Motor Vehicle Accident Injury Research Articles

Asphyxialdeath due to fracture of thyroid cartilage, cricoid cartilage and arytenoid cartilage as result of blunt trauma of neck in a motorcycle accident:An Autopsy report

Laryngeal fracture is rare but fatal traumatic injury which is mainly caused by severe blunt trauma from interpersonal violence, motor vehicle accident or sports injuries. Laryngeal fracture can lead to severe airway collapse and death.Mortality decreases to less than 5% once the airways made patent and laryngeal injuries are corrected.People must take motorcycle riding safety course to learn how to ride safely. Always follow traffic rules. The motor vehicle accident can be prevented largely through public awareness and education

TIBIAL DIAPHYSEAL FRACTURE, PANORAMIC REVISION

Introduction: Tibial fractures are quite common injuries. Since the tibia has a subcutaneous location, it is more likely to show exposed fractures. Exposed fractures of the tibial diaphysis are serious injuries that can result in significant long-term disability if not managed correctly. Objective: to detail current information related to tibial diaphysis fractures, etiology, epidemiology, anamnesis, physical examination, assessment, treatment, differential diagnosis, prognosis and complications. Methodology: a total of 29 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 17 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: tibia fractures, osteosynthesis, tibia fracture, intramedullary nails, leg trauma, exposed fractures. Results: tibial diaphysis fractures present an incidence of 16.9 per 100,000 individuals per year, being more common in the male sex, with 21.5 per 100,000 individuals per year, compared to 12.3 per 100,000 in the female sex. The most common triggers in males of tibial diaphysis fractures are motor vehicle accident injuries and sports. Conclusions: It is important to recognize the management of tibial fractures since they have a relatively high incidence. It is not uncommon to encounter an exposed tibial diaphysis fracture, so it is essential to identify, as well as perform damage control and appropriate management. The individual should undergo a complete examination and it may be necessary to implement the trauma life support protocol. In this type of fracture it is crucial to assess the neurovascular situation. In addition, complementary examinations should be requested to allow the best diagnosis, classification and treatment of the injuries. The treatment of tibia diaphysis fractures will depend on the specific situation and the patient's condition; however, external fixators are usually used for damage control and later intramedullary nails are used. Tibial diaphysis fractures may be accompanied by compartment syndrome and other complications. KEY WORDS: trauma, fractures, tibia, treatment.

Benefit-cost analysis for signalised pedestrian crossing implementation in Jakarta, Indonesia

To create a sustainable, safe, and dynamic transportation system, it is crucial to prioritize pedestrian safety. Pedestrians are considered vulnerable road users, and the severity of their injuries in motor vehicle accidents is relatively high. This study aims to evaluate the cost benefits by comparing the estimated reduction in accident losses with the costs incurred for improving crossing facilities using pelican crossings. The average accident loss is calculated in areas with crosswalks, along with the investment costs for enhancing pedestrian facilities by adding signals. From this, the benefits of reducing accident losses due to improved pedestrian facilities can be estimated. In the Polda Metro Jaya (PMJ) jurisdiction, the average accident loss at locations with zebra crossings is IDR 144,988,136, while the measurement cost based on the Transportation Agency's work plan is IDR 175,000,000. The benefit-cost analysis yields a ratio of 0.207, indicating that enhancing pedestrian crossing safety will provide long-term benefits.

Dementia increases risk of organ failure and hospital mortality of motorcycle crash‐related hospitalizations in Taiwan: A nationwide population‐based study

