Improve Injury Prevention Research Articles

570 Burn-Related Injuries Treated at Two Gulf Coast Hospitals During Following a Category 4 Hurricane

IntroductionNatural disasters are commonly associated with mass destruction and severe injuries. On August 29th, 2021 a category 4 hurricane made landfall before mandatory evacuations were ordered in a major metropolitan community. The powerful storm challenged disaster management teams and first responders as communities struggled to recover. Our study analyzes the demographics of those injured and the injury patterns treated at our state’s only verified burn/trauma center and the adjacent children’s hospital in the aftermath of the hurricane.MethodsA retrospective chart review was performed on patients seeking emergent care following the hurricane. Demographic data was abstracted from the medical records along with injury pattern including age, gender, mechanism of injury, total body surface area (TBSA), surgical interventions, and length of stay. In addition, brief surveys of fire chiefs from the two most impacted regions were performed to assess prehospital challenges.Results41 patients (76% male) presented to our ER with a median age of 44 (7 patients < 12 years of age). 85% of injuries occurred at home while 15% occurred at work. Of the 78% requiring admission, 66% underwent excision and autograft with a mean TBSA of 17% (range 1-80%). Power outages resulted in increased gas generator usage across the region. Most of the burn injuries following the storm were due to generator and cooking accidents (56%). Each fire chief reported up to 91 calls/day due to suspected carbon monoxide poisoning for the two weeks following the storm. A single event resulted in 8 inhalation injuries treated in our ER with one burn ICU admission. The mean hospital length of stay was 1.11 days/%TBSA for those undergoing surgery.ConclusionsHurricanes are more common today with many coastal cities as risk for similar natural disasters. Despite our generator safety media outreach efforts prior to the storm, this remains an opportunity for improved injury prevention. Many patients suffered delays in discharge as their homes/nursing facilities suffered structural damages and were without power and water. Disaster planning should account for limited disposition options during severe storms. Our study is the first to describe burn-related injuries from a category 4 storm and our communities’ response.

Qualitative Analysis of Risk Factors and Foot and Ankle Injuries in Ballet Dancers

Ballet dancers are exposed to high rates of foot and ankle injury. Nevertheless, there have been limited efforts to capture their perspectives regarding risk of injury, treatment compliance, and prevention. The purpose of this study was to portray the perspectives of ballet dancers collected through organized focus group discussions. Seven focus group sessions were conducted, with 47 ballet dancers participating. The conversation was directed to consider a variety of factors related to injury, both direct and remote. Transcripts from these focus groups were coded into ten major themes: internal pressure, external pressure, ballet milestones, seeking treatment, treatment compliance, targeted treatment, return to dance, nondance activities, physical fatigue, and activity preparation. It was found that participants returned to dancing prematurely after injury, faced significant internal and external pressure, lacked adherence to suggested treatment, and identified provider communication as lacking. The results of this study can help with efforts to reduce injuries, encourage treatment compliance, and improve injury prevention. Future studies might consider the effectiveness of specific interventional approaches.

Trends and external causes of traumatic brain injury and spinal cord injury mortality in south China, 2014\u20132018: an ecological study

BackgroundThe epidemiological evidence of traumatic brain injury (TBI) and spinal cord injury (SCI) mortality in mainland China is lacking. We aimed to assess the trends of TBI and SCI mortality, and their association with sex, age, location and external causes of injury in south China.MethodsMortality data were derived from the Disease Surveillance Points (DSPs) system of Guangdong province between 2014 and 2018. We examined the trends in mortality with Cochran–Armitage trend test, and the association between the socio-demographic factors and the TBI and SCI mortality by using negative binomial models. Subgroup analysis was performed by stratifying the external causes of TBI and SCI.ResultsThe age-standardized TBI mortality remained relatively stable (from 11.6 to 15.4 per 100,000), while the SCI mortality increased by 148.3% from 2014 to 2018. Compared with females and urban residents, the adjusted mortality rate ratios of males and rural residents were 2.3 and 2.0 for TBI, and 2.2 and 4.6 for SCI, respectively. TBI and SCI mortality increased substantially with age. Motor vehicle crashes and falls were the leading causes of TBI mortality in residents aged under 75 years and over 75 years, respectively. Falls were the most important external cause for SCI death of all ages.ConclusionsBeing male, rural and elderly residents are at higher risk of dying from TBI and SCI. The substantial burden of TBI and SCI caused by road traffic crashes and falls has called for the urgent need to improve injury prevention, pre-hospital aid, hospital treatment and recovery.

