Incidence Of Injury Research Articles

Head and neck injuries from personal motorised vehicles in the United States

BackgroundThe use of personal electric vehicles in the United States has increased head and neck injuries. This study analyses the types, frequencies, demographics and management of these injuries across motorised...

Common Knee Injuries and Preventive Measures for Adolescent Badminton Players during Training

In recent years, an increasing number of enthusiasts have embarked on badminton, particularly adolescents who have chosen as a career path in hopes of achieving excellent results on the court. However, due to variations in badminton coaching standards and differing instructional philosophies, many adolescent badminton players are repeatedly plagued by various injuries throughout their careers, with lower limb injuries being particularly prevalent (accounting for approximately 58% of all injuries). Among these lower limb injuries, more than half involve the ankles and knees, significantly impacting their careers. This paper focuses on common knee injuries experienced by adolescent badminton players, such as anterior cruciate ligament tears, meniscus injuries, and muscle strains. To effectively prevent these injuries, a series of scientific and systematic training recommendations are proposed. These include functional training of the muscles surrounding the knee joint, such as single-leg Romanian deadlifts and Bulgarian split squats, which help improve knee stability and thereby reduce the risk of injury. Additionally, functional training of the core deep stabilizing muscles, such as diaphragmatic breathing exercises and the Dead Bug exercise based on diaphragmatic breathing, is recommended to enhance the strength and stability of the core musculature and improve body balance, thereby lowering the incidence of knee injuries and achieving preventive effects. The aim is to provide effective preventive measures for knee injuries to adolescent badminton players, reducing their risk of injury and promoting the healthy development of the careers, provide a useful reference for scientific training and rehabilitation in badminton.

Evaluating Paediatric Injury Hospitalisations From Indoor Trampoline Parks Across Australia: A Multi-Centre Study.

The introduction and increasing popularity of indoor trampoline facilities has seen increases in the incidence of trampoline park injuries (TPIs), particularly amongst the paediatric population. A challenge to the development of effective injury prevention interventions is the limited study pool of detailed activity and outcome data to provide better understanding of the characteristics of injurious events. A cross-sectional study of individuals under 16 years of age hospitalised after TPI from November 2018 to December 2021 was conducted. Patient demographics and TPI characteristics were collected through prospective case notifications from clinicians across Australia, via the Australian Paediatric Surveillance Unit. Additional data were collected using retrospective medical record review at two major paediatric centres in Australia. In total, 48 cases of TPIs were reported: median age was 9.5 years with 28 (58.3%) being males. The most common injury mechanism was a fall on the trampoline (n = 34, 72.3%). The most commonly injured body region was upper limb (n = 27, 56.3%), followed by lower limb (n = 11, 22.9%): all limb injuries involved a fracture. Most patients required operative intervention (n = 37, 90.2%). The results from this study suggest that serious injuries continue to occur at trampoline parks, and thus remain an injury concern that requires attention. This issue needs to be addressed with consistent application of the Australian Standard, along with other injury prevention initiatives.

The incidence of vascular injuries in patients with negative cervical computed tomography (CT) following blunt trauma.

Computed tomography (CT) angiography is commonly utilized to quickly identify vascular injuries caused by blunt cervical trauma. It is often conducted alongside a cervical spine CT, based on established criteria. This study assessed the prevalence of cervical vascular injuries identified via CT angiography (CTA) in patients who had negative findings on cervical CT scans. A retrospective study was performed on patients who experienced blunt trauma from January 2020 to December 2022 and underwent both cervical CT and CTA. The sample size was determined using the formula: n = (Z^2 * P * (1 - P)) / E^2, assuming a 99% confidence interval, a 2% margin of error, and a proportion of 0.05. A total of 1,165 patients presented with acute blunt trauma to the head and neck during the study period. Out of those, 800 patients (68.7%) had negative cervical CT scans and only 5 patients (0.6%) were found to have vascular injuries on CTA, with an average age of 44.2 years. Regarding the severity of the injuries, three were classified as grade I and two as grade II. On the other hand, of the 365 patients with positive cervical CT, 44 patients (12%) had vascular injury on CTA, including 16 patients (4.5%) with grades III and IV injuries. The findings of this study suggest that CTA in patients with negative cervical CT scans seldom reveals vascular injuries, with no injuries exceeding grade II. This highlights the selective utility of CTA in this patient group.