AbstractBackgroundPrior studies showed dementia is associated with the increased risk of injuries in motorcycle crashes, especially in young onset dementia. However, little is known about the effect of young onset dementia on the risk of organ failure and hospital mortality of motorcycle crash‐related hospitalizations. This study describes the prevalence of organ failure and hospital mortality of motorcycle crash‐related hospitalizations among patients with and without dementia and assesses whether dementia is at higher risk of organ failure and hospital mortality of motorcycle crash‐related hospitalizations.MethodIn this population‐based cohort study, we compared patients with dementia aged 40‐64 years and its age‐ and sex‐ matched participants without dementia when they had the first hospitalization for motor vehicle accident injury (MVAI). Data in this study were obtained from the Taiwan National Health Insurance Research Database entries and Taiwan Police‐reported Traffic Accident Registry between 2006 and 2015. Major outcomes were development of organ failure and hospital mortality in motorcycle crash‐related hospitalizations. Logistic regression with generalized estimating equations were performed to account for hospital clustering effect.ResultIn patients with dementia, the prevalence rates of organ failure and hospital mortality was 6.88% and 4.44%, respectively, which were higher than participants without dementia (3.08% and 2.07%). After adjustment of potential confounders, patients with dementia had a 91% higher risk (95%CI 1.45‐2.51) of organ failure of motorcycle crash‐related hospitalizations than patients without dementia, especially those with respiratory organ failure (adjusted odds ratio [OR]1.96, 95%CI 1.46‐2.63). Similarity, patients with dementia were related with increased risk of hospital mortality (adjusted OR 1.39, 95%CI 1.01‐1.93).ConclusionIn motorcycle crash‐related hospitalizations, the presence of dementia may rise the risk of organ failure and hospital mortality, which warrants the concerns of healthcare providers.

Dementia increases medical costs and length of hospital stay of motorcycle crash‐related hospitalizations: A nationwide population‐based cohort study in Taiwan

AbstractBackgroundPrior studies showed dementia had a higher risk of hospitalization for a motor vehicle accident injury than the general population. However, the effect of dementia on the medical cost and length of inpatient days of motorcycle crash‐related hospitalizations still unknown. This study describes the total amount of medial cost and length of inpatient days for motorcycle crash‐related hospitalizations among patients with and without dementia and assesses whether dementia is related to a higher medical cost and length of inpatient days for motorcycle crash‐related hospitalizations.MethodThis was a population‐based, retrospective cohort study. Dementia aged 40‐64 and its age‐ and sex‐ matched participants without dementia were identified when they had the first hospitalization for MVAI. Data were obtained from the Taiwan National Health Insurance Research Database entries and Taiwan Police‐reported Traffic Accident Registry between 2006 and 2015. Linear regression with generalized estimating equations were applied to compare the medical cost and length of inpatient days of people with and without dementia.ResultOver the 10‐year follow‐up periods, the mean medical expenses related to the first hospitalization for MVAI among patient with and without dementia was NTD $ 81207±136647 and NTD $ 58947±135543, respectively, with a difference in log10 average inpatient costs of NTD $ 0.082 (95%CI 0.054‐0.110). Additionally, compared to patients without dementia, patients with dementia were significantly related to a longer inpatient stay due to the first hospitalization for MVAI (11.6±15.9 vs. 9.0±32.3 days), with a difference in log10 average inpatient days of 0.054 days (95%CI 0.029‐0.078).ConclusionIn motorcycle crash‐related hospitalizations, dementia was associated with higher medical cost and longer length of inpatient stay than those for patients without dementia.

Predictors of Surgical Versus Medical Management of Eyes in the Setting of Orbital Fracture at an Academic Level I Trauma Center.

We present clinical and imaging predictors of ocular injuries that required medical management versus surgical intervention in cases of orbital fractures. From 2014 to 2020, a retrospective review of patients with orbital fractures who received ophthalmologic consultation and computed scan (CT) analysis at a level I trauma center was performed. Inclusion criteria were patients with confirmed orbital fracture on CT and ophthalmology consultation. Patient demographics, associated injuries, comorbidities, management, and outcomes were collected. Two hundred and one patients and 224 eyes (11.4% bilateral orbital fractures) were included. Overall, 21.9% of orbital fractures presented with a significant concomitant ocular injury. Associated facial fractures were present in 68.8% of eyes. Management included surgical treatment in 33.5% of eyes and ophthalmology-directed medical treatment in 17.4%. On multivariate analysis, clinical predictors of surgical intervention were retinal hemorrhage (OR=4.7 (1.0-21.0), P =0.0437), motor vehicle accident injury (OR=2.7 (1.4-5.1), P =0.0030) and diplopia (OR=2.8 (1.5-5.3), P =0.0011). Imaging predictors of surgical intervention were herniation of orbital contents (OR=2.1 (1.1-4.0), P =0.0281) and multiple wall fractures (OR=1.9 (1.01-3.6), P =0.0450). Predictors of medical management were corneal abrasion (OR=7.7 (1.9-31.4), P =0.0041), periorbital laceration (OR=5.7 (2.1-15.6), P =0.0006), and traumatic iritis (OR=4.7 (1.1-20.3), P =0.0444). We demonstrated a 22% incidence of concomitant ocular trauma in orbital fracture patients at our level I trauma center. Predictors of the surgical intervention included multiple wall fractures, herniation of orbital contents, retinal hemorrhage, diplopia, and motor vehicle accident injury. These findings emphasize the importance of a multidisciplinary team in managing ocular and facial trauma.

