Background: It is essential to identify factors that predict helmet use, so as to mitigate the injury and mortality from bicycle accidents.
Objective: To examine the relationship between helmet use ...and the bicycle-related trauma injury outcomes among bicyclists with head/neck injury in the US.
Methods: Data from the 2002-2012 National Trauma Data Bank were used, including all trauma bicycle riders involved in bicycle-related accidents whose primary reason for the hospital or Intensive Care Unit stay was head or neck injury. Using multiple logistic regression, the association between helmet use, Injury severity score (ISS), length of stay in hospital (HLOS) and Intensive Care Unit (ICULOS), and mortality was examined.
Results: Of the 76,032 bicyclists with head/neck injury, 22% worn helmets. The lowest was among Blacks, Hispanics, and <17 years old. Wearing a helmet significantly reduces injury severity, HLOS, ICULOS, and mortality (i.e total and in-hospital). Males had a severe injury, longer HLOS, ICULOS, and higher mortality than female. Blacks and Hispanics had longer HLOS and ICULOS and higher total mortality than Whites, but had a similar chance for in-hospital mortality.
Conclusions: More effort is needed to enhance helmet use among at-risk bicycle riders, which may reduce injury severity, HLOS, ICULOS, and mortality.
Injuries are a widespread problem in the dairy industry. The objective of this study was to determine the prevalence of and explore the animal-based and environmental factors associated with hock, ...knee, and neck injuries on dairy cows in freestall housing in Ontario and Alberta, Canada. Freestall dairy farms in the provinces of Ontario (n=40) and Alberta (n=50) were visited for cross-sectional data collection. A purposive sample of 40 lactating Holstein cows was selected for detailed observation on each farm. Cows were scored for hock, knee, and neck injuries on a 3- or 4-point scale, combining the attributes of hair loss, broken skin, and swelling and with a higher score indicating a more severe injury. The highest hock and highest knee score were used in the analysis. Animal-based and environmental measures were taken to explore which factors were associated with injury. Overall, the prevalence of cows with at least one hock, knee, and neck injury was 47, 24, and 9%, respectively. Lame cows had a greater odds of hock injury odds ratio (OR)=1.46 than nonlame cows, whereas cows with fewer days in milk (DIM) had reduced odds of hock injury compared with those >120 DIM (OR=0.47, 0.64, and 0.81 for <50, 50–82, and 83–120 DIM, respectively). The odds of hock injury was lower on sand (OR=0.07) and concrete (OR=0.44) stall bases in comparison to mattresses. Conversely, the odds of knee injury was greater on concrete (OR=3.19) stall bases compared with mattresses. Cows in parity 1 (OR=0.45 and 0.27 for knee and neck injury, respectively) and 2 (OR=0.49 and 0.40 for knee and neck injury, respectively) had lower odds of knee and neck injury compared with cows in parity 4+. Low feed rail heights increased the odds of neck injury (OR=76.71 for rails between 128 and 140cm and OR=43.82 for rails ≤128cm). The odds of knee injury was greater on farms where any cows were observed slipping or falling when moving into the holding area for milking (OR=2.69) and lower on farms with rubber flooring in the alley along the feed bunk compared with bare concrete floors (OR=0.19). These results demonstrate that individual animal characteristics, as well as barn design and animal management, are associated with hock, knee, and neck injuries. These data can help to guide investigations into causes and prevention of injuries.
Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a ...prospective pediatric cohort and compare them to a de novo risk model.
We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model.
Of 4091 enrolled children, 74 (1.8%) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5% (95% confidence interval: 83.9%-97.2%) sensitive and 45.6% (44.0%-47.1%) specific for CSIs. The de novo model (diving, axial load, neck pain, inability to move neck, altered mental status, intubation, or respiratory distress) was 92.0% (85.7%-98.1%) sensitive and 50.3% (48.7%-51.8%) specific.
Our findings support previously identified pediatric CSI risk factors and prospective pediatric CSI prediction rule development.
Evaluating patients with a traumatic spinal cord injury can be complicated by other injuries. In this case, a 24-year-old woman injured by a needlefish presented with combined motor and sensory ...defects, cranial nerve deficits, and a blunt vascular injury. This case highlights the importance of neurologic and vascular localizations and an understanding of spinal cord injuries involving various ascending and descending tracts. Appreciation of these anatomical considerations through this case illustrates the diagnostic approach to neurologic evaluation. While we present a traumatic etiology for multiple neurologic syndromes, this case gives readers an opportunity to develop a comprehensive differential diagnosis and tailor investigations for other relevant etiologies. Readers walking through this stepwise process will ultimately arrive at several distinct but related diagnoses.
We report a suicidal neck injury without vital organ damage. Trauma was made by scissors for suicidal purposes. Upon admission, the patient underwent X-ray examination in 2 planes, gastroscopy, ...bronchoscopy, Doppler ultrasound of the neck vessels. Extraction of scissors and wound drainage were carried out under endotracheal anesthesia. Postoperative period was uneventful.
