Injury Severity Outcomes Research Articles

Correlation between MRI findings and functional outcomes in patients with calf muscle strain injuries: a retrospective study on 78 patients

BackgroundCalf muscle strain injuries (CMSI), also known as “tennis leg,” are frequently observed in middle-aged and physically active people, including non-professional athletes. While magnetic resonance imaging (MRI) is frequently used to assess the extent of these injuries, the relationship between MRI findings and long-term functional outcomes in non-athletic populations remains underexplored. This study aimed to investigate the correlation between MRI-detected injury severity and functional outcomes using the Achilles Tendon Rupture Score (ATRS) and the Tegner Activity Scale (TAS).MethodsA retrospective review was conducted on 78 non-athletic patients diagnosed with CMSI and were followed for an average of 25.6 ± 16.1 months. Injury severity was classified into three grades: Grade 1 (edema without architectural disruption), Grade 2 (partial muscle disruption with hematoma), and Grade 3 (complete muscle disruption or tendon detachment) based on MRI examination. The functional outcomes were assessed using the ATRS and TAS. A simple linear regression analysis was conducted to assess the impact of demographic variables and MRI findings on ATRS.ResultsThe mean ATRS at the final follow-up was 92.9 ± 10.6, with 75.6% of patients achieving an excellent outcome. Despite the excellent ATRS scores, a notable reduction in TAS was evident from the pre-injury assessment (4.4 ± 1.2) to the final follow-up (3.8 ± 1.3; p < 0.001). Moreover, 44.9% of patients did not resume their pre-injury activity levels. The regression analysis demonstrated no statistically significant correlation between MRI-detected injury severity, demographic factors (age, gender, BMI), and ATRS outcomes (R² = 0.094, adjusted R² = -0.011).ConclusionMRI-detected injury severity does not significantly predict long-term functional outcomes in patients with CMSI, even though most patients achieved excellent ATRS scores. However, nearly half of the patients did not return to their pre-injury activity levels. These findings suggest that additional factors might influence recovery, and further research is needed to elucidate these factors in non-athletic patients.Level of evidenceLevel IV, Retrospective case series.

Handy Insights: Could Online Patient-Reported Outcome Measures be used to Assess Hand Injury Rehabilitation?

This protocol explores the use of online patient-reported outcome measures (PROMs) to assess recovery following hand trauma surgery. Hand injuries significantly impact patients’ functional abilities and quality of life, making PROMs crucial for tracking recovery and guiding rehabilitation. This study leverages online versions of the Michigan Hand Outcomes Questionnaire (MHQ) and Hand Injury Severity Score (HISS) to assess patient perceptions of their recovery over time.Our prospective cohort study involves 250 participants who will complete these PROMs at four intervals post-surgery. We aim to understand how demographic factors such as age, gender, and injury severity influence recovery perceptions and outcomes. This research seeks to enhance patient care by identifying factors that influence postoperative outcomes and by tailoring rehabilitation strategies accordingly.•Prospective cohort study following hand trauma surgery.•Online PROMs using the MHQ and HISS.•Data collection at four time points: baseline, 2-4 weeks, 6-8 weeks, and 10-14 weeks post-surgery.By making these tools accessible online, this protocol aims to improve patient engagement, increase response rates, and provide valuable insights to guide personalized rehabilitation strategies.

Impact of speed on injury severity in single-vehicle run-off-road crashes: Insights from partially temporal constrained modeling approach

