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Cittadini F, Aulino G, Petrucci M, Raguso L, Oliveri ES, Beccia F, Novelli A, Strano-Rossi S, Franceschi F, Covino M. Bicycle-related accidents in Rome: Investigating clinical patterns, demographics, injury contexts, and health outcomes for enhanced public safety. Injury 2024; 55:111464. [PMID: 38452698 DOI: 10.1016/j.injury.2024.111464] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/03/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION This study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents. METHODS Data on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated. RESULTS Over the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients. CONCLUSIONS Although a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages.
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Affiliation(s)
- Francesca Cittadini
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Giovanni Aulino
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Martina Petrucci
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Luigi Raguso
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Elena Sofia Oliveri
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Flavia Beccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Novelli
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Sabina Strano-Rossi
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Francesco Franceschi
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marcello Covino
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Largo A. Gemelli 8, 00168 Rome, Italy
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Berthold O, Fegert JM, Brähler E, Jud A, Clemens V. Abusive head trauma: The body of the iceberg - A population-based survey on prevalence and perpetrators. Child Abuse Negl 2024; 149:106660. [PMID: 38295606 DOI: 10.1016/j.chiabu.2024.106660] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Research on abusive head trauma (AHT) is usually research on clinically identified cases, while population-based studies, having the potential to identify cases of shaking that did not end with hospital admission, are missing to date. OBJECTIVE Thus, we aimed to assess the prevalence of AHT and associated risk factors in a representative sample of the German population. PARTICIPANTS AND SETTING We conducted a cross-sectional, observational study in Germany from July to October 2021. Using different sampling steps including a random route procedure, a probability sample of the German population was generated. The final sample consisted of 2503 persons (50.2 % female, mean age: 49.5 years). METHODS Participants were asked about sociodemographic information in a face-to-face interview and whether they had been ever responsible for the care of an infant and whether they had ever performed potential harmful methods including shaking to calm it, intimate partner violence (IPV) and adverse childhood experiences (ACEs) using a questionnaire. RESULTS In total, 1.4 % of women (N = 18) and 1.1 % of men (N = 13) reported to have at least once shaken an infant to calm it. Ever having used a potential harmful parenting method in calming an infant was reported by 4.9 % of women (N = 61) and 3.1 % (N = 39) of men. No gender differences were seen. A low income, living with someone under 16 in the household and victimization and perpetration of IPV and ACEs are associated with increased risks of shaking and other potential harmful methods to calm an infant. CONCLUSIONS Our data suggest that despite better knowledge on the dangers of shaking, the percentage of women that shake infants might be higher than previously thought. Also, intimate partner violence and ACEs are key risk factor for shaking and harmful parenting behaviors in general. This has important implications for future prevention programs.
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Affiliation(s)
- Oliver Berthold
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany; Child Abuse Clinic, DRK Kliniken Berlin, Spandauer Damm 130, 14050 Berlin, Germany.
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany; Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Andreas Jud
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Vera Clemens
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
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Sehlikoğlu K, Türkoğlu A, Bork T, Batbaş M. Investigation of fatal traumatic head injuries. ULUS TRAVMA ACIL CER 2024; 30:160-166. [PMID: 38506383 DOI: 10.14744/tjtes.2024.32463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Traumatic head injuries (THIs) are one of the major causes of death in forensic cases. The aim of this study was to investigate the characteristics of patients with fatal THIs. METHODS In this study, a total of 311 patients with fatal THIs, who underwent postmortem examinations and/or autopsies, were retrospectively analyzed. Cases were evaluated based on sex, age group, incident origin, cause of the incident, presence of skull fracture, type of fractured bone (if any), fracture localization and pattern, presence and type of intracranial lesion (if any), and cause of death. RESULTS Out of the patients, 242 (77.8%) were male and 69 (22.2%) were female. Accidents accounted for 235 (75.6%) of the incidents, with in-vehicle traffic accidents causing 117 (37.6%). In 221 cases (71.1%), intracranial lesions and skull fractures were observed together. The most common fractures were base fractures (171 cases) and temporal bone fractures (153 cases). The rate of intracranial hemorrhage was lower in the adult age group (69.7%) compared to the older age group (92.6%). CONCLUSION The results obtained in this study indicate that the cause of the incident, type of fracture, presence of skull base fracture, and multiple skull fractures increase the likelihood of fatalities. The occurrence of skull fractures reduces intracranial pressure, thereby decreasing the incidence of intracranial lesions. The development and effective enforcement of road traffic safety policies and regulations will reduce the incidence of fatalities.
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Affiliation(s)
- Kerem Sehlikoğlu
- Department of Forensic Medicine, Adiyaman University, Faculty of Medicine, Adıyaman-Türkiye
| | - Abdurrahim Türkoğlu
- Department of Forensic Medicine, Firat University, Faculty of Medicine, Elazig-Türkiye
| | - Turgay Bork
- Department of Forensic Medicine, Firat University, Faculty of Medicine, Elazig-Türkiye
| | - Muhammet Batbaş
- The Council of Forensic Medicine, Elazig Branch Office of The Council of Forensic Medicine, Elazig-Türkiye
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Sokoloff M, Feldman KW, Levin AV, Rockter A, Armijo-Garcia V, Musick M, Weeks K, Haney SB, Marinello M, Herman BE, Frazier TN, Carroll CL, Hymel KP. Retinal hemorrhage variation in inertial versus contact head injuries. Child Abuse Negl 2024; 149:106606. [PMID: 38134727 DOI: 10.1016/j.chiabu.2023.106606] [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] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Abusive head trauma (AHT) is frequently accompanied by dense/extensive retinal hemorrhages to the periphery with or without retinoschisis (complex retinal hemorrhages, cRH). cRH are uncommon without AHT or major trauma. OBJECTIVE The study objectives were to determine whether cRH are associated with inertial vs. contact mechanisms and are primary vs. secondary injuries. PARTICIPANTS AND SETTING This retrospective study utilized a de-identified PediBIRN database of 701 children <3-years-old presenting to intensive care for head trauma. Children with motor vehicle related trauma and preexisting brain abnormalities were excluded. All had imaging showing head injury and a dedicated ophthalmology examination. METHODS Contact injuries included craniofacial soft tissue injuries, skull fractures and epidural hematoma. Inertial injuries included acute impairment or loss of consciousness and/or bilateral and/or interhemispheric subdural hemorrhage. Abuse was defined in two ways, by 1) predetermined criteria and 2) caretaking physicians/multidisciplinary team's diagnostic consensus. RESULTS PediBIRN subjects with cRH frequently experienced inertial injury (99.4 % (308/310, OR = 53.74 (16.91-170.77)) but infrequently isolated contact trauma (0.6 % (2/310), OR = 0.02 (0.0004-0.06)). Inertial injuries predominated over contact trauma among children with cRH sorted AHT by predetermined criteria (99.1 % (237/239), OR = 20.20 (6.09-67.01) vs 0.5 % (2/339), OR = 0.04 (0.01-0.17)). Fifty-nine percent of patients with cRH, <24 h altered consciousness, and inertial injuries lacked imaging evidence of brain hypoxia, ischemia, or swelling. CONCLUSIONS cRH are significantly associated with inertial angular acceleration forces. They can occur without brain hypoxia, ischemia or swelling suggesting they are not secondary injuries.
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Affiliation(s)
- Michael Sokoloff
- Department of Pediatrics, Pediatric Intensive Care, Sacred Heart Children's Hospital, Spokane, WA, United States of America.
| | - Kenneth W Feldman
- Department of Pediatrics, Seattle Children's, University of Washington's Harborview Medical Center, Seattle, WA, United States of America; Department of Pediatrics, Safe Child and Adolescent Network, Seattle Children's, Seattle, WA, United States of America.
| | - Alex V Levin
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester, Rochester, NY, United States of America.
| | - Adam Rockter
- University of Rochester School of Medicine, Rochester, NY, United States of America.
| | - Veronica Armijo-Garcia
- Department of Pediatrics, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, United States of America.
| | - Matthew Musick
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States of America.
| | - Kerri Weeks
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, KS, United States of America.
| | - Suzanne B Haney
- Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States of America.
| | - Mark Marinello
- Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA, United States of America.
| | - Bruce E Herman
- Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, United States of America.
| | - Terra N Frazier
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States of America.
| | - Christopher L Carroll
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, United States of America.
| | - Kent P Hymel
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States of America
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Kachelski C, Gavin K, Head H, Horton D, Anderst J. A lucid interval in a victim of abusive head trauma with multiple parenchymal lacerations. J Forensic Leg Med 2024; 101:102638. [PMID: 38185064 DOI: 10.1016/j.jflm.2023.102638] [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: 10/01/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
Abusive head trauma (AHT) is a leading cause of abusive deaths in children under age one. AHT can include intracranial hemorrhages, hypoxic ischemic injury, or parenchymal lacerations. Most infants with parenchymal lacerations present with acute neurological symptoms. There has been some published literature on lucid intervals in cases of AHT; however, there has not been a described lucid interval with parenchymal lacerations. Parenchymal lacerations typically present with acute symptomatology such as seizures, alteration in mental status, or increased fussiness/lethargy given the damage to neurons and brain structure. We present a case of a healthy 2-month-old who ultimately was diagnosed with AHT and three parenchymal lacerations and had a 2.5 hour period of normal neurological status prior to acute decompensation.
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Affiliation(s)
- Cree Kachelski
- Division of Emergency Medicine, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Center for Safe and Healthy Children and Adolescents, Mayo Clinic, Rochester, MN, USA.
| | - Kelsey Gavin
- Graduate Medical Education, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Hayden Head
- Division of Radiology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Danielle Horton
- Division of Child Adversity and Resilience, Children's Mercy Kansas City, Kansas City, MO, USA
| | - James Anderst
- Division of Child Adversity and Resilience, Children's Mercy Kansas City, Kansas City, MO, USA
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Koivisto MK, Puljula J, Levola JM, Mustonen A, Miettunen J, Alakokkare AE, Niemelä S. Adolescent alcohol and cannabis use as risk factors for head trauma in the Northern Finland Birth Cohort study 1986. Eur J Public Health 2023; 33:1115-1121. [PMID: 37616019 PMCID: PMC10710361 DOI: 10.1093/eurpub/ckad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the associations between cannabis use and frequency of alcohol intoxication in adolescence with the risk of traumatic brain injury and craniofacial fractures in early adulthood. Hypothesis was that using alcohol and cannabis in adolescence could increase the risk for head traumas. METHODS Data from the Northern Finland Birth Cohort 1986 (n = 9432 individuals) were used to investigate the prospective association between the self-reported frequency of alcohol intoxication (n = 6472) and cannabis use (n = 6586) in mid-adolescence and register-based, head trauma diagnoses by ages 32-33 years. To test the robustness of these associations, the statistical models were adjusted for a range of other confounders such as illicit drug use, previous head trauma and self-reported mental health problems. RESULTS In multivariate analyses, cannabis use was statistically significantly associated with a greater risk of traumatic brain injury among females [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.1-3.2, P = 0.024). Frequent alcohol intoxication was a statistically significant independent risk factor for both traumatic brain injury (HR 2.6, 95% CI 1.7-3.9, P < 0.001) and craniofacial fractures (HR 2.7, 95% CI 1.6-4.8, P < 0.001) among males. CONCLUSIONS Cannabis use in adolescence appears to associate independently with elevated risk for traumatic brain injury among females, and frequent alcohol intoxication in adolescence seems to associate with elevated risk of both traumatic brain injury and craniofacial fractures among males.
