High Risk Of Injury Research Articles

The Epidemiology, Management, and Outcomes of Civilian Gunshot Wounds to the Upper Extremity at an Urban Trauma Center.

Gunshot wounds (GSWs) create significant morbidity in the United States. Upper extremity (UE) GSWs are at high risk of combined injuries involving multiple organ systems and may require variable treatment strategies. This study details the epidemiology, management, and outcomes of civilian UE GSWs at an urban level 1 trauma center. Using the University of Pennsylvania Trauma Registry, all adult patients with UE GSWs from 2015 to 2020 who were at least 6-months postinjury were studied for demographics, injury pattern, operative details, and postoperative outcomes. Fisher exact and Wilcoxon rank sum tests were used to determine differences in treatment modalities and outcomes. In 360 patients, the most common victim was young (x̄ = 29.5 y old), African American (89.4%), male (94.2%), and had multiple GSWs (70.3%). Soft tissue-only trauma (47.8%) and fractures (44.7%) predominated. Presence of fracture was independently predictive of neurologic, vascular, and tendinous injuries (P < 0.001). Most soft tissue-only injuries were managed nonoperatively (162/173), whereas fractures frequently required operative intervention (115 of 161, P < 0.001). Despite a prevalence of comminuted (84.6%) and open (43.6%) fractures, hardware complications (7.5%) and wound infection (1.1%) occurred infrequently. Civilian GSWs to the UE with only soft tissue involvement can often be managed conservatively with antibiotic administration, bedside washout, and local wound care. Even with combined injuries and open fractures, single-stage operative debridement and fracture care with primary or secondary closure often prevail. As civilian ballistic trauma becomes more frequent in the United States, these data help inform patient expectations and guide management.

Effects of dexmedetomidine on renal function after cardiac surgery for infective endocarditis: An interim analysis of a randomized controlled trial

BackgroundPatients undergoing cardiac surgery for infective endocarditis (IE) are at a high risk of postoperative acute kidney injury (AKI) owing to heightened systemic inflammation. Therefore, we aimed to investigate the effect of dexmedetomidine on postoperative AKI in patients who underwent cardiac surgery for IE. MethodsA total of 63 patients who underwent cardiac surgery for IE were randomly assigned to receive either intravenous dexmedetomidine infusion of 0.4 μg kg−1 h−1 (DEX group) or normal saline infusion (control group) for 24 h after induction of anesthesia. The occurrence of AKI within seven days postoperation, epinephrine, norepinephrine, and interleukin-6 levels, as well as postoperative morbidities, were assessed. An intertrim analysis was conducted using Pocock's alpha spending function at α = 0.05 and β = 0.2. ResultsThis trial was early terminated according to the results of interim analysis performed when 60 % of the pre-set number of patients have been collected. The incidence of AKI was significantly lower in the DEX group than in the control group (32.3 % vs. 9.4 %, p = 0.025). Patients in the DEX group had significantly lower epinephrine levels than those in the control group, whereas norepinephrine and interleukin-6 levels were similar. Perioperative mean arterial pressure or heart rate did not differ between the groups. ConclusionsDexmedetomidine administration for 24 h starting from induction of anesthesia significantly reduced the incidence of postoperative AKI after cardiac surgery for IE (by 29 % vs. control) without hemodynamic side effects. This was accompanied by a significant attenuation of postoperative increase in serum epinephrine levels.

Predictors and Clinical Significance of Myocardial Injury in Elderly Patients Under the COVID-19 Pandemic.

The elderly patients are at increased high risk of myocardial injury and mortality after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aims to investigate the prevalence, predictors and prognostic implications of myocardial injury in the elderly patients with SARS-CoV-2 infection. Patients aged over 65 years were consecutively recruited between April to May, 2022. Myocardial injury was assessed using the high-sensitivity cardiac troponin T (hs-cTnT) assay. The primary endpoint was in-hospital mortality. A total of 347 patients were recruited with a median age of 81 years. 45.8% were male and 18 (5.2%) deceased before discharge. Myocardial injury (hs-cTnT over 99% upper reference limit [URL]) was detected in 202 (58.2%) of patients. Predictors of myocardial injury included age (per 5-year increase), hypertension, vaccination, creatine, and neutrophil-to-lymphocyte ratio. hs-cTnT over 3 × URL was independently correlated with in-hospital mortality (adjusted odds ratio [adOR], 13.21; 95% confidence interval [CI], 2.11-87.1; p = 0.005) in comparison to hs-cTnT > URL (adOR, 0.66; 95% CI, 0.09-5.92; p = 0.680). Myocardial injury was a common phenomenon and prognostic predictor in elder patients after SARS-CoV-2 infection. Higher threshold of myocardial injury may be considered to improve risk stratification.

