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Severe Injuries (severe + injury)
Selected AbstractsIntimate Partner Violence: Development of a Brief Risk Assessment for the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2009Carolyn Snider MD Abstract Objectives:, Women assaulted by intimate partners are frequently patients in emergency departments (EDs). Many victims and health care providers fail to take into account the potential risks of repeat partner violence. The objective of this study was to use data from a larger study of domestic violence risk assessment methods to develop a brief assessment for acute care settings to identify victims at highest risk for suffering severe injury or potentially lethal assault by an intimate partner or former partner. Methods:, Victims of intimate partner violence (IPV) were interviewed twice between 2002 and 2004. The baseline interview included the 20 items of Campbell's Danger Assessment (DA; predictor). The follow-up interview, conducted 9 months later on average, assessed abuse inflicted since the baseline interview (outcome). Multiple logistic regression was used to identify questions on the DA most predictive of severe abuse and potentially lethal assaults. Female IPV victims were recruited from New York City family courts, Los Angeles County Sheriff's Department 9-1-1 calls, New York City and Los Angeles shelters, and New York City hospitals; 666 women responded to the DA at baseline, and 60% participated in follow-up interviews. Results:, Severe injuries or potentially lethal assaults were experience by 14.9% of retained study participants between the baseline and follow-up interviews. The best brief prediction instrument has five questions. A positive answer to any three questions has a sensitivity of 83% (95% confidence interval = 70.6% to 91.4%). Conclusions:, This instrument can help predict which victims may be at increased risk for severe injury or potentially lethal assault and can aid clinicians in differentiating which patients require comprehensive safety interventions. [source] Triage and mortality in 2875 consecutive trauma patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010R. MEISLER Background: Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage. Methods: We prospectively registered all trauma patients in Eastern Denmark over 12 consecutive months. We analysed the flow of trauma patients through the system, the time spent at different locations, and we assessed the risk factors of mortality. Results: We included 2875 trauma patients, of whom 158 (5.5%) died before arrival at the hospital. Most patients (75.3%) were brought to local hospitals and patients primarily (n=82) or secondarily triaged (n=203) to the level I trauma centre were the most severely injured. Secondarily transferred patients spent a median of 150 min in the local hospital before transfer to the level I trauma centre and 48 min on transportation. Severe injury with an injury severity score >15 was seen in 345 patients, of whom 118 stayed at the local hospital. They had a significantly higher mortality than 116 of those secondarily transferred [45/118, 38.1% vs. 11/116, 9.7% (P<0.0001)]. Mortality within 30 days was 4.3% in admitted patients, and significant risk factors of death were violence [odds ratio (OR)=5.72], unconsciousness (OR=4.87), hypotension (OR=4.96), injury severity score >15 (OR=27.42), and age. Conclusions: Around 50% of all trauma deaths occurred at the scene. Increased survival of severely injured patients may be achieved by early transfer to highly specialised care. [source] Investigating Driver Injury Severity in Traffic Accidents Using Fuzzy ARTMAPCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 6 2002Hassan T. Abdelwahab This paper applies fuzzy adaptive resonance theory MAP (fuzzy ARTMAP) neural networks to analyze and predict injury severity for drivers involved in traffic accidents. The paper presents a modified version of fuzzy ARTMAP in which the training patterns are ordered using the K,means algorithm before being presented to the neural network. The paper presents three applications of fuzzy ARTMAP for analyzing driver injury severity for drivers involved in accidents on highways, signalized intersections, and toll plazas. The analysis is based on central Florida's traffic accident database. Results showed that the ordered fuzzy ARTMAP proved to reduce the network size and improved the performance. To facilitate the application of fuzzy ARTMAP, a series of simulation experiments to extract knowledge from the models were suggested. Results of the fuzzy ARTMAP neural network showed that female drivers experience higher severity levels than male drivers. Vehicle speed at the time of an accident increases the likelihood of high injury severity. Wearing a seat belt decreases the chance of having severe injuries. Drivers in passenger cars are more likely to experience a higher injury severity level than those in vans or pickup trucks. Point of impact, area type, driving under the influence, and driver age were also among the factors that influence the severity level. [source] Assessment of traumatic injuries to primary teeth in general practise and specialized paediatric dentistryDENTAL TRAUMATOLOGY, Issue 2 2010Carl Gösta Rasmusson Materials and methods:, A total of 323 children with traumatic injuries, 184 boys and 139 girls aged 7,83 months, participated in the study. All the children had first presented at a Public Dental Service clinic where they were examined by general dentists who decided, based on the severity of the trauma, to assign each child to one of the following two groups: Group A , recommended for treatment at the general practise (166 children with 257 traumatized incisor teeth). Group B , recommended for referral to a specialist in paediatric dentistry (157 children with 261 traumatized incisor teeth). Even in Group A, the specialist controlled the treatment decisions. The clinical diagnose and follow-up followed the recommendations presented by Andreasen & Andreasen. Results:, The distribution of trauma by age was similar in both groups, with about 60% occurring between 1 and 3 years. More injured teeth were extracted in children in Group B (n = 111) than in Group A (n = 33). A higher percentage of