Severe Thoracic Injuries Research Articles

Relationship of NIX expression with pulmonary alveolus apoptosis after severe thoracic collision injury

Objective To explore the relationship between the mRNA and protein expressions of NIX and the pulmonary alveolus apoptosis following severe acute lung injury (ALI). Methods Rat models of severe collision injury on the chest were built.The mRNA and protein expressions of NIX in the alveolar cells at 6,12,24,48,72 and 96 hours after injury were detected using immunohistochemistry,immunoblotting and RT-PCR.Meanwhile,apoptosis of the alveolar cells was checked at different time points with Tunel assay. Results The protein expression of NIX in the alveolar cells was observed both in experimental and control groups,which increased at 6 h post injury,peaked at 48 h and then declined till approaching the pre-injury level at 96 h.In the meantime,NIX showed a high expression both in the vascular endothelial cells (VECs) and the renal interstitial fibroblasts.The apoptosis of alveolar cells mainly presented in bronchi,blood vessel endothelium (BVE) and alveolar epithelium at 24 h post injury.The post-injury apoptosis rate of the alveolar cells was significantly higher than the pre-injury rate ( P ＜ 0.01 ),which reached the peak at 72 h and then decreased gradually.The changes of NIX protein in lung tissue showed a positive correlation with the apoptosis rate of alveolar cells after injury (r =0.303,P ＜ 0.01 ). Conclusions The up-regulated expression of NIX takes part in the pathophysiological process of apoptosis of the alveolar cells and shows consistency with the apoptosis rate change of the alveolar cells,as may be the molecular basis for apoptosis of the alveolar cells after ALI. Key words: Thoracic injuries; Pulmonary alveoli; Gene expression; Apoptosis

High frequency oscillatory ventilation as the most appropriate treatment for life threatening thoracic trauma

Acute respiratory failure is common in trauma patients and can be a threat to life in severe thoracic injury. We represent a case of severe respiratory failure after blunt thoracic injury with uncontrollable bleeding and massive air leak which was successfully managed with high frequency oscillatory ventilation. In our opinion high frequency oscillatory ventilation represent a safe and effective treatment of life threatening acute respiratory failure in trauma patients.

Severe Spinal Cord Injury Causes Immediate Multi-cellular Dysfunction at the Chondro-Osseous Junction

Spinal cord injury is associated with rapid bone loss and arrested long bone growth due to mechanisms that are poorly understood. In this study, we sought to determine the effects of severe T10 contusion spinal cord injury on the sublesional bone microenvironment in adolescent rats. A severe lower thoracic (vertebral T10) spinal cord injury was generated by weight drop (10 g×50 mm). Severely injured and body weight-matched uninjured male Sprague-Dawley rats were studied. At 3 and 5 days post-injury, we performed histological analysis of the distal femoral metaphysis, TUNEL assay, immunohistochemistry, real-time PCR, and western blot analysis compared to uninjured controls. We observed severe hindlimb functional deficits typical of this model. We detected uncoupled remodeling with increased osteoclast activity in the absence of osteoblast activity. We detected osteoblast, osteocyte, and chondrocyte apoptosis with suppressed osteoblast and chondrocyte proliferation and growth plate arrest due to spinal cord injury. We also detected altered gene expression in both whole bone extracts and bone marrow monocytes following spinal cord injury. We conclude that spinal cord injury results in altered gene expression of key regulators of osteoblast and chondrocyte activity. This leads to premature cellular apoptosis, suppressed cellular proliferation, growth plate arrest, and uncoupled bone remodeling in sublesional bone with unopposed osteoclastic resorption.

