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Biomedical subjects

J D States

Publications and source records attributed to J D States.

At least 19 recordsLinked to original sources
PubMed1999

Abbreviated injury scale unification: the case for a unified injury system for global use.

BACKGROUND: The Abbreviated Injury Scale (AIS), developed by the Association for the Advancement of Automotive Medicine is the most widely used anatomic injury severity scale in the world (Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale; 1985 and 1990 revisions. Des Plaines, IL: Association for the Advancement of Automotive Medicine). However, different user groups have modified the AIS system to fit their needs, and these modifications prevent ready comparison and trending of data collected in these systems in the United States and throughout the world. The United States currently has five AIS-based severity systems and two AIS-based impairment systems in use, with additional revisions forthcoming. Other modified AIS systems are known to be in use in the United Kingdom and Japan. The data collected in these systems cannot be accurately combined or compared without re-coding or the use of complex "mapping" methodologies. Furthermore, the expanding use of data linked from multiple databases to answer complex medical, engineering, or policy issues emphasizes the need for coordination between severity and other injury systems. Linkage of state-wide motor vehicle crash data with data from hospital injury classification systems, mortality files, trauma registry, and national crash databases brings into immediate focus the lack of well defined relationships between the severity coding systems and these other widely used injury systems (Mango N, Garthe E. SAE Congress, February, 1998; Johnson, S, Walker, J. NHTSA Technical Report. DOT HS 808 338, Washington, DC: NHTSA; January, 1996). With the expanding use of linked data in state and national policy decisions, it is vital that consistent standards for injury descriptions, severities, and impairments be available for clinical, engineering, and policy users. METHODS: This paper compares five anatomic severity systems and two impairment systems in terms of purpose, code structure, and use and discusses the reasons for the differences between these systems. With global "harmonization" encouraging greater sharing of international data, the paper also presents the relationship of the severity and impairment systems to US morbidity and reimbursement and worldwide mortality classification systems. RESULTS: To resolve compatibility issues resulting from multiple injury systems, the authors propose that a "unified" system for global use be developed, configured by inputs from major "data owners," users, and analysts. The proposed unified system has six key attributes: backward compatibility with historical data through "maps" so no data are lost; "scalability" to allow a simple level of use for developing countries, a more complex level for crash research and a detailed level for clinical hospital use, all with data compatibility; the ability to satisfy the needs of the engineering community for injury location information and aspect, and also the clinical requirement for precise injury description; inherent integration with whole body severity scores to permit easy computation; compatibility with other injury data systems such as mortality, morbidity, and reimbursement systems; and a mechanism and process to maintain and upgrade the system into the 21st century. CONCLUSION: The authors believe that a "unified" injury system is a necessary and crucial advance from the currently fragmented injury system situation. Unified data can provide a pool of consistent international data to support a variety of important research and prevention and treatment efforts and is essential to satisfy the global needs of the medical and engineering communities.

Abbreviated Injury Scale↗
PubMed1995

Humanitarian benefits of cadaver research on injury prevention.

This paper discusses the value of human cadaveric subjects in injury biomechanics research. Published data were used to estimate the number of cadavers used in the past 30 years and to show that, as a benefit to society, over 60 lives were saved and countless injuries prevented for each cadaver used in the development and validation of safety improvements. Ethical and religious concerns regarding the use of cadavers are also addressed. Because of the substantial humanitarian value of cadaver research and the lack of suitable specimens, it is proposed that cadaver resources be pooled and that institutions with surplus specimens supply the few cadaver testing laboratories with specimens each year. This approach will enable further development of safety systems and facilitate achieving the national goals for injury control.

Accidents, Traffic↗
PubMed1994

Deaths from motor vehicle crashes: patterns of injury in restrained and unrestrained victims.

