State helmet laws and motorcycle rider death rates.

Motorcycles are the most dangerous form of motorized transportation. Per vehicle miles traveled, motorcyclists are about 3 times as likely as passenger car occupants to be injured in a crash, and 16 times as likely to die. Because the majority of these deaths are caused by head injury, safety advocates have recommended mandatory use of motorcycle helmets.

To the rescue: optimally locating trauma hospitals and helicopters.

Injury (trauma) is the leading cause of death in the United States for people younger than 45 years of age. Each day, more than 170,000 men, women, and children are injured severely enough to seek medical care. About 400 of these people will die and another 200 will sustain a long-term disability as a result of their injuries.

Survival among elderly patients after fractures of the distal radius.

Studies have documented increased mortality rates in patients sustaining hip and vertebral fractures. Distal radius fractures are common injuries among the elderly and are a significant source of disability. This study analyzed survival rates in an elderly patient cohort after distal radius fractures and determined mortality risk factors.

The rural-urban continuum: variability in statewide serious firearm injuries in children and adolescents.

Objective: To compare rates of serious firearm injuries among children and adolescents treated in a statewide trauma system.

Materials And Methods: We reviewed the Pennsylvania Trauma Systems Foundation (Mechanicsburg) registry from January 1, 1987, through December 31, 2000, for all pediatric and adolescent patients (age 0-19 years) who sustained a serious firearm injury. Data included age, sex, weapon, geographic region, injury circumstance, and outcome.

Computer games may be good for your health.

Computer-based games and interactive simulators have matured to the point where they can have a significant impact on healthcare behavior decisions. Initial results from using one such game (Heart Sense) indicate that it can improve recognition of heart attack symptoms and shift behavioral issues so as to reduce pre-hospitalization delay in seeking treatment--thereby reducing myocardial infarction mortality and morbidity.

Modeling emotion and behavior in animated personas to facilitate human behavior change: the case of the HEART-SENSE game.

The goal of this research is to determine whether a computer based training game (HEART-SENSE) can improve recognition of heart attack symptoms and shift behavioral issues so as to reduce pre-hospitalization delay in seeking treatment. Since treatment delay correlates with adverse outcomes, this research could reduce myocardial infarction mortality and morbidity. In Phase I we created and evaluated a prototype virtual village in which users encounter and help convince synthetic personas to deal appropriately with a variety of heart attack scenarios and delay issues.

Helmet laws and motorcycle rider death rates.

We investigated motorcycle rider death rates between states with full motorcycle helmet laws and those without. This was done using both unadjusted bivariate analyses and multivariate random-effects generalized least squares regression models of rider death rates. Multivariate models were adjusted for the competing influences of several explanatory variables, including the existence of a motorcycle helmet law.

Predicting survival in pediatric trauma patients receiving cardiopulmonary resuscitation in the prehospital setting.

Objectives: To determine survival in pediatric trauma patients receiving cardiopulmonary resuscitation (CPR) in the prehospital setting and to identify subgroups of patients who may have increased survival rates.

Methods: Records were obtained from the National Pediatric Trauma Registry on all pediatric trauma patients (age <19 years) over an 82-month period who received CPR at the scene of the injury. Data were recorded as to type of injury, need for additional CPR at the receiving hospital, and intubation in the field.

A case series analysis of mass casualty incidents.

Introduction: Mass casualty incidents (MCIs) are infrequent but potentially overwhelming events that can stress the capabilities of even the most organized emergency medical services (EMS) system. The Maryland EMS system has been identified as a pioneer and leader in the field of prehospital emergency care and, as with many states, Maryland's regional preparation for MCIs has been integrated into its overall EMS systems planning.

Objective: To determine how successful this integration has been by examining a three-year history of response to MCIs in Maryland.

A trauma resource allocation model for ambulances and hospitals.

Objective: To develop a mathematical model for the location of trauma care resources.

Data Sources/study Setting: Severely injured patients queried from Maryland hospital discharge and vital statistics data. A spatial injury profile was created by parsing these patients into ZIP codes.

Fatal nontraffic injuries involving alcohol: A metaanalysis.

