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PubMed2006

Motorcycle helmet effect on a per-crash basis in Thailand and the United States.

OBJECTIVE: To compare the effectiveness of motorcycle helmets seen in prospective on-the-street motorcycle accident investigations. The data are drawn from two detailed, in-depth studies of motorcycle accidents, in which trained investigators collected extensive accident evidence on-scene immediately after the crash. This article compares helmeted and unhelmeted motorcycle riders on a per-accident basis for fatality rates, the rate of serious (AIS > 2) brain injuries among survivors, or an outcome that involved either of the two. METHODS: Nine hundred motorcycle crashes in Los Angeles and 969 crashes in Thailand were investigated in detail at the accident scenes, including photos of vehicles, skids, damage, and sometimes the rider. Helmets were collected and injury information was obtained from riders and care providers. This evidence was then used to reconstruct collision events to identify speeds, precrash motions, collision contacts, injury causation, and helmet performance. RESULTS: In both studies, approximately 6% of riders were killed and 20-25% were hospitalized. Overall, unhelmeted riders were two to three times as likely to be killed, and three times as likely to suffer either death or survival with AIS > 2 brain injury. Unhelmeted survivors had three to four times as many AIS > 2 brain injuries as helmeted riders on a per-crash basis. Nearly 100% of riders with AIS > 4 somatic injuries died. Such injuries were 30% of Thailand fatalities and 57% of L.A. fatalities, but only about 2-3% of the overall accident population. Among the 97-98% of riders with AIS < 5 somatic injuries, helmet use could prevent about three-fourths of fatalities and brain injuries. CONCLUSIONS: Helmets were extremely effective in preventing brain injury and death in 97% of the accident population in less-than-extreme crashes. Helmet use cannot prevent all fatalities because many of those killed succumb to below-the-neck injuries that a helmet cannot prevent.

Accidents, Traffic↗
PubMed2005

Costs of occupational injury and illness within the health services sector.

Knowledge of costs is essential to allocate medical resources efficiently. The authors' goal was to estimate and compare costs across occupations, industries, gender, race, and types of nonfatal injuries and illnesses. This is an incidence study of nationwide data, 1993. Nonfatal incidence data were drawn from the Bureau of Labor Statistics Annual Survey. Medical costs were from the Detailed Claims Information data set. Productivity (wage) costs were calculated using the Current Population Survey. Pain and suffering costs were estimated from data on jury verdicts. Injuries and illnesses to nursing aides and orderlies cost 2,200 million dollars; costs were 900 million dollars for registered nurses and 40 million dollars for licensed practical nurses. The ranking of health services industries in terms of costs was: hospitals (52 percent of all costs), nursing care facilities (38 percent), home care services (6 percent), physicians' offices (4 percent), and laboratories (<1 percent). Types of injuries (sprains, strains, fractures) were similar across occupations and industries, but types of illness (carpal tunnel syndrome, respiratory diseases) varied. The most costly injured body parts were: back, shoulder, knee, wrist, and neck. Injuries and illnesses comprised roughly 90 percent and 10 percent, respectively, of total costs. The hospital industry was the third most expensive of 313 U.S. industries. Costs of occupational injury and illness in the health services industry were high and varied across occupation, industry, disease, race, and gender.

Accidents, Occupational↗
PubMed1986

[Dog bite injuries of the head and neck].

Dog bite injuries of the head and neck concern mostly children. Early definite surgical treatment provides the best cosmetic results. If necessary, detached tissue must be re-implanted and defects be closed by flap plasties. Antibiotics are given to prevent infections. In most cases, a lack of knowledge or misinterpretation of the animal's behaviour caused the dog bite injury. Only a few animals were really "vicious". Rabies was not found among the animals covered by our study.

Animals↗
PubMed2004

Child booster seats and lethal seat belt injury.

A 7-year-old boy travelling in the rear seat of a sedan car was wearing a lap-shoulder seat belt and sitting on a booster seat. Following a collision the boy 'submarined' under the seat belt sustaining trauma to the anterior aspect of his neck, cardiac arrest and subsequent death from hypoxic-ischaemic encephalopathy. This case demonstrates a potential problem with unsecured older-style booster seats. Movement of a seat in a collision may cause a child to slip under a seat belt and sustain significant neck injuries. Seatbelts for children must be correctly fitted, booster seats or capsules must be securely fastened and manufacturer's recommendations for size and weight limits should be followed. Unfortunately older booster seats may not have attached instructions for installation and use, may not fit later model vehicles, may not conform to current safety recommendations and may have worn webbing. For these reasons their use should be discouraged.

