Differences in the epidemiology of out-of-hospital and in-hospital trauma deaths

BACKGROUND: Trauma is a leading cause of mortality. Holistic views of trauma systems consider injury as a public health problem that requires efforts in primary, secondary and tertiary prevention. However, the performance of trauma systems is commonly judged on the in-hospital mortality rate. Such a focus misses opportunities to consider all deaths within a population, to understand differences in in-hospital and out-of-hospital trauma deaths and to inform population-level injury prevention efforts. The aim of this study was to provide an epidemiological overview of out-of-hospital and in-hospital trauma deaths in a geographically-defined area over a 10-year period. METHODS: We performed a population-based review of out-of-hospital and in-hospital trauma deaths over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System and the Victorian State Trauma Registry. Temporal trends in population-based incidence rates were evaluated. RESULTS: Over the study period, there were 11,246 trauma deaths, of which 71% were out-of-hospital deaths. Out-of-hospital trauma deaths commonly resulted from intentional self-harm events (50%) and transport events (35%), while in-hospital trauma deaths commonly resulted from low falls (≤1 metre) (50%). The incidence of overall trauma deaths did not change over the study period (incidence rate ratio 0.998; 95%CI: 0.991, 1.004; P = 0.56). CONCLUSIONS: Out-of-hospital deaths accounted for most trauma deaths. Given the notable differences between out-of-hospital and in-hospital trauma deaths, monitoring of all trauma deaths is necessary to inform injury prevention activities and to reduce trauma mortality. The absence of a change in the incidence of both out-of-hospital and in-hospital trauma deaths demonstrates the need for enhanced activities across all aspects of injury prevention

A Generative Deep Learning Approach for Forensic Facial Reconstruction

Forensic facial reconstruction currently relies on subjective manual methods to reconstruct a recognizable face from a skull. Automated approaches using algorithms and statistical norms have been able to reliably construct faces in real-time, but are unable to generate areas of the face that do not correlate strongly to the bone beneath, such as the eyes, lips and ears. Recent developments in deep learning have shown that generative models can produce realistic images indistinguishable from genuine human faces. Applying these techniques, we propose a generative deep learning solution to perform facial reconstruction directly from the bone with limited data and no background expertise. The model is trained on 665 3D Computed Tomography (CT) head scans that have been cleaned of noise, rotated to correct orientation and then filtered by density to find bone and soft tissue to be used as input and label respectively. It is trained with a combination of adversarial and VGGFace2 perceptual loss. The model is then compared to two baseline deep generative models and achieves a mIoU of 0.9410 and facial detection score of 88.32%. Results show the model is able to consistently generate accurate jaw and muscle structures. Additionally, it generates realistic ears, eyes and noses - features that are traditionally difficult to generate automatically with traditional techniques. Our model provides the basis for a complete, end-to-end solution for forensic facial reconstruction, with no prior knowledge or training on reconstruction techniques

The nature and impact of occupational trauma exposure among staff working in a forensic medical and scientific service: a qualitative interview study

Employees of forensic medical service organizations are exposed to occupational trauma during their clinical, pathology, scientific and corporate duties. Adverse impacts, associated with occupational trauma exposure, can illicit negative outcomes that may influence a person's professional practice as well as their physical, behavioural and psychological reactions. Research exploring the impact of trauma exposure has typically focused on reduction of exposure, failing to address workplaces where exposure to trauma is a core activity for employees. This study explored the experiences of staff working at a state-wide forensic medical and scientific institution in Australia. Thematic analysis of 25 key-informant interviews identified that 1) trauma exposure is common and multifactorial in nature; 2) impacts of trauma exposure varies by personal characteristics and case circumstances; and 3) trauma exposure can be better managed when organizational and individual responsibility align. Awareness that a strong sense of purpose and contribution derived from the important nature of the work delivered, allows individuals to remain employed. The study also identified that facilitating a culture of openness regarding trauma exposure can lead to improved workplace wellbeing and retention of this dedicated workforce

Effectiveness of low dose computed tomography to detect fractures in paediatric suspected physical abuse: a systematic review.

The skeletal survey X-ray series is the current 'gold standard' when investigating suspected physical abuse (SPA) of children, in addition to a non-contrast computed tomography (CT) brain scan. This systematic literature review synthesised findings of published research to determine if low dose computed tomography (LDCT) could detect subtle fractures and therefore replace the skeletal survey X-ray series in the investigation of SPA in children aged under 3 years. Five electronic databases and grey literature were systematically searched from their inception to 28 April 2022. Primary studies were included where the population comprised paediatric patients up to 16 years and LDCT was used to detect fractures associated with SPA. Studies involving imaging investigations of the head, standard dose CT examinations or accidental trauma were excluded. Three studies met the inclusion criteria, all of which were case series. These studies did not report many of the criteria required to compare the accuracy of LDCT to X-ray, i.e. they did not meet the criteria for a diagnostic accuracy test. Therefore, it is difficult to conclude from the case series if LDCT is accurate enough to replace X-rays. Due to the gap in current literature, a phantom study and subsequent post-mortem CT study are recommended as the primary investigative methods to assess the ability of low-dose CT to identify the subtle fractures associated with SPA and to calculate how low the achievable CT dose can be. [Abstract copyright: © 2024. The Author(s).

