Penetrating spinal injury in childhood: the influence of mechanism on outcome. An epidemiological study

2018 ◽  
Vol 22 (4) ◽  
pp. 384-392 ◽  
Author(s):  
Joseph Piatt
Keyword(s):  
Public Health ◽  
Spinal Injury ◽  
Temporal Trends ◽  
Penetrating Injury ◽  
Hospital Death ◽  
Penetrating Injuries ◽  
Predominantly Black ◽  
Cross Sectional ◽  
Diagnostic Coding ◽  
Cord Injury

OBJECTIVEPenetrating injury of the spine in childhood commonly causes profound and life-long disability, but it has been the object of very little study. The goal of the current report is to document temporal trends in the nationwide incidence of this condition and to highlight the differences between penetrating injuries and closed injuries.METHODSThe Kids’ Inpatient Database was queried for spinal injuries in 1997, 2000, 2003, 2006, 2009, and 2012. Penetrating mechanism was determined by diagnostic coding for open injuries and by mechanistic codes for projectiles and knives. Nationwide annual incidences were calculated using weights provided for this purpose. Unweighted data were used as a cross-sectional sample to compare closed and penetrating injuries with respect to demographic and clinical factors. The effect of penetrating mechanism was analyzed in statistical models of death, adverse discharge, and length of stay (LOS).RESULTSThe nationwide incidence of penetrating spinal injury in patients less than 18 years of age trended downward over the study period. Patients with penetrating injury were older and much more predominantly male than patients with closed injuries. They resided predominantly in zip codes with lower median household incomes, and they were much more likely to have public health insurance or none at all. They were predominantly black or Hispanic. The risk of hospital death was no different, but penetrating injuries were associated with much higher rates of adverse discharge after LOS, averaging twice as long as closed injuries. Brain, visceral, and vascular injuries were powerful predictors of hospital death, as was upper cervical level of injury. The most powerful predictor of adverse discharge and LOS was spinal cord injury, followed by brain, visceral, and vascular injury and penetrating mechanism.CONCLUSIONSBecause its pathophysiology requires no elucidation, because the consequences for quality of life are dire, and because the population at risk is well defined, penetrating spinal injury in childhood ought to be an attractive target for public health interventions.

scholarly journals Knowledge and practice among the caretakers of bedridden patients on prevention of urinary tract infection

2014 ◽  
Vol 2 (1) ◽  
pp. 24-29 ◽  
Author(s):  
N Khanal
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Preventive Measures ◽  
Spinal Injury ◽  
Structured Interview ◽  
Cross Sectional ◽  
Term Care ◽  
Preventive Practices ◽  
Cord Injury

INTRODUCTION: Urinary tract infection (UTI) is one of the major complications of immobility or bedridden condition. Between 46-59% of spinal cord injury patients develop urinary tract infection during the first year of trauma. UTI is a second most common type of infection, accounting for nearly 25% of all infections and a serious health problem affecting millions of people each year. The findings of the study might be helpful to the long term care health institution for the development the strategies to involve the caretakers to prevent urinary tract infection in bedridden patients. OBJECTIVE: The purpose of the study was to find out the level of knowledge and current practice of caretakers of bedridden patients on prevention of urinary tract infection. METHODS: The descriptive and cross-sectional study design was adopted in this study. A self-prepared structured interview questionnaire and observation checklist was used to collect data from 30 caretakers of hospitalized bedridden patients of Nepal Orthopedic Hospital and Spinal Injury Rehabilitation Center Jorpati implying purposive & convenient sampling technique. RESULTS: Out of30 caretakers, no one had adequate (>80%) knowledge and 46.6% had moderate (50-80%) knowledge and 53.3% had low (<50%) knowledge on meaning, high risk group, contributing factors, signs & symptoms, consequences and preventive measures of UTI as a whole. Caretaker's preventive practices of UTI for their bedridden patients were not satisfactory except encourage the patient for drinking 2-3 liters water per day. CONCLUSION: Majorities (53.3%) of the caretakers of bedridden patients had low level knowledge on preventive measures of UTI. Similarly UTI preventive practices of caretakers were also not satisfactory. Therefore, awareness raising programme on preventive measures of UTI need to be organized specially for caretakers.DOI: http://dx.doi.org/10.3126/jucms.v2i1.10488 Journal of Universal College of Medical Sciences (2014) Vol.2(1): 24-29

