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PubMed2025

GRUMB: a genome-resolved metagenomic framework for monitoring urban microbiomes and diagnosing pathogen risk.

SUMMARY: Urban infrastructure hosts dynamic microbial communities that complicate biosurveillance and AMR monitoring. Existing tools rarely combine genome-resolved reconstruction with ecological modeling and batch-aware analytics tailored to infrastructure-scale studies. We present GRUMB (Genome-Resolved Urban Microbiome Biosurveillance), an open-source, SLURM-compatible pipeline that reconstructs high-quality metagenome-assembled genomes (MAGs) from shotgun sequencing reads and integrates taxonomic/functional annotation (CARD, VFDB), batch-aware normalization, ecological diagnostics and machine learning classification of environment types with uncertainty and risk scoring. GRUMB accepts either SRA project accessions or paired-end FASTQ files with metadata, and produces assemblies, MAGs, taxonomic and functional profiles, ecological outputs and risk-informed classification. Its modular design enables reproducible, infrastructure-scale biosurveillance across diverse environments. AVAILABILITY AND IMPLEMENTATION: GRUMB is freely available under the MIT License at: https://github.com/SuleimanAminu/genome-resolved-urban-microbiome-biosurveillance; Zenodo DOI: https://doi.org/10.5281/zenodo.15505402. Requirements: Linux (Ubuntu 20.04+), Python 3.11, R 4.2+, SLURM. Issues and feature requests are tracked on GitHub.

Microbiota↗

PubMed1991

[Sound localization in patients with asymmetrical hearing loss].

Good directional hearing ability demands good and symmetrical hearing in both ears. We report the effect of impaired hearing on the directional hearing ability of 98 patients, especially of patients with bilateral asymmetrical hearing loss. The directional testing device included 12 loudspeakers placed at 30 degree intervals in a circle with a diameter of 3.25 m, whose centre lay between the ears of the patient. In included an audiometer for producing the signals, an amplifier and a PDP11/23 computer interfaced to a loudspeaker switch bank. The subject's answers to 60 directionally randomized stimuli were recorded. During the presentation of the signal the patients were not allowed to turn their head. The patients had to name the number of the loudspeaker on the circle that they thought was producing the sound. In addition to the directional hearing test a pure-tone audiogram was done, and the middle- and high-frequency hearing loss estimated. The records of the directional hearing test were analysed in two new ways: firstly, vector analysis of the errors; secondly, averaging of the difference between the true interaural time delay and the virtual time difference, which was implicated in the possibly incorrect answer of the patient (effective delta-t-parameter). This average gives a score for the uncertainty in defining the correct "cone of confusion". In addition to the statistical analysis, two cases are reported showing the directional hearing ability of two patients with neuromas treated by transtemporal surgery, with some residual hearing.(ABSTRACT TRUNCATED AT 250 WORDS)

Audiometry↗

PubMed1987

Intimacy motivation and subjective mental health in a nationwide sample.

Over 1,200 adults in a representative nationwide sample were administered the Thematic Apperception Test (TAT) and an unstructured interview which produced 25 measures of subjective mental health and ultimately six factor scores: unhappiness, lack of gratification, strain, feelings of vulnerability, lack of self-confidence, and uncertainty. The TATs were scored for intimacy motivation (McAdams, 1980)--a recurrent preference or readiness for experiences of warm, close, and communicative interaction with others. Controlling for age, education, and their interaction, high intimacy motivation in women was associated with greater happiness and gratification, whereas in men it was associated with lack of strain and lack of uncertainty. Women high in intimacy motivation who were living alone reported lower levels of gratification and more uncertainty in their lives than other women. Intimacy motivation also declined significantly over the life span for women, but not for men. Finally, demographic effects on intimacy motivation were examined. Controlling for age, education, and their interaction, professional men (e.g., doctors, lawyers, and teachers) scored higher on intimacy motivation than did men in other occupational categories, while among women the occupational groups with highest intimacy motivation were service workers and craftspersons.

Adaptation, Psychological↗

PubMed2003

Health-related quality-of-life outcomes of sirolimus-treated kidney transplant patients after elimination of cyclosporine A: results of a 2-year randomized clinical trial.

