Showing papers on "Abbreviated Injury Scale published in 2002"

Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes.

Abstract: BACKGROUND: Pelvic fractures are often associated with major intraabdominal injuries or severe bleeding from the fracture site. OBJECTIVE: To study the epidemiology of pelvic fractures and identify important risk factors for associated abdominal injuries, bleeding, need for angiographic embolization, and death. METHODS: Trauma registry study on pelvic fractures from blunt trauma. Stepwise logistic regression was used to identify risk factors of severe pelvic fractures, associated abdominal injuries, need for major blood transfusion, therapeutic embolization, and death from pelvic fracture. Adjusted relative risks and 95% confidence intervals were derived. RESULTS: There were 16,630 trauma registry patients with blunt trauma, of whom 1,545 (9.3%) had a pelvic fracture. The incidence of abdominal injuries was 16.5%, and the most common injured organs were the liver (6.1%) and the bladder and urethra (5.8%). In severe pelvic fractures (Abbreviated Injury Scale [AIS] ≥ 4), the incidence of associated intraabdominal injuries was 30.7%, and the most commonly injured organs were the bladder and urethra (14.6%). Among the risk factors studied, motor vehicle crash is the only notable risk factor negatively associated with severe pelvic fracture. Major risk factors for associated liver injury were motor vehicle crash and pelvis AIS ≥ 4. Risk factors of major blood loss were age > 16 years, pelvic AIS ≥ 4, angiographic embolization, and Injury Severity Score (ISS) > 25. Age > 55 years was the only predictor for associated aortic injury. Factors associated with therapeutic angiographic embolization were pelvic AIS ≥ 4 and ISS > 25. The overall mortality was 13.5%, but only 0.8% died as a direct result of pelvic fracture. The only pronounced risk factor associated with mortality was ISS > 25. CONCLUSIONS: Some epidemiological variables are important risk factors of severity of pelvic fractures, presence of associated abdominal injuries, blood loss, and need of angiography. These risk factors can help in selecting the most appropriate diagnostic and therapeutic interventions.

Outcomes and costs of acute treatment of traumatic brain injury.

Abstract: BACKGROUND: Although there are nearly a quarter of a million hospitalizations for traumatic brain injury (TBI) in the United States each year, data on the outcomes and costs of TBI treatment in the acute-care setting are limited METHODS: Using a large, geographically diverse, multihospital database, we examined inpatient records for persons aged 16 years or older who were hospitalized for TBI between January 1, 1997, and June 30, 1999 Patients were stratified by TBI severity using an adaptation of the Abbreviated Injury Scale for administrative data (ICD/AIS), as follows: 2 = "moderate"; 3 = "serious"; 4 = "severe"; and 5 = "critical" Patient characteristics, patterns of treatment, and outcomes and costs were examined by injury severity and mechanism of injury RESULTS: Of 8,717 study subjects identified, 125% had moderate, 448% had serious, 296% had severe, and 132% had critical TBI Falls were the most common reported cause of injury (408%), followed by motor vehicle crashes (393%), blows to the head (113%), and gunshot wounds (24%) Average length of stay in hospital ranged from 67 days for moderate TBI to 175 days for critical TBI The overall rate of death in hospital was relatively low among patients with moderate (13%), serious (57%), and severe (87%) TBIs, but much higher among the most critically injured patients (520%) Costs of hospitalization averaged 8,189 dollars for moderate, 14,603 dollars for serious, 16,788 dollars for severe, and 33,537 dollars for critical TBI Costs also varied by injury type, averaging 20,084 dollars for gunshot wounds, 20,522 dollars for motor vehicle crashes, 15,860 dollars for falls, and 19,949 dollars for blows to the head CONCLUSION: The economic burden of TBI in the acute-care setting is substantial; treatment outcomes and costs vary considerably by TBI severity and mechanism of injury

A comparison of the abilities of nine scoring algorithms in predicting mortality.

Abstract: Objective The purpose of this study was to compare the abilities of nine Abbreviated Injury Scale (AIS)– and International Classification of Diseases, Ninth Revision (ICD-9)–based scoring algorithms in predicting mortality.Methods The scores collected on 76,871 incidents consist of four AIS-based al

The need for early angiographic embolization in blunt liver injuries.

