Location Of Injury Research Articles

FIRST AID EDUCATION DURING INJURY IN CHILDREN WITH RICE METHOD AT SEKOLAH INDONESIA SINGAPURA (SIS)

First Aid is an aid for emergency treatment of victims before help is provided by medical personnel. Injuries can occur anywhere, the location of injuries often occurs especially in the home and school environment. School-age children are a group that is vulnerable to injury, especially when entering celementary school. Injuries can become an emergency case and cause serious injuries and even death if not handled properly. To prevent injuries in children from getting worse, one of the methods that can be used to treat is the RICE (Rest, Ice, Compression, Elevation) method, which can first rest the injured part, apply an ice pack to reduce swelling, bandage the injured skin and elevate the injured area above the height of the heart area. First Aid community service with the RICE method at Sekolah Indonesia Singapura (SIS) is a positive activity that aims to increase children's knowledge and ability to perform first aid when injured or when children know other people are injured. The method used is counseling about first aid for injuries using the RICE method, demonstrating and distributing leaflets. The results of the analysis of children's ability to understand first aid material when injured with the RICE method before and after education is 30 (with an average pre test score of 70 and post test 100). The increase in participants' knowledge proves that with this counseling participants become more aware of what is related to first aid during injuries that can be treated with the RICE method to prevent more severe injuries. Keywords; First Aid, Emergency, RICE, Children

French mobile neurosurgical unit: a retrospective analysis of 22 years of mission

IntroductionThe French mobile neurosurgical unit (MNSU) is used to provide specific support to remote military medicosurgical units deployed in foreign theatres. If a neurosurgical casualty is present, the Role 2...

Postoperative opioid consumption patterns diverge between propensity matched patients undergoing traumatic and elective cervical spine fusion

BACKGROUND CONTEXTProlonged opioid therapy following spine surgery is an ongoing postoperative concern. While prior studies have investigated postoperative opioid use patterns in the elective cervical surgery patient population, to our knowledge, opioid use patterns in patients undergoing surgery for traumatic cervical spine injuries have not been elucidated. PURPOSEThe purpose of this study was to compare opioid use and prescription patterns in the postoperative pain management of patients undergoing traumatic and elective cervical spine fusion surgery. STUDY DESIGNRetrospective cohort study. PATIENT SAMPLEAdult patients with traumatic cervical injuries who underwent primary anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) during their initial hospital admission. The propensity matched, control group consisted of adult elective cervical fusion patients who underwent primary ACDF or PCDF. OUTCOME MEASURESDemographic data, surgical characteristics, spinal disease diagnosis, location of cervical injury, procedure type, operative levels fused, and Prescription Drug Monitoring Program (PDMP) data. PDMP data included the number of opioid prescriptions filled, preoperative opioid use, postoperative opioid use, and use of perioperative benzodiazepines, muscle relaxants, or gabapentin. Opioid consumption data was collected in morphine milligram equivalents (MME) and standardized per day. METHODSA 1:1 propensity match was performed to match traumatic injury patients undergoing cervical fusion surgery with elective cervical fusion patients. Traumatic injury patients were matched based on age, sex, CCI, procedure type, and cervical levels fused. Pre- and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use were assessed for the traumatic injury and elective patients. T- or Mann-Whitney U tests were used to compare continuous data and Chi-Squared or Fisher's Exact were used to compare categorical data. Multivariate stepwise regression using MME per day 0 – 30 days following surgery as the dependent outcome was performed to further evaluate associations with postoperative opioid use. RESULTSA total of 48 patients underwent fusion surgery for a traumatic cervical spine injury and 48 elective cervical fusion with complete PDMP data were assessed. Elective patients were found to fill more prescriptions (3.19 vs 0.65, p=.023) and take more morphine milligram equivalents (MME) per day (0.60 vs 0.04, p=.014) within 1 year prior to surgery in comparison to traumatic patients. Elective patients were also more likely to use opioids (29.2% vs 10.4%, p=.040) and take more MMEs per day (0.70 vs 0.05, p=.004) within 30 days prior to surgery. Within 30 days postoperatively, elective patients used opioids more frequently (89.6% vs 52.1%, p<.001) and took more MMEs per day (3.73 vs 1.71, p<.001) than traumatic injury patients. Multivariate stepwise regression demonstrated preoperative opioid use (Estimate: 1.87, p=.013) to be correlated with higher postoperative MME per day within 30 days of surgery. Surgery after traumatic injury was correlated with lower postoperative MME use per day within 30 days of surgery (Estimate: −1.63 p=.022). CONCLUSIONCervical fusion patients with a history of traumatic spine injury consume fewer opioids in the early postoperative period in comparison to elective cervical fusion patients, however both cohorts consumed a similar amount after the initial 30-day postoperative period. Preoperative opioid use was also a risk factor for higher consumption in the short-term postoperative period. These results may aid physicians in further understanding patients’ postoperative care needs based on presenting injury characteristics and highlights the need for enhanced follow-up care for traumatic cervical spine injury patients after fusion surgery.