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Affiliation(s)
- Maarit K Koivisto
- Department of Psychiatry, University of Turku, Turku, Finland
- Emergency Services, TYKS Acute, Turku University Hospital, Turku, Finland
| | - Jussi Puljula
- Department of Neurology, Lapland Central Hospital, Rovaniemi, Finland
| | - Jonna M Levola
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mustonen
- Faculty of Medicine and Health Technology, University Consortium of Seinäjoki, Tampere University, Tampere, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Psychiatry, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anni-Emilia Alakokkare
- Department of Psychiatry, University of Turku, Turku, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Solja Niemelä
- Department of Psychiatry, University of Turku, Turku, Finland
- Addiction Psychiatry Unit, Department of Psychiatry, Hospital District of South-West, Turku, Finland
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Levy BE, Quattrone M, Castle JT, Doud AN, Draus JM, Worhunsky DJ. Injury Pattern and Outcomes Following All-Terrain Vehicle Accidents in Kentucky Children: A Retrospective Study. Am Surg 2023; 89:5874-5880. [PMID: 37203181 DOI: 10.1177/00031348231173955] [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] [Indexed: 05/20/2023]
Abstract
PURPOSE All-terrain vehicles (ATVs) pose a significant risk for morbidity and mortality amongst children. We hypothesize that current vague legislation regarding helmet use impacts injury patterns and outcomes in pediatric ATV accidents. METHODS The institutional trauma registry was queried for pediatric patients involved in ATV accidents from 2006 to 2019. Patient demographics and helmet wearing status were identified in addition to patient outcomes, such as injury pattern, injury severity score, mortality, length of stay, and discharge disposition. These elements were analyzed for statistical significance. RESULTS 720 patients presented during the study period, which were predominantly male (71%, n = 511) and less than 16 years old (76%, n = 543). Most patients were not wearing a helmet (82%, n = 589) at time of injury. Notably, there were 7 fatalities. A lack of helmet use is positively associated with head injury (42% vs 23%, P < .01), intracranial hemorrhage (15% vs 7%, P = .03), and associated with lower Glasgow Coma Scale (13.9 vs 14.4, P < .01). Children 16 years and older were least likely to wear a helmet and most likely to incur injuries. Patients over 16 years had longer lengths of stay, higher mortality, and higher need for rehabilitation. CONCLUSION Not wearing a helmet is directly correlated with injury severity and concerning rates of head injury. Children 16 years and older are at greatest risk for injury, but younger children are still at risk. Stricter state laws regarding helmet use are necessary to reduce pediatric ATV-related injury burden. LEVEL OF EVIDENCE level III retrospective comparative study.
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Affiliation(s)
- Brittany E Levy
- Department of Pediatric Surgery, University of KentuckyChildren's Hospital, Lexington, KY, USA
| | - McKell Quattrone
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jennifer T Castle
- Department of Pediatric Surgery, University of KentuckyChildren's Hospital, Lexington, KY, USA
| | - Andrea N Doud
- Department of Pediatric Surgery, University of KentuckyChildren's Hospital, Lexington, KY, USA
| | - John M Draus
- Department of Surgery, Nemours Children's Health, Jacksonville, FL, USA
| | - David J Worhunsky
- Department of Pediatric Surgery, University of KentuckyChildren's Hospital, Lexington, KY, USA
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Thompson-Bagshaw DW, Quarrington RD, Dwyer AM, Jones NR, Jones CF. The Structural Response of the Human Head to a Vertex Impact. Ann Biomed Eng 2023; 51:2897-2907. [PMID: 37733109 PMCID: PMC10632295 DOI: 10.1007/s10439-023-03358-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
In experimental models of cervical spine trauma caused by near-vertex head-first impact, a surrogate headform may be substituted for the cadaveric head. To inform headform design and to verify that such substitution is valid, the force-deformation response of the human head with boundary conditions relevant to cervical spine head-first impact models is required. There are currently no biomechanics data that characterize the force-deformation response of the isolated head supported at the occiput and compressed at the vertex by a flat impactor. The effect of impact velocity (1, 2 or 3 m/s) on the response of human heads (N = 22) subjected to vertex impacts, while supported by a rigid occipital mount, was investigated. 1 and 2 m/s impacts elicited force-deformation responses with two linear regions, while 3 m/s impacts resulted in a single linear region and skull base ring fractures. Peak force and stiffness increased from 1 to 2 and 3 m/s. Deformation at peak force and absorbed energy increased from 1 to 2 m/s, but decreased from 2 to 3 m/s. The data reported herein enhances the limited knowledge on the human head's response to a vertex impact, which may allow for validation of surrogate head models in this loading scenario.
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Affiliation(s)
- Darcy W Thompson-Bagshaw
- School of Electrical & Mechanical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia
- Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Ryan D Quarrington
- School of Electrical & Mechanical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia
- Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Andrew M Dwyer
- Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia
| | - Nigel R Jones
- Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Claire F Jones
- School of Electrical & Mechanical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia.
- Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia.
- Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
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Liu YC, Chen IC, Yin HL, Wu YH, Lo SH, Liang WC, Jaw TS, Dai ZK, Hsu JH. Comparisons of characteristics and outcome between abusive head trauma and non-abusive head trauma in a pediatric intensive care unit. J Formos Med Assoc 2023; 122:1183-1188. [PMID: 37268475 DOI: 10.1016/j.jfma.2023.05.019] [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: 10/07/2022] [Revised: 03/27/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Abusive head trauma (AHT) is the leading cause of death in infants with traumatic brain injury (TBI). Early recognition of AHT is important for improving outcomes, but it can be challenging due to its similar presentations with non-abusive head trauma (nAHT). This study aims to compare clinical presentations and outcomes between infants with AHT and nAHT, and to identify the risk factors for poor outcomes of AHT. METHODS We retrospectively analyzed infants of TBI in our pediatric intensive care unit from January 2014 to December 2020. Clinical manifestations and outcomes were compared between patients with AHT and nAHT. Risk factors for poor outcomes in AHT patients were also analyzed. RESULTS 60 patients were enrolled for this analysis, including 18 of AHT (30%) and 42 of nAHT (70%). Compared with those with nAHT, patients with AHT were more likely to have conscious change, seizures, limb weakness, and respiratory failure, but with a fewer incidence of skull fractures. Additionally, clinical outcomes of AHT patients were worse, with more cases undergoing neurosurgery, higher Pediatric Overall Performance Category score at discharge, and more anti-epileptic drug (AED) use after discharge. For AHT patients, conscious change is an independent risk factor for a composite poor outcome of mortality, ventilator dependence, or AED use (OR = 21.9, P = 0.04) CONCLUSION: AHT has a worse outcome than nAHT. Conscious change, seizures and limb weaknesses but not skull fractures are more common in AHT. Conscious change is both an early reminder of AHT and a risk factor for its poor outcomes.
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Affiliation(s)
- Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ling Yin
- Department of Clinical Forensic Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsien Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hsing Lo
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chen Liang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Twei-Shiun Jaw
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Lai CD, Marret MJ, Jayanath S, Azanan MS. Abusive head trauma in infants: An observational single centre study comparing developmental and functional outcome between 18 months and 5 years. Child Abuse Negl 2023; 145:106434. [PMID: 37657172 DOI: 10.1016/j.chiabu.2023.106434] [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] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Abusive head trauma (AHT) is a major cause of traumatic brain injury in infancy. This exploratory study compared standardized developmental assessment versus functional outcome assessment between 18 months and 5 years of age following AHT in infancy. METHODS Observational cross-sectional study after surviving AHT in infancy. Seventeen children between 18 months and 5 years of age underwent clinical examination, developmental assessment using the Schedule of Growing Skills II (SGS II) and functional assessment using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds). Additional clinical information was extracted from medical records. RESULTS Age at assessment ranged from 19 to 53 months (median 26 months). Most (n = 14) were delayed in at least 1 domain, even without neurological or visual impairment or visible cortical injury on neuroimaging, including 8 children with favourable GOS-E Peds scores. The most affected domain was hearing and language. Delay in the manipulative domain (n = 6) was associated with visual and/or neurological impairment and greater severity of delay across multiple domains. Eleven (64.7 %) had GOS-E Peds scores indicating good recovery, with positive correlation between GOS-Peds scores and number of domains delayed (r = 0.805, p < 0.05). CONCLUSION The SGS-II detects behavioural and cognitive deficits not picked up by the GOS-E Peds. Combining both tools for assessment of AHT survivors under 5 years of age provides a comprehensive profile which addresses multiple domains of development and function, facilitating targeted intervention. Detection of developmental problems in the majority of survivors makes AHT prevention a public health priority.
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Affiliation(s)
- Charles Dekun Lai
- Department of Paediatrics, University of Malaya, 50603 Kuala Lumpur, Malaysia; Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak.
| | - Mary J Marret
- Department of Paediatrics, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Subhashini Jayanath
- Department of Paediatrics, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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11
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Ferdousi J, Post A, Karton C, Doelle K, Gilchrist MD, Hoshizaki TB. Head trauma analysis of laboratory reconstructed headers using 1966 Slazenger Challenge and 2018 Telstar 18 soccer balls. Sci Rep 2023; 13:18575. [PMID: 37903796 PMCID: PMC10616227 DOI: 10.1038/s41598-023-45489-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023] Open
Abstract
Retired soccer players are presenting with early onset neurodegenerative diseases, potentially from heading the ball. It has been proposed that the older composition of soccer balls places higher strains on brain tissues. The purpose of this research was to compare the dynamic head response and brain tissue strain of laboratory reconstructed headers using replicas of the 1966 Slazenger Challenge and 2018 Telstar 18 World Cup soccer balls. Head-to-ball impacts were physically conducted in the laboratory by impacting a Hybrid III head form at three locations and four velocities using dry and wet soccer ball conditions, and computational simulation was used to measure the resulting brain tissue strain. This research showed that few significant differences were found in head dynamic response and maximum principal strain between the dry 1966 and 2018 balls during reconstructed soccer headers. Headers using the wet 1966 soccer ball resulted in higher head form responses at low-velocity headers and lower head responses as velocities increased. This study demonstrates that under dry conditions, soccer ball construction does not have a significant effect on head and brain response during headers reconstructed in the laboratory. Although ball construction didn't show a notable effect, this study revealed that heading the ball, comparable to goalkeeper kicks and punts at 22 m/s, led to maximum principal strains exceeding the 50% likelihood of injury risk threshold. This has implications for the potential risks associated with repetitive heading in soccer for current athletes.
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Affiliation(s)
| | - Andrew Post
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Clara Karton
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada.
| | - Klara Doelle
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Michael D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
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12
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Lee EP, Hsia SH, Lin JJ, Chan OW, Wu HP. Predictors of neurologic outcomes and mortality in physically abused and unintentionally injured children: a retrospective observation study. Eur J Med Res 2023; 28:441. [PMID: 37848955 PMCID: PMC10580634 DOI: 10.1186/s40001-023-01430-x] [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: 02/24/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES This study aimed to identify the predictors of neurologic outcomes and mortality in physically abused and unintentionally injured children admitted to intensive care units (ICUs). METHODS All maltreated children were admitted to pediatric, neurosurgical, and trauma ICUs between 2001 and 2019. Clinical factors, including age, sex, season of admission, identifying settings, injury severity score, etiologies, length of stay in the ICU, neurologic outcomes, and mortality, were analyzed and compared between the physically abused and unintentionally injured groups. Neurologic assessments were conducted using the Pediatric Cerebral Performance Category scale. The study was approved by the Institutional Review Board of Chang Gung Memorial Hospital and the Ethics Committee waived the requirement for informed consent because of the anonymized nature of the data. RESULTS A total of 2481 children were investigated; of them, there were 480 (19.3%) victims admitted to the ICUs, including 156 physically abused and 324 unintentionally injured. Age, history of prematurity, clinical outcomes, head injury, neurosurgical interventions, clinical manifestations, brain computed tomography findings, and laboratory findings significantly differed between them (all p < 0.05). Traumatic brain injury was the major etiology for admission to the ICU. The incidence of abusive head trauma was 87.1% among the physically abused group. Only 46 (29.4%) and 268 (82.7%) cases achieved favorable neurologic outcomes in the physically abused and unintentionally injured groups, respectively. Shock within 24 h, spontaneous hypothermia (body temperature, < 35 °C), and post-traumatic seizure were strongly associated with poor neurologic outcomes and mortality in both groups. CONCLUSIONS Initial presentation with shock, spontaneous hypothermia at ICU admission, and post-traumatic seizure were associated with poor neurologic outcomes and mortality in physically abused and unintentionally injured children.
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Affiliation(s)
- En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Linko Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Linko Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Linko Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Oi-Wa Chan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Linko Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Ping Wu
- Department of Pediatrics, Chiayi Chang-Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzi City, Chiayi County, Taiwan.
