Dangers of Seatback Recline in a Moving Vehicle: How Seatback Recline Increases the Injury Severity and Shifts Injury Pattern

2015 ◽  
Author(s):  
Chandrashekhar K. Thorbole
Keyword(s):  
Injury Prevention ◽  
Injury Severity ◽  
Cervical Spinal Cord ◽  
Injury Pattern ◽  
Mechanism Analysis ◽  
Severe Injuries ◽  
Moving Vehicle ◽  
Frontal Crash ◽  
Cord Injury ◽  
Belt System

The seatbelt is the most important safety device that saves the life during vehicle collisions. The majority of vehicles available today are equipped with the conventional single loop three-point belt systems. In this belt system for the front outboard positions, the shoulder anchor point (D-Ring) is fixed on the vehicle B-pillar. Vehicle manufacturers are required to show the compliance with established FMVSS regulations ensuring adequate safety performance of restraint system during a frontal crash scenario. This performance evaluation is based on the study of the biomechanical response of the crash dummy used. In these evaluations, the front outboard seats and respective seatbacks are set to be based on manufacturers nominal riding position that usually consist of seatback recline less than 20 deg with vertical. The conventional belt and its fit around the occupant are the function of seatback recline angle. The belt fit get worse with higher seatback recline angles and reduce the level of protection offered during a frontal crash scenario. In some situations, this condition also causes severe to critical injuries. The purpose of this study was to conduct research on the effect of automotive reclined seatback in a moving vehicle on the deterioration of occupant protection and modification in the injury pattern. A real world case is investigated and presented in this paper explaining the dangers of reclined seat in moving a car with a conventional belt system. The investigation involved a detailed study of crash reports, Medical documents, medical scans, accident reconstruction, vehicle inspection, witness statements and other pertinent crash related facts. A surrogate study is conducted on a similar vehicle to identify occupant’s body configuration with respect to various interior components of the vehicle including the seatbelt webbing. The surrogate study also facilitates the understanding of interior marks generated by occupant contact during secondary impacts. A detailed injury mechanism analysis is conducted to identify the best injury prevention countermeasure in such scenario. The injured occupant sustained cervical spinal cord injury in this crash. Abdomen fat stranding analysis is conducted to conclude the lap belt submarining in the crash with reclined seatback. An MADYMO computer modeling study is conducted to explain the occupant kinematics in this frontal crash with reclined seatback and locked hanging shoulder portion of the webbing. The analysis provides insight regarding the kinematics and body interaction with various involved physical components inside the vehicle. This model shows submarining of the pelvis under lap belt that shows occupants vulnerability for abdomen injuries along with other associated severe injuries. The altered kinematics causes occupants neck to interact with the locked shoulder portion of the seatbelt. This knowledge is extremely important for the development of the best injury prevention schemes by improving the crashworthy performance of the vehicle to prevent such injuries.

Cervical Spinal Cord Injury Shows Markedly Lower than Predicted Mortality (>72 Hours After Multiple Trauma) From Sepsis and Multiple Organ Failure

2018 ◽  
Vol 35 (4) ◽  
pp. 378-382
Author(s):  
Oliver Kamp ◽  
Oliver Jansen ◽  
Rolf Lefering ◽  
Renate Meindl ◽  
Christian Waydhas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Multiple Trauma ◽  
Injury Severity ◽  
Multiple Organ ◽  
Injury Pattern ◽  
Significant Difference ◽  
Cord Injury

Background: Sepsis and multiple organ failure (MOF) remain one of the main causes of death after multiple trauma. Trauma- and infection-associated immune reactions play an important role in the pathomechanism of MOF, but the exact pathways remain unknown. Spinal cord injury (SCI) may lead to an altered immune response, and some studies suggest a prognostic advantage for such patients having sepsis or multiple trauma. Yet these findings need to be evaluated in larger cohorts of trauma patients. Methods: Retrospective, multicenter study, using the data of the TraumaRegister DGU. Patients with and without SCI surviving the initial first 72 hours after trauma were matched according to injury pattern and age. Comparative analysis considered morbidity (sepsis, MOF) and hospital mortality. Results: The study population included 800 matched pairs. As intended by the matching process, patients with cervical SCI had an otherwise comparable injury pattern but a higher severity of trauma (mean Injury Severity Score: 36 vs 29, mean number of diagnosis: 5.6 vs 4.4). They had a higher rate of sepsis (15.9% vs 10.9%, P = .005) and MOF (35.9% vs 24.1%, P < .001) while mortality revealed no significant difference (9.5% vs 9.9%, P = .866). Conclusions: Cervical SCI leads to an increased rate of sepsis and MOF but appears to be favorable with respect to outcome of sepsis and MOF following multiple trauma. Further research should focus on the pathomechanisms and the possible arising therapeutic options.

