Rate Of Severe Injuries Research Articles

Operative vacuum vaginal delivery: effect of compliance with recommended checklist

Purpose Even if the prerequisites and the technique of vacuum extraction are largely established, the role of a checklist in this field has not been tested. To evaluate the role of a checklist implementation on the compliance with the recommended rules in operative vacuum vaginal delivery (OVD) and on maternal and perinatal outcomes. Materials and methods Retrospective cohort study on OVD between January 2012 and December 2015 at two hospitals with a tradition of teaching of OVD. A checklist for OVD was introduced in 2014. Three rules had to be recorded: fetal head station and position determination, no more than four tractions, and no more than three cup applications. Adverse maternal outcomes included third- and fourth-degree perineal tears. Adverse neonatal outcome included asphyxia, need for neonatal resuscitation, NICU admission, major head injuries, scalp injuries, and bone or brachial plexus injuries. Results Introduction of a checklist for OVD resulted in an increase in the compliance with the rules (83.3 versus 62.8%, p < .001). Cases in which the rules were respected had lower incidence of third- and fourth-degree perineal lacerations after controlling for episiotomy, nulliparity, and indication for OVD (OR = 0.4, 95% CI 0.18–0.89), but similar rates of failure of OVD (2.1 versus 2.2%, p = 1) and adverse neonatal outcome (10.8 versus 11.7%, p=.71). Conclusion Knowledge and documented compliance with a checklist of recommended rules in OVD may assist in achieving a lower rate of severe perineal and anal sphincter injury but does not alter the success of the procedure or neonatal outcome.

Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm

To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the headamong infants born at 300-326weeks of gestation and compare different screening strategies. This was a retrospective cohort study of infants born at 300-326weeks or >326weeks of gestation with a birth weight <1500g admitted to neonatal intensive care units in the Canadian Neonatal Network from 2011 to 2016. Stepwise logistic regression analysis was used to identify significant risk factors and calculate aORs and 95% CIs. Risk factor-based screening strategies were compared. The rate of severe neurologic injury was 3.1% among infants screened (285/9221). Significant risk factors included singleton birth (aOR 1.96, 95% CI 1.35-2.85), 5-minute Apgar <7 (aOR 1.81, 95% CI 1.30-2.50), mechanical ventilation on day 1 (aOR 2.65, 95% CI 1.88-3.71), and treatment with vasopressors on day 1 (aOR 3.23, 95% CI 2.19-4.75). Risk categories were low (no risk factor, 1.2%, 25/2137), moderate (singleton with no other risk factor: 1.8%, 68/3678), and high (≥1 risk factor among 5-minute Apgar <7, receipt of vasopressors or mechanical ventilation on day 1: 5.6%, 192/3408). Screening moderate- to high-risk infants identified 91% (260/285) of infants with severe neurologic injury and would require screening fewer infants (1647 infants per year) than screening all infants <33weeks of gestation (2064 infants screened per year, 93% [265/285] of cases identified). Risk factor-based ultrasound scan of the head screening among infants born at 30-32weeks of gestation could help optimize resources better than gestational age based screening.

Systematic review: Do commercial tourniquets have potential to be a life-saving intervention for ambulance services?

Background:Globally, terrorist attacks have major impact because of high rates of mortality and severe injury. Compression with direct pressure may be time-consuming in limb exsanguination and accelerate onset of haemorrhagic shock. Tourniquet applications have undergone scrutiny over a long period, but recently tourniquets have been developed and modified for effective and efficient use in prehospital settings to mitigate adverse effects.Objectives:This systematic review aimed at examining commercial tourniquets that demonstrated efficacy for use in prehospital services.Methods:Six search engines (ScienceDirect, Ovid, PubMed, SAGE, SpringerLink, Taylor &amp; Francis) were used and articles of which 14 were selected for data analysis.Results:The findings were not sufficiently conclusive to pinpoint whether one tourniquet application was superior overall; however, Combat Application Tourniquet appeared to be better than other commercial tourniquets in terms of occlusion of distal blood flow, easy and quick self-application and fewer complications.Conclusion:In prehospital settings, ambulance personnel should not hesitate to apply tourniquets when encountering critical circumstances in which they must choose between saving life and potential complications.

