Fall, Crush, Kick: Mechanisms and Outcomes in a Cohort of Equine-Related Injuries

2021 ◽  
pp. 000313482110488
Author(s):  
Pratik Bhade ◽  
Amelia Parsons ◽  
Abbey Smiley ◽  
Jacob Shreffler ◽  
Nick Nash ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
The United States ◽  
Rib Fractures ◽  
High Rate ◽  
Protective Equipment ◽  
Solid Organ ◽  
Mechanism Of Injury ◽  
Severe Injuries ◽  
Protective Devices ◽  
Animal Size

Introduction The potential for significant traumatic injury to individuals who interact with horses remains high due to animal size, forces applied, and unpredictability. Despite an estimated 30 million riders in the United States annually, few recent publications have addressed this patient population. Objectives This study describes characteristics of patients injured in interactions with horses, focusing on mechanism of injury and use of protective equipment. Methods We queried our institution’s trauma registry for all patients admitted for equine-related injuries (ERI) between January 1, 2013 and December 31, 2017. We categorized by specific mechanism of injury (fall, crush, kick, fall + crush, and fall + kick) and presence or absence of protective devices. Results We discovered 143 patients admitted for injuries in equine-related accidents. Patients averaged 49.2 years old, and 62.2% were female. Crush injuries resulted in a high rate of rib fractures. Riders who were kicked had an increased chance of solid organ and facial injuries and falls most commonly led to rib fractures and extremity trauma. Despite lack of documentation on most subjects, protective devices were associated with less severe injuries in those with data (n = 36). Conclusions In this relatively large series of patients with ERI, we found mechanism differences within injury groups. Providers should more carefully document specific circumstances of ERIs. All individuals working with or around horses should exercise prudence and consider using protective equipment.

46 Increased Concomitant Burn and Trauma Injuries Follows an Increase in Overall Trauma Volume: A Descriptive Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S34-S35
Author(s):  
Spogmai Komak ◽  
Chuantao Jiang ◽  
Rebecca Crocker ◽  
Saleem Khan ◽  
Daniel J Freet ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Traumatic Injury ◽  
Operative Intervention ◽  
Burn Injuries ◽  
Electrical Injury ◽  
Solid Organ ◽  
Burn Patients ◽  
Mechanism Of Injury ◽  
Traumatic Injuries ◽  
Concomitant Injury

Abstract Introduction Concomitant traumatic injury in the burn patient complicates care coordination and increases morbidity and mortality. The incidence of concomitant injury, however, is uncommon and reported to range from 5–7%. In May 2020, our level 1 trauma center began seeing 40% more patients per month that the 12 months prior. We sought to determine the incidence of concomitant injury in burn patients during this time of increased trauma volume and to examine the associated traumatic injuries in this group. Methods The burn registry at a single ABA-verified burn center was examined from 5/20–9/20. Patients with concomitant burn and traumatic injury were examined with respect to: %TBSA burn, mechanism of injury, operative interventions, associated traumatic injuries, and length of hospital stay. Continuous data was presented as mean (standard deviation). Results Eighty-nine burn patients were admitted during this period, of whom 24 (26.9%) had concomitant traumatic injuries. The cohort was young and mostly male; the mean TBSA was 16% () (Table 1). The most common mechanism of injury was motor vehicle collision (12 or 50%), followed by fall after high voltage electrical injury (6 or 25%) and motorcycle collisions (5 or 21%). The most common associated injuries were: pulmonary contusions 29.1% (7/24); long bone fractures 25% (6/24); pelvic/acetabular fractures 20.8% (5/24); femur fractures 16.6% (4/24); and solid organ injury: 16.6% (4/24). Twenty patients (83.3%) required burn or trauma operative intervention during hospital stay. Of the 20 patients who required operative intervention, 85% underwent burn surgery and 55% underwent trauma surgery (solid organ or orthopedic). Forty percent of these patients required operation for both burn and traumatic injury. In looking specifically at the electric injury group, all six patients required operative intervention for burn injuries, and four required extremity fasciotomy. Patients with electrical injury had a significantly longer hospital stay relative to their TBSA (p< 0.04). Conclusions Concomitant trauma and burn injuries are infrequent yet present a major clinical challenge. Our recent increase in overall trauma volume was paralleled by an increase in patients with concomitant burn injuries. The associated traumatic injuries require a multi-disciplinary approach to minimize morbidity and restore function.

