Injured Body Region Research Articles

Tennis-Related Injuries Treated in United States Emergency Departments, 1990 to 2011

To analyze the patterns and causes of tennis-related injuries using, for the first time, a nationally representative data set. A retrospective cohort analysis was performed using the National Electronic Injury Surveillance System database. All tennis-related injuries treated in US emergency departments (EDs) from 1990 to 2011 were analyzed. During the study period, an estimated 492,002 (95% confidence interval, 364,668-619,336) individuals, aged 5 to 94 years, presented to US EDs for tennis-related injuries. Independent variables included patient age and gender, mechanism of injury, and location of injury event. Outcome variables included injury diagnosis, body region injured, disposition from ED, and involvement of the net. Most injuries were sustained by a nonspecific mechanism during play (37.9%) and occurred at a sport or recreation facility (83.4%). Children aged 5 to 18 years had a higher mean injury rate than adults older than 19 years. The most commonly injured body regions were the lower extremities (42.2%) and upper extremities (26.7%). Sprains or strains (44.1%) were the most common type of injury. The number of tennis-related injuries decreased by 41.4% during the years 1990 to 2011, and the tennis-related injury rates decreased by more than 45% during the study period. Among the 3.4% of patients who were admitted to the hospital, two-thirds (65.6%) involved patients 56 years of age or older. Despite the decrease in tennis-related injuries, the growing popularity of this sport warrants increased efforts to prevent injuries, especially among child and older adult participants.

Traumatic Injuries in Revue Dancers

Revue productions are a combination of dancing and singing, musical and spoken sequences, and acrobatics, performed with or without a story line, and characterized by a versatility of dance styles and a high number of performances (over 250 in a 10-month season). The aim of this quantitative single cohort study is to evaluate work-related traumatic injuries in this dance genre. Data were obtained from work accident reports of the German Social Accident Insurance Institution for the public sector in Berlin (UKB) involving 440 revue dancers (183 males and 257 females). Analysis was conducted with Excel 2007 and PASW Statistics 18. One out of three female dancers and one out of two male dancers sustained an acute injury in the course of a theatrical season (0.22 injuries per 1,000 hours). The incidence rate was 0.44 for males and 0.31 for females, with the lower extremity as the most commonly injured body region, followed by the spine. Of all occupational accidents, 75.1% happened on stage, with 69% during performances. The dance partner and dance floor were the most common exogenous factors resulting in a traumatic injury. Of all traumatic injuries, 81.7% occurred in the first 3 hours after starting work. Gender specific differences could be observed. Due to the limited availability of comparable studies of other forms of professional dance, in this study revue dance is largely considered as an independent genre.

Risk prediction score for death of traumatised and injured children.

BackgroundInjury prediction scores facilitate the development of clinical management protocols to decrease mortality. However, most of the previously developed scores are limited in scope and are non-specific for use in children. We aimed to develop and validate a risk prediction model of death for injured and Traumatised Thai children.MethodsOur cross-sectional study included 43,516 injured children from 34 emergency services. A risk prediction model was derived using a logistic regression analysis that included 15 predictors. Model performance was assessed using the concordance statistic (C-statistic) and the observed per expected (O/E) ratio. Internal validation of the model was performed using a 200-repetition bootstrap analysis.ResultsDeath occurred in 1.7% of the injured children (95% confidence interval [95% CI]: 1.57–1.82). Ten predictors (i.e., age, airway intervention, physical injury mechanism, three injured body regions, the Glasgow Coma Scale, and three vital signs) were significantly associated with death. The C-statistic and the O/E ratio were 0.938 (95% CI: 0.929–0.947) and 0.86 (95% CI: 0.70–1.02), respectively. The scoring scheme classified three risk stratifications with respective likelihood ratios of 1.26 (95% CI: 1.25–1.27), 2.45 (95% CI: 2.42–2.52), and 4.72 (95% CI: 4.57–4.88) for low, intermediate, and high risks of death. Internal validation showed good model performance (C-statistic = 0.938, 95% CI: 0.926–0.952) and a small calibration bias of 0.002 (95% CI: 0.0005–0.003).ConclusionsWe developed a simplified Thai pediatric injury death prediction score with satisfactory calibrated and discriminative performance in emergency room settings.

