Traffic Accident-related Injuries Research Articles

Household cost of road traffic accident-related injuries: A case study of St. Joseph Hospital, Koforidua in Ghana

Road traffic accidents (RTAs) are a prominent contributor to both mortality and morbidity, particularly affecting individuals aged 5–29 years. Road traffic Injuries impose substantial physical and economic burden on individuals, households, and governments, particularly in African nations. Thus, our study focuses on assessing the economic cost of road traffic accidents within the context of St. Joseph Hospital, Koforidua.A cross-sectional survey was conducted at the Emergency Unit of the St. Joseph Hospital with a sample size of 291 patients. A patient perspective was used in costing the management of RTAs. Data was descriptively analyzed with Microsoft Excel with means and standard deviations estimated for direct, indirect, and intangible costs to the patient.Total direct and indirect cost of road traffic accidents were approximately GHS1,973,801.28 (US$164,483.44) and GHS520,309.46 (US$43,359.12) respectively which represents 79.1 % and 20.9 % of the total cost. The annual average economic cost for all cases was GHS8,570.83 (US$714.24). Intangible costs were also found to be high, with 54.2 % patients rating their RTA burden to be between mild to moderate, 10.8 % as moderate to severe and 1.4 % as severe.RTA cost burden is huge for all households. Uninsured patients bear significantly higher costs than insured patients. Intangible costs were also high, prompting the need to provide psychological care to RTA victims and their families. Concerted efforts should be directed at strict enforcement, training, improvement of road infrastructure and legislation to reduce or curb road traffic accidents in LMICs.

The epidemiology of traumatic brain injuries in the fastest-paced city in China: a retrospective study.

Traumatic brain injury (TBI) seriously affects the quality of human health and the prognosis of the patient, but the epidemiological characteristics of TBI can vary among populations. Numerous changes have occurred in the epidemiological characteristics of individuals with TBI in the fast-paced city of Shenzhen, China. However, little is known about these characteristics. This study aimed to investigate the changes in TBI epidemiology, help clinicians improve medical treatment. In this retrospective cross-sectional analysis, we collected the data of 4,229 patients with TBI admitted to 20 hospitals in Shenzhen in 2017. We collected data on age, gender, cause and severity of the injury, eventual diagnosis, time from injury to admission in a neurosurgery department, and patient outcomes. Two neurosurgeons simultaneously collected the data. We compared these results with a similar study conducted in Shenzhen during the period from 1994 to 2003 to clarify and explain the changes in the epidemiological characteristics of TBI. The majority of respondents were men [2,830 (66.9%)]. The mean age was 32.5 ± 21.4 years. The youngest patient was less than 1 year old, and the oldest patient was 101 years old. A total of 3,947 (93.3%) patients had a favorable outcome, 219 (5.2%) had an unfavorable outcome, and 63 (1.5%) died. The predominant external cause was falls (1,779 [42.1%]); this was the most common cause of TBI in children and older adults. Riders of electric bicycles (423 [29.0%]) were the most vulnerable to traffic accident-related injuries. Time greater than 50 h from injury to admission to a neurosurgical department had a significant effect on prognosis (p < 0.001). The epidemiological characteristics of TBI have changed significantly over the past 20 years. Falls, rather than traffic accidents, were the most common cause of TBI. Further research is needed to devise solutions to decrease the incidence of falls and improve the outcomes of TBI.

Impact of lockdown policies during the COVID-19 outbreak on a trauma center of a tertiary hospital in China