Development and validation of risk stratification models for adult spinal deformity surgery

2019 ◽  
Vol 31 (4) ◽  
pp. 587-599 ◽  
Author(s):  
Ferran Pellisé ◽  
Miquel Serra-Burriel ◽  
Justin S. Smith ◽  
Sleiman Haddad ◽  
Michael P. Kelly ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
The United States ◽  
Adverse Outcomes ◽  
High Rate ◽  
Prognostic Models ◽  
Time To Event ◽  
European Continent ◽  
Event Risk ◽  
Risk Estimates

OBJECTIVEAdult spinal deformity (ASD) surgery has a high rate of major complications (MCs). Public information about adverse outcomes is currently limited to registry average estimates. The object of this study was to assess the incidence of adverse events after ASD surgery, and to develop and validate a prognostic tool for the time-to-event risk of MC, hospital readmission (RA), and unplanned reoperation (RO).METHODSTwo models per outcome, created with a random survival forest algorithm, were trained in an 80% random split and tested in the remaining 20%. Two independent prospective multicenter ASD databases, originating from the European continent and the United States, were queried, merged, and analyzed. ASD patients surgically treated by 57 surgeons at 23 sites in 5 countries in the period from 2008 to 2016 were included in the analysis.RESULTSThe final sample consisted of 1612 ASD patients: mean (standard deviation) age 56.7 (17.4) years, 76.6% women, 10.4 (4.3) fused vertebral levels, 55.1% of patients with pelvic fixation, 2047.9 observation-years. Kaplan-Meier estimates showed that 12.1% of patients had at least one MC at 10 days after surgery; 21.5%, at 90 days; and 36%, at 2 years. Discrimination, measured as the concordance statistic, was up to 71.7% (95% CI 68%–75%) in the development sample for the postoperative complications model. Surgical invasiveness, age, magnitude of deformity, and frailty were the strongest predictors of MCs. Individual cumulative risk estimates at 2 years ranged from 3.9% to 74.1% for MCs, from 3.17% to 44.2% for RAs, and from 2.67% to 51.9% for ROs.CONCLUSIONSThe creation of accurate prognostic models for the occurrence and timing of MCs, RAs, and ROs following ASD surgery is possible. The presented variability in patient risk profiles alongside the discrimination and calibration of the models highlights the potential benefits of obtaining time-to-event risk estimates for patients and clinicians.

Epidemiology of Acute Extensor Mechanism Injuries in Collegiate-Level Athletes in the United States

2021 ◽  
pp. 194173812110129
Author(s):  
Kevin K. Chen ◽  
Jimmy J. Chan ◽  
William Ranson ◽  
Nicholas Debellis ◽  
Hsin-Hui Huang ◽  
...  
Keyword(s):  
Large Scale ◽  
Injury Rate ◽  
Collegiate Athletes ◽  
The United States ◽  
Extensor Mechanism ◽  
Surveillance Program ◽  
Level Of Evidence ◽  
Severe Injuries ◽  
Male Athletes ◽  
Collegiate Level

Background: Extensor mechanism injuries involving the quadriceps tendon, patella, or patellar tendon can be a devastating setback for athletes. Despite the potential severity and relative frequency with which these injuries occur, large-scale epidemiological data on collegiate-level athletes are lacking. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: Knee extensor mechanism injuries across 16 sports among National Collegiate Athletic Association (NCAA) men and women during the 2004-2005 to 2013-2014 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Extensor mechanism injuries per 100,000 athlete-exposures (AEs), operative rate, annual injury and reinjury rates, in-season status (pre-/regular/postseason), and time lost were compiled and calculated. Results: A total of 11,778,265 AEs were identified and included in the study. Overall, 1,748 extensor mechanism injuries were identified, with an injury rate (IR) of 14.84 (per 100,000 AEs). N = 114 (6.5%) injuries were classified as severe injuries with a relatively higher median time loss (44 days) and operative risk (18.42%). Male athletes had higher risk of season-ending injuries in both all (3.20% vs 0.89%, P < 0.01) and severe (41.54% vs 16.33%, P < 0.01) extensor mechanism injuries. Similarly, contact injuries were more frequently season-ending injuries (4.44% vs 1.69%, P = 0.01). Women’s soccer (IR = 2.59), women’s field hockey (IR = 2.15), and women’s cross country (IR = 2.14) were the sports with the highest rate of severe extensor mechanism injuries. Conclusion: Extensor mechanism injuries in collegiate athletes represent a significant set of injuries both in terms of volume and potentially to their athletic careers. Male athletes and contact injuries appear to have a greater risk of severe injuries. Injuries defined as severe had a higher risk of operative intervention and greater amount of missed playing time. Clinical Relevance: Knowledge of the epidemiology of extensor mechanism injuries may help clinicians guide their athlete patients in sports-related injury prevention and management.