Incidence of Injuries in Resistance Training: Risk Factors and Most Affected Body Areas

Incidence of Injuries in Resistance Training: Risk Factors and Most Affected Body Areas

Injury incidence and associated factors among soccer players during the 2021 African Cup of Nations competition

Background Understanding the epidemiology of soccer injuries during specific international competitions is essential for customizing preventive strategies. Several studies have reported outcomes related to international competitions but, to the best of our knowledge, there has been no investigation into the injury patterns during any African Cup of Nations (AFCON) tournaments. This study aimed to analyse the incidence and the characteristics of soccer injuries during the 2021 African Cup of Nations (AFCON), which took place in Cameroon from January 9 to February 6, 2022. Methods A video-based analysis covering 52 matches was conducted by two independent consultant physicians. They reviewed injury replays to determine incidence and characteristics ( i.e. ; mechanisms, body location, match moment, player substitution, absence in the next match, and referee decisions). Results The tournament involved 519 male players, comprising 275 African (ALP) and 244 Non-African (NALP) league players. Eighty-seven injuries occurred, with incidences of 1.7 and 48.8 injuries per match and per 1000 match hours, respectively. Injury incidence rose with competition stages, particularly contact mechanism injuries. Non-contact injuries (23/87) predominantly occurred after 60 minutes of play (19/23), with the thigh being the most frequently affected body part (18/87). Older age and playing time significantly correlated with injury occurrence (p=0.032 and p<0.001, respectively). NALP midfielders and forwards were notably injured by contact mechanisms (36/45) in the attacking zone. Although non-contact mechanisms were more common in ALP than NALP (13/42 vs. 9/45), the difference lacked statistical significance (p=0.240), with a higher rate of muscle injuries (13/42 vs. 10/45, p=0.001). Conclusion Muscle injuries prevailed among professional soccer players in the 2021 AFCON, with older age and playing time identified as key associated factors. Muscle injuries were more prevalent in ALP compared to NALP.

Age, creatinine, and ejection fraction score is a risk factor for acute kidney injury after surgical aortic valve replacement

Background The incidence of acute kidney injury (AKI) increases after surgical aortic valve replacement (SAVR). This study aimed to characterize the risk factors of AKI after SAVR. Methods and Results We conducted a retrospective registry study based on data from 299 consecutive patients undergoing SAVR. At 48 h after SAVR, 41 patients developed AKI. There was a significantly higher prevalence of older age, higher body mass index (BMI), and diabetes mellitus in the AKI group. Previous use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) and β-blocker, intake and output volumes within 24 h, mechanical ventilation time, length of intensive care unit and hospital stay, baseline creatinine, baseline, 24 h, and 48 h estimated glomerular filtration rate were strongly associated with the incidence of AKI. BMI >24, history of hypertension, use of ACEI/ARB and β-blocker, and mechanical ventilation time were associated with AKI. Univariate logistic regression indicated that overweight, hypertension, use of ACEI/ARB and β-blocker, and mechanical ventilation time were associated with AKI. Notably, the ACEF score was an independent predictor of AKI. The receiver operating characteristic curve was employed to assess the ACEF score for predicting AKI and the best cutoff was 1.1. After dividing ACEF into quartiles, each one-unit increment in ACEF led to a 2.27-fold risk in the incidence of AKI among patients. Conclusions AKI is a generalizable phenomenon occurring frequently after SAVR. The ACEF score is an independent predictor of AKI among patients undergoing SAVR.

Incidence of Acute Kidney Injury in Relapsed and Refractory Multiple Myeloma treated with Teclistamab versus CAR T-cells.

