The prevalence of non-accidental trauma among children with polytrauma: A nationwide level-I trauma centre study

ObjectiveWe aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC).Summary of backgroundData 6–10% Of children who present at the emergency department with injuries, sustain polytrauma. Polytrauma may result from either accidental (AT) or NAT, i.e. inflicted or neglect. The prevalence of NAT among children with polytrauma is currently unclear.MethodsThis is a retrospective study that included children (0–18 years) with an Injury Severity Score >15, who presented at one of the 11 Level-I trauma centers (TC) in the Netherlands between January 1, 2010 and January 1, 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect-team. Cases in which conclusions were unavailable and there was no clear accidental cause of injuries were reviewed by an expert panel.ResultsThe study included 1623 children, 1452 (89%) were classified as AT, 171 (11%) as NAT; 39 (2,4%) inflicted and 132 (8,1%) neglect. Of pre-school aged children (<5 years) 41% sustained NAT (OR26.73, 95%CI 17.70–40.35), 35/342 (10%) inflicted and 104/342 (31%) neglect. Admission due to ‘cardiopulmonary arrest’ was the result of inflicted trauma (30% vs 0%,p < 0.001). NAT had a higher mortality rate (16% vs 10%, p = 0.006). Indicators of NAT were: (near-)drowning (OR10.74, 95%CI 5.94–19.41), burn (OR8.62, 95%CI 4.08–18.19) and fall from height (OR2.18, 95%CI 1.56–3.02).ConclusionsNAT was the cause of polytrauma in 11% of children in our nationwide level-I TC study; 41% of these polytrauma were the result of NAT experienced by preschool-aged children. Our data show the importance of awareness for NAT.     

Dyskinesia and FAB score predict future falling in Parkinson's disease

A growing body of research highlights the importance of cognition for prediction of falls in Parkinson's disease (PD). However, a previously proposed prediction model for future near falls and falls in PD, which includes history of near falls, tandem gait, and retropulsion, was developed without considering cognitive impairment. Therefore, by using a sample of 64 individuals with relatively mild PD and not excluding those with impaired cognition we aimed to externally validate the previously proposed model as well as to explore the value of additional predictors that also consider cognitive impairment. Since this validation study failed to support the proposed model in a PD sample including individuals with impaired global cognition, extended analyses generated a new model including dyskinesia (item 32 of Unified PD Rating Scale) and frontal lobe impairment (Frontal Assessment Battery—FAB) as significant independent predictors for future near falls and falls in PD. The discriminant ability of this new model was acceptable (AUC, 0. 80; 95% CI 0.68‐0.91). Replacing the continuous FAB scores by a dichotomized version of FAB with a cut‐off score ≤14 yielded slightly lower but still acceptable discriminant ability (AUC, 0. 79; 95% CI 0.68‐0.91). Further studies are needed to test our new model and the proposed cut‐off score of FAB in additional samples. Taken together, our observations suggest potentially important additions to the evidence base for clinical fall prediction in PD with concomitant cognitive impairment.     

Development and Validation of an Exercise Programme for Recovery Balance Impairments in Poststroke Patients

Background: Deterioration of balance is one of the most common and disabling physical-motor deficits in patients after a stroke that have a negative impact on quality of life and increase the risk of falls. Previous studies have evaluated the effectiveness of the exercises on specific aspects of balance. However, there is no structured exercise program divided by levels for balance impairment in poststroke patients. Methods: Delphi method was used to design the exercise programme, and then a pilot study was performed. For the pilot study, we included 14 poststroke adults patients (n = 7 in each group), with balance impairment, without previous severe functional dependence, sensorial deficit or dementia. Our 4 weeks intervention (5 times/week) is based on 9 exercise of progressive difficulty, offering a multidimensional approach training (biomechanical constraints, stability limits, anticipatory, postural responses, and sensory orientation). Patients in the intervention arm received 45 minutes of usual rehabilitation plus 15 minutes of the intervention proposed. The usual-care arm received 60 minutes of usual rehabilitation. Balance impairment (Mini BESTest) was assessed at the baseline and at 4 weeks. Differences between groups were analysed using Mann-Whitney U test. Results: The agreement for the intervention designed was reached after 2 rounds. Participants in pilot study were 69 (SD = 9.7) years, 21.4% females. Post-treatment, median improvements in Mini BESTest were 20 (SD = 8) and 11 (SD = 10) points, P < .01 for intervention and control group respectively. Conclusion: A multidimensional approach of balance impairments in poststroke patients through the validated exercise programme proposed, may improve balance deficits.     

Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis

PurposeThis systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community.ResultsA comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample’s results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high.ConclusionsIn older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.     

Gait kinetics impact shoe tread wear rate

BackgroundAdequate footwear is an important factor for reducing the risk of slipping; as shoe outsoles wear down, friction decreases, and slip and fall risk increases. Wear theory suggests that gait kinetics may influence rate of tread wear.Research questionDo the kinetics of walking (i.e., the shoe-floor force interactions) affect wear rate?MethodsFourteen participants completed dry walking trials during which ground reaction forces were recorded across different types of shoes. The peak normal force, shear force, and required coefficient of friction (RCOF) were calculated. Participants then wore alternating pairs of shoes in the workplace each month for up to 24 months. A pedometer was used to track the distance each pair of shoes was worn and tread loss was measured. The wear rate was calculated as the volumetric tread loss divided by the distance walked in the shoes. Three, mixed linear regression models were used to assess the impact of peak normal force, shear force, and RCOF on wear rate.ResultsWear rate was positively associated with peak RCOF and with peak shear force, but was not significantly related to peak normal forces.SignificanceThe finding that shear forces and particularly the peak RCOF are related to wear suggests that a person’s gait characteristics can influence wear. Therefore, individual gait kinetics may be used to predict wear rate based on the fatigue failure shoe wear mechanism.     

Peak Expiratory Flow and the Risk of Injurious Falls in Older Adults: The Role of Physical and Cognitive Deficits

ObjectivesPrevious studies showed that peak expiratory flow (PEF) is associated with health-related outcomes in advanced age, but the extent to which it may be related to falls risk remains unclear. We aimed to detect the association between PEF and injurious falls in older adults and to explore the role of cognitive and physical deficits in this association.DesignProspective study with a 6-year follow-up.Setting and ParticipantsThe study involves 2234 community-dwelling older adults with no history of pulmonary disease.MethodsFor each study participant, we assessed the PEF at baseline, expressed as standardized residual (SR) percentile and derived from the normalization of residuals between the measured and predicted PEF values (based on individual age, sex, and body height); incident injurious falls over 6 years, from Hospital Discharge Diagnosis; and physical and cognitive functioning at the baseline and at 3- and 6-year follow-ups by evaluating walking speed, balance, chair stand, and Mini-Mental State Examination, respectively.ResultsOver the follow-up, 232 individuals experienced injurious falls. Cox models indicated 7% higher risk of falls per each 10th reduction in PEF SR-percentile. The risk of injurious falls increased by more than twice for those who had PEF SR-percentile <10th as for values of 80th-100th (hazard ratio = 2.31, 95% confidence interval: 1.41-3.76). Physical deficits mediated 63% of the total effect of PEF on falls risk.Conclusions and ImplicationsOur findings suggest that low PEF is associated with higher risk of injurious falls in older adults, and most of this association is explained by balance or muscular strength deficits.     

Midlife falls are associated with increased risk of mortality in women: Findings from the National Health and Nutrition Examination Survey III

ObjectivesFalls are a public health concern for older adults but are also common among midlife adults. However, the consequences of falls occurring during midlife are not well understood.MethodsThis investigation assessed the relationship between falls and mortality among midlife adults using survey data from the Third National Health and Nutrition Examination Survey (n = 1,295), linked to the National Death Index. The relationship between recurrent falls (≥2 falls) in the past year and 10-year death rate was assessed using survey-weighted Cox regression.ResultsNearly 20 % of adults who died within 10 years of their interview date were recurrent fallers at the time of interview. For women only, recurrent fallers had more than 4-fold increased hazard of death within 10 years compared to non-recurrent fallers (HR = 4.41; 95 % CI:2.24,8.68).ConclusionsFindings suggest that midlife women are particularly vulnerable to adverse outcomes following recurrent falls. Fall prevention efforts should include efforts targeted at midlife women.