Analysis of factors influencing the degree of accidental injury of bicycle riders considering data heterogeneity and imbalance.

Bicycle safety has emerged as a pressing concern within the vulnerable transportation community. Numerous studies have been conducted to identify the significant factors that contribute to the severity of cyclist injuries, yet the findings have been subject to uncertainty due to unobserved heterogeneity and class imbalance. This research aims to address these issues by developing a model to examine the impact of key factors on cyclist injury severity, accounting for data heterogeneity and imbalance. To incorporate unobserved heterogeneity, a total of 3,895 bicycle accidents were categorized into three homogeneous sub-accident clusters using Latent Class Cluster Analysis (LCA). Additionally, five over-sampling techniques were employed to mitigate the effects of data imbalance in each accident cluster category. Subsequently, Bayesian Network (BN) structure learning algorithms were utilized to construct 32 BN models after pairing the accident data from the four accident cluster types before and after sampling. The optimal BN models for each accident cluster type provided insights into the key factors associated with cyclist injury severity. The results indicate that the key factors influencing serious cyclist injuries vary heterogeneously across different accident clusters. Female cyclists, adverse weather conditions such as rain and snow, and off-peak periods were identified as key factors in several subclasses of accident clusters. Conversely, factors such as the week of the accident, characteristics of the trafficway, the season, drivers failing to yield to the right-of-way, distracted cyclists, and years of driving experience were found to be key factors in only one subcluster of accident clusters. Additionally, factors such as the time of the crash, gender of the cyclist, and weather conditions exhibit varying levels of heterogeneity across different accident clusters, and in some cases, exhibit opposing effects.

Caracterización de los accidentes de tránsito en la provincia de Cienfuegos / Characterization of Traffic Accidents in Cienfuegos Province

Introducción: En la actualidad los accidentes de tránsito son considerados un serio problema de salud pública debido al número de lesionados y muertos que ocasionan, y a los recursos económicos que deben destinarse para su atención y recuperación. Objetivo: Caracterizar los accidentes de tránsito en la provincia de Cienfuegos durante el año 2019. Métodos: Se realizó un estudio descriptivo, retrospectivo, de corte transversal. El universo de estudio estuvo constituido por 300 lesionados en accidentes de tránsito en la provincia de Cienfuegos durante el año 2019, registrados por el Departamento de Estadística de Tránsito Provincial. Las variables utilizadas fueron: edad, sexo, lesiones leves, lesiones graves, fallecidos, municipio, horario de ocurrencia del hecho y causa del accidente. Resultados: Predominó el sexo masculino entre las víctimas, el 11,7 por ciento tenía entre 21 y 25 años. Las lesiones leves fueron las de mayor frecuencia. El municipio de mayor incidencia de los accidentes fue Cienfuegos (47 por ciento). Predominó el horario de 16:01 hasta las 20:00 horas. El 30,2 por ciento de los accidentes se originaron por no atender al control del vehículo. Conclusiones: Los accidentes de tránsito reportan un gran número de lesionados y fallecidos, lo que representa para los países un problema de salud, con un gran impacto en la esfera social y económica. Su prevención reviste una relevante importancia, donde la efectividad se logra con la colaboración entre los gobiernos y el sector sanitario (AU)

Introduction: Currently, traffic accidents are considered a serious public health problem, due to the number of injuries and deaths they cause, and the economic resources that must be allocated for their care and recovery. Objective: to characterize traffic accidents in Cienfuegos province during 2019. Methods: A descriptive, retrospective, cross-sectional study was carried out. The universe of study consisted of 300 injured subjects by traffic accidents in Cienfuegos province during 2019, and who were registered by the Provincial Department of Traffic Statistics. The variables used were age, sex, minor injuries, serious injuries, deceased, municipality, time of occurrence of the event and cause of the accident. Results: The male sex predominated among the victims, 11.7 percent were between 21 and 25 years old. Mild injuries were the most frequent. The municipality with the highest incidence of accidents was Cienfuegos (47 percent). The hours from 4:01 p.m. to 8:00 p.m. prevailed. 30.2 percent of the accidents originated from not paying attention to the control of the vehicle. Conclusions: Traffic accidents report a large number of injuries and deaths, which represents a health problem for the countries, with great impact on the social and economic sphere. Prevention is important, so that effectiveness is achieved with collaboration between governments and the health sector(AU)

The impact of helmet use on neurosurgical care and outcomes after pediatric all-terrain vehicle and dirt bike crashes: a 10-year single-center experience.

