Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

International Nuclear Information System (INIS)

Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y.; Hibbard, Roberta A.; Hicks, Ralph A.

2017-01-01

Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma

Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

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Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Hibbard, Roberta A.; Hicks, Ralph A. [Indiana University School of Medicine, Department of Pediatrics, Section of Child Protection Programs, Indianapolis, IN (United States)

2017-07-15

Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma

Prior opportunities to identify abuse in children with abusive head trauma.

Science.gov (United States)

Letson, Megan M; Cooper, Jennifer N; Deans, Katherine J; Scribano, Philip V; Makoroff, Kathi L; Feldman, Kenneth W; Berger, Rachel P

2016-10-01

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included. A prior opportunity was defined as prior evaluation by either a medical or child protective services (CPS) professional when the symptoms and/or referral could be consistent with abuse but the diagnosis was not made and/or an alternate explanation was given and accepted. Two-hundred-thirty-two children with AHT were identified; median age (IQR) was 5.40 (3.30, 14.60) months. Ten percent (22/232) died. Of the 232 patients diagnosed with AHT, 31% (n=73) had a total of 120 prior opportunities. Fifty-nine children (25%) had at least one prior opportunity to identify abuse in a medical setting, representing 98 prior opportunities. An additional 14 (6%) children had 22 prior opportunities through previous CPS involvement. There were no differences between those with and without a prior opportunity based on age, gender, race, insurance, mortality, or institution. Children with prior opportunities in a medical setting were more likely to have chronic subdural hemorrhage (48 vs. 17%, p<0.01) and healing fractures (31 vs. 19%, p=0.05). The most common prior opportunities included vomiting 31.6% (38/120), prior CPS contact 20% (24/120), and bruising 11.7% (14/120). Improvements in earlier recognition of AHT and subsequent intervention might prevent additional injuries and reduce mortality. Copyright © 2016 Elsevier Ltd. All rights reserved.

Head Injury Secondary to Suspected Child Maltreatment: Results of a Prospective Canadian National Surveillance Program

Science.gov (United States)

Bennett, Susan; Ward, Michelle; Moreau, Katherine; Fortin, Gilles; King, Jim; MacKay, Morag; Plint, Amy

2011-01-01

Objective: We sought to determine the incidence, clinical features, and demographic profile of head injury secondary to suspected child maltreatment (abuse or neglect) in Canada to help inform the development and evaluation of prevention programs for abusive head injuries. Methods: From March 1, 2005 to February 28, 2008, an average of 2,545…

Emergency Department Presentations for Injuries in Older Adults Independently Known to be Victims of Elder Abuse.

Science.gov (United States)

Rosen, Tony; Bloemen, Elizabeth M; LoFaso, Veronica M; Clark, Sunday; Flomenbaum, Neal E; Lachs, Mark S

2016-03-01

Elder abuse is under-recognized by emergency department (ED) providers, largely due to challenges distinguishing between abuse and accidental trauma. To describe patterns and circumstances surrounding elder abuse-related and potentially abuse-related injuries in ED patients independently known to be physical elder abuse victims. ED utilization of community-dwelling victims of physical elder abuse in New Haven, CT from 1981-1994 was analyzed previously. Cases were identified using Elderly Protective Services data matched to ED records. Sixty-six ED visits were judged to have high probability of being related to elder abuse and 244 were of indeterminate probability. We re-examined these visits to assess whether they occurred due to injury. We identified and analyzed in detail 31 injury-associated ED visits from 26 patients with high probability of being related to elder abuse and 108 visits from 57 patients with intermediate probability and accidental injury. Abuse-related injuries were most common on upper extremities (45% of visits) and lower extremities (32%), with injuries on head or neck noted in 13 visits (42%). Bruising was observed in 39% of visits, most commonly on upper extremities. Forty-two percent of purportedly accidental injuries had suspicious characteristics, with the most common suspicious circumstance being injury occurring more than 1 day prior to presentation, and the most common suspicious injury pattern being maxillofacial injuries. Victims of physical elder abuse commonly have injuries on the upper extremities, head, and neck. Suspicious circumstances and injury patterns may be identified and are commonly present when victims of physical elder abuse present with purportedly accidental injuries. Copyright © 2016 Elsevier Inc. All rights reserved.

CT identification of abdominal injuries in abused pre-school-age children

International Nuclear Information System (INIS)

Hilmes, Melissa A.; Hernanz-Schulman, Marta; Kan, J.H.; Greeley, Christopher S.; Piercey, Lisa M.; Yu, Chang

2011-01-01

Although the abdominopelvic CT findings of abdominal trauma in children have been described, little has been written about the subset of children who are victims of abuse. Our purpose is to describe abdominopelvic injuries in abused pre-school-age children as identified on CT. An IRB-approved retrospective review of our institutional child abuse registry was performed. Searching a 14-year period, we identified 84 children ≤ 5 years of age with medically diagnosed abuse who underwent CT. We reviewed imaging studies, operative reports, autopsy findings and patient outcomes. Consensus review of the CT examinations was performed by CAQ-certified pediatric radiologists, and findings were categorized as normal or by injury types (solid organ versus bowel). The injuries were analyzed in light of existing literature on pediatric accidental and non-accidental injuries. Of the 84 children, 35 (41.7%) had abdominal injuries. Abdominal injuries included liver (15), bowel (13), mesentery (4), spleen (6), kidneys (7), pancreas (4) and adrenal glands (3). Of these children, 26% (9/35) required surgical intervention for bowel, mesenteric and pancreatic injuries. Another 9/35 children died, not as a result of abdominal injuries but as a direct result of inflicted intracranial injuries. Our data indicate that abdominal injuries in abused children present in a pattern similar to that of children with accidental abdominal trauma, underscoring the need for vigilance and correlative historical and clinical data to identify victims of abuse. Mortality in abused children with intra-abdominal injury was frequently related to concomitant head injury. (orig.)

CT identification of abdominal injuries in abused pre-school-age children

Energy Technology Data Exchange (ETDEWEB)

Hilmes, Melissa A.; Hernanz-Schulman, Marta; Kan, J.H. [Vanderbilt Children' s Hospital, Department of Radiology and Radiological Sciences, Nashville, TN (United States); Greeley, Christopher S. [University of Texas Health Science Center at Houston, Department of Pediatrics, Houston, TX (United States); Piercey, Lisa M. [Vanderbilt Children' s Hospital, Department of Pediatrics, Nashville, TN (United States); Yu, Chang [Vanderbilt University, Department of Biostatistics, Nashville, TN (United States)

2011-05-15

Although the abdominopelvic CT findings of abdominal trauma in children have been described, little has been written about the subset of children who are victims of abuse. Our purpose is to describe abdominopelvic injuries in abused pre-school-age children as identified on CT. An IRB-approved retrospective review of our institutional child abuse registry was performed. Searching a 14-year period, we identified 84 children {<=} 5 years of age with medically diagnosed abuse who underwent CT. We reviewed imaging studies, operative reports, autopsy findings and patient outcomes. Consensus review of the CT examinations was performed by CAQ-certified pediatric radiologists, and findings were categorized as normal or by injury types (solid organ versus bowel). The injuries were analyzed in light of existing literature on pediatric accidental and non-accidental injuries. Of the 84 children, 35 (41.7%) had abdominal injuries. Abdominal injuries included liver (15), bowel (13), mesentery (4), spleen (6), kidneys (7), pancreas (4) and adrenal glands (3). Of these children, 26% (9/35) required surgical intervention for bowel, mesenteric and pancreatic injuries. Another 9/35 children died, not as a result of abdominal injuries but as a direct result of inflicted intracranial injuries. Our data indicate that abdominal injuries in abused children present in a pattern similar to that of children with accidental abdominal trauma, underscoring the need for vigilance and correlative historical and clinical data to identify victims of abuse. Mortality in abused children with intra-abdominal injury was frequently related to concomitant head injury. (orig.)

Imaging of spinal injury in abusive head trauma: a retrospective study

International Nuclear Information System (INIS)

Choudhary, Arabinda K.; Ishak, Ramsay; Zacharia, Thomas T.; Dias, Mark S.

2014-01-01

Spinal imaging has been a neglected part of abusive head trauma (AHT) imaging. As most of the radiographs and CT spine are negative in AHT in infants, the cervical spine is assumed to be normal. There is increasing evidence in the role of injury to brainstem and cervical cord in the pathogenesis of AHT. In addition, in courts of law, there is fierce debate about AHT, its mimics and other disparate nontraumatic diagnoses explaining the neuroradiological and skeletal findings. However, this discussion ignores the evidence and significance of spinal injury. We sought to study the cervical spine in an AHT cohort to understand the true prevalence of spinal injuries in AHT and contrast it with cohorts of accidental and nontraumatic groups to give the clinicians a robust diagnostic tool in evaluating AHT. The purpose of this study is to compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages < 48 months: (1) those with AHT, (2) those with accidental trauma, and (3) those with nontraumatic conditions. This comparative study included 183 children who underwent spine MRI: 67 with AHT, 46 with accidental trauma and a clinical suspicion of spinal injury, and 70 with nontraumatic conditions. Clinical and radiographic findings were collected in all cases and were analyzed retrospectively to identify MRI evidence of traumatic spinal injuries. The incidence of spinal injuries among the three groups was compared. The incidence of spinal ligamentous injuries was calculated for those with and without radiographic evidence of hypoxic-ischemic encephalopathy. All comparisons were performed using Fisher exact test with P < 0.05 considered statistically significant. Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were

Imaging of spinal injury in abusive head trauma: a retrospective study

Energy Technology Data Exchange (ETDEWEB)

Choudhary, Arabinda K. [Nemours A.I. DuPont Children Hospital, Department of Radiology, Wilmington, DE (United States); Ishak, Ramsay; Zacharia, Thomas T. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

2014-09-15

Spinal imaging has been a neglected part of abusive head trauma (AHT) imaging. As most of the radiographs and CT spine are negative in AHT in infants, the cervical spine is assumed to be normal. There is increasing evidence in the role of injury to brainstem and cervical cord in the pathogenesis of AHT. In addition, in courts of law, there is fierce debate about AHT, its mimics and other disparate nontraumatic diagnoses explaining the neuroradiological and skeletal findings. However, this discussion ignores the evidence and significance of spinal injury. We sought to study the cervical spine in an AHT cohort to understand the true prevalence of spinal injuries in AHT and contrast it with cohorts of accidental and nontraumatic groups to give the clinicians a robust diagnostic tool in evaluating AHT. The purpose of this study is to compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages < 48 months: (1) those with AHT, (2) those with accidental trauma, and (3) those with nontraumatic conditions. This comparative study included 183 children who underwent spine MRI: 67 with AHT, 46 with accidental trauma and a clinical suspicion of spinal injury, and 70 with nontraumatic conditions. Clinical and radiographic findings were collected in all cases and were analyzed retrospectively to identify MRI evidence of traumatic spinal injuries. The incidence of spinal injuries among the three groups was compared. The incidence of spinal ligamentous injuries was calculated for those with and without radiographic evidence of hypoxic-ischemic encephalopathy. All comparisons were performed using Fisher exact test with P < 0.05 considered statistically significant. Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were

Accidental and Nonaccidental Head Injuries in Infants: Distinguishing Characteristics

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J Gordon Millichap

2005-07-01

Full Text Available One hundred fifty infants hospitalized with head injury over a 3-year period, 57 (38% due to child abuse, were studied prospectively at the Departments of Pediatric Neurosurgery, Neuro-ophthalmology, and Legal Medicine, CHRU de Lille, France.

Injury patterns of child abuse: Experience of two Level 1 pediatric trauma centers.

Science.gov (United States)

Yu, Yangyang R; DeMello, Annalyn S; Greeley, Christopher S; Cox, Charles S; Naik-Mathuria, Bindi J; Wesson, David E

2018-05-01

This study examines non-accidental trauma (NAT) fatalities as a percentage of all injury fatalities and identifies injury patterns in NAT admissions to two level 1 pediatric trauma centers. We reviewed all children (<5years old) treated for NAT from 2011 to 2015. Patient demographics, injury sites, and survival were obtained from both institutional trauma registries. Of 4623 trauma admissions, 557 (12%) were due to NAT. However, 43 (46%) of 93 overall trauma fatalities were due to NAT. Head injuries were the most common injuries sustained (60%) and led to the greatest increased risk of death (RR 5.1, 95% CI 2.0-12.7). Less common injuries that increased the risk of death were facial injuries (14%, RR 2.9, 95% CI 1.6-5.3), abdominal injuries (8%, RR 2.8, 95% CI 1.4-5.6), and spinal injuries (3%, RR 3.9, 95% CI 1.8-8.8). Although 76% of head injuries occurred in infants <1year, children ages 1-4years old with head injuries had a significantly higher case fatality rate (27% vs. 6%, p<0.001). Child abuse accounts for a large proportion of trauma fatalities in children under 5years of age. Intracranial injuries are common in child abuse and increase the risk of death substantially. Preventing NAT in infants and young children should be a public health priority. Retrospective Review. II. Copyright © 2018. Published by Elsevier Inc.

Abusive head trauma in children: a literature review

Directory of Open Access Journals (Sweden)

Nahara R.L. Lopes

2013-09-01

Full Text Available Objective: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. Data source: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms “shaken baby syndrome” and “abusive head trauma” in English, Spanish, and Portuguese. Data synthesis: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. Conclusions: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level. Resumo: Objetivo: Fornecer uma revisão de literatura científica sobre trauma craniano violento pediátrico enquanto forma de maus-tratos físicos contra bebês e crianças, ressaltando prevalência, sinais e sintomas, consequências, fatores de risco para sua ocorrência e, principalmente, estratégias de prevenção. Fontes dos dados: Revisão nas bases de dados MEDLINE, SciELO, LILACS e Web of Science no período de 2001 a 2012 utilizando os termos �

Heading and head injuries in soccer.

Science.gov (United States)

Kirkendall, D T; Jordan, S E; Garrett, W E

2001-01-01

In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the

Skeletal injuries associated with sexual abuse

Energy Technology Data Exchange (ETDEWEB)

Johnson, Karl; Chapman, Stephen [Department of Radiology, Birmingham Children' s Hospital, Steelhouse Lane, B4 6NH, Birmingham (United Kingdom); Hall, Christine M. [Department of Radiology, Great Ormond Street Hospital for Children, London (United Kingdom)

2004-08-01

Background: Sexual abuse is often associated with physical abuse, the most common injuries being bruising and other soft-tissue injuries, but fractures occur in 5% of sexually abused children. The fractures described to date have formed part of the spectrum of injuries in these children and have not been specifically related to the abusive act. Objective: To describe concurrent sexual abuse and fractures. Materials and methods: Three children with pelvic or femoral shaft injuries in association with sexual abuse. Results: A 3-year-old girl with extensive soft-tissue injuries to the arms, legs and perineum also sustained fractures of both pubic rami and the sacral side of the right sacro-iliac joint. A 5-month-old girl with an introital tear was shown to have an undisplaced left femoral shaft fracture. A 5-year-old girl presented with an acute abdomen and pneumoperitoneum due to a ruptured rectum following sexual abuse. She had old healed fractures of both pubic rami with disruption of the symphysis pubis. Conclusions: Although the finding of a perineal injury in a young child may be significant enough for the diagnosis of abuse, additional skeletal injuries revealed by radiography will assist in confirmation of that diagnosis and may be more common than hitherto suspected. (orig.)

Skeletal injuries associated with sexual abuse

International Nuclear Information System (INIS)

Johnson, Karl; Chapman, Stephen; Hall, Christine M.

2004-01-01

Background: Sexual abuse is often associated with physical abuse, the most common injuries being bruising and other soft-tissue injuries, but fractures occur in 5% of sexually abused children. The fractures described to date have formed part of the spectrum of injuries in these children and have not been specifically related to the abusive act. Objective: To describe concurrent sexual abuse and fractures. Materials and methods: Three children with pelvic or femoral shaft injuries in association with sexual abuse. Results: A 3-year-old girl with extensive soft-tissue injuries to the arms, legs and perineum also sustained fractures of both pubic rami and the sacral side of the right sacro-iliac joint. A 5-month-old girl with an introital tear was shown to have an undisplaced left femoral shaft fracture. A 5-year-old girl presented with an acute abdomen and pneumoperitoneum due to a ruptured rectum following sexual abuse. She had old healed fractures of both pubic rami with disruption of the symphysis pubis. Conclusions: Although the finding of a perineal injury in a young child may be significant enough for the diagnosis of abuse, additional skeletal injuries revealed by radiography will assist in confirmation of that diagnosis and may be more common than hitherto suspected. (orig.)

Proposed diagnosis criteria for inflicted head injury of children younger than two years of age

International Nuclear Information System (INIS)

Fujiwara, Takeo; Okuyama, Makiko; Matsumoto, Tsutomu; Aritaki, Kentarou; Yotani, Nobuyuki; Miyasaka, Mikiko; Nishina, Sachiko

2008-01-01

It is difficult to distinguish whether children's head injuries are due to physical abuse or unintentional accidents. However, in the literature, medical findings specific to infant physical abuse were identified. Thus, we developed diagnostic criteria for inflicted head injury (IHI) and assessed its validity. Subjects were collected from all patients who were less than two years old when they visited National Center for Child Health (NCCHD) and Development and underwent head CT scan to assess head trauma from March 1, 2002 to December 31, 2005. Diagnostic criteria for IHI were developed based on definitions of Duhaime et al (1992) and Reece et al (2001). Validity of diagnosis criteria was assessed by comparing the official report to the Child Guidance Center (CGC) from NCCHD to the disposition decided by the CGC. Two-hundred and sixty cases were collected and diagnosed. There was a 86.5% match of the number of cases which were diagnosed as IHI or non-IHI using the IHI diagnostic criteria with official reports to CGC from NCCHD. Among the cases which were diagnosed as presumptive IHI and also reported to the CGC, 20 cases (83.3%) were regarded as abused cases by the CGC. The diagnostic criteria for IHI were valid and would be useful for pediatricians not to condone inflicted head injury. (author)

Variation of gunshot injury patterns in mortality associated with human rights abuses and armed conflict: an exploratory study.

Science.gov (United States)

Baraybar, Jose Pablo

2015-09-01

The analysis of the distribution of gunshot injuries in a sample of 777 sets of human remains of proven human rights abuse from Somaliland, the Balkans and Peru is compared to frequencies of injuries sustained by combatants in contemporary conflicts reported in the literature. Principal Component Analysis (PCA) reduced the data to three components accounting for 82.94% of the variance. The first component with 38.31% of variance shows segments Arms and thorax/abdomen to be positively correlated (0.887 and 0.662, respectively); the segment head/neck is strongly correlated (0.951) to the second component while the segment thorax/abdomen shows a low, negative correlation (-0.388). Finally in the third component only the legs are strongly correlated (0.991). Data was further subjected to a K-means cluster analysis to determine the likely groupings combining the four types of injuries. Each of the three clusters reproduced similar patterns observed in the PCA: Cluster 1 shows the prevalence of injuries to the thorax/abdomen and extremities in addition to injuries to the head/neck; Cluster 2 shows injuries to the head/neck and Cluster 3 injuries to the thorax/abdomen and a lower representation of the arms and legs. Most of the cases (70.5%), irrespective of geography and type of site (attack or detention), were grouped into Cluster 2. Such comparison shows that in human rights abuse, irrespective of their geography, gunshot injuries tend to follow a pattern favouring the head/neck and thorax/abdomen areas over the extremities, the reverse pattern observed in contemporary combat operations. In those settings gunshot wound trauma is the second cause of mortality/morbidity (after fragmenting ammunition) and its distribution concentrates on the extremities, thorax/abdomen and head; following the pattern of protective armour when it is used. Considering that human rights abuses are often presented as encounters between two armed groups in the context of counter

Preventing the Consequences of Alcohol Abuse: Identification of Soldiers at High Risk for Fatal and Serious Injuries

Science.gov (United States)

2007-01-01

comorbidity and head injury could have been an artifact of clinical protocols (e.g., toxicology screening when neurological damage is evident or...Drug dependence-cocaine dependence 304.3 - Drug dependence- cannabis dependence 304.4 - Drug dependence-amphetamine and other psychostimulant...unspecified drug dependence 305.2 – Nondependent abuse of drugs- cannabis abuse 305.3 – Nondependent abuse of drugs-hallucinogen abuse 305.4

Are Men With a History of Head Injury Less Responsive to Cognitive Behavioral Therapy for Intimate Partner Violence?

Science.gov (United States)

Akerele, Felicia A; Murphy, Christopher M; Williams, Megan R

2017-06-01

Head injury is highly prevalent among intimate partner violence (IPV) offenders. This study investigates responsiveness to cognitive behavioral therapy (CBT) for partnerviolent men with and without a history of head injury using archival data on 310 males seeking IPV counseling at a community domestic violence agency. Participants reported on their history of head injury, age at injury, and length of time unconscious in a structured interview at program intake. Criminal justice outcomes were assessed for the 2-year period after scheduled completion of treatment using a publicly available state database. A significantly greater percentage of men with a history of head injury (N = 84) than those without (N = 226) had criminal involvement for incidents of partner abuse during the follow-up period. In addition, men with a history of moderate-to-severe head injury (n = 25) had more criminal involvement for general violence than those with no history of head injury. The findings highlight the need to screen partner-violent men for head injury and to develop and investigate intervention enhancements for those individuals.

Imaging of Neonatal Child Abuse with an Emphasis on Abusive Head Trauma

NARCIS (Netherlands)

van Rijn, Rick R.; Spevak, Melissa R.

2011-01-01

Child abuse and neglect is a serious clinical and socioeconomic problem that is sometimes underestimated. One of the most devastating forms is abusive head trauma. This review addresses the radiological workup in cases of suspected child abuse. The use of all modalities, and their advantages and

Risk factors for mortality in children with abusive head trauma.

Science.gov (United States)

Shein, Steven L; Bell, Michael J; Kochanek, Patrick M; Tyler-Kabara, Elizabeth C; Wisniewski, Stephen R; Feldman, Kenneth; Makoroff, Kathi; Scribano, Philip V; Berger, Rachel P

2012-10-01

We sought to identify risk factors for mortality in a large clinical cohort of children with abusive head trauma. Bivariate analysis and multivariable logistic regression models identified demographic, physical examination, and radiologic findings associated with in-hospital mortality of children with abusive head trauma at 4 pediatric centers. An initial Glasgow Coma Scale (GCS) ≤ 8 defined severe abusive head trauma. Data are shown as OR (95% CI). Analysis included 386 children with abusive head trauma. Multivariable analysis showed children with initial GCS either 3 or 4-5 had increased mortality vs children with GCS 12-15 (OR = 57.8; 95% CI, 12.1-277.6 and OR = 15.6; 95% CI, 2.6-95.1, respectively, P < .001). Additionally, retinal hemorrhage (RH), intraparenchymal hemorrhage, and cerebral edema were independently associated with mortality. In the subgroup with severe abusive head trauma and RH (n = 117), cerebral edema and initial GCS of 3 or 4-5 were independently associated with mortality. Chronic subdural hematoma was independently associated with survival. Low initial GCS score, RH, intraparenchymal hemorrhage, and cerebral edema are independently associated with mortality in abusive head trauma. Knowledge of these risk factors may enable researchers and clinicians to improve the care of these vulnerable children. Copyright © 2012 Mosby, Inc. All rights reserved.

Chest Injuries Associated with Head Injury | Mezue | Nigerian ...

African Journals Online (AJOL)

Conclusion: Associated chest injuries result in higher mortality from head injuries. This association is more likely in the young and more productive. All patients presenting with head and spinal cord injury should be specifically and carefully evaluated for associated chest injuries. Computerized tomographic has not replaced ...

Head injury - first aid

Science.gov (United States)

... medlineplus.gov/ency/article/000028.htm Head injury - first aid To use the sharing features on this page, ... a concussion can range from mild to severe. First Aid Learning to recognize a serious head injury and ...

Boxing-related head injuries.

Science.gov (United States)

Jayarao, Mayur; Chin, Lawrence S; Cantu, Robert C

2010-10-01

Fatalities in boxing are most often due to traumatic brain injury that occurs in the ring. In the past 30 years, significant improvements in ringside and medical equipment, safety, and regulations have resulted in a dramatic reduction in the fatality rate. Nonetheless, the rate of boxing-related head injuries, particularly concussions, remains unknown, due in large part to its variability in clinical presentation. Furthermore, the significance of repeat concussions sustained when boxing is just now being understood. In this article, we identify the clinical manifestations, pathophysiology, and management of boxing-related head injuries, and discuss preventive strategies to reduce head injuries sustained by boxers.

Sternal fractures as a manifestation of abusive injury in children

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Hechter, Sloane; Manson, David [Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8 (Canada); Huyer, Dirk [Department of Pediatrics, Division of Suspected Child Abuse and Neglect, Hospital for Sick Children, Toronto, Ontario (Canada)

2002-12-01

Sternal fractures are rare injuries in children. The rarity of this injury is likely due to both the relative plasticity of the pediatric thorax and to the difficulty in establishing a radiographic diagnosis without dedicated views. Current literature suggests that this injury in young children is highly specific for abusive injury.Hypothesis. Sternal fractures are not highly specific for abusive injury. Materials and methods. This was a retrospective radiographic and clinical chart review of all documented sternal fractures over an 11-year period at a large pediatric hospital.Results. Of 12 children with sternal fractures identified, four were {<=}2 years of age and eight were {>=}3 years of age. The mechanism of injury was suspicious for child abuse in two children. Both of these children were {<=}2 years of age. In one toddler, an unwitnessed injury resulted in extensive initial familial anxiety until abusive injury was excluded.Conclusion. Sternal fractures are unusual injuries, yet they, in themselves, are not highly specific for abusive injury. (orig.)

Craniocerebral trauma in the child abuse syndrome: Radiological observations

International Nuclear Information System (INIS)

Merten, D.F.; Osborne, D.R.S.; Leonidas, J.C.

1984-01-01

Experience with craniocerebral trauma in 712 physically abused children is reviewed. Ninety-three (13%) had evidence of head trauma (cranial and/or intracranial). Seventy-seven of these patients had computed tomography (CT) of the head, and 47 had CT evidence of intracranial injury. Extracerebral fluid collections, predominantly convexity subdural hemorrhage, were the most common acute intracranial lesions. Concurrent intracranial and skeletal trauma (cranial and/or ectracranial) was present in 33 of the 47 patients (70%) with intracranial injury. A high incidence of skull fractures (45%) in those children with intracranial lesions suggest a significant role for impact head injuries (''battering'') in the pathogenesis of craniocerebral trauma in the child abuse syndrome. Greater emphasis on CT examination in evaluation of the abuse infant and child is recommended. (orig.)

Neuroimaging for non-accidental head injury in childhood: A proposed protocol

International Nuclear Information System (INIS)

Jaspan, T.; Griffiths, P.D.; McConachie, N.S.; Punt, J.A.G.

2003-01-01

Non-accidental head injury (NAHI) is a major cause of neurological disability and death during infancy. Radiological imaging plays a crucial role in evaluating craniospinal injury, both for guiding medical management and the forensic aspects of abusive trauma. The damage sustained is varied, complex and may be accompanied by an evolving pattern of brain injury secondary to a cascade of metabolic and physiological derangements. Regrettably, many cases are poorly or incompletely evaluated leading to diagnostic errors and difficulties in executing subsequent child care or criminal proceedings. It is evident, from cases referred to the authors, that imaging protocols for NAHI are lacking (or only loosely adhered to, if present) in many centres throughout the U.K. Future research in this field will also be hampered if there is a lack of consistent and reliable radiological data. There is no nationally agreed protocol for imaging NAHI. We propose such a protocol, based upon a wide experience in the medical management of child abuse and extensive involvement in the medicolegal aspects of NAHI. Jaspan, T., et al. (2003). Clinical Radiology58, 44--53

Neuroimaging for non-accidental head injury in childhood: A proposed protocol

Energy Technology Data Exchange (ETDEWEB)

Jaspan, T.; Griffiths, P.D.; McConachie, N.S.; Punt, J.A.G

2003-01-01

Non-accidental head injury (NAHI) is a major cause of neurological disability and death during infancy. Radiological imaging plays a crucial role in evaluating craniospinal injury, both for guiding medical management and the forensic aspects of abusive trauma. The damage sustained is varied, complex and may be accompanied by an evolving pattern of brain injury secondary to a cascade of metabolic and physiological derangements. Regrettably, many cases are poorly or incompletely evaluated leading to diagnostic errors and difficulties in executing subsequent child care or criminal proceedings. It is evident, from cases referred to the authors, that imaging protocols for NAHI are lacking (or only loosely adhered to, if present) in many centres throughout the U.K. Future research in this field will also be hampered if there is a lack of consistent and reliable radiological data. There is no nationally agreed protocol for imaging NAHI. We propose such a protocol, based upon a wide experience in the medical management of child abuse and extensive involvement in the medicolegal aspects of NAHI. Jaspan, T., et al. (2003). Clinical Radiology58, 44--53.

Sternal fractures as a manifestation of abusive injury in children

International Nuclear Information System (INIS)

Hechter, Sloane; Manson, David; Huyer, Dirk

2002-01-01

Sternal fractures are rare injuries in children. The rarity of this injury is likely due to both the relative plasticity of the pediatric thorax and to the difficulty in establishing a radiographic diagnosis without dedicated views. Current literature suggests that this injury in young children is highly specific for abusive injury.Hypothesis. Sternal fractures are not highly specific for abusive injury. Materials and methods. This was a retrospective radiographic and clinical chart review of all documented sternal fractures over an 11-year period at a large pediatric hospital.Results. Of 12 children with sternal fractures identified, four were ≤2 years of age and eight were ≥3 years of age. The mechanism of injury was suspicious for child abuse in two children. Both of these children were ≤2 years of age. In one toddler, an unwitnessed injury resulted in extensive initial familial anxiety until abusive injury was excluded.Conclusion. Sternal fractures are unusual injuries, yet they, in themselves, are not highly specific for abusive injury. (orig.)

Craniocerebral trauma in the child abuse syndrome: Radiological observations

Energy Technology Data Exchange (ETDEWEB)

Merten, D.F.; Osborne, D.R.S.; Radkowski, M.A.; Leonidas, J.C.

1984-07-01

Experience with craniocerebral trauma in 712 physically abused children is reviewed. Ninety-three (13%) had evidence of head trauma (cranial and/or intracranial). Seventy-seven of these patients had computed tomography (CT) of the head, and 47 had CT evidence of intracranial injury. Extracerebral fluid collections, predominantly convexity subdural hemorrhage, were the most common acute intracranial lesions. Concurrent intracranial and skeletal trauma (cranial and/or ectracranial) was present in 33 of the 47 patients (70%) with intracranial injury. A high incidence of skull fractures (45%) in those children with intracranial lesions suggest a significant role for impact head injuries (''battering'') in the pathogenesis of craniocerebral trauma in the child abuse syndrome. Greater emphasis on CT examination in evaluation of the abuse infant and child is recommended.

Anaphylaxis due to head injury.

Science.gov (United States)

Bruner, Heather C; Bruner, David I

2015-05-01

Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury.

Head injury in children

International Nuclear Information System (INIS)

Sugiura, Makoto; Mori, Nobuhiko; Yokosuka, Reiko; Yamamoto, Masaaki; Imanaga, Hirohisa

1981-01-01

Findings of computerized tomography (CT) in 183 cases of head injury in children were investigated with special reference to CT findings of mild head injury. As was expected, CT findings of mild head injury fell within the normal range, in almost all cases. However, abnormal findings were noticed in 4 out of 34 cases (12%) in acute stage and 7 out of 76 cases (9%) in chronic stage. They were 3 cases of localized low density area in acute stage and 6 cases of mild cerebral atrophy in chronic stage, etc. There were some cases of mild head injury in which CT findings were normal while EEG examination revealed abnormality. Also in some cases, x-ray study demonstrated linear skull fracture which CT failed to show. These conventional techniques could be still remained as useful adjunct aid in diagnosis of head injury. CT findings of cases of cerebral contusion in their acute stage were divided as follows; normal, low density, small ventricle and ventricular and/or cisternal hemorrhage, frequency of incidence being 38, 17, 22, 11% respectively. These findings were invariably converted to cerebral atrophy from 10 days to 2 months after the impacts. In the cases with intracranial hematoma revealed by CT, only 32% of them showed clinical signs of Araki's type IV in their acute stage and 63% of them showed no neurological defects, that is Araki's type I and II. A case of extreme diffuse cerebral atrophy which followed acute subdural hematoma caused by tear of bridging veins without cortical contusion was presented. (author)

Anaphylaxis Due to Head Injury

Directory of Open Access Journals (Sweden)

Bruner, Heather C.

2015-05-01

Full Text Available Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. [West J Emerg Med. 2015;16(3:435–437.

Head injury: audit of a clinical guideline to justify head CT

International Nuclear Information System (INIS)

Haydon, Nicholas B.

2013-01-01

Head injury causes significant morbidity and mortality, and there is contention about which patients to scan. The UK National Health Service Clinical Guideline (CG) 56 provides criteria for selecting patients with clinically important brain injury who may benefit from a head CT scan, while minimising the radiation and economic burden of scanning patients without significant injury. This study aims to audit the documentation of the use of these guidelines in a busy UK trauma hospital and discusses the comparison with an Australian (New South Wales (NSW) ) head injury guideline. A retrospective cohort study of 480 patients presenting with head injury to the emergency department over 2 months was performed. The patient notes were assessed for documentation of each aspect of the clinical guidelines. Criteria were established to assess the utilisation of the CG 56. A database of clinical data was amalgamated with the head CT scan results for each patient. For the UK CG 56, 73% of the criteria were documented, with the least documented being 'signs of basal skull fracture' and 'amnesia of events'. Thirty-two per cent of patients received head CT and of these, 24% (37 patients) were reported to have pathology. Twenty-four patients underwent head CT without clinical justification being documented, none of which had reported pathology on CT. The study shows that the head injury guidelines are not being fully utilised at a major UK trauma hospital, resulting in 5% of patients being exposed to ionising radiation without apparent documented clinical justification. The NSW guideline has distinct differences to the CG 56, with a more complex algorithm and an absence of specific time frames for head CT completion. The results suggest a need for further education and awareness of head injury clinical guidelines.

Head injuries in snowboarders compared with head injuries in skiers. A prospective analysis of 1076 patients from 1994 to 1999 in Niigata, Japan.

Science.gov (United States)

Fukuda, O; Takaba, M; Saito, T; Endo, S

2001-01-01

We investigated snowboarding-related head injury cases and skiing-related head injury cases during five ski seasons at one resort area. There were 634 snowboarding-related head injuries and 442 skiing-related head injuries. The number of snowboarding head injuries increased rapidly over the study period. More male snowboarders than female snowboarders suffered head injuries. For both snowboarders and skiers, head injuries frequently occurred on the easy and middle slopes. Falls were the most frequent causes of injury in both groups. Jumping was a more frequent cause of injury in the snowboarders (30%) than in the skiers (2.5%). Injury to the occipital region predominated in the snowboarders as compared with the skiers. There were 49 organic lesions in 37 snowboarders and 46 organic lesions in 33 skiers. Subdural hematoma was frequent in the snowboarding head injury group, and fracture was frequent in the skiing head injury group compared with the snowboarding group (not significant). Subdural hematoma was likely to be caused by a fall rather than by a collision, and bone fracture was likely to be caused by a collision rather than by a fall. Four snowboarders and one skier died as a result of their head injuries. Our data suggest that snowboarding head injuries may be prevented by protection of the occipital region and refraining from jumping by beginners.

OCULAR MANIFESTATIONS OF HEAD INJURIES

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Kanukollu Venkata Madusudana Rao

2016-12-01

Full Text Available BACKGROUND This prospective study aimed to evaluate the incidence of ocular manifestations in head injury and their correlation with the intracranial lesions. MATERIALS AND METHODS A total of 108 consecutive cases of closed head injury admitted in the neurosurgical ward of a tertiary teaching hospital underwent a thorough ophthalmic assessment. Clinical examination, radiological imaging and Glasgow Coma Scale (GCS were applied to grade the severity of injury. RESULTS Total number of 108 patients of head injury were examined of which 38 patients had ocular manifestations (35.18%. Of these, 85.18% were males, 84% of injuries were due to road traffic accidents and 16% were due to fall from a height. The ocular manifestations were as follows- Orbital complications were seen in 6 patients (15.8%. Anterior segment manifestations included black eyes seen in 10 patients (26.3%, subconjunctival haemorrhage in 10.5% of patients (4 patients, corneal involvement in 21% of patients (8 patients and pupillary involvement in 50% of patients (19 patients. Posterior segment manifestations were seen in 26.3% of patients (10 patients and were as follows- Purtscher’s retinopathy in 2 patients and optic atrophy in 5 patients. Cranial nerve palsies were seen in 15 patients (39.47% and supranuclear movement disorders were seen in 3 patients (8%. CONCLUSION Even though, neurosurgeons perform comprehensive clinical examination including eye examination, the main purpose is limited to aid topical diagnosis of neurological lesions. This study emphasises the importance of a detailed eye examination by an ophthalmologist to prevent irreversible visual loss in addition to aiding in the neurological diagnosis. Pupillary involvement, papilloedema and ocular motor paresis pointed to a more severe head injury. This observational prospective study helped us to correlate the severity of head injuries in association with ocular findings in patients admitted in neurosurgical ward

Heading for a fall? Management of head injury in infants.

LENUS (Irish Health Repository)

Williamson, M

2010-09-01

Head injury is one of the commonest reasons for infants (< 1 year) to attend the Emergency Department (ED). Clinical management varies considerably and concern about non accidental injury results in a high admission rate in some hospitals. Information was obtained on 103 children under one year of age presenting to the ED with head injury in a prospective study. The average age was 6.7 months and 57% of patients were male. Twenty eight babies had skull x rays with 1 skull fracture diagnosed. None required CT brain scan. Ninety eight (94%) were discharged home from the ED. There were no unplanned returns, readmissions or adverse events. The incidence of traumatic brain injury in children under one year of age presenting with head injury is low and the majority can be safely discharged home.

Development of Head Injury Assessment Reference Values Based on NASA Injury Modeling

Science.gov (United States)

Somers, Jeffrey T.; Melvin, John W.; Tabiei, Ala; Lawrence, Charles; Ploutz-Snyder, Robert; Granderson, Bradley; Feiveson, Alan; Gernhardt, Michael; Patalak, John

2011-01-01

NASA is developing a new capsule-based, crewed vehicle that will land in the ocean, and the space agency desires to reduce the risk of injury from impact during these landings. Because landing impact occurs for each flight and the crew might need to perform egress tasks, current injury assessment reference values (IARV) were deemed insufficient. Because NASCAR occupant restraint systems are more effective than the systems used to determine the current IARVs and are similar to NASA s proposed restraint system, an analysis of NASCAR impacts was performed to develop new IARVs that may be more relevant to NASA s context of vehicle landing operations. Head IARVs associated with race car impacts were investigated by completing a detailed analysis of all of the 2002-2008 NASCAR impact data. Specific inclusion and exclusion criteria were used to select 4071 impacts from the 4015 recorder files provided (each file could contain multiple impact events). Of the 4071 accepted impacts, 274 were selected for numerical simulation using a custom NASCAR restraint system and Humanetics Hybrid-III 50th percentile numerical dummy model in LS-DYNA. Injury had occurred in 32 of the 274 selected impacts, and 27 of those injuries involved the head. A majority of the head injuries were mild concussions with or without brief loss of consciousness. The 242 non-injury impacts were randomly selected and representative of the range of crash dynamics present in the total set of 4071 impacts. Head dynamics data (head translational acceleration, translational change in velocity, rotational acceleration, rotational velocity, HIC-15, HIC-36, and the Head 3ms clip) were filtered according to SAE J211 specifications and then transformed to a log scale. The probability of head injury was estimated using a separate logistic regression analysis for each log-transformed predictor candidate. Using the log transformation constrains the estimated probability of injury to become negligible as IARVs approach

The prevalence of elder abuse in the Porto Alegre metropolitan area

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Camila Mello dos Santos

2013-06-01

Full Text Available Abuse of the elderly is a form of violence to come to the public's attention. Dental professionals are in an ideal position to identify physical abuse. The aim of this study was to assess the prevalence of elderly abuse and analyze the database of injury reports that can be identified by dental teams. A documentary analysis study developed by the Elderly Protection Police Station of Porto Alegre, Rio Grande do Sul, was carried out. The information used came from 2,304 complaints filed at the aforementioned institution between the years of 2004 and 2006. The records of abuse are categorized as injury, neglect, mistreatment, theft, financial abuse, threat, disturbing the peace, atypical fact, and others. The injuries that could be identified by the dental team were classified according to the injury's location in the area of the head, face, mouth and neck. Descriptive analysis was performed, and chi-square tests were used to evaluate the distributions of the types of elder abuse in relation to sex and age. The most frequent of the different types of abuse was theft, with a prevalence of 17.8%, followed by disturbing the peace at 11.8%. Disturbing the peace, threat, and bodily injury were significantly associated with women. Elder abuse among women and men declines with age. The prevalence of head injury was 25% of the total injuries, most often in females, and in those aged < 70 years. Based on these results, it is necessary that the dental team observe the elderly person's appearance for suspicious physical signs.

Absence of rickets in infants with fatal abusive head trauma and classic metaphyseal lesions.

Science.gov (United States)

Perez-Rossello, Jeannette M; McDonald, Anna G; Rosenberg, Andrew E; Tsai, Andy; Kleinman, Paul K

2015-06-01

To determine if rickets is present in cases of infant homicide with classic metaphyseal lesions (CMLs) and other skeletal injuries. This study was exempt from the institutional human subjects board review because all infants were deceased. An archival review (1984-2012) was performed of the radiologic and histopathologic findings of 46 consecutive infant fatalities referred from the state medical examiner's office for the evaluation of possible child abuse. Thirty infants with distal femoral histologic material were identified. Additional inclusion criteria were as follows: (a) The medical examiner determined that the infant had sustained a head injury and that the manner of death was a homicide, (b) at least one CML was evident at skeletal survey, (c) CMLs were confirmed at autopsy, and (d) non-CML fractures were also present. Nine infants (mean age, 3.9 months; age range, 1-9 months) were identified. Two pediatric radiologists independently reviewed the skeletal surveys for rachitic changes at the wrists and knees. A bone and soft tissue pathologist reviewed the distal femoral histologic slices for rickets. There were no radiographic or pathologic features of rickets in the cohort. The findings provide no support for the view that the CML is due to rickets. Rather, they strengthen a robust literature that states that the CML is a traumatic injury commonly encountered in physically abused infants. RSNA, 2015

Skeletal imaging of child abuse (non-accidental injury)

International Nuclear Information System (INIS)

Offiah, Amaka; Rijn, Rick R. van; Perez-Rossello, Jeanette Mercedes; Kleinman, Paul K.

2009-01-01

In recent years there has been a worldwide increased awareness that children are physically abused by their carers. Radiologists play a vital role in the detection of inflicted injuries. This article reviews the skeletal imaging findings seen in child abuse. (orig.)

Skeletal imaging of child abuse (non-accidental injury)

NARCIS (Netherlands)

Offiah, A.; van Rijn, R.R.; Perez-Rossello, J.M.; Kleinman, P.K.

2009-01-01

In recent years there has been a worldwide increased awareness that children are physically abused by their carers. Radiologists play a vital role in the detection of inflicted injuries. This article reviews the skeletal imaging findings seen in child abuse

Skeletal imaging of child abuse (non-accidental injury)

Energy Technology Data Exchange (ETDEWEB)

Offiah, Amaka [Great Ormond Street Hospital, Radiology Department, London (United Kingdom); Rijn, Rick R. van [Academic Medical Centre Amsterdam, Department of Radiology, Amsterdam Zuid-Oost (Netherlands); Perez-Rossello, Jeanette Mercedes; Kleinman, Paul K. [Children' s Hospital Boston, Radiology Department, Boston, MA (United States)

2009-05-15

In recent years there has been a worldwide increased awareness that children are physically abused by their carers. Radiologists play a vital role in the detection of inflicted injuries. This article reviews the skeletal imaging findings seen in child abuse. (orig.)

Cervical spine injury in child abuse: report of two cases

Energy Technology Data Exchange (ETDEWEB)

Rooks, V.J.; Sisler, C.; Burton, B. [Tripler Army Medical Center, Honolulu, HI (United States). Dept. of Radiology

1998-03-01

Pediatric cervical spine injuries have rarely been reported in the setting of child abuse. We report two cases of unsuspected lower cervical spine fracture-dislocation in twin infant girls who had no physical examination findings to suggest cervical spine injury. Classic radio-graphic findings of child abuse were noted at multiple other sites in the axial and appendicular skeleton. Magnetic resonance (MR) imaging proved to be valuable in both the initial evaluation of the extent of cervical spine injury and in following postoperative changes. The unexpected yet devastating findings in these two cases further substantiate the importance of routine evaluation of the cervical spine in cases of suspected child abuse. (orig.)

Cervical spine injury in child abuse: report of two cases

International Nuclear Information System (INIS)

Rooks, V.J.; Sisler, C.; Burton, B.

1998-01-01

Pediatric cervical spine injuries have rarely been reported in the setting of child abuse. We report two cases of unsuspected lower cervical spine fracture-dislocation in twin infant girls who had no physical examination findings to suggest cervical spine injury. Classic radio-graphic findings of child abuse were noted at multiple other sites in the axial and appendicular skeleton. Magnetic resonance (MR) imaging proved to be valuable in both the initial evaluation of the extent of cervical spine injury and in following postoperative changes. The unexpected yet devastating findings in these two cases further substantiate the importance of routine evaluation of the cervical spine in cases of suspected child abuse. (orig.)

Radiological and forensic medicine aspects of traumatic injuries in child abuse.

Science.gov (United States)

Solarino, M; De Filippi, C; Solarino, B

2009-12-01

Child abuse is a topical issue in modern society and has social and medical implications which directly concern the doctor, both as a private citizen and as a health professional. Abuse injuries can be of very different types, e.g. physical, psychological or sexual. Hence they require a multidisciplinary and multispecialty approach, which must begin with an accurate medical examination, conducted in compliance with the lege artis principles and with respect for the victim's dignity. Diagnostic imaging becomes essential, together with epicrisis, which is useful to distinguish between accidental and abusive injuries. This paper describes the radiologist's key role in identifying physical injuries due to child abuse, in accordance with current regulations.

Abusive Head Trauma in Children: A Literature Review

Directory of Open Access Journals (Sweden)

Nahara R.L. Lopes

2013-09-01

Conclusions: : Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.

Video incident analysis of head injuries in high school girls' lacrosse.

Science.gov (United States)

Caswell, Shane V; Lincoln, Andrew E; Almquist, Jon L; Dunn, Reginald E; Hinton, Richard Y

2012-04-01

Knowledge of injury mechanisms and game situations associated with head injuries in girls' high school lacrosse is necessary to target prevention efforts. To use video analysis and injury data to provide an objective and comprehensive visual record to identify mechanisms of injury, game characteristics, and penalties associated with head injury in girls' high school lacrosse. Descriptive epidemiology study. In the 25 public high schools of 1 school system, 529 varsity and junior varsity girls' lacrosse games were videotaped by trained videographers during the 2008 and 2009 seasons. Video of head injury incidents was examined to identify associated mechanisms and game characteristics using a lacrosse-specific coding instrument. Of the 25 head injuries (21 concussions and 4 contusions) recorded as game-related incidents by athletic trainers during the 2 seasons, 20 head injuries were captured on video, and 14 incidents had sufficient image quality for analysis. All 14 incidents of head injury (11 concussions, 3 contusions) involved varsity-level athletes. Most head injuries resulted from stick-to-head contact (n = 8), followed by body-to-head contact (n = 4). The most frequent player activities were defending a shot (n = 4) and competing for a loose ball (n = 4). Ten of the 14 head injuries occurred inside the 12-m arc and in front of the goal, and no penalty was called in 12 injury incidents. All injuries involved 2 players, and most resulted from unintentional actions. Turf versus grass did not appear to influence number of head injuries. Comprehensive video analysis suggests that play near the goal at the varsity high school level is associated with head injuries. Absence of penalty calls on most of these plays suggests an area for exploration, such as the extent to which current rules are enforced and the effectiveness of existing rules for the prevention of head injury.

