scholarly journals FORENSIC MEDICAL ASSESSMENT OF INJURY SEVERITY OF LARYNX AND HYOID BONE BASED ON PRE-JUDICIAL AND JUDICIAL INVESTIGATION

2021 ◽  
Vol 21 (3) ◽  
pp. 196-200
Author(s):  
M.V. Gubin ◽  
G.I. Garyuk ◽  
I.Y. Serbinenko ◽  
V.M. Gubin ◽  
O.M. Irklienko
Keyword(s):  
Blunt Trauma ◽  
Hyoid Bone ◽  
Injury Severity ◽  
Objective Assessment ◽  
Traumatic Shock ◽  
Medical Assessment ◽  
Severe Injuries ◽  
Judicial Investigation ◽  
Medical Examinations ◽  
Further Development

Victims with fatal and non-fatal closed blunt trauma of the larynx and hyoid bone often become the object of forensic medical service during the pre-judicial and judicial investigation. The purpose of this study is to analyze the features of expert qualification of bodily injuries in victims with closed blunt trauma of the larynx and hyoid bone, depending on the nature and severity to determine ways to unify its forensic diagnosis. Materials and methods. The study was based on the conclusions of 35 forensic medical examinations of cases of closed blunt trauma of the larynx and hyoid bone, obtained from the leading expert institution of the Kharkiv region. Results. We determined the peculiarities of estimating the degrees of severity of above bodily injuries. Severe injuries were found in 12 (34.4%) cases of death of the victims from mechanical asphyxia, in one case of reflex cardiac arrest, and in one case of traumatic shock. Injuries of moderate severity were established by experts in 6 (17.1%) cases of lethal and in 6 (17.1%) cases of non-lethal cases with laryngeal cartilage fractures; in 2 (6.2%) cases of non-lethal injuries with acute oedema, hematoma, laryngeal stenosis of the second degree. 7 (20%) cases of non-lethal laryngeal injuries with further development of acute posttraumatic laryngitis were qualified as simple injuries. Conclusion. There are no clear morphoclinical criteria for objective assessment of injuries of the larynx and hyoid bone that can lead to pre-diagnostic expert errors. According to the results of the work, the ways to unify forensic medical assessment and diagnosis of such injury was determined.

scholarly journals Forensic medical examinattion of living persons in cases of injury of the organs of external respiration

2021 ◽  
Vol 8 (2) ◽  
pp. 95-99
Author(s):  
Vasil Olkhovsky ◽  
Mykola Gubin ◽  
Edgar Grygorian
Keyword(s):  
Methodological Approach ◽  
Objective Assessment ◽  
Traumatic Shock ◽  
Medical Examination ◽  
Expert Assessment ◽  
External Respiration ◽  
Medical Assessment ◽  
Solid Objects ◽  
Life Threatening ◽  
Post Traumatic

Backrgound. Trauma of external respiratory organs in victims is often a reason for the referral to forensic medical examination by law enforcement. Purpose of this work was to analyze the peculiarities of formation forensic medical expert conclusion, based on the results of determining the gravity of bodily injuries in victims with closed trauma of the organs external respiration, depending on their morphological and clinical characteristics and gravity, to find the ways to unify expert assessment. Subjects and Methods. 183 conclusions of forensic medical examination in the Kharkiv regional expert institution, on the cases of a closed blunt trauma of the organs of external respiration, were analyzed. Results. According to the mechanism of bodily injuries, in 171,1 (93,4 %) cases there was an impact of blunt solid objects on the neck and chest, in 11 (6 %) cases there was a compression of the neck by hands or other blunt solid objects, in 1 (0,5 %) case – a compression of the neck by hands and a loop. At the given trauma, modern experts’ approaches to an assessment of bodily injuries were defined. Grievous bodily injuries were defined in 17 (9,3 %) cases of trauma, with the emergence of life-threatening events such as acute respiratory failure, traumatic shock, mechanical asphyxia. Moderate bodily injuries were determined by experts in the 151 (82,5 %) cases, mostly injuries from fractures of ribs and cartilage of the larynx, at absence danger to life. Light bodily injuries were determined by experts in 15 (8,2 %) cases of mostly laryngeal injuries, complicated by its post-traumatic inflammation. The absence of unified scientific and methodological approach for the objective assessment of injuries of the external respiratory system organs has been defined. Conclusions. When conducting a forensic medical assessment of such injuries, there are cases of both underestimation and overestimation of the gravity of bodily injuries. According to the results of the performed investigation, further ways to unify morphological and clinical approaches at forensic-medical assessment of these bodily injuries were defined.

