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PubMed2003

Pelvic fractures in pediatric and adult trauma patients: are they different injuries?

BACKGROUND: Many aspects of pediatric trauma are considerably different from adult trauma. Very few studies have performed comprehensive comparisons between pediatric and adult pelvic fractures. The purpose of this study was to compare the incidence of pelvic fracture, the epidemiologic characteristics, type of associated abdominal injuries, and outcomes between pediatric (age </= 16 years) and adult (age > 16 years) patients. METHODS: This was a trauma registry study that included all blunt trauma admissions at a Level I trauma center during an 8-year period. The incidence and severity of pelvic fractures, associated abdominal injuries, need for blood transfusion, and mortality in the two age groups were compared with the two-sided Fisher's exact test. Stepwise logistic regression analysis was used to identify independent risk factors for associated abdominal injuries in pelvic fractures in the two age groups. RESULTS: The incidence of pelvic fractures was 10.0% (1,450 of 14,568) in the adult group and 4.6% (95 of 2,062) in the pediatric group (p < 0.0001). In motor vehicle and pedestrian injuries, adults were twice as likely and in falls from heights > 15 ft seven times as likely as children to suffer pelvic fractures. However, age group was not a significant predictor of the severity of pelvic fracture. Only 9.5% of pediatric fractures and 8.8% of adult fractures had a pelvis Abbreviated Injury Scale (AIS) score >/= 4. The incidence of associated abdominal injuries was high but similar in the two age groups (16.7% in adults and 13.7% in children, p = 0.48). Motor vehicle crash, pelvis AIS score >/= 4, and fall from height > 15 ft were significant predictors of associated abdominal injuries in the adult but not the pediatric group. The incidence of associated gastrointestinal injuries was similar in the two age groups (5.3% in children and 3.3% in adults, p = 0.37). The incidence of solid organ injuries was nearly identical in both groups (11.6% in children and 11.5% in adults). The need for blood transfusions and angiographic intervention was not significantly different between the two age groups. Exsanguination because of bleeding related to the pelvic fracture was responsible or possibly responsible in 42 deaths (2.9%) in the adult group and no deaths in the pediatric group. CONCLUSION: Pediatric trauma patients are significantly less likely than adults to suffer pelvic fractures, although the age group is not a significant risk factor for the severity of pelvic fracture. The incidence of associated abdominal injuries is high and similar in the two age groups. Motor vehicle crash, fall from a height, and pelvis AIS score >/= 4 were significant predictors of associated abdominal injuries in the adult but not the pediatric patients. The need for blood transfusion is similar in both groups irrespective of Injury Severity Score and pelvis AIS score. The mortality resulting from exsanguination related to pelvic fractures is very low, especially in pediatric patients.

Abdominal Injuries↗

PubMed1991

Injuries sustained by falls.

During a recent 4-year period, 381 patients were admitted with injuries sustained from falls. Equal numbers of patients were less than and greater than 50 years of age and included 53 children (less than or equal to 16 years) and 214 elderly (greater than or equal to 55 years). Falls from heights occurred predominantly in young males (mean age 34.2 years), were most commonly job or recreation related and resulted in higher injury severity scores (ISS). Falls in the elderly occurred more commonly in women, typically on a flat surface, and were less severe. Despite lower mean ISS, fall victims over 55 years of age had longer hospitalizations (11.4 vs. 4.5 days) and incurred higher hospital charges compared to younger patients. There were 35 deaths (9.2%). In patients under 55 years, deaths resulted from fall-related central nervous system (CNS) injury and/or multisystem trauma. In patients over 55 years, fatalities were most commonly related to pre-existent medical conditions. Based on a review of this experience, we conclude that: (1) unlike other causes of blunt and penetrating trauma, both sexes are equally at risk from fall-related injuries but sex incidence is age related; (2) falls from heights are more common in men; (3) advanced age and pre-existing medical conditions account for the increased morbidity and mortality following falls and; (4) cost containment measures for fall-related trauma must consider not only injury severity, but the age and pre-existent medical conditions of the patient.

Accidental Falls↗

PubMed2006

Are short boys with constitutional delay of growth and puberty candidates for rGH therapy according to FDA recommendations?