The safety effect of increased pedestrian protection, autonomous emergency braking for pedestrians and bicyclists on passenger cars, and speed management

This was the first retrospective study to estimate the effect of increased pedestrian protection, autonomous emergency braking, and speed management to reduce serious injuries among pedestrians and bicyclists. More specifically, the aim was to estimate the injury mitigating effects of the following interventions: AEB with pedestrian and bicyclist detection, Euro NCAP pedestrian test score, active bonnet, traffic calming at pedestrian and bicycle crossings, and additionally, the combined effect of the above-mentioned treatments. The main source of data was the Swedish traffic data acquisition system (Strada), where information of road traffic crashes between passenger cars and pedestrians or bicyclists for the period 1 January 2003–31 December 2022 was obtained. Cars with optional fitment of AEB systems were identified, and the license registration number was used to access individual car equipment lists to identify whether the vehicle was equipped with AEB with pedestrian and/or cyclist detection. Information about traffic calming at pedestrian and bicycle crossings was obtained from the Swedish Transport Administration. The injury metric used was risk of permanent medical impairment (RPMI) of at least one percent and ten percent. RPMI captures the risk of long-term medical impairment based on a diagnosed injury location and Abbreviated Injury Severity (AIS) score. The relative difference between the mean values of RPMI (mRPMI1%+ and mRPMI10%+) was calculated and tested using an independent two sample t-test which was conducted for unequal sample sizes and variance. Although many results were found to be statistically non-significant, the following results were found to be significant at least at 90% level. Pedestrian mRPMI10%+ was reduced by 44% in speed zones ≤ 50 km/h comparing the group struck by cars equipped with AEB with pedestrian detection compared to the group struck by cars without the system. For cyclists, the mRPMI10%+ was reduced by 35% in speed zones ≤ 50 km/h. For crashes within ± 20 meters from a pedestrian or bicycle crossing, the AEB system reduced 60% of pedestrians mRPMI10%+ at crossings with good safety standard compared to crossings of poor safety standard. The comparison of cars with poor performance (1–9 points) in the NCAP pedestrian test and cars with a high score (28–36 points) showed that pedestrian mRPMI10%+ was reduced by 48% across all speed limits, and by 64% including only those aged ≤ 64 years. For bicyclists, a significant reduction of cyclist mRPMI10%+ was found comparing low scoring cars to high scoring cars in ≤ 30 km/h speed limit (-73%) and across all speed limits (-36%). Including only those aged ≤ 64 years, the reduction was 49%. For the active bonnet, a significant reduction of mRPMI1%+ by 24% was observed but given that the rate of helmet wearing was higher in the group struck by cars with active bonnet, this difference cannot be attributed to an effect of an active bonnet. The STA safety rating of pedestrian and bicycle crossings showed that overall pedestrian mRPMI1%+ was reduced by 15%, while cyclists mRPMI10%+ was reduced by 32% comparing crossings of high safety level to crossings of poor safety level. The analysis of combined interventions showed that the total reduction of pedestrians and cyclists mRPMI10%+ together was 69%, from 6.4% to 2%. This paper demonstrates that a road environment with adapted infrastructure and speed, combined with passenger car technologies that improve the safety for vulnerable road users, can create significant reductions of serious (long-term) injuries among pedestrians and bicyclists.

Predicting Musculoskeletal Loading at Common Running Injury Locations Using Machine Learning and Instrumented Insoles.