Factors related to youth self-efficacy for injury prevention bicycle skills

Introduction: Bicycle riding is a common activity for children, but they are prone to bicycle-related injuries. It is well-established that injury prevention measures such as wearing a helmet and correctly riding a bicycle can reduce the severity of an injury and the likelihood of having an accident. However, how to increase bicycle injury prevention behaviors among children, who collectively fail to engage in injury prevention behaviors, is less well understood. Self-efficacy is consistently predictive of injury prevention behavior, making it an important approach to understanding injury prevention skills among this key population. The objective of this study was to explore and identify factors internal to the child as well as factors about his or her environment that predict a child’s self-efficacy for injury prevention skills. Method: Two generalized linear mixed effects models were created from survey data collected from elementary school students (n = 2,255) as part of a school-based bicycle education program. Models focused on self-efficacy for riding a bicycle and self-efficacy for wearing a helmet correctly. Results: In both models, road safety knowledge, opportunity for skill building through owning appropriate equipment (a bicycle or helmet), and situation through perception of neighborhood safety were predictive. The analyses reveal these variables as key factors for greater confidence, with feeling safe riding in the neighborhood, in particular, emerging as highly predictive of self-efficacy for injury prevention skills. Conclusions: These findings highlight the interplay of individual and environmental factors within confidence for injury prevention behavior. Given self-efficacy’s strong relationship to prevention behavior, these findings indicate actionable strategies. Practical Applications: The key factors highlighted in this study can be used by policymakers to target specific areas (e.g., neighborhood safety) to promote self-efficacy and thus improve injury prevention. These factors can also inform strategies for establishing safety skills in bicycle-safety education programs.

Epidemiology of Spine Injuries in National Collegiate Athletic Association Men's Wrestling Athletes.

Background:Spine injuries are common in collegiate wrestlers and can lead to reinjury, persistent pain, and time lost from participation.Purpose:To describe the epidemiology of spine injuries in National Collegiate Athletic Association (NCAA) wrestlers between academic years 2009 to 2010 and 2013 to 2014.Study Design:Descriptive epidemiology study.Methods:The incidence and characteristics of spine injuries were identified utilizing the NCAA–Injury Surveillance Program database. Spine injuries were assessed for injury type, injury mechanism, time of season, event type, recurrence, participation restriction, and time lost from participation. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). Injury rate ratios (IRRs) were calculated for event type and time of season, and results with 95% confidence intervals that did not include 1.0 were considered statistically significant.Results:There were an estimated 2040 spine injuries reported in the database over the 4-year period, resulting in an injury rate of 0.71 per 1000 AEs. Spine injuries were over twice as likely to occur in competitions as in practices (IRR, 2.02; 95% confidence interval, 1.10-3.69). More injuries occurred in both the preseason (0.94 per 1000 AEs) and the postseason (1.12 per 1000 AEs) compared with the regular season (0.55 per 1000 AEs). Contact injuries (42%) were the most common mechanism of injury, and brachial plexus injury (20%) was the most common diagnosis. Only 1.3% of injuries required surgery, and athletes most commonly returned to sport within 24 hours (33%) or within 6 days (25%).Conclusion:This investigation found an overall injury rate of 0.71 per 1000 AEs in wrestling athletes between academic years 2009 to 2010 and 2013 to 2014. The majority of these injuries were new, and athletes most commonly returned to sport within 24 hours. The injury rate was highest in competition, and both the preseason and the postseason showed a higher injury rate than that in season. Efforts to improve injury prevention and management should be informed by these findings.

How muscles maximize performance in accelerated sprinting.

