(st) quartile. The RR (95% CI) in the 2(nd), 3(rd), and 4(th) quartiles was 1.05 (1.02-1.07), 1.05 (1.02-1.08), and 1.06 (1.04-1.09) for the process score; and 1.02 (1.01-1.04), 1.05 (1.03-1.07), and 1.06 (1.04-1.09) for the outcome score compared to the 1(st) quartile score, respectively. In conclusion, our study design with blinded merge methods shows that total, process, and outcome qualities are related to the return to work of injured workers after controlling for other factors.

  18. "Oh the weather outside is frightful": Severe injury secondary to falls while installing residential Christmas lights.

    PubMed

    Driedger, Michael R; Gupta, Arjun; Wells, Bryan; Dixon, Elijah; Ball, Chad G

    2016-01-01

    Falls are an increasingly common source of severe traumatic injury. They now account for approximately 40% of both overall trauma volumes and injury-related deaths within Canada. In northern climates, the risk of all types of falls may increase during the fall/winter months when conditions become increasingly dangerous. The purpose of this study was to define the injury and patient demographics of severe trauma that occurs during falls associated with the installation of Christmas lights. All patients who were admitted to a referral level 1 trauma center (2002-2012) with severe injuries (ISS≥12) caused during Christmas light installation were retrospectively reviewed. Standard statistical methodology was utilised (p<0.05=significant). A total of 40 patients were severely injured (95% male; mean age=55 years; mean ISS=25.7 (range: 12-75)) while installing Christmas lights. Injuries included: neurologic (68%), thoracic (68%), spinal (43%), extremity (40%), and multiple other sites. Fall mechanisms were: ladder (65%), roof (30%), ground (3%) and railing (3%). Interventions included intubation and critical care (20%), as well as orthopaedic and neurosurgical operative repairs (30%). The median length of hospital stay was 15.6 days (range: 2-165). The fall-related morbidity (28%) and mortality (5%) were significant with a total of 12.5% patients requiring transfer to a long-term care or rehabilitation facility. Falls while installing Christmas lights during the fall/winter seasons can result in severe life-altering injuries with considerable morbidity and mortality. Caution should be employed when installing lights at any height. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Family burden after severe brain injury: the Italian experience with families and volunteer associations.

    PubMed

    Mosconi, Paola; Taricco, Mariangela; Bergamini, Mirna; Bosisio Fazzi, Luisella; Colombo, Cinzia; Patrucco, Valentina; Corti, Marinella; Giobbe, Dario; Guerreschi, Massimo; Magnarella, Maria Rita; Sallemi, Giovanni

    2011-01-01

    As part of the development of the Italian National Consensus Conference investigating the period from the hospital rehabilitation of patients with severe brain injury to their return to the community, a working group was appointed to identify the needs of brain injury patients and their families in Italy. Two postal self-administered survey questionnaires were carried out: one targeted families of patients with severe brain injury to evaluate their objective and subjective burdens and needs; the other focused on the viewpoints of volunteer associations helping people with severe brain injury. Issues explored were quality of discharge from hospital (information received, family participation, etc.), needs of the family (work, financial resources, spare time, relationships with friends and other relatives), and the viewpoint of volunteer associations. A total of 234 families (54% of sample) of patients (69% male, mean age 41 years) with severe brain injury returned the questionnaire. Most said they had been involved and informed in the hospital discharge process; about 17% had not been involved at all and only about one-third of families received satisfactory support during the discharge phase. Few families received any help from community social services (10%). Almost two-thirds of families had experienced financial difficulties and, in many cases, one family member had to change his/her work situation. Families' social relationships, travelling, hobbies, and spare time were significantly reduced. The 57 volunteer associations who returned the survey (84% response rate) confirmed that their members had experienced the same difficulties. Considering the difficulties and problems documented by these two surveys, more research is needed on effective interventions to support patients with severe brain injury and their families, particularly during the discharge phase from hospital to home and community life.

  20. Severe burn injury in europe: a systematic review of the incidence, etiology, morbidity, and mortality

    PubMed Central

    2010-01-01

    Introduction Burn injury is a serious pathology, potentially leading to severe morbidity and significant mortality, but it also has a considerable health-economic impact. The aim of this study was to describe the European hospitalized population with severe burn injury, including the incidence, etiology, risk factors, mortality, and causes of death. Methods The systematic literature search (1985 to 2009) involved PubMed, the Web of Science, and the search engine Google. The reference lists and the Science Citation Index were used for hand searching (snowballing). Only studies dealing with epidemiologic issues (for example, incidence and outcome) as their major topic, on hospitalized populations with severe burn injury (in secondary and tertiary care) in Europe were included. Language restrictions were set on English, French, and Dutch. Results The search led to 76 eligible studies, including more than 186,500 patients in total. The annual incidence of severe burns was 0.2 to 2.9/10,000 inhabitants with a decreasing trend in time. Almost 50% of patients were younger than 16 years, and ~60% were male patients. Flames, scalds, and contact burns were the most prevalent causes in the total population, but in children, scalds clearly dominated. Mortality was usually between 1.4% and 18% and is decreasing in time. Major risk factors for death were older age and a higher total percentage of burned surface area, as well as chronic diseases. (Multi) organ failure and sepsis were the most frequently reported causes of death. The main causes of early death (<48 hours) were burn shock and inhalation injury. Conclusions Despite the lack of a large-scale European registration of burn injury, more epidemiologic information is available about the hospitalized population with severe burn injury than is generally presumed. National and international registration systems nevertheless remain necessary to allow better targeting of prevention campaigns and further improvement of cost

  1. The impact of severe burn injury on skeletal muscle mitochondrial function

    PubMed Central

    Porter, Craig; Herndon, David N; Sidossis, Labros S; Borsheim, Elisabet

    2013-01-01

    Severe burn injury induces a pathophysiological response that affects almost every physiological system within the body. Inflammation, hypermetabolism, muscle wasting, and insulin resistance are all hallmarks of the pathophysiological response to burn injury, with perturbations in metabolism known to persist for several years post injury. Skeletal muscle is the main depot of lean tissue within the body and as the primary site of peripheral glucose disposal, plays an important role in metabolic regulation. Following a large burn, skeletal muscle functions as and endogenous amino acid store, providing substrates for more pressing functions post burn, such as the synthesis of acute phase proteins and the deposition of new skin. Subsequently, burn patients become cachexic, which is associated with poor outcomes in terms of metabolic health and functional capacity. While a loss of skeletal muscle contractile proteins per se will no doubt negatively impact functional capacity, detriments in skeletal muscle quality, i.e. a loss in mitochondrial number and/or function may be quantitatively just as important. The goal of this review article is to summarize the current understanding of the impact of burn injury on skeletal muscle mitochondrial content and function, to offer direction for future research concerning skeletal muscle mitochondrial function in patients with severe burns, and to renew interest in the role of these organelles in metabolic dysfunction following burn injury. PMID:23664225

  2. Effects of mild, moderate and severe closed head injury on long-term vocational status.

    PubMed

    Stambrook, M; Moore, A D; Peters, L C; Deviaene, C; Hawryluk, G A

    1990-01-01

    Survival from significant closed head injury (CHI) is frequently associated with cognitive defects, physical impairment, personality change, interpersonal difficulty and, in general, some degree of social dependence. Here we report a multidimensional assessment of quality of life of a sample of 131 male head-injury patients suffering a range of severities of insult with specific emphasis on vocational outcome. Of those patients who sustained a severe injury and were employed full-time prior to the CHI, only 55% were able to return to this level of employment. No differences were found between the moderate and severe groups in pre- or post-CHI occupational status, as measured by the Blishen (1967) quantitative social economic index, although both groups declined from pre- to post-CHI. Lower post-CHI occupational status was associated with lower GCS on admission and longer lengths of post-traumatic amnesia, with patient self-report of physical, cognitive and psychosocial difficulties, including spousal reports of confusion, belligerance, verbal expansiveness and the decreased ability to perform socially-expected activities. Stepwise multiple regression analysis accounted for 38% of variance in post-injury vocational status, with lower pre-injury vocational status, greater age, high physical and psychological difficulties and lower admission Glasgow Coma Scale score variables forming the regression equation. Implications are discussed in terms of rehabilitation issues, including vocational programming and planning.

  3. Interdisciplinary management of severe intrusion injuries in permanent incisors: a case series.

    PubMed

    Nazzal, H; Dhaliwal, H K; Littlewood, S J; Spencer, R J; Day, P F

    2014-11-01

    Intrusion injuries to the permanent dentition are amoung the most severe types of dental injuries, occurring in 0.3-1.9% of all dental trauma cases. The current clinical guidelines in the management of intrusion injuries are based on level B evidence due to the infrequent nature of this type of injury, coupled with a lack of high quality evidence-based studies. This paper presents four cases of severe intrusion injuries that were successfully managed using an interdisciplinary approach. The cases described here highlight the benefits of orthodontic repositioning of severely intruded teeth in the short and medium terms. Although orthodontic repositioning was unsuccessful in the final case, this did not preclude subsequent surgical repositioning. Interdisciplinary collaboration allowed two of the cases described to be effectively managed with premolar autotransplantation alongside orthodontic treatment. The cases demonstrated here indicate the difficulties in providing the current recommended treatment modalities at non-specialist clinics. They accentuate the importance of an immediate referral of such complex cases to a specialist centre where interdisciplinary management is readily available.

  4. Investigating driver injury severity patterns in rollover crashes using support vector machine models.

    PubMed

    Chen, Cong; Zhang, Guohui; Qian, Zhen; Tarefder, Rafiqul A; Tian, Zong

    2016-05-01

    Rollover crash is one of the major types of traffic crashes that induce fatal injuries. It is important to investigate the factors that affect rollover crashes and their influence on driver injury severity outcomes. This study employs support vector machine (SVM) models to investigate driver injury severity patterns in rollover crashes based on two-year crash data gathered in New Mexico. The impacts of various explanatory variables are examined in terms of crash and environmental information, vehicle features, and driver demographics and behavior characteristics. A classification and regression tree (CART) model is utilized to identify significant variables and SVM models with polynomial and Gaussian radius basis function (RBF) kernels are used for model performance evaluation. It is shown that the SVM models produce reasonable prediction performance and the polynomial kernel outperforms the Gaussian RBF kernel. Variable impact analysis reveals that factors including comfortable driving environment conditions, driver alcohol or drug involvement, seatbelt use, number of travel lanes, driver demographic features, maximum vehicle damages in crashes, crash time, and crash location are significantly associated with driver incapacitating injuries and fatalities. These findings provide insights for better understanding rollover crash causes and the impacts of various explanatory factors on driver injury severity patterns. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Melatonin prevents acute kidney injury in severely burned rats via the activation of SIRT1

    PubMed Central

    Bai, Xiao-Zhi; He, Ting; Gao, Jian-Xin; Liu, Yang; Liu, Jia-Qi; Han, Shi-Chao; Li, Yan; Shi, Ji-Hong; Han, Jun-Tao; Tao, Ke; Xie, Song-Tao; Wang, Hong-Tao; Hu, Da-Hai

    2016-01-01

    Acute kidney injury (AKI) is a common complication after severe burns. Melatonin has been reported to protect against multiple organ injuries by increasing the expression of SIRT1, a silent information regulator that regulates stress responses, inflammation, cellular senescence and apoptosis. This study aimed to investigate the protective effects of melatonin on renal tissues of burned rats and the role of SIRT1 involving the effects. Rat severely burned model was established, with or without the administration of melatonin and SIRT1 inhibitor. The renal function and histological manifestations were determined to evaluate the severity of kidney injury. The levels of acetylated-p53 (Ac-p53), acetylated-p65 (Ac-p65), NF-κB, acetylated-forkhead box O1 (Ac-FoxO1), Bcl-2 and Bax were analyzed to study the underlying mechanisms. Our results suggested that severe burns could induce acute kidney injury, which could be partially reversed by melatonin. Melatonin attenuated oxidative stress, inflammation and apoptosis accompanied by the increased expression of SIRT1. The protective effects of melatonin were abrogated by the inhibition of SIRT1. In conclusion, we demonstrate that melatonin improves severe burn-induced AKI via the activation of SIRT1 signaling. PMID:27599451

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

    PubMed

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

    2017-07-10

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

  7. A multivariate random-parameters Tobit model for analyzing highway crash rates by injury severity.

    PubMed

    Zeng, Qiang; Wen, Huiying; Huang, Helai; Pei, Xin; Wong, S C

    2017-02-01

    In this study, a multivariate random-parameters Tobit model is proposed for the analysis of crash rates by injury severity. In the model, both correlation across injury severity and unobserved heterogeneity across road-segment observations are accommodated. The proposed model is compared with a multivariate (fixed-parameters) Tobit model in the Bayesian context, by using a crash dataset collected from the Traffic Information System of Hong Kong. The dataset contains crash, road geometric and traffic information on 224 directional road segments for a five-year period (2002-2006). The multivariate random-parameters Tobit model provides a much better fit than its fixed-parameters counterpart, according to the deviance information criteria and Bayesian R(2), while it reveals a higher correlation between crash rates at different severity levels. The parameter estimates show that a few risk factors (bus stop, lane changing opportunity and lane width) have heterogeneous effects on crash-injury-severity rates. For the other factors, the variances of their random parameters are insignificant at the 95% credibility level, then the random parameters are set to be fixed across observations. Nevertheless, most of these fixed coefficients are estimated with higher precisions (i.e., smaller variances) in the random-parameters model. Thus, the random-parameters Tobit model, which provides a more comprehensive understanding of the factors' effects on crash rates by injury severity, is superior to the multivariate Tobit model and should be considered a good alternative for traffic safety analysis.

  8. Rehabilitation pathways and functional independence one year after severe traumatic brain injury.

    PubMed

    Sveen, Unni; Røe, Cecilie; Sigurdardottir, Solrun; Skandsen, Toril; Andelic, Nada; Manskow, Unn; Berntsen, Svein A; Soberg, Helene L; Anke, Audny

    2016-10-01

    After severe traumatic brain injury (TBI) it is recommended that patients in need of rehabilitation be transferred directly from acute care to specialized rehabilitation. However, recent European cohort studies found a variety of care pathways and delays in admission to rehabilitation after severe TBI. To study the pathways within rehabilitation services in a Norwegian national cohort with severe TBI and the association to functional independence 12 months post-injury. Observational prospective multicenter study. Regional trauma centers. A total of 163 adults, age 16-85 years, with severe TBI. The main variables were transfer between acute care and rehabilitation, type of rehabilitation services and functional independence. 75% of the patients had specialized TBI rehabilitation, 11% non-specialized and 14% no in-patient rehabilitation. In total, 48% were transferred directly to specialized rehabilitation from acute units in regional trauma centers. There were no differences in injury severity between patients transferred directly and non-directly, but the direct-transfer patients were younger. At 12 months post-injury, 71% were functionally independent and 90% lived in their home. Younger age, fewer days of ventilation and shorter post-traumatic amnesia were associated with independence. Among patients treated with specialized rehabilitation, direct transfer to rehabilitation was associated with functional independence (OR=4.3, P<0.01). A direct clinical pathway including specialized rehabilitation in dedicated units was associated with functional independence. Direct pathways from acute care to sub-acute specialized rehabilitation might prove beneficial to functional status.

  9. Investigating the influence of curbs on single-vehicle crash injury severity utilizing zero-inflated ordered probit models.

