Traumatic Brain Injury in Admitted Patients with Ocular Trauma.

Objectives: To characterize the epidemiology of simultaneous traumatic brain injury (TBI) and ocular trauma. Materials and Methods: In this retrospective, observational study, de-identified data from patients admitted with ocular trauma and TBI was extracted from the National Trauma Data Bank (2008-2014) using International Classification of Diseases 9th Revision, Clinical Modification diagnostic codes and E-codes relating to injury circumstances. Mechanisms, types of ocular and head injuries, intention, and demographic distribution were determined. Association of variables was calculated with Student's t and chi-squared tests and logistic regression analysis. Results: Of 316,485 patients admitted with ocular trauma, 184,124 (58.2%) also had TBI. The mean (standard deviation [SD]) age was 41.8 (23) years. Most were males (69.8%). Race/ethnicity distribution was 68.5% white, 13.3% black, and 11.4% Hispanic patients. The mean (SD) Glasgow Coma Score (GCS) was 12.4 (4.4) and Injury Severity Score (ISS) was 17 (10.6). Frequent injuries were orbital fractures (49.3%) and eye/adnexa contusions (38.3%). Common mechanisms were falls (27.7%) and motor vehicle-occupant (22.6%). Firearm-related trauma (5.2%) had the greatest odds of very severe injury (ISS >24) (odds ratio [OR]: 4.29; p<0.001) and severe TBI (GCS <8) (OR: 5.38; p<0.001). Assault injuries were associated with the greatest odds of mild TBI (OR: 1.36; p<0.001) and self-inflicted injuries with severe TBI (OR: 8.06; p<0.001). Eye/adnexal contusions were most associated with mild TBI (OR: 1.25; p<0.001). Optic nerve/visual pathway injuries had greater odds of severe TBI (OR: 2.91; p<0.001) and mortality (OR: 2.27; p<0.001) than other injuries. Of associated head injuries, the odds of severe TBI were greatest with skull base fractures (OR: 4.07; p<0.001) and mortality with intracerebral hemorrhages (OR: 4.28; p<0.001). Mortality occurred in 5.9% of patients. Conclusion: TBI occurred in nearly two-thirds of ocular trauma admissions. The mortality rate was low with implications for challenging rehabilitation and long-term disability in survivors.

Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review.

INTRODUCTION: Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma. METHODS: Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses. RESULTS: Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5). CONCLUSIONS: Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala.

Obstructive Sleep Apnea Syndrome in Heavy Truck Drivers: A Portuguese Prospective Cohort Study.

INTRODUCTION: Heavy truck drivers with untreated obstructive sleep apnea (OSA) are at higher risk of driving accidents. This study aims to estimate the prevalence of OSA and to identify the most frequent symptoms and comorbidities in heavy truck drivers. METHODS: This cohort study included the employees of a Portuguese transport company between 2019 and 2022. A home sleep apnea test (HSAT) was performed on all patients. SPSS® was used for statistical analysis, and a p-value lower than 0.05 was considered statistically significant. RESULTS: A total of 86 truck drivers were included, with a mean age of 48.02 years (min. 24, max 66) and a mean body mass index (BMI) of 30.14±4.4 kg/m². After performing an HSAT, it was found that 77.9% of drivers (n=67) had OSA, with a mean apnea-hypopnea index (AHI) of 16.72±14.69 events/hour. Concerning diagnosed patients, 44.78% (n=30) had mild, 31.32% (n=23) moderate, and 20.89% (n=14) severe OSA. Obesity, hypertension, and dyslipidemia had a statistically significant association. There were no statistically significant differences between patients with and without type II diabetes mellitus. The presence of nighttime and daytime symptoms had a statistically significant correlation with OSA diagnosis. Despite only eight patients reporting a high score on the Epworth Sleepiness Scale (ESS), 14 patients reported previous episodes of falling asleep while driving, which might be associated with the non-valorization of daytime sleepiness in these patients. The patients who reported previous episodes of falling asleep while driving were older and had higher BMI, higher ESS, and higher AHI. CONCLUSIONS: In the evaluated truck drivers, the prevalence of OSA was very high (77.9%), which reinforces the importance of screening for this pathology since, when left untreated, it is a major risk factor for exercising their profession safely.

