ABSTRACT
BACKGROUND: As electric bicycles (e-bikes) become increasingly popular, reports of injuries associated with e-bike usage are also rising. Patterns, characteristics, and severity of injuries following e-bike crashes need further investigation, particularly in contrast to injuries from conventional bicycle crashes. METHODS: This prospective observational study included 82 patients treated at a Level II trauma center for injuries resulting from an electric or conventional bicycle crash. Data were collected over one year (05.09.2017-19.09.2018) during in- and outpatient visits. A study-specific case report form was used to identify the bicycle type, cycling behavior (e.g., use of a helmet, safety gear, alcohol), and circumstances of the crash (e.g., road conditions, speed, cause of the incident, time of day, season). Additional information about patient demographics, treatment, and injury characteristics, such as the Injury Severity Score (ISS) and body region injured, were documented. Results were analyzed using chi-square, Fisher's exact, or Wilcoxon tests. Simple logistic or linear regression models were used to estimate associations. RESULTS: Of the 82 patients, 56 (67%) were riding a conventional bike and 27 (33%) were using an e-bike. Most incidents were either single-bicycle crashes (66%) or automobile collisions (26%), with no notable difference in prevalence rates between groups. Although a higher proportion of conventional bikers were male (67% vs. 48%), the difference was not significant. E-bikers were older (median 60 years (IQR 44-70) vs. 45 years (IQR 32-62); p = 0.008), were hospitalized more often (48% vs. 24%, p = 0.025), and had worse ISS (median 3 (IQR 2-4) vs. 1 (IQR 1-3), p < 0.001), respectively. Body regions most affected were the extremities (78%) and external/skin (46%), and these were distributed similarly in both groups. Concomitant injury patterns of the thorax/chest with external/skin were higher among e-bikers (p < 0.001). When we controlled for the difference in the median age of the two groups, only the injury severity score of e-bikers remained significantly worse. CONCLUSIONS: Hospitalization and chest trauma rates were higher among e-bikers. After controlling for the older age of this group, the severity of their injuries remained worse than in conventional cyclists. Initial clinical assessments at trauma units should include an evaluation of the thorax/chest, particularly among elderly e-bikers. LEVEL OF EVIDENCE: Level III.
ABSTRACT
BACKGROUND: Anesthesia guidelines advise objective neuromuscular monitoring. Acceleromyography, the standard technique used in clinical practice, is commonly used with the train-of-four (TOF) nerve stimulation pattern. Objective of this study was to compare the performance of two devices, TOF-Scan® and TOF-Cuff®. METHODS: This prospective, controlled observational study included patients undergoing surgery in general anesthesia with the need of neuromuscular blockade. Both neuromuscular monitoring devices were simultaneously placed on individual patients. Atracurium (0.5 mg/kg) was administered once. Main outcome measure was return time to TOF ratio ≥90%, secondary outcomes were time to TOF-ratio of 0% (during induction) and time to recovery to TOF-count of two. Results from the two devices were compared by Bland-Altman plots and one-sample t-test (P<0.05). RESULTS: Mean time to recovery to TOF ratio 90% was 79.6±13.6 min for TOF-Scan® and 70.8±12.8 min for TOF-Cuff® (P<0.001; mean bias 8.9 min, 95% CI: 5.8-12.0). Mean time to TOF-ratio 0% was 164.6±38.8 s for TOF-Scan® and 145.5±44.6 s for TOF-Cuff® (P<0.001; mean bias 19.1 s, 95% CI: 10.0-28.2). Mean time to recovery to TOF count two was 52.8±12.5 min for TOF-Scan® and 45.5±11.1 min for TOF-Cuff® (P<0.001; mean bias 7.3 min, 95% CI: 4.3-10.2). CONCLUSIONS: TOF-Cuff® consistently recorded the endpoints earlier than TOF-Scan®. Despite large intra-individual variations found with both devices, these results could be meaningful in a clinical setting.
