Incidence Of Injury Research Articles

Rib Fractures in Trauma Patients: Prevalence, Associated Injuries, and Mortality Trends.

Introduction Rib fractures are a common consequence of thoracic trauma, often signaling the presence of additional injuries and increasing the risk of mortality. This study aimed to elucidate the frequency, patterns, and mortality rates associated with rib fractures in multitrauma patients and to explore the association between rib fractures and other systemic injuries. Methods In a retrospective observational study at a tertiary care hospital, electronic medical records of multi-trauma patients over a four-year period were examined. Inclusion criteria encompassed adult patients who had undergone whole-body or chest and abdomen CT imaging. The study evaluated the incidence and location of rib fractures, associated thoracic and intra-abdominal injuries, and the in-hospital mortality rate. Results Among the 1,338 patients analyzed, rib fractures were identified in 273 (20.4%), with a median age of 33 years and 199 (72.9%) were male. Motor vehicle accidents were the most common trauma mechanism with a rate of 52% (n=142). Patients with rib fractures had significantly higher occurrences of pneumothorax (25.3%), hemothorax (20.9%), and intra-abdominal injuries (17.5%) (p<0.001). Notably, patients with six or more rib fractures exhibited a higher frequency of liver, spleen, and kidney injuries (p=0.003, p=0.011, p=0.001, respectively). The in-hospital mortality rate was 5.9% (n=17) for patients with rib fractures, significantly higher than those without (p<0.001). Conclusion Rib fractures in multi-trauma patients are an important indicator of severe concurrent injuries and are associated with a higher mortality rate. These findings advocate for a systemic and immediate evaluation of patients with rib fractures upon presentation in emergency departments to improve survival outcomes.

Effect of riding postures on kinematic responses and head injuries of ETW child passengers

Electric two-wheelers (ETWs) are extensively used for the transportation of vulnerable child passengers; however, diverse riding postures adopted by children may engender potential injury risks in the event of a collision. The objective of this study was to investigate the kinematics and head injuries of child passengers with different riding postures in ‘ETW-sedan’ collisional accidents. Typical riding postures were classified and different collision scenarios were designed using the orthogonal matrix analysis method. Multibody models of humans and vehicles were developed and validated using empirical accident data. The effects of riding postures of child passengers on head injury mechanisms and kinematics were studied. The result showed that it was the most dangerous posture when the child sat in the back seat and had a reverse facial orientation with the rider, due to the highest incidence of fatal head injury. A parametric study was further conducted on the effect of different impact velocities, impact angles, and offset distances. It was found that the velocity of the sedan was the most influencing factor, and severe damage can occur when the impact angle was ranging from 30 to 90°. The study could provide guidance for the safety protection of child passengers on ETWs.

Give It a Rest: The Impact of Rest Days on Musculoskeletal Injuries Among Starting Pitchers in Major League Baseball.

Examine the impact of rest days on musculoskeletal (MSK) injury incidence in Major League Baseball (MLB) starting pitchers. Descriptive epidemiological study. MLB pitching and injury reports. PARTICIPANTS: MLB starting pitchers. Data (2022-2023) were obtained from Baseball-Reference.com and fangraphs.com. Teams were grouped by average rest days between starts (Group A <5 rest days, Group B >5 rest days). Poisson regression was used to compare main outcome measure incidence rate ratios (IRRs). Number of rest days between starts. Pitches per start, MSK injury incidence, injured list (IL) days for MSK injury. From 2022 to 2023, the average MLB rest days between starts was 4.80. Group A had 54 teams. Group B had 6 teams. The range of average rest days per start by team was 4.56 to 5.73 with a mean of 4.80. Group B pitchers spent 10.7 days on IL for MSK injuries per 1000 pitches, while Group A spent 13.6 days on IL (IRR = 0.78 [95% CI, 0.72-0.85]; P < 0.0001). Group B averaged 0.93 more pitches per start than Group A (P = 0.0164). Group B had a lower number of IL assignments for MSK injuries per 1000 pitches (0.245 vs 0.351, IRR = 0.70 [95% CI, 0.38-1.18]; P = 0.1715). Starting pitchers on MLB teams averaging > 5 rest days between starts spent less time on the IL for MSK injuries than MLB teams averaging < 5 rest days from 2022 to 2023. There was no clinically significant difference in pitch count and no significant difference in the number of IL assignments for MSK injuries.