Wearables have the potential to provide accurate estimates of tissue loads at common running injury locations. Here we investigate the accuracy by which commercially available instrumented insoles (ARION; ATO-GEAR, Eindhoven, The Netherlands) can predict musculoskeletal loading at common running injury locations. Nineteen runners (10 males) ran at five different speeds, four slopes, with different step frequencies, and forward trunk lean on an instrumented treadmill while wearing instrumented insoles. The insole data were used as input to an artificial neural network that was trained to predict the Achilles tendon strain, and tibia and patellofemoral stress impulses and weighted impulses (damage proxy) as determined with musculoskeletal modeling. Accuracy was investigated using leave-one-out cross-validation and correlations. The effect of different input metrics was also assessed. The neural network predicted tissue loading with overall relative percentage errors of 1.95 ± 8.40%, -7.37 ± 6.41%, and -12.8 ± 9.44% for the patellofemoral joint, tibia, and Achilles tendon impulse, respectively. The accuracy significantly changed with altered running speed, slope, or step frequency. Mean (95% confidence interval) within-individual correlations between modeled and predicted impulses across conditions were generally nearly perfect, being 0.92 (0.89 to 0.94), 0.95 (0.93 to 0.96), and 0.95 (0.94 to 0.96) for the patellofemoral, tibial, and Achilles tendon stress/strain impulses, respectively. This study shows that commercially available instrumented insoles can predict loading at common running injury locations with variable absolute but (very) high relative accuracy. The absolute error was lower than the methods that measure only the step count or assume a constant load per speed or slope. This developed model may allow for quantification of in-field tissue loading and real-time tissue loading-based feedback to reduce injury risk.

Examining the role of social vulnerability, neighborhood characteristics, and geospatial patterns of firearm-related injuries and clinical outcomes in Milwaukee county

BackgroundPrevious work has shown socioenvironmental factors can influence firearm injury. Milwaukee County, Wisconsin is a diverse midwestern county with historic disinvestment in marginalized communities yielding stark segregation along racial and ethnic lines. It is also one of the many U.S. counties burdened by surging firearm injuries. The differences among communities within Milwaukee County provides a unique opportunity to explore the intersection of socioenvironmental factors that may affect clinical outcomes and geospatial patterns of firearm injury. MethodsThe trauma registry from the regional adult level 1 trauma center was queried for patients who sustained a firearm-related injury from 2015 to 2022 (N = 2402). The Social Vulnerability Index (SVI) ranking was derived using patient residence addresses to evaluate its association with traumatic injury clinical outcomes (i.e., in-hospital mortality, length of hospital stay, ICU or ventilator treatment, or injury severity score) and risk screening results for alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and depression. We evaluated hotspots of firearm injury density over time for patient residences and injury locations and distances between locations. A spatially lagged regression model tested the association between firearm injury density and SVI domains, alcohol outlet types, and park coverage. ResultsMost firearm injury patients were younger, male, racial or ethnic minorities from disadvantaged neighborhoods (SVI total; M = 0.86, SD = 0.15). SVI was not associated with any clinical outcomes. Of those screened, 12.9% screened positive for AUD and 44.5% screened at risk for PTSD, depression, or both. Hotspot analysis indicated consistent concentrations of firearm injury density. There were no differences in clinical outcomes between those injured inside or outside the home. Census tracts with lower socioeconomic status, greater off-premises and lower on-premises alcohol outlet density were associated with greater firearm injury density. ConclusionsIn Milwaukee County, firearm injury patients are injured in and often return to the same disadvantaged neighborhoods that may hamper recovery. Results replicate and expand previous work and implicate specific socioenvironmental factors for intervention and prevention of firearm injury.

Management of Suspected Peripheral Vascular Injuries in Orthopedic Trauma.

In orthopedic trauma, identification of extremity trauma combined with vascular injury is challenging. Missed diagnosis may result in amputation or even death. The purpose of this study was to investigate whether physical examination combined with handheld vascular ultrasound Doppler examination could be an effective method of screening for peripheral vascular injury and to explore the characteristics of vascular injuries in orthopedic trauma patients. Retrospective analysis of patients in the emergency department of orthopedic trauma in our hospital from January 2022 to October 2023. Physical examination combined with handheld vascular ultrasound Doppler examination was used as a screening method for suspected vascular injuries. Patients with suspected vascular injury would undergo further angiography and receive multidisciplinary treatment. Angiography was used as the gold standard for diagnosing vascular injuries. Patient demographics, mechanism of injury, location and type of injury, angiographic results, surgical notes, and early treatment outcome data were recorded. A total of 55 cases (58 limb injuries) with suspected vascular injury were ultimately included. Angiography revealed that 53 cases (55 limbs, positive rate 94.8%) were considered to have confirmed vascular injuries. Forty-three were male (81.1%) and 10 were female (18.9%), with mean age 44.1 ± 16.6 years. The main mechanism of injury was traffic accident (30, 56.7%). Most common site of vascular injuries was knee joint (30/55, 54.5%), and popliteal artery (23, 47.9%) was the most commonly injured blood vessel. After multidisciplinary collaborative treatment, overall patient mortality was 3.8% (2/53), and limb survival rate among surviving patients was 81.1% (43/53) in our study. In orthopedic trauma, "Hard signs" and "soft signs" combined with handheld vascular ultrasound Doppler examination were effective ways to screen for suspected vascular injuries. Most limbs had associated fractures or dislocations at the site of vascular injury. Collaboration of vascular surgery, microsurgery and orthopedic trauma may help improve patients' prognosis.

Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand.

The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care. This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85years in age who were injured in a road traffic crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were stratified by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural Māori, rural non-Māori, urban Māori, and urban non-Māori). In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous Māori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients' injuries occurred in a rural location. The EMS transport pathways to hospital for rural patients were slower to reach first hospital (total in slowest tertile of time 44% vs 7%, P ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, P = 0.001) compared to urban patients. Māori patients injured in a rural location were comparatively less likely than rural non-Māori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, P = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, P = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, P = 0.02). Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These findings, mirroring other health disparities for Māori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents.

Background: Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury among skiers, who form the largest patient cohort with aortic injuries in the alpine region of Tyrol, Austria. Methods: This retrospective, single-center study at the University Hospital of Innsbruck analyzed patients who underwent endovascular treatment for blunt traumatic aortic injury from 2005 to 2023. Patient data were extracted from electronic and digitalized medical history records. Subsequent analyses compared the baseline characteristics and clinical results of the skiing accident (SA) group to the motor vehicle accident (MVA) group. Results: A total of 48 BTAI patients receiving TEVAR were included, 25 (52%) from SAs versus 23 (48%) from MVAs, who were predominantly male (92% vs. 78.3%). Despite similar preoperative risk profiles and ASA Scores (1.44 vs. 1.74) and no marked differences in BTAI injury grades or the affected aortic zones, significant disparities emerged: the SA group experienced shorter median ICU stays (3 vs. 11 days, p = 0.0007), fewer concomitant injuries (5 vs. 7, p = 0.005), and lower Injury Severity Scores (ISSs) (29 vs. 33, p = 0.003) than their MVA counterparts. The presence of rib fractures alongside other thoracic injuries, such as lung injury, pneumothorax, or hemothorax, was strongly correlated with BTAI in patients following skiing accidents (OR = 128.5). Conclusions: The injury severities and locations of BTAI in SA patients were comparable to those in MVA patients, indicating similar mechanisms of thoracic trauma. However, the SA patients experienced fewer concurrent pelvic and extremity fractures, had less post-procedural morbidity, and required shorter ICU stays. The presence of rib fractures combined with other thoracic injuries strongly suggests BTAI. These indicators should lead to prompt imaging and appropriate therapy.

Skiing Injuries in the US Pediatric Population: An Analysis of National Injury Trends and Mechanisms Between 2012 and 2022.

While prevention protocols have been implemented, skiing-related musculoskeletal injuries and concussions continue to present to emergency departments in the United States. Previous literature has suggested the pediatric population may constitute up to 40% of skiing-related injuries. To assess injury trends and the underlying mechanisms of skiing injuries in pediatric patients seen at emergency departments in the United States. Descriptive epidemiology study. The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (age ≤18 years) skiing injuries between January 1, 2012, and December 31, 2022. Injury mechanism, location, disposition, and diagnosis were recorded, and the statistical sample weight assigned by NEISS by hospital was used to calculate national estimates (NEs). Injury trends were evaluated with linear regression analysis. Overall, 2951 pediatric skiing injuries were included (NE = 123,386). The mean age of the patients was 12.4 ± 3.5 years, with 61.3% of the injuries occurring in male patients. Impact with the ground was the most common injury mechanism (NE = 87,407; 70.8%). Fractures were the most common diagnosis (NE = 38,527, 31.2%), followed by strains/sprains (NE = 22,562, 18.3%), contusions/abrasions (NE = 16,257, 13.2%), and concussions (NE = 12,449, 10.1%). The lower leg was the most common fracture site (NE = 9509, 24.7%), followed by the shoulder (NE = 7131, 18.5%) and lower arm (NE = 5876, 15.3%). Analysis of annual injuries revealed no significant trend between 2012 and 2022 (P = .17), with fluctuations apparent throughout the study period. Significant decreases were seen in strains/sprains (P < .01) and contusions/abrasions (P < .01), but not in concussions (P = .57) or fractures (P = .70). Impacts with the snow/ground made up 70.8% of all injuries. Fractures were the most common injury diagnosis, followed by strains/sprains, with the lower leg being most frequently fractured. While strains/sprains and contusions/abrasions showed a significant decline, there were no significant trends in fractures and concussions between 2012 and 2022.

