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de Lange JE, Burrows L, Wadera A, Quenneville CE. Injury Risk for the Hand and Forearm Under Loading Representative of Behind Shield Blunt Trauma. Ann Biomed Eng 2024; 52:707-718. [PMID: 38127287 DOI: 10.1007/s10439-023-03418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
Ballistic shields protect users from a variety of threats, including projectiles. Shield back-face deformation (BFD) is the result of the shield absorbing energy from a projectile and deforming towards the user. Back-face deformation can result in localized blunt loading to the upper extremity, where the shield is supported by the user and may cause injury through behind armour blunt trauma (BABT) mechanisms. Post-mortem human subject (PMHS) responses are critical to identify the injury risk in these high-rate scenarios and are used to quantify the injury tolerance. Two vulnerable locations along the upper extremity were investigated-the hand and forearm-using eight PMHS to identify the fracture threshold resulting from shield BABT loading conditions. Impacts delivered to the hand at 16.4 ± 0.8 m/s resulted in failure loads of 3818 ± 897 N, whilst the forearm impacts delivered at a similar velocity of 16.9 ± 1.9 m/s had lower failure loads at 3011 ± 656 N. The corresponding 10% risk of hand and forearm fractures (as measured on a modified WorldSID Anthropomorphic Test Device) were identified as 11.0 kN and 8.1 kN, respectively, which should be used when evaluating future designs of composite ballistic shields. This study is the first known investigation of the upper extremity to this high loading rate scenario and provides the foundation for future biomechanical research in the area of behind shield blunt trauma.
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Affiliation(s)
- J E de Lange
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - L Burrows
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - A Wadera
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - C E Quenneville
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
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Zanotto T, Chen L, Fang J, Bhattacharya SB, Alexander NB, Sosnoff JJ. Minimizing fall-related injuries in at-risk older adults: The falling safely training (FAST) study protocol. Contemp Clin Trials Commun 2023; 33:101133. [PMID: 37122489 PMCID: PMC10130595 DOI: 10.1016/j.conctc.2023.101133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
Background Falls are the leading cause of accidental injury among the elderly. Fall prevention is currently the main strategy to minimize fall-related injuries in at-risk older adults. However, the success of fall prevention programs in preventing accidental injury in elderly populations is inconsistent. An alternative novel approach to directly target fall-related injuries is teaching older adults movement patterns which reduce injury risk. The purpose of the current study will be to explore the feasibility and preliminary efficacy of teaching at-risk older adults safe-falling strategies to minimize the risk of injury. Methods/design The Falling Safely Training (FAST) study will be a prospective, single-blinded randomized controlled trial. A total of 28 participants will be randomly assigned to four weeks of FAST or to an active control group with a 1:1 allocation. People aged ≥65 years, at-risk of injurious falls, and with normal hip bone density will be eligible. The FAST program will consist of a standardized progressive training of safe-falling movement strategies. The control group will consist of evidence-based balance training (modified Otago exercise program). Participants will undergo a series of experimentally induced falls in a laboratory setting at baseline, after the 4-week intervention, and three months after the intervention. Data on head and hip movement during the falls will be collected through motion capture. Discussion The current study will provide data on the feasibility and preliminary efficacy of safe-falling training as a strategy to reduce fall impact and head motion, and potentially to reduce hip and head injuries in at-risk populations. Registration The FAST study is registered at http://Clinicaltrials.gov (NCT05260034).
