A review of injury epidemiology in the UK and Europe: some methodological considerations in constructing rates

Toward the Application of Dual-Energy Computed Tomography with Virtual Non-Hydroxyapatite Color-Coded Maps to Identify Traumatic Fractures in Daily Emergency Settings

To evaluate the advantages of dual-energy computed tomography (DECT) virtual non-hydroxyapatite color mapping (VNHAP) in combination with standard bone CT (BCT) in the identification of subtle or occult traumatic fractures referred to emergency and acceptance departments (DEAs). Forty patients (22 men; mean age 83 ± 23.7 y) with suspected traumatic fractures referred to our emergency department and examined with a fast kilovoltage-switching single-source spectral CT scan between January and October 2023 were retrospectively reviewed. The BCT and VNHAP images were blindly evaluated by two radiologists with >10 years and <2 years of experience in musculoskeletal imaging. Both techniques were evaluated in terms of sensitivity (SE), specificity (SP), positive and negative predictive values (PPVs and NPVs) and accuracy for fracture detection, as confirmed at a 3-month clinical-instrumental follow-up. Inter-observer agreement and examination times were also analyzed. Fractures were confirmed in 18/40 cases. The highest values of diagnostic performance for VNHAP images were obtained in terms of SP (90.9% and 95%) and PPV (87.5% and 92.8%) and for the less experienced operator. No statistically significant differences were observed between the diagnostic accuracy of the two readers in the evaluation of VNHAP images. Inter-observer agreement was moderate (κ = 0.536) for BCT and substantial (κ = 0.680) for VNHAP. Comparing the two operators, a significantly longer examination time for BCT and no significant difference for VNHAP were registered. Our preliminary experience may encourage the employment of VNHAP maps in combination with BCT images in emergency settings. Their use could be time-saving and valuable in terms of diagnostic performance, especially for less experienced operators.

Epidemiology of Pediatric Musculoskeletal Trauma Patients Admitted to a Trauma Center in Northern India: A Prospective Cohort Study

Background Pediatric injuries are the leading cause of death and disability worldwide and place a considerable burden on nations with limited resources. A careful investigation of the epidemiology of pediatric musculoskeletal trauma can provide insight into its causation and the demography of the affected children and help us devise preventive strategies to reduce the burden of pediatric musculoskeletal trauma. Methodology Musculoskeletal trauma patients up to the age of 18 years were included in this prospective cohort study. Information about age, sex, time since the injury to presentation to a trauma center, mode of injury, the site where the injury was suffered, and the exact injury were recorded. Age was further recorded as 0 to 3 years, >3 to 6 years, >6 to 12 years, and >12 to 18 years. A subgroup analysis of the mode of injury was done using age group and sex.  Results A total of 201 patients were enrolled in the study. The age (mean ± standard deviation [SD]) of the enrolled patients was 12.48 ± 4.71 years. Of the 201 patients enrolled, 146 (72.63%) were males. The mean time since the injury to the reception in the emergency department of the King George's Medical University trauma center (a tertiary care center) was 19.13 ± 33.86 hours. The common mechanisms of injury observed were road traffic accidents (RTAs, 55.22%), falls from height (29.35%), and falls at ground level. There was a significant difference in the mode of injury in the age groups (P = 0.0297) and among males and females (P = 0.0034). Injuries to the lower limbs were most common in all age groups. Conclusions Our study presents the baseline epidemiological data on pediatric musculoskeletal injuries distributed by age groups, gender, mode of injury, site of injury, and region-wise distribution of injuries. The data may be used by policymakers in planning a pediatric trauma care system in India.

A Pilot Machine Learning Study Using Trauma Admission Data to Identify Risk for High Length of Stay

INTRODUCTION

Trauma patients have diverse resource needs due to variable mechanisms and injury patterns. The aim of this study was to build a tool that uses only data available at time of admission to predict prolonged hospital length of stay (LOS).

METHODS

Data was collected from the trauma registry at an urban level one adult trauma center and included patients from 1/1/2014 to 3/31/2019. Trauma patients with one or fewer days LOS were excluded. Single layer and deep artificial neural networks were trained to identify patients in the top quartile of LOS and optimized on area under the receiver operator characteristic curve (AUROC). The predictive performance of the model was assessed on a separate test set using binary classification measures of accuracy, precision, and error.

RESULTS

2953 admitted trauma patients with more than one-day LOS were included in this study. They were 70% male, 60% white, and averaged 47 years-old (SD: 21). 28% were penetrating trauma. Median length of stay was 5 days (IQR 3-9). For prediction of prolonged LOS, the deep neural network achieved an AUROC of 0.80 (95% CI: 0.786-0.814) specificity was 0.95, sensitivity was 0.32, with an overall accuracy of 0.79.

CONCLUSION

Machine learning can predict, with excellent specificity, trauma patients who will have prolonged length of stay with only physiologic and demographic data available at the time of admission. These patients may benefit from additional resources with respect to disposition planning at the time of admission.

OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis

The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.

Epidemiological characteristics of injury in Georgia: A one-year retrospective study

INTRODUCTION

Injury is a major health problem worldwide and a leading cause of death and disability. Disability caused by traumatic injury is often severe and long-lasting. Injuries place a large burden on societies and individuals in the community, both in cost and lost quality of life. Progress in developing effective injury prevention programs in developing countries is hindered by the lack of basic epidemiological injury data regarding the prevalence of traumatic injuries. The aim of this research was to describe the epidemiological characteristics of injury in all hospitals in Georgia.

METHODS

The database of the National Center for Disease Control and Public Health of Georgia for 2018, which includes all hospital admissions, was used to identify injury cases treated in hospitals. Cases were included based on the S and T diagnosis coded of ICD-10.

RESULTS

A total of 25,103 adult patients were admitted for an injury, of whom 14,798 (59%) were males and 10,305 (41%) were females, between the ages of 18 and 108 years old. The highest prevalence was among the age group 25-44 years old (n = 8654; 34%), followed by 45-64 years old (n = 6852; 27%). The main mechanism of injury was falls (n = 13,932; 55%) and exposure to mechanical forces (n = 2701; 11%). Over 1,50% (n = 379) of injuries resulted in death after hospitalization. The median hospital length of stay (LOS) was 2 days. There was a significant association between age, mechanism of injury, type of injury, performed surgical interventions, and longer LOS.

CONCLUSION

Injuries are prevalent throughout the life course and cause substantial hospitalization time. This research can help focus prevention efforts can focus on the demographic and injury causes that are most prevalent.

Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients

INTRODUCTION

The interaction of increasing age, Injury Severity Score (ISS), and complications is not well described in geriatric trauma patients. We hypothesized that failure to rescue rate from any complication worsens with age and injury severity.

METHODS

The National Trauma Data Bank (NTDB) was queried for injured patients aged 65 years or older from January 1, 2013 through December 31, 2016. Demographics and injury characteristics were used to compare groups. Mortality rates were calculated across subgroups of age and ISS, and captured with heatmaps. Multivariable logistic regression was performed to identify independent predictors of mortality.

RESULTS

614,496 geriatric trauma patients were included; 151,880 (24.7%) experienced a complication. Those with complications tended to be older, female, non-white, have non-blunt mechanism, higher ISS, and hypotension on arrival. Overall mortality was highest (19%) in the oldest (≥86 years old) and most severely injured (ISS ≥ 25) patients, with constant age increasing across each ISS group was associated with a 157% increase in overall mortality (P < .001, 95% CI: 148-167%). Holding ISS stable, increasing age group was associated with a 48% increase in overall mortality (P < .001, 95% CI: 44-52%). After controlling for standard demographic variables at presentation, the existence of any complication was an independent predictor of overall mortality in geriatric patients (OR: 2.3; 95% CI: 2.2-2.4).

CONCLUSIONS

Any complication was an independent risk factor for mortality, and scaled with increasing age and ISS in geriatric patients. Differences in failure to rescue between populations may reflect critical differences in physiologic vulnerability that could represent targets for interventions.

