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Injury Mechanisms (injury + mechanism)
Selected AbstractsReview article: Indications for thoracolumbar imaging in blunt trauma patients: A review of current literatureEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2009Enda O'Connor Abstract Thoracolumbar spine injury is a common complication of blunt multitrauma and up to one third of fractures are associated with spinal cord dysfunction. Delayed fracture diagnosis increases the risk of neurological complications. While validated screening guidelines exist for traumatic c-spine injury equivalent guidelines for thoracolumbar screening are lacking. We conducted a literature review evaluating studies of thoracolumbar injury in trauma patients to generate indications for thoracolumbar imaging. We performed MEDLINE and Pubmed searches using MeSH terms "Wounds, Nonpenetrating", "Spinal Fractures", "Spinal Injuries" and "Diagnostic Errors", MeSH/subheading terms "Thoracic Vertebrae/injuries" and "Lumbar Vertebrae/injuries" and keyword search terms "thoracolumbar fractures", "thoracolumbar injuries", "thoracolumbar trauma", "missed diagnoses" and "delayed diagnoses". Limits and inclusion criteria were defined prior to searching. We evaluated 16 articles; 5 prospective observational studies (1 cohort study) and 11 retrospective observational studies. Predictors of TL injury in prospective studies , high-risk injury mechanism, distracting injury, impaired cognition, symptoms/signs of vertebral fracture and known cervical fracture , were defined and used to construct a decision algorithm, which in a total of 14189 trauma patients from all eligible studies recommended TL screening in 856(99.1%) of 864 patients with TL fractures and would probably have directed TL imaging in the remaining 8 patients. There is limited low level evidence guiding surveillance TL imaging in adult blunt trauma patients. Despite this, we propose and evaluate an algorithm with a high negative predictive value for TL fractures. This should be incorporated into spinal injury assessment protocols. [source] Trauma in the city of Kerma: ancient versus modern injury patternsINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 1 2004M. Judd Abstract Injuries, whether accidental or intentional, have incapacitated humans and their primordial ancestors throughout time, although the injury mechanisms have become increasingly more technologically sophisticated. Interpretation of injury aetiology among past peoples is challenging, and often impossible, however, clinical research from developing countries provides a useful analogy with which to evaluate trauma or health patterns of an ancient society. This paper presents a systematic analysis of cranial and postcranial skeletal trauma among 223 adults who were excavated by George Reisner in 1923 from the city of Kerma (1750,1550 BC), Egypt's ancient nemesis in the struggle for control of the Nile River trade route. A total of 156 injuries (fractures, dislocations and muscle pulls among the skull, long bones, extremities and torso) were observed among 88 individuals, 48 of whom had one injury only. The skull was the most frequently traumatized element (11.2%) followed by the ulna (8.3%); 2.4% (48/2029) long bones were fractured. The modal distribution of the Kerma fractures was compared to the fracture distributions of two samples from India and Nigeria where falls were the most common cause of injury. Some characteristics of the three injury patterns were shared: males suffered the greatest frequency of injury, the economically active people (25 to 50 years of age) presented the most injuries among adults, and a small proportion of the victims had more than one major injury. However, the Kerma distribution of the fractured bones varied dramatically from the clinical injury distributions: the ulna and skull were among the least frequently injured bones in the modern samples, while the radius, humerus and lower leg were the most commonly traumatized elements among the modern people, but rare among the ancients. The configuration of the ulna and skull injuries at Kerma was characteristic of those associated with blunt force trauma in other clinical assessments and the absence of these specific lesions from the modern samples where accident was the primary injury mechanism presents a persuasive argument for interpersonal violence among the ancient Kerma people. Copyright © 2004 John Wiley & Sons, Ltd. [source] A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and GermanyANZ JOURNAL OF SURGERY, Issue 3 2010Johanna M. M. Nijboer Abstract Background:, The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million inhabitants and a well-established trauma system. Methods:, Trauma patients ,15 years of age, with an Injury Severity Score (ISS) , 16 admitted to the Princess Alexandra Hospital (PAH) and to the 59 German hospitals participating in the Trauma Registry of the German Society for Trauma Surgery (DGU-G) during the year 2005 were retrospectively identified and analysed. Results:, Both cohorts are comparable when it comes to demographics and injury mechanism, but differ significantly in other important aspects. Striking is the low number of primary admitted patients in the PAH cohort: 58% versus 83% in the DGU-G cohort. PAH patients were less physiologically deranged and less severely injured: ISS 25.2 ± 9.9 versus 29.9 ± 13.1 (P < 