intruded primary incisors were recorded in Group B (24%) compared with Group A (16%). Similarly, the percentage of concussions/subluxations, lateral luxations and complicated crown fractures was higher in Group B than in Group A. Conclusions:, The group referred for specialist treatment had more severe injuries and needed more complicated treatment than the group recommended for care by general dentists. However, the rate of sequelae in permanent successors was the same in both. [source] Dento-alveolar and maxillofacial injuries: a 5-year multi-center study.DENTAL TRAUMATOLOGY, Issue 1 2008Part 2: Severity, location These injuries may cause morbidity and demand meticulously planned treatment. Part 1 of this study focused on the incidence of general trauma injuries, as well as facial or dental trauma. The aim of part 2 is to evaluate the severity and location of the dento-alveolar and maxillofacial injuries over 5 years. A retrospective cohort study was conducted based on data from the Israel National Trauma Registry. Patients admitted and hospitalized due to trauma injuries during the years 2000,2004, totaled 111 010 in which 5886 (5.3%) were maxillofacial or dental injuries. Most of these injuries were traffic-related (54.5%), followed by events at home (18.7%). Facial injuries combined with injuries to other organs involved occurred in 3721 (63.2%) of the patients. Most minor injuries were noted when no other organs were involved, while severe injuries were more common when multiple organs were involved. More than 25% of facial injuries required surgery. Meticulous epidemiologic studies are needed to support the leading role, extent, and severity of maxillofacial trauma. [source] Etiological factors related to dental injuries in Norwegians aged 7,18 yearsDENTAL TRAUMATOLOGY, Issue 6 2003Anne B. Skaare Abstract ,,,Prevention of diseases and injuries is a field of priority for the health authorities in Norway. In 1990, an interdepartmental project was established in order to reduce the number of accidents, including dental injuries. The purpose of the present study was to examine the causes of dental injuries, the place of event and the possibilities for prevention. During a 1-year period, all new trauma episodes affecting children aged 7,18 years were registered by calibrated dentists in the public dental health service in the county of Nord-Trøndelag and in the capital city of Oslo. A distinction was made between school and leisure time accidents. The severity of injuries was classified as mild, moderate or severe, and the dentists were asked to judge whether the severe injuries were preventable. Nearly half of the 1275 injured individuals (48%) were injured at school. Almost half of the leisure time injuries occurred during children's play. Sports and traffic accidents were less common. Sports accidents represented only 8% of the total number of injuries, the same as the number of individuals injured by violence. Statistically significant associations were observed between the cause of injury and county (P < 0.001) and the cause of injury and age group (P < 0.001). In total, 4% of all injuries were classified as severe, of which only one-third were assumed to be preventable. In summary, because of the complexity of etiological factors, it is neither easy to prevent dental injuries nor to make guidelines on prevention. [source] Paediatric and adolescent horse-related injuries: Does the mechanism of injury justify a trauma response?EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2008John A Craven Objective: To identify the frequency, variety and disposition of horse-related injury presentations to the ED and to use this information to evaluate the existing institutional trauma team activation criteria following horse-related injuries. Methods: A retrospective case analysis was performed of all horse-related injury presentations to the ED of Women's and Children's Hospital, Adelaide, Australia, in the 5 year period between January 1999 and December 2003. Results: A total of 186 children presented with horse-related injuries during the 5 year study period. The median age of injury was 9 years (range 1,17 years), with 81% of presentations female and 60% of patients hospitalized. The mechanism of injury was divided into four groups: 148 falls (79%), 28 kicks (15%), 7 tramples (4%) and 5 bites (3%). There was one death. Seven presentations rated an Injury Severity Score >15, with full trauma team activation occurring for two of these presentations. Conclusion: Although horse-related injury presentations are uncommon, severe injuries do occur. Patients presenting with severe horse-related injuries do not always activate a full trauma team response based on current trauma team activation criteria. These severe injury presentations are supported by a limited trauma team response, which activates on the mechanism of injury. The effectiveness of this as a contingency system needs to be evaluated. [source] Surviving atlanto-occipital dislocationEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Benjamin M Bloom Abstract Traumatic atlanto-occipital dislocation carries a significant mortality and morbidity. We present the clinical and radiological features of a case of traumatic skeletal and central nervous system disunion. Thanks to a combination of early resuscitation and luck, the patient survived an improbably severe injury to leave hospital and enjoy a degree of independent life. Such severe injuries are usually fatal and the literature on such extensive cervical disruption is often confined to postmortem evidence. [source] Marginal mandibular nerve injury during neck dissection and its impact on patient perception of appearanceHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2009FRACDS(OMS), FRCS(OMFS), Martin D. Batstone MPhil(Surg) Abstract Background. Neck dissection to remove cervical lymph nodes is common practice in head and neck cancer management. The marginal mandibular nerve may be injured during neck dissection, particularly of level 1. The rate of injury to this nerve is underreported in the literature and its impact on patients is not well defined. Methods. An observational study was undertaken on patients who had undergone neck dissection over a 5-year period. The patients were examined for weakness and given a questionnaire related their perception of their appearance and their function. Results. Sixty-six patients were identified who had undergone 85 neck dissections. The rate of House Brackmann injury was 18% when analyzed by patient and 23% by neck. There were moderate correlations between observed injury and subjective responses to questions relating to ability to smile and weakness of the lower lip. Discussion. The rate of smile asymmetry following neck dissection is relatively high; however, severe injuries to the marginal mandibular nerve are uncommon. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Liver transplantation for the sequelae of intra-operative bile duct injuryHPB, Issue 3 2002E De Santibañes Background Intra-operative bile duct injuries (IBDI) are potentially severe complications of the treatment of benign conditions, with unpredictable long-term results. Multiple procedures are frequently needed to correct these complications. In spite of the application of these procedures, patients with severe injuries can develop irreversible liver disease. Liver transplantation (LT) is currently the only treatment available for such patients, but little information has been published concerning the results of LT. Methods Eight patients with LT for end-stage liver disease for IBDI were studied retrospectively. They had failure of multiple previous treatments and experienced recurrent episodes of cholangitis, oesophageal variceal bleeding, severe pruritus, refractory ascites and spontaneous peritonitis. Results Mean recipient hepatectomy time was of 243 minutes (range 140,295 min), the complete procedure averages 545 minutes (260,720) and intraoperative red-blood-cells consumption was 6.5 units (1,7). One patient required reoperation due to perforation of a Roux-en-Y loop, and three developed minor complications (2 wound infections, 1 inguinal lymphocele). One patient died due to nosocomial pneumonia (mortality rate 12.5%). One patient required retransplantation due to delayed hepatic artery thrombosis. At follow-up 75% of patients are alive with normal graft function and an excellent quality of life. Conclusions LT represents a safe curative treatment for end-stage liver disease after IBDI, albeit a major undertaking in the context of a surgical complication in the treatment of benign disease. The complications of the surgical procedure and the long-standing immunosupression impart a high cost for resolutions of these sequelae but LT represents the only long-term effective treatment for these selected patients. [source] Oral bleeding: Child abuse alertJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2002T Stricker Abstract: Physicians must be aware of histories, behaviours and physical findings of maltreated children. We report two cases of physical child abuse in which the initial symptom was oral bleeding. In both cases, the diagnosis was delayed and was made only after severe injuries were inflicted. Injuries to the oral cavity and oral bleeding of uncertain origin in infants should be considered seriously and should be carefully assessed in relation to adequacy of history to explain the mechanism of injury. When an infant has been injured and no adequate explanation is available to account for the mechanism, inflicted injury must be suspected and evaluated, so that in cases of child maltreatment, diagnosis and protection of the child from further injury can take place as early as possible. [source] Clinical study of cats injured and killed in road traffic accidents in CambridgeshireJOURNAL OF SMALL ANIMAL PRACTICE, Issue 8 2004I. Rochlitz Data were collected on the injuries, treatment and outcome of 128 cats involved in road accidents and seen as first-opinion cases in veterinary practices in Cambridgeshire. Sixteen cats were dead on arrival; the mortality rate for the remaining cats was 16 per cent. Half of the cats were aged between seven months and two years, with more males than females affected. Most cats had moderate injuries; strays had more severe injuries than owned cats. Areas of the body most often injured were the extremities, head and neck, pelvis and thorax. Skeletal injuries were present in 67 cats and neurological signs in 29. Diagnostic procedures and medical treatment were necessary for the majority of cats; surgery was required in 51 cases. Most cats were hospitalised for between two and seven days and some required up to one month of treatment. The cost of treatment was less than £400 for 84 per cent of cats. [source] COLLISIONS BETWEEN SHIPS AND WHALESMARINE MAMMAL SCIENCE, Issue 1 2001David W. Laist Abstract Although collisions with motorized ships are a recognized source of whale mortality, little has been done to compile information on the frequency of their occurrence or contributing factors. We searched historical records and computerized stranding databases for evidence of ship strikes involving great whales (i. e., baleen whales and the sperm whale). Historical records suggest that ship strikes fatal to whales first occurred late in the 1800s as ships began to reach speeds of 13-15 kn, remained infrequent until about 1950, and then increased during the 1950s-1970s as the number and speed of ships increased. Of 11 species known to be hit by ships, fin whales (Balaenoptera physalus) are struck most frequently; right whales (Eubalaena glacialis and E. australis), humpback whales (Megaptera novaeangliae), sperm whales (Physeter catodon), and gray whales (Escbricbtius robustus) are hit commonly. In some areas, one-third of all fin whale and right whale strandings appear to involve ship strikes. To assess contributing factors, we compiled descriptions of 58 collisions. They indicate that all sizes and types of vessels can hit whales; most lethal or severe injuries are caused by ships 80 m or longer; whales usually are not seen beforehand or are seen too late to be avoided; and most lethal or severe injuries involve ships travelling 14 kn or faster. Ship strikes can significantly affect small populations of whales, such as northern right whales in the western North Atlantic. In areas where special caution is needed to avoid such events, measures to reduce the vessel speed below 14 kn may be beneficial. [source] Assessment and Treatment of Pain