手外伤流行病学描述性研究

目的 通过对本院就诊的手外伤患的流行病学调查了解本行政区手外伤病例的构成、发病特点和社会影响及意义。方法 对2001年7月～2002年6月，在本院就诊的2664例急诊和住院手外伤患进行问卷调查，作描述性研究分析。结果 于外伤患占本院同期就诊患的3.56‰，以男性20～40岁青年居多，工伤占76.0％，开放性损伤占95.3％，手指损伤占74.2％，工伤患中私营企业员工占68.O％。结论本组手外伤患以男性青年为主，主要是私营企业的员工，与机器设备差、无安全保护措施、无熟练专业技能、劳动强度大等因素有关，手外伤对个人和社会造成很大损失，应加强对私营企业的安全生产监管，积极预防手外伤的发生。     

Terror-related injuries: a comparison of gunshot wounds versus secondary-fragments-induced injuries from explosives

BACKGROUND: Terror-related injuries caused by secondary fragments (SF) from explosive devices show a distinctive pattern in severity, distribution, outcomes of assault, and health-system resource use as compared with terror-related penetrating injuries caused by gunshot wounds. STUDY DESIGN: A case-comparison study conducted in a tertiary university hospital and the only Level I trauma center in the Jerusalem vicinity. During a period of 4 years, over 1,500 casualties of terror-related injuries were treated in one Level I trauma center. The study included 533 patients who were admitted for hospitalization. Excluded from the study were victims who were dead on arrival or who succumbed to their injuries within 30 minutes of arrival at the emergency department. Data were collected from trauma registry records. RESULTS: Gunshot-wound victims were mostly men, aged 19 to 30, and SF victims were more evenly distributed between the genders and across the age spectrum. Injury Severity Score (ISS) was considerably higher in SF victims, although critical mortality rates were higher in gunshot-wound victims. More than 40% of SF victims were injured in three or more body regions, as opposed to < 10% in gunshot-wound victims. Use of imaging modalities and ICUs was considerably higher for SF victims. CONCLUSIONS: Terror victims suffering from SF wounds have more complex, widespread, and severe injuries than victims suffering from gunshot wounds. They tend to involve multiple body regions and use more in-hospital resources. Attenuation of bus seats and protective vests can lead to a reduction in severity of these injuries.     

Firearm-related injuries and deaths among children and adolescents in Cape Town--1992-1996.

OBJECTIVE: To determine the epidemiological profile of firearm-related injuries among children and adolescents in Cape Town during recent years in order to further understand the epidemic of firearm violence as a public health problem in South Africa. DESIGN: A retrospective study was conducted of hospital, medico-legal laboratory (mortuary) and police data. SETTING: Metropolitan Cape Town, 1 January 1992-31 December 1996. STUDY POPULATION: All children and adolescents (under 19 years of age) with firearm injuries living in the Cape Town metropole during the study period. RESULTS: During the study period at least 1,736 children and adolescents were victims of firearm-related incidents; of these, 322 died (19%). The incidence of firearm injuries among this group almost tripled from 20.2/100,000 in 1992 to 58.1/100,000 in 1996. The firearm mortality rate also almost tripled during the period under review from 3.8/100,000 in 1992 to 10.3/100,000 in 1996. Approximately 60% of victims were coloured males, with 86% between 13 and 18 years of age. Twenty-one per cent of all victims aged over 12 years who died were intoxicated. Other characteristics of the victims and the circumstances surrounding the incidents are presented. CONCLUSIONS: These findings demonstrate the escalating epidemic of firearm-related injuries and deaths among children and adolescents in Cape Town. In addition, the study indicates the need for an integrated injury and death reporting system. Further research is needed to understand firearm-related injuries among children and adolescents in South Africa, and to develop policies and programmes for prevention that are effective in this setting.     

