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PubMed1998

Is it possible to recover from uncal herniation? Analysis of 71 head injured cases.

BACKGROUND: Uncal herniation (UH) caused by head trauma may become a fatal process if not treated rapidly. METHODS: We analysed the factors affecting the outcome in 71 surgically treated patients who had intracranial haematoma diagnosed by computerized tomography (CT), between January 1987 and June 1994 with the symptoms of UH. Age, incident-treatment interval, Glasgow Coma Scale (GCS), type of the lesion and the presence of polytrauma were correlated with Glasgow Outcome Scales (GOS) using SPSS PC+ statistical software. RESULTS: 49.3% of our patients were referred because of a fall from a height and 46.5% because of a motor vehicle accident. 12.7% of the patients were polytraumatized. The mean GCS of the series was 5.662. The mean GCS of the patients expired and who were in good recovery state were 4.8 and 6.9 respectively. Age, presence of polytrauma, type of the lesion and time interval between the incident and the treatment was found to be statistically insignificant when correlated with GOS. The correlation value between the GCS values and GOS was found to be highly significant (p < 0.00001). CONCLUSIONS: The findings showed that the degree of the herniation is the most important factor that affects the prognosis of the patients with UH. The reversibility of UH becomes more difficult if there are complications added during the grades of its progression but it may not be necessarily fatal and be reversible if appropriate interventions are rapidly performed.

Adolescent↗
PubMed1996

Fatal extradural hemorrhage following a fall from a baby bouncer.

Prevention of infant deaths from accidental falls from baby equipment requires the maintaining of safety standards and adequate supervision of the infant. Mason in 1989 stated that those under one year old are usually injured because they are left unattended in, for example, bouncing cradles or baby walkers. Severe accidental head injury is relatively uncommon in children under two years of age, and in those patients less than one year of age, accidental injury is 10 to 15 times more common than nonaccidental injury. Gallagher et al. state that falls are the most common cause of accidental injury to the head in children under two years of age (mainly on stairs), whereas falls in older children tend to cause limb injuries. Both falls and burns are well documented with regard to the baby walker, but the author has found no reference to injuries from baby bouncers. This case proves that it is not necessary for a child to fall from a great height to sustain a life-threatening head injury. This infant's head was only about two feet from the ground, and he landed on a thick carpet. Pivoting about the central point provided by the seat of the bouncer obviously increased the momentum of the head before it struck the ground and so the injury was more severe than a straightforward fall back from his own height to the ground. However, it is important to be aware that serious head injuries can result from apparently minor falls. It is hoped that this case will highlight the dangers that do exist when using the baby bouncer, especially if the equipment is worn and adult supervision is absent.

Accidental Falls↗
PubMed2006

Effect of growth hormone (GH) treatment on the near-final height of 1258 patients with idiopathic GH deficiency: analysis of a large international database.

CONTEXT: Treatment with GH has been used to correct the growth deficit in children with GH deficiency (GHD). Although successful in increasing height velocity, such treatment often falls short of helping patients achieve full genetic height potential. OBJECTIVE: This study set out to analyze near-final height (FH) data from a cohort of GH-treated children with idiopathic GHD. DESIGN, SETTING, AND PARTICIPANTS: Of 1258 evaluable patients in the Pfizer International Growth Database (KIGS) with GHD, 980 were of Caucasian origin, and 278 were of Japanese origin; 747 had isolated GHD (IGHD), and 511 had multiple pituitary hormone deficiencies (MPHD). MAIN OUTCOME MEASURES: Near-FH, relation to midparental height, and factors predictive of growth outcomes were the main outcome measures. RESULTS: Median height sd scores (SDS) at the start of treatment were -2.4 (IGHD) and -2.9 (MPHD) for Caucasian males and -2.6 (IGHD) and -3.4 (MPHD) for females, respectively; comparable starting heights were -2.9 (IGHD) and -3.6 (MPHD) for Japanese males and -3.3 (IGHD) and -4.0 (MPHD) for females, respectively. Corresponding near-adult height SDS after GH treatment were -0.8 (IGHD) and -0.7 (MPHD) for Caucasian males and -1.0 (IGHD) and -1.1 (MPHD) for females, respectively; and -1.6 (IGHD) and -1.9 (MPHD) for Japanese males and -2.1 (IGHD) and -1.8 (MPHD) for females, respectively. Differences between near-adult height and midparental height ranged between -0.6 and +0.2 SDS for the various groups, with the closest approximation to MPH occurring in Japanese males with MPHD. The first-year increase in height SDS and prepubertal height gain was highly correlated with total height gain, confirming the importance of treatment before pubertal onset. CONCLUSIONS: It is possible to achieve FH within the midparental height range in patients with idiopathic GHD treated from an early age with GH, but absolute height outcomes remain in the lower part of the normal range. Patients with MPHD generally had a slightly better long-term height outcome.

