Severe Injury Patterns Research Articles

Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up

PurposePatients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay.MethodsProspective and bicentric study with standardized transthoracic echocardiographic (TTE) follow-up during ICU stay with a maximum follow-up of 28 days. The different patterns of RV injury were isolated RV dilation, RV dysfunction (tricuspid annular plane systolic excursion < 17 mm and/or systolic tricuspid annular velocity < 9.5 cm/s and/or RV fractional area change < 35%) without RV dilation, RV dysfunction with RV dilation and acute cor pulmonale (ACP, RV dilatation with paradoxical septal motion). The different RV injury patterns were described and their association with Day-28 mortality was investigated.ResultsOf 118 patients with complete echocardiographic follow-up who underwent 393 TTE examinations during ICU stay, 73(62%) had at least one RV injury pattern during one or several TTE examinations: 29(40%) had isolated RV dilation, 39(53%) had RV dysfunction without RV dilation, 10(14%) had RV dysfunction with RV dilation and 2(3%) had ACP. Patients with RV injury were more likely to have cardiovascular risk factors, to be intubated and to receive norepinephrine and had a higher Day-28 mortality rate (27 vs. 7%, p < 0.01). RV injury was isolated in 82% of cases, combined with left ventricular systolic dysfunction in 18% of cases and 10% of patients with RV injury experienced several patterns of RV injury during ICU stay. The number of patients with de novo RV injury decreased over time, no patient developed de novo RV injury after Day-14 regardless of the RV injury pattern and 20(31%) patients without RV injury on ICU admission developed RV injury during ICU stay. Only the combination of RV dysfunction with RV dilation or ACP (aHR = 3.18 95% CI(1.16–8.74), p = 0.03) was associated with Day-28 mortality.ConclusionRV injury was frequent in COVID-19 patients, occurred within the first two weeks after ICU admission and was most often isolated. Only the combination of RV dysfunction with RV dilation or ACP could potentially be associated with Day-28 mortality.Clinical trial registration NCT04335162.

Prehospital Time Following Traumatic Injury Is Independently Associated With the Need for In-Hospital Blood and Early Mortality for Specific Injury Types

ObjectiveTreating traumatic hemorrhage is time sensitive. Prehospital care and transport modes (eg, helicopter and ground) may influence in-hospital events. We hypothesized that prehospital time (on-scene time [OST] and total prehospital time [TPT]) and transport mode are associated with same-day transfusion and mortality. Furthermore, we sought to identify regions of anatomic injury that modify the relationship between prehospital time and outcomes in strata corresponding to transport types. MethodsWe obtained prehospital, in-hospital, and trauma registry data from an 8-center cohort of adult nonburn trauma patients from 2017 to 2022 directly transported from the scene to the hospital and having an Injury Severity Score (ISS) > 9 for the Task Order 1 project of the Linking Investigators in Trauma and Emergency Services research network. We excluded patients missing prehospital times, patients < 18 years of age, patients from interfacility transfers, and recipients of prehospital blood. Our same-day outcomes were in-hospital transfusions within 4 hours and 24-hour mortality. Each outcome was adjusted using multivariable logistic regression for covariates of prehospital phases (OST and TPT), mode of transport (helicopter and ground), age, sex, ISS, Glasgow Coma Scale motor subscale score < 6, and field hypotension (systolic blood pressure < 90 mm Hg). We evaluated the association of prehospital time on outcomes for scene missions by transport mode across severe injury patterns defined by Abbreviated Injury Scale > 2 body regions. ResultsOf 78,198 subjects, 34,504 were eligible for the study with a mean age of 47.6 ± 20.3 years, ISS of 18 ± 11, OST of 15.9 ± 9.5 minutes, and TPT of 48.7 ± 20.3 minutes. Adjusted for injury severity and demographic factors, transport type significantly modified the relationship between prehospital time and outcomes. The association of OST and TPT with the odds of 4-hour transfusion was absent for the ground emergency medical services (GEMS) cohort and present for the helicopter emergency medical services (HEMS) ambulance cohort, whereas these times were associated with decreased 24-hour mortality for both transport types. When stratifying by injury to most anatomic regions, OST and TPT were associated with a decreased need for 4-hour transfusions in the GEMS cohort. However, OST was associated with increased early transfusion only among patients with severe injuries of the thorax, and this association persisted after adjusting additionally for injury type (odds ratio [OR] = 1.03; 95% confidence interval [CI], 1.00-1.05; P = .02). The presence of polytrauma supported an association between prehospital time and decreased 24-hour mortality for the GEMS cohort (OST: OR = 0.97; 95% CI, 0.95-0.99; P < .01; TPT: OR = 0.99; 95% CI, 0.98-0.99; P = .02), whereas no injuries showed significant association of helicopter prehospital time on mortality after adjustment. ConclusionWe determined that transport type affects the relationship between prehospital time and hospital outcomes (4-hour transfusion: positive relationship for HEMS and negative for GEMS, 24-hour mortality: negative for both transport types). Furthermore, we identified regions of anatomic injury that modify the relationship between prehospital time and outcomes in strata corresponding to transport types. Of these regions, most notable were severe isolated injuries to the thorax that supported a positive relationship between HEMS OST and 4-hour transfusions and polytrauma that showed a negative relationship between GEMS OST or TPT and 24-hour mortality after adjustment.

