Effect of vehicle type on the performance of second generation air bags for child occupants.
(49/646)
Passenger air bags experienced considerable design modification in the late 1990s, principally to mitigate risks to child passengers. This study utilized Data from the Partners for Child Passenger Safety study, a large-scale child-focused crash surveillance system, to examine the effect of vehicle type on the differential performance of first and second generation air bags on injuries to restrained children in frontal impact crashes. Our results show that the benefit of second-generation air bags was seen in passenger cars - those children exposed to second-generation air bags were half as likely to sustain a serious injury - and minivans. However, in SUVs the data suggest no reduction in injury risk with the new designs. This field data provides crucial real-world experience to the automotive industry as they work towards the next generation of air bag designs. (+info)
Performance of advanced air bags based on data William Lehman Injury Research Center and new NASS PSUs.
(50/646)
The Ryder Trauma Center is a Level I trauma center that treats only the most severely injured occupants of vehicle crashes as well as other severe cases of trauma. The center investigates these crashes through funding provided by the Alliance of Automobile Manufacturers and the U.S. Department of Transportation-sponsored Crash Injury Research and Engineering Network (CIREN) program. MAIS 3+ nonfatal and fatal injuries comprise approximately 2 percent of the total NASS/CDS cases. Among the Ryder trauma center cases, 50 percent are MAIS 3+ and 25 percent are fatal. If the MAIS 3+ fatal and nonfatal injuries were considered as "failures" and the remaining 98 percent with MAIS 2 or less as successes, this could be equated to the 75 percent failure rate (MAIS 3+ and fatal) in the trauma center cases for analysis purposes. The total database of frontal cases with no rollover consists of 147 drivers with first-generation airbags and 58 cases with second-generation airbags. (+info)
A comparison of biomechanical mechanisms of whiplash injury from rear impacts.
(51/646)
Several hypotheses have been proposed to explain the mechanism of injury in whiplash including, pressure on nerve root ganglia, stretching of facet capsules, or damage to facet articular cartilage. These injury mechanisms have not been directly compared in the same study. A comparison could provide insight into the most likely mechanism of whiplash injury. Twenty eight volunteers underwent rear impacts with head and chest acceleration data collected. The same apparatus was used to test 11 cervico-thoracic human cadaveric spines with an instrumented headform attached. Head acceleration, individual vertebral kinematics from high speed video, local nerve root pressure, and facet joint contact pressures were collected during impacts. Each specimen was tested first at an impact acceleration similar to that of volunteers, who reported minimal or no symptoms after the test, then at double the acceleration. Head X (forward) and Z (upward) accelerations of cadaveric specimens were very similar in time sequence and magnitude to those of unprepared volunteers. Pressure around the lower cervical nerve roots ranged from 2.7kPa to 10kPa, and occurred generally after chest but before peak head acceleration. Facets at C4-5 and C5-6 had the highest probability (64% and 71% respectively) of pinching. Neither pressure rise nor pinching changed significantly with increased acceleration. Vertebral intersegmental extension rotations (4 ( o ) -9.5 ( o ) ) and posterior translations (3.7-8.9 mm) peaked near maximum head excursion into the head restraint, at the time of peak head acceleration. Vertebral shear translations showed the largest (and only significant) increases with increased impact acceleration. This data implies that facet shearing was most sensitive to the increased acceleration in this experiment and may be a primary mechanism of cervical spine injury in rear impacts. (+info)
Intraorbital mucocele associated with old minor trauma--case report.
(52/646)
A 46-year-old white man complained of swelling in the left orbital region. The only significant event in his medical history was minor trauma which occurred during ice hockey 15 years previously. On admission, the only clinical finding was left-sided exophthalmos. Computed tomography and magnetic resonance imaging revealed a left intraorbital cystic mass lesion. The cystic mass was completely removed through a left subfrontal extradural approach. There was no anatomical contact with the paranasal sinuses and the orbital walls were intact. The cystic mass was isolated in the orbital cavity. Histological examination confirmed the diagnosis of mucocele. Generally, the cause of mucocele is chronic sinusitis, but we suspect that the old minor trauma was the most likely cause in the present case. (+info)
Increased free radical activity in burns.
(53/646)
In burn trauma there is excessive activity of FR at the site of injury that result in oxidative stressful state. This is reflected as elevated blood levels of LPP, UA and CLP. The fall of AA in serum appears to counteract the oxidative stress. Increased eCAT activity occurs as a metabolic response to compensate the oxidative stress. These alterations in the biochemical parameters occur parallel to the degree of burn injury. It is suggested that therapeutic use of antioxidants may be beneficial in the clinical management of burn patients. (+info)
Golden hour - early postinjury period.