Comparison of typical radiation doses and risks using an anthropomorphic ‘bone fracture’ phantom for commonly performed X‐ray projections in a 5‐year‐old

Introduction: Diagnostic reference levels (DRLs) are typical dose levels for medical imaging examinations for groups of standard‐sized patients or standard phantoms for broadly defined types of equipment used as a tool to aid optimisation of protection for medical exposures. Currently, there are no paediatric DRLs for conventional radiography (i.e. general X‐rays) published in Australia. The aim of this study was to establish typical radiation doses and risks that are representative of those delivered for commonly performed X‐ray projections for a 5‐year‐old/20 kg child using a 5‐year‐old anthropomorphic ‘bone fracture’ phantom in three dedicated paediatric radiology departments in Victoria. Methods: A total of 20 projection images were acquired for a standard 5‐year‐old/20 kg phantom using digital radiography X‐ray equipment. The air kerma‐area product (KAP) measured at each centre by a KAP metre, which was calibrated to a national primary standard, was considered to represent the median value for that centre for each X‐ray projection. Organ doses and effective dose were estimated using PCXMC software, and risks of radiation‐induced cancer and radiation‐induced death were calculated based on the BEIR VII report. Results: The typical doses for the individual X‐ray projections ranged from 3 mGy•cm2 to 86 mGy•cm2, whilst the effective doses ranged from 0.00004 to 0.07 mSv. The radiation risks were ‘minimal’ to ‘negligible’. Conclusion: The estimation of typical radiation doses and associated risks for a 5‐year‐old/20 kg phantom study provides reference values for guidance and is a first step in assisting optimisation at other institutions until national DRLs, based on patient data from the clinical setting, are published

Effect of external fixation rod coupling in computed tomography

Abstract External fixation is a common tool in the treatment of complex fractures, correction of limb deformity, and salvage arthrodesis. These devices typically incorporate radio-opaque metal rods/struts connected at varying distances and orientations between rings. Whilst the predominant imaging modality is plain film radiology, computed tomography (CT) may be performed in order for the surgeon to make a more confident clinical decision (e.g. timing of frame removal, assessment of degree of arthrodesis). We used a fractured sheep leg to systematically assess CT imaging performance with a Discovery CT750 HD CT scanner (GE Healthcare) to show how rod coupling in both traditional Ilizarov and hexapod frames distorts images. We also investigated the role of dual-energy CT (DECT) and metal artefact reduction software (MARS) on the visualisation of the fractured leg. Whilst mechanical reasons predominantly dictate the rod/strut configurations when building a circular frame, rod coupling in CT can be minimised. Firstly, ideally, all or all but one rod can be removed during imaging resulting in no rod coupling. If this is not possible, strategies for configuring the rods to minimise the effect of the rod coupling on the region of interest are demonstrated, e.g., in the case of a four-rod construct, switching the two anterior rods to a more central single one will achieve this goal without particularly jeopardising mechanical strength for a short period. It is also shown that the addition of DECT and MARS results in a reduction of artefacts, but also affects tissue and bone differentiation

Development of a simple numerical model for trabecular bone structures

PURPOSE: Advances in additive manufacturing processes are enabling the fabrication of surrogate bone structures for applications including use in high-resolution anthropomorphic phantoms. In this research, a simple numerical model is proposed that enables the generation of microarchitecture with similar statistical distribution to trabecular bone. METHODS: A human humerus, radius, ulna, and several vertebrae were scanned on the Imaging and Medical beamline at the Australian Synchrotron and the proposed numerical model was developed through the definition of two complex functions that encode the trabecular thickness and position-dependant spacing to generate volumetric surrogate trabecular structures. The structures reproduced those observed at 19 separate axial locations through the experimental bone volumes. The applicability of the model when incorporating a two-material approximation to absorption- and phase-contrast CT was also investigated through simulation. RESULTS: The synthetic structures, when compared with the real trabecular microarchitecture, yielded an average mean thickness error of 2 μm, and a mean difference in standard deviation of 33 μm for the humerus, 24 μm for the ulna and radius, and 15 μm for the vertebrae. Simulated absorption- and propagation-based phase contrast CT projection data were generated and reconstructed using the derived mathematical simplifications from the two-material approximation, and the phase-contrast effects were successfully demonstrated. CONCLUSIONS: The presented model reproduced trabecular distributions that could be used to generate phantoms for quality assurance and validation processes. The implication of utilizing a two-material approximation results in simplification of the additive manufacturing process and the generation of synthetic data that could be used for training of machine learning applications