Cause Of Injury Research Articles

An outbreak of multidrug-resistant Pseudomonas aeruginosa in a burns service in the North of England: challenges of infection prevention and control in a complex setting

Burns patients are at high risk of nosocomial infection, and Pseudomonas aeruginosa is one of the most common causes of wound and systemic infections resulting in significant morbidity and mortality in burns patients. To describe an outbreak of multidrug-resistant P.aeruginosa (MDR-Pa) at a specialist burns service and highlight the challenges in identifying the reservoir of infection despite extensive epidemiological, microbiological, and environmental investigations. Multi-disciplinary outbreak control investigation. Following an inter-hospital transfer of a burns patient from another country, an admission screen revealed that the patient was colonized with MDR-Pa. Subsequently nine more patients contracted MDR-Pa in the period from November 2015 to September 2017. Given the relatively long gap between confirmation of the index and subsequent cases, it was not possible to identify with certainty the reservoirs and mechanisms of spread of infection, although contamination of the burns service environment and equipment are likely to be contributory factors. Preventing infection transmission in specialist burns services is highly challenging, and it may not always be possible to identify and eradicate the reservoirs of infection for P.aeruginosa outbreaks. Our study supports the literature, providing additional evidence that inanimate, common contact surfaces play an important role in nosocomial transmission of P.aeruginosa. These surfaces should either be decontaminated efficiently between patient contacts or be single patient use. Enhanced vigilance is crucial, and, with strict adherence to infection prevention and control procedures, it is possible to reduce the risk of acquisition and spread of infection in patients.

Applying systems ergonomics methods in sport: A systematic review

IntroductionAs sports systems become increasingly more complex, competitive, and technology-centric, there is a greater need for systems ergonomics methods to consider the performance, health, and safety of athletes in context with the wider settings in which they operate. Therefore, the purpose of this systematic review was to identify and critically evaluate studies which have applied a systems ergonomics research approach in the context of sports performance and injury management. Material and methodsFive databases (PubMed, Scopus, ScienceDirect, Web of Science, and SPORTDiscus) were searched for the dates 01 January 1990 to 01 August 2017, inclusive, for original peer-reviewed journal articles and conference papers. Reported analyses were underpinned by a recognised systems ergonomics method, and study aims were related to the optimisation of sports performance (e.g. communication, playing style, technique, tactics, or equipment), and/or the management of sports injury (i.e. identification, prevention, or treatment). ResultsA total of seven articles were identified. Two articles were focussed on understanding and optimising sports performance, whereas five examined sports injury management. The methods used were the Event Analysis of Systemic Teamwork, Cognitive Work Analysis (the Work Domain Analysis Abstraction Hierarchy), Rasmussen's Risk Management Framework, and the Systems Theoretic Accident Model and Processes method. The individual sport application was distance running, whereas the team sports contexts examined were cycling, football, Australian Football League, and rugby union. ConclusionsThe included systems ergonomics applications were highly flexible, covering both amateur and elite sports contexts. The studies were rated as valuable, providing descriptions of injury controls and causation, the factors influencing injury management, the allocation of responsibilities for injury prevention, as well as the factors and their interactions underpinning sports performance. Implications and future directions for research are described.

Altered AKAP12 expression in portal fibroblasts and liver sinusoids mediates transition from hepatic fibrogenesis to fibrosis resolution

Liver fibrosis can be reversed by removing its causative injuries; however, the molecular mechanisms mediating the resolution of liver fibrogenesis are poorly understood. We investigate the role of a scaffold protein, A-Kinase Anchoring Protein 12 (AKAP12), during liver fibrosis onset, and resolution. Biliary fibrogenesis and fibrosis resolution was induced in wild-type (WT) or AKAP12-deficient C57BL/6 mice through different feeding regimens with 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC)-containing chow. AKAP12 expression in portal fibroblasts (PFs) and liver sinusoidal endothelial cells (LSECs) gradually decreased as fibrosis progressed but was restored after cessation of the fibrotic challenge. Histological analysis of human liver specimens with varying degrees of fibrosis of different etiologies revealed that AKAP12 expression diminishes in hepatic fibrosis from its early stages onward. AKAP12 KO mice displayed reduced fibrosis resolution in a DDC-induced biliary fibrosis model, which was accompanied by impaired normalization of myofibroblasts and capillarized sinusoids. RNA sequencing of the liver transcriptome revealed that genes related to ECM accumulation and vascular remodeling were mostly elevated in AKAP12 KO samples. Gene ontology (GO) and bioinformatic pathway analyses identified that the differentially expressed genes were significantly enriched in GO categories and pathways, such as the adenosine 3′,5′-cyclic monophosphate (cAMP) pathway. Knockdown of the AKAP12 gene in cultured primary PFs revealed that AKAP12 inhibited PF activation in association with the adenosine 3′,5′-cyclic monophosphate (cAMP) pathway. Moreover, AKAP12 knockdown in LSECs led to enhanced angiogenesis, endothelin-1 expression and alterations in laminin composition. Collectively, this study demonstrates that AKAP12-mediated regulation of PFs and LSECs has a central role in resolving hepatic fibrosis.

