Motor Vehicle Trauma Research Articles

Evaluation of children applying to emergency service after motor vehicle trauma

BackgroundTraffic accidents are significant causes of death and serious injury in children. Children's clinical findings are more subtle and there is a risk of faster deterioration. On the other hand, radiation sensitivity due to imaging is also high. These challenging factors highlight the importance of approaching pediatric trauma cases. In our study, we aimed to contribute to current approaches by examining the clinical course and profiles of children involved in traffic accidents. This study aimed to analyze the profiles and clinical courses of children involved in road traffic accidents. MethodsPediatric patients brought to our hospital due injuries from traffic accidents were retrospectively investigated. ResultsDuring the two-year period analyzed in the study, 605 child patients applied due to traffic accidents, accounting for 5.4 % of pediatric trauma cases. The majority of the children were between the ages of 12–17, with most accidents occurring in the summer. In total, 56.9 % were from in-vehicle traffic accidents, 36.7 % were from extra-vehicular traffic accidents, and 6.4 % were from motorcycle accidents. The imaging rate among the patients was 89 %, and 50.6 % had more than one tomography. More than half of the cases had no pathological findings, and only 6 % required hospitalization. Most cases were treated successfully with medical care, while 21.4 % needed interventional procedures, and 10 % received no treatment. The most common injuries were superficial skin lesions (11.1 %) and extremity fractures (10.2 %), with orthopedics being the most consulted department. Fractures were most common in the tibia and were more likely in motorcycle accidents than in-car accidents. ConclusionIn-vehicle accidents were the most frequent type of accident, and children under 4 years old had a higher incidence of in-car accidents than other age groups. Males made up 60 % of the cases, with boys having higher rates of motorcycle and extra-vehicular accidents compared to girls. While most children had no injuries from the accidents, those who did generally recovered well with outpatient monitoring. On the other hand, 89 % of patients underwent imaging at a high rate.

Association of social vulnerability and rehospitalization in pediatric motor vehicle trauma patients

IntroductionWe investigated social vulnerability index (SVI) as a tool to identify children at risk for readmission following motor vehicle collisions (MVC). Materials and MethodsAn exploratory retrospective cohort study was conducted of pediatric trauma activations (age 0–15) for MVCs 1/1/2012 to 6/30/2022 at a level 1 trauma center. Eligibility included residence within our center's catchment area. Excluded were mortalities during the index admission. Patient address was geocoded and linked with state-level census tract SVI. Per the CDC, SVI ≥90th percentile defined high vulnerability. We evaluated SVI theme: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), housing and transportation (HT). Outcomes included emergency department (ED) visits and re-hospitalization within 90 days of discharge. Kaplan-Meier plots, relative risk (aRR), and 95 % confidence intervals (95 %CI) adjusted for injury severity score (ISS) were estimated using log-binomial regression. ResultsOf 429 eligible subjects, 122 (28 %) resided in high SVI communities. High SVI patients had slightly higher mean ISS (8.6 vs 7.5). There was a similar risk of ED re-presentation across SVI groups (aRR=1.18; 95 %CI 0.61–2.29). However, although estimates were unstable, there was a possibility of increased risk of re-hospitalization among the high SVI group (aRR=2.34; 95 %CI 0.68–8.04). By theme, HT had the strongest association (aRR=1.71) for ED representation, whereas SES and HCD had the strongest associations for rehospitalization (aRR=2.03, 2.66, respectively). ConclusionWe observed possible associations between high SVI and higher rates of re-hospitalization. Future research with a larger sample may clarify associations. Level of EvidenceLevel IV; Prognosis Study.

Epidemiology and Management of Adult Laryngeal Trauma: An Analysis of the National Trauma Data Bank