Injury and Treatment Characteristics of Middle School-Aged Patients Under the Care of Athletic Trainers From 2010 to 2022: A Report From the Athletic Training Practice-Based Research Network.

Exploring sports-related musculoskeletal injuries and treatment characteristics in middle school sports may help inform patient care decisions such as appropriate medical coverage. To describe injury and treatment characteristics of middle school-aged athletes receiving care from athletic trainers within the Athletic Training Practice-Based Research Network (AT-PBRN). Descriptive study. Middle school. Middle school-aged athletes (n = 1011; male = 503, female = 506, 2 declined to answer) with sports-related musculoskeletal injuries. Electronic patient records were analyzed from the AT-PBRN from 59 athletic trainers across 14 states between 2010 and 2022. Summary statistics (frequency, percentages, median, and interquartile ranges [IQR]) were used to describe injury (age at injury, sex, sport, body part, and diagnosis) and treatment characteristics (type of treatment, number of visits, and number of procedures per visit). Football (17.7%, n = 179), basketball (17.6%, n = 178), and soccer (14.9%, n = 151) reported the highest number of injuries. The ankle (17.2%, n = 174), knee (16.5%, n = 167), and head (14.1%, n = 143) were the most common injury locations. Concussion (13.0%, n = 131), ankle strain/sprain (12.4%, n = 125), and thigh/hip/groin sprain/strain (11.1%, n = 112) were the most reported diagnoses. Therapeutic exercise or activities (27.6%, n = 1068), athletic trainer evaluation or re-evaluation (24.7%, n = 957), and hot/cold packs (19.8%, n = 766) were the most common services, with a median of 2 visits (IQR = 1 to 4) and 2 procedures (IQR = 1 to 2) per visit. Football, basketball, and soccer reported the most musculoskeletal injuries for middle school-aged athletes. Concussions were the most frequent diagnosis, followed by ankle sprains/strains. Our findings are similar to prior investigations at the high school and collegiate levels. Treatments at the middle school level were also similar to those that have been previously reported at the high school level with therapeutic exercise/activity, athletic trainer evaluation or re-evaluation, and hot/cold packs being the most common treatments. This information may be useful for informing patient care decisions at the middle-school level.

Epidemiology of pediatric hand lacerations: a retrospective cohort study focusing on age and injury-causing objects

Purpose: This study analyzed the epidemiology of pediatric hand lacerations in children under 6 years old, focusing on age-related characteristics and the household objects that caused these injuries.Methods: We conducted a retrospective study of patients under 6 years old who presented with hand lacerations at our emergency department from January 2016 to December 2023. Data were collected on demographics, injury-related factors (the affected hand and finger, injury location, and injury-causing object), need for surgical intervention, and damage to deep structures. Patients were categorized as infants (0–1 years), toddlers (1–3 years), or preschoolers (3–6 years). We recorded the frequency, surgical intervention rates, and affected deep structures for each injury-causing object.Results: Of 153 children treated for hand lacerations, toddlers were the most frequently injured (47.7%), followed by preschoolers (44.4%) and infants (7.8%). The index and middle fingers were particularly vulnerable in toddlers and preschoolers, while infantile injuries more commonly affected the palm. Among 31 identified objects, knives/blades, particularly cutting knives (13.7%) and broken glass (13.1%), were the leading causes, with injuries occurring primarily at home. Surgical intervention was necessary in 11.1% of cases, with eyebrow razors (33.3%) most often requiring surgery and causing damage to deep structures, including arteries, nerves, and flexor tendons.Conclusion: The study highlights the significant role of developmental behaviors in pediatric hand laceration risk. Many injuries were caused by everyday household objects, including eyebrow razors, that are often underestimated as potential dangers. Preventive measures and guardian education are crucial to reduce the incidence of these injuries.

