- Email: [email protected]
429 The Impact of Obesity on Cervical Spine Injuries in Trauma Patients
Research Forum Abstracts Methods: We conducted a prospective study within two university hospitals. Every patient treated by anticoagulants and victim of a head injury was included. Upon their arrival in the emergency department, they had a physical examination with determination of the Glasgow Coma Scale (GCS), and a blood test to measure the international normalized ratio (INR). A brain computed tomography (CT scan) was then carried up in the next hour. In case of intracranial hemorrhage, an antagonization of the anticoagulant activity was immediately performed. Otherwise, patients were monitored in the emergency department, and a second brain CT scan was realized 24 hours after the fall. The primary endpoint was the occurrence of an intracranial hemorrhage at the second CT scan. Results: Between July 2013 and December 2014, 419 patients were included. The average of age was at 81 12 years old and the sex ratio 0.79. 334 patients (79.8%) were treated with anti-vitamin K, 73 (17.4%) with new anticoagulants, and 12 patients by a low-molecular-weight heparin (2.9%). 407 patients (97.1%) had a GCS on arrival at 13 or 14, and 12 patients (2.9%) had a GCS at less than 13. 35 patients (10.4%) had an INR lower than 1.5, 201 patients (48.0%) had an INR between 1.5 and 3, 98 patients (23.3%) had an INR higher than 3. 43 patients (10.3%) had an intracranial hemorrhage at the initial CT scan [95% CI 7.4-13.2]. For 7 patients (1,7%), the second CT scan showed a delayed intracranial hemorrhage, despite a normal initial CT 1.7%, [95% CI 0.4-2.9]. Six patients with an intracranial hemorrhage were treated by anti-vitamin K, and one patient by dabigatran. The INR of these patients was between 1.4 and 3. They all received a treatment for antagonize the anticoagulant activity. No patient had required a neurosurgical procedure. Conclusion: Our study confirms the possibility of delayed intracranial hemorrhage in patients with anticoagulation who are victims of a head injury. The systematic implementation of a control CT scan 24 hours after the fall allows the detection of these lesions, and the therapeutic management.
429
The Impact of Obesity on Cervical Spine Injuries in Trauma Patients
Holden J, Moriarity R, Sterling S, Thompson J/University of Mississippi Medical Center, Jackson, MS
Background: Previous research suggests that obesity affects incidence and outcomes of traumatic injuries. The impact of obesity on cervical spine injury in trauma patients is unknown. Study Objective: To determine the association between obesity and cervical spine injury with and without spinal cord injury in patients with blunt traumatic injuries. Methods: A retrospective analysis of tertiary, academic emergency department (ED) databases was conducted for patients with cervical spine injuries over an eight-year period from January 2005 to December 2013. Patients were included if they presented to the ED for any blunt traumatic injury, had a documented cervical spine injury, and documented height and weight data. No additional exclusion criteria applied. Data was extracted from the ED electronic medical record, as well as the Trauma Registry for our institution. Cervical spine injury was categorized as: (1) Isolated spinal cord injury (SCI), or SCI without a cervical fracture; (2) Cervical spine fracture, with or without SCI. The incidence of each cervical spine injury was assessed with 95% confidence intervals (CI) for each body mass index (BMI) category (Underweight [UW, BMI40]). For further analysis, the incidence of injuries were evaluated by two categories: obese (BMI) > 25) and non-obese (BMI 25). Fisher exact r by c and Kruskal-Wallis were used for statistical analysis, as appropriate with P < .05 considered statistically significant. Results: A total of 897 patients met inclusion/exclusion criteria. Of those patients with cervical injury, the incidences of cervical fracture by BMI category were as follows: The incidence of Category 1 patients (isolated SCI) by BMI category were as follows: 7/71 (10%) in UW patients (CI 0.03, 0.17), 33/330 (10%) in NW patients (CI 0.07, 0.13), 25/323 (8%) in OW patients (CI 0.05, 0.11), 12/136 (9%) in Obese patients (CI 0.04, 0.14) and 5/37 (14%) in the Ext Obese (CI 0.02, 0.25). Category 2 (SCI with fracture) 65/71 (92%) in UW patients (CI 0.85, 0.98), 302/330 (92%) in NW patients (CI 0.88, 0.95), 300/323 (93%) in OW patients (CI: 0.90, 0.96), 126/136 (93%) in Obese patients (CI 0.88, 0.97) and 32/37 (86%) in the Ext Obese (CI: 0.75, 0.98). No statistical difference was found for either type of injury when comparing the obese versus non-obese groups. Conclusion: In this analysis of patients with known cervical spine injuries, BMI was not associated with cervical spine fracture or spinal cord injury.
