Childhood head injury and expression of schizophrenia in multiply affected families.
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BACKGROUND: The etiology of schizophrenia is believed to include genetic and nongenetic factors, with the pathogenesis involving abnormal neurodevelopment. We investigated whether mild head injury during brain maturation plays a role in the expression of schizophrenia in multiply affected families. METHODS: We compared the history and severity of head injuries in childhood (age, < or =10 years) and through adolescence (age, < or =17 years) in 67 subjects with narrowly defined schizophrenia and 102 of their unaffected siblings from 23 multiply affected families. In subjects with schizophrenia, only head injuries preceding the onset of psychosis were considered. RESULTS: Subjects in the schizophrenia group (n = 16 [23.9%]) were more likely than the unaffected siblings group (n = 12 [11.8%]) to have a history of childhood head injury (P =.04; odds ratio, 2.35 [95% confidence interval, 1.03-5.36]). Subjects in the schizophrenia group with a history of childhood head injury had a significantly younger median age at onset of psychosis (20 years) compared with those with no such history (25 years; z = -2.98; P =.003). The severity of head injury ranged from minimal to mild, including concussions, but within this narrow range, severity was correlated with younger age at onset (r(s) = -0.66; P =.005). Head injury occurred a median of 12 years before the onset of psychosis. Results were similar if head injuries during adolescence were included, but did not achieve statistical significance. CONCLUSIONS: Mild childhood head injury may play a role in the expression of schizophrenia in families with a strong genetic predisposition. Prospective studies of mild head injury should consider genetic predisposition for possible long-term neurobehavioral sequelae. (+info)
Predictors and severity of injury in assaults with barglasses and bottles.
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BACKGROUND: Although glasses and bottles are frequently used as weapons in assaults, there is little knowledge on which prevention strategies can be based. DESIGN: Scrutiny of a random sample of 1288 criminal injury compensation applications. OBJECTIVE: To identify predictors and relative severity of glass and bottle injury. METHOD: Injury site, severity, treatment, and demographic characteristics of victims and assailants were studied with reference to awards from the UK national Criminal Injuries Compensation Authority (CICA). MAIN OUTCOME MEASURES: Gender of victims and assailants, injury sites, treatment, and award (UK pounds) as indices of injury severity. RESULTS: Annual CICA awards to all victims of assaults in licensed premises during 1996-98 amounted to pound 4.08 million (for all glass/bottle assaults: pound 1.15 million = 28%). The mean cost of 746 glass assaults was pound 2347, compared with pound 2007 for 542 injuries from bottle assaults (mean difference pound 340; p<0.01). This difference largely reflected more eye injuries with glasses (26 cases: 3% of all glass assaults) than with bottles (eight cases: 1% of all bottle assaults). Bottle assault was significantly associated with unidentified assailants and scalp injuries; whereas glass injury was significantly linked to pub opening hours (midday to midnight), Thursdays, eye and face injuries, and treatment requiring sutures. Mean age of bottle assault victims (26.1 years) was lower than of glass victims (27.3 years; p<0.01), and same gender assaults were more frequent than between gender assaults for both bottle (p<0.001) and glass (p<0.001) assaults. Female victims were allocated to lower compensation awards more frequently than male victims; this was the case for both bottle (p<0.05) and glass (p<0.01) assaults. CONCLUSIONS: Assaults with bottles caused less serious injury and resulted in lower compensation costs. Injury distribution was linked to victim gender and weapon choice, but not to assailant gender. Prevention strategies should focus on both bottle and glass assaults and should take account of the setting and time in which drinking occurs. (+info)
Neurogenic fever after traumatic brain injury: an epidemiological study.
