Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures

BackgroundOpen pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality.MethodsA query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher’s exact test and chi-square test for categorical variables, and Welch’s t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications.ResultsA total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality.ConclusionWe report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population.Level of EvidenceLevel II, Retrospective study.     

Quantitative and Qualitative Changes in Cocaine Use Among American High School Seniors,College Students,and Young Adults

Objectives: To assess prevalence, predictors, and longitudinal patterns of cocaine use.

Methods: Nationally representative samples of high school seniors were studied each year from 1975 through 1987. Follow-up surveys of representative subsamples of each class were obtained. This design produces estimates for three populations: high school seniors, college students 1–4 years post high school, and high school graduates age 19–28.

Results: Substantial numbers of young Americans are using cocaine, and users are likely to continue using over long intervals.     

The association between sport-related concussion and musculoskeletal injury in university rugby athletes

ObjectivesThe study aimed to analyse the association between Sports-Related Concussion (SRC) and Subsequent Musculoskeletal Injury (MSK) in United Kingdom university-aged rugby union players whilst considering the effects of sex, athlete playing position and injury location.DesignRetrospective cohort study. A period of 365 days with 0–90, 91–180 and 181–365 days sub-periods was analysed for the following variables; MSK injury incidence, occurrence, severity, injury location, playing position and sex.SettingInjury data was collected from the Sports Development Centre database at Loughborough University.ParticipantsA total of 408 injuries in 181 athletes (55 females and 126 males) were included.ResultsThe MSK injury incidence of SRC group was significantly higher than control and higher post-SRC than pre-SRC period over a 365-day period (p=0.012 and p=0.034, respectively). The odds ratios of MSK injury incidence between groups and between periods were 1.62 (95% CI, 1.10–2.25) and 1.57 (95% CI ,1.08–2.29). A SRC was not associated with a greater time loss from a subsequent MSK injury or a specific MSK injury location.ConclusionsAthletes with a second recorded injury were more likely to sustain a MSK injury if they had experienced SRC, however, there was no indication a SRC resulted in greater time loss from a MSK injury.     

Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures

BackgroundOpen pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality.MethodsA query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher’s exact test and chi-square test for categorical variables, and Welch’s t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications.ResultsA total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality.ConclusionWe report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population.Level of EvidenceLevel II, Retrospective study.     

Alcohol Use among College Athletes: Do Intercollegiate,Club, or Intramural Student Athletes Drink Differently?

Background: Varsity student athletes are a high-risk drinking group, exhibiting a greater propensity to binge drink than their non-sport peers. Moreover, as intercollegiate athletic involvement increases, so too does alcohol consumption. There is little research, however, which examines drinking behaviors of students who participate in nonvarsity athletics. Objectives: Identify differences in alcohol-related behaviors and associated consequences among U.S. varsity, club, and intramural athletes, and nonathlete college students. Methods: Secondary data analysis of the 2011 National College Health Assessment (n = 29,939). Results: Intramural athletes binge drank more frequently (M = 1.1, SD = 1.7) than club athletes (M = 1.0, SD = 1.6), intercollegiate athletes (M = 0.9, SD = 1.5), and nonathletes (M = 0.6, SD = 1.3) and also experienced greater alcohol-related consequences. Intramural athletes consumed the most during their last drinking episode (M = 4.1, SD = 4.0) and reached the highest blood alcohol concentration (BAC) (M = 0.062, SD = 0.09).Compared to club and varsity athletes [M = 0.8, SD = 1.4; t (8,131) = ?9.6, p < .001], intramural-only athletes reported binge drinking significantly more frequently (M = 1.2, SD = 1.7) and also reached significantly higher BACs during most recent drinking episode (M = 0.064, SD = 0.08) than organized sport athletes [M = 0.057, SD = 0.08; t (8,050) = ?3.0, p = .003]. Conclusions: Intramural athletes represent a higher-risk drinking group than other athlete and nonathlete college students. Future research should investigate factors contributing to drinking differences among different athlete groups.     

Where you live matters: The roles of living arrangement and self-esteem on college students’ hazardous drinking behaviors

This study examined the influence of living arrangements and self-esteem on problematic alcohol use among 139 university students. Our findings replicate the well-established inverse association between self-esteem and problematic alcohol use. However, analyses disaggregated by living arrangement revealed that this association was inconsistent such that the inverse association between self-esteem and both binge drinking and alcohol-related problems was observed among participants living with parents, but not among students living on campus or off campus without parents. The moderating effect of living arrangement highlights the importance of considering living arrangements when examining risk factors for hazardous drinking among college students, as the pathways to problematic alcohol use may differ according to living situations.     

Experiential Aspects of Alcohol‐Induced Blackouts Among College Students

Our current understanding of alcohol‐induced memory blackouts is derived largely from research with middle‐aged, hospitalized, male alcoholics. In the present study, 50 undergraduate students (34 female and 16 male) with a history of at least one blackout were interviewed to gain insight into their experiences. Fragmentary blackouts, in which memory for events is fragmented, were far more common than blackouts of the en bloc type, in which a period of time is simply missing from memory. Most students recalled bits and pieces of events without cueing from others, yet still relied on friends, most also intoxicated themselves during the blackout period, to tell them what transpired. Thinking about the fragments triggered further recall in the majority of cases. Half of all subjects, more females than males, reported having been frightened by their last blackout experience. Being frightened typically led to more careful drinking for several weeks or longer. Characteristics of blackouts among college students in the present study are compared to the standard model of blackouts based on reports from alcoholics.     

The clinical pharmacology and antiarrhythmic efficacy of acetylprocainamide in patients with arrhythmias

The actions of acetylprocainamide, the major metabolite of procainamide in man, were studied in a placebo-controlled oral-dose-ranging trial in 16 persons with arrhythmias. The occurrences of arrhythmias decreased in 15 patients receiving acetylprocainamide and increased subsequently in 10 of 13 patients given placebo. The frequency of arrhythmias was reduced by more than 75 percent in nine patients. Antiarrhythmic effects were dependent on dose and serum drug concentrations, with levels of 10 to 24 μg/ml observed in patients with a reduction of more than 70 percent in premature ventricular complexes. The ratio of preejection period to left ventricular ejection time decreased during therapy. Side effects of light-headedness, insomnia, nausea and diarrhea occurred in six patients at serum levels ranging from 11 to 22 μg/ml. The serum half-life of acetylprocainamide lengthened from 7 to 21 hours as the creatinine clearance decreased from 105 to 35 ml/min. Acetylprocainamide has antiarrhythmic efficacy, but causes side effects in human beings. This compound appears to contribute to the effects of procainamide therapy and may be useful as an antiarrhythmic drug.