scholarly journals Temporal changes in slipped upper femoral epiphysis at a regional level: a declining incidence and literature review

2019 ◽  
Vol 13 (5) ◽  
pp. 445-456
Author(s):  
A. Tucker ◽  
J. Ballard ◽  
A. Cosgrove
Keyword(s):  
Knee Pain ◽  
Census Data ◽  
Slip Rate ◽  
Temporal Changes ◽  
Incidence Rates ◽  
Level Of Evidence ◽  
Delay In Diagnosis ◽  
Patient Demographics ◽  
Slipped Upper Femoral Epiphysis ◽  
Delays In Diagnosis

Purpose Slipped upper femoral epiphysis (SUFE) is one of the most common adolescent hip pathologies in children with potential for life-long morbidity secondary to avascular necrosis (AVN). The primary aim is to determine an up-to-date demographic of SUFE, as well as current trends in presentation and radiological characteristics. Secondary aims are to quantify prophylactic fixation and subsequent contralateral SUFE. Methods Between 01 January 2013 and 31 December 2015, all cases of SUFE were identified in Northern Ireland. Patient demographics, slip characteristics and outcomes are presented and the incidence rates were calculated using census data. Temporal changes in incidence, compared with a previous cohort, are demonstrated. Results A total of 56 patients (80 hips) were identified. Based on census data, SUFE incidence has declined from 7.14 to 4.69/100,000 population aged < 16 years. Male cases predominated by > 2:1 ratio, and tended to be older than female cases. Approximately 75% of patients were above the 75th centile for age-sex adjusted body weight. Knee pain as a presenting symptom led to a delay in diagnosis. Prophylactic fixation was performed in 25.9%, with contralateral slips occurring in 27.5%. AVN occurred in 7.4% and remained static. Conclusion The incidence of SUFE has declined ~34% in our region. When SUFE occurs, knee pain often results in a delay in definitive diagnosis, and commands clinical vigilance to avoid delays in diagnosis. Patients in our region should be aware of a 1-in-4 contralateral slip rate. Overall, AVN rates remain static and are acceptable, despite the declining incidence of SUFE. Level of evidence Level III - Retrospective Cohort Study

scholarly journals Factors Associated With Knee Pain and Heel Pain in Youth Soccer Players Aged 8 to 12 Years

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988337 ◽  
Author(s):  
Toshiyuki Iwame ◽  
Tetsuya Matsuura ◽  
Naoto Suzue ◽  
Joji Iwase ◽  
Hirokazu Uemura ◽  
...  
Keyword(s):  
Knee Pain ◽  
Cross Sectional Study ◽  
Heel Pain ◽  
Older Age ◽  
Soccer Players ◽  
Clinical Factors ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Youth Soccer ◽  
Study Participants

Background: Soccer is played by many children younger than 12 years. Despite its health benefits, soccer has also been linked to a high number of sport-related injuries. Purpose: To investigate the relationship between clinical factors and knee or heel pain in youth soccer players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Study participants included 602 soccer players aged 8 to 12 years who were asked whether they had experienced episodes of knee or heel pain. Data were collected on age, body mass index, years of playing soccer, playing position, and training hours per week. Associations of clinical factors with the prevalence of knee or heel pain were examined by univariate and multivariate logistic regression analyses. Results: Episodes of knee and heel pain were reported by 29.4% and 31.1% of players, respectively. Multivariate analyses revealed that older age and more years of playing soccer were significantly and positively associated with the prevalence of knee pain ( P = .037 and P = .015 for trend, respectively) but did not identify any significant associations for heel pain. Conclusion: In this study of youth soccer players, knee pain was associated with older age and more years of play, but heel pain was not significantly associated with any factor.

scholarly journals Injuries related to respiratory masks in the US are very rare

2021 ◽  
Author(s):  
Philip N. Cohen
Keyword(s):  
Census Data ◽  
Incidence Rates ◽  
Common Type ◽  
Respiratory Protection ◽  
Risk Of Falling ◽  
Injury Surveillance System ◽  
Household Products ◽  
The Us ◽  
Protection Devices ◽  
Almost All

