Assessment Of Injury Research Articles

Studying Contact Replays: Investigating Mechanisms, Management and Game Exposures (SCRIMMAGE) for brain health in the Australasian National Rugby League: a protocol for a database design

Concussions in contact sports are challenging for athletes, health professionals and sporting bodies to prevent, detect and manage. Design of interventions for primary prevention, early recognition of concussion and continuing...

Comprehensive Assessment of Injuries in Patients with Supracondylar Fractures of the Humerus in Childhood and Adolescence

Comprehensive Assessment of Injuries in Patients with Supracondylar Fractures of the Humerus in Childhood and Adolescence

Understanding of head injury assessment and return to play processes and associated factors in United States Major League Rugby players

ABSTRACT Objectives Evaluate professional rugby players’ self-reported perceived understanding of the head injury assessment (HIA) and return to play (RTP) processes and determine factors related to understanding and trust pertaining to these processes. Methods An electronic survey measured concepts of interest. A thematic analysis of player understanding was performed, and player statements were coded. Results 207 U.S. Major League Rugby (MLR) players participated (26.7 ± 3.4 years). HIA and RTP protocol understanding was not correlated with concussion history (p = 0.41). International rugby experience and trust regarding MLR support of the following protocols and opposing team medical staff practices varied in their relationship to HIA understanding. Trust that all MLR teams follow the same protocols was positively correlated with all HIA questions (ps < 0.03). No HIA questions were correlated with trust in their own team’s medical staff. All trust questions were significantly correlated with RTP process understanding. Qualitative analysis identified four HIA- and RTP-related themes: education needs, staffing needs, HIA criticisms, and importance of player safety. Conclusion International playing experience and greater trust in the MLR and league stakeholders were associated with greater player understanding of the HIA and RTP protocols. These results provide insight into the importance of educating players on league-specific concussion protocols.

Retrospective Review of Falls in Medical Inpatients Following Introduction of a Falls Proforma at Wexford General Hospital

Abstract Background Inpatient falls are the largest category of preventable inpatient adverse events in hospitals coming at both great financial and safety cost to a healthcare system. Approximately 30% of inpatient falls result in injury, 4-6% resulting in serious injury with older patients have the highest risk of falling and injury. The aim of this retrospective audit cycle was to improve standards of falls assessments performed by junior doctors. Methods We initially conducted a retrospective review of 7 medical inpatient falls in July 2023. Standards were compared against NICE Guidelines on Assessment and Prevention of Falls in older people 2013 and NICE guidelines on Assessment and early management of head injury 2023. 15 key elements were analysed: doctor identifier, date and time, history of fall, confusion, pain, loss of consciousness, amnesia, seizure, vomiting, medication review, hip fracture, wrist fracture, skull fracture, Glasgow Coma Scale and neurological deficit. One point was given for each of the 15 key elements noted in the falls review. Following introduction of a falls proforma, we re-audited 18 falls in February 2024 to analyse differences in scores. Results Prior to proforma introduction, 7 falls reviewed had an average score of 3 points. 4 falls were reviewed by SHOs, 1 each by an SpR and Intern and 1 NCHD review was unidentifiable. Mean age was 72. Following proforma introduction, 18 falls in 13 patients were analysed. 2 patients did not have a falls review, 15 were reviewed by SHOs, 1 by an Intern. Average age was 81. Proforma was used in 7 cases with an average score of 12.7, and no proforma was used in 11 cases with an average score of 5. Conclusion These findings demonstrate improved quality of falls reviews using proformas in line with guidelines compared to those without. More education is needed to incorporate proformas into standard practice.

Incidence, characteristics and risk factors of endotracheal tube-related pressure injuries in intensive care units.