Abstract: Background Although nonoperative management of blunt liver injury (BLI) has become standard practice, adjuncts to nonoperative therapy, such as angiographic embolization, have not been well characterized. Methods Patients with BLI were retrospectively identified at our American College of Surgeons–verified Level I trauma center from January 1997 through February 2001. Patients were stratified into four groups: those who received angiographic embolization (AE) as an early intervention when BLI was initially diagnosed (EARLY-AE); those who underwent AE after liver-related operation or later in the hospital course (LATE-AE); those treated with operation only (OR-ONLY); and nonoperative patients who also did not undergo AE (NO-OR). Results There were 126 patients with BLI, of whom 94 were NO-OR, 20 were OR-ONLY, 6 had LATE-AE, and 6 had EARLY-AE. The NO-OR group had significantly lower liver Abbreviated Injury Scale scores. Liver Abbreviated Injury Scale scores were not different between the EARLY-AE, LATE-AE, and OR-ONLY groups. Liver-related mortality was not lower for those treated with AE. There was a trend toward lower mortality for just the EARLY-AE group compared with the LATE-AE and OR-ONLY groups (0% vs. 50% and 35%). The number of units of packed red blood cells transfused and the number of liver-related operations were lower in the EARLY-AE compared with the LATE-AE group, but liver-related complications were not different between the EARLY-AE, LATE-AE, or OR-ONLY groups. AE was successful in arresting hemorrhage in 83% of the cases. Conclusion In this small series, we observed similar morbidity and mortality with AE compared with operative therapy. EARLY-AE did decrease blood use and the number of liver-related operations. AE can be performed on severely injured patients with comparable liver-related mortality and complications. Further study of the timing of and outcomes from AE is needed.

Preliminary report on the safety of heparin for deep venous thrombosis prophylaxis after severe head injury.

Abstract: Background Prophylaxis for venous thromboembolism (VTE) in head injured patients has avoided heparin products because of concern for exacerbating intracranial bleeding. The purpose of this study was to evaluate the safety of unfractionated heparin (UFH) for VTE prophylaxis after traumatic brain injury. Methods We retrospectively evaluated the early use of UFH in patients sustaining a severe closed head injury (Abbreviated Injury Scale score > 3) from January 1, 2000, through December 31, 2000. Two groups were formed on the basis of the timing of UFH administration: within 72 hours of admission (Early group), or after the third day of hospitalization (Late group), if at all. Intracranial bleeding related to UFH administration was assessed by computed tomographic scan of the head and/or clinical examination. Results Sixty-four of 76 patients with intracranial blood on admission head computed tomographic scan fulfilled study criteria. Seventy-three percent (n = 47) were in the Early group and 27% (n = 17) were in the Late group. None of the Early group had an increase in intracranial bleeding or deterioration on neurologic examination as a result of UFH administration. However, there was no statistical difference in VTE events between the two groups. Conclusion Early use of UFH in the severe head injured patient does not increase bleeding complications.

Comparing measures of injury severity for use with large databases.

Abstract: BACKGROUND: After recent debate about the best measure of anatomic injury severity, this study aimed to compare four measures based on Abbreviated Injury Scale scores derived using ICDMAP-90-the Modified Anatomic Profile (ICD/mAP), Anatomic Profile Score (ICD/APS), Injury Severity Score (ICD/ISS), and New Injury Severity Score (ICD/NISS)-with the International Classification of Diseases-based Injury Severity Score (ICISS). METHODS: Data were selected from New Zealand public hospital discharges from 1989 to 1998. There were 349,409 patients in the dataset, of whom 3,871 had died. Models were compared in terms of their discrimination and calibration using logistic regression. Age was included as a covariate. RESULTS: The ICISS and ICD/mAP were the best performing measures. Adding age significantly improved the discrimination and calibration of almost all the models. CONCLUSION: The ICISS is a viable alternative to ICDMAP-based measures for coding anatomic injury severity on large datasets.

