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PubMed2000

Risk factors and predictors of mortality in children after ejection from motor vehicle crashes.

PURPOSE: Mortality after ejection from a motor vehicle crash (MVC) has been studied extensively in adults. The magnitude of this problem in children is relatively unknown. We retrospectively examined fatalities resulting from ejection after MVC in the state of Pennsylvania to define risk factors and predictors of mortality in children. METHODS: The records for all patients 0 to 16 years of age involved in an MVC and entered in the Pennsylvania Trauma Outcome Study between 1993 and 1997 were reviewed. We examined mortality, length of hospitalization, major injuries sustained, and impact of safety restraint devices. Significant differences were determined using chi2 test. RESULTS: There were 2,298 children involved in MVCs during this period; 189 were ejected. A total of 77% of the ejected passengers were greater than 10 years of age, 16% were 0 to 4 years of age, and 7% were 5 to 9 years of age. Overall, 88% of the ejected occupants were unrestrained. Ejection nearly tripled the overall mortality rate and significantly increased the Injury Severity Score for each age group. Infants and children 0 to 4 years of age had the highest fatality rate despite having a lower Injury Severity Score than all other age groups. Head injuries accounted for the majority of deaths in all age groups. Children older than 10 years of age had a higher incidence of associated chest, abdominal, and pelvic injuries. CONCLUSION: Our data show that most children ejected from MVCs were either unrestrained or improperly restrained. Head injuries were the most common cause of death in all age groups. Greater public awareness through educational programs targeting parents and children at risk may reduce this serious problem.

Accidents, Traffic↗
PubMed1996

Light vehicle occupant ejections--a comprehensive investigation.

Occupant ejections, about 1.5% of all crash-involved occupant events, are relatively infrequent but very harmful events in highway crashes of light vehicles, including cars, pickup trucks, vans, and multipurpose vehicles (utility vehicles, jeeps, etc.). The disparity between frequency of harm to ejectees and ejection frequency is at least one order of magnitude. Partial ejections, although less frequent, have an incidence that is comparable to that of complete ejections, except for restrained occupants, where complete ejections are very infrequent. Notwithstanding the high effectiveness of safety belts in preventing ejections, and the multifold growth of safety belt use in the last 10 years, there is no detectable reduction in the ejection rate in the same period. Ejections per se and not other pre-ejection occupant impacts are responsible for the bulk of the harm to ejectees. Furthermore, ejected occupants sustain harm much larger than that which would have occurred, had these occupants not been ejected. "Closed glazing" is the leading ejection path. "Doors" and "windshield" are distant seconds. All glazing except the windshield fail overwhelmingly by disintegration. Latch failure is the primary mode of failure in opening doors. Hinges and other modes of failure are relatively minor concerns. The sources of data in this investigation are: the National Accident Sampling System for the years 1988 to 1991, and the Fatal Accident Reporting System for 1982 to 1992.

Accidents, Traffic↗
PubMed2005

Left ventricular dysfunction in hypertensive patients with Type 2 diabetes mellitus.

AIMS: To characterize left ventricular function in hypertensive patients with Type 2 diabetes and normal ejection fraction, and to relate these findings to pathogenic factors and clinical risk markers. METHODS: We examined 70 hypertensive patients with Type 2 diabetes mellitus with ejection fraction > 0.55 and fractional shortening > 0.25, all without any cardiac symptoms. Thirty-five non-diabetic subjects served as control subjects. Left ventricular longitudinal function was examined by tissue Doppler derived myocardial strain rate and peak systolic velocities. RESULTS: Hypertensive patients with diabetes had a significantly higher systolic strain rate (-1.1 +/- 0.3 s(-1) vs. -1.6 +/- 0.3 s(-1), P < 0.001) and lower systolic peak velocities (3.3 +/- 1.0 vs. 5.6 +/- 1.0 cm/s, P < 0.001) compared with control subjects. Myocardial systolic strain rate correlated significantly to left ventricular mass (r = 0.40, P < 0.01) and to both HbA1c (r = 0.43, P < 0.01), and fructosamine (r = 0.40, P < 0.01), but was not related to serum levels of carboxymethyllysine, albuminuria, blood pressure (dipping/non-dipping), or oral hypoglycaemic therapy. Patients with diastolic dysfunction had significantly higher levels of urine albumin [21.0 (5-2500) mg/l, vs. 9.5 (1-360), P < 0.01], heart rate (78 +/- 13 vs. 67 +/- 10 b.p.m., P < 0.005), and seated diastolic blood pressure (85 +/- 6 vs. 81 +/- 7 mmHg, P < 0.05) and non-dipping diastolic blood pressure was more frequent. CONCLUSIONS: Long axis left ventricular systolic function was significantly decreased in hypertensive patients with Type 2 diabetes mellitus, and is associated with hyperglycaemia and left ventricular hypertrophy. Diastolic dysfunction was closely related to increased diastolic blood pressure, non-dipping and increased urinary albumin excretion.

