Potential Traumatic Injury Research Articles

Methods for Collecting Oral Histories Amidst a Crisis

ABSTRACT Our goal in this project was to analyze past methodologies of oral history practitioners recording interviewees after traumatic events, which we define as widespread human-made and natural crises. The current COVID-19 pandemic and the reticence that some institutions have shown in engaging with oral history programs due to potential traumatic injury to participants influenced our objective. By examining a broad sample of cases, triangulating our data research tools, and engaging with oral history practitioners currently in the field, we hope to generate a responsible template for documenting the lived experiences of our current, extraordinary times. We studied oral history interviews with participants that ranged from the Rwandan genocide and Japanese American internment to those displaced by Hurricane Katrina. Ultimately, we found a need for more accurate community representation, unintuitive interview methodologies to positive outcomes and misconceptions around historical distance, or the amount of time between the traumatic event and the oral history interview, in academic standards.

Incidental findings in thoracic CTs performed in trauma patients: an underestimated problem.

Whole-body CT scans are commonly performed to assess trauma patients, and often reveal incidental findings (IFs) the patient may be unaware of. We assessed the prevalence, associations, and adequacy of follow-up of IFs. We retrospectively identified 1113 patients who had a chest CT to assess for traumatic injuries (6-year interval). We coded the radiology reports for IFs and queried our EMR regarding clinical history and adherence to follow-up recommendations for IFs mentioned in the reports. IFs are much more likely (62.2%) to be found in a chest CT scan than acute traumatic injuries (ATI, 32.4%), in patients being evaluated for potential traumatic injuries. A total of 86.4% of patients who had IFs also had another relevant ICD-10 diagnosis (RD). Lung nodules were the most common IF (45.7%). A multivariate logistic regression model (MLR) demonstrated an accuracy of 89% to predict IFs; the 3 statistically significant predictors (p < 0.05) were any RD (FDR logworth 68.6), followed by smoking history (29.8) and age (4.1). Radiologists recommended follow-up for IF 53.5% of the time, but only 13.9% of patients ever received a follow-up imaging exam or invasive procedure. IFs are much more common than ATI and can be accurately predicted based on MLR utilizing only 3 clinical variables. While radiologists often recommend follow-up for IFs in trauma patients, most are never effectively followed up or addressed, leading to increased risk of poor outcomes. Clinicians should be aware of the high prevalence of IFs and develop systems for appropriate, evidence-based recommendations, and effective management. • Incidental findings (IFs) are much more common (2×) than acute traumatic injuries (ATI) in chest CTs performed in trauma patients. • IFs can be accurately predicted via logistic regression modeling with only 3 variables (any relevant ICD-10 diagnosis; positive smoking history; age), which may help radiologist to focus their attention on higher risk patients. • Radiologists recommend follow-up for IFs more than half of the time; however, IFs are seldom followed up appropriately (less than 14%), leading to missed opportunities and potentially poor patient outcomes.

Editorial Comment: Pericardial traumatic injury in trans-catheter aortic valve implantation

Trans-catheter aortic valve implantation (TAVI) is a very promising new treatment for native aortic stenosis or failed bioprostheses [1]. Glutaraldehyde xenograft tissue is employed because of its pliability for folding during implantation and minimizing its size in order to reach its final position in the aortic root. In the CoreValve system, the stent is self-expanding, whereas in the Edwards Sapien, the valve has to be dilated by balloon inflation to approximate the stent to the aortic annulus without suturing, so as to prevent escape of the prosthesis and paravalvular leakage. In the latter procedure the pericardium is crushed against the stent. Since the operation is relatively easily accomplished with early success, the question arises of whether it might also be indicated in low-risk patients, thus avoiding sternotomy, general anaesthesia, cardio-pulmonary bypass and cardiac arrest. However, in contrast to the traditional surgical implant, TAVI requires cusp crimping and, in the case of the Edwards Sapien, balloon inflation. Both manoeuvres may be responsible for tissue injury. Previous observations by Zegdi et al. have shown evidence of cusp injury following percutaneous aortic valve deployment of the Edwards Sapien [2]. To confirm these preliminary findings, the same group made an experimental study, comparing the severity of traumatic cusp injury in home-made balloonvs self-expanding valved stents (VS); a non-crimped pericardium was used as a control [3]. According to the authors’ findings, all deployed valves were associated with microscopic lesions, in keeping with traumatic disruption, both in terms of transverse fractures and longitudinal cleavages. Transverse fractures were seen both in balloonand in self-expanding VS, whereas longitudinal cleavages were more frequently observed in balloon-expanded VS. Crushing and shearing of the pericardium during crimping and deployment are the most plausible causes. They may facilitate plasma and lipid insudation with tearing in the long term, thus affecting durability. These data support and expand the preliminary observations of the same authors [2]. An editorial comment by our group expressed some concern in interpreting these data, due to the limitations of technology used in pathological investigations [4]. However, the new data provided herein by Amahzoune et al. [3] seem to be convincing, even in the absence of macroscopic evidence of lacerations, commissural dehiscences or tears. They support the occurrence of some iatrogenic damage, particularly in balloon-expandable VS. However, in our opinion, the experiment should be repeated in a core lab employing special histological staining, such as picrosirius red, and scanning electron microscopy, to assess collagen waviness and to exclude the artifacts arising from manipulation at histology. If confirmed, these observations may cast a shadow on the safety of the TAVI procedure in terms of tissue integrity and biological compatibility, although crimping was proven not to influence propensity to cusp calcification in the long term [5]. Glutaraldehyde-fixed pericardium is the best available tissue because of its strength (thick fibrosa) and pliability (elasticity of wavy collagen bundles). If handled gently, as in the current secondand third-generation stented or stentless pericardial valve prostheses, it is not at risk of mechanical failure. Whether this is the case with TAVI—in which the pericardium is exposed to crimping or even crushing, with a potential traumatic injury— is a matter of concern. According to the findings by Amahzoune et al. [3], the following considerations may be put forward:

Physiological relevance and health cost benefits. Reply: “Disputing the Claims for Physiological Fitness and Health Adaptations from Purposeful Training using Off-road Vehicles” by Milburn et al.