Adolescent↗
PubMed1987

[Predilection sites of infantile skull fractures following blunt force].

Previous investigations on calvarial fractures in infants have shown that the flexibility and displacement of the infant calvarial are not sufficient to avoid fractures as a result of fall. From a table height onto hard ground - and in special cases, fractures cannot be avoided even after falls onto softly cushioned ground. The skull fractures are located in paper-thin, transparent, single-layer bone areas without diploe. The results of previous literature were compared with investigations of the skulls of 82 infants (from neonates up to infants 14 months of age). Congenital fissures, cranioschisis, locally retarded ossification in the cranium and craniotabes are all weak points where fracture has a tendency to occur even if the impact is minor. These ossification defects are increased in the ossa parietalia, but can also be found in the os frontale or in the os occipitale. The location is not always the same but can be detected by locating the skull transparency using diaphanoscopy.

Female↗
PubMed1997

Safety of surfaces and equipment for children in playgrounds.

BACKGROUND: The safety of playgrounds is important to protect children from injury, but studies are mostly done mainly under laboratory conditions without epidemiological data. We investigated the safety of different playground surfaces, and types and heights of equipment in public playgrounds in the City of Cardiff, UK. METHODS: We did a correlational study of 330 children aged between 0 and 14 years. All children were hurt when playing in playgrounds in Cardiff and presented to the Accident and Emergency Department in Cardiff Royal Infirmary during summer (April to September) 1992 and 1993, and the whole of 1994. We studied the children's hospital records to establish the type of injury and interviewed their parents to find out the playground and type of equipment involved. The main outcome measures were the number of children injured whilst playing, and injury rates per observed number of children on different surfaces, types, and heights of equipment. FINDINGS: Children sustained significantly more injuries in playgrounds with concrete surfaces than in those with bark or rubberised surfaces (p < 0.001). Playgrounds with rubber surfaces had the lowest rate of injury, with a risk half that of bark and a fifth of that of concrete. Bark surfaces were not significantly more protective against arm fractures than concrete. Most injuries were equipment related. Injury risk due to falls from monkey bars (suspended parallel bars or rings between which children swing) was twice that for climbing-frames and seven times that for swings or slides. The height of the equipment correlated significantly with the number of fractures (p = 0.005) from falls. INTERPRETATION: Rubber or bark surfacing is associated with a low rate of injuries and we support their use in all public playgrounds. Bark alone is insufficient, however, to prevent all injuries, particularly arm fractures. Rubberised impact-absorbing surfaces are safer than bark. We believe that playing on monkeys bars increases the risk of injury in playgrounds and that they should generally not be installed. Safety standards should be based on physical and epidemiological data. Our data suggest that the proposed raising of the maximum fall height from 2.5 m to 3.0 m in Europe is worrying.

Accidental Falls↗
PubMed1990

Overweight and mortality in Mexican Americans.