Teclistamab, a novel bispecific monoclonal antibody targeting CD3 and B-cell maturation antigen (BCMA), and chimeric antigen receptor T-cell (CAR-T) therapy are promising options for treating relapsed/refractory multiple myeloma (MM). However, the rates of acute kidney injury (AKI) associated with teclistamab remain inadequately characterized. This study aims to compare the incidence, severity, and outcomes of AKI between patients receiving teclistamab and CAR-T therapy. This was a retrospective study involving 64 patients with relapsed/refractory MM treated with either teclistamab or CAR-T therapy. All patients had previously received at least four lines of chemotherapy before being treated with either teclistamab or CAR-T. The primary outcome was the incidence of AKI, and secondary outcomes included AKI severity, kidney recovery rates, and mortality. Kaplan-Meier estimates for AKI-free survival were calculated, and hazard ratios (HRs) for AKI risk were determined using Cox proportional hazards models. Sixty-four patients met inclusion criteria for this study (30 received CAR-T and 34 received teclistamab therapy). Among these patients, 14 AKI events occurred in total (22%), with 10 events (29%) in the teclistamab group and 4 events (13%) in the CAR-T group. AKI-free survival estimates at 180 days after treatment initiation were 68% (95% confidence interval [CI]: 53%-87%) for teclistamab patients and 90% (95% CI: 79%-100%) for CAR-T patients. While patients receiving teclistamab were found to have an increased risk of an AKI event compared to those receiving CAR-T therapy, the results were not statistically significant (HR [95% CI]: 3.38 [0.93-12.31], P=0.065). This study suggests that patients treated with teclistamab may experience a higher incidence of AKI compared to those receiving CAR-T therapy. However, further research is required to determine whether this increased risk is attributable to disease progression or teclistamab itself. These results highlight the need for close kidney function monitoring in patients receiving teclistamab.

A Five-year Consumer Protection Database Study Yielded Emergent Demographic and Dermatological Condition Information Associated with Rock Climbing for One Hundred and Sixty-Six Patients

Introduction: Rock climbing is a popular activity that poses various injury risks, including falls, equipment failures, physical stress from climbing, and contact with falling objects. We aimed to quantify emergent dermatological injuries and conditions Methods: We used the NEISS database that collates data from over 100 emergency rooms and applied filters to analyze rock climbing injury and skin condition data from 2019 and 2023 for demographics, anatomical location, and types of injuries and conditions. Results: A total of 166 patient vignettes with 186 injuries were included. The majority of the climbers with dermatological injuries were male (64%), with the most common injuries found to be contusions or abrasions (n = 109) and the most common injury sites being the upper extremities (n = 61) and the head/neck (n = 50). Discussion: These results emphasize the need for targeted preventive measures to reduce the incidence of dermatological injuries among rock climbers, considering that the severity and impact of these injuries can be significant (e.g., lacerations) and prevalent in cosmetically sensitive areas (head/neck). Additional research should also be performed at ambulatory and outpatient settings to identify less emergent dermatological conditions associated with the sport and allow for appropriate guidance for those conditions.