Are there any benefits of prolonged hypothermic oxygenated perfusion? - Results from a national retrospective study.

Dual hypothermic oxygenated perfusion (DHOPE) is increasingly being used to extend liver preservation to improve transplant logistics. However, little is known about its benefits in high-risk liver grafts. This study aimed to investigate whether prolonged DHOPE provides benefits other than improved logistics in all liver types. We performed a national retrospective cohort study of 177 liver transplants from 12 Italian centers preserved with DHOPE for ≥4h between 2015 and 2022. A control group of 177 DHOPEs of <4h during the same period was created using 1:1 propensity score matching. The impact of risk profiles and preservation times on the outcomes was assessed using univariable and multivariable regression models. No significant differences in post-transplant outcomes were found between prolonged and short DHOPEs. However, the prolonged group had a significantly lower incidence of post-transplant acute kidney injury (AKI) compared to the short group (30.5% vs. 44.6%, p=0.008). Among prolonged DHOPEs, no differences in transplant outcomes were observed according to donor risk index (DRI), Eurotransplant definition for marginal grafts, and balance of risk (BAR) score. DHOPE duration was associated with a lower risk of AKI in multivariable models adjusted for DRI, Eutrotransplant marginal grafts, and BAR score. Prolonged HOPE confirmed its protective effect against AKI in a multivariable model adjusted for donor and recipient risk factors [OR: 0.412, 95%CI: 0.200-0.850, p=0.016]. Prolonged DHOPE is widely used to improve transplant logistics, provides good results with high-risk grafts, and appears to be associated with a lower risk of post-transplant AKI. These results provide further insight into the important role of DHOPE in preventing post-transplant complications.

Efficacy and safety of calcineurin inhibitors (CNIs) for septic patients in ICU: a cohort study from MIMIC database.

Sepsis is marked by a dysregulated immune response to infection. Calcineurin inhibitors (CNIs), commonly used as immunosuppressants, have unique properties that may help mitigate the overactive immune response in sepsis, potentially leading to better patient outcomes. This study aims to assess whether CNIs improve prognosis in septic patients and to evaluate any associated adverse reactions. We utilized the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV 2.2) database to identify septic patients who were treated with CNIs and those who were not. Propensity score matching (PSM) was employed to balance baseline characteristics between the CNI user group and the non-user group. The primary outcome was 28-day mortality, analyzed using the Kaplan-Meier method and Cox proportional hazard regression models to examine the relationship between CNI use and patient survival. From the MIMIC-IV database, 22,517 septic patients were identified. After propensity score matching, a sample of 874 patients was analyzed. The CNI group exhibited a significantly lower 28-day mortality risk compared to the non-user group (HR: 0.26; 95% CI: 0.17, 0.41) in the univariate Cox hazard analysis. Kaplan-Meier survival curves also demonstrated a significantly higher 28- and 365-day survival rate for CNI users compared to non-users (log-rank test p-value = 0.001). No significant association was found between CNI use and an increased risk of new-onset infection (p = 0.144), but an association with mild hypertension (P < 0.001) and liver injury (P < 0.001) was observed. The use of calcineurin inhibitors was associated with reduced short- and long-term mortality in septic patients without an increased incidence of new-onset infections, hyperkalemia, severe hypertension, or acute kidney injury (AKI). However, CNI use may lead to adverse effects, such as liver injury and mild hypertension.

Low back pain or injury before collegiate athletics, a potential risk factor for non-contact athletic injuries.