Remediation of attention deficits in head injury.

OpenAIRE

Nag S; Rao S

1999-01-01

Head injury is associated with psychological sequelae which impair the patient′s psychosocial functioning. Information processing, attention and memory deficits are seen in head injuries of all severity. We attempted to improve deficits of focused, sustained and divided attention. The principle of overlapping sources of attention resource pools was utilised in devising the remediation programme. Tasks used simple inexpensive materials. Four head injured young adult males with post conc...

PRACTICAL MANAGEMENT OF HEAD INJURY | Shehu | Annals of ...

African Journals Online (AJOL)

For an effective practical management of head injury, a clear knowledge of the various causes and mechanism of head injury is essential. The concept of the brain in a rigid cranial cavity makes the pathophysiological mechanism of head trauma unique. Most problems occur due to poor handling of patients at the site of ...

Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings

International Nuclear Information System (INIS)

Nimkin, K.; Kleinman, P.K.; Teeger, S.; Spevak, M.R.

1995-01-01

Distal humeral physeal injuries, in particular, fracture-separation of the distal humeral epiphysis, can be seen in abused infants. Detection of physeal injury in an infant of toddler may indicate the possibility of unsuspected abuse, particularly when an appropriate history explaining the circumstance of the fracture is lacking. In addition, the extent of injury can be difficult to characterize on plain radiographs. Ultrasonography (US) and MR imaging (MRI) may be of value in diagnosis and may obviate the need for intraoperative arthrography. We present MRI findings in three abused children with distal humeral physeal injuries. Sonographic correlation is also presented in one case. (orig.)

Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings

Energy Technology Data Exchange (ETDEWEB)

Nimkin, K. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Kleinman, P.K. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Teeger, S. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Spevak, M.R. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States)

1995-09-01

Distal humeral physeal injuries, in particular, fracture-separation of the distal humeral epiphysis, can be seen in abused infants. Detection of physeal injury in an infant of toddler may indicate the possibility of unsuspected abuse, particularly when an appropriate history explaining the circumstance of the fracture is lacking. In addition, the extent of injury can be difficult to characterize on plain radiographs. Ultrasonography (US) and MR imaging (MRI) may be of value in diagnosis and may obviate the need for intraoperative arthrography. We present MRI findings in three abused children with distal humeral physeal injuries. Sonographic correlation is also presented in one case. (orig.)

Sentence comprehension following moderate closed head injury in adults.

Science.gov (United States)

Leikin, Mark; Ibrahim, Raphiq; Aharon-Peretz, Judith

2012-09-01

The current study explores sentence comprehension impairments among adults following moderate closed head injury. It was hypothesized that if the factor of syntactic complexity significantly affects sentence comprehension in these patients, it would testify to the existence of syntactic processing deficit along with working-memory problems. Thirty-six adults (18 closed head injury patients and 18 healthy controls matched in age, gender, and IQ) participated in the study. A picture-sentence matching task together with various tests for memory, language, and reading abilities were used to explore whether sentence comprehension impairments exist as a result of a deficit in syntactic processing or of working-memory dysfunction. Results indicate significant impairment in sentence comprehension among adults with closed head injury compared with their non-head-injured peers. Results also reveal that closed head injury patients demonstrate considerable decline in working memory, short-term memory, and semantic knowledge. Analysis of the results shows that memory impairment and syntactic complexity contribute significantly to sentence comprehension difficulties in closed head injury patients. At the same time, the presentation mode (spoken or written language) was found to have no effect on comprehension among adults with closed head injury, and their reading abilities appear to be relatively intact.

The "swing-ding": a golf-related head injury in children.

Science.gov (United States)

Wang, Arthur; Cohen, Alan R; Robinson, Shenandoah

2011-01-01

In recent years there has been an increased incidence of golf-associated head injuries in children and adolescents. At the authors' institution, they have identified a unique pattern of head injury associated with a swinging golf club. In this study, the authors highlight the mechanism of this injury and report their experience treating it. The authors reviewed the database of Rainbow Babies and Children's Hospital Trauma Center and performed a retrospective analysis of golf injuries recorded over a 10-year period (January 2000-April 2010). They identified 13 children (9 boys and 4 girls) who sustained head injuries in golfing accidents. All patients were 10 years of age or younger. The medical charts were reviewed and follow-up interviews were conducted to better delineate the details of the injuries. Injuries included 13 depressed skull fractures, 7 epidural hematomas, and 1 cerebral contusion. All 13 patients sustained their injuries after being struck in the head by a golf club. Seven sustained injuries on the follow-through of the initial swing and 3 sustained injuries on the backswing. All but one patient required neurosurgical intervention. Five patients developed neurological sequelae. None of the children had prior experience with golf equipment. All but one injury occurred in the child's own backyard. There was no direct supervision by an adult in any of the cases. Golfing can lead to serious head injuries in children. The authors noticed a unique pattern of golf-related head injuries, previously not described, that they have termed the "swing-ding." This golf club-inflicted injury occurs when a child stands too close to a swinging golfer and is struck in the head, subsequently sustaining a comminuted depressed skull fracture in the frontal or temporal region, with or without further intracranial injury. The study suggests that a lack of adult supervision, minimal previous golf experience, and proximity of the child to the swinging golfer are all

Intention tremor after head injury

International Nuclear Information System (INIS)

Iwadate, Yasuo; Saeki, Naokatsu; Namba, Hiroki; Odaki, Masaru; Oka, Nobuo.

1989-01-01

Eight cases of intention tremor as a late complication of head injury were investigated. The patients ranged in age from 3 to 24 years. All received severe head injuries and lapsed into coma immediately afterward (Glasgow Coma Scale scores ≤8). Six patients exhibited decerebration or decortication. Hemiparesis was present in six cases and oculomotor nerve palsy in four. In the chronic stage, all patients displayed some degree of impairment of higher cortical function and five had dysarthria and/or ataxia. Initial computed tomography (CT) scans within 3 hours after the injury were obtained in five cases, of which four showed a hemorrhagic lesion in the midbrain or its surroundings. Other CT findings were diffuse cerebral swelling (four cases), intraventricular hemorrhage (three), and multiple hemorrhagic lesions (two). In the chronic stage, generalized cortical atrophy or ventricular enlargement was noted in five cases. These clinical features and CT findings indicate diffuse brain damage as well as midbrain damage and may reflect shearing injury. (author)

Ophthalmic manifestations of head injury.

Science.gov (United States)

Kowal, L

1992-02-01

Head injuries are frequently associated with ophthalmic problems. The commonest problems seen in this series of 161 patients with head injury were problems with poor accommodation (16% of patients; 58% of these persisted), convergence (14% of patients; 35% of these persisted), pseudomyopia (19%; 55% persisted) and optic atrophy (26% of the patients; 78% of these were mild and easily missed on routine testing, and 22% were severe). Motility disorders were common, especially cranial nerve palsies. Other less frequent motility disturbances included apparent inferior oblique palsy, comitant esotropia, and exotropia which was often of the convergence insufficiency type.

Injury patterns and mortality rates of motorcycle-related head injuries ...

African Journals Online (AJOL)

Background: Motorcycles are an emerging means of public transportation in many developing countries and has a poor safety record when compared to other road users. Subsequently, motorcycle injuries have been on the rise and head injuries are the leading cause of death, severe injury and disability globally.

Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies.

Science.gov (United States)

Tucker, Ross; Raftery, Martin; Kemp, Simon; Brown, James; Fuller, Gordon; Hester, Ben; Cross, Matthew; Quarrie, Ken

2017-08-01

The tackle is responsible for the majority of head injuries during rugby union. In order to address head injury risk, risk factors during the tackle must first be identified. This study analysed tackle characteristics in the professional game in order to inform potential interventions. 464 tackles resulting in a head injury assessment (HIA) were analysed in detail, with tackle type, direction, speed, acceleration, nature of head contact and player body position the characteristics of interest. Propensity to cause an HIA was significantly greater for active shoulder tackles, front-on tackles, high speeder tackles and an accelerating tackler. Head contact between a tackler's head and ball carrier's head or shoulder was significantly more likely to cause an HIA than contact below the level of the shoulder (incident rate ratio (IRR) 4.25, 95%-CI 3.38 to 5.35). The tackler experiences the majority (78%) of HIAs when head-to-head contact occurs. An upright tackler was 1.5 times more likely to experience an HIA than a bent at the waist tackler (IRR 1.44, 95% CI 1.18 to 1.76). This study confirms that energy transfer in the tackle is a risk factor for head injury, since direction, type and speed all influence HIA propensity. The study provides evidence that body position and the height of tackles should be a focus for interventions, since lowering height and adopting a bent at the waist body position is associated with reduced risk for both tacklers and ball carriers. To this end, World Rugby has implemented law change based on the present data. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Occupational injury among hospital patient-care workers: what is the association with workplace verbal abuse?

Science.gov (United States)

Sabbath, Erika L; Hurtado, David A; Okechukwu, Cassandra A; Tamers, Sara L; Nelson, Candace; Kim, Seung-Sup; Wagner, Gregory; Sorenson, Glorian

2014-02-01

To test the association between workplace abuse exposure and injury risk among hospital workers. We hypothesized that exposed workers would have higher injury rates than unexposed workers. Survey of direct-care workers (n = 1,497) in two hospitals. Exposure to workplace abuse was assessed through self-report; occupational injury reports were extracted from employee records. We tested associations between non-physical workplace violence and injury using log-binomial regression and multilevel modeling. Adjusted prevalence ratio (PR) for injury associated with being yelled at was 1.52 (95% CI 1.19, 1.95); for experiencing hostile/offensive gestures 1.43 (1.11, 1.82); and for being sworn at 1.41 (1.09, 1.81). In analyses by injury subtypes, musculoskeletal injuries were more strongly associated with abuse than were acute traumatic injuries. Associations operated on group and individual levels and were most consistently associated with abuse perpetrated by patients. Exposure to workplace abuse may be a risk factor for injuries among hospital workers. © 2013 Wiley Periodicals, Inc.

Comparison of intracranial computed tomographic (CT) findings in pediatric abusive and accidental head trauma

International Nuclear Information System (INIS)

Hymel, K.P.; Rumack, C.M.; Hay, T.C.; Strain, J.D.; Jenny, C.

1997-01-01

Background. Child abuse specialists rely heavily on diagnostic neuroimaging. Objectives. Study objectives were: (1) to compare the frequencies of six specific intracranial CT abnormalities in accidental and non-accidental pediatric head trauma, and (2) to assess interobserver agreement regarding these CT findings. Materials and methods. Three pediatric radiologists blindly and independently reviewed cranial CT scans of pediatric patients who sustained closed head trauma between 1991 and 1994. All patients were less than 4 years of age. Study cases included thirty-nine (50 %) with non-accidental head trauma and thirty-nine (50 %) with accidental head trauma. Each scan was evaluated for the presence or absence of the following six intracranial findings: (1) interhemispheric falx hemorrhage, (2) subdural hemorrhage, (3) large (non-acute) extra-axial fluid, (4) basal ganglia edema, (5) posterior fossa hemorrhage, and (6) frontal-parietal shearing tear(s). Interobserver agreement was calculated as the percentage of total cases in which all reviewers agreed a specific CT finding was present or absent. Diagnosis required independent agreement by all three pediatric radiologists. The frequencies of these six intracranial CT abnormalities were compared between the two study groups by Chi-square analysis and Fisher's exact test. Results. Interobserver agreement between radiologists was greater than 80 % for all lesions evaluated, with the exception of frontal-parietal shearing tear(s). Interhemispheric falx hemorrhage, subdural hemorrhage, large (non-acute) extra-axial fluid, and basal ganglia edema were discovered significantly more frequently in non-accidental trauma (P ≤.05). Conclusion. Although not specific for child abuse, discovery of these intracranial CT abnormalities in young patients should prompt careful evaluation of family and injury circumstances for indicators of non-accidental trauma. (orig.). With 6 figs., 2 tabs

Head injuries (TBI) to adults and children in motor vehicle crashes.

Science.gov (United States)

Viano, David C; Parenteau, Chantal S; Xu, Likang; Faul, Mark

2017-08-18

This is a descriptive study. It determined the annual, national incidence of head injuries (traumatic brain injury, TBI) to adults and children in motor vehicle crashes. It evaluated NASS-CDS for exposure and incidence of various head injuries in towaway crashes. It evaluated 3 health databases for emergency department (ED) visits, hospitalizations, and deaths due to TBI in motor vehicle occupants. Four databases were evaluated using 1997-2010 data on adult (15+ years old) and child (0-14 years old) occupants in motor vehicle crashes: (1) NASS-CDS estimated the annual incidence of various head injuries and outcomes in towaway crashes, (2) National Hospital Ambulatory Medical Care Survey (NHAMCS)-estimated ED visits for TBI, (3) National Hospital Discharge Survey (NHDS) estimated hospitalizations for TBI, and (4) National Vital Statistics System (NVSS) estimated TBI deaths. The 4 databases provide annual national totals for TBI related injury and death in motor vehicle crashes based on differing definitions with TBI coded by the Abbreviated Injury Scale (AIS) in NASS-CDS and by International Classification of Diseases (ICD) in the health data. Adults: NASS-CDS had 16,980 ± 2,411 (risk = 0.43 ± 0.06%) with severe head injury (AIS 4+) out of 3,930,543 exposed adults in towaway crashes annually. There were 49,881 ± 9,729 (risk = 1.27 ± 0.25%) hospitalized with AIS 2+ head injury, without death. There were 6,753 ± 882 (risk = 0.17 ± 0.02%) fatalities with a head injury cause. The public health data had 89,331 ± 6,870 ED visits, 33,598 ± 1,052 hospitalizations, and 6,682 ± 22 deaths with TBI. NASS-CDS estimated 48% more hospitalized with AIS 2+ head injury without death than NHDS occupants hospitalized with TBI. NASS-CDS estimated 29% more deaths with AIS 3+ head injury than NVSS occupant TBI deaths but only 1% more deaths with a head injury cause. Children: NASS-CDS had 1,453 ± 318 (risk = 0.32 ± 0.07%) with severe head injury (AIS 4+) out of 454,973 exposed

Tackler’s head position relative to the ball carrier is highly correlated with head and neck injuries in rugby

Science.gov (United States)

Hasegawa, Yoshinori; Shiota, Yuki; Ota, Chihiro; Yoneda, Takeshi; Tahara, Shigeyuki; Maki, Nobukazu; Matsuura, Takahiro; Sekiguchi, Masahiro; Itoigawa, Yoshiaki; Tateishi, Tomohiko; Kaneko, Kazuo

2018-01-01

Objectives To characterise the tackler’s head position during one-on-one tackling in rugby and to determine the incidence of head, neck and shoulder injuries through analysis of game videos, injury records and a questionnaire completed by the tacklers themselves. Methods We randomly selected 28 game videos featuring two university teams in competitions held in 2015 and 2016. Tackles were categorised according to tackler’s head position. The ‘pre-contact phase’ was defined; its duration and the number of steps taken by the ball carrier prior to a tackle were evaluated. Results In total, 3970 tackles, including 317 (8.0%) with the tackler’s head incorrectly positioned (ie, in front of the ball carrier) were examined. Thirty-two head, neck or shoulder injuries occurred for an injury incidence of 0.8% (32/3970). The incidence of injury in tackles with incorrect head positioning was 69.4/1000 tackles; the injury incidence with correct head positioning (ie, behind or to one side of the ball carrier) was 2.7/1000 tackles. Concussions, neck injuries, ‘stingers’ and nasal fractures occurred significantly more often during tackles with incorrect head positioning than during tackles with correct head positioning. Significantly fewer steps were taken before tackles with incorrect head positioning that resulted in injury than before tackles that did not result in injury. Conclusion Tackling with incorrect head position relative to the ball carrier resulted in a significantly higher incidence of concussions, neck injuries, stingers and nasal fractures than tackling with correct head position. Tackles with shorter duration and distance before contact resulted in more injuries. PMID:29162618

Motorcycle helmet type and the risk of head injury and neck injury during motorcycle collisions in California.

Science.gov (United States)

Erhardt, Taryn; Rice, Thomas; Troszak, Lara; Zhu, Motao

2016-01-01

The use of novelty motorcycle helmets is often prompted by beliefs that wearing a standard helmet can contribute to neck injury during traffic collisions. The goal of this analysis was to examine the association between helmet type and neck injury risk and the association between helmet type and head injury. Data were collected during the investigation of motorcycle collisions of any injury severity by the California Highway Patrol (CHP) and 83 local law enforcement agencies in California between June 2012 and July 2013. We estimated head injury and neck injury risk ratios from data on 7051 collision-involved motorcyclists using log-binomial regression. Helmet type was strongly associated with head injury occurrence but was not associated with the occurrence of neck injury. Rider age, rider alcohol use, and motorcycle speed were strong, positive predictors of both head and neck injury. Interventions to improve motorcycle helmet choice and to counteract misplaced concerns surrounding neck injury risk are likely to lead to reductions in head injury, brain injury, and death. Copyright © 2015 Elsevier Ltd. All rights reserved.

Child protection medical service demonstration centers in approaching child abuse and neglect in Taiwan.

Science.gov (United States)

Chang, Yu-Ching; Huang, Jing-Long; Hsia, Shao-Hsuan; Lin, Kuang-Lin; Lee, En-Pei; Chou, I-Jun; Hsin, Yi-Chen; Lo, Fu-Song; Wu, Chang-Teng; Chiu, Cheng-Hsun; Wu, Han-Ping

2016-11-01

Child abuse includes all forms of physical and emotional ill treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development, or dignity. In Taiwan, the Child Protection Medical Service Demonstration Center (CPMSDC) was established to protect children from abuse and neglect. We further analyzed and compared the trends and clinical characteristics of cases reported by CPMSDC to evaluate the function of CPMSDC in approaching child abuse and neglect in Taiwan. We prospectively recorded children with reported child abuse and neglect in a CPMSDC in a tertiary medical center from 2014 to 2015. Furthermore, we analyzed and compared age, gender, scene, identifying settings, time of visits, injury type, injury severity, hospital admission, hospitalization duration, and outcomes based on the different types of abuse and the different settings in which the abuse or neglect were identified. Of 361 child abuse cases (mean age 4.8 ± 5.36 years), the incidence was highest in 1- to 6-year-old children (n = 198, 54.85%). Physical abuse and neglect were predominant in males, while sexual abuse was predominant in females (P Neglect was most common (n = 279, 75.85%), followed by physical (n = 56, 15.51%) and sexual abuse (n = 26, 7.2%). The most common identifying setting was the emergency department (n = 320, 88.64%), with neglect being most commonly reported. Head, neck, and facial injuries were more common in physically abused children than in neglected and sexual abused children (P neglect (P abuse, and to increase the rate of registry. Cases of physical abuse had a higher Injury Severity Score, longer duration of hospitalization, and more injuries of head, face, and neck compared with other types of abuse. The reported rate of neglect was highly elevated after the CPMSDC established during the study period. Recognition of neglect is not easy, but the consequent injury, especially

Child abuse. Diagnostic imaging of skeletal injuries

International Nuclear Information System (INIS)

Stenzel, Martin; Mentzel, Hans-Joachim

2012-01-01

Diagnostic imaging, besides medical history and clinical examination, is a major component in assessment of cases of suspected physical child abuse. Performance of proper imaging technique, and knowledge of specific injury patterns is required for accurate image interpretation by the radiologist, and serves protection of the child in case of proven abuse. On the other side, it is essential to protect the family in unjustified accusations. The reader will be familiarised with essentials of the topic 'Physical child abuse', in order to be able to correctly assess quality, completeness, and results of X-ray films. Moreover, opportunities and limitations of alternative diagnostic modalities will be discussed. (orig.)

Computerised tomographic patterns in patients with head injury at ...

African Journals Online (AJOL)

2011-04-15

Apr 15, 2011 ... The clinical severity of head injury is classified based on ... head injury include road traffic accidents (RTA), assaults, ... information in the management of patients with head ... Materials and Methods ... The right cerebral hemisphere was involved in 13 cases .... Nerve palsies – 3rd, 5th, 6th cranial nerves. 3.

A video analysis of head injuries satisfying the criteria for a head injury assessment in professional Rugby Union: a prospective cohort study.

Science.gov (United States)

Tucker, Ross; Raftery, Martin; Fuller, Gordon Ward; Hester, Ben; Kemp, Simon; Cross, Matthew J

2017-08-01

Concussion is the most common match injury in professional Rugby Union, accounting for 25% of match injuries. The primary prevention of head injuries requires that the injury mechanism be known so that interventions can be targeted to specifically overall incidence by focusing on characteristics with the greatest propensity to cause a head injury. 611 head injury assessment (HIA) events in professional Rugby Union over a 3-year period were analysed, with specific reference to match events, position, time and nature of head contact. 464 (76%) of HIA events occur during tackles, with the tackler experiencing a significantly greater propensity for an HIA than the ball carrier (1.40 HIAs/1000 tackles for the tackler vs 0.54 HIAs/1000 tackles for the ball carrier, incidence rate ratio (IRR) 2.59). Propensity was significantly greater for backline players than forwards (IRR 1.54, 95% CI 1.28 to 1.84), but did not increase over the course of the match. Head to head contact accounted for the most tackler HIAs, with the greatest propensity. By virtue of its high propensity and frequency, the tackle should be the focus for interventions that may include law change and technique education. A specific investigation of the characteristics of the tackle is warranted to refine the approach to preventative strategies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Educational paper Abusive Head Trauma Part II: Radiological aspects

NARCIS (Netherlands)

Sieswerda-Hoogendoorn, Tessa; Boos, Stephen; Spivack, Betty; Bilo, Rob A. C.; van Rijn, Rick R.

2012-01-01

Abusive head trauma (AHT) is a relatively common cause of neurotrauma in young children. Radiology plays an important role in establishing a diagnosis and assessing a prognosis. Computed tomography (CT), followed by magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), is the

Fatal child abuse: a study of 13 cases of continuous abuse

Directory of Open Access Journals (Sweden)

Juhani Merikanto

2012-01-01

Full Text Available A parent who continuously physically abuses her/his child doesn’t aim to kill the child but commits an accidental filicide in a more violent outburst of anger. Fatal abuse deaths are prevented by recognition of signs of battering in time. Out of 200 examined intra-familial filicides, 23 (12% were caused by child battering and 13 (7% by continuous battering. The medical and court records of the victim and the perpetrator were examined. The perpetrator was the biological mother and the victim was male in 69 per cent of the cases. The abused children were either younger than one year or from two-and-a-half to four years old. Risk factors of the victim (being unwanted, premature birth, separation from the parent caused by hospitalization or custodial care, being ill and crying a lot and the perpetrator (personality disorder, low socioeconomic status, chaotic family conditions, domestic violence, isolation, alcohol abuse were common. The injuries caused by previous battering were mostly soft tissue injuries in head and limbs and head traumas and the battering lasted for days or even an year. The final assault was more violent and occurred when the parent was more anxious, frustrated or left alone with the child. The perpetrating parent was diagnosed as having a personality disorder (borderline, narcissistic or dependent and often substance dependence (31%. None of them were psychotic. Authorities and community members should pay attention to the change in child’s behavior and inexplicable injuries or absence from daycare. Furthermore if the parent is immature, alcohol dependent, have a personality disorder and is unable to cope with the demands the small child entails in the parent’s life, the child may be in danger.

Assessment of head injury of children due to golf ball impact.

Science.gov (United States)

Lee, Heow Pueh; Wang, Fang

2010-10-01

Head trauma injury due to impact by a flying golf ball is one of the most severe possible injury accidents on the golf course. Numerical simulations based on the finite element method are presented to investigate head injury in children due to impact by a flying golf ball. The stress and energy flow patterns in a head model during the golf ball impact are computed for various combinations of striking speed, falling angle of the golf ball before impact, and impact location. It is found that a child is more prone to head injury due to golf ball impact on the frontal and side/temporal areas. The simulated results are found to conform to the clinical reports on children's head injuries from flying golf balls.

Traumatic injuries: imaging of head injuries

Energy Technology Data Exchange (ETDEWEB)

Besenski, N. [Croatian Institute for Brain Research, Zagreb (Croatia)

2002-06-01

Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for

Traumatic injuries: imaging of head injuries

International Nuclear Information System (INIS)

Besenski, N.

2002-01-01

Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for

CT analysis of missile head injury

International Nuclear Information System (INIS)

Besenski, N.; Jadro-Santel, D.; Jelavic-Koic, F.; Pavic, D.; Mikulic, D.; Glavina, K.; Maskovic, J.

1995-01-01

Between August 1991 and December 1992, CT was performed in 154 patients who had suffered missile head injury during the war in the Republic of Croatia. In 54% CT was performed 1-24 h after injury, and in 27% follow-up CT was also obtained. The wounds were penetrating, tangential or perforating (45%, 34% and 21%, respectively). Haemorrhage was the most frequent lesion in the brain (84%). Follow-up CT evolution of haemorrhage, oedema, cerebritis, abscess, secondary vascular lesions, necrosis, encephalomalacia and hydrocephalus. The most dynamic changes occurred 7-14 days after injury. In 14% of cases, deep cerebral lesions were found in the corpus callosum, septum pellucidum periventricular region and pons, although bone and shell fragments were in a different part of the brain parenchyma. Such lesions were found in penetrating injuries only. CT proved very useful for assessing the extent and type of lesions. Although different mechanisms of brain damage in missile head injury are known, here they are, to the best of our knowledge, shown for the first time by CT. (orig.)

Head injury causation scenarios for belted, rear-seated children in frontal impacts.

Science.gov (United States)

Bohman, Katarina; Arbogast, Kristy B; Bostrom, Ola

2011-02-01

Head injuries are the most common serious injuries sustained by children in motor vehicle crashes and are of critical importance with regard to long-term disability. There is a lack of understanding of how seat belt-restrained children sustain head injuries in frontal impacts. The aim of the study was to identify the AIS2+ head injury causation scenarios for rear-seated, belt-restrained children in frontal impacts, including the set of parameters contributing to the injury. In-depth crash investigations from two National Highway Traffic Safety Administration (NHTSA) databases, the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS; 1997-2008) and the Crash Injury Research and Engineering Network (CIREN; 1996-2009), were collected and analyzed in detail. Selection criteria were all frontal impacts with principal direction of force (PDOF) of 11, 12, and 1 o'clock involving rear-seated, three-point belt-restrained, with or without booster cushion, children from 3 to 13 years with an AIS2+ head injury. Cases were analyzed using the BioTab method of injury causation assessment in order to systematically analyze the injury causation scenario for each case. There were 27 cases meeting the inclusion criteria, 19 cases with MAIS2 head injuries and 8 cases with MAIS3+ head injuries, including 2 fatalities. Three major injury causation scenarios were identified, including head contact with seatback (10 cases), head contact with side interior (7 cases,) and no evidence of head contact (9 cases). Head injuries with seatback or side interior contact typically included a PDOF greater than 10 degree (similar to the Insurance Institute for Highway Safety [IIHS] and EuroNCAP offset frontal testing) and vehicle maneuvers. For seatback contact, the vehicle's movements contributed to occupant kinematics inboard the vehicle, causing a less than optimal restraint of the torso and/or torso roll out of the shoulder belt. For side interior contact, the PDOF and

Concussions and Head Injuries in English Community Rugby Union Match Play.

Science.gov (United States)

Roberts, Simon P; Trewartha, Grant; England, Michael; Goodison, William; Stokes, Keith A

2017-02-01

Previous research has described general injury patterns in community-level rugby union, but specific information on time-loss head injuries has not been reported. To establish the incidence and nature of significant time-loss head injuries in English community rugby match play, and to identify the injury risk for specific contact events. Descriptive epidemiology study. Over 6 seasons, injury information was collected from 46 (2009-2010), 67 (2010-2011), 76 (2011-2012), 50 (2012-2013), 67 (2013-2014), and 58 (2014-2015) English community rugby clubs (Rugby Football Union levels 3-9) over a total of 175,940 hours of player match exposure. Club injury management staff reported information for all head injuries sustained during match play whereby the player was absent for 8 days or greater. Clubs were subdivided into semiprofessional (mean player age, 24.6 ± 4.7 years), amateur (24.9 ± 5.1 years), and recreational (25.6 ± 6.1 years) playing levels. Contact events from a sample of 30 matches filmed over seasons 2009-2010, 2010-2011, and 2011-2012 provided mean values for the frequency of contact events. The overall incidence for time-loss head injuries was 2.43 injuries per 1000 player match hours, with a higher incidence for the amateur (2.78; 95% CI, 2.37-3.20) compared with recreational (2.20; 95% CI, 1.86-2.53) ( P = .032) playing level but not different to the semiprofessional (2.31; 95% CI, 1.83-2.79) playing level. Concussion was the most common time-loss head injury, with 1.46 per 1000 player match hours. The tackle event was associated with 64% of all head injuries and 74% of all concussions. There was also a higher risk of injuries per tackle (0.33 per 1000 events; 95% CI, 0.30-0.37) compared with all other contact events. Concussion was the most common head injury diagnosis, although it is likely that this injury was underreported. Continuing education programs for medical staff and players are essential for the improved identification and management of

Children with burns referred for child abuse evaluation: Burn characteristics and co-existent injuries.

Science.gov (United States)

Pawlik, Marie-Christin; Kemp, Alison; Maguire, Sabine; Nuttall, Diane; Feldman, Kenneth W; Lindberg, Daniel M

2016-05-01

Intentional burns represent a serious form of physical abuse that must be identified to protect children from further harm. This study is a retrospectively planned secondary analysis of the Examining Siblings To Recognize Abuse (ExSTRA) network data. Our objective was to describe the characteristics of burns injuries in children referred to Child Abuse Pediatricians (CAPs) in relation to the perceived likelihood of abuse. We furthermore compare the extent of diagnostic investigations undertaken in children referred to CAPs for burn injuries with those referred for other reasons. Within this dataset, 7% (215/2890) of children had burns. Children with burns were older than children with other injuries (median age 20 months vs. 10 months). Physical abuse was perceived as likely in 40.9% (88) and unlikely in 59.1% (127). Scalds accounted for 52.6% (113) and contact burns for 27.6% (60). Several characteristics of the history and burn injury were associated with a significantly higher perceived likelihood of abuse, including children with reported inflicted injury, absent or inadequate explanation, hot water as agent, immersion scald, a bilateral/symmetric burn pattern, total body surface area ≥10%, full thickness burns, and co-existent injuries. The rates of diagnostic testing were significantly lower in children with burns than other injuries, yet the yield of skeletal survey and hepatic transaminases testing were comparable between the two groups. This would imply that children referred to CAPs for burns warrant the same level of comprehensive investigations as those referred for other reasons. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Mild head injury and attention deficit hyperactivity disorder in children.

Science.gov (United States)

Chasle, Veronique; Riffaud, Laurent; Longuet, Romain; Martineau-Curt, Marie; Collet, Yann; Le Fournier, Luc; Pladys, Patrick

2016-12-01

Post-concussion syndrome is a well-described complication following moderate and severe head trauma but whether it occurs after mild head injury in children remains unclear. The aim of this study was to evaluate whether exposure to mild head injury with potential additional risk factors (non-surgical lesion on computed tomographic, high kinetic trauma, or Glasgow Coma Scale <15) is associated with attention deficit hyperactivity disorder (ADHD) after the head trauma. This study was performed in an emergency department on children admitted between 2009 and 2013. It compared victims of mild head injury aged 6-16 years with matched children presenting isolated non-surgical forearm fracture (ratio1/2). ADHD was assessed using Conners' Global Index-Parent short version 3-40 months after the trauma. The patients were compared using chi-square test or Fisher's exact test, t test or u-test as appropriate with a p value set at 0.05. During the study period, 676 patients were admitted for mild head injury. Among them, 34 (5 %) fulfilled the inclusion criteria and were compared with 64 matched patients admitted for a forearm fracture. The groups were comparable. ADHD was observed in both groups (18 % in the mild head injury group, 11 % in the control group) with no significant differences between groups. The prevalence was high when compared to an expected frequency of 3.5-5.6 % in children aged 6-12 years in the general population. These results suggest that pre-existing ADHD may have contributed to injury proneness in both groups and does not argue for a specific risk of ADHD induced by mild head injury. The diagnosis of ADHD should be evoked at admission of children aged 6-16 years presenting with a trauma.

Is contrast-enhanced CT indicated in acute head injury

International Nuclear Information System (INIS)

Mauser, H.W.; Nieuwenhuizen, O. van; Veiga-Pires, J.A.

1984-01-01

The authors discuss the value of intravenous contrast enhancement in CT scanning in acute head injury. In a series of seventy consecutive patients they conclude that no incremental information was obtained by performing contrast-enhanced CT scans in the acute phase of the head injury. (orig.)

Head injury predictors in sports trauma--a state-of-the-art review.

Science.gov (United States)

Fernandes, Fábio A O; de Sousa, Ricardo J Alves

2015-08-01

Head injuries occur in a great variety of sports. Many of these have been associated with neurological injuries, affecting the central nervous system. Some examples are motorsports, cycling, skiing, horse riding, mountaineering and most contact sports such as football, ice and field hockey, soccer, lacrosse, etc. The outcome of head impacts in these sports can be very severe. The worst-case scenarios of permanent disability or even death are possibilities. Over recent decades, many In recent decades, a great number of head injury criteria and respective thresholds have been proposed. However, the available information is much dispersed and a consensus has still not been achieved regarding the best injury criteria or even their thresholds. This review paper gives a thorough overview of the work carried out by the scientific community in the field of impact biomechanics about head injuries sustained during sports activity. The main goal is to review the head injury criteria, as well as their thresholds. Several are reviewed, from the predictors based on kinematics to the ones based on human tissue thresholds. In this work, we start to briefly introduce the head injuries and their mechanisms commonly seen as a result of head trauma in sports. Then, we present and summarize the head injury criteria and their respective thresholds. © IMechE 2015.

Psychological injury in victims of child sexual abuse: A meta-analytic review

Directory of Open Access Journals (Sweden)

Bárbara G. Amado

2015-04-01

Full Text Available In order to assess the effects of child/adolescent sexual abuse (CSA/ASA on the victim's probability of developingsymptoms of depression and anxiety, to quantify injury in populational terms, to establish theprobability of injury, and to determine the different effects of moderators on the severity of injury, a meta-analysis was performed. Given the abundant literature, only studies indexed in the scientific databaseof reference, the Web of Science, were selected. A total of 78 studies met the inclusion criteria: they measuredCSA/ASA victimization or injury in terms of depression or anxiety symptoms, measured the effectsize or included data for computing them, and provided a description of the sample. The results showedthat CSA/ASA victims suffered significant injury, generally of a medium effect size and generalizable, victimshad 70% more probabilities of suffering from injury, and clinical diagnosis was significantly a moreadequate measure of injury than symptoms. The probability of chronic injury (dysthymia was greaterthan developing more severe injury, i.e., major depressive disorder (MDD. In the category of anxiety disorders,injury was expressed with a higher probability in specific phobia. In terms of the victim's gender,females had significantly higher rates of developing a depressive disorder (DD and/or an anxiety disorder(AD, quantified in a 42% and 24% over the baseline, for a DD and AD respectively. As for the type of abuse,the meta-analysis revealed that abuse involving penetration was linked to severe injury, whereas abusewith no contact was associated to less serious injury. The clinical, social, and legal implications of the resultsare discussed.

Characteristics of helmet or knit cap use in head injury of snowboarders.

Science.gov (United States)

Fukuda, Osamu; Hirashima, Yutaka; Origasa, Hideki; Endo, Shunro

2007-11-01

The rate of head injury is 1.86-6 times higher for snowboarding than for skiing. Detailed data about the usefulness of a helmet or knit cap for protecting against serious head injuries have not been reported. The present study evaluated the use of a helmet or knit cap for preventing head injuries. Questionnaire data were collected from 1,190 consecutive patients in a hospital during the 1999/2000-2002/2003 winter seasons at Uonuma ski resort, Niigata, Japan. Patients were divided into the helmet, knit cap, and no cap groups. Upper technical level was highest and jumping as the cause of injury was most frequent in the helmet group. After adjustment for other confounders, there was a significant negative association between the occurrence of serious head injury during snowboarding and female sex (adjusted odds ratio 0.55, 95% confidence interval 0.421-0.718, p jumping (adjusted odds ratio 2.25, 95% confidence interval 1.48-3.43, p = 0.0001). Among snowboarding maneuvers, only jumping showed a significant negative association between wearing of a helmet or knit cap and the occurrence of serious head injury (p = 0.036). Snowboarders who wear helmets might attempt dangerous maneuvers causing injuries. Wearing of a helmet or knit cap protected against serious head injuries on jumping. Every snowboarder should wear a helmet or knit cap on jumping to prevent head injury.

Child abuse: Awareness is the first step to action.

Science.gov (United States)

Paglia, L

2018-06-01

Most of the physical injuries that children are subjected to affect the head and neck region; approximately 50% of injuries due to child abuse occur in the orofacial region and almost 15% of these injuries are confined to the head region (Cairns A.M.). For this reason, the dental team has a key role in identifying and detecting child abuse. In addition, having paediatric dentists an ongoing relationship with their young patients and families give them the opportunity to observe and assess not only the physical and psychological condition of the children, but also the family environment (the majority of abuse cases toward children are from the caregiver or the parents). These types of lesions could be confused with occasional children traumatic injuries, and this is why dentist should be trained to detect the signs of child abuse, as well be informed on how these cases should be reported to authorities. In a recent research about child abuse in the United Arab Emirates-UAE (H. Al Hajeri et al. Assessment of the knowledge of United Arab Emirates dentists of child maltreatment, protection and safeguarding) more than half of the respondents (54.6%) were not aware of such guidelines/procedures. According to the authors, the main factors affecting the decision of reporting were the lack of knowledge on the appropriate reporting procedure (60%), and the fear of family retaliation toward the child (59%). The Arab colleagues rightly concluded: "diagnosis is a shared responsibility of the child protection team and no matter what obstacles and fears the dentist may have; the main priority is the child". More efforts should be made to improve knowledge, attitude and practice of dentists in this social problem in order to decrease child abuse worldwide.

Radial head fracture associated with posterior interosseous nerve injury

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Bernardo Barcellos Terra

Full Text Available ABSTRACT Fractures of the radial head and radial neck correspond to 1.7-5.4% of all fractures and approximately 30% may present associated injuries. In the literature, there are few reports of radial head fracture with posterior interosseous nerve injury. This study aimed to report a case of radial head fracture associated with posterior interosseous nerve injury. CASE REPORT: A male patient, aged 42 years, sought medical care after falling from a skateboard. The patient related pain and limitation of movement in the right elbow and difficulty to extend the fingers of the right hand. During physical examination, thumb and fingers extension deficit was observed. The wrist extension showed a slight radial deviation. After imaging, it became evident that the patient had a fracture of the radial head that was classified as grade III in the Mason classification. The patient underwent fracture fixation; at the first postoperative day, thumb and fingers extension was observed. Although rare, posterior interosseous nerve branch injury may be associated with radial head fractures. In the present case, the authors believe that neuropraxia occurred as a result of the fracture hematoma and edema.

Subtle Symptoms Associated with Self-Reported Mild Head Injury.

Science.gov (United States)

Segalowitz, Sidney J.; Lawson, Sheila

1995-01-01

A survey of 1,345 high school students and 2,321 university students found that 30-37% reported having experienced a head injury, with 12-15% reporting loss of consciousness. Significant relationships were found between mild head injury incidence and gender; sleep difficulties; social difficulties; handedness pattern; and diagnoses of attention…

Fall Risk Assessment Predicts Fall-Related Injury, Hip Fracture, and Head Injury in Older Adults.

Science.gov (United States)

Nilsson, Martin; Eriksson, Joel; Larsson, Berit; Odén, Anders; Johansson, Helena; Lorentzon, Mattias

2016-11-01

To investigate the role of a fall risk assessment, using the Downton Fall Risk Index (DFRI), in predicting fall-related injury, fall-related head injury and hip fracture, and death, in a large cohort of older women and men residing in Sweden. Cross sectional observational study. Sweden. Older adults (mean age 82.4 ± 7.8) who had a fall risk assessment using the DFRI at baseline (N = 128,596). Information on all fall-related injuries, all fall-related head injuries and hip fractures, and all-cause mortality was collected from the Swedish Patient Register and Cause of Death Register. The predictive role of DFRI was calculated using Poisson regression models with age, sex, height, weight, and comorbidities as covariates, taking time to outcome or end of study into account. During a median follow-up of 253 days (interquartile range 90-402 days) (>80,000 patient-years), 15,299 participants had a fall-related injury, 2,864 a head injury, and 2,557 a hip fracture, and 23,307 died. High fall risk (DFRI ≥3) independently predicted fall-related injury (hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 1.39-1.49), hip fracture (HR = 1.51, 95% CI =1.38-1.66), head injury (HR = 1.12, 95% CI = 1.03-1.22), and all-cause mortality (HR = 1.39, 95% CI = 1.35-1.43). DFRI more strongly predicted head injury (HR = 1.29, 95% CI = 1.21-1.36 vs HR = 1.08, 95% CI = 1.04-1.11) and hip fracture (HR = 1.41, 95% CI = 1.30-1.53 vs HR = 1.08, 95% CI = 1.05-1.11) in 70-year old men than in 90-year old women (P Fall risk assessment using DFRI independently predicts fall-related injury, fall-related head injury and hip fracture, and all-cause mortality in older men and women, indicating its clinical usefulness to identify individuals who would benefit from interventions. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

Variations in the presentation of aphasia in patients with closed head injuries.

LENUS (Irish Health Repository)

Kavanagh, Dara Oliver

2012-01-31

Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

Variations in the Presentation of Aphasia in Patients with Closed Head Injuries

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Dara Oliver Kavanagh

2010-01-01

Full Text Available Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

Role of age and injury mechanism on cervical spine injury tolerance from head contact loading.

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Yoganandan, Narayan; Chirvi, Sajal; Voo, Liming; Pintar, Frank A; Banerjee, Anjishnu

2018-02-17

The objective of this study was to determine the influence of age and injury mechanism on cervical spine tolerance to injury from head contact loading using survival analysis. This study analyzed data from previously conducted experiments using post mortem human subjects (PMHS). Group A tests used the upright intact head-cervical column experimental model. The inferior end of the specimen was fixed, the head was balanced by a mechanical system, and natural lordosis was removed. Specimens were placed on a testing device via a load cell. The piston applied loading at the vertex region. Spinal injuries were identified using medical images. Group B tests used the inverted head-cervical column experimental model. In one study, head-T1 specimens were fixed distally, and C7-T1 joints were oriented anteriorly, preserving lordosis. Torso mass of 16 kg was added to the specimen. In another inverted head-cervical column study, occiput-T2 columns were obtained, an artificial head was attached, T1-T2 was fixed, C4-C5 disc was maintained horizontal in the lordosis posture, and C7-T1 was unconstrained. The specimens were attached to the drop test carriage carrying a torso mass of 15 kg. A load cell at the inferior end measured neck loads in both studies. Axial neck force and age were used as the primary response variable and covariate to derive injury probability curves using survival analysis. Group A tests showed that age is a significant (P < .05) and negative covariate; that is, increasing age resulted in decreasing force for the same risk. Injuries were mainly vertebral body fractures and concentrated at one level, mid-to-lower cervical spine, and were attributed to compression-related mechanisms. However, age was not a significant covariate for the combined data from group B tests. Both group B tests produced many soft tissue injuries, at all levels, from C1 to T1. The injury mechanism was attributed to mainly extension. Multiple and noncontiguous injuries occurred

Review of adult head injury admissions into the intensive care unit of ...

African Journals Online (AJOL)

The most common mode of injury was road traffic accident. All the patients admitted to ICU had either moderate or severe head injury, with 73.7% having severe head injury. About 26.3% of the patients had associated cervical spine injuries and 50% had various musculoskeletal and soft tissue injuries. Cranial computed ...

The state of head injury biomechanics: past, present, and future part 2: physical experimentation.

Science.gov (United States)

Goldsmith, Werner; Monson, Kenneth L

2005-01-01

This presentation is the continuation of the article published in Critical Reviews of Biomedical Engineering, 29(5-6), 2001. That issue contained topics dealing with components and geometry of the human head, classification of head injuries, some early experimental studies, and tolerance considerations. It then dealt with head motion and load characterization, investigations during the period from 1939 to 1966, injury causation and early modeling efforts, the 1966 Head Injury Conference and its sequels, mechanical properties of solid tissues, fluid characterization, and early investigation of the mechanical properties of cranial materials. It continued with a description of the systematic investigations of solid cranial components and structural properties since 1966, fetal cranial properties, analytical head modeling, and numerical solutions of head injury. The paper concluded with experimental dynamic loading of human living and cadaver heads, dynamic loading of surrogate heads, and head injury mechanics. This portion of the paper describes physical head injury experimentation involving animals, primarily primates, human cadavers, volunteers, and inanimate physical models. In order to address the entire domain of head injury biomechanics in the two-part survey, it was intended that this information be supplemented by discussions of head injury tolerance and criteria, automotive and sports safety considerations, and the design of protective equipment, but Professor Goldsmith passed away before these sections could be completed. It is nevertheless anticipated that this attenuated installment will provide, in conjunction with the first part of the survey, a valuable resource for students and practitioners of head injury biomechanics.

A CLINICAL STUDY OF OCULAR MANIFESTATIONS IN PATIENTS OF HEAD INJURY

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Suhas Shamrao Sarawade

2017-04-01

Full Text Available BACKGROUND This study aims to record the prevalence and pattern of various ophthalmic manifestations in patients of head injury and to attempt a correlation between the ocular signs, neurological signs and final outcome. MATERIALS AND METHODS Hundred and twenty patients with head injury having ocular findings, presenting from December 2014 to July 2016, were taken for study. Detailed ophthalmological examination of the patients was carried out and the results of the study are depicted in the form of percentages, graphs and charts. RESULTS The most common cause of head injury found in our study was road traffic accident. The commonest eye finding was oedema and ecchymosis of eyelids. Prime causal factors affecting visual acuity found in our study were corneal tear, globe rupture, optic nerve injury and avulsion of eyeball. CONCLUSION Head injuries with ocular manifestations occur in younger age group. Road traffic accident was the most common cause. Males have to work outside their home for their jobs more than that of females. So they are more prone to accidents. Oedema and ecchymosis of eyelids constitute the most common ocular finding. Patients with mild ocular injuries pointed towards good visual prognosis. Most of them had mild head injury and hence good prognosis in terms of survival of the patient. The patients with severe ocular injuries like corneal tear, globe rupture and optic nerve injury showed poor visual prognosis.

Snowboard head injury: prospective study in Chino, Nagano, for two seasons from 1995 to 1997.

