Showing papers on "Eye injuries published in 1999"

Eye injuries in children: the current picture.

Abstract: AIMS—To investigate the current causes and outcomes of paediatric ocular trauma. METHODS—A prospective observational study of all children admitted to hospital with ocular trauma in Scotland over a 1 year period. RESULTS—The commonest mechanism of injury was blunt trauma, accounting for 65% of the total. 60% of the patients were admitted with a hyphaema. Injuries necessitating admission occurred most frequently at home (51%). Sporting activities were the commonest cause of injury in the 5-14 age group. There were no injuries caused by road traffic accidents or fireworks. Patients were admitted to hospital for a mean of 4.2 days (range 1-25 days). One (1%) child had an acuity in the "visually impaired" range (6/18-6/60) and one (1%) was "blind" (6/60) in the affected eye. No child was bilaterally blinded by injury and none required blind or partial sight registration. CONCLUSION—This study has shown that the incidence of eye injuries affecting children has fallen. The outcome of ocular trauma has improved significantly, and for the first time paediatric injuries appear to have a better prognosis than injuries affecting adults.

Epidemiology of eye injuries in rural Tanzania

Abstract: In the developing world, ocular trauma is an important cause of monocular blindness. However, little is known about the epidemiology of eye injuries in rural Africa. This study presents five- year data on hospitalized ocular injuries in a rural region in Tanzania. Data were collected from Mvumi Hospital, a tertiary hospital serving rural Dodoma, and the only hospital during this time period able to care for serious trauma. All in-patient charts from January 1, 1985 to December 31, 1989 were reviewed for cases of ocular trauma who presented within 30 days of injury. Data on demographics, cause of injury, visual acuity, and current diagnosis were abstracted. A total of 157 cases were recorded, of whom 69% were male. A third of the injuries occurred in those less than age 20. Injury with a stick was the most common cause, accounting for 67% of the cases. A third of the cases presented to the hospital 8 or more days after the injury, and most had poor visual acuity in the affected eye. In those age 20 or younger, 82% of females and 67% of males presented with visual acuity <3/60. Ruptured globe and uveitis were the most common diagnosis made at presentation. Preventive ophthalmology efforts in this area should focus on decreasing stick-related ocular injuries and improving rapid access to appropriate care when injuries occur.

Eye injuries in patients with major trauma.

Abstract: BACKGROUND: A study was performed to determine the type and frequency of ocular injuries in patients with major trauma. METHODS: All patients with ocular and adnexal injuries (n = 178) among 1,119 patients admitted with major trauma (Injury Severity Score >15) to the Royal Prince Alfred Hospital from July 1990 to December 1997 were analyzed. RESULTS: Sixteen percent of the major trauma cohort had ocular or orbital trauma. Fifty-five percent of patients with injuries involving the face had ocular or orbital injuries. A range of ocular injuries was seen. Analysis of the major trauma cohort showed that motor vehicle drivers, orbital and base of skull fractures, eyelid lacerations, and superficial eye injuries were strongly associated with vision-threatening injury. CONCLUSION: Patients with major trauma and facial injuries have a high risk of vision-threatening injury. Patients with orbital fractures, base of skull fracture, eyelid lacerations, and superficial eye injuries should be assessed by an ophthalmologist as part of the early management of their trauma to determine whether an ocular injury is present. Language: en

Intraocular foreign bodies. Factors influencing final visual outcome.

Abstract: PURPOSE To identify the prognostic factors of poor visual outcome (visual acuity < or =6/240) in eyes with intraocular foreign bodies. METHODS The records of 95 consecutive patients were retrospectively reviewed for 6 years (1990-1995). All eyes underwent a primary surgical repair and foreign-body removal (electromagnet or vitrectomy). The mean follow-up period was 25 months (6-72 months). Single analysis and multiple logistic stepwise regression analysis were performed to determine predictors of poor vision. RESULTS Thirty patients (31.6%) showed 6/240 or worse vision at the end of their follow-up period. Three significant predictive factors had independent and combined effects on post-operative visual outcome: a corneo-scleral entry wound (odds ratio (OR)=14.5, p=0.001), largest diameter of IOFB (OR=1.21, p=0.01) and the presence of secondary retinal detachment (OR=9.48, p=0.0002). Post-operative complications included traumatic cataracts (51%), retinal detachments (28%) and phthisis bulbi (8%). CONCLUSION Using multivariate analysis, corneo-scleral entry wound, largest diameter of foreign body and secondary retinal detachment were found to be predictors of poor visual outcome after intraocular foreign body removal. Our results suggest that patients with high-risk intraocular foreign body trauma should be candidates for pars plana vitrectomy rather than electromagnet procedure.

