Injury Victims Research Articles

Epidemiological pattern of injuries among road traffic crash victims: the first experience of a large tertiary care hospital in the West Bank of Palestine

BackgroundRoad traffic injuries are a global public health challenge. This study was conducted to describe the epidemiological patterns of road traffic injuries in a large tertiary care hospital in the West Bank of Palestine. In addition, associations between the different variables of the victims and the patterns of road traffic injuries were also assessed.MethodsThis study was conducted in a retrospective cohort observational design between January 2021 and July 2023 at a large tertiary care hospital in Nablus, Palestine. The data were collected from the electronic medical record system of the large tertiary care hospital using a data collection form.ResultsA total of 1,544 victims of traffic road injuries were included in this study. Lower limb (43.0%), neck (41.2), and upper limb (39.8%) injuries were the most common types of road traffic injuries sustained by the victims admitted to the large tertiary care hospital.The victims who were 30 years or older were more likely to sustain back injuries (aOR = 1.71, 95% CI: 1.20–2.45) pelvic injuries (aOR = 1.84, 95% CI: 1.08–3.12), chest injuries (aOR = 1.59, 95% CI: 1.06–2.38), and neck injuries (aOR = 2.54, 95% CI: 1.68–3.82) compared to the victims who were younger than 30 years.The victims who did not use seatbelts were more likely to sustain abdominal injuries (aOR = 1.88, 95% CI: 1.34–2.63) and head injuries (aOR = 1.49, 95% CI: 1.06–2.10) compared to the victims who used seatbelts. The victims who did not have the airbag deployed were more likely (aOR = 1.85, 95% CI: 1.31–2.63) to sustain neck injuries compared to the victims who had the airbag deployed.ConclusionThe epidemiological patterns of road traffic injuries in a large tertiary care hospital in Nablus, Palestine were described and the associations between the different variables of the victims and the patterns of road traffic injuries were assessed. The findings indicated a need to design measures to prevent/minimize these injuries. Future studies are still needed to determine the best measures to avoid/minimize the incidence of serious road traffic injuries.

The influence of intermittent venovenous hemodiafiltration on the course of acute kidney injury in multiple trauma victims

Background. Acute kidney injury (AKI) is a common complication of polytrauma that requires renal replacement therapy (RRT) in 10 to 28 % of cases. RRT methods can be divided into discrete, or intermittent, and continuous. There are currently no clear recommendations regarding the choice of the RRT method. The purpose was to study the effect of intermittent venovenous hemodiafiltration (HDF) on indicators of renal function, hemodynamics, homeostasis and inflammation in multiple trauma victims with rhabdomyolysis and AKI. Materials and methods. Fifty victims with multiple trauma complicated by rhabdomyolysis and AKI were examined. We investigated the levels of total creatine kinase and myoglobin, indicators of kidney function, frequency of vasopressor support, indicators of general blood analysis, liver complex, coagulogram, acid-base and gas composition of blood. The study was conducted upon admission, before the start and after the end of each HDF session and on the last day of treatment. Results. Multiple trauma with massive rhabdomyolysis led to AKI, manifested by oliguria and hyperazotemia (and from the 3rd day, by hyperkalemia), as well as cardiovascular failure, anemia, liver dysfunction, and inflammatory response. AKI progression to renal failure despite conservative therapy led to the beginning of HDF on 3.6 ± 0.8 days of hospital stay. HDF allowed to effectively reduce indicators of the renal complex and normalize the potassium level, and at the same time did not have a negative effect on hemostasis or other indicators of homeostasis. 72.9 % of victims needed two HDF sessions, 47.9 % — three, 31.3 % — four or more. The most pronounced reduction of hyperazotemia was observed after the second session. Among the survivors, restoration of adequate diuresis by the day 14 was observed in 39.3 % of cases. The mortality rate was 34.0 %. Laboratory markers of renal function were not significantly different between survivors and deceased; the difference was in markers of liver function, coagulogram and acid-base balance, as well as the need for vasopressor support. That is, the mortality was due to the progression not so much of kidney failure, but of the failure of other organs and systems. It should also be noted that the injury severity score among survivors was 23.5 ± 4.0 points, and among non-survivors — 40.5 ± 6.8 points (p < 0.001). Conclusions. Multiple trauma with massive rhabdomyolysis leads to the development of multiple organ failure. Intermittent HDF allows to quickly and effectively reduce azotemia and normalize potassium levels without adversely affecting coagulation or other indicators of homeostasis. Most multiple trauma victims need 2 or more sessions of HDF. Mortality remains high and primarily depends on the severity of anatomical injuries and the addition of other organs and systems failure.