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OBJECTIVES: To determine the incidence of neurogenic fever (NF) in a population of patients in the acute phase following severe traumatic brain injury (TBI); to identify factors associated with the development of NF following severe TBI in adults. METHODS: Charts of patients admitted from 1996 to 1999 with severe TBI at a large, urban mid-Atlantic teaching hospital were retrospectively evaluated based on diagnostic criteria for each episode of hyperthermia to determine the diagnosis of NF. Data were collected regarding mechanism and area of injury, severity of injury, and demographic factors to determine potential predictors of NF. RESULTS: Diffuse axonal injury (DAI) (OR 9.06, 95% CI 0.99 to 82.7) and frontal lobe injury of any type (OR 6.68, 95% CI 1.1 to 39.3) are independently predictive of an increased risk of development of NF following severe TBI. The presence of a skull fracture and lower initial Glasgow Coma Score (GCS) were individual predictors of development of NF, but did not contribute to the final model. CONCLUSIONS: These findings examine known and novel risk factors for this phenomenon in comparison to previously published literature on NF. A set of predictor variables was identified to help clinicians target patients at high risk for development of NF following severe TBI. It is hoped that earlier diagnosis and appropriate intervention for fever in the TBI patient will lead to improved outcomes. (+info)
A new approach to the analysis of multiple injuries using data from a national trauma registry.
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OBJECTIVE: To present a new systematic approach for summarizing multiple injury diagnosis data into patient injury profiles. DESIGN: International Classification of Diseases, ninth revision, clinical modification injury diagnosis codes were classified using a modification of the Barell body region by nature of injury diagnosis matrix, then grouped by body region, injury nature, or a combination of both. Profiles were built which describe patients' injury combinations based on matrix units, enabling the analysis of patients, and not only the study of injuries. SETTING: The Israeli national trauma registry was used to retrieve patient demographic data, injury details, and information on treatment and outcome. Patients or subjects: All hospitalized patients injured in road traffic accidents and included in the trauma registry from January 1997 to December 2000 were included. MAIN OUTCOME MEASURES: Patient profiles consisting of body regions, injury natures, their combination, and their clinical outcomes. RESULTS: The study population comprised 17459 patients. Head and neck injuries were the most frequent in all subpopulations except for motorcyclists who sustained most injuries in the extremities. Fractures were the most common injury nature (60%). Pedestrians and drivers had the highest proportion of multiple injuries in both profiles. Forty eight percent of the patients had a single cell profile. The most frequent conditions as a sole condition were extremity fractures (14%), internal injuries to the head (11%), and injuries of other nature to the torso (6%). Mortality, length of stay, and intensive care unit treatment varied dramatically between profiles and increased for multiple injury profiles. Inpatient death was an outcome for 3.3% overall; however, in patients with an internal injury to the head and torso, inpatient death rate was nine times higher, at 31%. CONCLUSIONS: Profiles maintain information on body region and nature of injury. The use of injury profiles in describing the injured improves the understanding of casemix and can be useful for efficient staffing in multidisciplinary trauma teams and for various comparisons. (+info)
Risk factors and characteristics of falls resulting in hip fracture in the elderly.
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BACKGROUND: Risk factors for injurious falls among elderly people differ from those for falls in general. The characteristics of falls play an important role in determining the risk of hip fracture. OBJECTIVE: To investigate the risk factors associated with the fall characteristics known to be associated with the majority of hip fractures, e.g., a lateral fall and a subsequent impact on the greater trochanter. METHODS: In this 6 month prospective observational case-control study, 101 individuals aged 65 years and over hospitalized following a hip fracture were interviewed 7-14 days after the accident. Data were also obtained from medical records, focusing on known predisposing and situational risk factors for the fall. We compared the risk factors between two groups: patients who suffered a lateral fall and subsequent impact on the greater trochanter of the femur, and patients who suffered other types of falls. RESULTS: Only 51.5% of the hip fracture patients reported that they had fallen directly to the side. Apart from age, there were no significant differences between the groups in other factors studied. When considering both fall direction and the area that took the main impact, we found that the majority of patients (85%) reported having fallen onto the posterolateral aspect and/or a fall with an impact on the greater trochanter. CONCLUSION: Our findings did not show differences (except for age) in the factors studied between the groups. This study suggests that both fall direction and the area that takes the main impact should be considered in the characteristics of falls that might cause a hip fracture. Characteristics associated with greatest fracture risk include a fall onto the posterolateral aspect and/or a fall with an impact on the greater trochanter. More studies are needed to evaluate potential risk factors associated with this type of injury. (+info)
Report of a feasibility study of accident surveillance in general practice.
