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Multiple Injuries (multiple + injury)
Selected AbstractsRisk evaluation and type of treatment of multiple dental trauma episodes to permanent teethDENTAL TRAUMATOLOGY, Issue 5 2000U. Glendor Abstract , Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident-prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6,18-year-old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12-year period (1976,1988). Forty-one of the patients were registered with MDTE with a range of 2,7 episodes and a mean of 2.9 episodes/patient (SD=1.1). The mean age at single and MDTE was 11.4 years (SD=3.6) and 8.6 years (SD=2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6,10 years than in the age interval 11,18 years (P<0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9,30.3% when the first trauma occurred before the age of 11, compared to 0,7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty-five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow-ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased. [source] Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint: Part 1EQUINE VETERINARY JOURNAL, Issue 8 2009Miss S. G. Dakin Summary Reasons for performing study: Osseous abnormalities. associated with collateral ligament (CL) injury of the distal interphalangeal (DIP) joint have been documented using magnetic resonance imaging (MRI) but there is currently limited information about the frequency of osseous pathology associated with CL injury. Objectives: To determine the frequency of occurrence of osseous abnormality coexistent with CL injury of the DIP joint and describe the distribution and character of osseous lesions; and to establish if there was an association between osseous abnormality and increased radiopharmaceutical uptake (IRU). Hypotheses: There would be a higher incidence of osseous abnormality at the insertion of an injured CL than at the origin; and a relationship between the presence of osseous abnormality and duration of lameness. Materials and methods: Magnetic resonance images of 313 feet of 289 horses with foot pain and a definitive diagnosis of collateral desmopathy of the DIP joint were analysed retrospectively for presence and type of osseous abnormality in the middle and distal phalanges. Scintigraphic images were examined and the presence of IRU in the middle or distal phalanges recorded. Results: Osseous abnormalities were detected in 143 (45.7%) feet, 27 (18.8%) of which had osseous and CL injury alone, while the remaining 116 had CL related osseous injury and multiple injuries within the hoof capsule. Entheseous new bone and endosteal irregularity of the middle and distal phalanges were the most frequent types of osseous abnormality. There was a higher incidence of osseous abnormalities medially than laterally and at the ligament insertion than at the origin. There was a significant association between presence of IRU and osseous injury. Conclusions: A variety of osseous lesions of differing severity are associated with CL injury. Normal radiopharmaceutical uptake does not preclude significant osseous pathology associated with CL injury. Clinical relevance: Further studies are necessary in order to determine if osseous abnormalities associated with CL injury influence prognosis for return to performance. [source] Ancient injury recidivism: an example from the Kerma period of ancient NubiaINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 2 2002Margaret Judd Abstract A topical trend in clinical research has been the study of repeat trauma, referred to by clinicians as "injury recidivism," which lends itself to the assessment of accumulated injuries among ancient people. The present investigation examined the healed injuries among two archaeological skeletal samples from the Kerma period (ca. 2500,1500 BC) of Sudanese Nubia. Both groups were known to have a high prevalence of multiple trauma,80% of 54 adults from the rural sites (O16 and P37) located near Dongola and 42% of 212 adults from the urban site of Kerma sustained nonfatal injuries. It was observed that a higher frequency of multi-injured adults displayed one or more violence-associated injury (cranial trauma, parry fracture). When all injuries were considered 38% of individuals with violence-related injuries had other traumatic lesions in contrast to 22% of individuals who experienced injuries associated with accidental falls (e.g., Colles', Smiths', Galeazzi, and paired forearm fractures), although this difference was not significant. When only the skulls and long bones were evaluated 81% of adults with multiple injuries to these major bones bore one or more violence-related injuries, while 60% of adults with single injuries sustained violence-related injuries. Most individuals with multiple injuries were male and less than 35 years of age; there was no significant difference in the frequency of violence- or accident-related multiple injury between the rural and urban communities. Although it cannot be established whether or not some of an individual's injuries were experienced during simultaneous or independent incidents, the pattern of multiple injury among these two ancient Nubian skeletal samples reflected the profile of injury recidivism observed by modern clinicians cross-culturally. Copyright © 2002 John Wiley & Sons, Ltd. [source] Predictors of delayed return to work after back injury: A case,control analysis of union carpenters in Washington StateAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 11 2009Kristen L. Kucera PhD Abstract Methods Union administrative records identified 20,642 union carpenters who worked in Washington State from 1989 to 2003. The Department of Labor and Industries provided records of workers' compensation claims and associated medical care. Work-related back claims (n,=,4,241) were identified by ANSI codes (back, trunk, or neck/back) or ICD-9 codes relevant to medical care consistent with a back injury. Cases (n,=,738) were defined as back injury claims with >90 days of paid lost time; controls (n,=,699) resulted in return to work within 30 days. Logistic regression models estimated odds ratios and 95% confidence intervals (OR, 95% CI) of delayed return to work (DRTW). Results Thirty percent of case claims and 8% of control claims were identified by an ICD-9 code. DRTW after back injury was associated with being female (2.7, 95% CI: 1.3,5.5), age 30,44 (1.2, 95% CI: 0.9,1.7) and age over 45 (1.6, 95% CI: 1.1,2.3), four or more years union experience (1.4, 95% CI: 1.1,1.8), previous paid time loss back claim (1.8, 95% CI: 1.3,2.5), and ,30-day delay to medical care (3.6, 95% CI: 2.1, 6.1). Evidence of more acute trauma was also associated with DRTW. Conclusions Use of ICD-9 codes identified claims with multiple injuries