Ocular injuries associated with motor vehicle accidents: long term effects on quality of life.

PURPOSE: To describe the prevalence and outcome of motor vehicle accidents-associated ocular injuries. METHODS: A survey of patients who presented to the emergency room at a level 1 trauma center with motor vehicle accidents-associated ocular injuries. A patient questionnaire and review of clinical notes were conducted for all patients. RESULTS: Of 274 motor vehicle accident victims with ocular injuries who presented to the emergency room, 40 (15%) responded to the survey. Over half of them were driving a vehicle, and most reported wearing a seat belt or a helmet. Most ocular injuries were mild. The most common injuries were bone fractures, subconjunctival hemorrhage, eyelid involvement and corneal injury. Most respondents had no change in vision and perceived their ocular involvement as a minor part of their injury. Most respondents returned to work and to driving within a year. CONCLUSION: Our study sheds light on the details and extent of ocular involvement and the visual ability to perform daily activities following motor vehicle accidents.

Injury Patterns in Vehicle Crashes: The Significance of Occupant Seating Position.

OBJECTIVES:  Investigating patterns among the outcomes of patients involved in motor vehicle accidents (MVAs) can provide information necessary to guide targeted interventions to improve road traffic safety. Our purpose is to identify any differences between passenger and driver injury severity and overall clinical course after MVAs. METHODS:  We performed a retrospective review and analysis of 3,693 patients involved in MVAs from 2016 to 2021. We divided the data into two groups, drivers and passengers, and compared the Injury Severity Score (ISS), Revised Trauma Score (RTS) on admission, days in the Intensive Care Unit (ICU), length of hospital stay (LOS), post Emergency Department (ED) disposition, discharge (DC) disposition, and signs of life on arrival (SOLA) to the ED. We compared mean ISS, New Injury Severity Score (NISS), RTS, length in ICU and LOS using a student's T-test and SOLA, post-ED and DC disposition using Chi-square analysis. RESULTS:  We did not find any statistically significant difference in ISS, RTS, days in ICU, LOS, or SOLA between the drivers and passengers. However, we did find a statistically significant difference in the post-ED (X2= 113.743, p=<0.0001) and DC disposition (X2=41.172, p=<0.0001) of drivers and passengers. After the ED and DC, more passengers were transferred to a higher level of care than expected, while the inverse was true for drivers. The number of drivers discharged to Skilled Nursing Facilities (SNFs) was also higher than expected, further contributing to the observed difference in DC disposition.  Conclusion: Our study found no statistically significant difference between driver and passenger injury severity, length of hospital stay, days in ICU, and SOLA after an MVA. The clinical courses of the two groups were found to be significantly different based on post-ED and DC disposition data. We identified limitations, such as a relatively small sample size and insufficient data on specific car seat locations for passengers, underscoring the need for a more nuanced exploration. Future research must broaden its scope to encompass diverse crash scenarios, vehicle design and safety technologies, seat belt dynamics, and age- and gender-specific vulnerabilities.

A systematic review of the impact of brain tumours on risk of motor vehicle crashes.