MP25-03 PELVIC FRACTURE URETHRAL INJURY – THE NATURE OF THE CAUSATIVE INJURY CORRELATES STRONGLY WITH SURGICAL TREATMENT AND OUTCOME

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2018MP25-03 PELVIC FRACTURE URETHRAL INJURY – THE NATURE OF THE CAUSATIVE INJURY CORRELATES STRONGLY WITH SURGICAL TREATMENT AND OUTCOME Stella Ivaz, Simon Bugeja, Anastasia Frost, Mariya Dragova, Daniela E. Andrich, and Anthony R. Mundy Stella IvazStella Ivaz More articles by this author , Simon BugejaSimon Bugeja More articles by this author , Anastasia FrostAnastasia Frost More articles by this author , Mariya DragovaMariya Dragova More articles by this author , Daniela E. AndrichDaniela E. Andrich More articles by this author , and Anthony R. MundyAnthony R. Mundy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.840AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is well recognised that pelvic fracture urethral injury (PFUI) is related to the nature of the pelvic ring disruption and that this disruption can be of several different types. We have assessed the specific nature of the injury and its relationship to outcome. METHODS We have studied 106 consecutive patients who had no previous open repair and had assessable pelvic CT scans at the time of injury as well as urethrography and a minimum of two years of follow-up. 66 patients (62%) had been involved in a road traffic accident (RTA) - half of them (n=33) as a driver or passenger in a car. 38 (36%) had been involved in work (n=32) or recreational activities (n=6). 2 patients had attempted suicide by jumping from a height (2%). RESULTS Of the 33 car accidents, 27 were lateral compression (LC) injuries and 4 were open-book (OB). Of the 33 patients who were pedestrians or who were RTA victims who had had motorcycle or bicycle accidents, 16 were LC, 12 were OB and 4 were vertical shear disruptions (VS). Of the work or recreational group 23 were LC, 11 were OB and 4 were VS. The remaining 4 patients were unclassifiable in this simple way. Of the 69 lateral compression fractures, 34 were "straight forward", 22 were crush injuries and the other 13 were not easily classifiable. Of the 34 "straightforward" injuries: 30 were car injuries, 2 were pedestrians and 2 were work injuries. Of the 22 crush injuries: 1 was a car injury, 18 were pedestrian injuries and 3 were work injuries. The surgery in these patients was step 1 - mobilisation and anastomosis - in 7%, step 2 - crural separation - in 52.5%, step 3 - inferior pubectomy - in 15%; and step 4 - supra-crural re-routing - in 17.5%. Other procedures were used in 8%. The success rate of surgery deteriorated from 95% for step 1 to 84% for Step 4 with each successive step. 60% of the step 3 cases and 67% of the step 4 patients were crush injuries. CONCLUSIONS Car drivers and passengers in accidents with other similar-sized vehicles tended to have less serious injuries and a better outcome than the other groups mainly because LC fractures seemed to cause less local trauma in the pelvis and were associated with shorter defects to bridge. Specifically, in a car driver or passenger, there was an 88% chance that the injury would be a "straightforward" "LC" injury causing an incomplete rupture with a 92% chance that it can be treated by a step 1 or step 2 BPA with a success rate of 93% - 96%. This interrelationship between the causative injury and the degree of trauma and the scale of surgery and the outcome might explain why the results of surgery in different areas of the world may give different results. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e326-e327 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Stella Ivaz More articles by this author Simon Bugeja More articles by this author Anastasia Frost More articles by this author Mariya Dragova More articles by this author Daniela E. Andrich More articles by this author Anthony R. Mundy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Spatial Epidemiology of Alcohol- and Drug-Related Health Problems Among Northern Plains American Indians: Nebraska and South Dakota, 2007 to 2012.

