Injury Registry Research Articles

PATTERN OF OCULAR TRAUMA AND VISUAL OUTCOME IN PATIENTS ATTENDING NATIONAL REFERRAL EYE HOSPITAL OF ERITREA

Background: Ocular trauma has been a significant disabling health problem and a leading cause of visual loss in lower-middle-income countries. These injuries have many diverse costs including human suffering, long-term disabilities, loss of productivity, and economic hardship. This study was aimed to describe the pattern of ocular trauma, its visual outcome, and the overall epidemiology of ocular trauma in all patients presenting to Berhan Eye Hospital, Asmara, Eritrea. Methods: A prospective observational study was conducted on ocular trauma patients who presented to Berhan Eye Hospital for the open globe, closed globe, and peri-orbital trauma from September – November 2018 after ethical approval from the Ministry of Health, Eritrea. Data on demography, initial and final visual acuity, type of injury as well as its outcome were collected using U.S Eye Injury Registry checklist. The types of injuries were classified according to Birmingham Eye Trauma Terminology System (BETTS), SPSS Version 22 was used. Results: Ocular trauma accounted for 1.94% of the total patients attending the outpatient department (OPD) and emergency during the studied period. Of the studied 280 participants, 218 (77.9%) patients were below 40 years of age. The male to female ratio was 2.4:1. Closed globe injuries accounted the highest 205 (73.21%) followed by the open globe injuries 75 (26.79%). Home and industrial premises were the main places where ocular injuries occurred in the participants. Conclusions: Ocular trauma affects mainly the younger age group. Blunt objects trauma in the eye are more common in low resource settings. Ocular trauma is an important cause of monocular blindness which can be prevented with early intervention and health promotion.

Higher risk of ACL rupture in amateur football compared to professional football: 5-year results of the \u2018Anterior cruciate ligament-registry in German football\u2019

PurposeAnterior cruciate ligament (ACL) injuries are a common severe type of football injury at all levels of play. A football-specific ACL registry providing both prospective ACL injury data according to the skill level and risk factors for ACL injury is lacking in the literature.MethodsThis study is based on the prospective ‘ACL registry in German Football’ implemented in the 2014–15 season. Professional (1st–3rd league), semi-professional (4th–6th league) and amateur leagues (7th league) were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2014–15 to the 2018–19 football season.ResultsOverall, 958 ACL injuries were registered during the 5-year study period. The incidence of ACL injuries was highest in amateur football (0.074/1000 h football exposure) compared to professional (0.058/1000 h; p < 0.0001) and semi-professional football (0.043/1000 h; p < 0.0001). At all skill levels, match incidence (professional: 0.343; semi-professional: 0.249; amateur: 0.319) was significantly higher than training incidence (professional: 0.015; semi-professional: 0.004; amateur: 0.005). Major risk factors were previous ACL injury (mean: 23.3%), other knee injuries (mean: 19.3%) and move to a higher league (mean: 24.2%).ConclusionThis sports-specific ACL registry provides detailed information on the incidence and risk factors for ACL injuries in football over five years. Risk factors are skill level, match exposure, move to a higher league and previous knee injury. These factors offer potential starting points for screening at-risk players and applying targeted prevention.Level of evidenceII.

How injury registration and preseason assessment are being delivered: An international survey of sports physical therapists

ObjectiveTo identify the role of sports physical therapists (PT) in the organization of injury registration and preseason assessment, applied in athletic organizations and sports teams of different gender and level world-wide. Designcross-sectional study. SettingLimeSurvey platform. ParticipantsSports PTs working with athletes invited through International Federation of Sports Physical Therapy. Main outcome measuresinjury registration and athlete's screening. Results414 sports PTs participated in this international survey (mean age of 37.66 (SD = 9.38) years). 340 participants indicated that the PT as the responsible for injury registration. Barriers to properly register injury throughout the season were indicated by 157 sports PT and 86 (54.77%) indicated a lack of time on their routine as the main factor. 93 participants (30.09%) indicated that they customize the prevention program based on the preseason assessment. Sports PTs who reported not performing a preseason assessment (92 participants - 22.22%) mainly indicated this to be consequence of lack of structure in the organization (44 participants – 47.82%). ConclusionThe majority of the sports PTs participate on injury registration and perform preseason assessment in athletes. However, lack of time in their routine and structure in the organization were recognized as the most important barriers to organize these properly.

