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Tenorio A, Hill LL, Doucet JJ. A border health crisis at the United States-Mexico border: an urgent call to action. Lancet Reg Health Am 2024; 31:100676. [PMID: 38304757 PMCID: PMC10827580 DOI: 10.1016/j.lana.2024.100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
In this Viewpoint, we provide an overview of the worsening trend of traumatic injuries across the United States-Mexico border after its recent fortification and height extension to 30-feet. We further characterize the international factors driving migration and the current U.S. policies and political climate that will allow this public health crisis to progress. Finally, we provide recommendations involving prevention efforts, effective resource allocation, and advocacy that will start addressing the humanitarian and economic consequences of current U.S. border policies and infrastructure.
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Affiliation(s)
- Alexander Tenorio
- Department of Neurosurgery, University of California, San Diego, San Diego, CA, USA
| | - Linda L. Hill
- School of Public Health, University of California, San Diego, San Diego, CA, USA
| | - Jay J. Doucet
- Department of Surgery, University of California, San Diego, San Diego, CA, USA
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2
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Kwee E, Borgdorff M, Schepers T, Halm JA, Winters HAH, Weenink RP, Ridderikhof ML, Giannakópoulos GF. Adjunctive hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries: a systematic review. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02426-2. [PMID: 38386077 DOI: 10.1007/s00068-023-02426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE Traumatic crush injuries of the lower limb often accompany severe complications. The incorporation of hyperbaric oxygen therapy to standard trauma care may have the potential to diminish injury-related complications and improve outcome in such cases. This systematic review aims to evaluate the effectiveness of hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries. METHODS The electronic databases Medline, Embase and Cochrane Library were searched to identify studies involving patients with crush-associated sever lower limb soft tissue injuries who received hyperbaric oxygen therapy in conjunction with standard trauma care. Relevant data on type of injury, hyperbaric oxygen therapy protocol and outcome related to wound healing were extracted. RESULTS In total seven studies met the inclusion criteria, involving 229 patients. The studies included two randomized clinical trials, one retrospective cohort study, three case series and one case report. The randomized placebo-controlled clinical trial showed a significant increase in wound healing and decrease in the need for additional surgical interventions in the patient group receiving hyperbaric oxygen therapy when compared to those undergoing sham therapy. The randomized non-placebo-controlled clinical trial revealed that early hyperbaric oxygen therapy reduces tissue necrosis and the likelihood of long-term complications. The retrospective cohort study indicated that hyperbaric oxygen therapy effectively reduces infection rates and the need for additional surgical interventions. The case series and case report presented beneficial results with regard to wound healing when hyperbaric oxygen therapy was added to the treatment regimen. CONCLUSION Hyperbaric oxygen therapy is generally considered a safe therapeutic intervention and seems to have a beneficial effect on wound healing in severe lower limb soft tissue injuries when implemented as an addition to standard trauma care.
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Affiliation(s)
- Esmee Kwee
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marieke Borgdorff
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jens A Halm
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hay A H Winters
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Robert P Weenink
- Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Milan L Ridderikhof
- Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Emergency Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Georgios F Giannakópoulos
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Twea P, Watkins D, Norheim OF, Munthali B, Young S, Chiwaula L, Manthalu G, Nkhoma D, Hangoma P. The economic costs of orthopaedic services: a health system cost analysis of tertiary hospitals in a low-income country. Health Econ Rev 2024; 14:13. [PMID: 38367132 PMCID: PMC10874068 DOI: 10.1186/s13561-024-00485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Traumatic injuries are rising globally, disproportionately affecting low- and middle-income countries, constituting 88% of the burden of surgically treatable conditions. While contributing to the highest burden, LMICs also have the least availability of resources to address this growing burden effectively. Studies on the cost-of-service provision in these settings have concentrated on the most common traumatic injuries, leaving an evidence gap on other traumatic injuries. This study aimed to address the gap in understanding the cost of orthopaedic services in low-income settings by conducting a comprehensive costing analysis in two tertiary-level hospitals in Malawi. METHODS We used a mixed costing methodology, utilising both Top-Down and Time-Driven Activity-Based Costing approaches. Data on resource utilisation, personnel costs, medicines, supplies, capital costs, laboratory costs, radiology service costs, and overhead costs were collected for one year, from July 2021 to June 2022. We conducted a retrospective review of all the available patient files for the period under review. Assumptions on the intensity of service use were based on utilisation patterns observed in patient records. All costs were expressed in 2021 United States Dollars. RESULTS We conducted a review of 2,372 patient files, 72% of which were male. The median length of stay for all patients was 9.5 days (8-11). The mean weighted cost of treatment across the entire pathway varied, ranging from $195 ($136-$235) for Supracondylar Fractures to $711 ($389-$931) for Proximal Ulna Fractures. The main cost components were personnel (30%) and medicines and supplies (23%). Within diagnosis-specific costs, the length of stay was the most significant cost driver, contributing to the substantial disparity in treatment costs between the two hospitals. CONCLUSION This study underscores the critical role of orthopaedic care in LMICs and the need for context-specific cost data. It highlights the variation in cost drivers and resource utilisation patterns between hospitals, emphasising the importance of tailored healthcare planning and resource allocation approaches. Understanding the costs of surgical interventions in LMICs can inform policy decisions and improve access to essential orthopaedic services, potentially reducing the disease burden associated with trauma-related injuries. We recommend that future studies focus on evaluating the cost-effectiveness of orthopaedic interventions, particularly those that have not been analysed within the existing literature.
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Affiliation(s)
- Pakwanja Twea
- University of Bergen, Bergen, Norway.
- Ministry of Health, Lilongwe, Malawi.
| | | | | | - Boston Munthali
- Lilongwe Institute of Orthopaedics and Neurosurgery, Lilongwe, Malawi
| | - Sven Young
- Lilongwe Institute of Orthopaedics and Neurosurgery, Lilongwe, Malawi
| | | | | | | | - Peter Hangoma
- University of Bergen, Bergen, Norway
- Chr. Michelson Institute (CMI), Bergen, Norway
- University of Zambia, Lusaka, Zambia
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Stomeo N, Ghio FE, Pallavicini P, Bonizzato S, Serini C, Perera Molligoda Arachchige AS, Carenzo L. Role of emergency teleradiology in a mass motorcycle event: the experience of the 2021 International Six Days of Enduro (ISDE). Emerg Radiol 2023; 30:725-731. [PMID: 37946090 DOI: 10.1007/s10140-023-02183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Provision of healthcare support at mass gathering sporting events is of paramount importance for the success of the event. Many of such events, like motorsports, have been increasingly taking place in remote and austere environments. In these settings, the use of first-line diagnostic tools, such as point of care ultrasound and portable X-ray, could aid in definitive care on the field for patients with minor trauma while also ensuring fast access to the appropriate level of care for patients requiring hospitalization. METHODS As part of the ISDE 2021 medical response plan, a field hospital equipped with portable digital X-ray and telemedicine was established. Data on patient admission, triage, treatments, diagnostics, and outcomes were collected for analysis. RESULTS During the 6-day competition, 79 patients sought medical care at the field hospital, with traumatic injuries accounting for 77% of cases. Of these, 47 were athletes and 32 were non-athletes. The majority (91%) arrived spontaneously, while 9% were transported directly. Upon admission, 68 patients were triaged as non-urgent (code 3) and 11 as urgent (code 2). Of those admitted, 69 received treatment and were discharged at the field hospital, while 10 were transferred elsewhere. Notably, four patients had major trauma, two had isolated fractures, and one needed a CT scan after losing consciousness. Overall, 29 missions were conducted on the race field, including 13 primary transports to local hospitals and 6 to the field hospital. Primary transport was primarily due to major trauma. Among 31 patients who had radiological exams, 11 (35.5%) had traumatic injuries. Of these, 5 were treated with braces and casts and discharged without hospitalization, 3 were advised for post-event care, and 3 were hospitalized. In contrast, patients with negative X-rays received on-site treatment, with 7 able to continue competing. CONCLUSIONS In summary, the successful implementation of portable X-ray machines and teleradiology at remote and austere high-risk sporting events holds great promise for enhancing on-site medical capabilities, allowing clinicians informed decisions, avoiding unnecessary hospitalization, and allowing athletes to continue with their competition. Provided that challenges related to cost, safety, connectivity, and power supply are effectively addressed.
