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

PubMed

Genese, Josephine Sun

2013-07-01

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

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

PubMed

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

2010-04-20

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

Information needs of patients with whiplash associated disorders: A Delphi study of patient beliefs.

PubMed

Sterling, Joanna; Maujean, Annick; Sterling, Michele

2018-02-01

Whiplash associated disorders (WAD) result in significant personal and economic costs. Patient education and reassurance are recommended treatments for acute WAD but the information needs of patients have not been investigated. To determine what information whiplash-injured patients believe is important to help recovery in the acute stage of injury. A Delphi design survey series with three rounds. Thirty-three participants who had sustained a whiplash injury within the last three years were invited to participate. Participants were asked to provide five statements, in response to an open-ended question, regarding what they believed was the most important information to provide to patients following a whiplash injury. Nineteen patients responded and 85 statements were collected and reviewed independently by two of the authors to remove duplicates. The importance of the remaining items was rated by the participants in the second survey round. Items rated by >50% of participants as important were included in the third survey round. To be deemed key information, >80% of participants had to rate an item as important in this final round. Eighteen items met the criteria for key information. These points addressed four areas: assessment and treatment, recovery and symptoms, patient attitudes during treatment and relationships with health practitioners. The key information points endorsed by patients in this study may provide useful information to constitute a basis for reassurance and education provided to patients with WAD. The results also suggest that improved relationships between patients with whiplash and health practitioners is required. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

PubMed

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

2012-08-20

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

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

PubMed

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

2017-12-01

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

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

PubMed

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

2011-04-01

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

Do X-ray-occult fractures play a role in chronic pain following a whiplash injury?

PubMed

Hertzum-Larsen, Rasmus; Petersen, Henrik; Kasch, Helge; Bendix, Tom

2014-08-01

Whiplash trauma in motor vehicle accidents (MVA) may involve various painful soft tissue damages, but weeks/months later a minority of victims still suffers from various long-lasting and disabling symptoms, whiplash-associated disorders (WAD). The etiology is currently unknown, but X-ray-occult fractures may be one cause in some cases. The purpose of this prospective study was to examine the association between occult fractures, as seen on bone single photon emission computed tomography (SPECT), with neck-, head- and arm pain. An inception cohort of 107 patients presenting with acute whiplash symptoms following an MVA was invited to have a cervical SPECT shortly post injury and again 6 months later. Associations between occult fractures and pain levels at baseline, 6 and 12 months of follow-up were analyzed. Eighty-eight patients had baseline SPECT performed at median 15 days (range 3-28) post injury, but only 49 patients accepted to have the follow-up SPECT at 6 months. Abnormal SPECT, defined as minimum one area of focal uptake, was seen in 32 patients at baseline, reflecting an occult fracture. Occult fractures were not associated with pain levels, neither at baseline nor at follow-up. Occult fractures do not seem to play a role for development of chronic pain after whiplash.

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

PubMed Central

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

2012-01-01

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

WHIPLASH INJURIES—Diagnosis and Treatment

PubMed Central

Huddleston, O. Leonard

1958-01-01

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

Acupuncture treatment of whiplash injury.

PubMed

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

2004-01-01

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

Whiplash and Whiplash Associated Disorder (WAS)

MedlinePlus

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

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

PubMed

Ivancic, Paul C

2011-12-01

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

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

PubMed

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

2016-09-01

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

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

PubMed Central

Winkelstein, Beth A.

2011-01-01

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

Cervical muscle area measurements in acute whiplash patients and controls.

PubMed

Ulbrich, Erika J; Anderson, Suzanne E; Busato, Andre; Abderhalden, Susanne; Boesch, Chris; Zimmermann, Heinz; Heini, Paul; Hodler, Juerg; Sturzenegger, Matthias

2011-03-01

To quantitatively compare the muscle cross-sectional areas (CSAs) of the cervical muscles in symptomatic acute whiplash patients versus healthy controls. We hypothesized, that symptomatic whiplash patients have smaller cervical muscle CSAs than matched controls and that smaller cervical muscle CSAs in women might explain that women more frequently are symptomatic after whiplash injury than men. Prospective controlled study. Thirty-eight consecutive acute whiplash patients were examined within 48 h after a motor vehicle accident and 38 healthy age- and sex-matched controls, each half female, half male, were examined with the same protocol. MRI CSA measurements were performed of the deep and total cervical extensor muscles as well as the sternocleidomastoid muscles using transversal STIR (Short T1 Inversion Recovery) sequences on level C2, C4, and C5 by two blinded raters. Clinical symptoms were assessed with patient questionnaires (EuroQuol 5D, Specific Whiplash Questionnaire, head- and neck pain intensity [VAS]). Agreement of measurements between the two raters was high (intraclass correlation 0.52 to 0.85 for the different levels). No significant difference in age and body mass index were seen between patients and controls and the distribution of genders across groups was identical. There were no significant differences between patients and controls for all CSAs. Women had consistently smaller CSAs than men. The CSAs showed no significant correlation with the pain intensity of neck pain and headache but a consistent tendency of less neck pain and more headache with greater CSAs. This small study provides no evidence that subjects with smaller CSAs of cervical extensor muscles have a higher risk in developing symptoms after a whiplash injury and confirms smaller CSA in women. Copyright © 2011 Wiley-Liss, Inc.

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

PubMed

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

1998-12-09

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

Cognitive function and distress after common whiplash injury.

PubMed

Smed, A

1997-02-01

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

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

PubMed Central

Haneline, Michael T.

2009-01-01

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

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

PubMed

Geldman, Mark; Moore, Ann; Cheek, Liz

2008-04-01

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

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

PubMed

Guo, Ying; Jia, Lian-shun

2011-07-01

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

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

PubMed

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

2004-09-01

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

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

PubMed Central

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

2007-01-01

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

Alterations of the transverse ligament: an MRI study comparing patients with acute whiplash and matched control subjects.

PubMed

Ulbrich, Erika Jasmin; Eigenheer, Sandra; Boesch, Chris; Hodler, Juerg; Busato, André; Schraner, Christian; Anderson, Suzanne E; Bonel, Harald; Zimmermann, Heinz; Sturzenegger, Matthias

2011-10-01

The objective of our study was to evaluate whether there is injury to the transverse ligament of the atlas in patients with acute whiplash. Ninety patients with an acute (< 48 hours) symptomatic whiplash-associated injury and 90 healthy age- and sex-matched asymptomatic control subjects (mean age of patients and control subjects, 36 years) were included. The maximal sagittal thickness of the transverse ligament was measured on midsagittal T1 volumetric interpolated breath-hold examination (VIBE) images and transverse reformatted VIBE images. The signal intensity of the transverse ligament was measured on transverse STIR images and on transverse reformatted T1 VIBE images before and after IV administration of gadoterate. Contrast between the transverse ligament and CSF and alterations of contrast after gadoterate injection were calculated. Patients had a minimally thicker transverse ligament (posttraumatic swelling) than control subjects, and the difference in thickness was significant in men only (p = 0.03). In patients, a significant signal alteration of the transverse ligament (p = 0.03) was seen on STIR (posttraumatic edema) and native VIBE sequences. The contrast between the transverse ligament and the CSF on VIBE images was significantly (p = 0.005) lower in patients than in control subjects. With the application of a contrast agent, the contrast difference between the transverse ligament and CSF in patients and control subjects was less pronounced (p = 0.038). There was no abnormal uptake of contrast agent by the transverse ligament or CSF. The results of our study indicate possible involvement of the transverse ligament in whiplash injury. Although MRI may be helpful to study injury-related changes of anatomic structures in cohorts, it is not suited for individual diagnosis because the alterations are too small.

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

PubMed Central

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

2009-01-01

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

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

PubMed

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

2012-01-01

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

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

PubMed

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

2006-07-01

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

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

PubMed

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

2013-09-01

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

The risk assessment score in acute whiplash injury predicts outcome and reflects biopsychosocial factors.

PubMed

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

2011-12-01

One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls. This study investigates a priori determined potential risk factors to develop a risk assessment tool, for which the expediency was examined. The whiplash-associated disorders (WAD) grading system that emerged from The Quebec Task-Force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining biopsychosocial disability after whiplash and new predictive factors, for example, risk criteria that comprehensively differentiate acute WLP in a biopsychosocial manner are needed. Consecutively, 141 acute WLP and 40 ankle-injured recruited from emergency units were examined after 1 week, 1, 3, 6, and 12 months obtaining neck/head visual analog scale score, number of nonpainful complaints, epidemiological, social, psychological data and neurological examination, active neck mobility, and furthermore muscle tenderness and pain response, and strength and duration of neck muscles. Risk factors derived (reduced cervical range of motion, intense neck pain/headache, multiple nonpain complaints) were applied in a risk assessment score and divided into seven risk strata. A receiver operating characteristics curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90. Risk strata and number of sick days showed a log-linear relationship. In stratum 1 full recovery was encountered, but for high-risk patients in stratum 6 only 50% and 7 only 20% had returned to work after 1 year (P < 5.4 × 10). Strength measures, psychophysical pain measurements, and psychological and social data (reported elsewhere) showed significant relation to risk strata. The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury. It has reasonable screening power for encountering work disability and reflects the biopsychosocial nature of whiplash injuries.

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

PubMed Central

Juan, Francisco J

2004-01-01

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

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

PubMed

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

2003-07-01

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

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

PubMed Central

2011-01-01

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

Antinociceptive reflex alteration in acute posttraumatic headache following whiplash injury.

PubMed

Keidel, M; Rieschke, P; Stude, P; Eisentraut, R; van Schayck, R; Diener, H

2001-06-01

Brainstem-mediated antinociceptive inhibitory reflexes of the temporalis muscle were investigated in 82 patients (47 F, 35 M, mean age 28.3 years, SD 9.4) with acute posttraumatic headache (PH) following whiplash injury but without neurological deficits, bone injury of the cervical spine or a combined direct head trauma on average 5 days after the acceleration trauma. Latencies and durations of the early and late exteroceptive suppression (ES1 and ES2) and the interposed EMG burst (IE) of the EMG of the voluntarily contracted right temporalis muscle evoked by ipsilateral stimulation of the second and third branches of the trigeminal nerve were analyzed and compared to a cohort of 82 normal subjects (43 F, 39 M, mean age 27.7 years, SD 7.1). Highly significant reflex alterations were found in patients with PH with a shortening of ES2 duration with delayed onset and premature ending as the primary parameter of this study, a moderate prolongation of ES1 and IE duration and a delayed onset of IE. The latency of ES1 was not significantly changed. These findings indicate that acute PH in whiplash injury is accompanied by abnormal antinociceptive brainstem reflexes. We conclude that the abnormality of the trigeminal inhibitory temporalis reflex is based on a transient dysfunction of the brainstem-mediated reflex circuit mainly of the late polysynaptic pathways. The reflex abnormalities are considered as a neurophysiological correlate of the posttraumatic (cervico)-cephalic pain syndrome. They point to an altered central pain control in acute PH due to whiplash injury.

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

PubMed Central

Conforti, Maria; Fachinetti, Giorgio Paolo

2013-01-01

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

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

PubMed

Conforti, Maria; Fachinetti, Giorgio Paolo

2013-04-01

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

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

PubMed Central

Yeung, Euson; Tong, Tiffany; Reed, Nick

2018-01-01

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

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

PubMed

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

1994-12-01

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

[Whiplash-associated disorders].

PubMed

Schmid, P

1999-09-25

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

Special issue : neck injuries and rear-end crashes

DOT National Transportation Integrated Search

1999-05-22

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

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

PubMed Central

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

2011-01-01

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

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

PubMed

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

2012-01-01

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

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

PubMed

Noll-Hussong, Michael

2017-03-27

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

Early mobilization of acute whiplash injuries.

PubMed Central

Mealy, K; Brennan, H; Fenelon, G C

1986-01-01

Acute whiplash injuries are a common cause of soft tissue trauma for which the standard treatment is rest and initial immobilisation with a soft cervical collar. Because the efficacy of this treatment is unknown a randomised study in 61 patients was carried out comparing the standard treatment with an alternative regimen of early active mobilisation. Results showed that eight weeks after the accident the degree of improvement seen in the actively treated group compared with the group given standard treatment was significantly greater for both cervical movement (p less than 0.05) and intensity of pain (p less than 0.0125). PMID:3081211

[Medical and legal considerations in whiplash injury].

PubMed

Castillo-Chávez, Miguel Angel

2013-01-01

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

Whiplash causes increased laxity of cervical capsular ligament

PubMed Central

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

2009-01-01

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

Localized cervical facet joint kinematics under physiological and whiplash loading.

PubMed

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

2005-12-01

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

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

PubMed

McKay, D C; Christensen, L V

1998-10-01

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

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

PubMed Central

2017-01-01

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

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

PubMed

Fice, Jason B; Cronin, Duane S

2012-04-05

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

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

PubMed

Kissel, W

1999-10-28

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

[Chronic whiplash syndrome--an overview].

PubMed

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

2002-05-20

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

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

PubMed

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

2004-03-01

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

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

PubMed

Kivioja, Jouko; Jensen, Irene; Lindgren, Urban

2005-08-01

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

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

PubMed

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

2016-08-01

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

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

PubMed Central

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

2013-01-01

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

Whiplash evokes descending muscle recruitment and sympathetic responses characteristic of startle

PubMed Central

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

2014-01-01

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

Measurement of cervical flexor endurance following whiplash.

PubMed

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

2005-07-22

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

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

PubMed

Ludolph, E; Meindl, U

1990-08-01

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

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

DTIC Science & Technology

2005-10-01

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

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

PubMed

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

2011-07-01

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

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

PubMed

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

2018-01-17

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

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

PubMed

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

2011-01-01

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

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

PubMed

Bergholm, Ulla; Johansson, Bengt H

2003-11-20

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

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

PubMed Central

2011-01-01

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

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

PubMed

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

2011-08-01

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

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

PubMed

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

2015-07-01

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

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

PubMed

Evans, Randolph W

2010-04-01

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

PubMed Central

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

2011-01-01

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

Neck ligament strength is decreased following whiplash trauma

PubMed Central

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

2006-01-01

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

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

PubMed

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

2003-07-12

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

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

PubMed

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

2001-07-01

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

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

DTIC Science & Technology

1975-09-01

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

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

PubMed

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

2000-04-01

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

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

PubMed

Zhang, Xiaowei; Zhou, Qing

2016-01-01

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

[Whiplash lesions and temporomandibular joint disorders].

PubMed

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

2004-11-01

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

Risk of cervical injuries in mixed martial arts.

PubMed

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

2005-07-01

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

Risk of cervical injuries in mixed martial arts

PubMed Central

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

2005-01-01

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

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

PubMed

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

2001-04-01

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

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

PubMed

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

2004-05-01

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

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

PubMed Central

2010-01-01

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

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

PubMed

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

2016-04-01

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

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

PubMed

Treleaven, Julia; Jull, Gwendolen; Sterling, Michele

2003-01-01

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

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

PubMed

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

2001-01-01

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

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

PubMed

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

2016-10-01

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

Altered perception of distorted visual feedback occurs soon after whiplash injury: an experimental study of central nervous system processing.

PubMed

Daenen, Liesbeth; Nijs, Jo; Roussel, Nathalie; Wouters, Kristien; Cras, Patrick

2012-01-01

Sensory and motor system dysfunctions have been documented in a proportion of patients with acute whiplash associated disorders (WAD). Sensorimotor incongruence may occur and hence, may explain pain and other sensations in the acute stage after the trauma. The present study aimed at (1) evaluating whether a visually mediated incongruence between sensory feedback and motor output increases symptoms and triggers additional sensations in patients with acute WAD, (2) investigating whether the pattern of sensations in response to sensorimotor incongruence differs among patients suffering from acute and chronic WAD, and healthy controls. Experimental study. Patients with acute WAD were recruited within one month after whiplash injury via the emergency department of a local Red Cross medical care unit, the Antwerp University Hospital, and through primary care practices. Patients with chronic WAD were recruited through an advertisement on the World Wide Web and from the medical database of a local Red Cross medical care unit. Healthy controls were recruited from among the university college staff, family members, and acquaintances of the researchers. Thirty patients with acute WAD, 35 patients with chronic WAD, and 31 healthy persons were subjected to a coordination test. They performed congruent and incongruent arm movements while viewing a whiteboard or mirror. RESULTS. Twenty-eight patients with acute WAD reported sensations such as pain, tightness, feeling of peculiarity, and tiredness at some stage of the test protocol. No significant differences in frequencies and intensities of sensations were found between the various test stages (P > .05). Significantly more sensations were reported during the incongruent mirror stage compared to the incongruent control stage (P < .05). The pattern in intensity of sensations across the congruent and incongruent stages was significantly different between the WAD groups and the control group. The course and prognostic value of susceptibility to sensorimotor incongruence after an acute whiplash trauma are not yet clear from these results. A prospective longitudinal study with an expanded study population is needed to investigate if those with a lowered threshold to visually mediated sensorimotor incongruence in the acute stage are at risk to develop persistent pain and disability. Patients with acute WAD present an exacerbation of symptoms and additional sensations in response to visually mediated changes during action. These results indicate an altered perception of distorted visual feedback and suggest altered central sensorimotor nervous system processing in patients with acute WAD.

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

PubMed Central

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

2011-01-01

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

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

PubMed

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

2014-01-01

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

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

PubMed

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

2006-02-01

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

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

PubMed

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

2007-11-01

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

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

PubMed

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

2012-01-01

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

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

PubMed

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

2008-09-18

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

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

PubMed

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

2007-04-01

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

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

PubMed

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

2015-07-01

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

Neck pain

MedlinePlus

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

Acute whiplash-associated disorders (WAD): the effects of early mobilization and prognostic factors in long-term symptomatology.

PubMed

Söderlund, A; Olerud, C; Lindberg, P

2000-10-01

To compare two different home exercise programmes for patients with acute whiplash-associated disorders (WAD). A further aim was to describe the initial prognostic variables related to self-reported pain at six months follow-up. A randomized treatment study with a follow-up period of six months. The study was undertaken in an orthopaedic clinic at a university hospital. A total of 59 symptomatic (neck pain, stiffness, etc.) patients with acute whiplash injury. Patients were randomized to a regular treatment group (RT group) and an additional-exercise treatment group (AT group). Pain Disability Index (PDI), Self-Efficacy Scale (SES), Coping Strategies Questionnaire (CSQ), neck range of motion (ROM), head posture, kinaesthetic sensibility, visual analogue scale (VAS). Patients given an additional exercise did not improve more than patients with regular treatment. Only one CSQ item, 'Ability to decrease pain', showed a significant difference between the groups in its pattern of change over time: the AT group had a significant increase between three and six months whilst values in the RT group decreased. Nonsymptomatic patients at six months follow-up were characterized by initially better self-efficacy, lower disability and significantly different patterns in the use of 'behavioural coping strategies' when compared with symptomatic patients. The nonsymptomatic patients also reported more frequent training than symptomatic patients, i.e. they complied better with the treatment regime. This home exercise programme, including training of neck and shoulder ROM, relaxation and general advice seems to be sufficient treatment for acute WAD patients when used on a daily basis. Additionally, patients reporting low self-efficacy and high disability levels may profit from more attention initially, as these psychological factors are significant predictors of pain at long-term follow-up.

An Attempt of Early Detection of Poor Outcome after Whiplash

PubMed Central

Laporte, Sebastien; Wang, Danping; Lecompte, Jennyfer; Blancho, Sophie; Sandoz, Baptiste; Feydy, Antoine; Lindberg, Pavel; Adrian, Julien; Chiarovano, Elodie; de Waele, Catherine; Vidal, Pierre-Paul

2016-01-01

The main concern with whiplash is that a large proportion of whiplash patients experience disabling symptoms or whiplash-associated disorders (WAD) for months if not years following the accident. Therefore, identifying early prognostic factors of WAD development is important as WAD have widespread clinical and economic consequences. In order to tackle that question, our study was specifically aimed at combining several methods of investigation in the same WAD patients at the acute stage and 6 months later. Our longitudinal, open, prospective, multi-center study included 38 whiplash patients, and 13 healthy volunteers matched for age, gender, and socio-economic status with the whiplash group. Whiplash patients were evaluated 15–21 days after road accident, and 6 months later. At each appointment, patients underwent a neuropsychological evaluation, a full clinical neurological examination, neurophysiological and postural tests, oto-neurological tests, cervical spine cord magnetic resonance imaging (MRI) with tractography (DTI). At 6 months, whiplash patients were categorized into two subgroups based on the results of the Diagnostic and Statistical Manual of Mental Disorders as having either favorable or unfavorable progression [an unfavorable classification corresponding to the presence of post-concussion symptom (PCS)] and we searched retrospectively for early prognostic factors of WAD predicting the passage to chronicity. We found that patients displaying high level of catastrophizing at the acute stage and/or post-traumatic stress disorder associated with either abnormalities in head or trunk kinematics, abnormal test of the otolithic function and at the Equitest or a combination of these syndromes, turned to chronicity. This study suggests that low-grade whiplash patients should be submitted as early as possible after the trauma to neuropsychological and motor control tests in a specialized consultation. In addition, they should be evaluated by a neuro-otologist for a detailed examination of vestibular functions, which should include cervical vestibular evoked myogenic potential. Then, if diagnosed at risk of WAD, these patients should be subjected to an intensive preventive rehabilitation program, including vestibular rehabilitation if required. PMID:27812348

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

PubMed

Klobas, Luciano; Axelsson, Susanna; Tegelberg, Ake

2006-11-01

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

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

PubMed

Descarreaux, Martin; Mayrand, Nancy; Raymond, Jean

2007-01-01

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

Stressful events and coping related to acute and sub-acute whiplash-associated disorders.

PubMed

Pettersson, Susanne; Bring, Annika; Åsenlöf, Pernilla

2017-03-01

Purpose To describe daily stressors affecting and coping strategies employed by individuals with whiplash-associated disorders (WAD) immediately to one month (acute) and three to four months (sub-acute) after injury events using a daily coping assessment. Levels of pain, anxiety, depressed mood and activity are also compared between phases. Method A descriptive prospective design with a content analysis approach was used. Participants completed daily coping assessments for one week during both acute and sub-acute phases. Main measure was whiplash-associated disorders-daily coping assessment (WAD-DCA). Results Nine participants used words describing recovery in the sub-acute phase; 31 described stressful events during both phases. Most frequently reported stressors were related to "symptoms", "emotions" and "occupations/studies". These were equally reported during both phases. Cognitive coping strategies were employed more often during the sub-acute phase (p = 0.008). The only behavioral strategy that increased in prevalence over time was the "relaxed" strategy (p = 0.001). Anxiety levels declined over time (p = 0.022). Conclusion The reported stressors were largely uniform across both acute and sub-acute phases; however, the use of cognitive coping strategies increased over time. The WAD-DCA captures individual stressors and coping strategies employed during a vulnerable phase of rehabilitation and can thus provide information that is useful to clinical practice. Implications for rehabilitation The WAD-DCA provides valuable information for clinical practice when employed during early phases of whiplash-associated disorder development. Reported stressors during the acute and sub-acute phases are essentially the same, whereas cognitive coping strategies grow in prevalence over time. Tailored treatments in early phases of whip-lash associated disorders may benefit from strategies aimed at matching patient-specific stressors with contextually adapted coping strategies.

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

PubMed

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

2000-01-01

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

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

DTIC Science & Technology

2008-01-01

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

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

PubMed

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

2016-01-01

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

Energy-absorbing car seat designs for reducing whiplash.

PubMed

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

2008-12-01

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

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

PubMed Central

Siegmund, Gunter P; Blouin, Jean-Sébastien

2009-01-01

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

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

PubMed

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

2015-10-16

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

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

PubMed

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

2001-10-01

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

Seat design principles to reduce neck injuries in rear impacts.

PubMed

Viano, David C

2008-12-01

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

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

PubMed

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

2005-01-01

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

Responsiveness of pain and disability measures for chronic whiplash.

PubMed

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

2007-03-01

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

Neck pain.

PubMed

Binder, Allan I

2008-08-04

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

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

PubMed

Revel, M

2003-04-01

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

Parameterization of Injury Victim Condition as a Function of Time

DTIC Science & Technology

1976-05-01

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

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

PubMed

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

2016-04-01

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

Patterns of acute whiplash-associated disorder in the Lithuanian population after road traffic accidents.

PubMed

Pajediene, Evelina; Janusauskaite, Jolita; Samusyte, Gintaute; Stasaitis, Kestutis; Petrikonis, Kestutis; Bileviciute-Ljungar, Indre

2015-01-01

To investigate acute whiplash-associated disorder in the Lithuanian population who are unaware of the phenomenon. Controlled cohort study. Seventy-one patients were enrolled from the emergency departments of the Kaunas region of Lithuania following road traffic accidents, examined within 3-14 days after the accident, and compared with 53 matched controls. Clinical neurological examination, including range of motion and motion-evoked pain or stiffness in the neck; spontaneous pain and pain pressure threshold. Questionnaires: Quebec Task Force questionnaire (QTFQ); Disability Rating Index (DRI); Cognitive Failures Questionnaire (CFQ); Hospital Anxiety and Depression Scale (HADS) and health perception. Sixty-six of 71 (93%) patients developed acute symptoms. The most frequent symptoms found after road traffic accidents were neck or shoulder pain; reduced or painful neck movements, including decreased range of motion; multiple subjective symptoms according to QTFQ and significantly reduced pain threshold. Perceived health status was decreased and DRI was increased, while HADS showed a significantly higher risk of developing anxiety. Higher grade whiplash-associated disorder was linked with a greater reduction in range of motion and more prominent neck pain. Road traffic accidents induce whiplash-associated disorder in patients who seek help, but who are unaware of the condition whiplash-associated disorder. Whiplash-associated disorder should be considered and treated as an entity per se.

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

PubMed

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

2003-04-01

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

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

PubMed

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

2008-06-01

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

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

DTIC Science & Technology

2007-04-01

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

TMJ disorders

MedlinePlus

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

Treatment of neck and shoulder pain in whip-lash syndrome patients with intracutaneous sterile water injections.

PubMed

Byrn, C; Borenstein, P; Linder, L E

1991-01-01

Ten whip-lash syndrome patients treated with intracutaneous triggerpoint injections with sterile water for pain relief were followed for 2 months. Pain intensity was evaluated with the Visual Analogue Scale (VAS). Eight patients became free from pain (VAS 0) and two patients improved to VAS 2 immediately after the treatment. Nine patients remained free from pain, three of them after one treatment, while six patients needed 2-4 treatments. One patient responded only a few hours after each of three treatments. Remarkably, with the relief of pain mobility was normalised in all patients. The method is suggested to be a first choice in the treatment of not only whip-lash patients but also for most acute and chronic musculo-skeletal triggerpoint pain syndromes.

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

PubMed

Woodhouse, Astrid; Liljebäck, Pål; Vasseljen, Ottar

2010-01-01

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

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

PubMed

Thuile, Ch; Walzl, M

2002-01-01

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

Burnout in Patients with Chronic Whiplash-Associated Disorders

ERIC Educational Resources Information Center

Clementz, Gunilla; Borsbo, Bjorn; Norrbrink, Cecilia

2012-01-01

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

Vestibular rehabilitation in a patient with whiplash-associated disorders.

PubMed

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

2006-12-01

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

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

PubMed

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

2016-07-01

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

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

PubMed

Flanders, Kelsey; Feldner, Heather

2017-10-01

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

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

PubMed

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

2015-12-01

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

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

PubMed

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

2018-05-01

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

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

PubMed Central

2010-01-01

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

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

PubMed

Krohne, Kariann; Ihlebaek, Camilla

2010-07-13

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

[Postural control disorders in initial phases of whiplash].

PubMed

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

2009-05-02

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

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

PubMed Central

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

2017-01-01

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

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

PubMed Central

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

2007-01-01

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

Traumatic hyphaema: a report of 472 consecutive cases.

PubMed

Ashaye, Adeyinka O

2008-11-26

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

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

PubMed

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

2003-01-01

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

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

PubMed

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

2010-04-01

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

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

PubMed Central

Huang, H.; Nightingale, R. W.

2018-01-01

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

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

PubMed

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

2018-01-01

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

Whiplash: pathophysiology, diagnosis, treatment, and prognosis.

PubMed

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

2004-06-01

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

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

PubMed

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

2012-01-01

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

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

PubMed

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

2016-07-20

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

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

PubMed

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

2011-11-01

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

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

DTIC Science & Technology

2014-07-01

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

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

PubMed

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

2007-01-01

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

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

PubMed

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

2011-03-15

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

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

PubMed

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

2015-06-01

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

Whiplash and the compensation hypothesis.

PubMed

Spearing, Natalie M; Connelly, Luke B

2011-12-01

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

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

PubMed

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

2016-08-03

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

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

PubMed Central

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

2016-01-01

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

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

NASA Astrophysics Data System (ADS)

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

2016-08-01

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

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

PubMed

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

2009-06-01

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

[Management of patients with simple cervical distortions].

PubMed

Foletti, G; Regli, F

1995-11-11

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

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

PubMed

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

2004-01-01

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

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

PubMed

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

2007-04-01

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

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

PubMed

Schuster, Corina; McCaskey, Michael; Ettlin, Thierry

2013-03-14

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

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

PubMed

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

2010-01-01

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

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

PubMed

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

2012-02-01

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

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

PubMed

Rosenfeld, Mark; Seferiadis, Aris; Gunnarsson, Ronny

2006-07-15

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

Spinal cord stress injury assessment (SCOSIA): clinical applications of mechanical modeling of the spinal cord and brainstem

NASA Astrophysics Data System (ADS)

Wong, Kenneth H.; Choi, Jae; Wilson, William; Berry, Joel; Henderson, Fraser C., Sr.

2009-02-01

Abnormal stretch and strain is a major cause of injury to the spinal cord and brainstem. Such forces can develop from age-related degeneration, congenital malformations, occupational exposure, or trauma such as sporting accidents, whiplash and blast injury. While current imaging technologies provide excellent morphology and anatomy of the spinal cord, there is no validated diagnostic tool to assess mechanical stresses exerted upon the spinal cord and brainstem. Furthermore, there is no current means to correlate these stress patterns with known spinal cord injuries and other clinical metrics such as neurological impairment. We have therefore developed the spinal cord stress injury assessment (SCOSIA) system, which uses imaging and finite element analysis to predict stretch injury. This system was tested on a small cohort of neurosurgery patients. Initial results show that the calculated stress values decreased following surgery, and that this decrease was accompanied by a significant decrease in neurological symptoms. Regression analysis identified modest correlations between stress values and clinical metrics. The strongest correlations were seen with the Brainstem Disability Index (BDI) and the Karnofsky Performance Score (KPS), whereas the weakest correlations were seen with the American Spinal Injury Association (ASIA) scale. SCOSIA therefore shows encouraging initial results and may have wide applicability to trauma and degenerative disease involving the spinal cord and brainstem.

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

PubMed

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

2006-11-01

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

Biomechanical analyses of whiplash injuries using an experimental model.

PubMed

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

2002-09-01

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

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

PubMed

Peterson, Seth

2015-01-01

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

Practice Safe Driving.

PubMed

2017-07-01

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

Addition of lateral bending range of motion measurement to standard sagittal measurement to improve diagnosis sensitivity of ligamentous injury in the human lower cervical spine.

PubMed

Leahy, P Devin; Puttlitz, Christian M

2016-01-01

This study examined the cervical spine range of motion (ROM) resulting from whiplash-type hyperextension and hyperflexion type ligamentous injuries, and sought to improve the accuracy of specific diagnosis of these injuries. The study was accomplished by measurement of ROM throughout axial rotation, lateral bending, and flexion and extension, using a validated finite element model of the cervical spine that was modified to simulate hyperextension and/or hyperflexion injuries. It was found that the kinematic difference between hyperextension and hyperflexion injuries was minimal throughout the combined flexion and extension ROM measurement that is commonly used for clinical diagnosis of cervical ligamentous injury. However, the two injuries demonstrated substantially different ROM under axial rotation and lateral bending. It is recommended that other bending axes beyond flexion and extension are incorporated into clinical diagnosis of cervical ligamentous injury.

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

PubMed

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

2012-09-01

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

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

PubMed

Berry, Gunnel; Svarovska, Beth

2014-08-01

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

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

PubMed

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

2018-06-01

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

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

PubMed

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

2013-09-01

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

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

PubMed

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

2007-10-01

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

Aircrew Automated Escape Systems (AAES) In-Service Usage Data Analyses. Volume 2. Papers Presented at the Annual SAFE Symposium (21st), San Antonio, Texas, 5,6,7,8 November 1983.

DTIC Science & Technology

1983-11-05

PILOT OF HIS INJURY AND PILOT RETURNED TO BASE RIO SUSTAINED MINIMAL ( WHIPLASH ) INJURY CAUSE WEIGHT OF HELMET AND MASK ON RiO’S HEAD WHILE IN...John Vetter (ESA-31 Division Head ). As has most unfortunately, despite the best of intentions of the team members to, for once, present the drafts...WARMINSTER NAVAIRTESTCEN (SY-70) PAXRIV NAVWPNCEN (64) CHINA LAKE NAVORDSTA (51) INDIAN HEAD NAVSAFECEN NORFOLK AFISC/SEL NORTON AFB,CA PACMISTESTCEN 1131 U.S

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

PubMed Central

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

2017-01-01

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

Does injury compensation lead to worse health after whiplash? A systematic review.

PubMed

Spearing, Natalie M; Connelly, Luke B; Gargett, Susan; Sterling, Michele

2012-06-01

One might expect that injury compensation would leave injured parties better off than they would otherwise have been, yet many believe that compensation does more harm than good. This study systematically reviews the evidence on this "compensation hypothesis" in relation to compensable whiplash injuries. PubMed, CINAHL, EMBASE, PEDro, PsycInfo, CCTR, Lexis, and EconLit were searched from the date of their inception to April 2010 to locate longitudinal studies, published in English, comparing the health outcomes of adults exposed/not exposed to compensation-related factors. Studies concerning serious neck injuries, using claimants only, or using proxy measures of health outcomes were excluded. Eleven studies were included. These examined the effect of lawyer involvement, litigation, claim submission, or previous claims on pain and other health outcomes. Among the 16 results reported were 9 statistically significant negative associations between compensation-related factors and health outcomes. Irrespective of the compensation-related factor involved and the health outcome measured, the quality of these studies was similar to studies that did not find a significant negative association: most took some measures to address selection bias, confounding, and measurement bias, and none resolved the potential for reverse causality bias that arises in the relationship between compensation-related factors and health. Unless ambiguous causal pathways are addressed, one cannot draw conclusions from statistical associations, regardless of their statistical significance and the extent of measures to address other sources of bias. Consequently, there is no clear evidence to support the idea that compensation and its related processes lead to worse health. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Assessing the existence of dissociative PTSD in sub-acute patients of whiplash.

PubMed

Hansen, Maj; Hyland, Philip; Armour, Cherie; Andersen, Tonny E

2018-03-16

Numerous studies investigating dissociative posttraumatic stress disorder (D-PTSD) have emerged. However, there is a lack of studies investigating D-PTSD following a wider range of traumatic exposure. Thus, the present study investigates D-PTSD using latent class analysis (LCA) in sub-acute patients of whiplash and associated risk factors. The results of LCA showed a three-class solution primarily distributed according to posttraumatic stress disorder (PTSD) symptom severity and thus no indication of D-PTSD. Dissociative symptoms, psychological distress (i.e. anxiety/depression), and pain severity significantly predicted PTSD severity. Combined, the results support the component model of dissociation and PTSD, while still stressing the importance of dissociative symptoms when planning treatment for PTSD.

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

PubMed

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

1976-08-01

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

Simulation of Blast on Porcine Head

DTIC Science & Technology

2015-07-01

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

Models of Cerebral System Mechanics.

DTIC Science & Technology

1986-07-20

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

Analytical Prediction of Turbulent Heat Transfer Parameters.

DTIC Science & Technology

1985-04-01

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

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

PubMed

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

2014-01-01

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

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

PubMed

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

2003-06-01

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

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

PubMed

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

2013-02-01

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

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

PubMed

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

2003-12-01

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

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

PubMed

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

2015-03-01

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

Mild Head Trauma and Chronic Headaches in Returning US Soldiers

DTIC Science & Technology

2009-04-01

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

Anthropometry. A Bibliography with Abstracts

DTIC Science & Technology

1975-08-01

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

Optimal designs for prediction studies of whiplash.

PubMed

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

2011-12-01

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

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

PubMed

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

2017-08-11

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

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

PubMed

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

2015-06-01

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

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

PubMed Central

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

2011-01-01

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

Sick Leave within 5 Years of Whiplash Trauma Predicts Recovery: A Prospective Cohort and Register-Based Study

PubMed Central

Carstensen, Tina Birgitte Wisbech; Fink, Per; Oernboel, Eva; Kasch, Helge; Jensen, Troels Staehelin; Frostholm, Lisbeth

2015-01-01

Background 10–22% of individuals sustaining whiplash trauma develop persistent symptoms resulting in reduced working ability and decreased quality of life, but it is poorly understood why some people do not recover. Various collision and post-collision risk factors have been studied, but little is known about pre-collision risk factors. In particular, the impact of sickness and socioeconomic factors before the collision on recovery is sparsely explored. The aim of this study was to examine if welfare payments received within five years pre-collision predict neck pain and negative change in provisional situation one year post-collision. Methods and Findings 719 individuals with acute whiplash trauma consecutively recruited from emergency departments or primary care after car accidents in Denmark completed questionnaires on socio-demographic and health factors immediately after the collision. After 12 months, a visual analogue scale on neck pain intensity was completed. 3595 matched controls in the general population were sampled, and national public register data on social benefits and any other welfare payments were obtained for participants with acute whiplash trauma and controls from five years pre-collision to 15 months after. Participants with acute whiplash trauma who had received sickness benefit for more than 12 weeks pre-collision had increased odds for negative change in future provisional situation (Odds Ratio (OR) (95% Confidence Interval (CI) = 3.8 (2.1;7.1)) and future neck pain (OR (95%CI) = 3.3 (1.8;6.3)), controlling for other known risk factors. Participants with acute whiplash trauma had weaker attachment to labour market (more weeks of sick leave (χ2(2) = 36.7, p < 0.001) and unemployment (χ2(2) = 12.5, p = 0.002)) pre-collision compared with controls. Experiencing a whiplash trauma raised the odds for future negative change in provisional situation (OR (95%CI) = 3.1 (2.3;4.4)) compared with controls. Conclusions Sick leave before the collision strongly predicted prolonged recovery following whiplash trauma. Participants with acute whiplash trauma had weaker attachment to labour market pre-collision compared with the general population. Neck pain at inclusion predicted future neck pain. Acute whiplash trauma may trigger pre-existing vulnerabilities increasing risk of developing whiplash-associated disorders. PMID:26098860

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

PubMed Central

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

2015-01-01

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

Kinematics of a Head-Neck Model Simulating Whiplash

NASA Astrophysics Data System (ADS)

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

2008-02-01

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

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

PubMed

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

2011-01-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-07-13

Whiplash-associated disorder (WAD) causes substantial social and economic burden internationally. Up to 60% of patients with WAD progress to chronicity. Research therefore needs to focus on effective management in the acute stage to prevent the development of chronicity. Approximately 93% of patients are classified as WADII (neck complaint and musculoskeletal sign(s)), and in the UK, most are managed in the private sector. In our recent systematic review, a combination of active and behavioural physiotherapy was identified as potentially effective in the acute stage. An Active Behavioural Physiotherapy Intervention (ABPI) was developed through combining empirical (modified Delphi study) and theoretical (social cognitive theory focusing on self-efficacy) evidence. This pilot and feasibility trial has been designed to inform the design of an adequately powered definitive randomised controlled trial. Two parallel phases. (1) An external pilot and feasibility cluster randomised double-blind (assessor and participants), parallel two-arm (ABPI vs standard physiotherapy) clinical trial to evaluate procedures and feasibility. Six UK private physiotherapy clinics will be recruited and cluster randomised by a computer-generated randomisation sequence. Sixty participants (30 each arm) will be assessed at recruitment (baseline) and at 3 months postbaseline. The planned primary outcome measure is the neck disability index. (2) An embedded exploratory qualitative study using semistructured indepth interviews (n=3-4 physiotherapists) and a focus group (n=6-8 patients) and entailing the recruitment of purposive samples will explore perceptions of the ABPI. Quantitative data will be analysed descriptively. Qualitative data will be coded and analysed deductively (identify themes) and inductively (identify additional themes). This trial is approved by the University of Birmingham Ethics Committee (ERN_15-0542). ISRCTN84528320. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Temporomandibular joint injury potential imposed by the low-velocity extension-flexion maneuver.

PubMed

Howard, R P; Hatsell, C P; Guzman, H M

1995-03-01

It has been proposed that significant temporomandibular joint injury can occur as a result of rapid extension-flexion motion of the neck (whip-lash). This motion, which is experienced by passengers in vehicles that undergo rear-end collisions, has been described as causing rapid protrusion and opening of the mandible. It has been speculated that this relative motion between the mandible and the cranium produces forces at the temporomandibular joint (TMJ) that injure the articular elements. The objective of this study was to measure these forces by an experimental method. Accelerometer sensor and high-speed cinematographic data were obtained from the kinematic responses of live human test subjects positioned as occupants in motor vehicles that underwent staged low-velocity rear-end collisions. Linear and moment forces generated at the TMJs were obtained from the resultant acceleration pulse at the craniomandibular complex, estimation of the mass properties of the mandible and its appended soft tissues, and the application of Newton's Second Law of motion. The maximum linear forces generated at the TMJ in a rear-end collision resulting in a velocity change of the test subject of 8 km/h (5 mph) were in the 7 to 10 N (1.6 to 2.2 lb) range. Moment forces at the joint peaked briefly at 0.55 N.m (4.81 lb-in). These force magnitudes generated at the TMJ constitute a minor fraction of the forces experienced at the joint during normal physiologic function. It is a conclusion of this study that injuries to the TMJ attributed to low-velocity "whiplash" cannot be accounted for by the joint forces produced by this maneuver.

The Effect of Soft and Rigid Cervical Collars on Head and Neck Immobilization in Healthy Subjects.

PubMed

Barati, Kourosh; Arazpour, Mokhtar; Vameghi, Roshanak; Abdoli, Ali; Farmani, Farzad

2017-06-01

Whiplash injury is a prevalent and often destructive injury of the cervical column, which can lead to serious neck pain. Many approaches have been suggested for the treatment of whiplash injury, including anti-inflammatory drugs, manipulation, supervised exercise, and cervical collars. Cervical collars are generally divided into two groups: soft and rigid collars. The present study aimed to compare the effect of soft and rigid cervical collars on immobilizing head and neck motion. Many studies have investigated the effect of collars on neck motion. Rigid collars have been shown to provide more immobilization in the sagittal and transverse planes compared with soft collars. However, according to some studies, soft and rigid collars provide the same range of motion in the frontal plane. Twenty-nine healthy subjects aged 18-26 participated in this study. Data were collected using a three-dimensional motion analysis system and six infrared cameras. Eight markers, weighing 4.4 g and thickened 2 cm 2 were used to record kinematic data. According to the normality of the data, a paired t -test was used for statistical analyses. The level of significance was set at α=0.01. All motion significantly decreased when subjects used soft collars ( p <0.01). According to the obtained data, flexion and lateral rotation experienced the maximum (39%) and minimum (11%) immobilization in all six motions using soft collars. Rigid collars caused maximum immobilization in flexion (59%) and minimum immobilization in the lateral rotation (18%) and limited all motion much more than the soft collar. This study showed that different cervical collars have different effects on neck motion. Rigid and soft cervical collars used in the present study limited the neck motion in both directions. Rigid collars contributed to significantly more immobilization in all directions.

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

PubMed

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

2015-02-01

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

Kinematics of a Head-Neck Model Simulating Whiplash

ERIC Educational Resources Information Center

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

2008-01-01

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

Whiplash headache is transitory worsening of a pre-existing primary headache.

PubMed

Stovner, L J; Obelieniene, D

2008-07-01

Acute and chronic whiplash headache are new diagnostic entities in the ICHD-2 (5.3, 5.4). In a prospective cohort study, 210 rear-end collision victims were identified consecutively from police records and asked about head and neck pain in questionnaires after 2 weeks, 3 months and 1 year. The results were compared with those of matched controls who were also followed for 1 year. Of 210 accident victims, 75 developed headache within 7 days. Of these, 37 had also neck pain and complied with the criteria for acute whiplash headache. These 37 had the same headache diagnoses, headache features, accompanying symptoms and long-term prognosis as the 38 without initial neck pain who therefore did not comply with the acute whiplash headache diagnosis. Previous headache was a major risk factor for headache both in the acute and chronic stage. Compared with the non-traumatized controls, headache in the whiplash group had the same prevalence, the same diagnoses and characteristic features, and the same prognosis. Both acute and chronic whiplash headache lack specificity compared with the headache in a control group, and have the same long-term prognosis, indicating that such headaches are primary headaches, probably elicited by the stress of the situation.

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

PubMed

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

2004-02-01

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

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

PubMed

Ferrari, Robert; Shorter, Edward

2003-11-01

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

Expectations for Recovery Important in the Prognosis of Whiplash Injuries

PubMed Central

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

2008-01-01

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

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

PubMed

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

2007-02-01

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

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

PubMed

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

2001-01-01

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

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

PubMed

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

2015-01-01

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

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

PubMed

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

2014-01-01

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

Occipital Neuralgia Diagnosis and Treatment: The Role of Ultrasound.

PubMed

Narouze, Samer

2016-04-01

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

Factors influencing neck pain intensity in whiplash-associated disorders.

PubMed

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

2006-02-15

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

Whiplash (image)

MedlinePlus

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

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

PubMed

Åsenlöf, Pernilla; Bring, Annika; Söderlund, Anne

2013-12-21

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

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

PubMed

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

2009-02-01

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

A test-based method for the assessment of pre-crash warning and braking systems.

PubMed

Bálint, András; Fagerlind, Helen; Kullgren, Anders

2013-10-01

In this paper, a test-based assessment method for pre-crash warning and braking systems is presented where the effectiveness of a system is measured by its ability to reduce the number of injuries of a given type or severity in car-to-car rear-end collisions. Injuries with whiplash symptoms lasting longer than 1 month and MAIS2+ injuries in both vehicles involved in the crash are considered in the assessment. The injury reduction resulting from the impact speed reduction due to a pre-crash system is estimated using a method which has its roots in the dose-response model. Human-machine interaction is also taken into account in the assessment. The results reflect the self-protection as well as the partner-protection performance of a pre-crash system in the striking vehicle in rear-end collisions and enable a comparison between two or more systems. It is also shown how the method may be used to assess the importance of warning as part of a pre-crash system. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparison of car seats in low speed rear-end impacts using the BioRID dummy and the new neck injury criterion (NIC).

