Self-reported Alcohol Use Is an Independent Risk Factor for Head and Brain Injury among Cyclists but Does Not Confound Helmets’ Protective Effect

Background

Head and brain injury accounts for most morbidity and mortality related to bicycle accidents, much of which can be mitigated by helmet use; but other factors, such as alcohol use and type of accident, also correlate with injury.

Objective

To examine the correlation between alcohol use, helmet use, riding environment, and rider characteristics, with the presence of head and severity of brain injury in a group of bicycle riders presenting to a regional trauma center after an accident.

Methods

Data were collected at the bedside and from the medical records for all bicycle accident victims presenting during a 2 ½-year period to a regional trauma center. Data were analyzed in Stata version 10 (StataCorp LP, College Station, TX) using chi-squared, analysis of variance, Kruskal-Wallis, or Wilcoxon rank-sum where appropriate.

Results

There were 427 patients enrolled, of which 82% were male, with a median age of 31 years. Two factors correlated with presence of head injury and severity of brain injury among bicycle riders presenting to the emergency department (ED) after an accident. For any head or brain injury, the odds ratios for helmet use and alcohol use were 0.5 (95% confidence interval [CI] 0.32–0.78) and 2.68 (95% CI 1.66–4.33). Of accidents presenting to the ED, helmeted riders were less likely to sustain a head or brain injury, and riders who reported alcohol use were more likely to sustain a head or brain injury.

Conclusions

Helmet use was protective for head or brain injury in non-drinking cyclists, but had a confounding effect in drinking riders.     

Unicycle Injuries in the United States

Background

Unicycles are single-wheel machines ridden for transportation or recreation. To our knowledge, no studies have been performed that describe injury rates of unicycle use.

Objective

The objective of this study was to describe the epidemiological characteristics of unicycle injuries treated in United States (US) emergency departments (EDs).

Methods

A retrospective analysis was performed using data from the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission from 1991 through 2010.

Results

An estimated 3360 patients were treated for unicycle injuries from 1991 to 2010, averaging 168 injuries per year in the United States. Ten to fourteen-year-old patients represented 41% of the entire study cohort. Fractures represented approximately one third (32.9%) of all injuries treated. More than half (52.9%) of all injuries involved an extremity. Six of the 85 cases studied involved a head injury; all were aged younger than 18 years. Only 3.53% of all studied cases were admitted for further treatment. The rest were treated in the ED and discharged to home. Fractures were the primary diagnosis in all admitted cases.

Conclusions

Based on NEISS data, unicycle injuries treated in EDs are relatively uncommon and rarely require admission. Of documented injuries, fractures and extremity injuries are most common. Additional research is needed to understand the underlying mechanisms of these injuries as well as the potential need for helmet use advocacy.     

Factors affecting severity of bicycle-related injuries: the role of helmets in preventing head injuries

Objectives: To identify factors that affect the severity of bicycle‐related injuries in patients with head injury compared with those without, so as to find whether the effect of using helmets extends beyond head protection, and to explore a direct protective effect of helmets on head injuries. Methods: A total of 297 patients with bicycle‐related injuries were studied. A generalized linear model was used to test the effect of age, sex, helmet use, cause of injury, year of injury, place of injury and whether the injury occurred on public or school holidays on the Injury Severity Score (ISS) in those patients who had head injury and those without. A logistic regression model was used to define the factors that contribute to head injury, while adjusting for ISS. Results: Factors affecting ISS in the generalized linear model in those who had head injury were: cause of injury (P = 0.01) and there was a trend for helmet use (P = 0.06). The significant factors that have affected ISS in the no head injury group were age (P = 0.002) and place of accident (P = 0.03). Logistic regression has shown that with each increase of 1 point in the ISS the odds of head injury increases by a factor of 1.22 (95% confidence interval 1.13–1.31) and the use of helmets reduces the odds of head injury by a factor of 0.48 (95% confidence interval 0.23–1.03). Conclusions: The reduced severity of injury in helmeted patients is because of protection of the head and not other body regions.     

Neurologic Outcome Score for Infants and Children

OBJECTIVES: To develop and validate a practical outcome instrument applicable to a broad range of neurologic deficits in children. METHODS: Reliability testing of a draft version of the Neurologic Outcome Scale for Infants and Children (NOSIC) in 100 children with a wide range of ages and levels of neurologic function was performed. After review of the reliability data by a panel of experts, the NOSIC was revised. Validity and reliability testing of the final NOSIC was performed in a new population of 157 children, 52 with cerebral palsy, motor delay, or language delay. Interrater reliability was assessed using Spearman rank correlation coefficients of two investigators' scores. NOSIC scores were correlated with scores on criterion-standard neuropsychological tests to assess validity. RESULTS: The median NOSIC score for normal children was 98, interquartile range 96-100; the median score for abnormal children was 87, interquartile range 58-96. Interrater reliability of the NOSIC scores of 84 patients rated by both raters demonstrated excellent reliability (rho = 0.77, 95% confidence interval [CI] = 0.62 to 0.88). Correlation of the NOSIC scores of the 127 patients who had neuropsychological testing with applicable criterion standards was rho = 0.63, 95% CI = 0.50 to 0.74. CONCLUSIONS: The NOSIC is a practical, reliable, valid, instrument applicable to infants and children with a broad range of neurologic deficits. It should be a useful research tool when neurologic function is an important outcome measure.     