Introduction: Laryngeal injuries are rare but life-threatening airway emergencies. Increased understanding of the epidemiology of these injuries can inform treatment and improve outcomes. We aimed to characterize the demographics and management of adult laryngeal trauma. Methods: The National Trauma Data Bank (NTDB) was queried from 2007 to 2015 for patients ≥18 years old with laryngeal trauma. Patient demographics, injury characteristics, and treatment course were collected. Outcomes were assessed via multivariate logistic regression. Results: From 7.3 million patients, 6,890 (0.1%) patients with laryngeal trauma were identified. Eighty-five percent of patients were male, and the median age was 40. Of these patients, 343 (5.0%) were dead on arrival and of the remaining patients, 510 (7.8%) of patients were deceased at discharge. Common concomitant injuries included facial fractures (27%), intracranial injuries (21%), and rib and sternum fractures (19%). The most common cause of injury was motor vehicle accident (26%), followed by assault with firearms/explosives (12%) and assault with cutting instruments (8%). Forty-three percent of patients received mechanical ventilation and 15% received surgical repair. After correcting for gender, age, and injury severity, firearm injuries (odds ratio [OR] 3.46, 95% CI: [2.88–4.15]) and cutting/piercing injuries (OR 2.23, 95% CI: [1.89–2.64]) were positively associated with the need for mechanical ventilation. Motor vehicle trauma (OR 0.63, 95% CI: [0.46–0.84]) was negatively associated with surgical repair while striking injuries (OR 1.61, 95% CI: [1.25–2.06]) were positively associated. Lastly, shorter time to tracheostomy was significantly associated with shorter ICU stays (p < 0.0001). Conclusion: This study is the largest epidemiologic study of laryngeal trauma to date and identifies the risk of surgical intervention with firearm and cutting injuries as well as the importance of earlier time to tracheostomy for ICU management.

Case report: Ocular signs of superficial siderosis; a rare neurodegenerative disorder

AimThis article seeks to describe superficial siderosis as a rare, acquired neurodegenerative disorder and provide a case report of the neuro-ophthalmological clinical signs of a patient presenting with previously undiagnosed superficial siderosis. ReportA 48-year-old female with a previous history of motor vehicle trauma and recurrent migranous headaches presented with seizure. Additionally, she described blurred vision and serial fundus examination revealed retinal haemorrhage followed by papilledema. Subsequent radiological investigation revealed superficial siderosis. ConclusionsTo our knowledge, this is the first report of retinal findings in a case of superficial siderosis. The case report seeks to provide clinicians with a wider breadth of information on the clinical presentation and response to intracranial pressure lowering therapy in a rare condition.

Sexuality and rehabilitation needs following traumatic motor vehicle injuries: Client and clinician perspectives

Aim and Background: Sexuality is an important aspect of being human, and is affected for people following trauma injuries. This study aimed to examine how sexuality is addressed during rehabilitation following traumatic motor vehicle injuries and to identify barriers to provision of this service. Methods: A convergent mixed methods approach with concurrent timing and an independent level of interaction was used to examine the perspectives and experiences of clients and clinicians towards addressing sexuality. A questionnaire was completed by eligible clients (n = 21) and semi-structured interviews (n = 10) were conducted with clinicians. Questionnaire data were analysed using descriptive statistics (frequency, means and SD) to provide an outline of sociodemographic and injury related information. Interview data from clinicians were analysed thematically. Results: Sexuality was described as being impacted for over half of clients. One third reported that sexuality was addressed as part of their rehabilitation. Core themes identified from the interviews of clinicians included: (1) ‘whole person’ approach, (2) timing, delivery and responsibility of discussions, (3) culture and comfort, and (4) future tools and skill sets. Conclusion: Clinicians and clients agreed that sexuality was important but inadequately addressed during rehabilitation. Clinicians were lacking comfort, training and resources to address sexuality consistently with clients. Sexuality should be addressed at multiple stages of rehabilitation to grant service-users the option for these discussions to occur.

Repetitive mild traumatic brain injuries in children of abuse

Repetitive mild traumatic brain injuries in children of abuse

Development and tolerability of a novel virtual- and proprioception-based car crash simulator as a new research tool in motor vehicle trauma research

Purpose: Investigations of causal theories of neck pain (NP) following motor vehicle crashes (MVC) has been difficult, as simulation is limited. Thus, we sought to evaluate tolerability to a novel virtual reality (VR)-based road collision simulator and screen for adverse reactions.Materials and Methods: Cross-sectional study. 25 healthy participants were exposed to a novel VR-based rear-end MVC with a small perturbation (0.2 g). The Simulator Sickness Questionnaire (SSQ) and Presence Questionnaire (PQ) were measured post-exposure and adverse reactions were recorded.Results: The system was well tolerated with no adverse reactions, however one participant reported NP the following day not lasting longer than 48 h. Participants reported low levels of simulator sickness (mean SSQ = 23.49 ± 21.98, range = 0.00 to 89.76; max score = 235.62), while presence (mean PQ = 91.04 ± 14.08, range = 54.00 to 112.00; max score = 133), was lower than literature recommendations.Conclusion: A VR-based road collision simulator can be safely used to explore the phenomenon of a motor vehicle crashes under controlled circumstances. Future work is needed to optimize the virtual reality environment and to investigate the effects of crash parameters.

