Specific Injury Patterns Research Articles

Traumatic injury patterns in humans from large feline predators: A systematic review and descriptive analysis

Background Traumatic attacks from large feline predators cause a small yet significant burden of disease in rural populations, are increasing in frequency, cause complex injuries and worsen human–wildlife conflicts. Data on the traumatic injury pattern found in victims of these animals is sparse, and this study aimed to collate and synthesise patterns of injury to inform the care and management of these patients. Methods A multi-ethnographic literature search (PubMed, Embase, Web of Science, Google Scholar, and other sources) was performed on 12/1/21 to capture all available data describing anatomical injury and the mechanism of injury sustained by humans from attacks by lions, leopards and tigers. Quality and bias assessment was performed using the Joanna Briggs Critical Evaluation tools. Results Of 5110 studies identified, 42 were included in this review totalling 84 individual patient cases. A total of 85% of fatal injuries were due to exsanguination combined with neuroaxis injury of the neck. All wounds were susceptible to tissue loss, infection and long-term neuro-vascular complications. Leopards injured anterior-midline structures of the neck more often than did lions and tigers, while the latter caused high-energy fractures. Time lag to treatment for survivors of wild attacks extended to multiple days, and occult injury was common. Conclusion In addition to the primary finding of complex neck injury, this study generated specific patterns of injury seen from the included species and highlighted occult injury and healthcare disparity as challenges in providing patient care.

The effect of age on injury patterns in pedestrian deaths.

Although it is known that elderly pedestrians are at increased risk of injury and death from vehicle crashes the specific pattern of lethal injuries related to age has not been extensively studied. Data on the numbers of pedestrian fatalities and ages were obtained from 1990 to 2020 from the Traffic Accident Reporting System, The University of Adelaide, Adelaide, South Australia and detailed autopsy data on fatal pedestrian crashes from the pathology database at Forensic Science SA, Adelaide, South Australia from 2000 to 2020. Fatal injuries were separated into the following regions: head/face, spine, chest, abdomen and limbs/skeleton. Analysis of 634 cases of pedestrian fatalities (1990-2020) showed a significant decline in numbers over the years (p < 0.001). Analysis of fatal injuries in 219 cases (2000-2020) showed a significant reduction in the proportion of fatal head injuries with increasing age (p < 0.05), a significant increase in the proportion of fatal chest injuries with increasing age (p < 0.01) and a significant increase in the proportion of fatal limb/skeletal injuries with increasing age (p < 0.05). Older pedestrians are, therefore, more likely to sustain lethal chest and limb/skeletal injuries than head injuries compared to those who are younger, presumably due to greater physical fragility that occurs with age, with loss of protective muscle bulk and bone density.

Patterns and Characteristics of Intentional Self-inflicted Hand Injuries among Military Personnel: A Retrospective Study and Proposal of Treatment Algorithm.

This retrospective chart review study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Our inclusion criteria included military personnel patients who presented to the emergency department with intentional self-inflicted hand-related injuries between 2016 and 2018. A total of 274 cases were included; 241 (88%) were men. Injuries to the left hand (52.2%) were more common than injuries to the right hand. The most common injury site involved the little finger (45.6%). The majority were followed up (97.8%), and 28.8% of cases had a complication. The majority of fractures were managed with open reduction and internal fixation (63.9%). Moreover, the mean sick leave duration was 23 days. Self-inflicted injuries can be challenging to diagnose when patients are manipulative about the cause and mechanism. Most self-inflicted injuries involved the left little finger, and most were treated with open reduction and internal fixation. A self-inflicted injury is possible in the context of an unusual injury with a vague medical history.

Rising Mortality in Pediatric Self-Inflicted Firearm Trauma Associated With Distinct Anatomic Injury

