Injury最新文献

Background: Electric bicycles (e-bikes) are becoming increasingly popular, offering higher speeds compared to traditional pedal bicycles. Despite their growing use, there is limited data on the epidemiology of e-bike related injuries in the pediatric population. Specifically, previous studies have not adequately explored the injury circumstances regarding e-bikes, particularly concerning loss of control due to speed. This study aims to assess the patterns and outcomes of e-bike injuries in children, hypothesizing that speeds higher than 20 miles per hour (MPH) result in more internal injuries necessitating hospital admission.

Methods: This retrospective cross-sectional study analyzed data from the National Electronic Injury Surveillance System, specifically targeting pediatric ages 0-18 e-bike injuries recorded between 2019 and 2023. We utilized natural language processing techniques to extract narratives from the database, identifying words related to the circumstances of injury, and distinguishing between speed-related incidents vs. non-speed-related incidents. The cohort was divided into two groups based on the identified cause: injuries due to increased speed and injuries attributed to other causes. We then conducted bivariate analyses to compare the characteristics and outcomes between these groups, focusing on the type of injury, its severity, and the need for hospital admission.

Results: A national estimate of 15,121 pediatric patients with injuries related to e-bikes (79.7% males and 71.3% adolescents aged 13-18) were identified. Injuries attributed to speed were associated with a higher incidence of head, neck, or facial injuries (49.1%¦vs 28.7%) compared to those resulting from other causes. A greater proportion of children with speed-related injuries sustained internal organ injuries (24.1%¦vs. 10.4%) and were admitted to the hospital (7.3%¦vs.4.7%). Of those injuries specified as "internal" 96.7% were head and neck injuries compared to 3.3% other anatomic sites. Over the five-year study period, the frequency of e-bike injuries showed a sharp increase, with 4.18% occurring in 2019 and 49.8% in 2023.

Conclusion: Pediatric e-bike injuries have increased in frequency and can be severe, requiring hospitalization. The findings highlight the risks associated with speeds higher than 20 MPH on e-bikes and the need for targeted safety measures and legislation especially related to prevention of head injuries. Future research should focus on the effectiveness of safety interventions, including helmet usage and speed control features on e-bikes.

Type of study: retrospective cross-sectional study.

Objective: Helmets play a critical role in preventing and reducing the severity of head injuries in high-risk sports. Understanding the factors influencing equestrian helmet use and safety perceptions is needed to optimise injury prevention strategies.

Methods: In this cross-sectional study of 596 equestrian participants aged ≥12 years, we assessed helmet use, factors influencing helmet purchase decisions, and perceptions of helmet safety. Chi square tests and regression models examined differences by age, professional status, jumping versus non-jumping disciplines and concussion history.

Results: Helmet use whilst riding was high (96 % participants). A high proportion of helmets used for competition (97 %) met at least one safety standard, however this was lower for recreational use (65 %). Younger equestrians (aged 12-44 years) and those who had not experienced a concussion were more likely to rank price as the most important factor for helmet purchase decision making. There were no differences by jumping or non-jumping equestrian disciplines or professional status. Older age and being female were independently linked with higher perceptions of helmet safety in the regression model (p = 0.01).

Conclusion: Safety messages need to focus on improving understanding of helmet standards and the reasoning behind safety recommendations to help reduce the injury risk in equestrian sports, particularly targeting adolescents/young adults.

Introduction: The global trauma burden disproportionately affects low- and middle-income countries(LMICs), which lack robust emergency medical services(EMS). The Global Prehospital Consortium determined Tier-1 EMS response intervals are a priority for investigation. On-scene response intervals for professional ambulance-driven Tier-2 EMS vary by density of centralized ambulance dispatch sites per population, requiring costly infrastructure to improve response times. Community bystander-driven (Tier-1) systems are less costly with diffuse and non-centrally dispatched responders. Therefore, we hypothesized Tier-1 EMS response intervals to emergencies are not distance-related, due to the inherent diffusion of Tier-1 responders.

Methods: In 2016, Tanzania Rural Health Movement launched a Tier-1 lay first responder(LFR) program in Tanzania integrated with Beacon, a mobile emergency medical dispatch(EMD) platform. LFRs were provided with a two-day training course. Chief complaints, diurnal emergency variation, and response/triage/encounter intervals were prospectively recorded for analysis. GIS software (ArcGIS Pro 2.8) evaluated encounter latitude/longitude and distance from Mwanza city center, compared with response interval, using a logarithmic distribution for correlational analysis.

Results: 1273 entries were prospectively catalogued (2017-2024). 60 encounters lacked ≥67 % data compliance, 136 lacked GPS coordinates, and 89 geographic/time outliers were excluded, leaving 988 encounters for analysis (77.6 %). Of chief complaints, 81.0 % were road traffic injury-related. Median dispatch to on-scene arrival interval = 1 minute 4 seconds (IQR:36s-5m9s) and median on-scene arrival to triage decision interval = 1 minute 2 seconds (IQR:37s-2m32s) (n = 988). There was no correlation between log (response time interval) and log (distance from Mwanza center) (r = 0.028, p = 0.380) (n = 1012).