Medical devices commonly used for the treatment and care of critically ill patients can cause pressure injuries in intensive care units (ICUs). The endotracheal tube (ETT) is one of the most common medical devices to cause pressure injuries. This study investigated the incidence of, characteristics of and risk factors for ETT-related pressure injuries for ICU patients. This study adopted a prospective descriptive research design. The sample consisted of 146 endotracheally intubated patients. Data were collected using a patient information form, an Endotracheal Tube-Related Pressure Injuries Assessment Form, the Braden Risk Assessment Tool and the Nutritional Assessment Test. The study revealed that 80.14% of the patients developed ETT-related pressure injuries. Over half of the ETT-related pressure injuries appeared on Day 3 or 4 (56.41%). High body mass index was found to be associated with the development of ETT-related pressure injuries (OR: 1.15, 95% CI: 1.05-1.26, p = .003). None of the other variables were statistically significant in the development of pressure injuries. The incidence of ETT-related pressure injuries was quite high in the internal, surgical and anaesthesia ICUs. High body mass index was associated with the development of ETT-related pressure injuries. Intensive care nurses should implement interventions to prevent ETT-related pressure injuries in critically ill patients receiving mechanical ventilation support. ETT-related pressure injuries are common in ICU patients. High body mass index was associated with the development of ETT-related pressure injuries in critically ill patients. The skin and mucosa should be assessed for the development of ETT-related pressure injuries during the daily assessment of the patients receiving mechanical ventilation support. The ETT should be repositioned regularly, and the most suitable ETT fixation method should be used.

Clinical Assessment and Management of Acute Spinal Cord Injury.

The information contained in this article is suitable for clinicians practicing in the United States desiring a general overview of the assessment and management of spinal cord injury (SCI), focusing on initial care, assessment, acute management, complications, prognostication, and future research directions. SCI presents significant challenges, affecting patients physically, emotionally, and financially, with variable recovery outcomes ranging from full functionality to lifelong dependence on caregivers. Initial care aims to minimize secondary injury through thorough neurological evaluations and imaging studies to assess the severity of the injury. Acute management prioritizes stabilizing respiratory and cardiovascular functions and maintaining proper spinal cord perfusion. Patients with unstable or progressive neurological decline benefit from timely surgical intervention to optimize neurological recovery. Subacute management focuses on addressing common complications affecting the respiratory, gastrointestinal, and genitourinary systems, emphasizing a holistic, multidisciplinary approach. Prognostication is currently based on neurological assessments and imaging findings, but emerging biomarkers offer the potential to refine outcome predictions further. Additionally, novel therapeutic interventions, such as hypothermia therapy and neuroprotective medications are being explored to mitigate secondary damage and enhance recovery. This paper serves as a high-yield refresher for clinicians for the assessment and management of acute spinal cord injury during index admission.

Assessment of acute radial artery injury after distal transradial access for coronary intervention: an optical coherence tomography study.

There is a paucity of data on acute radial artery (RA) injuries using optical coherence tomography (OCT) in patients undergoing coronary intervention via distal transradial coronary access (dTRA). To evaluate the incidence of acute RA injury following dTRA for coronary intervention using OCT. We retrospectively analyzed 200 consecutive patients with acute coronary syndrome (ACS) who underwent coronary intervention guided by OCT and RA-OCT after dTRA at our center between June 2021 and November 2022. Total length of RA was divided into three segments based on the sheath location during dTRA: no sheath protection portion (proximal RA segment) and sheath protection portion (divided into mid- and distal segments). Acute RA injuries, including tears, dissections, perforations, thrombi, and spasms, were analyzed. Radial artery occlusion (RAO) was assessed using ultrasonography 24h after dTRA. Acute RA injury was observed in 45.5% of patients after dTRA. The incidence of tear, dissection, perforation, thrombi, and spasm in all the patients was 11.5%, 16.5%, 1.5%, 17.5%, and 17.5%, respectively. In segment-level analysis, dissection and spasm were significantly more frequent in the proximal segment, followed by the mid and distal segments (11.0% vs. 5.5% vs. 4.5%, P = 0.015; 13.0% vs. 4.0% vs. 4.5%, P = 0.002). The rate of RAO at 24-h follow-up was 3.0%. Acute RA injuries were observed in nearly half of the patients using OCT via dTRA; dissection and spasm occurred more frequently in the proximal segment. Hydrophilic-coated sheaths have the potential advantage of preventing radial artery spasm and dissection.