BACKGROUND/AIMS: According to FDA-approved guidelines, boys whose height predictions fall to 160 cm or less are considered for treatment with recombinant growth hormone (rGH). The aim of this study was to analyze the value of different height prediction methods by accurately identifying those boys with constitutional delay of growth and puberty (CDGP) in whom final height (FH) prognosis was poor (<or=160 cm) and who might therefore be candidates for this treatment modality. METHODS: In 69 boys with CDGP diagnosed at a mean age of 14.9 +/-1.2 years, FH prediction was calculated by means of Bayley-Pinneau (BP), Roche-Wainer-Tissen (RWT), Tanner-Whitehouse II (TWII) and target height (TH) methods. At the age of 22.6 +/- 3.5 years their height was remeasured and the accuracy of height prediction was analyzed. RESULTS: In 6 men (8.7%) measured FH was <or=160 cm. Depending on the prediction method, different individual patients within the 14- to 16-year age range would have been candidates for rGH treatment. The BP method would have recruited 8 subjects of whom only 3 had FH <or=160 cm (sensitivity 50%, specificity 92%). The RWT and TW II methods identified only one recruit, and this patient did achieve FH <or=160 cm (sensitivity 17%, specificity 100%). None of the 8 subjects with FH <or=160 cm would have qualified for GH treatment using the TH method. In three boys none of the four methods predicted their final height <or=160 cm. CONCLUSION: Although some boys with CDGP may be considered the candidates for rGH treatment according to FDA recommendations, none of the available methods of prediction are sufficiently sensitive to reliably recruit 14- to 16-year-old boys whose final height will fall at or below 160 cm.

Adolescent↗

PubMed1989

Biomechanical properties of the proximal femur determined in vitro by single-energy quantitative computed tomography.

To assess the use of quantitative computed tomography as an in vivo predictor of fracture in the osteoporotic hip, we examined the in vitro relationship between single-energy quantitative computed tomography data, calibrated for scanner drift, and the mechanical properties of trabecular bone from the proximal femur. For 49 samples, the apparent density and ultimate strength were measured and their functional relationship to the computed tomography data determined. Apparent density demonstrated a moderate linear correlation to the computed tomography numbers (R2 = 0.60), and the ultimate strength was related through a power law (R2 = 0.83). In addition, for 8 intact femora, average computed tomographic data from the sub-capital region were moderately correlated to the ultimate fracture load applied under controlled in vitro conditions (R2 = 0.64). The average fracture energy for these femora was 43 J, a value more than an order of magnitude less than the energy available in a fall from standing height, suggesting that fall mechanics are a more important determinant of fracture risk than has been previously thought. The relationship between the energy absorbed to failure and the computed tomography data was best described by a power law (R2 = 0.90). Based on these results, it appears that quantitative computed tomography provides a potentially useful approach for the direct estimate of that component of fracture risk that can be attributed to a reduction in bone strength.

Aged↗

PubMed2006

Martial arts fall techniques decrease the impact forces at the hip during sideways falling.

Falls to the side and those with impact on the hip are risky for hip fractures in the elderly. A previous study has indicated that martial arts (MA) fall techniques can reduce hip impact force, but the underlying mechanism is unknown. Furthermore, the high impact forces at the hand used to break the fall have raised concerns because of the risk for wrist fractures. The purpose of the study was to get insight into the role of hand impact, impact velocity, and trunk orientation in the reduction of hip impact force in MA techniques. Six experienced judokas performed sideways falls from kneeling height using three fall techniques: block with arm technique (control), MA technique with use of the arm to break the fall (MA-a), and MA technique without use of the arm (MA-na). The results showed that the MA-a and MA-na technique reduced the impact force by 27.5% and 30%, respectively. Impact velocity was significantly reduced in the MA falls. Trunk orientation was significantly less vertical in the MA-a falls. No significant differences were found between the MA techniques. It was concluded that the reduction in hip impact force was associated with a lower impact velocity and less vertical trunk orientation. Rolling after impact, which is characteristic for MA falls, is likely to contribute to the reduction of impact forces, as well. Using the arm to break the fall was not essential for the MA technique to reduce hip impact force. These findings provided support for the incorporation of MA fall techniques in fall prevention programs for elderly.

