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Loring W Rue

Publications and source records attributed to Loring W Rue.

At least 73 records · Page 4Linked to original sources
PubMed2003

Age-related gender differential in outcome after blunt or penetrating trauma.

Although laboratory studies indicate that female rodents better tolerate the deleterious consequences of trauma and have higher survival rates than male rodents, it remains unclear whether a similar gender dimorphic pattern is evident in humans. In view of this, the association between gender and mortality in trauma patients admitted to a University Level I Trauma Center was assessed. All adult patients admitted to the University of Alabama at Birmingham Trauma Center with blunt or penetrating injury between July 1996 and March 2001 were selected for analysis. Patients were categorized by mechanism (blunt or penetrating), and odds ratios (ORs) were used to compare the risk of death among males compared with females. The ORs were stratified according to age and were adjusted for demographic, medical, and injury characteristics. Male blunt trauma patients <50 years old had a 2.5 times (95% CI 1.3-4.9) higher risk of death than females; however, for those > or = 50 years old, a smaller, nonstatistically significant difference was apparent (OR 1.4, 95% CI 0.8-2.3). Conversely, for penetrating trauma, males <50 years old exhibited an increased yet nonsignificant risk of death (OR 1.8, 95% CI 0.6-5.4), whereas those > or = 50 years old had a survival advantage (OR 0.1, 95% CI 0.02-0.5). Laboratory studies have demonstrated that estrogens are salutary and androgens are detrimental for survival following trauma-hemorrhage. The results of this study suggest that the physiologic pattern of premenopausal adult female sex hormones may provide a survival advantage in blunt trauma patients; however, the converse pattern prevails for the penetrating trauma patients.

Adult↗
PubMed2003

Death during theft from electric utilities.

Utilities that supply power are subject to theft of service and theft of hardware used to provide service. Individuals who try to steal from a power utility risk electrocution. We conducted a retrospective study of all individuals examined by the Jefferson County Coroner Medical Examiner Office from January 1981 through December 2001 and found that 8 individuals died trying to steal from a power utility. All decedents were men, with an average age of 33 years. Seven decedents were stealing copper, and 1 was stealing electricity. Only 1 decedent survived long enough to be admitted to a hospital. Five decedents were intoxicated, 3 with ethanol, 1 with cocaine, and 1 with both cocaine and ethanol. Seven decedents sustained electrical burns in keeping with the high voltage to which they were subjected. The unburned decedent died of laceration of the aorta at its origin from the heart, an injury sustained when the decedent fell from the power pole. All 8 decedents attempted their theft during daylight. Items found in the decedent's pockets, the presence of a ladder nearby, or the presence of electrical tools around the body may help to establish the attempted act of theft.

Adolescent↗
PubMed2003

Differential fluid regulation during and after soft tissue trauma and hemorrhagic shock in males and proestrus females.

Gender differences in immune and organ functions have been described in different rodent models of trauma- and pressure-controlled hemorrhagic shock. We hypothesized that gender influences the regulation of plasma and tissue fluids in rats under such conditions. To study this we used male and weight matched proestrus female Sprague-Dawley rats, which were assigned to three groups (n = 7/group): sham, maximal bleedout (trauma and 45 min of blood pressure at 35 mmHg without resuscitation), or 5 h after completion of trauma-hemorrhage and resuscitation. Trauma-hemorrhage involved midline laparotomy and approx. 90 min of hemorrhagic shock (35 mmHg), followed by fluid resuscitation (4x the shed blood volume with Ringers lactate). (51)Cr-EDTA, (125)I-albumin distribution, and wet weight/dry weight were used to calculate plasma volume and extracellular fluid volume and cellular water content. Proestrus female rats showed significantly higher plasma volumes compared with weight-matched males. The volume of blood withdrawn in the first 15 min of hemorrhagic shock was significantly less in proestrus females compared with males; however, there was no significant difference in the total shed blood volume. Moreover, proestrus females showed less interstitial edema formation compared with male rats at 5 h after resuscitation. We conclude that differences in the regulation of plasma and tissue volumes exist between males and proestrus females during and after trauma-hemorrhage. The increased circulating blood volume could contribute the improved immune and organ functions in proestrus females under those conditions.