Hepatitis after gene therapy, what are the possible causes?

Hepatitis is a common adverse event following gene therapy for haemophilia, often associated with a loss of transgene expression. Investigating the potential causes and implications of this is crucial for the overall success of treatment. Gene therapy trials using adeno-associated virus (AAV) vectors have demonstrated promising results marked by increases in factor FVIII and FIX levels and reductions in episodes of bleeding. However, hepatocellular injury characterised by elevations in alanine aminotransferases (ALT) has been noted. This liver injury is typically transient and asymptomatic, posing challenges in determining its clinical significance. Proposed causes encompass immune-mediated responses, notably T cell cytotoxicity in response to the AAV vector, direct liver injury from the viral capsid or transcribed protein via the unfolded protein response and pre-existing liver conditions. Liver biopsy data conducted years post-gene therapy infusion has shown sinusoidal infiltration without significant inflammation. The overall safety profile of gene therapy remains favourable with no evidence drug-induced liver injury (DILI) based on Hy's Law criteria. Essential pre-therapy monitoring and identifying patients at high risk of liver injury should involve liver function tests and non-invasive fibroscans, while novel blood-based biomarkers are under exploration. Further research is required to comprehend the mechanisms underlying transaminitis, loss of transgene expression and long-term effects on the liver, providing insights for optimising gene therapy for haemophilia.

336 Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries

INTRODUCTION: Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night. METHODS: Adults hospitalized for acute neurotraumatic injuries between January 1, 2015, and December 31, 2020, were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, inhospital characteristics, discharge dispositions, readmissions, and adjusted readmission risk. RESULTS: Of 1308 patients, 8.5% (n = 111) were homeless on admission to neurointensive care. Compared with nonhomeless individuals, homeless patients were younger (P = .004), predominantly male (P = .003), and less frail (P = .003) but had similar presenting Glasgow Coma Scale scores (P = .85), neurointensive care unit stay time (P = .15), neurosurgical interventions (P = .27), and in-hospital mortality (P = .17). Nevertheless, homeless patients had longer hospital stays (11.8 vs 10.0 days, P = .02), more unplanned readmissions (15.3% vs 4.8%, P &lt; .001), and more complications while hospitalized (54.1% vs 35.8%, P = .01), particularly myocardial infarctions (9.0% vs 1.3%, P &lt; .001). Homeless patients were mainly discharged to their previous living situation (46.8%). Readmissions were primarily for acute-on-chronic intracranial hematomas (4.5%). Homelessness was an independent predictor of 30-day unplanned readmissions (odds ratio 2.41 [95% CI 1.33-4.38, P = .004]). CONCLUSIONS: Homeless individuals experience longer hospital stays, more inpatient complications such as myocardial infarction, and more unplanned readmissions after discharge compared with their housed counterparts. These findings combined with limited discharge options in the homeless population indicate that better guidance is needed to improve the postoperative disposition and long-term care of this vulnerable patient population.

СОВЕРШЕНСТВОВАНИЕ КЛИНИКО-ЛАБОРАТОРНОЙ ДИАГНОСТИЧЕСКОЙ СИСТЕМЫ В РАМКАХ МЕДИЦИНСКИХ РЕАБИЛИТАЦИОННЫХ МЕРОПРИЯТИЙ ДЛЯ ЛИЦ ОПАСНЫХ ПРОФЕССИЙ