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Affiliation(s)
- Tobia Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
- Mobility Core, University of Kansas Center for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, United States
| | - Lingjun Chen
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - James Fang
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shelley B. Bhattacharya
- Department of Family & Community Medicine, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Neil B. Alexander
- VA Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Ann Arbor, MI, United States
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jacob J. Sosnoff
- Mobility Core, University of Kansas Center for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, United States
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
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Ugolini S, Walsh KC. Energy crisis: The need for a call on burns prevention. Burns 2023; 49:490-491. [PMID: 36535856 DOI: 10.1016/j.burns.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Sara Ugolini
- Cardiothoracic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Karl Christian Walsh
- Plastic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Golomb MR, Tejada JG, Ducis KA, Martinez ML. Acute and Delayed Cerebrovascular Injury From Gunshot to the Head in a 12-Year-Old Child During the COVID-19 Pandemic. Pediatr Neurol 2022; 130:1-3. [PMID: 35245820 PMCID: PMC8830928 DOI: 10.1016/j.pediatrneurol.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/16/2022] [Accepted: 02/05/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Meredith R Golomb
- Division of Child Neurology, Department of Neurology, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
| | - Juan G Tejada
- Division of Pediatric Neuroradiology, Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Katrina A Ducis
- Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont
| | - Mesha L Martinez
- Division of Pediatric Neuroradiology, Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
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Vincenzo JL, Patton SK, Lefler LL, McElfish PA, Wei J, Curran G. A qualitative study of older adults' facilitators, barriers, and cues to action to engage in falls prevention using health belief model constructs. Arch Gerontol Geriatr 2022; 99:104610. [PMID: 34954649 PMCID: PMC9344858 DOI: 10.1016/j.archger.2021.104610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/15/2021] [Accepted: 12/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Falls are the leading cause of fatal and nonfatal injuries among older adults. Decreasing falls is highly dependent on engagement in fall prevention activities. The Health Belief Model (HBM) theoretical framework was used to explore older adults' perceptions about falls prevention. RESEARCH DESIGN AND METHODS An informed grounded theory approach was applied. Four focus groups were conducted using semi-structured interview guides based on the HBM with 27 community-dwelling older adults (average age = 78 years). Deductive content analysis was used to apply constructs of the HBM to the data and explain the findings. RESULTS Potential reasons for not engaging in falls prevention included lack of self-perceived severity, susceptibility, and self-efficacy with a subtheme of lack of information about falls prevention from medical providers. Potential facilitators included older adults' knowledge and current engagement in falls prevention and socializing while engaging in falls prevention. Participants recommended cues to action to improve engagement in falls prevention from family, friends, physicians, pharmacists, and insurance companies; and using various modes to deliver cues to action, including print, audiovisual, online, and reminders. DISCUSSION AND IMPLICATIONS In this study, the HBM was used to understand older adults' potential barriers, facilitators, and cues to action to support engagement in falls prevention. Engagement in fall prevention behaviors could be improved by addressing barriers such as lack of knowledge, and lack of self-perceived severity and susceptibility to falls. Reinforcing the benefits of fall prevention, and promoting cues to action to engage in falls prevention may also support engagement.
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Affiliation(s)
- Jennifer L. Vincenzo
- University of Arkansas for Medical Sciences, Department of Physical Therapy, College of Health Professions
| | - Susan Kane Patton
- University of Arkansas, Department of Nursing, College of Education and Health Professions, United States.
| | | | - Pearl A. McElfish
- University of Arkansas for Medical Sciences, Office of Community Health and Research
| | - Jeanne Wei
- University of Arkansas for Medical Sciences, Department of Geriatrics, College of Medicine, Reynolds Institute on Aging, United States.
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, Departments of Pharmacy Practice and Psychiatry, Central Arkansas Veterans Healthcare System
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Kim SH, Lee WJ. Outcomes of grafted skin on the dorsum of the foot after car-tire friction injuries. Arch Plast Surg 2021; 48:678-84. [PMID: 34818716 DOI: 10.5999/aps.2021.00962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/10/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A car-tire friction injury on the dorsum of a child's foot often results in hypertrophic scarring of the wound margins. This study describes the clinical appearance of the injured areas and surgical complications that occurred during the follow-up period in a series of children with car-tire friction injuries who were treated with split-thickness skin grafts (STSGs). We describe the clinical features that we believe need to be highlighted when initially treating car-tire injuries in children. METHODS From May 2003 to June 2016, our retrospective study included 15 patients with car-tire injuries on the dorsum of the foot who were treated with surgical excision and STSG to cover the wound. RESULTS A total of 15 patients with car-tire injuries were treated. The average age was 6.26 years old. The average injury grade was 3.26. Two patients were treated using delayed repair, and 13 patients received STSG for initial management. Four patients experienced no complications, while 11 patients had hypertrophic scars and/or scar contracture after surgery. CONCLUSIONS A car-tire friction injury on the dorsum of a child's foot often results in hypertrophic scar formation or scar contracture even if proper management is undertaken. Since the occurrence of these complications in childhood can lead to a secondary deformity, it is important to properly treat car-tire friction wounds, inform patients and caregivers about potential complications, and ensure regular follow-up evaluations over a 12-month period following the initial surgery.
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Oliver-Welsh L, Richardson C, Ward DA. The hidden dangers of staying home: a London trauma unit experience of lockdown during the COVID-19 virus pandemic. Ann R Coll Surg Engl 2021; 103:160-166. [PMID: 33645278 DOI: 10.1308/rcsann.2020.7066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic resulted in reconfiguration of the NHS. Elective services were stopped and trauma services focused on decreasing patient-clinician interactions and managing injuries nonoperatively wherever possible. The everyday life of the general public changed dramatically with the introduction of a national lockdown to prevent the spread of COVID-19. This paper looks at the experience of a South West London trauma unit. MATERIALS AND METHODS All patients reviewed in fracture clinic and by the orthopaedic on-call team between 23 March to 23 April 2020 were included. Data on the mechanism of injury and whether this was a usual activity, the injury sustained and its management were collected. RESULTS A total of 167 trauma injuries were seen, compared with 735 new patients with injuries in the previous month. The number of trauma operations completed decreased by 38%; 55% of injuries occurred inside the home and 44% outside the home during daily exercise. Some 31% of injuries were secondary to a new activity taken up during lockdown. Three open fractures and two polytrauma cases were seen that would have normally been managed at the local major trauma centre. CONCLUSION Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.