Accidents, Traffic↗
PubMed1989

[Procedures in reconstructive interventions in the area of the face and neck after burn injuries].

Hypertrophic scars and tissue defects are the most common cause of functional and aesthetic problems in the head and neck of burn patients. For reconstructive surgery full-thickness or split thickness skin grafts are preferred. Pedicled flaps or free flaps are mostly used to correct contractures in the neck. The transplantation of bone or cartilage and tissue expansion are also used for special indications.

Burns↗
PubMed2004

Pathologic features of fatal falls from height.

Deaths due to falls from height are common in urban settings. At the time the body is found, it is often unclear whether the mode of death is accident, suicide, or homicide. To assess the injury pattern in fatal falls from height with special regard to criteria that might be helpful in discrimination between accident, suicide, and homicide, respectively, we reviewed 68 medicolegal autopsy cases (22 females, 46 males, age range 13-89 years) of fatal falls from height regarding demographic data, findings at the death scene, results of the postmortem examination, psychiatric history, and toxicologic findings. Among the 68 cases, there were 34 suicides, 23 accidents, and 11 unclarified cases, in 3 of which homicide was suspected. In general, suicides were from greater heights than accidents (mean height 22.7 m for suicides and 10.8 m for accidents, respectively; 79% of suicides from more than 16 m). Strikingly, severe head injuries predominantly occurred in falls from heights below 10 m (84%) and above 25 m (90%), whereas in the group of falls from 10 to 25 m, these lesions were seen less frequently (28%). Neck injuries like muscle bleeds and fractures of the hyoid bone were found in 33% of falls from more than 10 m and did not occur from less than 10 m. Our data stress that the evaluation of pathologic features alone is not sufficient to assess the mode of death in fatal falls from height. Instead, postmortem findings have to be considered within the framework of the subject's social, medical, and psychiatric history in conjunction with findings at the death scene and toxicology results to obtain the clearest possible picture of the circumstances of death.

Accidental Falls↗
PubMed2001

Helmet hazards. Do's & don'ts of football helmet removal.

EMS providers must use extreme caution when evaluating and treating an unconscious football player, especially when the extent of the injury remains unknown. Suspect any unconscious football player has an accompanying spinal injury until proven otherwise. If the football player isn't breathing or the possibility of respiratory arrest exists, it's essential that certified athletic trainers and EMS providers work quickly and effectively to remove the face mask and administer care. In most situations, the helmet doesn't need to be removed in the field. Proper management of head and neck injuries includes leaving the helmet in place whenever possible, removing only the face mask from the helmet and developing a plan to manage head- and neck-injured football players using well-trained sports medicine and EMS providers. EMS agencies should work with their local high school or college athletic trainers to practice these removal techniques prior to the start of the football season.

Emergency Treatment↗
PubMed1986

Laryngotracheal trauma: a protocol approach to a rare injury.

Laryngotracheal trauma is rare and complications are frequent. Twelve major series totalling 392 cases have been published over the past decade, with complication rates as high as 40%. We have treated over 30,000 trauma victims at our Level I Trauma Center over the past 5 years, of which 109 had neck injuries, but only 12 suffered cervical laryngotracheal trauma. The mechanism of injury was penetrating in eight and blunt trauma in four. The time to tracheostomy decannulation varied from 7 to 60 days. Airway patency was assured without stenosis or significant granulation tissue in 10 of the 12 patients. Three patients suffered permanent voice changes. Based on review of the 392 previously reported cases and a critical analysis of our 12 cases, a detailed management algorithm is proposed.

Adolescent↗
PubMedDate not supplied

Endovascular management of a gunshot wound injury to the innominate artery and brachiocephalic vein.

Surgical repair of penetrating injuries of the thoracic outlet with combined arterial and venous involvement is associated with considerable morbidity and mortality. A 37-year-old man presented to the emergency room with a left-sided penetrating zone I neck injury caused by a close-range handgun shot. This had resulted in an injury to the innominate artery and the origin of the right common carotid artery, with shunting to the brachiocephalic vein. This was managed endovascularly by stenting of the innominate artery and by coiling of the origin of the carotid artery. An endovascular approach to this injury is feasible and has the advantage of appropriate visualization of the vascular lesions with limited blood loss during the repair.