    PubMed

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

    2013-08-01

    The severity of traffic-related injuries has been studied by many researchers in recent decades. However, previous research has seldom accounted for the effects of curbed outside shoulders on traffic-related injury severity. This study applies the zero-inflated ordered probit (ZIOP) model to evaluate the influences of curbed outside shoulders, speed limit change, as well as other traditional factors on the injury severity of single-vehicle crashes. Crash data from 2003 to 2007 in the Illinois Highway Safety Database were employed in this study. The ZIOP model assumes that injury severity comes from two distinct sources: injury propensity and injury severity when this crash falls into the injury prone category. The modeling results show that on one hand, single-vehicle crashes that occurring on roadways with curbed outside shoulders are more likely to be injury prone. On the other hand, the existence of a curb decreases the likelihood of severe injury if the crash was in the injury prone category. As a result, the marginal effect analysis implies that the presence of curbs is associated with a higher likelihood of no injury and minor injury involved crashes, but a lower likelihood of incapacitating injury and fatality involved crashes. In addition, in the presence of curbed outside shoulders, the change of speed limit adds no significant impact to the injury severity of single-vehicle crashes. Moreover, the modeling results also highlight some interesting effects caused by vehicle type, light and weather conditions, and drivers' characteristics, as well as crash type and location. Through a comprehensive evaluation of the modeling results, the authors find that the ZIOP model performs well relative to the traditional ordered probit (OP) model, and can serve as an alternative in future studies of crash injury severity. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2016-03-01

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

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

    PubMed

    Zhu, Xiaoyu; Srinivasan, Sivaramakrishnan

    2011-01-01

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

  12. Severe burn injury, burn shock, and smoke inhalation injury in small animals. Part 2: diagnosis, therapy, complications, and prognosis.

    PubMed

    Vaughn, Lindsay; Beckel, Nicole; Walters, Patricia

    2012-04-01

    To review the evaluation and treatment of patients suffering from severe burn injury (SBI), burn shock, and smoke inhalation injury. Potential complications and prognosis associated with SBI are also discussed. Diagnosis of burn injury and burn shock is based on patient history and clinical presentation. Superficial burn wounds may not be readily apparent for the first 48 h whereas more severe wounds will be evident at presentation. Patients are diagnosed with local or SBI by estimating total body surface area involved using the 'Rule of Nines' or the Lund-Browder chart adapted from the human literature. Patients suffering from SBI require immediate and aggressive fluid therapy. Burn wounds require prompt cooling to prevent progressive tissue damage. Due to significant pain associated with burn wounds and therapeutic procedures, multimodal analgesia is recommended. Daily wound management including hydrotherapy, topical medications, and early wound excision and grafting is necessary with SBI. There are numerous complications associated with SBI. The most common complications include infections, hypothermia, intra-abdominal hypertension, and abdominal compartment syndrome. The prognosis of SBI in domestic animals is unknown. Based on information derived from human literature, patients with SBI and concomitant smoke inhalation likely have a worse prognosis than those with SBI or smoke inhalation alone. © Veterinary Emergency and Critical Care Society 2012.

  13. The accumulation of brain injury leads to severe neuropathological and neurobehavioral changes after repetitive mild traumatic brain injury.

    PubMed

    Gao, Huabin; Han, Zhaoli; Bai, Ruojing; Huang, Shan; Ge, Xintong; Chen, Fanglian; Lei, Ping

    2017-02-15

    Traumatic brain injury (TBI) is a major public health problem with long-term neurobehavioral sequela. The evidences have revealed that TBI is a risk factor for later development of neurodegenerative disease and both the single and repetitive brain injury can lead to the neurodegeneration. But whether the effects of accumulation play an important role in the neurodegenerative disease is still unknown. We utilized the Sprague Dawley (SD) rats to develop the animal models of repetitive mild TBI and single mild TBI in order to detect the neurobehavioral changes. The results of neurobehavioral test revealed that the repetitive mild TBI led to more severe behavioral injuries than the single TBI. There were more activated microglia cells and astrocytes in the repetitive mild TBI group than the single TBI group. In consistent with this, the levels of TNF-α and IL-6 were higher and the expression of IL-10 was lower in the repetitive mild TBI group compared with the single TBI group. The expression of amyloid precursor protein (APP) increased in the repetitive TBI group detected by ELISA and western blot. But the levels of total tau (Tau-5) and P-tau (ser202) seem no different between the two groups in most time point. In conclusion, repetitive mild TBI could lead to more severe neurobehavioral impairments and the effects of accumulation may be associated with the increased inflammation in the brain. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

    PubMed Central

    Brown Baer, Pamela R.; Wenke, Joseph C.; Thomas, Steven J.; Hale, Colonel Robert G.

    2012-01-01

    This case series describes craniomaxillofacial battle injuries, currently available surgical techniques, and the compromised outcomes of four service members who sustained severe craniomaxillofacial battle injuries in Iraq or Afghanistan. Demographic information, diagnostic evaluation, surgical procedures, and outcomes were collected and detailed with a follow-up of over 2 years. Reconstructive efforts with advanced, multidisciplinary, and multiple revision procedures were indicated; the full scope of conventional surgical options and resources were utilized. Patients experienced surgical complications, including postoperative wound dehiscence, infection, flap failure, inadequate mandibular healing, and failure of fixation. These complications required multiple revisions and salvage interventions. In addition, facial burns complicated reconstructive efforts by delaying treatment, decreasing surgical options, and increasing procedural numbers. All patients, despite multiple surgeries, continue to have functional and aesthetic deficits as a result of their injuries. Currently, no conventional treatments are available to satisfactorily reconstruct the face severely ravaged by explosive devices to an acceptable level, much less to natural form and function. PMID:24294409

  15. Intraarticular Entrapment of Os Subfibulare Following a Severe Inversion Injury of the Ankle: A Case Report

    PubMed Central

    Kose, Ozkan; Kilicaslan, Omer Faruk; Guler, Ferhat; Aktan, Cemil

    2015-01-01

    Introduction: Anterior Talofibular Ligament (ATFL) rupture is the most commonly injured anatomic structure in lateral ankle sprain. In some cases, ATFL avulsion fracture from the lateral malleolus may occur instead of purely ligamentous injuries. The ATFL avulsion fracture is detected as a small ossicle at the tip of lateral malleolus on direct radiographs, which is called os subfibulare in chronic cases. Case Presentation: Severe displacement of this ossicle to the tibiotalar joint space is an extremely rare injury. Herein, a case of intra-articular entrapment of os subfibulare following a severe inversion injury of the ankle, which caused a diagnostic challenge was presented. Conclusions: To the best of our knowledge, this is the first case of entrapment of os subfibulare in the talotibial joint space. Fixation of the os subfibulare to lateral malleolus resulted in union and excellent functional results. PMID:26101763

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

    PubMed

    Vannemreddy, Prasad; Bryan, Kris; Nanda, Anil

    2009-01-01

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

  17. The Effect of Trauma Center Designation and Trauma Volume on Outcome in Specific Severe Injuries

    PubMed Central

    Demetriades, Demetrios; Martin, Mathew; Salim, Ali; Rhee, Peter; Brown, Carlos; Chan, Linda

    2005-01-01

    Objective: The objective of this study was to investigate the effect of American College of Surgeons (ACS) trauma center designation and trauma volume on outcome in patients with specific severe injuries. Background: Trauma centers are designated by the ACS into different levels on the basis of resources, trauma volume, and educational and research commitment. The criteria for trauma center designation are arbitrary and have never been validated. Methods: The National Trauma Data Bank study, which included patients >14 years of age and had injury severity score (ISS) >15, were alive on admission and had at least one of the following severe injuries: aortic, vena cava, iliac vessels, cardiac, grade IV/V liver injuries, quadriplegia, or complex pelvic fractures. Outcomes (mortality, intensive care unit stay, and severe disability at discharge) were compared among level I and II trauma centers and between centers within the same level designation but different volumes of severe trauma (<240 vs ≥240 trauma admissions with ISS >15 per year). The outcomes were adjusted for age (<65 ≥65), gender, mechanism of injury, hypotension on admission, and ISS (≤25 and >25). Results: A total of 12,254 patients met the inclusion criteria. Overall, level I centers had significantly lower mortality (25.3% vs 29.3%; adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.71–0.94; P = 0.004) and significantly lower severe disability at discharge (20.3% vs 33.8%, adjusted OR, 0.55; 95% CI, 0.44–0.69; P < 0.001) than level II centers. Subgroup analysis showed that cardiovascular injuries (N = 2004) and grades IV–V liver injuries (N = 1415) had a significantly better survival in level I than level II trauma centers (adjusted P = 0.017 and 0.023, respectively). Overall, there was a significantly better functional outcome in level I centers (adjusted P < 0.001). Subgroup analysis showed level I centers had significantly better functional outcomes in complex pelvic

  18. Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage

    PubMed Central

    Ly, Thuan V.; Travison, Thomas G.; Castillo, Renan C.; Bosse, Michael J.; MacKenzie, Ellen J.

    2008-01-01

    Background: Lower-extremity injury severity scoring systems were developed to assist surgeons in decision-making regarding whether to amputate or perform limb salvage after high-energy trauma to the lower extremity. These scoring systems have been shown to not be good predictors of limb amputation or salvage. This study was performed to evaluate the clinical utility of the five commonly used lower-extremity injury severity scoring systems as predictors of final functional outcome. Methods: We analyzed data from a cohort of patients who participated in a multicenter prospective study of clinical and functional outcomes after high-energy lower-extremity trauma. Injury severity was assessed with use of the Mangled Extremity Severity Score; the Limb Salvage Index; the Predictive Salvage Index; the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score; and the Hannover Fracture Scale-98. Functional outcomes were measured with use of the physical and psychosocial domains of the Sickness Impact Profile at both six months and two years following hospital discharge. Four hundred and seven subjects for whom the reconstruction regimen was considered successful at six months were included in the analysis. We used partial correlation statistics and multiple linear regression models to quantify the association between injury severity scores and Sickness Impact Profile outcomes with the subjects' ages held constant. Results: The mean age of the patients was thirty-six years (interquartile range, twenty-six to forty-four years); 75.2% were male and 24.8% were female. The median Sickness Impact Profile scores were 15.2 and 6.0 points at six and twenty-four months, respectively. The analysis showed that none of the scoring systems were predictive of the Sickness Impact Profile outcomes at six or twenty-four months to any reasonable degree. Likewise, none were predictive of patient recovery between six and twenty-four months postoperatively as

  19. Assessment of endocrine abnormalities in severe traumatic brain injury: a prospective study.

    PubMed

    Tandon, Asheesh; Suri, Ashish; Kasliwal, Manish Kumar; Mahapatra, Ashok Kumar; Mehta, Veer Singh; Garg, Ajay; Sarkar, Chitra; Dogra, T D; Pandey, R M

    2009-11-01

    The frequency and pattern of endocrine abnormalities among patients with traumatic brain injury have been the subject matter of very few studies. This study was intended to assess the pattern of endocrine dysfunction following severe head injury. Severe head injury patients admitted to the Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, from January to December in 1 year formed the study group. Apart from clinical assessment, NCCT of the head was performed on all patients on admission. A complete anterior pituitary hormone analysis was performed within 24 h of injury and was repeated at 2 weeks, 3 months and 6 months amongst patients who survived. A total of 99 patients were included in the study. Forty of our patients succumbed in the hospital. Rest of the patients were followed up for 6 months. Elevations of cortisol followed by prolactin were the most common hormonal derangements at admission. Midline shift on CT scans was inversely related to cortisol elevation and directly related to GH elevation. Infarct on CT scans was inversely related to cortisol and LH elevation. A significant alteration was found in the decreasing trend of the mean T4 values and normalisation or a decreasing trend from initially elevated mean cortisol and GH levels during follow-up (p < 0.05). This study reveals that abnormalities in hormonal profiles appear to be relatively common in severe traumatic brain injury and fluctuate significantly over at least 6 months; there is a correlation with age and radiological findings. Performance of hormonal analysis evaluation should be considered in patients with severe brain injury so that appropriate hormonal replacement can be done to optimise the clinical outcome.

  20. Developing a burn injury severity score (BISS): adding age and total body surface area burned to the injury severity score (ISS) improves mortality concordance.

    PubMed

    Cassidy, J Tristan; Phillips, Michael; Fatovich, Daniel; Duke, Janine; Edgar, Dale; Wood, Fiona

    2014-08-01

    There is limited research validating the injury severity score (ISS) in burns. We examined the concordance of ISS with burn mortality. We hypothesized that combining age and total body surface area (TBSA) burned to the ISS gives a more accurate mortality risk estimate. Data from the Royal Perth Hospital Trauma Registry and the Royal Perth Hospital Burns Minimum Data Set were linked. Area under the receiver operating characteristic curve (AUC) measured concordance of ISS with mortality. Using logistic regression models with death as the dependent variable we developed a burn-specific injury severity score (BISS). There were 1344 burns with 24 (1.8%) deaths, median TBSA 5% (IQR 2-10), and median age 36 years (IQR 23-50). The results show ISS is a good predictor of death for burns when ISS≤15 (OR 1.29, p=0.02), but not for ISS>15 (ISS 16-24: OR 1.09, p=0.81; ISS 25-49: OR 0.81, p=0.19). Comparing the AUCs adjusted for age, gender and cause, ISS of 84% (95% CI 82-85%) and BISS of 95% (95% CI 92-98%), demonstrated superior performance of BISS as a mortality predictor for burns. ISS is a poor predictor of death in severe burns. The BISS combines ISS with age and TBSA and performs significantly better than the ISS. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  1. Are pentraxin 3 and transsignaling early markers for immunologic injury severity in polytrauma? A pilot study.

    PubMed

    Kleber, Christian; Becker, Christopher A; Schmidt-Bleek, Katharina; Schaser, Klaus D; Haas, Norbert P

    2013-09-01

    Inflammatory-related conditions and organ failure (OF) lead to late trauma mortality. Cytokine profiles can predict adverse events and mortality, potentially guiding treatment strategies (damage control surgery versus early total care). However, the specific cytokines to predict the clinical course in polytraumatized patients are not fully identified. We investigated the early pentraxin 3 (PTX3), IL-6, soluble IL-6 receptor (sIL-6R), and transsignaling ratio (TSR) in polytraumatized patients to estimate immunologic injury severity and predict OF and survival. We prospectively followed 58 patients with severe polytrauma, six patients with minor trauma, and 10 healthy volunteers. The mean Injury Severity Score (ISS) was 43 points and the mean Hannover Polytrauma Score (PTS) was 59 points, with a consequently high mortality rate (30%). Twenty-seven of the 58 polytraumatized patients (46%) developed OF, 67% systemic inflammatory response syndrome, and 38% sepsis. Mean sIL-6R concentrations in polytrauma initially were low. Mean PTX3 concentrations were high and peaked at 24 hours. The mean TSR peaked at 6 hours; at that time, the mean value was higher for nonsurvivors. PTX3 concentrations at admission were associated with injury severity calculated by ISS and PTS. Higher PTX3 serum concentrations 24 hours after admission correlated with lower probability for survival. PTX3, sIL-6R, and TSR were early markers for posttraumatic inflammatory status, OF, injury severity, and TSR for survival after polytrauma. The temporal profile of PTX3 and TSR might be used to anticipate the total injury severity and the clinical course and thereby guide decision making in polytraumatized patients.

  2. An empirical analysis of run-off-road injury severity crashes involving large trucks.

    PubMed

    Al-Bdairi, Nabeel Saleem Saad; Hernandez, Salvador

    2017-03-04

    In recent years, there has been an increasing interest in understanding the contributory factors to run-off-road (ROR) crashes in the US, especially those where large trucks are involved. Although there have been several efforts to understand large-truck crashes, the relationship between crash factors, crash severity, and ROR crashes is not clearly understood. The intent of this research is to develop statistical models that provide additional insight into the effects that various contributory factors related to the person (driver), vehicle, crash, roadway, and environment have on ROR injury severity. An ordered random parameter probit was estimated to predict the likelihood of three injury severity categories using Oregon crash data: severe, minor, and no injury. The modeling approach accounts for unobserved heterogeneity (i.e., unobserved factors). The results showed that five parameter estimates were found to be random and normally distributed, and varied across ROR crash observations. These were factors related to crashes that occurred between January and April, raised median type, loss of control of a vehicle, the indicator variable of speed not involved, and the indicator variable of two vehicles or more involved in the crashes. In contrast, eight variables were found to be fixed across ROR observations. Looking more closely at the fixed parameter results, large-truck drivers who are not licensed in Oregon have a higher probability of experiencing no injury ROR crash outcomes, and human related factor, fatigue, increases the probability of minor injury. The modeling framework presented in this work offers a flexible methodology to analyze ROR crashes involving large trucks while accounting for unobserved heterogeneity. This information can aid safety planners and the trucking industry in identifying appropriate countermeasures to help mitigate the number and severity of large-truck ROR crashes.

