20
Young adults
Sports injuries
In 2009, approximately 75 % of UK adults between 16–24 years and 66 % of the 25–44 age group participated in sports and physical activities. The most popular sports activities amongst young adults included walking, gym, cycling, and swimming, followed by football and jogging (Beaumont 2011).
Although the mechanisms of injuries associated with sports injuries are dependent on the type of activities, they are similar to those using motor vehicles, motorbikes and pedal cycles and involve energy and force of impact on the victim (Stewart & Allen 2007, Dandy & Edwards 2009). The incidence of people having sports-related injuries is dependent on geographical location and type of sport involved (Office for National Statistics 2011). Seventy-five per cent of all sporting injuries are classified as minor, with musculoskeletal and limb injuries the most common types. In the young adult, the muscles are the greatest points of weakness. The knee is the most vulnerable point in children under 15; after this and up to the age of 19 the pelvis is the weakest, with avulsion fractures most commonly occurring. From 19 to 30 years of age, the hamstring and quadriceps muscles are especially vulnerable. After the age of 30 the tendons start to degenerate and become weaker than the muscles.
Eighty-two per cent of all patients who present to health services with sporting injuries are treated in the ED, with possible subsequent referral to orthopaedic and /or physiotherapy clinics. The remainder are treated by GPs and sports physiotherapists. Many are overuse injuries and are usually caused by training errors, excessive load on the body, environmental problems, poor equipment, ineffective rules or violent play (Kannus 2000). Overuse injuries have a better chance of full recovery if treated by a clinician experienced in sports medicine, then followed by a correct rehabilitation programme.
The more serious sports injuries involve:
In the UK, the greatest number of sporting head injuries arise from golf and horse riding. Although serious spinal injuries are rare, approximately 20 % of patients in spinal injury units have sustained their injury as a result of a sporting activity. The most common sports to generate serious spinal injuries are horse riding, diving, rugby and other sports such as gymnastics, skiing and motor sports (Grundy & Swain 1996). These injuries have long-term implications for a young person. Paralysis, brain damage or serious reduction in mobility will almost certainly lead to loss of earnings, relationship and sexual problems, depression and a greatly altered lifestyle.
Most deaths from sport arise from professional boxing, followed by horse riding, skating, gymnastics and swimming. Although rare in the young adult, non-accidental sudden death may also occur during sporting activities. The most likely causes are cardiac myopathy, myocarditis, congenital disorders, arrhythmias and conduction disorders (Hillis 2000).
The priorities of management of sports injuries are the same as for other injuries – to save life and limb, to do no harm and prevent further harm (Gregory 2005). The short-term aims of treatment of minor sporting injuries are pain control, maintenance of range of movements, maintenance of basic strength, and re-establishment of neuromuscular function. After initial first aid, some injuries will require surgery and post-operative rehabilitation (Matthews 2000). Most injuries, however, can be treated conservatively using the following acronym:
P – protection of injured area from further damage using immobilization devices (e.g., slings, strapping, braces)
R – rest of part to avoid further harm and prolonged irritation
I – ice for control of pain, bleeding and swelling
C – compression for support and control of swelling
E – elevation for decreased bleeding and dispersal of oedema
There is little benefit gained in prolonging ‘PRICES’ guidelines past 72 hours post injury or subsequent exacerbation (Gregory 2005).
The administration of non-steroidal anti-inflammatory drugs may slightly speed the recovery from injury and also act as an analgesic. Sporting injuries benefit from physiotherapy with early controlled mobilization and functional rehabilitation. Minor sports injuries are rarely associated with major morbidity, although they are painful and inconvenient to the person involved and the overall cost to society is high due to their frequency (Greaves et al. 2009).
Road traffic accidents
Unintentional injuries are a leading cause of death and disability in the young adult (World Health Organization 2010). Despite dramatic falls in child death rates in the UK throughout the 20th century, young adults remain the largest accident risk group (Social Trends 2000, Department for Transport 2009). In the under-35-year age group, injury is the commonest cause of death and has been described as ‘the last great plague of the young’ (Skinner et al. 1991).