Majority of research surrounding the predictive value of clinical measurements and assessments for future athletic injury does not differentiate between contact and non-contact injuries. We assessed the association between clinical measures and questionnaire data collected prior to sport participation and the incidence of non-contact lower extremity (LE) injuries among Division III collegiate athletes. Prospective cohort study. University setting, NCAA Division III. 488 Division III freshmen athletes were recruited to participate in the study during their preseason physical examinations. 10,983 public schools. Prospective incidence of non-contact Lower extremity Injury. Athletes completed questionnaires to collect demographics and musculoskeletal pain history. Clinical tests, performed by trained examiners, included hip provocative tests, visual appraisal of a single leg squat to identify dynamic knee valgus, and hip range of motion (ROM). Injury surveillance for each athlete's collegiate career was performed. The athletic training department documented each athlete-reported, new onset injury and documented the injury location, type, and outcome (days lost, surgery performed). Univariable Generalized Estimating Equations (GEE) models were used to analyze the relationship between each clinical measure and the first occurrence of non-contact LE injury. An exchangeable correlation structure was used to account for repeated measurements within athletes (right and left limbs). Of the 488 athletes, 369 athletes (75%) were included in the final analysis. 69 non-contact LE injuries were reported. Responding "Yes" to "Have you ever had pain or an injury to your low back" was associated with an increased risk of non-contact LE, odds ratio = 1.59 (95%CI 1.03- 2.45, p=.04). No other clinical measures were associated with increased injury risk. A history of prior low back pain or injury was associated with an increased risk of sustaining a non-contact LE injury while participating in NCAA Division III athletics.

Effect of zoledronic acid and pamidronate on renal function.

There is limited data on the effect bisphosphonates have on renal function and the use of bisphosphonates in patients with baseline renal dysfunction. The purpose of this study was to determine the incidence of acute kidney injury (AKI) in patients after receiving zoledronic acid or pamidronate. A retrospective cohort analysis was conducted of patients who received one dose of a bisphosphonate, either zoledronic acid or pamidronate. The primary objective of this study was to determine the incidence of AKI after bisphosphonate administration. Baseline characteristics were compared, and unadjusted analyses of primary and secondary outcomes were completed using Pearson's chi-square or Fisher's exact test for categorical data and Mann-Whitney U test for continuous data. There was no difference found in AKI incidence between zoledronic acid and pamidronate (17.1% vs. 15.0%; p = 1.00). Additionally, there was no difference found in AKI incidence between patients with baseline renal dysfunction and those without, (25.0% vs. 15.0%; p = 0.322). There were no differences observed in either corrected calcium within seven days or serum creatinine (SCr) within 30 days returning to baseline after administration, nor were there differences in fever or hypophosphatemia incidences. Bisphosphonates may be used to treat hypercalcemia of malignancy in patients with and without renal dysfunction. AKI may occur post infusion; however, long-term effects on renal function are infrequent when hydrating patients prior to administration and adhering to the manufacturer's recommended infusion rate.

The Impact of Area Deprivation Index, Geography, and Mechanism on Incidence of Ballistic Injury to the Upper Extremity.

This study investigates the intersection of ballistic injuries, geography, and Area Deprivation Index (ADI). We hypothesized that both ADI and geography are correlated with incidence of upper extremity ballistic injuries. Further, we characterize and compare 2 distinct upper extremity gunshot injury populations presenting to our institution: those sustaining violent ballistic injuries and those who suffer an accidental, self-inflicted injury. Our purpose is to evaluate the impact of geography and ADI on the pattern of upper extremity gunshot injuries in Illinois and Missouri. This was a retrospective review of adult patients sustaining ballistic injury to the upper extremity at a single urban level I trauma center over 10 years (n = 797). Seven hundred thirty patients had home addresses in Illinois or Missouri; these addresses were geocoded and included for analysis. Mechanism of injury was self-reported. ADI was measured from the 2019 Neighborhood Atlas, in which deprivation increases from 1 to 100. Comparisons between groups were conducted with unpaired t tests, Fisher exact test, or χ2 testing, where appropriate. Addresses constituted 259 unique census tracts, and the average number of upper extremity gunshot wound incidents per tract was 3, with a maximum of 22; 15.4% of census block tracts made up almost half (48.4%) of the total ballistic injuries in the study period; 97.7% of violent injuries occurred in Urban areas, as compared with only 60% of accidental injuries (P < 0.05). ADI and incidence of upper extremity ballistic injury were positively correlated. ADI varied significantly between patients sustaining violent (median, 94; mean, 86.1) versus accidental self-inflicted (median, 79; mean, 70.9) injuries (P < 0.05). Fifty percent of violent injuries in our data set occurred in block groups from the 2 most deprived quintiles. Upper extremity gunshot wounds in general are concentrated in census blocks with high ADI. Violent injuries in particular are more likely to occur in urban areas with high ADI, whereas patients with accidental, self-inflicted injuries are more geographically and socioeconomically diverse. These differing populations require unique approaches to reduce incidence and morbidity.

