Browsing by Subject "Injury"
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Item Association between concussion and mental health in former collegiate athletes(Springer, 2014-12) Kerr, Zachary Y.; Evenson, Kelly R.; Rosamond, Wayne D.; Mihalik, Jason P.; Guskiewicz, Kevin M.; Marshall, Stephen W.; Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public HealthBACKGROUND: The existing research on the association between concussion and mental health outcomes is largely limited to former professional athletes. This cross-sectional study estimated the association between recurrent concussion and depression, impulsivity, and aggression in former collegiate athletes. METHODS: Former collegiate athletes who played between 1987-2012 at a Division I university completed an online questionnaire. The main exposure, total number of self-recalled concussions (sport-related and non-sport-related), were categorized as: zero (referent), one, two, or three or more concussions. The main outcomes were the depression module of The Patient Health Questionnaire (PHQ-9), the Short Form of the Barratt Impulsiveness scale (BIS15); and the 12-item Short Form of the Buss-Perry Aggression Questionnaire (BPAQ-SF). Depression was categorized into a binomial severity classification that differentiated between no or mild depression (PHQ-9 scores <10) and moderate to severe depression (PHQ-9 scores ≥10). Impulsivity and aggression were kept as continuous outcomes. Binomial regression estimated adjusted prevalence ratios (PR). Linear regression estimated adjusted mean differences (MD). RESULTS: Of the 797 respondents with complete data (21.9% completion rate), 38.8% reported at least one concussion. Controlling for alcohol dependence and family history of depression, the prevalence of moderate to severe depression among former collegiate athletes reporting three or more concussions in total was 2.4 times that of those reporting zero concussions [95% Confidence Interval (CI): 1.0, 5.7]. Controlling for alcohol dependence, family history of anxiety, relationship status, obtaining a post-graduate degree, and playing primary college sport professionally, former collegiate athletes reporting two or more concussions in total had higher mean scores for impulsivity, compared to those reporting no concussions (2 concussions MD = 2.7; 95% CI: 1.2, 4.1; 3+ concussions MD = 1.9; 95% CI: 0.6, 3.2). Controlling for alcohol dependence, sex, and relationship status, former collegiate athletes reporting three or more concussions in total had a higher mean score for aggression, compared to those reporting no concussions (MD = 3.0; 95% CI: 1.4, 4.7). CONCLUSIONS: Our study found an association between former concussion and greater risk of severe depression and higher levels of impulsivity and aggression among former collegiate athletes. Additional prospective studies better addressing causality and ascertaining valid lifetime concussion histories and medical histories are needed.Item A cohort study to identify and evaluate concussion risk factors across multiple injury settings: findings from the CARE Consortium(Biomed Central, 2019-01-14) Van Pelt, Kathryn L.; Allred, Dain; Cameron, Kenneth L.; Campbell, Darren E.; D’Lauro, Christopher J.; He, Xuming; Houston, Megan N.; Johnson, Brian R.; Kelly, Tim F.; McGinty, Gerald; Meehan, Sean; O’Donnell, Patrick G.; Peck, Karen Y.; Svoboda, Steven J.; Pasquina, Paul; McAllister, Thomas; McCrea, Michael; Broglio, Steven P.; Medicine, School of MedicineBACKGROUND: Concussion, or mild traumatic brain injury, is a major public health concern affecting 42 million individuals globally each year. However, little is known regarding concussion risk factors across all concussion settings as most concussion research has focused on only sport-related or military-related concussive injuries. METHODS: The current study is part of the Concussion, Assessment, Research, and Education (CARE) Consortium, a multi-site investigation on the natural history of concussion. Cadets at three participating service academies completed annual baseline assessments, which included demographics, medical history, and concussion history, along with the Sport Concussion Assessment Tool (SCAT) symptom checklist and Brief Symptom Inventory (BSI-18). Clinical and research staff recorded the date and injury setting at time of concussion. Generalized mixed models estimated concussion risk with service academy as a random effect. Since concussion was a rare event, the odds ratios were assumed to approximate relative risk. RESULTS: Beginning in 2014, 10,604 (n = 2421, 22.83% female) cadets enrolled over 3 years. A total of 738 (6.96%) cadets experienced a concussion, 301 (2.84%) concussed