Browsing by Subject "Injury"
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Item Open Access Barriers and Facilitators to Emergency Care: Acute Injury in the Kilimanjaro Region(2023) Frankiewicz, Parker LBackground: Trauma and injury present a significant global burden – one that is only exacerbated in low- and middle-income settings like Tanzania. We aimed to describe the landscape of emergency care and financial catastrophe in the Kilimanjaro region by leveraging the Three Delays Model.
Methods: This was a cross-sectional study using an ongoing traumatic injury registry as well as separate financial questionnaires collected by researchers from the Duke Global Health Institute at Duke University in collaboration with the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania from December 2022 until February 2023.
Results: The majority of the acute injury population that presented to the KCMC emergency department underwent some form of financial catastrophe due to the out-of-pocket (OOP) costs incurred due to their medical needs (catastrophic health expenditure (CHE): 66.1%; impoverishment: 85.5%). The households of those who experienced a financial catastrophe tended to include a greater number of dependents (CHE, 22% and impoverishment, 21% with ≥6 dependents) and a lower average monthly adult-equivalent income (CHE: 76,923 TZS; impoverishment: 96,774 TZS). Individuals who underwent a financial catastrophe also experienced a greater number of facility transfers as well as more transfers with later surgery. At the end of an individual’s hospital stay, those who experienced financial catastrophe incurred substantially more medical expenses. Those who experienced a CHE had OOP costs that were 3.4 times higher than those without; those who were impoverished had OOP costs that were 1.96 times higher than those who did not.
Conclusions: Delay 1 (decision to seek care) and Delay 2 (reaching appropriate care facility) could be significant factors for those who will later experience some form of financial catastrophe. Further research is needed to better assess potential impacts on patient health outcomes and develop targeted intervention strategies for those most at-risk.
Item Open Access Blast-Induced Neurotrauma and the Cavitation Mechanism of Injury(2019) Yu, Allen WeiTraumatic brain injuries (TBIs) are a major public health concern and socioeconomic burden worldwide. In recent years, brain injuries in US service personnel have focused attention on TBI affecting the military population (Bass et al., 2012). Blast injuries have become the most common cause of mortality and morbidity in soldiers returning from Iraq and Afghanistan (Owens et al., 2008, Warden, 2006). The frequency of blast-related sequelae found in allied forces has led some to call it the ‘signature wound’ of the wars abroad.
The growing incidence of TBI has spurred an increase in research efforts within the neurotrauma community to define TBI etiology. Identification of the critical injury mechanisms underlying TBI is an area of greatest need. Our understanding of TBI etiology, physical damaging mechanisms, and pathophysiology remains inadequate. The ability to design specific countermeasures and targeted prevention strategies is restricted by an incomplete understanding of the underlying damaging mechanisms.
Cavitation, the formation of vapor filled cavities in a liquid medium, has been proposed as a damaging mechanism of TBI in both blunt impacts (Ward et al., 1948, Gross, 1958) and blast-induced neurotrauma (Moore et al., 2008, Panzer et al., 2012c). The cavitation hypothesis of TBI centers on observation that high energy events such as high-explosive blast impingement onto the head generate large pressure transients in and around the brain. Localized areas of low pressure may surpass the tensile limits of the cerebrospinal fluid vaporizing the fluid and forming cavitation bubbles. These voids grow, potentially displacing surrounding tissue. When the bubbles collapse, perhaps violently, jets of liquid with potentially large localized pressures and temperatures may be created, damaging surrounding tissue.
The main objective of this dissertation was to develop an experimental foundation and provide empirical evidence for cavitation as a damaging mechanism of blast-induced TBI. This dissertation uses biofidelic surrogate head models of blast and in vivo animal models of blast injury to address the unanswered questions surrounding cavitation and blast neurotrauma. Foremost, cavitation response was observed in the surrogate head form exposed to blast conditions associated with injury. The 50% risk of cavitation occurs at a blast level of 262 kPa incident overpressure and 1.96 ms duration. This blast dosage represents a 62% chance of mild intracranial bleeding from scaled ferret experiments (Rafaels et al., 2012). Cavitation onsert, growth, and collapse were confirmed through high-speed imaging of the fluid layers of the contrecoup, while strong acoustic emission signatures associated with cavity collapse were captured and time matched with the video. Near-harmonic frequencies at 64 kHz, 126 kHz, and 267 kHz were associated with the energetic collapse of the bubbles. Our results provide compelling evidence that primary blast alone may induce cavitation that leads to TBI.
Evidence of cavitation was recorded in live porcine specimen exposed to blast. Acoustic sensors mounted to the skull of each specimen recorded acoustic emissions during blast exposure. Scaled spectral analysis revealed acoustic energy in higher frequencies bands with peaks at 64 kHz, 139 kHz, and 251 kHz, closely matching the spectral peaks associated with void collapse in surrogate experiments. To our knowledge, this study is the first to present evidence of blast-induced cavitation in a live animal model in the field of cavitation TBI research.
The results presented in this dissertation also greatly improve our understanding of how mechanical loads are imparted onto the head during a blast exposure and how this loading leads to cavitation onset. Strain analysis of the surrogate head indicates wall compliance from skull deformation and shear wave propagation through the skull as significant physical factors driving the tensile fluid responses in the head. Future design considerations for preventative measures should account for these physical mechanisms.
This dissertation also makes important contributions to blast injury research by presenting a clinically relevant murine model of blast TBI. Murine blast lethality risk and functional behavior outcomes before and after blast injury are presented. We provide guidelines for small animal blast testing, along with methodological recommendations for benchtop shock tube design and specimen placement in relation to the shock tube.
The contributions of this dissertation further serve as an important methodological guide to the neurotrauma and biomechanics community studying blast-related TBI and cavitation as a damaging mechanism. The developed surrogate head system and cavitation detection techniques provide a research template and are a springboard to future research efforts elucidating the damaging effects of cavitation during TBI.
Item Open Access Death Traps: Holes in Urban India(Environment and Planning D: Society and Space) Solomon, HarrisItem Open Access Determinants of Treatment Seeking Behavior Following Injury in Maringá, Brazil(2015) Toomey, NicoleBackground: Injury currently accounts for 6% of all disability adjusted life years (DALYS) lost. As the global incidence of injuries increases, so does the need for care. Current research on access to care and injury does not always account for injury severity or focus on the overall effects of injury. Our project focused on a medium-sized city in Brazil to determine what barriers to care after injury arise in Brazil’s universal health care system.
Methods: Households were randomly selected for survey in the 561 populated districts of the city of Maringa between May 2015 and September 2015. Demographic information was collected for the entire household; one individual from the household was then randomly selected to provide injury history. A chi-square analysis was used to determine the association between care seeking and demographics. A preliminary significance level of α = 0.20 was selected for inclusion of variables into the multivariate logistic regression. A full multivariate logistic regression model using injury as the primary exposure and seeking care as the outcome was run. Thirty reduced models were run; mean squared estimate (MSE) and Akaike Information Criterion (AIC) were calculated to find the best predictive model.
Results: 2678 households and individuals participated, 30.3% individuals reported an injury in their lifetime. The bivariate analysis found that gender (p = 0.034), cause of injury (p = 0.000), race (p = 0.051), severity (p = 0.103) and insurance status (p = 0.026) were potential predictors of seeking care. Education (p = 0.62), income (p = 0.343) and age (p = 0.838) were included in the multivariate model due to past significance in the literature. The reduced multivariate model that eliminated education level and race (MSE = 0.0274, AIC = 0.7689) was chosen as the best representative model and showed gender, age, socioeconomic status, and cause of injury as all strong predictors of care seeking.
Conclusions: Cause of injury is a major predictor for seeking care, as are factors related to socioeconomic status such as insurance and income. Injury cause potentially masked the effects of gender on care seeking. More research needs to be done on specific causes of injuries, the role of gender, and why socioeconomic status is still a barrier to care in a universal access system.