The Geriatric Research Center (GRC) table of desirable weights is based on the mortality experience of holders of 4.2 million policies issued by 25 life insurance companies in the USA and Canada. The GRC table defines optimum weight-for-height as the weight range which is associated with below average mortality for a given age and height group. People who fall outside this range, i.e. overweight or underweight, experience above average mortality for their age and height group. We classified 3176 Mexican Americans and 1841 non-Hispanic whites who participated in the San Antonio Heart Study according to the GRC table and found that Mexican Americans were less likely than non-Hispanic whites to be underweight and more likely to be overweight. The two effects did not offset one another, however, and fewer Mexican Americans were found to be in the 'just right' range. If the mortality experience of the population which generated the GRC table (largely non-Hispanic) applied to Mexican Americans, these results imply that Mexican Americans should have higher mortality rates than non-Hispanic whites. Vital statistics data from the state of Texas for the years 1979-81, however, fail to corroborate this prediction. Beyond age 45 years, an age range in which obesity and obesity-related disorders would be expected to exert an important influence on mortality, age-specific and age-adjusted all cause mortality was at last as good if not better in Mexican Americans than in non-Hispanic whites. These results could not be explained by ethnic differences in body fat distribution, since fat was less favorably distributed in Mexican Americans.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Injuries caused by parasailing].

The new sport of parasailing seems to be set to go through the same stages of enthusiasm, disillusionment and consolidation as hang gliding did some years ago. The high number of injuries we see in our clinic, which is in one of the areas of Germany where parasailing is most popular, shows that the phase of enthusiasm is still in full swing. A total of 48 injuries sustained during parasailing and treated in our clinic within 6 months were analyzed with reference to causes, patterns, and frequencies. Most of the injuries occurred with unfavorable wind and weather conditions; 58% of them occurred in the start phase as the result of falls on uneven ground, on rocks, or trees; 10% during the flight phase as a result of turbulence or collisions with obstacles; and 32% during the landing phase, mainly by falling on the back from some height while landing too slowly, or by falling forward while landing too fast with back wind. As to the sites of the injuries, 60% were to the lower extremity, 26% to the upper extremity, and 14% to the body. The most serious injuries were fractures (42%), contusions (26%), ligamentous lesions (19%), luxations (6%), and deep wounds (6%). The most frequent injuries were ligamentous lesions and fractures of the upper ankle (14), spine contusions (5), radial fractures (4), knee contusions (4), hand fractures (3), calcaneus fractures (2) and shoulder luxations (2). We classed 56% of the injuries as mild, 42% as moderate, requiring subsequent operation or hospital treatment, and 1 as severe, with 2 months' hospital inpatient treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries.

OBJECTIVE: Our objective was to describe types and distribution of cervical spine injuries in elderly patients in regard to causative trauma mechanism and patient age. MATERIALS AND METHODS: The distribution and type of 225 cervical spine injuries in 149 consecutive patients 65 years old and older over a 5-year interval were retrospectively assessed. For each patient, initial admission imaging studies were reviewed, and injuries were classified. Trauma mechanism (falls from standing or seated height vs higher energy mechanisms) and initial clinical and neurologic status were recorded. Data were correlated according to patients' age (65-75 years and >75 years) and causative trauma mechanism. RESULTS: Ninety-five (64%) of 149 patients had upper cervical spine injuries. Fifty-nine (40%) of 149 patients had multilevel injuries. Main causes for cervical spine injuries were motor vehicle crashes in "young elderly" (65-75 years old; 36/59, 61%) and falls from standing or seated height in "old elderly" (>75 years old; 36/90, 40%). Fracture patterns at risk for neurologic deterioration were common (>50%), even in the absence of acute myelopathy or radiculopathy. Patients older than 75 years, independent of causative mechanism, and patients who fell from standing height, independent of age, were more likely to have injuries of the upper cervical spine (p = 0.026 and p = 0.006, respectively). CONCLUSION: Cervical spine injuries in elderly patients tend to involve more than one level with consistent clinical instability and commonly occur at the atlantoaxial complex. Old elderly patients and patients who fall from standing height are more prone to injuries of the upper cervical spine.

Accidental Falls↗
PubMed1990

Effect of abdominal irradiation on growth in boys treated for a Wilms' tumor.

