Article

Knife-Related Injuries Treated in United States Emergency Departments, 1990–2008

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Abstract

Knives cause more disabling injuries than any other type of hand tool. This study investigates knife-related injuries requiring Emergency Department (ED) treatment among children and adults in the United States (US) from 1990 through 2008. A retrospective analysis of data from the National Electronic Injury Surveillance System of the Consumer Product Safety Commission was conducted. An estimated 8,250,914 (95% confidence interval [CI] 7,149,074-9,352,755) knife-related injuries were treated in US EDs from 1990 to 2008, averaging 434,259 (95% CI 427,198-441,322) injuries annually, or 1190 per day. The injury rate was 1.56 injuries per 1000 US resident population per year. Fingers/thumbs (66%; 5,447,467 of 8,249,410) were injured most often, and lacerations (94%; 7,793,487 of 8,249,553) were the most common type of injury. Pocket/utility knives were associated with injury most often (47%; 1,169,960 of 2,481,994), followed by cooking/kitchen knives (36%; 900,812 of 2,481,994). Children were more likely than adults to be injured while playing with a knife or during horseplay (p < 0.01; odds ratio 9.57; 95% CI 8.10-11.30). One percent of patients were admitted to the hospital, and altercation-related stabbings to the trunk accounted for 52% of these admissions. Knives represent an important source of morbidity and mortality to people of all ages. Manufacturers should develop safer knife designs that incorporate features, such as improved opening and closing mechanisms on pocket knives, to prevent these injuries. Other potential safety efforts include targeted educational interventions and changes in voluntary product safety standards and public policy.

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... A longitudinal study >16 y showed that falls from ladders account for an average of 136,118 emergency department visits annually in the United States, which translated to an average of 49.5 per 100,000 people per year [12]. At our institution, falls from ladders corresponded to 1.3% of the trauma evaluations over the study period. ...
... At our institution, falls from ladders corresponded to 1.3% of the trauma evaluations over the study period. The mean age in our population was 55.6 AE 14.8 y, which is about a decade older than in other studies [2,12]. This difference may be explained by regional demographic differences as Tucson has several retirement subsidiary communities and hosts an influx of older winter visitors. ...
... Both studies found that fractures were the most common injury type. However, using the National Electronic Injury Surveillance System (NEIS) database with 136,118 patients treated over a 16-y period, D'Souza et al. [12] found the most frequently injured body parts were lower and upper extremities, which accounted for 30% and 22%, respectively. We believe the different findings were the result of differences in injury classification and the fact that the NEIS database does not provide injury information to the detail that we were able to generate from a detailed chart review. ...
... In keeping with other trauma populations, patient age in ladder-related falls is associated with progressively increased risk of injury severity [6,11,[16][17][18][19]and subsequent hospital length of stay [17,20], with the median patient age in domestic ladder falls higher than in occupational settings [16,17]. In fatal cases, patients involved in domestic ladder use also tend to be older than those sustaining occupational ladder falls, despite similar Injury Severity Score (ISS) [20], which is most likely due to an increased prevalence of co-morbidities. ...
... In keeping with other trauma populations, patient age in ladder-related falls is associated with progressively increased risk of injury severity [6,11,[16][17][18][19]and subsequent hospital length of stay [17,20], with the median patient age in domestic ladder falls higher than in occupational settings [16,17]. In fatal cases, patients involved in domestic ladder use also tend to be older than those sustaining occupational ladder falls, despite similar Injury Severity Score (ISS) [20], which is most likely due to an increased prevalence of co-morbidities. ...
... In a separate component of the report focussing on completed coronial investigations over a 12 year period to 2012, domestic ladder fall deaths were attributed to head and cervical spine injury in 68% and 9% of cases respectively [9]. A United States database study of ladder fall patients admitted to emergency departments over a 16 year period to 2005, and including weighted data on 55,000 cases, found that 10% of patients required admission to hospital, 97% of injuries occurred in domestic settings, and the incidence of ladder-related injury increased by 50% over the data collection period [16]. The authors hypothesised that the increased incidence may be related in part to a growing interest in home improvement television programmes. ...
... Greater than one in four tree house– related injuries were diagnosed as a fracture to the arm. Consistent with our findings, previous studies on falls and playground injuries have shown that fractures (often to the upper limbs) are the most common type of injury, 2–5,9,10,13–30 that injury severity increases with height of fall,123416,17,20,21,23,26272831–33 and that boys are injured more often than girls.234511,1516171823,26,29,30,343536373839 Risk-taking behavior has been found to be more common in males than in females and in older children compared with younger children. ...
... Greater than one in four tree house– related injuries were diagnosed as a fracture to the arm. Consistent with our findings, previous studies on falls and playground injuries have shown that fractures (often to the upper limbs) are the most common type of injury, 2–5,9,10,13–30 that injury severity increases with height of fall,123416,17,20,21,23,26272831–33 and that boys are injured more often than girls.234511,1516171823,26,29,30,343536373839 Risk-taking behavior has been found to be more common in males than in females and in older children compared with younger children. ...
Article
The objective was to describe the epidemiology of tree house-related injuries in the United States among children and adolescents. The authors conducted a retrospective analysis using data from the National Electronic Injury Surveillance System for patients < or =19 years who were treated in an emergency department (ED) for a tree house-related injury from 1990 through 2006. An estimated 47,351 patients < or =19 years of age were treated in EDs for tree house-related injuries over the 17-year study period. Fractures were the most common diagnosis (36.6%), and the upper extremities were the most commonly injured body part (38.8%). The odds of sustaining a head injury were increased for children aged <5 years. Falls were the most common injury mechanism (78.6%) and increased the odds of sustaining a fracture. Falls or jumps from a height > or =10 feet occurred in 29.3% of cases for which height of the fall/jump was recorded. Boys had significantly higher odds of falling or jumping from a height of > or =10 ft than girls, and children 10 to 19 years old also had significantly higher odds of falling or jumping from a height of > or =10 feet, compared to those 9 years old and younger. The odds of hospitalization were tripled if the patient fell or jumped from > or =10 feet and nearly tripled if the patient sustained a fracture. This study examined tree house-related injuries on a national level. Tree house safety deserves special attention because of the potential for serious injury or death due to falls from great heights, as well as the absence of national or regional safety standards. The authors provide safety and prevention recommendations based on the successful standards developed for playground equipment.
... Injuries comprise the sixth leading cause of mortality globally and account for 9% of world deaths. 1 In low-to middle-income countries, about 90% of injury-related deaths are secondary to trauma. 2 Globally, emergency departments (EDs) have reported a rising incidence of knife-related injuries, both accidental and selfinflicted. 3,4 In the UK, in 2011, knife injuries represented a quarter of all cases of major trauma and 94.1% of cases of major penetrating trauma. Other studies in the UK reported that assault knife injuries represented 10.3% of all trauma cases; this percentage increased to 12.9% between 2015 and 2018. ...
... KRIs have become a growing public health problem. 3,4 We examined the epidemiology of KRI at the ED of ASUH, which is one of the major referral hospitals in Cairo. In this one-year study, the case load of KRI at the ASUH ED was more than one-fifth (22.9%) of all 611 trauma cases. ...
Article
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Purpose: For knife-related injuries (KRI), a comprehensive understanding of the incidence, mechanism, and pattern of injury is required for the development of prevention strategies. Unfortunately, reliable data on knife-related injuries are difficult to obtain. In Egypt, there is no national routine surveillance system for all knife injuries. The aim was to examine the epidemiologic characteristics of knife-related injuries at the Ain Shams University Hospital (ASUH) emergency department (ED). Patients and methods: A cross-sectional study was conducted on 140 patients who presented with knife injuries at the ASUH ED. Data collection was done during a randomly selected period of seven days each month from October 2018 to September 2019. The sociodemographic characteristics, injury-related variables, and outcomes of the injury were recorded on a structured worksheet. Results: Knife-related injuries represented 22.9% of all injury cases that presented to the ED. Majority of the knife-related injuries (87.86%) were accidental, 7.9% were assault, and 4.3% were self-inflicted. Home was the most reported place of injury. Most of the victims were discharged from the ED (87.1%), and 84.3% recovered completely. The mean hospital stay was 3.6 ± 1.3 days. Conclusion: Majority of the knife-related injuries were accidental, and the most common pattern was isolated chest injury with contusions. Cases that were not severe and had favorable prognosis (ie, complete recovery) comprised the largest proportion. Recommendations include development of a surveillance system may result in the effective control and prevention of this growing problem of knife-related injuries.
... Up to 80% of injuries involve zone II. According to international literature, the most frequent site of injury is the aerodigestive tract, followed by the major vascular structures and nerve injuries [2,3]. ...
... Like other authors, we believe that patients with neck injuries of various etiology should be admitted to multi profile trauma centers, since saving their lives may depend on the cooperation of many different specialists and implementation of multiple diverse therapeutic procedures [2,3,6,9,10]. ...
Article
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We would like to present a case report of a very unusual suicide attempt. A 48-year-old female patient tried to commit suicide by stabbing herself with a kitchen knife into her neck. Suicide by self-stabbing is uncommon, constituting only 1-3% of suicide attempts. Patients with self-inflicted stab wounds may have a higher incidence of surgical interventions based on the stab location. Surprisingly, the mortality associated with this kind of wound is low. Most medical centers have very limited experience with this infrequent injury. There are only a few case reports and small series published in the literature of the subject.