  3. Cognitive Deficits Post-Traumatic Brain Injury and Their Association with Injury Severity and Gray Matter Volumes.

    PubMed

    Livny, Abigail; Biegon, Anat; Kushnir, Tammar; Harnof, Sagi; Hoffmann, Chen; Fruchter, Eyal; Weiser, Mark

    2017-04-01

    Traumatic brain injury (TBI) is known to have a substantial though highly variable impact on cognitive abilities. Due to the wide range of cognitive abilities among healthy individuals, an objective assessment of TBI-related cognitive loss requires an accurate measurement of pre-morbid cognitive performance. To address this problem, we recruited 50 adults who sustained a TBI and had performed a cognitive baseline assessment in adolescence as part of the aptitude tests mandated by the Israeli Defense Forces. This group was matched with non-injured controls (n = 35). Pre- and post-injury cognitive assessments consisted of three domains-namely, verbal abstraction, mathematical reasoning, and non-verbal abstract reasoning (from the Wechsler Adult Intelligence Scale-Third Edition). The difference between post- and pre-injury scores was calculated as a measure of domain-specific cognitive decline. Voxel-based regression was used to correlate cognitive decline with modulated gray matter probability maps controlling for age, Glasgow Coma Scale, and total intracranial volume. Using objectively assessed cognitive scores, we found that abstract reasoning declined in both moderate-severe and mild TBI patients, whereas verbal abstraction declined only in the moderate-severe group. Mathematical reasoning was not affected by TBI. In the TBI patients, non-verbal abstract reasoning post-pre-injury change scores were negatively correlated with the volume of the insula. We conclude that access to pre-morbid neuropsychological data may have facilitated the discovery of the effects of mild TBI on abstract reasoning, as well as a significant correlation between TBI-related decline in this cognitive domain and the volume of the bilateral insula, both of which had not been appreciated in the past.

  4. The Association between Repetitive, Self-Injurious and Aggressive Behavior in Children with Severe Intellectual Disability

    ERIC Educational Resources Information Center

    Oliver, Chris; Petty, Jane; Ruddick, Loraine; Bacarese-Hamilton, Monique

    2012-01-01

    We evaluated the independent association between adaptive behavior, communication and repetitive or ritualistic behaviors and self-injury, aggression and destructive behavior to identify potential early risk markers for challenging behaviors. Data were collected for 943 children (4-18 years, M = 10.88) with severe intellectual disabilities. Odds…

  5. Comparative Testing of Hemostatic Dressing in a Large Animal Model (Sus Scorofa) with Severe hepatic Injuries

    DTIC Science & Technology

    2013-12-02

    hemostatic dressings in a large animal model (Sus scrofa ) with severe hepatic injuries PRINCIPAL INVESTIGATOR (PI) / TRAINING COORDINATOR (TC): Capt...to Date Sus scrofa 36 18 18 Note. Many fewer animals than approved were used because one of the original treatment groups (Lypressin- soaked gauze

  6. The Association between Repetitive, Self-Injurious and Aggressive Behavior in Children with Severe Intellectual Disability

    ERIC Educational Resources Information Center

    Oliver, Chris; Petty, Jane; Ruddick, Loraine; Bacarese-Hamilton, Monique

    2012-01-01

    We evaluated the independent association between adaptive behavior, communication and repetitive or ritualistic behaviors and self-injury, aggression and destructive behavior to identify potential early risk markers for challenging behaviors. Data were collected for 943 children (4-18 years, M = 10.88) with severe intellectual disabilities. Odds…

  7. Consonant Accuracy after Severe Pediatric Traumatic Brain Injury: A Prospective Cohort Study

    ERIC Educational Resources Information Center

    Campbell, Thomas F.; Dollaghan, Christine; Janosky, Janine; Rusiewicz, Heather Leavy; Small, Steven L.; Dick, Frederic; Vick, Jennell; Adelson, P. David

    2013-01-01

    Purpose: The authors sought to describe longitudinal changes in Percentage of Consonants Correct--Revised (PCC-R) after severe pediatric traumatic brain injury (TBI), to compare the odds of normal-range PCC-R in children injured at older and younger ages, and to correlate predictor variables and PCC-R outcomes. Method: In 56 children injured…

  8. Relation of Executive Functioning to Pragmatic Outcome following Severe Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Douglas, Jacinta M.

    2010-01-01

    Purpose: This study was designed to explore the behavioral nature of pragmatic impairment following severe traumatic brain injury (TBI) and to evaluate the contribution of executive skills to the experience of pragmatic difficulties after TBI. Method: Participants were grouped into 43 TBI dyads (TBI adults and close relatives) and 43 control…

  9. Relation of Executive Functioning to Pragmatic Outcome following Severe Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Douglas, Jacinta M.

    2010-01-01

    Purpose: This study was designed to explore the behavioral nature of pragmatic impairment following severe traumatic brain injury (TBI) and to evaluate the contribution of executive skills to the experience of pragmatic difficulties after TBI. Method: Participants were grouped into 43 TBI dyads (TBI adults and close relatives) and 43 control…

  10. Abnormal Functional MRI BOLD Contrast in the Vegetative State after Severe Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Heelmann, Volker

    2010-01-01

    For the rehabilitation process, the treatment of patients surviving brain injury in a vegetative state is still a serious challenge. The aim of this study was to investigate patients exhibiting severely disturbed consciousness using functional magnetic resonance imaging. Five cases of posttraumatic vegetative state and one with minimal…

  11. Empirical Analysis of Crash Injury Severity on Mountainous and Nonmountainous Interstate Highways.

    PubMed

    Ma, Xiaoxiang; Chen, Feng; Chen, Suren

    2015-01-01

    Mountainous (MT) highways usually exhibit complex geometry features such as steep gradients or sharp curves, which can cause considerably different driver behavior and vehicle performance compared to nonmountainous (NM) ones. In addition, MT highways experience adverse weather conditions more often than NM counterparts. We examine different characteristics of crash injury severity from an MT highway and an NM highway. One major interstate highway with typical MT terrain and another one with NM terrain in Colorado were selected for this study. A comparative investigation about the impact on injury severity from MT and NM highways is conducted. Separate mixed logit models are estimated for both highways with 4-year detailed crash data. Incorporating 2 major interstate highways from the same region into the comparative study offers some unique strength on investigating the impacts from different causes. As a result, the study provides better insights about contributing factors and associated mechanism for injury severity on MT highways. Substantial differences in the magnitude and direction of the influence of some contributing factors between MT and NM models are observed. Some new findings about injury severity on MT highways are made possible for the first time. The findings in this study provide scientific guidance to potentially improve the current highway design and traffic management policy on thousands of miles of MT highways in the country.

  12. Consonant Accuracy after Severe Pediatric Traumatic Brain Injury: A Prospective Cohort Study

    ERIC Educational Resources Information Center

    Campbell, Thomas F.; Dollaghan, Christine; Janosky, Janine; Rusiewicz, Heather Leavy; Small, Steven L.; Dick, Frederic; Vick, Jennell; Adelson, P. David

    2013-01-01

    Purpose: The authors sought to describe longitudinal changes in Percentage of Consonants Correct--Revised (PCC-R) after severe pediatric traumatic brain injury (TBI), to compare the odds of normal-range PCC-R in children injured at older and younger ages, and to correlate predictor variables and PCC-R outcomes. Method: In 56 children injured…

  13. Are metacognitive processes associated with posttraumatic stress symptom severity following acquired brain injury?

    PubMed

    Gill, Ian J; Mullin, Stephen; Simpson, Jane

    2015-01-01

    Although posttraumatic stress disorder (PTSD) after acquired brain injury (ABI) is relatively common, its causal mechanisms remain speculative and little research has considered psychological perspectives. The current study aimed to examine whether metacognitive variables were associated with posttraumatic stress symptom (PTSS) severity in individuals with an ABI. Participants who had a traumatic brain injury (n = 47) or subarachnoid haemorrhage (n = 93) completed questionnaires related to demographic, clinical, social support and metacognitive variables. Correlation analyses and a hierarchical multiple regression analysis, with total PTSS severity used as the outcome variable, were conducted. Results demonstrated that metacognitive factors were correlated with PTSS severity and were able to explain an additional and significant amount of variance in PTSS severity within the regression analysis. The results provide preliminary support that metacognitive variables are associated with PTSS after ABI. Clinical implications within rehabilitative settings are discussed, as well as theoretical and research implications in the context of the study's limitations. Posttraumatic stress disorder (PTSD) can impede quality of life after brain injury. Clinical, social and metacognitive processes all influence the development of PTSD after brain injury and should be considered within rehabilitative care plans. Rehabilitative care plans should incorporate interventions for PTSD when appropriate, and metacognitive interventions could prove beneficial.

  14. Abnormal Functional MRI BOLD Contrast in the Vegetative State after Severe Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Heelmann, Volker

    2010-01-01

    For the rehabilitation process, the treatment of patients surviving brain injury in a vegetative state is still a serious challenge. The aim of this study was to investigate patients exhibiting severely disturbed consciousness using functional magnetic resonance imaging. Five cases of posttraumatic vegetative state and one with minimal…

  15. Risk and Injury Severity of Obese Child Passengers in Motor Vehicle Crashes

    PubMed Central

    Kim, Jong-Eun; Hsieh, Min-Heng; Shum, Phillip C.; Tubbs, R. Shane; Allison, David B.

    2014-01-01

    Objective To investigate the risk and injury severity on the regional body (head, neck, and chest) of obese children in frontal motor vehicle crashes. Design and Methods No physical surrogates (i.e., crash dummies) for obese children are available and experiments on pediatric cadavers are generally not feasible. Therefore, we developed computational models of obese children using medical imaging processing and state-of-the-art modeling techniques. A hybrid modeling technique was used to integrate finite element model for torso fat layer into the standard multibody model to represent various levels of obese children for 3- and 6-year-old age group. The models were used to investigate injury severity under various crash scenarios through model simulations. Results The head injury criterion and chest acceleration were observed to increase as body mass index (BMI) increased. Meanwhile, no such correlations were found between BMI and neck injury and chest deformation. Forward head and torso excursions were observed to increase as obesity increased, owing to the momentum effect of greater body mass. Conclusions Obese children appear to have greater risks of the head and chest injuries than do their non-obese counterparts in frontal motor vehicle crashes, owing to higher head and chest accelerations induced by greater body excursion. PMID:25645729

  16. Differential activation of infiltrating monocyte-derived cells after mild and severe traumatic brain injury

    PubMed Central

    Trahanas, Diane M.; Cuda, Carla M.; Perlman, Harris; Schwulst, Steven J.

    2014-01-01

    Microglia are the resident innate immune cells of the brain. Although embryologically and functionally distinct, they are morphologically similar to peripheral monocyte-derived cells resulting in a poor ability to discriminate between the two cell types. The purpose of this study was to develop a rapid and reliable method to simultaneously characterize, quantify, and discriminate between whole populations of myeloid cells from the brain in a murine model of traumatic brain injury (TBI). Male C57BL/6 mice underwent TBI (n=16) or sham injury (n=14). Brains were harvested at 24 hours post injury. Multiparameter flow cytometry and sequential gating analysis was performed allowing for discrimination between microglia and infiltrating leukocytes as well as for the characterization and quantification of individual subtypes within the infiltrating population. The proportion of infiltrating leukocytes within the brain increased with the severity of injury and the predominate cell types within the infiltrating population were monocyte-derived (p=0.01). Additionally, the severity of injury altered the overall makeup of the infiltrating monocyte-derived cells. In conclusion, we describe a flow cytometry based technique for gross discrimination between infiltrating leukocytes and microglia as well as the ability to simultaneously characterize and quantify individual myeloid subtypes and their maturation states within these populations. PMID:26091024

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

    PubMed

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

    2011-01-01

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

  18. Assessment of brainstem damage by the auditory brainstem response in acute severe head injury.

    PubMed Central

    Tsubokawa, T; Nishimoto, H; Yamamoto, T; Kitamura, M; Katayama, Y; Moriyasu, N

    1980-01-01

    In 64 cases suffering from severe head injury (Glasgow coma scale: less than seven- the auditory brainstem responses (FARs) recorded at the vertex, which are thought to be volumet conducted far-field potentials reflecting the sequential electrical activities of the auditory afferen) system in the brainstem, were recorded in the neurosurgical intensive care room immediately after admission. The alterations in the responses were compared with the types of primary injury, neurological signs., CT findings and outcome following treatment. Based on the results obtained, it is concluded that the FAR is a useful indicator for predicting the effects of treatment on brainstem damage in patients with severe head injury, and that it provides more reliable information about the function of the brainstem than the neurological signs or CT findings. Moreover, it also offers a diagnostic method for primary brainstem injury. Three cases or primary brainstem injury without lesions in the supratentorial region were diagnosed by means of combined CT and FAR recording. Images PMID:7441277

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

    PubMed

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

    2014-03-01

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

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

    PubMed Central

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

    2014-01-01

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

  1. Comparison of severity and pattern of injuries between motorcycle riders and their pillions: a matched study.

    PubMed

    Chiang, Valerie X Y; Cheng, Jolene Y X; Zhang, Z C; Teo, Li-Tserng

    2014-01-01

    Motorcyclists and their pillion riders are the most vulnerable group of road users in Singapore, accounting for 50% of all road traffic accident fatalities in 2011. This study aims to compare the severity and pattern of injuries between matched pairs of riders and pillions. Thirty-two matched pairs who presented to the A&E of an urban hospital from 1 August 2011 to 20 March 2012 were enrolled. Data were obtained from the hospital's trauma registry records, clinical records and accident victims were interviewed individually. Analysis was done using Stata 10 and considered rider-pillion pairs. Thirty-one pairs agreed to participate. There was no statistically significant difference in the ISS between riders and pillions (p=0.25). There was no significant difference in the probability of survival, Revised Trauma Score, distribution of injuries, total duration of admission and ICU stay between riders and pillions. When one party of the matched pair sustained a head, face, thoracic, abdominal/pelvic, extremity or external injury, the likelihood that the other party had an injury in the same region was 31%, 14%, 10%, 14%, 56% and 68% respectively. Cohen's kappa values were 0.28, 0.15, 0.05, 0.17, 0.24 and -0.16 for the respective regions. By comparing the severity and pattern of injuries between naturally matched pairs on the same motorcycle, one can account for potential confounding by the type and impact of collision, rider experience, amount of time to availability of medical aid, and other factors that may influence the outcome. Our study shows no statistically significant difference in the ISS and distribution of injuries between riders and pillions of matched pairs. Therefore, future health and insurance policies should provide equal coverage for both riders and pillions. Medical practitioners should approach riders and pillions similarly as there is no significant difference in their injury distribution. When one party of a matched pair presents with a head

  2. Autologous bone marrow mononuclear cells reduce therapeutic intensity for severe traumatic brain injury in children.

    PubMed

    Liao, George P; Harting, Matthew T; Hetz, Robert A; Walker, Peter A; Shah, Shinil K; Corkins, Christopher J; Hughes, Travis G; Jimenez, Fernando; Kosmach, Steven C; Day, Mary-Clare; Tsao, KuoJen; Lee, Dean A; Worth, Laura L; Baumgartner, James E; Cox, Charles S

