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Sample records for head injury study

  1. Head Injuries

    Science.gov (United States)

    ... ATV) Safety Balance Disorders Knowing Your Child's Medical History First Aid: Falls First Aid: Head Injuries Preventing Children's Sports Injuries Getting Help: Know the Numbers Concussions Stay ...

  2. Vietnam Head Injury Study Phase III: A 30 Year Post-Injury Follow-Up Study

    National Research Council Canada - National Science Library

    Grafman, Jordan

    2004-01-01

    Implementation of the Vietnam Head Injury Study Phase III (VHIS - PIII) has begun. By November 2003 all study staff had been hired, and underwent subsequent training to administer the battery of tests...

  3. Computed tomographic study of the complication of head injury

    Energy Technology Data Exchange (ETDEWEB)

    Kojima, T.; Waga, S. (Mie Univ., Tsu (Japan). School of Medicine)

    1982-08-01

    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-seven of 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 seen 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.

  4. 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 ...

  5. Head Injuries in Children

    Science.gov (United States)

    Pennington, Nicole

    2010-01-01

    School nurses play a crucial role in injury prevention and initial treatment when injuries occur at school. The role of school nurses includes being knowledgeable about the management of head injuries, including assessment and initial treatment. The school nurse must be familiar with the outcomes of a head injury and know when further evaluation…

  6. Head Injuries in Urban Environment Skiing and Snowboarding: A Retrospective Study on Injury Severity and Injury Mechanisms.

    Science.gov (United States)

    Stenroos, A; Handolin, L

    2017-11-01

    During the last decade urban skiing and snowboarding has gained a lot of popularity. In urban skiing/snowboarding riders try to balance on handrails and jump off buildings. Previous studies in skiing and snowboarding accidents have mostly been conducted at hospitals located close to alpine terrain with big ski resort areas. The aim of this study is to evaluate the types and severity of traumatic brain injuries occurring in small, suburban hills and in urban environment, and to characterize injury patterns to find out the specific mechanisms of injuries behind. This study included all patients admitted to the Helsinki University Hospital Trauma Unit from 2006 to 2015 with a head injury (ICD 10 S06-S07) from skiing or snowboarding accidents in Helsinki capital area. Head injuries that did not require a CT-scan, and injuries older than 24 hours were excluded from this study. There were a total of 72 patients that met the inclusion criteria Mean length of stay in hospital was 2.95 days. According to the AIS classification, 30% had moderate, 14% had severe, and 10% had critical head injuries. Patients who got injured in terrain parks or on streets where more likely to be admitted to ICU than those injured on slopes. Based on GOS score at discharge, 78% were classified as having a good recovery from the injury, 13% had a moderate disability, 5% had a severe disability and 3% of the injuries were fatal. There were no statistically significant differences in decreased GOS between the accident sites. Head injuries occurring in small suburban hills and in urban environments can be serious and potentially fatal. The profile and severity of skiing injuries in urban environments and small, suburban hills is comparable to those on alpine terrain.

  7. The relationship between early childhood head injury and later life criminal behaviour: a longitudinal cohort study.

    Science.gov (United States)

    Jackson, Tracy L; Braun, Joseph M; Mello, Michael; Triche, Elizabeth W; Buka, Stephen L

    2017-08-01

    Childhood head injury has been associated with the development of behavioural and psychological problems. This study examined the relationship between head injury in young childhood and subsequent criminal behaviour. Data were from the Providence cohort of the Collaborative Perinatal Project, a multicentre longitudinal study aimed at identifying the role of perinatal and prenatal factors on child health. History of head injury between ages 0 and 7 years was ascertained from health records of 2893 children. In total, 120 (4%) of children had a head injury. Propensity score matching was used to match each head injury case to five controls. Negative binomial regression was used to estimate the relationship between head injury and number of arrests, and log binomial regression was used to estimate risk of conduct problems. Those who suffered any head injury from ages 0 to 7 years had approximately 1.5 times the rate of arrests and risk of conduct problems compared with uninjured controls, though results did not meet the pconduct problems (risk ratio=2.47, 95% CI 0.90 to 6.74) that approached statistical significance. Head injury in childhood was associated with increased criminality and conduct problems. Future work should identify mechanisms of this association in order to develop interventions to prevent criminal behaviour resulting from head injury. © 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.

  8. Head Injuries in Soccer.

    Science.gov (United States)

    Myrick, Karen M

    2016-07-01

    Soccer is currently the most popular and fastest growing sport worldwide, with approximately 265 million registered soccer players existing around the world. The popularity of the sport, coupled with the high incidence of 18.8-21.5 head injuries per 1,000 player hours reported, make it essential that clinicians, coaches, and the athletes, have a solid understanding of head injuries. The successful rehabilitation of athletes with head injuries relies upon early and accurate identification strategies and implementation of appropriate return to play measures across all areas in the continuum of care. Soccer is a frequently played sport, and head injuries are common. Therefore, it is imperative that clinicians, coaches, and the athletes themselves have a solid understanding of head injury prevention, diagnosis, and treatment options. The purpose of this article was to provide rehabilitation nurses with current information regarding frequently occurring head injuries in the widespread sport of soccer. © 2015 Association of Rehabilitation Nurses.

  9. Head injuries in children's football-results from two prospective cohort studies in four European countries.

    Science.gov (United States)

    Faude, O; Rössler, R; Junge, A; Aus der Fünten, K; Chomiak, J; Verhagen, E; Beaudouin, F; Dvorak, J; Feddermann-Demont, N

    2017-12-01

    Head injuries are considered harmful in children. We analyzed head and neck injuries in organized football in 7- to 12-year-old children. Data for this analysis were obtained from a prospective cohort study over two consecutive football seasons in two European countries, and a randomized intervention trial over one season in four European countries. Football exposure and injuries were documented through an online database. Detailed information regarding injury characteristics and medical follow-up was retrieved from coaches, children and parents by phone. Thirty-nine head injuries and one neck injury (5% of all 791 injuries) were documented during 9933 player-seasons (total football exposure 688 045 hours). The incidence was 0.25 [95%CI 0.15, 0.35] head/neck injuries per 1000 match hours (N=23 match injuries) and 0.03 [95%CI 0.02, 0.03] per 1000 training hours. Eleven concussions (27.5%), nine head contusions (22.5%), eight lacerations or abrasions (20%), two nose fractures (2.5%), and two dental injuries (2.5%) occurred. The remaining eight injuries were nose bleeding or other minor injuries. Thirty injuries (75%) resulted from contact with another player, and ten injuries were due to collision with an object, falling or a hit by the ball. Whereas 70% of all head injuries (N=28) were due to frontal impacts, 73% of concussions (N=8) resulted from an impact to the occiput. The incidence and severity of head injuries in children's football are low. Coaches and parents, however, should be sensitized regarding the potential of concussions, particularly after an impact to the occiput. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Epidemiology of head injury in Malaysian children: a hospital-based study.

    Science.gov (United States)

    Rohana, J; Ong, L C; Abu Hassan, A

    1998-09-01

    A prospective observational study was carried out at the Emergency Department, Hospital Kuala Lumpur to determine the proportion of accidental head injury among children and the circumstances of injury. The study was carried out from November 1993 to January 1994 on all children below 14 years who presented to the Emergency Department with accidental head injury. Accidental head injury made up (4.75%) of all cases seen at the Casualty Department. The ratio of boys to girls was 2:1. The mean age of head injured children was 5.2 (S.D. 3.63) years. The leading cause of head injury was fall (63%) followed by road traffic accidents (RTA) in (30.7%) while the rest were due to 'impact' (injury caused by flying object or missiles) injuries. More than half (54.4%) of those injured in RTA were pedestrians. Pedestrian injury was particularly important in the 5-< 14 years age group, where adult supervision was lacking in two thirds of the children. None of the patients who were involved in vehicle-related injuries had used a suitable protective or restraining device. All three patients who died were from this group. This study emphasises the need for stricter enforcement of laws related to the use of protective devices and measures to decrease child pedestrian injury. The issues of lack of adult supervision, both in and outside the home need to be addressed.

  11. Development of a Finite Element Head Model for the Study of Impact Head Injury

    Directory of Open Access Journals (Sweden)

    Bin Yang

    2014-01-01

    Full Text Available This study is aimed at developing a high quality, validated finite element (FE human head model for traumatic brain injuries (TBI prediction and prevention during vehicle collisions. The geometry of the FE model was based on computed tomography (CT and magnetic resonance imaging (MRI scans of a volunteer close to the anthropometry of a 50th percentile male. The material and structural properties were selected based on a synthesis of current knowledge of the constitutive models for each tissue. The cerebrospinal fluid (CSF was simulated explicitly as a hydrostatic fluid by using a surface-based fluid modeling method. The model was validated in the loading condition observed in frontal impact vehicle collision. These validations include the intracranial pressure (ICP, brain motion, impact force and intracranial acceleration response, maximum von Mises stress in the brain, and maximum principal stress in the skull. Overall results obtained in the validation indicated improved biofidelity relative to previous FE models, and the change in the maximum von Mises in the brain is mainly caused by the improvement of the CSF simulation. The model may be used for improving the current injury criteria of the brain and anthropometric test devices.

  12. Development of a finite element head model for the study of impact head injury.

    Science.gov (United States)

    Yang, Bin; Tse, Kwong-Ming; Chen, Ning; Tan, Long-Bin; Zheng, Qing-Qian; Yang, Hui-Min; Hu, Min; Pan, Gang; Lee, Heow-Pueh

    2014-01-01

    This study is aimed at developing a high quality, validated finite element (FE) human head model for traumatic brain injuries (TBI) prediction and prevention during vehicle collisions. The geometry of the FE model was based on computed tomography (CT) and magnetic resonance imaging (MRI) scans of a volunteer close to the anthropometry of a 50th percentile male. The material and structural properties were selected based on a synthesis of current knowledge of the constitutive models for each tissue. The cerebrospinal fluid (CSF) was simulated explicitly as a hydrostatic fluid by using a surface-based fluid modeling method. The model was validated in the loading condition observed in frontal impact vehicle collision. These validations include the intracranial pressure (ICP), brain motion, impact force and intracranial acceleration response, maximum von Mises stress in the brain, and maximum principal stress in the skull. Overall results obtained in the validation indicated improved biofidelity relative to previous FE models, and the change in the maximum von Mises in the brain is mainly caused by the improvement of the CSF simulation. The model may be used for improving the current injury criteria of the brain and anthropometric test devices.

  13. Overview of Head Injuries

    Science.gov (United States)

    ... brain. If the head injury is very severe, mechanical ventilation may be used. Doctors control blood pressure and minimize the amount of brain swelling by adjusting the amount of intravenous fluids given and sometimes by giving intravenous drugs that ...

  14. 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.

  15. Pediatric head injury.

    Science.gov (United States)

    Tulipan, N

    1998-01-01

    Pediatric head injury is a public health problem that exacts a high price from patients, their families and society alike. While much of the brain damage in head-injured patients occurs at the moment of impact, secondary injuries can be prevented by aggressive medical and surgical intervention. Modern imaging devices have simplified the task of diagnosing intracranial injuries. Recent advances in monitoring technology have made it easier to assess the effectiveness of medical therapy. These include intracranial pressure monitoring devices that are accurate and safe, and jugular bulb monitoring which provides a continuous, qualitative measure of cerebral blood flow. The cornerstones of treatment remain hyperventilation and osmotherapy. Despite maximal treatment, however, the mortality and morbidity associated with pediatric head injury remains high. Reduction of this mortality and morbidity will likely depend upon prevention rather than treatment.

  16. The prevalence of dental, facial and head injuries sustained by schoolboy rugby players. A pilot study.

    Science.gov (United States)

    Jagger, Robert G; Abbasbhai, Ali; Patel, Dilan; Jagger, Daryll C; Griffiths, Alex

    2010-07-01

    The aim of the study was to determine the prevalence of dental, orofacial and head injuries and of mouthguard use among schoolboy rugby players. All members of the first and second XV rugby squads at three secondary schools (two in England and one in Australia) were included in the study. All participants answered a questionnaire that sought information regarding dental, orofacial and head injuries. Statistical differences between groups were determined using chi-square tests for categorical variables and Kruskal-Wallis tests for discrete (count) variables. One hundred and seventy-eight completed questionnaires were returned (100% response rate). One hundred and twenty-five (70%) players reported having sustained at least one injury (range 1-4). Facial injuries were common. Dental injuries were the most prevalent injury: 46 (26%) were reported. Fractured teeth were reported by 20 (11%) players, and avulsed teeth by 7 (4%). There was evidence of a difference between schools in the prevalence of injured players (P=0.014), but among those reporting injuries, there was no difference between schools in the number of injuries (P=0.95). All players said that they used a mouthguard regularly. Dental, orofacial and head injuries were commonly reported. Dental injuries were the most prevalent type of injury. All players used mouthguards regularly.

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

    Directory of Open Access Journals (Sweden)

    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

  18. OCULAR MANIFESTATIONS OF HEAD INJURIES

    Directory of Open Access Journals (Sweden)

    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

  19. Research study on neck injury lessening with active head restraint using human body FE model.

    Science.gov (United States)

    Kitagawa, Yuichi; Yasuki, Tsuyoshi; Hasegawa, Junji

    2008-12-01

    The objective of this study is to examine the effectiveness of the active head restraint system in reducing neck injury risk of car occupants in low-speed rear impacts. A human body FE model "THUMS" was used to simulate head and neck kinematics of the occupant and to evaluate loading to the neck. Joint capsule strain was calculated to predict neck injury risk as well as NIC. The validity of the model was confirmed comparing its mechanical responses to those in human subjects in the literatures. Seat FE models were also prepared representing one with a fixed head restraint and the other one with an active head restraint system. The active head restraint system was designed to move the head restraint forward and upward when the lower unit was lower unit was loaded by the pelvis. Rear impact simulations were performed assuming a triangular acceleration pulse at a delta-V of 25 km/h. The model reproduced similar head and neck motions to those measured in the human volunteer test, except for active muscular responses. The calculated joint capsule strain also showed a good match with those of PMHS tests in the literature. A rear-impact simulation was conducted using the model with the fixed head restraint. The result revealed that NIC was strongly correlated with the relative acceleration between the head and the torso and that its maximum peak appeared when the head contacted the head restraint. It was also found that joint capsule strain grew in later timing synchronizing with the relative displacement. Another simulation with the active head restraint system showed that both NIC and joint capsule strain were lowered owing to the forward and upward motion of the head restraint. A close investigation of the vertebral motion indicated that the active head restraint reduced the magnitude of shear deformation in the facet joint, which contributed to the strain growth in the fixed head restraint case. Rear-impact simulations were conducted using a human body FE model, THUMS

  20. 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.

  1. Head injuries, heading, and the use of headgear in soccer.

    Science.gov (United States)

    Niedfeldt, Mark W

    2011-01-01

    Soccer has more than 265 million players around the world and is the only contact sport with purposeful use of the head for controlling and advancing the ball. Head contact in soccer has the potential to cause acute traumatic brain injury including concussion or, potentially, a pattern of chronic brain injury. Although early retrospective research on the effects of soccer heading seemed to suggest that purposeful heading may contribute to long-term cognitive impairment, prospective controlled studies do not support this and, in fact, suggest that purposeful heading may not be a risk factor for cognitive impairment. Headgear has not been shown to be effective in reducing ball impact but may be helpful in reducing the force of non-ball-related impacts to the head. There are concerns that universal use of headgear may cause more aggressive heading and head challenges, leading to increased risk of injury.

  2. Mechanisms of head injuries in elite football.

    Science.gov (United States)

    Andersen, T E; Arnason, A; Engebretsen, L; Bahr, R

    2004-12-01

    The aim of this study was to describe, using video analysis, the mechanisms of head injuries and of incidents with a high risk of head injury in elite football. Videotapes and injury information were collected prospectively for 313 of the 409 matches played in the Norwegian (2000 season) and Icelandic (1999 and 2000 season) professional leagues. Video recordings of incidents where a player appeared to be hit in the head and the match was consequently interrupted by the referee were analysed and cross referenced with reports of acute time loss injuries from the team medical staff. The video analysis revealed 192 incidents (18.8 per 1000 player hours). Of the 297 acute injuries reported, 17 (6%) were head injuries, which corresponds to an incidence of 1.7 per 1000 player hours (concussion incidence 0.5 per 1000 player hours). The most common playing action was a heading duel with 112 cases (58%). The body part that hit the injured player's head was the elbow/arm/hand in 79 cases (41%), the head in 62 cases (32%), and the foot in 25 cases (13%). In 67 of the elbow/arm/hand impacts, the upper arm of the player causing the incident was at or above shoulder level, and the arm use was considered to be active in 61 incidents (77%) and intentional in 16 incidents (20%). This study suggests that video analysis provides detailed information about the mechanisms for head injuries in football. The most frequent injury mechanism was elbow to head contact, followed by head to head contact in heading duels. In the majority of the elbow to head incidents, the elbow was used actively at or above shoulder level, and stricter rule enforcement or even changes in the laws of the game concerning elbow use should perhaps be considered, in order to reduce the risk of head injury.

  3. Study Of 50 Cases With Craniofacial Trauma Who Experienced Head Injuries

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    Ali Mesgarzadeh

    2016-01-01

    Full Text Available Background: It has been shown that cranial injuries associated with facial fractures may cause a great risk of mortality and neurological morbidity, which mainly occurs in young adults. Aims and objectives: Study of the features of facial injuries associated with head injuries, discussing the management options and detecting the outcomes following craniofacial trauma. Methods: This is a retrospective study carried out at Imam reza and Shohada Hospitals. Radiographs and hospital data of 50 patients with craniofacial trauma between January 2013 and December 2014, managed at the Oral and Maxillofacial surgery department were gathered and analyzed. Results: The greatest number of the patients had 20 to 50 years old (68% and most of them were male. (M/F ratio was 6.09:1. The most prevalent causes of the trauma in this study were the motor vehicle accidents (44% and falling from height (36%, respectively. The most common bone fracture among the patients was the zygomatic bone fx (38.2%. Among the symptoms which the patients presented, Loss of the consciousness (52% and headache (43% showed the highest prevalence. Compound depressed fractures, contusions and intracranial hematoma were the leading causes of the surgical intervention for intracranial lesions. A high number of patients who have died in this study had associated systemic injuries. Displaced facial bone fracture were the indications for operation in facial fractures. Conclusions: The majority of the patients with craniofacial trauma were the adult males and the leading cause of trauma were road traffic accidents. A high number of the patients had mild head injuries and required only a conservational therapy.     Keywords:  head injury; craniofacial trauma; facial fracture

  4. Head injury mechanisms in helmet-protected motorcyclists: prospective multicenter study.

    Science.gov (United States)

    Richter, M; Otte, D; Lehmann, U; Chinn, B; Schuller, E; Doyle, D; Sturrock, K; Krettek, C

    2001-11-01

    In a prospective study, three research groups at Hannover (H) and Munich (M) in Germany and Glasgow (G) in the United Kingdom collected data from motorcycle crashes between July 1996 and July 1998 to investigate head injury mechanisms in helmet-protected motorcyclists. The head lesions of motorcyclists with Abbreviated Injury Score-Head (AISHead) 2+ injuries and/or helmet impact were classified into direct force effect (DFE) and indirect force effect (IFE) lesions. The effecting forces and the force consequences were analyzed in detail. Two-hundred twenty-six motorcyclists (H, n = 115; M, n = 56; and G, n = 55) were included. Collision opponents were cars (57.8%), trucks (8.0%), pedestrians (2.3%), bicycles (1.4%), two-wheel motor vehicles (0.8%), and others (4.2%). In 25.4% no other moving object was involved. The mean impact speed was 55 km/h (range, 0-120 km/h) and correlated with AISHead. Seventy-six (33%) motorcyclists had no head injury, 21% (n = 48) AISHead 1, and 46% (n = 103) AISHead 2+. Four hundred nine head lesions were further classified: 36.9% DFE and 63.1% IFE. Lesions included 20.5% bone, 51.3% brain, and 28.1% skin. The most frequent brain lesions were subdural hematomas (22.4%, n = 47) and subarachnoid hematomas (25.2%, n = 53). Lesions of skin or bone were mainly DFE lesions, whereas brain lesions were mostly IFE lesions. A modification of the design of the helmet shell may have a preventative effect on DFE lesions, which are caused by a high amount of direct force transfer. Acceleration or deceleration forces induce IFE lesions, particularly rotation, which is an important and underestimated factor. The reduction of the effecting forces and the kinetic consequences should be a goal for future motorcycle helmet generations.

  5. 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.

    Directory of Open Access Journals (Sweden)

    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.

  6. 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

  7. Association between altered motor control of trunk muscles and head and neck injuries in elite footballers - An exploratory study.

    Science.gov (United States)

    Hides, Julie A; Mendis, M Dilani; Franettovich Smith, Melinda M; Miokovic, Tanja; Cooper, Andrew; Low Choy, Nancy

    2016-08-01

    Head and neck injuries are common in football. Injuries such as concussion can have serious consequences. Previous studies have shown that size and function of trunk muscles are predictive of lower limb injuries in professional Australian Football League (AFL) players. It is unknown whether measurement of trunk muscles can also be used to predict head and neck injuries. To examine whether trunk muscle measurements predict head and neck injuries incurred by professional AFL players. Prospective cohort study. Ultrasound imaging of trunk muscles was performed on 165 professional AFL players at the start of the pre-season and 168 players at the start of the playing season. Injury data were obtained from records collected by the AFL club staff during the playing season. The ability to contract the multifidus (MF) muscle at the L5/S1 vertebral level at the start of pre-season and start of the playing season predicted head and neck injury in the playing season. Sensitivity and specificity of the model were 56.3% and 76.6% for the pre-season and 50.0% and 77.2% for the playing season respectively. A model with potential clinical utility was developed for prediction of head and neck injuries in AFL players. These predictive values will need to be validated in other teams. Ability to contract MF is modifiable and this information could be incorporated into pre-season injury prevention programs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. 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.

  9. 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; Lyons, R; Evans, R; Newcombe, R; Nash, P; McCabe, M; Palmer, S

    2004-01-01

    Objective: To determine if headgear use by rugby players was associated with a reduced risk of head or facial laceration, abrasion, or fracture. Methods: 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). Results: 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. Conclusions: 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. PMID:15039251

  10. A Military Relevant Model of Closed Concussive Head Injury: Longitudinal Studies Characterizing and Validating Single and Repetitive mTBI

    Science.gov (United States)

    2015-10-01

    Currently it is not known what changes are taking place in the brain with a concussion , how long the changes last and what happens if a second (or...1 AD Award Number: W81XWH-12-2-0134 TITLE: A Military-Relevant Model of Closed Concussive Head Injury: Longitudinal Studies Characterizing and...3. DATES COVERED 30 Sep 2014 - 29 Sep 2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER A Military-Relevant Model of Closed Concussive Head Injury

  11. 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.

  12. Head injury, diagnostic X-rays, and risk of medulloblastoma and primitive neuroectodermal tumor: a Children's Oncology Group study.

    Science.gov (United States)

    Khan, Saira; Evans, Alison A; Rorke-Adams, Lucy; Orjuela, Manuela A; Shiminski-Maher, Tania; Bunin, Greta R

    2010-07-01

    A comprehensive case-control study was conducted to determine potential risk factors for medulloblastoma/primitive neuroectodermal tumor (PNET), a common brain tumor in children. This analysis evaluated possible associations between previous head injury and ionizing radiation exposure through diagnostic X-rays and medulloblastoma/PNET. Mothers of 318 cases head injury (OR: 0.78, 95% CI: 0.40-1.5) or head X-ray for any reason including head injury with medulloblastoma/PNET. A statistically non-significant excess of cases reported having an X-ray for reason other than head injury (OR 2.3, 95% CI 0.91-5.7). When cases that received an X-ray for a common symptom of medulloblastoma/PNET were considered unexposed this association weakened (OR: 1.3, 95% CI: 0.49-3.7). No dose-response relationship was observed. Head injury and exposure to diagnostic head X-rays were not associated with medulloblastoma/PNET in this study. Future studies should investigate all imaging procedures with ionizing radiation exposure including computed tomography scans and utilize radiation dose estimations.

  13. Head injuries in helmeted child bicyclists.

    Science.gov (United States)

    Grimard, G.; Nolan, T.; Carlin, J. B.

    1995-01-01

    OBJECTIVE: To determine the characteristics and the severity of head and facial injuries to helmeted child bicyclists, and whether the helmet contributed to the injury, and to study factors related to bicycle accidents. DESIGN: Retrospective review of two case series. Children sustaining head injury while not wearing helmets were studied as a form of reference group. SETTING: Large paediatric teaching hospital. SUBJECTS: 34 helmeted child bicyclists and 155 non-helmeted bicyclists, aged 5-14 years. MAIN OUTCOME MEASURES: Number of injuries, type of injuries, injury severity score, deaths, and accident circumstances. RESULTS: 79% of the head injuries of the helmeted child group were mild and two thirds of these had facial injuries. Children in the helmet group were in a greater proportion of bike-car collisions than the no helmet group and at least 15% of the helmets were lost on impact. There were no injuries secondary to the helmet. CONCLUSIONS: Most of the head injuries sustained by the helmeted children were of mild severity and there was no evidence to suggest that the helmet contributed to injury. Nevertheless, consideration should be given to designing a facial protector for the bicycle helmet and to improvement of the fastening device. PMID:9345988

  14. Civilian firearm injuries in head and neck

    OpenAIRE

    Sonkhya, Nishi; Singhal, Pawan; Srivastava, Subodh P.

    2005-01-01

    Firearm injuries to the head and neck contribute to substantial medical, medicolegal, economic as well as social problems. Internal wounds in the head and neck by firearms are usually complicated and are diagnostically and therapeutically challenging cases. Based on four cases of non-fatal firearm injuries, we discuss problems related to firearm wounds, their irregular path, final lodgment of the bullet and their diagnostic and therapeutic consequences. In the present study it was observed th...

  15. The effect of specialist neurosciences care on outcome in adult severe head injury: a cohort study.

    Science.gov (United States)

    Fuller, Gordon; Bouamra, Omar; Woodford, Maralyn; Jenks, Tom; Patel, Hirin; Coats, Timothy J; Oakley, Peter; Mendelow, A David; Pigott, Tim; Hutchinson, Peter J; Lecky, Fiona

    2011-07-01

    Head injury is the leading cause of death in trauma. UK national guidelines have recommended that all patients with severe head injury (SHI) should be treated in neuroscience centers. The aim of this study was to investigate the effect of specialist neuroscience care on mortality after SHI. We conducted a cohort study using prospectively recorded data from the largest European trauma registry, for adult patients presenting with blunt trauma between 2003 and 2009. Mortality and unadjusted odds of death were compared for patients with SHI treated in neuroscience units (NSU) versus nonspecialist centers. To control for confounding, odds of death associated with non-NSU care were calculated using propensity score-adjusted multivariate logistic regression (explanatory covariates: age, Glasgow Coma Score, Injury Severity Score, treatment center). Sensitivity analyses were performed to study possible bias arising from selective enrollment, from loss to follow-up, and from hidden confounders. 5411 patients were identified with SHI between 2003 and 2009, with 1485 (27.4%) receiving treatment entirely in non-NSU centers. SHI management in a non-NSU was associated with a 11% increase in crude mortality (P<0.001) and 1.72-fold (95% confidence interval: 1.52-1.96) increase in odds of death. The case mix adjusted odds of death for patients treated in a non-NSU unit with SHI was 1.85 (95% confidence interval: 1.57-2.19). These results were not significantly changed in sensitivity analyses examining selective enrollment or loss to follow-up, and were robust to potential bias from unmeasured confounders. Our data support current national guidelines and suggest that increasing transfer rates to NSUs represents an important strategy in improving outcomes in patients with SHI.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. An observational study of compliance with the Scandinavian guidelines for management of minimal, mild and moderate head injury

    DEFF Research Database (Denmark)

    Heskestad, Ben; Waterloo, Knut; Ingebrigtsen, Tor

    2012-01-01

    The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003), we showed low complia...... compliance, involving over-triage with computed tomography (CT) and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention....

  18. Head Injuries in Professional and Amateur Sports

    OpenAIRE

    Kapp, Spencer

    2017-01-01

    Concussions in sports have become such a large issue in today’s sports society. Each year it seems that we hear more and more about athletes who struggle dealing with head injuries. Athletes continue to get bigger, stronger and faster which brings more excitement to sports. There have been many injuries in contact sports at all levels that not only result in concussions but long-term head injuries that can that cause permanent damage. We have learned and studied so much about the effects that...

  19. Car Accident Reconstruction and Head Injury Correlation

    Science.gov (United States)

    Chawla, A.; Grover, V.; Mukherjee, S.; Hassan, A. M.

    2013-04-01

    Estimation of brain damage remains an elusive issue and controlled tests leading to brain damage cannot be carried out on volunteers. This study reconstructs real-world car accidents to estimate the kinematics of the head impact. This data is to be used to estimate the head injury measures through computer simulations and then correlate reported skull as well as brain damage to impact measures; whence validating the head FE model (Willinger, IJCrash 8:605-617, 2003). In this study, two crash cases were reconstructed. Injury correlation was successful in one of these cases in that the injuries to the brain of one of the car drivers could be correlated in terms of type, location and severity when compared with the tolerance limits of relevant injury parameters (Willinger, IJCrash 8:605-617, 2003).

  20. The management of trauma victims with head injury: a study by the National Confidential Enquiry into Patient Outcome and Death.