A time comparison study of motor vehicle crashes in Monroe County, New York, from 1983 to 1986 was completed. Using a database of police accident reports, hospital logs, and autopsy reports from the county coroner, the hospital and autopsy reports of 91 unrestrained and 27 restrained fatally injured victims were reviewed. The hypothesis was that safety belts do not change patterns of injury in fatally injured victims. Patient data, seating position, and direction of impact were the same for both groups, while ejections occurred only in the unrestrained group (19.8%). Injury Severity Score (ISS), major injuries in AIS-85 categories for the Head, Thorax, Abdomen, and in AIS-85 Code 5 or 6 categories for the Head, Thorax, Abdomen were the same in unrestrained and restrained victims, except for the greater incidence of cerebral contusions in the unrestrained group (71% vs. 37%, p = 0.002). Cranial injuries were the most likely cause of death in nearly two thirds of the victims in both groups. The incidence of major head (other than cerebral contusion), thoracic, and abdominal injuries in unrestrained and restrained fatally injured victims was the same. This suggests that severe collisions with crushing, intrusion, or significant deceleration exceed the ability of restraints to prevent many fatal injuries.

Abdominal Injuries↗
PubMed1991

Characteristics of motor vehicle accidents resulting in spinal cord injury.

The majority of cases of spinal cord injury (SCI) occur during car crashes. Yet, relatively little is known about the precise accident factors involved. The present study investigated 30 cases of SCI in automobile drivers that occurred in a series of 91 spinal cord injuries. A matched control group was also studied. SCI drivers were not different from controls in terms of mortality, number of rollover crashes, alcohol use, citations for contributing human factors, nighttime accidents, or unfavorable weather and road conditions. However, SCI drivers less frequently used restraints. Results are discussed in terms of preventive measures, specifically, those concerning restraint use, alcohol use, and driving behavior.

Accidents, Traffic↗
PubMed1990

A time comparison study of the New York State Safety Belt Use Law utilizing hospital admission and police accident report information.

New York state enacted the first safety belt use law in the United States in 1984. We evaluated the effects of the law by reviewing all hospital admissions from motor vehicle crashes in Monroe County, New York. We compared admissions for the 18 months prior to the effective date of the law with those for the 18 months after the law became effective. Police accident reports and hospital records were coupled and intensively reviewed. Motorcyclists, pedestrians, and bicyclists (bicycle collisions with motor vehicles) became controls for the study. Seat belt usage was determined from police and hospital record information. Analysis of the data revealed that safety belt use among patients hospitalized because of motor vehicle accidents increased from 11.2% before the law became effective to 53% after the law became effective. Hospital admissions decreased 11.9% among motor vehicle occupants and increased 2.6% among controls. The ISS decreased from 16.01 to 14.55 for motor vehicle occupants and increased from 14.77 to 15.11 among controls. Among subjects all injuries decreased except injuries of the spine and abdomen, which increased in the postlaw period.

Abdominal Injuries↗
PubMed1990

Injury impairment and disability scales to assess the permanent consequences of trauma.

Impairment and disability caused by injury are major public health costs in terms of monetary losses and personal suffering. Currently, there is no satisfactory method of measuring these losses. Impairment is the loss of function after injury healing. The level of impairment depends on the type and severity of injury in conjunction with medical-social factors. An Injury Impairment Scale (IIS) similar to the Abbreviated Injury Scale (AIS) is proposed, with severity codes of 0-6 like the AIS. The criteria of Mobility/Dexterity, Cognitive/Psychological, Cosmetic/Disfigurement, Sensory, Pain, and Sexual/Reproduction are used for coding impairment resulting from injury. Methods for determining whole body impairment (WBI) are discussed. Use of the highest impairment code on any criterion is suggested at this time to assign WBI. Disability depends on a patient's impairment and ability to accommodate the impairment. Factors such as education, past employment, family and community support, and personal and community resources play a role in the patient's ability to accommodate an impairment, fulfill the activities of daily living, socialize, and be productively employed. An Injury Disability Scale (IDS) and method of determining disability from impairment is proposed. Three patient case studies utilizing the proposed coding systems are presented. Validation of the injury impairment and disability scales will require in-depth evaluation by several institutes and medical facilities with large databases that include adequate follow-up examination information. This paper addresses the concepts for injury, impairment, and disability scaling and establishes a framework to undertake injury control research.

Disability Evaluation↗
PubMed1990

Psychiatric disorders and motor vehicle accidents.

The literature has often suggested a relationship between psychiatric illness and increased risk for motor vehicle accidents but few data exist, particularly those from prospective or case-controlled studies. The present study examined detailed accident and injury data from a large series (N = 1778) of motor vehicle crashes that included persons with diagnoses of psychiatric illnesses (n = 17); matched controls were also studied. As expected, drivers with psychiatric diagnoses used psychotropic medications more frequently than did controls. Drivers with psychiatric diagnoses did not have more frequent single-car crashes, unsafe speed or failure to yield violations, or less restraint use than did controls. Such drivers did less often drive motorcycles and tended to be less often cited for alcohol use. Implications of these results for efforts toward prevention and for further study are discussed.