PURPOSE: Brain tumours are associated with neurocognitive impairments that are important for safe driving. Driving is vital to maintaining patient autonomy, despite this there is limited research on driving capacity amongst patients with brain tumours. The purpose of this review is to examine MVC risk in patients with brain tumours to inform development of clearer driving guidelines. METHODS: A systematic review was performed using Medline and EMBASE. Observational studies were included. The outcome of interest was MVC or measured risk of MVC in patients with benign or malignant brain tumours. Descriptive analysis and synthesis without meta-analysis were used to summarise findings. A narrative review of driving guidelines from Australia, United Kingdom and Canada was completed. RESULTS: Three studies were included in this review. One cohort study, one cross-sectional study and one case-control study were included (19,135 participants) across United States and Finland. One study evaluated the incidence of MVC in brain tumour patients, revealing no difference in MVC rates. Two studies measured MVC risk using driving simulation and cognitive testing. Patients found at higher risk of MVC had greater degrees of memory and visual attention impairments. However, predictive patient and tumour characteristics of MVC risk were heterogeneous across studies. Overall, driving guidelines had clear recommendations on selected conditions like seizures but were vague surrounding neurocognitive deficits. CONCLUSION: Limited data exists regarding driving behaviour and MVC incidence in brain tumour patients. Existing guidelines inadequately address neurocognitive complexities in this group. Future studies evaluating real-world data is required to inform development of more applicable driving guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 2023 CRD42023434608.

Divergent trends in accidental deaths since return from an Afghanistan/Iraq deployment among army soldiers.

PURPOSE: Accidental death is a leading cause of mortality among military members and Veterans; however, knowledge is limited regarding time-dependent risk following deployment and if there are differences by type of accidental death. METHODS: Longitudinal cohort study (N = 860,930) of soldiers returning from Afghanistan/Iraq deployments in fiscal years 2008-2014. Accidental deaths (i.e., motor vehicle accidents [MVA], accidental overdose, other accidental deaths), were identified through 2018. Crude and age-adjusted mortality rates, rate ratios, time-dependent hazard rates and trends postdeployment were compared across demographic and military characteristics. RESULTS: During the postdeployment observation period, over one-third of deaths were accidental; most were MVA (46.0 %) or overdoses (37.9 %). Across accidental mortality categories (all, MVA, overdose), younger soldiers (18-24, 25-29) were at higher risk compared to older soldiers (40+), and females at lower risk than males. MVA death rates were highest immediately postdeployment, with a significant decreasing hazard rate over time (annual percent change [APC]: -6.5 %). Conversely, accidental overdose death rates were lowest immediately following deployment, with a significant increasing hazard rate over time (APC: 9.9 %). CONCLUSIONS: Observed divergent trends in risk for the most common types of accidental deaths provide essential information to inform prevention and intervention planning for the immediate postdeployment transition and long-term.

Pheochromocytoma-Induced Hypertension After Traumatic Brain Injury.

A 23-year-old female presented to the emergency department (ED) after sustaining a motor vehicle accident and subsequent loss of consciousness. In the ED, the patient was hemodynamically stable and was appropriately discharged with a diagnosis of mild traumatic brain injury. The patient presented 10 days post-injury to the outpatient brain injury clinic with complaints of headache, anxiety, and dizziness, with an elevated blood pressure of 160/100 mmHg. Initial head imaging, drug screen, complete blood count, and complete metabolic panel were unremarkable, however, urine and plasma metanephrines were found to be elevated. Abdominal computed tomography imaging revealed a pheochromocytoma, and the patient was adequately treated with medication and adrenalectomy with complete resolution of symptoms. Existing literature has indicated that stress and physical trauma can contribute to the escalation of pheochromocytoma symptoms in previously asymptomatic individuals; here, the stress and trauma stemming from an automobile accident and mild traumatic brain injury may have precipitated the onset of pheochromocytoma symptoms in the patient. Symptoms of pheochromocytoma can align with those commonly observed after traumatic brain injury (TBI), encompassing headaches, anxiety, and dizziness. Our case demonstrates the need for clinicians to consider the presence of pheochromocytoma in a post-traumatic brain injury patient.

Traumatic orthopaedic motor vehicle injuries: Are there age and sex differences in pedestrian and cyclist accidents in a major urban center?

