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ATS INFORM OCTOBER 2013
ATS INFORM INDUSTRY NEWS FROM AROUND THE TRAUMA ENVIRONMENT
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Music may soothe the savage beast, but a new study argues that novice teenage drivers who rock out to a playlist of favorite tunes may end up
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Sleep-deprived teens are at increased risk of getting hit by a vehicle while crossing the street, researchers warn.
Injury Prevention News OCTOBER 2013
In This Issue
Upcoming ATS Events
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INJURY PREVENTION NEWS
TRAUMA RESEARCH
5 INDUSTRY NEWS
For Teens, Favorite Tunes May Impair Driving Health Day, September 1, 2013
December 4th and 5th ATS TRAUMA PROGRAM MANAGER COURSE Kansas City, MO
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with impaired motor skills. Active listening -- humming along with, tapping out the beat of or otherwise getting absorbed by tracks youthful drivers know and like -- appears to distract them from the rules of the road, researchers report. The results published by Israeli Researchers in the October
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issue of the journal, Accident Analysis and Prevention, discuss an increase in error-prone behaviors, such as speeding, tailgating and
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one-handed steering, as well as aggressive and distracted lane-switching and passing. On the other hand, the Israeli investigators said, ‘certain types of music can actually promote safe teen driving, when comprised of less familiar, calming compositions.’
November 13th and 14th ATS TRAUMA PROGRAM MANAGER COURSE Indianapolis, IN
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Sleepy Teens Seem at Higher Risk for Pedestrian Accidents Health Day, September 6, 2013
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The new study included 55 teens, aged 14 and 15, whose ability to cross a street safely was tested in a virtual-reality setting in the Youth Safety Lab at the University of Alabama at
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Birmingham. Teens whose sleep was restricted to four hours the night before the test took more time to begin crossing a street, crossed with less time before contact with vehicles and had more close calls than those who slept for eight and a half hours. Four
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hours of sleep is half the amount considered adequate for 14- and 15-year-olds. The sleep-deprived teens averaged 2.2 close calls or hits by vehicles on 25 of the simulated street
ATS INFORM OCTOBER 2013
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New Science, Strategy May Halt Rate of Arm Injuries MLB, September 13, 2013
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It's common for American high school seniors to binge on alcohol, and some have as many as 15 or more drinks at a time, a new study shows. Binge drinking is defined as five or more drinks for men and four or more drinks for women, while having 10 or more drinks in a row is defined as extreme binge drinking, according to the study published in JAMA Pediatrics. Study background information describes short-term risks of binge drinking such as alcohol
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Matt Harvey will get a second opinion on his injured right elbow from renowned orthopedic surgeon Dr. James Andrews, hopeful that the partial tear in his ulnar collateral ligament won't require the Tommy John surgery that would all but eliminate his chances of pitching competitively in 2014. However the surgical situation shakes out, Harvey's injury was a bummer for baseball. The sport, after all, has gone to great lengths to protect its arms with pitch counts and innings caps. By and large, though, pitchers keep blowing
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out their arms at an alarming rate. Will Carroll, a sportswriter specializing in medical issues, conducted a study for Bleacher Report that found that one-third of pitchers on Major League rosters on Opening Day this season had Tommy John surgery at some point. And the ever-rising tide of arm trouble has created the game's greatest economic inefficiency. Carroll has estimated that in the decade from 2002-12, teams spent $1.7 billion on pitchers on the disabled list. Now, through monitoring, the game can explain this arm injury epidemic.