... Fractures were the most likely injuries to occur from ladder use, and the body parts most likely to be injured were the extremities. Male workers had a higher incidence of injuries associated with ladder use than women, and hospital admission rates increased as the elevation of the falls increased (D'Souza et al, 2007). This latter finding seems to corroborate the findings of Hinze and Coates (2011), who stated that the use of extension ladders is more likely to cause a fatal accident due to the height of the equipment. ...
... Fractures are also cited as the most frequent type of injury by other researchers (Partridge et al, 1998; Smith et al 2006), while others found that sprains and contusions occur more frequently (Faegermann and Larsen, 2000; Faegermann and Larsen, 2001). Some researchers have concluded that accidents are more likely to occur in certain demographics, specifically men (D'Souza et al 2007; Harvinder and Goldbloom, 2008), and older men (Camino et al, 2011; Mitra el al, 2007). Mitra et al. have suggested that intrinsic and extrinsic variables should be examined, which may identify a user's propensity to injury. ...
Article
Full-text available
Stepladders are frequently utilized on construction projects as a means of access to elevation. Stepladder heights commonly range from 4 feet (1.2 m) to 14 feet (4.3 m). Since these heights are not extreme, there is a common misperception that stepladder use presents a low risk. On the contrary, extreme care must be exercised to ensure that work on stepladders is performed safely, as described in the conspicuously located recommendations and brightly-colored warnings that adorn virtually all newly-purchased equipment. Despite this, accidents involving stepladders occur on a regular basis. This study was conducted to better understand the underlying causes of these accidents. The narrative descriptions of 180 stepladder-related fatalities were obtained from the U.S. Occupational Safety and Health Administration and were analyzed to identify the at-risk behaviors that preceded the fatality incidents. The results showed that most of the incidents should have been anticipated and could have been avoided. Unsafe practices such as improper lockout-tagout of electrical equipment, loss of balance, working on a folded stepladder, over-reaching, straddling the ladder, "walking" the ladder, poor footing, and unstable/shifting ladders, among others were identified. Virtually all of these fatalities could have been avoided by adhering to the guidelines posted on the stepladders and by complying with basic safe construction practices.
... The majority of the articles reported secondary database sources. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Two included both primary and secondary data, 46,47 and one collected primary data. 48 Of the three studies in which primary data were collected, one used an adaptation of the Nordic Medico-Statistical Committee (NOMESCO) classification 46 of products, 47 one used a list of product codes developed by the Council of Ministries of the European Union, 49 and one developed their own survey tool to collect information on consumer products. ...
... All studies included either hospital and/or emergency department admissions; eight studies 29,31,32,35,41,42,45,49 (38.1%) also included mortality data, and one study included information on injuries that required time off work. 48 Of the 21 studies, 10 focused on ladders and/or steps and stairs, [33][34][35]37,[39][40][41][42][43]50 one focused on wheelchairs and adult walkers, 39 one included only sports products, 38 and one included only bathroom products. 30 The remaining articles 29,31,32,36,45,[47][48][49] described the mortality and morbidity associated with a broad spectrum of consumer products. ...
Article
Full-text available
To conduct an environmental scan to identify the scope of literature on consumer products and injuries in seniors and to fill in some of the information gaps by exploring the relationship between assistive devices (AD) and fall-related injuries. The environmental scan included primary literature identified in Medline and EMBASE databases and grey literature was identified in Google and consumer product safety sites in the US, Canada, the UK, and Australia.Weighted logistic regression was then used to examine the relationship between socio-demographic factors, frailty indicators, and AD use at the time of the fall, and the type of health services utilized and psychological consequences of the fall based on data from the 2008-2009 Canadian Community Health Survey on Healthy Aging. The majority of the articles on consumer products and injuries reported secondary database sources and did not directly link the consumer product's influence on a given injury. We found AD use at the time of a fall was associated with hospitalization, worry about re-injury, and limiting one's activities due to this worry, even after adjustment for socio-demographic variables. When frailty variables were included in the model, however, AD use was no longer statistically significant. This study provides preliminary information on the relationship between AD use and fall-related outcomes. However, the current data are not sufficient to draw specific conclusions. More detailed questions regarding AD use for the entire population and additional questions regarding the contribution of the AD to the injury will help to provide a richer understanding of this relationship.
... К данным системы NIESS в своем исследовании (2017) также обращались доктора christopher E. Gaw, Thiphalak chounthirath и Gary A. Smith из Колумбуса (США) [27]. Временной период, оцененный ими в своей работе, включал 1991-2011 гг. ...
... Резюмируя все вышеизложенное, можно говорить, что ходунки представляют серьезную опасность для ребенка (травмы, вплоть до смертельного исхода [27,35]; ожоги [36][37][38][39][40]; возможность достичь опасных предметов, таких как нагреватели, пепельницы, электрические соединения, горячие напитки и т. д., в том числе яды [41]). ...
Article
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This article presents an overview of 40 literary sources regarding injuries caused by baby walkers. The data from the first studies on the submitted subjects (1981) to the present were estimated for the first time in Russian scientific literature. Significant variations in the structure and volume of injuries worldwide were shown. This may be caused by the difference in the living quarter structure, cultural features, errors in data collection, accuracy of data sources, and improvement of the devices. However, in our opinion, two factors have the greatest influence: the design and specific technical solution of such devices and the presence of stairs accessible to the child in a residential building. In addition, the possibility of children acquiring thermal trauma in a walker was described, including the ability to reach dangerous items, such as heaters, ashtrays, electrical connections, and hot drinks, including poisons. The danger of walkers as a factor influencing the normal formation of bipedal locomotion and motor pattern was indicated. The authors underline the need to inform the public regarding the dangers of walkers as much as possible or to introduce a complete ban on their use, which was done in Canada in 2004 that led to a decrease in the level of child injuries.
... 7D. In every traumatic injury of the hand treated in the emergency department the possibility of performing a follow-up should be considered [29][30][31][32][33][34][35][36][37][38]. ...
Article
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Traumatic wounds are one of the most common problems leading people to the Emergency Department (ED), accounting for approximately 5,4 % of all the visits, and up to 24 % of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop, involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture. Here we present the results of this work, shared by the Academy of Emergency Medicine and Care (AcEMC), and the World Society of Emergency Surgery (WSES).
... Sub-statements of Statement 7 are: any traumatic injury of the hand should be considered for a possible tendon injury, especially if located on the volar or dorsal side (7A); any traumatic injury of the hand should be considered for a nerve injury, especially if located on the lateral side of the fingers (7B); a physical examination should be performed in any traumatic injury of the hand to check for any eventual tendon or nerve damage before performing the anaesthesia (7C); in every traumatic injury of the hand treated in the ED the possibility of performing a follow-up should be considered (7D). [29][30][31][32][33][34][35][36][37][38] ...
Article
Full-text available
Traumatic wounds are among the most common problems leading people to the Emergency Department (ED), accounting for approximately 5.4% of all the visits, and up to 24% of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop , involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so-called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture.
... although our study only examined the most recent injury sustained by recreational padel players, we found similarities to previous sports research. as in previous research in tennis, 9,12,18 badminton, 11 squash, 19 and other sports, 20, 21 sprains/strains and lower extremity injuries were common. in tennis, ankle sprains typically occur due to sudden inversion and internal rotation during sideward-cutting motions. ...
Article
Background: Padel is a relatively new sport, with steady participation increases over the past 50 years. However, there is a need for data examining injury and associated risk factors. The study examined how intrinsic (e.g. age and sex) and extrinsic factors (e.g. padel participation and equipment) were associated with injury in recreational padel players. Methods: A self-administered questionnaire completed by 80 recreational padel players between September 2014 and March 2015 acquired data on: respondent demographics and padel-related activities; the number of injuries within the past year; characteristics of the last injury sustained; and extrinsic factors including respondents' evaluations of equipment (e.g., racquet control/power, footwear cushioning, flexibility, traction). Chi-square tests compared the proportion of respondents reporting injuries in the past year among those reporting and not reporting equipment-related issues. Results: Most respondents were male (57.5%), aged 30-40 years (46.3%), and played more than 2 padel sessions/week (48.8%). Overall, 40.0% reported sustaining at least one injury during the past year. Sex, age, frequency of padel sessions/week, and years of padel experience were not associated with the reporting of injury within the past year (p>0.05). The proportion of padel players reporting injuries in the past year was greater among those that wore padel-specific footwear than those that wore another kind of sports footwear (50.0% vs. 23.3%; p=0.02). Conclusions: Recreational padel players wearing padel-specific footwear were more at risk for injury than those not. Our findings highlight the need for additional research regarding injury risk and footwear.
... As mentioned in a previous survey [5], the two nonpowered hand tools causing the highest injury were the knife and the hammer that accounted for 44.3% and 10.0% of injuries and illnesses, respectively. Many efforts have been dedicated by ergonomists to research the knife and proposed feasible guides for design [6][7][8]. As for the hammer, previous studies focused on the handle design and suggested that it should be angled in the range of 5-40 • in order to reduce ulnar deviation, but there were no performance differences [1,3,9]. ...