Blood Flow Velocity↗
PubMed2002

Flipped out of control: single-vehicle rollover accidents in the Northern Territory.

OBJECTIVES: To study the incidence of and factors associated with single-vehicle rollover (SVRO) accidents in the "Top End" of the Northern Territory (NT); to identify factors associated with major injury and death from SVRO accidents. DESIGN: Retrospective analysis of records from the NT Department of Transport and Works' police database, Royal Darwin Hospital's trauma database, coroner's records, and case notes from public hospitals in the Top End. STUDY POPULATION: All patients involved in SVRO accidents in the Top End between 1 January 1996 and 31 December 1997 whose accident was documented by the police, who attended a public hospital, or who died. MAIN OUTCOME MEASURES: Types and incidence of all accidents; details of the accident scene, vehicle features, and population groups associated with SVRO accidents; factors associated with major injury and death. RESULTS: SVROs accounted for 30% of all accidents and 29% of all injuries and deaths (441 people) in the whole of the NT over the study period. Some of the factors associated significantly more frequently with SVRO accidents were (i) occurrence of the accident on a straight, dry, unsealed road; (ii) presence of a vehicle defect; (iii) travelling at excessive speed; and (iv) the person being male, aged 41-50 years, of Aboriginal descent. Among the 147 people who were admitted to hospital or died from SVRO accidents in the Top End, major injury occurred significantly more frequently if the person was under the influence of alcohol, was not wearing a seatbelt and was ejected; if the accident occurred in a rural area; and if the vehicle was speeding. Major injuries occurred in 21% (31/147), and death was more likely in those with head, chest and neck injuries. CONCLUSION: SVRO accidents are a major cause of morbidity and mortality in the Top End of the NT. Effective methods of limiting speeding, drink-driving and driver fatigue should be sought. Populations most at risk should be targeted.

Accidents, Traffic↗
PubMed2005

Analysis of 47 road traffic accident admissions to BMH Shaibah.

OBJECTIVE: To analyse road traffic accident (RTA) admissions to British Military Hospital (BMH) Shaibah with respect to seatbelt usage, position in vehicle, age, type of injury and mechanism of injury. METHOD: Retrospective analysis of discharge summaries and hospital notes of all service personnel admitted to BMH Shaibah due to RTA, from August 2003 to January 2004. Results During the study there were 315 reported RTA, 3 fatalities, and 47 inpatient admissions. 87% of admissions were male; in 32% of cases the vehicle had rolled and 28% of individuals admitted had been ejected from the vehicle. 85% of individuals had not been wearing their seatbelts and none of the ejected individuals had been restrained. 92% of those ejected were travelling in the rear of the Land Rover. Of those ejected, 38% suffered more than one type of injury, and 62% suffered a fracture, (accounting for 50% of all fractures admitted). 34% of admissions had sustained a fracture, and were evacuated to the UK. CONCLUSIONS: These figures correlate well with previous evidence showing the likelihood of serious injury is increased by more than 300% if the patient is ejected. Those travelling in the rear of a Land Rover would appear to be in the most dangerous position. Seatbelts are the single most effective means of reducing fatal and non-fatal injuries in motor vehicle accidents. Standing orders states that seatbelt use mandatory, but compliance is poor. This may be due to misconceptions on the relative dangers faced by soldiers in Iraq. Education and enforcement needs to be more effective if the Army is to reduce the number and seriousness of injuries attributable to RTA.