    2015-03-01

    The devastating effect of traumatic brain injury is exacerbated by an acute secondary neuroinflammatory response, clinically manifest as elevated intracranial pressure due to cerebral edema. The treatment effect of cell-based therapies in the acute post-traumatic brain injury period has not been clinically studied although preclinical data demonstrate that bone marrow-derived mononuclear cell infusion down-regulates the inflammatory response. Our study evaluates whether pediatric traumatic brain injury patients receiving IV autologous bone marrow-derived mononuclear cells within 48 hours of injury experienced a reduction in therapeutic intensity directed toward managing elevated intracranial pressure relative to matched controls. The study was a retrospective cohort design comparing pediatric patients in a phase I clinical trial treated with IV autologous bone marrow-derived mononuclear cells (n = 10) to a control group of age- and severity-matched children (n = 19). The study setting was at Children's Memorial Hermann Hospital, an American College of Surgeons Level 1 Pediatric Trauma Center and teaching hospital for the University of Texas Health Science Center at Houston from 2000 to 2008. Study patients were 5-14 years with postresuscitation Glasgow Coma Scale scores of 5-8. The treatment group received 6 million autologous bone marrow-derived mononuclear cells/kg body weight IV within 48 hours of injury. The control group was treated in an identical fashion, per standard of care, guided by our traumatic brain injury management protocol, derived from American Association of Neurological Surgeons guidelines. The primary measure was the Pediatric Intensity Level of Therapy scale used to quantify treatment of elevated intracranial pressure. Secondary measures included the Pediatric Logistic Organ Dysfunction score and days of intracranial pressure monitoring as a surrogate for length of neurointensive care. A repeated-measure mixed model with marginal linear

  3. A New Method to Classify Injury Severity by Diagnosis: Validation using Workers' Compensation and Trauma Registry Data

    PubMed Central

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

    2015-01-01

    Purpose Acute work-related trauma is a leading cause of death and disability among U.S. workers. Existing methods to estimate injury severity have important limitations. This study assessed a severe injury indicator constructed from a list of severe traumatic injury diagnosis codes previously developed for surveillance purposes. Study objectives were to: (1) describe the degree to which the severe injury indicator predicts work disability and medical cost outcomes; (2) assess whether this indicator adequately substitutes for estimating Abbreviated Injury Scale (AIS)-based injury severity from workers' compensation (WC) billing data; and (3) assess concordance between indicators constructed from Washington State Trauma Registry (WTR) and WC data. Methods WC claims for workers injured in Washington State from 1998-2008 were linked to WTR records. Competing risks survival analysis was used to model work disability outcomes. Adjusted total medical costs were modeled using linear regression. Information content of the severe injury indicator and AIS-based injury severity measures were compared using Akaike Information Criterion and R2. Results Of 208,522 eligible WC claims, 5% were classified as severe. Among WC claims linked to the WTR, there was substantial agreement between WC-based and WTR-based indicators (kappa=0.75). Information content of the severe injury indicator was similar to some AIS-based measures. The severe injury indicator was a significant predictor of WTR inclusion, early hospitalization, compensated time loss, total permanent disability, and total medical costs. Conclusions Severe traumatic injuries can be directly identified when diagnosis codes are available. This method provides a simple and transparent alternative to AIS-based injury severity estimation. PMID:25900409

  4. [The effects of dancing on the brain and possibilities as a form of rehabilitation in severe brain injuries].

    PubMed

    Kullberg-Turtiainen, Marjo

    2013-01-01

    Very little research has been done on the effect of dancing on the rehabilitation of patients having a severe brain injury. In addition to motor problems, the symptom picture of the sequelae of severe brain injuries often involves strong fatigability, reduced physiological arousal, disturbances of coordination of attention, difficulties of emotional control and impairment of memory. This review deals with the neural foundation of dancing and the possibilities of dancing in the rehabilitation of severe brain injuries.

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

    PubMed Central

    2010-01-01

    Background There is a paucity of epidemiological data on neck injury in amateur rugby union populations. The objective of this study was to determine the incidence, severity, aetiology and type of neck injury in Australian men's amateur rugby union. Methods Data was collected from a cohort of 262 participants from two Australian amateur men's rugby union clubs via a prospective cohort study design. A modified version of the Rugby Union Injury Report Form for Games and Training was used by the clubs physiotherapist or chiropractor in data collection. Results The participants sustained 90 (eight recurrent) neck injuries. Exposure time was calculated at 31143.8 hours of play (12863.8 hours of match time and 18280 hours of training). Incidence of neck injury was 2.9 injuries/1000 player-hours (95%CI: 2.3, 3.6). As a consequence 69.3% neck injuries were minor, 17% mild, 6.8% moderate and 6.8% severe. Neck compression was the most frequent aetiology and was weakly associated with severity. Cervical facet injury was the most frequent neck injury type. Conclusions This is the first prospective cohort study in an amateur men's rugby union population since the inception of professionalism that presents injury rate, severity, aetiology and injury type data for neck injury. Current epidemiological data should be sought when evaluating the risks associated with rugby union football. PMID:20594296

  6. Comparison of the severity of bilateral Le Fort injuries in isolated midface trauma.

    PubMed

    Bagheri, Shahrokh C; Holmgren, Eric; Kademani, Deepak; Hommer, Louis; Bell, R Bryan; Potter, Bryce E; Dierks, Eric J

    2005-08-01

    The Le Fort classification pattern established in 1901 by the French surgeon Rene Le Fort is commonly used in describing midface fractures. This frequently used classification system is based on predictable patterns of midface fractures initially described for blunt trauma. The purpose of this study was to compare the profile and outcome of patients with isolated bilateral Le Fort I, II, and III fractures. All patients presenting to the emergency department (ED) at Legacy Emanuel Hospital (Level I trauma center) in Portland, OR, between December 1990 and December 2003 with isolated bilateral Le Fort I, II, or III fractures with or without concomitant nonfacial injuries were identified retrospectively using the Hospital Trauma Registry. Patients were classified into study groups I (n = 22), II (n = 22), or III (n = 23) corresponding to the Le Fort classification, respectively. Sixty-seven patients had a diagnosis of isolated bilateral Le Fort I, II, or III fracture. The average Injury Severity Score (ISS) and hospital length of stay were 18.8 +/- 8.9 and 9.5 +/- 11.9 days, respectively. Blood alcohol was detected in 19 patients. Sixty-four injuries (95.5%) were secondary to blunt trauma, and the remaining 3 (4.5%), penetrating injuries. More than half of the patients (n = 35, 52.2%) were admitted to the intensive care unit (ICU), 18 patients (26.8%) were transferred to the hospital trauma ward from the ED, and 14 patients (20.9%) were taken directly to the operating room. Fifteen (22.4%) patients required a tracheostomy secondary to their maxillofacial injuries. A statistically significant difference in the ISS was detected between patients with Le Fort I versus those with II or III injuries ( P < .0001). Patients with Le Fort II or III fractures had a significantly higher probability of ICU admission or immediate operative intervention. Ten patients (43.5%) with Le Fort III injuries required tracheostomy versus 3 patients (13.6%) with Le Fort I, and 2 patients (9

  7. How to define severely injured patients? -- an Injury Severity Score (ISS) based approach alone is not sufficient.

    PubMed

    Paffrath, Thomas; Lefering, Rolf; Flohé, Sascha

    2014-10-01

    Multiple injured patients, polytrauma or severely injured patients are terms used as synonyms in international literature describing injured patients with a high risk of mortality and cost consuming therapeutic demands. In order to advance the definition of these terms, we analysed a large trauma registry. In detail, we compared critically ill trauma patients first specified on a pure anatomical base according to the ISS or NISS, second in the original "polytrauma definition" with two body regions affected and finally all of them combined with a physiological component. Records that were collected in the TraumaRegister DGU(®) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU) between 1993 and 2011 (92,479 patients) were considered for this study. All patients with primary admission from scene with a minimum hospital stay of 48 h and an Injury Severity Score (ISS)≥ 16 were included. Pre-hospital and early admission data were used to determine physiological risk factors and calculate individual risk of death using the Revised Injury Severity Classification (RISC). 45,350 patients met inclusion criteria. The overall hospital mortality rate was 20.4%. The predicted mortality according to the RISC-Score was 21.6%. 36,897 patients (81.4%) had injuries in several body regions. The prevalence of the five physiological risk factors varied between 17% (high age) and 34% (unconsciousness). There were 17,617 patients (38.8%) without any risk factor present on admission, while 30.6% (n=13,890) of the patients had one and 30.5% (n=13,843) had two or more factors present. Patients with ISS ≥ 16 but no physiological risk factor present had a very low mortality rate of 3.1% (542 of 17,617). With an increasing number of physiological factors there was an almost linear increase in mortality up to an 86% rate in patients with all five factors present. The 'polytrauma' definition of Butcher and colleagues with AIS ≥ 3 in at least two different body

  8. Pedestrian crashes: higher injury severity and mortality rate for light truck vehicles compared with passenger vehicles

    PubMed Central

    Roudsari, B; Mock, C; Kaufman, R; Grossman, D; Henary, B; Crandall, J

    2004-01-01

    Introduction: During the last two decades changes in vehicle design and increase in the number of the light truck vehicles (LTVs) and vans have led to changes in pedestrian injury profile. Due to the dynamic nature of the pedestrian crashes biomechanical aspects of collisions can be better evaluated in field studies. Design and settings: The Pedestrian Crash Data Study, conducted from 1994 to 1998, provided a solid database upon which details and mechanism of pedestrian crashes can be investigated. Results: From 552 recorded cases in this database, 542 patients had complete injury related information, making a meaningful study of pedestrian crash characteristics possible. Pedestrians struck by LTVs had a higher risk (29%) of severe injuries (abbreviated injury scale ⩾4) compared with passenger vehicles (18%) (p = 0.02). After adjustment for pedestrian age and impact speed, LTVs were associated with 3.0 times higher risk of severe injuries (95% confidence interval (CI) 1.26 to 7.29, p = 0.013). Mortality rate for pedestrians struck by LTVs (25%) was two times higher than that for passenger vehicles (12%) (p<0.001). Risk of death for LTV crashes after adjustment for pedestrian age and impact speed was 3.4 times higher than that for passenger vehicles (95% CI 1.45 to 7.81, p = 0.005). Conclusion: Vehicle type strongly influences risk of severe injury and death to pedestrian. This may be due in part to the front end design of the vehicle. Hence vehicle front end design, especially for LTVs, should be considered in future motor vehicle safety standards. PMID:15178671

  9. Early Acute Kidney Injury Predicts Progressive Renal Dysfunction and Higher Mortality in Severely Burned Adults

    PubMed Central

    Mosier, Michael J.; Pham, Tam N.; Klein, Matthew B.; Gibran, Nicole S.; Arnoldo, Brett D.; Gamelli, Richard L.; Tompkins, Ronald G.; Herndon, David N.

    2011-01-01

    The incidence and prognosis of acute kidney injury (AKI) developing during acute resuscitation have not been well characterized in burn patients. The recently developed Risk, Injury, Failure, Loss, and End-stage (RIFLE) classification provides a stringent stratification of AKI severity and can allow for the study of AKI after burn injury. We hypothesized that AKI frequently develops early during resuscitation and is associated with poor outcomes in severely burned patients. We conducted a retrospective review of patients enrolled in the prospective observational multicenter study “Inflammation and the Host Response to Injury.” A RIFLE score was calculated for all patients at 24 hours and throughout hospitalization. Univariate and multivariate analyses were performed to distinguish the impact of early AKI on progressive renal dysfunction, need for renal replacement therapy, and hospital mortality. A total of 221 adult burn patients were included, with a mean TBSA burn of 42%. Crystalloid resuscitation averaged 5.2 ml/kg/%TBSA, with urine output of 1.0 ± 0.6 ml/kg/hr at 24 hours. Sixty-two patients met criteria for AKI at 24 hours: 23 patients (10%) classified as risk, 32 patients (15%) as injury, and 7 (3%) as failure. After adjusting for age, TBSA, inhalation injury, and nonrenal Acute Physiology and Chronic Health Evaluation II ≥20, early AKI was associated with an adjusted odds ratio 2.9 for death (95% CI 1.1–7.5, P = .03). In this cohort of severely burned patients, 28% of patients developed AKI during acute resuscitation. AKI was not always transient, with 29% developing progressive renal deterioration by RIFLE criteria. Early AKI was associated with early multiple organ dysfunction and higher mortality risk. Better understanding of how early AKI develops and which patients are at risk for progressive renal dysfunction may lead to improved outcomes. PMID:20061841

  10. Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults.

    PubMed

    Mosier, Michael J; Pham, Tam N; Klein, Matthew B; Gibran, Nicole S; Arnoldo, Brett D; Gamelli, Richard L; Tompkins, Ronald G; Herndon, David N

    2010-01-01

    The incidence and prognosis of acute kidney injury (AKI) developing during acute resuscitation have not been well characterized in burn patients. The recently developed Risk, Injury, Failure, Loss, and End-stage (RIFLE) classification provides a stringent stratification of AKI severity and can allow for the study of AKI after burn injury. We hypothesized that AKI frequently develops early during resuscitation and is associated with poor outcomes in severely burned patients. We conducted a retrospective review of patients enrolled in the prospective observational multicenter study "Inflammation and the Host Response to Injury." A RIFLE score was calculated for all patients at 24 hours and throughout hospitalization. Univariate and multivariate analyses were performed to distinguish the impact of early AKI on progressive renal dysfunction, need for renal replacement therapy, and hospital mortality. A total of 221 adult burn patients were included, with a mean TBSA burn of 42%. Crystalloid resuscitation averaged 5.2 ml/kg/%TBSA, with urine output of 1.0 +/- 0.6 ml/kg/hr at 24 hours. Sixty-two patients met criteria for AKI at 24 hours: 23 patients (10%) classified as risk, 32 patients (15%) as injury, and 7 (3%) as failure. After adjusting for age, TBSA, inhalation injury, and nonrenal Acute Physiology and Chronic Health Evaluation II > or =20, early AKI was associated with an adjusted odds ratio 2.9 for death (95% CI 1.1-7.5, P = .03). In this cohort of severely burned patients, 28% of patients developed AKI during acute resuscitation. AKI was not always transient, with 29% developing progressive renal deterioration by RIFLE criteria. Early AKI was associated with early multiple organ dysfunction and higher mortality risk. Better understanding of how early AKI develops and which patients are at risk for progressive renal dysfunction may lead to improved outcomes.

  11. Predicting levels of independence with expressing needs and ideas 1 year after severe brain injury.

    PubMed

    Pape, Theresa Louise-Bender; Guernon, Ann; Lundgren, Sandra; Patil, Vijaya; Herrold, Amy A; Smith, Bridget; Blahnik, Melanie; Picon, Linda M; Harton, Brett; Peterson, Michelle; Mallinson, Trudy; Hoffmann, Michael

    2013-08-01

    Severe brain injury (BI) is a catastrophic event often evolving into a complex chronic and severely disabling condition making activity participation possible only with sustained caregiving. One aspect of building sustainable caregiving is early provision of information about expected outcomes germane to patients and their caregivers. An analysis was conducted to determine whether 2 levels of independence with expressing needs and ideas 1-year after severe BI could be predicted using variables available early after injury. The authors examined a subsample (n = 79) of participants of an outcome study who received repeated neurobehavioral evaluations with the Disorders of Consciousness Scale (DOCS) and who were assessed 1 year after injury with the Functional Independence Measures (FIM). Explanatory variables included DOCS measures, patient characteristics, coexisting conditions, and interventions. The outcome is measured with the FIM Expression item. Optimal data analysis was used to construct multivariate classification tree models. The 2nd (p = .004) DOCS visual measure and seizure (p = .004) entered the final model providing 79% accuracy in classifying more or less independence with expressing needs and ideas at 1 year. The model will correctly identify 78% of future severe BI survivors who will have more independence and 82% of persons who will have less independence. For persons incurring severe BI, it is possible to predict, early after injury, more and less independence with expressing needs and ideas 1-year after injury. This evidence is 1 contribution to a larger body of evidence needed to enable early caregiver education about recovery expectations in terms of patient functioning relative to caregiving needs, which in turn will help build sustainable caregiving for this population.