E-Bikes (Electrical Bicycles and Scooters) Related Neurosurgical Injuries in the Adult Population: A Single-Center Experience.

E-bikes (electrical bicycles and scooters) have been increasingly used as a means of transportation, especially among young adults. E-bikers have more accidents, at higher velocities and more severe kinematics, increasing the rate of neurosurgical injuries. Severe neurosurgical injury patterns result in significant morbidity and mortality. We collected data regarding adult patients (>18 years old), who suffered e-bike-related neurosurgical injuries, in a single tertiary medical center in Israel, between July 2019 and June 2020. Fifty-eight consecutive patients were included in this study. The average age was 34.9, and the average Glasgow Coma Scale (GCS) score upon admission was 13.2 and was significantly lower in operated patients (10.75). Fifty-four patients were riders; 51 (94.5%!) were not wearing a helmet. Fifty percent of patients had multiple types of trauma. Six patients suffered a spinal injury. Sixteen patients required either cranial or spinal surgery. Three patients died, and 1 remained in a vegetative state. Median Glasgow Outcome Scale-Extended (GOS-E) score at follow-up was 7.1. Operated patients stayed significantly longer in the intensive care unit (ICU) and in the hospital, and their GOS-E scores at discharge and follow-up were significantly lower. Most spinal injuries underwent surgery. Patients who wore helmets had significantly higher GCS scores and a shorter stay in the ICU and hospital. The unacceptable reality of the careless use of this transportation and the unique kinematics lead to severe neurosurgical injuries, comorbidities, and even mortality. Our results reflect the risks of e-bikes in the adult population. Most of our patients were in the mid-age group, and almost none had used a helmet. The results of this study highlight the potential need for neurosurgical treatment, and the need for long-term rehabilitation and follow-up, reflecting the emotional and financial toll of these injuries. Once again, this study showed that helmets save lives and emphasized the importance of protecting our heads.

Outcomes and potential for improvement in the prehospital treatment of penetrating chest injuries in a European metropolitan area: A retrospective analysis of 2009 – 2017

BackgroundTrauma is the leading cause of death in patients <45 years living in high-resource settings. However, penetrating chest injuries are still relatively rare in Europe – with an upwards trend. These cases are of particular interest to emergency medical services (EMS) due to available invasive treatment options like chest tube placement or resuscitative thoracotomy. To date, there is no sufficient data from Austria regarding penetrating chest trauma in a metropolitan area, and no reliable source to base decisions regarding further skill proficiency training on. MethodsFor this retrospective observational study, we screened all trauma emergency responses of the Viennese EMS between 01/2009 and 12/2017 and included all those with a National Advisory Committee for Aeronautics (NACA) score ≥ IV (= potentially life-threatening). Data were derived from EMS mission documentations and hospital files, and for those cases with the injuries leading to cardiopulmonary resuscitation (CPR), we assessed the EMS cardiac arrest registry and consulted a forensic physician. ResultsWe included 480 cases of penetrating chest injuries of NACA IV-VII (83% male, 64% > 30 years old, 74% stab wounds, 16% cuts, 8% gunshot wounds, 56% inflicted by another party, 26% self-inflicted, 18% unknown). In the study period, the incidence rose from 1.4/100,000 to 3.5/100,000 capita, and overall, about one case was treated per week. In the cases with especially severe injury patterns (= NACA V-VII, 43% of total), (tension-)pneumothorax was the most common injury (29%). The highest mortality was seen in injuries to pulmonary vessels (100%) or the heart (94%). Fifty-eight patients (12% of total) deceased, whereas in 15 cases, the forensic physician stated survival could theoretically have been possible. However, only five of these CPR patients received at least unilateral thoracostomy. Regarding all penetrating chest injuries, thoracostomy had only been performed in eight patients. ConclusionsSevere cases of penetrating chest trauma are rare in Vienna and happened about once a week between 2009 and 2017. Both incidence and case load increased over the years, and potentially life-saving invasive procedures were only reluctantly applied. Therefore, a structured educational and skill retention approach aimed at both paramedics and emergency physicians should be implemented. Trial registrationRetrospective analysis without intervention.