Article
Full-text available
Background: Hammering is a functional task in which the wrist generally follows a path of motion, however, previous studies paid relatively little attention to it. Objective: The main objective of this study is to determine the optimal working height while using a straight-handled hammer to perform the hammering task. Methods: Ten participants performed the hammering tasks on three different working heights (64, 80, and 96 cm) using three subjective hammering forces (light, medium, and heavy). Results: The results revealed that there were linear increasing trends of shoulder abduction, which increased with the increased working height when hammering and the trunk flexion revealed a contrary result. However, the ulnar deviation and trunk lateral bending were insensitive to the working heights. The hammering forces merely resulted in trunk flexion and lateral bending and no posture differences at upper extremities. Conclusion: The trade-off between acceptable trunk flexion and shoulder abduction was considered to determine a reasonable effective working height (by measuring downward from worker's elbow height) in the range from 25 cm to 35 cm with a mean 30 cm. This range will be valuable for hammering job design.
... Accidental sharp force injuries are very common in the community. A study from the United States of America (USA) examining knife related injuries to children and adults revealed that over one thousand kniferelated injuries were treated every day in emergency departments [22]. Sharp force injury accounted for 0.29% of all accidental deaths in a study from Dallas, USA, between 1990 and 1999 [23]. ...
Article
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Determining the manner of death in cases involving multiple stab injuries from a knife is generally straightforward. The medico-legal investigation of a stabbing death caused by a single stab injury from a knife comprises a smaller but potentially more problematic subset of forensic cases. We reviewed our institute’s experience with single stab injuries and endeavored to identify features identified at the post-mortem examination which may aid in the differentiation between cases of homicide, suicide and accidental death. The single stab injury was to the left chest in the majority of deaths from homicide and from suicide. Clothing was nearly always involved in cases of homicide, but was also seen in cases of suicide. The knife was found in situ in 9 of the 11 cases of suicide involving a chest injury, but was not seen in any of the cases of homicide. There were no cases of an accidental single stab death from a knife in our records. Clinical data on accidental stab injuries was sought via a search of the medical records of a major tertiary referral hospital. A single non-fatal case of an accidental single stab injury from a knife was identified after the conclusion of our study period. Accidental stab injuries from a knife causing injury or death are rare.
... According to a retrospective analysis of data from the National Electronic Injury Surveillance System of the Consumer Product Safety Commission, there were an average of 1,190 knife-related injuries treated in U.S. emergency departments per day from 1990 through 2008; cooking/kitchen knives represented 36% of all injuries. 15 A case report was developed for each patient to assess the applications of the Pitch Ointment in scar and wound management. ...
Article
There is a high incidence of household knife-related injuries requiring emergency department treatment in the U.S. The Pitch Ointment, a named formula developed by a compounding pharmacist, was used separately by two patients who suffered a knife injury in a finger and a foot. This formula combines Pinene (L-Alpha) 0.5% and Canada Balsam 5% in PracaSil-Plus, special ingredients with applications in scar and wound healing. The patients’ level of satisfaction with the Pitch Ointment was very high since all 4 treatment satisfaction domains by the Treatment Satisfaction Questionnaire for Medication (effectiveness, side effects, convenience, global satisfaction) were rated over 85. These results are consistent with the clinical improvements observed in the before and after treatment photographs. The success of these case reports is evidence to suggest that the Pitch Ointment may be recommended by compounding pharmacists as a viable treatment option in scar and wound management.
... were one of the top ten most frequently cited OSHA standards violated in 2016 (OSHA, n.d.1.). From 1990 to 2005, the number of falls in the U.S. had risen almost 50%, and the rate of ladder-related injuries rose almost 27% (D'Souza, Smith, & Trifiletti, 2007). ...
Article
This article describes the results of a survey intended as a preliminary assessment of consumer perceptions of the hazardousness of portable ladders and the warning labels provided on portable ladders. One hundred ten participants responded to an online survey tool called Amazon Mechanical Turk. The survey collected information about participants’ use of ladders, their ratings of familiarity with ladders, perceived hazardousness of portable ladders, and perception of warning labels on portable ladders. Results indicated a small but significant relationship between familiarity with ladders and their perceived hazardousness, and that participants thought that people should be warned about the hazards associated with ladder use. Implications for future research about consumer perception of portable ladder hazards and warnings are described.
... Durch Anwendung der Puppe-Regel [16] [23]. Aufgrund der Nähe zum Tat-Arm finden sich die Abwehrverletzungen eher am linken Arm des Opfers [19]. ...
Article
Background Victims of violence need special treatment in the emergency room, including exact documentation that can stand up in court. It may happen that the documentation must be made by the clinician if no forensic pathologist is on site Objectives The aim of this review is to provide clinicians a guide for documenting information from victims of violence and to identify potential victims of violence. Materials and methods Presentation of selected and typical cases, discussion of basic literature and expert opinions. Results Victims of violence can present a variety of injury patterns which the attending physician must recognize as being the result of violence. If urgent care is needed or no forensic pathologist is available, the documentation must be made by the clinician. Particular importance is attached to the exact photo documentation and description of injuries. Conclusions Commonly physicians and nurses are not adequately trained in dealing with medicolegal situations. Continuing education in the field of wound documentation in words and pictures is necessary in order to provide proper documentation. Cooperation between clinicians and forensic medicine specialists should be intensified.
... 242 Estimates of accidental or unintentional nonfatal shootings per year number more than 16,000, 243 and to their utility in criminal activities, but they include the frequent accidents involving guns, as where a child finds his parents' gun and kills or injures himself or another child with it." 245 Of course, some other commonplace items, such as knives, 246 hedge trimmers, 247 table saws, 248 and other household items 249 cause even more accidental injuries each year. Even so, most of these other items come under the regulatory purview of the Consumer Product Safety Commission, which monitors annual accidents, mandates manufacturer safety testing, orders product recalls, and so onbut guns are a statutory exception under the Consumer Product Safety Act. ...
Conference Paper
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Firearm policy in the United States is subject to longstanding political gridlock; victories and losses for each side of the issue run neck-and-neck. This paper inverts the problem and proposes a system for voluntary registration and certification of nonowners, those who want to waive or renounce their Second Amendment rights as a matter of personal conviction. The proposed system is analogous to both the registration of conscientious objectors during wartime conscriptions, and the newer suicide prevention laws whereby individuals can add their names to a do-not-sell list for firearm dealers-though the proposal made here is broader and more permanent. Voluntary registration, with official certification, would serve three important purposes. First, this would help create social identification markers for the gunless-by-choice movement, something that historically has been missing; formal signals and labels of identification with a movement are necessary for a movement's success, especially with prohibition or abstinence movements. Second, registration and certification as gunless would be a personal moral commitment marker; all societies provide ways for solemnizing one's vows and solidifying one's resolve on serious, lifelong moral decisions. Third, certification allows for a market-signaling effect, useful information that can trigger a beneficial response from the private sector; market responses, in turn, provide useful information about otherwise hotly-debated beliefs, such as whether guns in fact enhance or reduce safety for individuals and public places. This paper develops each of these points and describes the regulatory and statutory alternatives for a federal or state system of registration and certification.
... The significant degree of violence recidivism (18¢5%) has not been reported in previous UK-based studies. A US-based study undertaken in an urban trauma centre demonstrated that 15¢7% of those presenting with penetrating trauma were recidivists [22]. The true degree of recidivism may be higher than that demonstrated in our singlecentre study. ...
Article
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Background The incidence of knife-related injuries is rising across the UK. This study aimed to determine the spectrum of knife-related injuries in a major UK city, with regards to patient and injury characteristics. A secondary aim was to quantify their impact on secondary care resources. Methods Observational study of patients aged 16+ years admitted to a major trauma centre following knife-related injuries resulting from interpersonal violence (May 2015 to April 2018). Patients were identified using Emergency Department and discharge coding, blood bank and UK national Trauma Audit and Research prospective registries. Patient and injury characteristics, outcome and resource utilisation were collected from ambulance and hospital records. Findings 532 patients were identified; 93% male, median age 26 years (IQR 20–35). Median injury severity score was 9 (IQR 3–13). 346 (65%) underwent surgery; 133 (25%) required intensive care; 95 (17·9%) received blood transfusion. Median length of stay was 3·3 days (IQR 1·7–6·0). In-hospital mortality was 10/532 (1·9%). 98 patients (18·5%) had previous attendance with violence-related injuries. 24/37 females (64·9%) were injured in a domestic setting. Intoxication with alcohol (19·2%) and illicit drugs (17·6%) was common. Causative weapon was household knife in 9%, knife (other/unspecified) in 38·0%, machete in 13·9%, small folding blade (2·8%) and, unrecorded in 36·3%. Interpretation Knife injuries constitute 12·9% of trauma team workload. Violence recidivism and intoxication are common, and females are predominantly injured in a domestic setting, presenting opportunities for targeted violence reduction interventions. 13·9% of injuries involved machetes, with implications for law enforcement strategies.