Coronavirus disease 2019 (COVID-19) is a major and costly public health emergency. To investigate the impact of China's lockdown policies during the COVID-19 outbreak on the level I trauma center of a tertiary comprehensive hospital of Traditional Chinese Medicine. All patients admitted to our trauma center during a lockdown in 2020 and the same period in 2019 were enrolled. We collected data on demographics, daily visits, injury type, injury mechanism, injury severity score, and patient management for comparative analysis. The total number of patients in the trauma center of our hospital decreased by 50.38% during the COVID-19 Lockdown in 2020 compared to the same period in 2019. The average number of trauma visits per day in 2019 was 47.94, compared to 23.79 in 2020. Comparing the patients' demographic data, loss of employment was the most predominate characteristic in 2020 compared to 2019, while there was no significant difference in gender, age, and marital status between both periods. During the lockdown period, the proportion of traffic accident-related injuries, injuries due to falls greater than 1.5 m, and mechanical injuries decreased significantly, whereas the proportion of injuries caused by falls less than 1.5 m, cuts, assault, bites, and suicidal tendencies and other injuries increased relatively. In addition, the proportion of patients with minor injuries increased and serious injuries decreased during the lockdown. The hospitalization rate increased significantly, and there was no significant difference in emergency surgery and death rates. The lockdown policies during the COVID-19 outbreak significantly altered the number and mechanism of traumatic events in our hospital, which can be monitored regularly. Our results suggest that mandatory public health prevention and control measures by the government can reduce the incidence of traumatic events and the severity of traumatic injuries. Emergency surgery and mortality rates remain high, increased because of factors such as family injury and penetrating injury, and hospitalization rates have increased significantly. Therefore, our trauma center still needs to be fully staffed. Finally, from the perspective of the injury mechanism, indoor trauma is a major risk during a lockdown, and it is particularly important to develop prevention strategies for such trauma to reduce the medical burden of the next catastrophic epidemic.

Association of Blue Light–Filtering Intraocular Lenses With All-Cause and Traffic Accident–Related Injuries Among Patients Undergoing Bilateral Cataract Surgery in Finland

Blue light-filtering (BLF) intraocular lenses (IOLs) have been widely used in clinical practice for more than 20 years and have been implanted in millions of patients with cataracts worldwide. However, little evidence on the association of BLF IOLs with injuries is available. To assess the association of BLF IOLs with all-cause and traffic accident-related injuries and quality of vision while driving after bilateral cataract surgery. This retrospective registry-based cohort study included patients who underwent bilateral cataract surgery between September 3, 2007, and December 14, 2018, and were followed until December 14, 2021. Surgery was performed at the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. The 4986 participants received non-BLF IOLs (n = 2609) or BLF IOLs (n = 2377) in both eyes. Patients undergoing bilateral surgery between 2015 to 2016 with non-BLF IOLs (n = 102) or BLF IOLs (n = 91) and currently driving a car were interviewed using a structured questionnaire for visual performance while driving. Follow-up for a mean (SD) of 2166 (1110) days after second eye surgery. Kaplan-Meier and multivariable Cox proportional hazards regression analyses for the risk of all-cause and traffic accident-related injuries after surgery in the second eye obtained from the patient medical records were assessed. To improve follow-up precision, both death and the end of the follow-up were used as censoring events. A total of 4986 patients were included in the analysis (1707 [34.2%] men and 3279 [65.8%] women; mean [SD] age, 73.2 [8.6] years at the first surgery and 74.3 [8.8] years at the second). Injury-free survival rates preceding the first eye surgery were comparable between the non-BLF and BLF IOL groups (hazard ratio adjusted for age and sex, 0.95 [95% CI, 0.81-1.13; P = .57]). In multivariable Cox proportional hazards regression analysis controlling for age and sex, the use of BLF IOLs showed no advantage in overall injuries compared with the use of non-BLF IOLs (hazard ratio, 0.99 [95% CI, 0.88-1.11]; P = .85) or in any injury subtype. Subjective visual performance parameters for driving were all comparable between the non-BLF and BLF IOL groups except for glare when driving in the dark (evening or night), which occurred among 9 of 80 patients with BLF IOLs compared with 0 of 83 non-BLF IOLs (P < .001). The findings of this cohort study suggest that use of BLF IOLs was not associated with reduced risk of injuries, whereas glare during nighttime driving was significantly worse in the BLF IOL group with pseudophakia.

Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland.