Facial trauma and ocular/orbital injury.

Abstract: BACKGROUND AND OBJECTIVES: Ocular injuries occur commonly in patients with facial trauma Patients with significant eye injuries may present with grossly normal eyes and good visual acuity; however, subsequent ocular disorders may become apparent The estimates of incidence vary considerably Trauma is the second leading cause of blindness, and a review is, therefore, warranted METHODS AND MATERIALS: Several extensive studies are reviewed Blunt and penetrating trauma are examined by their respective subdivisions The initial assessment and ophthalmologic examination of patients with facial trauma are discussed, and the type of injury that may occur secondary to trauma is delineated Management is reviewed and discussed, including a recently developed diagnostic scoring system Three clinical cases illustrate the procedure RESULTS AND/OR CONCLUSIONS: The diagnosis of ocular injuries resulting from trauma is difficult The recently introduced scoring system was found to improve the procedure Based on this system, the authors have devised an algorithm to assist the clinician, with emphasis on visual acuity and the importance of visual examination

Epidemiology of open globe injuries

Abstract: BACKGROUND: Severe open globe injuries are frequent emergencies in an ophthalmologic clinic and required immediate operation The extent of these injuries is various depending on the mechanism of the injury and involvement of ocular tissue In many cases a full visual rehabilitation can be achieved but in a lot of cases blindness results To prevent such severe eye injuries it is important to judge the leading injury mechanisms For this we collected our data about open globe injuries PATIENTS AND METHODS: Retrospectively we collected the data from 103 consecutive patients in the year 1996 and 1997, presenting with an open globe eye injury followed by operation The data contained personal patients data, information about mechanism of injury, visual acuity, operation and rehabilitation Statistical analysis was performed using binomimal-test and t-test for paired and unpaired samples (p < 005) RESULTS: 854% were male Most of the injuries happened at home (38%) and at the working place (31%) Assaultive injuries happened in 68% 35% of all patients were craftmen (mechanics, electricians, or the locksmith were preferred) Pensioners were affected in 146% of all cases followed by small children (78%) and school children (78%) In 50% of all cases metal and glass were responsible for the trauma, explosions were noticed in 87% An intraocular foreign body was found in 379% In 62% of all cases no second operation was necessary An enucleation during the follow-up was performed in 2 cases CONCLUSION: At least a third of all severe eye injuries would have been preventable Concerning the non-preventable injuries accidents at home and in children were predominating The rate of the open globe injuries was 232 in 100000 people, which is about the same like in US-American studies Most of the injuries happened at home because of carelessness and would have been avoidable The rate of injuries at the working place is significantly higher than in the USA but there were significantly more gun-shot-injuries or offensive accidents abroad The rate of accidents at home and in traffic were the same We think that public campaigns and prevention strategies can help to reduce the potential risk of severe eye injuries

Molecular therapy in ocular wound healing

Abstract: Recent advances in molecular cell biology have revolutionised our understanding of medical diseases and provided new and alternative strategies for developing treatments. Here we review the spectrum of molecular therapies that are either currently available or have potential application as agents that are able to modulate the wound healing response in the eye. For the purposes of this review, we define molecular therapy as the targeting of specific molecules known to be involved in the processes of wound healing. This may be at the level of either protein or gene expression. The process of wound healing is involved in either the pathogenesis or failure of treatment of many of the major blinding or visually disabling conditions in the world today. It is implicated in scarring diseases throughout the eye, some examples of which are described below. The conjunctival wound healing response is important in many ocular conditions such as pemphigoid, trachoma, and chronic cicatrisation, where the development of complications arises from the disruption of the ocular surface.1 It is also a major determinant of outcome following glaucoma filtration and squint surgery.2The severity and extent of clinical disease are closely related to the degree of conjunctival scarring. Another example of scarring is that occurring in the cornea after excimer laser photorefractive keratectomy (PRK), giving rise to symptoms of haze and resulting, in some cases, in a reduction of the best corrected visual acuity.3 4 The scarring condition of proliferative vitreoretinopathy (PVR) accounts for 7–10% of surgical failures in primary retinal detachment repair procedures5 6 and is responsible for producing significant visual morbidity and blindness. It is characterised by the development of fibrosing and proliferating cellular membranes on the vitreous and retinal surfaces that contract and cause irreparable tractional retinal detachments. The complex process of wound healing …

The evaluation of ocular trauma in children between ages 0-12.