BACKGROUND: This study compared 2-year health-related quality-of-life (HRQL) outcomes of sirolimus (SRL)-treated kidney transplant patients after elimination of cyclosporine A (CsA) to patients continuing on a combined CsA and SRL regimen. METHODS: A randomized, open-label, clinical trial was performed in Europe, Australia, and Canada. Four hundred thirty kidney transplant patients were randomly assigned to sirolimus plus steroids (ST) (n=215) or SRL and CsA+ST (n=215) therapy after 3 months of combined SRL+CsA+ST treatment. HRQL was measured using the Kidney Transplant Questionnaire (KTQ) and the SF-36 Health Survey at month 3 (time of randomization) and months 12 and 24 after transplantation. Repeated-measures analysis of covariance was used to evaluate treatment differences in HRQL scores over the 2-year period. RESULTS: HRQL scores were available for 361 (86%) eligible study patients. Statistically significant treatment-by-assessment time interactions, favoring SRL+ST, were found on KTQ Fatigue (P=0.0158) and Appearance scores (P=0.0007). No treatment differences were observed in KTQ Physical Symptom, Uncertainty-Fear, and Emotion scores. Statistically significant treatment-by-assessment time interactions were observed for SF-36 Vitality scores (P=0.0203) but not other SF-36 scores (P>0.05). For Vitality scores, the SRL+ST group remained stable (mean, 0.4-point change) from month 3 to month 24 compared with decreases in the SRL+CsA+ST group (mean, -6.5-point change). CONCLUSIONS: SRL-based therapy with early elimination of CsA results in fewer appearance-related problems, less fatigue, and better vitality compared with continuous treatment with SRL, CsA, and ST.

Adult↗

PubMed1988

Injury severity scoring: influence of timing and nurse raters on accuracy.

The Abbreviated Injury Scale (AIS) and its incorporation into the Injury Severity Score (ISS) have become accepted as objective ways to quantitate the severity of trauma. To examine the practicality of using critical care nurses to initiate injury scoring within the first 24 hours of admission, a prospective study was undertaken. Nurses on the trauma intensive care unit were asked to calculate the ISS in patients admitted to the unit over a 4-month period. Scoring was completed within 24 hours of admission and recorded on an edited single-page chart constructed from the 1980 revision of the AIS. All patients were followed up until discharge, and the ISS was reviewed in the light of discharge diagnoses. One hundred four patients were studied, and accurate scores were calculated in 54 patients (51.9%). In three patients (2.9%) the single-page chart did not allow accurate scoring, and in 18 patients (17.3%) the diagnoses noted subsequent to the scoring time frame resulted in inaccuracy. Human errors resulted in inaccuracy in 28% of patients. In comparison with a concurrent study involving surgical residents, human error rates were similar. However, scoring within 24 hours, as opposed to 72 hours, resulted in significantly more errors related to diagnostic uncertainty. Initiation of the scoring process soon after admission, with subsequent correction during the hospital course, allows important information to be available at the earliest time.

Clinical Competence↗

PubMed2005

Tracking quasi-stationary flow of weak fluorescent signals by adaptive multi-frame correlation.

We have developed a novel cross-correlation technique to probe quasi-stationary flow of fluorescent signals in live cells at a spatial resolution that is close to single particle tracking. By correlating image blocks between pairs of consecutive frames and integrating their correlation scores over multiple frame pairs, uncertainty in identifying a globally significant maximum in the correlation score function has been greatly reduced as compared with conventional correlation-based tracking using the signal of only two consecutive frames. This approach proves robust and very effective in analysing images with a weak, noise-perturbed signal contrast where texture characteristics cannot be matched between only a pair of frames. It can also be applied to images that lack prominent features that could be utilized for particle tracking or feature-based template matching. Furthermore, owing to the integration of correlation scores over multiple frames, the method can handle signals with substantial frame-to-frame intensity variation where conventional correlation-based tracking fails. We tested the performance of the method by tracking polymer flow in actin and microtubule cytoskeleton structures labelled at various fluorophore densities providing imagery with a broad range of signal modulation and noise. In applications to fluorescent speckle microscopy (FSM), where the fluorophore density is sufficiently low to reveal patterns of discrete fluorescent marks referred to as speckles, we combined the multi-frame correlation approach proposed above with particle tracking. This hybrid approach allowed us to follow single speckles robustly in areas of high speckle density and fast flow, where previously published FSM analysis methods were unsuccessful. Thus, we can now probe cytoskeleton polymer dynamics in living cells at an entirely new level of complexity and with unprecedented detail.