Bilateral Lower Extremity Injuries in Pedestrian vs Motor Vehicle Accidents

Shah, Jason MD; Aspang, Jesse Seilern und; Baker, J’Lynn L; Shukla, Krunal; Marvin, David BS; Moore, Thomas Jr MD Author Information

Profiles of TBI Injury Severity as Predictors of Functional Outcomes and Well-being Outcomes

<h3>Research Objectives</h3> To identify profiles of traumatic brain injury (TBI) severity and relate profiles to functional and well-being outcomes. <h3>Design</h3> Longitudinal observational study with assessments during acute rehabilitation, discharge, and one year after injury. <h3>Setting</h3> Santa Clara Valley Medical Center (SCVMC) acute inpatient rehabilitation and general community setting. <h3>Participants</h3> Three hundred and seventy-nine individuals [76.8% male; mean(std) age=34.6(16.9) years] in the Traumatic Brain Injury Model Systems at SCVMC with head computed tomography (CT) data. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> At discharge- length of stay, Functional Independence Measure (FIM), and Disability Rating Scale (DRS). One-year post-injury- Glasgow Outcome Scale (GOS), FIM, and Satisfaction with Life Scale (SWLS). <h3>Results</h3> Reults: Latent profile analysis (LPA) was used to identify subgroups with similar patterns across 12 indicators of injury severity, including duration of post-traumatic amnesia, Glasgow Coma Scale, time to follow commands, and head CT variables. LPA identified four latent classes: Class1 (least severe; N=75), Class2 (intermediate; N=124), Class3 (moderate; N=144), and Class4 (most severe; N=27). Younger age, lower education, rural residence, injury in motor vehicle accidents, and earlier injury years were associated with worse severity (ps <.05). Latent classes were related to outcomes. Compared to Class1, hospital stays were longer, FIM scores lower, and DRS scores larger at discharge among individuals in Class3 and Class4 (all ps < .01). One-year post-injury, GOS and FIM scores were significantly lower in Class3 and Class4 than Class1 (ps <.01). FIM scores were also lower among individuals in Class2, compared to Class1 (p=.015). SWLS scores were lower only among individuals in Class3 (p=.036); other comparisons relative to Class1 were not significant. <h3>Conclusions</h3> Meaningful profiles of TBI severity can be identified from acute injury characteristics and may suggest premorbid populations at risk for worse injuries, including younger individuals and those with lower education. Improving classification may help focus on those at elevated risk for severe injury and inform clinical management and prognosis. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest or financial ties to disclose.

ALTERING THE MARKING OF THE REVERSE POSTERIOR INTEROSSEOUS ARTERY FLAP

BackgroundFull-thickness defects on the dorsum of the hand requires thin, soft, and pliable skin for which there are limited locoregional flaps. The reverse posterior interosseous artery (PIA) flap based on the communicating artery fulfills all above requirements and can reach upto the fingers. However, there has been discrepancy in the surface marking of the flap and the anatomical position of the vessel pedicle. We share our alteration with the marking and ease of harvesting this flap.Method and materialThis is a prospective study conducted at a private teaching hospital in Karachi, over a period of 2 years from November 2017 to December 2019. After taking consent and ensuring confidentiality of all patients who had PIA flap reconstruction, we collected patient's demographic details, mode of injury, and flap surface area. We altered the described skin marking and took measures to prevent venous congestion and noted the outcomes in term of flap congestion and flap loss.ResultsTwenty-eight patients with a mode age of 32 years were operated during this period. The majority (64.2%) had a motor vehicle accident and machine injuries. The mean surface area of flaps was 6 × 10 cm2, and 11 (39.2%) flaps had venous supercharging. All patients had a 10-20° wrist extension splint for 2 weeks. The mean follow-up of the patients was 14 ± 5 days, and 6 (21.4%) flaps developed a minimal marginal flap loss, which was managed conservatively.ConclusionBy minimally altering our surface marking, we experienced a easy and quick harvesting of this flap. However, one has to be vigilant and take all described precautions for venous congestion.