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13
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Tsutsumi S, Sasadai J, Maeda N, Shimizu R, Suzuki A, Fukui K, Arima S, Tashiro T, Kaneda K, Yoshimi M, Mizuta R, Ishihara H, Esaki H, Tsuchida K, Terada T, Komiya M, Urabe Y. Head Impact in Blind Football During the Tokyo Paralympics: Video-Based Observational Study. Am J Phys Med Rehabil 2023; 102:836-839. [PMID: 36757853 DOI: 10.1097/phm.0000000000002187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
ABSTRACT Head impacts during blind football are common and have high injury rates; however, their characteristics and impact are still underreported. We compared head impact characteristics in blind football players with and without falls on all 18 official blind football match videos from the Tokyo 2020 Paralympic games. The rate of head impacts with falls was significantly higher in the preliminary phase, offense phase, and during dribbling. Significant differences in the region of the head impacted were also observed among the impact subjects/objects. The findings in this study would contribute to the development of injury prevention measures to minimize head injuries from head impact in blind football.
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Affiliation(s)
- Shogo Tsutsumi
- From the Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan (ST, NM, KF, SA, T Tashiro, KK, MY, RM, HI, HE, KT, T Terada, MK, YU); and Sports Medical Center, Japan Institute of Sports Sciences (JISS), Tokyo, Japan (JS, RS, AS)
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14
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Grindle D, Untaroiu C. Effectiveness of Wearable Protection Equipment for Seated Pedestrians. Ann Biomed Eng 2023; 51:2086-2096. [PMID: 37249726 DOI: 10.1007/s10439-023-03249-3] [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: 04/17/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023]
Abstract
This study used finite element models to investigate the efficacy of seated pedestrian protection equipment in vehicle impacts. The selected safety equipment, a lap belt, an airbag vest, and a bicycle helmet, were chosen to mitigate the underlying biomechanical causes of seated pedestrian injuries reported in the literature. The impact conditions were based on the three most dangerous impact scenarios from a previous seated pedestrian impact study. Serious injury (AIS 3+) risks were compared with and without protective equipment. A 50th percentile male occupant model and two generic vehicle models, the family car (FCR) and sports utility vehicle (SUV), were used to simulate vehicle collisions. Three impact conditions were run with every combination of protective equipment (n = 24). The helmet reduced head and brain injury risks from the vehicle-head and ground-head contacts. The airbag reduced the head injury risk in the FCR vehicle-head contact but increased the brain injury risks in the SUV impacts from increased whiplash. The lap belt increased head injury risks for both the FCR and the SUV impacts because it created a stronger FCR vehicle-head contact and SUV ground-head contact. When the belt and airbag were used together the head injury risks dramatically decreased because the pedestrian body impacted the ground arm or leg first and slowly rolled onto the ground which resulted in softer ground-head contacts and in two instances, no ground-head contact. Only the helmet proved effective in all impact conditions. Future testing must be completed before recommending the belt or airbag for seated pedestrians.
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Affiliation(s)
- Daniel Grindle
- Department of Biomedical Engineering and Mechanics, Center for Injury Biomechanics, Virginia Tech, Collegiate Square Innovation Place (0151), 460 Turner St NW, Suite 304, Blacksburg, VA, 24060-3325, USA
| | - Costin Untaroiu
- Department of Biomedical Engineering and Mechanics, Center for Injury Biomechanics, Virginia Tech, Collegiate Square Innovation Place (0151), 460 Turner St NW, Suite 304, Blacksburg, VA, 24060-3325, USA.
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15
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[Death of craniocerebral injury caused by "steel ball" air gun shooting: A case report]. Fa Yi Xue Za Zhi 2023; 39:417-8. [PMID: 37859482 DOI: 10.12116/j.issn.1004-5619.2022.420203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
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16
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Beal JA. Decreasing the Effects of Cumulative Head Injuries in Adolescent Football Players. MCN Am J Matern Child Nurs 2023; 48:169. [PMID: 37101331 DOI: 10.1097/nmc.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Judy A Beal
- Judy A. Beal is a Professor and Dean Emerita, Simmons University, Boston, MA. Dr. Beal can be reached via email at
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17
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Obry S, Roman E, Tavernier E, Boutry N, Delval A, Blouet M, Tanase A, De Milly MN, Alison M, Vial J, Saint Martin P, Adamsbaum C, Morel B. The monthly incidence of abusive head trauma, inflicted skeletal trauma, and unexplained skin lesion in children in six French university hospitals during the COVID-19 pandemic. Child Abuse Negl 2023; 138:106063. [PMID: 36758374 PMCID: PMC9884623 DOI: 10.1016/j.chiabu.2023.106063] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic was a stressful period. Lockdowns may have added to parental difficulty leading to an increase in violence. This study aimed to compare the monthly incidence of high suspicion of child physical abuse before and during the COVID-19 pandemic. MATERIAL We have retrospectively reviewed imaging examinations of children having a skeletal X-ray examination in six university hospitals with high suspicion of abusive head traumatism (AHT), inflicted skeletal trauma (IST) and unexplained skin lesions (USL) between March 2020 and June 2021 and compared with the similar period from 2018 to 2019. The monthly incidence of the different physical maltreatment was analyzed using a QuasiPoisson regression model. RESULTS We included 178 children (n = 127 boys, 71.3 %), 110 during the pandemic period, median age 5 months. AHT was diagnosed in 91 children, 55 had inflicted skeletal trauma (IST) and 46 had unexplained skin lesions (USL). Among the 91 patients with AHT, 86 had a subdural hematoma (95.6 %) and 40 had bridging veins thrombosis (44 %). The ophthalmological examination performed on 89 children (97.9 %) revealed retinal hemorrhages in 57 children (89.8 %). The incidence of AHT doubled during the months of COVID-19 lockdowns (rate ratio = 2; 95 % CI [1.1; 3.6], p = 0.03). No difference in monthly incidence was observed for IST and USL groups. CONCLUSION A significant increase in AHT was observed during the months with lockdowns and curfews during the COVID-19 pandemic. This highlights the need for developing a national strategy to prevent physical abuse in children in this context.
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Affiliation(s)
- Sandra Obry
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Elodie Roman
- Department of Pediatric Radiology, Jeanne de Flandre Hospital, CHU, Lille, France
| | - Elsa Tavernier
- INSERM, SPHERE, UMR1246, Université de Tours et Nantes, Tours, France
| | - Nathalie Boutry
- Department of Pediatric Radiology, Jeanne de Flandre Hospital, CHU, Lille, France
| | | | - Marie Blouet
- Department of Pediatric Imaging, Fondation Lenval Children's Hospital, Nice, France
| | - Anca Tanase
- Department of Pediatric Imaging, Robert Debré Hospital, APHP (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Marie Noelle De Milly
- Department of Pediatric Imaging, Robert Debré Hospital, APHP (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Marianne Alison
- Department of Pediatric Imaging, Robert Debré Hospital, APHP (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Julie Vial
- Department of Pediatric Radiology, Children's Hospital, CHU, Toulouse, France
| | | | - Catherine Adamsbaum
- Pediatric Radiology Department, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Baptiste Morel
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.
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18
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Carmo GP, Dymek M, Ptak M, Alves-de-Sousa RJ, Fernandes FAO. Development, validation and a case study: The female finite element head model (FeFEHM). Comput Methods Programs Biomed 2023; 231:107430. [PMID: 36827824 DOI: 10.1016/j.cmpb.2023.107430] [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] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/18/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Traumatic brain injuries are one of the leading causes of death and disability in the world. To better understand the interactions and forces applied in different constituents of the human head, several finite element head models have been developed throughout the years, for offering a good cost-effective and ethical approach compared to experimental tests. Once validated, the female finite element head model (FeFEHM) will allow a better understanding of injury mechanisms resulting in neuronal damage, which can later evolve into neurodegenerative diseases. METHODS This work encompasses the approached methodology starting from medical images and finite element modelling until the validation process using novel experimental data of brain displacements conducted on human cadavers. The material modelling of the brain is performed using an age-specific characterization of the brain using microindentation at dynamic rates and under large deformation, with a similar age to the patient used to model the FeFEHM. RESULTS The numerical displacement curves are in good accordance with the experimental data, displaying similar peak times and values, in all three anatomical planes. The case study result shows a similarity between the pressure fields of the FeFEHM compared to another model, highlighting the future potential of the model. CONCLUSIONS The initial objective was met, and a new female finite element head model has been developed with biofidelic brain motion. This model will be used for the assessment of repetitive impact scenarios and its repercussions on the female brain.
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Affiliation(s)
- Gustavo P Carmo
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, Aveiro 3810-193, Portugal; LASI-Intelligent Systems Associate Laboratory, Portugal.
| | - Mateusz Dymek
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Łukasiewicza 5/7, Wrocław 50-370, Poland
| | - Mariusz Ptak
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Łukasiewicza 5/7, Wrocław 50-370, Poland
| | - Ricardo J Alves-de-Sousa
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, Aveiro 3810-193, Portugal; LASI-Intelligent Systems Associate Laboratory, Portugal
| | - Fábio A O Fernandes
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, Aveiro 3810-193, Portugal; LASI-Intelligent Systems Associate Laboratory, Portugal
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19
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Wei W, Petit Y, Arnoux PJ, Bailly N. Head-ground impact conditions and helmet performance in E-scooter falls. Accid Anal Prev 2023; 181:106935. [PMID: 36571970 DOI: 10.1016/j.aap.2022.106935] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Head injuries are common injuries in E-scooter accidents which have dramatically increased in recent years. The head impact conditions and helmet performance during E-scooter accidents are barely investigated. This study aims to characterize the head-ground impact biomechanics and evaluate bicycle helmet protection in typical E-scooter falls. METHOD The finite element (FE) model of a hybrid III dummy riding an E-scooter was developed and validated. The FE model with and without a bicycle helmet was used to reproduce twenty-seven E-scooter falls caused by the collision with a curb, in which different riding speeds (10, 20, and 30 km/h), curb orientations (30, 60, and 90°), and E-scooter orientations (-15, 0, and 15°) were simulated. Head-ground impact velocities and locations were evaluated for the unhelmeted configurations while the helmet performance was evaluated with the reduction of head injury metrics. RESULTS E-scooter falls always resulted in an oblique head-ground impact, with 78 % on the forehead. The mean vertical and tangential head-ground impact velocities were respectively 5.7 ± 1.5 m/s and 3.7 ± 2.0 m/s. The helmet significantly (p < 0.1) reduced the head linear acceleration, angular velocity, HIC_36, and BrIC, but not the angular acceleration. However, even with the helmet, the head injury metrics were mostly above the thresholds of severe head injuries. CONCLUSION Typical E-scooter falls might cause severe head injuries. The bicycle helmet was efficient to reduce head injury metrics but not to prevent severe head injuries. Future helmet standard evaluations should involve higher impact energy and the angular acceleration assessment in oblique impacts.
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Affiliation(s)
- Wei Wei
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France.
| | - Yvan Petit
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France; École de technologie supérieure, Canada
| | - Pierre-Jean Arnoux
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Nicolas Bailly
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
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20
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Toboła W, Papis M, Jastrzębski D, Perz R. Experimental research of energy absorbing structures within helmet samples made with the additive manufacturing method - preliminary study. Acta Bioeng Biomech 2023; 25:127-136. [PMID: 38314618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
PURPOSE This study aimed to develop an energy-absorbing structure for bicycle helmets to minimize head injuries caused by collisions. The research team explored three geometric structures produced through additive methods and compares their energy absorption properties with a standard bicycle helmet made of Expanded Polystyrene (EPS) foam. METHODS The study prepared samples of three geometric structures (a ball, a honeycomb and a conical shape) and a fragment of a bicycle helmet made of EPS foam with the same overall dimensions. Laboratory tests were conducted using a pneumatic hammer, piston compressor, anvil, triaxial accelerometer and data processing systems. Three crash tests were performed for each type of structure, and the anvil's maximum acceleration and stopping distance after the crash were analyzed. RESULTS The study found that the energy absorption properties of the Polylactic Acid (PLA) material printed with the incremental method were comparable or better than those of the EPS material used in helmets. The geometric structure of the energy-absorbing material played a crucial role in its effectiveness. The most promising results were obtained for the ball samples. CONCLUSIONS The study concluded that further research on energy-absorbing structures made using the Fused Deposition Modeling (FDM) method could be useful in the production of bicycle helmets. The results show that the geometric structure of the energy-absorbing material is a crucial factor in its effectiveness. The findings suggest that the ballshaped structure made with PLA material printed using the incremental method could be a promising design for bicycle helmets to minimize head injuries caused by collisions.
