Risk Of Subsequent Injury Research Articles

Ten years after: examination of adolescent screening questions that predict future violence-related injury

Purpose: To determine which screening questions used in routine adolescent health care maintenance visits correlate with subsequent violence-related injury. Methods: A prospective cohort study was undertaken of adolescents initially seen at the East Boston Neighborhood Health Center (EBNHC) in 1986. Risk factor data were collected based on the adolescent health intake form in the medical records. The primary outcome measure, time until first violence-related injury was determined through identification on chart review of the treatment of any such injuries at the urgent care center at EBNHC in the subsequent 10 years. Kaplan–Meier survival statistics and Cox proportional hazards models were used to account for loss of patients to follow-up. Results: Median follow-up for this sample was >5 five years. Male gender, cigarette smoking, alcohol use, other drug use, poor relationships with parents, not being in school or failing school, and history of fighting in the past year, predicted violence-related injury within the follow-up period. The number of fights in the past year appeared to have a dose–response effect on risk of subsequent violence-related injury. A simple screening instrument consisting of items concerning school status, drug use, and fighting history was used to stratify youth into low, moderate, and high risk of violence-related injury during the follow-up period. Conclusions: These results suggest that a simple three-item screening instrument may be used to stratify the risk of future injury at the time of adolescent health maintenance visits. Further research is indicated to validate this finding in other populations. Interventions designed to assist adolescents who are not in school or who have drug use problems should also incorporate violence prevention strategies.

Just how benign is renal dopamine?

Just how benign is renal dopamine?

Acute work injuries among electric utility linemen.

This analysis presents differences in acute work injury rates among electric utility linemen who perform different work tasks. Incidence-density rate ratios were the primary measure of association and are based on the work injury and person-time data for each job title. Logistic regression was used to model race, age, job experience, total inservice, prior injury, and time from prior injury. Transmission linemen had the lower acute injury rate with 18.9 per 100 person-work-years (95% CI 16-20), distribution linemen had 27.8 per 100 person-work-years (95% CI 27-28), and apprentice linemen had 43.3 per 100 person-work-years (95% CI 41-45). Injuries to the trunk and sprains and strains are the predominant injury categories. Having a prior lost time injury increases the risk for subsequent lost time injury for transmission linemen (OR = 1.6, 95% CI = 1.0-2.7) and for distribution linemen (OR = 1.5, 95% CI = 1.3-1.6).

A prospective study of ankle injury risk factors.

Many factors are thought to cause ankle ligament injuries. The purpose of this study was to examine injury risk factors prospectively and determine if an abnormality in any one or a combination of factors identifies an individual, or an ankle, at risk for subsequent inversion ankle injury. We examined 145 college-aged athletes before the athletic season and measured generalized joint laxity, anatomic foot and ankle alignment, ankle ligament stability, and isokinetic strength. These athletes were monitored throughout the season. Fifteen athletes incurred inversion ankle injuries. Statistical analyses were performed using both within-group (uninjured versus injured groups) data and within-subject (injured versus uninjured ankles) data. No significant differences were found between the injured (N = 15) and uninjured (N = 130) groups in any of the parameters measured. However, the eversion-to-inversion strength ratio was significantly greater for the injured group compared with the uninjured group. Analysis of the within-subject data demonstrated that plantar flexion strength and the ratio of dorsiflexion to plantar flexion strength was significantly different for the injured ankle compared with the contralateral uninjured ankle. Individuals with a muscle strength imbalance as measured by an elevated eversion-to-inversion ratio exhibited a higher incidence of inversion ankle sprains. Ankles with greater plantar flexion strength and a smaller dorsiflexion-to-plantar flexion ratio also had a higher incidence of inversion ankle sprains.

Smoking, Alcohol, and Neuromuscular Function in Older Women-Reply

In Reply. —Dr Slade suggests that nicotine may impair neuromuscular performance and increase the risk of subsequent injury. A relaxing effect of nicotine on the neuromuscular system has been described. 1 It may be one of several mechanisms acting together in a cumulative fashion to impair function. Dr Spilich suggests that one more such mechanism may be a direct effect of nicotine on the central nervous system. Nicotine and brain neurotransmitter systems have been studied, although their relationships to performance have been limited to animal investigations. 2 Others have documented lower cerebral blood perfusion levels in elderly chronic smokers compared with nonsmokers with improvement in perfusion within 1 year after smoking cessation. 3 Both of these central nervous system mechanisms could contribute to impaired performance. We hope our observations stimulate physiologic studies of the mechanism for this important adverse effect of smoking on the quality of smokers' lives.

Management of combined instabilities: Anterior cruciate ligament/medial collateral ligament and anterior cruciate ligament/lateral side

In our experience, combined injuries of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) or lateral side knee structures can occur in noncontact as well as contact sports. The MCL usually heals without surgical intervention. Repair of the ACL should be delayed (4 to 8 weeks) until the acute inflammatory phase subsides, motion is restored, the MCL heals, and quadriceps strength is relatively the same as that of the noninvolved leg. Decisions for total management depend on the patient's age, activities, demands, and desires. We recommend ACL reconstruction for those patients at high risk for recurrent instability and subsequent injury and modification of activities and/or brace use for low-risk patients. For patients with associated lateral side injuries, we test for varus laxity at 30° and the presence of anterior laxity. Varus laxity in extension and posterior laxity are absent. We perform a magnetic resonance imaging scan routinely for defining the lateral side injuries. Because lateral side injuries do not heal well with conservative treatment, we do not have the luxury of significantly delaying surgical management of ACL/lateral side injuries as we do for ACL/MCL injuries; hence, we perform reconstruction of the ACL and lateral direct repair of structures 7 to 10 days after injury. These patients, treated in the manner described and rehabilitated by our program, which emphasizes knee motion and early weight bearing, are able to predictably return to full activities with a stable functional knee.