Epidemiology pattern of traumatic injuries of adults older than 15 years in Kashan, Iran: A population-based study in 2018-2019

Background: Trauma is the first leading cause of death and disability in the active population in developing countries. In Iran, traumatic injuries are the second leading cause of death after cardiovascular disease and also the leading cause of years of life lost (YLL). Population-based surveys can estimate all types of injuries. This study aimed to estimate the annual incidence of nonfatal injuries in adults older than 15 years in Kashan.

Methods: In a cross-sectional population-based study, people older than 15 years who were living in Kashan during 2018-2019 were studied. A cluster stratified sampling method was used. Data analysis was performed using SPSS 22 software. Chi-square and t tests and ANOVA were used to analyze the data. Significance level was set as P ≤.05 and confidence interval (CI) at 95%.

Results: In this study, which included 3880 households residing in Kashan during 2018-2019, the incidence of all injuries was estimated to be 70.61(62.60-78.70) per 1000 people in 1 year. For traffic accidents, the incidence was estimated at 36.08 (30.20-42.00) per 1000 in 1 year. Also, 231 (77.7%) of people with trauma were male, 137 (50.0%) aged 20 to 39 years, and 191 (69.7) were married. The most common cause of injuries (n = 140; 51.1%) was related to traffic accidents, and among the traffic accidents, the highest cause was motorcycle accident (n = 99; 70.71%).

Conclusion: The results of this study showed that the highest rate of injuries occurred among men, younger ages, married, and those with primary education. Also, the results showed the most common causes of trauma were injured hand and foot and head, and the most common location in which trauma occurred was street. The findings of this study are important to better explain the epidemiology aspects of injuries in Kashan.

The Relationship between the Metabolic Syndrome and the Risk of Obstructive Sleep Apnea Evaluated by STOP-Bang Questionnaire in Professional Drivers in Shahroud, Iran, in 2020: A Case-Control Study

Background

The present study was conducted to investigate the relationship between metabolic syndrome and the risk of respiratory and sleep disorders in professional drivers.

Methods

This case-control study was conducted on professional drivers in Shahroud, Iran. The snoring, tiredness during daytime, observed apnea, high blood pressure, body mass index, age, neck circumference, gender (STOP-Bang) questionnaire was first used to assess obstructive sleep apnea (OSA). Then, based on the questionnaire scores, the participants were divided into two groups: those with and those without OSA. The relationship between this disorder and metabolic syndrome was then studied. Data were analyzed using descriptive and analytical tests (P<0.05).

Results

Based on the STOP-Bang questionnaire, 214 drivers with a high risk of OSA and 214 drivers with low risk were recruited for the study. According to the Adult Treatment Panel III criteria, 204 drivers (47.7%) had metabolic syndrome. There was a significant relationship between driver's license class and the risk of OSA. Metabolic syndrome components including fasting blood sugar, triglycerides, and hypertension, but not high-density lipoprotein cholesterol, were able to predict OSA in the professional drivers.

Conclusion

Given the high prevalence of metabolic syndrome and OSA, especially in drivers of high risk who may spend long hours transporting good and operating passenger vehicles, screening and treating these disorders are crucial in this part of the population. The researchers recommend holding regular training sessions about these disorders for professional drivers.

Burns and socioeconomic deprivation: the experience of an adult burns centre

INTRODUCTION

Burns incidence, mortality and complication rates have been shown to be directly correlated by race, gender and socioeconomic status. As such, socioeconomic status (SES) has been previously highlighted as a target for burn prevention in the UK and abroad. The Queen Elizabeth Hospital, Birmingham (QEHB) is the regional Burns Centre for the Midlands Burn Network, supporting a population of 13.7 million METHODS: 16-year retrospective review was performed of all acute adult burns assessed by the Burns and Plastics Department, QEHB. The data included patient demographics (age, gender, ethnic origin and postcode), mechanism of injury, total body surface area (TBSA) affected and whether first aid was given. IMD Rank, IMD Scores were obtained from individual postcodes, as well as incidence data per electoral ward.

RESULTS

In our analyses there were 3369 total acute admissions and acute assessments. 812 patients (24.1%) were in the most deprived decile. 1715 patients (50.9%) live within the 3 most deprived deciles. The deciles with the lowest completion of first aid were the first (524, 70.72%), third (257, 72.39%) and second (351, 72.82%).

CONCLUSIONS

This study shows patients from the most deprived areas are over-represented in burns incidence and are less likely to perform first aid. We feel this should be highlighted in burns prevention and education strategies.

A meta-analysis on anticoagulation after vascular trauma

Purpose

There is much debate regarding the use of anticoagulation following vascular trauma. The aim of this meta-analysis was to compare the outcome of trauma following administration of anticoagulation medication.

Methods

The literature search was carried out using Ovid MEDLINE and PubMed databases to search for keywords and MeSH terms including “Anticoagulation”, “Vascular Surgery”, “Vascular Trauma”, “Vascular Repair”, “Repair” and “Wounds and Injuries”.

Results

Use of anticoagulation was associated with a better prognosis for overall vascular trauma outcomes (weighted OR 0.46; 95% CI 0.34–0.64; P < 0.00001), as well as reduced risk of amputation for both lower and upper limb vascular trauma (weighted OR 0.42; 95% CI 0.22–0.78; P = 0.007), and reduced occurrence of reoperation events and amputations in isolated lower limb vascular trauma (weighted OR 0.27; 95% CI 0.14–0.52; P < 0.0001).

Conclusion

There was a statistically significant correlation between the use of anticoagulation and vascular trauma outcome. A major limitation with many of the studies includes a lack of prospective analysis and therefore we recommend prospective studies to properly elucidate prognostic outcomes following use of these anticoagulants. Further studies need to be conducted to assess the effects of timing of anticoagulant delivery, dosages and severity of traumatic injury. Thus, this would prove to be very useful in the formation of guidelines.

Quality of Life and Clinical Outcome After Traumatic Spleen Injury (SPLENIQ Study): Protocol for an Observational Retrospective and Prospective Cohort Study

Background

Little is known about the effect of a splenic rupture on the quality of life (QOL) of patients, although the spleen is one of the most frequently injured organs in blunt abdominal trauma. It is essential to obtain more knowledge about QOL after traumatic spleen injury so that this can be taken into account when choosing treatment.

Objective

The primary objective of the SPLENic Injury and Quality of life (SPLENIQ) study is to determine QOL after treatment for traumatic spleen injury. The secondary objective is to investigate clinical and imaging outcome in relation to QOL.

Methods

A combination of a retrospective single-center and a prospective multicenter observational cohort study will be conducted. Patients in the retrospective study have had a splenic injury after blunt abdominal trauma and were admitted for treatment to the ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis) in Tilburg between January 2005 and February 2017. Concerning the prospective cohort study, patients with splenic injury admitted to 1 of the 10 participating hospitals between March 2017 and December 2018 will be asked to participate. The follow-up period will be 1 year regarding QOL, clinical symptoms, and imaging. Patients in the retrospective study will complete 2 questionnaires: World Health Organization QOL assessment instrument-Bref (WHOQOL-Bref) and 12-Item Short-Form Health Survey (SF-12). Patients in the prospective study will complete 5 questionnaires at 1 week, 1 month, 3 months, 6 months, and 12 months after treatment: WHOQOL-Bref, SF-12, Euroqol 5-Dimensional 5-Level (EQ-5D-5L) questionnaire, Institute for Medical Technology Assessment (iMTA) Productivity Cost Questionnaire (iPCQ), and iMTA Medical Consumption Questionnaire (iMCQ). In both the retrospective and prospective study, patients treated with splenic artery embolization will undergo magnetic resonance imaging (MRI). The retrospective group will undergo MRI once, and the prospective group will undergo MRI 1 month and 1 year after treatment. Treatment of splenic injury depends on the severity of the splenic injury, the hemodynamic condition of the patient, and the hospital’s or doctor’s preference. This study is observational in nature without randomization. Concerning the retrospective data, multivariate analysis of covariance will be done. With regard to the prospective data, mixed linear modeling will be performed.

Results

This project was funded in April 2015 by ZonMw. The results of the retrospective study will be expected in March 2019. With regard to the prospective study, inclusion of patients was completed in December 2018 and data collection will be completed in December 2019. The first results will be expected in 2019.