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Affiliation(s)
- L Oliver-Welsh
- Department of Trauma and Orthopaedics, Kingston Hospital Foundation Trust, Kingston upon Thames, UK
| | - C Richardson
- Department of Trauma and Orthopaedics, Kingston Hospital Foundation Trust, Kingston upon Thames, UK
| | - D A Ward
- Department of Trauma and Orthopaedics, Kingston Hospital Foundation Trust, Kingston upon Thames, UK
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Savage SA, Zarzaur BL, Gaski GE, McCarroll T, Zamora R, Namas RA, Vodovotz Y, Callcut RA, Billiar TR, McKinley TO. Insights into the association between coagulopathy and inflammation: abnormal clot mechanics are a warning of immunologic dysregulation following major injury. Ann Transl Med 2020; 8:1576. [PMID: 33437775 PMCID: PMC7791215 DOI: 10.21037/atm-20-3651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Severe injury initiates a complex physiologic response encompassing multiple systems and varies phenotypically between patients. Trauma-induced coagulopathy may be an early warning of a poorly coordinated response at the molecular level, including a deleterious immunologic response and worsening of shock states. The onset of trauma-induced coagulopathy (TIC) may be subtle however. In previous work, we identified an early warning sign of coagulopathy from the admission thromboelastogram, called the MAR ratio. We hypothesized that a low MAR ratio would be associated with specific derangements in the inflammatory response. Methods In this prospective, observational study, 88 blunt trauma patients admitted to the intensive care unit (ICU) were identified. Concentrations of inflammatory mediators were recorded serially over the course of a week and the MAR ratio was calculated from the admission thromboelastogram. Correlation analysis was used to assess the relationship between MAR and inflammatory mediators. Dynamic network analysis was used to assess coordination of immunologic response. Results Seventy-nine percent of patients were male and mean age was 37 years (SD 12). The mean ISS was 30.2 (SD 12) and mortality was 7.2%. CRITICAL patients (MAR ratio ≤14.2) had statistically higher shock volumes at three time points in the first day compared to NORMAL patients (MAR ratio >14.2). CRITICAL patients had significant differences in IL-6 (P=0.0065), IL-8 (P=0.0115), IL-10 (P=0.0316) and MCP-1 (P=0.0039) concentrations compared to NORMAL. Differences in degree of expression and discoordination of immune response continued in CRITICAL patients throughout the first day. Conclusions The admission MAR ratio may be the earliest warning signal of a pathologic inflammatory response associated with hypoperfusion and TIC. A low MAR ratio is an early indication of complicated dysfunction of multiple molecular processes following trauma.
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Affiliation(s)
- Stephanie A Savage
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Ben L Zarzaur
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Greg E Gaski
- Department of Orthopedics, Inova Fairfax Medical Campus, Fairfax, Virginia, USA
| | - Tyler McCarroll
- Department of Orthopedics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rami A Namas
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rachael A Callcut
- Department of Surgery, University of California Davis School of Medicine, Davis, California, USA
| | - Timothy R Billiar
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Todd O McKinley
- Department of Orthopedics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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van Meijel EPM, Gigengack MR, Verlinden E, van der Steeg AFW, Goslings JC, Bloemers FW, Luitse JSK, Boer F, Grootenhuis MA, Lindauer RJL. Long-Term Posttraumatic Stress Following Accidental Injury in Children and Adolescents: Results of a 2-4-Year Follow-Up Study. J Clin Psychol Med Settings 2020; 26:597-607. [PMID: 30924029 PMCID: PMC6851392 DOI: 10.1007/s10880-019-09615-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In this study, we determined the long-term prevalence of posttraumatic stress disorder (PTSD) in children and adolescents after accidental injury and gained insight into factors that may be associated with the occurrence of PTSD. In a prospective longitudinal study, we assessed diagnosed PTSD and clinically significant self-reported posttraumatic stress symptoms (PTSS) in 90 children (11–22 years of age, 60% boys), 2–4 years after their accident (mean number of months 32.9, SD 6.6). The outcome was compared to the first assessment 3 months after the accident in 147 children, 8–18 years of age. The prevalence of PTSD was 11.6% at first assessment and 11.4% at follow-up. Children with PTSD or PTSS reported significantly more permanent physical impairment than children without. Children who completed psychotherapy had no symptoms or low levels of symptoms at follow-up. Given the long-term prevalence of PTSD in children following accidents, we recommend systematic monitoring of injured children. The role of possible associated factors in long-term PTSS needs further study.