Animals↗
PubMed2003

Motor vehicle crash-related mortality is associated with prehospital and hospital-based resource availability.

BACKGROUND: To date, attempts to assess the relationship between motor vehicle collision (MVC)-related mortality and medical resources availability have largely been unsuccessful. METHODS: Information regarding sociodemographic characteristics, prehospital resources, and hospital-based resources for each county (n = 67) in the state of Alabama was obtained. MVC-related mortality rates (deaths per 1,000 collisions) by county were calculated and compared according to prehospital and hospital-based resource availability within each county after correcting for sociodemographic factors. RESULTS: Counties with 24-hour availability of a general surgeon, orthopedic surgeon, neurosurgeon, computed tomographic scanner, and operating room were shown to have decreased MVC-related mortality (relative risk [RR], 0.88). The same was true for those counties with hospitals classified as Level I-II (RR, 0.71) and Level III-IV (RR, 0.83) trauma centers compared with counties with no trauma centers. CONCLUSION: Appropriate, readily available hospital-based resources are associated with lower MVC-related mortality rates. This information may be useful in trauma system planning and development.

Accidents, Traffic↗
PubMed2003

Relationship between age and lower extremity fractures in frontal motor vehicle collisions.

BACKGROUND: Older adults (aged > or = 65 years) represent the single fastest growing segment of the United States population and will comprise one in five Americans during the third decade of this century. As this population segment rapidly expands, lower extremity fractures (LE Fx) and their associated disability will become a greater public health concern. The purpose of this study was to quantify the risk for LE Fx from motor vehicle collisions (MVCs) according to age. METHODS: The 1995 to 2000 National Automotive Sampling System data files were used. Study entry was limited to front-seat occupants involved in frontal MVCs. Risk ratios for LE Fx and age were adjusted for gender, driver versus passenger, seat belt use, airbag deployment, delta-V, intrusion, and vehicle type. RESULTS: Beginning in the fourth decade, there was a trend of higher relative risk for LE Fx with age that reached statistical significance in the seventh decade of life. CONCLUSION: This study documented an increased risk of LE Fx in older MVC occupants. Efforts to prevent these disabling injuries and to better protect occupants' lower extremities in MVCs should include improved vehicle design and reevaluation of the existing federal motor vehicle safety standards.

Accidents, Traffic↗
PubMed2003

The association between gender and mortality among trauma patients as modified by age.

BACKGROUND: Several studies have reported a null association between gender and mortality after traumatic injury, whereas others found an age-specific association between male gender and increased mortality. Relatively small sample sizes may have contributed to the heterogeneity among existing studies; therefore, a large-sample-size study was undertaken. METHODS: The National Trauma Data Bank was queried, yielding data for over 150,000 patients involved in blunt or penetrating trauma. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the association between gender and mortality, both overall and according to mechanism of injury and age categories. RESULTS: Among those who sustained blunt trauma, male patients had a significant increase in the risk of death compared with female patients (OR, 1.49; 95% CI, 1.39-1.59) that was most apparent for those > or = 50 years of age (OR, 1.97; 95% CI, 1.84-2.11). For penetrating trauma patients, essentially no significant association, either overall (OR, 1.03; 95% CI, 0.91-1.17) or by age category, was apparent. CONCLUSION: This study found an association between gender and mortality among blunt trauma patients, particularly those aged > or = 50 years. Animal studies demonstrate that the sex hormones influence the inflammatory response to injury. These results may highlight the importance of sex hormones in traumatic injury outcomes.

Adult↗
PubMed2003

Occupant- and collision-related risk factors for blunt thoracic aorta injury.

