Factors Contributing to Traffic Accidents in Hospitalized Patients in Terms of Severity and Functionality

Factors associated with external causes in elderly attended by the mobile emergency care service

OBJECTIVE

To analyze the prevalence and factors associated with external causes in elderly people attended by the mobile emergency care service.

METHOD

Cross-sectional study with 1,972 pre-hospital care records of elderly victims of external causes from 2019 to 2020. A descriptive and bivariate analysis was performed, with a significance level of 5% (p<0.05).

RESULTS

The prevalence of external causes in elderly people attended by the mobile emergency service was 12.2%. Falling was the most frequent occurrence. The associations of the occurrence of falls with age from 90 years old (OR=29.31; p<0.001) and female gender (OR=5.38; p<0.001) stood out, as well as the suspicion of ingestion of alcoholic beverages with occurrence of violence (OR=4.17; p<0.001) and traffic accidents (OR=1.97; p<0.001).

CONCLUSION

The study showed factors associated with injuries due to external causes in theelderly and may support the formulation of coping strategies for this problem.

The burden of head trauma in rural and remote North Queensland, Australia

BACKGROUND

Head trauma is a leading cause of death and disability worldwide. Young males, Indigenous people, and rural/remote residents have been identified as high-risk populations for head trauma, however, Australian research is limited. Our aim was to define and describe the incidence, demographics, causes, prehospital interventions, and outcomes of head trauma patients transported by aeromedical services within North Queensland, Australia. We hypothesized that young, Indigenous males living remotely would be disproportionately affected by head trauma.

METHODS

We conducted a retrospective study of all head trauma patients transferred by air to or between Townsville, Cairns, Mount Isa and Mackay Hospitals between January 1, 2016 and December 31, 2018. Patients were identified from the Trauma Care in the Tropics data registry and followed for a median 30-months post-injury. Primary endpoints were patient and injury characteristics. Secondary outcome measures were hospital stay and mortality.

RESULTS

A total of 981 patients were included and 31.1 % were Indigenous. Sixty-seven percent of injuries occurred remotely and the median time from injury to hospital was 5.8-hours (range 67-3780 min). Eighty percent of severe head injuries occurred in males (p = 0.007). Indigenous and remote patients were more likely to sustain mild injuries. The most common mechanism of injury overall was vehicle accident (37.5 %), compared to assault in the Indigenous subgroup (46.6 %, p<0.001). The overall mortality rate was 4.9 %, with older age and lower initial Glasgow Coma Score significant predictors of in-hospital mortality. Prehospital intubation was associated with a 7-fold increased risk of mortality (p = 0.056), while patients that received tranexamic acid (TXA) were almost 5-times more likely to die.

CONCLUSIONS

In North Queensland, young Indigenous males are at highest risk of traumatic head injuries. Vehicle accidents are an important preventable cause of head injury in the region. TXA administration is an important consideration for remote head trauma retrievals, in which time to emergency care is prolonged. Appropriate treatment and risk stratification strategies considering time to definitive care, severity of injury, and other prehospital patient factors require further investigation.

Design and Optimization of an Adaptive Knee Joint Orthosis for Biomimetic Motion Rehabilitation Assistance

In this paper, an adaptive knee joint orthosis with a variable rotation center for biomimetic motion rehabilitation assistance suitable for patients with knee joint movement dysfunction is designed. Based on the kinematic information of knee joint motion obtained by a motion capture system, a Revolute-Prismatic-Revolute (RPR) model is established to simulate the biomimetic motion of the knee joint, then a corresponding implementation for repetitively driving the flexion-extension motion of the knee joint, mainly assembled by a double-cam meshing mechanism, is designed. The pitch curve of each cam is calculated based on the screw theory. During the design process, size optimization is used to reduce the weight of the equipment, resulting in a reduction from 1.96 kg to 1.16 kg, achieving the goal of lightweight equipment. Finally, a prototype of the designed orthosis with the desired biomimetic rotation function is prepared and verified. The result shows that the rotation center of the prototype can achieve biomimetic motion coincident with the rotation center of an active knee joint, which can successfully provide rehabilitation assistance for the knee joint flexion-extension motion.