Renal immunohistochemical investigation for the differentiation of the cause of multiple trauma fatalities

In fatalities with multiple traumatic injuries, it is important to determine the severity of trauma, the main damaged organ, and the antemortem pathophysiological condition. We examined 63 cases within 48 h of the postmortem interval, which included assaults, slips and falls and falls from heights, traffic accidents, and sharp instrumental injuries. Immunohistochemically, each kidney was stained against hemoglobin (Hb), myoglobin (Mb), superoxide dismutase (SOD), 8-hydroxy-2′-deoxyguanosine (8-OHdG), 150 kDa oxygen regulated protein (ORP150), pulmonary surfactant A (SP-A), and liver-type fatty acid binding protein (L-FABP). Bleeding or circulatory failure induced ORP150, 8-OHdG, and L-FABP in the kidney. Statistical analysis of the immunoreactivity revealed that in battered and/or abused cases, Hb could be considered a specific marker. Hb and Mb were observed in the cases with general severe trauma, such as slips and falls and falls from heights. In traffic accidents, ORP150 could reflect general circulatory failure with bleeding. SP-A was observed in the cases with severe thoracic injuries, such as lung injuries and multiple thoracic fractures. L-FABP appeared in cases with renal circulatory failure as well as renal injury. These findings suggest that immunohistochemical observation of the kidneys could be a useful tool in determining several key factors, such as the severity of injury, the specific damaged organ, and the pathological condition after injury.

A field evaluation of real-life motor vehicle accidents: Presence of unrestrained objects and their association with distribution and severity of patient injuries

Moving objects may pose an added threat to car occupants in motor vehicle accidents (MVAs). However, to our knowledge, there have only been two case studies published on the subject. For the present study, accident reports and photo documentation from MVAs were collected on-scene by dedicated paramedics. Emergency medical service personnel on-scene were interviewed as necessary. Potentially harmful unrestrained objects in the involved motor vehicles (MVs) were identified and categorised by type, weight and hardness. Seatback offset by unrestrained objects was noted. The patient injury distribution (Abbreviated Injury Scale (AIS) body regions) and severity (AIS severity scores and New Injury Severity Score (NISS) scores) were retrospectively determined from hospital and autopsy records, and their potential relationship to unrestrained objects was explored. A total of 190 accidents involving 338 MVs and 618 individuals were included. In total, 327 individuals (53%) were injured, and 61 (10%) died. 37 of 61 were not autopsied. The mean NISS was 17 (median 8, interquartile range (IQR) 1–27). Unrestrained objects were reported for 133 motor vehicles (39%) involving 293 individuals. 35% of the unrestrained objects found in the passenger compartment weighed >2kg. In the boot, 32% of objects weighed >20kg. Seatback offset associated with unrestrained objects was found for 45 individuals (15%). Unrestrained objects originally located in the boot (heavy luggage, groceries and tyres were the most frequently reported) had moved into the passenger compartment on impact in 27 cases, 24 of which were associated with seatback offset. An in-depth analysis was performed on 24 patients whose injuries were highly likely to be associated with unrestrained objects, as indicated by accident reports and medical documentation. Nineteen (79%) were involved in frontal collisions, and 12 (50%) died on-scene. The mean NISS was 51.7 (median 51, IQR 27–75) in the 17 (71%) patients with seatback offset and 37.2 (median 41, IQR 22.5–50) in the 7 (29%) without seatback offset. Seatback offset was associated with more severe head and thoracic injuries and an increased incidence of abdominal and pelvic injuries. Patients injured by unrestrained objects while sitting in unharmed car seats predominantly suffered head, cervical spine and thoracic injuries. Our results indicate a need for public information campaigns. The development of car backseats that can better sustain hits from heavy objects in the cargo boot is an important area for the motor vehicle production industry to explore.