OBJECTIVE: All-terrain vehicle (ATV) and dirt bike crashes frequently result in traumatic brain injury. The authors performed a retrospective study to evaluate the role of helmets in the neurosurgical outcomes of pediatric patients involved in ATV and dirt bike crashes who were treated at their institution during the last decade. METHODS: The authors analyzed data on all pediatric patients involved in ATV or dirt bike crashes who were evaluated at a single regional level I pediatric trauma center between 2010 and 2019. Patients were excluded if the crash occurred in a competition (n = 70) or if helmet status could not be determined (n = 18). Multivariable logistic regression was used to analyze the association of helmet status with the primary outcomes of 1) neurosurgical consultation, 2) intracranial injury (including skull fracture), and 3) moderate or severe traumatic brain injury (MSTBI) and to control for literature-based, potentially confounding variables. RESULTS: In total, 680 patients were included (230 [34%] helmeted patients and 450 [66%] unhelmeted patients). Helmeted patients were more frequently male (81% vs 66%). Drivers were more frequently helmeted (44.3%) than passengers (10.5%, p < 0.001). Head imaging was performed to evaluate 70.9% of unhelmeted patients and 48.3% of helmeted patients (p < 0.001). MSTBI (8.0% vs 1.7%, p = 0.001) and neurosurgical consultation (26.2% vs 9.1%, p < 0.001) were more frequent among unhelmeted patients. Neurosurgical injuries, including intracranial hemorrhage (16% vs 4%, p < 0.001) and skull fracture (18% vs 4%, p < 0.001), were more common in unhelmeted patients. Neurosurgical procedures were required by 2.7% of unhelmeted patients. One helmeted patient (0.4%) required placement of an intracranial pressure monitor, and no other helmeted patients required neurosurgical procedures. After adjustment for age, sex, driver status, vehicle type, and injury mechanism, helmet use significantly reduced the odds of neurosurgical consultation (OR 0.250, 95% CI 0.140-0.447, p < 0.001), intracranial injury (OR 0.172, 95% CI 0.087-0.337, p < 0.001), and MSTBI (OR 0.244, 95% CI 0.079-0.758, p = 0.015). The unadjusted absolute risk reduction provided by helmet use equated to a number-needed-to-helmet of 6 riders to prevent 1 neurosurgical consultation, 4 riders to prevent 1 intracranial injury, and 16 riders to prevent 1 MSTBI. CONCLUSIONS: Helmet use remains problematically low among young ATV and dirt bike riders, especially passengers. Expanding helmet use among these children could significantly reduce the rates of intracranial injury and MSTBI, as well as the subsequent need for neurosurgical procedures. Promoting helmet use among recreational ATV and dirt bike riders must remain a priority for neurosurgeons, public health officials, and injury prevention professionals.

Pattern and risk factors for childhood injuries in Dar es Salaam, Tanzania.

BACKGROUND: Injuries contribute to morbidity and mortality in children. This study was carried out to describe the pattern of childhood injuries and associated risk factors in Dar es Salaam, Tanzania. METHODS: This case control study was conducted in six selected health facilities in Dar es Salaam, Tanzania. Data were collected using a structured questionnaire. Cases and controls were children below 18 years who had suffered injuries and those without injury associated condition respectively. RESULTS: A total of 492 cases and 492 controls were included in the study, falls (32%), burns (26%), Road Traffic Injuries (14%) and cuts (10%) were the major types of injuries identified. Younger parents/guardians {Adjusted odds ratio (AOR)= 1.4; 95% CI: 1.4 -3.6}, more than six people in the same house (AOR= 1.8; 95% CI: 1.3-2.6), more than three children in the house {AOR= 1.4; 95% CI (1.0-2.0)}, absence of parent/guardian at time of injury occurrence (AOR= 1.6; 95% CI: 1.1-2.3), middle socio-economic (AOR=1.6; 95%CI: 1.1-2.4) and low socio-economic status (AOR= 1.5; 95% CI: 1.0-2.1) were independent risk factors for childhood injury. CONCLUSION: Falls, burns and road traffic injuries were the main injury types in this study. Inadequate supervision, overcrowding, lower socio-economic status and low maternal age were significant risk factors for childhood injuries.

Injury Characteristics and Predisposing Effects of Various Outdoor Traumatic Situations in Children and Adolescents.