Adult↗

PubMed1977

Histopathological variability in 'standardised' spinal cord trauma.

Feline spinal cords were traumatised by the weight dropping technique. Five trauma groups were studied (5 g X 80 cm, 10 g X 40 cm, 20 g X 20 cm, 40 g X 10 cm, and 80 g X 5 cm), each having a 'standardised' injury of '400 g--cm.' The spinal cords were sectioned serially two hours after contusion and examined by light microscopy. Relative to the larger weights falling from lesser heights, the smaller weights falling from greater heights were associated with less haemorrhage, oedema, axonal disruption, and myelin fragmentation as well as a smaller volume of grey matter containing altered anterior horn cells. In all trauma groups the cortical evoked responses disappeared at the time of the injury and did not reappear. Even though each trauma group received a '400 g--cm' contusion, each weight--height combination was associated with differing degrees of histopathological alterations. A plea is made for more accurate quantitation of experimental spinal cord trauma than the 'g--cm' unit.

Animals↗

PubMed2001

Nonoperative management of pediatric blunt hepatic trauma.

The purpose of this study was to examine the effect of operative versus nonoperative management of blunt hepatic trauma in children including transfusion practices. We reviewed the experience at our American College of Surgeons-verified Level I trauma center with pediatric commitment over a 5-year period. Children < or = 16 years of age suffering blunt liver injury as documented on admission CT scan were included in the study. Liver injuries identified on CT scan were classified according to the American Association for the Surgery of Trauma's Organ Injury Scaling system. All data are presented as mean +/- standard error. One case of pediatric liver trauma not identified on CT was excluded (prehospital cardiopulmonary resuscitation). Twenty-seven patients were included [age 9.3 +/- 1.0 years (range 3-16)]. Mechanisms of injury included motor vehicle crash (14), pedestrian struck by motor vehicle (7), bicycle crash (4), fall from height (1), and pedestrian struck by falling object (1). Trauma Score was 11.5 +/- 0.3. Distribution of Liver Injury Grade was as follows: grade I, 13; grade II, 9; grade III, 3; grade IV, 2; and grade V, 0. All five patients who underwent operative management had multiple organ injuries; three had concomitant splenic injury requiring operative repair; the remaining two had small bowel injury requiring repair. Hepatorrhaphy did not correlate with severity of liver injury: grade I, n = 1; II, n = 2; III, n = 1; and IV, n = 1. Three operated patients received blood transfusions. Twenty-two patients were managed with nonoperative treatment, of these only one required blood transfusion. No patients in the study died, three were transferred to subacute rehabilitation, one was transferred to another hospital, and 23 were discharged home. Our findings indicate that a majority of children with blunt hepatic injury as documented on CT scan can be managed with nonoperative treatment, and few require blood transfusions. Patients with multiple organ injury including simultaneous splenic injury are likely ideally managed through operative exploration and repair, whereas those with isolated liver injuries can be successfully managed nonoperatively.

Adolescent↗

PubMed1993

The aetiology, pattern and prognosis of fractures of the spine in Dar es Salaam, Tanzania.

To determine the aetiology, pattern and prognosis of fractures of the spine in Dar es Salaam, Tanzania we studied a total of 54 patients who had sustained fractures of the spine and were managed by the Orthopaedic/Trauma Department of Muhimbili Medical Centre from January to December 1992. Of these patients 50 were males and four females. Their ages ranged between 12 and 69 years with a mean of 35.5 years. The 21-30 year age group formed the majority of the patients (48.2 pc). Common causes for fractures of the spine observed were motor traffic accidents (MTA) accounting for 38.9 pc of the fractures, falls from heights (46.3 pc) and injuries from falling objects (11.1 pc). The vertebra in the C3-C5 and T11-L3 regions were most frequently fractured. Neurological deficits were observed in 33 patients (61.1 pc) with paraplegia and quadriplegia dominating the neurological pathology. Full recovery of the neurological deficit was observed in five patients (15.2 pc) and partial recovery in 10 (30.3 pc). The overall case fatality rate was 29.6 pc all of whom had neurological deficit. Cervical spine fractures had the worst prognosis accounting for 43.8 pc of the mortality. All patients except two were treated conservatively. There is a need to disseminate knowledge on the initial care for spinal injury patients so as to improve the prognosis of such patients.