Associated with Combat-Related PolytraumaPAIN MEDICINE, Issue 3 2009Michael E. Clark PhD ABSTRACT Due to the high rates of blast injuries sustained during operations in Iraq and Afghanistan, the number of soldiers returning with massive and multiple wounds is unprecedented. While casualty survival rates have improved dramatically, the extent and impact of these wounds on soldiers' functioning pose unique challenges for their rehabilitation. Pain is highly prevalent in these individuals with polytrauma injuries and is a source of suffering, as well as an impediment to rehabilitation. However, there are a number of obstacles to effective pain treatment in this group of war-injured, including their multiple and severe injuries, the high prevalence of brain injuries, cognitive impairments and emotional distress, the prolonged and intensive rehabilitation process, and the frequent need for repeated follow-up surgeries. As a result, we believe that a comprehensive, interdisciplinary approach to pain treatment is required. In this article we describe the model of pain care that has evolved at the Tampa Polytrauma Rehabilitation Center, which incorporates medical, rehabilitative, cognitive,behavioral, and interventional treatments targeting pain intensity as well as pain-related impairments and coping. We include a case study illustrating some key aspects of our approach. [source] Traumatic occupational injuries in Hispanic and foreign born workersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2010Linda Forst MD Abstract Background Hispanic and foreign-born workers suffer high rates of occupational fatality. Reasons for this are not well understood. Our aim was to gather information about the details related to severe, non-fatal occupational injuries in this vulnerable population. Methods Eight years of data were obtained from an urban trauma center. In addition, medical consultations of individuals admitted for an occupational injury during an 8-month period are reported. Results Hispanics were more highly represented than expected; their number of injuries steadily rose. Hispanics were more likely to be injured by machinery and hand tools. Workers reported hazardous working conditions, lack of workers compensation, short time in current employment, and not working in their usual job. Conclusion Trauma systems can provide a glimpse of risk factors for severe injuries in vulnerable workers. We recommend greater use of this data source, follow backs, long-term follow up of individuals, and improvement of surveillance of vulnerable working populations. Am. J. Ind. Med. 53:344,351, 2010. © 2009 Wiley-Liss, Inc. [source] Occupational injury disparities in the US hotel industry,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2010Susan Buchanan MD Abstract Background Hotel employees have higher rates of occupational injury and sustain more severe injuries than most other service workers. Method OSHA log incidents from five unionized hotel companies for a three-year period were analyzed to estimate injury rates by job, company, and demographic characteristics. Room cleaning work, known to be physically hazardous, was of particular concern. Results A total of 2,865 injuries were reported during 55,327 worker-years of observation. The overall injury rate was 5.2 injuries per 100 worker-years. The rate was highest for housekeepers (7.9), Hispanic housekeepers (10.6), and about double in three companies versus two others. Acute trauma rates were highest in kitchen workers (4.0/100) and housekeepers (3.9/100); housekeepers also had the highest rate of musculoskeletal disorders (3.2/100). Age, being female or Hispanic, job title, and company were all independently associated with injury risk. Conclusion Sex- and ethnicity-based disparities in injury rates were only partially due to the type of job held and the company in which the work was performed. Am. J. Ind. Med. 53:116,125 2010. © 2009 Wiley-Liss, Inc. [source] Outcomes in work-related injuries: A comparison of older and younger workersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2005Glenn S. Pransky MD, MOCCH Abstract Background The "graying of the workforce" has generated concerns about the physical capacity of older workers to maintain their health and productivity on the job, especially after an injury occurs. There is little detailed research on age-related differences in work outcomes after an occupational injury. Methods A self-report survey about occupational, health, and financial outcomes, and related factors was administered 2,8 weeks post-injury to workers aged <,55 and ,,55 who had lost time due to a work injury. Results Despite more severe injuries in older workers, most outcomes were similar in both age groups. In multivariate models, age was unrelated or inversely related to poor outcomes. Injury severity, physical functioning, and problems upon return to work were associated with adverse work injury outcomes. Conclusions Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect. Am. J. Ind. Med. 47:104,112, 2005. © 2005 Wiley-Liss, Inc. [source] LAWN MOWER INJURIES IN CHILDREN: A 30-YEAR EXPERIENCEANZ JOURNAL OF SURGERY, Issue 9 2008Anh Nguyen Background: Lawn mowers cause severe injuries that are particularly devastating to children. This study analyses the patterns and trends in lawn mower injuries involving children referred to Victoria's principal children's hospital. Methods: A retrospective review of the patient medical records at the Royal Children's Hospital (Melbourne) Victoria, Australia was carried out. The series included all patients admitted for lawn mower injury during the 30-year period spanning 1975,2004. Results: Lawn mower injuries treated at Royal Children's Hospital were severe and included partially amputated limbs. Overall, admissions for lawn mower injury generally decreased over time from n = 26 in the 1975,1979 interval to n = 14 in the 2000,2004 interval. However, the frequency of admission for injuries caused by ride-on mowers contradicted the overall trend and generally increased over time from n = 5 in the 1975,1979 interval to n = 11 in the 2000,2004 interval. This is of particular concern. Ride-on lawn mowers caused significantly more severe injuries requiring longer periods of admission and more operations