Every year in the United States, an estimated 1.6 to 3.8 million people sustain sports-related traumatic brain injuries (TBIs), with an appreciable number of these injuries coming from the sport of softball. Several studies have analyzed the impact performance of catcher’s masks within the context of baseball; however, virtually no studies have been performed on fielder’s masks within the context of softball. Thus, the main objective of the present work was to evaluate the protective capabilities of softball fielder’s masks. To better understand the injury mechanisms and frequency associated with softball head/facial injuries, epidemiological data from a national database was reviewed first. Results displayed “struck-by-ball” as the most frequent injury mechanism (74.3%) for all head/facial injuries with a large majority occurring to defensive players (83.7%). With further motivation, the present work focused on testing the impact attenuation and facial protection capabilities of fielder’s masks from softball impacts. Testing with an instrumented Hybrid III headform was conducted at two speeds and four impact locations for several protective conditions: six fielder’s masks, one catcher’s mask, and unprotected (no mask). The results showed that most fielder’s masks reduced head accelerations, but not to the standard of catcher’s masks. On average, they reduced peak linear and angular acceleration from 40-mph impacts by 36-49% and 14-45%, respectively, while for 60-mph impacts they were reduced by 25-42% and 13-46%, respectively. Plastic-frame fielder’s masks were observed to allow facial contact when struck at the nose region at high speed. Observed differences in impact attenuation across fielder’s mask designs further suggested influence from specific design features such as foam padding and frame properties. Overall, the results clearly demonstrate that head/facial injuries may be mitigated through the broader use of masks, while further optimization of impact attenuation for fielder’s masks is pursued.

Introdução: A frequência de vítimas de traumatismo cranioencefálico (TCE) nos serviços de emergência vem aumentando no mundo e conhecer a evolução dessas vítimas nas primeiras horas após lesão é um caminho importante para padronizar sua avaliação e alcançar melhores resultados no seu tratamento. Objetivos: Analisar, durante permanência na sala de emergência (SE), a evolução das vítimas que apresentaram TCE contuso como lesão principal e identificar, entre as variáveis demográficas, os indicadores de gravidade e as características do atendimento pré e intra-hospitalar, os fatores associados ao tempo de permanência na SE dessas vítimas. Método: Estudo do tipo corte prospectivo, com dados coletados na admissão da vítima de TCE na SE e 2, 4 e 6 horas após, ou até a transferência para tratamento definitivo em unidades específicas, ou óbito. Participaram desse estudo vítimas de TCE contuso como lesão principal, com idade 15 anos, admitidas em serviço de emergência referência para neurocirurgia, até 1 hora após trauma. A evolução das vítimas foi descrita pelas diferenças na pontuação Rapid Emergency Medicine Score (REMS) entre as avaliações na admissão na SE e 2, 4 e 6 horas após. Análises descritivas foram utilizadas para caracterização dos casos e descrever a evolução das vítimas. Testes estatísticos foram aplicados para verificar associação entre tempo de permanência na SE e idade, sexo, gravidade e características do atendimento pré e intra-hospitalar. Resultados: A casuística foi composta de 46 vítimas, 84,7% do sexo masculino, idade média de 34,7 anos (dp=15,1), 63% envolvidas em acidentes de trânsito. Na admissão na SE, o REMS médio dessas vítimas foi de 4,0 (dp=2,5), as médias do Injury Severity Score (ISS) e New Injury Severity Score (NISS) foram de 11,8 (dp=7,7) e 17,2 (dp=12,7), respectivamente. A Escala de Coma de Glasgow(ECGl) indicou 54,4% de casos de TCE grave e o Maximum Abbreviated Injury Scale/ região cabeça (MAIS/cabeça) apresentou média de 2,7 (dp=1,1). Entre a admissão na SE e 2 horas após, foram observadas mudanças desfavoráveis em 35,1% das vítimas e favoráveis em 27%; entre 2 e 4 horas, a evolução desfavorável foi constatada em 13,6% e favorável em 27,3%; entre 4 e 6 horas, constatou-se piora em 42,8% dos casos e melhora em 28,6%. Em média, as vítimas que tiveram piora apresentaram diferença de 2,8 (dp=2,3) no REMS entre admissão e 2 horas, de 2 (dp=0) entre 2 e 4 horas e de 2,3 (dp=0,5) entre 4 e 6 horas. Houve diferença estatisticamente significativa no tempo de permanência na SE somente em relação à variável uso de suporte hemodinâmico nesse serviço. Conclusão: A melhora de cerca de mais de ¼ das vítimas de TCE contuso ocorreu em todos os períodos de avaliação, porém a frequência dos casos de evolução desfavorável foi maior do que favorável entre admissão e 2 horas e ainda mais elevada após permanência de 4 horas na SE. O maior tempo de permanência na SE esteve relacionado com uso de suporte hemodinâmico nesse serviço. / Introduction: The frequency of traumatic brain injury (TBI) in emergency services is increasing worldwide and knowing the evolution of these victims in the first hours after injury is an important way to standardize their evaluation and achieve better treatment outcomes. Objectives: To analyze the evolution of the victims whose main lesion was blunt TBI and to identify, among demographic variables, severity indicators and characteristics of pre and in-hospital care, as well as factors associated with length of stay in the emergency room (ER) of these victims. Method: A prospective study, with data collected at the admission of the TBI victim at ER and 2, 4 and 6 hours after, or until transfer to definitive treatment in specific units, or death. Participants of this study presented blunt TBI as the main lesion, age 15 years and were admitted at ER for neurosurgery up to 1 hour after trauma. The evolution of the victims was described by the differences in the Rapid Emergency Medicine Score (REMS) among the assessments on admission at ER and 2, 4 and 6 hours after. Descriptive analyzes were used to characterize the cases and describe the evolution of the victims. Statistical tests were applied to verify the association between length of stay in ER and age, sex, severity and characteristics of pre and in-hospital care. Results: The casuistry consisted of 46 victims, 84.7% were male, mean age was 34.7 years (SD=15.1), and 63% were involved in traffic accidents. On admission at ER, the mean REMS of these victims was 4.0 (SD=2.5), the mean Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 11.8 (SD=7.7) and 17.2 (SD=12.7), respectively. Glasgow Coma Scale (GCS) indicated 54.4% of cases of severe TBI and the Maximum Abbreviated Injury Score/ head region (MAIS/head) showed an average of 2.7 (SD=1.1). From admission at ER until 2 hours later, unfavorable changes were observed in 35.1% of the victims and favorable changes were seen in 27%; between 2 and 4 hours, the unfavorable evolution was observed in 13.6% and favorable evolution was noted in 27.3%; between 4 and 6 hours, it was found worsening in 42.8% of the cases and improvement in 28.6%. On average, patients who experienced worsening had a difference of 2.8 (SD=2.3) in REMS from admission to 2 hours, 2 (SD=0) between 2 and 4 hours and 2.3 (SD=0.5) between 4 and 6 hours. There was a statistically significant difference in the lenght of stay in ER only in relation to the variable use of hemodynamic support in this service. Conclusion: The improvement of more than ¼ of the victims of blunt TBI occurred in all the evaluation periods, but the frequency of unfavorable cases was higher than favorable between admission and 2 hours and even higher after 4 hours in ER. The longer time in ER was related to the use of hemodynamic support in this service.

Law / LL.M.

Law / LL.M.