1 in 5 High School Seniors Binge Drinks: Study Health Day – September 16, 2013
What Kids Should Know About Spinal Injuries in Sports Wall Street Journal – September 16, 2013
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It could be a hard tackle in football, a cross-check in ice hockey or a fall from the top of a cheerleading pyramid. A new push is under way to raise awareness of a little-understood but dangerous risk to young athletes: injuries to the cervical spine, the highly vulnerable area between the first and seventh vertebrae that protects the spinal cord connecting the brain to the body. Players and teammates may not instantly recognize the severity
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poisoning, impaired driving and injury, while long-term risks include liver damage, alcoholism and harm to the developing brains of teens. Binge drinking among American teens has continued to decline since record levels in the late 1970s and early 1980s, but extreme binge drinking among teens has not declined since 2005, noted the study. While binge drinking is a serious public health problem among high school seniors, extreme binge drinking poses an
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even greater threat to their physical as well as mental well-being, said study authors. The noted lack of decline in observed rates of extreme binge drinking in the past decade ‘underscores the need for family, as well as community-based, interventions to address this dangerous trend.’
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of the damage, and the wrong move can damage or sever the spinal cord, resulting in paralysis or even death. In addition to programs to educate coaches, parents and students, a number of groups are pressing for more certified athletic trainers who are qualified to quickly recognize and respond to spinal and other injuries. Though less common than concussions, cervical-spine injuries most often occur when players in contact sports lower their head or
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tuck their chin into their chest and collide with another player, the ground or objects such as goal posts. While players often recover from injuries such as fractures of one or more vertebrae, commonly referred to as a broken neck, cervical spine injuries can also be quickly fatal.
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crossings, compared with 1.42 close calls or hits for those who had an adequate amount of sleep, according to the study, which was published Sept. 3 in the Journal of Adolescent Health.
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In states where most households have a gun, twice as many Americans commit suicide as in states with low rates of gun
ownership, according to a new study. Several studies have linked gun ownership to the risk of suicide by firearm, but some critics question whether people
State-Wide Gun Ownership Tied to Suicide Deaths Reuters Health – September 27, 2013
From Athletes to the Elderly: The Science of Trips and Falls Wall Street Journal – September 23, 2013
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New research into how we maintain our balance could help athletes and prevent falls among the elderly. Scientists are finding that maintaining stability and balance with each step we take requires complex coordination of foot placement, arm movement, trunk angle and neck and head motion. That's because every step is different from the one before it. There are slight variations in stride length and width and the angle at which the foot hits the ground, as well as small shifts of
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weight in the torso. People's bodies when walking must constantly make minuscule adjustments to accommodate these variations. The research on balance and stability could someday be used to help improve training techniques for athletes, such as skiers and gymnasts, for whom balance is critical, experts say. It also might be able to help doctors better predict people's risk of falling and lead to improvements in prevention and rehabilitation strategies. Falls are
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the number one reason for death and injury among people age 65 and older, according to the Centers for Disease Control and Prevention (CDC). More than two million older people went to an emergency room in 2010 because of a fall, the CDC says.
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living in states where lots of residents own guns are inherently more suicidal than those who live in places where ownership is less common. Researchers from Harvard University compared 16 states with the highest gun ownership rates to the six states with the lowest rates. Both of those groups included about 62 million people. In the high gun ownership group, 51% of adults lived in a household with firearms, versus 15% of adults in the low gun ownership group. In 2008-2009, there were about 7,300
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firearm suicides in the states with the most guns - including Alabama, Montana and West Virginia, according to an August 2013 report in the American Journal of Epidemiology. That compared to 1,700 suicides by gun in the low ownership states, such as Hawaii, Massachusetts and New York. The number of non-gun suicides in the two sets of states was similar, at about 4,200 and 4,300, respectively. What's more, statewide rates of suicide attempts did not differ based on levels of household gun ownership.
NHTSA Finds More Than a Third of Children Killed in Crashes Were Not in Car Seats or Wearing Seatbelts National Highway Traffic Safety Administration (NHTSA), September 18, 2013
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According to the Department of Transportation's National Highway Traffic Safety Administration, more than a third of children under age 13 who died in passenger vehicle crashes in 2011 were not in car seats or wearing seat belts. Motor vehicle crashes remain a leading cause of death for children. In 2011, almost
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two children under the age of 13 were killed and 338 were injured every day while riding in cars, SUVs, pickups and vans. Of the children killed, the percentage of unrestrained fatalities, with no car seat or seat belt, varied by vehicle type, with greater percentages of unrestrained fatalities occurring in larger vehicles: SUVs (55
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percent), pick-ups (43 percent), vans (40 percent), and cars (24 percent). From 1975 through 2011, NHTSA estimates that approximately 10,000 lives were saved by child restraints for children under the age of 5 in passenger vehicles, with more than 260 lives saved in 2011 alone.