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Affiliation(s)
- Els P M van Meijel
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. .,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Maj R Gigengack
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Eva Verlinden
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Alida F W van der Steeg
- Pediatric Surgical Center of Amsterdam, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam & VU University, Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Unit Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Jan S K Luitse
- Emergency Department, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frits Boer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Pediatric Psychology Department of the Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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Culotta PA, Burge LR, Bachim AN, Donaruma-Kwoh M. Are classic metaphyseal lesions pathognomonic for child abuse? Two cases of motor vehicle collision-related extremity CML and a review of the literature. J Forensic Leg Med 2020; 74:102006. [PMID: 33012309 DOI: 10.1016/j.jflm.2020.102006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 11/23/2022]
Abstract
Long bone fractures at the infant growth plate, known as classic metaphyseal lesions (CMLs), raise a strong suspicion for abusive injury. CMLs persist as a hallmark for inflicted injury although a handful of documented cases of CMLs created by other, non-abusive mechanisms within various healthcare settings are scattered throughout the past few decades of medical literature. The forces required to sustain a CML are typically defined as a combination of tensile, compressive, or rotational energy applied to the metaphyseal regions of an infant's long bones. Recently, two separate child protection teams each encountered a case of CML discovered after reported motor vehicle collisions (MVC). This provoked a critical appraisal of the medical literature to inform clinical practice regarding MVCs as a potential mechanism for this fracture type and to remind clinicians that there is no single injury pathognomonic for abuse.
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van Meijel EPM, Gigengack MR, Verlinden E, van der Steeg AFW, Goslings JC, Bloemers FW, Luitse JSK, Boer F, Grootenhuis MA, Lindauer RJL. The Association Between Acute Pain and Posttraumatic Stress Symptoms in Children and Adolescents 3 Months After Accidental Injury. J Clin Psychol Med Settings 2019; 26:88-96. [PMID: 29730799 DOI: 10.1007/s10880-018-9567-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Previous research suggests that acute pain is a risk factor for later posttraumatic stress symptoms (PTSS). In a prospective cohort study, we examined the association between acute pain from accidental injury and PTSS in children and adolescents, taking into account factors potentially related to pain or posttraumatic stress. Participants were 135 children and adolescents, 8-18 years old. We measured the worst experienced pain since the accident took place with a visual analogue scale. Three months after the accident, posttraumatic stress was assessed with a self-report measure. We found a positive association between acute pain and posttraumatic stress. The amount of pain was negatively associated with injury severity in girls and positively associated with the presence of an extremity fracture in boys. In children who reported severe pain, this pain was significantly associated with PTSS and may account for around 10% of the variance in the severity of PTSS. Although the experience of pain is subjective, our study indicates that severe pain is associated with the severity of later PTSS. Timely management of pain according to acute pain protocols in all phases and disciplines after accidental injury is therefore recommended.
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Ranney M, Karb R, Ehrlich P, Bromwich K, Cunningham R, Beidas RS. What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review. J Behav Med 2019; 42:724-740. [PMID: 31367937 PMCID: PMC8321509 DOI: 10.1007/s10865-019-00035-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/23/2019] [Indexed: 12/14/2022]
Abstract
The long-term consequences of exposure to firearm injury-including suicide, assault, and mass shootings-on children's mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth.
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Affiliation(s)
- Megan Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA.
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA.
- American Foundation for Firearm Injury Reduction in Medicine, PO Box 503, Williamstown, MA, 01267, USA.
| | - Rebecca Karb
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA
| | - Peter Ehrlich
- Department of Surgery, Section of Pediatric Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Kira Bromwich
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA
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Abstract
Pressured by questions tabled in parliament that point to a lack of adequate enforcement of regulations, the DCG(I) has abruptly initiated action to ensure payment of compensation for trial-related injuries. While it is astounding that non-compliance to the existing regulations could have gone unnoticed by quality assurance staff as well as by the ethics committees and the regulator, for over six years, sudden enforcement of the regulation has thrown up issues and challenges that are difficult to resolve in the absence of an adequately debated and thought-through guidance. In implementing regulations for suo moto compensation, India is seeking to establish a practice not previously tested elsewhere in the world. There is no doubt that industry must support the idea of putting patients first, but procedural considerations in fixing causality and determining the quantum of compensation promise to raise questions of morality, ethics, and jurisprudence that will not be easy to answer.
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