To study the effect of abdominal irradiation on spinal growth in childhood we have measured final height, sitting height, and leg length in 30 male survivors of a Wilms' tumor. Twenty-one patients received whole abdominal irradiation by either megavoltage therapy (MV: n = 11) or orthovoltage therapy (OV: n = 10); the remainder received flank irradiation. To examine the effect of the adolescent growth spurt on the irradiated spine we have followed prospectively seven patients who received whole abdominal irradiation and nine patients who received flank irradiation through puberty. Compared to a normal population there is a modest reduction in median final standing height SDS (H.SDS: -1.15) accompanied by a marked reduction in median final sitting height SDS (S.HT SDS: -2.41) with no apparent effect on median subischial leg length SDS (SILL.SDS: 0.04). This reduction in spinal growth is reflected by a strongly positive disproportion score (DPS; [SILL SDS-S.HT SDS] + 2.81). The incidence of scoliosis after abdominal irradiation has been low (10%). During puberty there is a significant fall in median sitting height SDS after both whole abdominal (median fall: -0.9, P = 0.02) and flank irradiation (median fall: -1.85, P = 0.01), and this is reflected in a significant increase in disproportion (DPS: whole abdominal; median rise +1.4, P = 0.02: flank, median rise +1.34, P = 0.01). After MV irradiation there is a significant correlation between the degree of disproportion and the age at treatment (P less than 0.0005). The younger the patient is at treatment the more severe is the restriction on spinal growth and the shorter and more disproportionate they become as an adult. The estimated eventual loss in potential height from abdominal irradiation at the age of one is 10 cm and at five years is 7 cm.

Abdomen↗
PubMed2007

Fractures in New Zealand elementary school settings.

BACKGROUND: There is a need for greater international understanding of student safety in schools. This New Zealand study investigated the causes and school location of fractures sustained by students attending elementary school, with special emphasis on the types of fractures sustained following falls from playground equipment of various heights. METHODS: Over a 1-year period, 76 participating schools (with a combined roll of over 25,000 students) completed a questionnaire about the nature and circumstances of student fractures sustained during regular school hours. RESULTS: Some 118 students sustained a total of 131 fractures. Injuries from playground equipment were no more frequent than those from general activities at school, and most were sustained in falls from heights less than 59 inches. Most fractures were to the upper limbs. Fractures were found to vary by gender and school size. CONCLUSIONS: The results are discussed in terms of the conditions and policies present in local schools, and the tension that exists in maintaining safety while offering appropriate challenges to students. Improvements in school safety may be more likely to result from a greater focus on the way that students interact at school, rather than on modifications to playground equipment.

Child↗
PubMed2001

Low-impact falls: demands on a system of trauma management, prediction of outcome, and influence of comorbidities.

BACKGROUND: Falls from a low height are an extremely common source of injury, the severity of which is often underestimated. As a result, low fall patients are usually not transferred to Level I trauma centers. There are surprisingly few systematic data relating to the demands made on systems of trauma care by patients with low falls. This study addresses this issue using information from a comprehensive national trauma database. The performance of TRISS methodology, and the factors associated with prolonged hospital stay, in low fall patients is also examined. METHODS: The study included 31,419 patients. Patients with low falls (< 2 m) were compared with those suffering high falls (> or = 2 m), motor vehicle crashes, assault, sports injuries, and a group with unclassified injuries. Probability of survival was estimated using TRISS, and its performance in different types of injury was assessed using measures of discrimination and calibration. The influence of coexistent medical conditions on mortality and length of stay was investigated using logistic regression. RESULTS: Low falls accounted for 45.5% of all admissions, and 43.9% of the total bed days. The low fall group was older (mean age, 61.6 years), and predominantly female (62.5%) in contrast to the other groups (both p < 0.001). There were fewer severely injured patients than in all of the other groups except sports injuries. The area under the receiver operating characteristic curve for TRISS applied to low falls (0.874) was less than that for high falls (0.969), motor vehicle crashes (0.973), assaults (0.960), sports (1.000), and unclassified injuries (0.965). Also, the calibration of the TRISS model was poor for patients with low falls. A logistic regression model derived from a training set of 5,000 patients gave slightly improved discrimination and markedly improved calibration when compared with TRISS. Although there was a strong relationship between the number of coexistent medical conditions and the risk of dying after a low fall, including data on comorbidities in a predictive model did not improve performance. Prolonged stay (defined as greater than the 90th centile, 23 days) was more likely in women (p < 0.005), or with advanced age (p < 0.001) or low initial calculated probability of survival (p < 0.001). Cardiovascular and central nervous system diseases and diabetes were associated with longer hospital stay (all p < 0.001). A logistic regression model using TRISS variables and comorbidity data gave poor prediction of prolonged stay. There was considerable variation in the length of stay between institutions. CONCLUSION: Patients with low falls make considerable demands on a system of trauma care. TRISS methodology performs less well in this group than with other types of injury. Chronic medical conditions are associated with increased mortality and more prolonged stay after a low fall. Between-institutional variation in length of stay was considerable and this, along with the poor performance of predictive models derived from routinely collected clinical data, make it unlikely that length of stay could be used as a measure of institutional performance. More robust audit measures for patients with low falls are required.