Impact of propofol versus desflurane anesthesia on postoperative hepatic and renal functions in infants with living-related liver transplantation: a randomized controlled trial

BackgroundThe effects of anesthetics on liver and kidney functions after infantile living-related liver transplantation (LRLT) are unclear. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) or desflurane-based inhalation anesthesia on postoperative liver and kidney functions in infant recipients after LRLT and to evaluate hepatic ischemia–reperfusion injury (HIRI).MethodsSeventy-six infants with congenital biliary atresia scheduled for LRLT were randomly divided into two anesthesia maintenance groups: group D with continuous inhalation of desflurane and group P with an infusion of propofol. The primary focus was to assess alterations of liver transaminase and serum creatinine (Scr) levels within the first 7 days after surgery. And the peak aminotransferase level within 72 h post-surgery was used as a surrogate marker for HIRI.ResultsThere were no differences in preoperative hepatic and renal functions between the two groups. Upon the intensive care unit (ICU) arrival, the levels of aspartate aminotransferase (AST, P = 0.001) and alanine aminotransferase (ALT, P = 0.005) in group P were significantly lower than those in group D. These changes persisted until the fourth and sixth days after surgery. The peak AST and ALT levels within 72 h after surgery were also lower in group P than in group D (856 (552, 1221) vs. 1468 (732, 1969) U/L, P = 0.001 (95% CI: 161–777) and 517 (428, 704) vs. 730 (541, 1100) U/L, P = 0.006, (95% CI: 58–366), respectively). Patients in group P had lower levels of Scr upon the ICU arrival and on the first day after surgery, compared to group D (17.8 (15.2, 22.0) vs. 23.0 (20.8, 30.8) μmol/L, P < 0.001 (95% CI: 3.0–8.7) and 17.1 (14.9, 21.0) vs. 20.5 (16.5, 25.3) μmol/L, P = 0.02 (95% CI: 0.0–5.0) respectively). Moreover, the incidence of severe acute kidney injury was significantly lower in group P compared to that in group D (15.8% vs. 39.5%, P = 0.038).ConclusionsPropofol-based TIVA might improve liver and kidney functions after LRLT in infants and reduce the incidence of serious complications, which may be related to the reduction of HIRI. However, further biomarkers will be necessary to prove these associations.

Frailty and 6-month trajectory of elderly trauma patients over the age of 65 years admitted to intensive care unit for severe trauma: experience of a level 1 trauma center

BackgroundThe aging global population forecasts a significant rise in severe trauma cases among individuals aged 65 and above. Frailty emerges as a paramount predictor of post-traumatic outcomes, surpassing age and trauma severity indices. Despite this, scant attention is given to the trajectory of elderly patients post-intensive care unit (ICU) stay following severe trauma, justifying this study. The objective of this study was to analyze trajectories (frailty, place of residence) following a major trauma requiring an ICU stay.Materials and methodsAn observational cohort study was conducted, leveraging data from a level 1 trauma center spanning 2018 to 2023. Inclusion criteria included elderly patients aged 65 and above admitted to the ICU for severe trauma. Data encompassed demographic profiles, trauma severity scores, clinical parameters, and frailty assessments sourced from the Traumabase database.ResultsAmong 293 patients included 190 were non-frail, frailty was correlated with elevated mortality rates (114 (38.9%) at 6 months), heightened incidence of traumatic brain injuries, and notable declines in post-traumatic autonomy. Only 39.2% of patients had resumed residence at home six months post-injury, with a conspicuous trend towards institutionalization, particularly among frail individuals.ConclusionThis study highlights the role of frailty in determining the outcomes of elderly patients following severe trauma. Frailty is associated with higher mortality, increased rates of institutionalization, and a decline in functional status. These results highlight the importance of assessing frailty in the trajectory of severely injured patients over the age of 65 years-old.