Thank you for the opportunity to respond to the Letter to the Editor entitled ‘‘Disputing the Claims for Physiological Fitness and Health Adaptations from Purposeful Training using Off-road Vehicles’’ by Milburn et al. (2012). We have several concerns with this Letter. First, we take exception to the authors’ opening sentence in which they imply a conflict of interest and appear to be attempting to discredit our research through our association with the Canadian Off-Highway Vehicles Distributors Council (COHV). We stated quite explicitly in our article that ‘‘This study was supported through a research grant organized by the COHV which included funds from both private and government sources’’. The COHV had no involvement at any stage of the research or manuscript preparation. Let us be clear that our interest in off-road vehicle riding has been, and remains, purely scientific in relation to the physiological and health-related indices associated with acute and habitual physical activity participation. We will accept it as true that the authors’ Letter to the Editor is similarly concerned only with the current science presented, and is in no way influenced by their previously published opinions objecting to the environmental, social and financial aspects of this activity (Bissix and Medicraft 2008). Milburn and colleagues appear to have overlooked important aspects of our article and of pertinent basic physiology research, in relation to the health benefits of physical activity participation. All physical activity participation has inherent risks (Goodman et al. 2011)—some more than others, and informed decisions regarding participation are only possible through consideration of both the risks and rewards. As we have acknowledged previously (Burr et al. 2010a), we do not deny the important concerns in regard to potential traumatic injury (and other issues such as land use and environmental impact); however, these issues are not germane to the evaluation of the effects on physiological health, fitness and chronic disease risk. We feel that the authors’ suggestion to disregard the possible health benefits of this activity for reasons apart from the question at hand (i.e. ‘‘is the physical activity stimulus capable of stimulating changes in health?’’) to be misguided. Given their previous publication exploring ‘‘...the problems of beer consumption as well as the emerging evidence of benefit’’ (Preedy 2009), we think the authors can appreciate our belief that these outlying objections to the validity of our results are analogous to suggesting evidence of the beneficial cardiovascular health effects of modest alcohol consumption (Gaziano et al. 1993) be similarly ignored owing to the role of alcohol in traumatic injury, the environmental impact of producing and shipping wine, or the ill effects of alcohol abuse on health (Eckardt et al. 1981; Ogden and Moskowitz 2004). Certainly these are all areas of concern, but do not change the original evidence of an association with health from a physiological perspective. Milburn and colleagues’ suggested that ‘‘none of the data indicates that riders met the important threshold of a minimum of 10 min at moderate intensity to conform to ACSM guidelines’’ is simply incorrect. Intensity and Communicated by Susan A. Ward.

The Diagnostic Yield of Conventional Radiographs and Computed Tomography in Dogs and Cats with Maxillofacial Trauma

To compare the diagnostic yield of conventional radiographs and computed tomography (CT) images of the skulls of dogs and cats with maxillofacial trauma (MFT). Prospective study. Dogs (n=9) and 15 cats with MFT. CT-scans and skull radiographs (4 standard projections) for each animal were evaluated using a semi-quantitative scoring system for the ability to identify 26 predefined, clinically relevant anatomic features (Part 1), and 27 predetermined potential traumatic injuries (Part 2). For Part 1, mean scores for each anatomic feature were recorded for every view and imaging modality. For Part 2, studies were evaluated for the frequency of cases where each predetermined traumatic injury was identified. Part 1: On radiographs it was easy to identify 17 of 26 anatomic features whereas 6 features were very difficult or impossible to identify on any view. All structures were considered easy or very easy to identify on CT. Scores for CT were lower than radiographs for evaluating dental occlusion and the integrity of the mandibular body. Part 2: CT scans demonstrated 1.6 times more maxillofacial injuries for dogs and 2.0 times more for cats than conventional radiographs. The average number of MFT injuries per animal by radiographs and CT-scan was 4.8 and 7.6 in dogs, and 3.8 and 7.7 in cats, respectively. CT is superior to conventional skull radiography for identification of anatomic structures and traumatic injuries in dogs and cats. Skull radiography is useful for visualizing the mandibular body and dental occlusion. CT allows for accurate assessment, diagnosis and treatment planning of MFT in dogs and cats.

Children's agricultural health: traumatic injuries and hazardous inorganic exposures.

Farming is one of the most hazardous occupational industries in the USA, and farms pose numerous health risks for youth visiting, living in, or working in the farm environment. This review discusses both potential traumatic injuries and hazardous inorganic exposures that are common in agricultural settings. An estimated 2 million youth under the age of 20 currently live or work on US farms. Approximately 103 farm fatalities occur in this age group each year; over 32,000 nonfatal youth injuries occurred on farms in 1998. Children working in US agriculture make up only 8% of the population of working minors overall, yet they account for 40% of work-related fatalities among minors. Farm children and youth are also exposed to potentially harmful chemicals, such as pesticides and solvents, and many of these exposures go undetected. The long-term health effects of exposure to pesticides or solvents are not known, but the developmental vulnerabilities of children and youth are of particular concern. Clinical and epidemiologic research in pediatric populations is needed to expand the empirical data, particularly for inorganic and organic exposures, musculoskeletal trauma, skin disorders, occupation-induced hearing loss, and psychosocial stress. Rural health professionals can work to reduce these risks to farm youth by becoming more aware of the problem, by conducting clinical and epidemiologic research, and by engaging in advocacy at state and local levels.