Comparison of Different Thoracic Trauma Scoring Systems in Regards to Prediction of Post-Traumatic Complications and Outcome in Blunt Chest Trauma

As accurate assessment of thoracic injury severity in the early phase after trauma is difficult, we compared different thoracic trauma scores regarding their predictive ability for the development of post-traumatic complications and mortality. Two hundred seventy-eight multiple trauma patients (ISS ≥ 16) age > 16 y with severe blunt chest trauma (AIS(chest) ≥ 3) admitted between 2000 and 2009 to Level I Trauma center were included. Exclusion criteria were severe traumatic brain injury (AIS(head) ≥ 3) and penetrating thoracic trauma. The association between AIS(chest), Pulmonary Contusion score (PCS), Wagner-score and Thoracic Trauma Severity score (TTS), and duration of ventilation, length of ICU stay, development of post-traumatic complications, and mortality was investigated. Statistical analysis was performed with χ(2)-test, ANOVA, logistic regression, and receiver operating characteristic (ROC) curve. Patients' mean age was 42.7 ± 17.0 y, the mean injury severity score was 28.7 ± 9.3 points. Overall, 60 patients (21.6%) developed ARDS, 143 patients (51.4%) SIRS, 110 patients (39.6%) sepsis, and 36 patients (13.0%) MODS. Twenty-two patients (7.9%) died. Among the examined thoracic trauma scores only the TTS was an independent predictor of mortality. With the TTS showing the best prediction power, the TTS, PCS, and Wagner-score were independent predictors of ventilation time, length of ICU stay, and the development of post-traumatic ARDS and MODS. Thoracic trauma scores combining anatomical and physiologic parameters like the TTS seem to be most suitable for severity assessment and prediction of outcome in multiple trauma patients with concomitant blunt chest trauma.

THORACIC TRAUMA

Objective: To assess the pattern of thoracic trauma in two semi urban university hospitals in Nigeria, to determine the injuries associated with thoracic trauma, its management and outcome in a setting of small thoracic units and limited intensive care unit facilities. Study Design: Observational Method: The hospital records of 142 patients who sustained thoracic trauma between September 2007 and September 2010 were reviewed. The mode of injury, specific intrathoracic trauma, associated injuries, management and outcome were analyzed. Results: Eighty-two percent (82%) of patients were males and 73% of patients were above 40 years. Blunt thoracic trauma accounted for 77% of thoracic injuries. Road Traffic Accident (RTA) was the commonest cause of Blunt Chest Trauma (90%) while Gunshot injuries constituted the commonest cause of Penetrating Chest Trauma (73%). The commonest specific thoracic injuries were Rib fractures and Haemopneumothorax. Extremity injuries were the commonest associated extrathoracic injuries. Mechanical ventilatory assistance was indicated in 8.5% of patients. Only 1.4% of patients had delayed thoracotomy on account of clotted haemothorax and Empyema Thoracis. 2.8% of patients had Laparotomy for repair of Traumatic Diaphragmatic hernia. Others were managed conservatively. The mortality rate was 9.9%. Mortality was mainly among patients who required mechanical ventilatory support and those with associated severe extra thoracic injuries. Most of the patients were discharged before 20 days on admission. Conclusions: The incidence of chest trauma can be reduced by minimizing the frequency of road traffic accidents, abating violence and improving security. Most patients that sustain thoracic trauma can be managed conservatively. Mortality usually occurs in patients with associated severe extrathoracic trauma and those who require ventilatory support. Improving Intensive care unit facilities and training more trauma/thoracic surgeons and intensivists in the developing countries will help to reduce the mortality rate of chest trauma.

Effects of High-Intensity Inspiratory Muscle Training Following a Near-Fatal Gunshot Wound

Severe injuries sustained during combat may classify individuals as undeployable for active service. It is imperative that every effort is made to optimize physical function following such injuries. A 38-year-old man sustained a gunshot wound during armed combat. The bullet entered via the left axilla and exited from the right side of the abdomen, resulting in severe thoracic and abdominal injuries. Five months later, he continued to describe severe dyspnea on exertion. During a cardiopulmonary exercise test on a cycle ergometer, he achieved a maximum rate of oxygen uptake of 2,898 mL·min(-1) (114% predicted) and maximum power of 230 W (114% predicted). His maximum forced inspiratory flow was 5.95 L·s(-1), and inspiratory reserve volume at test end was ∼80 mL. The test was terminated by the patient due to dyspnea that was too severe to tolerate. Video fluoroscopy demonstrated impaired right hemidiaphragm function. The main goals of therapy were to reduce dyspnea on exertion and to enable return to full work duties. A program of high-intensity, interval-based threshold inspiratory muscle training (IMT) was undertaken. An average of 5 sessions of IMT were completed each week for 10 weeks. During a repeat cardiopulmonary exercise test, the patient achieved a similar power and maximum rate of oxygen uptake. His maximum forced inspiratory flow increased by 48% to 8.83 L·s(-1), and he was limited by leg fatigue. High-intensity IMT was safe and well tolerated. It was associated with improvements in maximum forced inspiratory flow and changed the locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.