Comparative study of Indocyanine Green fluorescence imaging versus conventional fiber-optic imaging in laparoscopic choledochotomy for stone extraction and immediate biliary incision suturing.

To explore the Advantages of Indocyanine Green (ICG) Fluorescence Imaging over Conventional Fiber-Optic Imaging in Laparoscopic Cholangiography and Immediate Suture for Stone Removal. The study is a randomized controlled descriptive research. Consecutive patient data were collected from October 2022 to January 2024 at the Second People's Hospital of Chengdu for those who underwent laparoscopic bile duct exploration and stone removal, totaling 72 cases. According to the order of admission, they were randomly assigned to either the study group or the control group, with 36 cases in each group. Ten minutes preoperatively, indocyanine green (ICG) was administered intravenously through a peripheral vein to the subjects in the study group, to enable real-time fluorescent tracing of the extrahepatic bile ducts during surgery. This study compares the efficiency of bile duct structure and boundary recognition, the timeliness of bile duct incision positioning, operative time, blood loss, and the incidence of bile duct injury between patients who were injected with ICG and those who were not. In addition, it assesses liver function and white blood-cell counts rechecked 24h postoperatively, the duration of postoperative hospital stay, and the occurrence of bile leakage. The study included 72 patients, with 36 in the indocyanine green (ICG) fluorescence group and 36 in the conventional fiber-optic group, comprising 26 males and 46 females. There were 18 patients with a history of previous biliary exploration surgery and 23 who had undergone previous cholecystectomy. During surgery, ICG fluorescence was successfully visualized in all 36 cases of the ICG group, allowing for a clear view of the anatomical structure and boundaries of the extrahepatic bile ducts. Compared to the control group, the ICG fluorescence group demonstrated a reduction in the time required for identification of the biliary system and positioning of the bile duct incision, as well as a decrease in operative time and postoperative hospital stay; intraoperative blood loss and the incidence of bile leakage were also relatively reduced, with statistically significant differences (P < 0.05). However, there were no statistically significant differences in postoperative serum alanine aminotransferase levels, white blood-cell counts, direct bilirubin, and indirect bilirubin between the two groups (P > 0.05). One case of bile duct injury occurred in the control group. The application of ICG fluorescence navigation in laparoscopic cholecystectomy can effectively enhance the visibility of the bile ducts, rapidly identify the location for bile duct incision, and is conducive to reducing both the duration of surgery and postoperative hospital stay. It also minimizes intraoperative blood loss, prevents bile leakage and bile duct injuries. This program has demonstrating significant clinical value.

The relationship between tricuspid annular plane systolic excursion on transesophageal echocardiography and the incidence of postoperative acute kidney injury in patients undergoing coronary artery bypass grafting surgery: a multicenter prospective cohort study

BackgroundTo date, the relationship between the Transesophageal Echocardiography (TEE) monitoring indicator tricuspid annular plane systolic excursion (TAPSE) and the incidence of postoperative acute kidney injury (AKI) in Coronary Artery Bypass Grafting(CABG) patients remains unknown. The main objective of this study was to explore the relationship between the TAPSE and the incidence of AKI in CABG patients.MethodsThis was a multicenter prospective cohort study was conducted between September 2021 and July 2022. Among 266 patients aged at least 18 years who underwent elective CABG, 140 were included.ResultsWe measured TAPSE via M-mode TEE via the mid-esophageal (ME) right ventricle(RV) inflow-outflow view (60°). All echocardiographic measurements were performed three separate times at each time point: T0 (before the start of CABG), T2 (approximately 5 ∼ 10 min after neutralization of protamine) and T3 (before leaving the operating room), and then averaged. Serum creatinine was measured 1 day before and within 7 days after CABG. There was no statistically significant association between the TEE-monitoring indicator TAPSE and the incidence of postoperative AKI in patients who underwent CABG.ConclusionsThe TAPSE was not significantly correlated with postoperative AKI incidence and could not predict the early occurrence of postoperative AKI in CABG patients. TEE needs more evaluation for clinical efficacy of predicting the early occurrence of postoperative AKI in isolated CABG.