ACUTE MYOCARDIAL INJURY AFTER SURGICAL LUNG RESECTION: INCIDENCE, CLINICAL FEATURES, PREDICTORS

HighlightsAcute perioperative myocardial injury develops in 38.5% of patients with non – small cell lung cancer and is associated with the ThRCRI major cardiac events risk index, preoperative hemoglobin level and postoperative heart rate. Aim. To determine the incidence and predictors of acute myocardial injury after surgical treatment of patients with non – small cell lung cancer (NSCLC).Methods. The study included 104 men aged 63.0 [58–67] years who underwent lung resection for NSCLC. Blood levels of cardiac troponin I (cTnI) were determined before and 24 and 48 hours after surgery. Myocardial injury after noncardiac surgery (MINS) was diagnosed when postoperative cTnI increased > 99th percentile of the upper reference limit. Two patients with elevated cTnI of non-ischemic origin were excluded from the analysis. In groups with and without MINS, clinical parameters were compared and their relationships with the MINS development were assessed using univariate regression. Multivariate logistic regression analysis was performed to identify independent MINS predictors. ROC curves were constructed and threshold values of quantitative variables associated with the study outcome were determined.Results. MINS was diagnosed in 40 patients (38.5%). In 36 of them, the cTnI increase was asymptomatic. Among patients with MINS, in contrast to the group without MINS, the share of pneumonectomy, heart rate (HR) after surgery and the cardiac events risk index ThRCRI were higher, as well as hemoglobin level before surgery was lower. Using multiple logistic regression, a combination of factors that provides the greatest accuracy in predicting MINS was identified: ThRCRI index ≥ 1 (adjusted odds ratio (OR) 5.85, 95% confidence interval [1.41–24.28]), hemoglobin before surgery (OR 0.68 [0.5–0.91] for every 10 g/L), HR after surgery (OR 1.99 [1.26–3.13] for every 10 min–1). Threshold levels were established for hemoglobin before surgery (135 g/L), below which the OR for MINS was 2.54 [1.12–5.75], and postoperative HR (88 min–1), above which the OR for MINS was 2.64 [1.16–5.99].Conclusion. The incidence of acute myocardial injury after NSCLC surgery is 38.5%. In 90% of cases the MINS was asymptomatic. A mathematical model was created and following independent predictors of MINS were established: ThRCRI index ≥ 1, hemoglobin level before and heart rate after the surgery. At a threshold hemoglobin value < 135 g/L and HR>88 min–1, the risk of MINS increases significantly.

Valve Sparing Aortic Root Replacement in the Resternotomy Setting.

While valve-sparing aortic root replacement (VSRR) has demonstrated satisfactory outcomes, its utility in a reoperative sternotomy setting remains uncertain. This study evaluates the perioperative safety and long-term durability of reoperative sternotomy VSRR. All consecutive VSRR at two centers from 2005-2020 were included. Reoperative VSRR was defined as prior sternotomy for any reason. Time-dependent outcomes were compared between groups after balancing of covariates with inverse probability of treatment weighting. Multivariable Cox regression and Fine-Gray sub-distribution hazard model were used to identify factors associated with 10-year survival and aortic valve (AV) reintervention, respectively. Of 778 VSRR, 69 (8.9%) were reoperative sternotomies. Compared to primary, reoperative VSRR patients were younger (43 [34-54] vs 51 [39-61] years, p<0.001) and had less aortic insufficiency (33.3% vs 48.5%, p=0.02). Cardiopulmonary bypass times were longer in reoperative VSRR with similar rates of circulatory arrest. Reoperative VSRR had a higher incidence of postoperative acute kidney injury (10.1% vs 3.2%, p=0.01) and prolonged ventilation (24.6% vs 9.9%, p<0.001); operative mortality was higher in reoperative VSRR (2.9% (2/69) vs 1.4% (10/709)) although not significantly (p=0.66). Ten-year survival was 82.0% [70.0-96.0] and AV reintervention rate was 11.8% [2.3-19.4] after reoperative VSRR. After IPTW adjustment, survival and AV reintervention rates were not different. Reoperative sternotomy was not associated with long-term mortality (p=0.13) or AV reintervention (p=0.77) on multivariable analysis. Although complex, reoperative sternotomy VSRR can be performed with low operative mortality in carefully selected patients. Ten-year survival and AV reintervention rates were acceptable and comparable to primary VSRR.

ACE I/D Genotype and Risk of Non-Contact Injury in Moroccan Elite Athletes: A Pilot Study