Laparoscopic Repair of a Right-Sided Diaphragmatic Hernia: A Technical Report.

Introduction: Occult diaphragmatic hernias after trauma are relatively rare and may present months to years after the traumatic event. Clinical presentations range from asymptomatic incidental findings on imaging to life-threatening incarceration of abdominal visceral organs. This study presents a case of a patient with a symptomatic diaphragmatic hernia secondary to a trauma >30 years prior. A literature review of this defect was performed examining the pathophysiology, presentation, and operative considerations. Case Presentation: A 58-year-old male with a history of multiple traumatic motor vehicle accidents 30 years prior presented with abdominal pain and obstructive symptoms. Axial imaging demonstrated a right-sided diaphragmatic hernia defect containing small intestine, colon, and omentum. He ultimately underwent a transabdominal laparoscopic repair of the defect with mesh buttressing. Postoperative the patient recovered well and was discharged without complications. Conclusion: Limited data outside of case reports exist for surgical management of occult diaphragmatic hernias secondary to trauma. Reported management options include open and minimally invasive thoracic as well as open and minimally invasive abdominal approaches; each with advantages and disadvantages. Depending on the defect size, both primary repair and repair with mesh reinforcement are appropriate options. More data comparing the approach and repair technique are needed to determine the best technique.

Concomitant Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An 11 Year Review of the National Trauma Data Bank

Craniofacial trauma with concomitant cervical fractures (CCFs) is responsible for significant morbidity and mortality in the pediatric population. We aim to characterize its incidence, injury patterns, outcomes, and risk factors, along with identifying any association between mandible fractures and cervical injuries via the National Trauma Databank. A retrospective cohort study was performed using National Trauma Databank records between 2007 and 2017 to identify patients equal or under the age of 18 years hospitalized for maxillofacial trauma and with recorded cervical injury. Variables of interest include age, gender, race/ethnicity, trauma type (blunt vs penetrating), Injury Severity Score, area involved, mechanism of injury, comorbid conditions, inpatient complications, and discharge disposition. Retrospective cohorts were separated by CCF status. Univariate, bivariate, and multivariable regression analysis was utilized, with P-value <.05 considered statistically significant. A total of 32,952 patients were included in the study, with the majority being White (60.8%), male (68.2%), and between the ages of 13 and 18 years (65%). Of these, 8.2% experienced CCF. Most common mechanisms of injury were motor vehicle trauma (32.6%), interpersonal violence (18.8%), and falls (13.5%). Univariate analysis revealed patients with CCF were significantly older (15.2 vs 12.9; P<.001), more likely to be motor vehicle occupants (46.6 vs 31.9%; P<.001), and suffer polyfacial fractures (62.6 vs 60.7%; P<.001). Longer length of stay (9.4 vs 3.6days; P<.001) and significantly higher inpatient complications such as deep vein thrombosis, pulmonary embolism, unplanned intubation, severe sepsis, pressure ulcer, ventilator-associated pneumonia, and unplanned return to operating room were observed in the CCF cohort. Female gender (1.5 [1.37 to 1.64; 95% confidence interval {CI}] P<.001) and higher Injury Severity Score (1.12 [1.11 to 1.11; 95% CI] P<.001) were associated with significantly higher odds on multivariable analysis. The presence of a mandible fracture was not associated with increased CCF on multivariate analysis (1.06 [0.92 to 1.22; 95% CI] P=.36). There are statistically significant differences in demographics, outcomes, and injury patterns in maxillofacial patients with CCF that may help guide treatment. No association between mandible fractures and cervical trauma was identified.

Tradeoffs in Triage of Motor Vehicle Trauma by Rural 911 Emergency Medical Services Practitioners.