Effect of Different Insertion Methods on LMA Protector-Related Complications: A Prospective Randomized Double-Blind Clinical Trail.

The authors compared the effect of 2 insertion methods, namely the conventional laryngeal mask airway (LMA) insertion and the index finger-assisted LMA insertion, on the incidence of complications associated with LMA Protector insertion. The authors enrolled 300 patients, who underwent painless bronchoscopy. The patients ranged in age between 18 and 75 and were classified as American Society of Anesthesiologists grade I to III. They were randomly divided into 2 groups: a control group of 150 patients and an assisted group comprising 150 patients. LMA was inserted using the conventional and index finger-assisted insertion methods in both groups, respectively. The primary outcome was postoperative complications, such as oral mucosal injury and pharyngeal pain. Secondary outcomes included the success rate of first-time insertion, the incidence rate of inverse folding of LMA tips, oropharyngeal leak pressure (OLP), and other postoperative complications. Compared with the conventional LMA insertion method, index finger-assisted LMA insertion can significantly reduce the incidence rate of oral mucosal injury and pharyngeal pain, with fewer insertion failures. There was a statistically significant difference between the 2 groups in the visual field grading before adjustment for LMA alignment (P<0.0001). The conventional insertion method increased the likelihood of inverse folding of LMA tips. When the conventional insertion method was utilized, there was a significant difference in airway pressure and tidal volume before and after alignment under a fiberoptic bronchoscope (P<0.0001), but no significant difference in visual field grading and respiratory mechanics-related indicators. Index finger-assisted insertion can significantly reduce the incidence rate of LMA Protector-related complications and inverse folding of LMA tips.

Association between temperature and occupational injuries in Spain: The role of contextual factors in workers’ adaptation

BackgroundExtensive evidence links both cold and hot temperatures to an increased incidence of occupational injuries. Contextual modifiers of the temperature-injury association have been scarcely researched. The present study addresses temporal and spatial variations to identify factors associated with (mal)adaptation to heat and cold among Spanish workers. MethodsWe assessed the association between daily mean temperature and work injuries using quasi-Poisson time-series regression models in 48 Spanish provinces over the period 1988–2019, with comparative analyses with census and economic data for the sub-periods 1989–1993, 1999–2003, 2009–2013 and 2015–2019. We explored the spatial and spatiotemporal modification of the association by demographic and socioeconomic variables via cross-sectional and longitudinal meta-regressions. Findings:We found an increased risk of work-injuries by 4 % [95 % CI: 3 %-6 %] and 12 % [95 % CI: 10 %-13 %], for the 1st and 99th percentiles of temperature, respectively, for period 1988–2019. Heat had a greater overall impact than cold, and the groups more vulnerable to heat were male workers, under 35 years, and working in agriculture, construction and hostelry. Vulnerability to heat was highest in the earliest sub-period, while vulnerability to cold rose during periods of both economic expansion and recession. High educational attainment emerged as a protective factor during the warm months in the cross-sectional meta-regressions. ConclusionsOur findings suggest an adaptation of Spanish workers to high temperatures over time. However, preventive measures are needed for traditionally exposed workers (agriculture and construction), non-traditionally vulnerable sectors (hostelry), and young, male, and less educated workers during warm months. For cold vulnerability, targeted measures should focus on women, the elderly, and tertiary service workers, especially in colder regions. Addressing temperature vulnerability would enhance worker safety, reduce injuries, and yield economic benefits.