Science.gov (United States)

Nakaguchi, H; Fujimaki, T; Ueki, K; Takahashi, M; Yoshida, H; Kirino, T

1999-06-01

The popularity of snowboarding has been growing rapidly throughout the world. To date, however, the risk of head injury associated with this relatively new winter sport, especially in comparison with alpine skiing, has not been well analyzed. This study was conducted to assess the risk of head injury in snowboarding and to elucidate its features in comparison with skiing head injury. We prospectively analyzed 301 cases of head injuries related to snowboarding or skiing experienced from December of 1995 to May of 1997 at our institution, which is located close to the most popular skiing areas in Japan. Of those injuries, 143 cases were snowboard related and 158 cases were ski related. In addition to appropriate medical evaluation and medical care, detailed examination was performed on every patient to determine various factors, including sex, age, skill level, cause and mechanism of the accident, and the side of impact to the head. The data are statistically analyzed to elucidate unique features of snowboard head injury. During the study period, 2.2 million snowboarders and 4.2 million skiers visited the five skiing facilities that are covered by our hospital. Thus, the incidence of head injury was 6.5 per 100,000 visits for snowboarders and 3.8 per 100,000 visits for skiers. Beginning snowboarders more frequently sustained head injuries compared with beginning skiers (60 of 142 vs. 48 of 154, p = 0.022). Likewise, frequent causes of snowboarding head injuries were fall during jumping (43 of 139 vs. 2 of 147, pskiing head injuries (1.3%). Of 11 major head injury cases, 10 were caused by occipital impact. These results indicate that snowboarders, particularly beginners, are at higher risk for head injury, frequently involving occipital impact, and could lead to more major head injuries. We propose that measures should be taken to protect the head, especially the occiput, in snowboarding.

Computed tomographic study of the complication of head injury

International Nuclear Information System (INIS)

Kojima, Tadashi; Waga, Shiro

1982-01-01

Computed tomography (CT) is quite effective in the diagnosis of traumatic intracranial hemorrhage and cerebral contusion. Two hundred and nine consecutive patients with head injury were admitted to the hospital and studied by CT in the year from 1977 to 1980. Fourty-sevenof 209 patients had the complications of head injury, including 6 patients with carotidcavernous fistula (CCF), 6 with traumatic aneurysm, 10 with pneumocephalus, 4 with intracranial foreign body, 15 with optic nerve injury, and 14 with other cranial nerve palsy. Five patients with CCF had abnormal finding on CT. Two traumatic aneurysms of the superficial temporal artery were visualized on CT after injection of contrast material, but all traumatic aneurysms of the carotid siphon were not seven on CT. CT in all 10 patients with pneumocephalus and in all 4 patients with intracranial foreign body was of diagnostic value: On CT in two patients even small air bubbles were seen in details. In the CT examination of 29 patients who presented with cranial nerve injury, we could not find out any abnormality on CT. We emphasize that CT is much less effective in the diagnosis of vascular complication of head injury and traumatic cranial nerve injury. (author)

Ocular Complications among Cases of Head Injury Seen in a ...

African Journals Online (AJOL)

Background: Head injuries with ocular involvement are of great importance due to the visual morbidity and mortality which may result. Objective: To determine the pattern of ocular complications among cases of head injury seen in Memphys Hospital for Neurosurgery, Enugu, in south-eastern Nigeria. Patients and Methods: ...

Spinal cord injury and its association with blunt head trauma

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Paiva WS

2011-09-01

Full Text Available Wellingson S Paiva, Arthur MP Oliveira, Almir F Andrade, Robson LO Amorim, Leonardo JO Lourenço, Manoel J TeixeiraDivision of Neurosurgery, University of São Paulo, BrazilBackground: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury.Methods: A prospective study involving 1617 patients admitted in the emergency unit was carried out. Of these patients, 180 with moderate or severe head injury were enrolled. All patients were submitted to three-view spine series X-ray and thin cut axial CT scans for spine trauma investigations.Results: 112 male patients and 78 female patients, whose ages ranged from 11 to 76 years (mean age, 34 years. The most common causes of brain trauma were pedestrians struck by motor vehicles (31.1%, car crashes (27.7%, and falls (25%. Systemic lesions were present in 80 (44.4% patients and the most common were fractures, and lung and spleen injuries. 52.8% had severe and 47.2% moderate head trauma. Fourteen patients (7.8% suffered spinal cord injury (12 in cervical spine, one in lumbar, and one thoracic spine. In elderly patients, the presence of associated lesions and Glasgow Coma Scale (GCS < 9 were statistically significant as risk factors (P < 0.05 for spine injury.Conclusion: Spinal cord injury related to moderate and severe brain trauma usually affects the cervical spine. The incidence of spinal lesions and GCS < 9 points were related to greater incidence of spinal cord injury.Keywords: head injury, spine trauma, risk factors

Head Injury as Risk Factor for Psychiatric Disorders

DEFF Research Database (Denmark)

Orlovska, Sonja; Pedersen, Michael Skaarup; Benros, Michael Eriksen

2014-01-01

. METHOD: The authors used linkable Danish nationwide population-based registers to investigate the incidence of schizophrenia spectrum disorders, unipolar depression, bipolar disorder, and organic mental disorders in 113,906 persons who had suffered head injuries. Data were analyzed by survival analysis...... and adjusted for gender, age, calendar year, presence of a psychiatric family history, epilepsy, infections, autoimmune diseases, and fractures not involving the skull or spine. RESULTS: Head injury was associated with a higher risk of schizophrenia (incidence rate ratio [IRR]=1.65, 95% CI=1...

Children and youth with 'unspecified injury to the head': implications for traumatic brain injury research and surveillance.

Science.gov (United States)

Chan, Vincy; Mann, Robert E; Pole, Jason D; Colantonio, Angela

2015-01-01

The case definition for traumatic brain injury (TBI) often includes 'unspecified injury to the head' diagnostic codes. However, research has shown that the inclusion of these codes leads to false positives. As such, it is important to determine the degree to which inclusion of these codes affect the overall numbers and profiles of the TBI population. The objective of this paper was to profile and compare the demographic and clinical characteristics, intention and mechanism of injury, and discharge disposition of hospitalized children and youth aged 19 years and under using (1) an inclusive TBI case definition that included 'unspecified injury to the head' diagnostic codes, (2) a restricted TBI case definition that excluded 'unspecified injury to the head 'diagnostic codes, and (3) the 'unspecified injury to the head' only case definition. The National Ambulatory Care Reporting System and the Discharge Abstract Database from Ontario, Canada, were used to identify cases between fiscal years 2003/04 and 2009/10. The rate of TBI episodes of care using the inclusive case definition for TBI (2,667.2 per 100,000) was 1.65 times higher than that of the restricted case definition (1,613.3 per 100,000). 'Unspecified injury to the head' diagnostic codes made up of 39.5 % of all cases identified with the inclusive case definition. Exclusion of 'unspecified injury to the head' diagnostic code in the TBI case definition resulted in a significantly higher proportion of patients in the intensive care units (p definition of TBI for the children and youth population is important, as it has implications for the numbers used for policy, resource allocation, prevention, and planning of healthcare services. This paper can inform future work on reaching consensus on the diagnostic codes for defining TBI in children and youth.

Opioid Abuse after Traumatic Brain Injury: Evaluation Using Rodent Models

Science.gov (United States)

2015-09-01

craniotomy was cut with a trephine by hand over the right motor cortex . An injury cannula was fashioned from the hub of a female leur-lock 20g needle...ABSTRACT This project evaluated the effect of a moderate-level brain injury on risk for opioid abuse using preclinical models in rats . We assessed the...effect of brain injury on the rewarding effects of oxycodone in three rat self-administration procedures and found significant differences in the

Current controversies in the interpretation of non-accidental head injury

International Nuclear Information System (INIS)

Jaspan, Tim

The field of non-accidental injury (NAI) has been the subject of a number of theories and hypotheses of variable merit. Concerning injuries that occur within the intracranial compartment, much research has been undertaken to investigate the cause of SDH and parenchymal brain injury. Much, however, remains contentious, particularly regarding the medicolegal aspects of suspected child abuse. Issues that present the greatest challenges will be addressed. (orig.)

Current controversies in the interpretation of non-accidental head injury

Energy Technology Data Exchange (ETDEWEB)

Jaspan, Tim [Imaging Centre, University Hospital, Nottingham (United Kingdom)

2008-06-15

The field of non-accidental injury (NAI) has been the subject of a number of theories and hypotheses of variable merit. Concerning injuries that occur within the intracranial compartment, much research has been undertaken to investigate the cause of SDH and parenchymal brain injury. Much, however, remains contentious, particularly regarding the medicolegal aspects of suspected child abuse. Issues that present the greatest challenges will be addressed. (orig.)

Forensic medical study on morphology and formative mechanism of blunt head injury

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LI Hong-wei

2012-12-01

Full Text Available 【Abstract】 Objective: To study the patterns and morphologic characteristics of blunt head injury and analyse its formative mechanism in attempt to provide references for medicolegal expertise. Methods: The statistical analysis was done in terms of gender, age, as well as the nature, pattern, location, and feature of the injuries. Results: Among the 202 cases of head injury-induced death, 124 were male and 78 female with the age ranging from 1-81 years. Death caused by homicide was dominant (106, 52.5%, followed by suicide (49, 24.3% and accident (44, 21.8%. The majority of suicide-induced death were by falling from height, and traffic crash was responsible for majority of unexpected death cases. The morphology and pathogenesis of the injuries varied according to differences on the mode, magnitude, and orientation of the outside force giving rise to blunt injury as well as the character of vulnerants. Conclusion: Studies on the morphology and its forma-tive rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury. Key words: Brain; Head injuries, closed; Cranioce-rebral trauma; Forensic medicine

Head injury as a PTSD predictor among Oklahoma City bombing survivors.

Science.gov (United States)

Walilko, Timothy; North, Carol; Young, Lee Ann; Lux, Warren E; Warden, Deborah L; Jaffee, Michael S; Moore, David F

2009-12-01

The aim of the Oklahoma City (OKC) bombing retrospective review was to investigate the relationship between physical injury, environmental contributors, and psychiatric disorders such as posttraumatic stress disorder (PTSD) in an event-based, matched design study focused on injury. The 182 selected participants were a random subset of the 1,092 direct survivors from the OKC bombing. Only 124 of these 182 cases had a full complement of medical/clinical data in the OKC database. These 124 cases were assessed to explore relationships among PTSD diagnoses, levels of blast exposure, and physical injuries. Associations among variables were statistically tested using contingency analysis and logistic regression. Comparison of the PTSD cases to symptoms/diagnoses reported in the medical records reveals a statistically significant association between PTSD and head/brain injuries associated with head acceleration. PTSD was not highly correlated with other injuries. Although blast pressure and impulse were highly correlated with head injuries, the correlation with PTSD was not statistically significant. Thus, a correlation between blast pressure and PTSD may exist, but higher fidelity pressure calculations are required to elucidate this potential relationship. This study provides clear evidence that head injury is associated with subsequent PTSD, giving caregivers' information on what physical injuries may suggest the development of psychologic disorders to aid them in developing a profile for the identification of future survivors of terrorist attacks and Warfighters with brain injuries and potential PTSD.

Computed tomography: ocular manifestations in acute head injury ...

African Journals Online (AJOL)

Background: Acute head injuries are common in the population. Associated ocular injuries are occasionally encountered and these are of varying nature and outcome. Methods: We reviewed 98 brain computed tomographic results retrospectively. These are cases that were done between Jan. 2013- Jan. 2014. Statistical ...

Traumatic Brain Injury in Domestic Violence Victims: A Retrospective Study at the Barrow Neurological Institute.

Science.gov (United States)

Zieman, Glynnis; Bridwell, Ashley; Cárdenas, Javier F

2017-02-15

Domestic violence is a national health crisis, which affects people of all ages, races, and socioeconomic classes. Traumatic brain injury is common in victims because of the high frequency of head and neck injuries inflicted through abuse. These recurrent injuries can lead to chronic symptoms with high morbidity. We conducted a retrospective chart review of 115 patients with a history of head trauma as a result of domestic violence. All patients were seen in a subspecialty traumatic brain injury clinic, at which time information regarding their histories and self-reported symptoms were recorded. In total, 109 females and 6 males were included in our study, with an age range of 4-68 years. Overall, 88% reported more than one injury and 81% reported a history of loss of consciousness associated with their injuries. Only 21% sought medical help at the time of injury. Whereas 85% had a history of abuse in adulthood, 22% had experienced abuse in both childhood and adulthood, and 60% of the patients abused as children went on to be abused as adults. Headache was the most common chief complaint, but on a self-reported symptom severity scale, behavioral symptoms were the most severe. Psychiatric disease was present in 84% of patients. Traumatic brain injury is a frequent sequela of domestic violence, from which many victims sustain multiple injuries without seeking medical care. Brain injuries are often sustained over many years and lead to lasting physical, behavioral, and cognitive consequences. Better understanding of these injuries will lead to improved care for this population.

Risk of Parkinson's disease after hospital contact for head injury

DEFF Research Database (Denmark)

Rugbjerg, Kathrine; Ritz, Beate; Korbo, Lise

2008-01-01

OBJECTIVE: To determine whether a hospital contact for a head injury increases the risk of subsequently developing Parkinson's disease. DESIGN: Population based case-control study. SETTING: Denmark. PARTICIPANTS: 13 695 patients with a primary diagnosis of Parkinson's disease in the Danish national...... of history of head injury. RESULTS: An overall 50% increase in prevalence of hospital contacts for head injury was seen before the first registration of Parkinson's disease in this population (odds ratio 1.5, 95% confidence interval 1.4 to 1.7). The observed association was, however, due almost entirely...... to injuries that occurred during the three months before the first record of Parkinson's disease (odds ratio 8.0, 5.6 to 11.6), and no association was found between the two events when they occurred 10 or more years apart (1.1, 0.9 to 1.3). CONCLUSIONS: The steeply increased frequency of hospital contacts...

ocular complications among cases of head injury seen in a neurosurgi

African Journals Online (AJOL)

EZENWUGO CHIEDOZIE OBIORA

ocular cranial nerves were the most commonly occurring complication among the cases of head injury seen in Memphys. Hospital for Neurosurgery, Enugu. Key words: Ocular complications, head injury, Nigeria. INTRODUCTION. Road traffic accidents have been on the increase in Nigeria. Some studies have attributed this ...

Clinical utility of MR FLAIR imaging for head injuries

Energy Technology Data Exchange (ETDEWEB)

Ashikaga, Ryuichiro [Kinki Univ., Osaka-Sayama, Osaka (Japan). School of Medicine

1996-12-01

To study the utility of fluid attenuated inversion recovery (FLAIR) MR images in the evaluation of traumatic head injury, 56 patients with traumatic head injuries were examined with long TR/TE spin-echo (SE) sequences and FLAIR sequences. In 40 of them, long TR/short TE images were added to those sequences. Careful readings of MR images were done by two well-trained neuroradiologists. The chi-square test was used for statistical evaluation of our results. The relative sensitivities of FLAIR images were significantly better than those of long TR/TE, long TR/short TE images for the detection of diffuse axonal injury (p<0.01), cortical contusion (p<0.01), and subdural hematoma (p<0.01 for long TR/TE, p<0.05 for long TR/short TE). The number of cases of epidural hematoma and brainstem injury was too small for statistical significance to be determined. In 9 patients with corpus callosum injuries. FLAIR images demonstrated the lesions as abnormally high signal intensity in the septum pellucidum and fornix. Only sagittal FLAIR images could definitely discriminate the traumatic lesions of the fornix from the surrounding CSF. In addition, FLAIR images could easily discriminate DAI of the corpus callosum from CSF of the cavum velli interpositi. MR FLAIR images were found to be useful for detecting traumatic head injuries. (author)

Differential protective effects of motorcycle helmets against head injury.

Science.gov (United States)

Singleton, Michael D

2017-05-19

Although numerous observational studies have demonstrated a protective effect of motorcycle helmets against head injury, the degree of protection against specific head injury types remains unclear. Experimental biomechanics studies involving cadavers, animals, and computer models have established that head injuries have varying etiologies. This retrospective cross-sectional study compared helmet protection against skull fracture, cerebral contusion, intracranial hemorrhage, and cerebral concussion in a consecutive series of motorcycle operators involved in recent traffic crashes in Kentucky. Police collision reports linked to hospital inpatient and emergency department (ED) claims were analyzed for the period 2008 to 2012. Motorcycle operators with known helmet use who were not killed at the crash scene were included in the study. Helmet use was ascertained from the police report. Skull fracture, cerebral contusion, intracranial hemorrhage, and cerebral concussion were identified from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes on the claims records. The relative risks of each type of head injury for helmeted versus unprotected operators were estimated using generalized estimating equations. Helmets offer substantial protection against skull fracture (relative risk [RR] = 0.31, 95% confidence interval [CI], 0.23, 0.34), cerebral contusion (RR = 0.29, 95% CI, 0.16, 0.53), and intracranial hemorrhage (RR = 0.47, 95% CI, 0.35, 0.63). The findings pertaining to uncomplicated concussion (RR = 0.80, 95% CI, 0.64, 1.01) were inconclusive. A modest protective effect (20% risk reduction) was suggested by the relative risk estimate, but the 95% confidence interval included the null value. Motorcycle helmets were associated with a 69% reduction in skull fractures, 71% reduction in cerebral contusion, and 53% reduction in intracranial hemorrhage. This study finds that current motorcycle helmets do not protect equally against

Head and neck injuries from the Boston Marathon bombing at four hospitals.

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Singh, Ajay K; Buch, Karen; Sung, Edward; Abujudeh, Hani; Sakai, Osamu; Aaron, Sodickson; Lev, Michael

2015-10-01

The aim of this study was to evaluate the imaging findings of head and neck injuries in patients from the Boston Marathon bombing. A total of 115 patients from the Boston Marathon bombing presenting to four hospitals who underwent imaging to evaluate for head and neck injuries were included in the study. Twelve patients with positive findings on radiography or cross-sectional imaging were included in the final analysis. The radiographic, computed tomography (CT), and magnetic resonance (MR) imaging features of these patients were evaluated for the presence of shrapnel and morphological abnormality. Head and neck injuries were seen in 12 out of 115 patients presenting to the four hospitals. There were secondary blast injuries to the head and neck in eight patients, indicated by the presence of shrapnel on imaging. In the four patients without shrapnel, there were two with subgaleal hematomas, one with facial contusion and one with mastoid injury. There were two patients with subarachnoid hemorrhage, one with brain contusion, one with cerebral laceration, and one with globe rupture. There was frontal bone, nasal bone, and orbital wall fracture in one patient each. Imaging identified 26 shrapnel fragments, 21 of which were ball bearings. Injuries to the head and neck region identified on imaging from the Boston Marathon bombing were not common. The injuries seen were predominantly secondary blast injuries from shrapnel, and did not result in calvarial penetration of the shrapnel fragments.

Psychosocial consequences of head injury in children and adolescents: implications for rehabilitation.

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Livingston, M G; McCabe, R J

1990-01-01

Studies measuring psychosocial outcome in children and adolescents have shown that head injury leads to cognitive impairment which is directly related to the severity of injury in those with very severe head injury. Psychiatric disorders are also related to the severity of injury but here the relationship suggests that mediating factors are involved. No specific pattern of post-traumatic psychological/psychiatric dysfunction emerges from the studies, but it is clear that, as with adults, psychosocial recovery lags behind physical. Head injury affects the functioning of the young person in the family, at school, and within the wider community, often resulting in a secondary handicap of low self-esteem. The multitude of deficits which are a consequence of severe head injury present a challenge for rehabilitation specialists. A multi-disciplinary, multi-specialist, and multi-agency response is required. As a result, families are often presented with a bewildering array of treatments and programmes at different agencies. A case manager can be helpful in ensuring the appropriate use of available resources and can be the one professional in charge of a coordinating case record.

Postmortem CT of severe head injuries

International Nuclear Information System (INIS)

Tamura, Masaru; Tsukahara, Yoshio; Nagaseki, Yoshishige; Horikoshi, Satoru; Yodonawa, Masahiko

1983-01-01

CT findings of fatal head injuries were analysed for the cause of death. Postmortem CT examinations were undertaken on 14 cases who died before reaching the hospital or shortly after arrival at the hospital (immediate death group). CT were also examined in non-operative 20 cases who were comatose and who died within 24 hours after severe head injuries (early death group). In the immediate death group, the following findings were demonstrated: a huge amount of free intracranial and intraventricular air in 8 cases; traumatic basal subarachnoid hemorrhage in 3 cases; a mixture of pneumocephalus and subarachnoid hemorrhage in 2 cases, and intracranial hematoma in 1 case. In the early death group: a mixture of pneumocephalus and subarachnoid hemorrhage in 2 cases; traumatic subarachnoid hemorrhage in 5 cases; intracranial hematoma in 11 cases, and brain contusion in 2 cases. The huge amount of intracranial free air due to the severe fracture of the skull base will make the CNS collapse immediately. Basal subarachnoid hemorrhage with signs of brain-stem injuries may result in instantaneous death. Acute subdural hematoma with contusion and edema in elderly patients was the most frequent cause of death in the early death group. (author)

Utilization of head CT during injury visits to United States emergency departments: 2012-2015.

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Yun, Brian J; Borczuk, Pierre; Zachrison, Kori S; Goldstein, Joshua N; Berlyand, Yosef; Raja, Ali S

2018-05-18

Studies have shown increasing utilization of head computed tomography (CT) imaging of emergency department (ED) patients presenting with an injury-related visit. Multiple initiatives, including the Choosing Wisely™ campaign and evidence-based clinical decision support based on validated decision rules, have targeted head CT use in patients with injuries. Therefore, we investigated national trends in the use of head CT during injury-related ED visits from 2012 to 2015. This was a secondary analysis of data from the annual United States (U.S.) National Hospital Ambulatory Medical Care Survey from 2012 to 2015. The study population was defined as injury-related ED visits, and we sought to determine the percentage in which a head CT was ordered and, secondarily, to determine both the diagnostic yield of clinically significant intracranial findings and hospital characteristics associated with increased head CT utilization. Between 2012 and 2015, 12.25% (95% confidence interval [CI] 11.48-13.02%) of injury-related visits received at least one head CT. Overall head CT utilization showed an increased trend during the study period (2012: 11.7%, 2015: 13.23%, p = 0.09), but the results were not statistically significant. The diagnostic yield of head CT for a significant intracranial injury over the period of four years was 7.4% (9.68% in 2012 vs. 7.67% in 2015, p = 0.23). Head CT use along with diagnostic yield has remained stable from 2012 to 2015 among patients presenting to the ED for an injury-related visit. Copyright © 2017 Elsevier Inc. All rights reserved.

Suicidal and self-injurious behavior among patients with alcohol and drug abuse

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Al-Sharqi AM

2012-07-01

Full Text Available Abdullah Mohammed Al-Sharqi,1 Khaled Saad Sherra,2 Abdulhameed Abdullah Al-Habeeb,3 Naseem Akhtar Qureshi3,41Private Clinic, Riyadh, Saudi Arabia; 2Psychiatric Department, Faculty of Medicine, Mansoura University, Egypt; 3General Administration for Mental Health and Social Services, 4General Directorate of Research and Studies, Ministry of Health, Riyadh, Saudi ArabiaBackground: Self-injurious behavior, a major public health problem globally, is linked with alcohol and drug abuse. This cross-sectional study aimed to identify the prevalence and correlates of self-harming behavior in patients with alcohol or drug abuse problems.Methods: This was a one-year study that recruited a convenience sample of 736 outpatients and inpatients identified with alcohol or drug abuse, and was conducted at Al-Amal mental health hospitals in three major cities. All consecutively selected patients were interviewed on five working days for data collection on a semistructured sociodemographic form using the Columbia Suicide Severity Rating Scale Risk Assessment version.Results: In addition to the socioclinical profile revealed, 50.7% of respondents reported any suicidal ideation, while 6.9% reported self-injurious behavior without intent to die. Any suicidal and self-injurious behavior was reported by 13.1% of participants. A total of 71.3% of respondents reported any recent negative activating events. In addition to any treatment history, observed correlates were hopelessness (60.7%, perceived burden on family (29.5%, refusing a safety plan (26.1%, and sexual abuse (11%. Conversely, reasons for living (64.9%, fear of death or dying due to pain and suffering (64.3%, and spirituality (92% were largely endorsed as protective factors. There were multiple significant odds ratios (P ≤ 0.01 revealed when independent socioclinical variables were compared with dependent variables in terms of suspected risk and protective factors. In an adjusted logistic regression model

Screening injured children for physical abuse or neglect in emergency departments: a systematic review.

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Woodman, J; Lecky, F; Hodes, D; Pitt, M; Taylor, B; Gilbert, Ruth

2010-03-01

Screening markers are used in emergency departments (EDs) to identify children who should be assessed for possible physical abuse and neglect. We conducted three systematic reviews evaluating age, repeat attendance and injury type as markers for physical abuse or neglect in injured children attending EDs. We included studies comparing markers in physically abused or neglected children and non-abused injured children attending ED or hospital. We calculated likelihood ratios (LRs) for age group, repeat attendance and injury type (head injury, bruises, fractures, burns or other). Given the low prevalence of abuse or neglect, we considered that an LR of 10 or more would be clinically useful. All studies were poor quality. Infancy increased the risk of physical abuse or neglect in severely injured or admitted children (LRs 7.7-13.0, 2 studies) but was not strongly associated in children attending the ED (LR 1.5, 95% CI: 0.9, 2.8; one study). Repeat attendance did not substantially increase the risk of abuse or neglect and may be confounded by chronic disease and socio-economic status (LRs 0.8-3.9, 3 studies). One study showed no evidence that the type of injury substantially increased the risk of physical abuse or neglect in severely injured children. There was no evidence that any of the markers (infancy, type of injury, repeated attendance) were sufficiently accurate (i.e. LR >or= 10) to screen injured children in the ED to identify those requiring paediatric assessment for possible physical abuse or neglect. Clinicians should be aware that among injured children at ED a high proportion of abused children will present without these characteristics and a high proportion of non-abused children will present with them. Information about age, injury type and repeat attendances should be interpreted in this context.

Delayed epidural hematoma after mild head injury

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Radulović Danilo

2005-01-01

Full Text Available Background. Traumatic delayed epidural hematoma (DEH can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a “massive” epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.

Assessing the Prevalence of Traumatic Head Injury amongst Recreational Surfers in the United States.

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Swinney, Christian

2015-12-01

Surfing is a popular recreational sport that carries a substantial risk of injury. Although head injuries are frequently documented in the surfing population, an in depth assessment of the prevalence of surfing-related head injury has not been reported. A web-based survey was conducted in May of 2015. Participants were asked a series of questions regarding surfing-related injuries and demographic characteristics. A total of 50 responses were obtained, of which 35 (70%) reported sustaining a head injury. The most common injury was laceration of the head/face (n=27), followed by concussion (n=13). Other injuries, such as skull fracture and broken nose, were also reported. Only 2 of the 50 participants reported wearing a protective helmet. Neurosurgical intervention was required in 2 instances. Increased emphasis on preventative measures by the medical community may reduce the future incidence of such injuries. Medical professionals should be aware of the most common forms of injury sustained by the surfing population in order to better recognize and treat these conditions.

Factors Influencing Helmet Use, Head Injury, and Hospitalization Among Children Involved in Skateboarding and Snowboarding Accidents.

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Sadeghian, Homa; Nguyen, Brian; Huynh, Nhan; Rouch, Joshua; Lee, Steven L; Bazargan-Hejazi, Shahrzad

2017-01-01

Up to 75% of skateboarders and snowboarders admitted to the hospital sustain head injuries. It is unclear why not all children and teenagers wear helmets while snowboarding and skateboarding given the protection they afford. To report on the prevalence of, and factors associated with, skateboarding and snowboarding in injured children and to explore factors that influence helmet use, head injury, and hospitalization in this sample. A cross-sectional study of skateboard- and snowboard-associated injuries from 2003 to 2012 among individuals younger than age 18 years using National Electronic Injury Surveillance System (NEISS) data from approximately 100 hospitals. Helmet use, head injury, and hospitalization. Of 1742 patients in the study, 852 (48.9%) and 890 (51.1%) were skateboarders and snowboarders, respectively. Overall, 907 (52.1%) did not use helmets, and 704 (40.4%) sustained head injuries. Multiple logistic regression analysis showed that age, race/ethnicity, location of boarding, and engaging in skateboarding influenced helmet use. Sex, race/ethnicity, helmet use, and skateboarding predicted head injury. Age, sex, skateboarding, and head injury predicted hospital admission. Statistically significant differences exist in helmet use, head injury, and hospitalization rates between skateboarders and snowboarders. Our findings suggest that injury prevention and outreach programs are needed to increase helmet use and reduce the risk of head injury and hospitalization in skateboarders and other at-risk groups. Further studies are needed to clarify the association between race/ethnicity and helmet use among skateboarders and snowboarders.

Biomechanics of Head, Neck, and Chest Injury Prevention for Soldiers: Phase 2 and 3

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2016-08-01

AWARD NUMBER: W81XWH-10-2-0165 TITLE: “ Biomechanics of Head, Neck, and Chest Injury Prevention for Soldiers: Phase 2 & 3”.” PRINCIPAL INVESTIGATOR...27Sep2016 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-10-2-0165 “ Biomechanics of Head, Neck, and Chest Injury Prevention for Soldiers: Phase 2...Virginia Tech – Wake Forest University, Center for Injury Biomechanics and the U.S. Army entitled “ Biomechanics of Head, Neck, and Chest Injury

Meta-analytic evaluation of the association between head injury and risk of amyotrophic lateral sclerosis.

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Watanabe, Yukari; Watanabe, Takamitsu

2017-10-01

Head injury is considered as a potential risk factor for amyotrophic lateral sclerosis (ALS). However, several recent studies have suggested that head injury is not a cause, but a consequence of latent ALS. We aimed to evaluate such a possibility of reverse causation with meta-analyses considering time lags between the incidence of head injuries and the occurrence of ALS. We searched Medline and Web of Science for case-control, cross-sectional, or cohort studies that quantitatively investigated the head-injury-related risk of ALS and were published until 1 December 2016. After selecting appropriate publications based on PRISMA statement, we performed random-effects meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CI). Sixteen of 825 studies fulfilled the eligibility criteria. The association between head injuries and ALS was statistically significant when the meta-analysis included all the 16 studies (OR 1.45, 95% CI 1.21-1.74). However, in the meta-analyses considering the time lags between the experience of head injuries and diagnosis of ALS, the association was weaker (OR 1.21, 95% CI 1.01-1.46, time lag ≥ 1 year) or not significant (e.g. OR 1.16, 95% CI 0.84-1.59, time lag ≥ 3 years). Although it did not deny associations between head injuries and ALS, the current study suggests a possibility that such a head-injury-oriented risk of ALS has been somewhat overestimated. For more accurate evaluation, it would be necessary to conduct more epidemiological studies that consider the time lags between the occurrence of head injuries and the diagnosis of ALS.

Role of Postmortem Multislice Computed Tomography Scan in Close Blunt Head Injury

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Prijo Sidipratomo

2014-08-01

Full Text Available BACKGROUND: Conventional autopsy in Indonesia is not well accepted as it is contrary to religion and culture. New radiological imaging method such as multislice computed tomography (MSCT scan has potential to be a diagnostic tool in forensic pathology. The purpose of this study is to determine the ability of MSCT scan in finding abnormalities in close blunt head injury compared with autopsy. METHODS: This study used descriptive qualitative method. Postmortem cases in Department of Forensic Medicine and Radiology of Dr. Cipto Mangunkusumo Hospital were selected based on inclusion criteria. Then MSCT scan and autopsy were conducted. MSCT scan and autopsy results were compared and analyzed. RESULTS: There were 491 postmortem cases of blunt head injury. However, only 10 cases fulfilled inclusion criteria. Subarachnoid haemorrhages were identified 100% with MSCT scan and 80% with autopsy. Cerebral oedemas were identified 100% either with MSCT scan and autopsy. Subdural haemorrhages were identified 100% with MSCT scan, while 50% with autopsy. Multiple fractures were identified 80% with MSCT scan, while 40% with auto. CONCLUSIONS: MSCT scan showed a sensitive detection in finding abnormalities in close blunt head injury. Therefore it could be as an alternative choice of examination in close blunt head injury cases. KEYWORDS: multislice computed tomography scan, postmortem, blunt head injury, autopsy.

Pathophysiology of repetitive head injury in sports. Prevention against catastrophic brain damage

International Nuclear Information System (INIS)

Mori, Tatsuro; Kawamata, Tatsuro; Katayama, Yoichi

2008-01-01

The most common head injury in sports is concussion and experiencing multiple concussions in a short period of time sometimes can cause severe brain damage. In this paper, we investigate severe brain damage due to repeated head injury in sports and discuss the pathophysiology of repeated sports injury. The majority of these severe cases are usually male adolescents or young adults that suffer a second head injury before they have recovered from the first head injury. All cases that could be confirmed by brain CT scan after the second injury revealed brain swelling associated with a thin subdural hematoma. We suggested that the existence of subdural hematoma is one of the major causes of brain swelling after repeated head injury in sports. Since repeated concussions occurring within a short period may have a risk for severe brain damage, the diagnosis for initial cerebral concussion should be done appropriately. To prevent catastrophic brain damage, the player who suffered from concussion should not engage in any sports before recovery. The american Academy of Neurology and Colorado Medical Society set a guideline to return to play after cerebral concussion. An international conference on concussion in sports was held at Prague in 2004. The summary and agreement of this meeting was published and the Sports Concussion Assessment Tool (SCAT) was introduced to treat sports-related concussion. In addition, a number of computerized cognitive assessment tests and test batteries have been developed to allow athletes to return to play. It is important that coaches, as well as players and trainers, understand the medical issues involved in concussion. (author)

Nail gun injuries to the head with minimal neurological consequences: a case series.

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Makoshi, Ziyad; AlKherayf, Fahad; Da Silva, Vasco; Lesiuk, Howard

2016-03-16

An estimated 3700 individuals are seen annually in US emergency departments for nail gun-related injuries. Approximately 45 cases have been reported in the literature concerning nail gun injuries penetrating the cranium. These cases pose a challenge for the neurosurgeon because of the uniqueness of each case, the dynamics of high pressure nail gun injuries, and the surgical planning to remove the foreign body without further vascular injury or uncontrolled intracranial hemorrhage. Here we present four cases of penetrating nail gun injuries with variable presentations. Case 1 is of a 33-year-old white man who sustained 10 nail gunshot injuries to his head. Case 2 is of a 51-year-old white man who sustained bi-temporal nail gun injuries to his head. Cases 3 and 4 are of two white men aged 22 years and 49 years with a single nail gun injury to the head. In the context of these individual cases and a review of similar cases in the literature we present surgical approaches and considerations in the management of nail gun injuries to the cranium. Case 1 presented with cranial nerve deficits, Case 2 required intubation for low Glasgow Coma Scale, while Cases 3 and 4 were neurologically intact on presentation. Three patients underwent angiography for assessment of vascular injury and all patients underwent surgical removal of foreign objects using a vice-grip. No neurological deficits were found in these patients on follow-up. Nail gun injuries can present with variable clinical status; mortality and morbidity is low for surgically managed isolated nail gun-related injuries to the head. The current case series describes the surgical use of a vice-grip for a good grip of the nail head and controlled extraction, and these patients appear to have a good postoperative prognosis with minimal neurological deficits postoperatively and on follow-up.

Outcomes of a questionnaire survey on intracranial hypotension following minor head injury

International Nuclear Information System (INIS)

Dohi, Kenji; Aruga, Tohru; Abe, Toshiaki; Ogawa, Takeki; Onuma, Takehide; Katayama, Yoichi; Sakaki, Toshisuke; Shima, Katsuji; Hirakawa, Kimiyoshi

2007-01-01

Intracranial hypotension (IH) is a rare condition caused by leakage of cerebrospinal fluid (CSF). Recently, a small number of clinicians have proposed a new concept about IH following minor head injury. They suggest that many of their patients with IH can be successfully treated with epidural blood patch therapy. They also argue that some patients with post-traumatic cervical syndrome and general fatigue syndrome suffer from IH following minor head injury. Consequently, IH following minor head injury was widely recognized and dealt with as a social problem in Japan. On the other hand, pathophysiological aspects of the condition as well as the provisional criteria to describe this clinical entity remain to be elucidated. In 2006, the Japan Society of Neurotraumatology performed a questionnaire survey asking 44 hospitals belonging to trustees of this society about IH following minor head injury. This paper provides a report of the outcomes of this survey. The response rate to this questionnaire was 57% (25/44). Fifty-six percent of respondents did not have experience of IH following minor head injury. Moreover, respondents' criteria for describing this disease differed greatly, especially in the radiological examinations and symptoms for the diagnosis of this entity which showed significant variation. These problems might originate from the general features of this disease. With the exception of postural headache, the symptoms of this disease varied enormously. This wide range of symptoms confused with the pathophysiolosies of a great many similar conditions. As such, clarifications of the pathophysiological characteristics of IH following minor head injury, together with consensus on specific criteria to describe the condition, are required. In conclusion, the results of this survey revealed many serious scientific and social problems associated with the diagnosis and treatment of intracranial hypotension following minor head injury. Scientific study including the

Capabilities of Helmets for Preventing Head Injuries Induced by Ballistic Impacts

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D.V. Balandin

2004-01-01

Full Text Available The limiting performance of ballistically loaded helmets designed to reduce head injuries is studied analytically. The projectile does not penetrate the helmet. This analysis evaluates the absolute minimum of the peak displacement of the helmet shell relative to the head, provided that criteria measuring the severity of head injuries lie within prescribed limits. Rather than optimize a specific design configuration, e.g. a viscoelastic foam liner, characteristics of a time-dependent force representing the helmet liner are calculated. The formulation reduces the limiting performance analysis to an optimal control problem.

Suspected alcohol and addictive narcotic use were more at risk to severe head injury

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Woro Riyadina

2012-07-01

Full Text Available Latar belakang: Cedera kepala menyebabkan dampak seperti gangguan kognitif, perilaku dan keterbatasan fisik. Tujuan studi ini untuk menentukan faktor utama yang berkontribusi terhadap keparahan cedera kepala pada pasien yang dirawat inap di rumah sakit. Metode: Studi ini merupakan bagian dari penelitian “Pengembangan Database Registri Trauma sebagai Penunjang Sistem Surveilans Cedera”. Data dikumpulkan dengan cara abstraksi dari rekam medis oleh petugas terlatih dengan formulir registri pada pasien cedera yang dirawat inap di 3 rumah sakit dari bulan Januari – Agustus 2010. Keparahan cedera diklasifikasikan berdasarkan Glasgow Coma Scale (GCS dengan batasan nilai 3-9 mengalami cedera kepala berat, 10-12 cedera kepala sedang dan 13-15 cedera kepala ringan. Hasil: Dari 450 pasien cedera rawat inap terdapat 36 pasien (8% yang mengalami cedera kepala berat. Pasien dengan indikasi mengkonsumsi alkohol/narkotik mempunyai risiko hampir 5 kali mengalami cedera kepala berat [rasio odds suaian (ORa = 4,77; 95% interval kepercayaan (CI=1,04–21,75] dibanding tanpa indikasi. Pasien yang tidak dirujuk mempunyai risiko 5,5 kali  mengalami cedera kepala berat (ORa=5,50; 95% CI=2,28–13,27 dibanding pasien yang dirujuk. Pasien cedera karena kecelakaaan lalu lintas dibanding bukan kecelakaan lalu lintas mempunyai risiko 3 kali mengalami cedera kepala berat (ORa=3,43; 95% CI=1,14–10,32. Kesimpulan: Indikasi mengkonsumsi alkohol/narkotik berkontribusi paling besar terhadap keparahan cedera kepala. Kampanye anti alkohol/narkotik dan perlu dilakukan untuk mencegah cedera kepala berat. (Health Science Indones 2011;2:34-40   Abstract Background: The impact of head injuries were cognitive disorder, behavioral disorder and physical limitation. The objective of this study was to identify a major factor that contributes to head injury severity in hospitalized patients. Methods: This study was part of research "Development of Trauma Registry Databases as a

Unusual head and neck injury in elevator: autopsy study.

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Eren, B; Türkmen, N; Dokgöz, H

2012-10-01

Industrial injuries related to auto-load-carrying vehicles were not frequently reported in the literature. Presented case was, 31-year-old male furniture worker. Deceased was found in awkward position in furniture workshop. Victim was observed on his knees in front of the elevator, head and neck lodged within openings of the elevator, and head and neck structures compressed-guillotined by the lower platform of the elevator were detected. We presented rare case of head and neck compression by elevator. Key words: head - neck - accidents - elevator - autopsy.

Effect of the Earned Income Tax Credit on Hospital Admissions for Pediatric Abusive Head Trauma, 1995-2013.

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Klevens, Joanne; Schmidt, Brian; Luo, Feijun; Xu, Likang; Ports, Katie A; Lee, Rosalyn D

Policies that increase household income, such as the earned income tax credit (EITC), have shown reductions on risk factors for child maltreatment (ie, poverty, maternal stress, depression), but evidence is lacking on whether the EITC actually reduces child maltreatment. We examined whether states' EITCs are associated with state rates of hospital admissions for abusive head trauma among children aged tax filer gets money even if taxes are not owed) from nonrefundable EITCs (ie, tax filer gets credit only for any tax owed), controlling for state rates of child poverty, unemployment, high school graduation, and percentage of non-Latino white people. A refundable EITC was associated with a decrease of 3.1 abusive head trauma admissions per 100 000 population in children aged Tax refunds ranged from $108 to $1014 and $165 to $1648 for a single parent working full-time at minimum wage with 1 child or 2 children, respectively. Our findings with others suggest that policies such as the EITC that increase household income may prevent serious abusive head trauma.

Penetrating missile-type head injury from a defective badminton racquet.

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Pappano, Dante; Murray, Elizabeth; Cimpello, Lynn Babcock; Conners, Gregory

2009-06-01

Injuries occurring during badminton are rarely serious and primarily involve the lower extremities. We report an instance wherein a patient suffered serious brain injury related to playing with a defective badminton racquet. The possibility of similar injuries following the separation of the racquet head and shaft from the handle needs to be disseminated.

Injuries in recreational curling include head injuries and may be prevented by using proper footwear.

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Ting, D K; Brison, R J

2015-04-01

Our study examines a recreational curling population to describe patterns of injury occurrence, estimate risk of injury and to gauge attitudes towards equipment-based prevention strategies. In a retrospective case series, we queried the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a national injury surveillance database, for curling injuries entered between 1993 and 2011. Kingston General Hospital and Hotel Dieu Hospital provide the two Kingston, Ontario, sites for emergency department (ED) care and participate in CHIRPP. Each retrieved entry underwent a chart review. A secondary survey was mailed to select individuals who had experienced curling injuries to solicit details on their injury and attitudes towards equipment to prevent injury. We used descriptive statistics for rates and proportions. Over 90% of acute curling injuries resulted from a fall, and 31.7% were head impacts. We found that acute injuries requiring ED presentation occur at a rate of approximately 0.17 per 1000 athlete-exposures (95% CI: 0.12-0.22). The secondary survey was completed by 54% of potential respondents. Of survey respondents, 41.3% attributed their fall to a lack of proper footwear and 73.5% of respondents agreed with mandatory sport-specific footwear as a prevention strategy, but only 8% agreed with mandatory helmet wear. Although curling injuries requiring medical care are not common, head injuries make up a large proportion. Mandated use of appropriate footwear appears to be the most effective prevention strategy, as well as the measure deemed most acceptable by players.

Intracranial traumatic lesion risk factors in elderly patients with minor head injury

International Nuclear Information System (INIS)

Kochi, Masato; Hori, Shigeaki

2011-01-01

The authors conducted a retrospective analysis of the risk factors of intracranial traumatic lesions in elderly patients with minor head injury. Sixty-nine elderly patients with Glasgow Coma Scale (GCS) scores of 13-15 after head injury who had presented within 24 hours of trauma and admitted to hospital were included in this study. The indications for admission were a GCS score of 13 or 14 on presentation, loss of consciousness, retrograde or posttraumatic amnesia, local neurological deficit, severe headache and vomiting, dangerous mechanism of injury, skull fracture and abnormal CT findings. The relationship between the clinical findings and intracranial traumatic lesions was analized by univariate and multivariate analysis. The relationship between the clinical findings and surgical intervention was also analized by the same methods in those who had intracranial traumatic lesions. The mean and median age of patients were 81.1 and 83 years, respectively. Of 69 patients, 41 had intracranial traumatic lesions present on their CT scan. Of these, 6 needed surgical intervention. Multivariable logistic regression analysis showed that a Glasgow Coma Scale score of 13 and a loss of consciousness at injury were identified as independent risk factors of intracranial traumatic lesions in elderly patients with minor head injury and a dangerous mechanism of injury was identified as an independent risk factor of surgical intervention in those who had traumatic intracranial lesions. Our results offer useful information for evaluating patients with minor head injury in Japan's aging society. (author)

Comparison of External and Internal Injury in Cases of Fatal Blunt Trauma Head Injury Autopsied at Tertiary Care Centre in Eastern Nepal

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Bikash Sah

2017-07-01

Full Text Available Background & Objectives: Blunt trauma is more likely to be missed because clinical signs are less obvious in many regions of the body. This study was done with an objective to compare external and internal injuries of autopsy cases with fatal blunt trauma head injuries.Materials & Methods: This was a hospital based, cross sectional and analytical study done on the autopsy cases at B. P. Koirala Institute of Health Sciences, Dharan, Nepal (tertiary hospital in eastern Nepal from 13th April 2012 to 13th April 2013 with Head injuries by blunt trauma with or without concomitant non-head injuries. The decomposed bodies and the bodies where cause of trauma could not be differentiated were excluded. Postmortem examination was conducted on all the cases and the injuries present on all the body parts were noted. Abbreviated Injury Scale (AIS score was given for each injury. Appropriate statistical tool was used to compare the AIS scores of external and internal injuries. The test of significance was fixed at p < 0.01. Results: The correlation of scalp injuries with that of skull fracture, intracranial hemorrhage, cerebral injury and overall internal head injury were 0.591, 0.772, 0.439 and 0.600 respectively and all these correlations were statistically significant whereas the correlation between concomitant external and internal non-head injuries is -0.092 which is statistically not significant.Conclusion: Within the limits of this study it is possible to conclude that there was significant association between periodontitis and anxiety, and depression.

Dating the abusive head trauma episode and perpetrator statements: key points for imaging

International Nuclear Information System (INIS)

Adamsbaum, Catherine; Morel, Baptiste; Ducot, Beatrice; Antoni, Guillemette; Rey-Salmon, Caroline

2014-01-01

Shaken baby syndrome/abusive head trauma is a leading cause of morbidity and mortality in infants. The presence of a diffuse subdural hematoma without evidence of accident is a key diagnostic clue. The hematoma is typically attributed to rupture of the cerebral bridging veins due to violent shaking, with or without impact. Dating the incident, however, remains controversial. The aim of this article is to review the most reliable features used for dating the incident, based on both legal statements by perpetrators and medical documentation. The key points are: 1) The high (yet likely underestimated) frequency of repeated shaking is around 50%, 2) Children do not behave normally immediately after shaking, and the time of onset of even mild symptoms appears to be the best clue for dating the incident and 3) Brain imaging provides strong indicators of ''age-different'' injuries but the ranges for dating the causal event are wide. The density pattern in a single subdural hematoma location provides no reliable clues for assessing repeated violence. Only the finding of different density in two distant subdural hematomas argues in favor of ''age-different'' injuries, i.e. repeated violence. MRI is difficult to interpret in terms of dating subdural hemorrhages and must be analyzed in conjunction with CT. Most importantly, all of the child's previous clinical and radiological data must be carefully studied and correlated to provide accurate information on the date and repetition of the trauma. (orig.)