Unmet Needs, Pain, Shame, Regret, and Loss of Identity among Men with Urethral Injuries Resulting from Traffic Accidents; A Qualitative Study.

Urethral injuries are the most severe injuries caused by high-energy mechanisms such as traffic accidents, which have significant long-term serious consequences on the quality of life of the injured. Exploration of lived experiences of urethral injury in traffic accident victims is the main goal of this study. This is a phenomenological qualitative study among men suffering from urethral injuries due to traffic accidents and referred to hospitals for urethroplasty in Iran. Sixteen in-depth interviews were conducted with 15-59-year-old injured men from August 2022 to May 2023 using a semi-structured questionnaire at Shohada Hospital, considering maximum variation and achieving saturation. For data analysis, Colizzi's analysis method was implemented in MaxQDA2020. Lincoln's and Guba's criteria were assessed to achieve the trustworthiness of the study. Five main themes emerged from the interviews: Urethral Injury resulting from traffic accidents as a Complex, Unknown Problem with a general lack of public awareness, Unpleasant Experience with Permanent Suffering from pain, shame, regret, isolation, Urethral Injury Causes Regret and Loss of Normalcy, Impact on Sexual and Social Identity, and its long-term consequences as neglected health and socio-economic issues are the unmet needs of the injured patients. The majority of expressions related to low public awareness and poor infrastructure. There are needs neglected by public services, especially health care services. Alongside wresting with these issues, considering policies to support this vulnerable people, and their well-being, quality of life and prevent further damage in terms of physical, social and mental health is an axiom.

A glucocorticoid spike derails muscle repair to heterotopic ossification after spinal cord injury.

Why severe injury to the central nervous system (CNS) triggers the development of large neurogenic heterotopic ossifications (NHOs) within periarticular muscles remains unknown. We report that spinal cord injury (SCI) triggers a rapid corticosterone spike in mice, which is causal for NHO development because treatments with corticosterone or the synthetic glucocorticoid (GC) receptor (GR) agonist dexamethasone are sufficient to trigger heterotopic ossification and upregulate the expression of osteoinductive and osteogenic differentiation genes in injured muscles even without SCI. The central role for GR signaling in causing NHO is further demonstrated in mice deleted for the GR gene (Nr3c1), which no longer develop NHO after SCI. Furthermore, administration of clinical GR antagonists inhibits NHO development in mice with SCI. This study identifies endogenous GC as causing pathological NHO after CNS injury and suggests that GR antagonists may be of prophylactic use to prevent NHO development in victims of severe CNS injuries.

Incidence of cervical spine injury in victims of dismounted blast: a systematic review

IntroductionDismounted blast has the potential to cause life-threatening injuries to multiple simultaneous casualties, including injury to the cervical spine (c-spine). Spinal immobilisation can be costly in terms of time and...

Localization of a Bullet in a Firearm Injury Victim Using X-ray Imaging During Autopsy: A Case Report

Firearm injuries can result in varying degrees of trauma, depending on factors such as the type of firearm, range, and wound location. This case report presents the role of X-ray imaging in detecting a projectile causing fatal penetrating abdominal trauma in a 45-year-old male. The patient was found with a gunshot wound in his abdomen, and despite medical interventions, he succumbed to his injuries. X-ray imaging revealed a hyper-dense area resembling a bullet lodged in the abdominal cavity. Autopsy confirmed a close-range gunshot with significant internal damage to the peritoneum, mesentery, liver, and the bullet lodged near the L1 vertebra. This case underscores the value of radiological imaging in identifying projectile trajectory and injury severity, particularly in resource-limited settings. X-rays assist in distinguishing between penetrating and perforating wounds, aiding both forensic investigation and legal procedures. The integration of imaging in forensic autopsies improves the accuracy of injury assessment, especially in cases involving gunshot wounds.