BACKGROUND: Blunt thoracic aortic injury (BAI) is a rare and highly lethal injury. We sought to identify occupant and collision characteristics associated with motor vehicle collision (MVC)-related BAI. METHODS: The 1995 to 2000 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. The risk of BAI was calculated according to specific occupant (e.g., age, seat belt use) and collision (e.g., delta-V [estimated change in velocity], vehicular intrusion) characteristics. The association between BAI and these characteristics was calculated using risk ratios (RRs) and associated 95% confidence intervals (CIs). RESULTS: Specific occupant and collision characteristics demonstrated independent association with BAI. Occupant characteristics included age >or= 60 (RR, 3.6; 95% CI, 2.5-5.2), seat belt use (RR, 0.3; 95% CI, 0.2-0.5), and being a front-seat occupant (RR, 3.1; 95% CI, 1.5-6.3). Frontal and near-side MVCs were associated with an increased risk (RR, 3.1; 95% CI, 1.9-5.1; and RR, 4.3; 95% CI, 2.6-7.2, respectively) relative to other collision types. Collisions with a delta-V >or= 40 km/h (RR, 3.8; 95% CI, 2.6-5.6) or that produce extensive vehicle crush (>or= 40 cm) (RR, 4.1; 95% CI, 2.7-6.3) or intrusion (>or= 15 cm) (RR, 5.0; 95% CI, 3.5-7.3) also increase the risk of BAI. CONCLUSION: The risk factors for BAI identified in this study support generally accepted etiologic mechanisms for this injury.

Accidents, Traffic↗
PubMed2003

The association between occupant restraint systems and risk of injury in frontal motor vehicle collisions.

BACKGROUND: An evaluation of seat belt use and airbag deployment, either alone or in combination, on risk of injury to specific body regions has yet to be completed. METHODS: A retrospective cohort study of front seat occupants involved in police-reported, tow-away, frontal motor vehicle collisions using data from the 1995 through 2000 National Automotive Sampling System was conducted. Only vehicles with a change in velocity (delta-V) of >/= 15 km/h were included. Risk of injury (Abbreviated Injury Scale score >/= 2) to specific body regions was compared according to seat belt use and airbag deployment. RESULTS: Compared with completely unrestrained occupants, those using a seat belt alone or in combination with an airbag had a reduced overall risk of injury (relative risk, 0.42 and 0.71, respectively); no association was observed for those restrained with an airbag only (relative risk, 0.98). This pattern of results was similar for specific body regions with the exception of the lower extremity, wherein a significantly increased risk was observed for airbag deployment alone. CONCLUSION: Airbag deployment does not appear to significantly reduce the risk of injury either alone or in combination with seat belts. Airbag deployment without associated seat belt use may increase the risk of lower extremity injury.

Accidents, Traffic↗
PubMed2003

Endocrine targets in experimental shock.

Modified resuscitation regimens and cytokine blockade/receptor antagonism after trauma have not been successful in decreasing the mortality rates from sepsis in trauma patients; therefore, an alternative approach using endocrine targets as modulators or inhibitors may be useful. Information regarding the influence of gender and hormones on immune and cardiovascular responses after nonthermal trauma-hemorrhagic shock is, on the one hand, considerable but, on the other hand, disappointingly incomplete. Trauma-hemorrhagic shock produces gender dimorphic immune and cardiovascular responses; men exhibit cardiovascular depression and are immunosuppressed, whereas proestrus women do not show cardiovascular or immunologic depression under those conditions. Furthermore, experimental studies have demonstrated the use of hormones, hormone antagonists, sex steroids, and receptor antagonists as salutary adjuncts, without any adverse effects on gastrointestinal, hepatic, and renal functions, for restoring the depressed immune and cardiovascular responses after trauma-hemorrhage. Thus, flutamide, dehydroepiandrosterone, metoclopramide, and 17beta-estradiol, which are readily availably clinically and do not produce any adverse hemodynamic effects, appear to be safe and novel agents/hormones for the treatment of immune and cardiovascular depression after severe blood loss in male and female trauma victims.

Endocrine System↗
PubMed2003

Association between side air bags and risk of injury in motor vehicle collisions with near-side impact.

