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PubMed2003

Morbidity associated with four-wheel all-terrain vehicles and comparison with that of motorcycles.

BACKGROUND: The U.S. Consumer Product Safety Commission in their annual report (2001) of all-terrain vehicle (ATV) deaths and injuries concluded that in the late 1990s there had been a gradual increase in the number of deaths and injuries related to ATV collisions. The objective of our study was to describe the morbidity of four-wheel all-terrain vehicle collisions (ATVCs) and compare them with motorcycle collision (MCC) victims. METHODS: This was a 24-month (April 2000-November 2002) retrospective review of all trauma patients admitted. Statistical significance was defined at p < 0.05. RESULTS: A total of 2,380 blunt trauma patients were admitted, of which 74 (3.1%) were ATVC victims and 169 (7.1%) were MCC victims. The average age was 23.9 +/- 9.4 years for ATVC victims and 29.1 +/- 11.5 years (p < 0.001) for MCC victims. The median Injury Severity Score was 16.0 for the ATVC group and 13 for the MCC group (p = 0.106). ATVC patients had a higher incidence of head and neck injuries (56%) than MCC patients (30%) (p < 0.001). The incidence of chest and abdominal injuries was similar between groups. Mortality occurred in 15 of 74 (20%) ATVC patients and 24 of 169 (14.2%) MCC patients (p = 0.236). CONCLUSION: This study demonstrates that ATVCs are associated with significant morbidity and mortality. When compared with MCCs, ATVCs have similar mortality and a much higher incidence of head injuries. National tracking of ATVCs should be continued and improved in an effort to assist legislators in enacting laws protecting the riders of ATVs.

Accidents↗
PubMed1994

Trampolines in New Zealand: a decade of injuries.

Despite international concern about the safety of trampolines, they have become increasingly popular in New Zealand. While internationally attention has centred on a relatively few cases of catastrophic cervical spine injury, little research effort has been directed at placing these incidents in a wider context. To redress this, a descriptive epidemiological study of trampoline-related injury in New Zealand was undertaken. National hospitalization and mortality data for a 10-year period revealed 2098 hospitalizations and two deaths. The incidence rate for hospitalizations increased from 3.1 per 100,000 population per year in 1979 to 9.3 in 1988. Of the hospitalized victims, 71% were injured on home trampolines and 80% fell from the trampoline to the surrounding surface. Fractures were the commonest type of injury (68%), and the body site most frequently involved was the upper limb (53%). There was no evidence of a high incidence of severe head and neck injuries. It was concluded that, although existing trampoline standards addressed many of the issues raised by this research, measures to reduce the impact of falls from trampolines to the ground and to prohibit the provision of trampolines as 'play equipment' are required.

Accidental Falls↗
PubMed1994

[Reliability of registration of multi-trauma patients].

OBJECTIVE: Evaluation of the reliability of diagnostic codification by the Medical Codification Department (MCD) as a method of national hospital identification of multiple injury patients and description of epidemiology and mortality among the multiple injury group studied. DESIGN: Prospective/retrospective and descriptive. SETTING: Free University Hospital, Amsterdam. METHOD: The injuries of 207 severely injured patients presented at the Accident and Emergency department during the year 1992, were coded as an Injury Severity Score (ISS). Those having an ISS > or = 18 were reviewed on cause and outcome of the injury. The diagnose for codification (International Classification of Diseases-9 Clinical Modification) of the MCD, from which an Abbreviated Injury Score (AIS) and the ISS can be calculated, was evaluated. RESULTS: 24 out of the 207 severely injured patients were transferred to other hospitals after stabilisation because of lack of room. Of the remaining 183 patients 124 had an ISS > or = 18.44 (35%) patients died during their stay in hospital. 21 (48%) of them died within 2 hours. 28 (64%) multiple injury patients died during the first 24 hours after admission. Neurological damage was the main cause of death (59%), followed by exsanguination (30%). A traffic accident was the cause of the injuries in 61% and a fall or jump in 27%. The mean ISS of these patients was 29 and the maximum score was 66. Head and neck injuries were present in 80% of the patients. The codification of brain damage by the MCD resulted in several mistakes. Brain damage in multiple injury cases results in a high AIS. Since the ISS is calculated by multiplication of AIS values, small differences in AIS create considerable variations in ISS. CONCLUSION: Multiple injury patients need fast and adequate help because of the high mortality, especially in the first 24 hours. The diagnostic codification of the MCD was found not reliable enough to be used for a hospital identification and registration of multiple injury patients.