Accidents, Traffic↗
PubMed1975

[Orbital pulse analyses in healthy subjects and patients with cerebral arteriosclerosis].

81 normotensive persons were examined with the ophthalmodyamographic method. The measuring device was fixed with a constant, hypodiastolic pressure, and orbital volume pulses were registered and analysed according to qualitative and quantitative pulse criteria. Pulse criteria of younger persons were compared to those of older patients, pulses of persons with a normal vascular system were compared to pulses of persons suffering from cerebral vascular sclerosis. The most important results can be summarized as follows: 1. In old age pulses with arciform ascent or deep-seated anacrotic inflection are found more often. 2. The applanation of the dicrotic wave is seen more often in older patients and most often in patients with cerebral arteriosclerosis. Yet it is not specific for regressive changes of the arterial wall. 3. Pulses of the peripheral type with decrement of the incisura are found more often in younger persons with unimpaired blood vessels, presumably because of the more viscous-plastic properties of the vascular wall. 4. The quotient of dicrotism increases in old age. 5. The mean value of pulse wave transmission time, as a rule, diminishes in older persons, but non-hypertensive patients with cerebral arteriosclerosis have an increased pulse wave transmission time when compared to persons of the same age group without vascular changes. 6. Concerning the diagnostic value of differences between left and right it is important to notice that physiological differences of pulse criteria are considerable as far as amplitudes and height of discrotism are concerned; they are less prominent as to the period of rapid ejection (time between beginning of steep ascent and primary peak) and practivally below the measurable range as to semi-amplitude time (time that passes until half of the maximum amplitude is reached) and pulse wave transmission time. That means: measurable differences in regard to semi-amplitude time or pulse wave transmission time are reliable diagnostic criteria whereas differences in amplitudes and height of discrotism may bring false positive results.

Adult↗
PubMed2006

Orthopnea and tidal expiratory flow limitation in chronic heart failure.

BACKGROUND: Tidal expiratory flow limitation (FL) is common in patients with acute left heart failure and contributes significantly to orthopnea. Whether tidal FL exists in patients with chronic heart failure (CHF) remains to be determined. PURPOSES: To measure tidal FL and respiratory function in CHF patients and their relationships to orthopnea. METHODS: In 20 CHF patients (mean [+/- SD] ejection fraction, 23 +/- 8%; mean systolic pulmonary artery pressure [sPAP], 46 +/- 18 mm Hg; mean age, 59 +/- 11 years) and 20 control subjects who were matched for age and gender, we assessed FL, Borg score, spirometry, maximal inspiratory pressure (Pimax), mouth occlusion pressure 100 ms after the onset of inspiratory effort (P(0.1)), and breathing pattern in both the sitting and supine positions. The Medical Research Council score and orthopnea score were also determined. RESULTS: In the sitting position, tidal FL was absent in all patients and healthy subjects. In CHF patients, Pimax was reduced, and ventilation and P(0.1)/Pimax ratio was increased relative to those of control subjects. In the supine position, 12 CHF patients had FL and 18 CHF patients claimed orthopnea with a mean Borg score increasing from 0.5 +/- 0.7 in the sitting position to 2.7 +/- 1.5 in the supine position in CHF patients. In contrast, orthopnea was absent in all control subjects. The FL patients were older than the non-FL patients (mean age, 63 +/- 8 vs 53 +/- 12 years, respectively; p < 0.03). In shifting from the seated to the supine position, the P(0.1)/Pimax ratio and the effective inspiratory impedance increased more in CHF patients than in control subjects. The best predictors of orthopnea in CHF patients were sPAP, supine Pimax, and the percentage change in inspiratory capacity (IC) from the seated to the supine position (r(2) = 0.64; p < 0.001). CONCLUSIONS: In sitting CHF patients, tidal FL is absent but is common supine. Supine FL, together with increased respiratory impedance and decreased inspiratory muscle force, can elicit orthopnea, whom independent indicators are sPAP, supine Pimax and change in IC percentage.

Disease Progression↗
PubMed1981

Motor vehicle occupant injuries in noncrash events.