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Affiliation(s)
- Niccolò Stomeo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy.
| | | | - Paolo Pallavicini
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Bonizzato
- Critical Care Team, I-HELP, Grezzago, Italy
- Sport Medicine and Sport Cardiology Unit, MEDITEL, Saronno, Italy
| | - Carlo Serini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Preda T, Nafi M, Villa M, Cassina T. Traumatic injuries after manual and automatic mechanical compression during cardiopulmonary resuscitation, a retrospective cohort study. Resusc Plus 2023; 16:100465. [PMID: 37711684 PMCID: PMC10497787 DOI: 10.1016/j.resplu.2023.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Chest compressions during advanced cardiac life support is a life-saving, potential harmful procedure with high incidence of severe and life-threatening injuries. Previous studies suggest a possible correlation between the increased incidence of chest and/or abdominal trauma and the use of automatic mechanical compression devices. Methods An observational monocentric retrospective cohort study was conducted including all patients admitted to our Intensive Care Unit suffering from out-of-hospital cardiac arrest (OHCA) in Canton Ticino (Switzerland) from 2012 to 2021. The primary endpoint was to describe any resuscitation-related body injury. The secondary endpoints were to explore possible predictors of cardiopulmonary resuscitation (CPR) related injuries and their association with the 30-day mortality. Results We included 335 patients, 287 treated with manual chest compressions, 48 mechanically assisted. 55.5% of all resuscitated patients presented severe, or life-threatening lesions. Skeletal and thoracic injuries were the most frequent lesions followed by abdominal injuries. Mechanical assisted resuscitated patients presented higher risk of bleeding (OR 5.9; 95% CI 2.9-11.6) and increased CPR-related injuries (aOR 6.2; 95% CI 2.5-15.4) compared to standard manual chest compressions. In particular higher number of extra-thoracic and life-threatening lesions were described among the mechanical assisted CPR group. Patients with life-threatening had statistically significant higher mortality at 30-days compared to the severe and lesion's free cohort. Conclusion Traumatic lesions occurred frequently after chest compression and their severity was associated with increased 30-day mortality. Mechanical devices, compared to manual chest compression, appear to be more harmful and may play a role in causing body lesions and hemorrhagic events.
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Affiliation(s)
- Thierry Preda
- Università della Svizzera Italiana (USI), Lugano, Switzerland
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Matteo Nafi
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Michele Villa
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tiziano Cassina
- Università della Svizzera Italiana (USI), Lugano, Switzerland
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Hassanzadeh R, Farhadian M, Rafieemehr H. Hospital mortality prediction in traumatic injuries patients: comparing different SMOTE-based machine learning algorithms. BMC Med Res Methodol 2023; 23:101. [PMID: 37087425 PMCID: PMC10122327 DOI: 10.1186/s12874-023-01920-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 04/13/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Trauma is one of the most critical public health issues worldwide, leading to death and disability and influencing all age groups. Therefore, there is great interest in models for predicting mortality in trauma patients admitted to the ICU. The main objective of the present study is to develop and evaluate SMOTE-based machine-learning tools for predicting hospital mortality in trauma patients with imbalanced data. METHODS This retrospective cohort study was conducted on 126 trauma patients admitted to an intensive care unit at Besat hospital in Hamadan Province, western Iran, from March 2020 to March 2021. Data were extracted from the medical information records of patients. According to the imbalanced property of the data, SMOTE techniques, namely SMOTE, Borderline-SMOTE1, Borderline-SMOTE2, SMOTE-NC, and SVM-SMOTE, were used for primary preprocessing. Then, the Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), Artificial Neural Network (ANN), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost) methods were used to predict patients' hospital mortality with traumatic injuries. The performance of the methods used was evaluated by sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), accuracy, Area Under the Curve (AUC), Geometric Mean (G-means), F1 score, and P-value of McNemar's test. RESULTS Of the 126 patients admitted to an ICU, 117 (92.9%) survived and 9 (7.1%) died. The mean follow-up time from the date of trauma to the date of outcome was 3.98 ± 4.65 days. The performance of ML algorithms is not good with imbalanced data, whereas the performance of SMOTE-based ML algorithms is significantly improved. The mean area under the ROC curve (AUC) of all SMOTE-based models was more than 91%. F1-score and G-means before balancing the dataset were below 70% for all ML models except ANN. In contrast, F1-score and G-means for the balanced datasets reached more than 90% for all SMOTE-based models. Among all SMOTE-based ML methods, RF and ANN based on SMOTE and XGBoost based on SMOTE-NC achieved the highest value for all evaluation criteria. CONCLUSIONS This study has shown that SMOTE-based ML algorithms better predict outcomes in traumatic injuries than ML algorithms. They have the potential to assist ICU physicians in making clinical decisions.
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Affiliation(s)
- Roghayyeh Hassanzadeh
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Farhadian
- Research Center for Health Sciences, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Hassan Rafieemehr
- Department of Medical Laboratory Sciences, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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Wohlgemut JM, Marsden MER, Stoner RS, Pisirir E, Kyrimi E, Grier G, Christian M, Hurst T, Marsh W, Tai NRM, Perkins ZB. Diagnostic accuracy of clinical examination to identify life- and limb-threatening injuries in trauma patients. Scand J Trauma Resusc Emerg Med 2023; 31:18. [PMID: 37029436 PMCID: PMC10082501 DOI: 10.1186/s13049-023-01083-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Timely and accurate identification of life- and limb-threatening injuries (LLTIs) is a fundamental objective of trauma care that directly informs triage and treatment decisions. However, the diagnostic accuracy of clinical examination to detect LLTIs is largely unknown, due to the risk of contamination from in-hospital diagnostics in existing studies. Our aim was to assess the diagnostic accuracy of initial clinical examination for detecting life- and limb-threatening injuries (LLTIs). Secondary aims were to identify factors associated with missed injury and overdiagnosis, and determine the impact of clinician uncertainty on diagnostic accuracy. METHODS Retrospective diagnostic accuracy study of consecutive adult (≥ 16 years) patients examined at the scene of injury by experienced trauma clinicians, and admitted to a Major Trauma Center between 01/01/2019 and 31/12/2020. Diagnoses of LLTIs made on contemporaneous clinical records were compared to hospital coded diagnoses. Diagnostic performance measures were calculated overall, and based on clinician uncertainty. Multivariate logistic regression analyses identified factors affecting missed injury and overdiagnosis. RESULTS Among 947 trauma patients, 821 were male (86.7%), median age was 31 years (range 16-89), 569 suffered blunt mechanisms (60.1%), and 522 (55.1%) sustained LLTIs. Overall, clinical examination had a moderate ability to detect LLTIs, which varied by body region: head (sensitivity 69.7%, positive predictive value (PPV) 59.1%), chest (sensitivity 58.7%, PPV 53.3%), abdomen (sensitivity 51.9%, PPV 30.7%), pelvis (sensitivity 23.5%, PPV 50.0%), and long bone fracture (sensitivity 69.9%, PPV 74.3%). Clinical examination poorly detected life-threatening thoracic (sensitivity 48.1%, PPV 13.0%) and abdominal (sensitivity 43.6%, PPV 20.0%) bleeding. Missed injury was more common in patients with polytrauma (OR 1.83, 95% CI 1.62-2.07) or shock (systolic blood pressure OR 0.993, 95% CI 0.988-0.998). Overdiagnosis was more common in shock (OR 0.991, 95% CI 0.986-0.995) or when clinicians were uncertain (OR 6.42, 95% CI 4.63-8.99). Uncertainty improved sensitivity but reduced PPV, impeding diagnostic precision. CONCLUSIONS Clinical examination performed by experienced trauma clinicians has only a moderate ability to detect LLTIs. Clinicians must appreciate the limitations of clinical examination, and the impact of uncertainty, when making clinical decisions in trauma. This study provides impetus for diagnostic adjuncts and decision support systems in trauma.