PD46-04 TIME-RELATED CHANGES IN PATIENT-REPORTED BLADDER SYMPTOMS AND SATISFACTION AFTER SPINAL CORD INJURY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making IV (PD46)1 Sep 2021PD46-04 TIME-RELATED CHANGES IN PATIENT-REPORTED BLADDER SYMPTOMS AND SATISFACTION AFTER SPINAL CORD INJURY Odinachi Moghalu, John Stoffel, Sean Elliott, Blayne Welk, Sara Lenherr, Chong Zhang, Angela Presson, and Jeremy Myers Odinachi MoghaluOdinachi Moghalu More articles by this author , John StoffelJohn Stoffel More articles by this author , Sean ElliottSean Elliott More articles by this author , Blayne WelkBlayne Welk More articles by this author , Sara LenherrSara Lenherr More articles by this author , Chong ZhangChong Zhang More articles by this author , Angela PressonAngela Presson More articles by this author , and Jeremy MyersJeremy Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002060.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neurogenic lower urinary tract dysfunction is a significant source of concern and morbidity to individuals with spinal cord injury (SCI). Increased time from initial SCI is associated with improvements in bladder symptoms and satisfaction, despite a migration to bladder management strategies with higher morbidity such as indwelling catheters (IDC). We sought to better characterize the relationship between time from injury, bladder symptoms and satisfaction. METHODS: This is a cross-sectional analysis of time-related changes in patient reported bladder symptoms and satisfaction using data from the Neurogenic Bladder Research Group Spinal Cord Injury Registry. Study outcomes included: Neurogenic Bladder Symptom Score (NBSS-total) and its overall quality of life (QoL) question (NBSS-Satisfaction). Multivariable regression was performed to assess associations between time from injury and outcomes, adjusting for: demographics, injury characteristics, bladder management, and psychosocial aspects of health related QoL. Time from injury was categorized as 1-5 (ref.), 6-10, 11-15, 16-20, and >20 yrs. RESULTS: Of 1420 participants, median age at injury was 25.9 yrs. (IQR 19.7–38.8) and median time from injury was 11.6 yrs. (IQR 5.7–22.9). Primary bladder management changed with time from injury. There was a decline in use of clean intermittent catheterization (CIC) (55% 1-5 yrs. vs. 45% >20 yrs., p<0.001), and voiding (21% 1-5 yrs. vs. 17% >20 yrs., p<0.001) with increasing time from injury. Meanwhile, management with IDC (16% 1-5 yrs. vs. 21% >20 yrs.) and surgery (8% 1-5 yrs. vs 18% >20 yrs.) increased as time from injury increased (Figure 1). On multivariable analysis, increased time from injury was associated with less bladder symptoms (lower scores) at >20 yrs. from injury (NBSS-total -3.33, p<0.001) and better satisfaction in participants >10 yrs. from injury (NBSS-satisfaction 11-15 yrs. -0.36, 16-20 yrs. -0.59, >20 yrs. -0.86, p<0.001). CONCLUSIONS: Even in a contemporary population of SCI patients, there is a migration away from CIC, and an increase in IDC usage with time from injury. Despite this, there is a significant decrease in urinary symptoms, and improved QoL, even after adjusting for demographics, injury characteristics, bladder management, and psychosocial aspects of health related QoL. Source of Funding: This work was partially supported through a Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138). This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-05 (formerly 8UL1TR000105 and UL1RR025764) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e749-e750 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Odinachi Moghalu More articles by this author John Stoffel More articles by this author Sean Elliott More articles by this author Blayne Welk More articles by this author Sara Lenherr More articles by this author Chong Zhang More articles by this author Angela Presson More articles by this author Jeremy Myers More articles by this author Expand All Advertisement Loading ...