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TSN Corner
Struggles of Boston Amputees Mount
Wall Street Journal – September 20, 2013
Celeste Corcoran, a 47-year-old hairdresser from this working-class city northwest of Boston, lost both legs when twin bombs ripped through the Boston Marathon finish line. Five months later, even routine outings can leave her feeling wistful. State-of-the-art prostheses are slowly helping Mrs. Corcoran reclaim independence, but she can tolerate them only for a few hours a day. Her husband carries her upstairs to bed each night, and she sometimes feels stabbing pain in toes she lost months ago. Like many of the 16 people who lost limbs in the bombings, she has found recovery can be a grueling ordeal of setbacks and frustrations. Many of the bombing victims, including Mrs. Corcoran, feel fortunate to have survived. More than $60 million paid out from a compensation fund is easing financial anxieties. The amputees also benefit from medical advances growing out of the wars in Iraq and Afghanistan, such as prosthetic legs with knees controlled by computer chips. But as Boston moves on from the April 15th attack, which killed three people and wounded more than 260, some amputees find themselves on a lonely road, grappling not only with pain and repeated surgeries but with an emotional fallout that includes pressure to be billboards for Boston's resilience. Counselors say some amputees are starting to withdraw from all the appreciative attention they got—throwing out first pitches at Fenway Park and being honored at a Patriots football game—amid the realization their recoveries aren't straightforward tales of resolve and success.
Kids ED Visits for Sports Related Brain Injuries Rising, Milder Cases Admitted Reuters Health – October 1, 2013
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From 2002 to 2011, Cincinnati Children's Hospital saw a 92% increase in the number of children with sports-related brain injuries visiting the emergency department (ED). But the percentage of children admitted to the hospital for additional care for their injury held steady (around 10% annually), researchers say. And among those admitted, the severity of the injuries has significantly decreased, indicating that more patients are being admitted with milder injury. The findings
Needs of People with Disabilities Neglected in Disasters – UN Survey Thomson Reuters Foundation – October 11, 2013
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Most people living with disabilities are not prepared for disasters, nor are they consulted about their needs in emergencies, making them more likely to be killed or injured, according to a global survey released by the United Nations (U.N.).
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Responses to the U.N. survey revealed numerous problems experienced in crisis situations by people with seeing, hearing, mobility and communication difficulties - from failing to receive warning messages, to being stuck without elevators in tall buildings, unable to access emergency shelters and lacking sufficient medication. For example, only 20% of the 5,450 respondents from 126 countries said they could evacuate immediately and without difficulty in the event of a sudden disaster, such as a storm or flood. The rest would have a degree of difficulty in doing so, while 6% percent would not be able to leave their homes at all.
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suggest increased awareness and a higher level of concern for sports-related brain injuries among parents and coaches, according to the researchers.
Rewired Nerves Control Robotic Leg
Nature.com – September 30, 2013
The power of thought alone is not enough to move inanimate objects — unless the object is a robotic leg wired to your brain, that is. A 32-year-old man whose knee and lower leg were amputated in 2009 after a motorcycle accident is apparently the first person with a missing lower limb to control a robotic leg with his mind. A team led by biomedical engineer Levi Hargrove at the Rehabilitation Institute of Chicago in Illinois reported the breakthrough last week in the New England Journal of Medicine, including a video that shows the man using the bionic leg to walk up stairs and down a ramp, and to kick a football. The major advance is that the man does not have to use a remote-control switch or exaggerated muscle movements to tell the robotic leg to switch between types of movements, and he does not have to reposition the leg with his hands when seated. Scientists had previously shown that paralyzed people could move robotic arms using their thoughts and that able-bodied people can walk using robotic legs controlled by their brains. The latest work goes a step further by using muscle signals to amplify messages sent by the brain when the person intends to move.
