Classifying outcomes of care for injured patients.

Many trauma survivors face challenges of impaired functioning, limited activities and reduced participation. Recovery from injury after acute care, therefore, becomes an important public health issue. This commentary discusses a framework for evaluating outcomes of acute care.

A pilot survey on injury and safety concerns in international sledge hockey.

OBJECTIVE: To describe sledge hockey injury patterns, safety issues and to develop potential injury prevention strategies. DESIGN: Pilot survey study of international sledge hockey professionals, including trainers, physiotherapists, physicians, coaches and/or general managers. SETTING: Personal encounter or online correspondence. RESPONDENTS: Sledge hockey professionals; a total of 10 respondents from the 5 top-ranked international teams recruited by personal encounter or online correspondence. MAIN OUTCOME MEASUREMENTS: Descriptive Data reports on sledge athlete injury characteristics, quality of rules and enforcement, player equipment, challenges in the medical management during competition, and overall safety. RESULTS: Muscle strains and concussions were identified as common, and injuries were reported to affect the upper body more frequently than the lower body. Overuse and body checking were predominant injury mechanisms. Safety concerns included excessive elbowing, inexperienced refereeing and inadequate equipment standards. CONCLUSIONS: This paper is the first publication primarily focused on sledge hockey injury and safety. This information provides unique opportunity for the consideration of implementation and evaluation of safety strategies. Safety interventions could include improved hand protection, cut-resistant materials in high-risk areas, increased vigilance to reduce intentional head-contact, lowered rink boards and modified bathroom floor surfacing.

Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study.

OBJECTIVE: To evaluate the efficacy of captopril for management of hypertensive urgencies in autonomic dysreflexia. DESIGN: A 1-year, prospective, open-label pilot study. SETTING: Rehabilitation hospital. PATIENTS: Twenty-six consecutive patients older than 15 years with spinal cord injury above T6. INTERVENTIONS: During an autonomic dysreflexia episode, captopril 25mg was administered sublingually if systolic blood pressure (SBP) was at or above 150mmHg despite the use of nondrug measures. If SBP remained elevated 30 minutes after captopril administration, 1 dose of immediate-release nifedipine 5mg was given as rescue by the bite and swallow method and repeated, if necessary, in 15 minutes. MAIN OUTCOME MEASURE: SBP 30 minutes after captopril administration at initial autonomic dysreflexia episode. RESULTS: A total of 33 autonomic dysreflexia episodes were documented, of which 18 episodes in 5 patients were treated with drug therapy. Captopril alone was effective in 4 of 5 initial episodes (80%). Mean SBPs at baseline and 30 minutes after captopril were 178+/-18mmHg and 133+/-28mmHg, respectively. There were no cases of reactive hypotension. The addition of nifedipine successfully reduced SBP in the remaining patient. Of the combined 18 initial and repeat autonomic dysreflexia episodes, 94% were successfully treated with our protocol. CONCLUSION: Captopril appears to be safe and effective for autonomic dysreflexia management.