Single-vehicle run-off-road crashes accounts for approximately 35% of all the traffic fatalities in the U.S during the period of 2019–2021. This paper explores the association between driving speed and injury severity outcomes of single-vehicle run-off-road crashes. The single-vehicle run-off-road crash data from 2019 to 2021 on Interstate freeways in Florida are utilized, and categorized into periods of pre-, during-, and post-COVID-19 pandemic. The partially constrained temporal and temporal unconstrained random parameters logit models are developed considering three injury severity outcomes: no injury, minor injury and serious injury/fatality. Multiple variables in terms of driver, vehicle, roadway, environmental, crash, and temporal attributes are observed to significantly affect the injury severity. Moreover, temporal instability and transferability issues are validated through likelihood ratio test and out-of-sample prediction. In the partially constrained models, numerous variables such as indicators of new vehicle, male driver, and restraint-protected driving consistently yield identical parameter values across all periods, whereas various variables clearly illustrate the distinct differences across the three periods and three speed intervals. The marginal effects in the unconstrained models also display the obvious differences across three periods and three speed intervals. Moreover, the findings corroborate the increased risk outcomes linked to larger speed differences and the COVID-19 pandemic period. These results provide better understanding of the risk mechanisms underlying run-off-road crashes and furnish valuable direction for the formulation of effective safety interventions.

Spatiotemporal analysis of roadway terrains impact on large truck driver injury severity outcomes using random parameters with heterogeneity in means and variances approach

This study employs a partially temporally constrained modeling approach to examine spatiotemporal variations in driver injury severity in single-vehicle large truck crashes across different terrains in California, allowing for a nuanced understanding of how specific factors influencing injury outcomes may change over time. Utilizing crash data from January 1st, 2015, to December 31st, 2017, obtained from the Highway Safety Information System, this study categorizes terrains as flat, rolling, and mountainous terrain and employs a random parameter multinomial logit model with heterogeneity in means and variance to account for potential heterogeneity in crash injury outcomes. This approach helps understand how different terrains influence injury severities while allowing for parameter variability across observations. The analysis is further enriched by likelihood ratio tests to verify the stability and temporal transferability of the model estimates across different terrains and years. Notably, the study identifies truck overturning as the first and second event in a crash as a consistent parameter influencing injury severity across all years, emphasizing its importance regardless of terrain or time in single-vehicle large truck crashes. Furthermore, this study takes into account a wide range of variables, including driver characteristics, crash attributes, roadway characteristics, vehicle features, and environmental and temporal aspects. The findings highlight the importance of terrain-specific elements in traffic safety assessments and the need for focused measures to reduce serious injuries in truck crashes. The out-of-sample simulation revealed a significant increase in minor and severe injuries when flat terrain parameters were replaced with those from rolling or mountainous terrains. This research not only contributes to the existing literature by detailing the dynamics of injury severity in single-vehicle large truck crashes but also announces the utility of partially temporally constrained models in enhancing traffic safety management strategies.

The Role of Neuroinflammation in Shaping Neuroplasticity and Recovery Outcomes Following Traumatic Brain Injury: A Systematic Review.

Neuroplasticity and neuroinflammation are variables seen during recovery from traumatic brain injury (TBI), while biomarkers are useful in monitoring injury and guiding rehabilitation efforts. This systematic review examines how neuroinflammation affects neuroplasticity and recovery following TBI in animal models and humans. Studies were identified from an online search of the PubMed, Web of Science, and Embase databases without any search time range. This review has been registered on Open OSF (n) UDWQM. Recent studies highlight the critical role of biomarkers like serum amyloid A1 (SAA1) and Toll-like receptor 4 (TLR4) in predicting TBI patients' injury severity and recovery outcomes, offering the potential for personalized treatment and improved neurorehabilitation strategies. Additionally, insights from animal studies reveal how neuroinflammation affects recovery, emphasizing targets such as NOD-like receptor family pyrin domain-containing 3 (NLRP3) and microglia for enhancing therapeutic interventions. This review emphasizes the central role of neuroinflammation in TBI, and its adverse impact on neuroplasticity and recovery, and suggests that targeted anti-inflammatory treatments and biomarker-based personalized approaches hold the key to improvement. Such approaches will need further development in future research by integrating neuromodulation and pharmacological interventions, along with biomarker validation, to optimize management in TBI.

Modified Revised Trauma–Marshall Score as a Proposed Tool in Predicting the Outcome of Moderate and Severe Traumatic Brain Injury

Modified Revised Trauma–Marshall Score as a Proposed Tool in Predicting the Outcome of Moderate and Severe Traumatic Brain Injury

Examining Nursing Medical Malpractice Cases Related to Medications.