S154 Annals of Emergency Medicine
430
Alcohol Use Among Pedestrians Struck by Cars Is Associated With Increased Injury Severity and Hospital Length of Stay
Shah K, Bassan E, Rahman A, Slaughter D, Ali I, Moshier E, Galer A, England P, Agriantonis G, Kessler S, Ullman J/Icahn School of Medicine at Mount Sinai & Elmhurst Hospital Center, New York, NY; Bellevue Hospital Center, New York, NY; Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT; North Shore-LIJ University Hospital, Manhasset, NY
Study Objectives: Pedestrians comprise a significant proportion of traffic accident injuries and fatalities. This is especially apparent in New York City (NYC), where in 2013 pedestrians comprised 60.8% of all traffic fatalities which was well above the national mean. We seek to evaluate the effect of alcohol influence on pedestrian injury in NYC by evaluating the population in Queens, NY. Methods: Funded by the NY State Governor’s Traffic Safety Committee, we performed a prospective study between March 2012 and August 2014 at Elmhurst Hospital Center (EHC) in Queens, NY. Trained research assistants collected data in the emergency department via patient interview and chart review of pedestrians/cyclists who were struck by a motorized vehicle. Patients were assessed for a number of variables including demographics, patient behaviors including alcohol use, environmental factors, hospital length of stay (LOS), and mortality. Injury Severity Score (ISS) was calculated. Statistical analysis was performed by independent statisticians using SAS Version 9.4. We utilized multiplicative generalized linear and binomial regression models where appropriate. Results: A total of 416 patients (207 male: 209 female) were enrolled in the study. 36 (8.7%; 95% confidence interval [CI] ¼ 6.0-11.4%) pedestrians struck had used alcohol with a predominance of males (83%) versus female (17%); P < .0001. When comparing the cohort of “no alcohol involved” versus “alcohol involved,” there was no significant difference between the two groups with respect to age, insurance status, or primary language. Median ISS for injured pedestrians who used alcohol was higher than those who did not (10 vs 1; P < .0001). Pedestrians who used alcohol were more likely to have an ISS > 15 (42% vs 9%; P < .0001; prevalence ratio [PR] ¼ 4.67; 95% CI 2.74-7.95). Pedestrians who used alcohol were more likely to have head and neck injury (PR ¼ 2.12; 95% CI 1.29-3.48), facial injury (PR ¼ 3.19; 95% CI 1.59-6.39), chest injury (PR ¼ 3.01; 95% CI 1.42 - 6.36), abdominal injury (PR ¼ 4.02; 95% CI 2.06-7.83), and extremity injury (PR ¼ 2.51; 95% CI 1.68-3.74) when compared to pedestrians who did not use alcohol. With regard to disposition, pedestrians who used alcohol were more likely to be admitted to the hospital (54% vs 23% P < .0001; PR ¼ 2.35; 95% CI 1.65-3.36), had longer median LOS (1 vs 0 days; P < .0001), and were also more likely to be admitted for 10 days or more (29% vs 9%; P < .0010) when compared to those who did not use alcohol. There was no significant difference in mortality. Conclusion: Pedestrians who are injured while using alcohol are more likely to sustain severe injury and experience longer LOS.