Conclusions

To our knowledge, this is the first study that examines QOL in patients with a traumatic spleen injury. The SPLENIQ study responds to the shortage of information about QOL after treatment for traumatic spleen injury and may result in the development of a patient-oriented protocol.

Trial Registration

ClinicalTrials.gov NCT03099798; https://clinicaltrials.gov/ct2/show/NCT03099798 (Archived by WebCite at http://www.webcitation.org/714ZKV6A0).

International Registered Report Identifier (IRRID)

DERR1-10.2196/12391

Unintentional injuries: A profile of hospitalization and risk factors for in-hospital mortality in Beijing, China

INTRODUCTION

Unintentional injuries (UIs) impose a significant burden on low- and middle-income countries (LMICs). However, available UI epidemiological data are limited for LMICs, including China. This article aimed to provide an overview of the UI hospitalization profile, identify risk factors for in-hospital mortality and provide diagnosis-specific survival risk ratios (SRRs) for reference by LMICs using hospital discharge abstract data (DAD) from Beijing, China.

PATIENTS AND METHODS

A cross-sectional study was conducted for patients sustaining UIs requiring admission. Information was retrieved from 138 hospitals in Beijing to describe the demographics, injury nature, mechanisms, severity and hospital outcomes. Multivariate logistic regression was performed to identify and evaluate risk factors for in-hospital mortality for UIs.

RESULTS

Falls (57.1%), transport accidents (19.9%) and exposure to inanimate mechanical forces (16.4%) were the leading causes of UI hospitalization. Falls and transport accidents were responsible for 94.2% of the in-hospital deaths caused by UIs. Injury mechanisms differed among sex (χ² = 5322.1, P <  0.001) and age (χ² = 24,143.3, P <  0.001) groups. Male sex (OR: 1.50, 95% confidence interval (CI): 1.23-1.79), age ≥ 85 years (OR: 16.39, 95% CI: 7.46-36.00), Barthel Index at admission ≤ 60 (OR: 25.78, 95% CI: 13.30-49.95), modified Charlson comorbidity index ≥ 6 (OR: 2.60, 95% CI: 1.91-3.55), International Classification of Diseases-based injury severity score (ICISS) < 0.85 (OR: 15.17, 95% CI: 12.57-18.30), sustaining injuries to the head/neck (OR: 23.20, 95% CI: 7.31-73.64), injuries caused by foreign body entering through natural orifice (OR: 34.00, 95%CI: 6.37-181.54) and injuries resulting from transport accidents (OR: 1.71, 95% CI: 1.41-2.07) were important risk factors for in-hospital mortality for UIs.

CONCLUSIONS

Hospital DAD are an objective and cost-effective data source that allows for a hospital-based perspective of UI epidemiology. Sex, age, functional status at admission, comorbidities, injury nature, severity and mechanism are significantly associated with the in-hospital mortality of UIs in China. This study generates a reference dataset of diagnosis-specific SRRs from a large trauma population in China, which may be more applicable in injury severity estimation using ICISS in LMICs.

Pattern of intentional drowning mortality: a total population retrospective cohort study in Australia, 2006-2014

BACKGROUND

While a downward trend in unintentional drowning deaths in Australia has been observed, little is known about intentional drowning mortality. Limited information on intentional drowning death impedes the planning, implementation, and evaluation of prevention strategies. This study aims to describe rates of intentional fatal drowning in Australia and compare these to other categories of drowning.

METHODS

Data were sourced from the Australian Bureau of Statistics (ABS) over a 9-year period (2006-2014). Rates and trends of intentional drowning were compared with unintentional, water-transport related and undetermined intent drowning. Rates of intentional drowning deaths across gender, age groups, states/territories, remoteness of residence and First Peoples of Australia were calculated. Relative risk (RR) (95% confidence interval [CI]) was calculated, and chi-square tests of independence were performed (p < 0.05).

RESULTS

The crude mortality rate for intentional drowning deaths in Australia over the study period was 0.23/100000, lower than unintentional drowning (0.89/100000). Males were 1.6 (CI: 1.4-2.0) times more likely than females to intentionally drown, however females made up a significantly larger proportion of intentional drowning deaths (38.2%) compared to unintentional deaths (22.4%) (χ2 = 47.3; df = 1; p < 0.05). A significant linear association between age group and intentional drowning was observed (χ2 = 131.3; p < 0.05), with individuals aged 75 years and over 32.6 times more likely to intentionally drown. Non-Indigenous peoples were 4.1 times more likely to intentionally drown in comparison to First Peoples of Australia. Residents of Inner Regional, Outer Regional, and Major Cities were 4.2 times (CI: 0.6-30.0), 4.1 times (CI: 0.6-29.9), and 4.0 times (CI: 0.6-28.6) more likely to intentionally drown, respectively, compared with residents of Very Remote areas.

CONCLUSIONS

This study adds to the limited evidence currently available about intentional drowning rates and trends in Australia. Being male, of older age groups, non-Indigenous, residing in Inner and Outer Regional areas, and Major Cities were risk factors for intentional drowning deaths. Improving data collection systems and furthering understanding of the risk factors of intentional drowning, as well as the development, implementation, and evaluation of prevention programmes, are required to reduce the risk of intentional drowning death in Australia.

Analysis and Forecasting the Accident Mortality Trends in the Islamic Republic of Iran Applying Lee-Carter Model During the Years 2006 to 2035

Objective:

To predict the accident mortality trend in next two decades in Iran.

Methods:

The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education of Iran during the years 2006 to 2015. The information was collected via death certificate, burial permit, and reporting forms. To forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1.

Results:

Based on the results, the highest percentage of all causes of death from accidents (in unintentional accidents) goes to transport accidents, and most top intentional accidents belonged to intentional self-harm. The trends of unintentional accidents in the whole population and both sexes have reduced from 2006 to 2035, such that the rate has reduced from 62.2 in 2006 to 12.1 per 100 thousand populations in 2035. It is anticipated that the causes of death due to intentional accidents with the rate of 8.86 in 2006, will be 1.89 (per 100,000 population) in the year 2035.

Conclusion:

Accident mortalities have a significant role in the deaths of Iranian population; therefore, to reduce the impact of accident mortality on society, a precise approach is needed to monitor the trends as well as preventing measures and increasing the safety standards.

Negative pressure wound therapy for open traumatic wounds

BACKGROUND

Traumatic wounds (wounds caused by injury) range from abrasions and minor skin incisions or tears, to wounds with extensive tissue damage or loss as well as damage to bone and internal organs. Two key types of traumatic wounds considered in this review are those that damage soft tissue only and those that involve a broken bone, that is, open fractures. In some cases these wounds are left open and negative pressure wound therapy (NPWT) is used as a treatment. This medical device involves the application of a wound dressing through which negative pressure is applied and tissue fluid drawn away from the area. The treatment aims to support wound management, to prepare wounds for further surgery, to reduce the risk of infection and potentially to reduce time to healing (with or without surgical intervention). There are no systematic reviews assessing the effectiveness of NPWT for traumatic wounds.

OBJECTIVES

To assess the effects of NPWT for treating open traumatic wounds in people managed in any care setting.

SEARCH METHODS

In June 2018 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.

SELECTION CRITERIA

Published and unpublished randomised controlled trials that used NPWT for open traumatic wounds involving either open fractures or soft tissue wounds. Wound healing, wound infection and adverse events were our primary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected eligible studies, extracted data, carried out a 'Risk of bias' assessment and rated the certainty of the evidence. Data were presented and analysed separately for open fracture wounds and other open traumatic wounds (not involving a broken bone).