The aim of this study was to analyze medication-related nursing medical malpractice cases to gain insights regarding how malpractice risk can be reduced. The criminal prosecution and verdict of nurse RaDonda Vaught focused attention on the potential medicolegal risk for nurses related to medications. Medication-related medical malpractice cases involving nurses were obtained from a national database. Various attributes of these cases were examined, including contributing factors, injury severity, and case outcomes. Authors identified 231 nursing medication-related medical malpractice cases closed from 2017 to 2021. The most frequent adverse events involved medication administration. Not following policies or protocols was the most common contributing factor. Opioids and epinephrine were the medications most frequently involved in the cases. Indemnity payments were made in 56.3% of the cases, with an average indemnity payment of $366 002. Nursing medication-related medical malpractice cases are relatively uncommon, which may reassure nurses regarding medicolegal risk. Medications and contributing factors involved in the cases suggest patient safety interventions including education related to policies, procedures, and protocols.

The Effect of Corticosteroids on the Progression and Outcomes of Polytrauma in Children

Polytrauma in children are among the most common causes of death in the pediatric intensive care unit (ICU).The aim of this study was to evaluate the effect of systemic corticosteroids (SCS) on the progression, laboratory parameters, and outcomes of severe multiple injuries in children requiring ICU.Materials and methods. A retrospective, observational, multicenter (case-control and cross-sectional) study included 203 patients from pediatric ICUs across the Russian Federation. The Abbreviated Injury Scale (AIS) score was 36.81 (25–48), and the Pediatric Trauma Score (PTS) was 5.2 (2–8). SCS were administered to 113 (55.7%) children, 19 (9.36%) of whom died.Results. The most severe changes in laboratory parameters, such as an increase in amylase (35.3 vs. 18.3; P0.001) and activated partial thromboplastin time (APTT) (28.9 vs. 25.8; P0.001), were documented upon admission of children with multiple traumatic injuries to the hospital compared with subsequent days of treatment in the ICU. The average fluid volume (as a percentage of age-related fluid requirements) on the first day of treatment in the ICU was 118.53% and did not exceed 84.42% on subsequent days (P0.001). Higher systolic blood pressure (SBP) during the first three days of ICU treatment was observed in children treated without SCS. SBP tended to decrease by day 5, and then a tendency toward arterial hypertension emerged on days 6–7. In children treated with SCS, blood pressure remained stable during the first seven days in the ICU, contributing to a favorable outcome.Conclusion. The use of SCS in children with severe polytrauma from the first day of ICU treatment contributed to the stabilization of hemodynamic parameters and improved control of shock signs. A positive response to SCS in these patients can be considered a marker for a favorable disease course during ICU treatment.

Retrospective analysis of fractures in crab-eating foxes (Cerdocyon thous)

This study assessed axial and appendicular fractures in crab-eating foxes (Cerdocyon thous; Linnaeus, 1766) admitted to the Reference Center for Wildlife. Medical records and plain radiographs of C. thous were retrospectively evaluated. Seventy-four free-ranging C. thous were admitted over 10 years, of which 21 had fractures in the appendicular and/or axial skeleton. Appendicular skeleton fracture was verified in 42.86 % of the animals, five of whom had long bone involvement and four the hip bones. More than one fracture in the appendicular skeleton occurred in 14.28 % of the animals, with the most common being a long bone fracture with a hip fracture. Axial skeleton fractures were observed in 9.52 % of the cases, with one fracture located in the vertebral column and the other in the head. Five animals died and nine were euthanized due to injury severity, prognosis and/or poor outcome after treatment. Seven animals showed good evolution after treatment, and four animals were released. In conclusion, hip bone fractures, isolated or combined with injuries to other bones of the axial and/or appendicular skeleton, were the most common injuries in C. thous. The characteristics of multiple trauma were associated with high mortality and complications.

