A high-fidelity human cervical muscle finite element model for motion and injury studies

Active muscle response is a key factor in the motion and injury of the human head and neck. Due to the limitations of experimentation and the shortcomings of previous finite element models, the influence of material parameters of cervical muscle on motions of the head and neck during a car crash have not been comprehensively investigated. In the present work, a model of the cervical muscle in a 50th-percentile adult male was constructed. The muscles were modelled using solid finite elements, with a nonlinear-elastic and viscoelastic material and a Hill material modelling the passive and active parts of each muscle, respectively. The head dynamic responses of the model were validated using results obtained from volunteer sled tests. The influence of the material parameters of a muscle on head and neck motions were determined. Our key finding was that the greater the stiffness and the contraction strength of the neck muscles, the smaller the rotation angle of the head and the neck, and, hence, the lower the risk of head and neck injury to occupants in a car crash.

Epidemiology of sports-related fatalities during organized school sports in Japanese high schools between 2009 and 2018

Limited literature has investigated epidemiology of sports-related fatalities during high school organizes sports in Japan. Therefore, the purposes of this study are to determine the frequency and incidence rate of sports-related fatalities in Japanese high schools by cause and sports, and to examine the type of on-site first responder. Insurance claim data of sports-related fatalities in Japanese high schools reported to Japan Sports Council Injury and Accident Mutual Aid Benefit System between 2009 and 2018 were retrieved as the primary data source. All fatalities were classified into direct or indirect type by the reported etiology and further categorized into cardiac-related, head and neck injury, exertional heat stroke (EHS), or other. Frequency and incidence rate were calculated by cause of death and sports, and incidence rates were expressed per 100,000 athlete-years (AY) with 95% confidence interval (CI). Information regarding first responder to the incident was also retrieved and examined by frequency. A total of 63 sports-related fatalities were analyzed. The overall incidence rate was 0.45 (95%CI = 0.25–0.65) per 100,000AY. The incidence rates of direct and indirect fatalities declined from 0.36 and 0.50 per 100,000AY to 0.28 and 0.00 per 100,000AY, respectively. The leading cause of deaths was cardiac-related (n = 30/63, 47.6%), followed by head and neck injury (n = 15/63, 23.8%) and EHS (n = 14/63, 22.2%). The number of fatalities was highest in male baseball (n = 12/63, 19.0%) and the incidence rate was highest in male judo (4.79 per 100,000 AY, 95%CI: 0.68–8.15). Coach was the most frequently reported first responder onsite (n = 52/63, 82.5%). Medically trained personnel were involved in onsite care in two cases (3.2%). In conclusion, the occurrence of sports-related fatalities has declined over time from 2009 to 2018. To deliver appropriate medical care onsite for better survival, employment of medically trained personnel should be promoted in high school sports setting in Japan.

Neonatal Nasal Tip Necrosis Secondary to Suspected In Utero Pressure/Positioning

Head and neck injury as a consequence of in utero pressure and birth trauma is a rare event. We report a case of a patient who was born full-term via vaginal delivery and presented soon after birth with skin changes over the nasal tip consistent with a pressure-related injury that progressed to a stable eschar. Conservative management with close clinical monitoring resulted in a well-healed wound over the nasal tip. A detailed discussion regarding the diagnosis and management of head and neck lesions after birth is provided.

Head and Neck Injury Patterns among American Football Players

Importance: American football is a popular high-impact sport, leading to 2.7 million injuries in the United States annually. Recent evidence in football-related neurological damage has spurred national interest in player-safety. Football players injure their head and neck in up to 26% of total injuries. Variation in injury patterns between age groups and correlated hospitalizations for football-related head and neck injury has yet to be characterized. Objective: Our aim is to evaluate injury patterns among American-football related head and neck trauma. Methods: A retrospective cohort study of patients with football-related head and neck injury in the National Electronic Injury Surveillance System (NEISS). Results: Nearly 100 000 ED visits for football-related head and neck injuries occur annually. Males comprised 95% of patients, with a median age of 13. The head comprised 70% of injuries followed by the face (13%). The most common diagnoses were concussions (39%), internal organ injury (26%), and lacerations (11%). Pediatric patients were more likely to sustain concussions while adults experienced more lacerations ( P < .05%). Fractures and nerve damage were rare injuries but caused a disproportionate share of hospitalizations. Conclusion: Pediatric males are most likely to present for emergency care from football-related injury to the head and neck. Evaluating physicians can anticipate concussions, internal organ injury, and lacerations among presenting patients. Concussions, facial fractures, and nerve damage are injuries most likely to lead to hospitalization.