Data on injuries sustained by child occupants in motor vehicles occurring in noncrash events are generally unrecorded. This study was undertaken to ascertain the occurrence of medically confirmed injuries sustained by child occupants in motor vehicles as a result of noncrash events. Seventy-nine children were seen in the emergency room for evaluation of injuries that they incurred as occupants in motor vehicle incidents over a period of 18 months. The majority of injuries occurred in crash events. However, 18 (23%) were injured in noncrash events. These events included sudden stops, swerves, turns, and movement of an unrestrained child within the vehicle. The mechanism of injury was either ejection from the vehicle or impact with an interior area of the vehicle. In five of the 18 cases safety restraint use could not be established. Of the 13 cases in which information was obtained, no child was restrained. Although the injuries were predominantly minor (Abbreviated Injury Scale (AIS) 1), two children sustained moderate injury (AIS 2), and one child sustained severe injury (AIS 3). These results need to be confirmed by a larger study and if confirmed, the additional hazard of injury from noncrash events should be incorporated into health education messages that currently place primary emphasis on the potential for injury in crash events.

Abdominal Injuries↗
PubMed2002

Presynaptic adenosine A1 receptors regulate retinohypothalamic neurotransmission in the hamster suprachiasmatic nucleus.

Adenosine has been implicated as a modulator of retinohypothalamic neurotransmission in the suprachiasmatic nucleus (SCN), the seat of the light-entrainable circadian clock in mammals. Intracellular recordings were made from SCN neurons in slices of hamster hypothalamus using the in situ whole-cell patch clamp method. A monosynaptic, glutamatergic, excitatory postsynaptic current (EPSC) was evoked by stimulation of the optic nerve. The EPSC was blocked by bath application of the adenosine A(1) receptor agonist cyclohexyladenosine (CHA) in a dose-dependent manner with a half-maximal concentration of 1.7 microM. The block of EPSC amplitude by CHA was antagonized by concurrent application of the adenosine A(1) receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX). The adenosine A(2A) receptor agonist CGS21680 was ineffective in attenuating the EPSC at concentrations up to 50 microM. Trains of four consecutive stimuli at 25 ms intervals usually depressed the EPSC amplitude. However, after application of CHA, consecutive responses displayed facilitation of EPSC amplitude. The induction of facilitation by CHA suggested a presynaptic mechanism of action. After application of CHA, the frequency of spontaneous EPSCs declined substantially, while their amplitude distribution was unchanged or slightly reduced, again suggesting a mainly presynaptic site of action for CHA. Application of glutamate by brief pressure ejection evoked a long-lasting inward current that was unaffected by CHA at concentrations sufficient to reduce the evoked EPSC amplitude substantially (1 to 5 microM), suggesting that postsynaptic glutamate receptor-gated currents were unaffected by the drug. Taken together, these observations indicate that CHA inhibits optic nerve-evoked EPSCs in SCN neurons by a predominantly presynaptic mechanism.

Adenosine↗
PubMed2005

Nurse-recorded clinic and ambulatory blood pressures correlate equally well with left ventricular mass and carotid intima-media thickness.

OBJECTIVE: To assess relationships between noninvasive ambulatory blood pressure (BP), clinic BP (mean value of three readings in the seated position measured by nurses), structural cardiac indices, intima-media thickness of the common carotid artery and several hormones. DESIGN: Cross-sectional study of 75 subjects with hypertension and left ventricular hypertrophy (HTH) according to echocardiography, 35 subjects with hypertension and normal left ventricular dimensions (HT) and 23 normotensive subjects (NT). RESULTS: We found an excellent correlation between mean 24-h ambulatory BP and clinic BP, the r-value for systolic BP being 0.82 and for diastolic levels 0.78 (both P < 0.0001). Clinic and ambulatory BP correlated equally well with left ventricular (LV) mass index (r-values between 0.55 and 0.64, all P < 0.0001) and to intima-media thickness of the carotid artery (r = 0.18-0.34, P < 0.01). The systolic white-coat effect (clinic BP - day-time BP) was higher in the HTH and HT compared with NT and was weakly correlated to LV mass index (r = 0.18, P = 0.04). Nondippers (mean arterial night/day BP ratio of > 0.9) had higher brain (6.1 +/- 7.5 pmol L(-1) vs. 3.7 +/- 3.2 pmol L(-1), P = 0.01) and atrial (14 +/- 3.4 pmol L(-1) vs. 9.3 +/- 5.4 pmol L(-1), P = 0.04) natriuretic peptide levels, and also exhibited a lower ejection fraction (49 +/- 8% vs. 57 +/- 9%, P = 0.006), than dippers. CONCLUSION: Clinic BP recordings performed by nurses as three measurements 1 min apart provide excellent relationship to target organ damage. Nondippers exhibited signs of a more advanced hypertensive organ damage than dippers which corresponds well with the poor prognosis linked to this condition.

