scholarly journals Increased population density of neurosurgeons associated with decreased risk of death from motor vehicle accidents in the United States

2012 ◽  
Vol 117 (3) ◽  
pp. 599-603 ◽  
Author(s):  
Atman Desai ◽  
Kimon Bekelis ◽  
Wenyan Zhao ◽  
Perry A. Ball
Keyword(s):  
Population Density ◽  
General Practitioners ◽  
Cause Of Death ◽  
Motor Vehicle ◽  
The United States ◽  
Median Number ◽  
Motor Vehicle Accidents ◽  
Outcome Variable ◽  
Vehicle Accidents ◽  
Risk Of Death

Object Motor vehicle accidents (MVAs) are a leading cause of death and disability in young people. Given that a major cause of death from MVAs is traumatic brain injury, and neurosurgeons hold special expertise in this area relative to other members of a trauma team, the authors hypothesized that neurosurgeon population density would be related to reduced mortality from MVAs across US counties. Methods The Area Resource File (2009–2010), a national health resource information database, was retrospectively analyzed. The primary outcome variable was the 3-year (2004–2006) average in MVA deaths per million population for each county. The primary independent variable was the density of neurosurgeons per million population in the year 2006. Multiple regression analysis was performed, adjusting for population density of general practitioners, urbanicity of the county, and socioeconomic status of the county. Results The median number of annual MVA deaths per million population, in the 3141 counties analyzed, was 226 (interquartile range [IQR] 151–323). The median number of neurosurgeons per million population was 0 (IQR 0–0), while the median number of general practitioners per million population was 274 (IQR 175–410). Using an unadjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.90 fewer MVA deaths per million population (p < 0.001). On multivariate adjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.01 fewer MVA deaths per million population (p < 0.001), with a respective decrease in MVA deaths of 0.03 per million population for an increase in 1 general practitioner (p = 0.007). Rural location, persistent poverty, and low educational level were all associated with significant increases in the rate of MVA deaths. Conclusions A higher population density of neurosurgeons is associated with a significant reduction in deaths from MVAs, a major cause of death nationally. This suggests that the availability of local neurosurgeons is an important factor in the overall likelihood of survival from an MVA, and therefore indicates the importance of promoting neurosurgical education and practice throughout the country.

Trauma

2018 ◽  
Author(s):  
David A. Young
Keyword(s):  
Cause Of Death ◽  
Life Support ◽  
Motor Vehicle ◽  
The United States ◽  
Motor Vehicle Accidents ◽  
Advanced Trauma Life Support ◽  
Traumatic Injuries ◽  
Vehicle Accidents ◽  
One Year ◽  
Uncontrolled Bleeding

Traumatic injuries are the most common cause of death within the United States for children above one year of age Most traumatic injuries in children are a result of motor vehicle accidents, child abuse (or nonaccidental trauma), drowning, thermal injury, or falls. Motor vehicle accidents are the leading cause of death for children above the age of one year. Strategies of Advanced Trauma Life Support (ATLS) utilize a standardized approach to promptly identify and manage life-threatening traumatic injuries. These strategies include recognition of cardiopulmonary disorders, volume resuscitation, and prevention of additional injuries including to the cervical spine. A management plan for severe and uncontrolled bleeding is critically important to have established when caring for children with traumatic injuries. Many strategies have been developed to manage severe and uncontrolled bleeding including the use of massive transfusion protocols, damage control surgery, and hemostatic agents.

Abstract 2367: Increased Density Of Neuroscience Providers Is Associated With Decreased Risk Of Death From Stroke In The United States

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Atman Desai ◽  
Kadir Erkmen ◽  
Kimon Bekelis ◽  
Wenyan Zhao ◽  
Perry A Ball
Keyword(s):  
United States ◽  
General Practitioners ◽  
Healthcare Providers ◽  
The United States ◽  
Median Number ◽  
Outcome Variable ◽  
Risk Of Death ◽  
Resource File ◽  
Special Expertise ◽  
Persistent Poverty

Background. Stroke is a leading cause of death and disability in the United States. Given that neurologists and neurosurgeons hold special expertise in this area relative to other healthcare providers, we hypothesized that the density of neuroscience providers would be associated with reduced mortality from stroke across US counties. Methods. The Area Resource File 2009-2010 was retrospectively analyzed. The primary outcome variable was the three-year (2004-2006) average in cerebrovascular disease deaths per million population for each county. The primary independent variable was the combined density of neurosurgeons and neurologists per million population in the year 2006. Multiple regression analysis was performed, adjusting for density of general practitioners, urbanicity of the county, and socioeconomic status of the county. Results. The median number of annual stroke deaths per million population, in the 3139 counties analyzed, was 586 (IQR 449-754). The median number of neuroscience providers (neurologist or neurosurgeon) per million population was 0 (IQR 0-26), while the median number of general practitioners per million population was 274 (IQR 175-410). Each increase of one neuroscience provider per million population was associated with 0.71 fewer deaths from stroke per million population ( p < 0.001). On multivariate adjusted analysis, each increase of one neuroscience provider per million population was associated with 0.38 fewer stroke deaths per million population ( p < 0.001). Rural location (p<0.001) and increased density of general practitioners ( p < 0.001), were associated with significant increases in the rate of stroke deaths, while persistent poverty and low educational levels were not significant. Conclusions. Higher density of specialist neuroscience providers is associated with significant reduction in deaths from stroke, a major cause of mortality nationally. This suggests that the availability of specialists is an important factor in the overall likelihood of survival from stroke, and therefore underlines the importance of promoting specialist education and practice throughout the country.

