Biomechanical Investigation of Pediatric Accidents

儿科事故的生物力学调查

• 批准号: 6623840
• 负责人: GINA E. BERTOCCI
• 金额: $ 6.18万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-04-01 至 2004-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6623840
• 关键词: X ray; accidental falls; accidents; arm; behavioral /social science research tag; biomechanics; bone fracture; child (0-11); child abuse; computer simulation; diagnosis design /evaluation; environment; epidemiology; human subject; information systems; mental disorder diagnosis; model design /development; patient oriented research; pediatrics; photon absorptiometry

DESCRIPTION (provided by applicant): Child abuse and neglect is the leading cause of trauma-related death in children < 4 years age, killing more children than motor vehicle crashes and drowning combined. Every year in the US, nearly 2,000 children die, 18,000 are permanently disabled, and 150,000 children are seriously injured from child abuse and neglect. Fractures are second only to bruising as a presentation of abuse and indicate the child is being subjected to trauma that is potentially life threatening. Humerus fractures are common in child abuse, especially children 1 year or less, but can also occur accidentally. Because caregivers fabricate histories as to how the injury occurred, and because children are too young or often afraid to communicate what happened, the clinician must decide if the reported accident history and injury are consistent and compatible. A current lack of biomechanical understanding of fractures in children makes differentiation between intentional and unintentional trauma more difficult. Decisions are typically empiric rather than evidence-based, resulting in both missed cases of abuse and over-diagnosis in innocent families. Because the child's safety may rest on this single determination, a more scientific approach is needed. Before one can better identify injuries resulting from child abuse, one must first gain a more scientific understanding of the injury mechanisms and the resulting forces necessary to generate fractures in the infant and child. The PIs have chosen to focus their study on those children 0-10 years who present with accidental humerus fractures. The study is designed to increase scientific knowledge of pediatric humerus bone strength through assessing bone geometry using plain x-rays and bone mineralization using dual energy x-ray absorptiometry (DXA). Additionally, for each case they intend to advance the biomechanical understanding of pediatric accidents through scene investigations coupled with biodynamic calculations characterizing the accident. By building a database of these case-based injury scenarios that are truly unintentional and well documented, the PIs can begin to better understand the relationship between intrinsic biological properties of bone, fracture incidence and extrinsic biomechanical characteristics of a specific injury scenario. The proposed comprehensive model, which focuses on the relationship between case-specific intrinsic biological properties and extrinsic biomechanical characteristics of the specific accident, is the first step towards aiding clinicians in objectively identifying false accident histories. Through the use of computer simulation techniques they will further the understanding of how accident environment factors can influence key biomechanical measures associated with injury risk. The project specific aims include: 1. Conduct a clinical study in young children with humerus fractures to explore the relationship between radiographic derived bone properties and biochemical measures. 2. Develop and validate computer simulation models to investigate the biomechanics of hypothetical common pediatric falls. The long term goal is to develop a clinical tool that predicts the likelihood of pediatric fracture for a given accident scenario aiding clinicians in determining between intentional and unintentional injury.

描述（由申请人提供）：虐待和忽视儿童是主要问题 4 岁以下儿童创伤相关死亡的原因，导致更多儿童死亡 比机动车碰撞和溺水的总和还要多。在美国，每年几乎 2,000 名儿童死亡，18,000 名儿童永久残疾，150,000 名儿童 因虐待和忽视儿童而受重伤。骨折仅次于 瘀伤是虐待的表现，表明孩子正在遭受虐待 可能危及生命的创伤。肱骨骨折很常见 虐待儿童，尤其是一岁或以下的儿童，但也可能发生 偶然。因为护理人员捏造了关于受伤过程的历史 发生过，并且因为孩子太小或经常害怕沟通 发生了什么，临床医生必须决定所报告的事故历史和 伤害是一致且相容的。 目前对儿童骨折缺乏生物力学认识，使得 区分有意和无意的创伤更加困难。 决策通常是经验性的而不是基于证据的，导致 漏掉了无辜家庭的虐待和过度诊断案件。因为 儿童的安全可能取决于这个单一的决定，一个更科学的决定 需要采取方法。在人们能够更好地识别因以下原因造成的伤害之前 虐待儿童，首先必须对伤害有更科学的认识 产生断裂所需的机制和合力 婴儿和儿童。 PI 选择将研究重点放在这些孩子身上 0-10 岁因意外肱骨骨折而就诊的患者。该研究是 旨在增加儿童肱骨骨强度的科学知识 通过使用普通 X 射线和骨矿化评估骨几何形状 使用双能 X 射线吸收测定法 (DXA)。此外，对于每种情况，他们 旨在促进对儿科事故的生物力学理解 通过现场调查结合生物动力学计算 描述事故的特征。通过建立这些基于案例的伤害数据库 对于真正无意且有据可查的场景，PI 可以开始 更好地理解内在生物学特性之间的关系 骨、骨折发生率和外在生物力学特征 具体的伤害场景。所提出的综合模型重点关注 病例特异性内在生物学特性与 具体事故的外在生物力学特征，是第一个 帮助临床医生客观识别虚假事故的一步 历史。 通过使用计算机模拟技术，他们将 进一步了解事故环境因素如何影响 与受伤风险相关的关键生物力学措施。 该项目的具体目标包括： 1. 对患有肱骨骨折的幼儿进行临床研究 探索射线照相衍生的骨特性与 生化措施。 2. 开发并验证计算机模拟模型以研究 假设的常见儿科跌倒的生物力学。 长期目标是开发一种临床工具来预测可能性 特定事故场景下的儿童骨折情况，帮助临床医生 判断故意伤害和非故意伤害。