SARS-Co-V-2 positive status is associated with a more seriously injured population of trauma patients but not independently associated with worse outcomes of trauma care.

SARS-CoV-2 positive status has been considered a predominantly incidental finding among trauma patients. We sought to examine whether concurrent infection is associated with worse outcomes in a contemporary cohort of injured patients during the COVID-19 pandemic. Retrospective cohort analysis of a level I trauma center's institutional registry from May 1, 2020 through June 30, 2021. The prevalence of COVID in the trauma population was compared monthly using prevalence ratios relative to population estimates. Unadjusted cohorts of COVID+ vs COVID- trauma patients were compared. COVID+ patients then were matched on age, mechanism of injury, year, and injury severity score (ISS) with COVID- controls for adjusted analysis with a primary composite outcome of mortality. Out of n=2,783 trauma activations, n=51 (1.8%) were COVID+. Compared to the general population, the trauma population had prevalence ratios for COVID of 5.3 to 79.7 (median=20.8). Compared to COVID- patients, COVID+ patients had worse outcomes, including a higher proportion who were admitted to the ICU, required intubation, underwent a major operation, and had greater total charges and a longer length of stay. However, these differences appeared related to more severe injury patterns in the COVID+ cohort. In the adjusted analysis, no significant differences between groups in any of the outcome variables were observed. Worse trauma outcomes in COVID+ patients appear to be correlated to the more substantial patterns of injury observed in this group. Trauma patients have substantially higher rates of SARS-CoV-2 positivity than the local population at large. These results reinforce that this population is vulnerable to multiple threats. They will guide the ongoing delivery of care in shaping the needs for testing, PPE for those delivering care, and the capacity and operational needs of trauma systems that must care for a population with such high rates of SARS-CoV-2 infection.

Complications in the Treatment of Mandibular Condylar Fracture, Surgical Versus Non-Surgical Treatment

Background: The facial fractures include Condylar fractures are most common in mandibular fractures, which have the highest fracture incidence after nasal bone fractures. Three different traumatic forces can result in condylar injury: the first is energy imparted to a static person by a moving object, such as a blow to the face from a cricket bat; the second is a moving person striking a static object, such as a child falling and striking the ground; and the third is a combination of the first two forces, such as when a person is moving and an automobile is moving and is hit by an automobile. This kind of force typically has the biggest impact and causes the most severe injury patterns. Objective: To compare frequency of Complications of two procedures for the treatment of mandibular condylar fracture surgical versus conservative treatment. Methodology: This Randomized control trial was held in the Tertiary Care Hospital Karachi for 6 months from 12 Jul, 2019 to 12 Jan, 2020. ERC were taken before data collection. Patients suffering from mandibular condylar fracture and fulfilling exclusion and inclusion criteria and who were ready to give informed consent after explaining study protocol, risk benefit ratio and data usage for research were included in our study. The first group labelled as "A" was treated by closed reduction and immobilization and second group labelled as group "B" was undergone internal fixation and open reduction. Results: The mean age and standard deviation of the 72 patients was determined to be 40.85 ± 12.93 years, respectively, with the 18 years was the minimum age and the 65 years being maximum. Frequency of gender was shown in Graph 1.The minimum duration of fracture was 1 day, and maximum were 7 days. The minimum mouth opening was 15mm and maximum was 35mm (Table 1). Trismus was present in 5/72 (6.9%) patients while it was absent in 67/72 (93.1%) patients (Table 2). Malocclusion was present in 20/72 (27.8%) patients while it was absent in 52/72 (72.2%) patients. Unilateral Side of fracture was present in 40/72 (55.6%) patients while Bilateral was present in 32/72 (44.4%) patients (Table 3) Conclusions: In conclusion, closed reduction had clinically satisfactory results, although open reduction and internal fixation produced more accurate to reduce the complications. Keywords: Closed reduction, Internal fixation, Open reduction,complications

Changes in injury patterns, injury severity and hospital mortality in motorized vehicle accidents: a retrospective, cross-sectional, multicenter study with 19,225 cases derived from the TraumaRegister DGU®.