scholarly journals Injury surveillance in taekwondo and judo during physiotherapy coverage of the seventh all Africa Games

2001 ◽  
Vol 57 (1) ◽  
pp. 32-34 ◽  
Author(s):  
J. S. Phillips ◽  
J. M. Frantz ◽  
S. L. Amosun ◽  
W. Weitz
Keyword(s):  
Early Diagnosis ◽  
Injury Prevention ◽  
Risk Ratio ◽  
Medical Staff ◽  
Injury Risk ◽  
Injury Severity ◽  
Upper Limbs ◽  
Severe Injuries ◽  
High Incidence ◽  
Type Of Injury

Objective: To obtain data relating to the incidence of injuries sustained during taekwondo and judo competitions at the 7th All Africa Games.Methods: Prospective recording of injuries sustained by athletes who sought physiotherapy services at the games. Details of type of injury, injury sites and injury severity were obtained.Results: Seventy athletes out of 390 participants reported injuries. The overall injury risk ratio was 0.18. Injuries reported were strains/sprains (65,6%), bruises/contusions (16.1%) and dislocations or fractures (12,9%). The upper limbs were more commonly injured. Of the injuries sustained, approximately 18%, 69% and 13% were respectively classified as mild, moderate and severe injuries.Conclusions: The high incidence of moderate to severe injuries highlights the need for injury prevention programs and the presence of medical staff at major tournaments in order to make early diagnosis and appropriate intervention.

Cervical Spinal Cord Injury Associated with Near-Drowning Does Not Increase Pneumonia Risk or Mortality

2011 ◽  
Vol 77 (4) ◽  
pp. 426-429
Author(s):  
Thomas Butler ◽  
Susanna Shin ◽  
Jay Collins ◽  
Rebecca C. Britt ◽  
Scott F. Reed ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Injury Severity ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Demographic Data ◽  
Pulmonary Complications ◽  
Discharge Data ◽  
Near Drowning ◽  
Discharge Disposition ◽  
Cord Injury

Body surfing accidents (BSA) can cause cervical spinal cord injuries (CSCIs) that are associated with near-drowning (ND). The submersion injury from a ND can result in aspiration and predispose to pulmonary complications. We predicted a worse outcome (particularly the development of pneumonia) in patients with CSCIs associated with ND. A retrospective review was performed of patients who were treated at Eastern Virginia Medical School for a CSCI resulting from a blunt mechanism. Data collected included basic demographic data, data regarding injury and in-hospital outcomes, and discharge data, including discharge disposition. Statistics were performed using χ2 and Student t test. In 2003 to 2008, 141 patients were treated for CSCIs with inclusion criteria. Thirty patients (21%) had an associated ND (BSA) and 111 patients (79%) did not (BLT). The cohorts were similar in mean age (BSA, 45 years; BLT, 50 years; P = 0.16) and male gender distribution (BSA, 93%; BLT, 79%; P = 0.13). The cohorts were similar in injury severity using Injury Severity Score (BSA, 22; BLT, 24; P = 0.65). The cohorts were similar in rates of developing pneumonia (BSA, 3%; BLT, 12%; P = 0.31). The rate of infection was significantly higher in the cohort without an associated near-drowning (BSA, 10%; BLT, 32%; P = 0.033). The mean intensive care unit stay (BSA, 3.5 days; BLT, 11.3 days; P = 0.057) and the rate of mortality were similar (BSA, 10%; BLT, 10% P = 0.99). Those patients with an associated ND had a shorter hospital stay (BSA, 5.7 days; BLT, 22.2 days; P = 0.007) and a better chance of being discharged home (BSA, 57%; BLT, 27%; P = 0.004). CSCIs after a BSA do better than their counterparts without an associated ND. CSCIs associated with ND appear to be isolated injuries with minimal pulmonary involvement despite submersion injuries.

Blunt Assault: ‘Million Dollar Baby’

2014 ◽  
Vol 80 (1) ◽  
pp. 72-75 ◽  
Author(s):  
Pantelis Hadjizacharia ◽  
Peter Rhee ◽  
Viraj Pandit ◽  
Hassan Aziz ◽  
Donald Green ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Injury Severity ◽  
Cervical Spinal Cord ◽  
Spine Injury ◽  
Cervical Spine Fracture ◽  
Case Review ◽  
Retrospective Case ◽  
Cord Injury ◽  
Hands And Feet ◽  
Head Neck