Virtual Reality Gets Real Results in TBI Rehabilitation
Medscape – October 3, 2013
Virtual-reality (VR) game–based therapy led by a virtual personal instructor produces real improvements in coordination in patients with traumatic brain injury (TBI) and moderate postural and coordination deficits, a study from Central Michigan University shows. VR therapy consists of a series of VR exercises and interactive games that address postural and coordination problems. They resemble the content, sequence, timing, and dosage of a regular therapeutic program, she said. The therapy is delivered through a relatively low-cost Microsoft Xbox Kinect system, which has the ability to record a patient's movements at 30 Hz. Patients can use the VR system in the clinic or at home. The study design involved 2 pretests conducted 2 to 4 weeks apart, 15 VR game–based sessions over 5 to 6 weeks followed by a post-test, and then a retention test 4 weeks later. In 3 out of 4 skills, movements were significantly improved, and they all exceeded the minimum detectable changes established for those skills, the study reported. Patients improved their postural stability, gait, and arm movements at the time of the post-test, and these improvements were maintained completely or to some degree by the time of the retention test. Only ataxia failed to improve.
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Dr. Babak Sarani's morning rounds at George Washington University Hospital on Monday, September 16th were interrupted at about 8:45 a.m. The hospital's horn blared and a voice over the intercom called in the highest level of alert: Trauma Yellow. Sarani, the chief trauma surgeon at GW Hospital, rushed out of the surgical ward and down to the emergency room. Within minutes, Sarani was mobilizing dozens of doctors, nurses and anesthesiologists in what was shaping up to be one of the most intense days of their careers. Multiple people had been shot at the Washington Navy Yard about four miles away, and one patient was already en route to the hospital with a bullet wound to the head. But after scanning the news on his iPhone and speaking with other doctors on call, Sarani prepared for many more.
The shooting was high profile and brought media attention to Foggy Bottom, but GW Hospital's surgeons have seen an increasing number of trauma patients each day. The hospital counted nearly 2,000 patients
Mobilized in Minutes, GW Hospitals’s Trauma Team Responds to Crisis The GW Hatchet – September 22, 2013
Street drugs called "bath salts" were linked to nearly 23,000 emergency department visits in the United States in 2011, a new report says. Bath salts are amphetamine-like stimulants that have become increasingly popular among recreational drug users in recent years. Despite the name, these synthetic drugs have nothing to do with the crystals you might sprinkle in a bathtub. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) report, is the first national study to look at bath salts-related emergency department visits since the drugs appeared a few years ago. The report said that 67 percent of emergency department visits linked to bath salts also involved the use of another drug. Fifteen percent of the visits involved the use of bath salts with marijuana or synthetic forms of marijuana.
Major Trauma Centers Getting Low Risk Patients MedPage Today – September 11, 2013
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More than one-third of low-risk injured patients are taken by emergency medical services (EMS) to major trauma centers, according to a study published in the September issue of Health Affairs. The Oregon Health and Science University in Portland estimated hospital-level differences in the adjusted cost of acute care for injured patients transported by 94 EMS agencies to 122 hospitals in seven regions, overall and by injury severity. The researchers found that among
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301,214 patients, the average adjusted per-episode cost of care was $5,590 higher in a level 1 trauma center than in a non-trauma hospital. Among patients with minor, moderate, and serious injuries there were hospital-level differences in cost. More than one-third of the 248,342 low-risk patients who did not meet field triage guidelines for transport to trauma centers were still transported to major trauma centers, accounting for up to 40 percent of acute injury costs.
Trauma Industry News ‘Bath Salts’ Drugs Led to 23,000 ER Visits in One Year: US Reports Health Day – September 17, 2013
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so far this year, up from 1,300 patients in all of 2011. Nearly 200 of this year's patients headed to the hospital's emergency room with gunshot wounds.