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Affiliation(s)
- Wojciech Toboła
- Institute of Aeronautics and Applied Mechanics, Warsaw University of Technology, Warsaw, Poland
| | - Mateusz Papis
- Institute of Aeronautics and Applied Mechanics, Warsaw University of Technology, Warsaw, Poland
| | - Dominik Jastrzębski
- Institute of Aeronautics and Applied Mechanics, Warsaw University of Technology, Warsaw, Poland
| | - Rafał Perz
- Institute of Aeronautics and Applied Mechanics, Warsaw University of Technology, Warsaw, Poland
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21
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Cercone DJ, Berger RP, Manole MD, Soung JK, Coombs CM, Noorbakhsh KA. Increased severity of abusive head trauma during the first year of the COVID-19 pandemic. Child Abuse Negl 2023; 135:105971. [PMID: 36427395 PMCID: PMC9676164 DOI: 10.1016/j.chiabu.2022.105971] [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] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Abusive head trauma (AHT) is the leading cause of death from physical abuse in children. Reports regarding the impact of the COVID-19 pandemic on rates and severity of AHT are limited and with conflicting results. OBJECTIVE To determine the number and clinical characteristics of AHT cases presenting to a pediatric tertiary care center during the first year of the COVID-19 pandemic compared to the two prior years. PARTICIPANTS AND SETTING We performed a retrospective cohort study of patients <5 years old diagnosed with AHT at a single pediatric tertiary care center over a three-year period. METHODS Data were obtained for the pandemic year and two years before, including demographics, length of stay, physical and retinal examination findings, radiologic studies, electroencephalogram results, and mortality. RESULTS There were 27 cases of AHT during the first year of the pandemic and 55 during the two pre-pandemic years. Length of stay was similar for the two cohorts. The mortality rate was higher during the pandemic (29.6 % vs. 3.6 %; p < .01), as were the proportion of patients with retinal hemorrhages (84.6 % vs. 41.5 %; p < .01) and abnormal cervical spine imaging (52.6 % vs. 21.2 %; p = .02). There were no differences in age, sex, race, abnormalities on dermatological exam, skeletal surveys, and electroencephalograms. CONCLUSIONS We did not observe an increase in the number of patients with AHT during the pandemic but did see an increase in mortality, patients with retinal hemorrhages, and patients with abnormalities on cervical spine imaging. These data suggest a higher severity of AHT presenting to a pediatric tertiary care center during the pandemic.
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Affiliation(s)
- Dominic J Cercone
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Rachel P Berger
- Division of Child Advocacy, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Mioara D Manole
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Jane K Soung
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Carmen M Coombs
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States; Division of Child Advocacy, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Kathleen A Noorbakhsh
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
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22
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Rezapur-Shahkolai F, Vesali-Monfared E, Barati M, Tapak L. Prediction of Helmet Use Behavior among Motorcyclists Based on the Theory of Planned Behavior. J Res Health Sci 2022; 22:e00564. [PMID: 37571935 PMCID: PMC10422160 DOI: 10.34172/jrhs.2022.99] [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: 11/12/2022] [Revised: 11/23/2022] [Accepted: 12/12/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Road traffic injuries (RTIs) are one of the most critical factors that endanger human health. More specifically, head and neck injuries are the main causes of deaths and disabilities among motorcyclists. This study aimed to investigate the predictive factors of helmet use behavior among motorcyclists based on the theory of planned behavior (TPB). STUDY DESIGN This study followed the cross-sectional design. METHODS This study was conducted on randomly selected 730 motorcyclist employees in Qom, Iran, in 2021. The data collection tool was a self-administered researcher-made questionnaire, including items on demographic characteristics, history of RTIs, and constructs of TPB. Data were analyzed using descriptive summary statistics, analysis of variance, independent samples t test, Pearson correlation coefficient, and structural equation modeling (SEM). RESULTS In this study, only 9.8% of the participants reported that they always used a helmet while riding a motorcycle. About 60% reported a history of a motorcycle crash, and 11.5% had a history of head injuries. The direct effect of attitude, subjective norms, and perceived behavioral control on the intention to use a helmet were statistically significant, explaining 59% of the variation in behavioral intention (intention to use a helmet) (R2=0.59). Moreover, perceived behavioral control and behavioral intention had significant effects on helmet use behavior (R2=0.26). CONCLUSION The prevalence of helmet use among the studied population was very low. Moreover, TPB was useful in identifying the determinants of behavior and especially behavioral intention of helmet use among motorcyclists.
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Affiliation(s)
- Forouzan Rezapur-Shahkolai
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ehsan Vesali-Monfared
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Barati
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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23
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El Beltagy MA, Elbaroody M. The diagnosis and management of abusive head injuries in infancy in Egypt. Childs Nerv Syst 2022; 38:2365-2369. [PMID: 36588129 DOI: 10.1007/s00381-022-05806-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 01/03/2023]
Abstract
Child death owed to abuse and negligence is not uncommon, and its real incidence is unknown. The most common cause of fatal child abuse is head trauma. Abusive head injuries (AHI) most often involve brain injury of infants and young children. The outcomes of AHI vary from complete recovery to severe brain damage and death. This article highlights the diagnosis and management of AHI in infancy in Egypt, with a special focus on the social, medical, and legal aspects. The authors emphasize the importance of reporting cases suspected of AHI to the relevant authorities; this will guard against the recurrence of abuse to the child and will have a positive impact on the community.
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Affiliation(s)
- Mohamed A El Beltagy
- Neurosurgery Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.
- Neurosurgery Department, Children's Cancer Hospital Egypt (CCHE, Cairo, 57357), Egypt.
| | - Mohammad Elbaroody
- Neurosurgery Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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24
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Pakyurek M, Badawy M, Ugalde IT, Ishimine P, Chaudhari PP, McCarten-Gibbs K, Nobari O, Kuppermann N, Holmes JF. Does attention-deficit/hyperactivity disorder increase the risk of minor blunt head trauma in children? J Child Adolesc Psychiatr Nurs 2022; 35:356-361. [PMID: 35962779 PMCID: PMC9637762 DOI: 10.1111/jcap.12390] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/07/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
PROBLEM It is unclear if attention-deficit hyperactivity disorder (ADHD) increases the risk of head trauma in children. METHODS We conducted a multicenter prospective observational study of children with minor blunt head trauma. Guardians were queried, and medical records were reviewed as to whether the patient had previously been diagnosed with ADHD. Enrolled patients were categorized based on their mechanism of injury, with a comparison of those with motor vehicle collision (MVC) versus non-MVC mechanisms. FINDINGS A total of 3410 (84%) enrolled children had ADHD status available, and 274 (8.0%; 95% confidence interval, CI: 7.1, 9.0%) had been diagnosed with ADHD. The mean age was 9.2 ± 3.5 years and 64% were males. Rates of ADHD for specific mechanisms of injury were: assaults: 23/131 (17.6%; 95% CI 11.5, 25.2%), automobile versus pedestrian 23/173 (13.3%; 95% CI: 8.6, 19.3%), bicycle crashes 26/148 (17.6%; 95% CI: 11.8, 24.7%), falls 107/1651 (6.5%; 95% 5.3, 7.8%), object struck head 31/421 (7.4%; 5.1, 10.3%), motorized vehicle crashes (e.g., motorcycle, motor scooter) 11/148 (7.4%; 3.8, 12.9%), and MVCs 46/704 (6.5%; 95% CI: 4.8, 8.6%). CONCLUSION Children with ADHD appear to be at increased risk of head trauma from certain mechanisms of injury including assaults, auto versus pedestrian, and bicycle crashes but are not at an increased risk for falls.
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Affiliation(s)
- Murat Pakyurek
- Department of Psychiatry and Behavioral Sciences, School of Medicine, UC Davis, Sacramento, California, USA
| | - Mohamed Badawy
- Department of Pediatrics, UT Southwestern, Dallas, Texas, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Paul Ishimine
- Department of Emergency Medicine and Pediatrics, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Kevan McCarten-Gibbs
- Department of Emergency Medicine, UCSF Benioff Children's Hospital, Oakland, California, USA
| | - Ozra Nobari
- Department of Psychiatry and Behavioral Sciences, School of Medicine, UC Davis, Sacramento, California, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine and Pediatrics, School of Medicine, UC Davis, Sacramento, California, USA
| | - James F Holmes
- Department of Emergency Medicine, School of Medicine, UC Davis, Sacramento, California, USA
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25
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Mańka-Malara K, Mierzwińska-Nastalska E. Head Trauma Exposure in Mixed Martial Arts. Int J Environ Res Public Health 2022; 19:ijerph192013050. [PMID: 36293623 PMCID: PMC9603147 DOI: 10.3390/ijerph192013050] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 05/06/2023]
Abstract
Combat sports training involves a high risk of head injury. Previously published research on head trauma exposure in MMA evaluated only the knockouts (KO), without calculating all head strikes. The aim of the research was to evaluate the total head trauma exposure during MMA competitions among male and female fighters. Two thousand four hundred and eighty-eight MMA fights from all numbered UFC events between 2000 and 2021 were analyzed. A database containing the results from officially published scorecards with information such as the outcome of a fight, its duration, number of strikes (significant and total amount of hits) depending on location and knockdowns was created. Additional video verification of the knockout technique was carried out. The athletes received an average of 2.41 significant head strikes out of a total of 6.30 head strikes per minute. Head strikes were more common in female fights than in male. Women executed more total and significant head strikes per minute than men. Head trauma caused the ending of 31.6% of all fights-more often in male fights (32.2%) than female (23.1%). It was the most common cause of knockouts-88.1%. Professional fights in mixed martial arts involve high exposure to head trauma. A careful evaluation of the risk involved in training in such a discipline is necessary to provide adequate prevention methods.
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Paudel M, Yap FF, Rosli TBM, Tan KH, Xu H, Vahdati N, Butt H, Shiryayev O. A computational study on the basis for a safe speed limit for bicycles on shared paths considering the severity of pedestrian head injuries in bicyclist-pedestrian collisions. Accid Anal Prev 2022; 176:106792. [PMID: 35952395 DOI: 10.1016/j.aap.2022.106792] [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] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Bicyclists and pedestrians are two large vulnerable groups of road users. Many cities have allowed cyclists to share space with pedestrians on footpaths and off-road paths to reduce conflict with motor vehicles. The risk of bicyclist-pedestrian accidents is also increasing accordingly. Therefore, there is a need to understand the factors that affect the risk of injury in such accidents, especially to pedestrians who are considered more vulnerable. This paper presents a detailed investigation of bicyclist-pedestrian collisions and possible injury outcomes. The study has considered five levels of collision speed ranging from 10 km/h to 30 km/h, three pedestrian profiles (adult, child, and elderly) differentiated by their weight and height, three bicycles with different masses, and five impact directions. The bicyclist-pedestrian collision simulations have been analyzed based on four metrics: throw distance, peak head velocity on impact with the ground, head injury criterion (HIC) value, and the probability of severe head injury. For each simulation, the throw distance and peak head velocity on impact with the ground are extracted. Following that, the HIC and the probability of severe head injury to pedestrians are computed. The results show a significant effect of collision speed (p < 0.05) on all four metrics. The analysis has been further extended to study the effect of height and weight profile, bicycle mass, and impact directions on bicyclist-pedestrian collisions. According to the results, the impact directions largely influence the outcome of bicycle-pedestrian collisions. In general, direct impacts on pedestrian body center have been found to yield higher HIC values and probability of severe head injury to pedestrians than off-center impacts. Also, video analysis of simulated collisions has suggested that the accident mechanism depends on weight and height profiles (correlated with different age groups) and impact directions. Finally, recommendations have been proposed based on the study, including a speed limit of not more than 12 km/h for bicyclists on narrow shared paths and footpaths where risks of collisions with pedestrians are high. The results and analysis presented could be helpful for developing legislation to minimize conflicts between bicyclists and pedestrians on shared paths and to reduce potential injury to pedestrians.