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

    PubMed

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

    2015-01-01

    The aim of this study was to examine community integration by the Community Integration Questionnaire (CIQ) 2 years after injury in a divided TBI sample of moderately and severely injured patients. The second aim was to identify social-demographic, injury-related and rehabilitation associated predictors of CIQ. A cohort study. Outpatient follow-up. Fifty-seven patients with moderate (n = 21) or severe (n = 36) TBI were examined with the Community Integration Questionnaire (CIQ) at 2 years after injury. Possible predictors were analysed in a regression model using CIQ total score at 2 years as the outcome measure. The Community Integration Questionnaire. At 2 years follow-up, there was significant difference between the moderately and severely injured patients in the productivity scores (p < 0.003), while difference in the total CIQ scores approached the significance level (p = 0.074). Significant predictors of a higher CIQ score were living with a spouse, higher Glasgow Coma Scale (GCS) in the acute phase, shorter Post-Traumatic Amnesia (PTA), longer rehabilitation stay (LOS) and use of rehabilitation service. Use of rehabilitation service (B = 7.766) and living with a spouse (B = 4.251) had the largest influence. This means that living with a spouse, better score on the GCS scale, shorter PTA, longer LOS and use of rehabilitation service after discharge equated to better community integration 2 years after TBI Conclusions: Two years after TBI the moderately injured patients have a higher productivity level than the severely injured patients. Marital status, injury severity and rehabilitation after injury were associated with community integration 2 years after TBI.

  13. Association of Serum Uric Acid Level with the Severity of Brain Injury and Patient’s Outcome in Severe Traumatic Brain Injury

    PubMed Central

    Hatefi, Masoud; Dastjerdi, Masoud Moghadas; Ghiasi, Bahareh

    2016-01-01

    Introduction The prognostic value of serum Uric Acid (UA) levels in Traumatic Brain Injury (TBI) is unclear. Aim To investigate the relationship between serum UA levels and prognosis of patients with TBI when in hospital and at six months after discharge. Materials and Methods All patients attended our emergency department during July 2014 and December 2015 and were consecutively entered into the study and among 890 evaluated candidates based on inclusion criteria we finally investigated the serum UA levels of 725 TBI patients. Computed Tomography (CT) images of the brain were obtained within the first 24 hours of hospitalization. Outcome was assessed using the Glasgow Outcome Scale (GOS) score at discharge and at six months after discharge. Results Data of 725 patients (42.89% men; mean age: 54.69±12.37 years) were analyzed. Mean±Standard Deviation (SD) of Glasgow Coma Scale (GCS) scores was 4.65±1.76. Serum levels of UA, when in hospital and at six months after discharge, among those who died were lower than those who survived (in hospital: 0.126±0.026 vs. 0.243±0.942 mmol/l, p = 0.000; 6 months post-discharge: 0.130±0.044 vs. 0.286±0.069 mmol/l, p<0.001). The mean UA plasma was significantly different between deceased and alive patients according to GOS scores (p<0.001 and p=0.030, respectively). The UA levels showed a significant relationship with GCS scores and severity of brain injury assessed using the Marshall Classification Score (p=0.005). Conclusion Our results showed a strong relationship between UA levels and patients’ outcomes either in hospital or at six months after discharge. Serum UA level could be considered as a valuable marker for evaluating the severity of brain injury and outcomes of TBI. PMID:28208906

  14. Influence of alcohol consumption on incidence and severity of open-globe eye injuries in adults.

    PubMed

    Rüfer, Florian; Peters, Andrea; Klettner, Alexa; Treumer, Felix; Roider, Johann

    2011-12-01

    .0000). Open-globe eye injuries under alcohol intoxication are more often caused by a third party and have a worse prognosis. Open-globe injuries under alcohol intoxication occur in a different spatio-temporal setting and exhibit a more severe type of injury. Risk behavior combined with alcohol consumption therefore seems to be an independent factor for the incidence of open-globe eye injuries.

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

    PubMed

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

    2013-01-01

    To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI). Posttraumatic hydrocephalus (PTH) may lead to clinical deterioration and poor outcome if untreated. However, PTH can be successfully treated if detected. Nevertheless, PTH is easily overlooked during rehabilitation, particularly in severe cases. We prospectively followed all patients (n = 444) in Eastern Denmark (population 2.5 mill) sustaining severe TBI, who required lengthy rehabilitation between 2000 and 2010. All patients with PTH were tracked retrospectively. Demographics, surgery, injury severity, consciousness level, and disability were compared for patients with versus without PTH. Independent predictors of PTH during rehabilitation were identified through multiple logistic regression models. PTH occurred in 14.2% and 3/4 emerged during rehabilitation. Patients with PTH were older, had more severe brain injuries, were more frequently in vegetative state, and needed longer rehabilitation stays. After adjusted analyses, however, only older age and low level of consciousness were independently associated with PTH. Most cases of PTH emerge during rehabilitation. Therefore, attention towards this complication should be present also beyond the acute stage after TBI, particularly among older patients and patients with severe disordered consciousness.

  16. Sustained attention and information processing speed in chronic survivors of severe closed head injury.

    PubMed

    Levin, H S; High, W M; Goldstein, F C; Williams, D H

    1988-01-01

    Sustained attention and information processing speed in 15 long-term survivors of severe closed head injury and 14 demographically matched controls have been examined. The average time between head injury and testing was 3.6 years. The performance of patients on all tasks was impaired relative to controls, thus documenting persistent deficits in attention. Of particular interest was the finding that controls were capable of redirecting and improving their sustained attention during a test session versus the steady decline in patient performance. The findings are discussed within the framework of controlled attentional processes.

  17. Associations between care pathways and outcome 1 year after severe traumatic brain injury.

    PubMed

    Godbolt, Alison K; Stenberg, Maud; Lindgren, Marie; Ulfarsson, Trandur; Lannsjö, Marianne; Stålnacke, Britt-Marie; Borg, Jörgen; DeBoussard, Catharina Nygren

    2015-01-01

    To assess associations between real-world care pathways for working-age patients in the first year after severe traumatic brain injury and outcomes at 1 year. Prospective, observational study with recruitment from 6 neurosurgical centers in Sweden and Iceland. Follow-up to 1 year, independently of care pathways, by rehabilitation physicians and paramedical professionals. Patients with severe traumatic brain injury, lowest (nonsedated) Glasgow Coma Scale score 3 to 8 during the first 24 hours and requiring neurosurgical intensive care, age 18 to 65 years, and alive 3 weeks after injury. Length of stay in intensive care, time between intensive care discharge and rehabilitation admission, outcome at 1 year (Glasgow Outcome Scale Extended score), acute markers of injury severity, preexisting medical conditions, and post-acute complications. Logistic regression analyses were performed. A multivariate model found variables significantly associated with outcome (odds ratio for good outcome [confidence interval], P value) to be as follows: length of stay in intensive care (0.92 [0.87-0.98], 0.014), time between intensive care discharge and admission to inpatient rehabilitation (0.97 [0.94-0.99], 0.017), and post-acute complications (0.058 [0.006-0.60], 0.017). Delays in rehabilitation admission were negatively associated with outcome. Measures to ensure timely rehabilitation admission may improve outcome. Further research is needed to evaluate possible causation.

  18. Persistent hypogonadotropic hypogonadism in men after severe traumatic brain injury: temporal hormone profiles and outcome prediction

    PubMed Central

    Barton, David J.; Kumar, Raj G.; McCullough, Emily H.; Galang, Gary; Arenth, Patricia M.; Berga, Sarah L.; Wagner, Amy K.

    2015-01-01

    Objective (1) Examine relationships between persistent hypogonadotropic hypogonadism (PHH) and long-term outcomes after severe traumatic brain injury (TBI); (2) determine if sub-acute testosterone levels can predict PHH. Setting Level 1 trauma center at a university hospital. Participants Consecutive sample of men with severe TBI between 2004 and 2009. Design Prospective cohort study. Main Measures Post-TBI blood samples were collected during week 1, every 2 weeks until 26 weeks, and at 52 weeks. Serum hormone levels were measured, and individuals were designated as having PHH if ≥50% of samples met criteria for hypogonadotropic hypogonadism. At 6 and 12 months post-injury, we assessed global outcome, disability, functional cognition, depression, and quality-of-life. Results We recruited 78 men; median (IQR) age was 28.5 (22–42) years. 34 patients (44%) had PHH during the first year post-injury. Multivariable regression, controlling for age, demonstrated PHH status predicted worse global outcome scores, more disability, and reduced functional cognition at 6 and 12 months post-TBI. Two-step testosterone screening for PHH at 12–16 weeks post-injury yielded a sensitivity of 79% and specificity of 100%. Conclusion PHH status in men predicts poor outcome after severe TBI, and PHH can accurately be predicted at 12–16 weeks. PMID:26360007

  19. Difference in rural and urban driver-injury severities in highway-rail grade crossing accidents.

    PubMed

    Hao, Wei; Kamga, Camille

    2015-09-22

    Based on the Federal Railway Administration (FRA) database, there were 25,945 highway-rail crossing accidents in the United States between 2002 and 2011. With an extensive research, analysis results showed that there were substantial differences between rural and urban areas at highway-rail grade crossings. However, there is no published study specific on driver's injury severity at highway-rail grade crossings classified by area types. Using an ordered probit modelling approach, the study explores the determinants of driver-injury severity at rural highway-rail grade crossings compared with urban highway-rail grade crossings. The analysis found that motor vehicle driver's injury level at rural highway-rail grade crossing is extremely higher than urban area. Compared to collisions at urban area, collisions happened at rural area tend to result in more severe injuries. These crashes were more prevalent if vehicle drivers are driving at a high speed or the oncoming trains are high-speed. Moreover, highway-rail grade crossing accidents were more likely to occur at rural area without pavement and lighting.

  20. Arterial reconstruction after mangled extremity: injury severity scoring systems are not predictive of limb salvage.

    PubMed

    Elsharawy, Mohamed Amin

    2005-01-01

    The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI). During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.

  1. Influence of cerebral oxygenation following severe head injury on neuropsychological testing.

    PubMed

    Meixensberger, J; Renner, C; Simanowski, R; Schmidtke, A; Dings, J; Roosen, K

    2004-06-01

    Despite recent advances in the management of severe head injury the mortality and morbidity remains high. Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) are crucial parameters for the correct management at the intensive care unit, due to their therapeutic and prognostic importance. In addition, regional brain tissue oxygenation (ptiO2) seems to be of importance. While different studies demonstrated the impact of cerebral hypoxia on outcome (mortality), no data are available focusing on morbidity (neuropsychological deficits). Therefore, our study is carried out to demonstrate a possible relationship between amount of cerebral oxygenation during acute stage after severe head injury and neuropsychological outcome. Besides ICP and CPP, ptiO2 was monitored in 40 severely head injured patients during the ICU stay from the day of admission until day 10. Monitoring data were stored and amount of hypoxic episodes were calculated. Besides outcome using the Glasgow Outcome Scale neuropsychological testing was performed 2-3 years after injury. Analysing the quality of brain tissue oxygenation, a relationship to the performance in neuropsychological tests could be found. Patients with low brain tissue oxygenation had a worse outcome in neuropsychological testing, especially concerning intelligence and memory. Associated with these deficits patients showed a reduced performance in their profession. Our data suggest a possible predictive value of brain tissue oxygen on morbidity analysing neurocognitive function after head injury. This may implicate monitoring and treatment of cerebral hypoxia. Copyright 2004 W.S. Maney and Son Ltd

  2. [Utility of diffusion-weighted magnetic resonance imaging in severe focal traumatic brain injuries].

    PubMed

    Prieto-Valderrey, F; Muñiz-Montes, J R; López-García, J A; Villegas-Del Ojo, J; Málaga-Gil, J; Galván-García, R

    2013-01-01

    To describe the apparent diffusion coefficient (ADC) in a series of severe traumatic brain injuries, their clinical and outcome features, and possible implications. A descriptive, observational case-series study was carried out. Patients with severe traumatic brain injuries (TBIs) admitted to the ICU were subjected to MRI study using a 1.5 T scanner. Diffusion-weighted images (DWMR) were obtained using the following echo-planar pulse sequence: TR 10000 ms, TE 126.9 ms, with b values 1000 s/mm2 in the three spatial dimensions. Combining the three sets of images, an isotropic image conforming a map of the mean ADCs was obtained. DWMR was performed in 23 patients with severe TBI admitted to the ICU between 2001 and 2004. In the MR images we selected 26 regions of interest (ROIs) where ADC was recorded. We observed a clear increase in diffusion in non-treated space-occupying lesions versus other types of injuries and the normal values. A poorer outcome was recorded in patients with lower ADC values. Mean ADC in the lesions was greater than the normal values and greater in contusions than in other types of injuries, as an expression of extracellular edema. ADCs were decreased in patients with a poor outcome, suggesting an association between ischemia and the patient prognosis. Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  3. Long-term physical, psychological and social consequences of severe injuries.

    PubMed

    van der Sluis, C K; Eisma, W H; Groothoff, J W; ten Duis, H J

    1998-05-01

    This 6 year follow-up study was designed to evaluate the long-term physical, psychological and social outcomes of severely injured patients (Injury Severity Score of greater than or equal to 16). Patients were treated at the University Hospital Groningen, the Netherlands, between January 1989 and December 1989. Outcomes were assessed using a postal questionnaire. After injury, the 55 respondents had predominantly complaints of the extremities, the spine and the head. Psychological complaints were present in 84 per cent of patients and mainly concerned fatigue, slowness and memory impairments. Despite these physical and psychological complaints, 74 per cent of patients were able to return to work and the memory succeeded in complying with job requirements. Injuries of the extremities and the spine were risk factors for failing to return to work. Social consequences were also reflected in broken marriages (6/22) and changes of leisure activities (45 per cent). On the basis of the impairments and disabilities revealed, we conclude that further improvement of the long-term outcomes of severely injured patients may be achieved by advancements in the treatment of injuries to the head, spine or extremities, comprehensive psychological support and vocational rehabilitation.

  4. Circulating Microvesicles Are Elevated Acutely following Major Burns Injury and Associated with Clinical Severity.

    PubMed

    O'Dea, Kieran P; Porter, John R; Tirlapur, Nikhil; Katbeh, Umar; Singh, Suveer; Handy, Jonathan M; Takata, Masao

    2016-01-01

    Microvesicles are cell-derived signaling particles emerging as important mediators and biomarkers of systemic inflammation, but their production in severe burn injury patients has not been described. In this pilot investigation, we measured circulating microvesicle levels following severe burns, with severe sepsis patients as a comparator group. We hypothesized that levels of circulating vascular cell-derived microvesicles are elevated acutely following burns injury, mirroring clinical severity due to the early onset and prevalence of systemic inflammatory response syndrome (SIRS) in these patients. Blood samples were obtained from patients with moderate to severe thermal injury burns, with severe sepsis, and from healthy volunteers. Circulating microvesicles derived from total leukocytes, granulocytes, monocytes, and endothelial cells were quantified in plasma by flow cytometry. All circulating microvesicle subpopulations were elevated in burns patients on day of admission (day 0) compared to healthy volunteers (leukocyte-microvesicles: 3.5-fold, p = 0.005; granulocyte-microvesicles: 12.8-fold, p<0.0001; monocyte-microvesicles: 20.4-fold, p<0.0001; endothelial- microvesicles: 9.6-fold, p = 0.01), but decreased significantly by day 2. Microvesicle levels were increased with severe sepsis, but less consistently between patients. Leukocyte- and granulocyte-derived microvesicles on day 0 correlated with clinical assessment scores and were higher in burns ICU non-survivors compared to survivors (leukocyte MVs 4.6 fold, p = 0.002; granulocyte MVs 4.8 fold, p = 0.003). Mortality prediction analysis of area under receiver operating characteristic curve was 0.92 (p = 0.01) for total leukocyte microvesicles and 0.85 (p = 0.04) for granulocyte microvesicles. These findings demonstrate, for the first time, acute increases in circulating microvesicles following burns injury in patients and point to their potential role in propagation of sterile SIRS-related pathophysiology.