The Mediating Role of Pain Catastrophizing: Understanding the Relationship Between Psychological Distress and Functional Disability in Mild Traumatic Brain Injury

Background. Recovery following brain injury can be significantly impeded by the way in which an individual appraises pain, which in turn, can affect ability to cope with pain, and result in psychological distress. Pain catastrophizing, implicated in the appraisal of pain, can exacerbate the intensity of pain-related distress and impact psychological well-being. However, the concurrent evaluation of these phenomena via functional outcomes has not been examined in mild traumatic brain injury. Material and methods. The present study evaluated de-identified archival data of 190 patients with mild traumatic brain injury following injury in motor vehicle accidents. Of primary interest was whether pain catastrophizing mediated the relationship among psychological distress (i.e., anxiety, depression) and functional disability outcomes in patients with mild traumatic brain injury. Results. Pain catastrophizing was found to have a significant mediating effect on the relationship between anxiety and functional disability, as well as for depression and functional disability. Age, gender, time since injury, and/or pain intensity, were not significant predictors of outcome. Although, pain severity was linked to pain catastrophizing. Moreover, the current work also evaluated feigning amongst a subset of patients with mild traumatic brain injury. Interestingly, it appears that the presence of psychological distress, irrespective of the nature of that reporting, is itself predictive of functional well-being. This is an important clinical finding and supports the role of psychological factors on real-life functional compromise in patients with mild traumatic brain injury. Conclusion. The present study found that psychological distress and functional disability are mediated by pain catastrophizing in patients with mild traumatic brain injury. It also appears that the presence of psychological distress, irrespective of the level of reported complaints (i.e., the over-reporting of symptomatology) itself, is predictive of functional well-being.

Blunt traumatic aortic injury: CT angiography images and short review of current literature

Blunt traumatic aortic injury in high-energy motor vehicle accidents is a rare but life-threatening condition. Proper treatment after prompt and accurate diagnosis is critical to reduce the death rate. The purpose of this article was to highlight the points to be considered in blunt traumatic aortic injury due to high-energy motor vehicle accident.

Relationship Between Restraint System Use and Brachial Plexus Injuries in Motor Vehicle Accidents: A Case–Control Study from the National Trauma Databank

High-speed motor vehicle accidents (MVAs) are an important cause of brachial plexus injury (BPI). Some case reports have demonstrated shoulder seat belt use resulting in traction injuries to the brachial plexus. We used a national trauma registry to determine the association between seat belt use and brachial plexus injury in MVAs. The authors queried the National Trauma Databank between 2016 and 2017 for patients with a hospital admission following an MVA. Cases with BPI were identified using International Classification of Diseases, Tenth Edition, Clinical Modification, diagnosis codes. Case-control matching by age and sex was performed to identify 2 non-BPI controls for every case of BPI. Multivariable conditional logistic regression adjusting for body mass index, alcohol use, and drug use was then performed to determine the adjusted association between safety equipment use (seat belt use and airbag deployment) and BPI. A total of 526,007 cases of MVAs were identified, of which 704 (0.13%) sustained a BPI. The incidences of BPI in patients were the following without any protective device (0.16%), with airbag deployment alone (0.08%), with seat belt use alone (0.08%), and with combined airbag deployment and seat belt use (0.07%). Following 1:2 case-control matching by age and sex and multivariable conditional logistic regression, seat belt use (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.42-0.71; P < 0.001) and airbag deployment (OR 0.52; 95% CI 0.33-0.82; P= 0.004) were found to be associated with decreased odds for BPI, with the least odds observed with combined seat belt use and airbag deployment (OR 0.49; 95% CI 0.33-0.74; P= 0.001). Despite anecdotal evidence suggesting increased likelihood of BPI with shoulder seat belt use, case-control analysis from a national trauma registry demonstrated that both seat belt use and airbag deployment are associated with lower odds of sustaining BPIs in MVAs, with the greatest protective effect observed with combined use. Future studies adjusting for rider location (passenger vs. driver) and other potential confounders such as make, type and speed of vehicle may help further characterize this association.