INTRODUCTION: Injuries caused by road traffic have become the leading cause of death in people aged 5 to 29 years, with pedestrians and cyclists being disproportionately affected. Research has demonstrated age and sex differences in road accidents in European populations. The purpose of this study was to determine age and sex-specific differences in pedestrian and cyclist accidents involving passenger cars at a single Level 1 Trauma Center in a major US metropolitan area. METHODS: We performed a retrospective chart review of 1,845 patients that presented to a single level 1 trauma center from January 1, 2016 - October 1st, 2021, and were involved in a motor vehicle vs. pedestrian or motor vehicle vs. cyclist accidents. Demographics, injury pattern, abbreviated injury scores (AIS), and hospital stay were analyzed, and the data was stratified by pedestrian vs. cyclist, biological sex, and race. Chi square analysis, t tests, and binomial logistic regression was used to examine sex and age-based differences. RESULTS: Pedestrian vs. motor vehicle collisions (N = 1359, 74%) occurred more frequently than cyclists (N = 475, 26%) with an overall mortality rate of 6%. The mean age of pedestrians and cyclists was 39 and 42 years of age, respectively. Overall, more female than male patients had hand (mean=0.05 vs. 0.02) (p = 0.03) and pelvis fractures (mean 0.28 vs. 0.19) (p = 0.007). Females had a 1.2 times higher likelihood of getting a pelvis fracture than males (95% CI, 1.06 to 1.43). Linear regression analysis found a statistically significant relationship between older age and increased AIS severity (p < .001). Half of our sample consisted of Black patients (49.6% Black vs. 42.1% white). CONCLUSION: Female pedestrians and cyclists are at increased risk of obtaining pelvis fractures when in a traumatic road accident than males, regardless of age stratification, and age is a predictor of injury severity. Our study also found that race-based differences exist, with Black patients being injured more frequently. Further research is needed to better understand demographics at risk for traumatic road accidents, as well as evaluation of city infrastructure for biking and walking.

Unintentional Injuries Among Young Adolescents at a Level-One Trauma Center in Saudi Arabia: A Cross-Sectional Study.

Background Unintentional injuries are the leading preventable cause of mortality across different demographics. This study aims to assess the prevalence, severity, contributing factors, and clinical outcomes of unintentional injuries among adolescent patients. Methods A retrospective study was conducted using the charts of patients admitted with unintentional injuries (motor vehicle accidents (MVA), falls, pedestrian injuries, burns, etc.) to the emergency department (ED) from January 2016 to December 2018 at a level-one trauma center in Riyadh, Saudi Arabia. A total of 721 patients' charts were reviewed, but only 52 patients were consecutively included as per the definition of an adolescent. All variables, including severity and outcome, were assessed. Results The overall prevalence of unintentional injuries was 7.2 per 100 adolescent patients. The most common cause of unintentional injury were MVAs, which were reported in 35 (71%), with head and neck region injuries among 38 (73%) patients. The overall mortality was noted at 10 per 52 (19%) patients. The mean Injury Severity Score (ISS) score was 17.81±12.76. The patients who stayed longer in the ED were not associated with pelvic and lower extremity injuries, with a p-value=0.008. The ISS was the significant predictor of mortality, with an odds ratio (OR) of 1.6, a confidence interval (CI) of 1.02-2.65, and a p-value=0.04. Conclusion MVAs were the main cause of unintentional injuries among adolescents. Future recommendation plans for adolescents should include stricter implementation of road traffic laws to control this early, preventable death among adolescents.

Consequences of neglected traumatic spinal cord injuries.