Abbreviated Injury Scale↗
PubMed2005

Gridiron football injuries.

OBJECTIVE: To review the available football epidemiology literature to identify risk factors, facilitate injury prevention and uncover deficiencies that may be addressed by future research. DATA SOURCES: A literature search of Sports Discus (1940-2003), Eric (1967-2003), EMBASE (1988-2003), MEDLINE (1966-2003), CINAHL (1984-2003), and Web of Science (1993-2003) identified the published articles on American football in athletes of high school age and younger. MAIN RESULTS: Injury rate increases with the level of play (grade in school), player age, and player experience. The lower extremity (knee and ankle joints) is most frequently injured. Football injuries are much more common in games than in practice, and occur to players who are being tackled, tackling or blocking. Most injuries are mild, including contusion, strain and sprain. Rule changes with the prohibition of initial contact with the helmet or face-mask reduced catastrophic head and neck injuries. CONCLUSION: Although no sport or recreational activity is completely risk-free, football epidemiology research is critical to injury prevention. The existing medical literature provides some valuable insights, but an increased emphasis on prospective research is required to test the efficacy of preventative measures. Quality research may contribute to a reduction in football injury risk by defining the role of player conditioning and strength training, coaching of safety fundamentals, avoidance of dangerous activities, as well as proper medical supervision and care. Sports medicine personnel, coaches, and officials must strive to minimize injuries through progressive education, improved coaching techniques, effective officiating, and equipment modifications.

Adolescent↗
PubMed1995

Review of typical ice hockey injuries. Survey of the North American NHL and Hockey Canada versus European leagues.

Ice hockey is considered to be one of the fastest and roughest of all sports. Prospective injury reports of the North American National Hockey League, the Canadian Amateur Hockey Association and of several European teams (UdSSR, CSSR, Sweden and Switzerland) are reviewed to evaluate the patterns, anatomic locations, circumstances and sequelae of ice hockey-related injuries. Although different injury reporting systems are used in North America and Europe, knee injuries (sprains of the collateral ligaments) accounted for the majority of games missed (40%), followed by injuries to the shoulder (dislocation, acromio-clavicular joint separation, rotator cuff strain and tears, 20%), the groin (15%), and the back (10%). Mandatory helmets and face masks reduced the number of facial and eye injuries to a quarter from 1972 to 1983. The frequency of only concussion but also cervical spine lesions is increasing. The prevention of head, face, eye and neck injuries should mainly be accomplished by enforcement of current rules (mandatory helmets with face masks) and institution of new rules. Improvement in protective equipment would also have the effect of decreasing the frequency of injuries. Ice hockey is the fastest team sport and involves both finesse and controlled aggression. It is also considered to be one of the roughest of all sports. In recent years, ice hockey has grown tremendously in popularity, not only in the United States and in Canada but also in many European countries [1]. The number of both professional and amateur hockey players has increased with the expanding interest in the sport around the world [1].(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Pulmonary air embolism in severe head injury.

