A QUANTITATIVE TEST OF UPPER EXTREMITY FUNCTION.
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Today in Brazil the "Hospital Internment Authorizations" (AIH) represents about 80% of the total internments in the country and constitutes a data base of easy access available in CD-ROM. This high coverage allows one to draw a reasonable picture, close to reality, of the morbidity demanding hospitalization. Among the causes there is the diagnostic category lesions and poisonings noteworthy for severity and frequency. Hospital internments by this diagnostic category occurring in a month in 1994 have been focused on. Some epidemiological and hospital use characteristics, such as demographic aspects, specific diagnostic category, length of stay and mortality are described. It was observed that lesions and poisonings accounted for 5% to 6% of all hospital internments in the country, being predominantly among men under 65 of age. This diagnostic category was the first cause of hospital internments among men of from 15 to 29 years of age. Fractures were the most frequent specific diagnosis (about 37.5%), almost all of them involving members (legs or arms). The injuries were mainly located in hands, arms, head and neck and occurred predominantly among young men, leading to the believe that they were due to work or traffic accidents. Regarding burns, the fragment occurrence among children under 5 years of age is worthy of note. The authors lament the lack of information as to their causes such as would enable appropriate preventive actions to be taken.
The injuries in 90 patients caused by rubber bullets are described. There was 1 death and 17 people in the series had permanent disabilities or deformities. In 41 patients the injuries necessitated admission to hospital. One fatality outside this series is known. Injuries to the head and neck were frequent and severe.
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Injuries trends of passenger car drivers in head-on collisions are identified based on crash data extracted from the National Automotive Sampling System. Annual injury incidence levels are estimated for years 1990-2007. Over that period, the number of crashes is predicted to rise by 71%. However, the number of serious injuries to drivers is expected to rise by only 41% and driver fatalities are anticipated to decrease by 9%. Meantime, the types of injuries suffered by drivers are changing. Year-to-year shifts in injury patterns result from changes in vehicle size classes within the US vehicle fleet population and increases in seat belt use and air bag availability. The effectiveness of air bags in saving lives is estimated to be 30%, and with more air bag-equipped cars on the road, the probability of sustaining a life-threatening head or a torso injury is reduced. Air bags, however, are not as effective in preventing upper and lower extremity injuries, and thus arm and leg injuries will become more prevalent in years to come.
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Although upper-extremity injuries alone are usually not life-threatening, they can produce significant immediate or long-term morbidity, especially if there is an associated nerve injury. The diagnosis of an arterial injury may be readily apparent, but the excellent upper-extremity collateral circulation may create palpable distal pulses despite a significant proximal arterial injury. Therefore, a high index of suspicion and the liberal use of arteriography are necessary to avoid missing these injuries. Compression of the brachial plexus by a hematoma can produce a serious neurologic deficit. Prompt evacuation of the hematoma may significantly reduce the deficit, another fact that supports an aggressive surgical approach in these patients. The long-term results of upper-extremity vascular injuries are usually determined by the extent of any associated nerve injuries.
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