Browsing by Subject "Neurologic injury"

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    The Neglected Price of Pediatric Acute Kidney Injury: Non-renal Implications
    (Frontiers Media, 2022-06-30) Pande, Chetna K.; Smith, Mallory B.; Soranno, Danielle E.; Gist, Katja M.; Fuhrman, Dana Y.; Dolan, Kristin; Conroy, Andrea L.; Akcan-Arikan, Ayse; Pediatrics, School of Medicine
    Preclinical models and emerging translational data suggest that acute kidney injury (AKI) has far reaching effects on all other major organ systems in the body. Common in critically ill children and adults, AKI is independently associated with worse short and long term morbidity, as well as mortality, in these vulnerable populations. Evidence exists in adult populations regarding the impact AKI has on life course. Recently, non-renal organ effects of AKI have been highlighted in pediatric AKI survivors. Given the unique pediatric considerations related to somatic growth and neurodevelopmental consequences, pediatric AKI has the potential to fundamentally alter life course outcomes. In this article, we highlight the challenging and complex interplay between AKI and the brain, heart, lungs, immune system, growth, functional status, and longitudinal outcomes. Specifically, we discuss the biologic basis for how AKI may contribute to neurologic injury and neurodevelopment, cardiac dysfunction, acute lung injury, immunoparalysis and increased risk of infections, diminished somatic growth, worsened functional status and health related quality of life, and finally the impact on young adult health and life course outcomes.
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    Spinal Injury Associated With Firearm Use
    (Cureus, 2021-03-16) Loder, Randall T.; Mishra, Abhipri; Atoa, Bradley; Orthopaedic Surgery, School of Medicine
    Objective 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).
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    The Neglected Price of Pediatric Acute Kidney Injury: Non-renal Implications
    (Frontiers Media, 2022-06-30) Pande, Chetna K.; Smith, Mallory B.; Soranno, Danielle E.; Gist, Katja M.; Fuhrman, Dana Y.; Dolan, Kristin; Conroy, Andrea L.; Akcan-Arikan, Ayse; Pediatrics, School of Medicine
    Preclinical models and emerging translational data suggest that acute kidney injury (AKI) has far reaching effects on all other major organ systems in the body. Common in critically ill children and adults, AKI is independently associated with worse short and long term morbidity, as well as mortality, in these vulnerable populations. Evidence exists in adult populations regarding the impact AKI has on life course. Recently, non-renal organ effects of AKI have been highlighted in pediatric AKI survivors. Given the unique pediatric considerations related to somatic growth and neurodevelopmental consequences, pediatric AKI has the potential to fundamentally alter life course outcomes. In this article, we highlight the challenging and complex interplay between AKI and the brain, heart, lungs, immune system, growth, functional status, and longitudinal outcomes. Specifically, we discuss the biologic basis for how AKI may contribute to neurologic injury and neurodevelopment, cardiac dysfunction, acute lung injury, immunoparalysis and increased risk of infections, diminished somatic growth, worsened functional status and health related quality of life, and finally the impact on young adult health and life course outcomes.