Predictors and Motivation for Seat Belt Use – A Case Study in Bosnia and Herzegovina

The use of seat belts, for drivers and car occupants, results in reducing the rate of fatalities and severe road injuries. In this research, the methodology of the survey was applied through the self-reporting behaviour of the respondents who determined the subjective risk based on the attitudes of the traffic participants. To evaluate the statistical significance of the categorical variables, Pearson's chi-square test was used. For certain groups of examinees, the results of the relationship (association) between socio demographic characteristics were analysed as predictors of behaviour with the degree of seat belt use. Some other predictors of behaviour, such as the road and mood predictors were analysed as well. Interest was also focused on finding out what motivated certain groups of examinees to use the seat belt. Based on the results of this research, it is possible to classify the drivers and car occupants into certain groups with respect to the seat belt use while driving. This can help in determining the ways of eliminating problems related to the low degree of seat belt use.

Comparison of Injury in Male and Female Amateur Rugby Union

PURPOSE: Despite recent growth in game popularity worldwide, Women’s Rugby Union is currently lacking rigorous, comprehensive injury surveillance programs (World Rugby). This long-term study aimed to monitor injury trends, that may emerge, which will aid future implementation of evidence-based injury prevention strategies to minimize injury risk and enhance player welfare, for the female and male game. METHODS: Using a bespoke web-based injury recording system (IRISweb), 15 male and 4 female national league clubs were recruited for a full season of monitoring in Ireland, representing 479 male and 129 female players. Each club nominated an ‘injury recorder’, who was a team physician or physiotherapist trained in use of the IRISweb system. In 10% of clubs the head coach, qualified in first aid, recorded injuries. In all cases the team physician reviewed all injuries for ‘return to play’ ensuring classification validity. Measures included injury incidence, type, timing, severity, and playing position. RESULTS: The most commonly reported match injuries for men’s clubs were concussion (12%), followed by ankle ligament sprains (11%); for women, it was ankle ligament sprains (11%) and concussion (11%). Concussion injuries resulted in an average of 30 days absence from Rugby match or training activities for men and 23 days for women. Timing of all injuries showed incidence rate (per 1000 player hours) for men of 7.6/10.6/19.1/11.5 for 1st/2nd/3rd/4th match quarter respectively, and 7.1/12.8/12.8/11.5 for women, showing an early 2nd quarter peak for women. The position with the highest proportion of injury was openside flanker forward (no.7) for men and inside centre back (no.12) for women. The majority of injuries for both sexes were moderate or severe (greater than eight days absence). Women presented with a significantly lower rate (13.5 Vs 18.5; p<0.05) of severe injuries. CONCLUSIONS: The amateur women’s game in Ireland has presented with both similarities and differences in injury occurrence compared to the men’s game. Marked differences surround an earlier match timing of women’s injury, and less severe occurrence of women’s injury. Practitioners should note the most common injuries occurring and the playing positions most frequently injured and develop welfare and prevention strategies around this knowledge.

Meprin \u03b2 metalloproteases associated with differential metabolite profiles in the plasma and urine of mice with type 1 diabetes and diabetic nephropathy