Abstract: Ocular trauma is the leading cause of noncongenital unilateral blindness in children under 20 years old. In this study, 138 patients (36 female, 102 male) with ocular trauma between November 1983 and October 1996 were reviewed retrospectively at the Department of Ophthalmology, Ondokuz Mayis University Faculty of Medicine. Twenty-four of these patients were blunt trauma and 114 were perforating eye injury. The mean age of the patients was 6.96+/-3.01 years. Mean post-treatment follow-up was 10.7 months (range 1 to 121 months). Forty-five patients were admitted to the eye clinic within the first 24 hours after trauma. The most frequent finding was hyphema in blunt injury, and corneal laceration in perforating injury. The most frequent cause of injury was wood and stone in blunt trauma and glass and knife in perforating trauma. While the ratio of visual acuities equal to or better than finger counting was 37.5 percent (9 eyes) in blunt trauma cases and 20.2 percent (23 eyes) in perforating trauma cases prior to treatment, it was 79.2 percent (19 eyes) and 55.3 percent (63 eyes), respectively, at last visit examination post-treatment. The most frequent complication was traumatic cataract in blunt trauma and corneal leukoma and anterior synechia in perforating trauma. The results obtained suggested that socioeconomic and sociocultural status and family negligence are important factors in eye injuries in children that occur during games. Language: en

Laser pointers revisited: a survey of 14 patients attending casualty at the Bristol Eye Hospital

Abstract: AIMS The largest clinical series of laser pointer exposures to date is described, to document any long term visual sequelae and assess objectively the visual threat from transient ocular exposure. METHODS 14 cases were collected prospectively and triaged by ophthalmic nurses before referral to an ophthalmologist for a complete ophthalmic examination. Regardless of the need for clinical follow up, all patients were contacted by telephone at a mean interval of 10.5 months following exposure to inquire about new or persisting symptoms. RESULTS 11/14 cases presented within 24 hours of exposure and 5/14 incidents were reported to the police. Reduced acuity in the affected eye compared with the contralateral were documented in 5/14 cases. The commonest physical sign was a punctate epitheliopathy, seen in 5/14 cases, and the commonest symptom was ocular discomfort, reported by 11/14 patients. There were no consistent retinal findings. Follow up by telephone survey revealed that two patients were wearing new glasses, but had not been refracted before the exposure; one had intermittent ocular discomfort; the remaining 11 were asymptomatic. CONCLUSIONS This study is reassuring to the ophthalmology community and the general public in failing to demonstrate consistent, long term damaging effects of transient ocular exposure to laser pointer beams.

A 12-year ophthalmologic experience with the shaken baby syndrome at a regional children's hospital.

Abstract: PURPOSE: To examine the ophthalmologic experience with the shaken baby syndrome (SBS) at one medical center, including clinical findings, autopsy findings, and the visual outcome of survivors. METHODS: One hundred sixteen patients admitted from 1987 to 1998 for subdural hematomas of the brain secondary to abuse were included. RESULTS: Retinal hemorrhages were detected in 84% of the children, but this important finding had been missed often by nonophthalmologists. Poor visual response, poor pupillary response, and retinal hemorrhage correlated strongly with demise of the child. One child who died had pigmented retinal scars from previous abuse, a condition not previously observed histopathologically. The clinical and autopsy findings varied somewhat, probably because of the differing conditions for examination. No correlation could be made between computerized tomography scans done during life and the subdural hemorrhage of the optic nerve found on autopsy. Half of the surviving patients were known to have good vision. One fourth of the patients had poor vision, largely due to cerebral visual impairment from bilateral injury posterior to the optic chiasm. Severe neurologic impairment correlated highly with loss of vision. CONCLUSION: This series provides information on the frequency of eye findings in SBS patients. No fundus finding is pathognomonic for SBS. When retinal hemorrhages are found in young children, the likelihood that abuse occurred is very high. The difficulty that nonophthalmologists have in detecting retinal hemorrhage may be an important limiting factor in finding these children so they may be protected from further abuse. Language: en

Loss of visual acuity due to eye injuries among 6292 school children in the Sultanate of Oman.