Factors Affecting Driver Injury Severity in the Wrong-Way Crash: Accounting for Potential Heterogeneity in Means and Variances of Random Parameters

2021 ◽  
pp. 036119812110098
Author(s):  
Miao Yu ◽  
Jinxing Shen ◽  
Changxi Ma
Keyword(s):  
High Speed ◽  
Injury Severity ◽  
Unobserved Heterogeneity ◽  
Research Effort ◽  
Random Parameter ◽  
Policy Implications ◽  
Contributing Factors ◽  
Severe Injuries ◽  
Data Set ◽  
Severity Levels

Because of the high percentage of fatalities and severe injuries in wrong-way driving (WWD) crashes, numerous studies have focused on identifying contributing factors to the occurrence of WWD crashes. However, a limited number of research effort has investigated the factors associated with driver injury-severity in WWD crashes. This study intends to bridge the gap using a random parameter logit model with heterogeneity in means and variances approach that can account for the unobserved heterogeneity in the data set. Police-reported crash data collected from 2014 to 2017 in North Carolina are used. Four injury-severity levels are defined: fatal injury, severe injury, possible injury, and no injury. Explanatory variables, including driver characteristics, roadway characteristics, environmental characteristics, and crash characteristics, are used. Estimation results demonstrate that factors, including the involvement of alcohol, rural area, principal arterial, high speed limit (>60 mph), dark-lighted conditions, run-off-road collision, and head-on collision, significantly increase the severity levels in WWD crashes. Several policy implications are designed and recommended based on findings.

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.

A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

2017 ◽  
Vol 32 (6) ◽  
pp. 631-635 ◽  
Author(s):  
Joshua Nackenson ◽  
Amado A. Baez ◽  
Jonathan P. Meizoso
Keyword(s):  
Emergency Medical Services ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Femur Fracture ◽  
Descriptive Analysis ◽  
Penetrating Trauma ◽  
Physical Exam ◽  
Medical Services ◽  
Prehospital Treatment ◽  
Emergency Medical

AbstractStudy ObjectivesTraction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).MethodsThis is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.ResultsThere were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).ConclusionAlthough signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.NackensonJ, BaezAA, MeizosoJP. A descriptive analysis of traction splint utilization and IV analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.

Children and Terror Casualties Receive Preference in ICU Admissions

2012 ◽  
Vol 6 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Kobi Peleg ◽  
Michael Rozenfeld ◽  
Eran Dolev ◽  
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Age Groups ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Severe Injuries ◽  
Level I ◽  
Hospital Emergency Departments ◽  
Trauma Type

ABSTRACTObjective: Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events.Methods: Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry.Results: All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU.Conclusions: Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.(Disaster Med Public Health Preparedness. 2012;6:14–19)

scholarly journals The Applicability of Trauma and Injury Severity Score for a Blunt Trauma Population in Korea and a Proposal of New Models Using Score Predictors

2016 ◽  
Vol 57 (3) ◽  
pp. 728 ◽  
Author(s):  
Kyoungwon Jung ◽  
Yo Huh ◽  
John Cook-Jong Lee ◽  
Younghwan Kim ◽  
Jonghwan Moon ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Population ◽  
New Models ◽  
Trauma And Injury

scholarly journals Functional optical coherence tomography of retinal photoreceptors

2018 ◽  
Vol 243 (17-18) ◽  
pp. 1256-1264 ◽  
Author(s):  
Xincheng Yao ◽  
Taeyoon Son ◽  
Tae-Hoon Kim ◽  
Yiming Lu
Keyword(s):  
Vision Loss ◽  
Objective Assessment ◽  
Age Related Macular Degeneration ◽  
Retinal Stimulation ◽  
Age Related ◽  
Retinal Photoreceptors ◽  
Severe Vision Loss ◽  
Further Development