431
Effects of Burn Location and Investigator on Burn Depth in a Porcine Model
Singer AJ, Toussaint J, Chung W, Raut V/Stony Brook University, Stony Brook, NY; Arteriocyte, Inc., Cleveland, OH
Study Objectives: In order to be useful, animal models should be reproducible and consistent regardless of sampling bias, investigator creating burn, and burn location. We determined the variability in burn depth based on biopsy location, burn location and investigator in a porcine model of partial thickness burns. We hypothesized that burn depth would be similar for both investigators and among biopsy locations. Methods: Twenty-four partial thickness burns (2.5 by 2.5 cm each) were created on the backs of two anesthetized pigs by two investigators (one experienced, one inexperienced) using a previously validated model. In one of the pigs, the necrotic epidermis covering the burns was removed. Five full thickness 4 mm punch biopsies were obtained one hour after injury from the four corners and center of the burns and stained with Hematoxylin and Eosin and Masson’s Trichrome for determination of burn depth by a board certified dermatopathologist blinded to burn location and investigator. Comparisons of burn depth by biopsy location, burn location and investigator were performed with T-tests and ANOVA as appropriate. Results: The mean (SD) depth of injury to blood vessels (the main determinant of burn progression) was 1.8 (0.3) mm, which included 75% of the dermal depth. Debrided burns were 0.24 mm deeper than non-debrided burns (P < .001). Burn depth increased marginally from cephalic to caudal, but not from midline to lateral. Burn depth was similar for both investigators and among biopsy locations. Conclusion: Burn depth was greater for debrided and caudal burns, but did not differ based on investigator, biopsy site, and medial-lateral location.
Volume 66, no. 4s : October 2015
429
The Impact of Obesity on Cervical Spine Injuries in Trauma Patients
Holden J, Moriarity R, Sterling S, Thompson J/University of Mississippi Medical Center, Jackson, MS
Background: Previous research suggests that obesity affects incidence and outcomes of traumatic injuries. The impact of obesity on cervical spine injury in trauma patients is unknown. Study Objective: To determine the association between obesity and cervical spine injury with and without spinal cord injury in patients with blunt traumatic injuries. Methods: A retrospective analysis of tertiary, academic emergency department (ED) databases was conducted for patients with cervical spine injuries over an eight-year period from January 2005 to December 2013. Patients were included if they presented to the ED for any blunt traumatic injury, had a documented cervical spine injury, and documented height and weight data. No additional exclusion criteria applied. Data was extracted from the ED electronic medical record, as well as the Trauma Registry for our institution. Cervical spine injury was categorized as: (1) Isolated spinal cord injury (SCI), or SCI without a cervical fracture; (2) Cervical spine fracture, with or without SCI. The incidence of each cervical spine injury was assessed with 95% confidence intervals (CI) for each body mass index (BMI) category (Underweight [UW, BMI40]). For further analysis, the incidence of injuries were evaluated by two categories: obese (BMI) > 25) and non-obese (BMI 25). Fisher exact r by c and Kruskal-Wallis were used for statistical analysis, as appropriate with P < .05 considered statistically significant. Results: A total of 897 patients met inclusion/exclusion criteria. Of those patients with cervical injury, the incidences of cervical fracture by BMI category were as follows: The incidence of Category 1 patients (isolated SCI) by BMI category were as follows: 7/71 (10%) in UW patients (CI 0.03, 0.17), 33/330 (10%) in NW patients (CI 0.07, 0.13), 25/323 (8%) in OW patients (CI 0.05, 0.11), 12/136 (9%) in Obese patients (CI 0.04, 0.14) and 5/37 (14%) in the Ext Obese (CI 0.02, 0.25). Category 2 (SCI with fracture) 65/71 (92%) in UW patients (CI 0.85, 0.98), 302/330 (92%) in NW patients (CI 0.88, 0.95), 300/323 (93%) in OW patients (CI: 0.90, 0.96), 126/136 (93%) in Obese patients (CI 0.88, 0.97) and 32/37 (86%) in the Ext Obese (CI: 0.75, 0.98). No statistical difference was found for either type of injury when comparing the obese versus non-obese groups. Conclusion: In this analysis of patients with known cervical spine injuries, BMI was not associated with cervical spine fracture or spinal cord injury.
S154 Annals of Emergency Medicine
430
Alcohol Use Among Pedestrians Struck by Cars Is Associated With Increased Injury Severity and Hospital Length of Stay
Shah K, Bassan E, Rahman A, Slaughter D, Ali I, Moshier E, Galer A, England P, Agriantonis G, Kessler S, Ullman J/Icahn School of Medicine at Mount Sinai & Elmhurst Hospital Center, New York, NY; Bellevue Hospital Center, New York, NY; Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT; North Shore-LIJ University Hospital, Manhasset, NY
Study Objectives: Pedestrians comprise a significant proportion of traffic accident injuries and fatalities. This is especially apparent in New York City (NYC), where in 2013 pedestrians comprised 60.8% of all traffic fatalities which was well above the national mean. We seek to evaluate the effect of alcohol influence on pedestrian injury in NYC by evaluating the population in Queens, NY. Methods: Funded by the NY State Governor’s Traffic Safety Committee, we performed a prospective study between March 2012 and August 2014 at Elmhurst Hospital Center (EHC) in Queens, NY. Trained research assistants collected data in the emergency department via patient interview and chart review of pedestrians/cyclists who were struck by a motorized vehicle. Patients were assessed for a number of variables including demographics, patient behaviors including alcohol use, environmental factors, hospital length of stay (LOS), and mortality. Injury Severity Score (ISS) was calculated. Statistical analysis was performed by independent statisticians using SAS Version 9.4. We utilized multiplicative generalized linear and binomial regression models where appropriate. Results: A total of 416 patients (207 male: 209 female) were enrolled in the study. 36 (8.7%; 95% confidence interval [CI] ¼ 6.0-11.4%) pedestrians struck had used alcohol with a predominance of males (83%) versus female (17%); P < .0001. When comparing the cohort of “no alcohol involved” versus “alcohol involved,” there was no significant difference between the two groups with respect to age, insurance status, or primary language. Median ISS for injured pedestrians who used alcohol was higher than those who did not (10 vs 1; P < .0001). Pedestrians who used alcohol were more likely to have an ISS > 15 (42% vs 9%; P < .0001; prevalence ratio [PR] ¼ 4.67; 95% CI 2.74-7.95). Pedestrians who used alcohol were more likely to have head and neck injury (PR ¼ 2.12; 95% CI 1.29-3.48), facial injury (PR ¼ 3.19; 95% CI 1.59-6.39), chest injury (PR ¼ 3.01; 95% CI 1.42 - 6.36), abdominal injury (PR ¼ 4.02; 95% CI 2.06-7.83), and extremity injury (PR ¼ 2.51; 95% CI 1.68-3.74) when compared to pedestrians who did not use alcohol. With regard to disposition, pedestrians who used alcohol were more likely to be admitted to the hospital (54% vs 23% P < .0001; PR ¼ 2.35; 95% CI 1.65-3.36), had longer median LOS (1 vs 0 days; P < .0001), and were also more likely to be admitted for 10 days or more (29% vs 9%; P < .0010) when compared to those who did not use alcohol. There was no significant difference in mortality. Conclusion: Pedestrians who are injured while using alcohol are more likely to sustain severe injury and experience longer LOS.
431
Effects of Burn Location and Investigator on Burn Depth in a Porcine Model
Singer AJ, Toussaint J, Chung W, Raut V/Stony Brook University, Stony Brook, NY; Arteriocyte, Inc., Cleveland, OH
Study Objectives: In order to be useful, animal models should be reproducible and consistent regardless of sampling bias, investigator creating burn, and burn location. We determined the variability in burn depth based on biopsy location, burn location and investigator in a porcine model of partial thickness burns. We hypothesized that burn depth would be similar for both investigators and among biopsy locations. Methods: Twenty-four partial thickness burns (2.5 by 2.5 cm each) were created on the backs of two anesthetized pigs by two investigators (one experienced, one inexperienced) using a previously validated model. In one of the pigs, the necrotic epidermis covering the burns was removed. Five full thickness 4 mm punch biopsies were obtained one hour after injury from the four corners and center of the burns and stained with Hematoxylin and Eosin and Masson’s Trichrome for determination of burn depth by a board certified dermatopathologist blinded to burn location and investigator. Comparisons of burn depth by biopsy location, burn location and investigator were performed with T-tests and ANOVA as appropriate. Results: The mean (SD) depth of injury to blood vessels (the main determinant of burn progression) was 1.8 (0.3) mm, which included 75% of the dermal depth. Debrided burns were 0.24 mm deeper than non-debrided burns (P < .001). Burn depth increased marginally from cephalic to caudal, but not from midline to lateral. Burn depth was similar for both investigators and among biopsy locations. Conclusion: Burn depth was greater for debrided and caudal burns, but did not differ based on investigator, biopsy site, and medial-lateral location.
Volume 66, no. 4s : October 2015