Analysis of injuries and treatment of 3,401 inpatients in 2008 Wenchuan earthquake--based on Chinese Trauma Databank

Objective： A catastrophic earthquake struck Wenchuan region of West China on May 12, 2008 and caused more than 69 225 deaths. This study was to analyze injury characteristics and treatment of the seismic patients based on Chinese Trauma Databank, which will be helpful for improvement of future medical rescue in potential disasters. Methods： Based on inpatients＇ medical records of seismic patients admitted into 11 hospitals, data were registered with Trauma Database System Version 3.0. Patients＇ general information, causes, clinical characteristics and treatment of injuries were studied. Results： Main causes for seismic injuries were blunt strike （68.2%）, crush/burying 08.7%） and slip/falling （11.5%）. Slip/falling was the main cause for spinal injuries and accounted for 19. 1%, which was higher than the percentage for other body part. Extremity injuries accounted for 54.8% of all injuries. Fractures accounted for 53.1%. Lower extrem-ity fracture accounted for 70.1% of lower extremity injury and spinal fracture accounted for 85.9% of spinal injury. The proportion of spinal injuries with AIS ≥4 was higher than that of other injured locations except for the abdomen. Debridement and suturation for single injury and multiple injury patients accounted for 64.7% and 42.9% of their operations respectively. Conclusions： Blunt strike, crush/burying and slip/ falling are the main causes for seismic injuries. The most frequently injured site is extremity. The main injury type is fracture, especially for the lower extremities and the spine. Multiple injury patients were mainly treated by operation, including debridement and suturation, closed reduction and external fixation, etc.     

5.12汶川8.0级地震伤员的四肢放射学表现分析

目的分析5．12汶川8．0级地震中伤员四肢损伤类型和影像表现。方法回顾分析自2008年5月13日-5月27日在绵阳市中心医院放射科就诊的1121例地震伤员中四肢检查的671伤员的放射学资料，其中平片检查668人，约1200处投照部位，CT检查19人23个部位。结果446例伤员放射学检查为阳性，总阳性率约为66．47％，其中四肢单部位损伤为355例（52．91％），多个四肢损伤为91例（13．56％）。共有558个部位损伤，按发生率高低排列，依次为胫腓骨142例（25．45％），足踝113例（20．25％）、髋关节及股骨112例（20．07％），肘关节及尺桡骨54例（9．68％）、肱骨47例（8．42％），手腕38例（6．81％），肩关节36例（6．45％），锁骨16例（2．87％）；按照骨折类型，粉碎性骨折317例（56．81％），横行骨折102例（18．28％），关节脱位37例（6．63％），斜行骨折37例（6．63％），螺旋形骨折31例（5．56％），线形骨折17例（3．05％），嵌插骨折13例（2．33％），骺分离4例（0．72％）。结论地震造成四肢损害以下肢为主，骨折类型以粉碎性骨折及横行骨折为主。     

Abdominal injuries sustained in severe traffic accidents by seatbelt wearers

In Finland during the period 1972-1983, there were 3,564 severe traffic accidents involving one or more victims dying within 30 days of the accident. Forty-two of the victims had been wearing a seatbelt and had an abdominal trauma as the main cause of death or as first diagnosis of injury. Small intestine and colon injuries were more common in the severely injured victims than was the case with the fatally injured ones and in these accidents the injury mechanism was always deceleration or contusion, which was in most cases caused by the seatbelt. Liver injuries seem to be the major abdominal cause of fatality, and in the fatally injured group, half of the victims sustained the fatal abdominal injury through gross crushing impact. When the direction of the impact was analyzed, all the victims seated on the receiving side of the vehicle in lateral impact collisions sustained an abdominal injury with fatal outcome. It seems that the seatbelt is less effective in protecting wearers from severe or fatal abdominal injuries in lateral impact collisions.     