Accidental Falls↗

PubMed1995

[Head injuries in children and adolescents: causes and natures].

To investigate the nature of exposure factors, and effectiveness of countermeasures in head injuries in children and adolescent of Taiwan area, we conducted a retrospective study on 820 children and adolescents with head injuries consecutively admitted to Chang Gung Memorial Hospital from January 1985 to December 1989. We analyzed the data by chart review and divided the cases into four age-groups: group A (0-4 years old), group B (5-9 years old), group C (10-14 year old) and group D (15-17 years old). The boy to girl ratio was 2.43. The largest proportions of head injuries were the adolescents in group D. The most common cause of head injury was traffic accidents (74%); while the falls were contributed the main cause in other studies. In all group A, B and D, the majority of traffic accidents were pedestrian injury; while in group D, the motorcyclists or car drivers were responsible for the accidents. Fall from height was the major cause of fall in all four age-groups, but it was fall from bicycle or during play or sports in group C. Injuries were most common in summer and clustered at afternoon in all patients. Majority of head injuries occurred outdoors. Most children and adolescents suffered from mild head injury, but there were still 203 cases with severe head injury (24%). Eighty-one cases (9.9%) were either discharged in critical condition or died at the hospital. There were no significant differences in mortality among four age-groups.

Accidental Falls↗

PubMed2004

Head injuries from falls in preschool children.

Falls are a leading cause of morbidity and mortality among children. We performed a retrospective analysis of pediatric patients under 7 years of age admitted to our department after a fall from January 1994 through December 1999 to describe the characteristics of fall-related head injury and to determine the clinical parameters influencing outcome. The patients were divided into two groups according to age: group I (babies and toddlers, 0-3 years) and group II (preschool children, 4-6 years). Falls were classified as low and high level. Sixty-eight cases were identified and falls accounted for 35.2% of head injuries. There were more boys than girls, and more low-level falls(LLF) than high-level falls (HLF), particularly in group I. Although more common in HLF, significant intracranial injuries were also sustained from LLF. Calvarial fractures were the most frequent type of head injury and were more common in LLF than HLF. Admission Glasgow Coma Scale score, types of head injury and hypoxia on admission were significantly correlated with Glasgow Outcome Scale score, but age, sex, extracranial injury and height of fall did not influence clinical outcome. From this study, we concluded that the height of fall should not limit the evaluation of patients and that aggressive management is mandatory to improve outcome even in patients with poor prognostic factors.

Accidental Falls↗

PubMed2004

Timing of preparatory landing responses as a function of availability of optic flow information.

This study investigated temporal patterns of EMG activity during self-initiated falls with different optic flow information ('gaze directions'). Onsets of EMG during the flight phase were monitored from five experienced volunteers that completed 72 landings in three gaze directions (downward, mid-range and horizontal) and six heights of fall (10-130 cm). EMG recordings were obtained from the right gastrocnemius, tibialis anterior, biceps femoris and rectus femoris muscles, and used to determine the latency of onset (L(o)) and the perceived time to contact (T(c)). Impacts at touchdown were also monitored using as estimates the major peak of the vertical ground reaction forces (F(max)) normalized to body mass, time to peak (T(max)), peak impulse (I(norm)) normalized to momentum, and rate of change of force (dF(max)/dt). Results showed that L(o) was longer as heights of fall increased, but remained within a narrow time-window at >50 cm landings. No significant differences in L(o) were observed when gaze direction was changed. The relationship between T(c) and flight time followed a linear trend regardless of gaze direction. Gaze direction did not significantly affect the landing impacts. In conclusion, availability of optic flow during landing does not play a major role in triggering the preparatory muscle actions in self-initiated falls. Once a structured landing plan has been acquired, the relevant muscles respond relative to the start of the fall.

Adult↗

PubMed1996

Traumatic rupture of the aorta.