Adult↗
PubMedDate not supplied

Elastase-induced saccular aneurysms in rabbits: comparison of geometric features with those of human aneurysms.

BACKGROUND AND PURPOSE: The development of more effective intracranial aneurysm therapy depends on the ability to test various intravascular occlusion devices and techniques in preclinical animal models. This requires the creation of experimental aneurysms, which, ideally, should mimic the size and geometric features of human intracranial aneurysms. The purpose of this study was to characterize the morphologic features of elastase-induced saccular aneurysms in rabbits to determine whether the morphology of such aneurysms mimics that of human intracranial aneurysms. METHODS: Elastase-induced saccular aneurysms were created in 40 New Zealand white rabbits. Intravenous digital subtraction angiography was performed 14 days after surgery. Relative to an external sizing device, the following dimensions were determined: aneurysm dome (height and width), aneurysm neck diameter, and parent artery diameter. Based on maximal diameter, aneurysms were categorized as small (2.0-4.9 mm), medium-sized (5.0-9.9 mm), or large (10-16 mm), and as narrow-necked (<4.0 mm neck width) or wide-necked (>4.0 mm neck width). Mean dome-neck ratio was calculated and compared with that of human aneurysms. RESULTS: All aneurysm cavities were angiographically patent. Widths of the cavities ranged from 2.5 to 7.1 mm (mean, 4.1 +/- 1.2 mm); heights ranged from 3.0 to 15.6 mm (mean, 8.8 +/- 2.6 mm). Three (7.5%) of 40 aneurysms were small, 20 (50%) were medium-sized, and 17 (42.5%) were large. Twenty-two (55%) of 40 aneurysms were small-necked, and 18 (45%) were wide-necked. Mean dome-neck ratio was 1.13 +/- 0.54. Mean parent artery diameter was 4.3 +/- 1.4 mm. CONCLUSION: Saccular aneurysms of sizes similar to that of human intracranial aneurysms were reliably created using a simple method of vessel ligation and elastase injury. Neck sizes varied with both large and small-necked aneurysms created.

Angiography, Digital Subtraction↗
PubMed2000

WHIPS--Volvo's Whiplash Protection Study.

Whiplash associated disorders (WAD) resulting from rear end car impacts are an increasing problem. WAD are usually not life threatening, but are one of the most important injury categories with regard to long-term consequences. This paper is a review of Volvo's Whiplash Protection Study (WHIPS), which is the result of more than ten years of concentrated research efforts in the area of neck injuries in car collisions, with the focus on rear end car impacts. The study follows the whole chain from accident research to the development of a seat for increased protection against WAD. Results from Volvo's accident research are summarized. Existing biomechanical knowledge regarding possible injury mechanisms are presented and discussed. Based on the interpretation of accident research and biomechanical knowledge, guidelines for improved protection against WAD in rear end impacts are presented. Requirements and test methods based on the guidelines are explained. An important part of the study is a new rear end impact dummy, BioRID. Test results using the new dummy are presented. Finally, the paper explains the design of a new seat for increased WAD protection, the WHIPS-seat. Results from the accident research and biomechanical research emphasize the importance of considering the whole spine of the occupant and, accordingly, the whole seat when addressing WAD in rear end impacts, with a particular focus on low and moderate impact severity. Low and moderate impact severity crashes should be focused. Also important to consider are the individual differences between occupants, the seating position and the variety of seating postures. All results, including sub-system testing, mathematical modeling, sled testing, as well as geometrical parameters show that the WHIPS-seat will have considerable potential for offering increased protection against WAD in rear end impacts.

Accidents, Traffic↗
PubMed2000

Blunt carotid artery injury after accidental neck compression: report of a case.

Almost all cases of carotid artery injury are precipitated by a high-energy impact such as motor vehicle accidents or gunshot wounds, and are usually diagnosed using angiography. We report herein a case of carotid artery injury induced by a low-energy insult with rare clinical signs which was diagnosed using ultrasonography as well as angiography. A 37-year-old man sustained an accidental compression of the neck and was transferred to our emergency room. Horner's syndrome and phrenic nerve palsy were detected on the left side. Ultrasonography demonstrated two sites of injury with an intimal flap of the distal left common carotid artery as well as angiography. The patient was placed on anticoagulants and was discharged on the 10th hospital day with both Horner's syndrome and phrenic nerve palsy. This case suggests that surgeons should investigate any possible carotid artery injury, even after low-velocity injuries such as compression of the neck, and therefore an ultrasonic examination should be performed at the initial evaluation and at follow-up studies. In addition, further investigations are also called for to investigate the utility of anticoagulation in the treatment of carotid artery injury.