scholarly journals Analysis of Severe Injuries in Crashes Involving Large Trucks Using K-Prototypes Clustering-Based GBDT Model

Safety ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. 32
Author(s):  
Syed As-Sadeq Tahfim ◽  
Chen Yan
Keyword(s):  
Injury Severity ◽  
Unobserved Heterogeneity ◽  
The United States ◽  
Clustering Methods ◽  
Severe Injuries ◽  
Traffic Crash ◽  
Crash Data ◽  
Boosted Decision Trees ◽  
The Individual ◽  
Crash Characteristics

The unobserved heterogeneity in traffic crash data hides certain relationships between the contributory factors and injury severity. The literature has been limited in exploring different types of clustering methods for the analysis of the injury severity in crashes involving large trucks. Additionally, the variability of data type in traffic crash data has rarely been addressed. This study explored the application of the k-prototypes clustering method to countermeasure the unobserved heterogeneity in large truck-involved crashes that had occurred in the United States between the period of 2016 to 2019. The study segmented the entire dataset (EDS) into three homogeneous clusters. Four gradient boosted decision trees (GBDT) models were developed on the EDS and individual clusters to predict the injury severity in crashes involving large trucks. The list of input features included crash characteristics, truck characteristics, roadway attributes, time and location of the crash, and environmental factors. Each cluster-based GBDT model was compared with the EDS-based model. Two of the three cluster-based models showed significant improvement in their predicting performances. Additionally, feature analysis using the SHAP (Shapley additive explanations) method identified few new important features in each cluster and showed that some features have a different degree of effects on severe injuries in the individual clusters. The current study concluded that the k-prototypes clustering-based GBDT model is a promising approach to reveal hidden insights, which can be used to improve safety measures, roadway conditions and policies for the prevention of severe injuries in crashes involving large trucks.

scholarly journals Cognitive mapping as an approach to facilitate organ donation among African Americans

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110294
Author(s):  
Jayme E Locke ◽  
Rhiannon D Reed ◽  
Richard M Shewchuk ◽  
Katherine L Stegner ◽  
Haiyan Qu
Keyword(s):  
Decision Making ◽  
African Americans ◽  
Organ Donation ◽  
Cognitive Mapping ◽  
The United States ◽  
Two Dimensions ◽  
Nominal Group ◽  
Solid Organ ◽  
Related Information ◽  
Empirical Framework

Making up 13.4% of the United States population, African Americans (AAs) account for 28.7% of candidates who are currently waiting for an organ donation. AAs are disproportionately affected by end-organ disease, particularly kidney disease, therefore, the need for transplantation among this population is high, and the high need is also observed for other solid organ transplantation. To this end, we worked with the AA community to derive an empirical framework of organ donation strategies that may facilitate AA decision-making. We used a cognitive mapping approach involving two distinct phases of primary data collection and a sequence of data analytic procedures to elicit and systematically organize strategies for facilitating organ donation. AA adults ( n = 89) sorted 27 strategies identified from nominal group technique meetings in phase 1 based on their perceived similarities. Sorting data were aggregated and analyzed using Multidimensional scaling and hierarchical cluster analyses. Among 89 AA participants, 68.2% were female, 65.5% obtained > high school education, 69.5% reported annual household income ≤ $50,000. The average age was 47.4 years (SD = 14.5). Derived empirical framework consisted of five distinct clusters: fundamental knowledge, psychosocial support, community awareness, community engagement, and system accountability; and two dimensions: Approach, Donor-related Information. The derived empirical framework reflects an organization scheme that may facilitate AA decision-making about organ donation and suggests that targeted dissemination of donor-related information at both the individual-donor and community levels may be critical for increasing donation rates among AAs.

scholarly journals Direct-Acting Antivirals and Organ Transplantation: Is There Anything We Can’t Do?

2020 ◽  
Vol 222 (Supplement_9) ◽  
pp. S794-S801
Author(s):  
Matthew R Kappus ◽  
Cameron R Wolfe ◽  
Andrew J Muir
Keyword(s):  
Organ Transplantation ◽  
The United States ◽  
Virologic Response ◽  
Hcv Infection ◽  
Solid Organ ◽  
Direct Acting Antiviral ◽  
Transplant Candidates ◽  
Direct Acting ◽  
High Sustained Virologic Response ◽  
Waitlist Mortality

Abstract The opioid epidemic has resulted in an increase in organ donors with hepatitis C virus (HCV) infection in the United States. With the development of direct-acting antiviral regimens that offer high sustained virologic response rates even in the setting of immunosuppression after transplantation, these HCV-viremic organs are now being offered to transplant candidates with or without preexisting HCV infection. Strategies for HCV treatment with HCV-viremic organs have included delayed and preemptive approaches. This review will discuss key studies in the different solid organ transplants, recent reports of adverse events, and ethical and regulatory considerations. The efficacy of current HCV therapies has created this important opportunity to improve survival for patients with end-organ failure through greater access to organ transplantation and decreased waitlist mortality rate.