Long-Term Medical Consequences for Child Occupants 0 to 12 Years Injured in Car Crashes

Objective: There is limited knowledge of the long-term medical consequences for children injured in car crashes. Thus, in the event of injury, the aim of the study was to specify patterns and risks of injuries resulting in permanent medical impairment of children (0–12 years) for different body regions and injury severity levels, according to Abbreviated Injury Scale (AIS). The aim was also to compare the impairment outcome with adults. Methods: Data were obtained from the Folksam insurance company, including reported car crashes from 1998 to 2010 with at least one injured child 0–12 years of age. In all, 2619 injured children with 3704 reported medical diagnoses were identified. All injuries were classified according to the AIS 2005 revision. If the child had not recovered within 1 year postinjury an assessment of permanent medical impairment (PMI) was made by one or several medical specialists. Results: In all, 55 children sustained 59 injuries resulting in PMI of which 75 percent were at AIS 1 or AIS 2. The head and cervical spine were the body regions sustaining the most injuries resulting in PMI. Sixty-eight percent of all injuries resulting in PMI were AIS 1 injuries to the cervical spine, with the majority occurring in frontal or rear impacts. Given an injury to the cervical spine, the risk of injuries resulting in PMI was 3 percent, and older children (≥6 years) had a significantly higher risk (3% versus 1%) than younger children. The head was the second most commonly injured body region with injuries resulting in PMI (12/59), which were predominantly AIS 2+. In addition, mild traumatic brain injuries at AIS 1 were found to lead to PMI. Whereas for children the injuries leading to PMI were primarily limited to the head and cervical spine, adults sustained injuries that led to PMI from a more diverse distribution of body regions. Conclusion: The pattern of injuries resulting in permanent medical impairment is different for children and adults; therefore, safety priorities for children need to be based on child data. The majority of those injuries leading to PMI were at lower AIS levels. Furthermore, AIS 1 cervical spine and AIS 1+ head injuries should be given priority concerning mitigation of long-term consequences for children.

Association of head, thoracic and abdominal trauma with delayed diagnosis of co-existing injuries in critical trauma patients

BackgroundManagement of critically injured patients is usually complicated and challenging. A structured team approach with comprehensive survey is warranted. However, delayed diagnosis of co-existing injuries that are less severe or occult might still occur, despite a standard thorough approach coupled with advances in image intervention. Clinicians are easily distracted or occupied by the more obvious or threatening conditions. We hypothesised that the major area of injured body regions might contribute to this unwanted condition. MethodsA retrospective study of all trauma patients admitted to our surgical intensive care units (ICU) was performed to survey the incidence of delayed diagnosis of injury (DDI) and the association between main body region injured and possibility of DDI. Demographic data and main body regions injured were compared and statistically analysed between patients with and without DDI. ResultsDuring the two-year study period, a total 976 trauma patients admitted to our surgical ICU were included in this study. The incidence of DDI was 12.1% (118/976). Patients with DDI had higher percentages of thoracic, abdominal, and pelvic injuries (30.5%, 16.1%, and 7.6% respectively) than the non-DDI group (14.7%, 7.5%, and 3.0% respectively) (p<0.001, 0.003, and 0.024 respectively). A logistic regression model demonstrated that head (odds ratio=1.99; 95%CI=1.20–3.31), thoracic (odds ratio=2.44; 95%CI=1.55–3.86), and abdominal injuries (odds ratio=2.38; 95%CI=1.28–4.42) were independently associated with increasing DDI in patients admitted to the surgical ICU. DiscussionIn conclusion, critical trauma patients admitted to the surgical ICU with these categories of injuries were more likely to have DDI. Clinicians should pay more attention to patients admitted due to injuries in these regions. More detailed and dedicated secondary and tertiary surveys should be given, with more frequent and careful re-evaluation.