0.001). Subsequently, they less often needed surgery (61% versus 79%), ICU admission (49% versus 92%) and had a lower mortality: 9.8% versus 17.9% of the DGU-G cohort. Conclusions:, Relevant differences were the low number of primary admissions, the lesser severity of injuries, and the low mortality of the patients treated at the PAH. These differences are likely to be interrelated and Queensland's size and suboptimal organization of trauma care may have played an important role. [source] Pediatric Tree House,Related Injuries Treated in Emergency Departments in the United States: 1990,2006ACADEMIC EMERGENCY MEDICINE, Issue 3 2009Charles Randazzo Abstract Objectives:, The objective was to describe the epidemiology of tree house,related injuries in the United States among children and adolescents. Methods:, The authors conducted a retrospective analysis using data from the National Electronic Injury Surveillance System for patients ,19 years who were treated in an emergency department (ED) for a tree house,related injury from 1990 through 2006. Results:, An estimated 47,351 patients ,19 years of age were treated in EDs for tree house,related injuries over the 17-year study period. Fractures were the most common diagnosis (36.6%), and the upper extremities were the most commonly injured body part (38.8%). The odds of sustaining a head injury were increased for children aged <5 years. Falls were the most common injury mechanism (78.6%) and increased the odds of sustaining a fracture. Falls or jumps from a height ,10 feet occurred in 29.3% of cases for which height of the fall/jump was recorded. Boys had significantly higher odds of falling or jumping from a height of ,10 ft than girls, and children 10 to 19 years old also had significantly higher odds of falling or jumping from a height of ,10 feet, compared to those 9 years old and younger. The odds of hospitalization were tripled if the patient fell or jumped from ,10 feet and nearly tripled if the patient sustained a fracture. Conclusions:, This study examined tree house,related injuries on a national level. Tree house safety deserves special attention because of the potential for serious injury or death due to falls from great heights, as well as the absence of national or regional safety standards. The authors provide safety and prevention recommendations based on the successful standards developed for playground equipment. [source] Induction of endogenous neural precursors in mouse models of spinal cord injury and diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2005M. F. Azari Adult neural precursor cells (NPCs) in the mammalian central nervous system (CNS) have been demonstrated to be responsive to conditions of injury and disease. Here we investigated the response of NPCs in mouse models of spinal cord disease [motor neuron disease (MND)] with and without sciatic nerve axotomy, and spinal cord injury (SCI). We found that neither axotomy, nor MND alone brought about a response by Nestin-positive NPCs. However, the combination of the two resulted in mobilization of NPCs in the spinal cord. We also found that there was an increase in the number of NPCs following SCI which was further enhanced by systemic administration of the neuregulatory cytokine, leukaemia inhibitory factor (LIF). NPCs were demonstrated to differentiate into astrocytes in axotomized MND mice. However, significant differentiation into the various neural cell phenotypes was not demonstrated at 1 or 2 weeks following SCI. These data suggest that factors inherent to injury mechanisms are required for induction of an NPC response in the mammalian spinal cord. [source] Trauma in the city of Kerma: ancient versus modern injury patternsINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 1 2004M. Judd Abstract Injuries, whether accidental or intentional, have incapacitated humans and their primordial ancestors throughout time, although the injury mechanisms have become increasingly more technologically sophisticated. Interpretation of injury aetiology among past peoples is challenging, and often impossible, however, clinical research from developing countries provides a useful analogy with which to evaluate trauma or health patterns of an ancient society. This paper presents a systematic analysis of cranial and postcranial skeletal trauma among 223 adults who were excavated by George Reisner in 1923 from the city of Kerma (1750,1550 BC), Egypt's ancient nemesis in the struggle for control of the Nile River trade route. A total of 156 injuries (fractures, dislocations and muscle pulls among the skull, long bones, extremities and torso) were observed among 88 individuals, 48 of whom had one injury only. The skull was the most frequently traumatized element (11.2%) followed by the ulna (8.3%); 2.4% (48/2029) long bones were fractured. The modal distribution of the Kerma fractures was compared to the fracture distributions of two samples from India and Nigeria where falls were the most common cause of injury. Some characteristics of the three injury patterns were shared: males suffered the greatest frequency of injury, the economically active people (25 to 50 years of age) presented the most injuries among adults, and a small proportion of the victims had more than one major injury. However, the Kerma distribution of the fractured bones varied dramatically from the clinical injury distributions: the ulna and skull were among the least frequently injured