We sought to provide a more comprehensive understanding of how the individual leg muscles act synergistically to generate a ground force impulse and maximize the change in forward momentum of the body during accelerated sprinting. We combined musculoskeletal modelling with gait data to simulate the majority of the acceleration phase (19 foot contacts) of a maximal sprint over ground. Individual muscle contributions to the ground force impulse were found by evaluating each muscle's contribution to the vertical and fore-aft components of the ground force (termed "supporter" and "accelerator/brake," respectively). The ankle plantarflexors played a major role in achieving maximal-effort accelerated sprinting. Soleus acted primarily as a supporter by generating a large fraction of the upward impulse at each step whereas gastrocnemius contributed appreciably to the propulsive and upward impulses and functioned as both accelerator and supporter. The primary role of the vasti was to deliver an upward impulse to the body (supporter), but these muscles also acted as a brake by retarding forward momentum. The hamstrings and gluteus medius functioned primarily as accelerators. Gluteus maximus was neither an accelerator nor supporter as it functioned mainly to decelerate the swinging leg in preparation for foot contact at the next step. Fundamental knowledge of lower-limb muscle function during maximum acceleration sprinting is of interest to coaches endeavoring to optimize sprint performance in elite athletes as well as sports medicine clinicians aiming to improve injury prevention and rehabilitation practices.

Lower extremity muscle contributions to ACL loading during a stop-jump task

Landing is considered a high-risk movement, especially landings from a stop-jump task, as they are often associated with lower extremity injuries, such as anterior cruciate ligament injuries (ACL). Females demonstrate lower extremity landing mechanics that often place them at a larger risk of injury compared to their male counterparts. While efforts have been made to understand lower extremity mechanics during stop-jump landings, little is known regarding the musculature function during these tasks and how they may influence ACL loading. Understanding lower extremity muscle contributions to ACL loading (FACL) may give insight to improving injury prevention protocols. Ten healthy, recreationally active females completed five trials of an unanticipated stop-jump task. Right leg kinematics, kinetics, and electromyography data were collected with three-dimensional motion capture, force plates, and electromyography sensors, respectively. Modified musculoskeletal models were scaled based on participant-specific anthropometrics, and muscle forces were obtained using static optimization. An induced acceleration analysis combined with a previously established mathematical ACL loading model was used to calculate lower extremity muscle contribution to FACL. The vastus lateralis, vastus intermedius, vastus medials, biceps femoris long head, semimembranosus, and soleus were found to be the primary contributors to FACL, with the vastus lateralis being the largest contributor. These data suggest that muscles traditionally known as ACL unloaders may in certain conditions load the ACL. These results also suggest that future injury prevention protocols should target muscles specifically to mitigate the influence the vastus lateralis has on ACL loading.

Combining the Copenhagen Adduction Exercise and Nordic Hamstring Exercise Improves Dynamic Balance Among Male Athletes: A Randomized Controlled Trial.

Copenhagen adduction exercise (CAE) and Nordic hamstring exercise (NHE) reduce the incidence of groin and hamstring injuries. Efficient dynamic balance can improve motor performance and reduce the risk of injuries in athletes. However, the effects of these exercises on dynamic balance have not been investigated. CAE and NHE, as well as a combination of both exercises, would improve dynamic balance among amateur male athletes. Randomized controlled trial. Level 1. A total of 200 male athletes aged 21.9 ± 2.4 years were included in the study and randomly assigned to 4 groups: CAE group (n = 50), NHE group (n = 50), CAE and NHE group (n = 50), and a control group (n = 50). A total of 177 male athletes completed the study. The primary outcome measure was the limit of stability (LoS), which was measured using the Biodex Stability System to assess the performance of the dynamic balance. The LoS of the athletes' performance was measured pre- and postintervention after 6 weeks. The LoS significantly improved in all treatment groups, including CAE (44.5% ± 5.3%), NHE (43.2% ± 5.3%), and CAE + NHE (48.4% ± 5.1%) groups when compared with the control group (28.3% ± 4.8%) after 6 weeks (all Ps < 0.01). The improvement of LoS was significantly greater in the CAE + NHE group compared with other groups (CAE, NHE, and control groups). There was a significant increase in dynamic balance performance postintervention among male athletes. CAE and NHE may improve injury prevention programs. The results of this study provide evidence for athlete trainers and coaches to consider including the CAE and NHE as components of injury prevention programs to improve balance capacity and performance in athletes. Such improvements in balance may prevent injury risk and decrease absenteeism and injury-related financial burdens.