    Science.gov (United States)

    Smith, N C E; Findlay, G P; Weyman, D; Freeth, H

    2013-03-01

    In 2006 the National Confidential Enquiry into Patient Outcome and Death undertook a large prospective study of trauma care, which revealed several findings pertaining to the management of head injuries in a sample of 493 patients. Case note data were collected for all trauma patients admitted to all hospitals accepting emergencies in england, wales, Northern Ireland and the Channel Islands over a three-month period. severely injured patients with an injury severity score (iss) of ≥16 were included in the study. the case notes for these patients were peer reviewed by a multidisciplinary group of clinicians, who rated the overall level of care the patient received. Of the 795 patients who met the inclusion criteria for the study, 493 were admitted with a head injury. Room for improvement in the level of care was found in a substantial number of patients (265/493). Good practice was found to be highest in high volume centres. The overall head injury management was found to be satisfactory in 84% of cases (319/381). This study has shown that care for trauma patients with head injury is frequently rated as less than good and suggests potential long-term remedies for the problem, including a reconfiguration of trauma services and better provision of neurocritical care facilities.

  1. A population-based study of survival and discharge status for survivors after head injury

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Teasdale, T W

    2004-01-01

    -Meier survival functions were calculated for these two categories. Hospital records for a random sample of 389 survivors in 1997 after cranial fracture, acute brain lesion or chronical subdural haematoma, which occurred in 1982, 1987 and 1992 in patients aged 15 years or more at injury, were reviewed. Survivors......OBJECTIVES: Creation of a basis for the planning of rehabilitation after head injury in Denmark. MATERIALS AND METHODS: Patients with cranial fractures or traumatic cerebral lesions occurring in Denmark in 1979-93 were identified by computerized searches in the national hospital register. Kaplan...... were characterized by age, gender, place and severity of injury, as well as neurophysical, speech and mental deficits at discharge from hospital. RESULTS: Acute/subacute mortality of hospitalized patients was 27% for cerebral lesions and 4% after cranial fracture. As attrition by death outweighed...

  2. Head injury and risk for Parkinson disease

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

  3. 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.

  4. Head injury in Germany: A population-based prospective study on epidemiology, causes, treatment and outcome of all degrees of head-injury severity in two distinct areas.

    Science.gov (United States)

    Rickels, Eckhard; von Wild, Klaus; Wenzlaff, Paul

    2010-01-01

    Little is known about the ratio of mild traumatic brain injury (TBI) to moderate and severe TBI, about the time that elapses until primary care is given, about the number of patients requiring immediate surgery and about the early outcome and the costs. In a prospective study two regions taken as model examples were investigated: the City of Hanover with its surrounding catchment area and Münster with its regions. From 1 March 2000 until 28 February 2001 all patients were recruited who were admitted to a hospital emergency department due to a TBI; 6783 patients (58.4% male, 41.6% female; 29.7% children < 16 years) were included; 5220 (73%) received in-hospital treatment; and 258 were given early rehabilitation. The incidence of TBI is 332 per 100 000 head of population. The GCS (Glasgow Coma Scale) or other forms of neurological examinations were performed in only 56% of all cases. According to the GCS status, 90.2% are classified as mild, 3.9% as moderate and 5.2% as severe. Intubation is given only to 76.1% of patients with severe TBI. Lethality was 1%. The predominant cause of TBI is falls, with 52.5% of all cases, while 26.3% were due to road accidents. The time elapsing between the accident event and initial examination at the hospital is less than 1 hour in 63% of all cases. X-rays were taken in 82% of all cases of TBI, with 19.3% of the patients receiving a CT scan; 58.7% of all TBI patients have additional injuries of the facial skull, 8.8% of the vertebral column, 7.2% of the thorax, 2.6% of the abdomen, 3.4% of the pelvis and 19.6% of one or more extremities. One year after the accident, 50% of all patients still required treatment even after mild TBI. It is necessary to follow the TBI guidelines, e.g. regarding intubation and neurological examination. The indication for cranial x-rays and CT should be reconsidered.

  5. 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

  6. Cognitive dysfunction in young men following head injury in childhood and adolescence: a population study

    DEFF Research Database (Denmark)

    Teasdale, T W; Engberg, A W

    2003-01-01

    OBJECTIVES: To examine the prevalence of cognitive dysfunction among young men who had suffered a head injury during childhood or adolescence, in particular focusing upon the effects of age and the severity of the injury. METHODS: By cross linkage of Danish national registers for hospital...... admissions and the draft board, 3091 young men were identified who had been injured before age 18 and tested at age 18 or shortly thereafter: 970 had suffered a single concussion and were in hospital for one day only; 521 had two concussions at separate times and were in hospital for one day only on each...... Danish men appearing before the draft board had a score classified as dysfunctional). RESULTS: For young men who had suffered a single concussion, cranial fracture, or cerebral lesion before 12 years of age, resulting in less than 12 days of hospital admission (n = 376), rates of cognitive dysfunction...

  7. Abusive Head Trauma and Mortality-An Analysis From an International Comparative Effectiveness Study of Children With Severe Traumatic Brain Injury.

    Science.gov (United States)

    Miller Ferguson, Nikki; Sarnaik, Ajit; Miles, Darryl; Shafi, Nadeem; Peters, Mark J; Truemper, Edward; Vavilala, Monica S; Bell, Michael J; Wisniewski, Stephen R; Luther, James F; Hartman, Adam L; Kochanek, Patrick M

    2017-08-01

    Small series have suggested that outcomes after abusive head trauma are less favorable than after other injury mechanisms. We sought to determine the impact of abusive head trauma on mortality and identify factors that differentiate children with abusive head trauma from those with traumatic brain injury from other mechanisms. First 200 subjects from the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial-a comparative effectiveness study using an observational, cohort study design. PICUs in tertiary children's hospitals in United States and abroad. Consecutive children (age seizures (28.6% vs 7.7%; p seizures during resuscitation (31.4 vs 9.7%; p = 0.002). After adjusting for covariates, there was no difference in mortality (abusive head trauma, 25.7% vs nonabusive head trauma, 18.7%; hazard ratio, 1.758; p = 0.60). A similar proportion died due to refractory intracranial hypertension in each group (abusive head trauma, 66.7% vs nonabusive head trauma, 69.0%). In this large, multicenter series, children with abusive head trauma had differences in prehospital and in-hospital secondary injuries which could have therapeutic implications. Unlike other traumatic brain injury populations in children, female predominance was seen in abusive head trauma in our cohort. Similar mortality rates and refractory intracranial pressure deaths suggest that children with severe abusive head trauma may benefit from therapies including invasive monitoring and adherence to evidence-based guidelines.

  8. PEDIATRIC HEAD INJURIES, MECHANISM TO MANAGEMENT: EXPERIENCE OF A SINGLE CENTER

    Directory of Open Access Journals (Sweden)

    Pankaj

    2016-01-01

    Full Text Available INTRODUCTION Head injury is very common in modern life. Patients of any age group may have head injury however mechanism of head injury, pathophysiology and outcome of head injury is quite different in adults as compared to children. Road traffic accident is a common mode of head injury in adults while fall from height and household abuse is common mode in children. In Western countries, there is a separate registry system for pediatric head injury but there is no such system exist in india. Our present study is focused on pediatric head injury and evaluation of factors that affect the final outcome in pediatric patients.

  9. Symptom Experience and Quality of Life in Children after Sport-Related Head Injuries: A Cross-Sectional Study.

    Science.gov (United States)

    Vassilyadi, Michael; Macartney, Gail; Barrowman, Nick; Anderson, Peter; Dube, Karen

    2015-01-01

    Sports are a major cause of concussions, and little is known about the symptom experience and health-related quality of life (HRQL) in children who remain symptomatic for over 3 months following such head injuries. A cross-sectional study of children aged 10-18 years was performed who were referred to the Neurosurgery Clinic at our centre following a head injury. Symptom experience was measured using the modified Concussion Symptom Scale, and HRQL was measured using the Pediatric Quality of Life Inventory (PedsQL). The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to assess neurocognitive and neurobehavioural sequelae. Symptoms with the highest mean symptom scores on a Likert scale of 0-6 in 35 children at the time of assessment included headaches (3.1), poor concentration (2.7), memory problems (2.1), fatigue (2.1) and sensitivity to noise (2.0). Compared with normative data, children in this study had ImPACT summary scores between the 28th and 38th percentiles and a comparably low Cognitive Efficiency Index score. Mean scores for females were consistently statistically significantly lower (p Children continue to experience many symptoms at least 3 months following sport-related head injuries that significantly impact their HRQL and neurocognitive abilities. © 2015 S. Karger AG, Basel.

  10. Learning people's names following severe closed-head injury

    NARCIS (Netherlands)

    Milders, M.V.

    Although problems remembering people's names rank highly among the subjective complaints of patients with closed-head injuries, very few studies have examined their memory for people's names by objective measurements. An experiment is reported in which patients with severe closed-head injuries and

  11. Rehabilitation interventions after mild head injury.

    Science.gov (United States)

    Ponsford, Jennie

    2005-12-01

    This review examines current management and rehabilitation strategies for mild traumatic brain injury, with emphasis on the need to address multiple potential causative factors in order to enhance outcomes and to conduct more controlled efficacy studies. Whilst most individuals who sustain mild traumatic brain injury make a good recovery, a proportion experience significant ongoing disability. In some cases this is due to diffuse axonal injury and cognitive impairment, but in others symptoms are exacerbated by factors such as pain, stress, personality issues or litigation, or in children, previous head injury, behavioural or learning difficulties. Provision of information early after injury results in reduced symptom reporting in adults and children. There is also a need, however, to address these other factors in treatment. Psychological therapy using a cognitive behavioural approach may be helpful, but controlled evaluations of such interventions have been lacking. Recent uncontrolled studies have examined the impact of computer-mediated interventions to remediate visual and verbal processing and oculomotor problems and the impact of quantitative electroencephalography. More rigorous efficacy studies of these approaches are needed. Guidelines for management of sports-related concussion and timing of return to play also require a more solid scientific basis. The evidence base for management of mild traumatic brain injury is still very limited. There is a need to conduct more carefully controlled prospective studies and examine the influence of factors not directly related to the brain injury as a basis for formulating more uniform management guidelines.

  12. Head injuries among FIS World Cup alpine and freestyle skiers and snowboarders: a 7-year cohort study.

    Science.gov (United States)

    Steenstrup, Sophie E; Bere, Tone; Bahr, Roald

    2014-01-01

    Traumatic brain injury is the leading cause of death for skiers and snowboarders. Fatal head injuries have also occurred at the International Ski Federation (FIS) World Cup (WC) level. We therefore wanted to describe the risk of head injuries across disciplines and sex among WC skiers and snowboarders. We conducted retrospective interviews with FIS WC athletes at the end of seven consecutive seasons (2006-2013) to register injuries sustained during the competitive season. Head injuries were classified as 'head/face' injuries and did not include neck or cervical spine injuries. To calculate the exposure, we extracted data from the official FIS website for all WC competitions for each of the athletes interviewed. A total of 2080 injuries were reported during seven WC seasons. Of these, 245 (11.8%) were head/face injuries. Of the 245 head/face injuries reported, nervous system injuries/concussions were the most common (81.6%) and 58 of these were severe (23.7%). The injury incidence per 1000 competition runs was higher in freestyle (1.8, 95% CI 1.2 to 2.4) than in alpine skiing (0.9, 95% CI 0.6 to 1.2; risk ratio (RR) 2.05, 95% CI 1.25 to 3.46) and snowboard (1.0, 95% CI 0.6 to 1.3; RR 1.85, 95% CI 1.15 to 2.99). Women had a higher injury incidence (5.8, 95% CI 4.8 to 6.9) versus men (3.9, 95% CI 3.2 to 4.6; RR 1.48, 95% CI 1.15 to 1.90) throughout the season (per 100 athletes). The majority of head/face injuries were nervous system injuries/concussions and one in four injuries was severe. Freestyle skiers had the highest overall head injury incidence. Across all disciplines, the injury incidence was higher in women than in men.

  13. Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams' head medical officers.

    Science.gov (United States)

    McCall, Alan; Dupont, Gregory; Ekstrand, Jan

    2016-06-01

    (1) To quantify current practice at the most elite level of professional club football in Europe with regard to injury prevention strategy; (2) to describe player adherence and coach compliance to the overall injury prevention programme. A structured online survey was administered to the Head medical officers of 34 elite European teams currently participating in the UEFA Elite Club Injury Study. The survey had 4 sections; (1) risk factors for injury, (2) assessment and monitoring of injury risk, (3) prevention strategies and (4) coach compliance and player adherence to the injury prevention process. 33 (97%) Medical officers of the teams responded. The most important perceived injury risk factor was previous injury. Four of the top 6 risk factors-physical fitness, accumulated fatigue, reduced recovery time between matches and training load-were related to player workload. The top 3 preventative exercises were eccentric, balance/proprioception and core training. Regarding monitoring, the top 3 tools implemented were measurement of workload, subjective wellness and a general medical screen. The subjectively rated level of coach compliance in UEFA teams was perceived as 'high', while the player adherence varied from none at all to perfect. Medical officers place importance on workload-related variables as risk factors for injury in elite European football players. A lack of consistently high player adherence may limit the effects of contemporary injury prevention programmes in elite European footballers. 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/

  14. Head injury: Calabar Teaching Hospital experience | Ikpeme ...

    African Journals Online (AJOL)

    The pattern and distribution of head injuries shows that a typical head injured patient in our locality is a male, aged between 21 and 30 years involved in a motorcycle related accident. Accidents frequently occured between 7 and 9pm and though 75% of patients arrived in hospital within 6 hours of injury, 17% of all cases ...

  15. A seven-year study on head injury in infants, Iran —— the changing pattern

    Directory of Open Access Journals (Sweden)

    Fakharian Esmaeil

    2014-06-01

    Full Text Available Objective: Head injury (HI is the leading cause of mortality and life-long disability in infants. Infants have different anatomical and pathophysiological brain structures from other age groups. The aim of this study was to survey infant HI patients admitted to Shahid Behest Hospital in Kashan, Iran from 2004 to 2010, and to identify the causes of HIs in this age group. Methods: In this retrospective study, all HI patients under the age of two who were hospitalized for more than 24 hours between January 2004 and January 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed. Results: Infants comprised 20.8% of all children (under 15 years old with HIs and 65.1% of the injuries occurred in the home. Falls were the most common cause of injury (63.4%. In hospital mortality was 6.6 per 100 000 infants. A decreasing trend was seen in home events, but HIs caused by traffic accidents were increasing during the study period. The amount of HI infants resulting from car accidents has tripled from the years 2004 to 2010. Conclusion: Although home events and falling are the main causes of infant HIs and need attention, our study showed an increase of HIs caused by road traffic accidents, especially by car accidents, thus legislation for the implementation of protective equipment such as child safety seats and programs is urgently needed. Key words: Infant; Brain injuries; Epidemiology

  16. Epidemiology and management of paediatric head injury in eastern Nepal

    Directory of Open Access Journals (Sweden)

    Agrawal A

    2008-01-01

    Full Text Available Background: In children, majority of the head injuries are minor and management of critically ill children depend on a team approach using well-rehearsed, systematic management protocols that can be implemented within hours after injury. This study was carried out to ascertain the epidemiology and management of know the demographic profile and etiology of paediatric head injury in our setting, to know the clinical and radiological characteristics of head injury patients and to know the treatment options and outcome in paediatric head injuries. Patients and Methods: Details of all children (age < 16 years with head injury seen in 1 year from 01.04.2005 to 31.03.2006 were retrospectively reviewed. Demographic profile, clinical details, investigations, treatment offered, and outcome were noted in a proforma. All data were analyzed by appropriate SPSS 11.0 statistical software tools. Results: There were total 43 patients. Young male children were more commonly affected in present series with a mean age of 7.67 years (median - 5.010 years, range 6 months-16 year. Fall (65.11% was the most common mode of injury followed by road traffic accidents (RTAs (25.6%. Mild head injuries (65.11% were most common. Most common complaint was loss of consciousness and all the patients with severe head injury presented loss of consciousness. All patients with mild head showed good recovery; with moderate head injury, nine patients showed good recovery and three patients recovered with moderate disability. Patients with severe head injury (three patients had 100% mortality. Conclusions: In urban areas of Nepal, RTAs like vehicular crashes, motor cycle accidents, and pedestrian hit by moving vehicle are more common and in rural areas fall from height are commoner. We need to develop child safety legislations and risk-specific intervention programs in Nepal.

  17. Acute arterial infarcts in patients with severe head injuries

    Directory of Open Access Journals (Sweden)

    Deepak Agrawal

    2012-01-01

    Full Text Available Aims and Objectives: To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Materials and Methods: Patients with severe head injury (Glasgow coma score (GCS ≤8 presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS at 1 month post-injury or at death (whichever came earlier. Results: Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1% had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3-85 years. Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1-3 was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21 in patients with severe head injury without arterial infarct. Conclusions: A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-a-vis patient without these findings.

  18. Head injuries of Roman gladiators.

    Science.gov (United States)

    Kanz, Fabian; Grossschmidt, Karl

    2006-07-13

    Gladiator remains from a recently unearthed cemetery in ancient Ephesus (Turkey) offer a unique opportunity for proving common theories involving the weaponry and techniques of gladiator fighting based on the evidence supplied by cranial bones. This mass grave is the first of its kind to undergo a thorough osteological and forensic examination. A minimum number of individuals (MNI) analyses revealed that at least 68 individuals. All individuals found turned out to have been males aged between 20 and 30 years, except for one female associated with a female slave gravestone, and one male aged 45-55 years, had been buried in this area of the cemetery. The male mean body height was 168 cm (S.D.=5 cm), which lies inside the normal range of height for Roman populations at those times. Eleven (16% of MNI) individuals exhibit a total of 16 well-healed antemortal cranial traumata. Five of the 11 individuals showed multiple trauma. Ten (15% of MNI) individuals exhibited a total of 10 perimortal cranial traumata. This is a surprisingly high frequency of deadly head injuries, taking into account that most of the gladiator types wore helmets. A possible explanation could be the frequently reported deathblow technique used by the hammer-carrying death god "Dis Pater". The gladiator weaponry is well known through historical sources. At least one injury per known type of offensive weapon could be identified, as well as evidence for the most popular, the gladiator trident, which was found to be represented by one perimortem and two antemortem injuries. Overall the reportedly very strict nature of combat rules for gladiator fights could be confirmed by the absence of multiple perimortal traumatized individuals, showing a lack of the excessive violence commonly observed on medieval battle ground victims. This graveyard gives the opportunity to confirm historical aspects and to check the reliability of forensic methods for identification of antemortem, perimortem, or postmortem bone

  19. Catastrophic head injuries in high school and college football players.

    Science.gov (United States)

    Boden, Barry P; Tacchetti, Robin L; Cantu, Robert C; Knowles, Sarah B; Mueller, Frederick O

    2007-07-01

    Catastrophic head injuries in football are rare but tragic events. To update the profile of catastrophic head injuries in high school and college football players and to describe relevant risk factors. Case series; Level of evidence, 4. We reviewed 94 incidents of severe football head injuries reported to the National Center for Catastrophic Sports Injury Research during 13 academic years (September 1989 through June 2002). In the study period there were an average of 7.23 (standard deviation = 2.05) direct high school and college catastrophic head injuries in scholastic football participants per year. There were 0.67 injuries per 100 000 (95% confidence interval: 0.54, 0.81 per 100 000) high school and 0.21 injuries per 100 000 (95% confidence interval: 0.0, 0.49 per 100 000) college participants for a risk ratio of 3.28 (95% confidence interval: 0.81, 13.3). The injuries resulted in subdural hematoma in 75 athletes, subdural hematoma with diffuse brain edema in 10 athletes, diffuse brain edema in 5 athletes, and arteriovenous malformation or aneurysm in 4 athletes. Fifty-nine percent of the contacts reported that the athlete had a history of a previous head injury, of which 71% occurred within the same season as the catastrophic event. Thirty-nine percent of the athletes (21 of 54) were playing with residual neurologic symptoms from the prior head injury. There were 8 (9%) deaths as a result of the injury, 46 (51%) permanent neurologic injuries, and 36 (40%) serious injuries with full recovery. Most players sustained a major impact to the head either from tackling or being tackled. The incidence of catastrophic head injuries in football has remained low since the advent of the modern day football helmet in the early 1970s. The incidence of catastrophic head injuries in football is dramatically higher at the high school level than at the college level. Although the reason for this discrepancy is unclear, an unacceptably high percentage of high school players were

  20. Nonuse of bicycle helmets and risk of fatal head injury: a proportional mortality, case-control study.

    Science.gov (United States)

    Persaud, Navindra; Coleman, Emily; Zwolakowski, Dorothy; Lauwers, Bert; Cass, Dan

    2012-11-20

    The effectiveness of helmets at preventing cycling fatalities, a leading cause of death among young adults worldwide, is controversial, and safety regulations for cycling vary by jurisdiction. We sought to determine whether nonuse of helmets is associated with an increased risk of fatal head injury. We used a case-control design involving 129 fatalities using data from a coroner's review of cycling deaths in Ontario, Canada, between 2006 and 2010. We defined cases as cyclists who died as a result of head injuries; we defined controls as cyclists who died as a result of other injuries. The exposure variable was nonuse of a bicycle helmet. Not wearing a helmet while cycling was associated with an increased risk of dying as a result of sustaining a head injury (adjusted odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.3). We saw the same relationship when we excluded people younger than 18 years from the analysis (adjusted OR 3.5, 95% CI 1.4-8.5) and when we used a more stringent case definition (i.e., only a head injury with no other substantial injuries; adjusted OR 3.6, 95% CI 1.2-10.2). Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury. Policy changes and educational programs that increase the use of helmets while cycling may prevent deaths.

  1. Nonuse of bicycle helmets and risk of fatal head injury: a proportional mortality, case–control study

    Science.gov (United States)

    Persaud, Navindra; Coleman, Emily; Zwolakowski, Dorothy; Lauwers, Bert; Cass, Dan

    2012-01-01

    Background: The effectiveness of helmets at preventing cycling fatalities, a leading cause of death among young adults worldwide, is controversial, and safety regulations for cycling vary by jurisdiction. We sought to determine whether nonuse of helmets is associated with an increased risk of fatal head injury. Methods: We used a case–control design involving 129 fatalities using data from a coroner’s review of cycling deaths in Ontario, Canada, between 2006 and 2010. We defined cases as cyclists who died as a result of head injuries; we defined controls as cyclists who died as a result of other injuries. The exposure variable was nonuse of a bicycle helmet. Results: Not wearing a helmet while cycling was associated with an increased risk of dying as a result of sustaining a head injury (adjusted odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3–7.3). We saw the same relationship when we excluded people younger than 18 years from the analysis (adjusted OR 3.5, 95% CI 1.4–8.5) and when we used a more stringent case definition (i.e., only a head injury with no other substantial injuries; adjusted OR 3.6, 95% CI 1.2–10.2). Interpretation: Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury. Policy changes and educational programs that increase the use of helmets while cycling may prevent deaths. PMID:23071369

  2. [Mild head injuries in the elderly].

    Science.gov (United States)

    Thaler, Heinrich W; Jung-Schmidsfeld, Jochen; Pienaar, Simon

    2017-07-01

    In the elderly, particularly those over 80 years old, head injuries often occur as a result of falls. The majority suffer from mild head injury. After clarification of the initial symptoms in these patients, the main aim is to recognize or exclude intracranial injuries (bleeding). Demonstration of intracranial bleeding is possible with cranial computed tomography (CCT), which in contrast to magnetic resonance imaging (MRI) can be quickly carried out in most cases; however, most patients with mild head injury show no intracranial bleeding. The performance of CCT and the often necessary hospital admission place a severe physical and psychological burden on the elderly. The plasma parameter S100B, combined with the clinical findings, is a valuable instrument for decision making in the management of elderly patients with mild head injury.

  3. Prognosis of severe head injuries.

    Science.gov (United States)

    Levati, A; Farina, M L; Vecchi, G; Rossanda, M; Marrubini, M B

    1982-12-01

    The authors have analyzed retrospectively a series of 288 consecutive patients with severe head injury observed between January, 1977, and May, 1980. Seventy-three patients were excluded as not being compatible with those of the International Data Bank. The remaining 215 patients complied with the definition of coma given by Jennett. All patients, after appropriate cardiopulmonary resuscitation, diagnostic measures, and, when required, surgical treatment, were managed in the Neurosurgical Intensive Care Unit with endotracheal intubation, controlled hyperventilation, mild dehydration, dexamethasone in standard doses, and sedation. The mortality rate was 39.5%. Of the survivors, 59.2% made a good recovery, 18.4% remained moderately disabled, 6.1% were severely disabled, and 1.5% were in a persistent vegetative state. The most reliable predictive criteria were: absence of brain-stem reflexes, neurological status, abnormal motor patterns, arterial hypotension, and presence of mass lesions. It is concluded that no sign has an absolute prognostic value when considered independently of its time course.

  4. Head Injury, from Men to Model

    OpenAIRE

    Brink, Willem Aart

    2000-01-01

    textabstractIn well developed countries, injury is the leading cause of death and disability among young adults. In less developed countries the incidence of injury is high and rapidly increasing, but the relative mortality due to injuries is overshadowed by other causes, such as infections and malnutrition. In the United States of America each year approximately 1.000.000 people are treated and released from hospital emergency departments because of head injury. About 80% of patients receivi...

  5. Early tracheostomy in closed head injuries: experience at a tertiary center in a developing country – a prospective study

    Directory of Open Access Journals (Sweden)

    Priyambada Binita

    2005-10-01

    Full Text Available Abstract Background An important factor contributing to the high mortality in patients with severe head trauma is cerebral hypoxia. The mechanical ventilation helps both by reduction in the intracranial pressure and hypoxia. Ventilatory support is also required in these patients because of patient's inability to protect the airway, persistence of excessive secretions, and inadequacy of spontaneous ventilation. Prolonged endotracheal intubation is however associated with trauma to the larynx, trachea, and patient discomfort in addition to requirement of sedatives. Tracheostomy has been found to play an integral role in the airway management of such patients, but its timing remains subject to considerable practice variation. In a developing country like India where the intensive care facilities are scarce and rarely available, these critical patients have to be managed in high dependency cubicles in the ward, often with inadequately trained nursing staff and equipment to monitor them. An early tracheostomy in the selected group of patients based on Glasgow Coma Score(GCS may prove to be life saving.Against this background a prospective study was contemplated to assess the role of early tracheostomy in patients with isolated closed head injury. Methods The series consisted of a cohort of 50 patients admitted to the surgical emergency with isolated closed head injury, that were not considered for surgery by the neuro-surgeon or shifted to ICU, but had GCS score of less than 8 and SAPS II score of more than 50. First 50 case records from January 2001 that fulfilled the criteria constituted the control group. The patients were managed as per ATLS protocol and intubated if required at any time before decision to perform tracheostomy was taken. These patients were serially assessed for GCS (worst score of the day as calculated by senior surgical resident and SAPS scores till day 15 to chart any changes in their status of head injuries and predictive

  6. Injuries to the head and neck in Homer's Odyssey.

    Science.gov (United States)

    Stathopoulos, Panagiotis; Ghaly, Ghaly Adly; Azari, Afroditi

    2016-07-01

    The Odyssey and the Iliad are the most prominent works of ancient Greek epic poetry, and we have retrieved injuries to the head and neck mentioned in the Odyssey. We studied the texts both in ancient Greek and the translations in modern Greek and English and searched for references to trauma to the head and neck. We recorded the injuries, the attacker and defender, the weapons used, the site, and the result. There were 11 injuries of the head and neck, nine of which were fatal. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Mechanics of blast loading on the head models in the study of traumatic brain injury using experimental and computational approaches.

    Science.gov (United States)

    Ganpule, S; Alai, A; Plougonven, E; Chandra, N

    2013-06-01

    Blast waves generated by improvised explosive devices can cause mild, moderate to severe traumatic brain injury in soldiers and civilians. To understand the interactions of blast waves on the head and brain and to identify the mechanisms of injury, compression-driven air shock tubes are extensively used in laboratory settings to simulate the field conditions. The overall goal of this effort is to understand the mechanics of blast wave-head interactions as the blast wave traverses the head/brain continuum. Toward this goal, surrogate head model is subjected to well-controlled blast wave profile in the shock tube environment, and the results are analyzed using combined experimental and numerical approaches. The validated numerical models are then used to investigate the spatiotemporal distribution of stresses and pressure in the human skull and brain. By detailing the results from a series of careful experiments and numerical simulations, this paper demonstrates that: (1) Geometry of the head governs the flow dynamics around the head which in turn determines the net mechanical load on the head. (2) Biomechanical loading of the brain is governed by direct wave transmission, structural deformations, and wave reflections from tissue-material interfaces. (3) Deformation and stress analysis of the skull and brain show that skull flexure and tissue cavitation are possible mechanisms of blast-induced traumatic brain injury.

  8. On Impact: Students with Head Injuries

    Science.gov (United States)

    Canto, Angela I.; Chesire, David J.; Buckley, Valerie A.

    2011-01-01

    Students with head injuries may not be as "low incidence" as previously believed. Recent efforts from the American Academy of Pediatrics (2010), the National Football League, and other agencies are attempting to raise awareness of traumatic brain injury (TBI) among students. Along with awareness, there has been an increased publicity effort via…

  9. Chest Injuries Associated with Head Injury

    African Journals Online (AJOL)

    .[4,5] The presence of injuries that contribute to early secondary brain injury by the presence of hypoxemia. (<60 mmHg or 8 kPa) or hypotension (systolic blood pressure. <90 mmHg) on admission has been used to predict 6-month mortality ...

