Cent Of Injuries Research Articles

Evaluation of physical health, mental wellbeing, and injury in a UK Police Firearms unit

ABSTRACT The aim was to examine the health and wellbeing of UK police firearms officers and to identify the incidence and severity of work-related injuries. Data from 96 officers were derived from an online self-report survey. General health indicators, physical activity levels, WHO-5 wellbeing score, and injury data from the previous 12-months were collected. Thirty work-related injuries (31%) occurred with an injury rate of 31 injuries per 100 FTE worked within the firearms unit in the previous year. Fifty per cent of officers took no time off for recovery. Twenty-nine per cent of injuries were classified as severe and the mechanisms of more severe injuries were linked to occupational demands. Officers who exercised ≥four times per week reported significantly less injuries, while low physical activity levels were associated with significantly lower wellbeing. UK police firearms officers are at a high risk of occupational injury, and physical activity can play an important role in reducing injury and improving wellbeing.

Have changes in computerised tomography guidance positively impacted detection of cervical spine injury in children? A review of the Trauma Audit and Research Network data

Background Clinically significant damage to the cervical spine in children is uncommon, but missing this can be life-changing for patients. The balance between rarity and severity leads to inconsistent scanning, with both resource and radiation implications. In 2014, the United Kingdom’s National Institute for Health and Care Excellence updated their computerised tomography neck imaging guidance in children. The aim of this study was to assess if the change in guidance had resulted in a change in diagnosis or imaging rates. Methods A retrospective review of the national Trauma Audit and Research Network’s data for computerised tomography spine imaging in children in 2012–2013 was compared to the same data sample collected in 2015–2016. Results The percentage of children presenting with neck trauma who were imaged reduced from 15.5 to 14.1% with an increase in confirmed cervical spine injury from 1.6 to 2.3% between the two time periods. The specificity of computerised tomography scanning increased from 10 to 16.4%. There was variation in scan rates, with major trauma centres scanning a greater percentage of children of all ages and with all injury scores, than trauma units. Discussion This study suggests national guidance can impact clinical care in a relatively short timeframe. Variation in how guidance is applied, with major trauma centres scanning proportionately more children with a lower yield, could be because scanning is more readily available, or because trauma protocols encourage more scans. Twenty per cent of injuries were not found on the initial computerised tomography, in keeping with previously reported data, because the injuries were ligamentous or cord contusion. This suggests a role for early magnetic resonance imaging in children with suspected spinal injury.

An epidemiology of paediatric cervical spine injuries at the Red Cross War Memorial Children's Hospital over a ten-year period

Background: Paediatric cervical spine injury (CSI) is rare compared to adult CSI. Very little has been published regarding the epidemiology and outcome of CSI in children in South Africa. The objective of this retrospective study is to characterise the epidemiology and report on the outcome of CSI in children <13 years at a tertiary referral centre for paediatric trauma. Methods: We performed a retrospective study of CSI at our hospital over a ten-year period. The Picture Archiving and Communication System (PACS) of our institution was searched for patients with CSIs. Search terms included: cervical spine fracture, subluxation, dislocation, contusion, SCIWORA (spinal cord injury without radiographic abnormality) and retroclival haematoma. Demographic and clinical data were obtained from hospital records. Injury-related variables were compared for children ≤8 and >8 years due to anatomical and biomechanical differences observed. Outcome was assessed using the Frankel grading. Results: Sixty-six children were identified with a cumulative incidence of 0.1%. The median age was 7 years (inter-quartile range 4–8.8) and 65% were male. All injuries were caused by blunt trauma. Passenger motor vehicle injury (MVA) accounted for 52% of injuries. Injuries due to physical abuse, and recreational and sporting activities did not occur. Children ≤8 years of age incurred more injuries than those >8 years (74.2% vs 25.8%). Ninety-eight per cent of injuries occurred in the upper cervical spine (C1–C4) of children ≤8 years. Of the 13 (19.6%) children with neurologic injury, five (7.5%) had complete spinal cord injury, four (6%) had incomplete neurology, and three (4.5%) died. SCIWORA occurred in six (9%) children with variable outcome. Seven patients (10.6%) were operated for instability. An injury severity score (ISS) of 25 (13–34) was associated with poor outcome. The mortality rate was 4.5% and all children who died were ≤8 years with upper CSIs and closed head injuries (CHIs) related to MVA. Conclusion: CSI occurred in 0.1% of patients evaluated following trauma. MVAs, either pedestrian or passenger, were responsible for the majority of these injuries. Children ≤8 years were more frequently injured and sustained injuries to the upper cervical spine. The majority of paediatric CSIs are stable injuries that can be managed conservatively; however, urgent surgical stabilisation is indicated for unstable injuries. CSI with associated CHI caused by MVAs in young children is associated with death. Even though our patients are referred from high violence communities, no CSIs were attributed to physical abuse or penetrating injury. Level of evidence: Level 4