Predictive factors for acute renal failure in crush injuries in the Sichuan earthquake

IntroductionThe Sichuan earthquake caused a large number of crush injuries and many of them developed acute renal failure (ARF). A retrospective study was performed on victims with crush injuries of West China Hospital to investigate the predictive factors for acute renal failure (ARF) in crush injuries.Patients and methodsMedical records of injured victims treated in West China Hospital within the first week after the Sichuan earthquake were retrospectively reviewed and 101 patients with crush injury were enrolled in the study. We divided them into an ARF group and a non-ARF group. The clinical data of included patients were extracted and analysed.ResultsPatients with ARF accounted for 42% of the included population. Patients younger than 20 made up the biggest age category (45%), and the entrapped time under the debris (22 [IQR 3.5–38] h) was longer than previous reports. In univariate analysis, male gender, multiple crush injuries, medical comorbidities, surgical interventions and infections were more frequent in patients with ARF than in those without ARF. Mean arterial pressure was higher in the ARF group. Besides, the risk of ARF was increased by creatine kinase >14,494.5 IU/L most significantly, followed by time under the rubble >4 h, aspartate transaminase >453.5 IU/L, albumin <27.15 g/L and white blood cell >11.8 × 10⁹/L. In multivariate analysis, male gender, time under the rubble, multiple crush injuries, surgical interventions, infections and creatine kinase level were independently associated with ARF in crush injuries.ConclusionsThe entrapped time under the debris, multiple crush injuries, male gender, infections, and creatine kinase level are predictive factors for ARF in crush injuries.     

不同时期胸部创伤的特点及救治经验

目的比较不同时期收治胸部创伤（胸伤）的特点，围绕其院内死亡原因总结救治经验。方法将１６３９例胸伤分为１９９０年前、后两组，比较不同时期病例数、致伤原因、严重胸伤构成比及住院死亡率，并对伤后早期与晚期常见致死原因失血性休克、成人呼吸窘迫综合征（ＡＲＤＳ）和多系统器官衰竭（ＭＳＯＦ）等进行分析。结果９０年代后收治胸伤病例增多，穿透性刃器伤、重症钝性胸伤、连枷胸、肺挫伤和ＡＲＤＳ病例明显增加，住院死亡率从４．３０％降至２．９６％；住院早期死亡原因以失血性休克为主，晚期死亡原因多为ＡＲＤＳ和ＭＳＯＦ。结论应针对９０年代胸伤特点，围绕严重胸伤常见的致死原因，进一步改进急救和后续处理，降低死亡率。     

Medical needs at high school football games in milwaukee

To help clarify the medical needs at high school football games, injury and treatment data were recorded during medical coverage of 67 varsity games. Injury evaluations were performed on 11 1 athletes for 139 injuries. Sixty-four injuries resulted in the athlete not returning to complete the game and 8 injuries resulted in the athlete being unable to return to play for over 1 week. Contusions (26.6%), sprains (21.6%), strains (8.6%), and suspected fractures (8.6%) accounted for most of the injuries. The most common sites of injuries were the knee (14.4%), lower leg (13.7%), and ankle (1 1.5Oh). Icing and taping were the most common treatments provided. The frequency of injuries verifies the importance of qualified medical coverage at high school football games. The nature of most injuries indicates that besides having skills in basic emergency medicine, the medical personnel should be skilled in the management of acute soft tissue injuries.J Orthop Sports Phys Ther 1988;10(5):167-171.     

Triage during the week of the Sichuan earthquake: A review of utilized patient triage, care, and disposition procedures

Objectives

There exists no standard hospital emergency department (ED) triage procedure model for earthquake victims. This study provides an overview of the hospital triage procedure used for patients evaluated and treated at the West China Hospital of Sichuan University, Chengdu in the Sichuan province of China, following the May 12, 2008 Wenchuan earthquake.

Methods

Emergency triage and treatment teams were comprised of senior emergency medicine (EM) attending physician, junior EM attending physician, EM residents, and specialty surgeons. Retrospective analysis of the hospital medical records of 2283 earthquake victims was performed. Victims’ demographic data, triage process and group assignments, diagnoses and dispositions were reviewed.