A prospective study of the quality of pre‐hospital emergency ventilation in patients with severe head injury

Abstract: Background Pre-hospital endotracheal intubation for the purpose of controlled ventilation may prevent secondary brain injury in patients with severe head injury. In view of the limited monitoring devices utilized in the pre-hospital setting, little is known about the ‘quality' of controlled ventilation initiated in the pre-hospital setting. Methods Included in this prospective study were 122 trauma patients with severe head injury (abbreviated injury scale score ≥3). In all cases, the pre-hospital treatment included endotracheal intubation in the field. Upon hospital admission, and maintaining the same ventilation mode and setting initiated in the pre-hospital setting, arterial blood gas samples were taken. Results ‘Optimal' oxygenation ( P a O 2 >100 mm Hg) was achieved in 85.2% and ‘adequate' ventilation ( P a CO 2 35–45 mm Hg) in 42.6% of the patients upon hospital admission. ‘Optimal' oxygenation as well as ‘adequate' ventilation was achieved in 37.7% of the study population. Hypoxaemia ( P a O 2 P a CO 2 >45 mm Hg) in 16.4%, and hypocapnia ( P a CO 2 Conclusions Endotracheal intubation and controlled ventilation of the lungs initiated in the pre-hospital setting do not guarantee optimal oxygenaton and ventilation in patients with severe head injury.

Standardized outcome evaluation after blunt multiple injuries by scoring systems: a clinical follow-up investigation 2 years after injury.

Abstract: OBJECTIVE: The objective of this study was to evaluate the state of rehabilitation in patients with blunt multiple injuries 2 years after their initial injuries, using several standardized scales and a recently described comprehensive scoring system, by means of a prospective clinical multicenter study. METHODS: Two years after the initial injury, patients with blunt multiple injuries (Injury Severity Score > or = 16) underwent a clinical follow-up in 5 German Level I trauma centers. The reassessment included a complete head-to-toe examination of the musculoskeletal system and a neurologic examination. The following patient-assessed health status scores were used to determine the quality of life: Short-Form 12, Functional Independence Measurement, and Musculoskeletal Function Assessment. Moreover, a comprehensive scoring system developed in our department (Hannover Score for Polytrauma Outcome HASPOC.) was used that includes provider-report (physician's examination) and self-report (score systems) criteria. RESULTS: Two hundred fifty-four of 312 patients who had been injured between January 1995 and July 1996 were reexamined between January 1, 1997, and July 1, 1998. Among the remaining 58 patients, 9 had died by the time of follow-up, and 49 patients had not accepted the invitation. The mean age of those patients who underwent reexamination was 36 +/- 13 years, the mean Injury Severity Score was 24 +/- 6, and the mean initial Glasgow Coma Scale score was 11 +/- 4 (Abbreviated Injury Scale (AIS) head score of 3.3 +/- 1.1; AIS face, 1.4 +/- 0.1; AIS chest, 3.0 +/- 0.8; AIS abdomen, 1.7 +/- 0.6; and AIS extremities, 3.4 +/- 0.8). The general outcome (Short-Form 12) was as follows: grade I, 9%; grade II, 25%; grade III, 29%; grade IV, 25%; grade V, 6%; and grade VI, 6%. The outcome of the injured extremity demonstrated moderate or severe restrictions according to the Musculoskeletal Function Assessment in 41% of injuries of the lower extremity and in 16% of injuries of the upper extremity. Among patients with injuries to the lower extremity, 52% experienced pain or impaired ability to walk related to an injury of the foot or ankle, 31% indicated pain after a knee or thigh injury, and 27% indicated pain after a femoral or hip injury. The most severe deficits in the range of motion occurred in the foot and the ankle region (13.4% deficit of range of motion Language: en

Restraint use and injury patterns among children involved in motor vehicle collisions.

Abstract: BACKGROUND: Motor vehicle collisions are the leading cause of death among children older than 1 year. Use of appropriate restraint systems is associated with reductions in morbidity and mortality in this age group. No studies have evaluated the association between specific injury patterns and restraint use among children. The purpose of this study was to evaluate differences in risks of injuries in different body regions according to restraint use among children 0 to 11 years of age. METHODS: The 1995 to 1999 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away collisions. Information on occupant (seating position, restraint use), collision (change in velocity, vehicle intrusion), and outcome characteristics was evaluated. Risks of injuries in different body regions (Abbreviated Injury Scale, 1990 Revision score > or = 2) were calculated and compared according to restraint use. RESULTS: Between 1995 and 1999, there were approximately 1.5 million children 0 to 11 years of age involved in police-reported tow-away MVCs who met the inclusion criteria for this study. Compared with unrestrained children, properly restrained children had significantly lower overall injury risk (risk ratio [RR], 0.37); significant risk reductions were also observed for injuries to the head (RR, 0.18), thorax (RR, 0.35), and lower extremities (RR, 0.26), and mortality (RR, 0.26). Significant risk reductions were not noted when comparing improperly restrained children with unrestrained children. CONCLUSION: Proper restraint use among children is associated with lower risk of injury. Educational initiatives should focus not only on encouraging restraint use but also on ensuring that parents know the appropriate age-dependent restraint method and how to use it properly.