BACKGROUD: Many studies have reported injury characteristics of individual traumatic situations. However, a comparative analysis of specific risks is meaningful to better understand injury characteristics and help establish injury-prevention measures. This study was conducted to investigate and compare injury characteristics in children and adolescents by various outdoor traumatic situations. METHODS: Outdoor traumatic situations were determined and classified into physical activity-related injury (n = 3,983) and pedestrian (n = 784) and passenger (n = 1,757) injuries in traffic accidents. Home injury (n = 16,121) was used as the control group. Then, the characteristics of each outdoor trauma were compared with 1:1 matched indoor trauma (among home injuries); each outdoor traumatic situation's predisposing risk for the injured body part, injury type, and injury severity were analyzed; and changes by age of frequency ranking among physical activity-related injuries were investigated. RESULTS: Outdoor trauma showed higher risks for limb injuries (injured body part), fracture and muscle/tendon injuries (injury type), and severe injuries (severity) than indoor trauma. Various outdoor traumatic situations presented different predisposing effects on injury characteristics. Among physical activity-related injuries, bicycle injury was commonest across all ages, and playing activities were common causes for injury for individuals of age < 9 years, whereas sports activities overwhelmed the common causes thereafter. CONCLUSIONS: The findings would help to better understand the specific injury risk of various outdoor traumatic situations and may potentially facilitate the establishment of more effective injury-prevention measures.

Risk factors of unintentional injury among children in New Zealand: a systematic review.

OBJECTIVE: To identify contemporary studies investigating multifaceted and inter-linked contributory frameworks for unintentional injuries among children in New Zealand. METHODS: A literature review was performed in seven databases. Studies published in English up to February 2020 reporting risk factors for child injury in New Zealand were included. Eligible study designs included: cohort, case-control and case-crossover studies. The quality of studies was assessed using the GATE frame tool. The PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) reporting guidelines were followed. RESULTS: Thirteen studies fulfilled the inclusion criteria, dating from 1977 to 2008. The factors associated with child injury (0 to 14 years) included socioeconomic disadvantage, number of children, younger maternal age and sole parents. Vehicle speed and traffic volume were associated with an increased risk of driveway-related pedestrian injury. CONCLUSION: The review findings have reinforced the need for cross-agency action to address the social determinants of child injury. Implications for public health: Contemporary longitudinal studies are needed to assist in understanding how the interactions between children, family and their wider societal context affect their risk of experiencing injury over time.

Quantitative sonographic assessment of quadriceps muscle thickness for fall injury prediction in patients undergoing maintenance hemodialysis: an observational cohort study.

BACKGROUND: Accidental fall risk is high in patients undergoing maintenance hemodialysis. Falls are associated with fatal injury, comorbidities, and mortality. Risk assessment should be a primary component of fall prevention. This study investigated whether quadriceps muscle thickness measured using ultrasonography can predict fall injury among dialysis patients. METHODS: Using an observational cohort study design, 180 ambulatory hemodialysis patients were recruited from 2015 to 2016 from four dialysis clinics. The sum of the maximum quadriceps muscle thickness on both sides and the average of the maximum thigh circumference and handgrip strength after hemodialysis were calculated. Patients were stratified according to tertiles of quadriceps muscle thickness. Fall injury was surveyed according to the patient's self-report during the one-year period. RESULTS: Among the 180 hemodialysis patients, 44 (24.4%) had fall injuries during the 12-month follow-up period. When the quadriceps muscle thickness levels were stratified into sex-specific tertiles, patients in the lowest tertile were more likely to have a higher incidence of fall injury than those in the higher two tertiles (0.52 vs. 0.19 and 0.17 fall injuries/person-year). After adjusting for covariates, lower quadriceps muscle thickness was found to be an independent predictor of fall injury (hazard ratio [95% confidence interval], 2.33 [1.22-4.52], P < 0.05). Receiver operating characteristic curves were constructed to determine the optimal cutoffs of quadriceps muscle thickness, thigh circumference, and handgrip strength that best predicted fall injury (quadriceps muscle thickness, 3.37 cm and 3.54 cm in men and women; thigh circumference, 44.6 cm and 37.2 cm in men and women; and handgrip strength, 23.3 kg and 16.5 kg in men and women). Using these cutoff values, the areas under the curve were 0.662 (95% CI, 0.576-0.738), 0.625 (95% CI, 0.545-0.699), and 0.701 (95% CI, 0.617-0.774), for quadriceps muscle thickness, thigh circumference, and handgrip strength, respectively. Quadriceps muscle thickness was a more precise predictor of fall injury than thigh circumference and had similar diagnostic performance as handgrip strength tests in dialysis patients. CONCLUSIONS: Quadriceps muscle thickness can be measured easily at the bedside using ultrasonography and is a precise predictor of fall injury in patients undergoing maintenance hemodialysis.