Results

In the 2 weeks following the Wenchuan earthquake, 2283 total patients with earthquake-related injuries were admitted to our hospital. 54 victims (2.4%) were lost to follow up. Patients were triaged into four main groups: resuscitation (n = 6), urgent treatment (n = 369), delayed treatment (n = 1502), and minor injuries (n = 406). 68.9% (1572/2283) of the patients were admitted to the hospital during the 15 days after the earthquake. The overall hospital mortality rate was 1.0% (15/1572). 1304 victims were transferred to nearby hospitals after initial treatment, stabilization, or surgery.

Conclusions

Proper triage strategy should be established prior to the onset of a mass casualty event and should be appropriate to both the severity of the disaster and the accepting facility resource availability. Triage methods utilizing multi-specialty treatment teams and dynamic hospital-wide coordination are critical for efficient, efficacious patient management. Hopefully, sharing with the emergency medicine community the arduous challenges we faced in the wake of the Wenchuan earthquake will be useful for planning the response to future disasters.     

Injury Patterns from Major Urban Terrorist Bombings in Trains: The Madrid Experience

BACKGROUND: Terrorist urban mass casualty incidents (MCI) in the last 3 years have targeted commuter trains at rush hour, producing large numbers of casualties. Civilian care providers are usually not familiar with the types of blast injuries sustained by victims of these MCI. METHODS: We focus on the injury patterns sustained by casualties of the Madrid, 11 March 2004, terrorist bombings, at the seven hospitals that received most victims. Data were gathered of casualties who had injuries other than superficial bruises, transient hearing loss from barotrauma without eardrum perforation, and/or emotional shock. The degree of severity in critical patients was assessed with the ISS. RESULTS: The bombings resulted in 177 immediate fatalities, 9 early deaths, and 5 late deaths. Most survivors had noncritical injuries, but 72 (14%) of 512 casualties assessed had an Injury Severity Score (ISS) >15. The critical mortality rate was of 19.5%. The most frequently injured body regions were the head-neck and face. Almost 50% of casualties had ear-drum perforation, and 60% of them were bilateral. There were 43 documented cases of blast lung injury, with a survival rate of 88.3%. Maxillofacial and open long-bone fractures were most prevalent. Gustillo's grade III of severity predominated in tibia-fibular and humeral fractures. Upper thoracic fractures (D1-6 segment) represented 65% of all vertebral fractures and were associated with severe blast to the torso. Severe burns were uncommon. Eye injuries were frequent, although most were of a mild-to-moderate severity. Abdominal visceral lesions were present in 25 (5%) patients. A multidisciplinary approach was necessary in most operated patients, and orthopedic trauma procedures accounted for 50% of the caseload in the first 24 h. CONCLUSIONS: Ninety-three percent of the fatalities of the Madrid trains terrorist bombings were immediate, and most survivors had noncritical injuries. Closed doors increased the immediate fatality rate in the trains. Severely wounded casualties presented specific patterns of injuries, some of them life-threatening and unusual in other types of trauma mechanisms. Ear-lobe amputations and upper thoracic spine fractures were markers of critical injuries.     

Mechanisms and weapons in physical elder abuse injuries: Findings from legally adjudicated cases

