Johannes Kingma

Measurement of severity of sports injuries: an epidemiological study

Objective: To evaluate the severity of sports injuries in relation to the severity of injuries due to other causes and in relation to type of sport, using generally applied measures of injury severity. Subjects: A total of 12 403 patients, 4–50 years old, who were treated in the trauma department of the Groningen University Hospital for a sports injury, from January 1990 until January 1997. Method: All patients treated because of an injury entered the study. A distinction was made between injuries caused by playing sports, home and leisure accidents, traffic accidents and violence. The severity of the injuries was assessed by using the criteria of rate of admission, Injury Severity Scale (ISS). Finally the sports injuries were analysed with regard to type of sport. Results: In total, 57 760 injuries were registered. After injuries due to home and leisure accidents (44%; 25 228) sports injuries (21%; 12 403) were the most frequent cause of injury. Of the patients with a sports injury, 7.9% (980) were admitted, which is more than with home and leisure accidents (6.7%; 1690) but less than with traffic accidents (21.5%; 2202) and violence (9.3%; 364). In a majority of cases, admission was related to a limited number of types of sport. The mean ISS of sports injuries was low, as with injuries following home and leisure accidents and violence. The percentage of sports injuries with an ISS higher than or equal to 16 and the percentage mortality were both low in comparison to injuries due to violence or traffic accidents. Conclusions: Sports injuries rank second highest in terms of cause of injury, after home and leisure accidents; and rank third in terms of severity, after traffic accidents and violence. Even though the ISS is low, sports injuries may have serious consequences.

The Construction of a Developmental Scale for Seriation

In this study the relationship between seriation tasks and number line comprehension tasks are reported. Subjects were 595 children from kindergarten and primary school grades 1 and 2. Three types of tasks were administered: six seriation tasks derived from Piagets publications, six seriation tasks provided with irrelevant cues and number line comprehension tasks. With the use of the stochastic Mokken scale analysis, it was shown that a selection of six of the 12 original seriation tasks appeared to form a strong Mokken scale, which was invariant for different samples at the same point in time of test administration. The reliability of the items of the found scale and the predictive value of these items for number line comprehension, were equal to the values found with the original 12 seriation tasks. A strong relationship of r = .80 was found between the items on the constructed scale and the number line comprehension tasks administered three months after the test administration of the seriation tasks.

Neck sprain after motor vehicle accidents in drivers and passengers

Abstract Neck sprain is a general term denoting a soft tissue injury of the neck, which seldom causes major disability but is considered a modern epidemic. The purpose of the present study was to determine the prevalence of sprain of the neck injury due to motor vehicle accidents (MVAs) in both drivers and passengers. In addition, the degree of seat belt wearing in both driver and passenger was analysed. A second aim was to identify groups at risk by analysing the age and gender distribution of patients with neck sprain. The results of this population-based study revealed a sharp increase in neck sprain from 1989 through 1995, whereas a more or less stable pattern was found for seat belt use. The sharp increase was found to be attributable to outpatients. Finally, we found a driver predominance as well as a female predominance; groups at risk were the 20- to 24-year-olds for drivers and 15- to 19-year-olds for passengers.

Applying the Quebec Task Force criteria as a frame of reference for studies of whiplash injuries

Research prior to 1995 showed a diversity of either inclusion or exclusion criteria (or both) for diagnosing whiplash injury. As a consequence, the Quebec Task Force (QTF) developed expert-based criteria, which may be considered as a the new gold standard. Here, we examined the inclusion criteria and exclusion criteria used in research populations from the major 82 research studies performed during the period 1980-1998, comparing their similarities and dissimilarities to the QTF standard. None of the articles satisfied the QTF definitions completely, either before or after their introduction in 1995. Nevertheless, the QTF still seems to have had some impact on either the published inclusion or exclusion criteria. We observed that both sets of criteria showed a qualitative shift following the QTF publication in 1995. For the inclusion criteria, we found both a statistically significant increase in use of the QTF definition (acceleration-deceleration mechanism, rear-end collision, motor vehicle collision or other mishaps) and in the criterion neck pain. We also observed some smaller changes in both inclusion and exclusion criteria but none of these was significant statistically.

Severity of injuries due to accidental fall across the life span : A retrospective hospital-based study

This retrospective study investigated injuries due to accidental fall across the life span for which 19,593 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1997. 64% of the accidental falls were found for those in the age range between 10 years and 59 years; however, the proportion of accidental falls with regard to other causes of injuries by age group were the highest in youngsters (infants up to 9 years old) and in elderly persons (over 60 years old), 43% or more of these patients having falls with injuries. The clinically treated patients had on the average a statistically greater Injury Severity Score (7.2) than the outpatients (2.4). The highest percentages of medically treated inpatients were the patients of 60 years and over. Their mean ISS score was about the same for elderly inpatients, but the percentage of clinical treatment increased with age as well as the mortality. 30% of the injuries were found in the lower extremities and 30% in the upper extremities. Bone fracture was statistically significantly the major (36%) injury followed by contusion (20%). 34% of the accidental falls occurred at home, and statistically significantly more females, 50 years of age and older, were injured than males.