In the last 20years, the number of fatalities due to road traffic accidents (RTA) in Germany has steadily decreased from 7503 to 2724 per year. Due to legal regulations, educational measures and the continuous development of safety technology the number of severe traumatic injuries and injury patterns are most likely to change. The aim of the study was to analyse severely injured motorcyclists (MC) and car occupants (CO) that were involved in RTAs in the last 15years and investigate the development and changes of injury patterns, injury severity and hospital mortality. We retrospectively evaluated data from the TraumaRegister DGU® (TR-DGU) considering all RTA-related injured MCs and COs (n = 19,225) that were registered in the TR-DGU from 2006 to 2020 with a primary admission to a trauma center with continuous participation (14 of 15years) in the TR-DGU, an Injury Severity Score (ISS) ≥ 16 and aged between 16 and 79years. The observation period was divided into three 5-year interval subgroups for further analysis. The mean age increased by 6.9years and the ratio of severely injured MCs to COs changed from 1:1.92 to 1:1.45. COs were in 65.8% male and more often severely injured in the age groups under 30, while the majority of severely injured MCs were in the age group around 50years and in 90.1% male. The ISS (-3.1 points) as well as the mortality of both groups (CO: 14.4% vs. 11.8%; MC: 13.2% vs. 10.2%) steadily decreased over time. Nevertheless, the standardized mortality ratio (SMR) hardly changed and stayed < 1.Regarding the injury patterns, the greatest decline of injuries with AIS 3 + were to the head (CO: -11.3%; MC: -7.1%), in addition, a decrease of injuries to extremities (CO: -1.5%; MC: -3.3%), to the abdomen (CO: -2.6%; MC:-3.6%), to the pelvis in COs (-4.7%) and to the spine (CO: + 0.1%; MC:-2.4%) were observed. Thoracic injuries increased in both groups (CO: + 1.6%; MC: + 3.2%) and, furthermore, pelvic injuries in MCs (+ 1.7%). Another finding was the increase of the utilization of whole body CTs from 76.6 to 95.15%. The severity of injuries and their incidence, especially head injuries, have decreased over the years and seem to contribute to a decreasing hospital mortality of polytraumatized MCs and COs injured in traffic accidents. Young drivers and an increasing number of seniors are the age groups at risk and require special attention and treatment.

Mechanism of Injury and Age Predict Operative Intervention in Pediatric Perineal Injury.

Literature characterizing pediatric perineal trauma is sparse and generally limited to females. The purpose of this study was to characterize pediatric perineal injuries with specific focus on patient demographics, mechanisms of injury, and care patterns at a regional level 1 pediatric trauma center. Retrospective review of children aged younger than 18 years evaluated at a level 1 pediatric trauma center from 2006 to 2017. Patients were identified by International Classification of Diseases-9 and 10 codes. Extracted data included demographics, injury mechanism, diagnostic studies, hospital course, and structures injured. The χ 2 and t tests were used to examine differences between subgroups. Machine learning was used to predict variable importance in determining the need for operative interventions. One hundred ninety-seven patients met inclusion criteria. Mean age was 8.5 years. A total of 50.8% were girls. Blunt trauma accounted for 83.8% of injuries. Motor vehicle collisions and foreign bodies were more common in patients aged 12 years and older, whereas falls and bicycle-related injuries were more common in those younger than 12 years ( P < 0.01). Patients younger than 12 years were more likely to sustain blunt trauma with isolated external genital injuries ( P < 0.01). Patients aged 12 and older had a higher incidence of pelvic fractures, bladder/urethral injuries, and colorectal injuries, suggesting more severe injury patterns ( P < 0.01). Half of patients required operative intervention. Children aged 3 years or younger and older than 12 years had longer mean hospital stays compared with children aged 4 to 11 years ( P < 0.01). Mechanism of injury and age constituted more than 75% of the variable importance in predicting operative intervention. Perineal trauma in children varies by age, sex, and mechanism. Blunt mechanisms are the most common, with patients frequently requiring surgical intervention. Mechanism of injury and age may be important in deciding which patients will require operative intervention. This study describes injury patterns in pediatric perineal trauma that can be used to guide future practice and inform injury prevention efforts.

Early Use of Extracorporeal Membrane Oxygenation for Traumatically Injured Patients: A National Trauma Database Analysis.

