The prognosis following acute primary glenohumeral dislocation.
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We have studied 105 patients with 107 acute, primary, dislocations of the glenohumeral joint seen between January 1, 1991 and July 1, 1994. The mean time of follow-up was 71 months (46 to 91). In 34% the injury occurred during a sports activity and in 28% at home. The bias toward sport was even greater in patients less than 40 years of age, and in men. In patients older than 40 years of age, and in women, the dislocation occurred more often at home. The overall probability of recurrence within four years was 26%. Age was the most significant prognostic factor in recurrence which took place in 64% of patients less than 20 years of age and in 6% of those older than 40 years. Statistically, there was no difference between the rates of recurrence in patients who were active in sport and those who were not. The mean Rowe score for the whole group was 87 (15 to 100). Associated fractures were found in 20 patients (19%) and nerve injuries in 22 (21%). None of those in whom a fracture of the greater tuberosity was seen subsequently suffered a recurrent dislocation. At follow-up we found that 36 patients (34%) had not returned to their former employment but in only 2% was this owing to the injured shoulder. (+info)
Causes of fatal childhood accidents in North Staffordshire, 1980-1989.
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Sixty-nine children aged under 15 years were identified from coroners' records as having died as a result of an accident between 1980 and 1989. Road traffic accidents (RTAs) accounted for the majority of cases (n = 38; 55% of total) and in almost all of these, the unsafe behaviour of the child was considered to be at fault. Most fatal accidents occurred between 15.00 and 21.00 hrs and within 2 km of the child's home; the majority of children killed were not supervised by an adult at the time of the accident. Considerable variation in mortality within the district was observed with several areas having a rate significantly higher than the district as a whole. Head injury was the most commonly recorded cause of death (n = 37, 53%) confirming the importance of head injury as a cause of childhood mortality. Road safety educational and engineering measures as well as adequate adult supervision and awareness could have prevented the vast majority of these accidental deaths. Coroners records are a vital and often poorly utilized source of locally relevant information regarding childhood accidents which should be of use to all interested agencies including child accident prevention groups. (+info)
Case report. Self-induced grand mal epilepsy.
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A case of a male patient who accidentally induced a grand mal seizure with a home-made electronics device. Other comparative cases are described. (+info)
The epidemiology of ocular trauma in rural Nepal.
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AIMS: To estimate the incidence of ocular injury in rural Nepal and identify details about these injuries that predict poor visual outcome. METHODS: Reports of ocular trauma were collected from 1995 through 2000 from patients presenting to the only eye care clinic in Sarlahi district, Nepal. Patients were given a standard free eye examination and interviewed about the context of their injury. Follow up examination was performed 2-4 months after the initial injury. RESULTS: 525 cases of incident ocular injury were reported, with a mean age of 28 years. Using census data, the incidence was 0.65 per 1000 males per year, and 0.38 per 1000 females per year. The most common types of injury were lacerating and blunt, with the majority occurring at home or in the fields. Upon presentation to the clinic, 26.4% of patients had a best corrected visual acuity worse than 20/60 in the injured eye, while 9.6% had visual acuity worse than 20/400. 82% were examined at follow up: 11.2% of patients had visual acuity worse than 20/60 and 4.6% had vision worse than 20/400. A poor visual outcome was associated with increased age, care sought at a site other than the eye clinic, and severe injury. 3% of patients were referred for further care at an eye hospital at the initial visit; 7% had sought additional care in the interim between visits, with this subset representing a more severe spectrum of injuries. CONCLUSIONS: The detrimental effects of delayed care or care outside of the specialty eye clinic may reflect geographic or economic barriers to care. For optimal visual outcomes, patients who are injured in a rural setting should recognise the injury and seek early care at a specialty eye care facility. Findings from our study suggest that trained non-ophthalmologists may be able to clinically manage many eye injuries encountered in a rural setting in the "developing" world, reducing the demand for acute services of ophthalmologists in remote locations of this highly agricultural country. (+info)
Epidemiology of electrical and lightning related deaths and injuries among Canadian children and youth.
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Among burn injuries, electrical injuries constitute a small but devastating fraction. To describe the epidemiology of electrical injuries in Canadian children, data on deaths and emergency department visits related to electrical injuries, including lightning strikes, were obtained from provincial coroners' offices and the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) respectively, for the years 1991-96. Twenty one deaths and 606 emergency visits highlight that electrical related deaths, more frequent among school age children, are more likely the result of high voltage and lightning strike, while emergency department visits, more frequent among younger children, are more likely the result of low voltage. While the introduction of legislated standards for child safe outlets and educational programs for parents, children, and youth are recommended strategies toward reducing the frequency of these incidents, these strategies require further evaluation before their effectiveness can be estimated. (+info)
Mothers' home-safety practices for preventing six types of childhood injuries: what do they do, and why?