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Affiliation(s)
- Jared M Wohlgemut
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
- Ward 12D, Trauma Service, Royal London Hospital, Barts NHS Health Trust, Whitechapel Road, London, E1 1FR, UK.
| | - Max E R Marsden
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Ward 12D, Trauma Service, Royal London Hospital, Barts NHS Health Trust, Whitechapel Road, London, E1 1FR, UK
- Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine, Birmingham, UK
| | - Rebecca S Stoner
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Ward 12D, Trauma Service, Royal London Hospital, Barts NHS Health Trust, Whitechapel Road, London, E1 1FR, UK
| | - Erhan Pisirir
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Evangelia Kyrimi
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Gareth Grier
- London's Air Ambulance, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Michael Christian
- London's Air Ambulance, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Thomas Hurst
- London's Air Ambulance, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - William Marsh
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Nigel R M Tai
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Ward 12D, Trauma Service, Royal London Hospital, Barts NHS Health Trust, Whitechapel Road, London, E1 1FR, UK
- Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine, Birmingham, UK
| | - Zane B Perkins
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Ward 12D, Trauma Service, Royal London Hospital, Barts NHS Health Trust, Whitechapel Road, London, E1 1FR, UK
- London's Air Ambulance, Royal London Hospital, Barts Health NHS Trust, London, UK
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Zhai M, Bono K, Zhang WW, Bonne S, Gordon E, Zerbo E, Quijote H, Glass N. Drug and Alcohol Use in Trauma Patients Before and During the COVID-19 Pandemic. J Surg Res 2023; 283:999-1004. [PMID: 36915029 PMCID: PMC9691443 DOI: 10.1016/j.jss.2022.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Since the implementation of national stay-at-home orders during the COVID-19 pandemic, there has been rising concerns regarding prolonged social isolation that many individuals face. Given the link between increased stress and alcohol and drug use, our study investigated admission trends and patterns of alcohol and drug use in trauma patients. METHODS This was a single center, retrospective cohort study comparing trauma patients admitted before the pandemic and during the first wave. We compared patient demographics, injury characteristics, and outcomes of substance screen negative, positive, and unscreened patients admitted. Patients screened positive if they had a positive urine drug screen (UDS) and/or a blood alcohol concentration (BAC) ≥10 mg/dL. RESULTS There were 3906 trauma admissions in the year prior to and 3469 patients in the first year of the pandemic. No significant demographic differences were presented across time periods. Rates of UDS and BAC screening remained consistent. Equivalent rates of alcohol and drug positivity occurred (34% versus 33%, 17% versus 18%, P = 0.49). The total prevalence of alcohol use disorders (4% versus 5%, P < 0.001) and psychiatric disorders (6% versus 7%, P = 0.02) increased during the pandemic. CONCLUSIONS The prevalence of diagnosed alcohol use and psychiatric disorders in trauma patients increased during the COVID-19 pandemic while rates of acute alcohol and drug screen positivity remained the same. These observations suggest a possible link between pandemic stressors and exacerbation of alcohol use and psychiatric conditions in trauma patients. During a changing pandemic landscape, it remains pertinent to increased screening for these conditions regardless of substance screen positivity upon admission.
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Affiliation(s)
- Merry Zhai
- New Jersey Medical School, Newark, New Jersey
| | - Kristy Bono
- New Jersey Medical School, Newark, New Jersey
| | - Wei Wei Zhang
- New Jersey Medical School, General Surgery, Newark, New Jersey
| | - Stephanie Bonne
- New Jersey Medical School, General Surgery, Newark, New Jersey
| | - Emily Gordon
- New Jersey Medical School, Medicine, Newark, New Jersey
| | - Erin Zerbo
- New Jersey Medical School, Psychiatry, Newark, New Jersey
| | | | - Nina Glass
- New Jersey Medical School, General Surgery, Newark, New Jersey.
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Motamedi DS, Fitzgerald ZT, Schmit B, Mushtaq R. Spectrum of injuries with "less-lethal" beanbag weapons: pictorial essay. Emerg Radiol 2023; 30:119-126. [PMID: 36401711 DOI: 10.1007/s10140-022-02104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
Beanbag weapons are gaining popularity with increasing daily use as a non-lethal or less-lethal alternative to traditional firearms. While these are considered "less-lethal," these are associated with a spectrum of serious injuries. We present a pictorial essay of these injuries ranging from mild skin contusions to more severe solid organ injuries.
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Affiliation(s)
- Damon Salar Motamedi
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Berndt Schmit
- Department of Radiology, George Washington University, Washington, DC, USA
| | - Raza Mushtaq
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA.
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10
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Reitano E, Cioffi SPB, Airoldi C, Chiara O, La Greca G, Cimbanassi S. Current trends in the diagnosis and management of traumatic diaphragmatic injuries: A systematic review and a diagnostic accuracy meta-analysis of blunt trauma. Injury 2022; 53:3586-3595. [PMID: 35803743 DOI: 10.1016/j.injury.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/08/2022] [Accepted: 07/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic diaphragmatic injuries (TDI) are wounds or ruptures of the diaphragm due to thoraco-abdominal trauma. Nowadays, CT-scan is considered the gold standard for TDI diagnosis. The aim of this study was to assess the current diagnostic accuracy of CT-scan in the diagnosis of TDI and describe the management of this type of injury. METHODS A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers searched the literature in a systematic fashion using online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the diagnosis and the following management of TDI were included. Pooled estimates of sensitivity, specificity, and positive/negative likelihood (with corresponding 95% confidence intervals) were analyzed based on the bivariate model for blunt TDI. The Newcastle-Ottawa scale for cohort studies was used for the quality assessment of selected articles. The PROSPERO registration number was as follows: CRD42022301282. RESULTS Fifteen studies published between 2001 and 2019 were included. All included studies reported a contrast-enhanced computed tomography as the preferred method to obtain diagnostic imaging. Left-sided TDI was the type of injury most frequently found. False negative TDI at CT-scan were more frequent than false positive TDI (11.13 ± 23.24 vs. 2.66 ± 6.65). Six studies on blunt TDI were included in the meta-analysis, showing a high sensitivity [0.80 (95%CI 0.65-0.90)] and specificity [0.98 (95%CI 0.89-1.00)] of the CT-scan in detecting TDI. Overall, 7 articles reported laparotomy as the method of choice to repair TDI. Only 3 studies reported a laparoscopic and/or thoracoscopic approach to TDI repair. CONCLUSION CT-scan has a good sensitivity and specificity for blunt TDI diagnosis. However, TDI diagnosis and management are often delayed. The use of water-soluble contrast in CT-scan should be considered when the diagnosis of TDI is not defined after the first scan, and clinical suspicion is still high. In this context, a highly trained trauma team is essential for trauma management and correct imaging interpretation.
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Affiliation(s)
- Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
| | | | - Chiara Airoldi
- Unit of Medical Statistics and Epidemiology, Department of Translation Medicine, University of Piemonte Orientale, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Osvaldo Chiara
- Unit of Medical Statistics and Epidemiology, Department of Translation Medicine, University of Piemonte Orientale, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Gaetano La Greca
- Department of Biomedical and Biotechnological sciences, University of Catania, Via Santa Sofia 97, 95123, Catania, Italy
| | - Stefania Cimbanassi
- University of Milan, General surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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11
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Mulas V, Catalano L, Geatti V, Alinari B, Ragusa F, Golfieri R, Orlandi PE, Imbriani M. Major trauma with only dynamic criteria: is the routine use of whole-body CT as a first level examination justified? Radiol Med 2021; 127:65-71. [PMID: 34843028 DOI: 10.1007/s11547-021-01430-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Risks and benefits of systematic use of whole-body CT (WBCT) in patients with major trauma when no injury is clinically suspected is still subject of controversy. WBCT allows early identification of potentially evolving lesions, but exposes patients to the risk of high radiation dose and iodine contrast agent. The study aimed to assess if WBCT could be avoided in trauma patients with negative clinical examination. MATERIALS AND METHODS This retrospective study included polytrauma patients admitted to the Emergency Department in a six-month period, who had undergone a WBCT scan for major dynamic criteria, with hemodynamic stability, absence of clinical and medical risk factors for major trauma. The patients (n = 233) were divided into two groups according to the absence (n = 152) or presence (n = 81) of clinical suspicion of organ injury. The WBCT results were classified as negative, positive for minor and positive for major lesions. RESULTS The average patient age was 44 years. CT scans were completely negative in 111 (47.6%) patients, whose 104 (93.7%) were in the negative clinic group. 122 (52.4%) CT scans were positive, 69 (56.6%) for minor lesions and 53 (43.4%) for major lesions. Among the 48 (39.3%) positive CT scans in patients with negative clinic, only 5 (10.4%) were positive for major lesions. We found a significant difference in the frequency of injuries between the clinically negative and clinically positive patient groups (p < 0.001). CONCLUSION A thorough clinical examination associated with a primary radiological evaluation may represent a valid diagnostic approach for trauma with only major dynamic criteria to limit the use of WBCT.
