Risk Of Subsequent Injury Research Articles

Psychosocial work factors in new or recurrent injuries among hospital workers: a prospective study.

Accumulating evidence suggests an important role for psychosocial work factors in injury, but little is known about the interaction between psychosocial factors and previous injury experience on subsequent injury risk. We examined the relationships between psychosocial work factors and new or recurrent injury among hospital workers. We studied 492 hospital workers including 116 cases with baseline injury and 376 injury-free referents at baseline over follow-up. Job strain, total support, effort-reward imbalance, overcommitment, and musculoskeletal injury at baseline were examined in logistic regression models as predictors of new or recurrent injury experienced during a 2-year follow-up period. The overall cumulative incidence of injury over follow-up was 35.6 % (51.7 % for re-injury among baseline injury cases; 30.6 % for new injury among referents). Significantly increased risks with baseline job strain (OR 1.26; 95 % CI 1.02-1.55) and effort-reward imbalance (OR 1.42; 95 % CI 1.12-1.81) were observed for injury only among the referents. Overcommitment was associated with increased risk of injury only among the cases (OR 1.58; 95 % CI 1.05-2.39). The effects of psychosocial work factors on new or recurrent injury risk appear to differ by previous injury experience, suggesting the need for differing preventive strategies in hospital workers.

Cranial nerve VI palsy after dural-arachnoid puncture.

In this article, we provide a literature review of cranial nerve (CN) VI injury after dural-arachnoid puncture. CN VI injury is rare and ranges in severity from diplopia to complete lateral rectus palsy with deviated gaze. The proposed mechanism of injury is cerebrospinal fluid leakage causing intracranial hypotension and downward displacement of the brainstem. This results in traction on CN VI leading to stretch and neural demyelination. Symptoms may present 1 day to 3 weeks after dural-arachnoid puncture and typically are associated with a postdural puncture (spinal) headache. Resolution of symptoms may take weeks to months. Use of small-gauge, noncutting spinal needles may decrease the risk of intracranial hypotension and subsequent CN VI injury. When ocular symptoms are present, early administration of an epidural blood patch may decrease morbidity or prevent progression of ocular symptoms.

Extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers: a systematic review protocol.

Review question/objective Review question: which extrinsic and intrinsic factors are associated with non-contact injury in adult cricket pace bowlers? Review objective: the objective of this review is to determine the extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers. Inclusion criteria Types of participants This review will consider studies that include male cricket pace bowlers over the age of 18 years from all levels of play. Types of intervention(s)/phenomena of interest This review will consider studies evaluating the association between extrinsic and intrinsic factors, and lower quarter injury in pace bowlers. Intrinsic factors may include, but will not be limited to, muscle strength, flexibility, balance and biomechanics, while extrinsic factors may include bowling, but will not be limited to, workload, player position and time of play. Types of outcomes This review will consider studies that include any of the following outcome measures: non-contact injury. A non-contact injury is defined as an injury which is significant enough to cause an inability to fully or partially participate in training or matches and which was caused by an overuse mechanism rather than collision-type injuries.

Effect of neurocognition and concussion on musculoskeletal injury risk.

Research regarding musculoskeletal injury risk has focused primarily on anatomical, neuromuscular, hormonal, and environmental risk factors; however, subsequent injury risk screening and intervention programs have been largely limited to neuromuscular factors and have faced challenges in both implementation and efficacy. Recent studies indicate that poor neurocognitive performance, either at baseline or in the aftermath of a concussion, is associated with elevated risk of musculoskeletal injury. Despite the relatively limited current understanding regarding the nature of the relationship between different aspects of neurocognitive performance and musculoskeletal injury risk, this is a promising area of research that may yield significant advances in musculoskeletal injury risk stratification, rehabilitation, and prevention.

Perioperative aspirin and clonidine and risk of acute kidney injury: a randomized clinical trial.

Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain and each intervention has the potential for harm. To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. A 2 × 2 factorial randomized, blinded, clinical trial of 6905 patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days after surgery, and were assigned to take oral clonidine (0.2 mg) or placebo 2 to 4 hours before surgery, and then a transdermal clonidine patch (which provided clonidine at 0.2 mg/d) or placebo patch that remained until 72 hours after surgery. Acute kidney injury was primarily defined as an increase in serum creatinine concentration from the preoperative concentration by either an increase of 0.3 mg/dL or greater (≥26.5 μmol/L) within 48 hours of surgery or an increase of 50% or greater within 7 days of surgery. Aspirin (n = 3443) vs placebo (n = 3462) did not alter the risk of acute kidney injury (13.4% vs 12.3%, respectively; adjusted relative risk, 1.10; 95% CI, 0.96-1.25). Clonidine (n = 3453) vs placebo (n = 3452) did not alter the risk of acute kidney injury (13.0% vs 12.7%, respectively; adjusted relative risk, 1.03; 95% CI, 0.90-1.18). Aspirin increased the risk of major bleeding. In a post hoc analysis, major bleeding was associated with a greater risk of subsequent acute kidney injury (23.3% when bleeding was present vs 12.3% when bleeding was absent; adjusted hazard ratio, 2.20; 95% CI, 1.72-2.83). Similarly, clonidine increased the risk of clinically important hypotension. In a post hoc analysis, clinically important hypotension was associated with a greater risk of subsequent acute kidney injury (14.3% when hypotension was present vs 11.8% when hypotension was absent; adjusted hazard ratio, 1.34; 95% CI, 1.14-1.58). Among patients undergoing major noncardiac surgery, neither aspirin nor clonidine administered perioperatively reduced the risk of acute kidney injury. clinicaltrials.gov Identifier: NCT01082874.

High School Athletes' Perceptions of Concussion.

Background:The perception high school athletes have regarding concussions may influence their injury-reporting behavior, and if their perceptions are based on incorrect or incomplete information, they may be at risk for subsequent head injuries.Purpose:To determine whether the recent influx of concussion information has had a positive impact on high school athletes’ knowledge of concussions, to determine their perceptions regarding the severity of a concussion injury, and to determine whether receiving correct information will potentially alter their future reporting behavior.Study Design:Cross-sectional study; Level of evidence, 4.Methods:A total of 454 high school athletes (212 females, 242 males; mean age, 15.7 ± 1.15 years) from 6 different schools participated in an anonymous survey. The researchers met with teams individually at their high schools to collect data and provide an educational intervention regarding sports-related concussions. The survey questions assessed the athletes’ personal injury histories and perceptions and knowledge of the severity of concussion injuries.Results:There was a difference in the number of athletes who reported having their “bell rung” (n = 297) versus the number of athletes reporting at least 1 concussion (n = 172) (t (453) = −11.60, P = .000, d = −0.54). There was also a difference in the number of athletes who reported a history of at least 1 concussion at the beginning of the study session (n = 172) versus the number of athletes who reported at least 1 concussion at the end of the session (n = 292) (t (453) = −12.018, P = .000, d = 0.732). Fifty percent of athletes also stated that the importance of a game/event should dictate when they return to play.Conclusion:High school athletes continue to fail to realize when they have sustained a concussion. Additionally, athletes lack understanding regarding the severity and seriousness of a concussion. A better effort at formalized education must be made if the culture of sports is to change.Clinical Relevance:Allied health care professionals need to continue to put forth a great effort in educating all student athletes on what a concussion is and the dangers of a concussion injury. Preseason meetings should be used as an opportunity to provide formalized education to all student athletes.