bones in the modern samples, while the radius, humerus and lower leg were the most commonly traumatized elements among the modern people, but rare among the ancients. The configuration of the ulna and skull injuries at Kerma was characteristic of those associated with blunt force trauma in other clinical assessments and the absence of these specific lesions from the modern samples where accident was the primary injury mechanism presents a persuasive argument for interpersonal violence among the ancient Kerma people. Copyright © 2004 John Wiley & Sons, Ltd. [source] Chronic ethanol feeding affects proteasome-interacting proteinsPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 13 2009Marie-Pierre Bousquet-Dubouch Abstract Studies on alcoholic liver injury mechanisms show a significant inhibition of the proteasome activity. To investigate this phenomenon, we isolated proteasome complexes from the liver of rats fed ethanol chronically, and from the liver of their pair-fed controls, using a non-denaturing multiple centrifugations procedure to preserve proteasome-interacting proteins (PIPs). ICAT and MS/MS spectral counting, further confirmed by Western blot, showed that the levels of several PIPs were significantly decreased in the isolated ethanol proteasome fractions. This was the case of PA28,/, proteasome activator subunits, and of three proteasome-associated deubiquitinases, Rpn11, ubiquitin C-terminal hydrolase 14, and ubiquitin carboxyl-terminal hydrolase L5. Interestingly, Rpn13 C-terminal end was missing in the ethanol proteasome fraction, which probably altered the linking of ubiquitin carboxyl-terminal hydrolase L5 to the proteasome. 20S proteasome and most 19S subunits were however not changed but Ecm29, a protein known to stabilize the interactions between the 20S and its activators, was decreased in the isolated ethanol proteasome fractions. It is proposed that ethanol metabolism causes proteasome inhibition by several mechanisms, including by altering PIPs and proteasome regulatory complexes binding to the proteasome. [source] Loss of Solute Carriers in T Cell-Mediated Rejection in Mouse and Human Kidneys: An Active Epithelial Injury,Repair ResponseAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010G. Einecke T cell-mediated rejection of kidney allografts causes epithelial deterioration, manifested by tubulitis, but the mechanism remains unclear. We hypothesized that interstitial inflammation triggers a stereotyped epithelial response similar to that triggered by other types of injury such as ischemia-reperfusion. We identified solute carrier transcripts with decreased expression in mouse allografts, and compared their behavior in T cell-mediated rejection to native kidneys with ischemic acute tubular necrosis (ATN). Average loss of solute carrier expression was similar in ATN (77%) and T cell-mediated rejection (75%) with high correlation of individual transcripts. Immunostaining of SLC6A19 confirmed loss of proteins. Analysis of human kidney transplant biopsies confirmed that T cell-mediated rejection and ATN showed similar loss of solute carrier mRNAs. The loss of solute carrier expression was weakly correlated with interstitial inflammation, but kidneys with ATN showed decreased solute carriers despite minimal inflammation. Loss of renal function correlated better with decreased solute carrier expression than with histologic lesions (r = 0.396, p < 0.001). Thus the loss of epithelial transcripts in rejection is not a unique consequence of T cell-mediated rejection but an active injury,repair response of epithelium, triggered by rejection but also by other injury mechanisms. [source] Utility of Base Deficit for Identifying Major Injury in Elder Trauma PatientsACADEMIC EMERGENCY MEDICINE, Issue 9 2007Shahriar Zehtabchi MD Background: Early identification of serious injuries is especially important in elders. Base deficit (BD) is an indicator of serious injury in trauma patients. There are limited data to support the utility of BD in elders who have sustained trauma. Objectives: To assess the diagnostic performance of BD in identifying major injury in elders. Methods: This was a prospective, observational, preliminary study. Elder (age 65 years and older) patients with significant injury mechanisms had BD analyzed during initial emergency department resuscitation. Major injury was defined by an Injury Severity Score ,15, a decrease in hematocrit of more than ten points, or blood transfusion. Patients were stratified into two groups of minor and major injuries. Data were reported as means (±SD). Receiver operating characteristic (ROC) curves tested the diagnostic ability of BD to identify major injury. Results: Seventy-four patients were enrolled; the mean (±SD) age was 75 (±7) years, and 57% were male. Twenty-four patients (32%) had major injury. The mean (±SD) for BD in the major injury group (,2.9 [±6] mmol/L) was significantly different from that in the minor injury group (0.8 [±3] mmol/L), with a mean difference of 3.7 (95% confidence interval = 1.4 to 5.9). ROC curves revealed that BD was able to identify major injury in elder patients (area under the ROC curve, 0.72; 95% confidence interval = 0.60 to 0.85; p = 0.0003). Conclusions: The preliminary data from this study indicate that in trauma patients aged 65 years and older, increased BD at emergency department arrival can predict life-threatening injury. [source] | ||||||||||