Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study

STUDY DESIGN: An epidemiological study conducted all over the country. OBJECTIVE: The present retrospective study was conducted to survey the new traumatic spinal cord injury (SCI) cases during 1992 in Turkey. SETTING: Intensive care units, emergency services and departments of orthopaedic surgery, neurosurgery and rehabilitation of state hospitals, rehabilitation centers, military and university hospitals. METHODS: Postal questionnaires were used for data collection and the records from medical institutes nation-wide were reviewed for the analysis of the epidemiological factors. RESULTS: Five hundred and eighty-one new traumatic SCI cases were reported in 1992. The annual incidence was found to be 12.7 per million population. Male to female ratio was 2.5:1 and the average age at injury was 35.5+/-15.1 (35.4+/-14.8 for males and 35.9+/-16.0 for females). The most common cause of injury was motor vehicle accidents (48.8%) followed by falls (36.5%), stab wounds (3.3%), gunshot injuries (1.9%) and injuries from diving (1.2%). One hundred and eighty-seven patients (32.18%) were tetraplegic and 394 patients (67.8%) were paraplegic. The most common level of injury was C5 among tetraplegics and T12 among paraplegics. The most prevalent associated injury was head trauma followed by extremity fractures. Severe head trauma resulting in death may obscure the real incidence of SCI and may cause underreporting of cases in epidemiological studies. CONCLUSION: Considering that motor vehicle accidents and falls were found to be the leading causes of traumatic SCI, it was concluded that the prevention measures should be focused mainly on these in order to reduce the frequency of SCI in Turkey.     

Traumatic aortic injuries in the pediatric population

Background/Purpose

Blunt trauma is the leading cause of pediatric injury, but pediatric aortic injuries are rare. We undertook this study to investigate the demographics, treatment, and outcomes of children with blunt aortic injuries and report our experience over a 10-year period.

Methods

After Institutional Review Board approval, a 10-year retrospective review of all pediatric patients admitted with blunt aortic injury was performed. Patient demographics, injury details and severity score (Injury Severity Score), treatment, and outcomes were recorded.

Results

There were 11 children, with ages ranging from 7 to 19 years. The most common mechanism of injury was motor vehicle crashes (8). Initial computed tomography demonstrated all 11 injuries: 7 thoracic aortic (TA) and 4 abdominal aortic (AA) injuries. Associated injuries were common. The TA injuries included 4 transections, 2 intimal flaps, and 1 pseudoaneurysm. Three of these were managed nonoperatively. The AA injuries included 3 intimal flaps and 1 dissection. Three of these were also managed nonoperatively. There were no complications in the 4 children with AA or in the 3 children with TA managed nonoperatively. Complications in the 4 children undergoing operative repair of the TA included paraplegia, renal failure, recurrent laryngeal nerve injury, and pulmonary embolus. The mean hospital stay was 8 days. All children survived, with all but one discharged directly to home.

Conclusions

Blunt aortic injury in children is uncommon and is primarily associated with motor vehicle crashes. Injuries to the abdominal aorta were seen with restrained children vs those to the thoracic aorta that were seen in children who were unrestrained.     

Traumatic brain injury in an aging population

The epidemiology of traumatic brain injury (TBI) is changing in several Western countries, with an increasing proportion of elderly TBI patients admitted to the intensive care unit (ICU). We describe a series of 1366 adult patients admitted to three neuro-ICUs in which 44% of cases were 50 years of age or older. The health status before trauma (rated using the APACHE score) was worse in older patients. In all 604 patients had emergency removal of intracranial masses, with extradural hematomas more frequent in young cases and subdural hematomas more frequent in older patients. Outcomes were classified according to the Glasgow Outcome Scale (GOS) 6 months post-trauma, as favorable (GOS score 4-5), or unfavorable (GOS score 1-3). Favorable outcomes were achieved by 50% of patients, but the proportions of unfavorable outcomes rose with age. Mortality was the main cause of unfavorable outcomes 6 months after injury in older patients. Logistic regression analysis indicates that several parameters independently contributed to outcome, including the motor component of the Glasgow Coma Scale (GCS), pupils, CT findings, and early hypotension. Additionally, the odds ratios were very high for age and health status before TBI. Patients admitted to the ICU are increasingly older, have co-morbidities, and have specific types of intracranial lesions. Early rescue, surgical treatment, and intensive care of these patients may produce excellent results up to the age of 59 years, with favorable outcomes still possible for 39% of cases aged 60-69 years, without an excessive burden of severely disabled patients.     