Determinants influencing alcohol-related two-vehicle crash severity: A multivariate Bayesian hierarchical random parameters correlated outcomes logit model

Alcohol-related driving remains a significant concern due to its profound association with the likelihood of traffic crashes and the severity of resulting injuries, especially between two vehicles. To investigate the determinants influencing the alcohol-related two-vehicle crash severity, a foundational framework employed was a multinomial logit model. Meanwhile, by incorporating random intercept from individual case and vehicle levels to accommodate unobserved heterogeneity, and covariance matrices to underscore correlated outcomes, a multivariate hierarchical random parameters correlated outcomes logit model was proposed. Additionally, to further explore the potential temporal instability of explanatory variables, a random slope from a per-year indicator was introduced into the model. Crash data from the US Statewide Integrated Traffic Records System (SWITRS) database spanning from January 1, 2016, to December 31, 2021, was used. Three crash injury severity categories were examined, encompassing severe injury, minor injury, and no injury, with characteristics related to the driver, vehicle, road, environment, crash, and time serving as explanatory variables. The model results highlighted significant heterogeneity, with each case and vehicle accounting for 56.9% of the total variance for minor injuries and 50.8% for severe injuries. Furthermore, a significant negative correlation was explicitly exhibited between minor injury and severe injury outcomes at the case level. In terms of potential temporal instability, we provided per-year (2016–2019) parameter estimates and identified significant instability for indicators such as non-intersection, broadside and head-on collisions, cloudy weather conditions, and drivers who had been drinking but were not under the influence. Considering the impact of the COVID-19 pandemic, we divided the accident time into pre-COVID and during-COVID periods, modeling parameter estimates for both periods. This analysis revealed significant instability in several factors influenced by the pandemic. Additionally, noteworthy disparities in the estimated results of explanatory variables emerged in comparison to those general two-vehicle crashes or alcohol-related crashes, providing valuable insights. For instance, drivers who had been drinking but were not under the influence were less likely to sustain severe injuries, but the probability of minor injuries increased. These findings underscore the significance of thorough investigations into the determinants of injury severity in alcohol-impaired two-vehicle crash severity, along with the temporal instability of such factors. They hold important implications for effective traffic safety management and the formulation of prohibitive countermeasures.

A comparison between bridge-related and non-bridge crashes: severity, vehicle involvement, and motorists’ characteristics

Objectives Bridges, though representing a small portion of transport networks by length, are still prone to traffic crashes. Despite extensive research on bridge-related crashes globally, there’s a scarcity of studies exploring differences between bridge- and non-bridge-related crashes. Thus, this paper attempts to add to the current knowledge by comparing bridge-related crashes and non-bridge crashes using a case study in Victoria, Australia. Methods By utilizing crash data in Victoria between January 2006 and April 2023; the Chi-squared test is conducted to examine differences between crash types. Partial proportion odds models are then employed to establish if bridge-related crashes tend to be more severe. Results In general, the analysis reveals that bridge-related crashes tend to result in more severe injury outcomes compared to non-bridge crashes. Furthermore, there is evidence that bridge-related crashes are more likely to be single-vehicle, to involve a heavy vehicle as well as young/male motorists, and to occur on high-speed roads, regional areas and at nighttime than non-bridge crashes. Conclusions A targeted program aiming at enhancing traffic safety at bridges is recommended due to the higher severity of bridge-related crashes. Considering the presence of bridges on the road network, and particularly in regional areas where many are in poorer conditions, it is essential to consider retrofitting as well as low-cost solutions in order to complement motorist education and awareness programs. Specific groups with higher risks of being involved in bridge-related crashes, such as young male motorists, should be targeted in these programs.

Perfusion imaging metrics after acute traumatic spinal cord injury are associated with injury severity in rats and humans.