AimsEurope has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-19 pandemic could overrun the Irish healthcare system. As such, the Irish government opted to introduce a national lockdown on the 27 March 2020 in an attempt to stem the flow of admissions to hospitals. Similar lockdowns in the UK and New Zealand have resulted in reduced emergency department presentations and trauma admissions. The aim of this study is to assess the effect of the national lockdown on trauma presentations to a model-3 hospital in Dublin, Ireland.MethodsA retrospective study was conducted. All emergency department presentations between 27 March 2019 to 27 April 2020 and 27 March 2020 to 27 April 2020 were cross-referenced against the National Integrated Medical Imaging System-Picture Archiving Communication System (NIMIS-PACS) radiology system to identify those with radiologically proven skeletal trauma. These patients were grouped according to sex, age, discharge outcome, mechanism of injury, and injury location.ResultsA 21% decrease in radiologically proven trauma was observed on comparison with the same time-period last year. Additionally, a 40% reduction in trauma admissions was observed during the COVID-19 lockdown. A 60% reduction in sports-related injuries and road traffic accident-related injuries was noted during the national lockdown. However, a 17% increase was observed in patients sustaining trauma because of domestic accidents.ConclusionVariation was observed in both the volume and nature of trauma presentations during the COVID-19 lockdown. As would be expected, a reduction was seen in the number of injuries resulting from outdoor activities. Interestingly, increased rates of domestic injuries were seen during this period which could represent an unintended consequence of the prolonged period of lockdown.Cite this article: Bone Joint Open 2020;1-6:261–266.

Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland

Aims Europe has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-19 pandemic could overrun the Irish healthcare system. As such, the Irish government opted to introduce a national lockdown on the 27 March 2020 in an attempt to stem the flow of admissions to hospitals. Similar lockdowns in the UK and New Zealand have resulted in reduced emergency department presentations and trauma admissions. The aim of this study is to assess the effect of the national lockdown on trauma presentations to a model-3 hospital in Dublin, Ireland. Methods A retrospective study was conducted. All emergency department presentations between 27 March 2019 to 27 April 2020 and 27 March 2020 to 27 April 2020 were cross-referenced against the National Integrated Medical Imaging System-Picture Archiving Communication System (NIMIS-PACS) radiology system to identify those with radiologically proven skeletal trauma. These patients were grouped according to sex, age, discharge outcome, mechanism of injury, and injury location. Results A 21% decrease in radiologically proven trauma was observed on comparison with the same time-period last year. Additionally, a 40% reduction in trauma admissions was observed during the COVID-19 lockdown. A 60% reduction in sports-related injuries and road traffic accident-related injuries was noted during the national lockdown. However, a 17% increase was observed in patients sustaining trauma because of domestic accidents. Conclusion Variation was observed in both the volume and nature of trauma presentations during the COVID-19 lockdown. As would be expected, a reduction was seen in the number of injuries resulting from outdoor activities. Interestingly, increased rates of domestic injuries were seen during this period which could represent an unintended consequence of the prolonged period of lockdown. Cite this article: Bone Joint Open 2020;1-6:261–266.

Evaluation of the Single-Dose Toxicity of TA Pharmacopuncture in Rats.

ObjectivesTA is a polyherbal extract comprising seven herbs, typically used for the pharmacopuncture treatment of patients with traffic accident-related injuries and musculoskeletal diseases. This animal study was conducted to evaluate the safety of the TA extract, using a single-dose toxicity test.MethodsThe dose range and sampling time were first established. Six-week-old Sprague–Dawley rats were administered 1.0 mL of TA or normal saline (control), intramuscularly, for the single-dose toxicity test. The general condition, mortality, and histology of all rats were observed for 2 weeks.ResultsNo abnormal symptoms or deaths were observed in any group. The body weights of the rats in the TA and control groups were similar. No significant differences in histopathology were observed between the groups.ConclusionOur study indicates that 1.0 mL of TA extract may be safely administered for pharmacopuncture for treatment of patients in traditional medicine clinics.

