Equestrian Injury is Costly, Disabling, and Frequently Preventable: The Imperative for Improved Safety Awareness

2013 ◽  
Vol 79 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Kristina Guyton ◽  
Emily Houchen-Wise ◽  
Ellen Peck ◽  
John Mayberry
Keyword(s):  
Injury Severity ◽  
Head Injuries ◽  
Bodily Pain ◽  
Hospital Charge ◽  
Daily Activities ◽  
Equipment Failure ◽  
Helmet Use ◽  
Physical Problems ◽  
Safety Awareness

Horse-related injury can be severe and disabling. We investigated the causes, severity, and costs of equestrian injury with the goal of injury prevention. A retrospective review of horse-related injuries from 2001 to 2008 identified 231 patients with a mean age of 38 years and a mean Injury Severity Score of 11 (range, 1 to 45). Mean length of stay was 5.5 days. Fifty-nine patients (25%) required 84 surgeries. Helmet use was 20 per cent and of the 172 patients not wearing a helmet while mounted, 38 per cent received potentially preventable head injuries. There were three deaths of which two were the result of intracranial hemorrhage in riders not wearing a helmet. Mean hospital charge was $29,800 for a total of $6.9 million. Ninety-one patients completed a survey regarding causation and disability. Thirty-four per cent reported wearing a helmet at the time of injury. Forty per cent reported that poor environmental factors contributed, 30 per cent reported poor horse and rider pairing, and 9 per cent reported equipment failure. Fifty-nine per cent reported long-term disabilities. Compared with the general population, respondents had diminution in their ability to perform usual daily activities associated with physical problems, diminution in social function, and higher bodily pain. We conclude that equestrian injury is costly, disabling, and frequently preventable.

Long-Term Anesthetic-Dependent Hypoactivity after Repetitive Mild Traumatic Brain Injuries in Adolescent Mice

2016 ◽  
Vol 38 (3) ◽  
pp. 220-238 ◽  
Author(s):  
Bridgette D. Semple ◽  
Raha Sadjadi ◽  
Jaclyn Carlson ◽  
Yiran Chen ◽  
Duan Xu ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Vasogenic Edema ◽  
Head Injuries ◽  
Traumatic Brain Injuries ◽  
Return To Play ◽  
Brain Maturation ◽  
Long Term Outcomes ◽  
Mild Traumatic Brain Injuries

Recent evidence supports the hypothesis that repetitive mild traumatic brain injuries (rmTBIs) culminate in neurological impairments and chronic neurodegeneration, which have wide-ranging implications for patient management and return-to-play decisions for athletes. Adolescents show a high prevalence of sports-related head injuries and may be particularly vulnerable to rmTBIs due to ongoing brain maturation. However, it remains unclear whether rmTBIs, below the threshold for acute neuronal injury or symptomology, influence long-term outcomes. To address this issue, we first defined a very mild injury in adolescent mice (postnatal day 35) as evidenced by an increase in Iba-1- labeled microglia in white matter in the acutely injured brain, in the absence of indices of cell death, axonal injury, and vasogenic edema. Using this level of injury severity and Avertin (2,2,2-tribromoethanol) as the anesthetic, we compared mice subjected to either a single mTBI or 2 rmTBIs, each separated by 48 h. Neurobehavioral assessments were conducted at 1 week and at 1 and 3 months postimpact. Mice subjected to rmTBIs showed transient anxiety and persistent and pronounced hypoactivity compared to sham control mice, alongside normal sensorimotor, cognitive, social, and emotional function. As isoflurane is more commonly used than Avertin in animal models of TBI, we next examined long-term outcomes after rmTBIs in mice that were anesthetized with this agent. However, there was no evidence of abnormal behaviors even with the addition of a third rmTBI. To determine whether isoflurane may be neuroprotective, we compared the acute pathology after a single mTBI in mice anesthetized with either Avertin or isoflurane. Pathological findings were more pronounced in the group exposed to Avertin compared to the isoflurane group. These collective findings reveal distinct behavioral phenotypes (transient anxiety and prolonged hypoactivity) that emerge in response to rmTBIs. Our findings further suggest that selected anesthetics may confer early neuroprotection after rmTBIs, and as such mask long-term abnormal phenotypes that may otherwise emerge as a consequence of acute pathogenesis.

