Injury Characteristics Research Articles

Prevalence and Characteristics of Injury among Travelers in Bali, Indonesia

Background: Injuries occurred in nearly 6 million deaths and 52 million disability-adjusted life years annually, which caused 15% of the global disease burden. More than 90% of this burden occurred in low and middle-income countries (LMICs) where injury control capacity and initiatives are lacking. Methods: This was a cross-sectional study conducted in several hospitals dealing with travelers suffering from injuries. Data were obtained from the medical records which were identified for analysis purposes. 5589 travelers visited the study sites within the 2018-2019 period. More than 12% were admitted. Among those patients, 108 were eligible to be included in this study. Results: Most types of traumas experienced by tourists were closed fractures in as many as 49 people (45.4%). Conclusion: The prevalence of trauma in travelers is still high. Therefore, prevention strategies must be conducted.

Standardizing quality utilization of interventional radiology treatments of blunt splenic injury: SQUIRTS study

ObjectivesNonoperative management (NOM) of blunt splenic injury (BSI) is well accepted in appropriate patients. Splenic artery embolization (SAE) in higher-grade injuries likely plays an important role in increasing the success of NOM. We previously implemented a protocol requiring referral of all BSI grades III-V undergoing NOM for SAE. It is unknown the risk of complications as well as longitudinal outcomes. We aimed to examine the splenic salvage rate and safety profile of the protocol. We hypothesized the splenic salvage rate would be high and complications would be low. MethodsA retrospective study was performed at our Level 1 trauma center over a 9-year period. Injury characteristics and outcomes in patients sustaining BSI grades III-V were collected. Outcomes were compared for NOM on protocol (SAE) and off protocol (no angiography or angiography but no embolization). Complications for angiographies were examined. ResultsBetween January 2010 and February 2019, 570 patients had grade III-V BSI. NOM was attempted in 359 (63 %) with overall salvage rate of 91 % (328). Of these, 305 were on protocol while 54 were off protocol (41 no angiography and 13 angiography but no SAE). During the study period, for every grade of injury a pattern was seen of a higher salvage rate in the on-protocol group when compared to the off-protocol group (Grade III, 97 %(181/187) vs. 89 %(32/36), Grade IV, 91 %(98/108) vs. 69 %(9/13) and Grade V, 80 %(8/10 vs. 0 %(0/5). The overall salvage rate was 94 %(287) on protocol vs. 76 %(41) off protocol (p < 0.001, Cochran-Mantel-Haenszel test). Complications occurred in only 8 of the 318 who underwent angiography (2 %). These included 5 access complications and 3 abscesses. ConclusionThe use of a protocol requiring routine splenic artery embolization for all high-grade spleen injuries slated for non-operative management is safe with a very low complication rate. NOM with splenic angioembolization failure rate is improved as compared to non-SAE patients’ at all higher grades of injury. Thus, SAE for all hemodynamically stable patients of all high-grade types should be considered as a primary form of therapy for such injuries.

Assessment of the quality of life of moderate and severe burn patients in Saudi Arabia using the Burn Specific Health Scale-Brief

Improvements in the mortality rate for burn injuries has led to an increase in the number of major burn survivors. Burn injuries pose significant physical and psychological consequences that impact the quality of life of burn survivors. The current study assessed the quality of life of major burn survivors in Saudi Arabia using the Burn Specific Health Scale-Brief (Arabic version). A total of 48 major burn survivors completed a validated online survey. Additional data, including demographics, burn injury characteristics, and treatment strategies, were collected from electronic health records. The mean extent of the patients’ burn injuries was 32 % of total body surface area. The average number of surgical interventions was four (ranging between two to 15 procedures). Over 40 % of the patients experience significant difficulties in performing their jobs. About 94 % are bothered by the appearance of their burn scars. Exposure to sun and hot weather remains a significant burden for the majority. The mean scale score was 99 out of 148. The number of surgical interventions was found to be related to a lower quality of life score (p-value = 0.02). Gender, age, and total body surface area had no predictive value for lower quality of life after burn injury. Even several years after sustaining burn injuries, burn patients continue to exhibit long-term complications and limitations in their functional status and daily living. Furthermore, the number of surgical interventions burn survivors have undergone is a negative predictor for their quality of life.