PubMed

Boström, O; Fredriksson, R; Håland, Y; Jakobsson, L; Krafft, M; Lövsund, P; Muser, M H; Svensson, M Y

2000-03-01

Long-term whiplash associated disorders (WAD) 1-3 sustained in low velocity rear-end impacts is the most common disability injury in Sweden. Therefore, to determine neck injury mechanisms and develop methods to measure neck-injury related parameters are of importance for current crash-safety research. A new neck injury criterion (NIC) has previously been proposed and evaluated by means of dummy, human and mathematical rear-impact simulations. So far, the criterion appears to be sensitive to the major car and collision related risk factors for injuries with long-term consequences. To further evaluate the applicability of NIC, four seats were tested according to a recently proposed sled-test procedure. 'Good' as well as 'bad' seats were chosen on the basis of a recently presented disability risk ranking list. The dummy used in the current tests was the Biofidelic Rear Impact Dummy (BioRID). The results of this study showed that NICmax values were generally related to the real-world risk of long-term WAD 1-3. Furthermore, these results suggested that NICmax calculated from sled tests using the BioRID dummy can be used for evaluating the neck injury risk of different car seats.

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

PubMed

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

2016-09-14

To develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI. Modified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round. Online international survey. A purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form. 36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus. Experts suggested and agreed the underlying principles and treatment components of the ABPI for the management of acute WADII. The ABPI was underpinned by social cognitive theory focusing on self-efficacy enhancement prior to conducting a phase II trial. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

PubMed

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

2015-04-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2017-09-01

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

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

PubMed

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

2001-06-01

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

Flagellate dermatitis after consumption of Shiitake mushrooms

PubMed Central

Kreft, Burkhard; Marsch, Wolfgang Ch.

2014-01-01

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

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

PubMed

Makarov, G V; Levin, O S

2004-01-01

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

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

PubMed

Treleaven, Julia; Jull, Gwendolen; Grip, Helena

2011-06-01

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

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

PubMed

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

2014-05-01

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

Mechanisms of cervical spine injuries for non-fatal motorcycle road crash.

PubMed

Ooi, S S; Wong, S V; Radin Umar, R S; Azhar, A A; Yeap, J S; Megat Ahmad, M M H

2004-06-01

Cervical spine injuries such as subluxation and fracture dislocation have long been known to result in severe consequences, as well as the trauma management itself. The injury to the region has been identified as one of the major causes of death in Malaysian motorcyclists involved in road crashes, besides head and chest injuries (Pang, 1999). Despite this, cervical spine injury in motorcyclists is not a well-studied injury, unlike the whiplash injury in motorcar accidents. The present study is a retrospective study on the mechanisms of injury in cervical spine sustained by Malaysian motorcyclists, who were involved in road crash using an established mechanistic classification system. This will serve as an initial step to look at the cervical injuries pattern. The information obtained gives engineer ideas to facilitate design and safety features to reduce injuries. All cervical spine injured motorcyclists admitted to Hospital Kuala Lumpur between January 1, 2000 and December 31, 2001 were included in the present study. Based on the medical notes and radiological investigations (X-rays, CT and MRI scans), the mechanisms of injuries were formulated using the injury mechanics classification. The result shows that flexion of the cervical vertebrae is the most common vertebral kinematics in causing injury to motorcyclists. This indicates that the cervical vertebrae sustained a high-energy loading at flexion movement in road crash, and exceeded its tolerance level. The high frequency of injury at the C5 vertebra, C6 vertebra and C5-C6 intervertebral space are recorded. Classification based on the Abbreviated Injury Scale (AIS) is made to give a view on injury severity, 9.1% of the study samples have been classified as AIS code 1, 51.5% with AIS 2 and 21.2% with AIS 3.

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

PubMed Central

2013-01-01

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

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

PubMed

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

2005-01-01

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

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

PubMed

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

2016-04-01

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

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

PubMed

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

2017-04-01

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

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

PubMed

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

2016-09-01

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

Average male and female virtual dummy model (BioRID and EvaRID) simulations with two seat concepts in the Euro NCAP low severity rear impact test configuration.

PubMed

Linder, Astrid; Holmqvist, Kristian; Svensson, Mats Y

2018-05-01

Soft tissue neck injuries, also referred to as whiplash injuries, which can lead to long term suffering accounts for more than 60% of the cost of all injuries leading to permanent medical impairment for the insurance companies, with respect to injuries sustained in vehicle crashes. These injuries are sustained in all impact directions, however they are most common in rear impacts. Injury statistics have since the mid-1960s consistently shown that females are subject to a higher risk of sustaining this type of injury than males, on average twice the risk of injury. Furthermore, some recently developed anti-whiplash systems have revealed they provide less protection for females than males. The protection of both males and females should be addresses equally when designing and evaluating vehicle safety systems to ensure maximum safety for everyone. This is currently not the case. The norm for crash test dummies representing humans in crash test laboratories is an average male. The female part of the population is not represented in tests performed by consumer information organisations such as NCAP or in regulatory tests due to the absence of a physical dummy representing an average female. Recently, the world first virtual model of an average female crash test dummy was developed. In this study, simulations were run with both this model and an average male dummy model, seated in a simplified model of a vehicle seat. The results of the simulations were compared to earlier published results from simulations run in the same test set-up with a vehicle concepts seat. The three crash pulse severities of the Euro NCAP low severity rear impact test were applied. The motion of the neck, head and upper torso were analysed in addition to the accelerations and the Neck Injury Criterion (NIC). Furthermore, the response of the virtual models was compared to the response of volunteers as well as the average male model, to that of the response of a physical dummy model. Simulations with the virtual male and female dummy models revealed differences in dynamic response related to the crash severity, as well as between the two dummies in the two different seat models. For the comparison of the response of the virtual models to the response of the volunteers and the physical dummy model, the peak angular motion of the first thoracic vertebra as found in the volunteer tests and mimicked by the physical dummy were not of the same magnitude in the virtual models. The results of the study highlight the need for an extended test matrix that includes an average female dummy model to evaluate the level of occupant protection different seats provide in vehicle crashes. This would provide developers with an additional tool to ensure that both male and female occupants receive satisfactory protection and promote seat concepts that provide the best possible protection for the whole adult population. This study shows that using the mathematical models available today can provide insights suitable for future testing. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

PubMed

Pedler, Ashley; Motlagh, Helena; Sterling, Michele

2013-02-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2016-12-01

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

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

PubMed

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

2017-07-01

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

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

PubMed

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

2015-10-01

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

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

PubMed

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

2004-12-10

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

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

PubMed

Woodhouse, Astrid; Stavdahl, Øyvind; Vasseljen, Ottar

2010-03-01

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

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

PubMed

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

2007-03-01

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

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

PubMed

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

1998-10-01

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

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

PubMed

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

2013-09-01

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

Psychological impact of injuries sustained in motor vehicle crashes: systematic review and meta-analysis.

PubMed

Craig, Ashley; Tran, Yvonne; Guest, Rebecca; Gopinath, Bamini; Jagnoor, Jagnoor; Bryant, Richard A; Collie, Alex; Tate, Robyn; Kenardy, Justin; Middleton, James W; Cameron, Ian

2016-09-08

The aim of this meta-analysis was to determine the psychological impact associated with motor vehicle crash (MVC)-related physical injuries. Systematic review and meta-analysis. Multiple search engines included MEDLINE (via OVID), PsycINFO and Embase, and studies were sourced from scientific journals, conference papers and doctoral theses. A high-yield search strategy was employed. Terms like 'psychological distress', 'depression', 'PTSD' and 'motor vehicle accident' were employed. These key words were run primarily and secondary searches were then conducted in association with the major injury types. Studies needed to compare psychological distress in people injured in an MVC with uninjured controls who had not recently experienced an MVC. Searches resulted in the identification of 2537 articles, and after eliminating duplicates and studies not meeting inclusion criteria, 24 studies were selected involving 4502 injured participants. These studies were entered into separate meta-analyses for mild to moderate traumatic brain injury (mTBI), whiplash-associated disorder (WAD) and spinal cord injury (SCI). Elevated psychological distress was associated with MVC-related injuries with a large summary effect size in WAD (0.90), medium to large effect size in SCI (0.69) and small to medium effect size in mTBI (0.23). No studies meeting inclusion criteria were found for burns, fractures and low back injury. Increased psychological distress remains elevated in SCI, mTBI and WAD for at least 3 years post-MVC. Rehabilitation strategies are needed to minimise distress subsequent to MVC-related physical injuries and the scientific robustness of studies requires improvement. 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/

Psychological impact of injuries sustained in motor vehicle crashes: systematic review and meta-analysis

PubMed Central

Tran, Yvonne; Guest, Rebecca; Gopinath, Bamini; Jagnoor, Jagnoor; Bryant, Richard A; Collie, Alex; Tate, Robyn; Kenardy, Justin; Middleton, James W; Cameron, Ian

2016-01-01

Objective The aim of this meta-analysis was to determine the psychological impact associated with motor vehicle crash (MVC)-related physical injuries. Design Systematic review and meta-analysis. Data sources Multiple search engines included MEDLINE (via OVID), PsycINFO and Embase, and studies were sourced from scientific journals, conference papers and doctoral theses. Study selection A high-yield search strategy was employed. Terms like ‘psychological distress’, ‘depression’, ‘PTSD’ and ‘motor vehicle accident’ were employed. These key words were run primarily and secondary searches were then conducted in association with the major injury types. Studies needed to compare psychological distress in people injured in an MVC with uninjured controls who had not recently experienced an MVC. Data extraction Searches resulted in the identification of 2537 articles, and after eliminating duplicates and studies not meeting inclusion criteria, 24 studies were selected involving 4502 injured participants. These studies were entered into separate meta-analyses for mild to moderate traumatic brain injury (mTBI), whiplash-associated disorder (WAD) and spinal cord injury (SCI). Results Elevated psychological distress was associated with MVC-related injuries with a large summary effect size in WAD (0.90), medium to large effect size in SCI (0.69) and small to medium effect size in mTBI (0.23). No studies meeting inclusion criteria were found for burns, fractures and low back injury. Increased psychological distress remains elevated in SCI, mTBI and WAD for at least 3 years post-MVC. Conclusions Rehabilitation strategies are needed to minimise distress subsequent to MVC-related physical injuries and the scientific robustness of studies requires improvement. PMID:27609849

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

PubMed

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

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

PubMed

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

2015-02-01

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

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

PubMed

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

2011-12-01

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

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

PubMed

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

2013-03-01

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

Head repositioning accuracy in patients with whiplash-associated disorders.

PubMed

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

2006-01-15

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

Visuo-proprioceptive interactions in degenerative cervical spine diseases requiring surgery.

PubMed

Freppel, S; Bisdorff, A; Colnat-Coulbois, S; Ceyte, H; Cian, C; Gauchard, G; Auque, J; Perrin, P

2013-01-01

Cervical proprioception plays a key role in postural control, but its specific contribution is controversial. Postural impairment was shown in whiplash injuries without demonstrating the sole involvement of the cervical spine. The consequences of degenerative cervical spine diseases are underreported in posture-related scientific literature in spite of their high prevalence. No report has focused on the two different mechanisms underlying cervicobrachial pain: herniated discs and spondylosis. This study aimed to evaluate postural control of two groups of patients with degenerative cervical spine diseases with or without optokinetic stimulation before and after surgical treatment. Seventeen patients with radiculopathy were recruited and divided into two groups according to the spondylotic or discal origin of the nerve compression. All patients and a control population of 31 healthy individuals underwent a static posturographic test with 12 recordings; the first four recordings with the head in 0° position: eyes closed, eyes open without optokinetic stimulation, with clockwise and counter clockwise optokinetic stimulations. These four sensorial situations were repeated with the head rotated 30° to the left and to the right. Patients repeated these 12 recordings 6weeks postoperatively. None of the patients reported vertigo or balance disorders before or after surgery. Prior to surgery, in the eyes closed condition, the herniated disc group was more stable than the spondylosis group. After surgery, the contribution of visual input to postural control in a dynamic visual environment was reduced in both cervical spine diseases whereas in a stable visual environment visual contribution was reduced only in the spondylosis group. The relative importance of visual and proprioceptive inputs to postural control varies according to the type of pathology and surgery tends to reduce visual contribution mostly in the spondylosis group. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

[Biomechanical aspects of cervical trauma].

PubMed

Walz, F; Meine, J

1994-07-01

The biomechanical expert opinion on the injury mechanism is necessary in few cases only. However, the judgement of these cases is extremely compromised if mechanically wrong terms are introduced in the clinical report. Since the injury mechanism in the neck is very complex the clinical physician should concentrate on the clinical findings familiar to him; usually the clinician lacks technical case documentation and specific training in injury biomechanics. The relevant mechanisms of neck injuries are an indirect trauma induced by a) a head contact leading to compression, hyperflexion, hyperextension and/or hypertranslation and b) a non-head-contact mechanism (hyperflexion or hyperextension, hypertranslation, acceleration). A non-contact mechanism occurs e.g. during a rear end impact without head restraint (hyperextension) or a frontal collision of a belted occupant (hyperflexion) without head impact. The term "whiplash" is misleading and incorrect: It presumes a virtually non existing two phase movement back and forth (or vice versa) like during the development of the crack of the whip. Secondly, it mixes the physical criterion mechanism with the anatomical or morphological criterion injury e.g. distortion, sprain etc. A (head)-contact mechanism is due to a corresponding momentum exerted from the head on the neck. Again, the anatomical or morphological terms are equal, but the mechanism is different. During a contact mechanism as well as during a non-contact mechanism not only a hyperflexion or a hyperextension can occur; in the first phase of the impact also a shearing force between the upper vertebral bodies (CO-C2) may load the intervertebral structures by hypertranslation.

The Physical Activity Scale for Individuals with Physical Disabilities: test-retest reliability and comparison with an accelerometer.

PubMed

van der Ploeg, Hidde P; Streppel, Kitty R M; van der Beek, Allard J; van der Woude, Luc H V; Vollenbroek-Hutten, Miriam; van Mechelen, Willem

2007-01-01

The objective was to determine the test-retest reliability and criterion validity of the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD). Forty-five non-wheelchair dependent subjects were recruited from three Dutch rehabilitation centers. Subjects' diagnoses were: stroke, spinal cord injury, whiplash, and neurological-, orthopedic- or back disorders. The PASIPD is a 7-d recall physical activity questionnaire that was completed twice, 1 wk apart. During this week, physical activity was also measured with an Actigraph accelerometer. The test-retest reliability Spearman correlation of the PASIPD was 0.77. The criterion validity Spearman correlation was 0.30 when compared to the accelerometer. The PASIPD had test-retest reliability and criterion validity that is comparable to well established self-report physical activity questionnaires from the general population.

Research paradigms in psychosomatic medicine with special emphasis on whiplash - cervical hyperextension flexion injury (CHFI).

PubMed

Merskey, Harold

2003-01-01

There have been a number of attempts, particularly in the last five decades to understand the origins of pain in terms of psychological or psychosomatic patterns. These include psychoanalytic explanations relying on hysterical mechanisms, and psychophysiological proposals. The occurrence of pain in the course of psychiatric illness and its remission after the illness, has long been known and is not a controversial issue. However, the reported explanations of pain without overt and obvious prior psychiatric illness have largely failed to convince a significant portion of the professional establishment. These explanations have very often coincided with the interests of insurance companies, whether those insurance companies were providing medical benefits, disability insurance or workers' or accident compensation. Critical examination of the evidence generated by insurance company related research indicates profound weaknesses in it.

New approach to evaluate rotation of cervical vertebrae

NASA Astrophysics Data System (ADS)

Hahn, Matthias

2001-07-01

Functional deficits after whiplash injury can be analyzed with a quite novel radiologic method by examination of joint-blocks in C0/1 and C1/2. Thereto the movability of C0, C1 and C2 is determined with three spiral CT-scans of the patient's cervical spine. One series in neutral and one in maximal active lateral right and left rotation each. Previous methods were slice based and time consuming when manually evaluated. We propose a new approach to a computation of these angles in 3D. After a threshold segmentation of bone tissue, a rough 2D classification takes place for C0, C1 and C2 in each rotation series. The center of an axial rotation for each vertebra is gained from the approximation of its center of gravity. The rotation itself is estimated by a cross-correlation of the radial distance functions. From the previous rotation the results are taken to initialize a 3D matching algorithm based on the sum of squared differences in intensity. The optimal match of the vertebrae is computed by means of the multidimensional Powell minimization algorithm. The three translational and three rotational components build a six-dimensional search-space. The vertebrae detection and rotation computation is done fully automatic.

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

PubMed

Freund, B J; Schwartz, M

2000-02-01

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

Developing biologically-based assessment tools for physical therapy management of neck pain.

PubMed

MacDermid, Joy C; Gross, Anita R; Galea, Victoria; McLaughlin, Laurie M; Parkinson, William L; Woodhouse, Linda J

2009-05-01

Neck pain is a common and episodic condition that is treated using a spectrum of interventions known to be moderately effective but is associated with a significant incidence of chronic pain. Recently, there has been increased focus on defining biological aspects of neck pain. Studies have indicated that neurophysiological, biomechanical, and motor control abnormalities are present and may be useful either in prognosis or classification. We review some of these findings in the context of our own work defining biological markers that may form the basis for clinical tests that can be used for prognosis, classification, or outcome evaluation in patients with neck pain. We have identified abnormalities in neurophysiology using quantitative sensory testing (vibration, touch, and current perception) and response to cold provocation that are related to neck disability. We have identified altered muscle biochemistry by measuring circulating muscle proteins in a lumbar surgery model and are now applying those methods to whiplash injury. We have incorporated capnography into treatment to address central physiological changes present in some patients by monitoring and training CO2 levels. We have developed an innovative new test, the Neck Walk Index, that captures abnormal control of head movement during slow gait as a means of differentiating patients with neck pain from either unaffected controls or individuals with other pathologies. We have used time-varying 3-dimensional joint orientation kinematics to assess deficits in motor control during an upper extremity reach task, the results showing that poor coordination and control of the shoulder girdle leads to shoulder guarding and inconsistencies in elbow joint movement. Despite some promising early results, future research is needed to determine how these measures help clinicians to diagnose, evaluate, and forecast future outcome for patients who present with neck pain. Diagnosis, level 5.

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

PubMed Central

2013-01-01

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

Two different courses of impaired cervical kinaesthesia following a whiplash injury. A one-year prospective study.

PubMed

Oddsdottir, Gudny Lilja; Kristjansson, Eythor

2012-02-01

A longitudinal study was conducted to observe persons with neck pain after motor vehicle collisions. The aims were to reveal the prospective development of cervical kinaesthesia and to investigate the association between the test results and self-reported pain and disabilities. Two different cervical kinaesthetic tests, the Fly test and the Head-Neck Relocation test, measured movement control and the relocation accuracy of the cervical spine, respectively. Self-assessment measures included pain intensity (VAS), neck pain and disability (NDI), fear of re-injury (TAMPA) and psychological distress (GHQ-28). Seventy-four subjects entered the study, but 47 were eligible, as they participated in all 4 measurements at 1, 3, 6 and 12 months post-collision. According to the performances on the two kinaesthetic tests, the subjects could be classified into improvement and non-improvement groups, respectively. The result revealed, for the first time, two different courses of deficient cervical kinaesthesia. About half of the participants showed significant deteriorating performances in both kinaesthetic tests throughout the year (p < 0.002), while the other half improved their performances (p < 0.02). Generally, the relationships between the kinaesthetic tests and the self-assessment scores were not significant, irrespective of the performances on the two kinaesthetic tests. Accordingly, the results of the questionnaires correlated poorly or weakly with the kinaesthetic test results at all assessment points. The need for developing a new questionnaire, capturing the symptoms prevalent in patients with neck pain and cervical sensorimotor impairments is urgent. What determines the two different kinaesthetic courses need to be scrutinised in future research. Copyright © 2011 Elsevier Ltd. All rights reserved.

Effective acupuncture practice through diagnosis based on distribution of meridian pathways & related syndromes.

PubMed

Chen, Yemeng; Zheng, Xin; Li, Hui; Zhang, Qunce; Wang, Tianfang

2011-01-01

This article discusses the importance of acupuncture practice utilizing diagnosis and distribution of various meridians and connecting channels based on meridian theory. The meridian system is considered as basic anatomy for acupuncture, so the corresponding pathways and related syndromes of different channels should play a key role in differentiation, known as meridian-related pattern differentiation. Since this doctrine originated in ancient times and was not so well developed in later generations, many acupuncturists are not able to utilize it efficiently. The authors survey how this doctrine was weakened during the past century, especially in acupuncture education for foreigners, and how this important method is currently being reinvigorated. This article also lays out the ways this doctrine can be applied clinically and introduces examples of a variety of indications including some difficult cases, such as whiplash injury, intervertebral disc herniation, oculomotor nerve paralysis, and eczema, etc.

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

PubMed

Severinsson, Yvonne; Bunketorp, Olle; Wenneberg, Bengt

2010-01-01

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

A Study of Impairing Injuries in Real World Crashes Using the Injury Impairment Scale (IIS) and the Predicted Functional Capacity Index (PFCI-AIS)

PubMed Central

Barnes, Jo; Morris, Andrew

2009-01-01

The ability to predict impairment outcomes in large databases using a simplified technique allows researchers to focus attention on preventing costly impairing injuries. The dilemma that exists for researchers is to determine which method is the most reliable and valid. This study examines available methods to predict impairment and explores the differences between the IIS and pFCI applied to real world crash injury data. Occupant injury data from the UK Co-operative Crash Injury Study (CCIS) database have been coded using AIS 1990 and AIS 2005. The data have subsequently been recoded using the associated impairment scales namely the Injury Impairment Scale (IIS) and the predicted Functional Capacity Index (pFCI) to determine the predicted impairment levels of injuries at one year post crash. Comparisons between the levels of impairment were made and any differences further explored. Injury data for the period February 2006 to September 2008 from the CCIS database were used in the analysis which involved a dataset of 2,437 occcupants who sustained over 8000 injuries. This study found some differences between the impairment scales for injuries coded to the AIS 1990 and AIS 2005 coding dictionaries. The pFCI predicts 31.5% of injuries to be impairing in AIS 2005, less than the IIS (38.5%) using AIS 1990. Using CCIS data the pFCI predicted that only 6% of the occupants with a coded injury would have an impairing injury compared to 24% of occupants using the IIS. The main body regions identified as having the major differences between the two impairment scales for car occupants were the head and spine. Follow up data were then used for a small number of cases (n=31, lower extremity and whiplash injuries) to examine any differences in predicted impairment versus perceived impairment. These data were selected from a previous study conducted between 2003 and 2006 and identified the discrepancy between predicted impairment and actual perceived impairment as defined by the participant. Overall the work highlights the variaton between the pFCI and IIS and emphasises the importance and need for a single validated impairment scale that can be universally applied. This would allow emphasis to be directed towards preventing injuries that are associated with the most significant impairment outcomes. PMID:20184844

A study of impairing injuries in real world crashes using the Injury Impairment Scale (IIS) and the predicted Functional Capacity Index (PFCI-AIS).

PubMed

Barnes, Jo; Morris, Andrew

2009-10-01

The ability to predict impairment outcomes in large databases using a simplified technique allows researchers to focus attention on preventing costly impairing injuries. The dilemma that exists for researchers is to determine which method is the most reliable and valid. This study examines available methods to predict impairment and explores the differences between the IIS and pFCI applied to real world crash injury data. Occupant injury data from the UK Co-operative Crash Injury Study (CCIS) database have been coded using AIS 1990 and AIS 2005. The data have subsequently been recoded using the associated impairment scales namely the Injury Impairment Scale (IIS) and the predicted Functional Capacity Index (pFCI) to determine the predicted impairment levels of injuries at one year post crash. Comparisons between the levels of impairment were made and any differences further explored. Injury data for the period February 2006 to September 2008 from the CCIS database were used in the analysis which involved a dataset of 2,437 occcupants who sustained over 8000 injuries. This study found some differences between the impairment scales for injuries coded to the AIS 1990 and AIS 2005 coding dictionaries. The pFCI predicts 31.5% of injuries to be impairing in AIS 2005, less than the IIS (38.5%) using AIS 1990. Using CCIS data the pFCI predicted that only 6% of the occupants with a coded injury would have an impairing injury compared to 24% of occupants using the IIS. The main body regions identified as having the major differences between the two impairment scales for car occupants were the head and spine. Follow up data were then used for a small number of cases (n=31, lower extremity and whiplash injuries) to examine any differences in predicted impairment versus perceived impairment. These data were selected from a previous study conducted between 2003 and 2006 and identified the discrepancy between predicted impairment and actual perceived impairment as defined by the participant. Overall the work highlights the variation between the pFCI and IIS and emphasises the importance and need for a single validated impairment scale that can be universally applied. This would allow emphasis to be directed towards preventing injuries that are associated with the most significant impairment outcomes.

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

PubMed

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

2016-03-01

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

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

PubMed

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

2012-03-01

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

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

PubMed

Sand, T; Bovim, G; Helde, G

1992-11-01

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

Increasing climate whiplash in 21st century California

NASA Astrophysics Data System (ADS)

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

2017-12-01

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

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

PubMed

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

2011-08-01

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

Research on injury compensation and health outcomes: ignoring the problem of reverse causality led to a biased conclusion.

PubMed

Spearing, Natalie M; Connelly, Luke B; Nghiem, Hong S; Pobereskin, Louis

2012-11-01

This study highlights the serious consequences of ignoring reverse causality bias in studies on compensation-related factors and health outcomes and demonstrates a technique for resolving this problem of observational data. Data from an English longitudinal study on factors, including claims for compensation, associated with recovery from neck pain (whiplash) after rear-end collisions are used to demonstrate the potential for reverse causality bias. Although it is commonly believed that claiming compensation leads to worse recovery, it is also possible that poor recovery may lead to compensation claims--a point that is seldom considered and never addressed empirically. This pedagogical study compares the association between compensation claiming and recovery when reverse causality bias is ignored and when it is addressed, controlling for the same observable factors. When reverse causality is ignored, claimants appear to have a worse recovery than nonclaimants; however, when reverse causality bias is addressed, claiming compensation appears to have a beneficial effect on recovery, ceteris paribus. To avert biased policy and judicial decisions that might inadvertently disadvantage people with compensable injuries, there is an urgent need for researchers to address reverse causality bias in studies on compensation-related factors and health. Copyright © 2012 Elsevier Inc. All rights reserved.

Associations with legal representation in a compensation setting 12 months after injury.

PubMed

Casey, Petrina P; Feyer, Anne Marie; Cameron, Ian D

2015-05-01

Many people with Whiplash Associated Disorder (WAD) seek treatment though a compensation system where factors such as legal involvement have been reported as having a negative impact on recovery outcomes. To compare those with and without legal involvement in their compensation claim, and identify associations with legal involvement at 12 months post injury; and longer term disability. Inception cohort study. 246 people with WAD compensation claim. Legal involvement and Functional Rating Index at 12 months post injury. Participants were recruited from an insurance database. Baseline health (Functional Rating Index, Pain Catastrophising Scale and SF-36), socio-economic, work capacity, and claims data were collected within three months of injury and 12 months. Logistic regression models were used to identify associations with legal involvement at 12 months; and disability (FRI) at 12 months. At baseline 246 participants were enrolled into the study in a median 72 days post injury. At 12 months post injury 52 (25%) had engaged a lawyer. The significant independent associations with legal involvement at 12 months were higher levels of initial disability, work disability, speaking a language other than English at home and lower levels of mental health. Specifically, the odds of lawyer involvement at 12 months post injury was 4.9 times greater for those with work disability; 2.3 times greater for those who spoke a language other than English at home. In terms of health, they had poorer mental health and for every 10 unit increase in the baseline FRI score the odds of having lawyer involvement increased by 38%. DISABILITY: at 12 months (FRI) was significantly independently associated with, PCS-helplessness (p<0.001), age (p<0.001) and prior claim (p=0.001). This study suggests the people with lawyer involvement in their claim 12 months after injury have socio-economic disadvantage, have had a prior claim and a worse baseline health profile compared to those without a lawyer. Understanding this profile could allow for improved claims processes and targeted interventions to assist this group through any perceived complexities in the system and address the underlying reasons for lawyer participation within compensation schemes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Altered motor control patterns in whiplash and chronic neck pain.

PubMed

Woodhouse, Astrid; Vasseljen, Ottar

2008-06-20

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

Altered motor control patterns in whiplash and chronic neck pain

PubMed Central

Woodhouse, Astrid; Vasseljen, Ottar

2008-01-01

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

The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

PubMed

Holm, Lena W; Carroll, Linda J; Cassidy, J David; Hogg-Johnson, Sheilah; Côté, Pierre; Guzman, Jamie; Peloso, Paul; Nordin, Margareta; Hurwitz, Eric; van der Velde, Gabrielle; Carragee, Eugene; Haldeman, Scott

2008-02-15

Best evidence synthesis. To undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic collisions. Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research. A systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published 1980-2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide the body of the best evidence synthesis. The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females. WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accurate denominators for calculating risk, and better consideration of confounding factors, are needed.

Thoracic dysfunction in whiplash associated disorders: A systematic review

PubMed Central

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

2018-01-01

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

Circummandibular Wires for Treatment of Dentoalveolar Fractures Adjacent to Edentulous Areas: A Report of Two Cases.

PubMed

Maloney, Karl

2015-09-01

In general, dentoalveolar fractures are a common injury seen in emergency departments, dental offices, and oral and maxillofacial surgery practices. These injuries can be the result of direct trauma or indirect trauma. Direct trauma more often causes trauma to the maxillary dentition due to the exposure of the maxillary anterior teeth. Indirect trauma is usually the result of forced occlusion secondary to a blow to the chin or from a whiplash injury. Falls are the most common mechanism of injury seen in the pediatric group. In adolescents, many of these fractures are sustained during sporting activities. However, the use of mouth guards and other protective equipment has decreased this number. Most adult injuries are caused by motor vehicle accidents, contact sports, falls, bicycles, interpersonal violence, medical/dental mishaps, and industrial accidents. Early intervention to reduce and stabilize the fracture is required to establish a bony union and ensure correct function. Most dentoalveolar fractures have bilateral stable adjacent dentition and are treated with a closed technique utilizing an acid-etch/resin splint followed by splint removal at 4 weeks. Other inferior stabilization treatments used are arch bars and other wiring techniques. It is widely accepted that semirigid stabilization techniques, such as an acid-etch/resin splint or wiring procedures, are adequate to treat dentoalveolar fractures. This is in contrast to the treatment of mandible fractures where AO principles of rigid fixation are often followed. Fractures that are unable to be reduced sometimes necessitate an open reduction followed by internal fixation, sometimes using a secondary splint for mobile teeth. In those rare cases when there are not stable adjacent teeth bilaterally other modalities must be considered. In the present report, two cases are presented where circummandibular wires were used to treat fractured mandibular dentoalveolar segments adjacent to edentulous areas.

Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability

PubMed Central

Steilen, Danielle; Hauser, Ross; Woldin, Barbara; Sawyer, Sarah

2014-01-01

The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability. PMID:25328557

Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.

PubMed

Steilen, Danielle; Hauser, Ross; Woldin, Barbara; Sawyer, Sarah

2014-01-01

The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.

Patterns and Predictors of Failed and Sustained Return-to-Work in Transport Injury Insurance Claimants.

PubMed

Gray, Shannon E; Hassani-Mahmooei, Behrooz; Cameron, Ian D; Kendall, Elizabeth; Kenardy, Justin; Collie, Alex

2018-02-12

Purpose To determine the incidence of employed people who try and fail to return-to-work (RTW) following a transport crash. To identify predictors of RTW failure. A historical cohort study was conducted in the state of Victoria, Australia. People insured through the state-based compulsory third party transport accident compensation scheme were included. Inclusion criteria included date of crash between 2003 and 2012 (inclusive), age 15-70 years at the time of crash, sustained a non-catastrophic injury and received at least 1 day of income replacement. A matrix was created from an administrative payments dataset that mapped their RTW pattern for each day up to 3 years' post-crash. A gap of 7 days of no payment followed by resumption of a payment was considered a RTW failure and was flagged. These event flags were then entered into a regression analysis to determine the odds of having a failed RTW attempt. 17% of individuals had a RTW fail, with males having 20% lower odds of experiencing RTW failure. Those who were younger, had minor injuries (sprains, strains, contusions, abrasions, non-limb fractures), or were from more advantaged socio-economic group, were less likely to experience a RTW failure. Most likely to experience a RTW failure were individuals with whiplash, dislocations or particularly those admitted to hospital. Understanding the causes and predictors of failed RTW can help insurers, employers and health systems identify at-risk individuals. This can enable earlier and more targeted support and more effective employment outcomes.

Whiplash

MedlinePlus

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

Radiofrequency Neurotomy

MedlinePlus

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

Procedural justice and quality of life in compensation processes.

PubMed

Elbers, Nieke A; Akkermans, Arno J; Cuijpers, Pim; Bruinvels, David J

2013-11-01

There is considerable evidence that being involved in compensation processes has a negative impact on claimants' health. Previous studies suggested that this negative effect is caused by a stressful compensation process: claimants suffered from a lack of communication, a lack of information, and feelings of distrust. However, these rather qualitative findings have not been quantitatively investigated yet. This observational study aimed to fill this gap of knowledge, investigating the claimants' perceived fairness of the compensation process, the provided information, and the interaction with lawyers and insurance companies, in relation to the claimants' quality of life. Participants were individuals injured in traffic accidents, older than 18 years, who were involved in a compensation process in the Netherlands. They were recruited by three claims settlement offices. Outcome measures were procedural, interactional, and informational justice, and quality of life. Participants (n=176) perceived the interaction with lawyers to be fairer than the interaction with insurance companies (p<.001). The length of hospital stay was positively associated with procedural justice (β=.31, p<.001). Having trunk/back injury was negatively related to procedural justice (β=-.25, p=.001). Whiplash injury and length of time involved in the claim process were not associated with any of the justice scales. Finally, procedural justice was found to be positively correlated with quality of life (rs=.22, p=.004). The finding that the interaction with insurance companies was considered less fair than the interaction with lawyers may imply that insurers could improve their interaction with claimants, e.g. by communicating more directly. The result that claimants with mild injuries and with trunk/back injuries considered the compensation process to be less fair than those with respectively severe injuries and injuries to other body parts suggests that especially the former two require an attentive treatment. Finally, the fact that procedural justice was positively correlated with quality of life could implicate that it is possible to improve claimants' health in compensation processes by enhancing procedural justice, e.g. by increasing the ability for claimants to express their views and feelings and by involving claimants in the decision-making process. Copyright © 2012 Elsevier Ltd. All rights reserved.

Out-of-Position Rear Impact Tissue-Level Investigation Using Detailed Finite Element Neck Model.

PubMed

Shateri, Hamed; Cronin, Duane S

2015-01-01

Whiplash injuries can occur in automotive crashes and may cause long-term health issues such as neck pain, headache, and visual and auditory disturbance. Evidence suggests that nonneutral head posture can significantly increase the potential for injury in a given impact scenario, but epidemiological and experimental data are limited and do not provide a quantitative assessment of the increased potential for injury. Although there have been some attempts to evaluate this important issue using finite element models, none to date have successfully addressed this complex problem. An existing detailed finite element neck model was evaluated in nonneutral positions and limitations were identified, including musculature implementation and attachment, upper cervical spine kinematics in axial rotation, prediction of ligament failure, and the need for repositioning the model while incorporating initial tissue strains. The model was enhanced to address these issues and an iterative procedure was used to determine the upper cervical spine ligament laxities. The neck model was revalidated using neutral position impacts and compared to an out-of-position cadaver experiment in the literature. The effects of nonneutral position (axial head rotation) coupled with muscle activation were studied at varying impact levels. The laxities for the ligaments of the upper cervical spine were determined using 4 load cases and resulted in improved response and predicted failure loads relative to experimental data. The predicted head response from the model was similar to an experimental head-turned bench-top rear impact experiment. The parametric study identified specific ligaments with increased distractions due to an initial head-turned posture and the effect of active musculature leading to reduced ligament distractions. The incorporation of ligament laxity in the upper cervical spine was essential to predict range of motion and traumatic response, particularly for repositioning of the neck model prior to impact. The results of this study identify a higher potential for injury in out-of-position rear collisions and identified at-risk locations based on ligament distractions. The model predicted higher potential for injury by as much as 50% based on ligament distraction for the out-of-position posture and reduced potential for injury with muscle activation. Importantly, this study demonstrated that the location of injury or pain depends on the initial occupant posture, so that both the location of injury and kinematic threshold may vary when considering common head positions while driving.

A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review.

PubMed

Teodoro, Tiago; Edwards, Mark J; Isaacs, Jeremy D

2018-05-07

Functional cognitive disorder (FCD) describes cognitive dysfunction in the absence of an organic cause. It is increasingly prevalent in healthcare settings yet its key neuropsychological features have not been reported in large patient cohorts. We hypothesised that cognitive profiles in fibromyalgia (FM), chronic fatigue syndrome (CFS) and functional neurological disorders (FNDs) would provide a template for characterising FCD. We conducted a systematic review of studies with cognition-related outcomes in FM, CFS and FND. We selected 52 studies on FM, 95 on CFS and 39 on FND. We found a general discordance between high rates of subjective cognitive symptoms, including forgetfulness, distractibility and word-finding difficulties, and inconsistent objective neuropsychological deficits. Objective deficits were reported, including poor selective and divided attention, slow information processing and vulnerability to distraction. In some studies, cognitive performance was inversely correlated with pain, exertion and fatigue. Performance validity testing demonstrated poor effort in only a minority of subjects, and patients with CFS showed a heightened perception of effort. The cognitive profiles of FM, CFS and non-cognitive FND are similar to the proposed features of FCD, suggesting common mechanistic underpinnings. Similar findings have been reported in patients with mild traumatic brain injury and whiplash. We hypothesise that pain, fatigue and excessive interoceptive monitoring produce a decrease in externally directed attention. This increases susceptibility to distraction and slows information processing, interfering with cognitive function, in particular multitasking. Routine cognitive processes are experienced as unduly effortful. This may reflect a switch from an automatic to a less efficient controlled or explicit cognitive mode, a mechanism that has also been proposed for impaired motor control in FND. These experiences might then be overinterpreted due to memory perfectionism and heightened self-monitoring of cognitive performance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Knowledge and application of correct car seat head restraint usage among chiropractic college interns: a cross-sectional study.

PubMed

Taylor, John Am; Burke, Jeanmarie; Gavencak, John; Panwar, Pervinder

2005-03-01

Cervical spine injuries sustained in rear-end crashes cost at least $7 billion in insurance claims annually in the United States alone. When positioned correctly, head restraint systems have been proven effective in reducing the risk of whiplash associated disorders. Chiropractors should be knowledgeable about the correct use of head restraint systems to educate their patients and thereby prevent or minimize such injuries. The primary objective of this study was to determine the prevalence of correct positioning of car seat head restraints among the interns at our institution. The secondary objective was to determine the same chiropractic interns' knowledge of the correct positioning of car seat head restraints. It was hypothesized that 100 percent of interns would have their head restraint correctly positioned within an acceptable range and that all interns would possess the knowledge to instruct patients in the correct positioning of head restraints. Cross-sectional study of a convenient sample of 30 chiropractic interns from one institution. Interns driving into the parking lot of our health center were asked to volunteer to have measurements taken and to complete a survey. Vertical and horizontal positions of the head restraint were measured using a beam compass. A survey was administered to determine knowledge of correct head restraint position. The results were recorded, entered into a spreadsheet, and analyzed. 13.3 percent of subjects knew the recommended vertical distance and only 20 percent of subjects knew the recommended horizontal distance. Chi Square analyses substantiated that the majority of subjects were unaware of guidelines set forth by the National Highway Traffic Safety Administration (NHTSA) for the correct positioning of the head restraint (chi(2) (vertical) = 16.13, chi(2) (horizontal) = 10.80, p <.05). Only 6.7 percent of the subjects positioned their head restraint at the vertical distance of 6 cm or less (p <.05). However, 60 percent of the subjects positioned their head restraint at the recommended horizontal distance of 7 cm or less, but this was no different than could be expected by chance alone (p >.05). Interestingly, the 13.3 percent of the subjects who were aware of the vertical plane recommendations did not correctly position their own head restraint in the vertical plane. Similarly, only half of the subjects who were aware of the horizontal plane recommendations correctly positioned their head restraint in the horizontal plane. The data suggest that chance alone could account for the correct positioning of the head restraint in our subjects. The results of this cross-sectional study raise concerns about chiropractic intern knowledge and application of correct head restraint positioning. The importance of chiropractors informing patients of the correct head restraint position should be emphasized in chiropractic education to help minimize or prevent injury in patients involved in motor vehicle collisions.

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

PubMed

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

2002-11-01

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

Is compensation "bad for health"? A systematic meta-review.

PubMed

Spearing, Natalie M; Connelly, Luke B

2011-01-01

There is a common perception that injury compensation has a negative impact on health status, and systematic reviews supporting this thesis have been used to influence policy and practice decisions. This study evaluates the quality of the empirical evidence of a negative correlation between injury compensation and health outcomes, based on systematic reviews involving both verifiable and non-verifiable injuries. Systematic meta-review (a "review of reviews"). PubMED, CINAHL, EMBASE, PEDro, PsycInfo, EconLit, Lexis, ABI/INFORM, The Cochrane Library, and the AHRQ EPC were searched from the date of their inception to August 2008, and hand searches were conducted. Selection criteria were established a priori. Included systematic reviews examined the impact of compensation on health, involved adults, were published in English and used a range of outcome measures. Two investigators independently applied standard instruments to evaluate the methodological quality of the included reviews. Data on compensation scheme design (i.e., the intervention) and outcome measures were also extracted. Eleven systematic reviews involving verifiable and non-verifiable injuries met the inclusion criteria. Nine reviews reported an association between compensation and poor health outcomes. All of them were affected by the generally low quality of the primary (observational) research in this field, the heterogeneous nature of compensation laws (schemes) and legal processes for seeking compensation, and the difficulties in measuring compensation in relation to health. Notwithstanding the limitations of the research in this field, one higher quality review examining a single compensation process and relying on primary studies using health outcome (rather than proxy) measures found strong evidence of no association between litigation and poor health following whiplash, challenging the general belief that legal processes have a negative impact on health status. Moves to alter scheme design and limit access to compensation on the basis that it is "bad for health" are therefore premature, as evidence of such an association is unclear. 2009 Elsevier Ltd. All rights reserved.

A Comprehensive Review of Low-Speed Rear Impact Volunteer Studies and a Comparison to Real-World Outcomes.

PubMed

Cormier, Joseph; Gwin, Lisa; Reinhart, Lars; Wood, Rawson; Bain, Charles

2018-02-27

This study combined all prior research involving human volunteers in low-speed rear-end impacts and performed a comparative analysis of real-world crashes using the National Automotive Sampling System - Crashworthiness Data System. The aim of this study was to assess the rates of neck pain between volunteer and real-world collisions as well as the likelihood of an injury beyond symptoms as a function of impact severity and occupant characteristics in real-world collisions. A total of 51 human volunteer studies were identified that produced a dataset of 1984 volunteer impacts along with a separate dataset of 515,601 weighted occupants in real-world rear impacts. Operating-characteristic curves were created to assess the utility of the volunteer dataset in making predictions regarding the overall population. Change in speed or delta-V was used to model the likelihood of reporting symptoms in both real-world and volunteer exposures and more severe injuries using real-world data. Logistic regression models were created for the volunteer data and survey techniques were used to analyze the weighted sampling scheme with the National Automotive Sampling System database. Symptom reporting rates were not different between males and females and were nearly identical between laboratory and real-world exposures. The minimal risk of injury predicted by real-world exposure is consistent with the statistical power of the large number of volunteer studies without any injury beyond the reporting of neck pain. This study shows that volunteer studies do not under-report symptoms and are sufficient in number to conclude that the risk of injury beyond neck strain under similar conditions is essentially zero. The real-world injury analyses demonstrate that rear impacts do not produce meaningful risks of cervical injury at impacts of similar and greater severity to those of the volunteer research. Future work concerning the mechanism of whiplash-related trauma should focus on impacts of severity greater than those in the current literature. 3This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.

Whiplash syndrome: kinematic factors influencing pain patterns.

PubMed

Cusick, J F; Pintar, F A; Yoganandan, N

2001-06-01

The overall, local, and segmental kinematic responses of intact human cadaver head-neck complexes undergoing an inertia-type rear-end impact were quantified. High-speed, high-resolution digital video data of individual facet joint motions during the event were statistically evaluated. To deduce the potential for various vertebral column components to be exposed to adverse strains that could result in their participation as pain generators, and to evaluate the abnormal motions that occur during this traumatic event. The vertebral column is known to incur a nonphysiologic curvature during the application of an inertial-type rear-end impact. No previous studies, however, have quantified the local component motions (facet joint compression and sliding) that occur as a result of rear-impact loading. Intact human cadaver head-neck complexes underwent inertia-type rear-end impact with predominant moments in the sagittal plane. High-resolution digital video was used to track the motions of individual facet joints during the event. Localized angular motion changes at each vertebral segment were analyzed to quantify the abnormal curvature changes. Facet joint motions were analyzed statistically to obtain differences between anterior and posterior strains. The spine initially assumed an S-curve, with the upper spinal levels in flexion and the lower spinal levels in extension. The upper C-spine flexion occurred early in the event (approximately 60 ms) during the time the head maintained its static inertia. The lower cervical spine facet joints demonstrated statistically greater compressive motions in the dorsal aspect than in the ventral aspect, whereas the sliding anteroposterior motions were the same. The nonphysiologic kinematic responses during a whiplash impact may induce stresses in certain upper cervical neural structures or lower facet joints, resulting in possible compromise sufficient to elicit either neuropathic or nociceptive pain. These dynamic alterations of the upper level (occiput to C2) could impart potentially adverse forces to related neural structures, with subsequent development of a neuropathic pain process. The pinching of the lower facet joints may lead to potential for local tissue injury and nociceptive pain.

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

PubMed

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

2010-08-01

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

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

PubMed

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

2014-03-24

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

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

PubMed Central

2014-01-01

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

[Rupture of the Achilles tendon].

PubMed

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

2014-10-01

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

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

PubMed Central

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

2013-01-01

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

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

PubMed

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

2009-03-01

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

Variability in the control of head movements in seated humans: a link with whiplash injuries?