Warm-Ups and Coaches' Perceptions: Searching for Clues to Improve Injury Prevention in Youth Basketball.

Introduction: Regular use of neuromuscular training (NMT) warm-up programs improves performance and prevents injuries. However, low level of adoption of these programs remains a problem. Understanding the current warm-ups in youth basketball and coaches' perceptions on injury prevention can guide the design of superior implementation strategies. This study describes warm-ups in youth basketball and coaches' injury prevention-related knowledge, attitudes, beliefs, and information sources.Methods: Youth basketball coaches (n = 50) completed a preseason questionnaire. The questionnaire covered warm-up length, use of aerobic/agility/balance/strength/other exercises in the warm-up, injury-related knowledge, attitudes, beliefs, and sources of information.Results: Typical warm-up duration was ≤ 10 min (48.0% of coaches, 95% CI: ±13.8%). All coaches included aerobic exercises in their warm-up. Agility, strength, and balance exercises were utilized by 80.0% (95% CI: ±11.7%), 70.7% (95% CI: ±13.6%), and 26.8% (95% CI: ±13.6%) of coaches, respectively. Most coaches agreed to some extent that basketball injuries are preventable (94%) and that participating in a NMT warm-up program would reduce player's risk of injury (92%). Other coaches were identified as the most common source of information on warm-ups and injury prevention.Discussion: Coaches use parts of effective NMT warm-up programs, but balance exercises are not well adopted. Considering the level of evidence supporting the importance of balance exercises in injury prevention, it is crucial to improve the implementation of NMT warm-up programs in youth basketball, for example, through educational courses. As fellow coaches were identified as the most important source of information, coaches' role in knowledge translation should be emphasized.

Upper body injuries and Key Performance Indicators in professional basketball players

ntroduction: Upper body injuries are less common than lower body injuries in basketball, but there is still a lack of knowled-ge about the relationship among their occurrence and the performance profile of professional basketball players. This study aimed to analyse the relationships between upper-body injuries and Key Performance Indicators (KPIs) of basketball players. Material and method: Statistical variables of 554 professional basketball players (age: 26.97±4.86 years, height: 199.23±8.80 cm, minutes per season: 441.18±301.41) in Spanish ACB (Asociación de Clubes de Baloncesto) professional competition were analysed for two seasons (2012-13 and 2013-14). Besided, injury reports were registered and injuries were categorized with OSICS-10 classification. The players who played the most minutes during the season were more likely to suffer lumbar spine, head, wrist, and hand injuries. The players injured in the thoracic spine obtained a better average in steals per minute. The players injured in the head or the elbow had better +/- performance per minute. The players injured in the neck had better means per minute in received fouls, free throws made and attempted. Results: The players injured in the lumbar spine had better means, per minute played, in assists, probably by their continuous column twists to protect the ball with the body to avoid bumps. Players injured in the shoulder had more blocked shots per minute than those not injured, probably because the realization of a block involves a shoulder flexion and rotation. It would be interesting to carry out a specific follow-up in this type of player, for this type of injury. This information could be helpful to improve injury prevention with the use of KPIs of basketball.

Play safe with Sisimpur: an evaluation of a child injury prevention intervention in Bangladesh

For children under the age of 18 in Bangladesh, road traffic injuries, drowning, animal bites, poisonous substances, falls, burns, and electrocutions and fire-related burns pose significant and serious risk and are a leading cause of mortality, especially in rural areas. Despite this, there is limited evidence of what works to increase children’s knowledge of injury prevention and decrease incidents of unintentional injury. This study addresses this gap by presenting findings from an evaluation of Play Safe with Sisimpur. Leveraging the popularity of Sisimpur, the Bangladeshi co-production of Sesame Street, Play Safe with Sisimpur employed a school-based child-to-child and adult-to-adult mentorship model, designed to improve injury prevention knowledge and promote behavior change. Child survey results demonstrate a significant change between baseline and end line in the knowledge of children related to injury prevention and treatment for burns, electrocution, falls, household hazards, playing safe, road traffic injuries, and water safety. Adult mentee survey results demonstrate a significant change between baseline and end line in the knowledge of adult mentees related to injury prevention and treatment of animal injuries, burns, falls, household hazards, and road traffic injuries.