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Affiliation(s)
- Milan Paudel
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore; Transport Research Center @ NTU, Singapore.
| | - Fook Fah Yap
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore; Transport Research Center @ NTU, Singapore
| | - Tantyana Binte Mohamed Rosli
- Transport Research Center @ NTU, Singapore; School of Social Sciences, Nanyang Technological University, Singapore
| | | | - Hong Xu
- Transport Research Center @ NTU, Singapore; School of Social Sciences, Nanyang Technological University, Singapore
| | - Nader Vahdati
- Department of Mechanical Engineering, Khalifa University of Science and Technology, Healthcare Engineering Innovation Center, SAN Campus, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - Haider Butt
- Department of Mechanical Engineering, Khalifa University of Science and Technology, Healthcare Engineering Innovation Center, SAN Campus, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - Oleg Shiryayev
- Department of Mechanical Engineering, University of Alaska Anchorage, 3211 Providence Dr., ECB 301, Anchorage, AK 99508, USA
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Wang F, Huang J, Hu L, Hu S, Wang M, Yin J, Zou T, Li Q. Numerical investigation of the rider's head injury in typical single-electric self-balancing scooter accident scenarios. J R Soc Interface 2022; 19:20220495. [PMID: 36128701 PMCID: PMC9490341 DOI: 10.1098/rsif.2022.0495] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022] Open
Abstract
As the use of electric self-balancing scooters (ESSs) increases, so does the number of related traffic accidents. Because of the special control method, mechanical structure and driving posture, ESSs are prone to various single-vehicle accidents, such as collisions with fixed obstacles and falls due to mechanical failures. In various ESS accident scenarios, the rider's head injury is the most frequent injury type. In this study, several typical single-ESS accident scenarios are reconstructed via computational methods, and the risk of riders' head/brain injury is assessed in depth using various injury criteria. Results showed that two types of ESSs (solo- and two-wheeler) do not have clear differences in head kinematics and head injury risks; the head kinematics (or falling posture) and ESS accident scenario exhibit a distinct effect on the head injury responses; half of the analysed ESS riders have a 50% probability of skull fracture, a few riders have a 50% risk of abbreviated injury scale (AIS) 4+ brain injury, and none has a diffuse axonal injury; the ESS speed plays an important role in producing the head/brain injury in ESS riders, and generally, higher ESS speed generates higher level of predicted head injury parameters. These findings will provide theoretical support for preventing head injury among ESS riders and data support for developing and legislating ESSs.
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Affiliation(s)
- Fang Wang
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, Hunan People's Republic of China
| | - Jiaxian Huang
- School of Mechanical and Automotive Engineering, Xiamen University of Technology, Xiamen, Fujian, People's Republic of China
| | - Lin Hu
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, Hunan People's Republic of China
| | - Shenghui Hu
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, Hunan People's Republic of China
| | - Mingliang Wang
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, Hunan People's Republic of China
| | - Jiajie Yin
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, Hunan People's Republic of China
| | - Tiefang Zou
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, Hunan People's Republic of China
| | - Qiqi Li
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, Hunan People's Republic of China
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Koçak H, Tuncay İ. Evaluation of trauma cases in different types of mass gathering events. ULUS TRAVMA ACIL CER 2022; 28:781-789. [PMID: 35652867 PMCID: PMC10443015 DOI: 10.14744/tjtes.2021.17971] [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: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are several factors affecting trauma cases in mass gatherings (MG). Event type, mood of the crowd, age, gender and educational background are among these factors. It is to identify the relationship between the event types of trauma cases and temperature variables observed in MG. METHODS It is a descriptive epidemiological study. The universe of the research consists of 112 emergency medical service records (ambulance) in organizations such as Çanakkale Victory and Martyrs' Memorial Day (ÇVMMD), Zeytinli Rock Fest, Deaflympics, and European Youth Olympic Winter Festival (EYOF). For the statistical evaluations of the study, frequency analysis, Chi-square test, and logistic regression were used. RESULTS Within the scope of the research, 474 emergency medical service cases were examined. About 49.5% (n=235) of the cases took place at the DEAFOLIMPICS. About 57.6% (n=273) of the cases are male. The age average of the cases is 30.3±16.5 (Min: 0, Max: 92). When the pre-diagnosis range at the ÇVMMD is examined, it is seen that 27.7% (n=20) of the cases are trauma cases while 72.2% (n=52) are non-trauma cases. Among the trauma cases, the most frequently observed ones are soft-tissue trauma, multi-trauma, lower limb injury, and head trauma. When the other cases are examined, the most common ones are angina pectoris, nausea-vomiting, asthma, and ache. In the research, 38.3% (n=90) of the cases at the DEAFOLIMPICS are trauma cases, while 61.7% (n=145) are non-trauma cases. While the trauma cases mostly consist of soft-tissue injury and lower limb injury, the non-trauma cases include nausea-vomiting and upper respiratory infections. While the trauma cases were caused by multi-trauma, sharp object injury, soft-tissue injury, and head trauma, the pre-diagnosis of the non-trauma cases mainly included mental confusion and behavioral disorder due to use of alcohol; conversion; behavioral changes due to use of substance and drug use; hypotension; and allergic reaction. CONCLUSION As a consequence of the logistic regression modeling, the trauma cases were found to be 1.6 times (p<0.05) higher in men than women and 9.5 times more in those who participated in the EYOF event than those who participated in the ÇVMMD event (p<0.05).
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Affiliation(s)
- Hüseyin Koçak
- Bezmialem Vakıf University Institute of Health Sciences, Disaster Medicine Doctorate Program, İstanbul-Turkey
| | - İbrahim Tuncay
- Department of Disaster Medicine, Bezmialem Vakıf University Institute of Health Sciences, İstanbul-Turkey
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29
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Eysenbach L, Leventhal JM, Gaither JR, Bechtel K. Circumstances of injury in children with abusive versus non-abusive injuries. Child Abuse Negl 2022; 128:105604. [PMID: 35339797 DOI: 10.1016/j.chiabu.2022.105604] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although previous studies have examined differences in the characteristics of abusive versus non-abusive injuries, no study has focused on the differences in the circumstances surrounding these injuries, such as whether the event that caused the injury was witnessed or heard, or EMS was called. OBJECTIVE To determine predictors related to the circumstances of the injury (COI) for distinguishing abusive versus non-abusive injuries. PARTICIPANTS/SETTING Children younger than 3-years-old who were hospitalized with either a head injury or a fracture and evaluated by the child abuse consultation service between June 1, 2008 and June 30, 2017. METHODS In this case-control study, abusive (cases) and non-abusive (controls) injuries were determined by a consensus of two experts blinded to the COI. Multivariable logistic regression was used to identify COI predictors of abusive injuries. RESULTS We identified 302 children: 80 cases (26.5%) and 222 controls (73.5%). Abused children were less likely to have a clear event described (p < .001). Of the 251 with a clear event, we found that the significant variables for abuse were father's presence (adjusted odds ratio [aOR] 8.37; 95% CI 3.35-20.92), delay ≥24 h in seeking care (aOR 6.23; 95% CI 1.95-19.92) and calling EMS (aOR 3.21; 95% CI 1.10-9.36). In contrast, the event being heard (aOR 0.22; 95% CI 0.08-0.0.59) and the child being dropped (aOR 0.09; 95% CI 0.01-0.77) were less likely to be abusive. CONCLUSION We identified five COI predictors that may help clinicians in determining whether a child's injuries are due to abuse.
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Affiliation(s)
- Lindsay Eysenbach
- University of Washington Affiliated Hospitals, United States of America
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Stivaros S, Paddock M, Rajai A, Cliffe H, Connolly DJ, Dineen RA, Dixon R, Edwards H, Evans E, Halliday K, Jackson K, Landes C, Oates AJ, Stoodley N, Offiah AC. Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown. Arch Dis Child 2022; 107:575-581. [PMID: 35177407 PMCID: PMC8882637 DOI: 10.1136/archdischild-2021-323444] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/28/2021] [Indexed: 11/03/2022]
Abstract
Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown. OBJECTIVE To assess the number, type and outcome of radiological investigations for children presenting to hospital with suspected physical abuse (SPA; including abusive head trauma) during the first national COVID-19 enforced lockdown compared with the prelockdown period. DESIGN Multicentre, retrospective, observational, interrupted time series analysis. SETTING Eight secondary/tertiary paediatric centres between January 2018 and July 2020 inclusive. PARTICIPANTS 1587 hospital assessed children undergoing radiographic skeletal surveys (SkS) and head CT imaging performed for SPA/child protection concerns. MAIN OUTCOME MEASURES Incidence and severity of fractures identified on SkS; head injury (composed of incidence rates and ratios of skull fracture, intracranial haemorrhage (ICH) and hypoxic ischaemic injury (HII)) on head CT imaging; and ratio of antemortem and postmortem SkS. RESULTS 1587 SkS were performed: 1282 (81%) antemortem, 762 (48%) male, and positive findings in 582 (37%). Median patient age was 6 months. There were 1.7 fractures/child prelockdown versus 1.1 fractures/child during lockdown. There was no difference between positive/negative SkS rates, the absolute ratio of antemortem/postmortem SkS or absolute numbers of head injury occurring between January 2018 and February 2020 and the lockdown period April-July 2020. Likewise, prelockdown incidence and rates of skull fracture 30/244 (12%), ICH 28/220 (13%) and HIE 10/205 (5%) were similar to lockdown, 142/1304 (11%), 171/1152 (15%) and 68/1089 (6%), respectively. CONCLUSION The first UK COVID-19 lockdown did not lead to an increase in either the number of antemortem or postmortem radiological investigations performed for SPA, or the number or severity of fractures and intracranial injuries identified by these investigations.
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Affiliation(s)
- Stavros Stivaros
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, UK
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK
| | - Michael Paddock
- Department of Medical Imaging, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
- Department of Oncology & Metabolism, Damer Street Building, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Azita Rajai
- Centre for Biostatistics, Division of Population Health, Manchester Academic Science Centre, The University of Manchester, Manchester, UK
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Cliffe
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Daniel Ja Connolly
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Robert A Dineen
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Rachel Dixon
- Department of Paediatric Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Harriet Edwards
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
- Department of Radiology, Aintree University Hospital, Liverpool, Merseyside, UK
| | - Emily Evans
- Department of Radiology, University Hospital Coventry, Coventry, UK
| | - Katherine Halliday
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kandise Jackson
- Department of Radiology, Royal Oldham Hospital, Oldham, Greater Manchester, UK
| | - Caren Landes
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Adam J Oates
- Department of Radiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Neil Stoodley
- Department of Radiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Amaka C Offiah
- Department of Oncology & Metabolism, Damer Street Building, The University of Sheffield, Sheffield, South Yorkshire, UK
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, UK
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Mehta N, Bliss L, Trolard A, Kondis JS. The Relationship Between Temperature and Temporal Patterns and Incidence of Abusive Head Trauma in a Midwest Region Hospital. Child Maltreat 2022; 27:194-201. [PMID: 35081795 DOI: 10.1177/10775595211072825] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Abusive head trauma (AHT) is a leading cause of death and disability in children and one of the most lethal forms of child abuse. Most known risk factors for AHT pertain to the infant's caregiver and limited research has assessed external influences beyond the familial or caregiver/infant dyad. Objective: Our primary objective was to determine if temperature patterns are associated with AHT events. Secondary outcomes included associations between AHT and specific days of the week, months, or seasons. Methods: This was a retrospective review of 198 patients under 24 months old who were diagnosed with AHT at Saint Louis Children's Hospital. Demographic information was obtained from the medical record for each patient. For each AHT incident, the date and zip code of the incident were recorded. Temperature on the date of incident was identified using the Midwestern Regional Climate Center (MRCC). Chi square tests were utilized to calculate differences in cases per year as well as temperature and seasonal variation. Results: Temperature was not associated with a statistically significant increase in cases of AHT. There was an increase in cases as temperatures rose, but no statistically significant associations between incidence of AHT and day of the week, month, or season. Conclusion: Our study suggests no significant association between AHT incidence and temperature or temporal patterns in this Midwest hospital.