cadets were female. Female sex and previous concussion were the most consistent estimators of concussion risk across all concussion settings. Compared to males, females had 2.02 (95% CI: 1.70-2.40) times the risk of a concussion regardless of injury setting, and greater relative risk when the concussion occurred during sport (Odds Ratio (OR): 1.38 95% CI: 1.07-1.78). Previous concussion was associated with 1.98 (95% CI: 1.65-2.37) times increased risk for any incident concussion, and the magnitude was relatively stable across all concussion settings (OR: 1.73 to 2.01). Freshman status was also associated with increased overall concussion risk, but was driven by increased risk for academy training-related concussions (OR: 8.17 95% CI: 5.87-11.37). Medical history of headaches in the past 3 months, diagnosed ADD/ADHD, and BSI-18 Somatization symptoms increased overall concussion risk. CONCLUSIONS: Various demographic and medical history factors are associated with increased concussion risk. While certain factors (e.g. sex and previous concussion) are consistently associated with increased concussion risk, regardless of concussion injury setting, other factors significantly influence concussion risk within specific injury settings. Further research is required to determine whether these risk factors may aid in concussion risk reduction or prevention.Item The Demographics of Non-motor Vehicle Associated Railway Injuries Seen at Trauma Centers in the United States 2007 - 2014(Cureus, 2019-10) Raymond, Jodi; Loder, Randall T.; Schneble, Christopher A.; Orthopaedic Surgery, School of MedicineIntroduction The majority of railway injury studies are limited by small sample size, restricted to a small geographical distribution, or located outside the United States (US). The aim of our study was to assess the demographic patterns associated with non-motor vehicle railway injuries in the US using a national trauma center database. Materials and Methods Data from the National Trauma Data Bank data from 2007 - 2014 were used; 3,506 patients were identified. For all statistical analyses, a p-value < 0.05 was considered significant. Results The patients were 81% male with an average age of 38.6 + 17.1 years and an Injury Severity Score (ISS) of 16.8 + 13.8. Males compared to females were younger (37.7 vs 42.5 years, p = 0.000002), had greater length of stays (12.7 vs 9.8 days, p = 0.000006), and higher ISS scores (17.1 vs 15.4, p = 0.0007). The geographic distribution within the US was most common in the South (32.0%) and least in the Northeast (18.9%). The racial composition was 67.5% White, 19.1% Black, 11.5% Hispanic/Latino, and 1.9% others. The most common mechanisms of injury were hitting/colliding with rolling stock (38.6%), followed by a fall in or from a train (19.5%), and collision with an object (13.5%). The majority of patients were pedestrians or passengers (68.5%); employees accounted for 12.5%. Although the majority were pedestrian/passengers for all regions, the Midwest had a greater proportion of employees (22.0%) compared to the other regions (7.8% to 12.2%) (p < 10-6), and thus injuries were more commonly work-related (24.6% vs 6.7% - 13.7%, p < 10-6). Work-related injuries were less severe (ISS 11.2 vs 17.3 - p < 10-6) and more commonly occurred due to a fall (32.8% vs 17.9%, p < 10-6). Alcohol and/or drug involvement was present in 40.7% and was less in those with work-related injuries (2.2%). Overall mortality was 6.4% and was less in those having a work-related injury (2.0 vs 6.6% p = 0.000004). Conclusion For non-motor vehicle USA railway injuries, the average age was 38.5 years; 80.6% were male. The injuries were least common in the Northeast and most common in the South. Racial distribution mirrored that of the US population. Alcohol involvement was present in 29%, lower than in previous studies. Mortality was 6.4%, also lower than previously reported.Item How combinations of state firearm laws link to low firearm suicide and homicide rates: A configurational analysis(Elsevier, 2022-12) Rich, John A.; Miech, Edward J.; Semenza, Daniel C.; Corbin, Theodore J.; Medicine, School of MedicineFirearm violence, including both homicide and suicide, is a major public health problem in the United States (US). To decrease firearm mortality, US states have implemented laws to restrict firearm availability. We evaluated ten state firearm laws using configurational comparative methods (CCMs) designed to uncover how multiple factors are linked to a given outcome. We applied coincidence analysis, a novel CCM, to ten firearm laws in US states in 2016, to assess how different combinations of firearm laws distinguished states with low