Cervical Spine Motion During Extrication: A Pilot Study

Spinal immobilization is one of the most commonly performed pre-hospital procedures. Little research has been done on the movement of the neck during immobilization and extrication. In this study we used a sophisticated infrared six-camera motion-capture system (Motion Analysis Corporation, Santa Rosa, CA), to study the motion of the neck and head during extrication. A mock automobile was constructed to scale, and volunteer patients, with infrared markers on bony prominences, were extricated by experienced paramedics. We found in this pilot study that allowing an individual to exit the car under his own volition with cervical collar in place may result in the least amount of motion of the cervical spine. Further research should be conducted to verify these findings. In addition, this system could be utilized to study a variety of methods of extrication from automobile accidents

Identification of hematomas in mild traumatic brain injury using an index of quantitative brain electrical activity

Rapid identification of traumatic intracranial hematomas following closed head injury represents a significant health care need because of the potentially life-threatening risk they present. This study demonstrates the clinical utility of an index of brain electrical activity used to identify intracranial hematomas in traumatic brain injury (TBI) presenting to the emergency department (ED). Brain electrical activity was recorded from a limited montage located on the forehead of 394 closed head injured patients who were referred for CT scans as part of their standard ED assessment. A total of 116 of these patients were found to be CT positive (CT+), of which 46 patients with traumatic intracranial hematomas (CT+) were identified for study. A total of 278 patients were found to be CT negative (CT−) and were used as controls. CT scans were subjected to quanitative measurements of volume of blood and distance of bleed from recording electrodes by blinded independent experts, implementing a validated method for hematoma measurement. Using an algorithm based on brain electrical activity developed on a large independent cohort of TBI patients and controls (TBI-Index), patients were classified as either positive or negative for structural brain injury. Sensitivity to hematomas was found to be 95.7% (95% CI=85.2, 99.5), specificity was 43.9% (95% CI=38.0, 49.9). There was no significant relationship between the TBI-Index and distance of the bleed from recording sites (F=0.044, p=0.833), or volume of blood measured F=0.179, p=0.674). Results of this study are a validation and extension of previously published retrospective findings in an independent population, and provide evidence that a TBI-Index for structural brain injury is a highly sensitive measure for the detection of potentially life-threatening traumatic intracranial hematomas, and could contribute to the rapid, quantitative evaluation and treatment of such patients

Incidence of emergency department visits for electric rental scooters using detailed ridership data

INTRODUCTION: Electric scooter (e-scooter) rental usage has increased exponentially around the country, expanding to more than 120 cities by the end of 2018. Early attempts to capture the safety effects of widespread adoption of this technology have been hampered by lack of accurate ridership data. Here we describe a 17-month evolution of ridership characteristics in St. Louis, Missouri, and the frequency of e-scooter rental-related injuries serious enough to require an emergency department (ED) visit over this time frame; we also provide estimates of incidence rates of injuries based on company ridership data. METHODS: We performed a combination retrospective chart review and prospective questionnaire-based analysis of adult e-scooter rental-related ED visits in both downtown St. Louis Level 1 trauma centers during the first 17 months of e-scooter rental usage (August 2018-December 2019). The retrospective portion focused on demographics, alcohol use, helmet use, disposition, operative repair, and temporal and severity markers. The prospective portion focused on more detailed crash and rider data. Finally, we used ridership data from both e-scooter rental companies in St. Louis to estimate incidence and temporal trends. RESULTS: A total of 221 patients had e-scooter rental-related ED visits. The median age of our population was 31 years with 58.8% male and 53.8% White. There were no deaths. Ninety-two patients were found to have fractures with 38% requiring surgery. Of the 21 patients diagnosed with head injury, five had an intracranial bleed. Overall incidence of ED visits related to e-scooters was 2.1 per 10,000 trips and 2.2 per 10,000 miles with the number of ED visits by month closely correlated with the number of rides per month (Pearson correlation coefficient = 0.95). CONCLUSION: The number of e-scooter rental-related injuries seen in St. Louis trauma centers was relatively low and correlated closely with overall number of rides. The number of injuries decreased and were less severe from 2018 to 2019 with infrequent intracranial injuries and a large percentage of fractures requiring operative repair

Cervical Spine Motion During Extrication: A Pilot Study

Spinal immobilization is one of the most commonly performed pre-hospital procedures. Little research has been done on the movement of the neck during immobilization and extrication. In this study we used a sophisticated infrared six-camera motion-capture system (Motion Analysis Corporation, Santa Rosa, CA), to study the motion of the neck and head during extrication. A mock automobile was constructed to scale, and volunteer patients, with infrared markers on bony prominences, were extricated by experienced paramedics. We found in this pilot study that allowing an individual to exit the car under his own volition with cervical collar in place may result in the least amount of motion of the cervical spine. Further research should be conducted to verify these findings. In addition, this system could be utilized to study a variety of methods of extrication from automobile accidents. [WestJEM. 2009;10:74-78.

Cervical Spine Motion During Extrication: A Pilot Study

Spinal immobilization is one of the most commonly performed pre-hospital procedures. Little research has been done on the movement of the neck during immobilization and extrication. In this study we used a sophisticated infrared six-camera motion-capture system (Motion Analysis Corporation, Santa Rosa, CA), to study the motion of the neck and head during extrication. A mock automobile was constructed to scale, and volunteer patients, with infrared markers on bony prominences, were extricated by experienced paramedics. We found in this pilot study that allowing an individual to exit the car under his own volition with cervical collar in place may result in the least amount of motion of the cervical spine. Further research should be conducted to verify these findings. In addition, this system could be utilized to study a variety of methods of extrication from automobile accidents. [WestJEM. 2009;10:74-78.