Lethal injuries in single stabs to the trunk – A study on homicides and suicides in Sweden

IntroductionHomicides using knives or other sharp objects are the most common type of homicide in Europe, and the second most common type of homicide worldwide. In contrast, suicides using sharp objects are rarer, constituting only a few per cent of all suicides in western countries. We investigated single stab injuries to the trunk in both homicides and suicides to assess differences in extent of injuries and in medical care, which could be of value for trauma management, public health and forensic assessment. MethodsWe identified all cases in Sweden between 2010 and 2021 that died of a single stab to the trunk, in either a homicide (n = 94) or a suicide (n = 45), and that were the subject of a forensic autopsy. We obtained data on demographics, hospital care and injured structures. To assess the severity of injuries, we applied AIS (Abbreviated Injury Score) and NISS (New Injury Severity Score). The inter-rater reliability of NISS between two raters was evaluated with intra-class correlation (ICC), with 95 % confidence intervals (CI). The data was analysed using Fisher's exact test, Mann-Whitney U test and logistic regression models. ResultsThe inter-rater reliability between the two NISS raters showed an ICC of 0.87 (95 % CI 0.68−0.95). We observed a larger variation of injuries in suicides, with a higher proportion of both unsurvivable (NISS 75) and minor injuries (NISS ≤ 8) (66.7 % and 8.9 % respectively) compared to in homicides (46.8 % and 0 % respectively). We observed a larger proportion of injuries to the heart in suicides (68.9% vs. 46.8 %, p = 0.018). In homicides, injuries involving vessels (52.1% vs. 13.3 %, p < 0.001) and hospital care (56.4 % vs. 8.9 %, p < 0.001) were significantly more common compared to suicides. Discussion and conclusionCausation (self-inflicted or assaults) seems to be associated with characteristics of injury and the likelihood of receiving hospital care. These findings could potentially be valuable for trauma management and forensic assessment of manner of death, however, determining the mortality of the injuries would require a comparison group comprising injured survivors.

Epidemiology of Non-Contact Muscle Injuries in the Italian Male Elite Under-19 Football (Soccer) Championship

BackgroundWhile extensive research exists on muscle injuries among adult football players, a notable gap persists in studies concerning younger footballers. The aim of the current study is to provide epidemiological data on the characteristics of time-loss muscle injuries in young football players participating in the Italian Under-19 male elite Championship (“Primavera 1”).ResultsConducted as a multicentre, prospective, observational cohort study, this research gathered injury data from the 2022-23 season across 14 of the 18 Clubs in the first Italian Under-19 championship. The cohort comprised 391 players with a mean age (± standard deviation) of 18.0 ± 0.4 years. A total of 479 injuries were reported, resulting in 14,231 days of activity lost. Of these, muscle injuries were 209 (44%), accounting for 4,519 (32%) days lost. Overall muscle injuries incidence was 1.82/1000 hours, with a mean injury burden of 39.4 days lost/1000 hours. Almost all muscle injuries (206 out of 209: 98.5%) occurred in hamstrings, quadriceps, adductors, calf and iliopsoas. Hamstrings injuries were the most burdensome (18.8 days lost/1000 hours) accounting for nearly half of all days lost due to muscle injuries. Incidence and burden of adductors injuries (0.25 injuries and 4.1 days lost/1000 hours, respectively) were found to be comparable to calf injuries (0.24 injuries and 4.7 days lost/1000 hours, respectively). Iliopsoas injuries accounted for a noteworthy portion of the total, with an injury incidence of 0.16/1000 hours and a burden of 3.3 days lost/1000 hours. Injuries with myo-tendinous or myo-aponeurotic involvement demonstrated delayed return-to-football compared to those without such involvement (35.6 vs. 18.5 days, p < 0.0001).ConclusionsThe study highlighted a peculiar distribution of non-contact muscle injuries among elite young football players. While hamstring injuries were confirmed as the most burdensome, incidence and burden of adductors and calf injuries were found to be similar. A significant incidence and burden of iliopsoas injuries were observed. These findings suggest potential implementations for targeted injury prevention strategies in the Italian male elite Under-19 football Championship.

The Association Between Injury Characteristics and in-Patient Outcomes in a Cohort of Adult Patients Admitted to a State Spinal Unit Following Spinal Injuries: A Retrospective Observational Study.

