Comparing the surgical timelines of military and civilians traumatic lower limb amputations.
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ABSTRACT:
SUBMITTER: Staruch RM
PROVIDER: S-EPMC4773379 | biostudies-literature | 2016 Mar
REPOSITORIES: biostudies-literature
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Project description:Background: Traumatic upper extremity amputation in a child can be a life-altering injury, yet little is known about the epidemiology or health care costs of these injuries. In this study, using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), we assess these trends to learn about the risk factors and health care costs of these injuries. Methods: Using the HCUP KID from 1997 to 2012, patients aged 20 years old or younger with upper extremity traumatic amputations were identified. National estimates of incidence, demographics, costs, hospital factors, patient factors, and mechanisms of injury were assessed. Results: Between 1997 and 2012, 6130 cases of traumatic upper extremity amputation occurred in children. This resulted in a $166 million cost to the health care system. Males are 3.4 times more likely to be affected by amputation than females. The most common age group to suffer amputation is in older children, aged 15 to 19 years old. The frequency of amputation has declined 41% from 1997 to 2012. The overwhelming majority of amputations (92.54%) involved digits. Conclusions: Pediatric traumatic amputations of the upper extremity are a significant contribution to health care spending. Interventions and educational campaigns can be targeted based on national trends to prevent these costly injuries.
| S-EPMC6900692 | biostudies-literature
Project description:BackgroundAutomatically detecting falls with mobile phones provides an opportunity for rapid response to injuries and better knowledge of what precipitated the fall and its consequences. This is beneficial for populations that are prone to falling, such as people with lower limb amputations. Prior studies have focused on fall detection in able-bodied individuals using data from a laboratory setting. Such approaches may provide a limited ability to detect falls in amputees and in real-world scenarios.ObjectiveThe aim was to develop a classifier that uses data from able-bodied individuals to detect falls in individuals with a lower limb amputation, while they freely carry the mobile phone in different locations and during free-living.MethodsWe obtained 861 simulated indoor and outdoor falls from 10 young control (non-amputee) individuals and 6 individuals with a lower limb amputation. In addition, we recorded a broad database of activities of daily living, including data from three participants' free-living routines. Sensor readings (accelerometer and gyroscope) from a mobile phone were recorded as participants freely carried it in three common locations-on the waist, in a pocket, and in the hand. A set of 40 features were computed from the sensors data and four classifiers were trained and combined through stacking to detect falls. We compared the performance of two population-specific models, trained and tested on either able-bodied or amputee participants, with that of a model trained on able-bodied participants and tested on amputees. A simple threshold-based classifier was used to benchmark our machine-learning classifier.ResultsThe accuracy of fall detection in amputees for a model trained on control individuals (sensitivity: mean 0.989, 1.96*standard error of the mean [SEM] 0.017; specificity: mean 0.968, SEM 0.025) was not statistically different (P=.69) from that of a model trained on the amputee population (sensitivity: mean 0.984, SEM 0.016; specificity: mean 0.965, SEM 0.022). Detection of falls in control individuals yielded similar results (sensitivity: mean 0.979, SEM 0.022; specificity: mean 0.991, SEM 0.012). A mean 2.2 (SD 1.7) false alarms per day were obtained when evaluating the model (vs mean 122.1, SD 166.1 based on thresholds) on data recorded as participants carried the phone during their daily routine for two or more days. Machine-learning classifiers outperformed the threshold-based one (P<.001).ConclusionsA mobile phone-based fall detection model can use data from non-amputee individuals to detect falls in individuals walking with a prosthesis. We successfully detected falls when the mobile phone was carried across multiple locations and without a predetermined orientation. Furthermore, the number of false alarms yielded by the model over a longer period of time was reasonably low. This moves the application of mobile phone-based fall detection systems closer to a real-world use case scenario.
| S-EPMC5656773 | biostudies-literature
Project description:BackgroundThe burden of diabetes mellitus (DM) and its associated complications continue to burgeon, particularly in low- and middle-income countries (LMICs). Lower limb amputation (LLA) is one of the most life-altering complications of DM, associated with significant morbidity, mortality and socio-economic impacts. High-income countries have reported a decreasing incidence of DM-associated LLA, but the situation in many LMICs is unknown. We aim to conduct a systematic review to determine the incidence and prevalence of DM-associated LLA in LMICs to better inform appropriate interventions and health system response.Methods and analysisA systematic search of the literature will be conducted on five databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus and African Journal Online (AJOL). Only observational, quantitative studies reporting the incidence and/or prevalence of DM-related LLA will be considered. A validated study design-specific critical appraisal tool will be used to assess the risk of bias in individual studies. We will determine the incidence of LLA by examining the number of new cases of LLA among individuals with confirmed DM diagnosis during the specified period, while the prevalence will be based on the total number of all new and existing LLAs in a population. LLA will be considered as the resection of the lower limb from just above the knee to any point down to the toe. If heterogeneity is low to moderate, a random-effects meta-analysis will be conducted on extracted crude prevalence/incidence rates, with the median and interquartile range also reported. The systematic review will be performed in accordance with the JBI guideline for prevalence and incidence review. Study reporting will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline.Prospero registration numberCRD42021238656.