Identification and triage of severely injured patients to trauma centers is paramount to survival. Many patients are undertriaged in rural areas and do not receive proper care. The decision-making processes involved in triage are not well understood and should be assessed to improve the triage process and outcomes. Triage decision-making processes were explored through emergency medical services (EMS) practitioner focus groups and a discrete choice experiment (DCE). Attributes of trauma determined from focus groups and the literature included patient demography, injury mechanism, and trauma center distance. DCE data were analyzed using mixed logit models. High-risk mechanism, decreased age, multiple comorbidities, and pregnancy were found to increase the preference for triage. Greater trauma center distance was found to decrease preference for triage, but practitioners were willing to trade off up to 2 h of travel time to transport a third-trimester pregnancy and 48 min of travel time to transport a 25-y-old than they would a 50-y-old with the same comorbidities, injuries, and stability. Our findings suggest that current forms of EMS protocols may not be appropriately tailored to support the mechanisms underlying practitioner decision making. Public health professionals and researchers should consider using DCEs to better understand EMS practitioner decision making and identify structures and incentives that may improve patient outcomes and optimally guide appropriate triage decisions. Discrete choice experiments are an effective method to elicit prehospital practitioners' preferences around transport of the traumatized patient.Practitioner biases observed in EMS transport data are recovered in stated preference models incorporating individual preference heterogeneity.There is a discrepancy between the triage priorities recommended by protocol and those measured from prehospital practitioners' decisions-this may have implications in over- and undertriage rates and prehospital protocol design.

Comparison of Trauma in Dogs due to Direct Motor Vehicle Collision or Fall from Open Pick-up Truck Bed during Transportation (2002-2020).

The aim of this study was to report injuries sustained by dogs following motor vehicle trauma: direct motor vehicle collision (MVC), and fall from an open pickup truck bed during transportation (PTB). Medical records of dogs involved in motor vehicle trauma between 2002 and 2020 were reviewed. Signalment, mode of injury, injuries sustained, and treatments performed were recorded. An owner questionnaire investigated effects of the trauma on the dog and owner. Six hundred and ninety-eight dogs met the inclusion criteria (569 MVC, 102 PTB). Orthopaedic trauma was significantly more common after PTB (90.2%) (MVC, 75.6%; p = 0.011). There were not any differences in the prevalence of soft tissue injuries between groups (76.4% MVC, 67.6% PTB; p = 0.058), however, MVC dogs had significantly more thoracic (26.9% MVC, 4.4% PTB) and abdominal (12.9% MVC, 0% PTB) trauma (p <0.001). Surgical treatments were performed significantly more often after PTB (71.6%) (MVC, 47.6%) (p <0.001). Discharge rate after PTB (95.0%) was significantly higher (MVC, 84.0%) (p <0.001). Aftercare was reported to be significantly more difficult after PTB (76.2%) (MVC, 34.0%; p = 0.002). MVC and PTB result in significantly different trauma. PTB causes predominantly orthopaedic and integument injuries, whereas MVC results in thoracic and abdominal trauma. Survival to discharge is greater following PTB than MVC.

Pediatric cerebrovascular trauma: Incidence, management, and outcomes

BackgroundPediatric cerebrovascular trauma (CVT) is rare. There is an increasing use of endovascular management in vascular trauma. We studied the incidence, management, and outcomes of CVT in the pediatric population using the NTDB (National Trauma Data Bank). MethodsThe NTDB was queried for CVT in patients less than 18 years of age over a recent three-year period (2017–2019). Demographics, injury mechanism, type and location, Glasgow Coma Score (GCS), length of stay (LOS), surgical approach (open vs endovascular), and morbidity/mortality were evaluated. Statistical analysis included χ2 and student's t-tests or Fisher's exact tests where appropriate. ResultsOf 386,918 pediatric trauma cases, 1536 (0.4%) suffered 1821 CVT. Blunt trauma accounted for 69.3%. Patients were predominantly male (65.4%) and white (57.5%), with an mean age of 14 years. There were 998 (55%) carotid artery injuries, including 846 common/internal carotid and 145 external carotid. Other vessel injuries included 141 (11%) intracranial carotid, 571 (31%) vertebral artery and 252 (14%) jugular vein. Mean number of vessels injured was 1.2. Motor vehicle trauma was most common (49.3%) followed by firearm injury (21%). The mean GCS was 11, and mean total LOS was 11.3 days. Majority of interventions were performed in an open fashion (65.7%), whereas 29.7% were performed endovascularly. Stroke rate was 3.1%. Patients with multiple vascular injuries had an overall mortality of 29% (p<0.0001). ConclusionWhile not accorded as much importance as blunt injury, penetrating CVT comprises of 30% of injuries. Nearly 1/3rd of all cases needing surgical intervention were managed with endovascular techniques. Level of evidenceIII.