Eye injuries in motor vehicle accidents: Epidemiology, spectrum of injury and analysis of risk factors

Purpose: To study the epidemiology, clinico-radiological pattern and visual outcome in patients having ocular injuries following road traffic accident and also compare various risk factors associated with it. Materials and Methods: A prospective, hospital based, observational study was performed at a teaching hospital of North India. Various parameters including demographics, time, place and session of injury, type of road, vehicle & collision, type of injury, severity & location of injury, radiological findings and initial & final visual acuity were analysed. The association between ocular trauma and characteristics of the accident were evaluated. Results: Out of 402 patients of ocular trauma, 101 eyes of 95(23.63%) patients had injuries due to road traffic accidents. It was observed that males were affected predominantly (88.40%).The ratio between men and women was 7.6:1, age ranged from 1 year to 67 years. The most vulnerable age group was 21-30 year (25.30%) followed by 31-40 year (24.20%) and 11-20 year (21.10%).Maximum injury victims were illiterate (33.68%) or had primary education only (29.47%). The majority were married (68.42%) and belonged to rural background (42.10%). Most of the road traffic accidents occur in summer season (47.37%). Majority of the victims sustained injury in the afternoon between 12.00 -17.59 hrs (29.47%) and in evening between 18.00-23.59 hrs (27.33%). 57.89 % victims were not using any protective gear at the time of injury. Driving under influence of alcohol (42.11%) and sleepiness or drowsiness of victims (21.05%) were found to be an important risk factor in ocular injury. 43.61% of the accidents took place at highway. Two-wheeler occupants (30.53%) were more prone to ocular trauma than pedestrians (13.68%), three-wheelers occupants (5.26%) and car occupants (21.05%). However 29.47% victims were travelling in heavy vehicles like bus/ truck. The most common mode of road accident was collision with other stationary

The Role of Obesity in Motor Vehicle Injuries and Fatalities in the Pediatric Population: A Systematic Review.

A systematic review done to evaluate obesity as a risk factor for injuries and mortality in motor vehicle accidents (MVAs) in the pediatric population, as there has not been a systematic review done in over 10 years. This study aims to update the literature regarding obesity as a risk factor for injuries in MVAs in the pediatric population. A systematic review was conducted according to the PRISMA guidelines with strict inclusion and exclusion criteria, resulting in the use of 3 total articles to analyze obesity as a risk factor for overall injury and mortality in the pediatric population. Zaveri et al demonstrated a statistically significant, but weak, decrease in the odds of extremity injury in overweight patients ages 2 to 17 years old (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-1.0, P ≤ 0.05). On the other hand, Pollack et al and Haricharan et al found an increase in extremity injury in the obese population, in ages 9 to 15 years (OR = 2.54, 95% CI = 1.15-5.59, P ≤ 0.05), and 10 to 17 years (Age 10-13: OR = 6.06, 95% CI = 2.23-16.44, P ≤ 0.05, Age 14-17 OR = 1.44, 95% CI = 1.04-2.00, P ≤ 0.05), respectively. Haricharan et al also found an increase in thoracic injuries in obese children, ages 2 to 13 and increased risk of head/face/neck injury in obese children ages 2 to 5 (OR = 3.67, 95% CI = 1.03-13.08, P ≤ 0.05), but a decreased risk of head injury in obese children ages 14 to 17 (OR = 0.33, 95% CI = 0.18-0.60, P ≤ 0.05). There are sparse data that are conflicting, regarding the effect of obesity on extremity injuries in the pediatric population. Obesity is not protective against thoracic, head, or abdominal injuries. However, it was found to be a risk factor for trunk injuries in ages 2 to 13, as well as head/face/neck injuries for ages 2 to 5. Since the literature is so sparse, further research is warranted in these areas.

Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis

BackgroundAfter concussion many people have cervicogenic headache, visual dysfunction, and vestibular deficits that can be attributed to brain injury, cervical injury, or both. While clinical practice guidelines outline treatments to address the symptoms that arise from the multiple involved systems, no preferred treatment sequence for post-concussion syndrome has emerged.PurposeThis study sought to describe the clinical and patient-reported outcomes for people with post-concussion symptoms after a protocol sequenced to address cervical dysfunction and benign paroxysmal positional vertigo within the first three weeks of injury, followed by integrated vision and vestibular therapy.Study DesignRetrospective longitudinal cohort analysisMethodsRecords from a concussion clinic for 38 patients (25 male 13 female, aged 26.9±19.7 years) with post-concussion symptoms due to sports, falls, assaults, and motor vehicle accident injuries were analyzed. Musculoskeletal, vision, and vestibular system functions were assessed after pragmatic treatment including early cervical manual therapy and canalith repositioning treatment—when indicated—integrated with advanced vision and vestibular rehabilitation. Patient-reported outcomes included the Post-Concussion Symptom Scale (PCSS) for general symptoms; and for specific symptoms, the Dizziness Handicap Index (DHI), Convergence Insufficiency Symptom Scale (CISS), Activities-specific Balance Confidence scale (ABC), and the Brain Injury Vision Symptom Survey (BIVSS). Paired t-tests with Bonferroni correction to minimize familywise error (p<0.05) were used to analyze the clinical and patient-reported outcomes.ResultsAfter 10.4±4.8 sessions over 57.6±34.0 days, general symptoms improved on the PCSS (p=0.001, 95%CI=12.4-30.6); and specific symptoms on the DHI (p<0.001, 95%CI=14.5-33.2), CISS (p<0.002, 95%CI=7.1-18.3), ABC (p<0.024, 95%CI=-.3 - -.1), and BIVSS (p<0.001, 95%CI=13.4-28.0). Clinical measures improved including cervical range-of-motion (55.6% fully restored), benign paroxysmal positional vertigo symptoms (28/28, fully resolved), Brock string visual convergence (p<0.001, 95%CI=3.3-6.3), and score on the Balance Error Scoring System (p<0.001, 95%CI=5.5-11.6).ConclusionA rehabilitation approach for post-concussion syndrome that sequenced cervical dysfunction and benign paroxysmal positional vertigo treatment within the first three weeks of injury followed by integrated vision and vestibular therapy improved clinical and patient-reported outcomes. Level of Evidence: 2b