Extracorporeal membrane oxygenation (ECMO) in acute trauma patients is a poorly characterized event. While ECMO most commonly has been deployed for advanced cardiopulmonary or respiratory failure following initial resuscitation, growing levels of evidence for out of hospital cardiac arrest support early ECMO cannulation as part of resuscitative efforts. We sought to perform a descriptive analysis evaluating traumatically injured patients, who were placed on ECMO, during their initial resuscitation period. We performed a retrospective analysis of the Trauma Quality Improvement Program Database from 2017 to 2019. All traumatically injured patients who received ECMO within the first 24 hours of their hospitalization were assessed. Descriptive statistics were used to define patient characteristics and injury patterns associated with the need for ECMO, while mortality represented the primary outcome evaluated. A total of 696 trauma patients received ECMO during their hospitalization, of which 221 were placed on ECMO within the first 24 hours. Early ECMO patients were on average 32.5 years old, 86% male, and sustained a penetrating injury 9% of the time. The average ISS was 30.7, and the overall mortality rate was 41.2%. Prehospital cardiac arrest was noted in 18.2% of the patient population resulting in a 46.8% mortality. Of those who underwent resuscitative thoracotomy, a 53.3% mortality rate was present. Early cannulation for ECMO in severely injured patients may provide an opportunity for rescue therapy following severe injury patterns. Further evaluation regarding the safety profile, cannulation strategies, and optimal injury patterns for these techniques should be evaluated.

Evaluation of the decision-making process within the table-top exercise of the Terror and Disaster Surgical Care (TDSC®) course

PurposeThe threat of terror is omnipresent in Europe and the number of attacks worldwide is increasing. The target of attacks in Europe is usually the civilian population. Incalculable dangerous situations at the scene of the event and severe injury patterns such as complex gunshot and explosion injuries with a high number of highly life-threatening people present rescue forces, emergency physicians and subsequently hospitals with medical, organizational as well as tactical and strategic challenges. The Terror and Disaster Surgical Care (TDSC®) course trains clinical decision-makers to meet these challenges of a TerrorMASCAL in the first 24–48 h.MethodsA table-top exercise was developed for the TDSC® course as a decision training tool, which was prospectively evaluated in six courses. The evaluation took place in 3 courses of the version 1.0, in 3 courses in the further developed version 2.0 to different target values like, e.g., the accuracy of the in-hospital triage. Furthermore, 16 TDSC® course instructors were evaluated.ResultsFor the evaluation, n = 360 patient charts for version 1.0 and n = 369 for version 2.0 could be evaluated. Overall, the table-top exercise was found to be suitable for training of internal clinical decision makers. Version 2.0 was also able to depict the action and decision-making paths in a stable and valid manner compared to the previous version 1.0. The evaluation of the instructors also confirmed the further value and improvement of version 2.0.ConclusionWith this prospective study, the table-top exercise of the TDSC® course was tested for decision stability and consistency of the participants’ decision paths. This could be proven for the selected target variables, it further showed an improvement of the training situation. A further development of the table-top exercise, in particular also using digital modules, will allow a further optimization.http://www.bundeswehrkrankenhaus-ulm.de

Neurologically Intact Survival after Bihemispheric Penetrating Head Trauma: A Case Report

BackgroundPatients with penetrating head trauma that crosses the midline of the brain have a high mortality rate; most die in the prehospital setting or during initial resuscitative efforts. However, surviving patients are often neurologically intact and several factors other than bullet path, including post-resuscitation Glasgow Coma Scale, age, and pupillary abnormalities, must be considered in aggregate when prognosticating patients. Case ReportWe present a case of an 18-year-old man who presented unresponsive after a single gunshot wound to the head that traversed the bilateral hemispheres. The patient was managed with standard care and without surgical intervention. He was discharged from the hospital neurologically intact 2 weeks after his injury. Why Should an Emergency Physician Be Aware of This?Patients with such apparently devastating injuries are at risk of premature termination of aggressive resuscitative efforts based on clinician bias that these efforts are futile and that patients cannot recover to a neurologically meaningful outcome. Our case reminds clinicians that patients with severe injury patterns with bihemispheric involvement can recover with good outcomes, and that bullet path is only one variable among multiple that must be considered to predict clinical outcome.

EVALUATION OF HAMSTRING MATCH INJURY FREQUENCY, INCIDENCE AND SEVERITY PATTERNS AMONG THE EUROPEAN TOP FIVE FOOTBALL LEAGUES DURING THE SEASON 2022/2023.