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Affiliation(s)
- Violante Mulas
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola University Hospital, 40138, Bologna, Italy. .,Radiology Unit, Maggiore Hospital "Carlo Alberto Pizzardi", 40133, Bologna, Italy.
| | - Leonardo Catalano
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola University Hospital, 40138, Bologna, Italy.,Radiology Unit, Maggiore Hospital "Carlo Alberto Pizzardi", 40133, Bologna, Italy
| | - Valentina Geatti
- Radiology Unit, Santa Maria Della Scaletta Hospital, 40026, Imola, Italy
| | | | - Federica Ragusa
- Radiology Unit, Sant'Anna University Hospital, 44124, Ferrara, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola University Hospital, 40138, Bologna, Italy
| | - Paolo Emilio Orlandi
- Radiology Unit, Maggiore Hospital "Carlo Alberto Pizzardi", 40133, Bologna, Italy
| | - Michele Imbriani
- Radiology Unit, Maggiore Hospital "Carlo Alberto Pizzardi", 40133, Bologna, Italy
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12
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Eichinger M, Robb HDP, Scurr C, Tucker H, Heschl S, Peck G. Challenges in the PREHOSPITAL emergency management of geriatric trauma patients - a scoping review. Scand J Trauma Resusc Emerg Med 2021; 29:100. [PMID: 34301281 PMCID: PMC8305876 DOI: 10.1186/s13049-021-00922-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group. METHODS AND FINDINGS A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review. CONCLUSIONS Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.
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Affiliation(s)
- Michael Eichinger
- Major Trauma and Cutrale Perioperative and Ageing Group, Imperial College Healthcare NHS Trust, London, UK
| | - Henry Douglas Pow Robb
- Academic Clinical Fellow in General Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Cosmo Scurr
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | | | - Stefan Heschl
- Department of Cardiac, Thoracic and Vascular Anaesthesiology and Intensive Care, Medical University Hospital, Graz, Austria
| | - George Peck
- Cutrale Peri-operative and Ageing Group, Imperial College London, London, UK
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Abstract
PURPOSE OF REVIEW This review article seeks to highlight common youth athlete knee conditions due to overuse or trauma and elucidate differences from the adult populations. RECENT FINDINGS Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures. Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.
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Affiliation(s)
- Anne Kuwabara
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| | - Emily Kraus
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| | - Michael Fredericson
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
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14
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McGraw C, Salottolo K, Carrick M, Lieser M, Madayag R, Berg G, Banton K, Hamilton D, Bar-Or D. Patterns of alcohol and drug utilization in trauma patients during the COVID-19 pandemic at six trauma centers. Inj Epidemiol 2021; 8:24. [PMID: 33752758 PMCID: PMC7983106 DOI: 10.1186/s40621-021-00322-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Since the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions. We explored the impact of the national stay-at-home orders on alcohol or drug use and screenings among trauma admissions. Methods This was a retrospective cohort study at six Level I trauma centers across four states. Patients admitted during the period after the onset of the COVID-19 restrictions (defined as March 16, 2020-May 31, 2020) were compared with those admitted during the same time period in 2019. We compared 1) rate of urine drug screens and blood alcohol screens; 2) rate of positivity for drugs or alcohol (blood alcohol concentration ≥ 10 mg/dL); 3) characteristics of patients who were positive for drug or alcohol, by period using chi-squared tests or Fisher’s exact tests, as appropriate. Two-tailed tests with an alpha of p < 0.05 was used on all tests. Results There were 4762 trauma admissions across the study period; 2602 (55%) in 2019 and 2160 (45%) in 2020. From 2019 to 2020, there were statistically significant increases in alcohol screens (34% vs. 37%, p = 0.03) and drug screens (21% vs. 26%, p < 0.001). Overall, the rate of alcohol positive patients significantly increased from 2019 to 2020 (32% vs. 39%, p = 0.007), while the rate of drug positive patients was unchanged (57% vs. 52%, p = 0.13). Of the 1025 (22%) patients who were positive for alcohol or drugs, there were significant increases in a history of alcoholism (41% vs. 26%, p < 0.001), and substance abuse (11% vs. 23%, p < 0.001) in the 2020 period. No other statistically significant differences were identified among alcohol or drug positive patients during COVID-19 compared to the same period in 2019. Conclusions Our first wave of COVID-19 data suggests that trauma centers were admitting significantly more patients who were alcohol positive, as well those with substance use disorders, potentially due to the impact of social restrictions and guidelines. Further longitudinal research is warranted to assess the alcohol and drug positive rates of trauma patients over the COVID-19 pandemic.
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Affiliation(s)
- Constance McGraw
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA
| | - Kristin Salottolo
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA
| | - Matthew Carrick
- Trauma Services Department, Medical City Plano, Plano, TX, USA
| | - Mark Lieser
- Trauma Services Department, Research Medical Center, Kansas City, MO, USA
| | - Robert Madayag
- Trauma Services Department, St. Anthony Hospital, Lakewood, CO, USA
| | - Gina Berg
- Trauma Services Department, Wesley Medical Center, Wichita, KS, USA
| | - Kaysie Banton
- Trauma Services Department, Swedish Medical Center, Englewood, CO, USA
| | - David Hamilton
- Trauma Services Department, Penrose-St. Francis Health Services, Colorado Springs, CO, USA
| | - David Bar-Or
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA.
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15
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Paydar S, Parva E, Ghahramani Z, Pourahmad S, Shayan L, Mohammadkarimi V, Sabetian G. Do clinical and paraclinical findings have the power to predict critical conditions of injured patients after traumatic injury resuscitation? Using data mining artificial intelligence. Chin J Traumatol 2021; 24:48-52. [PMID: 33358634 PMCID: PMC7878456 DOI: 10.1016/j.cjtee.2020.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 09/18/2020] [Accepted: 10/10/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The triage and initial care of injured patients and a subsequent right level of care is paramount for an overall outcome after traumatic injury. Early recognition of patients is an important case of such decision-making with risk of worse prognosis. This article is to answer if clinical and paraclinical signs can predict the critical conditions of injured patients after traumatic injury resuscitation. METHODS The study included 1107 trauma patients, 16 years and older. The patients were trauma victims of Levels I and II triage and admitted to the Rajaee (Emtiaz) Trauma Hospital, Shiraz, in 2014-2015. The cross-industry process for data mining methodology and modeling was used for assessing the best early clinical and paraclinical variables to predict the patients' prognosis. Five modeling methods including the support vector machine, K-nearest neighbor algorithms, Bagging and Adaboost, and the neural network were compared by some evaluation criteria. RESULTS Learning algorithms can predict the deterioration of injured patients by monitoring the Bagging and SVM models with 99% accuracy. The most-fitted variables were Glasgow Coma Scale score, base deficit, and diastolic blood pressure especially after initial resuscitation in the algorithms for overall outcome predictions. CONCLUSION Data mining could help in triage, initial treatment, and further decision-making for outcome measures in trauma patients. Clinical and paraclinical variables after resuscitation could predict short-term outcomes much better than variables on arrival. With artificial intelligence modeling system, diastolic blood pressure after resuscitation has a greater association with predicting early mortality rather than systolic blood pressure after resuscitation. Artificial intelligence monitoring may have a role in trauma care and should be further investigated.
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Affiliation(s)
- Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Parva
- Technical and Vocational University, Shiraz, Iran,Corresponding author.
| | - Zahra Ghahramani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeedeh Pourahmad
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Shayan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Mohammadkarimi
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golnar Sabetian
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Giuseppe G, Ilaria M, Federico D, Alessandro C, Simona G, Nazerian P, Marco B, Stefano G. Severe thoracic or abdominal injury in major trauma patients can safely be ruled out by "Valutazione Integrata Bed Side" evaluation without total body CT scan. Ir J Med Sci 2020; 190:799-805. [PMID: 32888166 DOI: 10.1007/s11845-020-02351-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND During the initial assessment of trauma patients, the severity of injury is very often not immediately recognizable. In trauma centers, a total body CT (TBCT) scan is routinely used to evaluate this kind of patients, even if it is burdened with health risk, economical costs, and logistical difficulties. AIM We investigated the use of a clinical guide to establish a safe alternative to this routine practice. METHODS We enrolled retrospectively 438 patients referring to the Emergency Department of Careggi University Hospital in Florence (Italy) over a 1-year period from 2014 to 2015, with the evidence of trauma and high-priority triage codes and then subjected to TBCT. We created a tool called VIBS ("Valutazione Integrata Bed Side") (from the Italian translation of "Bed Side Integrated Evaluation") which included all clinical, laboratory, and diagnostic data acquired bedside during the primary survey. Every VIBS profile was dichotomized in negative or positive if there was at least one altered item. We performed an analysis of correlation between VIBS and TBCT to determine sensibility, specificity, positive, and negative predictive value and likelihood ratio of VIBS. RESULTS Sensibility of VIBS in the prediction of positive CT scan was 100% and specificity was 31.7%. Positive and negative predictive value (95% C.I.) was 44.3 (38.8-49.5) and 100 (94.0-99.9). Positive and negative likelihood ratios were 1.464 and 0. Failure rate resulted in 0% and efficiency was 20.54%. CONCLUSIONS VIBS can safely rule out severe thoracic or abdominal injuries. This approach could limit the use of TBCT in one-fifth of suspected major trauma patients.