Pattern, severity and circumtances of injuries sustained in road traffic accidents: A tertiary care hospital-based study

Introduction:Expansion in road network, motorization, and urbanization in the country has been accompanied by a rise in road accidents leading to road traffic injuries (RTIs). Today RTIs are one of the leading causes of deaths, disabilities, and hospitalizations with severe socioeconomic costs across the world.Objectives:The following study analyses the: Age and sex distribution of injured in road traffic accidents (RTAs).Circumstances leading to RTA.Pattern and severity of injuries sustained in RTAs cases. Design:Retrospective record-based study.Materials and Methods:The aim of this study was to audit retrospectively the circumstances, severity, and pattern of injury sustained by vehicle occupants presenting to the Saraswathi Institute of Medical Sciences (SIMS) hospital Hapur, for a period of one year. Data were collected using the case sheets of 347 patients from the medical records section of hospital and analyzed using SPSS computer software version 16.0. Results are interpreted in terms of percentage, mean, chi-square, and z-test.Results:The pattern and severity of injuries sustained by 347 vehicle occupants admitted to the emergency department of SIMS, Hapur were retrospectively documented. Male victims 258 (74.35%) were more commonly involved than females 89 (25.65%) and majority of victims 141 (40.63%) were in age group of 20-30 years. Urban victims 222 (64.00%) outnumbered rural. The most frequently injured body regions were the extremities 499 (53.54%), followed by maxillofacial180(19.31%).. Out of total 802 external injuries, the most common type of injury was lacerations 307 (38.28%), abrasions 306 (38.15%)and followed by bruises 154 (19.20%). Multiple external injuries were more common on upper limb 216 (26.93%), lower limbs 210 (26.18%) and face 170 (21.20%), while crush injuries were more predominently seen in both the limbs. While laceration were common on face 120 (38.83%). Injuries to the chest 19 (2.36%), abdomen13 (1.61%), and spine 11 (1.36%) were seen in roughy equal proprotion of victims. The bones on right side 55 (55.55%) were more commonly fractured which is statistically significant. Skull injuries were mostly found on frontal 77 (47.53%), followed by parietal bone 33 (20.37%), mostly on right side. Conclusion: RTAs constitute a major public health problem in our setting. Urgent preventive measures targeting at reducing the occurrence of RTAs are necessary to reduce the morbidity and mortality resulting from these injuries.

Intentional injury patientsattending a Nigerian Accident and Emergency Department

Intentional injuries are a common presentation to Accident and Emergency (A&E) Departments and make a significant contribution to theglobal injury burden. This descriptive study aims to determine the pattern and treatment outcome of intentional injuries presenting to the A&E Department of Benue State University Teaching Hospital, Makurdi, Nigeria (BSUTH). Case records of all patients who presented to the A&E Department between July 2012 and December 2013 were analyzed for age, gender, circumstance surrounding injury, weapon used, body region injured, injury sustained, treatment offered, and outcome of treatment. Sixty patients with intentional injuries were included in the study. They consisted of 50 males (83.3%) and 10 females (16.7%) with ages ranging from 15 to 65 years with a modal age group of 20-29 years. The extremities were the most predominantly injured body regions (n=26, 43.3%) and firearms were the most common weapons employed (n=31, 51.7%). While armed robbery (n=31, 51.7%) was the most common reason for the injuries, attempted suicide (n=2, 3.3%) was the least.Soft tissue injuries and debridement were the most common injury type and treatment modality encountered respectively.The death rate was 8.3% with majority of deaths (80%) resulting from firearm injuries. Keywords: Intentional injury, violence, Accident and Emergency, Nigeria

The structure of trauma patients, its management and health care in the University Hospital of Alexandroupolis.