BackgroundMeprin metalloproteases are abundantly expressed in the brush border membranes of kidney proximal tubules and small intestines. Meprins are also expressed in podocytes and leukocytes (monocytes and macrophages). Meprins are implicated in the pathophysiology of diabetic nephropathy (DN) but underlying mechanisms are not fully understood. Single nucleotide polymophisms (SNPs) in the meprin β gene were associated with DKD in human subjects. Furthermore, meprin α and β double deficiency resulted in more severe kidney injury and higher mortality rates in mice with Streptozotocin (STZ)-induced type 1 diabetes. Identification of meprin substrates has provided insights on how meprins could modulate kidney injury. Meprin targets in the kidney include extracellular matrix (ECM) proteins, modulators of inflammation, and proteins involved in the protein kinase A (PKA) and PKC signaling pathways. The current study used a global metabolomics approach to determine how meprin β expression impacts the metabolite milieu in diabetes and DKD.MethodsLow dose STZ was used to induce type 1 diabetes in 8-week old wild-type (WT) and meprin β knockout (βKO) mice. Blood and urine samples were obtained at 4 and 8 weeks post-STZ injection. Assays for albumin, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule − 1 (KIM-1), and cystatin C were used for biochemical assessment of kidney injury. Data for biomarkers of kidney injury utilized two-way ANOVA. Metabolomics data analysis utilized UPLC-QTOF MS and multivariate statistics.ResultsThe number of metabolites with diabetes-associated changes in levels were significantly higher in the WT mice when compared to meprin βKO counterparts. Annotated meprin β expression-associated metabolites with strong variable importance in projection (VIP) scores play roles in lipid metabolism (LysoPC(16:1(9Z)), taurocholic acid), amino acid metabolism (indoxyl sulfate, hippuric acid), and neurotransmitter/stress hormone synthesis (cortisol, 3-methoxy-4-hydroxyphenylethylene glycolsulfate, homovanillic acid sulfate). Metabolites that associated with meprin β deficiency include; 3,5-dihydroxy-3′,4′-dimethoxy-6,7-methylenedioxyflavone 3-glucuronide, pantothenic acid, and indoxyl glucuronide (all decreased in plasma).ConclusionTaken together, the annotated metabolites suggest that meprin β impacts complications of diabetes such as DKD by altering distinct metabolite profiles.

Impact of contrast extravasation on computed tomography of the psoas major muscle in patients with blunt torso trauma.

The clinical significance of contrast extravasation (CE) on computed tomography (CT) of the psoas major muscle after blunt torso trauma and the optimal management of patients requiring transcatheter arterial embolization (TAE) of the lumbar artery have not been well elucidated. The aim of this study was to investigate the impact of CE on CT to determine the need for TAE of the lumbar artery. We examined a single-center retrospective cohort of blunt torso trauma patients who underwent contrast-enhanced CT from 2008 to 2017. Basic demographics and clinical data were obtained, including the number of lumbar transverse process fractures (LTPFs) and maximum psoas major muscle hematoma (PMMH) size and ratio. Maximum PMMH size was analyzed by measuring the cross-sectional area of hematoma size at the level of CE. Psoas major muscle hematoma size ratio was obtained by dividing maximum PMMH size by psoas major muscle size of the unaffected side at the same slice level. A total of 762 patients were included. One hundred seventeen patients had LTPFs and/or PMMH. Of 117 patients, 25 had CE on CT of the psoas major muscle and had significantly higher rates of older age and severe injury compared with those without CE. Of the 25 patients with CE, 13 required TAE of the lumbar artery. Patients who required TAE had a significantly higher number of LTPFs (4 vs. 2, p = 0.011) and higher PMMH size ratio (2.10 vs. 1.32, p = 0.016). Psoas major muscle hematoma size ratio revealed moderate accuracy (area under the receiver operating characteristic curve, 0.782). Approximately half of the blunt torso trauma patients with CE on CT of the psoas major muscle will require TAE of the lumbar artery. Higher number of LTPFs and larger PMMH size can be a predictor of the need for TAE of the lumbar artery among patients with CE on CT. Therapeutic/care management, level IV.

Safe Streets for All? Analyzing Infrastructural Response to Pedestrian and Cyclist Crashes in New York City, 2009–2018

Although cycling and walking carry a host of benefits, neither the benefits nor the risks—those of injury and fatality—are equitably distributed. Although research has shown higher income and gentrified areas have better access to protected bicycle infrastructure, low-income and communities of color are overrepresented in severe injury and fatality rates among cyclists and pedestrians. This research employs temporal, spatial, and socio-economic data to study the distribution of cycling infrastructure and safety improvements in New York City between income groups and boroughs. The integration of temporal data representing pedestrian and cyclist injury and fatality, and infrastructure installation date, point toward the establishment of time trends in the relationship between traffic violence and safety investment. Socio-economic factors are analyzed to see how this relationship and access more generally are related to income. We observed that lower-income groups continue to be overrepresented in crashes across New York’s boroughs, with the exception of Manhattan, and although crash rates have fallen in the years since 2009, these gains do not improve the position of lower-income groups, which continue to experience a disproportionate share of fatalities and injuries. However, longitudinal multi-level logistic models controlling for reported pedestrian and cyclist injuries in previous years uncovered additional relationships between socio-economic status, injuries, location, and safety investment. For example, the implementation of safety improvements and speed humps are significantly related to reported injuries in previous years; this finding supports the city’s stated goals of targeting improvements to areas most in need of improved safety for vulnerable road users.