Accidents, Traffic↗
PubMed1989

The role of the orthopedist in injury prevention.

Injury is an endemic disease process that is a leading cause of death and the leading cause of disability in the United States today. Among physicians, the orthopedic surgeon is most likely to be consulted by injured patients. Traditionally, orthopedists have played an important role in injury prevention as exemplified by the field of sports medicine. Three mechanisms have been demonstrated to be effective means of controlling the injury problem: (1) persuading persons at risk of injury to alter their behavior; (2) requiring individual behavior changes by law or administrative rule; and (3) providing automatic protection by product and environmental design. Specific strategies for implementing injury-prevention programs by the orthopedic surgeon are physician education, patient education, and public education.

Environment Design↗
PubMed1987

Fatal injuries caused by underarm use of shoulder belts.

Safety belt use has dramatically increased in the past decade in North America because of safety belt use laws. Underarm use of shoulder belts is a means of relieving neck irritation and other complaints from shoulder belts but may result in serious or fatal injuries. Loads far in excess of the injury tolerance of the lower chest and upper abdomen are imposed by the shoulder belt in the underarm position. Six recent cases are presented in which fatal injury was caused by underarm use of shoulder belts. Lacerations of the liver, spleen, intestines, mesentery, diaphragm, and aorta, and spine injury have occurred in accidents, most of which should have been survivable. The motoring public must be warned that underarm use of shoulder belts is hazardous and may cause fatal injuries in otherwise survivable accidents.

Accidents, Traffic↗
PubMed1987

The prevention of injury secondary to motor vehicle accidents.

Motor vehicle accidents are a common cause of death for all age groups but are the most serious threat to life for patients aged one to 34 years. Major progress has been made in reducing these losses through improved highway design, improved laws, adjudication of laws controlling the drunk driver, and the advent of vehicle safety design standards. A federal law enacted in 1966 established the National Highway Traffic Safety Administration (NHTSA) and the Federal Motor Vehicle Safety Standards (FMVSS). Motor vehicles, particularly passenger cars, now provide effective protection for occupants because of vehicle safety design features required by the FMVSS. Safety belts are the single most effective safety device available and are required equipment in virtually all motor vehicles sold in the United States. Passive protection for nonusers of safety belts is rapidly improving with the availability of air bags and automatic belt systems, improved windshields, steering wheels, dashboards, and seats, and other vehicle crashworthiness features. Motorcyclists, bicyclists, and pedestrians are also provided with improved protection because of the FMVSS.

Accidents, Traffic↗
PubMed1979

Femoral shaft perforation: a complication of total hip reconstruction.

Perforation of the femoral shaft by the stem of the prosthesis is a rare, but serious complication following total hip replacement. It is a complication that is avoidable if meticulous attention is given to preoperative planning and intraoperative technique. The major predisposing factors for this complication are previous hip surgery, hip dysplasia, osteoporosis and poor exposure. Every attempt should be made to discover a perforation during surgery and to correct the alignment of the femoral stem. The patients who have experienced this complication have had a poor result suffering pain, loosening or femoral shaft fracture necessitating surgical revision.

Aged↗
PubMed1978

Cervical fractures and fracture-dislocations sustained without head impact.

Because of its flexibility and structure, the cervical spine is disposed to various mechanisms of injury: although not so common as injuries caused by head impacts, cervical fractures and/or fracture-dislocations have been reported without direct impact to the head. Some cervical injuries reported have been sustained by wearers of lap and shoulder belts in auto accidents; however, we do not consider belt use a potential hazard because ample evidence has accrued in the medical and engineering literature to document general injury and fatality reduction by use of seatbelts. We believe that in many instances occupants would be more seriously injured or killed were belts not worn. The present paper reviews reports of cervical injuries without head impact found in the literature and case histories of such injuries from the Highway Safety Research Institute of The University of Michigan, as well as experimental studies in animals, cadavers, and volunteer subjects.

Accidents, Traffic↗