Setting the baseline: a description of cannabis poisonings at a Canadian pediatric hospital prior to the legalization of recreational cannabis.

This study describes the events and circumstances preceding children aged 16 years or younger being treated for cannabis poisoining in the emergency department (ED) of a Canadian pediatric hospital. We extracted cannabis poisoning treated in the ED at British Columbia Children's Hospital (BCCH) between 1 January, 2016 and 31 December, 2018, from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The poisonings were distinguished by the inadvertent or intentional ingestion of cannabis. We reviewed the hospital's electronic health information system and the patients' health records to obtain additional information on the context, including spatial and temporal characteristics. Of the 911 poisonings treated at BCCH, 114 were related to intentional cannabis use (12.5%). Fewer than 10 poisonings resulted from inadvertent ingestions by children and the median age for these was 3 years. All inadvertent ingestion occurred at home and involved cannabis belonging to the patient's family. The vast majority of poisonings resulted from the intentional use of cannabis only (28.9%) or cannabis use with other psychoactive substances (co-ingestions; 71.1%). The median patient age was 15 years. Most patients reported consuming cannabis through inhalation with peers. Cannabis and co-ingestion poisonings were more often reported on weekdays than weekends. The consumption of cannabis leading to poisoning more often occurred in private residences. Patients with cannabis poisoning more often sought medical treatment themselves or were helped by their family. The characteristics of cannabis poisonings among children are described for the three-year period prior to recreational cannabis legalization in Canada in order to set a baseline for future comparisons. Implications for improving injury prevention initiatives and policies are discussed.

How can we support best practice? A situational assessment of injury prevention practice in public health

BackgroundTo effectively impact the significant population burden of injury, we completed a situational assessment of injury prevention practice within a provincial public health system to identify system-wide priorities for capacity-building to advance injury prevention in public health.MethodsA descriptive qualitative study was used to collect data on the current practice, challenges and needs of support for injury prevention. Data was collected through semi-structured interviews (n = 20) and focus groups (n = 19). Participants included a cross-section of injury prevention practitioners and leadership from public health units reflecting different population sizes and geographic characteristics, in addition to public health researchers and experts from academia, public health and not-for-profit organizations. Thematic analysis was used to code all of the data by one reviewer, followed by a second independent reviewer who coded a random selection of interview notes. Major codes and sub codes were identified and final themes were decided through iterations of coding comparisons and categorization. Once data were analysed, we confirmed the findings with the field, in addition to participating in a prioritization exercise to surface the top three needs for support.ResultsMajor themes that were identified from the data included: current public health practice challenges; capacity and resource constraints, and; injury as a low priority area. Overall, injury prevention is a broad, complex topic that competes with other areas of public health. Best practices are challenged by system-wide factors related to resources, direction, coordination, collaboration, and emerging injury public health issues. Injury is a reportedly under prioritized and under resourced public health area of practice. Practitioners believe that increasing access to data and evidence, and improving collaboration and networking is required to promote best practice.ConclusionsThe results of this study suggest that there are several system level needs to support best practice in public health injury prevention in Ontario including reducing research to practice gaps and supporting opportunities for collaboration. Our research contributes to the literature of the complexity of public health practice, and presents several mechanisms of support to increase capacity at a system level to improve injury prevention practice, and eventually lessen the population burden of injury.