Auto tricycle injuries and the vulnerability of occupants and pedestrians in a developing Country: A multi-center study.

Auto tricycle is an emerging common means of public transport in Nigeria. This study aimed to determine the scope and type of collisions and injuries from auto tricycles crashes in Nigeria, and identify potential areas for interventions to facilitate injury prevention. This was a prospective study of all the patients with auto tricycle injuries that visited Emergency rooms of three Nigerian tertiary hospitals from 1st February 2015 to 31st July 2016. There were 210 victims; auto tricycle - other vehicle collisions, lone auto tricycle collisions and auto tricycle- pedestrian collisions accounted for injuries in 67.2%, 19% and 13.8% of them respectively. Preponderance of collisions at nighttime (60%), and on intra-city roads (86.7%) was observed. The rate of severe injury was significantly higher on inter-city than intra-city roads (32.11% vs. 9.3%, P < 0.001), and in daytime than night time (16.7% vs. 6.0%, P < 0.043). The lower extremity (50%), head (38.6%) and upper extremity (30.4%) were the three top anatomical regions involved. The case fatality rate was 1.4%: head injury accounted for two-third of the mortality. In Nigeria, auto tricycle has come to stay as a means of public transport and vulnerable road users are not immune to auto tricycle related injuries and its associated morbidity and mortality. This calls for preventive strategies, based on the findings in this study, which may curb the menace of auto tricycle crash and resultant injuries.

Analysis of injury mechanism of the elderly and non-elderly groups in minor motor vehicle accidents

Objective: The purpose of this study is to investigate the injury patterns of noncatastrophic accidents by individual age groups.Methods: Data were collected from the Korean In-Depth Accident Study database based on actual accident investigation. The noncatastrophic criteria were classified according to U.S. experts from the Centers for Disease Control and Prevention’s recommendations for field triage guidelines of high-risk automobile crash criteria by vehicle intrusions more than 12 in. on occupant sites (including the roof) and more than 18 in. on any site. The Abbreviated Injury Scale (AIS) was used to determine injury patterns for each body region. Severely injured patients were classified as Maximum Abbreviated Injury Scale (MAIS) 3 or higher.Results: In this study, the most significant injury regions were the head and neck, extremities, and thorax. In addition, the incidence of severe injury among elderly patients was nearly 1.6 times higher than that of non-elderly patients. According to age group, injured body regions among the elderly were the thorax, head and neck, and extremities, in that order. For the non-elderly groups, these were head and neck, extremities, and thorax. Severe injury rates were slightly different for the elderly group (head and neck, abdomen) and non-elderly group (thorax, head and neck).Conclusions: In both age groups, the rate of severe injury is proportional to an increase in crush extent zone. Front airbag deployment may have a relatively significant relationship to severe injuries.

Effect of Seat Condition on Abdominal Injuries to Vehicle Occupants in Frontal Impact Accidents

Vehicle occupants were killed in 33% of all traffic accidents in Japan in 2017. Of the vehicles in vehicle-to-vehicle accidents, 54% were impacted from the front. In frontal impact accidents, when the lap belt moves away from the iliac crests of the pelvis of a vehicle occupant, the belt moves directly into the abdomen. Here, we investigated causes of abdominal injuries to vehicle occupants, because the abdomen is associated with the highest rates of severe injury and fatality. The purpose of this study was to clarify the correlation between downward movement of the seat and of the lap belt away from the iliac crests of a human occupant of a car, in the event of a frontal impact. We investigated this phenomenon by conducting simulations using an anthropomorphic 50th percentile male (AM50) human model wearing a three-point seatbelt. We set two deformable seat conditions: Vertical movement and lean forward movement. Our results revealed that the lap belt came off from both of the iliac crests during lean forward movement but only from one of the iliac crests during vertical movement. We concluded that abdominal injuries can be caused by downward movement together with forward rotation in the seat during vehicle-to-vehicle frontal impacts.