Background. Protective facemasks are important for preventing the spread of COVID-19, and almost all Americans have worn them at least some of the time during the pandemic. There are reasonable concerns about some ill effects of mask-wearing, especially for people who wear masks for extended periods, and for the risk of falling as a result of visual obstruction. But there are also unsupported fears and objections stemming from misinformation and fueled by political disputes. Methods. The study analyzed the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) for 2020, using the product code for Respiratory Protection Devices, and calculated population incidence rates using Census data. Results. The NEISS included 128 cases, representing an estimated 5122 reported injuries in the population (95% CI 3322, 6922). The overall rate of injury reports was 1.54 per 100,000 U.S. residents (95% CI 1.00, 2.08). People over age 75 had higher rates than the population overall, with 5.27 injuries per 100,000 (95% CI 2.17, 8.37). The most common type of incidents involved facial injuries, rashes, falls, and those that might be considered anxiety-related. Conclusion. Wearing protective face masks is extremely safe, especially in comparison with other common household products, and in light of their protective benefits with regard to prevent the spread of COVID-19. This information may be useful for public health messaging, and for practitioners trying to increase compliance with mask-wearing guidance.

scholarly journals Evaluation of Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL), as an Early Biomarker and Prognostic Factor of Contrast Induced Acute Kidney Injury (CI-AKI) following Cardiac Catheterization

2016 ◽  
Vol 33 (3) ◽  
pp. 133-139
Author(s):  
Azizun Nessa ◽  
Masud Ahmed ◽  
Md Amzad H Fakir ◽  
Mamun Mostafi
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Military Hospital ◽  
Urine Ngal ◽  
Cross Sectional ◽  
Delay In Diagnosis ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Patient Demographics ◽  
Neutrophil Gelatinase

Acute kidney injury (AKI) usually detected by s. creatinine, which rises after 48 hrs of insult causes delay in diagnosis and to take preventive or therapeutic measures. Hence amongst many neutrophil gelatinase associated lipocalin (NGAL) is emerging as early, sensitive, and most promising biomarker of AKI both in urine and plasma. This prospective cross sectional observational study was carried out in Combined Military Hospital (CMH) Dhaka from October 2011 to March 2012. A total of willing 100 adult patients undergoing elective coronary angiogram (CAG) with normal kidney function were included in this study. Our study defined contrast induced AKI (CI-AKI) as rise of serum creatinine by >25% or e”0.5 mg/dl from baseline after exposure to contrast media and urine NGAL e”100 ng/ml was taken as cut off value to predict AKI as calculated by ROC curve. The main outcome measures were urine NGAL at 4 hrs and serum creatinine at 48 hrs after CAG. Significant elevation of urine NGAL was noted in 9 patients after 4 hrs of CAG, of them 8 (8%) patients developed raised s. creatinine (AKI) after 48 hrs. Patient demographics and procedural factors were although statistically significant in few instances but none was predictive of AKI.J Bangladesh Coll Phys Surg 2015; 33(3): 133-139

scholarly journals LB20. Impact of School-Located Influenza Vaccination on Vaccination Coverage, School Absenteeism, and Influenza Hospitalization

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S766-S766
Author(s):  
Jade Benjamin-Chung
Keyword(s):  
School District ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Census Data ◽  
Incidence Rates ◽  
Control School ◽  
School Absenteeism ◽  
California Department ◽  
Catchment Areas ◽  
The Impact

Abstract Background School-located influenza vaccination programs aim to increase influenza vaccination coverage and produce indirect effects by interrupting influenza transmission. We evaluated the impact of a program that delivered the inactivated influenza vaccine in 2016–2017 to elementary schools in a large, diverse urban school district in Oakland, California on vaccination coverage, school absenteeism, and influenza hospitalization. Methods We conducted a prospective cohort study and used pre-program data from the California Department of Education on school characteristics to identify a control school district with similar characteristics to the program district. We measured parent recall of student influenza vaccination in surveys in 2017 in 44 schools per district (N = 6,070). We obtained absence data from school districts and influenza hospitalization data for district catchment areas prior to and during the program. We used generalized linear models to estimate difference-in-differences (DIDs) in absence rates during influenza season adjusting for month, race, and grade to account for differences in pre-program rates. Standard errors accounted for school clusters. For influenza hospitalization, we estimated cumulative incidence rates using census data to obtain the population size and risk ratios (RR) using modified Poisson regression. Results Vaccination coverage was 56.7% in control schools and 63.9% in program schools (difference = 7.2%; 95% CI 3.6%, 10.8%). 24% of students in program schools were vaccinated at school. Absences per 100 days were 5.40 vs. 6.68 in program vs. control sites for all absences and 3.01 vs. 3.60 for illness-related absences; DIDs were statistically significant for illness absences. Among all ages, the risk ratio for influenza hospitalization in program vs. control districts was 0.65 (95% CI 0.55, 0.78) among all ages and 0.71 for adults 65 or older (95% CI 0.57, 0.89). Hospitalization was too rare among elementary aged students to estimate RRs in that group. Conclusion Elementary school-located influenza vaccination increased influenza vaccination and decreased school absence and influenza hospitalization. There was an indirect effect on hospitalization in the elderly and nonelementary aged groups. Disclosures All authors: No reported disclosures.