Actins↗

PubMed1995

Beyond posttraumatic stress disorder: object relations and reality testing disturbances in physically and sexually abused adolescents.

OBJECTIVE: To evaluate posttraumatic stress disorder (PTSD) symptom severity, object (interpersonal) relations disturbances, and reality testing disturbances in a sample of physically and sexually abused adolescents. METHOD: Subjects were 37 students, 16 boys and 21 girls, enrolled at a private, residential school for children with various conduct problems. Students completed several psychological tests, including the Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) and the Bell Object Relations and Reality Testing Inventory. RESULTS: Of the 37 students, 22 (59.5%) had CPTSD-RI scores in the severe and the very severe ranges. The most common object relations and reality testing disturbances were insecure attachment and uncertainty of perception, respectively. CPTSD-RI scores were positively correlated with two of the four object relations scores (insecure attachment and egocentricity) and with all three reality testing scores (reality distortion, uncertainty of perception, and hallucinations/delusions). Mean CPTSD-RI scores were higher for students whose abuse had involved sex (sexual and physical abuse, sexual abuse only) than they were for students whose abuse had been physical only. Alienation and social incompetence, the two object relations disturbances not correlated with PTSD symptom severity, were associated with having experienced abuse at an early age and having been abused by a parent or stepparent (versus a nonparent). CONCLUSION: To address more effectively the long-term difficulties associated with child maltreatment, clinicians and clinician-investigators ought to evaluate interpersonal and reality testing disturbances, as well as PTSD symptom severity.

Adolescent↗

PubMed1998

Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial.

OBJECTIVE: To assess the medical and psychosocial effects of early hospital discharge after surgery for breast cancer on complication rate, patient satisfaction, and psychosocial outcomes. DESIGN: Randomised trial comparing discharge from hospital 4 days after surgery (with drain in situ) with discharge after drain removal (mean 9 days in hospital). Psychosocial measurements performed before surgery and 1 and 4 months after. SETTING: General hospital and cancer clinic in Rotterdam with a socioeconomically diverse population. SUBJECTS: 125 women with operable breast cancer. MAIN OUTCOME MEASURES: Incidence of complications after surgery for breast cancer, patient satisfaction with treatment, and psychosocial effects of short stay or long stay in hospital. RESULTS: Patient satisfaction with the short stay in hospital was high; only 4% (2/56 at 1 month after surgery and 2/52 at 4 months after surgery) of patients indicated that they would have preferred a longer stay. There were no significant differences in duration of drainage from the axilla between the short stay and long stay groups (median 8 v 9 days respectively, P=0.45) or the incidence of wound complications (10 patients v 9 patients). The median number of seroma aspirations per patient was higher for the long stay group (1 v 3.5, P=0.04). Leakage along the drain occurred more frequently in short stay patients (21 v 10 patients, P=0.04). The two groups did not differ in scores for psychosocial problems (uncertainty, anxiety, loneliness, disturbed sleep, loss of control, threat to self esteem), physical or psychological complaints, or in the coping strategies used. Before surgery, short stay patients scored higher on scales of depression (P=0.03) and after surgery they were more likely to discuss their disease with their families (at 1 month P=0.004, at 4 months P=0.04). CONCLUSIONS: Early discharge from hospital after surgery for breast cancer is safe and is well received by patients. Early discharge seems to enhance the opportunity for social support within the family.

Breast Neoplasms↗

PubMed2000

Medical students' attitudes toward pain and the use of opioid analgesics: implications for changing medical school curriculum.

BACKGROUND: Barriers to pain management include physicians' lack of knowledge and attitudes. Our aim was to investigate future physicians' knowledge and attitudes toward pain and the use of opioid analgesics. METHODS: We tested a medical school class during their freshman and senior years. Stepwise regression analysis was used to identify the personal traits that predicted opiophobia. RESULTS: The professionalization process of medical training may reinforce negative attitudes. Psychologic characteristics were associated with reluctance to prescribe opioids, and fears of patient addiction and drug regulatory agency sanctions. CONCLUSIONS: Consistent attitudes were found in senior medical students with preferences for certain specialty areas and the practitioners of their future specialties, suggesting a "preselection" effect. Higher scores on reliance on high technology, external locus of control, and intolerance of clinical uncertainty were associated with higher scores on one or more of the three dimensions of opiophobia. Implications for medical education are discussed.