Risk Factors for Anterior Glenohumeral Instability

Background: While anterior glenohumeral instability has been shown to be common in young athletes, the risk factors for injury are poorly understood. Purpose/Hypothesis: To determine the modifiable and nonmodifiable risk factors for anterior shoulder instability in a high-risk cohort. The hypothesis was that specific baseline factors would be associated with the subsequent risk of injury. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: We conducted a prospective cohort study in which 714 young athletes were followed from June 2006 through May 2010. Baseline assessments included a subjective history of instability, physical examination by a sports medicine fellowship–trained orthopaedic surgeon, range of motion, strength with a handheld dynamometer, and bilateral noncontrast shoulder magnetic resonance imaging (MRI). A musculoskeletal radiologist measured glenoid version, glenoid height, glenoid width, glenoid index (height-to-width ratio), glenoid depth, rotator interval (RI) height, RI width, RI area, RI index, and the coracohumeral interval. Subjects were followed to document all acute anterior shoulder instability events during the 4-year follow-up period. The time to anterior shoulder instability event during the follow-up period was the primary outcome of interest. Univariate and multivariable Cox proportional hazards regression models were used to analyze the data. Results: Complete data were available for 714 subjects. During the 4-year surveillance period, there were 39 anterior instability events documented at a mean of 285 days. While we controlled for covariates, significant risk factors of physical examination were as follows: apprehension sign (hazard ratio [HR], 2.96; 95% CI, 1.48-5.90; P = .002) and relocation sign (HR, 4.83; 95% CI, 1.75-13.33; P = .002). Baseline range of motion and strength measures were not associated with subsequent injury. Significant anatomic risk factors on MRI measurement were glenoid index (HR, 8.12; 95% CI, 1.07-61.72; P = .043) and the coracohumeral interval (HR, 1.20; 95% CI, 1.08-1.34; P = .001). Conclusion: This prospective cohort study revealed significant risk factors for shoulder instability in this high-risk population. Physical examination findings of apprehension and relocation were significant while controlling for history of injury. The anatomic variables of significance were not surprising—tall and thin glenoids were at higher risk compared with short and wide glenoids, and the risk of instability increased by 20% for every 1-mm increase in coracohumeral distance.

English

In today's world high velocity road traffic accidents, sports activities and increased fitness awareness, ACL injuries is a common clinical problem. Once upon a time ACL rupture led to a relatively safe existence and was thought to be of less significance. Now with improved knee kinematics and clinical skills, it has been established that post ACL injury, the prevalence of clinically significant meniscal damage increases with time and is associated with increasing disability and arthrosis. Ligament reconstruction has not been shown to prevent arthrosis, but studies show that it appears to reduce the risk of subsequent meniscal injury and improve anteroposterior knee motion and facilitates return to high level sporting activities. As surgical techniques like Arthroscopy improve the ability to tackle complex problems, complex decisions regarding Meniscal repair and transplantation, Cartilage repair and regeneration are now commonplace, as are decisions regarding the need for Osteotomies in Arthritically unstable knees. Arthroscopic reconstruction of the Anterior Cruciate Ligament with patellar bone - tendon - bone graft is minimally invasive and is relatively quick and simple to perform, although attention to detail as required for good results. Thus arthroscopy helps in diagnosis and treatment of internal derangement and on extra articular reconstruction. Thus this procedure consists of a combined procedure of arthroscopy for diagnosis and treatment of internal derangement and an extra articular reconstruction by means of bone- patellar tendon-bone graft by minimally invasive, quick and simple surgery. Although attention to detail is required for good results.

Fast bowling match workloads over 5-26 days and risk of injury in the following month.

This study examined whether high match fast bowling workloads in the short to medium term were associated with increased bowling injury rates. Prospective cohort study. Over a 15 year period, workload patterns for 235 individual fast bowlers during time periods from 5 to 26 days were examined to consider whether there was an increased injury rate during the month (28 days) subsequent to the workload. Fast bowlers who bowled more than 50 match overs in a 5 day period had a significant increase in injury over the next month compared to bowlers who bowled 50 overs or less RR 1.54 (95% CI 1.04-2.29). For periods ranging from 12 to 26 days, there was no statistically-significant increase in injury over the next month from exceeding thresholds of certain amounts of overs, although bowlers who bowled more than 100 overs in 17 days had a non-significant increase in injury over the next month RR 1.78 (95% CI 0.90-3.50). There were no statistically-significant increases in subsequent injury risk for high workloads for periods of 12-26 days, although exceeding 100 overs in 17 days (or less) was associated with higher injury rates. Compression of cricket fixtures is likely to have only a minimal contribution to increased fast bowling injury rates being seen in the T20 era (along with sudden workload increases due to transferring between forms of the game, which has been previously established as a major contributor).

“Contrast-Less” Stent-Assisted Coiling of an A1 Aneurysm

Iodine-based contrast medium used in diagnostic and therapeutic cerebrovascular imaging may cause renal toxicity, especially in patients with underlying renal impairment. Contrast dilution may impede efforts of the neurointerventionalist to treat intracranial vascular pathology. A 36-year-old man with renal impairment presented with an unruptured A1 segment anterior cerebral artery aneurysm. Previously obtained magnetic resonance angiography was fused with intraoperative noncontrast computed tomography and live 2-dimensional fluoroscopic images. The aneurysm was successfully treated with stent-assisted coil embolization without the use of contrast. Neurointervention without contrast was feasible, and although the presented case is one example, the imaging fusion techniques used in this case can substantially decrease the exposure to contrast and subsequent risk of renal injury during intracranial procedures. Further development of and experience with this technique is needed to improve its safety and efficacy.

Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players

BackgroundLittle is known about the short-term and long-term sequelae of concussion, and about when athletes who have sustained such injuries can safely return to play.PurposeTo examine whether sports-related concussion increases...

Risk Factors and Predictors Of Subsequent ACL Injury After ACL Reconstruction: Prospective Analysis Of 2801 Primary ACL Reconstructions

Objectives:Retear of an ACL after an ACL reconstruction (ACLR) is devastating for all involved. Understanding risk factors and predictors of subsequent ACL tear after an ACLR is vital for patient education of subsequent risk of injury and if a predictor is modifiable, to make adjustments to minimize the risk of repeat ACL tear. The objectives of this study were 1) to identify the risk factors and predictors for ispilateral and contralateral ACL tears after primary ACLR and 2) to compare retear risk between the 2002/03 and 2007/08 cohorts. This is the largest and most comprehensive prospective analysis of this kind in the literature.Methods:Data from the 2002-2008 MOON database was used to identify risk factors for ACL retear. Subjects who had a primary ACLR with no history of contralateral knee surgery and had 2 year follow-up data were included. Subjects who had multiligament surgery were excluded. Graft type (auto-BTB, auto-hamstring, allograft), age, Marx score at time of index surgery, sport played post ACLR, sex, smoking status, lateral meniscus tear at the time of ACLR, medial meniscus tear at the time of ACLR, BMI, and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. The analysis was repeated using the 2002/3 and 2007/8 cohort and included age, graft, sex, and Marx. An ANOVA with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time.Results:A total of 2801 subjects met all inclusion/exclusion criteria. There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two year follow-up. The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (p=0.04) and 4.67 times greater for an allograft (p<0.001) compared to auto-BTB. The odds of ipsilateral retear decrease by 8% for every yearly increase in age (p < 0.001) and increases by 6% for every increased point on the Marx score (p = 0.017). The odds of contralateral ACL tear increase by 7% for every increased point on the Marx score (p = 0.004) and decreases by 5% for every one point increase in BMI (p = 0.03). In 2002/3, there were 61/815 (7.5%) retears compared to 37/1056 (3.5%) in 2007/8. The odds of retear by for the 2002/03 and 2007/08 cohorts are summarized in table 1. The mean age (figure 1) of subjects receiving BTB and hamstring remained constant over time whereas the mean age of subjects receiving allograft rose by seven years (p < 0.001). Hamstring use was a predictor of retear compared to BTB in the 02/03 group (7.9% vs. 4.2%), but not in the 07/08 group (4.1% vs. 3.4%).Conclusion:Age, activity, and graft type were predictors of increased risk of ipsilateral graft failure after ACLR. Higher activity and lower BMI were found to be risk factors in contralateral ACL tears. Allograft use in young active patients was shown to be a risk factor for graft retear in the 02/03 group, subsequent to this, graft choice changed to using allografts in older and less active patients with an associated decrease in graft retear risk in the 07/08 group. The contralateral ACL injury risk did not change from the early group to the later group. The risk of ACL graft retear was lower for all graft types in the 07/08 group compared to the 02/03 group. The relative decrease risk in hamstring autografts compared to BTB in 07/08 compared to 02/03 may be due to improved surgical techniques, rehabilitation, and/or slower return to play guidelines, and bears further investigation.

113: Incidence and Mechanisms of Mild Traumatic Brain Injury in Children Presenting to the Emergency Room