Objectives: Spinal cord injuries cause major disabilities and are devastating events for both patients and healthcare providers. Most traumatic spinal cord injuries (TSCIs) are due to motor vehicle accidents (MVAs). Neglected injuries result in complications and poor outcomes. Here, we investigated the causes, consequences, and outcomes of neglected TSCIs. Methods: This case series study was performed at King Abdulaziz Medical City, Riyadh, KSA. Of the 750 patients treated between February 2016 and February 2021, 18 patients met our inclusion criterion of neglected high-energy TSCI with neurological deficit, necessitating surgical intervention more than 14 days after the index trauma. Results: Of the 18 patients with neglected TSCIs, 72.2% were men. The patients' mean age at the time of injury was 36.8 years, 77.8% were from outside Riyadh, and all patients had MVA-induced TSCIs, 88.9% of which were attributable to delayed referral to a tertiary center. The mean duration of neglect was 43 days, and the longest duration was 125 days. The most common site of injury was the thoracolumbar region (55.5%). The American Spinal Injury Association impairment scale score improved in two patients. Bed sores occurred in 55.5%, and deep vein thrombosis occurred in 27.8% of patients. Postoperatively, 77% of patients required intensive care unit admission. Most patients (12) did not receive specialized spinal cord injury rehabilitation postoperatively. Conclusion: Early referral of patients with TSCIs is crucial to prevent short- and long-term complications.

The impact of recreational cannabis markets on motor vehicle accident, suicide, and opioid overdose fatalities.

In the U.S., an increasing number of states are legalizing regulated commercial markets for recreational cannabis, which allows private industry to produce, distribute, and sell marijuana to those 21 and older. The health impacts of these markets are not fully understood. Preliminary evidence suggests recreational markets may be associated with increased use among adults, which indicates there may be downstream health impacts on outcomes related to cannabis use. Three causes of death that are linked to cannabis use are motor vehicle accidents, suicide, and opioid overdose. Drawing on data from U.S. death certificates from 2009 to 2019, we conducted a difference-in-differences analysis to estimate the impact of recreational markets on fatalities from motor vehicle accidents, suicide, and opioid overdose in seven states: Colorado, Washington, Oregon, Alaska, Nevada, California, and Massachusetts. States with comprehensive medical cannabis programs with similar pre-trends in deaths were used as comparisons. For each outcome, a pooled estimate was generated with a meta-analysis using random effects models. The results revealed substantial increases in crash fatalities in Colorado, Oregon, Alaska, and California of 16%, 22%, 20%, and 14%, respectively. Based on estimates from all seven states, recreational markets were associated with a 10% increase in motor vehicle accident deaths, on average. This study found no evidence that recreational markets impacted suicides. Most states saw a relative reduction in opioid overdose death that ranged between 3 and 28%. On average, recreational markets were associated with an 11% reduction in opioid overdose fatalities.

Blood alcohol concentration and road accidents: Underestimation due to time of the arrival to the emergency department (ED) or delay in blood sampling. A 4-Year Retrospective Study in Rome.

Alcohol is a significant public health issue, according to the World Health Organization. Our study aims to analyze the correlation between blood alcohol concentrations (BACs) of drivers, their demographic features, and the possible underestimation of BACs due to the time elapsed between hospital admission and blood sampling. Methods: This study includes patients evaluated for BAC levels in the emergency department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCCS from January 2013 to December 2016. BAC levels were compared in patients involved in road crashes according to age group, sex, and time of the accident. The delays in blood sampling and BAC measurement in the ED were recorded for each patient. The time between the accident and access to the hospital in most cases was unknown. Results: A total of 398 patients were included in the analysis, 107 of them had BACs more than 0.05 g/L., and 86 of these individuals had BAC levels more than 0.5 g/L. Road accident patients had higher rates of positive BAC readings at night and on weekends. A significant delay in blood sampling for BAC determination was observed. Discussion: This study demonstrates a critical bias due to the arrival time at the ED and the delay in blood sampling that inevitably influences and underestimates the BAC, resulting in possible false negative results (BAC values below the cutoff). Zero tolerance or a retrospective BAC calculation could mitigate this bias. It is necessary to implement preventive strategies to reduce instances of driving under the influence (DUI) of alcohol.

Sample size bias in the empirical assessment of the acute risks associated with daylight saving time transitions.