Abstract: . Purpose: In 1992–94 a nation-wide survey in primary schools in the Sultanateof Oman for ocular disorders was conducted. This report focuses on the preva-lence of visual acuity loss after injury. Methods and material: A random selection of 6292 children from Grades 1 and6 from all primary schools in the country provided the research sample.Children who failed the visual acuity screening test received a complete ‘‘on thespot’’ eye examination by the pediatric ophthalmologist. Results: 12 children were found to have monocular low vision (VA ° 0.3 toamaurosis) caused by injury. Total prevalence for loss of vision in one eye was0.19%, with 0.15% in 6-year-olds and 0.25% in 12-year-olds. Traumatic catar-acts were noted in 4 children, 3 of these were in need of surgery. One child hadaphakia after trauma surgery and needed a secondary lens implant. Conclusion: Altogether the prevalence of traumatic monocular visual damagein our study was 0.19%. Next to amblyopia, injury is the main reason for mon-ocular loss of vision in childhood, however, both are preventable. Informationabout trauma prevention and the need for adequate ophthalmic care shouldbe emphasized. Regular and repeated screening of visual acuity in children isessential.

Penetrating eye injury in war.

Abstract: The percentage of penetrating eye injuries in war has increased significantly in this century compared with the total number of combat injuries. With the increasing use of fragmentation weapons and possibly laser weapons on the battle-field in the future, the rate of eye injuries may exceed the 13% of the total military injuries found in Operations Desert Storm/Shield. During the Iran-Iraq War (1980-1988), eye injuries revealed that retained foreign bodies and posterior segment injuries have an improved prognosis in future military ophthalmic surgery as a result of modern diagnostic and treatment modalities. Compared with the increasing penetrating eye injuries on the battlefield, advances in ophthalmic surgery are insignificant. Eye armor, such as visors that flip up and down and protect the eyes from laser injury, needs to be developed. Similar eye protection is being developed in civilian sportswear. Penetrating eye injury in the civilian sector is becoming much closer to the military model and is now comparable for several reasons. Language: en

Primary intraocular lens implantation during pars plana vitrectomy and intraretinal foreign body removal.

Abstract: Purpose To evaluate visual and surgical outcomes as well as complication rates after cataract extraction and primary intraocular lens (IOL) implantation during pars plana vitrectomy for removal of foreign bodies embedded or impacting in the retina. Methods Six consecutive cases of simultaneous cataract extraction and IOL implantation combined with vitreous surgery and intraocular foreign body extraction were retrospectively analyzed. In five cases, the foreign body was intraretinal; in one case, it was preretinal with retinal impact site. The follow-up period ranged from 5 to 45 months (mean 21.3 months). Results Visual acuity improved by two or more lines in five of six eyes. In five eyes, best-corrected postoperative visual acuity was better than 20/40. One eye was successfully reoperated for retinal detachment that developed 2 months postoperatively. In four eyes, the IOL was implanted into the capsular bag; in two cases, the IOL was placed in the ciliary sulcus. No postoperative complication was attributed to IOL implantation. Conclusion Primary IOL implantation after combined cataract and vitreoretinal surgery is a safe and attractive option, reducing the need for two separate operations in selected patients with penetrating ocular injury and retained intraocular foreign bodies. The main advantage is more rapid visual rehabilitation with a single operation, reducing costs and patient discomfort.

Laser injuries of the eye.

Abstract: With the increasing use of lasers in the military and industry, a moderate number of significant retina injuries have occurred. These injuries have been due to lasers in the visible and near-infrared spectrum primarily, with a pulse duration in the nanosecond range. Use of lasers in the ophthalmic community has resulted also in structural damage to the cornea, lens, IOL, and retina. Because we have no proven treatment for most injuries to the retina, we must continue to strongly emphasize the use of wavelength-specific protective goggles to try to prevent future eye injuries. Language: en

Visual recovery in unilateral traumatic pediatric cataracts treated with posterior chamber intraocular lens and anterior vitrectomy in Pakistan