PD36-04 AUTONOMIC DYSREFLEXIA: WHAT VARIABLES ARE ASSOCIATED WITH WORSENING SYMPTOMS IN SPINAL CORD INJURED PEOPLE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (PD36)1 Sep 2021PD36-04 AUTONOMIC DYSREFLEXIA: WHAT VARIABLES ARE ASSOCIATED WITH WORSENING SYMPTOMS IN SPINAL CORD INJURED PEOPLE? John Stoffel, Rita Shehirian, Sara Lenherr, Sean Elliott, Diana O'Dell, Jeremy Myers, and Blayne Welk John StoffelJohn Stoffel More articles by this author , Rita ShehirianRita Shehirian More articles by this author , Sara LenherrSara Lenherr More articles by this author , Sean ElliottSean Elliott More articles by this author , Diana O'DellDiana O'Dell More articles by this author , Jeremy MyersJeremy Myers More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002040.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Autonomic dysreflexia (AD) can impact both the safety and quality of life of spinal cord injured people (SCI). We investigated whether bladder, bowel or pain symptoms were associated with worsening AD symptoms. METHODS: The Neurogenic Bladder Spinal Cord Injury registry prospectively enrolled SCI people in an observational study between 1/1/2016 – 6/30/2017. People self-reported demographic, clinical, and injury information. Quality of life was assessed with Neurogenic Bowel Dysfunction (NBD), Neurogenic Bladder Symptom Score (NBSS), and SCI SF-12 questionnaires. Chronic pain was reported as a dichotomous (y/n) variable. The severity of AD was assessed from a validated AD following SCI (ADFSCI) instrument and included domains of exercise, sexual activity, bladder function, bowel function, provoked and unprovoked activities. Total ADFSCI score ranged from 0 – 24. Bladder management was defined as surgical reconstruction (augment/diversion), indwelling catheter (suprapubic/urethral), any clean intermittent catheterization (CIC), or voiding. Univariate analysis and a logistic regression model were used to determine associations between variables and ADFSCI score. RESULTS: The registry enrolled 1470 people, of which 843 (57%) had paraplegia and 894 (60%) were men. The median age was 45 years and median time from injury was 11 years. Bladder management was reported as CIC in 754 (51%), indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). On univariate analysis, higher ADFSCI scores were reported among people with complete (3.91 vs 3.37, p = 0.02) and cervical/thoracic injures (3.83 CT vs 1.53 LS, p<0.0001), chronic pain (3.89 vs 2.86, p=0.0004), and multiple UTI’s (4.39 vs 2.66, p<0.0001). Rising ADFSCI score correlated with positively with increasing NBD score (r=0.243, p <0.0001) and negatively with age (r=-0.189, p <0.0001). Patients with indwelling catheters (5.25) or reconstructive surgery (4.48) had higher ADFSCI scores than CIC (3.00) and voiding (2.85) (p<0.0001). Multivariable analysis showed that level of injury, age, NBD score, and bladder management remained significantly associated with rising ADFSCI score. CONCLUSIONS: There were multiple variables associated with increased autonomic dysreflexia symptoms in this SCI cohort including level of injury, younger age, and worsening bowel symptoms. From a urologic standpoint, people with an augment/diversion or bladder managed with indwelling catheter had more AD symptoms compared to CIC or voiding. Source of Funding: PCORI © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e596-e596 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Stoffel More articles by this author Rita Shehirian More articles by this author Sara Lenherr More articles by this author Sean Elliott More articles by this author Diana O'Dell More articles by this author Jeremy Myers More articles by this author Blayne Welk More articles by this author Expand All Advertisement Loading ...

Sparsity of burn centers and prolonged length of hospital stay: A nationwide study

IntroductionThe optimal distribution of burn centers remains unclear. We aimed to determine the appropriate number of burn centers per population (density) and examined a nationwide registry with the hypothesis that low-density burn centers would be associated with unfavorable outcomes. Patients and methodsA retrospective study was conducted using the Japanese Society of Burn Injury registry (2011–2021). Burn center density was defined as the number of burn centers per one million population in each prefecture, and centers were trisected on the basis of density. Hospital-free days until day 30 were compared between patients at high-, middle-, and low-density centers. Inverse probability weighting was conducted to adjust baseline characteristics, including age, burn mechanism, and burn severity. ResultsWe included 6764, 6209, and 2200 patients at high-, middle-, and low-density burn centers, respectively. After adjusting for patient demographics and burn severity, patients at high- and middle-density centers (≥0.4 centers per one million population) had longer hospital-free days compared with those at low-density centers (11 [0–23] vs 11 [0–23] vs 8 [0–22] days; p < 0.001). ConclusionsLow burn center density (<0.4 centers per one million population) was associated with longer hospital stay, whereas no higher limit was determined.