Acute Disease↗

PubMedDate not supplied

Uncertainty in prostate cancer. Ethnic and family patterns.

PURPOSE: Prostate cancer occurs 37% more often in African-American men than in white men. Patients and their family care providers (FCPs) may have different experiences of cancer and its treatment. This report addresses two questions: 1) What is the relationship of uncertainty to family coping, psychological adjustment to illness, and spiritual factors? and 2) Are these patterns of relationship similar for patients and their family care givers and for whites and African-Americans? DESCRIPTION OF STUDY: A sample of white and African-American men and their family care givers (N = 403) was drawn from an ongoing study, testing the efficacy of an uncertainty management intervention with men with stage B prostate cancer. Data were collected at study entry, either 1 week after post-surgical catheter removal or at the beginning of primary radiation treatment. Measures of uncertainty, adult role behavior, problem solving, social support, importance of God in one's life, family coping, psychological adjustment to illness, and perceptions of health and illness met standard criteria for internal consistency. Analyses of baseline data using Pearson's product moment correlations were conducted to examine the relationships of person, disease, and contextual factors to uncertainty. RESULTS: For family coping, uncertainty was significantly and positively related to two domains in white family care providers only. In African-American and white family care providers, the more uncertainty experienced, the less positive they felt about treatment. Uncertainty for all care givers was related inversely to positive feelings about the patient recovering from the illness. For all patients and for white family members, uncertainty was related inversely to the quality of the domestic environment. For everyone, uncertainty was related inversely to psychological distress. Higher levels of uncertainty were related to a poorer social environment for African-American patients and for white family members. For white patients and their family members, higher levels of uncertainty were related to lower scores on adult role behavior (shopping, running errands). For white family members, higher levels of uncertainty were related to less active problem solving and less perceived social support. Finally, higher levels of uncertainty were related to the importance of God for white patients and family care providers. CLINICAL IMPLICATIONS: The clearest finding of the present study is that there are ethnic differences in the relationship of uncertainty to a number of quality-of-life and coping variables. This has immediate implications for the assessment of psychosocial responses to cancer and cancer treatment. Much of what is in curricula is based on clinical and research experience primarily with white individuals. The experience of uncertainty related to cancer and its treatment is influenced by the cultural perspectives of patients and their families. To assist patients and families with the inevitable uncertainties of the cancer experience, healthcare providers need to reconsider their ethnocentric assumptions and develop more skill in assessing patient and family beliefs, values, cultural perspectives, and the influence of these on patient and family uncertainties.

Adaptation, Psychological↗

PubMed2006

Insulin dynamics predict body mass index and z-score response to insulin suppression or sensitization pharmacotherapy in obese children.

OBJECTIVE: To assess the use of oral glucose tolerance testing (OGTT) to predict efficacy of insulin sensitization (metformin) or suppression (octreotide) because insulin resistance and insulin hypersecretion may impact pharmacotherapeutic efficacy in obese children. STUDY DESIGN: Forty-three and 24 obese children, with and without central nervous system (CNS) insult, underwent OGTT. Insulin sensitivity was expressed as composite insulin sensitivity index (CISI), and secretion as corrected insulin response (CIRgp). Those without CNS insult received metformin (weight-based dosing) for 6 to 16 months. Those with CNS insult received octreotide SQ 15 microg/kg/d for 6 months. Body mass index (BMI) and z-score responses were modeled using CIRgp and CISI. RESULTS: Metformin: With CIRgp and CISI = 1, BMI z-score in white children declined by 0.23 over the first 4 months (P < .001), and by 0.14 over the next year (P = .33). Each 2-fold increase in CIRgp or CISI attenuated BMI z-score reduction, but with wide uncertainty (P = .24). Black children exhibited little response. Octreotide: With CIRgp and CISI = 1, BMI z-score decreased by 0.23 in the first 4 months (P = .052). Efficacy was dependent on an interaction between CIRgp and CISI (P = .051). CONCLUSIONS: Efficacy of metformin was predicted by pretreatment insulin resistance. Efficacy of octreotide was predicted by insulin hypersecretion and sensitivity.