Accidents, Occupational↗
PubMed1998

The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis.

STUDY DESIGN: A prospective study was conducted in 37 patients with cervical spondylosis with incomplete cord injury to assess the role of decompression in these patients. OBJECTIVES: To evaluate surgical and nonsurgical outcomes in patients with pre-existing cervical spondylosis of the spine, in whom an incomplete spinal cord syndrome developed after a minor neck injury. SUMMARY OF BACKGROUND DATA: The benefits of surgical treatment of incomplete cord injury with cervical spondylosis is controversial but remains a treatment option. The results of this study clarified the benefits of surgery in such patients. METHODS: Radiographic findings and outcomes based on post-spinal injury motor function score were compared retrospectively in 37 patients with cervical spondylosis. Sixteen patients were treated operatively and 21 were treated nonoperatively. RESULTS: The neurologic conditions of 13 of the 16 patients (81.2%) treated surgically improved within 2 days of surgery. Comparing the improvement of the two groups at defined intervals, there were statistically significant differences (P < 0.006) between the surgical and nonsurgical patients at 1-month and 6-month follow-ups. Nevertheless, 13 of the 21 patients (62%) treated nonoperatively had recovered to at least muscle Grade 3 at the 2-year follow-up, but their recovery was slower than that of the surgical group. CONCLUSION: Although neurologic improvement after an incomplete spinal cord injury when no bony lesion was present was slow during the first few months after trauma, more than 60% of the patients showed neurologic recovery with a muscle grade higher than 3 at 2-year follow-up. Surgical decompression, however, was associated with immediate neurologic improvement, faster recovery of neurologic function, early mobilization, better long-term neurologic outcome, briefer hospital stays, and fewer complications related to long confinements in bed than was nonoperative treatment.

Adult↗
PubMed2000

Antigraviceptive neck muscle responses to "moving up and moving down" in human.

The responses of neck muscle to sudden transit from one 'g' to hyper 'g', work to support the head and remain the relative position of head on trunk as common observed: i.e. in sudden acceleration or deceleration by car or ejection of pilot from aircraft. Accordingly it is highly possible that the neck muscle responses to moving up may be important to prevent the neck injury due to sudden linear acceleration such as moving up against gravity. However little is known about the evaluation of mechanism of this reflex. Therefore the present study was conducted with two aims. The first aim was to investigate the neck muscle responses to vertical linear acceleration bv 0.4 g produced with an electro-hydraulic servo-system. We chose the vertical linear acceleration because it activates mainly sacculus, from which afferents have been demonstrated to be connected directly to sternocleidomastoid muscle in animals and human. The second aim was to determine whether there is a difference of neck muscle response to moving down and moving up.

Acceleration↗
PubMed1995

Delayed onset of fatal basilar thrombotic embolus after whiplash injury.

BACKGROUND: Whiplash injuries are generally seen after rear-end rather than frontal car collisions. Previous reports have documented death up to 8 days after serious whiplash injury. We report a case of lethal basilar thrombotic embolus that occurred 2 months after the patient's injury in a collision. CASE DESCRIPTION: After whiplash trauma in a car accident, a 50-year-old taxi driver suffered from headache and episodic visual disturbances. Two months after the accident he suddenly lost consciousness and was admitted to the hospital. A CT scan performed at that time was indicative of basilar thrombosis. The patient died 3 days later. The autopsy revealed a thrombosis in the right vertebral artery and a thrombotic embolus in the basilar artery. Microscopically, a lesion of the right vertebral artery was found at the level of the atlantoaxial joint. CONCLUSIONS: We conclude that the whiplash injury caused a lesion of the right vertebral artery, leading to repeated transient ischemic attacks and finally to a fatal basilar thrombotic embolus. We suggest that in patients with disturbances of the vertebrobasilar circulation, attention should be paid to occurrence of neck trauma in the preceding 3 months. Further, anticoagulant therapy should particularly be considered in patients who after suffering neck injuries develop signs of transient ischemic attacks with origin from the posterior cerebral circulation.

Basilar Artery↗