Accidental Falls↗
PubMed2003

Spine fractures in falling accidents: analysis of multidetector CT findings.

The purpose of the present study was to assess incidence, fracture type, and location of spine fractures due to falls. All emergency room CT requests during a time period of 26 months were reviewed retrospectively. Patients who had fallen or jumped and were initially examined with multidetector CT (MDCT) were included. The MDCT studies were evaluated by two radiologists for trauma location, fracture type, and multiple level involvement. A total of 237 patients (184 males, 53 female, age range 16-86 years, mean age 42 years) met the inclusion criteria. A total of 203 vertebral fractures were seen in 127 patients. Burst fracture (n=78) was the most frequent type of trauma, usually located in the thoracolumbar junction (50%). Also, compression fracture (n=52) was most common in the thoracolumbar junction (39%). Posterior column fracture (n=52) was most frequently detected in the cervical spine (40%). Multiple-level spine fractures were seen in 41 (32%) of the injured patients, of which 12 (29%) had fractures at noncontinuous levels. With increasing height the overall incidence of fractures increased, and burst fractures and multiple level spine fractures became more frequent. Age had no effect on fracture type or location. Spine fractures due to falls are common. Burst fracture is the most common fracture type and most frequently seen in the thoracolumbar junction. Multiple-level fractures were seen in 32% of the cases, of which 29% were seen at noncontinuous levels. Serious spine fractures are seen in all falling height and age groups.

Accidental Falls↗
PubMed1985

Changes in height velocity of obese preadolescents during weight reduction.

Height velocities prior to and during weight reduction were determined retrospectively in 19 obese children selected because of a 10% or greater fall in weight for height. Mean duration of the weight reduction period was 9.7 months. All children were treated with a balanced calorie-deficit diet containing 1.5 to 2.0 g of protein per kilogram of ideal body weight per day. Height velocities were normalized by calculating the Z score for each one. Prior to weight reduction, the mean (+/- SD) Z score for height velocity was 2.32 +/- 2.47 units. Eleven patients were 2 SDs or more above the mean height velocity for age and sex. During weight reduction, the mean Z score for height velocity decreased significantly to 0.62 +/- 2.37 units. The change in Z score before and during weight reduction was significantly correlated with the change in weight but not with the change in weight for height. These data indicate that even mildly restrictive diets may be associated with a reduction in linear growth velocity. The implications of these observations for the risk of other adverse consequences of weight reduction are not clear. Nonetheless, our observations emphasize the importance of careful monitoring of obese children during mildly restrictive dietary therapy.

Child↗
PubMed2004

Circumstances and consequences of falls in residential care: the New Zealand story.

AIMS: To describe the circumstances and consequences of falls in long-term residential care homes in New Zealand. METHODS: A study followed 14 residential care facilities over 18 months and recorded all falls experienced by 680 residents (97% participation rate). The number and characteristics of falls are described according to the timing, activities, direction, and severity of falls. Predictors of injury are examined using regression techniques. RESULTS: 271 residents sustained 954 falls, 63% of which resulted in injury. The rate of falls increased in the afternoons especially in rest homes. Environmental hazards were involved with 15% of falls. Falling in the dining room was associated with fewer injuries, and falling from a standing height, and to the side, were independently associated with major injury such as hip fracture. CONCLUSION: The timing and circumstances of observed falls and their subsequent injuries is useful information for healthcare planners, and staff involved in the care of older people living in long-term residential care settings.