The aim of this study was to determine the incidence and mortality from traumatic ruptures of thoracic aortas (TAR) in a well defined population over a 7 year period. The study provides a retrospective analysis of case files of all deaths from road traffic accidents and falls from heights, the usual causes of TAR, filed in the Forensic Medicine Unit of the Pathology Department of the University of Edinburgh, for Lothian and Borders Region. Of the 276 fatal road traffic collisions and falls from heights identified in archival material, 66 traumatic aortic ruptures were found in the period between 1988 and 1994. Only 11% of these patients were alive on arrival to a hospital or an emergency department. To decrease the high mortality rate the following are required: an earlier, more sustained and vigorous, on site resuscitation; efficient screening methods for the diagnosis of TAR in multi-traumatised patients; identification of the specific characteristics of those traumatic episodes which are likely to be associated with a high risk of rupture, and an increase in the number of surgical interventions for ruptured aortas.

Journal Article↗

PubMed2000

Prevention of falls in the construction industry: evidence for program effectiveness.

OBJECTIVE: The objective of this study was to review the evidence for the effectiveness of different strategies to prevent falls from heights in the construction industry. SEARCH STRATEGY: We used the Cochrane Collaboration search strategy to search the following electronic databases: MEDLINE, EMBASE, NIOSHTIC, PsycINFO and Dissertation Abstracts. The reference lists from each potentially eligible study were checked, and knowledgeable people in the field were contacted for additional leads to published reports. SELECTION CRITERIA: Studies were included if they (1) examined the effectiveness of an intervention to decrease falls from heights to construction workers, (2) included data on one of the outcomes of interest, and (3) included a comparison group. MAIN RESULTS: We identified only three studies for review. An ecologic study found some evidence that regulations with enforcement may decrease falls in construction industry. Two studies on educational efforts suggested that educational programs may decrease falls but methodologic limitations restricted the conclusions that could be drawn. CONCLUSIONS: There are few data to support the effectiveness of current programs to decrease fall-related injuries in the construction industry. Rigorous evaluation of these interventions is indicated.

Accident Prevention↗

PubMed2001

Delayed presentation of traumatic rupture of the diaphragm.

Diaphragmatic injuries occur frequently after penetrating rather than blunt trauma and account for 8% of all organ injuries from penetrating trauma. Motor vehicle accidents account for approximately 50% of blunt injuries, followed in frequency by falls from height. The mechanism of injury in these accidents is that the body quickly decelerates while the organs continue to move downward or forward at maximal velocity, tearing vessels and tissues from their points of attachment. In this paper we are presenting 3 cases of traumatic diaphragmatic rupture due to motor vehicle accidents and fall from height, in which the diagnosis was delayed. Patient one was initially diagnosed with hemorrhagic pleural fluid for investigation, patient 2 was diagnosed 4 months later and patient 3 presented 7 years after the initial trauma. All were successfully treated surgically once the diagnosis was established.

Accidents, Traffic↗

PubMed1995

Childhood injuries and the importance of documentation in the emergency department.

The purpose of this study is 1) to evaluate the extent to which documentation of the medical record is completed for dependent children who present for evaluation of an acute injury, and 2) to examine the factors that favorably or adversely influence completion of the medical record. The emergency department (ED) ledgers of 669 children less than nine years of age were reviewed, including 172 (25.7%) who presented for evaluation of an acute injury. Each of the latter charts was examined for basic demographic data, as well as information about injury type and mechanism, ED provider, and involvement of social services personnel. The ledgers were further examined to determine completeness of chart documentation in several relevant areas, including the circumstances and characteristics of the acute injury, pertinent past medical history, and course of management and referral while in the ED. Each of 15 individual documentation variables was assigned a score of either zero (incompletely/not addressed or documented) or one (completely addressed or documented). The 15 individual scores were equally weighted and summed, resulting in a total documentation score ranging from zero (failure to address or document any of the 15 variables) to 15 (all variables completely addressed/documented). The mechanisms of injury included falls from height (48.3%), direct blunt impact other than falls (26.7%), penetrating injury (6.4%), burn (5.2%), and ingestion (8.1%). Seventeen patients (9.9%) were admitted for primarily medical, and one (0.6%) for primarily social, indications; one patient died as a result of his injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMed1997

Surgical treatment of seat belt type injury of the thoracolumbar spine.

