Could changes in the wheelchair delivery system improve safety?

Despite emerging evidence about the high incidence and severity of wheelchair-related injuries, regulations governing wheelchair safety are almost nonexistent in Canada. The authors believe that, to improve wheelchair safety, a concerted effort by government, manufacturers, purchasing groups, users and clinicians is needed. Health Canada''s Health Protection Branch should treat wheelchairs as medical devices (as defined in the Food and Drugs Act 1985) and improve its injury-reporting network. Manufacturers should give a higher priority to safety in wheelchair design, improve their educational materials and formalize postmarketing surveillance. Purchasing groups should try to ensure that they do not stifle innovation in wheelchair design by setting unrealistic reimbursement ceilings and should use their market power more effectively. Users should obtain their wheelchairs in specialized settings, heed safety warnings and make more effective use of litigation when such action is warranted. Clinicians should ensure that patients are equipped with the most appropriate wheelchair for their needs, that they are given adequate training in safe wheelchair use and that they understand the dangers involved. Rapid changes in wheelchair technology and emerging evidence about the high incidence and severity of injuries related to wheelchair use suggest that such changes are needed in the wheelchair delivery system.     

Morbidity and mortality of car occupants: comparative survey over 24 months.

The severity of injuries sustained by 2577 car occupants in road traffic accidents in the catchment area of one district accident service during February 1982 to January 1984 inclusive was assessed using the injury severity score system. In the first 12 months the mean injury severity score for front seat occupants injured in a road traffic accident was 4.94 and in the second 12 month period, after the implementation of the seat belt law, the mean injury severity score of all injured front seat occupants was 2.80. These figures indicated a reduction in injury severity of front seat occupants of 53.4% on the previous 12 month figures. The severity of injury sustained by unbelted front seat occupants and back seat passengers showed no significant change over the two years. The number of front seat occupants killed or sustaining serious injuries (injury severity score greater than 12) showed a reduction of 54% in the 12 months beginning February 1983. Front seat occupants requiring admission for injuries sustained showed a decline of 42% in the 12 months after the introduction of the seat belt law, and deaths among front seat occupants fell by 27% compared with the previous 12 months. After the implementation of seat belt legislation those front seat occupants killed or sustaining serious injuries included a significantly higher proportion of victims who were not wearing their seat belts or showed positive evidence of alcohol intake at the time of the accident. This series suggests that the incidence of serious injury or deaths among front seat occupants of cars has decreased substantially since the seat belt law became effective on 31 January 1983.     

Weapons injuries during and after periods of conflict: retrospective analysis.

OBJECTIVE: To assess the relative frequency of weapon injuries during conflict and after periods of conflict in the absence of disarmament. DESIGN: Retrospective analysis of a database of war wounds. SETTING: Region with a protracted conflict between rival combatant groups and a subsequent transition to the uncontested military authority of a single power. SUBJECTS: 2332 people who received weapons injuries during the conflict or post-conflict periods and were admitted to hospital within 24 hours of injury. MAIN OUTCOME MEASURES: Percentage change in mean monthly admission rate by weapon type between conflict and post-conflict periods; annual incidence of injury by weapon type during conflict and post-conflict periods; percentage change in annual incidence by weapon type between conflict and post-conflict periods. RESULTS: Mean monthly admission rates for injuries from fragmentation munitions decreased by 8% between conflict and post-conflict periods and by 23% for injuries from mines and 32% for gunshot injuries. The decline in admissions for all injuries was 23%. After adjustment for population growth over the study period, declines in annual incidence were 22% for fragmentation munitions injuries, 34% for mine injuries, and 40% for gunshot injuries. The decline in incidence for all injuries was 33%. In-hospital mortality from weapons related injuries increased from 2.5% to 6.1% (P < 0.001) between conflict and post-conflict periods. CONCLUSIONS: In this setting, continued availability of weapons is associated with increased mortality and a level of injuries from weapons that is only somewhat reduced from that observed during a period of conflict.     

