Surface Contact Features, Impact Obliquity, and Preimpact Rotational Motion in Concussive Helmet-to-Ground Impacts: Assessment via a New Impact Test Device.

This paper reports the development of a test device for replicating unique features of concussion-causing helmet-to-ground impacts. Helmet-to-ground impacts are characterized by an oblique impact velocity vector, preimpact rotational motion of the helmeted head, and an impact into a compliant frictional surface of unknown effective mass. No helmet assessment testing program replicates these impact characteristics, yet they influence brain injury risk and therefore may influence helmet design priorities. To replicate these mechanics, the carriage of a drop tower was modified by the addition of a curvilinear bearing track and a hinged torso-neck fixture to which a helmeted head of a Hybrid III anthropomorphic test device was mounted. Preimpact rotational motion of the head was imparted by forcing a link arm to follow the curvilinear path as the carriage fell under gravity. At impact, the rotating helmeted head struck a vertically mounted surface. The ground impact features of head kinematics are illustrated by comparing rear impacts into a rigid, low-friction surface against those into a compliant frictional surface simulating turf. With the rigid, low-friction surface, the head experienced a change in rotational rate of approximately 40 rad/s, which corresponded to a peak rotational acceleration of approximately αy = - 4000 rad/s2. In contrast, peak rotational acceleration with the compliant frictional surface was approximately αy = - 1000 rad/s2 while the helmet was in contact with the surface. Neck loads were significantly greater with the compliant frictional surface. Translational head acceleration was less sensitive to the surface characteristics, with the peak of the anterior-posterior component essentially unchanged.

Comparison of three different methods to estimate the burden of disease of burn injuries in Western Australia in 2011-2018.

BACKGROUND: Priority setting and resource allocation in health care, surveillance and interventions is based increasingly on burden of disease. Several methods exist to calculate the non-fatal burden of disease of burns expressed in years lived with disability (YLDs). The aim of this study was to assess the burden of disease due to burns in Western Australia 2011-2018 and compare YLD outcomes between three existing methods. METHODS: Data from the Burns Service of Western Australia was used. Three existing methods to assess YLDs were compared: the Global Burden of Disease (GBD) method, a method dedicated to assess injury YLDs (Injury-VIBES), and a method dedicated to assess burns YLDs (INTEGRIS-burns). RESULTS: Incidence data from 2,866 burn patients were used. Non-fatal burden of disease estimates differed substantially between the different methods. Estimates for 2011-2018 ranged between 610 and 1,085 YLDs per 100.000 based on the Injury-VIBES method; between 209 and 324 YLDs based on the INTEGRIS-burns method; and between 89 and 120 YLDs based on the GBD method. YLDs per case were three to nine times higher when the Injury-VIBES method was applied compared to the other methods. Also trends in time differed widely through application of the different methods. There was a strong increase in YLDs over the years when the Injury-VIBES method was applied, a slight increase when the INTEGRIS-burns method was applied and a stable pattern when the GBD method was applied. CONCLUSION: This study showed that the choice for a specific method heavily influences the non-fatal burden of disease expressed in YLDs, both in terms of annual estimates as well as in trends over time. By addressing the methodological limitations evident in previously published calculations of the non-fatal burden of disease, the INTEGRIS-burns seems to present a method to provide the most robust estimates to date, as it is the only method adapted to the nature of burn injuries and their recovery.

Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test.

BACKGROUND: There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. METHODS: We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. RESULTS: The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered "asymptomatic" as they didn't present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5-99.5%] and 98.7% [CI] [92.8-99.8%] respectively, with a range of confidence [CI] of 95%. CONCLUSIONS: Our study's main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.

Pitfalls in the Interpretation of Traumatic Socioethnic Practices.

The purpose of this case study was to raise awareness among forensic pathologists and medicolegal death investigators regarding two unique socioethnic practices and regional customs that have significant forensic implications. We present two cases involving coining (gua sha) and bloodletting (sapi) that represent two forms of traditional customs that involve the use of blunt force and sharp force trauma, respectively. In coining, the skin lesions are produced as a result of dermabrasion with oils and oval objects such as coin. In sapi, multiple superficial linear scrapes are made in the skin as part of a bloodletting ceremony. The identification of these lesions will prevent the interpretation of them as non-voluntary-inflicted trauma.