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Affiliation(s)
- Nehali Mehta
- Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
| | - Laura Bliss
- Department of Neurology, 2429Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne Trolard
- Institute of Public Health, 573506Washington University in Saint Louis, St Louis, MO, USA
| | - Jamie S Kondis
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
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Abstract
BACKGROUND Skateboarding is a popular sport and U.S. trauma centers care for a significant number of skateboard-related injuries (SRIs). However, injury prevention strategies are still underdeveloped. This study was designed to compare the epidemiology, type, and location of skateboard injury as well as the use and influence of protective gear over two time periods. METHODS This is a retrospective National Trauma Data Bank study including all patients with SRIs between 2007and 2016. Study groups were divided into two 5-year periods: 2007-2011 and 2012-2016. The incidence and severity of traumatic brain injury (TBI), as well as the compliance and effectiveness of protective gear and skate parks, was assessed in various age groups in the two study periods using univariable and multivariable analyses. Univariable analysis was used to compare the two study periods, logistic regression analysis was performed to identify independent predictors of head injury and severe TBI. RESULTS 24,903 patients presented with SRIs: 10,594 from 2007 to 2011 and 14,309 from 2012 to 2016. Helmet use was low in both periods (5.7% and 5.4% respectively). The incidence of severe TBI (head AIS≥3) did not change significantly during the two periods (31.6% vs. 30.8%, p = 0.162). In children with severe TBI, there was no significant difference in helmet use across all ages, (10.4% vs. 11.5%, p = 0.467; 6.4% vs. 6.5%, p = 0.753; 4.2% vs. 3.7%, p = 0.201, respectively) with the lowest usage in the older than 16 years age group. On logistic regression, male gender (OR 1.526, 95% CI 1.372-1.698, p<0.001) was associated with increased odds of severe TBI, while helmet use (OR 0.534, 95% CI 0.455-0.627, p<0.001) and injuries at skate parks (OR 0.584, 95% CI 0.541-0.630, p<0.001), near home (OR 0.465, 95% CI 0.418-0.518, p<0.001), and public buildings (OR 0.386, 95% CI 0.440-0.541, p<0.001) were associated with reduced odds of severe TBI. CONCLUSIONS Helmet use in patients with SRIs is low in all pediatric age groups. Helmet use and skate parks are protective against severe TBI. Older age children and male gender are at increased risk of severe TBI after skateboard-related injuries, and more targeted preventive education and legislation are needed.
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Affiliation(s)
- Delbrynth P Mitchao
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, U.S
| | - Meghan Lewis
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, U.S..
| | - Dominik Jakob
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, U.S
| | - Elizabeth R Benjamin
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, U.S
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, U.S
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Findley KA. Letter to the Editor re: Narang et al. on overturned abusive head trauma and shaken baby syndrome convictions. Child Abuse Negl 2022; 127:105577. [PMID: 35221136 DOI: 10.1016/j.chiabu.2022.105577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Keith A Findley
- University of Wisconsin Law School, 975 Bascom Mall, Madison, WI 53706, USA.
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Górniak A, Matla J, Górniak W, Magdziak-Tokłowicz M, Krakowian K, Zawiślak M, Włostowski R, Cebula J. Influence of a Passenger Position Seating on Recline Seat on a Head Injury during a Frontal Crash. Sensors 2022; 22:s22052003. [PMID: 35271149 PMCID: PMC8914925 DOI: 10.3390/s22052003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
Presently, most passive safety tests are performed with a precisely specified seat position and carefully seated ATD (anthropomorphic test device) dummies. Facing the development of autonomous vehicles, as well as the need for safety verification during crashes with various seat positions such research is even more urgently needed. Apart from the numerical environment, the existing testing equipment is not validated to perform such an investigation. For example, ATDs are not validated for nonstandard seatback positions, and the most accurate method of such research is volunteer tests. The study presented here was performed on a sled test rig utilizing a 50cc Hybrid III dummy according to a full factorial experiment. In addition, input factors were selected in order to verify a safe test condition for surrogate testing. The measured value was head acceleration, which was used for calculation of a head injury criterion. What was found was an optimal seat angle −117°—at which the head injury criteria had the lowest represented value. Moreover, preliminary body dynamics showed a danger of whiplash occurrence for occupants in a fully-reclined seat.
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Affiliation(s)
- Aleksander Górniak
- Laboratory of Vehicle Dynamics and Safety, Department of Automotive Engineering, Mechanical Faculty, Wrocław University of Science and Technology, Na Grobli 13, 50-421 Wrocław, Poland; (J.M.); (W.G.); (M.M.-T.)
- Correspondence:
| | - Jędrzej Matla
- Laboratory of Vehicle Dynamics and Safety, Department of Automotive Engineering, Mechanical Faculty, Wrocław University of Science and Technology, Na Grobli 13, 50-421 Wrocław, Poland; (J.M.); (W.G.); (M.M.-T.)
| | - Wanda Górniak
- Laboratory of Vehicle Dynamics and Safety, Department of Automotive Engineering, Mechanical Faculty, Wrocław University of Science and Technology, Na Grobli 13, 50-421 Wrocław, Poland; (J.M.); (W.G.); (M.M.-T.)
| | - Monika Magdziak-Tokłowicz
- Laboratory of Vehicle Dynamics and Safety, Department of Automotive Engineering, Mechanical Faculty, Wrocław University of Science and Technology, Na Grobli 13, 50-421 Wrocław, Poland; (J.M.); (W.G.); (M.M.-T.)
| | - Konrad Krakowian
- Department of Automotive Engineering, Mechanical Faculty, Wrocław University of Science and Technology, Braci Gierymskich 164, 51-640 Wrocław, Poland; (K.K.); (M.Z.); (R.W.)
| | - Maciej Zawiślak
- Department of Automotive Engineering, Mechanical Faculty, Wrocław University of Science and Technology, Braci Gierymskich 164, 51-640 Wrocław, Poland; (K.K.); (M.Z.); (R.W.)
| | - Radosław Włostowski
- Department of Automotive Engineering, Mechanical Faculty, Wrocław University of Science and Technology, Braci Gierymskich 164, 51-640 Wrocław, Poland; (K.K.); (M.Z.); (R.W.)
| | - Jacek Cebula
- Crowd Sp. z o.o. Sp. kom., Gwiaździsta 10/10, 53-413 Wrocław, Poland;
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Eismann EA, Theuerling J, Makoroff KL. The role of household composition of children diagnosed with abusive head trauma. Child Abuse Negl 2022; 124:105481. [PMID: 35007972 DOI: 10.1016/j.chiabu.2021.105481] [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] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/27/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND To prevent abusive head trauma (AHT), many studies focus on understanding the risk factors. Few studies assess the role of household composition. OBJECTIVE To describe the household composition of children diagnosed with AHT and assess the relationships between patient and household characteristics, perpetration, and fatality. PARTICIPANTS AND SETTING Children admitted to a large pediatric hospital with AHT between January 1, 2010 and December 31, 2019. METHODS The diagnosis of AHT was made at initial hospitalization by a child abuse pediatrician with a multidisciplinary team review. The electronic medical records of identified patients were reviewed to identify demographic information, the number and ages of all of their siblings and the number and relationship to patients of all adults who were reported as being present at the time of AHT and therefore considered to be possible perpetrators. Descriptive statistics were used to characterize the sample. Comparisons were made using Fisher exact tests and Mann-Whitney tests. RESULTS Children with AHT who were under 12 months of age and had siblings in the home, particularly siblings under age 5, had greater odds of being injured by a biological parent. Children 12 months or older and children without siblings had greater odds of being injured by a boyfriend or girlfriend of their parent or guardian. CONCLUSIONS In cases of AHT, the possible perpetrator differed based on the presence of young siblings living in the home, which has important implications for AHT prevention.
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Affiliation(s)
- Emily A Eismann
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Jack Theuerling
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Kathi L Makoroff
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
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Abstract
OBJECTIVES The purpose of the study was to evaluate patterns of fall-related injury through childhood and identify risk factors for more severe fall-related injuries with the goal of informing targeted prevention strategies for different ages. METHODS The study population consisted of pediatric patients in the Iowa Trauma Registry from January 1, 2010, to December 31, 2014, who sustained an unintentional fall-related injury (N = 3856 patients). Multinomial logistic regression analysis was used to predict injury severity. Adjusted odds ratios were calculated characterizing the relationship between fall severity and age, sex, race, and fall type. RESULTS More males (62%) sustained a fall-related injury during the study period when compared with females (38%; P < 0.0001). Head injuries were the most common type of injury in the younger than 1 year age group (77%), whereas fractures were the predominant injury type in all other age groups, followed by head injuries. Those younger than 1 year (adjusted odds ratio, 4.0; 95% confidence interval, 2.36-6.90) and aged 15 to 18 years (adjusted odds ratio, 1.9; 95% confidence interval, 1.17-3.03) were more likely to have an Injury Severity Score of ≥16 than those aged 10 to 14 years. CONCLUSIONS Recommendations and prevention strategies need to focus on specific risk factors to reduce the harm of multilevel falls. As we have shown, patterns of fall injuries presenting to trauma hospitals differ by age, thus suggesting that prevention strategies focus on specific age groups.
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Affiliation(s)
| | | | - Carri Casteel
- Departments of Occupational and Environmental Health
| | | | - James Torner
- Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
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Hasjim BJ, Grigorian A, Schubl SD, Lekawa M, Kim D, Bernal N, Nahmias J. Helmets Protect Pediatric Bicyclists From Head Injury and Do Not Increase Risk of Cervical Spine Injury. Pediatr Emerg Care 2022; 38:e360-e364. [PMID: 33181791 DOI: 10.1097/pec.0000000000002290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Only 21 states have mandatory helmet laws for pediatric bicyclists. This study sought to determine the incidence of helmeted riders among pediatric bicyclists involved in a collision and hypothesized the risk of a serious head and cervical spine injuries to be higher in nonhelmeted bicyclists (NHBs) compared with helmeted bicyclists (HBs). METHODS The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for pediatric (age <16 years) bicyclists involved in a collision. Helmeted bicyclists were compared with NHBs. A serious injury was defined by an abbreviated injury scale grade of greater than 2. RESULTS From 3693 bicyclists, 3039 (82.3%) were NHBs. Compared with HBs, NHBs were more often Black (21.6% vs 3.8%, P < 0.001), Hispanic (17.5% vs 9.3%, P < 0.001), without insurance (4.6% vs 2.4%, P = 0.012), and had a higher rate of a serious head injury (24.6% vs 9.3%, P < 0.001). Both groups had similar rates of complications and mortality (P > 0.05). The associated risk of a serious head (odds ratio = 3.17, P < 0.001) and spine injury (odds ratio = 0.41, P = 0.012) were higher and lower respectively in NHBs. Associated risks for cervical spine fracture or cord injury were similar (P > 0.05). CONCLUSIONS Pediatric bicyclists involved in a collision infrequently wear helmets, and NHBs was associated with higher risks of serious head injury. However, the associated risk of serious spine injury among NHBs was lower. The associated risks for cervical spine fracture or cervical cord injuries were similar. Nonhelmeted bicyclists were more likely to lack insurance and to be Black or Hispanic. Targeted outreach programs may help decrease the risk of injury, especially in at-risk demographics.