Exploring the potential utility of a wearable accelerometer for estimating impact forces in ballet dancers

ABSTRACTExcessive forces and/or loading rates during landing may place ballet dancers at risk for overuse injury. The ability to estimate and monitor the landing forces of ballet dancers could help to improve injury prevention and rehabilitation; however, force platforms are not conducive to testing outside of a laboratory. Fortunately, it may be possible to indirectly assess landing forces via a wearable accelerometer. The purposes of this study were to examine the relationship between impact accelerations, recorded via a pelvis-worn accelerometer, and the peak forces and loading rates during performance of a common ballet manoeuvre, and to examine if a wearable accelerometer is sensitive to fatigue-related changes in landing forces. Fifteen ballet dancers continuously performed a ballet manoeuvre until self-determined exhaustion while impact accelerations and landing forces were simultaneously recorded using an accelerometer and force platforms. We observed very strong, positive relationships between the impact accelerations and the peak forces and loading rates during the landings. In addition, the changes in impact accelerations with fatigue paralleled the changes in the peak forces and loading rates. As a result, it appears that a wearable accelerometer could be used to estimate and monitor landing forces in ballet dancers.

Is a professional soccer player’s dominant lower limb at higher risk of injury than their non-dominant lower limb? A systematic review

Background: Understanding incidences of soccer injuries is important to improving injury prevention and rehabilitation.Objective: To investigate whether a professional soccer player’s dominant lower limb (LL) is at higher risk of injury than their non-dominant LL.Methods: A systematic search was conducted using PubMed, SportsDiscus, CINHAL, SCOPUS and OpenGrey (09/01/2018–22/02/2018). Search terms included Sport*, injur* risk factor*, lower limb, limb dominance (LD), dominan*, functional laterality, handedness, limb preference, kicking leg, football, professional*. Observational studies reporting association between LD and LL injury in adult, professional soccer were eligible. Risk of bias was assessed with the ROBINS-I tool, articles with serious/critical risk of bias were excluded. Methodological quality was assessed using the Joanna Briggs Institute Tool.Results: 14 articles were eligible following risk of bias assessment (8 high quality, 6 low quality; 12 males, 2 females). Males: Results, based on seven high quality articles, found that quadriceps, knee joint/ligament, adductor and ankle injuries occurred more frequently on the dominant LL, whilst LD had no association with hamstring, calf and patella tendinopathy injuries. Females: one high quality study found anterior cruciate ligament injuries occurred more frequently on the non-dominant LL.Conclusions: For males, kicking may be influential in quadriceps and adductor injury mechanisms and player-to-player contact influential in knee joint/ligament and ankle injury mechanisms. For females, anterior cruciate ligament injury may occur more frequently during unilateral non-dominant LL loading. Further investigation is needed into the impact of contact on dominant-side injuries in males and the influence of LD on injury in females.

Sex and Maturation Differences in Performance of Functional Jumping and Landing Deficits in Youth Athletes.

Understanding how neuromuscular and biomechanical deficits that are associated with knee injuries change as youth mature may improve injury prevention strategies in this population. To investigate sex and maturation differences in jump-landing technique performance in youths using a practical clinical tool. Cross-sectional study. High Performance Center Laboratory. A total of 165 youth athletes were included in this study. The main outcome measures were each of the 10 items of the modified tuck jump assessment and the total score. These measures include (1)knee valgus at landing, (2)thighs do not reach parallel, (3)thighs not equal side to side, (4)foot placement not shoulder width apart, (5)foot placement not parallel, (6)foot contact timing not equal, (7)excessive landing contact noise, (8)pause between jumps, (9)technique declines prior to 10 seconds, and (10)does not land in same footprint. Only knee valgus at landing had a significant sex × maturation interaction. The main effect of maturation was significant for items 2, 3, 6, 7, 9, and total score. Plyometric technique performance improved with increasing maturation. The main effect of sex was significant for items 1 and 9, with males performing better than females. Female athletes demonstrate increased knee valgus at landing and fatigue relative to males during jump-landing performance. Overall, there was a trend of improved jump-landing performance with maturation.

Nonfatal motor vehicle related injuries among deployed US Service members: Characteristics, trends, and risks for limb amputations.

