Age-related differences in mechanism, cause, and location of trauma deaths.

BACKGROUND: Trauma death has traditionally been described as primarily occurring in young men exposed to penetrating trauma or road traffic accidents. The epidemiology of trauma fatalities in Europe may change as a result of the increasing proportion of elderly patients. The goal of this study was to describe age-related differences in trauma type, mechanism, cause and location of death in a well-defined European region. METHODS: We prospectively registered all trauma patients and severe burn patients in eastern Denmark over 12 consecutive months. We analyzed all trauma fatalities in our region regarding the trauma type, mechanism, cause and location of death. RESULTS: A total of 2,923 patients were registered, of which 292 (9.9%) died within 30 days. Mortality increased with age, with a mortality of 46.1% in patients older than 80 years old. Blunt trauma was the most frequent trauma type at all ages, but the trauma mechanism differed among ages, with falls constituting 46.8% of trauma deaths in the elderly. The primary cause of death was head and spine injuries across all age-groups. Death took place before arrival at the hospital in 45% of the cases, but death during primary admission became increasingly important with advanced age. CONCLUSION: Increasing age was associated with higher mortality, an increased proportion of falls and fatal head or spine injuries.

Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists.

Twenty-four orthopaedic surgeons classified 42 pairs of radiographs according to the Neer system for proximal humeral fractures. Mean kappa value for inter-observer agreement was 0.27 (95% CI 0.26-0.28) with no clinically significant difference between orthopaedic residents ( n=9), fellows ( n=6) and specialists ( n=9). Mean kappa for agreement of displacement versus non-displacement was 0.41 (95% CI 0.39-0.43) overall, and 0.50 (95% CI 0.45-0.56) within the specialist group. The agreement found in our study is unsatisfactory from a clinical perspective.

Improved interobserver variation after training of doctors in the Neer system. A randomised trial.

We investigated whether training doctors to classify proximal fractures of the humerus according to the Neer system could improve interobserver agreement. Fourteen doctors were randomised to two training sessions, or to no training, and asked to categorise 42 unselected pairs of plain radiographs of fractures of the proximal humerus according to the Neer system. The mean kappa difference between the training and control groups was 0.30 (95% CI 0.10 to 0.50, p = 0.006). In the training group the mean kappa value for interobserver variation improved from 0.27 (95% CI 0.24 to 0.31) to 0.62 (95% CI 0.57 to 0.67). The improvement was particularly notable for specialists in whom kappa increased from 0.30 (95% CI 0.23 to 0.37) to 0.79 (95% CI 0.70 to 0.88). These results suggest that formal training in the Neer system is a prerequisite for its use in clinical practice and research.

[Parent groups. Crisis intervention for parents of extremely premature infants during hospitalization]. / Foraeldregrupper. Kriseintervention til foraeldre under indlaeggelse ved ekstremt for tidlig fødsel.

The aim of the study was to evaluate the benefit from participation in parent groups for parents of extremely premature new-born babies. The participation in the parent groups led by the psychologist took place during the hospitalization of the child on the neonatal ward. All parents of extremely premature new-borns admitted to the neonatal department, Hvidovre Hospital, Copenhagen, Denmark in the period from 1 January 1992 to 30 June 1994, were asked to fill in questionnaires. The study population comprised the parents of 58 children. The parents of 14 children did not want to participate. Of the remaining 44 children, 36 were alive and eight had died at the time of the study. Most parents participated in the parent group and the majority stated they had benefited from the participation. It is therefore considered a relevant psychological task to establish parent groups for parents of extremely premature new-borns as a mean of crisis intervention in the neonatal department.

[Attitudes of parents towards treatment of extremely premature infants]. / Foraeldreholdninger til behandling af ekstremt tidligt fødte børn.

The aim of this study was to evaluate the attitude among parents of extremely premature newborn children towards fixed lower limits for treatment and towards parent involvement in decisions about the treatment of their child. All parents with extremely premature newborns admitted from January 1, 1992 to June 30, 1994 to the Neonatal Department, Hvidovre Hospital, Copenhagen, Denmark, were asked to fill in questionnaires. The study population comprised the parents of 58 children. The parents of 14 children did not want to participate. Of the remaining 44, 36 children were alive and eight had died at the time of the study. Almost all parents stated that neither birth weight nor gestational age were acceptable as criteria for treatment or non-treatment of premature newborns. This attitude contrasted with the recommendation in 1994 from The Danish Council of Ethics. Half of the parents expressed a wish to be involved in the decisions about the treatment of their newborn child. This attitude agreed with the recommendation from the Danish Council of Ethics.

Genotoxicity of acrylic bone cements.

The genotoxicity of conventional polymethylmethacrylate (PMMA) and a new formulation of bone cement: methylmethacrylate/n-decylmethacrylate/isobornylmethacrylate (MMA/DMA/IBMA) were tested by micronucleus test and reverse mutation assays of Salmonella typhimurium (Ames test). In extracts from cement pellets (37 degrees, 72 hr) with water and water/ethanol the concentration of MMA was reduced by 13-19 times with the new formulation and the concentrations of accelerators were reduced by 4-5 times. New chemical constituents (DMA, IBMA, dihydroxy-propyl-p-toluidine) were found in negligible concentrations. In the micronucleus test all three cement brands were found non-mutagenic and in the Ames test scattered increased revertant ratios were found without differences between the three brands. The new formulation does not possess any increased risk of genotoxicity.