Despite high abstinence rates, American Indians experience elevated rates of many alcohol and other drug problems. American Indians also predominantly reside in poor and rural areas, which may explain some observed health disparities. We investigated whether geographic areas including reservations or large American Indian populations exhibited greater incidence of alcohol- and drug-related hospitalizations. We obtained inpatient hospitalization records for 2 Northern Plain states (Nebraska and South Dakota) for the years 2007 to 2012. We constructed zip code counts for 10 categories of hospitalization with diagnoses or injury causation commonly associated with alcohol or drug use. We related these to community sociodemographic characteristics using Bayesian Poisson space-time regression models and examined associations with and without controls for whether each zip code was located within an American Indian reservation. Controlling for other demographic and economic characteristics, zip codes with greater percentage of American Indians exhibited greater incidence for all 10 substance abuse-related health outcomes (9 of 10 well supported); zip code areas within American Indian reservations had greater incidence of self-inflicted injury and drug dependence and abuse, and reduced incidence of alcohol cirrhosis and prescription opioid poisoning. However, the analyses generally demonstrated no well-supported differences in incidence associated with local residence percentages of American Indian versus African American. In our analyses, ethnicity or heredity alone did not account for alcohol- and drug-related hospitalizations among Native populations. Aspects of social, economic, and political dimensions of Native lives must be considered in the etiology of alcohol- and drug-related problems for rural-dwelling indigenous peoples.

Applying Machine Learning to Workers' Compensation Data to Identify Industry-Specific Ergonomic and Safety Prevention Priorities: Ohio, 2001 to 2011.

This study leveraged a state workers' compensation claims database and machine learning techniques to target prevention efforts by injury causation and industry. Injury causation auto-coding methods were developed to code more than 1.2 million Ohio Bureau of Workers' Compensation claims for this study. Industry groups were ranked for soft-tissue musculoskeletal claims that may have been preventable with biomechanical ergonomic (ERGO) or slip/trip/fall (STF) interventions. On the basis of the average of claim count and rate ranks for more than 200 industry groups, Skilled Nursing Facilities (ERGO) and General Freight Trucking (STF) were the highest risk for lost-time claims (>7 days). This study created a third, major causation-specific U.S. occupational injury surveillance system. These findings are being used to focus prevention resources on specific occupational injury types in specific industry groups, especially in Ohio. Other state bureaus or insurers may use similar methods.

Causation and apportionment analysis of injury and physical impairment

Causation and apportionment analysis of injury and physical impairment

Cardiovascular complications after non-cardiac surgery.

Cardiac complications are common after non-cardiac surgery. Peri-operative myocardial infarction occurs in 3% of patients undergoing major surgery. Recently, however, our understanding of the epidemiology of these cardiac events has broadened to include myocardial injury after non-cardiac surgery, diagnosed by an asymptomatic troponin rise, which also carries a poor prognosis. We review the causation of myocardial injury after non-cardiac surgery, with potential for prevention and treatment, based on currently available international guidelines and landmark studies. Postoperative arrhythmias are also a frequent cause of morbidity, with atrial fibrillation and QT-prolongation having specific relevance to the peri-operative period. Postoperative systolic heart failure is rare outside of myocardial infarction or cardiac surgery, but the impact of pre-operative diastolic dysfunction and its ability to cause postoperative heart failure is increasingly recognised. The latest evidence regarding diastolic dysfunction and the impact on non-cardiac surgery are examined to help guide fluid management for the non-cardiac anaesthetist.

Kinematic analysis of pressing situations in female collegiate football games: New insight into anterior cruciate ligament injury causation.

The most common events during which anterior cruciate ligament (ACL) injuries occur in football are pressing situations. This study aimed to describe the knee and hip joint kinematics during pressing situations in football games to identify kinematic patterns in actions with a high risk for ACL injuries. We filmed 5 female collegiate football matches and identified 66 pressing situations. Five situations with a large distance between the trunk and foot placements in the sagittal plane were analyzed using a model-based image-matching technique. The mean knee flexion angle at initial contact (IC) was 13° (range, 8°-28°) and increased by 11° (95% confidence interval [CI], 3°-14°) at 40ms after IC. As for knee adduction and rotation angles, the knee positions were close to neutral at IC, and only minor knee angular changes occurred later in the sequences. The mean hip flexion was 25° (range, 8°-43°) at IC and increased by 22° (95% CI, 11°-32°) after 100ms. The hip was also externally rotated by 7° (range, -19° to 3°) at IC, and gradually rotated internally, reaching 10° of internal rotation (range, -5° to 27°) at 100ms after IC. This study suggests that the observed knee valgus, internal hip and knee rotation, and static hip flexion previously reported in non-contact ACL injury events are unique to injury situations. In contrast, neither rapid knee valgus nor increased internal rotation was seen in non-injury pressing maneuvers.