Prioritisation of catheterised patients for elective bladder outflow obstruction surgery in the current coronavirus disease 2019 era to reduce catheter-associated morbidity

2020 ◽  
pp. 205141582096403
Author(s):  
Angela Kit Ying Lam ◽  
Kathie Wong ◽  
Tharani Nitkunan
Keyword(s):  
Median Time ◽  
Waiting Times ◽  
Waiting List ◽  
Transurethral Resection Of Prostate ◽  
Outflow Obstruction ◽  
Level Of Evidence ◽  
Bladder Outflow Obstruction ◽  
Patient Demographics ◽  
Accident And Emergency ◽  
Included Patient

Objectives: This study aimed to audit the waiting times for a transurethral resection of prostate (TURP) at our institution, and to evaluate the extent of catheter-associated morbidity in this population. Methods: This was a retrospective closed-loop audit, with cycle one between 1 January 2018 and 31 December 2018 and cycle two between 1 October 2019 and 29 February 2020. Data collected included patient demographics, catheter status, catheter-associated presentations to accident and emergency (A&E), admissions and waiting times for TURP. The waiting-list form now has a catheter box, and a goal of 30 days from waitlisting to operation was set for those catheterised. Results: In cycle 1, 36% of the 181 patients were catheterised, and waited a median of 119 days (interquartile range (IQR) 59–163 days) for their TURP, while those not catheterised waited a median of 118 days (IQR 57.75–188.25 days). Catheterised patients presented to A&E 93 times, resulting in 13 admissions, compared to two presentations and zero admissions for those not catheterised. The median time from catheter insertion to first A&E attendance was 20 days (IQR 2–101 days). In cycle 2, 33% of the 55 patients were catheterised, with the median waiting-list time falling to 32 days (IQR 22–46 days) in those catheterised and 33 days (IQR 20–49 days) in those not catheterised. All 11 A&E attendances were from catheterised patients, with no admissions. The median time from insertion to first A&E attendance was nine days (IQR 4–40 days). Eighty-eight per cent of the waiting-list forms had appropriately ticked the catheter box. Conclusion: Our study shows that catheterised patients awaiting a TURP are more likely to have complications necessitating A&E attendance. Prioritisation of these patients on the waiting list for bladder outflow obstruction surgery may help to reduce catheter-associated morbidity. Level of evidence: Level 2c.

scholarly journals Banning open carry of unloaded handguns decreases firearm-related fatalities and hospital utilization

2018 ◽  
Vol 3 (1) ◽  
pp. e000196 ◽  
Author(s):  
Rachael A Callcut ◽  
Anamaria M Joyce Robles ◽  
Matthew W Mell
Keyword(s):  
Unintentional Injury ◽  
State Level ◽  
Incidence Rates ◽  
Level Of Evidence ◽  
Firearm Injuries ◽  
Level Data ◽  
Before And After ◽  
Gun Laws ◽  
The Law ◽  
Incident Rate

BackgroundSince 1967, in California it has been illegal to openly carry a loaded firearm in public except when engaged in hunting or law enforcement. However, beginning January 1, 2012, public open carry of unloaded handguns also became illegal. Fatal and non-fatal (NF) firearm injuries were examined before and after adoption of the 2012 ban to quantify the effect of the new law on public health.MethodsState-level data were obtained directly from California and nine other US state inpatient and emergency department (ED) discharge databases, and the Centers for Disease Control Web-Based Injury Statistics Query and Reporting System. Case numbers of firearm fatalities, NF hospitalizations, NF ED visits, and state-level population estimates were extracted. Each incident was classified as unintentional, self-inflicted, or assault. Crude incidence rates were calculated. The strength of gun laws was quantified using the Brady grade. There were no changes to open carry in these nine states during the study. Using a difference-in-difference technique, the rate trends 3 years preban and postban were compared.ResultsThe 2012 open carry ban resulted in a significantly lower incident rate of both firearm-related fatalities and NF hospitalizations (p<0.001). The effect of the law remained significant when controlling for baseline state gun laws (p<0.001). Firearm incident rate drops in California were significant for male homicide (p=0.023), hospitalization for NF assault (p=0.021  male; p=0.025 female), and ED NF assault visits (p=0.04). No significant decreases were observed by sex for suicides or unintentional injury. Changing the law saved an estimated 337 lives (3.6% fewer deaths) and 1285 NF visits in California during the postban period.DiscussionOpen carry ban decreases fatalities and healthcare utilization even in a state with baseline strict gun laws. The most significant impact is from decreasing firearm-related fatal and NF assaults.Level of evidenceIII, epidemiology.