IntroductionSelf-inflicted injuries are the second leading cause of pediatric (10-18 y old) mortality. Self-inflicted firearm trauma (SIFT) was responsible for up to half of these deaths in certain age groups. We hypothesized that SIFT prevalence has increased and is associated with specific demographics, injury patterns, and outcomes. Materials and methodsData were abstracted from the 2007-2018 American College of Surgeons (ACS) Trauma Quality Programs Participant Use Files (TQP-PUF). Pediatric (1-17 yold) victims of firearm violence were eligible. Age, race, gender, anatomic region, and intent were abstracted. Variables were analyzed using chi-squared tests, t-tests, and single-variate linear regression models. Temporal trends were analyzed using ANCOVA tests. Multivariate logistic regressions were conducted to identify factors influencing mortality. Significance was P < 0.05. ResultsThere were 41,239 pediatric firearm trauma patients (SIFT: 5.5% [n = 2272]). SIFT incidence increased over the 12-y period (2007 (n = 67) versus 2018 (n = 232), P < 0.05). SIFT was significantly associated with Caucasian race, 67% (n = 1537), teenagers, 90% (n = 2056), male gender, 87% (n = 1978), and a higher median injury severity score (ISS) than other intents of injury (SIFT: 20.0 (IQR: 9.0, 25.0) versus other: 9.0 (IQR: 1.0-13.0), P < 0.001). The SIFT mortality rate was 44% (n = 1005). On multivariate regression head gunshot wounds (OR: 21.1, 95% C.I.: 9.9-45.2, P = 0.001), and ISS (OR:1.1, 95% C.I.: 1.1-1.1, P = 0.001) were significantly associated with mortality. Compared to other intents, SIFT mortality rates increased at a higher annual rate (P < 0.001). ConclusionsComprehensive local and federal policy changes to reduce firearms access and increase pediatric mental health support may mitigate these injuries.

Analysis of Biomechanics of Motor Vehicle Collisions for Passenger Cars: Implications for Passenger Vehicle Safety and Future Car Design Innovations

IntroductionInvestigating biomechanics of injury patterns from motor vehicle collisions (MVCs) informs improvements in vehicle safety. This study aims to investigate two-vehicle MVCs involving a passenger car and specific injury patterns associated with sources of injury, collision biomechanics, vehicle properties, and patient outcomes. MethodsRetrospective cohort study conducted to evaluate the biomechanics of specific injury patterns seen in MVCs involving passenger cars using the Crash Injury Research Engineering Network database between the years 2005 and 2015. ResultsA total of 631 MVC cases were included from 2005 to 2015. The majority of cases involved injuries to the head or neck, the thorax, and the abdomen (80.5%). Head/neck injuries from the steering wheel were associated with significantly higher injury severity score compared to those from seatbelts (26.11 versus 18.28, P < 0.001) and airbags (26.11 versus 20.10, P = 0.006), as well as a >6-fold higher fatality rate (P = 0.019). Thoracic injuries caused by the center console were twice as likely to be fatal than those caused by the seatbelt (P = 0.09). ConclusionsOccupants suffering injuries to the head/neck, the thorax, and the abdomen had higher injury severity score and fatality rates compared to other body regions, demonstrating that manufacturing and safety guidelines should focus on minimizing these injury patterns. Head/neck injuries caused by the steering wheel were associated with worse outcomes compared to those caused by seatbelts and airbags, further emphasizing the benefits of these critical safety features. Integration of innovative safety features like center-mounted airbags may improve occupant safety.

Single-Stage Surgical Treatment of Multi-ligament Knee Injuries Results in Lower Cost and Fewer Complications and Unplanned Reoperations Compared With Staged Treatment

PurposeTo compare complications, unplanned reoperations, and costs between single-stage and 2-stage treatment of multi-ligament knee injuries.MethodsThe MarketScan database was queried (2007-2016), identifying patients undergoing surgery for a multi-ligament knee injury. The single-stage cohort was defined as having at least 2 Current Procedural Terminology codes for ligament reconstruction at the index procedure without a Current Procedural Terminology code for ligament reconstruction appearing in the database for the following 12 months. The 2-stage cohort was defined as undergoing multiple ligament reconstruction procedures within a 12-month period with subsequent ligament procedure codes that differed from the index ligament reconstruction codes. Propensity score matching was performed using a greedy nearest-neighbor algorithm to match specific injury patterns between the 2 cohorts. Baseline demographic characteristics, medical comorbidities, and the Charlson Comorbidity Index were recorded. Complications, unplanned reoperations, and total health care expenditures were recorded for up to 5-year follow-up. Two-sample t tests, χ2 tests, and Fisher exact tests were used with an α level of .05 set as significant.ResultsWe identified 1,150 patients who underwent surgery for multi-ligament knee injuries (1,080 with single-stage approach and 270 with 2-stage approach). No significant differences in baseline characteristics or medical comorbidities were found between the cohorts. After propensity score matching, the single-stage group had fewer complications at 30, 90, 180, and 365 days (P < .05). Two-stage treatment increased the risk of reoperation at 1 year (5.5 times) and 2 years (4.9 times) after the index procedure. Health care expenditures were lower in the first 9 months for the staged cohort, but from 9 months ($31,210 vs $22,252, P < .0001) through 5 years, total costs were higher in this group.ConclusionsSingle-stage surgical treatment of multi-ligament knee injuries results in fewer complications and reoperations and lower total costs compared with 2-stage treatment, even after controlling for the number and combination of ligaments injured.Level of EvidenceLevel III, retrospective cohort study.