Understanding forensic psychiatry in healthcare practices and collaboration between legal nurse consultants and physicians.

In 2000, the Institute of Medicine stunned many professionals with their published report that noted the vast number of deaths that occur each year in hospitals across the United States which reach as many as 98,000. Therefore, it comes as no surprise that the healthcare arena faces litigious issues regularly, with some specialties budgets being significantly impacted by the cost of maintaining liability insurance. Legal Nurse Consultants and forensic physicians working in tandem but who work independently from treating clinicians can carry out forensic independent medical examinations (IME). This can help to assess the validity of malpractice claims, including issues of causation and degree of injuries claimed due to the incident(s) and recommend treatment strategies where appropriate. Reviews can cover a wide range of issues such as a person's past or current testamentary capacity, a prisoner or an accused person's mental health and/or mental impairment where necessary sending them for more assessment or treatment outside prison. This article argues that independent medical reviews are a useful tool that can assist the civil and criminal courts processes.

Maxillofacial prostheses challenges in resource constrained regions

Background: This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations.Method: A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries.Results: Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach.Conclusions: In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities.Implications for RehabilitationMore information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments.The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations.The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

Automated recognition of rear seat occupants' head position using Kinect™ 3D point cloud

IntroductionChild occupant safety in motor-vehicle crashes is evaluated using Anthropomorphic Test Devices (ATD) seated in optimal positions. However, child occupants often assume suboptimal positions during real-world driving trips. Head impact to the seat back has been identified as one important injury causation scenario for seat belt restrained, head-injured children (Bohman et al., 2011). There is therefore a need to understand the interaction of children with the Child Restraint System to optimize protection. MethodNaturalistic driving studies (NDS) will improve understanding of out-of-position (OOP) trends. To quantify OOP positions, an NDS was conducted. Families used a study vehicle for two weeks during their everyday driving trips. The positions of rear-seated child occupants, representing 22 families, were evaluated. The study vehicle – instrumented with data acquisition systems, including Microsoft Kinect™ V1 – recorded rear seat occupants in 1120 driving 26 trips. Three novel analytical methods were used to analyze data. To assess skeletal tracking accuracy, analysts recorded occurrences where Kinect™ exhibited invalid head recognition among a randomly-selected subset (81 trips). Errors included incorrect target detection (e.g., vehicle headrest) or environmental interference (e.g., sunlight). When head data was present, Kinect™ was correct 41% of the time; two other algorithms – filtering for extreme motion, and background subtraction/head-based depth detection are described in this paper and preliminary results are presented. Accuracy estimates were not possible because of their experimental nature and the difficulty to use a ground truth for this large database. This NDS tested methods to quantify the frequency and magnitude of head positions for rear-seated child occupants utilizing Kinect™ motion-tracking. ResultsThis study's results informed recent ATD sled tests that replicated observed positions (most common and most extreme), and assessed the validity of child occupant protection on these typical CRS uses. SummaryOptimal protection in vehicles requires an understanding of how child occupants use the rear seat space. This study explored the feasibility of using Kinect™ to log positions of rear seated child occupants. Initial analysis used the Kinect™ system’s skeleton recognition and two novel analytical algorithms to log head location. Practical applicationsThis research will lead to further analysis leveraging Kinect™ raw data – and other NDS data – to quantify the frequency/magnitude of OOP situations, ATD sled tests that replicate observed positions, and advances in the design and testing of child occupant protection technology.

Molecular study for the virulence strain of Pseudomonas aeruginosa isolated from burn patients

Pseudomonas aeruginosa became an important cause of wound and burn infections and serious mortality in burn patients. The virulence factors of these bacteria including their capacity to form biofilm, their ability to hold antibiotics resistance genes as well as rapid motility in vivo and in vitro. Thus the present study was designed to highlight some the virulence factors among different strains of Pseudomonas aeruginosa. All isolated strains (10 isolates) had the capacity to produce biofilm ,one of them (No.3) has shown high level of biofilm (OD.2.5) and it was resisted to most antimicrobial agents; for this reason further investigation was carried out including gene expression by PCR technique and motility. Results showed that all strains were able to resist most common antibiotics; the molecular study for Strain 3 gave clear band of gene size 1.2pb which is responsible for resistance to aminoglycoside group. Understanding the virulence factors mechanisms of Pseudomonas aeruginosa is of a big importance in order to reduce the mortality in burn patients.