Epidemiology of training injuries in amateur taekwondo athletes: a retrospective cohort study

The objectives of this study were to estimate the incidence and describe the pattern and severity of training injuries in taekwondo, and to compare pattern and severity of training injuries with competition injuries. One hundred and fifty-two active Australian amateur taekwondo athletes, aged 12 years or over, completed an online survey comprising questions on training exposure and injury history over the preceding 12 months. The main outcome measures were: overall injury incidence rate per athlete-year; training injury incidence rate per athlete-year, per 1000 athlete-training-sessions, and per 1000 athlete-hours of training; injury severity; and injury proportions by anatomical region and by type of injury. Injury incidence rates were calculated with 95% confidence intervals using standard methods, while injury proportions were compared using Fisher''s exact test. The vast majority (81.5%) of taekwondo injuries in an average athlete-year occurred during training. The training injury incidence rate was estimated to be 1.6 (95% CI: 1.4, 1.9) per athlete-year, 11.8 (95% CI: 10.4, 13.4) per 1000 athlete-training-sessions, and 7.0 (95% CI: 6.1, 7.9) per 1000 athlete-hours of training. Among athletes with five or fewer injuries, the severity and injury pattern of training injuries were, by and large, the same as for competition injuries. Approximately sixty percent (60.3%) of training injuries required treatment by a health professional. Considering the burden of training injuries exceeds that of competition injuries, taekwondo governing bodies and stakeholders are encouraged to devote more efforts towards the identification of risk factors for, and prevention of, training injuries in the sport of taekwondo.     

Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers.

OBJECTIVES--To study circumstances of bicycle accidents and nature of injuries sustained and to determine effect of safety helmets on pattern of injuries. DESIGN--Prospective study of patients with cycle related injuries. SETTING--Accident and emergency department of teaching hospital. SUBJECTS--1040 patients with complete data presenting to the department in one year with cycle related injuries, of whom 114 had worn cycle helmets when accident occurred. MAIN OUTCOME MEASURES--Type of accident and nature and distribution of injuries among patients with and without safety helmets. RESULTS--There were no significant differences between the two groups with respect to type of accident or nature and distribution of injuries other than those to the head. Head injury was sustained by 4/114 (4%) of helmet wearers compared with 100/928 (11%) of non-wearers (P = 0.023). Significantly more children wore helmets (50/309 (16%)) than did adults (64/731 (9%)) (P < 0.001). The incidence of head injuries sustained in accidents involving motor vehicles (52/288 (18%)) was significantly higher than in those not involving motor vehicles (52/754 (7%)) (chi 2 = 28.9, P < 0.0001). Multiple logistic regression analysis of probability of sustaining a head injury showed that only two variables were significant: helmet use and involvement of a motor vehicle. Mutually adjusted odds ratios showed a risk factor of 2.95 (95% confidence interval 1.95 to 4.47, P < 0.0001) for accidents involving a motor vehicle and a protective factor of 3.25 (1.17 to 9.06, P = 0.024) for wearing a helmet. CONCLUSION--The findings suggest an increased risk of sustaining head injury in a bicycle accident when a motor vehicle is involved and confirm protective effect of helmet wearing for any bicycle accident.     

Non-fatal injuries sustained by back seat passengers.

Of 2,275 cases of non-fatal injuries sustained by all categories of road users 185 were inflicted on back seat passengers. Twenty-six such passengers sustained severe and 66 moderately severe injuries. Only two patients (aged 18 months and 3 years) wore any form of restraint. Back seat passengers may be injured by impact with the rear of the front seat or other objects in the rear compartment; by objects in the front compartment; or by being thrown out of the car completely. An adequate restraint system, such as the lap-and-diagnoal type of seat belt, would reduce the incidence and severity of injuries.     