Glass table tops: An unusual source of lethal domestic injury.

A 42-year-old woman who fell through a glass tabletop had her lower back pierced by a long shard of glass. She rapidly exsanguinated. At autopsy, a single penetrating wound was present in her left lower back, with complete transection of her left kidney and a 3.5 L haematoperitoneum. Death was due to exsanguination following accidental transection of the left kidney by a penetrating glass injury of the lower back. Glass-topped tables are a well-recognised source of injury in a domestic setting There are far more non-lethal than lethal injuries, many of which involve children. Quite long shards may remain undetected in wounds for considerable amounts of time. Non-tempered glass is a particular risk for breakage. Glass-topped tables should not be used as substitutes for chairs, particularly in overweight or obese individuals.

Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald.

OBJECTIVE: To demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald. DESIGN: Prospective multicentre cross-sectional study. SETTING: 20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units. PATIENTS: Children aged 5 years and younger who attended hospital with a scald. MAIN OUTCOME MEASURES: Primary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral. RESULTS: Of 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (p<0.0001), as were those with symmetrically distributed (p<0.0001) and unwitnessed (p=0.007) scalds. CONCLUSIONS: An understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds.

Fall-related hospitalization of patients in Iran.

PURPOSE: Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional accidents. The aim of this study was to investigate the different types of fall according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in hospitalized patients visiting specialized accident and trauma hospitals of Mashhad, Iran. METHODS: This was a cross sectional retrospective study performed between March 20, 2013 and March 20, 2014. The research population consisted of all medical records of patients for fall injuries in three specialized accident and trauma hospitals. ICD-10 was adopted to categorize all types of falls (w00-w19). The results obtained were analyzed by SPSS 16. RESULTS: Altogether 7,448 cases were included. The codes w18 (fall on same level) and w09 (fall involving playground equipment) with the frequencies of 1,856 and 1,303, respectively in both genders had the maximum number of falls. The maximum percentage of mortality has been related to "fall on and from ladder"," fall from cliff "and "fall on same level involving ice and snow". CONCLUSION: As falls can cause irrecoverable injuries including mortality of people, thus health authorities and policymakers should take preventive measures given the causes of falls and the root of this type of injuries, so that the costs resulting from this cause and its injuries can be reduced.

Magnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019.

OBJECTIVE: To examine, using the National Poison Data System (the data warehouse for poison control centers in the US), magnet foreign body injuries in pediatric patients. We sought to report demographic data, outcome data, and case trends between 2008 and 2019. STUDY DESIGN: We conducted a retrospective analysis of the National Poison Data System for patients younger than 19 years of age with a magnet "exposure," which poison centers define as an ingestion, inhalation, injection, or dermal exposure to a poison. RESULTS: A total of 5738 magnet exposures were identified. Most were male (3169; 55%), <6 years old (3572; 62%), with an unintentional injury (4828; 84%). There were 222 patients (3.9%) with a confirmed medical "effect," defined as signs, symptoms, and clinical findings not including therapeutic interventions (eg, endoscopy). There was a 33% decrease in cases from 418 (2008-2011) to 281 per year (2012-2017) after high-powered magnet sets were removed from the market. Calls subsequently increased 444% to 1249 per year (2018-2019) after high-powered magnet sets re-entered the market. Cases from 2018 and 2019 increased across all age groups and account for 39% of magnet cases since 2008. CONCLUSIONS: Significant increases in magnet injuries correspond to time periods in which high-powered magnet sets were sold, including a 444% increase since 2018. These results reflect the increased need for preventative or legislative efforts.

Machine Learning in Aging: An Example of Developing Prediction Models for Serious Fall Injury in Older Adults.

