- For a description of catastrophic injuries not applicable to the central nervous system, see Major trauma .
A catastrophic injury is a severe injury to the spinal cord, spinal cord, or brain, and may also include a skull or vertebral fracture. This is part of the definition for the legal term catastrophic injury, which is based on the definition used by the American Medical Association.
The National Center for Catastrophic Sports Injury Research in the United States classifies catastrophic injuries based on three outcomes related to them: death, which causes permanent severe functional disability, and which causes severe head or neck trauma without permanent disability. Fatal injury may be a direct result of the trauma suffered during an activity, or it may occur indirectly. Nonfatal nonfatal injuries can not occur indirectly as a result of systemic failure from mobilization during activity, such as from cardiovascular conditions, heat illness, activity hyponatremia, or dehydration, or complications of nonfatal injury. Indirect death is usually caused by cardiovascular conditions, such as hypertrophic cardiomyopathy and coronary artery disease.
Fatal injuries may reveal "unknown anatomical or physiological abnormalities". Individuals with certain anatomic anomalies should not participate in some activities. For example, contact sports are contraindicated for individuals with an odontoid anomaly process, because any violent impact can result in catastrophic injury. This is because the wrong odontoid process can cause instability between the atlas and the axis (cervical vertebrae C1 and C2). Those with atlanto-occipital fusion should also avoid contact sports.
Video Catastrophic injury
With activity
Participation in sporting or recreational activities can cause severe sports injuries, especially if not supervised or if involved with little or no protection. Direct deaths in sports are rare, as most sports deaths are indirect and are associated with non-exercise cardiovascular problems.
In the United States, American football has the largest incidence of catastrophic injuries per population, whereas cheerleading is associated with the greatest incidence of direct injury disasters at both interscholastic and inter-level levels.
Cervical spine trauma is most common in sports and activities involving contact and impact, especially American football, rugby, ice hockey, gymnastics, skiing, wrestling and diving. The 2005 report by the National Center for Catastrophic Sports Injury Research in the United States states that sports that need attention to potential injury disasters are American football, ice hockey, baseball, wrestling, gymnastics, and track and field.
The incidence of catastrophic injuries is four times higher in college than in secondary schools in the United States. Sport accounts for between 5% and 10% of all spinal cord and spinal cord injuries in the United States, and 15% in Australia. The incidence of catastrophic injuries for all sports is low, less than 0.5 per 100,000 participants.
A study in the Canadian province of Ontario based on epidemiological data from 1986, 1989, 1992, and 1995 states that the greatest incidence of catastrophic injuries occurred in snowmobiling, cycling, ice hockey, and skiing. Of the 2,154 reported injuries, 1,756 were sustained by men and 368 by women. The only activity in the study where female casualties outnumbered males was riding. The study also states that field and floor sports have a relatively low incidence of catastrophic injuries, and that July has the highest incidence of injuries. Drowning was the cause of 357 deaths, and there were 640 head and 433 spinal cord injuries.
The study found 79.2% of injuries could be prevented; from over 1,500 responses, 346 involving alcohol consumption, and 1,236 were not supervised. Most of the alcohol related injuries suffered in snowmobiling (124), fishing 41, dive (40), boating excluding canoes (31), swimming (31), driving all-terrain vehicles (24), and cycling (23). Other studies have concluded that alcohol consumption is a common risk factor "associated with all types of exposure" (ie, activity) for traumatic brain injury.
Classification of sports by contact
The American Academy of Pediatrics has classified sports based on possible collisions and contacts. It recommends against participation in boxing.
Classified as contacts and collisions including basketball, boxing, diving, field hockey, soccer, ice hockey, lacrosse, martial arts, rodeo, rugby, ski jumps, soccer, handball team, water polo, and wrestling.