  10. Preschool Children with Head Injury: Comparing Injury Severity Measures And Clinical Care

    Science.gov (United States)

    Youngblut, JoAnne M.; Caicedo, Carmen; Brooten, Dorothy

    2014-01-01

    The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head injuries only, 20% had other fractures, 5% had organ damage, and 7% had all three. Injury severity was measured by head AIS and GCS scores. Treatments and procedures included tubes/lines, blood/blood products, and medications. Children with head injuries only had fewer hospital days, less severe head injuries, and near normal GCS scores. They were less likely to have tubes/lines and medications. Children were discharged with medications (61%) and medical equipment (14%). Five children were discharged to long-term care facilities, and five were discharged to rehabilitation facilities. Concordance of head AIS and GCS categories occurred for only 50 (28%) children. Although the GCS is the gold standard for identifying changes in neurological status, it was not as helpful in representing hospital care. Head AIS injury categories clustered children in more homogeneous groups and better represented hospital care. Head AIS categories are better indicators of injury severity and care provided than GCS. Head injury AIS score may be an important addition to GCS for guiding care. PMID:24640315

  11. Head Injury as Risk Factor for Psychiatric Disorders

    DEFF Research Database (Denmark)

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

    2014-01-01

    OBJECTIVE: Studies investigating the relationship between head injury and subsequent psychiatric disorders often suffer from methodological weaknesses and show conflicting results. The authors investigated the incidence of severe psychiatric disorders following hospital contact for head injury....... 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...

  12. Anabolic steroids and head injury.

    Science.gov (United States)

    Mills, James D; Bailes, Julian E; Turner, Ryan C; Dodson, Sean C; Sakai, Jun; Maroon, Joseph C

    2012-01-01

    The suggestion has been made that neurological changes seen in the syndrome of chronic traumatic encephalopathy may be due to exogenous anabolic steroid use rather than traumatic brain injury. To determine whether administration of anabolic steroids alters the pathophysiology of traumatic brain injury. Sixty adult male Sprague-Dawley rats and a linear acceleration model of traumatic brain injury were used. Experimental groups were (1) preinjury anabolic steroids, (2) preinjury placebo carrier, (3) anabolic steroids without injury, (4) no steroids and no injury, (5) postinjury placebo carrier, and (6) postinjury anabolic steroids. Following a 30-day recovery, rats were euthanized, and brainstem white matter tracts underwent fluorescent immunohistochemical processing and labeling of β-amyloid precursor protein (APP), a marker of axonal injury. Digital imaging and statistical analyses were used to determine whether anabolic steroid administration resulted in a significant change in the number of injured axons. There was no statistically significant difference in number of APP-positive axons by immunohistochemical analysis between respective anabolic steroid and placebo groups. Using a standard acceleration-deceleration model of mild traumatic brain injury, we have shown successful visualization of traumatically injured axons with antibody staining of APP. Our results indicate no statistically significant effect of anabolic steroids on the number of APP-positive axons. With the use of this model, and within its limitations, we see no adverse effect or causative role of anabolic steroid administration on the brain following mild traumatic brain injury using APP counts as a marker for anatomic injury.

  13. Effects of external helmet accessories on biomechanical measures of head injury risk: An ATD study using the HYBRIDIII headform.

    Science.gov (United States)

    Butz, Robert C; Knowles, Brooklynn M; Newman, James A; Dennison, Christopher R

    2015-11-05

    Competitive cycling is a popular activity in North America for which injuries to the head account for the majority of hospitalizations and fatalities. In cycling, use of helmet accessories (e.g. cameras) has become widespread. As a consequence, standards organizations and the popular media are discussing the role these accessories could play in altering helmet efficacy and head injury risk. We conducted impacts to a helmeted anthropomorphic headform, with and without camera accessories, at speeds of 4m/s and 6m/s, and measured head accelerations, forces on the head-form skull, and used the Simulated Injury Monitor to estimate brain tissue strain. The presence of the camera reduced peak linear head acceleration (51% - 4m/s impacts, 61% - 6m/s, p0.05) as were velocities (77%, p0.05) in 6m/s impacts with the camera accessory. Based on CSDM-25 for 4m/s tests, the risk of severe concussion was reduced (p0.05) from 18% (no camera) to 58% (camera). Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. A population-based study of survival and discharge status for survivors after head injury

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Teasdale, T W

    2004-01-01

    were characterized by age, gender, place and severity of injury, as well as neurophysical, speech and mental deficits at discharge from hospital. RESULTS: Acute/subacute mortality of hospitalized patients was 27% for cerebral lesions and 4% after cranial fracture. As attrition by death outweighed....... There was no tendency with time of injury with regard to percentage occurrence of neurophysical, speech or mental deficits at discharge. The calculated number of candidates for rehabilitation of personal activities of daily life briefly after injury was 9.8 per 100 000 with cerebral lesion and 1.2 per 100 000...

  15. Informational needs in families after their child's mild head injury.

    Science.gov (United States)

    Falk, Ann-Charlotte; von Wendt, Lennart; Klang, Birgitta

    2008-02-01

    When a child is hospitalized due to an illness or injury, the entire family may experience stress and/or anxiety. According to parents who have been in such a situation, providing adequate information is one of the most valuable ways to help the family deal with such feelings. Most mild head injuries suffered by children do not require hospitalisation and in such cases, their families should be provided with appropriate information in connection with their visit to the emergency ward. In the present study, family informational needs are characterized. The families of 57 children who had suffered a mild head injury at 0-15 years of age answered one open-ended question. The analysis was carried out using content analysis. This analysis revealed two types of needs, i.e., a need for information concerning the head injury itself and how to provide care, as well as a need for reassurance and support in sharing and coping with the emotional burden. Despite differences in the severity of the child's head injury and requirement for hospitalisation, all the families expressed the same informational needs but also the need for emotional support. In connection with the treatment of children with head injuries, health-care personnel should provide the parents both with information concerning the injury and its treatment and with emotional support.

  16. PRACTICAL MANAGEMENT OF HEAD INJURY

    African Journals Online (AJOL)

    . 1. The airway is cleared of secretions, vomitus or other materials. The unconscious patient with a lot of secretions or craniofaciai injuries may require tracheal intubation. 2. Cervical spine is immobilized until cervical X-ray excludes spinal.

  17. Sports-related Head Injury

    Science.gov (United States)

    ... Snowboarding, Snowmobiling): 16,948 Horseback Riding: 14,466 Gymnastics/Dance/Cheerleading: 10,223 Golf: 10,035 Hockey: ... changes that are not picked up by CT. Brain Injury Symptoms Pain: Constant or recurring headache Motor ...

  18. Head injury is not a risk factor for multiple sclerosis: a prospective cohort study

    DEFF Research Database (Denmark)

    Pfleger, C C H; Koch-Henriksen, N; Stenager, E

    2009-01-01

    or to be refuted conclusively. OBJECTIVE: To determine whether head trauma is associated with an increased risk of developing MS. METHOD: A cohort of 150,868 subjects, 95,111 men, and 55,757 women registered in the National Danish Patient Registry with hospital admission for cerebral concussion, contusion...

  19. 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...

  20. Severe head injury in children: early prognosis and outcome.

    Science.gov (United States)

    Zuccarello, M; Facco, E; Zampieri, P; Zanardi, L; Andrioli, G C

    1985-01-01

    The outcome is reported in 62 children with severe head injuries following a road traffic accident. All patients were comatose for at least 6 h; all patients were graded using the Glasgow Coma Score (GCS) or the Children Coma Score (CCS). Fifty-four patients were comatose immediately after injury, 8 after a lucid interval. Thirty patients had isolated head injuries and 32 had associated injuries, either long bone fractures or rupture of an abdominal organ. Additional information concerning main brainstem reflexes, posture and respiration was included in the study. The overall mortality was 32%. The goal of the study was to identify those clinical features available soon after injury which are important indicators of treatment and outcome.

  1. Spinal cord injury and its association with blunt head trauma

    Directory of Open Access Journals (Sweden)

    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

  2. Venous injury in abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Arabinda K. [Nemours A. I. duPont Hospital for Children, Department of Radiology, Wilmington, DE (United States); Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

    2015-11-15

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  3. Computed tomography features of head injury in Ghanaian children ...

    African Journals Online (AJOL)

    Background: Injuries to the head are common in children. There are several reports in literature of head injury and evaluation with computed tomography scan (CT scan) but only a few focus on children. Method: A retrospective review of films and reports of the CT scans of 41 children with head injury. Results: Positive CT ...

  4. Helmets for preventing head and facial injuries in bicyclists.

    Science.gov (United States)

    Thompson, D C; Rivara, F P; Thompson, R

    2000-01-01

    Each year, in the United states, approximately 900 persons die from injuries due to bicycle crashes and over 500,000 persons are treated in emergency departments. Head injury is by far the greatest risk posed to bicyclists, comprising one-third of emergency department visits, two-thirds of hospital admissions, and three-fourths of deaths. Facial injuries to cyclists occur at a rate nearly identical to that of head injuries. Although it makes inherent sense that helmets would be protective against head injury, establishing the real-world effectiveness of helmets is important. A number of case-control studies have been conducted demonstrating the effectiveness of bicycle helmets. Because of the magnitude of the problem and the potential effectiveness of bicycle helmets, the objective of this review is to determine whether bicycle helmets reduce head, brain and facial injury for bicyclists of all ages involved in a bicycle crash or fall. To determine whether bicycle helmets reduce head, brain and facial injury for bicyclists of all ages involved in a bicycle crash or fall. We searched The Cochrane Controlled Trials Register, MEDLINE, EMBASE, Sport, ERIC, NTIS, Expanded Academic Index, CINAHL, PsycINFO, Occupational Safety and Health, and Dissertations Abstracts. We checked reference lists of past reviews and review articles, studies from government agencies in the United States, Europe and Australia, and contacted colleagues from the International Society for Child and Adolescent Injury Prevention, World Injury Network, CDC funded Injury Control and Research Centers, and staff in injury research agencies around the world. Controlled studies that evaluated the effect of helmet use in a population of bicyclists who had experienced a crash. We required that studies have complete outcome ascertainment, accurate exposure measurement, appropriate selection of the comparison group and elimination or control of factors such as selection bias, observation bias and confounding

  5. Association between head injury and helmet use in alpine skiers: cohort study from a Swiss level 1 trauma center.

    Science.gov (United States)

    Baschera, Dominik; Hasler, Rebecca M; Taugwalder, David; Exadaktylos, Aristomenis; Raabe, Andreas

    2015-04-15

    The association between helmet use during alpine skiing and incidence and severity of head injuries was analyzed. All patients admitted to a level 1 trauma center for traumatic brain injuries (TBIs) sustained from skiing accidents during the seasons 2000-2001 and 2010-2011 were eligible. Primary outcome was the association between helmet use and severity of TBI measured by Glasgow Coma Scale (GCS), computed tomography (CT) results, and necessity of neurosurgical intervention. Of 1362 patients injured during alpine skiing, 245 (18%) sustained TBI and were included. TBI was fatal in 3%. Head injury was in 76% minor (Glasgow Coma Scale, 13-15), 6% moderate, and 14% severe. Number and percentage of TBI patients showed no significant trend over the investigated seasons. Forty-five percent of the 245 patients had pathological CT findings and 26% of these required neurosurgical intervention. Helmet use increased from 0% in 2000-2001 to 71% in 2010-2011 (palpine skiers. Logistic regression analysis showed no significant difference in TBI with regard to helmet use, but increased risk for off-piste skiers. The limited protection of helmets and dangers of skiing off-piste should be targeted by prevention programs.

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

    NARCIS (Netherlands)

    M. Smits (Marion); G.C. Houston (Gavin); D.W.J. Dippel (Diederik); P.A. Wielopolski (Piotr); M.W. Vernooij (Meike); P.J. Koudstaal (Peter Jan); M.G.M. Hunink (Myriam); A. van der Lugt (Aad)

    2011-01-01

    textabstractIntroduction: 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

  7. Delayed epidural hematoma after mild head injury

    Directory of Open Access Journals (Sweden)

    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.

  8. Demographic Profile and Pathological Patterns of Head Injury in Albania

    OpenAIRE

    Sabri Hoxha; Bardhyl Çipi; Flamur Hoxha; Brunela Kullolli; Brela Xhaferaj; Alkerta Ibranji; Ervin Çerçiz Mingomataj

    2014-01-01

    Introduction: Head injury (HI) is a serious morbid state caused by structural changes of the scalp, skull, and/or its contents, due to mechanical forces. Generally, the most frequent cause of HI is road traffic accident (RTA), followed by homicidal and falling injuries. The aim of present study is to assess epidemiology data, causes and patterns responsible for HI among Albanian subjects. Methodology: All HI cases (1000) are collected by the Forensic Institute of Albania, based on medical and...

  9. Radial head fracture associated with posterior interosseous nerve injury

    Directory of Open Access Journals (Sweden)

    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.

  10. 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

  11. On-the-field management of athletic head injuries.

    Science.gov (United States)

    Durand, Pierre; Adamson, Gregory J

    2004-01-01

    Head injuries are prevalent in collision sports. Concussions represent the relatively benign end of the spectrum of injuries. Severe closed head injuries include epidural hematomas, acute subdural hematomas, intracerebral hematomas, intraventricular hematomas, subarachnoid hemorrhages, and diffuse axonal injuries. Second impact syndrome represents a severe cerebral autoregulatory dysfunction that can lead to death in an athlete who sustains a second (often minor) closed head trauma while still symptomatic from a previous head injury. Generally, athletes who have suffered a severe closed head injury should not return to play. Exceptions include athletes asymptomatic for 1 year who return to a noncontact sport and those who recover completely from an epidural hematoma without underlying brain injury. Several guidelines for returning athletes to play have been proposed and are commonly used. The team physician has the responsibility of on-the-field evaluation and management of athletes with head injuries, as well as of advising them when it is safe to return to play.

  12. Evaluation of Head and Brain Injury Risk Functions Using Sub-Injurious Human Volunteer Data.

    Science.gov (United States)

    Sanchez, Erin J; Gabler, Lee F; McGhee, James S; Olszko, Ardyn V; Chancey, V Carol; Crandall, Jeff R; Panzer, Matthew B

    2017-08-15

    Risk assessment models are developed to estimate the probability of brain injury during head impact using mechanical response variables such as head kinematics and brain tissue deformation. Existing injury risk functions have been developed using different datasets based on human volunteer and scaled animal injury responses to impact. However, many of these functions have not been independently evaluated with respect to laboratory-controlled human response data. In this study, the specificity of 14 existing brain injury risk functions was assessed by evaluating their ability to correctly predict non-injurious response using previously conducted sled tests with well-instrumented human research volunteers. Six degrees-of-freedom head kinematics data were obtained for 335 sled tests involving subjects in frontal, lateral, and oblique sled conditions up to 16 Gs peak sled acceleration. A review of the medical reports associated with each individual test indicated no clinical diagnosis of mild or moderate brain injury in any of the cases evaluated. Kinematic-based head and brain injury risk probabilities were calculated directly from the kinematic data, while strain-based risks were determined through finite element model simulation of the 335 tests. Several injury risk functions substantially over predict the likelihood of concussion and diffuse axonal injury; proposed maximum principal strain-based injury risk functions predicted nearly 80 concussions and 14 cases of severe diffuse axonal injury out of the 335 non-injurious cases. This work is an important first step in assessing the efficacy of existing brain risk functions and highlights the need for more predictive injury assessment models.

  13. 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...

  14. The Effect of Various Types of Motorcycle Helmets on Cervical Spine Injury in Head Injury Patients: A Multicenter Study in Taiwan

    Science.gov (United States)

    Lin, Mau-Roung; Chu, Shu-Fen; Tsai, Shin-Han; Bai, Chyi-Huey; Chiu, Wen-Ta

    2015-01-01

    Introduction. The relationship between cervical spine injury (CSI) and helmet in head injury (HI) patients following motorcycle crashes is crucial. Controversy still exists; therefore we evaluated the effect of various types of helmets on CSI in HI patients following motorcycle crashes and researched the mechanism of this effect. Patients and Methods. A total of 5225 patients of motorcycle crashes between 2000 and 2009 were extracted from the Head Injury Registry in Taiwan. These patients were divided into case and control groups according to the presence of concomitant CSI. Helmet use and types were separately compared between the two groups and the odds ratio of CSI was obtained by using multiple logistic regression analysis. Results. We observed that 173 (3.3%) of the HI patients were associated with CSI. The HI patients using a helmet (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.19−0.49), full-coverage helmet (0.19, 0.10−0.36), and partial-coverage helmet (0.35, 0.21−0.56) exhibited a significantly decreased rate of CSI compared with those without a helmet. Conclusion. Wearing full-coverage and partial-coverage helmets significantly reduced the risk of CSI among HI patients following motorcycle crashes. This effect may be due to the smooth surface and hard padding materials of helmet. PMID:25705663

  15. Severe head injury in children - a preventable but forgotten epidemic

    African Journals Online (AJOL)

    with severe head injuries to the trauma unit of Red Cross. War Memorial Hospital during the last 4 years. Our goal was ... biochemical monitoring, measurement of arterial oxygen and carbon dioxide, fluid restriction and anticonvulsant ... patients doomed to a poor quality of life. The results of this study were then analysed ...

  16. Accidental and Nonaccidental Head Injuries in Infants: Distinguishing Characteristics

    Directory of Open Access Journals (Sweden)

    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.

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

    African Journals Online (AJOL)

    2011-04-15

    Apr 15, 2011 ... modality in the investigation of these cases. However, literature on this subject ... Materials and Methods: A prospective study involving patients with head injury referred for CT scan from the Accident and Emergency Unit of .... restricted access due to cost, distance to facility/location, and lack of awareness of ...

  18. Social Cognition after Head Injury: Sarcasm and Theory of Mind

    Science.gov (United States)

    Channon, S.; Pellijeff, A.; Rule, A.

    2005-01-01

    Closed head injury (CHI) is associated with communication difficulties in everyday social interactions. Previous work has reported impaired comprehension of sarcasm, using sarcastic remarks where the intended meaning is the opposite of the sincere or literal meaning. Participants with CHI in the present study were assessed using two types of…

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

    African Journals Online (AJOL)

    Background: Head injuries rank high among morbidities due to trauma. Computerised tomography is an important modality in the investigation of these cases. However, literature on this subject in the south.south geopolitical zone of Nigeria is sparse. This study therefore aimed to document the computerized tomographic ...

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  2. Pilot study of the effects of mixed light touch manual therapies on active duty soldiers with chronic post-traumatic stress disorder and injury to the head.

    Science.gov (United States)

    Davis, Lauren; Hanson, Brenda; Gilliam, Sara

    2016-01-01

    This pilot study was designed to examine the effects of mixed Light Touch Manual Therapies (LTMT) on headache, anxiety and other symptoms suffered by active duty United States service members experiencing chronic Post-Traumatic Stress Disorder (PTSD). Ten service members diagnosed with PTSD and having a self-reported injury to the head acquired at least two years prior, were provided with two hour-long sessions of mixed LTMT given a week apart. Data to assess the immediate and durable effects were gathered before and after the LTMT sessions. Results indicate that headache, anxiety, and pain interference were significantly reduced during the course of the pilot study. This suggests that mixed LTMT may be helpful in reducing some of the symptoms of PTSD and injury to the head. Further studies will be needed to determine if LTMT is an effective non-pharmacological treatment for headache, anxiety or other problems associated with PTSD or injury to the head. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Delayed coma in head injury : Consider cerebral fat embolism

    NARCIS (Netherlands)

    Metting, Zwany; Rodriger, Lars A.; Regtien, Joost G.; van der Naalt, Joukje

    Objective: To describe a case of a young man with delayed coma after mild head injury, suggestive of cerebral fat embolism (CFE). To underline the value of MR imaging in the differential diagnosis of secondary deterioration in mild head injury. Case report: A 21-year-old man admitted with mild head

  4. Nonmissile Penetrating Injury to the Head: Experience with 17 Cases.

    Science.gov (United States)

    Chowdhury, Forhad H; Haque, Mohammod Raziul; Hossain, Zahed; Chowdhury, Noman Khaled; Alam, Sarwar Murshed; Sarker, Mainul Haque

    2016-10-01

    Penetrating nonmissile injuries to the head are far less common than missile penetrating injuries. Here we describe our experience in managing 17 cases of nonmissile injury to the head, likely the largest such series reported to date. We also highlight the surgical steps and techniques used to remove in situ objects (including weapons) in the penetrating wounds that have not been described previously. We conducted a retrospective study of cases of nonmissile, low-velocity penetrating injuries of the head managed in our department. The recorded data of patients with penetrating head injuries were studied for the cause of the injury, type of object, type and extent of penetration, Glasgow Coma Scale score on admission, other clinical issues, evaluation and assessment, interval from penetration to operation, surgical steps and notes, difficulty during the operation, major and minor complications, follow-up, and ultimate outcome. Our 17 cases included 6 cases of accidental penetration and 11 cases of penetration as the result of violence. Weapons and other foreign objects causing injury included a teta (a pointed metal weapon with a wooden handle and a barb near the tip, used for hunting and fishing) in 4 cases, a dao (a sharp metal cutting instrument with a wooden handle used for cutting vegetables, fish, meat, bamboo, wood, etc.) in 3 cases, a bamboo stick in 3 cases, a metal rod in 2 cases, a knife in 2 cases, a sharp stone in 1 case, a metal steam chamber cover in 1 case, and a long peg in 1 case. GCS on admission was between 13 and 15 in 15 cases. Only 1 patient exhibited limb weakness. Four patients with an orbitocranial penetrating injury had 1-sided vision loss; 2 of these patients had orbital evisceration, and 1 of these patients died. In 14 patients, the foreign object was in situ at presentation and was removed surgically. Computed tomography scan and plain X-ray of the head were obtained in all patients. Postoperatively, 2 patients (11.7%) needed support in

  5. 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

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

    Science.gov (United States)

    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

  7. Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.

    LENUS (Irish Health Repository)

    Ghori, Kamran A

    2012-02-03

    BACKGROUND: Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome. DESIGN: 28 patients with severe head injury (Glasgow Coma Score <9) who required sedation and ventilation were randomly assigned to receive midazolam (n =15) or propofol (n = 13) based sedation. Blood samples were drawn daily for 5 days for estimation of S100beta and NO concentrations. Neurological outcome was assessed 3 months later as good (Glasgow Outcome Score [GOS], 4-5) or poor (GOS, 1-3). RESULTS: A good neurological outcome was observed in 8\\/15 patients (53%) in the midazolam group and 7\\/13 patients (54%) in the propofol group. Patients with a poor outcome had higher serum S100beta concentrations on ICU admission and on Days 1-4 in the ICU than those with a good outcome (mean [SD] on Day 1, 0.99 [0.81] v 0.41 [0.4] microg\\/L; Day 2, 0.80 [0.81] v 0.41 [0.24] microg\\/L; Day 3, 0.52 [0.55] v 0.24 [0.25] microg\\/L; and Day 4, 0.54 [0.43] v 0.24 [0.35] microg\\/L; P<0.05). There was no significant difference on Day 5. Plasma NO concentrations were not associated with outcome. In subgroup analysis, there was no difference in S100beta and NO concentrations between patients with a good outcome versus those with a poor outcome in either the midazolam or propofol group. CONCLUSIONS: Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.

  8. Effect of Helmet Use on Traumatic Brain Injuries and Other Head Injuries in Alpine Sport.

    Science.gov (United States)

    Bailly, Nicolas; Laporte, Jean-Dominique; Afquir, Sanae; Masson, Catherine; Donnadieu, Thierry; Delay, Jean-Baptiste; Arnoux, Pierre-Jean

    2018-01-31

    Sport helmet effectiveness in preventing traumatic brain injury (TBI) has been repeatedly questioned. This study assesses the effect of helmet use on risk of TBI and other types of head injury (OTHI) in alpine sports. From 2012 to 2014, data on the injured population were collected by physicians in on-mountain clinics in 30 French ski resorts, and interviews were conducted on the slope to sample a noninjured control population. Two sets of cases (1425 participants with TBI and 1386 with OTHI) were compared with 2 sets of controls (2145 participants without injury and 40,288 with an injury to a body part other than the head). The effect of helmet use on the risk of TBI and OTHI was evaluated with a multivariate logistic regression adjusted for age, sex, sport, skill level, crash type, and crash location. Using participants without injury as control, we found that helmet wearers were less likely to sustain any head injury (odds ratio [OR] TBI = 0.65; OR OTHI = 0.42). When considering participants with an injury to another body part as control, the risk of OTHI was lower among helmet wearers (OR OTHI : 0.61). However, no significant effect was found for the risk of TBI. Participants with low skill levels, those aged 50 years, snowboarders, and those involved in collision and in snowpark accidents were at higher risk of head injury. This study confirms the effectiveness of helmets in protecting users from head injuries but questions their effects on TBI, especially concussion. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  9. 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.

  10. Isolated head injury is a cause of shock in pediatric trauma patients.

    Science.gov (United States)

    Gardner, Alison; Poehling, Katherine A; Miller, Chadwick D; Tooze, Janet A; Petty, John

    2013-08-01

    Current trauma resuscitation protocols from the American College of Surgeons, Committee on Trauma, recommend intravascular volume expansion to treat shock after major trauma, assuming that hemorrhage is present. However, this assumption may not be correct. The purpose of this study was to identify the proportion of children with severe shock after trauma presenting with isolated head injury versus hemorrhagic injury. A retrospective review of all pediatric trauma patients (aged 0-15 years) was conducted over a 5-year period. Severe shock was defined as the presence of both an elevated blood lactate level and low blood pressure for age. Traumatic injuries were classified as hemorrhagic injuries, head injuries, combined hemorrhagic and head injuries, or other injuries, by analyzing International Classification of Diseases, Ninth Revision diagnostic codes. A total of 31 (5%) of 680 pediatric trauma patients presented with severe shock. Among these 31 pediatric trauma patients, 9 (29%) had isolated head injury. Isolated head injury among children with shock was most frequently observed among children younger than 5 years (50%), and a decreased trend was noted with increasing age (23% for children 5-11 years and 0% for children 12-15 years [P = 0.03, Cochran-Armitage exact trend test]). Isolated head injury was observed in 29% of children 0 to 15 years of age with severe shock after trauma and in 50% of children younger than 5 years. Head injury is an important cause of severe shock in pediatric trauma, particularly among young children.

  11. Does padded headgear prevent head injury in rugby union football?

    Science.gov (United States)

    McIntosh, Andrew S; McCrory, Paul; Finch, Caroline F; Best, John P; Chalmers, David J; Wolfe, Rory

    2009-02-01

    Concussion is a serious problem in many contact sports, including rugby union football. The study's primary aim was to measure the efficacy of padded headgear in reducing the rates of head injury or concussion. A cluster randomized controlled trial with three arms was conducted with rugby union football teams as the unit of randomization. Teams consisted of males participating in under 13-, 15-, 18-, and 20-yr age group competitions. The interventions were "standard" and "modified" padded headgear. Headgear wearing and injury were measured for each study team at each game over two seasons. Eighty-two teams participated in year 1 and 87 in year 2. A total of 1493 participants (10,040 player hours) were in the control group, 1128 participants (8170 player hours) were assigned to the standard headgear group, and 1474 participants (10,650 player hours) were assigned to the modified headgear group. The compliance rates were low in all groups, but 46% of participants wore standard headgear. An intention-to-treat analysis showed no differences in the rates of head injury or concussion between controls and headgear arms. Incidence rate ratios for standard headgear wearers referenced to controls were 0.95 and 1.02 for game and missed game injuries. Analyses of injury rates based on observed wearing patterns also showed no significant differences. Incidence rate ratios for standard headgear wearers referenced to nonwearers were 1.11 and 1.10 for game and missed game injuries. Padded headgear does not reduce the rate of head injury or concussion. The low compliance rates are a limitation. Although individuals may choose to wear padded headgear, the routine or mandatory use of protective headgear cannot be recommended.

  12. Head injury patterns in helmeted and non-helmeted cyclists admitted to a London Major Trauma Centre with serious head injury.

    Directory of Open Access Journals (Sweden)

    Anna E Forbes

    Full Text Available Cycle use across London and the UK has increased considerably over the last 10 years. With this there has been an increased interest in cycle safety and injury prevention. Head injuries are an important cause of mortality and morbidity in cyclists. This study aimed to ascertain the frequency of different head injury types in cyclists and whether wearing a bicycle helmet affords protection against specific types of head injury.A retrospective observational study of all cyclists older than 16 years admitted to a London Major Trauma Centre between 1st January 2011 and 31st December 2015 was completed. A cohort of patients who had serious head injury was identified (n = 129. Of these, data on helmet use was available for 97. Comparison was made between type of injury frequency in helmeted and non-helmeted cyclists within this group of patients who suffered serious head injury.Helmet use was shown to be protective against intracranial injury in general (OR 0.2, CI 0.07-0.55, p = 0.002. A protective effect against subdural haematoma was demonstrated (OR 0.14, CI 0.03-0.72, p = 0.02. Wearing a helmet was also protective against skull fractures (OR 0.12, CI 0.04-0.39, p<0.0001 but not any other specific extracranial injuries. This suggests that bicycle helmets are protective against those injuries caused by direct impact to the head. Further research is required to clarify their role against injuries caused by shearing forces.In a largely urban environment, the use of cycle helmets appears to be protective for certain types of serious intra and extracranial head injuries. This may help to inform future helmet design.