Helmets Matter: Kentucky All-Terrain Vehicle Crashes Seen at a Tennessee Trauma Center

2018 ◽  
Vol 84 (2) ◽  
pp. 289-293
Author(s):  
George M. Testerman ◽  
Daniel C. Prior ◽  
Tamie D. Wells ◽  
Sarah E. Rollins ◽  
Stephen L. Oesch
Keyword(s):  
Relative Risk ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma Registry ◽  
Head Injuries ◽  
Multiple Logistic Regression Analysis ◽  
Multiple Logistic Regression ◽  
Helmet Use ◽  
State Laws ◽  
Helmet Laws

All-terrain vehicle (ATV) safety laws, including helmet use, vary by state and are sporadically enforced. Kentucky state laws require safety helmets only for younger riders. We hypothesized that ATV riders injured in Kentucky and seen at a Tennessee trauma center would more likely be unhelmeted, have more severe head injuries, and have higher mortality rates than those injured in Virginia or Tennessee. A Trauma Registry review of 750 injured ATV riders from June 1, 2005, through June 1, 2015 examined state location of accident, helmet use, markers of injury severity, and outcomes. Multiple logistic regression analysis examined predictors of severe head injuries and death with P < 0.05 significant. Unhelmeted ATV rider status predicted more severe head injuries (relative risk 23.5, P < 0.001) and death (relative risk 4.6, P < 0.001). ATV riders injured in the state of Kentucky were twice as numerous. In addition, they were more likely than ATVriders injured in Tennessee or Virginia to be unhelmeted, to have severe head injuries, and to sustain fatal injuries (all P < 0.001). This single trauma center study lends support for maintaining and enforcing current universal helmet laws for ATVriders of all ages in states where they are in effect and highlights the need to upgrade helmet laws that apply only to some riders.

All-Terrain Vehicle Injuries: Are They Dangerous? A 6-Year Experience at a Level I Trauma Center after Legislative Regulations Expired

2005 ◽  
Vol 71 (11) ◽  
pp. 937-941 ◽  
Author(s):  
A.H. Fonseca ◽  
M.G. Ochsner ◽  
W.J. Bromberg ◽  
D. Gantt
Keyword(s):  
Injury Severity ◽  
Public Awareness ◽  
Head Injuries ◽  
Progressive Increase ◽  
Helmet Use ◽  
Closed Head Injuries ◽  
Safety Regulations ◽  
Number Of Patients ◽  
Closed Head ◽  
Level I

All-terrain vehicles (ATVs) have increased in popularity and sales since 1971. This rise in popularity led to an increase in injuries resulting in voluntary industry rider safety regulations in 1988, which expired without renewal in 1998. Our purpose was twofold, to determine the incidence and severity of ATV injuries in our patient population and what, if any impact the safety regulations had. To further characterize the risk of ATV use, we compared them to a vehicle generally recognized as dangerous, the motorcycle (MC). Our trauma registry was reviewed from January 1998 through August 2004 for ATV or MC injured. Data collected included age, gender, mortality, Injury Severity Score (ISS), helmet use, and injury distribution. These were compared to our data from the decade of regulation. There were 352 MC and 221 ATV patients. ATV injured demonstrated a higher proportion of pediatric and female patients ( P < 0.001 and P < 0.01, respectively), a decrease in helmet use (8.6% vs 64.7%, P < 0.001), and increased closed head injuries (CHI) (54.2% vs 44.9%, P < 0.05) compared with MC injured. ISS and mortality were similar. The average number of patients from 1988 to 1998 was 6.9/yr compared to 31.6/yr ( P < 0.001) during 1998–2004 with equal ISS. Our data show that there has been a dramatic and progressive increase in the number of ATV crashes since expiration of industry regulations. ATVs are as dangerous as MCs based on patient ISS and mortality. There are significantly more children and women injured on ATVs. The lower rate of helmet use in ATVs may account for the significantly greater incidence of CHI. These data mandate the need for injury prevention efforts for ATV riders, in particular children, through increased public awareness and new legislation.

Pediatric Equestrian Injuries: Assessing The Impact of Helmet Use

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 487-489
Author(s):  
G. Randall Bond ◽  
Richard A. Christoph ◽  
Bradley M. Rodgers
Keyword(s):  
Emergency Department ◽  
Prospective Observational Study ◽  
Injury Severity ◽  
Head Injuries ◽  
University Of Virginia ◽  
Severity Scale ◽  
Helmet Use ◽  
The Mean ◽  
The University ◽  
The Impact

Objective. To assess the impact of helmet use on the pattern, and severity of pediatric equestrian injuries. Design. A prospective observational study of all children less than 15 years of age who were brought to the University of Virginia children's Emergency Department with horse-related injuries. Results. During the two-year period of the study, 32 children were evaluated. Two children were injured when a horse stepped on them. Thirty children fell from or were thrown from a horse. Of these, 20 were wearing a helmet. Head injuries were more frequent in those patients not wearing helmets. The mean Modified Injury Severity Scale (MISS) score for riders without a helmet (12.9) was significantly higher (more severe) than that for helmeted riders (2.8). All three patients with a Glascow Coma Score &lt;15 on arrival were not wearing a helmet at the time of injury. The frequency of hospitalization was significantly higher for those not wearing a helmet. Compared with other common mechanisms of childhood injury the mean Modified Injury Severity Scale score of injured riders was exceeded only by that of pedestrians struck by a car. Conclusion. Equestrian injuries are more severe than those suffered from other common pediatric mechanisms. Helmet use is associated with decreased frequency and severity of central nervous system injury.