Annotation. Risky professions are associated with working conditions in which production factors cause a threat to the life of an employee and a high risk of injury. Employees of law enforcement agencies (armed forces, law enforcement agencies, Ministry of Emergency Situations) are included in the list of dangerous professions. Their work is associated with the presence of threats to life and health, psychological and physical overstrain, overwork, suddenness of events with a shortage of time, information overload, etc. Their adaptive mechanisms are often deformed. Among them, one of the most vulnerable is the endocrine system. In order to fully implement all measures for the provision of medical care and rehabilitation of persons performing official tasks in conditions adversely affecting their health, special medical and psychological programs have been developed and are successfully functioning in law enforcement agencies. They include a variety of aspects, among which the leading ones are assessment, consideration of the psychophysiological condition, its pharmacological and non-drug correction by various methods. Modern realities dictate the need for continuous improvement of this system. The proposed model implies the improvement of the laboratory level of endocrinological care in law enforcement agencies within the framework of general medical preventive and rehabilitation measures. It includes several stages (preventive, curative and informational-analytical), which, in turn, are divided into blocks. Each of them serves as an integral part of medical support in the system of rehabilitation measures for persons of dangerous professions, forming a whole multi-level dynamic process. It is emphasized that the organization of comprehensive rehabilitation measures in relation to employees of law enforcement agencies exposed to various occupational risks, in addition to traditional medical and psychological support of activities, should include a mandatory laboratory endocrinological link as an integral part of the general system of departmental medical support.

Emergency presentations for farm-related injuries in older adults residing in south-western Victoria, Australia.

Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation. This study identified regions with high farm-related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50yr. Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017-2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age-standardised incidence rates (per 1000population/year) were calculated. For men and women combined, there were 31218 emergency presentations for any injury, and 1150 (3.68%) of these were farm-related. The overall age-standardised rate for farm-related injury presentations was 2.6 (95% CI 2.4-2.7); men had a higher rate than women (4.1, 95% CI 3.9-4.4 versus 1.2, 95% CI 1.0-1.3, respectively). For individual LGAs, the highest rates of farm-related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two-thirds of farm-related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as "other" (including private car, 83.3%). There were also several common injury causes identified: "other animal related injury" (20.2%), "cutting, piercing object" (19.5%), "fall ⟨1m" (13.1%), and "struck by or collision with object" (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%). This study provides data to inform future research and resource allocation for the prevention of farm-related injuries.

Wearable fiber-free optical sensor for continuous monitoring of neonatal cerebral blood flow and oxygenation.

Unstable cerebral hemodynamics places preterm infants at high risk of brain injury. We adapted an innovative, fiber-free, wearable diffuse speckle contrast flow-oximetry (DSCFO) device for continuous monitoring of both cerebral blood flow (CBF) and oxygenation in neonatal piglets and preterm infants. DSCFO uses two small laser diodes as focused-point and a tiny CMOS camera as a high-density two-dimensional detector to detect spontaneous spatial fluctuation of diffuse laser speckles for CBF measurement, and light intensity attenuations for cerebral oxygenation measurement. The DSCFO was first validated against the established diffuse correlation spectroscopy (DCS) in neonatal piglets and then utilized for continuous CBF and oxygenation monitoring in preterm infants during intermittent hypoxemia (IH) events. Significant correlations between the DSCFO and DCS measurements of CBF variations in neonatal piglets were observed. IH events induced fluctuations in CBF, cerebral oxygenation, and peripheral cardiorespiratory vitals in preterm infants. However, no consistent correlation patterns were observed among peripheral and cerebral monitoring parameters. This pilot study demonstrated the feasibility of DSCFO technology to serve as a low-cost wearable sensor for continuous monitoring of multiple cerebral hemodynamic parameters. The results suggested the importance of multi-parameter measurements for understanding deep insights of peripheral and cerebral regulations. The innovative DSCFO technology may serve as a low-cost wearable sensor for continuous bedside monitoring of multiple cerebral hemodynamic parameters in neonatal intensive care units. Concurrent DSCFO and DCS measurements of CBF variations in neonatal piglet models generated consistent results. No consistent correlation patterns were observed among peripheral and cerebral monitoring parameters in preterm neonates, suggesting the importance of multi-parameter measurements for understanding deep insights of peripheral and cerebral regulations during IH events. Integrating and correlating multiple cerebral functional parameters with clinical outcomes may identify biomarkers for prediction and management of IH associated brain injury.

The Complete Anatomy of the Anterior Ethmoidal Artery: A Meta-Analysis with Implications for Sinus and Skull Base Surgery.