Blunt vascular neck injuries: diagnosis and outcomes of extracranial vessel injury.

Abstract: Background: Blunt vascular neck injuries (BVNIs) are rare, often occult, and potentially devastating injuries. The purpose of this study was to identify a high-risk group, which would benefit from screening. Methods: Patients with BVNIs were identified from our trauma registry and charts were reviewed. Potential risk factors for BVNI were evaluated by univariate and multivariate logistic regression. Results: Thirty-one BVNIs were identified in 22 patients. The stroke rate was 60% and the mortality rate was 25%. Univariate analysis showed Glasgow Coma Scale score ≤ 8, head injury (Abbreviated Injury Scale [AIS] score ≥ 3), basal skull fracture, facial injury, other neck injury, thorax injury (AIS score ≥ 3), abdominal injury, and cervical spine injury to be significant (p < 0.05). The multivariate predictive model had two predictors remaining significant: thorax injury (AIS [thorax] score ≥ 3) and Glasgow Coma Scale score ≤ 8. Conclusion: Screening should be undertaken for patients at increased risk for BVNI: those with risk factors identified in our regression analysis and factors previously reported.

Incidence and characteristics of motor vehicle collision-related blunt thoracic aortic injury according to age.

Abstract: BACKGROUND Motor vehicle collision-related blunt thoracic aorta injury (BAI) is rare and highly lethal. Vascular disease as related to advancing age potentially subjects older adults to increased risk of BAI; the mechanisms associated with such injuries may be different as compared with younger adults. The goal of the present study is to test this hypothesis using population-based data. METHODS The 1995 to 1999 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away crashes. BAI was defined according to the Abbreviated Injury Scale codes. Among those with BAI, information on occupant (age, seating position, restraint use), collision (collision type, delta-V, vehicle intrusion), and outcome characteristics were obtained and compared according to age. RESULTS The overall incidence of BAI was 6.8 per 10,000 occupants and there was a steady increase in the BAI rate for advancing decades of life. The proportion of occupants with BAI who die at the scene of the collision is relatively consistent across all age groups ( approximately 85%). Among those who survive to receive medical care, ultimate survival is lowest among those aged 60 and older. Near-side collisions were responsible for more BAI among older adults than other age groups (50% vs. 20.6%, p < or = 0.05). Older adults sustained BAI in collisions with lower delta-V values compared with younger persons (p < or = 0.05). CONCLUSION Older adults have the highest rate of motor vehicle collision-related BAI, and their injuries tend to occur in less severe collisions. A high level of suspicion for BAI among older adults should not be reserved for high-energy collisions only.

Preinjury cervical alignment affecting spinal trauma.

Abstract: Object. The authors tested the hypothesis that initial alignment of the head—neck complex affects cervical spine injury mechanism, trauma rating, injury classification based on stability, and fracture pattern. Methods. Thirty intact human cadaveric head—neck complexes were prepared by fixing the thoracic end in polymethylmethacrylate. The cranium was unconstrained. The initial spinal alignment was described in terms of eccentricity, defined as the anteroposterior position of the occipital condyles with respect to the T-1 vertebral body. The specimens were subjected to impact loading delivered using an electrohydraulic testing device. Outcomes after injury were identified using radiography and computerized tomography. The mechanisms of injury were classified according to fracture pattern into compression—extension, compression—flexion, hyperflexion, and vertical compression. Trauma was graded according to the Abbreviated Injury Scale rating system. Based on clinical assessment, injuries were classified as ...

Road traffic accident mortality in Singapore.