Right thalamic infarction after closed head injury

International Nuclear Information System (INIS)

Nagaya, Takashi; Doi, Terushige; Katsumata, Tsuguo; Kuwayama, Naoto

1986-01-01

We reported a case of right thalamic infarction after a closed head injury. A 12-year-old boy was hit by an autotruck. He was semi-comatose, with left temporal scalp swelling and excoriation in the left lower limb. Three days after the accident, he exhibited left hemiparesis. CT scans on the day of the accident showed no abnormality, but on the following day, right thalamic infarction appeared. Right carotid angiography showed only an irregular vascular shadow in the cisternal segment of the right internal carotid artery. Vascular obstruction after closed head injury is rare, especially in the intracranial vessels, and several pathogeneses may be postulated. The right thalamic infarction in this case was supposed to be due to the damage of the perforators from the right posterior communicating artery and the right posterior cerebral artery, which were struck as a contre-coup by the force from the left side. (author)

The association of temporomandibular disorder pain with history of head and neck injury in adolescents.

Science.gov (United States)

Fischer, Dena J; Mueller, Beth A; Critchlow, Cathy W; LeResche, Linda

2006-01-01

To evaluate the risk of self-reported temporomandibular disorder (TMD) pain among adolescents in relation to previous head and/or neck injury. 3,101 enrollees (11 to 17 years of age) of a nonprofit integrated health-care system were interviewed by telephone. Two hundred four cases with self-reported TMD pain and 194 controls without self-reported TMD pain frequency-matched to the cases by age and gender completed standardized in-person interviews and physical examinations in which reports of previous head/neck injuries were recorded. Odds ratio (OR) estimates and 95% confidence intervals (CIs) of the relative risks of TMD pain associated with prior head and/or neck injuries were calculated using logistic regression. A greater proportion of subjects reporting TMD pain (36%) than controls (25%) had a history of head and/or neck injuries (OR = 1.8, 95% CI, 1.1-2.8). In a separate analysis, the presence of TMD based upon the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was assessed in relation to prior head and/or neck injury. Cases reporting TMD pain and meeting the RDC/TMD criteria for myofascial pain and/or arthralgia or arthritis were 2.0 (CI, 1.0-3.8) times more likely to have had a prior head injury than were controls with neither self-reported nor RDC/TMD pain diagnoses. The results suggest a modest association of prior head injuries with both self-reported and clinically diagnosed TMD pain in adolescents.

Severe head injury in children - a preventable but forgotten epidemic

African Journals Online (AJOL)

Severe head injury in a child is a sociological disaster that crosses all sociological ... permanently disabled each year as a result of accidental injury." Over a ..... the daylight when transportation of the patient is more rapid; this results in some ...

Epidemiological features of 1 281 patients with head injuries arising from the 2008 Wenchuan earthquake

Directory of Open Access Journals (Sweden)

YANG Chao-hua

2012-04-01

Full Text Available 【Abstract】Objective: To analyze the epidemiologi-cal features of patients with head injuries in the 2008 Wenchuan earthquake. Methods: Medical records of patients with head inju-ries who were admitted to 14 hospitals in Deyang, Mianyang and Chengdu cities after the earthquake were retrospec-tively analyzed. The patients’ age, gender, cause of injury, diagnosis, and outcome were analyzed retrospectively. Results: A total of 1 281 patients with 807 males and 474 females were included. According to Glasgow Coma Scale score at admission, 1 029 patients presented with mild injury, 161 moderate injury and 91 severe injury. The major cause of injuries (83% was bruise by collapsed buildings. Open head injuries accounted for 60.8%. A total of 720 pa-tients underwent surgical treatment. Good recovery was achieved in 1 056 patients, moderate disability in 106, se-vere disability in 71, coma in 29 and death in 19. Conclusions: In this series, male patients were more than female patients. The main cause of injury was hit by falling objects due to building collapse. Minor and open craniocerebral injuries were most common. The epidemio-logical features of head injuries in Wenchuan earthquake may be helpful to preparation for future rescue. Key words: Brain injuries; Epidemiology; Earthquakes; Rescue work

Injuries in recreational curling include head injuries and may be prevented by using proper footwear

Directory of Open Access Journals (Sweden)

D. K. Ting

2015-04-01

Full Text Available Introduction: Our study examines a recreational curling population to describe patterns of injury occurrence, estimate risk of injury and to gauge attitudes towards equipment-based prevention strategies. Methods: In a retrospective case series, we queried the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP, a national injury surveillance database, for curling injuries entered between 1993 and 2011. Kingston General Hospital and Hotel Dieu Hospital provide the two Kingston, Ontario, sites for emergency department (ED care and participate in CHIRPP. Each retrieved entry underwent a chart review. A secondary survey was mailed to select individuals who had experienced curling injuries to solicit details on their injury and attitudes towards equipment to prevent injury. We used descriptive statistics for rates and proportions. Results: Over 90% of acute curling injuries resulted from a fall, and 31.7% were head impacts. We found that acute injuries requiring ED presentation occur at a rate of approximately 0.17 per 1000 athlete-exposures (95% CI: 0.12–0.22. The secondary survey was completed by 54% of potential respondents. Of survey respondents, 41.3% attributed their fall to a lack of proper footwear and 73.5% of respondents agreed with mandatory sport-specific footwear as a prevention strategy, but only 8% agreed with mandatory helmet wear. Conclusions: Although curling injuries requiring medical care are not common, head injuries make up a large proportion. Mandated use of appropriate footwear appears to be the most effective prevention strategy, as well as the measure deemed most acceptable by players.

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers.

Science.gov (United States)

Barr, Ronald G

2012-10-16

Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant-caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally.

Head injury and risk for Parkinson disease

DEFF Research Database (Denmark)

Kenborg, Line; Rugbjerg, Kathrine; Lee, Pei-Chen

2015-01-01

in medical records. Patients were matched to 1,785 controls randomly selected from the Danish Central Population Register on sex and year of birth. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. RESULTS: We observed no association between any head......OBJECTIVE: To examine the association between head injuries throughout life and the risk for Parkinson disease (PD) in an interview-based case-control study. METHODS: We identified 1,705 patients diagnosed with PD at 10 neurologic centers in Denmark in 1996-2009 and verified their diagnoses...

Accidental head injuries in children under 5 years of age

International Nuclear Information System (INIS)

Johnson, K.; Fischer, T.; Chapman, S.; Wilson, B.

2005-01-01

AIM: To evaluate the type and nature of head injuries sustained by children under the age of 5 years who present to a busy accident and emergency (A and E) department following an accidental fall. MATERIALS AND METHODS: This study included all children under the age of 5 years, who over an 8-month period were referred to our A and E Department with head injury following an accidental fall. Data were collected regarding the height of the fall, whether or not stairs were involved, the type of surface that the child landed on and the height of the child. This was correlated with any soft-tissue injury or skull fracture. RESULTS: A total of 72 children (aged 4 months to 4.75 years) fulfilled all the criteria for an accidental fall. The heights of the falls ranged from less than 50 cm to over 3 m, with the majority below 1 m. Of the falls, 49 were onto a hard surface and 23 were onto a soft surface. Of the 72 children, 52 had visible evidence of head injury, 35 (71%) of 49 being the result of falls onto hard surfaces and 17 (74%) of 23 onto soft (carpeted) surfaces. There was no significant difference in the type of surface that resulted in a visible head injury. A visible head injury was seen in all children who fell from a height of over 1.5 m and in 95% of children who fell over 1 m. Of the 72 children, 32 (44%) had skull radiographs performed in accordance with established guidelines and 4 (12.5%) were identified as having a fracture. Of the 3 linear parietal fractures 2 were inflicted by falls of just over 1 m (from a work surface) and 1 by a fall of 80 to 90 cm onto the hard-edged surface of a stone fire surround. The 4th was a fracture of the base of skull following a fall from more than 3 m (from a first-storey window). CONCLUSIONS: In the vast majority of domestic accidents children do not suffer significant harm. Skull fractures are rare and probably occur in less than 5% of cases. To cause a skull fracture the fall needs to be from over 1 m or, if from a

[Diagnostic and organizational error in head injuries].

Science.gov (United States)

Zaba, Czesław; Zaba, Zbigniew; Swiderski, Paweł; Lorkiewicz-Muszyíska, Dorota

2009-01-01

The study aimed at presenting a case of a diagnostic and organizational error involving lack of detection of foreign body presence in the soft tissues of the head. Head radiograms in two projections clearly demonstrated foreign bodies that resembled in shape flattened bullets, which could not have been missed upon evaluation of the X-rays. On the other hand, description of the radiograms entered by the attending physicians to the patient's medical record indicated an absence of traumatic injuries or foreign bodies. In the opinion of the authors, the case in question involved a diagnostic error: the doctors failed to detect the presence of foreign bodies in the head. The organizational error involved the failure of radiogram evaluation performed by a radiologist.

Educational paper: Abusive Head Trauma part I. Clinical aspects.

Science.gov (United States)

Sieswerda-Hoogendoorn, Tessa; Boos, Stephen; Spivack, Betty; Bilo, Rob A C; van Rijn, Rick R

2012-03-01

Abusive Head Trauma (AHT) refers to the combination of findings formerly described as shaken baby syndrome. Although these findings can be caused by shaking, it has become clear that in many cases there may have been impact trauma as well. Therefore a less specific term has been adopted by the American Academy of Pediatrics. AHT is a relatively common cause of childhood neurotrauma with an estimated incidence of 14-40 cases per 100,000 children under the age of 1 year. About 15-23% of these children die within hours or days after the incident. Studies among AHT survivors demonstrate that approximately one-third of the children are severely disabled, one-third of them are moderately disabled and one-third have no or only mild symptoms. Other publications suggest that neurological problems can occur after a symptom-free interval and that half of these children have IQs below the 10th percentile. Clinical findings are depending on the definitions used, but AHT should be considered in all children with neurological signs and symptoms especially if no or only mild trauma is described. Subdural haematomas are the most reported finding. The only feature that has been identified discriminating AHT from accidental injury is apnoea. AHT should be approached with a structured approach, as in any other (potentially lethal) disease. The clinician can only establish this diagnosis if he/she has knowledge of the signs and symptoms of AHT, risk factors, the differential diagnosis and which additional investigations to perform, the more so since parents seldom will describe the true state of affairs spontaneously.

Child abuse. Diagnostic imaging of skeletal injuries; Kindesmisshandlung. Radiologische Diagnostik skelettaler Verletzungsfolgen

Energy Technology Data Exchange (ETDEWEB)

Stenzel, Martin; Mentzel, Hans-Joachim [Universitaetsklinikum Jena (Germany). Sektion Paediatrische Radiologie

2012-06-15

Diagnostic imaging, besides medical history and clinical examination, is a major component in assessment of cases of suspected physical child abuse. Performance of proper imaging technique, and knowledge of specific injury patterns is required for accurate image interpretation by the radiologist, and serves protection of the child in case of proven abuse. On the other side, it is essential to protect the family in unjustified accusations. The reader will be familiarised with essentials of the topic 'Physical child abuse', in order to be able to correctly assess quality, completeness, and results of X-ray films. Moreover, opportunities and limitations of alternative diagnostic modalities will be discussed. (orig.)

A six year prospective study of the incidence and causes of head and neck injuries in international football.

Science.gov (United States)

Fuller, C W; Junge, A; Dvorak, J

2005-08-01

To identify those risk factors that have the greatest impact on the incidence of head and neck injuries in international football. A case-control study of players sustaining head and neck injuries during 20 FIFA tournaments (men and women) from 1998 to 2004. Video recordings of incidents were used to identify a range of parameters associated with the incidents. Team physicians provided medical reports describing the nature of each injury. chi2 tests (pvideo sequences. The commonest injuries were contusions (53%), lacerations (20%), and concussions (11%). The incidence of all head and neck injuries was 12.5/1000 player hours (men 12.8, women 11.5) and 3.7 for lost-time injuries (men 3.5, women 4.1). The commonest causes of injury involved aerial challenges (55%) and the use of the upper extremity (33%) or head (30%). The unfair use of the upper extremity was significantly more likely to cause an injury than any other player action. Only one injury (a neck muscle strain) occurred as a result of heading the ball throughout the 20 tournaments equivalent to 0.05 injuries/1000 player hours. Players' actions most likely to cause a head or neck injury were the use of the upper extremity or the head but in the majority of cases these challenges were deemed to be fair and within the laws of the game.

Head, Neck, Face, and Shoulder Injuries in Female and Male Rugby Players.

Science.gov (United States)

Havkins, Sabina B.

1986-01-01

Injuries to 150 players in the Southern California Rugby Football Union were studied in order to compare head, neck, face, and shoulder injury rates for female and male players. While overall rates did not differ significantly, women received fewer disabling injuries. Ways to decrease injuries are recommended. (Author/MT)

Personality change following head injury: assessment with the NEO Five-Factor Inventory.

Science.gov (United States)

Lannoo, E; de Deyne, C; Colardyn, F; de Soete, G; Jannes, C

1997-11-01

We evaluated personality change following head injury in 68 patients at 6 months postinjury using the NEO Five-Factor Inventory to assess the five personality dimensions of the Five-Factor Model of Personality. All items had to be rated twice, once for the preinjury and once for the current status. Twenty-eight trauma patients with injuries to other parts of the body than the head were used as controls. For the head-injured group, 63 relatives also completed the questionnaire. The results showed no differences between the ratings of head-injured patients and the ratings of trauma control patients. Both groups showed significant change in the personality dimensions Neuroticism, Extraversion, and Conscientiousness. Compared to their relatives, head-injured patients report a smaller change in Extraversion and Conscientiousness. Changes were not reported on the Openness and Agreeableness scales, by neither the head-injured or their relatives, nor by the trauma controls.

Biomechanical aspects of sports-related head injuries.

Science.gov (United States)

Park, Min S; Levy, Michael L

2008-02-01

With the increased conditioning, size, and speed of professional athletes and the increase in individuals engaging in sports and recreational activities, there is potential for rising numbers of traumatic brain injuries in sports. Fortunately, parallel strides in basic research technology and improvements in computer and video technology have created a new era of discovery in the study of the biomechanical aspects of sports-related head injuries. Although prevention will always be the most important factor in reducing the incidence of sports-related traumatic brain injuries, ongoing studies will lead to the development of newer protective equipment, improved recognition and management of concussions on the field of play, and modification of rules and guidelines to make these activities safer and more enjoyable.

Dating the abusive head trauma episode and perpetrator statements: key points for imaging

Energy Technology Data Exchange (ETDEWEB)

Adamsbaum, Catherine; Morel, Baptiste [AP-HP, CHU Bicetre, Service d' Imagerie Pediatrique, Paris (France); Ducot, Beatrice [Universite Paris Sud, Faculte de Medecine, Le Kremlin Bicetre (France); INSERM CESP U 1018, Paris (France); Antoni, Guillemette [Universite Paris Sud, Faculte de Medecine, Le Kremlin Bicetre (France); Rey-Salmon, Caroline [AP-HP, CHU Hotel Dieu, Unite Medico-Judiciaire, Paris (France)

2014-12-15

Shaken baby syndrome/abusive head trauma is a leading cause of morbidity and mortality in infants. The presence of a diffuse subdural hematoma without evidence of accident is a key diagnostic clue. The hematoma is typically attributed to rupture of the cerebral bridging veins due to violent shaking, with or without impact. Dating the incident, however, remains controversial. The aim of this article is to review the most reliable features used for dating the incident, based on both legal statements by perpetrators and medical documentation. The key points are: 1) The high (yet likely underestimated) frequency of repeated shaking is around 50%, 2) Children do not behave normally immediately after shaking, and the time of onset of even mild symptoms appears to be the best clue for dating the incident and 3) Brain imaging provides strong indicators of ''age-different'' injuries but the ranges for dating the causal event are wide. The density pattern in a single subdural hematoma location provides no reliable clues for assessing repeated violence. Only the finding of different density in two distant subdural hematomas argues in favor of ''age-different'' injuries, i.e. repeated violence. MRI is difficult to interpret in terms of dating subdural hemorrhages and must be analyzed in conjunction with CT. Most importantly, all of the child's previous clinical and radiological data must be carefully studied and correlated to provide accurate information on the date and repetition of the trauma. (orig.)

Neurosurgery for management of severe head injury

International Nuclear Information System (INIS)

Seitz, K.; Richter, H.P.

1998-01-01

Neurosurgery as a treatment of severe head injuries is not restricted to invasive surgery but also includes peri-operative intensive care medicine. Thanks to the technological progress and advanced diagnostic tools, especially drug treatments and their efficiency as well as risks can be far better monitored and analysed today. (orig./CB) [de

Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head.

Science.gov (United States)

Turco, Lauren; Cornell, David L; Phillips, Bradley

2017-08-01

Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with greater mortality and morbidity than other penetrating traumatic brain injuries (TBIs). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head nonoperatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI. PubMed was searched for query terms, and PRISMA guidelines were used. Studies were selected by relevance and inclusion of data regarding etiology, diagnosis, and management of bihemispheric TBI. Case reports, studies not in English, and records lacking information on mechanism or bihemispheric injuries were excluded. Thirteen studies were included and most contained level IV evidence. The mean mortality rate of all head GSWs was 62% in adults and 32% in children. Bihemispheric GSWs had greater mortality rates of 82% in adults and 60% in children. There was a larger proportion of self-inflicted injury in studies with greater rates of bihemispheric injuries. Bihemispheric injuries have greater mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. Although bihemispheric injuries historically have been considered nonsalvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population. Copyright © 2017 Elsevier Inc. All rights reserved.

Cranial imaging in child abuse

Energy Technology Data Exchange (ETDEWEB)

Demaerel, P.; Wilms, G. [Department of Radiology, University Hospitals, Leuven (Belgium); Casteels, I. [Department of Ophthalmology, University Hospitals, Leuven (Belgium)

2002-04-01

Serious head injury in children less than 2 years old is often the result of child abuse. The role of the different neuroimaging modalities in child abuse is reviewed. Skull X-ray and cranial CT are mandatory. Repeat or serial imaging may be necessary and brain MR imaging may contribute to the diagnostic work-up, particularly in the absence of characteristic CT findings. The radiologist plays an important role in accurately identifying non-accidental cranial trauma. The clinical presentation can be non-specific or misleading. The possibility should be considered of a combined mechanism, i.e., an underlying condition with superimposed trauma. In this context, the radiologist is in the front line to suggest the possibility of child abuse. It is therefore important to know the spectrum of, sometimes subtle, imaging findings one may encounter. Opthalmological examination is of the greatest importance and is discussed here, because the combination of retinal hemorrhages and subdural hematoma is very suggestive of non-accidental cranial trauma. (orig.)

Cranial imaging in child abuse

International Nuclear Information System (INIS)

Demaerel, P.; Wilms, G.; Casteels, I.

2002-01-01

Serious head injury in children less than 2 years old is often the result of child abuse. The role of the different neuroimaging modalities in child abuse is reviewed. Skull X-ray and cranial CT are mandatory. Repeat or serial imaging may be necessary and brain MR imaging may contribute to the diagnostic work-up, particularly in the absence of characteristic CT findings. The radiologist plays an important role in accurately identifying non-accidental cranial trauma. The clinical presentation can be non-specific or misleading. The possibility should be considered of a combined mechanism, i.e., an underlying condition with superimposed trauma. In this context, the radiologist is in the front line to suggest the possibility of child abuse. It is therefore important to know the spectrum of, sometimes subtle, imaging findings one may encounter. Opthalmological examination is of the greatest importance and is discussed here, because the combination of retinal hemorrhages and subdural hematoma is very suggestive of non-accidental cranial trauma. (orig.)

How children with head injury represent real and deceptive emotion in short narratives.

Science.gov (United States)

Dennis, M; Barnes, M A; Wilkinson, M; Humphreys, R P

1998-02-15

Narratives are not only about events, but also about the emotions those events elicit. Understanding a narrative involves not just the affective valence of implied emotional states, but the formation of an explicit mental representation of those states. In turn, this representation provides a mechanism that particularizes emotion and modulates its display, which then allows emotional expression to be modified according to particular contexts. This includes understanding that a character may feel an emotion but inhibit its display or even express a deceptive emotion. We studied how 59 school-aged children with head injury and 87 normally-developing age-matched controls understand real and deceptive emotions in brief narratives. Children with head injury showed less sensitivity than controls to how emotions are expressed in narratives. While they understood the real emotions in the text, and could recall what provoked the emotion and the reason for concealing it, they were less able than controls to identify deceptive emotions. Within the head injury group, factors such as an earlier age at head injury and frontal lobe contusions were associated with poor understanding of deceptive emotions. The results are discussed in terms of the distinction between emotions as felt and emotions as a cognitive framework for understanding other people's actions and mental states. We conclude that children with head injury understand emotional communication, the spontaneous externalization of real affect, but not emotive communication, the conscious, strategic modification of affective signals to influence others through deceptive facial expressions.

Does hypokalemia contribute to acute kidney injury in chronic laxative abuse?

Directory of Open Access Journals (Sweden)

Eun-Young Lee

2015-06-01

Full Text Available Prolonged hypokalemia from chronic laxative abuse is recognized as the cause of chronic tubulointerstitial disease, known as “hypokalemic nephropathy,” but it is not clear whether it contributes to acute kidney injury (AKI. A 42-year-old woman with a history of chronic kidney disease as a result of chronic laxative abuse from a purging type of anorexia nervosa (AN-P, developed an anuric AKI requiring hemodialysis and a mild AKI 2 months later. Both episodes of AKI involved severe to moderate hypokalemia (1.2 and 2.7 mmol/L, respectively, volume depletion, and mild rhabdomyolysis. The histologic findings of the first AKI revealed the remnants of acute tubular necrosis with advanced chronic tubulointerstitial nephritis and ischemic glomerular injury. Along with these observations, the intertwined relationship among precipitants of recurrent AKI in AN-P is discussed, and then we postulate a contributory role of hypokalemia involved in the pathophysiology of the renal ischemia-induced AKI.

Artificial neural networks: Predicting head CT findings in elderly patients presenting with minor head injury after a fall.

Science.gov (United States)

Dusenberry, Michael W; Brown, Charles K; Brewer, Kori L

2017-02-01

To construct an artificial neural network (ANN) model that can predict the presence of acute CT findings with both high sensitivity and high specificity when applied to the population of patients≥age 65years who have incurred minor head injury after a fall. An ANN was created in the Python programming language using a population of 514 patients ≥ age 65 years presenting to the ED with minor head injury after a fall. The patient dataset was divided into three parts: 60% for "training", 20% for "cross validation", and 20% for "testing". Sensitivity, specificity, positive and negative predictive values, and accuracy were determined by comparing the model's predictions to the actual correct answers for each patient. On the "cross validation" data, the model attained a sensitivity ("recall") of 100.00%, specificity of 78.95%, PPV ("precision") of 78.95%, NPV of 100.00%, and accuracy of 88.24% in detecting the presence of positive head CTs. On the "test" data, the model attained a sensitivity of 97.78%, specificity of 89.47%, PPV of 88.00%, NPV of 98.08%, and accuracy of 93.14% in detecting the presence of positive head CTs. ANNs show great potential for predicting CT findings in the population of patients ≥ 65 years of age presenting with minor head injury after a fall. As a good first step, the ANN showed comparable sensitivity, predictive values, and accuracy, with a much higher specificity than the existing decision rules in clinical usage for predicting head CTs with acute intracranial findings. Copyright © 2016 Elsevier Inc. All rights reserved.

Head Injury in the Elderly: What Are the Outcomes of Neurosurgical Care?

Science.gov (United States)

Whitehouse, Kathrin Joanna; Jeyaretna, Deva Sanjeeva; Enki, Doyo Gragn; Whitfield, Peter C

2016-10-01

Epidemiologic studies show that an increasing proportion of those presenting with head trauma are elderly. This study details the outcomes of elderly patients with head trauma admitted to a regional United Kingdom neurosurgical unit. The notes and imaging were reviewed of all patients with head injury aged ≥75 years, admitted from 1 January 2007 to 31 December 2010, including mortality data up to at least 2 years after discharge. Outcomes comprised death as an inpatient, by 30 days and 1 year after discharge; Glasgow Outcome Score; discharge Glasgow Coma Scale (GCS) score; recurrence; readmission; reoperation; and complication. A total of 263 patients were admitted: 26 with acute subdural hematoma (ASDH); 175 with chronic subdural hematoma (CSDH); and 46 with mixed subdural collections (ACSDH). Sixteen patients had other head injury diagnoses. Patients with ASDH had a significantly lower survival rate than did those with CSDH or ACSDH: the odds of inpatient death for patients with ASDH was 15.38 (vs. those with CSDH). For all subdural hematomas (SDHs), low American Society of Anesthesiologists score was an independent predictor of early death. Death at 1 year was predicted by head injury severity measured by admission GCS score (P = 0.028), long anesthetic (P = 0.002), and the presence of bilateral SDH (P = 0.002). Unfavorable Glasgow Outcome Scale score (1-3) was predicted by age greater than 85 years (P = 0.029); larger depth of subdural (P neurosurgery after head injury have SDHs. Our results are better than many previously reported; however, the rate of death for those with ASDH is still high. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Child abuse

International Nuclear Information System (INIS)

Dorst, J.P.; Johns Hopkins Medical Institutions, Baltimore, MD

1982-01-01

Child abuse is common in most, if not all, Western nations; it probably occurs worldwide. It may be a major factor in the increase in violence throughout much of the world. Radiologists who treat children should think of the possibilitys of abuse whenever they diagnose a fracture, intracranial bleed, ar visceral injury, especially when the history is not compatible with their findings. Metaphyseal 'corner' fractures in infants usually are caused by abuse. Less than 20% of abused children, however, present injuries that can be recognized by radiologic techniques. Consequently normal roentgenograms, nuclear medicine scans, ultrasound studies, and computed tomograms do not exclude child abuse. (orig.)

Child abuse

Energy Technology Data Exchange (ETDEWEB)

Dorst, J.P.

1982-08-01

Child abuse is common in most, if not all, Western nations; it probably occurs worldwide. It may be a major factor in the increase in violence throughout much of the world. Radiologists who treat children should think of the possibilitys of abuse whenever they diagnose a fracture, intracranial bleeding or visceral injury, especially when the history is not compatible with their findings. Metaphyseal 'corner' fractures in infants usually are caused by abuse. Less than 20% of abused children, however, present injuries that can be recognized by radiologic techniques. Consequently normal roentgenograms, nuclear medicine scans, ultrasound studies, and computed tomograms do not exclude child abuse.

Spinal cord injury and its association with blunt head trauma

OpenAIRE

Paiva, Wellingson S; Oliveira, Arthur MP; Andrade, Almir F; Amorim, Robson LO; Lourenço, Leonardo JO; Teixeira, Manoel J

2011-01-01

Wellingson S Paiva, Arthur MP Oliveira, Almir F Andrade, Robson LO Amorim, Leonardo JO Lourenço, Manoel J TeixeiraDivision of Neurosurgery, University of São Paulo, BrazilBackground: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury.Methods: A prospective study involving 1617 patien...

Risk of maltreatment-related injury: a cross-sectional study of children under five years old admitted to hospital with a head or neck injury or fracture.

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Joseph Jonathan Lee

Full Text Available To determine the predictive value and sensitivity of demographic features and injuries (indicators for maltreatment-related codes in hospital discharge records of children admitted with a head or neck injury or fracture.Population-based, cross sectional study.NHS hospitals in England.Children under five years old admitted acutely to hospital with head or neck injury or fracture.Hospital Episodes Statistics, 1997 to 2009.Maltreatment-related injury admissions, defined by ICD10 codes, were used to calculate for each indicator (demographic feature and/or type of injury: i the predictive value (proportion of injury admissions that were maltreatment-related; ii sensitivity (proportion of all maltreatment-related injury admissions with the indicator.Of 260,294 childhood admissions for fracture or head or neck injury, 3.2% (8,337 were maltreatment-related. With increasing age of the child, the predictive value for maltreatment-related injury declined but sensitivity increased. Half of the maltreatment-related admissions occurred in children older than one year, and 63% occurred in children with head injuries without fractures or intracranial injury.Highly predictive injuries accounted for very few maltreatment-related admissions. Protocols that focus on high-risk injuries may miss the majority of maltreated children.

Essential radiology for head injury

International Nuclear Information System (INIS)

Mok, D.W.H.; Kreel, L.

1988-01-01

The book covers the guidelines established by the Royal College of Radiologists for the radiographic evaluation of head injuries. It presents a chapter reviewing the normal radiologic anatomy of the skull in six different projections. The advantages and limitations of each projection are addressed. The third chapter, contains 43 radiographs dedicated to the calcified pineal gland and other intracranial calcifications. The book reports on specific types of fractures: linear fractures of the vault, depressed fractures of the vault, fractures in children, fractures of the base of the skull, and fractures of the facial bones

Team medicine in head injury. Usefulness of telemedicine in cooperation with medically depopulated areas

International Nuclear Information System (INIS)

Takazawa, Hiroki; Morita, Takahiro; Narisawa, Ayumi; Saito, Atsushi; Koyama, Shinya; Sasaki, Tatsuya; Nishijima, Michiharu

2011-01-01

Our hospital is located between Tsugaru and Shimokita Peninsulas that are wide medically depopulated areas. The depopulated Tsugaru District has only 2 neurosurgical units, and many patients have to be transferred from the district general hospitals. Since 1989, we have been using an image transfer system that is useful for accurately diagnosing patients with head injury. Between January 2005 and September 2010, 644 patients with head injury were admitted to our hospital. The patients who used and did not use telemedicine were 78 and 566, respectively. In both groups, the background (age, gender, and type of head injury), surgery rate, and time of entry into the operating room were analyzed. There were no significant differences in the age, gender, and type of head injuries between the 2 groups. The surgery rate was 25.6% (28 patients) in the telemedicine group and 12.4% (70 patients) in the direct admission group. The average amount of time between admission and entry into the operating room was 2 h and 13 min in the telemedicine group and 2 h and 57 min in the direct admission group. There were significant differences between the telemedicine and direct admission groups (p<0.05). These results suggest that telemedicine is useful in the treatment of patients with head injuries in a widely depopulated area. (author)

Do head-restraints protect the neck from whiplash injuries?

Science.gov (United States)

Morris, F

1989-01-01

Over an 11-month period a study was made of all patients presenting to an accident and emergency department who had sustained whiplash as a result of rear-bumper impacts. The patients were analysed with respect to the presence of head-restraints in their vehicles. A significant increase in the incidence of whiplash was found in patients whose vehicles did not have head-restraints fitted. Legislation requiring all passenger cars to have head-restraints fitted as standard would have a major impact in reducing the number of whiplash injuries sustained in rear bumper impacts. PMID:2712983

Diagnostic imaging of child abuse

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Oguma, Eiji; Aihara, Toshinori [Saitama Children' s Medical Center, Iwatsuki (Japan)

2002-04-01

The major role of imaging in cases of suspected child abuse is to identify the physical injuries and to confirm the occurrence of abuse. In severely abused infants, the imaging findings may be the only evidence for a diagnosis of inflicted injury. Imaging may be the first clue to abuse in children seen with apparent other conditions and lead to appropriate measures to protect them from the risk of more serious injury. The radiologist must be familiar with imaging findings of inflicted injuries to fulfill these roles. (author)

Diagnostic imaging of child abuse

International Nuclear Information System (INIS)

Oguma, Eiji; Aihara, Toshinori

2002-01-01

The major role of imaging in cases of suspected child abuse is to identify the physical injuries and to confirm the occurrence of abuse. In severely abused infants, the imaging findings may be the only evidence for a diagnosis of inflicted injury. Imaging may be the first clue to abuse in children seen with apparent other conditions and lead to appropriate measures to protect them from the risk of more serious injury. The radiologist must be familiar with imaging findings of inflicted injuries to fulfill these roles. (author)

Families, Head Injury, and Cognitive-Communicative Impairments: Issues for Family Counseling.

Science.gov (United States)

DePompei, Roberta; Zarski, John J.

1989-01-01

This paper calls for the incorporation of family counseling into rehabilitation programs treating cognitive-communicative disorders in head-injured individuals. The paper describes general family responses that may be anticipated when a family system experiences head injury, functional versus dysfunctional family responses to a crisis, and three…

Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study

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Archana Waganekar

2018-01-01

Full Text Available Context: Based on Glasgow Coma Scale (GCS, head injury can be classified as minor (GCS 13–15, moderate (GCS 9–12, and severe (GCS 3–8. There is a lot of controversy in the use of computed tomography (CT in head injury patients. Aims: This study was intended to estimate the rate of CT positivity in head injury patients and to define the criteria for doing CT in head injury patients. Settings and Design: This was a prospective observational study in the emergency department (ED over a 12-month period. Subjects and Methods: Study involved all head injury patients attending ED. Risk factors studied were a loss of consciousness (LOC, vomiting, seizures, ear bleed, nosebleed, external injuries, and alcohol intoxication. Statistical Analysis Used: Comparison of CT positivity with the patient's demographics and clinical characteristics was carried out using Chi-square. Results: A total of 1782 patients were included in this study. Overall CT positivity was 50.9%. In minor head injury (MHI, CT positivity rate was 38%. The study showed significant association of CT positivity with five variables: LOC >5 min, vomiting, seizures, ear bleed, and nosebleed. Conclusions: From the study, we recommend following: CT is indicated in all patients with moderate and severe head injury (GCS ≤12. Low threshold for taking CT is advisable in elderly and alcohol-intoxicated patients. In MHI, CT is indicated if any one of the following risk factors are present: LOC >5 min, history of vomiting, history of seizures, history of ear bleed, and history of nosebleed.

Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma

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Culotta, Paige A.; Tran, Quynh-Anh; Donaruma-Kwoh, Marcella [Texas Children' s Hospital, Section of Public Health Pediatrics, Baylor College of Medicine, Houston, TX (United States); Crowe, James E.; Jones, Jeremy Y.; Mehollin-Ray, Amy R.; Tran, H.B.; Dodge, Cristina T. [Texas Children' s Hospital, The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX (United States); Camp, Elizabeth A. [Texas Children' s Hospital, Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX (United States); Cruz, Andrea T. [Texas Children' s Hospital, Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX (United States); Texas Children' s Hospital, Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX (United States)

2017-01-15

Young children with suspected abusive head trauma often receive skull radiographs to evaluate for fractures as well as computed tomography (CT) of the head to assess for intracranial injury. Using a CT as the primary modality to evaluate both fracture and intracranial injury could reduce exposure to radiation without sacrificing performance. To evaluate the sensitivity of CT head with (3-D) reconstruction compared to skull radiographs to identify skull fractures in children with suspected abusive head trauma. This was a retrospective (2013-2014) cross-sectional study of infants evaluated for abusive head trauma via both skull radiographs and CT with 3-D reconstruction. The reference standard was skull radiography. All studies were read by pediatric radiologists and neuroradiologists, with ten percent read by a second radiologist to evaluate for interobserver reliability. One hundred seventy-seven children (47% female; mean/median age: 5 months) were included. Sixty-two (35%) had skull fractures by radiography. CT with 3-D reconstruction was 97% sensitive (95% confidence interval [CI]: 89-100%) and 94% specific (CI: 87-97%) for skull fracture. There was no significant difference between plain radiographs and 3-D CT scan results (P-value = 0.18). Kappa was 1 (P-value <0.001) between radiologist readings of CTs and 0.77 (P = 0.001) for skull radiographs. CT with 3-D reconstruction is equivalent to skull radiographs in identifying skull fractures. When a head CT is indicated, skull radiographs add little diagnostic value. (orig.)

The CRASH trial protocol (Corticosteroid randomisation after significant head injury [ISRCTN74459797

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2001-06-01

Full Text Available Abstract Background Worldwide, millions of people are treated each year for significant head injury. A substantial proportion die, and many more are disabled. If short term corticosteroid infusion could be reliably shown to reduce these risks by just a few percent then this might affect the treatment of a few hundred thousand patients a year, protecting thousands from death or long term disability. Study design CRASH is a large simple, placebo-controlled trial of the effects of a 48-hour infusion of corticosteroids on death and on neurological disability, among adults with head injury and some impairment of consciousness. Head injured patients with impaired consciousness who are judged to be 16 years or older are eligible if the responsible doctor is, for any reason, substantially uncertain whether or not to use corticosteroids. Organisation The CRASH trial will determine reliably the effects on death and disability of a short corticosteroid infusion following significant head injury. To detect or refute improvements of only a few percent in outcome, many thousands of acute head injury patients must be randomised between control and steroid infusions. Such large numbers will be possible only if hundreds of doctors and nurses can collaborate in the participating emergency departments. Since they are busy, and working in emergency situations, the trial involves them in almost no extra work: no special investigations or changes to usual management are required, and data collection is absolutely minimal. The trial is on-going and new collaborators are welcome. Further information about the trial is available at http://www.crash.lshtm.ac.uk

[Prevalence of helmet use in children and adolescents in Germany and preventable bicycle-related head injuries].

Science.gov (United States)

Gutsche, J; Hintzpeter, B; Neuhauser, H; Schlaud, M

2011-08-01

Head injuries are the main cause of death in bicycle-related accidents among children and adolescents. According to a Cochrane Review, the risk of head injury (OR 0.31; 95% CI 0.26-0.37) or brain injury (OR 0.31; 95% CI 0.23-0.42) decreases by 69% if a helmet is worn. This study presents the prevalence of helmet use in cycling children and adolescents in Germany and the proportion of head injuries that could be prevented by wearing helmets. The potential effects of increased helmet wearing rates on the population attributable risk percentage for head injuries (PAR%) are demonstrated. The prevalence of helmet use in children aged 3-17 years was analysed using data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The percentage of head injuries preventable by helmet use in this group is estimated by calculating PAR%. Prevalence rates of helmet use and odds ratios from a Cochrane Review about the effectiveness of bicycle helmets for the prevention of head injuries were used for analysis. The potential effect of increased helmet use is shown in 3 scenarios by means of differences of PAR% values in the most relevant age groups. The older the children, the less likely they are to wear a helmet: 89.5% (95% CI 88.0%-90.8%) of the 3- to 6-year-old children wear a helmet when cycling but only 11.0% (95% CI 9.3%-12.9%) of 14- to 17-year-old adolescents do. In the youngest group (3-6 years) 19% of bicycle-related head injuries are attributable to the non-use of helmets, but this proportion rises to 67% in the oldest group (14-17 years). The PAR% of head injuries associated with not wearing a helmet may be reduced by more than a third by increasing the helmet wearing rate to 67% (2 out of 3) among adolescents, and may be reduced to half if 75% of adolescents wore a helmet. Particularly older children and adolescents hardly use bicycle helmets, hence the rate of preventable head injury is high. Efforts towards increasing helmet use

Circularity bias in abusive head trauma studies could be diminished with a new ranking scale

DEFF Research Database (Denmark)

Högberg, Göran; Colville-Ebeling, Bonnie; Högberg, Ulf

2016-01-01

Causality in abusive head trauma has never been fully established and hence no gold standard exists for the diagnosis. Implications hereof include bias introduced by circular reasoning and a shift from a trustful doctor patient relationship to a distrustful one when the caregiver statement...

Head and Maxillofacial Injuries in Child and Adolescent Victims of Automotive Accidents

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Alessandro Leite Cavalcanti

2014-01-01

Full Text Available Background. Victims of motor vehicle accidents may suffer multiple lesions, including maxillofacial injuries. The aim of this study was to evaluate the prevalence and factors associated with head, facial, and maxillofacial injuries in child and adolescent victims of automobile accidents. A cross-sectional study was carried out with analysis of forensic medical reports from the Legal Medical Institute of Campina Grande, Brazil, between January 2008 and December 2011. Descriptive and inferential statistical analysis was conducted using the chi-square test (α = 0.05. From 1613 medical reports analyzed, the sample is composed 232 (14.4% reports referring to child and adolescent victims of automobile accidents aged 0–19 years of both sexes. Victims were mostly adolescents aged from 15 to 19 years (64.2%, males (73.7%, and motorcyclists (51.3%. More than half of the victims had single lesions (54.3% located in the head (20.7% and face (21.6%. Head injuries occurred more frequently in children aged 0–4 years (53.8%, PR = 5.065, 95% CI = 1.617–5.870 and pedestrians (30.4%, PR = 2.039, 95% CI = 1.024–4.061, while facial and maxillofacial injuries occurred in higher proportion among females (31.1%, PR = 0.489, 95% CI = 0.251–0.954. Our findings suggest that accidents involving motorcyclists are the most prevalent, affecting male adolescents aged from 15 to 19 years, resulting in a high frequency of injuries in the head and face regions.

Hospitalised and Fatal Head Injuries in Viti Levu, Fiji: Findings from an Island-Wide Trauma Registry (TRIP 4)

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Kool, Bridget; Raj, Naina; Wainiqolo, Iris; Kafoa, Berlin; McCaig, Eddie; Ameratunga, Shanthi

2012-01-01

Background Globally, head injury is a substantial cause of mortality and morbidity. A disproportionately greater burden is borne by low- and middle-income countries. The incidence and characteristics of fatal and hospitalised head injuries in Fiji are unknown. Methods Using prospective data from the Fiji Injury Surveillance in Hospital system, the epidemiology of fatal and hospitalised head injuries was investigated (2004–2005). Results In total, 226 hospital admissions and 50 fatalities (66% died prior to admission) with a principal diagnosis of head injury were identified (crude annual rates of 34.7 and 7.7/100,000, respectively). Males were more likely to die and be hospitalised as a result of head injury than females. The highest fatality rate was among those in the 30–44-year age group. Road traffic crashes were the leading causes of injuries resulting in death (70%), followed by ‘hit by person or object’ and falls (14% each). Among people admitted to hospital, road traffic crashes (34.5%) and falls (33.2%) were the leading causes of injury. The leading cause of head injuries in children was falls, in 15–29-year-olds road traffic crashes, and in adults aged 30–44 years or 45 years and older ‘hit by person or object’. Among the two major ethnic groups, Fijians had higher rates of falls and ‘hit by person or object’ and Indians higher rates for road traffic crashes. There were no statistically significant differences between the overall rates of head injuries or the fatal and non-fatal rates among Fijians or Indians by gender following age standardisation to the total Fijian national population. Conclusion Despite underestimating the overall burden, this study identified head injury to be a major cause of death and hospitalisation in Fiji. The predominance of males and road traffic-related injuries is consistent with studies on head injuries conducted in other low- and middle-income countries. The high fatality rate among those aged 30–44

BIOMECHANICS OF HEAD INJURY IN OLYMPIC TAEKWONDO AND BOXING

Science.gov (United States)

Fife, G.P.; Pieter, W.

2013-01-01

Objective The purpose was to examine differences between taekwondo kicks and boxing punches in resultant linear head acceleration (RLA), head injury criterion (HIC15), peak head velocity, and peak foot and fist velocities. Data from two existing publications on boxing punches and taekwondo kicks were compared. Methods For taekwondo head impacts a Hybrid II Crash Dummy (Hybrid II) head was instrumented with a tri-axial accelerometer mounted inside the Hybrid II head. The Hybrid II was fixed to a height-adjustable frame and fitted with a protective taekwondo helmet. For boxing testing, a Hybrid III Crash Dummy head was instrumented with an array of tri-axial accelerometers mounted at the head centre of gravity. Results Differences in RLA between the roundhouse kick (130.11±51.67 g) and hook punch (71.23±32.19 g, d = 1.39) and in HIC15 (clench axe kick: 162.63±104.10; uppercut: 24.10±12.54, d = 2.29) were observed. Conclusions Taekwondo kicks demonstrated significantly larger magnitudes than boxing punches for both RLA and HIC. PMID:24744497

Radioimmunoassay of serum creatine kinase BB as index of brain damage after head injury

Energy Technology Data Exchange (ETDEWEB)

Phillips, J P; Jones, H M; Hitchcock, R; Adams, N; Thompson, R J [Addenbrooke' s Hospital, Cambridge (UK)

1980-09-20

Brain-type creatine kinase isoenzyme (CK-BB) was measured by radioimmunoassay in the serum of 54 patients with head injuries. CK-BB was not detectable in 476 out of 1006 controls, the remaining 530 normal samples containing a mean of 1.5 +- SDO.75 ..mu..g/l. The mean CK-BB concentrations in patients with mild, moderate, and fatal head injuries were all significantly higher than the control value (p<0.01 in each instance). Patients with serious head injury had serum concentrations many times the normal value, in two cases within 30 minutes after impact. Fatally injured patients continued to have high serum concentrations several days after injury. In less serious cases values approached normal within two or three days. Every patient with evidence of cerebral laceration, bruising, or swelling had a serum CK-BB concentration above normal. Raised concentrations were found in 14 out of 22 patients with concussion only. Thus the serum CK-BB concentration appears to be a sensitive index of brain damage and may prove useful in the management and follow-up of head-injured patients.

Radioimmunoassay of serum creatine kinase BB as index of brain damage after head injury

International Nuclear Information System (INIS)

Phillips, J.P.; Jones, H.M.; Hitchcock, R.; Adams, N.; Thompson, R.J.

1980-01-01

Brain-type creatine kinase isoenzyme (CK-BB) was measured by radioimmunoassay in the serum of 54 patients with head injuries. CK-BB was not detectable in 476 out of 1006 controls, the remaining 530 normal samples containing a mean of 1.5 +- SDO.75 μg/l. The mean CK-BB concentrations in patients with mild, moderate, and fatal head injuries were all significantly higher than the control value (p<0.01 in each instance). Patients with serious head injury had serum concentrations many times the normal value, in two cases within 30 minutes after impact. Fatally injured patients continued to have high serum concentrations several days after injury. In less serious cases values approached normal within two or three days. Every patient with evidence of cerebral laceration, bruising, or swelling had a serum CK-BB concentration above normal. Raised concentrations were found in 14 out of 22 patients with concussion only. Thus the serum CK-BB concentration appears to be a sensitive index of brain damage and may prove useful in the management and follow-up of head-injured patients. (author)

A population-based study of sport and recreation-related head injuries treated in a Canadian health region.

Science.gov (United States)

Harris, Andrew W; Jones, C Allyson; Rowe, Brian H; Voaklander, Donald C

2012-07-01

To report the rates of SR-related HIs presenting to EDs in a Canadian population-based sample. Descriptive epidemiology study. Using administrative data, sport and recreation-related emergency department presentations for persons 0-35 years of age, from April 1997 through March 2008, were obtained from the Edmonton Zone (formerly the Capital Health Region), Alberta Health Services through the Ambulatory Care Classification System. Of the 3,230,890 visits to the emergency departments of the five hospitals in Edmonton, 63,219 sport and recreation-related injury records and 4935 sport and recreation-head injury records were identified. Head injuries were most frequently treated for the activities of hockey (20.7%), cycling (12.0%), and skiing/snowboarding/sledding. Males accounted for 71.9% (n=3546) and patients less than 18 years of age sustained 3446 (69.8%) sport and recreation-head injuries. Sport and recreation-related head injuries most frequently treated in emergency departments involve common activities such as hockey, cycling, skiing/snowboarding/sledding, and soccer. Males and those less than 18 years of age sustain the majority of sport and recreation-related head injuries treated in emergency departments. These findings underscore the importance of sport-specific policies and safety promotion for the prevention of head injuries, in sports and recreational activities. Copyright © 2011 Sports Medicine Australia. All rights reserved.