BACKGROUND: Side air bags (SABs) have been introduced in an attempt to reduce the risk of injury in near-side-impact motor vehicle collisions (MVCs). The impact of SABs on MVC-related mortality and morbidity has yet to be evaluated with a large population-based study. The objective of this study was to assess the effectiveness of SABs in reducing the risk of injury or death in near-side-impact MVCs. METHODS: A retrospective study investigated outboard front seat occupants involved in police-reported, near-side-impact MVCs using data from the General Estimates System (1997-2000). The risk of MVC-related nonfatal and fatal injury for occupants of vehicles with and without SABs was compared. RESULTS: Front seat occupants of vehicles with SABs had a risk of injury similar to that of occupants of vehicles without SABs (risk ratio [RR], 0.96; 95% CI confidence interval [CI], 0.79-1.15). Adjustment for the potentially confounding effects of age, gender, seat belt use, seating position, damage severity and location, and vehicle body type did not meaningfully affect the association (RR, 0.90; 95% CICI, 0.76-1.08). CONCLUSIONS: There is no association between the availability of SABs and overall injury risk in near-side-impact MVCs. Future research is necessary to determine the effectiveness of SABs in preventing the injuries for which they were specifically designed.

Accidents, Traffic↗
PubMed2003

Early versus delayed fixation of pelvic ring fractures.

This retrospective study reports outcomes, after early and delayed surgical stabilization of fractures of the pelvic ring, in terms of pulmonary complications, length of hospital stay, and cost of hospitalization. The hospital course of 151 patients admitted to an academic teaching hospital who sustained acute fractures of the pelvic ring between June 1996 and December 2000 was reviewed. Patient demographics, Injury Severity Score (ISS), timing of operative fixation, and the incidence of pulmonary complications were analyzed. Radiographs were reviewed and fractures classified according to the modified Tile system. Tile fracture types B and C patients who underwent fixation within 1 week of injury (n = 71) were compared to those in whom surgery was delayed (n = 28). Adjusting for the ISS, early-repair patients had a lower risk of pulmonary complications (RR = 0.49, 95% CI = 0.25-0.96), a reduced length of hospital stay (12.2 vs. 20.5 days; P = 0.0005), and overall reduced cost of care (57,084 dollars vs. 158,625 dollars; P = 0.0317). Pelvic ring fixation within the first week of injury results in significantly reduced incidence of pulmonary complication, hospital stay, and cost of care regardless of injury severity. The coordinated team approach to insure prompt resuscitation, stabilization, and operative fixation results in more optimal patient outcomes.

Adult↗
PubMed2002

Flutamide induces relaxation in large and small blood vessels.

HYPOTHESIS: Flutamide, a testosterone receptor antagonist, produces various beneficial effects in male rats following hemorrhagic shock, possibly as a result of a direct vasodilating effect on large and small vessels in the rat. DESIGN, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The aorta and the small intestine were isolated from normal male and female Sprague-Dawley rats. Isolated aortic rings were placed in the organ bath and constricted by 2 x 10(-7)M norepinephrine bitartrate (Sigma, St Louis, Mo). Flutamide-induced and testosterone-induced vascular relaxation dose-response curves were then determined. The dose-response curves of flutamide were also determined in the small blood vessels of the isolated small intestine under conditions of constant flow following preconstriction induced by 5 x 10(-6 )M norepinephrine bitartrate. The effects of prior incubation with testosterone (8 x 10(-5)M) and sex differences on flutamide-induced vascular relaxation were also examined in aortic rings and in the small intestine. Moreover, flutamide-induced relaxation in endothelium-denuded aortic rings and in aortic rings from animals subjected to trauma and hemorrhagic shock was examined. RESULTS: Flutamide induced significant relaxation in aortic rings and small intestinal blood vessels in healthy males. The flutamide-induced relaxation in vessels from normal males was partially attenuated by prior incubation with the male sex steroid testosterone, and was significantly lower in females. Flutamide-induced vascular relaxation in the aorta was partially attenuated by endothelium removal, but it was not significantly affected by trauma and hemorrhagic shock in male rats. CONCLUSIONS: Flutamide has a direct vasodilating effect on large and small vessels in rats, which involves sex-dependent mechanisms. Thus, the beneficial effects of flutamide on cardiovascular responses in males following trauma and hemorrhagic shock may be due to the direct vascular relaxation induced by this agent.