  13. Current topics in sports-related head injuries: a review.

    Science.gov (United States)

    Nagahiro, Shinji; Mizobuchi, Yoshifumi

    2014-01-01

    We review the current topic in sports-related head injuries including acute subdural hematoma (ASDH), concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football in the USA and judo in Japan. It is thought that rotational acceleration is most likely to produce not only cerebral concussion but also ASDH due to the rupture of a parasagittal bridging vein, depending on the severity of the rotational acceleration injury. Repeated sports head injuries increase the risk for future concussion, cerebral swelling, ASDH or CTE. To avoid fatal consequences or CTE resulting from repeated concussions, an understanding of the criteria for a safe post-concussion return to play (RTP) is essential. Once diagnosed with a concussion, the athlete must not be allowed to RTP the same day and should not resume play before the concussion symptoms have completely resolved. If brain damage has been confirmed or a subdural hematoma is present, the athlete should not be allowed to participate in any contact sports. As much remains unknown regarding the pathogenesis and pathophysiology of sports-related concussion, ASDH, and CTE, basic and clinical studies are necessary to elucidate the crucial issues in sports-related head injuries.

  14. Head injury at a tertiary referral centre in the Eastern Region of Nepal

    African Journals Online (AJOL)

    Background: The purpose of this epidemiologic study was to determine the pattern and characteristics of head injuries and to establish an epidemiologic data bank for designing preventive strategies for head injuries in the eastern region of Nepal. Patients and Methods: This retrospective review was done at B.P.Koirala ...

  15. 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…

  16. The study protocol for the Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics.

    Science.gov (United States)

    Garner, Alan A; Fearnside, Michael; Gebski, Val

    2013-09-14

    The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely lacking however. In particular the efficacy of early anaesthesia/muscle relaxant assisted intubation has proved difficult to substantiate. This article describes the design and protocol of the Head Injury Retrieval Trial (HIRT) which is a randomised controlled single centre trial of physician prehospital care (delivering advanced interventions such as rapid sequence intubation and blood transfusion) in addition to paramedic care for severe blunt TBI compared with paramedic care alone. Primary endpoint is Glasgow Outcome Scale score at six months post injury. Issues with trial integrity resulting from drop ins from standard care to the treatment arm as the result of policy changes by the local ambulance system are discussed. This randomised controlled trial will contribute to the evaluation of the efficacy of advance prehospital interventions in severe blunt TBI. ClinicalTrials.gov: NCT00112398.

  17. Falls in young children with minor head injury: A prospective analysis of injury mechanisms.

    Science.gov (United States)

    Samuel, Nir; Jacob, Ron; Eilon, Yael; Mashiach, Tania; Shavit, Itai

    2015-01-01

    Fall is a common mechanism of injury (MOI) in young children and an important risk factor for traumatic brain injury (TBI). Most children who fall have a minor head injury (MHI), defined as a blunt head trauma that occurred in a patient who is conscious and responsive. To seek a possible association between MOI and injury severity. A single centre cohort study was conducted. Data were collected on patients aged 0-2 years with MHI. Clinically-significant TBI (csTBI), defined as head injury resulting in death, intubation or neurosurgery, was the primary outcome measure. Traumatic finding on CT scan (TFCT) was the secondary outcome measure. Five hundred and ninety-five patients were analysed. Eight types of falls were identified: from ground-level, down stairs, from a bed, from a changing table, from furniture, from adult-hold, from a playground-device and from a stroller/baby-carriage. One patient (0.16%) had csTBI. Thirty-one (5.2%) underwent CT scans, TFCT was diagnosed in 17 (2.8%) patients; 10 (1.7%) linear skull-fractures, two (0.3%) depressed skull-fractures and five (0.8%) intracranial haemorrhages. Regression analysis did not reveal a statistically significant association between any of the MOI and the presence of TFCT. The risk for csTBI was low and no association was found between MOI and injury severity.

  18. 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.

  19. Experimental Injury Biomechanics of the Pediatric Head and Brain

    Science.gov (United States)

    Margulies, Susan; Coats, Brittany

    Traumatic brain injury (TBI) is a leading cause of death and disability among children and young adults in the United States and results in over 2,500 childhood deaths, 37,000 hospitalizations, and 435,000 emergency department visits each year (Langlois et al. 2004). Computational models of the head have proven to be powerful tools to help us understand mechanisms of adult TBI and to determine load thresholds for injuries specific to adult TBI. Similar models need to be developed for children and young adults to identify age-specific mechanisms and injury tolerances appropriate for children and young adults. The reliability of these tools, however, depends heavily on the availability of pediatric tissue material property data. To date the majority of material and structural properties used in pediatric computer models have been scaled from adult human data. Studies have shown significant age-related differences in brain and skull properties (Prange and Margulies 2002; Coats and Margulies 2006a, b), indicating that the pediatric head cannot be modeled as a miniature adult head, and pediatric computer models incorporating age-specific data are necessary to accurately mimic the pediatric head response to impact or rotation. This chapter details the developmental changes of the pediatric head and summarizes human pediatric properties currently available in the literature. Because there is a paucity of human pediatric data, material properties derived from animal tissue are also presented to demonstrate possible age-related differences in the heterogeneity and rate dependence of tissue properties. The chapter is divided into three main sections: (1) brain, meninges, and cerebral spinal fluid (CSF); (2) skull; and (3) scalp.

  20. 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.

  1. Severe head injury among children: prognostic factors and outcome.

    Science.gov (United States)

    Bahloul, Mabrouk; Ben Hamida, Chokri; Chelly, Hedi; Chaari, Adel; Kallel, Hatem; Dammak, Hassen; Rekik, Noureddine; Bahloul, Kamel; Ben Mahfoudh, Kheireddine; Hachicha, Mongia; Bouaziz, Mounir

    2009-05-01

    To determine predictive factors of mortality among children after traumatic brain injury. A retrospective study over 8 years of 222 children with severe head injury (Glasgow Coma Scale score road traffic accident (75.7%). Mean Glasgow Coma Scale score was 6+/-1.5, mean Injury Severity Score (ISS) was 28.2+/-6.9, mean Paediatric Trauma Score (PTS) was 3.7+/-2.1 and mean Paediatric Risk of Mortality (PRISM) was 14.3+/-8.5; 54 children (24.3%) died. Univariate analysis showed that low PTS on admission, high ISS or PRISM, presence of shock or meningeal haemorrhage or bilateral mydriasis, and serum glucose > 10 mmol l(-1) were associated with mortality rate. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 20 and bilateral mydriasis on admission. In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic accidents. Short-term prognosis is poor, with a high mortality rate (24.3%), and is influenced by demographic, clinical, radiological and biological factors.

  2. An unusual case of penetrating head injury in a child

    Directory of Open Access Journals (Sweden)

    Karim Tanweer

    2010-01-01

    Full Text Available Penetrating head injuries can be the result of numerous intentional or unintentional events, including missile wounds, stab wounds, and motor vehicle or occupational accidents (nails, screw-drivers. Penetrating head injuries in children constitute only a small part of the total number of traumatic head injuries seen in casualty. We report a case of neuro-trauma who was operated in our institution. Patient, 4 years male presented in casualty on 15/01/09 with a iron rod penetrating into the skull.

  3. Penetrating head injury from angle grinder: A cautionary tale

    OpenAIRE

    S SenthilKumaran; N Balamurgan; Arthanari, K; Thirumalaikolundusubramanian, P

    2010-01-01

    Penetrating cranial injury is a potentially life-threatening condition. Injuries resulting from the use of angle grinders are numerous and cause high-velocity penetrating cranial injuries. We present a series of two penetrating head injuries associated with improper use of angle grinder, which resulted in shattering of disc into high velocity missiles with reference to management and prevention. One of those hit on the forehead of the operator and the other on the occipital region of the co-w...

  4. An Independent, Prospective, Head to Head Study of the Reliability and Validity of Neurocognitive Test Batteries for the Assessment of Mild Traumatic Brain Injury

    Science.gov (United States)

    2013-03-01

    traumatic brain injury; concussion ; neurocognitive assessment 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a...Sports Concussion Arm, preseason baseline testing was conducted prior to the fall and winter sports seasons for soccer (men/women), field hockey ... hockey , field hockey , rugby, wrestling), football will provide the large quantity of both baseline testing participants and concussed athletes. 6

  5. Minor whiplash head injury with major debilitation.

    Science.gov (United States)

    Yarnell, P R; Rossie, G V

    1988-01-01

    A group of patients suffering major debility after minor whiplash head trauma, seen in one office practice, has been retrospectively studied. Typically, acute neck and upper back aches and headache evolved into a multiple somatic, affective and cognitive dysfunction syndrome. Neuropsychological evaluations noted impairments on tests of cognitive flexibility, non-verbal reasoning, new learning/memory, psychomotor agility, and attention. However, in the subacute period, neurological examination, imaging and clinical electrophysiological studies were unable to localize, structurally or functionally, the source of the above dysfunctions.

  6. Antiplatelet therapy: a double-edged sword in head injury?

    OpenAIRE

    Beynon, Christopher; Sakowitz, Oliver W

    2013-01-01

    Antiplatelet therapy for the treatment of cardiovascular diseases is common in the ageing population. Whether this therapy exacerbates brain injury after head trauma is an important, but unsettled, topic. In this issue of Critical Care, Fabbri and colleagues address the question of whether pre-injury intake of antiplatelet medication increases the risk profile of patients with posttraumatic intracranial lesions after head trauma. Antiplatelet medication, and in particular clopidogrel, increas...

  7. 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.

  8. Ultrasonic Nakagami-parameter characterization of parotid-gland injury following head-and-neck radiotherapy: A feasibility study of late toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Xiaofeng; Wu, Ning; Wang, Yuefeng [Radiation Oncology, Emory University, Atlanta, Georgia 30322 (United States); Tridandapani, Srini [Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia 30322 (United States); School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332 (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia 30322 (United States); Beitler, Jonathan J.; Yu, David S.; Curran, Walter J.; Liu, Tian, E-mail: tliu34@emory.edu [Radiation Oncology, Emory University, Atlanta, Georgia 30322 and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322 (United States); Bruner, Deborah W. [Radiation Oncology, Emory University, Atlanta, Georgia 30322 (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia 30322 (United States); School of Nursing, Emory University, Atlanta, Georgia 30322 (United States)

    2014-02-15

    Purpose: The study aims to investigate whether Nakagami parameters—estimated from the statistical distribution of the backscattered ultrasound radio-frequency (RF) signals—could provide a means for quantitative characterization of parotid-gland injury resulting from head-and-neck radiotherapy. Methods: A preliminary clinical study was conducted with 12 postradiotherapy patients and 12 healthy volunteers. Each participant underwent one ultrasound study in which ultrasound scans were performed in the longitudinal, i.e., vertical orientation on the bilateral parotids. For the 12 patients, the mean radiation dose to the parotid glands was 37.7 ± 9.5 Gy, and the mean follow-up time was 16.3 ± 4.8 months. All enrolled patients experienced grade 1 or 2 late salivary-gland toxicity (RTOG/EORTC morbidity scale). The normal parotid glands served as the control group. The Nakagami-scaling and Nakagami-shape parameters were computed from the RF data to quantify radiation-induced parotid-gland changes. Results: Significant differences in Nakagami parameters were observed between the normal and postradiotherapy parotid glands. Compared with the control group, the Nakagami-scaling parameter of the postradiotherapy group decreased by 25.8% (p < 0.001), and the Nakagami-shape parameter decreased by 31.3% (p < 0.001). The area under the receiver operating characteristic curve was 0.85 for the Nakagami-scaling parameter and was 0.95 for the Nakagami-shape parameter, which further demonstrated the diagnostic efficiency of the Nakagami parameters. Conclusions: Nakagami parameters could be used to quantitatively measure parotid-gland injury following head-and-neck radiotherapy. Moreover, the clinical feasibility was demonstrated and this study provides meaningful preliminary data for future clinical investigation.

  9. [Usefulness of biomarkers in the prognosis of severe head injuries].

    Science.gov (United States)

    Gordillo-Escobar, E; Egea-Guerrero, J J; Rodríguez-Rodríguez, A; Murillo-Cabezas, F

    2016-03-01

    Severe head injuries have a great socioeconomic and public health impact. Despite progress in diagnosis and treatment, no sufficiently reliable predictive models have been established for developing clinical trials and promoting effective therapeutic strategies capable of improving the prognosis. In the last decades, several brain damage biomarkers have been studied as potential diagnostic and prognostic tools in traumatic brain injury. However, all of them have limitations that preclude their universalized application. The properties of the known biomarkers -both those traditionally shown to correlate with severity and prognosis, and those recently announced as promising options- should be analyzed. New studies are needed to define their properties, both isolatedly and in combined use. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  10. Severe-to-fatal head injuries in motor vehicle impacts.

    Science.gov (United States)

    Yoganandan, Narayan; Baisden, Jamie L; Maiman, Dennis J; Gennarelli, Thomas A; Guan, Yabo; Pintar, Frank A; Laud, Prakash; Ridella, Stephen A

    2010-07-01

    Severe-to-fatal head injuries in motor vehicle environments were analyzed using the United States Crash Injury Research and Engineering Network database for the years 1997-2006. Medical evaluations included details and photographs of injury, and on-scene, trauma bay, emergency room, intensive care unit, radiological, operating room, in-patient, and rehabilitation records. Data were synthesized on a case-by-case basis. X-rays, computed tomography scans, and magnetic resonance images were reviewed along with field evaluations of scene and photographs for the analyses of brain injuries and skull fractures. Injuries to the parenchyma, arteries, brainstem, cerebellum, cerebrum, and loss of consciousness were included. In addition to the analyses of severe-to-fatal (AIS4+) injuries, cervical spine, face, and scalp trauma were used to determine the potential for head contact. Fatalities and survivors were compared using nonparametric tests and confidence intervals for medians. Results were categorized based on the mode of impact with a focus on head contact. Out of the 3178 medical cases and 169 occupants sustaining head injuries, 132 adults were in frontal (54), side (75), and rear (3) crashes. Head contact locations are presented for each mode. A majority of cases clustered around the mid-size anthropometry and normal body mass index (BMI). Injuries occurred at change in velocities (DeltaV) representative of US regulations. Statistically significant differences in DeltaV between fatalities and survivors were found for side but not for frontal impacts. Independent of the impact mode and survivorship, contact locations were found to be superior to the center of gravity of the head, suggesting a greater role for angular than translational head kinematics. However, contact locations were biased to the impact mode: anterior aspects of the frontal bone and face were involved in frontal impacts while temporal-parietal regions were involved in side impacts. Because head

  11. 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.

  12. On Impact: A Case of a Student with Head Injuries

    Science.gov (United States)

    Buckley, Valerie A.; Chesire, David J.; Canto, Angela I.

    2011-01-01

    This article describes a case of a student with head injuries. While the symptom presentation for students with traumatic brain injury (TBI) can be vastly different, this case represents common symptoms seen in students who are recovering from a concussion. The authors suggest that school psychologists query the teacher and parents about their…

  13. 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 ...

  14. Current Approaches to the Treatment of Head Injury in Children

    Directory of Open Access Journals (Sweden)

    Chih-Fen Hu

    2013-04-01

    Full Text Available Head trauma is one of the most challenging fields of traumatology and demands immediate attention and intervention by first-line clinicians. Symptoms can vary from victim to victim and according to the victim's age, leading to difficulties in making timely and accurate decisions at the point of care. In children, falls, accidents while playing, sports injuries, and abuse are the major causes of head trauma. Traffic accidents are the main cause of disability and death in adolescents and adults. Injury sites include facial bones, muscles, ligaments, vessels, joints, nerves, and focal or whole-brain injuries. Of particular importance are cranial and intracranial injuries. A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. A penetrating injury occurs when an object pierces the skull and affects the brain tissue. Early diagnosis and proper management are crucial to treat patients with potentially life-threatening head and neck trauma. In this review, we discuss the different cases of traumatic brain injury and summarize the current therapies and neuroprotective strategies as well as the related outcomes for children with traumatic brain injury.

  15. computed tomography: ocular manifestations in acute head injury ...

    African Journals Online (AJOL)

    Administrator

    Methods: We reviewed 98 brain computed tomographic results retrospectively. These are ... post-traumatic amnesia, neurologic signs of brain. 3 injury or .... Table 2: Indications and ocular findings in relation to gender. Variables. Gender. P. Male. Female. Indications. Acute mild closed head injury. 12(15.0). 1(5.6). 0.442.

  16. Head Injury, from Men to Model

    NARCIS (Netherlands)

    W.A. van den Brink (Willem Aart)

    2000-01-01

    textabstractIn well developed countries, injury is the leading cause of death and disability among young adults. In less developed countries the incidence of injury is high and rapidly increasing, but the relative mortality due to injuries is overshadowed by other causes, such as infections and

  17. 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

  18. Comparison of risk factors for cervical spine, head, serious, and fatal injury in rollover crashes.

    Science.gov (United States)

    Funk, James R; Cormier, Joseph M; Manoogian, Sarah J

    2012-03-01

    Previous epidemiological studies of rollover crashes have focused primarily on serious and fatal injuries in general, while rollover crash testing has focused almost exclusively on cervical spine injury. The purpose of this study was to examine and compare the risk factors for cervical spine, head, serious, and fatal injury in real world rollover crashes. Rollover crashes from 1995-2008 in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) were investigated. A large data set of 6015 raw cases (2.5 million weighted) was generated. Nonparametric univariate analyses, univariate logistic regression, and multivariate logistic regression were conducted. Complete or partial ejection, a lack of seatbelt use, a greater number of roof inversions, and older occupant age significantly increased the risk of all types of injuries studied (pseating position increased the risk of fatal, head, and cervical spine injury (p<0.05), but not serious injury in general. Higher BMI was associated with an increased risk of fatal, serious, and cervical spine injury (p<0.05), but not head injury. Greater roof crush was associated with a higher rate of fatal and cervical spine injury (p<0.05). Vehicle type, occupant height, and occupant gender had inconsistent and generally non-significant effects on injury. This study demonstrates both common and unique risk factors for different types of injuries in rollover crashes. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    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.

  20. Risk of intracranial injury after minor head trauma in patients with pre-injury use of clopidogrel.

    Science.gov (United States)

    Levine, Michael; Wyler, Benjamin; Lovecchio, Frank; Roque, Pedro; Raja, Ali S

    2014-01-01

    Clopidogrel is an adenosine diphosphate receptor antagonist. The risk of intracranial hemorrhage following minor head trauma in patients with pre-injury use of clopidogrel has not been fully determined. This case-controlled study examined the effects of pre-injury use of clopidogrel in adult (age 14 years and older) patients with minor head trauma. During the study period, 1660 patients head computed tomography scans were performed in the emergency department, of which 658 met inclusion criteria. Intracranial hemorrhage was noted in 30% of patients on clopidogrel, compared with 2.2% of those patients without pre-injury use of clopidogrel. After performing a logistic regression analysis for confounders, the pre-injury use of clopidogrel was significantly associated with intracranial hemorrhage in this study population (OR 16.7; 95% CI 1.71-162.7). The use of clopidogrel is associated with a significantly increased risk of developing intracranial hemorrhage following minor trauma. © 2013.

  1. Do recurrent seizure-related head injuries affect seizures in people with epilepsy?

    Science.gov (United States)

    Friedman, David E; Chiang, Sharon; Tobias, Ronnie S

    2012-02-01

    Seizure-related head injuries (SRHIs) are among the most commonly encountered injuries in people with epilepsy (PWE). Whether head injury has an effect on preexisting epilepsy is not known. The purpose of this study was to systematically assess for any possible effects of SRHIs on seizure frequency and seizure semiology over a 2-year period. We identified 204 patients who have been followed at the Baylor Comprehensive Epilepsy Center from 2008 to 2010. SRHI occurred in 18.1% of the cohort. Most injuries (91%) were classified as mild. Though seizure frequency varied following head injury, overall seizure frequency was not significantly impacted by presence or absence of SRHI over the 2-year study period. Changes in seizure semiology were not observed in those with SRHIs. Although mild SRHI is common among PWE, it does not appear to have an effect on seizure characteristics over a relatively short period. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. Do recurrent seizure-related head injuries affect seizures in people with epilepsy?

    Science.gov (United States)

    Friedman, David E.; Chiang, Sharon; Tobias, Ronnie S.

    2015-01-01

    Seizure-related head injuries (SRHIs) are among the most commonly encountered injuries in people with epilepsy (PWE). Whether head injury has an effect on preexisting epilepsy is not known. The purpose of this study was to systematically assess for any possible effects of SRHIs on seizure frequency and seizure semiology over a 2-year period. We identified 204 patients who have been followed at the Baylor Comprehensive Epilepsy Center from 2008 to 2010. SRHI occurred in 18.1% of the cohort. Most injuries (91%) were classified as mild. Though seizure frequency varied following head injury, overall seizure frequency was not significantly impacted by presence or absence of SRHI over the 2-year study period. Changes in seizure semiology were not observed in those with SRHIs. Although mild SRHI is common among PWE, it does not appear to have an effect on seizure characteristics over a relatively short period. PMID:22227592

  3. 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.…

  4. The effect of brain tomography findings on mortality in sniper shot head injuries.

    Science.gov (United States)

    Can, Çağdaş; Bolatkale, M; Sarıhan, A; Savran, Y; Acara, A Ç; Bulut, M

    2017-06-01

    Penetrating gunshot head injuries have a poor prognosis and require prompt care. Brain CT is a routine component of the standard evaluation of head wounds and suspected brain injury. We aimed to investigate the effect of brain CT findings on mortality in gunshot head injury patients who were admitted to our emergency department (ED) from the Syrian Civil War. The study group comprised patients who were admitted to the ED with gunshot brain injury. Patients' GCS scores, prehospital intubations and brain CT findings were examined. 104 patients were included (92% male, mean age 25 years). Pneumocephalus, midline shift, penetrating head injury, patients with GCS scores ≤6 and patients who had to be intubated in the prehospital period were associated with higher mortality (p<0.05). The results of this study demonstrated that pneumocephalus, midline shift, a penetrating head injury, GCS scores ≤6 and prehospital intubation are associated with high mortality, whereas patients with temporal bone fracture, perforating or single cerebral lobe head injury had a higher survival rates. The temporal bone has a relatively thin and smooth shape compared with the other skull bones so a bullet is less fragmented when it has penetrated the temporal bone, which could be a reason for the reduced cavitation effect. In perforating head injury, the bullet makes a second hole and so will have deposited less energy than a retained bullet with a consequent reduction in intracranial injury and mortality. Further studies are required to reach definitive conclusions. 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/.

  5. Childhood head injury: causes, outcome, and outcome predictors. A Nigerian perspective.

    Science.gov (United States)

    Odebode, T O; Abubakar, A M

    2004-05-01

    Head injury is the most common cause of death following trauma among children in most developed and underdeveloped countries. Management of the head-injured child remained conservative in the hands of the general and orthopedic surgeons until October 2000 in our center. To determine outcome and outcome-predictors in children managed nonoperatively for head injury in Ilorin, Nigeria, a 10-year retrospective study of children managed for head injury was done. Outcome was measured by Glasgow outcome scoring. Clinical variables including age, gender, and postresuscitation Glasgow coma score were tested against Glasgow outcome score by linear regression analysis. During the study period (1989-1999), 267 children (173 males and 94 females) aged 16 years and below with head injuries were admitted. Their injuries were due mostly to road traffic accidents (64.1%) and falls (30.7%). Other injuries were domestic, sport-related, or due to assaults or the fall of collapsed walls, water-pots, and coconut shells on victims' heads. Head injuries were isolated in 60% of patients but associated with skeletal, facial, and spinal injuries in 58, 18, and seven cases, respectively. They were mild in 100 (37.5%), moderate in 73 (27.3%), but severe in 94 (35.2%) cases. Outcome was good in 207 (77.5%) but fatal in 38 (14.2%) children. Only age (p=0.0206) and coma score (p=0.0000), but not gender (p= 0.3043), could predict outcome. Outcome was good in more than 75% of cases of head-injured children managed nonoperatively. It varied with the patient's age and postresuscitation Glasgow coma score.

  6. Penetrating head injury from angle grinder: A cautionary tale

    Directory of Open Access Journals (Sweden)

    S Senthilkumaran

    2010-01-01

    Full Text Available Penetrating cranial injury is a potentially life-threatening condition. Injuries resulting from the use of angle grinders are numerous and cause high-velocity penetrating cranial injuries. We present a series of two penetrating head injuries associated with improper use of angle grinder, which resulted in shattering of disc into high velocity missiles with reference to management and prevention. One of those hit on the forehead of the operator and the other on the occipital region of the co-worker at a distance of five meters. The pathophysiological consequence of penetrating head injuries depends on the kinetic energy and trajectory of the object. In the nearby healthcare center the impacted broken disc was removed without realising the consequences and the wound was packed. As the conscious level declined in both, they were referred. CT brain revealed fracture in skull and changes in the brain in both. Expeditious removal of the penetrating foreign body and focal debridement of the scalp, skull, dura, and involved parenchyma and Watertight dural closure were carried out. The most important thing is not to remove the impacted foreign body at the site of accident. Craniectomy around the foreign body, debridement and removal of foreign body without zigzag motion are needed. Removal should be done following original direction of projectile injury. The neurological sequelae following the non missile penetrating head injuries are determined by the severity and location of initial injury as well as the rapidity of the exploration and fastidious debridement.

  7. Penetrating head injury from angle grinder: A cautionary tale.

    Science.gov (United States)

    Senthilkumaran, S; Balamurgan, N; Arthanari, K; Thirumalaikolundusubramanian, P

    2010-01-01

    Penetrating cranial injury is a potentially life-threatening condition. Injuries resulting from the use of angle grinders are numerous and cause high-velocity penetrating cranial injuries. We present a series of two penetrating head injuries associated with improper use of angle grinder, which resulted in shattering of disc into high velocity missiles with reference to management and prevention. One of those hit on the forehead of the operator and the other on the occipital region of the co-worker at a distance of five meters. The pathophysiological consequence of penetrating head injuries depends on the kinetic energy and trajectory of the object. In the nearby healthcare center the impacted broken disc was removed without realising the consequences and the wound was packed. As the conscious level declined in both, they were referred. CT brain revealed fracture in skull and changes in the brain in both. Expeditious removal of the penetrating foreign body and focal debridement of the scalp, skull, dura, and involved parenchyma and Watertight dural closure were carried out. The most important thing is not to remove the impacted foreign body at the site of accident. Craniectomy around the foreign body, debridement and removal of foreign body without zigzag motion are needed. Removal should be done following original direction of projectile injury. The neurological sequelae following the non missile penetrating head injuries are determined by the severity and location of initial injury as well as the rapidity of the exploration and fastidious debridement.

  8. Head, face and neck injury in youth rugby: incidence and risk factors.

    Science.gov (United States)

    McIntosh, A S; McCrory, P; Finch, C F; Wolfe, R

    2010-02-01

    In this study, the incidence of head, neck and facial injuries in youth rugby was determined, and the associated risk factors were assessed. Data were extracted from a cluster randomised controlled trial of headgear with the football teams as the unit of randomisation. No effect was observed for headgear use on injury rates, and the data were pooled. General school and club-based community competitive youth rugby in the 2002 and 2003 seasons. Young male rugby union football players participating in under-13, under 15, under 18 and under 21 years competitions. Eighty-two teams participated in year 1 and 87 in year 2. Injury rates for all body regions combined, head, neck and face calculated for game and missed game injuries. 554 head, face and neck injuries were recorded within a total of 28 902 h of rugby game exposure. Level of play and player position were related to injury risk. Younger players had the lowest rates of injury; forwards, especially the front row had the highest rate of neck injury; and inside backs had the highest rate of injuries causing the player to miss a game. Contact events, including the scrum and tackle, were the main events leading to injury. Injury prevention must focus on the tackle and scrum elements of a youth rugby game.

  9. Head injury mechanisms in FIS World Cup alpine and freestyle skiers and snowboarders.

    Science.gov (United States)

    Steenstrup, Sophie Elspeth; Bakken, Arnhild; Bere, Tone; Patton, Declan Alexander; Bahr, Roald

    2018-01-01

    Head injuries represent a concern in skiing and snowboarding, with traumatic brain injuries being the most common cause of death. To describe the mechanisms of head and face injuries among World Cup alpine and freestyle skiers and snowboarders. We performed a qualitative analysis of videos obtained of head and face injuries reported through the International Ski Federation Injury Surveillance System during 10 World Cup seasons (2006-2016). We analysed 57 head impact injury videos (alpine n=29, snowboard n=13, freestyle n=15), first independently and subsequently in a consensus meeting. During the crash sequence, most athletes (84%) impacted the snow with the skis or board first, followed by the upper or lower extremities, buttocks/pelvis, back and, finally, the head. Alpine skiers had sideways (45%) and backwards pitching falls (35%), with impacts to the rear (38%) and side (35%) of the helmet. Freestyle skiers and snowboarders had backwards pitching falls (snowboard 77%, freestyle 53%), mainly with impacts to the rear of the helmet (snowboard 69%, freestyle 40%). There were three helmet ejections among alpine skiers (10% of cases), and 41% of alpine skiing injuries occurred due to inappropriate gate contact prior to falling. Athletes had one (47%) or two (28%) head impacts, and the first impact was the most severe (71%). Head impacts were mainly on snow (83%) on a downward slope (63%). This study has identified several characteristics of the mechanisms of head injuries, which may be addressed to reduce risk. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. 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.