Traumatic spinal cord injury (tSCI) causes an immediate loss of neurological function, and the prediction of recovery is difficult in the acute phase. In this study, we used contrast-enhanced ultrasound imaging to quantify intraspinal vascular disruption acutely after tSCI. In a rodent thoracic tSCI model, contrast-enhanced ultrasound revealed a perfusion area deficit that was positively correlated with injury severity and negatively correlated with hindlimb locomotor function at 8 weeks after injury. The spinal perfusion index was calculated by normalizing the contrast inflow at the injury center to the contrast inflow in the injury periphery. The spinal perfusion index decreased with increasing injury severity and positively correlated with hindlimb locomotor function at 8 weeks after injury. The feasibility of intraoperative contrast-enhanced ultrasound imaging was further tested in a cohort of 27 patients with acute tSCI of varying severity and including both motor-complete and motor-incomplete tSCIs. Both the perfusion area deficit and spinal perfusion index were different between motor-complete and motor-incomplete patients. Moreover, the perfusion area deficit and spinal perfusion index correlated with the injury severity at intake and exhibited a correlation with extent of functional recovery at 6 months. Our data suggest that intraoperative contrast-enhanced, ultrasound-derived metrics are correlated with injury severity and chronic functional outcome after tSCI. Larger clinical studies are required to better assess the reliability of the proposed contrast-enhanced ultrasound biomarkers and their prognostic capacity.

Investigating factors affecting injury severity of single-vehicle run-off-road crashes

This study aimed to identify and investigate the contributing factors influencing injury severity in single-vehicle run-off-road (ROR) crashes, which are known for their high severity. The primary objective was to analyze and compare the impact of these factors across three distinct vehicle classes: passenger cars, sport utility vehicles (SUVs), and pickups. A mixed logit model with heterogeneity in mean and variance was developed to analyze the injury severity outcomes in ROR crashes for the three vehicle classes. The model accounted for the potential variations in the impact of contributing factors across different vehicle types. The study revealed several significant variables consistently influencing injury severity across all three vehicle classes. These included driver age, alcohol or drug usage, seatbelt utilization, airbag deployment, higher travel speeds, and the vehicle model year post-2010. Notably, as driver age increased, the impact on changes in injury severity outcomes was more pronounced for pickup drivers compared to those operating passenger cars and SUVs. Among the common findings was the highly effective role of seatbelt usage in mitigating injury severity in ROR crashes. Additionally, passenger cars were associated with increased injury severity, particularly at relatively higher travel speeds exceeding 75 mph when contrasted with SUVs and pickups traveling between 61 and 75 mph. The study highlights the importance of considering vehicle class-specific factors in analyzing injury severity in ROR crashes. Recommendations include further in-depth investigations into distinct factors contributing to injury severity within each vehicle class and utilizing more extensive crash datasets to gain additional insights for enhancing road safety.

Preterm Sex Differences in Neurodevelopment and Brain Development from Early Life to 8 Years of Age

To examine sex differences in neurodevelopmental outcomes and brain development from early life to 8 years in males and females born preterm. This was a prospective cohort study of infants born very preterm (24-32 weeks' gestation) and followed to 8 years with standardized measures of neurodevelopment. Brain magnetic resonance imaging (MRI) scans were performed soon after birth, term-equivalent age, and 8 years. The relationship between sex, severe brain injury, early pain exposure, fractional anisotropy (FA), and neurodevelopmental outcomes were assessed using multivariable generalized estimating equations. Males (N=78) and females (N=66) were similar in clinical risk factors. Male sex was associated with lower cognitive scores (β=-3.8, P=0.02) and greater motor impairment (OR=1.8, P=0.04) across time. Male sex was associated with lower superior white matter FA across time (β=-0.01, P=0.04). Sex moderated the association between severe brain injury, early pain, and neurodevelopmental outcomes. With severe brain injury, males had lower cognitive scores at 3 years (P<0.001). With increasing pain, females had lower cognitive scores at 8 years (P=0.008), and males had greater motor impairment at 4.5 years (P=0.001) and 8 years (P=0.05). Males born preterm had lower cognitive scores and greater motor impairment compared with females, which were associated with differences in white matter maturation. The association between severe brain injury, early pain exposure, and neurodevelopmental outcomes was moderated by sex, indicating a differential response to early-life adversity in males and females born preterm.

Persistent pulmonary hypertension and short-term neurological outcomes in infants with moderate to severe hypoxic ischemic encephalopathy.