Clinical aspects of thoraco-abdominal injuries associated with brain injuries

The results of treatment of 31 patients with thoraco-abdominal trauma in combination with the brain trauma were analysed. Detection of the leading injury which determined the severity of a state of the sufferers offered considerable difficulties. In choice of a method for treatment the preference was given to the least traumatic methods providing saving the life of a patient. Seven sufferers died.     

Traumatic brain injuries in illustrated literature: experience from a series of over 700 head injuries in the Asterix comic books

Background  

The goal of the present study was to analyze the epidemiology and specific risk factors of traumatic brain injury (TBI) in the Asterix illustrated comic books. Among the illustrated literature, TBI is a predominating injury pattern.     

Traumatic brain injury in a county jail population: prevalence,neuropsychological functioning and psychiatric disorders

Primary objective : To determine the prevalence of traumatic brain injury (TBI) among inmates in a county jail population.

Research design : Cross-sectional, observational study.

Methods and procedures : A standardized interview was used to determine prevalence of TBI in 69 randomly selected inmates. To examine cognitive and emotional differences between subjects with and without recent TBI, neuropsychological tests and structured psychiatric diagnostic interviews were conducted with 50 subjects (the first 25 with TBI and the first 25 without TBI in the prior year).

Results : Sixty (87.0%) reported TBI over their lifetime; 25 (36.2%) reported TBI in the prior year. The latter group had significantly worse anger and aggression scores and had a trend towards poorer cognitive test results and a higher prevalence of psychiatric disorders than the group without TBI in the prior year.

Conclusion : This study suggests the need for increased attention to TBI and its cognitive, behavioural and psychiatric sequelae in jail populations.     

Thoracic adolescent idiopathic scoliosis: perinatal and environmental aspects in a Swedish population and their relationship to curve severity

A perinatal and environmental survey was done on 551 adolescent patients with idiopathic thoracic scoliosis to determine if maternal age, paternal age, patient's sex, birth order, season of birth, birth weight, weight at 10 years, socioeconomic group, or population density influenced the severity of the curve. No difference between mild and severe scoliotic patients emerged in any of the factors. A significant difference between the study group and the general population was found in maternal age. Scoliosis was commoner in higher socioeconomic groups. The rate of illegitimacy among scoliotic patients was half that expected. None of the factors examined was of value in predicting curve severity.     

Severe penile injuries: a problem of severity and reconstruction

OBJECTIVES

To report our experience of treating severe penile injuries with different causes and treatments, as penile trauma presents a difficult physical and psychological problem, and the type and extent of injury varies from mild to severe, sometimes even with total amputation.

PATIENTS AND METHODS

We analysed retrospectively 43 patients (mean age 28 years, range 5–52 years) with severe penile injuries referred to us from March 1999 to August 2007. The causes of penile injuries differed, including iatrogenic trauma (20), traffic accidents (11), burns (three), self‐amputation (two), ritual circumcision (two), penile fracture (two), gunshot trauma (two) and electrocution (one). The management required a wide variety of surgical techniques tailored to each patient depending on the type and extent of injury.

RESULTS

The mean (range) follow‐up was 47 (10–108) months. The aesthetic and functional results, including satisfactory sexual intercourse were good in 35 patients. There were complications in seven patients; infection after implanting an inflatable penile prosthesis in one, protrusion of a semirigid prosthesis in one, urethral complications (one stenosis and two fistulae) in three and partial skin flap necrosis in two.

CONCLUSIONS

Severe penile injuries should be treated on an individual basis, applying different techniques. However, treatment can be effective and safe only in specialized centres.     

Characterization of idiopathic scoliosis in a clinically well-defined population.