Different patient and activity-related characteristics result in different injury profiles for patients with anterior cruciate ligament and posterior cruciate ligament injuries

PurposeTo compare patient characteristics including patient sex, age, body mass index (BMI), activities at the time of injury and injury profiles in patients with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries.MethodsData were obtained from the Swedish National Knee Ligament Registry. Two study groups were created: (1) index ACL reconstruction (ACL group) and (2) index PCL reconstruction (PCL group). Between-group differences were investigated using Fisher’s exact test and Fisher’s non-parametric permutation test for dichotomous variables and continuous variables, respectively.ResultsOf 39,010 patients, 38,904 were ACL injuries. A larger proportion of patients with combined injuries to the PCL, meniscus and cartilage were female, aged > 25 years and with a BMI of > 35 kg/m2 compared with patients with combined injuries to the ACL, meniscus and cartilage. An isolated ACL injury was more commonly found in males, while all other injury profiles of ACL, including combined injuries with meniscus, cartilage and collateral ligament injuries, were more frequently observed in females. The PCL injuries were sustained either during pivoting sports, non-pivoting sports or were traffic-related.ConclusionDifferent patient characteristics (BMI, age and sex), and activities at the time of injury (sport- versus traffic-related activities), resulted in distinct injury profiles for the ACL and PCL groups. These findings provide valuable information of the way specific injury patterns of cruciate ligament injuries occur, and subsequently may help clinicians with the diagnostic process of ACL and PCL injuries.Level of evidenceIII.

Placental pathology is necessary to understand common pregnancy complications and achieve an improved taxonomy of obstetrical disease

The importance of a fully functioning placenta for a good pregnancy outcome is unquestioned. Loss of function can lead to pregnancy complications and is often detected by a thorough placental pathologic examination. Placental pathology has advanced the science and practice of obstetrics and neonatal-perinatal medicine by classifying diseases according to underlying biology and specific patterns of injury. Many past obstacles have limited the incorporation of placental findings into both clinical studies and day-to-day practice. Limitations have included variability in the nomenclature used to describe placental lesions, a shortage of perinatal pathologists fully competent to analyze placental specimens, and a troubling lack of understanding of placental diagnoses by clinicians. However, the potential use of placental pathology for phenotypic classification, improved understanding of the biology of adverse pregnancy outcomes, the development of treatment and prevention, and patient counseling has never been greater. This review, written partly in response to a recent critique published in a major obstetrics-gynecology journal, reexamines the role of placental pathology by reviewing current concepts of biology; explaining the most recent terminology; emphasizing the usefulness of specific diagnoses for obstetrician-gynecologists, neonatologists, and patients; previewing upcoming changes in recommendations for placental submission; and suggesting future improvements. These improvements should include further consideration of overall healthcare costs, cost-effectiveness, the clinical value added of placental assessment, improvements in placental pathology education and practice, and leveraging of placental pathology to identify new biomarkers of disease and evaluate novel therapies tailored to specific clinicopathologic phenotypes of both women and infants.

Developing a National Trauma Research Action Plan: Results from the postadmission critical care research gap Delphi survey.

The 2016 National Academies of Science, Engineering and Medicine report included a proposal to establish a National Trauma Research Action Plan. In response, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care from prehospital care to rehabilitation as part of an overall strategy to achieve zero preventable deaths and disability after injury. The Postadmission Critical Care Research panel was 1 of 11 panels constituted to develop this research agenda. We recruited interdisciplinary experts in surgical critical care and recruited them to identify current gaps in clinical critical care research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. The first of four survey rounds asked participants to generate key research questions. On subsequent rounds, we asked survey participants to rank the priority of each research question on a 9-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as ≥60% of panelists agreeing on the priority category. Twenty-five subject matter experts generated 595 questions. By Round 3, 249 questions reached ≥60% consensus. Of these, 22 questions were high, 185 were medium, and 42 were low priority. The clinical states of hypovolemic shock and delirium were most represented in the high-priority questions. Traumatic brain injury was the only specific injury pattern with a high-priority question. The National Trauma Research Action Plan critical care research panel identified 22 high-priority research questions, which, if answered, would reduce preventable death and disability after injury. Diagnostic Tests or Criteria; Level IV.

