L. W. Rue

Cecal ligation and puncture.

The model of cecal ligation and puncture (CLP) in rodents has been used extensively to investigate the clinical settings of sepsis and septic shock. This model produces a hyperdynamic, hypermetabolic state that can lead to a hypodynamic, hypometabolic stage, and eventual death. Blood cultures are positive for enteric organisms very early after CLP. The model has been widely used over the past 26 years and is highly versatile in adapting to a range of severity and testing objectives. It is inexpensive to prepare and technically straightforward. Aspects of sepsis research investigated using CLP include energetics, metabolism, resuscitation, antibiotic therapy, microbial factors, cardiovascular responses, immune function, mediator release, and cytokine expression patterns. The challenge of the small circulating blood volume in rodents can be overcome by using micromethods that enable analysis of small volumes, or alternatively, by using a large number of animals to obtain serial samples.

Gender differences in acute response to trauma-hemorrhage.

To understand the pathogenesis of a disease, experimental models are needed. A good experimental model is the one that simulates responses observed in the clinical setting. In recent years, clinical studies have indicated that gender might be a factor that plays a significant role in the outcome of patients with shock, trauma, and sepsis. These observations are now being evaluated in experimental setting. Studies performed in a rodent model of trauma-hemorrhage have concluded that alterations in immune and cardiac functions after trauma-hemorrhage are more markedly depressed in adult males, and ovariectomized and aged females. However, both are maintained in castrated males and in proestrus females. Moreover, the survival rate of proestrus females subjected to sepsis after trauma-hemorrhage is significantly higher than age-matched males or ovariectomized females. Although these observations suggest gender-specific response after trauma-hemorrhage, the mechanisms responsible for gender specificity remain largely unknown. Furthermore, in other injuries such as burn, experimental studies dealing with sexual dimorphism are limited. Therefore, more studies in clinical and experimental settings are required to determine whether gender-specific responses are global across the injuries or are observed in specific injury situations. Studies are also needed to delineate underlying mechanisms responsible for differences between males and females after trauma-hemorrhage. The information gained from the experimental studies will help in designing innovative therapeutic approaches for the treatment of trauma patients.

Reduction of vancomycin-resistant enterococcal infections by limitation of broad-spectrum cephalosporin use in a trauma and burn intensive care unit

Both vancomycin and third-generation cephalosporin use are believed to contribute to a rise in vancomycin-resistant enterococci (VRE) infections. In 1998, the largest number of VRE infections in our hospital occurred in the trauma/burn intensive care unit (TBICU), accounting for nearly 20% of hospital infections. In an attempt to control the VRE infection rate, antibiotic protocols for prophylaxis, empiric, and definitive therapy were initiated during the final quarter of 1998 to minimize cephalosporin use by the introduction of piperacillin/tazobactam. Therefore, we undertook a study of the VRE infection rate for the TBICU in relation to vancomycin, piperacillin/tazobactam, piperacillin, third-generation cephalosporin, and total cephalosporin use before and after efforts to limit cephalosporins. These data were compared to those in the medical and surgical intensive care units. During 1998, seven VRE infections occurred in the TBICU. Following initiation of antibiotic protocols, one case of VRE infection occurred in the subsequent month and no cases in the 17 months since. The decrease in the VRE infection rate corresponded with a significant increase in the use of piperacillin/tazobactam and a reduction in third-generation and total cephalosporin use. In contrast, cephalosporin use in the medical and surgical intensive care units remains significantly higher than in the TBICU, and neither unit has had a reduction in their VRE infection rates.

Long-term trends in mortality according to age among adult burn patients.

The purpose of this study was to evaluate differences in mortality among adult burn patients over a 25-year period according to age. All patients admitted to a regional burn center between 1973 and 1997 were divided into three age groups (18-34, 35-54, and 55 and older), and mortality rates were compared over time. Between 1973 and 1997, the proportion of patients in each age group remained consistent, as did the type of burns. The average total body surface area burned declined steadily from 31.6% in the 1970s to 18.2% in the late 1990s. The absolute change in mortality was small (7.7%), moderate (16.3%), and large (30.2%) in the young, middle-aged, and old, respectively. However, the relative change demonstrated the opposite pattern. The results of this study suggest that declines in mortality among adult burn patients have occurred across the age spectrum over the past 25 years.

Fatal occupational electrocutions in the United States.

Introduction: The highest proportions of fatal occupational electrocutions have occurred among those employed in the electrical trades and in the construction and manufacturing industries. Methods: Data from 1992 through 1999 were obtained from the Bureau of Labor Statistics Census of Fatal Occupational Injuries. Results: Occupational electrocution deaths occurred almost entirely among males, with the highest rates among those aged 20–34 and among whites and American Indians. They were highest during the summer months, in the South, and in establishments employing 10 or fewer workers. The highest rates occurred in the construction, mining, and agriculture, forestry, and fishing industries and among trades associated with these industries. Conclusions: Electrocution continues to be a significant cause of occupational death. Workers need to be provided with safety training and employers, particularly smaller employers, persuaded of the need for safety training.