Neurological and Functional Recovery in Multiple Injured Patients With Paraplegia: Outcome After 1 Year

Injuries of thoracic vertebrae in multiple trauma patients are often accompanied by severe thoracic injuries and sensorimotor deficits. However, until now, it is not clear whether and how the severity of trauma influences the neurologic and functional outcome in paraplegic patients during the first year after the trauma. The aim of the study was to compare two cohorts of multiple injured paraplegic patients with and without conversion in the American Spinal Injury Association Impairment Scale (AIS) with regard to the severity of spinal trauma, the severity of thorax trauma, the type of fracture, and the functional outcome 1 year after the date of injury. Twenty-one traumatic paraplegic patients (neurologic level T1-T12) were included in the study based on a retrospective analysis of the Heidelberg European Multicenter Study about Spinal Cord Injury database (www.emsci.org) from 2002 to 2007. In all patients, the Polytraumaschluessel (PTS), the AO classification, the AIS, and the Spinal Cord Independence Measure were collected. Patients with no change in the AIS (group 1, n=14) were compared with patients with AIS changes (group 2, n=7), and t test and χ test were performed (p<0.05). Differences in both groups concerning fracture classification were confirmed (p=0.046). A relation between neurologic improvement in the AIS and the severity of trauma (p=0.058) after 1 year was not found. The subitem PTST in the thoracic area showed statistical significance comparing the two groups (p=0.005). Both groups significantly improved functionally (Spinal Cord Independence Measure, p=0.035) during the first year but with no significant difference between the groups after 1 year. Our data suggest that functional improvement is achieved independently from neurologic recovery. The combined assessment of the PTS, the AO classification, and the AIS in multiple-injured paraplegic patients can contribute to provide a better prognostication of the neurologic changes during rehabilitation and the outcome after 1 year than the AIS alone.

Reducing Chest Injuries in Automobile Collisions: Rib Fracture Timing and Implications for Thoracic Injury Criteria

The purpose of this study was to quantify the biomechanical response of the human thorax during dynamic shoulder belt loading representative of that seen in a severe automotive collision. Two post-mortem human surrogates (PMHSs) (one male and one female) were instrumented with 26 single-axis strain gages on the ribs, sternum, and clavicle. The thorax of each PMHS was placed on a custom spine support bracket designed to support the thorax on either side of the spinous process, thereby allowing free motion at the costovertebral joints. In addition, the support bracket raised the thorax above the flat base plate, which could otherwise constrain the deformation and motion of the posterior region of the rib cage. The thorax of each PMHS was then loaded using a custom table-top belt loading system that generated thoracic displacement rates representative of a severe automotive collision, 1.3m/s for the male PMHS and 1.0m/s for the female PMHS. The rib fracture timing data, determined by analyzing the strain gage time histories, showed that severe thoracic injury (AIS=3) occurred at 16% chest compression for the male and 12% chest compression for the female. However, these values are well below the current thoracic injury criteria of 29% chest compression for the male and 23% chest compression for the female. This data illustrates that serious thoracic injury (AIS=3) occurs at lower chest compressions than the current ATD thoracic injury criteria. Overall, this study provides critical data that can be used in the design and validation of advanced ATDs and finite element models, as well as the establishment of improved, more stringent thoracic injury criteria.