Bruising caused by traditional Chinese massage therapy (ba sha) complicating the assessment of a case of fatal child abuse.

Precise evaluation of bruises and patterned skin lesions in infants and children is an essential requirement in cases of potential abuse. Such injuries may be markers of more significant internal injuries and/or may be supportive of an assault rather than an accident. On occasion, however, unusual patterned skin lesions may be identified that have been inflicted as part of traditional therapeutic techniques. A five-year-old boy from a rural Chinese community is reported who died from ligature strangulation. In addition to bruises from abusive trauma he had a series of unusual patterned, often-paired, bruises over the anterior and posterior aspects of both shoulders, unrelated to the ligature mark. Upon further police inquiries it transpired that his grandmother and mother had been using traditional Chinese therapeutic massage or "ba sha" to treat an episode of vomiting. The term means "to pull out fever" and involves firm pinching of the skin between the thumb and index finger, often on the neck, chest or back. An awareness of the potential manifestations of traditional therapies is important in contemporary forensic practice so that injuries caused by these treatments are not confused with non-therapeutic inflicted injury.

[The forensic medical characteristics and assessment of the neck injuries resulting from intubation].

The objective of the present study was to detect injuries to the sublungual bone, larynx, and trachea resulting from intubation in the patients including those with the blunt neck trauma and to determine their character and localization. Another objective was the forensic medical evaluation of these injuries from the standpoint of harm to human health. A total of 80 cases of death from neck injuries were available for the analysis. These subjects underwent tracheal intubation prior to death that was performed either by an ambulance crew or in a hospital setting. Forty of these patients had the blunt neck trauma inflicted in the preceding period. It was shown that tracheal intubation leads in 60% of the patients to isolated or combined fractures of the sublingual bone, laryngeal and tracheal cartilages in the form of the injuries to the greater horns of the hyoid bone and the inferior horns of the thyroid cartilage, fissures in the arch of the cricoid cartilage, sometimes cracks and complete fractures of the tracheal cartilages, and breaks of the connections between the hyoid bone body and its greater horns. The scope of the injuries in the neck region is larger and their severity higher when intubation is performed in the patients with the blunt neck trauma compared with the subjects undergoing intubation in the absence of previous external injurious impacts. It is concluded that forensic medical expertise and examination of the corpses of the subjects who had undergone tracheal intubation prior to death coming should include the removal of the entire complex of the neck organs together with the unopened larynx and the cervical portion of the trachea. Differential diagnostics of the injuries inflicted by tracheal intubation following the blunt neck trauma should be performed only by means of the comprehensive assessment of the external defects and the fractures of the constituents of the hyoid-laryngeal-tracheal complex using the graphical and vector methods of analysis.

[Peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process].

The objective of the present study was to elucidate the peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process. The case report described in this paper demonstrates that the unfavourable outcome of an injury is not infrequently attributable to the inadequacy and drawbacks of the existing schemes for the provision of medical aid. However, the health status of the victim depends on the life-threatening character of the primary injury and its naturally developing infectious complications.

Utility of clinical examination and CT scan in assessment of penetrating neck trauma.

Managing penetrating injuries adequately and effectively depends a great deal on proper assessment of the injury. This study carried out was done at The Aga Khan University Hospital to assess the role of clinical examination and CT scan imaging in evaluation of penetrating neck injuries. A total of 68 students were included, with ages ranging from 3 to 74 years. The involved zones and the injured structures were noted. Results showed a high sensitivity of clinical examination in assessing vascular (81%) and airway trauma (77%), with a low sensitivity for esophageal trauma (34%). For CT scan the sensitivity was 90% for vascular trauma, 83% for airway trauma and 53% for esophageal injuries. Clinical findings and CT scan imaging are important assessment tools for evaluation of penetrating neck traumas, with a high sensitivity for vascular and airway injuries.

An assessment of the usefulness of routine histological examination in hanging deaths.