Conclusions: In this community-based EMS model, response times were rapid and not associated with geographic distance, highlighting the effectiveness of decentralized Tier-1 systems when combined with mobile dispatch technology. These findings support the scalability of low-cost, bystander-driven EMS networks in LMICs without reliance on traditional costly dispatch infrastructure, offering a promising strategy to address the global trauma burden.

Individuals experiencing homelessness are known to be at an increased risk of poor health outcomes compared to those of relatively higher socioeconomic statuses. Specifically, a major cause of morbidity for people experiencing homelessness is traumatic injury. While poor outcomes after a traumatic injury for people experiencing homelessness is well documented in the American context, such literature for the Canadian context remains sparse. In this retrospective cohort study of 4551 trauma patients admitted at a Level 1 trauma center in Montreal, Canada, from 2016-2019 (inclusive), we determined the trauma outcomes of patients experiencing homelessness. We found that the outcomes between homeless and non-homeless trauma patients to be similar, but experiencing homelessness was associated with a 71 % increase in the odds of intubation. Healthcare coverage may have the potential to mitigate some of the adverse effects of a low socioeconomic status.

Background: Traumatically injured patients who are detained by law enforcement have variable disposition possibilities that may be unclear to providers. This creates difficulties in discharge planning, and may contribute to disparities in outpatient care. The objective of this study was to evaluate emergency department (ED) utilization, readmissions, and follow-up for traumatically injured patients discharged to jail compared to those discharged to home.

Methods: This was a retrospective review of traumatically injured patients at a Level 1 trauma center from 2015 - 2022. All patients discharged to jail were propensity matched 1:1 to a subset of patients discharged to home. The match was based on age, gender, race, mechanism of injury, and Injury Severity Score. The primary outcome was ED utilization within 60 days. Secondary outcomes were unplanned readmissions and attendance at trauma-related follow-up appointments. Outcomes were compared between the two groups.

Results: There were 392 matched pairs. Patients discharged to jail were more likely to visit the ED compared to home patients (25 % vs 18 %, OR 1.46, 95 % CI 1.02 - 2.10, p = 0.030). There were no differences in unplanned readmissions (6 % vs 7 %, OR 0.86, 95 % CI 0.48 - 1.53, p = 0.579) between the two groups. Patients discharged to jail were more likely to visit the ED with concerns regarding obtaining their discharge prescriptions (19 % vs 1 %, p < 0.001), and 30 % (n = 7) of these patient readmissions were due to the jail not being able to accommodate their medical cares. A total of 28 % of patients discharged to jail had no trauma-related ambulatory follow-up compared to 15 % of home patients (OR 2.33, 95 % CI 1.59 - 3.49, p < 0.001).

Conclusion: Patients discharging to jail face fragmented transitions of care which creates barriers in outpatient healthcare engagement. They are more likely to visit the emergency department, and are less likely to have appropriate trauma related follow-up care. Targeted interventions are necessary to support this patient population to improve outpatient care after injury.

Background: Equestrian sports have been found to cause high rates of injuries. In clinical practise after such injuries, polytrauma protocol workups usually include whole-body computed tomography (WBCT), CT of the chest, abdomen and pelvis with intravenous iodine contrast medium, and CT of the cervical spine and brain without contrast. The purpose was to investigate the use of WBCT in equestrian-related accidents, to analyse demographics, mechanism of injury (MOI), therapy and severity of equine-related accidents, radiology, and the use of protecting equipment.

Material and methods: This is a retrospective study including a cohort of patients who were admitted to trauma centres at Queen Silvia Children's Hospital (paediatric <16 years) and Sahlgrenska University Hospital (adult ≥16 years) in Gothenburg in the period 2010 - 2020 due to equestrian-related injuries. Medical records were studied concerning patient demographics, MOI, protective equipment, injuries suffered, Injury Severity Score (ISS), surgery, and hospital length of stay.

Results: There were 1341 patients (97 % female, 43 % paediatric) with equestrian-related accidents who were admitted to the hospitals. Of these, 262 were assessed as polytrauma, of whom 77 % were adults with median age of 38 years and 23 % were paediatric with median age of 13 years. WBCT was performed in 54 % of adult and 52 % of paediatric patients. The MOI was mainly fall from a horse 241/262 (92 %), and in 27/241 (11 %) the horse also fell on the rider. In the 262 patients, spine injury was seen in 32 %, thoracic injury in 29 %, cerebral hemorrhages in 22 (8 %), tetraplegia in 2 (0.8 %), and paraplegia in 1 (0.4 %). Abdominal injury was mostly seen in liver 13/262 (5 %). The median ISS was 4 (IQR 1-9). There were 59 % of paediatric and 48 % of adult patients hospitalized for a median of 2 days (IQR 1-5), and 14 needed intensive care. Surgery was required in 33 patients. Wearing of helmets and vests was recorded in 146 (56 %) and 58 (22 %) of the individuals, respectively.