This study aims to explore the specific muscle injury types, nature of match injury frequency and match incidence of the European top five football leagues (UEFA, 2023), to compare match hamstring injury severity characteristics and to study differences in match injury, frequency and incidence between the five leagues during the season 2022/2023. The sample size was N= 2678 (SD ± 41.8) male players from the “Big Five” European professional football leagues with a mean age of 26.7 (SD ± 4.6) years and an average of 1303 minutes played per player with an average of a 27-player squad. A total number of 630 hamstring match injuries was recorded among the 98 clubs. Most of the injuries (N=298) required a two to four-week absence from football. The total playing exposure hours per league was 11,640.48, (SD ± 124.5). The severe injury patterns of severe injuries represent 28.6% of the total of all severity patterns, indicating an extremely high hamstring injury burden.

Blast Injury Patterns Among Israel Defense Forces Fatalities.

The incidence of blast injuries on the battlefield has risen over the last several decades. In order to improve prevention and treatment, it is essential to understand the severity and bodily distribution of these injuries. This study aims to characterize blast injury patterns among IDF fatalities. This is a descriptive, retrospective study on postmortem reports of military-blast fatalities between the years 1982 and 2021. Body regions injured according to the Abbreviated Injury Scale (AIS) were described. The frequency of body region injury combinations was mapped, and the correlation between injured body regions was calculated using Pearson's coefficient. Analysis of a subgroup with a postmortem computed tomography (CT-PM) or autopsy was performed, describing severe (AIS ≥ 3) injury patterns. Overall, 222 fatalities suffered from blast injury, with most injuries affecting the upper and lower extremities (63.7% and 66.5%, respectively), followed by the head (57.1%) and the thorax (56.6%). The median number of injured body regions was 4 (interquartile range, 2-5). The most frequent injury combinations were the upper and lower extremities (51%), the upper extremities and the thorax (45%), and the lower extremities and the thorax (41%). In all, 47/222 (21.2%) fatalities had a documented autopsy or CT-PM report. Among the fatalities with CT-PM or autopsy, the head (63.8%) and the thorax (57.4%) were most frequently severely injured (AIS ≥ 3). Among blast fatalities in the military setting, the extremities were most commonly injured. However, data suggest that the head and thorax are more likely to sustain severe blast injuries resulting in mortality. Blast injuries in this cohort were characterized by concomitant involvement of several regions. Development of protective gear to minimize the multisystem injuries inflicted by blast injuries is warranted and should be focused on distinct types and anatomical distribution of severe blast injuries as reported in this study. Level III, Retrospective analysis.

Dooring Bicycle Accidents with Severe Injury Patterns: 10-Year Study of a Level 1 Trauma Center

Dooring Bicycle Accidents with Severe Injury Patterns: 10-Year Study of a Level 1 Trauma Center Abstract. Studies in Switzerland, Germany and Austria have shown that, contrary to popular belief, dooring accidents are among the most common bicycle accidents. The resulting injuries are often serious and often lead to hospital admission. All dooring accidents of the Inselspital Emergency Department in Bern between 2012 and 2021 were identified and evaluated retrospectively. The data were generated from the database of the management system (Ecare) of the University Hospital Bern by means of a search query with the German keywords: "Autotüre", "Autotuere", "Dooring" and were anonymised. Most patients were female and on average 34 years old; most injuries occurred to the head and the extremities. Treatment was mostly done on an outpatient basis. The ISS (Injury Severity Score) was an average of 3.5. One of the patients needed emergency surgery. This is the first Swiss study to systematically record and evaluate dooring accidents. Since cycling is a trend, especially in urban areas, and consequently the number of cyclists is constantly increasing, it can be assumed that the number of dooring injuries will also increase and corresponding prevention measures will have to be taken. The current COVID-19 pandemic tends to aggravate the problem, as in the context of infection control the number of cyclists and, consequently, accidents is increasing, especially in urban areas, in the context of infection control. This said, it is crucial to gain more information about the time slots of the accidents and the casualties through appropriate studies in order to take adequate preventive and protective measures.

Outcomes After Operative Treatment of Pediatric Monteggia Fracture-Dislocations: Comparison Between Open and Closed Injuries.