Contrast-enhanced Ultrasound as a Method of Splenic Injury Assessment

Abstract Splenic injuries are common in abdominal trauma, as the spleen is one of the most often harmed organs. The treatment of splenic injuries underwent major changes during the past decades, shifting from a surgical approach to nonoperative management. This change of the proceedings results from a constantly growing awareness of the spleen’s crucial hematological and immunological function and was possible owing to the advances in radiological techniques. In a setting of high-energy trauma in hemodynamically stable patients, computed tomography (CT) remains the gold standard. Where ultrasonography (US) is of major importance is in cases of unstable patients undergone high-energy trauma or in patients after low-energy trauma. Nevertheless, baseline US’s sensitivity is not sufficient to detect splenic traumatic injuries; hence, a new method was developed involving ultrasound contrast agents (UCAs), called contrast-enhanced ultrasound (CEUS). In a low-energy trauma setting, it facilitates the diagnosis of abdominal lesions with a sensitivity close to that of CT, without the disadvantages of the latter. In addition, CEUS can be used in the follow-up of abdominal traumatic injuries. The fact that CEUS preserves CT’s sensitivity while not carrying the risk of radiation-induced cancer makes it feasible for children and pregnant women. This review aims to discuss the technical aspects of CEUS, the limitations, and possibilities regarding this modality, present the appearance of both a healthy and injured spleen, and compare CEUS’s effectiveness to that of CT through an analysis of retrievable studies.

Assessing head injury risks in electric scooter accidents: A multi-body simulation study with insights into sex differences

E-scooters have become increasingly popular for short-distance travel in urban areas, but this rise in usage also brings about an increased risk of accidents. Studies have shown that approximately 40% of electric scooter accident victims admitted to hospitals suffer head injuries. Therefore, it is crucial to implement safety measures and improve safety systems and equipment to mitigate these risks. One approach to gaining insights into the injuries users face is through simulations using the multi-body method. This method allows for the reconstruction of accidents by modeling and analyzing the dynamic behavior of interconnected bodies. This study aims to assess the impacts on the user’s head and the injuries they may sustain in electric scooter accidents using numerical methods. Initially, a reference scenario was established based on a YouTube video, with the assumption that the user was an average-height man. Simulations were conducted for various percentiles, including both males and females. Different velocities were simulated to determine the threshold velocity at which survival becomes practically impossible. Two scenarios were considered: one where the car braked for 0.333 s and another where the distance between the start the braking task and the collision was kept constant. The location of the first head impact on the vehicle was also examined. Injury assessment was conducted using two criteria: Head Injury Criterion (HIC) and Brain Injury Criterion (BrIC). The study found that smaller individuals are more vulnerable to severe injuries, and higher car velocities correlate with more severe user injuries. Furthermore, the location of the first impact varies between genders, with women more likely to experience impacts in the lower part of the windshield, while men tend to experience impacts in the central zone. This study highlights the importance of considering user characteristics and accident dynamics in assessing injury risks associated with e-scooters.

B - 52 A Pilot Study for the Responsible Concussion Commentary Checklist: Evaluating Commentary of Head Injury Assessment in the Australian National Rugby League

Abstract Objective Focus on sport-related concussion has increased due to growing concerns regarding the long-term effects of repeated concussion. To improve player safety, some sports have adopted new injury assessment and management protocols. These efforts may be undercut by the live media coverage of concussion, which is known to downplay concussion. This pilot study explored how live sports commentary from the Australian National Rugby League portrays concussion in the context of the newly introduced Head Injury Assessment (HIA) protocol. Method 15 concussions were randomly selected from the 69 HIA-tiggering events from rounds 1 to 8 of the 2024 season. The live commentary for those events was evaluated using a concussion commentary checklist. This multi-item checklist was developed from existing recommendations for the responsible reporting of concussion. The checklist evaluated the extent to which the commentary met the gold standard requirements (e.g., used the correct injury terminology) and yielded an overall impression score (commentary quality). Results Impression ratings revealed that the commentary was rarely scored as high quality, indicating that it did not meet the gold standard expected for accurate and responsible commentary of on field instances of suspected concussion. The scores for the individual checklist items were also frequently low. Commonly identified issues included the use of incorrect injury terminology and injury minimisation. Conclusion This pilot study showed that the live commentary of suspected concussion was poor. The findings have implications for concussion awareness through changed practices in live sports commentary. Commentary guidance is needed to prevent the spread of misinformation about concussion among sport spectators.