Entry of air into the venous system leading to intracardiac air and pulmonary air embolism (PAE) has been reported in various clinical settings such as neurosurgical interventions in the sitting position and in autopsies on patients with head and neck injuries. We report the case of a 29-year-old male who developed severe pulmonary dysfunction after severe head injury in a high-velocity car accident. Chest X-ray showed bilateral diffuse patchy infiltrates. Pneumothorax, haemothorax, pulmonary aspiration, various forms of pulmonary oedema and pulmonary contusion could be excluded. Furthermore, there was an open laceration of the frontal sinus and maxillo-facial fractures. The history of spontaneous respiration in sitting position at the scene, rapid improvement of pulmonary function within 30 h, small amounts of air in the brain parenchyma, and circulatory shock despite elevated central venous pressure in the initial phase led to the diagnosis of PAE as the primary cause of pulmonary dysfunction. The diagnostic approach and basic therapeutical principles in patients with PAE are described. In conclusion, the case presented emphasizes the importance of considering PAE as a possible cause of respiratory failure in patients with severe head injury.

Accidents, Traffic↗
PubMed2002

Ring fracture of the skull base: case report and review of the literature.

Ring fractures of the skull base are rare and have hitherto been regarded as invariably fatal injuries. They are difficult to diagnose, as routine radiographs of the head and spine are usually normal. Increasing use of computerized tomography in the evaluation of head and neck injuries may, however, lead to an increased frequency of diagnosis of this injury. We present a case of such a fracture where the patient survived with a generally good neurological recovery.

Accidental Falls↗
PubMed2004

Whiplash injuries in Finland--the possibility of some sociodemographic and psychosocial factors to predict the outcome after one year.

PURPOSE: The aim of our study was to evaluate if there was any relation between the change experienced in the condition of health or the length of the reported sick leaves after one year of whiplash injury and different sociodemographic and psychosocial factors. METHOD: Our study design is a prospective 1-year-follow-up study. The material was collected in the year 1998 from neck injuries that had been caused by traffic accidents. The insurance companies sent a notice of the accident with medical certificate to the research team. After this we sent questionnaires to the injured and after one year of the accident a new inquiry was done. One hundred and eighty-two persons returned the 1-year-follow-up questionnaire which formed the material of this study. RESULTS: The persons who had the lowest basic education and people over 60 years of age had more health problems after one year of the accident. The other sociodemographic and psychosocial factors had only limited prognostic value when we evaluated the experienced change of health one year after the whiplash injury. Only 71 persons reported that they had been on sick leave because of the whiplash injury and of them only 21 reported sick leave over 1 month. CONCLUSIONS: Several sociodemographic and psychosocial factors can have relation to the deterioration of health experienced after whiplash injury but in this prospective study they proved to have only limited prognostic value in the long term symptoms with the exception of the education.

Accidents, Traffic↗
PubMed1988

Traumatic atlanto-axial subluxation.

Traumatic atlanto-axial subluxation is a rare injury which may not be revealed on routine radiographs, especially when there is muscle spasm. We report on seven patients with atlanto-axial subluxation as a result of neck injury; only two of them had significant head injuries. Three patients presented with a neurological deficit attributable to the injury, one immediate and two with delayed onset. Traumatic atlanto-axial instability, occurring in an otherwise healthy patient, has a potential for neurological disaster; early consideration of operative treatment is indicated.

Adult↗
PubMed1990

Closed head injuries in athletes.

Nervous system sports-related injuries constitute a major source of serious morbidity and mortality in athletes. In particular, acute closed head injuries account for some 6000 potentially preventable deaths and literally millions of episodes of less severe head injuries each year. The long-term significance of chronic head injuries resulting from repetitive blows to the brain is only now being fully appreciated. Similarly subtle neuropsychological changes are being increasingly recognized resulting from milder head injuries. Although head injuries are almost inevitable and unavoidable sequelae of most contact and competitive sports, much can and should be done to reduce the serious acute and chronic neurologic complications inherent in these activities. Prevention of catastrophic sports injuries by careful preseason examination, education, training, and conditioning, and ongoing counseling of the athlete is of paramount importance. The use of carefully fitted protective headgear, and avoidance of maneuvers that may directly result in serious head injuries are also key. The immediate evaluation, evacuation, and triage of the injured athlete must take place carefully and expeditiously. Skillful, experienced, and compassionate definitive care must then ensue. In the long term, the complications and analysis of accurate statistical data on the magnitude of sports injuries in general, and nervous system involvement in particular, must be studied. Presently, only a few sports have accumulated such data, such as in the National Football Head and Neck Injury Registry. In the final analysis, it is the cooperative responsibility of the medical and athletic communities to strive to reduce these tragic injuries.