Injury incidence and specific injury patterns in app-based bodyweight training (Freeletics): results of an international survey with 3668 participants

BackgroundThe aim of this study was to analyze incidences and sport-specific injury patterns among users of a bodyweight-based training method instructed by a smartphone app (Freeletics Bodyweight App).MethodsAn online questionnaire based on current validated epidemiological observation methods was designed using the statistic website Surveymonkey. Subscribers of the Freeletics Bodyweight App were contacted via an online link. Injury incidence, defined as an event leading to a training pause of at least 1 day, was recorded. The type of injury was reported and classified. Furthermore, all participants were asked whether they recognized any positive or negative effects on their subjective health status. The collected data were analyzed using Surveymonkey statistic services.ResultsA total of 4365 Freeletics users responded to the questionnaire, 3668 completed forms were subject of further investigation. The injury period prevalence reported by users of the Freeletics App was 24% in men and 21% in women. The most frequently reported site of injury was the shoulder (29%) and the knee joint (28%), with strains (28.5%) and other muscle injuries (14.4%) being the most frequently reported types of injuries. An injury incidence rate of 4.57 per 1000 h was calculated, with injuries occurring less frequently in experienced users. Most participants reported a distinct positive effect of the app-based training on their health status.ConclusionIn comparison to other sports activities app-based bodyweight training is associated with a comparably low injury period prevalence. The vast majority of injuries were reported to have resolved within one week.

DoD-VA Trauma Infection Research Collaboration.

In the aftermath of wars, there is a surge in the number of wounded service members who leave active duty and become eligible for healthcare through the Department of Veterans Affairs (VA). Collaborations between the Department of Defense (DoD) and VA are crucial to capture comprehensive data and further understand the long-term impact of battlefield trauma. We provide a summary of the development, methodology, and status of an effective collaboration between the Infectious Disease Clinical Research Program and the St. Louis VA Health Care System with the multicenter, observational Trauma Infectious Disease Outcomes Study (TIDOS), which examines the short- and long-term outcomes of deployment-related trauma. As part of TIDOS, wounded service members who transitioned to participating military hospitals in the United States (2009-2014) were given the opportunity to enroll in a prospective follow-up cohort study to continue to capture infection-related data after their hospital discharge. Enrollees in the TIDOS cohort who left military service and received health care through the VA also had the option of consenting to have relevant VA medical records abstracted and included with the study data. Infections considered to be complications resulting from the initial trauma were examined. Among 1,336 TIDOS enrollees, 1,221 (91%) registered and received health care through the VA with 633 (47%) consenting to follow-up using VA records and comprising the TIDOS-VA cohort. Of the first 337 TIDOS-VA cohort enrollees, 38% were diagnosed with a new trauma-related infection following hospital discharge (median: 88 days; interquartile range: 18-351 days). Approximately 71% of the infections were identified through DoD sources (medical records and follow-up) and 29% were identified through VA electronic medical records, demonstrating the utility of DoD-VA collaborations. The TIDOS DoD-VA collaboration has also been utilized to assess intermediate and long-term consequences of specific injury patterns. Among 89 TIDOS-VA cohort enrollees with genitourinary trauma, 36% reported sexual dysfunction, 21% developed at least one urinary tract infection, 14% had urinary retention/incontinence, and 8% had urethral stricture. The rate of urinary tract infections was 0.05/patient-year during DoD follow-up time and 0.07/patient-year during VA follow-up time. Wider capture of infection-related outcome data through the DoD-VA collaboration provided a clearer picture of the long-term infection burden resulting from deployment-related trauma. Planned analyses include assessment of osteomyelitis among combat casualties with amputations and/or open fractures, evaluation of mental health and social factors related to injury patterns, and examination of health care utilization and cost in relation to infectious disease burdens.

Bone Marrow Edema Injury Patterns in the Pediatric Knee: An MRI Study.

