[Causes, injuries, therapy and possibilities of prevention of equine-related accidents. Results of a 2-center-study]. / Ursachen, Verletzungen, Therapie und Präventionsmöglichkeiten von Unfällen im Reitsport. Ergebnisse einer 2-Center-Studie.

BACKGROUND: Horse riding is associated with a high rate of injuries. The possibilities of prevention are limited because of deficient knowledge about the causes and mechanisms of equine-related accidents. In the present study 198 equine-related accidents were analyzed and based on these data risk groups were identified and guidelines to improve safety in horse riding were formulated. MATERIAL AND METHODS: In this 2-center study the accidents of 169 riders over a period of 12 months were analyzed. Data on equine-related patterns of injury and the resulting treatment were collated from the clinical records. Additionally, a questionnaire was completed on the day of trauma by the patients, which covered age, gender, the cause and mechanism of injury and the use of safety equipment at the time of the accident. RESULTS: There were 169 (85.5%) female and 29 (14.5%) male riders with a median age of 27.2 years (range 5-74 years). Of the riders 55 (27.8%) were aged 18 years or younger, 134 (67.7%) riders were treated as outpatients while 64 (32.3%) required hospitalization, 51 (25.8%) required surgical treatment, 66 (33.3%) used a helmet and 14 (7.1%) a body protector at the time of accident. DISCUSSION: Equestrians wear helmets increasingly more when riding but the willingness to wear body protectors is disappointing. Protective headgear has been proven to reduce the risk of injuries but based on these data a positive effect of body protectors could not be shown. In this study safety vest users suffered from injuries of the upper body more often than those who did not wear a body protector. Children and adolescents often overestimate their skills; therefore, teaching and supervision of inexperienced young riders along with the use of protective equipment can prevent major injuries.

[Reasons for underuse of oral anticoagulation in atrial fibrillation-associated stroke: prospective study of German stroke patients]. / Analyse des "Nichtgebrauchs" der oralen Antikoagulation zur Schlaganfallprävention bei Vorhofflimmern: Eine prospektive Studie.

Oral anticoagulation in atrial fibrillation (AF) is effective in primary and secondary prevention of cardioembolic stroke, but is often underused in practice. The detailed reasons for non-use of oral anticoagulation are less well known. We prospectively analyzed 105 consecutive cases of acute ischemic stroke associated with atrial fibrillation. Patients were investigated by a semi-structured interview. The most frequent reasons for underuse were: unknown AF (43 %). In case of known AF: reluctance of patients (30 %), contraindications (25 %) and compliance problems (20 %). There was good agreement between patients and physicians views about nonuse or aborted use of oral anticoagulation (kappa 0.64 and 0.93, respectively). Unknown atrial fibrillation is the most prevalent cause of underutilization of oral anticoagulation in acute stroke patients. Since atrial fibrillation is easy to detect in most cases, it could be worthwhile to screen elderly patients without contraindications for anticoagulation.

[Primary diagnosis and follow-up after thoracic trauma and lung contusion]. / Primär- und Verlaufsdiagnostik nach Thoraxtrauma und Lungenkontusion.

In 212 patients after injury of the thorax (54 males, 158 females; penetrating (15), blunt (197), multiple trauma (128)) 158 cases demonstrated rib fractures and 103 radiological proven pneumo- or hematothoraces or sometimes both, 108 of 138 had to be drained. 96.5% of the effusions and 98% of the pneumothoraces were clinical confirmed. 93.5% of 97 pulmonary contusions (79 unilateral, 18 bilateral) were detected by bronchoscopy within 10 h, 72% by x-ray. Caused by anatomical problems or for additional diagnosis 4 patients underwent thoracic CT. During ICU treatment 31 patients developed septic complications without detection in x-ray studies. In CT (n = 64) we found: 5 empyema, 13 pleural effusions, 4 pneumothoraces, 4 pneumocysts, 72 condensations of a lobe. After CT we performed: 9 resections of the lower lobe, 1 pneumectomy, 1 decortication, 7 thoracotomies with drainage, 8 drainages. To detect a septic focus under treatment the CT proved being an important diagnostic tool in chest trauma and lung contusion.