GW Hospital's trauma surgeons are prepared to handle the most extreme situations, from a terrorist attack to a presidential assassination attempt, because of the hospital's proximity to the White House and other government buildings. Those crisis situations are rare, but the last time a gunman made an attempt on a U.S. president's life –more than three decades ago – GW trauma surgeons operated on President Ronald Reagan and other victims.
Sarani and his colleagues meet every month to ensure the hospital has enough doctors and nurses on backup in case of a crisis. But the hospital doesn't organize drills, because as Sarani said, "If you plan for that, then I think you're destined for failure. Those events are just chaotic."
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A number of national initiatives in Denmark were associated with improvements in use of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest and subsequent survival, researchers found. Over about a 10-year period, the percentage of out-of-hospital arrests that involved bystander CPR more than doubled from 21.1% to 44.9%, according to Copenhagen University Hospital Gentofte in Denmark. Following that trend were significant improvements in survival to hospital arrival and at 30 days and 1 year. Whether the increase in bystander CPR was directly responsible for the survival gains remains unclear. But the closely parallel time course for the increase in bystander CPR and survival, together with the large positive association between bystander CPR and survival, may suggest a positive effect of increasing rates of bystander CPR and, subsequently, survival, according to the study authors.
Three gunshot victims from last week's Navy Yard shooting were treated at MedStar Washington Hospital Center, and trauma doctors told News4 they were ready to handle more victims. Just before 9 a.m. on Monday, September 16th, 2013, the hospital began receiving calls of an active shooter at the Navy Yard with multiple victims down. The hospital then set up 10 different teams consisting of surgeons, doctors, nurses, anesthesiologists, X-Ray technicians and even a chaplain. Physicians called the scenario "controlled chaos." The hospital staff has handled mass casualty incidents before -- the Metro train derailment in 2009 when doctors treated seven victims and 9/11 when 10 Pentagon victims arrived to the hospital.
Bystander CPR Tied to Better Survival MedPage Today – October 1, 2013
Surgeons Reflect on Trauma of Navy Yard Shooting NBC4 Washington – September 25, 2013
Quality of Care May Vary Within a Hospital by Insurance Type Health Affairs, October 2013
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New data indicate that the quality of care patients receive in a given hospital may be linked to the type of insurance they have, and Medicare patients, researchers say, may be particularly at risk for lower-quality care. Research shows that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care. These findings suggest that to help reduce care disparities, public payers and hospitals should
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measure care quality for different insurance groups and monitor differences in treatment practices within hospitals.
Stressful Incidents of Physical Violence Against Emergency Nurses Journal of Issues in Nursing – October 2013
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Physical violence against nurses has become an endemic problem in health care. Researchers have identified that physical violence affects nurses in nearly all work environments and all regions of
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the world. Patient care settings with reports of physical violence include medical/ surgical, obstetrical/ gynecological, emergency, psychiatric/ behavioral, intensive care, pediatric, and long-term care settings Specific to emergency nursing, the rate of physical assaults against emergency nurses was 1.8 assaults per nurse, per year. Discussion of the study findings suggests that efforts to prevent violence and promote workplace safety need to focus on designing work environments that allow for the quick egress of employees, establishing and consistently enforcing policies aimed at violence prevention, and maintaining positive working relationships with security officers.
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The U.S. healthcare system could cut trauma care spending by $136.7 million annually by preventing overtriage of low-risk injured patients to major trauma centers, according to a Health Affairs study. Trauma care is the second-largest driver of U.S. healthcare spending, according to the study. Treating seriously injured adults costs approximately $30 billion annually, and the country spends about $163 billion — 10 percent of all U.S. medical spending — treating all injured patients. The study included injured children and adults transported to 122 hospitals in various regions in Oregon, Washington, California, Utah and Colorado. The patients' treatment during the study period of 2006 to 2008 resulted in more than $1.01 billion in acute-care costs. Of the 288,832 patients with minor to moderate injuries, 41.5 percent received care at major trauma centers, where the cost per patient is higher compared with the cost at other trauma centers and non-trauma hospitals. These findings demonstrate the importance of field triage process accuracy to minimize excess costs, according to the study.