Shell abnormalities in scaphitid ammonites

The kinds incidence of shell abnormalities were investigated in over 2000 adult Late Cretaceous scaphitid ammonites. Most are species of Hoploscaphites Discoscaphites from the Maastrichtian Fox Hills Formation; for comparison, four older species of Scaphites were also studied. Four kinds of abnormalities vary in their incidence among the Fox Hills taxa but display no general trends. (1) Morton's syndrome, shell asymmetry unrelated to external injury, occurs in 3 to 6% of the Fox Hills scaphites. (2) Suture wander. veering-off of the ventral lobe of the suture from the midline of the venter, occurs in most Fox Hills taxa with an incidence ranging from 1 to 11%. (3) Stretch pathology, an attenuation of the shell on the posterior part of the adult body chamber, is confined to Hoploscaphifes nicolleti. (4) Externally inflicted injury, indicated by repaired damage on mature shells, has an average incidence of 10% in Fox Hills scaphites except in the stratigraphically youngest H. nebrascensis H. cheyennewis which approach 25 40% respectively. Good correlation between percent injuries adult size ornamentation is obtained only in Discoscaphifes; all morphs of the co-occurring Hoploscaphites display nearly the same incidence of injuries regardless of their morphologic variation. The stratigraphically youngest H. nebrascensis becomes larger more nodose simultaneously sustains more injuries. However, its dimorph H. cheyennensis remains morphologically unchanged although its incidence of injuries quadruples. These injury data, in themselves, do not support the hypothesis that predators were contributing more heavily to the mortality of Maastrichtian ammonites precipitated their extinction.     

Effects of BMI on the risk and frequency of AIS 3+ injuries in motor‐vehicle crashes

Objective: Determine the effects of BMI on the risk of serious‐to‐fatal injury (Abbreviated Injury Scale ≥ 3 or AIS 3+) to different body regions for adults in frontal, nearside, farside, and rollover crashes. Design and Methods: Multivariate logistic regression analysis was applied to a probability sample of adult occupants involved in crashes generated by combining the National Automotive Sampling System (NASS‐CDS) with a pseudoweighted version of the Crash Injury Research and Engineering Network database. Logistic regression models were applied to weighted data to estimate the change in the number of occupants with AIS 3+ injuries if no occupants were obese. Results: Increasing BMI increased risk of lower‐extremity injury in frontal crashes, decreased risk of lower‐extremity injury in nearside impacts, increased risk of upper‐extremity injury in frontal and nearside crashes, and increased risk of spine injury in frontal crashes. Several of these findings were affected by interactions with gender and vehicle type. If no occupants in frontal crashes were obese, 7% fewer occupants would sustain AIS 3+ upper‐extremity injuries, 8% fewer occupants would sustain AIS 3+ lower‐extremity injuries, and 28% fewer occupants would sustain AIS 3+ spine injuries. Conclusions: Results of this study have implications on the design and evaluation of vehicle safety systems.     

Occupational accidents and injuries in construction industry in Jeddah city

In Saudi Arabia, the construction industry has been growing remarkably during the past several years. However, the most hazardous worksites in the country may be found in this industry. This study identified the causes of accidents and injuries in the construction industry among 300 workers in Jeddah City, situated on the coast of the Red Sea. Results from the questionnaire showed that the major cause of accidents and injuries is the lack of awareness about occupational safety and lack of experience among the workers (>82%); and the most common type of accidents and injuries that occur in the construction industry, are workers falling from a height (>80%), and electrical shock (>60%). Recommendations to prevent accidents and injuries in this industry are provided in this paper.     

A General Framework For Prioritizing Research To Reduce Injuries And Diseases in Mining

A strategy for prioritizing mining health and safety research by evaluating the potential for risk reduction through interventions is proposed. Mining has one of the highest incidence rates of injury and disease found in major industries. The main premise of this paper is that often the best opportunities to reduce these rates are not revealed by retrospective analysis of injury and illness data. Instead, a proactive approach is needed that accounts for risks to specific hazards that can be abated by engineering or behavioral interventions. The process proposed here begins with development of prospective interventions. The degree of reduction in risk to be expected from an intervention then is determined from statistics on the mining worker population, the expected degree of success of the intervention, and the expected change in the severity of injuries resulting from the intervention. Three disparate mining health and safety concerns are presented to demonstrate common problems in assessing risks of injury and illness and describe additional data needs. Information on events preceding injuries and illnesses and more detailed demographic data on the mining work force are needed to analyze injury and illness data more precisely. Detailed information on exposure to specific hazards is necessary to evaluate the potential for an intervention to reduce risk of injury or illness.     

Children Domestic Accidents Profile in Jazan Region,a call for new policies to improve safety of home environment

High-frequency home accidents draw more attention to the protection of our home environment. WHO has reported that home deaths were among the first 20 causes of death in the 0–14 age group worldwide in 2012. This innovative research was designed to examine children under 15 years of age at home, in 2018 in the Jazan area of Saudi Arabia. Data were collected retrospectively from 19 hospitals in the Jazan area of southern Saudi Arabia during the period from September to December 2019. Data showed that, for the first time, the incidence rate of child home incidents in the Jazan area was 7.4 per 100 children in 2018. Falling, burning, swallowing foreign bodies, and domestic violence were among the most common types of injuries recorded. Home safety continued to be one of the main public health issues in the area with 29,812 home injuries in 1 year, 36.8% bone fractures, 31.6% body distortions, 9.2% distortion fractures and 5.3% child impairment. This study is a crucial step towards addressing the severity of home accidents in Saudi Arabia; troubling figures need further analysis, regular registry, informed policies and well-planned action to avoid these types of accidents.     

Incidence of injury in kickboxing participation

Cardio kickboxing classes have become a popular form of exercise to enhance fitness. This study surveyed kickboxing participants and instructors to ascertain the severity, type, and incidence of injuries sustained while performing cardio kickboxing exercise. The respondents consisted of 77.4% instructors and 29.3% participants with a mean age of 32.29 years (+/-8.98 years). Injury from kickboxing exercise was reported by 29.3% of the respondents, 31% of the instructors, and 15.5% of the participants. The most common site of injury for instructors was the back, followed by the knee, hip, and shoulder. The most common site of injury for participants was the back, knee, and ankle. Strains were the most common type of injury reported, followed by sprains and tendinitis. More than half of the injuries reported were new injuries (64%), with almost 59% of the total injuries reported causing a disruption of the normal exercise routine or an alteration of normal daily activities. Instructors who reported using music speeds greater than 140 beats per minute had a higher incidence of injury, compared with instructors who used music between 125 and 139 beats per minute. The wrist and elbow had the highest percentage of new injuries reported. This study suggests that kickboxing exercise can be a safe form of exercise for fitness purposes. Keeping music speeds below 140 beats per minute and limiting the number of kickboxing sessions per week may help to reduce injury rates.     

Persistence of Health Inequalities in Childhood Injury in the UK; A Population-Based Cohort Study of Children under 5

BackgroundInjury is a significant cause of childhood death and can result in substantial long-term disability. Injuries are more common in children from socio-economically deprived families, contributing to health inequalities between the most and least affluent. However, little is known about how the relationship between injuries and deprivation has changed over time in the UK.MethodsWe conducted a cohort study of all children under 5 registered in one of 495 UK general practices that contributed medical data to The Health Improvement Network database between 1990–2009. We estimated the incidence of fractures, burns and poisonings by age, sex, socio-economic group and calendar period and adjusted incidence rate ratios (IRR) comparing the least and most socio-economically deprived areas over time. Estimates of the UK annual burden of injuries and the excess burden attributable to deprivation were derived from incidence rates.ResultsThe cohort of 979,383 children experienced 20,804 fractures, 15,880 burns and 10,155 poisonings, equating to an incidence of 75.8/10,000 person-years (95% confidence interval 74.8–76.9) for fractures, 57.9 (57.0–58.9) for burns and 37.3 (35.6–38.0) for poisonings. Incidence rates decreased over time for burns and poisonings and increased for fractures (p<0.001 test for trend for each injury). They were significantly higher in more deprived households (IRR test for trend p<0.001 for each injury type) and these gradients persisted over time. We estimate that 865 fractures, 3,763 burns and 3,043 poisonings could be prevented each year in the UK if incidence rates could be reduced to those of the most affluent areas.ConclusionsThe incidence of burns and poisonings declined between 1990 and 2009 but increased for fractures. Despite these changes, strong socio-economic inequalities persisted resulting in an estimated 9,000 additional medically-attended injuries per year in under-5s.     

Training injuries in rugby league: an evaluation of skill-based conditioning games

This study investigated the site and nature of rugby league training injuries, and identified the training activities that were most likely to result in injury in rugby league players. The incidence of training injuries was prospectively studied in 60 semiprofessional rugby league players over 1 season. Injury data was collected from 72 training sessions, which included all preseason and in-season training sessions. Injuries were described according to site, type, and the training activity performed at the time of injury. The majority of injuries (90.9 per 1000 training hours, 37.5%) were sustained in traditional conditioning activities that involved no skill component (i.e., running without the ball). In contrast, the incidence of injuries sustained while participating in skill-based conditioning games (26.0 per 1000 training hours, 10.7%) was low. These results suggest that skill-based conditioning games offer a safe, effective method of conditioning for rugby league players.     

医学干预对武警某部军事训练伤的影响

目的：探讨医学干预对南方某武警部队战士训练伤发生情况的影响。方法：随机将南方某武警部队的一大队,按照干预措施施训,作为干预组;另一大队按照以往常规方法进行训练,不加任何干预措施,作为对照组。观察6个月内的两大队（干预组和对照组）的训练伤发生情况。结果：骨关节和软组织损伤为常见。实施医疗干预可有效降低军事训练伤的发生率（17．95％〈29．18％）,其主要效果在于大幅度降低了骨关节损伤的发生率（6．53％〈10.31％）和软组织损伤的发生率（5．59％〈9．92％）。结论：实施医学干预可有效降低我武警部队军事训练伤的发生率。     

Floor anchorage load and safety space for adult wheelchair users during a crash

Over the last 20 years in France as well as generally in Europe and also in North America, the integration of disabled people into society has become a more and more pressing issue. Work is in progress to increase the safety level of wheelchair occupants up to becoming equivalent to that of able-bodied road vehicles occupants. Present world practices are that wheelchair occupants who are unable to transfer to a vehicle seat for transportation remain in their wheelchair, which is secured to the vehicle floor using tie downs, and the occupant is restrained in the wheelchair. The aim of this paper was to perform a series of crash tests to make sure that the current standards are suitable to identify possible failures in safety in the restraint systems intended for wheelchair users. To date, there is no specific regulatory criterion related to floor anchorage for wheelchairs in vehicles during a crash. At a 48 km/h crash test, loads reached 30 kN on rear anchorage, and 13 kN on shoulder belt. Also the kinematics analysis of the wheelchair user during impact pointed out dimension of his safety space.     

Retrospective Cohort Analysis of Chest Injury Characteristics and Concurrent Injuries in Patients Admitted to Hospital in the Wenchuan and Lushan Earthquakes in Sichuan,China

Background

The aim of this study was to compare retrospectively the characteristics of chest injuries and frequencies of other, concurrent injuries in patients after earthquakes of different seismic intensity.

Methods

We compared the cause, type, and body location of chest injuries as well as the frequencies of other, concurrent injuries in patients admitted to our hospital after the Wenchuan and Lushan earthquakes in Sichuan, China. We explored possible relationships between seismic intensity and the causes and types of injuries, and we assessed the ability of the Injury Severity Score, New Injury Severity Score, and Chest Injury Index to predict respiratory failure in chest injury patients.

Results

The incidence of chest injuries was 9.9% in the stronger Wenchuan earthquake and 22.2% in the less intensive Lushan earthquake. The most frequent cause of chest injuries in both earthquakes was being accidentally struck. Injuries due to falls were less prevalent in the stronger Wenchuan earthquake, while injuries due to burial were more prevalent. The distribution of types of chest injury did not vary significantly between the two earthquakes, with rib fractures and pulmonary contusions the most frequent types. Spinal and head injuries concurrent with chest injuries were more prevalent in the less violent Lushan earthquake. All three trauma scoring systems showed poor ability to predict respiratory failure in patients with earthquake-related chest injuries.