Androgen Antagonists↗
PubMed2002

Restraint use and injury patterns among children involved in motor vehicle collisions.

BACKGROUND: Motor vehicle collisions are the leading cause of death among children older than 1 year. Use of appropriate restraint systems is associated with reductions in morbidity and mortality in this age group. No studies have evaluated the association between specific injury patterns and restraint use among children. The purpose of this study was to evaluate differences in risks of injuries in different body regions according to restraint use among children 0 to 11 years of age. METHODS: The 1995 to 1999 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away collisions. Information on occupant (seating position, restraint use), collision (change in velocity, vehicle intrusion), and outcome characteristics was evaluated. Risks of injuries in different body regions (Abbreviated Injury Scale, 1990 Revision score > or = 2) were calculated and compared according to restraint use. RESULTS: Between 1995 and 1999, there were approximately 1.5 million children 0 to 11 years of age involved in police-reported tow-away MVCs who met the inclusion criteria for this study. Compared with unrestrained children, properly restrained children had significantly lower overall injury risk (risk ratio [RR], 0.37); significant risk reductions were also observed for injuries to the head (RR, 0.18), thorax (RR, 0.35), and lower extremities (RR, 0.26), and mortality (RR, 0.26). Significant risk reductions were not noted when comparing improperly restrained children with unrestrained children. CONCLUSION: Proper restraint use among children is associated with lower risk of injury. Educational initiatives should focus not only on encouraging restraint use but also on ensuring that parents know the appropriate age-dependent restraint method and how to use it properly.

Accidents, Traffic↗
PubMed2002

Incidence and characteristics of motor vehicle collision-related blunt thoracic aortic injury according to age.

BACKGROUND: Motor vehicle collision-related blunt thoracic aorta injury (BAI) is rare and highly lethal. Vascular disease as related to advancing age potentially subjects older adults to increased risk of BAI; the mechanisms associated with such injuries may be different as compared with younger adults. The goal of the present study is to test this hypothesis using population-based data. METHODS: The 1995 to 1999 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away crashes. BAI was defined according to the Abbreviated Injury Scale codes. Among those with BAI, information on occupant (age, seating position, restraint use), collision (collision type, delta-V, vehicle intrusion), and outcome characteristics were obtained and compared according to age. RESULTS: The overall incidence of BAI was 6.8 per 10,000 occupants and there was a steady increase in the BAI rate for advancing decades of life. The proportion of occupants with BAI who die at the scene of the collision is relatively consistent across all age groups ( approximately 85%). Among those who survive to receive medical care, ultimate survival is lowest among those aged 60 and older. Near-side collisions were responsible for more BAI among older adults than other age groups (50% vs. 20.6%, p < or = 0.05). Older adults sustained BAI in collisions with lower delta-V values compared with younger persons (p < or = 0.05). CONCLUSION: Older adults have the highest rate of motor vehicle collision-related BAI, and their injuries tend to occur in less severe collisions. A high level of suspicion for BAI among older adults should not be reserved for high-energy collisions only.

Accidents, Traffic↗
PubMed2002

Injury rates among restrained drivers in motor vehicle collisions: the role of body habitus.