scholarly journals P116: Colder, but no less safe: A comparison of bicycle related traumas in winter compared to summer cyclists

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S106-S107
Author(s):  
S. Davis ◽  
J. Delaney
Keyword(s):  
Protective Factor ◽  
Injury Severity ◽  
Head Injuries ◽  
Severity Scale ◽  
Chi Square ◽  
Helmet Use ◽  
Trauma Severity ◽  
Significant Difference ◽  
Level I ◽  
Chi Square Analysis

Introduction: This study aimed to examine difference in trauma injuries between bicycle users in winter months compared to summer months. Behavioral variables were also examined to assess seasonal variability, as well as associations with traumas. Methods: This was a retrospective cohort study of all bicycle related traumas presenting to a level I trauma center between the years 1998-2018. All data was collected through a standardized trauma database. Seasonal differences were examined by comparing trauma severity and behavior patterns between patients arriving in the months May-September (summer) and those arriving in November-March (winter). Outcome measures included: Injury Severity Scale, GCS, type of accident, helmet use, demographics and alcohol level. Groups were compared using t-tests and Chi-square analysis as appropriate. Results: A total of 980 bicycle related traumas were analyzed. There were a significantly greater number of injuries in the summer as compared to winter months (879 in summer vs. 101 in winter). While most injuries in both groups were rated in the severe range of the Injury Severity Scale, there were no differences in injury severity, initial GCS, deaths, or head injuries between the two seasons. There were also no differences in drug, alcohol, or helmet use. The only significant difference between seasons was that winter riders were more likely to be male. Overall, helmet use was associated with lower injury severity, less head trauma, and a higher initial GCS. Use of alcohol was associated with less likelihood of wearing a helmet. Conclusion: In conclusion, bicycle use in winter does not appear to be associated with worse outcomes than summer. Public health interventions can continue to encourage winter bicycle use, with the encouragement of helmet use and avoidance of alcohol when cycling as an important protective factor in both seasons.

Two-Wheel Vehicular Trauma: An Age-Based Analysis

2012 ◽  
Vol 78 (10) ◽  
pp. 1066-1070 ◽  
Author(s):  
Justin Wagner ◽  
Ajit Rai ◽  
Felipe Ituarte ◽  
Areti Tillou ◽  
Henry Cryer ◽  
...  
Keyword(s):  
Older Patients ◽  
Injury Severity ◽  
Head Injuries ◽  
Functional Decline ◽  
Female Gender ◽  
Public Health Campaign ◽  
Health Campaign ◽  
Helmet Use ◽  
Vehicle Type ◽  
Direct Target

We retrospectively reviewed a series of 516 patients with motorcycle (n = 353) and bicycle (n = 162) injuries; 384 patients (74%) were younger than age 50 years and 132 (26%) were older. No significant differences by age group were seen in gender, helmet use, substance use, complications, or mortality. Older patients had more severe (Injury Severity Score [ISS] greater than 15) injuries (35 vs 18%; P < 0.001), longer intensive care unit stay (1.8 vs 0.9 days; P = 0.03), and more frequent discharge to subacute facilities (27 vs 10%; P < 0.001). When analyzed by vehicle type, fewer older bicyclists used helmets (63 vs 99%; P < 0.001) and more sustained severe head injuries (42 vs 16%; P = 0.002) and critical (ISS greater than 25) overall injuries (19 vs 6%; P = 0.033). Among older patients, independent predictors of mortality included emergent intubation ( P < 0.001), critical injury ( P = 0.006), severe head/neck injury ( P = 0.027), tachycardia at presentation ( P = 0.014), and female gender ( P = 0.026). We conclude that motorcycle and bicycle accidents cause major injuries in older patients with substantial use of hospital and posthospital resources. Older bicyclists are vulnerable to head injury and to greater functional decline. Helmet use among older bicyclists should be a direct target for a public health campaign.