Abstract: Purpose: To evaluate visual recovery in unilateral traumaticcataracts in children treated with posterior chamber intraocular lensimplantation and anterior vitrectomy.Methods: Sixteen childrenwith unilateral traumatic cataract between ages 3–10 years (mean, 5years 8 months) were treated with posterior chamber intraocular lensimplantation and anterior vitrectomy. Surgery was performed between2 weeks and 7 months (mean, 7.75 weeks) after injury. Follow up wasbetween 9 and 29 months (mean, 17.9 months). Results: The mostcommon postoperative complication was fibrinous uveitis, which developedin 4 children (25%). All eyes had a clear visual axis postoperatively; nonerequired capsulotomy. The mean postoperative refraction was +0.9 diopters(range, +3.50 to -2.75 diopters). Three eyes (18.75%) had visual acuityof 6/9, 8 eyes (50%) had visual acuity of 6/12 or better, and 11 eyes (68.75%)had visual acuity of 6/18 or better. The cause of poor visual acuity was cystoidmacular edema in one eye, macular scars in two eyes, and amblyopia in one eye.Conclusions: Unilateral traumatic cataractsin children in whom aphakia is correctedwith posterior chamber lens implantation combinedwith anterior vitrectomy resultin good visual outcome, and we recommendthis treatment modality in traumaticcataract in children.

Chemical eye injuries in the workplace. Prevention and management.

Abstract: 1. The majority of ocular burns are related to accidents at work. Acute ocular chemical injuries require emergent recognition and management. 2. Copious irrigation of the eye, done immediately at the scene, is the most important factor in the long term prognosis of ocular chemical burns. 3. After irrigation has been completed and the eyes have been allowed to rest, visual acuity can be tested and referrals can be made to health care facilities and an ophthalmologist. 4. The nurse conducts health hazard assessments of the workplace, provides information about workplace chemicals and their risks, and ensures proper safety protective equipment and emergency supplies. Practicing emergency procedures such as irrigation is important. 5. The nurse monitors and analyzes injury exposure episodes and trends, along with coordinating referrals, treatments, and follow up care for workers with ocular chemical burns. Language: en

Increasing paintball related eye trauma reported to a state eye injury registry.

Abstract: Objectives —To evaluate an apparent increase in documented trauma from paintball related eye injuries reported to the Eye Injury Registry of Indiana. Methods —A retrospective review of cases reported to the database is reported, with representative case histories. Results —No injuries from paintball were reported during the period June 1992 to June 1996. Over the next two years 11 injuries were reported, representing 4% of all ocular trauma reports over this period. Visual outcome is poor in many of these eyes and more than one half present with posterior segment ocular injury. Conclusions —Severe ocular trauma results from impacts from paintball pellets, and the occurrence of injuries appears to be increasing due to growth in popularity of this war game. Diligent use of eye protection by all participants is necessary to prevent a continuing rise in ocular trauma prevalence from this activity.

Eye injuries caused by cow horns

Abstract: PURPOSE: To assess ocular injuries caused by cow horns; to investigate clinical findings, treatment, and visual outcome in a population of dairy farmers; and to propose possible preventive measures. METHODS: A retrospective review was conducted to identify patients seen over a 45-month period with cow horn-inflicted eye injuries. Eleven patients were identified and their charts reviewed for demographics, mechanism of injury, initial and final visual acuity, surgeries performed, and anatomic outcome. RESULTS: The mean age of the patients was 64 years. Seven patients had open-globe injuries with vitreous hemorrhage. In five cases, pars plana vitrectomy was performed. Final best-corrected visual acuity was

Road traffic accidents and ocular trauma: experience at tripoli eye hospital, libya.

Abstract: Road traffic accidents (RTA) are common occurrences every day. With the ever increasing number of various road transport vehicles, and the increasing number of new drivers, traffic accidents keep on increasing, causing mild to severe human injury, including injuries to the eyes. Eye injuries, often resulting in some visual loss, create enormous costs both to the victim and to society. There is great need for more active interest in the prevention of eye injuries. It is necessary to accumulate relevant data of damage caused by road traffic accidents (RTA) and, also, to evaluate the present situation in Libya. The Casualty Service of the Tripoli Eye Hospital, which receives trauma cases, is open day and night. Many cases of eye injuries are sent from the Trauma Centre, Central Hospital, Tripoli. Ocular involvement in road traffic accidents may involve the eyelids, lacrimal canaliculi, orbital wall, conjunctiva, cornea, sclera and the extra-ocular muscles. There may be prolapse of uveal tissue, vitreous loss, traumatic cataract, retinal detachment, vitreous haemorrhage, choroidal rupture, optic nerve avulsion or a ruptured globe. This two year study, from 1 October 1993 until 30 September 1995, reports the ocular trauma caused by road traffic accidents in patients attending or referred to the Tripoli Eye Hospital.