Adolescent↗

PubMed1999

Women's uncertainties, coping, and moods regarding abnormal papanicolaou results.

The overall purpose of this study was to understand the process of coping with the news of abnormal cervical cancer screening results. The specific aims were (1) to compare women's uncertainty about the implications of abnormal Papanicolaou (Pap) tests and women's psychological distress over time and (2) to describe relationships among uncertainty, perceived coping ability, coping strategies that were used and helpful, and psychological distress. Seventy-five women were interviewed using standardized measures after hearing the news of their abnormal Paps tests; 40 completed similar questionnaires before follow-up colposcopy, and 35 of these also completed questionnaires after colposcopy. Women's uncertainty about abnormal Pap test results decreased over time. Negative mood scores, reflecting psychological distress, did not change over time. Uncertainty about Pap tests, ambiguity about cancer, and perceived inability to deal with Pap test results were related positively. Uncertainty was related positively to the coping strategy of catharsis as well as to negative mood scores both after receiving the news and precolposcopy. Catharsis was associated with higher negative mood scores, but acceptance was associated with lower negative mood scores. The helpfulness of relaxation and diversion was associated with lower negative mood scores. Clinical interventions can address women's uncertainty and promote coping strategies to reduce psychological distress among women with abnormal cervical cancer screening results.

Adaptation, Psychological↗

PubMed2005

Laparoscopic management of cryptorchidism in adults.

OBJECTIVES: Little is reported on the management of impalpable testis in adults. We present the impact of laparoscopy in this patient group. PATIENTS AND METHODS: Twelve adult patients have been referred to our centre over the last year, with impalpable testis. Pre-operative assessment was by either ultrasound or magnetic resonance imaging (MRI) or both. Quality of life and patient satisfaction were assessed by validated SF8 and client satisfaction (CSQ-8) questionnaires. Patients were also administered a self constructed questionnaire specifically looking at the impact of a laparoscopic service on their condition. RESULTS: The mean age was 29 yrs (range: 19-36). Two patients declined treatment. Of ten patients undergoing transperitoneal laparoscopy, five had intra-abdominal testes treated by laparoscopic orchidectomy (none malignant), two had the vas going into the deep ring and needed inguinal orchidectomy for an impalpable nubbin while in three cases there were blind ending vessels and vas. SF8 scores for physical HRQoL were unchanged but mental scores were significantly improved (p < 0.03). All patients were completely satisfied with a mean CSQ-8 score of 30.6 out of a possible 32. The majority of patients indicated that the availability of a laparoscopic service had prompted them to seek medical advice. CONCLUSIONS: Laparoscopic examination and orchidectomy is a safe and reliable procedure. Excellent patient satisfaction and quality of life are achievable. In particular mental health scores improve as previous uncertainty is removed. The advent of laparoscopy has encouraged adult patients to seek advice regarding a condition that has been present since childhood. We advocate the use of laparoscopy in evaluating and treating adult patients with maldescended testes.

Adult↗

PubMed2005

[Diagnosis and treatment of acute pancreatitis].

In patients with abdominal pain, an acute pancreatitis is likely when lipase is elevated more than 3-fold above normal. The diagnosis should be confirmed by an imaging technique (either sonography or CT). The determination of the severity is difficult as all methods (laboratory values, imaging systems, scores) exhibit a significant uncertainty. The regular clinical investigation of the patients is still needed. In contrast to a severe course, in mild or moderate disease the treatment of the patient in an intensive care unit is not obligatory. In biliary pancreatitis the extraction of biliary stones after papillotomy is indicated and in severe disease the procedure should be done without delay. Meanwhile enteral nutrition is standard treatment although the data are not completely convincing. Further measures are administration of pain killers, volume substitution and treatment of pulmonary and renal failure. Although data are not completely clear the prophylactic administration of antibiotics in necrotizing pancreatitis is routine. Puncture of the necrosis may be used to detect the responsible microorganisms. In patients with infected necrosis who deteriorate during conservative treatment, necrosectomy may be an option. There is a tendency to postpone the operation until the necrosis can be clearly separated from non-necrotic tissue. Although a specific pharmacological agent for the treatment of pancreatitis is still not available, the above procedure has led to a significant reduction of mortality in patients with severe acute pancreatitis.

