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Michael L Nance

Publications and source records attributed to Michael L Nance.

33 records · Page 2Linked to original sources
PubMed2003

Suboptimal restraint affects the pattern of abdominal injuries in children involved in motor vehicle crashes.

BACKGROUND: Both solid and hollow visceral abdominal injuries have been associated with the use of seat belts in children involved in motor vehicle crashes. The relationship between the types of restraint used and the pattern of abdominal injury is unknown. METHODS: A probability sample of restrained children involved in crashes was enrolled in an ongoing crash surveillance system (1998 through 2002) linking insurance claims data to telephone survey and crash investigation data. Significant abdominal injuries were considered when the Abbreviated Injury Scale (AIS) score was > or =2 and were defined as hollow visceral (HV; intestine, bladder), or solid visceral (liver, spleen, pancreas, kidney). Restraint type was categorized as optimal restraint (OR) or suboptimal restraint (S-OR) based on the child's age and size. RESULTS: For the 33 months of review, interviews were obtained for 13,558 restrained children aged 0 to 15 years, of which, 56% were OR (n = 7,591) and 44% were S-OR (n = 5,967). A significant abdominal injury was recorded in 78 children. A hollow visceral injury was recorded in 38 (9 OR and 29 S-OR), and a solid visceral injury in 32 (18 OR and 14 S-OR). Both hollow and solid visceral injuries were present in 8 children (2 OR and 6 S-OR). Suboptimally restrained children had a higher risk for hollow visceral injury when compared with optimally restrained children (Odds Ratio, 4.14 [95% Confidence Interval 1.33 to 13.22, P <.01]). CONCLUSIONS: Among restrained children with intraabdominal injuries, those who were suboptimally restrained were 4 times more likely to have a hollow visceral than a solid visceral injury when compared with those who were optimally restrained. This suggests that the mechanism of injury for hollow viscus may be directly related to the improper positioning of the restraint.

Abbreviated Injury Scale↗
PubMed2003

Ureteral stenting in the management of urinoma after severe blunt renal trauma in children.

Posttraumatic urinomas are well-described complications associated with the nonoperative management of major blunt renal injuries. Urinoma drainage using a percutaneously placed catheter has been the traditional method used to alleviate symptoms and promote resolution without the need for open intervention. The authors describe 2 pediatric cases in which urinomas associated with grade IV renal lacerations were treated successfully utilizing internal ureteral stents.

Adolescent↗
PubMed2003

Nonintracranial fatal firearm injuries in children: implications for treatment.

BACKGROUND: Understanding the injury characteristics of nonintracranial fatal (NIF) gunshot wounds in children treated in a statewide trauma system will help guide effective treatment strategies. METHODS: This study was a retrospective analysis of children fatally injured with firearms. The review included demographic information, firearm injury characteristics, and outcome. The setting included trauma centers participating in a statewide trauma registry. Patients were all children (age < 18 years) treated in trauma centers for NIF gunshot wounds from January 1988 through December 2000. The main outcome measures were characteristics of fatal firearm injuries in children. RESULTS: Over the 13-year period, there were 1,954 children with firearm injuries including 368 (18.8%) children with fatal wounds. Of the fatally wounded children, 177 (48.1%) had no intracranial injury. The NIF injury population was 90.4% male, with a mean age of 14.9 years (range, <1-17 years) and an Injury Severity Score of 38.2 (range, 9-75). Over 95% of deaths in this group occurred within 24 hours of admission. Although injuries to the thorax were most common (78.5%), 48.6% of the NIF cohort had injuries to multiple body regions, including 31% with injuries in both the abdomen and thorax. Compared with all children wounded by firearms, NIF firearm injury patients had, on average, more body regions injured (1.6 vs. 1.1, p < 0.001) and a greater total number of injuries (6.0 vs. 3.5, p < 0.001). Patients with an NIF injury were more likely to suffer a major vascular injury (54.8% vs. 13.8%, p < 0.001), lung injury (56.5% vs. 12.9%, p < 0.001), or cardiac injury (44.6% vs. 4.6%, p < 0.001) than all children with a firearm injury. CONCLUSION: Most children who arrive at trauma centers alive and subsequently die from NIF firearm injuries do so rapidly from major vascular and thoracic injury. Almost half of these children have injuries to multiple body regions, further complicating management. Innovative, aggressive treatment approaches should be sought to improve survival in this extremely injured cohort of children.