Our aim was to investigate the relationship between persistent pulmonary hypertension of the newborn (PPHN), short-term brain injury or death, and clinical parameters in infants with moderate to severe hypoxic ischemic encephalopathy (HIE). Retrospective single-center cohort study of 274 HIE infants, 230 underwent Therapeutic Hypothermia (TH). Primary outcome was severe HIE brain injury on MRI and/or death within the first month of life in relation to presence and severity of PPHN (clinical or echocardiographic). Secondary outcomes were HIE brain injury pattern, abnormal electroencephalogram (EEG), seizures, clinical, and laboratory differences. A logistic regression model was performed to evaluate PPHN presence and severity as risk factor for brain injury or death. The combined outcome of severe brain injury or death was higher in the clinical PPHN group vs non-PPHN (32.6 vs 22.8%, p = 0.014). There was no difference in brain injury, seizure burden or EEG abnormalities associated with PPHN, despite those with PPHN being sicker with higher ventilation needs and worse laboratory values than those without. Mortality had a strong correlation with echocardiographic PPHN with the highest incidence in severe (36%) vs moderate (7.7%) vs mild PPHN (10%, p = 0.002). Highest mortality had those with 'early exit' who did not complete 72 hours of TH (71.4%). In infants with HIE, PPHN was not associated with increased risk of brain injury as evident on MRI, nor seizure burden, despite being sicker with worse laboratory values. However, mortality rates were higher the worse the PPHN, especially with early exit from TH.

Thalamic volume in very preterm infants: associations with severe brain injury and neurodevelopmental outcome at two years.

Several studies demonstrate the relationship between preterm birth and a reduced thalamus volume at term-equivalent age. In contrast, this study aims to investigate the link between the thalamic growth trajectory during the early postnatal period and neurodevelopment at two years of age. Thalamic volume was extracted from 84 early MRI scans at postmenstrual age of 32.33 (± 2.63) weeks and 93 term-equivalent age MRI scans at postmenstrual age of 42.05 (± 3.33) weeks of 116 very preterm infants (56% male) with gestational age at birth of 29.32 (± 2.28) weeks and a birth weight of 1158.92 (± 348.59) grams. Cognitive, motor, and language outcomes at two years of age were assessed with Bayley Scales of Infant and Toddler Development Third Edition. Bivariate analysis was used to describe the clinical variables according to neurodevelopmental outcomes and multilevel linear regression models were used to examine the impact of these variables on thalamic volume and its relationship with neurodevelopmental outcomes. The results suggest an association between severe brain injury and thalamic growth trajectory (β coef = -0.611; p < 0.001). Moreover, thalamic growth trajectory during early postnatal life was associated with the three subscale scores of the neurodevelopmental assessment (cognitive: β coef = 6.297; p = 0.004; motor: β coef = 7.283; p = 0.001; language: β coeficient = 9.053; p = 0.002). These findings highlight (i) the impact of severe brain injury on thalamic growth trajectory during early extrauterine life after preterm birth and (ii) the relationship of thalamic growth trajectory with cognitive, motor, and language outcomes.

Rethinking cycling safety: The role of gender in cyclist crash injury severity outcomes

Given the ongoing climate crisis and the need for environmentally friendly communities, there has been an increasing interest in sustainable mobility solutions such as cycling. This study seeks to incorporate an equitable component to studying cycling safety and uses one full year’s data of 4,457 single bicycle-single motor vehicle crashes that took place in 2022 in the state of Florida to estimate a series of random parameters multinomial logit models with heterogeneity in the means and variances to capture gender differences in outcome severities. A comparison of advanced statistical models such as unconstrained and partially constrained approaches, that were previously employed in the literature to test for temporal stability, is undertaken in a new application. A partially constrained model is estimated to best identify gender specific factors and argue the need to evaluate and promote safety of female and male cyclists separately. The study finds substantial differences between how the contributing factors and crash circumstances impact the crash injury severity of women and men cyclists. It evaluates factors such as age, location, cyclist behavior, weather, and road design as well as performs out-of-sample simulation to gain additional insights. The findings of this research emphasize the need for targeted approaches in designing our cities and policy making that account for the collective differences in behavior and experience of women and men cyclists.