Background: The anatomical characteristics of the anterior ethmoidal artery (AEA) exhibit a high degree of variability, especially regarding its topography. Methods: PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to identify all studies that included information regarding the morphometric and topographical characteristics of the AEA. Results: Ultimately, a compilation of 38 studies meeting the predetermined criteria, and possessing comprehensive and pertinent data, were incorporated into the current meta-analysis. In the overall analysis, reports of the AEA being embedded within the skull base or at the level of the skull base producing a bony protrusion were found in 56.91% of cases (95% CI: 43.55-69.80%). The mean diameters of the AEA in the intraorbital and intracranial areas were 0.94 mm and 0.76 mm, respectively. Moreover, the artery coursed most commonly between the second and third lamellae, with a prevalence of 65.82% (95% CI: 55.39-75.56%). Conclusions: The AEA may be at a high risk of iatrogenic injury during various sinus and skull base surgeries, especially if the surgeon performing these procedures is unfamiliar with the vast number of variations this vessel may exhibit. The spatial relationship between this vessel and the skull base is especially variable, and understanding this variability goes hand in hand with intraoperative safety.

Intracranial Epidermoid Cyst: A Volumetric Study of a Surgically Challenging Benign Lesion

BackgroundIntracranial epidermoid cysts are rare, benign tumors. Nevertheless, the microsurgical removal of these cysts is challenging. This is due to their capacity to adhere to the neuro-vascular tissue as well as the associated difficulties in micro-surgically peeling off their capsular wall hidden in dead angles. To better understand the rate of recurrence after surgical intervention, we have performed pre- and postoperative volumetric analysis of epidermoid cysts allowing the estimation of their growth rate after resection. MethodsImaging data from 22 patients diagnosed and surgically treated for an intracranial epidermoid cyst between 2000 – 2022 was retrospectively collected from two European neurosurgical centers with microsurgical expertise. Volumetric analysis was performed on magnetic resonance imaging (MRI) data. ResultsAverage cyst volume at diagnosis, prior to any surgery, measured in 12 patients, was 28877.6 ± 10250.4 mm3 (SEM). Estimated growth rate of incompletely-resected epidermoids after surgery was 1630.05 mm3 ± 729.95 (SEM). Assuming linear growth dynamics and normalizing to postoperative residual volume, the average postoperative growth rate corresponded to 61.5 ± 34.3% (SEM) of the postoperative residual volume per year. We observed signs of recurrence during a radiological follow-up period of 6.0 ± 2.8 years (SD) in more than 50% of our patients. ConclusionsDue to their slow-growing nature, epidermoid cysts can often reach a complex multicompartmental size before resection, even in young patients, thus requiring complex approaches with challenging capsular resection which implies a high risk of nerve and vascular injury per se. Tumor recurrence may be predicted based on postoperative volumetry.

The effect of 8 weeks of personalized exercises on some health indicators and fat profile of firefighters in Isfahan city

Introduction: Due to the nature of their job, firefighters are at high risk of physical and mental injuries; Therefore, maintaining their physical and mental health is of particular importance. Personalized exercise training can help improve the health of firefighters and reduce the risk of injury.&#x0D; Materials and Methods: This study was experimental and practical and was conducted on the firefighters of Isfahan city. Through invitation to cooperation, 70 people were randomly divided into two experimental groups (18 people) and (18 people control). Sports training was done for 8 weeks in three sessions per week. Physical fitness indicators were evaluated before and after the exercises, and blood samples were taken for evaluation before and 48 hours after the end of the intervention. Correlated T-test was used for intra-group comparisons and independent T-test was used for inter-group comparisons at a significance level of 05/0 and analyzes were performed using spss software.&#x0D; Results: The results showed that these exercises can have a positive effect on the health indicators of firefighters, including aerobic capacity (p=005/0), muscle strength (p=01/0) and flexibility (p=01/0) and some fat indicators, such as decreasing triglyceride (p=005/0) and decreasing LDL (p=01/0) and increasing (p=03/0) HDL.&#x0D; Conclusion: Personalized physical exercises can help improve muscle strength and flexibility and improve cardiovascular health.