PubMed Central

Vibert, N; MacDougall, H G; de Waele, C; Gilchrist, D P D; Burgess, A M; Sidis, A; Migliaccio, A; Curthoys, I S; Vidal, P P

2001-01-01

The aim of this study was to determine how context and on-line sensory information are combined to control posture in seated subjects submitted to high-jerk, passive linear accelerations. Subjects were seated with eyes closed on a servo-controlled linear sled. They were asked to relax and received brief accelerations either sideways or in the fore-aft direction. The stimuli had an abrupt onset, comparable to the jerk experienced during a minor car collision. Rotation and translation of the head and body were measured using an Optotrak system. In some of the subjects, surface electromyographic (EMG) responses of selected neck and/or back muscles were recorded simultaneously. For each subject, responses were highly stereotyped from the first trial, and showed little sign of habituation or sensitisation. Comparable results were obtained with sideways and fore-aft accelerations. During each impulse, the head lagged behind the trunk for several tens of milliseconds. The subjects' head movement responses were distributed as a continuum in between two extreme categories. The ‘stiff’ subjects showed little rotation or translation of the head relative to the trunk for the whole duration of the impulse. In contrast, the ‘floppy’ subjects showed a large roll or pitch of the head relative to the trunk in the direction opposite to the sled movement. This response appeared as an exaggerated ‘inertial’ response to the impulse. Surface EMG recordings showed that most of the stiff subjects were not contracting their superficial neck or back muscles. We think they relied on bilateral contractions of their deep, axial musculature to keep the head-neck ensemble in line with the trunk during the movement. About half of the floppy subjects displayed reflex activation of the neck muscles on the side opposite to the direction of acceleration, which occurred before or during the head movement and tended to exaggerate it. The other floppy subjects seemed to rely on only the passive biomechanical properties of their head-neck ensemble to compensate for the perturbation. In our study, proprioception was the sole source of sensory information as long as the head did not move. We therefore presume that the EMG responses and head movements we observed were mainly triggered by the activation of stretch receptors in the hips, trunk and/or neck. The visualisation of an imaginary reference in space during sideways impulses significantly reduced the head roll exhibited by floppy subjects. This suggests that the adoption by the central nervous system of an extrinsic, ‘allocentric’ frame of reference instead of an intrinsic, ‘egocentric’ one may be instrumental for the selection of the stiff strategy. The response of floppy subjects appeared to be maladaptive and likely to increase the risk of whiplash injury during motor vehicle accidents. Evolution of postural control may not have taken into account the implications of passive, high-acceleration perturbations affecting seated subjects. PMID:11313451

Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

PubMed

van der Velde, Gabrielle; Yu, Hainan; Paulden, Mike; Côté, Pierre; Varatharajan, Sharanya; Shearer, Heather M; Wong, Jessica J; Randhawa, Kristi; Southerst, Danielle; Mior, Silvano; Sutton, Deborah; Jacobs, Craig; Taylor-Vaisey, Anne

2016-12-01

Whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD) are prevalent conditions that impact society and impose a significant economic burden on health-care systems. Health economic evidence on WAD and NAD interventions has been sparse: only three economic evaluations of interventions for NAD were identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (NPTF). An updated overview is needed to inform health-care policy and guidelines. This study aimed to determine the cost-effectiveness of interventions for grades I-III WAD and NAD in children and adults. Systematic review of health economic literature, best-evidence synthesis. We systematically searched CINAHL, the Cochrane economic databases (Health Technology Assessment, NHS Economic Evaluation Database), EconLit, EMBASE, MEDLINE, PsycINFO, and Tufts CEA Registry from 2000 to 2015 for economic evaluations of WAD and NAD interventions. We appraised relevant evaluations using the Scottish Intercollegiate Guidelines Network Methodology Criteria for Economic Evaluations. We extracted data, including mean costs (standardized to 2013 Canadian dollars [CAD]) and quality-adjusted life years (QALYs), from studies with adequate methodological quality. We recalculated cost-effectiveness statistics based on the standardized currency using a willingness-to-pay of CAD $50,000 per additional QALY. Funding was provided by the Ministry of Finance. Our search identified 1,616 citations. Six studies fulfilled our selection criteria, including three studies previously reviewed by the NPTF. Structured education appears cost-effective for adults with WAD. For adults with NAD, acupuncture added to routine medical care; manual therapy; multimodal care that includes manual therapy; advice and exercise; and psychological care using cognitive-behavioral therapy appear cost-effective. In contrast, adding manual therapy or diathermy to advice and exercise; multimodal care by a physiotherapist or physician; and behavioral-graded activity do not appear cost-effective for adults with NAD. Our review adds to the findings of the NPTF. Recent evidence suggests that structured education is cost-effective for WAD, whereas advice and exercise and multimodal care that include manual therapy are cost-effective for NAD. Obtaining more robust health economic evidence for non-invasive interventions for WAD and NAD in children and adults remains an essential research priority. Copyright © 2015 Elsevier Inc. All rights reserved.

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

PubMed

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

2016-12-01

In 2008, the Neck Pain Task Force (NPTF) recommended exercise for the management of neck pain and whiplash-associated disorders (WAD). However, no evidence was available on the effectiveness of exercise for Grade III neck pain or WAD. Moreover, limited evidence was available to contrast the effectiveness of various types of exercises. To update the findings of the NPTF on the effectiveness of exercise for the management of neck pain and WAD grades I to III. Systematic review and best evidence synthesis. Studies comparing the effectiveness of exercise to other conservative interventions or no intervention. Outcomes of interest included self-rated recovery, functional recovery, pain intensity, health-related quality of life, psychological outcomes, and/or adverse events. We searched eight electronic databases from 2000 to 2013. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results of scientifically admissible studies were synthesized following best-evidence synthesis principles. We retrieved 4,761 articles, and 21 randomized controlled trials (RCTs) were critically appraised. Ten RCTs were scientifically admissible: nine investigated neck pain and one addressed WAD. For the management of recent neck pain Grade I/II, unsupervised range-of-motion exercises, nonsteroidal anti-inflammatory drugs and acetaminophen, or manual therapy lead to similar outcomes. For recent neck pain Grade III, supervised graded strengthening is more effective than advice but leads to similar short-term outcomes as a cervical collar. For persistent neck pain and WAD Grade I/II, supervised qigong and combined strengthening, range-of-motion, and flexibility exercises are more effective than wait list. Additionally, supervised Iyengar yoga is more effective than home exercise. Finally, supervised high-dose strengthening is not superior to home exercises or advice. We found evidence that supervised qigong, Iyengar yoga, and combined programs including strengthening, range of motion, and flexibility are effective for the management of persistent neck pain. We did not find evidence that one supervised exercise program is superior to another. Overall, most studies reported small effect sizes suggesting that a small clinical effect can be expected with the use of exercise alone. Copyright © 2014 Elsevier Inc. All rights reserved.

Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

PubMed

Yu, Hainan; Côté, Pierre; Southerst, Danielle; Wong, Jessica J; Varatharajan, Sharanya; Shearer, Heather M; Gross, Douglas P; van der Velde, Gabrielle M; Carroll, Linda J; Mior, Silvano A; Ameis, Arthur; Jacobs, Craig L; Taylor-Vaisey, Anne L

2016-12-01

In 2008, the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders recommended patient education for the management of neck pain. However, the effectiveness of education interventions has recently been challenged. To update the findings of the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of structured patient education for the management of patients with whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). Systematic review of the literature and best-evidence synthesis. Randomized controlled trials that compared structured patient education with other conservative interventions. Self-rated recovery, functional recovery (eg, disability, return to activities, work, or school), pain intensity, health-related quality of life, psychological outcomes such as depression or fear, or adverse effects. We systematically searched eight electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, DARE, PubMed, and ICL) from 2000 to 2012. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized in evidence tables and synthesized following best-evidence synthesis principles. We retrieved 4,477 articles. Of those, nine were eligible for critical appraisal and six were scientifically admissible. Four admissible articles investigated patients with WAD and two targeted patients with NAD. All structured patient education interventions included advice on activation or exercises delivered orally combined with written information or as written information alone. Overall, as a therapeutic intervention, structured patient education was equal or less effective than other conservative treatments including massage, supervised exercise, and physiotherapy. However, structured patient education may provide small benefits when combined with physiotherapy. Either mode of delivery (ie, oral or written education) provides similar results in patients with recent WAD. This review adds to the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders by defining more specifically the role of structured patient education in the management of WAD and NAD. Results suggest that structured patient education alone cannot be expected to yield large benefits in clinical effectiveness compared with other conservative interventions for patients with WAD or NAD. Moreover, structured patient education may be of benefit during the recovery of patients with WAD when used as an adjunct therapy to physiotherapy or emergency room care. These benefits are small and short lived. Copyright © 2014 Elsevier Inc. All rights reserved.

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

PubMed

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

2013-01-01

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

Articulation at shoulder level--a pilot experimental study on car seat comfort.

PubMed

Coelho, Denis Alves; Dahlman, Sven

2012-01-01

This article reports on a pilot experimental study aimed at a first evaluation of the introduction of an articulation in the upper part of the seat backrest. The idea of introducing this articulation sprang from prevention of whiplash injuries and this study tentatively assesses its potential for improvement in comfort. This was done considering a pre-defined articulation height. A height for the articulation of 43.5 cm above the H-point of a reference seat was theoretically deduced based on a population with an average sitting height of 88 cm. Participants evaluated the articulated seat in comparison with the reference seat. Twelve participants were divided into three groups of sitting height. In a laboratory environment subjective comfort evaluations and preferred values of deployment of the articulation and of counter-tilting of the headrest were registered. Driving on the roads completed and validated the laboratory assessments. The reference seat was deemed less comfortable for the participants with short and medium sitting height than for the tall ones. There was a notable improvement in comfort for most of the medium and short sitting height participants when using the articulated seat. The articulation was fully deployed by most participants. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

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

Treesearch

Nancy L. Shaw; Warren P. Clary

1996-01-01

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

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

PubMed

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

2016-05-01

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

A study of cervical spine kinematics and joint capsule strain in rear impacts using a human FE model.

PubMed

Kitagawa, Yuichi; Yasuki, Tsuyoshi; Hasegawa, Junji

2006-11-01

Many efforts have been made to understand the mechanism of whiplash injury. Recently, the cervical facet joint capsules have been focused on as a potential site of injury. An experimental approach has been taken to analyze the vertebral motion and to estimate joint capsule stretch that was thought to be a potential cause of pain. The purpose of this study is to analyze the kinematics of the cervical facet joint using a human FE model in order to better understand the injury mechanism. The Total Human Model for Safety (THUMS) was used to visually analyze the local and global kinematics of the spine. Soft tissues in the neck were newly modeled and introduced into THUMS for estimating the loading level in rear impacts. The model was first validated against human test data in the literature by comparing vertebrae motion as well as head and neck responses. Joint capsule strain was estimated from a maximum principal strain output from the elements representing the capsule tissues. A rear-end collision was then simulated using THUMS and a prototype seat model, assuming a delta-V of 25 km/h. The trajectory of the vertebrae was analyzed in a local coordinate system defined along the joint surface. Strain growth in the joint capsules was explained, as related to contact events between the occupant and the seat. A new seat concept was proposed to help lessen the loading level to the neck soft tissues. The foam material of the seat back was softened, the initial gap behind the head was reduced and the head restraint was stiffened for firm support. The lower seat back frame was also reinforced to withstand the impact severity at the given delta-V. Another rear impact simulation was conducted using the new seat concept model to examine the effectiveness of the new concept. The joint capsule strain was found to be relatively lower with the new seat concept. The study also discusses the influence of seat parameters to the vertebral motion and the resultant strain in the joint capsules. The meaning of the contact timing of the head to the head restraint was examined based on the results in terms of correlation with injury indicators such as NIC and the joint capsule strain.

Penile injuries: A 10-year experience

PubMed Central

Krishna Reddy, S.V.; Shaik, Ahammad Basha; Sreenivas, K.

2014-01-01

We report our 10-year experience with penile injuries. We retrospectively reviewed the records of 156 cases of male external genitalia injuries between May 2002 and December 2012. Of these, only 26 patients presented without urethral injuries and were included in this study. Patients were divided into 4 groups: Group 1 (n = 12) with patients with penile fractures injuries; Group 2 (n = 5) with patients with penile amputation injuries; Group 3 (n = 2) with patients with penile penetrating injuries; and Group 4 (n = 7) with patients with penile soft tissue injuries. Grading of injury was done using the American Association for the Surgery of Trauma (AAST)-Organ injury scale of penile injury. Penile injuries without urethral injuries are urological emergencies which require immediate attention. PMID:25295134

Clinical presentation and manual therapy for upper quadrant musculoskeletal conditions

PubMed Central

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

2011-01-01

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

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

PubMed

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

2014-05-01

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

Self-inflicted injuries are an important cause of penetrating traumatic injuries in Japan.

PubMed

Izawa, Yoshimitsu; Suzukawa, Masayuki; Lefor, Alan K

2016-10-01

Japan has a low crime rate, but a high suicide rate. The aim of this study is to review the causes of penetrating traumatic injuries in a tertiary care emergency center in Japan. We retrospectively reviewed all admissions for traumatic injuries over a 3-year period, and calculated the proportion of patients with penetrating traumatic injuries. Weapon used, age, gender, Injury Severity Score, cause of injury, and site of injury in all patients with penetrating injuries were reviewed. The proportion of patients with penetrating injuries among patients with all types of traumatic injuries requiring surgical intervention was calculated. Of 1,321 patients admitted over 3 years, 65 patients (5%) suffered from penetrating injuries. Most were stab wounds, with only one gunshot (2%). The most common site of injury was an extremity (48%). The most common cause of penetrating injury was self-inflicted (38%). The abdomen is the most common site injured among self-inflicted injuries. Of patients with all types of traumatic injuries requiring surgical intervention, penetrating injuries accounted for 23%. Penetrating injuries represent 23% of all patients with traumatic injuries who required surgical intervention. Self-inflicted penetrating injuries were most common, supporting the need for preventive services. Acute care surgeons must be familiar with the surgical management of penetrating traumatic injuries, even in a country with a low crime rate.

Patient injuries in operative rhinology during a ten-year period: Review of national patient insurance charts.

PubMed

Blomgren, K; Aaltonen, L-M; Lehtonen, L; Helmiö, P

2018-02-01

To assess factors contributing to patient injuries in operative rhinology. Data of the accepted patient injury claims involving operative rhinology, between the years 2001 and 2011, were obtained from the Finnish Patient Insurance Centre registry. Two senior otolaryngologists analysed and evaluated the injury mechanisms. Analysis and classification of factors contributing to patient injuries. During the ten-year study period, there were 67 patient injuries in operative rhinology, comprising 36% of all patient injuries in otorhinolaryngologic surgery. The majority (78%) of patients were treated in university or central hospitals and almost all (90%) by fully trained otolaryngology specialists. The factors contributing to the injuries were errors in surgical technique, like lesions to the orbit, skull base and meninges, and adjacent nerves, as well as mistakes with removable packings left in situ. Nearly half of the patients had undergone endoscopic sinus surgery. One patient died because of bleeding from the intracranial artery. Fourteen patients (21%) needed a re-operation due to the injury. Patient injuries in rhinology were caused by typical complications of common operations performed by otorhinolaryngology specialists. The increased volume of endoscopic sinus surgery was evident also in patient injuries. © 2017 John Wiley & Sons Ltd.

[Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience].

PubMed

Vodička, J; Doležal, J; Vejvodová, Š; Šafránek, J; Špidlen, V; Třeška, V

2016-01-01

PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma patients died within 24 hours of injury (61.5%). CONCLUSIONS Chest injury, almost always blunt, is often diagnosed in polytrauma patients. A prevalent cause of multiple trauma is a traffic accident. Chest injury most frequently involves pulmonary contusion. Nearly half of chest injuries require surgery, of which 2/3 are urgent procedures. The procedure most frequently performed in polytrauma patients with chest injury is chest drainage and this is also a sufficient procedure in 75% of surgically treated patients. polytrauma, chest injury, pulmonary contusion, surgical treatment, chest drainage.

Multiple injuries after earthquakes: a retrospective analysis on 1,871 injured patients from the 2008 Wenchuan earthquake.

PubMed

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

2012-05-17

Multiple injuries have been highlighted as an important clinical dimension of the injury profile following earthquakes, but studies are scarce. We investigated the pattern and combination of injuries among patients with two injuries following the 2008 Wenchuan earthquake. We also described the general injury profile, causes of injury and socio-demographic characteristics of the injured patients. A retrospective hospital-based analysis of 1,871 earthquake injured patients, totaling 3,177 injuries, admitted between 12 and 31 May 2008 to the People's Hospital of Deyang city (PHDC). An electronic, webserver-based database with International Classification of Diseases (ICD)-10-based classification of earthquake-related injury diagnoses (IDs), anatomical sites and additional background variables of the inpatients was used. We analyzed this dataset for injury profile and number of injuries per patient. We then included all patients (856) with two injuries for more in-depth analysis. Possible spatial anatomical associations were determined a priori. Cross-tabulation and more complex frequency matrices for combination analyses were used to investigate the injury profile. Out of the 1,871 injured patients, 810 (43.3%) presented with a single injury. The rest had multiple injuries; 856 (45.8%) had two, 169 (9.0%) patients had three, 32 (1.7%) presented with four injuries, while only 4 (0.2%) were diagnosed with five injuries. The injury diagnoses of patients presenting with two-injuries showed important anatomical intra-site or neighboring clustering, which explained 49.1% of the combinations. For fractures, the result was even more marked as spatial clustering explained 57.9% of the association pattern. The most frequent combination of IDs was a double-fracture, affecting 20.7% of the two-injury patients (n = 177). Another 108 patients (12.6%) presented with fractures associated with crush injury and organ-soft tissue injury. Of the 3,177 injuries, 1,476 (46.5%) were fractures. Most injuries were located in the head (22.9%) and lower extremities (30.8%). Multiple injuries are put forward as an important component of the injury profile after this earthquake. A pattern of injury combinations and spatial aggregation of injuries was also found. Clinical diagnosis and treatment should be adapted to care of these patients. More studies are needed to generalize these findings.

Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients

PubMed Central

Moatshe, Gilbert; Dornan, Grant J.; Løken, Sverre; Ludvigsen, Tom C.; LaPrade, Robert F.; Engebretsen, Lars

2017-01-01

Background: Information on the incidence, injury mechanisms, ligament injury patterns, and associated injuries of knee dislocations is lacking in the literature. There is a need to characterize ligament injury patterns and associated injuries in knee dislocations to avoid missing common associated diagnoses and to plan surgical treatment. Purpose: To evaluate patient demographics, ligament injury patterns and associated injury patterns, and associated injuries in patients with knee dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 303 patients with knee dislocations treated at a single level 1 trauma center were followed prospectively. Injury mechanism; ligament injury patterns; associated neurovascular, meniscal, and cartilage injuries; and surgical complications were recorded. The Schenck knee dislocation classification was used to classify the ligament injury patterns. Results: The mean age at injury was 37.8 ± 15.3 years. Of the 303 patients included, 65% were male and 35% were female. There was an equal distribution of high-energy and low-energy injuries. Injury to 3 major ligaments was the most common, with Schenck classification type KD III-M constituting 52.4% of the injuries and KD III-L comprising 28.1%. Meniscal injuries and cartilage injuries occurred in 37.3% and 28.3% of patients, respectively. Patients with acute injuries had significantly lower odds of a cartilage injury than those with chronic injuries (odds ratio [OR], 0.28; 95% CI, 0.15-0.50; P < .001). Peroneal nerve injuries were recorded in 19.2% of patients (10.9% partial and 8.3% complete deficit), while vascular injuries were recorded in 5%. The odds of having a common peroneal nerve injury were 42 times greater (P < .001) among those with posterolateral corner injury (KD III-L) than those without. The odds for popliteal artery injury were 9 times greater (P = .001) among those with KD III-L injuries than other ligament injury types. Conclusion: Medial-sided bicruciate injuries were the most common injury pattern in knee dislocations. Cartilage injuries were common in chronically treated patients. There was a significant risk of peroneal nerve injury with lateral-sided injuries. PMID:28589159

Pattern of Injuries from Road Traffic Accidents Presented at a Rural Teaching Institution of Karachi.

PubMed

Shamim, Muhammad

2017-08-01

The aim of the study is to study the pattern of injuries from road traffic accidents presented at the emergency department of a rural teaching institution in Karachi. This descriptive case series was conducted prospectively in the Emergency Department of Fatima Hospital and Baqai Medical University from 1 January 2012 to 21 March 2013. There were 385 patients in the series. All of the patients with recent injuries from road traffic accidents were included. Cases with injuries more than 72 h old were excluded. The majority of patients had lower limb injuries 172 (44.7%), followed by head and neck injuries 107 (27.8%), multiple injuries 62 (16.1%), upper limb injuries 22 (5.7%), abdominoperineal injuries 19 (5%), and chest injuries 3 (0.8%). Majority (229, 59.5%) of patients were given first aid treatment and discharged, while 151 (39.3%) patients were either admitted or referred to better equipped hospitals. Three patients were brought dead, and two patients left against medical advice. The lower limb injuries were the commonest road traffic accidental injuries, followed by head and neck injuries, multiple injuries, upper limb injuries, abdominoperineal injuries, and chest injuries.

Clinical clearance of the cervical spine in patients with distracting injuries: It is time to dispel the myth.

PubMed

Rose, Melanie K; Rosal, Lindy M; Gonzalez, Richard P; Rostas, Jack W; Baker, Jeremy A; Simmons, Jon D; Frotan, Mohammed A; Brevard, Sydney B

2012-08-01

The purpose of this study was to prospectively assess the sensitivity and efficacy of clinical examination for screening of cervical spine (c-spine) injury in awake and alert blunt trauma patients with concomitant "distracting injuries." During the 24-month period from December 2009 to December 2011, all blunt trauma patients older than 13 years were prospectively evaluated with a standard cervical spine examination protocol by the trauma surgery team at a Level 1 trauma center. Awake and alert patients with a Glasgow Coma Score (GCS) ≥14 underwent clinical examination of the cervical spine. Clinical examination was performed regardless of "distracting injuries." Patients without complaints of pain or tenderness on physical exam had their cervical collar removed, and the c-spine was considered clinically cleared of injury. All awake and alert patients with "distracting injuries," including those clinically cleared and those with complaints of c-spine pain or tenderness underwent computerized tomographic (CT) scanning of the entire c-spine. "Distracting injuries" were categorized into three anatomic regions: head injuries, torso injuries and long bone fractures. Patients with minor distracting injuries were not considered to have a "distracting injury." During the 24-month study period, 761 blunt trauma patients with GCS ≥14 and at least one "distracting injury" had been entered into the study protocol. Two-hundred ninety-six (39%) of the patients with "distracting injuries" had a positive c-spine clinical examination, 85 (29%) of whom were diagnosed with c-spine injury. Four hundred sixty-four (61%) of the patients with "distracting injuries"’ were initially clinically cleared, with one patient (0.2%) diagnosed with a c-spine injury. This yielded an overall sensitivity of 99% (85/86) and negative predictive value greater than 99% (463/464) for cervical spine clinical examination in awake and alert blunt trauma patients with "distracting injuries." In the awake and alert blunt trauma patient with "distracting injuries," clinical examination is a sensitive screening method for cervical spine injury. Radiological assessment is unnecessary for safe clearance of the asymptomatic cervical spine in awake and alert blunt trauma patients with "distracting injuries." These findings suggest the concept of "distracting injury" in the context of cervical spine clinical examination is invalid. Expanding the utility of cervical spine clinical examination to patients with "distracting injuries" allows for significant reduction of both healthcare cost and radiation exposure.

Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery

PubMed Central

Jiang, Yan; Gao, Bo; Zhang, Xiaohua; Zhao, Jianjie; Chen, Jinping; Zhang, Shu; Luo, Donglin

2014-01-01

Aim: To summary the experience for prevention and treatment of recurrent laryngeal nerve (RLN) injury in thyroid surgery. Methods: Clinical features of 623 patients who received thyroid surgery from January 2010 to December 2012 were analyzed retrospectively, and the features of RLN injury and intraoperative as well as postoperative treatments were reviewed. Results: RLN injury occurred in 31 patients (4.98%), in which, unilateral RLN injury occurred in 27 patients and bilateral RLN injuries occurred in 4 patients (temporary injury in 28 patients and permanent injury in 3 patients). 6 patients underwent RLN anastomosis during surgery and exhibited transient hoarseness after surgery. RLN exploration and decompression was given in 1 patient and the patient got normal vocal cord motion 2 months after surgery. 1 patient with bilateral injuries received tracheotomy and CO2 laser resection of arytenoid cartilage and achieved recovery 1 year later. Conclusions: In order to prevent RLN injury, the anatomic variations of RLN should be mastered. Routine exposure of RLN can effectively prevent the injury in patients receiving the second or multiple surgeries. Early interventions for RLN injury include mainly early discovery, early exploration and early anastomosis, and the function of RLN in some patients can recover completely. Subsequent treatments mainly focus on the improvement of the voice, expansion of glottis and melioration of dyspnea. PMID:24482694

Surgical management of colorectal injuries: colostomy or primary repair?

PubMed

Papadopoulos, V N; Michalopoulos, A; Apostolidis, S; Paramythiotis, D; Ioannidis, A; Mekras, A; Panidis, S; Stavrou, G; Basdanis, G

2011-10-01

Several factors have been considered important for the decision between diversion and primary repair in the surgical management of colorectal injuries. The aim of this study is to clarify whether patients with colorectal injuries need diversion or not. From 2008 to 2010, ten patients with colorectal injuries were surgically treated by primary repair or by a staged repair. The patients were five men and five women, with median age 40 years (20-55). Two men and two women had rectal injuries, while 6 patients had colon injuries. The mechanism of trauma in two patients was firearm injuries, in two patients was a stab injury, in four patients was a motor vehicle accident, in one woman was iatrogenic injury during vaginal delivery, and one case was the transanal foreign body insertion. Primary repair was possible in six patients, while diversion was necessary in four patients. Primary repair should be attempted in the initial surgical management of all penetrating colon and intraperitoneal rectal injuries. Diversion of colonic injuries should only be considered if the colon tissue itself is inappropriate for repair due to severe edema or ischemia. The role of diversion in the management of unrepaired extraperitoneal rectal injuries and in cases with anal sphincter injuries is mandatory.

Outcome of children with blunt liver or spleen injuries: Experience from a single institution in Korea.

PubMed

Kim, Ki Hoon; Kim, Jin Soo; Kim, Woon-Won

2017-02-01

The aim of this study is to evaluate the demographics, injury pattern, and treatment outcomes among children hospitalized for the management of blunt liver and spleen injury at a single institution in Korea, and to document trends in treatment strategies of children with blunt torso trauma. Children (<20 years) with blunt liver and spleen injuries, hospitalized at our center between May 2010 and February 2016, were included in the present study. Data were retrospectively analyzed for demographic and injury-related information were obtained. During the study period, 34 patients with blunt liver injury and 21 patients with blunt spleen injury presented at the center. The most common cause of liver and spleen injury was motor vehicle collision, followed by fall. Thirty patients (88.2%) with liver injuries and 18 patients (85.7%) with spleen injuries were managed conservatively. No cases of mortality occurred in patients with spleen injury group; one patient (2.9%) died in patients with liver injury due to uncontrolled bleeding. Our data demonstrated that 85.7% of patients with spleen injuries and 88.2% of patients with liver injuries were managed nonoperatively. Operative management was chosen more selectively, being applied in patients with high grade organ injury scores or abrupt changes in vital status. Our findings will contribute to the available data concerning children with traumatic injuries in Korea. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

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

PubMed

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

2014-08-01

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

Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction.

PubMed

Worley, John R; Brimmo, Olubusola; Nuelle, Clayton W; Cook, James L; Stannard, James P

2018-06-13

The purpose of this study was to determine incidence of concurrent peroneal nerve injury and to compare outcomes in patients with and without peroneal nerve injury after surgical treatment for multiligament knee injuries (MLKIs). A retrospective study of 357 MLKIs was conducted. Patients with two or more knee ligaments requiring surgical reconstruction were included. Mean follow-up was 35 months (0-117). Incidence of concurrent peroneal nerve injury was noted and patients with and without nerve injury were evaluated for outcomes. Concurrent peroneal nerve injury occurred in 68 patients (19%). In patients with nerve injury, 45 (73%) returned to full duty at work; 193 (81%) patients without nerve injury returned to full duty ( p  = 0.06). In patients with nerve injury, 37 (60%) returned to their previous level of activity; 148 (62%) patients without nerve injury returned to their previous level of activity ( p  = 0.41). At final follow-up, there were no significant differences in level of pain (mean visual analog scale 1.6 vs. 2; p  = 0.17), Lysholm score (mean 88.6 vs. 88.8; p  = 0.94), or International Knee Documentation Committee score (mean 46.2 vs. 47.8; p  = 0.67) for patients with or without peroneal nerve injury, respectively. Postoperative range of motion (ROM) (mean 121 degrees) was significantly lower ( p  = 0.02) for patients with nerve injury compared with patients without nerve injury (mean 127 degrees). Concurrent peroneal nerve injury occurred in 19% of patients in this large cohort suffering MLKIs. After knee reconstruction surgery, patients with concurrent peroneal nerve injuries had significantly lower knee ROM and trended toward a lower rate of return to work. However, outcomes with respect to activity level, pain, and function were not significantly different between the two groups. This study contributes to our understanding of patient outcomes in patients with concurrent MLKI and peroneal nerve injury, with a focus on the patient's ability to return to work and sporting activity. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fractures and dislocations of the hand in polytrauma patients: Incidence, injury pattern and functional outcome.

PubMed

Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

2017-04-01

Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients. A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma. In a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury). The incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS). Copyright © 2017 Elsevier Ltd. All rights reserved.

Analysis of 78 patients with spinal injuries in the 2008 Sichuan, China, earthquake.

PubMed

Chen, Rigao; Song, Yuemin; Kong, Qingquan; Zhou, Chunguang; Liu, Limin

2009-05-01

To analyze the clinical features of patients with spinal injuries and to better cope with future disasters, we retrospectively reviewed 78 patients' medical records after the 2008 Sichuan, China, earthquake. All patients survived, and the mean time patients spent under rubble was 12.2 hours. The largest number of victims were in the 30- to 39-year age group (24.3%), followed by the 20- to 29-year age group (21.8%) and the 40- to 49-year age group (20.5%). Isolated spinal injuries occurred in 55 patients (71.5%). Multilevel spinal injuries occurred in 23 patients (29.5%). The most common region for spinal injuries was the lumbar spine (38.5%), followed by the thoracic spine and the cervical spine. Nearly 53.8% of these spinal injuries resulted in some form of neurologic disability. Thoracic injury contributed to the majority of the neurologic injury. Lumbar injury seldom resulted in neurologic damage. Almost all cervical injuries were associated with severe spinal cord injury. The majority of patients sustained injuries in addition to their spinal injuries. More than one-third of patients (35.7%) had upper extremity fractures, 12.1% had pelvic fractures, and 44.5% had lower extremity fractures. The most commonly injured bone in the upper extremity was the humerus and in the lower extremity, the femur. Other associated injuries included head (19.6%), thoracic (39.8%), abdominal (8.9%), and urologic (2.56%) injuries. The high frequency of multilevel injuries of the spine and additional injuries reaffirms the need for vigilance in patient assessment.

Association of head trauma with cervical spine injury, spinal cord injury, or both.

PubMed

Iida, H; Tachibana, S; Kitahara, T; Horiike, S; Ohwada, T; Fujii, K

1999-03-01

Links between cervical spine and/or spinal cord injuries and head trauma have not been reported in detail. 188 patients with cervical spine and/or spinal cord injury were divided into two groups, i.e., with upper cervical and mid-lower cervical injury, and compared for head injury. Associated head trauma was investigated in 188 patients with cervical spine and/or spinal cord injuries; 35% had moderate or severe injuries. Brain damage was more frequently observed in patients with upper cervical injury than in those with mid to lower cervical injury. Those patients with upper cervical injury appeared to have an elevated risk of suffering skull base fractures, traumatic subarachnoid hemorrhage, and contusional hemotoma. Approximately one third of patients with cervical spine and/or spinal cord injuries had moderate or severe head injuries. Brain damage was more frequently associated with upper cervical injury. Those patients with upper cervical injury are at greater risk of suffering from skull base fractures and severe intracranial hematomas than those with mid to lower cervical injury.

Management and treatment of splenic trauma in children.

PubMed

Arslan, Serkan; Guzel, Mahmut; Turan, Cuneyt; Doğanay, Selim; Kopru, Mehmet

2015-01-01

To assess types of splenic traumas, accompanying injuries, their management and results. We studied the reports of 90 patients (64 boys, 26 girls) who were treated for splenic injuries as a result of blunt abdominal trauma between 2005-2012. Age, sex, hospitalization time, mechanisms of traumas, accompanying injuries and management methods were recorded. Causes of trauma were falls from height (46 patients, 51%), pedestrian traffic accidents (17 patients, 19%), passenger traffic accidents (11 patients, 12%), bicycle accidents (10 patients, 11%) and falling objects from height (6 patients, 6.6%). Splenic injury alone was observed in 57 patients (63.3%) and other organ injuries together with splenic injury in 33 patients (36.7%). Splenectomy was performed in six patients (6.6%) due to hemodynamic instability and small intestine repair due to small intestine injury in one patient (1.1%). None of these patients died from their injuries. A large proportion of splenic injuries recover with conservative therapy. Some of the advantages of conservative therapy include short hospitalization time, less need for blood transfusion, and less morbidity and mortality. Falls from height and traffic accidents are important factors in etiology. The possibility of other organ injuries together with splenic injuries should be considered.

Outcomes of truncal vascular injuries in children

PubMed Central

Allison, Nathan D.; Anderson, Christopher M.; Shah, Shinil K.; Lally, Kevin P.; Hayes-Jordan, Andrea; Tsao, Kuo-Jen; Andrassy, Richard J.; Cox, Charles S.

2011-01-01

Background Pediatric truncal vascular injuries occur infrequently and have a reported mortality rate of 30% to 50%. This report examines the demographics, mechanisms of injury, associated trauma, and outcome of patients presenting for the past 10 years at a single institution with truncal vascular injuries. Methods A retrospective review (1997-2006) of a pediatric trauma registry at a single institution was undertaken. Results Seventy-five truncal vascular injuries occurred in 57 patients (age, 12 ± 3 years); the injury mechanisms were penetrating in 37%. Concomitant injuries occurred with 76%, 62%, and 43% of abdominal, thoracic, and neck vascular injuries, respectively. Nonvascular complications occurred more frequently in patients with abdominal vascular injuries who were hemodynamically unstable on presentation. All patients with thoracic vascular injuries presenting with hemodynamic instability died. In patients with neck vascular injuries, 1 of 2 patients who were hemodynamically unstable died, compared to 1 of 12 patients who died in those who presented hemodynamically stable. Overall survival was 75%. Conclusions Survival and complications of pediatric truncal vascular injury are related to hemodynamic status at the time of presentation. Associated injuries are higher with trauma involving the abdomen. PMID:19853755

Patient participation in pressure injury prevention: giving patient's a voice.

PubMed

Latimer, Sharon; Chaboyer, Wendy; Gillespie, Brigid

2014-12-01

Pressure injuries burden patients and healthcare organisations, with some preventative practices having little impact on prevalence reduction. Patient participation in care may be an effective pressure injury prevention strategy, yet patient preferences are unknown. The aim of this interpretive study was to describe patients' perceptions of their current and future role in pressure injury prevention. Semi-structured interviews were conducted with 20 adult inpatients recruited from four medical units, at two Australian metropolitan hospitals. Interview data were analysed using content analysis, with three categories emerging: 'experiencing pressure injuries'; 'participating in pressure injury prevention'; and 'resourcing pressure injury prevention and treatment'. These categories reflect the complex nature of participants' pressure injury experience. The findings suggest participants gather pressure injury knowledge from first-hand and vicarious experience; knowledge they bring to hospital. Most participants preferred a proactive pressure injury prevention role. Many identified barriers in the healthcare environment that impeded their participation and affected their experience of pressure injuries and pressure injury prevention. If patient participation as a pressure injury prevention strategy is to be considered, nurses and organisations need to view patients as partners. © 2013 Nordic College of Caring Science.

[Contentious diseases--a medico-social phenomenon from an insurance medicine perspective].

PubMed

Regenauer, A

2008-03-01

A group of illnesses that are difficult to assess objectively, comprising such conditions as fibromyalgia, chronic fatigue syndrome, attention-deficit hyperactivity disorder, whiplash injury, and last but not least a multitude of somatoform disorders, has become a growing concern to Western health care systems and insurance industries. Thus far, the medical literature has failed to provide informative overviews of this group, which at first glance admittedly seems to be rather heterogeneous. If at all, the disorders have been grouped together under the term ,,controversial illnesses" to differentiate them from other diseases. The insurance industry - and claims departments, in particular - are increasingly having to deal with this rapidly growing phenomenon, which affects not only life business, but also health, worker's compensation and motor third-party liability. When paying compensation and settling claims, insurers are often left with a feeling that the illness may have been ,,imaginary" or aggravated. Is there a common basis for this new disorder mega-trend - independent of the recognition of the conditions by medical associations? This article aims at providing an overview of the common characteristics of the group of disorders, including a description of the key physical, psychological and social aspects. In particular, it is intended to deepen insurers' understanding of the risks arising from social change. The article also examines the disorder prevalence in Western societies and the possible causes of the significant increase.

Clearing the Cervical Spine in a War Zone: What Other Injuries Matter?

PubMed

Drew, Jennifer; Chou, Victoria B; Miller, Catriona; Borg, Bryson; Ingalls, Nichole; Shackelford, Stacy

2015-07-01

Cervical spine clearance requires clinicians to assess the reliability of physical examination based on a patient's mental status and distracting injuries. Distracting injuries have never been clearly defined in military casualties. Retrospective review was conducted of patients entered into Department of Defense Trauma Registry January 2008 to August 2013, identifying blunt trauma patients with cervical spine injury and Glasgow Coma Score ≥ 14. Physical examination and radiology results were abstracted from medical records and injury diagnoses were obtained from Department of Defense Trauma Registry. Groups were compared, p-value of < 0.05 was considered significant. A total of 149 patients met study criteria; 20 patients (13%) had a negative clinical examination of the cervical spine. Coexisting injuries identified in patients with negative physical examination included injuries in proximity to the neck (head, thoracic spine, chest, or humerus) in 17 (85%) patients. In 3 patients (15%), coexisting injuries were not in proximity to the neck and included pelvic, femur, and tibia fractures. All patients without coexisting injury (n = 37) had a positive physical examination. Physical examination of multitrauma casualties with neck injury may be unreliable when distracting injuries are present. When no distracting injuries were present, the physical examination was accurate in all patients. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries

PubMed Central

Demetriades, Demetrios; Hadjizacharia, Pantelis; Constantinou, Costas; Brown, Carlos; Inaba, Kenji; Rhee, Peter; Salim, Ali

2006-01-01

Objective: To assess the feasibility and safety of selective nonoperative management in penetrating abdominal solid organ injuries. Background: Nonoperative management of blunt abdominal solid organ injuries has become the standard of care. However, routine surgical exploration remains the standard practice for all penetrating solid organ injuries. The present study examines the role of nonoperative management in selected patients with penetrating injuries to abdominal solid organs. Patients and Methods: Prospective, protocol-driven study, which included all penetrating abdominal solid organ (liver, spleen, kidney) injuries admitted to a level I trauma center, over a 20-month period. Patients with hemodynamic instability, peritonitis, or an unevaluable abdomen underwent an immediate laparotomy. Patients who were hemodynamically stable and had no signs of peritonitis were selected for further CT scan evaluation. In the absence of CT scan findings suggestive of hollow viscus injury, the patients were observed with serial clinical examinations, hemoglobin levels, and white cell counts. Patients with left thoracoabdominal injuries underwent elective laparoscopy to rule out diaphragmatic injury. Outcome parameters included survival, complications, need for delayed laparotomy in observed patients, and length of hospital stay. Results: During the study period, there were 152 patients with 185 penetrating solid organ injuries. Gunshot wounds accounted for 70.4% and stab wounds for 29.6% of injuries. Ninety-one patients (59.9%) met the criteria for immediate operation. The remaining 61 (40.1%) patients were selected for CT scan evaluation. Forty-three patients (28.3% of all patients) with 47 solid organ injuries who had no CT scan findings suspicious of hollow viscus injury were selected for clinical observation and additional laparoscopy in 2. Four patients with a “blush” on CT scan underwent angiographic embolization of the liver. Overall, 41 patients (27.0%), including 18 cases with grade III to V injuries, were successfully managed without a laparotomy and without any abdominal complication. Overall, 28.4% of all liver, 14.9% of kidney, and 3.5% of splenic injuries were successfully managed nonoperatively. Patients with isolated solid organ injuries treated nonoperatively had a significantly shorter hospital stay than patients treated operatively, even though the former group had more severe injuries. In 3 patients with failed nonoperative management and delayed laparotomy, there were no complications. Conclusions: In the appropriate environment, selective nonoperative management of penetrating abdominal solid organ injuries has a high success rate and a low complication rate. PMID:16998371

Abdominal injuries in a low trauma volume hospital - a descriptive study from northern Sweden

PubMed Central

2014-01-01

Background Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital. Methods This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009. Results The median New Injury Severity Score was 9 (range: 1–57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT < 60 min after emergency room arrival. Penetrating trauma caused injuries in seven patients. Solid organ injuries constituted 78% of abdominal injuries. Non-operative management succeeded in 82 patients. Surgery was performed for 28 patients, either immediately (n = 17) as result of operative management or later (n = 11), due to non-operative management failure; the latter mainly occurred with hollow viscus injuries. Patients with multiple abdominal injuries, whether associated with multiple trauma or an isolated abdominal trauma, had significantly more non-operative failures than patients with a single abdominal injury. One death occurred within 30 days. Conclusions Non-operative management of patients with abdominal injuries, except for hollow viscus injuries, was highly successful in our low trauma volume hospital, even though surgeons receive low exposure to these patients. However, a growing proportion of surgeons lack experience in decision-making and performing trauma laparotomies. Quality assurance programmes must be emphasized to ensure future competence and quality of trauma care at low trauma volume hospitals. PMID:25124882

[Characteristics and Treatment Strategies for Penetrating Injuries on the Example of Gunshot and Blast Victims without Ballistic Body Armour in Afghanistan (2009 - 2013)].

PubMed

Güsgen, Christoph; Willms, Arnulf; Richardsen, Ines; Bieler, Dan; Kollig, Erwin; Schwab, Robert

2017-08-01

Much like other countries, Germany has recently seen terrorist attacks being planned, executed or prevented at the last minute. This highlights the need for expertise in the treatment of penetrating torso traumas by bullets or explosions. Data on the treatment of firearm injuries and, even more so, blast injuries often stems from crises or war regions. However, it is difficult to compare injuries from such regions with injuries from civilian terrorist attacks due to the ballistic body protection (protective vests, body armour) worn by soldiers. Methods An analysis was performed based on data from patients who were treated in the German Military Hospital Mazar-e Sharif for gunshots or injuries from explosions in the years 2009 to 2013. The data selection was based on patients with penetrating injuries to the thorax and/or abdomen. For better comparability with civilian attack scenarios, this study only included civilian patients without ballistic body protection (body armour, protective vests). Results Out of 117 analysed patients, 58 were affected by firearms and 59 by explosive injuries of the thorax or abdomen. 60% of patients had a thoracic injury, 69% had an abdominal injury, and 25.6% had combined thoracic-abdominal injuries. Blast injury patients were significantly more affected by thoracic trauma. As regards abdominal injuries, liver, intestinal, and colonic lesions were leading in number. Patients with blast injuries had significantly more injured organs and a significantly higher ISS averaging 29. 26% of the shot patients and 41% of the blast wounded patients received Damage Control Surgery (DCS). Despite a lower ISS, gunshot victims did not have a lower total number of operations per patient. Overall mortality was 13.7% (10.3% gunshot wounds, 16.7% blast injury). The highest mortality rate (25.7%) was recorded for patients with combined thoracoabdominal injuries (vs. 8.3% for thoracic and 8.7% for abdominal injuries). The ISS of deceased patients was significantly higher at 32.9%. Conclusion Patients without ballistic protection of the torso have high mortality rates, especially when suffering thoracoabdominal blast injuries. Blast injuries frequently lead to the DCS indication. The care of firearm and blast injury patients requires knowledge and competence in the damage control procedures for thorax and abdomen. Georg Thieme Verlag KG Stuttgart · New York.

Lack of evidence to support routine digital rectal examination in pediatric trauma patients.

PubMed

Shlamovitz, Gil Z; Mower, William R; Bergman, Jonathan; Crisp, Jonathan; DeVore, Heather K; Hardy, David; Sargent, Martine; Shroff, Sunil D; Snyder, Eric; Morgan, Marshall T

2007-08-01

Current advanced trauma life support guidelines recommend that a digital rectal examination (DRE) should be performed as part of the initial evaluation of all trauma patients. Our primary goal was to estimate the test characteristics of the DRE in pediatric patients for the following injuries: (1) spinal cord injuries, (2) bowel injuries, (3) rectal injuries, (4) pelvic fractures, and (5) urethral disruptions. We conducted a nonconcurrent, observational, chart review study of a consecutive series of pediatric trauma patients. We enrolled all patients younger than 18 years seen in our ED from January 2003 to February 2005, for whom the trauma team was activated and who had a documented DRE. For each patient, we reviewed all available clinical documents in a computerized medical record system to identify the DRE findings followed by review of radiological reports, operative reports, and discharge summaries to identify specific injuries. Two hundred thirteen patients met our selection criteria and were included in the analysis. We identified 3 patients with spinal cord injury (1% prevalence), 13 patients with bowel injury (6%), 5 patients with rectal injury (2%), 12 patients with a pelvic fracture (6%), and 1 patient with urethral disruption (0.5%). The DRE failed to diagnose (false-negative rate) 66% of spinal cord injuries, 100% of bowel injuries, 100% of rectal wall injuries, 100% of pelvic fractures, and 100% of urethral disruption injuries. The DRE has poor sensitivity for the diagnosis of spinal cord, bowel, rectal, bony pelvis, and urethral injuries. Our findings suggest that the DRE should not be routinely used in pediatric trauma patients.

Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study.