The Association Between Injury Characteristics and in-Patient Outcomes in a Cohort of Adult Patients Admitted to a State Spinal Unit Following Spinal Injuries: A Retrospective Observational Study.

Injuries in Athletics (Track and Field): A Narrative Review Presenting the Current Problem of Injuries

Objective: In Athletics (Track and Field), athletes can be affected by injuries, especially in their quest for top performance. Therefore, we aim to provide an overview of the current knowledge about the problem of injuries in Athletics. Main findings: It is necessary to maintain a clear definition of “injury” when stakeholders in Athletics discuss clinical, administrative, and/ or research perspectives. There are several possible methodological approaches to collect injury data in Athletics depending on the context, population, and injury definition. In general, about two thirds of Athletics athletes sustain at least one injury during an Athletics season, and there are about 100 injuries per 1000 registered athletes during an international championship. The injury rates and characteristics vary by sex and discipline. The injuries can affect athletes physically, psychologically, and socially, with short- and long-term consequences for musculoskeletal function, athletics performance and athletics career. Although it is logical to try to reduce the injury risk, little scientific evidence is currently available to help Athletics-related stakeholders. Conclusions: Injury can currently be considered as an omnipresent problem in Athletics, which affects their practice, with consequences on performance and health. Injury risk is today an undeniable part of the life of Athletics athletes, which implies that there is a pressing need to continue the development of injury risk reduction strategies, to scientifically evaluate their efficacy, and to implement them in sports practice.

Epidemiology of Pediatric Dog Walking-Related Injuries Among Children Presenting to US Emergency Departments, 2001 to 2020.

Dog walking is associated with a significant injury burden among adults, but the risk of injury associated with dog walking among children is poorly understood. This study describes the epidemiology of children treated at US emergency departments for injuries related to leash-dependent dog walking. The National Electronic Injury Surveillance System (NEISS) database was retrospectively analyzed to identify children (5 to 18years of age) presenting to US emergency departments between 2001 and 2020 with dog walking-related injuries. Primary outcomes included annual estimates of injury incidence, injury characteristics, and risk factors for fracture or traumatic brain injury (TBI). Weighted estimates, odds ratios (ORs), and 95% confidence intervals (CIs) were generated using NEISS sample weights. An estimated 35,611 children presented to US emergency departments with injuries related to dog walking. The mean age of patients was 11 years, and most patients were girls (63%). Over half (55%) of injuries were orthopaedic, and patients commonly injured their upper extremity (57%) and were hurt while falling when pulled or tripped by the leash (55%). The most frequent injuries were wrist strain/sprain (5.6%), finger strain/sprain (5.4%), and ankle strain/sprain (5.3%). On multivariable analysis, injured children aged 5 to 11 years were more likely to have sustained a TBI (OR: 3.2, 95% CI: 1.1-9.7) or fracture (OR: 1.6; 95% CI: 1.1-2.3). Boys were more likely than girls to have experienced a fracture (OR: 2.0, 95% CI: 1.3-2.5). Dog walking-related injuries in children are primarily orthopaedic and involve the upper extremity. Younger children and boys are at greater risk for serious dog walking-related injuries. Level III.

Emergency Department Thoracotomy: A National Trauma Databank analysis

IntroductionEmergency Department Thoracotomy (EDT) warrants further investigation in the pediatric population due to concerns about its futility. Our study evaluates how patient demographics, injury characteristics, and physiologic status influence pediatric EDT outcomes in blunt and penetrating trauma. MethodsThis retrospective study analyzed patients ≤19 years who received EDT within 1 hour of arrival to the ED from the National Trauma Data Bank. Cases were stratified by blunt and penetrating trauma. Descriptive statistics and univariate analysis were used to identify predictors of survival post-EDT. ResultsOf the 1,075 pediatric patients who underwent Emergency Department Thoracotomy (EDT), 79.6 % experienced penetrating trauma and 20.4 % blunt trauma, with survival rates at 25.9 % and 9.1 %, respectively. Survivors of penetrating trauma typically presented with more stable vital signs, such as pulse rate, oximetry, and Glasgow Coma Scale (GCS) scores, and lower Injury Severity Scores (ISS), all correlating with survival (p < 0.05). Survivors of blunt trauma were distinguished by higher respiratory rates and temperatures (p < 0.05). Risk factor analysis indicated that age-adjusted bradycardia, age-adjusted hypotension, and pre-hospital cardiac arrest were significant predictors of mortality across trauma types (penetrating trauma: OR = 18.7, 6.2, and 20.7; blunt trauma: OR = 12, 2.69, and 6.4, all p < 0.05). Notably, pre-hospital respiratory support was associated with a reduced risk of mortality for both types of trauma (OR = 0.32 for penetrating, and OR = 0.23 for blunt, p < 0.05). ConclusionsThe study affirms the significance of pre-hospital care, showing that stable vitals and respiratory support enhance pediatric thoracotomy outcomes. Ongoing research into pediatric-specific trauma protocols are needed. Type of StudyRetrospective cohort Level of EvidenceIII