Incidence and Risk Factors for Perioperative Pressure Injuries: Prospective Descriptive Study

PurposePressure injuries can often occur in patients undergoing surgical, diagnostic, or other invasive procedures, so it is important to assess patients in the perioperative period. This study was conducted to determine the incidence and risk factors of perioperative pressure injury. DesignA cross-sectional, prospective, and descriptive study. MethodsThis study involved 158 patients who met the study's eligibility criteria between May 2022 and July 2022. The data were collected using the Patient Information Form, Munro Scale, Braden Scale, and pressure injury staging form. The patients were monitored postoperatively or for 3 days. FindingsPressure injury developed in 13.9% of the patients. Perioperative risk factors were age, edema, mobilization time, parenteral nutrition, blood transfusion, and glucose level, while preoperative albumin level was lower in patients with pressure injury. In the postoperative period, the risk factors were duration of mobilization and transition to oral feeding, length of intensive care unit stay, and low Braden score. In multivariate analysis, the variables that showed significance with the risk of pressure injury were postoperative Munro score and edema. ConclusionsIt is crucial to evaluate the risk factors for pressure injury in patients who have undergone surgical procedures.

Obstetric Anal Sphincter Injury After Episiometer-Guided Versus Conventional Episiotomy in Instrumental Deliveries: A Randomized Controlled Trial.

Guidelines recommend episiotomy for instrumental vaginal delivery with an optimal incision angle of 60° to protect the anal sphincter. The "Episiometer" is a new device promising a 60° incision angle. We compared the incidence of obstetric anal sphincter injury (OASI) and post-repair suture angle of episiotomies made with conventional "eyeballing" versus Episiometer guided during instrumental delivery. We conducted this randomized controlled trial in a tertiary care teaching institute in southern India after ethical committee approval, trial registration, and informed consent. We randomized (block) 328 pregnant women aged 18 years and above with term, singleton fetuses delivered by instruments into Episiometer-guided (164) or conventional episiotomy (164) groups (allocation concealed). We compared the OASI (identified clinically) and the suture angle measured from the midline (assessor blinded) in the two groups. We followed up on the subjects at 6 and 12 weeks to assess perineal pain and fecal/flatus incontinence. The incidence of OASI of 0.61% in the Episiometer group was significantly lower compared with 4.88% in the eyeballing group (Chi-squared = 5.6; p = 0.02; adjusted risk ratio = 5.9; CI 0.7-46.1; p = 0.09). A significantly higher proportion of subjects (59.1%) in the Episometer group had a post-suture angle between 36 and 40° compared with 36.6% in the eyeballing group (Chi-squared = 21.8, p < 0.001). We found no significant difference in the perineal pain or Wexner score during follow-up. The Episiometer-guided episiotomy during instrumental delivery resulted in a significantly higher suture angle and lower obstetric anal sphincter injuries than with conventional eyeballing.

Epidemiological analysis of a 10-year retrospective study of pediatric trauma in intensive care

Pediatric trauma plays a crucial role in pediatric mortality, with traffic injuries and falls frequently cited as leading causes of significant injuries among children. A comprehensive investigation, including geographical factors, is essential for developing effective strategies to prevent injuries and alleviate the burden of pediatric trauma. This study involved a retrospective analysis of clinical data from pediatric patients admitted to our hospital’s intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. This retrospective study included 951 pediatric patients (mean age: 4.79 ± 3.24 years; mean weight: 18.45 ± 9.02 kg; median time to ICU admission post-injury: 10.86 ± 14.95 h). Among these patients, 422 (44.4%) underwent emergency surgery, and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 ± 146.62 h. The mean duration of ICU stay was 6.24 ± 8.01 days, and the overall mean hospitalization duration was 16.08 ± 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0–6 years (70.7%), with males comprising 60.0% of patients. Injury incidents predominantly occurred between 12 and 6 PM (44.5%) and on non-workdays (37.6%). The most common locations where injuries occurred were roadsides (49%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single-site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 ± 8.86. Following active intervention, 871 patients (91.59%) showed improvement, while 80 (8.41%) succumbed to their injuries. Traffic injuries remain the primary cause of pediatric trauma leading to ICU admission, underscoring the importance of using appropriate child restraint systems and protective gear as fundamental preventive measures. The increased incidence of injuries among children aged < 6 years and those residing in rural areas highlights the need for targeted preventive strategies, necessitating tailored interventions and public policy formulations that address these high-risk populations.