Abstract: The aim of this study was to identify factors that contribute to road traffic accident mortality and the patterns of injuries sustained by these victims, with a view to identifying areas for future intervention. All road traffic accident deaths that occurred in Singapore over a period of 1 year were reviewed. A total of 226 deaths occurred: 82.3% of the victims were male. The median age was 31 years. Blood alcohol was detected in 42 (18.7%) victims. In general, head (86.7%), followed by thoracic (67.7%) and abdominal (31.4%) injuries, were the most common injuries. Severe lower extremity trauma was most common among pedestrians and pedal cyclists (20.6% and 11.0%, respectively). The mean Injury Severity Score was 38.7. The relative risk of mortality between motorcyclists and motorcar drivers was 18.8:1. Suggestions for future prevention and intervention include stricter enforcement of speed limits, more severe penalties for drunk driving, helmet use among pedal cyclists, and the introduction of pre-hospital advanced airway management.

Injury rates among restrained drivers in motor vehicle collisions: the role of body habitus

Abstract: Background Previous studies have examined the independent effects of occupant height, obesity, and body mass index in motor vehicle collisions and identified related injury patterns. The hypothesis of this study was that as the driver’s body habitus diverges from the 50% percentile male Hybrid III Crash Dummy (H3CD), the frequency of injury changes. Methods The 1995 to 1999 National Automotive Sampling System Crashworthiness Data System was used. Study entry was limited to restrained drivers who were then subdivided into height and weight categories. Incidence rates were calculated for injuries to selected body regions as defined by the Abbreviated Injury Scale for overall, frontal, and driver’s side collisions. Results When grouped according to height and weight as descriptors of body habitus, injury rates for restrained drivers were increased as well as decreased in several subgroups. This association was seen in overall, frontal, and driver’s side collisions. Conclusion The H3CD plays a major role in vehicular cabin interior design and crash testing. For drivers with a body habitus different from that of the H3CD, the vehicle cabin/body fit changes and the safety features may perform differently, which could account for these observations.

Evaluation of a child safety program based on the WHO Safe Community model

Abstract: Objectives: To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries.Study design: A population based quasiexperimental design was used. Cross sectional pre-implementation and post-implementation data were collected in intervention (Motala municipality) and control (Mjolby municipality) areas, both in Ostergotland county, Sweden.Results: The total relative risk of child injury in the intervention community decreased more (odds ratio 0.74; 95% confidence interval (CI) 0.68 to 0.81) than in a control community exposed only to national level injury prevention programs (0.93; 95% CI 0.82 to 1.05). The relative risk of moderately (abbreviated injury scale (AIS) 2) severe injury in the study area was reduced to almost a half (odds ratio 0.49; 95% CI 0.41 to 0.57), whereas the risk of minor (AIS 1) injuries decreased only slightly (odds ratio 0.89; 95% CI 0.80 to 0.99). The risk of severe or fatal (AIS 3–6) injuries remained constant.Conclusions: After introduction of an injury prevention program based on the WHO Safe Community model, the relative risk for child injury in the intervention community decreased significantly more than in a control community exposed only to national injury prevention programs.

Identifying injuries and motor vehicle collision characteristics that together are suggestive of diaphragmatic rupture

Abstract: BACKGROUND: Diaphragmatic rupture (DR) remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. Our purpose was to identify motor vehicle collision (MVC) characteristics and patient injuries that collectively could identify the presence of a DR. METHODS: The National Automotive Sampling System was used to identify occupants involved in MVCs from 1995 to 1999 who sustained abdominal (Abbreviated Injury Scale score >or= 2) and/or thoracic injuries (Abbreviated Injury Scale score >or= 2). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to quantify the association between patient injuries, vehicle collision characteristics, and DR. Sensitivity and specificity were also calculated to determine the ability of organ injury and MVC characteristics to correctly classify patients with and without DR. RESULTS: Overall, occupants sustaining a DR had a significantly higher delta-V (DeltaV) (49.8 kilometers per hour [kph] vs. 33.8 kph, por= 30 cm or DeltaV >or= 40 kph with specific organ injuries generated a sensitivity for indicating the likelihood of diaphragm injury ranging from 68% to 89%. Patients with any of the following characteristics had a sensitivity for detecting DR of 91%: splenic injury, pelvic fracture, DeltaV >or= 40 kph, or occupant compartment intrusion from any direction >or= 30 cm. CONCLUSION: Specific MVC characteristics combined with patient injuries have been identified that are highly suggestive of DR. For this subpopulation, additional invasive procedures including exploratory laparotomy, laparoscopy, or thoracoscopy may be warranted to exclude DR.