Development of a machine learning algorithm for predicting in-hospital and 1-year mortality after traumatic spinal cord injury

BACKGROUND CONTEXTCurrent prognostic tools such as the Injury Severity Score (ISS) that predict mortality following trauma do not adequately consider the unique characteristics of traumatic spinal cord injury (tSCI). PURPOSEOur aim was to develop and validate a prognostic tool that can predict mortality following tSCI. STUDY DESIGNRetrospective review of a prospective cohort study. PATIENT SAMPLEData was collected from 1245 persons with acute tSCI who were enrolled in the Rick Hansen Spinal Cord Injury Registry between 2004 and 2016. OUTCOME MEASURESIn-hospital and 1-year mortality following tSCI. METHODSMachine learning techniques were used on patient-level data (n=849) to develop the Spinal Cord Injury Risk Score (SCIRS) that can predict mortality based on age, neurological level and completeness of injury, AOSpine classification of spinal column injury morphology, and Abbreviated Injury Scale scores. Validation of the SCIRS was performed by testing its accuracy in an independent validation cohort (n=396) and comparing its performance to the ISS, a measure which is used to predict mortality following general trauma. RESULTSFor 1-year mortality prediction, the values for the Area Under the Receiver Operating Characteristic Curve (AUC) for the development cohort were 0.84 (standard deviation=0.029) for the SCIRS and 0.55 (0.041) for the ISS. For the validation cohort, AUC values were 0.86 (0.051) for the SCIRS and 0.71 (0.074) for the ISS. For in-hospital mortality, AUC values for the development cohort were 0.87 (0.028) and 0.60 (0.050) for the SCIRS and ISS, respectively. For the validation cohort, AUC values were 0.85 (0.054) for the SCIRS and 0.70 (0.079) for the ISS. CONCLUSIONSThe SCIRS can predict in-hospital and 1-year mortality following tSCI more accurately than the ISS. The SCIRS can be used in research to reduce bias in estimating parameters and can help adjust for coefficients during model development. Further validation using larger sample sizes and independent datasets is needed to assess its reliability and to evaluate using it as an assessment tool to guide clinical decision-making and discussions with patients and families.

No increased injury incidence in the German Bundesliga after the SARS-CoV-2 virus lockdown

IntroductionThe coronavirus lockdown in 2020 resulted in a worldwide suspension of professional sports. The first major professional football league to restart after the lockdown was the German Bundesliga. This study investigates whether the injury incidence increased after the restart of the season with only 9 days of regular preparation time and without any friendly matches in comparison to three control periods.Materials and methodsIn a prospective cohort study, injury analysis (at least 1 day of absence from official football matches or training sessions) of the German Bundesliga registry was standardised according to Hägglund et al. (Br J Sports Med 39:340–346, 2005) and Fuller et al. (Clin J Sports Med 16:97–106, 2006) for data collection and to previous publications for the validated use of media sources for injury registration. The study period after the lockdown in May and June of the 2019–2020 season was compared to three control periods: the period directly before the lockdown, the beginning of the 2019–2020 season and the 2018–2019 season final.ResultsThe nine match days after the restart of the 2019–2020 season showed an overall injury incidence of 4.9 per 1000 h football. This rate was significantly lower than that of the previous season final (9 last match days, overall injury incidence: 6.9 per 1000 h football; p < 0.001) and not increased compared to the rates after the summer break (9 match days; incidence: 5.5/1000 h, p > 0.05) or the winter break (8 match days; incidence: 5.6/1000 h, p > 0.05).ConclusionThe period after the unexpected break in the 2019–2020 season due to the coronavirus lockdown and the rapid return to competition showed no increase in the injury rate compared to the pre-lockdown period and a lower injury rate than in the previous season final. The unintentional mid-season rest with its potential for physical recovery and individual fitness training seems to have had a positive effect on injury occurrence.