BACKGROUND: Advances in computational algorithms and the availability of large datasets with clinically relevant characteristics provide an opportunity to develop machine learning prediction models to aid in diagnosis, prognosis, and treatment of older adults. Some studies have employed machine learning methods for prediction modeling, but skepticism of these methods remains due to lack of reproducibility and difficulty in understanding the complex algorithms that underlie models. We aim to provide an overview of two common machine learning methods: decision tree and random forest. We focus on these methods because they provide a high degree of interpretability. METHOD: We discuss the underlying algorithms of decision tree and random forest methods and present a tutorial for developing prediction models for serious fall injury using data from the Lifestyle Interventions and Independence for Elders (LIFE) study. RESULTS: Decision tree is a machine learning method that produces a model resembling a flow chart. Random forest consists of a collection of many decision trees whose results are aggregated. In the tutorial example, we discuss evaluation metrics and interpretation for these models. Illustrated using data from the LIFE study, prediction models for serious fall injury were moderate at best (area under the receiver operating curve of 0.54 for decision tree and 0.66 for random forest). CONCLUSIONS: Machine learning methods offer an alternative to traditional approaches for modeling outcomes in aging, but their use should be justified and output should be carefully described. Models should be assessed by clinical experts to ensure compatibility with clinical practice.

Hit-and-runs more common with pedestrians lying on the road: Analysis of a nationwide database in Japan.

PURPOSE: To determine the trends with fatally or otherwise injured pedestrians lying on the road and the relationship to hit-and-run incidents in Japan. METHODS: We extracted data for 2012-2016 from the records of the Institute for Traffic Accident Research and Data Analysis, Japan, a nationwide traffic accident database. All the injured and fatally injured pedestrians were selected. We examined the levels of pedestrian injury, vehicle speed immediately before the collision, whether or not the pedestrian was lying on the road, and hit-and-run incidents. Chi-square test was employed to make a statistical comparison between the two groups. RESULTS: The database contained data on 286,383 pedestrian casualties and 7256 fatalities; 8.3% of fatalities (602 persons) and 0.6% of casualties (1827 persons) involved pedestrians lying on the road. The rates of fatalities and severe injuries were significantly higher for pedestrians who were lying on the road than for those who were not. Hit-and-run incidents were evident in 4.0% of casualties and 7.3% of fatalities. The rate of hit-and-run cases was also significantly higher among pedestrians who were lying on the road. Among fatally injured pedestrians not lying on the road, the rates with speeds of ≥30 km/h did not differ significantly between hit-and-run and other cases. However, when the pedestrians were lying on the road, the rate was significantly increased in hit-and-run cases. CONCLUSION: This is the first report to focus on pedestrians lying on the road and being involved in hit-and-run incidents. In addition to preventing hit-and-run incidents, prevention of pedestrians lying on the road could also decrease fatalities.

High prevalence of unintentional injuries and socio-psychological correlates among school-going adolescents in Timor-Leste.

OBJECTIVES: The study aimed to report on the prevalence and socio-psychological correlates of non-fatal injury among school-going adolescents in Timor-Leste. METHODS: Cross-sectional data from the 2015 Timor-Leste "Global School-based Health Survey (GSHS)" included 3,704 school children (median age 16 years, interquartile range 3) that were representative of all students in secondary school, excluding grade 12. RESULTS: The proportion of participants with one or multiple serious injuries in the past year was 70.0% (40.6% once, 17.2% two-three times and 12.2% 4-12 times). The most frequent cause of the reported injury were "I fell" (33.8%) and motor vehicle (10.2%) and the most common type of injury was "a broken bone or dislocated joint" (7.8%) and "cut, puncture or stab wound" (6.7%). In adjusted multinomial logistic regression analysis, suicide attempt was associated with one injury, and truancy was associated with both one and multiple injury. Current tobacco use, lifetime cannabis use, soft drink consumption, and loneliness were associated with multiple injuries. CONCLUSIONS: Several variables were identified that could be targeted in injury prevention programmes in this school population.

The prognostic value of platelet-to-lymphocyte ratio on in-hospital mortality in admitted adult traffic accident patients.

BACKGROUND: The predictive value of platelet-to-lymphocyte ratio (PLR) in acute illness is well known, but further evaluation is needed in traffic accident patients. METHODS: This retrospective observational study enrolled consecutive adult patients involved in traffic accidents who were admitted to the study hospital's emergency department during 1 year. The initial platelet and lymphocyte counts after arrival at the emergency department were the variables of interest. The primary outcome was in-hospital mortality. Data on baseline characteristics, comorbidities, and physiological and laboratory variables were collected. Multivariate Cox proportional hazard modelings were used to identify the variables independently associated with the outcome. RESULTS: A total of 1,522 traffic accident patient were screened, and 488 patients were enrolled. In all, 43 (8.8%) patients died in the hospital. The median PLR was 115.3 (interquartile range 71.3;181.8). The in-hospital mortality rate of the 1st tertile of PLR (21.5%) was significantly higher than the rates of the 2nd (2.5%) and 3rd (2.5%) tertiles. The area under the receiver operating characteristic curve of PLR for in-hospital survival was 0.82 (95% confidential interval [CI], 0.74-0.89), which was greater than that of lymphocyte count (0.72; 95% CI 0.63-0.81) and platelet count (0.67; 95% CI 0.57-0.76). The Kaplan-Meier curves showed a significant difference in survival between the tertiles (p<0.001). The Cox regression model showed that the 2nd tertile of PLR was independently associated with lower in-hospital mortality (adjusted hazard ratio 0.30; 95% CI, 0.09-0.98), compared to the 1st tertile. CONCLUSION: PLR was significantly associated with an increased risk of in-hospital mortality in admitted adult traffic accident patients.