P6.07: Risk Factors for Trauma Death Among Transplant Recipients

Objective: To identify demographic and morphometric risk factors for trauma death among kidney, liver and pancreas recipients. Introduction: Trauma is a leading cause of death in the United States. Individuals with chronic disease, notably cancer, are at increased risk for death due to unintentional injury. This may stem from the psychosocial stress, poor quality of life and physical disability that result from serious illness. Though solid organ transplant has the potential to extend and improve the lives of those with chronic disease, these individuals may remain in a state of suboptimal physical and mental health after surgery that predisposes them to death from trauma. Methods: A retrospective analysis was performed using UNOS data from 100,705 adults with a history of kidney, liver or pancreas transplant between 2000-2021. Basic patient, donor and transplant characteristics of the two groups (trauma death or all other cause death) were compared via univariate and multivariate statistical analysis. The trauma death group consisted of deceased recipients in the SRTR registry with the diagnosis code TRAUMA: MOTOR VEHICLE ACCIDENT or TRAUMA: OTHER. The risk factors compared include age, sex, ethnicity, wait time, BMI at the time of transplant, history of diabetes, glucocorticoid use, graft failure, as well as donor and transplant characteristics such as organ share type, donor age, sex and ethnicity. Statistical significance was defined by p-value <0.05. Results: The data included 100,705 transplant recipients in total. The largest proportion of death secondary to trauma was seen in the kidney group (0.8%), followed by liver (0.7%) and then pancreas (0.3%). Male sex was the most significant risk factor for trauma death among kidney and liver recipients (OR=1.67, OR=1.68, respectively). Whites were also at elevated risk for trauma death relative to their non-White counterparts in the kidney and liver groups (OR=1.32, OR=1.31, respectively). In both of organ categories, age conferred a protective effect (OR=0.97 for kidney, OR=0.98 for liver). Unique findings in the kidney cohort include that those with a longer wait time were 0.02% less likely to die from trauma and those with diabetes mellitus were 19% less likely to die from trauma. Whereas kidney recipients who died via trauma were less likely to have experienced graft loss, trauma deaths in the liver group were more common among those with a history of graft loss. The total number of trauma deaths in the pancreas cohort (n=13) was too small to run logistic regression analysis. Conclusions: Certain demographic characteristics including White race and male sex are associated with increased risk for trauma death among kidney and liver transplant recipients. Advancing age was associated with a decreased risk in these two cohorts. We believe these findings may help identify patients at risk for trauma death and provide opportunities for early intervention to prevent unnecessary loss of life.

Randomized trial of three airway management techniques for restricted access in a simulated pediatric scenario

PurposeEmergency pediatric airway management during restricted access to the head is challenging and may relate to an entrapped motor vehicle trauma. Video laryngoscopy and supraglottic airways have separately been described to facilitate face-to-face airway management. We hypothesized that video laryngoscopy might be superior to direct laryngoscopy or supraglottic device use to establish ventilation during face-to-face airway management, studied in a simulated pediatric entrapped motor vehicle scenario. MethodsEthics approval was obtained from local REB. 45 experienced airway practitioners managed the airway of a pediatric manikin representing a 6 year old (SimJunior). With a cervical collar applied and in the sitting position, the manikin's head was only accessible from the left anterolateral side. Following a standardized demonstration, airway management using a Macintosh #2 blade (DL), a Storz C-MAC® D-Blade (VL) and a #2.5 LMA Supreme™ (SGD) was performed once each in a random order. Outcomes included success rate, time to ventilation (TTV), percentage of glottic opening (POGO) for DL and VL and ease of use on a 10-point Likert scale (VAS). Data was analyzed using analysis of variance for TTV and VAS and t-test for POGO. Statistical significance was deemed at P < 0.05. Data are presented as median and interquartile range. ResultsSuccess rate was 95% for both DL and SGD and 93% for VL. TTV was significantly less with SGD compared to DL and VL. TTV was 31 s (28, 35) for DL, 46 s (31, 62) for VL and 20 s (17, 24) for SGD. POGO was significantly improved with VL (100%) compared to DL (80%). Participants rated SGD significantly easier to use than VL, but not easier than DL. DiscussionAll three techniques have high success rates. Time to establish ventilation with the SGD was significantly faster compared to DL and VL and participants rated SGD easiest to use. The utility of VL was limited due to significantly longer time to ventilation, despite significantly improved view compared to DL, similar to adult studies. Since time and success are clinically important, this study suggests that supraglottic devices should be considered for primary emergency pediatric airway management in situations with restricted access to the head.