MAIN RESULTS

Seven RCTs (1377 participants recruited) met the inclusion criteria of this review. Study sample sizes ranged from 40 to 586 participants. One study had three arms, which were all included in the review. Six studies compared NPWT at 125 mmHg with standard care: one of these studies did not report any relevant outcome data. One further study compared NPWT at 75 mmHg with standard care and NPWT 125mmHg with NPWT 75 mmHg.Open fracture wounds (four studies all comparing NPWT 125 mmHg with standard care)One study (460 participants) comparing NPWT 125 mmHg with standard care reported the proportions of wounds healed in each arm. At six weeks there was no clear difference between groups in the number of participants with a healed, open fracture wound: risk ratio (RR) 1.01 (95% confidence interval (CI) 0.81 to 1.27); moderate-certainty evidence, downgraded for imprecision.We pooled data on wound infection from four studies (596 participants). Follow-up varied between studies but was approximately 30 days. On average, it is uncertain whether NPWT at 125 mmHg reduces the risk of wound infection compared with standard care (RR 0.48, 95% CI 0.20 to 1.13; I2 = 56%); very low-certainty evidence downgraded for risk of bias, inconsistency and imprecision.Data from one study shows that there is probably no clear difference in health-related quality of life between participants treated with NPWT 125 mmHg and those treated with standard wound care (EQ-5D utility scores mean difference (MD) -0.01, 95% CI -0.08 to 0.06; 364 participants, moderate-certainty evidence; physical component summary score of the short-form 12 instrument MD -0.50, 95% CI -4.08 to 3.08; 329 participants; low-certainty evidence downgraded for imprecision).Moderate-certainty evidence from one trial (460 participants) suggests that NPWT is unlikely to be a cost-effective treatment for open fractures in the UK. On average, NPWT was more costly and conferred few additional quality-adjusted life years (QALYs) when compared with standard care. The incremental cost-effectiveness ratio was GBP 267,910 and NPWT was shown to be unlikely to be cost effective at a range of cost-per-QALYs thresholds. We downgraded the certainty of the evidence for imprecision.Other open traumatic wounds (two studies, one comparing NPWT 125 mmHg with standard care and a three-arm study comparing NPWT 125 mmHg, NPWT 75 mmHg and standard care)Pooled data from two studies (509 participants) suggests no clear difference in risk of wound infection between open traumatic wounds treated with NPWT at 125 mmHg or standard care (RR 0.61, 95% CI 0.31 to 1.18); low-certainty evidence downgraded for risk of bias and imprecision.One trial with 463 participants compared NPWT at 75 mmHg with standard care and with NPWT at 125 mmHg. Data on wound infection were reported for each comparison. It is uncertain if there is a difference in risk of wound infection between NPWT 75 mmHg and standard care (RR 0.44, 95% CI 0.17 to 1.10; 463 participants) and uncertain if there is a difference in risk of wound infection between NPWT 75 mmHg and 125 mmHg (RR 1.04, 95% CI 0.31 to 3.51; 251 participants. We downgraded the certainty of the evidence for risk of bias and imprecision.

AUTHORS' CONCLUSIONS

There is moderate-certainty evidence for no clear difference between NPWT and standard care on the proportion of wounds healed at six weeks for open fracture wounds. There is moderate-certainty evidence that NPWT is not a cost-effective treatment for open fracture wounds. Moderate-certainty evidence means that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. It is uncertain whether there is a difference in risk of wound infection, adverse events, time to closure or coverage surgery, pain or health-related quality of life between NPWT and standard care for any type of open traumatic wound.

Injury pyramid of unintentional injuries according to sex and age in South Korea

Objective

The injury-related disease burden in South Korea is relatively high compared to that in other nations. This study was conducted to identify the scale and causes of injury by severity, using an injury pyramid and analyzing the sex and age-dependent differences and the basic demographic characteristics.

Methods

Unintentional injury was estimated for each group after classifying injury-related deaths, hospitalizations, and outpatient department (OPD) visits based on their severity. The injury pyramid was calculated by classifying the injury outcomes into deaths, hospitalizations, and outpatient visits.

Results

The incidence of unintentional injury included 31.74 deaths, 1,715.27 hospitalizations, and 7,317.55 OPD visits per 100,000 persons. The incidence of injury was higher among males than that among females. There were more hospitalizations and OPD visits than deaths among females. The mortality and hospitalization rates due to injury per 100,000 persons were the highest among those ≥75 years old, and the OPD visit rate was the highest among preschool children aged 0 to 6 years. The injury mechanisms that caused most deaths and hospitalizations in South Korea were injuries related to traffic, falls, poisoning, and burns/fires.

Conclusion

The scale of unintentional injury varies based on sex, age, and injury mechanism; additionally there are differences in the incidence of injuries between males and females depending on their age and injury mechanism. The high incidence of injury in elderly people could be a factor that increases the burden of injury in South Korea; hence, it is necessary to develop an injury prevention program that targets the elderly.

Socioeconomic Status and Non-Fatal Adult Injuries in Selected Atlanta (Georgia USA) Hospitals

BACKGROUND

Injury mortality data for adults in the United States and other countries consistently show higher mortality for those with lower socioeconomic status (SES). Data are sparse regarding the role of SES among adult, non-fatal US injuries. The current study estimated non-fatal injury risk by household income using hospital emergency department (ED) visits.

METHODS

A total of 1,308,892 ED visits at 10 Atlanta (Georgia USA) hospitals from 2001-2004 (347,866 injuries) were studied. The SES was based on US census-block group income, with subjects assigned to census blocks based on reported residence. Logistic regression was used to determine risk by SES for injuries versus all other ED visits, adjusting for demographics, hospital, and weather. Supplemental analyses using hospital data from 2010-2013, without data on SES, were conducted to determine whether earlier patterns by race, age, and gender persisted.

RESULTS

Risk for many injury categories increased with higher income. Odds ratio by quartiles of increasing income (lowest quartile as referent, 95% confidence interval [CI] given for upper most quartile) were 1.00, 1.23, 1.34, 1.40 (95% CI 1.36-1.45) for motor vehicle accidents; 1.00, 1.03, 1.11, 1.24 (95% CI 1.20-1.29) for being struck by objects; 1.00. 0.99, 1.04, 1.12 (95% CI 1.00-1.25) for suicide; and 1.00, 1.03, 1.05, 1.12 (95% CI 1.09-1.15) for falls. In contrast, decreased injury risk with increased household income was seen for assaults (1.00, 0.83, 0.73, 0.67 [95% CI 0.63-0.72], by increasing quartiles). These trends by income did not differ markedly by race and gender. Whites generally had less risk of injuries, with the exception of assaults and motor vehicle accidents. Males had higher risk of injury than females, with the exception of falls and suicide attempts. Patterns of risk for race, age, and gender were consistent between 2001-2004 and 2010-2013.

CONCLUSION

For most non-fatal injuries, those with higher income had more risk of ED visits, although the opposite was true for assault. Hulland E , Chowdhury R , Sarnat S , Chang HH , Steenland K . Socioeconomic status and non-fatal adult injuries in selected Atlanta (Georgia USA) hospitals. Prehosp Disaster Med. 2017;32(4):403-413.

FDP/fibrinogen ratio reflects the requirement of packed red blood cell transfusion in patients with blunt trauma

PURPOSE

To find factors that predict the requirement of packed red blood cells (pRBC) transfusion in patients with blunt trauma on arrival at the hospital.

METHODS

We conducted blood tests in trauma patients whose trauma severity was suspected as being 3 and over in the Abbreviated Injury Scale. Patients were divided into the blood transfusion (BT) and control groups according to the requirement of pRBC transfusion within 24h after arrival.

RESULTS

We analyzed 347 patients (BT group, n=14; control group, n=333). On univariate analysis, there were significant differences in Glasgow Coma Scale (GCS), rate of positive FAST (focused assessment with sonography for trauma) finding, hematocrit, international normalized ratio of prothrombin time, activated partial thromboplastin time, fibrinogen (Fib), and level of fibrin degradation products (FDP). On multivariable analysis, positive FAST finding, GCS, Fib, and FDP influenced the requirement of pRBC transfusion. In the area under the receiver operating characteristic curve analysis, Fib and FDP were markers that predicted the requirement of pRBC transfusion. The FDP/Fib ratio had a better correlation with the requirement of pRBC transfusion than FDP or Fib.

CONCLUSIONS

The FDP/Fib ratio can be easily measured and may be a predictor of the need for pRBC transfusion.

Hospitalization costs and estimates of direct and indirect economic losses due to injury sustained in road traffic crashes: Results from a one-year cohort study in three European countries (The REHABILAID project)

Introduction

The financial cost of injuries sustained in road traffic crashes is high for victims, families and national budgets, but there is limited information on the cost of injury from the victims’ perspective, especially in terms of the hard-to-reach multi-trauma patient population such as those admitted to the intensive care units of hospitals.