Abstract 31: Nifedipine Increases Vascular Formations in Skin Wounds

Introduction: Loss of skin integrity can result in a wound. Wounds are associated with high cost and disability for patients. Peripheral arterial disease may be the cause of wounds that infect and lead to amputations. Our objective was to evaluate whether the use of nifedipine in wounds is associated with greater amounts of new vascular formations and collagen when compared to placebo. Hypothesis: The new vascular formation in wounds is greater in those treated with nifedipine than in those treated with placebo. Methods: We performed 32 wounds in pigs and locally applied placebo or nifedipine (1%, 10% or 20%). Wounds were evaluated macro and microscopically at 6 different moments. A logistic longitudinal model of mixed effects was applied. For this purpose, the response to moderate or marked polymorphonuclear cells was considered as a dependend variable, with the comparison groups (placebo, nifedipine 1%, 10% and 20%) as the explanatory variable. Based on the placebo group, the OR was estimated with its respective confidence interval for the nifedipine groups at the different doses. Value of p <0.05 was considered significant. This study was approved by the animal research ethics committee. Results: The figure below shows the comparison of new vascular formation and collagen between groups at six different times. Conclusions: The use of nifedipine in wounds was associated with greater vascular formation when compared to placebo. There were differences in the production of collagen between the groups evaluated (in the groups of nifedipine 10% and 20% less amount of collagen). Nifedipine may have a positive impact on the healing of skin wounds.

Child understandings of the causation of childhood burn injuries: Child activity, parental domestic demands, and impoverished settings.

Burns are a global public health problem. In South Africa, the rate of paediatric burn deaths is 5 times higher than other upper middle-income countries, with concentrations in impoverished settings. Globally, the majority of research focuses on expert and caregiver descriptions of burn occurrence, causation, and prevention, with limited consideration of children's perspectives. This study investigated children's understanding of the causation and prevention of childhood burns. Data were collected from eighteen 10- to 11-year-old children living in selected impoverished, fire-affected neighbourhoods in Cape Town, through 3 isiXhosa focus groups. All focus groups were transcribed, coded, and analysed for emerging themes through thematic analysis. Themes regarding burn causation and risks centred around 4 themes: (a) developmental limits in context; (b) domestic chores, child capacity, and inability to say "no"; (c) inadequate supervision and compromised caregiving; and (d) unsafe structures. Child accounts of prevention pertained to (e) burn injury prevention activities in comprised environments and emphasized child agency, and upgrading the physical environment. The children in this study ascribed burn injuries as the consequence of their developmental limits in the context of poverty, constraints on parental supervision, and unsafe environments. The children recommended safety education and upgrading their physical environments as part of burns injury prevention. The child accounts offer useful insights to inform safety interventions in impoverished settings.

Human fatalities caused by animal attacks: A six-year autopsy study.

Deaths caused by animal attacks in urban as well as rural areas are rising. With dwindling forest cover and with more interaction of animals with humans in day-to-day life, we need to understand the reasons, manner and causes of these fatal events. We studied 151 cases of fatal animal/human conflicts and in particular, the manner and mechanism of causation of injuries with respect to different types of animals. In this region there were more fatal snake bites followed by cattle attacks. Humans are at some risk while in the vicinity of animals whether in the wild or in human settlements. Human/animal conflicts occur due to reducing habitat for animals and the demands of humans. One must be aware of the potential dangers from animals and as a health care provider it is our duty to educate the public at large. They need to be cautious when around animals, seek medical care after an animal injury and wear protective equipment when working around or with animals.