Database selection matters: A case study in child restraint use and injury patterns using North Carolina motor vehicle traffic crash report and trauma registry data

Objective While proper restraint use is protective against motor traffic vehicle crash (MVTC)-associated morbidity and mortality, it is inconsistently measured across health and MVTC data sources. This project addresses this gap by assessing differences in child restraint measures between two North Carolina (NC) datasets and comparing the utility of these sources to evaluate patterns of child restraint use and associated health outcomes. Methods We analyzed 2018 NC MVTC and NC Trauma Registry (NCTR) data for children ≤15 years old, both separately and as linked MVTC-NCTR records. We calculated mean and standard deviation for continuous variables and frequency and proportion for categorical variables. Among linked records, we compared reported restraint use and performed age-adjusted logistic regression to estimate associations between restraint use and severe injury. Results A lower proportion of pediatric MVTC victims were reported as unrestrained in the MVTC (14.7%) versus NCTR (25.8%) data. Among linked MVTC-NCTR records, only 41.3% featured perfect concordance of restraint information between datasets. Among linked records, child restraint was reported for 31.3% of children, while the NCTR data allowed more granular coding of child restraint (30.3% overall), including child booster seat (13.5%), child car seat (8.7%), infant car seat (4.8%), and unrestrained in child car seat (3.4%). Age-adjusted regression analyses of the linked data revealed that lap/shoulder seatbelt use was significantly associated with lower likelihood of severe injury compared to being unrestrained whether informed by MVTC (OR = 0.39; 95% CI: 0.16, 0.93) or NCTR (OR = 0.38; 95% CI: 0.15, 0.96) data. While the association between reported use of a child car seat and severe injury was not statistically significant in the MVTC data (OR = 0.50; 95% CI: 0.19, 1.32), child car seat use reported in the NCTR data revealed a significant association (OR = 0.16; 95% CI: 0.03, 0.93). Conclusions Linked crash and trauma center data allow for identifying important patterns of restraint use among pediatric passengers in MVTCs. Dataset-dependent differences in measuring restraint use have critical public health implications and illustrate the importance of careful dataset selection prior to analysis, as the use of different data sources may impact overall study conclusions.

Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Seroprevalence in Decedents Undergoing Forensic Postmortem Examination: Feasibility for Real-Time Pandemic Surveillance.

BackgroundPopulation-based seroprevalence studies offer comprehensive characterization of coronavirus disease 2019 (COVID-19) spread, but barriers exist and marginalized populations may not be captured. We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody seroprevalence among decedents in Maryland over 6 months in 2020.MethodsData were collected on decedents undergoing forensic postmortem examination in Maryland from 24 May through 30 November 2020 from whom a blood specimen could be collected. Those with available blood specimens were tested with the CoronaCHEK lateral flow antibody assay. We assessed monthly seroprevalence compared to the statewide estimated number of cases and proportion of positive test results (testing positivity). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for associations of demographic characteristics, homelessness, and manner of death with SARS-CoV-2 antibodies.ResultsAmong 1906 decedents, 305 (16%) were positive for SARS-CoV-2 antibodies. Monthly seroprevalence increased from 11% to 22% over time and was consistently higher than state-level estimates of testing positivity. Hispanic ethnicity was associated with 2- to 3.2-fold higher seropositivity (P < .05) irrespective of sex. Deaths due to motor vehicle crash were associated with 62% increased seropositivity (aPR, 1.62 [95% CI, 1.15–2.28]) vs natural manner of death. Though seroprevalence was lower in decedents of illicit drug overdose vs nonoverdose in early months, this shifted, and seroprevalence was comparable by November 2020.ConclusionsDecedents undergoing forensic postmortem examination, especially those dying due to motor vehicle trauma, may be a sentinel population for COVID-19 spread in the general population and merits exploration in other states/regions.

Characteristics and Patterns of Facial Fractures in the Elderly Population in the United States Based on Trauma Quality Improvement Project Data.