Do Normative Composite Scores on the Functional Movement Screen Differ Across High School, Collegiate, and Professional Athletes? A Critical Review.

The Functional Movement Screen (FMS) is a battery of 7 unloaded tests designed to rate human movement competency. Injury rates vary across the different level of a sport. The purpose of this critical review was to determine whether normative FMS composite scores differ across high school, collegiate, and professional athletic populations and to determine whether normative composite scores correlate with rates of severe injury across different collegiate sports. PubMed, Web of Science, and EBSCO databases from inception to September 2017 with the following syntax: "functional movement screen*" OR "movement screen*". Additional records were identified by citation tracking and hand search of articles. A total of 708 records identified, of which 36 were included. Studies were included if they reported a FMS composite score for one of the groups. Two reviewers (T.R.P. and F.K.) screened records for the author and year; sample size; study design; sport(s); number, age, and sex of participants; testing conditions; methodological quality; and mean or median composite score(s). Normative FMS composite scores were invariant to level of play, with 61% of reported scores falling between 14 and 16, despite injury rates increasing by level of play. Scores for high school, college, and professional athletes were 14.1, 14.8, and 15.7, respectively. There was a significant positive relationship between composite scores and rate of severe injury in college sports (r(11) = 0.66, P = 0.014). Our findings potentially undermine the FMS's predictive validity. Although the FMS may have other applications, this critical review provides further evidence against the composite score for injury prediction in competitive athletes.

Perineal trauma with vaginal birth after a previous caesarean section: A retrospective cohort study.

There is a paucity of information regarding perineal injuries in women who achieve vaginal birth after caesarean section (VBAC). To ascertain the rate of severe perineal injuries in women achieving VBAC at a major tertiary obstetric hospital, and to determine if vaginal birth is more likely to be associated with perineal injuries in women with one previous caesarean section compared with nulliparous women. A retrospective cohort study was undertaken of women with singleton pregnancies at term who delivered vaginally between 2013 and 2016. We compared nulliparous women with women who had undergone one previous caesarean section. The primary outcome analysed was the rate of third and fourth degree tears in each group. Secondary outcomes were major post-partum haemorrhage and instrumental delivery. Totals of 10663 nulliparous women and 629 VBAC women achieved vaginal birth. Of the VBAC women, 418 achieved their first vaginal birth (first VBAC group). Overall, there was no significant difference in the rate of third and fourth degree tears in the VBAC group compared with the nulliparous group (6.0% vs 5.6%; P=0.73). There was no significant increase in anal sphincter injuries in the first VBAC group compared with the nulliparous group (6.0% vs 7.4%; P=0.25). No overall difference in the rate of severe perineal injuries between VBAC women and nulliparous women who achieve vaginal birth was observed in this study.

DOES PRETERM INFANTS BORN OUTSIDE TERTIARY PERINATAL CENTRE HAVE AN IMPACT ON NEURODEVELOPMENTAL AND GROWTH OUTCOME AT 36 MONTHS CORRECTED AGE?

Abstract BACKGROUND Infants born in tertiary perinatal centres (inborn) have higher survival and lower morbidity than outborn infants. However, there is limited information regarding the long term neurodevelopmental and growth outcomes among outborn preterm infants. OBJECTIVES To compare the neurodevelopmental and growth outcomes at 36 months corrected age (CA) between outborn and inborn infants born &lt; 29 weeks. DESIGN/METHODS This is a retrospective cohort study. We included infants born &lt;29 weeks admitted to Foothills Medical Centre, Calgary between January 2000 and December 2012, who had neurodevelopmental(ND) assessment up to 36 months CA. Infants with intrauterine infection, major congenital and chromosomal anomalies were excluded. Our primary outcome was composite of death or neurodevelopmental impairment (NDI). We compared ND and growth outcomes between inborn and the outborn infants using univariate and multivariate logistic regression analysis. RESULTS Of 1235 eligible infants, 175 (14%) were outborn. Outborn infants were lower in GA (25.8 ± 1.7 wk vs 26.2 ± 1.5 wk), had lower chorioamnionitis rate (15% vs 24%), received less antenatal steroid (55% vs 90%) and maternal antibiotics (51% vs 68%). Neonatal morbidities were similar between the two groups except that outborn infants had higher rates of severe brain injury (24% vs 12%) and mortality (22% vs 11%). Of 1078 eligible survivors, 1048 (97%) were followed. There was no difference in ND outcomes (Table). Multivariate regression analysis controlling for potential confounders (GA, gender, chorioamnionitis, antenatal steroids and maternal age) showed outborn status was not associated with composite primary outcome of death or ND impairment (adjusted OR: 1.09, 95% CI, 0.69, 1.70). Growth outcomes were not significantly different between two groups. CONCLUSION In this cohort, neurodevelopmental and growth outcomes does not appear to be significantly different between outborn and infants at 36 months corrected age.