Mild traumatic brain injury (mTBI), often called concussion, is a common injury sustained by children participating in sports and recreational activities. There is evidence to suggest that children who has sustained a concussion is at increased risk for subsequent head injuries, and that such injuries may be cumulative and lead to prolonged or persistent symptoms. Prevention strategies for mTBI should aim at age-specific mechanism of injury. The aim of this study was to determine the mechanisms of minor traumatic brain injury (mTBI) among children presenting to the emergency room. A retrospective study of all emergency room visits for minor traumatic brain injury suffered by children between zero and 18 years of age between November 2010 and November 2011. Children with loss of consciousness, post-traumatic amnesia and/or short-lived impairment of neurological function were considered to suffer from mTBI. A total of 518 cases of mTBI were reported, 87 were not considered for this study due to missing information required for diagnosis of mTBI. A total of 431 confirmed case of mTBI were identified with an estimated incidence of 12.7 per 1000 children per year (95% CI 11.6 to 13.9 per 1000). Of these, 191 (44%) were children between 0 and 4 years of age, 70 (16%) five to nine years old, 96 (22%) 10 to 14 years old and 74 (17%) 15 to 17 years old. The two most frequent mechanisms leading to mTBI were falls from height (38%) and sports related injury (27%). The latter was responsible for 61% of mTBI suffered by children between 10 and 17 years of age, when, on the other hand, falls from height represented 69% of the zero to four years old cases. mTBI is very prevalent in the pediatric population and is caused by a variety of mechanisms. This study reveals that mTBIs affect preschoolers at home resulting from a fall from a height in proportion comparable to sports related mTBI among older children.

Factors predictive of subsequent injury in a longitudinal cohort study

ObjectivesThe aims are to: (1) Determine the cumulative incidence of self-reported subsequent injury (of any anatomical site or injury type) occurring between 3 months and 12 months after a sentinel...

High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury?

BackgroundIdentifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle.ObjectiveWe evaluated two unique prospective cohorts with similar populations...

CHANGING HAND POSITIONS ALTERS LOWER EXTREMITY BIOMECHANICS DURING LANDING

BackgroundDuring gameplay, athletes frequently change their trunk and hand placement positions (e.g. ball handling). Changing trunk positions alters lower extremity (LE) biomechanics and subsequent injury risk during sport. However, whether...

DOES A MODIFIED RUGBY SCRUM ENGAGEMENT PROCESS IMPROVE THE STABILITY OF THE SCRUM AND MINIMISE THE LIKELIHOOD OF SCRUM COLLAPSE?

BackgroundRugby Union scrums which collapse possess a higher injury risk than completed scrums. A mechanically stable scrum should limit the motions which generate uncontrolled and hazardous (non-axial) loading on front...

NATIONAL TEAM RUGBY PLAYER INJURY TYPES, RATES AND RISK FACTORS OVER TWO-YEARS

BackgroundInjury surveillance may provide valuable information regarding relationships between initial and subsequent injuries. Subsequent Injury Categorisation (SIC) may be useful in sports such as rugby that have high rates of...

Femur shaft fracture at a young age and the risk of subsequent severe injuries during childhood: a cohort study

BackgroundA child who suffers a fracture or a soft-tissue injury at a young age faces an increased risk of subsequent injuries during childhood. This risk could be related to personal and family characteristics or to lower-than-average bone-mineral density. The purpose of this nationwide cohort study was to estimate the association between a femur shaft fracture at a young age and the subsequent risk of hospitalization for injuries during childhood.MethodsWe compared the subsequent risk of hospitalization for injuries during childhood among 1,404 children (exposed) who were one to three years of age when they suffered a femur shaft fracture with the risk among 13,814 randomly selected, gender- and age-matched femur fracture–free children (unexposed). Hazard ratios (HRs) and 95% confidence intervals (CIs) for severe injuries defined as fractures or soft-tissue injuries requiring hospital admission were estimated in a Cox proportional hazards model.ResultsExposed children exhibited no significantly increased risk of upper-extremity fractures or soft-tissue injuries during childhood, regardless of sex and follow-up time. Boys exhibited a 162% increased risk of suffering a lower leg fracture requiring hospital admission (HR?=?2.62, 95% CI: 1.45–4.71), but the refracture risk was not significant for girls 2.02 (0.58–6.97).ConclusionsWe found an increased risk for subsequent fractures in the lower leg that requires inpatient care during childhood for boys, but not for girls, who were one to three years of age when they first suffered a femur shaft fracture. This increased fracture risk is probably not simply the result of greater risk-taking among boys. The explanation might relate to factors affecting the bone quality of the lower leg.

Younger Patients Are at Increased Risk for Graft Rupture and Contralateral Injury After Anterior Cruciate Ligament Reconstruction

Background: Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive. Purpose: To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter. Results: Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29% sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury. Conclusion: Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined.