RESUMEN
Lumbar spine injuries resulting from heavy or repetitive lifting remain a prevalent concern in workplaces. Back-support devices have been developed to mitigate these injuries by aiding workers during lifting tasks. However, existing devices often fall short in providing multidimensional force assistance for asymmetric lifting, an essential feature for practical workplace use. In addition, validation of device safety across the entire human spine has been lacking. This paper introduces the Bilateral Back Extensor Exosuit (BBEX), a robotic back-support device designed to address both functionality and safety concerns. The design of the BBEX draws inspiration from the anatomical characteristics of the human spine and back extensor muscles. Using a multi-degree-of-freedom architecture and serially connected linear actuators, the device's components are strategically arranged to closely mimic the biomechanics of the human spine and back extensor muscles. To establish the efficacy and safety of the BBEX, a series of experiments with human participants was conducted. Eleven healthy male participants engaged in symmetric and asymmetric lifting tasks while wearing the BBEX. The results confirm the ability of the BBEX to provide effective multidimensional force assistance. Moreover, comprehensive safety validation was achieved through analyses of muscle fatigue in the upper and the lower erector spinae muscles, as well as mechanical loading on spinal joints during both lifting scenarios. By seamlessly integrating functionality inspired by human biomechanics with a focus on safety, this study offers a promising solution to address the persistent challenge of preventing lumbar spine injuries in demanding work environments.
Asunto(s)
Músculos de la Espalda , Diseño de Equipo , Elevación , Humanos , Masculino , Fenómenos Biomecánicos , Adulto , Elevación/efectos adversos , Músculos de la Espalda/fisiología , Traumatismos Vertebrales/prevención & control , Adulto Joven , Robótica/instrumentación , Dispositivo Exoesqueleto , Vértebras Lumbares/fisiología , Vértebras Lumbares/lesiones , Columna Vertebral/fisiología , Columna Vertebral/anatomía & histología , ElectromiografíaRESUMEN
BACKGROUND: Motorcycle crashes pose a persistent public health problem with disproportionate rates of severe injuries and mortality. This study aims to analyze injury patterns and outcomes with regard to helmet use. We hypothesized that helmet use is associated with fewer head injuries and does not increase the risk of cervical spine injuries. METHODS: The National Trauma Data Bank was queried for all motorcycle driver crashes between 2007-2017. Univariable analysis was used to compare demographics, clinical data, injury patterns using abbreviated injury scale, and outcomes between helmeted motorcycle drivers and non-helmeted motorcycle drivers who were injured in traffic crashes. Independent factors associated with mortality were determined by regression analysis after adjustment for potential confounders. RESULTS: A total of 315,258 patients were included for analysis, 66 % of these patients were helmeted. The sample was 92.5 % male and the median age was 41 years. Non-helmeted motorcycle drivers were more likely to sustain severe head trauma (head abbreviated injury scale ≥ 3: 28.5 % vs. 13.3 %, p < 0.001), had higher intensive care unit-admission (38 % vs. 30.2 %, p<0.001), mechanical ventilation (20.1 % vs. 13 %, p<0.001) and overall mortality rates (6.2 % vs. 3.9 %, p<0.001). Cervical spine injuries occurred in 10.6 % of non-helmeted motorcycle drivers and in 9.5 % of helmeted motorcycle drivers (p<0.001). Helmet use was identified as an independent factor associated with lower mortality [OR 0.849 (0.809-0.891), p<0.001]. CONCLUSION: Helmet use is protective for severe head injuries and associated with decreased mortality. Helmet use was not associated with increased rates of cervical spine injuries. On the contrary, fewer injuries were observed in helmeted motorcycle drivers. Public health initiatives should be aimed at enforcement of universal helmet laws within the United States and across the world.