PubMed

Langdorf, Mark I; Medak, Anthony J; Hendey, Gregory W; Nishijima, Daniel K; Mower, William R; Raja, Ali S; Baumann, Brigitte M; Anglin, Deirdre R; Anderson, Craig L; Lotfipour, Shahram; Reed, Karin E; Zuabi, Nadia; Khan, Nooreen A; Bithell, Chelsey A; Rowther, Armaan A; Villar, Julian; Rodriguez, Robert M

2015-12-01

Chest computed tomography (CT) diagnoses more injuries than chest radiography, so-called occult injuries. Wide availability of chest CT has driven substantial increase in emergency department use, although the incidence and clinical significance of chest CT findings have not been fully described. We determine the frequency, severity, and clinical import of occult injury, as determined by changes in management. These data will better inform clinical decisions, need for chest CT, and odds of intervention. Our sample included prospective data (2009 to 2013) on 5,912 patients at 10 Level I trauma center EDs with both chest radiography and chest CT at physician discretion. These patients were 40.6% of 14,553 enrolled in the parent study who had either chest radiography or chest CT. Occult injuries were pneumothorax, hemothorax, sternal or greater than 2 rib fractures, pulmonary contusion, thoracic spine or scapula fracture, and diaphragm or great vessel injury found on chest CT but not on preceding chest radiography. A priori, we categorized thoracic injuries as major (having invasive procedures), minor (observation or inpatient pain control >24 hours), or of no clinical significance. Primary outcome was prevalence and proportion of occult injury with major interventions of chest tube, mechanical ventilation, or surgery. Secondary outcome was minor interventions of admission rate or observation hours because of occult injury. Two thousand forty-eight patients (34.6%) had chest injury on chest radiography or chest CT, whereas 1,454 of these patients (71.0%, 24.6% of all patients) had occult injury. Of these, in 954 patients (46.6% of injured, 16.1% of total), chest CT found injuries not observed on immediately preceding chest radiography. In 500 more patients (24.4% of injured patients, 8.5% of all patients), chest radiography found some injury, but chest CT found occult injury. Chest radiography found all injuries in only 29.0% of injured patients. Two hundred and two patients with occult injury (of 1,454, 13.9%) had major interventions, 343 of 1,454 (23.6%) had minor interventions, and 909 (62.5%) had no intervention. Patients with occult injury included 514 with pulmonary contusions (of 682 total, 75.4% occult), 405 with pneumothorax (of 597 total, 67.8% occult), 184 with hemothorax (of 230 total, 80.0% occult), those with greater than 2 rib fractures (n=672/1,120, 60.0% occult) or sternal fracture (n=269/281, 95.7% occult), 12 with great vessel injury (of 18 total, 66.7% occult), 5 with diaphragm injury (of 6, 83.3% occult), and 537 with multiple occult injuries. Interventions for patients with occult injury included mechanical ventilation for 31 of 514 patients with pulmonary contusion (6.0%), chest tube for 118 of 405 patients with pneumothorax (29.1%), and 75 of 184 patients with hemothorax (40.8%). Inpatient pain control or observation greater than 24 hours was conducted for 183 of 672 patients with rib fractures (27.2%) and 79 of 269 with sternal fractures (29.4%). Three of 12 (25%) patients with occult great vessel injuries had surgery. Repeated imaging was conducted for 50.6% of patients with occult injury (88.1% chest radiography, 11.9% chest CT, 7.5% both). For patients with occult injury, 90.9% (1,321/1,454) were admitted, with 9.1% observed in the ED for median 6.9 hours. Forty-four percent of observed patients were then admitted (4.0% of patients with occult injury). In a more seriously injured subset of patients with blunt trauma who had both chest radiography and chest CT, occult injuries were found by chest CT in 71% of those with thoracic injuries and one fourth of all those with blunt chest trauma. More than one third of occult injury had intervention (37.5%). Chest tubes composed 76.2% of occult injury major interventions, with observation or inpatient pain control greater than 24 hours in 32.4% of occult fractures. Only 1 in 20 patients with occult injury was discharged home from the ED. For these patients with blunt trauma, chest CT is useful to identify otherwise occult injuries. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Trauma-associated lung injury differs clinically and biologically from acute lung injury due to other clinical disorders*

PubMed Central

Calfee, Carolyn S.; Eisner, Mark D.; Ware, Lorraine B.; Thompson, B. Taylor; Parsons, Polly E.; Wheeler, Arthur P.; Korpak, Anna; Matthay, Michael A.

2009-01-01

Objective Patients with trauma-associated acute lung injury have better outcomes than patients with other clinical risks for lung injury, but the mechanisms behind these improved outcomes are unclear. We sought to compare the clinical and biological features of patients with trauma-associated lung injury with those of patients with other risks for lung injury and to determine whether the improved outcomes of trauma patients reflect their baseline health status or less severe lung injury, or both. Design, Setting, and Patients Analysis of clinical and biological data from 1,451 patients enrolled in two large randomized, controlled trials of ventilator management in acute lung injury. Measurements and Main Results Compared with patients with other clinical risks for lung injury, trauma patients were younger and generally less acutely and chronically ill. Even after adjusting for these baseline differences, trauma patients had significantly lower plasma levels of intercellular adhesion molecule-1, von Willebrand factor antigen, surfactant protein-D, and soluble tumor necrosis factor receptor-1, which are biomarkers of lung epithelial and endothelial injury previously found to be prognostic in acute lung injury. In contrast, markers of acute inflammation, except for interleukin-6, and disordered coagulation were similar in trauma and nontrauma patients. Trauma-associated lung injury patients had a significantly lower odds of death at 90 days, even after adjusting for baseline clinical factors including age, gender, ethnicity, comorbidities, and severity of illness (odds ratio, 0.44; 95% confidence interval, 0.24 – 0.82; p = .01). Conclusions Patients with trauma-associated lung injury are less acutely and chronically ill than other lung injury patients; however, these baseline clinical differences do not adequately explain their improved outcomes. Instead, the better outcomes of the trauma population may be explained, in part, by less severe lung epithelial and endothelial injury. PMID:17944012

Expanded Occupational Safety and Health Administration 300 log as metric for bariatric patient-handling staff injuries.

PubMed

Randall, Stephen B; Pories, Walter J; Pearson, Amy; Drake, Daniel J

2009-01-01

Mobilization of morbidly obese patients poses significant physical challenges to healthcare providers. The purpose of this study was to examine the staff injuries associated with the patient handling of the obese, to describe a process for identifying injuries associated with their mobilization, and to report on the need for safer bariatric patient handling. We performed our study at a 761-bed, level 1 trauma center affiliated with a U.S. medical school. The hospital's Occupational Safety and Health Administration (OSHA) 300 log was expanded to the "E-OSHA 300 log" to specifically identify injuries the staff attributed to bariatric patient handling. The 2007 E-OSHA 300 log was analyzed to identify and describe the frequency, severity, and nature of bariatric versus nonbariatric patient handling injuries. The analyses revealed that during 2007, although patients with a body mass index of > or =35 kg/m(2) constituted <10% of our patient population, 29.8% of staff injuries related to patient handling were linked to working with a bariatric patient. Bariatric patient handling accounted for 27.9% of all lost workdays and 37.2% of all restricted workdays associated with patient handling. Registered nurses and nursing assistants accounted for 80% of the injuries related to bariatric patient handling. Turning and repositioning the patient in bed accounted for 31% of the injuries incurred. The E-OSHA 300 log narratives revealed that staff injuries associated with obese and nonobese patient handling were usually performed using biomechanics and not equipment. Manual mobilization of morbidly obese patients increases the risk of caregiver injury. A tracking indicator on the OSHA 300 logs for staff injury linked to a bariatric patient would provide the ability to compare obese and nonobese patient handling injuries. The E-OSHA 300 log provides a method to identify the frequency, severity, and nature of caregiver injury during mobilization of the obese. Understanding the heightened risk of injury associated with manual bariatric patient handling should help healthcare institutions identify deficiencies in their current injury prevention program and focus resources more precisely for safer, systems-based bariatric patient-handling solutions. Effective patient handling systems should also reduce the aura of fear that might be present in some caregivers when mobilizing a bariatric patient.

Healthcare Industry Injuries by Patient Contact Status in Kentucky, 2012-2014.

PubMed

Ranzenberger, Kristen; Bunn, Terry L; Slavova, Svetla

2016-10-01

The healthcare industry continues to have a high number of reported injuries. The purpose of this study was to characterize healthcare industry injuries by patient contact status, identify the occupations associated with healthcare injuries by patient contact status, and determine healthcare injury rates by occupation to gain a better understanding of healthcare industry-compensated injuries and better target safety practices and programs in the healthcare industry. Kentucky healthcare industry workers' compensation first reports of injuries from calendar years 2012-2014 were categorized into injuries involved in direct patient contact versus injuries without direct patient contact using narrative text analysis. Injury numbers and rates were calculated for a number of data variables. Healthcare injuries without direct patient contact (55% of all first reports of injuries) occurred more frequently among older workers (45 years old and older [51%]), in "other" occupations such as housekeeping and maintenance (28%), and as a result of falls/slips/trips (39%) and sprains/tears (38%). In contrast, a higher percentage of healthcare injuries involving direct patient contact occurred among workers younger than 35 years (48%), in healthcare support occupations (50%), and resulting from sprains/tears (66%) and lifting/handling (52%), compared with those without direct patient contact. Findings from this study can better target the need for new and/or additional specific workplace safety training, especially in the healthcare support and nursing occupations with and without patient contact.

Low falls: an underappreciated mechanism of injury.

PubMed

Helling, T S; Watkins, M; Evans, L L; Nelson, P W; Shook, J W; Van Way, C W

1999-03-01

This is a retrospective study designed to evaluate the pattern and severity of injuries that result from low falls, defined as falls from less than 20 ft, subsequent mortality, and requirements of hospital resources. Our hypothesis is that many of these injuries, even without cardiopulmonary instability, are worthy of trauma center care. The records of all patients entered into the hospital trauma registry at an urban Level I trauma center during the years 1991 through 1997 who suffered low falls and who either died after admission or were hospitalized for at least 3 days were reviewed. Patients suffering isolated hip fractures were excluded. One hundred seventy-six patients constituted the study population. This group accounts for about 2% of all admissions for falls at our institution. Patterns of injury were examined. Age, mechanism of injury, Injury Severity Score (ISS), and cardiopulmonary or neurologic instability on admission were documented. Mortality, length of intensive care unit and hospital stays, as well as billed hospital charges, were reviewed. The majority of patients (62%) were younger than 50 years. Sixty patients had ISS >15 and 116 patients had ISS >9. Sixty patients had multisystem injuries requiring specialty care. Head injuries were found in 81 patients (35%), and vertebral fractures or spinal cord injuries were found in 49 patients (22%), including 9 quadriplegics and 5 paraplegics. There were seven patients with intra-abdominal injuries (five spleen and two bowel injuries). There was one patient with a rupture of the thoracic aorta. Seventeen patients had deteriorating neurologic or pulmonary function on arrival, but the majority (90%) were stable. Of the 159 "stable" patients, 48 suffered head injuries, 7 were quadriplegic, and 3 were paraplegic. All intra-abdominal injuries were in this group. Overall, 14 of 176 patients (8%) died. Seven deaths were in patients older than 60 years, and seven deaths were in younger patients (p = 0.04). The majority of deaths (9 of 14) were from head trauma. Care in the intensive care unit was required in 92 of 176 patients. Nine patients had billed charges exceeding $100,000. Low falls can cause significant injuries, most commonly to the head and spine. Based on mechanism of injury alone, patients injured in low falls might not be taken to trauma centers. We have found, however, that many of these patients sustain serious multisystem injuries, even though they are stable initially. Although these patients represent only a fraction of those who fall, our study would support adjustment of triage guidelines to recommend transport of such patients, particularly elderly patients, to trauma centers.

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.

Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients.

PubMed

Giannakopoulos, G F; Saltzherr, T P; Beenen, L F M; Reitsma, J B; Bloemers, F W; Goslings, J C; Bakker, F C

2012-09-01

Despite the presence of diagnostic guidelines for the initial evaluation in trauma, the reported incidence of missed injuries is considerable. The aim of this study was to assess the missed injuries in a large cohort of trauma patients originating from two European Level-1 trauma centres. We analysed the 1124 patients included in the randomised REACT trial. Missed injuries were defined as injuries not diagnosed or suspected during initial clinical and radiological evaluation in the trauma room. We assessed the frequency, type, consequences and the phase in which the missed injuries were diagnosed and used univariate analysis to identify potential contributing factors. Eight hundred and three patients were male, median age was 38 years and 1079 patients sustained blunt trauma. Overall, 122 injuries were missed in 92 patients (8.2%). Most injuries concerned the extremities. Sixteen injuries had an AIS grade of ≥ 3. Patients with missed injuries had significantly higher injury severity scores (ISSs) (median of 15 versus 5, p<0.001). Factors associated with missed injuries were severe traumatic brain injury (GCS ≤ 8) and multitrauma (ISS ≥ 16). Seventy-two missed injuries remained undetected during tertiary survey (59%). In total, 31 operations were required for 26 initially missed injuries. Despite guidelines to avoid missed injuries, this problem is hard to prevent, especially in the severely injured. The present study showed that the rate of missed injuries was comparable with the literature and their consequences not severe. A high index of suspicion remains warranted, especially in multitrauma patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

Is peroneal nerve injury associated with worse function after knee dislocation?

PubMed

Krych, Aaron J; Giuseffi, Steven A; Kuzma, Scott A; Stuart, Michael J; Levy, Bruce A

2014-09-01

Peroneal nerve palsy is a frequent and potentially disabling complication of multiligament knee dislocation, but little information exists on the degree to which patients recover motor or sensory function after this injury, and whether having this nerve injury--with or without complete recovery--is a predictor of inferior patient-reported outcome scores. The purposes of this study were to (1) report on motor and sensory recovery as well as patient-reported outcomes scores of patients with peroneal nerve injury from multiligament knee dislocation; (2) compare those endpoints between patients who had partial versus complete nerve injuries; and (3) compare patient-reported outcomes among patients who sustained peroneal nerve injuries after knee dislocation with a matched cohort of multiligament knee injuries without nerve injury. Thirty-two patients were identified, but five did not have 2-year followup and are excluded (16% lost to followup). Twenty-seven patients (24 male, three female) with peroneal nerve injury underwent multiligament knee reconstruction and were followed for 6.3 years (range, 2-18 years). Motor grades were assessed by examination and outcomes by International Knee Documentation Committee (IKDC) and Lysholm scores. Retrospectively, patients were divided into complete (n = 9) and partial nerve palsy (n = 18). Treatment for complete nerve palsy included an ankle-foot orthosis for all patients, nonoperative (one), neurolysis (two), tendon transfer (three), nerve transfer (one), and combined nerve/tendon transfer (one). Treatment for partial nerve palsy included nonoperative (12), neurolysis (four), nerve transfer (one), and combined nerve/tendon transfer (one). Furthermore, patients without nerve injury were matched by Schenck classification, age, and sex. Data were analyzed using univariate and multivariate models. Overall, 18 patients (69%) regained antigravity ankle dorsiflexion after treatment (three complete nerve palsy [38%] versus 15 partial nerve palsy [83%]; p = 0.06). One patient with complete nerve palsy (13%) and 13 patients with partial nerve palsy (72%) regained antigravity extensor hallucis longus strength (p = 0.01). IKDC and Lysholm scores were similar between complete nerve palsy and partial nerve palsy groups. After controlling for confounding variables such as patient age, body mass index, injury interval to surgery, mechanism of injury, bicruciate injury, and popliteal artery injury status, there was no difference between patients with peroneal nerve injury and those without on Lysholm or IKDC scores. With multiligament knee dislocation and associated peroneal nerve injury, patients with partial nerve injury are more likely to regain antigravity strength when compared with those with a complete nerve injury, but their overall function may not improve. After controlling for confounding variables in a multivariate model, there was no difference in Lysholm or IKDC scores between patients with peroneal nerve injury and those without. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey.

PubMed

Yazgan, Cisel; Aksu, Nalan M

2016-06-01

To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries.

Influence of Acute Kidney Injury Defined by the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score on the Clinical Course of PICU Patients.

PubMed

Cabral, Felipe Cezar; Ramos Garcia, Pedro Celiny; Mattiello, Rita; Dresser, Daiane; Fiori, Humberto Holmer; Korb, Cecilia; Dalcin, Tiago Chagas; Piva, Jefferson Pedro

2015-10-01

To evaluate the predictive value of the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria for disease course severity in patients with or without acute kidney injury admitted to a PICU. Retrospective cohort study. A 12-bed PICU at a tertiary referral center in Southern Brazil. All patients admitted to the study unit over a 1-year period. A database of all eligible patients was analyzed retrospectively. Patients were classified by pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score at admission and worst pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score during PICU hospitalization. The outcomes of interest were length of PICU stay, duration of mechanical ventilation, duration of vasoactive drug therapy, and mortality. The Pediatric Index of Mortality 2 was used to assess overall disease severity at the time of PICU admission. Of 375 patients, 169 (45%) presented acute kidney injury at the time of admission and 37 developed acute kidney injury during PICU stay, for a total of 206 of 375 patients (55%) diagnosed with acute kidney injury during the study period. The median Pediatric Index of Mortality 2 score predicted a mortality rate of 9% among non-acute kidney injury patients versus a mortality rate of 16% among acute kidney injury patients (p = 0.006). The mortality of patients classified as pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease F was double that predicted by Pediatric Index of Mortality 2 (7 vs 3.2). Patients classified as having severe acute kidney injury (pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease I + F) exhibited higher mortality (14.1%; p = 0.001) and prolonged PICU length of stay (median, 7 d; p = 0.001) when compared with other patients. Acute kidney injury is a very frequent occurrence among patients admitted to PICUs. The degree of acute kidney injury severity, as assessed by the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria, is a good predictor of morbidity and mortality in this population. Pediatric Index of Mortality 2 tends to underestimate mortality in pediatric patients with severe acute kidney injury.

[Clinical studies on lower urinary tract injury].

PubMed

Tanaka, M; Ozono, S; Takashima, K; Yoshida, K; Hirao, Y; Okajima, E; Kaneko, Y; Tabata, S; Yoshida, K; Moriya, A

1997-01-01

A total of 61 patients with lower urinary tract injuries were treated at Nara Medical University and its affiliated hospitals, between January 1985 and June 1995. There were 9 patients with bladder injuries and 52 patients with urethral injuries. The main cause of bladder injury was a traffic accident sustained in 4 patients (44.5%) and that of urethral injury was an occupational accident sustained in 27 cases (51.9%). The major associated injuries were a bone fracture seen in 45 patients (73.8%) and an intrascrotal hematoma seen in 28 patients (45.9%). Posterior urethral injuries associated with pelvic bone fractures were classified into 3 types according to the classification reported by Colapinto et al.; 8 patients (32.0%) into Type I, 8 (32.0%) into Type II and 9 (36.0%) into Type III. Of the 25 patients with posterior urethral injuries, 8 (32.0%) underwent immediate surgical treatment, 12 (48.0%) underwent initial cystostomies and delayed surgical treatment and 5 (20.0%) received indwelling of urethral catheters. Postoperative complications of urethral injury included urethral stricture in 30 patients (57.7%), incontinence in 3 (5.8%) and impotence in 3 (5.8%). A significant relationship between the duration of cystostomy and the incidence of postoperative urethral stricture was observed in our patients. Therefore at least three weeks of cystostomy will be necessary in the management of patients with complicated urethral injuries.

The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center.

PubMed

Johnson, Jeremy J; Garwe, Tabitha; Raines, Alexander R; Thurman, Joseph B; Carter, Sandra; Bender, Jeffrey S; Albrecht, Roxie M

2013-03-01

Diagnostic laparoscopy (DL) has decreased the rate of nontherapeutic laparotomy for patients suffering from penetrating injuries. We evaluated whether DL similarly lowers the rate of nontherapeutic laparotomy for patients with blunt injuries. All patients undergoing DL over a 10-year period (ie, 2001-2010) in a single level 1 trauma center were classified by the mechanism of injury. Demographic and perioperative data were compared using the Student t and Fisher exact tests. There were 131 patients included, 22 of whom sustained blunt injuries. Patients suffering from blunt injuries were more severely injured (Injury Severity Score 18.0 vs 7.3, P = .0001). The most common indication for DL after blunt injury was a computed tomographic scan concerning for bowel injury (59.1%). The rate of nontherapeutic laparotomy for patients sustaining penetrating vs blunt injury was 1.8% and nil, respectively. DL, when coupled with computed tomographic findings, is an effective tool for the initial management of patients with blunt injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

Comparison of isolated and concomitant liver injuries: is hepatic trauma entirely responsible for the outcome?

PubMed

Yazici, P; Aydin, U; Sozbilen, M

2010-01-01

This study was undertaken to examine both isolated and concomitant liver injuries to clarify the role of liver trauma on outcome. This retrospective study was a review of all abdominal trauma patients who presented with liver injuries, with or without concomitant injury at Ege University School of Medicine over a 3-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with isolated hepatic injury (Group A) were compared with patients who had concomitant hepatic injury (liver and spleen/small bowel) (Group B). Significance was set at 95% confidence intervals. Of 368 patients, 80 (21%) presented with liver injury. Of these, the aetiology was as follows: 53 (66.2%) blunt injury, 19 (23%) penetrating injury, and 8 (10%) gun shot trauma. There were 38 patients in Group A and 42 in Group B. Of these 42 patients, 19 were diagnosed with serious types of injury ; eight thoracic, three open long bone fracture, one intra-cardiac, one intracranial. Six additional patients were observed with injuries to large abdominal vessels. Eleven patients (28.9%) with isolated hepatic injury were managed non-operatively. Mortality, intensive care unit and hospital length of stay, and transfusion requirements were significantly higher in Group B. Only the number of transfused blood units and the grade of liver injury were found to be effective on outcome whereas stepwise regression analysis revealed that injury type (penetrating) and blood transfusion were predictive for mortality. This study highlighted that although isolated liver injury results in good outcome with non-operative management, concomitant injuries to the liver lead to a higher failure and mortality rate. However, liver injury itself is rarely responsible for death.

Pancreaticoduodenectomy: a rare procedure for the management of complex pancreaticoduodenal injuries.

PubMed

Asensio, Juan A; Petrone, Patrizio; Roldán, Gustavo; Kuncir, Eric; Demetriades, Demetrios

2003-12-01

Pancreaticoduodenectomy (Whipple's procedure) is a formidable procedure when undertaken for severe pancreaticoduodenal injury. The purposes of this study were to review our experience with this procedure for trauma; to classify injury grades for both pancreatic and duodenal injuries in patients undergoing pancreaticoduodenectomy according to the American Association for the Surgery of Trauma-Organ Injury Scale for pancreatic and duodenal injury; and to validate existing indications for performance of this procedure. We performed a retrospective 126-month study (May 1992 to December 2002) of all patients admitted with proven complex pancreaticoduodenal injuries requiring pancreaticoduodenectomy. Eighteen patients were included; mean age was 32 +/- 12 years (SD), mean Revised Trauma Score was 6.84 +/- 2.13 (SD), and mean Injury Severity Score was 27 +/- 8 (SD). There were 17 penetrating injuries (94%) and 1 blunt injury (6%). One of 18 patients had an emergency department thoracotomy and died (100% mortality); 5 of the remaining 17 patients required operating room thoracotomies, and only 1 survived (80% mortality). There was 1 AAST-OIS pancreas grade IV injury, and there were 17 pancreas grade V injuries and 18 AAST-OIS duodenum grade V injuries. Indications for pancreaticoduodenectomy were: massive uncontrollable retropancreatic hemorrhage, 13 patients (72%); massive unreconstructable injury to the head of the pancreas/main pancreatic duct and intrapancreatic portion/distal common bile duct, 18 patients (100%); and massive unreconstructable injury, 18 patients (100%). Mean estimated blood loss was 6,888 +/- 7,866 mL, and overall survival was 67% (12 of 18 patients). Complex pancreaticoduodenal injuries requiring pancreaticoduodenectomy (Whipple's procedure) are uncommon but highly lethal; virtually all are classified as AAST-OIS grade V for both pancreas and duodenum. Current indications for performance of pancreaticoduodenectomy are valid and should be strictly applied during procedure selection.

Pressure Injury Development in Patients Treated by Critical Care Air Transport Teams: A Case-Control Study.

PubMed

Dukes, Susan F; Maupin, Genny M; Thomas, Marilyn E; Mortimer, Darcy L

2018-04-01

The US Air Force transports critically ill patients from all over the world, with transport times commonly ranging from 6 to 11 hours. Few outcome measures have been tracked for these patients. Traditional methods to prevent pressure injuries in civilian hospitals are often not feasible in the military transport environment. The incidence rate and risk factors are described of en route-related pressure injuries for patients overseen by the Critical Care Air Transport Team. This retrospective, case-control, medical records review investigated risk factors for pressure injury in patients who developed a pressure injury after their transport flight compared with those with no documented pressure injuries. The pressure injury rate was 4.9%. Between 2008 and 2012, 141 patients in whom pressure injuries developed and who had received care by the team were matched with 141 patients cared for by the team but did not have pressure injury. According to regression analysis, body mass index and 2 or more Critical Care Air Transport Team transports per patient were associated with pressure injury development. Although the pressure injury rate of 4.9% in this cohort of patients is consistent with that reported by civilian critical care units, the rate must be interpreted with caution, because civilian study data frequently represent the entire intensive care unit length of stay. Targeted interventions for patients with increased body mass index and 2 or more critical care air transports per patient may help decrease the development of pressure injury in these patients. ©2018 American Association of Critical-Care Nurses.

Recent trends in the management of combined pancreatoduodenal injuries.

PubMed

Lopez, Peter P; Benjamin, Robert; Cockburn, Mark; Amortegui, Jose D; Schulman, Carl I; Soffer, Dror; Blackbourne, Lorne H; Habib, Fahim; Jerokhimov, Igor; Trankel, Susan; Cohn, Stephen M

2005-10-01

In an effort to better characterize the natural history of pancreatoduodenal injuries, we present a review of clinical experiences in the treatment of combined traumatic pancreatoduodenal injuries, focusing on patients in extremis. Records of patients with abdominal trauma admitted to a level 1 trauma center from 1997 to 2001 were reviewed. Of 240 patients who sustained a pancreatic or duodenal injury, 33 had combined pancreatoduodenal injuries. Eighty-two per cent of the patients (27/33) in this series had penetrating injuries, 72 per cent (24) sustained gunshot wounds (GSW). Thirty-one patients were male, and the mean age was 33 years (range, 7-74). These patients presented with an average Injury Severity Score (ISS) of 22 +/- 12 and an average Glasgow Coma Score of 14 +/- 2. Overall length of stay was 39 +/- 59 days (range, 0-351 days). These 33 patients underwent a total of 57 laparotomies with an average of 1.7 operations per patient (range, 1 to 5 operations). Eighty-four per cent of the patients had an associated gastrointestinal injury and 45 per cent had a major vascular injury. Thirteen of the 33 (39%) patients presented in extremis, all 13 underwent an abbreviated laparotomy. The complication rate was 36 per cent, including fistula, abscess, pancreatitis, and organ dysfunction. There were 6 hospital deaths for a mortality rate of 18 per cent. Pancreatoduodenal injuries are associated with a variety of other serious injuries, which add to the overall complexity of these patients. Abbreviated laparotomy may be helpful when managing combined pancreatoduodenal injuries in patients who are in extremis.

Trauma deaths in the first hour: are they all unsalvageable injuries?

PubMed

MacLeod, Jana B A; Cohn, Stephen M; Johnson, E William; McKenney, Mark G

2007-02-01

With the advent of trauma systems, time to definitive care has been decreased. We hypothesized that a subset of patients who are in extremis from the time of prehospital transport to arrival at the trauma center, and who ultimately die early after arrival, may in fact have a potentially salvageable single-organ injury. We reviewed all deaths that occurred in the first hour after hospital admission. Trauma registry, medical records, and autopsy reports for 556 patients were evaluated. The median time to arrival was 39 minutes, and the median Injury Severity Score was 29. Blunt injuries (53%) were most commonly auto-accident injuries (134 of 285 patients; 47%). Penetrating wounds (42%) were mostly gunshot wounds to the chest (73 of 233 patients; 31%). For patients with initial vital signs, the most common cause of death was isolated brain injury (26 patients; 28%). Possibly survivable injuries (single organ or vessel) occurred in 35 (38%) patients, of which 4 were isolated spleen injuries (4%). Some patients with potentially survivable single organ injuries did not have associated head injuries. An aggressive approach is warranted on patients with detectable vital signs on at least one occasion in the field but who arrive at the trauma center in extremis.

Natural history of nonoperative management for grade 4 and 5 liver and spleen injuries in children.

PubMed

Yang, Jeannie C; Sharp, Susan W; Ostlie, Daniel J; Holcomb, George W; St Peter, Shawn D

2008-12-01

Nonoperative management is standard treatment of blunt liver or spleen injuries. However, there are few reports outlining the natural history and outcomes of severe blunt hepatic and splenic trauma. Therefore, we reviewed our experience with nonoperative management of grade 4 or 5 liver and spleen injuries. A retrospective analysis was performed on patients with grade 4 or 5 (high-grade) blunt liver and/or spleen injuries from April 1997 to July 2007 at our children's hospital. Demographics, hospital course data, and follow-up data were analyzed. There were 74 high-grade injuries in 72 patients. There were 30 high-grade liver and 44 high-grade spleen injuries. Two patients had both a liver and splenic injury. High-grade liver injuries had a significantly longer length of intensive care and hospital stay compared to high-grade spleen injuries. There were also a significantly higher number of transfusions, radiographs, and total charges in the high-grade liver injuries when compared to the high-grade splenic injuries. The only mortality from solid organ injury was a grade 4 liver injury with portal vein disruption. In contrast, there was only one complication from a high-grade splenic injury-a pleural effusion treated with thoracentesis. There were 5 patients with complications from their liver injury requiring 18 therapeutic procedures. Three patients (10%) with liver injury required readmission as follows: one 5 times, one 3 times, and another one time. Patients with high-grade liver injuries have a longer recovery, more complications, and greater use of resources than in patients with similar injuries to the spleen.

Traumatic intracranial injury in intoxicated patients with minor head trauma.

PubMed

Easter, Joshua S; Haukoos, Jason S; Claud, Jonathan; Wilbur, Lee; Hagstrom, Michelle Tartalgia; Cantrill, Stephen; Mestek, Michael; Symonds, David; Bakes, Katherine

2013-08-01

Studies focusing on minor head injury in intoxicated patients report disparate prevalences of intracranial injury. It is unclear if the typical factors associated with intracranial injury in published clinical decision rules for computerized tomography (CT) acquisition are helpful in differentiating patients with and without intracranial injuries, as intoxication may obscure particular features of intracranial injury such as headache and mimic other signs of head injury such as altered mental status. This study aimed to estimate the prevalence of intracranial injury following minor head injury (Glasgow Coma Scale [GCS] score ≥14) in intoxicated patients and to assess the performance of established clinical decision rules in this population. This was a prospective cohort study of consecutive intoxicated adults presenting to the emergency department (ED) following minor head injury. Historical and physical examination features included those from the Canadian CT Head Rule, National Emergency X-Radiography Utilization Study (NEXUS), and New Orleans Criteria. All patients underwent head CT. A total of 283 patients were enrolled, with a median age of 40 years (interquartile range [IQR] = 28 to 48 years) and median alcohol concentration of 195 mmol/L (IQR = 154 to 256 mmol/L). A total of 238 of 283 (84%) were male, and 225 (80%) had GCS scores of 15. Clinically important injuries (injuries requiring admission to the hospital or neurosurgical follow-up) were identified in 23 patients (8%; 95% confidence interval [CI] = 5% to 12%); one required neurosurgical intervention (0.4%, 95% CI = 0% to 2%). Loss of consciousness and headache were associated with clinically important intracranial injury on CT. The Canadian CT Head Rule had a sensitivity of 70% (95% CI = 47% to 87%) and NEXUS criteria had a sensitivity of 83% (95% CI = 61% to 95%) for clinically important injury in intoxicated patients. In this study, the prevalence of clinically important injury in intoxicated patients with minor head injury was significant. While the presence of the common features associated with intracranial injury in nonintoxicated patients should raise clinical suspicion for intracranial injury in intoxicated patients, the Canadian CT Head Rule and NEXUS criteria do not have adequate sensitivity to be applied in intoxicated patients with minor head injury. © 2013 by the Society for Academic Emergency Medicine.

Management of Zone III Missile Injuries Involving the Carotid Artery and Cranial Nerves

PubMed Central

Levine, Zachary T.; Wright, Donald C.; O'Malley, Sean; Olan, Wayne J.; Sekhar, Laligam N.

2000-01-01

Carotid and cranial nerve injuries from zone III (high cervical/cranial base) missile injuries are rare and difficult to treat. We have treated five patients with such injuries. We present our management scheme, and compare it to the management of the same injuries in other reports. Five consecutive zone III missile injuries presented to our institution. Trauma assessment by the trauma team, followed by detailed neurological assessment and radiographs (angiogram and computed tomography) were obtained on admission. All patients presented with dysphagia and carotid artery injury with good collateral flow, documented by angiogram. Two patients had facial nerve injury, one had trigeminal nerve injury, one patient presented with tongue weakness, and one patient suffered conductive hearing loss. No patient had evidence of stroke clinically or radiographically. Carotid artery injury was managed with bypass (3 of 5) or ligation (2 of 5). Cranial nerve injuries were documented and treated aggressively with surgery if needed. All patients were discharged to home. Patients presenting with zone III missile injuries should receive an expeditious neurological exam and four-vessel angiogram after initial trauma survey and resuscitation. Bypass of the injured portion of carotid artery is a valid treatment in the hemodynamically stable patient. The unstable patient should undergo ligation to stop hemorrhage and protect against immediate risk for stroke, with the option to bypass later. Cranial nerve injuries should be pursued and aggressively treated to minimize morbidity and prevent mortality. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8 PMID:17171097

Injuries caused by fragmenting rifle ammunition.

PubMed

Jorgensen, Jorgen Joakim; Naess, Paal Aksel; Gaarder, Christine

2016-09-01

Although penetrating injuries are encountered on a regular basis in high volume trauma centres, most civilian trauma teams will be unfamiliar with the treatment of patients with injuries caused by fragmenting ammunition. The terrorist attacks in Norway on July 22, 2011 included a shooting spree causing 69 deaths and 60 injured. One of the weapons used was a semi-automatic rifle, calibre 5.56mm, with soft tip, short stop ammunition. The aim of the present study was to describe the characteristic injury patterns and lessons learned from the treatment of multiple patients admitted at the regional trauma centre with injuries from this type of ammunition. We undertook an observational study of patients admitted at Oslo University Hospital, Ulleval after the shooting spree at Utoya on July 22, 2011. Data on demographics, injuries, injury severity, surgical procedures and outcome were collected prospectively. Of the 21 patients admitted after the shooting incident, 18 were identified with injuries caused by fragmenting ammunition and included in the study. Median age was 17 years (IQR 16, 19), median ISS 21 (IQR 12, 30) and 12 patients were female. They had been hit by a total of 38 projectiles, of which 32 were fragmenting bullets. Of the seven patients who sustained injuries to the head, neck and face, one patient required a craniotomy and one patient had a non-survivable head injury. Of the 11 patients with torso injuries, six of the eight patients with chest injuries had intra-thoracic injuries that could be treated with chest tubes only. One patient had cardiac tamponade, requiring thoracotomy. Six patients underwent laparotomy, four of them more than one. Of the 10 patients with extremity injuries, two had nerve injuries and six patients had fractures. Five amputations were performed within the first nine days. A total of 101 operations were required within the first four weeks. The majority of these were repeated soft tissue debridements due to progressive necrosis. Knowledge about the specific challenges created by the progressive soft tissue necrosis caused by fragmenting ammunition should lead to planned, repeated debridements to reduce total tissue loss and complications. Copyright © 2016 Elsevier Ltd. All rights reserved.

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

PubMed Central

Aksu, Nalan M

2016-01-01

Objective: To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. Methods: This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Results: Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Conclusion: Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Advances in knowledge: Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries. PMID:26959613

Management of war-related vascular injuries: experience from the second gulf war.

PubMed

Jawas, Ali; Abbas, Alaa K; Nazzal, Munier; Albader, Marzoog; Abu-Zidan, Fikri M

2013-07-01

To study the biomechanism, pattern of injury, management, and outcome of major vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second Gulf War. This is a descriptive retrospective study. War-related injured patients who had major vascular injuries and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. Studied variables included age, gender, anatomical site of vascular injury, mechanism of injury, associated injuries, type of vascular repair, and clinical outcome. 36 patients having a mean (SD) age of 29.8 (10.2) years were studied. 32 (89%) were males and 21 (58%) were civilians. Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%). Eight patients (22%) presented with shock.There were 31 arterial injuries, common and superficial femoral artery injuries were most common (10/31). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of primary amputation. 3/21 (14.3%) patients had secondary amputation after attempted arterial vascular repair of an extremity. There were a total of 17 venous injuries, 13 managed by lateral suture repair and 4 by ligation. The median (range) hospital stay was 8 (1-76) days. 5 patients died (14%). Major vascular injuries occurred in 10% of hospitalized war-related injured patients. Our secondary amputation rate of extremities was 14%. The presence of a vascular surgeon within a military surgical team is highly recommended. Basic principles and techniques of vascular repair remain an essential part of training general surgeons because it may be needed in unexpected wars.

Arterial injuries in civilian practice in Lagos, Nigeria.

PubMed

Thomas, M O; Giwa, S O; Adekoya-Cole, T O

2005-12-01

This is a retrospective study of patients managed at the Lagos University Teaching Hospital for peripheral arterial injuries from January 1995 to April 2003. The aim was to study the pattern of peripheral arterial injuries in Lagos. Nigeria and to look at the outcome of management and see what improvements could be made in future. Data was collated from case notes of patients, operation register in theatre and admission and discharge books from the surgical wards and the data bank of consultants involved in patients' management. Forty-one patients. 37 males and 4 females. were treated within the study period (M:F ratio of 9:1). Twenty three patients (56.1%) suffered gunshot injuries during armed robbery attacks while 9 patients (22.0%) had stab injuries in civilian violence. Twenty-one patients (3 with gunshot injuries and 18 non gunshot penetrating injuries) were managed by direct suturing of vessels. Eight patients had prosthetic graft interposition while 2 patients had reversed saphenous vein grafts. Two patients had the superficial branches of their radial arteries tied up at the wrist. Gun shot injuries from armed robbery attack was the commonest cause of peripheral arterial injuries in this environment during the period of study.

PTSD-8: A Short PTSD Inventory

PubMed Central

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

2010-01-01

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

PTSD-8: A Short PTSD Inventory.

PubMed

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

2010-09-28

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

Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study.

PubMed

Williams, Michael D; Watts, Dorraine; Fakhry, Samir

2003-11-01

Blunt injury to the colon is rare. Few studies of adequate size and design exist to allow clinically useful conclusions. The Eastern Association for the Surgery of Trauma Multi-institutional Hollow Viscus Injury (HVI) Study presents a unique opportunity to definitively study these injuries. Patients with blunt HVI were identified from the registries of 95 trauma centers over 2 years (1998-1999). Patients with colon injuries (cases) were compared with blunt trauma patient undergoing a negative laparotomy (controls). Data were abstracted by chart review. Of the 227,972 patients represented, 2,632 (1.0%) had an HVI and 798 had a colonic/rectal injury (0.3%). Of patients diagnosed with HVI, 30.2% had a colon injury. No physical findings or imaging modalities were able to discriminate colonic injury. Logistic regression modeling yielded no clinically useful combination of findings that would reliably predict colonic injury. In patients undergoing laparotomy, presence of colon injury was associated with a higher risk of some complications but not mortality. Colon injury was associated with increased hospital (17.4 vs. 13.1, p < 0.001) and intensive care unit (9.7 vs. 6.9, p = 0.003) length of stay. Almost all colon patients (92.0%) underwent laparotomy within 24 hours of injury. Colonic injury after blunt trauma is rare and difficult to diagnose. No diagnostic test or combination of findings reliably excluded blunt colonic injury. Despite the inadequacy of current diagnostic tests, almost all patients with colonic injury were taken to the operating room within 24 hours. Even with relatively prompt surgery, patients with colon injury were at significantly higher risk for serious complications and increased length of stay. In contrast to small bowel perforation, delay in operative intervention appears to be less common but is still associated with serious morbidity.

Horse-related injuries in children - unmounted injuries are more severe: A retrospective review.

PubMed

Wolyncewicz, Grace E L; Palmer, Cameron S; Jowett, Helen E; Hutson, John M; King, Sebastian K; Teague, Warwick J

2018-05-01

Horse-related injuries account for one quarter of all paediatric sports fatalities. It is not known whether the pattern of injury spectrum and severity differ between children injured whilst mounted, compared with those injured unmounted around horses. We aimed to identify any distinctions between the demographic features, spectrum and severity of injuries for mounted versus unmounted patients. Trauma registry data were reviewed for 505 consecutive paediatric patients (aged<16years) admitted to a large paediatric trauma centre with horse-related injuries over a 16-year period. Patients were classified into mounted and unmounted groups, and demographics, injury spectrum, injury severity, and helmet usage compared using odds ratios and Wilcoxon rank-sum tests. More patients (56%) were injured in a private setting than in a sporting or supervised context (23%). Overall, head injuries were the most common horse-related injury. Mounted patients comprised 77% of the cohort. Mounted patients were more likely to sustain upper limb fractures or spinal injuries, and more likely to wear helmets. Unmounted were more likely to be younger males, and more likely to sustain facial or abdominal injuries. Strikingly, unmounted children had significantly more severe and critical Injury Severity Scores (OR 2.6; 95% CI 1.5, 4.6) and longer hospital stay (2.0days vs 1.1days; p<0.001). Unmounted patients were twice as likely to require intensive care or surgery, and eight times more likely to sustain a severe head injury. Horse-related injuries in children are serious. Unmounted patients are distinct from mounted patients in terms of gender, age, likelihood of personal protective equipment use, severity of injuries, and requirement for intensive or invasive care. This study highlights the importance of vigilance and other safety behaviours when unmounted and around horses, and proposes specific targets for future injury prevention campaigns, both in setting of organised and private equestrian activity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Knee dislocations with vascular injury: outcomes in the Lower Extremity Assessment Project (LEAP) Study.

PubMed

Patterson, Brendan M; Agel, Julie; Swiontkowski, Marc F; Mackenzie, Ellen J; Bosse, Michael J

2007-10-01

The purpose of this study is to report the clinical and functional results of a cohort of patients with knee dislocations associated with vascular injury. Patients with knee dislocation and associated vascular injury were prospectively assessed for outcome of severe lower extremity trauma during 2 years. The Sickness Impact Profile was used to assess the functional recovery of the patient. Surgeon and therapist assessments documented clinical metrics and treatment, including salvage or amputation, neurologic recovery, knee stability, and knee motion. Eighteen patients sustained a knee dislocation and an associated popliteal artery injury. Seven patients were found to have an additional vascular injury. All patients underwent repair of the vascular injury. At the time of final follow-up, 14 knees were successfully salvaged and four required amputation (1 below knee amputation, 2 through knee amputation, and 1 above knee amputation). Eighteen patients had at least a popliteal injury and underwent repair of the vascular injury. The patients with a limb-threatening knee dislocation that was successfully reconstructed had Sickness Impact Profile scores of 20.12 at 3 months, 13.18 at 6 months, 12.08 at 1 year, and 7.0 at 2 years after injury. Patients who sustain a limb-threatening knee dislocation have a moderate to high level of disability 2 years after injury. Nearly one in five patients who present to a Level I trauma center with a dysvascular limb associated with a knee dislocation will require amputation. Prolonged warm ischemia time was associated with a high rate of amputation. Patients who sustain vascular injuries associated with a knee dislocation need immediate transport to a trauma hospital, rapid assessment and diagnosis at presentation, and revascularization. Patients with these injuries can be effectively treated without angiography before surgery.

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.

Analysis of 162 colon injuries in patients with penetrating abdominal trauma: concomitant stomach injury results in a higher rate of infection.

PubMed

O'Neill, Patricia A; Kirton, Orlando C; Dresner, Lisa S; Tortella, Bartholomew; Kestner, Mark M

2004-02-01

Fecal contamination from colon injury has been thought to be the most significant factor for the development of surgical site infection (SSI) after trauma. However, there are increasing data to suggest that other factors may play a role in the development of postinjury infection in patients after colon injury. The purpose of this study was to determine the impact of gastric wounding on the development of SSI and nonsurgical site infection (NSSI) in patients with colon injury. Post hoc analysis was performed on data prospectively collected for 317 patients presenting with penetrating hollow viscus injury. One hundred sixty-two patients with colon injury were subdivided into one of three groups: patients with isolated colon wounds (C), patients with colon and stomach wounds with or without other organ injury (C+S), and patients with colon and other organ injury but no stomach injury (C-S) and assessed for the development of SSI and NSSI. Infection rates were also determined for patients who sustained isolated gastric injury (S) and gastric injury in combination with other injuries other than colon (S-C). Penetrating Abdominal Trauma Index, operative times, and transfusion were assessed. Discrete variables were analyzed by Cochran-Mantel-Haenszel chi2 test and Fisher's exact test. Risk factor analysis was performed by multivariate logistic regression. C+S patients had a higher rate of SSI infection (31%) than C patients (3.6%) (p=0.008) and C-S patients (13%) (p=0.021). Similarly, the incidence of NSSI was also significantly greater in the C+S group (37%) compared with the C patients (7.5%) (p=0.07) and the C-S patients (17%) (p=0.019). There was no difference in the rate of SSI or NSSI between the C and C-S groups (p=0.3 and p=0.24, respectively). The rate of SSI was significantly greater in the C+S patients when compared with the S-C patients (31% vs. 10%, p=0.008), but there was no statistical difference in the rate of NSSI in the C+S group and the S-C group (37% vs. 24%, p=0.15). The addition of a gastric injury to a colon injury has a synergistic effect on the rate of postoperative infection.

Vascular injury is associated with increased mortality in winter sports trauma.

PubMed

Eun, John C; Bronsert, Michael; Hansen, Kristine; Moulton, Steven L; Jazaeri, Omid; Nehler, Mark; Greenberg, Joshua I

2015-01-01

Trauma is the leading cause of injury and death for individuals aged 1-44 years. Up to 8% of the US population participates in winter sports, and although vascular injuries are uncommon in these activities, little is published in this area. We sought to identify the incidence, injury patterns, and outcomes of vascular injuries resulting from winter sports trauma. Patients with winter sports trauma and the subset with vascular injuries were identified by accessing the National Trauma Data Bank querying years 2007-2010. Patients with and without vascular injuries were then compared. Admission variables included transport time, emergency department hypotension (systolic blood pressure < 90), Glasgow Coma Scale ≤ 8, Injury Severity Score ≥ 25, fractures, solid organ injury, and vascular injury. Outcomes were analyzed and associations with vascular injuries were determined. A total of 2,298 patients were identified with winter sports-related trauma and 28 (1.2%) had associated vascular injuries. Overall, the top 3 injuries were head trauma (16.7%), thoracic vertebral fractures (5.5%), and lumbar vertebral fractures (5.1%). The most common associated vascular injures were to the popliteal artery (17.7%), splenic artery (14.7%), and brachial blood vessels (14.7%). In the entire cohort, 1 patient (0.04%) suffered an amputation and 15 patients (0.7%) died. There were no amputations in the vascular injury group. Mortality was 0.6% in patients without a vascular injury compared with 7.1% of those with a vascular injury (P = 0.01). Although vascular injury is an uncommon associated finding in winter sports trauma, it is associated with a significant increase in mortality. These findings highlight the need for rapid identification of traumatic vascular injuries, which predicts worse overall outcomes in this patient population. Copyright © 2015 Elsevier Inc. All rights reserved.