Idiopathic scoliosis is a highly prevalent disorder, familial in nature, with marked clinical variability. The purpose of this study was to characterize idiopathic scoliosis in a large series of families to be used for a genome-wide search. One hundred thirty-one multigenerational families (892 individuals) with at least two affected individuals were studied. Data obtained included curve pattern, treatment, and back pain. Maximum curvature as a continuous variable was evaluated using t tests for dichotomous characteristics and linear correlation for continuous variables. An analysis of familial loading was done. Four hundred forty-four individuals were classified as affected (82% female; 18% male). The right thoracic and left lumbar curves had the highest mean curvature (49 degrees). Mean curve size was greater in individuals with back pain. Back pain was most prevalent in the right thoracic and left lumbar curve pattern. The Pearson correlation coefficient between the number of affected family members and the maximum degree of curvature was 0.16, suggesting that the greater the lateral curvature, the higher the proportion of family members affected with scoliosis. The sample population is consistent with those of previous studies in relation to gender and curve size. Statistically, the familial nature of this disorder is supported.     

Traumatic diaphragmatic rupture: associated injuries and outcome

A retrospective case note analysis was performed on all patients treated for traumatic diaphragmatic rupture (TDR) at a major teaching hospital between January 1990 and August 1998. Patients were identified from the prospectively maintained UK Trauma and Research Network Database. Of the 480 cases of torso trauma admitted during the study period, 16 (3.3%) had TDR. Blunt trauma accounted for 13 (81%) of the injuries. A radiological pre-operative diagnosis was made in 10 (62.5%) patients. Seven of these were made on initial chest radiography, two on ultrasound scan and one on computed tomography. All patients underwent a midline laparotomy and TDR was subsequently diagnosed at operation in 6 patients. The left hemidiaphragm was ruptured in 14 (87.5%) patients and there was visceral herniation in 8 (50%). Twelve patients with blunt trauma had associated abdominal and extra-abdominal injuries, but only one of the three patients with penetrating trauma had other injuries. The median Injury Severity Score (range) was 21 (9-50). The median time (range) spent on the intensive care unit was 2 days (0-35 days). Pulmonary complications occurred in 7 (44%) patients. Two (12.5%) patients died from associated head injuries. TDR results from blunt and penetrating torso trauma, is uncommon, rarely occurs in isolation and is associated with a high morbidity and mortality. A high index of suspicion makes early diagnosis more likely as initial physical and radiological signs may be lacking.     

Traumatic cervical spine injuries in a patient with pycnodysostosis

European Journal of Orthopaedic Surgery & Traumatology - Pycnodysostosis is a rare hereditary disease, characterized by systemic bone sclerosis. Susceptibility to long bone fractures is...     

Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity

OBJECTIVE: The purpose of this study was to compare data obtained from a statewide data set for elderly patients (age > 64 years) that presented with traumatic brain injury with data from nonelderly patients (age > 15 and < 65 years) with similar injuries. METHODS: The New York State Trauma Registry from January 1994 through December 1995, from trauma centers and community hospitals excluding New York City (45,982 patients), was examined. Head-injured patients were identified by International Classification of Diseases, Ninth Revision diagnosis codes. A relative head injury severity scale (RHISS) was constructed on the basis of groups of these codes (range, 0 = none to 3 = severe). Comparisons were made with nonelderly patients for mortality, Glasgow Coma Scale (GCS) score at admission and discharge, Injury Severity Score, New Injury Severity Score, and RHISS. Outcome was assessed by a Functional Independence Measure score in three major domains: expression, locomotion, and feeding. Data were analyzed by the chi2 test and Mann-Whitney U test, with p < 0.05 considered significant. RESULTS: There were 11,772 patients with International Classification of Diseases, Ninth Revision diagnosis of head injury, of which 3,244 (27%) were elderly. There were more male subjects in the nonelderly population (78% male subjects) compared with the elderly population (50% men). Mortality was 24.0% in the elderly population compared with 12.8% in the nonelderly population (risk ratio, 2.2; 95% confidence interval, 1.99-2.43). The elderly nonsurvivors were statistically older, and mortality rate increased with age. Stratified by GCS score, there was a higher percentage of nonsurvivors in the elderly population, even in the group with only moderately depressed GCS score (GCS score of 13-15; risk ratio, 7.8; 95% confidence interval, 6.1-9.9 for elderly vs. nonelderly). Functional outcome in all three domains was significantly worse in the elderly survivors compared with the nonelderly survivors. CONCLUSION: Elderly traumatic brain injury patients have a worse mortality and functional outcome than nonelderly patients who present with head injury even though their head injury and overall injuries are seemingly less severe.