  11. Characterization of Closed Head Impact Injury in Rat

    Directory of Open Access Journals (Sweden)

    Yi Hua

    2015-01-01

    Full Text Available The closed head impact (CHI rat models are commonly used for studying the traumatic brain injury. The impact parameters vary considerably among different laboratories, making the comparison of research findings difficult. In this work, numerical CHI experiments were conducted to investigate the sensitivities of intracranial responses to various impact parameters (e.g., impact depth, velocity, and position; impactor diameter, material, and shape. A three-dimensional finite element rat head model with anatomical details was subjected to impact loadings. Results revealed that impact depth and impactor shape were the two leading factors affecting intracranial responses. The influence of impactor diameter was region-specific and an increase in impactor diameter could substantially increase tissue strains in the region which located directly beneath the impactor. The lateral impact could induce higher strains in the brain than the central impact. An indentation depth instead of impact depth would be appropriate to characterize the influence of a large deformed rubber impactor. The experimentally observed velocity-dependent injury severity could be attributed to the “overshoot” phenomenon. This work could be used to better design or compare CHI experiments.

  12. Pattern of CT Findings in Head Injuries: A Sub-urban Tertiary ...

    African Journals Online (AJOL)

    Fifty Eight patients referred to the Radiology department for Computerized axial Tomography following a road traffIC injury with a suspicion of head injury were studied. A retrospective review of the CT request cards, film reports and case notes (where available) were carried out. The mean age of patients was 34.8 ± 19.3 yrs ...

  13. Prognostic value of corpus callosum injuries in severe head trauma.

    Science.gov (United States)

    Cicuendez, Marta; Castaño-León, Ana; Ramos, Ana; Hilario, Amaya; Gómez, Pedro A; Lagares, Alfonso

    2017-01-01

    This study was performed to investigate the relationship between corpus callosum (CC) injury and prognosis in traumatic axonal injury (TAI). We retrospectively reviewed 264 patients with severe head trauma who underwent a conventional MR imaging in the first 60 days after injury. They were selected from a prospectively collected database of 1048 patients with severe head trauma admitted in our hospital. TAI lesions were defined as areas of increased signal intensity on T2 and FLAIR or areas of decreased signal on gradient-echo T2. We attempted to determine whether any MR imaging findings of TAI lesions at CC could be related to prognosis. Neurological impairment was assessed at 1 year after injury by means of GOS-E (good outcome being GOS-E 4/5 and bad outcome being GOS-E motor score at admission, and pupillary reactivity) and the Extended model (including CT information and second insults). We found 97 patients (37 %) with TAI at CC and 167 patients (63 %) without CC lesions at MR. A total of 62 % of the patients with CC lesions had poor outcome, whereas 38 % showed good prognosis. The presence of TAI lesions at the corpus callosum was associated with poor outcome 1 year after brain trauma (p CC lesions measured on T2 and FLAIR sequences was negatively correlated with the GOS-E after adjustment for independent prognostic factors (p = 0.01, OR 2.23, 95 % CI:1.17-4.26). Also the presence of lesions at splenium was statistically related to worse prognosis (p = 0.002, OR 8.1, 95 % CI: 2.2-29.82). We did not find statistical significance in outcome between hemorrhagic and non-hemorrhagic CC lesions. The presence of CC is associated with a poor outcome. The total volume of the CC lesion is an independent prognostic factor for poor outcome in severe head trauma.

  14. Antiplatelet therapy: a double-edged sword in head injury?

    Science.gov (United States)

    Beynon, Christopher; Sakowitz, Oliver W

    2013-04-23

    Antiplatelet therapy for the treatment of cardiovascular diseases is common in the ageing population. Whether this therapy exacerbates brain injury after head trauma is an important, but unsettled, topic. In this issue of Critical Care, Fabbri and colleagues address the question of whether pre-injury intake of antiplatelet medication increases the risk profile of patients with posttraumatic intracranial lesions after head trauma. Antiplatelet medication, and in particular clopidogrel, increased the risk for haematoma progression, need for neurosurgical intervention and an unfavourable outcome. Clinicians should consider this increased risk profile in the treatment of respective patients. Since its introduction as an analgesic in 1897, aspirin has surprised the medical community more than once due to its versatile properties. Prevention of secondary brain damage through aspirin has been reported for ischaemic stroke and subarachnoid haemorrhage. In cases of acute traumatic haemorrhage after head injury, antiplatelet therapy's neuroprotective effects may be outweighed by the increased bleeding tendency.

  15. Prevalence of head injury and medically diagnosed concussion in junior-level community-based Australian Rules Football.

    Science.gov (United States)

    Hecimovich, Mark D; King, Doug

    2017-03-01

    For junior-level Australian Rules Football there is a paucity of head injury and concussion surveillance data; thus, the primary aim was to document head injury and concussion incidence in participants aged 9-17 years with a secondary aim to identify the mechanism-of-injury. A prospective cohort study in which a designated representative for each of the 41 teams recorded on a weekly basis the number of head injuries suspected of being a concussion, diagnosed concussions and the mechanism-of-injury during competition games over the course of a 12-game season. For analysis three groups were formed - number of Player-Seasons, Athlete-Exposures, head injury and concussion incidence per 1000 Athlete-Exposures - and were calculated. Narrative data was categorised. There was 13 reported head injuries resulting in seven concussions in the sample population (n = 976). The incidence rates for head injury and concussion were 1.1 (95% confidence interval: 0.5-1.7) and 0.59 (95% confidence interval: 0.2-1.0) per 1000 Athlete-Exposures. There were four head injuries resulting in two concussions in the 12-13-year-old group and nine head injuries and five concussions in the 14-17-year-old group. Two categories emerged for mechanism-of-injury: player-to-surface and player-to-player, with 9 of the 13 head injuries resulting from player-to-player contact. The incidence rates were similar in the two older groups and lower in comparison with American football and rugby. The data collected have advanced our knowledge of head injury incidence and established baseline data which to compare in future years and may assist in development of preventative measures. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  16. Capabilities of Helmets for Preventing Head Injuries Induced by Ballistic Impacts

    Directory of Open Access Journals (Sweden)

    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.

  17. Evoked potentials and head injury. 2. Clinical applications.

    Science.gov (United States)

    Rappaport, M; Hopkins, H K; Hall, K; Belleza, T

    1981-10-01

    The method of rating abnormality of evoked brain potential patterns and assessing the extent and severity of cortical and subcortical brain dysfunction in head injury patients described in Part I is applied in a clinical context. Evoked potential abnormality (EPA) scores are found to be significantly correlated both with admission and outcome disability approximately one year after head injury. Correlations increase with the increase in the number of sensory modalities tested. Correlations between EPA scores and clinical disability (measured by the Disability Rating Scale) decrease with time after injury. Significant correlations, however, persist for about 60 days after onset of injury. It was found that EP pattern abnormalities can reflect specific sensory (and at times motor) deficits in noncommunicative patients and thereby contribute significantly to early treatment and rehabilitation planning.

  18. 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.......OBJECTIVE: To investigate relations between predictors and outcomes, and especially to identify predictors influencing the time trend in recovery after mild traumatic brain injury. METHODS: We included 59 patients with mild head injury in a prospective study. They underwent comprehensive assessment...

  19. Do recurrent seizure-related head injuries affect seizures in people with epilepsy?

    OpenAIRE

    Friedman, David E.; Chiang, Sharon; Tobias, Ronnie S.

    2012-01-01

    Seizure-related head injuries (SRHIs) are among the most commonly encountered injuries in people with epilepsy (PWE). Whether head injury has an effect on preexisting epilepsy is not known. The purpose of this study was to systematically assess for any possible effects of SRHIs on seizure frequency and seizure semiology over a 2-year period. We identified 204 patients who have been followed at the Baylor Comprehensive Epilepsy Center from 2008 to 2010. SRHI occurred in 18.1% of the cohort. Mo...

  20. Head Start Impact Study

    Data.gov (United States)

    U.S. Department of Health & Human Services — Nationally representative, longitudinal information from an evaluation where children were randomly assigned to Head Start or community services as usual;direct...

  1. Demographic Profile and Pathological Patterns of Head Injury in Albania

    Directory of Open Access Journals (Sweden)

    Sabri Hoxha

    2014-03-01

    Full Text Available Introduction: Head injury (HI is a serious morbid state caused by structural changes of the scalp, skull, and/or its contents, due to mechanical forces. Generally, the most frequent cause of HI is road traffic accident (RTA, followed by homicidal and falling injuries. The aim of present study is to assess epidemiology data, causes and patterns responsible for HI among Albanian subjects. Methodology: All HI cases (1000 are collected by the Forensic Institute of Albania, based on medical and forensic records of traumatized subjects between 2007- 2012. The prospectively-collected and descriptive information is focused on demographic data, responsible factors, type and level of cranial and brain injury, as well as their outcome. Results: The majority of HI victims were male (84% of age range of 15yrs -35yrs (70%. RTA was the HI cause in 88%, followed by homicides (3.8%, falling (3% etc. With respect to injury mechanisms, extra-dural hematoma was found in 93% of cases, followed by cerebral edema (61%, cerebral contusion (37%, skull bone fractures (35%, etc. Severe alteration of the consciousness was observed in 57% of the cases, while amnesia lasted longer than 4 weeks in 44% of the subjects included in our study. Discussion: This survey demonstrates that the majority of HI victims' is young and middle age males target group exposed to RTA. The increase of vehicles' use in placecountry-regionAlbania is more evident than RTA-related HI, indicating that driving newer vehicles with safer technology or helmets use while motorcycling can potentially decline the fatal outcome.

  2. 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

  3. Impaired cerebral autoregulation during head up tilt in patients with severe brain injury

    DEFF Research Database (Denmark)

    Riberholt, Christian Gunge; Olesen, Niels Damkjær; Thing, Mira

    2016-01-01

    mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P frequency domain revealed lower magnitudes of ∼0.......1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury.......Early mobilization is of importance for improving long-term outcome for patients after severe acquired brain injury. A limiting factor for early mobilization by head-up tilt is orthostatic intolerance. The purpose of the present study was to examine cerebral autoregulation in patients with severe...

  4. Readability of information leaflets given to attenders at hospital with a head injury.

    Science.gov (United States)

    Macdonald, S; McMillan, T M; Kerr, J

    2010-04-01

    It is common practice for information leaflets to be given to people attending hospital after a head injury. Their role is potentially important in alerting the patient or their family to possible undetected or late-emerging cerebral complications in addition to providing guidance aimed to reduce the risk of further injury, or negative social or employment outcomes during recovery. This study examines the readability of information sheets provided by emergency departments in all Scottish hospitals. Discharge advice leaflets pertaining to head injury from every ED in Scotland were obtained (45 leaflets from 30 hospital sites). Readability was assessed using two recognised formulae (SMOG and FRE). Legibility was assessed using the Royal National Institute for the Blind Clear Print Guidelines. Content was compared to the Scottish Intercollegiate Guidelines Network (SIGN46) recommendations on the early management of head injury. It is estimated that less than 30% of the population would understand more than 90% of the head injury leaflets. Fewer than half of the leaflets provide even half of the patient information recommended by SIGN46. Analyses of other indicators from clear print guidelines are presented, together with a recommended format for a head injury leaflet and a metric is proposed for evaluating the usefulness of patient information leaflets in general.

  5. 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 ...

  6. Headache in traumatic brain injuries from blunt head trauma

    OpenAIRE

    Chelse, Ana B.; Epstein, Leon G.

    2015-01-01

    Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI) among a large cohort of children 2-18 years of age.

  7. Computed Tomography (CT) in civilian gunshot head injuries in ...

    African Journals Online (AJOL)

    Computed tomagrttpliy (CI ) in civ ¡htm ¡>mi.<(lihead injuries' in Ibaclan □□ M. O. Ubajimi el al ventricular haemorrhage was reported in 14.3% (Table 3) and were reported in the cases with multiple intracranial bullets. (fig. 3). This type of haemorrhage was diagnosed by the replacement of the usual hypodense ...

  8. Skiing and snowboarding head injuries in 2 areas of the United States.

    Science.gov (United States)

    Greve, Mark W; Young, David J; Goss, Andrew L; Degutis, Linda C

    2009-01-01

    To explore the use of helmets in skiers and snowboarders injured at ski runs and terrain parks in Colorado and the northeast United States and to examine differences in head injury severity in terrain parks as compared to ski runs. This was a retrospective cohort study. We reviewed emergency department medical records of injured skiers at 9 medical facilities in Colorado, New York, and Vermont to examine the frequency of helmet use, type of terrain on which injuries occurred, and effect of injury event type and helmet use on change in mental status. Injuries that occurred from July 2002 to July 2004 were included. Eligible patients were skiers and snowboarders who sustained a head injury as defined by International Classification of Diseases-9 codes for acute head injuries. Data elements included event location, mechanism of injury, helmet use, loss of consciousness, neurologic findings, Glasgow Coma Scale score, and initial outcome. Data were entered into SPSS for analysis. Of 1013 patients, 52.6% were skiing, 46.7% were snowboarding, and the remainder engaged in other activities such as sledding or using a sit ski. Most (78.7%) were using a ski run, whereas 19.1% were at a terrain park when their injuries occurred, and 37.1% were wearing helmets. Most injuries (74.1%) occurred when the victim hit his/her head on the snow; 10.0% and 13.1% occurred in collisions with other skiers and fixed objects, respectively. There were significantly fewer instances of loss of consciousness in fall events in the Colorado group (chi(2): 4.127; P < .05), a significantly lower incidence of loss of consciousness in helmet users who struck a fixed object (chi(2): 5.800; P < .05), and a significantly higher incidence of skiers colliding with fixed objects in the Northeast (chi(2): 14.05; P < .005). There were significantly more documented head injuries in terrain parks, even when controlling for helmet use (chi(2): 5.800; P < .05). There is an increased risk of head injury, regardless

  9. Non-accidental head injury - the evidence

    Energy Technology Data Exchange (ETDEWEB)

    David, Timothy J. [University of Manchester, Blackley, Department of Child Health, Booth Hall Children' s Hospital, Manchester (United Kingdom)

    2008-06-15

    A postmortem examination and the CT scan documented the above injuries (neuropathology showed acute but with foci of older subdural bleeding) and indicated that in addition there were five recent rib fractures (left ribs 3-5 posteriorly and right ribs 6-7 posteriorly), a large perimacular retinal fold in the left retina, and subscalp bruising in the area of the anterior fontanelle and the occipital area. Family proceedings were commenced in order to protect the 2-year-old girl. Expert forensic, neuro- and eye pathologists instructed on behalf of the girl's father were of the view that the baby's injuries were likely to have resulted from the fall from the bed to the carpet, or alternatively from the step-father's efforts to revive the infant; other possibilities being apnoea and cerebral anoxia and cardiac arrest resulting from gastrooesophageal reflux or overly rough rocking of the baby in a baby rocker by the 2-year-old girl, the scalp bruising allegedly being the result of palpation of the baby's fontanelle by the treating paediatricians. The rib fractures were attributed to cardio-pulmonary resuscitation. This short review looks at the type of evidence that might help one to distinguish between the differing opinions offered as to the cause of this child's injuries. (orig.)

  10. No impact of early intervention on late outcome after minimal, mild and moderate head injury

    DEFF Research Database (Denmark)

    Heskestad, Ben; Waterloo, Knut; Baardsen, Roald

    2010-01-01

    To evaluate the effect of an educational intervention on outcome after minimal, mild and moderate head injury.......To evaluate the effect of an educational intervention on outcome after minimal, mild and moderate head injury....

  11. St Hugh's Military Hospital (Head Injuries), Oxford 1940-1945.

    Science.gov (United States)

    Weiner, M F; Silver, J

    2017-06-01

    Despite being open for only five years, St Hugh's Military Hospital (Head Injuries) has a seminal place in the history of neurology, neurosurgery and rehabilitation medicine. At its peak, during the Normandy campaign of 1944, it provided 430 beds for the treatment of service personnel. Between 1940 and 1945, 13,000 patients were referred to St Hugh's providing a unique opportunity for ground-breaking research into the management of head injuries. The doctors at St Hugh's collaborated with research scientists at Oxford University in many areas of fundamental research including the treatment of infection, the mechanics of brain injury, brain surgery, neuropsychiatry and rehabilitation, and the use of electroencephalograms. This paper documents these scientific advances and considers their influence on the practice of neurology and neurosurgery in the UK.

  12. Cervical spine injury in children with head injury in Ibadan, Nigeria ...

    African Journals Online (AJOL)

    Cervical spine injury in children with head injury in Ibadan, Nigeria. AA Adeolu, MT Shokunbi, AO Malomo, EO Komolafe, AF Adeleye. Abstract. No Abstract. African Journal of Paediatric Surgery Vol. 1(2) 2005: 76-79. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta-analysis

    Science.gov (United States)

    Russell, Kelly; Christie, Josh; Hagel, Brent E.

    2010-01-01

    Background The prevention of head injuries in alpine activities has focused on helmets. However, no systematic review has examined the effect of helmets on head and neck injuries among skiers and snowboarders. Methods We searched electronic databases, conference proceedings and reference lists using a combination of the key words “head injury or head trauma,” “helmet” and “skiing or snowboarding.” We included studies that used a control group; compared skiers or snowboarders with and without helmets; and measured at least one objectively quantified outcome (e.g., head injury, and neck or cervical injury). Results We included 10 case–control, 1 case–control/case-crossover and 1 cohort study in our analysis. The pooled odds ratio (OR) indicated that skiers and snowboarders with a helmet were significantly less likely than those without a helmet to have a head injury (OR 0.65, 95% confidence interval [CI] 0.55–0.79). The result was similar for studies that used controls without an injury (OR 0.61, 95% CI 0.36–0.92), those that used controls with an injury other than a head or neck injury (OR 0.63, 95% CI 0.52–0.80) and studies that included children under the age of 13 years (OR 0.41, 95% CI 0.27–0.59). Helmets were not associated with an increased risk of neck injury (OR 0.89, 95% CI 0.72–1.09). Interpretation Our findings show that helmets reduce the risk of head injury among skiers and snowboarders with no evidence of an increased risk of neck injury. PMID:20123800

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

    OpenAIRE

    Kavanagh, Dara Oliver; Lynam, Conor; Düerk, Thorsten; Casey, Mary; Eustace, Paul W.

    2010-01-01

    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 rev...

  16. Headache in traumatic brain injuries from blunt head trauma.

    Science.gov (United States)

    Dayan, Peter S; Holmes, James F; Hoyle, John; Atabaki, Shireen; Tunik, Michael G; Lichenstein, Richard; Miskin, Michelle; Kuppermann, Nathan

    2015-03-01

    To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches). This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT). Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location. ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom. Copyright © 2015 by the American Academy of Pediatrics.

  17. Decision making in head injury management in the Edwin Smith Papyrus.

    Science.gov (United States)

    Sanchez, Gonzalo Moreno; Burridge, Alwyn Louise

    2007-01-01

    The Edwin Smith Papyrus (circa 1650-1550 BC) is a didactic trauma treatise of major interest to neurosurgery, as it deals primarily with cranial and spine injuries. Information regarding the patient's condition is conveyed in the papyrus with sufficient clarity to allow a clinical assessment of each injury. The ancient Egyptian physician/teacher lists the key diagnostic elements in each case, and then pronounces his opinion of the treatment potential in one of three verdicts: 1) "a medical condition I can treat;" 2) "a medical condition I can contend with;" or 3) "a medical condition you will not be able to treat." The structural organization of the text according to regional injuries of increasing severity permits analysis of sequential cases, and makes it possible to determine which clinical features led the ancient Egyptian physician to give the first or second verdict in the less severe injuries, but the third in the worst cases. Interestingly, the ancient physicians were not deterred from contending with injuries in the presence of basilar skull fractures, traumatic meningismus, skull perforation without overt neurological deficit, drowsiness, limited facial fractures, or closed head injuries without depressed fragments. Factors identified as determinant for the third verdict in head injuries are depressed skull fragments, dura laceration with exposed brain, infected cranial wounds/tetanus, major craniofacial fractures, deep skull-penetrating stab wounds, and aphasia. This study describes three case sequences of head injuries.

  18. [Spanish versions of the Simplified Motor Score and the Glasgow Coma Scale in out-of-hospital treatment of head injury in adults: a preliminary study of each scale's ability to predict adverse events].

    Science.gov (United States)

    Roca, Guillem; Mayol, Sergi; García, Esteban; Casajuana, Edgar; Quintana, Salvador

    2015-06-01

    To determine the ability of the modified (Spanish) version of the Simplified Motor Score (mSMS) to predict adverse events during hospitalization and to compare its predictive ability to that of the Glasgow Coma Scale (GCS) in adults with head injuries treated outside the hospital. Observational study of retrospective cohorts including all patients over the age of 14 years attended for head injuries occurring within 24 hours of treatment by an advanced life-support unit staffed by nurses between May 1, 2013, and May 1, 2014. The mSMS was a translation of the English original, created through a process of discussions of direct and back translations to arrive at consensus. Out-of-hospital patient records were searched to find GCS and mSMS scores. To predict the ability of each scale to predict brain injuries, neurosurgery, intubation, and/or inhospital death, we calculated the area under the receiving operator characteristic curves (AUCs). Of the total of 115 head-injury patients attended, 64 met the inclusion criteria. The mean (SD) age was 47 (24) years. Twelve (18.8%) patients developed some form of adverse event during hospitalization; 91.6% had brain damage, 58.3% required intubation, 8.3% required surgery, and 41.6% died. The AUC for the GCS was 0.907 (95% CI, 0.81-1.00; P<.001); the AUC for the mSMS was 0.796 (95% CI, 0.64-0.95; P=.001). Although the ability of the mSMS to predict in-hospital adverse outcomes is good, it is inferior to the GCS in adults with head injuries attended outside the hospital.

  19. P300 after head injury: pseudodelay caused by reduced P3A amplitude.

    Science.gov (United States)

    Elting, Jan-Willem; van der Naalt, Joukje; van Weerden, Tiemen W; De Keyser, Jacques; Maurits, Natasha M

    2005-11-01

    We compared conventional P300 analysis with source analysis in normal subjects and head-injury patients. Based on earlier findings of improved P300 component identification and reduced P3B latency variability with source analysis in normal subjects, our aim was to investigate whether source analysis could improve the distinction between these groups. In total, 21 healthy control subjects and 21 patients with mild to moderate head injury were included in this study. A standard auditory 2-tone oddball paradigm was used. Latencies and amplitudes obtained with conventional P300 analysis were compared with source analysis results. With conventional analysis, head-injury patients had delayed P300 latencies and reduced P300 amplitudes in comparison to controls, while source analysis showed no latency differences for both P3A and P3B components. Instead, source analysis indicated absence of P3A components in 43% of patients. The P300 delay in head-injury patients, observed with conventional analysis, is a pseudodelay caused by decreased P3A amplitudes. Consequently, the unaffected P3B component with its later latency determines conventional P300 latency in these patients. Conventional P300 latency cannot be used to conclude that there was delayed early stimulus processing in head-injury patients.

  20. 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.

  1. The study protocol for the Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics

    OpenAIRE

    Garner, Alan A; Fearnside, Michael; Gebski, Val

    2013-01-01

    Background The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely lacking however. In particular the efficacy of e...

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

    Directory of Open Access Journals (Sweden)

    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

  3. Impaired Cerebral Autoregulation during Head Up Tilt in Patients with Severe Brain Injury.

    Directory of Open Access Journals (Sweden)

    Christian Gunge Riberholt

    Full Text Available Early mobilization is of importance for improving long-term outcome for patients after severe acquired brain injury. A limiting factor for early mobilization by head-up tilt is orthostatic intolerance. The purpose of the present study was to examine cerebral autoregulation in patients with severe acquired brain injury and a low level of consciousness. Fourteen patients with severe acquired brain injury and orthostatic intolerance and fifteen healthy volunteers were enrolled. Blood pressure was evaluated by pulse contour analysis, heart rate and RR-intervals were determined by electrocardiography, middle cerebral artery velocity was evaluated by transcranial Doppler, and near-infrared spectroscopy determined frontal lobe oxygenation in the supine position and during head-up tilt. Cerebral autoregulation was evaluated as the mean flow index calculated as the ratio between middle cerebral artery mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P < 0.001. Spectral analysis of heart rate variability in the frequency domain revealed lower magnitudes of ~0.1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury.

  4. The Current State of Head and Neck Injuries in Extreme Sports

    OpenAIRE

    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 a...

  5. 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.)

  6. Efficacy of Family Intervention in Acquired Head-Injury Cases in India

    Directory of Open Access Journals (Sweden)

    Mysore Narasimha Vranda

    2012-12-01

    Full Text Available Purpose: In India, there are few studies on interventions for families of persons with acquired or traumatic brain injuries. This study aimed to test the efficacy of the Family Intervention Package (FIP with caregivers of persons with head injuries.Method: The study was carried out at the Neuro-Surgery Department of the National Institute for Mental Health and Neuro Sciences (NIMHANS, Bangalore, India. Ninety persons with severe head injuries and their caregivers were included in the study using the socio-demographic schedule and family interaction pattern scale.Results: The findings revealed that the Family Intervention Package (FIP was effective in bringing about changes in the functioning of persons with head injuries, and interactions among their families in the experimental group, as compared to the control group.Conclusion: The multi-disciplinary team dealing with persons with head injury need to recognise the importance of multi-component FIP for this group and their families. The current FIP should be made a part of treatment in clinical settings.doi: 10.5463/dcid.v23i3.120

  7. Field Data on Head Injuries in Side Airbag Vehicles in Lateral Impact

    Science.gov (United States)

    Yoganandan, Narayan; Pintar, Frank A.; Gennarelli, Thomas A.

    2005-01-01

    Field data on side airbag deployments in lateral crashes and head injuries have largely remained anecdotal. Consequently, the purpose of this research was to report head injuries in lateral motor vehicle impacts. Data from the National Automotive Sampling System files were extracted from side impacts associated with side airbag deployments. Matched pairs with similar vehicle characteristics but without side airbags were also extracted. All data were limited to the United States Federal Motor vehicle Safety Standards FMVSS 214 compliant vehicles so that the information may be more effectively used in the future. In this study, some fundamental analyses are presented regarding occupant- and vehicle-related parameters. PMID:16179147

  8. Prospective memory in patients with closed head injury: a review.

    Science.gov (United States)

    Shum, David; Levin, Harvey; Chan, Raymond C K

    2011-07-01

    This paper aimed to review the limited, but growing literature on prospective memory (PM) following closed head injury (CHI). Search of two commonly used databases yielded studies that could be classified as: self- or other-report of PM deficits; behavioral PM measures in adults with CHI, behavioral PM measures in children and adolescents with CHI, and treatment of PM in adults with CHI. The methodology and findings of these studies were critically reviewed and discussed. Because of the small number of studies, meta-analysis was only conducted for studies that used behavioral PM measures in adults to integrate findings. PM deficits were found to be commonly reported by patients with CHI and their significant others and they could be identified using behavioral measures in adults, children and adolescents with CHI. However, more work is needed to clarify the nature and mechanisms of these deficits. Although some promising results have been reported by studies that evaluated PM treatment, most studies lack tight experimental control and used only a small number of participants. The paper concluded with some suggestions for future research. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Clothing hanger injuries: pediatric head and neck traumas in the United States, 2002-2012.

    Science.gov (United States)

    Walls, Andrew; Pierce, Matthew; Wang, Hongkun; Harley, Earl H

    2014-02-01

    To discuss pediatric clothing hanger injuries and review the National Electronic Injury Surveillance System to elucidate frequency and promote increased public awareness among pediatric otolaryngologists. Cross-sectional analysis of a national database. National Electronic Injury Surveillance System Database. A retrospective review of the National Electronic Injury Surveillance System provided a nationally weighted sampling estimate of 394 pediatric incident reports involving clothing hangers. Each incident report was analyzed for impalement, facial laceration, and contusion injuries to the mouth, face, and head. In addition, hospital disposition and location of the described incident were also obtained. Upon review of the National Electronic Injury Surveillance System, incident rates of pediatric oral impalement (95% confidence interval [CI], 0.10-0.41), facial laceration (95% CI, 0.22-0.41), and facial abrasion injuries (95% CI, 0.15-0.44) frequently involved the metal clothing hanger design. In addition, most of the reported injuries occurred within the home and involved lacerations to the oral cavity. This is the first multiyear, nationally representative study to analyze clothing hanger injuries in the pediatric population. We demonstrate that these injuries occur more frequently than the medical literature currently reports and also elucidate that children are more likely to obtain laceration injuries by metal clothing hangers within the home. Furthermore, we provide a recommendation for standardization of the National Electronic Injury Surveillance System such that product safety analysis may occur and reduce further pediatric incidents.

  10. Computed Tomography (CT) in civilian gunshot head injuries in ...

    African Journals Online (AJOL)

    Total 28 100.00. Table 3 Spectrum of CT findings and incidence in the 28 gunshot head injuries. CT findings Number %. Location of Bullet fragments. Intra parenchymal 20 66.6. Parietal lobe 9 32.1. Frontal lobe 6 21.4. Temporal lobe 3 10.7. Occipital lobe 2 7.1. Intraosseus 6 21.4. Both intraparenchymal and intraosseous 4 ...

  11. Predicting severe head injury after light motor vehicle crashes: implications for automatic crash notification systems.