(Un)ergonomic working conditions for a paramedic in a medical ambulance

The work of a paramedic, is characterised by a high risk of injury. Ergonomic, psychological, and biomechanical factors are considered risk factors in the profession of emergency medical technicians. Ensuring ergonomic working conditions for emergency medical technicians is a priority and requires a thorough assessment both in the design process and during the operation of the ambulance, to provide a diagnosis of the current state and present necessary recommendations for modernization. Identifying stressors will enable the design of an ergonomic interior for the ambulance, ensuring comfort and reliability for members of the emergency medical team, thereby reducing the risk of injuries. The authors of this article developed a comprehensive methodology for assessing the nuisances occurring during the paramedic's work, which required specialised preliminary research. The research included the measurement and analysis of the paramedic's movement kinematics during typical medical procedures, both at a standstill and while driving the ambulance. For the analysis of motion kinematics, a non-invasive method called myoMotion was employed, and the study was conducted in a Mercedes ambulance. This article contains preliminary results on the evaluation of movement kinematics. These demonstrated the necessity for the paramedic to adopt forced positions when performing medical procedures. The ranges of movement of the individual body parts of the paramedic deviated from accepted norms, resulting in musculoskeletal overload. The acquired knowledge forms the basis for a detailed analysis of tasks performed within each procedure from the perspective of the spatial structure of the ambulance, the arrangement of equipment and medical supplies, their accessibility during work, and the organization of work within the ambulance. Additional identification of musculoskeletal system stress, its sources, and the formulation of modification recommendations for the ambulance interior will enable ensuring the comfort and reliability of the work for emergency medical teams, thereby reducing the risk of injuries in the workplace. Med Pr Work Health Saf. 2024;75(1):31-44.

Decreased sagittal slope of the medial tibial spine and deep concavity of the lateral tibial spine are risk factors for noncontact anterior cruciate ligament injury.

This study aimed to assess the relationship between the geometric features of tibial eminence and susceptibility to noncontact anterior cruciate ligament (ACL) injuries. Patients with unilateral noncontact knee injuries between 2015 and 2021 were consecutively enroled in this study. Based on knee magnetic resonance imaging (MRI) and arthroscopic visualisation, patients were categorised into the case group (ACL rupture) and control group (ACL intact). Using MRI, the geometric features of tibial eminence were characterised by measuring the sagittal slopes, depth of concavityand coronal slopes of the inclined surfaces of the tibial spines. Univariate and multivariate logistic regressions were conducted to explore independent associations between quantified geometric indices of tibial eminence and the risk of noncontact ACL injuries. This study included 187 cases and 199 controls. A decreased sagittal slope of the medial tibial spine (MTSSS) (combined group: odds ratio [OR]: 0.87 [0.82, 0.92], p < 0.001; females: OR: 0.88 [0.80, 0.98], p = 0.020; males: OR: 0.87 [0.81, 0.93], p < 0.001) and an increased depth of concavity in the lateral tibial spine (LTSD)(combined group: OR: 1.51 [1.24, 1.85], p < 0.001; females: OR: 1.65 [1.12, 2.43], p = 0.012; males: OR: 1.44 [1.11, 1.89], p = 0.007) were independent risk factors for noncontact ACL injuries. Moreover, a steeper coronal slope of the inclined surface of the medial tibial spine was a significant predictor of noncontact ACL injuries for males (MTSCS: OR: 1.04 [1.01, 1.08], p = 0.015) but not for females. Geometric features of tibial eminence, particularly a decreased MTSSS and an increased LTSD, were identified as independent risk factors for noncontact ACL injuries. These findings will help clinicians identify individuals at high risk of ACL injury and facilitate the development of targeted prevention strategies. Level III.

Mitigating Blast Hazards: Experimental Evaluation of Anti-Shatter Films and Catcher-Cable Systems on Conventional Windows

In light of terrorist attacks and accidents, the need for structural protection against explosive events has increased significantly in recent decades. Conventional unprotected windows pose a particularly high risk of injury to building occupants due to glass fragments and window frames being propelled into the interior and exterior of a building. This article addresses new experimental research on the protection of conventional single casement windows with insulating glass units (double-paned) and window frames made of un-plasticized polyvinyl chloride (uPVC) against blast loads. Entire window systems were tested in ten shock-tube tests using different retrofit-configurations. The retrofitted protective measures include anti-shatter films and catcher-cable systems. Furthermore, the influence of steel profiles inserted in the window frames is investigated. The applied blast loads met the requirements for ER1-certification according to EN 13541:2012 (tested at a reflected peak overpressure of 66.7 kPa and a reflected maximum impulse of 417.7 kPa∙ms). In the test series, various measurement methods were used to capture the velocity of the window fragments, the dynamic cable forces, and the hazard. The data provide valuable information for the design and implementation of catcher-cable systems for existing buildings, which can improve the occupant safety in the event of an explosion.

Development of interpretable machine learning models for prediction of acute kidney injury after noncardiac surgery: a retrospective cohort study.