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Affiliation(s)
| | - Melara Ilaria
- Emergency Medicine Fellowship Program, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Coppa Alessandro
- Department of Emergency Medicine, S.Giuseppe Hospital, Empoli, Italy
| | | | | | - Bartolini Marco
- Department of Radiology, Careggi University Hospital, Florence, Italy
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17
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Brants A, van der Woude B, IJsseldijk M, Vy DT, Verbeek R. A validation study for a clinical decision rule for acute wrist injury. Eur J Trauma Emerg Surg 2020. [PMID: 32880006 DOI: 10.1007/s00068-020-01474-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Acute wrist injury is a common reason for visiting the emergency department. To date, there are no implemented clinical decision rules to predict a fracture in this group of patients. We previously identified six clinical predictors in adult patients with acute wrist trauma. The aim of this study was to validate these predictors as a decision rule in a validation cohort. METHODS This prospective cohort study was conducted in the emergency department at five hospitals in the Netherlands and included adults with acute wrist injury. All collaborating physicians performed a standardized physical examination and data were collected in a case report form. The main outcome was defined as the radiographic presence of a wrist fracture. Six clinical variables that were significantly associated with a fracture (ρ < 0.01) were included in a model to develop the clinical decision rule. RESULTS A total of 493 fractures in 724 patients were identified by radiographic assessment. Almost all of the clinical variables were associated with the presence of a fracture. Our decision rule had a sensitivity of 0.97 (95% CI 0.96-0.99) with a specificity of 0.26 (95% CI 0.20-0.32) in this validation cohort. Application of the decision rule resulted in a reduction in radiographic assessment rate of 10% at the cost of missing 2% of the fractures. CONCLUSION The decision rule showed a high sensitivity and low specificity, possible due to the high pre-test probability of a wrist fracture in the cohort. Our study needs further validation in other populations.
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18
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Gill S, Sutherland M, McKenney M, Elkbuli A. U.S. alcohol associated traffic injuries and fatalities from 2014 to 2018. Am J Emerg Med 2020; 38:2646-9. [PMID: 33041116 DOI: 10.1016/j.ajem.2020.07.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alcohol-impaired motor vehicle collision (MVC) fatalities comprise almost a third of total crash fatalities in the United States (U.S.). They also impose 20% of the total costs of MVCs annually. This study aims to evaluate an association between blood alcohol concentration (BAC) and number of crash injuries and fatalities from 2014 to 2018 in the U.S. Additionally, we aim to recommend solutions to reduce alcohol-impaired driving related injuries and fatalities. METHODS A retrospective analysis of National Highway Traffic Safety Administration (NHTSA) data of crash injuries, fatalities, and BAC levels (0.00 g/dl, 0.01-0.07 g/dl, and ≥ 0.08 g/dl) from 2014 through 2018. Descriptive statistical analysis and independent sample t-tests were conducted, with significance defined as p < .05. RESULTS Compared to BAC 0.01-0.07 g/dl,BAC ≥0.08 g/dl resulted in significantly more injuries (6779 vs. 1357, p < .001) and fatalities (10,522 vs. 1894, p < .001). CONCLUSION BAC level ≥ 0.08 g/dl produced significantly greater injuries and fatalities in comparison to lower BAC levels evaluated. Given the effects of alcohol-impaired driving on MVCs, the legal BAC level should be re-evaluated to protect citizens and reduce incidence of alcohol related traffic injuries and fatalities. Educational programs promoting responsible alcohol consumption need to be in place for individuals at high risk for driving under the influence.
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Abstract
Traumatic injuries are described as injuries resulting from external or internal forces that can affect the quality of life of the patients. Different types of facial structures are injured due to traumatic forces. Multiple injuries can occur depending upon intensity of forces. The management of traumatic dental injuries is often difficult. Various types of management techniques have been advocated for comprehensive treatment of traumatic injuries. Splinting has become one of the commonly used methods for management of traumatized teeth. It helps in repositioning and stabilization of teeth. Different types of splints have been used for management of traumatic injuries depending on the type of injury and type of fixation required. The purpose of this case series is to present management of traumatic injuries to anterior teeth in children using different types of splints. Four cases have been included in this case series. Different types of splints have their own advantages and disadvantages and should be applied judiciously depending upon the type and extent of traumatic injuries.
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Affiliation(s)
- Mridula Goswami
- Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Arshad Eranhikkal
- Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
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20
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Eskandari F, Shafieian M, Aghdam MM, Laksari K. A knowledge map analysis of brain biomechanics: Current evidence and future directions. Clin Biomech (Bristol, Avon) 2020; 75:105000. [PMID: 32361083 DOI: 10.1016/j.clinbiomech.2020.105000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/27/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
Although brain, one of the most complex organs in the mammalian body, has been subjected to many studies from physiological and pathological points of view, there remain significant gaps in the available knowledge regarding its biomechanics. This article reviews the research trends in brain biomechanics with a focus on injury. We used published scientific articles indexed by Web of Science database over the past 40 years and tried to address the gaps that still exist in this field. We analyzed the data using VOSviewer, which is a software tool designed for scientometric studies. The results of this study showed that the response of brain tissue to external forces has been one of the significant research topics among biomechanicians. These studies have addressed the effects of mechanical forces on the brain and mechanisms of traumatic brain injury, as well as characterized changes in tissue behavior under trauma and other neurological diseases to provide new diagnostic and monitoring methods. In this study, some challenges in the field of brain injury biomechanics have been identified and new directions toward understanding the gaps in this field are suggested.
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Affiliation(s)
- Faezeh Eskandari
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Mehdi Shafieian
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran.
| | - Mohammad M Aghdam
- Department of Mechanical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Kaveh Laksari
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
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21
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Quiroz HJ, Parreco J, Easwaran L, Willobee B, Ferrantella A, Rattan R, Thorson CM, Sola JE, Perez EA. Identifying Populations at Risk for Child Abuse: A Nationwide Analysis. J Pediatr Surg 2020; 55:135-139. [PMID: 31757508 PMCID: PMC7848807 DOI: 10.1016/j.jpedsurg.2019.09.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 09/29/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Child abuse is a national, often hidden, epidemic. The study objective was to determine at-risk populations that have been previously hospitalized prior to their admission for child abuse. METHODS The Nationwide Readmissions Database (NRD) was queried for all children hospitalized for abuse. Outcomes were previous admissions and diagnoses. χ2 analysis was used; significance equals p < 0.05. RESULTS 31,153 children were hospitalized for abuse (half owing to physical abuse) during the study period. 11% (n = 3487) of these children had previous admissions (one in three to a different hospital), while 3% (n = 1069) had multiple hospitalizations. 60% of prior admissions had chronic conditions, and 12% had traumatic injuries. Children with chronic conditions were more likely to have sexual abuse (89% vs. 57%, p < 0. 001) and emotional abuse (75% vs. 60%, p < 0. 01). 25% of chronic diagnoses were psychiatric, who were also more likely to have sexual and emotional abuse (47% vs. 5.5% and 10% vs. 1%, all p < 0. 001). CONCLUSION This study uncovers a hidden population of children with past admissions for chronic conditions, especially psychiatric diagnoses that are significantly associated with certain types of abuse. Improved measures to accurately identify at-risk children must be developed to prevent future childhood abuse and trauma. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Hallie J. Quiroz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, RMSB RM 1010, 1600 NW 10th Avenue, Miami, Florida 33136,Corresponding author. Tel.: +1 316 253-8950. (H.J. Quiroz)
| | - Joshua Parreco
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | | | - Brent Willobee
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Anthony Ferrantella
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Chad M. Thorson
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Juan E. Sola
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Eduardo A. Perez
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
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Ferreira MT, Coelho C, Cunha E, Wasterlain SN. Evidences of trauma in adult African enslaved individuals from Valle da Gafaria, Lagos, Portugal (15th-17th centuries). J Forensic Leg Med 2019; 65:68-75. [PMID: 31108434 DOI: 10.1016/j.jflm.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/25/2022]
Abstract
The aim of this work is to discuss the frequency of traumatic bone injuries in a quite unique skeletal assemblage of enslaved people from Valle da Gafaria, Lagos, Portugal (15th-17th centuries). In all, 30 males, 58 females, and 15 individuals of unknown sex were included in the study. The skeletal remains were macroscopically observed for traumatic lesions. When present, the traumatic bone injuries were classified as having occurred ante or perimortem. The antemortem lesions were also studied through radiological analysis. Traumatic lesions were identified in 11 men (36.7%), 23 women (39.7%) and two individuals of unknown sex (13.3%). From these 36 individuals, 61.1% presented antemortem trauma, 25.0% perimortem trauma and 13.9% exhibited simultaneously ante and perimortem trauma. The mechanism of all traumatic injuries was blunt force trauma. From the 9965 analysed bones, 186 exhibited traumatic lesions (87 antemortem, 97 perimortem, and two with both ante and perimortem lesions). The bone more affected by antemortem trauma was the 5th right intermediate foot phalange (40.0%) and by perimortem trauma was the skull (11.4%), probably related to accidents and interpersonal violence, respectively. When analysed by sex, the only significant differences were found in the skull and the right 5th proximal foot phalanges, men (57.1%) presenting more lesions than women (15.4%). The obtained results are consistent with an arduous life, corroborating historical sources which document labour accidents, physical punishments and hard work in the populations of slaves.