Asunto(s)
Traumatismos Craneocerebrales , Traumatismos del Cuello , Traumatismos Vertebrales , Humanos , Masculino , Estados Unidos/epidemiología , Adulto , Femenino , Dispositivos de Protección de la Cabeza , Motocicletas , Accidentes de Tránsito , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/prevención & control , Traumatismos Vertebrales/epidemiología , Traumatismos Vertebrales/prevención & controlRESUMEN
PURPOSE: The purpose of this study was to evaluate whether prolonged re-boarding of restraint children in motor vehicle accidents is sufficient to prevent severe injury. METHODS: Data acquisition was performed using the Trauma Register DGU® (TR-DGU) in the time period from 2010 to 2019 of seriously injured children (AIS 2 +) aged 0-5 years as motor vehicle passengers (MVP). Primarily treated and transferred patients where included. RESULTS: The study group included 727 of 2030 (35.8%) children, who were severely injured (AIS 2 +) in road traffic accidents, among them 268 (13.2%) as MVPs in the age groups: 0-1 years (42.5%), 2-3 years (26.1%) and 4-5 years (31.3%). The pattern of severe injury was head/brain (56.0%), thoracic (42.2%), abdominal (13.1%), fractures (extremities and pelvis, 52.6%) and spine/severe whiplash (19.8%). The 0-1-year-old MVPs showed the significantly highest proportion of brain injuries with Glasgow Coma Score (GCS) < 8 and severe injury to the spine. The 2-3-year-olds showed the significantly highest proportion of fractures especially the lower extremity and highest proportion of cervical spine injuries of all spine injuries, while the 4-5-year-olds, the significantly highest proportion of abdominal injury and second highest proportion of cervical spine injury of all spine injuries. MVPs of the 0-1-year-old and 2-3-year-old groups showed a higher median Injury Severity Score (ISS) of 21.5 and 22.1 points than the older children (17.0 points). They also suffered an AIS-6-injury significantly more often (9 of 21) of spine (p = 0.001). Especially the cervical spine was significantly more often involved. Passengers at the age of 0-1 years were treated with cardiopulmonary resuscitation (CPR) three times as often as older children in the prehospital setting and twice as often at admission in the Trauma Resuscitation Unit (TRU). Their survival rate was 7 out of 8 (0-1 years), 1 out of 6 (2-3 years) and 1 out of 4 (4-5 years). CONCLUSION: Although the younger MVPs are restraint in a re-boarding position, severe injury to the spine and head occurred more often, while older children as front-faced positioned MVPs suffered from significantly higher rates of abdominal and more often severe facial injury. Our data show, that it is more important to properly restrain children in their adequate car seats (i-size-Norm) and additionally consider the age-related physiological and anatomical specific risks of injury as well as co-factors in road traffic accidents, than only prolonging the re-boarding position over the age of 15 months as a single method.
Asunto(s)
Fracturas Óseas , Traumatismos Vertebrales , Accidentes de Tránsito/prevención & control , Adolescente , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Vehículos a Motor , Traumatismos Vertebrales/epidemiología , Traumatismos Vertebrales/prevención & control , Centros TraumatológicosRESUMEN
Spinal injury and back pain are a common problem facing patients seeking medical care including athletes, which can lead to significant disability, medical costs, and impaired performance for these patients. Rehabilitation including core muscle stabilization, Kinesio taping, and flexibility have been shown to help with treatment and prevention. Critical factors such as equipment, technique, and rule changes can also be an important part of spine injury prevention.
Asunto(s)
Traumatismos en Atletas/prevención & control , Traumatismos Vertebrales/prevención & control , Traumatismos en Atletas/complicaciones , Cinta Atlética , Humanos , Dolor de la Región Lumbar/etiología , Traumatismos Vertebrales/complicacionesRESUMEN
OBJECTIVE: Motorcycle helmets are the most common and effective protective device to reduce head injuries and mortality in crashes among powered two-wheeler riders. Even if they are globally recognized as effective, there are still concerns regarding their correct use, which is necessary to achieve maximum head protection. The goal of this systematic review is to assess which characteristics of helmet design and use showed a positive influence on rider safety, in order to provide insights to improve end-user helmet usage. METHODS: A literature search was carried out combining two sets of keywords, one related with either motorcycle or rider and the other referring to either protective equipment or injuries. After the exclusion of duplicates, 977 papers were screened by reviewers, thus identifying 32 papers that were analyzed in group discussions. RESULTS: Among the papers included in this study, no strong conflicting conclusions emerged in their results. The studies focusing on the use of different types of helmets highlighted that full-face helmets, compared with other standard helmets, have a positive influence on head injuries and facial injuries. Correct fastening was clearly beneficial for head and facial injuries, induced injuries, and helmet ejection. CONCLUSIONS: This systematic review provides important insights to improve the usage of helmets by end-users. Correct fastening is a crucial factor to avoid helmet roll-off during a crash. Most studies agreed that full-face helmets provide higher protection in comparison with other standard helmets, especially for facial injuries, and no negative influence with respect to neck and spinal injuries.
Asunto(s)
Accidentes de Tránsito/prevención & control , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Motocicletas/estadística & datos numéricos , Traumatismos Vertebrales/prevención & control , Accidentes de Tránsito/mortalidad , Adulto , Traumatismos Craneocerebrales/prevención & control , Traumatismos Faciales/prevención & control , Humanos , Masculino , Equipos de Seguridad/estadística & datos numéricos , Adulto JovenRESUMEN
ABSTRACT: Cervical spinal injuries are a rare, but potentially devastating occurrence in sports. Although many of these injuries occur in unsupervised sports, they are also seen in organized sports - most commonly in football, wrestling, and ice hockey. Additionally, although each sport is associated with its own unique injury patterns, axial loading remains a common theme seen in cervical injuries associated with significant neurologic impairment. Regardless of the mechanism, a cautious and conservative approach should be taken with regards to evaluation, management, and return to play.
Asunto(s)
Traumatismos en Atletas , Fútbol Americano , Traumatismos Vertebrales , Traumatismos en Atletas/prevención & control , Vértebras Cervicales/lesiones , Humanos , Traumatismos Vertebrales/prevención & control , TriajeAsunto(s)
Lesiones Encefálicas/prevención & control , COVID-19/complicaciones , Maltrato a los Niños/prevención & control , Hospitales Pediátricos/organización & administración , Administración de la Seguridad/organización & administración , Traumatismos Vertebrales/prevención & control , Centros de Atención Terciaria/organización & administración , Preescolar , Estudios Transversales , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Reino UnidoRESUMEN
Astronauts are at increased risk of spine injury. With a view to developing training approaches for the muscles of the spine in microgravity, this study examined the effects of axial loading and postural cues on the contraction of transversus abdominis and lumbar multifidus in supine lying using a novel exercise device (GravityFit). Thirty (18 males and 12 females) endurance-trained runners without a history of spinal pain aged 33-55 years were recruited. Magnetic resonance imaging (MRI) was performed under one rest and five exercise conditions, which involved variations in axial loading and postural cues. Whole volume of the abdominal and lumbar paraspinal muscles was imaged and transversus abdominis thickness and length and multifidus anteroposterior and mediolateral thickness measured. Transversus abdominis contraction was greatest in the 'stretch tall plus arm extension' (length, - 15%, P < 0.001; thickness, + 19%, P < 0.001) and 'stretch tall plus arm extension and thoracic cue' (length, - 16%, P < 0.001; thickness, + 18%, P < 0.001) conditions. The contraction of multifidus was the greatest in the 'arm extension and thoracic cue' (anteroposterior, + 3.0%, P = 0.001; mediolateral, - 4.2%, P < 0.001) and 'stretch tall plus arm extension and thoracic cue' (anteroposterior, + 6.0%, P < 0.001; mediolateral, - 2.1%, P = 0.022) conditions. This study provides proof-of-principle for an exercise approach that may be used to facilitate the automatically contraction of the transversus abdominis and multifidus muscles. Axial loading of the body, with or without arm loading, most consistently led to contraction of the transversus abdominis and lumbar multifidus muscles, and regional differences existed in the contraction within the muscles.
Asunto(s)
Músculos Abdominales/fisiología , Contracción Muscular , Músculos Paraespinales/fisiología , Acondicionamiento Físico Humano/métodos , Postura , Traumatismos Vertebrales/prevención & control , Soporte de Peso , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos Vertebrales/etiología , Ingravidez/efectos adversosRESUMEN
INTRODUCTION: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. METHODS: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique (NGT) meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. RESULTS: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the NGT meeting created and refined conclusions and recommendations until consensus was achieved. CONCLUSIONS: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.
Asunto(s)
Traumatismos en Atletas/terapia , Servicios Médicos de Urgencia/métodos , Traumatismos Vertebrales/terapia , Traumatismos en Atletas/prevención & control , Técnica Delphi , Remoción de Dispositivos , Servicios Médicos de Urgencia/normas , Socorristas/educación , Dispositivos de Protección de la Cabeza , Humanos , Equipos de Seguridad , Restricción Física , Traumatismos Vertebrales/prevención & control , Transporte de Pacientes , Estados UnidosRESUMEN
CONTEXT AND OBJECTIVE: Among the different products and protective gear used by riders of two-wheeled motorized vehicles, back protectors that are designed to prevent damage to the spinal column are widely used today compared other protections. However, few studies measure their effectiveness. Can their effectiveness be measured? How do they help decrease or change the nature of thoracolumbar traumas that occur? To address these questions and remedy the lack of objective data regarding these products, an epidemiological, clinical, and biomechanical analysis of motorcycle riders who were admitted to a French trauma center after an accident was performed. So, this study investigates the effectiveness of back protectors, including their ability to prevent specific mechanisms of thoracic and lumbar spinal injuries related to TWMV accidents. METHOD: A questionnaire was administered to victims of accidents involving two-wheeled motorized vehicles who were admitted to the trauma room at the Marseille trauma center over the course of 2016. Collect data are related to the victim, the accident scenario, and a detailed description of the observed injuries using AIS (Abbreviated Injury Scale) coding and Magerl classification. Univariate analyses and Fisher tests were performed for victims who were or were not wearing back protectors. RESULTS: This study collected data from 124 victims. Almost half of the victims were wearing a back protector at the time of the accident (53 victims, thus 43% of riders). Collectively, twenty-nine victims who were wearing back protectors had 57 thoracolumbar injuries, and twenty eight victims who were not wearing back protectors had 75 thoracolumbar lesions. The results from this study show that there is no significant difference in the nature and mechanism of thoracolumbar injuries as a function of back protection. The majority of the thoracolumbar injuries were not severe. They were primarily bone injuries, essentially compression fractures, regardless of whether a back protector was worn. CONCLUSION: This study shows that the use of back protection does not decrease the number, type, or mechanism of thoracolumbar injuries associated with accidents involving two-wheeled motorized vehicles. However, it suggests that lumbar vertebral injuries are deflected towards the thoracic vertebrae when back protectors are worn. Finally, it suggests that the design of back protectors should be reconsidered to better protect riders from what are referred to as compression fractures (craniocaudal force), which remain the primary form of fracture regardless of the rider's characteristics, based on the data analyzed.
Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Fracturas por Compresión/prevención & control , Motocicletas , Ropa de Protección/estadística & datos numéricos , Traumatismos Vertebrales/prevención & control , Escala Resumida de Traumatismos , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Fracturas por Compresión/epidemiología , Humanos , Vértebras Lumbares/lesiones , Masculino , Persona de Mediana Edad , Traumatismos Vertebrales/epidemiología , Encuestas y Cuestionarios , Vértebras Torácicas/lesiones , Centros Traumatológicos/estadística & datos numéricos , Adulto JovenRESUMEN
The objective was to investigate the effects of functional (FT) and traditional (TT) training on trunk muscles maximal isometric strength, rate of force development and endurance with trained elderly women. Forty-five elderly women were directed into three groups: FT (n =1 6), TT (n = 14) and Control (n = 15). The FT (multi-planar, and multi-articular movements) and TT (primarily machine-based resistance exercises) performed mobility, muscle strength and power exercises. Both training groups also performed intermittent cardiometabolic activities. The maximum strength and endurance of the trunk muscles were verified, both at baseline and after 12 weeks of training (3xweek for 50 min each). Data were analyzed using a 2-way ANCOVA with contrast of adjusted mean values. FT significantly increased all variables: maximum trunk flexor strength (p = 0.002, 22%); rate of flexor force development (p = 0.001, 84%); trunk extensors maximal strength (p = 0.003, 17%); trunk extensor rate of force development (p = 0.05, 16%); trunk flexors (p = 0.001, 19%) and extensors (p = 0.017, 13%) endurance compared to baseline. TT showed an increase only in RFD of trunk extensors (p = 0.003, 53%), and flexors (p = 0.033, 42%), and trunk flexors endurance (p = 0.008, 11%). However, there was no statistically significant difference between groups. FT promoted improvement in all variables; strength, endurance and rate of force development of the trunk flexors and extensors of the elderly. On the other hand, TT improved only the rate of force development of trunk flexors and extensors and endurance of the trunk flexors. FT is recommended for elderly women as it improves a broader array of physiological parameters.
Asunto(s)
Fuerza Muscular/fisiología , Músculo Esquelético/fisiología , Resistencia Física/fisiología , Entrenamiento de Fuerza/métodos , Actividades Cotidianas , Anciano , Femenino , Humanos , Contracción Isométrica/fisiología , Persona de Mediana Edad , Equilibrio Postural/fisiología , Traumatismos Vertebrales/prevención & control , Columna Vertebral/fisiología , TorsoRESUMEN
A short cut review was carried out to establish whether patients presenting to the emergency department after a near drowning should have cervical spine immobilisation. A search of the literature found only three studies directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that cervical spine injuries are rare in drowning and near drowning unless there is a history of diving or a fall or signs of trauma. Cervical spine immobilisation should be reserved for cases where there is a reasonable suspicion of a spinal injury.
Asunto(s)
Vértebras Cervicales/lesiones , Medicina de Emergencia Basada en la Evidencia/normas , Ahogamiento Inminente/complicaciones , Restricción Física/normas , Traumatismos Vertebrales/prevención & control , Buceo/efectos adversos , Servicio de Urgencia en Hospital/normas , Medicina de Emergencia Basada en la Evidencia/instrumentación , Medicina de Emergencia Basada en la Evidencia/métodos , Humanos , Masculino , Selección de Paciente , Guías de Práctica Clínica como Asunto , Equipos de Seguridad , Restricción Física/instrumentación , Restricción Física/métodos , Traumatismos Vertebrales/diagnóstico , Traumatismos Vertebrales/etiología , Adulto JovenRESUMEN
The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2018, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. Key recommendations include the concept that interventions should be goal oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique oriented (immobilization). This evidence-based, goal-oriented approach does not support the immobilization of suspected spinal injuries via rigid collars or backboards.
Asunto(s)
Pautas de la Práctica en Medicina , Traumatismos de la Médula Espinal/terapia , Traumatismos Vertebrales/terapia , Medicina Silvestre/normas , Humanos , Inmovilización/efectos adversos , Inmovilización/métodos , Sociedades Médicas , Traumatismos de la Médula Espinal/prevención & control , Traumatismos Vertebrales/prevención & control , Medicina Silvestre/métodosRESUMEN
INTRODUCTION: To evaluate the long-term consolidation of vertebral metastases (VM) after preventive vertebroplasty (PV) and to report risk factors of pathological fracture despite PV. MATERIALS AND METHODS: Files of 100 consecutives cancer patients referred for PV of VM were retrospectively analyzed. We enumerated 215 VM at the time of the PV procedure (T0): 138 VM were considered at risk of pathological fracture and had PV (treated-VM), and 77 VM were not cemented. We compared the VM characteristics using the spine instability neoplastic score (SINS) at T0 and the rate of pathologic fracture between treated-VM and untreated-VM using Kaplan-Meier method. We analyzed risk factors of pathological fracture despite PV using treated-VM characteristics and quality of cement injection criteria. RESULTS: Despite a lower SINS value at T0 (p < 0.001), the rate of pathological fracture was significantly higher among untreated-VM compared to the treated-VM, (log-rank, p < 0.001). Major risk factors of fracture among treated-VM were: SINS value ≥ 8 (p < 0.012), mechanical pain (p = 0.001), osteolytic lesion (p = 0.033), metastatic vertebral body involvement > 50% with no collapse (p < 0.001) and unilateral posterior involvement by the vertebral metastasis (p = 0.024), Saliou score < 9 (p = 0.008), vertebral metastasis filling with cement < 50% (p = 0.007) and the absence of cement's contact with vertebral endplates (p = 0.014). CONCLUSION: PV is long-term effective for consolidation of VM and must be discussed at the early diagnosed. Quality of cement injection matters, suggesting that techniques that improve the quantity and the quality of cement diffusion into the VM must be developed.
Asunto(s)
Fracturas Espontáneas/etiología , Fracturas Espontáneas/prevención & control , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/prevención & control , Neoplasias de la Columna Vertebral/complicaciones , Vertebroplastia/métodos , Cementos para Huesos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Traumatismos Vertebrales/prevención & control , Neoplasias de la Columna Vertebral/secundario , Columna Vertebral/cirugía , Resultado del TratamientoRESUMEN
Wool harvesting remains an important industry in Australia, but its workers suffer from extreme rates of injury, in particular, the lower back injuries. Reducing injuries in sheep shearing could be as simple as extending shearer rest periods between sheep, but the effect of this has not previously been studied. The lumbar flexion-relaxation phenomenon is present in sheep shearing and the onset angle of this phenomenon can provide insight into lower back injury risk. The increase in the onset angle of lumbar flexion-relaxation over several work-rest periods for a simulated sheep shearing task is studied. The rate of increase in the onset angle of lumbar flexion-relaxation was higher when shorter breaks were taken for all participants at least unilaterally, indicating that longer rest breaks could reduce back injury risk. Due to the constraints of the sheep shearing occupation, this type of intervention is better suited to learner and novice shearers. Assistive robotic devices would be more suited to reduce injuries in expert shearers, and some insight is provided for the application of these within sheep shearing. Further study of this phenomenon in sheep shearing could provide additional insight to developing an assistive device that could reduce injury.
Asunto(s)
Crianza de Animales Domésticos/métodos , Región Lumbosacra/fisiología , Exposición Profesional/prevención & control , Traumatismos Vertebrales/prevención & control , Adulto , Animales , Australia , Humanos , Masculino , Aparatos Ortopédicos , Descanso , Ovinos , Lana , Adulto JovenRESUMEN
BACKGROUND: There is uncertainty regarding the efficacy of ski helmets in preventing traumatic injury. We investigated the relationship between helmet use, injury types, and injury severity among skiers and snowboarders. METHODS: The trauma registry at a Northeast American College of Surgeons Level I trauma center was queried by International Classification of Diseases Codes-9th or 10th Revision for skiing and snowboarding injury between 2010 and 2018. The primary exposure was helmet use and primary outcome was severe injury (Injury Severity Score >15). We performed univariate and multivariable logistic regression to assess for injury types and severity associated with helmet use. RESULTS: Seven hundred twenty-one patients (65% helmeted, 35% unhelmeted) met inclusion criteria. Helmet use doubled during the study period (43% to 81%, p < 0.001), but the rate of any head injury did not significantly change (49% to 43%, p = 0.499). On multivariable regression, helmeted patients were significantly more likely to suffer severe injury (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.30-3.11), intracranial hemorrhage (OR, 1.81; 95% CI, 1.10-2.96), chest injury (OR, 1.66; 95% CI, 1.05-2.61), and/or lumbosacral spine injury (OR, 1.84; 95% CI, 1.04-3.25) than unhelmeted patients. Helmeted patients were half as likely to suffer cervical spine injury (OR, 0.51; 95% CI, 0.30-0.89) and a third as likely to sustain skull fracture and/or scalp laceration (OR, 0.30; 95% CI, 0.14-0.64). More patients who hit a stationary object were helmeted compared with those who fell from standing height onto snow (70% vs. 56% respectively, p < 0.001). After adjustment, hitting a stationary object was the injury mechanism most significantly associated with severe injury (OR, 2.80; 95% CI, 1.79-4.38). CONCLUSION: Helmeted skiers and snowboarders evaluated at a Level I trauma center were more likely to suffer severe injury, including intracranial hemorrhage, as compared with unhelmeted participants. However, they were less likely to sustain skull fractures or cervical spine injuries. Helmeted patients were also more likely to hit a stationary object. Our findings reinforce the importance of safe skiing practices and trauma evaluation after high-impact injury, regardless of helmet use. LEVEL OF EVIDENCE: Prognostic and epidemiological, level IV.
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Traumatismos Craneocerebrales/diagnóstico , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Hemorragias Intracraneales/epidemiología , Esquí/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/prevención & control , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/prevención & control , Masculino , Persona de Mediana Edad , Traumatismos del Cuello/epidemiología , Traumatismos del Cuello/etiología , Traumatismos del Cuello/prevención & control , Estudios Retrospectivos , Esquí/estadística & datos numéricos , Traumatismos Vertebrales/epidemiología , Traumatismos Vertebrales/etiología , Traumatismos Vertebrales/prevención & control , Centros Traumatológicos/estadística & datos numéricos , Adulto JovenRESUMEN
Objetivos: Comparar la autoextracción (AE) frente a la AE con collarines en sujetos con bajo riesgo de lesión cervical. Método: Estudio de simulación mediante análisis biomecánico con sensores inerciales, determinando la desalineación de la columna cervical durante la AE con y sin collarines cervicales. Resultados: El desequilibrio fue 3,12 (DE 34,62) grados mayor con el collarín STIFNECK (SN) (IC al 95% de -15,33 a 21,57; p =0,7234) que con AE y también 5,95 (DE 31,76) grados mayor con collarín X-COLLAR (XC) (IC al 95% de -10,98 a 22,87; p = 0,4654) que con AE. Cuando comparamos la AE con los diferentes tipos de collarines, observamos que con el collarín XC se produjeron 2,83 (DE 12,10) grados de desalineación más que con el collarín SN (IC al 95% de -3,62 a 9,27; p = 0,3650). Conclusiones: La desalineación de la columna cervical mediante la AE es similar a la provocada cuando se aplican collarines cervicales
Objective: To compare self-extraction with and without a cervical collar in subjects at low risk of cervical spine injuries. Methods: Simulation study analyzing biomechanical data from inertial sensors to detect misalignment of the cervical spine during self-extraction with and without a cervical collar. Results: Misalignment was a mean (SD) 3.12 (34.62) degrees greater during self-extraction with a Stiffneck collar in place (95% CI, -15.33 to 21.57 degrees; P=.7234) than during extraction without a collar. Misalignment was also greater, by 5.95 (31.76) degrees, with an X-collar in place (95% CI, -10.98 to 22.87; P=.4654) than without a collar. The between-collar comparison of differences showed that misalignment was 2.83 (12.10) degrees greater with the X-collar (95% CI, -3.62 to 9.27 degrees; P=.3650). Conclusion: Misalignment of the cervical spinal column is similar during self-extraction with or without a cervical collar in place
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Accidentes de Tránsito , Vértebras Cervicales/lesiones , Traumatismos del Cuello/prevención & control , Traumatismos Vertebrales/prevención & control , Restricción Física/instrumentación , Equipos de Seguridad , Fenómenos Biomecánicos , Voluntarios Sanos , Traumatismos del Cuello/etiología , Evaluación de Resultado en la Atención de Salud , Traumatismos Vertebrales/etiología , RiesgoRESUMEN
Background: Recent studies demonstrate an association between spinal immobilization and neck pain, increased use of radiographs, and increased admission rates for pediatric trauma patients. There is an increasing trend toward spinal protection protocols that limit the use of backboards in trauma patients. However, many of these protocols do not address the youngest patients. Objectives: The objective was to analyze whether implementation of a selective prehospital pediatric spinal protection protocol was associated with a reduction in spinal imaging, hospital admission rates, and Emergency Department (ED) length of stay (LOS). Methods: We conducted a single center retrospective chart review to assess the effect of implementing a new selective pediatric spinal immobilization protocol in an EMS system. Patients transported to the same center from a neighboring EMS jurisdiction without a protocol change were analyzed for comparison. We extracted data for all pediatric patients with trauma-related discharge diagnoses transported by EMS to a pediatric trauma center for one year before and after the implementation of the protocol. Results: There were 878 eligible trauma patients transported under the new protocol, compared to 782 transported prior to implementation. We did not find a significant difference in the percentage of trauma patients who received spinal imaging pre- and post-protocol change (20% vs. 18%, OR 0.84 [95% CI 0.66, 1.07]), but did observe a significant reduction in the proportion of trauma patients who were admitted to the hospital (25% vs. 18%, OR 0.66 [95% CI 0.52, 0.83]). This reduced admission rate was not observed in the neighboring jurisdiction. Conclusions: Implementation of a selective spinal immobilization protocol was associated with reduced admission rates, but did not significantly reduce rates of plain radiographs.