BACKGROUND: Seat belt type injury of thoracolumbar spine is an uncommon injury characterized by disruption of the posterior elements of the spine. The fracture has long been treated conservatively, but progressive kyphotic deformity developed frequently. METHODS: From January, 1991 through December, 1992, 10 cases of seat belt type injury of the thoracolumbar spine were encountered at our hospital with an incidence of 8% in overall spinal fractures. Of these patients, eight patients were male and two were female, average age 30.7 years old. The causes included motor-vehicle accident in five patients, fall from height in four, and stricken by a falling electric pole in one. None of the victims of motor vehicle accidents wore seat belt. All of them received open reduction, posterior internal fixation and posterior fusion. RESULTS: After follow-up for an average of 42.2 months, the average kyphotic angulation was 5.7 degrees. Back pain and function of these patients were all rated good. None of them suffered from neurologic deficit. One patient with breakage of transpedicular screws was encountered during follow-up, but there was no complaint. CONCLUSIONS: In treating seat belt type injuries of spinal column, benefits of operation outweigh the risks. Besides, the clinical result is satisfactory and more aggressive surgical approach should be encouraged.

Accidents, Traffic↗

PubMed2003

Spectrum of unnatural fatalities in the Chandigarh zone of north-west India--a 25 year autopsy study from a tertiary care hospital.

A 25 year (1977-2002) autopsy study of 5933 unnatural fatalities from a tertiary care hospital of north-west India revealed an abrupt rise in unnatural deaths (3050; 51.4%) since 1997. 84.2% subjects were between the age group of 16 and 45. Accidental deaths (79.3%) constituted the majority of unnatural fatalities followed by suicidal (13.9%) and homicidal (6%) deaths. Road traffic accidents (RTAs), burn, poisoning, accidental falls from height and firearm injury were responsible for 94.5% of the total unnatural deaths. A male preponderance (73.4%) was seen in all causes of deaths except for burns where females (61%) outnumbered males (39%). The incidence of fatalities due to poisoning and burns had increased from 5.7% and 22.6% to 12% and 24.3%, respectively, whereas due to fire arms and machinery accidents decreased from 4.5% and 1.2% to 1.2% and 0.4%, respectively. The proportion of mortality due to road traffic accidents (50.3%) and accidental fall from height (6.9%) remained almost static. Two-wheeler occupants (motor cycles, etc. 33.3%) were the main victims in road traffic accidents. Pouring of kerosene oil (36% dowry death), malfunctioning and bursting of kerosene oil stove (43.5%) were the most common factors in burn deaths. Between 1977 and 1987 barbiturates (33.3%), organophosphates (23.8%) and copper sulphate (14.3%) and in 1987-1997 organophosphates (45%) and aluminium phosphide (26.5%) were the major fatal poisons. Since 1992 aluminium phosphide (80%), a fumigant pesticide used for wheat preservation was the most common poison. The incidence of suicidal deaths increased from 10.9% (1987-1992) to 15.7% (1997-2002) with a peak incidence of 18.2% in 1992-1997, when this pesticide with no effective antidote was made freely available in the market.

Journal Article↗

PubMed2002

Hospitalizations for fall-related injuries among active-duty Army soldiers, 1980-1998.

Data from the Total Army Injury and Health Outcomes Database (TAIHOD) were used to describe 28,352 fall-related hospitalizations among active-duty Army soldiers between 1980 and 1998. Soldiers who were younger than age 26, single, and had a high school education or less were at greatest risk. Falls from a height were more likely to be fatal than other types of falls, accounting for 88% of all fatalities. In cases where duty status was known, 64% of the falls took place while the soldier was on duty and half of these occurred during training. The most common type of fall during training was fall from a height (37%). Falls on stairs and ladders accounted for 49% of all off-duty falls. Future research should include identification of specific behavioral and occupational risk factors for falls, particularly those occurring during training activities, and falls occurring off duty.

Accidental Falls↗