Materials and methods

The current study received funding by the European Commission Directorate-General Mobility and Transport. It is a prospective, prevalence-based, cost-of-illness study. Participants admitted in the intensive care units of seven public hospitals in Greece, Germany and Italy because of injuries from road traffic crashes, during one year, were enrolled in the study. Patients were followed-up for one year after the intensive care unit admission to report emerging direct and indirect costs related to their injury.

Results

A total of 120 people were enrolled. Males, those aged 25–49, motorcyclists and those severely injured (Maximum Abbreviated Injury Scale (MAIS) 3+) with highest severity located at the central part of the body, accounted for the highest percentages of both the direct and indirect injury costs. The highest average direct costs were for females, those aged 50–64, pedestrians and those slightly injured (MAIS 1 or 2) with highest severity at the central region of the body. Males, patients aged 25–49, car passengers and truck drivers as well as those slightly injured (MAIS 1 or 2) with highest severity at multiple locations were over-represented in the average indirect costs.

Conclusions

Those groups that account for a high percentage of injury costs should be targeted in health policy initiatives.

The Epidemilogical Characteristics of Motorcyclists Associated Injuries in Road Traffics Accidents; A Hospital-Based Study

OBJECTIVES

To determine the epidemiology of injuries of the motorcyclists in road traffic accidents (RTIs) between 2008 and 2014 in East Azarbayejan province of Iran.

METHODS

A cross-sectional study was performed in East Azerbaijan province in Imam Reza hospital on motorcyclists subjected to injuries in RTIs between 2008 and 2014. Demographic characteristics (age, sex), duration of hospitalization, final status of injured people after discharge from the hospital, admission ward, number of admissions due to injuries in RTIs, nature of injury, and the clinical services provided to injured people were gathered from hospital information system (HIS). Demographic characteristics (age, sex), duration of hospitalization, final status of injured people after discharge from the hospital, admission ward, number of admissions due to injuries in RTIs, injured site of the body, nature of injury, and the clinical services provided injured people were gathered from HIS. Standardized data collection form was used for uniform handling of the data.

RESULTS

Most of the victims (94.4%) were male. The most frequent injuries pertained to the age group of 18-30 with 1676 (51.4%) injuries. Head, abdomen, lower back, lumbar spine, and pelvis, were the most common injured sites, respectively. Reduction of fracture and dislocation and cranial puncture were the most common provided services. The lowest survival time belonged to the age group over 60 years old.

CONCLUSION

Injuries to the head are the most prevalent injuries among motorcyclists in RTIs. So it is suggested that proper interventions be implemented to ensure wearing helmet by motorcyclist and pillion passengers.

Impact of socio-economic status on unplanned readmission following injury: A multicenter cohort study

BACKGROUND

Unplanned readmissions cost the US economy approximately $17 billion in 2009 with a 30-day incidence of 19.6%. Despite the recognised impact of socio-economic status (SES) on readmission in diagnostic populations such as cardiovascular patients, its impact in trauma patients is unclear. We examined the effect of SES on unplanned readmission following injury in a setting with universal health insurance. We also evaluated whether additional adjustment for SES influenced risk-adjusted readmission rates, used as a quality indicator (QI).

STUDY DESIGN

We conducted a multicenter cohort study in an integrated Canadian trauma system involving 56 adult trauma centres using trauma registry and hospital discharge data collected between 2005 and 2010. The main outcome was unplanned 30-day readmission; all cause, due to complications of injury and due to subsequent injury. SES was determined using ecological indices of material and social deprivation. Odds ratios of readmission and 95% confidence intervals adjusted for covariates were generated using multivariable logistic regression with a correction for hospital clusters. We then compared a readmission QI validated previously (original QI) to a QI with additional adjustment for SES (SES-adjusted QI) using the mean absolute difference.

RESULTS

The cohort consisted of 52,122 trauma admissions of which 6.5% were rehospitalised within 30 days of discharge. Compared to patients in the lowest quintile of social deprivation, those in the highest quintile had a 20% increase in the odds of all-cause unplanned readmission (95% CI=1.06-1.36) and a 27% increase in the odds of readmission due to complications of injury (95% CI=1.04-1.54). No association was observed for material deprivation or for readmissions due to subsequent injuries. We observed a strong agreement between the original and SES-adjusted readmission (mean absolute difference= 0.04%).

CONCLUSIONS

Patients admitted for traumatic injury who suffer from social deprivation have an increased risk of unplanned rehospitalisation due to complications of injury in the 30 days following discharge. Better discharge planning or follow up for such patients may improve patient outcome and resource use for trauma admissions. Despite observed associations, results suggest that the trauma QI based on unplanned readmission does not require additional adjustment for SES.

Preventing Child Pedestrian Injury: A Guide for Practitioners

Each year, an estimated 270,000 pedestrians die from road traffic-related injuries, (worldwide) and children are among the most vulnerable. Child pedestrian injuries occur primarily in residential areas, often on the same street or in close proximity to the child's home, and 90% of injured child pedestrians are unaccompanied by an adult at the time of the injury. The cause of these injuries is a complex combination of factors related not only to characteristics of the child but also the built environment, the road configuration, features of the motor vehicle that might reduce injury, and driver behavior. Accordingly, effective interventions must incorporate education, technology, and improved infrastructure. The medical practitioner can not only provide the necessary education but can also be a powerful voice for changes in pedestrian infrastructure that make walking safer. This article explores the current state of childhood pedestrian injuries using examples from the United States and Australia. Pedestrian interventions and the role that primary care and lifestyle practitioners play in promoting safe pedestrian behaviors among their patients and their families are discussed.

Epidemiology of Pediatric Trauma and Its Patterns in Western Iran: A Hospital Based Experience

BACKGROUND & OBJECTIVE

Trauma is a major cause of mortality in children aged 1 to 14 years old and its patterns differs from country to country. In this study we investigated the epidemiology and distribution of non-intentional trauma in the pediatric population.

MATERIALS & METHODS

The archives of 304 children below 10 years old who presented to Taleghani trauma care center in Kermanshah, Iran from March to September 2008, were reviewed. Patients' demographic and injury related information were registered. The participants were categorized into three age groups of 0-2, 3-6 and 7-10 years old and the data was compared among age groups and between both sexes.

FINDINGS

The most common cause for trauma was falling from heights (65.5%) and road traffic accidents (16.4%). The most common anatomical sites of injury were the upper limbs followed by the head and neck (36.8% and 31.2%, respectively). Injuries mostly occurred in homes (67.4%). The injuries were mostly related to the orthopedics and the neurosurgery division (84.1% and 13.1%, respectively). Accident rates peaked during the hours of 18-24 (41.3%). Male and female patients did display any difference regarding the variables.Children between the ages of 0-2 years old had the highest rate of injury to the head and neck area (40.3%) (p=0.024). Falls and road traffic accidents displayed increasing rates from the ages of 0-2 to 3-6 and decreasing rates to the ages of 7-10 years old (p=0.013). From the ages of 0-2 to 3-6 years old, street accidents increased and household traumas decreased. After that age household trauma rates increased and street accidents decreased (p=0.005). Children between the ages of 7-10 years old had the highest rate of orthopedic injury (p=0.029).

CONCLUSION

Special planning and health policies are needed to prevent road accidents especially in children between the ages of 3-6 years old. Since homes were the place where children between the ages of 0-2 were mostly injured, parents should be educated about the correct safety measures that they need to take regarding their children's environments. The orthopedics department needs to receive the most training and resources for the management of pediatric trauma.

Young adult's own and parental social characteristics predict injury morbidity: a register-based follow-up of 135,000 men and women

Background

Sociodemographic differences in injury mortality are well-established, but population-level studies on social patterns of injury morbidity remain few in numbers, particularly among young adults. Yet injuries are the leading cause of mortality, morbidity and disability among young people. Studies among children have shown steep social gradients in severe injuries, but less is known on the social patterning of injuries in late adolescence and early adulthood, when young people are in the process of becoming independent adults. This study examines how young adults’ current living arrangements, education, main economic activity, and parental social background are associated with hospital-treated injuries in late adolescence and early adulthood.