Independent Predictors of Recurrence of Vertigo Among Nigerians

Background: Recurrence of vertigo indicates a morbidity to the patient and a dilemma for the managing physician. Objectives: To describe the characteristics of vertigo, document prevalence and explore the characteristics which could independently predict recurrence of vertigo. Methods: A cross-sectional study of patients managed for vertigo in a tertiary facility was retrospectively done. Patients’ demographic and clinical characteristics, associations of vertigo, audiological symptoms, comorbid illnesses, and duration to achieve control of vertigo were recorded. Recurrence of vertigo was used to categorize the patients. The factors that were associated with recurrence on univariate analyses were evaluated as independent predictors of recurrence of vertigo. Results: The 73 patients with a male-to-female ratio of 1:1.4 were aged 35 -78 (mean 56.6±9.9) years. The associated symptoms included body weakness (34.2%), audiological symptoms (38.4%), 27.4% had antecedent head and neck injury and vertigo was precipitated or aggravated by changes in the head and neck position in 63.0% Vertigo was controlled within 1 -7 (Median 2) days, 35.6% had a recurrence of vertigo. Age, the experience of nausea and vomiting, previous head and neck injury, presence of comorbidity, and long duration to achieve control of vertigo were significantly associated with recurrence of vertigo. All these factors except the presence of comorbidity could independently predict the recurrence of vertigo. Conclusion: Vertigo is common in adult females, and mostly positional in type. About a third of patients may have a recurrence of vertigo. Age, especially above 57 years, nausea and vomiting, head and neck injury and prolonged period to control vertigo may independently predict recurrence of vertigo.

Epidemiology of Trauma Patients Presented at Emergency Department of Trauma Center

Background: Emergency Department of National Trauma Center Nepal Center is the only specialized trauma care hospital in Nepal, in operation since 2012. Traumatic injury is one of the major causes for mortality worldwide. This study aims to see the epidemiology, pattern of injuries and outcome of the patients presenting to the emergency room.Methods: After getting ethical approval, we included all patients presenting to the Emergency Department with at least one injury, between Jan 2018 to Dec 2020. Informations on age, gender, mechanism of injury and outcome was abstracted for all patients presenting to the emergency department. Data were extracted from hospital database with the permission of hospital authority.Results: Total of 49991 patients presented to emergency department with different types of injuries. Among them 7792 (14.0%) needed hospital admission. Fall and road crashes comprised almost 80% of admitted cases. Mortality was 2.1% of admitted patients, mostly with head injuries followed by multiple injuries. Conclusions: Among the patient visiting the trauma center during the study period most common mechanism of the injury were fall and road crash with head and neck injury. Majority of the patients were only managed in the ward without surgery.Keywords: Emergency care; triage; trauma care system; unintentional injury

Evaluation of Lung Contusion, Associated Injuries, and Outcome in a Major Trauma Center in Shiraz, Southern Iran

Objective. Blunt chest trauma as one of the most common injuries in trauma cases can cause significant morbidity and mortality. The purpose of this study was to determine the clinical course of traumatic injuries with an initial diagnosis of a pulmonary contusion in patients. Method. In this retrospective study, we evaluated the demographic and clinical features of patients who were referred to a major trauma center in southern Iran. In our study, patients were enrolled with the diagnosis of pulmonary contusion. All included patients were above 16 years of age, with an initial CT scan in favor of pulmonary contusion, while patients not being hospitalized for more than 48 hours were excluded from the study. Results. Among the 434 patients included in our study, 366 (84%) were male and the mean age was 41.17 (SD = 17.89). Among them, the majority (80.4%) had right side lung contusion and 47 patients (10.8%) had right rib fracture. The most common injuries were head and neck injury (56.9%) and limbs (30%). In 25% of cases, pulmonary contusion was associated with pneumothorax and 15.8% with hemothorax. Also, 49.6% of patients were transferred to the ICU. The mortality rate in our study was 15.2% (n = 66). Conclusion. Although recent advances in pulmonary care and ventilator management have been achieved, there is still considerable morbidity and mortality associated with this condition. Therefore, there is a need to provide a national guideline based on native patient information for better management.