The present study was designed to describe the patterns of trauma patients using a newly-introduced trauma registry, as well as retrospectively assess the management and outcome facts of these patients. The study included 2346 patients (62.15% male) with a mean age of 34.06 +/- 23.77 years. Of these patients, 355 were multiple trauma patients. Privately owned vehicles were used as a mode of transportation for most of the trauma patients (96.65%). Data regarding patient demographics, arrival at the Emergency Department, mechanism of injury, injury severity, anatomical location and type of injury were collected and analyzed. Falls were the most prevalent mechanism of injury, accounting for 62.19% of the total admitted cases, with other causes (that also included occupational accidents and machinery trauma) being the second most prevalent, and MVAs--the third with a rate of 11.46%. The most commonly injured body regions were the extremities (50.26%), the head (42.50%), and the torso (19.39%). Fractures represented 11.46% of the injuries, while open wounds were much more frequent (29.41%). The mean abbreviated injury severity (AIS) score was 1.78 +/- 1.48 for all admitted patients and 3.56 +/- 1.02 for multiple trauma patients. A multi-disciplinary approach was required for 23% of the multiple trauma patients. The clinic admission rate for the whole patient sample was 13.55% and 48.96% for multiple trauma patients. The mean duration of stay for all clinic admissions was 2.7 days and 2.9 days for multiple trauma patients. With the epidemiology of trauma in Greece being rather poorly investigated, the present study manages to identify the major epidemiological patterns of trauma cases presenting to a tertiary regional hospital and addresses the need for development and implementation of injury prevention activities and policies.

Pediatric Shopping-Cart-Related Injuries Treated in US Emergency Departments, 1990-2011

This study investigates the effect of the 2004 US shopping cart safety standard on shopping-cart-related injuries among children younger than 15 years of age by retrospectively analyzing data from the National Electronic Injury Surveillance System. An estimated 530 494 children younger than 15 years were treated in US emergency departments for shopping-cart-related injuries from 1990 to 2011, averaging 24 113 children annually. The most commonly injured body region was the head (78.1%). The annual concussion/closed head injury rate per 10 000 children increased significantly (P < .001) by 213.3% from 0.64 in 1990 to 2.02 in 2011. Although a shopping cart safety standard was implemented in the United States in 2004, the overall number and rate of injuries associated with shopping carts have not decreased. In fact, the number and rate of concussions/closed head injuries have continued to climb. Increased prevention efforts are needed to address these injuries among children.

Correlation between hemodynamic stability and major trauma (ISS &gt;15)

Background The Injury Severity Score (ISS) is an anatomical scoring system that provides an overall score for patients with multiple injuries. Each injury is assigned an Abbreviated Injury Scale (AIS) score and is allocated to one of six body regions. Only the highest AIS score in each body region is used. The 3 most severely injured body regions have their score squared and added together to produce the ISS score. The ISS score is virtually the only anatomical scoring system in use and correlates linearly with mortality, morbidity, hospital stay and other measures of severity. Major trauma is commonly defined using an Injury Severity Score (ISS) threshold of 15. Patients with major trauma should be managed in major trauma centre for the best outcomes. ISS score is done retrospectively and therefore we were trying to find some basic observations, which we can relate to ISS. Objective: To evaluate the correlation between hemodynamic stability (SBP) and ISS score. Method We analysed the notes of last 329 patients, who met the criteria of major trauma. Settings: It was conducted at UHB, UK (level 1 trauma centre). Design: It is a retrospective study. Inclusion criteria: All adults, which triggered the major trauma tool. Exclusion: Patients with age less than 16 yrs. Results Total patients: 329. Systolic Blood pressure 15: 230 patients (69.9%). ISS score 9–15: 55 patients (16.7%). ISS score 15. Discussion Physiological parameters are always crucial in the initial assessment of the traumatized patients. They help us assessing the degree of shock but how well the correlate with the anatomical injuries isn’t very clear. Determining the extent of injury to a patient, either by physiological or anatomical parameters, is central to healthcare funding. Being able to estimate the severity with the help of different parameters on presentation can lead to even smooth journey of the patient. We can plan imaging, theatre or ITU beds etc. As in other studies systolic BP alone has weak correlation in predicting with trauma outcome. Our results are the same, systolic BP alone doesn’t seem to have a significant correlation with injury severity score and thus predicting trauma outcome. Thus proving the point that low systolic BP doesn’t always mean that it’s a severely injured patient.

Refining the trauma triage algorithm at an Australian major trauma centre: derivation and internal validation of a triage risk score.