Seasonal Dynamics in Burn Profiles: A Comprehensive Retrospective Analysis at the Burn Care Centre, PIMS, Islamabad (2016-2022).

Seasons have a major impact on the frequency and characteristics of burn injuries; in warmer months, thermal burns from outdoor activities are more common, while in cooler months, incidents involving heating sources and fires are more common. It is essential to comprehend these trends in order to customize safety precautions and awareness initiatives. Studies on the impact of seasonal variations help burn centers allocate resources more effectively in order to prepare for variations in patient volume and severity. Data from January 2016 to December 2022, with an emphasis on burn types excluding nonburn cases, were analyzed retrospectively over a 7-year period at the Burn Care Centre in Pakistan Institute of Medical Sciences, Islamabad. The research examined hospital stays, demographics, burn causes, admissions, total burned surface area, and death rates while dividing the years into winter and summer seasons for analysis. With 4014 admitted patients, the study found that winter admissions increased by 11.007%, with winter admissions accounting for 55.503% of all admissions and summer admissions for 44.496%. The gender distribution stayed the same, with 54.59% of the population being male and 45.99% being female. Hospital stays were longer for summer admissions (16.428) than for winter admissions (11.285). Summertime saw a rise in electric burn cases (307 cases), with a 43 case fatality rate. With 1699 cases, flame burns predominated in the epidemiology of burns, followed by scald burns with 1384 cases. In conclusion, seasonal differences have a substantial impact on burn profiles, with winter seeing a marked rise in occurrences. Men are also more likely to sustain electric burns, particularly in the summer. Effective management and prevention techniques depend on an understanding of these patterns.

A Scoping Review of PTSD and Depression in Adult Burn Patients: A Call for Standardized Screening and Intervention Research.

Despite the growing incidence of burn injuries globally and the advancements in physical recovery, the psychological aspect of burn trauma recovery remains inadequately addressed. This review aims to consolidate existing literature posttraumatic stress disorder (PTSD) and depression in adult burn survivors, recognizing the need for a holistic approach to burn recovery that encompasses both physical and mental health. The comprehensive analysis of 156 studies revealed significant variations in methodological approaches, leading to challenges in creating standardized protocols for mental health assessment in burn care. Key findings include the identification of a wide range of psychological assessment tools and a substantial research gap in low and middle-income countries, where the majority of burn injuries occur. Only 7.0% of the studies assessed interventions for PTSD or depression, indicating a lack of focus on treatment modalities. The studies identified demographic factors, patient history, psychosocial factors, burn injury characteristics, and treatment course as risk factors for PTSD and depression post-burn injury. The review highlights the need for early screening, intervention, and attention to subjective experiences related to burn injury, as these are strong predictors of long-term psychological distress. It also emphasizes the complexity of addressing psychological distress in burn survivors and the need for more standardized practices in assessing PTSD and depression specific to this population.