| S-EPMC9009695 | biostudies-literature
Project description:ObjectiveThis systematic review aims to evaluate current literature for the prevalence, causes, and effect of low back pain (LBP) in traumatic lower limb amputees, specifically its association with the kinematics and kinetics of the lumbar spine and lower extremities.Data sourcesDatabases (EMBASE, MEDLINE, Scopus, CINAHL, PsycINFO) were searched systematically for eligible studies from inception to January 2018.Study selectionThe inclusion terms were synonyms of low back pain, lower limb amputation, and trauma, whereas studies involving nontraumatic amputee populations, single cases, or reviews were excluded. 1822 studies were initially identified, of which 44 progressed to full-text reading, and 11 studies were included in the review.Data extractionTwo independent reviewers reviewed the included studies, which were evaluated using a quality assessment tool and the Grades of Recommendation, Assessment, Development and Evaluation system for risk of bias, prior to analyzing results and conclusions.Data synthesisThere was an LBP prevalence of 52%-64% in traumatic amputees, compared to 48%-77% in the general amputee population (predominantly vascular, tumor, trauma), attributed to a mixture of biomechanical, psychosocial, and personal factors. These factors determined the presence, frequency, and severity of the pain in the amputees, significantly affecting their quality of life. However, little evidence was available on causality.ConclusionThe high prevalence of LBP in traumatic amputees highlights the necessity to advance research into the underlying mechanics behind LBP, specifically the spinal kinematics and kinetics. This may facilitate improvements in rehabilitation, with the potential to improve quality of life in traumatic amputees.
| S-EPMC7853329 | biostudies-literature
Project description:BACKGROUND: The mobility of older individuals has often been only partially assessed, without considering all important aspects such as potential (available) versus effective (used) mobilities and the physical and psychosocial factors that modulate them. This study proposes a new model for evaluating mobility that considers all important aspects, applied here to lower-limb amputees with vascular origin. This model integrates the concepts of potential mobility (e.g. balance, speed of movement), effective mobility (e.g. life habits, movements in living areas) and factors that modulate these two types of mobility (e.g. strength, sensitivity, social support, depression). The main objective was to characterize potential and effective mobility as well as mobility modulators in a small sample of people with lower-limb amputations of vascular origin with different characteristics. The second objective of this pilot study was to assess the feasibility of measuring all variables in the model in a residential context. METHODS: An observational and transversal design was used with a heterogeneous sample of 10 participants with a lower-limb amputation of vascular origin, aged 51 to 83, assessed between eight and 18 months after discharge from an acute care hospital. A questionnaire of participant characteristics and 16 reliable and valid measurements were used. RESULTS: The results show that the potential mobility indicators do not accurately predict effective mobility, i.e., participants who perform well on traditional measures done in the laboratory or clinic are not always those who perform well in the real world. The model generated 4 different profiles (categories) of participants ranging from reduced to excellent potential mobility and low to excellent effective mobility, and characterized the modulating factors. The evaluations were acceptable in terms of the time taken (three hours) and the overall measurements, with a few exceptions, which were modified to optimize the data collected and the classification of the participants. For the population assessed, the results showed that some of the negative modulators (particularly living alone, no rehabilitation, pain, limited social support, poor muscle strength) played an important role in reducing effective mobility. CONCLUSION: The first use of the model revealed interesting data that add to our understanding of important aspects linked to potential and effective mobility as well as modulators. The feasibility of measuring all variables in the model in a residential context was demonstrated. A study with a large number of participants is now warranted to rigorously characterize mobility levels of lower-limb amputees with vascular origin.
| S-EPMC2955596 | biostudies-literature
Project description:The optimal timing of surgical therapy for traumatic spinal cord injury (TSCI) remains unclear. The purpose of this study is to evaluate the impact of "ultra-early" (<4 h) versus "early" (4-24 h) time from injury to surgery in terms of the likelihood of neurologic recovery. The effect of surgery on neurological recovery was investigated by comparing the assessed initial and final values of the American Spinal Injury Association (ASIA) Impairment Scale (AIS). A post hoc analysis was performed to gain insight into different subgroup regeneration behaviors concerning neurological injury levels. Datasets from 69 cases with traumatic spinal cord injury were analyzed. Overall, 19/46 (41.3%) patients of the "ultra-early" cohort saw neurological recovery compared to 5/23 (21.7%) patients from the "early" cohort (p = 0.112). The subgroup analysis revealed differences based on the neurological level of injury (NLI) of a patient. An optimal cutpoint for patients with a cervical lesion was estimated at 234 min. Regarding the prediction of neurological improvement, sensitivity was 90.9% with a specificity of 68.4%, resulting in an AUC (area under the curve) of 84.2%. In thoracically and lumbar injured cases, the estimate was lower, ranging from 284 (thoracic) to 245 min (lumbar) with an AUC of 51.6% and 54.3%. Treatment within 24 h after TSCI is associated with neurological recovery. Our hypothesis that intervention within 4 h is related to an improvement in the neurological outcome was not confirmed in our collective. In a clinical context, this suggests that after TSCI there is a time frame to get the right patient to the right hospital according to advanced trauma life support (ATLS) guidelines.