A mouse model of weight-drop closed head injury: emphasis on cognitive and neurological deficiency

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Igor Khalin

2016-01-01

Full Text Available Traumatic brain injury (TBI is a leading cause of death and disability in individuals worldwide. Producing a clinically relevant TBI model in small-sized animals remains fairly challenging. For good screening of potential therapeutics, which are effective in the treatment of TBI, animal models of TBI should be established and standardized. In this study, we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model. We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice. Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury. Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI.

Patients who reattend after head injury: a high risk group.

Science.gov (United States)

Voss, M.; Knottenbelt, J. D.; Peden, M. M.

1995-01-01

OBJECTIVE--To assess risk factors for important neurosurgical effects in patients who reattend after head injury. DESIGN--Retrospective study. SUBJECTS--606 patients who reattended a trauma unit after minor head injury. MAIN OUTCOME MEASURES--Intracranial abnormality detected on computed tomography or the need for neurosurgical intervention. RESULTS--Five patients died: two from unrelated causes and three from raised intracranial pressure. On multiple regression analysis the only significant predictor for both abnormality on computed tomography (14.4% of reattenders) and the need for operation (5% of reattenders) was vault fracture seen on the skull radiograph (P personality change, and seizures were significantly associated only with abnormality on computed tomography. Headache, dizziness, nausea, and vomiting were common in reattenders but were found to have no independent significance. CONCLUSIONS--All patients who reattend after head injury should undergo computed tomography as at least 14% of scans can be expected to yield positive results. Where this facility is not available patients with predictors for operation should be urgently referred for neurosurgical opinion. Other patients can be readmitted and need referral only if symptoms persist despite symptomatic treatment or there is neurological deterioration while under observation. These patients are a high risk group and should be treated seriously. PMID:8520273

Cognitive contributions to theory of mind ability in children with a traumatic head injury.

Science.gov (United States)

Levy, Naomi Kahana; Milgram, Noach

2016-01-01

The objective of the current study is to examine the contribution of intellectual abilities, executive functions (EF), and facial emotion recognition to difficulties in Theory of Mind (ToM) abilities in children with a traumatic head injury. Israeli children with a traumatic head injury were compared with their non-injured counterparts. Each group included 18 children (12 males) ages 7-13. Measurements included reading the mind in the eyes, facial emotion recognition, reasoning the other's characteristics based on motive and outcome, Raven's Coloured Progressive Matrices, similarities and digit span (Wechsler Intelligence Scale for Children - Revised 95 subscales), verbal fluency, and the Behaviour Rating Inventory of Executive Functions. Non-injured children performed significantly better on ToM, abstract reasoning, and EF measures compared with children with a traumatic head injury. However, differences in ToM abilities between the groups were no longer significant after controlling for abstract reasoning, working memory, verbal fluency, or facial emotion recognition. Impaired ToM recognition and reasoning abilities after a head injury may result from other cognitive impairments. In children with mild and moderate head injury, poorer performance on ToM tasks may reflect poorer abstract reasoning, a general tendency to concretize stimuli, working memory and verbal fluency deficits, and difficulties in facial emotion recognition, rather than deficits in the ability to understand the other's thoughts and emotions. ToM impairments may be secondary to a range of cognitive deficits in determining social outcomes in this population.

Prognosis of head injury. In relation to age, CT findings and the GCS on admission

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Tanaka, Satoshi; Kamei, Ichiro; Ooiwa, Yoshitsugu; Hyotani, Genhachi; Yabumoto, Michio; Kuriyama, Tsuyoshi [Japanese Red Cross Society, Wakayama (Japan). Wakayama Medical Center; Kakishita, Koji; Inui, Yoshiro

1996-02-01

We have carried out a retrospective study of head injury patients to determine the factors that predict their outcomes. The subjects consisted of 74 head injury patients (Glasgow Coma Scale: 3-12) treated at our hospital from January, 1989 to March, 1994. Age, CT findings and the GCS on admission were investigated as outcome-predicting factors. CT findings were classified according to the TCDB (Traumatic Coma Data Bank) and the outcomes were evaluated using the Glasgow Outcome Scale 3 months after the head injury. In our study, the factors indicated favorable outcomes were as follows; age younger than 50 years old, GCS higher than 6, appearance of the basal cisterns on CT scan, existence of removable acute epidural hematoma. In contrast, the factors that indicated unfavorable outcomes were as follows; disappearance of the basal cisterns on CT scan, existence of apparent acute subdural hematoma and/or intracranial hematoma associated with cerebral contusion. Based on these findings, we can more accurately estimate the prognosis of head injury. (author)

Infantile abuse: Radiological diagnosis

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Ana Teresa Araujo Reyes

2006-08-01

Full Text Available Infantile abuse is a frequent problem, that must be suspected to bediagnosed, the children victims of infantile abuse can present anytype of injury, nevertheless there are associated injuries common toan inferred trauma that constitute radiological patterns highly specific for abuse, among them are the metafisial injuries, posterior costal fractures and first costal arc fractures, fractures of the toracolumbar region, fractures without apparent explanation, fractures in different stage of evolution, subdural hematoma, subarachnoid hemorrhage, intraparenquimatose contusion and diffuse axonal injury, which combined with the history of the trauma, the age, the development of mental abilities, as well as the mechanism guides the injury diagnose.

The epidemiological trends of head injury in the largest Canadian adult trauma center from 1986 to 2007.

Science.gov (United States)

Cadotte, David W; Vachhrajani, Shobhan; Pirouzmand, Farhad

2011-06-01

This study documents the epidemiology of head injury over the course of 22 years in the largest Level I adult trauma center in Canada. This information defines the current state, changing pattern, and relative distribution of demographic factors in a defined group of trauma patients. It will aid in hypothesis generation to direct etiological research, administrative resource allocation, and preventative strategies. Data on all the trauma patients treated at Sunnybrook Health Sciences Centre (SHSC) from 1986 to 2007 were collected in a consecutive, prospective fashion. The authors reviewed these data from the Sunnybrook Trauma Registry Database in a retrospective fashion. The aggregate data on head injury included demographic data, cause of injury, and Injury Severity Score (ISS). The collected data were analyzed using univariate techniques to depict the trend of variables over years. The authors used the length of stay (LOS) and number of deaths per year (case fatality rate) as crude measures of outcome. A total of 16,678 patients were treated through the Level I trauma center at SHSC from January 1986 to December 2007. Of these, 9315 patients met the inclusion criteria (ISS > 12, head Abbreviated Injury Scale score > 0). The median age of all trauma patients was 36 years, and 69.6% were male. The median ISS of the head-injury patients was 27. The median age of this group of patients increased by 12 years over the study period. Motorized vehicle accidents accounted for the greatest number of head injuries (60.3%) although the relative percentage decreased over the study period. The median transfer time of patients sustaining a head injury was 2.58 hours, and there was an approximately 45 minute improvement over the 22-year study period. The median LOS in our center decreased from 19 to 10 days over the study period. The average case fatality rate was 17.4% over the study period. In multivariate analysis, more severe injuries were associated with increased LOS as

Computed Tomography: Ocular Manifestations In Acute Head Injury

African Journals Online (AJOL)

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Methods: We reviewed 98 brain computed tomographic results retrospectively. ... was also performed to compare the difference of the ocular findings and sexes. ... Ocular findings were more in males and the severity of the ocular findings was .... Male. Female. Indications. Acute mild closed head injury. 12(15.0). 1(5.6).

Head injuries presenting to emergency departments in the United States from 1990 to 1999 for ice hockey, soccer, and football.

Science.gov (United States)

Delaney, J Scott

2004-03-01

To examine the number and rates of head injuries occurring in the community as a whole for the team sports of ice hockey, soccer, and football by analyzing data from patients presenting to US emergency departments (EDs) from 1990 to 1999. Retrospective analysis. Data compiled for the US Consumer Product Safety Commission using the National Electronic Injury Surveillance System were used to generate estimates for the total number of head injuries, concussions, internal head injuries, and skull fractures occurring on a national level from the years 1990 to 1999. These data were combined with yearly participation figures to generate rates of injuries presenting to the ED for each sport. There were an estimated 17,008 head injuries from ice hockey, 86,697 from soccer, and 204,802 from football that presented to US EDs from 1990 to 1999. The total number of concussions presenting to EDs in the United States over the same period was estimated to be 4820 from ice hockey, 21,715 from soccer, and 68,861 from football. While the rates of head injuries, concussions, and combined concussions/internal head injuries/skull fractures presenting to EDs per 10,000 players were not always statistically similar for all 3 sports in each year data were available, they were usually comparable. While the total numbers of head injuries, concussions, and combined concussions/skull fractures/internal head injuries presenting to EDs in the United States are different for ice hockey, soccer, and football for the years studied, the yearly rates for these injuries are comparable among all 3 sports.

Using PANDA (Preventing the Abuse of Tobacco, Narcotics, Drugs, and Alcohol) in a Baltimore City Head Start Setting: A Preliminary Study.

Science.gov (United States)

Belcher, Harolyn M. E.; Lockhart, Paula J.; Perkins-Parks, Susan; McNally, Margaret

2000-01-01

Describes an evaluation of a substance abuse prevention curriculum, Preventing the Abuse of Tobacco, Narcotics, Drugs, and Alcohol (PANDA), taught to African American Head Start preschool students, examining changes in children's self-concept following participation. Overall, students demonstrated significantly improved self-concept, and PANDA…

Preliminary study on the head-injury by using SPECT with 99mTc-HMPAO

International Nuclear Information System (INIS)

Guan Yihui; Liu Yongchang; Lin Xiangtong

1994-01-01

After the acute period of head trauma some cases of patients may have some symptoms, such as headache, poor memory, vertigo, et al. In this study, among 42 patients most of whom had normal CT or MRI abnormal findings of brain perfusion imaging were seen in 33 patients (78.6%). Multiple perfusion defects were observed in some patients (13/42). These indicate that the head-injury syndrome is closely related to brain blood perfusion. authors' conclusion is that the brain SPECT is able to find out the etiology of head injury syndrome

Influence of history of head trauma and epilepsy on delinquents in a juvenile classification home.

Science.gov (United States)

Miura, Hideki; Fujiki, Masumi; Shibata, Arihiro; Ishikawa, Kenji

2005-12-01

Juvenile delinquents often show poor impulse control and cognitive abnormalities, which may be related to disturbances in brain development due to head trauma and/or epilepsy. The aim of the present study was to examine the influence of head trauma and/or epilepsy on delinquent behavior. We examined 1,336 juvenile delinquents (1,151 males and 185 females) who had been admitted to the Nagoya Juvenile Classification Home, Aichi, Japan. Among them, 52 subjects with a history of epilepsy, convulsion or loss of consciousness, head injury requiring neurological assessment and/or treatment, or neurosurgical operation (head trauma/epilepsy group), were examined by electroencephalography and compared to subjects without these histories (control group) with respect to types of crime, history of amphetamine use, psychiatric treatment, child abuse, and family history. Among the 52 subjects, 43 (82.7%) showed abnormal findings. The head trauma/epilepsy group had significantly higher rates of psychiatric treatment (Phistory of drug abuse (Pdelinquents who had a history of head trauma and/or epilepsy showed a high prevalence of electroencephalograph abnormality, and higher rates of psychiatric treatment and family history of drug abuse, and were more likely to be sent to juvenile training school by the family court.

Incidence and severity of head and neck injuries in victims of road traffic crashes: In an economically developed country.

Science.gov (United States)

Bener, Abdulbari; Rahman, Yassir S Abdul; Mitra, Biswadev

2009-01-01

Head and neck injuries following the road traffic crashes (RTCs) are the most common cause of morbidity and mortality in most developed and developing countries and may also result in temporary or permanent disability. The aim of this study was to determine the incidence pattern of head and neck injuries, investigate its trend and identify the severity of injuries involved with road traffic crashes (RTCs) during the period 2001-2006. This is a retrospective descriptive hospital based study. The patients with head and neck injuries were seen and treated in the Accident and Emergency Department of the Hamad General Hospital and other Trauma Centers of the Hamad Medical Corporation following the road traffic crashes during the period 2001-2006. This study is a retrospective analysis of 6709 patients attended and treated at the Accident and Emergency and Trauma centers for head and neck injuries over a 6 year period. Head and neck injuries were determined according to the ICD 10 criteria. Of these, 3013 drivers, 2502 passengers, 704 pedestrians and 490 two wheel riders (motor bike and cyclists). Details of all the road traffic crash patients were compiled in the database of the Emergency Medical Services (EMS), and the data of patients with head and neck injuries were extracted from this database. A total of 6709 patients with head and neck injuries was reported during the study period. Majority of the victims were non-Qataris (68.7%), men (85.9%) and in the age group 20-44 years (68.5%). There were statistical significant differences in relation to age, nationality, gender, and accident during week ends for head and neck injuries (pQatar from road traffic crashes. The incidence of head and neck injuries is still very high in Qatar, but the severity of injury was mild in most of the victims. The findings of the study highlighted the need for taking urgent steps for safety of people especially drivers and passengers.

Time pressure management as a compensatory strategy training after closed head injury

NARCIS (Netherlands)

Fasotti, L; Kovacs, F; Eling, PATM; Brouwer, WH

Following severe closed head injury, deficits in speed of information processing are common. As a result, many head-injured patients experience a feeling of "information overload" in daily tasks that once were relatively easy. Many remedial programmes have been designed that treat different aspects

Delayed symptoms and death after minor head trauma with occult vertebral artery injury.

OpenAIRE

Auer, R N; Krcek, J; Butt, J C

1994-01-01

Head injury without loss of consciousness is seldom accompanied by grave complications. We report the case of an 18 year old cyclist who was struck by a car in a minor road traffic accident, suffered minor head injury without loss of consciousness, and died unexpectedly seven weeks later with vomiting and coma. Necropsy revealed an expanding cerebellar infarct and vertebral artery thrombosis, superimposed on an old dissecting intramural haematoma of the right vertebral artery in the atlantoax...

Clinical assessment of suspected child physical abuse

International Nuclear Information System (INIS)

Rohrer, T.

2009-01-01

Violence against children has many faces. Child physical abuse, neglect, sexual abuse and interparental violence can cause acute and permanent damage and affect children's development and their life plans in the long term. In industrialized nations almost 1 child in 10 is affected. Up to 10% of child physical abuse cases involve the central nervous system with 80% of these cases occurring during the first year of life. Worldwide more than 50,000 children die as a result of violence, abuse and neglect every year, according to the United Nations Children's Fund UNICEF. In Germany, there are about 120 cases of non-accidental head injury per year. In addition to the officially known cases there is a large grey area for all forms of violence. Recognition of these cases and the provision of help for the victims require an appropriate suspicion and understanding of the pertinent pathophysiology. Suspicion must be based on a well-documented medical history and multidisciplinary diagnostic assessment. Medical confidentiality prevents the disclosure of such information making early detection networks and guidelines for collaboration absolutely indispensable. (orig.) [de

Asymmetry of critical closing pressure following head injury

OpenAIRE

Kumar, A; Schmidt, E; Hiler, M; Smielewski, P; Pickard, J; Czosnyka, M

2005-01-01

Objective: Critical closing pressure (CCP) is the arterial pressure below which the vessels collapse. Hypothetically it is the sum of intracranial pressure (ICP) and vessel wall tension in the cerebral circulation. This study investigated transhemispherical asymmetry of CCP by studying its correlation with radiological findings on computed tomography (CT) scans in head injury patients.

Workshop for disabled survivors of severe head injury.

Science.gov (United States)

London, P S

1973-08-18

Existing services for the disabled do not cater for the needs of lame-brain survivors of severe head injury who may be capable of productive work though they may never become employable. A grant from the Nuffield Provincial Hospitals Trust made it possible to set up in 1967 a special workshop in premises provided by the regional hospital board. The hospital management committee assumed financial responsibility for the centre after three years, and after five years the Department of Health and Social Security purchased adjoining premises, which will double the present accommodation for about 35 persons. Though 45% of the 101 patients attending the workshop have returned to work, no financial support has yet been received from the Department of Employment. A suitably staffed hostel is needed for patients who live too far away to travel daily to and from the workshop. This undertaking has shown a need for special facilities for some of the victims of severe head injury, who differ in many important ways from other disabled persons.

Intraindividual variability as an indicator of malingering in head injury.

Science.gov (United States)

Strauss, Esther; Slick, Daniel J; Levy-Bencheton, Judi; Hunter, Michael; MacDonald, Stuart W S; Hultsch, David F

2002-07-01

The utility of various measures of malingering was evaluated using an analog design in which half the participants (composed of three groups: naive healthy people, professionals working with head-injured people, individuals who suffered a head injury but not currently in litigation) were asked to try their best and the remainder was asked to feign believable injury. Participants were assessed with the Reliable Digit Span (RDS) task, the Victoria Symptom Validity Test (VSVT), and the Computerized Dot Counting Test (CDCT) on three separate occasions in order to determine whether repeat administration of tests improves prediction. The results indicated that regardless of an individual's experience, consideration of both level of performance (particularly on forced-choice symptom validity tasks) and intraindividual variability holds considerable promise for the detection of malingering.

Head injury management guidelines for general practitioners

Directory of Open Access Journals (Sweden)

Jeremy C Ganz

2011-01-01

Full Text Available A complete examination of a head injured patient in the hospital requires a number of instruments. These include a stethoscope, sphygmomanometer, ophthalmoscope, otoscope, cotton wool, safety pin, tuning fork, reflex hammer and a small key to test the plantar response. Few of these are required at the accident scene. This is because, in the hospital, the aim is optimal definitive treatment. At the accident scene, the aim is prevention of secondary injury, rapid recording of the most important findings and safe efficient transport to the hospital. This short paper reviews how the local doctor should undertake a neurosurgical assessment of traumatic brain injury patients. Moreover, the primary management at accident scenes is described and the rationale behind the approach is outlined

Effectiveness of rugby headgear in preventing soft tissue injuries to the head: a case-control and video cohort study.

Science.gov (United States)

Jones, S J; Lyons, R A; Evans, R; Newcombe, R G; Nash, P; McCabe, M; Palmer, S R

2004-04-01

To determine if headgear use by rugby players was associated with a reduced risk of head or facial laceration, abrasion, or fracture. An emergency department based case-control study in South Wales, UK, with cases being rugby players treated for superficial head and facial injuries and controls being their matched opponents during the game. A review of videos of the 41 games in the 1999 Rugby World Cup was also carried out to compare with the case-control study. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to measure association between exposure (headgear wearing) and outcome (head and facial injuries). In the case-control study, 164 pairs were analysed, with headgear worn by 12.8% of cases and 21.3% of controls. Headgear use was associated with substantial but non-significant reductions in superficial head (OR = 0.43, 95% CI 0.13 to 1.19) and facial (OR = 0.57, 95% CI 0.21 to 1.46) injuries. The video study followed 547 players over 41 games, during which there were 47 bleeding injuries to the head. Headgear use significantly reduced the risk of bleeding head injury in forwards (OR = 0.14, 95% CI 0.01 to 0.99, p = 0.02), but not in backs. There was also a higher risk of facial injury among forwards, but this was not significant. The combined results suggest that headgear can prevent certain types of superficial head injuries in players at all levels of the game, but the evidence is strongest for superficial head injury in elite forwards. A randomised controlled trial would be the best way to study this further.

Update on child abuse prevention.

Science.gov (United States)

Krugman, Scott D; Lane, Wendy G; Walsh, Christina M

2007-12-01

Child abuse remains a significant problem in the United States with 2.9 million reports and 825 000 indicated cases in 2005. This report will highlight recent efforts toward child abuse prevention, focusing on home visiting programs, abusive head trauma primary prevention, parent training programs, sexual abuse prevention, and the effectiveness of laws banning corporal punishment. Most home visitation programs have demonstrated a lack of effectiveness in recent randomized trials. One exception is the Nurse Family Partnership, which remains the most effective and longest enduring intervention for high-risk families. Child sexual abuse prevention programs and parent training programs need further evaluation with more rigorous methodology and outcome measures. Providing universal parent education about coping with crying infants appears to be effective in lowering the incidence of abusive head trauma. Although advocated for, further study will determine the effectiveness of laws banning corporal punishment or mandating abusive head trauma education to parents of newborns. Pediatricians play an important role in the prevention of child maltreatment. Their knowledge of the effectiveness of different programs can help guide parents toward appropriate services.

Paediatric head injuries in the Kwazulu-Natal Province of South Africa: a developing country perspective.

Science.gov (United States)

Okyere-Dede, Ebenezer K; Nkalakata, Munyaradzi C; Nkomo, Tshepo; Hadley, G P; Madiba, Thandinkosi E

2013-01-01

We investigated the causes, management and outcome of head injuries in paediatric patients admitted to the paediatric surgery unit at King Edward VIII Hospital over a 3-year period, from 1999 to 2001. There were 506 patients (331 male; M:F ratio 2:1) and the mean age was 71.99 +36.8 months (2 weeks to 180 months). The injuries were due to: motor vehicle crashes (324); falls (121); assault (30); inadvertent injury (23); and unknown (11). Forty-nine patients (9%) were admitted with a Glasgow Coma Scale ≤8. The most common intracranial pathology on computed tomography was: intracranial haematoma/haemorrhage (44); contusion (16); and brain oedema (10). Nineteen patients (3.4%) underwent neurosurgical intervention and the rest were managed conservatively. Eighteen died in hospital (3.6%). The mean hospital stay was 5 ± 12 days. Twenty-three patients (4.5%) were discharged with neurological sequelae. Few paediatric patients are admitted with severe head injury: the majority from blunt injury caused by motor vehicle crashes. Management mainly requires simple neurological observation in a general ward with a surprisingly good prognosis. Specific protocols for paediatric head injuries have been proposed based on these findings.

Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary?

Science.gov (United States)

Tallapragada, Krishna; Peddada, Ratna Soundarya; Dexter, Mark

2018-03-01

Previous studies have shown that children with isolated linear skull fractures have excellent clinical outcomes and low risk of surgery. We wish to identify other injury patterns within the spectrum of paediatric mild head injury, which need only conservative management. Children with low risk of evolving neurosurgical lesions could be safely managed in primary hospitals. We retrospectively analysed all children with mild head injury (i.e. admission Glasgow coma score 13-15) and skull fracture or haematoma on a head computed tomography scan admitted to Westmead Children's Hospital, Sydney over the years 2009-2014. Data were collected regarding demographics, clinical findings, mechanism of injury, head computed tomography scan findings, neurosurgical intervention, outcome and length of admission. Wilcoxon paired test was used with P value <0.05 considered significant. Four hundred and ten children were analysed. Three hundred and eighty-one (93%) children were managed conservatively, 18 (4%) underwent evacuation of extradural haematoma (TBI surgery) and 11 (3%) needed fracture repair surgery. Two children evolved a surgical lesion 24 h post-admission. Only 17 of 214 children transferred from peripheral hospitals needed neurosurgery. Overall outcomes: zero deaths, one needed brain injury rehabilitation and 63 needed child protection unit intervention. Seventy-five percentage of children with non-surgical lesions were discharged within 2 days. Eighty-three percentage of road transfers were discharged within 3 days. Children with small intracranial haematomas and/or skull fractures who need no surgery only require brief inpatient symptomatic treatment and could be safely managed in primary hospitals. Improved tertiary hospital transfer guidelines with protocols to manage clinical deterioration could have cost benefit without risking patient safety. © 2017 Royal Australasian College of Surgeons.

Isolated Post-Traumatic Radial Head Dislocation, A Rare and Easily Missed Injury-A Case Report

Directory of Open Access Journals (Sweden)

V Gupta

2013-03-01

Full Text Available Dislocation of the head of the radius may be either congenital, an isolated injury or more commonly part of a complex injury to the elbow such as the Monteggia fracturedislocation. Isolated traumatic radial head dislocation without associated injuries in children is a rare and easily missed condition. We report such a case in a 7-year-old boy without any associated injuries or co-morbid conditions. Initially the diagnosis was missed, and 6 weeks later open reduction was performed with annular ligament reconstruction surgery. At the one-year follow up, the patient had returned to most normal activities, showing only slight terminal restriction of pronation. We discuss the injury mechanism and management for the Monteggia fracturedislocation and review the available literature.

Experience on treatment of acute head injury combined with optic nerve damage

International Nuclear Information System (INIS)

Gao Heng; Feng Dongxia; Ma Yuanpin; Chen Jinqing

2000-01-01

Objective: To investigate the therapeutic principle for the management of acute head injury combined with optic nerve damage. Method: the clinical data of treatment and prognosis from 24 patients, in which 15 received operative and 9 conservative measures were collected and analyzed. Results: In 15 operated cases, the vision of 10 cases including one with blindness before operation was improved obviously, while those of other 5 did not get any improvement. In 9 conservatively treated cases, the vision was improved in 4 cases, deteriorated in 4 case and no change in 1 case with blindness after injury. Conclusion: One the optic nerve damage has been manifested by clinical or radiological evidences in acute head injury patients, despite it was primary or secondary reason, surgical optic nerve bone canal decompression should be done as soon as possible

Attention to affective pictures in closed head injury: event-related brain potentials and cardiac responses.

Science.gov (United States)

Solbakk, Anne-Kristin; Reinvang, Ivar; Svebak, Sven; Nielsen, Christopher S; Sundet, Kjetil

2005-02-01

We examined whether closed head injury patients show altered patterns of selective attention to stimulus categories that naturally evoke differential responses in healthy people. Self-reported rating and electrophysiological (event-related potentials [ERPs], heart rate [HR]) responses to affective pictures were studied in patients with mild head injury (n = 20; CT/MRI negative), in patients with predominantly frontal brain lesions (n = 12; CT/MRI confirmed), and in healthy controls (n = 20). Affective valence similarly modulated HR and ERP responses in all groups, but group differences occurred that were independent of picture valence. The attenuation of P3-slow wave amplitudes in the mild head injury group indicates a reduction in the engagement of attentional resources to the task. In contrast, the general enhancement of ERP amplitudes at occipital sites in the group with primarily frontal brain injury may reflect disinhibition of input at sensory receptive areas, possibly due to a deficit in top-down modulation performed by anterior control systems.

Indications for computed tomography in patients with mild head injury

International Nuclear Information System (INIS)

Ono, Kenichiro; Wada, Kojiro; Takahara, Takashi; Shirotani, Toshiki

2007-01-01

The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46±23 years), with mild head injury (Glasgow Coma Scale [GCS] score≥14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r=0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age≥60 years, male sex, JCS score≥1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score>0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age≥60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n=21) or patient request (n=17). These indications for CT including JCS may be useful in the management of patients with mild head injury. (author)

The scourge of head injury among commercial motorcycle riders in Kampala; a preventable clinical and public health menace.

Science.gov (United States)

Kamulegeya, Louis H; Kizito, Mark; Nassali, Rosemary; Bagayana, Shiela; Elobu, Alex E

2015-09-01

Trauma is an increasingly important cause of disease globally. Half of this trauma is from road traffic injuries with motorcycles contributing 21-58%. Low protective gear use, lack of regulation and weak traffic law enforcement contribute to unsafe nature of commercial motorcycles also known as "boda boda" in Uganda. To determine the prevalence of protective gear use, the occurrence of head injury and the relationship between the two among commercial motorcycle riders in Kampala. Following ethical approval we recruited consecutive consenting participants to this analytical cross-sectional study. Data was collected using pretested interviewer administered questionnaires, double entered in Epidata and analyzed with STATA. Proportions and means were used to summarize data. Odds ratios were calculated for association between wearing helmets and occurrence and severity of head injury. All 328 participants recruited were male. Of these, 18.6% used Protective gear and 71.1 % sustained head injury. Helmets protected users from head injury (OR 0.43, 95% CI, 0.23-0.8) and significantly reduced its severity when it occurred. Protective gear use was low, with high occurrence of head injury among commercial motorcycle riders in Uganda. More effective strategies are needed to promote protective gear use among Uganda's commercial motorcycle riders.

The Current State of Head and Neck Injuries in Extreme Sports

Science.gov (United States)

Sharma, Vinay K.; Rango, Juan; Connaughton, Alexander J.; Lombardo, Daniel J.; Sabesan, Vani J.

2015-01-01

Background: Since their conception during the mid-1970s, international participation in extreme sports has grown rapidly. The recent death of extreme snowmobiler Caleb Moore at the 2013 Winter X Games has demonstrated the serious risks associated with these sports. Purpose: To examine the incidence and prevalence of head and neck injuries (HNIs) in extreme sports. Study Design: Descriptive epidemiological study. Methods: The National Electronic Injury Surveillance System (NEISS) was used to acquire data from 7 sports (2000-2011) that were included in the Winter and Summer X Games. Data from the NEISS database were collected for each individual sport per year and type of HNI. Cumulative data for overall incidence and injuries over the entire 11-year period were calculated. National estimates were determined using NEISS-weighted calculations. Incidence rates were calculated for extreme sports using data from Outdoor Foundation Participation Reports. Results: Over 4 million injuries were reported between 2000 and 2011, of which 11.3% were HNIs. Of all HNIs, 83% were head injuries and 17% neck injuries. The 4 sports with the highest total incidence of HNI were skateboarding (129,600), snowboarding (97,527), skiing (83,313), and motocross (78,236). Severe HNI (cervical or skull fracture) accounted for 2.5% of extreme sports HNIs. Of these, skateboarding had the highest percentage of severe HNIs. Conclusion: The number of serious injuries suffered in extreme sports has increased as participation in the sports continues to grow. A greater awareness of the dangers associated with these sports offers an opportunity for sports medicine and orthopaedic physicians to advocate for safer equipment, improved on-site medical care, and further research regarding extreme sports injuries. PMID:26535369

Clinical Utility of '99mTc-HMPAO Brain SPECT Findings in Chronic Head Injury

International Nuclear Information System (INIS)

Chung, Jin ll; Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Lee, Jong Doo; Park, Chang Yoon; Kim, Young Soo

1992-01-01

Minima deterioration of cerebral perfusion or microanatomical changes were undetectable on conventional Brain CT or MRI. So evaluation of focal functional changes of the brain parenchyme is essential in chronic head injury patients, who did not show focal anatomical changes on these radiological studies. However, the patients who had longstanding neurologic sequelae following head injury, there had been no available imaging modalities for evaluating these patients precisely. Therefore we tried to detect the focal functional changes on the brain parenchyme using 99m Tc-HMPAO Brain SPECT on the patients of chronic head injuries. Twenty three patients who had suffered from headache, memory dysfunction, personality change and insomnia lasting more than six months following head injury were included in our cases, which showed no anatomical abnormalities on Brain CT or MRI. At first they underwent psychological test whether the symptoms were organic or not. Also we were able to evaluate the cerebral perfusion changes with 99m Tc-HMPAO Brain SPECT in 22 patients among the 23, which five patients were focal and 17 patients were nonfocally diffuse perfusion changes. Thus we can predict the perfusion changes such as local vascular deterioration or functional defects using 99m Tc-HMPAO Brain SPECT in the patients who had suffered from post-traumatic sequelae, which changes were undetectable on Brain CT or MRI.

Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss

Energy Technology Data Exchange (ETDEWEB)

Brors, D. [Univ. Hospital Wuerzburg (Germany). Dept. of Oto-Rhino-Laryngology, Head- and Neck-Surgery; Dept. of Ear, Nose and Throat Diseases, Head, Neck and Facial Plastic Surgery, Klinikum Fulda (Germany); Schaefers, M. [Dept. of Neurology, University Hospital Wuerzburg (Germany); Schick, B.; Draf, W. [Dept. of Ear, Nose and Throat Diseases, Head, Neck and Facial Plastic Surgery, Klinikum Fulda (Germany); Dazert, S. [Univ. Hospital Wuerzburg (Germany). Dept. of Oto-Rhino-Laryngology, Head- and Neck-Surgery; Kahle, G. [Department of Radiology, Hospital Fulda (Germany)

2001-02-01

Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible. (orig.)

Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss

Energy Technology Data Exchange (ETDEWEB)

Brors, D [Univ. Hospital Wuerzburg (Germany). Dept. of Oto-Rhino-Laryngology, Head- and Neck-Surgery; Dept. of Ear, Nose and Throat Diseases, Head, Neck and Facial Plastic Surgery, Klinikum Fulda (Germany); Schaefers, M [Dept. of Neurology, University Hospital Wuerzburg (Germany); Schick, B; Draf, W [Dept. of Ear, Nose and Throat Diseases, Head, Neck and Facial Plastic Surgery, Klinikum Fulda (Germany); Dazert, S [Univ. Hospital Wuerzburg (Germany). Dept. of Oto-Rhino-Laryngology, Head- and Neck-Surgery; Kahle, G [Department of Radiology, Hospital Fulda (Germany)

2001-02-01

Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible. (orig.)

Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss

International Nuclear Information System (INIS)

Brors, D.; Schaefers, M.; Schick, B.; Draf, W.; Dazert, S.

2001-01-01

Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible. (orig.)

‘Studying Injured Minds’ - The Vietnam Head Injury Study and 40 years of brain injury research

Directory of Open Access Journals (Sweden)

Vanessa eRaymont

2011-03-01

Full Text Available The study of those who have sustained traumatic brain injuries (TBI during military conflicts has greatly facilitated research in the fields of neuropsychology, neurosurgery, psychiatry, neurology and neuroimaging. The Vietnam Head Injury Study (VHIS is a prospective, long-term follow-up study of a cohort of 1,221 Vietnam veterans with mostly penetrating brain injuries, which has stretched over more than 40 years. The scope of this study, both in terms of the types of injury and fields of examination, has been extremely broad. It has been instrumental in extending the field of TBI research and in exposing pressing medical and social issues that affect those who suffer such injuries. This review summarizes the history of conflict-related TBI research and the VHIS to date, as well as the vast range of important findings the VHIS has established.

Organisation of traumatic head injury management in the Nordic countries

DEFF Research Database (Denmark)

Sollid, S; Sundstrøm, T; Ingebrigtsen, T

2009-01-01

; 67% had specific protocols for the treatment of traumatic head injury. Computed tomography (CT) was available in 93% of the hospitals, and 59% of the hospitals could link CT scans to the regional neurosurgical department. CONCLUSIONS: Most Nordic hospitals are well prepared to manage patients...

Characteristics of Syntactic Comprehension Deficits Following Closed Head Injury versus Left Cerebrovascular Accident.

Science.gov (United States)

Butler-Hinz, Susan; And Others

1990-01-01

Two studies examined the ability to assign thematic roles and to coindex referentially dependent noun phrases in closed head injured adults (N=20), adult stroke patients (N=20), and normal adults (N=20). Results suggested that syntactic comprehension disturbances are similar following left cerebral hemisphere infarction and closed head injury.…

Role of skull radiography in the initial evaluation of minor head injury: a retrospective study

International Nuclear Information System (INIS)

Murshid, W.R.

1994-01-01

The use of skull radiography in the initial evaluation of minor head injured patients is controversial. In an attempt to evaluate its benefits, a retrospective study of 566 cases subjected to skull radiography following close minor head trauma (Glasgow Coma Scale 13-15), is presented. A skull fracture (linear vault, depressed or base of skull) was present in 64 (11%) cases. Only three (5%) who were found to have a skull fracture on skull radiography developed an intracranial injury which required surgery. Intracranial injuries developed in 19 (3%) cases and were followed by surgery in six (32%). All, except for one case, had a decreased level of consciousness and a Glasgow Coma Scale less than 15, few had focal neurological deficits. Management had not been altered by the results of skull radiography in any of the cases. We concluded that skull radiographs are unnecessary for the decision process in closed minor head injury because management decisions are based primarily on a careful neurological examination. When intracranial injuries are a concern, a CT scan should be obtained. (author)

Delayed life-threatening subdural hematoma after minor head injury in a patient with severe coagulopathy: a case report

NARCIS (Netherlands)

Engelen, Marc; Nederkoorn, Paul J.; Smits, Marion; van de Beek, Diederik

2009-01-01

Minor head injury is a frequent cause for neurologic consultation and imaging. Most patients with minor head injury will make an uneventful recovery, but in a very small proportion of these patients life threatening intracranial complications occur. We describe a patient on oral anticoagulation

Delayed life-threatening subdural hematoma after minor head injury in a patient with severe coagulopathy: A case report

NARCIS (Netherlands)

M. Engelen (Marc); P.J. Nederkoorn (Paul); M. Smits (Marion); D. van de Beek (Diederik)

2009-01-01

textabstractMinor head injury is a frequent cause for neurologic consultation and imaging. Most patients with minor head injury will make an uneventful recovery, but in a very small proportion of these patients life threatening intracranial complications occur. We describe a patient on oral

Exploring the mechanisms of vehicle front-end shape on pedestrian head injuries caused by ground impact.

Science.gov (United States)

Yin, Sha; Li, Jiani; Xu, Jun

2017-09-01

In pedestrian-vehicle accidents, pedestrians typically suffer from secondary impact with the ground after the primary contact with vehicles. However, information about the fundamental mechanism of pedestrian head injury from ground impact remains minimal, thereby hindering further improvement in pedestrian safety. This study addresses this issue by using multi-body modeling and computation to investigate the influence of vehicle front-end shape on pedestrian safety. Accordingly, a simulation matrix is constructed to vary bonnet leading-edge height, bonnet length, bonnet angle, and windshield angle. Subsequently, a set of 315 pedestrian-vehicle crash simulations are conducted using the multi-body simulation software MADYMO. Three vehicle velocities, i.e., 20, 30, and 40km/h, are set as the scenarios. Results show that the top governing factor is bonnet leading-edge height. The posture and head injury at the instant of head ground impact vary dramatically with increasing height because of the significant rise of the body bending point and the movement of the collision point. The bonnet angle is the second dominant factor that affects head-ground injury, followed by bonnet length and windshield angle. The results may elucidate one of the critical barriers to understanding head injury caused by ground impact and provide a solid theoretical guideline for considering pedestrian safety in vehicle design. Copyright © 2017 Elsevier Ltd. All rights reserved.

Multi-scale mechanics of traumatic brain injury : predicting axonal strains from head loads

NARCIS (Netherlands)

Cloots, R.J.H.; Dommelen, van J.A.W.; Kleiven, S.; Geers, M.G.D.

2013-01-01

The length scales involved in the development of diffuse axonal injury typically range from the head level (i.e., mechanical loading) to the cellular level. The parts of the brain that are vulnerable to this type of injury are mainly the brainstem and the corpus callosum, which are regions with

Pseudoaneurysm of the occipital artery: an unusual cause of persisting headache after minor head injury.

LENUS (Irish Health Repository)

Aquilina, K

2012-02-03

Post-traumatic pseudoaneurysms of the extracranial arteries in the scalp are uncommon sequelae of head injury. We report on a patient who presented four weeks after a minor head injury with a tender, pulsating and enlarging mass in the course of the left occipital artery. There was associated headache radiating to the vertex. Computed tomographic angiography confirmed the lesion to be a pseudoaneurysm of the occipital artery. The lump was resected with complete resolution of symptoms.

Pathophysiological changes detected by MRI within 24 hours after head injury

International Nuclear Information System (INIS)

Nagaoka, Tsukasa; Wakabayashi, Shinichi; Nariai, Tadashi; Ohno, Kikuo; Hirakawa, Kimiyoshi; Fukui, Shinsuke; Takei, Hidenori.

1995-01-01

This report concerns the evaluation of the usefulness of high-field magnetic resonance imaging (MRI) for the diagnosis and prognosis of patients with head injuries. For this purpose we compared the CT and MRI results obtained on 48 such patients. MRI of all cases was taken within 24 hours after head injury using a 1.5-Tesla unit. The sensitivity of the two modalities in the detection of small traumatic lesions was compared. Traumatic lesions of 23 patients (47.9%) were not detected by CT, but they were demonstrated on MRI. Overall, MRI was significantly more sensitive than CT in detecting early and/or subtle traumatic changes of the brain parenchyma (P 1 -WI and T 2 -WI. (B) Corpus callosum lesions with hyperintensity on T 2 -WI were in fact hemorrhagic contusions by signal changes on sequential MRI. The follow-up of chronological changes of a given corpus callosum lesion was essential for confirmation of its pathology. (C) In one case, scratch-like lesions with strong hypointensity on T 1 -WI and hyperintensity on T 2 -WI were clearly demonstrated in the white matter. These observations appeared to indicate axonal damages. (D) Even if initial GCS score is low ( 2 -WI and subsequently disappeared completely. We conclude that performing MRI in the early stage of a head injury is of utility for the understanding of pertinent pathophysiological changes and for predicting outcome. (author)

Pediatric radiological diagnostics in suspected child abuse

International Nuclear Information System (INIS)

Erfurt, C.; Schmidt, U.; Hahn, G.; Roesner, D.

2009-01-01

Advanced and specialized radiological diagnostics are essential in the case of clinical suspicion of pediatric injuries to the head, thorax, abdomen, and extremities when there is no case history or when ''battered child syndrome'' is assumed on the basis of inadequate trauma. In particular, the aim of this sophisticated diagnostic procedure is the detection of lesions of the central nervous system (CNS) in order to initiate prompt medical treatment. If diagnostic imaging shows typical findings of child abuse, accurate documented evidence of the diagnostic results is required to prevent further endangerment of the child's welfare. (orig.) [de

Metaphyseal fractures mimicking abuse during treatment for clubfoot

International Nuclear Information System (INIS)

Grayev, A.M.; Boal, D.K.B.; Wallach, D.M.; Segal, L.S.

2001-01-01

Background. Metaphyseal injuries resembling the classic metaphyseal lesion (CML) of abuse may occur as the result of serial casting during treatment of clubfoot deformity. Mentioned in the orthopedic literature in 1972, this iatrogenic fracture has not been described in the radiologic literature nor has the similarity to injuries occurring with abuse been previously recognized. Objective. To describe the mechanism and radiographic appearance of metaphyseal injury observed during serial casting of clubfoot. Note similarities to the CML of abuse. Materials and methods. Eight children ranging in age from 1 to 4 months underwent casting for clubfoot. Five orthopedic surgeons from three different institutions performed the casting. Two patients had spina bifida and one, arthrogryposis. A complete skeletal survey was performed on one child who was abused; there was no suspicion of abuse in the remaining seven. Results. All children manifest injury with periosteal new bone. One child had clear evidence of abuse with 24 rib fractures. X-rays of lower extremities in short leg casts revealed bilateral tibial metaphyseal fractures. Four other children had metaphyseal fractures resembling the CML of abuse, and three developed an area of sclerosis within the metaphysis. Conclusion. In the setting of serial casting for equinovarus deformity, metaphyseal injury even the CML of abuse may be noted. Since inflicted injuries are almost always unobserved and explanations rarely offered, the fact that the CML occurs as a result of orthopedic manipulation may offer some further insight concerning the pathogenesis of this well-described abuse injury. (orig.)

Metaphyseal fractures mimicking abuse during treatment for clubfoot

Energy Technology Data Exchange (ETDEWEB)

Grayev, A.M.; Boal, D.K.B. [Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA (United States); Wallach, D.M.; Segal, L.S. [Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA (United States)

2001-08-01

Background. Metaphyseal injuries resembling the classic metaphyseal lesion (CML) of abuse may occur as the result of serial casting during treatment of clubfoot deformity. Mentioned in the orthopedic literature in 1972, this iatrogenic fracture has not been described in the radiologic literature nor has the similarity to injuries occurring with abuse been previously recognized. Objective. To describe the mechanism and radiographic appearance of metaphyseal injury observed during serial casting of clubfoot. Note similarities to the CML of abuse. Materials and methods. Eight children ranging in age from 1 to 4 months underwent casting for clubfoot. Five orthopedic surgeons from three different institutions performed the casting. Two patients had spina bifida and one, arthrogryposis. A complete skeletal survey was performed on one child who was abused; there was no suspicion of abuse in the remaining seven. Results. All children manifest injury with periosteal new bone. One child had clear evidence of abuse with 24 rib fractures. X-rays of lower extremities in short leg casts revealed bilateral tibial metaphyseal fractures. Four other children had metaphyseal fractures resembling the CML of abuse, and three developed an area of sclerosis within the metaphysis. Conclusion. In the setting of serial casting for equinovarus deformity, metaphyseal injury even the CML of abuse may be noted. Since inflicted injuries are almost always unobserved and explanations rarely offered, the fact that the CML occurs as a result of orthopedic manipulation may offer some further insight concerning the pathogenesis of this well-described abuse injury. (orig.)

Helmet Use and Head Injury in Homer's Iliad.

Science.gov (United States)

Swinney, Christian

2016-06-01

Homer's detailed descriptions of head injuries inflicted during the Trojan War are of particular interest to individuals in the medical community. Although studies have examined the prevalence of such injuries, none have examined the preventive measures taken to avoid them. An in-depth review of helmet use in Homer's Iliad was conducted to address this previously unexplored facet of the epic. An English translation of Homer's text was reviewed for all references to helmet use. The number of helmet references in each book was recorded, along with other pertinent details for each reference. There were 87 references to helmets (40 combat, 47 noncombat). The helmet belonged to a Greek warrior in 41 cases (47.1%), a Trojan warrior in 38 cases (43.6%), a divinity in 5 cases (5.7%), and a general group of warriors in 3 cases (3.4%). Helmet use provided protective benefit to Greek warriors at a rate of 30.0% (3 of 10) and Trojan warriors at a rate of 11.1% (2 of 18). This difference was not statistically significant (P = 0.23). The overall combined protective benefit of helmet use in the text was 17.9% (5 of 28). Helmets belonging to 15 specific Greek warriors and 18 specific Trojan warriors were referenced in the text. Helmets belonging to Hector (n = 12) and Achilles (n = 8) were most frequently mentioned. Helmet use and head injury both play a prominent role in Homer's Iliad. Helmets are frequently used in combat settings but with relatively little success. Helmets are also used in various noncombat settings. Copyright © 2016 Elsevier Inc. All rights reserved.

The Evidence for Brain Injury in Whiplash Injuries

Directory of Open Access Journals (Sweden)

Michael P. Alexander

2003-01-01

Full Text Available The evidence that brain damage can occur in injuries that produce whiplash is reviewed. The clinical phenomena for the two injuries are the same. Pure whiplash injury implies no, or minimal head contact, but many patients also have head contact against a head rest or the steering wheel or windshield. The relative severity of the neck injury and the head injury distinguishes whiplash from mild closed head injury. If there is brain injury is some patients with whiplash, it, by definition, falls at the mildest end of the concussion spectrum. The relationship between these two injuries is examined.

Recovery versus retest effects in attention after closed head injury

NARCIS (Netherlands)

Spikman, J.M.; Timmerman, M.E.; van Zomeren, A.H; Deelman, B.G.