Item Open Access Development and Validation of a Culturally-Relevant Pain Scale for Kiswahili-Speaking Patients in a Tanzanian Emergency Department(2017) Meier, BrianBackground: Acutely painful conditions, responsible for a large proportion of Emergency Department patients around the world, are inadequately assessed and poorly treated. Routine use of scales to quantify pain is recommended to improve analgesic practice. Currently, no such scale has been validated for use in Kiswahili-speaking patients in Tanzania. The objective of this study was to develop and assess a culturally relevant pain intensity scale for use in injury patients at the Kilimanjaro Christian Medical Center in Moshi, Tanzania. Methods: This was a two-part study, with the initial phase using focus groups to develop a pain scale. The second phase used a convenience sample of injury patients to assess the scale for validity and reliability. Analysis of variance, intra-class correlation coefficients, and Bland-Altman Analysis were used to assess validity and reliability. We used focus groups and surveys to develop a pain scale, which was subsequently tested in injury patients. Results: A 100-point numeric pain scale was developed and tested among 98 injury patients. The intra-class correlation coefficient of scores was 0.97 (95% CI 0.96 - 0.98) and Bland-Altman analysis found that 95% of the differences were between -23.5 and +20.7. Conclusions: Our results suggest that a 100-point numeric rating scale is valid and reliable for use Tanzanian injury patients.
Item Open Access Epidemiology and Predictors of Mortality of Traumatic Brain Injury at Kigali University Teaching Hospital Accident and Emergency Department(2015) Krebs, ElizabethBackground:
Traumatic Brain Injury (TBI) is a leading cause of death and disability. TBI patients in low and middle- income countries (LMIC) have twice the odds of death than in high-income countries. There is limited data describing the epidemiology and mortality predictors for TBI in LMIC.
Objective:
Determine epidemiology and predictors of mortality in TBI patients at Kigali University Teaching Hospital Accident and Emergency Department (KUTH A&E).
Methods:
Consecutive, injured KUTH A&E patients were prospectively screened for inclusion by reported head trauma, alteration in consciousness, headache, or visible head trauma. Exclusion criteria were <10 years old, presenting >48 hours after injury, or repeat visits. Data were assessed for association with death using logistic regression. Significant variables were included in an adjusted multivariable logistic regression model then refined via backwards elimination until all variables were significant at P <0.05.
Results:
684 patients enrolled between October 7, 2013 and April 6, 2014. 12 (2%) were excluded due to incomplete data. 81% were male with mean age of 31.5 years (range 10 - 89). Most patients (75%) had mild TBI (Glasgow Coma Score (GCS) 14-15), while 15% had moderate (GCS 9-13), and 10% had severe TBI (GCS 3-8). Multivariable logistic regression and refinement by backwards elimination determined that GCS <14, hypoxia, tachycardia and age >50 years predicted mortality.
Conclusion:
GCS <14, hypoxia, tachycardia and age >50 years were associated with mortality among TBI patients at KUTH A&E. These findings can guide clinicians in prioritizing care for patients at highest risk of mortality.
Item Open Access Increasing Motorcycle Taxi Driver Conspicuity in Tanzania(2014) Sumner, Steven AllanMotorcycle crash related injuries and deaths are increasing rapidly in many African nations. Utilizing conspicuity measures, such as wearing reflective, fluorescent safety vests, are effective as crash prevention strategies. Furthermore, use of some conspicuity measures is mandated by law among motorcycle-taxi drivers in Tanzania. Nonetheless, uptake remains low. Locally appropriate strategies to improve crash preventative behaviors are needed.
To explore whether use of conspicuity measures could be improved through eliminating cost-barriers, we tested a distribution strategy involving the provision of free motorcycle safety vests among a population of motorcycle-taxi drivers in Moshi, Tanzania. We conducted a cluster randomized controlled trial among 180 motorcycle-taxi drivers in which half of the participants (90) were randomized to the intervention arm and received a free reflective vest. The other half of the participants (90) were randomized to the control arm and did not receive free vests. Whether motorcycle taxi drivers used the reflective vest was then unobtrusively observed on city streets over a period of three months.
Mixed-effects logistic regression was used to estimate differential uptake of the vests between trial arms. At baseline, 3.3% of individuals in both arms used a reflective vest. In three months of follow-up, 79 drivers in the intervention arm and 82 drivers in the control arm were able to be observed. In the intervention arm the average proportion of observations during which drivers were observed to be using a reflective vest was 9.5%, compared to 2.0% in the control arm (odds ratio: 5.5, 95% confidence interval: 1.1-26.9, p-value: 0.04). Distribution of free reflective vests did lead to an increase in vest usage, however, the increase was minimal. Removing economic barriers alone appears insufficient to adequately improve adherence to conspicuity measures.
Item Open Access Injury characteristics and their association with clinical complications among emergency care patients in Tanzania.(African journal of emergency medicine : Revue africaine de la medecine d'urgence, 2022-12) Zimmerman, Armand; Barcenas, Loren K; Pesambili, Msafiri; Sakita, Francis; Mallya, Simon; Vissoci, Joao Ricardo Nickenig; Park, Lawrence; Mmbaga, Blandina T; Bettger, Janet Prvu; Staton, Catherine ABackground
Over 5 million people annually die from injuries and millions more sustain non-fatal injuries requiring medical care. Ninety percent of injury deaths occur in low- and middle-income countries (LMICs). This study describes the characteristics, predictors and outcomes of adult acute injury patients presenting to a tertiary referral hospital in a low-income country in sub-Saharan Africa.Methods
This secondary analysis uses an adult acute injury registry from Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. We describe this patient sample in terms of socio-demographics, clinical indicators, injury patterns, treatments, and outcomes at hospital discharge. Outcomes include mortality, length of hospital stay, and functional independence. Associations between patient characteristics and patient outcomes are quantified using Cox proportional hazards models, negative binomial regression, and multivariable logistic regression.Results
Of all injury patients (n=1365), 39.0% were aged 30 to 49 years and 81.5% were men. Most patients had at least a primary school education (89.6%) and were employed (89.3%). A majority of injuries were road traffic (63.2%), fall (16.8%), or assault (14.0%) related. Self-reported comorbidities included hypertension (5.8%), HIV (3.1%), and diabetes (2.3%). Performed surgeries were classified as orthopedic (32.3%), general (4.1%), neurological (3.7%), or other (59.8%). Most patients reached the hospital at least four hours after injury occurred (53.9%). Mortality was 5.3%, median length of hospital stay was 6.1 days (IQR: 3.1, 15.0), self-care dependence was 54.2%, and locomotion dependence was 41.5%.Conclusions
Our study sample included primarily young men suffering road traffic crashes with delayed hospital presentations and prolonged hospital stays. Being older, male, and requiring non-orthopedic surgeries or having HIV portends a worse prognosis. Prevention and treatment focused interventions to reduce the burden of injury mortality and morbidity at KCMC are needed to lower injury rates and improve injury outcomes.Item Open Access Injury Detection and Localization in the Spine using Acoustic Emission(2016) Shridharani, Jay KetanThe National Spinal Cord Injury Statistical Center estimates there are 12,500 new cases of spinal cord injury (SCI) in the United States every year (www.nscisc.uab.edu, 2014) and vehicular crashes are the leading cause. Spinal injuries can have extensive long term consequences leading to widespread social and economic costs as well as the human cost of living with chronic, sometimes debilitating, pain (Côté et al. 1998, Côté et al. 2001, Daffner et al. 2003, Harrop et al. 2001, Sekhon et al. 2001). Within the military population, spinal injuries are a common result of repeated loading from high-speed planing watercraft (Bass et al. 2005, Gollwitzer et al. 1995, Schmidt et al. 2012), high performance aircraft (Coakwell et al. 2004, de Oliviera et al. 2005), and underbody blast exposure (Vasquez et al. 2011, Wilson 2006). Therefore, there is interest within the automotive, military, and clinical communities to understand the biomechanics the failure mechanics of the osteoligamentous structures in the spine.
Acoustic emissions have been shown to be produced during micro-cracking of cortical bone (Kohn 1995). However, there has been minimal work utilizing acoustic emission to detect cortical and trabecular bone damage. The research in this dissertation developed experimental and analytic methods of sensitively assessing when failure (both micro-cracks and more extensive failures) occurs in the cervical spine using acoustic emissions.