An Arm-Powered Racing Bicycle

A new arm-powered racing bicycle is described. The features and performance of this bicycle are delineated, and the relative advantages over tricycles are outlined.     

Emergency Department Management and Follow-up of Children with Bicycle Spoke Injuries

Background

Evidence for a standard x-ray study and cast immobilization in emergency department (ED) management and follow-up of children with bicycle spoke injury (BSI) is absent.

Objective

To describe the injury pattern and outpatient follow-up and care of ED patients with BSI. In addition, patient characteristics predicting the presence of a fracture and long-term follow-up were assessed.

Methods

This was a retrospective study including BSI patients < 9 years of age. Kruskal-Wallis test was used to compare groups with a fracture, soft tissue injury, and mild skin abrasion. Multivariable logistic regression analysis was used to identify independent predictors of a fracture and long-term outpatient follow-up.

Results

Twenty-three percent of 141 included patients had a fracture, with a median (interquartile range) follow-up of 27 (23–40) days. For soft tissue injury and mild abrasions this was 9 (6–14) and 7 (5–9) days, respectively (p < 0.001). No clinical variables could predict a fracture. Fifty-six (40%) patients required no further care after the first outpatient visit at ∼1 week. Triage category yellow and swelling were independent predictors for more than one outpatient visit, besides presence of fracture. Corrected odds ratios (95% confidence interval) were 2.42 (0.99–5.88) and 4.76 (1.38–16.39), respectively. Only 12% of 141 patients had none of these predictors at ED presentation.

Conclusions

A quarter of ED patients with BSI have a fracture with no clinical signs that could predict the presence of a fracture, justifying a standard x-ray study in ED management. Only 12% of ED patients with BSI have no fracture and no signs that predict long-term follow-up. In this group, further studies are warranted to investigate the benefit of cast immobilization for fractures and soft tissue injury.     

Analysis of School Injuries Resulting in Emergency Department or Hospital Admission

OBJECTIVE: To describe the epidemiology of school injuries resulting in emergency department (ED) visits, hospital admission, or death. METHODS: Utah statewide school injuries from 1992 to 1996 were probabilistically linked to statewide ED records (1996 only), inpatient hospital records (1992-1996), and death certificate records (1992-1996). RESULTS: There were 43,881 school injuries for the years 1992 through 1996. In 1996, 1,534 of 6,354 total school injuries (17.5%) resulted in ED evaluation. Between 1992 and 1996, 354 school injuries (0.8%) necessitated hospital admission. The overall rates of school injuries (per 1,000 students) of primary (kindergarten-grade 6) and secondary (grades 7-12) school students requiring ED evaluation were 3.29 and 3.28, respectively; for hospital admission, 0.165 and 0.139. Abbreviated Injury Scale-1990 (AIS-90) regions identified in ED patients were the upper extremity (39.2%), face (20.8%), and lower extremity (17.1%), while AIS regions among inpatients were lower extremity (29.1%), upper extremity (26.6%), and head (22.6%). There were a total of 1,123 hospital days, and total charges of $2.16 million. The ED charges totaled $545,000. Median length of hospital stay was 1 day, and median hospital charge was $3,080. There were four fatalities. CONCLUSIONS: This study emphasizes the significance of school injuries and the need for interventions to prevent these injuries     

中枢神经系统（CNS）损伤后功能恢复的理论（二）

上一节介绍了CNS损伤后功能恢复的理论和促进因素以及脑可塑性理论的发展与概念。本节将讨论脑可塑性理论的形态和生理学依据及其在人和动物身上的证明。并且依据Luria的功能重组理论,用图说明了影响脑可塑性的内、外因素。     

Promoting the use of bicycle helmets during primary care visits

PURPOSE: The purpose of this article is to communicate ways in which the nurse practitioner (NP) working with the pediatric population can incorporate bicycle helmet use education into the primary care setting. DATA SOURCES: Review of literature on bicycle helmets, safety, and head injury, retrieved from scientific journals and reliable Internet sources. CONCLUSIONS: Bicycling has become a popular sport for both children and adults. Despite excellent benefits, bicycling can pose hazards to riders when safety measures are not practiced. Head injury has been cited as the leading cause of death in bicycle-related injuries. The simplest and single most effective device available to reduce head injury and death is the bicycle helmet. IMPLICATIONS FOR PRACTICE: NPs working with the pediatric population can have a profound impact on safety and health through promoting bicycle helmet use to both the child and accompanying parent during children's primary care visits. NPs can also become involved beyond the institution and act as role models for children, form coalitions, and serve as community advocates for new or stronger helmet legislation and enforcement of bicycle helmet laws.     