firearm homicide or suicide rates from those states with higher rates. The suicide analysis included all 50 US states; the homicide analysis involved the 47 US states with homicide rates reported by the Centers for Disease Control and Prevention (CDC) in 2016. For low firearm suicide rates, we identified three solution pathways - the presence of universal background checks OR the presence of under 21 firearm possession restrictions OR the presence of junk gun bans - which were sufficient for low firearm suicide rates with high consistency (0.87) and coverage (0.76). For low firearm homicide rates, we identified three solution pathways - presence of under 21 firearm possession restrictions OR the presence of universal background checks together with the absence of trafficking prohibited laws OR membership in the Northern Great Plains -which were sufficient for low firearm homicide rates with high consistency (0.87) and coverage (0.81). We conclude that CCM analysis can add new insights to how multiple firearm laws work together to reduce firearm violence.Item Injury Patterns and Associated Demographic Characteristics in Children with a Fracture from Equines: A US National Based Study(MDPI, 2024-11-27) Loder, Randall T.; Walker, Alyssa L.; Blakemore, Laurel C.; Orthopaedic Surgery, School of MedicineBackground: Fractures often occur due to equestrian activities with injury patterns varying by age. The purpose of this study was to investigate in detail fracture patterns and associated demographics in children due to equine activities. Materials: The US National Electronic Injury Surveillance System was queried for all injuries with the consumer product code 1239 (horseback riding) from 2000 to 2023. Those <16 years old with fractures were extracted. Statistical analyses were performed with SUDAAN 11.0.01™ software to obtain national estimates. Results: There were an estimated 101,677 patients with a fracture. Girls comprised 72.5% and the patient was discharged from the hospital in 81.5% of cases. Fractures involved the upper extremity in 80,973 (80.0%), the pelvis/lower extremity in 11,794 (11.7%), the spine in 3060 (3.0%), the skull/face in 4321 (4.4%), and the rib/sternum in 940 (0.9%). The humerus, elbow, radius/ulna, and wrist accounted for 62.4% of all the fractures. The youngest age group (0- to 5-year-olds) had more boys and was more likely to be admitted to the hospital. The child was injured due to a fall from the horse in 75.7%, bucked/thrown off/kicked off in 17.0%, with the remaining 7.3% from other mechanisms. Conclusions: This extensive description of fractures in children due to equestrian injuries can be used to determine the effectiveness of future prevention strategies, such as protective equipment and educational programs. It also gives pediatric trauma and orthopedic surgeons an overall view of the types of fractures which occur in children due to equestrian activities.Item Physical Examination is the Best Predictor of the Need for Abdominal Surgery in Children Following Motor Vehicle Collision(Elsevier, 2018-01) Drucker, Natalie A.; McDuffie, Lucas; Groh, Eric; Hackworth, Jodi; Bell, Teresa M.; Markel, Troy A.; Pediatrics, School of MedicineBACKGROUND: Exploratory laparotomy in children after motor vehicle collision (MVC) is rare. In the absence of definitive hemorrhage or free abdominal air on radiographic imaging, predictors for operative exploration are conflicting. OBJECTIVE: The purpose of this study was to explore objective findings that may aid in determining which children require operative abdominal exploration after MVC. METHODS: Data from 2010-2014 at an American College of Surgeons-certified level 1 pediatric trauma center were retrospectively reviewed. Demographics, vital signs, laboratory data, radiologic studies, operative records, associated injuries, and outcomes were analyzed and p < 0.05 was considered statistically significant. RESULTS: Eight hundred sixty-two patients 0-18 years of age presented to the hospital after an MVC during the study period. Seventeen patients (2.0%) required abdominal exploration and all were found to have intraabdominal injuries. Respiratory rate was the only vital sign that was significantly altered (p = 0.04) in those who required abdominal surgery compared with those who did not. Physical examination findings, such as the seat belt sign, abdominal bruising, abdominal wound, and abdominal tenderness, were present significantly more frequently in those requiring abdominal surgery (p < 0.0001). Each finding had a negative predictive value for the need for operative exploration of at least 0.98. There were no significant differences in trauma laboratory values or radiographic