COVID-19 Early After a Deceased Donor Kidney Transplant Surgery

Many transplant centers reduced their solid organ transplant procedures in response to the coronavirus disease 2019 pandemic.1,2 We describe the course of a kidney transplant recipient who presented with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 10 days after transplant surgery. The patient is a 41-year-old Hispanic woman with end-stage kidney disease secondary to lupus nephritis on maintenance hydroxychloroquine 200 mg daily who presented for a zero HLA A, B, DR mismatched deceased donor kidney transplant. The donor was involved in a motor vehicle accident and sustained multiple injuries resulting in his death. He had a negative SARS-CoV-2 nasopharyngeal swab. The patient denied symptoms of SARS-CoV-2 infection or exposure to SARS-CoV-2-positive individuals and stayed at home before transplant except for going to her dialysis unit. Her preoperative nasopharyngeal swab for SARS-CoV-2 was negative and her chest X-ray was normal. She received induction immunosuppression with intravenous high-dose steroids and reduced-dose rabbit anti-thymocyte globulin, 3 mg/kg per our center’s protocol for zero antigen-mismatched transplants, and maintenance tacrolimus, mycophenolate 500 mg twice daily and prednisone taper in addition to hydroxychloroquine. She had immediate allograft function and was discharged 5 days following her transplant with serum creatinine of 1.7 mg/dL. Her absolute lymphocyte count at the time of discharge was 550 cells/mm3. Ten days posttransplant, she developed a fever of 100°F, dry cough, sore throat, and 2 episodes of diarrhea. A nasopharyngeal swab was obtained and was positive for SARS-CoV-2. It is thought that she acquired SARS-CoV-2 infection from contact with a family member who worked in a grocery store. Her oxygen saturation was 97% on room air and she had normal vital signs. Chest X-ray showed a new discoid opacity within the right lower lung (Figure 1). Mycophenolate was held, prednisone dose was immediately reduced from 20 mg to 10 mg and then to 5 mg maintenance, tacrolimus was dosed to maintain trough levels of 7–10 ng/mL, and hydroxychloroquine was increased to 200 mg twice daily, based on earlier reports in the pandemic about its presumed effectiveness. C-reactive protein was 0.4 mg/dL, absolute lymphocyte count was 1200 cells/mm3, and serum creatinine was 1.1 mg/dL. She received 1 unit of convalescent plasma transfusion through Food and Drug Administration expanded access pathway under a protocol that was approved by our Institutional Review Board; however, after completion, she developed urticaria, which was treated with antihistamines. She had a positive direct antiglobulin test confirming the transfusion reaction. She remained clinically stable and was discharged after 1 day of hospitalization with a pulse oximeter to monitor her oxygen saturation at home. More than 60 days have passed since discharge, and she continues to do well.FIGURE 1.: Left, Preoperative chest X-ray. Right, Chest X-ray at the day of presentation with COVID-19 symptoms.This report demonstrates that despite acquiring SARS-CoV-2 at the “peak” of immunosuppression, which included lymphocyte depletion, our patient had only mild symptoms and did not develop serious complications. The utility of convalescent plasma in renal transplant recipients with SARS-CoV-2 is not well defined. A recent report described successful recovery in a kidney transplant recipient who had severe infection with SARS-CoV-2 and was treated with 2 units of convalescent plasma.3 In view of the very recent and “heavy” immunosuppression in our patient, we decided to utilize convalescent plasma, despite her mild illness. More data are needed to better describe SARS-CoV-2 infection and treatment in peritransplant period. Finally, it is crucial to highlight the importance of taking meticulous measures and precautions in this patient population, especially in the presence of household contacts working at potentially “high risk” jobs for acquiring and transmitting SARS-CoV-2. Self-quarantine, physical distancing, and frequent hand hygiene should be undertaken at the highest potential levels.

Prevalence of ligamentous knee injuries in pedestrian versus motor vehicle accidents

BackgroundThe purpose of this study was to determine the prevalence and characteristics of ligamentous knee injuries and to compare patient demographics, associated injuries and hospital stay to pedestrians who did not sustain a ligamentous knee injury.MethodsA retrospective review of all adult patients presenting as pedestrians struck by a motor vehicle to a level 1 trauma center over a three-year period was performed. Demographics, length of stay, orthopedic and non-orthopedic traumatic injuries were recorded. Magnetic resonance imaging was reviewed for ligamentous, bony and chondral injuries.ResultsFive hundred thirty-nine patients were included. Sixty-seven (12.4%) patients sustained a total of 84 ligamentous knee injuries. OF these knee injuries that had MRI (55/84), the majority (96%) were multi-ligamentous in nature. Patients with ligamentous knee injury were more likely to also be affected by traumatic brain injury, solid organ injury, cervical and lumbar spine injury, pelvic ring injuries, distal femur fractures, patella fractures, knee dislocations, tibial plateau fractures, tibial pilon fractures, and deep vein thrombosis when compared to patients who did not sustain ligamentous knee injury. Patients who sustained ligamentous knee injury were more likely to require hospital and intensive care admission and had a longer overall hospital stay.ConclusionGiven the high prevalence of ligamentous knee injuries in this patient population, these patients should be thoroughly evaluated for a ligamentous knee injury. If ligamentous knee injury is suspected, MRI should be considered as a majority of these injuries involved multiple structures. Patients with ligamentous knee injuries often had multi-system injuries with resulting longer hospital stay when compared to those without ligamentous knee injuries.

