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）：虐待和忽视儿童是领导 <4岁的儿童与创伤有关的死亡原因，杀死更多的孩子 比机动车撞车和溺水合并。每年在美国，几乎 2,000名儿童死亡，18,000人永久残疾，150,000名儿童 因虐待和忽视儿童而受到严重伤害。裂缝仅次于 瘀伤是虐待的介绍，表明孩子正在受到 可能威胁生命的创伤。肱骨骨折很常见 在虐待儿童中，尤其是1岁以下的儿童，但也可能发生 偶然。因为护理人员捏造了有关如何受伤的历史 发生了，因为孩子太年轻或经常害怕交流 发生了什么事，临床医生必须决定报告的事故历史和 伤害是一致且兼容的。 目前对儿童骨折的生物力学理解缺乏 故意和意外创伤之间的区分更加困难。 决策通常是经验性的，而不是基于证据的，这两者都 错过无辜家庭中虐待和过度诊断的案件。因为 孩子的安全可能基于这个单一的决心，这是更科学的 需要方法。在一个人可以更好地识别由 虐待儿童，必须首先对伤害有更科学的理解 机制和产生裂缝所必需的力量 婴儿和孩子。 PI选择将他们的研究集中在这些孩子上 0-10岁的人出现意外的肱骨骨折。这项研究是 旨在提高小儿肱骨强度的科学知识 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射线吸收法（DXA）。此外，对于每种情况 打算提高对小儿事故的生物力学理解 通过场景调查，结合生物动力计算 表征事故。通过构建这些基于病例伤害的数据库 PIS可以开始 更好地了解固有生物学特性之间的关系 骨骼，骨折的发生率和外在生物力学特征 具体伤害方案。拟议的综合模型，重点是 病例特定的内在生物学特性与 特定事故的外在生物力学特征是第一个 迈向帮助临床医生客观地确定虚假事故 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 与伤害风险相关的关键生物力学措施。 该项目的特定目的包括： 1。对肱骨骨折的幼儿进行临床研究 探索放射线派生的骨特性与 生化措施。 2。开发和验证计算机模拟模型以研究 假设的普通小儿跌倒的生物力学。 长期目标是开发一种预测可能性的临床工具 在给定事故情况下的小儿骨折的临床医生 确定故意和无意伤害。