Abdominal Pain↗

PubMed2005

Integrated versus sealed-over recovery in schizophrenia: BORRTI and executive function.

Ego functioning of 222 outpatients with a diagnosis of schizophrenia or schizoaffective disorder was evaluated using the Bell Object Relations and Reality Testing Inventory (BORRTI). Sixty-one of these had BORRTI profiles identified as sealed-over recovery style, and 36 had profiles interpreted as integrated recovery style. Groups were compared on demographic characteristics, symptom profiles, and the Wisconsin Card Sorting Test, a performance measure of executive function. Groups had comparably low levels of positive symptoms, but the integrated recovery group had higher scores on the BORRTI uncertainty of perception scale. The integrated recovery group had significantly fewer minority patients, higher IQ, and higher levels of emotional discomfort. The sealed-over recovery group had higher levels of cognitive disorganization. When differences in ethnicity and IQ were controlled for, the integrated recovery group had better executive functioning. Wisconsin Card Sorting Test categories completed emerged as the significant predictor in a logistic regression, explaining 19% of the variance. These findings support the discriminant validity of these two recovery styles and reveal the importance of executive function in a recovery style that allows for investment in relationships, affect tolerance, and acknowledgment of symptoms.

Adaptation, Psychological↗

PubMed2006

Validity of verbal autopsy procedures for determining cause of death in Tanzania.

OBJECTIVES: To validate verbal autopsy (VA) procedures for use in sample vital registration. Verbal autopsy is an important method for deriving cause-specific mortality estimates where disease burdens are greatest and routine cause-specific mortality data do not exist. METHODS: Verbal autopsies and medical records (MR) were collected for 3123 deaths in the perinatal/neonatal period, post-neonatal <5 age group, and for ages of 5 years and over in Tanzania. Causes of death were assigned by physician panels using the International Classification of Disease, revision 10. Validity was measured by: cause-specific mortality fractions (CSMF); sensitivity; specificity and positive predictive value. Medical record diagnoses were scored for degree of uncertainty, and sensitivity and specificity adjusted. Criteria for evaluating VA performance in generating true proportional mortality were applied. RESULTS: Verbal autopsy produced accurate CSMFs for nine causes in different age groups: birth asphyxia; intrauterine complications; pneumonia; HIV/AIDS; malaria (adults); tuberculosis; cerebrovascular diseases; injuries and direct maternal causes. Results for 20 other causes approached the threshold for good performance. CONCLUSIONS: Verbal autopsy reliably estimated CSMFs for diseases of public health importance in all age groups. Further validation is needed to assess reasons for lack of positive results for some conditions.

Adolescent↗

PubMed2006

Preliminary testing of a just-in-time, user-defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions.

OBJECTIVE: To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. DESIGN: Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. SAMPLE: Fifty-one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. INTERVENTION: A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. OUTCOMES: Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). RESULTS: Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. CONCLUSIONS: A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients.

Adult↗

PubMed1994

[Criteria for legal assessment of rotator cuff rupture].

The judgement of the correlation between an accident and a rotator cuff tear has an important role in legal and private accident insurance. Owing to the high morbidity of degenerative alterations and ruptures of the rotator cuff tendons, the causality of an acute traumatic rupture can be difficult to demonstrate, which means assessments are often controversial. In a retrospective study we evaluated 25 orthopaedic assessments and tried to find rules for an objective estimation. The judgement of correlation between trauma and rotator cuff tear should be based on four pillars: history, trauma mechanism, initial findings and course of the functional deficit. Possible mechanisms of traumatic rupture are discussed from various angles. Important clinical findings, e.g. a functional supraspinatus deficit, should be fully documented. X-Rays of both shoulders can lead to indirect demonstration of preexistent changes in the rotator cuff. Sonographic evaluation can show up the rotator cuff tear and demonstrate signs of acute injury. After persistent pain and functional deficit, in a few cases operative and microscopic findings will lead to a correct estimate of causality. Because of the diagnostic uncertainty a 20-point score is introduced for retrospective assessment of the history (2 points), trauma mechanism (3 points), initial clinical, radiological and sonographic findings (10 points) and course of functional deficit (5 points) to evaluate the role of trauma in rotator cuff tears. Using this score trauma can be classified as the main or partial cause or as irrelevant to the pathogenesis of rotator cuff tears.

Adult↗