Classified as limited contact include baseball, cycling, cheerleading, canoeing and kayaking, fencing, floor hockey, soccer flags, gymnastics, handball, horse riding, badminton, skating (ice skating, inline skating , roller skating), skiing (cross-country skiing, downhill skiing, water skiing), skateboarding, snowboarding, softball, squash, ultimate frisbee, volleyball, and windsurfing or surfing, and high jumps and field trips and pole vaults.
Sports is classified as non-contact including darts, badminton, body building, bowling, cold water canoeing and kayaking, curling, dancing, golf, orienteering, power lifts, running races, riflery, jumping rope, paddling, running, sailing, scuba diving, swimming, table tennis, tennis, weightlifting and weight training, trails and disc field events, spears, and shot puts and all track events.
American Football
From 1945 to 2005, there were 497 fatalities, of which 69% were the result of brain injury and 16% of spinal cord injuries. Currently, the most common catastrophic injury in American football is a cervical spinal cord injury, which is also a "leading cause of the second death caused by soccer". An 84% reduction in head injury and a 74% reduction in casualties were directly attributable to the adoption of NOCSAE standards for football helmets and regulatory changes to tackle.
Football has the highest incidence of cervical spinal cord injury in the United States per population. From 1977 to 2001, the incidence of cervical spine injuries among high school, college and professional participants was 0.52, 1.55, and 14 per 100,000, respectively.
From 1982 to 1988, 75% of direct deaths and 40% of indirect victims in college sports were associated with football; for high school athletes, the rates are 75% and 33% respectively. Indirect death is usually caused by heart failure or heat exhaustion. Indirect deaths in high school and college football have been linked to heat stroke, heart-related conditions, viral meningitis, and even lightning strikes.
The most common mechanism for catastrophic cervical spinal cord injury in American football is axial loading or resultant compression of tackling spears, where players use a helmet crown as the starting point of contact to attack other players. This form of handling was banned in 1976 for high school and college football, resulting in significant reductions in this type of catastrophic injury. For example, the incidence of quadriplegia decreased from 2.24 and 10.66 per 100,000 participants in secondary schools and colleges in 1976, to 1.30 and 2.66 per 100,000 participants in 1977. Since 1977, about 67% of all Catastrophic injuries in football are the result of players making tackles.
In a paper Catastrophic Football Injury: 1977-1998 published in 2000 by the journal Neurosurgery , Robert Cantu and Frederick Mueller recommend that "players should use shoulders to block and tackling "instead of" using the head as a breaker ". The objective of the rule against spears, plowing, and inhabiting is to protect the culprits and the opponents from head trauma or catastrophic injuries. Mueller also pointed out that coaches remove players from the game if they show symptoms of concussion, such as dizziness, headache, nausea, or sensitivity to light.
Baseball
Baseball has a high incidence of catastrophic injuries, the most common being a skull injury usually occurs during a collision between the first baseline diving head and a fielder, resulting in axial compression injuries to the baseline. Other causes include collisions, such as between catcher and basperner, or being hit by a ball thrown or thrown.
Canoe
In the Ontario study, all recorded disaster injuries for recreational canoe were fatal, and accounted for 4.3% of all sport and recreational deaths in the province. Of the 27 cases, 24 deaths from drowning, and others from cerebral contusions, brain lacerations, and skull fractures. Kano drowning death "is often correlated with alcohol consumption", as it increases the chances of drowning and reduces the likelihood of recovery from immersion. They are often associated with young men who are not experienced in canoeing.
Cheerleading
The main cause of increased incidence of catastrophic injury to cheerleaders is "the evolution of cheerleading into activity like gymnastics". This is a major cause of catastrophic injury for women, representing over 65% of catastrophic injuries occurring in high school and female college athletes in the United States.
High-risk activities include the construction of a pyramid, which produces several catastrophic injuries each year, 'cart bumps', and tumbling, all of which are usually performed on a hard surface. The Cheerleader Pyramid is banned in Minnesota and North Dakota.