that would otherwise not be captured by ANSI codes alone. Though carpenters of younger age and inexperience were at increased risk for a paid lost time back injury claim, older carpenters and more experienced workers, once injured, were more likely to have DRTW as were those who experienced acute events. Am. J. Ind. Med. 52:821,830, 2009. © 2009 Wiley-Liss, Inc. [source] A qualitative evaluation of the Care of the Critically Ill Surgical Patient courseANZ JOURNAL OF SURGERY, Issue 10 2009Mario Giuseppe Zotti Abstract Background:, The Care of the Critically Ill Surgical Patient (CCrISP) course was adapted by the Royal Australasian College of Surgeons, being made compulsory for all Basic Surgical Trainees in 2001. The aim of this study was to evaluate whether the course objectives were achieved and identify strengths and weaknesses. Methods:, A retrospective cohort study was completed, after CCrISP Committee support of the proposed conduct, by distribution of questionnaires to instructors and trainees who had completed CCrISP in 2006 or earlier. The questionnaires were qualitative and designed to evaluate the success of CCrISP objectives. Results:, Fourteen instructors and 40 Victorian trainees completed the questionnaires. The major weaknesses identified by the instructors were the trainees' management of complications, nutrition, multiple injuries and sedation, procedural skills and mentoring. Trainees identified weaknesses in procedural skills and mentoring. Both groups identified the strongest areas being the emphasis on communication skills, utilization of clinical knowledge and acumen, management of shock and haemorrhage and management of the acute abdomen. The trainees further identified the systematic approach to the critically ill surgical patient as a major strength. Conclusion:, The primary objectives of the CCrISP course have been met. This study has identified teaching of communication skills, shock and haemorrhage and the systematic approach being the strengths of the course, whereas further refining of the mentoring process and reconsidering the importance of procedural skills is needed, both of which are secondary objectives. [source] Alteration of inflammatory response following small-volume resuscitationBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000F. Gebhard Background Small-volume resuscitation is rather effective in the primary volume treatment of major trauma. Blood pressure stabilizing effects occur immediately but last for a limited period only. Influences on inflammatory reactions in humans have not been reported so far. This prospective randomized study therefore analysed the inflammatory response in the very early (pre)clinical period after administration of crystalloids plus starch, hyperosmolar/hyperoncotic starch and lyophilized plasma solutions. Methods Upon approval of the ethics committee, 41 patients were enrolled with multiple injuries (injury severity score (ISS) mean 34 (range 9,75)). The patients received randomly either standard solutions, i.e. starch plus crystalloids (group C (control); n = 14), hyperosmolar/hyperoncotic starch (group S (small volume); n = 14) or lyophilized plasma (group L (lyoplasma); n = 13). Subsets were performed according to the different solutions as well as to the severity of trauma (ISS below 17, 18,31, 32 or more) and survivors/non-survivors. The first blood sample was obtained at the scene of the accident before cardiopulmonary resuscitation, when appropriate. Subsequently, blood samples were collected hourly. All samples were spun immediately at 4°C and stored at ,70°C. Interleukin (IL) 6 as well as several different prostaglandins (PGI2, thromboxane A2, PGE2) were determined to characterize the overall inflammatory response. Results Eleven casualties (seven men and four women, mean age 31 years) died because of major trauma within 24 h after the incident. In all patients IL-6 levels promptly increased within the first 2 h, most pronounced in patients with the severest trauma (ISS greater than 32) and non-survivors. Patients in groups C and S had a comparable time course of IL-6 plasma levels with a slightly higher release in minor injuries (ISS less than 30). The same was true for prostaglandins. In contrast, patients in group L had clearly higher IL-6 concentrations during the first 2,12 h, again most pronounced in those with the severest trauma (ISS greater than 32). Conclusion These results demonstrate that the early systemic inflammatory response after small-volume resuscitation is rather similar to that of patients infused with standard-volume therapy after trauma. In contrast, lyoplasma seems to increase the inflammatory response regardless of the injury severity. © 2000 British Journal of Surgery Society Ltd [source] Ancient injury recidivism: an example from the Kerma period of ancient NubiaINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 2 2002Margaret Judd Abstract A topical trend in clinical research has been the study of repeat trauma, referred to by clinicians as "injury recidivism," which lends itself to the assessment of accumulated injuries among ancient people. The present investigation examined the healed injuries among two archaeological skeletal samples from the Kerma period (ca. 2500,1500 BC) of Sudanese Nubia. Both groups were known to have a high prevalence of multiple trauma,80% of 54 adults from the rural sites (O16 and P37) located near Dongola and 42% of 212 adults from the urban site of Kerma sustained nonfatal injuries. It was observed that a higher frequency of multi-injured adults displayed one or more violence-associated injury (cranial trauma, parry fracture). When all injuries were considered 38% of individuals with violence-related injuries had other traumatic lesions in contrast to 22% of individuals who experienced injuries associated with accidental falls (e.g., Colles', Smiths', Galeazzi, and paired forearm fractures), although this difference was not significant. When only the skulls and long bones were evaluated 81% of adults with multiple injuries to these major bones bore one or more violence-related injuries, while 60% of adults with single injuries sustained violence-related injuries. Most individuals with multiple injuries were male and less than 35 years of age; there was no significant difference in the frequency of violence- or accident-related multiple injury between the rural and urban communities. Although it cannot be established whether or not some of an individual's injuries were experienced during simultaneous or independent incidents, the pattern of multiple injury among these two ancient Nubian skeletal samples reflected the profile of injury recidivism observed by modern clinicians cross-culturally. Copyright © 2002 John Wiley & Sons, Ltd. [source] | ||||||||||