Weekend woodsmen: Overview and comparison of injury patterns associated with power saw and axe utilization in the United States.

INTRODUCTION: Power saw and axe injuries are associated with significant morbidity and are increasingly managed in the emergency department (ED). However, these injuries have not been summarily reported in the literature. We aim to evaluate and compare the common injury patterns seen with use of power saws and axes. MATERIALS AND METHODS: Data from the National Electronic Injury Surveillance System- All Injury Program (NEISS-AIP) database was analyzed during 2006 to 2016. All patients with nonfatal injuries relating to the use of power saws or axes were included. Baseline demographics type and location of injuries were collected. Descriptive statistical analyses were performed using Chi Square or Fisher's exact test. RESULTS: Information on (n = 18,250) patients was retrieved from the NEISS-AIP database. Injuries were caused by power saw n = 16,384 (89%) and axe n = 1866 (11%) use, and mostly involved males (95%). The most frequently encountered injury was laceration axe n = 1166 (62.5%); power saw n = 11,298 (68.9%). Approximately half of all injuries in both groups involved the fingers and hand. Most injuries occurred at home (65%) and were attributed to power saw use (89%). CONCLUSIONS: Power saws and axes can cause significant injuries, the majority of which occurred at home and were primarily associated with power saw use. Lacerations and injuries to the finger and hand were prevalent in both study groups. Further research into power saw and axe injuries should place emphasis on preventative measures and personal protective equipment (PPE). LEVEL OF EVIDENCE: IV Study type: Retrospective review.

External Validation of a Tube Thoracostomy Complication Classification System.

BACKGROUND: Tube thoracostomy (TT) is a commonly performed procedure which is associated with significant complication rates. Currently, there is no validated taxonomy to classify and compare TT complications across different populations. This study aims to validate such TT complication taxonomy in a cohort of South African trauma patients. METHODS: Post hoc analysis of a prospectively collected trauma database from Pietermaritzburg Metropolitan Trauma Service (PMTS) in South Africa was performed for the period January 2010 to December 2013. Baseline demographics, mechanism of injury and complications were collected and categorized according to published classification protocols. All patients requiring bedside TT were included in the study. Patients who necessitated operatively placed or image-guided TT insertion were excluded. Summary and univariate analyses were performed. RESULTS: A total of 1010 patients underwent TT. The mean age was (±SD) of 26 ± 8 years. Unilateral TTs were inserted in n = 966 (96%) and bilateral in n = 44 (4%). Complications developed in 162 (16%) patients. Penetrating injury was associated with lower complication rate (11%) than blunt injury (26%), p = 0.0001. Higher complication rate was seen in TT placed by interns (17%) compared to TT placed by residents (7%), p = 0.0001. Complications were classified as: insertional (38%), positional (44%), removal (9%), infective/immunologic (9%), and instructional, educational or equipment related (0%). CONCLUSIONS: Despite being developed in the USA, this classification system is robust and was able to comprehensively assign and categorize all the complications of TT in this South African trauma cohort. A universal standardized definition and classification system permits equitable comparisons of complication rates. The use of this classification taxonomy may help develop strategies to improve TT placement techniques and reduce the complications associated with the procedure. LEVEL OF EVIDENCE: V. STUDY TYPE: Single Institution Retrospective review.

Pathophysiology of Aortic Valve Stenosis: Is It Both Fibrocalcific and Sex Specific?

Our understanding of the fundamental biology and identification of efficacious therapeutic targets in aortic valve stenosis has lagged far behind the fields of atherosclerosis and heart failure. In this review, we highlight the most clinically relevant problems facing men and women with fibrocalcific aortic valve stenosis, discuss the fundamental biology underlying valve calcification and fibrosis, and identify key molecular points of intersection with sex hormone signaling.