  5. Acute Serum Hormone Levels: Characterization and Prognosis after Severe Traumatic Brain Injury

    PubMed Central

    McCullough, Emily H.; Niyonkuru, Christian; Ozawa, Haishin; Loucks, Tammy L.; Dobos, Julie A.; Brett, Christopher A.; Santarsieri, Martina; Dixon, C. Edward; Berga, Sarah L.; Fabio, Anthony

    2011-01-01

    Abstract Experimental traumatic brain injury (TBI) studies report the neuroprotective effects of female sex steroids on multiple mechanisms of injury, with the clinical assumption that women have hormonally mediated neuroprotection because of the endogenous presence of these hormones. Other literature indicates that testosterone may exacerbate injury. Further, stress hormone abnormalities that accompany critical illness may both amplify or blunt sex steroid levels. To better understand the role of sex steroid exposure in mediating TBI, we 1) characterized temporal profiles of serum gonadal and stress hormones in a population with severe TBI during the acute phases of their injury; and 2) used a biological systems approach to evaluate these hormones as biomarkers predicting global outcome. The study population was 117 adults (28 women; 89 men) with severe TBI. Serum samples (n=536) were collected for 7 days post-TBI for cortisol, progesterone, testosterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Hormone data were linked with clinical data, including acute care mortality and Glasgow Outcome Scale (GOS) scores at 6 months. Hormone levels after TBI were compared to those in healthy controls (n=14). Group based trajectory analysis (TRAJ) was used to develop temporal hormone profiles that delineate distinct subpopulations in the cohort. Structural equations models were used to determine inter-relationships between hormones and outcomes within a multivariate model. Compared to controls, acute serum hormone levels were significantly altered after severe TBI. Changes in the post-TBI adrenal response and peripheral aromatization influenced hormone TRAJ profiles and contributed to the abnormalities, including increased estradiol in men and increased testosterone in women. In addition to older age and greater injury severity, increased estradiol and testosterone levels over time were associated with increased mortality and worse global

  6. Severe esophageal injuries caused by accidental button battery ingestion in children.

    PubMed

    Fuentes, Sara; Cano, Indalecio; Benavent, María Isabel; Gómez, Andrés

    2014-10-01

    Button batteries represent a low percentage of all foreign bodies swallowed by children and esophageal location is even less frequent. However, these cases are more likely to develop severe injuries. The aim of this essay is to report three cases treated in our institution and review previous reports. Chart review and literature search. We treated three children between 2-7- years old with button batteries lodged at esophagus. They all presented esophageal burns (EB), which evolved in esophageal stenosis in two out of the three cases. We found 29 more cases in literature and the injuries included EB, esophageal perforation (EP) and tracheoesophageal fistula (TEF). Swallowed button batteries rarely remain in esophagus, but these cases present a higher risk of tisular damage. Injuries can take place even after few hours; and therefore, endoscopy must be performed as soon as possible. Further study on button batteries' safety and the establishment of a maximum size for them would be good preventive measures.

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

    PubMed

    Kaiser, Radek; Waldauf, Petr; Haninec, Pavel

    2012-07-01

    Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively(1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail. Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper,22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents(63.2%) followed by car accidents (23.5%), bicycle accidents(10.7%) and pedestrian collisions (3.1%) (p<0.001).Patients involved in car accidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (p<0.001). Lower plexus palsy was significantly increased in patients after car accidents (9.3%,p<0.05). In the two main groups (car and motorcycle accidents),significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%). Study results indicate that the most common injury was an upper plexus palsy. It was

  8. Is Goshinjo therapy effective in cognitive impairment after severe traumatic brain injury?

    PubMed

    Hashimoto, Keiji; Kida, Kisho

    2013-04-25

    We report a case of a 21-year-old man who had severe traumatic brain injury as a result of an accident at the age of 16 years. Two years and 4 months after the trauma, at the age of 19 years, he still had severe right hemiplegia and cognitive dysfunction including aphasia and attention and memory disturbance. Conventional rehabilitation programs could not resolve all of the neuropsychological problems. He started receiving Goshinjo therapy over a period of 22 months. Following the therapy, significant improvements in verbal intelligence quotient (assessed by the Wechsler Adult Intelligence Scale-Third Edition) and attention and concentration function (using the Wechsler Memory Scale-Revised), and remission of traumatic epilepsy were observed. Goshinjo therapy is suspected to be effective in the treatment of cognitive dysfunction in the chronic stage after severe traumatic brain injury.

  9. Surviving severe traumatic brain injury in Denmark: incidence and predictors of highly specialized rehabilitation

    PubMed Central

    Odgaard, Lene; Poulsen, Ingrid; Kammersgaard, Lars Peter; Johnsen, Søren Paaske; Nielsen, Jørgen Feldbæk

    2015-01-01

    Purpose To identify all hospitalized patients surviving severe traumatic brain injury (TBI) in Denmark and to compare these patients to TBI patients admitted to highly specialized rehabilitation (HS-rehabilitation). Patients and methods Patients surviving severe TBI were identified from The Danish National Patient Registry and The Danish Head Trauma Database. Overall incidence rates of surviving severe TBI and incidence rates of admission to HS-rehabilitation after severe TBI were estimated and compared. Patient-related predictors of no admission to HS-rehabilitation among patients surviving severe TBI were identified using multivariable logistic regression. Results The average incidence rate of surviving severe TBI was 2.3 per 100,000 person years. Incidence rates of HS-rehabilitation were generally stable around 2.0 per 100,000 person years. Overall, 84% of all patients surviving severe TBI were admitted to HS-rehabilitation. Female sex, older age, and non-working status pre-injury were independent predictors of no HS-rehabilitation among patients surviving severe TBI. Conclusion The incidence rate of hospitalized patients surviving severe TBI was stable in Denmark and the majority of the patients were admitted to HS-rehabilitation. However, potential inequity in access to HS-rehabilitation may still be present despite a health care system based on equal access for all citizens. PMID:25848317

  10. Analysis of driver injury severity in wrong-way driving crashes on controlled-access highways.

    PubMed

    Pour-Rouholamin, Mahdi; Zhou, Huaguo

    2016-09-01

    For more than five decades, wrong-way driving (WWD) has been notorious as a traffic safety issue for controlled-access highways. Numerous studies and efforts have tried to identify factors that contribute to WWD occurrences at these sites in order to delineate between WWD and non-WWD crashes. However, none of the studies investigate the effect of various confounding variables on the injury severity being sustained by the at-fault drivers in a WWD crash. This study tries to fill this gap in the existing literature by considering possible variables and taking into account the ordinal nature of injury severity using three different ordered-response models: ordered logit or proportional odds (PO), generalized ordered logit (GOL), and partial proportional odds (PPO) model. The findings of this study reveal that a set of variables, including driver's age, condition (i.e., intoxication), seatbelt use, time of day, airbag deployment, type of setting, surface condition, lighting condition, and type of crash, has a significant effect on the severity of a WWD crash. Additionally, a comparison was made between the three proposed methods. The results corroborate that the PPO model outperforms the other two models in terms of modeling injury severity using our database. Based on the findings, several countermeasures at the engineering, education, and enforcement levels are recommended. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    PubMed Central

    2012-01-01

    Objectives The authors present a novel approach to nonresectional therapy in major hepatic trauma utilizing intraabdominal perihepatic vacuum assisted closure (VAC) therapy in the porcine model of Grade V liver injury. Methods A Grade V injury was created in the right lobe of the liver in a healthy pig. A Pringle maneuver was applied (4.5 minutes total clamp time) and a vacuum assisted closure device was placed over the injured lobe and connected to suction. The device consisted of a perforated plastic bag placed over the liver, followed by a 15 cm by 15cm VAC sponge covered with a nonperforated plastic bag. The abdomen was closed temporarily. Blood loss, cardiopulmonary parameters and bladder pressures were measured over a one-hour period. The device was then removed and the animal was euthanized. Results Feasibility of device placement was demonstrated by maintenance of adequate vacuum suction pressures and seal. VAC placement presented no major technical challenges. Successful control of ongoing liver hemorrhage was achieved with the VAC. Total blood loss was 625 ml (20ml/kg). This corresponds to class II hemorrhagic shock in humans and compares favorably to previously reported estimated blood losses with similar grade liver injuries in the swine model. No post-injury cardiopulmonary compromise or elevated abdominal compartment pressures were encountered, while hepatic parenchymal perfusion was maintained. Conclusion These data demonstrate the feasibility and utility of a perihepatic negative pressure device for the treatment of hemorrhage from severe liver injury in the porcine model. PMID:23217091

  12. 4-Phenylbutyric Acid Attenuates Pancreatic Beta-Cell Injury in Rats with Experimental Severe Acute Pancreatitis

    PubMed Central

    Guo, Wen-yi; Zhao, Liang; Xiang, Ming-wei; Mei, Fang-chao; Abliz, Ablikim; Hu, Peng; Deng, Wen-hong; Yu, Jia

    2016-01-01

    Endoplasmic reticulum (ER) stress is a particular process with an imbalance of homeostasis, which plays an important role in pancreatitis, but little is known about how ER stress is implicated in severe acute pancreatitis (SAP) induced pancreatic beta-cell injury. To investigate the effect of 4-phenylbutyric acid (4-PBA) on the beta-cell injury following SAP and the underlying mechanism, twenty-four Sprague-Dawley rats were randomly divided into sham-operation (SO) group, SAP model group, and 4-PBA treatment group. SAP model was induced by infusion of 5% sodium taurocholate into the biliopancreatic duct. 4-PBA or normal saline was injected intraperitoneally for 3 days in respective group before successful modeling. Results showed that 4-PBA attenuated the following: (1) pancreas and islet pathological injuries, (2) serum TNF-α and IL-1β, (3) serum insulin and glucose, (4) beta-cell ultrastructural changes, (5) ER stress markers (BiP, ORP150, and CHOP), Caspase-3, and insulin expression in islet. These results suggested that 4-PBA mitigates pancreatic beta-cell injury and endocrine disorder in SAP, presumably because of its role in inhibiting excessive endoplasmic reticulum stress. This may serve as a new therapeutic target for reducing pancreatic beta-cell injury and endocrine disorder in SAP upon 4-PBA treatment. PMID:27656209

  13. Analysis of injury severity of large truck crashes in work zones.

    PubMed

    Osman, Mohamed; Paleti, Rajesh; Mishra, Sabyasachee; Golias, Mihalis M

    2016-12-01

    Work zones are critical parts of the transportation infrastructure renewal process consisting of rehabilitation of roadways, maintenance, and utility work. Given the specific nature of a work zone (complex arrangements of traffic control devices and signs, narrow lanes, duration) a number of crashes occur with varying severities involving different vehicle sizes. In this paper we attempt to investigate the causal factors contributing to injury severity of large truck crashes in work zones. Considering the discrete nature of injury severity categories, a number of comparable econometric models were developed including multinomial logit (MNL), nested logit (NL), ordered logit (ORL), and generalized ordered logit (GORL) models. The MNL and NL models belong to the class of unordered discrete choice models and do not recognize the intrinsic ordinal nature of the injury severity data. The ORL and GORL models, on the other hand, belong to the ordered response framework that was specifically developed for handling ordinal dependent variables. Past literature did not find conclusive evidence in support of either framework. This study compared these alternate modeling frameworks for analyzing injury severity of crashes involving large trucks in work zones. The model estimation was undertaken by compiling a database of crashes that (1) involved large trucks and (2) occurred in work zones in the past 10 years in Minnesota. Empirical findings indicate that the GORL model provided superior data fit as compared to all the other models. Also, elasticity analysis was undertaken to quantify the magnitude of impact of different factors on work zone safety and the results of this analysis suggest the factors that increase the risk propensity of sustaining severe crashes in a work zone include crashes in the daytime, no control of access, higher speed limits, and crashes occurring on rural principal arterials.

  14. Forensic pathological evaluation of injury severity and fatal outcome in traffic accidents: five illustrative autopsy cases of clinically unexpected death.

    PubMed

    Michiue, Tomomi; Ishikawa, Takaki; Quan, Li; Zhu, Bao-Li; Maeda, Hitoshi

    2008-01-01

    In forensic casework, investigation of injury severity in traffic accidents is important for evaluating the mortality, occasionally in terms of the adequacy of clinical management. The present study evaluated 5 cases of clinically unexpected delayed collapse followed by death using the abbreviated injury scale (AIS), injury severity score (ISS), and a clinical trauma care method (trauma and injury severity score, TRISS). In these cases, major injury (AIS = 3-5) was found in the head, chest and/or abdomen at autopsy, and ISS was estimated to be 11-45 (serious to critical but not incompatible with life). By the TRISS method, the probability of survival (P (s)) was estimated to be >0.5 for all cases (0.60-0.99), suggesting that these were preventable deaths. However, the present cases showed several common features: (a) fatality due to closed injury/-ies to the thoracic and/or abdominal viscera, (b) alert and poor symptoms/clinical signs, and (c) poor positive findings in diagnostic imaging at early times after injury, and (d) complications of other evident injuries, suggesting difficulties in the clinical diagnosis of potentially fatal injuries, but (e) possibly predictable fatal injury when typical patterns of traffic accident injury were considered.

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2012-01-01

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

  17. Utilities of scrotal flap for reconstruction of penile skin defects after severe burn injury.

    PubMed

    Guo, Le; Zhang, Minghua; Zeng, Jizhang; Liang, Pengfei; Zhang, Pihong; Huang, Xiaoyuan

    2017-06-06

    In the present study, we aimed to present our experience of an effective two-stage surgical approach using scrotal skin flap for patients with penile skin defects following severe burn injury. A total of 17 patients with penile skin defects underwent scheduled two-stage reconstruction using scrotal skin flap from January 2004 to October 2016. Patients, who were selected as eligible candidates for scrotal flap, exhibited a wide range of indications, including iatrogenic injuries (e.g., diathermy treatment after circumcision), scalding, flame injuries and electrical burns. During the first stage, the denuded penis secondary to debridement was temporally embedded in scrotal skin flap through an intrascrotal tunnel created between the skin and darto's fascia. During the second stage, the skin around the penis was separated and divided from the scrotum after incising the scrotal skin at the ventral penile base. After a mean follow-up of 30 months, the reconstructed penises yielded satisfactory aesthetic outcomes and maintained erectile function. The mean age of patients was 35 years (19-55 years), and the median follow-up was 30 months (12-60 months). No major perioperative complication occurred except for dehiscence of scrotal skin after 2nd stage in three patients, and split-thickness skin grafts were applied for recovery of scrotum. Of 17 cases, 15 patients (88.2%) were in satisfactory cosmetic appearance. All patients regained penile sensation and normal voiding function in standing position. The International Index of Erectile Function (IIEF) was used to assess sexual function, with 13 patients (76.5%) reported normal erectile function, while the rest 4 reported mild erectile dysfunction. With regards to intercourse satisfaction domain, encouraging results indicated a total of 17 patients resumed sexual intercourse after surgery. In overall satisfaction domain, 11/17 (64.7%) reported a satisfaction from "very" to "moderately" with their overall sex life and

  18. Treatment of Severe Adult Traumatic Brain Injury Using Bone Marrow Mononuclear Cells.

    PubMed

    Cox, Charles S; Hetz, Robert A; Liao, George P; Aertker, Benjamin M; Ewing-Cobbs, Linda; Juranek, Jenifer; Savitz, Sean I; Jackson, Margaret L; Romanowska-Pawliczek, Anna M; Triolo, Fabio; Dash, Pramod K; Pedroza, Claudia; Lee, Dean A; Worth, Laura; Aisiku, Imoigele P; Choi, Huimahn A; Holcomb, John B; Kitagawa, Ryan S

