The ability to calculate quality-adjusted life-years (QALYs) for degenerative cervical myelopathy (DCM) would enhance treatment decision making and facilitate economic analysis. QALYs are calculated using utilities, or health-related quality-of-life (HRQoL) weights. An instrument designed for cervical myelopathy disease would increase the sensitivity and specificity of HRQoL assessments. The objective of this study is to develop a multi-attribute utility function for the modified Japanese Orthopedic Association (mJOA) Score. We recruited a sample of 760 adults from a market research panel. Using an online discrete choice experiment (DCE), participants rated 8 choice sets based on mJOA health states. A multi-attribute utility function was estimated using a mixed multinomial-logit regression model (MIXL). The sample was partitioned into a training set used for model fitting and validation set used for model evaluation. The regression model demonstrated good predictive performance on the validation set with an AUC of 0.81 (95% CI: 0.80-0.82)). The regression model was used to develop a utility scoring rubric for the mJOA. Regression results revealed that participants did not regard all mJOA domains as equally important. The rank order of importance was (in decreasing order): lower extremity motor function, upper extremity motor function, sphincter function, upper extremity sensation. This study provides a simple technique for converting the mJOA score to utilities and quantify the importance of mJOA domains. The ability to evaluate QALYs for DCM will facilitate economic analysis and patient counseling. Clinicians should use these findings in order to offer treatments that maximize function in the attributes viewed most important by patients

Surfing is a popular UK water-sport. Recommendations for protective gear are based on studies abroad from trauma from large waves and reef breaks which may not be relevant in the UK. This study assesses the aetiology of UK surfing injuries in order to assist treatment and provide formative recommendations on protective equipment. Data was collected from UK surf clubs via an online survey. 130 individuals reported 335 injuries. M:F ratio 85:45, median age 28 (range 17–65). Head injuries were the most common (24%) followed by foot and ankle (19%). Surfers collided most often with their own boards (31%) followed by rocks/coral (15%), the sea (11%) and other surf boards (10%). Lacerations were the commonest injury (31%); followed by bruises/ black-eyes (24%) and joint/ligament sprains (15%). Concussions (5%), fractures (3%) and teeth injuries (1%) were rare. Less than 1/3 of all injuries required professional medical attention, 2 required operative intervention. Surfing injuries in the UK are common but usually minor. Serious head injuries (fractures and concussions) are rare. There is insufficient evidence to warrant the routine use of protective helmets whilst surfing in the UK, although protective head and foot gear may be considered when surfing the rarer reef/ rock breaks

The timely management of anticoagulated elderly trauma patients remains a contentious issue. Presently, the literature consists of largely contradictory expert opinions without evidence from randomised control trials. This study seeks to audit the practices of a non-metropolitan orthopaedic service, as a prelude to developing a local protocol for optimal management. All orthopaedic admissions to Toowoomba Hospital from January 2004 to December 2008 were reviewed. Approximately 700 patients over the age of 60 years were admitted with lower limb trauma. Those patients with pre-injury medication with warfarin and clopidogrel were identified, along with chronologically matched untreated patients. Those patients with coexisting head-injures, and those with sub therapeutic INR (INR <1.5) on admission were excluded from the study groups. Groups were analysed with respect to age, Injury Severity Score, ASA, time to theatre, time to discharge, transfusion requirement, and complications. Statistical analysis was completed using the T-test. Of the 700 patients identified, 24 were treated with warfarin and 28 treated with clopidogrel. Two patients with pre-injury warfarin use were excluded due to sub therapeutic INR on admission (INR 1.0 and 1.3). The control and treatment groups were statistically similar with respect to age, Injury Severity Score, and ASA. Injury patterns were similar across groups with over 80% proximal femoral fractures in each group. In both the warfarin and clopidogrel groups there was a statistically significant increase in time from admission to theatre compared with their matched controls (P<0.001). Average number of days to theatre was seven days and five days for the clopidogrel and warfarin groups respectively, compared to two days for both control groups. There was no significant difference between the groups in length of time from operation to the end of their acute care. There was no increase in transfusion requirement in those patients with pre-injury clopidogrel use. Pre-injury warfarinisation demonstrated a trend toward increased transfusion requirement compared with the matched controls (P=0.052); however, this was not significant. There was no clinically significant increase in complications in those patients with pre-injury use of warfarin or clopidogrel. This study demonstrated no increased morbidity in elderly patients with lower limb trauma when being treated with anticoagulants prior to injury. However, there is a significant delay in operative intervention in these patients. We believe this presents a case for early reversal of anticoagulant therapy in order to expedite treatment