Stimulants associated with reduced risk of hospitalization for motor vehicle accident injury in patients with obstructive sleep apnea-a nationwide cohort study

BackgroundThe risk of injury directly related to hospitalization for motor vehicle accidents (MVAs) in the obstructive sleep apnea (OSA) patients has not been thoroughly understood. Our study aimed to examine the association between the OSA and the hospitalization for an MVA injury.MethodsThis retrospective cohort study used Taiwan’s National Health Insurance Research Database (NHIRD) between 2000 and 2015. The OSA patients aged ≥20 years by age, sex, and index-year matched by non-OSA controls were enrolled (1:3). We used the Cox proportional regression model to evaluate the association between the OSA and the hospitalization for an MVA injury.ResultsThe incidence rate of hospitalization for an MVA injury was higher in the OSA cohort (N = 3025) when compared with the non-OSA controls (N = 9075), as 575.3 and 372.0 per 100,000 person-years, respectively (p < 0.001). The Kaplan-Meier analysis showed that the OSA cohort had a significantly higher incidence of hospitalization for the MVA injury (log-rank test, p < 0.001). After adjusting for the covariates, the risk of hospitalization for the MVA injury among the OSA was significantly higher (hazard ratio [HR] =2.18; 95% confidence interval [CI] = 1.79–2.64; p < 0.001). Stimulants usage was associated with a nearly 20% decrease in the risk of an overall hospitalization for an MVA injury in the OSA patients.ConclusionsThis study provides evidence that patients with OSA are at a two-fold higher risk of developing hospitalization for an MVA injury, and the usage of modafinil and methylphenidate was associated with a lower risk of an overall hospitalization for the MVA injury.

Analysis of Facial Injuries in Motor Vehicle Accidents According to the Location of the Seat and Seat-Belt Use.

The purpose of this study was to evaluate facial trauma in accidents involving a passenger car. In particular, the authors assessed differences in types of facial trauma and severity according to the location of the seat and seat-belt use. A 7-year retrospective review of data was conducted for 419 patients with facial trauma resulting from motor vehicle accidents. Patients who used a seat belt faced a lower risk of severe soft-tissue injury in comparison with having mild soft-tissue injury than patients who did not use a seat belt (P = 0.0129). Additionally, patients who used a seat belt had a lower risk of accompanying facial bone fracture requiring surgical operation than patients who did not use a seat belt (P = 0.0168). In terms of facial bone fracture according to seat location, patients who had sat in the back seat had more risk of accompanying facial bone fracture than patients who had sat in the passenger's seat (P = 0.0392). In terms of facial bone fractures requiring surgical operation, the patients who had sat in a back seat faced more risk of needing a surgical operation than patients who had sat in the driver's seat (P = 0.0479). The results of the study reveal that wearing a seat belt effectively reduces severe facial soft-tissue injury and facial bone fracture requiring surgical operation. In particular, the authors note that sitting in a back seat is riskier in terms of facial bone injury than sitting in a front seat.

The Risk of Hospitalization for Motor Vehicle Accident Injury in Narcolepsy and the Benefits of Stimulant Use: A Nationwide Cohort Study in Taiwan.

To examine the risk of hospitalization for motor vehicle accident injury (MVAI) in patients with narcolepsy and the effects of stimulant use on MVAI occurrence in patients with narcolepsy. This is a population-based, retrospective cohort study using Taiwan's National Health Insurance Research Database between 2000 and 2013. We included patients with narcolepsy based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, 347. The case and matched control participants were selected in a ratio of 1:3, and the traffic accident (ICD-9-CM codes: E810-E819) plus injury codes (ICD-9-CM codes: 800.xx-999.xx) due to MVAI following hospitalization were used for the study outcome. The type of injury, causes, intentionality, and the effects of stimulant use on patients with narcolepsy were also assessed. A total of 1,316 participants were enrolled, including 329 participants with narcolepsy and 987 participants without narcolepsy. During a 14-year follow-up period, a total of 104 participants had MVAI, of whom 47 (1,559.54 per 100,000 person-years) belonged to the narcolepsy cohort and 57 (556.21 per 100,000 person-years) to the non-narcolepsy cohort. After adjusting for covariates, the risk of hospitalization for MVAI among participants with narcolepsy was still significantly higher than those without narcolepsy (adjusted hazard ratio = 6.725; 95% confidence interval = 4.421-10.231; P < .001). The use of modafinil or methylphenidate, as monotherapy or combined treatment, was associated with a lower risk of MVAI in the narcolepsy cohort. Patients with narcolepsy may have a higher risk of hospitalization for MVAI and stimulant use could mitigate such risk.