In vitro assessment of vascular injury following stent retriever retraction in clinically-relevant endothelialized silicone models.

Mechanical thrombectomy devices have potential to injure the vessel during treatment of acute ischemic stroke. The goal of the current work was to tailor in vitro endothelialized silicone models for stent retriever assessment and to evaluate endothelial injury following treatment by various stent retriever designs and sizes. Clinically-relevant neurovascular geometries were first modeled out of silicone, then sterilized, coated with fibronectin, placed in bioreactors, seeded with human endothelial cells, and cultivated under flow. Several sizes of two different commercially available stent retrievers were then deployed in, and retracted through, vessels. Vessels were immediately harvested and stained. Endothelial injury, identified as denudation, was quantified using ImageJ. Results illustrated that endothelial injury ranged from 16-18% in wire/microcatheter-only treated vessels, 37-61% in 1-pass treatments, and 52-70% in 2-pass treatments. Overall this work showcases an in vitro approach for early stage assessment of the extent and location of vascular injury following stent retriever retraction.

ECHO OEM virtual community of learning for primary care.

Health issues caused and/or exacerbated by work are common in patients seeking primary health care. Yet, primary care providers generally receive little or no training in the assessment and management of occupational injuries and illnesses. To conduct a pilot project to develop, implement and evaluate a programme to teach occupational and environmental medicine to primary healthcare providers. We followed the Extensions for Community Healthcare Outcomes (ECHO) model to connect primary healthcare providers with experts in Occupational and Environmental Medicine (OEM). We employed an observational pre-post study design to assess changes in self-efficacy, knowledge, attitudes and beliefs towards OEM. From September 2021 to June 2022, we offered two cycles of 12 sessions each. Participants came from medicine, nursing, psychology, occupational and physical therapy, chiropractic, kinesiology, social work, and pharmacy. Sixty-seven participants completed both pre- and post-ECHO questionnaires. Self-efficacy and knowledge ratings significantly increased after attendance at ECHO compared to the pre-ECHO responses. Attitudes and beliefs were unchanged in most of the items assessed. Participants rated their satisfaction with ECHO between 59% and 97%. Our pilot study demonstrated the challenges in implementing the first ECHO OEM in Canada. Findings show acceptability and satisfaction, improved self-efficacy, and small increases in knowledge, but not overall attitudes and beliefs. There is a need to understand barriers to participation and to target participants with less knowledge and experience in occupational and environmental medicine.

ПОСЛЕОПЕРАЦИОННОЕ СНИЖЕНИЕ СКОРОСТИ КЛУБОЧКОВОЙ ФИЛЬТРАЦИИ В ПРОЦЕНТАХ КАК МАРКЕР ОЦЕНКИ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧКИ И ПРЕДИКТОР ДОЛГОСРОЧНЫХ ФУНКЦИОНАЛЬНЫХ РЕЗУЛЬТАТОВ ЕЕ РЕЗЕКЦИИ

The existing criteria of acute kidney injury assessment fail to identify kidney parenchyma damage of small severity and predict long-term outcomes of its resection. The aim of the research was to assess percentage reduction of glomerular filtration rate as a marker for acute kidney injury and functional outcome one year after surgery

Injury Assessment of Pedestrians, Bicyclists, and Motorcyclists Utilizing Linkage of Police-Reported Crash Data to EMS Data in Michigan