Pediatric motor vehicle related injuries in the Navajo Nation: the impact of the 1988 child occupant restraint laws.

Abstract: Background: Navajo motor vehicle mortality is the highest among the 12 Indian Health Service (IHS) administrative areas. In July 1988, the Navajo Nation enacted a primary enforcement safety belt use and a child restraint law. Objective: Assess the impact of the laws on the rate and severity of pediatric (0–19 years) motor vehicle injury resulting in hospitalizations in the Navajo Nation. Methods: Hospitalizations associated with motor vehicle related injury discharges were identified by International Classification of Diseases , 9th revision, CM E codes, 810–825 (.0,.1) from the Navajo IHS hospital discharge database. Age specific rates for the period before the law, 1983–88, were compared with those after enactment and enforcement, 1991–95. Severity of injury, measured by the abbreviated injury scale (AIS) score and new injury severity score (NISS), was determined with ICDMAP-90 software. Wilcoxon rank sum and χ 2 tests were used for analysis. Results: Discharge rates (SE) for motor vehicle injury (per 100 000) decreased significantly in all age groups: 0–4 years (62 (7) to 28 (4)), 5–11 years (55.3 (6) to 26 (4)), and 15–19 years (139 (14) to 68 (7)); p=0.0001. In children 0–4 years, the median AIS score decreased from 1.5 (1,3) (25th, 75th centile) to 1 (1,2), p=0.06, and the median NISS decreased from 3.5 (1,9) to 2 (1,5), p=0.07. The proportion of children with NISS scores >4 decreased significantly for the 0–4 year age group (p=0.03). Conclusions: Concurrent with enactment of the Navajo Nation occupant and child restraint laws there was a reduction in the rate of motor vehicle related hospital discharges for children. Severity of injury declined in very young Navajo children. The effect of enactment and enforcement of this Native American child occupant restraint law may serve as an example of an effective injury control effort directed at Native American children.

Deep venous thrombosis and ABO blood group are unrelated in trauma patients.

Abstract: Background: Although epidemiologic studies of the general population have demonstrated a deficit of blood group O among patients with deep venous thrombosis (DVT), few studies have evaluated the importance of blood group in high-risk patients. The purpose of this study was to evaluate the importance of ABO blood group as a thrombotic risk factor in injured patients. Methods: Injured patients with a discharge diagnosis of DVT were identified from an institutional trauma registry and compared with control patients matched for age and Injury Severity Score. ABO blood types of patients and controls were obtained from the regional blood center database. Results: Three hundred forty-three case-control pairs were identified from a total of 401 consecutive cases of DVT. Blunt injury was the predominant mechanism of injury, accounting for 90.4% of cases. Chest (p = 0.01) and extremity (p < 0.001) Abbreviated Injury Scale scores were independent predictors of DVT. However, there was no significant difference in blood group distribution or the A to O ratio between patients with and without DVT. For non-type O patients, the odds ratio for developing DVT was 1.1 (95% confidence interval, 0.8-1.5; p = 0.5) in comparison with type O patients. Conclusion: These data do not support a clinically relevant association between blood type and DVT in trauma patients. Injury-associated derangements of coagulation may be more important than any hypercoagulability related to blood type in this population.

Occupational injuries among construction workers in Hong Kong

Abstract: OBJECTIVE: To explore the nature and severity of occupational injuries among construction workers and its risk factors in Hong Kong METHODS: One hundred and twenty-two injured construction workers in a public hospital and an equal number of workmate controls were studied Contents included socio -demographic characteristics, the availability and use of safety equipment, smoking and alcohol consumption, etc Abbreviated injury scale (AIS) and injury severity score (ISS) were employed for describing the nature, pattern and severity of injuries RESULTS: Single injuries were seen in 80% of cases Of 149 injuries classified by body region, 49% were external, 26% involved either the upper or lower extremities, and 11% were spinal injuries Working at height was associated with the injury severity score Safety hazards were identified in the work environment in 68% of the cases Significant odds ratios for accidents were obtained for 'no formal education', 'non safety training' and 'current smokers' CONCLUSIONS: The results implicated that construction was a hazardous occupation in Hong Kong Improving the work environment and promoting safety education among construction workers would be helpful for minimizing or eliminating occupational injuries in construction occupation in Hong Kong Language: zh

Shopping trolley-related injuries to children in New Zealand, 1988-97.