The effect of labor epidural analgesia on maternal-fetal outcomes: a retrospective cohort study.

To evaluate the impact of labor epidural analgesia on maternal-fetal safety outcomes in a signal Chinese academic medical center. A single-intervention impact study was conducted at The Second Affiliated Hospital, Wenzhou Medical University. The study period was divided into three phases: (1) baseline phase: from January 1 and June 30, 2009 when no analgesic method was routinely employed during labor; (2) phase-in period: the epidural analgesia was implemented 8a.m.-5p.m. during weekdays; and (3) the post-No Pain Labor N'Delivery phase when the labor epidural was applied 24h a day, 7days a week, from June 1, 2010 and June 30, 2011. The maternal-fetal safety outcomes of delivery were compared between the different periods. There were 15,415 deliveries with 42.3% of nulliparous parturients in the 31-month study period. As the primary outcomes, the labor epidural analgesia rate increased from 0 to 57%, the vaginal delivery rate increased, and cesarean delivery rate decreased by 3.5% after full implementation. As the secondary outcomes, the rate of episiotomy and severe perineal injury after the implementation periods were significant decreased. The rate of postpartum oxytocin administration was decreased by 17.8%. No significant difference between the baseline and implementation periods was found in the rate of postpartum hemorrhage, Apgar scores less than 7 at both 1 and 5min, 7-day mortality, and the overall neonatal intensive care unit admission rate. Implementation of labor epidural analgesia increased the vaginal delivery rate and use of labor epidural analgesia is safe to parturients and fetus.

11.361 sports injuries in a 15-year survey of a Level I emergency trauma department reveal different severe injury types in the 6 most common team sports.

Severe sports-related injuries are a common affliction treated in Level I trauma departments. Detailed knowledge on injury characteristics from different medical settings is essential to improve the development of injury prevention strategies in different team sports. Team sport injuries were retrospectively analysed in a Level I trauma department registry over 15 years. Injury and treatment data were compared with regard to competition and training exposure. Injury data such as "time of visitation", "type of injury", "multiple injured body regions" and "immediate hospitalisation" helped to define the severity level of each team sports injury. At the Level I trauma department, 11.361 sports-related injuries were seen over 15 years, of which 34.0 % were sustained during team sports. Soccer injuries were the most common injuries of all team sports (71.4 %). The lower extremity was the most affected body region overall, followed by the upper extremity. Head injuries were mainly seen in Ice hockey and American football and concussion additionally frequently in team handball. Slight injuries like sprains or contusions occurred most frequently in all team sports. In soccer and team handball, injuries sustained in competition were significantly more severe (p < 0.001) than those sustained in practice.Volleyball and basketball had a trend to higher rate of severe injuries sustained during practice sessions. Depending on the specific injury profile of each team sports, injury prevention strategies should address competitive as well as training situations, whichmay need different strategies.

Prevalence of fall injuries and risk factors for fall among hospitalized children in a specialized childrens hospital in Saudi Arabia.

BACKGROUNDFall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children’s falls during hospitalization.OBJECTIVESIdentify the prevalence of fall injuries among hospitalized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall.DESIGNDescriptive, cross-sectional prevalence study.SETTINGSpecialized children’s hospital.PATIENTS AND METHODSData was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children ≤14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded.MAIN OUTCOME MEASURESPrevalence and possible risk factors for fall events.SAMPLE SIZE48.RESULTSThe prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1–5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03).CONCLUSIONRisk factor identification is required to prevent falls and their severe outcomes.LIMITATIONSUnderreporting and single-centered study.