Magnitude of road traffic accident related injuries and fatalities in Ethiopia

BackgroundIn many developing countries there is paucity of evidence regarding the epidemiology of road traffic accidents (RTAs). The study determines the rates of injuries and fatalities associated with RTAs in Ethiopia based on the data of a recent national survey.MethodsThe study is based on the secondary data of the Ethiopian Demographic and Health Survey conducted in 2016. The survey collected information about occurrence injuries and accidents including RTAs in the past 12 months among 75,271 members of 16,650 households. Households were selected from nine regions and two city administrations of Ethiopia using stratified cluster sampling procedure.ResultsOf the 75,271 household members enumerated, 123 encountered RTAs in the reference period and rate of RTA-related injury was 163 (95% confidence interval (CI): 136–195) per 100,000 population. Of the 123 causalities, 28 were fatal, making the fatality rate 37 (95% CI: 25–54) per 100,000 population. The RTA-related injuries and fatalities per 100,000 motor vehicles were estimated as 21,681 (95% CI: 18,090–25,938) and 4,922 (95% CI: 3325–7183), respectively. Next to accidental falls, RTAs were the second most common form of accidents and injuries accounting for 22.8% of all such incidents. RTAs contributed to 43.8% of all fatalities secondary to accidents and injuries. Among RTA causalities, 21.9% were drivers, 35.0% were passenger vehicle occupants and 36.0% were vulnerable road users including: motorcyclists (21.0%), pedestrians (12.1%) and cyclists (2.9%). Approximately half (47.1%) of the causalities were between 15–29 years of age and 15.3% were either minors younger than 15 years or seniors older than 64 years of age. Nearly two-thirds (65.0%) of the victims were males.ConclusionRTA-related causalities are extremely high in Ethiopia. Male young adults and vulnerable road users are at increased risk of RTAs. There is a urgent need for bringing road safety to the country's public health agenda.

Epidemiology of Pediatric Musculoskeletal Injuries and Their Pattern in a Tertiary Care Center of North India.

Background:Trauma is emerging as an epidemic and a leading cause of morbidity and mortality in children. Children <15 years of age comprise about 32.8% or about 1/3rd of the total Indian population. In India, up to one fourth of hospital admissions and approximately 15% of deaths in children are due to injury. This study presents the epidemiology, various causes and pattern of musculoskeletal injuries in pediatric population of North India.Materials and Methods:This is an observational, prospective hospital-based study conducted in a tertiary care center of North India for 6 months from July to December 2016. All pediatric patients in the age group 0-15 years who presented to the orthopedic emergency and out patient department with a history of trauma were included in the study.Results:Children aged 6-15 years (58%) suffered more injuries than children under 5 years of age (42%). Male pediatric population (58.5%) had more musculoskeletal injuries as compared to female pediatric population of the same age group (41.5%) in both the groups. Urban pediatric population (68.78%) suffered more injuries as compared to rural population of the same age group. Right extremities were more commonly involved in both the age groups. Upper limb injuries (50.59% in 0-5 years age group and 47.42% in 6- 15 years age group) were most common followed by lower limb and pelvic injuries. Very few (2.9% in 0- 5 years age group and 4.8% in 6-15 years age group) patients sustained isolated spinal injuries. Out of the 3712 patients 59.40% of patients had a history of fall, followed by road traffic accident related injuries (32%). The most common injuries were superficial injuries i.e., abrasions and bruises. The second most common injury was cut or open wounds mostly seen on hand, forearm and legs.Conclusion:The high incidence of pediatric trauma on roads and falls indicates the need for more supervision during playing and identification of specific risk factors for these injuries in our setting. Injuries in pediatric age group by and large is a preventable condition. Therefore, injury prevention in children should be a priority.