Preserving functional properties and inhibiting postharvest peel browning in guava during cold storage via 24-epibrassinolide application

Postharvest peel browning is one of the primary issues accountable for the subdued consumer acceptability and market value of guava fruit. However, postharvest treatment with brassinosteroid can reduce the peel browning to some extent through various modes of action. In current study, the influence of exogenous 24-epibrassinolide (EBL) application on antioxidant system and chilling injury (CI) characteristics of guavas during cold storage at 10 ± 1 ℃ were assessed. The mature green fruit exposed to various concentrations (15, 30, 45, 60 and 75 µg kg−1) of EBL displayed a notably lower fruit weight loss, respiration rate, electrolyte leakage and CI index, while higher consumer acceptability. Further, treatment with EBL has recorded lower amassing of hydrogen peroxide and malondialdehyde by suppressing lipoxygenase activity. Postharvest EBL application also heightened the content of total phenolics, ascorbic acid, total flavonoids and total antioxidant capacity. The enhanced activities of ascorbate peroxidase, catalase, superoxide dismutase and peroxidase due to EBL application impede the burst of reactive oxygen species. Moreover, correlation and regression analysis of tested biochemical parameters including enzymatic and non-enzymatic antioxidants exhibited a strong association and contributed 98.24–99.88 % variability in fruit weight loss, respiration rate, electrolyte leakage, CI index and consumer acceptability. Among different concentrations tested, 60 µg kg−1 EBL-treated guavas exhibited the desirable qualities and least CI index. From the study, it is concluded that the novelty of EBL can be gainfully harnessed in a postharvest handling system to induce cold tolerance and widen the storage life of cold-stored guava fruit.

Electric scooter-associated orthopedic injuries cause long absence from work, regret and are emerging as a major cause of hip fractures in young individuals: a comprehensive study from a regional trauma center in a densely populated urban setting

This study aimed to give a full spectrum of orthopedic injuries associated with electric scooter (e-scooter) use and analyze related factors, report on follow-up data from the patient's perspective and make a comparative etiological analysis of young adult hip fractures. A total of 851 consecutive patients were admitted to the Emergency Department following e‑scooter injuries between January 2021 and July 2022, of whom 188 had 214 orthopedic injuries. The demographics, injury, and incident characteristics of these patients were collected. All fractures were classified as per the AO/OTA classification. Two groups were created as operatively or conservatively treated patients and data were comparatively analyzed. Follow-up examination incorporated a survey using binary questions on patients' perspectives. An etiological comparative analysis of hip fractures in young adults admitted to the same center between 2016 and 2022 was conducted. The median patient age was 25. Inexperienced drivers constituted 32% of the injured. The protective gear use rate was at 3%. Higher speed (p = 0.014) and age (p = 0.011) were significantly associated with operative treatment. A total of 39% of the operated patients could not return to preinjury physical function, while 74% regretted using an e‑scooter. The most common etiological factor for traumatic young hip fractures was fall from a height between 2016 and 2020, whereas it became e‑scooter accidents in 2021-2022. The rate of e‑scooter-related operative treatment is high and leaves the patient in regret (84%) and a physically limited condition (39%). A speed limit of ≤ 15 km/h could decrease the rate of operative injuries. The e‑scooter was identified as the top etiological factor in the last 2 years for traumatic young hip fractures. II, Diagnostic cohort study.

The association between body mass index and physical function in adult burn survivors: A Burn Model System National Database study

IntroductionAn area of rehabilitation research in burns is the impact of co-morbidities on disease trajectory. Obesity is a comorbidity of increasing public health concern, but its role remains controversial regarding burn injury and physical recovery. Our aim was to evaluate the association between body mass index (BMI) categories as a measure of obesity at discharge and self-reported physical function (PF) during recovery of adult burn survivors. MethodsThis is a retrospective study on data collected by four major US burn centers, which contribute to the Burn Model System National Database. The data included BMI obtained at hospital discharge and self-reported PF-mobility, using the PROMIS measures assessed at 6, 12, and 24 months after burn. Subjects were classified into weight status categories based on BMI: underweight (BMI <18.5), normal weight (18.5 ≤ BMI <25), overweight (25 ≤ BMI <30), obesity class 1 (30 ≤ BMI <35), obesity class 2 (35 ≤ BMI <40), and obesity class 3 (BMI ≥40). Mixed-effects linear regression models were used to assess the association between BMI categories and PF scores over time, adjusted for patient and injury characteristics. ResultsA total of 496 adult burn patients aged 47 ± 16 years were included, with mean total body surface area (TBSA) burned of 18 ± 19 % and mean BMI at discharge of 28 ± 7 kg/m2. PROMIS PF scores significantly improved over time in the recovery phase after burn (time effect, p < 0.001). Compared to overweight burn patients, normal-underweights exhibited lower PF score by an average of 4.06 units (p = 0.001) but scores increased linearly by an estimated 0.17 units per month (p = 0.01) over the 24 months after discharge. Similarly, compared to overweight burn patients, class 1 obese reported lower PF score by a mean 2.67 units (p = 0.07) but PF increased linearly by 0.15 units per month (p = 0.07) over the 24 months after discharge. These findings were independent of the effects of age at discharge, sex, TBSA burned, and hand and leg burn. ConclusionBeing overweight was associated with improved and faster recovery of PF scores compared to normal, underweight, and obese burn patients during long-term recovery. Hence, our data suggests that long-term recovery and restoration of PF in adult burn survivors is not compromised by a small excess in body weight.