Macrophage transcriptome changes in response to cardiac injuries are determined by the type of lesion rather than their ontogenetic nature

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CRC1425 - DFG Introduction Resident macrophages account for 5% of the cells in the healthy heart. In response to cardiac injury, monocytes infiltrate and differentiate into recruited macrophages complementing the original resident macrophage population, and together orchestrate cardiac remodeling. We aim to identify the extent to which macrophage origin, tissue location and type of cardiac injury determine macrophage phenotypes in ischemic and non-ischemic cardiac injuries over time. Results and methods We use a reporter mouse line CX3CR1Yfp CreER/+:R26tdT/+ to visualize and quantify fluxes of resident and recruited macrophages and their respective localizations within the heart following ischemia and reperfusion (I/R) injury and pressure overload after transversal aortic constriction (TAC), respectively. Interestingly, macrophage numbers peaked during the first week post-surgery in both the local/acute and the global/continuous injury models. Initially, recruited macrophages outnumbered the resident macrophage pool within the infarct area but ultimately reached a near 1:1 equilibrium at 4 weeks post I/R injury. In the remote myocardium the 1:1 equilibrium established already during the first week. In TAC-injured hearts, the 1:1 ratio of recruited and resident hearts also established within the first week post-surgery and persisted up to 8 weeks of follow-up even as cardiac function deteriorated. In the infarct, recruited macrophages showed increased cytokine synthesis, defensive response, and cell adhesion pathways during the first week after injury. Many inflammatory pathways remained activated up to day 28 post MI despite simultaneous activation of the anti-inflammatory response. Formerly resident macrophages and their progeny also mounted an immune response throughout the healing process. Unexpectedly, by day 28 post MI when a stable scar had formed, resident and recruited macrophage population transcriptomes converted onto a common, pro-inflammatory steady state phenotype, that differed from their originally divergent gene expression profiles in the healthy heart by over one thousand genes. In the remote zone, however, resident macrophages maintained cellular homeostasis function, unlike recruited macrophages that retained an inflammatory program. Following TAC surgery, transcriptional profiles remained differentially regulated at all time points tested, where recruited subset induced immune response and resident macrophages upregulated tissue remodeling genes. Conclusion Ischemic and non-ischemic cardiac injuries induce a transient peak of monocyte recruitment and macrophage differentiation in and around cardiac lesions which lead to a permanent integration of recruited monocyte-derived macrophages into the pool of tissue resident macrophages – albeit at different paces. The type of injury and macrophage localization within the changing tissue microenvironment determine partial or complete override of ontogenic cell programs.

Avulsion and Soft Tissue Injuries of the Ulnar Collateral Ligament in Children and Adolescents

Background: Although pediatric medial epicondylar fractures and apophysitis are well studied, patterns of subapophyseal avulsion and ligamentous injuries of the medial elbow in this population merit investigation to inform optimal treatment strategies. Purpose: To describe the occurrence and demographic correlates of ulnar collateral ligament (UCL) avulsion and soft tissue injuries of the pediatric and adolescent elbow. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An institutional review board–approved review was conducted to identify consecutive patients with medial elbow injuries treated in a tertiary pediatric sports medicine practice between 2016 and 2021. Radiographs were obtained during injury evaluation, and patients with nondisplaced medial epicondylar apophysitis and complete epicondylar fracture were excluded, resulting in 150 patients with soft tissue injuries occurring distal to the medial epicondyle apophysis (subapophyseal) for study. Radiographs were evaluated for bony avulsion of the UCL from either the medial epicondyle proximally or the ulnar sublime tubercle distally. Injuries without radiographic evidence of bony avulsion, but with clinical examination findings consistent with ligamentous injury, were classified as radiographically negative UCL injuries, and magnetic resonance imaging (MRI) was performed to further evaluate these injuries if moderate to severe medial swelling of the elbow or significant concern for medial structural injury was present on examination. These MRI scans were evaluated to classify the UCL injury and assess for periosteal or cartilaginous avulsions. Results: A total of 150 patients (mean age, 12.5 ± 3.4 years; 70 female), 55% (150/274) of the entire medial elbow injury population, had a subapophyseal injury. Of these patients, 62 had a bony avulsion detected on radiograph, and 88 had a radiographically negative injury. In addition to the 62 radiographic avulsions, the 61 MRI scans obtained on those radiographically negative injuries revealed 33 complete UCL disruptions, resulting in 63.3% (95/150) of patients sustaining a complete ligamentous disruption. With the MRI scans, 37 (61%) cases of cartilaginous or periosteal avulsion of the UCL were diagnosed. Overall, 66% of all 150 subapophyseal injuries had a bony, cartilaginous, or periosteal UCL avulsion. Patients with cartilaginous (mean age, 10.3 years) and bony (mean age, 10.6 years) avulsions were younger than those with central ligament injury (mean age, 14.2 years) or periosteal (mean age, 14.2 years) avulsions (P = .005). There was a significant association between the mechanism of injury and the location of UCL tear identified on MRI scans: traumatic falls were associated with distal tears, and throwing injuries were associated with proximal tears (P < .001). Conclusion: UCL central ligament and avulsion lesions may be frequently diagnosed after injury to the pediatric medial elbow, the majority of which are complete injuries, and may require MRI for diagnosis. The mechanism of injury may predict the location of ligamentous injury, and osteocartilaginous avulsions are more likely to present at younger ages than injuries to the soft tissue of the UCL or periosteum. The prevalence of these injuries merits further investigation into best protocols of nonoperative treatment or surgical repair techniques and outcomes.