A retrospective study was carried out on 100 randomly selected medico-legal autopsies of victims who had committed suicide by hanging. All cases had undergone full police and coronial investigation. Complete external and internal examinations had been carried out including routine histological examination of organs. The age range of victims was 15-94 years (average, 41.7 years) with a male-to-female ratio of 7:1. External and internal injuries were consistent with the reported events. Diagnoses based purely on histology included hepatic steatosis (n = 16), asthma (n = 3), lymphocytic thyroiditis (n = 2), and pulmonary and cardiac sarcoidosis (n = 1). A large cell carcinoma of the lung and a rectal adenocarcinoma were confirmed. Histological evaluation was, however, of limited usefulness in contributing to the medico-legal evaluation of cases, with careful scene, external and internal examinations providing the most relevant information. The results of histological examination of tissues were all incidental to the cause, mechanism, and manner of death.

Métodos de valoración del tratamiento de la patología degenerativa cervical / Methods of assessing the treatment of cervical degenerative disease

Los cientificos trataron de elaborar una teoría del origen de la vida. Los cambios climáticos, las distintas divisiones del planeta y los elementos óseos encontrados permitieron elaborar una línea de evolución desde los "Homos" hasta el hombre actual. Con la bipedestación se manifiestan modificaciones en la estructura vertebral; características anatómicas cervicales influyen en la biomecánica. La anatomía comparada nos muestra su importancia y función, como en las apófisis unciformes. La patología degenerativa de dicho segmento no escapa a características comunes a toda columna vertebral, pero por tener una estructura y función diferentes, hay aspectos propios influyentes como: incidencia de la lordosis en el proceso degenerativo, función de las apófisis unciformes en la limitación de la rotación. Diseñamos un método de valoración del tratamiento quirúrgico de la patología degenerativa; creamos criterios de inclusión y exclusión para los 30 pacientes que formaron la muestra; revisamos nuestro trabajo de más de 15 años

SUMMARY: Scientists sought to develop a theory or the origin of life. Climate change, the various divisions of the globe and the bony elements found allowed to develop a line of evolution from the "Homo" to man today. With the standing manifest changes in the structure vertebral anatomic features affect cervical biomechanics. Comparative anatomy shows us its importance and function, as in the vertebral unciformes. Degenerative disease of the segment is no excrption to features common to all spine, but have a different structure and function, there are some influential themselves as incidence of lordosis in the degenerative process of the vertebral unciformes function in limiting the rotation. We designed a method to evaluate surgical treatment of degenerative disease; create inclusion and exlclusion critiria for the 30 patients who formed the sample, we reviewed our work over 15 years

Percutaneous versus Conventional Tracheostomy in Burned Patients with Inhalation Injury.

The aim of the study was to compare conventional tracheostomy with percutaneous dilatational tracheostomy in patients with inhalation burn injury. A total of 37 patients with severe burn injuries and associated inhalation injury, underwent percutaneous tracheostomy in our burn unit and were retrospectively compared with 22 patients who underwent conventional surgical tracheostomy. In the first group, 25 of 37 patients and in the second group 17 of 22 patients presented with partial or full-thickness burn injuries (or both) in the neck region. The cost of the procedure, operating time, complications, and incidence of pulmonary infection were recorded. There were no significant perioperative complications in the percutaneous tracheostomy group, and no patient required surgical revision or conversion to surgical tracheostomy. In the conventional tracheostomy group, 2 patients developed tracheal stenosis, 1 had a tracheoesophageal fistula, and 10 had stomal infections. The average procedure time in the first group was 9 minutes, and in the second group it was 22 minutes. The cost of the bedside percutaneous tracheostomy was one-fifth the cost of a conventional tracheostomy. The incidence of pulmonary sepsis was 45% after percutaneous tracheostomy compared to 68% after conventional tracheostomy. With the percutaneous technique, spontaneous closure of the stoma occurred within 1 to 3 days after removal of the tracheostomy tube, whereas with the conventional technique it was within 5 to 7 days. Percutaneous tracheostomy is associated with a lower complication rate and can be safely performed at the bedside. Moreover, it is faster and can be done at a lower cost than conventional open tracheostomy.