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Affiliation(s)
- Bima J Hasjim
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Areg Grigorian
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Sebastian D Schubl
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Michael Lekawa
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Dennis Kim
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, LA County Harbor-UCLA Medical Center, Torrance, CA
| | - Nicole Bernal
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Jeffry Nahmias
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
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Caron F, Tourneux P, Tchidjou HK, Taleb A, Gouron R, Panuel M, Klein C. Incidence of child abuse with subdural hemorrhage during the first year of the COVID-19 pandemic: a nationwide study in France. Eur J Pediatr 2022; 181:2433-2438. [PMID: 35302178 PMCID: PMC8929282 DOI: 10.1007/s00431-022-04387-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED The global COVID-19 pandemic prompted governments to impose unprecedented sanitary measures, such as social distancing, curfews, and lockdowns. In France and other countries, the first COVID-19 lockdown raised concerns about an increased risk of child abuse. Abusive head trauma (AHT) is one of the most serious forms of child abuse in children aged 0-24 months and constitutes the leading cause of death in children under 2 years of age. Subdural hemorrhage (SDH) is present in 89% of cases of AHT and constitutes one of the most specific, objective clinical presentations in the diagnosis of child abuse. In a French nationwide study, we sought to evaluate the potential impact of the first year of the COVID-19 pandemic on the incidence of hospital admissions for child abuse with SDH, relative to the two previous years. We conducted a nationwide, retrospective study of data in the French national hospital discharge summary database by applying the International Classification of Diseases (10th Revision) codes for SDH and for child abuse. After including children aged up to 24 months with a diagnosis of child abuse and/or SDH following hospital admission anywhere in France between January 1, 2018, and December 31, 2020, we compared the incidence of child abuse, the incidence of SDH + child abuse, and the demographic data for 2020 with the corresponding values for 2018 and 2019. There were no significant differences in the number of hospital admissions due to child abuse or SDH + child abuse between 2020 and the 2018/2019 control years. The incidence of SDH + child abuse was higher among boys than among girls. There were significantly fewer hospital admissions in May 2020 (p = 0.01) and significantly more in December 2020 (p = 0.03), relative to the same months in the two preceding years. There was a nonsignificant trend toward a lower incidence of hospital admission for child abuse in 2020, relative to 2019 (decrease: 6.4%) and 2018 (decrease: 7.6%). CONCLUSION When considering children under the age of 24 months in France, the incidence of hospital admission for SDH in the context of child abuse was not significantly higher in 2020 than in the two previous years. WHAT IS KNOWN • The impact of COVID-19 lockdown on child abuse and more specifically on subdural hemorrhage remains unknown. WHAT IS NEW • There was no increase in hospitalizations for child abuse and AHT. • We found that boys are more often victims of child abuse and subdural hemorrhage among children aged less than 12 months.
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Affiliation(s)
- Fiorella Caron
- Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - Pierre Tourneux
- Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
- PériTox Laboratory UMR_I 01, UFR de Medicine, University of Picardie Jules Verne, Amiens, France
| | | | - Ariski Taleb
- Department of Medical Information, Montreuil-sur-Mer Medical Center, Montreuil-sur-Mer, France
| | - Richard Gouron
- Department of Pediatric Orthopedics, University of Picardie Jules Verne and Amiens Picardie University Medical Center, Amiens, France
| | - Michel Panuel
- Department of Medical Imaging Hôpital Nord, Hôpitaux de Marseille, Assistance Publique, Marseille, France
| | - Céline Klein
- Department of Pediatric Orthopedics, University of Picardie Jules Verne and Amiens Picardie University Medical Center, Amiens, France
- Service d’Orthopédie Pédiatrique, CHU Amiens-Picardie, 1 rue du Professeur Cabrol, 80054 Amiens Cedex 1, France
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Abstract
OBJECTIVES Abusive head trauma (AHT) is the leading cause of death from trauma in children less than 2 years of age. A delay in presentation for care has been reported as a risk factor for abuse; however, there has been limited research on this topic. We compare children diagnosed with AHT to children diagnosed with accidental head trauma to determine if there is a delay in presentation. METHODS We retrospectively studied children less than 6 years old who had acute head injury and were admitted to the pediatric intensive care unit at a pediatric hospital from 2013 to 2017. Cases were reviewed to determine the duration from symptom onset to presentation to care and the nature of the head injury (abusive vs accidental). RESULTS A total of 59 children met inclusion criteria. Patients who had AHT were significantly more likely to present to care more than 30 minutes after symptom onset (P = 0.0015). Children who had AHT were more likely to be younger (median, 4 vs 31 months; P < 0.0001) and receive Medicaid (P < 0.0001) than those who had accidental head trauma. Patients who had AHT were more likely to have a longer length of stay (median, 11 vs 3 days; P < 0.0001) and were less likely to be discharged home than patients who had accidental head trauma (38% vs 84%; P = 0.0005). CONCLUSIONS Children who had AHT were more likely to have a delayed presentation for care as compared with children whose head trauma was accidental. A delay in care should prompt clinicians to strongly consider a workup for abusive injury.
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Affiliation(s)
| | | | | | - Suzanne B Haney
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
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40
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Vallarta-Rodríguez RA, Moreno-Pizarro E, Garza-Elizondo CADL, Vallarta-Compeán S. Craniofacial trauma: Experience in private hospital care during the pandemic provoked by SARS-CoV-2. CIR CIR 2022; 90:497-502. [PMID: 35944456 DOI: 10.24875/ciru.22000139] [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: 03/01/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The onset of the SARS-Cov-2 pandemic brought with it important changes in the hospital care for all diseases. According to the international literature, since the beginning of the pandemic there has been an impact in the incidence, etiology, and severity of head trauma, all these changes as a direct consequence of lockdown. OBJECTIVE In this article we analyzed the characteristics of craniofacial trauma in patients admitted to a private hospital in Mexico City during the SARS-CoV-2 pandemic. METHOD Medical records from patients admitted in Medica Sur between March 2020 and June 2021. In this study, incidence, etiology, severity of the injuries and the SARS-CoV-2 PCR result performed upon admission were analyzed. RESULTS Although there is no study in Mexico like ours, the results were similar to those reported by other hospital centers worldwide, presenting a greater number of cases classified as mild craniofacial trauma, in addition to finding that the main age group affected were older adults. CONCLUSIONS The reported information in our study provides a general view of craniofacial trauma characteristics during SARS-CoV-2 pandemic.
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Affiliation(s)
| | | | - César A de la Garza-Elizondo
- Servicio de Cirugía Plástica y Reconstructiva, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
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Narang SK, Sachdev KK, Bertocci K, Pierre-Wright MJ, Kaczor K, Bertocci G, Pierce MC. Overturned abusive head trauma and shaken baby syndrome convictions in the United States: Prevalence, legal basis, and medical evidence. Child Abuse Negl 2021; 122:105380. [PMID: 34743053 DOI: 10.1016/j.chiabu.2021.105380] [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] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Media reports and the Innocence Network assert that wrongful Abusive Head Trauma (AHT)/Shaken Baby Syndrome (SBS) convictions pervade the United States (U.S.) criminal justice system. Yet, no empirical evaluation of overturned AHT/SBS convictions has been conducted. OBJECTIVE To evaluate the prevalence, legal basis, and characteristics of appellate rulings of AHT/SBS convictions. PARTICIPANTS AND SETTING U.S. appellate cases in a legal database, Westlaw. METHODS Retrospective review of AHT/SBS convictions that had appellate rulings from January 2008 through December 2018. Multiple search terms ensured all potential AHT/SBS cases were included. A mixed-methods analysis was conducted on overturned AHT/SBS convictions. RESULTS We identified a total of 1431 unique AHT/SBS criminal convictions that had appellate rulings since 2008. Of those, 49 convictions (3%) were overturned, and 1382 (97%) were affirmed/upheld. Of those overturned, 20 cases (1% overall) were overturned on medical evidence-related grounds. The most common themes from the medical evidence-related reversals were controversy over the AHT/SBS diagnosis (n = 12) and accidental injury mechanism (n = 11). After being overturned on appeal, upon retrial, 42% of defendants either re-plead guilty to or were convicted again of the same offense. CONCLUSION(S) AHT/SBS convictions are rarely overturned on medical evidence-related grounds. When overturned, medical evidence-related themes seldom reflect new scientific or clinical discoveries, but rather are alternative or differing medical opinions from those offered at the original trial. Our data tends to support the concerns of other authors regarding irresponsible communication of medical information in AHT/SBS cases.
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Affiliation(s)
- S K Narang
- Child Advocacy and Protection Services, Children's Wisconsin, Wauwatosa, WI 53214, United States of America.
| | - K K Sachdev
- University of Illinois College of Medicine at Chicago, Chicago, IL 60612, United States of America
| | - K Bertocci
- University of Louisville, J.B. Speed School of Engineering, Department of Bioengineering, Louisville, KY 40292, United States of America
| | - M J Pierre-Wright
- Northwestern University Feinberg School of Medicine, Chicago, IL 60201, United States of America
| | - K Kaczor
- Mary Ann and J. Milburn Smith Child Health Outreach, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States of America
| | - G Bertocci
- University of Louisville, J.B. Speed School of Engineering, Department of Bioengineering, Louisville, KY 40292, United States of America
| | - M C Pierce
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, United States of America; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America
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Lepard JR, Spagiari R, Corley J, Barthélemy EJ, Kim E, Patterson R, Venturini S, Still MEH, Lo YT, Rosseau G, Mekary RA, Park KB. Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis. PLoS Med 2021; 18:e1003795. [PMID: 34534215 PMCID: PMC8486090 DOI: 10.1371/journal.pmed.1003795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/01/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. METHODS AND FINDINGS A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. CONCLUSIONS In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.
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Affiliation(s)
- Jacob R. Lepard
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | | | - Jacquelyn Corley
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Ernest J. Barthélemy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, United States of America
| | - Eliana Kim
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- University of California-San Francisco School of Medicine, San Francisco, California, United States of America
| | - Rolvix Patterson
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Sara Venturini
- Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Megan E. H. Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, United States of America
| | - Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Rania A. Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- School of Pharmacy, MCPHS University, Boston, Massachusetts, United States of America
| | - Kee B. Park
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Shimoni Z, Danilov V, Hadar S, Froom P. Head Computed Tomography Scans in Elderly Patients with Low Velocity Head trauma after a Fall. Isr Med Assoc J 2021; 23:359-363. [PMID: 34155849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Recommendations for a head computed tomography (CT) scan in elderly patients without a loss of consciousness after a traumatic brain injury and without neurological findings on admission and who are not taking oral anticoagulant therapy, are discordant. OBJECTIVES To determine variables associated with intracranial hemorrhage (ICH) and the need for neurosurgery in elderly patients after low velocity head trauma. METHODS In a regional hospital, we retrospectively selected 206 consecutive patients aged ≥ 65 years with head CT scans ordered in the emergency department because of low velocity head trauma. Outcome variables were an ICH and neurological surgery. Independent variables included age, sex, disability, neurological findings, facial fractures, mental status, headache, head sutures, loss of consciousness, and anticoagulation therapy. RESULTS Fourteen patients presented with ICH (6.8%, 3.8-11.1%) and three (1.5%, 0.3-4.2%) with a neurosurgical procedure. One patient with a coma (0.5, 0.0-2.7) died 2 hours after presentation. All patients who required surgery or died had neurological findings. Reducing head CT scans by 97.1% (93.8-98.9%) would not have missed any patient with possible surgical utility. Twelve of the 14 patients (85.7%) with an ICH had neurological findings, post-trauma loss of consciousness or a facial fracture were not present in 83.5% (95% confidence interval 77.7-88.3) of the cohort. CONCLUSIONS None of our patients with neurological findings required neurosurgery. Careful palpation of the facial bones to identify facial fractures might aid in the decision whether to perform a head CT scan.
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Affiliation(s)
- Zvi Shimoni
- Department of Internal Medicine B, Laniado Hospital, Netanya, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Vendi Danilov
- Department of Neurology, Laniado Hospital, Netanya, Israel
| | - Shoshana Hadar
- Department of Neurology, Laniado Hospital, Netanya, Israel
| | - Paul Froom
- Department of Clinical Utility, Laniado Hospital, Netanya, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kovler ML, Ziegfeld S, Ryan LM, Goldstein MA, Gardner R, Garcia AV, Nasr IW. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. Child Abuse Negl 2021; 116:104756. [PMID: 33004213 PMCID: PMC7518108 DOI: 10.1016/j.chiabu.2020.104756] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The Covid-19 pandemic has forced mass closures of childcare facilities and schools. While these measures are necessary to slow virus transmission, little is known regarding the secondary health consequences of social distancing. The purpose of this study is to assess the proportion of injuries secondary to physical child abuse (PCA) at a level I pediatric trauma center during the Covid-19 pandemic. METHODS A retrospective review of patients at our center was conducted to identify injuries caused by PCA in the month following the statewide closure of childcare facilities in Maryland. The proportion of PCA patients treated during the Covid-19 era were compared to the corresponding period in the preceding two years by Fisher's exact test. Demographics, injury profiles, and outcomes were described for each period. RESULTS Eight patients with PCA injuries were treated during the Covid-19 period (13 % of total trauma patients), compared to four in 2019 (4 %, p < 0.05) and three in 2018 (3 %, p < 0.05). The median age of patients in the Covid-19 period was 11.5 months (IQR 6.8-24.5). Most patients were black (75 %) with public health insurance (75 %). All injuries were caused by blunt trauma, resulting in scalp/face contusions (63 %), skull fractures (50 %), intracranial hemorrhage (38 %), and long bone fractures (25 %). CONCLUSIONS There was an increase in the proportion of traumatic injuries caused by physical child abuse at our center during the Covid-19 pandemic. Strategies to mitigate this secondary effect of social distancing should be thoughtfully implemented.