1999-01-01

Recovery in 60 patients with a closed-head injury (CHI) in the first year posttrauma was assessed repeatedly with a series of attention tests. A matched group of healthy subjects was tested at the same intervals to allow us to control for practice effects. The results of a multilevel analysis for

Brain CT findings in head injury with skull fracture

International Nuclear Information System (INIS)

Jeong, In Tae; Lee, Hae Kyung; Chung, Mi Kyung; Kwon, Kwi Hyang; Kim, Ki Jeong

1982-01-01

CT has revolutionized the evaluation and management of patients with head injuries. CT in non-invasion and rapidly provides accurate information regarding the presence, extent and nature of intracranial lesions resulting from trauma. We have reviewed the CT scans of 114 patients, who got head injury with confirmed to skull fracture in plain films. The results were as follows: 1. Of all cases, traffic accident was the most frequent cause and in children fall down was more than 50%. 2. Compound linear fracture was the most frequent type fractures in plain skull film.3. Of all 114 cases, epidural hematoma was 16%, subdural hematoma was 18.4%, intracerebral hematoma was 14.4%, subdural hygroma was 2.4%, normal finding was 50%. 4. Mortality rate was 13.2%. 5. Fracture was detected by CT about 28.9%, depression fracture was more easily detected in CT. 6. Incidence rate of counter coup lesion was 14.9% and mortality rate was higher than same site lesion. 7. The shape of epidural hematoma was biconvex in 75%, planoconvex in 25%. 8. The shape of subdural hematoma was cresentic shape 82.6%, biconvex shape 8.7%, planoconvex shape 8.7%

Frequent mild head injury promotes trigeminal sensitivity concomitant with microglial proliferation, astrocytosis, and increased neuropeptide levels in the trigeminal pain system.

Science.gov (United States)

Tyburski, Ashley L; Cheng, Lan; Assari, Soroush; Darvish, Kurosh; Elliott, Melanie B

2017-12-01

Frequent mild head injuries or concussion along with the presence of headache may contribute to the persistence of concussion symptoms. In this study, the acute effects of recovery between mild head injuries and the frequency of injuries on a headache behavior, trigeminal allodynia, was assessed using von Frey testing up to one week after injury, while histopathological changes in the trigeminal pain pathway were evaluated using western blot, ELISA and immunohistochemistry.  RESULTS: A decreased recovery time combined with an increased mild closed head injury (CHI) frequency results in reduced trigeminal allodynia thresholds compared to controls. The repetitive CHI group with the highest injury frequency showed the greatest reduction in trigeminal thresholds along with greatest increased levels of calcitonin gene-related peptide (CGRP) in the trigeminal nucleus caudalis. Repetitive CHI resulted in astrogliosis in the central trigeminal system, increased GFAP protein levels in the sensory barrel cortex, and an increased number of microglia cells in the trigeminal nucleus caudalis. Headache behavior in rats is dependent on the injury frequency and recovery interval between mild head injuries. A worsening of headache behavior after repetitive mild head injuries was concomitant with increases in CGRP levels, the presence of astrocytosis, and microglia proliferation in the central trigeminal pathway. Signaling between neurons and proliferating microglia in the trigeminal pain system may contribute to the initiation of acute headache after concussion or other traumatic brain injuries.

Drugs of abuse and addiction: A slippery slope toward liver injury.

Science.gov (United States)

Roy, Dijendra Nath; Goswami, Ritobrata

2016-08-05

Substances of abuse induce alteration in neurobehavioral symptoms, which can lead to simultaneous exacerbation of liver injury. The biochemical changes of liver are significantly observed in the abused group of people using illicit drugs or drugs that are abused. A huge amount of work has been carried out by scientists for validation experiments using animal models to assess hepatotoxicity in cases of drugs of abuse. The risk of hepatotoxicity from these psychostimulants has been determined by different research groups. Hepatotoxicity of these drugs has been recently highlighted and isolated case reports always have been documented in relation to misuse of the drugs. These drugs induce liver toxicity on acute or chronic dose dependent process, which ultimately lead to liver damage, acute fatty infiltration, cholestatic jaundice, liver granulomas, hepatitis, liver cirrhosis etc. Considering the importance of drug-induced hepatotoxicity as a major cause of liver damage, this review emphasizes on various drugs of abuse and addiction which induce hepatotoxicity along with their mechanism of liver damage in clinical aspect as well as in vitro and in vivo approach. However, the mechanisms of drug-induced hepatotoxicity is dependent on reactive metabolite formation via metabolism, modification of covalent bonding between cellular components with drug and its metabolites, reactive oxygen species generation inside and outside of hepatocytes, activation of signal transduction pathways that alter cell death or survival mechanism, and cellular mitochondrial damage, which leads to alteration in ATP generation have been notified here. Moreover, how the cytokines are modulated by these drugs has been mentioned here. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Influence of prayer and prayer habits on outcome in patients with severe head injury.

Science.gov (United States)

Vannemreddy, Prasad; Bryan, Kris; Nanda, Anil

2009-01-01

The objective of the study is to evaluate the effect of prayers on the recovery of the unconscious patients admitted after traumatic brain injury. A retrospective study of patients with severe head injury was conducted. The Glasgow Coma Scale and Glasgow Outcome Scale scores were examined along with age, gender, smoking, and alcohol intake. There were 13 patients who received prayer and 13 who did not receive prayer during the hospital stay with almost identical mean Glasgow Coma Scale score. The prayer group stayed in the hospital for more days (P = .03). On multivariate analysis, patients' age (P = .01), admission Glasgow Coma Scale score (P = .009), and prayer habits (P = .007) were significant factors. Patients with prayers habits recovered better following severe head injury. The role of intercessory prayer needs further studies in larger groups.

Interactive eBooks in educating patients and their families about head injury regardless of age.

Science.gov (United States)

Sahyouni, Ronald; Mahmoodi, Amin; Mahmoodi, Amir; Huang, Melissa; Tran, Diem Kieu; Chen, Jefferson W

2017-05-01

Traumatic Brain Injury (TBI) is a common and debilitating injury that is particularly prevalent in patients over 60. Given the influence of head injury on dementia (and vice versa), and the increased likelihood of ground-level falls, elderly patients are vulnerable to TBI. Educational interventions can increase knowledge and influence preventative activity to decrease the likelihood of further TBI. We sought to determine the efficacy of interactive tablet-based educational interventions in elderly patients on self-reported knowledge. Patients and family members, ages 20-90, presenting to a NeuroTrauma clinic completed a pre-survey to assess baseline TBI or concussion knowledge, depending on their diagnosis. Participants then received an interactive electronic book (eBook), or a text-based pamphlet with identical information, and completed a post-survey to test interim knowledge improvement. All participants (n=180), regardless of age, had significantly higher post-survey scores (peBook (n=39) scored lower than their younger counterparts despite higher pre-survey scores (peBook (n=20, 90) significantly improved on the post-survey (peBook (p<0.01, 95% CI). We demonstrated that interactive educational interventions are effective in the elderly TBI population. Enhanced educational awareness in the elderly population, especially patients at risk or with prior TBI, may prevent further head injury by educating patients on the importance of avoiding further head injury and taking precautionary measures to decrease the likelihood of further injury. Copyright © 2017 Elsevier B.V. All rights reserved.

The influence of severe malnutrition on rehabilitation in patients with severe head injury.

Science.gov (United States)

Dénes, Zoltán

2004-10-07

The purpose of the study was to evaluate the consequences of severe malnutrition in patients with severe head injury during rehabilitation. The data were collected from medical records of patients admitted to the neurorehabilitation unit over the last 5 years. Twenty of 1850 patients had severe malnutrition, the body mass index (BMI) of these patients were under 15 (10-14) kg/m2. The majority of patients suffered traumatic brain damage (17/20). Thirteen patients arrived with percutaneous endoscopic gastrotomy /PEG, three nasogastric tube in 3 cases we placed PEG. The nutritional strategy included a high-calorie diet, by means of bolus feeding five times during the day, continuous feeding during the night; the daily intake target being more than 2500 kcal. During rehabilitation treatment the majority of patients (13/20) revealed weight gain with a rate of 0.5-2 kg/week. The following complications were treated during the rehabilitation phase: 20 pressure sores, 20 contractures, 11 urinal infections, 6 cases of pneumonia, 2 of purulent bronchitis, 6 of sepsis, 1 penoscrotal abscess, epidydymitis, and 1 case of purulent arthritis. The patients required total assistance at the time of admission. At discharge 10 patients remained completely dependent, 6 patients needed minimal assistance, and 4 patients could perform daily activities independently. The average length of stay in our unit was 78/6-150/days. Patients with head injury suffering from severe malnutrition exhibit serious complications at the time of admission as well as during rehabilitation treatment. The patients were very difficult to mobilize. The length of stay at the rehabilitation unit was 28 days longer when complicated by malnutrition, than head injuries showing normal nutritional status. These findings underline the importance of adequate nutrition in patients with head injury in both the acute ward and in the rehabilitation unit.

Brain SPECT in severs traumatic head injury

International Nuclear Information System (INIS)

Beaulieu, F.; Eder, V.; Pottier, J.M.; Baulieu, J.L.; Fournier, P.; Legros, B.; Chiaroni, P.; Dalonneau, M.

2000-01-01

The aim of this work was to compare the results of the early brain scintigraphy in traumatic brain injury to the long term neuropsychological behavior. Twenty four patients had an ECD-Tc99m SPECT, within one month after the trauma; scintigraphic abnormalities were evaluated according to a semi-quantitative analysis. The neuropsychological clinical investigation was interpreted by a synthetic approach to evaluate abnormalities related to residual motor deficit, frontal behavior, memory and language disorders. Fourteen patients (58%) had sequela symptoms. SPECT revealed 80 abnormalities and CT scan only 31. Statistical analysis of uptake values showed significantly lower uptake in left basal ganglia and brain stem in patients with sequela memory disorders. We conclude that the brain perfusion scintigraphy is able to detect more lesions than CT and that it could really help to predict the neuropsychological behavior after severe head injury. Traumatology could become in the future a widely accepted indication of perfusion SPECT. (authors)

Functional brain study of chronic traumatic head injury

International Nuclear Information System (INIS)

Ceballos Alonso, Concepcion; Pelegrin Valero, Carmelo; Cordoba Diaz de Laspra, Elena

2000-01-01

Explosive aggressive behaviour is a significant clinical and medico-legal problem in patients suffering from head injury. However, experts in neuropsychiatry have proposed a specific category for this disorder: the o rganic aggressive syndrome: . The basic reason for proposing this diagnosis is that it describes the specificity of the violent conduct secondary to 'brain damage' with greater precision. Early diagnosis and treatment of the injury is critical. The impact of hnetium-99m-hexamethylpropuleneamine oxime (HMPAO) was examined for measuring brain damage in correlation to neuropsychological performance in patients with traumatic brain injury (TBI). We thus report the case of a twelve-year-old child with a history of CET, who presents with serious episodes of heteroaggressiveness and suggest the usefulness of single photon emission computerized tomography (SPECT) to establish the validity of this psychiatric diagnosis. The appearance of modern functional neuro-image techniques (SPECT) may help to increase the validity of clinical diagnoses in the field of psychiatry in general and of forensic psychiatry in particularly, as the related findings may be used as demarcation criteria to establish syndromic diagnoses (Au)

Scalp Hematoma Characteristics Associated With Intracranial Injury in Pediatric Minor Head Injury.

Science.gov (United States)

Burns, Emma C M; Grool, Anne M; Klassen, Terry P; Correll, Rhonda; Jarvis, Anna; Joubert, Gary; Bailey, Benoit; Chauvin-Kimoff, Laurel; Pusic, Martin; McConnell, Don; Nijssen-Jordan, Cheri; Silver, Norm; Taylor, Brett; Osmond, Martin H

2016-05-01

Minor head trauma accounts for a significant proportion of pediatric emergency department (ED) visits. In children younger than 24 months, scalp hematomas are thought to be associated with the presence of intracranial injury (ICI). We investigated which scalp hematoma characteristics were associated with increased odds of ICI in children less than 17 years who presented to the ED following minor head injury and whether an underlying linear skull fracture may explain this relationship. This was a secondary analysis of 3,866 patients enrolled in the Canadian Assessment of Tomography of Childhood Head Injury (CATCH) study. Information about scalp hematoma presence (yes/no), location (frontal, temporal/parietal, occipital), and size (small and localized, large and boggy) was collected by emergency physicians using a structured data collection form. ICI was defined as the presence of an acute brain lesion on computed tomography. Logistic regression analyses were adjusted for age, sex, dangerous injury mechanism, irritability on examination, suspected open or depressed skull fracture, and clinical signs of basal skull fracture. ICI was present in 159 (4.1%) patients. The presence of a scalp hematoma (n = 1,189) in any location was associated with significantly greater odds of ICI (odds ratio [OR] = 4.4, 95% confidence interval [CI] = 3.06 to 6.02), particularly for those located in temporal/parietal (OR = 6.0, 95% CI = 3.9 to 9.3) and occipital regions (OR = 5.6, 95% CI = 3.5 to 8.9). Both small and localized and large and boggy hematomas were significantly associated with ICI, although larger hematomas conferred larger odds (OR = 9.9, 95% CI = 6.3 to 15.5). Although the presence of a scalp hematoma was associated with greater odds of ICI in all age groups, odds were greatest in children aged 0 to 6 months (OR = 13.5, 95% CI = 1.5 to 119.3). Linear skull fractures were present in 156 (4.0%) patients. Of the 111 patients with scalp hematoma and ICI, 57 (51%) patients had

Quetiapine Induced Acute Dystonia in a patient with History of severe Head Injury

Directory of Open Access Journals (Sweden)

Robert G. Bota

2010-01-01

Full Text Available A patient with a history of severe head injury 10 years ago regained ability to walk after years of being bound to a wheelchair. During the last psychiatric hospitalization, quetiapine was increased to therapeutic dose using a normal titration. As a result the patient developed dystonia of multiple muscle groups requiring 4 days of hospitalization for remittance of symptoms. In this paper, we take a close look at the literature concerning extrapiramidal symptoms (EPS in this context, and we suggest that in patients with a history of head injury, it is warranted to consider a slower titration of antipsychotic medications, including ones that are considered having a lower risk of EPS such as quetiapine.

Four cases with localized brain-stem lesion on CT scan following closed head injury

International Nuclear Information System (INIS)

Saeki, Naokatsu; Odaki, Masaru; Oka, Nobuo; Takase, Manabu; Ono, Junichi.

1981-01-01

Cases of primary brain-stem injury following closed head injury, verified by a CT scan, have been increasingly reported. However, most of them have other intracranial lesions in addition to the brain stem, resulting in a poor outcome. The CT scan of 200 cases with severe head injury-Araki's classification of types 3 and 4 - were analysed. Four cases out of them had localized brain-stem lesion without any other significant intracranial injury on a CT scan at the acute stage and had a better outcome than had previously been reported. In this analysis, these 4 cases were studied, and the CT findings, prognosis, and pathogenesis of the localized brain-stem injury were discussed. Follow-up CT of three cases, and taken one month or more later, showed diffuse cortical atrophy. This may indicate the presence of diffuse cerebral injury which could not be seen on CT scans at the acute stage. This atrophic change may also be related with the mechanism of posttraumatic conscious impairment and posttraumatic neurological deficits, such as mental symptoms and impairment of the higher cortical function. Shearing injury is a probable pathogenesis for this diffuse cortical injury. On the other hand, one case did not have any cortical atrophy on a follow-up CT scan. Therefore, this is a case with a localized primary brain-stem injury. Coup injury against the brain stem by a tentorial margin in a case with a small tentorial opening is a possible mechanism producing the localized brain-stem injury. (J.P.N.)

Radiologists' Training, Experience, and Attitudes About Elder Abuse Detection.

Science.gov (United States)

Rosen, Tony; Bloemen, Elizabeth M; Harpe, Jasmin; Sanchez, Allen M; Mennitt, Kevin W; McCarthy, Thomas J; Nicola, Refky; Murphy, Kieran; LoFaso, Veronica M; Flomenbaum, Neal; Lachs, Mark S

2016-12-01

Elder abuse is underrecognized, and identification of subtle cases requires a high index of suspicion among all health care providers. Because many geriatric injury victims undergo radiographic imaging, diagnostic radiologists may be well positioned to identify injury patterns suggestive of abuse. Little is known about radiologists' experience with elder abuse. Our goal was to describe knowledge, attitudes, training, and practice experience in elder abuse detection among diagnostic radiologists. We conducted 19 interviews with diagnostic radiologists at a large urban academic medical center using a semistructured format. Data from these sessions were coded and analyzed to identify themes. Only two radiologists reported any formal or informal training in elder abuse detection. All subjects believed they had missed cases of elder abuse. Even experienced radiologists reported never having received a request from a referring physician to assess images for evidence suggestive of elder abuse. All subjects reported a desire for additional elder abuse training. Also, subjects identified radiographic findings or patterns potentially suggestive of elder abuse, including high-energy injuries such as upper rib fractures, injuries in multiple stages of healing, and injuries inconsistent with reported mechanism. Radiologists are uniquely positioned to identify elder abuse. Though training in detection is currently lacking, providers expressed a desire for increased knowledge. In addition, radiologists were able to identify radiographic findings suggestive of elder abuse. On the basis of these findings, we plan to conduct additional studies to define pathognomonic injury patterns and to explore how to empower radiologists to incorporate detection into their practice.

Radiologists’ Training, Experience, and Attitudes About Elder Abuse Detection

Science.gov (United States)

Rosen, Tony; Bloemen, Elizabeth M.; Harpe, Jasmin; Sanchez, Allen M.; Mennitt, Kevin W.; McCarthy, Thomas J.; Nicola, Refky; Murphy, Kieran; LoFaso, Veronica M.; Flomenbaum, Neal; Lachs, Mark S.

2017-01-01

OBJECTIVE Elder abuse is underrecognized, and identification of subtle cases requires a high index of suspicion among all health care providers. Because many geriatric injury victims undergo radiographic imaging, diagnostic radiologists may be well positioned to identify injury patterns suggestive of abuse. Little is known about radiologists’ experience with elder abuse. Our goal was to describe knowledge, attitudes, training, and practice experience in elder abuse detection among diagnostic radiologists. SUBJECTS AND METHODS We conducted 19 interviews with diagnostic radiologists at a large urban academic medical center using a semistructured format. Data from these sessions were coded and analyzed to identify themes. RESULTS Only two radiologists reported any formal or informal training in elder abuse detection. All subjects believed they had missed cases of elder abuse. Even experienced radiologists reported never having received a request from a referring physician to assess images for evidence suggestive of elder abuse. All subjects reported a desire for additional elder abuse training. Also, subjects identified radiographic findings or patterns potentially suggestive of elder abuse, including high-energy injuries such as upper rib fractures, injuries in multiple stages of healing, and injuries inconsistent with reported mechanism. CONCLUSION Radiologists are uniquely positioned to identify elder abuse. Though training in detection is currently lacking, providers expressed a desire for increased knowledge. In addition, radiologists were able to identify radiographic findings suggestive of elder abuse. On the basis of these findings, we plan to conduct additional studies to define pathognomonic injury patterns and to explore how to empower radiologists to incorporate detection into their practice. PMID:27732066

Neuropsychology of perpetrators of domestic violence: the role of traumatic brain injury and alcohol abuse and/or dependence.

Science.gov (United States)

Romero-Martínez, Ángel; Moya-Albiol, Luis

2013-12-01

Neuropsychological impairments of the executive functions, memory, attention, intelligence quotient, and empathy have been found in perpetrators of domestic violence (intimate partner violence). These impairments could be partially explained by alcohol abuse, dependence, or traumatic brain injuries. This study reviews the neuropsychological deficits of perpetrators of intimate partner violence. At the same it seeks to integrate and relate these main points with their neuroanatomical correlates. We have also established the relationship between alcohol abuse, dependence, brain damage (including traumatic brain injuries) and those deficits. Scientific literature has been reviewed by means of Google Scholar, PsycINFO, PubMed, Medline and ISI Web of Knowledge. Perpetrators of domestic violence present high mental rigidity, as well as low levels of inhibition, processing speed, verbal and attention skills, and abstract reasoning. Additionally, perpetrators show working and long play memory impairments. Moreover, those deficits could be impaired by traumatic brain injuries and alcohol abuse and/or dependence. Nonetheless, these both variables are not enough to explain the deficits. Functional abnormalities on the prefrontal and occipital cortex, fusiform gyrus, posterior cingulate gyrus, hippocampus, thalamus and amygdala could be associated with these impairments. An analysis of these mechanisms may assist in the development of neuropsychological rehabilitation programmes that could help improve current therapies.

Computerized tomography and prognosis in paediatric head injury

International Nuclear Information System (INIS)

Tomberg, T.; Rink, U.; Pikkoja, E.; Tikk, A.

1996-01-01

The authors have analysed the computerized tomography (CT) findings and their correlation with the clinical state, early and late outcome in children and adolescents with head injuries (HI). This study represents clinical and CT data of 82 consecutive HI patients under 18 years of age. Among them 51 (62%) were boys and 31 (38 %) girls. The application of CT to the evaluation of the morphologic manifestations of HI in children has shown some differences in forms and mechanisms of injury and in outcome compared to adults. In the paediatric HI the most frequent finding was diffuse brain swelling with CT evidence of ventricular and cisternal compression or obliteration. Prognostically the most unfavourable findings were shearing injury, intracerebral and subdural haematomas combined with brain swelling and parenchymal damage. According to the Lidcombe impairment scale, outcome from severe paediatric HI was determined in the 3rd and 6th months, one year and 2 years after the injury. The outcome two years after severe HI varied to a great extent and was better in children than in adults. Although there was long-term disruption of the patient's quality of life, our data show that as there are no predictors of individual outcomes in child HI, no child should be excluded from early and long-term rehabilitation. (author)

Impact of mandatory motorcycle helmet wearing legislation on head injuries in Viet Nam: results of a preliminary analysis.

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Passmore, Jonathon; Tu, Nguyen Thi Hong; Luong, Mai Anh; Chinh, Nguyen Duc; Nam, Nguyen Phuong

2010-04-01

To compare estimated prevalence of head injuries among road traffic injury patients admitted to hospitals, before and after the introduction of a mandatory helmet law in the Socialist Republic of Viet Nam. Before and after study of all road traffic injury patients with head injuries admitted to 20 provincial and central hospitals 3 months before and after the new law came into effect on 15 December 2007. Relative risk was computed and comparison made for the periods of 3 months before and after the new law. The study found a 16 percent reduction in the risk of road traffic head injuries (4683 to 3522; relative risk [RR] 0.84; 95% confidence interval [CI] 0.81-0.87) and an 18 percent reduction in the risk of road traffic death (deaths in hospital plus injured patients discharged to die at home; 566 to 417; RR 0.82; 95% CI 0.73-0.93). Over the first 3 months of the comprehensive mandatory helmet legislation there has been a significant reduction in the risk of road traffic head injuries among patients admitted to 20 hospitals. The Viet Nam Government's decision to require all motorcycle riders and passengers to wear helmets is suspected of leading to positive road safety benefits and should be seen as a policy example for other low- and middle-income countries with a high utilization of motorcycles for transport.

Assessment of Substances Abuse in Burn Patients by Using Drug Abuse Screening Test

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Kobra Gaseminegad

2012-04-01

Full Text Available There has been an increase in the frequency of substance abuse among hospitalized burn injury patients. However, few studies have investigated substance abuse among burn patients. This study was aimed to identify the incidence of substance abuse in burn injury patients using the "Drug Abuse Screening Test" (DAST-20. We determined the validity of DAST-20 in spring 2010. Subsequently, this descriptive study was performed on 203 burn injury patients who fit the study's inclusion criteria. We chose a score of 6 as the cutoff and thus achieved a sensitivity of 89% and a specificity of 85% for the DAST-20. During the study, we gathered demographic data, burn features and DAST-20 results for all patients. Patients with scores of 6 or more were considered to be substances abusers. A statistical analysis was conducted using SPSS v16 software. According to the DAST-20 results, 33% of the patients were in the user group. The mean score of DAST-20 was significantly higher among users than it was among nonusers (P<0.05. The level of substance abuse was severe in 77% of users. No significant differences were found among the substances, with the exception of alcohol. Substance abuse is an important risk factor for burn patients. In addition, this study showed that DAST-20 is a valid screening measure for studies on burn patients.

Pediatric patients with severe head injury in Japan Neurotrauma Data Bank. Analysis of the prognostic factors

International Nuclear Information System (INIS)

Miki, Tamotsu; Haraoka, Jo

2009-01-01

The purpose of this study is to evaluate the clinical characteristics of the pediatric patients in the Japan Neurotrauma Data Bank: Project 2004. Project 2004 consisted of severe head injury patients with a Glasgow Coma Scale (GCS) score of 8 or less on admission or during course and patients who were operated for traumatic intracranial lesion between 2004-2006. The subjects were 101 pediatric patients aged 15 years old or less (mean: 7.8 y/o). We retrospectively examined the patients' age, GCS, cause of injury, duration and time of patient transfer, pupillary abnormality, body temperature, serum glucose level, Injury Severity Score (ISS) excluding cranio-cervical score, skull fracture, CT classification of the Traumatic Coma Data Bank (TCDB), main lesion of focal brain injury on CT, and traumatic subarachnoid hemorrhage (SAH) on CT. The mortality rate in children is lower than in adults: 18.8% vs. 39.7%. The factors that correlated to the poor outcome in pediatric patients are lower GCS score on admission, pupillary abnormality, hyperglycemia (more than 200 mg/dl), complications of severe other organ injury, diffuse injury III according to classification of CT, acute subdural hematoma and SAH. Pathophysiologically pediatric patients are not miniatures of adult patients. The data of Project 2004 is extremely significant and indicates the profile of one general view of pediatric patients with severe head injury in Japan. However, further collection of data and careful analysis are necessary for standardizing pediatric head trauma care. (author)

Suicidal and self-injurious behavior among patients with alcohol and drug abuse

OpenAIRE

Al-Sharqi, Abdullah Mohammed; Sherra, Khaled Saad; Al-Habeeb, Abdulhameed Abdullah; Qureshi, Naseem Akhtar

2012-01-01

Abdullah Mohammed Al-Sharqi,1 Khaled Saad Sherra,2 Abdulhameed Abdullah Al-Habeeb,3 Naseem Akhtar Qureshi3,41Private Clinic, Riyadh, Saudi Arabia; 2Psychiatric Department, Faculty of Medicine, Mansoura University, Egypt; 3General Administration for Mental Health and Social Services, 4General Directorate of Research and Studies, Ministry of Health, Riyadh, Saudi ArabiaBackground: Self-injurious behavior, a major public health problem globally, is linked with alcohol and drug abuse. This cross-...

Fatal head injury: a sequelae to electric shock - a case report.

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Jayanth, S H; Hugar, Basappa S; Chandra, Y P Girish; Krishnan, A Gokula

2015-03-01

Deaths due to electric shock are increasing despite stringent laws and preventive measures. These shocks are a leading cause of death amongst construction workers. In about 20% of the cases, no visible injury due to electricity can be seen. In some cases, non-electrical injuries are present and at times there are no eyewitnesses to provide a detailed account of events. In such circumstances, examination of scene of death, autopsy and accident reconstruction with the help of an electrical expert are all necessary to determine the cause of death. Here, we report one such case where a mason working on the second floor of a building under construction sustained an electrical injury, following which he was thrown to the ground sustaining a fatal traumatic injury. After careful consideration, his death was attributed to the head injury. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Computed tomography findings in young children with minor head injury presenting to the emergency department greater than 24h post injury.

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Gelernter, Renana; Weiser, Giora; Kozer, Eran

2018-01-01

Large studies which developed decision rules for the use of Computed tomography (CT) in children with minor head trauma excluded children with late presentation (more than 24h). To assess the prevalence of significant traumatic brain injury (TBI) on CT in infants with head trauma presenting to the emergency department (ED) more than 24h from the injury. A retrospective chart review of infants less than 24 months old referred for head CT because of traumatic brain injury from January 2004 to December 2014 in Assaf-Harofeh medical center was conducted. We used the PECARN definitions of TBI on CT to define significant CT findings. 344 cases were analyzed, 68 with late presentation. There was no significant difference in the age between children with late and early presentation (mean 11.4 (SD 5.6) month vs 10. 5 (SD 7.0) month, P=0.27). There was no significant difference between the groups in the incidence of significant TBI (22% vs 19%, p=0.61). Any TBI on CT (e.g. fracture) was found in 43 (63%) patients with late presentation compared with 116 (42%) patients with early presentation (p=0.002, OR 2.37, 95% CI 1.37-4.1). A similar rate of CT-identified traumatic brain injury was detected in both groups.‏ There was no significant difference in the incidence of significant TBI on CT between the groups.‏ Young children presenting to the ED more than 24 hours after the injury may have abnormal findings on CT. Copyright © 2017 Elsevier Ltd. All rights reserved.

A DESCRIPTIVE STUDY OF PATTERN OF FATAL HEAD INJURY IN HELMETED AND NONHELMETED VICTIMS OF TWO WHEELER ACCIDENTS

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P. A. Sheeju

2016-07-01

Full Text Available BACKGROUND Motor vehicle crashes are a major cause of fatality all over the world. By 2020, motor vehicle injury is projected to become the third leading contributor to the global burden of disease in the world. Motor cyclists are about 25 times more likely than car occupants to die in Road Traffic Accidents. Data on the incidence and types of crashes is required to guide safety policy. Knowledge of how injuries are caused and of what type they are of valuable instrument for identifying interventions and monitoring the effectiveness of intervention. The present study was done to find out the factors that contribute for motor cycle crashes and to study the injury pattern seen in helmeted and non-helmeted victims. MATERIAL AND METHODS Victims of two wheeler accidents brought for autopsy in a Govt. Medical College were studied from October 2010 to August 2011. Two wheelers include motor cycles, scooters and mopeds. Bicycles were excluded from the study. Accidents include all types; against all types of vehicles running on the road, collision with any object, surface or any animal or fall from vehicle. The details of the accident were collected in a printed proforma from relative/witnesses and from police officials. The injuries were entered in the specific columns of proforma. Data was analysed with MS Excel. RESULTS Death due to head injury is more in non-helmeted (52.5% compared to helmeted drivers (43.8 % whereas injury to chest and abdomen and limbs are more in helmeted. Combination of injuries (Head+Chest+Abdomen predominated in helmeted drivers (18.8% compared to 5% in non-helmeted drivers. Spinal injuries were more in helmeted than in non-helmeted. CONCLUSION The pattern of head injury was analysed in detail in helmeted and non-helmeted drivers. This will help in detailing of pattern of head injury in both groups.

Chest Injuries Associated with Head Injury

African Journals Online (AJOL)

Traumatic brain injury (TBI) is a common cause of mortality and severe morbidity. Although there have been significant advances in management, associated severe injuries, in particular chest injuries, remain a major challenge. Extracranial injuries, especially chest injuries increase mortality in patients with TBI in both short.

Safety and efficacy of pharmacologic thromboprophylaxis following blunt head injury: a systematic review.

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Reeves, Fairleigh; Batty, Lachlan; Pitt, Veronica; Chau, Marisa; Pattuwage, Loyal; Gruen, Russell L

2013-10-01

Patients with blunt head injury are at high risk of venous thromboembolism. However, pharmacologic thromboprophylaxis (PTP) may cause progression of intracranial hemorrhage, and clinicians must often weigh up the risks and benefits. This review aimed to determine whether adding PTP to mechanical prophylaxis confers net benefit or harm and the optimal timing, dose, and agent for PTP in patients with blunt head injury. We searched MEDLINE, EMBASE, The Cochrane Library Central Register of Controlled Trials (CENTRAL), and www.clinicaltrials.gov on April 24, 2013, to identify controlled studies and ongoing trials that assessed the efficacy or safety of thromboprophylaxis interventions in the early management of head-injured patients. Studies were classified based on types of interventions and comparisons, and the quality of included studies was assessed using Cochrane risk-of-bias tool and the Newcastle-Ottawa Quality Assessment Scale. We intended to undertake a meta-analysis if studies were sufficiently similar. Sixteen studies met the inclusion criteria, including four randomized controlled trials. At least two randomized controlled trials were at high risk of bias owing to inadequate randomization and concealment of allocation, and observational studies were potentially confounded by substantial differences between comparison groups. Heterogeneity of included studies precluded meta-analysis. Results were mixed, with some studies supporting and others refuting addition of PTP to mechanical interventions. Little evidence was available about dose or choice of agent. The safety and efficacy of early PTP in patients without early progression of hemorrhage is unclear. There is currently insufficient evidence to guide thromboprophylaxis in patients with blunt head injury. Standardized definitions and outcome measurements would facilitate comparison of outcomes across future studies. Studies in mixed populations should report head-injured specific subgroup data. Future

Influence of impact speed on head and brain injury outcome in vulnerable road user impacts to the car hood.

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Fredriksson, Rikard; Zhang, Liying; Boström, Ola; Yang, King

2007-10-01

EuroNCAP and regulations in Europe and Japan evaluate the pedestrian protection performance of cars. The test methods are similar and they all have requirements for the passive protection of the hood area at a pedestrian to car impact speed of 40 km/h. In Europe, a proposal for a second phase of the regulation mandates a brake-assist system along with passive requirements. The system assists the driver in optimizing the braking performance during panic braking, resulting in activation only when the driver brakes sufficiently. In a European study this was estimated to occur in about 50% of pedestrian accidents. A future system for brake assistance will likely include automatic braking, in response to a pre-crash sensor, to avoid or mitigate injuries of vulnerable road users. An important question is whether these systems will provide sufficient protection, or if a parallel, passive pedestrian protection system will be necessary. This study investigated the influence of impact speed on head and brain injury risk, in impacts to the carhood. One car model was chosen and a rigid adjustable plate was mounted under the hood. Free-flying headform impacts were carried out at 20 and 30 km/h head impact velocities at different under-hood distances, 20 to 100 mm; and were compared to earlier tests at 40 km/h. The EEVC WG17 adult pedestrian headform was used for non-rotating tests and a Hybrid III adult 50th percentile head was used for rotational tests where linear and rotational acceleration was measured. Data from the rotational tests was used as input to a validated finite element model of the human head, the Wayne State University Head Injury Model (WSUHIM). The model was utilized to assess brain injury risk and potential injury mechanism in a pedestrian-hood impact. Although this study showed that it was not necessarily true that a lower HIC value reduced the risk for brain injury, it appeared, for the tested car model, under-hood distances of 60 mm in 20 km/h and 80 mm

Brain MR imaging in child abuse

International Nuclear Information System (INIS)

Sato, Y.; Ellerbroek, C.J.; Alexander, R.; Kao, S.C.S.; Yuh, W.T.C.; Smith, W.L.

1988-01-01

Intracranial injuries represent the most severe manifestation of child abuse. CT of the brain is the current standard for evaluation of these infants; however, MR imaging offers several potential advantages. MR imaging and CT were performed in ten infants who suffered intracranial trauma owing to child abuse. CT was slightly better at demonstrating subarachnoid hemorrhage and had definite advantages for defining fractures. MR imaging was superior in the demonstration of subacute extraaxial hemorrhage, deep brain injuries owing to shearing effects from shaking, and anoxic injuries. MR imaging has a definite complementary role in the evaluation of acute intracranial trauma in child abuse victims

Illicit drug exposure in patients evaluated for alleged child abuse and neglect.

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Oral, Resmiye; Bayman, Levent; Assad, Abraham; Wibbenmeyer, Lucy; Buhrow, Jakob; Austin, Andrea; Bayman, Emine O

2011-06-01

Substantiation of drug exposure in cases with alleged maltreatment is important to provide proper treatment and services to these children and their families. A study performed at University of Iowa Hospitals and Clinics showed that 30% of pediatric patients with burn injuries, which were due to child maltreatment, were also exposed to illicit drugs. The children presenting to the University of Iowa Hospitals and Clinics with alleged maltreatment have been tested for illicit substances since 2004. The objective of this study was to analyze the presence of illicit drug exposure in the pediatric subpopulation admitted to pediatric inpatient and outpatient units for an evaluation for abuse/neglect. The study design is a retrospective chart review. Using hospital databases, every pediatric chart with a child abuse/neglect allegation was retrieved. The association between risk factors and clinical presentation and illicit drug test result was assessed. Excel and SAS were used for statistical analysis. Institutional review board approval was obtained to conduct this study. Six hundred sixty-five charts met study inclusion criteria for child abuse/neglect allegation. Of those, 232 cases were tested for illicit drugs between 2004 and 2008 per the testing protocol. Thirty-four cases (14.7%) tested positive on a drug test. Positive test rates based on clinical presentation were 28.6% (18/63) in neglect cases, 16.1% (5/31) in cases with soft tissue injuries, 14.3% (4/28) in burn injuries, 10.0% (2/20) in cases with sexual abuse, 7.1% (2/28) in cases with fractures, and 4.8% (3/62) in abusive head trauma cases. There were long-term abuse findings in 129 children (55.6%). Logistic regression analysis revealed that positive drug testing was most significantly associated with clinical symptoms suggesting physical abuse or neglect versus sexual abuse (odds ratio [OR] = 6.70; 95% confidence interval [CI], 1.26-35.49; P = 0.026), no or public health insurance versus those with

EFFECT OF CEREBROPROTEIN HYDROLYSATE WITH CITICOLINE VERSUS CITICOLINE ALONE IN THE INITIAL MANAGEMENT OF HEAD INJURY AND ITS CLINICAL OUTCOME “A PROSPECTIVE RANDOMISED COMPARATIVE STUDY”

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Varadaraju D. N

2017-06-01

Full Text Available BACKGROUND Traumatic brain injury is an important cause of morbidity. It also represents the most frequent reason for neurological illness after headache. Compared with other types of brain insult, traumatic brain injury produces more diffuse injury causing more cognitive and neuropsychiatric disturbances. Various drugs have been used in an attempt to improve the clinical outcome, citicoline and Cerebrolysin hydrolysate have been used to improve the clinical outcome in traumatic brain injury. The evidence thus far has been conflicting with reports in favour and against the use of these drugs in the clinical benefit of the patients with traumatic brain injury. We attempt to determine the benefits and advantages of using these drugs in the management of traumatic brain injury. MATERIALS AND METHODS This is a prospective study comprising 60 patients of head injury admitted in the Department of Neurosurgery at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. The purpose of the current study is to evaluate the effect of cerebroprotein hydrolysate with citicoline compared to citicoline alone in the initial management of head injury and its clinical outcome and to assess the improvement. RESULTS Sixty patients with head injury were recruited and divided into group A and group B randomly. The mean age was 43.5 years with 43 male patients and 17 female patients. The GCS at admission of 27 patients was mild head injury and of 33 patients was moderate head injury. Group A had 13 patients with mild head injury and 17 patients with moderate head injury. Group B had 14 patients with mild and 16 patients with moderate head injury at the time of admission. The GCS was assessed at 1 week and 3 weeks. On assessing the patients at 1 week, group A had 14 patients with mild head injury and 16 patients with moderate head injury, whereas group B had 14 patients with mild and 16 patients with moderate head injury. The extended Glasgow Outcome Scale

Traumatic brain injury and alcohol/substance abuse: A Bayesian meta-analysis comparing the outcomes of people with and without a history of abuse.

Science.gov (United States)

Unsworth, David J; Mathias, Jane L

2017-08-01

Alcohol and substance (drugs and/or alcohol) abuse are major risk factors for traumatic brain injury (TBI); however, it remains unclear whether outcomes differ for those with and without a history of preinjury abuse. A meta-analysis was performed to examine this issue. The PubMed, Embase, and PsycINFO databases were searched for research that compared the neuroradiological, cognitive, or psychological outcomes of adults with and without a documented history of alcohol and/or substance abuse who sustained nonpenetrating TBIs. Data from 22 studies were analyzed using a random-effects model: Hedges's g effect sizes measured the mean difference in outcomes of individuals with/without a history of preinjury abuse, and Bayes factors assessed the probability that the outcomes differed. Patients with a history of alcohol and/or substance abuse had poorer neuroradiological outcomes, including reduced hippocampal (g = -0.82) and gray matter volumes (g = -0.46 to -0.82), and enlarged cerebral ventricles (g = -0.73 to -0.80). There were limited differences in cognitive outcomes: Executive functioning (g = -0.51) and memory (g = -0.39 to -0.43) were moderately affected, but attention and reasoning were not. The findings for fine motor ability, construction, perception, general cognition, and language were inconclusive. Postinjury substance and alcohol use (g = -0.97 to -1.07) and emotional functioning (g = -0.29 to -0.44) were worse in those with a history of alcohol and/or substance abuse (psychological outcomes). This study highlighted the type and extent of post-TBI differences between persons with and without a history of alcohol or substance abuse, many of which may hamper recovery. However, variation in the criteria for premorbid abuse, limited information regarding the history of abuse, and an absence of preinjury baseline data prevented an assessment of whether the differences predated the TBI, occurred as a result of ongoing alcohol/substance abuse, or

Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse

International Nuclear Information System (INIS)

Nguyen, Pamela H.; Burrowes, Delilah M.; Ali, Saad; Shaibani, Ali; Bowman, Robin M.

2007-01-01

Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse. We hope to raise physician awareness of child abuse when faced with these imaging findings. (orig.)

Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse

Energy Technology Data Exchange (ETDEWEB)

Nguyen, Pamela H.; Burrowes, Delilah M.; Ali, Saad; Shaibani, Ali [Feinberg School of Medicine of Northwestern University, Department of Radiology, Chicago, IL (United States); Bowman, Robin M. [Feinberg School of Medicine of Northwestern University, Department of Neurological Surgery, Chicago, IL (United States)

2007-06-15

Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse. We hope to raise physician awareness of child abuse when faced with these imaging findings. (orig.)

Children with burn injuries-assessment of trauma, neglect, violence and abuse

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Antoinette Runge

2011-07-01

Full Text Available Burns are an important cause of injury to young children, being the third most frequent cause of injury resulting in death behind motor vehicle accidents and drowning. Burn injuries account for the greatest length of stay of all hospital admissions for injuries and costs associated with care are substantial. The majority of burn injuries in children are scald injuries resulting from hot liquids, occurring most commonly in children aged 0-4 years. Other types of burns include electrical, chemical and intentional injury. Mechanisms of injury are often unique to children and involve exploratory behavior without the requisite comprehension of the dangers in their environment. Assessment of the burnt child includes airway, breathing and circulation stabilization, followed by assessment of the extent of the burn and head to toe examination. The standard rule of 9s for estimating total body surface area (TBSA of the burn is inaccurate for the pediatric population and modifications include utilizing the Lund and Browder chart, or the child’s palm to represent 1% TBSA. Further monitoring may include cardiac assessment, indwelling catheter insertion and evaluation of inhalation injury with or without intubation depending on the context of the injury. Risk factors and features of intentional injury should be known and sought and vital clues can be found in the history, physical examination and common patterns of presentation. Contemporary burn management is underscored by several decades of advancing medical and surgical care however, common to all injuries, it is in the area of prevention that the greatest potential to reduce the burden of these devastating occurrences exists.

Cutaneous sign of abuse: Kids are not just little people.

Science.gov (United States)

Jinna, Sphoorthi; Livingston, Nina; Moles, Rebecca

Skin injury is the most common form of child physical abuse. Although the pattern and visual appearance of skin injury and the treatment needed for the injury is similar in children and adults, characteristics of infant and childhood skin may complicate the diagnosis of injury. A good understanding of normal developmental presentation of accidental injury from infancy to adulthood, locations for injury that should trigger consideration of abuse, and cutaneous mimics of abuse across the lifespan are critical to the identification of suspected abuse. Adults and older children can provide a history directly to providers, though it should be noted that abused adults and children may not always disclose the true cause of their injuries. In infants and very young children, a history from the patient is lacking due to the verbal abilities of the child, and a parent or other caregiver may provide a false or misleading history that can complicate the diagnosis and treatment. The approach to taking the history, when abuse is suspected, is a critical part of the evaluation, and best practice will vary depending on whether your patient is a child or an adult. Copyright © 2017. Published by Elsevier Inc.

Head and face injuries and helmet use among injured motorcyclists with road accidents in Isfahan, Iran

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Azam Dadkhah

2015-10-01

Full Text Available BACKGROUND AND AIM: The study aimed to assess the frequency of head and face injuries in motorcyclists who had an accident and to find out the relationship between helmet use and frequency of these injuries. METHODS: A cross-sectional study with multi-stage sampling method provides data on the injured motorcyclists with road accidents. Data came from a registration form which has documented information of each injured person who had a road accident and hospitalized in the biggest hospital of Isfahan University of Medical Sciences, Iran (Al-Zahra. All the registration forms were surveyed for hospitalization period, treatment costs, severity of injury, and date of accident during 2010 (n = 1626. Later, among the list of injured motorcyclists during the last 3 months of the registration form, 125 cases were randomly selected and interviewed by phone regarding occurrence of the head and face injuries and whether wearing helmet during the accident. Confidence intervals (CI, Chi-square, and Phi and Cramer’s correlation coefficient were applied. The ethical approval was provided. RESULTS: Accident by motorcycle was 31.0% of all road accidents. The frequency of motorcycle accidents was higher in the autumn and among 21-25 year olds. The mean period of hospitalization was 4.3 days and the mean of hospital costs was about 9000000 Rials [about 8200 United States dollar (USD, in 2010]. Of motorcyclist, 35.0% reported they were helmeted when they had the accident. The frequency of head and face injuries was 51.0% among all the injured motorcyclists, 22.0% and 78.0% among the helmeted and non-helmeted motorcyclists, respectively (P = 0.009, r = -0.267. CONCLUSION: Motorcycle accidents comprise a large number of road accidents and cause substantial morbidity and financial impact for the community members. Head and face injuries are the most common trauma in motorcyclists, and the injury rate is higher among non-helmeted motorcyclists.

Corpus callosum lesions after closed head injury in children: MRI, clinical features and outcome

International Nuclear Information System (INIS)

Mendelsohn, D.B.; Bruce, D.

1992-01-01

Thirty-four children who sustained moderate to severe closed head injury underwent magnetic resonance imaging (MRI). Eight (24%) had MRI evidence of corpus callosum injury, most commonly within the posterior body and splenium. In contradistinction to reports in adults, there was no definite relationship between callosal injury and lower initial Glasgow Coma Scale scores, nor was there a significantly higher incidence of primary brain-stem lesions, diffuse axonal shear injury or intraventricular hemorrhage. In none of these 8 children did the initial admission computed tomography show evidence of callosal injury. Callosal injuries on MRI are not necessarily a poor prognostic finding, the majority of the 8 children showing good functional recovery. (orig.)

A literature review of findings in physical elder abuse.