Epidemiology of spinal injury in childhood and adolescence in the United States: 1997–2012

2018 ◽  
Vol 21 (5) ◽  
pp. 441-448 ◽  
Author(s):  
Joseph Piatt ◽  
Nicholas Imperato
Keyword(s):  
United States ◽  
Children And Adolescents ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
The United States ◽  
Population Based ◽  
Motor Vehicle Crash ◽  
Hospital Death ◽  
Childhood And Adolescence ◽  
Cord Injury

OBJECTIVEThere has been no successful study of trends in population-based incidences of pediatric spinal injury in the United States. The goal of the current study was to develop robust data to correct this deficiency in contemporary trauma epidemiology.METHODSDischarges coded for spinal injury were extracted from the Kids’ Inpatient Database for 1997, 2000, 2003, 2006, 2009, and 2012 for patients younger than 18 years. Childhood was defined as ages 0 through 14 years and adolescence as ages 15, 16, and 17 years. Denominator population data were taken from the website of the US Census. Annual incidences were estimated for hospitalization for spinal injury, spinal cord injury (SCI), and hospital death with spinal injury. Mechanistic and anatomical patterns of injury were studied.RESULTSThe annual population-based incidences of hospitalization for spinal injury, SCI, and death with spinal injury trended downward from 1997 to 2012 for children and adolescents in the United States. Rates of SCI and death fell faster than overall hospitalization rates, suggesting lower thresholds for admission or greater diagnostic sensitivity to minor injuries over time. The incidence of hospitalization for spinal injury was roughly 8 times greater for adolescents than for children, and the incidence of SCI was roughly 6 times greater. Motor vehicle crash predominated among mechanisms for both children and adolescents, but penetrating injuries and sport injuries were more commonly associated with SCI. Lumbosacral injuries predominated in both children and adolescents, but injuries of the cervical spine were more commonly associated with SCI.CONCLUSIONSFurther research is needed to identify the cause or causes of the observed decline in injury rates. Epidemiological data can inform and support prevention efforts.

scholarly journals The energy expenditure of people with spinal cord injury whilst walking compared to an able-bodied population

2016 ◽  
Vol 72 (1) ◽  
Author(s):  
Jana Vosloo ◽  
M. Veronica Ntsiea ◽  
Piet Becker
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Energy Expenditure ◽  
Spinal Injury ◽  
Range Of Movement ◽  
Cross Sectional ◽  
Cord Injury ◽  
Walking Velocity ◽  
Hip Flexion ◽  
Study Participants

Background: In the field of spinal cord injury (SCI) research there is an emphasis on the ability to ambulate.Purpose: To determine the ambulation energy expenditure (EE) and factors that affect ambulation EE in SCI participants compared to able-bodied participants.Methods: This was a cross-sectional study. Participants were recruited from seven SCI rehabilitation units within the Johannesburg area. The following were used: demographic questionnaire to capture participants’ characteristics, modified Ashworth scale for spasticity; goniometer for range of movement (ROM); American Spinal Injury Association (ASIA) scale for patient classification; accelerometer for EE and the six-minute walk test (6MWT) for endurance. Characteristics of the study participants were summarised using descriptive statistics. Data were analysed as follows: two-sample t-test for comparison between the able-bodied and SCI sample and Pearson product moment correlations for relationship between identified factors and EE.Results: Participants comprised 45 in the SCI group and 21 in the able-bodied group. The mean energy expenditure per metre (EE/m) for the SCI participants was 0.33 (± 0.29) calories compared to 0.08 (± 0.02) calories for the able-bodied participants. A decrease in walking velocity resulted in an increase in EE. For SCI participants, every decrease in degree of hip flexion ROM resulted in a 0.003 increase in EE/m walked. A unit decrease in velocity resulted in an increase of 0.41 in EE/m walked. Energy expenditure per metre decreased from ASIA A to ASIA D. Crutch walking utilised 0.34 calories per metre less energy than walking frames (p = 0.03).Conclusion: Based on this study’s findings, factors to consider in order to maximise energy efficiency whilst walking are maintaining hip flexion ROM and optimising velocity of walking.Keywords: Energy expenditure; Factors affecting energy expenditure; Range of motion; Walking Velocity

scholarly journals Relaciones entre sexismo e ideología de género con autoconcepto y autoestima en personas con Lesión Medular