Background and Objectives: The insertion/deletion (I/D) polymorphism in ACE, the gene encoding the angiotensin-converting enzyme (ACE), has been suggested as a genetic variation that can influence exercise performance and risk of injury in elite athletes. The I allele has been associated with enhanced endurance performance and with reduced inflammation, while the D allele has been associated with improved performance in strength and power activities. However, the role of this genetic variant in the incidence of non-contact injury is underexplored. This study investigated the possible association of ACE I/D genotypes with the risk of non-contact injury in elite Moroccan athletes. Materials and Methods: Forty-three elite male athletes (19 cyclists and 24 field hockey players) from the Moroccan national team participated voluntarily. Non-contact injuries were recorded for all athletes and classified according to the IOC consensus statement by the medical staff of the teams. ACE I/D polymorphism genotyping was performed by polymerase chain reaction (PCR) using genomic DNA from blood samples. Results: There were four cyclists (21.05%) and eight field hockey players (33.33%) with a non-contact injury during the season. The distribution of the ACE I/D genotypes was similar in the athletes with vs. without non-contact injury for cyclists (DD/ID/II 25.00/50.00/25.00% vs. 46.67/40.00/13.33% non-injured, respectively; X2 = 0.69, p = 0.70), field hockey players (DD/ID/II 50.00/50.00/0.00% vs. 50.00/43.75/6.25%; X2 = 0.54, p = 0.76) and for the whole group of athletes (DD/ID/II 41.67/50.00/8.33% vs. 48.39/41.94/9.68%; X2 = 0.22, p = 0.89). In the whole group of athletes, neither the dominant (DD + ID vs. II = OR: 1.17, 95% CI: 0.15–16.56, p = 0.89) nor the recessive (DD vs. ID + II = OR: 1.31, 95% CI: 1.31–4.89, p = 0.69) models showed an increased risk of non-contact injury. Conclusions: The distribution of the ACE I/D genotypes was similar in elite cycling and field hockey athletes with or without non-contact injury during the season. These results indicate that there is no significant association between the ACE I/D polymorphism and the susceptibility to non-contact injury in these athletes. Further research is warranted to validate these findings and to investigate their broader implications for advancing knowledge in sports injury prevention and optimizing athlete management strategies.

Prediction of post-contrast acute kidney injury by bedside ultrasonography

BackgroundThe incidence of contrast-induced acute kidney injury (CI-AKI) in the general population ranges from 0.6 to 2.3%, whereas for specific high-risk patients, the incidence can reach more than 30–40%. Ultrasound measurements of the development of CI-AKI after contrast-enhanced imaging for diagnosis in the emergency department (ED) have yet to be adequately studied. Accordingly, we aimed to evaluate the usefulness of Doppler ultrasound measurements for predicting CI-AKI in patients with normal renal function.MethodsThis prospective, observational, single-center study was conducted in the ED of a tertiary teaching and research hospital between 1 January and 1 July 2024. All patients who presented to the tertiary training and research hospital ED, who were admitted to the hospital with a decision to undergo contrast-enhanced tomography for diagnosis, and who did not meet any exclusion criteria were included in the study. Patients included in the study were evaluated by ultrasonographic measurements (interlobar renal artery peak systolic velocity (PSV), interlobar renal artery end-diastolic velocity (EDV), inferior vena cava (IVC) collapsibility index, and renal resistive index (RRI)).ResultsThe postcontrast RRI cutoff values were calculated to predict CI-AKI. The area under the curve (AUC) for the postcontrast RRI was 0.914, and the cutoff value for the postcontrast RRI was 0.70 (≥), exhibiting 72.7% sensitivity and 95.6% specificity.ConclusionPostcontrast RRI ultrasound measurements performed after diagnostic contrast imaging in the ED show high specificity in predicting CI-AKI development. Postcontrast ultrasound measurements may predict CI-AKI development, allowing further measures to be taken. Further studies are needed to confirm these findings.Trial registrationClinical trial number: not applicable.

Severe Injuries of Former Portuguese Football Players: A Post-Career Burden?