... Numerous studies identified the head, neck, and chest as being commonly associated with fatal sharp force injuries (Karlsson, 1998;Webb et al., 1999;Shabbir et al., 2004;Konig, 2006;Maxwell et al., 2007;Smith, 2013;Vassalini, Verzeletti, & De Ferrari, 2014;De-Giorgio et al., 2015). Fatalities were primarily due to cardiac injury or transection of major vessels (Pallett et al., 2014;Kristoffersen et al., 2016). ...
Article
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This paper examined the use of lethal force by law enforcement against people brandishing knives in the United States. The purpose of the research was to better understand the correlates of lethal force encounters and inform the development and implementation of systems and procedures designed to monitor, predict, and reduce the frequency of fatal police/civilian violence. There are two parts to this mixed-methods study: a quantitative analysis of the distribution of fatal event factors and descriptive epidemiology of fatal police encounters among persons brandishing knives. A non-probability sample (n = 174) was assembled from publicly reported use-of-force fatalities. The analysis revealed the typical decedent was a mentally ill 37-year-old White male brandishing a kitchen knife. Most encounters involved 2-4 officers firing 2-4 bullets at a person no more than 10-feet away. Police injuries, while uncommon, tended to be moderate, but none were fatal. Contrary to previous studies, Thursday was the most lethal day of the week. California accounted for 29% of all fatal encounters. Future research is needed to examine Black decedents' over-representation, explore the unexpectedly high number of deaths in California, and evaluate trends over time.
... Die meisten Autoren empfehlen die Verabreichung einer prophylaktischen kalkulierten Antibiose, um einer lokalen Infektion oder einer Meningitis vorzubeu- gen [7,8]. Wie hoch die Infektionsgefahr ist, lässt sich schwer abschätzen. ...
... According to Smith (2013), cooking/kitchen knives has constituted 36% of knife-related injuries treated in United States emergency departments, between 1990 and 2008. Vegetables consist of large groups of plants consumed as food by both human and animals. ...
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This paper entails the design and fabrication of a manually operated vegetable leaf slicing machine. The developed machine consists of a hopper, the cutter housing, the cutting blades, the rotating shaft, and a wooden handle. The machine was designed to enhance the hygienic slicing of vegetable leaf materials and for prevention of knife-related injuries for both domestic and commercial use. The machine was tested with a slicing efficiency of 95.52 % with a provision of an alternative quick vegetable cutting process with no injuries, no electric power supply and with little or no noise to the operating environment. Keywords: Vegetables, slicing, cutting blade, knives, hopper
... The Office of National Statistics knife crime data for England and Wales reported a 43% increase from 2011 to 2018-2019 [2]. However, the UK incidence remains significantly lower than countries such as the USA [3] and South Africa [4]. ...
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IntroductionAssaults inflicting penetrating head and neck trauma have potential for serious morbidity or mortality. This paper studies in-depth all cases treated at a level one trauma centre in the North East of England over 10 years.Methods All patients assaulted with sharp implements to the head and neck treated from 2010 to 2019 were identified using clinical codes.ResultsRetrospective data collection were as follows: 214 patients identified (189 male, 25 female). Average age was 31.5 years (range 3–80). The majority presented between 20:00 and 05:00. Knives were the commonest weapon. Fifty-two had scalp, 137 face and 69 neck injuries. Forty-eight percent had additional non-head and neck injuries. Eighty-six percent required admission, 16.6% to intensive care. Oral and maxillofacial and plastic surgeons provided most treatment. One hundred two required treatment under general and 96 local anaesthetic. Sixteen patients had significant vascular injury, 1 brachial plexus injury, 4 facial nerve injuries (of which 3 repaired) and one required parotid duct repair. Mean length of stay was 3.7 days. No mortality was recorded. Incidence significantly increased from 2010 to 2019.Conclusions Head and neck penetrating injuries occur frequently, often with other injuries and mainly in young males. Incidence of significant vascular or nerve injury was low. This study provides important data for those planning trauma services.
... With the increasing availability of firearms in the late 20th century, the incidence of penetrating thoracic trauma markedly increased and then stabilized over time (7). Firearm injuries and stabbings account for more than half of penetrating thoracic injuries in the United States (7,9,10). The number of people who die from transmediastinal penetrating trauma is unknown (11). ...
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Penetrating transmediastinal injury (TMI) is associated with a high mortality rate and presents a challenging diagnostic scenario. Previous dogma mandated surgical exploration or extensive and invasive investigations for all patients sustaining transmediastinal penetrating trauma, regardless of hemodynamic status. Since the late 1990s, the paradigm has changed, with most centers adopting a tiered approach to management based on clinical presentation. Transmediastinal penetrating trauma is a rare injury pattern and can result from gunshot wounds, stab wounds, blast injuries, and other missiles. The most predominant source, however, remains gunshot wounds, accounting for the vast majority of these injuries. A systematic approach in the emergency department to diagnosis and management should be undertaken and patients in extremis or with hemodynamic compromise rapidly identified. The unstable patient forgoes further investigations and the surgeon must use knowledge about the hypothesized trajectory, results of limited imaging, chest tube output, and anticipation of resuscitative maneuvers to select the best operative approach. In patients who are sufficiently stable to undergo CT angiogram (CTA) of the chest, the trajectory of the missile or impalement can often be deduced and this is used to guide further investigation or operation. In those where ambiguity remains, more focused tests such as echocardiography, pericardial window, esophagoscopy or esophagography, and bronchoscopy can be used to assess the mediastinal structures. For the stable patient, management proceeds with cautious and expeditious investigations to determine the extent of underlying organ-specific injuries. Thus, in patients with this injury pattern, determination of the patient's clinical status is critical to determine the appropriate course of management.
Article
Occupational accidents suffered by workers in Spain when using ladders were analyzed over a six year period from 2003-2008, during which the total of notified ladder-related accidents amounted to 21,725. Different accident-related factors were identified for the purpose of developing a pattern of those factors that had the greatest influence on the seriousness and the fatality of such accidents. Thus, a series of variables were examined such as age and length of service of the injured worker, firm size, the work sector, the injury suffered, and the part of the body that was injured. Since falls is the most frequent and most serious of ladder related occupational accidents, a special analysis of falls was performed. The findings showed that the seriousness of ladder-related accidents increased with the age of the injured worker. Likewise, accidents at places other than the usual workplace were more serious and registered higher fatalities than those that occurred at the usual place of work. The analysis of falls from ladders established that accidents in smaller-sized firms were of greater seriousness and involved more fatalities than those in larger-sized firms. The investigation also underlined the need for stricter compliance with preliminary safety assessments when working with ladders.
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Ladder falls comprise 16% of all US workplace fall-related fatalities, and ladder use may be particularly hazardous among older workers. This follow-back study of injured workers from a nationally representative sample of US emergency departments (ED) focused on factors related to ladder falls in three domains of the work environment: work equipment, work practices, and worker-related factors. Risk factors for fractures, the most frequent and severe outcome, were also evaluated. Workers injured from a ladder fall, treated in one of the 65 participating ED in the occupational National Electronic Injury Surveillance System (NEISS) were asked to participate. The questionnaire included worker demographics, injury, ladder and work equipment and environment characteristics, work tasks, and activities. Multivariate logistic regression models estimated odds ratios and 95% confidence intervals of a work-related fracture. Three-hundred and six workers experiencing an injury from an--on average--7.5-foot-fall from a step, extension, or straight ladder were interviewed primarily from construction, installation, maintenance, and repair professions. Injuries were most frequently to the arm, elbow or shoulder; head, neck, or face with diagnoses were primarily fracture, strain, sprain, contusion or abrasion. Workers were most frequently standing or sitting on the ladder while installing, hanging an item, or performing a repair when they fell. Ladder movement was the mechanism in 40% of falls. Environmental conditions played a role in <10% of cases. There was a significant association between fracture risk and fall height while working on the ladder that was also influenced by older work age. This study advances knowledge of falls from ladders to support those who specify means and methods, select equipment, and plan, supervise, or manage the performance of employees working at heights.
Article
The epidemiology of traumatic shoulder dislocations is poorly understood. The aim of the current study was to determine the incidence of shoulder dislocations presenting to hospital emergency departments in the United States and define demographic risk factors for these injuries. The National Electronic Injury Surveillance System, a probability sample of all injuries presenting to emergency departments in the United States, was queried for shoulder dislocations from 2002 through 2006. Patient and injury characteristics were analyzed. United States Census data were utilized to calculate incidence rates for the United States population and subgroups. Incidence rate ratios were then calculated with respect to age, sex, and race. A total of 8940 shoulder dislocations were identified, resulting in an overall incidence rate in the United States of 23.9 (95% confidence interval, 20.8 to 27.0) per 100,000 person-years. The male incidence rate was 34.90 (95% confidence interval, 30.08 to 39.73) per 100,000 person-years, with an incidence rate ratio of 2.64 (95% confidence interval, 2.39 to 2.88) relative to the female incidence rate. It was found that 71.8% of the dislocations were in males. Stratified by decade, the maximum incidence rate (47.8 [95% confidence interval, 41.0 to 54.5]) occurred in those between the ages of twenty and twenty-nine years; 46.8% of all dislocations were in patients between fifteen and twenty-nine years of age. There were no significant differences based on race. Dislocations most frequently resulted from a fall (58.8%) and occurred at home (47.7%) or at sites of sports or recreation (34.5%). Overall, 48.3% of injuries occurred during sports or recreation. The estimated incidence rate of shoulder dislocations in the United States is 23.9 per 100,000 person-years, which is approximately twice the previously reported value. A young age and male sex are risk factors for shoulder dislocation in the United States population.