IntroductionElder abuse is common, but many characteristics have not been well-described, including injury mechanisms and weapons in physical abuse. Better understanding of these may improve identification of elder abuse among purportedly unintentional injuries. Our goal was to describe mechanisms of injury and weapons used and their relation to injury patterns.MethodsWe partnered with District Attorney's offices in 3 counties and systematically examined medical, police, and legal records from 164 successfully prosecuted physical abuse cases of victims aged ≥60 from 2001 to 2014.ResultsVictims sustained 680 injuries (mean 4.1, median 2.0, range 1–35). Most common mechanisms were: blunt assault with hand/fist (44.5%), push/shove, fall during altercation (27.4%), and blunt assault with object (15.2%). Perpetrators more commonly used body parts as weapons (72.6%) than objects (23.8%). Most commonly used body parts were: open hands (55.5% of victims sustaining injuries from body parts), closed fists (53.8%), and feet (16.0%). Most commonly used objects were: knives (35.9% of victims sustaining injuries from objects) and telephones (10.3%). The most frequent mechanism/injury location pair was maxillofacial/dental/neck injury by blunt assault with hand/fist (20.0% of all injuries). The most frequent mechanism/injury type pair was bruising by blunt assault with hand/fist (15.1% of all injuries). Blunt assault with hand/fist injury was positively associated with victim female sex (OR: 2.27, CI: [1.08 – 4.95]; p = 0.031), while blunt assault with object mechanisms was inversely associated with victim female sex (OR: 0.32, CI: [0.12 - 0.81]; p = 0.017).ConclusionPhysical elder abuse victims are more commonly assaulted with an abuser's body part than an object, and the mechanisms and weapons used impact patterns of injury.     

Homicidal penetrating incised wounds of the thorax. An autopsy study of 52 cases

During March-June and August-September 1981, 245 medicolegal autopsies were conducted by the author at the Johannesburg and Diepkloof government mortuaries. In 52 cases (21.2%) penetrating incised wounds of the thorax were found to be the cause of death. These involved diverse and often multiple thoracic structures - ventricles, atria, interventricular septum, lungs, and, in particular, blood vessels. In most of these cases death was ascribed to either exsanguination and the attendant hypovolaemic shock or, in those wounds involving the pericardium and myocardium, cardiac tamponade. Several findings emerged from this study: (i) an abysmally low number of the victims (5.8%) reached a medical facility alive; (ii) no females were seen, and the 21-30 year age group predominated (46.2%); (iii) 80.8% had arrived at the casualty department during a weekend; (iv) 71.2% had received a single fatal penetrating incised wound; (v) nearly two-thirds of the wounds seen were inflicted over the precordial area; (vi) almost 80% of the victims had a positive blood alcohol level, this ranging from 10 mg/dl to 340 mg/dl; (vii) there was a paucify of blunt force injuries in addition to the primary penetrating incised would/s; and (viii) there was a low percentage of 'defence' wounds among these victims of homicidal assaults.     

Epidemiology of childhood burns in the critical care medical center of Kinki University Hospital in Osaka, Japan

The objective of the present study was to describe the characteristics of pediatric burns in order to prepare a program for the prevention of severe burn injuries in children. We conducted a retrospective study of burn victims aged 15 years or younger who were hospitalized in our Critical Care Medical Center between 1982 and 1997. There were 73 children with burn injuries hospitalized in our center during the study period. The greatest number were children 1 year old. The average % body surface area burned was 21. 5+/-20.5%. The most important causes of pediatric burns were found to be hot bath water and other hot liquids. Hot bath scalds accounted for about half of the pediatric burns occurring in all age groups, and they were often extensive. Non-bath scalds accounted for about one-third of the pediatric burns and were most frequent in children 2 years and younger. All the injuries sustained at home occurred when a family member was in the house.Similar to many reports from overseas, non-bath scalds were one of the most common causes of burns in this study; however, hot bath scalds were the most important cause.These data are being used to develop a prevention program. We also consider it necessary to educate children and their family members about the dangers of burn injuries.     