Congenital internal rotation deformity of the distal femur presenting as patellofemoral instability and pain

2019 ◽  
Vol 4 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Xinyuan Zhang ◽  
John Attenello ◽  
Marc R Safran ◽  
David W Lowenberg
Keyword(s):  
Internal Rotation ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Distal Femur ◽  
Case Series ◽  
Patellofemoral Instability ◽  
Level Of Evidence ◽  
Femoral Antetorsion ◽  
Derotational Osteotomy ◽  
Anterior Knee

ObjectivesFemoral antetorsion, defined as the angle of rotation of the femoral head and neck axis in relation to the transcondylar axis of the distal femur, is a cause for patellofemoral instability and anterior knee pain. Most clinical reports do not distinguish between antetorsion of the femur distal to the isthmus and anteversion of the proximal femur, which is another cause of femoral internal rotational deformity.MethodsThis retrospective observational case series evaluated four cases in three female patients who underwent evaluation of surgical intervention for chronic anterior knee pain since childhood. Physical examination and radiographic images supported the diagnosis of internal rotation deformity at the distal femora in all four cases. Distal femoral derotational osteotomy of 45°, 60° and 30° were performed, respectively. Kujala scoring system for patellofemoral pathology was used to assess the change in knee symptoms before and after the osteotomies.ResultsThis study demonstrated successful treatment of the resultant knee symptoms from femoral antetorsion with distal femur derotational osteotomy in all three patients.ConclusionsPatellofemoral syndrome is multifactorial, and the true anatomic reason for each patient’s individual pathology must be determined before surgery proceeds.Level of evidenceLevel V.

scholarly journals Streamlining Definitive Care for Occult Scaphoid Fractures: A Retrospective Review of the Workup of Scaphoid Nonunions and Applying Lessons Learned

2020 ◽  
Vol 185 (7-8) ◽  
pp. e958-e962
Author(s):  
Shian Liu Peterson ◽  
John Scott Donoughe ◽  
Derrick O’Neal ◽  
Kyle Mombell ◽  
Dominic GomezLeonardelli
Keyword(s):  
Retrospective Review ◽  
Delayed Diagnosis ◽  
Medical System ◽  
Service Members ◽  
X Rays ◽  
Scaphoid Nonunion ◽  
Delay In Diagnosis ◽  
Scaphoid Fractures ◽  
Initial Imaging ◽  
Delays In Diagnosis

Abstract Introduction The process for working up scaphoid fractures from frontline providers to the specialty care clinic is variable. Initial imaging can often be negative and the management algorithm is not clearly defined. Delays in diagnosis are a contributing factor to scaphoid nonunion. Fractures may not be identified by frontline providers on initial presentation because of radiographically occult injuries. If not treated promptly, scaphoid fractures may be complicated by nonunion, avascular necrosis, and osteoarthritis. Materials and Methods Retrospective review of scaphoid nonunions from 2017 to 2018 in a single tertiary care institution after internal review board approval was obtained (NMCSD.QI.2019.0003). Cases were identified using an ICD 10 search for “scaphoid (navicular) fracture non-union” and subtypes. Charts were examined for time between injury and presentation, injury and diagnosis, initial radiologic workup, and limited duty (LIMDU). Nonparametric statistical analysis for linear and categorical data was conducted using SPSS. A subgroup of patients who had a delay in diagnosis of greater than 30 days upon entering the medical system was further analyzed and identified as the “delayed diagnosis” cohort. Results In total, 30 patients with scaphoid nonunion were identified. Overall, 35% of patients had negative initial X-rays and averaged 42.1 days until diagnosis. In total, 100% of patients required at least one LIMDU period, averaging 1.4 periods, for a total of 6,404 days and 16% went on to a physical evaluation board (PEB). In 9 (30%) of these patients, injury was initially not identified upon entering the medical system resulting in average of 139.7 days until diagnosis; this became known as the delayed diagnosis subgroup. Further analysis of the delayed diagnosis subgroup demonstrated significantly more initial negative X-rays (P &lt; .005) at a rate of 77% (7/9). A delay in diagnosis was significantly associated with PEB (R = 0.4, P = .031) with 33% of these patients going on to a PEB. Conclusions Delayed diagnosis of a scaphoid fracture is a contributing factor for excessive light duty, high rates of LIMDU utilization, and ultimately medical separation of service members. Overall, in all patients who had scaphoid nonunions, the average time to diagnosis was 42.1 days with 35% of patients presenting with negative initial imaging. A delayed diagnosis subgroup was identified and notable for a higher rate of initial negative X-rays, an average of 139.7 days until diagnosis, and a 33% PEB rate. In total, 77% of patients with a delay in diagnosis of more than 30 days had an initial negative X-ray. An evidence-based algorithm for diagnosing occult scaphoid fractures may prevent delays in diagnosis, thus increasing the readiness of active duty service members.