To derive and internally validate a clinical prediction rule for trauma triage. Ambulance presentations requiring trauma team activation between 2007 and 2011 at a single inner city major trauma centre were analysed. The primary outcome was major trauma, defined as Injury Severity Score >15, intensive care unit admission or in-hospital death. Demographic details, vital signs on arrival at hospital, mechanism of injury and injured body regions were used in the modelling process. Multivariable logistic regression was used on a randomly selected derivation sample. Receiver operating characteristic (ROC) analysis and Hosmer-Lemeshow tests were used to assess the discrimination and calibration of the derived model. The model was further tested using bootstrapping cross-validation. A total of 3027 patients were identified. Predictors selected for the prediction model were age ≥65years (OR 1.58, 95%CI 1.08-2.32, p=0.02), abnormal vital signs (OR 3.72, 95%CI 2.64-5.25), Glasgow Coma Scale score ≤13 (OR 14, 95%CI 9.23-23.34 p<0.001), penetrating injury (OR 5.13, 95%CI 2.76-9.54, p<0.001), multiregion injury (OR 4.72 95%CI 3.45-6.46, p<0.001), falls (OR 1.51 95%CI 1.06-2.15, p=0.02) and motor vehicle crashes (OR 0.56, 95%CI 0.35-0.90, p=0.02). The ROC area under the curve (AUC) for the final model was 0.85 (95%CI 0.83-0.87) with a Hosmer-Lemeshow test statistic p=0.83. Bootstrapping cross-validation demonstrated an identical AUC. We have derived and internally validated a trauma risk prediction rule using trauma registry data. This may assist with the formulation of revised local and regional trauma triage protocols. External validation is required before implementation.

Pediatric and Youth Traffic-Collision Injuries in Al Ain, United Arab Emirates: A Prospective Study

AimTo study the mechanism of road traffic collisions (RTC), use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries.MethodsAll RTC injured children and youth (0–19-year-olds) who were admitted to Al Ain City’s two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed.Results245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37%) followed by front impact collision (32%). 32 (13%) of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170) vehicle passengers used seatbelts and 13% (3/23) motorcyclists a helmet.ConclusionsMale drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.

Comparison of Children and Youth Gymnastic Injuries Via Sport Medicine Federation Injury Surveillance System in Iran, 2009- 2010

The present study purposed to compare the sport injuries of child and youth gymnastic athletes via the data of Sport Medicine Federation Injury Surveillance System of Iran in 2009 and 2010. A retrospective analysis was conducted of the data for children and youth gymnastic athletes presented to the injury surveillance system in two years. Mann-Whitney U test was used with the significance level of p < 0.05. There was a significant difference between children and youth injuries (p = 0.001). Boys’ and girls’ injuries were significantly different (p = 0.034), however, it was not significant between men and women (p = 0.894). Upper extremity was the most frequently injured body region in all age and sex groups except men. Forearm, elbow and wrist were the most frequently injured body parts. As a results, children are more susceptible to injury i n gymnastic in Iran. Thus, they should be paid attention more in preventive programs and measures.

Characteristics of Injuries Sustained by Snowboarders in a Terrain Park

To determine injured body regions and injury type resulting from snowboarding on aerial and nonaerial terrain park features and the accuracy of ski patrol assessments compared with physician diagnoses. Case series study. An Alberta terrain park during the 2008-2009 and 2009-2010 seasons. There were 333 snowboarders injured on features (379 injuries). Aerial or nonaerial terrain park feature used at injury, injured body region, injury type, and additional risk factors were recorded from ski patrol Accident Report Forms, emergency department medical records, and telephone interviews. Odds of injury to body regions and injury types on aerial versus nonaerial features were calculated using multinomial logistic regression. Accuracy of ski patrol injury assessments was examined through sensitivity, specificity, and kappa (κ) statistics. The wrist was the most commonly injured body region (20%), and fracture was the most common injury type (36%). Compared with the upper extremity, the odds of head/neck [odds ratio (OR), 2.58; 95% confidence interval (CI), 1.37-4.85] and trunk (OR, 3.65; 95% CI, 1.68-7.95) injuries were significantly greater on aerial features. There was no significant association between aerial versus nonaerial feature and injury type. The accuracy of ski patrol injury assessment was higher for injured body region (κ = 0.65; 95% CI, 0.54-0.75) than for injury type (κ = 0.29; 95% CI, 0.22-0.37). Snowboarders were significantly more likely to sustain head/neck or trunk injuries than upper extremity injuries on aerial features. Investigators should acknowledge potential misclassification when using ski patrol injury assessments.