Epidemiology of hospitalized burns patients in Taiwan

Previous studies based on either single hospital data or sampling of specific groups of hospitalized burns victims in Taiwan have provided only minimal epidemiological information. The study is designed to provide additional data on the epidemiology of hospitalized burns patients in Taiwan. Data were obtained from the Burn Injury Information System (BIIS), which brings together information supplied by 34 contracted hospitals. The study time course spanned a 2-year period from July 1997 to June 1999. Patient characteristics (age, sex, education level, etc.), causes and severity of injuries, and medical care measures were explored. A total of 4741 patients were registered with BIIS over the study period. The majority of hospitalized patients (67%) were male. The age distribution of burns patients showed peaks occurring at the age groups of 0-5 and 35-44 years. Over the time course of a day, burn injuries occurred more frequently from 10:00 to 12:00 h and 16:00 to 18:00 h. Injuries suspected as the result of suicide, homicide or child abuse accounted for 4.8% of hospitalized cases. More than 48% of the burns occurred in the home. The leading type of burn injury was scalding, followed by naked flame, explosion, electrical burns, and chemical burns due to caustic or corrosive substances. The mean percent total body surface area (%TBSA) for adults was 19%, and for young children was 12%. The average length of hospital stay was 18 days. In conclusion, children under 5 years and adults between 35 and 44 years of age are two high-risk groups for burn injuries. Corresponding to meal preparation time, hot substances such as boiling water, hot soup, etc. are the most common agents responsible for scalds. Prevention programs for reducing the risk of burn injuries during cooking and eating are required, especially for parents with young children.     

Etiology and outcome of burns in Tabriz, Iran. An analysis of 2963 cases.

BACKGROUND AND AIMS: Burn injuries still produce a significant morbidity and mortality in Iran. A 3-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of patients in Tabriz. MATERIAL AND METHODS: Two thousand nine hundred sixty + three patients were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn. There is one burn center in the East Azarbygan province serving 3.3 million people over an area of 47,830 sq.km. RESULTS: The overall incidence rates of hospitalization and death were 30.5% and 5.6% per 100000 person years. The mean patient age was 22 years, and the male: female ratio was 1.275. There were 555 deaths altogether (18.7%). The highest incidence of burns was in the 1-9 age group (29.2%). Patients with less than 40 percent of burned surface constituted 79.8% of injuries. The most common cause of burns was kerosene accident in adults and scald injuries in children. The mean length of hospitalization was 13 days. The mean body surface area burned was larger with higher mortality in females than in males (p < 0.001). Inhalation injuries were strongly associated with large burns and were present in all flame-burn fatalities. CONCLUSION: In our opinion, social factors are the main drive leading to an unacceptably high rate of burn injuries in our societies. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable; educational programs might reduce the incidence of burn injuries.     

Snowboarding injuries of the chest: comparison with skiing injuries.

BACKGROUND: Snowboarding injuries have become more common with the remarkable increase in the sport's popularity. However, although there are many reports of orthopedic injuries caused by snowboarding, there are few reports on injuries to the chest. In this study, we attempted to identify the characteristics of snowboarding injuries of the chest in comparison with alpine skiing injuries. METHODS: Between December of 1988 and April of 1997, 1,579 and 9,108 patients were treated for snowboarding and skiing injuries, respectively. All patients were initially examined by emergency physicians who used chest x-ray film. Patients with known or suspected chest injuries were further examined by using chest computed tomography and ultrasonography by thoracic and general surgeons. A total of 96 snowboarding patients and 247 skiing patients had chest injuries. RESULTS: The chest injuries among snowboarders accounted for 6.1% of all injuries compared with only 2.7% amongst skiers. Snowboarders with chest injuries were younger, more often beginners, and more frequently occurred during the afternoon than skiers. Several distinct patterns of injury were noted among these two groups. As the cause of injury, a riding mistake during jumping was significantly higher for snowboarders (50.0%) than for skiers (0%). The incidence of rib fracture during snowboarding (55.2%) was significantly higher than during skiing (41.3%). There were no mortalities in either group. CONCLUSION: A riding mistake during improper jumping may be the primary cause of chest snowboarding injuries. Furthermore, snowboarders are much more likely to injure the chest, particularly by rib fractures, than skiers.     