‘Just send them all to a burn centre’: Managing burn resources in a mass casualty incident

Burn experts estimate that 20–30 per cent of injuries from mass casualty events result in serious burns, many requiring specialised care only available at burn centres. Yet, in the USA there are less then 1,850 burn beds available to provide such a level and quality of care. To address this concern, burn centres are beginning to put into practice new mass casualty triage and transport guidelines that must coordinate with local, regional and federal response plans, while still adhering to an accepted standard of care. This presentation describes how one US burn centre developed and implemented a Homeland Security Exercise and Evaluation Program (HSEEP) designed mass casualty incident (MCI) exercise focused on coordinating ‘the right patient to the right facility at the right time’, based upon acuity and bed availability. Discussion will enable planners to identify methodologies adaptable for incorporation into catastrophic emergency management operations within their regions.

Risk factors for tail injuries in dogs in Great Britain

The aim of the current study was to quantify the risk of tail injury, to evaluate the extent to which tail docking reduces this risk, and to identify other major...

Bite and kick injuries in horses: Prevalence, risk factors and prevention

Studies on the prevalence and predisposing factors of bite and kick injuries in horses have not been reported in a population-based data sample. To investigate the prevalence of bite and kick injuries in horses and associated risk factors in a representative sample of horses in Switzerland. A questionnaire on the incidence of disease and injury, which included the frequency of bite and kick injuries and their association with breed, housing, use and feeding regime, was sent to 2559 horse owners randomly selected throughout Switzerland. The data of 2912 horses with 897 disorders diagnosed by a veterinarian were analysed. There were 231 injuries, 50 (21.6%) caused by a bite or kick from another horse; this number corresponded to 5.6% of all diseases and injuries and concerned only 1.7% of all the horses evaluated. Warmblood, Thoroughbred and Arabian horses had a 4.3 times higher risk of bite or kick injuries than horses of other breeds. Eighteen per cent of injuries were associated with a change in housing management and occurred regardless of whether horses were kept in groups permanently or sporadically. A stable group hierarchy and a housing system that provides adequate space and is adapted to horse-specific behaviour are important factors in prevention and kick and bite injuries.

Maxillofacial trauma in major trauma patients

Trauma has been identified as a major public health problem in Australia. Maxillofacial trauma constitutes a significant proportion of trauma, although epidemiological studies in Australia are few. The purpose of this study was to assess the prevalence and the epidemiological pattern of maxillofacial trauma occurring in major trauma patients. Data were obtained from the Victorian State Trauma Registry, which included all major trauma patients in Victoria. All data relating to maxillofacial trauma defined according to Abbreviated Injury Scale and International Classification of Diseases codes from 1 July 2001 to 30 June 2004 were selected. Data collected included demographic and injury details, and operative procedures carried out. Sixteen per cent of major trauma patients sustained maxillofacial trauma. The highest frequency of injuries occurred in the 15-24 years age group. More males were affected than females (3:1). The majority of injuries were due to transportrelated causes (69 per cent) and occurred mostly on roads, streets or highways (70 per cent). Falls were the cause of 15 per cent of injuries, 10.5 per cent of these injuries were fatal while 20.7 per cent needed rehabilitation. The most common type of bony injury was a fractured maxilla. The need for preventive strategies to be reinforced has been highlighted as transport-related injuries remain high especially in the younger age groups.

Management of Gulf War casualties.

During the Gulf War 84 patients underwent surgery in the Jubail Armed Forces Hospital, Saudi Arabia. The median time to evacuate casualties to hospital was 8 h 40 min. Fragments caused 88 per cent of injuries; 11 per cent were caused by bullets. Multiple lesions were encountered in 70 per cent of patients. The extremities (76 per cent) were the most frequently injured site, the lower limbs more so than the upper. Soft tissue injuries prevailed (59 per cent).