Other causes include inadequate supervision, poorly trained trainers, and equipment used.
Fishing
In a study in Ontario, fishing resulted in 126 catastrophic accidents, of which 117 were fatal, 110 from drowning. Of these, 119 events were attributed to men, of which 112 were fatalities. Fisheries have the highest catastrophic injury rate for all injuries for every activity in Ontario, as 2.54% of all fishing injuries are disastrous.
Severe injuries in fishing may be related to equipment, fish, alcohol, or the environment. Equipment problems generally involve a penetrating injury from the use of hooks and spears, but may also be caused by fishing rods, baits, weights, or baits. Fish-related injuries result from errors in handling, poisoning, and contamination from consumption. Environmental causes may include excessive exposure to solar radiation, lightning strikes, hypothermia during ice fishing, snake bites, and viral infections that are spread by mosquitoes.
Gymnastics
Gymnastics has a relatively low incidence of catastrophic injury, the number of catastrophic injuries associated with the number of participants. In the United States from 1982 to 2007, nineteen severe injuries were reported from 147 million high schools and 8 million college participants.
Official club-level injury surveillance data in Australia showed no severe injury to elite participants from 1983 to 1993. Elite athletic malignant injuries to the spinal cord have been recorded in China, Japan and the United States, most notably Sang Lan and Julissa Gomez. There is "no data rate of research reporting" for catastrophic injuries for club-level gymnasts in the United States.
Ice Hockey
The most common catastrophic injury that occurs in ice hockey is cervical spinal cord injury, which is most common in C5, C6, or C7. The most common cause is checking from behind. Such an examination was banned from hockey in 1985, which has resulted in a decrease in the incidence of spinal cord injuries and reduction of head and neck injuries.
The increase in standards for hockey helmets and the requirement that they be charged in competitive play has resulted in a serious reduction in head injury and death. Although full face protection (helmets with cages) does not reduce the incidence of injuries or concussions compared to standard helmets, it reduces the incidence of facial injuries and lacerations.
Porting
Porters carrying loads in their heads are subjected to axial strains that aggravate degenerative changes in the cervical spine, and have an etiological role in spondylosis.
In a 1968 study, Laurence Levy recorded six serious injuries suffered by porters at Harare Central Hospital in Harare, Zimbabwe. Of these, one dies instantaneously, and five becomes quadriplegic, one as a result of the herniated intervertebral disk and four of the fracture or fracture dislocations.
Rugby
For the rugby union, the incidence of catastrophic injuries from 1952 to 2005 in the UK was 0.84 per 100,000 per year. In all other countries, from 1970 to 2007 the incidence was 4.6 per 100,000 per year. For rugby league, it's 2 per 100,000 per year. In the rugby union in France, the incidence of catastrophic cervical spine injuries decreased from 2.1 per 100,000 in the 1996-1997 season to 1.4 per 100,000 in the 2005-2006 season, which has been linked to changes in the rules on scrum.
The most common causes are scrum, ruck or maul, and tackle. Research from Australia states that prevention of injury to young rugby should focus on scrum and tackle, and that risk factors are game level (age group) and player position. It also shows that "neck injuries in the scrum and to the front row are big problems".
The use of scrum cap or other padded head pads does not reduce the incidence of concussion or head or neck trauma.
Skiing and snowboarding
In a survey of scientific literature from 1990 to 2004, 24 studies covering 10 countries show an increased incidence of traumatic brain injury (TBI) and spinal cord injuries among alpine skiers and snowboarders. The most common cause of death is head injury, which can be reduced by 22-60% by helmet use. Incidence increased coincidentally "with the development and acceptance of acrobatic and high-speed activities".
Most deaths are caused by massive head, neck or thoracoabdominal injuries, of which TBI counts between 50% and 88% and spinal cord injuries between 1% and 13%. Ski deaths occur between 0.050 and 0.196 per 100,000 participants. Head injury represents 28.0% of all injuries to skiers and 33.5% for skiers.