Symptomatic pediatric patients referred for magnetic resonance imaging (MRI) commonly present with traumatic bone marrow edema (BME) patterns. We sought to associate discrete MRI patterns of BME with specific injury mechanisms in pediatric knee injuries to classify injury patterns by anatomical location of the BME. We aimed to group these into 6 patterns: patellar dislocation, extensor mechanism overload, hyperextension, single compartment impaction, ligament avulsion/translation, and direct contusion. We retrospectively reviewed 314 MRIs performed with a standard protocol on symptomatic patients aged 3 to 18 years at 1 institution. Our analysis included images, reports, and traumatic BME patterns. A musculoskeletal radiologist and orthopedic surgeon independently assigned 1 of the 6 injury patterns to each scan. After exclusion criteria were applied to the 314 MRIs, 62 (19.7%) remained, 40 boys and 22 girls. The average age was of 12.2 years. The most frequent injury patterns were patellar dislocation (n = 22, 35%) and extensor mechanism overload (n = 14, 22%). κ value associated with pattern determination was .766, indicating substantial concordance. Bone marrow edema signal intensity on fat-suppressed sequences was classified as severe in 92% of cases. The strength of pediatric knee ligaments and tendons relative to epiphyseal bone may contribute to a high rate of BME injury patterns seen on MRI in symptomatic pediatric patients. We found that pediatric BME could be classified into 6 specific injury patterns, which might be useful to clinicians in recognizing mechanisms of injury. Further clinical studies are needed to assess the clinical differences in both short-term and long-term outcomes of the BME patterns described.

PC26. PEDIATRIC DOG BITE INJURIES: A 5-YEAR NATIONWIDE STUDY OF OVER 56,000 PATIENTS

PUROPSE: Dog bites encompass a high percentage of pediatric ED visits, with little epidemiological data reported. This study aims to explore nationwide incidence of pediatric dog bites and assess risk factors for specific injury patterns. METHODS: A retrospective cohort study was conducted of pediatric dog bite injuries in the United States from 2015-2020 referencing the Pediatric Health Information System database. Patient characteristics, anatomic distributions, and intervention rates were analyzed. RESULTS: 56,106 patients were included, majority male (55.1%) with a median age 6.8 years. Incidence cycled seasonally, with peaks in July (median=1,217) and nadirs in February (median=760). A significant increase was seen per overall ED presentations during the COVID pandemic (p<0.05). The most common anatomic location of injury was the head (62.1%), followed by upper extremities (25.1%), with relative proportions varying with age. Overall, 8.0% patients required repair in the operating room. Injuries isolated to the head (OR=2.6, p<.001) and multiple anatomic regions (OR=2.6, p<.001) more likely required operative intervention. CONCLUSION: Incidence of pediatric dog bites remains high, with significant seasonal variability. Infants and toddlers disproportionately suffer injuries to the head and neck, with anatomic location of bites successively lower as children grow. The COVID pandemic ushered a spike in injuries, the cause of which is unknown and is difficult to discern from our data; nevertheless, new dog adoptions and prolonged human contact during quarantine are potential drivers.

POS-490 GLOMERULAR MICROANGIOPATHY ASSOCOATED WITH PROLONGED USE OF BEVACIZUMAB IN A PATIENT WITH RENAL-CELL CARCINOMA - CASE REPORT