Cost for traffic accident related injuries and its comparison it with the national standard: A case study in Iran

Introduction: Since the World Health Organization (WHO) has emphasized the importance of estimating the economic costs and traffic-related injuries the society as well as their roles in the analysis of cost efficiency; traffic-related accidents toll estimation has risen as one of the main concerns of the WHO.Materials and methods: This analytical, descriptive study is an applied research conducted in 2015 in Isfahan province. Among the 35 educational health centers and hospitals in Isfahan, 19 hospitals were selected randomly according to the type of the centers. Information was gathered using traffic accidents system and imported into the Microsoft Excel software. In a country standard, the cost for each patient in traffic accident by NO. 400/11607, dated 9/7/2016 has announced from the Ministry of Health and Medical Education to the Isfahan University of Medical Sciences.Results: The highest average spending per injured patient is in the Imam Musa Kazim hospital, and lowest average spending per patient can be seen in the hospital Behnia Tiran. (Please elaborate more information in this section) Discussion and Conclusion: Imam Musa Kazem and Imam Hussein Children’s Teaching Hospital including: the high average of staying patients, type and cost of equipment in Al Zahra educational health treatment center, the consuming prostheses and the utilization of capital equipment such as CT scan machine Multi 64 makes to increase the average cost of a patient in centers compared to other health centers. On the other hand, the cost of accidental outpatients is not registered in the system, so these factors make the average cost of hospitals higher than country standard.

Traffic accident-related injuries in horses

Horses involved in road traffic accidents (RTAs) are commonly presented to veterinarians with varying types of injuries. The aim of this study was describe the pattern and severity of traffic accident-related injuries in horses in a single hospital population. Medical records of horses either hit by a motorized vehicle or involved in RTAs whilst being transported from 1993 to 2015 were retrospectively reviewed and the following data was extracted: Signalement, hospitalisation time, month in which the accident happened, cause of the accident, place of the accident and type of vehicle hitting the horse. Further the different body sites injured (head, neck, breast, fore limb, abdomen, back and spine, pelvis and ileosacral region, hind limb, tail and genital region), the type of injury (wounds, musculoskeletal lesions and internal lesions) and the presence of neurological signs were retrieved from the medical records. 34 horses hit by motorized vehicles and 13 horses involved in RTAs whilst being transported were included in the study. Most of the accidents where horses were hit by motorized vehicles occurred during December (14.7%) and October (14.7%), horses were most commonly hit by cars (85.3%) and the majority of accidents occurred on main roads (26.5%). In 29.4% of the cases, horses had escaped from their paddock and then collided with a motorized vehicle. Most of the accidents with horses involved in RTAs whilst being transported occurred during April (30.8%) and June (23.1%). In 76.9% of the cases the accident happened on a freeway. In the horses hit by motorized vehicles the proximal hind limbs were the body site most commonly affected (44.1%), followed by the proximal front limbs (38.2%) and the head (32.4%). When horses were involved in RTAs whilst being transported the proximal fore limbs (61.5%), the proximal hind limbs (53.8%) and the distal hind limbs, back and head (38.5% each) were the most common injured body sites. Wounds were the most common type of injury in both groups(85.3% hit by motorized vehicle, 76.9% transported ones). In horses hit by a motorized vehicle 35.3% suffered from fractures, in 20.6% a synovial structure was involved and in 5.9% a tendon lesion was present. 14.7% suffered from internal lesions and 14.7% showed neurologic symptoms (40% peripheral, 60% central neurologic deficits). On the other hand, in horses involved in a RTA whilst being transported 30.8% suffered from fractures. There were no synovial structures injured and no tendon injuries were present. Furthermore there were no internal lesions present and only one horse involved in a RTA showed central neurologic symptoms. Injuries of horses being hit by a motorized vehicle were more severe than when horses were protected by a trailer and involved in an RTA whilst being transported. The study has been able to identify the different injury types of traffic accident-related injuries in horses. Awareness of the nature of these injuries is important, to avoid underestimation of their severity.