Background/Objectives: Football players have a high injury risk due to the physical demands of their profession, which can negatively affect their quality of life (QoL) in the long term. The aim of this study is to characterize the severe injuries that former Portuguese football players suffered throughout their professional careers and investigate the resulting impacts on the physical domain of QoL after retirement. Methods: This study includes 84 former Portuguese football players (48.8 ± 8.2 years) who underwent reform between 1988 and 2018 and played in professional leagues (15.2 ± 3.2 years of career duration), namely, first division leagues (n = 43) and secondary division leagues (n = 41). Quantitative and qualitative interview data are used by a validated interview guide and from results of the physical domain obtained by the application of the World Health Organization Quality of Life questionnaire (WHOQOL-Bref). Results: Former players had 2.1 ± 1.5 severe injuries throughout their careers. The most common injuries involve the knee (47.5%) and foot/ankle (17.2%), with the anatomical area of the knee as the most likely to require surgical intervention (60%). The association between tactical-positional status and the incidence of severe injuries is significant, with defenders sustaining less severe injuries throughout their careers. This study found a statistically significant linear model (F(1.82) = 8.089, p &lt; 0.006) that explains 7.9% of the variation in the physical domain of QoL (R2ajuste = 0.079). For each severe injury sustained throughout a career, there is an estimated decrease of 2.7 values in QoL perception in the physical domain. Conclusions: The higher the number of severe injuries sustained during a career, the lower the perception of QoL in the physical domain of former players in their post-career. These findings highlight the need to optimize training programs and injury prevention and recovery protocols for long-term QoL improvement in the physical domain of football players.

Enhancing Performance and Preventing Injuries in Cricketers: The Role of Functional Movement Screening

Functional Movement Screening (FMS) has emerged as a vital tool in sports science for identifying movement inefficiencies, preventing injuries, and enhancing athletic performance. In cricket, a sport characterized by its unique combination of asymmetrical movements, repetitive actions, and high physical demands, FMS offers significant potential to optimize player outcomes. This paper investigates the application of FMS in cricket, focusing on its role in detecting biomechanical dysfunctions, designing corrective interventions, and monitoring performance improvements over time. By examining a cohort of state-level cricketers, the study highlights the effectiveness of FMS in reducing injury incidence, improving movement efficiency, and enhancing key performance metrics such as agility and accuracy. The findings underscore the importance of integrating FMS into cricket training programs and emphasize the need for a multidisciplinary approach involving coaches, physiotherapists, and sports scientists. Despite challenges in implementation, such as resource limitations and the need for specialized training, FMS proves to be a transformative tool in advancing the health and performance of cricketers. Future research directions include the establishment of sport-specific benchmarks, the integration of wearable technology for real-time assessments, and longitudinal studies to explore sustained benefits.

Impact of remnant cholesterol on short-term and long-term prognosis in patients with prediabetes or diabetes undergoing coronary artery bypass grafting: a large-scale cohort study

BackgroundRemnant cholesterol (remnant-C) contributes to atherosclerotic cardiovascular disease (ASCVD), particularly in individuals with impaired glucose metabolism. Patients with impaired glucose metabolism and ASCVD remain at significant residual risk after coronary artery bypass grafting (CABG). However, the role of remnant-C in this population has not yet been investigated.MethodsAdult patients with prediabetes or diabetes undergoing isolated CABG were consecutively enrolled in a longitudinal cohort between 2013 and 2018. The impact of remnant-C on short-term and long-term outcomes after CABG was evaluated. The short-term outcomes included major perioperative complications. The long-term outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs). Remnant-C was analyzed as both a categorical and continuous variable. Logistic regression, Cox regression, and restricted cubic spline analyses were performed with multivariate adjustments.ResultsIn terms of perioperative outcomes, patients with elevated remnant-C had a higher incidence of acute kidney injury (AKI) stage 2/3 (high vs. low remnant-C: 3.2% vs. 2.4%; OR: 1.404, 95% CI 1.080–1.824). Each 1-standard deviation (SD) increase in remnant-C was associated with a 16.6% higher risk of AKI stage 2/3 (OR: 1.160, 95% CI 1.067–1.260). Long-term outcomes were assessed after a median follow-up of 3.2 years, during which 1,251 patients (9.3%) experienced MACCEs. Each 1-SD increase in remnant-C was associated with a 6.6% higher risk of MACCEs (HR: 1.066, 95% CI 1.012–1.124), a 7.1% higher risk of all-cause death (HR: 1.071, 95% CI 1.008–1.209), and an 11.2% higher risk of myocardial infarction (HR: 1.112, 95% CI 1.011–1.222). These associations remained consistent when remnant-C was treated as a categorical variable. Importantly, the association between remnant-C and MACCEs was independent of LDL-C levels; higher remnant-C levels were associated with increased MACCE risk regardless of whether LDL-C was ≤ 2.6 mmol/L or > 2.6 mmol/L. Subgroup analysis indicated that this risk was more pronounced in insulin-treated patients.ConclusionsRemnant-C is associated with AKI and MACCEs in patients with diabetes or prediabetes undergoing CABG. The MACCE risk associated with remnant-C is independent of LDL-C and is more pronounced in insulin-treated patients.Graphical Remnant cholesterol (Remnant-C) may be an important risk factor for patients with impaired glucose metabolism undergoing coronary artery bypass grafting (CABG), however its role remains unknown. In our study, 13,426 CABG patients with prediabetes or diabetes were enrolled from a large longitudinal cohort to assess the impact of remnant-C on both perioperative and long-term outcomes. We found that higher remnant-C levels were significantly associated with an increased risk of acute kidney injury (AKI) perioperatively, as well as long-term adverse outcomes, including major adverse cardiovascular and cerebrovascular events (MACCEs), independent of LDL-C levels. HR, hazard ratio; CI, confidence interval; SD, Standard deviation; remnant-C, remnant cholesterol; MACCEs, major adverse cardiovascular and cerebrovascular events; CABG, coronary artery bypass grafting.