Science.gov (United States)

Murphy, Kieran; Waa, Sheila; Jaffer, Hussein; Sauter, Agnes; Chan, Amanda

2013-02-01

To review the medical literature for reports on the types of physical injuries in elder abuse with the aim of eliciting patterns that will aid its detection. The databases of PubMed, CINAHL, EMBASE, and TRIP were searched from 1975 to March 2012 for articles that contained the following phrases: "physical elder abuse," "older adult abuse," "elder mistreatment," "geriatric abuse," "geriatric trauma," and "nonaccidental geriatric injury." Distribution and description of injuries in physical elder abuse from case-control studies, cross-sectional studies, case series, and case reports as seen at autopsy, in hospital emergency departments, or in medicolegal reports were tabulated and summarized. A review of 9 articles from a total of 574 articles screened yielded 839 injuries. The anatomic distribution in these was as follows: upper extremity, 43.98%; maxillofacial, dental, and neck, 22.88%; skull and brain, 12.28%; lower extremity, 10.61%; and torso, 10.25%. Two-thirds of injuries that occur in elder abuse are to the upper extremity and maxillofacial region. The social context in which the injuries takes place remains crucial to accurate identification of abuse. This includes a culture of violence in the family; a demented, debilitated, or depressed and socially isolated victim; and a perpetrator profile of mental illness, alcohol or drug abuse, or emotional and/or financial dependence on the victim. Copyright © 2013 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Development of a screening MRI for infants at risk for abusive head trauma

Energy Technology Data Exchange (ETDEWEB)

Flom, Lynda; Panigrahy, Ashok [Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Pittsburgh, PA (United States); Fromkin, Janet [University of Pittsburgh, Department of Pediatrics, Children' s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (United States); Tyler-Kabara, Elizabeth [University of Pittsburgh, Department of Neurosurgery, Children' s Hospital of Pittsburgh of UPMC, McGowan Institute for Regenerative Medicine, Pittsburgh, PA (United States); Berger, Rachel P. [University of Pittsburgh, Department of Pediatrics, Children' s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (United States); University of Pittsburgh, Safar Center for Resuscitation Research, Pittsburgh, PA (United States)

2016-04-15

Abusive head trauma (AHT) is an important cause of morbidity in infants. Identifying which well-appearing infants are at risk for AHT and need neuroimaging is challenging, and concern about radiation exposure limits the use of head CT. Availability of an MRI protocol that is highly sensitive for intracranial hemorrhage would allow for AHT screening of well-appearing infants without exposing them to radiation. To develop a screening MRI protocol to identify intracranial hemorrhage in well-appearing infants at risk for AHT. Infants enrolled in a parent study of well-appearing infants at increased risk for AHT were eligible for the current study if they underwent both head CT and conventional brain MRI. A derivation cohort of nine infants with AHT was used to identify sequences that provided the highest sensitivity for intracranial hemorrhage. A validation cohort of 78 infants including both controls with normal neuroimaging and cases with AHT was used to evaluate the accuracy of the selected sequences. Three pulse sequences - axial T2, axial gradient recalled echo (GRE) and coronal T1-W inversion recovery - were 100% sensitive for intracranial hemorrhage in the derivation cohort. The same sequences were 100% sensitive (25/25) and 83% specific (44/53) for intracranial hemorrhage in the validation cohort. A screening MRI protocol including axial T2, axial GRE and coronal T1-W inversion recovery sequences is highly sensitive for intracranial hemorrhage and may be useful as a screening tool to differentiate well-appearing infants at risk for AHT who should undergo head CT from those who can safely be discharged without head CT. Additional research is needed to evaluate the feasibility of this approach in clinical practice. (orig.)

Characteristics of associated craniofacial trauma in patients with head injuries: An experience with 100 cases

Directory of Open Access Journals (Sweden)

Rajendra Prasad

2009-01-01

Full Text Available Background: Facial fractures and concomitant cranial injuries carry the significant potential for mortality and neurological morbidity mainly in young adults. Aims and Objectives: To analyze the characteristics of head injuries and associated facial injuries, the management options and outcome following cranio-facial trauma. Methods: This retrospective review was performed at Justice K. S. Hegde Charitable Hospital, and associated A. B. Shetty Memorial Institute of Dental sciences, Deralakatte, Mangalore. Following Ethical Committee approval, hospital charts and radiographs of 100 consecutive patients of cranio-facial trauma managed at the Department of Oral and Maxillofacial Surgery and Neurosurgery between January 2004 and December 2004 were reviewed. Results: Majority of the patients were in the 2nd to 4th decade (79% with a male to female ratio of -8.09:1. Road traffic accidents were the common cause of craniofacial trauma in present study (54% followed by fall from height (30%. Loss of consciousness was the most common clinical symptom (62% followed by headache (33%. Zygoma was the most commonly fractured facial bone 48.2% (alone 21.2%, in combination 27.2%. Majority of patients had mild head injury and managed conservatively in present series. Causes of surgical intervention for intracranial lesions were compound depressed fracture, contusion and intracranial hematoma. Operative indications for facial fractures were displaced facial bone fractures. Major causes of mortality were associated systemic injuries. Conclusion: Adult males are the most common victims in craniofacial trauma, and road traffic accidents were responsible for the majority. Most of the patients sustained mild head injuries and were managed conservatively. Open reduction and internal fixation with miniplates was used for displaced facial bone fractures.

Head Injury and Intracranial Pressure Monitor Using Ultrasonic and Low-Frequency (ULFA) Detection

National Research Council Canada - National Science Library

Vo-Dinh, Tuan

2000-01-01

The main objective of this research project is the development of a non-invasive method and instrument for head injury detection and monitoring using a new approach based on ultrasonic and low-frequency acoustic (ULFA...

Is early detection of abused children possible?: a systematic review of the diagnostic accuracy of the identification of abused children

Science.gov (United States)

2013-01-01

Background Early detection of abused children could help decrease mortality and morbidity related to this major public health problem. Several authors have proposed tools to screen for child maltreatment. The aim of this systematic review was to examine the evidence on accuracy of tools proposed to identify abused children before their death and assess if any were adapted to screening. Methods We searched in PUBMED, PsycINFO, SCOPUS, FRANCIS and PASCAL for studies estimating diagnostic accuracy of tools identifying neglect, or physical, psychological or sexual abuse of children, published in English or French from 1961 to April 2012. We extracted selected information about study design, patient populations, assessment methods, and the accuracy parameters. Study quality was assessed using QUADAS criteria. Results A total of 2 280 articles were identified. Thirteen studies were selected, of which seven dealt with physical abuse, four with sexual abuse, one with emotional abuse, and one with any abuse and physical neglect. Study quality was low, even when not considering the lack of gold standard for detection of abused children. In 11 studies, instruments identified abused children only when they had clinical symptoms. Sensitivity of tests varied between 0.26 (95% confidence interval [0.17-0.36]) and 0.97 [0.84-1], and specificity between 0.51 [0.39-0.63] and 1 [0.95-1]. The sensitivity was greater than 90% only for three tests: the absence of scalp swelling to identify children victims of inflicted head injury; a decision tool to identify physically-abused children among those hospitalized in a Pediatric Intensive Care Unit; and a parental interview integrating twelve child symptoms to identify sexually-abused children. When the sensitivity was high, the specificity was always smaller than 90%. Conclusions In 2012, there is low-quality evidence on the accuracy of instruments for identifying abused children. Identified tools were not adapted to screening because of

Clinical Utility of '9{sup 9m}Tc-HMPAO Brain SPECT Findings in Chronic Head Injury

Energy Technology Data Exchange (ETDEWEB)

Chung, Jin ll; Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Lee, Jong Doo; Park, Chang Yoon; Kim, Young Soo [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1992-03-15

Minima deterioration of cerebral perfusion or microanatomical changes were undetectable on conventional Brain CT or MRI. So evaluation of focal functional changes of the brain parenchyme is essential in chronic head injury patients, who did not show focal anatomical changes on these radiological studies. However, the patients who had longstanding neurologic sequelae following head injury, there had been no available imaging modalities for evaluating these patients precisely. Therefore we tried to detect the focal functional changes on the brain parenchyme using {sup 99m}Tc-HMPAO Brain SPECT on the patients of chronic head injuries. Twenty three patients who had suffered from headache, memory dysfunction, personality change and insomnia lasting more than six months following head injury were included in our cases, which showed no anatomical abnormalities on Brain CT or MRI. At first they underwent psychological test whether the symptoms were organic or not. Also we were able to evaluate the cerebral perfusion changes with {sup 99m}Tc-HMPAO Brain SPECT in 22 patients among the 23, which five patients were focal and 17 patients were nonfocally diffuse perfusion changes. Thus we can predict the perfusion changes such as local vascular deterioration or functional defects using {sup 99m}Tc-HMPAO Brain SPECT in the patients who had suffered from post-traumatic sequelae, which changes were undetectable on Brain CT or MRI.

Pontomedullary lacerations and concomitant head and neck injuries: their underlying mechanism. A prospective autopsy study.

Science.gov (United States)

Živković, Vladimir; Nikolić, Slobodan; Strajina, Veljko; Babić, Dragan; Djonić, Danijela; Djurić, Marija

2012-09-01

It is a well-documented fact that pontomedullary lacerations (PML) occur as a result of severe craniocervical injury, but their underlying mechanism has yet to be fully clarified. The aim of this prospective study has been to give greater insight into the underlying mechanism of PML through determining the site of blunt head-impact, as well as the presence of concomitant head and neck injuries in cases of brainstem PML. A total of 56 cases with partial PML have been analysed for this study. The case group was composed of 40 men and 16 women, averaging in age 44.2 ± 19.2 years and consisting of 7 motorcyclists, 4 bicyclists, 18 car occupants, 16 pedestrians, and 10 victims of falls from a height, as well as 1 victim of a fall from standing height. The presented study has shown that there are several possible mechanisms of PML. Impact to the chin, with or without a skull base fracture, most often leads to this fatal injury, due to the impact force transmission either through the jawbone or vertebral column; most likely in combination with a fronto-posterior hyperextension of the head. Additionally, lateral head-impacts with subsequent hinge fractures and PML may also be a possible mechanism. The jawbone and other facial bones are able to act as shock absorbers, and their fracture may diminish the energy transfer towards the skull and protect the brain and brainstem from injury. The upper cervical spine can act as damper and energy absorber as well, and may prevent any occurrence of fracture to the base of the skull.

pattern of referrals of head injury to the university college hospital ...

African Journals Online (AJOL)

INTRODUCTION. In the developing countries, also known as low-middle income countries (LMIC), head injury (HI) constitutes a sizeable proportion of the clinical caseloads of most neurosurgical units.1-3 The optimal care of many cases of HI, especially the severe ones, is time bound. The time was put at 4 hours for ...

Identifying Potential Child Abuse through Oral Examination

Directory of Open Access Journals (Sweden)

Jillian N. Printz

2017-01-01

Full Text Available Limited reports of oropharyngeal trauma exist in the literature even though this type of injury is extremely common in pediatric populations. There are no widely agreed upon diagnostic and management tools for such injuries in abuse cases, emphasizing the importance of reporting rare cases of orofacial trauma. This case report of a soft palate laceration demonstrates an instance of initially unrecognized potential child abuse. We aim to clarify understanding of such injuries. Furthermore, the report highlights the need for recognition of oral signs of child abuse in order to promote early detection, reporting, and appropriate management.

Head and neck control varies with perturbation acceleration but not jerk: implications for whiplash injuries.

Science.gov (United States)

Siegmund, Gunter P; Blouin, Jean-Sébastien

2009-04-15

Recent studies have proposed that a high rate of acceleration onset, i.e. high jerk, during a low-speed vehicle collision increases the risk of whiplash injury by triggering inappropriate muscle responses and/or increasing peak head acceleration. Our goal was to test these proposed mechanisms at realistic jerk levels and then to determine how collision jerk affects the potential for whiplash injuries. Twenty-three seated volunteers (8 F, 15 M) were exposed to multiple experiments involving perturbations simulating the onset of a vehicle collision in eyes open and eyes closed conditions. In the first experiment, subjects experienced five forward and five rearward perturbations to look for the inappropriate muscle responses and 'floppy' head kinematics previously attributed to high jerk perturbations. In the second experiment, we independently varied the jerk ( approximately 125 to 3 000 m s(-3)) and acceleration ( approximately 0.65 to 2.6 g) of the perturbation to assess their effect on the electromyographic (EMG) responses of the sternocleidomastoid (SCM), scalene (SCAL) and cervical paraspinal (PARA) muscles and the kinematic responses of the head and neck. In the first experiment, we found neither inappropriate muscle responses nor floppy head kinematics when subjects had their eyes open, but observed two subjects with floppy head kinematics with eyes closed. In the second experiment, we found that about 70% of the variations in the SCM and SCAL responses and about 95% of the variations in head/neck kinematics were explained by changes in perturbation acceleration in both the eyes open and eyes closed conditions. Less than 2% of the variation in the muscle and kinematic responses was explained by changes in perturbation jerk and, where significant, response amplitudes diminished with increasing jerk. Based on these findings, collision jerk appears to have little or no role in the genesis of whiplash injuries in low-speed vehicle crashes.

The autopsy-correlation of computed tomography in acute severe head injuries

International Nuclear Information System (INIS)

Tomita, Shin; Kim, Hong; Mikabe, Toshio; Karasawa, Hideharu; Watanabe, Saburo

1981-01-01

We discuss the importance of Contrast-Enhanced CT (C.E.CT) in establishing the variety of the intracranial pathological process in acute severe head injuries. During a two-and-a-half-year period (June, 1977 - December, 1979) thirty-three patients with acute severe head injuries were autopsied, all of whom had been scanned on admission. Among them, 14 patients had undergone both plain CT and C.E.CT on admission. Brain slices were examined macroscopically in three categories; brain contusion, subarachnoid hemorrhage, and intracerebral hemorrhage. Each category was then compared retrospectively with the plain CT and C.E.CT findings. C.E.CT was found to correspond much better to the autopsy finding than plain CT in the following three points: (1) C.E.CT clearly enhances the contusion areas and reveals occult contusion areas. (2) C.E.CT enhances the areas corresponding to the subarachnoid space due to the breakdown of brain-surface blood vessels. (3) C.E.CT reveals the enlargement and formation of the intracerebral hematoma by the extravasation of the intravenous contrast material from injured arterial vessels. (author)

Field Marshal Erwin Rommel: the head injury that may have prolonged the Second World War.

Science.gov (United States)

Fuhrman, Heather A; Mullin, Jeffrey P; Sloffer, Chris A

2016-07-01

War-related head injury, indeed neurological injury in general, has been a part of the history of humankind for as long as there has been warfare. Such injuries can result in the removal of the individual from combat, thus eliminating any subsequent contribution that he or she might have made to the battle. However, at times, the injuries can have more wide-reaching effects. In the case of commanders or leaders, the impact of their injuries may include the loss of their influence, planning, and leadership, and thus have a disproportionate effect on the battle, or indeed the war. Field Marshal Erwin Rommel was a talented military strategist and leader who was respected by friends and foes alike. He held an honored reputation by the German people and the military leadership. His head injury on July 17, 1944, resulted in his being removed from the field of battle in northern France, but also meant that he was not able to lend his stature to the assassination attempt of Adolph Hitler on July 20. It is possible that, had he been able to lend his stature to the events, Hitler's hold on the nation's government might have been loosened, and the war might have been brought to an end a year earlier. The authors review Rommel's career, his injury, the subsequent medical treatment, and his subsequent death.

Clinical analysis of spinal cord injury with or without cervical ossification of the posterior longitudinal ligament, spondylosis, and canal stenosis in elderly head injury patients

International Nuclear Information System (INIS)

Nakae, Ryuta; Onda, Hidetaka; Yokobori, Shoji; Araki, Takashi; Fuse, Akira; Toda, Shigeki; Kushimoto, Shigeki; Yokota, Hiroyuki; Teramoto, Akira

2010-01-01

Patients with degenerative diseases of the cervical spine, such as ossification of the posterior longitudinal ligament, spondylosis, and canal stenosis, sometimes present with acute spinal cord injury caused by minor trauma. However, the relative risk of cervical cord injury with these diseases is unknown. The clinical and radiological features of 94 elderly patients with head injury, 57 men and 37 women aged from 65 to 98 years (mean 76.6 years), were retrospectively analyzed to assess the association of spinal cord injury with degenerative cervical diseases. Degenerative cervical diseases were present in 25 patients, and spinal cord injury was more common in the patients with degenerative diseases (11/25 patients) than in the patients without such diseases (3/69 patients; relative risk=10.2). The incidence of degenerative cervical diseases seems to be increasing in Japan because life expectancy has increased and the elderly are a rapidly growing part of the population. A fall while walking or cycling is a common mechanism of head injury and/or cervical cord injury in the elderly. To decrease the occurrence of cervical myelopathy, prevention by increasing social awareness and avoiding traffic accidents and falls is important. (author)

Management and outcome of low velocity penetrating head injury caused by impacted foreign bodies.

Science.gov (United States)

Moussa, Wael Mohamed Mohamed; Abbas, Mohamed

2016-05-01

Penetrating head injuries with impacted foreign bodies are rare, associated with a high incidence of morbidity and potentially life-threatening. In this study, we aimed at investigating the outcome of these cases as well as analyzing the factors affecting the prognosis. A retrospective study in which the records of 16 patients who had penetrating head injuries caused by low-velocity impacted foreign bodies were revised. All patients were males with a mean age of 28.9 years (range, 18 to 50 years). The follow-up period ranged from 4 to 13 months with a mean of 8.1 months. Causes of injury were construction accidents in 6 (37.5 %) patients, assault in 6 (37.5 %) and road traffic accidents in 4 (25 %). The impacted objects included a bar of iron, a piece of wood, a nail, a sickle and a piece of glass. Diagnostic computerized tomography (CT) of the brain was carried out on admission in all patients. Thirteen (81.3 %) patients were submitted to surgery, and all had the appropriate management in the form of antibiotics and dehydrating measures as required. The primary outcome measure was the Glasgow Outcome Scale (GOS) at the end of follow-up. At the end of follow-up, ten (62.5 %) patients had a GOS score of 5, two (12.5 %) patients had a score of 4, and four (25 %) patients had a score of 1. Low-velocity penetrating head injuries are most common in young adult males. With the appropriate management, a majority of even the most severe cases can have a favorable outcome.

Imaging Findings in Elder Abuse: A Role for Radiologists in Detection.

Science.gov (United States)

Wong, Natalie Z; Rosen, Tony; Sanchez, Allen M; Bloemen, Elizabeth M; Mennitt, Kevin W; Hentel, Keith; Nicola, Refky; Murphy, Kieran J; LoFaso, Veronica M; Flomenbaum, Neal E; Lachs, Mark S

2017-02-01

Emergency department assessment represents a critical but often missed opportunity to identify elder abuse, which is common and has serious consequences. Among emergency care providers, diagnostic radiologists are optimally positioned to raise suspicion for mistreatment when reviewing imaging of geriatric injury victims. However, little literature exists describing relevant injury patterns, and most radiologists currently receive neither formal nor informal training in elder abuse identification. We present 2 cases to begin characterisation of the radiographic findings in elder abuse. Findings from these cases demonstrate similarities to suspicious findings in child abuse including high-energy fractures that are inconsistent with reported mechanisms and the coexistence of acute and chronic injuries. Specific injuries uncommon to accidental injury are also noted, including a distal ulnar diaphyseal fracture. We hope to raise awareness of elder abuse among diagnostic radiologists to encourage future large-scale research, increased focus on chronic osseous findings, and the addition of elder abuse to differential diagnoses. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Ischemic Retinopathy and Neovascular Proliferation Secondary to Severe Head Injury

Directory of Open Access Journals (Sweden)

Muge Coban-Karatas

2014-01-01

Full Text Available We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma.

Biomechanics of Head, Neck, and Chest Injury Prevention for Soldiers

Science.gov (United States)

2011-03-01

30 am – 5:00 pm Overview of Blast Physics and Applications Doubletree Hotel Crystal City Arlington VA, Between the Pentagon and National Airport at...provided) 8:30 Introduction and Overview Dr. Stefan Duma, Virginia Tech Head Injury Biomechanics 8:45 “Instrumented Helmet Data Collection and Analysis...of NASA Suit Interface and Landing Conditions” Ms. Kerry Danelson, Wake Forest University 4:05 “Modeling Human Variation: Orbit Anthropometry and

Several unusual cases of child abuse.

Science.gov (United States)

Palmer, H; Weston, J T

1976-10-01

All childhood deaths which occurred in New Mexico during 1974 and 1975 were reviewed. Nine fatal instances of abuse were identified representing the entire spectrum of physical abuse: neglect, abuse in a single episode of injury, repetitive abuse, or sexual abuse. Several cases are summarized. These are unusual either in the distribution of pathologic findings or in the problems encountered in court presentation.

Age related outcome in acute subdural haematoma following traumatic head injury.

LENUS (Irish Health Repository)

Hanif, S

2009-09-01

Acute subdural haematoma (ASDH) is one of the conditions most strongly associated with severe brain injury. Reports prior to 1980 describe overall mortality rates for acute subdural haematomas (SDH\\'s) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. The elderly are predisposed to bleeding due to normal cerebral atrophy related to aging, stretching the bridging veins from the dura. Prognosis in ASDH is associated with age, time from injury to treatment, presence of pupillary abnormalities, Glasgow Coma Score (GCS) or motor score on admission, immediate coma or lucid interval, computerized tomography findings (haematoma volume, degree of midline shift, associated intradural lesion, compression of basal cisterns), post-operative intracranial pressure and type of surgery. Advancing age is known to be a determinant of outcome in head injury. We present the results of a retrospective study carried out in Beaumont Hospital, Dublin, Ireland\\'s national neurosurgical centre. The aim of our study was to examine the impact of age on outcome in patients with ASDH following severe head injury. Only cases with acute subdural haematoma requiring surgical evacuation were recruited. Mortality was significantly higher in older patients (50% above 70 years, 25.6% between 40 and 70 years and 26% below 40 years). Overall poor outcome (defined as Glasgow outcome scores 3-5) was also higher in older patients; 74.1% above 70 years, 48% between 40 and 70 years and 30% below 40 years. Poor outcome in traumatic acute subdural haematoma is higher in elderly patients even after surgical intervention.

Early insulin resistance in severe trauma without head injury as outcome predictor? A prospective, monocentric pilot study

Directory of Open Access Journals (Sweden)

Bonizzoli Manuela

2012-10-01

Full Text Available Abstract Background Hyperglycemia following major trauma is a well know phenomenon related to stress-induced systemic reaction. Reports on glucose level management in patients with head trauma have been published, but the development of insulin resistance in trauma patients without head injury has not been extensively studied. The aim of this study was therefore to investigate the prognostic role of acute insulin-resistance, assessed by the HOMA model, in patients with severe trauma without head injury. Methods All patients consecutively admitted to the Intensive Care Unit (ICU of a tertiary referral center (Careggi Teaching Hospital, Florence, IT for major trauma without head injury (Jan-Dec 2010 were enrolled. Patients with a previous diagnosis of diabetes mellitus requiring insulin therapy or metabolism alteration were excluded from the analysis. Patients were divided into “insulin resistant” and “non-insulin resistant” based on the Homeostasis Model Assessment index (HOMA IR. Results are expressed as medians. Results Out of 175 trauma patients admitted to the ICU during the study period, a total of 54 patients without head trauma were considered for the study, 37 of whom met the inclusion criteria. In total, 23 patients (62.2% resulted insulin resistant, whereas 14 patients (37.8% were non-insulin resistant. Groups were comparable in demographic, clinical/laboratory characteristics, and severity of injury. Insulin resistant patients had a significantly higher BMI (P=0.0416, C-reactive protein (P=0.0265, and leukocytes count (0.0301, compared to non-insulin resistant patients. Also ICU length of stay was longer in insulin resistant patients (P=0.0381. Conclusions Our data suggest that admission insulin resistance might be used as an early outcome predictor.

Abuse

Science.gov (United States)

... physical injury, leave marks, or cause pain. Sexual abuse is any type of sexual contact between an adult and anyone younger than 18; between a significantly older child and a younger child; or if one person ...

Childhood physical abuse in outpatients with psychosomatic symptoms

Directory of Open Access Journals (Sweden)

Kubo Chiharu

2008-03-01

Full Text Available Abstract Background In Japan and Asia, few studies have been done of physical and sexual abuse. This study was aimed to determine whether a history of childhood physical abuse is associated with anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. Methods We divided 564 consecutive new outpatients at the Department of Psychosomatic Medicine of Kyushu University Hospital into two groups: a physically abused group and a non-abused group. Psychological test scores and the prevalence of self-injurious behavior were compared between the two groups. Results A history of childhood physical abuse was reported by patients with depressive disorders(12.7%, anxiety disorders(16.7%, eating disorders (16.3%, pain disorders (10.8%, irritable bowel syndrome (12.5%, and functional dyspepsia(7.5%. In both the patients with depressive disorders and those with anxiety disorders, STAI-I (state anxiety and STAI-II (trait anxiety were higher in the abused group than in the non-abused group (p In the patients with depressive disorders, the abused group was younger than the non-abused group (p Conclusion A history of childhood physical abuse is associated with psychological distress such as anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. It is important for physicians to consider the history of abuse in the primary care of these patients.

Head Injury as a Risk Factor for Dementia and Alzheimer's Disease: A Systematic Review and Meta-Analysis of 32 Observational Studies.

Directory of Open Access Journals (Sweden)

Yanjun Li

Full Text Available Head injury is reported to be associated with increased risks of dementia and Alzheimer's disease (AD in many but not all the epidemiological studies. We conducted a systematic review and meta-analysis to estimate the relative effect of head injury on dementia and AD risks.Relevant cohort and case-control studies published between Jan 1, 1990, and Mar 31, 2015 were searched in PubMed, Web of Science, Scopus, and ScienceDirect. We used the random-effect model in this meta-analysis to take into account heterogeneity among studies.Data from 32 studies, representing 2,013,197 individuals, 13,866 dementia events and 8,166 AD events, were included in the analysis. Overall, the pooled relative risk (RR estimates showed that head injury significantly increased the risks of any dementia (RR = 1.63, 95% CI 1.34-1.99 and AD (RR = 1.51, 95% CI 1.26-1.80, with no evidence of publication bias. However, when considering the status of unconsciousness, head injury with loss of consciousness did not show significant association with dementia (RR = 0.92, 95% CI 0.67-1.27 and AD (RR = 1.49, 95% CI 0.91-2.43. Additionally, this positive association did not reach statistical significance in female participants.The findings from this meta-analysis indicate that head injury is associated with increased risks of dementia and AD.

Motorcycle helmet use and the risk of head, neck, and fatal injury: Revisiting the Hurt Study.

Science.gov (United States)

Rice, Thomas M; Troszak, Lara; Ouellet, James V; Erhardt, Taryn; Smith, Gordon S; Tsai, Bor-Wen

2016-06-01

Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investigation of 900 motorcycle collisions in the city of Los Angeles. The Goldstein results have been adopted by the anti-helmet community to justify resistance to compulsory motorcycle helmet use on the grounds that helmets may cause neck injuries due to their mass. In the current study, we replicated Goldstein's models to understand how he obtained his unexpected results, and we then applied modern statistical methods to estimate the association of motorcycle helmet use with head injury, fatal injury, and neck injury among collision-involved motorcyclists. We found Goldstein's analysis to be critically flawed due to improper data imputation, modeling of extremely sparse data, and misinterpretation of model coefficients. Our new analysis showed that motorcycle helmets were associated with markedly lower risk of head injury (RR 0.40, 95% CI 0.31-0.52) and fatal injury (RR 0.44, 95% CI 0.26-0.74) and with moderately lower but statistically significant risk of neck injury (RR 0.63, 95% CI 0.40-0.99), after controlling for multiple potential confounders. Copyright © 2016 Elsevier Ltd. All rights reserved.

Clinical factors associated with intracranial complications after pediatric traumatic head injury: an observational study of children submitted to a neurosurgical referral unit

DEFF Research Database (Denmark)

Åstrand, Ramona Alice; Undén, Johan; Hesselgard, Karin

2010-01-01

Clinically validated guidelines for the management of head injury in children do not exist, and the treatment is often based upon adult management routines. In order to examine the safety of this procedure, an analysis of clinical factors associated with complications after pediatric head injury ...

Clinical factors associated with intracranial complications after pediatric traumatic head injury: an observational study of children submitted to a neurosurgical referral unit

DEFF Research Database (Denmark)

Åstrand, Ramona Alice; Undén, Johan; Hesselgard, Karin

2010-01-01

Clinically validated guidelines for the management of head injury in children do not exist, and the treatment is often based upon adult management routines. In order to examine the safety of this procedure, an analysis of clinical factors associated with complications after pediatric head injury...

Vestibular and stabilometric findings in whiplash injury and minor head trauma.

Science.gov (United States)

Nacci, A; Ferrazzi, M; Berrettini, S; Panicucci, E; Matteucci, J; Bruschini, L; Ursino, F; Fattori, B

2011-12-01

Vertigo and postural instability following whiplash and/or minor head injuries is very frequent. According to some authors, post-whiplash vertigo cannot be caused by real injury to vestibular structures; other authors maintain that vestibular damage is possible even in the case of isolated whiplash, with vascular or post-traumatic involvement. Furthermore, many of the balance disorders reported after trauma can be justified by post-traumatic modification to the cervical proprioceptive input, with consequent damage to the vestibular spinal reflex. The aim of this study was to evaluate the vestibular condition and postural status in a group of patients (Group A, n = 90) affected with balance disorders following whiplash, and in a second group (Group B, n = 20) with balance disorders after minor head injury associated with whiplash. Both groups were submitted to videonystagmography (VNG) and stabilometric investigation (open eyes - O E, closed eyes - CE, closed eyes with head retroflexed - CER) within 15 days of their injuries and repeated within 10 days after conclusion of cervical physiotherapy treatment. The VNG tests revealed vestibulopathy in 19% of cases in Group A (11% peripheral, 5% central, 3% in an undefined site) and in 60% of subjects in Group B (50% peripheral, 10% central). At the follow-up examination, all cases of non-compensated labyrinth deficit showed signs of compensation, while there were two cases (2%) in Group A and one case (5%) in Group B of PPV. As far as the altered posturographic recordings are concerned, while there was no specific pattern in the two groups, they were clearly pathologic, especially during CER. Both in OE and in CE there was an increase in the surface values and in those pertaining to shifting of the gravity centre on the sagittal plane, which was even more evident during CER. In Group A, the pre-post-physiotherapy comparison of CER results showed that there was a statistically significant improvement in the majority of the

Microstructural brain injury in post-concussion syndrome after minor head injury

International Nuclear Information System (INIS)

Smits, Marion; Wielopolski, Piotr A.; Vernooij, Meike W.; Lugt, Aad van der; Houston, Gavin C.; Dippel, Diederik W.J.; Koudstaal, Peter J.; Hunink, M.G.M.

2011-01-01

After minor head injury (MHI), post-concussive symptoms commonly occur. The purpose of this study was to correlate the severity of post-concussive symptoms in MHI patients with MRI measures of microstructural brain injury, namely mean diffusivity (MD) and fractional anisotropy (FA), as well as the presence of microhaemorrhages. Twenty MHI patients and 12 healthy controls were scanned at 3 T using diffusion tensor imaging (DTI) and high-resolution gradient recalled echo (HRGRE) T2*-weighted sequences. One patient was excluded from the analysis because of bilateral subdural haematomas. DTI data were preprocessed using Tract Based Spatial Statistics. The resulting MD and FA images were correlated with the severity of post-concussive symptoms evaluated with the Rivermead Postconcussion Symptoms Questionnaire. The number and location of microhaemorrhages were assessed on the HRGRE T2*-weighted images. Comparing patients with controls, there were no differences in MD. FA was decreased in the right temporal subcortical white matter. MD was increased in association with the severity of post-concussive symptoms in the inferior fronto-occipital fasciculus (IFO), the inferior longitudinal fasciculus and the superior longitudinal fasciculus. FA was reduced in association with the severity of post-concussive symptoms in the uncinate fasciculus, the IFO, the internal capsule and the corpus callosum, as well as in the parietal and frontal subcortical white matter. Microhaemorrhages were observed in one patient only. The severity of post-concussive symptoms after MHI was significantly correlated with a reduction of white matter integrity, providing evidence of microstructural brain injury as a neuropathological substrate of the post-concussion syndrome. (orig.)

Head injury in asylum seekers and refugees referred with psychological trauma.

Science.gov (United States)

Doherty, S M; Craig, R; Gardani, M; McMillan, T M

2016-01-01

Individuals who seek asylum are frequently fleeing violent persecution and may experience head injury (HI). However, little is known about the prevalence of HI in asylum seekers and refugees (ASR) despite the potential for HI to significantly affect cognitive and emotional functioning and to compromise asylum outcomes. This preliminary study investigates the prevalence of HI in ASR referred to a complex psychological trauma service. Participants were 115 adult ASR referred to a community psychological trauma service with moderate to severe mental health problems associated with psychological trauma. They were screened for a history of HI using a questionnaire developed for the study. Interpreters were used when required. The overall prevalence of HI was 51%. At least 38% of those with HI had a moderate-severe HI that could cause persisting disability. In 53% of those with HI, the cause was torture, human trafficking or domestic violence. Repeat HI can have cumulative effects on function; it was common, and was reported in 68% of those with HI. An injury to the head was not known to mental health clinicians prior to screening in 64% of cases. The emotional and cognitive consequences of HI in ASR may increase the vulnerability of this disadvantaged group, and can be associated with neurobehavioural problems affecting daily life and may compromise asylum outcomes. Routine screening for HI in ASR is needed, as are links to neuropsychology and brain injury services for advice, assessment and intervention.

Adult functioning of mothers with traumatic brain injury at high risk of child abuse: a pilot study.

Science.gov (United States)

van Vliet-Ruissen, Cora; McKinlay, Audrey; Taylor, Annabel

2014-01-01

There is little information regarding the impact that traumatic brain injury (TBI) has on the functioning of mothers at risk of child abuse. This study evaluated adult functioning (e.g. child abuse, substance use, criminal convictions, and mental health problems) of mothers, at high risk for child abuse, who also had a history of TBI compared with those without TBI. It was hypothesised that mothers with a history of TBI would engage in higher rates of dysfunctional behaviour compared to those with no history of TBI. Participants were 206 women engaged in a child abuse prevention programme for mothers who are highly socially disadvantaged, and at high risk for child abuse. Using historical data collected as part of the referral, and self report intake process, this study compared child abuse, mental health problems (depression, anxiety, substance use) and rates of criminal offending for mothers with a history of TBI versus those with no history of TBI. Mothers with TBI were no more likely than those without TBI to have engaged in child abuse. However, mothers with a history of TBI were significantly more likely to have one or more mental health problems, engage in substance use and have a history of criminal offending. Parents with TBI who have been identified as high risk for engaging in child abuse have increased risk for mental health problems and criminal offending. These issues need to be considered when designing parenting programmes in order for intervention strategies to be effective.

Head Injury and Intracranial Pressure Monitor Using Ultrasonic and Low-Frequency Acoustic (ULFA) Detection

National Research Council Canada - National Science Library

Vo-Dinh, Tuan

2001-01-01

The main objective of this research project is the development of a non-invasive method and instrument for head injury detection and monitoring using a new approach based on ultrasonic and low-frequency acoustic (ULFA...

CT findings and outcome in head injury

Energy Technology Data Exchange (ETDEWEB)

Yamaura, Akira

1984-12-01

CT findings and outcome were discussed in head injuries. Parenchymal findings were classified into 5 categories; ''normal'', ''hemispheric (isodense) swelling'', ''hemorrhagic lesions'', ''diffuse cerebral swelling'', and ''low density''. The worst outcome (73% mortality) was seen in ''hemispheric swelling''. This abnormality was quite often associated with acute subdural hematoma. Multiple ''hemorrhagic lesions'' were associated with much poorer outcome than single lesions. The older groups had more acute subdural hematomas and more ''hemorrhagic lesions''. And ''hemorrhagic lesions'' were more often multiple and larger in the older group. (author).

Optimal timing of tracheostomy after trauma without associated head injury.

Science.gov (United States)

Keenan, Jeffrey E; Gulack, Brian C; Nussbaum, Daniel P; Green, Cindy L; Vaslef, Steven N; Shapiro, Mark L; Scarborough, John E

2015-10-01

Controversy exists over optimal timing of tracheostomy in patients with respiratory failure after blunt trauma. The study aimed to determine whether the timing of tracheostomy affects mortality in this population. The 2008-2011 National Trauma Data Bank was queried to identify blunt trauma patients without concomitant head injury who required tracheostomy for respiratory failure between hospital days 4 and 21. Restricted cubic spline analysis was performed to evaluate the relationship between tracheostomy timing and the odds of inhospital mortality. The cohort was stratified based on this analysis. Unadjusted characteristics and outcomes were compared. Multivariable logistic regression was used to evaluate the effect of tracheostomy timing on mortality after adjustment for age, gender, race, payor status, level of trauma center, injury severity score, presentation Glasgow coma scale, and thoracic and abdominal abbreviated injury score. There were 9662 patients included in the study. Restricted cubic spline analysis demonstrated a nonlinear relationship between timing of tracheostomy and mortality, with higher odds of mortality occurring with tracheostomy placement within 10 d of admission compared with later time points. The cohort was therefore stratified into early and delayed tracheostomy groups relative to this time point. The resulting groups contained 5402 (55.9%) and 4260 (44.1%) patients, respectively. After multivariable adjustment, the delayed tracheostomy group continued to have significantly reduced odds of mortality (Adjusted odds ratio, 0.82, 95% confidence interval, 0.71-0.95, C-statistic, 0.700). Among non-head injured blunt trauma patients with prolonged respiratory failure, tracheostomy placement within 10 d of admission may result in increased mortality compared with later time points. Copyright © 2015 Elsevier Inc. All rights reserved.

Clinical value of computerized tomography scanning in severe head injury

International Nuclear Information System (INIS)

Kobayashi, Shiro; Yano, Masami; Otsuka, Toshibumi; Nakazawa, Shozo

1982-01-01

Serial computerized tomography (SCT) was performed on 138 patients suffering from severe head injuries (8 or less on the Glasgow Coma Scale). Standard practice called for scans to be done upon admission (within hours of the injury), and after 1, 3, 7 days and 1 month. Subsequent CT's depended on the patient's condition. Clinical results at the time of discharge were graded according to the Glasgow Outcome Scale. Patients who died, were in a persistent vegetative state, or were severely disabled were considered to have a ''bad outcome''. On the other hand, patients who were somewhat disabled or made good recoveries were considered to have a ''good outcome''. During the serial CT scan, there were new findings (not visualized on the initial CT but appearing on subsequent ones) in 91 of the 138 patients. These new findings were classified as follows; 1) decreased density collection in the subdural space (DDC), 2) ventricular dilation (VD), 3) intracerebral hematoma (ICH), 4) intraventricular hemorrhage (IVH), 5) extracerebral hematoma (ECH), 6) edema (E), 7) infarction (I). We defined ICH, IVH, ECH, E and I as new lesions. Of the 60 patients with new lesions 12 had good outcomes and 48 had poor outcomes. There were 78 patients who did not have any new lesions, 60 with good outcomes and 18 with poor outcomes. A significant correlation was found between good outcomes and the absence of new lesions, and between bad outcomes and the development of new lesions (p 2 = 44.038). We conclude that SCT can help predict the outcome with severe head injury patients and may be very important in their examination and care. (J.P.N.)

Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong.

Science.gov (United States)

Taw, Benedict B T; Lam, Alan C S; Ho, Faith L Y; Hung, K N; Lui, W M; Leung, Gilberto K K

2012-07-01

Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We aim to review the outcome of severely head-injured patients after discharge from acute care at a designated trauma center in Hong Kong. This is a retrospective study of prospectively collected data of patients admitted with severe head injuries between 2004 and 2008. Patients' functional status post-discharge was assessed using the Extended Glasgow Outcome Score (GOSE). Of a total of 1565 trauma patients, 116 had severe head injuries and 41 of them survived acute hospital care. Upon the last follow-up, 23 (56.1%) of the acute-care survivors had improvements in their GOSE, six (11.8%) experienced deteriorations, and 12 (23.5%) did not exhibit any change. The greatest improvement was observed in patients with GOSE of 5 and 6 upon discharge, but two of the 16 patients with GOSE 2 or 3 also had a good recovery. On logistic regression analysis, old age and prolonged acute hospital stay were found to be independent predictors of poor functional outcome after a mean follow-up duration of 42 months. Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery. Copyright © 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.

HYPERTRANSLATION OF THE HEAD BACKWARDS - PART OF THE MECHANISM OF CERVICAL WHIPLASH INJURY

NARCIS (Netherlands)

PENNING, L

Based upon a review of the literature, a theory is developed that in whiplash injury the primary mechanism of the trauma is not hyperretroflexion but hypertranslation of the head backwards. Thus a hyperanteflexion (not hyperretroflexion) of the upper cervical spine, probably especially of the

Establishment of a head injury by club model in rabbits and experimental conditions

International Nuclear Information System (INIS)

Cao Yunxing; Xi Huanjiu; Zhang Jing; Li Hongwei; Yin Zhiyong; Zhao Hui

2013-01-01

Objective: To establish an animal model to replicate the injury by club in forensic medicine. Methods: Twenty-four New Zealand white rabbits were divided into control group (n=4), minor injury group (n=10), and severe injury group (n=10). Based on the BIM-Ⅱ Horizontal Bio-impact Machine, a self-designed iron bar was used to produce head injury by club. Six hours after injury, all the rabbits were subjected to a CT examination and dissected to observe the injury morphology and undergo routine pathological examination. Four control, six minor and severe rabbits were given moisture content examination. Results: Varying degrees of positive signs of the nervous system were observed in all the injured rabbits within 6 hours. The mortality rate was 1/10 in the minor injury group and 6/10 in the severe injury group. The morphological changes consisted of different levels of scalp hematoma, skull fracture, epidural hematoma, subdural hematoma, subarachnoid hemorrhage and brain injury. The difference in moisture content between the three groups was of statistical significance. Conclusion: Under the rigidly-controlled experimental condition, this animal model produces good reproducibility and stable results. Meanwhile, it can simulate the morphology of injury by club and be used to study the mechanism of injury by club in forensic medicine. (authors)

Primary identification of an abused child in dental office: A case report

Directory of Open Access Journals (Sweden)

Santos J

2007-01-01

Full Text Available Although the injuries of child abuse are many and varied, several types of injuries are common to abuse. Many of these injuries are within the scope of dentistry or easily observed by the dental professional in the course of routine dental treatment. The authors present a case of child abuse with multiple bruises. The child had been spanked in the previous night and the morning of the attendance by his mother. This case emphasized that all practitioners should be vigilant when patients present with abnormal injuries which may be the result of abuse and further investigation should be instigated.

Computed tomography in acute head injury

Energy Technology Data Exchange (ETDEWEB)

Takeda, T; Inagawa, T; Yamada, T; Sota, K [Shimane Prefectural Central Hospital (Japan)

1981-01-01

After the introduction of CT (GE-CT/T) in January, 1980, we experienced 81 cases of head injury. We diagnosed these cases into normal in 50 cases, epidural hematoma in 8 cases, subdural hematoma in 5 cases, intracerebral hematoma in 3 cases, cerebral contusion or cerebral swelling in 14 cases and combined hematoma in 1 case, based on CT findings. We diagnose normal, when no abnormal finding is present intracranially. Epidural hematoma is visualized as a bicrescent-shaped high density area on CT scan. Subdural hematoma appears as a crescent-shaped high density area on CT finding. Intracranial hematoma is visualized as a high density area in the brain tissue on CT scan. Cerebral contusion presents as salt and pepper appearance on CT scan representing area of high and low density complex. Brain swelling is visualized as disappearance or compression of ventricles, cisterns, sulci and gyri.

Pediatric gunshot penetrating head injury: a case report with 2-year follow-up

OpenAIRE

Steven Tandean; Marsal Risfandi; Iskandar Japardi

2018-01-01

Gunshot is a rare subset of penetrating head injury, and generally the victim dies before arriving at the hospital. This paper reported a case of an intracranial gunshot injury in a 12 year-old boy that was shot by his friend, whose primary intention was to play around, using a revolver. A missile projectile penetrated from mid frontal and came out from right occipital. Vital signs were stable with GCS 8 from physical examination. A rational management strategy should permit a good outcome. T...

Detection and monitoring of cerebral hemodynamic disturbances with transcranial color-coded duplex sonography in patients after head injury

International Nuclear Information System (INIS)

Kochanowicz, J.; Mariak, Z.; Lyson, T.; Lewko, J.; Krejza, J.; Bilello, M.

2006-01-01

Reduced cerebral blood flow after severe head injury results in an increased risk of ischemic brain damage. Blood flow should therefore be monitored with a simple, reliable method. Transcranial color-coded Doppler sonography (TCCS) is an accepted tool for the diagnosis of cerebral vasospasm; however, its usefulness in evaluating patients with head injury has not been proven. Cerebral blood-flow velocity in the middle, anterior, and posterior cerebral arteries was measured with a 2.5 MHz probe (Aplio SSA 770A, Toshiba, Japan) in 36 subjects with moderate or severe head injury. Serial measurements of resistance index (RI), peak-systolic, end-diastolic, and mean velocity in the middle cerebral arteries were performed 2-24 h after head trauma and in the subsequent days during hospitalization. Immediately after head trauma, increased RI values, and unusually decreased blood-flow velocity (mainly in MCA) were observed. Microcirculation disturbances were suspected because the end-diastolic velocity had substantially diminished. Changes in blood-flow parameters correlated with the clinical state, and in most cases, a poor prognosis. In some patients, blood-flow velocity increased above the normal reference limit and this implied poor prognosis. Transcranial color-coded Doppler sonography is a reliable, repeatable, and accessible tool that provides information about cerebral blood-flow disturbances and may hold diagnostic and prognostic importance. (orig.)

Plasma aldosterone and CT findings in head injury, especially in acute subdural hematoma

Energy Technology Data Exchange (ETDEWEB)

Takahashi, Hideaki

1988-12-01

As we have already reported, an increase in the plasma aldosterone level was regulary found after severe head injury. And the values of plasma aldosterone in unconscious patients with increased intracranial pressure were significantly higher than those in patients without unconsciousness. Thus, plasma aldosterone in acute phase of head injury seems to be a sensitive index of increased intracranial pressure. In the present study, we measured plasma aldosterone levels in three groups ; subdural hematoma with mid-line shift (group A), cerebral contusion without mid-line shift (group B) and cerebral conceussion (group C). In group A, the peak value of aldosterone was markedly high (283.9 +- 142.5). In B, the peak value (143.7 +- 27.8) was higher than in C (116.3 +- 35.0). And, correlation between the serum aldosterone levels and CT findings, especially the mid-line shift was found. As a conclusion, the serum levels of aldosterone seems to be associated with intracranial pressure.

Characteristics of fatal abusive head trauma among children in the USA: 2003-2007: an application of the CDC operational case definition to national vital statistics data.

Science.gov (United States)

Parks, Sharyn E; Kegler, Scott R; Annest, Joseph L; Mercy, James A

2012-06-01

In March of 2008, an expert panel was convened at the Centers for Disease Control and Prevention to develop code-based case definitions for abusive head trauma (AHT) in children under 5 years of age based on the International Classification of Diseases, 10th Revision (ICD-10) nature and cause of injury codes. This study presents the operational case definition and applies it to US death data. National Center for Health Statistics National Vital Statistics System data on multiple cause-of-death from 2003 to 2007 were examined. Inspection of records with at least one ICD-10 injury/disease code and at least one ICD-10 cause code from the AHT case definition resulted in the identification of 780 fatal AHT cases, with 699 classified as definite/presumptive AHT and 81 classified as probable AHT. The fatal AHT rate was highest among children age definition can help to identify population subgroups at higher risk for AHT defined by year and month of death, age, sex and race/ethnicity. This type of definition may be useful for various epidemiological applications including research and surveillance. These activities can in turn inform further development of prevention activities, including educating parents about the dangers of shaking and strategies for managing infant crying.

Head Injuries

Science.gov (United States)

... a severe blow to the head can still knock the brain into the side of the skull ... following certain precautions and taking a break from sports and other activities that make symptoms worse. Playing ...

Feasibility of a skills-based substance abuse prevention program following traumatic brain injury.

Science.gov (United States)

Vungkhanching, Martha; Heinemann, Allen W; Langley, Mervin J; Ridgely, Mary; Kramer, Karen M

2007-01-01

To demonstrate the feasibility of a skills-based substance abuse prevention counseling program in a community setting for adults who sustained traumatic brain injury. Convenience sample of 117 participants (mean age=35 years) with preinjury history of alcohol or other drug use. Intervention group participants (n=36) from 3 vocational rehabilitation programs; a no-intervention comparison group (n=81) from an outpatient rehabilitation service. 12 individual counseling sessions featuring skills-based intervention. Changes in self-reported alcohol and other drug use, coping skillfulness, affect, and employment status from baseline to 9 months postintervention. Significant differences were noted at baseline for the intervention and comparison groups on ethnicity, time postinjury, marital status, and employment (Pcoping skillfulness (Pskills-based intervention provides a promising approach to promoting abstinence from all substances and increasing readiness for employment for adults with traumatic brain injuries in outpatient settings.