Incidence of intracranial injury in orbital wall fracture patients not classified as traumatic brain injury.

PubMed

Lee, Hyung-Joo; Kim, Youn-Jung; Seo, Dong-Woo; Sohn, Chang Hwan; Ryoo, Seung Mok; Ahn, Shin; Lee, Yoon-Seon; Kim, Won Young; Lim, Kyoung Soo

2018-05-01

The detection of intracranial injury in patients with facial injury rather than traumatic brain injury (TBI) remains a challenge for emergency physicians. This study aimed to evaluate the incidence and risk factors of intracranial injury in patients with orbital wall fracture (OWF), who were classified with a chief complaint of facial injury rather than TBI. This retrospective case-control study enrolled adult OWF patients (age ≥18 years) who presented at the hospital between January 2004 and March 2016. Patients with definite TBI were excluded because non-contrast head computed tomography (CT) is recommended for such patients. A total of 1220 patients with OWF were finally enrolled. CT of the head was performed on 677 patients, and the incidence of concomitant intracranial injury was found to be 9% (62/677). Patients with definite TBI were excluded. Symptoms raising a suspicion of TBI, such as loss of consciousness, alcohol intoxication, or vomiting, were present in 347 of the patients, with 44 of these patients (13%) showing a concomitant intracranial injury. Of the 330 patients without such symptoms, 18 (6%) demonstrated a concomitant intracranial injury. In OWF patients, superior wall fracture (odds ratio [OR], 4.15; 95% confidence interval [CI], 2.06-8.34; P < 0.001), associated frontal bone fracture (OR, 4.38; 95% CI, 2.08-9.23; P < 0.001), and older age (decades) (OR, 1.03; 95% CI, 1.01-1.04; P = 0.002) were independent risk factors for concomitant intracranial injury. Emergency physicians should maintain a high degree of suspicion of TBI, even when their primary concern is facial trauma with OWF. Head CT is recommended for OWF patients with a superior OWF, frontal bone fracture, or increased age. Copyright © 2018 Elsevier Ltd. All rights reserved.

Chest injuries associated with earthquakes: an analysis of injuries sustained during the 2008 Wen-Chuan earthquake in China.

PubMed

Hu, Jia; Guo, Ying-Qiang; Zhang, Er-Yong; Tan, Jin; Shi, Ying-Kang

2010-08-01

The goal of this study was to analyze the patterns, therapeutic modalities, and short-term outcomes of patients with chest injuries in the aftermath of the Wen-Chuan earthquake, which occurred on May 12, 2008 and registered 8.0 on the Richter scale. Of the 1522 patients who were referred to the West China Hospital of Sichuan University from May 12 to May 27, 169 patients (11.1%) had suffered major chest injuries. The type of injury, the presence of infection, Abbreviated Injury Score (AIS 2005), New Injury Severity Score (NISS), treatment, and short-term outcome were all documented for each case. Isolated chest injuries were diagnosed in 129 patients (76.3%), while multiple injuries with a major chest trauma were diagnosed in 40 patients (23.7%). The mean AIS and the median NISS of the hospitalized patients with chest injuries were 2.5 and 13, respectively. The mortality rate was 3.0% (5 patients). Most of the chest injuries were classified as minor to moderate trauma; however, coexistent multiple injuries and subsequent infection should be carefully considered in medical response strategies. Coordinated efforts among emergency medical support groups and prior training in earthquake preparedness and rescue in earthquake-prone areas are therefore necessary for efficient evacuation and treatment of catastrophic casualties.

Duodenal Injury: Analysis of Common Misconceptions in Diagnosis and Treatment

PubMed Central

Flint, Lewis M.; McCoy, Martha; Richardson, J. David; Polk, Hiram C.

1980-01-01

Seventy-five consecutive patients who sustained injuries to the duodenum were admitted to our hospital over a nine-year period. Nineteen blunt injuries and 56 penetrating injuries were encountered. Blunt injuries were usually the result of motor vehicle accidents and steering wheel impact was frequently implicated. Penetrating injuries most commonly followed gunshot wounds, particularly those where the bullet tract travelled transversely across the peritoneal cavity. Seventy-nine per cent of the patients had two or more associated intra-abdominal organ injuries with other intestinal injuries, biliary tract injuries, and pancreatic injuries predominating. Forty-seven per cent of the patients were admitted in shock. Following blunt injury, diagnostic delay was encountered in two patients. Adjuncts to diagnosis such as abdominal roentgenograms, serum amylase levels, and contrast gastroduodenography, were not helpful. Peritoneal lavage, however, was valuable in patients with equivocal physical findings. Intraoperative diagnosis was also challenging. Complete mobilization of the structures surrounding the duodenum to provide exposure of the entire duodenum was necessary. Six injuries that initially appeared trivial would have been missed had this procedure not been followed. Suture closure was the most common reparative technique used. Tube decompression of the duodenum was a valuable addition. No suture line dehiscences were encountered in ten patients so treated. Overall mortality in patients surviving more than 24 hours was 12%. PMID:7387230

Self-injury and incontinence in psychogenic seizures.

PubMed

Peguero, E; Abou-Khalil, B; Fakhoury, T; Mathews, G

1995-06-01

Two patients who incurred significant injuries during psychogenic seizures prompted us to do a telephone survey of self-injury and incontinence in 102 consecutive patients diagnosed with psychogenic seizures by EEG-closed-circuit TV (EEG-CCTV) monitoring. Seventy-three patients (or a close family member or friend) were reached by telephone and responded to our survey. During typical attacks of psychogenic seizures, 40% reported injuries, 44% reporting tongue biting, and 44% reported urinary incontinence. Suicide attempts were reported by 32% and were more common in those with self-injury and urinary incontinence. We compared the results of patients with psychogenic seizures with those of 30 patients with refractory epilepsy documented by ictal recordings, using a similar telephone survey. Injuries of all types were more commonly reported by epilepsy patients. Burn injuries were reported only by patients with epilepsy. Suicide attempts were more commonly reported by the psychogenic seizure group. Self-injury and incontinence are commonly reported by psychogenic seizure patients. In view of their significant association with suicide attempts, they may indicate an underlying depression.

Liver enzyme abnormalities in taking traditional herbal medicine in Korea: A retrospective large sample cohort study of musculoskeletal disorder patients.

PubMed

Lee, Jinho; Shin, Joon-Shik; Kim, Me-Riong; Byun, Jang-Hoon; Lee, Seung-Yeol; Shin, Ye-Sle; Kim, Hyejin; Byung Park, Ki; Shin, Byung-Cheul; Lee, Myeong Soo; Ha, In-Hyuk

2015-07-01

The objective of this study is to report the incidence of liver injury from herbal medicine in musculoskeletal disease patients as large-scale studies are scarce. Considering that herbal medicine is frequently used in patients irrespective of liver function in Korea, we investigated the prevalence of liver injury by liver function test results in musculoskeletal disease patients. Of 32675 inpatients taking herbal medicine at 7 locations of a Korean medicine hospital between 2005 and 2013, we screened for liver injury in 6894 patients with liver function tests (LFTs) at admission and discharge. LFTs included t-bilirubin, AST, ALT, and ALP. Liver injury at discharge was assessed by LFT result classifications at admission (liver injury, liver function abnormality, and normal liver function). In analyses for risk factors of liver injury at discharge, we adjusted for age, sex, length of stay, conventional medicine intake, HBs antigen/antibody, and liver function at admission. A total 354 patients (prevalence 5.1%) had liver injury at admission, and 217 (3.1%) at discharge. Of the 354 patients with liver injury at admission, only 9 showed a clinically significant increase after herbal medicine intake, and 225 returned to within normal range or showed significant liver function recovery. Out of 4769 patients with normal liver function at admission, 27 (0.6%) had liver injury at discharge. In multivariate analyses for risk factors, younger age, liver function abnormality at admission, and HBs antigen positive were associated with injury at discharge. The prevalence of liver injury in patients with normal liver function taking herbal medicine for musculoskeletal disease was low, and herbal medicine did not exacerbate liver injury in most patients with injury prior to intake. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Management of rectal traumatism in the pediatric age].

PubMed

Palazón, P; Juliá, V; Amado, V; Saura, L; Tarrado, X; Ribó, J M

2012-10-01

In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We present our experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with associated malformations) and non-iatrogenic accidental injuries. A CT was performed in 4 cases. None of them was explored with sigmoidoscopy. We performed colostomy without primary repair in four patients, primary injury repair with colostomy in two patients, and one patient underwent primary repair without colostomy. All patients had a long evolution (mean hospital length of stay was 31,4 days) with many dressings and some of them required relaparotomy. Fecal continence and long term results have been, in all of them, satisfactories. An early and complete diagnosis of anorectal injuries is basic for an appropriate approach to the treatment. Primary repair of injuries without colostomy could be a safe procedure as a first treatment in selected patients: stables, with no contamination and no associated injuries. It is very important to individualize each patient to minimize the morbidity, reduce the hospital length of stay and reach a full continence.

Patterns of injury seen in road crash victims in a South African trauma centre.

PubMed

Parkinson, Fran; Kent, S; Aldous, C; Oosthuizen, G; Clarke, D L

2013-10-22

Road traffic crashes (RTCs) account for a significant burden of disease in South Africa. This prospective study reviews basic demographic and outcome data of patients who sustained an RTC-related injury and analyses the common patterns of injury associated with specific mechanisms of injury. We reviewed all patients seen at a single regional hospital (Edendale Hospital, Pietermaritzburg, KwaZulu-Natal) with injuries sustained in RTCs over a 10-week period. State mortuary data were gathered on all RTC-related fatalities over the same period. Three hundred and five patients were seen at the hospital over the 10-week period. The average transfer time to hospital was 9.2 hours (range 1 - 17 hours) One hundred patients were admitted and the rest were discharged home from the emergency department. Of the admitted cohort, 59 were motor vehicle occupants (MVC group) and 41 were pedestrians (PVC group). PVC patients commonly had lower limb, head, radio-ulnar and clavicular injuries, while MVC patients commonly had neck and intra-abdominal injuries. Thirty-seven patients had multiple injuries. The in-hospital mortality rate was 5.6%, but the overall mortality rate was 10.0%, as 15 patients died at the scene. Patterns of injury differ according to the mechanism of injury. Pedestrians impact against various parts of the vehicle and the ground and so sustain injuries to their arms and legs. Occupants of vehicles impact against the dashboard and steering wheel and are more likely to sustain torso injuries. The low number of severe injuries and multiple injuries and the relatively low inpatient mortality rate are a consequence of the triage effect of long delays in transfer. More severely injured patients are more likely to die at the scene.

Challenges in the management of pancreatic and duodenal injuries.

PubMed Central

Moncure, M.; Goins, W. A.

1993-01-01

A retrospective analysis of 44 consecutive patients with pancreatic or duodenal injuries admitted to an urban trauma center over a 6-year period was undertaken. Thirty-three patients had pancreatic injuries, including eight with combined duodenal injuries. Eleven patients had duodenal injuries. The mean age was 28 years, and 93% of the patients were male. Penetrating abdominal trauma accounted for the majority of injuries. Class I pancreatic injuries were the most common (55%), followed by those with class III (21%) and class II (18%). The majority (55%) of pancreatic injuries were managed by drainage with or without suturing; distal pancreatectomy was used in 39% of patients. Duodenal injuries were managed by primary repair in 50% of cases and pyloric exclusion/diverticulization techniques were used in 20% of cases. The mean first 24 hours transfusion requirement was 6.8 packed red blood cells. Complications were common, occurring in 61% of patients surviving longer than 24 hours. Intraabdominal abscess developed in 31% of all patients, 42% of whom required relaparotomy. Pancreatic fistulas occurred in 16% of patients with pancreatic injuries. Six patients died, 83% within 8 hours of admission, all as a result of gunshot wounds. Increased mortality was seen in patients with higher blood transfusion requirements, higher penetrating abdominal trauma index, shotgun wounds, the need for pancreaticoduodenectomy, hypotension on admission, and the presence of an associated major vascular injury. We conclude that early operation and efficacious control of hemorrhage is of prime importance in decreasing the mortality rate associated with these injuries.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8254694

Firefighter burn injuries: predictable patterns influenced by turnout gear.

PubMed

Kahn, Steven A; Patel, Jignesh H; Lentz, Christopher W; Bell, Derek E

2012-01-01

Approximately 100 firefighters suffer fatal injuries annually and tens of thousands receive nonfatal injuries. Many of these injuries require medical attention and restricted activity but may be preventable. This study was designed to elucidate etiology, circumstances, and patterns of firefighter burn injury so that further prevention strategies can be designed. In particular, modification of protective equipment, or turnout gear, is one potential strategy to prevent burn injury. An Institutional Review Board-approved retrospective review was conducted with records of firefighters treated for burn injury from 2005 to 2009. Data collected included age, gender, TBSA, burn depth, anatomic location, total hospital days per patient, etiology, and circumstances of injury. Circumstances of injury were stratified into the following categories: removal/dislodging of equipment, failure of equipment to protect, training errors, and when excessive external temperatures caused patient sweat to boil under the gear. Over the 4-year period, 20 firefighters were treated for burn injury. Mean age was 38.9 ± 8.9 years and 19 of 20 patients were male. Mean burn size was 1.1 ± 2.7% TBSA. Eighteen patients suffered second-degree burns, while two patients suffered first-degree burns. Mean length of hospitalization was 2.45 days. Scald burns were responsible for injury to 13 firefighters (65%). Flame burns caused injury to four patients (20%). Only three patients received contact burns (15%). The face was the site most commonly burned, representing 29% of injuries. The hand/wrist and ears were the next largest groups, with 23 and 16% of the injuries, respectively. Other areas burned included the neck (10%), arm (6.5%), leg (6.5%), knees (3%), shoulders (3%), and head (3%). Finally, the circumstance of injury was evaluated for each patient. Misuse and noncontiguous areas of protective equipment accounted for 14 of the 20 injuries (70%). These burns were caused when hot steam/liquid entered the gear via gaps in the sleeve or face mask. Three patients (15%) received injury due to removal/dislodging of their safety equipment, two patients (10%) suffered their injuries during training exercises when they were not wearing their safety equipment, and the final patient (5%) received burns due to sweat evaporation. Firefighter burn injuries occur to predictable anatomic sites with common injury patterns. Modification and optimization of gear to eliminate gaps that allow steam/hot liquid entry may decrease burn injury. Improving education regarding the use of protective equipment may also be beneficial.

Traumatic injury to the portal vein.

PubMed Central

Mattox, K L; Espada, R; Beall, A R

1975-01-01

Traumatic injuries to the upper abdominal vasculature pose difficult management problems related to both exposure and associated injuries. Among those injuries that are more difficult to manage are those involving the portal vein. While occurring rarely, portal vein injuries require specific therapeutic considerations. Between January, 1968, and July, 1974, over 2000 patients were treated operatively for abdominal trauma at the Ben Taub General Hospital. Among these patients, 22 had injury to the portal vein. Seventeen portal vein injuries were secondary to gunshot wounds, 3 to stab wounds, and 2 to blunt trauma. Associated injuries to the inferior vena cava, pancreas, liver and bile ducts were common. Three patients had associated abdominal aortic injuries, two with acute aorto-caval fistulae. Nine patients died from from failure to control hemorrhage. Eleven were long-term survivors, including two who required pancreataico-duodenectomy as well as portal venorrhaphy. Late complications were rare. The operative approach to patients with traumatic injuries to multiple organs in the upper abdomen, including the portal vein, requires aggressive management and predetermined sequential methods of repair. In spite of innumerable associated injuries, portal vein injuries can be successfully managed in a significant number of patients using generally available surgical techniques and several adjunctive maneuvers. PMID:1130870

Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison.

PubMed

Coyer, Fiona; Miles, Sandra; Gosley, Sandra; Fulbrook, Paul; Sketcher-Baker, Kirstine; Cook, Jane-Louise; Whitmore, Jacqueline

2017-09-01

Hospital-acquired pressure injury is associated with increased morbidity and mortality and considered to be largely preventable. Pressure injury prevalence is regarded as a marker of health care quality. To compare the state-wide prevalence, severity and location of pressure injuries of intensive care unit patients compared to patients in non-intensive care wards. The study employed a secondary data analysis design to extract and analyse de-identified pressure injury data from all Queensland Health hospitals with level I-III intensive care facilities that participated in Queensland Bedside Audits between 2012-2014. The sample included all adult ICU and non-ICU patients that provided consent for the Queensland Bedside Audits, excluding those in mental health units. Excluding Stage I, overall hospital-acquired pressure injury prevalence from 2012 to 2014 was 11% for intensive care patients and 3% for non-intensive care patients. Intensive care patients were 3.8 times more likely (RR 2.7-5.4, 95% CI) than non-intensive care patients to develop a pressure injury whilst in hospital. The sacrum/coccyx was the most common site of hospital-acquired pressure injury in all patients (intensive care patients 22%; non-intensive care patients 35%) however, mucosal pressure injury proportion was significantly higher in intensive care patients (22%) than in non-intensive care patients (2%). Stage II HAPI prevalence was the most common stage reported, 53% for intensive care patients compared to 63% for non-intensive care patients. There are significant differences in hospital-acquired pressure injury prevalence by stage and location between intensive care and non-intensive care patients reflecting the possible impact of critical illness on the development of skin injury. This has implications for resource funding for pressure injury prevention and the imposition of government initiated financial penalties for hospital-acquired pressure injury. For future comparisons to be effective between intensive care units, benchmarking partners should share similar characteristics and relevant targets. Copyright © 2016 Australian College of Critical Care Nurses Ltd. All rights reserved.

Immediate postoperative complications of combined penetrating rectal and bladder injuries.

PubMed

Crispen, Paul L; Kansas, Bryan T; Pieri, Paola G; Fisher, Carol; Gaughan, John P; Pathak, Abhijit S; Mydlo, Jack H; Goldberg, Amy J

2007-02-01

Combined penetrating trauma involving the rectum and bladder has been associated with increased postoperative morbidity. Specific complications resulting from these injuries include colovesical fistula, urinoma, and abscess formation. A retrospective review of Temple University Hospital trauma database was performed. Patients were categorized by having an isolated rectal (n = 29), isolated bladder (n = 16), or combined injury (n = 24). Records were reviewed for sex, age, site of injury, location of rectal and bladder injuries, operative intervention, fistula formation, urinoma formation, abscess formation, time to urinary catheter removal, length of intensive care unit stay, and length of hospital stay. Patient sex and age did not differ significantly between groups, nor was there a significant difference in location of rectal injury between groups. Presacral drainage was utilized in all patients with extraperitoneal injuries. Fecal diversion was performed in all patients, except two with intraperitoneal rectal injuries. Omental flap interposition between rectal and bladder injuries was utilized in one patient. No significant difference was noted in immediate postoperative complications between groups including fistula, urinoma, and abscess formation. However, all cases of colovesical fistula (n = 2) and urinoma (n = 2) formation were noted in those patients with rectal and posterior bladder injuries. Combined rectal and bladder injuries were not associated with an increase in immediate postoperative complications compared with isolated rectal and bladder injuries. However, postoperative fistula and urinoma formation occurred only in patients with a combined rectal and posterior bladder injury. Consequently, these patients may benefit from omental flap interposition between injuries to decrease fistula and urinoma formation.

[Management of penetrating ocular injuries and endophthalmitis in thirteen-year follow-up period].

PubMed

Vukosavljević, Miroslav

2006-01-01

Ocular trauma is one of the most common causes of unilateral morbidity and blindness in the world today. Frequency of penetrating ocular injuries and endophthalmitis after injuries caused by explosive weapons during the war in former Yugoslavia in the period 1991-1999 as well as eye injuries in the period 2000-2004 was examined. During 1991-1999, 647 patients with eye injuries were hospitalized at Eye Clinic, MMA, out of whom 500 cases with penetrating eye injuries. In 2000-2004 period, 601 patients with eye injuries were treated, out of whom 297 had penetrating eye injuries (including patients from Montenegro and Republica Srpska). All patients underwent thorough ophthalmological examination, antibiotic treatment and VPP or other required surgical interventions. All 500 patients from the first period had severe penetrating eye injuries. Intrabulbar foreign bodies (IFB) were detected in 286 cases, while 214 cases with penetrating eye injuries had no intrabulbar foreign bodies. Almost all patients had multiple head and body injuries as well. Endophthalmitis was observed in 29 eyes (5.2%) upon admission to hospital. In the second observed period (2000-2004), 196 (66%) out of 297 penetrating eye injuries had IOFB, and 101 (34%) was without IOFB. Endophthalmitis was observed in 34 eyes (8.4%). War eye injuries are a special group of injuries. Relatively low percent of posttraumatic endophthalmitis is definitely worth attention, especially in comparison with peacetime eye penetrating injuries.

Complications of nonoperative management of high-grade blunt hepatic injuries.

PubMed

Kozar, Rosemary A; Moore, John B; Niles, Sarah E; Holcomb, John B; Moore, Ernest E; Cothren, C Clay; Hartwell, Elizabeth; Moore, Frederick A

2005-11-01

Nonoperative management of blunt hepatic injuries is highly successful. Complications associated with high-grade injuries, however, have not been well characterized. The purpose of the present study was therefore to define hepatic-related complications and associated treatment modalities in patients undergoing nonoperative management of high-grade blunt hepatic injuries. Three hundred thirty-seven patients from two regional Level I trauma centers with grade 3 to 5 blunt hepatic injuries during a 40-month period were reviewed. Complications and treatment of hepatic-related complications in patients not requiring laparotomy in the first 24 hours were identified. Of 337 patients with a grade 3 to 5 injury, 230 (68%) were managed nonoperatively. There were 37 hepatic-related complications in 25 patients (11%); 63% (5 of 8) of patients with grade 5 injuries developed complications, 21% (19 of 92) of patients with grade 4 injuries, but only 1% (1 of 130) of patients with grade 3 injuries. Complications included bleeding in 13 patients managed by angioembolization (n = 12) and laparotomy (n = 1), liver abscesses in 2 patients managed with computed tomography-guided drainage (n = 2) and subsequent laparotomy (n = 1). In one patient with bleeding, hepatic necrosis followed surgical ligation of the right hepatic artery and required delayed hepatic lobectomy. Sixteen biliary complications were managed with endoscopic retrograde cholangiopancreatography and stenting (n = 7), drainage (n = 5), and laparoscopy (n = 4). Three patients had suspected abdominal sepsis and underwent a negative laparotomy, whereas an additional three patients underwent laparotomy for abdominal compartment syndrome. Nonoperative management of high-grade liver injuries can be safely accomplished. Mortality is low; however, complications in grade 4 and 5 injuries should be anticipated and may require a combination of operative and nonoperative management strategies.

Acute pain in an emergency clinic: latency of onset and descriptor patterns related to different injuries.

PubMed

Melzack, R; Wall, P D; Ty, T C

1982-09-01

Features of acute pain were examined in patients at an emergency clinic. Patients who had severe, life-threatening injuries or who were agitated, drunk, or 'in shock' were excluded from the study. Of 138 patients who were alert, rational and coherent, 51 (37%) stated that they did not feel pain at the time of injury. The majority of these patients reported onset of pain within an hour of injury, although the delays were as long as 9 h or more in some patients. The predominant emotions of the patients were embarrassment at appearing careless or worry about loss of wages. None expressed any pleasure or indicated any prospect of gain as a result of the injury. The occurrence of delays in pain onset was related to the nature of the injury. Of 46 patients whose injuries were limited to skin (lacerations, cuts, abrasions, burns), 53% had a pain-free period. Of 86 patients with deep-tissue injuries (fractures, sprains, bruises, amputation of a finger, stabs and crushes), only 28% had a pain-free period. The McGill Pain Questionnaire was administered to patients who felt pain immediately after injury or after a delay, and revealed a normal distribution of sensory scores but very low affective scores compared to patients with chronic pain. The results indicate that the relationship between injury and pain is highly variable and complex.

Epidemiology of Aquatic and Recreational Water Sport Injuries: A Case-Control Analysis.

PubMed

Kane, Ian; Ong, Alvin; Radcliff, Kris E; Austin, Luke S; Maltenfort, Mitchell; Tjoumakaris, Fotios

2015-09-01

The purposes of the current investigation are to evaluate the epidemiology of water sport injuries at a coastal tertiary trauma center and to determine the association of these activities with spinal column injury and to determine whether aquatic trauma injuries differ significantly from those that occur terrestrially. A retrospective review of a consecutive series of 105 patients with aquatic-based mechanisms of injury admitted to a Level II trauma center over a 3-year period, as well as a matched control cohort with terrestrial-based mechanisms of injury, was conducted. Patients were treated at a Level II trauma center from January 1, 2008, to December 31, 2010. All patients received a full trauma work-up on arrival. Patients were identified retrospectively from a prospectively collected database (N=5298). Eligible patients were identified from billing/coding data as having mechanisms of injury related to an aquatic setting. Patients were evaluated using standard trauma protocols. Spinal column and cord injury occurrence and differences between groups were reviewed. Personal watercrafts accounted for the majority of injuries (n=39). Cervical (33.3%), closed-head (25.7%), and thoracolumbar (21.9%) injuries accounted for the majority of injury types. The cervical spinal column and the spinal cord were at an increased risk of injury in the aquatic injury cohort (P<.0001). The current data show the high incidence of spinal column and cord injuries in this patient population relative to controls. Practitioners who care for trauma patients near an aquatic environment should be aware of the high prevalence of these injuries, with proper spinal cord preservation protocols in place to optimize outcome. Copyright 2015, SLACK Incorporated.

Trampoline related injuries in adults.

PubMed

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

2016-01-01

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

Early post-splenectomy sepsis after missile injury in adults.

PubMed Central

Ellias, Y. A.; Elias, M. A.; Gorey, T. F.

1991-01-01

Early septic complications were studied in 292 patients operated on for penetrating missile injury of the abdomen with involvement of either the spleen or the liver, at Basrah Teaching Hospital between January 1983 and April 1986. Depending on associated injuries, patients with splenectomy were divided into three groups, the first with isolated splenic injury, the second with splenic and associated extra-intestinal organ injury, and the third with splenic and intestinal injuries with or without extra-intestinal organ injury. Patients with hepatic injury were classified similarly. Splenectomy was carried out for any degree of splenic injury. Grade I hepatic injuries were managed by débridement and suturing while major grades II-IV underwent segmentectomy or lobectomy. Patients were considered septic if they had any three of four clinical criteria: temperature higher than 39 degrees C; significant haemodynamic deterioration; respiratory alkalosis, or oliguria. Of the total, 79 were excluded due to: early transfer 51, incomplete records 8, perioperative death 11, and having combined splenic and hepatic injuries 9 (excluded by definition), leaving 104 (74.8%) patients with splenectomy and 109 (71.1%) with hepatic injury available for study. Sepsis developed in 48 (46.1%) of patients after splenectomy and in 28 (25.7%) with hepatic injury. This difference was significant (P greater than 0.005). In patients with isolated splenic injury, eight (25.8%) were septic while three (13.6%) of those with isolated hepatic injury developed sepsis. This was not significant (P = 0.32, Fisher's exact test). When either was associated with an injury to an extra-intestinal organ, 15 (50%) of the splenectomy group developed sepsis compared to five (23.8%) of the hepatic injury group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2042899

Subaxial cervical spine injuries in children and adolescents.

PubMed

Murphy, Robert F; Davidson, Austin R; Kelly, Derek M; Warner, William C; Sawyer, Jeffrey R

2015-03-01

Limited data exist on pediatric subaxial cervical spine injuries. The goal of this study was to characterize the injuries and initial treatment of a large consecutive series of patients with injuries from C3 to C7. Medical records and radiographs of consecutive patients admitted with cervical spine fractures and/or dislocations at a single level 1 pediatric trauma center from 2003 to 2013 were reviewed. Data abstracted included age, injury type and level, mechanism of injury, associated nonspine injuries, neurological status, length of hospitalization, and initial treatment. Fifty-one patients were grouped into 3 age ranges: infant, 0 to 3 years (2); youth, 4 to 12 years (13); and adolescent, 13 to 16 years (36). Isolated fractures were identified in both infants and accounted for most of injuries in youths (85%) and adolescents (86%). Single vertebra or single vertebral level injuries were present in 65% of patients, most commonly at C7 (36%) or C6 (29%). No correlation existed between cervical level injured and patient age. Multiple cervical spine injuries occurred in 1 infant, 3 youths, and 14 adolescents. Other concomitant thoracic and/or lumbar spine injuries were found in 1 infant and 3 adolescents. The most common mechanisms of injury were motor vehicle accidents (53%) and sports (14%). High-energy trauma was associated with higher rates of noncontiguous spinal injuries and associated nonspinal injuries, with a longer length of hospitalization. Neurological deficits were observed in 8 patients: 1 infant, 2 youths, and 5 adolescents, of which 5 resulted from high-energy trauma. One infant and all youth patients were treated nonoperatively; 26 adolescents (73%) were treated in a cervical collar or with observation, 1 was treated with halo-vest immobilization, and 9 had surgical treatment. Most subaxial cervical spine injuries in pediatric and adolescent patients are isolated fractures at C6 and C7. High-energy mechanisms are associated with noncontiguous spinal injuries and other nonspine injuries. Most patients can be treated in a cervical collar, but adolescent patients are more likely to require halo placement or surgical intervention. Level IV-retrospective, diagnostic.

Defining the gastroesophageal junction in trauma: Epidemiology and management of a challenging injury.

PubMed

Schellenberg, Morgan; Inaba, Kenji; Bardes, James M; OʼBrien, Daniel; Lam, Lydia; Benjamin, Elizabeth; Grabo, Daniel; Demetriades, Demetrios

2017-11-01

Injuries to the gastroesophageal (GE) junction are infrequently encountered because of the high mortality of associated injuries. Consequently, there is a paucity of literature on the patient demographics and treatment options. The aim of this study was to examine the epidemiology, surgical management, and outcomes of these rare injuries. Patients presenting to LAC + USC Medical Center (January 2008 to August 2016) with traumatic esophageal or gastric injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification and 10th Rev. codes) were extracted from the trauma registry. Patient charts were reviewed, and all patients who sustained an injury to the GE junction were enrolled. Patient demographics, injury characteristics, procedures, and outcomes were analyzed. Of the 238 patients who sustained an injury to the esophagus or stomach during the study period, 28 (12%) were found to have a GE junction injury. Mean age was 26 years (range, 14-57 years), 89% male. Mechanism of injury was penetrating in 96% (n = 27), the majority of which were gunshot wounds (n = 22, 81%). Most patients (n = 18, 64%) were taken directly to the operating room. Ten (36%) underwent computed tomography scan before going to the operating room, all demonstrating a GE junction injury. All patients underwent repair via laparotomy. One (4%) also required thoracotomy to facilitate delayed reconstruction. GE junction injuries were typically managed with primary repair (n = 22, 79%). Associated injuries were frequent (n = 26, 93%), and injury severity was high (mean Injury Severity Score, 25 [9-75]). Mortality was 25% (n = 7), and all patients required intensive care unit admission. Most did not require total parenteral nutrition (n = 25, 89%) or a surgically placed feeding tube (n = 26, 93%). Of the 13 patients who presented for clinical follow-up, all but one (n = 12, 92%) were eating independently by the first clinic visit. GE junction injuries are uncommon and occur almost exclusively after penetrating trauma. Patients are severely injured with a high mortality rate and frequently have associated intracavitary injuries. Most can be fixed through the abdomen alone and do not require thoracotomy for repair. Despite the severity of injuries, the majority of survivors are eating independently by the first clinic visit. Epidemiological, level V.

Impact of associated injuries in the Floating knee: A retrospective study

PubMed Central

Rethnam, Ulfin; Yesupalan, Rajam S; Nair, Rajagopalan

2009-01-01

Background Floating knee injuries are usually associated with other significant injuries. Do these injuries have implications on the management of the floating knee and the final outcome of patients? Our study aims to assess the implications of associated injuries in the management and final outcome of floating knee. Methods 29 patients with floating knees were assessed in our institution. A retrospective analysis of medical records and radiographs were done and all associated injuries were identified. The impact of associated injuries on delay in initial surgical management, delay in rehabilitation & final outcome of the floating knee were assessed. Results 38 associated injuries were noted. 7 were associated with ipsilateral knee injuries. Lower limb injuries were most commonly associated with the floating knee. Patients with some associated injuries had a delay in surgical management and others a delay in post-operative rehabilitation. Knee ligament and vascular injuries were associated with poor outcome. Conclusion The associated injuries were quite frequent with the floating knee. Some of the associated injuries caused a delay in surgical management and post-operative rehabilitation. In assessment of the final outcome, patients with associated knee and vascular injuries had a poor prognosis. Majority of the patients with associated injuries had a good or excellent outcome. PMID:19144197

Characteristics of Cervical Spine Injury in Pediatric Patients With Facial Fractures.

PubMed

Halsey, Jordan N; Hoppe, Ian C; Marano, Andrew A; Kordahi, Anthony M; Lee, Edward S; Granick, Mark S

2016-01-01

Cervical spine injury may present with pediatric patients having sustained fractures of the craniofacial skeleton. Management considerations of the cervical spine often take priority to the fractures of the facial skeleton. The goal of this study was to examine this subset of patients with a focus on initial presentation and need for intervention. A retrospective review from 2000 to 2012 of all facial fractures in patients ≤ 18 years at a level 1 trauma center was performed. Patient demographics, location of fractures, and the presence of a cervical spine injury were collected. During this time period, 285 patients met inclusion criteria. Ten patients were found to have a cervical spine injury. Fractures of the zygoma and orbit were significantly associated with a cervical spine injury. Patients with a cervical spine injury had a Glasgow Coma Scale of 11.2 compared with 13.8 in those without (P < 0.05). C1 was injured in 4 patients, C2 in 2 patients, and C3 to C7 in 4 patients. A surgical airway was required in 1 patient, and 6 were intubated in the trauma bay. Fractures of the mandible were significantly associated with injury to C2. Le Fort fractures and palate fractures approached significance with injury to C1. Only 1 patient had neurologic impairment at presentation, manifested as upper extremity parasthesias, and underwent decompression and fusion in the operating room. Those patients admitted (90%) were all admitted for reasons other than management of the cervical spine injury. The majority of patients (70%) were treated with collar immobilization. One patient expired. No patients had a neurologic deficit at the time of discharge. In this study only 1 cervical spine injury necessitated intervention, with an eventual full recovery. Cervical spine injuries presenting with fractures of the facial skeleton appear to be relatively benign in this series; however, care must be taken to identify all such injuries to avoid exacerbation during maneuvers commonly used for facial fracture treatment. Special caution should be used when examining patients with a depressed Glasgow Coma Scale or in those with upper midface fractures.

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

PubMed

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

2005-12-01

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

Treatment of penetrating hepatic injuries: a retrospective analysis of 50 patients.

PubMed

Gonullu, D; Koksoy, F N; Ilgun, S; Demiray, O; Yucel, O; Yucel, T

2009-01-01

The aim of this study was to determine the possibility of non-operative treatment via retrospective analysis of our patients. Fifty patients with penetrating hepatic injuries were examined retrospectively with respect to trauma scores, associated injuries, complications, and mortality parameters. Thirteen injuries were caused by firearms, whereas 37 injuries were caused by stab wounds. Forty-three patients (86%) underwent laparotomy and 7 patients (14%) were monitored by CT and clinical findings (nonoperative group, NO group). The laparotomies were evaluated as non-therapeutic in 11 patients (22%) (NTL group) and therapeutic in 32 patients (64%) (TL group). The morbidity and mortality rates were 40 and 10%, respectively. RTS and ISS scores of the nonsurviving and the surviving patients were significantly different. The rates of major venous, grade IV-V hepatic injuries, and gunshot wounds were significantly higher in the nonsurviving patients when compared to the surviving patients. Major venous and grade IV-V hepatic injuries were the primary factors determining mortality and these injuries generally occurred as a result of firearm injuries. NTL occurring at a rate of 22% would decrease to 2% if 'RTS <7' criteria was added to the hemodynamic instability and/or peritoneal irritation findings determining surgical candidacy. Copyright 2009 S. Karger AG, Basel.

Anticipated Transfusion Requirements and Mortality in Patients with Orthopedic and Solid Organ Injuries.

PubMed

Callahan, Devon S; Ashman, Zane; Kim, Dennis Y; Plurad, David S

2016-10-01

Long bone fractures are cited as an etiology for significant blood loss; however, there is scant supporting literature. We examined the relationship between long bone fractures, blood transfusions, and solid organ injuries. We hypothesize that transfusions are rare with long bone fractures in the absence of a liver or splenic injury. We performed a retrospective analysis of patients admitted with femur, tibia, and humerus fractures. Outcomes included transfusion requirements and mortality. A total of 1837 patients were included. There were 182 patients with at least one solid organ injury. A greater portion of patients with femur fractures and a lower proportion of patients with tibia fractures required transfusion. Adjusting for solid organ injuries, there was no difference in transfusions for any patient with these fractures compared with the group, or when grouped by organ injury severity. A solid organ injury significantly increases the risk of death among patients with long bone fractures. Blood loss requiring transfusion in patients with orthopedic and solid organ injuries should not be attributed to the presence of fractures alone. The need for transfusions in these patients should lower the threshold for reimaging or intervention for the solid organ injury. Further study is warranted to quantify blood loss by fracture type with or without solid organ.

The Influence of Meniscal and Anterolateral Capsular Injury on Knee Laxity in Patients With Anterior Cruciate Ligament Injuries.

PubMed

Musahl, Volker; Rahnemai-Azar, Ata A; Costello, Joanna; Arner, Justin W; Fu, Freddie H; Hoshino, Yuichi; Lopomo, Nicola; Samuelsson, Kristian; Irrgang, James J

2016-12-01

The role of the anterolateral capsule (ALC) as a secondary restraint to quantitative rotatory laxity of patients with an anterior cruciate ligament (ACL) injury is currently debated. The purpose was to determine the influence of concomitant ALC injuries as well as injuries to other soft tissue structures on rotatory knee laxity in patients with an ACL injury. It was hypothesized that a concomitant ALC injury would be associated with increased rotatory knee laxity as measured during a quantitative pivot-shift test. Cross-sectional study; Level of evidence, 3. Forty-one patients with an ACL injury (average age, 23 ± 6.9 years) were enrolled. Two blinded musculoskeletal radiologists reviewed magnetic resonance imaging (MRI) scans for the presence of ACL injuries and concomitant soft tissue injuries including the ALC, medial collateral ligament, lateral collateral ligament, posterolateral corner, medial meniscus, and lateral meniscus. A standardized pivot-shift test was performed under anesthesia, and rotatory laxity was quantified according to anterior translation of the lateral tibial compartment during the pivot-shift maneuver. The Student t test was used to analyze the data. Statistical significance was set at P < .05. A complete ACL rupture was confirmed in all of the patients. MRI evidence of an ALC injury was observed in 21 (51%) of the patients. Patients with MRI evidence of an ALC injury had significantly higher rotatory knee laxity (3.6 ± 1.5 mm) compared with those without an ALC injury (2.7 ± 1.5 mm; P = .04). Lateral and medial meniscus injuries were detected in 17 (41%) and 19 (46%) patients, respectively. Patients with MRI evidence of either a medial meniscus injury or lateral meniscus injury had significantly higher rotatory knee laxity compared with patients without these injuries (medial meniscus: 3.7 ± 1.4 mm vs 2.7 ± 1.6 mm, respectively; lateral meniscus: 3.7 ± 1.7 mm vs 2.7 ± 1.3 mm, respectively) (P = .03 for both). MRI evidence of a concomitant injury to the ALC, medial meniscus, or lateral meniscus is associated with increased knee rotatory laxity in patients with an ACL injury. These structures may function as important secondary stabilizers in an ACL-injured knee. Careful assessment and proper treatment of injuries to these secondary stabilizers should be considered, especially in knees with a high level of the pivot shift. © 2016 The Author(s).

Missile Diaphragmatic Injuries: Kashmir Experience

PubMed Central

Lone, Reyaz A; Akbar, Bhat M; Sharma, ML; Lateef, Wani M; Ahangar, AG; Lone, GN; Dar, A M; Singh, Shyam; Shah, Mubbashir; Hussain, Zahur; Irshad, Ifat; Rasool, Fouzia

2009-01-01

Background: Importance of repairing a diaphragmatic tear due to a missile injury cannot be overemphasized. Even a small diaphragmatic rent should be repaired because of morbidity and mortality caused by subsequent herniation and strangulation. Methods: Fifty-three cases with diaphragmatic injuries caused by penetrating missiles were studied from January 1997 to January 2007. All the patients were primarily explored either for thoracic or abdominal penetrating trauma; the diaphragmatic injury was an associated incidental intraoperative finding. Thoracotomy was performed in 18 patients, Laprotomy in 33 patients and in two patients combined thorocoabdominal approach was utilised for managing associated visceral injuries. Results: Overall mortality was 37.7%. Mortality was dependent on associated injuries of thoracic and abdominal viscera. Most patients died due to associated injuries and septicaemia. None of the patients had any sequelae of diaphragmatic repair. Conclusion: Immediate repair of diaphragmatic injury is of paramount importance to prevent subsequent complications of herniation and strangulation. PMID:21475506

Adrenal trauma: Elvis Presley Memorial Trauma Center experience.

PubMed

Mehrazin, Reza; Derweesh, Ithaar H; Kincade, Matthew C; Thomas, Adam C; Gold, Robert; Wake, Robert W

2007-11-01

Adrenal gland injury is a potentially devastating event if unrecognized in the treatment course of a trauma patient. We reviewed our single-center experience and outcomes in patients with adrenal gland trauma. We performed a retrospective review of all patients presenting with trauma to the Regional Medical Center at Memphis who had adrenal gland injuries from January 1991 through March 2006. Each chart was reviewed with attention to the demographics, associated injuries, complications, and outcomes. Patients were stratified into two subgroups according to age (35 years or younger and older than 35 years) to allow for an age-based comparison between the two groups. Of 58,000 patients presenting with trauma, 130 (0.22%) were identified with adrenal injuries, of which 8 (6.2%) were isolated and 122 (93.8%) were not. Of these 130 patients, 125 (96.2%) had their injury diagnosed by computed tomography and 5 (3.8%) had their injury diagnosed during exploratory laparotomy. Right-sided injuries predominated (78.5%), with six (4.6%) bilateral. Four patients (3.1%) underwent adrenalectomy. Seven patients (5.4%) with adrenal injuries died. One patient (0.77%) required chronic steroid therapy. Patients older than 35 years were more likely to have complications such as deep venous thrombosis, pneumonia, and urinary tract infections. Patient age of 35 years or younger was associated with a significantly increased incidence of liver lacerations. Adrenal gland injury is uncommon, although mostly associated with greater injury severity. Although adding to morbidity, most are self-limited and do not require intervention.

Retrospective Cohort Analysis of Chest Injury Characteristics and Concurrent Injuries in Patients Admitted to Hospital in the Wenchuan and Lushan Earthquakes in Sichuan, China

PubMed Central

Yuan, Yong; Zhao, Yong-Fan

2014-01-01

Background The aim of this study was to compare retrospectively the characteristics of chest injuries and frequencies of other, concurrent injuries in patients after earthquakes of different seismic intensity. Methods We compared the cause, type, and body location of chest injuries as well as the frequencies of other, concurrent injuries in patients admitted to our hospital after the Wenchuan and Lushan earthquakes in Sichuan, China. We explored possible relationships between seismic intensity and the causes and types of injuries, and we assessed the ability of the Injury Severity Score, New Injury Severity Score, and Chest Injury Index to predict respiratory failure in chest injury patients. Results The incidence of chest injuries was 9.9% in the stronger Wenchuan earthquake and 22.2% in the less intensive Lushan earthquake. The most frequent cause of chest injuries in both earthquakes was being accidentally struck. Injuries due to falls were less prevalent in the stronger Wenchuan earthquake, while injuries due to burial were more prevalent. The distribution of types of chest injury did not vary significantly between the two earthquakes, with rib fractures and pulmonary contusions the most frequent types. Spinal and head injuries concurrent with chest injuries were more prevalent in the less violent Lushan earthquake. All three trauma scoring systems showed poor ability to predict respiratory failure in patients with earthquake-related chest injuries. Conclusions Previous studies may have underestimated the incidence of chest injury in violent earthquakes. The distributions of types of chest injury did not differ between these two earthquakes of different seismic intensity. Earthquake severity and interval between rescue and treatment may influence the prevalence and types of injuries that co-occur with the chest injury. Trauma evaluation scores on their own are inadequate predictors of respiratory failure in patients with earthquake-related chest injuries. PMID:24816485

Retrospective cohort analysis of chest injury characteristics and concurrent injuries in patients admitted to hospital in the Wenchuan and Lushan earthquakes in Sichuan, China.

PubMed

Zheng, Xi; Hu, Yang; Yuan, Yong; Zhao, Yong-Fan

2014-01-01

The aim of this study was to compare retrospectively the characteristics of chest injuries and frequencies of other, concurrent injuries in patients after earthquakes of different seismic intensity. We compared the cause, type, and body location of chest injuries as well as the frequencies of other, concurrent injuries in patients admitted to our hospital after the Wenchuan and Lushan earthquakes in Sichuan, China. We explored possible relationships between seismic intensity and the causes and types of injuries, and we assessed the ability of the Injury Severity Score, New Injury Severity Score, and Chest Injury Index to predict respiratory failure in chest injury patients. The incidence of chest injuries was 9.9% in the stronger Wenchuan earthquake and 22.2% in the less intensive Lushan earthquake. The most frequent cause of chest injuries in both earthquakes was being accidentally struck. Injuries due to falls were less prevalent in the stronger Wenchuan earthquake, while injuries due to burial were more prevalent. The distribution of types of chest injury did not vary significantly between the two earthquakes, with rib fractures and pulmonary contusions the most frequent types. Spinal and head injuries concurrent with chest injuries were more prevalent in the less violent Lushan earthquake. All three trauma scoring systems showed poor ability to predict respiratory failure in patients with earthquake-related chest injuries. Previous studies may have underestimated the incidence of chest injury in violent earthquakes. The distributions of types of chest injury did not differ between these two earthquakes of different seismic intensity. Earthquake severity and interval between rescue and treatment may influence the prevalence and types of injuries that co-occur with the chest injury. Trauma evaluation scores on their own are inadequate predictors of respiratory failure in patients with earthquake-related chest injuries.

Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma.

PubMed

Schnüriger, B; Inderbitzin, D; Schafer, M; Kickuth, R; Exadaktylos, A; Candinas, D

2009-01-01

Little is known about the clinical importance of concomitant injuries in polytraumatized patients with high-grade blunt liver injury. A retrospective single-centre study was performed to investigate the safety of non-operative management of liver injury and the impact of concomitant intra- and extra-abdominal injuries on clinical outcome. Some 183 patients with blunt liver injury were admitted to Berne University Hospital, Switzerland, between January 2000 and December 2006. Grade 3-5 injuries were considered to be high grade. Immediate laparotomy was required by 35 patients (19.1 per cent), owing to extrahepatic intra-abdominal injury (splenic and vascular injuries, perforations) in 21 cases. The mortality rate was 16.9 per cent; 22 of the 31 deaths were due to concomitant lesions. Of 81 patients with high-grade liver injury, 63 (78 per cent) were managed without surgery; liver-related and extra-abdominal complication rates in these patients were 11 and 17 per cent respectively. Grades 4 and 5 liver injury were associated with hepatic-related and extra-abdominal complications. Concomitant injuries are a major determinant of outcome in patients with blunt hepatic injury and should be given high priority by trauma surgeons. An algorithm for the management of blunt liver injury is proposed. Copyright (c) 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Prevalence of graduated compression stocking-associated pressure injuries in surgical intensive care units.

PubMed

Hobson, Deborah B; Chang, Tracy Y; Aboagye, Jonathan K; Lau, Brandyn D; Shihab, Hasan M; Fisher, Betsy; Young, Samantha; Sujeta, Nancy; Shaffer, Dauryne L; Popoola, Victor O; Kraus, Peggy S; Knorr, Gina; Farrow, Norma E; Streiff, Michael B; Haut, Elliott R

2017-08-01

This study aimed to determine the prevalence of static graduated compression stocking (sGCS)-associated pressure injury among patients in surgical intensive care units (ICUs). We retrospectively reviewed data from wound care rounds between April 2011 and June 2012 at 3 surgical ICUs at an urban, tertiary care hospital. Patients with sGCS-associated pressure injury were identified and descriptive analysis was performed on their demographic, perioperative, and postoperative characteristics. We examined 1787 individual patients during 2391 patient encounters. A total of 129 (7.2%) of patients developed pressure injuries. Forty patients (2.2%) developed sGCS-associated pressure injury. Static GCS-associated pressure injury accounted for 31% (40/129) of all pressure injuries and 74% (40/54) of all medical device-related pressure injury. Eighteen (45%) and 6 (15%) developed stage 1 and 2 pressure injury, respectively, and 16 (40%) developed deep tissue injuries. The mean age of our patients was 64.7 years, about half (47.5%) were male, and their mean Acute Physiology and Chronic Health Evaluation II score was 18.8. Many had comorbid conditions, including obesity (44.5%) and diabetes (42.5%), and required mechanical ventilation (45%). Pressure injuries are a notable complication of sGCS in surgical ICU patients. Appropriate measures are required to help avoid this potentially preventable harm. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of Patient Pre-Injury and Injury Characteristics on Acute Rehabilitation Outcomes for Traumatic Brain Injury

PubMed Central

Corrigan, John D.; Horn, Susan D.; Barrett, Ryan S.; Smout, Randall J.; Bogner, Jennifer; Hammond, Flora M.; Brandstater, Murray E.; Majercik, Sarah

2015-01-01

Objective To examine associations of patient and injury characteristics with outcomes at inpatient rehabilitation discharge and 9 months post-discharge for patients with traumatic brain injury (TBI) Design Prospective, longitudinal observational study Setting 10 inpatient rehabilitation centers (9 US, 1 Canada) Participants Consecutive patients (n=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI injury, and divided into 5 subgroups based on rehabilitation admission FIM Cognitive score Interventions Not applicable Main Outcome Measures Rehabilitation length of stay, discharge to home, and FIM at discharge and 9 months post-discharge. Results Severity indices increased explained variation in outcomes beyond that accounted for by patient characteristics. FIM Motor scores were generally the most predictable. Higher functioning subgroups had more predictable outcomes then subgroups with lower cognitive function at admission. Age at injury, time from injury to rehabilitation admission, and functional independence at rehabilitation admission were the most consistent predictors across all outcomes and subgroups. Conclusions Findings from previous studies of the relationships among patient and injury characteristics and rehabilitation outcomes were largely replicated. Discharge outcomes were most strongly associated with injury severity characteristics; while predictors of functional independence at 9 months post-discharge included both patient and injury characteristics. PMID:26212398

A Single-Center Review of Facial Fractures as the Result of High-Speed Projectile Injuries

PubMed Central

Liu, Farrah C.; Halsey, Jordan N.; Hoppe, Ian C.; Ciminello, Frank S.; Lee, Edward S.; Granick, Mark S.

2018-01-01

Purpose: Gunshot injuries to the face that result in fractures of the underlying skeleton present a challenge in management. The goal of this study was to evaluate patterns of facial fractures as a result of gunshot injuries and strategies for management. Methods: A retrospective review of facial fractures resulting from gunshot injuries in a level 1 trauma center was performed for the years 2000 to 2012. Data were collected for patient demographics, fracture distribution, concomitant injuries, and surgical management strategies. Results: A total of 190 patients sustained facial fractures from a gunshot injury. The average age was 29.9 years, and 90% were male. Sixteen injuries were self-inflicted. The most common fractures were of the mandible and the orbit. Uncontrolled hemorrhage was noted on presentation in 68 patients; 100 patients were intubated on arrival. The average Glasgow Coma Scale score on arrival was 11.9. Concomitant injuries included skull fracture, intracranial hemorrhage, and intrathoracic injury. Surgical management was required in 89 patients. Nine patients required soft-tissue coverage. Thirty patients expired. Conclusion: Gunshot injuries to the face resulting in fractures of the underlying skeleton have high instances of morbidity and mortality. Life-threatening concomitant injuries can complicate management of facial fractures in this population. PMID:29713397

Badminton injuries.

PubMed Central

Krøner, K; Schmidt, S A; Nielsen, A B; Yde, J; Jakobsen, B W; Møller-Madsen, B; Jensen, J

1990-01-01

In a one year period, from 1 January 1986 to 31 December 1986, 4303 patients with sports injuries were treated at Aarhus Amtssygehus and Aarhus Kommunehospital. The mean age was 21.6 years (range 7-72 years) and 2830 were men. Two hundred and seventeen badminton injuries occurred in 208 patients (136 men) with a mean age of 29.6 years (range 7-57 years), constituting 4.1 percent of all sport injuries in Aarhus. Joints and ligaments were injured in 58.5 percent of the patients, most frequently located in the lower limb and significantly more often among patients younger than 30 years of age. Muscle injury occurred in 19.8 percent of the patients. This type of injury was significantly more frequent among patients older than 30 years of age. Most injuries were minor. However, 6.8 percent of the patients were hospitalized and 30.9 percent received additional treatment by a physician. As the risk of injury varies with age, attempts to plan training individually and to institute prophylactic measures should be made. PMID:2078802

Prevalence and clinical features of sports-related lumbosacral stress injuries in the young.

PubMed

Kaneko, Hideto; Murakami, Mototsune; Nishizawa, Kazuya

2017-05-01

Stress injuries (stress fractures and stress reactions) of the lumbosacral region are one of the causes of sports-related lower back pain in young individuals. These injuries can be detected by bone marrow edema lesion on MRI. However, little is known about the prevalence and clinical features of early stage lumbosacral stress injuries. This study aimed to evaluate the epidemiology of lumbosacral stress injuries. A total of 312 patients (under 18 years of age) who complained of sports-related lower back pain that had lasted for ≥7 days underwent magnetic resonance imaging (MRI) scans. We reviewed patients' records retrospectively. MRI showed that 33.0% of the patients had lumbar stress injuries and 1.6% had sacral stress injuries. Lumbar stress injuries were more common in males than in females and were found in 30% of 13- to 18-year-old patients. About 50% of the patients that participated in soccer or track and field were diagnosed with lumbar stress injuries. No clinical patterns in the frequencies of sacral stress injuries were detected due to the low number of patients that suffered this type of injury. Plain radiography is rarely able to detect the early stage lesions associated with lumbosacral stress injuries, but such lesions can be detected in the caudal-ventral region of the pars interarticularis on sagittal computed tomography scans. Thirty-three percent of young patients that complained of sports-related lower back pain for ≥7 days had lumbar stress injuries, while 1.6% of them had sacral stress injuries. Clinicians should be aware of the existence of these injuries. MRI is useful for diagnosing lumbosacral stress injuries.

Treatment and outcome of traumatic biliary injuries in children.

PubMed

Soukup, Elizabeth S; Russell, Katie W; Metzger, Ryan; Scaife, Eric R; Barnhart, Douglas C; Rollins, Michael D

2014-02-01

Traumatic biliary tract injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract injuries in children, management strategies, and outcome. We conducted a retrospective review of patients with biliary tract injury using the trauma registry at our level 1 pediatric trauma center from 2002-2012. Twelve out of 13,582 trauma patients were identified, representing 0.09% of all trauma patients. All were secondary to blunt trauma. Mean age was 9.7 years [range 4-15], and mean Injury Severity Score was 31 ± 14, with overall survival of 92%. Biliary injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during laparotomy (3). Two patients with ductal injuries developed late strictures after initial management with ERCP and stent placement. One of the two patients ultimately required a left hepatectomy, and the other has been managed conservatively without evidence of cholangitis. Two patients required placement of additional drains and prolonged antibiotics for superinfection following biloma drainage. Biliary tract injuries are rare in children, and many are amenable to adjunctive therapy, including ERCP and biliary stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract injuries or transections. © 2014.

Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction.

PubMed

Webster, Kate E; Feller, Julian A; Leigh, Warren B; Richmond, Anneka K

2014-03-01

Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive. To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these. Case-control study; Level of evidence, 3. A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter. Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29% sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury. Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined.

Boarding Injuries: The Long and the Short of It

PubMed Central

Fabian, Leslie A.; Thygerson, Steven M.; Merrill, Ray M.

2014-01-01

As the popularity of longboarding increases, trauma centers are treating an increased number of high severity injuries. Current literature lacks descriptions of the types of injuries experienced by longboarders, a distinct subset of the skateboarding culture. A retrospective review of longboarding and skateboarding injury cases was conducted at a level II trauma center from January 1, 2006, through December 31, 2011. Specific injuries in addition to high injury severity factors (hospital and intensive care unit (ICU) length of stay (LOS), Injury Severity Score (ISS), patient treatment options, disposition, and outcome) were calculated to compare longboarder to skateboarder injuries. A total of 824 patients met the inclusion criteria. Skull fractures, traumatic brain injuries (TBI), and intracranial hemorrhage (ICH) were significantly more common among longboard patients than skateboarders (P < 0.0001). All patients with an ISS above 15 were longboarders. Hospital and ICU LOS in days was also significantly greater for longboarders compared with skateboarders (P < 0.0001). Of the three patients that died, each was a longboarder and each experienced a head injury. Longboard injuries account for a higher incidence rate of severe head injuries compared to skateboard injuries. Our data show that further, prospective investigation into the longboarding population demographics and injury patterns is necessary to contribute to effective injury prevention in this population. PMID:24660063

Comparison of injury epidemiology between the Wenchuan and Lushan earthquakes in Sichuan, China.

PubMed

Hu, Yang; Zheng, Xi; Yuan, Yong; Pu, Qiang; Liu, Lunxu; Zhao, Yongfan

2014-12-01

We aimed to compare injury characteristics and the timing of admissions and surgeries in the Wenchuan earthquake in 2008 and the Lushan earthquake in 2013. We retrospectively compared the admission and operating times and injury profiles of patients admitted to our medical center during both earthquakes. We also explored the relationship between seismic intensity and injury type. The time from earthquake onset to the peak in patient admissions and surgeries differed between the 2 earthquakes. In the Wenchuan earthquake, injuries due to being struck by objects or being buried were more frequent than other types of injuries, and more patients suffered injuries of the extremities than thoracic injuries or brain trauma. In the Lushan earthquake, falls were the most common injury, and more patients suffered thoracic trauma or brain injuries. The types of injury seemed to vary with seismic intensity, whereas the anatomical location of the injury did not. Greater seismic intensity of an earthquake is associated with longer delay between the event and the peak in patient admissions and surgeries, higher frequencies of injuries due to being struck or buried, and lower frequencies of injuries due to falls and injuries to the chest and brain. These insights may prove useful for planning rescue interventions in trauma centers near the epicenter.

Evaluation of a 15-year experience with splenic injuries in a state trauma system.

PubMed

Harbrecht, Brian G; Zenati, Mazen S; Ochoa, Juan B; Puyana, Juan C; Alarcon, Louis H; Peitzman, Andrew B

2007-02-01

The management of splenic injuries has evolved with a greater emphasis on nonoperative management. Although several institutions have demonstrated that nonoperative management of splenic injuries can be performed with an increasing degree of success, the impact of this treatment shift on outcome for all patients with splenic injuries remains unknown. We hypothesized that outcomes for patients with splenic injuries have improved as the paradigm for splenic injury treatment has shifted. Consecutive patients from 1987 to 2001 with splenic injuries who were entered into a state trauma registry were reviewed. Demographic variables, injury characteristics, and outcome data were collected. The number of patients who were diagnosed with splenic injuries increased from 1987 through 2001, despite a stable number of institutions submitting data to the registry. The number of minor injuries and severe splenic injuries remained stable, and the number of moderately severe injuries significantly increased over time. Overall mortality rate improved but primarily reflected the decreased mortality rates of moderately severe injuries; the mortality rate for severe splenic injuries was unchanged. Trauma centers are seeing increasing numbers of splenic injuries that are less severe in magnitude, although the number of the most severe splenic injuries is stable. The increased proportion of patients with less severe splenic injuries who are being admitted to trauma centers is a significant factor in the increased use and success rate of nonoperative management.

Hand Injuries by the Killer Kite Manja and Their Management.

PubMed

Mir, Mohd Altaf; Ali, Adil Mahmud; Yaseen, Mohd; Khan, Arshad Hafeez

2017-05-01

Although hand injuries due to kite strings seem to be trivial, these injuries could be serious enough to lose the function of hand. This case series in the division of Plastic and Reconstructive Surgery of our institution from August 2014 to January 2016 evaluated the clinic-etiological profile, severity and management of hand injuries due to kite strings assessed clinically and radiologically. Eleven patients reported kite related injuries during two years, and 5 presented during 17 months. Of 11 patients, 8 were male and 3 were female with a M:F ratio of 2.66:1. The majority of patients presented with the mean age of 19.9±4.27 years. Eight patients presented acutely to the emergency while 3 believed the injury to be trivial and had delayed presentation. Injuries in the right hand were 8 and 3 in the left hand. Seven patients had injuries in zone II of the hand while 4 presented with zone III injuries. Total number of injured digits was 14 (1.4±1.11), total number of injured tendons was 26 (2.36±2.18), only one patient had nerve injury (mean=0.09), and no patient had any major vessel injury. So strict attention to safety measures and parental/guardian supervision while flying kites can avoid many preventable injuries to life and limb and also let the sport be an enjoyable and safe.

Performance of the craniocervical flexion test, forward head posture, and headache clinical parameters in patients with chronic tension-type headache: a pilot study.

PubMed

Fernandez-de-las-Peñas, César; Pérez-de-Heredia, Marta; Molero-Sánchez, Alberto; Miangolarra-Page, Juan Carlos

2007-02-01

Case-control, descriptive pilot study. To describe the differences in the performance of the craniocervical flexion test (CCFT) between individuals with chronic tension-type headache (CTTH) and healthy controls. To assess the relationship between the CCFT, forward head posture, and several clinical variables related to the intensity and temporal profile of headache. Musculoskeletal impairments of the craniocervical region might play an important role on the pathogenesis of CTTH. Deficits in the performance of the CCFT have been reported in patients with cervicogenic headache, nonspecific neck pain, and whiplash injury, but not in individuals with CTTH. Ten patients with CTTH and 10 comparable controls without headache were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and to record the pain history. The CCFT was performed with the subject supine and required performing a gentle head-nodding action of craniocervical flexion. The activation pressure score (pressure that the subject can achieve and hold for 10 seconds), the performance pressure index (calculated by multiplying the activation pressure score by the number of successful repetitions), and the highest pressure score (the highest level that each subject was able to hold for 10 seconds from 20 to 30 mm Hg) were measured. Side-view pictures of each subject were taken in both sitting and standing positions to assess forward head posture (FHP) by measuring the craniovertebral angle. All measures were taken by an assessor blinded to the subject's condition. Patients with CTTH had significantly lower values in both active pressure score and performance pressure index (P < .001), but not in the highest pressure score (P = .057), compared to controls. Patients with CTTH had a smaller craniovertebral angle (mean +/- SD, 42.0 degrees +/- 6.6 degrees), indicating a more FHP than controls (48.8 degrees +/- 2.5 degrees), in the standing position (P < .01); but not in the sitting position (CTTH, 39 degrees +/- 8.9 degrees; controls, 42.8 degrees +/- 8.9 degrees, P = .10). No association between FHP and any of the CCFT variables was found (P >.05). Headache intensity and frequency did not seem to be related to the CCFT variables, but there was a positive association between headache duration and activation pressure score (r(s), = 0.746, P = .02) and highest pressure score (r(s), = 0.743, P = .02). These findings suggest possible impairments of the musculoskeletal system in individuals with CTTH, although it is not possible to determine if these impairments contributed to the etiology of CTTH or are as a result of the chronic headache condition.

Quantifying the Risk of Spinal Injury in Motor Vehicle Collisions According to Ambulatory Status: A Prospective Analytical Study.

PubMed

McCoy, Christopher Eric; Loza-Gomez, Angelica; Lee Puckett, James; Costantini, Samantha; Penalosa, Patrick; Anderson, Craig; Schultz, Carl

2017-02-01

The association between ambulation at the scene of a motor vehicle collision (MVC) and spinal injury has never been quantified. To evaluate the association between ambulation and spinal injury in patients involved in a MVC. Prospective analytical-observational cohort study. Inclusion: patients sustaining traumatic injury in a MVC. Exclusion: < 18 years old, pregnancy. spinal injury defined as injury to the cervical, thoracic, or lumbar spinal cord, bones, or ligaments. Secondary outcome: Injury resulting in neurological deficit, need for surgery, or death. A generalized linear model was used to evaluate the association between outcome and predictor variables. Risk ratios [RR] were reported with a point estimate and 95% confidence interval (CI). A two-tailed alpha of < 0.05 was the threshold for statistical significance. There were 704 patients analyzed. Nonambulatory patients were 2.29 times more likely to sustain a spinal injury, compared to ambulatory patients (RR 2.29, 95% CI 1.34-3.91). Patients ≥ 65 years of age were 3.27 times more likely to sustain a spinal injury (RR 3.27, 95% CI 1.66-6.45). Patients with a Glasgow Coma Scale score ≤ 8 were 4.93 times more likely to sustain a spinal injury (RR 4.93, 95% CI 1.86-13.10). In this prospective analytical-observational study evaluating the association between ambulatory status and spinal injury in patients involved in MVCs, we observed that those patients who were nonambulatory were more than two times as likely to have a spinal injury compared to those patients who were ambulatory at the scene. Copyright © 2016 Elsevier Inc. All rights reserved.

Gastrointestinal Injuries in Blunt Abdominal Traumas.

PubMed

Gönüllü, D; Ilgun, S; Gedik, M L; Demiray, O; Öner, Z; Er, M; Köksoy, F N

2015-01-01

To discuss the efficiency of RTS (Revised TraumaScore), ISS (Injury Severity Score), and factors that affect mortality and morbidity in gastrointestinal injuries due to blunt trauma.Method and methods: Patients with gastrointestinal injuries due to blunt trauma operated within the last six years have been studied retrospectively in terms of demographics,injury mechanism and localization, additional injuries, RTS and ISS, operative technique, morbidity, mortality and duration of hospitalization. Of the eighteen cases, cause of injury was a traffic accident for 11 (61.1%), fall from height for 5 (27%) and physical attack for 2 (11%). Among the eighteen patients,there were 21 gastrointestinal injuries (11 intestinal, 6 colon,3 duodenum, 1 stomach). 10 (55.6%) had additional intraabdominal injuries while the number for extra-abdominal injuries were 12 (66.7%). Primary suture (10), segmentary resection (9) and pyloric exclusion (2) were the operations performed for the twenty-one gastrointestinal injuries.Although statistically not significant, 13(72.2%) patients with additional injuries compared with 5 (27.8%) patients with isolated gastrointestinal injuries, were found to have lower RTS (7.087/7.841), higher ISS (19.4/12.2), longer duration of hospitalization (11.5/8.4 day) as well as higher morbidity (7/1) and mortality (2/0) rates. Comparing the RTS (7.059/7.490) of patients who have and have not developed morbidity revealed no significant difference.However, ISS (23.9/12.2) was significantly higher in patients who have developed morbidity (p=0.003). RTS (6.085 7.445) and ISS (39.5/14.6) of patients who have survived were significantly different than patients who have not(p=0.037 and p=0.023, respectively) Additional injuries in patients with gastrointestinal injury due blunt abdominal traumas increases, although not significantly, morbidity, mortality and duration of hospitalization even when operated early. High ISS is significantly related to the risk of both morbidity and mortality while low RTS is significantly related only to the mortality risk. Celsius.

The epidemiology of upper airway injury in patients undergoing major surgical procedures.

PubMed

Hua, May; Brady, Joanne; Li, Guohua

2012-01-01

Airway injury is a potentially serious and costly adverse event of anesthesia care. The epidemiologic characteristics of airway injury have not been well documented. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is a multicenter, prospective, outcome-oriented database for patients undergoing major surgical procedures. Using the NSQIP data for the years 2005 to 2008, we examined the incidence of, and risk factors for, airway injury. Of the 563,190 patients studied, 1202 (0.2%) sustained airway injury. The most common airway injury was lip laceration/hematoma (61.4%), followed by tooth injury (26.1%), tongue laceration (5.7%), pharyngeal laceration (4.7%), and laryngeal laceration (2.1%). Multivariable logistic modeling revealed an increased risk of airway injury in patients with Mallampati class III (adjusted odds ratio [OR], 1.69; 99% confidence interval [CI], 1.36-2.11, relative to patients with Mallampati classes I and II) or class IV (adjusted OR, 2.6; 99% CI, 1.52-4.02), and in patients aged 80 years or older (adjusted OR, 1.50; 99% CI, 1.02-2.19, relative to patients aged 40 to 49 years). The risk of airway injury for patients undergoing major surgical procedures is approximately 1 in 500. Patients with difficult airways as indicated by Mallampati classes III and IV are at significantly increased risk of sustaining airway injury during anesthesia for major surgical procedures.

Dirt bikes injuries in children.

PubMed

Abdelgawad, A A; Maxfield, D; Tran, S; Mclean, S; Kanlic, E M

2013-12-01

Dirt bike riding is becoming a more popular recreational activity among children. Injuries associated with this recreational activity did not gain attention in the medical literature. The purpose of this study is to assess orthopedic injuries associated with dirt bike riding. We retrospectively studied injuries occurring in children less than 18 years old, while riding dirt bikes, that required admission to the trauma department in our level one trauma center during the period 2000-2010. There were 24 admissions (23 patients). The mean age was 13. Fourteen patients had brain injuries. Six patients had abdominal injuries. One patient died shortly after arriving to the emergency department. Fourteen patients had face and neck injuries. The average injury severity score was 8.5. Thirteen patients' admissions (54 %) had orthopedic fractures. Five of 13 patients (38 %) suffered more than one fracture. Eight patients needed orthopedic intervention (seven of these were in operating room under general anesthesia and one in the emergency department under conscious sedation). Femur fracture was the most common cause for performing surgery in this group of patients. Riding dirt bikes is not a safe recreational activity. Orthopedic injuries constitute a major component of the injuries affecting children riding dirt bikes. Orthopedic surgeons (being responsible for treating most of these children) have the obligation to warn the community against the possible dangers facing children who ride dirt bikes.

Low Prevalence of Anterior and Posterior Cruciate Ligament Injuries in Patients With Achondroplasia.

PubMed

Brooks, Jaysson T; Ramji, Alim F; Lyapustina, Tatyana A; Yost, Mary T; Ain, Michael C

2017-01-01

Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries and their subsequent reconstructions are common in the general population, but there has been no research regarding ACL or PCL injuries in patients with achondroplasia, the most common skeletal dysplasia. Our goals were to (1) evaluate the prevalence of ACL and PCL injuries in adolescents and adults with achondroplasia, (2) compare this prevalence with that reported for the general population, (3) determine how many patients with ACL or PCL injuries underwent ligament reconstruction as treatment, and (4) determine patient activity levels as they relate to the rate of ACL/PCL injuries and reconstructions. We reviewed medical records of 430 patients with achondroplasia seen in the senior author's clinic from 2002 through 2014. Demographic data were reviewed, as well as any documentation of ACL or PCL injury or reconstruction. We called all 430 patients by telephone, and 148 agreed to participate in our survey, whereas 1 declined. We asked these patients about their history of ACL or PCL injury or reconstruction, as well as current and past physical activity levels. No ACL or PCL injuries were found on chart review. One patient reached by telephone reported an ACL injury that did not require reconstruction. This yielded a theoretical prevalence of 3/430 (0.7%). Of the 148 patients surveyed, 43 (29%) reported low physical activity, 75 (51%) reported moderate physical activity, and 26 (17%) reported high physical activity. There was no significant difference in the rate of ACL injury when stratified by physical activity level (P=0.102). ACL and PCL injuries and reconstructions are extremely rare in patients with achondroplasia, which cannot be completely ascribed to a low level of physical activity. One possible explanation is that patients with achondroplasia, on an average, have a more anterior tibial slope compared with those without achondroplasia, which decreases the force generated within the ACL and may protect against ACL injury. Further research is needed to explore possible causes. Level IV-retrospective review.

Colostomy and drainage for civilian rectal injuries: is that all?

PubMed Central

Burch, J M; Feliciano, D V; Mattox, K L

1989-01-01

One hundred consecutive patients with injuries to the extraperitoneal rectum were treated over a ten-year period at an urban trauma center. The mechanisms of injury included firearms in 82 patients, stab wounds in 3 patients, a variety of other penetrating injuries in 10 patients, and in 5 patients the injuries resulted from blunt trauma. Treatment of the rectal injury was determined by the bias of the operating surgeon, the condition of the patient, and the magnitude of the rectal injury. Proximal loop colostomies were performed in 44 patients, diverting colostomies in 51 patients, Hartmann's procedure in 4 patients, and an abdominoperineal resection in 1 patient. Extraperitoneal rectal perforations were closed in 21 patients and the rectum was irrigated free of feces in 46 patients. Transperineal, presacral drainage was used in 93 patients. Infectious complications potentially related to the management of the rectal wound occurred in 11 patients (11%) and included abdominal or pelvic abscesses (4 patients), wound infections (6 patients), rectocutaneous fistulas (3 patients), and missile tract infections (2 patients). Four patients (4%) died as a result of their injuries. Of the therapeutic options available, statistical analysis revealed that only the failure to drain the presacral space increased the likelihood of infectious complications (p = 0.03); however, as it could not be determined with certainty that the use of, or failure to use, any particular therapeutic option had an effect on the risk of death. It is concluded that colostomy and drainage are the foundations of the successful treatment of civilian injuries to the extraperitoneal rectum. The use of adjuncts such as diverting colostomies, repair of the rectal wound, and irrigation of the rectum has little effect on mortality and morbidity. PMID:2705824

Outcomes after pancreatic trauma: experience at a single institution

PubMed Central

Al-Ahmadi, Khaled; Ahmed, Najma

2008-01-01

Objective Pancreatic injury following trauma is unusual, and there are few data regarding outcomes, particularly with respect to endocrine and exocrine function. The purpose of this study was to review our institutional experience in regard to this relatively infrequent injury and to determine the incidence of trauma-induced endocrine and exocrine pancreatic dysfunction as indicated by patient self-report. Methods After receiving institutional research ethics approval, we identified all patients with pancreatic injuries in our trauma registry database over a 5-year period. The diagnostic, operative information, hospital course and complication rates were abstracted from medical records. Patients who could be contacted completed a telephone-administered questionnaire to assess pancreatic function. Results We identified 25 patients who had suffered a pancreatic injury. Of these, 16 patients suffered blunt injury, and 9 suffered penetrating injury. Of the 25 patients, 13 underwent pancreatic surgery, and 6 required distal pancreatectomy. Early pancreas-specific complications occurred in 7 of 22 surviving patients (31.8%). Of the 25 patients identified, 6 could not be contacted for follow-up information. Of 19 patients contacted, 4 reported endocrine dysfunction. One of these was insulin-dependant before injury. No patient in this series reported exocrine dysfunction. The overall mortality rate in our series was 12%. Conclusion Pancreatic injuries comprised about 1% of injuries captured by our trauma registry. Outcomes were similar in patients who suffered blunt or penetrating trauma. Of these patients, 52% underwent pancreatic surgery; 16% of patients in this small series reported endocrine deficiency posttrauma. PMID:18377752

An emerging etiological factor for hand injuries in the pediatric population: public exercise equipment.

PubMed

Akşam, Berrak; Akşam, Ersin; Ceran, Candemir; Demirseren, Mustafa Erol

2016-01-01

The purpose of this study was to describe the role of public exercise equipment in pediatric hand traumas as a preventable etiological factor. Pediatric patients with hand injuries referred from the emergency department were evaluated retrospectively. Age and gender of the patients, timing, etiology, mechanism of hand trauma, localization of the injury, diagnoses of the patients, and hospitalization rates were reviewed. Amongst the 310 pediatric patients evaluated, 31 patients (10%) experienced injury related to public exercise equipment. Within this group of patients, most were between 5 to 9 years of age, and all injuries were blunt and crush type. Lacerations and fractures were the main diagnoses. Complex injuries that required inpatient care were reported in 19.3% of the patients. Public exercise equipment-related injuries are increasingly prevalent in pediatric hand traumas. Preventive actions such as shielding the moving parts should be taken to reduce these rates.

Subxiphoid pericardial window to exclude occult cardiac injury after penetrating thoracoabdominal trauma.

PubMed

Hommes, M; Nicol, A J; van der Stok, J; Kodde, I; Navsaria, P H

2013-10-01

An occult cardiac injury may be present in patients with an acute abdomen after penetrating thoracoabdominal trauma. This study assessed the use of a subxiphoid pericardial window (SPW) as a diagnostic manoeuvre in this setting. This was a retrospective review of a trauma database (2001-2009). Patients presenting with a penetrating thoracoabdominal injury with an acute abdomen, and in whom there was concern about a potential cardiac injury from the site or tract of the injury, were included. Fifty patients with an indication for emergency laparotomy underwent a SPW for a possible cardiac injury. An occult haemopericardium was present at SPW in 14 patients (28 per cent) mandating, median sternotomy. Nine cardiac injuries (18 per cent) were identified including five tangential injuries and four perforations. The specific complication rate relating to the SPW was 2 per cent. The SPW is a useful technique at laparotomy to identify cardiac injuries in patients with penetrating thoracoabdominal injuries. © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

Usefulness of routine computed tomography in the evaluation of penetrating war injuries to the chest.

PubMed

Darwish, Bassam; Mahfouz, Mohammad Z; Izzat, Mohammad Bashar

2018-05-02

This review was conducted to compare the contributions of chest X-ray (CXR) and computed tomography (CT) towards detecting intrathoracic damage in patients with penetrating war injuries to the chest and to determine whether identification of additional injuries by chest CT will have an impact on the choice of therapeutic interventions and clinical outcomes. We reviewed records of 449 patients (374 men, mean age 29.3 ± 14.8 years) who were admitted to our hospital with penetrating war injuries to the chest over a 7-year period. Collected data included mechanisms of injury, associated injuries, results of CXRs and chest CTs, methods of management, in-hospital stays, complications and mortalities. Immediate screening CXRs were obtained in all patients not requiring emergent thoracotomies, of which 91.4% showed positive signs of injury. Chest CTs were performed at the discretion of the physicians in 49.4% of patients, and CXR-positive findings were confirmed in all cases, while revealing additional injuries in 11% of patients. Chest CT findings led to additional closed chest drainage in 5.6% of patients but had no impact on treatment strategy in 94.4% of scanned patients. Follow-up CXRs showed new positive findings in 22 patients, leading to additional closed chest drainage in 3 patients and delayed open thoracotomies in 7 other patients. CXRs continue as the primary diagnostic modality in the assessment of patients with penetrating war injuries to the chest. Chest CTs can be omitted in most patients, thus reducing CT imaging case-load substantially, while most clinically significant chest injuries remain sufficiently recognized.

[Protein S100b in differential diagnosis of brain concussion and superficial scalp injury in inebriated patients].

PubMed

Matek, J; Vajtr, D; Krška, Z; Springer, D; Filip, M; Zima, T

2012-10-01

Concussion cannot be differentiated from superficial scalp injury, especially in inebriated or uncooperative patients. This can have serious medical or forensic consequences. The aim of the study was to determine whether serum concentrations of S-100b in mild traumatic brain injury (MTBI) patients are significantly higher than those in patients with superficial scalp injury with scalp wound and alcohol intoxication. A total of 50 patients with head injury, 25 with mild concussion without scalp wound and alcohol intoxication, 25 superficial scalp injury patients with scalp wound and clinical signs of inebriety. Neurological status and cranial CT scan were evaluated 60-120 minutes after injury in all the 50 patients to exclude focal cerebral injury or skull fracture. The serum levels of S-100b were significantly increased in patients with concussion (median 0.36 ± 0.15 μg/l ) in comparison with the group of patients with scalp injury and alcohol intoxication (median 0.09 ± 0.002 μg/l). All 50 patients had a normal cranial CT finding and neurological status. In all superficial scalp injury patients alcohol intoxication was confirmed (0.96 - 3.11š). We proved significantly higher values of S-100b in patients with brain concussion. Diagnostically decisive value of S-100b concentration in the serum was set at 146 μg/l and higher (94% sensitivity and 100% specificity). Alcohol intoxication (up to 3.11 š) and scalp wound seem to have had no crucial impact on serum S-100b level.

Musculoskeletal injuries resulting from patient handling tasks among hospital workers.

PubMed

Pompeii, Lisa A; Lipscomb, Hester J; Schoenfisch, Ashley L; Dement, John M

2009-07-01

The purpose of this study was to evaluate musculoskeletal injuries and disorders resulting from patient handling prior to the implementation of a "minimal manual lift" policy at a large tertiary care medical center. We sought to define the circumstances surrounding patient handling injuries and to identify potential preventive measures. Human resources data were used to define the cohort and their time at work. Workers' compensation records (1997-2003) were utilized to identify work-related musculoskeletal claims, while the workers' description of injury was used to identify those that resulted from patient handling. Adjusted rate ratios were generated using Poisson regression. One-third (n = 876) of all musculoskeletal injuries resulted from patient handling activities. Most (83%) of the injury burden was incurred by inpatient nurses, nurses' aides and radiology technicians, while injury rates were highest for nurses' aides (8.8/100 full-time equivalent, FTEs) and smaller workgroups including emergency medical technicians (10.3/100 FTEs), patient transporters (4.3/100 FTEs), operating room technicians (3.1/100 FTEs), and morgue technicians (2.2/100 FTEs). Forty percent of injuries due to lifting/transferring patients may have been prevented through the use of mechanical lift equipment, while 32% of injuries resulting from repositioning/turning patients, pulling patients up in bed, or catching falling patients may not have been prevented by the use of lift equipment. The use of mechanical lift equipment could significantly reduce the risk of some patient handling injuries but additional interventions need to be considered that address other patient handling tasks. Smaller high-risk workgroups should not be neglected in prevention efforts.

What is the role of endoscopic retrograde cholangiopancreatography in assessing traumatic rupture of the pancreatic in children?

PubMed

Keil, Radan; Drabek, Jiri; Lochmannova, Jindra; Stovicek, Jan; Rygl, Michal; Snajdauf, Jiri; Hlava, Stepan

2016-01-01

Trauma is one of the most common causes of morbidity and mortality in the pediatric population. The diagnosis of pancreatic injury is based on clinical presentation, laboratory and imaging findings, and endoscopic methods. CT scanning is considered the gold standard for diagnosing pancreatic trauma in children. This retrospective study evaluates data from 25 pediatric patients admitted to the University Hospital Motol, Prague, with blunt pancreatic trauma between January 1999 and June 2013. The exact grade of injury was determined by CT scans in 11 patients (47.8%). All 25 children underwent endoscopic retrograde cholangiopancreatography (ERCP). Distal pancreatic duct injury (grade III) was found in 13 patients (52%). Proximal pancreatic duct injury (grade IV) was found in four patients (16 %). Major contusion without duct injury (grade IIB) was found in six patients (24%). One patient experienced duodeno-gastric abruption not diagnosed on the CT scan. The diagnosis was made endoscopically during ERCP. Grade IIB pancreatic injury was found in this patient. One patient (4%) with pancreatic pseudocyst had a major contusion of pancreas without duct injury (grade IIA). Four patients (16%) with grade IIB, III and IV pancreatic injury were treated exclusively and nonoperatively with a pancreatic stent insertion and somatostatine. Two patients (8%) with a grade IIB injury were treated conservatively only with somatostatine without drainage. Eighteen (72 %) children underwent surgical intervention within 24 h after ERCP. ERCP is helpful when there is suspicion of pancreatic duct injury in order to exclude ductal leakage and the possibility of therapeutic intervention. ERCP can speed up diagnosis of higher grade of pancreatic injuries.

[Treatment of patients with different degree of acute respiratory distress syndrome caused by inhalation of white smoke].

PubMed

Yang, F W; Xin, H M; Zhu, J H; Feng, X Y; Jiang, X C; Gong, Z Y; Tong, Y L

2017-12-20

Objective: To summarize the treatment experience of patients with different degree of acute respiratory distress syndrome (ARDS) caused by inhalation of white smoke from burning smoke bomb. Methods: A batch of 13 patients with different degree of ARDS caused by inhalation of white smoke from burning smoke bomb, including 2 patients complicated by pulmonary fibrosis at the late stage, were admitted to our unit in February 2016. Patients were divided into mild (9 cases), moderate (2 cases), and serious (2 cases) degree according to the ARDS Berlin diagnostic criteria. Patients with mild and moderate ARDS were conventionally treated with glucocorticoid. Patients with severe ARDS were sequentially treated with glucocorticoid and pirfenidone, and ventilator-assisted breathing, etc. were applied. The vital signs, arterial oxygenation index, changes of lung imaging, pulmonary ventilation function, general condition, and the other important organs/systems function were timely monitored according to the condition of patients. The above indexes were also monitored during the follow-up time of 10-15 months post injury. Data were processed with SPSS 18.0 statistical software. Results: (1) The symptoms of respiratory system of patients with mild and moderate ARDS almost disappeared after 3 days' treatment. Their arterial oxygenation index was decreased from post injury day 1 to 4, which almost recovered on post injury day 7 and completely recovered one month post injury. The symptoms of respiratory system of patients with severe ARDS almost disappeared at tranquillization condition 1-3 month (s) post injury. Their arterial oxygenation index was decreased from post injury day 3 to 21, which gradually recovered 1-3 month (s) post injury and was normal 15 months post injury. (2) Within 24 hours post injury, there was no obvious abnormality or only a little texture enlargement of lung in image of chest CT or X-rays of patients with mild and moderate ARDS. One patient with moderate ARDS had diffuse patchy and ground-glass like increased density shadow (pulmonary exudation for short) at post injury hour 96. Chest iconography of all patients with mild and moderate ARDS showed no abnormalities 10 months post injury. Both lungs of each of the two patients with severe ARDS showed obvious pulmonary exudation at post injury hours 45 and 75, respectively. One patient with severe ARDS showed no abnormality in chest image 10 months post injury, but there was still a small mesh-like increased density shadow in double lobes with slight adhesion of pleura in the other patient with severe ARDS 15 months post injury. (3) All patients showed severe restrictive hypoventilation when admitted to hospital. Pulmonary ventilation function of patients with mild and moderate ARDS recovered to normal one month post injury, and they could do exercises like running, etc. Pulmonary ventilation function of one patient with severe ARDS recovered to normal 6 months post injury, and the patient could do exercises like running, etc. The other patient with severe ARDS showed mild restrictive hypoventilation 15 months post injury and could do exercises like rapid walking, etc. (4) The condition of all mild and one moderate ARDS patients was better on post injury day 3, and they were transferred to the local hospital for subsequent treatment and left hospital on post injury day 21. One patient with moderate ARDS healed and left hospital on post injury day 29. Patients with severe ARDS healed and left hospital on post injury day 81. During the follow-up time of 10-15 months post injury, the other important organs/systems of all patients showed no abnormality, and there was no adverse reaction of glucocorticoid like osteoporosis, femoral head necrosis, or metabolic disorder. Two patients with severe ARDS did not have any adverse reaction of pirfenidone like liver function damage, photosensitivity, anorexia, or lethargy. Conclusions: Early enough and uninterrupted application of glucocorticoid can significantly reduce the ARDS of patients caused by inhalation of white smoke from burning smoke bomb. Sequential application of glucocorticoid and pirfenidone can effectively treat pulmonary fibrosis at the late stage.

Danger on the Farm: A Comparison of Agricultural and Animal-Related Injuries.

PubMed

Weaver, Jessica L; Kimbrough, Charles W; Broughton-Miller, Kimberly; Frisbie, Michelle; Wojcik, Jodi; Pentecost, Karina; Bozeman, Matthew C; Nash, Nicholas A; Harbrecht, Brian G

2017-05-01

Animal-related injuries are common in rural areas. Agricultural workers can suffer severe injuries involving farm machinery or falls. The spectrum of injuries related to rural activities is poorly defined and characterizing these injuries will improve injury prevention efforts. Records for injured patients admitted between 2010 and 2013 were retrospectively reviewed. Patients with a mechanism of injury involving a large animal or with the injury site listed as "farm" were included. Patients with agricultural injuries (n = 85) were older with more multisystem injuries than patients injured by animals (n = 132) but the Injury Severity Score was equivalent. There was no difference in intensive care unit length of stay, ventilator days, or mortality. There was no difference in frequency of solid organ injury, pelvic fractures, rib fractures, or hemo- or pneumothorax between groups. Animal injuries had more frequent traumatic brain injuries (22.4% vs 10.5%, P = 0.03), whereas agricultural injuries had more vertebral fractures (20.5% vs 9.2%). Of toxicology screens performed, 25 per cent (22/88) were positive. No significant differences were found between occupational versus recreational animal injuries. Agricultural and animal-related injuries have different characteristics but Injury Severity Score and mortality were similar. Severe injuries from both mechanisms are common in rural communities and injury prevention activities are needed in both settings.

Blunt splenic trauma in children: are we too careful?

PubMed

De Jong, W J J; Nellensteijn, D R; Ten Duis, H J; Albers, M J I J; Moumni, M El; Hulscher, J B F

2011-08-01

There has been a shift from operative treatment (OT) to non-operative treatment (NOT) of splenic injury. We evaluated the outcomes of treatment of pediatric patients with blunt splenic trauma in our hospital, with special focus on the outcomes after NOT. The data of all patients <18 years with radiologically proven blunt splenic injury admitted between 1988 and 2007 were retrospectively analyzed. Mechanism of injury, type of treatment, ICU stay, total hospital stay, morbidity and mortality were assessed. Patients suffering isolated splenic injuries were assessed separately from patients with multiple injuries. Patients were subsequently divided into those admitted before and after 2000. There were 64 patients: 49 males and 15 females with a mean age of 13 years (range 0-18). 3 patients died shortly after admission due to severe neurological injury and were excluded. In the remaining 61 patients concomitant injuries, present in 62%, included long bone fractures (36%), chest injuries (16%), abdominal injuries (33%) and head injuries (30%). Mechanisms of injury were: car accidents (26%), motorcycle (20%), bicycle (19%), fall from height (17%) and pedestrians struck by a moving vehicle (8%). A change in treatment strategy was evident for the pre- and post-2000 periods. Significantly more patients had NOT after 2000 in both the isolated splenic injury group and the multi-trauma group [4/11 (36%) before vs. 10/11 (91%) after (p=0.009); 15/19 (79%) before vs. 8/20 (40%) after 2000 (p=0.03)]. There was also a significant shift to spleen-preserving operations. All life-threatening complications occurred within <24 h after injury. Mortality for the entire cohort was 7%; all of these patients were treated operatively. When comparing the median ICU and hospital stay before and after 2000 it was found to be significantly higher in the isolated injury group and remained statistically the same in the multi-trauma group. Splenic injury in children is associated with substantial mortality. This is due to concomitant injuries and not to the splenic injury. Non-operative treatment is increasingly preferred to operative procedures when treating splenic injuries in hemodynamically, stable children. ICU and hospital stay have, despite the change from OT to NOT, remained the same. Complications after NOT are rare. We are still observing children in hospital for a longer period than is necessary. © Georg Thieme Verlag KG Stuttgart · New York.

CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison.

PubMed

Bailitz, John; Starr, Frederic; Beecroft, Matthew; Bankoff, Jon; Roberts, Roxanne; Bokhari, Faran; Joseph, Kimberly; Wiley, Dorian; Dennis, Andrew; Gilkey, Susan; Erickson, Paul; Raksin, Patricia; Nagy, Kimberly

2009-06-01

An estimated 10,000 Americans suffer cervical spine injuries each year. More than 800,000 cervical spine radiographs (CSR) are ordered annually. The human and healthcare costs associated with these injuries are enormous especially when diagnosis is delayed. Controversy exists in the literature concerning the diagnostic accuracy of CSR, with reported sensitivity ranging from 32% to 89%. We sought to compare prospectively the sensitivity of cervical CT (CCT) to CSR in the initial diagnosis of blunt cervical spine injury for patients meeting one or more of the NEXUS criteria. The study prospectively compared the diagnostic accuracy of CSR to CCT in consecutive patients evaluated for blunt trauma during 23 months at an urban, public teaching hospital and Level I Trauma Center. Inclusion criteria were adult patient, evaluated for blunt cervical spine injury, meeting one or more of the NEXUS criteria. All patients received both three-view CSR and CCT as part of a standard diagnostic protocol. Each CSR and CCT study was interpreted independently by a different radiology attending who was blinded to the results of the other study. Clinically significant injuries were defined as those requiring one or more of the following interventions: operative procedure, halo application, and/or rigid cervical collar. Of 1,583 consecutive patients evaluated for blunt cervical spine trauma, 78 (4.9%) patients received only CCT or CSR and were excluded from the study. Of the remaining 1,505 patients, 78 (4.9%) had evidence of a radiographic injury by CSR or CCT. Of these 78 patients with radiographic injury, 50 (3.3%) patients had clinically significant injuries. CCT detected all patients with clinically significant injuries (100% sensitive), whereas CSR detected only 18 (36% sensitive). Of the 50 patients, 15 were at high risk, 19 at moderate risk, and 16 at low risk for cervical spine injury according to previously published risk stratification. CSR detected clinically significant injury in 7 high risk (46% sensitive), 7 moderate risk (37% sensitive), and 4 low risk patients (25% sensitive). Our results demonstrate the superiority of CCT compared with CSR for the detection of clinically significant cervical spine injury. The improved ability to exclude injury rapidly provides further evidence that CCT should replace CSR for the initial evaluation of blunt cervical spine injury in patients at any risk for injury.