Drug-induced thrombotic microangiopaty (TMA) known to be associated with the usage of the vascular endothelial growth factor inhibitors; since 2007, several cases of TMA, associated with bevacizumab, had been reported. In 2019, Person et al. described specific pattern of injury in 17 patients receiving bevacizumab, and introduced the term bevacizumab-associated glomerular microangiopathy instead of TMA; none on these patients had renal-cell carcinoma We present a case of glomerular microangiopathy, associated with prolonged bevacizumab treatment in a patient with renal-cell carcinoma 61 years old Caucasian female was referred for kidney biopsy. She underwent resection of her right kidney for the renal-cell carcinoma twice, and received bevacizumab for 8 years; 18 months before admission she developed new-onset arterial hypertension and nephrotic syndrome. At admission, she had general edema, her blood pressure was 200/100 mm Hg; the rest of her physical examination was unremarkable. Her urine protein excretion was 6400mg/24 hours with blunt urine sediment; hemoglobin was 10.4g/dL, platelet count was 322x109/L, ESR 59mL/min, serum creatinine 120µmol/L, total protein 5.4g/dL, serum albumin 2.4g/dL, LDH 224U/L. Other blood chemistry parameters, immunoglobulins, C3, C4 and CRP levels were normal. ECG, chest CT, kidneys and abdomen ultrasound showed nothing but right kidney postoperative changes and mild bilateral hydrothorax. Kidney biopsy light microscopy on paraffin-imbedded sections stained with haematoxylin-eosin, periodic acid-Schiff (PAS), Masson’s trichrome, and Jones silver found 10 sclerosed glomeruli, the rest 26 were enlarged, with lobular appearance, without hypercellularity or crescents. Most capillary lumens were widened, with single-contour capillary walls, lacking endothelial layer, and occupied with homogenous acellular mild eosinophilic, PAS negative, non-fuchsinophilic, Jones-negative coarse pseudothrombi (Figures 1, 2). Diffuse acute tubular epithelial injury with brush-border loss, without casts or interstitial fibrosis/tubular atrophy, and mild thickening of arterioles and small arteries due to muscular layer hypertrophy was found. Immunofluorescence on formalin fixed paraffin-embedded tissue with FITC-conjugated antibodies to human IgA, IgG, IgM, C1q, C3, fibrinogen, kappa and lambda light chains showed diffuse homogenous IgA, IgG, IgM, C1q, C3, fibrinogen, kappa and lambda +/++ expression in pseudothrombi. Based on the presence of pseudothrombi and absence of the TMA clinical features we diagnosed bevacizumab-associated glomerular microangiopathy, discontinued bevacizumab, and started ACE-inhibitors and aspirin with the outpatient follow-up. A month later, her edema resolved, blood pressure was 150/90 mm Hg, urine protein excretion was 780mg/24 hours, serum albumin 3.1g/dL, and serum creatinine 112µmol/L. A year later, she was doing well, without edema; her blood pressure was 130/80 mm Hg, hemoglobin 13.0g/dL, total protein 7.3g/dL, serum albumin 4.2g/dL, and serum creatinine 88µmol/LView Large Image Figure ViewerDownload Hi-res image Download (PPT) The patient treated with bevacizumab for 8 years developed bevacizumab-associated glomerular microangiopathy, which is an extremely rare complication in a renal-cell carcinoma setting. Withdrawn of bevacizumab lead to the resolution of clinical symptoms and restoration of kidney function

Imaging Review of Alpine Ski Injuries.

Skiing is a continuously evolving winter sport, responsible for a considerable number of musculoskeletal injuries. Specific injury patterns and mechanisms in the upper and lower extremities, head, and spine are influenced by skier expertise and skill, position during injury, and environmental conditions. Predilection for certain joints and injury patterns have changed over time, largely due to technological advancements in equipment, increased awareness campaigns, and preventive protocols. Knowledge and understanding of these trends and developments can aid the radiologist to reach a timely and accurate diagnosis, thereby guiding clinical management and potentially reducing the overall incidence of debilitation and death.

Octogenarian Motor Vehicle Collisions: Injury Patterns Matter.

IntroductionMotor vehicle collision (MVC) is the second most common mechanism of injury among octogenarians and is on the rise. These “oldest old” trauma patients have higher mortality rates than expected. This study examined potential factors influencing this increased mortality including comorbidities, medications, injury patterns, and hospital interventions.MethodsA 10-year retrospective review was conducted of patients aged 80 and over who were injured in an MVC. Data collected included patient demographics, comorbidities, medication use prior to injury, collision details, injury severity and patterns, hospitalization details, outcomes, and discharge disposition.ResultsA total of 239 octogenarian patients were identified who were involved in an MVC. Overall mortality was 18.8%. An increased mortality was noted for specific injury patterns, patients injured in a rural setting, and those who were transfused, intubated, or admitted to the ICU. No correlation was found between mortality and medications or comorbidities.ConclusionsThe high mortality rate for octogenarian patients involved in an MVC was related to injury severity, type of injury, and in-hospital complications, and not due to comorbidities and prior medications.