Adolescent↗
PubMed2003

The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures.

BACKGROUND: Computed tomographic (CT) scanning is sensitive in detecting pelvic fractures in the pediatric patient. Pelvic fractures in the pediatric population rarely require emergent intervention, thus providing time to obtain the optimal imaging study. The objective of this study was to compare pelvic radiographs and abdominal pelvic CT scans of all pediatric trauma patients with pelvic injury to determine the role of pelvic imaging in the immediate trauma resuscitation. METHODS: A retrospective review was performed of pediatric patients (age < 18 years) with a pelvic fracture identified from the registry of a Level I pediatric trauma center for the period 1993 to 2001. Patients with a documented pelvic injury and both a pelvic CT scan and pelvic radiograph available for review were extracted for analysis. For this study, all films were re-reviewed by an attending pediatric radiologist, and the abnormalities were categorized by the area of injury. The data were comparatively analyzed according to the area of injury and the soft tissue findings. RESULTS: For the 8-year period, 130 pediatric patients with a pelvic fracture were identified, including 103 patients with both a pelvic CT scan and radiographs. Of the 151 fractures identified by pelvic CT scan, 81 were also identified by the pelvic radiograph (54%). There were 38 soft tissue hematomas noted by pelvic CT scan and only 2 identified by the pelvic radiograph. The greatest discrepancy was noted in comparison of the sacral region (16 abnormal pelvic CT scans vs. 3 abnormal radiographs); the least discrepancy was noted in the evaluation of the hip (6 abnormal pelvic CT scans vs. 5 abnormal radiographs). CONCLUSION: The pelvic radiograph lacked the sensitivity of the pelvic CT scan for detecting pelvic fractures in all anatomic areas evaluated. Pelvic CT scan also offers additional information regarding soft tissue injury not available on most pelvic radiographs. In the trauma patient that will undergo abdominopelvic CT scanning as part of the trauma evaluation, a pelvic radiograph may be superfluous. Screening pelvic radiography should be reserved for the rare unstable patient or the patient in whom an abdominopelvic CT scan is not otherwise indicated.

Abdominal Injuries↗
PubMed2002

The rural-urban continuum: variability in statewide serious firearm injuries in children and adolescents.

OBJECTIVE: To compare rates of serious firearm injuries among children and adolescents treated in a statewide trauma system. MATERIALS AND METHODS: We reviewed the Pennsylvania Trauma Systems Foundation (Mechanicsburg) registry from January 1, 1987, through December 31, 2000, for all pediatric and adolescent patients (age 0-19 years) who sustained a serious firearm injury. Data included age, sex, weapon, geographic region, injury circumstance, and outcome. RESULTS: During the 14-year period, 3781 children and adolescents sustained a serious firearm injury and were treated at a participating Pennsylvania trauma center. The population was 90.7% male, with a mean age of 16.5 years. Adolescents (age 15-19 years) represented more than 85% of the study population. There were 744 deaths (19.7%). The urban counties had an average annual population-based rate of serious firearm injury of 28.3/100 000; suburban counties, 2.8/100 000; metropolitan counties, 2.4/100 000; and nonmetropolitan counties, 2.4/100 000. Urban counties had a higher rate for all injury circumstances (unintentional, assault, and self-inflicted) than all nonurban counties. Assault was the most common overall injury circumstance (78.7%), and was the most common circumstance in urban counties (88.5%) and among adolescents (age 15-19 years [84.2 %]). Unintentional injuries predominated in nonmetropolitan counties (56.7%) and in young children (aged <5 years [50.6%] and 5-9 years [61.4%]). Handguns were the most common weapon type in all age groups, geographic regions, and injury circumstances. CONCLUSIONS: Rates of serious firearm injuries among children and adolescents are 10-fold higher in urban than nonurban regions. Assaultive injury mechanisms predominated in urban areas, unintentional injuries in the nonurban counties. Firearm injury statistics are heavily influenced by events in the urban counties. Intervention and prevention strategies need to account for these regional discordances to optimize efficacy.