Evaluation of the criteria for angiotomography indications in the diagnosis of carotid and vertebral arterial injury associated with blunt trauma

PubMed Central

2010-01-01

Background Blunt carotid and vertebral artery injury (BCVI) occur infrequently. The incidence of this type of injury is difficult to determine as many emergency room patients are neurologically asymptomatic. The statistics have not been reported in Brazil. The objectives of the current study were: To evaluate the accuracy of criteria used to recommend angiotomography in the diagnosis of cervical BCVI in 100 patients with blunt cervical trauma in the trauma services section of a Brazilian quaternary care hospital. Methods During a 30-month (2006-2008), all patients admitted to the emergency room of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo with blunt cervical trauma and potential risk of cervical vessel injury, were subjected to cervical angiotomography to diagnose BCVI. The data analyzed are presented as mean ± standard deviation, and statistical analyses included Chi-square and Fisher's exact tests, and the Mann-Whitney test. Results During the study period 2467 blunt trauma patients were admitted. In 100 patients that met the criteria for inclusion in the study, angiotomography identified 23 with BCVI, including 17 males and six females. The mean patient age was 34.81 ± 14.84 years. Car crash (49%) and car-pedestrian accidents (24%) were the most frequent causes of injury. Ten patients had internal carotid artery injuries, two patients had common carotid artery injuries, and 11 patients had vertebral artery injuries. Seven patients presented with Degree I arterial injuries, 10 patients presented with Degree II artery injuries, four patients presented with Degree IV artery injuries, one patient presented with a Degree V artery injury, and one patient had a carotid fistula. Seven out of the 23 patients with BCVI (30.4%) presented with cervical vertebrae fractures, and 11 out of the 23 patients with BCVI (47.8%) presented with facial fractures (LeFort II and III). Conclusions Although there is no consensus regarding the criteria that should be used to indicate angiotomography for BCVI diagnosis, we conclude that the criteria used in the current study led to a diagnosis of BCVI in 0.93% of 2,467 trauma patients, BCVI injuries were associated with more severe traumas and did not affect mortality. PMID:20579381

Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury☆

PubMed Central

Bilgin, Sevil; Guclu-Gunduz, Arzu; Oruckaptan, Hakan; Kose, Nezire; Celik, Bülent

2012-01-01

Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury. PMID:25624828

Prognostication of Learning Curve on Surgical Management of Vasculobiliary Injuries after Cholecystectomy

PubMed Central

Dar, Faisal Saud; Zia, Haseeb; Rafique, Muhammad Salman; Khan, Nusrat Yar; Salih, Mohammad; Hassan Shah, Najmul

2016-01-01

Background. Concomitant vascular injury might adversely impact outcomes after iatrogenic bile duct injury (IBDI). Whether a new HPB center should embark upon repair of complex biliary injuries with associated vascular injuries during learning curve is unknown. The objective of this study was to determine outcome of surgical management of IBDI with and without vascular injuries in a new HPB center during its learning curve. Methods. We retrospectively reviewed patients who underwent surgical management of IBDI at our center. A total of 39 patients were included. Patients without (Group 1) and with vascular injuries (Group 2) were compared. Outcome was defined as 90-day morbidity and mortality. Results. Median age was 39 (20–80) years. There were 10 (25.6%) vascular injuries. E2 injuries were associated significantly with high frequency of vascular injuries (66% versus 15.1%) (P = 0.01). Right hepatectomy was performed in three patients. Out of these, two had a right hepatic duct stricture and one patient had combined right arterial and portal venous injury. The number of patients who developed postoperative complications was not significantly different between the two groups (11.1% versus 23.4%) (P = 0.6). Conclusion. Learning curve is not a negative prognostic variable in the surgical management of iatrogenic vasculobiliary injuries after cholecystectomy. PMID:27525124

Missile cardiac injuries: review of 16 years' experience.

PubMed

Lone, Reyaz Ahmed; Wani, Mehmood Ahmad; Hussain, Zahur; Dar, Abdul Majid; Sharma, Mukhand Lal; Bhat, Mohd Akbar; Ahangar, Abdul Gani

2009-07-01

Penetrating cardiac trauma represents an increasingly important form of trauma due to the frequent use of firearms and bombs in civilian violence. We report our experience over the past 16 years with missile-induced cardiac injuries. A retrospective study reviewing 40 cases (30 males, 10 females) of missile cardiac injuries was conducted. The nature of injuries, management and outcomes were analyzed. The ages ranged from 14-68 years. The mean time in which patients reached the hospital was 4.1 hours. Forty percent of the patients had firearm injuries and the remaining 60% had pellet or splinter injuries to the heart. Survival was noted in 37.5% in the gunshot group and in 66.6% in the splinter/pellet group. The survival in patients with isolated cardiac injury was 60%, while it was only 40% in those with associated injuries. Single-chamber injury was noted in 87.5% of the patients and the survival in these was 62.8%. Fourteen complications were noted in the patients who were resuscitated. One patient was re-explored for excessive bleeding and a missed right ventricular perforation was repaired. In missile cardiac injuries, results are best if operated early, and outcome depends upon multiple factors including clinical status at arrival, time interval till management, nature of injury, and associated injuries.

Infectious complications following duodenal and/or pancreatic trauma.

PubMed

Tyburski, J G; Dente, C J; Wilson, R F; Shanti, C; Steffes, C P; Carlin, A

2001-03-01

Patients with pancreatic and/or duodenal trauma often have a high incidence of infectious complications. In this study we attempted to find the most important risk factors for these infections. A retrospective review of the records of 167 patients seen over 7 years (1989 through 1996) at an urban Level I trauma center for injury to the duodenum and/or pancreas was performed. Fifty-nine patients (35%) had isolated injury to the duodenum (13 blunt, 46 penetrating), 81 (49%) had isolated pancreatic trauma (18 blunt, 63 penetrating), and 27 (16%) had combined injuries (two blunt, 25 penetrating). The overall mortality rate was 21 per cent and the infectious morbidity rate was 40 per cent. The majority of patients had primary repair and/or drainage as treatment of their injuries. Patients with pancreatic injuries (alone or combined with a duodenal injury) had a much higher infection rate than duodenal injuries. The patients with duodenal injuries had significantly lower penetrating abdominal trauma indices, number of intra-abdominal organ injuries, and incidence of hypothermia. On multivariate analysis independent factors associated with infections included hypothermia and the presence of a pancreatic injury. Although injuries to the pancreas and duodenum often coexist it is the pancreatic injury that contributes most to the infectious morbidity.

Outcome Assessments of Patients with Posttraumatic “Ultra-Time Vascular Injuries” of the Extremities

PubMed Central

Sun, Yi-Feng; Fang, Qiong-Xuan; Zhan, Hong-Yan; Wang, Fan; Cao, Wei; Zhao, Gang

2015-01-01

The management of posttraumatic vascular injury that presents after 8 h, or “ultra-time vascular injury”, is daunting, and inciting recognition of this injury is vital. We retrospectively analyzed 29 patients with ultra-time vascular injuries to determine the patients’ demographic characteristics and identify the determinants for amputation and disability. The age distribution of the high-risk population was from 18 years to 40 years, which indicated that these patients had plenty of productive life remaining. Injuries to the lower limbs (79.31%) were over four times more common than injuries to the upper limbs (17.24%), and open and blunt injuries occurred most commonly. The overall rate of limb salvage was 82.76% (24/29) and limb function is excellent in 45.83% (11/24) of the patients. The remaining patients experienced different degrees of disability in their limbs, which was determined by the anatomic location of the injury, and the presence of a combined arterial and venous injury, nerve injury, and complex soft tissue injury, as well as the occurrence of compartment syndrome. Hence, we recommend limb-salvage treatment for patients with traumatic ultra-time vascular injuries, particularly for those aged between 18 years and 40 years. Furthermore, we encourage the development of limb-salvage techniques for ultra-time vascular injuries. PMID:26639214

Pediatric spine fractures: a review of 137 hospital admissions.

PubMed

Carreon, Leah Y; Glassman, Steven D; Campbell, Mitchell J

2004-12-01

The anatomy and biomechanics of the growing spine produce failure patterns different from those in adults. Spinal injury in the pediatric patient is a concern as prevention of further neurologic damage and deformity and the good potential for recovery make timely identification and appropriate treatment of such injury critical. A retrospective clinical case series was conducted to present data from a large series of pediatric patients with spine injuries from a single regional trauma center. One hundred thirty-seven children with spine injuries were seen over 10 years and were divided into three age groups: 0-9, 10-14, and 15-17 years. Analysis of variance and chi2 were used to analyze differences between groups. There were 36 patients aged 0-9, 49 aged 10-14, and 52 aged 15-17. Spine injury incidence increased with age. Motor vehicular accidents were the most common cause in this series. There were 36% cervical, 34% thoracic, 29% lumbar, 34% multilevel contiguous, and 7% multilevel noncontiguous involvement. Nineteen percent had spinal cord injury. Thirteen of 21 complete neurologic injuries and all 3 incomplete injuries improved. Cord injury was more common in the 0-9 age group. Four of five patients with spinal cord injury without radiographic abnormality (SCIWORA) were in the 0-9 age group and had complete neurologic injuries. Young children with cervical injuries were more likely to die than older children. Fifty-three percent had associated injuries. Eighteen percent underwent decompression, fusion, and instrumentation. Two patients developed scoliosis. The complication rate in surgical patients was higher than in patients treated nonsurgically and in polytrauma patients. This may be related to the severity of the initial injury. Our results suggest age-related patterns of injury that differ from previous work. The incidence of cord injury is 20% with higher frequencies in the young child. Potential for neurologic recovery is good. Young children have a higher risk for death than older children. There was no predominance of cervical injuries in the young child. The incidence of SCIWORA was low. Higher complication rates were seen in polytrauma and surgical patients.

Association between injury pattern of patients with multiple injuries and circulating levels of soluble tumor necrosis factor receptors, interleukin-6 and interleukin-10, and polymorphonuclear neutrophil elastase.

PubMed

Hensler, Thorsten; Sauerland, Stefan; Bouillon, Bertil; Raum, Marcus; Rixen, Dieter; Helling, Hanns-J; Andermahr, Jonas; Neugebauer, Edmund A M

2002-05-01

Our knowledge about the bidirectional interactions between brain and whole organism after trauma is still limited. It was the purpose of this prospective clinical study to determine the influence of severe head trauma (SHT) as well as trauma in different anatomic injury regions on posttraumatic inflammatory mediator levels from patients with multiple injuries. Thirty-five healthy controls, 33 patients with an isolated SHT, 47 patients with multiple injuries without SHT, and 45 patients with both SHT and multiple injuries were studied. The posttraumatic plasma levels of soluble tumor necrosis factor receptors p55 and p75, interleukin (IL)-6, IL-10, and polymorphonuclear neutrophil (PMN) elastase were monitored using enzyme-linked immunosorbent assay technique. The influence of head injuries as well as thorax, abdomen, and extremity injuries on the mediator release from patients with multiple injuries was investigated by multivariate linear regression models. The soluble tumor necrosis factor receptor p55/p75 ratio was significantly elevated within 3 hours of trauma in all three injury groups and returned to reference ratios after 12 hours. The lowest increase was found in patients suffering from an isolated SHT. Lowest mediator levels in this patient population were also found for IL-6, IL-10, and PMN elastase during the first 36 hours after trauma. Additional injuries to the head, thorax, abdomen, and extremity modulated mediator levels to a different degree. No specific effect was found for SHT when compared with other injury groups. Thorax injuries caused the quickest rise in mediator levels, whereas abdominal injuries significantly increased PMN elastase levels 12 to 24 hours after trauma. Traumatic injuries cause the liberation of various mediators, without any specific association between anatomic injury pattern and the pattern of mediator release.

Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score.

PubMed

Rowell, Susan E; Barbosa, Ronald R; Diggs, Brian S; Schreiber, Martin A; Holcomb, J B; Wade, C E; Brasel, K J; Vercruysse, G; MacLeod, J; Dutton, R P; Hess, J R; Duchesne, J C; McSwain, N E; Muskat, P; Johannigamn, J; Cryer, H M; Tillou, A; Cohen, M J; Pittet, J F; Knudson, P; De Moya, M A; Schreiber, M A; Tieu, B; Brundage, S; Napolitano, L M; Brunsvold, M; Sihler, K C; Beilman, G; Peitzman, A B; Zenait, M S; Sperry, J; Alarcon, L; Croce, M A; Minei, J P; Kozar, R; Gonzalez, E A; Stewart, R M; Cohn, S M; Mickalek, J E; Bulger, E M; Cotton, B A; Nunez, T C; Ivatury, R; Meredith, J W; Miller, P; Pomper, J; Marin, B

2011-08-01

The Injury Severity Score (ISS) is widely used as a method for rating severity of injury. The ISS is the sum of the squares of the three worst Abbreviated Injury Scale (AIS) values from three body regions. Patients with penetrating injuries tend to have higher mortality rates for a given ISS than patients with blunt injuries. This is thought to be secondary to the increased prevalence of multiple severe injuries in the same body region in patients with penetrating injuries, which the ISS does not account for. We hypothesized that the mechanism-based difference in mortality could be attributed to certain ISS ranges and specific AIS values by body region. Outcome and injury scoring data were obtained from transfused patients admitted to 23 Level I trauma centers. ISS values were grouped into categories, and a logistic regression model was created. Mortality for each ISS category was determined and compared with the ISS 1 to 15 group. An interaction term was added to evaluate the effect of mechanism. Additional logistic regression models were created to examine each AIS category individually. There were 2,292 patients in the cohort. An overall interaction between ISS and mechanism was observed (p = 0.049). Mortality rates between blunt and penetrating patients with an ISS between 25 and 40 were significantly different (23.6 vs. 36.1%; p = 0.022). Within this range, the magnitude of the difference in mortality was far higher for penetrating patients with head injuries (75% vs. 37% for blunt) than truncal injuries (26% vs. 17% for blunt). Penetrating trauma patients with an AIS head of 4 or 5, AIS abdomen of 3, or AIS extremity of 3 all had adjusted mortality rates higher than blunt trauma patients with those values. Significant differences in mortality between blunt and penetrating trauma patients exist at certain ISS and AIS category values. The mortality difference is greatest for head injured patients.

Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years.

PubMed

Tan, K K; Chiu, M T; Vijayan, A

2010-12-01

Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.

Ocular trauma resulting from paintball injury.

PubMed

Pahk, Patricia J; Adelman, Ron A

2009-04-01

Paintball-related ocular injuries result in severe damage and loss of vision. Despite efforts to increase public awareness and improve safety features, the incidence of eye injuries has increased over time. We examined the characteristics and ocular effects of paintball injury at our tertiary referral center. Retrospective review of charts of patients with paintball injury between 1998-2005. Fourteen patients were evaluated for paintball injury; 13 (93%) were male and one (7%) was female. Average age was 17 years (range from 9 to 30). Thirteen patients (95%) did not wear eye protection; one is unknown. Injuries occurred while playing paintball in three patients (21%); ten (71%) were injured in either accidental (four patients) or intentional (six patients) shootings not associated with play. Minimum follow-up was 6 weeks, except for one patient who was lost to follow-up. Seven patients (50%) had final visual acuity (VA) better than 20/200, six patients (43%) were 20/200 or worse, and information on one patient was not available. VA, except in one case, improved with treatment. Decreased VA in this case was due to proliferative vitreoretinopathy (PVR). Hyphema was noted in ten patients (71%), vitreous hemorrhage in eight (57%), retinal hemorrhage in six (43%), retinal tear or detachment in six (43%), commotio retinae in six (43%), iris injury in five (36%), keratopathy in four (29%), lens injury in two (14%), subluxation of lens in two (14%), secondary glaucoma in two (14%), open globe/intraocular foreign body (IOFB) in one (7%), choroidal rupture in one (7%), and proliferative vitreoretinopathy (PVR) in one (7%). Ten patients (71%) required intervention (surgery, laser retinopexy or cryotherapy). Paintball trauma results in significant ocular injury and loss of vision. Most injuries occur in unsupervised settings without proper eye protection. Ten patients (71%) were injured in accidental or intentional shootings. Lack of supervision and use of paintball materials as assault weapons make the risk for ocular injury more significant. Improved safety features of paintball equipment, along with continued education of proper eye protection, may reduce the incidence of severe ocular injuries.

Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma

PubMed Central

Stengel, Dirk; Ottersbach, Caspar; Matthes, Gerrit; Weigeldt, Moritz; Grundei, Simon; Rademacher, Grit; Tittel, Anja; Mutze, Sven; Ekkernkamp, Axel; Frank, Matthias; Schmucker, Uli; Seifert, Julia

2012-01-01

Background: Contrast-enhanced whole-body computed tomography (also called “pan-scanning”) is considered to be a conclusive diagnostic tool for major trauma. We sought to determine the accuracy of this method, focusing on the reliability of negative results. Methods: Between July 2006 and December 2008, a total of 982 patients with suspected severe injuries underwent single-pass pan-scanning at a metropolitan trauma centre. The findings of the scan were independently evaluated by two reviewers who analyzed the injuries to five body regions and compared the results to a synopsis of hospital charts, subsequent imaging and interventional procedures. We calculated the sensitivity and specificity of the pan-scan for each body region, and we assessed the residual risk of missed injuries that required surgery or critical care. Results: A total of 1756 injuries were detected in the 982 patients scanned. Of these, 360 patients had an Injury Severity Score greater than 15. The median length of follow-up was 39 (interquartile range 7–490) days, and 474 patients underwent a definitive reference test. The sensitivity of the initial pan-scan was 84.6% for head and neck injuries, 79.6% for facial injuries, 86.7% for thoracic injuries, 85.7% for abdominal injuries and 86.2% for pelvic injuries. Specificity was 98.9% for head and neck injuries, 99.1% for facial injuries, 98.9% for thoracic injuries, 97.5% for abdominal injuries and 99.8% for pelvic injuries. In total, 62 patients had 70 missed injuries, indicating a residual risk of 6.3% (95% confidence interval 4.9%–8.0%). Interpretation: We found that the positive results of trauma pan-scans are conclusive but negative results require subsequent confirmation. The pan-scan algorithms reduce, but do not eliminate, the risk of missed injuries, and they should not replace close monitoring and clinical follow-up of patients with major trauma. PMID:22392949

Childhood motocross truncal injuries: high-velocity, focal force to the chest and abdomen

PubMed Central

Kennedy, Raelene D; Potter, D Dean; Osborn, John B; Zietlow, Scott; Zarroug, Abdalla E; Moir, Christopher R; Ishitani, Michael B; McIntosh, Amy

2012-01-01

Objectives To review the need for operative intervention and critical care services for motocross truncal injuries in children. Design cohort Retrospective review of patients identified via the hospital trauma registry. Setting Our Level 1 Pediatric Trauma Center serves five motocross tracks. These patients require frequent medical care for injuries. Participants All patients ≤17 years of age with truncal injuries sustained during motocross activities, between 2000 and 2011, were identified through the trauma registry. Primary and secondary outcome measures Operative intervention, intensive care unit (ICU) admission, length of stay, morbidity and demographics were reviewed. Results Motocross injured 162 children. Thirty (18.5%) were thoracic or abdominal injuries. Operative intervention was required in eight (27%) patients. Mean injury severity score (ISS) was 11.8. ICU admission was required in 50% and average hospital length of stay was 4.1 days. The most common injuries include pulmonary contusion, pneumothorax, spleen and liver lacerations. 13% of subjects suffered truncal injury from motocross on more than one occasion. Conclusions Paediatric motocross-related truncal injuries are significant. Surgical intervention is required in 27% of patients. The lower ISS incurred from motocross combined with high surgical and ICU admission rates suggests focal high-impact injuries to the chest and abdomen. Despite significant injury, 13% of motocross patients suffer recurrent injuries. Parents and children need injury prevention education. PMID:23166134

Cervical spine injuries in pediatric patients.

PubMed

Platzer, Patrick; Jaindl, Manuela; Thalhammer, Gerhild; Dittrich, Stefan; Kutscha-Lissberg, Florian; Vecsei, Vilmos; Gaebler, Christian

2007-02-01

Cervical spine injuries are uncommon in pediatric trauma patients. Previous studies were often limited by the small numbers of patients available for evaluation. The aim of this study was to determine the incidence and characteristics of pediatric cervical spine injuries at this Level 1 trauma center and to review the authors' experiences with documented cases. This study retrospectively analyzed the clinical records of all pediatric trauma patients with skeletal and/or nonskeletal injuries of the spine that were admitted to this Level 1 trauma center between 1980 and 2004. Those with significant injuries of the cervical spine were identified and included in this study. Pediatric patients were defined as patients younger than the age of 17 years. In addition, they were stratified by age into two study groups: group A included patients aged 8 years or fewer and group B contained patients from the ages of 9 to 16 years. We found 56 pediatric patients with injuries of the cervical spine that met criteria for inclusion. Thirty-one female and 25 male patients with an average age of 8.9 years (range, 1-16 years) sustained significant skeletal and/or nonskeletal injuries of the cervical spine and were entered in this study. Thirty patients (54%) were aged 8 years or fewer and entered into study group A, whereas 26 patients (46%) from the ages of 9 to 16 met criteria for inclusion in study group B. An analysis of data revealed that younger patients (group A) showed significantly more injuries of the upper cervical spine, whereas older children (group B) sustained significantly more injuries of the lower level. Spinal cord injuries without radiographic findings were only found in study group A. In addition, younger children were more likely injured by motor vehicle crashes, whereas older children more commonly sustained C-spine injuries during sports activities. Two-thirds of our patients showed neurologic deficits, and the overall mortality was 28%. The results of our study were similar to several previous reports, underscoring a low incidence (1.2%) and age-related characteristics. Younger children had a predilection for injuries of the upper cervical spine, whereas children in the older age group sustained significantly more injuries of the lower cervical spine. Spinal cord injuries without radiographic abnormalities were only seen in the younger age group. Despite the low incidence of cervical spine injuries in pediatric patients, increased efforts at prevention are demanded because mortality rate (27%) and incidence of neurologic deficits (66%) were dreadfully high in our series.

Retrospective evaluation of canine and feline maxillomandibular trauma cases. A comparison of signalment with non-maxillomandibular traumatic injuries (2003-2012).

PubMed

Mulherin, B L; Snyder, C J; Soukup, J W; Hetzel, S

2014-01-01

To determine differences in signalment between maxillomandibular (MM) and non-maxillomandibular (non-MM) trauma patients to help predict the type of injury sustained. A medical records database was searched from December 2003 to September 2012 to identify all MM trauma patients. A random sample of non-MM trauma patients was generated for comparison. Patient species, age, sex, weight, and injury aetiology were recorded for both populations. Sixty-seven MM trauma patients and 129 non-MM trauma patients were identified. Feline patients were almost twice as likely to be presented for MM trauma compared with non-MM trauma. The median weight of canine patients suffering MM injury was significantly less than that of non-MM patients (p = 0.025). A significant association existed between the causes of injuries associated with MM and non-MM trauma populations (p = 0.000023). The MM trauma patients were more likely to sustain injury as a result of an animal altercation (Bonferroni p = 0.001) while non-MM injuries were more likely to result from motor vehicle accidents (Bonferroni p = 0.001). Overall, animals that were less than one year of age with traumatic injuries were overrepresented (65/196) in comparison to the entire patient population. The results of this study may help guide clinicians in the evaluation and screening of trauma patients that are presented as an emergency. Cats, small dogs and animals suffering from animal altercations should all be closely evaluated for MM injury.

Intracutaneous sterile water for back pain in labour.

PubMed Central

Reynolds, J. L.

1994-01-01

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

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

DTIC Science & Technology

1995-05-01

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

Spinal column and spinal cord injuries in mountain bikers: a 13-year review.

PubMed

Dodwell, Emily R; Kwon, Brian K; Hughes, Barbara; Koo, David; Townson, Andrea; Aludino, Allan; Simons, Richard K; Fisher, Charles G; Dvorak, Marcel F; Noonan, Vanessa K

2010-08-01

Multiple studies have described in general the injuries associated with mountain biking, and detailed accounts of spine injuries sustained in hockey, gymnastics, skiing, snowboarding, rugby, and paragliding have previously been published. However, no large-scale detailed assessment of mountain biking associated spinal fractures and spinal cord injuries has previously been published. This study was undertaken to describe the patient demographics, injuries, mechanisms, treatments, outcomes, and resource requirements associated with spine injuries sustained while mountain biking. Case series; Level of evidence, 4. Patients who were injured while mountain biking, and who were seen at a provincial spine referral center between 1995 and 2007 inclusive, with spinal cord injuries and/or spine fracture were included. A chart review was performed to obtain demographic data, and details of the injury, treatment, outcome, and resource requirements. A total of 102 men and 5 women were identified for inclusion. The mean age at injury was 32.7 years (95% confidence interval 30.6, 35.0). Seventy-nine patients (73.8%) sustained cervical injuries, while the remainder sustained thoracic or lumbar injuries. Forty-three patients (40.2%) sustained a spinal cord injury. Of those with cord injuries, 18 (41.9%) were American Spinal Injury Association (ASIA) A, 5 (11.6%) were ASIA B, 10 (23.3%) ASIA C, and 10 (23.3%) ASIA D. Sixty-seven patients (62.6%) required surgical treatment. The mean length of stay in an acute hospital bed was 16.9 days (95% confidence interval 13.1, 30.0). Thirty-three patients (30.8%) required intensive care unit attention, and 31 patients (29.0%) required inpatient rehabilitation. Of the 43 patients (40.2%) seen with spinal cord injuries, 14 (32.5%) improved by 1 ASIA category, and 1 (2.3%) improved by 2 ASIA categories. Two patients remained ventilator-dependent at discharge. Spine fractures and spinal cord injuries caused by mountain biking accidents typically affect young, male, recreational riders. The medical, personal, and societal costs of these injuries are high. Injury prevention should remain a primary goal, and further research is necessary to explore the utility of educational programs, and the effect of helmets and other protective gear on spine injuries sustained while mountain biking.

Patient and Trauma Center Characteristics Associated with Helicopter Emergency Medical Services Transport for Patients with Minor Injuries in the United States

PubMed Central

Cheung, Brian H.; Delgado, M. Kit; Staudenmayer, Kristan L.

2015-01-01

Background Helicopter emergency medical services (EMS) transport is expensive, and previous work has shown that cost-effective use of this resource is dependent on the proportion of minor injuries flown. To understand how over-triage to helicopter EMS versus ground EMS can be reduced, it is important to understand factors associated with helicopter transport of patients with minor injuries. Objectives The aim was to characterize patient and hospital characteristics associated with helicopter transport of patients with minor injuries. Methods This was a retrospective analysis of adults ≥18 years who were transported by helicopter to Level I/II trauma centers from 2009 through 2010 as identified in the National Trauma Data Bank. Minor injuries were defined as all injuries scored at an Abbreviated Injury Scale (AIS) < 3. Patient and hospital characteristics associated of being flown with only minor injuries were compared in an unadjusted and adjusted fashion. Hierarchical, multivariate logistic regression was used to adjust for patient demographics, mechanism of injury, presenting physiology, injury severity, urban-rural location of injury, total EMS time, hospital characteristics, and region. Results A total of 24,812 records were identified, corresponding to 76,090 helicopter transports. The proportion of helicopter transports with only minor injuries was 36% (95% confidence interval [CI] = 34% to 39%). Patient characteristics associated with being flown with minor injuries included being uninsured (odds ratio [OR] 1.36, 95% CI = 1.26 to 1.47), injury by a fall (OR 1.32, 95% CI = 1.20 to 1.45), or other penetrating trauma (OR 2.52, 95% CI = 2.12 to 3.00). Being flown with minor injuries was more likely if the patient was transported to a trauma center that also received a high proportion of patients with minor injuries by ground EMS (OR 1.89, 95% CI = 1.58 to 2.26) or a high proportion of EMS traffic by helicopter (OR 1.35, 95% CI = 1.02 to 1.78). No significant association with urban-rural scene location, or total EMS time was found. Conclusions Better recognizing which patients with falls and penetrating trauma have serious injuries that could benefit from being flown may lead to the more cost-effective use of helicopter EMS. More research is needed to determine why patients without insurance, who are most at risk for high out-of-pocket expenses from helicopter EMS, are at higher risk for being flown when only having minor injuries. This suggests that interventions to optimize cost-effectiveness of helicopter transport will likely require an evaluation of helicopter triage guidelines in the context of regional and patient needs. PMID:25377400

Use of laparoscopy in trauma at a level II trauma center.

PubMed

Barzana, Daniel C; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W

2011-01-01

Enthusiasm for the use of laparoscopy in trauma has not rivaled that for general surgery. The purpose of this study was to evaluate our experience with laparoscopy at a level II trauma center. A retrospective review of all trauma patients undergoing diagnostic or therapeutic laparoscopy was performed from January 2004 to July 2010. Laparoscopy was performed in 16 patients during the study period. The average age was 35 years. Injuries included left diaphragm in 4 patients, mesenteric injury in 2, and vaginal laceration, liver laceration, small bowel injury, renal laceration, urethral/pelvic, and colon injury in 1 patient each. Diagnostic laparoscopy was performed in 11 patients (69%) with 3 patients requiring conversion to an open procedure. Successful therapeutic laparoscopy was performed in 5 patients for repair of isolated diaphragm injuries (2), a small bowel injury, a colon injury, and placement of a suprapubic bladder catheter. Average length of stay was 5.6 days (range, 0 to 23), and 75% of patients were discharged home. Morbidity rate was 13% with no mortalities or missed injuries. Laparoscopy is a seldom-used modality at our trauma center; however, it may play a role in a select subset of patients.

Factors influencing bladder stone formation in patients with spinal cord injury.

PubMed

Favazza, Terry; Midha, Meena; Martin, Jessicca; Grob, B Mayer

2004-01-01

Bladder stones that form in patients with spinal cord injury (SCI) can cause significant morbidity. This study sought to analyze factors associated with bladder stone formation to determine which patients might be at increased risk to develop bladder stones. A review of 56 SCI patients treated for bladder calculi over a 10-year period at a single institution was performed. These patients were compared with a control population of general SCI patients known to be stone free. The factors compared were patient age, duration of injury, level of injury, completeness of injury, method of bladder management, and the presence of documented urinary tract infections with urease-producing organisms. All patients with stones were male and had a median age of 58.5 years. The median level of injury was C6, the median time since injury was 21 years, 66% had complete injuries, 68% managed their bladders with indwelling catheters or suprapubic tubes, and 83% had a history of infections with urease-producing organisms. When compared with the control group, patients forming bladder stones were older (P = 0.03), were more likely to have indwelling catheters (P < 0.0001), had a history of infections with urease-producing organisms (P = 0.04), and had complete injuries (P = 0.018). This information can be used to identify patients who have an increased risk of bladder stones and measures can be taken to reduce their incidence and morbidity.

Exposure to Surgery and Anesthesia After Concussion Due to Mild Traumatic Brain Injury.

PubMed

Abcejo, Arnoley S; Savica, Rodolfo; Lanier, William L; Pasternak, Jeffrey J

2017-07-01

To describe the epidemiology of surgical and anesthetic procedures in patients recently diagnosed as having a concussion due to mild traumatic brain injury. Study patients presented to a tertiary care center after a concussion due to mild traumatic brain injury from July 1, 2005, through June 30, 2015, and underwent a surgical procedure and anesthesia support under the direct or indirect care of a physician anesthesiologist. During the study period, 1038 patients met all the study inclusion criteria and subsequently received 1820 anesthetics. In this population of anesthetized patients, rates of diagnosed concussions due to sports injuries, falls, and assaults, but not motor vehicle accidents, increased during 2010-2011. Concussions were diagnosed in 965 patients (93%) within 1 week after injury. In the 552 patients who had surgery within 1 week after concussive injury, 29 (5%) had anesthesia and surgical procedures unrelated to their concussion-producing traumatic injury. The highest use of surgery occurred early after injury and most frequently required general anesthesia. Orthopedic and general surgical procedures accounted for 57% of procedures. Nine patients received 29 anesthetics before a concussion diagnosis, and all of these patients had been involved in motor vehicle accidents and received at least 1 anesthetic within 1 week of injury. Surgical and anesthesia use are common in patients after concussion. Clinicians should have increased awareness for concussion in patients who sustain a trauma and may need to take measures to avoid potentially injury-augmenting cerebral physiology in these patients. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Changes in Body Temperature in Incomplete Spinal Cord Injury by Digital Infrared Thermographic Imaging

PubMed Central

Song, Yun-Gyu; Won, Yu Hui; Park, Sung-Hee; Ko, Myoung-Hwan

2015-01-01

Objective To investigate changes in the core temperature and body surface temperature in patients with incomplete spinal cord injuries (SCI). In incomplete SCI, the temperature change is difficult to see compared with complete spinal cord injuries. The goal of this study was to better understand thermal regulation in patients with incomplete SCI. Methods Fifty-six SCI patients were enrolled, and the control group consisted of 20 healthy persons. The spinal cord injuries were classified according to International Standards for Neurological Classification of Spinal Cord Injury. The patients were classified into two groups: upper (neurological injury level T6 or above) and lower (neurological injury level T7 or below) SCIs. Body core temperature was measured using an oral thermometer, and body surface temperature was measured using digital infrared thermographic imaging. Results Twenty-nine patients had upper spinal cord injuries, 27 patients had lower SCIs, and 20 persons served as the normal healthy persons. Comparing the skin temperatures of the three groups, the temperatures at the lower abdomen, anterior thigh and anterior tibia in the patients with upper SCIs were lower than those of the normal healthy persons and the patients with lower SCIs. No significant temperature differences were observed between the normal healthy persons and the patients with lower SCIs. Conclusion In our study, we found thermal dysregulation in patients with incomplete SCI. In particular, body surface temperature regulation was worse in upper SCIs than in lower injuries. Moreover, cord injury severity affected body surface temperature regulation in SCI patients. PMID:26605167

Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania

PubMed Central

2011-01-01

Background Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. Patients and methods This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. Results A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P < 0.001), whereas mortality was significantly associated with pre-morbid illness, associated injuries, trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P < 0.001). Conclusion Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region. PMID:21244706

Rotational injury of cervical facets: CT analysis of fracture patterns with implications for management and neurologic outcome.

PubMed

Shanmuganathan, K; Mirvis, S E; Levine, A M

1994-11-01

Imaging studies of patients with rotational facet injuries of the cervical spine were retrospectively reviewed to determine the prevalence and pattern of associated fractures, to correlate injury pattern with recommended surgical stabilization, and to assess neurologic outcome. Radiographs and CT scans obtained for 40 consecutive patients with rotational facet injuries of the cervical spine during a 70-month period were retrospectively reviewed to determine injury level, presence, and orientation of facet fractures, and concurrent nonfacet injuries. Imaging findings were reviewed to assess the likelihood of instability and to determine the most appropriate stabilization requirement. Medical records were reviewed to ascertain mechanism of injury, initial neurologic deficit, and surgical findings. Among the 40 patients with cervical rotational facet injuries, 11 (27%) had pure unilateral facet dislocation or subluxation without associated fractures, and 29 (73%) had concurrent facet fractures involving the inferior facet of the rotated vertebra (n = 13), the superior facet of the subjacent vertebra (n = 9), or both (n = 7). Injury of the rotated vertebra was unilateral in 22 patients but bilateral in 18 patients. Facet fractures frequently extended into the ipsilateral lamina or articular pillar or both. An avulsion fracture from the posteroinferior aspect of the rotated vertebral body, indicating disk disruption, occurred in 10 patients (25%), and seven patients (17%) had complete isolation of an articular pillar. Facet fractures were confirmed for 27 patients who underwent surgical stabilization. Neurologic deficits developed in 29 (73%) of the 40 patients and included radiculopathy in 11 patients and cord syndromes in 18 patients. Pure dislocation without a facet fracture was more likely to lead to a cord syndrome (p = .006). Cervical rotational facet injuries are often accompanied by facet fractures and bilateral damage of the rotated vertebra. These injuries contribute to rotational instability and require specific internal fixation based on a precise delineation of all injuries. Facet dislocations without fractures have a significantly higher association with cord syndromes than do rotational facet injuries with fractures. CT, particularly with parasagittal reformations, is valuable in identifying all injuries of the rotated and subjacent vertebrae.

Blast injury from explosive munitions.

PubMed

Cernak, I; Savic, J; Ignjatovic, D; Jevtic, M

1999-07-01

To evaluate the effect of blast in common war injuries. One thousand three hundred and three patients injured by explosive munitions and demonstrating extremity wounds without other penetrating injuries were admitted to the Military Medical Academy in Belgrade between 1991 and 1994. Of these, 665 patients (51%) had symptoms and physical signs that were compatible with the clinical diagnosis of primary blast injury, whereas the remaining 658 patients did not. Random sampling of 65 patients in the blast group during the early posttraumatic period showed statistically significant elevations in blood thromboxane A2 (TxA2), prostacyclin (PGI2), and sulfidopeptide leukotrienes compared with the random sample of 62 patients in the nonblast group. This difference could not be accounted for by differing injury severity between the groups, because the severity of wounds as measured by both the Injury Severity Score and the Red Cross Wound Classification was similar in both groups. Amongst blast patients, 200 patients (30%) had long-term (1 year) symptoms and signs reflecting central nervous system disorders. These symptoms and signs were only sporadically found in 4% of the nonblast patients. These findings indicate that primary blast injury is more common in war injuries than previously thought and that of those affected by blast, a surprisingly high proportion retain long-term neurologic disability. The elevation in eicosanoids could be used to confirm and monitor blast injury. In relation to the immediate management of patients injured by explosive weapons, it follows that particular attention should be paid to the presence and/or development of blast injury. Our findings indicate that blast is more common in war injuries than previously thought. Eicosanoid changes after blast injury suggest that blast injury causes a major physiologic stress. A variety of effects on the central nervous system suggest that blast injury could be responsible for some aspects of what is now considered to be the posttraumatic stress disorder.

Chronic consequences of acute injuries: worse survival after discharge.

PubMed

Shafi, Shahid; Renfro, Lindsay A; Barnes, Sunni; Rayan, Nadine; Gentilello, Larry M; Fleming, Neil; Ballard, David

2012-09-01

The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward. Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File. Survival rates were measured at 30, 90, and 180 days and 1 and 2 years from injury among two groups of trauma patients who survived to discharge: major trauma (Abbreviated Injury Scale score ≥ 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score ≤ 2 injuries, n = 1,171). Control groups matched to each trauma group by age and sex were simulated from the US general population using annual survival probabilities from census data. Kaplan-Meier and log-rank analyses conditional upon survival to each time point were used to determine changes in risk of mortality after discharge. Cox proportional hazards models with left truncation at the time of discharge were used to determine independent predictors of mortality after discharge. The survival rate in trauma patients with major injuries was 92% at 30 days posttrauma and declined to 84% by 3 years (p > 0.05 compared with general population). Minor trauma patients experienced a survival rate similar to the general population. Age and injury severity were the only independent predictors of long-term mortality given survival to discharge. Log-rank tests conditional on survival to each time point showed that mortality risk in patients with major injuries remained significantly higher than the general population for up to 6 months after injury. The survival rate of trauma patients with major injuries remains significantly lower than survival for minor trauma patients and the general population for several months postdischarge. Surveillance for early identification and treatment of complications may be needed for trauma patients with major injuries. Prognostic study, level III.

[Internal fixation with one-hole microplate for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture].

PubMed

Wang, Xi-Xun; Sun, De-Tao; Chen, Xu-Hui; Li, Jun; Cui, Yan; Hu, Ji-Chao; Shu, Zheng-Hua; He, Jian; Ding, Chao-Qi; Chen, Bo

2015-03-01

To study clinical effects of one-hole microplate internal fixation for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture. Twenty-two patients (16 males, 6 females) with collateral ligament injuries of the metacarpophalangeal joint of the thumb combined fracture were treated with one-hole microplate internal fixation. The age of the patients ranged from 18 to 53 years old with a mean age of 28.5 years old. The duration from injury to surgery ranged from 2 hours to 2 months, and the mean time was 6 days. All the patients had collateral ligament injuries combined with fracture of the metacarpophalangeal joint of the thumb. Thirteen patients had injuries in the right hand and 9 patients had injuries in the left hand. There were 18 cases of closed wound and 4 cases of open wound. Eighteen patients had fresh injuries (< 2 weeks) and 4 had old injuries (> 2 weeks). Sixteen patients had injuries in the ulnar collateral ligament of the thumb combined with fracture, 6 patients had radial collateral ligament injuries of the thumb combined with fracture, 4 cases of which were complicated with injuries of abductor pollicis brevis and the end of the flexor pollicis brevis tender. The size of the avulsed fragment was about 3.0 mm x 4.0 mm to 6.0 mm x 7.0 mm. The incisions of 22 patients healed by first intention. The follow-up periods ranged from 6 months to 5 years old,with an average of 2.5 years old. The thumb function was evaluated by Saetta and other evaluation criteria, and 20 patients got an excellent result and 2 good. The application of one-hole microplate internal fixation in treating collateral ligament injuries with fracture of the metacarpophalangeal joint of the thumb is an effective method.

Analysis on sports and recreation activity-related eye injuries presenting to the Emergency Department

PubMed Central

Moon, Sungbae; Ryoo, Hyun Wook; Ahn, Jae Yun; Park, Jung Bae; Seo, Kang Suk; Shin, Sang Do; Song, Kyoung Jun; Lee, Kang Hyun; Yoo, In Sool; Cho, Jin Seong; Ryu, Hyun Ho; Jeong, Tae Oh; Yeom, Seok Ran; Kim, Young Taek; Hong, Sung Ok

2016-01-01

AIM To investigate the incidence and general characteristics of sports-related eye injuries in patients visiting the Emergency Department. METHODS A cross-sectional, multi-center, observational study. Patients with an injured eye who visited the Emergency Department at one of nine hospitals in Korea were enrolled. All data were prospectively collected between March and September 2010 using a questionnaire. Eye injuries that occurred during risky sports were examined by gender and age. Additionally, the rate of open globe injuries that occurred with and without protective eyewear was examined for each activity. Continuous variables were compared using Student's t-test and categorical variables were compared using Chi-square test. RESULTS A total of 446 patients had sports-related eye injuries. Teenagers (10-19 years old) and young adults (20-29 years old) had the most eye injuries. Eye injuries accounted for 0.2% of Emergency Department patients. Baseball was the most common cause of sports-related eye injuries, followed by soccer and hiking. Protective gear was worn by 9.4% of all patients. Patients that were 30-39 years of age had the highest rate of protective gear use, followed by patients that were 40-49 years of age. The proportion of sports-related eye injuries that were open-globe injuries was highest for soccer and hiking. CONCLUSION Although injuries were most common in patients below the age of 10 years, these patients had the lowest rate of protective eyewear use. Injuries in adults over 40 years of age most commonly occurred during hiking, but the rate of protective eyewear use was low. Young athletes should be educated on and provided with protective eyewear and policies protective gear use should be established. For older adults, eye protection should be encouraged, especially during hiking. PMID:27803871

Management of traumatic brachial artery injuries: A report on 49 patients

PubMed Central

Ekim, Hasan; Tuncer, Mustafa

2009-01-01

BACKGROUND AND OBJECTIVE: The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability. The purpose of our study was to review our experience with brachial artery injuries over a 9-year period, describing the type of injury, surgical procedures, complications, and associated injuries. PATIENTS AND METHODS: Forty-nine patients with brachial artery injury underwent surgical repair procedures at our hospital, from the beginning of May 1999 to the end of June 2008. The brachial artery injuries were diagnosed by physical examination and Doppler ultrasonography. Depending on the mode of presentation, patients were either taken immediately to the operating room for bleeding control and vascular repair or were assessed by preoperative duplex ultrasonography. RESULTS: This study group consisted of 43 males and 6 females, ranging in age from 6 to 65 years with a mean (SD) age of 27.9 (6.7) years. The mechanism of trauma was penetrating in 45 patients and blunt in the remaining 4 patients. Stab injury was the most frequent form of penetrating trauma (24 of 45). Treatment included primary arterial repair in 5 cases, end-to-end anastomosis in 28 cases, interposition vein graft in 15 cases, and interposition-ringed polytetrafluoroethylene graft in 1 case. Associated injuries were common and included venous injury (14), bone fracture (5), and peripheral nerve injury (11). Fifteen patients developed postoperative complications. One patient underwent an above-elbow amputation. CONCLUSIONS: Prompt and appropriate management of the brachial artery injuries, attention to associated injuries, and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. PMID:19318753

Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war.

PubMed

Er, Erhan; Çorbacıoğlu, Şeref Kerem; Güler, Sertaç; Aslan, Şahin; Seviner, Meltem; Aksel, Gökhan; Bekgöz, Burak

2017-01-01

Aimed to analyze demographical data and injury characteristics of patients who were injured in the Syrian Civil War (SCW) and to define differences in injury characteristics between adult and pediatric patients. Patients who were injured in the SCW and transferred to our emergency department were retrospectively analyzed in this study during the 15-month period between July 2013 and October 2014. During the study period, 1591 patients who were the victims of the SCW and admitted to our emergency department due to war injury enrolled in the study. Of these patients, 285 were children (18%). The median of the injury severity score was 16 (interquartile range [IQR]: 9-25) in all patients. The most frequent mechanism of injury was blunt trauma (899 cases, 55%), and the most frequently-injured region of the body was the head (676 cases, 42.5%). Head injury rates among the children's group were higher than those of the adult group (P < .001). In contrast, injury rates for the abdomen and extremities in the children's group were lower than those in the adult group (P < .001, P < .001). The majority of patients were adults, and the most frequent mechanism of injury was blunt trauma. Similarly, the children were substantially affected by war. Although the injury severity score values and mortality rates of the child and adult groups were similar, it was determined that the number of head injuries was higher, but the number of abdomen and extremity injuries was lower in the children's group than in the adult group. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Rib fractures and their association With solid organ injury: higher rib fractures have greater significance for solid organ injury screening.