Incidence and nature of epidemiological injuries to elite South African cricket players.

OBJECTIVES: The study investigated the incidence and nature of injuries sustained by elite cricketers during a season and the possible risk factors associated with these injuries. METHODS: Fourteen physiotherapists and three doctors recorded 163 injuries sustained by 88 cricketers. RESULTS: Bowling accounted for 40.5% of the injuries, while fielding and batting accounted for 25.6% and 21.5% of the injuries, respectively. The injuries occurred while practising for or playing in club (3.7%), provincial 'B' (8.0%), provincial (51.5%) and international (36.8%) matches and occurred primarily during 4- and 5-day (33.1%) and 1-day (27.0%) matches. First-time injuries made up 63.6% of the injuries, recurrent injuries from previous seasons made up 28.4% and 8.0% of the injuries recurred again at a later stage during the season. Of the injuries 62.6% were acute, 14.7% chronic and 22.7% were acute injuries on existing chronic injuries. The majority of the injuries were muscle (37.4%), joint (20.9%) and tendon (15.3%) injuries. The primary mechanisms of injury were as a result of overuse (30.7%); running to catch or field (15.3%); during the bowling delivery or follow-through (12.3%); and being struck by the ball while batting (11.0%). CONCLUSIONS: Coaches, players and the medical support team need to be aware of the incidence, nature and cause of injuries, so that the risk of injury can be further reduced.     

Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran

Objective： To describe mortality pattern and to determine undiagnosed fatal injuries according to autopsy findings among road traffic accident victims in Yazd, Iran.
Methods： In this retrospective study, 251 victims of road traffic accidents who were admitted to a tertiary trauma hospital over a two-year period （2006 and 2007） and received medical cares were included. Hospital records were reviewed to gather demographic characteristics, road user type, and medical data. Autopsy records were also reviewed to determine actual causes of death and possible undiagnosed injuries occurred in the initial assessment of the emergency unit or during hospitalization.
Results： There were 202 males （80.5%） and 49 females （19.5%）. The mean （＋SD） age of fatalities was 34.1 （＋21.5） years. Pedestrian-vehicle accidents were the most common cause of trauma （100 cases, 39.8%）. The most common cause of death was central nervous system injury （146 cases, 58.1%）. The other causes were skull base fractures （10%）, internalbleeding （8%）, lower limb hemorrhage （8%）, skull vault fractures （4%）, cervical spinal cord injury （3.6%）, airway compromise （3.2%）, and multifactor cases （5.1%）, respectively. Thirty-six fatal injuries in 30 victims （12%） mainly contributed to death according to autopsy, but were not diagnosed in initial assessments. The head （72.2%） and cervical spine （13.8%） regions were the two most common sites for undi- agnosed injuries.
Conclusion： Training courses for emergency unit medical staff with regard to interpreting radiological findings of head and neck and high clinical suspicion for cervical spine injuries are essential to improve the quality of early hospital care and reduce the mortality and morbidity of traffic accident patients.     

Incidence and characteristics of bicycle injuries by source of information

Data from analysis of bicycle injuries in a defined, semirural Finnish population were compared with the national hospital discharge register and official police statistics and were related to national data on prevalence of bicycling. The results suggested an incidence of 7.3 injured persons/1000 population, which was 20-fold the figure derived from the police statistics. Inclusion of injuries treated at health centres doubled the number requiring medical attention. Bicycle injuries accounted for 52% of all traffic injuries. A motor vehicle was involved in 11% of bicycle injuries. In these accidents 18% of the victims were hospitalized, but only 6% in other bicycle accidents. Police and hospital records overestimated the proportion of motor vehicle crashes, involvement of elderly persons and incidence of head injuries and fractures. Non-motor vehicle bicycle accidents accounted for most of bicycle injuries, for 58% of in-patients and 93% of out-patients. Information from all levels of health care is required for injury control.