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BACKGROUND: There is a nationally established mechanism for surveillance of accidents operating in a sample of accident and emergency (A&E) departments but no equivalent in primary care. Reduction of accidents presenting to hospitals or family doctors is a target set out in the Department of Health's Our Healthier Nation document. AIMS: To assess the merit and feasibility of collecting information on accidents in primary care, and documentation of the range and severity of accidents presenting. DESIGN OF STUDY: General practitioner (GP) reports following accidents to persons presenting to primary care. SETTING: GPs in six large practices in the Midlands (69,000 registered patients) completed questionnaires for 1233 persons sustaining accidents at home or during leisure activity during one year from September 1997. RESULTS: Main outcome measures were validation of results and description of the type of accidents presenting to primary care. Recruitment varied considerably between practices, but it was not possible for this to be validated, chiefly because of the limitations of morbidity coding systems. Overall, 18 per 1000 registered persons a year reported an accident initially to the GP, approximately one-sixth of the number presenting to A&E departments. Nine-tenths of the injuries reported were trivial or minor. There were similarities between GP and A&E patients concerning the mechanism or location of injury, but proportionately more elderly and females presented to primary care. CONCLUSIONS: Surveillance of accidents in primary care is possible, but the discipline required for reliable data capture is considerable and hindered by limitations of morbidity coding systems regarding accidents. However, there are important differences in terms of the types of accidents and injuries seen and the age and sex of persons presenting in primary care and A&E departments. (+info)
The Hybrid III dummy as a discriminator of injurious and non-injurious restraint loading.
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This study evaluates the ability of the Hybrid III dummy and its associated injury criteria to discriminate sled tests with injurious conditions from those without. Ninety-three matched human cadaver and Hybrid III frontal sled tests over a range of impact speeds and restraint conditions are considered. Chest acceleration, deflection, and CTI are used as predictors of rib fracture outcome in the matched cadaver tests. Univariate and multivariate models are developed to evaluate the importance of the dummy measures relative to three experimental parameters (test speed, restraint condition, seating position) and three cadaver characteristics (age, gender, mass). The primary findings are, first, that chest acceleration has no utility for injury discrimination (Kruskal's Gamma = 0.0319, area under the receiver-operator characteristic = 0.500). Second, the functional relationship between any Hybrid III injury measure and injury risk is sensitive to all three experimental factors. Injury risk models with consideration of this dependence are presented. It is shown that the Hybrid-III chest deflection corresponding to a given level of injury risk is greatest for air bag loading, lowest for belt loading, and intermediate for combined loading. This is shown to be non-biofidelic, since chest deflection as measured directly on the cadaver does not exhibit this sensitivity. (+info)
The blue ribbon panel on depowered and advanced airbags - status report on airbag performance.
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In February 2000, a group of highway safety organizations sent a letter to the Secretary of the U.S. Department of Transportation expressing concern about a possible return to the 30-mph rigid barrier test using unbelted dummies previously required by Federal Motor Vehicle Safety Standard (FMVSS) 208. The letter asked the National Highway Traffic Safety Administration (NHTSA) to expedite data collection of the real-world crash experience of airbag-equipped vehicles certified to the 30-mph sled test using unbelted dummies because of suggestions that depowered airbags may not provide the same level of protection, particularly to larger, unbelted occupants. For the same reason, the letter also recommended that the auto industry commit funding for additional data collection and to establish a panel of experts to evaluate the data. In response, the Alliance of Automobile Manufacturers (Alliance) committed to funding a 3-year program to be managed by an independent third party. A panel of experts consisting of representatives from thehighway safety research community, the National Transportation Safety Board, academia, medical institutions, and the insurance industry was established as the Blue Ribbon Panel (BRP) for Evaluation of Depowered and Advanced Airbags and met for the first time in February 2001. The BRP also includes representatives from NHTSA and the automobile industry who participate as observers. The BRP held its first public meeting in April 2003 to provide an update of its activities and to summarize the real-world evidence on the performance of depowered airbags. This AAAM session will provide a brief summary of the public meeting. (+info)