Accidental Falls↗
PubMedDate not supplied

Nutrition status, education participation, and school achievement among Kenyan middle-school children.

OBJECTIVE: The intervening effects of nutrition status on school attendance rates among Kenyan middle school pupils were assessed. The study also examined the effects of nutrition status on primary school achievement scores for the eighth-grade class of 1997. METHODS: Data were obtained on 851 pupils enrolled in the five indexed schools. Anthropometric measures included weight for age, height for age, and relative weight for height, and the values were derived from the raw data. Percentage of attendance rates derived from daily school attendance and raw scores on the Kenya Certificate of Primary Education were the measures of educational participation and achievement. Statistical analysis included descriptive statistics, analyses of variance, correlation, and linear regression analyses. RESULTS: Twenty-nine percent of the children fell below the 90% cutoff value for acceptable relative weight for height. The percentages of the population falling below -2 standard deviations on indices for height for age and weight for age were 16.64 and 3.78, respectively. Univariate analyses showed that anthropometric assessment varied by school and sex. School attendance rates varied by school and grade. Achievement scores on the Kenya Certificate of Primary Education varied by school and the interaction of sex by school. Regression analysis showed attendance rate to be the strongest predictor of achievement, followed by relative weight for height. CONCLUSION: Prevalence of nutritional stress is a significant educational problem in this population. The association between attendance rate and nutrition status is a function of socioeconomic status. The predictive effect of nutrition status on educational achievement is more evident for girls with poor socioeconomic status.

Adolescent↗
PubMed2003

Causes of femoral shaft fracture in children under five years of age.

OBJECTIVE: To study the causes of femoral shaft fracture in children younger than 5 years of age. STUDY DESIGN: Retrospective, descriptive study. PATIENTS AND METHOD: Medical records and radiographs of 39 children younger than 5 years of age with femoral shaft fractures treated in Queen Sirikit National Institute of Child Health during the years 1996-2001 were reviewed. The responsible causes for the femoral shaft fracture given by caretakers by interview were collected. RESULTS: The most common history was falling or jumping from a height (36%) followed by traffic accidents (26%) and object or person falling on top of them (23%) respectively. Only one case presented with a history of abuse. Nine cases were suspected of abuse, but, without further investigations it was not possible to identify the exact cause of fracture. CONCLUSION: Histories given by caretakers for the cause of femoral shaft fracture in children younger than 5 years of age are varied. The orthopedists should find out the exact cause of fracture to prevent missed or delayed diagnosis of abuse that may have occurred.

Child Abuse↗
PubMed2003

Using test dummy experiments to investigate pediatric injury risk in simulated short-distance falls.

BACKGROUND: Short-distance falls, such as from a bed, are often falsely reported scenarios in child abuse. In attempting to differentiate between abusive and nonabusive injury, knowledge of factors that affect injury risk in falls could prove useful. OBJECTIVES: To assess the biomechanics associated with simulated short-distance falls in children (one fall scenario, without attempting to maximize injury potential) and to investigate the effect of impact surface type on injury risk. METHODS: Repeatable fall experiments from bed height (0.68 m) onto different surfaces were conducted using an instrumented side-lying Hybrid II 3-year-old test dummy. Biomechanical measures assessed in falls included head acceleration, pelvis acceleration, femur loading, and head injury criteria. RESULTS: Fall dynamics resulted in the pelvis or legs making first contact. Biomechanical measures assessed in simulated bed falls were below known head injury criteria and lower extremity injury thresholds. The impact surface type had a significant effect on head injury risk and lower extremity loading. Playground foam proved to have the lowest associated injury risk of all the tested surfaces. CONCLUSIONS: The biomechanics of a child falling from a short distance, such as from a bed, were investigated using an experimental laboratory mock-up and an instrumented test dummy. Despite the impact surface having an effect on injury risk, rolling from a 0.68-m (27-in) horizontal surface from a side-lying posture presented low risk of contact-type head injury and leg injury on all tested impact surfaces.

Accidental Falls↗