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OBJECTIVE: To identify determinants of mothers' home-safety practices for preventing six types of common injuries to children (burns, poisoning, drowning, cuts, strangulation/suffocation/choking, and falls). METHODS: Home interviews were conducted with mothers of children 19-24 and 25-30 months old about home-safety practices. For each of 30 safety precautions to prevent these six types of injuries, mothers indicated whether or not they engaged in the practice, and explained why. RESULTS: Regression analyses revealed both common and unique determinants of mothers' home-safety practices to prevent these six types of home injuries. For burns, cuts, and falls, beliefs that child characteristics and parent characteristics elevated the child's risk of injury were the key determinants of the mother's engaging in precautionary measures. For drowning, poisoning, and suffocation/strangulation/choking, health beliefs also contributed to predict mothers' practices, including beliefs about potential injury severity and extent of effort required to implement precautionary measures. CONCLUSIONS: The factors that motivated mothers to engage in precautionary measures at home varied depending on the type of injury. Intervention programs to enhance maternal home-safety practices will need to target different factors depending on the type of injury to be addressed. (+info)
Unsupervised firearm handling by California adolescents.
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OBJECTIVE: Relatively little is known about the behavior of adolescents around firearms. The present investigation was undertaken to estimate the proportion of community-residing adolescents who report that they have ever handled a gun without adult knowledge or supervision. METHODS: A random digit dial interview was conducted with 5801 California adolescents as part of the California Health Interview Survey. Respondents were asked whether they have ever held a gun and whether they have ever done so without adult knowledge or supervision. Study design and population weights were applied to these data. In addition, adolescents' reports about the most recent unsupervised handling incident were coded to ascertain what they were doing with the gun as well as with whom and where the incident occurred. RESULTS: One third (33%) of California adolescents report that they have handled a firearm; 5% report that they have done so without adult knowledge or supervision. Half (49%) of all unsupervised handling involved shooting and only 11% occurred in the respondent's home. Several demographic variables (being male, African American, living in a rural area) and risk behaviors (smoking, drinking, being the victim of a gun related threat), as well as having a gun in the home and parents not knowing the adolescent's whereabouts in the afternoon were each associated with unsupervised gun handling. CONCLUSIONS: Unsupervised gun handling is associated with other health risk behaviors. Unsupervised gun handling typically involves shooting the gun and usually occurs with friends, away from the home. (+info)
My home is my castle! Or is it? Hospitalizations following home injury in Israel, 1997-2001.
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BACKGROUND: Although the home is perceived to be a safe haven, it is a scene of numerous injuries. OBJECTIVES: To characterize home injury in Israel, the victims, injury circumstances and outcomes, and to identify groups at high risk for injury in order to focus future interventions and thus effectively prevent these injuries and their associated hospitalizations. METHODS: We analyzed 5 year records (1997-2001) from the National Trauma Registry of all patients arriving at eight trauma centers following home injury and admitted to hospital, transferred to another medical center, or died in the emergency department. RESULTS: The study group included 26,921 patients, constituting 34% of all unintentional hospitalized trauma patients. Twenty-seven percent were children (0-4 years) and 37% were elderly (> or = 65 years), the two age groups whose home injury accounted for most of the trauma injuries. Among children more boys (59%) than girls (41%) were injured, but the opposite was true for the elderly (30% males and 70% females). The share of females among the home-injured increased with age. Falls caused 79% of all home injuries (97% among the elderly) and bums 9%, increasing to 18% among children (0-4 years). Among non-Jewish home-injured patients, infants predominated (50% compared to 20% among Jews). Moderate to critical injuries amounted for 42%, with 38% of the home-injured and 60% of the elderly requiring surgery. The clinical and economic consequences of home injuries differed according to the type of injury, with bums carrying the heaviest toll of prolonged intensive care and hospital stay. Overall, hospital stay averaged 6.2 days per patient (median 3 days). CONCLUSIONS: Falls among the elderly, bums among children, and a high prevalence of hospitalization among non-Jewish children define groups at high risk for home injuries. Prevention programs should be based on these findings and should focus on the more vulnerable groups. (+info)