Open pediatric Monteggia fracture-dislocations are a relatively uncommon injury pattern, with limited numbers reported in previous series. Open fracture-dislocations frequently represent more severe injury patterns with potential for contamination. We aim to determine differences in long-term clinical and functional outcomes in the operative management of closed versus open pediatric Monteggia fracture-dislocations. A retrospective review of operatively treated pediatric Monteggia fracture-dislocations was performed. Closed versus open injuries were compared in both clinical outcomes, as well as patient-reported outcomes through Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Of 30 operatively treated injuries, 12/30 (40%) were open fracture-dislocations. Patients were followed clinically for an average of 15.65 months in open injuries and an average of 4.61 months in closed injuries. A trend toward increased time to union was observed, however, significance was not achieved; open injuries averaged 8.0 versus 5.8 weeks for closed injuries ( P =0.07). Two patients (11%) in the closed fracture group experienced postoperative complications; both were minor. Five patients (42%) in the open fracture-dislocation group experienced a total of 6 postoperative complications; 5 of the 6 complications were major. QuickDASH scores were obtained at an average of 5 years postoperatively; mean QuickDASH scores were higher in the open fracture group, 13.1, compared with the closed fracture group, 5.9 ( P =0.038). Increased QuickDASH scores were independently associated with presence of postoperative complications. QuickDASH score could be expected to increase by 12.5 points in those with major complications ( P =0.044). We present the largest single cohort of pediatric open Monteggia fracture-dislocation injuries to date. These injuries are predictive of poorer outcomes including trend toward increased time to union, increased risk of major complication, and can independently predict worse long-term patient-reported functional outcomes. Level III-these data represent a retrospective comparative study of clinical and functional outcomes.

Prevention of severe injuries of child passengers in motor vehicle accidents: is re-boarding sufficient?

PurposeThe purpose of this study was to evaluate whether prolonged re-boarding of restraint children in motor vehicle accidents is sufficient to prevent severe injury.MethodsData acquisition was performed using the Trauma Register DGU® (TR-DGU) in the time period from 2010 to 2019 of seriously injured children (AIS 2 +) aged 0–5 years as motor vehicle passengers (MVP). Primarily treated and transferred patients where included.ResultsThe study group included 727 of 2030 (35.8%) children, who were severely injured (AIS 2 +) in road traffic accidents, among them 268 (13.2%) as MVPs in the age groups: 0–1 years (42.5%), 2–3 years (26.1%) and 4–5 years (31.3%). The pattern of severe injury was head/brain (56.0%), thoracic (42.2%), abdominal (13.1%), fractures (extremities and pelvis, 52.6%) and spine/severe whiplash (19.8%). The 0–1-year-old MVPs showed the significantly highest proportion of brain injuries with Glasgow Coma Score (GCS) < 8 and severe injury to the spine. The 2–3-year-olds showed the significantly highest proportion of fractures especially the lower extremity and highest proportion of cervical spine injuries of all spine injuries, while the 4–5-year-olds, the significantly highest proportion of abdominal injury and second highest proportion of cervical spine injury of all spine injuries. MVPs of the 0–1-year-old and 2–3-year-old groups showed a higher median Injury Severity Score (ISS) of 21.5 and 22.1 points than the older children (17.0 points). They also suffered an AIS-6-injury significantly more often (9 of 21) of spine (p = 0.001). Especially the cervical spine was significantly more often involved. Passengers at the age of 0–1 years were treated with cardiopulmonary resuscitation (CPR) three times as often as older children in the prehospital setting and twice as often at admission in the Trauma Resuscitation Unit (TRU). Their survival rate was 7 out of 8 (0–1 years), 1 out of 6 (2–3 years) and 1 out of 4 (4–5 years).ConclusionAlthough the younger MVPs are restraint in a re-boarding position, severe injury to the spine and head occurred more often, while older children as front-faced positioned MVPs suffered from significantly higher rates of abdominal and more often severe facial injury. Our data show, that it is more important to properly restrain children in their adequate car seats (i-size-Norm) and additionally consider the age-related physiological and anatomical specific risks of injury as well as co-factors in road traffic accidents, than only prolonging the re-boarding position over the age of 15 months as a single method.