Traumatic arteriovenous fistula: experience with 202 patients.

Experience with the management of 202 patients with 210 traumatic arteriovenous fistulas is reported. Penetrating trauma accounted for 98 per cent of injuries caused mainly by stabs (63 per cent) and missile wounds (26 per cent). Seven of 15 patients with shotgun wounds had multiple lesions. Over half of all fistulas occurred in the cervico-mediastinal vessels; abdominal and thoracic vessels were infrequently involved. The upper limbs were involved in 22 per cent and the lower limbs in 20 per cent. Some 133 patients were diagnosed and treated within 1 week of injury; 69 presented 1 week to 12 years later. Machinery murmur was noted in 61 per cent of the early presenters, but was an almost universal finding in those presenting late. Only three patients had cardiac failure and all had underlying cardiomyopathy. Active overt haemorrhage was not common. Arterial continuity was restored in 80 per cent of cases, usually by autogenous reconstruction. Venous injury was usually treated by ligation or lateral suture. Patients treated within 1 week of injury had a lower rate of perioperative mortality and morbidity than those treated late, due mainly to technical difficulties in controlling the vessels caused by fibrosis and massive venous dilatation. If a policy of selective exploration of penetrating trauma is to be followed, careful assessment for arteriovenous fistula must be made and the patient evaluated at regular intervals for several months. Shotgun injuries require routine angiography at the time of presentation. The earlier treatment is instituted, the better the results.

SEVERE TRAUMA CAUSED BY STABBING AND FIREARMS IN METROPOLITAN SYDNEY, NEW SOUTH WALES, AUSTRALIA

Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre. Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed. Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15-82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed - laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1-107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination. Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma.

The impact of the Intifada on the health of a nation*

This article describes the nature and extent of non‐fatal injuries sustained by Palestinians during the first three months of the second intifada in late 2000 by looking at two sets of data. 10,279 cases were obtained from the records of the Red Crescent Organization, which provides first level emergency care via ambulance crews in the West Bank and Gaza Strip. For 6,071 cases in the West Bank, additional information was available from the Ministry of Health, which keeps records of first and second emergency level care provided at hospitals and health points. The Ministry of Health cases were classified by type of weapon, site of injury and level of treatment provided. Fifty‐eight per cent of injuries occurred in young men 18–34 years, but 25 per cent occurred in school children, ten per cent in people over 50 years and five per cent in females. Fifty‐nine per cent of the injuries were caused by bullets and 76 per cent of these affected the upper part of the body; 13.4 per cent of the injuries were severe, with major implication for disability and the need for long‐term care and support.

Epidemiology of facial trauma in a sample of patients aged 1–18 years

This study reviews the epidemiology of patients aged 1–18 years treated for maxillofacial injuries during a 3 year period at a tertiary care centre. Of the 276 patients, 65.5% were aged 1–10 years. Seventy-three per cent of injuries were to the soft tissues and 15% of injuries were fractures. The mandible and zygoma were the most commonly fractured facial bones. In the adolescent group, facial fractures accounted for over half of all injuries. Injuries of 96.8% were classed as minor to moderate. Falls were by far, the commonest cause of injury, but with increasing age, assaults became more common. A surprisingly high incidence of dog bite injuries was noted, particularly in children under 7 years of age.

Hand Injuries in Farmers: A 10-Year Review

A retrospective review of hand injuries in farmers was carried out in the Regina Health District. One hundred twelve injuries requiring hospitalization were recorded over 10 years. Injuries presented throughout the year, with a peak in August that was associated with the harvest. An increased rate of injury was also associated with age. Entanglement in machinery comprised 84% of injuries, of which swathers, power take-offs, combines and augers made up the majority of causes. Eighty-one per cent of injuries were open, with injury to the index, long and ring fingers being most common. The overall amputation rate was 30%. Patterns of injury relating to each machine were collected, and from these results a classification system is proposed.