2017 ◽  
Vol 33 (2) ◽  
pp. 225 ◽  
Author(s):  
Manuela Torregrosa-Ruiz ◽  
María-Ángeles Molpeceres-Pastor ◽  
Jose-Manuel Tomás-Miguel
Keyword(s):  
Gender Stereotypes ◽  
Spinal Injury ◽  
Self Esteem ◽  
Self Concept ◽  
Cross Sectional ◽  
Specific Effects ◽  
Cord Injury ◽  
And Gender

The process of adapting to a physical disability is complex and multi-dimensional. It is influenced by many variables that affect adequate life adjustment and psychological wellbeing. This study addresses the specific effects of sexism and gender stereotypes on self-esteem and self-concept in persons with spinal cord injury (SCI). The research design is cross-sectional and correlational. The sample comprises 127 persons, including 95 men and 32 women, with a long-term spinal injury. The results of the MANOVAs do not demonstrate statistically significant differences based on sex for the following variables: self-esteem, self-concept, traditional sexism and neosexism. The relationships among variables suggest that negative relationships exist between neosexism and family and emotional self-concept and self-esteem among men with SCI, though not among women with SCI. The discussion emphasizes the important role of intervention programs that strengthen gender equality in order to reduce sexism.

Abstract W MP100: Hospital SAH Volume Associated With Better Outcomes

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Aditya S Pandey ◽  
Neeraj Chaudhary ◽  
Joseph J Gemmete ◽  
Byron G Thompson ◽  
James Burke
Keyword(s):  
Systems Of Care ◽  
Temporal Trends ◽  
High Volume ◽  
Primary Diagnosis ◽  
Hospital Death ◽  
Inpatient Mortality ◽  
Cross Sectional ◽  
Discharge Home ◽  
Volume Outcome ◽  
Aggressive Care

Objective: The net impact of hospital care on outcomes in subarachnoid hemorrhage (SAH) has not been well established. We hypothesized that increased experience and technical expertise at high volume hospitals would lead to better outcomes. Methods: We performed a serial cross-sectional retrospective study using the Nationwide Inpatient Sample from 2002-2010. All adult (>18 years) discharges with a primary diagnosis of SAH (ICD-9-CM 435) from 2002-2010 were included and records with trauma or AVM were excluded. Survey-weighted descriptive statistics were used to estimate temporal trends. Multi-level logistic regression was used to estimate volume-outcome associations for two outcomes: inpatient mortality and discharge home. Models were adjusted for demographics, year, transfer status, insurance status, all individual Charlson comorbidities, intubation, and APR-DRG mortality. Analyses were repeated by excluding records where aggressive care was not pursued _ no intubation, no procedures and in-hospital death within 48 hours. Results: A total of 66,818 discharges were included in the weighted sample, including 19, 356 who received clipping or coiling. Inpatient mortality declined from 32.2% (30.1%- 33.9%) to 22.2% (20.8%-23.6%) from 2002 to 2010 while discharges to home increased from 28.5% (27.0-30.03%) to 40.8% (39.1%-42.4%). Hospitals in the highest volume quintile (greater than 63 discharges per year) had an unadjusted inpatient mortality of 22.7% (95% CI 22.0%-23.2%) compared to 41.5% (39.0%-43.7%) in quintile 3 (11-21 discharges per year) compared to 51.9% (47.0 -55.7%) in quintile 1 (less than 6 discharges per year). Similar trends were observed when excluding cases where aggressive care was not pursued. The proportion of patients discharged home also increased with hospital volume: 39.3 %( 38.0-39.9%) in quintile 5 vs. 23.2% (21.0%-25.1%) in quintile 3 vs. 16.7% (13.0%-19.7%) in quintile 1. Conclusion: Inpatient SAH mortality has decreased over time while the likelihood of discharge home has increased. High volume hospitals have more favorable outcomes than low volume hospitals and the magnitude of this effect is substantial. SAH volume should be accounted for in developing SAH systems of care.