BACKGROUND: Previous studies have examined the independent effects of occupant height, obesity, and body mass index in motor vehicle collisions and identified related injury patterns. The hypothesis of this study was that as the driver's body habitus diverges from the 50% percentile male Hybrid III Crash Dummy (H3CD), the frequency of injury changes. METHODS: The 1995 to 1999 National Automotive Sampling System Crashworthiness Data System was used. Study entry was limited to restrained drivers who were then subdivided into height and weight categories. Incidence rates were calculated for injuries to selected body regions as defined by the Abbreviated Injury Scale for overall, frontal, and driver's side collisions. RESULTS: When grouped according to height and weight as descriptors of body habitus, injury rates for restrained drivers were increased as well as decreased in several subgroups. This association was seen in overall, frontal, and driver's side collisions. CONCLUSION: The H3CD plays a major role in vehicular cabin interior design and crash testing. For drivers with a body habitus different from that of the H3CD, the vehicle cabin/body fit changes and the safety features may perform differently, which could account for these observations.

Accidents, Traffic↗
PubMed2002

Identifying injuries and motor vehicle collision characteristics that together are suggestive of diaphragmatic rupture.

BACKGROUND: Diaphragmatic rupture (DR) remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. Our purpose was to identify motor vehicle collision (MVC) characteristics and patient injuries that collectively could identify the presence of a DR. METHODS: The National Automotive Sampling System was used to identify occupants involved in MVCs from 1995 to 1999 who sustained abdominal (Abbreviated Injury Scale score >or= 2) and/or thoracic injuries (Abbreviated Injury Scale score >or= 2). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to quantify the association between patient injuries, vehicle collision characteristics, and DR. Sensitivity and specificity were also calculated to determine the ability of organ injury and MVC characteristics to correctly classify patients with and without DR. RESULTS: Overall, occupants sustaining a DR had a significantly higher delta-V (DeltaV) (49.8 kilometers per hour [kph] vs. 33.8 kph, p< 0.0001) and a greater degree of occupant compartment intrusion (70.6 cm vs. 48.3 cm, p< 0.0001). Specific abdominal and thoracic organ injuries were associated with DR, including thoracic aortic tears (OR, 5.2; 95% CI, 2.2-12.5), splenic injury (OR, 8.4; 95% CI, 3.9-17.8), pelvic fractures (OR, 4.7; 95% CI, 2.7-8.0), and hepatic injuries (OR, 4.2; 95% CI, 1.7-10.6). Combining frontal or near-side lateral occupant compartment intrusion >or= 30 cm or DeltaV >or= 40 kph with specific organ injuries generated a sensitivity for indicating the likelihood of diaphragm injury ranging from 68% to 89%. Patients with any of the following characteristics had a sensitivity for detecting DR of 91%: splenic injury, pelvic fracture, DeltaV >or= 40 kph, or occupant compartment intrusion from any direction >or= 30 cm. CONCLUSION: Specific MVC characteristics combined with patient injuries have been identified that are highly suggestive of DR. For this subpopulation, additional invasive procedures including exploratory laparotomy, laparoscopy, or thoracoscopy may be warranted to exclude DR.

Abdominal Injuries↗
PubMed2002

Gender differences in mortality following burn injury.

Clinical and experimental studies have demonstrated higher mortality following nonthermal trauma among males compared with females. To date, few clinical retrospective studies have focused on gender differences in outcome following burn injury with respect to age. All patients admitted to the University of Alabama at Birmingham (UAB) Burn Center between January 1994 and December 2000 were selected for inclusion in the study. Gender differences in demographic, clinical, and outcome characteristics were compared. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the association between mortality and gender, both overall and stratified by age. Over the 7-year study period, 1229 males and 382 females were admitted to the UAB Burn Center, and mortality rates were 7.2% and 13.4%, respectively (P = 0.0002). Female patients were more likely to be older, of the black race, and in poorer health. In addition, females were more likely to suffer flame and scald burns. The association between mortality and gender was modified by age. Up to age 60, mortality rates among females were over twice that of males (OR 2.3, 95% Cl 1.4-3.8); however, no difference was noted among those 60 and older (OR 0.9, 95% Cl 0.5-1.6). These associations persisted following adjustment for potentially confounding variables. Causes and timing of death were similar for males and females. Women less than 60 years of age who sustain burn injuries have an increased risk of death compared with males. Differences in the natural history of nonthermal trauma and burn injury may provide insight regarding these divergent findings.

Adult↗