findings between the 2 groups. CONCLUSION: Data from this study solidify the relationship between specific physical examination findings and the need for abdominal exploration after MVC in children. In addition, these data suggest that a lack of the seat belt sign, abdominal bruising, abdominal wounds, or abdominal tenderness are individually predictive of patients who will not require surgical intervention.Item Promoting Use of Booster Seats in Rural Areas Through Community Sports Programs(Wiley, 2013) Aitken, Mary E.; Miller, Beverly K.; Anderson, Byron L.; Swearingen, Christopher J.; Monroe, Kathy W.; Daniels, Dawn; O'Neil, Joseph; Scherer, L. R. "Tres"; Hafner, John; Mullins, Samantha H.; Pediatrics, School of MedicineBackground: Booster seats reduce mortality and morbidity for young children in car crashes, but use is low, particularly in rural areas. This study targeted rural communities in 4 states using a community sports-based approach. Objective: The Strike Out Child Passenger Injury (Strike Out) intervention incorporated education about booster seat use in children ages 4-7 years within instructional baseball programs. We tested the effectiveness of Strike Out in increasing correct restraint use among participating children. Methods: Twenty communities with similar demographics from 4 states participated in a nonrandomized, controlled trial. Surveys of restraint use were conducted before and after baseball season. Intervention communities received tailored education and parents had direct consultation on booster seat use. Control communities received only brochures. Results: One thousand fourteen preintervention observation surveys for children ages 4-7 years (Intervention Group [I]: N = 511, Control [C]: N = 503) and 761 postintervention surveys (I: N = 409, C: N = 352) were obtained. For 3 of 4 states, the intervention resulted in increases in recommended child restraint use (Alabama +15.5%, Arkansas +16.1%, Illinois +11.0%). Communities in 1 state (Indiana) did not have a positive response (-9.2%). Overall, unadjusted restraint use increased 10.2% in intervention and 1.7% in control communities (P = .02). After adjustment for each state in the study, booster seat use was increased in intervention communities (Cochran-Mantel-Haenszel odds ratio 1.56, 95% confidence interval [1.16-2.10]). Conclusions: A tailored intervention using baseball programs increased appropriate restraint use among targeted rural children overall and in 3 of 4 states studied. Such interventions hold promise for expansion into other sports and populations.Item Quantifying risk of injury from usual alcohol consumption: An instrumental variable analysis(Wiley, 2021) Ye, Yu; Cherpitel, Cheryl J.; Terza, Joseph V.; Kerr, William C.; Economics, School of Liberal ArtsBackground: There have been numerous studies of roadside accidents among emergency room patients showing elevated risk of injury from acute alcohol consumption, i.e. recent drinking prior to the injury event, with large effect size and a dose-response relationship observed. In contrast, studies quantifying the association between injury risk and chronic consumption such as past year average volume show that relative risk estimates are low compared to those from acute consumption. Methods: Using the US National Alcohol Surveys (NAS) combining four waves for years 2000–2015 (N=29,571, 53% overall cooperation rate), risk of any past-year injury was first estimated by past-year volume using logistic regression. An instrumental variable (IV) analysis utilizing the two-stage residual inclusion (2SRI) approach was then conducted to estimate injury risk from volume, further adjusting for unobserved confounders, using state beer and spirits tax rates, zip code-level outlet and bar density, and control state status as instruments. Results: Based on the combined US population surveys and controlling for socio-demographics, odds ratios of injury from average volume of 1, 2 and 5 drinks per day were 1.12 [95% confidence interval: 1.02, 1.24], 1.10 [1.00, 1.22], and 1.04 [0.88, 1.22], respectively, using conventional logistic regression, compared to 1.67 [1.00, 2.78], 2.38 [0.87, 6.54] and 6.98 [0.57, 85.89] using the IV method. The proportion of injury attributed to alcohol also increased in magnitude, from 6.2% [0.3%, 11.9%] using the conventional approach to 17.9% [8.2%, 27.7%] using the IV method. Conclusions: Findings suggest that the association between injury and chronic alcohol consumption may be confounded by unobserved factors, with the risk estimate possibly biased downward.Item Sildenafil as a Rescue Agent Following Intestinal Ischemia and Reperfusion Injury(Elsevier, 2020-02) Moore, Hannah