Motor vehicle-related (MVR) incidents are important causes of morbidity among deployed US service members (SMs). Nonbattle MVR injuries are usually similar to civilian MVR injuries, while battle MVR injuries are often unique due to the blast effects from precipitating explosive mechanisms. Our primary objective was to describe the characteristics and trends of nonfatal MVR injuries sustained by deployed US SMs. A second objective was to assess the association between mechanism of injury (i.e., explosive vs. nonexplosive) and limb amputation. We conducted a retrospective cross-sectional analysis using data from the Department of Defense Trauma Registry collected from October 2001 to December 2018. Descriptive statistics were reported stratified by mechanism of injury (explosive vs. nonexplosive). The association between mechanism of injury and limb amputation was assessed using logistic regression models. There were 3,119 US casualties who sustained nonfatal MVR injuries, 2,380 (76.3%) SMs sustained nonexplosive MVR injuries while 739 (23.7%) sustained explosive MVR injuries. Of all MVR casualties, 2,085 (66.9%) were in Iraq or Syria and 1034 (33.1%) in Afghanistan. The annual prevalence of nonfatal MVR battle casualties was highest in Iraq and Syria from 2003 to 2009 and Afghanistan from 2009 to 2014, ranging overall 15 to 50 MVR casualties per 1,000 wounded in action. There were 92 limb amputations associated with MVR incidents. Compared with nonexplosive MVR mechanisms, explosive MVR mechanisms had higher association with limb amputation (adjusted odds ratio, 2.6; confidence interval, 1.7-3.9), even after adjusting for injury year and Injury Severity Score (AOR, 2.1; confidence interval: 1.4-3.4). Motor vehicle-related incidents are an important cause of injury in US military operations. Compared with nonexplosive MVR incidents, explosive MVR incidents result in more severe injuries, and have a higher associated risk of limb amputation. Continued efforts to improve injury prevention through protective equipment and medical training specific to MVR injuries are needed. Prognostic and epidemiological study, Level III.

Characterizing injury at a tertiary referral hospital in Kenya.

IntroductionInjury accounts for more than 5.8 million deaths globally with an increasing burden in the developing world. In Kenya, trauma is one of the top 10 leading causes of death. However, no formal continuous injury surveillance systems are in place to inform injury prevention, pre-hospital care or emergency department management. The aim of this study was to implement a hospital-based trauma registry to characterize high acuity injuries presenting to a private tertiary, teaching and referral hospital in Kenya.MethodsFrom January to December 2015, data was prospectively collected at a private tertiary, teaching and referral hospital in Nairobi, Kenya. Patients presenting with a traumatic injury for the first time who were admitted to the hospital for at least 48 hours were included in the study. Basic information pertaining to demographics, details of the injury, pre-hospital care and transport, hospital-based management, length of stay and disposition were collected. An injury severity score (ISS) was calculated on each patient and stratified by the mechanism of injury. Descriptive statistics and multivariate logistic regression were used to analyze data and assess risk factors associated with injury severity.ResultsThere were 101 patients included in the study, the majority of whom were 30 to 39 years of age and male (63%). Seventy-one per cent of patients had a preexisting medical condition with hypertension (26%) and diabetes (13%) being the most common. The most common mechanism of injury was fall (46%) followed by road traffic incidents (RTI) (32%). Most injuries took place at home (43%). Most RTI were caused by cars (63%), with the driver being the most frequently injured (38%). The most common mode of arrival to the emergency department was by private car (72%). The median time between the accident and arrival at the emergency department was 1hr 10 minutes. The majority of the patients had injuries to one area (83%) with the extremities/bony pelvis (72%) being the most common. The median Injury Severity Score was 5 (range 1–34) with the majority (90%) classified as minor injuries (ISS<12). The highest severity of injury as determined by ISS was seen in gunshot wounds.ConclusionsInjured patients in Kenya showed concordance with prior studies looking at injury prevalence in the developing world when looking at demographics and place of injury. However, differences were found when looking at the mechanism of injury, with falls surpassing road traffic incidents. A delayed presentation to the hospital was also noted in this patient population. Given the rate of traumatic injuries in Kenya and their contribution to morbidity, mortality and overall healthcare costs, there is a need to implement formal trauma registries in all major hospitals in Kenya to generate more data that can be used to improve injury prevention, the overall trauma system and enhance training and preparedness.