Snowmobiling
In the Ontario study, snowmobiling had the highest incidence and prevalence of recreational catastrophic injury from any activity (290 incidents, 120 fatalities). It had the second highest incidence of catastrophic injuries per participant (88.2 per 100,000), the largest incidence per 100,000 population (0.706), and the largest incidence of death per 100,000 population (0.292). It is also an activity in which alcohol consumption is most prevalent in catastrophic events (124), representing more than one third of all events in which alcohol is a factor. Other contributing factors include "poor lighting, young age and unsuitable terrain".
Track and put
The majority of fatalities related to track and field in the United States are associated with pole vaulting. Deaths and other catastrophic injuries on track and field occur by participants or spectators being beaten by discs, shot puts, or javelin throws.
Water sports
Most of the injuries associated with diving and swimming in the United States occur when someone dives into shallow water. This is the cause of 2.6% of all cervical spine injury receipts, and is mainly sustained by recreational divers. The most common causes are diving into shallow water, lack of experience, inadequate supervision, and alcohol consumption.
Catastrophic swimming injuries in the Ontario study are four times more common in men than women. The incidence of catastrophic injuries in competitive swimming is very low, and almost all injuries occur in recreational and non-competitive swimming.
Wrestling
From 1981 to 1999 in the United States, 35 catastrophic injuries related to wrestling were reported, one at college and the other in high school, incidence 1 per 100,000 per year. They are caused by three positions: defensive position during takedown (74%), down position (23%), and lying position (3%). Most occur in lower weight classes, and 80% occur during matches. In Iran from 1998 to 2005, the incidence of catastrophic injuries was 1.99 per 100,000 participants per year.
Most of the injuries are cervical fractures or major cervical ligament injuries. One athlete died, one third became tetraplegic, one paralyzed, and six others suffered from residual neurological deficits.
Catastrophic wrestling injuries can be prevented, and associated risk factors include mismanagement, lack of supervision by trainers, and inappropriate injury management.
Other activities
In the UK, the incidence of annual catastrophic injuries for employment-related situations is 0.9 per 100,000. The incidence is highest in agriculture (6.0 per 100,000) and construction (6.0 per 100,000), and the lowest in the service sector (0.4).
This incident is 3.7 per 100,000 for pedestrians, 2.9 per 100,000 for car dwellers, and 190 per 100,000 for motorcyclists.
Vehicle accidents accounted for 43% of catastrophic spinal cord injuries in the United States and 45% in Australia.
In the Ontario study, the most common recreational disaster injuries in snowmobile (290 incidents, 120 casualties), cycling (289 incidents, 67 casualties), fishing (126 incidents, 117 casualties), boating (excluding canoes, 112 incidents , 72 casualties), diving (105 incidents, 5 casualties) and swimming (100 incidents, 86 casualties). The largest incidents per participant were recorded for diving (511.0 per 100,000), snowmobiling (88.2 per 100,000), parachuting (62.9 per 100,000), tobogganing or sled (37.7 per 100,000), gantole (29, 4 per 100,000), water polo (24.5 per 100,000), scuba diving (12.2 per 100,000), hunting (12.2 per 100,000), horseback riding (11.6 per 100,000), archery (11.1 per 100,000), and fishing (11.0 per 100,000). The largest incidents per 100,000 population were recorded for snowmobiling (0.706), cycling (0.701), ice hockey (0.462), fishing (0.307), boating excluding canoes (0.273), diving (0.256), swimming (0.243) and baseball (0.217). The largest incidence of fatalities per 100,000 population was recorded for snowmobiling (0.292), fishing (0.285), swimming (0,200), boating excluding canoes (0.175), cycling (0.163), canoeing (0.066), driving all terrain (0.039) (0.037), and horse riding (0,024). Catastrophic cycling injuries are most prevalent in cities, especially Toronto (64), Ottawa (21), and London (7). Sink represents more than half the casualty of sport and recreation in the Ontario study.