Lower extremity injury and return to sports of elite taekwondo athletes

Abstract Objective We attempted to analyze the characteristics of lower-extremity injuries that occur during training based on the sex and weight class of elite taekwondo (TKD) athletes and the effect of pain scores on the return to sports periods (RTSP). Methods and Methods: We included 198 elite TKD athletes who participated in January–December 2023 and were trained in Korea. Injury incidence rates (IIR) were expressed as Poisson rates with 95% confidence intervals per 1,000 h of training. One-way analysis of variance was conducted to determine the pain score and RTSP according to sex, weight, and injury type. In addition, we performed simple linear regression to determine the effects of pain score on the RTSP. Results The lower-extremities IIR was 2.45 injuries per 1000 training hours, including 0.77 contact and 1.68 non-contact injuries. The IIR was lower in male than in female athletes (p&lt;0.001), the most common injuries occurred in the ankle (0.78) and knee(0.53). In addition, the ligament (0.99) and muscle (0.70) were the most common injury types. All athletes demonstrated significant differences in pain scores (p&lt;0.001) and RTSP (p&lt;0.001) based on the injury type. In addition, we observed a significant difference between the pain score (p&lt;0.001) and RTSP (p=0.004) based on sex. For every 1-point increase in pain score, all athletes had a 1.43-day increase in RTSP. Conclusion These results can be used as data to develop injury prevention programs for TKD athletes and to determine their RTSP.

WP3.8 - Estimating the Disease Burden and Epidemiological Characteristics of Burn Injuries in the United Kingdom: a systematic analysis of the global burden of disease study 2019

Abstract Background Burn injuries pose a substantial public health challenge globally, with profound physical, psychosocial, and financial consequences for individuals, households, and communities. This study aims to assess the disease burden and epidemiological characteristics of burn injuries in the United Kingdom (UK). Methods Utilising data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we estimated the prevalence, age-standardised incidence, and years lived with disability (YLD) for burn injuries in the UK. Burn injuries were further classified based on the total burn surface area (TBSA), distinguishing between &amp;lt;20% and &amp;gt;= 20% TBSA. Result In 2019, the age-standardised incidence rate of burn injuries in the UK was estimated at 330.65 per 100,000 (268.59-409.52). Incidence rates have demonstrated a stable downtrend since 1990. Over 90% of burn injuries in the UK were categorised as &amp;lt;20% TBSA. Younger age groups experienced a higher disease burden. England exhibited the highest age-standardised incidence rate of burn injuries (344.98 per 100,000), along with a threefold higher rate of burn injuries &amp;gt;20% TBSA (29.64 per 100,000) compared to Wales, Northern Ireland, and Scotland. The burden of disability attributed to burn injuries in the UK was estimated at 84.38 YLD per 100,000 (49.16-139.56), with the highest burden observed in England (88.90 per 100,000). Conclusion This study underscores the substantial disease burden imposed by burn injuries in the UK, alongside disparities in their distribution and warrant further studies in addressing the social and economic determinants of burn injuries.

Drug-induced liver injury related to gene therapy: A new challenge to be managed.

Gene therapy is being successfully developed for the treatment of several genetic disorders. Various methods of gene transfer have been developed to enable the production of the deficient enzyme or protein. One of the most important is adeno-associated virus vectors, which have been shown to be viable for use in invivo gene therapy. Several gene therapies have already been approved. They are also promising for acquired diseases. Important examples include gene therapy for haemophilia A and B, X-linked myotubular myopathy, spinal muscular atrophy and several liver diseases such as Criggler-Najjar disease, alpha-1 antitrypsin deficiency and Fabry disease. However, the introduction of a foreign compound into hepatocytes leads to hepatic reactions with heterogeneous phenotypic expression and a wide spectrum of severity, ranging from mild transaminase elevation to acute liver failure. Several mechanisms appear to be involved in liver injury, including an immune response, but also direct toxicity depending on the method of gene transfer. As a result, the incidence, expression and severity of liver injury vary from indication to indication and from patient to patient. Patients treated for haemophilia A are more prone to transaminase elevation than those treated for haemophilia B. Corticosteroids are successfully used to correct liver reactions but also to prevent degradation of the transferred gene and loss of therapeutic activity. The aim of this review is to describe the risk of liver injury according to the indication for gene therapy and the short- and long-term management currently proposed to prevent or correct liver reactions in clinical practice.