    Science.gov (United States)

    Talmor, Daniel; Thompson, Kimberly M; Legedza, Anna T R; Nirula, Ram

    2006-07-01

    Motor vehicle crashes (MVC) are a leading public health problem. Improving notification times and the ability to predict which crashes will involve severe injuries may improve trauma system utilization. This study was undertaken to develop and validate a model to predict severe head injury following MVC using information readily incorporated into an automatic crash notification system. A cross-sectional study with derivation and validation sets was performed. The cohort was drawn from drivers of vehicles involved in MVC obtained from the National Automotive Sampling System (NASS). Independent multivariable predictors of severe head injury were identified. The model was able to stratify drivers according to their risk of severe head injury indicating its validity. The areas under the receiver-operating characteristic (ROC) curves were 0.7928 in the derivation set and 0.7940 in the validation set. We have developed a prediction model for head injury in MVC. As the development of automatic crash notification systems improves, models such as this one will be necessary to permit triage of what would be an overwhelming increase in crash notifications to pre-hospital responders.

  12. A Review of Sport-Related Head Injuries.

    Science.gov (United States)

    Mizobuchi, Yoshifumi; Nagahiro, Shinji

    2016-04-01

    We review current topics in sport-related head injuries including acute subdural hematoma (ASDH), traumatic cerebrovascular disease, cerebral concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football and Japanese judo. Rotational acceleration can cause either cerebral concussion or ASDH due to rupture of a parasagittal bridging vein. Although rare, approximately 80% of patients with cerebral infarction due to sport participation are diagnosed with ischemia or infarction due to arterial dissection. Computed tomography angiography, magnetic resonance angiography, and ultrasound are useful for diagnosing arterial dissection; ultrasound is particularly useful for detecting dissection of the common and internal carotid arteries. Repeated sports head injuries increase the risks of future concussion, cerebral swelling, ASDH, and CTE. To avoid fatal consequences of CTE, it is essential to understand the criteria for safe post-concussion sports participation. Once diagnosed with a concussion, an athlete should not be allowed to return to play on the same day and should not resume sports before the concussion symptoms have completely resolved. Information about the risks and management of head injuries in different sports should be widely disseminated in educational institutions and by sport organization public relations campaigns.

  13. Injury risk assessment of non-lethal projectile head impacts.

    Science.gov (United States)

    Oukara, Amar; Nsiampa, Nestor; Robbe, Cyril; Papy, Alexandre

    2014-01-01

    Kinetic energy non-lethal projectiles are used to impart sufficient effect onto a person in order to deter uncivil or hazardous behavior with a low probability of permanent injury. Since their first use, real cases indicate that the injuries inflicted by such projectiles may be irreversible and sometimes lead to death, especially for the head impacts. Given the high velocities and the low masses involved in such impacts, the assessment approaches proposed in automotive crash tests and sports may not be appropriate. Therefore, there is a need of a specific approach to assess the lethality of these projectiles. In this framework, some recent research data referred in this article as "force wall approach" suggest the use of three lesional thresholds (unconsciousness, meningeal damages and bone damages) that depend on the intracranial pressure. Three corresponding critical impact forces are determined for a reference projectile. Based on the principle that equal rigid wall maximal impact forces will produce equal damage on the head, these limits can be determined for any other projectile. In order to validate the consistence of this innovative method, it is necessary to compare the results with other existing assessment methods. This paper proposes a comparison between the "force wall approach" and two different head models. The first one is a numerical model (Strasbourg University Finite Element Head Model-SUFEHM) from Strasbourg University; the second one is a mechanical surrogate (Ballistics Load Sensing Headform-BLSH) from Biokinetics.

  14. A Comparison of dynamic impact response and brain deformation metrics within the cerebrum of head impact reconstructions representing three mechanisms of head injury in ice hockey

    OpenAIRE

    Kendall, Marshall; Post, Andrew; Gilchrist, M. D.

    2012-01-01

    Ice hockey has been identified as having one of the highest concussion rates. The three most likely causes of concussive injury are; falls to the ice, shoulder to head impacts and punches to the head. The purpose of this study was to examine how these three mechanisms of injury in the sport of ice hockey influence the dynamic response of the head form and the magnitude and distribution of maximum principal strain in the cerebrum. The three impact mechanisms were simulated using a Hybrid III h...

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Maxillofacial injuries and traumatic brain injury--a pilot study.

    Science.gov (United States)

    Rajandram, Rama Krsna; Syed Omar, Syed Nabil; Rashdi, Muhd Fazly Nizam; Abdul Jabar, Mohd Nazimi

    2014-04-01

    Maxillofacial injuries comprising hard tissue as well as soft tissue injuries can be associated with traumatic brain injuries due to the impact of forces transmitted through the head and neck. To date, the role of maxillofacial injury on brain injury has not been properly documented with some saying it has a protective function on the brain while others opposing this idea. This cross-sectional retrospective study evaluated all patients with maxillofacial injuries. The aim of the study was to analyze the occurrence and relationship of maxillofacial injuries with traumatic brain injuries. We retrospectively studied the hospital charts of all trauma patients seen at the accident and emergency department of UKM Medical Centre from November 2010 until November 2011. A detail analysis was then carried out on all patients who satisfied the inclusion and exclusion criteria. A total of 11294 patients were classified as trauma patients in which 176 patients had facial fractures and 292 did not have facial fractures. Middle face fractures was the most common pattern of facial fracture seen. Traumatic brain injury was present in 36.7% of maxillofacial cases. A significant association was found between facial fractures and traumatic brain injury (P maxillofacial injuries with or without facial fractures are at risk of acute or delayed traumatic brain injury. All patients should always have proper radiological investigations together with a proper observation and follow-up schedule. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Face shield design against blast-induced head injuries.

    Science.gov (United States)

    Tan, Long Bin; Tse, Kwong Ming; Tan, Yuan Hong; Sapingi, Mohamad Ali Bin; Tan, Vincent Beng Chye; Lee, Heow Pueh

    2017-12-01

    Blast-induced traumatic brain injury has been on the rise in recent years because of the increasing use of improvised explosive devices in conflict zones. Our study investigates the response of a helmeted human head subjected to a blast of 1 atm peak overpressure, for cases with and without a standard polycarbonate (PC) face shield and for face shields comprising of composite PC and aerogel materials and with lateral edge extension. The novel introduction of aerogel into the laminate face shield is explored and its wave-structure interaction mechanics and performance in blast mitigation is analysed. Our numerical results show that the face shield prevented direct exposure of the blast wave to the face and help delays the transmission of the blast to reduce the intracranial pressures (ICPs) at the parietal lobe. However, the blast wave can diffract and enter the midface region at the bottom and side edges of the face shield, resulting in traumatic brain injury. This suggests that the bottom and sides of the face shield are important regions to focus on to reduce wave ingress. The laminated PC/aerogel/PC face shield yielded higher peak positive and negative ICPs at the frontal lobe, than the original PC one. For the occipital and temporal brain regions, the laminated face shield performed better than the original. The composite face shield with extended edges reduced ICP at the temporal lobe but increases ICP significantly at the parietal lobe, which suggests that a greater coverage may not lead to better mitigating effects. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Functional outcomes of motor vehicle crash head injuries in pediatric and adult occupants.

    Science.gov (United States)

    Schoell, Samantha L; Weaver, Ashley A; Talton, Jennifer W; Baker, Gretchen; Doud, Andrea N; Barnard, Ryan T; Stitzel, Joel D; Zonfrillo, Mark R

    2016-09-01

    The objective of the study was to develop a disability-based metric for motor vehicle crash (MVC) injuries, with a focus on head injuries, and compare the functional outcomes between the pediatric and adult populations. Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System (NTDB-RDS) for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3, 4, and 5 head injuries in NASS-CDS 2000-2011. Pediatric (ages 7-18), adult (19-45), middle-aged (46-65), and older adult (66+) patients with an FIM score available who were alive at discharge and had an AIS 3, 4, or 5 injury were included in the study. The NTDB-RDS contains a truncated form of the FIM instrument, including 3 items (self-feed, locomotion, and verbal expression), each graded on a scale of 1 (full functional dependence) to 4 (full functional independence). Patients within each age group were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each age group by dividing the number of patients who sustained a specific injury and were disabled by the number of patients who sustained the specific injury. To account for the impact of more severe associated coinjuries, a maximum AIS (MAIS) adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS ranged from 0 (0% disability risk) to 1 (100% disability risk). An analysis of the most frequent FIM components associated with disabling MVC head injuries revealed that disability across all 3 items (self-feed, locomotion, and expression) was the most frequent for pediatric and adult patients. Only locomotion was the most frequent for middle-aged and older adults. The mean DRMAIS for MVC head injuries was 35% for pediatric patients, 36% for adults, 38% for middle-aged adults, and 44% for older adults. Further analysis was conducted by grouping the head injuries into 8 groups based on the structure of injury and injury

  19. Minor head injury: CT-based strategies for management--a cost-effectiveness analysis.

    NARCIS (Netherlands)

    Smits, M.; Dippel, D.W.; Nederkoorn, P.J.; Dekker, H.M.; Vos, P.E.; Kool, D.R.; Rijssel, D.A. van; Hofman, P.A.; Twijnstra, A.; Tanghe, H.L.; Hunink, M.G.M.

    2010-01-01

    PURPOSE: To compare the cost-effectiveness of using selective computed tomographic (CT) strategies with that of performing CT in all patients with minor head injury (MHI). MATERIALS AND METHODS: The internal review board approved the study; written informed consent was obtained from all interviewed

  20. Minor Head Injury: CT-based Strategies for Management - A Cost-effectiveness Analysis

    NARCIS (Netherlands)

    Smits, Marion; Dippel, Diederik W. J.; Nederkoorn, Paul J.; Dekker, Helena M.; Vos, Pieter E.; Kool, Digna R.; van Rijssel, Daphne A.; Hofman, Paul A. M.; Twijnstra, Albert; Tanghe, Hervé L. J.; Hunink, M. G. Myriam

    2010-01-01

    Purpose: To compare the cost-effectiveness of using selective computed tomographic (CT) strategies with that of performing CT in all patients with minor head injury (MHI). Materials and methods: The internal review board approved the study; written informed consent was obtained from all interviewed

  1. CT scan in severe diffuse head injury: physiological and clinical correlations.

    OpenAIRE

    Teasdale, E.; Cardoso, E.; Galbraith, S; Teasdale, G

    1984-01-01

    CT scan findings, clinical features and intracranial pressure were studied in patients with severe diffuse head injury. Compression of the 3rd ventricle and basal cisterns closely correlated with an intracranial pressure greater than 20 mmHg, with clinical signs of midbrain dysfunctions and worse prognosis. These CT scan findings can indicate whether intracranial pressure monitoring is appropriate.

  2. Kinematics of judo breakfall for osoto-gari: Considerations for head injury prevention.

    Science.gov (United States)

    Koshida, Sentaro; Ishii, Takanori; Matsuda, Tadamitsu; Hashimoto, Toshihiko

    2017-06-01

    Previous studies suggest that increasing the skill level of judokas will decrease the number of head injuries sustained during judo. However, the kinematics are poorly understood, making it difficult to establish an effective breakfall teaching programme. Therefore, we studied the kinematic parameters of breakfall for osoto-gari to identify the risk of judo-related head injuries by comparing experienced and novice judokas. This information will provide insight into developing a better prevention plan for judo-related head injuries. A total of 10 experienced and 12 novice judokas volunteered to participate in this study. The kinematic data of the breakfall motion for osoto-gari were collected using a three-dimensional motion analysis technique (200 Hz). We observed a significantly higher peak neck extension momentum in the novice group than in the experienced group. This suggests that neck extension momentum during breakfall is associated with the risk of head injuries during judo. In addition, the novice judokas demonstrated a significantly greater flexed pattern in the trunk and hip movement than the experienced judokas (P < 0.05). The results suggest that the trunk and lower extremity motion are important kinematic parameters that determine the skill level in performing the breakfall for osoto-gari.

  3. [Ballistic approach in head injuries caused by missiles].

    Science.gov (United States)

    Jourdan, P; Billant, J B; Desgeorges, M

    1989-01-01

    If the missile head injury treatment is relatively well codified, wound ballistic, on the other hand, is not well known of neurosurgeons. Different means of study and tissue simulants are being listed. In face of numerous contradictory results, we shall only retain the M.L. Fackler method with 10% gelatin. Experimental results will depend on: 1. Missile parameters. For instance, in soft homogeneous tissue, one can discern shells with an uncertain path, full jacketed bullets which tumble after a variable "neck", and non jacketed missiles which cause wound through "mushrooming" and/or fragmentation effect. Buckshot wounds obey the rule "all or none". 2. Body reactions, particularly the clash with a hard material like bone, which can overturn everything described in soft tissues. These wound ballistic notions have lead us to formulate two pathogenic hypothesizes, allowing us to understand sometime case reports which had first seemed paradoxical: the brain structure, enclosed in the skull will not able to survive any major temporary cavity, the more or less deep missile pathway through the skull will be very different according to the type and energy of the missile, and to the hardness of pierced bone.

  4. A review of 100 closed head injuries associated with facial fractures.

    Science.gov (United States)

    Haug, R H; Savage, J D; Likavec, M J; Conforti, P J

    1992-03-01

    One hundred closed head injuries associated with facial fractures treated over a 78-month period at a level I trauma center in Northeast Ohio were reviewed. The incidence of closed head injury in patients with facial fractures was 17.5%. Males suffered closed head injuries four times more often than females, and sustained severe intracranial injuries eight times as often. The 16- to 30-year age group predominated (59%). Although motor vehicle accidents were the most frequent cause of injury (61%), motorcycle accidents were associated with the most severe head injury. The mandible/midface fracture ratio (1.3:1) was almost half that of the non-head-injured population (2.1:1). Facial fracture complications were found to have a similar incidence (14%) as in the non-head-injured population, but were associated with more severe intracranial injuries.

  5. Modeling and Optimization of Airbag Helmets for Preventing Head Injuries in Bicycling.

    Science.gov (United States)

    Kurt, Mehmet; Laksari, Kaveh; Kuo, Calvin; Grant, Gerald A; Camarillo, David B

    2017-04-01

    Bicycling is the leading cause of sports-related traumatic brain injury. Most of the current bike helmets are made of expanded polystyrene (EPS) foam and ultimately designed to prevent blunt trauma, e.g., skull fracture. However, these helmets have limited effectiveness in preventing brain injuries. With the availability of high-rate micro-electrical-mechanical systems sensors and high energy density batteries, a new class of helmets, i.e., expandable helmets, can sense an impending collision and expand to protect the head. By allowing softer liner medium and larger helmet sizes, this novel approach in helmet design provides the opportunity to achieve much lower acceleration levels during collision and may reduce the risk of brain injury. In this study, we first develop theoretical frameworks to investigate impact dynamics of current EPS helmets and airbag helmets-as a form of expandable helmet design. We compared our theoretical models with anthropomorphic test dummy drop test experiments. Peak accelerations obtained from these experiments with airbag helmets achieve up to an 8-fold reduction in the risk of concussion compared to standard EPS helmets. Furthermore, we construct an optimization framework for airbag helmets to minimize concussion and severe head injury risks at different impact velocities, while avoiding excessive deformation and bottoming-out. An optimized airbag helmet with 0.12 m thickness at 72 ± 8 kPa reduces the head injury criterion (HIC) value to 190 ± 25 at 6.2 m/s head impact velocity compared to a HIC of 1300 with a standard EPS helmet. Based on a correlation with previously reported HIC values in the literature, this airbag helmet design substantially reduces the risks of severe head injury up to 9 m/s.

  6. Office management of mild head injury in children and adolescents.

    Science.gov (United States)

    Garcia-Rodriguez, Juan Antonio; Thomas, Roger E

    2014-06-01

    To provide family physicians with updated, practical, evidence-based information about mild head injury (MHI) and concussion in the pediatric population. MEDLINE (1950 to February 2013), the Cochrane Database of Systematic Reviews (2005 to 2013), the Cochrane Central Register of Controlled Trials (2005 to 2013), and DARE (2005 to 2013) were searched using terms relevant to concussion and head trauma. Guidelines, position statements, articles, and original research relevant to MHI were selected. Trauma is the main cause of death in children older than 1 year of age, and within this group head trauma is the leading cause of disability and death. Nine percent of reported athletic injuries in high school students involve MHI. Family physicians need to take a focused history, perform physical and neurologic examinations, use standardized evaluation instruments (Glasgow Coma Scale; the Sport Concussion Assessment Tool, version 3; the child version of the Sport Concussion Assessment Tool; and the Balance Error Scoring System), instruct parents how to monitor their children, decide when caregivers are not an appropriately responsible resource, follow up with patients promptly, guide a safe return to play and to learning, and decide when neuropsychological testing for longer-term follow-up is required. A thorough history, physical and neurologic assessment, the use of validated tools to provide an objective framework, and periodic follow-up are the basis of family physician management of pediatric MHI. Copyright© the College of Family Physicians of Canada.

  7. Imaging findings in diffuse axonal injury after closed head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Parizel, P.M.; Oezsarlak, Oe.; Goethem, J.W. van; Hauwe, L. van den; Schepper, A.M. de [Department of Radiology, Universitair Ziekenhuis Antwerpen (University of Antwerp), Edegem (Belgium); Dillen, C.; Cosyns, P. [Department of Psychiatry, Universitair Ziekenhuis Antwerpen (University of Antwerp), Edegem (Belgium); Verlooy, J. [Department of Neurosurgery, Universitair Ziekenhuis Antwerpen (University of Antwerp), Edegem (Belgium)

    1998-07-01

    Even in patients with closed head trauma, brain parenchyma can be severely injured due to disruption of axonal fibers by shearing forces during acceleration, deceleration, and rotation of the head. In this article we review the spectrum of imaging findings in patients with diffuse axonal injuries (DAI) after closed head trauma. Knowledge of the location and imaging characteristics of DAI is important to radiologists for detection and diagnosis. Common locations of DAI include: cerebral hemispheric gray-white matter interface and subcortical white matter, body and splenium of corpus callosum, basal ganglia, dorsolateral aspect of brainstem, and cerebellum. In the acute phase, CT may show punctate hemorrhages. The true extent of brain involvement is better appreciated with MR imaging, because both hemorrhagic and non-hemorrhagic lesions (gliotic scars) can be detected. The MR appearance of DAI lesions depends on several factors, including age of injury, presence of hemorrhage or blood-breakdown products (e. g., hemosiderin), and type of sequence used. Technical aspects in MR imaging of these patients are discussed. Non-hemorrhagic lesions can be detected with fluid attenuated inversion recovery (FLAIR), proton-density-, or T2-weighted images, whereas gradient echo sequences with long TE increase the visibility of old hemorrhagic lesions. (orig.) With 12 figs., 12 refs.

  8. Interpretation and comprehension of linguistic humour by adolescents with head injury: a group analysis.

    Science.gov (United States)

    Docking, K; Murdoch, B E; Jordan, F M

    2000-01-01

    The aim of the present study was to determine the ability of adolescents with a head injury to interpret and comprehend linguistic humour. Nine adolescents with head injury aged between 12 years 1 month and 15 years 4 months, and nine individually matched adolescents aged between 12 years 1 month and 16 years 1 month were administered a humour test, a standard language battery, the CELF-3, and the Self-Esteem Index. The test of humour abilities required each subject to recognize and select an explanation from a group of three, as to what made each item funny. Items were based on morphological, semantic and syntactic humour elements. Comparison at a group level demonstrated that adolescents with head injury performed significantly poorer in the interpretation and comprehension of linguistic humour than a group of individually matched peers. Contrary to expectations, a relationship between the level of self-esteem and humour comprehension did not exist. The findings of the present study suggest that further research into the effects of head injury on linguistic humour in adolescents is warranted, particularly from a case-by-case perspective.

  9. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kadom, Nadja [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Boston University Medical Center, Boston, MA (United States); Khademian, Zarir; Vezina, Gilbert; Shalaby-Rana, Eglal [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Rice, Amy [Independent Consultant (Biostatistics), Chevy Chase, MD (United States); Hinds, Tanya [Children' s National Medical Center, Child and Adolescent Protection Center, Washington, DC (United States)

    2014-07-15

    In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories. This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1. The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20-679 days). Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with abusive head trauma (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a

  10. A 10-Year Analysis of Head and Neck Injuries Involving Nonpowder Firearms.

    Science.gov (United States)

    Dandu, Kartik V; Carniol, Eric T; Sanghvi, Saurin; Baredes, Soly; Eloy, Jean Anderson

    2017-05-01

    Objectives Firearms have an enduring and visible presence within American culture. However, the public health impact of nonpowder firearms and other "toy" guns has not been fully studied. These guns-including BB guns (ie, ball bearing), paintball guns, and pellet guns-are typically marketed to a younger audience. The objective of this study is to analyze head and neck injuries related to nonpowder firearms. Study Design Cross-sectional analysis of a national database. Setting Academic medical center. Subjects and Methods The National Electronic Injury Surveillance System was queried for head and neck injuries involving nonpowder guns, including air, BB, and pellet guns, and associated ammunition. Analysis of age, sex, incidence, injury location, and diagnosis was performed. Results From 2005 to 2014, there were 1695 cases recorded, or 55,060 estimated emergency room visits, due to injuries related to nonpowder guns and fired ammunition. The majority of patients were male (80.9%). These injuries were most common in children 6 to 12 years of age (37.9%), followed by those 13 to 18 years old (27.1%) and adults (≥19 years old; 17.8%), while preschool children (0-5 years) represented 17.2%. The most common injury diagnosis was penetrating foreign body (34.9%), followed by lacerations (24.3%) and contusions/abrasions (13.7%). Conclusion Nonpowder and other nonlethal firearm-related injuries to the head and neck region are a frequent source of emergency room visits nationally. Safety measures and public education on a mainstream level are required.

  11. A novel head-neck cooling device for concussion injury in contact sports.

    Science.gov (United States)

    Wang, Huan; Wang, Bonnie; Jackson, Kevin; Miller, Claire M; Hasadsri, Linda; Llano, Daniel; Rubin, Rachael; Zimmerman, Jarred; Johnson, Curtis; Sutton, Brad

    2015-01-01

    Emerging research on the long-term impact of concussions on athletes has allowed public recognition of the potentially devastating effects of these and other mild head injuries. Mild traumatic brain injury (mTBI) is a multifaceted disease for which management remains a clinical challenge. Recent pre-clinical and clinical data strongly suggest a destructive synergism between brain temperature elevation and mTBI; conversely, brain hypothermia, with its broader, pleiotropic effects, represents the most potent neuro-protectant in laboratory studies to date. Although well-established in selected clinical conditions, a systemic approach to accomplish regional hypothermia has failed to yield an effective treatment strategy in traumatic brain injury (TBI). Furthermore, although systemic hypothermia remains a potentially valid treatment strategy for moderate to severe TBIs, it is neither practical nor safe for mTBIs. Therefore, selective head-neck cooling may represent an ideal strategy to provide therapeutic benefits to the brain. Optimizing brain temperature management using a National Aeronautics and Space Administration (NASA) spacesuit spinoff head-neck cooling technology before and/or after mTBI in contact sports may represent a sensible, practical, and effective method to potentially enhance recover and minimize post-injury deficits. In this paper, we discuss and summarize the anatomical, physiological, preclinical, and clinical data concerning NASA spinoff head-neck cooling technology as a potential treatment for mTBIs, particularly in the context of contact sports.

  12. Head Injuries in School-Age Children Who Play Golf

    Science.gov (United States)

    Reuter-Rice, Karin; Krebs, Madelyn; Eads, Julia K.

    2016-01-01

    Traumatic brain injury (TBI) is the leading cause of death and disability in children. We conducted a prospective study, which examined injury characteristics and outcomes of school-age children of 5.0-15.0 years (N = 10) who were admitted to hospital for a TBI. This study evaluated the role of age, gender, the Glasgow Coma Scale, mechanisms and…

  13. Alcohol consumption, blood alcohol concentration level and guideline compliance in hospital referred patients with minimal, mild and moderate head injuries

    DEFF Research Database (Denmark)

    Harr, Marianne Efskind; Heskestad, Ben; Ingebrigtsen, Tor

    2011-01-01

    In 2000 the Scandinavian Neurotrauma Committee published guidelines for safe and cost-effective management of minimal, mild and moderate head injured patients.The aims of this study were to investigate to what extent the head injury population is under the influence of alcohol, and to evaluate...... whether the physicians' compliance to the guidelines is affected when patients are influenced by alcohol....

  14. Chronic post-traumatic headache after mild head injury

    DEFF Research Database (Denmark)

    Kjeldgaard, Dorte; Forchhammer, Hysse; Teasdale, Tom

    2014-01-01

    BACKGROUND: The aetiology behind chronic post-traumatic headache (CPTH) after mild head injury is unclear and management is complicated. In order to optimize treatment strategies we aimed to characterize a CPTH population. METHODS: Ninety patients with CPTH and 45 patients with chronic primary...... headaches were enrolled from the Danish Headache Center. All patients were interviewed about demographic and headache data. They completed the Harvard Trauma Questionnaire (HTQ), Rivermead Post Concussion Symptoms Questionnaire, SF-36 and a headache diary. RESULTS: The CPTH group experienced more cognitive...

  15. Virtopsy--fatal motor vehicle accident with head injury.

    Science.gov (United States)

    Aghayev, Emin; Thali, Michael; Jackowski, Christian; Sonnenschein, Martin; Yen, Kathrin; Vock, Peter; Dirnhofer, Richard

    2004-07-01

    A man wearing no protective helmet was struck by a motor vehicle while riding a bicycle. He was loaded on his left side, and the impact point of his head was his occiput on the car roof girder. He was immediately transported to the general hospital, where he passed away. Postmortem examination using multi-slice computed tomography (MSCT) revealed an extensively comminuted fracture of the posterior part and the base of the skull. Observed were deep direct and contrecoup brain bruises, with the independent fractures of the roof of the both orbits. Massive subdural and subarachnoidal hemorrhage with cerebral edema and shifting of the mid-line towards left side were also detected. MSCT and autopsy results were compared and the body injuries were correlated to vehicle damages. In conclusion, postmortem imaging is a good forensic visualization tool with great potential for documentation and examination of body injuries and pathology.

  16. 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 (p<0.001). The male to female ratio for head and neck injury was 6.1:1. There was a disproportionately higher incidence of accidents during weekends (27.8%). Majority of the patients had mild injury (87.2%), followed by moderate (7.3%) and severe (5.5%). The highest frequency of head injury was among the young adults 20-44 years (68

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

    Science.gov (United States)

    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

  18. Helmet use and risk of head injuries in alpine skiers and snowboarders: changes after an interval of one decade.

    Science.gov (United States)

    Sulheim, Steinar; Ekeland, Arne; Holme, Ingar; Bahr, Roald

    2017-01-01

    In a previous study, we concluded that a safety helmet can reduce the risk for head injury by 60%. Other studies reported similar effects, resulting in a general recommendation to wear a helmet while skiing or snowboarding. To determine the effect of the expected increased helmet wear on the risk of head injury one decade after the recommendation. Ski patrols reported injury cases in major Norwegian alpine ski resorts. Injury type, helmet use and other risk factors were recorded. A multiple logistic regression analysis was used to assess the relation between individual risk factors and the risk of head injuries by comparing head injured skiers (cases) with skiers and snowboarders who reported other injuries (controls). Helmet use was associated with improved odds for head injuries (OR: 0.45, 95% CI 0.34 to 0.60; pskiing helmet. This may be due to new skiing trends in the alpine resorts. 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/.

  19. 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.

  20. Three-dimensional head kinematics and clinical outcome of patients with neck injury treated with spinal manipulative therapy: a pilot study.

    Science.gov (United States)

    Osterbauer, P J; Derickson, K L; Peles, J D; DeBoer, K F; Fuhr, A W; Winters, J M

    1992-10-01

    Finite helical axis parameters (FHAP) of the cervical spine and clinical measures were obtained to evaluate neck function and the clinical effects of spinal manipulative therapy in patients with "whiplash" (WL) type neck injury. Descriptive case series, 1 yr follow-up. Three private chiropractic practices. Ten consecutive new patients with a history of neck injury, nine asymptomatic, volunteer controls. A 6-wk regimen of short lever manually assisted adjustments with an Activator Instrument, while acute, four patients received interferential electrotherapy. Cervical FHAP during normal movements, neck pain (visual analogue scale), active cervical range of motion and follow-up questionnaire. Based on six patients, the FHAPs appeared to mirror the clinical condition, being markedly deviant from the patterns observed in the control group for at least one or more of the tracking tasks for all but one of the patients. Mean pain scores decreased from 44.1 to 10.5 (t = 4.93; p < .0001) and mean total range of motion increased from 234 to 297 degrees (t = 5.68; p < .0001). At 1 yr, seven respondents noted stability of their symptoms at or near the level reported immediately after the 6-wk treatment period. Based on these preliminary data: a) FHAPs may aid in diagnosing and monitoring treatment of neck dysfunction, b) spinal manipulative therapy may be beneficial to some patients with neck injury and future study is warranted as a means to promote recovery of patients with neck injuries.

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

    Energy Technology Data Exchange (ETDEWEB)

    Smits, Marion; Wielopolski, Piotr A.; Vernooij, Meike W.; Lugt, Aad van der [Erasmus MC-University Medical Centre Rotterdam, Department of Radiology (Hs-224), PO Box 2040, Rotterdam (Netherlands); Houston, Gavin C. [Applied Science Lab, GE Healthcare, Hertogenbosch (Netherlands); Dippel, Diederik W.J.; Koudstaal, Peter J. [Erasmus MC-University Medical Centre Rotterdam, Department of Neurology, Rotterdam (Netherlands); Hunink, M.G.M. [Erasmus MC-University Medical Centre Rotterdam, Department of Radiology (Hs-224), PO Box 2040, Rotterdam (Netherlands); Erasmus MC-University Medical Centre Rotterdam, Department of Epidemiology, Rotterdam (Netherlands); Harvard School of Public Health, Department of Health Policy and Management, Boston, MA (United States)

    2011-08-15

    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.)