Study Objective: Estimates of alcohol involvement in fatal injuries vary widely. For injuries other than those involving motor vehicles, no national data exist and the quality of regional data is limited. This study synthesizes US medical examiner studies of nontraffic fatalities for the purpose of estimating alcohol involvement by injury mechanism and intent.

A population-based study of trauma recidivism.

Background: Patients with repeat presentations to acute care hospitals for new injuries are trauma recidivists. Prospective identification of those patients at greatest risk will permit focusing of limited hospital prevention resources.

Methods: A population-based analysis of patients with recurrent trauma presenting to all hospitals in Nevada during a 5-year period was conducted.

Geographic variation in serious nonfatal firearm injuries in Pennsylvania.

Objective: The purpose of this study was to characterize the geographic epidemiology of serious nonfatal firearm injuries (NFFI) within Pennsylvania during a 6-year period.

Methods: A historical review of data from the Pennsylvania Trauma System Foundation trauma registry was completed using county-level data. Based on a format adapted from the United States Department of Agriculture, NFFI in Pennsylvania were classified by their county of occurrence: central city counties, metropolitan counties, nonmetropolitan counties, or rural counties.

Shotgun wounds in children. Not just accidents.

Objective: To characterize the demographic characteristics of shotgun wounds in children and adolescents across various regions within a state.

Design: Retrospective case study.

Setting: Accredited trauma centers in Pennsylvania.

A correlation of air plethysmography and color-flow-assisted duplex scanning in the quantification of chronic venous insufficiency.

Purpose: Air plethysmography has been useful in assessing patients who have chronic venous insufficiency. Limb reflux times determined by color-flow-assisted duplex scanning have been shown to correlate with the severity of chronic venous insufficiency. The purpose of this study was to compare air plethysmographic measurements with reflux times obtained by color-flow-assisted duplex scanning in patients with chronic venous insufficiency.

Urban trauma transport of assaulted patients using nonmedical personnel.

Objective: To describe one urban trauma transport system to clarify the impact of transport by nonmedical personnel on patient outcome.

Methods: Retrospective data were assembled over a six-year period through the use of the state trauma registry for an urban county served by seven state-accredited trauma centers. A subset of 4,767 consecutive assaulted patients was analyzed using the TRISS method to estimate survival probability.

Fatal venous air embolism after removal of a central venous catheter.

Venous air embolism is an infrequent, but potentially disastrous, occurrence after the insertion or removal of central venous catheters. The authors describe fatal venous air embolism after removal of a central venous catheter in a 43-year-old man recovering from coronary artery bypass surgery. They discuss the pathophysiology, diagnosis, treatment, and prevention.

Bicarbonate therapy in the treatment of lactic acidosis: medicine or toxin?

The metabolic acidosis resulting from poor tissue perfusion is considered to have several significant hemodynamic effects. Correction of the acidosis with sodium bicarbonate seems to be a rational approach to this problem. However, the current medical literature shows little clinical benefit to this tactic.

Examination of carotid arteries with quantitative color Doppler flow imaging.

The results of conventional duplex scanning were compared with QCDFI. A total of 224 consecutive patients comprising 442 unilateral carotid systems were examined by conventional duplex techniques. MPSV, as determined by QCDFI, were recorded for each of the 442 carotid segments and grouped according to the previously determined degrees of stenosis.

Distribution and quantification of venous reflux in lower extremity chronic venous stasis disease with duplex scanning.

Purpose: The purpose of this study was to use color-flow duplex scanning to identify the anatomic distribution of venous reflux and to quantify venous reflux times in patients with various stages of chronic venous insufficiency (CVI).

Methods: Color-flow-assisted duplex scanning was used to identify the anatomic distribution of venous reflux and to quantify reflux times in the deep and superficial venous systems of patients with symptomatic (CVI). Two hundred two patients with class I to III CVI were examined.

Neuroleptic malignant syndrome in the intensive care unit.

The authors describe the postoperative course of a 43-year-old man. Haloperidol was administered for agitation while the patient was in the intensive care unit. After administration of this drug, neuroleptic malignant syndrome developed.