Contrasting reports exist in the literature regarding the management of patients with blunt assault to the head, neck, and face and more importantly for clearing the cervical spine. The purpose of our study was to determine the risk of cervical spine injuries after blunt assault to the head, neck, and face and its association with other injuries. We performed a retrospective case review of all blunt assault trauma admissions to the head, neck, and face at our Level I trauma center. We identified all patients who were assaulted with hands and feet and blunt instruments. A total of 3286 patients with blunt assault to the head, neck, and face were identified of whom 11 (0.003%) were found to have a cervical spine fracture or cervical spine subluxation. None of the patients had a cervical spinal cord injury. The 11 patients composed our study population with a mean age of 39 ± 7.8 years, 100 per cent were male, and the mean Injury Severity Score was 12 ± 7.9. Five (45%) patients required surgery for stabilization of the cervical spine. Mortality was reported in only one patient who had a C7 transverse process fracture. Cervical spine injury after blunt assault is rare but does occur and encompasses significant injuries requiring surgical intervention. However, these injuries are the result of direct blows to the cervical spine and we suggest that assaulted patients with no direct trauma to the neck do not require an exhaustive evaluation of the cervical spine.

scholarly journals Diaphragm pacing decreases hospital charges for patients with acute cervical spinal cord injury

2020 ◽  
Vol 5 (1) ◽  
pp. e000528
Author(s):  
Andrew J Kerwin ◽  
Yohan Diaz Zuniga ◽  
Brian K Yorkgitis ◽  
Jennifer Mull ◽  
Albert T Hsu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Linear Regression ◽  
Injury Severity ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Multivariate Linear Regression ◽  
Hospital Charges ◽  
Diaphragm Pacing ◽  
Cord Injury

BackgroundCervical spinal cord injury (CSCI) is devastating and costly. Previous research has demonstrated that diaphragm pacing (DPS) is safe and improves respiratory mechanics. This may decrease hospital stays, vent days, and costs. We hypothesized DPS implantation would facilitate liberation from ventilation and would impact hospital charges.MethodsWe performed a retrospective review of patients with acute CSCI between January 2005 and May 2017. Routine demographics were collected. Patients underwent propensity matching based on age, injury severity score, ventilator days, hospital length of stay, and need for tracheostomy. We then adjusted total hospital charges by year using US Bureau of Labor Statistics annual adjusted Medical Care Prices. Bivariate and multivariate linear regression statistics were performed using STATA V.15.ResultsBetween July 2011 and May 2017, all patients with acute CSCI were evaluated for DPS implantation. 40 patients who had laparoscopic DPS implantation (DPS) were matched to 61 who did not (NO DPS). Following DPS implantation, there was a statistically significant increase in spontaneous Vt compared with NO DPS (+88 mL vs −13 mL; 95% CI 46 to 131 vs −78 to 51 mL, respectively; p=0.004). Median time to liberation after DPS was significantly shorter (10 vs 29 days; 95% CI 6.5 to 13.6 vs 23.1 to 35.3 days; p<0.001). Adjusted hospital charges were significantly lower for DPS on multivariate linear regression models controlling for year of injury, sex, race, injury severity, and age (p=0.003).DiscussionDPS implantation in patients with acute CSCI produces significant improvements in spontaneous Vt and reduces time to liberation, which translated into reduced hospital charges on a risk-adjusted, inflation-adjusted model. DPS implantation for patients with acute CSCI should be considered.Level of evidenceLevel III.

Nerve repair using acidic fibroblast growth factor in human cervical spinal cord injury: a preliminary Phase I clinical study

2008 ◽  
Vol 8 (3) ◽  
pp. 208-214 ◽  
Author(s):  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Yun-An Tsai ◽  
Yu-Chun Chen ◽  
Henrich Cheng
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Growth Factor ◽  
Injury Severity ◽  
Cervical Spinal Cord ◽  
Nerve Repair ◽  
Fibroblast Growth ◽  
Acidic Fibroblast Growth Factor ◽  
Repair Strategy ◽  
Cord Injury

Object The aim of this study was to assess functional outcomes of nerve repair using acidic fibroblast growth factor (FGF) in patients with cervical spinal cord injury (SCI). Methods Nine patients who had cervical SCI for longer than 5 months were included in pre- and postoperative assessments of their neurological function. The assessments included evaluating activities of daily living, associated functional ability, and degree of spasticity, motor power, sensation, and pain perception. After the first set of assessments, the authors repaired the injured segment of the spinal cord using a total laminectomy followed by the application of fibrin glue containing acidic FGF. Clinical evaluations were conducted 1, 2, 3, 4, 5, and 6 months after the surgery. Preoperative versus postoperative differences in injury severity and grading of key muscle power and sensory points were calculated using the Wilcoxon signed-rank test. Results The preoperative degree of injury severity, as measured using the American Spinal Injury Association (ASIA) scoring system, showed that preoperative motor (52.4 ± 25.9 vs 68.6 ± 21.5), pinprick (61.0 ± 34.9 vs 71.6 ± 31.0), and light touch scores (57.3 ± 33.9 vs 71.9 ± 30.2) were significantly lower than the respective postoperative scores measured 6 months after surgery (p = 0.005, 0.012, and 0.008, respectively). Conclusions Based on the significant difference in ASIA motor and sensory scale scores between the preoperative status and the 6-month postoperative follow-up, this novel nerve repair strategy of using acidic FGF may have a role in the repair of human cervical SCI. Modest nerve regeneration occurred in all 9 patients after this procedure without any observed adverse effects. This repair strategy thus deserves further investigation, clinical consideration, and refinement.