during admission in comparison to standard mowers. Rural location at the time of injury was a risk factor associated with requiring longer periods of admission and more operations during admission. Children injured while operating mowers were generally older than children injured as bystanders. Conclusion: Lawn mower injuries are a significant cause of morbidity. These injuries are particularly devastating to children. The tragedy is keenly felt in the realization that these devastating injuries to children could all be prevented. Strategic preventative measures should be developed through partnership between the medical profession, the media, industry specialists and the wider community. [source] SEVERE TRAUMA CAUSED BY STABBING AND FIREARMS IN METROPOLITAN SYDNEY, NEW SOUTH WALES, AUSTRALIAANZ JOURNAL OF SURGERY, Issue 4 2005Kenneth Wong Background: Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre. Methods: Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed. Results: Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15,82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed , laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1,107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination. Conclusions: Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma. [source] Interventions for treating traumatized permanent front teeth: avulsed (knocked out) and replantedAUSTRALIAN DENTAL JOURNAL, Issue 2 2010P Day Background:, Dental trauma is common. One of the most severe injuries is when a permanent tooth is knocked completely out (avulsed) of the mouth. In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on how best to prepare teeth for replantation. Objectives:, To compare the effects of a range of interventions for managing traumatized permanent teeth with avulsion injuries. Search strategy:, The Cochrane Oral Health Group's Trials Register (to 28th October 2009); CENTRAL (The Cochrane Library 2009, Issue 4); MEDLINE (1950 to October 2009); EMBASE (1980 to October 2009); http://www.clinicaltrials.gov/;www.controlled-trials.com/ and reference lists of articles were searched. There were no language restrictions. Selection criteria:, Only randomized controlled trials (RCTs), that included a minimum follow-up period of 12 months, for interventions for avulsed and replanted permanent teeth were considered. Data collection and analysis:, Two review authors independently extracted data and assessed trial quality and the risk of bias in studies to be included. Main results:, Three studies, involving a total of 162 patients and 231 teeth were identified. Study one (with a high risk of bias) investigated the effect of extra-oral endodontics. This showed no significant difference in radiographic resorption compared with intra-oral endodontics provided at week 1 for teeth avulsed for longer than 60 minutes dry time. Study two (which had a moderate risk of bias) investigated a 10-minute soaking in thymosin alpha 1 prior to replantation and then its further use as a daily gingival injection for the first 7 days. They reported a strong benefit at 48 months (14% with periodontal healing in the control group versus 77% for the experimental group). Study three (with a high risk of bias) investigated a 20-minute soaking with gentamycin sulphate (4 × 107 U/L) for both groups prior to replantation and then the use of hyperbaric oxygen daily in the experimental group for 80 minutes for the first 10 days. They reported a strong benefit at 12 months (43% periodontal healing versus 88% for the experimental group). There was no formal reporting of adverse events. Authors' conclusions:, The available evidence suggests that extra-oral endodontics is not detrimental for teeth replanted after more than 60 minutes dry time. Studies with moderate/high risk of bias indicate that soaking in thymosin alpha 1 and gentamycin sulphate followed by hyperbaric oxygen may be advantageous. However, they have not previously been reported as interventions for avulsed teeth and need further validation. More evidence with low risk of bias is required and, with the low incidence of avulsed teeth, collaborative multicentre trials are indicated. Plain language summary:, Treatments for managing knocked out and replanted front teeth. Injuring your front teeth during childhood is common. One of the most severe injuries occurs when the tooth is knocked totally out of the mouth (avulsed). Often the best option is to replant the tooth as quickly as possible. This is true only for permanent teeth. Once replanted the tooth can heal in two ways if managed correctly. Ideally the ligament around the root reforms and the tooth can be expected to last as long as any other tooth; this is known as ,periodontal healing'. When there is too much damage to the ligament, healing occurs by bony replacement and the tooth is replaced by bone and lost over a few years. This is called ,bony healing'. Bony healing causes significant problems in the medium term for children and treatments for this are the subject of a different Cochrane review. A missing front upper tooth or teeth, as a result of not replanting an avulsed tooth or as a treatment for bony healing, can have a major effect on dental and facial ,good looks'. This can affect the individual's self-esteem and general social interaction, as well as how others think and see them. This Cochrane review investigated what treatments encourage the tooth to repair by periodontal healing. Three studies were found. The benefits of these treatments require further investigation before specific medicaments can be advised. This is because the studies had weakness in their design which may have influenced the benefits they found. The following general treatment principle can be concluded which reinforces current treatment guidelines: For teeth with little chance of periodontal healing, a root canal treatment can be carried out before the tooth is replanted without further detrimental effects. [source] Children and adolescents injured in traffic , associated psychological consequences: a literature reviewACTA PAEDIATRICA, Issue 1 2009Eva Olofsson Abstract Aim: To identify the prevalence of post-traumatic stress disorder (PTSD) and PTSD symptoms (PTSS) among children and adolescents injured in traffic, and to assess