External Validation of a Prognostic Model for Early Mortality After Traumatic Brain Injury

Traumatic brain injury (TBI) is a major cause of lost disability-adjusted life years, and a valid model allowing prediction of outcome would be welcome. For a clinical prediction model to be valid, generalization to other populations must be possible. The aim of this study was to externally validate a model for in-hospital mortality in patients with TBI, which was recently development at the University of Southern California (USC). The validation cohort was derived from a hospital-based, prospectively collected trauma registry in Oslo, Norway. We included patients admitted with a head injury without hypotension, severe thoracic, or abdominal injury (n = 3,136). We calculated the probability of death according to the USC model. The performance of the model was evaluated using measures of calibration and discrimination in the total sample and subgroups according to initial Glasgow Coma Scale (GCS) score. The USC model provided excellent discrimination (area under the receiver operating characteristic curve, AUC = 0.93), but unsatisfactory calibration (p < 0.001) for the total sample (GCS 3-15). In the GCS 4-8 subgroup we found good discrimination (AUC = 0.89) but poor calibration (Hosmer-Lemeshow test, p < 0.001). The findings question the external validity of the USC model, suggesting that it should not be implemented as a tool for short-term mortality prediction in our TBI population.

Alcohol and psychoactive drugs increased the pre-hospital mortality in 655 fall-related fatalities in Greece: A call for management protocols

IntroductionThe frequency of alcohol and psychoactive drugs in fall-related fatalities and their effect on type, severity of injury and location of death constitute the subjects of this study. MethodsA retrospective analysis based on autopsy and toxicology compared demographics, location of injury; intention for the injury, height of fall, Abbreviated Injury Scale – 90 (AIS-90), post-mortem Injury Severity Score (ISS), and location of death. ResultsAmongst 655 fall-related fatalities screened for alcohol and psychoactive drugs 123 (18.8%) were classified in the positive toxicology group (PTG) and the remaining in the negative toxicology group (NTG).The median ages were 48 (16–94) years for the PTG and 62 (12–96) years for the NTG.The screened represent 31% of the national toll. The median height of fall was 7m and the median blood alcohol concentration was 53 (1.5–630)mg/dl.Males were more likely to be included in the PTG than females (21.6 versus 13.6%; p=0.014) as were the aged between 11 and 60 years.The odds of severe (AIS≥3) head, thoracic, abdominal, extremity, and spine injuries were not influenced by toxicology status.Fatalities of the PTG were as likely to have severe trauma (ISS≥16) as were fatalities of the NTG (93.5 versus 90.8%; p=0.34).There was no significant difference of ISS between PTG (median ISS 43, range: 6–75) and NTG (median ISS 35, range: 3–75).Nevertheless, 76.4% of the subjects of the PTG died during the pre-hospital stage of care compared to 60.5% of the subjects of the NTG, which was highly significant (or=2.80, p=0.001) after controlling for confounders as age, gender, intention for injury, height of fall, and ISS. ConclusionsIn fall related trauma, alcohol and psychoactive drugs increased the risk of death during the pre-hospital stage by 2.80 times. This is strong evidence that specific protocols for their early management should be instituted.

Development of Autonomic Dysreflexia after Spinal Cord Injury Is Associated with a Lack of Serotonergic Axons in the Intermediolateral Cell Column