(54/646)
Quality and adequacy of specialized first aid for patients affected by high energy trauma is extremely important factor in order to reduce postraumatic disability and mortality of polytrauma patients. Treatment strategies for high energy trauma management are in early stages of development. Adequate aid can be rendered only in a few centers of Lithuania. Pre-hospital and very early hospital stages of patients with high energy trauma, which significance is proven, are unsatisfactory and inadequate. A retrospective study was performed in order to analyze efficacy and adequacy of pre-hospital (Kaunas Emergency Station, KES) and very early hospital (Kaunas University of Medicine Hospital Emergency Room, ER) management stages for 53 patients affected by high energy trauma and admitted to Kaunas University of Medicine Hospital during the period of 2001-2002. Averaged injury severity score, according to ISS, was 21.3, mortality rate was 34%. It was established long duration of pre-hospital and early hospital stage of management (accordingly 34+/-6.5 and 50+/-17.2 minutes), extremely rare monitoring of vital signs in pre-hospital stage (breathing was evaluated for 1.9% of patients, heart rate for 26.4% of patients). Fluid therapy as a part of complex treatment was applied for 7.5% of patients in pre-hospital stage and 3.8% in very early hospital stage. (+info)
Training in trauma surgery: quantitative and qualitative aspects of a new paradigm for fellowship.
(55/646)
OBJECTIVE: To describe outcomes from a clinical trauma surgical education program that places the board-eligible/board-certified fellow in the role of the attending surgeon (fellow-in-exception [FIE]) during the latter half of a 2-year trauma/surgical critical care fellowship. SUMMARY BACKGROUND DATA: National discussions have begun to explore the question of optimal methods for postresidency training in surgery. Few objective studies are available to evaluate current training models. METHODS: We analyzed provider-specific data from both our trauma registry and performance improvement (PI) databases. In addition, we performed TRISS analysis when all data were available. Registry and PI data were analyzed as 2 groups (faculty trauma surgeons and FIEs) to determine experience, safety, and trends in errors. We also surveyed graduate fellows using a questionnaire that evaluated perceptions of training and experience on a 6-point Likert scale. RESULTS: During a 4-year period 7,769 trauma patients were evaluated, of which 46.3% met criteria to be submitted to the PA Trauma Outcome Study (PTOS, ie, more severe injury). The faculty group saw 5,885 patients (2,720 PTOS); the FIE group saw 1,884 patients (879 PTOS). The groups were similar in respect to mechanism of injury (74% blunt; 26% penetrating both groups) and injury severity (mean ISS faculty 10.0; FIEs 9.5). When indexed to patient contacts, FIEs did more operations than the faculty group (28.4% versus 25.6%; P < 0.05). Death rates were similar between groups (faculty 10.5%; FIEs 10.0%). Analysis of deaths using PI and TRISS data failed to demonstrate differences between the groups. Analysis of provider-specific errors demonstrated a slightly higher rate for FIEs when compared with faculty when indexed to PTOS cases (4.1% versus 2.1%; P < 0.01). For both groups, errors in management were more common than errors in technique. Twenty-one (91%) of twenty-three surveys were returned. Fellows' feelings of preparedness to manage complex trauma patients improved during the fellowship (mean 3.2 prior to fellowship versus 4.5 after first year versus 5.8 after FIE year; P < 0.05 by ANOVA). Eighty percent rated the FIE educational experience "great -5" or "exceptional- 6." Eighty-five percent consider the current structure of the fellowship (with FIE year) as ideal. Ninety percent would repeat the fellowship. CONCLUSION: The educational experience and training improvement offered by the inclusion of a FIE period during a trauma fellowship is exceptional. Patient outcomes are unchanged. The potential for an increased error rate is present during this period of clinical autonomy and must be addressed when designing the methods of supervision of care to assure concurrent senior staff review. (+info)
Preliminary examination of cognitive reserve theory in closed head injury.
(56/646)
This investigation was designed to provide preliminary support for cognitive reserve theory in closed head injury (CHI), and demonstrate the effectiveness of using the Oklahoma premorbid intelligence estimate (OPIE) in research and clinical activities. Out of a possible 124 consecutive referrals, 26 patients (N=26) who underwent neuropsychological assessment following brain injury met study inclusion/exclusion criteria. Participants were included if they had exited post-traumatic amnesia (PTA), demonstrated uncompromised upper extremity use, displayed adequate verbal communication, and were judged capable of completing a full neuropsychological evaluation. Participants were divided into a closed head injury-negative premorbid history (CHI-) or closed head injury-positive premorbid history (CHI+) group based upon premorbid variables (e.g., history of alcoholism). Groups did not differ in terms of demographic variables or premorbid IQ. Despite having less severe head injuries, the CHI+ group had a greater pre-post difference for PIQ, and a significantly larger VIQ/PIQ discrepancy than the CHI- group. In conclusion, these findings suggest that the CHI+ group had diminished cognitive reserve secondary to the aggregate effects of premorbid insult, which resulted in greater cognitive decline following an additional stressor (i.e., CHI) than what might otherwise be expected from the head injury alone. (+info)