Injury Frequency and Location Comparison of Full Time and Part Time SWAT Operators

Injury Frequency and Location Comparison of Full Time and Part Time SWAT Operators

Epidemiological and clinical characteristics of hospitalized unintentional injuries among children in central China from 2017–2023

ObjectivesTo examine the epidemiological and clinical characteristics of hospitalized unintentional injuries among children in Central China and theoretically propose preventive and control measures.MethodsWe conducted a retrospective study of children aged 0–18 years with unintentional injuries who were admitted to a tertiary hospital in Central China from January 2017 to December 2023. We examined various aspects of the unintentional injuries, including age, gender, urban-rural distribution, external causes, trends, location of injury, cost, and length of stay.ResultsA total of 20,166 children with hospitalized unintentional injuries were enrolled. The median age with IQR was 2.8 (1.6, 5.1) years, with majority of the patients (57.0%) were aged 1–3 years, while the fewest were aged 11–18 years. The male-to-female ratio was 1.8:1, and the urban-to-rural ratio was 1.1:1. The most common external causes were foreign bodies (41.7%), exposure to inanimate mechanical forces (25.1%), and falls (22.1%). The most frequently injured body parts were head (72.5%). The total number of unintentional injuries exhibited an increasing trend from 2017–2022, and a decreasing trend from 2022–2023. The urban-rural distribution reversed after 2020. The overall hospitalization cost was 20,810,870.4 USD, with an median cost of 758.7 (556.4, 1,186.2) USD per person.ConclusionUnintentional injuries imposed a heavy burden on society and families. However, the number of cases and the urban-rural distribution showed significant trend changes from 2017–2023. The external causes varied by age group, gender, and region, while prevention and control measures should be developed accordingly.

Muscle Injuries in Elite Youth Football Academy: A Six-Year Longitudinal Study on the U15 Football Team

To develop specific preventive strategies, it is necessary to investigate in detail the occurrence of injuries in young football players. This study aimed to provide details about the type, location, severity, and contact nature of muscle injuries in elite U15 Croatian football players. A total number of 130 muscle injuries occurred during the six competitive seasons, of which 88 were DOMS injuries and 42 were rupture injuries. Specifically, 87% of all muscle injuries belonged to the four major groups, with only 15 injuries to the other muscle groups: hamstrings (43), quadriceps (41), adductors (25), calves (6). The muscle injury incidence was stable during the observed period as the injury incidence rate ratio (IRR) was 1.01 (95%CI: 0.99–1.03), with 3.13 (95%CI: 3.09–3.17) muscle injuries per 1000 h of exposure in the first season and 3.06 (95%CI: 3.02–3.1) in the sixth season. A significantly higher risk for muscle injuries was discovered in the competition as the incidence for the whole observed period was 7.38 (95%CI: 7.29–7.47) compared to 2.25 (95%CI: 2.24–2.26) in the training period. Despite the relatively stable number of sustained muscle injuries, the relative proportion of muscular injuries increased over the years due to a severe decrease in the total number of injuries. Regarding the proportion of players who had sustained a muscle injury, our results suggest that approximately two out of five players can expect a muscular injury over the one-season period. Relatively high injury expectancy rates, as well as reinjury rates, require specific preventive interventions that will reduce the number and severity of new and recurred injuries. Future studies should include a wide set of predictor variables in order to establish the most important injury risk factors.