Methods

The study uses prospective, individual-level data gathered from several administrative sources. From a representative 11% sample of the total Finnish population, we included young people between ages 17–29 years during the follow-up (N = 134 938). We used incidence rates and Cox proportional hazards models to study hospital-treated injuries and poisonings in 1998–2008.

Results

Higher rates of injury were found among young adults living alone, single mothers, the lower educated and the non-employed, as well as those with lower parental social background, experience of childhood family changes or living with a single parent, and those who had left the parental home at a young age. Injury risks were consistently higher among young adults with lower education, but current living arrangements and main economic activity showed some age-related nuances in the associations: both earlier and later than average transitions in education, employment, and family formation associated with increased injury risks. The social differentials were strongest in poisonings, intentional self-harm, and assaults, but social patterns were also found in falls, traffic-related injuries and other unintentional injuries, underlining the existence of multiple distinct mechanisms and pathways behind the differentials.

Conclusions

The transition to adulthood is a life period of heightened risk of injury, during which both parental social background and the young people’s own social position are important determinants of serious injuries that require inpatient care.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1763-9) contains supplementary material, which is available to authorized users.

Premature mortality due to social and material deprivation in Nova Scotia, Canada

INTRODUCTION

Inequalities in health attributable to inequalities in society have long been recognized. Typically, those most privileged experience better health, regardless of universal access to health care. Associations between social and material deprivation and mortality from all causes of death--a measure of population health, have been described for some regions of Canada. This study further examines the link between deprivation and health, focusing on major causes of mortality for both rural and urban populations. In addition, it quantifies the burden of premature mortality attributable to social and material deprivation in a Canadian setting where health care is accessible to all.

METHODS

The study included 35,266 premature deaths (1995-2005), grouped into five causes and aggregated over census dissemination areas. Two indices of deprivation (social and material) were derived from six socioeconomic census variables. Premature mortality was modeled as a function of these deprivation indices using Poisson regression.

RESULTS

Premature mortality increased significantly with increasing levels of social and material deprivation. The impact of material deprivation on premature mortality was similar in urban and rural populations, whereas the impact of social deprivation was generally greater in rural populations. There were a doubling in premature mortality for those experiencing a combination of the most extreme levels of material and social deprivation.

CONCLUSIONS

Socioeconomic deprivation is an important determinant of health equity and affects every segment of the population. Deprivation accounted for 40% of premature deaths. The 4.3% of the study population living in extreme levels of socioeconomic deprivation experienced a twofold increased risk of dying prematurely. Nationally, this inequitable risk could translate into a significant public health burden.

Epidemiology of trauma in an acute care hospital in Singapore

Background:

Trauma injury is the leading cause of mortality and hospitalization worldwide and the leading cause of potential years of productive life lost. Patients with multiple injuries are prevalent, increasing the complexity of trauma care and treatment. Better understanding of the nature of trauma risk and outcome could lead to more effective prevention and treatment strategies.

Materials and Methods:

A retrospective review of 1178 trauma patients with Injury Severity Score (ISS) ≥ 9, who were admitted to the Acute and Emergency Care of an acute care hospital between January 2011 and December 2012. The statistical analysis included calculation of percentages and proportions and application of test of significance using Pearson's chi-square test or Fisher's exact test where appropriate.

Results:

Over the study period, 1178 patients were evaluated, 815 (69.2%) males and 363 (30.8%) females. The mean age of patients was 52.08 ± 21.83 (range 5-100) years. Falls (604; 51.3%) and road traffic accidents (465; 39.5%) were the two most common mechanisms of injury. Based on the three most common mechanisms of injury, i.e. fall on the same level, fall from height, and road traffic accident, the head region (484; 45.40%) was the most commonly injured in the body, followed by lower limbs (377; 35.37%) and thorax (299; 28.05%).

Conclusion:

Fall was the leading cause of injury among the elderly population with road traffic injuries being the leading cause among the younger group. There is a need to address the issues of injury control and prevention in these areas.

Inclusion of 'minor' trauma cases provides a better estimate of the total burden of injury: Queensland Trauma Registry provides a unique perspective

INTRODUCTION

Injury is recognised as a frequent cause of preventable mortality and morbidity; however, incidence estimates focusing only on the extent of mortality and major trauma may seriously underestimate the magnitude of the total injury burden. There currently exists a paucity of information regarding minor trauma, and the aim of this study was to increase awareness of the contribution of minor trauma cases to the total burden of injury.

METHODS

The demographics, injury details, acute care factors and outcomes of both minor trauma cases and major trauma cases were evaluated using data from the state-wide trauma registry in Queensland, Australia, from 2005 to 2010. The impact of changes in Abbreviated Injury Scale (AIS) versions on the classification of minor and major injury cases was also assessed.

RESULTS

Over the 6-year period, minor cases [Injury Severity Score (ISS) ≤ 12] accounted for almost 90% of all trauma included on the Queensland Trauma Registry (QTR). These cases utilised more than half a million acute care bed days, underwent more than 66,500 operations, and accounted for more than 48,000 patient transport episodes via road ambulance, fixed wing aircraft, or helicopter. Furthermore, more than 5800 minor trauma cases utilised in-hospital rehabilitation services; almost 3000 were admitted to an ICU; and more than 20,000 were admitted to hospital for greater than one week. When using the contemporary criteria for classifying trauma (AIS 08), the proportion of cases classified as minor trauma (87.7%) and major trauma (12.3%) were similar to the proportion using the traditional criteria for AIS90 (87.9% and 12.1%, respectively).

CONCLUSIONS

This evaluation of minor trauma cases admitted to public hospitals in Queensland detected high levels of demand placed on trauma system resources in terms of acute care bed days, operations, ICU admissions, in-hospital rehabilitation services and patient transportation, and which are all associated with high cost. These data convincingly demonstrate the significant burden of injury imposed by minor trauma cases serious enough to be admitted to hospital.

Population-wide incidence estimates for soft tissue knee injuries presenting to healthcare in southern Sweden: data from the Skåne Healthcare Register

Introduction

Soft tissue knee injury is a well-established and potent risk factor for development of knee osteoarthritis. However, there is a paucity of epidemiological data from the general population. Our aim was to estimate the annual person-level incidence for a wide spectrum of clinically diagnosed soft tissue knee injuries, and their distribution by age, sex, and season.

Methods

In Sweden, in- and outpatient health care is registered using each individuals’ unique personal identifier including International Classification of Diseases (ICD) 10 diagnostic code(s) as determined by physicians’ clinical examination. For the calendar years 2004–2012, we studied the population in southern Sweden, Skåne region (approx. 1.3 million). We identified residents who had at least one visit to a physician with clinically diagnosed knee ligament, meniscal, or other soft-tissue injury (S80.0, S83 and all subdiagnoses). We then calculated the mean annual incidence over the 9-year period. As a secondary objective, we investigated potential seasonal variation.

Results

The annual incidence for males and females was 766 (95% CI: 742, 789) and 676 (649, 702) per 100,000 persons/year respectively. For males and females, the peak rate occurred in 15 to 19 year-olds (1698 per 100,000 men and 1464 per 100,000 women, respectively). In women, rates were lowest in the 25 to 34 year-old age range before rising again between the ages of 35 and 49 years. We found substantial seasonal variation, greatest in men, with peaks in March-May and August-October.

Conclusions

The incidence of clinically diagnosed soft-tissue knee injury peaks in adolescence and emerging adulthood. However, a range of knee injuries continue to occur across the adult lifespan including at ages when osteoarthritis is typically diagnosed and managed. The potential cumulative effect on osteoarthritis progression of these injuries may warrant further investigation.

Electronic supplementary material

The online version of this article (doi:10.1186/ar4678) contains supplementary material, which is available to authorized users.