The acoustic emissions from cortical and trabecular bone failure were characterized using a Welch power spectrum density estimate and continuous wavelet transform. The power spectrum density results showed both cortical bone and trabecular bone failure produced wideband acoustic emission signals with spectral peaks between from 20 kHz to 1380 kHz and 24 kHz to 1382 kHz respectively. The continuous wavelet transform showed the spectral content begins with high frequency content followed quickly by low frequency content, but the low frequency lasts for a longer time causing it to dominate the response in the Welch power spectrum density. The first frequency component in the continuous wavelet transform was used to characterize the signals and was found to form three distinct bands in the cortical bone tests (166 ± 52.6 kHz, 379 ± 37.2 kHz, and 668 ± 63.4 kHz) and one band in the trabecular bone tests (185 ± 37.9 kHz). Therefore, observing spectral content within these bands suggests failure of the respective bone.
This dissertation also uses continuous wavelet transform to identify failure in whole cervical spine compression tests. Whole cervical spines placed in a pre-flexed and pre-extended posture were compressed to induce failure while being monitored for acoustic emissions. Cortical bone failure was identified in the acoustic emissions when local maxima in the continuous wavelet transform fell within the spectral bands associated with cortical bone failure previously identified. The timing of these failures was matched to the force-displacement response to identify the initiation of failure and the major failure. Cortical bone failure was detected at 70-90% of the failure load suggesting that the failure occurs as an evolution from micro-cracks to the eventual major failure. Locating these micro-cracks before the major failure forms may be useful in the prediction of the location of failure.
This dissertation also presents a technique to calculate the AE source location for AEs generated from fracture. The primary obstacle for AE source localization in the spine is that the speed of sound is different in cortical bone (Prevrhal et al. 2001), trabecular bone (Cardoso et al. 2003), intervertebral disc (Pluijm et al. 2004), ligaments (Kijima et al. 2009), and also differs based on its direction of travel in cortical bone (Kann et al. 1993) and likely in the other materials. Any algorithm must account for these differences to obtain any useful level of accuracy. The algorithm presented in this dissertation is based on hyperbolic source location algorithms (De Ronde et al. 2007, O'Toole et al. 2012, Salinas et al. 2010) except that it iterates on the speed of sound over a specified range, and convergence is defined as when the solution change is minimized. This procedure calculated the AE source location with a mean error of 5.7 mm and a standard deviation of 3.8 mm.
The contributions and conclusions of this dissertation provide methodology and results to evaluate the failure mechanics in the spine. Although these procedures were developed for use in the spine, they are of great value to the biomechanics community because they are applicable to every body region. The recommendations presented will serve to better understand the failure mechanics of the human body and will likely lead to better defined and safer standards for protective equipment. It also provides data for the generation of finite element models that require failure criteria.
Item Open Access Measuring and Applying Motivational Constructs in a Brief Intervention for Reducing Harmful Alcohol Use in ED Patients in Moshi, Tanzania(2021) Agnihotri, DeeptiBackground: Self Determination Theory (SDT) conceptualizes human motivation in terms of a spectrum. However, literature is scarce on how to measure self-determination in different languages or how self-determination can influence the effectiveness of healthcare interventions. The aim of this study was to translate and culturally adapt a psychometric questionnaire on self-determination (TSRQ) as well as SMS booster messages for a Brief Intervention (BI) aimed at reducing harmful alcohol use among injury patients presenting at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania.
Methods: A mixed-methods approach was used to evaluate the psychometric properties of the TSRQ and SMS booster messages. Likert-scale surveys were administered on expert panels to assess translation quality and adherence to theory.
Results: Quantitative analyses confirmed that the Swahili translation of the TSRQ accurately reflected SDT constructs. Exploratory Factor Analysis (EFA) revealed a two-domain model had a better fit than the original three-domain TSRQ. Expert panel surveys indicated that the SMS booster messages maintained strong connections to tenets of SDT.
Conclusion: This was the first study to conduct a cross-cultural validation of the TSRQ in Tanzania and the first to implement and assess motivational constructs in SMS booster messages for a BI to promote safe alcohol use. The TSRQ is a valid, clinically useful scale but could be improved with more items. SMS booster messages touch on many SDT constructs, affirming their motivational utility.
Item Open Access Mid-upper Arm Circumference (MUAC) and injury characteristics in hospitalized patients in an emergency department of North Tanzania(2021) Ramirez, ThaisBackground: The impact of malnutrition on the outcomes of hospitalized adult patients in resource-limited settings is not fully described. We aimed to report our observation of the comparison made between mid-upper arm circumference (MUAC) and injury outcomes in adults admitted to the Emergency Department of a hospital in Moshi, Tanzania. Methods: This study was a secondary analysis based on an on-going Trauma registry collected by researchers from the Duke Global Health Institute at Duke University in collaboration with the Kilimanjaro Christian Medical Centre (KCMC) from April 2018 until April 2020. Results: Females were significantly more likely to have higher MUAC scores than males (B=1.90; SE=0.49; p-value=0.000). Compared to single patients, those married were more likely to have higher MUAC (B=1.28; SE=0.48; p-value=0.007). Compared to advanced education, patients identified with basic education were less likely to have higher MUAC (B=-1.46; SE=0.42; p-value=0.000). Although glasgow outcome was not significantly associated with MUAC score in our univariate analysis (B=-1.20; SE=1.46; p-value=0.41), in our adjusted model, lower good recovery were less likely to have higher muac scores then other glasgow outcomes (B=-2.02; SE=0.73; p-value=0.000). Conclusions: Undernutrition in hospital patients is often unrecognized and there is a need for simple means of screening to facilitate targeted nutritional intervention. Further research is needed to understand the pathophysiology of malnutrition during acute illness and validate MUAC cut-off points for hospitalized adults.
Item Open Access Pediatric Head and Neck Dynamic Response: A Computational Study(2011) Dibb, Alan ThomasTraumatic injuries are the leading cause of death to children between the ages of one to nineteen years in the United States. The primary source of these traumatic injuries is motor vehicle traffic, with the head being the primary region of the body to suffer injury. While the pediatric neck is also prone to injury, it is particularly notable since it governs head excursion and acceleration, thus influencing head impacts and injuries. Pediatric fatalities can be prevented through safety improvements to vehicle compartments and child restraints by way of advanced biofidelic pediatric anthropomorphic testing devices (ATDs) and a more complete understanding of pediatric biomechanics. Computer models of the pediatric head and neck provide a valuable tool to combine results from pediatric postmortem human specimen (PMHS), radiological, and human volunteer studies to investigate the dynamics of the pediatric head and neck. The current study produced the first validated computer model of the pediatric head and neck which were created using the framework of a validated adult model. Radiology studies were conducted to determine pediatric cervical muscle cross sectional areas, vertebral anthropometry, and vertebral inertial properties. The results of these studies were combined with available pediatric PMHS properties to create the six and ten year old models. The models were validated against pediatric volunteer low speed frontal impacts and were then used to simulate higher rate and injurious inducing loading scenarios. The six and ten year old flexion bending stiffnesses were found to be 36% and 45% of the adult bending stiffness, respectively. The pediatric tensile stiffnesses were found to be 67% and 76% of the adult tensile stiffness. The tensile failure tolerance of the six year old was between 1490 and 2300 N and of the ten year old between 2040 and 3170 N. The adult and pediatric Hybrid III ATDs were found to be on average 2.5 times stiffer in flexion bending than the computer models. Biofidelity corridors were created with the models to be used to guide future ATD designs. Overall, the pediatric models provide a general tool that can be used to assess the safety of children during motor vehicle crashes.
Item Open Access Quantifying injury rates on nesting leatherback turtles (Dermochelys coriacea) at Sandy Point National Wildlife Refuge, St. Croix(2017-04-27) DeLand, SarahSandy Point National Wildlife Refuge (SPNWR) in St. Croix is one of three critical US nesting locations for leatherback sea turtles (Dermochelys coriacea). Many female leatherbacks nesting at SPNWR have been observed with injuries, but these injuries have not yet been incorporated in the long term research study at this site. My research focused on collecting photographs of the injuries on nesting females during the 2016 nesting season, March through June. These photographs were used to identify trends in the timing of injuries, the rate of healing, possible cause of injuries, and the common injury locations on leatherbacks. Results show that female leatherbacks are sustaining injuries all throughout the nesting season and that these are likely due to interactions with sharks. This research will help identify threats to this population and guide future research.Item Open Access Studies of the Human Head from Neonate to Adult: An Inertial, Geometrical and Structural Analysis with Comparisons to the ATD Head(2011) Loyd, Andre MatthewChild head injury is a very costly problem, both in terms of morbidity/mortality and direct medical costs. In fact, it is the leading cause of death and disability for those in the United States under age 18-years-old. Currently, head injury in children ages newborn to 19-years-old is responsible for 7500 deaths per year--30% of all childhood deaths in the United States. Given its importance and effect on the population, the study of pediatric head injury is greatly hindered by the lack of available pediatric post mortem human specimen (PMHS) data. As a substitute for PMHS testing, anthropometric test devices (ATDs) and finite element models (FEMs) have been developed to model the head. However, there is a dearth of data for the design and validation of these models.