Hyperactivity in School-Age Boys and Subsequent Risk of Injury

Hyperactive boys between 6 and 8 years of age, identified through systematic population-based screening of a community in London, were compared prospectively with a nonhyperactive control group to determine whether they were at greater risk of sustaining injuries. The study sample was drawn from 1296 completed parent and teacher questionnaires. Hyperactive groups were designated in three ways (parental report, teacher report, and combined parent and teacher report). Injuries were assessed by reviewing the medical records of the five emergency departments serving the community. Although boys with conduct problems did sustain more injuries than control subjects, no relationship between hyperactivity and injury was found. Similarly, when milder injuries were excluded from the analysis, the association remained negative. The absence of an association could not be accounted for by differential parental protectiveness of boys designated hyperactive. This study, which has a power of .80 to determine an increase in the relative risk of injury of 1.5, found no effect for hyperactive behavior in boys. Hyperactive behavior is probably not a risk factor for injury; if it is, it exerts a modest effect, less than 1.5, therefore accounting for less than 4% of injuries to school-aged boys.

Postprandial hemodynamics and oxygenation in developing piglet intestine

Age-related differences in the intestinal hemodynamic and oxygenation responses to feeding were studied in 1-day- (never-nursed and nursed-fasted), 3-day-, 2-wk-, and 1-mo-old piglets. A distal branch of the superior mesenteric vein draining an isolated loop of jejunoileum was used to measure intestinal blood flow, arteriovenous oxygen content difference, venous pressure, and capillary pressure. Calculations of oxygen uptake and vascular resistance were performed from the measured variables. Radioactive microspheres were used to measure fractionated flow. After luminal instillation of a cow milk-based formula, postprandial oxygen uptake increased to a similar extent in all age groups. In never-nursed newborns the increase was achieved by a dramatic rise in oxygen extraction with no change in total flow, while all other groups demonstrated a combined increase in blood flow and oxygen extraction. Mucosal blood flow increased to a similar extent in all age groups, but in never-nursed newborns it was at the expense of muscularis-serosa flow. Thus, because oxygen extraction and mucosal blood flow appear to be near maximal during feeding alone, newborn intestine may be at risk for tissue hypoxia and subsequent mucosal injury in the presence of a superimposed cardiovascular stress.

Alcohol and Fatal Injuries Among US Adults

Use of alcohol is an important risk factor for fatal injuries. However, little information on the relationship between self-reported alcohol use and subsequent risk of fatal injury is available. Therefore, we examined the relationship between the usual number of drinks consumed per occasion and the incidence of fatal injuries in a cohort of US adults. Using data on self-reported alcohol use obtained from 13,251 adults who were included in the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (mean length of follow-up, 9.3 years), we calculated the incidence of fatal injury according to the usual number of drinks consumed per occasion. After we adjusted for the effects of age, sex, race, and education, persons who consumed five or more drinks per occasion were nearly twice as likely to die from injuries (relative risk, 1.9; 95% confidence interval, 1.0 to 3.5) than persons who drank fewer than five drinks per occasion. A dose-response relationship was observed between the usual number of drinks consumed per occasion and risk of fatal injury, with persons who reported drinking nine or more drinks per occasion being 3.3 times more likely to die from injuries (95% confidence interval, 1.3 to 8.3). These data demonstrate the impact of alcohol use on mortality from injuries in the United States and suggest that self-reported alcohol consumption is an important indicator of risk for fatal injury.

Preschool Behavior Problems and Subsequent Risk of Injury

The hospital records of 951 children from a previously established birth cohort for which behavioral and extensive background information was available were checked for 3 years following the fifth birthday of the youngest child. The aim was to determine whether children with certain specific behavior disorders had a higher rate of injury than those without. Although the predicted relationships between overactive behavior, decreased concentration, and injury rate were not found, the hypothesis of an increased risk of injury for boys and for children with discipline problems was confirmed. Also, the association between male sex and injury remained after controlling for the behavior variables related to injury. In general, some support was found for the suggestion of increased risk of injury among children who have specific behavior problems, although, contrary to widespread belief, this relationship accounts for only a small percentage of the injuries found in the cohort. Moreover, the relationship is modified by maternal characteristics and by the sex of the child. Unexpectedly, encopresis and marked fears were found to be risk factors for injury, although these effects were relatively small.

Button battery ingestion: Assessment of therapeutic modalities and battery discharge state

Button batteries immersed in a simulated gastric environment (0.1N hydrochloric acid) demonstrated less crimp dissolution (corrosion of the metal can) after the addition of neutralizing doses of eight of nine antacids tested. Of 64 ingestion episodes in dogs, clinical manifestations of button battery-induced injury were limited to a single animal developing guaiac-positive stools. Endoscopic lesions included only mild gastritis, occurring with a frequency comparable to that observed in dogs prior to battery ingestion. After ingestion blood mercury levels were not significantly elevated. Crimp dissolution was absent in discharged cells, implying a decreased risk of electrolyte leakage or subsequent tissue injury in patients who ingest spent cells. No protective effect of metoclopramide, cimetidine, or magnesium citrate could be demonstrated in the canine model.

Stab wounds in children

The Pediatric Surgical Service of Harlem Hospital Center admitted 75 children, 16-years-old and younger, with stab wounds since 1969. Rapid resuscitation and triage of children with major injuries directly to the operating room achieved 100% survival. Review of the circumstance of injury revealed that 75% of the stab wounds were inflicted by children and 66% were known to have been intentional. Social service and psychiatric intervention for troubled children and their families is essential and may decrease the risk of subsequent traumatic injury.