With the increase in the elderly population in the United States, the number of people seeking care for trauma injuries is expected to increase. However, nationwide studies on epidemiological profile of elderly facial fractures remain sparse. The authors present the epidemiological measures of elderly facial fractures on national scale. Characteristics of facial fractures among younger adults (18-64 years old) and the elderly population (65-74 years old, 75-84 years old and 85 years and above) have been examined using the 2016 American College of Surgeons-Trauma Quality Improvement Program databank. Variables studied included facial fracture patterns, mechanisms of injury, treatment variables, and demographic descriptive data. Of 104,183 elderly trauma patients, 3415 presented with facial fractures, making up 3.3% (versus 6.5% in younger adults). Majority of facial fractures in 85 and over group (60.7%) were experienced by females, compared to only 19.5% in the younger adult group. Most common mechanism of injury in the elderly was falls, versus motor vehicle trauma in younger adults. The most common type of facial fractures among both groups were nasal fractures. Elderly patients presented with fewer zygoma, mandibular and nasal fractures when compared to younger adults, whereas showing more maxillary/malar and orbital bone fractures. Elderly patients experienced less operative management (4.3%-8.2%) compared to younger adults (15.6%). Concurrently, mortality rates were higher in the elderly patients (9.9%-11.8%) when compared to the younger adults (8.0%). Elderly patients presented with different causes of injury, distribution of fractures, and rates of operative management compared to younger adults.

Successful Nonsurgical Management of a Traumatic Dens Fracture in a Cat with Clinical and Radiographic Resolution

ABSTRACTAn adult domestic shorthair presented with obtundation, vestibular ataxia, head tilt, and visible evidence of facial injury following motor vehicle trauma. Plain radiographs and computed tomography imaging revealed a complete minimally displaced transverse fracture of the caudal aspect of the dens of the C2 vertebra and multiple minimally displaced cranial fractures. The dens fracture was managed with 8 wk of strict rest, followed by 4 wk of supervised activity at home. No external immobilization was performed. Neurological examinations at 8 days, 10 wk, and 9 mo following initial presentation were normal. Repeat radiographic and computed tomography examinations at 10 wk and 9 mo following the traumatic event demonstrated progressive and eventual complete osseous union of the fractured dens. To the authors’ knowledge, this is the first report of successful nonsurgical management of a traumatic dens fracture in an adult cat with documented radiographic and clinical resolution. This report suggests that nonsurgical management can be considered in such cats and that complete resolution with osseous union is feasible.

The impact of BMI on morbidity and mortality after femoral fractures.

PurposeFemur fractures are the result of high energy injury and are associated with life-threatening complications. Therefore, we studied how body mass index (BMI) contributes to complications after femoral fractures.MethodsUsing the 2016 American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) database, we stratified 41,362 patients into groups based on their BMI: Normal Weight (NW), Overweight (OW), Obese (OB), Severely Obese (SO), and Morbidly Obese (MO). We compared each BMI group to the NW cohort for differences in demographic factors, comorbidities, complications, and mechanism of injury.ResultsOB, SO, and MO patients sustained higher rates of traumatic injury from high energy mechanisms, such as motor vehicle trauma, in comparison to NW patients, who sustained more injuries from falls (p < 0.05). Correspondingly, obese patients were more likely than NW patients to sustain shaft and distal end fractures (p < 0.05). At hospital admission, obese patients presented with more comorbidities, such as bleeding disorders, congestive heart failure, diabetes mellitus, and hypertension (p < 0.05). Despite these individual findings, patients with OB, SO, and MO BMI, as opposed to NW BMI, were independently associated with a higher probability of developing at least one post-trauma complication. More specifically, MO patients were associated with a 45% higher odds of developing a complication (p < 0.05).ConclusionIrrespective of presenting with more comorbidities and sustaining high energy injuries, OB, SO, and MO patients were independently associated with having a higher risk of developing complications following a femoral fracture. Overall, better clinical outcomes are observed among patients with no underlying conditions and normal BMI.

The diagnosis of scapulohumeral luxation and avulsion fracture with 3-dimensional computed tomography in a yellow-legged gull (Larus michahellis)

An adult yellow-legged gull (Larus michahellis) of unknown sex was evaluated with history of motor vehicle trauma and unable to fly. The patient, that on first examination showed no clinical sign, was diagnosed on second day with scapulohumeral luxation and avulsion fracture via 3-dimensional computed tomography. Computed tomography is a noninvasive, well-recognized diagnostic procedure in avian medicine. This is the first case report to describe use of computed tomography to diagnosis scapulohumeral luxation and avulsion fracture in a yellow-legged gull (Larus michahellis).