predictors of such post-traumatic stress. Methods: Studies identified from electronic databases were reviewed. Results: Based on a review of 12 studies, fulfilling specified criteria, the prevalence of PTSS was estimated at 30% within 1 month and 13% at 3,6 months. The prevalence of PTSD was almost 30% at 1,2 months and decreased to the same level as PTSS at 3,6 months. Perceived threat and high levels of distress, anxiety symptoms and being female were significantly associated with PTSD and PTSS. Injury severity was positively related to the number of PTSD symptoms in one of eight studies. Types of accident, age and socioeconomic status were not related to the development of PTSD/PTSS. Conclusion: Any child will be at risk of PTSD/PTSS, not just those with severe injuries. Trauma care should include procedures that could identify and prevent stress reactions in order to minimize the risk of associated psychological consequences. [source] Trauma Center Utilization for Children in California 1998,2004: Trends and Areas for Further AnalysisACADEMIC EMERGENCY MEDICINE, Issue 4 2007N. Ewen Wang MD Abstract Background: While it is known that trauma systems improve the outcome of injury in children, there is a paucity of information regarding trauma system function amid changes in policies and health care financing that affect emergency medical systems for children. Objectives: To describe the trends in the proportion of pediatric trauma patients acutely hospitalized in trauma-designated versus non,trauma-designated hospitals. Methods: This was a retrospective observational study of a population-based cohort obtained by secondary analysis of a publicly available data set: the California Office of Statewide Health Planning and Development Patient Discharge Database from 1998 to 2004. Patients were included in the analysis if they were 0,19 years old, had International Classification of Disease, Ninth Revision (ICD-9) diagnostic codes and E-codes indicative of trauma, had an unscheduled admission, and were discharged from a general acute care hospital (N= 111,566). Proportions of patients hospitalized in trauma-designated hospitals versus non,trauma-designated hospitals were calculated for Injury Severity Score and death. Injury Severity Scores were calculated from ICD-9 codes. Primary outcomes were hospitalization in a trauma center and death two or more days after hospitalization. Results: Over the study period, the proportion of children aged 0,14 years with acute trauma requiring hospitalization and who were cared for in trauma-designated hospitals increased from 55% (95% confidence interval [CI] = 54% to 56%) in 1998 to 66% (95% CI = 65% to 67%) in 2004 (p < 0.01). For children aged 15,19 years, the proportion increased from 55% (95% CI = 54% to 57%) in 1998 to 74% (95% CI = 72% to 75%) in 2004 (p < 0.0001). When trauma discharges were stratified by injury severity, the proportion of children with severe injury who were hospitalized in trauma-designated hospitals increased from 69% (95% CI = 66% to 72%) in 1998 to 84% (95% CI = 82% to 87%) in 2004, a rate higher than in children with moderate injury (59% [95% CI = 58% to 61%] in 1998 and 75% [95% CI = 74% to 76%] in 2004) and mild injury (51% [95% CI = 50% to 52%] in 1998 and 63% [95% CI = 62% to 64%] in 2004) (p < 0.0001 for each injury severity category and both age groups). Of the hospitalized children who died two or more days after injury (n= 502), 18.1% died in non,trauma-designated hospitals (p < 0.002 for children aged 0,14 years; p = 0.346 for children aged 15,19 years). Conclusions: An increasing majority of children with trauma were cared for in trauma-designated hospitals over the study period. However, 23% of children with severe injuries, and 18.1% of pediatric deaths more than two days after injury, were cared for in non,trauma-designated hospitals. These findings demonstrate an important opportunity for improvement. If we can characterize those children who do not access the trauma system despite severe injury or death, we will be able to design clinical protocols and implement policies that ensure access to appropriate regional trauma care for all children in need. [source] Surviving atlanto-occipital dislocationEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Benjamin M Bloom Abstract Traumatic atlanto-occipital dislocation carries a significant mortality and morbidity. We present the clinical and radiological features of a case of traumatic skeletal and central nervous system disunion. Thanks to a combination of early resuscitation and luck, the patient survived an improbably severe injury to leave hospital and enjoy a degree of independent life. Such severe injuries are usually fatal and the literature on such extensive cervical disruption is often confined to postmortem evidence. [source] Trauma Team Activation Criteria as Predictors of Patient Disposition from the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 1 2004Michael A. Kohn MD Many trauma centers use mainly physiologic, first-tier criteria and mechanism-related, second-tier criteria to determine whether and at what level to activate a multidisciplinary trauma team in response to an out-of-hospital call. Some of these criteria result in a large number of unnecessary team activations while identifying only a few additional patients who require immediate operative intervention. Objectives: To separately evaluate the incremental predictive value of individual first-tier and second-tier trauma team activation criteria for severe injury as reflected by patient disposition from the emergency department (ED). Methods: This was a prospective cohort study in which activation criteria were collected prospectively on all adult patients for whom the trauma team was activated during a five-month period at an urban, Level 1 trauma center. Severe injury disposition ("appropriate" team activation) was defined as immediate operative intervention, admission to the intensive care unit (ICU), or death in the ED. Data analysis consisted of recursive partitioning and multiple logistic regression. Results: Of the 305 activations for the mainly physiologic first-tier criteria, 157 (51.5%) resulted in severe injury disposition. The first-tier criterion that caused the greatest increase in "inappropriate" activations for the lowest increase in "appropriate" activations was "age > 65." Of the 34 additional activations due to this criterion, seven (20.6%) resulted in severe injury disposition. Of the 700 activations for second-tier, mechanism-related criteria, 54 (7.7%) resulted in ICU or operating room admissions, and none resulted in ED death. The four least predictive second-tier criteria were "motorcycle crash with separation of rider,""pedestrian hit by motor vehicle,""motor vehicle crash with rollover," and "motor vehicle crash with death of occupant." Of the 452 activations for these four criteria, only 18 (4.0%) resulted in ICU or operating room admission. Conclusions: The four least predictive second-tier, mechanism-related criteria added little sensitivity to the trauma team activation rule at the cost of substantially decreased specificity, and they should be modified or eliminated. The first-tier, mainly physiologic criteria were all useful in predicting the need for an immediate multidisciplinary response. If increased specificity of the first-tier criteria is desired, the first criterion to eliminate is "age > 65." [source] MEGX disposition in critically-ill trauma patients: subsequent assessments during the first week following traumaFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 6 2002Federico Pea ABSTRACT The objective of this study was to evaluate MEGX disposition as a surrogate marker in assessing the influence that injury may exert on liver function during the first week after the traumatic event in young vs. elderly patients. The MEGX exposure over time was assessed at 0.25, 0.5, 1, 2, 4 and 6 h after the intravenous administration of a 1 mg/kg lidocaine test dose in 12 young and 7 elderly trauma patients on days1, 4 and 7 after a severe injury (Apache II score > 10). MEGX plasma concentration,time profiles were consistently different on day 1 in the elderly vs. young, consistent with a statistically significant lower rate of both lidocaine clearance and MEGX formation, and with a considerably longer MEGX elimination in the elderly than in the young. This suggests an impairment of liver blood flow as a result of splanchnic vasoconstriction occurring mainly in elderly trauma patients. A significant improvement in MEGX disposition occurred on days 4 and 7 vs. the day of trauma in most elderly, whereas minor changes were observed in the young. Multiple factors may account for these major changes in the elderly: the more severe status, the major sensitivity to the pathophysiologic changes induced by trauma, and also at least partially the ageing processes. Although referring to a limited number of observations, our findings on MEGX disposition suggest that liver function may be affected by the severity of injury, even if the influence of age should not be underestimated in these patients. [source] Severe alterations of endothelial and glial cells in the blood-brain barrier of dystrophic mdx miceGLIA, Issue 3 2003Beatrice Nico Abstract In this study, we investigated the involvement of the blood-brain barrier (BBB) in the brain of the dystrophin-deficient mdx mouse, an experimental model of Duchenne muscular dystrophy (DMD). To this purpose, we used two tight junction markers, the Zonula occludens (ZO-1) and claudin-1 proteins, and a glial marker, the aquaporin-4 (AQP4) protein, whose expression is correlated with BBB differentiation and integrity. Results showed that most of the brain microvessels in mdx mice were lined by altered endothelial cells that showed open tight junctions and were surrounded by swollen glial processes. Moreover, 18% of the perivascular glial endfeet contained electron-dense cellular debris and were enveloped by degenerating microvessels. Western blot showed a 60% reduction in the ZO-1 protein content in mdx mice and a similar reduction in AQP4 content compared with the control brain. ZO-1 immunocytochemistry and claudin-1 immunofluorescence in mdx mice revealed a diffuse staining of microvessels as compared with the control ones, which displayed a banded staining pattern. ZO-1 immunogold electron microscopy showed unlabeled tight junctions and the presence of gold particles scattered in the endothelial cytoplasm in the mdx mice, whereas ZO-1 gold particles were exclusively located at the endothelial tight junctions in the controls. Dual immunofluorescence staining of ,-actin and ZO-1 revealed colocalization of these proteins. As in ZO-1 staining, the pattern of immunolabeling with anti,,-actin antibody was diffuse in the mdx vessels and pointed or banded in the controls. ,-actin immunogold electron microscopy showed gold particles in the cytoplasms of endothelial cells and pericytes in the mdx mice, whereas ,-actin gold particles were revealed on the endothelial tight junctions and the cytoskeletal microfilaments of pericytes in the controls. Perivascular glial processes of the mdx mice appeared faintly stained by anti-AQP4 antibody, while in the controls a strong AQP4 labeling of glial processes was detected at light and electron microscope level. The vascular permeability of the mdx brain microvessels was investigated by means of the horseradish peroxidase (HRP). After HRP injection, extensive perivascular areas of marker escape were observed in mdx mice, whereas HRP was exclusively intravascularly localized in the controls. Inflammatory cells, CD4-, CD8-, CD20-, and CD68-positive cells, were not revealed in the perivascular stroma of the mdx brain. These findings indicate that dystrophin deficiency in the mdx brain leads to severe injury of the endothelial and glial cells with disturbance in ,-actin cytoskeleton, ZO-1, claudin-1, and AQP4 assembly, as well as BBB breakdown. The BBB alterations suggest that changes in vascular permeability are involved in the pathogenesis of the neurological dysfunction associated with DMD. GLIA 42:235,251, 2003. © 2003 Wiley-Liss, Inc. [source] Nerve perforation with pencil point or short bevelled needles: histological outcomeACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010T. STEINFELDT Background: In the case of needle nerve contact during peripheral blocks, pencil point needles are considered less traumatic compared with bevelled needles. However, there are not enough data to prove this