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Affiliation(s)
- Maria Teresa Ferreira
- Laboratory of Forensic Anthropology, Centre for Functional Ecology, Department of Life Sciences, University of Coimbra, Portugal; Centro de Investigação em Antropologia e Saúde, Department of Life Sciences, University of Coimbra, Portugal.
| | - Catarina Coelho
- Laboratory of Forensic Anthropology, Centre for Functional Ecology, Department of Life Sciences, University of Coimbra, Portugal
| | - Eugénia Cunha
- Laboratory of Forensic Anthropology, Centre for Functional Ecology, Department of Life Sciences, University of Coimbra, Portugal; Instituto Nacional de Medicina Legal e Ciências Forenses, IP, Portugal
| | - Sofia N Wasterlain
- Laboratory of Forensic Anthropology, Centre for Functional Ecology, Department of Life Sciences, University of Coimbra, Portugal; Centro de Investigação em Antropologia e Saúde, Department of Life Sciences, University of Coimbra, Portugal
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Yamaguchi R, Makino Y, Chiba F, Torimitsu S, Yajima D, Inokuchi G, Motomura A, Hashimoto M, Hoshioka Y, Shinozaki T, Iwase H. Frequency and influencing factors of cardiopulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 Guidelines: a retrospective study based on autopsy and postmortem computed tomography. Int J Legal Med 2017; 131:1655-1663. [PMID: 28905100 DOI: 10.1007/s00414-017-1673-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 08/30/2017] [Indexed: 02/08/2023]
Abstract
AIM To determine the frequency of cardiopulmonary resuscitation (CPR)-related injuries and factors involved in their occurrence, data based on forensic autopsy and postmortem computed tomography (PMCT) during implementation of the 2010 American Heart Association Guidelines for CPR were studied. METHODS We retrospectively evaluated data on adult patients with non-traumatic deaths who had undergone manual CPR and autopsy from January 2012 to December 2014. CPR-related injuries were analyzed on autopsy records and PMCT images and compared with results of previous studies. RESULTS In total, 180 consecutive cases were analyzed. Rib fractures and sternal fractures were most frequent (overall frequency, 66.1 and 52.8%, respectively), followed by heart injuries (12.8%) and abdominal visceral injuries (2.2%). Urgently life-threatening injuries were rare (2.8%). Older age was an independent risk factor for rib fracture [adjusted odds ratio (AOR), 1.06; 95% confidence interval (CI), 1.04-1.08; p < 0.001], ≥ 3 rib fractures (AOR, 1.06; 95% CI, 1.02-1.09; p = 0.002), and sternal fracture (AOR, 1.03; 95% CI, 1.01-1.05; p < 0.001). Female sex was significantly associated with sternal fracture (AOR, 2.08; 95% CI, 1.02-4.25; p = 0.04). Chest compression only by laypersons was inversely associated with rib and sternal fractures. Body mass index and in-hospital cardiac arrest were not significantly associated with any complications. The frequency of thoracic skeletal injuries was similar to that in recent autopsy-based studies. CONCLUSIONS Implementation of the 2010 Guidelines had little impact on the frequency of CPR-related thoracic skeletal injuries or urgently life-threatening complications. Older age was the only independent factor related to thoracic skeletal injuries.
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Affiliation(s)
- Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan.,Education and Research Center of Legal Medicine, Department of Forensic Radiology and Imaging, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Mari Hashimoto
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
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Naik RM, Pennemetsa RR, Reddy S, Gadde P, Rayapureddy S. "Quirky Bulb" On the Lower Jaw: An Organizing Haematoma. J Clin Diagn Res 2017; 11:ZD01-ZD02. [PMID: 28893050 PMCID: PMC5583842 DOI: 10.7860/jcdr/2017/16485.10148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/07/2015] [Indexed: 11/24/2022]
Abstract
Organizing Haematoma is a rare, non/neoplastic benign lesion with locally destructive behaviour that may mimic a malignancy. Usually symptoms do not occur, while the lesion remains localized. An Organized Haematoma is an encapsulated blood clot undergoing neovascularization and fibrosis. It has also been referred to as a hemophilic pseudotumour and/or a haematoma like tumour, which is rarely found in the head and neck region. Other reported cases have been related to trauma or an underlying haemangioma. However, most of the cases have no identifiable underlying pathology, trauma or systemic disease. We are reporting an unusual presentation of Organizing Haematoma over the edentulous mandible.
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Affiliation(s)
- Raghavendra Mahadev Naik
- Reader, Department of Oral Medicine and Radiology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | | | - Sudhakara Reddy
- Professor, Department of Oral Medicine and Radiology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Praveen Gadde
- Senior Lecturer, Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Sruthi Rayapureddy
- Postgraduate Student, Department of Oral Medicine and Radiology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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25
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Piccolo CL, Galluzzo M, Ianniello S, Trinci M, Russo A, Rossi E, Zeccolini M, Laporta A, Guglielmi G, Miele V. Pediatric musculoskeletal injuries: role of ultrasound and magnetic resonance imaging. Musculoskelet Surg 2017; 101:85-102. [PMID: 28155066 DOI: 10.1007/s12306-017-0452-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Abstract
Pediatric musculoskeletal system is particularly prone to traumatic and sports-related injuries, both acute and chronic, i.e., overuse injuries, because of inherent conditions of weakness, such as the open physis, representing the weakest aspect within the bone, the ligamentous supports and changing biomechanics. Being aware that a quick diagnosis is essential to preserve the good functionality of the limb involved, it is mandatory for the radiologist to recognize the most common patterns of these injuries, identifying those requiring a prompt surgery, as well as be confident with the technique performed, and be supported by an important background experience and knowledge skills.
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Abstract
The advent of multi-detector computed tomography (MDCT) has drastically improved the outcomes of patients with multiple traumatic injuries. However, there are still diagnostic challenges to be considered. A missed or the delay of a diagnosis in trauma patients can sometimes be related to perception or other non-visual cues, while other errors are due to poor technique or poor image quality. In order to avoid any serious complications, it is important for the practicing radiologist to be cognizant of some of the most common types of errors. The objective of this article is to review the various types of errors in the evaluation of patients with multiple trauma injuries or polytrauma with MDCT.
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Affiliation(s)
- Mariano Scaglione
- Department of Diagnostic Imaging, P.O. Pineta Grande, Castel Volturno, Caserta, Italy.,Department of Radiology, Dartford & Gravesham NHS Trust, Dartford, UK
| | - Francesco Iaselli
- Department of Diagnostic Imaging, P.O. Pineta Grande, Castel Volturno, Caserta, Italy. .,, 118, Corso Umberto I, 80138, Naples, Italy.
| | - Giacomo Sica
- U.O. Radiologia, Stabilimento Ospedaliero di Nottola - Montepulciano, Ospedali Riuniti della Valdichiana, Siena, Italy
| | - Beatrice Feragalli
- Section of Diagnostic Imaging, Department of Clinical Sciences and Bioimaging, University Gabriele D'Annunzio, Chieti, Italy
| | - Refky Nicola
- Division of Emergency Imaging, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, 14642, USA
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27
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Abbas I, Mohammad SA, Peddireddy PR, Mocherla M, Koppula YR, Avidapu R. Oral Health Status of Underground Coal Mine Workers of Ramakrishnapur, Adilabad District, Telangana, India - A Cross-Sectional Study. J Clin Diagn Res 2016; 10:ZC28-31. [PMID: 26894171 DOI: 10.7860/jcdr/2016/15777.7059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/09/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Standard of living and quality of life of people has been improved by the expanding industrial activity, but at the other end it has created many occupational hazards. Coal mining is one of the major age old industries throughout the world and in India. Till date very less literature is available worldwide and in India concerning the oral health status of laborers in this field. AIM To assess the oral health status of underground coal mine workers, oral hygiene practices, alcohol and tobacco habits. MATERIALS AND METHODS A cross-sectional descriptive study was conducted among the underground coal mine workers of a coal mine located in Adilabad district, Telangana, according to the criteria described in the World Health Organization (WHO) Oral Health Assessment form (2013). STATISTICAL ANALYSIS Descriptive statistics were done. RESULTS A total of 356 workers participated in the study. Ninety percent of the subjects were with tobacco and/or alcohol habits. Dental caries was prevalent in more than half (55.6%) of the study subjects with a mean DMFT of 2.32±2.99. About 48.3% study subjects were with untreated dental caries and 20.3% subjects were with missing teeth. DMFT ≤=6 was seen in 45.5% of subjects and 10.1% have DMFT scores ≥=7. Periodontal disease was the most prevalent condition seen in the population with 94.4% subjects having unhealthy periodontium in terms of gingival bleeding and/or periodontal pockets. About 186 (52.25%) and 145 (40.73%) of subjects were with 0-3mm and 4-5mm loss of attachment respectively. Fourteen percent of population showed dental traumatic injuries. CONCLUSION The findings highlighted the high caries prevalence, higher periodontal disease, traumatic injuries which requires immediate intervention.