Article
Background: Various characteristics of floors and floor coverings are well established as injury hazards. Loose carpeting, such as rugs, is often cited as a hazard leading to injury. Purpose: To describe the epidemiology and patterns of rug, mat, and runner-related injuries in patients seeking emergency treatment. Methods: Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 100 000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed. Results: An estimated 245 605 patients were treated in US emergency departments for rug-related injuries during the study period, with an average of 12 280 cases per year. Females (72.3%) and individuals older than 64 years (47.1%) sustained the largest number of injuries. Patients younger than 6 years were more likely to injure the head or neck region (RR, 3.52 [95% CI, 3.26-3.81]) compared with all other groups. Patients older than 18 years were more likely to experience a fracture or dislocation (RR, 2.52 [95% CI, 2.13-2.88]) and sustain an injury as a result of tripping or slipping on a rug (RR, 1.36 [95% CI, 1.26-1.41] compared with other age groups. Increasing age was associated with increased risk of hospitalization in this study. Patients who sustained an injury from a rubber or plastic mat/rug were significantly less likely to be admitted (RR, 0.67 [95% CI, 0.55-0.83]). Injuries occurring in kitchens or bathrooms resulted in significantly higher admission rates (RR, 1.45 [95% CI, 1.34-1.54]). Conclusions: Rug-related injuries are an important source of injury for individuals of all ages.
Article
Objectives: We describe trends in occupational and nonoccupational injury among working-age adults in Ontario. Methods: We conducted an observational study of adults aged 15 to 64 over the period 2004 through 2011, estimating the incidence of occupational and nonoccupational injury from emergency department (ED) records and, separately, from survey responses to 5 waves of a national health interview survey. Results: Over the observation period, the annual percentage change (APC) in the incidence of work-related injury was -5.9% (95% confidence interval [CI] = -7.3, -4.6) in ED records and -7.4% (95% CI=-11.1, -3.5) among survey participants. In contrast, the APC in the incidence of nonoccupational injury was -0.3% (95% CI=-0.4, 0.0) in ED records and 1.0% (95% CI=0.4, 1.6) among survey participants. Among working-age adults, the percentage of all injuries attributed to work exposures declined from 20.0% in 2004 to 15.2% in 2011 in ED records and from 27.7% in 2001 to 16.9% in 2010 among survey participants. Conclusions: Among working-age adults in Ontario, nearly all of the observed decline in injury incidence over the period 2004 through 2011 is attributed to reductions in occupational injury.
Article
To summarise the extent to which narrative text fields in administrative health data are used to gather information about the event resulting in presentation to a health care provider for treatment of an injury, and to highlight best practise approaches to conducting narrative text interrogation for injury surveillance purposes. Systematic review. Electronic databases searched included CINAHL, Google Scholar, Medline, Proquest, PubMed and PubMed Central. Snowballing strategies were employed by searching the bibliographies of retrieved references to identify relevant associated articles. Papers were selected if the study used a health-related database and if the study objectives were to a) use text field to identify injury cases or use text fields to extract additional information on injury circumstances not available from coded data or b) use text fields to assess accuracy of coded data fields for injury-related cases or c) describe methods/approaches for extracting injury information from text fields. The papers identified through the search were independently screened by two authors for inclusion, resulting in 41 papers selected for review. Due to heterogeneity between studies meta-analysis was not performed. The majority of papers reviewed focused on describing injury epidemiology trends using coded data and text fields to supplement coded data (28 papers), with these studies demonstrating the value of text data for providing more specific information beyond what had been coded to enable case selection or provide circumstantial information. Caveats were expressed in terms of the consistency and completeness of recording of text information resulting in underestimates when using these data. Four coding validation papers were reviewed with these studies showing the utility of text data for validating and checking the accuracy of coded data. Seven studies (9 papers) described methods for interrogating injury text fields for systematic extraction of information, with a combination of manual and semi-automated methods used to refine and develop algorithms for extraction and classification of coded data from text. Quality assurance approaches to assessing the robustness of the methods for extracting text data was only discussed in 8 of the epidemiology papers, and 1 of the coding validation papers. All of the text interrogation methodology papers described systematic approaches to ensuring the quality of the approach. Manual review and coding approaches, text search methods, and statistical tools have been utilised to extract data from narrative text and translate it into useable, detailed injury event information. These techniques can and have been applied to administrative datasets to identify specific injury types and add value to previously coded injury datasets. Only a few studies thoroughly described the methods which were used for text mining and less than half of the studies which were reviewed used/described quality assurance methods for ensuring the robustness of the approach. New techniques utilising semi-automated computerised approaches and Bayesian/clustering statistical methods offer the potential to further develop and standardise the analysis of narrative text for injury surveillance.
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Introduction: The management of haemodynamically stable patients who present following a penetrating abdominal injury (PAI) remains variable between mandatory surgical exploration and more selective non-operative approaches. The primary aim of this study was to assess compliance with an algorithm guiding selective non-operative management of haemodynamically stable patients with PAI. The secondary aim was to examine the association between compliance and unnecessary laparotomies. Methods: This was a retrospective cohort study involving all patients with PAI that presented to a major trauma centre from January 2007 to December 2011. Data were extracted from the trauma registry and patients' electronic medical records. Results: There were 189 patients included in the study, of which 79 (41.8 %) patients complied with the algorithm. The laparotomy rate in the setting of algorithm compliance was significantly lower than algorithm non-compliance (12.7 vs. 68.2 %; p < 0.01) as were unnecessary laparotomy rates (0 vs. 33.3 %; p = 0.03). Conclusion: Among haemodynamically stable patients presenting with PAI, compliance with an algorithm guiding selective non-operative management was low, but associated with lower laparotomy and lower unnecessary laparotomy rates. Improved compliance with algorithms directed towards selective non-operative management of PAI should be encouraged with stringent vigilance towards patient safety.
Article
Background There is a lack of high-quality population-based literature describing the epidemiology of primary anterior shoulder dislocation. Purpose To (1) calculate the incidence density rate (IDR) of primary anterior shoulder dislocation requiring closed reduction (CR; “index event”) in the general population and demographic subgroups, and (2) determine the rate of and risk factors for repeat shoulder CR. Study Design Cohort study (prognosis); Level of evidence, 2. Methods All patients who underwent shoulder CR by a physician in Ontario between April 2002 and September 2010 were identified with administrative databases. Exclusion criteria included age <16 and >70 years, posterior dislocation, and prior shoulder dislocation or surgery. Index event IDR was calculated for all populations/subgroups, and IDR comparisons were made. Repeat shoulder CR was sought until September 2012. Risk factors for repeat shoulder CR were identified with a Prentice, Williams, and Peterson proportional hazards model. Results There were 20,719 persons (median age, 35 years; 74.3% male) who underwent a shoulder CR after a primary anterior shoulder dislocation (23.1/100,000 person-years). The IDR was highest among young males (98.3/100,000 person-years). A total of 3940 (19%) patients underwent repeat shoulder CR after a median of 0.9 years, of which 41.7% were ≤20 years of age. Less than two-thirds of all first repeat shoulder CR events occurred within 2 years; in fact, 95% occurred within 5 years. The risk of repeat shoulder CR was lowest if the primary reduction had been performed by an orthopaedic surgeon (hazard ratio [HR], 0.76; 95% CI: 0.64, 0.90; P = .002) or was associated with a humeral tuberosity fracture (HR, 0.71; CI, 0.53, 0.95; P = .02). Older age (HR, 0.97; CI, 0.97, 0.98; P < .0001) and higher medical comorbidity score (HR, 0.92; CI, 0.87, 0.98; P = .009) were also protective. Risk was highest among males (HR, 1.26; CI, 1.16, 1.36; P < .0001) and patients from low-income neighborhoods (HR, 1.23; CI, 1.13, 1.34; P < .0001). Conclusion Young male patients have the highest incidence of primary anterior shoulder dislocation requiring CR and the greatest risk of repeat shoulder CR. Patient, provider, and injury factors all influence repeat shoulder CR risk. A comprehensive understanding of the epidemiology of primary anterior shoulder dislocation will aid management decisions and injury prevention initiatives.