Epidemiological characteristics of hospital reported road traffic injuries case in Tianjin, 2013

To understand the distribution of reported road traffic injuries case in Tianjin from January to December 2013. The injury data was collected from the disease surveillance system which covered all the areas in Tianjin. All the reported injury cases were at their first medical care seeking in sentinel hospitals from 1 January 2013 to 31 December 2013. A total of 26 405 injury cases were reported, including 103 deaths (0.4%), during this period with the incidence of 263.01/100 000. The male to female ratio of the cases was 1.68: 1 and average age of the cases was (40.24 ± 17.58) years. The injuries caused by motor vehicle traffic accident accounted for 74.0% (19 547 cases) and the non-motor vehicle traffic accident caused cases accounted for 26.0% (6 858). The first four areas with higher incidence were Binhai (684.86/100 000) , Dongli (634.03/100 000) , Xiqing (519.83/100 000) and Jinnan (504.12/100 000) districts. The three districts with lower incidence were Heping (44.69/100 000), Nankai (52.36/100 000) and Hedong (64.34/100 000) districts. The mild, moderate and serious cases accounted for 59.7% (15 771 cases), 33.1% (8 747 cases) and 6.8% (1 783 cases) respectively. The differences in incidence among different districts and age groups were statistical significant (P<0.005). The death number in Tanggu district was highest, accounting for (26.21%) of the total, and age specific death number was highest in age group 45-64 years, accounting for 46.60% of the total. The case number and severity of road traffic accident caused injury varied with area and age group in Tianjin. It is necessary to develop targeted prevention and control measures to reduce the incidence of road traffic accident related injuries.

Gender-related differences in distances travelled, driving behaviour and traffic accidents among university students

Although mortality from traffic accident-related injuries is known to be higher in males especially among young drivers, the influence of gender on each link in the causal chain that leads to this outcome is not well understood, particularly in Spain. The aim of this study was to analyse gender-related differences in distances travelled, driving behaviour and the frequency of involvement in traffic accidents in a sample of undergraduate students at the University of Granada.This cross-sectional study involved a sample of 1574 students recruited during three consecutive academic years from 2007–2008 to 2009–2010 who agreed to complete a questionnaire which evaluated patterns in distances travelled, use of safety devices, risky driving behaviours and involvement in traffic accidents.The results showed that men drove more kilometres than women, and described themselves as better and faster drivers than women. Male drivers used all safety devices less frequently than women, and were involved in risky driving behaviours more often. Although the crude analysis showed no differences between genders in reported accidents, the adjusted analysis showed a trend for men to report accidents less frequently than women.

Incidences, Types, and Influencing Factors of Snow Disaster–Associated Injuries in Ningbo, China, 2008

The incidence, types, and influencing factors of injuries due to snow-ice disasters are essential for public health preparedness. This study was designed to assess such factors of injuries during the 22-day snowstorm in Ningbo, Zhejiang Province, China, in 2008. A multistage cluster probability sampling method was applied to select the study population in urban, rural, and mountainous areas. Data including sociodemographic characteristics, frequency, and types of injuries during the snowstorm between January 20 and February 10, 2008, were obtained by face-to-face interviews using a structured questionnaire and by checking the participants' medical records. Univariate and multivariate regression analyses were used to determine the factors significantly associated with the risk of injuries. A total of 3169 residents of 1416 families took part in this survey. In 581 residents, 602 injuries were identified. Incidences of frostbite, falling injury, and traffic accident-related injury were 12.78%, 5.30%, and 0.50%, respectively. Injury occurred more frequently in women than in men (odds ratio [OR], 1.42; 95% CI, 1.19-1.70). Frostbite occurred more frequently in women than in men (adjusted OR, 1.86; 95% CI, 1.43-2.41) and more frequently in urban areas than in other areas (adjusted OR, 1.65; 95% CI, 1.24-2.20). Travel by bus or car, wearing a scarf, wearing gloves, wearing a raincoat, reducing outdoor activity, and performing regular physical exercise were independent protective factors of frostbite, with an adjusted OR (95% CI) of 0.35 (0.20-0.61), 0.45 (0.33-0.62), 0.35 (0.26-0.48), 0.45 (0.33-0.61), 0.36 (0.27-0.48), and 0.18 (0.13-0.24), respectively. Falling injury occurred more often in mountainous areas than in other areas (adjusted OR, 1.74; 95% CI, 1.27-2.42). Age 45 years or older, working outside more than 15 days, and wearing a raincoat were independent risk factors of falling injury, with an adjusted OR (95% CI) of 2.30 (1.60-3.32), 1.92 (1.36-2.72), and 2.21 (1.56-3.11), respectively. Falling and traffic accident-related injuries were mainly due to slippery roads. Frostbite and falling injury were the major injuries caused by an unprecedented snow-ice disaster. Keeping warm and maintaining regular physical exercise appeared to reduce frostbite risk. Public health intervention also reduced the risk of falling and traffic accident-related injuries.