M.; Drucker, Natalie A.; Hosfield, Brian D.; Shelley, W. Chris; Markel, Troy A.; Surgery, School of MedicineBackground: Acute mesenteric ischemia carries a significant morbidity. Measures to improve blood flow parameters to the intestine may ameliorate the disease. Sildenafil, a phosphodiesterase 5 inhibitor, increases cyclic guanosine monophosphate and has been shown to prevent the effects of ischemia when given before injury. However, its effects as a rescue agent have not been established. We therefore hypothesized that sildenafil, when given as a rescue agent for intestinal ischemia, would improve mesenteric perfusion, limit intestinal epithelial injury, and decrease intestinal leukocyte chemoattractants. Methods: Eight to 12 wk-old-male C57BL/6J mice underwent laparotomy and temporary occlusion of the superior mesenteric artery for 60 min. Following ischemia, reperfusion was permitted, and before closing the abdomen, sildenafil was injected intraperitoneally in a variety of concentrations. After 24 h, reperfusion was reassessed. Animals were euthanized and intestines evaluated for histologic injury and leukocyte chemoattractants. Results: Postischemic administration of sildenafil did not improve mesenteric perfusion following intestinal ischemia and reperfusion injury. However, sildenafil did improve histologic injury scores in dose ranges of 0.01 to 10 mg/kg. No difference was noted in histological injury with 100 mg/kg dose, and all members of the 1000 mg/kg group died within 24 h of injury. Epithelial protection was not facilitated by the leukocyte chemoattractants Regulated on Activation, Normal T Cell Expressed, and Secreted, macrophage inflammatory protein 1 alpha, monocyte chemoattractant protein, neutrophil activating protein, or granulocyte colony stimulating factor. Conclusions: Administration of sildenafil following intestinal ischemia may limit intestinal mucosal injury but does not appear to alter mesenteric perfusion or leukocyte chemoattractant influx.Item Spinal Injury Associated With Firearm Use(Cureus, 2021-03-16) Loder, Randall T.; Mishra, Abhipri; Atoa, Bradley; Orthopaedic Surgery, School of MedicineObjective Injuries associated with firearms are a significant health burden. However, there is no comprehensive study of firearm spinal injuries over a large population. It was the purpose of this study to analyze the demographics of spinal firearm injuries across the entire United States for all ages using a national database. Methods A retrospective review of prospectively collected data using the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2015 (ICPSR 37276) was performed. The demographic variables of patients with spinal injuries due to firearms were analyzed with statistical analyses accounting for the weighted, stratified nature of the data, using SUDAAN 11.0.01™ software (RTI International, Research Triangle Park, North Carolina, 2013). A p-value of < 0.05 was considered statistically significant. Results For the years 1993 through 2015, there were an estimated 2,667,896 emergency department (ED) visits for injuries due to firearms; 10,296 of these injuries (0.4%) involved the spine. The vast majority (98.2%) were due to powder firearm gunshot wounds. Those with a spine injury were more likely to have been injured in an assault (83.7% vs. 60.2%), involved a handgun (83.5% vs. 60.2%), were male (90.8% vs. 86.4%), were admitted to the hospital (86.8% vs. 30.9%), and were seen in urban hospitals (86.7 vs. 64.6%). The average age was 28 years with very few on those < 14 years of age. Illicit drug involvement was over four times as frequent in those with a spine injury (34.7% vs. 8.0%). The cervical spine was involved in 30%, thoracic in 32%, lumbar in 32%, and sacrum in 6%. A fracture occurred in 91.8% and neurologic injury in 33%. Injuries to the thoracic spine had the highest percentage of neurologic involvement (50.4%). There was an annual percentage decrease for patients with and without spine involvement in the 1990s, followed by increases through 2015. The average percentage increase for patients with a spine injury was 10.3% per year from 1997 onwards (p < 10-6), significantly greater than the 1.5% for those without spinal involvement (p = 0.0001) from 1999 onwards. Conclusions This nation-wide study of spinal injuries associated with firearms covering all ages can be used as baseline data for future firearm studies. A reduction in the incidence of such injuries can be guided by our findings but may be difficult due to sociopolitical barriers (e.g. socioeconomic status of the injured patients, differences in political opinion regarding gun control in the US, and geospatial patterns of firearm injury).