Clinical and radiological profile of cervical spine injuries in maxillofacial trauma patients reporting to a tertiary trauma centre in central Kerala

The aim of the study was to determine the clinical and radiological profile of patients with cervical spine injuries in maxillofacial trauma patients following road traffic accidents in central Kerala. Percentage of cervical spine injuries associated with maxillofacial injuries, age and sex distribution, frequency of the type of cervical spine injury were studied. A descriptive cross sectional study was conducted on two hundred and fifty patients with maxillofacial trauma who reported to the Department Of Oral and Maxillofacial surgery, Government Dental College, Kottayam between July 2023 and June 2024 and who gave the consent for the study.Clinical evaluation of cervical spine was undertaken as the part of the initial assessment of all trauma patients. Neck pain was assessed with visual analog scale of 1-10 and altered sensations in upper limbs were evaluated. Lateral neck x-ray was taken to rule out cervical injury in all patients without C.T scan. The data was entered into MS excel spread sheet and analysed using SPSS version 20. Proportions were used to study categorical variables, mean and standard deviation were used for quantitative variables. Chi square test was used to test the difference in proportions of categorical variables. p values less than 0.05 was considered statistically significant in the data. The study has shown that there is a statistically significant occurrence of cervical spine injuries in maxillofacial trauma victims in road traffic accidents. The presence of maxillofacial trauma with cervical spine injury mandates prompt management with immediate reference to neurosurgeon to reduce morbidity.

Study of Pattern of Craniofacial Injuries in Road Traffic Accident Cases Autopsied in Midnapore Medical College

Background: The objective of this study was to investigate the pattern of craniofacial injuries in victims of fatal road traffic accidents, observed through autopsies conducted at Midnapore Medical College, West Midnapore from January 2021 to December 2023. Methods: It is a retrospective, cross- sectional observational study. Data was collected by thorough analysis of the injuries documented in post-mortem reports of all the alleged road traffic accident cases where victim sustained Cranio- facial injuries within a time span of 3 years, from 1st January 2021 to 31st December, 2023. Data was analysed using Microsoft Excel. Conclusion: The study highlights the necessity of context-specific interventions to address the unique injury patterns observed in West Midnapore's road traffic accidents. Improving road infrastructure, raising traffic safety awareness, and promoting protective measures like seat belts and helmets can reduce severe craniofacial injuries. The prevalence of maxillofacial fractures underscores the face's vulnerability, with long-term physical and psychological impacts. Effective prevention strategies, such as strict traffic regulations and awareness campaigns on the dangers of distracted or impaired driving, are essential. Despite limitations, the study provides valuable insights into craniofacial injury patterns in fatal accidents, stressing the need for enhanced road safety, stronger traffic laws, and better post-accident care. Interdisciplinary collaboration among healthcare professionals, law enforcement, and policymakers is crucial for developing comprehensive strategies to manage and prevent these injuries. By examining regional injury characteristics and comparing them with other studies, this research contributes to the broader understanding of craniofacial trauma, offering significant implications for improving road safety, trauma care, and forensic practices.

Traumatic brain injuries: a neuropsychological review.

The best predictor of functional outcome in victims of traumatic brain injury (TBI) is a neuropsychological evaluation. An exponential growth of research into TBI has focused on diagnosis and treatment. Extant literature lacks a comprehensive neuropsychological review that is simultaneously scholarly and practical. In response, our group included, and went beyond a general overview of TBI's, which commonly include definition, types, severity, and pathophysiology. We incorporate reasons behind the use of particular neuroimaging techniques, as well as the most recent findings on common neuropsychological assessments conducted in TBI cases, and their relationship to outcome. In addition, we include tables outlining estimated recovery trajectories of different age groups, their risk factors and we encompass phenomenological studies, further covering the range of existing-promising tools for cognitive rehabilitation/remediation purposes. Finally, we highlight gaps in current research and directions that would be beneficial to pursue.