Autonomic dysreflexia consistently develops in patients and in rats after severe upper thoracic spinal cord injury (SCI) as a result of exaggerated spinal sympathetic excitation. In this study we induced episodic hypertension in rats after varying degrees of SCI severity to investigate the contribution of serotonergic bulbospinal axons to the development of autonomic dysreflexia after SCI. Female Wistar rats (250-300 g) were used in all experiments in the following groups: (1) uninjured, (2) clip compression at T4 of 20, 35, or 50 g, (3) spinal cord transection at T4, and (4) intrathecal 5,7-dihydroxytryptamine creatinine sulfate (5,7-DHT). Immunohistochemistry for choline acetyl transferase and serotonin (5-HT) was performed on T8-T12 spinal segments to identify sympathetic preganglionic neurons, and to assess 5-HT-containing axons in the intermediolateral cell column (IMLC), respectively. Testing for autonomic dysreflexia was conducted by measuring mean arterial pressure (MAP) at rest and after colon distension-induced hypertension. We observed that the magnitude of the pressor response seen after colon distension correlated with SCI severity and density of 5-HT-immunoreactive axons in the IMLC. Intrathecal administration of the 5-HT(2A) agonist dimethoxy-4-iodamphetamine increased resting MAP and blocked colon distension-induced hypertension, whereas the 5-HT(2A) antagonist ketanserin decreased resting MAP and was permissive to the colon distension-induced pressor response in SCI rats. These results suggest that the SCI-induced loss of serotonergic inputs into the spinal cord IMLC is proportional to the pathogenesis of autonomic dysreflexia and hypotension seen after SCI. We thus conclude that sparing of serotonergic axons beyond a critical threshold preserves cardiovascular regulation and prevents the development of autonomic dysreflexia.

Comparative Analysis of the Pattern of Severe Injury Due to Road Traffic Accidents in Children

Objective: to study stepwise differences in the severity and pattern of severe traumatic injuries due to road traffic accidents in patients during the qualified and specialized stages of medical care in the age groups of 1 month to 18 years in the Rostov Region. Material and methods. The 2004—2009 case reports were used to make a retrospective comparative assessment of the condition of victims with severe road traffic injury at care stages in 2 groups: 1) one-month- to 18-year-old children who had been primarily admitted to the qualified-stage intensive care units (n=61); 2) one-month-to 18-year-old patients from the intensive care unit of the Regional Children&#8217;s Hospital, referred from the qualified-stage intensive care units (n=133). Results. The number of specialized-stage children in grave and extremely extensive grave condition at the specialized stage was 14.7% more than that at the qualified stage (100 and 85.3%, espectively). Concomitant injury was encountered more frequently (by 13%) in the specialized-stage patients (73.7 and 60.7%, respectively). The severity of road traffic injury was determined mainly by brain injuries at the qualified irnd specialized stages (96.7 and 96.1%), by skeletal injuries (11.6% more frequently) and thoracic ones (9.8% more frequently) at the specialized stage. The prevalence of abdominal injuries at the qualified stage was 9.8% higher. The pattern of brain injury in the specialized-stage patients showed a preponderance of brain contusion and epidural hematomas by 18.5 and 6.5%, respectively. Conclusion. Severe thoracic and brain injuries (craniocerebral injuries, brain contusion, and intracranial hematomas) are an indication for patient referral to the specialized care stage in order to perform high-technological diagnostic and therapeutic methods. Key words: children, road traffic accidents, severe injury, medical care stages.

Traumatic limb amputations at a levelI trauma center.

The purpose of this study was to analyze the epidemiology and outcomes after traumatic amputation of the upper (UEA) and lower (LEA) extremities. The Los Angeles County+University of Southern California Medical Center trauma registry was utilized to identify all patients sustaining traumatic amputation during the years 1996-2007. The demographics, mechanism of injury, clinical characteristics, associated injuries, surgical procedures, complications, and outcomes were obtained for these patients. During the 12-year study period, 130 patients suffered limb amputation, accounting for 0.25% of all trauma admissions. Thirteen patients (10%) were excluded because they were transferred from another facility after amputation or died in the emergency department. Of the remaining 117 patients, mean age was 38.1±16.4years and 77.8% were male. The predominant mechanism of injury was automobile versus pedestrian (27.4%), followed by work-related accidents (23.9%). Patients struck by vehicles were more likely to suffer LEA (93.8% versus 6.2%, p<0.001), while patients with work-related accidents were more likely to sustain UEA (81.5% versus 18.5%, p<0.001). Only nine patients underwent reattachment, all of which were for UEA and unsuccessful. Overall, 24.8% developed a complication during their hospital course, 55.2% of which were extremity related. Overall mortality was 3.4%, primarily attributed to associated severe traumatic brain injuries and thoracic injuries. Patients with LEA had longer hospital and intensive care unit (ICU) length of stay; however, after adjusting for confounders, this difference did not reach statistical significance (adjusted mean difference: 2.1 and 1.2days, p=0.69 and 0.79, respectively). A higher percentage of patients with LEA required discharge to a skilled nursing facility or rehabilitation center when compared with patients with UEA (29.6% versus 4.8%, p=0.001). Traumatic limb amputation is a rare consequence of civilian trauma. Amputation is rarely the primary cause of death; however, these devastating injuries are associated with significant intensive care unit and hospital lengths of stay. Although no mortality difference was detected, when compared with patients with upper extremity amputations, patients with lower extremity amputations were more severely injured, required revision extremity surgery more often, had a higher complication rate, and more frequently required discharge to a long-term facility.