In Michigan, police crash reports are the primary source of data on traffic crashes. Though many aspects are very reliable, some details are difficult to observe or require subjective judgement. Injury severity, which is central to the road safety issue, unfortunately falls into the second category. The KABCO injury scale used by law enforcement classifies injuries as “possible,” “suspected minor,” and “suspected serious” which may not correspond to determinations made by medical professionals. EMS records can provide a means to improve crash injury data using medical evaluations, but these records are not linked to the police reports. This project explores the linkage of police crash reports and EMS records using both Michigan data sources from 2018 to 2021. Given the association between severity of injuries and person type, three crash subsets with high injury risk were the focus: pedestrians, bicyclists, and motorcyclists. Collectively, these person types represent 25.1% of the police reported fatalities and suspected serious injuries in Michigan in 2022 despite being only 1.2% of the crashing population. Person-level records for pedestrians, bicyclists, and motorcyclists were identified and divided into three separate datasets for each data source. EMS data events were restricted cases believed to be associated with traffic crashes using ICD-10 injury codes. Personal identifiers were not provided, so probabilistic linkage was used to link person crash records to EMS records. Event date, location, ambulance ID, and person demographic variables were utilized. Linkage rates and injury severity agreement was computed to assess differences between the two datasets.

Microfluidic point-of-care testing device for multiplexed detection of liver function blood markers.

In this work, we developed a novel microfluidic paper-based analytical device to quantify the blood markers of liver function from human fingertips and whole blood samples. The device can quickly acquire information for screening liver injury and supporting clinical decision-making by simultaneously performing quantitative tests for alanine aminotransferase, aspartate aminotransferase, and albumin. We evaluated the detection accuracy and the storage stability of the device using fingertip samples. The yielded results of our device correlated well with those from Mindray BS350s, even under the conditions of 35 °C and 90%RH. Thus, it offers an effective platform for clinical assessment of liver injury particularly in resource-limited areas.

Comparison of efficacy and safety of different suction pressure for speeding non-ventilated lung collapse in uniport video-assisted thoracoscopic surgery: a randomized-controlled trial

BackgroundThe bronchial suction has been applied in speeding lung collapse. Low suction pressure may not speed lung collapse, but high pressure causes occult lung injury. The aim of the study was to explore efficacy and safety of different suction pressure for speeding lung collapse.MethodsEighty-four subjects undergoing uniport video-assisted thoracoscopic surgery (VATS) were randomly assigned for non-suction (Group 0), -10 cmH2O suction pressure (Group − 10), and − 30 cmH2O suction pressure (Group − 30). The primary outcome were the lung collapse scores (LCS) at 0 min (T0) after the visualization of the lung using a 10-point visual analogue scale and area under the curve (AUC) of LCS over time. The secondary outcomes included disconnection from the ventilator, the assessment of occult lung injury using NOS-3 expression, histologic scores of lung injury, and lung W/D weight ratio, intraoperative hypoxemia, the incidence of perioperative pulmonary complications.ResultsBoth the LCS at T0 and AUC analysis showed that compared with Group 0, Group − 10 and Group − 30 significantly achieved good lung collapse (P < 0.05), but no difference between Group − 10 and Group − 30. Four patients in Group 0 were treated with disconnection maneuver. The assessment of occult lung injury showed no differences.ConclusionsApplying − 10 cmH2O suction pressure for 1 min when pleural incision is a relatively safe method to promote lung collapse without the occurrence of occult lung injury.Trial registrationChinese Clinical Trial Registry number, ChiCTR2200062991. Registered on 26/08/2022.

Quantitative assessment of chlorine gas inhalation injury based on endoscopic OCT and spectral encoded interferometric microscope imaging with deep learning.

Chlorine exposure can cause severe airway injuries. While the acute effects of chlorine inhalation are well-documented, the structural changes resulting from the post-acute, high-level chlorine exposure remain less understood. Airway sloughing is one of the standards for doctors to evaluate the lung function. Here, we report the application of a high-resolution swept-source optical coherence tomography system to investigate the progression of injury based on airway sloughing evaluation in a chlorine inhalation rabbit model. This system employs a 1.2mm diameter flexible fiberoptic endoscopic probe via an endotracheal tube to capture in vivo large airway anatomical changes before and as early as 30minafter acute chlorine exposure. We conducted an animal study using New Zealand white rabbits exposed to acute chlorine gas (800 ppm, 6min) during ventilation and monitored them using optical coherence tomography (OCT) for 6h. To measure the volume of airway sloughing induced by chlorine gas, we utilized deep learning for the segmentation task on OCT images. The results showed that the volume of chlorine induced epithelial sloughing on rabbit tracheal walls initially increased, peaked around 30min, and then decreased. Furthermore, we utilized a spectral encoded interferometric microscopy system to study ex vivo airway cilia beating dynamics based on Doppler shift, aiding in elucidating how chlorine gas affects cilia beating function. Cilia movability and beating frequency were decreased because of the epithelium damage. This quantitative approach has the potential to enhance the diagnosis and monitoring of injuries from toxic gas inhalation and to evaluate the efficacy of antidote treatments for these injuries.