In the United States, the Consumer Product Safety Commission (CPSC) recorded nearly 1,000 fatalities between 1967 and 1987 as a result of driving all-terrain vehicles, more than half of whom were younger than 16. This led to the filing of an Act of Consumer Product Safety Act in 1987, which effectively ended the sale of three-wheeled ATVs. Since then, 35% of deaths are individuals less than 16 years of age. The American Academy of Pediatrics and the CPSC recommend that individuals younger than 16 should not ride ATVs.
Maps Catastrophic injury
Effects and management
The types of acute catastrophic spinal injuries are associated with unstable fractures and dislocations, intervertebral herniation, and transient quadriplegia. It most often affects the cervical spine, but also affects the thoracolumbar spine (thoracic and lumbar vertebrae) and the physical, or causing cord neuroprachia and occasionally spinal injuries without radiographic abnormalities (SCIWORA).
Response to non-fatal catastrophic spinal cord injury by patients varies according to "social, economic, and educational background".
The most common initial response is depression. About 6% of patients with spinal injuries commit suicide, usually in the immediate years after injury. With ten years after the injury, suicide rates are similar to the general population.
Many patients recover only part of their injuries, and must cope with paralysis or mental deficiency, usually requiring lifelong medical care.
About 90% of patients who are single when injured are single five years after the injury. There was a high incidence of divorce and separation after the injury, although this decreased after the first year after the injury.
Many patients with catastrophic spinal cord injury improve their education. Immediately after the injury, the average level of education falls below the general population; fifteen years after the injury, it is above the general population.
The victims of catastrophic injuries may also have terrible facial injuries, such as fractured facial bones, especially those originating from events related to ice hockey, cycling, and snowmobiles.
Medical issues
Many secondary medical problems are associated with catastrophic spinal cord injury. These include cardiovascular complications, such as deep vein thrombosis, pulmonary embolism, orthostatic hypotension, bradycardia, autonomic dysfunction, thermoregulation changes, and altered cardiac function as a result of injury to the sympathetic nervous system.
Other problems may include lung and gastrointestinal problems, heterotopic osification, osteoporosis, and other pathological fractures. Pneumonia is a common cause of death among patients with spinal cord injury.
A skull fracture occurs when the bone in the skull breaks out, and can penetrate the brain, tearing arteries, veins, or meninges, which cause functional impairment, communication, thinking, or feeling. Brain laseration (rupture of brain tissue) or cerebral contusions (bruised brain tissue) usually damages the cerebral cortex, resulting in permanent neurologic deficits.
Life care package
A life care plan is set for the patient to meet the patient's needs. This is an individual document that describes additional services, support, equipment, and additional requirements for patients to reflect changes in the patient's condition. It usually contains target results, dates, and timelines.
Components of a life-care plan may include:
- architectural renovations to patient homes, including bathtubs, toilets, and driveways and exits
- transport, like adaptive van
- auxiliary technology and adaptive tools, including wheelchair
- letter management
- care and nursing supervision
- drugs, medical supplies (such as catheters), and medical equipment
- care and facilities services
- home care and services
This is in addition to information on surgical and treatment interventions, diagnostic tests, therapeutic interventions (speech therapy, rehabilitation, etc.), Counseling, and handling complications. This may also include educational and vocational services.
In the United States, 2.55% of hospitalized catastrophic injury patients enroll in Medicaid to cover their medical bills. In Disaster Injuries in Sport and Recreation: Causes and Prevention: A Canadian Study, Charles Tator stated that the average case of non-fatal catastrophic injury costs around $ 7.5 million (Canadian dollars, normalized to 2006) lost income, lifetime care, and rehabilitation services, and Ontario's economic costs of approximately $ 2,125 billion per year.