Cyanoacrylate tissue adhesive augmented tenoplasty: a new surgical procedure for bilateral severe chemical eye burns.

Abstract: Purpose To report on cyanoacrylate tissue adhesive augmented tenoplasty, a new surgical procedure for bilateral severe chemical eye injuries. Methods A 26-year-old man presented with bilateral severe (grade IV) chemical burns involving the eye, periorbital tissues, face, and neck. Despite adequate medical therapy, corneal, limbal, and scleral ulceration progressed in both eyes. Secondary Pseudomonas keratitis necessitated therapeutic penetrating keratoplasty in the right eye. Tenoplasty and glued-on rigid gas permeable contact lens were unsuccessful to arrest progression of corneolimboscleral ulceration in the left eye. We applied n-butyl cyanoacrylate tissue adhesive directly on the ulcerating corneal, limbal, and scleral surface to augment tenoplasty. Results The left ocular surface healed with resultant massive fibrous tissue proliferation and symblepharon on the nasal side. Ocular surface rehabilitation resulted in a vascularized leukomatous corneal opacity with upper temporal clear cornea. The patient achieved visual acuity of 6/36 in the left eye. Conclusion We suggest that cyanoacrylate tissue adhesive-augmented tenoplasty can be undertaken to preserve ocular integrity and retain visual potential in a severe chemical eye injury.

Prevention of work related injuries: a look at eye protection use and suggested prevention strategies

Abstract: Eye injuries account for 6% of all national injuries, with 60% of those injured professing to not having worn any eye protection. Most injuries (70%) are from flying objects that come around the front of a flat "eyeglass type" personal protective device. Blindness prevention include educating managers and employees, and purchasing and distributing effective eye wear protection.

Epidemiology of general and sports eye injuries

Abstract: Because vision is our primary contact with our environment, loss of sight is the most feared of all disabilities. The threat of permanent loss of vision is always dramatic, but especially so if suffered acutely. The fear of going blind has far-reaching implications for the individual whose eye is injured. Ocular injuries typically affect young persons with previously normal vision and may cause immediate blindness in one or both eyes. Those affected are often faced with loss of career or educational opportunities and commonly suffer permanent physical disfigurement as well. Eye injuries are devastating to both the victim and the family. In addition to the physical and psychologicaP6 cost of eye injuries to the affected people, the direct and indirect financial costs to society are enormous. In industrialized nations, ocular trauma is now the most common reason for hospitalization of ophthalmology patients exceeding 24 hours. Although the prognosis of a severe eye injury has improved markedly in the last two decades, the outlook remains guarded, especially in cases with posterior segment involvement.10 Prevention of ocular trauma, therefore, should have a high priority, not only among ophthalmologists but among all health care professionals, legislators, educators, and leaders in research funding allocation, industry, and sports, among others. The overwhelming majority of eye injuries are preventable,3O but prevention can be most effective when properly targeted toward areas pinpointed with the help of adequate, high-quality surveillance data. With the risk factors reliably identified, preventive measures can be designed, tested on sample populations, and, if found to be effective, deployed widely. The newly introduced preventive measures can then be monitored by the same surveillance system. Although the focus of modern epidemiology turned from contagious diseases to a wide variety of topics (i.e., cancer, cardiovascular disease), trauma has, until recently, remained a research area in which financial support has consistently lagged in importance. As the National Research Council reported in 1988, the ratio of years of life lost to injury versus cardiovascular diseases and stroke was 1.95 to 1; the ratio for injury versus cancer was 2.41 to 1. When federal research expenditures (in million dollars) and preretirement lives lost (in million years) were analyzed in the United States in 1981, however, the ratio was 587 for cancer, 297 for cardiovascular disease and stroke, and only 27 for injury." In the United States, "injury ranks as one the nation's most pressing health problems,"" with over 140,000 lives lost annually and a much larger number of persons suffering nonfatal but severe and disabling injuries each month. Trauma is the leading cause of death for individuals under the age of 45 in this country. Injury-related deaths resulted in the loss of over 3.5 million work-years in 1984, exceeding the total for cancer and cardiovascular disease combined. Trauma is now the primary reason for seeking medical attention in the United States, accounting for 99 million annual visits to physicians, a quarter more than cardiovascular disease-related visits."