Analysis of oral and maxillofacial injuries in women victims of domestic violence

Analysis of oral and maxillofacial injuries in women victims of domestic violence

Internal blood loss in fatal liver lacerations - determining lethality from relative blood loss.

Certificates of medical evidence are often used to aid the court in assessing the cause and severity of a victim's injuries. In cases with significant blood loss, the question whether the bleeding itself was life-threatening sometimes arises. To answer this, the volume classification of hypovolemic shock described in ATLS® is commonly used as an aid, where a relative blood loss > 30% is considered life-threatening. In a recent study of deaths due to internal haemorrhage, many cases had a relative blood loss < 30%. However, many included cases had injuries which could presumably cause deaths via other mechanisms, making the interpretation uncertain. To resolve remaining ambiguity, we studied whether deaths due to isolated liver lacerations had a relative blood loss < 30%, a cause of death where the mechanism of death is presumably exsanguination only. Using the National Board of Forensic Medicine autopsy database, we identified all adult decedents, who had undergone a medico-legal autopsy 2001-2021 (n = 105 952), where liver laceration was registered as the underlying cause of death (n = 102). Cases where death resulted from a combination of also other injuries (n = 79), and cases that had received hospital care, were excluded (n = 4), leaving 19 cases. The proportion of internal haemorrhage to calculated total blood volume in these fatal pure exsanguinations ranged from 12 to 52%, with 63% of cases having a proportion < 30%. Our results lend further support to the claim that the volume classification of hypovolemic shock described in ATLS® is inappropriate for assessing the degree of life-threatening haemorrhage in medico-legal cases.

Anxiety-like Characteristics, Forepaw Thermal Sensitivity Changes and Glial Alterations 1 Month After Repetitive Blast Traumatic Brain Injury in Male Rats.

Many military service members are victims of repetitive blast traumatic brain injuries (rbTBI) and endure diverse altered psychological and behavioural conditions during their lifetime. Some of these conditions include anxiety, post-traumatic stress and pain. Thus, this study attempts to fill the knowledge gap on enduring behavioural and neuroinflammatory marker alterations 1 month after rbTBI. Although previous rbTBI animal studies have shown behavioural and histopathological changes either a few days (acute) or many months (chronic) after trauma, knowledge related to post-traumatic changes during the intermediate timeframe, i.e. a month after rbTBI is less clear or unavailable. Sprague-Dawley rats (male; n = 12) were assigned to either rbTBI or sham conditions. Animals assigned to the rbTBI group were subjected to 1 blast exposure per day for three consecutive days, while animals in the sham group were exposed to identical experimental conditions sans blast exposure. All animals were tested for anxiety at baseline. 30 days post-injury, animals were tested again for anxiety and paw thermal sensitivity, followed by brain harvest for immunohistochemical analyses. Animals exposed to rbTBI showed signs of anxiety-like behaviour on parameters of elevated plus-maze and behavioural signs of pain indicated by reduced thermal withdrawal latency of the forepaw. Histologically, brain sections from animals exposed to rbTBI showed a significantly increased number of microglial/macrophage and astrocytic counts in the medial prefrontal cortex. Data from this initial preclinical study support the prevalence of putative anxiety-like behaviour, enhancement in forepaw thermal sensitivity and increase in the number of glial cells even 1 month after rbTBI. These findings have potential implications in the treatment evaluation of blast-exposed military and civilian populations and emphasise the need for devising protective measures for people susceptible to single or repeated exposures. A greater further understanding of rbTBI-related chronic concurrent behavioural and neuropathological sequela is warranted.

(Post-)Colonial Violence: Ripper Street and Moral Injury

The period crime drama Ripper Street (BBC/multiple production partners, 2012–2016) engages in a variety of postcolonial sociocultural critiques. One of these areas of critique includes the moral injury/-ies suffered by Sergeant (later Inspector) Bennet Drake (played by Jerome Flynn), who served in Sudan and Egypt as part of the colonial military before becoming a police officer. Often called upon to engage in what would now be considered police brutality, Drake’s increasingly ambivalent relationship to violence, those who command (or have commanded) him, and the expressions of shame and self-harm he exhibits make him a clear victim of moral injury. This article will explore how Drake is represented, and also how he is representative of returning soldiers, contextualised in both colonial (contemporary to the period in which the series is set) and postcolonial (contemporary to the period in which it was filmed) critique.