Traumatic injuries to the hand and wrist in youth elite handball are most frequently localised to the thumb and proximal interphalangeal joints

2020 ◽  
Author(s):  
Veronika Mandlik ◽  
Leonard Achenbach ◽  
Marc Rüwe ◽  
Matthias Kuhr ◽  
Kai Fehske
Keyword(s):  
Injury Prevention ◽  
Injury Severity ◽  
Wrist Injuries ◽  
Prevention Measures ◽  
Severe Injuries ◽  
Traumatic Injuries ◽  
Previous Season ◽  
Location Type ◽  
Type Of Injury ◽  
Return To Competition

Abstract Introduction Hand and wrist injuries have been described as the second most common severe injuries in handball. However, no evidence exists regarding the specific characteristics of these injuries. The aim of this study was to determine the injury pattern of hand and wrist injuries in youth handball. Materials and Methods Two-hundred and ninety-six adolescent elite handball players (mean age: 14.0 ± 0.8 years) completed a retrospective survey regarding their hand and wrist injuries during the previous season. The injury questionnaire was adapted from sports-specific questionnaires to the demands of hand and wrist injuries in handball and included injury location, type of injury and injury severity. Results One-hundred and twenty-three (42 %) players reported 156 injuries (0.53 injuries per season per player) to their hands or wrists in the past season. Injuries to the proximal interphalangeal joints were most frequently described (n = 74, 47 %). The thumb was involved in 46 (29 %) cases. Sprains (n = 113, 72 %) were the most common type of injury. Thirty-six percent of moderate and severe injuries (> 7 days time loss) had not been treated by a physician. Conclusions The rates of hand and wrist injuries are high in youth elite handball. Injury prevention strategies and return to competition criteria should focus on the thumb and the interphalangeal joints. Further research into these injuries is essential to identify risk factors and to develop adequate injury prevention measures.

scholarly journals Trends in Demographics and Markers of Injury Severity in Traumatic Cervical Spinal Cord Injury

2021 ◽  
Author(s):  
Bizhan Aarabi ◽  
Jennifer S. Albrecht ◽  
J. Marc Simard ◽  
Timothy Chryssikos ◽  
Gary Schwartzbauer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Injury Severity ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury

Danger on the Farm: A Comparison of Agricultural and Animal-Related Injuries

2017 ◽  
Vol 83 (5) ◽  
pp. 507-511 ◽  
Author(s):  
Jessica L. Weaver ◽  
Charles W. Kimbrough ◽  
Kimberly Broughton-Miller ◽  
Michelle Frisbie ◽  
Jodi Wojcik ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Injury Prevention ◽  
Rural Areas ◽  
Severity Score ◽  
Injury Severity ◽  
Organ Injury ◽  
Large Animal ◽  
Solid Organ ◽  
Severe Injuries ◽  
Agricultural Injuries

Animal-related injuries are common in rural areas. Agricultural workers can suffer severe injuries involving farm machinery or falls. The spectrum of injuries related to rural activities is poorly defined and characterizing these injuries will improve injury prevention efforts. Records for injured patients admitted between 2010 and 2013 were retrospectively reviewed. Patients with a mechanism of injury involving a large animal or with the injury site listed as “farm” were included. Patients with agricultural injuries (n = 85) were older with more multisystem injuries than patients injured by animals (n = 132) but the Injury Severity Score was equivalent. There was no difference in intensive care unit length of stay, ventilator days, or mortality. There was no difference in frequency of solid organ injury, pelvic fractures, rib fractures, or hemo- or pneumothorax between groups. Animal injuries had more frequent traumatic brain injuries (22.4% vs 10.5%, P = 0.03), whereas agricultural injuries had more vertebral fractures (20.5% vs 9.2%). Of toxicology screens performed, 25 per cent (22/88) were positive. No significant differences were found between occupational versus recreational animal injuries. Agricultural and animal-related injuries have different characteristics but Injury Severity Score and mortality were similar. Severe injuries from both mechanisms are common in rural communities and injury prevention activities are needed in both settings.

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