Risk of injury for occupants of motor vehicle collisions from unbelted occupants

Objective: Unbelted occupants may increase the risk of injury for other occupants in a motor vehicle collision (MVC). This study evaluated the association between occupant restraint use and the risk of injury (including death) to other vehicle occupants. Design: A population based cohort study. Setting: United States. Subjects: MVC occupants (nu200a=u200a152 191 unweighted, nu200a=u200a18 426 684 weighted) seated between a belted or unbelted occupant and the line of the principal direction of force in frontal, lateral, and rear MVCs were sampled from the 1991–2002 National Automotive Sampling System General Estimates System. Offset MVCs were not included in the study. Main outcome measure: Risk ratios and 95% confidence intervals for injury (including death) for occupants seated contiguous to unbelted occupants compared to occupants seated contiguous to belted occupants. Risk ratios were adjusted for at risk occupant’s sex, age, seating position, vehicle type, collision type, travel speed, crash severity, and at risk occupants’ own seat belt use. Results: Exposure to unbelted occupants was associated with a 40% increased risk of any injury. Belted at risk occupants were at a 90% increased risk of injury but unbelted occupants were not at increased risk. Risks were similar for non-incapacitating and capacitating injuries. There was a 4.8-fold increased risk of death for exposed belted occupants but no increased risk of death for unbelted occupants. Conclusions: Belted occupants are at an increased risk of injury and death in the event of a MVC from unbelted occupants.

Motor vehicle crash-related mortality is associated with prehospital and hospital-based resource availability.

BACKGROUNDnTo date, attempts to assess the relationship between motor vehicle collision (MVC)-related mortality and medical resources availability have largely been unsuccessful.nnnMETHODSnInformation regarding sociodemographic characteristics, prehospital resources, and hospital-based resources for each county (n = 67) in the state of Alabama was obtained. MVC-related mortality rates (deaths per 1,000 collisions) by county were calculated and compared according to prehospital and hospital-based resource availability within each county after correcting for sociodemographic factors.nnnRESULTSnCounties with 24-hour availability of a general surgeon, orthopedic surgeon, neurosurgeon, computed tomographic scanner, and operating room were shown to have decreased MVC-related mortality (relative risk [RR], 0.88). The same was true for those counties with hospitals classified as Level I-II (RR, 0.71) and Level III-IV (RR, 0.83) trauma centers compared with counties with no trauma centers.nnnCONCLUSIONnAppropriate, readily available hospital-based resources are associated with lower MVC-related mortality rates. This information may be useful in trauma system planning and development.

Vehicle rollover risk and electronic stability control systems

Background: Electronic stability control (ESC) systems were developed to reduce motor vehicle collisions (MVCs) caused by loss of control. Introduced in Europe in 1995 and in the USA in 1996, ESC is designed to improve vehicle lateral stability by electronically detecting and automatically assisting drivers in unfavorable situations. Aim: To examine the relationship between vehicle rollover risk and presence of ESC using a large national database of MVCs. Methods: A retrospective cohort study for the period 1995 through 2006 was carried out using data obtained from the National Automotive Sampling System General Estimates System. All passenger cars and sport utility vehicles (SUVs)/vans of model year 1996 and later were eligible. Vehicle ESC (unavailable, optional, standard) was determined on the basis of make, model, and model year. Risk ratios (RRs) and 95% CIs were calculated to compare rollover risk by vehicle ESC group. Results: For all crashes, vehicles equipped with standard ESC had decreased risk of rollover (RRu200a=u200a0.62, 95% CI 0.50 to 0.77) compared with vehicles with ESC unavailable. The association was consistent for single-vehicle MVCs (RRu200a=u200a0.61, 95% CI 0.46 to 0.82); passenger cars had decreased rollover risk (RRu200a=u200a0.77, 95% CI 0.52 to 1.12), but SUVs/vans had a more dramatically decreased risk (RRu200a=u200a0.40, 95% CI 0.26 to 0.61). Conclusions: This study supports previous results showing ESC to be effective in reducing the risk of rollover. ESC is more effective in SUVs/vans for rollovers related to single-vehicle MVCs.

Recent trends in television tip over-related injuries among children aged 0–9 years

Objective: To describe recent trends in television tip over-related injuries among children aged 0–9 years, and to compare injury rates with sales of newer digital televisions. Methods: Digital television sales data were obtained from marketing data provided by the Television Bureau of Advertising. Data regarding television tip over-related injuries among children aged 0–9 years were obtained from the 1998–2007 National Electronic Injury Surveillance System. A Wald χ2 test, estimated from logistic analysis, was used to determine whether the distribution of injury types differed by age group. Pearson’s correlation was used to estimate the association between digital television sales and television tip over-related injuries. Results: An estimated 42u2009122 (95% CI 35u2009199 to 49u2009122) injuries from television tip-overs were treated in US emergency departments from 1998 to 2007. The injury rate was highest for children aged 1–4 years (18.6/100u2009000). A majority of injuries (63.9%) involved the head and neck for children under 1 year of age, while a higher proportion of injuries among children aged 1–4 involved the hip and lower extremity (42.9% and 31.0%, respectively), and shoulder and upper extremity (16.8%) for children aged 5–9. A strong, positive correlation was observed between television sales and annual injury rates (ru200a=u200a0.89, p<0.001). Conclusion: Estimates of injury rates were similar to previously reported estimates, particularly for the increased proportion of head and neck injuries among very young children. While digital television sales were strongly correlated with increased injury rates, the lack of information regarding the type of television involved prevents inference regarding causation.

Serious occupational burn injuries treated at a regional burn center

This article will present the epidemiology of occupational burn injuries among patients admitted to a regional burn center. Patients admitted to University of Alabama at Birmingham University Hospital Burn Center between November 1994 and December 1999 for occupational burn injuries were studied. Descriptive statistics were generated for demographic, clinical, and outcome characteristics. Approximately one-quarter of all burn center admissions had sustained occupational burn injuries. The most common burns were flame, electrical, and scald burns. The most heavily represented occupations were manufacturing (19.1%), electrician (16.2%), and laborer (16.2%). Burn type varied with occupation. Over