Study: Minimizing Overtriage Could Save $136.7M Annually Beckers Hospital Review – September 9, 2013
Addressing a Dangerous Epidemic Abuse of Painkillers and Other Prescription Drugs Kaiser Health News – October 7, 2013
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Hospitals, a reliable source of employment growth in the recession and its aftermath, are starting to cut thousands of jobs amid falling insurance payments and inpatient visits. The payroll cuts are surprising because the Affordable Care Act (ACA), whose implementation took a big step forward this month, is eventually expected to provide health coverage to as many as 30 million additional Americans. Health care providers announced
A Job Engine Sputters as Hospitals Cut Staff USA Today – October 13, 2013
About 50 Americans die every day from a prescription drug overdose — a tally that, in most states, turns out to be more than deaths from car accidents. In a new report, “Prescription Drug Abuse: Strategies to Stop the Epidemic,” researchers at the Trust for America’s Health found that rates of overdose and addiction doubled since 1999 in most states. In West Virginia — the state with the highest number of drug overdose deaths — the rate was six times higher than fourteen years ago. Researchers said the emergence of prescription drugs like oxycodone has benefitted many people but is also marked by a corresponding rise in misuse. The Trust for America’s Health, along with other public health and law enforcement experts, reviewed national recommendations and examined a set of 10 indicators that were having a positive impact, including certain laws and educational initiatives. But most states had in place six or less of the indicators that help curb the issue. Only New Mexico and Vermont had all 10 strategies touted by the report. South Dakota had the lowest number: two.
Trauma Research
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more layoffs than any other industry last month — 8,128 — largely because of reductions by hospitals. So far this year, the health care sector has announced 41,085 layoffs, the third-most behind financial and industrial companies. Total private hospital employment is still up by 36,000 in the past 12 months, but it's down by 8,000 since April, and more staff reductions are expected into next year.
People who believe it's wrong to get behind the wheel while drunk may change their minds after actually becoming intoxicated, a new study suggests. Analyzing 82 young adults, researchers from the University of Missouri compared their attitudes and willingness to drive drunk on two separate occasions: when they were sober and after drinking moderate amounts of alcohol. Funded by the National Institute of Alcohol Abuse and Alcoholism, the study was published in the journal, Alcoholism: Clinical and Experimental Research. About one-third of all fatal vehicle crashes in the United States each year involve an alcohol-impaired driver. In 2010, that translated to more than 10,000 preventable alcohol-related traffic deaths, according to NHTSA. One potential factor, according to research team, is that although people may know that drinking and driving is a bad idea, those sober beliefs may go out the window after a few drinks.
Peoples Beliefs on Drunk Driving Health Day – September 12, 2013
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One in nine U.S. troops who suffered combat wounds in Iraq or Afghanistan had a spinal injury, a much higher rate than in previous wars, according to a new study. Researchers analyzed U.S. Department of Defense casualty records from 2005 to 2009 and found that spinal injuries were present in 11 percent of nearly 7,900 troops wounded in combat in the two countries. Fractures
Vitamin D Deficiency Often Seen in Trauma Bone Breaks Health Day – September 13, 2013
Low levels of vitamin D are commonly found in people who suffer traumatic bone fractures, according to a new study. Because vitamin D is an essential component in repairing bone damage, patients with low vitamin D levels are at higher risk for improper healing of broken bones. The University of Missouri researchers examined vitamin D levels in about 900 adults who suffered traumatic bone fractures as the result of incidents such as falls and car crashes. About 79 percent of men and 76 percent of women in the study had lower-than-recommended vitamin D levels, and about 40 percent of the women and 38 percent of the men had severely low vitamin D levels. Study authors highlighted that low and deficient vitamin D is common for orthopedic trauma patients of all ages, finding that among young adults 18 to 25 years old, nearly 55 percent had low or severely low vitamin D, and 29 percent had deficient levels.