Adolescent↗
PubMed2002

Estimates of the incidence and costs associated with handlebar-related injuries in children.

BACKGROUND: The US Consumer Product Safety Commission is considering handlebar regulation regarding impact performance to address the risk of abdominal and pelvic organ injuries in bicyclists. OBJECTIVE: To provide national estimates of incidence and costs of handlebar-related abdominal and pelvic organ injuries. DESIGN AND SETTING: Censuses of hospital discharge data from 19 states were extrapolated to determine national estimates. The percentage of abdominal and pelvic injuries associated with handlebars was estimated based on a case series from a pediatric trauma center. Costs were estimated using standard methods. PARTICIPANTS: All subjects younger than 20 years treated as inpatients and discharged from acute care hospitals for non-motor vehicle bicycle-related injury in 19 states in 1997 and at a pediatric trauma center located in one of the states between January 1, 1996, and December 31, 2000. MAIN OUTCOME MEASURES: Incidence of bicycle-related handlebar abdominal and pelvic organ injury, total hospital charges, lifetime medical payments, lifetime productivity loss, and lifetime monetized quality-adjusted life-years. RESULTS: An estimated 1147 subjects (95% confidence interval, 1082-1215; 1.49 per 100 000 subjects 19 years and younger) in the United States had serious non-motor vehicle-involved bicycle-related abdominal or pelvic organ injury leading to hospitalization in 1997, and 886 (95% confidence interval, 828-944; 1.15 per 100 000 subjects 19 years and younger) of these injuries likely were associated with handlebars. The estimated national costs associated with handlebar-related abdominal and pelvic organ injuries were $9.6 million in total hospital charges, $10.0 million in lifetime medical costs (including claims processing), $11.5 million in lifetime productivity losses, and $503.9 million in lifetime monetized quality-adjusted life-years. CONCLUSIONS: Handlebar-related abdominal and pelvic organ injuries pose a serious health risk to children and result in substantial health care costs. Requirements for safer handlebar designs may provide one avenue to achieve a health and economic benefit.

Abdominal Injuries↗
PubMed2002

Practical points in evaluation and resuscitation of the injured child.

The ultimate goal of resuscitation of an injured child is delivery of oxygen to intracellular organelles in order to maintain aerobic metabolism. This can be obtained by following ATLS protocols with immediate attention to the "ABCDE's" and compulsive reevaluation of the adequacy of resuscitation maneuvers. After stabilization, seriously injured children should be transferred to trauma centers with established pediatric trauma programs utilizing preexisting transfer agreements and protocols. Pediatric trauma is indeed a team endeavor, requiring the coordinated expertise and teamwork of prehospital EMS providers, trauma team members, and the pediatric trauma and rehabilitation centers. With careful and compulsive communication and coordination, injured children can be returned to their families in better mental and physical condition than pre-injury with reasonable expectation of a full and productive life.

Abdominal Injuries↗
PubMed2002

Nonoperative management of blunt extrahepatic biliary duct transection in the pediatric patient: case report and review of the literature.

An 11-year-old boy sustained a grade IV liver injury and complete disruption of the left hepatic duct (LHD) secondary to a sledding accident. Although he became hemodynamically stable after initial resuscitation in the emergency department and the intensive care unit (ICU), serial paracentesis procedures were necessary to manage abdominal compartment syndrome (ACS). The fluid initially was serosanguinous but subsequently became bile stained. A bile leak was confirmed by a technetium 99m dimethyliminodiacetic acid (HIDA) scan and an endoscopic retrograde cholangiogram (ERCP). The LHD transection was treated with percutaneous drainage of the subhepatic space and a transampullary biliary stent. The leak sealed within 8 days, and follow-up ERCP as an outpatient showed no extravasation but could not visualize the LHD. Repeat computed tomography (CT) scan 3(1/2) months after injury showed the liver laceration to be healed with atrophy of the left lobe and no ductal dilatation. The patient has had a complete recovery, resumed all activities, and currently is 20 months after his injury with no sequelae.