Analysis of the current usage of resuscitative endovascular balloon occlusion of the aorta (REBOA) in pediatric trauma patients: a retrospective observational study from the American College of Surgeons–Trauma Quality Improvement Program databases

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) has been an established life-saving procedure for adult trauma patients, but the evidence for its use in pediatric patients is still under...

Exploratory analysis of injury severity under different levels of driving automation (SAE Levels 2 and 4) using multi-source data

Vehicles equipped with automated driving capabilities have shown potential to improve safety and operations. Advanced driver assistance systems (ADAS) and automated driving systems (ADS) have been widely developed to support vehicular automation. Although the studies on the injury severity outcomes that involve automated vehicles are ongoing, there is limited research investigating the difference between injury severity outcomes for the ADAS and ADS equipped vehicles. To ensure a comprehensive analysis, a multi-source dataset that includes 1,001 ADAS crashes (SAE Level 2 vehicles) and 548 ADS crashes (SAE Level 4 vehicles) is used. Two random parameters multinomial logit models with heterogeneity in the means of random parameters are considered to gain a better understanding of the variables impacting the crash injury severity outcomes for the ADAS (SAE Level 2) and ADS (SAE Level 4) vehicles. It was found that while 67 percent of crashes involving the ADAS equipped vehicles in the dataset took place on a highway, 94 percent of crashes involving ADS took place in more urban settings. The model estimation results also reveal that the weather indicator, driver type indicator, differences in the system sophistication that are captured by both manufacture year and high/low mileage as well as rear and front contact indicators all play a role in the crash injury severity outcomes. The results offer an exploratory assessment of safety performance of the ADAS and ADS equipped vehicles using the real-world data and can be used by the manufacturers and other stakeholders to dictate the direction of their deployment and usage.

Urinary renal tubular epithelial cells and casts as predictors of renal outcomes in patients with biopsy-proven diabetic nephropathy.

Urine sediment examination is a time-tested and non-invasive diagnostic tool. Thisstudy investigated the characteristics of urine sediment and its association with severity and renal outcomes in diabetic nephropathy (DN) patients. A total of 201 biopsy-proven diabetic nephropathy patients (according to the pathological classification of diabetic nephropathyproposed by the Renal Pathology Society in 2010)who underwent manual urine sediment microscopic examination were included. We compared the clinicopathologicalcharacteristics of diabetic nephropathy patients with and without urinary renal tubular epithelial cells (RTECs) or renal tubular epithelial cell casts. The predictive value of urinary renal tubular epithelial cells or renal tubular epithelial cell casts for renal outcomes in diabetic nephropathy was analyzed. Fifty of 201 (24.9%) diabetic nephropathy patients had renal tubular epithelial cells or renal tubular epithelial cell casts in urine sediment. Diabetic nephropathy patients with renal tubular epithelial cells or renal tubular epithelial cell casts in urine sediment had a significantly higher level of proteinuria [6.0 (3.1, 9.7)vs.3.6 (1.8, 6.8) g/24h, p = 0.001], higher serum creatinine [227.9 (151.6, 338.1)vs.177.0 (104.4, 288.4) μmol/L, p = 0.016] and lower estimated glomerular filtration rate (eGFR) [25.8 (15.8, 44.8)vs.35.7 (19.9, 65.0) mL/min/1.73m2, p = 0.025] than those without.Cox regression analysis demonstrated that the presence of urinaryrenal tubular epithelial cells or renal tubular epithelial cell casts was independently associated with the development of end-stage kidney disease (ESKD) in diabetic nephropathy patients [HR 1.670, 95% CI (1.042, 2.676), p = 0.033]. Adding the presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts to the predictive model could improve the effectiveness of the model for predicting the risk of ESKD within one year after renal biopsy. The presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts was associated with more severe kidney injury and worse renal outcomes in patients with diabetic nephropathy, thus perhaps providing a noninvasive biomarker for predicting diabetic nephropathy.