Biliary complications associated with laparoscopic cholecystectomy: analysis of common misconceptions

AIMS: General surgeons often express the view that the majority of biliary complications following laparoscopic cholecystectomy are caused by trainee surgeons; complications occur most often in the presence of difficult anatomy or pathology; biliary injuries occur more proximally in the biliary tree than at open cholecystectomy; most injuries are recognized at the time of surgery; and most complications can be managed non-operatively. The aim of this study was to determine if these views are substantiated in clinical practice. METHODS: Thirty consecutive patients were referred to a specialist hepatobiliary unit over a 7-year period with biliary complications following laparoscopic cholecystectomy. The mode of presentation, management and outcome of these patients were analysed. RESULTS: In 21 cases the initial operator was a consultant. Four of the 30 complications occurred in the presence of an anatomical variation or unusually difficult pathology. Only patients in whom a previous attempt at repair had been made had injuries at or proximal to the bile duct confluence; the only two deaths occurred in this group. Only 41 per cent of injuries were detected at the time of surgery and 89 per cent required further surgical intervention, hepaticojejunostomy being the most common procedure performed (75 per cent). CONCLUSIONS: The majority of bile duct injuries are not caused by trainees, do not occur because of unusual anatomy or pathology, do not occur in the proximal biliary tree, are not recognized at the time of the initial operation and often require major reconstructive procedures for their management.

Dog Bite Injuries in Children: A Preliminary Survey

Dog bite injuries in children are a preventable health problem. To characterize this type of injury, we have undertaken to define demographic criteria and patterns of injury inflicted by dogs in our pediatric population. A retrospective chart review was conducted of pediatric patients with dog bite injuries admitted to a Level I pediatric trauma center from January 1986 through June 1998. Patient demographics, canine characteristics, and hospital patient data were collected and analyzed using the Excel program and appropriate statistical methodology. There were 67 patient records reviewed. Thirty-eight (57%) of the patients were male, and 29 (43%) were female. There were 43 (64%) white children, 22 (33%) African-American children, and 2 (3%) Hispanic children. The average age of the children was 6.2 +/- 4.2 years, with an average weight of 23.3 +/- 13.7 kg. More than half the attacks occurred in the afternoon and 55 per cent of these attacks were documented as "unprovoked" attacks. Thirty-one (46%) of these attacks involved family pets, and 30 (45%) dogs were known to the attacked child. The head and neck was involved in greater than 67 per cent of these injuries. Pit bulls caused 25 per cent of the bite injuries. Large dogs were responsible for 88 per cent of the attacks. Forty-four (66%) patients required operative intervention. Twenty-eight of these patients had multiple anatomical areas injured. There were 44 procedures involving the head and neck, 21 involving extremities, and 6 involving other areas of the body. All patients 5 years of age and under had head and neck injuries. Dog bite injuries requiring admission occur more in male children. Caucasian and African American children were the majority of children affected. The children under 5 years of age suffered the most devastating injuries. More than half of these attacks were not provoked. More than two-thirds of the injuries to these children involved the head and neck. We conclude that effective prevention strategies must stress careful supervision of young children and the family or neighbor's dog, a scenario that may easily lead to complacency and set the stage for a severe injury.

Epidemiology and mortality of burns in Tehran, Iran

In order to assist with the prevention of burn injuries the epidemiology of burns in Tehran was investigated. In a retrospective study, 1239 files of patients who were living in Tehran and were injured between March 1994 and March 1995 were studied. Sixty-three per cent of patients were male and 37 per cent were female (age range, 1 month to 93 years). The highest incidence of burns was in the 16–25 age group ( 30 100000 ). Patients with below 40 per cent of burned surface constituted 52.5 per cent of injuries. The most common cause of burns was kerosene accidents. The most common cause of burns in children was boiling water. In terms of social class the highest rate of burns was observed among illiterate people (burn rate (BR) 39 100000 ). The mean length of hospitalization was 12 days. Of the 1239 cases, 737 patients died. The mortality rate was 51 per cent in males and 69 per cent in females. The mean body surface area burned was higher in females. The mortality rate was higher and the length of hospitalization was shorter in comparison with other studies in other countries.

A prospective study of non-fatal childhood road traffic accidents: what can seat restraint achieve?