Intergenerational Childhood Exposure to Intimate Partner Violence, Maternal Psychological Distress, and Physical Injury Victimization in Emerging Adults

Intergenerational Childhood Exposure to Intimate Partner Violence, Maternal Psychological Distress, and Physical Injury Victimization in Emerging Adults

Prehospital Care for Road Traffic Injury Victims.

Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most low- and middle-income countries. This study aims to describe the prehospital care received by the road traffic injury (RTI) victims presenting to a level I Trauma Care Center in Central Kerala, India. This was a hospital-based prospective observational study, which included consecutive victims of RTI attending the emergency department within 24-h of the event. A structured interview schedule was developed for collecting the data on various domains and the patients were followed up for their duration of hospital stay. A total of 920 RTI victims, were included in this study. Two percent (17/920) of first responders had some sort of training in trauma care whereas the rest were untrained. The time taken to get any help at the scene after an RTI was 8 ± 12.9 min (95% confidence interval [CI] 7.16-8.84) and for first medical contact 25 ± 16 min (95% CI 24-26). No attempt at field stabilization occurred in any case. Three percent (26/920) had received some form of prehospital care, like arrest of hemorrhage using a compression bandage and splinting of the fractured limb with a wooden plank. None of the patients received supplemental oxygen, airway management, or cervical spine immobilization at the site of the accident or en route to the hospital. A lack of an organized prehospital care system results in minimal care before hospital admission. Urgent establishment of ambulance services and structured prehospital care tailored to our health-care system is imperative.

Retrospective analysis of nonfatal skeletal injuries sustained in road incidents involving electric scooters

BACKGROUND: Although scooters were officially recognized as vehicles in the Russian Federation not so long ago, the incidence of scooter injuries has been growing for several years. AIM: To analyze epidemiological data and the nature of injuries in victims of nonfatal electric scooter incidents. MATERIALS AND METHODS: The study included 78 medical records of persons injured in road incidents involving electric scooters who were treated in the trauma department of the Regional Hospital No. 4 of Adler between 2020 and 2021. The nature of the injury by sex, age, seasonality, time of day, and characteristics of damage depending on the category of road users (driver and pedestrian) were analyzed retrospectively. RESULTS: Of the 78 road incidents involving electric scooters, 28 occurred in 2020 and 50 in 2021. The sex distribution was nearly the same, with ≥40 men and 38 women, and their median age was 36 (30–45.8) years. Most of the accidents (n=52) occurred in summer and autumn months. The exact time of injury was known in 35 cases (17‰ in the daytime, 18‰ in the evening. Depending on the circumstances, all accidents were divided into falls from electric scooters (n=73), collisions of moving scooters with pedestrians (n=3), and collisions of moving scooters with a moving car (n=2). Of the 73 patients who sustained fractures, 67 had a closed type. Intra-articular fractures were detected in 41 victims. Lowe-limb fractures (n=43) prevailed over fractures of other localizations. In addition, 18 cases of knee injuries and 14 cases of trauma to the proximal tibial epiphysis were recorded. CONCLUSION: The incidence of scooter injury is increasing. In the warm regions of the Russian Federation, such accidents have a year-round prevalence with predominance in the summer months owing to the large influx of vacationers. More often than other incidents, falls from electric scooters are noted, resulting in lower limb injuries, including with intra-articular fractures of the condyles of the tibia.

Performance of the neutrophil-lymphocyte ratio as a predictor of severity and mortality in children and adolescents with traumatic brain injury.