Article
Introduction Seasonal media reports often describe the dangers of pumpkin carving, yet little data exists regarding the actual incidence of hand injuries resulting from pumpkin carving. The purpose of this study is to describe, quantify, and trend ED encounters associated with pumpkin-related knife injuries. Methods The National Electronic Injury Surveillance System (NEISS) was queried for pumpkin-related knife injuries from 2012 to 2021. Patient demographic and injury data was collected and analyzed to describe trends in incidence, patient demographics, and injury patterns associated with an ED encounter for a pumpkin-related knife injury. Results There were an estimated 20,579 (95% CI: 17,738–23,420) pumpkin-related knife injuries from 2012 to 2021. The incidence of pumpkin-related knife injuries remained stable over time (R² = 0.195, P = 0.201). Hand injuries comprised 87.6% of all injuries, with the thumb (33.5%) and index finger (25.0%) most commonly affected. Men and women were injured at similar rates (51.6% vs 48.4%). The most common demographic injured were 10 to 19-year olds (31.5%) followed by children <10-years old (19.5%). Women ages 10 to 19-years old were the most commonly injured subgroup (10.0% of all injuries). Most ED presentations occurred on Saturdays (16.5%) or Sundays (23.3%). The large majority occurred during the months of October (83.5%) followed by November (11.2%), with almost half of all cases (45.6%) occurring in the last week of October. Peak incidence of injury occurred on October 30th. Conclusion Pumpkin-related knife injuries are a preventable cause of hand injury with predictably high-incidence in fall months. Additionally, our data suggests further precautions should be taken to prevent injury in pediatric patients. Understanding at-risk populations in addition to implementing public safety initiatives and education on safe pumpkin-carving techniques could prevent serious injuries in the future.
Conference Paper
This video presents a novel technique for embedding optic fibers into a metal blade to sense objects that the knife is cutting. In particular, we present a design for a kitchen knife with fiber optics between the edge of the blade and the handle, with a skin-color sensor that overcomes the complex conditions in the kitchen. Hoping this design will lead to future work on minimizing cooking injuries, our handheld device also includes a simple finger-protection mechanism in the form of a retracting blade. We present our novel hardware design, an initial study of imaging capabilities, and a discussion of future directions.
Article
Objective: The aim of the study was to describe grill-related injuries in pediatric patients seeking emergency treatment. Methods: Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. United States Census Bureau data were used to calculate injury rates per 100,000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed. Results: An estimated 308,560 children were treated in US emergency departments for grill-related injuries during the study period, with an average of 15,428 cases per year. The rate of injuries increased by 32.3% during the study period. Males (62.8%) and children aged 11 to 18 years (55.8%) sustained the largest number of injuries. Children younger than 5 years were more likely to injure the head and neck (RR, 1.26 [95% CI, 1.21-1.33]), be injured by impact with a grill (RR, 1.97 [95% CI, 1.88-2.07]), and sustain burns (RR, 1.39 [95% CI, 1.35-1.45]) when compared with other age groups. Children aged 11 to 18 years were more likely to experience a fracture or dislocation (RR, 2.07 [95% CI, 1.58-2.72]) and more likely to sustain a grill-related injury while the grill was not in use (RR, 7.95 [95% CI, 6.25-10.12]). Conclusions: The rate of grill-related injuries among children is increasing, which underscores the need for increased prevention efforts. Prevention strategies should address measures such as lighting a grill and grill location in addition to burn prevention.
Article
Objective: To demonstrate the gap between injury epidemiology of terror-related stabbings (TRS) and non-terror-related intentional stabbings. Background: Terror attacks with sharp instruments have multiplied recently, with many victims of these incidents presented to hospitals with penetrating injuries. Because most practical experience of surgeons with intentional stabbing injuries comes from treating victims of interpersonal violence, potential gaps in knowledge may exist if injuries from TRS significantly differ from interpersonal stabbings (IPS). Methods: A retrospective study of 1615 patients from intentional stabbing events recorded in the Israeli National Trauma Registry during the period of "Knife Intifada" (January 2013-March 2016). All stabbings were divided into TRS and IPS. The 2 categories were compared in terms of sustained injuries, utilization of hospital resources, and clinical outcomes. Results: TRS patients were older, comprised more females and were ethnically homogenous. Most IPS incidents happened on weekdays and at night hours, whereas TRS events peaked midweek during morning and afternoon hours. TRS patients had more injuries of head, face, and neck, and severe head and neck injuries. IPS patients had more abdomen injuries; however, respective injuries in the TRS group were more severe. Greater injury severity of the TRS patients reflected on their higher hospital resources utilization and greater in-hospital mortality. Conclusions: Victims of terror stabbings are profoundly different in their characteristics, sustain injuries of a different profile and greater severity, require more hospital resources, and have worse off clinical outcomes, emphasizing the need of the healthcare systems to adjust itself appropriately to deal successfully with future terror attacks.
Article
The aim of this study is to reveal the features of changes in the structure of the cerebral cortex at different periods of the postmortem period after death from massive blood loss complicated by hemorrhagic shock. The morphological and morphometric features of the nervous and vascular structures were determined during death from blood loss complicated by hemorrhagic shock. The brain of 12 corpses of persons who died from stab and cut wounds of blood vessels and internal organs with sharp instruments at various times of the postmortem period were examined. It was found that as the time elapsed after death from hemorrhagic shock increases, an increase in destructive changes in both neurons and intracerebral vessels is observed in the brain. Autolytic processes to a greater extent occur in the intracerebral vessels in comparison with neurons, which is more pronounced in the later periods. The dimensions of the perineuronal and perivascular spaces in the dynamics of the postmortem period increase synchronously after death from hemorrhagic shock.
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Working at heights includes ladders, scaffolds and platforms roof, and working over tanks and pits, at the edge of elevated structures, or on top of vehicles or trailers. Falling from heights, especially from buildings, is a significant public health problem and is responsible for many serious and fatal injuries. Are such falls described in the Bible? What are the consequences of falling from a height? How can we deal with this disaster? How can such falls be prevented? Biblical texts which describe a fall from a building were examined and the verses were studied from a contemporary viewpoint.
Article
Introduction: Recent media reports have described knife injuries sustained while preparing avocados; however, this rise has not been reported in the literature. The purpose of this study is to describe, quantify, and trend emergency department (ED) encounters associated with avocado-related knife injuries. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for avocado-related knife injuries from 1998 to 2017. Patient demographic and injury data was collected and analyzed to describe trends in incidence, patient demographics, and injury patterns associated with an ED encounter for an avocado-related knife injury. Results: There were an estimated 50,413 (95% Confidence Interval: 46,333-54,492) avocado-related knife injuries from 1998 to 2017. The incidence of avocado-related knife injuries increased over this time period (1998-2002 = 3143; 2013-2017 = 27,059). This increase correlated closely with a rise in avocado consumption in the U.S. (Pearson's Correlation: 0.934, p < 0.001) Women comprised 80.1% of injuries. The most common demographic injured were 23 to 39-year old females (32.7%), while the least common was males under the age of 17 (0.9%). Most ED presentations occurred on Saturdays (15.9%) or Sundays (19.9%) and the majority occurred during the months of April through July (45.6%). Injuries were much more common on the left (and likely non-dominant) hand. Conclusion: Avocado-related knife injuries are a preventable cause of hand injury. The incidence has risen significantly in recent years, possibly due to an increased consumption of avocados in the United States. Education on safe avocado preparation techniques and public safety initiatives, such as warning labels, could help prevent serious injuries in the future.
Article
Stab wounds result in more than 400 000 injuries treated annually nationwide in the United States.¹ Management includes operative and selective nonoperative management (SNOM) depending on hemodynamic stability, stab wound location, presence of peritoneal signs, and surgeon preference.
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Introduction: Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument. Materials and methods: This was a prospective observational study, conducted and reported according to the STROBE statement. All adult patients with ladder-related injuries who presented to two EDs in southeast Queensland, Australia between October 2015 and October 2016 were approached. Initial participant interviews took place at the time of ED presentation or shortly thereafter, with follow-up telephone interview at six-months. Results: There were 177 enrolments, 43 (24%) were lost to follow up. There were statistically significant changes post-injury for three of the four AQoL dimensions: independence, social relationships and psychological wellbeing, as well as the global AQoL. Twenty-four (18%) participants reported a clinically significant deterioration in independence, 26 (20%) participants reported a clinically significant deterioration in their social relationships, and 34 participants (40%) reporting a clinically significant deterioration in their psychological wellbeing. Nine of the twelve individual items (in AQoL dimension) deteriorated after injury, there was no change in two items (vision and hearing) and an improvement reported in one (communication). The largest changes (> 25% of participants) were reported with sleeping, anxiety worry and depression, and pain. Across the global AQoL dimension, 65 (49%) participants reported a clinically significant deterioration. The severity of injury as measured by the ISS was an independent predictor of the change in AQoL scores (p<0.001). Conclusions: Injuries related to falls from ladders continue to have a profound impact on patients at six-months post-injury as measured using the AQoL instrument. This adds to previous research which has demonstrated considerable morbidity and mortality at the time of injury. Prevention: Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.