Abstract: Objective: To describe the epidemiology of shopping trolley related injuries (fatalities and hospitalizations) to children in New Zealand prior to the introduction of a voluntary standard for shopping trolleys. Methodology: To identify cases, a key word search was conducted of national mortality and hospitalization databases for the years 1988–97. Cases were limited to children under 15 years of age. Results: For the 10 year period investigated, 282 hospitalizations and no fatalities were identified. A significant increasing trend for hospitalizations was detected (χ2 = 17.6, 1 d.f.; P < 0.001). Ninety-two per cent of children hospitalized were aged under 5 years and two-thirds were aged 2 years or younger. Ninety per cent of injuries resulted from falls from trolleys, 84% of injuries were to the head or face and 22% were rated serious (AIS-3) on the Abbreviated Injury Scale. Conclusions: The incidence of injuries associated with shopping trolleys increased between 1988 and 1997. Following the introduction of a voluntary standard for shopping trolleys in 1999, which included specifications for child harnesses, trends in injury should be monitored.

Developing a culture of safety in a reluctant audience

Abstract: Objective To describe the injury pattern of skateboarding injuriestoday. Methods The pattern of injuries, circumstances, and severitywere investigated in a study of 139 people injured in skateboarding accidentsduring 1995 through 1998 inclusive and admitted to the University Hospital ofUmea, Umea, Sweden. This is the only hospital in the area, servinga population of 135,000. Results Of the 139 injured, 3 were pedestrainshit by a skateboard rider; the rest were riders. The age range was 7 to 47years (mean, 16.0). The severity of the injuries was minor (Abbreviated InjuryScale 1) to moderate (Abbreviated Injury Scale 2); fractures were classifiedas moderate. The annual number of injuries increased during the study period.Fractures were found in 29% of the casualties, and four children hadconcussion. The most common fractures were of the ankle and wrist. Olderpatients had less severe injuries, mainly sprains and soft tissue injuries.Most children were injured while skateboarding on ramps and at arenas; only 12(9%) were injured while skateboarding on roads. Some 37% of the injuriesoccurred because of a loss of balance and 26% because of a failed trickattempt. Falls caused by surface irregularities resulted in the highestproportion of the moderate injuries. Conclusions Skateboarding shouldbe restricted to supervised skateboard parks, and skateboarders should berequired to wear protective gear. These measures would reduce the number ofskateboarders injured in motor vehicle collisions, the personal injuries amongskateboarders, and the number of pedestrians injured in collisions withskateboarders.

Belted driver protection in frontal impact - what has been achieved and where do future priorities lie?

Abstract: Examining injuries to real people in real crashes is the most meaningful way to validate improvements in crashworthiness as well as to determine where future priorities lie. Examination of U.K national statistics showed that, coincident with the introduction of airbag/pretensioner restraints, there was a significant fall in the rates of killed/seriously injured car occupants as well as a significant fall in the number of car occupant fatalities. Interrogation of the UK in-depth crash injury data for belted drivers in frontal crashes between 20-70 km/h ETS showed substantial reductions in AIS 2+ injury to the head in newer cars. In the same sample of crashes, no corresponding reductions in AIS 2+ injury were found for the chest, thigh and leg.

Crash scene photography in motor vehicle crashes without air bag deployment.

Abstract: OBJECTIVE: To determine whether vehicle characteristics, measured using crash scene photography, are associated with anatomic patterns of injury and severity of injury sustained in motor vehicle crashes (MVCs) without air bag deployment. METHODS: A prospective observational study was conducted over 22 months, using 12 fire departments serving two hospitals. Two vehicle photographs (exterior and interior) were taken at each MVC. Vehicular variables were assigned by grading the photographs with a standardized scoring system, and outcome information on each patient was collected by chart review. RESULTS: Five hundred fifty-nine patients were entered into the study. Frontal crashes and increasing passenger space intrusion (PSI) were associated with head, facial, and lower-extremity injuries, while rear crashes were associated with spinal injuries. Restraint use had a protective effect in head, facial, and upper and lower extremity injuries, yet was associated with higher odds of spinal injury. Lack of restraint use, increasing PSI, and steering wheel deformity were associated with an increased hospital length of stay and hospital charges, yet only steering wheel deformity was associated with increasing injury severity when adjusting for other crash variables. CONCLUSIONS: Out-of-hospital variables, as obtained from crash vehicle photography, are associated with injury site, injury severity, hospital length of stay, and hospital charges in patients involved in MVCs without air bag deployment.