心电图运动负荷试验在冠心病诊断中的价值

目的：探讨心电图踏车运动试验对冠心病的诊断价值。方法：102例男性与48例女性心电图踏车运动试验结果与冠状动脉造影结果进行对比分析。结果：心电图踏车运动试验诊断冠心病的敏感性73．5％（50／68），特异性82．9％（68／82），准确性78．7％（118／150）。多支冠状动脉病变患者心电图踏车运动试验阳性率显著高于单支病变P〈0.01。中高危人群心电图踏车运动试验的阳性率38．8％，冠状动脉造影阳性率52．9％；低危人群心电图踏车运动试验的阳性率10．3％，冠状动脉造影阳性率13．8％，两组人群的阳性率有显著性差异，P〈0．01。女性运动试验假阳性率高于男性（分别为29％和9．8％，P〈0．05）。结论：简便、易行和无创伤的心电图踏车运动试验是评价心肌缺血和协助诊断冠心病的重要手段，结合冠心病的易患因素综合分析，对确诊冠心病拟诊患者有重要的参考价值，同时可为选择适合行冠状动脉造影的高危患者提供重要依据。     

中枢神经系统(CNS)损伤后功能恢复的理论(六)

本节继续介绍功能恢复的外界影响。     

Traumatic Brain Injuries Evaluated in U.S. Emergency Departments, 1992-1994

OBJECTIVE: To describe the incidence and patient characteristics of traumatic brain injuries (TBIs) treated in U.S. emergency departments (EDs). METHODS: A secondary analysis was performed on data from the National Hospital Ambulatory Medical Care Survey administered from 1992 to 1994. An ED visit was determined to represent a case of TBI if the case record contained ICD-9-CM codes of 800.0-801.9, 803.0-804.9, or 850.0-854.1. RESULTS: The average annual estimate of new TBI treated in U.S. EDs was 1,144,807, equaling 444 per 100,000 persons (95% CI = 390 to 498), which represents approximately 3,136 new cases of TBI per day and accounts for 1.3% of all ED visits. Males were 1.6 times as likely as females to suffer TBI until the age of 65 years, when the female rate exceeded the male. The rate for blacks was 35% higher than that for whites. The highest overall incidence rate of TBI occurred in the less-than-5-year age group (1,091 per 100,000), closely followed by the more-than-85-year age group (1,026 per 100,000). Falls represented the most common mechanism of TBI injury, followed by motor vehicle-related trauma. CONCLUSIONS: This study underscores the ongoing need for effective surveillance of all types of TBI and evaluation of prevention strategies targeting high-risk individuals. It serves as a clinically grounded and ED-based corroboration of prior survey research, providing a basis for comparison of incidence rates over time and a tool with which to measure the efficacy of future interventions.     

Contracting with Children and Helmet Distribution in the Emergency Department to Improve Bicycle Helmet Use

OBJECTIVES: To determine whether injury prevention counseling and behavioral counseling delivered in the emergency department (ED) could result in increases in self-reported bicycle helmet use. METHODS: The authors undertook a trial of counseling in 222 children recruited in an urban ED between August 2000 and October 2001. All consenting patients in the ED aged 5 to 15 years who did not have life-threatening conditions were eligible. One hundred nine children were assigned to the control group on the basis of attendance on an odd-numbered day, and they received a photocopied photograph of the hospital. One hundred thirteen children were assigned to the intervention group, and they received a personal counseling session and signed a contract promising to wear their bicycle helmets. In addition, 57 of the intervention children were assigned (based on having an even-numbered birthday) to be fitted with helmets if they did not already own them. Parents were telephoned four weeks after the ED encounter for follow-up. RESULTS: Follow-up data were obtained for 148 children (67% follow-up rate), of whom only 69 reported riding a bicycle in the four weeks after their ED visit. Of the final sample of 69 children, 38 belonged to one of the intervention groups, and 25 of these (66%) reported always wearing a helmet while cycling during the four weeks after their ED visit, versus 13 of 31 (42%) in the control group (odds ratio, 2.66; p < 0.05). The effect of the intervention was independent of whether the children owned a helmet at baseline. CONCLUSIONS: Injury prevention counseling in the ED using "The Injury Prevention Program" (TIPP) sheet, behavioral contracting, and helmet distribution may have a significant effect on reports of subsequent bike helmet use.     

脑损伤后内分泌功能的变化及其发生机制

在创伤性颅脑损伤和脑血管病急性期，均可出现下丘脑-垂体．肾上腺皮质轴、下丘脑-垂体-甲状腺轴和下丘脑-垂体-性腺轴功能紊乱，主要是由于下丘脑和垂体原发或继发性损伤所致。脑损伤后急性期的体内大多数激素水平的变化是暂时性的，也可能是可逆的，但部分病例在恢复期合并有垂体功能减退，出现分泌功能不足的表现。激素的缺乏可能会影响到脑损伤患者的预后，目前需要建立一个指南以明确哪部分患者、什么时候以及怎样进行激素替代治疗。