Article
Background The effect of obliquity of tendon laceration on repair strength is not well studied. The overwhelming majority of biomechanical studies assess repair strength following a laceration that is perpendicular to the long axis of the tendon. The aim of this study was to investigate whether the angle of tendon laceration affects the core suture strength. Methods In all, 110 fresh human cadaveric flexor tendons were cut at varying angles of 15°, 30°, 45°, and 60° and the control group at 90°. All tendons were repaired with 6-strand modified Tang technique. The repair strength was tested using a custom-made tensioning machine, and the initial static gap force and the ultimate breaking force were measured. Results The mean gap force and 95% confidence interval (CI) for the 15°, 30°, 45°, 60°, and 90° groups were 15.2 N (11.4-19.0 N), 15.8 N (13.6-18.1 N), 15.6 N (13.1-18.4 N), 16.6 N (13.7-19.5 N), and 22.3 N (16.6-27.9 N), respectively. In the same respective order, the break force and 95% CI were 25.9 N (21.9-29.8 N), 26.5 N (23.2-29.7 N), 31.1 N (26.1-36.1 N), 35.6 N (28.2-43.1 N), and 51.8 N (62.5-41.0), respectively. The Fisher least significant difference demonstrated significant differences between the control group and all experimental groups for both gap force and break force. Conclusions Obliquity of tendon laceration affects the core suture strength when compared with a transverse cut. Flexor tendons cut at 90° demonstrated a higher overall gap force and breaking strength that were statistically significant when compared with all obliquely cut groups. These findings should be considered when repairing and starting postoperative therapy for obliquely cut tendons.
Article
Background Hand and finger lacerations presenting to U.S. emergency departments (EDs) are common, although the burden of these injuries is not well understood. Objective Our aim is to describe the epidemiology and causes of hand and finger lacerations in U.S. EDs. Methods This National Electronic Injury Surveillance System database review investigates hand and finger lacerations presenting to EDs in the United States from 2015 to 2019. Results Annually, hand and finger lacerations account for 243,844 and 587,451 ED visits, respectively. Affected patients are frequently White (70.5%), male (63.4%), and aged 18 through 44 years (46.3%). The top three products linked to hand and finger lacerations are knives (30.5%), metal containers (4.2%), and drinkware (3.8%), and men are less likely to have injuries from these products than women, especially knives (odds ratio 0.76; 95% confidence interval 0.60–0.96; p < 0.02). Although a minority of hand and finger lacerations involve alcohol (1.2%), men have greater rates of alcohol involvement than women (χ²1 = 11.7; p < 0.001). Lacerations frequently occur in the home (61.3%). Many patients (44.2%) present to very large hospitals, and nearly one-half of patients younger than 5 years and one-third of patients aged 5 through 17 years present to pediatric hospitals. Most patients (97.4%) are treated and released without admission and 0.2% are transferred to another hospital. Patients with alcohol, drug, or medication involvement are more likely to leave against medical advice, be admitted, or held for observation (p < 0.001). Conclusions Hand and finger lacerations result in a significant number of ED visits. A better understanding of injury trends and presentations can guide injury prevention in manufacturing, education, and public health.
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Objectives: To describe the characteristics of patients who presented to the ED from a ladder-related fall and their injuries, highlight the impact of ladder-related falls on the ED, identify contributing factors of ladder falls and draw recommendations to improve ladder safety. Methods: A prospective observational study was conducted in two EDs. Patients' demographics and ED services used were obtained from medical records. A 53-item questionnaire was used to gather information about the type of ladder used, ladder activity, circumstances of the fall, contributing factors and future recommendations. Results: A total of 177 patients were recruited for this study. The typical patient was male, over the age of 50 and using a domestic ladder. The ED length of stay was between 30 min and 16 h, and was longer if patients were transferred to the short stay unit. Services most utilised in the ED included diagnostic tests, procedures and referrals to other healthcare teams. Most falls occurred because of ladder movement and slips or misstep. The major contributing factors identified were a combination of user features and flaws in ladder setup. Conclusions: Ladder-related falls carry a considerable burden to the ED. Recommendations include ladder safety interventions that target ladder users most at risk of falls: men, ≥50 years old and performing domestic tasks. Safety interventions should emphasise task avoidance, education and training, utilisation of safety equipment and appropriate ladder setup.
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Stab injuries of the spinal cord are rare. We report a case of a 22-year-old male who was hospitalized because of a spinal cord injury resulting from a stab wound in the posterior thoracolumbar area. On admission, the patient had 2/5 muscle strength of the right leg (monoparesis) and hypoesthesia below the L1 level. Radiological investigation revealed the retained tip of a knife that penetrated the spinal canal at the T12 level. An urgent right T12 hemilaminotomy was performed and retained knife fragment was removed. Six months after operation, the motor deficit had completely improved although hypoesthesia was still present. Surgery should be considered as the first-line treatment in cases of incomplete injuries of the spinal cord with retained metallic object.
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This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are shown on selected hospital, clinic, patient, and visit characteristics, as well as selected trends in OPD visits since 1993. The report highlights variation in use across the major types of OPD clinics surveyed. The data shown in this report were collected from the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. During 2003, an estimated 94.6 million visits were made to hospital OPDs in the United States, about 33.1 visits per 100 persons. This rate represents a 35-percent increase since 1993, although rates have been stable since 1999. Infants under 12 months of age had a visit rate of 88.7 visits per 100 persons, a rate that increased by 23 percent since 1993. Increasing trends in OPD visit rates were found for persons 50-64 years of age (up by 30 percent), 13-21 years of age (up by 32 percent), 22-49 years of age (up by 34 percent), and 1-12 years of age (up by 71 percent). Females had higher OPD visit rates than males (39.6 compared with 26.4 visits per 100 persons), and black or African American persons had higher OPD visit rates than white persons (59.7 compared with 29.9 visits per 100 persons). Medicaid and State Children's Health Insurance Program patients used OPDs for preventive care services more frequently than private pay patients. The preventive care visit rate by Hispanic and Latino patients was twice the rate by non-Hispanic patients. Diphtheria, tetanus, and acellular pertussis (DTaP) was the most frequently provided vaccine to children under age 18 years. Between 1993-94 and 2003, the proportion of visits involving only mid-level providers increased from 5.9 to 12.6 percent of visits.
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To investigate recent trends in in-patient admissions in England for assaults that involve a stabbing. Design and data source Time-series analysis of the NHS Health and Social Care Information Centre's Hospital Episode Statistics (HES) database. Setting England, April 1997 to March 2005. Main outcome measure All completed hospital admissions with a mention of assault by sharp object (International Classification of Diseases, Tenth Revision, code X99) in the relevant diagnosis fields in HES. In the eight years between 1st April 1997 and 31st March 2005 the number of people admitted to hospital reportedly following an assault involving a sharp object rose by 30%, from 3770 patients in 1997/8 to 4891 in 2004/5. One hundred and fifty-four of these people died (0.5%). Forty-two percent (14 220) of admissions were on a Saturday or Sunday. Males accounted for 90% (males 30 464 and females 3406) of admissions. Forty-nine percent (14 786) of the men, and 41% (1383) of the women, had injuries to the head, neck or thorax. The number of recorded hospital admissions from stabbing assaults increased between 1997 and 2005. Approximately 13 people a day are currently admitted to hospital for treatment after being stabbed. Further research is required to identify effective interventions to reduce the number of stabbings.
Article
There is a paucity of population-based research on health service utilization related to penetrating trauma in Canada, even though such trauma can result in serious injury or death, and gunshot wounds have been labelled the "the new public health issue." Complete epidemiologic data, including emergency department (ED) visits and hospitalizations, for penetrating trauma is not available. The objective of this paper is to describe the epidemiology of ED visits for firearm-related and knife-related penetrating trauma in one Canadian province. All EDs in the province of Ontario (pop. approx. 12 400 000 at the time of the study) submit data on ED visits to the National Ambulatory Care Reporting System. This database includes patients' demographic information (i.e., age, sex and geographic area of residence), the reason for the visit, disposition (i.e., admitted to hospital or sent home), and other diagnostic information. For visits related to injuries, the cause of injury is also reported (e-codes according to the Canadian Enhancement to the International Statistical Classification of Diseases and Related Health Problems, 10th rev [ICD-10-CA]). All patients seen in Ontario EDs for an injury related to a firearm, knife, or sharp object, were included in our study. Of the 1.2 million ED visits in 2002-03 for trauma in Ontario, 40 240 (3.4%) patients were treated for injuries relating to penetrating trauma. Most patients were male, and most were 15-24 years of age. Penetrating trauma was frequently a result of knives or sharp objects (39 654 visits or 98.5%); only 1.5% (n = 586) of these injuries were caused by firearms. Of those hospitalized, 151 were related to firearms and 1455 were related to knives/ sharp objects. Analyzing administrative data provides an estimate of the impact of penetrating trauma on a population, thereby providing prevention programs with data upon which to design their strategies. Evidence-based prevention strategies are needed to reduce the burden of penetrating trauma. Monitoring ED and hospitalization data over time will help to assess trends and provide evidence for the effectiveness of such strategies.
Article
Penetrating knife injuries of the face are more common in South Africa than the rest of the world. These injuries can be life-threatening, especially where the major blood vessels of the face are involved. The approach to treatment should be multidisciplinary, beginning with the trauma unit to provide airway maintenance and haemodynamic stabilisation. An interventional radiologist may be consulted for angiography. The aim of the present study was to retrospectively analyse all cases of knife-inflicted penetrating injuries to the maxillofacial region with the knife in situ and subsequently develop a management protocol to be used by maxillofacial surgery registrars when presented with such cases. It was a retrospective, cross-sectional and record-based study, analysing all penetrating knife injuries reported at various hospitals for a period of 11 years. In this study, 24 cases of knife injuries were analysed. Twenty-one patients (87.5%) in this series were male and three (12.5%) were female. Of these 24 patients, 13 (54.2%) were coloured and 11 (45.8%) were black. There were no white or Indian patients. Post-surgical recovery of all patients was rapid and uneventful, and there were no fatalities. Patients with knife injuries to the face with no definite signs of vascular injury can thus be safely and accurately managed on the basis of physical examination and plain-film radiography. An angiogram is mandatory if the patient presents with excessive bleeding, an expanding haematoma or if the knife blade is in the region of any large vessels.