| S-EPMC8703655 | biostudies-literature
Project description:AimsProvision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders.Method1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples.ResultsCompared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5-0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1-0.6; NS: OR: 0.2, 95% CI: 0.1-0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3-0.6; NS: OR: 0.5, 95% CI: 0.3-0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4-5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3-8.0) were observed in DS with high combat exposure compared with civilians.ConclusionsRates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.
| S-EPMC6998688 | biostudies-literature
Project description:BackgroundThermal discomfort is prevalent among prosthesis users. This observational study of thirty unilateral lower-limb prosthesis users compared their skin temperatures and the thermal discomfort experienced during exercise between their residual and contralateral limbs.MethodsParticipants performed a 2-minute interval cycling exercise test. Skin temperature was measured at matched locations on each leg during the 1-minute rest intervals. Average rate-of-change in skin temperature was compared between legs using a repeated measures analysis of variance. Participants rated thermal discomfort on each leg before and after exercise, and a Wilcoxon signed-rank test was used to compare legs. Ordinal regression evaluated the relationship between the rate-of-change in temperature on the residual limb and the perceived thermal discomfort.FindingsAfter exercise, thermal discomfort ranked higher on the amputated side (P?=?0.007). On average, both legs cooled during exercise (P?=?0.002), but the difference between legs was not significant. The rate-of change in skin temperature on the residual limb during exercise did not relate to the thermal discomfort experienced (odds ratio of 0.357).InterpretationThese findings indicate that in this patient population, skin temperature does not explain the thermal discomfort experienced, and subjective thermal discomfort is inadequate for detecting thermoregulatory issues, with potential implications for long-term tissue health.
| S-EPMC6839397 | biostudies-literature
Project description:PurposeTo describe the quality of life(QOL) of Syrian people with lower limb amputation after the war.MethodsA cross-sectional study conducted at the Military Hospital in Lattakia, from May to August 2019. A convenience sample of 65 adult males who had previously undergone amputation of a lower limb was included in this study. Participants' data were collected including age, marital status, employment, time since amputation, level of amputation, type of amputation and the use of assistive devices. The QOL was measured using the World Health Organization Quality of Life Brief Version (WHO QOL-BREF). Data analysis was done by using SPSS version 20.ResultsForty (61.5%) of subjects were between age of 40-60. Below knee and unilateral lower-limb amputees formed the highest number 52 (80.0%) and 51 (78.5%) respectively. The mean scores of environment, physical health, psychological, and social relationships domains of QOL were 15.86, 15.18, 14.66, and 6.64, respectively. There were statistically significant differences in various domains of QOL between groups with different status of employment, financial support, amputated lower limb, duration since amputation, and cause of amputation (P < 0.05).ConclusionThere is a need to pay attention to experiences and the quality of life among Syrian patients with war-related amputation.
| S-EPMC7424144 | biostudies-literature
Project description:BackgroundTraumatic arm amputations can be treated with replantation or surgical formalization of the stump with or without subsequent prosthetic fitting. In the literature, many authors suggest the superiority of replantation. This systematic review compared available literature to analyze whether replantation is functionally and psychologically more profitable than formalization and prosthetic fitting in patients with traumatic arm amputation.MethodsFunctional outcome and satisfaction levels were recorded of patients with amputation levels below elbow, through elbow, and above elbow.ResultsFunctional outcomes of 301 replantation patients and 172 prosthesis patients were obtained. In the replantation group, good or excellent functional scores were reported in 39% of above elbow, 55% of through elbow, and 50% of below elbow amputation cases. Nearly 100% of patients were satisfied with the replanted limb. In the prosthesis group, full use of the prosthesis was attained in 48% of above elbow and in 89% of below elbow amputation patients. Here, 29% of patients elected not to use the prosthesis for reasons including pain and functional superfluity. In both replantation patients and prosthesis wearers, a below elbow amputation yielded better functional results than higher amputation levels.ConclusionsReplantation of a traumatically amputated arm leads to good function and higher satisfaction rates than a prosthesis, regardless of the objective functional outcome. Sensation and psychological well-being seem the two major advantages of replantation over a prosthesis. The current review of the available literature shows that in carefully selected cases replantation could be the preferred option of treatment.
| S-EPMC4560425 | biostudies-literature