Paediatric head injuries treated in a children's emergency department from Cluj-Napoca, Romania

The aim of the study was to describe paediatric head injuries and identify factors that led to advanced care. Incident cases of head injuries that sought care from December 2008 to October 2010 at Children's Emergency Hospital Cluj-Napoca were evaluated. The main outcome was transfer or admission to advanced care. From a total of 3053 children treated for an injury, 1541 (50.4%) presented with head injury. A total of 960 (62.3%) of the children with a head injury required advanced care treatment. Young children were more likely to suffer a head injury than older children, but a higher proportion of older children required advanced care (70.3%). Children who suffered a head injury as a consequence of road traffic were almost five times more likely to require advanced care (OR: 4.97; 3.09-8.06) than being released. Our results suggest that data on injuries provide evidence-based information on the nature of injuries children are prone to, and what activity, type, and mechanism of injury impact Romanian children.

Homicidal injuries during January and February, 2011 in Mansoura City, Egypt

Studies dealing with analyzing cases of violence are very important, as these can be prevented to a high percentage. The aim of this study was to analyze the pattern of homicidal injuries compared to other causes of traumatic injuries in the population of Dakahlia province-Egypt during January and February, 2011 through reviewing cases' primary reports. In addition, the present work aimed to document traumatic injuries during the 25th January Egyptian revolution, 2011 in Mansoura City. Reports were reviewed for the available data including age, sex, residence as well as type, site, cause and mode of traumatic injuries. Out of 2270 cases' reports, 63.3% were from the Mansoura University Emergency hospital. Among the cases, 77.4% were males and 54.3% were from rural areas. Assaults (28%) were the 2nd leading cause of injuries preceded by road traffic accidents (29.8%). The commonest reported injuries due to assaults were cut wounds, contusions, firearm injuries and stab wounds while the commonest areas injured were the head, hands and chest. Assault injuries especially firearm injuries were more frequent during and shortly after revolution. Guns which are prohibited by law and other sharp and pointed instruments were freely used, a condition that is highly preventable by enforcing stringent laws.

Pattern of Traumatic Injuries and Injury Severity Score in a Major Trauma Center in Shiraz, Southern Iran

OBJECTIVE

To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran.

METHODS

This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We recorded the trauma injury information of 1217 patients who were admitted to of emergency room of the Nemazee hospital during a 13-months period by means of a standard questionnaire. ISS was then obtained for every single patient.

RESULTS

The mean age of patients was 26.6 ± 15.1 (range 1-95) years. The commonest type of trauma including 279 cases (22.9%) was car accident and the least resulted from shotgun injuries in 13 (1.1%) patients. The lowest ISS was due to assault multiple blunt traumas and the highest ISS resulted from shotgun injury. The mean ISS was about 6.3 ± 1.8 (range 1-66). Overall, 86 patients had scores above 17 (7.1%). A total of 69 male patients (7.5%) compared to 17 females (5.7%) had severe injury (ISS>17). Trauma injuries were significantly more severe in males compared to females (p=0.014). In the sunny and hot seasons total number of patient was higher. The mean ISS was highest in during spring (p<0.001).

CONCLUSION

In Shiraz, most of the trauma injuries are occurred during summer and hot weather. Men have greater number of injuries and higher ISS compared to women. The lowest ISS was due to assault multiple blunt trauma and the highest ISS was caused by shotgun injury, and car accident was the commonest cause of trauma with head and neck being the most frequent sites in our patients.

Penetrating assaults in children: often non-fatal near-miss events with opportunities for prevention in the UK

INTRODUCTION

Media reports portray a growing problem of gun and stab assaults amongst UK children. Recent legislative changes aim to increase integration between services and protect children better. Child victims of gun or stab assaults are at increased risk of reinjury and are therefore vital targets for interventions shown to be effective at preventing violent injury. There is currently a paucity of data with which to inform public debate, guide policy and develop prevention strategies. We therefore aimed to provide contemporary data on the epidemiology and clinical outcomes for intentional gun and stab injuries in children, using a large UK city as a model environment and also to ascertain whether interventions to prevent violent injury are currently in routine use in a sample of UK urban paediatric EDs.

METHODS

A retrospective case series analysis was performed of children (<16 years) attending Emergency Departments (EDs) in a typical major UK city with high levels of deprivation. In addition, we undertook a qualitative survey of a sample of UK urban paediatric EDs regarding their use of violent injury prevention strategies in children.

RESULTS

Contrary to media reports and data from London, rates of gun and stab assault remained unchanged through the study (2003-2008). Although tragic fatal injury can occur, the majority of injuries were minor, with most children not requiring admission. Of those admitted, a minority needed surgery (mainly wound debridement and closure). Socioeconomically deprived, adolescent boys appear to be particularly at risk, with attacks at weekends and in public spaces beyond home and school being more common. Interventions to prevent violent reinjury are not currently employed in paediatric EDs in the 15 most populated urban areas of the UK.

CONCLUSIONS

Patient safety literature emphasises the need to identify near miss events. Media reports of tragic child deaths due to gunshot and stabbing are actually accompanied by large numbers of minor wounds that we should see as near miss events. Measures shown to reduce reinjury in these high-risk groups could now be pursued in the UK for patient safety and child protection purposes.

The relationship between family socioeconomic condition and childhood injury frequency in selected locations in the Czech Republic

Background

Childhood injury rates are monitored worldwide because they markedly affect morbidity and mortality of children. There are numerous works that point out the relationship between family socioeconomic status and injuries, where lower socioeconomic levels are linked to higher numbers of injuries.

Material/Methods

The goal of this work was to evaluate the relationship between family socioeconomic status and childhood injuries in the Czech Republic. The research was carried out between 1/7/2009 and 31/12/2010. A 2-part questionnaire was used to gather information. The first part, “Injury/poisoning of children,” included information on the injury itself; the second part, “Family functionality,” concerned family socioeconomic situations. We collected a total of 874 questionnaires in the South-Bohemian region and 132 questionnaires from a selected county in the North-Bohemian region. A database identical with the questionnaire assignment was established, comprising all the data accumulated.

Results

The injury rate in families living in poor socioeconomic situations in locality 8 was statistically significantly higher compared to families in good socioeconomic situations. The number of home injuries was 205. Families with incomes that were twice the subsistence level had more child protective measures in their households. There was a statistically significant relationship between the number of child protective measures and injury frequency in families. Children in families having higher incomes (twice that of subsistence level) were more likely to suffer injuries related to organized sports as compared to those in families having lower incomes.

Conclusions

The literature and research data show that preventive programs have the largest effect on reduction in childhood morbidity and mortality with respect to injuries.

[Accidental mortality and compensation payment in school activities among elementary, middle and high school students in Seoul over twenty years (1988-2007)]

PURPOSE

The purpose of this study was to identify accidental mortality during school activities of students in elementary, middle or high school in Seoul and consequent compensation payment.

METHODS

Fifty-eight students died due to accidents during the period 1988 through 2007. Data were obtained from the Seoul School Safety and Insurance Association, and Seoul Metropolitan Office of Education. Chi-square, t test, and ANCOVA were used in the data analysis.

RESULTS

Among students, 75.9% were male and 37.9% were high school students. Accidental mortality was 1.61 per one million students (2.33 for male, and 0.82 for female students, and 0.93, 2.13 and 2.31 for elementary, middle and high school students, respectively). Mortality caused by drowning and falls per one million student was 0.85 and 0.74 for male, and 0.23 and 0.35 for female students. After age, year and cause were adjusted using ANCOVA, the mean compensation payment was 40,615 thousand won for male, and 62,000 thousands for female students. Highest compensation payment was 127,137 thousand for cerebral concussion after age, gender, year and cause were adjusted.

CONCLUSION

To decrease student accidental mortality, especially drowning and falls, development of efficient safety-enforcing education is essential to prevent injuries and avoid preventable compensation costs.

Epidemiological burden of minor, major and fatal trauma in a national injury pyramid

BACKGROUND

The impact of trauma on population health is underestimated because comprehensive overviews of the entire severity spectrum of injuries are scarce. The aim of this study was to measure the total health impact of fatal and non-fatal unintentional injury in the Netherlands.

METHODS

Epidemiological data for the four levels of the injury pyramid (general practitioner (GP) registry, emergency department (ED) registers, hospital discharge and mortality data) were obtained for the whole country. For all levels, the incidence and years of life lost (YLL) owing to premature death, years lived with disability (YLD) and disability-adjusted life-years (DALYs) were calculated.