Article
One hundred four patients treated for injuries incurred while hunting were prospectively studied during two consecutive fall seasons. A questionnaire was completed at initial evaluation and hospital records were subsequently reviewed. One hundred (98%) patients were male. Patient ages ranged from 10 to 78 years (median = 32 years). Mechanism of injury included knife or arrow penetrations (25), firearm wounds (12), falls (17), overexertion (5), and misadventures with hazards (40). Soft tissue, maxillofacial and orthopedic injuries predominated. Four patients experienced cardiac events. Hypothermia was noted in three, and animal-related injuries occurred in five. Eighteen (17%) patients were hospitalized. Serious injury was evident in 34 (33%). There were no deaths. Outpatient follow-up was necessary in 90%. Mishaps most frequently occurred because of overexcitement, unfamiliarity with equipment, or carelessness. Alcohol and drug use were only rarely identified. Almost one half of patients were injured during the 9-day gun deer hunting season. A wide variety of injuries occur during hunting activities. While many are minor, serious morbidity with potential long-term disability may result. Costs in time and money may be substantial. Simple measures could prevent many hunting-related mishaps.
Article
Injuries to the hand in the home are common and form a substantial proportion of hand injuries seen in accident departments. Two of us (AFSF and JS) recognised an increasing number of cases of a characteristic and preventable injury, caused by the person trying to separate stacked frozen food items with a sharp knife. We therefore reviewed the case notes of patients at three hospitals and also examined the Department of Trade's home accident surveillance system database for similar injuries.
Article
This retrospective review of eight years of trauma registry data at an inner-city level-1 trauma center was undertaken to discover at what age urban children start to become at high risk of being victims of either a major gunshot wound or stabbing. We reviewed data from 2,191 patients who were the victim of either a gunshot wound or stabbing, were 18 years of age or under, and met pre-established criteria to qualify as a major trauma victim. There was a rise and subsequent fall in both overall crime and intentional injury rates during the eight-year period. Nevertheless, in each of the eight years studied, the risk of being a victim of a major gunshot wound or stabbing rose abruptly at age 14 (p<0.01) and the incidence continued to rise sharply through age 18.
Article
Even with optimal treatment, injuries from pumpkin carving accidents may leave people with compromised hand function. Pumpkin carving tools may reduce the incidence and/or magnitude of these injuries. However, evidence that they are safer is required before these knives can be recommended. Two pumpkin carving knives were compared to a serrated and a plain kitchen knife. The forces required to cut and pierce a pumpkin were determined and then applied by a servo-hydraulic machine to each knife placed against cadaver hands in a manner designed to either lacerate Zone 2 of the finger (six tests for each knife) or to puncture the hand. Inspection and dissection determined the extent of injury. The pumpkin knives produced some injuries, however, they were fewer and less severe than those caused by the kitchen knives. Tools designed specifically for pumpkin carving may indeed be safer. Use of these products, and increased overall awareness of the risks of pumpkin carving in general, which clinicians could help promote, might reduce the frequency and severity of pumpkin carving injuries.
Article
Only 171 patients with injuries that were caused as a result of stubbing treated in Jan Bozy Regional Hospital in Lublin in the years 1997-2000, were analysed. The injured people were mostly men aged 21-40. 142 people were treated in outpatient clinic, and 29 were hospitalized. The medium ime spent in hospital was about 7 days. Eleven of the hospitalized patients were operated on immediately. On the basis of the analysis of the research results it was estimated that: 1. The most frequent tool ausing stabbed wounds in the case of hospitalized patients was a knife, and in outpatients--a nail. 2. The circumstances in which the stabbed wounds were most often appearing were accidents (out-patient clinic) and in the case of hospitalized patients assaults by unknown culprits. 3. The most frequent localization of the stabbed wounds among the hospitalized patients was chest and among the outpatients an arm or a leg.
Article
Homicide rates have been increasing in Scotland, and homicides involving knives are of particular concern. and results We use mortality and population data from 1981 to 2003 to calculate smoothed, standardized mortality rates for all homicides and homicides involving knives and other sharp objects, for all of Scotland and separately for Glasgow. Over half of homicides where the victim was male involved the use of a knife. Over 20 years, the homicide rate rose 83%, whilst that involving knives increased by 164%. The rapid increase in homicide involving knives is becoming a public health problem. Proposed changes to legislation are unlikely to halt this rise.
Article
Attempting to separate frozen food with a knife can result in serious injury to the hand. This injury is prevalent and is a common reason for referral to hand surgeons. Ten cases were reviewed over a 3-month period; the causative frozen food varied widely. Seven of the 10 patients required surgical exploration, and of these 7 patients, 3 were found to have significant injury. The injuries varied from digital nerve injuries to damaged flexor tendons. The other 4 patients were all found to have only soft tissue damage.
Article
The purpose of this study was to characterize big game hunter visits to a rural hospital's emergency department (ED). Using data collected on fatalities, injuries, and illnesses over a 9-year period, trends were noted and comparisons made to ED visits of alpine skiers, swimmers, and bicyclists. Out-of-hospital hunter fatalities reported by the county coroner's office were also reviewed. Cautionary advice is offered for potential big game hunters and their health care providers. Self-identified hunters were noted in the ED log of a rural Colorado hospital from 1997 to 2005, and injury or illness and outcome were recorded. Additional out-of-hospital mortality data were obtained from the county coroner's office. The estimated total number of big game hunters in the hospital's service area and their average days of hunting were reported by the Colorado Division of Wildlife. The frequencies of hunters' illnesses, injuries, and deaths were calculated. A total of 725 ED visits--an average of 80 per year--were recorded. Nearly all visits were in the prime hunting months of September to November. Twenty-seven percent of the hunter ED patients were Colorado residents, and 73% were from out of state. Forty-five percent of the visits were for trauma, 31% for medical illnesses, and 24% were labeled "other." The most common medical visits (105) were for cardiac signs and symptoms, and all of the ED deaths (4) were attributed to cardiac causes. The most common trauma diagnosis was laceration (151), the majority (113) of which came from accidental knife injuries, usually while the hunter was field dressing big game animals. Gunshot wounds (4, < 1%) were rare. Horse-related injuries to hunters declined while motor vehicle- and all-terrain vehicle (ATV)-related injuries increased. The five out-of-hospital deaths were cardiac related (3), motor vehicle related (1), and firearm related (1). Fatal outcomes in big game hunters most commonly resulted from cardiac diseases. Gunshot injuries and mortalities were very low in this population. Knife injuries were common. Hunters and their health care providers should consider a thorough cardiac evaluation prior to big game hunts. Hunter safety instructors should consider teaching aspects of safe knife use. Consideration should be given to requiring and improving ATV driver education.
Article
Stabbing is the most common method for violent death in the UK. As part of their investigation, forensic pathologists are commonly asked to estimate or quantify the degree of force required to create a wound. The force required to penetrate the skin and body by a knife is a complex function of the sharpness of the knife, the area of the body and alignment with cleavage lines of the skin, the angle of attack and the relative movement of the person stabbing relative to the victim being stabbed. This makes it difficult for the forensic pathologist to give an objective answer to the question; hence, subjective estimations are often used. One area where some degree of quantification is more tractable is in assessing how sharp an implement (particularly a knife) is. This paper presents results of a systematic study of how the different aspects of knife geometry influence sharpness and presents a simple test for assessing knife sharpness using drop testing. The results show that the radius of the blunt edge at the tip is important for controlling the penetration ability of a kitchen knife. Using high-speed video, it also gives insight into the mechanism of knife penetration into the skin. The results of the study will aid pathologists in giving a more informed answer to the question of the degree of force used in stabbing.
Topic: Knife safety Available at: http://safety.cat. com/toolbox
  • Toolbox
Toolbox Talks. Topic: Knife safety. Available at: http://safety.cat. com/toolbox. Accessed June 24, 2011.
HSE information sheet How to reduce your hand knife injuries. Plastics Processing Sheet No 12
  • Health
  • Safety
  • Executive
Health and Safety Executive (HSE). HSE information sheet. How to reduce your hand knife injuries. Plastics Processing Sheet No 12. May 2000. Available at: http://www.hse.gov.uk/pubns/pps12.pdf. Accessed June 24, 2011.
Knife safety. Indiana FACS Best Practices Available at
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Brattain DH. Knife safety. Indiana FACS Best Practices. 2007. Available at: http://www.docstoc.com/docs/29119195/CAF-KNIFESAFETY. Accessed June 24, 2011.
Knife definition Available at: http://www. webster-dictionary.net/definition/knife
  • Webster Dictionary
Webster Dictionary. Knife definition. Available at: http://www. webster-dictionary.net/definition/knife. Accessed June 24, 2011.