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Affiliation(s)
- Irram Abbas
- Senior Lecturer, Department of Public Health Dentistry, Sri Sai College of Dental Surgery , Vikarabad, Hyderabad, India
| | - Shakeel Anjum Mohammad
- Professor, Department of Public Health Dentistry, Sri Sai College of Dental Surgery , Vikarabad, Hyderabad, India
| | - Parthasarathi Reddy Peddireddy
- Professor and Head, Department of Public Health Dentistry, Sri Sai College of Dental Surgery , Vikarabad, Hyderabad, India
| | - Monica Mocherla
- Reader, Department of Public Health Dentistry, Sri Sai College of Dental Surgery , Vikarabad, Hyderabad, India
| | - Yadav Rao Koppula
- Reader, Department of Public Health Dentistry, Sri Sai College of Dental Surgery , Vikarabad, Hyderabad, India
| | - Rajashekhar Avidapu
- Post Graduate Student, Department of Public Health Dentistry, Sri Sai College of Dental Surgery , Vikarabad, Hyderabad, India
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28
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Rougé-Maillart C, Houdu S, Darviot E, Buchaillet C, Baron C. Anal lesions presenting in a cohort of child gastroenterological examinations. Implications for sexual traumatic injuries. J Forensic Leg Med 2015; 32:25-9. [PMID: 25882145 DOI: 10.1016/j.jflm.2015.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/18/2014] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to describe the anal lesions found in children during a pediatric gastroenterology consultation when the reason for the complaint was related to a digestive disease. This prospective descriptive study included 100 children under 15 years of age over a 13-month period, consulting due to digestive symptoms. The children were under 8 years old (90%) and 25% were under 3.1 years old. Constipation was the most frequent reason for consultation (69%). Fifty-one anal lesions were observed, of which 58.8% were anal fissures, 15.7% were skin tags and 5.8% were venous congestions related to straining. Anal fissures and skin tags were located at the median line, according to the clock-face method in supine position. No child had more than two anal lesions. No anal dilatation, sphincter hypotonia, anal scars, anal lacerations or bruises were found. The two most common anal lesions were anal fissures and skin tags. These anal lesions were mainly observed at the median line and were due to constipation. No cases of multiple anal lesions were found in terms of common digestive diseases.
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Affiliation(s)
- Clotilde Rougé-Maillart
- LUNAM Université, CHU Angers, 49933 Angers Cedex, France; CHU Angers, Department of Forensic Medicine, 49933 Angers Cedex, France.
| | - Sora Houdu
- CHU Angers, Department of Forensic Medicine, 49933 Angers Cedex, France
| | - Estelle Darviot
- CHU Angers, Department of Pedestrian, 49933 Angers Cedex, France
| | - Céline Buchaillet
- CHU Angers, Department of Forensic Medicine, 49933 Angers Cedex, France
| | - Céline Baron
- LUNAM Université, CHU Angers, 49933 Angers Cedex, France
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Oteir AO, Smith K, Stoelwinder JU, Middleton J, Jennings PA. Should suspected cervical spinal cord injury be immobilised?: a systematic review. Injury 2015; 46:528-35. [PMID: 25624270 DOI: 10.1016/j.injury.2014.12.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 12/21/2014] [Accepted: 12/30/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spinal cord injuries occur worldwide; often being life-threatening with devastating long term impacts on functioning, independence, health, and quality of life. OBJECTIVES Systematic review of the literature to determine the efficacy of cervical spinal immobilisation (vs no immobilisation) in patients with suspected cervical spinal cord injury (CSCI); and to provide recommendations for prehospital spinal immobilisation. METHODS Searches were conducted of the Cochrane library, CINAHL, EMBASE, Pubmed, Scopus, Web of science, Google scholar, and OvidSP (MEDLINE, PsycINFO, and DARE) databases. Studies were included if they were relevant to the research question, published in English, based in the prehospital setting, and included adult patients with traumatic injury. RESULTS The search identified 1471 citations, of which eight observational studies of variable quality were included. Four studies were retrospective cohorts, three were case series and one a case report. Cervical collar application was reported in penetrating trauma to be associated with unadjusted increased risk of mortality in two studies [(OR, 8.82; 95% CI, 1.09-194; p=0.038) & (OR, 2.06; 95% CI, 1.35-3.13)], concealment of neck injuries in one study and increased scene time in another study. While, in blunt trauma, one study indicated that immobilisation might be associated with worsened neurological outcome (OR, 2.03; 95% CI, 1.03-3.99; p=0.04, unadjusted). We did not attempt to combine study results due to significant heterogeneity of study design and outcome measures. CONCLUSION There is a lack of high-level evidence on the effect of prehospital cervical spine immobilisation on patient outcomes. There is a clear need for large prospective studies to determine the clinical benefit of prehospital spinal immobilisation as well as to identify the subgroup of patients most likely to benefit.
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Affiliation(s)
- Ala'a O Oteir
- Department of Community Emergency Health and Paramedic Practice, Monash University Melbourne, Victoria, Australia.
| | - Karen Smith
- Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Johannes U Stoelwinder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James Middleton
- Rehabilitation Studies Unit, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia
| | - Paul A Jennings
- Department of Community Emergency Health and Paramedic Practice, Monash University Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia
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Egea-Guerrero JJ, Freire-Aragón MD, Serrano-Lázaro A, Quintana-Díaz M. Resuscitative goals and new strategies in severe trauma patient resuscitation. Med Intensiva 2014; 38:502-12. [PMID: 25241268 DOI: 10.1016/j.medin.2014.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/03/2014] [Accepted: 06/16/2014] [Indexed: 11/17/2022]
Abstract
Traumatic injuries represent a major health problem all over the world. In recent years we have witnessed profound changes in the paradigm of severe trauma patient resuscitation, new concepts regarding acute coagulopathy in trauma have been proposed, and there has been an expansion of specific commercial products related to hemostasis, among other aspects. New strategies in severe trauma management include the early identification of those injuries that are life threatening and require surgical hemostasis, tolerance of moderate hypotension, rational intravascular volume replacement, prevention of hypothermia, correction of acidosis, optimization of oxygen carriers, and identification of those factors required by the patient (fresh frozen plasma, platelets, tranexamic acid, fibrinogen, cryoprecipitates and prothrombin complex). However, despite such advances, further evidence is required to improve survival rates in severe trauma patients.
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Affiliation(s)
- J J Egea-Guerrero
- Unidad de Neurocríticos. Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina (IBiS)/CSIC Universidad de Sevilla, Sevilla, España.
| | - M D Freire-Aragón
- Unidad de Neurocríticos. Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Serrano-Lázaro
- Unidad de Cuidados Intensivos, Hospital Clínico Universitario de Valencia, Valencia, España
| | - M Quintana-Díaz
- Unidad de Cuidados Intensivos, Hospital Universitario de La Paz, Madrid, España
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31
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Sandhu M, Gulia S, Nagpal M, Sachdev V. Circular enamel hypoplasia: a rare enamel developmental disturbance in permanent teeth. J Clin Diagn Res 2014; 8:ZD39-ZD40. [PMID: 25302282 PMCID: PMC4190809 DOI: 10.7860/jcdr/2014/9483.4750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/19/2014] [Indexed: 06/04/2023]
Abstract
Circular enamel hypoplasia, a type of enamel hypoplasia is an extensive enamel disturbance that results in a demarcating line surrounding the crown of the injured teeth visible both clinically and radiographically that most frequently occurs as a result of trauma in children around the age of two years. Clinical features include poor aesthetics, dentin sensitivity, increased susceptibility to dental caries and malocclusion. Early radiographic diagnosis of such teeth is important for timely intervention and subsequent treatment.