[A focal abdominal swelling after an accident with a 'space scooter']. / Een zwelling van de buik na een val op een 'space scooter'.

A 7-year-old boy presents at the Emergency Department with an abdominal swelling after an accident with a space scooter. He was diagnosed with a traumatic anterior abdominal wall hernia, for which he underwent surgical correction.

Establishment of a road traffic trauma registry for northern Sri Lanka.

Road traffic injuries are a neglected global public health problem. Over 1.25 million people are killed each year, and middle-income countries, which are motorising rapidly, are the hardest hit. Sri Lanka is dealing with an injury-related healthcare crisis, with a recent 85% increase in road traffic fatality rates. Road traffic crashes now account for 25 000 injuries annually and 10 deaths daily. Development of a trauma registry is the foundation for injury control, care and prevention. Five northern Sri Lankan provinces collaborated with Jaffna Teaching Hospital to develop a local electronic registry. The Centre for Clinical Excellence and Research was established to provide organisational leadership, hardware and software were purchased, and data collectors trained. Initial data collection was modified after implementation challenges were resolved. Between 1 June 2017 and 30 September 2017, 1708 injured patients were entered into the registry. Among these patients, 62% were male, 76% were aged 21-50, 71.3% were motorcyclists and 34% were in a collision with another motorcyclist. There were frequent collisions with uncontrolled livestock (12%) and with fixed objects (14%), and most patients were transported by private vehicles without prehospital care. Head (n=315) and lower extremity (n=497) injuries predominated. Establishment of a trauma registry in low-income and middle-income countries is a significant challenge and requires invested local leadership; the most challenging issue is ongoing funding. However, this pilot registry provides a valuable foundation, identifying unique injury mechanisms, establishing priorities for prevention and patient care, and introducing the concept of an organised system to this region.

An evaluation of scooter injury and injury patterns following widespread adoption of E-scooters in a major metropolitan area.

OBJECTIVE: Despite the increasing use of e-scooters globally, the pattern of injuries on diagnostic imaging had not been well-documented to date. We performed a retrospective study utilizing our health system's radiology database to characterize the injury distribution and imaging features of scooter injuries. METHODS: We utilized our radiology report database searching for any imaging report containing the word "scooter", beginning September 1, 2017, when scooters were first introduced to our area through December 1, 2018. RESULTS: Our search yielded a total of 54 patients with 105 imaging studies. The injuries predominantly affected the musculoskeletal system, with a predilection to the upper extremity. We had no cases of visceral or neurotrauma. CONCLUSION: Musculoskeletal injuries were the predominant form of scooter injury. The lack of visceral injury suggests that emergency physicians should consider having a higher clinical threshold for ordering these studies in patients with scooter injuries.

Extracorporeal Shock Wave Therapy for Pain Relief After Arthroscopic Treatment of Osteochondral Lesions of Talus.

Arthroscopic treatment is an effective technique for osteochondral lesion of talus (OLT); however, some patients still suffer pain and limitation of activities after surgery. The purpose of this study was to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) after ankle arthroscopy for OLT. We reviewed the clinical history of a series of 78 patients with OLT who underwent arthroscopic microfracture. ESWT was prescribed for 15 patients who complained of ankle pain and restriction of weightbearing activities 3 months postoperatively. The parameters assessed were visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale scores (before ESWT, at 6 and 12 weeks, and at last follow-up after ESWT) and magnetic resonance imaging (MRI) before and 1 year after ESWT. Follow-up was 27.8 ± 15.2 months. VAS and AOFAS scores showed a significant improvement at 12 weeks after ESWT and a progressive trend at last follow-up. Areas of lesions in sagittal plane in MRI were distinctly reduced at last follow-up. ESWT for osteochondral lesions of talus after arthroscopy results in good clinical outcomes.