The helmet plays an important role in protection of pilot's head and enhances the pilot's capabilities and performance significantly with the use of mounted devices such as the Night Vision Goggle ...(NVG). However, the use of helmet-mounted devices might increase the risk of injury due to the increased helmet weight and change in the centre of gravity of head. In this study, four helmets with different combinations of mounted devices were modelled in a validated human head-neck multi-body model to analyse their effects on the pilot's neck injury during simulated ejection. The probability of neck injury was evaluated and predicted using the
neck injury criteria and human injury risk curves, considering the tolerance of injury for upper and lower cervical segment. It was demonstrated that the helmet-mounted devices would increase the compression force and bending moment on cervical spine, especially for the lower cervical segments with higher
. In the cases with Night Vision Goggle,
of the lower cervical segment reached 0.54, which exceeded the requirement in aviation filed. For the cases with Visor, excessive extension occurred, resulting in a high
. The simulation results of this study could provide a reference for helmet and mounted devices design and offer a proposal for the protection of pilots during ejection.
Stab wound to the neck with neurological deficits Forestiere, Matthew J; Matsushima, Kazuhide; Demetriades, Demetrios
The journal of trauma and acute care surgery,
12/2021, Letnik:
91, Številka:
6
Journal Article
There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable ...method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients.
We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010.
The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered "asymptomatic" as they didn't present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% CI 86.5-99.5% and 98.7% CI 92.8-99.8% respectively, with a range of confidence CI of 95%.
Our study's main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.
As cell phones gain more influence in daily life, they also become potentially more hazardous. Injuries resulting from cell phone use have long been reported largely in the context of driving-related ...incidents, but other mechanisms of injury have been underreported.
To assess the incidence, types, and mechanisms of head and neck injuries associated with cell phone use.
Retrospective cross-sectional study using data from a national database of individuals with head and neck injuries related to cell phone use who presented to emergency departments in the United States between January 1998 and December 2017.
Incidence, types, and mechanisms of injury related to cell phone use in the US population.
A reported total of 2501 patients (1129 55.0% female, 795 38.8% white, and 772 37.6% aged 13-29 years) presented with injuries of the head and neck related to cell phone use; the estimated weighted national total was 76 043 patients (42 846 females 56.3%, 34 894 45.9% white, and 29 956 39.4% aged 13-29 years). The most commonly reported subsites of injuries in the head and neck region included the head (33.1% of estimated total); face, including eyelid, eye area, and nose (32.7%); and neck (12.5%). The most common injury diagnoses included laceration (26.3% of estimated total), contusion/abrasion (24.5%), and internal organ injury (18.4%). Age group distributions showed that most injuries associated with cell phone user distraction occurred among individuals aged 13 to 29 years (60.3%; Cramer V = 0.29). In addition, those younger than 13 years were significantly more likely to sustain direct mechanical injury from a cell phone (82.1%) than to have a cell phone use-associated injury (17.9%) (Cramer V = 0.305), whereas a cell phone use-associated injury was more likely than a direct mechanical injury to occur among those aged 50 to 64 years (68.2% vs 31.8%; Cramer V = 0.11) and those older than 65 years (90.3% vs 9.7%; Cramer V = 0.29).
Cell phone-related injuries to the head and neck have increased steeply over the recent 20-year period, with many cases resulting from distraction. Although the disposition of most cases is simple, some injuries bear a risk of long-term complications. Many of these injuries occurred among those aged 13 to 29 years and were associated with common activities, such as texting while walking. These findings suggest a need for patient education about injury prevention and the dangers of activity while using these devices.
Early identification of non-fatal strangulation in the context of intimate partner violence (IPV) is crucial due to its severe physical and psychological consequences for the individual experiencing ...it. This study investigates the under-reported and underestimated burden of IPV-related non-fatal strangulation by analysing assault-related injuries leading to anoxia and neck injuries.
An IRB-exempt, retrospective review of prospectively collected data were performed using the National Electronic Injury Surveillance System All Injury Programme data from 2005 to 2019 for all assaults resulting in anoxia and neck injuries. The type and mechanism of assault injuries resulting in anoxia (excluding drowning, poisoning and aspiration), anatomical location of assault-related neck injuries and neck injury diagnosis by morphology, were analysed using statistical methods accounting for the weighted stratified nature of the data.
Out of a total of 24 493 518 assault-related injuries, 11.6% (N=2 842 862) resulted from IPV (defined as perpetrators being spouses/partners). Among 22 764 cases of assault-related anoxia, IPV accounted for 40.4%. Inhalation and suffocation were the dominant mechanisms (60.8%) of anoxia, with IPV contributing to 41.9% of such cases. Neck injuries represented only 3.0% of all assault-related injuries, with IPV accounting for 21% of all neck injuries and 31.9% of neck contusions.
The study reveals a significant burden of IPV-related anoxia and neck injuries, highlighting the importance of recognising IPV-related strangulation. Comprehensive screening for IPV should be conducted in patients with unexplained neck injuries, and all IPV patients should be screened for strangulation events.
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