Factors associated with pressure ulcers in patients with complete or sensory-only preserved spinal cord injury: is there any difference between traumatic and nontraumatic causes?

2009 ◽  
Vol 11 (4) ◽  
pp. 438-444 ◽  
Author(s):  
Keyvan Davatgaran Taghipoor ◽  
Roya Habibi Arejan ◽  
Mohammad Reza Rasouli ◽  
Soheil Saadat ◽  
Mojgan Moghadam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcers ◽  
Spinal Injury ◽  
Univariate Analysis ◽  
Cross Sectional Study ◽  
Sensory Function ◽  
Cross Sectional ◽  
Cord Injury

Object Pressure ulcers (PUs) are common complications in patients with complete spinal cord injury (SCI) or incomplete SCI in which sensory function is spared. Most studies analyzing associated factors of PU and SCI have been performed in cases of traumatic SCI and in just a few cases of nontraumatic SCI. This study was designed to look specifically at the differences in causative factors of PU in cases of traumatic and nontraumatic SCIs. Methods The authors performed a retrospective, cross-sectional study evaluating patients with complete and incomplete SCIs (American Spinal Injury Association Grades A and B) under the coverage of the financial, medicosocial, and rehabilitative support provided by the State Welfare Organization of Iran (SWOI). There were 3791 cases of traumatic SCI (63.2%) and 2110 cases of nontraumatic SCI (35.2%). For 94 patients (1.6%), sufficient data were not available. Results A PU was detected in 39.2% of all patients with an SCI (71.8% of those with traumatic SCI vs 28.2% of those with nontraumatic SCI). A univariate analysis showed a significant association between occupation, education, and the presence of PU in patients with a traumatic SCI (p < 0.05). This contrasted with nontraumatic SCI in which an association between PU and age was noted (p < 0.05). Using logistic regression, traumatic cause, older age, an interval less than 1 year since the onset of SCI, male sex, and single status were found to significantly increase the risk of PU in all patients with an SCI. However, a higher education level had a preventive effect on PU. Conclusions This study revealed some risk factors for PU in the authors' setting. The authors' findings suggest a possible difference between the risk factors for PU in patients with both types of SCI. Further study on the pathoetiology of these differences is paramount in the future.

scholarly journals Epidemiology and Clinical Management of Traumatic Spine Injuries at a Major Government Hospital in Cambodia

2017 ◽  
Vol 11 (6) ◽  
pp. 908-916 ◽  
Author(s):  
Jee-Hye Choi ◽  
Paul J. Park ◽  
Vuthy Din ◽  
Nang Sam ◽  
Vycheth Iv ◽  
...  
Keyword(s):  
Clinical Management ◽  
Spinal Injury ◽  
Cross Sectional Study ◽  
Government Hospital ◽  
Sectional Study ◽  
Clinical Practices ◽  
Cross Sectional ◽  
Phnom Penh ◽  
Cord Injury