RESULTS

Unintentional injury resulted in 67 547 YLL and 161 775 YLD respectively, amounting to 229 322 DALYs (14.1 per 1000 inhabitants). Home and leisure, and traffic injuries caused most DALYs. Minor injury (GP and ED treatment) contributed 37.3 per cent (85 504 DALYs; 5.2 per 1000) to the total burden of injury, whereas injuries requiring hospital admission contributed 33.3 per cent (76 271 DALYs; 4.7 per 1000) and fatalities contributed 29.5 per cent (67 547 DALYs; 4.1 per 1000). Men aged 15-65 years had the greatest burden of injury, resulting in a share of 39.6 per cent for total DALYs owing to unintentional injury. The highest individual burden resulted from death (19 DALYs per patient).

CONCLUSION

Trauma causes a major burden to society. For priority setting in public health and the identification of opportunities for prevention it is important that burden-of-injury estimates cover the entire spectrum of injuries, ranging from minor injury to death.

Trauma and amyotrophic lateral sclerosis: a case-control study from a population-based registry

BACKGROUND AND PURPOSE

Published reports on the association between amyotrophic lateral sclerosis (ALS) and trauma are controversial suggesting the need for a new case-control study done in a large population.

METHODS

A case-control study was undertaken in Italy to assess this association. Cases were patients with newly diagnosed ALS from four population-based registries. For each case, two hospital controls were selected, matched for age, sex, and province of residence, one with a neurological (non-degenerative) disease and one with a non-neurological disease (other than orthopedic or surgical). Traumatic events (defined as accidental events causing injuries requiring medical care) were recorded with details on type, site, timing, severity, and complications. The risks were assessed as odds ratios (ORs) with 95% confidence intervals (CI), crude and adjusted for age, sex, education, interviewee (patient or surrogate), physical activity, smoking, alcohol, and coffee.

RESULTS

The study population comprised 377 patients in each of the three groups. One or more traumatic events were reported by 225 cases (59.7%), 191 neurological controls (50.7%), and 179 non-neurological controls (47.5%) (P < 0.01) (OR 1.63; 95% CI 1.25-2.14) (P < 0.01). The ORs were 3.07 (95% CI 1.86-5.05) for patients reporting 3+ traumatic events and 2.44 (95% CI 1.36-4.40) for severe traumatic events. The ORs remained significant when the analysis was limited to events that occurred 5+ and 10+ years before ALS onset, to incident ALS, and direct informant.

CONCLUSION

Antecedent trauma, repeated trauma, and severe trauma may be risk factors for ALS.

Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review

Background

The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs) on fall prevention.

Methods

An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ≥ 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls".

Results

The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes.

Conclusions

No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.

Population based estimates of non-fatal injuries in the capital of Iran

Background

Fatal injuries are at the top of the injury pyramid; however, non-fatal injuries are quite common and impose huge medical expenses on the population. Relying on hospital data will underestimate the incidence of non-fatal injuries. The aim of this study was to estimate the annual incidence and out of pocket medical expenses of all injuries in urban population of Tehran (the capital city of Iran).

Methods

Using the cluster random sampling approach, a household survey of residents of greater Tehran was performed on April 2008. At randomly selected residential locations, interviewers asked one adult person to report all injuries which have occurred during the past year for all household members, as well as the type of injury, place of occurrence, the activity, cause of accidents resulting in injuries, the amount of out of pocket medical expenses for injury, and whether they referred to hospital.

Results

This study included 2,450 households residing in Tehran during 2007-8. The annual incidence of all injuries was 188.7 (180.7-196.9), significant injuries needing any medical care was 68.8 (63.7-74.2), fractures was 19.3 (16.6 - 22.4), and injuries resulted in hospitalization was 16.7 (14.2 - 19.6) per 1000 population. The annual incidence of fatal injuries was 33 (7-96) per 100,000 Population. In children aged 15 or less, the annual incidence of all injuries was 137.2 (120.0 - 155.9), significant injuries needing any medical care was 64.2 (52.2 - 78.0), fractures was 21.8 (15.0 - 30.7), and injuries resulted in hospitalization was 6.8 (3.3 - 12.5) per 1000 population. The mean out of pocket medical expense for injuries was 19.9 USD.

Conclusion

This population based study showed that the real incidence of non-fatal injuries in the capital of Iran is more than the formal hospital-based estimates. These injuries impose non trivial medical and indirect cost on the community. The out of pocket medical expense of non-fatal injuries to Tehran population is estimated as 27 million USD per year. Effective strategies should be considered to minimize these injuries and decrease the great financial burden to public and the health system.

Influence of socioeconomic status on trauma center performance evaluations in a Canadian trauma system

BACKGROUND

Trauma center performance evaluations generally include adjustment for injury severity, age, and comorbidity. However, disparities across trauma centers may be due to other differences in source populations that are not accounted for, such as socioeconomic status (SES). We aimed to evaluate whether SES influences trauma center performance evaluations in an inclusive trauma system with universal access to health care.

STUDY DESIGN

The study was based on data collected between 1999 and 2006 in a Canadian trauma system. Patient SES was quantified using an ecologic index of social and material deprivation. Performance evaluations were based on mortality adjusted using the Trauma Risk Adjustment Model. Agreement between performance results with and without additional adjustment for SES was evaluated with correlation coefficients.

RESULTS

The study sample comprised a total of 71,784 patients from 48 trauma centers, including 3,828 deaths within 30 days (4.5%) and 5,549 deaths within 6 months (7.7%). The proportion of patients in the highest quintile of social and material deprivation varied from 3% to 43% and from 11% to 90% across hospitals, respectively. The correlation between performance results with or without adjustment for SES was almost perfect (r = 0.997; 95% CI 0.995-0.998) and the same hospital outliers were identified.

CONCLUSIONS

We observed an important variation in SES across trauma centers but no change in risk-adjusted mortality estimates when SES was added to adjustment models. Results suggest that after adjustment for injury severity, age, comorbidity, and transfer status, disparities in SES across trauma center source populations do not influence trauma center performance evaluations in a system offering universal health coverage.

[<<RETRATO>> (REgistro de TRAuma grave de la provincia de TOledo): general view and mortality]

OBJECTIVE

To analyze the management and progression of the critical trauma patient.

DESIGN

A retrospective, descriptive analysis.

SETTING

The ICU in the province of Toledo.

PATIENTS

All patients with traumatic injury admitted during the 2001-2007 period (7 years).

MAIN VARIABLES OF INTEREST

These include the variables at the scene of the accident, pre-hospitalization, during transportation, variables on admission and during development until discharge or death.

RESULTS

A total of 1090 trauma patients admitted were included. Of these, 79.5% were male, with an average age of 36.5 years (16% ≥ 65 years). There was a progressive decrease of patients from 2001 (142 patients) to 2007 (133 patients), with 46.9% admissions between May and September. A total of 29.4% did not belong to the health area. The causes were car accident (43.3%), fall from a height/fall (20.8%), motorcycle accident (13.8%), pedestrian being run over (6.6%). There were 2172 injuries; 30.1% had 3 injuries and 8.4% ≥ 4. The most frequently occurring injury was a head injury (33.7%), followed by thoracic trauma (20.2%) and orthopedic trauma (15.6%). 36.4% required surgery on the first day. Average length of stay in the ICU was 10.4+/-13.2 days. Time on mechanical ventilation was 7.3+/-12 days (median 1 day). Fifteen percent died in the ICU. This remains within the multivariable ICU mortality prediction model, including the pre-hospitalization variables: age (OR 1.05; 95% CI: 1.03-1.06), mydriasis (OR 2.6; 95% CI: 1.3-5.3), motor component of the Glascow Coma Score (GCS) (OR 0.7; 95% CI: 0.6-0.8), pre-hospitalization shock (OR 3.2; 95% CI: 1.8-5.5) and Injury Severity Score (ISS) (OR 1.1; 95% CI: 1.05-1.1).

CONCLUSIONS

The use of multicenter trauma registers gives an overall view of trauma management and helps improve the care.