Adult↗
PubMed1981

Cervical injuries suffered in automobile crashes.

The National Crash Severity Study data in which occupants sustained severe, critical-to-life, or fatal cervical injuries were reviewed. Of passenger cars damaged severely enough to be towed from the scene, it is estimated that one in 300 occupants sustained a neck injury of a severe nature. The neck-injury rate rose to one in 14 occupants for those ejected from their cars, although many of these injuries resulted from contacts within the car before or during the process of ejection. Severe neck injuries were rather rare in cars struck in the rear, but were more common in frontal and side impacts. Occupants between 16 and 25 years of age had such injuries more than twice as often as those in any other age group. Most of the neck injuries of a more severe nature involved the cervical spine or spinal cord. Injuries of the anterior aspect of the neck were relatively infrequent, and usually resulted from direct blunt impacts. National projections of the number of fatalities related to cervical injuries indicates that 5940 deaths, or approximately 20% of all in-car deaths, include fatal cervical spine injuries, and that about 500 cases of quadriplegia per year result from automobile accidents.

Accidents, Traffic↗
PubMed1993

Causes and costs of injuries in multiple trauma patients requiring extrication from motor vehicle crashes.

Prospective and contemporaneous medical and economic cost studies of 144 victims of motor vehicle crashes admitted to a regional level I trauma center with multiple injuries (ISS > or = 16) revealed 122 non-ejected patients, of whom 102 required extrication (EXTRIC) from the vehicle for physical or medical reasons and 20 who did not (N group). There were no differences in age (EXTRIC, 34 +/- 17 years; N, 41 +/- 24 years), type of crash (Frontal: 57% EXTRIC, 60% N; Lateral: 32% EXTRIC, 35% N) restraint use (35% EXTRIC, 35% N), or mortality (29% EXTRIC, 30% N). However, the estimated maximum speed before the crash was higher in EXTRIC patients (50 +/- 16 mph vs. 46 +/- 18 mph N, p < 0.04), as was the change in velocity (delta V) on impact (EXTRIC 30 +/- 15 mph; N, 24 +/- 8 mph, p < 0.01). Brain injuries (51% EXTRIC vs. 35% N) and lower extremity injuries were more numerous in EXTRIC patients (59% vs. 20% N, p < 0.003) and the number of splenic, lower extremity, and pelvic injuries associated with shock was greater in EXTRIC patients, p < 0.02; as were postinjury complications. As a result, operating room costs from orthopedic and plastic surgery increased professional charges in the EXTRIC group versus the N group ($20,000, EXTRIC; $17,000, N) and critical care costs ($13,000, EXTRIC; $4,000, N) with total costs of $72,000 and $77,000, respectively. The lower extremity injuries in EXTRIC patients were primarily a result of body part contacts with intrusions (CIs) of the car occupant compartment structures [73% with vs. 24% without (p < 0.0001)]. In lateral MVCs, brain injuries were also more commonly associated with CIs of the side window frame or A pillar (72% CI vs. 25% no CI; p < 0.035); but as a whole in MVCs in which extrication was necessary, lower extremity injuries from instrument panel or toepan CIs appeared more frequent than those resulting from contacts only (p < 0.0001). In EXTRIC patients, 69% of those in shock had CI injuries, and 80% of the deaths in the EXTRIC group were associated with CI injury. These data suggest that measures designed to prevent CIs by strengthening car passenger compartment structures may reduce the incidence of severe brain and lower extremity injuries and may reduce the need for extrication after MVCs.

Accidents, Traffic↗