Hyperbaric Chamber Treatments Did Not Help with Mild TBI USA Today – September 21, 2013
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Scientists found no significant benefit to a popular idea of using a pressurized chamber to force oxygen into the brain to heal mild brain injuries suffered by tens of thousands of Iraq and Afghanistan combat veterans, according to a scientific study by the Pentagon and Department of Veterans Affairs (VA). The study results leave the military and the VA without any tool for directly treating an injury characterized as a "signature wound" of the two wars. Some troops exposed to several roadside bombs during operations had more than one mild traumatic brain injury (TBI)
Spinal Injuries to Soldiers Much More Common in Iraq, Afghanistan Wars Health Day – September 20, 2013
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were involved in more than 80 percent of spinal injuries. Three-quarters of spinal injuries were caused by explosions and about 15 percent by gunshots, found the study in the Sept. 15 issue of the journal Spine. Overall, spinal damage occurred at a rate of 4.4 injuries per 10,000 U.S. military personnel deployed to Iraq or Afghanistan, with a rate of four per 10,000 for spinal fractures. In contrast, the rate of injuries to limbs was about 15 per 10,000 troops, according to the study. Soldiers in Afghanistan were more likely to sustain spinal injuries than those in Iraq, and members of the Army were more likely to sustain the injuries than those in other branches of the military. Researchers said the rate of spinal injuries is perhaps 10 times higher than in the Vietnam War. However, they noted that in previous wars, most soldiers with spinal trauma were injured so severely that they did not survive.
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or concussion from exposure to blasts. More than 230,000 troops have suffered mild TBI since 2000, according to the Pentagon. Ten percent of Iraq and Afghanistan veterans at the VA report ongoing mild brain injury symptoms such as headaches, light sensitivity and problem-solving deficits. The hyperbaric chamber thought to be
an answer is identical to decompression chambers used to treat divers suffering from the bends or decompression sickness. A group of private doctors contend they have used hyperbaric chambers to successfully treat mild brain injury. There has been some research showing that the treatment improves survival rates in cases of severe brain injury. Adherents say that breathing pressurized oxygen raises oxygen levels in the brain, boosting the health of damaged cells and improving brain function. Several members of Congress have backed the concept. In response, the Pentagon and VA in 2009 launched a series of four research efforts to test the assertion. The latest study, published this week in the Journal of Head Trauma Rehabilitation, is the second and mirrors findings from the first published 2011. Both found no significant benefit from using the chamber on troops.
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Prevalence of Exposure to Risk Factors for Violence Among Young Adults Seen in an Inner-City Emergency Department Western Journal of Emergency Medicine – October 2013
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Injuries account for the majority of childhood injuries and deaths in the United States (U.S.), with homicide and suicide ranked as the second and third leading cause of death, respectively, among adolescents aged 15–19. Furthermore, injuries from
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interpersonal assaults in this age group accounted for 656,000 visits to U.S. emergency departments (EDs) in 2008. Non-fatal violent injuries in adolescents often precede fatal violence and homicide, making this a pressing public health concern for research and prevention initiatives. As both a societal safety net and a healthcare provider to those with limited resources, many behavioral scientists have highlighted the potential of the
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ED as a site for screening for health risks and initiating prevention programs. Over 30% of young adults presenting to an urban ED reported high exposure to risk factors for violent injury. The high prevalence of these risk factors among ED patients highlights the potential benefit of a survey instrument to identify youth who might benefit from a targeted, ED-based violence prevention program.