Conclusions: Only 54 % of adult and 52 % of paediatric patients underwent a WBCT after equestrian - related polytrauma indicating inadequate assessment. The documentation rate of safety equipment was low.

Introduction: Urotrauma requiring intervention can be managed by trauma surgery (TS), urologic surgery (US) or interventional radiology (IR). There is no clear consensus on preferable specialty for intervention, and limited data compare outcomes by specialty. This study aims to characterize interventions for urotrauma by specialty and analyze outcomes at our institution.

Methods: We conducted a retrospective review of patients at our Level I Trauma Center with urotrauma requiring intervention from 2020-2023. We performed a descriptive analysis of demographics, injury type, specialty involved, intervention type, injury severity score (ISS), and post-operative course.

Results: Of 387 patients identified, 23 % (87/387) required intervention with median age 32 (IQR 24-48) years. Kidney injuries were most common (68 %, 59/87), followed by ureteral (13 %, 11/87) and bladder (13 %, 11/87). TS performed most of the interventions (47 %, 41/87), followed by US (41 %, 36/87), and IR (12 %, 10/87). TS performed nephrectomy at a higher rate than US (67 %, 24/36 vs 8 %, 1/13). Of the cohort, 20 % (17/87) were readmitted, with 65 % (11/17) requiring a procedure and 63 % (7/11) of which were related to initial urologic injury. US was not initially consulted in nearly 60 % (4/7) of cases requiring urologic intervention upon readmission. The rate of urologic intervention upon readmission was 38 % (3/8) among patients who had an initial urologic consultation, compared to 100 % (4/4) among those who did not. Median length of stay (LOS) for readmitted patients was 76.7 h among those who received an initial US consultation and 134.1 h among those who did not. Follow-up occurred in 86 % (24/28) and 70 % (27/37) of patients treated by US and TS, respectively.

Discussion: TS conducted most urotrauma interventions, while US managed most non-renal cases. The nephrectomy rate for renal trauma was lower when managed by US, suggesting a more organ-preserving approach. Patients without initial US consultation had a nearly 3-fold higher rate of readmission for urologic intervention, longer readmission hospital LOS, and lower follow-up rates. These clinically meaningful trends suggest that US consultation may improve outcomes by reducing the need for nephrectomy, minimizing reinterventions, reducing hospitalization length, and improving continuity of care. Multidisciplinary collaboration should be pursued in the management of urotrauma.

Background: In recent years, more studies have focused on the outcome parameter (health-related) Quality of Life (QOL) after a severe injury. Psychological complaints are known to be associated with QOL. However, little is known about long-term QOL. Studies in other fields, have shown that, apart from disease, patients' personality may be associated with (long-term) QOL.

Aim: The aim of this study was to evaluate QOL, psychological complaints, and physical limitations about ten years after a severe injury and to compare this with the patients' situation 7 years earlier. Furthermore, the association between long-term QOL and patients' personality was examined.

Methods: The 156 patients who participated in a study to investigate QOL, psychological problems and physical limitations seven years ago, were reassessed to determine their current situation using the same questionnaires as seven years earlier. In addition, patients' personality was assessed.

Results: The response rate was 58%. Except for the social component, no significant differences in patients' QOL, psychological complaints and physical limitations were found in comparison with seven years earlier. The social domain scores had decreased. Personality was significantly associated with all QOL domains. Psychological complaints were not an important confounder in the association between personality and long-term QOL, but they did in the relationship between personality and physical complaints.

Conclusion: The QOL, psychological, and physical situation of severely injured patients ten years after their injury is comparable to their situation three years after their injury. Personality was an important factor, strongly associated with long-term QOL. Therapy focused at extending coping strategies may be helpful for patients at risk for low QOL, since no further spontaneous recovery was observed.

Level of evidence: This is a Basic Science paper and, therefore, does not require a level of evidence.

This letter evaluates the methodological shortcomings in the FEA research conducted by Ma et al. (2025) that contrasts hook plates with tension-band wiring for patellar fractures. Unresolved concerns consist of: uniform bone material characteristics simplifying biomechanics; static loads neglecting dynamic physiological forces; idealized fracture spaces missing clinical variation; and unverified interfaces exaggerating stability. These gaps may exaggerate the effectiveness of the implant. We suggest personalized modeling, simulations of dynamic loading, and studies on mesh convergence to enhance clinical significance. Tackling these issues would enhance forthcoming evaluations of orthopedic devices based on FEA.