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Affiliation(s)
- Meera Sandhu
- Professor, Department of Pedodontics and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, U.P, India
| | - Shweta Gulia
- Post-Graduate Student, Department of Pedodontics and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, U.P, India
| | - Mehak Nagpal
- Post-Graduate Student, Department of Pedodontics and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, U.P, India
| | - Vinod Sachdev
- Head of Department and Professor, Department of Pedodontics and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, U.P, India
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Novy E, Charpentier C, Guerci P, Settembre N, Malikov S, Audibert G. [ Traumatic injuries of the descending thoracic aorta apart from the isthmus: diagnosis and therapeutic approach]. ACTA ACUST UNITED AC 2013; 32:799-802. [PMID: 24161295 DOI: 10.1016/j.annfar.2013.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022]
Abstract
Lesions involving the descending thoracic aorta apart from isthmus are rare and less known by anesthetists. We report the clinical course of two severely injured patients who sustained a thoracic aortic rupture in whom favorable outcome was achieved with endovascular treatment. Mechanisms, diagnosis and therapeutics aspects of these rare lesions are discussed according to literature.
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Wanke EM, Mill H, Arendt M, Wanke A, Koch F, Groneberg DA. Occupational accidents in professional dancers with regard to different professional dance styles. Work 2013; 49:597-606. [PMID: 24004796 DOI: 10.3233/wor-131736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The term "professional dance" comprises various dance styles. There are no studies which investigated work related traumatic injuries with regard to five different dance styles. OBJECTIVE To define dance-style related differences of traumatic injuries. METHODS The basis for the evaluation were the occupational injuries of professional dancers of six theaters (n=1339; f: n=658, m: n=681) and one State Ballet School (n=612; f:n=421, m: n=191). RESULTS Independent of the dance style, the lower extremity (leg and hip) is the most frequently injured anatomical region (p< 0.001). The more dancers move away from the classical dance technique, the more traumatic head/neck injuries increase (p<0.001). Injury patterns and injured structures also show differences subject to dance styles (p< 0.001). In classical dance the most commonly sustained injuries are due to intrinsic factors with the significance of extrinsic factors increasing the more dancers diverge from defined classical dance techniques. CONCLUSION The results shown in the study clarify the enormous dance-style related differences in traumatic injuries sustained by dancers. These differences support the development of dance-style related injury prevention measures and suggest further investigations with the focus being placed on the influence of organizational structures (e.g. number of performances) as well as on the working environments.
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Affiliation(s)
- Eileen M Wanke
- Dance Medicine Department, Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
| | - Helmgard Mill
- Department Prevention, Unfallkasse Berlin, Berlin, Germany
| | - Michael Arendt
- Department Prevention, Unfallkasse Berlin, Berlin, Germany
| | - Alice Wanke
- Department Nursing and Management, Hamburg University of Applied Sciences,Hamburg, Germany
| | - Franziska Koch
- Dance Medicine Department, Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David A Groneberg
- Dance Medicine Department, Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
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Chariot P, Briffa H, Lepresle A, Lefèvre T, Boraud C. Fitness for detention in police custody: a practical proposal for improving the format of medical opinion. J Forensic Leg Med 2013; 20:980-5. [PMID: 24237804 DOI: 10.1016/j.jflm.2013.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 04/08/2013] [Accepted: 07/22/2013] [Indexed: 11/23/2022]
Abstract
Health issues among arrestees are a worldwide concern for which only local policies have been established. Physicians attending detainees in police custody are expected to decide whether the detainee's health status is compatible with detention in a police station and make any useful observations. A high degree of heterogeneity in the information collected by the physician and transmitted to the police has been observed. We analyzed the content and limitations of available documents and developed a model that could serve as a guide for any attending physician. The document presented here has been used in France on over 50,000 occasions since June 2010. We developed a two-page template consisting of (1) a standard medical certificate to be sent to the authority who requested the doctor's attendance and (2) a confidential medical record, not sent to the requesting authority. We evaluated perceived health by the three global health indicators of the Minimum European Health Module and used DSM IV criteria for the evaluation of addictive disorders. In the case of recent traumatic injuries, the certificate has also included the collection of data on traumatic injuries and the contexts of their occurrence. The proposed certificate achieved several goals, by protecting the interests of the person examined, in case of poor conditions of arrest or detention, protecting doctors in cases of legal proceedings, and allowing epidemiological data to be collected. The certificate may also contribute to an international awareness of medical care for detainees in police custody.
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35
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C SK, Rao A, K S, G HR. Multidisciplinary Approach in Management of Fractured Central Incisor through Composite Plug Stabilization - A Case Report. J Int Oral Health 2013; 5:79-82. [PMID: 24155581 PMCID: PMC3768080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 01/10/2013] [Indexed: 06/02/2023] Open
Abstract
Crown fracture is the most frequent type of traumatic injury in permanent dentition. Traumatized anterior teeth requires quick functional and esthetic repair. Traditionally such injuries have been restored with conventional post-core and crown techniques after endodontic treatment. This article presents an innovative technique of managing a complicate crown fracture of anterior tooth where plain orthodontic band was used for stabilization and post endodontic restoration was done with adhesively luted fiber reinforced composite post through fragment and composite plug stabilization. How to cite this article: Sushil K C, Rao A, Sheila K, Hanumanth R G. Multidisciplinary Approach in Management of Fractured Central Incisor through Composite Plug Stabilization - A Case Report. J Int Oral Health 2013; 5(1):79-82.
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Affiliation(s)
- Sushil Kumar C
- Department of Conservative and Endodontics, Dr.H.S.R.S.M Dental College Hingoli, Maharashtra, India
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Abstract
AIM The paper aims to present a study conducted in Dera Bassi, Mohali, India. The purpose of the study was to ascertain the prevalence of traumatic dental injuries (TDI) in children of age group 7-12 years in private schools in Gulabgarh village. MATERIAL #ENTITYSTARTX00026; METHOD Age & sex distribution, etiological factors, risk factors and cause of injury were the parameters taken into consideration. The data collected was processed and analyzed using the SPSS statistical software program. RESULTS The overall prevalence of dental trauma was 14.5%, amongst the 880 subjects examined, out of which, 63.2% males and 36.4% females were found to be affected. The maxillary central incisor was found to be most commonly affected tooth (43.8%). The most common cause of injury reported was fall during playing (37.5%). CONCLUSION Enamel fracture was most prevalent (50%). No risk factor was significantly higher than others; however children with Angle's class II div 1 malocclusion exhibited greater risk factor for traumatic injuries.
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Affiliation(s)
- Rohini Dua
- Department of Pedodontics and Preventive Dentistry, National Dental College and Hospital, Dera Bassi, Mohali, Punjab, India
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Vanka A, Ravi KS, Roshan NM, Shashikiran ND. Analysis of Reporting Pattern in Children Aged 7 to 14 Years with Traumatic Injuries to Permanent Teeth. Int J Clin Pediatr Dent 2010; 3:15-9. [PMID: 27625551 PMCID: PMC4955039 DOI: 10.5005/jp-journals-10005-1048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 09/29/2009] [Indexed: 11/23/2022] Open
Abstract
Aim To analyze the pattern of traumatic injuries to permanent anterior teeth reporting to the dental department with regards to age, gender, cause, proportion of different types of injury and time of reporting. Materials and Methods Children aged 7 to 14 years with trauma or related sequelae were included. The data was collected retrospectively on the basis of case history, clinical findings, radiographs and vitality tests. Ellis’ classification was used to record injuries to anterior teeth. Results Boys had more injuries with the highest injuries at 12 years. Various causes of trauma included Falls, RTA, hits by object/person and bicycle related. The most common injury reported were cases of Ellis’ class IV (50.7%) and the maxillary central incisors being the teeth most frequently involved (75%). The time lapsed after injury was more than 1 year in 42.8% cases and 62% cases reported with complications. Conclusion Our findings suggest that a large number of cases reported in the age group 10 to 13 years with Class IV Ellis’ fracture largely when symptoms appear. Reporting was delayed by more than a year in several cases, the barriers for which need to be analyzed, to develop strategies regarding prevention of traumatic injuries and their consequences.
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Affiliation(s)
- Amit Vanka
- Professor, Department of Pedodontics, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
| | - K S Ravi
- Senior Lecturer, Department of Pedodontics, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
| | - N M Roshan
- Senior Lecturer, Department of Pedodontics, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
| | - N D Shashikiran
- Dean, Professor and Head, Department of Pedodontics, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
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