A prospective study of children attending an Accident and Emergency Department was carried out at the Royal Aberdeen Children's Hospital, to determine the association between injury risk and seat restraint usage, and to estimate the likely impact of seat restraint usage at various target levels on the incidence of non-fatal injuries. The subjects were all 91 cases of non-fatal childhood road traffic accidents attending the casualty department between December 1989 and November 1990. The main outcome measures were relative risks of three grades of injury severity and four types of non-fatal injury, population attributable risk fractions and estimated likely reduction in incidence of non-fatal injury at three set target levels of seat restraint usage. It was found that 42 (46 per cent) children presenting to the A&E Department were unrestrained; 78 (85.7 per cent) children sustained some injury. The relative risk for children travelling unrestrained in a car for all injuries combined is 1.7 (95 per cent confidence interval (CI) 1.17-2.45), the relative risk for head injury is 3.13 (1.78-5.51) and for face injury 3.03 (1.44-6.37). The risk of sustaining any moderate or worse injury was 3.25 (1.05-10.07). It is estimated that 24.4 per cent (minimum 5.5 per cent; maximum 45 per cent) of all non-fatal injuries sustained by a child car passenger can be prevented if all children are restrained in a child safety seat or seat restraint; 49.5 per cent of head injuries (minimum 43.4 per cent; maximum 71.9 per cent) and 48.4 per cent of face injuries (minimum 21.9 per cent; maximum 75.3 per cent) are preventable.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrical burns in Kuwait: A review and analysis of 64 cases

Sixty-four patients with electrical burns were admitted to the Department of Plastic Surgery, Ibn Sina Hospital, Kuwait during the past 6 years. There were 1202 admissions during this period, the incidence of electrical burns being 5.3 per cent. Sixty-nine per cent of the patients sustained injury from direct contact with live electrical wire, the remaining 31 per cent sustained flash burns. The incidence of low voltage injury was much higher as compared to high voltage. Forty-four per cent of these injuries were not work related. Less than 10 per cent of the body surface area was involved in about 80 per cent of the patients. A total of 65 operations was carried out in 39 patients. Twenty of these patients had repeated debridements until the wound was ready for coverage. All 64 patients survived.

Audit of thermally injured children under 5 years of age

One-third of all admissions to the Wessex Regional Burns Unit (WRBU) are children under 5 years of age. These patients constitute a disproportionately large part of the workload in terms of nursing and medical care. A review of children admitted to the WRBU over a 5-year period was undertaken. Information was stored in a computer database (dBASE-IV) to simplify data analysis and to develop a system of data collection which can be used for audit. Eighty-one per cent of injuries were due to scalds. The mean burn surface area (BSA) was 8 per cent, and 78 per cent of injuries were smaller than 10 per cent BSA. Skin grafting was required in 44 per cent of patients. The mean time to operation was 13 days after injury. Significant hypertrophic scarring occurred in 60 per cent of patients and 12 per cent of patients were readmitted for further surgical procedures. There was one death. In an extension to the main database, associations between clinical and physiological observations and morbidity were sought. The data suggest that behavioural changes, 'shock', profound lymphocytopenia and pyrexia greater than 39.5 degrees C should be treated as strongly suggestive of the development of complications in the early stages after injury.

After‐hours treatment of anterior dental trauma in Newcastle and western Sydney: a four‐year study

This study investigated anterior dental trauma presenting after-hours in Newcastle and western Sydney. During the four-year period 1983-1986, all patients presenting with anterior dental injuries to the Royal Newcastle Hospital (n = 382) or Westmead Hospital (n = 362) on week nights, weekends or public holidays were studied. In both areas, upper central incisors were the teeth injured most frequently. The mean numbers of teeth injured per patient were 1.9 at Newcastle and 2.0 at Westmead. The frequencies of injury types found in Newcastle and Westmead were similar. Luxations and avulsions accounted for 39.5 per cent of injuries at Newcastle and 39.6 per cent at Westmead. In Newcastle, the rate of occurrence of trauma was highest and relatively uniform in the 6-11, 12-17 and 18-23 year age groups. At Westmead, it was highest in the 6-11 year age group, followed closely by the 12-17 year age group. In both centres, the four main causes of trauma were falls, assaults and fights, sports and bicycle accidents. These accounted for 69 per cent of all injuries in Newcastle and for 69.4 per cent at Westmead. This study found a great similarity between Newcastle and western Sydney in relation to the predominant age and sex groups affected, causes of trauma, injury types and numbers and locations of injured teeth per patient. It is suggested that anterior dental trauma presenting after-hours may be more severe, involve more teeth per patient and affect predominantly older age groups than is the situation during normal hours.