Overview on Causes, Diagnosis and Management of Knee Injuries in Children and Adolescents: Review Article

This review aimed to summarize the updates in the causes, diagnosis and management of knee injuries in children and adolescents. Knee injuries are common and are often the result of multiple forces: varus, valgus, hyperextension, hyperflexion, internal rotation, external rotation, anterior or posterior translation, and axial loading. Certain combinations of force are known to cause specific patterns of injury. A knee injury can affect any ligaments, tendons, or fluid-filled sacs (bursae) that surround the knee joint, as well fas the bones, cartilage, and ligaments that make up the joint itself. ACL injuries are one of the most common types of knee injuries, including a torn meniscus that is common in sports that require jumping jacks, patellar fractures, and knee bruises. Magnetic resonance imaging (MRI) is often used to more fully evaluate knee injuries. Radiologists can accurately identify individual lesions and combinations of lesions. Surgical and non-surgical treatments are performed depending on the case.

Hamstring injury patterns in professional male football (soccer): a systematic video analysis of 52 cases

ObjectiveTo closely describe the injury inciting events of acute hamstring injuries in professional male football (soccer) using systematic video analysis.MethodsVideo footage from four seasons (2014–2019) of the two highest divisions...

A natural history of efavirenz drug-induced liver injury.

Efavirenz (EFV), a non-nucleoside reverse transcriptase inhibitor, has been a component of first-line antiretroviral therapy (ART) in the South African HIV/AIDS programme since 2004. It is extensively used in ART programmes in other low- and middle-income countries. The natural history of the previously recognised EFV drug-induced liver injury (DILI) is not known. To define and establish a causality assessment for EFV DILI and document its natural history by detailing a patient cohort. All relevant features characterising the patterns of clinical and histological injury, the duration of clinical and biochemical recovery and the associated mortality rate were documented. Factors associated with specific histological patterns of liver injury were analysed. Patients were prospectively included after meeting causality and inclusion criteria for EFV DILI. Clinical, demographic and liver histological features (where possible) were documented from the time of presentation and throughout follow-up. Prednisone at 0.25 - 0.5mg/kg was initiated at the discretion of the treating hepatologist. Fifty patients were prospectively included in the analysis. The median age was 34 (interquartile range (IQR) 29 - 39) years, males being older than females (p=0.014). Most (92%) were female, and 86% were of black African ethnicity. The median duration of ART at presentation was 6 months, with half of the women having initiated ART during pregnancy, at a median gestation of 24 (IQR 11 - 36) weeks. The median CD4 nadir at ART treatment initiation was 517 cells/µL, with no significant difference in CD4 nadir between those who were pregnant and those who were not (p=0.6). The median RUCAM (Roussel Uclaf Causality Assessment Method) score was 7, and among the 75% of patients who had liver biopsies, three histological patterns were identified: submassive necrosis (60%), nonspecific hepatitis (35%), and mixed cholestatic hepatitis (5%). On multivariate analysis, predictors for the development of submassive necrosis included younger age (&lt;30 years; p=0.045), ART initiation in pregnancy (p=0.02), and a baseline CD4 count &gt;350 cells/µL (p=0.018). For the nonspecific hepatitis group, pregnancy was also an associated factor (p=0.04). The mortality rate was 14%, with a median time from admission to death of 15days. The median (IQR) time to initial hospital discharge was a lengthy 33 (24 - 52) days. Biochemical recovery was prolonged, necessitating a follow-up period of more than a year at an outpatient specialist clinic, with 86% of patients initiating a protease inhibitor-based ART regimen successfully. EFV DILI is a severe drug complication of ART with appreciable mortality and significant inpatient morbidity, requiring prolonged hospitalisation and follow-up.

Overuse Injuries in Teenagers

Overuse injuries in teenagers have increased in incidence in the past decades. Adequately diagnosing these injuries is a challenge (Figures 1 and 2), especially when unfamiliar with the specific overuse injury patterns and the development steps of the teenager musculoskeletal system. When considering overuse injuries in this population it is helpful to focus on two points or resemblance and dissemblance between teenagers and adults: Teenagers are the same as adults. Increasingly teenagers are exposed to a higher – more professional – level of sport activities. Likewise, the specific activities they have to perform for their specific sport are the same as in adults (Figures 3 and 4). Teenagers are not the same as adults. Their intrinsic biomechanics differ greatly from that of adults, with the growing (apo)physis as the most striking difference between both. Thus, the same specific activity result in different injuries (Figure 5). In this lecture, we will focus mainly on similarities between overuse injuries in different anatomical regions. How do these injuries relate to each other, considering their similarities in development and different types of stress? Could we use the basics of one type of overuse injury as a guideline for the other injuries?