The goal of this study was to use pediatric PMHSs to both advance the study of pediatric head injury and to provide validation data for ATD and finite element head models. 14 pediatric heads, 8 adult heads, and 6 ATD heads were studied to obtain geometrical, inertial, structural stiffness, and impact properties. The computational tomography (CT) method was used on pediatric heads to get inertial properties, and clinical CT scans were used to develop average head and skull contours for 12 different age groups. To obtain impact properties, the heads were dropped onto a rigid plate from 15cm and 30cm, and the acceleration-time pulses were analyzed to obtain acceleration HIC and other impact properties. The heads were then placed between two aluminum plates and compressed at four different rates to obtain structural stiffness values. Using the PMHS results, the ATD heads were compared against age-matched human heads, and the scaling rules used for ATD production were tested for accuracy.
The study found that between the ages of 5-months-old and 22-months-old, the human head was susceptible to fracture from drops as low as 15cm. The structural stiffness of the human head was shown to increase by three orders of magnitude from neonate to adult. For the impact properties, the human head's peak acceleration and head injury criteria increased with age, while the human head's pulse duration and coefficient of restitution decreased with age. The 50th percentile Hybrid III head was found to adequately model the response of the adult head for multiple head impact locations, while the 3-year-old Q3 child ATD was found to be too stiff during impact. Overall, this study provides novel data that can be directly applied to pediatric head injury curves, and pediatric ATD and finite element head models.
Item Open Access Survey of Pain Management Practices in a Tanzanian Emergency Department(2020) Minnig, Mary CatherineBackground:
Injury is a leading cause of morbidity and mortality globally, accounting for 11% of global disability-adjusted life years (DALYs) and 6% of global years lived with disability (YDLs). The burden of injury is disproportionately high in low- and middle-income countries (LMICs), including Tanzania. Early and effective pain management for injury patients is essential to ensure proper physical, psychological, and emotional outcomes and recovery, yet few studies have examined emergency department analgesic strategies in Tanzania. This study aimed to analyze the sociodemographic and injury characteristics associated with severe pain of injury patients admitted to the Kilimanjaro Christian Medical Centre (KCMC) emergency department, and qualitatively describe analgesic practices and challenges in the KCMC ED.
Methods:
Self-reported sociodemographic and pain data (score 0-100) data were collected from a prospective trauma registry of adult patients (n=1181) admitted to KCMC ED for acute injury. Injury severity data were determined by the Kampala Trauma Score (KTS). Descriptive statistics were performed and multivariable linear regressions assessed the association between sociodemographic and injury characteristics with severe pain. KCMC ED physicians and nurses (n=11) were recruited to participate in qualitative interviews aimed at understanding common analgesic practices and challenges in the ED setting.
Results:
Mean pain level decreased across all sociodemographic characteristics between ED admittance and ED discharge. Participants who were either separated or widowed were likely to experience higher reduction in pain level during ED treatments than those who reported living with a partner. Participants who were admitted to the KCMC ED for road traffic injury or fall were more likely to experience lower reduction in pan level than participants with assault injuries. Interviewed KCMC ED physicians and nurses described high usage of pharmacological analgesic methods for traumatic injury patients.
Conclusion:
It is important to understand effective analgesic treatments that can be administered as early as possible post-injury. KCMC ED pain management modalities are generally effective at reducing pain of traumatic injury patients. Adjustments to strategies for road traffic accident and fall injury patients may be made so that higher levels of pain reduction are achieved.