Hemorrhoidal Laser procedure (HeLP) and Hemorrrrhoidal Laser procedure + mucopexy (HeLPexx) and other Emerging Technologies

2020 ◽  
Vol 15 ◽  
Author(s):  
Paolo Giamundo
Keyword(s):  
Laser Treatment ◽  
Dentate Line ◽  
Mucosal Prolapse ◽  
Daily Activities ◽  
Common Goal ◽  
Superior Rectal Artery ◽  
Doppler Probe ◽  
The Common ◽  
Probe Set

Background: Minimally-invasive treatments for hemorrhoids should be encouraged as they cause low morbidity, reasonable discomfort and quicker return to work. According to the “vascular theory” hemorrhoidal disease is mainly caused by blood overflow into hemorrhoidal plexus deriving from the superior hemorrhoidal arteries. Introduction: Many different procedures have been described in the literature with the common goal of reducing the blood flow into the hemorrhoidal piles. ‘HeLP’ (Hemorrhoids Laser Procedure) is a novel form of dearterialization to treat patients suffering from symptomatic hemorrhoids. Methods: The procedure consists of the closure of the terminal branches of the superior rectal artery approximately 2-3 cm above the dentate line by means of laser shots originated by a diode laser platform. The arteries, at that level, have variable location and distribution. Therefore, a doppler probe set at the frequency of 20MHz helps identifying the arteries that would be missed otherwise. The laser beam is well tolerated by patients. For this reason, anesthesia is not required in most cases and the procedure allows a quick return to daily activities. In case of concomitant severe mucosal prolapse, the laser treatment can be combined with suture mucopexy. Three to six running sutures allow a complete lifting of hemorrhoidal piles, securing long-term resolution of symptoms. Results and Conclusions: ‘HeLP’ is indicated in patients with symptomatic hemorrhoids where conservative treatment failed and when mucosal prolapse is scarce or not symptomatic. The addition of mucopexy to laser treatment (HeLPexx) contributes to overall resolution of symptoms when mucosal prolapse is an issue, Emborrhoid is another novel, ‘hi-tech’ form of selective dearterialization used in selected case of hemorrhoids where main symptom is bleeding. It is generally used in cases where surgery is contraindicated due to severe concomitant diseases.

Relationship of helmet use and head injuries among motorcycle crash victims in El Paso county, Colorado, 1989–1990

1995 ◽  
Vol 27 (3) ◽  
pp. 363-369 ◽  
Author(s):  
Barbara Gabella ◽  
Kathy L. Reiner ◽  
Richard E. Hoffman ◽  
Magdalena Cook ◽  
Lorann Stallones
Keyword(s):  
Head Injuries ◽  
El Paso ◽  
Helmet Use ◽  
El Paso County ◽  
Relationship Of

Cost-Effectiveness Analysis of Bicycle Helmet Subsidies in a Defined Population

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 902-907
Author(s):  
Robert S. Thompson ◽  
Diane C. Thompson ◽  
Frederick P. Rivara ◽  
Angela A. Salazar
Keyword(s):  
Cost Effectiveness ◽  
Head Injuries ◽  
Puget Sound ◽  
Cost Effectiveness Analysis ◽  
Bicycle Helmet ◽  
Discount Rates ◽  
Health Maintenance ◽  
Helmet Use ◽  
Bicycle Safety ◽  
Effectiveness Analysis

Objective. To examine the potential effects of bicycle safety helmet cost subsidy on bicycle head injury rates and costs. Design. Using empiric data on the incidence and costs of bicycle injuries to children, we examined the hypothetical effects of various bicycle helmet subsidies in a cost-effectiveness analysis. A hypothetical cohort of 100 000 5- through 9-year-olds was followed for 5 years after helmet cost subsidization. Sensitivity analyses were done of three different levels of safety helmet subsidy ($5, $10, $15), three discount rates (2%, 4%, 6%), 10 levels of safety helmet use ranging from 10% to 100%, and the occurrence or nonoccurrence of catastrophic head injuries. Patients. Forty-three children 5 through 9 years of age and 27 children 10 through 14 years of age with head injuries due to bicycling were identified through emergency department surveillance of a population of 29 533. Setting. Group Health Cooperative of Puget Sound, a large health maintenance organization. Outcome measures. Bicycle head injuries prevented and the savings or costs associated with various subsidy, safety helmet use, and discount rates. Results. Hypothetically, an increase in bicycle helmet use rates to 40% to 50% due to subsidies of $5 or $10 prevents 564 to 840 head injuries in a cohort of 100 000 5- through 9-year-olds over 5 years. Under these conditions and a 2% discount rate, cost savings ranging from $189 207 to $427 808 will result when catastrophic head injuries are included in the analysis. Conclusion. Subsidization of bicycle safety helmets to achieve a cost of $14 to $20 per helmet and use rates of 40% to 50% will likely prove cost-effective. Empirical evidence from a Seattle campaign suggests that such helmet use rates are achievable.

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