The assessment of the acute impact of daylight saving time (DST) transitions is a question of great interest for an understanding of the benefits and inconveniences of a practice that is now under public scrutiny in Europe and America. Here, we report a thorough analysis of a record of 13 well-known research studies that reported increased risks associated with DST transitions in health issues - acute myocardial infarction, ischemic strokes and trauma admissions - and in societal issues - accidents, traffic accidents and fatal motor vehicle accidents. We found that a five percent increase of the risks suffices to understand the reported increased risks associated with the spring transition. Reported values above this threshold are impacted by the sample size of the study. In the case of the autumn transition, no increase in the risks is found.

Traumatic brain injuries and maxillofacial fractures: a systematic review and meta-analysis.

Traumatic brain injuries (TBIs) associated with maxillofacial fractures (MFFs) are a public health concern worldwide, especially among adult-aged males. There is an urgent need for early detection of associated TBIs in patients with MFFs during the initial assessment and treatment stage to reduce morbidity and mortality. The objective of the present study was to systematically review the literature to determine specific MFF situations associated with TBIs and to identify the factors associated with TBIs in patients with MFFs. The protocol was developed in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42020155912. Overall, of 26,774 patients recorded, 13,667 patients (51.04%) sustained MFFs with an associated TBI. The male to female ratio was 4.8:1. RTA was the most common cause. The most common TBIs were concussions, contusions, and closed brain injuries. Within the limits of this study, it was concluded that TBI-related MFFs should be suspected whenever maxillary or mandibular bone fractures occur, especially among adults, males, and people with injuries caused by RTAs and assaults. There is a need to increase the awareness of maxillofacial surgeons on the possible associations of combined maxillofacial trauma and brain injuries.

International Consensus Statement on Obstructive Sleep Apnea.

BACKGROUND: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION: This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

The proximal femur fracture epidemic continued during the COVID-19 pandemic: Results of an observational study.

INTRODUCTION: The aim of this study was to compare the volume and characteristics of emergency trauma surgery procedures done at our hospital between March 20 and April 20, 2020 (the first month of the national lockdown in France) and to compare these data to the same period in 2019. We hypothesized that a portion of fractures are unavoidable, thus specific preventative measures will be needed to reduce their incidence. METHODS: This was a continuous, observational and single center study. All patients who required urgent surgery for a fracture between March 20 and April 20, 2020, were included. Data for the same period in 2019 was retrieved. All the procedures were done at our hospital, which is a regional level II trauma center. RESULTS: During the first month of the lockdown, 70 patients underwent emergency surgery because of a fracture, versus 109 patients in the same period in 2019, thus an overall 36% drop. The mean age of the patients was higher in 2020 (68.4 years SD=22) than in 2019 (60.3 years SD=24, p=0.0210). There were fewer recreational and motor vehicle accidents in 2020 (34 vs. 10) and fewer work-related accidents (7 vs. 2) although the number of accidents at home were similar (65 vs. 55). CONCLUSION: During a public health emergency, it is vital to continue doing trauma surgery procedures, even though it requires a specific care pathway. The lockdown and associated behavioral changes have altered the spectrum of trauma surgery. A major decrease in motor vehicle, recreation and work-related accidents is the avoidable portion of this surgical activity, justifying specific preventative measures during a public health crisis. Conversely, the incidence of geriatric fractures - particularly of the proximal femur - did not change much overall, thus there is need for additional preventative measures in these patients. LEVEL OF EVIDENCE: V, observational study.

The Role of Emotional Dysregulation, Impulsivity Traits and Aggressive Behaviors in Adolescents Who Sustain Multiple Motor-Vehicle Crashes.