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Servicios Médicos de Urgencia , Traumatismos Vertebrales/prevención & control , Adolescente , Niño , Preescolar , Protocolos Clínicos , Femenino , Hospitalización , Humanos , Masculino , Estudios Retrospectivos , Traumatismos Vertebrales/diagnóstico , Centros TraumatológicosRESUMEN
INTRODUCTION: Helmet use during motorcycle crashes (MCCs) has been shown to reduce traumatic brain injury and mortality. However, preventive effects of its use on cervical spine injury remain controversial. In this study, we evaluated whether helmet use can reduce cervical spine injury during MCCs. PATIENTS AND METHODS: A case-control study using data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) registry was conducted. Cases were defined as patients with cervical spine injury [≥2 points in the Abbreviated Injury Scale (AIS)] in MCCs from 2011 to 2016. Four controls were matched to one case with strata which included age and sex from the EDIIS registry. Primary outcome was cervical spine injury, secondary outcome was intensive care unit (ICU) admission, and tertiary outcomes was mortality. Multivariable logistic regression analysis was used to calculate odds ratios (OR) with 95% confidence intervals (CIs) to evaluate the associations between helmet use and related outcomes. RESULTS: In total, 2600 patients were analysed; among these, 1145 (44.0%) used helmets at the time of crashes. The helmet group showed lower alcohol consumption and mortality rates than the no helmet group (alcohol: 3.2% vs. 9.2%, respectively, and mortality: 2.4% vs. 7.1%, respectively; p < 0.01). Compared with the no helmet group, the helmet group was less likely to have cervical spine injury [adjusted OR, 0.62 (0.51-0.77)]. In addition, helmet use has been shown to help prevent ICU admission and mortality [adjusted OR, 0.45 (0.36-0.56) and 0.32 (0.21-0.51), respectively]. CONCLUSION: Helmet use was found to have significant preventive effects on cervical spine injury during MCCs.
Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Vértebras Cervicales/lesiones , Dispositivos de Protección de la Cabeza , Motocicletas , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos Vertebrales/fisiopatología , Adulto , Consumo de Bebidas Alcohólicas/mortalidad , Estudios de Casos y Controles , Vértebras Cervicales/fisiopatología , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Traumatismos de la Médula Espinal/mortalidad , Traumatismos de la Médula Espinal/prevención & control , Traumatismos Vertebrales/mortalidad , Traumatismos Vertebrales/prevención & control , Centros TraumatológicosRESUMEN
OBJECTIVES: To compare self-extraction with and without a cervical collar in subjects at low risk of cervical spine injuries. MATERIAL AND METHODS: Simulation study analyzing biomechanical data from inertial sensors to detect misalignment of the cervical spine during self-extraction with and without a cervical collar. RESULTS: Misalignment was a mean (SD) 3.12 (34.62) degrees greater during self-extraction with a Stiffneck collar in place (95% CI, -15.33 to 21.57 degrees; P=.7234) than during extraction without a collar. Misalignment was also greater, by 5.95 (31.76) degrees, with an X-collar in place (95% CI, -10.98 to 22.87; P=.4654) than without a collar. The between-collar comparison of differences showed that misalignment was 2.83 (12.10) degrees greater with the X-collar (95% CI, -3.62 to 9.27 degrees; P=.3650). CONCLUSION: Misalignment of the cervical spinal column is similar during self-extraction with or without a cervical collar in place.
OBJETIVO: Comparar la autoextracción (AE) frente a la AE con collarines en sujetos con bajo riesgo de lesión cervical. METODO: Estudio de simulación mediante análisis biomecánico con sensores inerciales, determinando la desalineación de la columna cervical durante la AE con y sin collarines cervicales. RESULTADOS: El desequilibrio fue 3,12 (DE 34,62) grados mayor con el collarín STIFNECK (SN) (IC al 95% de 15,33 a 21,57; p =0,7234) que con AE y también 5,95 (DE 31,76) grados mayor con collarín X-COLLAR (XC) (IC al 95% de 10,98 a 22,87; p = 0,4654) que con AE. Cuando comparamos la AE con los diferentes tipos de collarines, observamos que con el collarín XC se produjeron 2,83 (DE 12,10) grados de desalineación más que con el collarín SN (IC al 95% de 3,62 a 9,27; p = 0,3650). CONCLUSIONES: La desalineación de la columna cervical mediante la AE es similar a la provocada cuando se aplican collarines cervicales.