Early identification of patients at high-risk of postoperative acute kidney injury (AKI) can facilitate the development of preventive approaches. This study aimed to develop prediction models for postoperative AKI in noncardiac surgery using machine learning algorithms. The authors also evaluated the predictive performance of models that included only preoperative variables or only important predictors. Adult patients undergoing noncardiac surgery were retrospectively included in the study (76457 patients in the discovery cohort and 11910 patients in the validation cohort). AKI was determined using the KDIGO criteria. The prediction model was developed using 87 variables (56 preoperative variables and 31 intraoperative variables). A variety of machine learning algorithms were employed to develop the model, including logistic regression, random forest, extreme gradient boosting, and gradient boosting decision trees. The performance of different models was compared using the area under the receiver operating characteristic curve (AUROC). Shapley Additive Explanations (SHAP) analysis was employed for model interpretation. The patients in the discovery cohort had a median age of 52 years (IQR: 42-61 years), and 1179 patients (1.5%) developed AKI after surgery. The gradient boosting decision trees algorithm showed the best predictive performance using all available variables, or only preoperative variables. The AUROCs were 0.849 (95% CI: 0.835-0.863) and 0.828 (95% CI: 0.813-0.843), respectively. The SHAP analysis showed that age, surgical duration, preoperative serum creatinine, and gamma-glutamyltransferase, as well as American Society of Anesthesiologists physical status III were the most important five features. When gradually reducing the features, the AUROCs decreased from 0.852 (including the top 40 features) to 0.839 (including the top 10 features). In the validation cohort, the authors observed a similar pattern regarding the models' predictive performance. The machine learning models the authors developed had satisfactory predictive performance for identifying high-risk postoperative AKI patients. Furthermore, the authors found that model performance was only slightly affected when only preoperative variables or only the most important predictive features were included.

Development and Feasibility of an Adolescent Dancer Screen.

Adolescent dancers are at high risk for injuries due to the physical demands of dance training and the physiological changes that occur during adolescence. Though studies report high injury rates, there are few standardized screening tools available for adolescent dancers. To develop and describe a standardized, feasible, evidence-based, and clinically relevant screen for adolescent dancers. Descriptive Epidemiology Study. Dancers at two suburban pre-professional dance studios, in two cohorts, participated in the Columbia Adolescent Dancer Screen (CADS) that includes dance injury history, health questionnaires (EAT-26, SF-36, DFOS), aerobic capacity, range of motion, strength, balance/orthopedic special tests, and dance technique. Participants were asked to complete a weekly injury surveillance questionnaire derived from the Dance-Specific Oslo Sports Trauma Research Centre Questionnaire on Health Problems for 14 weeks following the screening. Feasibility was assessed using process and content analysis in four areas: practicality, demand, implementation, and adaptation. Descriptive data were collected from 32 female dancers aged 11-17 with cohort one averaging 18.57 dance hours per week and cohort two averaging 10.6 dance hours per week. The screen was practical, able to screen seven to eight dancers per hour utilizing nine assessors and requiring a one-hour commitment from dancers. Cost and space requirements were considered and kept to a minimum while utilizing portable equipment. All screening slots were filled with all dancers agreeing to follow-up injury surveillance, indicating high demand. The screen was implemented with two cohorts with revisions to improve efficiency applied for the second cohort. The CADS is a feasible screening tool for adolescent dancers that overcomes barriers by being pragmatic, evidence-based, and efficient. Screening can be implemented to obtain baseline values, inform wellness recommendations, and establish relationships with medical professionals. Level 3b.

The ground is the limit: epidemiology of skydiving accidents over 25 years and in 2.1 million jumps in the Netherlands with sub-analysis of injuries reported by medical professionals in the past five years