US Pediatric Injuries Involving Amusement Rides, 1990-2010

This study investigates pediatric injuries involving amusement rides treated in US emergency departments by retrospectively analyzing data from the National Electronic Injury Surveillance System. From 1990 to 2010, an estimated 92 885 children ≤17 years sought treatment in US hospital emergency departments for injuries involving amusement rides, yielding an annual average of 4423 injuries. The average annual injury rate was 6.24 injuries per 100 000 US children, and the mean patient age was 8.73 years. The head and neck was the most commonly injured body region (28.0%), and the most common type of injury was a soft tissue injury (29.4%). Falling in, on, off, or against the ride was the most frequent mechanism of injury (31.7%). Only 1.5% of injuries resulted in hospitalization. An improved national system for monitoring injuries involving amusement rides is needed. There are opportunities to improve the safety of amusement rides for children, especially to prevent injuries from falls.

Softball injuries treated in US EDs, 1994 to 2010

BackgroundSoftball is a popular participant sport in the United States. This study investigated the epidemiology of softball injuries with comparisons between children and adults. MethodsData from the National Electronic Injury Surveillance System for patients 7 years and older treated in an emergency department (ED) for a softball injury from 1994 through 2010 were analyzed. ResultsAn estimated 2107823 (95% confidence interval [CI], 1736417-2479229) patients were treated in US EDs for a softball injury during the 17-year study period. The annual number of injuries decreased by 23.0% from 1994 to 2010 (P < .001); however, during the last 6 years of the study, injuries increased by 11.7% (P = .008). The annual rate of softball injuries increased significantly during the study period (P = .035). The most commonly injured body regions were the hand/wrist (22.2%) and face (19.3%). Being hit by a ball was the most common mechanism of injury (52.4%) and accounted for most of face (89.6%) and head (75.7%) injuries. Injuries associated with running (relative risk, 2.36; 95% CI, 1.97-2.82) and diving for a ball (relative risk, 4.61; 95% CI, 3.50-6.09) were more likely to occur among adult than pediatric patients. ConclusionsTo our knowledge, this is the first study to investigate softball injuries using a nationally representative sample. Softball is a common source of injury among children and adults. Increased efforts are needed to promote safety measures, such as face guards, mouth guards, safety softballs, and break-away bases, to decrease these injuries.

White Paper: functionality and efficacy of wrist protectors in snowboarding—towards a harmonized international standard

The wrist is the most frequently injured body region among snowboarders. Studies have shown that the risk of sustaining a wrist injury can be reduced by wearing wrist protection. Currently, there are a wide variety of wrist protection products for snowboarding on the market that offer a range of protective features. However, there are no minimum performance standards for snowboarding wrist protectors worldwide. The International Society for Skiing Safety convened a task force to develop a White Paper to evaluate the importance and necessity of a minimum performance for all wrist protectors used in snowboarding. The White Paper outlines the need for a general framework for a harmonized international standard and reviews the existing evidence. Therefore, this White Paper may serve as a common base for future discussions. The broader goal of developing and implementing such a standard is to reduce the incidence and the severity of wrist injuries in snowboarding without increasing the risk of adverse events, such as upper arm or shoulder injury. The European standard for inline skating wrist protectors (EN 14120) can serve as a starting point for efforts related to a standard for snowboard wrist protectors, but certain modifications to the standard would be required. It is hypothesized that implementation of a snowboarding wrist protector standard would result in fewer and less severe wrist injuries in the sport and could translate into more riding days for healthy snowboarders and significant health-care costs savings.