Doxycycline Versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus Aureus-Associated Acute Pulmonary Exacerbations in People With Cystic Fibrosis.

Among people with cystic fibrosis (PwCF), methicillin-resistant Staphylococcus aureus (MRSA)-associated acute pulmonary exacerbations (APEs) have been increasing in prevalence and can cause rapid declines in lung function and increased mortality. Fortunately, since 2019, incidence has started to decline. The purpose of this study was to evaluate if doxycycline has comparable efficacy to vancomycin for the treatment of APEs in PwCF. Given the potential toxicities and intolerances associated with vancomycin, evaluating alternative therapies such as doxycycline is warranted. A multicenter retrospective cohort study was conducted in adult and pediatric PwCF who received greater than 48 hours of either vancomycin or doxycycline to treat MRSA-associated APEs between May 1, 2014, and August 31, 2021. The primary outcome was the number of PwCF with a return to ≥90% of baseline forced expiratory volume in the first second (FEV1). There were 229 PwCF encounters screened, of which 89 met inclusion criteria (n = 26, vancomycin; n = 63, doxycycline). There were no differences between vancomycin and doxycycline for the primary outcome: 18/26 (69.2%) in the vancomycin group vs 51/63 (81.0%) in the doxycycline group (P = 0.23). Secondary outcomes were similar between groups, including no difference in incidence of acute kidney injury (AKI), although a significantly higher incidence of adverse events occurred in the vancomycin arm. The findings of this study suggest doxycycline may be a reasonable alternative to vancomycin for MRSA-associated APEs, particularly in PwCF who may not tolerate vancomycin or who require concomitant nephrotoxins such as intravenous (IV) aminoglycosides.