    2017-04-01

    Preclinical studies using bone marrow derived cells to treat traumatic brain injury have demonstrated efficacy in terms of blood-brain barrier preservation, neurogenesis, and functional outcomes. Phase 1 clinical trials using bone marrow mononuclear cells infused intravenously in children with severe traumatic brain injury demonstrated safety and potentially a central nervous system structural preservation treatment effect. This study sought to confirm the safety, logistic feasibility, and potential treatment effect size of structural preservation/inflammatory biomarker mitigation in adults to guide Phase 2 clinical trial design. Adults with severe traumatic brain injury (Glasgow Coma Scale 5-8) and without signs of irreversible brain injury were evaluated for entry into the trial. A dose escalation format was performed in 25 patients: 5 controls, followed 5 patients in each dosing cohort (6, 9, 12 ×10(6) cells/kg body weight), then 5 more controls. Bone marrow harvest, cell processing to isolate the mononuclear fraction, and re-infusion occurred within 48 hours after injury. Patients were monitored for harvest-related hemodynamic changes, infusional toxicity, and adverse events. Outcome measures included magnetic resonance imaging-based measurements of supratentorial and corpus callosal volumes as well as diffusion tensor imaging-based measurements of fractional anisotropy and mean diffusivity of the corpus callosum and the corticospinal tract at the level of the brainstem at 1 month and 6 months postinjury. Functional and neurocognitive outcomes were measured and correlated with imaging data. Inflammatory cytokine arrays were measured in the plasma pretreatment, posttreatment, and at 1 and 6 month follow-up. There were no serious adverse events. There was a mild pulmonary toxicity of the highest dose that was not clinically significant. Despite the treatment group having greater injury severity, there was structural preservation of critical regions of interest

  19. The impact of acute hyponatraemia on severe traumatic brain injury in rats.

    PubMed

    Ke, C; Poon, W S; Ng, H K; Tang, N L; Chan, Y; Wang, J Y; Hsiang, J N

    2000-01-01

    The effect of experimental acute hyponatraemia on severe traumatic brain injury (TBI) was studied in a modified impact-acceleration model. The cortical contusional volume was quantified by image analysis on serial sections, injured axons were visualized and quantified by beta-Amyloid Precursor Protein (beta-APP) immunohistochemical staining. Regional brain water content was estimated by the wet-dry weight method. The experiment was conducted in Group I (injury only) and Group II (injury followed by acute hyponatraemia). Comparison between the two groups showed that acute hyponatraemia significantly increased contusional volume (3.24 +/- 0.70 mm3 vs. 1.80 +/- 0.65 mm3, P = 0.009) and the number of injured axons (128.7 +/- 44.3 vs. 41.7 +/- 50.1, P = 0.04) in the right thalamus & basal ganglia region. Water content of the brain stem region was also significantly increased by acute hyponatraemia (73.71 +/- 0.14% vs. 72.28 +/- 0.93%, P = 0.004). These results suggest that acute hyponatraemia potentiates secondary brain damage in severe TBI by augmentation of both focal contusion and diffuse axonal injury. The injured brain stem region is more susceptible to edema formation induced by experimental acute hyponatraemia.

  20. Potential role of soluble TRAIL in epithelial injury in children with severe RSV infection.

    PubMed

    Bem, Reinout A; Bos, Albert P; Wösten-van Asperen, Roelie M; Bruijn, Martijn; Lutter, Rene; Sprick, Martin R; van Woensel, Job B M

    2010-06-01

    Lower respiratory tract infection by respiratory syncytial virus (RSV) is a frequent cause of acute lung injury in young children and infants. Studies in adults and animals suggest that tumor necrosis factor receptor (TNFR) ligands may mediate lung injury by causing apoptosis of epithelial cells. The main goal of the present study was to determine whether the TNF-related apoptosis-inducing ligand (Apo2L/TRAIL) pathway may be implicated in epithelial injury during severe RSV infection in children. We report elevated levels of soluble (s)TRAIL released by leukocytes in bronchoalveolar lavage fluid (BALF) of patients with RSV-associated respiratory failure (n = 22) as compared with mechanically ventilated patients without pulmonary illness (n = 7). Primary bronchial epithelial cells of children without pulmonary disease obtained by nonbronchoscopic cytobrushing expressed both death receptors TRAIL-R1 and -R2, and were found to be susceptible for cell death by human recombinant sTRAIL in vitro. Furthermore, BALF from a patient with RSV induced cell death in these cells, which was partly attenuated by inhibiting TRAIL signaling. These data suggest that the TRAIL pro-apoptotic pathway may contribute to lung epithelial injury in severe RSV infection in children.

  1. Base excess as a predictor for injury severity in pediatric trauma patients.

    PubMed

    Levi, Yochai; Jeroukhimov, Igor; Peleg, Kobi; Rozenfeld, Michael; Shavit, Itai; Kozer, Eran

    2013-10-01

    Base excess is considered a predictor of mortality and severity of injury in trauma patients. Base excess had been widely examined in different settings. Only few studies have examined the role of base excess in pediatric trauma patients. To evaluate the value of admission base excess in pediatric trauma patients with respect to intensive care unit (ICU) admission rate and length of hospital stay. A retrospective study of pediatric trauma patients was conducted at a Level II trauma center. All patients aged 0-16 years for which a trauma team was activated over the years 2006-2009 were included. Study database included admission base excess, mechanism of injury, location and nature of injury, injury severity score, length of hospital stay, and ICU admission. The study group consisted of 359 patients. There was a weak linear correlation between admission base excess, length of stay in the hospital, and ICU admission. Base excess seemed to show a stronger correlation for the youngest age group (0-6 years) and no correlation for the middle age group. There was a positive but weak correlation (R Spearman = 0.26) between admission base excess and Injury Severity Score (ISS). However, 40% of the children with an ISS score >25 had normal admission base excess values. The area under the curve of the receiver operating characteristic curves of base excess for predicting ICU admission was 0.66. The admission base excess in pediatric trauma patients seems to be a weak prognostic factor in our facility. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Role of the maxillofacial surgeon in the management of severe ocular injuries after maxillofacial fractures

    PubMed Central

    Roccia, Fabio; Boffano, Paolo; Guglielmi, Valeria; Forni, Paolo; Cassarino, Emanuele; Nadalin, Juri; Fea, Antonio; Gerbino, Giovanni

    2011-01-01

    Aim: This study was designed to evaluate the incidence of severe ocular injuries associated to maxillofacial fractures and report their management in the Emergency Department. Patients and Methods: Among the 1779 patients admitted for maxillofacial fractures, those with partial or total loss of vision at the time of emergency consultation were included in the study. Data collected from the patients’ medical records included age, gender, mechanism of injury, location and type of facial fractures, type of ocular injuries and cause of blindness, methods of treatment, and days of hospitalization. Results: Forty patients (2.2%), 32 men and 8 women, ranging from 17 to 85 years of age, presented with severely reduced vision or blindness associated to fractures of the facial middle third with involvement of one or more orbital walls, mainly caused by motor vehicle and work accidents. In 18 patients, severe ocular injuries were determined by direct lesion of the globe, in 14 by direct or indirect traumatic optic neuropathy and in 8 by a retrobulbar hematoma. Direct lesion of the eyeball was treated by prompt repair or enucleation of the globe, though no or little recovery of vision was obtained. Ophthalmologic and/or maxillofacial treatment of the anterior compartment lesions of the eye allowed a partial or total recovery of the vision. A partial or total recovery of the vision was observed in almost all the patients with indirect traumatic optic neuropathy after administration of steroids according to NASCIS II protocol. Likewise, an evident improvement of the vision was obtained by immediate drainage of retrobulbar hematoma. Conclusions: Early diagnosis of the nature of the ophthalmic injury and treatment are important, and involvement of the ophthalmologist is mandatory. PMID:21769204

  3. Establishment of Quantitative Severity Evaluation Model for Spinal Cord Injury by Metabolomic Fingerprinting

    PubMed Central

    Yang, Hao; Cohen, Mitchell Jay; Chen, Wei; Sun, Ming-Wei; Lu, Charles Damien

    2014-01-01

    Spinal cord injury (SCI) is a devastating event with a limited hope for recovery and represents an enormous public health issue. It is crucial to understand the disturbances in the metabolic network after SCI to identify injury mechanisms and opportunities for treatment intervention. Through plasma 1H-nuclear magnetic resonance (NMR) screening, we identified 15 metabolites that made up an “Eigen-metabolome” capable of distinguishing rats with severe SCI from healthy control rats. Forty enzymes regulated these 15 metabolites in the metabolic network. We also found that 16 metabolites regulated by 130 enzymes in the metabolic network impacted neurobehavioral recovery. Using the Eigen-metabolome, we established a linear discrimination model to cluster rats with severe and mild SCI and control rats into separate groups and identify the interactive relationships between metabolic biomarkers in the global metabolic network. We identified 10 clusters in the global metabolic network and defined them as distinct metabolic disturbance domains of SCI. Metabolic paths such as retinal, glycerophospholipid, arachidonic acid metabolism; NAD–NADPH conversion process, tyrosine metabolism, and cadaverine and putrescine metabolism were included. In summary, we presented a novel interdisciplinary method that integrates metabolomics and global metabolic network analysis to visualize metabolic network disturbances after SCI. Our study demonstrated the systems biological study paradigm that integration of 1H-NMR, metabolomics, and global metabolic network analysis is useful to visualize complex metabolic disturbances after severe SCI. Furthermore, our findings may provide a new quantitative injury severity evaluation model for clinical use. PMID:24727691

  4. A kinetic energy model of two-vehicle crash injury severity.

    PubMed

    Sobhani, Amir; Young, William; Logan, David; Bahrololoom, Sareh

    2011-05-01

    An important part of any model of vehicle crashes is the development of a procedure to estimate crash injury severity. After reviewing existing models of crash severity, this paper outlines the development of a modelling approach aimed at measuring the injury severity of people in two-vehicle road crashes. This model can be incorporated into a discrete event traffic simulation model, using simulation model outputs as its input. The model can then serve as an integral part of a simulation model estimating the crash potential of components of the traffic system. The model is developed using Newtonian Mechanics and Generalised Linear Regression. The factors contributing to the speed change (ΔV(s)) of a subject vehicle are identified using the law of conservation of momentum. A Log-Gamma regression model is fitted to measure speed change (ΔV(s)) of the subject vehicle based on the identified crash characteristics. The kinetic energy applied to the subject vehicle is calculated by the model, which in turn uses a Log-Gamma Regression Model to estimate the Injury Severity Score of the crash from the calculated kinetic energy, crash impact type, presence of airbag and/or seat belt and occupant age.

  5. The effects of road-surface conditions, age, and gender on driver-injury severities.

    PubMed

    Morgan, Abigail; Mannering, Fred L

    2011-09-01

    Drivers' adaptation to weather-induced changes in roadway-surface conditions is a complex process that can potentially be influenced by many factors including age and gender. Using a mixed logit analysis, this research assesses the effects that age, gender, and other factors have on crash severities by considering single-vehicle crashes that occurred on dry, wet, and snow/ice-covered roadway surfaces. With an extensive database of single-vehicle crashes from Indiana in 2007 and 2008, estimation results showed that there were substantial differences across age/gender groups under different roadway-surface conditions. For example, for all females and older males, the likelihood of severe injuries increased when crashes occurred on wet or snow/ice surfaces-but for male drivers under 45 years of age, the probability of severe injuries decreased on wet and snow/ice surfaces - relative to dry-surface crashes. This and many other significant differences among age and gender groups suggest that drivers perceive and react to pavement-surface conditions in very different ways, and this has important safety implications. Furthermore, the empirical findings of this study highlight the value of considering subsets of data to unravel the complex relationships within crash-injury severity analysis.

  6. Truck-involved crashes injury severity analysis for different lighting conditions on rural and urban roadways.

    PubMed

    Uddin, Majbah; Huynh, Nathan

    2017-11-01

    This paper investigates factors affecting injury severity of crashes involving trucks for different lighting conditions on rural and urban roadways. It uses 2009-2013 Ohio crash data from the Highway Safety Information System. The explanatory factors include the occupant, vehicle, collision, roadway, temporal and environmental characteristics. Six separate mixed logit models were developed considering three lighting conditions (daylight, dark, and dark-lighted) on two area types (rural and urban). A series of log-likelihood ratio tests were conducted to validate that these six separate models by lighting conditions and area types are warranted. The model results suggest major differences in both the combination and the magnitude of impact of variables included in each model. Some variables were significant only in one lighting condition but not in other conditions. Similarly, some variables were found to be significant in one area type but not in other area type. These differences show that the different lighting conditions and area types do in fact have different contributing effects on injury severity in truck-involved crashes, further highlighting the importance of examining crashes based on lighting conditions on rural and urban roadways. Age and gender of occupant (who is the most severely injured in a crash), truck types, AADT, speed, and weather condition were found to be factors that have significantly different levels of impact on injury severity in truck-involved crashes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Biomarkers of lung epithelial injury and inflammation distinguish severe sepsis patients with acute respiratory distress syndrome.

    PubMed

    Ware, Lorraine B; Koyama, Tatsuki; Zhao, Zhiguo; Janz, David R; Wickersham, Nancy; Bernard, Gordon R; May, Addison K; Calfee, Carolyn S; Matthay, Michael A

    2013-10-24

    Despite recent modifications, the clinical definition of the acute respiratory distress syndrome (ARDS) remains non-specific, leading to under-diagnosis and under-treatment. This study was designed to test the hypothesis that a biomarker panel would be useful for biologic confirmation of the clinical diagnosis of ARDS in patients at risk of developing ARDS due to severe sepsis. This was a retrospective case control study of 100 patients with severe sepsis and no evidence of ARDS compared to 100 patients with severe sepsis and evidence of ARDS on at least two of their first four ICU days. A panel that included 11 biomarkers of inflammation, fibroblast activation, proteolytic injury, endothelial injury, and lung epithelial injury was measured in plasma from the morning of ICU day two. A backward elimination model building strategy on 1,000 bootstrapped data was used to select the best performing biomarkers for further consideration in a logistic regression model for diagnosis of ARDS. Using the five best-performing biomarkers (surfactant protein-D (SP-D), receptor for advanced glycation end-products (RAGE), interleukin-8 (IL-8), club cell secretory protein (CC-16), and interleukin-6 (IL-6)) the area under the receiver operator characteristic curve (AUC) was 0.75 (95% CI: 0.7 to 0.84) for the diagnosis of ARDS. The AUC improved to 0.82 (95% CI: 0.77 to 0.90) for diagnosis of severe ARDS, defined as ARDS present on all four of the first four ICU days. Abnormal levels of five plasma biomarkers including three biomarkers generated by lung epithelium (SP-D, RAGE, CC-16) provided excellent discrimination for diagnosis of ARDS in patients with severe sepsis. Altered levels of plasma biomarkers may be useful biologic confirmation of the diagnosis of ARDS in patients with sepsis, and also potentially for selecting patients for clinical trials that are designed to reduce lung epithelial injury.

  8. Factors prognosticating the outcome of decompressive craniectomy in severe traumatic brain injury: A Malaysian experience

    PubMed Central

    Sharda, Priya; Haspani, Saffari; Idris, Zamzuri

    2014-01-01

    Objective: The objective of this prospective cohort study was to analyse the characteristics of severe Traumatic Brain Injury (TBI) in a regional trauma centre Hospital Kuala Lumpur (HKL) along with its impact of various prognostic factors post Decompressive Craniectomy (DC). Materials and Methods: Duration of the study was of 13 months in HKL. 110 consecutive patients undergoing DC and remained in our centre were recruited. They were then analysed categorically with standard analytical software. Results: Age group have highest range between 12-30 category with male preponderance. Common mechanism of injury was motor vehicle accident involving motorcyclist. Univariate analysis showed statistically significant in referral area (P = 0.006). In clinical evaluation statistically significant was the motor score (P = 0.040), pupillary state (P = 0.010), blood pressure stability (P = 0.013) and evidence of Diabetes Insipidus (P < 0.001). In biochemical status the significant statistics included evidence of coagulopathy (P < 0.001), evidence of acidosis (P = 0.003) and evidence of hypoxia (P = 0.030). In Radiological sector, significant univariate analysis proved in location of the subdural clot (P < 0.010), location of the contusion (P = 0.045), site of existence of both type of clots (P = 0.031) and the evidence of edema (P = 0.041). The timing of injury was noted to be significant as well (P = 0.061). In the post operative care was, there were significance in the overall stability in intensive care (P < 0.001), the stability of blood pressure, cerebral perfusion pressure, pulse rates and oxygen saturation (all P < 0.001)seen individually, post operative ICP monitoring in the immediate (P = 0.002), within 24 hours (P < 0.001) and within 24-48 hours (P < 0.001) period, along with post operative pupillary size (P < 0.001) and motor score (P < 0.001). Post operatively, radiologically significant statistics included evidence of midline shift post operatively in the CT scan

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

    PubMed

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

    2016-11-01

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

  10. Evaluating the effectiveness of a participatory ergonomics approach in reducing the risk and severity of injuries from manual handling.