Investigation of the Safety Effects of Knee Bolster Air Bag Deployment in Similar Real-World Crash Comparisons

Objective: The lower extremity is the most frequently injured body region and knee–thigh–hip (KTH) injuries account for half of these injuries. Knee bolster air bags (KBABs) have been incorporated in some vehicles to serve as an additional restraint for the occupant's knees and reduce KTH injuries. To investigate the safety benefits of KBABs, similar frontal crashes with opposing KBAB deployment were selected from the Crash Injury Research and Engineering Network (CIREN) database. Methods: An 8-point similarity scoring algorithm was used to quantify crash and occupant similarity and select case comparisons. A total of 183 cases without a KBAB were scored for similarity to 9 KBAB cases. These similarity scores were used to select 31 final case comparisons. The effect of KBAB deployment on occupant injury patterns was investigated with a particular focus on KTH injuries. Results: Over half of the occupants exposed to a KBAB sustained no KTH injuries and a reduction in femur fractures was observed in KBAB occupants (P = .036). However, increases in proximal tibia/fibula and foot/ankle fractures were observed in KBAB occupants (P = .022 and .002, respectively). Mildly significant decreases in pelvic fractures and Abbreviated Injury Scale (AIS) 2+ head injuries were observed in the KBAB occupants, supporting the notion that KBABs reduce forward occupant excursion (P = .094 and .055, respectively). Investigation of each case comparison yielded further insight into the reasons for injury pattern differences between cases with opposing KBAB deployment. In addition to KBAB deployment status, differences in occupant factors (age, height, and weight) and crash factors (delta V and belt use) between the cases for a particular comparison could explain variation in injury patterns. Conclusions: The current study presents a preliminary in-depth qualitative and quantitative assessment of KBAB safety benefits. However, further investigation is recommended to provide conclusive evidence of KBAB effectiveness.

Risk stratification by injury distribution in polytrauma patients -- does the clavicular fracture play a role?

BackgroundThoracic and extremity injuries are common in polytraumatized patients. The clavicle limits the upper thoracic cage and connects the body and upper extremities. It is easy to examine and is visible on standard emergency room radiographs. We hypothesize that clavicular fracture in polytrauma patients indicates the presence of further injuries of the upper extremities, head, neck and thorax.Material and methodsRetrospective study including patients admitted between 2008 and 2012 to a level-I trauma center. Inclusion criteria: ISS > 16, two or more injured body regions, clavicular fracture. Control group: patients admitted in 2011, ISS > 16, two or more injured body regions, no clavicular fracture. Patient information was obtained from the patients’ charts; evaluation of radiographic findings was performed; scoring was based on the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) AIS/ISS; data were analyzed using Pearson’s correlation and the Mann–Whitney U-test in SPSS (version 11.5.1); graphs were drawn using EXCEL®.ResultsThirty-four patients with clavicular fracture (C+) and 40 without (C-) were included; the mean ISS was 25 (range 16–57), m = 70%, f = 30%; age 43.3 years (range 9–88); clavicular fractures were positively correlated with severe thoracic (p = 0.011, OR 4.5: KI 1.3–15.3), external (p < 0.001, OR 9.2: KI 2.7–30.9) and upper extremity injuries (p < 0.001, OR 33.2: KI 6.9–16.04 resp. p = 0.004, OR 12.5: KI 1.5–102.9). C + showed a lower head/neck AIS (p = 0.033), higher thorax AIS (p = 0.04), arm/shoulder AIS (p = 0.001) and external AIS (0.003) than C-. Mean hospital stay and ICU treatment time were longer in the C + group (p = 0.001 and p = 0.025 respectively).ConclusionA clavicular fracture can be diagnosed easily and may be used as a pointer for further thoracic and upper extremity injuries in polytrauma patients that might have been otherwise missed. Special attention should be paid on second and tertiary survey.

THE ESTABLISHMENT OF SCHOOL BASED INJURY SURVEILLANCE SYSTEM IN JIANGSU, CHINA

BackgroundChild injuries have been a significant public health problem worldwide. Although information technology is becoming the backbone of all injury surveillance systems, many child injury data collections are resource intensive,...