Presentations and management of hospitalized patients with upper extremity fractures at a level 1 trauma center: a 5-year observational study

BackgroundUpper extremity injuries (UEIs) are common in the emergency departments, yet they are under-reported in developing countries. This study examined the frequency, injury characteristics, and treatment approaches of upper extremity fractures (UEFs) among hospitalized trauma patients in a nationally representative population.MethodsWe conducted a retrospective, observational study including all the hospitalized patients with UEFs in the only level 1 trauma center in Qatar between July 2015 and August 2020. Comparative analyses were performed according to injury mechanisms, severity, and management approach.ResultsA total of 2,023 patients sustained UEIs with an average age of 34.4 ± 12.9 years, and 92% were males. Motor vehicle crashes (MVCs; 42.3%) were the primary cause of shoulder girdle injuries in 48.3% of cases. Fractures of the radius, ulna, and hands occurred in 30.8, 16.5 and 14.5%, respectively. Young adults were more involved in MVCs and motorcycle crashes (MCCs), while pedestrians who were typically older had a higher rate of humerus fractures. Patients with MCCs had a higher rate of clavicle and ulna fractures. Pedestrians were at risk of serious injuries, with a higher mean injury severity score and lower Glasgow Coma Scale.ConclusionMost UEFs patients were young males and mainly affected by MVCs. Shoulder girdle, particularly clavicle and scapula/glenoid fractures, emerged as common injury sites. The study highlighted the potential risk of pedestrian injuries, as reflected in higher injury severity, concomitant injuries, and higher mortality. Future studies are needed to optimize preventive measures by incorporating insights into specific injury mechanisms and patterns of UEIs.

Incidence and outcomes of pediatric patients with dual diagnosis of traumatic spinal cord injury and brain injury on an inpatient rehabilitation unit.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are diagnoses commonly encountered on the pediatric rehabilitation unit. However, there is limited evidence in the literature addressing the incidence of or rehabilitation outcomes in pediatric patients with a dual diagnosis of TBI and SCI. To determine incidence and functional outcomes of the dual diagnosis population. Retrospective cohort study. Inpatient rehabilitation unit within an academic pediatric hospital. Pediatric patients admitted to a single inpatient rehabilitation unit with a diagnosis of traumatic SCI between 2006 and 2019. Fifty-four patient records were identified and 26 met inclusion criteria. Not applicable. Presence of concomitant TBI in patients with diagnosed SCI. Seven of 26 patients were given a dual diagnosis of TBI and SCI during their initial rehabilitation hospitalization. After review of charts, authors identified 12 additional patients with suspected dual diagnoses based on injury characteristics and symptoms. There were no significant differences in functional outcomes across diagnosis groups. Incidence of dual diagnosis among pediatric patients with traumatic SCI was initially found to be 27%; the retrospective review indicated that TBI may be underdiagnosed in this patient population, and the dual diagnosis incidence may be as high as 73%. All patients had improved functional outcomes during their rehabilitation stays regardless of presence or absence of TBI.