Lack of Axonal Sprouting of Spared Propriospinal Fibers Caudal to Spinal Contusion Injury Is Attributed to Chronic Axonopathy

We have previously shown that a small percentage of long descending propriospinal tract (LDPT) axons are spared, whereas few short thoracic propriospinal (TPS) fibers survive 2 weeks following severe (50 mm weight drop) low thoracic spinal cord contusion injury (SCI). Here, we extended those findings to a moderate (25 mm weight drop) T9 SCI and assessed the effects of this lesion severity on propriospinal tract fibers at different time periods after injury. We anterogradely labeled fibers with fluororuby (FR) or WGA-HRP to determine their location and number 2, 4, 6, and 16 weeks post-SCI. Findings were compared with non-injured controls. At chronic time points, surviving FR-labeled LDPT fibers rostral to the injury remained as reactive endings or as putative regenerative sprouts. Caudal to the injury, spared LDPT fibers ran along a rim of lateral and ventral white matter, and ended as small abnormal-appearing putative terminal boutons or reactive endings within the intermediate gray matter of lumbosacral cord, with little axonal arborization and no evidence of injury-induced sprouting. One striking difference in the WGA-HRP experimental operates was the increased density of labeling of spared axons within the white matter caudal to the injury compared to controls. This labeling pattern was reminiscent of the labeling found after axotomy in studies by others, and raises a question as to contusion injury-induced impaired axonal transport. We hypothesize that axonal sprouting of axons after partial spinal cord injury seen in previous investigations was not found in the present investigation because of the additional pathological effects of contusion injury, similar to what is observed after traumatic brain injury.

Vehicle Model Year and Crash Outcomes: A CIREN Study

Objective: To quantify the effect of model year (MY) on the occurrence of severe injuries and death after involvement in motor vehicle crashes. Methods: Cases involving adult front seat occupants of vehicles MY ≥ 1994 equipped with frontal airbags were selected from the Crash Injury Research and Engineering Network (CIREN) database. Cases were grouped by MY: 1994–1997, 1998–2004, and 2005–2007 (MY groups [MYG] 1, 2, and 3, respectively. MYGs were compared in relation to mortality, Injury Severity Score (ISS), and the occurrence of Abbreviated Injury Severity score (AIS) 3+ and AIS4+ injuries to each body region using Mantel Haenszel chi-square, Kruskal-Wallis, and Bonferroni corrected t test. To adjust for confounders, multiple logistic regression models were built to explore the association of MYG with death. Covariates included age, BMI, delta v, principal direction of force (PDOF), restraint use, and vehicle type. Results: A total of 1888 cases was distributed within MYG1 (34%), MYG2 (62%), and MYG (34%). Age, gender, BMI, and PDOF distribution did not differ among MYGs. Though ISS distribution was not different, a decrease in the occurrence of AIS4+ of the thorax and spine regions was noted over time. Mortality also decreased over time (18, 9, and 4% MYG 1, 2, and 3, respectively). Multivariate analysis revealed a protective effect of MYG2 and MGY3 (odds ratio [OR], 0.57 [0.44–0.75] and 0.22 [0.07–0.50], respectively) in relation to death. Conclusions: Front seat occupants of later MY vehicles injured during crashes experience a decreased likelihood of very severe thoracic injuries, spinal injuries, and death.