  2. Maxillofacial injuries among trauma patients undergoing head computerized tomography; A Ugandan experience.

    Science.gov (United States)

    Krishnan, Ullas Chandrika; Byanyima, Rosemary Kusaba; Faith, Ameda; Kamulegeya, Adriane

    2017-01-01

    The aim of this study was to investigate epidemiological features of maxillofacial fractures within trauma patients who had head and neck computed tomography (CT) scan at the Mulago National referral hospital. CT scan records of trauma patients who had head scans at the Department of Radiology over 1-year period were accessed. Data collected included sociodemographic factors, type and etiology of injury, and concomitant maxillofacial injuries. A total of 1330 trauma patients underwent head and neck CT scan in the 1-year study period. Out of these, 130 were excluded due to incomplete or unclear records and no evidence of injury. Of the remaining 1200, 32% (387) had maxillofacial fractures. The median age of the patients with maxillofacial fractures was 28 (range = 18-80) years and 18-27 age group was most common at 47.5%. Road traffic accidents constituted 49.1% of fractures. The single most affected isolated bone was the frontal bone (23%). The number of maxillofacial bones fractured was predicted by age group (df = 3 F = 5.358, P = 0.001), association with other fractures (df = 1 F = 5.317, P = 0.03). Good matched case-control prospective studies are needed to enable us tease out the finer difference in the circumstances and pattern of injury if we are to design appropriate preventive measures.

  3. External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center.

    Science.gov (United States)

    Schachar, Jennifer L; Zampolin, Richard L; Miller, Todd S; Farinhas, Joaquim M; Freeman, Katherine; Taragin, Benjamin H

    2011-08-01

    Head CT scans are considered the imaging modality of choice to screen patients with head trauma for neurocranial injuries; however, widespread CT imaging is not recommended and much research has been conducted to establish objective clinical predictors of intracranial injury (ICI) in order to optimize the use of neuroimaging in children with minor head trauma. To evaluate whether a strict application of the New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR) and National Emergency X-Radiography Utilization Study II (NEXUS II) in pediatric patients with head trauma presenting to a non-trauma center (level II) could reduce the number of cranial CT scans performed without missing clinically significant ICI. We conducted an IRB-approved retrospective analysis of pediatric patients with head trauma who received a cranial CT scan between Jan. 1, 2001, and Sept. 1, 2008, and identified which patients would have required a scan based on the criteria of the above listed decision instruments. We then determined the sensitivities, specificities and negative predictive values of these aids. In our cohort of 2,101 patients, 92 (4.4%) had positive head CT findings. The sensitivities for the NOC, CCHR and NEXUS II were 96.7% (95%CI 93.1-100), 65.2% (95%CI 55.5-74.9) and 78.3% (95%CI 69.9-86.7), respectively, and their negative predictive values were 98.7%, 97.6% and 97.2%, respectively. In contrast, the specificities for these aids were 11.2% (95%CI 9.8-12.6), 64.2% (95%CI 62.1-66.3) and 34.2% (95%CI 32.1-36.3), respectively. Therefore, in our population it would have been possible to scan at least 10.9% fewer patients. The number of cranial CT scans conducted in our pediatric cohort with head trauma would have been reduced had any of the three clinical decision aids been applied. Therefore, we recommend that further validation and adoption of pediatric head CT decision aids in non-trauma centers be considered to ultimately increase patient safety while reducing medical

  4. Alcohol consumption, blood alcohol concentration level and guideline compliance in hospital referred patients with minimal, mild and moderate head injuries.

    Science.gov (United States)

    Harr, Marianne Efskind; Heskestad, Ben; Ingebrigtsen, Tor; Romner, Bertil; Rønning, Pål; Helseth, Eirik

    2011-04-17

    In 2000 the Scandinavian Neurotrauma Committee published guidelines for safe and cost-effective management of minimal, mild and moderate head injured patients.The aims of this study were to investigate to what extent the head injury population is under the influence of alcohol, and to evaluate whether the physicians' compliance to the guidelines is affected when patients are influenced by alcohol. This study included adult patients (≥15 years) referred to a Norwegian University Hospital with minimal, mild and moderate head injuries classified according to the Head Injury Severity Scale (HISS). Information on alcohol consumption was recorded, and in most of these patients blood alcohol concentration (BAC) was measured. Compliance with the above mentioned guidelines was registered. The study includes 860 patients. 35.8% of the patients had consumed alcohol, and 92.1% of these patients had a BAC ≥ 1.00‰. Young age, male gender, trauma occurring during the weekends, mild and moderate head injuries were independent factors significantly associated with being under the influence of alcohol. Guideline compliance was 60.5%, and over-triage was the main violation. The guideline compliance showed no significant correlation to alcohol consumption or to BAC-level. This study confirms that alcohol consumption is common among patients with head injuries. The physicians' guideline compliance was not affected by the patients' alcohol consumption, and alcohol influence could therefore not explain the low guideline compliance.

  5. A Mechanistic End-to-End Concussion Model That Translates Head Kinematics to Neurologic Injury

    Directory of Open Access Journals (Sweden)

    Laurel J. Ng

    2017-06-01

    Full Text Available Past concussion studies have focused on understanding the injury processes occurring on discrete length scales (e.g., tissue-level stresses and strains, cell-level stresses and strains, or injury-induced cellular pathology. A comprehensive approach that connects all length scales and relates measurable macroscopic parameters to neurological outcomes is the first step toward rationally unraveling the complexity of this multi-scale system, for better guidance of future research. This paper describes the development of the first quantitative end-to-end (E2E multi-scale model that links gross head motion to neurological injury by integrating fundamental elements of tissue and cellular mechanical response with axonal dysfunction. The model quantifies axonal stretch (i.e., tension injury in the corpus callosum, with axonal functionality parameterized in terms of axonal signaling. An internal injury correlate is obtained by calculating a neurological injury measure (the average reduction in the axonal signal amplitude over the corpus callosum. By using a neurologically based quantity rather than externally measured head kinematics, the E2E model is able to unify concussion data across a range of exposure conditions and species with greater sensitivity and specificity than correlates based on external measures. In addition, this model quantitatively links injury of the corpus callosum to observed specific neurobehavioral outcomes that reflect clinical measures of mild traumatic brain injury. This comprehensive modeling framework provides a basis for the systematic improvement and expansion of this mechanistic-based understanding, including widening the range of neurological injury estimation, improving concussion risk correlates, guiding the design of protective equipment, and setting safety standards.

  6. Finite element analysis of occupant head injuries: parametric effects of the side curtain airbag deployment interaction with a dummy head in a side impact crash.

    Science.gov (United States)

    Deng, Xingqiao; Potula, S; Grewal, H; Solanki, K N; Tschopp, M A; Horstemeyer, M F

    2013-06-01

    In this study, we investigated and assessed the dependence of dummy head injury mitigation on the side curtain airbag and occupant distance under a side impact of a Dodge Neon. Full-scale finite element vehicle simulations of a Dodge Neon with a side curtain airbag were performed to simulate the side impact. Owing to the wide range of parameters, an optimal matrix of finite element calculations was generated using the design method of experiments (DOE); the DOE method was performed to independently screen the finite element results and yield the desired parametric influences as outputs. Also, analysis of variance (ANOVA) techniques were used to analyze the finite element results data. The results clearly show that the influence of moving deformable barrier (MDB) strike velocity was the strongest influence parameter on both cases for the head injury criteria (HIC36) and the peak head acceleration, followed by the initial airbag inlet temperature. Interestingly, the initial airbag inlet temperature was only a ~30% smaller influence than the MDB velocity; also, the trigger time was a ~54% smaller influence than the MDB velocity when considering the peak head accelerations. Considering the wide range in MDB velocities used in this study, results of the study present an opportunity for design optimization using the different parameters to help mitigate occupant injury. As such, the initial airbag inlet temperature, the trigger time, and the airbag pressure should be incorporated into vehicular design process when optimizing for the head injury criteria. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    OpenAIRE

    Sidipratomo, Prijo; Prija, Trijono Karmawan Sukana; Murtala, Bachtiar; Purwadianto, Agus; Lawrence, Gatot Susilo

    2014-01-01

    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 M...

  8. 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.

  9. Emergency department reported head injuries from skiing and snowboarding among children and adolescents, 1996-2010.

    Science.gov (United States)

    Graves, Janessa M; Whitehill, Jennifer M; Stream, Joshua O; Vavilala, Monica S; Rivara, Frederick P

    2013-12-01

    To evaluate the incidence of snow-sports-related head injuries among children and adolescents reported to emergency departments (EDs), and to examine the trend from 1996 to 2010 in ED visits for snow-sports-related traumatic brain injury (TBI) among children and adolescents. A retrospective, population-based cohort study was conducted using data from the National Electronic Injury Surveillance System for patients (aged ≤17 years) treated in EDs in the USA from 1996 to 2010, for TBIs associated with snow sports (defined as skiing or snowboarding). National estimates of snow sports participation were obtained from the National Ski Area Association and utilised to calculate incidence rates. Analyses were conducted separately for children (aged 4-12 years) and adolescents (aged 13-17 years). An estimated number of 78 538 (95% CI 66 350 to 90 727) snow sports-related head injuries among children and adolescents were treated in EDs during the 14-year study period. Among these, 77.2% were TBIs (intracranial injury, concussion or fracture). The annual average incidence rate of TBI was 2.24 per 10 000 resort visits for children compared with 3.13 per 10 000 visits for adolescents. The incidence of TBI increased from 1996 to 2010 among adolescents (p<0.003). Given the increasing incidence of TBI among adolescents and the increased recognition of the importance of concussions, greater awareness efforts may be needed to ensure safety, especially helmet use, as youth engage in snow sports.

  10. Pattern of referrals of head injury to the University College Hospital ...

    African Journals Online (AJOL)

    ... a pivotal role in the management of head injury in Nigeria. The results support an urgent need for stakeholders in the health sector to provide all that is required to uphold the status of the Hospital as a center of excellence in neurosurgery and neurosciences. Keywords: Head injury, Referrals, Neurosurgery, UCH, Ibadan ...

  11. Age Related Pattern And Outcome Of Head Injury In Indigenous Africa

    African Journals Online (AJOL)

    Road traffic injury was the commonest cause of trauma to the head. Children were most often injured as pedestrians while adults and older patients were more often victims of passenger vehicular accidents. Older patients had the poorest outcome with a mortality rate of 48.7%. They were more prone to severe head injury ...

  12. 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.

  13. 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.

  14. 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

    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. To examine the incidence and prevalence of head and neck injuries (HNIs) in extreme sports. Descriptive epidemiological study. 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. 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. 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.

  15. The Effect of Alcohol Intoxication on Mortality of Blunt Head Injury

    Directory of Open Access Journals (Sweden)

    Hsing-Lin Lin

    2014-01-01

    Full Text Available Alcohol is found to have neuroprotection in recent studies in head injuries. We investigated the association of blood alcohol concentration (BAC with mortality of patients with blunt head injury after traffic accident. All patients sustaining blunt head injury caused by traffic accident brought to our emergency department who had obtained a brain computed tomography scans and BAC were analyzed. Patients with unknown mechanisms, transfers from outside hospitals, and incomplete data were excluded. Logistic regression was used to identify independent predictors of mortality. During the study period, 3,628 patients with brain computed tomography (CT were included. Of these, BAC was measured in 556 patients. Patients with the lowest BAC (less than 8 mg/dl had lower mortality; intoxicated patients with BAC between 8 and less than 100 mg/dl were associated with significantly higher mortality than those patients in other intoxicated groups. Adjusted logistic regression demonstrated higher BAC group and Glasgow coma scale (GCS scores, and lower ISS and age were identified as independent predictors of reduced mortality. In our study, we found that patients who had moderate alcohol intoxication had higher risk of mortality. However, higher GCS scores, lower ISS, and younger age were identified as independent predictors of reduced mortality in the study patients.

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Kavanagh, Dara Oliver; Lynam, Conor; Düerk, Thorsten; Casey, Mary; Eustace, Paul W

    2010-01-01

    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.

  19. 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.

  20. A qualitative exploration of work-related head injury: vulnerability at the intersection of workers' decision making and organizational values.

    Science.gov (United States)

    Kontos, P; Grigorovich, A; Nowrouzi, B; Sharma, B; Lewko, J; Mollayeva, T; Colantonio, A

    2017-10-18

    Work-related head injury is a critical public health issue due to its rising prevalence; the association with profound disruption of workers' lives; and significant economic burdens in terms of medical costs and lost wages. Efforts to understand and prevent these types of injuries have largely been dominated by epidemiological research and safety science, which has focused on identifying risk at the level of the individual worker, population group, or organizational sector. Limited research has focused on the perspectives of the workers, a key stakeholder group for informing understanding of vulnerability to work-related head injury. This study explored workers' perspectives to better understand their decision-making and how and why their injuries occurred. We conducted a qualitative study using in-depth semi-structured interviews with thirty-two adult workers who had sustained a work-related head injury. Workers were recruited from an urban clinic in central Ontario, Canada. Labour Process Theory informed the thematic analysis. Three hazardous work conditions were identified: insufficient training; inadequate staffing; and inattention to the physical environment. In addition, professional and organizational norms were implicated in vulnerability to head injury including putting the client before the worker and the pressure to work unsafely. The findings also highlight a complex interrelationship between workers' decision-making and professional and organizational norms that produces vulnerability to head injury, a vulnerability which oftentimes is reproduced by workers' decisions to work despite hazardous conditions. Our findings suggest that, beyond the need to redress the inattention to hazards in the physical environment, there is a need to address norms that influence worker decision-making to improve the safety of workers. Using Labour Process Theory highlights an important social dynamic within workplace sectors that could inform future development and

  1. A qualitative exploration of work-related head injury: vulnerability at the intersection of workers’ decision making and organizational values

    Directory of Open Access Journals (Sweden)

    P. Kontos

    2017-10-01

    Full Text Available Abstract Background Work-related head injury is a critical public health issue due to its rising prevalence; the association with profound disruption of workers’ lives; and significant economic burdens in terms of medical costs and lost wages. Efforts to understand and prevent these types of injuries have largely been dominated by epidemiological research and safety science, which has focused on identifying risk at the level of the individual worker, population group, or organizational sector. Limited research has focused on the perspectives of the workers, a key stakeholder group for informing understanding of vulnerability to work-related head injury. This study explored workers’ perspectives to better understand their decision-making and how and why their injuries occurred. Methods We conducted a qualitative study using in-depth semi-structured interviews with thirty-two adult workers who had sustained a work-related head injury. Workers were recruited from an urban clinic in central Ontario, Canada. Labour Process Theory informed the thematic analysis. Results Three hazardous work conditions were identified: insufficient training; inadequate staffing; and inattention to the physical environment. In addition, professional and organizational norms were implicated in vulnerability to head injury including putting the client before the worker and the pressure to work unsafely. The findings also highlight a complex interrelationship between workers’ decision-making and professional and organizational norms that produces vulnerability to head injury, a vulnerability which oftentimes is reproduced by workers’ decisions to work despite hazardous conditions. Conclusions Our findings suggest that, beyond the need to redress the inattention to hazards in the physical environment, there is a need to address norms that influence worker decision-making to improve the safety of workers. Using Labour Process Theory highlights an important social

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

    Science.gov (United States)

    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

  3. Head injuries in winter sports: downhill skiing, snowboarding, sledding, snowmobiling, ice skating and ice hockey.

    Science.gov (United States)

    Chaze, Brian; McDonald, Patrick

    2008-02-01

    Winter sports are often associated with high speed, which carries with it the potential for collision. As such, head injuries are among the more commonly encountered injuries in winter-related sporting activities. This article focuses on popular winter sports such as downhill skiing and snowboarding, sledding, snowmobiling, ice skating, and hockey. In virtually all of these activities, the incidence and severity of head injuries can be reduced by the use of appropriate protective headgear.

  4. Glasgow Coma Scale and outcomes after structural traumatic head injury in early childhood.

    Directory of Open Access Journals (Sweden)

    Natasha L Heather

    Full Text Available OBJECTIVE: To assess the association of the Glasgow Coma Scale (GCS with radiological evidence of head injury (the Abbreviated Injury Scale for the head region, AIS-HR in young children hospitalized with traumatic head injury (THI, and the predictive value of GCS and AIS-HR scores for long-term impairment. METHODS: Our study involved a 10-year retrospective review of a database encompassing all patients admitted to Starship Children's Hospital (Auckland, New Zealand, 2000-2010 with THI. RESULTS: We studied 619 children aged <5 years at the time of THI, with long-term outcome data available for 161 subjects. Both GCS and AIS-HR scores were predictive of length of intensive care unit and hospital stay (all p<0.001. GCS was correlated with AIS-HR (ρ=-0.46; p<0.001, although mild GCS scores (13-15 commonly under-estimated the severity of radiological injury: 42% of children with mild GCS scores had serious-critical THI (AIS-HR 3-5. Increasingly severe GCS or AIS-HR scores were both associated with a greater likelihood of long-term impairment (neurological disability, residual problems, and educational support. However, long-term impairment was also relatively common in children with mild GCS scores paired with structural THI more severe than a simple linear skull fracture. CONCLUSION: Severe GCS scores will identify most cases of severe radiological injury in early childhood, and are good predictors of poor long-term outcome. However, young children admitted to hospital with structural THI and mild GCS scores have an appreciable risk of long-term disability, and also warrant long-term follow-up.

  5. Can glasgow score at discharge represent final outcome in severe head injury?

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    Deepak Agrawal

    2012-01-01

    Full Text Available Background: Patients with head injury continue to improve over time and a minimum follow-up of six months is considered necessary to evaluate outcome. However, this may be difficult to assess due to lack of follow-up. It is also well known that operated patients who return for cranioplasty usually have the best outcome. Aims and Objectives: To assess the outcome following severe head injury using cranioplasty as a surrogate marker for good outcome. Materials and Methods: This was a retrospective study carried out from January 2009 to December 2010. All patients with severe head injury who underwent decompressive craniectomy (DC in the study period were included. Patients who came back for cranioplasty in the same period were also included. Case records, imaging and follow up visit data from all patients were reviewed. Glasgow Coma Score (GCS on admission and Glasgow Outcome Score (GOS at discharge were assessed. Observations and Results: Of the 273 patients, 84.25% (n=230 were males and 15.75% (n= 43 were females. The mean age was 34.3 years (range 2-81 years, SD 16.817. The mean GCS on admission was 5.615 (range 3-8, SD 1.438. The in-hospital mortality was 54% (n=149. Good outcome (GOS of 4 or 5 at discharge was attained in 22% (n=60 patients. Sixty five patients returned for cranioplasty (with a GOS of 4 or 5 during the study period. There was no statistical difference in the number of patients discharged with good outcome and those coming back for cranioplasty in the study period (P>0.5. Patients who came back for cranioplasty were younger in age (mean age 28.815 years SD 13.396 with better admission GCS prior to DC (mean GCS 6.32 SD1.39. Conclusions: In operated severe head injury patients significant number of patients (24% in our study have excellent outcome. However, insignificant number of patients had further improvement to GOS 4 or 5 (good outcome from the time of initial discharge. This suggests that due to lack of intensive

  6. Angle grinder injuries: a cause of serious head and neck trauma.

    Science.gov (United States)

    Wongprasartsuk, S; Love, R L; Cleland, H J

    2000-03-20

    Over the past 12 months, the Victorian Trauma Centre at the Alfred Hospital, Melbourne, has dealt with serious head and neck injuries associated with angle grinder use. Three cases are presented, documenting the circumstances and severity of these injuries and subsequent management. Angle grinder injuries are a source of serious morbidity and mortality, much of which is preventable.

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

    Science.gov (United States)

    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.

  8. 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

  9. Telemark skiing injuries: an 11-year study.

    Science.gov (United States)

    Made, C; Borg, H; Thelander, D; Elmqvist, L G

    2001-11-01

    This study evaluated telemark injuries in a Swedish ski area in terms of injury ratio, location, and causes over time. During the seasons of 1989-2000 all injured telemark skiers ( n=94) who attended the medical center in Tärnaby, Sweden, within 48 h after the accident were registered and asked to fill in an injury form. A control group of noninjured telemark skiers were interviewed in the season of 1999-2000. The most common cause of injury was fall (70%) and the injury ratio was 1.2. There was a higher proportion of beginners in the injured population, and they had a fall/run ratio of 0.7, compared with 0.3 for average and advanced skiers. Ankle/foot injuries were most common (28% of injuries) followed by knee (20%) and head/neck (17%). The ankle/foot injuries decreased from 35% to 22% in the seasons 1989-1995 to 1995-2000. Beginners had more ankle/foot injuries than skilled participants. The severity of ankle/foot injuries classified as the Abbreviated Injury Scale group 2 or higher decreased from 33% to 21% during the study period. Twenty-seven percent used plastic and 73% leather boots. We found no association between boot material and ankle/foot injuries. The proportion of high boots with two or more buckles was 51%. High boots appeared to be protective against ankle/foot injuries. The proportion of high boots increased from 24% to 67% during the study period. Thus ankle/foot injuries were the most common injury location, but have decreased over time. The severity of these injuries has also decreased. A possible explanation could be the increased use of high boots.

  10. Sensitivity of head and cervical spine injury measures to impact factors relevant to rollover crashes.

    Science.gov (United States)

    Mattos, G A; Mcintosh, A S; Grzebieta, R H; Yoganandan, N; Pintar, F A

    2015-01-01

    Serious head and cervical spine injuries have been shown to occur mostly independent of one another in pure rollover crashes. In an attempt to define a dynamic rollover crash test protocol that can replicate serious injuries to the head and cervical spine, it is important to understand the conditions that are likely to produce serious injuries to these 2 body regions. The objective of this research is to analyze the effect that impact factors relevant to a rollover crash have on the injury metrics of the head and cervical spine, with a specific interest in the differentiation between independent injuries and those that are predicted to occur concomitantly. A series of head impacts was simulated using a detailed finite element model of the human body, the Total HUman Model for Safety (THUMS), in which the impactor velocity, displacement, and direction were varied. The performance of the model was assessed against available experimental tests performed under comparable conditions. Indirect, kinematic-based, and direct, tissue-level, injury metrics were used to assess the likelihood of serious injuries to the head and cervical spine. The performance of the THUMS head and spine in reconstructed experimental impacts compared well to reported values. All impact factors were significantly associated with injury measures for both the head and cervical spine. Increases in impact velocity and displacement resulted in increases in nearly all injury measures, whereas impactor orientation had opposite effects on brain and cervical spine injury metrics. The greatest cervical spine injury measures were recorded in an impact with a 15° anterior orientation. The greatest brain injury measures occurred when the impactor was at its maximum (45°) angle. The overall kinetic and kinematic response of the THUMS head and cervical spine in reconstructed experiment conditions compare well with reported values, although the occurrence of fractures was overpredicted. The trends in predicted

  11. Impairments in learning, memory, and metamemory following childhood head injury.

    Science.gov (United States)

    Crowther, Jason E; Hanten, Gerri; Li, Xiaoqi; Dennis, Maureen; Chapman, Sandra B; Levin, Harvey S

    2011-01-01

    To assess postinjury changes in learning, memory, and metamemory abilities following childhood traumatic brain injury. Prospective, longitudinal with 5 assessments made from baseline to 24 months postinjury. A total of 167 children (aged 5-15 years) with traumatic brain injury (TBI; 64 severe, 55 moderate, and 48 mild). Children completed a judgment of learning task with 4 recall trials and made 3 metamemory judgments. Relative to those with mild TBI, children with moderate or severe TBI performed worse at earlier times postinjury and had a greater change in performance over time. Performance for moderate and severe groups peaked at 12 months and the performance gap between them and mild TBI group increased slightly from 12 to 24 months. Traumatic brain injury severity did not affect initial study-recall trial performance, but groups did diverge in performance with repeated study. Greater TBI severity was associated with poorer performance on prospective metamemory judgments, but not retrospective judgments. Traumatic brain injury severity affected prospective judgments of memory performance and learning strategies, but did not appear to affect either word retention or the forgetting of words over a delay. Implications for rehabilitation are discussed.

  12. Microwave Hematoma Detector for the Rapid Assessment of Head Injuries

    Energy Technology Data Exchange (ETDEWEB)

    Hadded, W.; Chang, J.; Rosenbury, T.; Dallum, G.; Welsch, P.; Scott, D.; Duarte, D.; Acevedo-Bolton, V.

    2000-02-11

    A non-invasive microwave device for the detection of epi/subdural hemorrhaging (hematoma) is under current development. The final device will be highly portable and allow real time assessment of head injuries, thereby satisfying early detection needs of the field technician as well as providing a tool for repetitious monitoring of high-risk individuals. The device will adopt the advanced technology of micropower impulse radar (MIR) which is a state of the art low cost ultra wide band (UWB) microwave radar developed here at LLNL. It will consist of a MIR transmitting and receiving module, a computer based signal processing module, and a device-to-patient signal coupling module--the UWB antenna. The prototype design is being guided by the needs of the patient and the practitioner along with the prerequisites of the technology including issues such as the specificity of the device, efficacy of diagnosis, accuracy, robustness, and patient comfort. The prototype development follows a concurrent approach which .includes experiments designed to evaluate requirements of the radar and antenna design, phantom development to facilitate laboratory investigations, and investigation into the limits of adapting pre-existing non-medical MIR devices to medical applications. This report will present the accomplishments and project highlights to date in the fiscal year 1999. Future project projections will also be discussed.

  13. The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players.

    Science.gov (United States)

    Delaney, J S; Al-Kashmiri, A; Drummond, R; Correa, J A

    2008-02-01

    To examine the effects of protective headgear in adolescent football (soccer) players. Cross-sectional study. Oakville Soccer Club, Oakville, Canada. Football players aged 12-17 years. A questionnaire examining the 2006 football season using self-reported symptoms. The number of concussions experienced during the current football season, the duration of symptoms, injuries to the head and face and any associated risk factors for these injuries. In the population studied, 47.8% had experienced symptoms of a concussion during the current football year. 26.9% of athletes who wore headgear (HG) and 52.8% of those who did not wear headgear (No-HG) had concussions. Approximately 4 out of 5 athletes in each group did not realize they had suffered a concussion. More than one concussion was experienced by 50.0% of the concussed HG athletes and 69.3% of the concussed No-HG group. 23.9% of all concussed players experienced symptoms for at least 1 day or longer. Variables that increased the risk of suffering a concussion during the 2006 football year included being female and not wearing headgear. Being female and not wearing football headgear increased the risk of suffering an abrasion, laceration or contusion on areas of the head covered by football headgear. Adolescent football players experience a significant number of concussions. Being female may increase the risk of suffering a concussion and injuries on the head and face, while the use of football headgear may decrease the risk of sustaining these injuries.

  14. Can the initial history predict whether a child with a head injury has been abused?

    Science.gov (United States)

    Hettler, Joeli; Greenes, David S

    2003-03-01

    Previous studies of child abuse have used the presenting history as part of the case definition of abuse. Thus, data from these studies cannot be used to determine the diagnostic utility of historical features for identifying cases of abuse. The objective of this study was to determine the diagnostic utility of certain historical features for identifying cases of abusive head trauma. We retrospectively studied all children, aged 0 to 3 years, who had acute traumatic intracranial injury and were admitted to a tertiary care pediatric hospital from 1993 to 2000. Cases were categorized as either "definite abuse" or "not definite abuse" on the basis of radiologic, ophthalmologic, and physical examination findings, without regard to the presenting history. Forty-nine (30%) of 163 children met the criteria for definite abuse. Having no history of trauma had a high specificity (0.97) and positive predictive value (PPV; 0.92) for abuse. Among the subgroup of patients with persistent neurologic abnormality at hospital discharge (n = 34), having a history of no or low-impact trauma had a specificity of 1.0 and a PPV of 1.0 for definite abuse. Injuries were blamed on home resuscitative efforts in 12% of definite abuse cases and 0% of not definite abuse cases. The initial history of trauma was changed in 9% of definite abuse cases, as compared with 0% of not definite abuse cases. Among young children with a head injury, certain historical features have high specificity and PPV for diagnosing child abuse.

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

    Science.gov (United States)

    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

  16. The impact of preoperative hip heterotopic ossification extent on recurrence in patients with head and spinal cord injury: a case control study.

    Directory of Open Access Journals (Sweden)

    François Genêt

    Full Text Available BACKGROUND: The preoperative Heterotopic Ossification (HO extent is usually one of the main used criteria to predict the recurrence before excision. Brooker et al built a radiologic scale to assess this pre operative extent around the hip. The aim of this study is to investigate the relationship between the recurrence risk after hip HO excision in Traumatic Brain Injury (TBI and Spinal Cord Injury (SCI patients and the preoperative extent of HO. METHODOLOGY/PRINCIPAL FINDINGS: A case control study including TBI or SCI patients following surgery for troublesome hip HO with (case, n = 19 or without (control, n = 76 recurrence. Matching criteria were: sex, pathology (SCI or TBI and age at the time of surgery (+/-4.5 years. For each etiology (TBI and SCI, the residual cognitive and functional status (Garland classification, the preoperative extent (Brooker status, the modified radiological and functional status (GCG-BD classification, HO localization, side, mean age at the CNS damage, mean delay for the first HO surgery, and for the case series, the mean operative delay for recurrence after the first surgical intervention were noted. CONCLUSIONS/SIGNIFICANCE: The median delay for first HO surgery was 38.6 months (range 4.5 to 414.5; for the case subgroup and 17.6 months (range 5.7 to 339.6 for the control group. No significant link was found between recurrence and operative delay (p = 0.51; the location around the joint (0.07; the Brooker (p = 0.52 or GCG-BD status (p = 0.79. Including all the matching factors, no significant relationship was found between the recurrence HO risk and the preoperative extent of troublesome hip HO using Brooker status (OR = 1.56(95% CI: 0.47-5.19 or GCG-BD status (OR class 3 versus 2 = 0.67(95% CI: 0.11-4.24 and OR class 4 versus 2 = 0.79(95%CI: 0.09-6.91. Until the pathophysiology of HO development is understood, it will be difficult to create tools which can predict HO recurrence.