Postoperative opioid consumption patterns diverge between propensity matched patients undergoing traumatic and elective cervical spine fusion

BACKGROUND CONTEXTProlonged opioid therapy following spine surgery is an ongoing postoperative concern. While prior studies have investigated postoperative opioid use patterns in the elective cervical surgery patient population, to our knowledge, opioid use patterns in patients undergoing surgery for traumatic cervical spine injuries have not been elucidated. PURPOSEThe purpose of this study was to compare opioid use and prescription patterns in the postoperative pain management of patients undergoing traumatic and elective cervical spine fusion surgery. STUDY DESIGNRetrospective cohort study. PATIENT SAMPLEAdult patients with traumatic cervical injuries who underwent primary anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) during their initial hospital admission. The propensity matched, control group consisted of adult elective cervical fusion patients who underwent primary ACDF or PCDF. OUTCOME MEASURESDemographic data, surgical characteristics, spinal disease diagnosis, location of cervical injury, procedure type, operative levels fused, and Prescription Drug Monitoring Program (PDMP) data. PDMP data included the number of opioid prescriptions filled, preoperative opioid use, postoperative opioid use, and use of perioperative benzodiazepines, muscle relaxants, or gabapentin. Opioid consumption data was collected in morphine milligram equivalents (MME) and standardized per day. METHODSA 1:1 propensity match was performed to match traumatic injury patients undergoing cervical fusion surgery with elective cervical fusion patients. Traumatic injury patients were matched based on age, sex, CCI, procedure type, and cervical levels fused. Pre- and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use were assessed for the traumatic injury and elective patients. T- or Mann-Whitney U tests were used to compare continuous data and Chi-Squared or Fisher's Exact were used to compare categorical data. Multivariate stepwise regression using MME per day 0 – 30 days following surgery as the dependent outcome was performed to further evaluate associations with postoperative opioid use. RESULTSA total of 48 patients underwent fusion surgery for a traumatic cervical spine injury and 48 elective cervical fusion with complete PDMP data were assessed. Elective patients were found to fill more prescriptions (3.19 vs 0.65, p=.023) and take more morphine milligram equivalents (MME) per day (0.60 vs 0.04, p=.014) within 1 year prior to surgery in comparison to traumatic patients. Elective patients were also more likely to use opioids (29.2% vs 10.4%, p=.040) and take more MMEs per day (0.70 vs 0.05, p=.004) within 30 days prior to surgery. Within 30 days postoperatively, elective patients used opioids more frequently (89.6% vs 52.1%, p<.001) and took more MMEs per day (3.73 vs 1.71, p<.001) than traumatic injury patients. Multivariate stepwise regression demonstrated preoperative opioid use (Estimate: 1.87, p=.013) to be correlated with higher postoperative MME per day within 30 days of surgery. Surgery after traumatic injury was correlated with lower postoperative MME use per day within 30 days of surgery (Estimate: −1.63 p=.022). CONCLUSIONCervical fusion patients with a history of traumatic spine injury consume fewer opioids in the early postoperative period in comparison to elective cervical fusion patients, however both cohorts consumed a similar amount after the initial 30-day postoperative period. Preoperative opioid use was also a risk factor for higher consumption in the short-term postoperative period. These results may aid physicians in further understanding patients’ postoperative care needs based on presenting injury characteristics and highlights the need for enhanced follow-up care for traumatic cervical spine injury patients after fusion surgery.

Patient Characteristics and Postoperative Outcomes of Surgically Treated Inferior Pole Patellar Sleeve Fractures.

Despite representing over half of all pediatric patella fractures, inferior pole patellar sleeve fractures (PSFs) are a relatively uncommon pediatric injury. As a result, existing literature on PSFs is limited to case reports and small case series. The purpose of this study was to evaluate the radiographic and clinical characteristics of operatively treated PSFs as well as outcomes following surgical management. A retrospective review of all inferior pole PSFs requiring surgery from 2007 to 2023 was performed at a single urban tertiary care children's hospital. Cases were identified using diagnostic and billing codes. Patient demographics, injury characteristics, surgical techniques, and postoperative rehabilitation practices were recorded. Regional skeletal maturity, fracture characteristics, and postreduction patellar height were recorded. Postoperative complications were recorded and categorized using the modified Clavien-Dindo Classification System (CDS). Thirty-eight inferior pole PSFs were identified meeting study criteria. The majority of patients were male (86.8%), and the mean age at injury was 11.0 years (range: 7.2 to 15.0). Mean BMI was 21.1. Radiographically, the majority of patients were Epiphyseal Fusion Stage 0 (nonunion), with a median postreduction Caton-Deschamps index (CDI) of 1.2 (IQR: 1.1 to 1.3). These fractures were predominantly treated with suture-based fixation (84%). Postoperative immobilization varied within the cohort, and the initiation of knee ROM was permitted at a median of 3.5 (IQR: 2.0 to 4.6) weeks. All patients regained full range of motion and straight leg raise without extensor lag, and return-to-sport was achieved by a median of 17.6 weeks (IQR: 12.8 to 30.3). Complications occurred in 10 (26.3%) patients, with 3 (7.9%) requiring a return to the OR (CDS Grade III). Inferior pole PSFs appear to occur most commonly among prepubertal males of normal BMI and normal patellar height. Despite variable rehabilitation protocols, operative management resulted in restoration of extensor mechanism function. Eight percent of patients experienced complications requiring unplanned surgery. This large series improves our understanding of the epidemiology, injury characteristics, and postoperative outcomes of an operatively treated cohort of a rare injury pattern. Level IV.