Quantitative assessment of rotator cuff injuries using synthetic MRI and IDEAL-IQ imaging techniques

PurposeTo evaluate synthetic magnetic resonance imaging (SyMRI) and iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL-IQ) imaging for a comprehensive evaluation of rotator cuff injuries (RCI). MethodsNinety-seven patients with RCI were classified into four groups based on the arthroscopic results: (grade II), partial tear (grade III), complete tear (grade IV), and controls (grade I). T1 (Transverse Relaxation Time 1), T2 (Transverse Relaxation Time 2), proton density (PD), and fat fraction (FF) were evaluated using SyMRI and IDEAL-IQ. Measurement reliability was assessed using intraclass correlation coefficients (ICC). The diagnostic potential for grading RCI was evaluated using ordinal regression and ROC analyses. ResultsA high measurement reliability (ICC > 0.7) was observed across subregions. T1 and T2 significantly varied across grades, particularly T2 in the lateral subregion between grades III and IV (P < 0.001) and the central subregion between grades II and III (P < 0.001). ROC analyses yielded valuable diagnostic accuracy, including T2 in the lateral subregion with an AUC of 0.891, distinguishing grade I from grade IV. Positive correlations were found between T2 values in specific shoulder subregions and injury grade (r = 0.615 for lateral, r = 0.542 for medial, both P < 0.001). In grade IV, FF was notably increased in the supraspinatus, infraspinatus, and subscapularis muscles compared with grades I-III. There were no significant FF variations in the teres minor muscle among grades. ConclusionsQuantitative MRI parameters from SyMRI and IDEAL-IQ, especially T2 and FF, may classify and assess RCI severity. The results could help improve the accuracy of diagnosing different grades of RCI, offering clinicians additional tools for improving patient outcomes through personalized medicine.

‘Their role has a lot of purpose beyond being just being about exercises’: a qualitative study of patients’ experiences of physiotherapy following a mild traumatic brain injury

Following a mild traumatic brain injury (mTBI; also known as concussion), physiotherapists may be involved in injury identification, assessment and rehabilitation. However, how people perceive and experience the physiotherapist’s role...

Multiparametric MRI based assessment of kidney injury in a mouse model of ischemia reperfusion injury

Kidney diseases pose a global healthcare burden, with millions requiring renal replacement therapy. Ischemia/reperfusion injury (IRI) is a common pathology of acute kidney injury, causing hypoxia and subsequent inflammation-induced kidney damage. Accurate detection of acute kidney injury due to IRI is crucial for timely intervention. We used longitudinal, multi-parametric magnetic resonance imaging (MRI) employing arterial spin labelling (ASL), diffusion weighted imaging (DWI), and dynamic contrast enhanced (DCE)-MRI to assess IRI induced changes in both the injured and healthy contralateral kidney, in a unilateral IRI mouse model (n = 9). Multi-parametric MRI demonstrated significant differences in kidney volume (p = 0.001), blood flow (p = 0.002), filtration coefficient (p = 0.038), glomerular filtration rate (p = 0.005) and apparent diffusion coefficient (p = 0.048) between the injured kidney and contralateral kidney on day 1 post-IRI surgery. Identification of the injured kidney using principal component analysis including most of the imaging parameters demonstrated an area under the curve (AUC) of 0.97. These results point to the utility of multi-parametric MRI in early detection of IRI-induced kidney damage suggesting that the combination of various MRI parameters may be suitable for monitoring the extent of injury in this model.