Relationships and Mechanisms Between Occupational Risk Factors and Distal Upper Extremity Disorders.

The relationships between workplace risk factors and upper extremity injuries from epidemiological and laboratory studies were examined. Epidemiological studies are associated with several limitations, affecting the strength of association between risk factors and the development of injuries. In this narrative review, we identified epidemiological and laboratory studies (published primarily since 1997) investigating exposure to workplace risk factors (force, repetition, posture, vibration) and risk of hand/wrist tendon-related disorders, epicondylitis, and carpal tunnel syndrome (CTS). Forceful exertions are strongly associated with hand/wrist tendon-related disorders, epicondylitis, and CTS. Dose-response relationships were found for epicondylitis (repetition) and CTS (posture). Interactions demonstrate multiplicative effects of risk factors for injury risk. Laboratory studies display clear associations between task demands and biomechanical measures linked to mechanisms for upper extremity injuries with animal models providing further evidence of a dose-response between risk factors and injury. Forceful, repetitive work requiring non-neutral postures are associated with increasing risk of hand/wrist tendon-related disorders, epicondylitis, and CTS as evidenced by epidemiology studies and laboratory-based investigations of humans and animals. Understanding the relationship between exposure levels of workplace risk factors and upper extremity disorders can improve injury prevention and rehabilitation strategies.

Dynamic Postural Stability During Rested and Fatigued Backwards Single-Leg Jump-Landings

Poor time to stabilization (TTS) during backward single-leg jump-landing (BSLJL) is a risk factor for injury. PURPOSE: The purpose of this study was to assess the reliability of TTS and effect of fatigue on TTS. It was hypothesized that TTS would demonstrate adequate reliability, and that fatigue would worsen TTS. METHODS: Nine active subjects (4 F, 5 M, 24.8 ± 3.4 y, 1.77 ± 0.08 m, 74.7 ± 15.3 kg) performed BSLJL on the dominant (D) and non-dominant (ND) leg. BSLJL was performed barefoot by jumping backwards on the test leg over a 0.15 m hurdle, landing on the test leg on a force plate with hands on the hips, and stabilizing as quickly as possible. During session 1, subjects performed 10 trials without familiarization. During session 2, subjects performed 3 trials (PRE), rested for 5 minutes, and re-performed 3 trials (POST). During session 3, subjects completed a 5 to 7 minute fatigue protocol consisting of step-ups, L-drills, vertical jumps, and agility ladder drills between PRE and POST instead of resting. Sessions 2 and 3 were completed in a randomized order. TTS was quantified as time from initial contact to when vertical ground reaction force remained within 5% of the subject’s body mass for 1 s. RMANOVA and paired t-tests were used to compare TTS, and typical error (TE) was used to quantify reliability. Significance was set to p ≤ 0.05. RESULTS: During session 1, BSLJL TTS did not improve over 10 trials on D (p = 0.18) or ND (p = 0.49). During session 2, TTS was similar PRE and POST on D (1.12 ± 0.47 vs 1.17 ± 0.40 s, p = 0.81) and ND (1.27 ± 0.53 vs 1.05 ± 0.57 s, p = 0.09), and had a within-day TE of 0.02 and 0.16 s, respectively. During session 3, TTS was similar PRE and POST on D (1.21 ± 0.32 vs 1.60 ± 1.05 s, p = 0.22), but greater at POST compared to PRE on ND (1.21 ± 0.51 vs 1.60 ± 0.58 s, p = 0.04). The between-day TE assessed using PRE TTS from session 2 and 3 was 0.36 s on D and ND. CONCLUSION: BSLJL learning effects are negligible, although familiarization trials are likely needed. Between-day reliability does not appear adequate. Using TTS to longitudinally monitor injury risk may be inappropriate. Fatigue appears to degrade TTS, but does not affect all subjects equally, and effects may be masked by large inter-subject variation in TTS. Identifying factors related to susceptibility to fatigue induced decrements may improve injury prevention measures.