Athletic Injuries↗
PubMed1982

[Double fracture of the spine. A case report].

A case of fracture dislocation of the dorsolumbar junction together with a dislocation of the cervical spine, complicated by a head injury, is presented. The patient escaped any neurological damage. It is stressed that unstable spinal injuries often present without any leading neurological signs. A high index of suspicion and routine clinical and radiological examination of the entire spine in all patients with head and neck injuries is essential to prevent the tragedy of permanent spinal cord injuries.

Adult↗
PubMed2000

Unstable cervical spine without spinal cord injury in penetrating neck trauma.

Cervical spine instability in the neurologically intact patient following penetrating neck trauma has been considered rare or non-existent. We present a case of a woman with an unstable C5 fracture without spinal cord injury after a gunshot wound to the neck. Considerations regarding the risk of cervical spine instability are discussed, as well as suggestions for a prudent approach to such patients.

Cervical Vertebrae↗
PubMedDate not supplied

Prediction of outcome in whiplash-associated disorders using West Haven-Yale Multidimensional Pain Inventory.

OBJECTIVE: To investigate the predictive capacity of the West Haven-Yale Multidimensional Pain Inventory (MPI) with regard to prolonged pain, using car occupants who had sustained a neck sprain in a traffic accident. DESIGN: A prospective cohort study including a one-year follow-up. PATIENTS: One hundred thirty adults were examined by a specialized neck-injury team after a first visit to an accident and emergency department. The subjects answered the MPI questionnaire within one month of the accident. OUTCOME MEASURES: One year later, the patients answered a questionnaire about residual neck pain. The main outcome was determined by the question, "Do you have residual pain which you relate to the accident?" RESULTS: One hundred twenty-three (95%) of the subjects completed the study. Ninety-seven reported pain of some degree that they related to the accident. All but one of the MPI variables differed significantly between the group with residual pain and the group without pain. The variable interference had the strongest correlation with the outcome. Its discriminative capacity was 81% for those with pain and 94% for those without pain one year later. CONCLUSIONS: The MPI may be used at an early stage to identify patients who may develop chronic neck-pain after a traffic accident, at least in those who want a follow-up session after an initial visit to an accident and emergency department.

Accidents, Traffic↗
PubMed2001

Adaptive plasticity of head movement propensity.

Individual humans exhibit differing propensity to move the head in association with saccadic shifts in gaze. We assessed whether this tendency can be modified in normal subjects by either reducing neck mobility with a cervical collar or restricting the field of view using aperture spectacles. We quantified head movement propensity in terms of the range of orbital eccentricity within which the eyes are customarily maintained (customary ocular motor range), and the range of final eye-in-head eccentricity for which a planned saccade is likely to be executed without a concomitant head movement (eye-only range). Three subjects wore rigid collars during waking hours for periods of up to 9 days. We measured customary and eye-only ranges with the collar removed, at various times during the adaptation and recovery periods. Collar adaptation reduced head movement propensity in all three subjects, increasing the average customary ocular range from 27.6 +/- 8.9 degrees (mean +/- SD) to 66.1 +/- 4.5 degrees and the eye-only range from 24.6 +/- 17.0 degrees to 67.6 +/- 7.4 degrees. In two subjects the modifications persisted for weeks following final collar removal. In parallel with the reduction in head movement propensity, all subjects improved in their ability to maintain eccentric gaze, suggesting that neck restriction led to effects at the level of the brainstem. Three subjects were adapted to spectacles, masked to restrict the field of view to approximately 20 degrees. The aperture spectacles were worn for periods of up to 9 days. When tested without the apertures, one subject exhibited a definite increase in head movement propensity; in the other two, the data were equivocal, indicating either a small increase in head movement propensity or no effect. Averaged across subjects, customary ocular motor range decreased from 35.1 +/- 12.8 degrees to 25.4 +/- 13.4 degrees and eye-only range decreased from 35.1 +/- 7.5 degrees to 23.0 +/- 4.0 degrees. The marked difference in the magnitudes of collar- and spectacle-induced changes suggests that the responses to the two restrictive appliances are mediated by different mechanisms. Collar adaptation may involve parametric modulation of circuits mediating reflex recruitment of head movements, while aperture adaptation may primarily reflect substitution of an alternative mode of head control triggered by the presence of the restricted field of view, with only minor parametric modulation of the underlying head recruitment circuit. The enduring effects of restricting neck mobility upon head movement tendencies may relate to the common clinical association between neck injury and persistent dysequilibrium.