CHILDREN IN TRAFFIC ACCIDENTS

PEDIATRICS ◽  
1969 ◽  
Vol 44 (5) ◽  
pp. 847-854
Author(s):  
G. Anthony Ryan
Keyword(s):  
Lower Limb ◽  
Traffic Accidents ◽  
The United States ◽  
Rear Seat ◽  
Age Group ◽  
Front Seat ◽  
Severe Injuries ◽  
Rural Highways ◽  
Points Of View ◽  
Seating Position

The part that children play in traffic accidents has been studied by numerous workers from differing points of view. Slätis,1 in a study of 5,291 persons injured in traffic accidents and receiving medical treatment in Sweden, found that 16.3% were less than 15 years of age. An examination by Mackay2 of a series of 250 accidents investigated at the scene in Birmingham, England, found that children less than 16 years of age formed 6.2% of the 464 persons involved. In Brisbane, Australia, Jamieson and Tait3 found that children less than 15 years old formed 10.9% of a group of 1,000 admissions or deaths from traffic accidents. Gädeke4 in Germany, found children less than 15 years old were injured more often in rural accidents, that traffic accidents formed 35 to 40% of all fatal accidents in children, and that injuries to the head and lower limb were most common. In Sweden, Ekström, et al.5 found that the majority of children involved in accidents they studied were pedestrians or pedal cyclists, and 40% were between 5 and 9 years old. Moore and Lilienfeld6 reported on 31,001 occupants of known age in 14,520 automobiles involved in injury-producing accidents on rural highways in the United States. They found that children less than 12 years of age formed 9%, adolescents age 12 to 18 years formed 16%, and adults of more than 18 years formed 75%. They found that children received fewer and less severe injuries than adolescents or adults, in each seating position. Front seat passengers in each age group were injured more often and more severely than rear seat passengers.

Impact of alcohol and drug use on bicycle and electric scooter injuries and hospital admissions in the United States

Trauma ◽  
2021 ◽  
pp. 146040862110443
Author(s):  
Nikan K Namiri ◽  
Austin W Lee ◽  
Gregory M Amend ◽  
Jason Vargo ◽  
Benjamin N Breyer
Keyword(s):  
United States ◽  
Drug Use ◽  
Head Trauma ◽  
Hospital Admissions ◽  
Body Part ◽  
The United States ◽  
Severe Injuries ◽  
Injury Surveillance System ◽  
Alcohol And Drug Use ◽  
Awareness Campaigns

Introduction Bicycles and electric scooters (e-scooters) are convenient and accessible means of transportation. Participant safety is contingent on available infrastructure and safe riding practices including not riding while intoxicated. Understanding national prevalence and injury characteristics of bicycle and e-scooter riders who ride while intoxicated may promote awareness campaigns for safe riding practices and decrease morbidity. Methods The National Electronic Injury Surveillance System (NEISS) provides national estimates of injuries that present to emergency departments across the United States. We obtained case information on admitting status, body part injured, diagnosis of injury, age, sex, alcohol usage, and drug usage. We then queried NEISS for injuries related to bicycles and e-scooters in 2019. Results A weighted total of 270,571 (95% confidence interval (CI): 204,517–336,625) bicycle injuries occurred in the United States during 2019; alcohol and drug use were associated with 7% (95% CI: 6–9) and 2% (95% CI: 2–3) of all injuries, respectively. Twenty-four percent (CI: 18--31) of alcohol- and 29% (95% CI: 20–41) of drug-related bicycle injuries resulted in hospital admissions, compared to 15% (95% CI: 12–17) of non–alcohol- and 15% (95% CI: 13–18) of non–drug-related injuries ( p < .001 and p = .002, respectively). A total of 28,702 (95% CI: 13,975–43,428) e-scooter injuries occurred in 2019; alcohol and drug use were associated with 8% (95% CI: 5–12) and 1% (95% CI: 1–2) of injuries, respectively. Sixty percent (95% CI: 47–72) of alcohol-related e-scooter injuries resulted in head trauma, compared to 28% (95% CI: 24–32) of non–alcohol-related injuries ( p < .001). Conclusions Intoxication is associated with increasingly severe injuries, hospital admissions, and head trauma in bicycle and e-scooter riders. The findings support awareness campaigns to educate riders about risky practices, improve non-auto infrastructure, and promote helmet usage.

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