Adolescents tend to experience multiple motor-vehicle crashes (MVCs). Recent literature has thoroughly explored the psychological consequences following an MVC, but prior psychological functioning, the ability to regulate one's emotions and tendencies to impulsivity and aggressive behaviors have been far less explored. This study aims to explore the emotional-behavioral functioning, measured with the Youth Self-Report (YSR); emotional dysregulation, measured with the Difficulties in Emotional Regulation Scale (DERS); impulsivity traits, measured with the Barratt Impulsiveness Scale (BIS-11); and the capacity to be mindful, measured with the Mindful Attention Awareness Scale (MAAS), in adolescents that have experienced one or more MVCs in a year. N = 295 adolescents who visited an emergency department for MVCs were divided in two groups based on the number of MVCs they had sustained over the course of a year. The adolescents in Group 1 sustained more than three MVCs, and adolescents in Group 2 sustained only one. Participants were assessed through self-report questionnaires. Adolescents showed difficulties in emotional regulation, impulsivity traits, aggressive behaviors and a low capacity to be mindful. These results may be useful in the creation of intervention and prevention programs focused on emotional awareness targets for adolescents.

The Prevalence of Pediatric Lower Limb Fractures Following Motor Vehicle Accidents at King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia.

Background Pediatric injuries are a very common and serious issue that may result in permanent harm. Regardless of the etiology of the injury, children represent up to 25% of all cases visiting the emergency room. Children suffer nearly twice as many fractures as adults, with males being more vulnerable to this type of injury. Methods A retrospective cohort study was conducted among 2777 patients, and a total of 203 patients who fit the inclusion criteria were included. Data were collected using the electronic system at King Abdullah Specialist Children's Hospital (KASCH). Participants were selected by a non-probability purposive sampling method and data analysis was carried out using the SPSS program. Results The prevalence of motor vehicle accidents (MVAs) related to lower limb fractures was estimated to be 7.3%. The patients had an average mean age of 8.6±4 years, with 10-14 years being the most common age group affected (48.3%) with male predominance (72.4%). Furthermore, femoral fractures were the most commonly identified type (31.5%), and a pedestrian was the most common mechanism of multiple lower limb fractures. Additionally, the highest reported mechanism of injury of lower limb fractures was MVAs. Moreover, the current study shows that most of those patients were treated surgically (55.1%). Conclusion Conclusively, our cohort estimated that the prevalence is 7.3% of MVAs-related lower limb fractures among all children presented to the KASCH Emergency Department. Our study showed that children who were 10-14 years of age were the most affected. There is a male over female predominance. A femur was the most common bone to be affected. Lastly, further safety awareness programs and campaigns are important to be initiated by governmental authorities.

Prevalence of medical factors related to aging among older car drivers: a multicenter, cross-sectional, descriptive study.

AIM: An increasing number of older adults in Japan are at an increased risk of road traffic crashes. This study aimed to investigate the prevalence of potential underlying medical factors that increase the risk of road traffic crashes among older people. METHODS: This cross-sectional observational study was conducted in 11 medical institutions in Japan using self-administered questionnaires and physical examination from January to May 2021. The background and social data, data on the use of nursing care insurance, and clinical data suggestive of polypharmacy, sarcopenia, cognitive impairment, and frailty/oral frailty were obtained. The prevalence of these factors was compared between everyday and occasional drivers. RESULTS: Data of 127 patients were collected; their median (interquartile range) age was 73 (70-78) years. Of the total participants, 82 were men (64.6%) and 45 were women (35.4%). There were 77 everyday drivers and 50 occasional drivers. Of these, 121 (95.3%) had not applied for nursing care insurance, but the numbers of those who required help 1 and 2 were 1 (0.8%) and 3 (2.4%), respectively. Prevalence of medical factors was as follows: polypharmacy, 27.6%; sarcopenia, 8.7%; dementia, 16.4%; frailty, 15.0%; and oral frailty, 54.3%; it was not significantly different between every day and occasional drivers. Intention to return the car license was significantly higher among the occasional drivers (2.6% vs. 14.0%; odds ratio: 6.7, 95% confidence interval: 1.2-70.6, p = 0.024). CONCLUSION: We uncovered the prevalence of medical factors that can be associated with road traffic crashes among Japanese older people aged ≥ 65 years in our community.