Genitourinary Injuries Secondary to Break Dancing in Children and Adolescents

PEDIATRICS ◽  
1986 ◽  
Vol 77 (6) ◽  
pp. 922-924
Author(s):  
JOHN P. GEARHART ◽  
FRANKLIN C. LOWE
Keyword(s):  
Children And Adolescents ◽  
Blunt Trauma ◽  
Cause Of Death ◽  
Motor Vehicle ◽  
Pediatric Trauma ◽  
Motor Vehicle Accidents ◽  
Genitourinary Tract ◽  
Trauma Centers ◽  
Rare Occurrence ◽  
Vehicle Accidents

Trauma to the lower genitourinary tract in children and adolescents has been a rare occurrence. However, with the advent of pediatric trauma centers, more of these injuries are now being seen and evaluated. Although trauma to the genitourinary tract alone is an uncommon cause of death, trauma centers are seeing more children in which decisions regarding the management of the genitourinary tract must be made. Most injuries that have been reported have been secondary to blunt trauma such as straddle injuries, falls, or motor vehicle accidents. Recently, two cases of lower genitourinary tract trauma have been seen associated with the current fad of break dancing.

What Kills Our Kids?

Pained ◽  
2020 ◽  
pp. 45-48
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
United States ◽  
Motor Vehicle ◽  
Chromosomal Abnormalities ◽  
The United States ◽  
Motor Vehicle Accidents ◽  
Childhood Mortality ◽  
The Other ◽  
Past Century ◽  
Vehicle Accidents ◽  
Vision Zero

This chapter asks what kills children and what people can do about it. One of the greatest triumphs in health over the past century has been the dramatic decrease in childhood mortality, yet children still die. In 2016, there were, in the United States, about 38,000 deaths of children under the age of 19. Roughly half of deaths occur in early childhood due to genetic conditions, chromosomal abnormalities, and other perinatal conditions, many of which people do not know how to treat. However, we should be able to prevent most of the other half. The leading causes of injury deaths are motor vehicle deaths and gun-related deaths. Understanding how to prevent them can provide a template for stopping other childhood deaths. The chapter then considers the Vision Zero initiative, passed by the Swedish parliament 20 years ago, which aims to reduce traffic fatalities to zero. Just like motor vehicle accidents, childhood deaths from guns will not end until people work to create a safer environment by reducing the availability of firearms.

Simulating Axonal Stretch During Traumatic Brain Injury Events

2010 ◽  
Author(s):  
Jean-Pierre Dollé ◽  
Jeffrey Barminko ◽  
Rene Schloss ◽  
Martin L. Yarmush
Keyword(s):  
Brain Injuries ◽  
Motor Vehicle ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
The United States ◽  
Motor Vehicle Accidents ◽  
Inertial Forces ◽  
Vehicle Accidents ◽  
Rapid Deceleration ◽  
The Brain

Traumatic Brain Injuries (TBI) affect up to 1.5 million people annually within the United States with as many as 250,000 being hospitalized and 50,000 dying [1]. TBI events occur when the brain experiences a sudden trauma such as a rapid deceleration of the brain that typically occurs during motor vehicle accidents. During rapid deceleration events, the brain is subjected to high inertial forces that can result in a shearing or elongation of axons that is commonly known as Diffuse Axonal Injury (DAI) [2,3].

scholarly journals Analysis of patients with spinal cord trauma associated with traumatic brain injury

2014 ◽  
Vol 13 (4) ◽  
pp. 302-305 ◽  
Author(s):  
João Simão de Melo Neto ◽  
Waldir Antônio Tognola ◽  
Antonio Ronaldo Spotti ◽  
Dionei Freitas de Morais
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Spinal Cord ◽  
Brain Injury ◽  
Injury Risk ◽  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Vehicle Accidents ◽  
Risk Of Death ◽  
Cord Injury

Objective: Characterize victims of spinal cord injury (SCI) associated with traumatic brain injury (TBI) and risk factors. Methods: Study conducted with 52 victims of SCI associated with TBI. The variables studied were: sex; age; marital status; occupation; educational level; religion; etiology and the lesion area; neurological condition by the ASIA scale; associated injuries and potential risk factors. Results: The male (85%), aged between 21-30 years (25%), civil status stable union (56%), low level of education (69%) and the Roman Catholic religion (77%) presented the greater number of victims. Motor vehicle accidents (58%) were the main etiology. The cervical segment had higher injury risk (RR=3.48, p&lt;0.0001). The neurological status ASIA-E (52%), the syndromic neck pain (35%) and the rate of mild TBI (65%) were the most frequent. Complications occurred in 13 patients with increased frequency of pneumonia (62%). The length of hospital stay was significantly higher (20&#177;28 days) and 17% of patients died. Men (RR=2.14, p=0.028) and individuals exposed to motor vehicle accidents (RR=1.91, p=0.022) showed a higher risk of these lesions concurrently. Moreover, these patients had 2.48 (p&lt;0.01) higher risk of death than victims of SCI alone. Conclusion: The SCI associated with TBI was more frequent in men, young adults, and individuals exposed to motor vehicle accidents. The cervical spine is more likely to be affected. Furthermore, the length of hospitalization is significantly higher and the subjects analyzed have higher risk of death.

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