Biomechanical Investigation of Pediatric Accidents

描述(申请人提供)：虐待儿童和忽视儿童是主要原因 与创伤相关的儿童死亡原因&4岁，导致更多儿童死亡 比车祸和溺水加起来还多。每年在美国，几乎 2,000名儿童死亡，18,000名永久残疾，150,000名儿童 因虐待和忽视儿童而严重受伤。骨折仅次于 瘀伤是虐待的表现，表明孩子受到了虐待 可能危及生命的创伤。肱骨骨折是常见的 虐待儿童，特别是1岁或1岁以下的儿童，但也可能发生 不小心。因为照顾者捏造了受伤的历史 发生，因为孩子太小或经常害怕交流 发生了什么，临床医生必须决定是否报告的事故历史和 伤病是一致的，相容的。 目前对儿童骨折缺乏生物力学的了解使 区分故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，结果是两者都 无辜家庭中的虐待和过度诊断的漏诊案例。因为 儿童的安全可能取决于这一单一的决心，一个更科学的 方法是必要的。在人们能够更好地识别由以下原因引起的伤害之前 虐待儿童，首先必须对伤害有更科学的了解 产生骨折所需的机制和所产生的力 婴儿和儿童。私家侦探们选择将他们的研究重点放在这些孩子身上 0-10岁，出现意外的肱骨骨折。这项研究是 旨在增加对儿童肱骨骨强度的科学知识 通过使用普通x射线和骨矿化来评估骨几何形状 采用双能X线骨密度仪(DXA)。此外，对于每一种情况，他们都 旨在提高对儿科意外的生物力学认识 通过现场调查和生物动力学计算 描述了这起事故。通过建立这些基于案例的伤害的数据库 如果场景确实是无意的并且有很好的文档记录，那么PI就可以开始 为了更好地理解内在生物特性之间的关系 骨量、骨折发生率和外生物力学特征 具体的伤害场景。建议的综合模式，重点是 病例特有的内在生物学特性与 外在生物力学特征的具体事故，是第一 向协助临床医生客观鉴定虚假事故迈进一步 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指标。 该项目的具体目标包括： 1.开展幼儿肱骨骨折的临床研究 探讨放射学衍生骨特性与骨密度的关系 生化指标。 2.开发和验证计算机模拟模型，以研究 假想的儿科常见跌倒的生物力学。 长期目标是开发一种临床工具，可以预测这种可能性 在给定的意外情况下的儿科骨折帮助临床医生 确定故意伤害和非故意伤害。

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.