Graves\u2019 disease overlapping with chronic hepatitis B and methimazole-induced liver injury and autoimmune hepatitis: a case report

BackgroundLiver injury related to Graves’ Disease (GD) includes hepatotoxicity of thyroid hormone excess, drug-induced liver injury, and changes resulting from concomitant liver disease. Methimazole (MMI) has been shown to induce several patterns of liver injury. However, the diagnosis and treatment of autoimmune hepatitis (AIH) overlapping with either GD or chronic hepatitis B are challenging.Case presentationA 35-year-old man from China presented with a two-year history of GD and a 10-day history of progressive jaundice. He had taken MMI for two months and discontinuing treatment due to liver toxicity 1 year ago and for another 6 days 20 days prior to hospitalization. The patient was diagnosed with GD overlapping with chronic hepatitis B and MMI-induced liver injury with early stage of acute-on-chronic liver failure on admission. However, the elevated aminotransferase and bilirubin levels could not be controlled after correction of liver failure and effective control of HBV replication and hyperthyroidism by daily oral entecavir and one-time oral administration of 131-iodine. The patient underwent liver biopsy on the 43rd day of hospitalization, showing HBsAg expression on the membrane of hepatocytes and typical histopathological characteristics of AIH. He was finally diagnosed with GD overlapping with chronic hepatitis B and MMI-induced liver injury and AIH. The elevated aminotransferase and bilirubin completely returned to normal by 3-month glucocorticoid therapy and continuous entecavir treatment and there was no recurrence during a 6-month follow-up, suggesting that AIH in this patient is different from classical AIH or GD-associated AIH.ConclusionsGD together with AIH is a complex and difficult subject. It needs to be clarified whether MMI or HBV can act as a trigger for AIH in this patient.

Patterns of Injury in the Spanish Football League Players.

Background: The study of football injuries is a subject that concerns the scientific community. The problem of most of the available research is that it is mainly descriptive. The objective of this study is to discover and analyse the patterns of injury in the Spanish Football League (2016–2017 season). Methods: The sample data consisted of 136 given injuries identified by the official physicians of the football clubs. The analysis was performed by using traditional statistic tests, T-pattern detection and polar coordinate analysis. Results: The analysis revealed several patterns of injury: (a) The defender suffered a rupture of the hamstring muscles after a sprint, (b) knee sprains happened due to a received tackle, (c) fibrillar adductor rupture appeared mostly among defenders and (d) fibrillar ruptures took place mostly throughout the first part. Conclusions: There is a marked shift in the tendency regarding the player who gets more injured, from the midfielder to the defender. The most common injury was fibrillar rupture. The most common scenario in which this injury occurred was that in which the player injured himself after a sprint (24%). A week without competing seems to be insufficient as a prevention mechanism for injuries.

A Descriptive Analysis of Supermassive Transfusion Recipients Among US and Coalition Forces During Combat Operations in Afghanistan and Iraq.

Hemorrhage is the leading cause of potentially preventable death on the battlefield. Resuscitation with blood products is essential to restore circulating volume, repay the oxygen debt, and prevent coagulopathy. Massive transfusion (MT) occurs frequently after major trauma; a subset of casualties requires a supermassive transfusion (SMT), and thus, mobilization of additional resources remains unclear. This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry. In this analysis, we isolated U.S. and Coalition casualties that received at least 1 unit of packed red blood cells (PRBCs) or whole blood (WB). Given a lack of consensus on the definition of SMT recipients, we included those patients receiving the top quartile of PRBC and WB administered within the first 24 hours following arrival to a military treatment facility. We identified 25,897 adult casualties from January 1, 2007 to March 17, 2020. Within this dataset, 2,608 (9.0%) met inclusion for this analysis. The median number of total products administered within the first 24 hours was 8 units of PRBC or WB. The upper quartile was 18 units (n = 666). Compared to all other blood product recipients, patients in the SMT cohort had a higher median injury severity score (27 vs 18, P < 0.001), were most frequently injured by explosives (84.9% vs 68.6%, P < 0.001), had a higher mean emergency department (ED) pulse (128 vs 111, P < 0.001), a lower mean systolic blood pressure (122 vs 132 mm Hg, P < 0.001), and a higher mean international normalized ratio (1.68 vs 1.38, P < 0.001). SMT patients experienced lower survival to hospital discharge (85.8% vs 93.3%, P < 0.001). Compared to all other PRBC and WB recipients, SMT patients experienced more injury by explosives, severe injury patterns, ED vital sign derangements, and mortality. These findings may help identify those casualties who may require earlier aggressive resuscitation. However, more data is needed to define this population early in their clinical course for early identification to facilitate rapid resource mobilization. Identifying casualties who are likely to die within 24 hours compared to those who are likely to survive, may assist in determining a threshold for a SMT.

Restraint use and severe injury patterns among pediatric passengers in motor vehicle crashes: Exploring the utility of linked health data and implications of database selection

Restraint use and severe injury patterns among pediatric passengers in motor vehicle crashes: Exploring the utility of linked health data and implications of database selection