Spinal Injury Associated With Firearm Use

Objective Injuries associated with firearms are a significant health burden. However, there is no comprehensive study of firearm spinal injuries over a large population. It was the purpose of this study to analyze the demographics of spinal firearm injuries across the entire United States for all ages using a national database. Methods A retrospective review of prospectively collected data using the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2015 (ICPSR 37276) was performed. The demographic variables of patients with spinal injuries due to firearms were analyzed with statistical analyses accounting for the weighted, stratified nature of the data, using SUDAAN 11.0.01™ software (RTI International, Research Triangle Park, North Carolina, 2013). A p-value of < 0.05 was considered statistically significant. Results For the years 1993 through 2015, there were an estimated 2,667,896 emergency department (ED) visits for injuries due to firearms; 10,296 of these injuries (0.4%) involved the spine. The vast majority (98.2%) were due to powder firearm gunshot wounds. Those with a spine injury were more likely to have been injured in an assault (83.7% vs. 60.2%), involved a handgun (83.5% vs. 60.2%), were male (90.8% vs. 86.4%), were admitted to the hospital (86.8% vs. 30.9%), and were seen in urban hospitals (86.7 vs. 64.6%). The average age was 28 years with very few on those < 14 years of age. Illicit drug involvement was over four times as frequent in those with a spine injury (34.7% vs. 8.0%). The cervical spine was involved in 30%, thoracic in 32%, lumbar in 32%, and sacrum in 6%. A fracture occurred in 91.8% and neurologic injury in 33%. Injuries to the thoracic spine had the highest percentage of neurologic involvement (50.4%). There was an annual percentage decrease for patients with and without spine involvement in the 1990s, followed by increases through 2015. The average percentage increase for patients with a spine injury was 10.3% per year from 1997 onwards (p < 10-6), significantly greater than the 1.5% for those without spinal involvement (p = 0.0001) from 1999 onwards. Conclusions This nation-wide study of spinal injuries associated with firearms covering all ages can be used as baseline data for future firearm studies. A reduction in the incidence of such injuries can be guided by our findings but may be difficult due to sociopolitical barriers (e.g. socioeconomic status of the injured patients, differences in political opinion regarding gun control in the US, and geospatial patterns of firearm injury)

Report on the Challenges of Air Transportation Experienced by People with Disabilities

Boarding an airplane is difficult for persons with mobility impairments and increases the risk of injury to both passengers and employees. Airplane seats are uncomfortable and lack the necessary support for many individuals with disabilities. Additionally, airplane restrooms can be inaccessible to wheelchair users. Potential solutions for these issues include the use of detachable plane seats or personal wheelchairs on board and an airplane redesign to provide additional restroom space. The number of service and emotional support animals being brought on airplanes have also increased substantially over the past few years. Passengers that travel with their service animals must contend with having to follow different rules for different airlines carriers and not having sufficient space for animals to be safe and comfortable

Quality of Life after Palliative Pelvic Exenteration for Gynecologic Malignancy

Case Summary: Patient is a 44yo female with metastatic vulvar squamous cell carcinoma (SCC) diagnosed after 1-year history of a vulvar lesion, initially treated with radiation and radical vulvectomy. Following vulvectomy she developed an enlarging chronic wound, exposing her pubic ramus. Biopsies revealed recurrent SCC and osteomyelitis of the pubic ramus. Pain associated with the wound severely limited her ability to sit and ambulate. A tumor board decided to proceed with a palliative total pelvic exenteration 21 months after initial diagnosis of SCC for pain relief, including removal of the uterus, right fallopian tube and ovary, bladder, distal ureters, vagina, rectum, pubic symphysis, and pubic rami. Perineal reconstruction was completed with left pedicled anterolateral thigh flap with pedicled vastus lateralis flap. Unfortunately, she developed severe left hip pain due to persistent osteomyelitis and was diagnosed with locally recurrent SCC a few months after surgery