Sports Members' Participation in Assessment of Incidence Rate of Injuries in Five Sports from Records of Hospital-Based Clinical Treatment

This study is about the incidence rate of sports injuries in five different types of sports, gymnastics, soccer, volleyball, hockey, and basketball, for which 5,154 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1994. Incidence rate had been computed by membership participation. Basketball had the highest incidence rate (231 injured persons per 10,000 participants), followed by hockey (158 injured persons per 10,000 participants). The highest mean Injury Severity Score, 2.39, was found for gymnastics which had the lowest incidence rate (7 injured persons per 10,000 participants). Gymnastics had the highest percentage (12%) clinically treated patients, whereas basketball had the smallest percentage (2%) of clinically treated patients. The most frequent type of injury was distorsion, except for hockey, in which contusion had the highest percentage of occurrence. For all five types of sports, the majority (about 90%) of the injuries were observed at either the lower or at the upper extremities.

Interrater reliability for the basic categories of the AO/ASIF's system as a frame of reference for classifying distal radial fractures

This study is about agreement on the assignment into the three basic classes or categories (A, B, C) of the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixations (AO/ASIF) classification system for distal radial fractures. A random sample of 124 distal radial fractures was classified by two experienced observers. Their agreement was calculated according to Cohens kappa statistic. To investigate the possible bases for disagreement, all conflicting X-ray assessments were discussed in a consensus meeting. It appeared that the kappa value was .65 (good agreement) before the meeting; kappa rose to .86 (excellent agreement) after the consensus meeting. It appeared that the undisplaced fractures were a major source of disagreement. Further, the presence of articular involvement was an important issue. It was frequently noted that one observer classified the fracture as extraarticular (basic Class A), while the other observer chose classification as an intra-articular fracture (basic Class C) or vice versa. This phenomenon has been called the A/C reversal shift. It is concluded that radiological innovations might enhance agreement on articular involvement, and a separate category for undisplaced fractures should be defined in the Arbeitsgemeinschaft für Osteosynthesefragen (AO) system. However, agreement on relevant distinctive features and discussion of conflicting assessments may also be important in achieving excellent agreement.

A Comparison of Four Methods of Scaling for the Acquisition of Early Number Concept.

Four different methods of scaling for constructing a developmental scale of early number concept were compared: the Guttman scale analysis, the stochastic Mokken scale analysis, the ordering theoretic method, and the item tree analysis. Ss were 537 kindergarten and Grade 1 primary school children who were given three types of number comparison tasks, linear, linear-nonlinear, and nonlinear. The stochastic Mokken scale analysis was the most suitable one for constructing a developmental scale of these number comparison tasks. The final scale consisted of 12 equivalent number-comparison tasks, which together formed a strong Mokken scale. Implications for the development of early number concept are discussed.

Clinicians' recognition of 10 different types of distal radial fractures

This study concerned baseline performance in recognition of 10 different types of distal radial fractures. Verbal tasks of admitting knowing about fractures and Visual tasks were designed for each fracture type. The Verbal task of admitting knowing consisted of a description with the relevant distinctive features of the fracture. The surgical resident was asked whether he admitted knowing the particular fracture described. The Visual task consisted of X-rays for which the subject had to label the fracture or identify its distinctive features. The test was presented to 30 surgical trainees working in five teaching hospitals. On the Verbal task of admitting knowing, scores were statistically significantly higher (68% “yes”) than on the Visual task (33% correct). Responses met our criterion of 80% correct for the following fracture types: Colless, distal forearm, and Smiths fracture. For seven other fracture types (combination radius and scaphoid, radial styloid process, dorsal Bartons, volar Bartons, pilon, chauffeurs, and lunate load fracture), the 80% criterion was not met. Analysis of the incorrect answers on the Visual task indicated that the surgical residents tended to label unknown fracture types as Colless or Smiths fractures. Furthermore, the residents tended to overestimate their own diagnostic competence (overconfidence bias) for several fracture types. It was concluded that to improve diagnosis, the relevant distinctive features of distal radial fractures should be taught.

The aetiology and long-term effects of injuries due to bicycle accidents in persons aged fifty years and older

This retrospective study concerns the aetiology and psychological long-term effects of injuries due to bicycle accidents in 329 patients 50 years and older who attended the Emergency Unit of the University Hospital at Groningen during the period 1990 through 1992. Long-term effects were assessed three years after hospital discharge. The one-sided bicycle accident (with no other traffic involved) was the major (63.2%) cause, mostly due to loss of balance or to a foot slipping from the pedal. The main category of the second major cause was collision with other traffic. Of the bicycle accidents 66% occurred within 15 minutes after departure; 80% of the accidents happened in good weather conditions and daylight, and 7.6% of the patients had taken tranquilizers before biking. The majority of the injuries were observed at the upper extremities (28.8%) and head or face (25.8%). The percentage of clinically treated patients increased across ages from 25% in the 50- to 54-yr.-old category to 45% in the category 75-yr. and older. Three years after the incident, long-term psychological effects were still observed in 29% of the patients.