Prediction of time trends in recovery of cognitive function after mild head injury

DEFF Research Database (Denmark)

Müller, Kay; Ingebrigtsen, Tor; Wilsgaard, Tom

2009-01-01

. There was significant improvement of performance after 6 months. APOE-epsilon4 genotype was the only independent factor significantly predicting less improvement. CONCLUSION: The presence of the APOE-epsilon4 allele predicts less recovery of cognitive function after mild head injury....... change. RESULTS: A Glasgow Coma Scale score of less than 15, traumatic brain injury demonstrated with computed tomography, magnetic resonance imaging, and serum S-100B greater than 0.14 microg/L predicted impaired cognitive performance both at baseline and after 6 months; APOE genotype did not...

Susceptibility of the MMPI-2-RF neurological complaints and cognitive complaints scales to over-reporting in simulated head injury.

Science.gov (United States)

Bolinger, Elizabeth; Reese, Caitlin; Suhr, Julie; Larrabee, Glenn J

2014-02-01

We examined the effect of simulated head injury on scores on the Neurological Complaints (NUC) and Cognitive Complaints (COG) scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Young adults with a history of mild head injury were randomly assigned to simulate head injury or give their best effort on a battery of neuropsychological tests, including the MMPI-2-RF. Simulators who also showed poor effort on performance validity tests (PVTs) were compared with controls who showed valid performance on PVTs. Results showed that both scales, but especially NUC, are elevated in individuals simulating head injury, with medium to large effect sizes. Although both scales were highly correlated with all MMPI-2-RF over-reporting validity scales, the relationship of Response Bias Scale to both NUC and COG was much stronger in the simulators than controls. Even accounting for over-reporting on the MMPI-2-RF, NUC was related to general somatic complaints regardless of group membership, whereas COG was related to both psychological distress and somatic complaints in the control group only. Neither scale was related to actual neuropsychological performance, regardless of group membership. Overall, results provide further evidence that self-reported cognitive symptoms can be due to many causes, not necessarily cognitive impairment, and can be exaggerated in a non-credible manner.

Diagnostic imaging of child abuse

International Nuclear Information System (INIS)

Kleinman, P.K.

1987-01-01

This book provides a description for all the known radiological alterations occurring in child abuse. This allows for precise interpretation of findings by radiologists. It also helps eliminate the confusion among both clinicians and non-medical personnel involved in the diagnosis, management, and legal issues related to child abuse. CONTENTS: Introduction; Skeletal trauma: general considerations; Extremity trauma; Bony thoracic trauma; Spinal trauma; Dating fractures; Visceral trauma; Head trauma; Miscellaneous forms of abuse and neglect; The postmortem examination; Differential diagnosis of child abuse; Legal considerations; Psychosocial considerations; Technical considerations and dosimetry

Validation of the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS Head computed tomographic (CT decision instrument for selective imaging of blunt head injury patients: An observational study.

Directory of Open Access Journals (Sweden)

William R Mower

2017-07-01

Full Text Available Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI] can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99.0%. A secondary goal of the study was to complete an independent validation and comparison of the Canadian and NEXUS Head CT rules among the subgroup of patients meeting the inclusion and exclusion criteria.We conducted a prospective observational study of the NEXUS Head CT DI in 4 hospital emergency departments between April 2006 and December 2015. Implementation of the rule requires that patients satisfy 8 criteria to achieve "low-risk" classification. Patients are excluded from "low-risk" classification and assigned "high-risk" status if they fail to meet 1 or more criteria. We examined the instrument's performance in assigning "high-risk" status to patients requiring neurosurgical intervention among a cohort of 11,770 blunt head injury patients. The NEXUS Head CT DI assigned high-risk status to 420 of 420 patients requiring neurosurgical intervention (sensitivity, 100.0% [95% confidence interval [CI]: 99.1%-100.0%]. The instrument assigned low-risk status to 2,823 of 11,350 patients who did not require neurosurgical intervention (specificity, 24.9% [95% CI: 24.1%-25.7%]. None of the 2,823 low-risk patients required neurosurgical intervention (negative predictive value [NPV], 100.0% [95% CI: 99.9%-100.0%]. The DI assigned high-risk status to 759 of 767 patients with significant intracranial injuries (sensitivity, 99.0% [95% CI: 98.0%-99.6%]. The instrument assigned low-risk status to 2,815 of 11

Imaging and Diagnosis of Physical Child Abuse.

Science.gov (United States)

Johnson, Marlene M

2017-09-01

Child abuse involves grave and disturbing acts of violence that can have lasting physical and emotional consequences for children and their families. The diagnosis of child abuse is emotionally difficult for those involved, and an error in judgment either way can have a detrimental effect on the health and safety of the child. Physicians rely on the skills of the imaging team to produce high-quality images that assist in differentiating inflicted injuries from accidental trauma. This article explores the significance of imaging in child abuse by discussing the types of injuries that occur and the imaging studies that aid in diagnosing physical child abuse. ©2017 American Society of Radiologic Technologists.

Penetrating head injury with bilateral eye avulsion due to Himalayan bear bite.

Science.gov (United States)

Roka, Yam B; Roka, Narayani; Shrestha, Manzil; Puri, Puspa R; Adhikari, Hari B

2012-12-01

The Himalayan black bear (Ursus thibetanus or Selenarctos thibetanus), although an omnivore, is more carnivorous than its American counterpart. It is also more aggressive towards humans and is a threatened species because of the deforestation in the Himalayas. Furthermore, poverty, encroachment of the forest, extensive deforestation, lack of education and living near the forest are factors that increase the probability of such animal injuries. We report the case of a 35-year-old woman who suffered a severe penetrating head injury with scalp and bilateral eye avulsion, which was managed successfully. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Successful renal transplantation from a brain-dead deceased donor with head injury, disseminated intravascular coagulation and deranged renal functions

Directory of Open Access Journals (Sweden)

P P Ghuge

2013-01-01

Full Text Available Deceased donors (DDs with the brain death due to head injury are the major source of organs for transplantation. The incidence of post-head injury disseminated intravascular coagulation (DIC ranges from 24% to 50%. Many centers do not accept organs from donors with DIC due to increased risk of primary graft non-function and/or high chances of morbidity/mortality. We performed two successful renal transplants from a DD with head injury with DIC and deranged renal function. One of the recipients developed transient thrombocytopenia, but there was no evidence of DIC or delayed graft functions in either of the recipients. Over a follow-up of 1 month, both are doing well with stable graft function and hematological profile. Thus, a carefully selected DD with severe DIC even with deranged renal function is not a contraindication for organ donation if other risk factors for primary non-function are excluded. This approach will also help in overcoming organ shortage.

Isolated traumatic head injury in children: Analysis of 276 observations

Directory of Open Access Journals (Sweden)

Bahloul Mabrouk

2011-01-01

Full Text Available Background : To determine predictive factors of mortality among children after isolated traumatic brain injury. Materials and Methods : In this retrospective study, we included all consecutive children with isolated traumatic brain injury admitted to the 22-bed intensive care unit (ICU of Habib Bourguiba University Hospital (Sfax, Tunisia. Basic demographic, clinical, biochemical, and radiological data were recorded on admission and during ICU stay. Results : There were 276 patients with 196 boys (71% and 80 girls, with a mean age of 6.7 ± 3.8 years. The main cause of trauma was road traffic accident (58.3%. Mean Glasgow Coma Scale score was 8 ± 2, Mean Injury Severity Score (ISS was 23.3 ± 5.9, Mean Pediatric Trauma Score (PTS was 4.8 ± 2.3, and Mean Pediatric Risk of Mortality (PRISM was 10.8 ± 8. A total of 259 children required mechanical ventilation. Forty-eight children (17.4% died. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 24 (OR: 10.98, neurovegetative disorder (OR: 7.1, meningeal hemorrhage (OR: 2.74, and lesion type VI according to Marshall tomographic grading (OR: 13.26. Conclusion : In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored.

Psychogenic Nonepileptic Seizures after Head Injury: A Case Report

Directory of Open Access Journals (Sweden)

Laura Scévola

2009-01-01

another medical illness. The gold standard for PNES diagnosis is video electroencephalogram (Video-EEG. PNESs are defined by modern psychiatry as conversion and dissociative disorders but these disorders may coexist with many others psychiatric disorders, including depression, posttraumatic stress disorder, and personality disorders. It is well known that epileptic seizures are a frequent and well-studied complication of traumatic head injury (THI. However, THI may also generate psychic symptoms including PNES. In this paper we describe a patient who developed PNES after THI in a bus accident and received a diagnosis of refractory epilepsy for 24 years until she underwent Video-EEG.

When Bigger Is Better: Household Size, Abuse Injuries, Neglect, and Family Response in Novosibirsk, Russia.

Science.gov (United States)

Emery, Clifton R; Eremina, Tatiana; Arenas, Carmen; Kim, Jaeyop; Chan, Ko Ling

2017-02-01

Although previous research has demonstrated larger households to be at higher risk of physical abuse and neglect of children, we argue that unilateral conceptualization of larger households as a risk factor is inappropriate. Application of resource dilution theory must capture the possibility that larger families may have more members with both the agency and will to intervene against child maltreatment. We hypothesized a negative interaction between household size and protective informal social control by family members in predicting abuse injuries and neglect. A three-stage probability proportional to size cluster sample representative of Novosibirsk, Russia, was collected from 306 cohabiting couples. One parent in each household was interviewed. A focal child was selected using most recent birthday. When responses limited to families with minor children (below age 18) were selected, 172 families remained in the data. Physical abuse and neglect were measured using the Conflict Tactics Scales (CTS). Protective informal social control by family members was measured using the Informal Social Control of Child Maltreatment (ISC_CM) Scale. Models were tested using random effects regression and logistic regression. Nearly 7% of focal children were injured in the last year, 10% were neglected. Consistent with previous research, protective informal social control was associated with lower odds of injury and fewer instances of neglect. The significant negative interaction between household size and protective control is consistent with the idea that larger households may be protective when adult family members intervene against maltreatment to protect children. Replication and further investigation of protective ISC_CM in Western populations is much needed. Future research should not conceptualize or measure household size as a unilateral risk factor.

Mortality resulting from head injury in professional boxing.

Science.gov (United States)

Baird, Lissa C; Newman, C Benjamin; Volk, Hunter; Svinth, Joseph R; Conklin, Jordan; Levy, Michael L

2010-11-01

The majority of boxing-related fatalities result from traumatic brain injury. Biomechanical forces in boxing result in rotational acceleration with resultant subdural hematoma and diffuse axonal injury. Given the inherent risk and the ongoing criticism boxing has received, we evaluated mortalities associated with professional boxing. We used the Velaquez Fatality Collection of boxing injuries and supplementary sources to analyze mortality from 1950 to 2007. Variables evaluated included age at time of death, association with knockout or other outcome of match, rounds fought, weight class, location of fight, and location of pretermial event. There were 339 mortalities between 1950 and 2007 (mean age, 24 ± 3.8 years); 64% were associated with knockout and 15% with technical knockout. A higher percentage occurred in the lower weight classes. The preterminal event occurred in the ring (61%), in the locker room (17%), and outside the arena (22%), We evaluated for significant changes after 1983 when championship bouts were reduced from 15 to 12 rounds. There was a significant decline in mortality after 1983. We found no significant variables to support that this decline is related to a reduction in rounds. Rather, we hypothesize the decline to be the result of a reduction in exposure to repetitive head trauma (shorter careers and fewer fights), along with increased medical oversight and stricter safety regulations. Increased efforts should be made to improve medical supervisions of boxers. Mandatory central nervous system imaging after a knockout could lead to a significant reduction in associated mortality.

Does trauma team activation associate with the time to CT scan for those suspected of serious head injuries?

Science.gov (United States)

Rados, Alma; Tiruta, Corina; Xiao, Zhengwen; Kortbeek, John B; Tourigny, Paul; Ball, Chad G; Kirkpatrick, Andrew W

2013-11-18

Traumatic brain injury (TBI) constitutes the leading cause of posttraumatic mortality. Practically, the major interventions required to treat TBI predicate expedited transfer to CT after excluding other immediately life-threatening conditions. At our center, trauma responses variably consist of either full trauma activation (FTA) including an attending trauma surgeon or a non-trauma team response (NTTR). We sought to explore whether FTAs expedited the time to CT head (TTCTH). Retrospective review of augmented demographics of 88 serious head injuries identified from a Regional Trauma Registry within one year at a level I trauma center. The inclusion criteria consisted of a diagnosis of head injury recorded as intubated or GCS FTA (median 50 vs. 26 minutes, p FTA). Without FTA, most delays (69%) were for emergency intubation. TTCTH after securing the airway was longer for NTTR group (median 38 vs. 26 minutes, p =0.0013). Even with no requirements for ED interventions, TTCTH for FTA was less than half versus NTTR (25 vs. 61 minutes, p =0.0013). Multivariate regression analysis indicated age and FTA with an attending surgeon as significant predictors of TTCTH, although the majority of variability in TTCTH was not explained by these two variables (R² = 0.33). Full trauma activations involving attending trauma surgeons were quicker at transferring serious head injury patients to CT. Patients with FTA were younger and more seriously injured. Discerning the reasons for delays to CT should be used to refine protocols aimed at minimizing unnecessary delays and enhancing workforce efficiency and clinical outcome.

Head injury in asylum seekers and refugees referred with psychological trauma

OpenAIRE

Doherty, S.M.; Craig, R.; Gardani, M.; McMillan, T.M.

2016-01-01

Objective. Individuals who seek asylum are frequently fleeing violent persecution and may experience head injury (HI). However, little is known about the prevalence of HI in asylum seekers and refugees (ASR) despite the potential for HI to significantly affect cognitive and emotional functioning and to compromise asylum outcomes. This preliminary study investigates the prevalence of HI in ASR referred to a complex psychological trauma service. Method. Participants were 115 adult ASR referred ...

Drug abuse

International Nuclear Information System (INIS)

Simon, T.R.; Seastrunk, J.W.; Malone, G.; Knesevich, M.A.; Hickey, D.C.

1991-01-01

This paper reports that this study used SPECT to examine patients who have abused drugs to determine whether SPECT could identify abnormalities and whether these findings have clinical importance. Fifteen patients with a history of substance abuse (eight with cocaine, six with amphetamine, and one with organic solvent) underwent SPECT performed with a triple-headed camera and Tc-99m HMPAO both early for blood flow and later for functional information. These images were then processed into a 3D videotaped display used in group therapy. All 15 patients had multiple areas of decreased tracer uptake peppered throughout the cortex but mainly affecting the parietal lobes, expect for the organic solvent abuser who had a large parietal defect. The videotapes were subjectively described by a therapist as an exceptional tool that countered patient denial of physical damage from substance abuse. Statistical studies of recidivism between groups is under way

Significance of focal relaxation times in head injury

Energy Technology Data Exchange (ETDEWEB)

Inao, Suguru; Furuse, Masahiro; Saso, Katsuyoshi; Yoshida, Kazuo; Motegi, Yoshimasa; Kaneoke, Yoshiki; Izawa, Akira

1987-11-01

Serial examinations by nuclear magnetic resonance-computed tomography were carried out in 35 head-injured patients aged 7 to 77 years. The injuries were classified as cerebral contusion (nine cases), acute epidural hematoma (eight cases), acute cerebral swelling (two cases), and chronic subdural hematoma (16 cases). The results of 92 measurements were divided into two groups: acute stage (within 3 days of injury) and chronic stage (2 weeks or longer after injury). The spin-lattice relaxation times (T/sub 1/) of brain tissue adjacent to chronic subdural hematoma were evaluated pre- and postoperatively. A Fonar QED 80-alpha system was used for magnetic resonance imaging and measurement of focal T/sub 1/. The T/sub 1/ values at the region of interest were measured 3 to 5 times by the field focusing technique (468 gauss in the focused spot), and the mean value was used for evaluation. The standard T/sub 1/ values obtained from healthy subjects were 290 +- 41 msec in the cerebral cortex and 230 +- 34 msec in the white matter. Prolongation of T/sub 1/ in perifocal brain gradually shortened over time and normalized in the chronic stage. The degree of contusional edema may have been reflected in alterations in T/sub 1/. In contrast, parenchymal injury resulted in a progressive T/sub 1/ elevation, which far exceeded 500 msec in the chronic stage. Such time courses of T/sub 1/ may indicate irreversible tissue damage. There were no noticeable changes in tissue T/sub 1/ over time in patients with acute diffuse cerebral swelling or those who underwent evacuation of acute epidural or chronic subdural hematomas. The underlying pathophysiology in such situations seems to be not brain edema but cerebral hyperemia. In the presence of ischemia, the T/sub 1/ value was prolonged in the early stage, reflecting progression of is chemic edema. (Abstract Truncated)

Paid family leave's effect on hospital admissions for pediatric abusive head trauma.

Science.gov (United States)

Klevens, Joanne; Luo, Feijun; Xu, Likang; Peterson, Cora; Latzman, Natasha E

2016-12-01

Paediatric abusive head trauma (AHT) is a leading cause of fatal child maltreatment among young children. Current prevention efforts have not been consistently effective. Policies such as paid parental leave could potentially prevent AHT, given its impacts on risk factors for child maltreatment. To explore associations between California's 2004 paid family leave (PFL) policy and hospital admissions for AHT, we used difference-in-difference analyses of 1995-2011 US state-level data before and after the policy in California and seven comparison states. Compared with seven states with no PFL policies, California's 2004 PFL showed a significant decrease in AHT admissions in both <1 and <2-year-olds. Analyses using additional data years and comparators could yield different results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The research into head injury criteria dependence on car speed

Directory of Open Access Journals (Sweden)

L. Pelenytė-Vyšniauskienė

2007-12-01

Full Text Available There are many ways of car collisions which depend on car motion modes before and after crashes, speed, kinds of baskets, their heights, weights and rigidity. The machinery of the occupant’s movement at the moment of the crash is even more diffi cult. In order to find out precisely the chance of body injury, it is important to measure not only parameters that were mentioned above but also occupant’s height, weight, age, position of sitting, condition of body, whether there was any protection system used. The largest number of car crashes happen at the moment of frontal crash. This article’s aim is to analyse the types of frontal crashes and their repartition, to diagnose what part in occupant’s safety the protection system’s use takes, and also to analyse head injury coefficient dependence on car speed and show critical injuries and fatality limits in cases when driver is driving with no seat-belts in and while the car is without airbag. The research is done at the moment of ideal frontal crash by simulating distance from the occupant body to the wheel in diff erent types of baskets.

Nonaccidental trauma: clinical aspects and epidemiology of child abuse

Energy Technology Data Exchange (ETDEWEB)

Hobbs, Christopher J. [St James' s University Hospital, Department of Community Paediatrics, Leeds (United Kingdom); Bilo, Robert A.C. [Netherlands Forensic Institute, Department of Forensic Pathology, The Hague (Netherlands)

2009-05-15

Radiologists play a key role in the recognition of child abuse. In the last century, radiologists pioneered the identification of nonaccidental injuries, including fractures and brain injury, and together with colleagues in paediatrics advocated the protection of children from abuse. Prevalence studies in many countries have revealed the widespread and hidden nature of child maltreatment. New and complex forms of abuse, e.g. fabricated or induced illness, have been recognized. Physical abuse affects 7-9% of children in the UK, although fewer suffer the severe or life-threatening injuries seen by radiologists. A high index of suspicion of nonaccidental trauma is required where known patterns of injury or inconsistencies of presentation and history are detected. In many cases the diagnosis is readily made, although some cases remain contentious or controversial and consume much clinical time and energy. Differences of view between doctors are tested in the courts. Adverse publicity has made this work unpopular in the UK. Knowledge of the differential diagnosis of unexplained or apparent injury is essential for accurate diagnosis, vital where errors in either direction can be disastrous. New UK radiological guidelines will assist radiologists in achieving best evidence-based practice. (orig.)

Nonaccidental trauma: clinical aspects and epidemiology of child abuse

International Nuclear Information System (INIS)

Hobbs, Christopher J.; Bilo, Robert A.C.

2009-01-01

Radiologists play a key role in the recognition of child abuse. In the last century, radiologists pioneered the identification of nonaccidental injuries, including fractures and brain injury, and together with colleagues in paediatrics advocated the protection of children from abuse. Prevalence studies in many countries have revealed the widespread and hidden nature of child maltreatment. New and complex forms of abuse, e.g. fabricated or induced illness, have been recognized. Physical abuse affects 7-9% of children in the UK, although fewer suffer the severe or life-threatening injuries seen by radiologists. A high index of suspicion of nonaccidental trauma is required where known patterns of injury or inconsistencies of presentation and history are detected. In many cases the diagnosis is readily made, although some cases remain contentious or controversial and consume much clinical time and energy. Differences of view between doctors are tested in the courts. Adverse publicity has made this work unpopular in the UK. Knowledge of the differential diagnosis of unexplained or apparent injury is essential for accurate diagnosis, vital where errors in either direction can be disastrous. New UK radiological guidelines will assist radiologists in achieving best evidence-based practice. (orig.)

Group psychotherapy for persons with traumatic brain injury: management of frustration and substance abuse.

Science.gov (United States)

Delmonico, R L; Hanley-Peterson, P; Englander, J

1998-12-01

Residual emotional and behavioral difficulties in individuals who have sustained a traumatic brain injury (TBI) have been well documented in the literature. The issues are complex, interdependent, and often include substance abuse, depression, anxiety, chronic suicidal or homicidal ideation, poor impulse control, and significant degrees of frustration and anger. Often, preexisting psychological conditions and poor coping strategies are exacerbated by the trauma. Emotional and behavioral difficulties can interfere with the neurorehabilitation process at all levels. In acute rehabilitation, these issues have traditionally been addressed on an individual basis. However, in postacute settings, an interpersonal group format can be effectively implemented. The majority of individuals with TBI have minimal funding for long-term cognitive and behavioral remediation; often the only avenue available is support groups. This article will describe group psychotherapy models used with individuals with acute or postacute TBI within a comprehensive rehabilitation center. Interdisciplinary treatment of frustration and substance abuse and a continuum of care will be emphasized. Education, social support, skills development, interpersonal process, and cognitive-behavioral approaches will also be discussed. The psychotherapy groups focus on treatment of substance abuse and frustration management through education, social support, and development of interpersonal skills. Practical considerations of running such groups are presented.

Local macroeconomic trends and hospital admissions for child abuse, 2000-2009.

Science.gov (United States)

Wood, Joanne N; Medina, Sheyla P; Feudtner, Chris; Luan, Xianqun; Localio, Russell; Fieldston, Evan S; Rubin, David M

2012-08-01

To examine the relationship between local macroeconomic indicators and physical abuse admission rates to pediatric hospitals over time. Retrospective study of children admitted to 38 hospitals in the Pediatric Hospital Information System database. Hospital data were linked to unemployment, mortgage delinquency, and foreclosure data for the associated metropolitan statistical areas. Primary outcomes were admission rates for (1) physical abuse in children <6 years old, (2) non-birth, non-motor vehicle crash-related traumatic brain injury (TBI) in infants <1 year old (which carry high risk for abuse), and (3) all-cause injuries. Poisson fixed-effects regression estimated trends in admission rates and associations between those rates and trends in unemployment, mortgage delinquency, and foreclosure. Between 2000 and 2009, rates of physical abuse and high-risk TBI admissions increased by 0.79% and 3.1% per year, respectively (P ≤ .02), whereas all-cause injury rates declined by 0.80% per year (P < .001). Abuse and high-risk TBI admission rates were associated with the current mortgage delinquency rate and with the change in delinquency and foreclosure rates from the previous year (P ≤ .03). Neither abuse nor high-risk TBI rates were associated with the current unemployment rate. The all-cause injury rate was negatively associated with unemployment, delinquency, and foreclosure rates (P ≤ .007). Multicenter hospital data show an increase in pediatric admissions for physical abuse and high-risk TBI during a time of declining all-cause injury rate. Abuse and high-risk TBI admission rates increased in relationship to local mortgage delinquency and foreclosure trends.

Effect of head restraint backset on head-neck kinematics in whiplash.

Science.gov (United States)

Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A

2006-03-01

Although head restraints were introduced in the 1960s as a countermeasure for whiplash, their limited effectiveness has been attributed to incorrect positioning. The effect of backset on cervical segmental angulations, which were previously correlated with spinal injury, has not been delineated. Therefore, the practical restraint position to minimize injury remains unclear. A parametric study of increasing head restraint backset between 0 and 140mm was conducted using a comprehensively validated computational model. Head retraction values increased with increasing backset, reaching a maximum value of 53.5mm for backsets greater than 60mm. Segmental angulation magnitudes, greatest at levels C5-C6 and C6-C7, reached maximum values during the retraction phase and increased with increasing backset. Results were compared to a previously published head restraint rating system, wherein lower cervical extension magnitudes from this study exceeded mean physiologic limits for restraint positions rated good, acceptable, marginal, and poor. As head restraint contact was the limiting factor in head retraction and segmental angulations, the present study indicates that minimizing whiplash injury may be accomplished by limiting head restraint backset to less than 60mm either passively or actively after impact.

Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma

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Zuccoli, Giulio [Children' s Hospital of Pittsburgh of UPMC, Department of Pediatric Radiology, Pittsburgh, PA (United States); Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Pittsburgh, PA (United States); Panigrahy, Ashok; Haldipur, Anshul; Willaman, Dennis [Children' s Hospital of Pittsburgh of UPMC, Department of Pediatric Radiology, Pittsburgh, PA (United States); Squires, Janet; Wolford, Jennifer [Children' s Hospital of Pittsburgh of UPMC, Division of Child Advocacy, Pittsburgh, PA (United States); Sylvester, Christin; Mitchell, Ellen; Lope, Lee Ann [Children' s Hospital of Pittsburgh of UPMC, Eye Center, Pittsburgh, PA (United States); Nischal, Ken K. [Children' s Hospital of Pittsburgh of UPMC, Eye Center, Pittsburgh, PA (United States); Children' s Hospital of Pittsburgh of UPMC, Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, Eye Center, Pittsburgh, PA (United States); Berger, Rachel P. [Children' s Hospital of Pittsburgh of UPMC, Division of Child Advocacy, Pittsburgh, PA (United States); University of Pittsburgh Medical Center, Safar Center for Resuscitation Research, Pittsburgh, PA (United States)

2013-07-15

This study aims to evaluate the capability of magnetic resonance imaging (MRI) susceptibility weighted images (SWI) in depicting retinal hemorrhages (RH) in abusive head trauma (AHT) compared to the gold standard dilated fundus exam (DFE). This is a retrospective, single institution, observational study on 28 patients with suspected AHT, who had a DFE and also underwent brain MRI-SWI as part of routine diagnostic protocol. Main outcome measures involved evaluation of patients to determine whether the RH could be identified on standard and high-resolution SWI sequences. Of the 21 subjects with RH on DFE, 13 (62 %) were identified by using a standard SWI sequence performed as part of brain MRI protocols. Of the 15 patients who also underwent an orbits SWI protocol, 12 (80 %) were positive for RH. None of the seven patients without RH on of DFE had RH on either standard or high-resolution SWI. Compared with DFE, the MRI standard protocol showed a sensitivity of 75 % which increased to 83 % for the orbits SWI protocol. Our study suggests the usefulness of a tailored high-resolution orbits protocol to detect RH in AHT. (orig.)

Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma

International Nuclear Information System (INIS)

Zuccoli, Giulio; Panigrahy, Ashok; Haldipur, Anshul; Willaman, Dennis; Squires, Janet; Wolford, Jennifer; Sylvester, Christin; Mitchell, Ellen; Lope, Lee Ann; Nischal, Ken K.; Berger, Rachel P.

2013-01-01

This study aims to evaluate the capability of magnetic resonance imaging (MRI) susceptibility weighted images (SWI) in depicting retinal hemorrhages (RH) in abusive head trauma (AHT) compared to the gold standard dilated fundus exam (DFE). This is a retrospective, single institution, observational study on 28 patients with suspected AHT, who had a DFE and also underwent brain MRI-SWI as part of routine diagnostic protocol. Main outcome measures involved evaluation of patients to determine whether the RH could be identified on standard and high-resolution SWI sequences. Of the 21 subjects with RH on DFE, 13 (62 %) were identified by using a standard SWI sequence performed as part of brain MRI protocols. Of the 15 patients who also underwent an orbits SWI protocol, 12 (80 %) were positive for RH. None of the seven patients without RH on of DFE had RH on either standard or high-resolution SWI. Compared with DFE, the MRI standard protocol showed a sensitivity of 75 % which increased to 83 % for the orbits SWI protocol. Our study suggests the usefulness of a tailored high-resolution orbits protocol to detect RH in AHT. (orig.)

[The German guideline "legal evaluation after closed head injury"].

Science.gov (United States)

Wallesch, C W; Fries, W; Marx, P; du Mesnil de Rochemont, R; Roschmann, R; Schmidt, R; Schwerdtfeger, K; Tegenthoff, M; Widder, B

2013-09-01

In 2005, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Legal Evaluation) together with other Societies published a guideline for the legal evaluation of patients with closed head injuries. Meanwhile, not only scientific progress in imaging techniques but also in other fields such as neuropsychology has necessitated a revision, which is presented here. In the mean time, the handling of guidelines has been systematised in Germany so that a registration with the Cooperation of German Medical Learned Societies is applied for and publication in the German Guideline Registry is expected. © Georg Thieme Verlag KG Stuttgart · New York.

Deficit in figure-ground segmentation following closed head injury.

Science.gov (United States)

Baylis, G C; Baylis, L L

1997-08-01

Patient CB showed a severe impairment in figure-ground segmentation following a closed head injury. Unlike normal subjects, CB was unable to parse smaller and brighter parts of stimuli as figure. Moreover, she did not show the normal effect that symmetrical regions are seen as figure, although she was able to make overt judgments of symmetry. Since she was able to attend normally to isolated objects, CB demonstrates a dissociation between figure ground segmentation and subsequent processes of attention. Despite her severe impairment in figure-ground segmentation, CB showed normal 'parallel' single feature visual search. This suggests that figure-ground segmentation is dissociable from 'preattentive' processes such as visual search.

Medieval times' influencing figure Rhaze's approach to head injuries in Liber Almansoris.

Science.gov (United States)

Acıduman, Ahmet; Aşkit, Cağatay; Belen, Deniz

2014-12-01

To present the chapter "On wound of the head and fracture of the head bone" of Kitāb al-Manṣūrī / Liber Almansoris, which was one of the early works of Rhazes. Both Arabic (Süleymaniye Manuscript Library, Ayasofya collection, Nr. 3751 and Millet Library, Feyzullah Efendi collection, Nr. 1327) and the Latin (Basileae, 1544) texts of Kitāb al-Manṣūrī / Liber Almansoris were studied, and the 26th section of the 7th chapter, entitled "Fī al-shajja kasr al-'aẓm al-ra's / De plagis capitis et fractura cranei / On wound of the head and fracture of the head bone" was translated into English and English text created. Rhazes underlined removing bone fragments in depressed and separated fractures of cranium along with protection of the dura, but he did not describe any surgical technique in this chapter. Galen's contemplation for the care of the dura with its integrity and as well his proposal to remove the bone fragments for preventing the dura from injury were the golden standards at the time that Rhazes also followed in the treatment of skull fractures. Copyright © 2014 Elsevier Inc. All rights reserved.

The prevalence of lifetime abuse among older adults in seven European countries.

Science.gov (United States)

Eslami, Bahareh; Viitasara, Eija; Macassa, Gloria; Melchiorre, Maria Gabriella; Lindert, Jutta; Stankunas, Mindaugas; Torres-Gonzalez, Francisco; Barros, Henrique; Ioannidi-Kapolou, Elisabeth; Soares, Joaquim J F

2016-11-01

To investigate the lifetime prevalence rate of abuse among older persons and to scrutinize the associated factors (e.g. demographics). This cross-sectional population-based study had 4467 participants, aged 60-84, from seven European cities. Abuse (psychological, physical, sexual, financial and injuries) was measured based on The Revised Conflict Tactics Scale, and the UK survey of abuse/neglect of older people. Over 34 % of participants reported experiencing lifetime psychological, 11.5 % physical, 18.5 % financial and 5 % sexual abuse and 4.3 % reported injuries. Lifetime psychological abuse was associated with country, younger age, education and alcohol consumption; physical abuse with country, age, not living in partnership; injuries with country, female sex, age, education, not living in partnership; financial abuse with country, age, not living in partnership, education, benefiting social/partner income, drinking alcohol; and sexual abuse with country, female sex and financial strain. High lifetime prevalence rates confirm that elder abuse is a considerable public health problem warranting further longitudinal studies. Country of residence is an independent factor associated with all types of elder abuse which highlights the importance of national interventions alongside international collaborations.

Divided attention years after severe closed head injury : The effect of dependencies between the subtasks

NARCIS (Netherlands)

Brouwer, W; Verzendaal, M; van der Naalt, J; Smit, J; van Zomeren, E

2001-01-01

Lesions of white matter which connects distant brain areas are characteristic for closed head injury (CHI). It was predicted that this impairs divided attention only if dependent subtasks are used which require communication between corresponding brain processes. Fourteen chronic severe CHI patients

Development and psychometric properties of the Carer - Head Injury Neurobehavioral Assessment Scale (C-HINAS) and the Carer - Head Injury Participation Scale (C-HIPS): patient and family determined outcome scales.

Science.gov (United States)

Deb, Shoumitro; Bryant, Eleanor; Morris, Paul G; Prior, Lindsay; Lewis, Glyn; Haque, Sayeed

2007-06-01

Develop and assess the psychometric properties of the Carer - Head Injury Participation Scale (C-HIPS) and its biggest factor the Carer - Head Injury Neurobehavioral Assessment Scale (C-HINAS). Furthermore, the aim was to examine the inter-informant reliability by comparing the self reports of individuals with traumatic brain injury (TBI) with the carer reports on the C-HIPS and the C-HINAS. Thirty-two TBI individuals and 27 carers took part in in-depth qualitative interviews exploring the consequences of the TBI. Interview transcripts were analysed and key themes and concepts were used to construct a 49-item and 58-item patient (Patient - Head Injury Participation Scale [P-HIPS]) and carer outcome measure (C-HIPS) respectively, of which 49 were parallel items and nine additional items were used to assess carer burden. Postal versions of the P-HIPS, C-HIPS, Mayo Portland Adaptability Inventory-3 (MPAI-3), and the Glasgow Outcome Scale-Extended (GOSE) were completed by a cohort of 113 TBI individuals and 80 carers. Data from a sub-group of 66 patient/carer pairs were used to compare inter-informant reliability between the P-HIPS and the C-HIPS, and the P-HINAS and the C-HINAS respectively. All individual 49 items of the C-HIPS and their total score showed good test-retest reliability (0.95) and internal consistency (0.95). Comparisons with the MPAI-3 and GOSE found a good correlation with the MPAI-3 (0.7) and a moderate negative correlation with the GOSE (-0.6). Factor analysis of these items extracted a 4-factor structure which represented the domains 'Emotion/Behavior' (C-HINAS), 'Independence/Community Living', 'Cognition', and 'Physical'. The C-HINAS showed good internal consistency (0.92), test-retest reliability (0.93), and concurrent validity with one MPAI subscale (0.7). Assessment of inter-informant reliability revealed good correspondence between the reports of the patients and the carers for both the C-HIPS (0.83) and the C-HINAS (0.82). Both the C

Development and psychometric properties of the Patient-Head Injury Participation Scale (P-HIPS) and the Patient-Head Injury Neurobehavioral Assessment Scale (P-HINAS): patient and family determined outcomes scales.

Science.gov (United States)

Deb, Shoumitro; Bryant, Eleanor; Morris, Paul G; Prior, Lindsay; Lewis, Glyn; Haque, Sayeed

2007-06-01

To develop a measure to assess post-acute outcome following from traumatic brain injury (TBI) with particular emphasis on the emotional and the behavioral outcome. The second objective was to assess the test-retest reliability, internal consistency, and factor structure of the newly developed patient version of the Head Injury Participation Scale (P-HIPS) and Patient-Head Injury Neurobehavioral Scale (P-HINAS). Thirty-two TBI individuals and 27 carers took part in in-depth qualitative interviews exploring the consequences of the TBI. Interview transcripts were analyzed and key themes and concepts were used to construct the 49-item P-HIPS. A postal survey was then conducted on a cohort of 113 TBI patients to 'field test' the P-HIPS and the P-HINAS. All individual 49 items of the P-HIPS and their total score showed good test-retest reliability (0.93) and internal consistency (0.95). The P-HIPS showed a very good correlations with the Mayo Portland Adaptability Inventory-3 (MPAI-3) (0.87) and a moderate negative correlation with the Glasgow Outcome Scale-Extended (GOSE) (-0.51). Factor analysis extracted the following domains: 'Emotion/Behavior,' 'Independence/Community Living,' 'Cognition' and 'Physical'. The 'Emotion/Behavior' factor constituted the P-HINAS, which showed good internal consistency (0.93), test-retest reliability (0.91) and concurrent validity with MPAI subscale (0.82). Both the P-HIPS and the P-HINAS show strong psychometric properties. The qualitative methodology employed in the construction stage of the questionnaires provided good evidence of face and content validity.

Acceptability of the Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A qualitative study with child protection professionals.

Science.gov (United States)

Cowley, Laura E; Maguire, Sabine; Farewell, Daniel M; Quinn-Scoggins, Harriet D; Flynn, Matthew O; Kemp, Alison M

2018-05-09

The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) based on combinations of six clinical features: head/neck bruising; apnea; seizures; rib/long-bone fractures; retinal hemorrhages. We aimed to determine the acceptability of PredAHT to child protection professionals. We conducted qualitative semi-structured interviews with 56 participants: clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom. Interviews were recorded, transcribed and imported into NVivo for thematic analysis (38% double-coded). We explored participants' evaluations of PredAHT, their opinions about the optimal way to present the calculated probabilities, and their interpretation of probabilities in the context of suspected AHT. Clinicians, child protection social workers and police thought PredAHT would be beneficial as an objective adjunct to their professional judgment, to give them greater confidence in their decisions. Lawyers and pathologists appreciated its value for prompting multidisciplinary investigations, but were uncertain of its usefulness in court. Perceived disadvantages included: possible over-reliance and false reassurance from a low score. Interpretations regarding which percentages equate to 'low', 'medium' or 'high' likelihood of AHT varied; participants preferred a precise % probability over these general terms. Participants would use PredAHT with provisos: if they received multi-agency training to define accepted risk thresholds for consistent interpretation; with knowledge of its development; if it was accepted by colleagues. PredAHT may therefore increase professionals' confidence in their decision-making when investigating suspected AHT, but may be of less value in court. Copyright © 2018 Elsevier Ltd. All rights reserved.

Case of bilateral complete posterior dislocation of lens caused by elder abuse

Directory of Open Access Journals (Sweden)

Matsumoto Y

2012-02-01

Full Text Available Tetsuya Mutoh1,2, Thomas Tien2, Megumi Horie1, Yukihiro Matsumoto1, Makoto Chikuda11Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan; 2Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USAAbstract: We report a case of bilateral complete dislocation of lenses into the vitreous cavities due to elder abuse in a patient with senile dementia. According to the patient’s son, bilateral complete lens dislocation occurred after he hit his father in the head with socks in order to control his violent behavior. Although the patient was taken to our ophthalmological ward for a planned vitrectomy, restlessness and inability to remain in his room during the night led to his leaving the hospital. The patient has not returned but did receive a vitrectomy at another clinic. While the number of patients with senile dementia has dramatically increased, no specific remedy is currently available. When treating medical concerns of seniors with unknown backgrounds, elder abuse needs to be considered as a potential cause of such injuries.Keywords: bilateral dislocation of lenses, elder abuse, senile dementia, vitrectomy

Head and neck injury patterns in fatal falls: epidemiologic and biomechanical considerations.

Science.gov (United States)

Freeman, Michael D; Eriksson, Anders; Leith, Wendy

2014-01-01

Fatal falls often involve a head impact, which are in turn associated with a fracture of the skull or cervical spine. Prior authors have noted that the degree of inversion of the victim at the time of impact is an important predictor of the distribution of skull fractures, with skull base fractures more common than skull vault fractures in falls with a high degree of inversion. The majority of fatal fall publications have focused on skull fractures, and no research has described the association between fall circumstances and the distribution of fractures in the skull and neck. In the present study, we accessed data regarding head and neck fractures resulting from fatal falls from a Swedish autopsy database for the years 1992-2010, for the purposes of examining the relationships between skull and cervical spine fracture distribution and the circumstances of the fatal fall. Out of 102,310 medico-legal autopsies performed there were 1008 cases of falls associated with skull or cervical spine fractures. The circumstances of the falls were grouped in 3 statistically homogenous categories; falls occurring at ground level, falls from a height of stairs, and falls from ≥3 m. Only head and neck injuries and fractures that were associated with the fatal CNS injuries were included for study, and categorized as skull vault and skull base fractures, upper cervical injuries (C0-C1 dislocation, C1 and C2 fractures), and lower cervical fractures. Logistic regression modeling revealed increased odds of skull base and lower cervical fracture in the middle and upper fall severity groups, relative to ground level falls (lower cervical <3 m falls, OR = 2.55 [1.32, 4.92]; lower cervical ≥3 m falls, OR = 2.23 [0.98, 5.08]; skull base <3 m falls, OR = 1.82 [1.32, 2.50]; skull base ≥3 m falls, OR = 2.30 [1.55, 3.40]). C0-C1 dislocations were strongly related to fall height, with an OR of 8.3 for ≥3 m falls versus ground level. The findings of increased odds of skull

Pathophysiological and behavioral deficits in developing mice following rotational acceleration-deceleration traumatic brain injury

Directory of Open Access Journals (Sweden)

Guoxiang Wang

2018-01-01

Full Text Available Abusive head trauma (AHT is the leading cause of death from trauma in infants and young children. An AHT animal model was developed on 12-day-old mice subjected to 90° head extension-flexion sagittal shaking repeated 30, 60, 80 and 100 times. The mortality and time until return of consciousness were dependent on the number of repeats and severity of the injury. Following 60 episodes of repeated head shakings, the pups demonstrated apnea and/or bradycardia immediately after injury. Acute oxygen desaturation was observed by pulse oximetry during respiratory and cardiac suppression. The cerebral blood perfusion was assessed by laser speckle contrast analysis (LASCA using a PeriCam PSI system. There was a severe reduction in cerebral blood perfusion immediately after the trauma that did not significantly improve within 24 h. The injured mice began to experience reversible sensorimotor function at 9 days postinjury (dpi, which had completely recovered at 28 dpi. However, cognitive deficits and anxiety-like behavior remained. Subdural/subarachnoid hemorrhage, damage to the brain-blood barrier and parenchymal edema were found in all pups subjected to 60 insults. Proinflammatory response and reactive gliosis were upregulated at 3 dpi. Degenerated neurons were found in the cerebral cortex and olfactory tubercles at 30 dpi. This mouse model of repetitive brain injury by rotational head acceleration-deceleration partially mimics the major pathophysiological and behavioral events that occur in children with AHT. The resultant hypoxia/ischemia suggests a potential mechanism underlying the secondary rotational acceleration-deceleration-induced brain injury in developing mice.

A new objective method for CT triage after minor head injury--serum S100B

DEFF Research Database (Denmark)

Undén, Johan; Rommer, Bertil Roland

2009-01-01

The risk of acute intracranial complication after minor head injury (MHI) is low. Despite this, a computed tomography (CT) scan is generally recommended for all patients following MHI. Admission for clinical observation is a secondary management option when a CT scan is unavailable or is judged i...

Head injury in childhood: comparison of sonography with the conventional X-ray and CT

International Nuclear Information System (INIS)

Steiner, S.; Riebel, T.; Nazarenko, O.; Bassir, C.; Steger, W.; Vogl, T.; Felix, R.

1996-01-01

Purpose: The purpose of our study was to compare the value of ultrasound, conventional X-ray diagnosis and CT in detecting skull fractures and intracranial haemorrhage in children suffering from a head injury. Material and methods: We examined 210 children who had a head injury. In all cases the calvarium was investigated by ultrasound using a 7.0 MHz linear transducer. In children with an open fontanel (n=190) the cerebrum was screened additionally by ultrasound following a standard protocol. The sonographic findings were correlated to the X-ray examination (n=21) and CT (n=13). Results: Ultrasound enabled diagnosis of linear calvarial fractures (n=29), depressed fratures (n=6) and intracranial haemorrhage (n=8). X-Ray and XT examination confirmed the diagnosis of linear calvarial fractures in 16 cases, of depressed fractures in 6 cases. CT confirmed the sonographic diagnosis of intracranial haemorrhage in 8 cases. Conclusion: Ultrasound as a primary method can replace the conventional X-ray in detecting calvarial fracture and posttraumatic sequelae. Additional CT examination depends on the sonographic and neurological status. (orig.) [de

Radiological diagnosis in patients with head injury alone or in combination with multiple trauma

International Nuclear Information System (INIS)

Rieger, J.; Linsenmaier, U.; Pfeifer, K.J.; Reiser, M.

2002-01-01

Purpose. Head injury alone or in combination with multiple trauma is the main cause of death and severe disability in individuals under 45 years old. This review is intended to describe the relevant imaging modalities, to analyze their specific value and limitations and to illustrate the most important radiologic findings. The indications for diagnostic imaging within the context of an interdisciplinary linkage of diagnostic and therapeutic measures are discussed.Material and methods. Recent publications are analyzed and compared to the experiences of our own hospital. In terms of a critical synoptic assessment the currently best standard of care is described in consideration of an interdisciplinary care concept.Results. Radiologic imaging modalities crucially contribute to the complete injury assessment and provide an indispensable basis for any therapeutic decision. Comprehensive neuromonitoring and reliable demonstration of delayed or secondary brain damage is impossible without modern imaging technology. Computed tomography (CT) further continues to be the most important imaging modality, while magnetic resonance imaging despite it's partly superior diagnostic informations remains reserved to particular diagnostic problems.Conclusions. Suitable constructive prerequisites, an interdisciplinary care concept and integration of the radiologist in hospital-adapted diagnostic and therapeutic algorithms significantly improves the outcome of patients with acute head injury. Beside the correct diagnosis itself the time to establish a diagnosis above all has a crucial impact on successful management and good outcome of these patients. (orig.) [de

Does bruising help determine which fractures are caused by abuse?

Science.gov (United States)

Valvano, Thomas J; Binns, Helen J; Flaherty, Emalee G; Leonhardt, Dan E

2009-11-01

To determine whether the presence or absence of bruising can be used to differentiate between abusive and nonabusive fractures, a retrospective study was conducted of patients with acute fractures referred to a child abuse team. A bruise and fracture were considered associated if both occurred on the same body site. Chart summaries, excluding information on bruising, were reviewed by 2 abuse experts to assign cause of injury. Of the 150 participants, fractures of 93 (62%) were categorized as abusive and 57 (38%) as nonabusive. Bruising associated with a fracture was found for 26% of abused and 25% of nonabused children. Most children (61%) had no bruises anywhere on the body, and this did not differ significantly by cause of injury. The sensitivity of a bruise associated with a fracture to predict abuse was only 26%. The presence or absence of bruising was not useful to differentiate between abusive and nonabusive fractures.