Prevention of bicycle accidents.

OBJECTIVE: To elucidate the way of reducing the number of bicycle accidents. A prospective study of all casualties from bicycle accidents attending an accident unit for a 29-month period was performed (1831 patients). A more detailed questionnaire on the causes of accidents was used for the last 12 months of the study (818 patients). RESULTS: In the 0-7 and 8-12 years age groups, 87.5 per cent and 66.2 per cent, respectively, were due to cyclist error. The 8-12-year-old cyclists were twice as likely to have caused the accident if they had not had formal training (risk ratio = 2.0). Over the age of 18 years, 41.4 per cent were due to another road user. A motor vehicle was involved in 633 of the 1831 accidents. CONCLUSIONS: Children under the age of 8 years should not be allowed on public roads. Older children should only be allowed on the roads after formal training. This should become part of the school curriculum. A campaign to increase the awareness of motorists would be expected to reduce the number of cycle accidents. It would be beneficial to dedicate more roads and tracks to cycle use. Cyclists should be encouraged to wear more protective gear.     

Pediatric bicycle trauma

Bicycle-related trauma is a serious pediatric problem. Serious injuries and even fatalities can occur, and care must be taken to avoid undertreating these patients. In an effort to further define the problem, 201 consecutive patients admitted for bicycle trauma were reviewed. The patients ranged in age from 3 to 16 years and 76% (153/201) were male. Head trauma was the most common admission diagnosis (99/201; 49%). Fourteen per cent (28/201) were admitted to the Intensive Care Unit and 23% (47/201) required an operative procedure. The average hospital stay was 3 days; however, patients who were admitted at least 24 hours after injury had an average hospital stay of 7 days.     

Airway choices in maxillofacial trauma

Successful management of the patient's airway is central to the safe practice of anaesthesia. Whilst anaesthetists are faced with an ever increasing range of equipment, they must still select appropriate equipment for each patient and be competent in its use.Understanding the advantages and limitations of the available devices in particular situations is an important element of clinical education. Our article focuses on approaches to airway management in cases of maxillofacial trauma and on the equipment available for such cases.After a brief overview of the changing patterns of maxillofacial injury, issues affecting the airway management of the maxillofacial trauma patient are addressed.Differentiating devises in to those that use supraglottic or infraglottic approaches or are blind or under direct vision techniques, we outline the possible uses of a wide range of clinically available devises.Unfamiliarity with equipment and technical options has been associated with poorer clinical outcomes as has inability or lack of preparedness to escalate treatment. Should other more easily applied and less invasive techniques fail, cricothyroidotomy remains the fallback approach.     

Anaesthesia for maxillofacial trauma

Facial trauma is common and can produce both physical and psycho-logical problems for patients. Managing patients in both the emer-gency setting and elective theatre environment can be extremely challenging, so airway interventions should be carefully planned so the safest and most effective technique can be chosen. This may mean that direct laryngoscopy may not be the safest or most straight-forward option and awake tracheal intubation, videolaryngoscopy, submental intubation or awake tracheostomy may be a better choice in a given set of circumstances. An understanding of common mechanisms of injury and pathologies and the likely difficulties that will be present are essential. Senior anaesthetic input and effective teamwork are required to provide excellent levels of care for these patients.     

Impaired quality of life after bicycle trauma

IntroductionBicycle crashes often affect individuals in working age, and can impair quality of life (QoL) as a consequence. The aim of this study was to investigate QoL in bicycle trauma patients and to identify those at risk of impaired QoL.Patients and methods173 bicycle trauma patients who attended a level I trauma centre from 2010 to 2012 received Hadorn's QoL questionnaire six months after their crash. Medical data was collected from the patient's records. Univariate ordinal logistic regression was used to investigate the association between QoL and other factors.Results148 patients returned the questionnaire (85.5%). The majority had only mild or minor injuries (85.1%; n = 126). However, 72.1% (n = 106) still suffered from pain or other physical symptoms more than six months after their bicycle crash. Patients with a Glasgow Coma Scale (GCS) ≤13 or an Injury Severity Score (ISS) >15 experienced impaired emotions/outlook on life (p-values 0.003 and 0.045, respectively). Physical suffering was reported by patients with a GCS ≤13 and in those with injuries to the cervical spine (p-values 0.02 and 0.025, respectively). Patients with an ISS >15 or facial fractures experienced limitations in daily activities (p-values 0.031 and 0.025, respectively).ConclusionsMore than 70% of bicycle trauma patients suffered physically more than six months after their crash, even though only 15% were severely injured. Risk factors for an impaired QoL were cervical spine injuries or facial fractures, a GCS ≤13 and an ISS >15.     