    PubMed

    Carrivick, Philip J W; Lee, Andy H; Yau, Kelvin K W; Stevenson, Mark R

    2005-06-22

    Manual handling is the greatest contributor to non-fatal injury and disease in the workplace, commonly accounting for one-third of national injury counts. Interventional strategies that have focused on selecting or modifying the worker have been ineffective in reducing injury risk. In recent times, participatory ergonomics has been widely adopted as a process to reduce the risk of injury from manual handling but it is not well validated as an intervention. This study evaluated the effectiveness of a participatory ergonomics risk assessment approach in reducing the rate and severity of injuries from manual and non-manual handling sustained by a cohort of 137 cleaners within a hospital setting. The date of injury and the workers' compensation claim cost and hours lost from work were obtained for each injury incurred during the 4-year pre-intervention and 3-year intervention period. The age, gender and hours worked were ascertained for every cleaner whether injured or not. Using generalized linear mixed modelling analysis, reductions of rate of injury by two-thirds, workers' compensation claim costs by 62% and hours lost by 35% for manual handling injuries were found to be associated with the intervention period. Although the cleaners experienced a significant intervention period reduction in non-manual handling injury rate, the corresponding changes in severity of injury were not significant. The success of the intervention supports the adoption of a participatory ergonomics approach in reducing the rate and consequence of injuries in the workplace.

  11. Fentanyl and Midazolam Are Ineffective in Reducing Episodic Intracranial Hypertension in Severe Pediatric Traumatic Brain Injury.

    PubMed

    Welch, Timothy P; Wallendorf, Michael J; Kharasch, Evan D; Leonard, Jeffrey R; Doctor, Allan; Pineda, Jose A

    2016-04-01

    To evaluate the clinical effectiveness of bolus-dose fentanyl and midazolam to treat episodic intracranial hypertension in children with severe traumatic brain injury. Retrospective cohort. PICU in a university-affiliated children's hospital level I trauma center. Thirty-one children 0-18 years of age with severe traumatic brain injury (Glasgow Coma Scale score of ≤ 8) who received bolus doses of fentanyl and/or midazolam for treatment of episodic intracranial hypertension. None. The area under the curve from high-resolution intracranial pressure-time plots was calculated to represent cumulative intracranial hypertension exposure: area under the curve for intracranial pressure above 20 mm Hg (area under the curve-intracranial hypertension) was calculated in 15-minute epochs before and after administration of fentanyl and/or midazolam for the treatment of episodic intracranial hypertension. Our primary outcome measure, the difference between predrug and postdrug administration epochs (Δarea under the curve-intracranial hypertension), was calculated for all occurrences. We examined potential covariates including age, injury severity, mechanism, and time after injury; time after injury correlated with Δarea under the curve-intracranial hypertension. In a mixed-effects model, with patient as a random effect, drug/dose combination as a fixed effect, and time after injury as a covariate, intracranial hypertension increased after administration of fentanyl and/or midazolam (overall aggregate mean Δarea under the curve-intracranial hypertension = +17 mm Hg × min, 95% CI, 0-34 mm Hg × min; p = 0.04). The mean Δarea under the curve-intracranial hypertension increased significantly after administration of high-dose fentanyl (p = 0.02), low-dose midazolam (p = 0.006), and high-dose fentanyl plus low-dose midazolam (0.007). Secondary analysis using age-dependent thresholds showed no significant impact on cerebral perfusion pressure deficit (mean Δarea under the curve

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

    PubMed

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

    2012-01-01

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

  13. Do seat belts and air bags reduce mortality and injury severity after car accidents?

    PubMed

    Cummins, Justin S; Koval, Kenneth J; Cantu, Robert V; Spratt, Kevin F

    2011-03-01

    We studied National Trauma Data Bank data to determine the effectiveness of car safety devices in reducing mortality and injury severity in 184,992 patients between 1988 and 2004. Safety device variables were seat belt used plus air bag deployed; only seat belt used; only air bag deployed; and, as explicitly coded, no device used. Overall mortality was 4.17%. Compared with the no-device group, the seat-belt-plus-air-bag group had a 67% reduction in mortality (adjusted odds ratio [AOR], 0.33; 99% confidence interval [CI], 0.28-0.39), the seatbelt- only group had a 51% mortality reduction (AOR, 0.49; 99% CI, 0.45-0.52), and the air-bag-only group had a 32% mortality reduction (AOR, 0.68, 99% CI, 0.57-0.80). Injury Severity Scores showed a similar pattern.

  14. [Hemodynamic correction in children with severe traumatic injuries by the means of transpulmonary hemodilution].

    PubMed

    Lekmanov, A U; Azovskiĭ, D K; Piliutnik, S F; Gegueva, E N

    2011-01-01

    The purpose of the research is t objectify the indications for use of catecholamines and/or change of the infusion therapy volume based on transpulmonary thermodilution in children with severe traumatic injuries. The examined group consisted of 22 children with thermal concomitant or isolated trauma and drowning. All the patents were transferred to the Intensive Care Unit from other hospitals. Hemodynamic parameter estimation was based upon transpulmonary thermodilution. Results indicate, that based upon dynamic assessment of cardiac output, preload (global end diastolic volume index) and postload (systemic vascular resistance index) it is possible to carry out an early targeted correction of the fluid therapy and chose the right type of inotorpic support. Transpulmonary thermodilution in children with severe traumatic injuries allows achieving optimal parameters of blood circulation just 24 hours after its adaption.

  15. Successful treatment of inverted Takotsubo cardiomyopathy after severe traumatic brain injury with milrinone after dobutamine failure.

    PubMed

    Mrozek, Ségolène; Srairi, Mohamed; Marhar, Fouad; Delmas, Clément; Gaussiat, François; Abaziou, Timothée; Larcher, Claire; Atthar, Vincent; Menut, Rémi; Fourcade, Olivier; Geeraerts, Thomas

    2016-01-01

    Takotsubo cardiomyopathy can occur at the early phase of severe acute brain injuries. In the case of cardiac output decrease or shock, the optimal treatment is still a matter of debate. Due to massive stress hormone release, the infusion of catecholamines may have limited effects and may even aggravate cardiac failure. Other inotropic agents may be an option. Levosimendan has been shown to have potential beneficial effects in this setting, although milrinone has not been studied. We report a case of a young female presenting with inverted Takotsubo cardiomyopathy syndrome after severe traumatic brain injury. Due to hemodynamic instability and increasing levels of infused norepinephrine, dobutamine infusion was begun but rapidly stopped due to tachyarrhythmia. Milrinone infusion stabilized the patient's hemodynamic status and improved cardiac output without deleterious effects. Milrinone could be a good alternative when inotropes are required in Takotsubo cardiomyopathy and when dobutamine infusion is associated with tachyarrhythmia. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. JSNT-Guidelines for the Management of Severe Head Injury (Abridged edition).

    PubMed

    Shima, Katsuji; Aruga, Tohru; Onuma, Takehide; Shigemori, Minoru

    2010-01-01

    The aim of this article is to introduce the principal part of the JSNT-guidelines for the management of severe head injury in adults. The JSNT-guidelines were developed in 2000 by the Guidelines Committee of the Japan Society of Neurotraumatology (JSNT) based on the results of literature review and the Committee consensus. The guidelines updated in 2006 consist of 7 topics pertaining not only to prehospital care, initial, ICU and surgical management, but also the management of pediatric and geriatric patients. The JSNT-guidelines are of practical nature accounting for the difference in the medical system and conditions in Japan, but in their essence they are similar to those of Western countries. Reports on the application of these guidelines indicate their positive affect on the results of management of severe head injury.

  17. Disproportionately severe memory deficit in relation to normal intellectual functioning after closed head injury.

    PubMed Central

    Levin, H S; Goldstein, F C; High, W M; Eisenberg, H M

    1988-01-01

    The presence of disproportionate memory impairment with relatively preserved intellectual functioning was examined in 87 survivors of moderate or severe closed head injury. Approximately one-fourth of the patients tested at 5 to 15 and/or 16 to 42 months after injury manifested defective memory on both auditory and pictorial measures despite obtaining Wechsler Verbal and Performance Intelligence Quotients within the average range. The findings indicate that disproportionately severe memory deficit persists in a subgroup of closed head injured survivors which is reminiscent in some cases of the amnesic disturbance arising from other causes. Evaluation of long term memory in relation to cognitive ability could potentially identify important distinctions for prognosis and rehabilitation in head injured patients. PMID:3225586

  18. Disproportionately severe memory deficit in relation to normal intellectual functioning after closed head injury.

    PubMed

    Levin, H S; Goldstein, F C; High, W M; Eisenberg, H M

    1988-10-01

    The presence of disproportionate memory impairment with relatively preserved intellectual functioning was examined in 87 survivors of moderate or severe closed head injury. Approximately one-fourth of the patients tested at 5 to 15 and/or 16 to 42 months after injury manifested defective memory on both auditory and pictorial measures despite obtaining Wechsler Verbal and Performance Intelligence Quotients within the average range. The findings indicate that disproportionately severe memory deficit persists in a subgroup of closed head injured survivors which is reminiscent in some cases of the amnesic disturbance arising from other causes. Evaluation of long term memory in relation to cognitive ability could potentially identify important distinctions for prognosis and rehabilitation in head injured patients.

  19. Occupant-level injury severity analyses for taxis in Hong Kong: A Bayesian space-time logistic model.

    PubMed

    Meng, Fanyu; Xu, Pengpeng; Wong, S C; Huang, Helai; Li, Y C

    2017-11-01

    This study aimed to identify the factors affecting the crash-related severity level of injuries in taxis and quantify the associations between these factors and taxi occupant injury severity. Casualties resulting from taxi crashes from 2004 to 2013 in Hong Kong were divided into four categories: taxi drivers, taxi passengers, private car drivers and private car passengers. To avoid any biased interpretation caused by unobserved spatial and temporal effects, a Bayesian hierarchical logistic modeling approach with conditional autoregressive priors was applied, and four different model forms were tested. For taxi drivers and passengers, the model with space-time interaction was proven to most properly address the unobserved heterogeneity effects. The results indicated that time of week, number of vehicles involved, weather, point of impact and driver age were closely associated with taxi drivers' injury severity level in a crash. For taxi passengers' injury severity an additional factor, taxi service area, was influential. To investigate the differences between taxis and other traffic, similar models were established for private car drivers and passengers. The results revealed that although location in the network and driver gender significantly influenced private car drivers' injury severity, they did not influence taxi drivers' injury severity. Compared with taxi passengers, the injury severity of private car passengers was more sensitive to average speed and whether seat belts were worn. Older drivers, urban taxis and fatigued driving were identified as factors that increased taxi occupant injury severity in Hong Kong. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Loss of the Inducible Hsp70 Delays the Inflammatory Response to Skeletal Muscle Injury and Severely Impairs Muscle Regeneration

    PubMed Central

    Howard, Travis M.; Ahn, Bumsoo; Ferreira, Leonardo F.

    2013-01-01

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

  1. Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study.

    PubMed

    Tohme, Sophia; Delhumeau, Cecile; Zuercher, Mathias; Haller, Guy; Walder, Bernhard

    2014-01-07

    Severe traumatic brain injury (TBI) is a significant health concern and a major burden for society. The period between trauma event and hospital admission in an emergency department (ED) could be a determinant for secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors associated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of mortality and impaired consciousness of survivors at 14 days. A multicenter, prospective cohort study was performed in dedicated trauma centres of Switzerland. Adults with severe TBI (Abbreviated Injury Scale score of head region (HAIS) >3) were included. Main outcome measures were death and impaired consciousness (Glasgow Coma Scale (GCS) ≤13) at 14 days. The associations between risk factors and outcome were assessed with univariate and multivariate regression models. 589 patients were included, median age was 55 years (IQR 33, 70). The median GCS in ED was 4 (IQR 3-14), with abnormal pupil reaction in 167 patients (29.2%). Median ISS was 25 (IQR 21, 34). Three hundred seven patients sustained their TBI from falls (52.1%) and 190 from a road traffic accidents (32.3%). Median time from Out-of-hospital Emergency Medical Service (OHEMS) departure on scene to arrival in ED was 50 minutes (IQR 37-72); 451 patients had a direct admission (76.6%). Prehospital hypotension was observed in 24 (4.1%) patients, hypoxemia in 73 (12.6%) patients and hypothermia in 146 (24.8%). Prehospital hypotension and hypothermia (apart of age and trauma severity) was associated with mortality. Prehospital hypoxemia (apart of trauma severity) was associated with impaired consciousness; indirect admission was a protective factor. Mortality and impaired consciousness at 14 days do not have the same prehospital risk factors; prehospital hypotension and hypothermia is associated with mortality, and prehospital hypoxemia with impaired consciousness.

  2. Treatment of Adult Severe Traumatic Brain Injury Using Autologous Bone Marrow Mononuclear Cells

    DTIC Science & Technology

    2014-12-01

    AD_________________ Award Number: W81XWH-11-1-0460 TITLE: TREATMENT OF ADULT SEVERE TRAUMATIC BRAIN INJURY USING AUTOLOGOUS BONE MARROW ...AUTOLOGOUS BONE MARROW MONONUCLEAR CELLS” 5a. CONTRACT NUMBER 5b. GRANT NUMBER: W81XWH-11-1-0460 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Charles S. Cox...Our primary hypothesis is that bone marrow mononuclear cell (BMMNC) autologous transplantation after TBI is safe. Our secondary hypothesis is that

  3. Immune endocrinological evaluation in patients with severe vascular acquired brain injuries: therapeutical approaches.

    PubMed

    Amico, Angelo Paolo; Terlizzi, Annamaria; Annamaria, Terlizzi; Megna, Marisa; Marisa, Megna; Megna, Gianfranco; Gianfranco, Megna; Damiani, Sabino; Sabino, Damiani

    2013-06-01

    It is known that in severe acquired brain injuries there is process of neuroinflammation, with the activation of a local and general stress response. In our study we considered six patients with disorders of consciousness (five in vegetative state and one in minimal consciousness state) in subacute phase, which had both a clinical assessment and a functional imaging (fMRI): in all these patients we analised blood levels of osteopontin (OPN), a cytokin involved in neuroinflammation but also in neurorepair with a still discussed role. Besides we studied the lymphocyte subsets and blood levels of some hormones (ADH, ACTH, PRL, GH, TSH, fT3, fT4). We found a positive correlation between the levels of serum osteopontin (higher than normal in all subjects) and the severity of the brain injury, especially for prognosis: actually, the patient with the lowest level has emerged from minimal consciousness state, while the one with the highest level has died a few days after the evaluation. The lymphocyte subset was altered, with a general increase of CD4+/CD3+ ratio, but without a so strict correlation with clinical severity; the only hormone with a significant increase in the worse patients was prolactin. In fMRI we detected some responses to visual and acoustic stimuli also in vegetative states, which had no clinical response to this kind of stimulation but generally have had a better prognosis. So we conclude that osteopontin could be a good marker of neuroinflammation and relate to a worse prognosis of brain injuries; the lymphocyte alterations in these disorders are