PubMed

Rostas, Jack W; Lively, Timothy B; Brevard, Sidney B; Simmons, Jon D; Frotan, Mohammad A; Gonzalez, Richard P

2017-04-01

The purpose of this study was to identify patients with rib injuries who were at risk for solid organ injury. A retrospective chart review was performed of all blunt trauma patients with rib fractures during the period from July 2007 to July 2012. Data were analyzed for association of rib fractures and solid organ injury. In all, 1,103 rib fracture patients were identified; 142 patients had liver injuries with 109 (77%) associated right rib fractures. Right-sided rib fractures with highest sensitivity for liver injury were middle rib segment (5 to 8) and lower segment (9 to 12) with liver injury sensitivities of 68% and 43%, respectively (P < .001); 151 patients had spleen injuries with 119 (79%) associated left rib fractures. Left middle segment rib fractures and lower segment rib fractures had sensitivities of 80% and 63% for splenic injury, respectively (P < .003). Rib fractures higher in the thoracic cage have significant association with solid organ injury. Using rib fractures from middle plus lower segments as indication for abdominal screening will significantly improve rib fracture sensitivity for identification of solid organ injury. Copyright © 2016 Elsevier Inc. All rights reserved.

Injury Patterns and Outcomes of Ice-Fishing in the United States

PubMed Central

Thiels, Cornelius A.; Hernandez, Matthew C.; Zielinski, Martin D.; Aho, Johnathon M.

2016-01-01

Introduction Fishing is a common pastime. In the developed world, it is commonly performed as a recreational activity. We aim to determine injury patterns and outcomes among patients injured while ice fishing. Methods Data on initial emergency department visits from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) from 2009-2014 were analyzed. All patients with fishing related injuries were included. Primary endpoint was rate of admission or transfer. Secondary endpoints were defined a priori anatomical injury categories and patients were assigned into groups. Descriptive and power analysis was performed between patients with ice-fishing and traditional fishing related injuries. Results We identified 8220 patients who sustained fishing related injuries, of which n=85 (1%) involved ice fishing. Ice fishing injuries occurred primarily in males (88%) with a mean age of 39.4 years ± 17.5 (std dev). The most common injuries related to ice fishing were: orthopedic/musculoskeletal (46%), minor trauma (37%), and major trauma (6%). Hot thermal injuries (burns) were the fourth most common type of ice-fishing injury (5%) but rarely occurred in warmer fishing months (<1%, p=0.004). Cold thermal injuries (1%) and hypothermia (0%) were rare among ice-fishing injuries and immersion/drowning occurred in 5% of cases. The rate of admission/transfer was significantly greater in ice-fishing (11%) than the traditional fishing patients 3%, p<0.001), power was 89.7%. Conclusion Ice fishing is associated with more severe injury patterns and more thermal injuries and immersion injuries than traditional fishing. Providers and participants should be aware of the potential risks and benefits and counseled appropriately. PMID:27117462

Injury patterns and outcomes of ice-fishing in the United States.

PubMed

Thiels, Cornelius A; Hernandez, Matthew C; Zielinski, Martin D; Aho, Johnathon M

2016-07-01

Fishing is a common pastime. In the developed world, it is commonly performed as a recreational activity. We aim to determine injury patterns and outcomes among patients injured while ice fishing. Data on initial emergency department visits from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) from 2009-2014 were analyzed. All patients with fishing related injuries were included. Primary endpoint was rate of admission or transfer. Secondary endpoints were defined a priori anatomical injury categories and patients were assigned into groups. Descriptive and power analysis was performed between patients with ice-fishing and traditional fishing related injuries. We identified 8220 patients who sustained fishing related injuries, of which n=85 (1%) involved ice fishing. Ice fishing injuries occurred primarily in males (88%) with a mean age of 39.4years ±17.5 (std dev). The most common injuries related to ice fishing were: orthopedic/musculoskeletal (46%), minor trauma (37%), and major trauma (6%). Hot thermal injuries (burns) were the fourth most common type of ice-fishing injury (5%) but rarely occurred in warmer fishing months (<1%, P=.004). Cold thermal injuries (1%) and hypothermia (0%) were rare among ice-fishing injuries and immersion/drowning occurred in 5% of cases. The rate of admission/transfer was significantly greater in ice-fishing (11%) than the traditional fishing patients 3%, (P<.001), power was 90%. Ice fishing is associated with more severe injury patterns and more thermal injuries and immersion injuries than traditional fishing. Providers and participants should be aware of the potential risks and benefits and counseled appropriately. Copyright © 2016 Elsevier Inc. All rights reserved.

Cardiac and great vessel injuries after chest trauma: our 10-year experience.

PubMed

Onan, Burak; Demirhan, Recep; Öz, Kürşad; Onan, Ismihan Selen

2011-09-01

Cardiovascular injuries after trauma present with high mortality. The aim of the study was to present our experience in cardiac and great vessel injuries after chest trauma. During the 10-year period, 104 patients with cardiac (n=94) and great vessel (n=10) injuries presented to our hospital. The demographic data, mechanism of injury, location of injury, other associated injuries, timing of surgical intervention, surgical approach, and clinical outcome were reviewed. Eighty-eight (84.6%) males presented after chest trauma. The mean age of the patients was 32.5±8.2 years (range: 12-76). Penetrating injuries (62.5%) were the most common cause of trauma. Computed tomography was performed in most cases and echocardiography was used in some stable cases. Cardiac injuries mostly included the right ventricle (58.5%). Great vessel injuries involved the subclavian vein in 6, innominate vein in 1, vena cava in 1, and descending aorta in 2 patients. Early operations after admission to the emergency were performed in 75.9% of the patients. Thoracotomy was performed in 89.5% of the patients. Operative mortality was significantly high in penetrating injuries (p=0.01). Clinicians should suspect cardiac and great vessel trauma in every patient presenting to the emergency unit after chest trauma. Computed tomography and echocardiography are beneficial in the management of chest trauma. Operative timing depends on hemodynamic status, and a multidisciplinary team approach improves the patient's prognosis.

Ocular firework injuries at New Year's eve.

PubMed

Sacu, Stefan; Ségur-Eltz, Nikolaus; Stenng, Karin; Zehetmayer, Martin

2002-01-01

To prospectively study mechanisms and injury characteristics of ocular firework burns. A prospective analysis of all patients with firework injuries attending the Department of Ophthalmology, University of Vienna, between 1994 and 2001. We looked for classes of fireworks and mechanisms of injuries. The number of diagnoses was established and their severity classified. During this period (8 years) we identified 116 eyes of 102 patients. 67/102 (66%) of all injuries were caused by class II and III fireworks. Patients ranged between 4 and 83 years. Ocular injuries occurred more frequently in males (69, 68%) and affected the right eye in 53 patients (52.5%). Ocular firework injuries to minors (under the age of 18 years) occurred in 48 (49%). The most common types of injury were skin and corneal erosions and abrasions (32/116, 28%). 11/116 eyes (10%) had severe injuries. 8 of 11 severe injuries (72%) occurred in minors (<18 years). 2 patients (1.7%) developed permanent blindness. In 32/116 patients (28%), the ocular trauma resulted in visual impairment, mainly due to corneal scars or retinal pathologies. In all patients, the severity index was 1.4 +/- 0.8. In minors the severity index was 1.6 +/- 1.0, in adults 1.2 +/- 0.5 (p = 0.013). Injuries in minors were significantly more severe than those in adults. Possible preventive measures include legislation, education of minors and eye protection. Copyright 2002 S. Karger AG, Basel

Traumatic colon injuries -- factors that influence surgical management.

PubMed

Jinescu, G; Lica, I; Beuran, M

2013-01-01

This study sought to evaluate current trends in surgical management of colon injuries in a level I urban trauma centre, in the light of our increasing confidence in primary repair. Our retrospective study evaluates the results of 116 patients with colon injuries operated at Bucharest Clinical Emergency Hospital, in the light of some of the most commonly cited factors which could influence the surgeon decision-making process towards primary repair or colostomy. Blunt injuries were more common than penetrating injuries (65% vs. 31%). Significant other injuries occurred in 85 (73%) patients. Primary repair was performed in 95 patients (82%). Fecal diversion was used in 21 patients(18%). Multiple factors influence the decision-making process: shock, fecal contamination, associated injuries and higher scores on the Abdominal Trauma Index (ATI) and Colon Injury Scale (CIS). Colon related intra-abdominal complications occurred in 7% of patients in whom the colon injury was closed primarily and in 14% of patients in whom a stoma was created, ATI having a predictive role in their occurrence. The overall mortality rate was 19%. Primary repair of colon injuries, either by primary suture or resection and anastomosis, is a safe method in the management of the majority of colonic injuries. Colostomy is preferred for patients with ATI ≥ 30 and CIS ≥ 4. Surgical judgment remains the final arbiter in decision making. Celsius.

Caring for Patients with traumatic brain injury: a survey of nurses' perceptions.

PubMed

Oyesanya, Tolu O; Brown, Roger L; Turkstra, Lyn S

2017-06-01

The purpose of this study was to determine nurses' perceptions about caring for patients with traumatic brain injury. Annually, it is estimated that over 10 million people sustain a traumatic brain injury around the world. Patients with traumatic brain injury and their families are often concerned with expectations about recovery and seek information from nurses. Nurses' perceptions of care might influence information provided to patients and families, particularly if inaccurate knowledge and perceptions are held. Thus, nurses must be knowledgeable about care of these patients. A cross-sectional survey, the Perceptions of Brain Injury Survey (PBIS), was completed electronically by 513 nurses between October and December 2014. Data were analysed with structural equation modelling, factor analysis, and pairwise comparisons. Using latent class analysis, authors were able to divide nurses into three homogeneous sub-groups based on perceived knowledge: low, moderate and high. Findings showed that nurses who care for patients with traumatic brain injury the most have the highest perceived confidence but the lowest perceived knowledge. Nurses also had significant variations in training. As there is limited literature on nurses' perceptions of caring for patients with traumatic brain injury, these findings have implications for training and educating nurses, including direction for development of nursing educational interventions. As the incidence of traumatic brain injury is growing, it is imperative that nurses be knowledgeable about care of patients with these injuries. The traumatic brain injury PBIS can be used to determine inaccurate perceptions about caring for patients with traumatic brain injury before educating and training nurses. © 2016 John Wiley & Sons Ltd.

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

PubMed

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

2018-06-01

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

Neck pain with radiculopathy.

PubMed

Bhagawati, Dimpu; Gwilym, Stephen

2015-12-23

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

Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience.

PubMed

Veysi, Veysi T; Nikolaou, Vassilios S; Paliobeis, Christos; Efstathopoulos, Nicolas; Giannoudis, Peter V

2009-10-01

A review of prospectively collected data in our trauma unit for the years 1998-2003 was undertaken. Adult patients who suffered multiple trauma with an Injury Severity Score (ISS) of >/=16, admitted to hospital for more than 72 hours and with sustained blunt chest injuries were included in the study. Demographic details including pre-hospital care, trauma history, admission vital signs, blood transfusions, details of injuries and their abbreviated injury scores (AIS), operations, length of intensive care unit and hospital stays, Injury Severity Score (ISS) and mortality were analysed. Fulfilling the inclusion criteria with at least one chest injury were 1,164 patients. The overall mortality reached 18.7%. As expected, patients in the higher AIS groups had both a higher overall ISS and mortality rate with one significant exception; patients with minor chest injuries (AIS(chest) = 1) were associated with mortality comparable to injuries involving an AIS(chest) = 3. Additionally, the vast majority of polytraumatised patients with an AIS(chest) = 1 died in ICU sooner than patients of groups 2-5.

Injuries sustained during contact with law enforcement: An analysis from US trauma centers.

PubMed

Schellenberg, Morgan; Inaba, Kenji; Cho, Jayun; Tatum, James M; Barmparas, Galinos; Strumwasser, Aaron; Grabo, Daniel; Bir, Cynthia; Eastman, Alexander; Demetriades, Demetrios

2017-12-01

Injuries sustained by civilians from interaction with police are a polarizing contemporary sociopolitical issue. Few comprehensive studies have been published using national hospital-based data. The aim of this study was to examine the epidemiology of these injuries to better understand this mechanism of injury. Patients entered into the National Trauma Data Bank (NTDB) (January 2007 to December 2012) with E-codes E970.0 to E976.0 (International Classification of Diseases, Ninth Revision, Clinical Modification), identifying injuries associated with law enforcement in the course of legal action, were enrolled. Patients' demographics, injury characteristics, procedures, and outcomes were collected and analyzed. Patients injured by other civilians (E960.0-E968.0) were used for comparison. Of 4,146,428 patients in the NTDB, 7,203 (0.17%) were injured during interaction with police. The numbers of patients in consecutive study years were 858, 1,103, 1,148, 1,274, 1,316, and 1,504. The incidence of these injuries was stable over time (0.17-0.18%) (p = 0.129). Patients had a median age of 31 years (range, 0-108), and 94.3% were male. Median injury severity score was 9 (interquartile range [IQR], 4-17). The most common mechanism of injury was gunshot wound (44%).Patients were white, 43%; black, 30%; Hispanic, 17%; Asian, 1%; and Other, 9%. As a proportion of the total race-specific NTDB trauma population, there was an average of 1.13 white patients, 2.71 Hispanic patients, and 3.83 black patients per 1,000. Mechanism, injury severity score, and outcomes did not vary by race. Compared to patients injured by civilians, patients injured by police are more likely to be white (43% vs 25%, p < 0.001) and injured by gunshot wounds (44% vs 32%, p < 0.001). Based on data from trauma centers across the United States, the rate of injuries sustained during interactions with police has been stable over time. Gunshot wounds are the most common mechanism of injury. Proportionally, black patients are the most frequently injured race. When compared to patients injured by civilians, however, patients injured by police are more likely to be white. This study provides a step toward a better understanding of police-associated injuries. Prognostic/epidemiologic study, level III.

Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma.

PubMed

Astur, Diego Costa; Xerez, Marcos; Rozas, João; Debieux, Pedro Vargas; Franciozi, Carlos Eduardo; Cohen, Moises

2016-01-01

To analyze the incidence of ACL and meniscal injuries in a population of recreational and elite athletes from Brazil and the relation of these injuries with their sports activities. This was a prospective observational study of 240 patients with ACL and/or meniscal injuries submitted to surgical treatment. Data of patients and sport modality, as well as Tegner score were registered in the first clinical evaluation. The patients were divided into three groups: (1) isolated rupture of the ACL; (2) ACL injury associated with meniscal injury; (3) isolated menisci injury. The majority of the patients belonged to group 1 (44.58%), followed by group 2 (30.2%) and 3 (25%). Most patients were soccer players. The mean time from sport practice to injury in group 1 was 17.81 years. In group 2, it was 17.3 years, and in group 3, 26.91 years. Soccer athletes presented ACL injury in 0.523/1000 h of practice and meniscal injury in 0.448/1000 h of practice. Before the injury, the mean Tegner score obtained for groups 1, 2, and 3 were 7.18, 7.34, and 6.53, respectively. After knee injury, those values were 3.07, 3.18, and 2.87, respectively. Soccer was the sport that caused the majority of lesions, regardless the group. Furthermore, patients from groups 1 and 2 had less time of practice prior to the injury (17.81 and 17.3 years) than the patients of group 3 (26.91 years). Women presented a higher risk to develop ACL and meniscal injuries in 1000 h of game/practice. Running, volleyball, and weightlifting are in ascending order of risk for ACL and/or meniscal injury. Regarding the return to sport practice, the efficiency of all athletes was impaired because of the injury.

Diving injuries of the cervical spine in amateur divers.

PubMed

Korres, Demetrios S; Benetos, Ioannis S; Themistocleous, George S; Mavrogenis, Andreas F; Nikolakakos, Leonidas; Liantis, Panagiotis T

2006-01-01

Diving injuries are the cause of potentially devastating trauma, primarily affecting the cervical spine. Our purpose was to describe our experience with diving injuries treatment. Retrospective review. Twenty patients with diving injuries. Using the American Spinal Injury Association (ASIA) impairment scales as the primary outcome measure, the patients' neurological status before and after treatment was assessed. In this way we were able to draw conclusions about neurological improvement or deterioration in response to conservative or operative treatment. We retrospectively reviewed 20 patients with diving injuries of the cervical spine who were admitted to our institute over a 34-year period from 1970 until 2004. The typical patient profile was of a young, healthy, athletic male who suffered an injury to the cervical spine after diving into shallow water. The number of cases corresponds to 2.6% of all admitted cervical spine injuries. All injures occurred between May and September. The most commonly fractured vertebrae were C5 and C6. Four patients were treated operatively and 16 conservatively. The indications for surgical treatment were posttraumatic instability and persistent neurological deficit. The mean follow-up of the patients was 17 years. Five patients died within the first month of their hospitalization and 1 patient died 1 year after his injury. Of the 14 patients who were available for follow-up 5 years past injury time, 6 improved neurologically and 8 remained unchanged in relation to their neurology upon admission. Of the 11 patients who were available for follow-up 10 years past injury time, 9 remained neurologically unchanged, 1 deteriorated, and 1 improved in relation to their neurology in the 5-year follow-up. Diving injuries of the cervical spine demonstrate high mortality and morbidity rates. Recovery depends on the severity of the initial neurological damage. Conservative treatment is justified in specific patients and can lead to improvement of the initial neurological deficit.

Venous thromboembolism after major venous injuries: Competing priorities.

PubMed

Frank, Brian; Maher, Zoё; Hazelton, Joshua P; Resnick, Shelby; Dauer, Elizabeth; Goldenberg, Anna; Lubitz, Andrea L; Smith, Brian P; Saillant, Noelle N; Reilly, Patrick M; Seamon, Mark J

2017-12-01

Venous thromboembolism (VTE) after major vascular injury (MVI) is particularly challenging because the competing risk of thrombosis and embolization after direct vessel injury must be balanced with risk of bleeding after surgical repair. We hypothesized that venous injuries, repair type, and intraoperative anticoagulation would influence VTE formation after MVI. A multi-institution, retrospective cohort study of consecutive MVI patients was conducted at three urban, Level I centers (2005-2013). Patients with MVI of the neck, torso, or proximal extremities (to elbows/knees) were included. Our primary study endpoint was the development of VTE (DVT or pulmonary embolism [PE]). The 435 major vascular injury patients were primarily young (27 years) men (89%) with penetrating (84%) injuries. When patients with (n = 108) and without (n = 327) VTE were compared, we observed no difference in age, mechanism, extremity injury, tourniquet use, orthopedic and spine injuries, damage control, local heparinized saline, or vascular surgery consultation (all p > 0.05). VTE patients had greater Injury Severity Score (ISS) (17 vs. 12), shock indices (1 vs. 0.9), and more torso (58% vs. 35%) and venous (73% vs. 48%) injuries, but less often received systemic intraoperative anticoagulation (39% vs. 53%) or postoperative enoxaparin (47% vs. 61%) prophylaxis (all p < 0.05). After controlling for ISS, hemodynamics, injured vessel, intraoperative anticoagulation, and postoperative prophylaxis, multivariable analysis revealed venous injury was independently predictive of VTE (odds ratio, 2.7; p = 0.002). Multivariable analysis of the venous injuries subset (n = 237) then determined that only delay in starting VTE chemoprophylaxis (odds ratio, 1.3/day; p = 0.013) independently predicted VTE after controlling for ISS, hemodynamics, injured vessel, surgical subspecialty, intraoperative anticoagulation, and postoperative prophylaxis. Overall, 3.4% of venous injury patients developed PE, but PE rates were not related to their operative management (p = 0.72). Patients with major venous injuries are at high risk for VTE, regardless of intraoperative management. Our results support the immediate initiation of postoperative chemoprophylaxis in patients with major venous injuries. Therapeutic/care management, level IV.

Differences in Callosal and Forniceal Diffusion between Patients with and without Postconcussive Migraine.

PubMed

Alhilali, L M; Delic, J; Fakhran, S

2017-04-01

Posttraumatic migraines are common after mild traumatic brain injury. The purpose of this study was to determine if a specific axonal injury pattern underlies posttraumatic migraines after mild traumatic brain injury utilizing Tract-Based Spatial Statistics analysis of diffusion tensor imaging. DTI was performed in 58 patients with mild traumatic brain injury with posttraumatic migraines. Controls consisted of 17 patients with mild traumatic brain injury without posttraumatic migraines. Fractional anisotropy and diffusivity maps were generated to measure white matter integrity and were evaluated by using Tract-Based Spatial Statistics regression analysis with a general linear model. DTI findings were correlated with symptom severity, neurocognitive test scores, and time to recovery with the Pearson correlation coefficient. Patients with mild traumatic brain injury with posttraumatic migraines were not significantly different from controls in terms of age, sex, type of injury, or neurocognitive test performance. Patients with posttraumatic migraines had higher initial symptom severity ( P = .01) than controls. Compared with controls, patients with mild traumatic brain injury with posttraumatic migraines had decreased fractional anisotropy in the corpus callosum ( P = .03) and fornix/septohippocampal circuit ( P = .045). Injury to the fornix/septohippocampal circuit correlated with decreased visual memory ( r = 0.325, P = .01). Injury to corpus callosum trended toward inverse correlation with recovery ( r = -0.260, P = .05). Injuries to the corpus callosum and fornix/septohippocampal circuit were seen in patients with mild traumatic brain injury with posttraumatic migraines, with injuries in the fornix/septohippocampal circuit correlating with decreased performance on neurocognitive testing. © 2017 by American Journal of Neuroradiology.

Changing pattern and outcome of pediatric chest injuries in urban Syria.

PubMed

Darwish, Bassam; Mahfouz, Mohammad Z; Al-Nosairat, Saeed; Izzat, Mohammad Bashar

2018-01-01

Background Pediatric chest injuries were infrequent in our practice, but the outbreak of the Syrian crisis resulted in an increase in number and a change in the pattern of thoracic trauma incidents. We compared our experience of pediatric chest injuries before and during the crisis. Methods We reviewed the records of 256 children aged 12.8 ± 5 years who were admitted to our hospital with the diagnosis of chest trauma over a 12-year period. Collected data included mechanism of injury, associated injuries, method of management, length of hospital stay, complications, and mortality. Results The incidence of pediatric chest injuries increased significantly following the outbreak of the crisis, and penetrating injuries prevailed, mainly due to shrapnel, bullets, and stab wounds. Forty percent of patients with blunt injuries and 20% of those with penetrating injuries were managed conservatively, whereas urgent thoracotomies were indicated in 10%, mostly in patients with penetrating injuries. Associated injuries were more frequent in patients with blunt injuries and resulted in a longer hospital stay and an increased mortality rate. The overall mortality rate was 7.8% and it was higher in children younger than 7 years of age and in patients who had been subjected to blunt injuries. Conclusions There has been a recent substantial upsurge in the incidence of pediatric thoracic trauma, with a predominance of penetrating injuries. Most patients could be managed nonoperatively, but a small subset required an open thoracotomy. The presence of associated injuries constitutes the main determinant of prognosis in this group of patients.

Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: an analysis of a National Trauma Registry database.

PubMed

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

2014-09-01

Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has reduced the rate of unnecessary immediate laparotomies; however, due to its limited sensitivity in the diagnosis of hollow viscus injuries (HVI), this may be at the expense of a rise in the incidence of missed HVI. The aim of this study was to assess the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, and to evaluate whether a correlation exists between this incidence and the severity of hepatic or splenic injuries. A retrospective cohort study involving blunt trauma patients with splenic and/or liver injuries, between the years 1998 and 2012 registered in the Israel National Trauma Registry. The association between the presence and severity of splenic and/or liver injuries and the incidence of HVI was examined. Of the 57,130 trauma victims identified as suffering from blunt torso injuries, 2335 (4%) sustained hepatic injuries without splenic injuries (H group), 3127 (5.4%) had splenic injuries without hepatic injuries (S group), and 564 (1%) suffered from both hepatic and splenic injuries (H+S group). Overall, 957 patients sustained 1063 HVI. The incidence of HVI among blunt torso trauma victims who sustained neither splenic nor hepatic injuries was 1.5% which is significantly lower than in the S (3.1%), H (3.1%), and H+S (6.7%) groups. In the S group, there was a clear correlation between the severity of the splenic injury and the incidence of HVI. This correlation was not found in the H group. The presence of blunt splenic and/or hepatic injuries predicts a higher incidence of HVI, especially if combined. While in blunt splenic injury patients there is a clear correlation between the incidence of HVI and the severity of splenic injury, such a correlation does not exist in patients with blunt hepatic injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

Severe pancreatico-duodenal injuries: the effectiveness of pyloric exclusion with vagotomy.

PubMed

Buck, J R; Sorensen, V J; Fath, J J; Horst, H M; Obeid, F N

1992-09-01

The operative management and clinical course of 17 patients treated for severe pancreatico-duodenal injuries from 1983 to 1990 was reviewed. The etiology of these injuries was gunshot wound in 15 patients; stab wound in 1 patient; and a motor vehicle accident in 1 patient. Seven patients presented in shock with a systolic blood pressure of less than 80. At exploration, 57 associated injuries were found in the 17 patients including 16 major vascular injuries. All patients were treated with pyloric exclusion and drainage. Vagotomy was performed in eight patients. None of these 17 patients were felt to have extensive enough damage to require pancreatico-duodenectomy. Two patients died in the immediate postoperative period of severe coagulopathy and two patients died of sepsis. Seven patients had complications related to the pancreatico-duodenal injury. All seven developed pancreatic fistulas; three also had pancreatitis and two developed multiple enterocutaneous fistulas. Systemic complications included pulmonary complications in eight patients and sepsis in five patients, including two patients with abdominal abscesses. Six patients bled in the immediate postoperative period secondary to coagulopathy. Three patients had complications related to pyloric exclusion. One developed afferent loop syndrome necessitating reoperation. The other two had marginal ulcers, which either perforated or bled and required reoperation. Of interest, neither of these two patients had vagotomy initially. The results of this series confirm the effectiveness of pyloric exclusion with vagotomy for severe pancreatico-duodenal injury.

Femur fractures should not be considered distracting injuries for cervical spine assessment.

PubMed

Dahlquist, Robert T; Fischer, Peter E; Desai, Harsh; Rogers, Amelia; Christmas, A Britton; Gibbs, Michael A; Sing, Ronald F

2015-12-01

The National Emergency X-Radiography Utilization Study (NEXUS) clinical decision rule is extremely sensitive for clearance of cervical spine (C-spine) injury in blunt trauma patients with distracting injuries. We sought to determine whether the NEXUS criteria would maintain sensitivity for blunt trauma patients when femur fractures were not considered a distracting injury and an absolute indication for diagnostic imaging. We retrospectively analyzed blunt trauma patients with at least 1 femur fracture who presented to our emergency department as trauma activations from 2009 to 2011 and underwent C-spine injury evaluation. Presence of C-spine injury requiring surgical intervention was evaluated. Of 566 trauma patients included, 77 (13.6%) were younger than 18 years. Cervical spine injury was diagnosed in 53 (9.4%) of 566. A total of 241 patients (42.6%) had positive NEXUS findings in addition to distracting injury; 51 (21.2%) of these had C-spine injuries. Of 325 patients (57.4%) with femur fractures who were otherwise NEXUS negative, only 2 (0.6%) had C-spine injuries (95% confidence interval [CI], 0.2%-2.2%); both were stable and required no operative intervention. Use of NEXUS criteria, excluding femur fracture as an indication for imaging, detected all significant injuries with a sensitivity for any C-spine injury of 96.2% (95% CI, 85.9%-99.3%) and negative predictive value of 99.4% (95% CI, 97.6%-99.9%). In our patient population, all significant C-spine injuries were identified by NEXUS criteria without considering the femur fracture a distracting injury and indication for computed tomographic imaging. Reconsidering femur fracture in this context may decrease radiation exposure and health care expenditure with little risk of missed diagnoses. Copyright © 2015 Elsevier Inc. All rights reserved.

Cervical spine injuries in civilian victims of explosions: Should cervical collars be used?

PubMed

Klein, Yoram; Arieli, Izhar; Sagiv, Shaul; Peleg, Kobi; Ben-Galim, Peleg

2016-06-01

Semirigid cervical collars (SRCCs) are routinely applied to victims of explosions as part of the prehospital trauma protocols. Previous studies have shown that the use of SRCC in penetrating injuries is not justified because of the scarcity of unstable cervical spine injuries and the risk of obscuring other neck injuries. Explosion can inflict injuries by fragments penetration, blast injury, blunt force, and burns. The purpose of the study was to determine the occurrence of cervical spine instability without irreversible neurologic deficit and other potentially life-threatening nonskeletal neck injuries among victims of explosions. The potential benefits and risks of SRCC application in explosion-related injuries were evaluated. This is a retrospective cohort study of all explosion civilian victims admitted to Israeli hospitals during the years 1998 to 2010. Data collection was based on the Israeli national trauma registry and the hospital records and included demographic, clinical, and radiologic details of all patients with documented cervical spine injuries. The cohort included 2,267 patients. All of them were secondary to terrorist attacks. SRCC was applied to all the patients at the scene. Nineteen patients (0.83%) had cervical spine fractures. Nine patients (0.088%) had unstable cervical spine injury. All but one had irreversible neurologic deficit on admission. A total of 151 patients (6.6%) had potentially life-threatening penetrating nonskeletal neck injuries. Unstable cervical spine injuries secondary to explosion are extremely rare. The majority of unstable cervical spine fractures were secondary to penetrating injuries, with irreversible neurologic deficits on admission. The application of SRCC did not seem to be of any benefit in these patients and might pose a risk of obscuring other neck injuries. We recommend that SRCC will not be used in the prehospital management of victims of explosions. Prognostic/epidemiologic study, level III.

[Urogenital trauma associated with pelvic ring fractures].

PubMed

Pavelka, T; Houcek, P; Hora, M; Hlavácová, J; Linhart, M

2010-02-01

To evaluate, in a retrospective study, injuries to the urogenital tract in patients with pelvic ring fractures. MATERIAL In the years 1998-2007, a total of 308 patients with pelvic ring fractures were treated. The study did not comprise patients with low-energy fractures, such as apophyseolysis in children, osteoporotic bone fractures or pathologic fractures. It also did not include patients with multiple injuries who died within 6 hours of admission to the hospital. The group consisted of 186 men and 122 women with an average age of 34 (range, 6 to 76) years. The fractures sustained were classified as type A in 5 %, type B in 57 % and type C in 38 % of the patients. The average follow-up was 71 (range, 13 to 121) months. A primary injury to the urogenital tract was recorded in 50 (16 %) patients. Injury to the urethra was found in 23 (7.5%) and urinary bladder trauma in 18 (6%) patients, vaginal injury was in four women (1%), and penis injury in three (1%) and lacerated testicles in two men (1%). Injury to the urogenital tract was associated with a pelvic ring fracture type A in 5 %, type B in 34 % and type C in 61 % of the patients. Out of the 23 patients with urethral trauma, only six (26 %) were free from functional and subjective complaints; eight (35 %) continued to receive therapy for urethral stenosis seven (30 %) reported urinary incontinence, and seven men (30 %) had erection problems. In six patients (26%) the lasting sequelae were combined. The 18 patients with injury to the bladder reported no subjective complaints at a one-year follow-up. Two patients with penis root injury had erectile dysfunction. Two patients with the loss of both testicles were in the care of a psychiatrist. The patients' satisfaction was evaluated on a 0-to10-point scale. The average value for the whole group was 4.1 points. In the patients with erectile dysfunction, the value was 0.8, and in those with isolated injury to the urinary bladder it was 9.4 points. The increasing number of injuries to the urogenital tract associated with permanent sequelae is caused by a growing number of pelvic ring fractures as well as, and this is more important, by decreasing mortality in patients with severe trauma to the pelvic ring The extent of urogenital injury is related to the degree of dislocation of the pelvic skeleton. Injury to the male urethra is the most frequent urogenital trauma because of the male anatomy. It occurs most often in unstable C type fractures when the pelvic ring is disrupted with bone displacement due to shear force at the site of urethra attachment. The consequences are related to the quality of treatment of urogenital tract injury as well as to how the skeletal injury is managed. The lasting effects of the primary injury to nerve structures are beyond repair by therapy. Injury to the urethra results in erectile dysfunction in 50 % of the injured patients it is often associated with urinary incontinence that has a strong effect on the patient's life quality. Isolated trauma to the urinary bladder has a good prognosis. The incidence of post-traumatic incontinence is not high, but reduces the patient's personal and social comfort. A prerequisite for a successful therapeutic outcome is a good cooperation of the orthopaedic surgeon and urologist. Key words: pelvic ring fractures, urogenital injury.

Laparoscopic management of retroperitoneal injuries from penetrating abdominal trauma in haemodynamically stable patients.

PubMed

Koto, Modise Zacharia; Matsevych, Oleh Y; Mosai, Fusi; Balabyeki, Moses; Aldous, Colleen

2018-02-27

Laparoscopy is increasingly utilised in the trauma setting. However, its safety and reliability in evaluating and managing retroperitoneal injuries are not known. The aim of this study was to analyse our experience with laparoscopic management of retroperitoneal injuries due to penetrating abdominal trauma (PAT) and to investigate its feasibility, safety and accuracy in haemodynamically stable patients. Over a 4-year period, patients approached laparoscopically with retroperitoneal injuries were analysed. Mechanism, location and severity of injuries were recorded. Surgical procedures, conversion rate and reasons for conversion and outcomes were described. Of the 284 patients with PAT, 56 patients had involvement of retroperitoneum. Stab wounds accounted 62.5% of patients. The mean Injury Severity Score was 7.4 (4-20). Among retroperitoneal injuries, the colon (27%) was the most commonly involved hollow viscera followed by duodenum (5%). The kidney (5%) and the pancreas (4%) were the injured solid organs. The conversion rate was 19.6% and was mainly due to active bleeding (73%). Significantly more patients with gunshot wound were converted to laparotomy (38% vs. 9%). Therapeutic laparoscopy was performed in 36% of patients. There were no recorded missed injuries or mortality. Five (9%) patients developed the Clavien-Dindo Grade 3 complications, three were managed with reoperation, one with drainage/debridement and one with endovascular technique. Laparoscopic management of retroperitoneal injuries is safe and feasible in haemodynamically stable patients with PAT. However, a high conversion rate indicates difficulties in managing these injuries. The requirements are the dexterity in laparoscopy and readiness to convert in the event of bleeding.

A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service.

PubMed

Madsen, A S; Laing, G L; Bruce, J L; Clarke, D L

2016-09-01

Introduction The aim of this comparative study of gunshot wounds (GSWs) and stab wounds (SWs) to the neck was to quantify the impact of the mechanism of injury on the outcome and management of penetrating neck injury (PNI). Methods A prospective trauma registry was interrogated retrospectively. Data were analysed pertaining to demographics and injury severity score (ISS), physiology on presentation, anatomical site of wounds and injuries sustained, investigations, management, outcome and complications. Results There were 452 SW and 58 GSW cases over the 46 months of the study. Patients with GSWs were more likely to have extracervical injuries than those with SWs (69% vs 63%). The incidence of a 'significant cervical injury' was almost twice as high in the GSW cohort (55% vs 31%). For patients with transcervical GSWs, this increased to 80%. The mean ISS was 17 for GSW and 11 for SW patients. Those in the GSW cohort presented with threatened airways and a requirement for an emergency airway three times as often as patients with SWs (24% vs 7% and 14% vs 5% respectively). The incidence among GSW and SW patients respectively was 5% and 6% for airway injuries, 12% and 8% for injuries to the digestive tract, 21% and 16% for vascular injuries, 59% and 10% for associated cervical injuries, 36% and 14% for maxillofacial injuries, 16% and 9% for injuries to the head, and 35% and 45% for injuries to the chest. In the GSW group, 91% underwent computed tomography angiography (CTA), with 23% of these being positive for a vascular injury. For SWs, 74% of patients underwent CTA, with 17% positive for a vascular injury. Slightly more patients with GSWs required operative intervention than those with SWs (29% vs 26%). Conclusions Patients with GSWs to the neck have a worse outcome than those with injuries secondary to SWs. However, the proportion of neck injuries actually requiring direct surgical intervention is not increased and most cases with PNI secondary to GSWs can be managed conservatively with a good outcome. Imaging should be performed for all GSWs to the neck.

Management of Nail Bed Injuries Associated with Fingertip Injuries.

PubMed

George, Alexander; Alexander, Reena; Manju, C

2017-01-01

Management of nail injuries can often be a challenging experience, especially in presence of complex fingertips' injuries that include soft tissue loss and distal phalanx injury. Most studies found in the literature focus on individual injuries and describe methods to tackle those injuries, notwithstanding the fact that the nail, nailbed, distal phalanx, soft tissue and skin of the finger tip form a complex and often more than one element of this complex is injured. This retrospective study therefore focuses on the management of nail bed injuries as a part of the complex finger tip injury and outlines the surgical principles and techniques that were used in their management. Two hundred and forty patients from a tertiary care center in different clinical settings where a wide variety of cases involving the nail bed injuries were included in this study. Patients comprised of 192 (80%) males and 48 (20%) females with the average male age of 37.3 years (range 1-66 years) and average female age of 29 years (range 1-59 years). 210 patients had single finger involment, 30 patients had two finger involvement (total fingers involved- 270). The middle finger was most commonly involved while the index finger was the second most commonest finger involved. In 198 (89.18%) patients local anaesthesia was used while in the rest: regional blocks [ n = 10 (4.5%)] and general anaesthesia [ n = 14 (6.3%)] were used. In this retrospective study, out of the total of two hundred and forty patients, 222 (92.5%) patients underwent surgery, while the rest 18 (7.5%) were treated conservatively. Two hundred and ten patients who underwent surgery had complete healing over the course of treatment and followup, while four patients needed secondary interventional. Eight patients who had surgery were migrant workers were lost to follow up after surgery. Eight patients had postoperative complications that included infection, secondary necrosis, wound breakdown and non healing fractures. Accurate and timely diagnosis of nail bed injury and its meticulous repair is cardinal to the management of any nail bed injury. However all nail bed injuries must be seen in the context of associated injuries of the finger tip complex, namely skin, soft tissue and distal phalanx injuries. Fixation of associated bony injury which closely underlines the nail bed and provides physical support to the nail bed along with correction of soft tissue injuries in the form of flaps or grafts, compounded by the repair or replacement of nail plate in the first 24 hours.

Gastrointestinal injuries from blunt abdominal trauma in children.

PubMed

Ameh, E A; Nmadu, P T

2004-04-01

To determine the pattern, presentation and outcome of gastrointestinal injuries from blunt abdominal trauma in children. A retrospective study. Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Twenty one children managed for gastrointestinal injuries from blunt trauma from 1984-2002. The pattern, presentation, management and outcome of gastrointestinal injuries from blunt trauma. In the 19 year period, 1984-2002, 92 children were treated for blunt abdominal trauma, 21(23%) of who had injuries to the gastrointestinal tract. Three presenting after 24 hours had evidence of peritonitis. In six children with isolated gastrointestinal tract (GIT) injury who presented within two hours, abdominal signs were vague at initial evaluation but became marked over a few hours at repeated examination. In eight with associated intraabdominal injuries, abdominal signs were marked at initial examination and five presented with shock. Free peritoneal air was present on plain abdominal and chest radiograph in three of ten patients, dilated bowel loops in six and fluid levels in one. Diagnostic peritoneal lavage or paracentesis was positive in four patients with isolated GIT injuries and eight with associated intraabdominal injuries. There were 24 injuries in the 21 patients consisting of 15 perforations, five contusions, two seromuscular tears, and two gangrene from mesenteric injury. The small intestine was involved in 11 patients, colon six, stomach five, duodenum one and rectum one. Seven (35%) patients had associated extraabdominal injuries. Treatment consisted of simple closure of perforations, over sewing of contusions, resection and anastomosis for gangrene and repair with protective stoma for the rectal injury. One patient each developed prolonged ileus, urinary tract infection and chest infection, respectively postoperatively. Mortality was 28%, all of who had associated intraabdominal or extraabdominal injuries. Gastrointestinal injury from blunt abdominal trauma in children, though uncommon, carries a high mortality, usually from associated intraabdominal or extraabdominal injuries.

Applicability of an established management algorithm for colon injuries following blunt trauma.

PubMed

Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Shahan, Charles P; Cullinan, Darren R; Fabian, Timothy C; Croce, Martin A

2013-02-01

Operative management at our institution for all colon injuries have followed a defined algorithm (ALG) based on risk factors originally identified for penetrating injuries. The purpose of this study was to evaluate the applicability of the ALG to blunt colon injuries. Patients with blunt colon injuries during 13 years were identified. As per the ALG, nondestructive (ND) injuries are treated with primary repair. Patients with destructive wounds (serosal tear of ≥50% colon circumference, mesenteric devascularization, and perforations) and concomitant risk factors (transfusion of >6 U packed red blood cells and/or presence of significant comorbidities) are diverted, while patients with no risk factors undergo resection plus anastomosis (RA). Outcomes included suture line failure (SLF), abscess, and mortality. Stratification analysis was performed to determine additional risk factors in the management of blunt colon injuries. A total 151 patients were identified: 76 with destructive injuries and 75 with ND injuries. Of those with destructive injuries, 44 (59%) underwent RA and 29 (39%) underwent diversion. All ND injuries underwent primary repair. Adherence to the ALG was 95%: three patients with destructive injuries underwent primary repair, and five patients with risk factors underwent RA. There were three SLFs (2%) (one involved deviation from the ALG) and eight abscesses (5%). Colon-related mortality was 2.1%. Stratification analysis based on mesenteric involvement, degree of shock, and need for abbreviated laparotomy failed to identify additional risk factors for SLF following RA for blunt colon injuries. Adherence to an ALG, originally defined for penetrating colon injuries, simplified the management of blunt colon injuries. ND injuries should be primarily repaired. For destructive wounds, management based on a defined ALG achieves an acceptably low morbidity and mortality rate. Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Forensic Identification of Bipartite Patella Misdiagnosed as Patella Fracture.

PubMed

Ma, Jingyuan; Shi, Fang; Huang, Chongya; Gu, Shanzhi

2017-07-01

Bipartite patella is recognized as a developmental anomaly of ossification. Most of them are asymptomatic and are discovered incidentally. Bipartite patella is sometimes misdiagnosed as a patella fracture, because the x-ray images of both these conditions may appear very similar. In this case, the patient complained of left knee pain after x-ray films revealed a fracture-like line in the left patella. The patient was then diagnosed as having a patella fracture. In China, the injury degree is categorized as serious injury, minor injury, and trivial injury. As the injury degree of patellar fracture is identified as minor injury, the defendant who injured the patient will be sentenced to prison for ≤3 years. However, the defendant objected to this judgment and applied for the second evaluation of injury degree. On the basis of the site of injury, clinical manifestations, and imaging findings, we diagnosed the patient with bipartite patella which belongs to normal anatomic variant. Therefore, the injury degree of the patient was not minor injury. © 2017 American Academy of Forensic Sciences.

[The incidence and risk factors of ventilator-associated pneumonia in patients with severe traumatic brain injury].

PubMed

Marjanović, Vesna; Novak, Vesna; Velicković, Ljubinka; Marjanović, Goran

2011-01-01

Patients with severe traumatic brain injury are at a risk of developing ventilator-associated pneumonia. The aim of this study was to describe the incidence, etiology, risk factors for development of ventilator-associated pneumonia and outcome in patients with severe traumatic brain injury. A retrospective study was done in 72 patients with severe traumatic brain injury, who required mechanical ventilation for more than 48 hours. Ventilator-associated pneumonia was found in 31 of 72 (43.06%) patients with severe traumatic brain injury. The risk factors for ventilator-associated pneumonia were: prolonged mechanical ventilation (12.42 vs 4.34 days, p < 0.001), longer stay at intensive care unit (17 vs 5 days, p < 0.001) and chest injury (51.61 vs 19.51%, p < 0.009) compared to patients without ventilator-associated pneumonia. The mortality rate in the patients with ventilator-associated pneumonia was higher (38.71 vs 21.95%, p = 0.12). The development of ventilator-associated pneumonia in patients with severe traumatic brain injury led to the increased morbidity due to the prolonged mechanical ventilation, longer stay at intensive care unit and chest injury, but had no effect on mortality.

Risk factors for ventilator-associated pneumonia: among trauma patients with and without brain injury.

PubMed

Gianakis, Anastasia; McNett, Molly; Belle, Josie; Moran, Cristina; Grimm, Dawn

2015-01-01

Ventilator-associated pneumonia (VAP) rates remain highest among trauma and brain injured patients; yet, no research compares VAP risk factors between the 2 groups. This retrospective, case-controlled study identified risk factors for VAP among critically ill trauma patients with and without brain injury. Data were abstracted on trauma patients with (cases) and without (controls) brain injury. Data gathered on n = 157 subjects. Trauma patients with brain injury had more emergent and field intubations. Age was strongest predictor of VAP in cases, and ventilator days predicted VAP in controls. Trauma patients with brain injury may be at higher risk for VAP.

Hepatic enzymes have a role in the diagnosis of hepatic injury after blunt abdominal trauma.

PubMed

Tan, Ker-Kan; Bang, Shieh-Ling; Vijayan, Appasamy; Chiu, Ming-Terk

2009-09-01

Delayed diagnosis of patients with severe liver injuries is associated with an adverse outcome. As computed tomographic (CT) scan is not always available in the management of blunt abdominal trauma worldwide, the present study was undertaken to determine the accuracy of selected haematological markers in predicting the presence of hepatic injury and its severity after blunt abdominal trauma. A retrospective review of all patients with blunt abdominal trauma presented to our institution over a 3-year period was performed. Patients were excluded if they suffered penetrating injuries, died in the emergency department or if the required blood tests were not performed within 24h of the accident. The grading of the hepatic injury was verified using CT scans or surgical findings. Ninety-nine patients with blunt abdominal trauma had the required blood tests performed and were included in the study. The median injury severity score was 24 (range 4-75). Fifty-five patients had hepatic injuries, of which 47.3% were minor (Grades I and II) while 52.7% had major hepatic injuries (Grades III-V). There were no patients with Grade VI injuries. A raised ALT was strongly associated with presence of hepatic injuries (OR, 109.8; 95% CI, 25.81-466.9). This relation was also seen in patients with raised AST>2 times (OR, 21.33; 95% CI, 7.27-62.65). This difference was not seen in both bilirubin and ALP. ALT>2 times normal was associated with major hepatic injuries (OR, 7.15; 95% CI, 1.38-37.14; p=0.012) while patients with simultaneous raised AST>2 times and ALT>2 times had a stronger association for major hepatic injuries (OR, 8.44; 95% CI, 1.64-43.47). Abnormal transaminases levels are associated with hepatic injuries after blunt abdominal trauma. Patients with ALT and AST>2 times normal should be assumed to possess major hepatic trauma and managed accordingly. Patients with normal ALT, AST and LDH are unlikely to have major liver injuries.