<sec><title>Study Design</title><p>Cross sectional study.</p></sec><sec><title>Purpose</title><p>To characterize the pattern of injury, describe the current clinical management, and determine the outcomes in traumatic spine injury (TSI) patients presenting to a major government hospital in Phnom Penh, Cambodia.</p></sec><sec><title>Overview of Literature</title><p>There is a paucity of literature on epidemiology or current clinical practices for TSIs in Cambodia. The findings from this study can thus serve as a valuable resource for future progress in treating TSIs in low-income countries.</p></sec><sec><title>Methods</title><p>This study was a cross-sectional study of TSI patients admitted to Preah Kossamak Hospital in Phnom Penh, Cambodia. Demographics, cause of spinal injury, spinal level of injury, surgical procedures and techniques, complications, and American Spinal Injury Association (ASIA) grades were recorded and analyzed.</p></sec><sec><title>Results</title><p>Eighty patients were admitted with TSI between October 2013 and June 2014. Falls from heights were the most common cause of TSI, followed by road traffic accidents. 78% of the admitted patients underwent at least one surgical procedure. Without intraoperative imaging, 4 patients (6%) had wrong level surgery, and 1 patient (2%) had misplacement of pedicle screws. Sacral decubitus ulcers were the most common non-surgically related complication. Antibiotics were administered to &gt;90% of patients. There were no in-hospital mortalities. Of the 60 spinal cord injury (SCI) patients, 32% (19/60) showed improvement in their ASIA grade at the time of discharge, and 52% (31/60) showed no change. At follow-up, 32% (19/60) of SCI patients reported improvement, and 8% (5/60) reported no change. However, 36 SCI patients (60%) were lost to follow-up.</p></sec><sec><title>Conclusions</title><p>Despite technological limitations, outcomes of TSI patients in Cambodia appear favorable with evidence of clinical improvement and low mortality.</p></sec>

scholarly journals Multi detector computed tomography imaging in penetrating injuries

2020 ◽  
Vol 8 (6) ◽  
pp. 2259
Author(s):  
Namrita Sachdev ◽  
Yashvant Singh ◽  
Sana . ◽  
Dipshi Mehta
Keyword(s):  
Penetrating Trauma ◽  
Trauma Centre ◽  
Penetrating Injury ◽  
The Body ◽  
Initial Assessment ◽  
Emergency Laparotomy ◽  
Solid Organ ◽  
Penetrating Injuries ◽  
Cross Sectional ◽  
Female Ratio

Background: Penetrating injuries forms an important component of surgical emergencies. Penetrating trauma typically involves the violation of the body by a gunshot wound (GSW) or stab wound. Emergency laparotomy is the accepted management in patients with a penetrating injury who are not hemodynamically stable. However, selective non-operative management has been shown to decrease the rate of unnecessary surgery. Plain radiographs and FAST are useful for initial assessment of these patients. Multi detector CT is an indispensable tool in the evaluation of patients who are stable and are candidates for conservative treatment.Methods: A cross sectional observational study was carried out on 40 patients admitted with penetrating injury to the trauma centre of PGIMER and Dr RML hospital. Of the 40 patients, 14 were taken for emergency laparotomy. In 26 cases, MDCT was done to evaluate for solid organ, hollow organ and vascular injuries.Results: The mean age of patients was 38 years, with male to female ratio of 5:1. Stab injury was the commonest type of injury, followed by gunshot wounds. Liver was the commonest solid organ involved, followed by kidneys and spleen. Other organs involved were diaphragm, small bowel and colon.Conclusions: Penetrating injuries can be life-threatening, making prompt diagnosis essential. Recognizing key abnormalities on MDCT ensures patients are triaged appropriately. Multi-detector CT is thus widely used to evaluate penetrating injuries in stable patients.

scholarly journals Características clínicas, complicaciones secundarias y apoyos en personas con lesión medular traumática en Asturias

2020 ◽  
Vol 19 (4) ◽  
pp. 322-348
Author(s):  
Andrea Rodríguez Alonso ◽  
Enrique Oltra Rodríguez
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Traumatic Spinal Cord Injury ◽  
American Spinal Injury Association ◽  
Secondary Complications ◽  
Cross Sectional ◽  
Cord Injury