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Affiliation(s)
- Mark L Kovler
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Susan Ziegfeld
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Leticia M Ryan
- Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mitchell A Goldstein
- Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rebecca Gardner
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alejandro V Garcia
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Isam W Nasr
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Srinivas S, McLoughlin RJ, Hazeltine MD, Green J, Hirsh MP, Cleary MA, Aidlen JT. Pediatric snow sport injuries differ by age. J Pediatr Surg 2021; 56:520-525. [PMID: 32653163 DOI: 10.1016/j.jpedsurg.2020.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/14/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Unintentional injury is the leading cause of death among pediatric patients. There were 13,436 injuries related to snow sports in those younger than 15 in 2015, with 4.8% requiring admission. These sports are high-risk given the potential for injury even when using protective equipment. We hypothesized that snow sport injury patterns would differ based on patient age. METHODS A cross-sectional analysis of the 2009 and 2012 Kids' Inpatient Database was performed. Cases of injuries were identified and analyzed using ICD-9 codes. National estimates were obtained using case weighting. Multivariable logistic regression was used to assess for confounders. RESULTS Within 745 admissions, there was a statistically significant decrease in skull/facial fractures with increasing age and a statistically significant increase in abdominal injuries with increasing age. Children in early and middle childhood were at increased odds of being hospitalized with skull/facial fractures, while older children were more likely hospitalized with abdominal injuries. CONCLUSIONS Within the pediatric snow sport population, younger children are more likely to experience head injuries, while older children are more likely to experience abdominal injuries. Further research is needed to determine the origin of this difference, and continued legislation on helmets is also necessary in reducing intracranial injuries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shruthi Srinivas
- University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA, USA 01655
| | - Robert J McLoughlin
- University of Massachusetts Medical School, Department of Surgery, 55 Lake Ave N, Worcester, MA, USA 01655
| | - Max D Hazeltine
- University of Massachusetts Medical School, Department of Surgery, 55 Lake Ave N, Worcester, MA, USA 01655.
| | - Jonathan Green
- University of Massachusetts Medical School, Department of Surgery, 55 Lake Ave N, Worcester, MA, USA 01655
| | - Michael P Hirsh
- University of Massachusetts Medical School, Department of Surgery, Division of Pediatric Surgery, 55 Lake Ave N, Worcester, MA, USA 01655
| | - Muriel A Cleary
- University of Massachusetts Medical School, Department of Surgery, Division of Pediatric Surgery, 55 Lake Ave N, Worcester, MA, USA 01655
| | - Jeremy T Aidlen
- University of Massachusetts Medical School, Department of Surgery, Division of Pediatric Surgery, 55 Lake Ave N, Worcester, MA, USA 01655
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Abstract
ABSTRACT Camels are ungulates of the genus Camelus and have been used for centuries in parts of Asia and Africa for transport and sustenance. Handling of camels is not without its dangers, and 4 cases from South Australia are reported with a review of lethal camel-related issues. Case 1 is a 56-year-old man who died of multiple blunt force injuries after he had attempted to move a 7-year-old female dromedary (Camelus dromedarius). Case 2 is a 65-year-old woman who was crushed by 1 or more camels that she had been training. Case 3 is a 1-year-old girl who died of blunt craniocerebral trauma after the car in which she was traveling rolled when the driver swerved to avoid a herd of camels that had strayed onto the road. Case 4 is a 66-year-old woman who died of ischemic and hypertensive cardiac disease exacerbated by physical activity while rounding up camels. Deaths associated with camels involve kicking, stomping, kneeling or sitting on a victim, or biting and shaking and throwing. Lethal mechanisms include hemorrhage from vascular injuries and internal organ disruption, crush asphyxia, and blunt craniospinal injuries. Death may also follow falls from camels or vehicle collisions. Camels also carry a wide range of zoonotic diseases, the most significant of which is Middle Eastern respiratory syndrome. Handling of camels may also exacerbate underlying organic illnesses such as cardiac disease. Those working with camels should be aware that the size, strength, and temperament of these animals may make them dangerous and that they also carry potentially lethal zoonotic diseases.
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Na WI, Park JO, Cho GC, Lee EJ, Wang SJ, Park HA. Risk Factors for Intracranial Injury Caused by Falls at Home in Korea Using Data from the Emergency Department-based Injury In-depth Surveillance (2011-2018). J Korean Med Sci 2021; 36:e53. [PMID: 33619919 PMCID: PMC7900530 DOI: 10.3346/jkms.2021.36.e53] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/10/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. METHODS Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. RESULTS In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74-15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08-6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03-4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02-1.88) in females and 0.56 (95% CI, 0.48-0.66) in males. CONCLUSION In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.
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Affiliation(s)
- Won Il Na
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Ju Ok Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Eui Jung Lee
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soon Joo Wang
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hang A Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Korea.
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Fakhry SM, Morse JL, Garland JM, Wilson NY, Shen Y, Wyse RJ, Watts DD. Increasing BMI is associated with higher mortality, worsening outcomes and highly specific injury patterns following trauma: A multi-institutional analysis of 191,274 patients. J Trauma Acute Care Surg 2021; 90:376-383. [PMID: 33502149 DOI: 10.1097/ta.0000000000003040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the prevalence of obesity has increased, trauma centers are faced with managing this expanding demographics' unique care requirements. Research on the effects of body mass index (BMI) in trauma patients remains conflicting. This study aims to evaluate the impact of BMI on patterns of injury and patient outcomes following trauma. METHODS Patients from 87 hospitals' trauma registries were selected. Those missing height, weight, disposition, or who died in the emergency department were excluded. The BMI categories were calculated from admission height and weight and verified against the electronic medical records. Patients were grouped by the National Institutes of Health-defined obesity class and compared by rate of mortality and in-hospital complications. Logistic regression was used to estimate associations, adjusting for age, gender, race, Injury Severity Score, and number of comorbidities. RESULTS There were 191,274 patients, 53% male; mean age was 60.4 years, mean Glasgow Coma Scale score 14.4, mean Injury Severity Score of 8.8, and 40.4% normal weight. Increased BMI was associated with an injury pattern of increased rates of extremity fractures (humerus, femur, tibia/fibula) and decreased rates of hip fractures and head injuries. Compared with the normal weight group, patients were more likely to die if they were Underweight (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.01-1.38), obese class II (AOR, 1.24; 95% CI, 1.07-1.45), or obese class III (AOR, 1.55; 95% CI, 1.29-1.87). Obese class III was associated with higher odds of a National Trauma Data Standard complication (AOR, 1.20; 95% CI, 1.11-1.30). CONCLUSION In this large multicenter study, increasing BMI and lower than normal BMI were strongly associated with higher mortality. Increasing BMI was also associated with longer length of stay, increased complications, and unique injury patterns. These untoward outcomes, coupled with a distinct injury pattern, warrant care guidelines specific to trauma patients with higher BMI, as well as those with BMI lower than normal. LEVEL OF EVIDENCE Epidemiological, Level III.
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Affiliation(s)
- Samir M Fakhry
- From the Center for Trauma and Acute Care Surgery Research, Clinical Operations Group (S.M.F., J.L.M., J.M.G., N.Y.W., Y.S., R.W., D.D.W.), HCA Healthcare, Nashville, Tennessee
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Al-Hajj S, Arjinian S, Hamadeh Z, Al-Zaghrini E, El Asmar K. Child transport injuries and deaths in Lebanon: a multicentre retrospective study. BMJ Open 2020; 10:e037973. [PMID: 33109652 PMCID: PMC7592305 DOI: 10.1136/bmjopen-2020-037973] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 08/24/2020] [Accepted: 09/13/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Road traffic injury (RTI) constitutes the leading cause of deaths and disabilities for individuals aged 5-29 years globally. Lebanon suffers from a high toll of transport mortality and morbidity, though accurate and reliable RTI data are limited. The aim of this study is to assess the prevalence and the characteristics of child transport injuries and deaths in Lebanon and to determine their outcomes and associated risk factors. METHODS We conducted a multicentre retrospective study to analyse data on transport injuries and deaths for children aged 0-17 years over a 3-year period (2015-2017). Data were captured from multiple sources, including police reports and the emergency departments of 30 hospitals across the country . We performed logistic regression models to examine the effects and test the association of multiple simultaneous factors on the child injury outcome and severity. RESULTS A total of 3,033 cases of child transport injuries and 237 fatalities were collected. The majority of the cases were males (73%) (mean (SD) age=11 (±5) years). Transport victims were Lebanese (66.5%) and Syrian refugees (27.9%). The most commonly reported factor contributing to child's RTI was a child riding in high-speed vehicles (25%) and the most affected body regions were upper and lower extremities (29.9%), followed by head injuries (26.1%). Pedestrians had higher odds of sustaining fatal injuries compared to four-wheel vehicle occupants (OR=1.6; 95% CI: 1.17 to 2.27). Older age groups of 6-14 years (OR=0.51; 95% CI: 0.79 to 0.69) and 15-17 years (OR=0.41; 95% CI: 0.30 to 0.61) had lower odds of dying from transport injuries compared to the younger age group of 0-5 years. CONCLUSION Child transport injury is a major public health problem in Lebanon. Findings from this study urge policy-makers and health professionals to implement evidence-based child transport safety policies and behaviour change programs to reduce child transport injuries and deaths.
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Affiliation(s)
- Samar Al-Hajj
- Health Management and Policy Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | | | - Elie Al-Zaghrini
- Emergency Medicine Department, Faculty of Medicine, Lebanese American University, Beirut, Lebanon
| | - Khalil El Asmar
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Xiao Z, Wang L, Mo F, Lv X, Yang C. Influences of impact scenarios and vehicle front-end design on head injury risk of motorcyclist. Accid Anal Prev 2020; 145:105697. [PMID: 32750527 DOI: 10.1016/j.aap.2020.105697] [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] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
Motorcycle to vehicle collision is one of the most common accidents in the world and usually leads to serious or fatal head injuries to motorcyclists. This study aims to investigate the influences of impact scenarios and vehicle front-end design parameters on head injury risk of the motorcyclist. Five general vehicle types and different impact scenarios were selected for a parametric analysis. Impact scenarios were set according to ISO, 13232 regulation considering impact angles and impact speeds. Five vehicle types of Sedan, MPV (Multi-Purpose Vehicle), SUV (Sport Utility Vehicle), EV (Electric Vehicle) and 1-Box vehicle were included. HIC15 (Head Injury Criterion), head angular acceleration and CSDM (Cumulative Strain Damage Measure) were calculated to evaluate head injury risk of the motorcyclist. The results show that the critical impact speed for HIC15 and head angular acceleration was around 15 m/s, while the critical speed for CSDM was approximately 10 m/s. Impact angle of 45° show extremely high injury risk to the motorcyclist head. Bonnet leading edge height and its combination with other parameter present high influences on motorcyclist head injuries, and the increasing the bonnet leading edge height can potentially reduce head injury risk of motorcyclists. In summary, the present research results provide some theoretic bases for determining the test speed in motorcycle-vehicle crash regulation and design consideration for typical vehicle front end shape.
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Affiliation(s)
- Zhi Xiao
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, 410082 Changsha, China; State Key Laboratory of Vehicle NVH and Safety Technology, 401122 Chongqing, China
| | - Li Wang
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, 410082 Changsha, China
| | - Fuhao Mo
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, 410082 Changsha, China; Aix-Marseille University, IFSTTAR, LBA UMRT24, Marseille, France.
| | - Xiaojiang Lv
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, 410082 Changsha, China; Zhejiang Key Laboratory of Automobile Safety Technology, GEELY Automobile Research Institute, 311228 Hangzhou, China
| | - Chunhui Yang
- School of Computing, Engineering and Mathematics, Western Sydney University, Locked Bag 1797, Penrith, NSW, Australia
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