Profile of chest trauma in a level I trauma center

BACKGROUND: Chest injuries are seen with increasing frequency in urban hospitals. The profile of chest injuries depends on the size of the hospital and the level of trauma center. The data regarding the true incidence of chest trauma are scant. METHODS: One thousand three hundred fifty-nine consecutive patients seen at a Level I trauma center were analyzed. The nature of injury, methods of treatment, and morbidity and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality after chest trauma. RESULTS: The overall mortality was 9.41%. Low Glasgow Coma Scale score, older age, presence of penetrating chest injury, long bone fractures, fracture of more than five ribs, and liver and spleen injuries were independent predictors of death after chest trauma. A model was created for predicting the mortality based on various factors. CONCLUSION: Most chest injuries can be treated with simple observation. Only 18.32% of patients required tube thoracostomy and 2.6% needed thoracotomy. Low Glasgow Coma Scale score and advanced age are the most significant independent predictors of mortality.     

The radiology of upper airway obstruction in maxillofacial trauma

One of the prime considerations in the management of maxillofacial trauma is the diagnosis and prevention of acute upper airway obstruction. Each division of the upper aerodigestive tract may cause respiratory obstruction. In the oral cavity, a "flail" mandible, an "Andy Gump" deformity, and a sublingual hematoma may occur. In the nasopharnynx, an impacted midface, a split palate, and a nasopharyngeal hematoma may result. In the oropharynx and hypopharynx, an expanding hematoma in the retropharyngeal or lateral pharyngeal spaces may be seen. Although airway obstruction in maxillofacial trauma is a clinical diagnosis, the judicious use of radiographs helps to identify patients at risk. In this study, we review the anatomy of the upper aerodigestive tract and the potential sites of airway obstruction. A review of the radiology of airway obstruction in maxillofacial trauma will also be presented.     

Pelvic trauma in rapidly fatal motor vehicle accidents

OBJECTIVE: To study the incidence and nature of pelvic fractures in rapidly fatal automobile accidents. DESIGN: Retrospective. SETTING: County Medical Examiner's Office. PATIENTS: The files of 255 consecutive motor vehicle accident fatalities examined at the Jefferson County Coroner/Medical Examiner's office (study period 1996-1998) were reviewed. We correlated this information with our previous findings, derived from a review of 392 such cases (study period 1994-1996). RESULTS: Approximately 25% of decedents involved in rapidly fatal automobile accidents sustained pelvic fractures. In 93% of the cases, postmortem radiographs were available and suitable for scoring according to the Orthopaedic Trauma Association nomenclature. The distribution of pelvic fractures by type was type A, 16%; type B, 32%; and type C, 52%, with the most common pelvic fracture being type C1 (26%). Additionally, pedestrians and motorcyclists were twice as likely to sustain a pelvic fracture, and the severity of pelvic fracture type seemed to correlate with increasing speed of the automobile. No correlation between drug use or direction of impact and incidence or type of pelvic fracture was observed. Compared with published studies on survivors of automobile accidents, our data suggest that pelvic injuries may tend to be more severe in victims who do not survive to hospitalization. CONCLUSIONS: Our data indicate that current estimates about the mortality of pelvic fractures may be faulty due to exclusion of victims who fail to survive to hospitalization. This series suggests that an appreciation of the full spectrum of pelvic ring disruptions requires collaboration between orthopaedic surgeons and forensic pathologists.     

Common femoral artery injury secondary to bicycle handlebar trauma

Blunt trauma from bicycle handlebars is associated with well-described injuries of the abdominal viscera. These injuries result from the forceful compression of the relatively immobile abdominal organs between the handlebar end and the vertebral bodies. The common femoral artery is also immobile as it passes anterior to the superior pubic ramus, rendering this vessel susceptible to a similar mechanism of injury. We have treated two children who sustained thrombosis of the common femoral artery caused by bicycle handlebar trauma. The lack of familiarity with this uncommon mode of injury may contribute to delayed diagnosis and increased morbidity. We therefore wish to draw attention to this mechanism of injury.     

Assessment of the survivors of major trauma accidents

Little has been written on the outcome of the survivors of major trauma accidents. The Glasgow outcome scale has been used to assess outcome following neurotrauma. This study of 90 patients reviewed at an average of 3.2 years post-injury used a modified form of the Glasgow outcome scale expanded to include all abbreviated injury score body areas. The average injury severity score was 23.3. The majority of patients had a satisfactory outcome.