Prevention
One of the paradigms used in injury prevention is the Haddon Matrix developed by William Haddon Jr. from the National Highway Safety Bureau in the late 1960s. The matrix is ​​designed to categorize road safety phenomena, and apply public health models to traffic-related epidemiology. It consists of ten strategies implemented based on temporality, namely pre-event strategy (primary prevention), event strategy (secondary prevention), and post-event strategy (tertiary prevention). The purpose of injury prevention is to reduce "injury burden on individuals and communities", which includes mortality, morbidity, disability, and economic costs.
Ten strategies are:
- pre-event strategy
- prevent danger creation
- reduce the number of hazards
- prevent hazard release
- change the rate or distribution of hazard release
- event strategy
- separates potential victims from harm, in time or space
- separate potential victims from harm by barrier
- change the danger
- increases individual resistance to hazards
- post-event strategy
- counters inflict damage
- stabilize, treat, and rehabilitate injured individuals
In Disaster Head Injury at College Collegiate Sport, Frederick Mueller states that the frequency of catastrophic injuries can be reduced by:
- requires all participants to submit their medical history and have a mandatory pre-participation exam
- requires all schools, colleges and universities to have certified athletic trainers in the faculty
- game enforcement by officials and trainers, and player education on head contact
- remove players showing symptoms of a concussion or head trauma from the game
- educate players, parents, trainers about head injury symptoms and the danger of recurrent injuries
- the athletic trainer should be prepared to respond to catastrophic injury events
Preparation for a catastrophic injury event includes a written emergency plan, which should include evacuation, transport and communications plans, and notify the hospital's emergency department about matches and training schedules for teams and clubs. Response to a catastrophic injury event should reduce its severity, such as through first aid administration. In Disaster Injuries in Sport and Recreation: Causes and Prevention: A Canadian Study , Charles Tator states that an effective injury prevention program involves education, engineering, and enforcement. Education is intended to inform participants of the potential hazards of risk behavior in the activity, and the "involved engineering modifies the environment to create a safer environment", such as maintaining a playing field or improving equipment design.
Response
Sports, league, and association organizations have integrated disaster injury plans as part of their emergency action and emergency management plans, and have also changed the rules to prevent or reduce the incidence of catastrophic injuries. The plan includes a notification system, which can be used to contact families of injured athletes, athletic coordinators, officials, law offices and risk management, and institutional insurance operators. This may also include the formation of disaster-stricken teams, which may include athletic directors, athlete head trainers, team doctors, legal counsel, and media relations.
In 1985, the National Athletic Athletic Association created an insurance plan for member institutions to benefit college athletes who suffered catastrophic injuries, in response to increased student compensation claims filed by students. It is designed to protect member institutions "against the sudden and substantial costs of injury benefits", usually obtained by students through workers' compensation claims and litigation. The injured students receive immediate benefits and are not litigated, but retain the right to litigation in cases of negligence by the institution. In 2005, 25% of funds for payment of insurance claims were associated with cheerleading.
The National Federation of High School Associations implements a medical plan for their high school athletic associations and member and district schools. This allows a disastrous student athlete to receive "medical benefits, rehabilitation, and loss of work" to death regardless of the right to litigation. The institute does not need to invest the human and financial resources associated with litigation, in addition to the potential award to the plaintiff, and the students receive immediate and lifetime benefits.
Athletic associations, organizations and leagues are updating their rules based on research on massive injuries. The number of enforcement rules can explain the variation in the incidence of catastrophic injuries between jurisdictions.
Litigation
In Canada, in May 2012, the biggest award for catastrophic brain injury plaintiff was $ 18.4 million, and the greatest award for catastrophic spinal injury plaintiff was $ 12.33 million.
In South Africa, the largest malpractice settlement for the Medical Protection Society in 2011 was R17 million, administered to patients suffering catastrophic neurologic damage as a result of surgical procedures.
Note
References
Source of the article : Wikipedia
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