Adaptation, Physiological↗
PubMed2001

Comparison of the isometric cervical extension strength and a cross-sectional area of neck extensor muscles in college wrestlers and judo athletes.

Increasing neck muscle strength can play an important role in preventing neck injuries in contact sports. The purpose of this study was to examine the actual conditions of the isometric cervical extension strength (ICES) and the cross-sectional area (CSA) of neck extensor muscles in male athletes participating in college wrestling and judo. The subjects comprised 18 wrestlers and 37 judo athletes from Nippon Sports Science University in Japan. The ICES was measured at eight angles (126 degrees, 108 degrees, 90 degrees, 72 degrees, 54 degrees, 36 degrees, 18 degrees, 0 degrees ). Transverse slices of 10 mm thickness were obtained at the position of each intervertebral disc between C2 and C3, C3 and C4, C4 and C5 and C5 and C6 using magnetic resonance imaging. The ICES of the wrestlers were significantly higher than those of the judo athletes. The ICES curve against the angle in wrestlers tended to differ from that of judo athletes. The CSA of neck extensor muscles in the wrestlers was significantly larger at all intervertebral levels examined than those of the judo athletes. A significant difference was observed in the CSA of the deepest area of neck extensor muscles between the groups although the difference was not significant in the superficial area. In this study, the ICES and the CSA in wrestlers were shown to be significantly higher and larger respectively than in the judo athletes, indicating a significant difference between these two sports.

Adolescent↗
PubMed2000

Patterns of abdominal injuries in frontal and side impacts.

Public awareness for safety and vehicle improvements has contributed to significant reduction in injuries secondary to motor vehicle crashes. The spectrum of trauma has shifted from one region of the body to another with varying consequences. For example, airbags have minimized head and neck injuries for adults while emphasizing the lower regions of the human body. Studies have concentrated on the changing patterns of these injuries in frontal impacts. However, there is almost a paucity of data with regard to the characterization of abdominal injuries. Consequently, this study was conducted to determine the patterns of abdominal injuries in frontal and side impacts with an emphasis on more recent crashes. In particular, the frequency and severity of trauma were investigated with a focus on the various abdominal organs (e.g., spleen and liver). Results indicate that side crashes contribute to a large percentage of injuries to the abdomen. The liver and spleen organs are most vulnerable; therefore, it may be beneficial to apply concerted efforts to focus on injury biomechanics research and prioritization activities in these areas of the abdomen. These data may be of benefit to develop anthropomorphic dummies with improved biofidelity.

Abdominal Injuries↗
PubMed1995

Blunt carotid artery injury: devastating consequences of undetected pseudoaneurysm.

A case of delayed embolization of a traumatic pseudoaneurysm of the right common carotid artery, resulting in fatal cerebral infarction, is reported. This case emphasizes the importance to detect occult lesions to the carotid arteries after blunt neck injuries and to treat aggressively pseudoaneurysms located upstream to a cerebral vessel to prevent embolic complications.

Adult↗