An inflammatory cascade associated with the systemic neutrophil response can be triggered after traumatic brain injury (TBI), causing neuronal dysfunction, which is considered to be related to the prognosis of the victims. The scope of this research is to identify the performance of the neutrophil-lymphocyte ratio (NLR) as a predictor of prognosis considering TBI severity and death as outcomes in a group of pediatric patients. We retrospectively evaluated NLR through a consecutive review of the medical records (cross-sectional study) of children and adolescents aged < 17years victims of TBI. To determine the highest NLR value identified as a predictor, different cutoff points were tested for each outcome. The cutoff points were defined based on the area under curve (AUC) of the receiver operating characteristic (ROC). Among the 82 children with TBI included in the sample, the performance of AUC-ROC was 0.72 when evaluating NLR as a predictor of TBI severity, with NLR cutoff point of 3, and 0.76 when considering mortality as the outcome, with an increase in the cutoff point to 11. NLR can be considered a biomarker of brain injury in children and adolescent victims of TBI. Patients with NLR ≥ 3 had a fivefold higher probability of severe TBI and patients with NLR ≥ 11 experienced a ninefold higher risk of death.

The Prevalence and Nature of Victimization among First Semester Students at Urban, Hispanic-Serving Institutions (HSIs)

ABSTRACT Victimization is associated with compromised psychosocial functioning and educational attainment, but research has yet to investigate the victimization experiences of students who attend Hispanic-Serving Institutions, specifically, to inform programming and services. This study examines the prevalence and nature of victimization (i.e. non-sexual interpersonal victimization, stalking, contact and non-contact sexual victimization, property victimization, identity theft, and familial abuse) among a cohort of 2,388 first-semester students from two urban HSIs. Similar to previous research, 41% of students experienced victimization prior to enrollment and 24% experienced multiple types of victimization. Notably, 27% of students experienced at least one type of victimization since enrollment, with 13% experiencing multiple types of victimization and one-third of victims experiencing repeat victimization. Differences in risk for victimization since enrollment emerged across race and ethnicity, gender, sexual orientation, campus residence, and employment status. Overall, victimization incidents were more likely to occur off-campus and be perpetrated by non-university affiliated individuals. Presence of a weapon and victim injury were uncommon. The findings speak to the experiences of students at urban HSIs, and results related to risk and nature of victimization incidents should be used to inform prevention efforts and support services at urban HSIs.

Impact of biomechanical exposure (job-exposure matrix 'MADE') and social support on return to work following occupational injuries

ObjectivesTo identify the determinants that influence the outcome of the return to work (RTW) after occupational injuries. MethodsWe conducted a cross-sectional study at the National Health Insurance Fund of Tunisia among victims of occupational injuries. Individual and professional factors have been evaluated through a face-to-face questionnaire for ten months. Biomechanical exposure was estimated by the job-exposure matrix "MADE" and social support by the Social Support Scale. Along with descriptive statistics, we used bivariate analysis, binary logistic regression, and random forest. ResultsWe included 199 injured workers aged 20–60 years (mean = 42.73; 79.9 % male).Of the 199 injured workers, 39.7 % had unsuccessful RTW. Low social support, biomechanical exposure, blue-collar workers, working long hours, and severe injuries were associated with an unsuccessful return to work. In the variable importance plot issued from the random forest model, low social support at work was the most important risk factor of an unsuccessful RTW, followed by MADE variables: repetitiveness and effort. ConclusionBiomechanical exposure and social support are main influencers of the return-to-work process.

Probing the Causal Contribution of Reasoning to Third-Party Moral Judgment of Harm Transgressions.

Recent work has supported the role of reasoning in third-party moral judgment of harm transgressions. In particular, reasoning may increase the weight of intention in moral judgment, especially following accidental harm, a situation that presumably requires judges to balance considerations about the outcome endured by a victim on the one hand and considerations about an agent's intention to cause harm on the other hand. Three preregistered lab-based studies aimed to test the causal contribution of reasoning to moral judgment of harm transgressions using experimental manipulations borrowed from the reasoning literature: time pressure (Experiment 1), cognitive load (Experiment 2), and priming (Experiment 3). Participants (N = 284) were presented with short fictitious scenarios in which the agent's intention toward a potential victim (harmful or neutral intent) and the action's outcome (victim's injury or no harm) were manipulated. Participants then reported their moral judgment of the agent's behavior (wrongness and deserved punishment) and their empathy toward the victim. We found that time pressure reduced judgment severity toward agents who had the intention to harm, but the reasoning manipulations overall did not impact judgment severity toward agents who harmed accidentally. We discuss why reasoning may sometimes influence how individuals account for intention in third-party moral judgment of harm transgressions.