notion. Therefore, the aim of this study was to challenge the hypothesis that nerve perforation with short bevelled needles is associated with major nerve damage compared with pencil point needles. Methods: In five anaesthetised pigs, the brachial plexus was exposed bilaterally. Up to eight nerves underwent needle nerve perforation using a pencil point needles cannula or an short bevelled needle. After 48 h, the nerves were resected. The specimens were processed for visual examination and the detection of inflammatory cells (haematoxylin,eosin, i.e. CD68-immunohistochemistry to detect macrophages), myelin damage (Kluver,Barrera staining) and intraneural haematoma. The grade of nerve injury was characterised by an objective score ranging from 0 (no injury) to 4 (severe injury). Results: Fifty nerves were examined. According to the injury score applied, there was no significant difference between the pencil point needles [median (inter-quartile range) 2.0 (2.0,2.0)] and the short bevelled-needle group [median 2.0 (2.0,2.0) P=0.23]. No myelin damage was observed. Signs of post-traumatic inflammation were equally distributed among both groups. Conclusions: In the present study, the magnitude of nerve injury after needle nerve perforation was not related to one of the applied needle types. Post-traumatic inflammation rather than structural damage of nerve tissue is the only notable sign of nerve injury after needle nerve perforation with either needle type. However, neither the pencil point- nor the short bevelled needle can be designated a less traumatic device. [source] Hepatocyte progenitors in man and in rodents , multiple pathways, multiple candidatesINTERNATIONAL JOURNAL OF EXPERIMENTAL PATHOLOGY, Issue 1 2005Joanna Laurson Summary In severe injury, liver-cell progenitors may play a role in recovery, proliferating, and subsequently differentiating into mature liver cells. Identifying these progenitors has major therapeutic potential for ex vivo pharmaceutical testing, bioartificial liver support, tissue engineering and gene therapy protocols. Potential liver-cell progenitors have been identified from bone marrow, peripheral blood, cord blood, foetal liver, adult liver and embryonic stem cells. Differences and similarities are found among cells isolated from rodents and humans. This review will discuss identifying markers and differentiation potential in in vitro and in vivo models of these putative progenitors in both humans and rodents. [source] Postinjury estrogen treatment of chronic spinal cord injury improves locomotor function in ratsJOURNAL OF NEUROSCIENCE RESEARCH, Issue 8 2010Eric A. Sribnick Abstract Spinal cord injury (SCI) causes loss of neurological function and, depending on serverity, may cause paralysis. The only recommended pharmacotherapy for the treatment of SCI is high-dose methylprednisolone, and its use is controversial. We have previously shown that estrogen treatment attenuated cell death, axonal and myelin damage, calpain and caspase activities, and inflammation in acute SCI. The aim of this study was to examine whether posttreatment of SCI with estrogen would improve locomotor function by protecting cells and axons and reducing inflammation during the chronic phase following injury. Moderately severe injury (40 g · cm force) was induced in male Sprague-Dawley rats following laminectomy at T10. Three groups of animals were used: sham (laminectomy only), vehicle (dimethyl sulfoxide; DMSO)-treated injury group, and estrogen-treated injury group. Animals were treated with 4 mg/kg estrogen at 15 min and 24 hr postnjury, followed by 2 mg/kg estrogen daily for the next 5 days. After treatment, animals were sacrificed at the end of 6 weeks following injury, and 1-cm segments of spinal cord (lesion, rostral to lesion, and caudal to lesion) were removed for biochemical analyses. Estrogen treatment reduced COX-2 activity, blocked nuclear factor-,B translocation, prevented glial reactivity, attenuated neuron death, inhibited activation and activity of calpain and caspase-3, decreased axonal damage, reduced myelin loss in the lesion and penumbra, and improved locomotor function compared with vehicle-treated animals. These findings suggest that estrogen may be useful as a promising therapeutic agent for prevention of damage and improvement of locomotor function in chronic SCI. © 2010 Wiley-Liss, Inc. [source] Fasting is neuroprotective following traumatic brain injury,JOURNAL OF NEUROSCIENCE RESEARCH, Issue 8 2008Laurie M. Davis Abstract To determine the neuroprotective effect of fasting after traumatic brain injury (TBI) and to elucidate the potential underlying mechanisms, we used a controlled cortical impact (CCI) injury model to induce either a moderate or a severe injury to adult male Sprague Dawley rats. Tissue-sparing assessments were used to determine the level of neuroprotection of fasting, hypoglycemia (insulin 10 U), or ketone (1.66 mmoles/kg/day or 0.83 mmoles/kg/day; D-beta-hydroxtbutyrate) administration. Mitochondrial isolation and respiratory studies were utilized to determine the functionality of mitochondria at the site of injury. We also investigated biomarkers of oxidative stress, such as lipid/protein oxidation, reactive oxygen species (ROS) production, and intramitochondrial calcium load, as a secondary measure of mitochondrial homeostasis. We found that fasting animals for 24 hr, but not 48 hr, after a moderate (1.5 mm), but not severe (2.0 mm), CCI resulted in a significant increase in tissue sparing. This 24-hr fast also decreased biomarkers of oxidative stress and calcium loading and increased mitochondrial oxidative phosphorylation in mitochondria isolated from the site of injury. Insulin administration, designed to mimic the hypoglycemic effect seen during fasting did not result in significant tissue sparing after moderate CCI injury and in fact induced increased mortality at some injection time points. However, the administration of ketones resulted in increased tissue sparing after moderate injury. Fasting for 24 hr confers neuroprotection, maintains cognitive function, and improves mitochondrial function after moderate (1.5 mm) TBI. The underlying mechanism appears to involve ketosis rather than hypoglycemia. © 2008 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||