Effect of pump type on outcomes in neonates with congenital diaphragmatic hernia requiring ECMO.

With the exception of neonatal respiratory failure, most centers are now using centrifugal over roller-type pumps for the delivery of extracorporeal membrane oxygenation (ECMO). Evidence supporting the use of centrifugal pumps specifically in infants with congenital diaphragmatic hernia (CDH) remains lacking. We hypothesized that the use of centrifugal pumps in infants with CDH would not affect mortality or rates of severe neurologic injury (SNI). Infants with CDH were identified within the ELSO registry (2000-2016). Patients were then divided into those undergoing ECMO with rollertype pumps or centrifugal pumps. Patients were matched based on propensity score (PS) for the ECMO pump type based on pre-ECMO covariates. This was done for all infants and separately for each ECMO mode, venovenous (VV) and venoarterial (VA) ECMO. We identified 4,367 infants who were treated with either roller or centrifugal pumps from 2000-2016. There was no difference in mortality or SNI between the two pump types in any of the groups (all infants, VA-ECMO infants, VV-ECMO infants). However, there was at least a six-fold increase in the odds of hemolysis for centrifugal pumps in all groups: all infants (odds ratio [OR] 6.99, p<0.001), VA-ECMO infants (OR 8.11, p<0.001 and VV-ECMO infants (OR 9.66, p<0.001). For neonates with CDH requiring ECMO, there is no survival advantage or difference in severe neurologic injury between those receiving roller or centrifugal pump ECMO. However, there is a significant increase in red blood cell hemolysis associated with centrifugal ECMO support.

Ski and snowboard school programs: Injury surveillance and risk factors for grade‐specific injury

The objective of our study was to evaluate incidence rates and profile of school program ski and snowboard-related injuries by school grade group using a historical cohort design. Injuries were identified via Accident Report Forms completed by ski patrollers. Severe injury was defined as those with ambulance evacuation or recommending patient transport to hospital. Poisson regression analysis was used to examine the school grade group-specific injury rates adjusting for risk factors (sex, activity, ability, and socioeconomic status) and accounting for the effect of clustering by school. Forty of 107 (37%) injuries reported were severe. Adolescents (grades 7-12) had higher crude injury rates (91 of 10000 student-days) than children (grades 1-3: 25 of 10000 student-days; grades 4-6: 65 of 10000 student-days). Those in grades 1-3 had no severe injuries. Although the rate of injury was lower in grades 1-3, there were no statistically significant grade group differences in adjusted analyses. Snowboarders had a higher rate of injury compared with skiers, while higher ability level was protective. Participants in grades 1-3 had the lowest crude and adjusted injury rates. Students in grades 7-12 had the highest rate of overall and severe injuries. These results will inform evidence-based guidelines for school ski/snowboard program participation by school-aged children.

Bike helmets – a dangerous fixation? On the bike helmet’s place in the cycling safety discourse in the United States

Despite the increasing popularity of the bicycle as a mode of urban transport in the United States, compared to much of the industrialized West, the US cycling scene continues to struggle with a high fatality and severe injury rate, and comparatively low levels of cycling. In contrast to the most bicycle-friendly countries, which have achieved high rates of safe cycling not through widespread adoption of bicycle safety helmets, but through bicycle-friendly infrastructure and policy, the US appears to have maintained a greater fixation on, and a higher rate of use of, bicycle helmets. In this paper, I seek to examine whether there is evidence of a helmet fixation, to sketch out the broad strokes of such a fixation as a discourse, and to offer an explanation of the effects of this discourse. Using a qualitative analysis of the official online presence of 25 US city planning departments relating to bicycling and bicycle safety, I first provide evidence that the helmet does in fact take a central place in the US urban bike safety discourse, and I characterize four rhetorical strategies used to encourage helmet use. I then argue that this helmet fixation is ultimately tied to the (re)production of unfettered automobility, and that it arguably hampers efforts to actually improve bicycle safety. I subsequently suggest implications for research, practice, and advocacy.