Age-related macular degeneration (AMD) is the leading cause of severe vision loss and legal blindness. It is known that retinal photoreceptors are the primary target of AMD. Therefore, a reliable method for objective assessment of photoreceptor function is needed for early detection and reliable treatment evaluation of AMD and other eye diseases such as retinitis pigmentosa that are known to cause photoreceptor dysfunctions. Stimulus-evoked intrinsic optical signal (IOS) changes promise a unique opportunity for objective assessment of physiological function of retinal photoreceptor and inner neurons. Instead of a comprehensive review, this mini-review is to provide a brief summary of our recent in vitro and in vivo optical coherence tomography (OCT) studies of stimulus-evoked IOS changes in animal retinas. By providing excellent axial resolution to differentiate individual retinal layers, depth-resolved OCT revealed rapid IOS response at the photoreceptor outer segment. The fast photoreceptor-IOS occurred almost right away (∼ 2 ms) after the onset of retinal stimulation, differentiating itself from slow IOS changes correlated with inner neural and hemodynamic changes. Further development of the functional IOS instruments and retinal stimulation protocols may provide a feasible solution to pursue clinical application of functional IOS imaging for objective assessment of human photoreceptors. Impact statement Retinal photoreceptors are the primary target of age-related macular degeneration (AMD) which is the leading cause of severe vision loss and legal blindness. An objective method for functional assessment of photoreceptor physiology can benefit early detection and better treatment evaluation of AMD and other eye diseases that are known to cause photoreceptor dysfunctions. This article summarizes in vitro study of IOS mechanisms and in vivo demonstration of IOS imaging of intact animals. Further development of the functional IOS imaging may provide a revolutionary solution to achieve objective assessment of human photoreceptors.

scholarly journals Child safety programs for primary school children decrease the injury severity of dog bites

2021 ◽  
Author(s):  
Bernhard Kienesberger ◽  
Christoph Arneitz ◽  
Vanessa Wolfschluckner ◽  
Christina Flucher ◽  
Peter Spitzer ◽  
...  
Keyword(s):  
Primary School ◽  
School Children ◽  
Prevention Program ◽  
Injury Severity ◽  
Primary School Children ◽  
Child Safety ◽  
Dog Bite ◽  
Severe Injuries ◽  
Dog Bites ◽  
The Impact

AbstractThis study focuses on the impact of a prevention program regarding dog bites in children. As a consequence of our previous investigation in 2005, we have initiated a child safety program for primary school children starting January 2008 until present to teach children how to avoid dog attacks and how to behave in case of an attack. In our retrospective study, we analyzed all patients younger than 15 years presenting with dog-related injuries between 2014 and 2018. As the main indicator for success of the prevention measures taken, we have defined the severity of injury in comparison to our previous study. Out of 296 children with dog-related injuries, 212 (71.6%) had sustained a dog bite. In the vast majority (n = 195; 92%), these patients presented with minor injuries; the extremities were most commonly affected (n = 100; 47%). Injuries to the head (n = 95; 45%) and trunk (n = 18; 8%) were less frequent. The proportion of severe injuries (8%) was significantly lower compared to our previous study, where 26% of children presented with severe injuries necessitating surgical intervention, while the number of patients requiring in-hospital treatment declined from 27.5% in the period 1994–2003 to 9.0% in the period between 2014 and 2018 (p < 0.05).Conclusion: Teaching of primary school children may effectively reduce the injury severity of dog bites. What is Known:• Dog bites are a substantial healthcare problem especially in children. What is New:• This study shows that a broad-based prevention program for primary school children can effectively decrease the severity but not the frequency of dog bite injuries in children.

scholarly journals Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not have Worse Radiological and Functional Outcomes than Accidental Fallers

2020 ◽  
Author(s):  
Yi-Hsun Yu ◽  
Ying-Chao Chou ◽  
Yung-Heng Hsu ◽  
I-Jung Chen ◽  
Lien-Chung Wei
Keyword(s):  
Functional Outcomes ◽  
Injury Severity ◽  
Adjustment Disorder ◽  
Acetabular Fractures ◽  
Clinical Parameters ◽  
Severe Injuries ◽  
Severity Scores ◽  
Surgical Treatments ◽  
Major Diagnosis

Abstract Background: Individuals who fell from heights of >6 m accidentally or intentionally can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods: Between 2014 and 2017, individuals who fell from heights of >6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments were enrolled. The fallers were divided into the intentional and accidental fallers, and their clinical parameters were statistically evaluated and compared.Results: Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. Conclusions: The intentional fallers with pelvic and acetabular fractures might be accompanied by more severe injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers.

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