Abdominal Injuries↗
PubMed2002

Pattern of abdominal free fluid following isolated blunt spleen or liver injury in the pediatric patient.

BACKGROUND: This study correlated isolated, blunt liver or spleen injury with the presence, location, and amount of free fluid in the pediatric blunt trauma patient. METHODS: The hospital trauma registry was reviewed for the period 1/89 to 12/99 for pediatric patients (age < or = 17 years) who sustained blunt, isolated spleen or liver injury and had an abdominal CT scan. Patients with other intraabdominal injuries or inadequate scans were excluded. CT scans were reviewed by two radiologists and the isolated liver or spleen injury confirmed and graded. The presence, location, and amount of free fluid were evaluated in the RUQ, LUQ, and pelvis. Free fluid was quantified as 0 = no fluid, 1 = small amount, 2 = moderate, and 3 = large for each area. RESULTS: There were 134 pediatric patients with an isolated spleen (n = 66) or liver (n = 68) injury. Free fluid was noted in 101 patients (75%), more commonly with spleen (82%) than with liver (69%) injuries. As injury grade increased, so did frequency of patients with free fluid (grade 1 = 50% to grade 5 = 100%) and mean total volume (sum of fluid scores from each region) of free fluid (grade 1 = 0.75 to grade 5 = 6.5). The mean total volume of free fluid was greater for splenic injury (3.1) than for liver injury (1.7). The pelvis was the most common location for free fluid (liver 53%, spleen 71%) and had the greatest mean volume of free fluid (liver 0.9, spleen 1.5) of any single region. CONCLUSION: There is a direct correlation between the severity of the isolated injury and the likelihood and volume of associated free fluid. The pelvis was the most common location to detect free fluid and had the greatest estimated fluid volume.

Adolescent↗
PubMed2002

Skateboard-associated injuries: participation-based estimates and injury characteristics.

BACKGROUND: Skateboarding is a popular recreational activity but has attendant associated risks. To place this risk in perspective, participation-based rates of injury were determined and compared with those of other selected sports. Skateboard-associated injuries were evaluated over time to determine participation-based trends in injury prevalence. METHODS: Rates of skateboard-associated injury were studied for the 12-year period 1987 to 1998 for participants aged 7 years or older. The National Electronic Injury Surveillance System provided injury estimates for skateboarding and the selected additional sporting activities. The National Sporting Goods Association annual survey of nationally representative households provided participation estimates. A participation-based rate of injury was calculated from these data sets for the selected sports for the year 1998. RESULTS: The 1998 rate of emergency department-treated skateboard-associated injuries-8.9 injuries per 1,000 participants (95% confidence interval [CI], 6.2, 11.6)-was twice as high as in-line skating (3.9 [95% CI, 3.1, 4.8]) and half as high as basketball (21.2 [95% CI, 18.3, 24.1]). The rate of skateboard-associated injuries declined from 1987 to 1993 but is again increasing: the 1998 rate was twice that of 1993 (4.5 [95% CI, 1.6, 7.4] and 8.9 [95% CI, 6.2, 11.6], respectively). Increases occurred primarily among adolescent and young adult skateboarders. The most frequent injuries in 1998 were ankle strain/sprain and wrist fracture: 1.2 (95% CI, 0.8, 1.6) and 0.6 (95% CI, 0.4, 0.8) per 1,000, respectively. Skateboard-associated injuries requiring hospitalization occurred in 2.9% and were 11.4 (95% CI, 7.5, 17.5) times more likely to have occurred as a result of a crash with a motor vehicle than injuries in those patients not hospitalized. CONCLUSION: This study is the first to relate skateboarding and other sport injuries to participation exposures. We found that skateboarding is a comparatively safe sport; however, increased rates of injury are occurring in adolescent and young adult skateboarders. The most common injuries are musculoskeletal; the more serious injuries resulting in hospitalization typically involve a crash with a motor vehicle. This new methodology that uses participation-based injury rates might contribute to more effective injury control initiatives.

Adolescent↗