Epidemiological Characteristics of Paediatric Eye Injuries in a Large Metropolitan City in South Korea: A Multicentre, Prospective Study

ABSTRACT Purpose The aim of this study was to identify the epidemiological characteristics of paediatric eye injury in a large metropolitan city based on age group and sex. Methods This prospective, multicentre, observational study used data extracted from the eye injury registry for tertiary teaching hospitals in Daegu, South Korea, between August 2016 and July 2018. Children aged < 16 years were classified as infants, pre-schoolers, school children, and adolescents based on their age group. Results This study included 502 patients; most eye injuries occurred among boys (n = 349, 69.5%) and school children (n = 168, 33.5%). Unstructured play (n = 268, 53.4%) was the most common cause of eye injury, followed by sports (n = 69, 13.7%) and home activities (n = 52, 10.4%). Among adolescent boys, eye injuries were mostly caused by sports activities (n = 49, 37.7%), including soccer and basketball. Only 1 out of 69 children wore protective eyewear during sports activities. Eye injuries occurred most often in school (n = 63, 41.2%) during adolescence and at home (n = 270, 53.8%) in most other age groups. Conclusion Eye injuries were more common in boys. Boys and girls had relatively higher proportion of eye injuries during sports and home activities, respectively. In infants to school children, eye injuries mainly occurred at home and by unstructured play, whereas in adolescents, they mostly occurred at school and during sports activities. To prevent eye injuries sustained during sports in adolescents, wearing personal protective equipment during high-risk exercise in schools or sports facilities is recommended.

Decision-making to stop or continue playing after football injuries - a systematic video analysis of 711 injury situations in amateur football

ABSTRACT Scientific injury registration via video analysis is lacking in amateur football. The purpose of this study was to analyse match injury situations with a focus on the decisions made by players and referees after sustaining a football trauma. In a retrospective cohort study, traumatic injuries sustained in any of the 305 matches of the highest amateur level (4th league) in Germany in the 2015–16 season were assessed by means of video analysis and a standardised video protocol. In total, 711 traumatic incidents at 919 different body regions had been recorded. The three most frequently injured body regions were the ankles (34.1%), the head (17.5%) and the knees (17.0%). 90% (n = 156) of head injuries were direct contact injuries, this percentage was significantly higher than that of contact injuries on ankle (68.4%; p < 0.001) or knee (52.6%; p = 0.001). Referees decided on foul play significantly more often in case of knee injuries (57.1%; p = 0.002) or ankle injuries (64.5%; p < 0.001) than in head injuries (39.8%). Only 26.1% of players with a head injury opted for substitution, which was lower than after ankle (27.8%; p = 0.78) and knee injuries (34.0%; p = 0.13). In conclusion, amateur football is associated with a considerable number of injury situations that are followed by match interruptions and the substitution of players. Players and referees decided to continue playing more often after a head injury than after an injury to other body regions. An advanced education programme on the risks and management of head injuries in football is required to prevent long-term health consequences.

Proposal for evaluation and registration of sport injuries in skateboarding. Professional skateboarding injury prevention survey.

The recent incorporation of skateboarding as an Olympic discipline has aroused interest in the epidemiological analysis of injuries suffered in this sport with the aim of adopting preventive measures and thus reduce the athlete's time out of training or competition. There is little published on the topic. The few statistical data available refers to amateur practice and analyzes information obtained retrospectively. This situation leads to bias because It does not register relevant data that could be seen directly on the field of play or through video analysis. For example: issues involving the mechanism of injury, type of fall, etc. We propose this survey to be trialed in professional competitions and training in order to collect information from non-amateur practice of skateboarding. It will allow us to make effective decisions on preventive actions. All international federations should have access to it.

2021 Canadian Spine Society Abstracts.

# Abstract 45. Determining clinically important improvement following surgery for degenerative conditions of the spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) Registry {#article-title-2} There is significant variability in clinically important improvement (CII)

Neurotrauma Registry Implementation in Colombia: A Qualitative Assessment.

Objectives Latin America is among several regions of the world that lacks robust data on injuries due to neurotrauma. This research project sought to investigate a multi-institution brain injury registry in Colombia, South America, by conducting a qualitative study to identify factors affecting the creation and implementation of a multi-institution TBI registry in Colombia before the establishment of the current registry. Methods Key informant interviews and participant observation identified barriers and facilitators to the creation of a TBI registry at three health care institutions in this upper-middle-income country in South America. Results The study identified barriers to implementation involving incomplete clinical data, limited resources, lack of information and technology (IT) support, time constraints, and difficulties with ethical approval. These barriers mirrored similar results from other studies of registry implementation in low- and middle-income countries (LMICs). Ease of use and integration of data collection into the clinical workflow, local support for the registry, personal motivation, and the potential future uses of the registry to improve care and guide research were identified as facilitators to implementation. Stakeholders identified local champions and support from the administration at each institution as essential to the success of the project. Conclusion Barriers for implementation of a neurotrauma registry in Colombia include incomplete clinical data, limited resources and lack of IT support. Some factors for improving the implementation process include local support, personal motivation and potential uses of the registry data to improve care locally. Information from this study may help to guide future efforts to establish neurotrauma registries in Latin America and in LMICs.

Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries

BackgroundLow-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive...

O36: DEVELOPING A TRAUMA REGISTRY IN A MIDDLE INCOME COUNTRY – BOTSWANA

Abstract Background Botswana has a large burden of disease from injury, but no trauma registry. This study sought to design and pilot test a trauma registry at two hospitals. Methods A cross sectional study was piloted at a tertiary hospital and a secondary level hospital in Botswana. The study consisted of two stages: stage 1 mainly involved stakeholder consultations on existing data collection tools. Stage 2 consisted of two phases: Phase I involved retrospective collection of existing data from existing data collection tools and Phase II collected data prospectively using the proposed trauma registry prototype. Results The pre-hospital road traffic accident data is collected using hard copy forms and some of this data is transferred to a stand-alone electronic registry. The hospital phase of road traffic accident data all goes into hard copy files then stored in institutional registry departments. The post-hospital data is also partially stored as hard copies and some data is stored in a stand-alone electronic registry. The demographics, pre-hospital, triage, diagnosis, management and disposition had a high percent variable completion rate with no significant difference between phases I and II. However, the primary survey variables in Phase I had a low percent variable completion rate which was significantly different from the high completion rates in phase II at both hospitals. A similar picture was observed for the secondary survey at both hospitals. Conclusion Electronic trauma registries are feasible and data completion rate is high when using the electronic data registry as opposed to data collected using the existing paper-based data collection tools. Keywords Trauma registry, Injury registry, Road Traffic Accident Trauma Registry, Road Traffic Crushes Registry, Road Accident Registry. SYSTEMATIC REVIEWS

An evaluation of the representativeness of a national spinal cord injury registry: a population-based cohort study.

Population-based cohort study for the western part of Quebec. To determine the impact of declining to participate in a national spinal cord injury (SCI) registry on patient outcomes and continuum of care. Level-1 trauma center specialized in SCI care in Montreal, Canada. This cohort study compared the outcomes of 444 patients who were enrolled in the Rick Hansen SCI registry and 140 patients who refused. Logistic regression analyses were performed to assess the association between voluntary participation and the outcomes, while adjusting for confounding factors. The main outcomes were: attendance to follow-up 6- to 12-month post injury, 1-year mortality, and the occurrence of pressure injury during acute care. Declining to be enrolled in the registry was a significant predictor of lower attendance to specialized follow-up (adjusted odds ratio [OR] 0.04, 95% confidence interval [CI] 0.02-0.08). It was also associated with a higher 1-year mortality rate (OR 12.50, CI 4.50-33.30) and higher occurrence of pressure injury (OR 2.56, CI 1.56-4.17). This study sheds invaluable insight on individuals that researchers and clinicians are usually blind to in SCI cohort studies. This study suggests that decline to participate in a registry during the care hospitalization may be associated with worsened health, poorer outcomes, and reduced follow-up to specialized care. Declining the enrollment to voluntary registry could represent a potential prognostic factor for future research.

Localization of Brachial Plexopathies Using a Novel Diagnostic Program.

Background: Assessing the extent and specific location of brachial plexus injuries can be difficult given the variety of mechanisms of injury and anatomic complexity of the plexus. We developed a program to accurately assess the location of a patient's neurologic injury based on electromyographic data. Purpose: We sought to test our hypothesis that the location of traumatic brachial plexopathies could be accurately assessed with a novel program that processed electromyogram (EMG) and mechanism of injury data. Methods: This retrospective diagnostic cohort study was carried out with a novel diagnostic algorithm developed with the Python programming language. The program accepts user input of muscles demonstrating decreased motor unit recruitment, positive sharp waves, or fibrillation potentials. The testing data set was derived from a registry of brachial plexus injuries treated at our center. The primary outcome was the percent concordance of the algorithm's diagnosis with the surgical diagnosis. Results: Ninety-five cases met the inclusion criteria. Median time from injury onset to EMG examination was 4 months; median time from EMG examination to surgery was 1.2 months. The program diagnosis matched the surgical diagnosis in 92 out of 95 (97%) of cases, including cases with multilevel injuries and additional peripheral nerve injuries. Conclusion: This program accurately localized brachial plexopathies in nearly all cases, including those involving polytrauma or complex patterns of injury. This algorithm may be valuable as an aid to complete electrodiagnostic examinations, a diagnostic adjunct when planning treatment of severe plexus palsies, or an educational tool.