Optimal Position for External Chest Compression During Cardiopulmonary Resuscitation Medscape – October 2013
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Cardiopulmonary resuscitation (CPR) has been recognized as a standard method for resuscitation since its introduction in the 1960s. In cardiac arrest, tissue perfusion critically depends on CPR until spontaneous circulation returns. Therefore, chest compression is the essential factor in supplying blood to the vital organs during CPR. Although the cardiac output generated by chest compression is within 17–27% of the normal cardiac output, it has been proved that the survival rate for cardiac arrest patients on
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whom CPR was performed was increased two to threefold than that in patients who did not receive CPR. There have been a number of studies to increase cardiac output generated by chest compression during CPR; however, most dealt with compression rate and depth rather than compression location. According to the guideline for CPR announced by the International Liaison Committee on Resuscitation, the American Heart Association and the European Resuscitation Council in 2005, it was suggested that the rescuer should compress at the point where the sternum and internipple line meet. However, there is insufficient evidence for the proper hand position for
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chest compression, and it was changed more ambiguously to the lower half of the sternum in the 2010 guidelines. In this chest CT-based study, the structures below each chest compression point and the area of the left ventricle actually compressed were analyzed in each patient who received CPR, to study the efficiency and validity of the currently recommended chest compression location. Only a small proportion of the ventricle is subjected to external chest compression when CPR is performed according to the current guidelines. Compression of the sternum at the sternoxiphoid junction might be more effective to compress the ventricles.
Pain, Confusion and Function Following Hip Facture Medscape – October 2013
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Hip fractures are common among elderly and can be anticipated to increase in frequency with the aging of the population. Often life-limiting, these injuries are associated with significant secondary comorbid conditions, including acute confusional
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states, which often negatively affect the patient's outcome. Patients with hip fracture also typically experience other disease processes that not only contribute to the fall that caused the fracture, but also impede recovery. Although a large body of research has examined confusion, pain, and functional status in these patients as separate events, little study of
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these problems in aggregate, particularly during the acute hospitalization phase, has yet taken place. The purpose of this study was to examine confusion, pain and pain relief, physical and psychological well-being, functional status, and quality of care in a sample of elderly hospitalized patients with hip fracture.
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Ambulance Still Best Choice for Stroke Transport MedPage Today – October 14, 2013
If "time is brain", then patients with ischemic stroke should get to the emergency department by ambulance rather than private
vehicle, one study suggested. Arrival times of 3 hours or less were more likely in an ambulance than in a private vehicle, according to researchers at Tulane University in New Orleans. But after adjustments, neither scores on the modified Rankin Scale at discharge nor length of stay for acute ischemic stroke patients were significantly different between patients who had been delivered to the hospital via ambulance versus private vehicle, they reported in a poster presented at the American Neurological Association's annual meeting. Study authors found that the severity of stroke symptoms and the length of time between the onset of symptoms and receiving treatment in a hospital were the greatest predictors of patient outcomes.
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Postconcussion Self-Report Does Reflect Recovery Medscape – October 14, 2013
Despite self-reports of recovery after concussion, 40% of college football players still had statistically significant impairments on postconcussion cognitive testing, a study from Columbia University has found. Subtle postconcussion cognitive impairment is under-recognized yet easily identifiable by neuropsychiatric testing. Meaningful objective thresholds for cognitive impairment after a sports concussion have not been established, even though computer-based neuropsychological testing is becoming the standard of care in many sports settings. Researchers sought to identify differences in cognitive function based on computerized neuropsychological
testing among Columbia University football players before and after a first concussion. Their ultimate goal is to identify objective, numeric criteria that can be used as benchmarks for concussion severity
80% of Excessively Long Trauma Stays Due to Administrative Hold-Up JAMA Surgery – October 17, 2013
While only 5 percent of trauma patients experience excessively prolonged hospital stays, only 20 percent of those stays are clinical, according to an article published in the Journal of the American Medical Association. Researchers at a level I trauma center tracked stays for more than 3,000 trauma patients to determine the causes of expensive, excessively prolonged stays. They discovered patients experiencing excessively long stays tended to be older blunt trauma patients without private insurance. This group was more often discharged to post-acute care facilities and had higher hospitalization costs, though group members experienced the same injury severity and in-hospital complication rates as other trauma patients. Nonclinical discharge delays were related to difficulties in rehabilitation facility placement (47 percent of cases), in-hospital operational delays (26 percent of cases) or payer-related issues (7 percent of cases). The study concluded cost reduction efforts surrounding length of stay should focus on improving transitions between acute and post-acute care.