scholarly journals A Review of a Decade of Rugby Union Injury Epidemiology: 2007-2017

2018 ◽  
Vol 10 (3) ◽  
pp. 223-227 ◽  
Author(s):  
Pierre L. Viviers ◽  
Jeandré T. Viljoen ◽  
Wayne Derman
Keyword(s):  
Epidemiological Studies ◽  
Incidence Rates ◽  
Rugby Union ◽  
Level Of Evidence ◽  
Injury Rates ◽  
Injury Epidemiology ◽  
Severity Of Injury ◽  
Substantial Risk ◽  
Level 3 ◽  
Research Findings

Context: Rugby union is the most widely played team collision sport globally. As with other contact sports, there is substantial risk of injury. To date, the majority of studies on injury epidemiology have focused on elite male cohorts, which inherently prevents extrapolation of research findings to other groups within the player continuum. This review aims to describe emerging injury trends across the spectrum of various rugby union subpopulations and to highlight gaps that may influence future injury prevention tactics. Evidence Acquisition: Relevant articles published from 2007 to 2017 were obtained by searching MEDLINE, PubMed, and SPORT Discus. Studies on 15-a-side rugby union, implemented according to the 2007 consensus statement on injury definitions and data collection procedures for injuries in rugby union, were used. Study Design: Clinical review. Level of Evidence: Level 3. Results: Match injuries occur more frequently than training injuries. Injury rates increase consistently according to age and level of play. Severity of injury often is greater among lower levels of the game, and sex-specific differences relating to injury patterns and incidence rates exist. Conclusion: To date, a paucity of injury surveillance data exists for women and players of both sexes at all levels of community rugby union. Furthermore, the incidence of injuries and illnesses are poorly reported in epidemiological studies. Despite methodological differences, injury trends remain consistent throughout all levels of play.

Factors associated with delays in diagnosis of pediatric, adolescent and young adult patients with central nervous system tumors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13532-e13532
Author(s):  
Diane Marie Puccetti ◽  
Lena Winestone ◽  
Jeffrey McPheeters ◽  
Jennifer Jill Wilkes ◽  
Henry J. Henk ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Young Adult ◽  
Adolescent And Young Adult ◽  
Urgent Care ◽  
Cns Tumors ◽  
Cancer Symptoms ◽  
Delay In Diagnosis ◽  
Factors Associated ◽  
Delays In Diagnosis

e13532 Background: Central Nervous System (CNS) tumors are the most common solid tumor in children and have the highest mortality. Delays in diagnosis (Dx) may lead to reduced survival. We identify factors associated with delays in Dx in pediatric, adolescent and young adult (AYA) patients with CNS tumors. Methods: A retrospective cohort from the OptumLabs Data Warehouse, which includes claims data for privately insured enrollees in a large US health plan, was identified. Patients diagnosed with CNS tumors between 2001-17 continuously enrolled 6 months prior to diagnosis (Dx) were included. The onset of cancer symptoms was identified by the date of the first encounter associated with cancer symptoms. Time to Dx was calculated as the days between cancer symptom onset and Dx date. The likelihood of presenting with symptoms and the time to Dx (among those with symptoms) was modeled using logistic regression and included sociodemographic and clinical factors. A delay in Dx was defined as > 3 months after a symptom. Results: We identified 6,627 eligible patients, 5,637 (85%) of whom presented with symptoms prior to Dx. Likelihood of a delay appears greatest in those first presenting to a specialist (OR 1.28 vs PCP; P = .24 ) but lowest in those presenting to Urgent care/ER (OR .56 vs PCP; P < 0.001) and was greatest among children < 5 years of age were more likely to present with a symptom (table). However, among those with a symptom, children < 5 had the longest time to Dx (Median 122 days). Males were less likely to present with a symptom prior to Dx (OR .80, P = 0.040) and when experiencing a symptom they experienced shorter time to Dx compared to females (Median 85 vs 110 days). Race, income, and census region were not significant predictors of either likelihood of presenting with symptoms or delay in time to Dx. Conclusions: This study indicates that young children < 5 years had a longer delay in diagnosis compared to older patients. [Table: see text]

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