Trend Reversal in Lake Michigan Contribution to Snowfall

AbstractOne of the most notable ways the Laurentian Great Lakes impact the region’s climate is by augmenting snowfall in downwind locations during autumn and winter months. Among many negative consequences, this surplus of snow can cause substantial property damage to homes and can escalate the number of traffic accident–related injuries and fatalities. The consensus among several previous studies is that lake-effect snowfall increased during the twentieth century in various locations in the Great Lakes region. The goal of this study is to better understand variability and long-term trends in Lake Michigan’s lake-contribution snowfall (LCS). LCS accounts for both lake-effect and lake-enhanced events. In addition, this study updates findings from previous investigations using snowfall observations found by a recent study to be appropriate for climate studies. It is demonstrated that considerable variability exists in 5-yr periods of LCS east and south of Lake Michigan from 1920 to 2005. A general increase in LCS from the early 1920s to the 1950–80 period at locations typically downwind of the lake was found. Thereafter, LCS decreased through the early 2000s, indicating a distinct trend reversal that is not reported by earlier studies. The reasons for this reversal are unclear. The reversal is consistent with observed increasing minimum temperatures during winter months after the 1970s, however.

The value of postmortem computed tomography in trauma victims with traffic accident-related injuries

The value of postmortem computed tomography in trauma victims with traffic accident-related injuries

Full-Thickness Skin Grafts: Maximizing Graft Take Using Negative Pressure Dressings to Prepare the Graft Bed

Full thickness skin grafts (FTSGs) remain a good option for resurfacing defects of the face, neck, and dorsum of the feet. It results in soft, pliable, functional skin with minimal contraction. However, FTSG may result in patchy or irregular "take" resulting in recurrent contractures and pigmentary discrepancies. This study examines the use of a negative pressure dressing (NPD) to increase FTSG take. Wounds resulting from trauma, postburn contracture release, and an excision of a congenital nevus were included in the study. The wounds were prepared by surgical excision or debridement. A NPD was then applied for a period of 7 days, at which time the wounds were inspected and, if there was sufficient granulation tissue, covered with a FTSG. If the wound had not yet granulated sufficiently another NPD was placed and reassessed in 7 days. The FTSGs were harvested from the groin and abdominal area exactly to the size of the defect. A sponge bolster dressing was then applied. The take of the FTSG was judged using a grid of 1 x 1-cm squares. The wounds were measured and the amount of graft take was calculated as a percentage of the wound size. Complications in both the wound as well as the donor sites were noted. Twenty-four patients were included in the study. The mean age was 6 years (range 1-14 years), including 9 burn contracture excisions, 14 road traffic accident-related injuries, and 1 excision of a congenital nevus. The site involved was the foot (6 patients), ankle (9 patients), axilla (2 patients), forearm (4 patients), face (2 patients), and the neck (1 patient). The average surface area of the defect was 78 cm2 (range 18-264 cm2). Groin skin was harvested in all the cases. The NPD was applied on average for 8 days (range 7-15 days). The mean graft take was 95% (range 70%-100%). Only 1 patient had significant graft loss of 30%. Donor site morbidity was low, attaining primary closure in all but 2. Mean follow-up was 9 months. The results of this study confirm that the use of NPD enhances FTSG take.