Attach great importance to clinical study on complex and critically severe thoracic injuries

众所周知,在所有的外伤中,胸外伤死亡率位居前列.可是,大多数严重的胸伤患者都死在院前,在和平年代的医疗实践中,严重的胸伤并不多见.常见的肋骨骨折不需特殊处理,卧床、止痛、必要时胸壁固定即可。

Injury patterns among obese children involved in motor vehicle collisions

Purpose The purpose of this study was to compare injury patterns among obese children to their nonobese counterparts involved in motor vehicle collisions. Methods A nationwide data collection program containing occupant, collision, and injury details from police-reported tow-away crashes between 1997 and 2006 were used. Risk ratios (RRs) and associated 95% confidence intervals (CIs) were adjusted for age, sex, restraint, seat track position, vehicle curb weight, and total velocity change. Results An estimated 9 million children aged 2 to 17 years (20.2% obese) were involved in motor vehicle collisions during the study period. Among 2-to-5-year-olds, obesity increased the risk of severe head (RR, 3.67; 95% CI, 1.03-13.08) and thoracic (2.27; 1.01-5.08) injuries. Among 6-to-9-year-olds, obesity increased risk of thoracic (2.31; 1.08-4.95) and lower extremity (LE) injuries (1.89; 1.03-3.47). Among 10-to-13-year-olds, obesity increased the risk of severe thoracic (1.98; 1.08-3.65) and LE (6.06; 2.23-16.44) injuries. Among 14-to-17-year-olds, obesity increased risk of severe LE injuries (1.44; 1.04-2.00) but decreased risk of abdominal (0.20; 0.07-0.60) and head (0.33; 0.18-0.60) injuries, very similar to the pattern reported in obese adults. Conclusion The pattern of obesity-associated injuries changes from a higher risk of head and thoracic injuries among young children to a pattern in late teenagers that is similar to obese adults.

The management of trauma victims in England and Wales: a study by the National Confidential Enquiry into Patient Outcome and Death☆☆☆

Trauma is the leading cause of death in the first four decades of life in western countries. A national prospective study was conducted in the UK to examine the process and quality of care of severely injured patients. We present a previously unpublished analysis of the severity of injury, place of treatment, quality of care and survival amongst patients with thoracic injuries. All UK hospitals with an emergency department were asked to provide prespecified clinical and process data on all patients presenting with significant injuries between 1st February and 30th April 2006. All data were stripped of patient, clinician and institutional identifiers before review by expert advisors. Data adequate for analysis were obtained on 1735 of 2203 injured patients reported. An injury severity score (ISS) > or = 16, the threshold for severe injury, was derived from case records of 795 patients, who comprise the study denominator. Of these, 387 (49%) had a thoracic injury, usually as part of polytrauma. The mortality rate was 8% (of 13) 9% (of 23) 10% (of 175) 14% (of 136) 22% (of 37) and 100% (of 3) for the six ascending grades of severity for the thoracic component of the ISS score. One hundred and seventy-six of the 795 patients (22%) had a thoracic injury sufficient for them to be classified as severely injured regardless of any other injuries. The quality of care as assessed by expert advisors showed an apparent association with overall trauma volume of the 142 treating hospitals. For patients with thoracic injuries where the specialty of the team in charge could be identified (n = 284/387) trauma and orthopaedics (T and O) cared for 36%, critical medicine 22%, general surgery 19%, neurosurgery 8% and only 5% were in the care of thoracic surgeons. One or more chest drains were inserted in 203/795 (26%) of patients, few of them by thoracic surgeons. Given that polytrauma patients rarely come under the care of thoracic surgeons and yet frequently have severe thoracic injuries there is a clear need for T and O surgeons and generalists to have a good grounding in thoracic procedures.