Nursing intervention analysis: Understanding the characteristics of trauma patients in a regional emergency medical center

Introduction: This study aims to analyze nursing interventions for trauma patients at regional emergency medical centers based on injury types, mechanisms, and sites, providing foundational data for nursing education programs. Specific goals include understanding trauma patient characteristics, determining the frequency of nursing interventions by injury types, mechanisms, and sites and identifying variations in nursing interventions based on injury characteristics.Methods: Conducted retrospectively, this study contributes basic data for creating nursing education materials. It includes 661 eligible trauma patients out of 19,920 visits to the S city regional emergency medical center between March 1, 2019, and February 29, 2020.Results: This research is pivotal in gathering contexts for nursing interventions among trauma patients, providing essential information for the development of nursing education resources. It emphasizes the importance of a comprehensive analysis of interventions tailored to the type, location, and mechanism of injuries to ensure effective patient care. The development and ongoing use of educational materials for nurses remain vital.Conclusions: This investigation highlights the importance of documenting and analyzing nursing intervention strategies in trauma care, establishing a solid foundation for educational content in this field. Continuous examination of varied interventions according to injury characteristics is crucial for delivering precise and effective nursing care. The sustained development and application of educational resources in nursing are essential for improving patient outcomes.

Description of Wound Patterns on the Bodies of Murder Victims due to Blunt Violence at the Bhayangkara Tk General Hospital. I East Jakarta Police Health Center for the 2021 – 2022 Period

Murder is the behavior of a person or group of people that results in the loss of another person's life. Murder incidents can be motivated by various reasons so that someone plans or executes the murder of another person. Blunt trauma is a condition caused by mechanical violence from a blunt object. Blunt trauma can cause abrasions, contusions, lacerations, and fractures. This study aims to determine the pattern of wounds on the bodies of murder victims resulting from the blunt force at the Bhayangkara General Hospital Tk. I, Pusdokkes Polri, East Jakarta, for the period 2021 – 2022. This research uses a retrospective descriptive research method with a total sampling method using data from application letters for post-mortem and repertum and post-mortem et repertum for murder victims at the Pusdokkes Polri Hospital. The data results showed that there were 55 victims of murder due to blunt force, with the largest age distribution in the 31-40 year age group with 17 victims (30.9%). Based on gender, the highest number of victims were men - 28 victims (50.9%), while there were 27 victims (49.1%) for women. Based on the time group, the most incidents were found in 06.01-12.00 with 22 victims (40%). Based on the injury location group, the largest number of victims with injuries to the head and face was 51 victims (29.1%). Based on the type of violence, 41 victims (39.4%) had the most bruises on the head and face, 11 victims (47.8%) had the most bruises on the neck, and five victims had bruises on the shoulder (55.6%), at the chest location, the most abrasion wounds were found, namely ten victims (41.7%), at the back location there were nine victims (56.3%), at the stomach location the number of bruises was found at seven victims (58.3%), at the pelvic location there were abrasions and fractures each with one victim (50.0%), at the upper extremity location the most were bruises with 18 victims (40.9%), and at the location of the lower extremities found the highest number of bruises, namely 14 victims (41.2%).

Microbial Colonization of Explants after Osteosynthesis in Small Animals: Incidence and Influencing Factors.

Despite recent advancements in antibiotics, hygienic measures, and peri-operative systemic antibiotics, post-operative infections in osteosynthesis remain prevalent and continue to be among the most common surgical complications, leading to delayed fracture healing, osteomyelitis, implant loosening, and loss of function. Osteosynthesis implants are routinely utilized in veterinary medicine and the current study investigates the microbial colonization of implants following osteosynthesis in small animals, along with its incidence and influencing factors. The results are analyzed in regard to correlations between infection, patient, disease progression, and radiographic images, as well as other factors that may promote infection. Seventy-one explants from sixty-five patients were examined and evaluated for microbial colonization. Factors like body weight and age, location and type of plate and additional injuries like lung lesions, the surgeon's experience, or the number of people present during the surgical procedure seem to influence the development of an infection. Of the animals, 60% showed osteolytic changes and 73.3% of those with dysfunctional mobility had an implant infection. Microorganisms were detected in almost 50% of the explants, but a clinically relevant infection was only present in five patients (7.3%), suggesting that the presence of microorganisms on an implant does not necessarily lead to treatment complications.