Introducción: La lesión medular traumática es un acontecimiento sobrevenido y frecuentemente devastador debido a la pérdida funcional, a las complicaciones secundarias y a la inexistencia de tratamiento curativo. Se plantea como un reto personal, sanitario y social. El objetivo del estudio es describir las características epidemiológicas, clínicas y los apoyos utilizados de las personas con lesión medular traumática del Principado de Asturias.Materiales y método: Estudio observacional, descriptivo y transversal. La población estuvo conformada por personas con lesión medular traumática ingresadas por cualquier causa en el Hospital Universitario Central de Asturias del 1 de enero de 2005 al 31 de enero de 2015.Resultados: El número de casos fue 92. Un 76,9% eran hombres. La edad media fue 48,5 años y la edad media cuando se produjo la lesión 40,2 años. Las causas más frecuentes fueron los accidentes: de tráfico, laborales y fortuitos. El tipo de lesión más frecuente: según afectación de miembros, la paraplejia con un 38,5%; según la extensión, la lesión incompleta con un 52,6%; según el nivel neurológico, la lesión dorsal con un 45,4% y según la escala de clasificación de la American Spinal Injury Association (ASIA), la lesión ASIA A con un 50,7%. Como complicaciones secundarias más frecuentes: el 68,7% presenta vejiga neurógena, el 60,2% intestino neurógeno, el 46,5 úlceras por presión, 46,4% espasticidad y el 30,1% dolor neuropático. Conclusiones: Existe una alta prevalencia de complicaciones secundarias en la lesión medular, siendo necesario aunar esfuerzos en la prevención y tratamiento de las mismas. Background and objective: Traumatic spinal cord injury is a supervening and often devastating event due to functional loss, secondary complications and lack of curative treatment. It is posed as a personal, health and social challenge. The objective of the study is to describe the epidemiological, clinical and support characteristics of people with traumatic spinal cord injury in the Principality of Asturias.Materials and method: Observational, descriptive and cross-sectional study. The population comprised people with traumatic spinal cord injury admitted for any reason at the Central University Hospital of Asturias from January 1, 2005 to January 31, 2015.Results: The number of cases was 92. 76.9% were men. The average age was 48.5 years old and the average age when the injury occurred was 40.2 years old. The most frequent causes were accidents: traffic, labor and fortuitous. The most frequent type of injury: according to limb involvement, paraplegia with 38.5%; according to the extension, the incomplete lesion with 52.6%; according to the neurological level, the dorsal lesion with 45.4% and according to the classification scale of the American Spinal Injury Association (ASIA), the ASIA A lesion with 50.7%. As most frequent secondary complications: 68.7% have neurogenic bladder, 60.2% neurogenic bowel, 46.5% pressure ulcers, 46.4% spasticity and 30.1% neuropathic pain.Conclusions: There is a high prevalence of secondary complications in spinal cord injury, being necessary to join efforts in the prevention and treatment of them.

Twitter Usage Using Common Reference to Tinnitus

2020 ◽  
Vol 29 (2) ◽  
pp. 206-217
Author(s):  
Jianyuan Ni ◽  
Monica L. Bellon-Harn ◽  
Jiang Zhang ◽  
Yueqing Li ◽  
Vinaya Manchaiah
Keyword(s):  
Nonprofit Organizations ◽  
Temporal Trends ◽  
Temporal Analysis ◽  
Cross Sectional ◽  
For Profit ◽  
Common Reference ◽  
Personal Experiences ◽  
Twitter Users ◽  
Sectional Analysis ◽  
Share Information

Objective The objective of the study was to examine specific patterns of Twitter usage using common reference to tinnitus. Method The study used cross-sectional analysis of data generated from Twitter data. Twitter content, language, reach, users, accounts, temporal trends, and social networks were examined. Results Around 70,000 tweets were identified and analyzed from May to October 2018. Of the 100 most active Twitter accounts, organizations owned 52%, individuals owned 44%, and 4% of the accounts were unknown. Commercial/for-profit and nonprofit organizations were the most common organization account owners (i.e., 26% and 16%, respectively). Seven unique tweets were identified with a reach of over 400 Twitter users. The greatest reach exceeded 2,000 users. Temporal analysis identified retweet outliers (> 200 retweets per hour) that corresponded to a widely publicized event involving the response of a Twitter user to another user's joke. Content analysis indicated that Twitter is a platform that primarily functions to advocate, share personal experiences, or share information about management of tinnitus rather than to provide social support and build relationships. Conclusions Twitter accounts owned by organizations outnumbered individual accounts, and commercial/for-profit user accounts were the most frequently active organization account type. Analyses of social media use can be helpful in discovering issues of interest to the tinnitus community as well as determining which users and organizations are dominating social network conversations.

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