BackgroundSkydiving is the fastest nonmotorized sport; and consequently is not without risk. In the last decades, skydiving has become considerably safer but injuries and fatalities still occur. Incidents are reported to and administered by the Royal Netherlands Aeronautical Association (KNVvL). From 1995 to 2020, 2715 incidents were reported; of which 1503 resulted in injury and 26 in fatality. There is a need for more information available on the particular type, severity, and factors which contribute to skydiving-related injuries worldwide. This study aims to investigate patterns in occurrence rates, examine demographic and skydiving-related factors linked to injuries, and analyze the types and severity of injuries relating to these contributing factors.MethodsThe Dutch KNVvL database – covering more than 25 years of data – was examined for contributing factors. An analysis of the severity and types of injury resulting from incidents over the last five years were matched with a search of hospital databases.ResultsThe rate of injuries pattern increases starting from 2016, with novice jumpers having the highest risk of injury. Most injuries occur during the landing phase. The lower extremities and the spine are most affected, with fractures being the most prevalent type of injury. More than half of the patients were admitted to hospital, with 10% requiring surgery, resulting in months of rehabilitation.ConclusionThis study is the first in the Netherlands, and only the second worldwide to analyze technical incident databases in combination with data from medical information systems. Skydiving accidents of experienced jumpers should be considered as ‘high-energy trauma,’ therefore treatment should follow standard trauma guidelines. In less experienced skydivers, it is critical to conduct a secondary survey to assess the extremities adequately. Clinicians should also pay attention to friction burns that can arise due to friction between the skin and skydive equipment, a phenomenom that is already known in road traffic accidents.

Is quitting an option? The power of brotherhood among non-scholarship college football players in risk decision-making

Football upholds traditional masculine ideals of toughness, aggression, and dominance despite the risk of serious injury. This study uses a qualitative framework to understand why non-scholarship National Collegiate Athletic Association (NCAA) Division III college football players risk their health through athletics. Interviews revealed that players go through two stages of risk reassessment wherein the player strongly weighs the costs and benefits of playing versus quitting. Once football players continue past the second stage, virtually nothing will prevent them from continuing their involvement with the team. They have determined that the costs of playing a high-contact sport with a high risk of injury are worth the friendships, forming a “Brotherhood” among the teammates. This paper discusses the implications for athletes, coaches, administrators, and health professionals.

Contemporary management of open extremity fractures: What you need to know.

Open extremity fractures are high-risk injuries prone to significant complications, including soft tissue loss, bone defects, infection, infected nonunion, and the necessity for limb amputation. Large-scale multicenter prospective studies from the Lower Extremity Assessment Project and the Major Extremity Trauma Research Consortium have provided novel scientific insights pertinent to the timeliness and appropriateness of specific treatment modalities aimed at improving outcomes of patients with open extremity injuries. These include the imperative for early administration of intravenous antibiotics within 3 hours of injury, preferably within 1 hour of hospital admission. Unlike the proven value of early antibiotics, the time to initial surgical debridement does not appear to affect infection rates and patient outcomes. Recent evidence-based consensus guidelines from the American Academy of Orthopedic Surgeons provide scientific guidance for preventing surgical site infections in patients with open extremity fractures and support the decision making of limb salvage versus amputation in critical open extremity injuries. Patient survival represents the overarching priority in the management of any trauma patient with associated orthopedic injuries. Therefore, the timing and modality of managing open fractures must take into account the patient's physiology, response to resuscitation, and overall injury burden. The present review was designed to provide a state-of-the-art overview on the recommended diagnostic workup and management strategies for patients with open extremity fractures, based on the current scientific evidence.

Renal Trauma in an Adolescent of a Tertiary Care Hospital; Is Ultrasound Adequate?

Children are at high risk of renal injury from blunt trauma than adults. Renal trauma can be from direct, blunt, penetrating and iotrogenic injury. Renal injuries are accounting for 10% of abdominal trauma. In our cases, renal injury caused to patient after falling from bicycle in September 2023. Depending upon the pre-existing congenital or acquired renal pathology, its incidence increases. Blunt trauma comprises more than 95% of traumatic renal injury. Patient with renal trauma present with flank &amp;/or abdominal pain and with hematuria. Computed tomography (CT) is the investigation of choice in evaluation of blunt renal injury. Ultrasound is helpful in detecting hemoperitonum in patients with suspected intraperitoneal injury. FAST (Fast Abdominal Sonography for Trauma), thus is important. Sonography was conducted to precisely diagnose and detect renal injuries caused by blunt abdominal trauma. Ultrasonography is also useful in detecting injuries and it is less value in evaluating those with suspected extraperitoneal injury. In some cases, MRI, Renal angiogram and scintigraphy may be useful. In our case, an adolescent boy with fall from bicycle sustaining blunt abdominal trauma in September 2023 with Gr-IV injury to right kidney is under observation as hemodynamically stable. No Pediatric renal trauma guidelines have been established though children are at higher risk of renal injury from blunt trauma than adults.