Johnson‐Greene, Douglas

Objective To determine the accuracy of ultrasound guidance compared to palpation in performing carpometacarpal joint injections in cadavers. Design In all, 36 carpometacarpal joints were randomized to either ultrasound-guided or palpation-based injections, with 1 cc of blue latex solution injected into each joint. The specimens were then dissected and the distribution of the latex was assessed by two independent, blinded raters. Injection accuracy was evaluated on a four-point quartile rating scale of 1–4, corresponding to the amount of the latex solution within the joint (1 = 0–25%, 2 = 26–50%, 3 = 51–75%, 4 = 76–100%). Inter-rater reliability was a secondary measure. Results The mean rating of accuracy was 2.1 for both palpation-based and ultrasound-guided injections. There was no statistically significant difference in accuracy between the two injectors. Chi-square analysis testing differences in accuracy for the two conditions was not statistically significant. The Cronbach’s alpha for rater 2 was 0.74, which represents an acceptable level of reliability. A Friedman’s Chi-square for the two raters was 2.3 ( p = 0.13), indicating no significant difference between raters. Conclusion Ultrasound guidance did not improve the accuracy of carpometacarpal joint injections in cadavers. However, the high inter-rater reliability attests to the value of the novel assessment scale.

SummaryObjectiveDetermine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate‐to‐severe TBI requiring rehabilitation and surviving at least 5 years.MethodsUsing the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h–7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined.ResultsPTS incidence during acute hospitalization was highest immediately (<24 h) post‐TBI (8.9%). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2%). Late PTS cumulative incidence from injury to year 1 was 11.9%, and reached 20.5% by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self‐identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23–32 (year 5 RR = 2.43) and 33–44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively).SignificanceIn this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high‐risk subgroups and to delineate contributors to race/age associations on long‐term seizure outcomes.