Many of the more serious injuries of adulthood result from road traffic accidents (RTAs). Road deaths in the UK are now one of the lowest in Europe. In 2000, road deaths equated to 6 adults per 100 000 and 2 children per 100 000; the highest numbers are in Portugal with 33 adult deaths per 100 000 and 8 children per 100 000. By 2009, the number killed had fallen 38 %, with the number seriously injured approximately 44 % lower (Office for National Statistics 2000, Department for Transport 2009).
While the number of fatal head injuries has begun to decline, a pattern of blunt abdominal trauma has emerged (Cope & Stebbings 1996). The main causes of death from RTAs in young adults are:
For each fatality on the roads there are over 12 serious injuries and 50 minor injuries: 36 % of people with serious spinal injuries receive them as a result of RTAs, predominantly from cars, vans or motorcycles (Grundy & Swain 1996).
The number of pedestrian deaths has remained consistent since 1953. The greatest numbers are among elderly people, with a disproportionately high number also occurring in the age group 1–14 years. The highest number of fatalities for pedal cyclists occurs in the 5–14 age group. Those dying in cars, however, are predominantly young adults, but fatalities from motor vehicles, motorcycles and bicycles in this age group have dropped by about one-third. The introduction of the mountain bike has led to a huge surge in the popularity of cycling, with off-road cycling and safety helmets helping to lessen the number of accidents. Legislation limiting the engine capacity of motorcycles that learners can ride has led to a 40 % reduction in those killed or seriously injured on motorbikes. Since the 1980s the imposition of speed restrictions and attention to safer road design has contributed to falling road deaths, as have the recent mandatory use of rear seat belts, crumple zones, anti-brake-lock devices, air bags and seasonal anti-drink–drive campaigns. A disproportionately high number of people involved in RTAs have consumed alcohol, and these people are the most likely to sustain serious injuries. Approximately 17 % of all road fatalities are linked to alcohol, with approximately 40 % of pedestrians killed in car accidents having blood alcohol levels above the legal driving limit (Department for Transport 2009).
Alcohol-related attendances
The most popular leisure activity named by young adults is ‘going to the pub’ (Office for National Statistics 2000). Only 7 % of men and 13 % of women call themselves non-drinkers. The remaining 80 % have widely differing drinking habits, with occupations, genetic and parental influences, life events, race, religion, peer pressure and personality all having an effect on alcohol consumption. The heaviest drinking occurs among young adults in the age range 16–24 years (Royal College of Psychiatrists and Royal College of Physicians 2000). Guidelines recommend that men and women drink no more than four and three units, respectively, in one day. However, one study of nightclubs found men consuming an average of 15 units and women 10 units during a night out (Deehan & Saville 2003). Young women in particular are drinking more, with the percentage of 16- to 24-year-old women exceeding the recommended weekly drinking limits doubling over the past decade (Rickards et al. 2004). The changes in image of pubs to café bars, music pubs, family pubs, nightclubs and rave music venues have all made drinking more accessible to young people. Half of 18–24-year-olds visit pubs at least twice a week and 40 % visit nightclubs at least once a fortnight (Mintel 2003).
In the UK, alcohol misuse and alcohol-related harm cost the NHS nearly ≤3 billion in 2006/2007 with an estimated 800 000 alcohol-attributable hospital admissions in 2006/2007 (Purshouse et al. 2010). More than 600 000 violent incidents occur in or around pubs every year (Simmons et al. 2002) and at least one in ten nightlife assaults involves the threatened use of glasses or bottles (Budd 2003), while an estimated 5000 people are injured every year by glass used as a weapon, with many permanently scarred (Deehan 1999).
In one study, some 10 % of ambulance call-outs were alcohol-related (Martin et al. 2012). Alcohol-related attendances in the ED may be prompted by injuries, intoxication, medical problems or antisocial behaviour. The former two reasons are most common in the young adult who has had a single episode of heavy drinking, while the latter two are common in the older, habitual heavy drinker. Alcohol acts as a CNS depressant and, although it stimulates conversation and sociability, it also impairs judgement, slows reflexes and can lead to aggressive and violent behaviour. Moulton & Yates (1999) recommend that, due to the high incidence of trauma in patients with alcohol intoxication, when assessing an intoxicated patient ED staff should be aware of the possibility of non-obvious physical injury, including cervical spine and head injury. They advise the following management of the aggressive drunk patient when considering their possible fitness for discharge:
