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的 4岁以下儿童与创伤有关的死亡原因， 比车祸和溺水加起来还要多在美国，几乎每年 2，000名儿童死亡，18，000名儿童终身残疾，150，000名儿童 因虐待和忽视儿童而严重受伤。骨折是仅次于 瘀伤作为虐待的表现，并表明儿童正在遭受 可能危及生命的创伤肱骨骨折很常见 在虐待儿童，特别是1岁或以下儿童，但也可能发生 意外地因为护理人员编造了关于受伤的历史 发生，因为孩子们太小或往往害怕沟通， 发生了什么，临床医生必须决定是否报告的事故历史， 伤害是一致和相容的。 目前缺乏对儿童骨折的生物力学理解， 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，导致两者兼而有之。 在无辜的家庭中遗漏了虐待和过度诊断的案例。因为 孩子的安全可能取决于这一单一的决心，更科学的 方法是必要的。在人们能够更好地识别 虐待儿童，首先必须对伤害有一个更科学的认识 机制和所产生的必要的力量，以产生裂缝， 婴儿和儿童。 私家侦探们选择把他们的研究重点放在这些孩子身上 0-10出现肱骨意外骨折的患者这项研究是 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， 旨在促进对儿科事故的生物力学理解， 通过现场调查和生物动力学计算 描述事故。通过建立一个数据库， 在真正无意且记录良好的情况下，PI可以开始 为了更好地理解内在生物学特性之间的关系， 骨折发生率和外在生物力学特征 具体伤害情况。拟议的综合模式侧重于 病例特异性内在生物学特性与 外在的生物力学特性的具体事故，是第一位的 帮助临床医生客观识别虚假事故的步骤 历史 通过使用计算机模拟技术， 进一步了解事故环境因素如何影响 与损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. 对肱骨骨折的幼儿进行临床研究， 探索放射学衍生骨特性与 生化措施。 2. 开发和验证计算机模拟模型，以调查 假设的常见小儿福尔斯跌倒的生物力学。 长期目标是开发一种临床工具， 儿科骨折的特定事故场景，帮助临床医生 区分故意伤害和非故意伤害。