Head Impact Situations in Professional Football (Soccer).

To assess head impact incidents (HIIs) and to distinguish diagnosed head injuries from other incidents, a video observation analysis of match HIIs was conducted in the German Bundesliga (2017/18 season). Video recordings of each match were screened to identify the respective events. Head injury data were identified by a prospective injury registry. HII and head injury incidence rates (IR) were calculated with 95% CIs. The total number of HIIs was 1,362 corresponding to an IR of 134.9/1000 match hours (95% CI 127.9–142.2). In 123 HII (IR 12.2, 95% CI 10.2–14.5) the contact was classified as severe. Head contact with the opponent was the most frequent cause (85%). The most frequent mechanism was in 44% (combined) the arm and elbow-to-head, followed by head-to-head and hand-to-head contacts (each 13%). In 58%, the HIIs occurred during header duels. Twenty-nine head injuries were recorded (IR 2.9, 95% CI 2.0–4.1). Concussions/traumatic brain injuries accounted for 48%, head/facial fractures 24%, head/facial contusions 21%, and lacerations/abrasions 7%. The number of HIIs not classified as concussions/more severe trauma was high. Identification of HIIs and head injury severity should be improved during on-field assessment as many head injuries might go unrecognised based on the large number of HIIs.

The Shieh Score as a Risk Assessment Tool for Hospital-Acquired Pressure Injuries: A Retrospective Cohort Study.

To design a new risk assessment tool to identify patients at high risk for hospital-acquired pressure injuries. The researchers developed the Shieh Score using retrospective data of 406,032 hospital admissions from January 2014 to December 2016 with 1,299 pressure injury cases from the pressure injury registry. A decision tree and best subset logistic regression were used to select predictors from demographic and clinical candidate variables, which were then used to construct the Shieh Score. The final Shieh Score included the following measures: sex, age, diabetes, glomerular filtration rate, albumin level, level of function, use of IV norepinephrine, mechanical ventilation, and level of consciousness. The Shieh Score had a higher Youden Index, specificity, and positive predictive value than the Braden Scale. However, the Braden Scale had a higher sensitivity compared with the Shieh Score. The Shieh Score is an alternative risk assessment tool that may effectively identify a smaller number of patients at high risk for hospital-acquired pressure injuries with a higher specificity and positive predictive value than the Braden Scale.

Judo Injuries Frequency in Europe's Top-Level Competitions in the Period 2005-2020.

Background: The present study assesses the frequency of injury in Europe’s top-level judokas, during top-level competitions, and defines risk factors. Methods: The members of the EJU Medical Commission collected injury data over the period of 2005 to 2020 using the EJU Injury Registration Form at Europe’s top judoka tournaments. Results: Over the 15 years of the study, 128 top-level competitions with 28,297 competitors were included; 699 injuries were registered. Of all competitors, 2.5% needed medical treatment. The knee (17.4%), shoulder (15.7%), and elbow (14.2%) were the most common anatomical locations of injury. Sprains (42.2%) were by far the most frequent injury type, followed by contusions (23.1%). Of all contestants, 0.48% suffered an injury which needed transportation to hospital. There was a statistically significant higher frequency of elbow injuries in female athletes (p < 0.01). Heavy-weight judokas suffered a remarkably low number of elbow injuries, with more knee and shoulder injuries. Light-weight judokas were more prone to elbow injuries. Conclusions: We found there was a low injury rate in top-level competitors, with a greater frequency of elbow injuries in female judokas. During the 15 years of injury collection data, an injury incidence of 2.5% was found, with a remarkable high injury rate in the women’s −52 kg category, and statistically significantly more elbow injuries in women overall.