Incidence of fall-from-height injuries and predictive factors for severity

Abstract Context The injuries caused by falls-from-height (FFH) are a significant public health concern. FFH is one of the most common causes of polytrauma. The injuries persist to be significant adverse events and a challenge regarding injury severity assessment to identify patients at high risk upon admission. Understanding the incidence and the factors that predict injury severity can help in developing effective intervention strategies. Artificial intelligence (AI) predictive models are emerging to assist in clinical assessment with challenges. Objectives This retrospective study investigated the incidence of FFH injuries utilizing conventional statistics and a predictive AI model to understand the fall-related injury profile and predictive factors. Methods A total of 124 patients who sustained injuries from FFHs were recruited for this retrospective study. These patients fell from a height of 15–30 feet and were admitted into a level II trauma center at the border of US-Mexica region. A chart review was performed to collect demographic information and other factors including Injury Severity Score (ISS), Glasgow Coma Scale (GCS), anatomic injury location, fall type (domestic falls vs. border wall falls), and comorbidities. Multiple variable statistical analyses were analyzed to determine the correlation between variables and injury severity. A machine learning (ML) method, the multilayer perceptron neuron network (MPNN), was utilized to determine the importance of predictive factors leading to in-hospital mortality. The chi-square test or Fisher’s exact test and Spearman correlate analysis were utilized for statistical analysis for categorical variables. A p value smaller than 0.05 was considered to be statistically different. Results Sixty-four (64/124, 51.6 %) patients sustained injuries from FFHs from a border wall or fence, whereas 60 (48.4 %) sustained injuries from FFHs at a domestic region including falls from roofs or scaffolds. Patients suffering from domestic falls had a higher ISS than border fence falls. The height of the falls was not significantly associated with injury severity, but rather the anatomic locations of injuries were associated with severity. Compared with border falls, domestic falls had more injuries to the head and chest and longer intensive care unit (ICU) stay. The MPNN showed that the factors leading to in-hospital mortality were chest injury followed by head injury and low GCS on admission. Conclusions Domestic vs. border FFHs yielded different injury patterns and injury severity. Patients of border falls sustained a lower ISS and more lower-extremity injuries, while domestic falls caused more head or chest injuries and low GCS on admission. MPNN analysis demonstrated that chest and head injuries with low GCS indicated a high risk of mortality from an FFH.

Volume of intraoperative normal saline versus lactated Ringer's solution on acute kidney injury: A secondary analysis of the SOLAR trial.

Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group. Secondary analysis of a single-center multiple cross-over cluster trial. Intraoperative care. We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution. Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution. The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0-1, 1-2, 3-4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24h. The risk of AKI did not differ significantly in patients given 0-1, 1-2, or 3-4L saline or lactated Ringers solutions. In contrast, patients given 2-3 or>4L of lactated Ringer's solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories. While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.

State-Level Helmet Use Laws, Helmet Use, and Head Injuries in EMS Patients Involved in Motorcycle Collisions

ABSTRACT OBJECTIVES Motorcycle helmets save lives and reduce serious injury after motorcycle collisions (MCC). In 2022, 18 states had laws requiring helmet use by motorcyclists aged ≥21 years. Our objective was to compare helmet use and head trauma in emergency medical services (EMS) patients involved in MCC in states with and without helmet use laws. METHODS We conducted an analysis of the 2022 ImageTrend Collaborate national EMS dataset. We included 9-1-1 responses where the patient was a motorcyclist in a transport accident (ICD-10 V20-V29) and aged ≥21 years. Patient demographics, incident urbanicity, helmet use, presence of state helmet use law, patient disposition, Glasgow Coma Scale (GCS) score, and trauma team activations were examined. Our primary outcome of interest was EMS documentation of helmet use (yes/no). Our secondary outcome was the presence of a head injury. We examined EMS-documented head injury, defined using clinician impressions and chief complaint anatomical location. Chi-square tests were used to assess differences in proportions, and a multivariable logistic regression model was used to estimate odds of moderate/severe head injury adjusted for covariates of interest. RESULTS A total of 15,891 patient encounters were included, 10,738 (67.6%) occurred in states without helmet use laws. States without helmet use laws had higher proportions of unhelmeted patients (56.8% vs 24.2%, p < 0.001), encounters in non-metro/rural areas (19.7% vs 13.3%, p < 0.001), and GCS-defined moderate/severe head injuries (4.6% vs 2.3%, p < 0.001). In a multivariable model that included 10-yr age groups, sex, race, urbanicity, and documented helmet use, the adjusted odds of moderate/severe head injury were lower for females (0.47, 95%CI, 0.35-0.65) and Black patients (0.47, 95%CI 0.32-0.70), and were higher for incidents in nonmetro/rural areas (1.58, 95%CI 1.28-1.95) and when EMS had not documented helmet use (3.17, 95%CI 2.56-3.92) CONCLUSIONS In this retrospective cross-sectional study, a higher proportion of patients involved in MCCs in states without helmet laws were not wearing helmets at the time of injury, and unhelemted patients had increased likelihood of sustaining a head injury. Emergency medical services agencies in states without helmet laws should prepare their systems and clinicians for an increased incidence of head injuries after MCCs.