All-terrain vehicle injuries at Arrowhead Regional Medical Center (Level II): epidemiology, risks, and outcome.

The growing popularity of all-terrain vehicles (ATVs) has contributed to a rise in the number of injuries and fatalities nationwide. The Consumer Product Safety Commission reported 8,104 fatalities from 1982 to 2006 and over 146,600 emergency room-treated visits in 2006 with children 16 years of age and younger comprising roughly 29 per cent in both categories. To investigate the epidemiology and outcome of ATV-related injuries and to explore variables contributing to morbidity and mortality, we conducted a single-center, retrospective study of ATV-injured patients presenting to trauma emergency between 2003 and 2007 at a Level II trauma center. In summary, we witnessed an upward trend in the incidence of ATV injuries during this 5-year span. With 156 documented cases, adolescents aged 17 to 20 years represented the largest group (19.2%), whereas children 16 years of age and younger contributed to 12.8 per cent. Overall mortality rate was 0.64 per cent. Positive blood alcohol concentration was detected in 21 per cent. Individuals using protective gear were 1.4 and four times less likely to suffer loss of consciousness and Glasgow Coma Scale score 8 or less, respectively, compared with those without protection. Abrasions, concussions, fractures, and other life-threatening solid organ injuries were documented in virtually every organ system. With such poor outcomes, we conclude that riding an ATV is an inherently dangerous activity. To minimize the burden of injury, riders are encouraged to develop competency through training courses, compliance with safety precautions, and modification of high-risk behaviors.

Combined Immunosuppression Impairs Immunogenicity to Tetanus and Pertussis Vaccination Among Patients with Inflammatory Bowel Disease.

BACKGROUND: Pertussis epidemics have recently emerged across the United States, prompting broad public health recommendations for adult Tdap vaccination (tetanus, diphtheria, acellular pertussis). The impact of immunosuppressive regimens for inflammatory bowel disease (IBD) on vaccine responses to the Tdap vaccine is not known. METHODS: We performed a prospective controlled trial between April 2011 and March 2012. Adults with IBD were consecutively stratified based on therapeutic regimen into one of 5 groups: A: no IBD therapy or 5-aminosalicylates alone; B: maintenance biologic monotherapy; C: maintenance immunomodulator monotherapy; D: combined biologic and immunomodulator therapy; and E: healthy age-matched controls. Subjects received Tdap, and serum antibody levels against tetanus toxoid, pertussis toxoid, and filamentous hemagglutinin (FHA) were drawn just before and approximately 4 weeks after vaccination. The primary outcome was the booster response rate to each antigen. Secondary outcomes included the differences in pregeometric and postgeometric mean titers. RESULTS: A total of 98 subjects enrolled, and 84 completed the study. Tetanus response rates were 55%, 56%, 40%, 27%, and 63% across groups A to E, respectively. Group D rates were lower than those of group B (P = 0.02). Postvaccination pertussis toxoid responses were 59%, 72%, 47%, 45%, and 75%, while FHA responses were 86%, 72%, 80%, 64%, and 75% across groups A to E, respectively. Prevaccination and postvaccination geometric mean titer differences for FHA were lower in group D than those in group A (P = 0.05). CONCLUSIONS: Antibody responses to tetanus and pertussis vaccination may be affected by therapeutic drug regimen. Patients with IBD should optimally receive Tdap before starting immunomodulators, particularly when used in combination with anti-tumor necrosis factor alpha agents.