Evaluation of the cushion effect in blunt abdominal trauma patients: A computerized analysis

BackgroundObesity may serve as a protective factor in blunt abdominal trauma (BAT) patients due to a "cushion effect". In this study, we aim to use computed tomography (CT) scans to measure abdominal adiposity and its correlation with injury severity in BAT patients. MethodsWe conducted a retrospective analysis of male BAT patients who had undergone CT scans. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were manually measured and height-normalized for analysis at lumbar levels L2 and L3. Statistical methods were used to compare differences in adiposity between patients with and without severe abdominal injuries. For controls, we also compared adipose tissue in patients with and without severe trauma to the chest, where less fat typically accumulates. ResultsWe included 361 male participants and conducted a comparative analysis of their demographic and injury characteristics. Patients without severe abdominal injuries had significantly higher SAT and VAT indices at both L2 and L3 (p < 0.05). However, these measures showed no significant differences between patients with and without severe chest trauma. Solid organ injuries, particularly liver injuries, were associated with decreased SAT and VAT. ConclusionIncrease abdominal adiposity was linked to lower abdominal injury severity and solid organ injuries, particularly liver injuries. In addition to conventional BMI for evaluating obesity, either subcutaneous or visceral adipose tissue over lumbar levels L2 and L3 can be used to assess the "cushion effect."

Elevated extracellular particle concentration in plasma predicts in-hospital mortality after severe trauma.

Extracellular particles (EPs), particularly extracellular vesicles, play a crucial role in regulating various pathological mechanisms, including immune dysregulations post-trauma. Their distinctive expression of cell-specific markers and regulatory cargo such as cytokines or micro-ribonucleic acid suggests their potential as early biomarkers for organ-specific damage and for identifying patients at risk for complications and mortality. Given the critical need for reliable and easily assessable makers to identify at-risk patients and guide therapeutic decisions, we evaluated the early diagnostic value of circulating EPs regarding outcomes in severely injured multiple-trauma patients. Plasma samples were collected from 133 severely injured trauma patients (Injury Severity Score (ISS) ≥16) immediately upon arrival at the emergency department (ED). Patients were categorized into survivors and non-survivors. Injury characteristics and outcomes related to sepsis, pneumonia, or early (<1 day after admission) and late mortality were assessed. Circulating EPs, cytokine profiles, and blood counts of platelets and leukocytes were determined. Receiver operating characteristic analyses were conducted. Despite no significant differences in injury pattern or severity, non-survivors exhibited significantly elevated counts of circulating EPs compared to survivors. The optimal cut-off for EPs <200 nm indicating non-survivors was 17380/µl plasma, with a sensitivity of 77% and a specificity of 61% in predicting in-hospital mortality. Later non-survivors received significantly higher numbers of units of packed red blood cells [8.54 ± 5.45 vs. 1.29 ± 0.36 units], had higher serum lactate [38.00 ± 7.51 vs. 26.98 ± 1.58 mg/dL], significantly lower platelet counts [181.30 ± 18.06 vs. 213.60 ± 5.85 *10³/µL] and lower heart rates [74.50 ± 4.93 vs. 90.18 ± 2.06 beats/minute] upon arrival at the ED compared to survivors. Our results demonstrate the high diagnostic potential of elevated concentrations of circulating EPs <200 nm for identifying patients at risk of mortality after severe trauma. This parameter shows comparable sensitivity to established clinical predictors. Early evaluation of EPs concentration could complement assessment markers in guiding early therapeutic decisions.