English

Equines are essential in the farming and transport systems of many areas of developing countries including Ethiopia. However, their socioeconomic importance is often under recognized and they suffer from poor husbandry practices which threaten their welfare and health. Wound is main problem emanated from such practice that results in deviation of their health and welfare. Cross-sectional study was conducted from November, 2016 to January, 2017 with the objective to determine the prevalence and associated risk factors of wound in randomly selected equine in and around Assella town. Physical examination and semi-structured questionnaire were simultaneously employed to collect necessary information and possible risk factors. Out of 400 equines (278 horses and 122 donkeys) examined 250 were found to have wound on one or more of their body parts and the overall would prevalence was 62.5% of which 65.8% was in horses and 54.9% was observed in donkeys. Multivariable logistic regression analysis showed that the prevalence of wound was significantly higher in horse (65.8%) than donkeys (54.9%) (OR=3.509; 95% CI=1.505, 8.184, p= 0.004), the prevalence was higher in adult (66.6%) than in young equine (43.8%) (OR= 2.782, CI= 1.244, 6.225, p=0.013), in males (69.4%) than in females (42.1%) (OR= 4.192, CI=2.122, 8.281, p= 0.000), in poor body conditioned equines (97.0%) than in good body conditioned equines14.6% (OR=454.614, CI=124.291, 1662.829). Moreover, the prevalence of wound in relation to harnessing type was 69.3, 62.8 and 52% in grass, plastic and traditionally prepared leather, respectively. However, this variation was not statically significant (p= 0.111).There was significant variation in causes of wound between horse and donkeys and the wound caused by improper harness was highest (X2=39. 357, P-=0.000) in both horses (35.55%) and donkeys (25%). Similarly, the owners response to the management of wound in horses and donkeys was significantly (X2=15.308, p=0.032) different and the majority of donkeys (71.6%) and horses (65.5%) did not receive any help from their owners. This study revealed a high prevalence of equines wound in and around Asella town which indicate the prevailing situation of equine welfare and health problems. This strongly calls for a continuous awareness creation to equine owners on proper management and handling and improve their welfare and health thereby enhance the utilization and improve the livelihood of the community. Key words: Equines, wound, prevalence, risk factors, Asella.

Severe soft tissue injuries of the upper extremity in motor vehicle crashes involving partial ejection: the protective role of side curtain airbags

IntroductionPartial ejection (PE) of the upper extremity (UE) can occur in a motor vehicle crash (MVC) resulting in complex and severe soft tissue injuries (SSTI). This study evaluated the relationship between partial ejection and UE injuries, notably SSTIs, in MVCs focusing on crash types and characteristics, and further examined the role of side curtain airbags (SCABs) in the prevention of partial ejection and reducing SSTI of the UE. MethodsWeighted data was analyzed from the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) from 1993 to 2012. Logistic regression models were used to assess the relationship of PE with SSTI of the UE and the effect of SCABs in both nearside impacts and rollover collisions. Crash Injury Research and Engineering Network (CIREN) case studies illustrated PE involving SSTI of the UE, and long term treatment. ResultsRollover and nearside impact collisions had the highest percentages of partial ejection, with over half occurring in rollover collisions. Annually over 800 SSTIs of the UE occurred in all MVCs. For nearside lateral force impacts, a multivariable analysis adjusting for belt use and delta V showed a 15 times (OR 15.35, 95% CI 4.30, 54.79) greater odds of PE for occupants without SCABs compared to those with a SCAB deployment. No occupants (0 of 51,000) sustained a SSTI of the UE when a SCAB deployed in nearside impacts, compared to 0.01% (114 of 430,000) when SCABs were unavailable or did not deploy. In rollover collisions, a multivariable analysis adjusted for number of quarter turns and belt use showed 3 times the odds (OR 3.02, 95% CI 1.22, 7.47) of PE for occupants without SCABs compared to those with a SCAB deployment. Just 0.17% (32 of 19,000) of the occupants sustained a SSTI of the UE in rollovers with a SCAB deployment, compared to 0.53% (2294 of 431,000) of the occupants when SCABs were unavailable or did not deploy. CIREN case studies illustrated the injury causation of SSTI of the UE due to partial ejection, and the long term treatment and medical costs associated with a SSTI to the UE. ConclusionsThe majority of severe soft tissue injuries (SSTI) of the upper extremity (UE) involved partial ejection out the nearside window of outboard seated occupants in nearside impacts and rollover collisions. Real world case studies showed that SSTIs of the upper extremity require extensive treatment, extended hospitalization and are costly. Occupants without a side curtain airbag (SCAB) deployment had an increase in the odds of partial ejection. SCAB deployments provided protection against partial ejection and prevented SSTIs of the UE, with none occurring in nearside impacts, and a small percentage and reduction occurring in rollover collisions compared to those where SCABs were unavailable or did not deploy.

Protecting occupants during passenger vehicle rollover crashes

Protecting occupants during passenger vehicle rollover crashes

690 - Pelvic fracture urethral injury – the nature of the causative injury correlates strongly with surgical treatment and outcome

690 - Pelvic fracture urethral injury – the nature of the causative injury correlates strongly with surgical treatment and outcome