Conclusions

Previous studies may have underestimated the incidence of chest injury in violent earthquakes. The distributions of types of chest injury did not differ between these two earthquakes of different seismic intensity. Earthquake severity and interval between rescue and treatment may influence the prevalence and types of injuries that co-occur with the chest injury. Trauma evaluation scores on their own are inadequate predictors of respiratory failure in patients with earthquake-related chest injuries.     

Orofacial injuries reported by junior and senior basketball players

The increased popularity of sports, apart from being beneficial to health, also results in a larger number of injuries, a part of which are also injuries to the stomatognatic system. According to the data from literature orofacial injuries in basketball are frequent, but relatively minor. The World Dental Federation places basketball into the category of medium-risk sports for the occurrence of injuries to the stomatognatic system. The purpose of this investigation was to determine incidence, type and severity of orofacial injuries during basketball and the frequent of the mouthguard use in a selected sample of basketball players from the City of Zagreb and the Zagreb County. The sample consists of 195 athletes who actively participate in basketball, 61 junior and 134 senior players. A total of 2 615 injuries to the stomatognatic system were documented in this research, 529 (20.2%) of those refer to juniors and 2 086 (79.8%) to seniors. The most common injuries are lacerations and contusions of soft tissue 84.4% (21.5% juniors and 78.5% seniors), followed by temporomandibular joint injuries and oral muscles stiffness 13.4% (14.9% juniors and 85.1% seniors) and 2.2% dental injuries (3.5% juniors and 96.5% seniors). Only 6.7% of players (13 players--2 juniors and 11 seniors) have tried to wear a mouthguard, while only one 1% of them (2 players--one junior and one senior) frequently used it. Total number of injuries shows that sports injuries are common during basketball. Average number of almost 4 injuries per player is relatively high. Dental injuries and temporomandibular joint injuries and oral muscles stiffness are relatively rare, only 16%. Lacerations and contusions of soft tissues represent 84% of all injuries and that minor injuries do not require professional care.     

Injuries in Rugby Union football.

In a prospective study of 185 players attached to 10 British rugby clubs, 151 injuries were recorded among 98 of them (53%) during a single season. Forwards sustained significantly more injuries than backs. The standard of rugby, players'' body weights, degree of fitness, and presence of joint hypermobility did not affect the risk of injury. The leg was the most common site of injury. Head and neck injuries were significantly more common when play was static and on wet pitches. Scrummaging accounted for no neck injuries. Almost half the injuries occurred during the last quarter of games. Foul play might have caused as many as 47 (31%) of all reported injuries. Complete eradication of deliberately dangerous play would considerably reduce the high incidence of injuries in this sport.     

入伍新训中膝关节损伤的特点与防治研究

目的：通过对某部新入伍官兵训练中膝关节损伤发生原因、特点进行流行性病学调查和分析,为合理训练,预防损伤发生和 治疗相关伤病提供指导依据。方法：对某部2013 年度450 名新入伍官兵的训练伤发病情况进行统计分析,重点分析膝关节损伤 发生率、伤病类型和致伤原因,并对其严重者进行关节镜治疗,观察和分析术后随访效果。结果：某部新兵的训练伤发生率为 20.0%。以关节急性扭伤最为多见,占81.1%。其中膝关节损伤共发生32 例,占训练伤发病率为7.1%,占训练伤发病率43.8%,其 中膝关节周围肌肉损伤20 例、交叉韧带损伤1 例、半月板损伤9 例、侧副韧带损伤2 例。致伤率最高的前3 位科目是5000 米负 重跑、跨越障碍训练、格斗训练,共27 例,占膝关节训练伤总数的84.4%。所有受伤患者中,12 例行手术治疗,20 例给予石膏、支具 固定、休息等保守治疗。经随访所有患者均得到较好的功能恢复。结论：对于新兵膝关节训练伤预防工作非常重要,避免致残;关 节镜手术技术的进步对于膝关节军事训练伤治疗有良好的效果。