Medical consequences of violence: a two-year prospective study from a primary care accident and emergency department in Norway.

Abstract: Objective - To assess the medical consequences of violence from the perspective of a primary care accident and emergency department. Design - Prospective observational study. Setting - Bergen Legevakt (AED). Subjects - All assault victims treated at the AED 1994-96. Main outcome measures - Diagnoses, treatments, number of consultations at the AED, sickness certificates, rates of admittances to hospitals, referrals to specialists and injury severity ratings using Abbreviated Injury Scale (AIS) and Shepherd's injury severity scale. Results - 1803 assault victims were registered, 433 (24%) females and 1370 (76%) males. Most injuries were of slight severity, corresponding to AIS 0 to 1 (82%) or Shepherd's scale 0 to 1 (74%). Bruises/contusions and cuts/lacerations dominated. The majority of patients did not receive any specific treatment at the AED and they were not given sickness certificates, but 11% were admitted to hospitals and 30% were referred to specialists. Males were more likely to be seriously inju...

Practical application of the Injury Severity Score (ISS) in expert forensic testimony

Abstract: The retrospective analysis of the autopsy records of 50 homicides showed that the Injury Severity Score (ISS), a numerical scoring system initially developed to quantify the severity of injuries sustained in road traffic accidents, can also be useful for objectively describing and ranking the overall severity of trauma with regard to forensic issues. The present case report illustrates to what extent the ISS can help to assess the contribution of each assailant in homicides committed by several perpetrators. In the case presented the court was convinced that one perpetrator had inflicted four deep stab wounds to the victim's face (each with bony lesions), 2 stabs to the chest piercing the right lower pulmonary lobe and causing a haemothorax of 200 ml, an abdominal stab wound without involvement of a parenchymatous organ as well as multiple defence wounds of the arms. Thereafter, a second perpetrator was thought to have inflicted several heavy blows with a full water bottle causing severe contusions on the right side of the forehead, the chin, the left side of the face and a spider's web fracture of the frontal bone. Using the ISS an injury severity score of 24 was assigned to the first complex of injuries and a score of 10 to the second complex. The forensic conclusions with regard to prognosis and lethal outcome are discussed.

[Seriously injured patients intubated at the accident site. A three-year survey from the mobile emergency care unit in Aarhus].

Abstract: BACKGROUND The success rate of out-of-hospital endotracheal intubations performed by paramedics has been questioned. It seems to be difficult to achieve and keep a routine. The aim was to describe the severity of injuries and the number of such intubations in trauma patients treated by the Mobile Emergency Care Unit (MECU) staffed with an anaesthetist. MATERIALS AND METHODS The case records of all trauma patients on whom the MECU, Arhus, performed endotracheal intubation at the accident site from 1 May 1997 to 30 April 2000 were studied. Lesions were classified according to the abbreviated injury scale (AIS), and the injury severity scores (ISS) were calculated. Severe injury was defined as an ISS > 15. RESULTS Over the three-year period the MECU attended 2546 trauma patients, 95 (3.7%) of whom were intubated at the site. In one case, endotracheal intubation was not possible and cricothyrotomy had to be performed. Of the patients intubated at the site 65 had an ISS > 15. This, according to previous studies, corresponded to about 20% of all severely injured patients arriving at our hospital. Sixty patients had severe lesions in the head region. In sixty-eight cases (72%) endotracheal intubation was preceded by anaesthesia. DISCUSSION Out-of-hospital endotracheal intubation of trauma patients was not a frequent intervention, as compared to all emergency calls, but it was relatively frequent in the severely injured brought to our hospital. If endotracheal intubation is to be one of the available interventions in the prehospital setting, this study confirms that it should preferably be done by physicians experienced in intubation and anaesthesia.