  17. Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study

    OpenAIRE

    Fabbri, Andrea; Servadei, Franco; Marchesini, Giulio; Bronzoni, Carolina; Montesi, Danilo; Arietta, Luca

    2013-01-01

    Introduction Pre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and positive computed tomography (CT) scans. We aimed to determine the potential risk of pre-injury antiplatelet drug use on short- and long-term outcome of head injured subjects admitted to emergency departments (EDs) in Italy for extended observation. Methods A total of 1,558 adult subjects with mild, moderate and severe head injury admitted to Italian EDs were studied. In multivariable...

  18. Analysis of a severe head injury in World Cup alpine skiing.

    Science.gov (United States)

    Yamazaki, Junya; Gilgien, Matthias; Kleiven, Svein; McIntosh, Andrew S; Nachbauer, Werner; Müller, Erich; Bere, Tone; Bahr, Roald; Krosshaug, Tron

    2015-06-01

    Traumatic brain injury (TBI) is the leading cause of death in alpine skiing. It has been found that helmet use can reduce the incidence of head injuries between 15% and 60%. However, knowledge on optimal helmet performance criteria in World Cup alpine skiing is currently limited owing to the lack of biomechanical data from real crash situations. This study aimed to estimate impact velocities in a severe TBI case in World Cup alpine skiing. Video sequences from a TBI case in World Cup alpine skiing were analyzed using a model-based image matching technique. Video sequences from four camera views were obtained in full high-definition (1080p) format. A three-dimensional model of the course was built based on accurate measurements of piste landmarks and matched to the background video footage using the animation software Poser 4. A trunk-neck-head model was used for tracking the skier's trajectory. Immediately before head impact, the downward velocity component was estimated to be 8 m·s⁻¹. After impact, the upward velocity was 3 m·s⁻¹, whereas the velocity parallel to the slope surface was reduced from 33 m·s⁻¹ to 22 m·s⁻¹. The frontal plane angular velocity of the head changed from 80 rad·s⁻¹ left tilt immediately before impact to 20 rad·s⁻¹ right tilt immediately after impact. A unique combination of high-definition video footage and accurate measurements of landmarks in the slope made possible a high-quality analysis of head impact velocity in a severe TBI case. The estimates can provide crucial information on how to prevent TBI through helmet performance criteria and design.

  19. TH-E-BRF-09: Gaussian Mixture Model Analysis of Radiation-Induced Parotid-Gland Injury: An Ultrasound Study of Acute and Late Xerostomia in Head-And-Neck Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Liu, T [Department of Radiation Oncology and Winship Cancer Institute, Emory Univ, Atlanta, GA (United States); Yu, D; Beitler, J; Curran, W; Yang, X [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA (United States); Tridandapani, S [Department of Radiology and Imaging Sciences and Winship Cancer Institute, Emory University, Atlanta, GA (United States); Bruner, D [School of Nursing and Winship Cancer Institute, Emory Univesity, Atlanta, GA (United States)

    2014-06-15

    Purpose: Xerostomia (dry mouth), secondary to parotid-gland injury, is a distressing side-effect in head-and-neck radiotherapy (RT). This study's purpose is to develop a novel ultrasound technique to quantitatively evaluate post-RT parotid-gland injury. Methods: Recent ultrasound studies have shown that healthy parotid glands exhibit homogeneous echotexture, whereas post-RT parotid glands are often heterogeneous, with multiple hypoechoic (inflammation) or hyperechoic (fibrosis) regions. We propose to use a Gaussian mixture model to analyze the ultrasonic echo-histogram of the parotid glands. An IRB-approved clinical study was conducted: (1) control-group: 13 healthy-volunteers, served as the control; (2) acutetoxicity group − 20 patients (mean age: 62.5 ± 8.9 years, follow-up: 2.0±0.8 months); and (3) late-toxicity group − 18 patients (mean age: 60.7 ± 7.3 years, follow-up: 20.1±10.4 months). All patients experienced RTOG grade 1 or 2 salivary-gland toxicity. Each participant underwent an ultrasound scan (10 MHz) of the bilateral parotid glands. An echo-intensity histogram was derived for each parotid and a Gaussian mixture model was used to fit the histogram using expectation maximization (EM) algorithm. The quality of the fitting was evaluated with the R-squared value. Results: (1) Controlgroup: all parotid glands fitted well with one Gaussian component, with a mean intensity of 79.8±4.9 (R-squared>0.96). (2) Acute-toxicity group: 37 of the 40 post-RT parotid glands fitted well with two Gaussian components, with a mean intensity of 42.9±7.4, 73.3±12.2 (R-squared>0.95). (3) Latetoxicity group: 32 of the 36 post-RT parotid fitted well with 3 Gaussian components, with mean intensities of 49.7±7.6, 77.2±8.7, and 118.6±11.8 (R-squared>0.98). Conclusion: RT-associated parotid-gland injury is common in head-and-neck RT, but challenging to assess. This work has demonstrated that the Gaussian mixture model of the echo-histogram could quantify acute and

  20. Hyperbaric oxygen therapy for the prevention of radiation-induced tissue injury in the head and neck region. : An experimental mouse study

    NARCIS (Netherlands)

    L. Spiegelberg (Linda)

    2015-01-01

    markdownabstract__Abstract__ Each year, more than 500.000 cases of head and neck cancer (HNC) occur worldwide. More than half of these are oral cavity cancers, while the rest comprises pharyngeal and laryngeal cancers (Figure 1). The vast majority (~90%) of HNC diagnoses are squamous cell

  1. 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.

  2. 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.

  3. [Specificities of prosthetic and orthotic rehabilitation in amputees with head injury].

    Science.gov (United States)

    Teofilovski, Mirko; Parapid, Biljana; Rakić, Miodrag; Popović, Nikola; Teofilovski-Parapid, Gordana

    2011-12-01

    BACKGROUND/AIM. The prosthetic-orthotic rehabilitation (POR) of amputees with head injury within the polytrauma presents a specific entity. The number of traumas caused by the traffic and the low-intensity war conflicts, increases constantly. The aim of our study was to examine the influence of complications on the POR duration and outcome in polytrauma amputees with head injury (PTAHI) recording complications at the beginning and during the POR. The study was carried out on the patients divided into two groups of 35 polytrauma male patients each of corresponding age with unilateral transfemoral amputation caused by the war injury. The experimental group consisted of the amputees with head injury. Standard clinical techniques and procedures, as well as special functional evaluation techniques were used. The PATHI started POR with a greater number of complications (average rate 7.29 vs 5.11 per patient; W = 928.000: Z = 3.730: p = 0.000). There was a highly significant positive correlation between this number and the Barthel Score value change (Fx, H, p admision, the amount of complications defined for the value 4 of POR outcome was significantly higher than values 2 and 3, respectively (H = 8.948; df = 2; p = 0.011). The PTAHI developed significantly more frequently complications during rehabilitation (X2 = 1.061; df = 1; p < 0.01). The proportion of the examinees with the value 4 who developed complications during rehabilitations was significantly higher than those with value 2 (Fp = 3.406; df1 = 2; df2 = 67; p = 0.038). The rehabilitation of the PTAHI lasted significantly longer (average 259.09 vs 183.63 days; W = 923.500; Z = -3.748; p = 0.000). The PTAHI including head injuries started prosthetic-orthotic rehabilitation with more prosthetic complications and their psychological status was worse, resulting in the longer duration of rehabilitation whereas the outcome itself was poor. The value 4 of the prosthetic-orthotic rehabilitation outcome can be expected

  4. Specificities of prosthetic and orthotic rehabilitation in amputees with head injury

    Directory of Open Access Journals (Sweden)

    Teofilovski Mirko

    2011-01-01

    Full Text Available Background/Aim. The prosthetic-orthotic rehabilitation (POR of amputees with head injury within the polytrauma presents a specific entity. The number of traumas caused by the traffic and the low-intensity war conflicts, increases constantly. The aim of our study was to examine the influence of complications on the POR duration and outcome in polytrauma amputees with head injury (PTAHI recording complications at the beginning and during the POR. Methods. The study was carried out on the patients divided into two groups of 35 polytrauma male patients each of corresponding age with unilateral transfemoral amputation caused by the war injury. The experimental group consisted of the amputees with head injury. Standard clinical techniques and procedures, as well as special functional evaluation techniques were used. Results. The PATHI started POR with a greater number of complications (average rate 7.29 vs 5.11 per patient; W = 928.000: Z = 3.730: p = 0.000. There was a highly significant positive correlation between this number and the Barthel Score value change (Fx, H, p < 0.01, and negative significant correlation considering prosthetic use and functional capacity test values (Fx, H p < 0.05. On admision, the amount of complications defined for the value 4 of POR outcome was significantly higher than values 2 and 3, respectively (H = 8.948; df = 2; p = 0.011. The PTAHI developed significantly more frequently complications during rehabilitation (X2 = 1.061; df = 1; p < 0.01. The proportion of the examinees with the value 4 who developed complications during rehabilitations was significantly higher than those with value 2 (Fp = 3.406; df1 = 2; df2 = 67; p = 0.038. The rehabilitation of the PTAHI lasted significantly longer (average 259.09 vs 183.63 days; W = 923.500; Z = -3.748; p = 0.000. Conclusion. The PTAHI including head injuries started prostheticorthotic rehabilitation with more prosthetic complications and their psychological status was worse

  5. Physiological emotional under-arousal in individuals with mild head injury.

    Science.gov (United States)

    Baker, Julie M; Good, Dawn E

    2014-01-01

    This study examined the potential emotional sequelae following self-reported mild head injury (MHI; e.g. 'altered state of consciousness' [ASC]) in university students with a particular focus on arousal status and responsivity to experimental manipulation of arousal. A quasi-experimental design (n = 91) was used to examine arousal status (self-reported and physiological indices) and response to manipulated arousal (i.e. induced psychosocial stress/activation; reduced activation/relaxation) between persons who acknowledged prior MHI and persons with no-MHI. University students who self-reported MHI were physiologically under-aroused and less responsive to stressors (both laboratory and environmental) compared to their no-MHI cohort. Those with reported loss of consciousness demonstrated the most attenuated emotional arousal responses (i.e. flattened electrodermal responsivity) relative to those with only a reported ASC, followed by those with no-MHI. The under-arousal in traumatic brain injury has been hypothesized to be associated with ventromedial prefrontal cortex disruption. This under-arousal may be mirrored in persons who self-report experiencing subtle head trauma. Students who reported MHI may be less able to physiologically respond and/or cognitively appraise stressful experiences as compared to their no-MHI cohort; and experience subtle persistent consequences despite the subtle nature of the reported head trauma.

  6. 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.

  7. Clinical manifestations that predict abnormal brain computed tomography (CT in children with minor head injury

    Directory of Open Access Journals (Sweden)

    Nesrin Alharthy

    2015-01-01

    Full Text Available Background: Computed tomography (CT used in pediatric pediatrics brain injury (TBI to ascertain neurological manifestations. Nevertheless, this practice is associated with adverse effects. Reports in the literature suggest incidents of morbidity and mortality in children due to exposure to radiation. Hence, it is found imperative to search for a reliable alternative. Objectives: The aim of this study is to find a reliable clinical alternative to detect an intracranial injury without resorting to the CT. Materials and Methods: Retrospective cross-sectional study was undertaken in patients (1-14 years with blunt head injury and having a Glasgow Coma Scale (GCS of 13-15 who had CT performed on them. Using statistical analysis, the correlation between clinical examination and positive CT manifestation is analyzed for different age-groups and various mechanisms of injury. Results: No statistically significant association between parameteres such as Loss of Consciousness, ′fall′ as mechanism of injury, motor vehicle accidents (MVA, more than two discrete episodes of vomiting and the CT finding of intracranial injury could be noted. Analyzed data have led to believe that GCS of 13 at presentation is the only important clinical predictor of intracranial injury. Conclusion: Retrospective data, small sample size and limited number of factors for assessing clinical manifestation might present constraints on the predictive rule that was derived from this review. Such limitations notwithstanding, the decision to determine which patients should undergo neuroimaging is encouraged to be based on clinical judgments. Further analysis with higher sample sizes may be required to authenticate and validate findings.

  8. Injury rate and injury pattern among elite World Cup snowboarders: a 6-year cohort study.

    Science.gov (United States)

    Major, D H; Steenstrup, S E; Bere, T; Bahr, R; Nordsletten, L

    2014-01-01

    There is limited knowledge on the injury rate and injury pattern in the different disciplines among elite snowboarders. The aim of this study was to describe and compare the injury rate and injury pattern among the different International Ski Federation (Fédération Internationale de Ski, FIS) World Cup (WC) snowboard disciplines. We conducted retrospective interviews with FIS WC snowboard athletes at the end of each season in the period 2007-2012, to register all acute injuries sustained during training or competition during the competitive season requiring attention by medical personnel. To calculate the exposure, we obtained information from result lists from the FIS competition database for all WC competitions for each of the interviewed athletes. We registered a total of 574 injuries among 1432 athletes, accounting for an overall injury rate of 40.1 injuries/100 athlete/season. A total of 171 injuries occurred during the FIS WC competitions, corresponding to 6.4 injuries/1000 runs. During competition, injury risk was highest in snowboard cross with 11.9/1000 runs, followed by 6.3 in halfpipe, 3.6 in big air and 2.8 in parallel giant slalom/parallel slalom (PGS/PSL). Snowboard cross also had the highest risk of severe injuries (>28 days absence). No differences in injury risk were detected between male and female snowboarders. The most commonly injured body part was the knee (17.8%), followed by the shoulder/clavicle (13.4%) and head/face (13.2%). The risk of knee injury (the most common injury type) and head injury was significantly higher in snowboard cross and halfpipe compared to PGS/PSL. The risk of injuries was higher in snowboard cross than in halfpipe, big air and PGS/PSL. The most commonly injured body part was the knee. Prevention of snowboard injuries among elite snowboarders should focus on knee injuries, severe injuries and snowboard cross athletes.

  9. 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.

  10. Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward.

    Science.gov (United States)

    Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A

    2011-06-01

    Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

  11. Epilepsy after head injury in dogs: a natural model of posttraumatic epilepsy.

    Science.gov (United States)

    Steinmetz, Sonja; Tipold, Andrea; Löscher, Wolfgang

    2013-04-01

    In humans, traumatic brain injury (TBI) is one of the most common causes of acquired (symptomatic) epilepsy, but as yet there is no treatment to prevent the development of epilepsy after TBI. Animal models of posttraumatic epilepsy (PTE) are important to characterize epileptogenic mechanisms of TBI and to identify clinically effective antiepileptogenic treatments. The prevalence and phenomenology of naturally occurring canine epilepsy are similar to those in human epilepsy. However, the risk of epilepsy after TBI has not been systemically studied in dogs. We therefore performed a large retrospective study in 1,000 dogs referred to our clinical department over a period of 11.5 years with the aim to determine the incidence of early and late seizures after head trauma in this species. Two strategies were used: in group I (n = 392), we evaluated whether dogs referred for the treatment of a head trauma (group Ia) or other trauma (group Ib) developed seizures after the trauma, whereas in group II (n = 608) we evaluated whether dogs referred for the treatment of recurrent epileptic seizures had a history of head trauma. Data for this study were obtained from our clinical database, questionnaires sent to the dogs' owners, and owner interviews. In group Ia, 6.6% of the dogs developed PTE, which was significantly different from group Ib (1.9%), indicating that head trauma increased the risk of developing epilepsy by a factor of 3.4. The risk of PTE increased with severity of TBI; 14.3% of the dogs with skull fracture developed PTE. In group II, 15.5% of the dogs with epilepsy had a history of head injury, which was significantly higher than the incidence of PTE determined for group Ia. Our study indicates that head trauma in dogs is associated with a significant risk of developing epilepsy. Therefore, dogs with severe TBI are an interesting natural model of PTE that provides a novel translational platform for studies on human PTE. Wiley Periodicals, Inc. © 2013

  12. The fronto-temporal component in mild and moderately severe head injury

    NARCIS (Netherlands)

    Minderhoud, JM; vanZomeren, AH; vanderNaalt, J

    The history of the identification of the so-called (fronto-)temporal lobe contusion is reviewed. Treatment of minor head injuries actually starts with the right diagnosis. Injuries of the temporal lobe, characterized by a comparatively long period of post-traumatic amnesia should be distinguished

  13. Nontraumatic head and neck injuries: a clinical approach. Part 2.

    Science.gov (United States)

    Brea Álvarez, B; Esteban García, L; Tuñón Gómez, M; Cepeda Ibarra, Y

    Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons. As explained in the first part of this update, these entities affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Maintaining the same approach as in the first part, focusing on the clinical presentations in the emergency department rather than on the anatomic regions affected, we will study the entities that present with two patterns: those that present with a combination of cervical numbness, dysphagia, and dyspnea and those that present with acute sensory deficits. In the latter group, we will specifically focus on visual deficits, because this is the most common symptom that calls for urgent imaging studies. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. 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.

  15. Neonatal head injury unrelated to birth trauma in South-East Nigeria.

    Science.gov (United States)

    Uche, E O; Emejulu, J K; Ekenze, S O; Okorie, E; Uche, N J

    2013-01-01

    Neonatal head trauma resulting from causes other than birth trauma has rarely been the focus of many a research theme in the literature. To highlight the occurrence of non-birth trauma related neonatal head injury, and evaluate the causes and outcome of treatment. A 3 year retrospective review of neonatal patients with head injury from two tertiary hospitals in South-East Nigeria between July 2009 and June 2012 (n-37). Data was collected from patients' birth and medical records. Data was analyzed using the SPSS version 15. Among the one hundred and seventy-six cases (11.78)% pediatric head injury cases seen, thirty seven (2.48)% occurred in neonatal patients. The most common cause of head injury was fall 22 cases [59.5%]. Children of mothers with low educational qualification were more likely to sustain falls 22 cases (59.5%). Road traffic accident (n = 15) was associated with more severe injuries and poorer outcome. Operative treatment was associated with increased mortality (two of three cases). The mortality rate in our series is 8.10%. Reduction of neonatal head trauma could be achieved through improved maternal education.

  16. 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.

  17. Traumatic brain injuries in illustrated literature: experience from a series of over 700 head injuries in the Asterix comic books.

    Science.gov (United States)

    Kamp, Marcel A; Slotty, Philipp; Sarikaya-Seiwert, Sevgi; Steiger, Hans-Jakob; Hänggi, Daniel

    2011-06-01

    The goal of the present study was to analyze the epidemiology and specific risk factors of traumatic brain injury (TBI) in the Asterix illustrated comic books. Among the illustrated literature, TBI is a predominating injury pattern. A retrospective analysis of TBI in all 34 Asterix comic books was performed by examining the initial neurological status and signs of TBI. Clinical data were correlated to information regarding the trauma mechanism, the sociocultural background of victims and offenders, and the circumstances of the traumata, to identify specific risk factors. Seven hundred and four TBIs were identified. The majority of persons involved were adult and male. The major cause of trauma was assault (98.8%). Traumata were classified to be severe in over 50% (GCS 3-8). Different neurological deficits and signs of basal skull fractures were identified. Although over half of head-injury victims had a severe initial impairment of consciousness, no case of death or permanent neurological deficit was found. The largest group of head-injured characters was constituted by Romans (63.9%), while Gauls caused nearly 90% of the TBIs. A helmet had been worn by 70.5% of victims but had been lost in the vast majority of cases (87.7%). In 83% of cases, TBIs were caused under the influence of a doping agent called "the magic potion". Although over half of patients had an initially severe impairment of consciousness after TBI, no permanent deficit could be found. Roman nationality, hypoglossal paresis, lost helmet, and ingestion of the magic potion were significantly correlated with severe initial impairment of consciousness (p ≤ 0.05).

  18. 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.

  19. Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury in a Spanish hospital.

    Science.gov (United States)

    Valle Alonso, Joaquín; Fonseca Del Pozo, Francisco Javier; Vaquero Álvarez, Manuel; Lopera Lopera, Elisa; Garcia Segura, Marisol; García Arévalo, Ricardo

    2016-12-16

    To compare two scales for assessment of patients with mild head injury. The Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) according to their diagnostic accuracy in patients attending an emergency department, and to determine the most important predictive values. Cross-sectional study in a first-level Hospital in the period of January 2011 to January 2013. Patients with mild head injury criteria were included. All the patients underwent a computed tomography (CT) of the head as part of internal protocol and the CCHR and NOC criteria were recorded for each patient. We consider the main variable the presence of traumatic lesions on CT and, as secondary variables, neurosurgical intervention and post-concussion syndrome. Sensitivity, specificity, predictive values and validity index (VI) of the CCHR and the NO criteria in the subgroup of patients with a Glasgow Coma Scale (GCS) score of 15 points were compared. A total of 217 patients, of whom 197 had a GCS score of 15 points were evaluated. Both rules showed 100% sensitivity when a significant injury was presented in the CT, the CCHR 100% (95% CI: 97.4%-100%) and the NO criteria 100% (95% CI: 97.4%-100%); but the CCHR achieved higher values of specificity 25.3% (95% CI: 18.6%-32%), positive predictive value (PPV) and VI. The two rules showed a 100% sensitivity regarding neurosurgical intervention; however the CCHR with high-risk criteria showed better specificity, PPV and VI 55.2 (95% CI: 8.3%-62.2%) compared to the NO criteria 7.6 (95% CI: 3.8%-11.5%). With regard to post-concussion syndrome criteria NO criteria showed better sensitivity 100% (95% CI: 96.2%-100%) and predictive values, but lower specificity and VI compared with the CCHR 76.9% (95% CI: 50.2%-100%). Our study demonstrates the high sensitivity of the CCHR and the NO criteria in patients with mild head injury, both to detect a significant clinical lesion on CT or the need for neurosurgical intervention and better specificity of CCHR compared

  20. Significant head accelerations can influence immediate neurological impairments in a murine model of blast-induced traumatic brain injury.

    Science.gov (United States)

    Gullotti, David M; Beamer, Matthew; Panzer, Matthew B; Chen, Yung Chia; Patel, Tapan P; Yu, Allen; Jaumard, Nicolas; Winkelstein, Beth; Bass, Cameron R; Morrison, Barclay; Meaney, David F

    2014-09-01

    Although blast-induced traumatic brain injury (bTBI) is well recognized for its significance in the military population, the unique mechanisms of primary bTBI remain undefined. Animate models of primary bTBI are critical for determining these potentially unique mechanisms, but the biomechanical characteristics of many bTBI models are poorly understood. In this study, we examine some common shock tube configurations used to study blast-induced brain injury in the laboratory and define the optimal configuration to minimize the effect of torso overpressure and blast-induced head accelerations. Pressure transducers indicated that a customized animal holder successfully reduced peak torso overpressures to safe levels across all tested configurations. However, high speed video imaging acquired during the blast showed significant head accelerations occurred when animals were oriented perpendicular to the shock tube axis. These findings of complex head motions during blast are similar to previous reports [Goldstein et al., 2012, "Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model," Sci. Transl. Med., 4(134), 134ra160; Sundaramurthy et al., 2012, "Blast-Induced Biomechanical Loading of the Rat: An Experimental and Anatomically Accurate Computational Blast Injury Model," J. Neurotrauma, 29(13), pp. 2352-2364; Svetlov et al., 2010, "Morphologic and Biochemical Characterization of Brain Injury in a Model of Controlled Blast Overpressure Exposure," J. Trauma, 69(4), pp. 795-804]. Under the same blast input conditions, minimizing head acceleration led to a corresponding elimination of righting time deficits. However, we could still achieve righting time deficits under minimal acceleration conditions by significantly increasing the peak blast overpressure. Together, these data show the importance of characterizing the effect of blast overpressure on head kinematics, with the goal of producing models focused on understanding the

  1. Utility of Emergency Department Observation Units for Neurologically Intact Children With Head CT Abnormalities Secondary to Acute Closed Head Injury.

    Science.gov (United States)

    Lefort, Roxanna; Hunter, Jill V; Cruz, Andrea T; Caviness, A Chantal; Luerssen, Thomas G; Adekunle-Ojo, Aderonke

    2017-03-01

    The aim of the study was to evaluate the utility of the emergency department observation unit (EDOU) for neurologically intact children with closed head injuries (CHIs) and computed tomography (CT) abnormalities. A retrospective cohort study of children aged 0 to 18 years with acute CHI, abnormal head CT, and a Glasgow Coma Scales score of 14 or higher admitted to the EDOU of a tertiary care children's hospital from 2007 to 2010. Children with multisystem trauma, nonaccidental trauma, and previous neurosurgical or coagulopathic conditions were excluded. Medical records were abstracted for demographic, clinical, and radiographic findings. Poor outcome was defined as death, intensive care unit admission, or medically/surgically treated increased intracranial pressure. Two hundred two children were included. Median (range) age was 14 (4 days-16 years) months; 51% were male. The most common CT findings were nondisplaced (136, 67%) or displaced (46, 23%) as well as skull fractures and subdural hematomas (38, 19%); 54 (27%) had less than 1 CT finding. The most common interventions included repeat CT (42, 21%), antiemetics (26, 13%), and pain medication (29, 14%). Eighty-nine percent were discharged in less than 24 hours. Inpatient admission from the EDOU occurred in 6 (3%); all were discharged in less than 3 days. One patient required additional intervention (corticosteroid therapy). She had a subdural hematoma, persistent vomiting, intractable headache, and a nonevolving CT. Neurologically intact patients on initial ED evaluation had a very low likelihood of requiring further interventions, irrespective of CT findings. Although prospective evidence is necessary, this supports reliance on clinical findings when evaluating a well-appearing child with an acute CHI.

  2. Simulation of Head Impact Leading to Traumatic Brain Injury

    National Research Council Canada - National Science Library

    Taylor, Paul A; Ford, Corey C

    2006-01-01

    ... to insipient conditions necessary for the onset of TBI. Our simulation results demonstrate that wave interactions within the head generate significant levels of stress at localized regions within the brain on an early time...

  3. The scourge of head injury among commercial motorcycle riders in ...

    African Journals Online (AJOL)

    Departement of Biomedical Engineering, Makerere University College of Health Sciences. Abstract. Background: Trauma is an increasingly ... Road traffic injuries are the leading cause of injury-re- lated deaths and disability worldwide but more so ..... Dissertation for Master of Med- icine (Orthopaedic and Traumatology) of ...

  4. Altered consciousness following head injury in advanced renal failure: Find the culprit

    Directory of Open Access Journals (Sweden)

    Kun-Lin Wu

    2016-01-01

    Full Text Available Conscious change following head injury needs a scrutiny of the "nontraumatic" cause to avoid inappropriate management and catastrophic complication. We described an 81-year-old diabetic woman with advanced chronic kidney disease (CKD (estimated glomerular filtration rate: 6 ml/min/1.73 m 2 re-presented to Emergency Department with altered mentality and generalized muscular hypotonia 2 days after falling with a head injury. Her initial mentality was alert, and computed tomography of the brain was negative for organic lesions; she has been given oral baclofen 10 mg daily to control her associated spastic back pain. The repeated laboratory and imaging studies were still unrevealing. Her serum baclofen concentration was markedly elevated (1437 ng/ml. With emergent hemodialysis for two sessions, complete elimination of serum baclofen concentration was accompanied by full recovery of her consciousness. Nontraumatic causes, especially drug-induced neurotoxicity, must be kept in mind in traumatic patients with CKD and unexplained neurological feature.

  5. Predicting multiplanar cervical spine injury due to head-turned rear impacts using IV-NIC.

    Science.gov (United States)

    Ivancic, Paul C; Panjabi, Manohar M; Tominaga, Yasuhiro; Malcolmson, George F

    2006-09-01

    Intervertebral Neck Injury Criterion (IV-NIC) hypothesizes that dynamic three-dimensional intervertebral motion beyond physiological limit may cause multiplanar soft-tissue injury. Present goals, using biofidelic whole human cervical spine model with muscle force replication and surrogate head in head-turned rear impacts, were to: (1) correlate IV-NIC with multiplanar injury, (2) determine IV-NIC injury threshold at each intervertebral level, and (3) determine time and mode of dynamic intervertebral motion that caused injury. Impacts were simulated at 3.5, 5, 6.5, and 8 g horizontal accelerations of T1 vertebra (n = 6; average age: 80.2 years; four male, two female donors). IV-NIC was defined at each intervertebral level and in each motion plane as dynamic intervertebral rotation divided by physiological limit. Three-plane pre- and post-impact flexibility testing measured soft-tissue injury; that is significant increase in neutral zone (NZ) or range of motion (RoM) at any intervertebral level, above baseline. IV-NIC injury threshold was average IV-NIC peak at injury onset. IV-NIC extension peaks correlated best with multiplanar injuries (P NIC injury thresholds ranged between 1.1 at C0-C1 and C3-C4 to 2.9 at C7-T1. IV-NIC injury threshold times were attained between 83.4 and 150.1 ms following impact. Correlation between IV-NIC and multiplanar injuries demonstrated that three-plane intervertebral instability was primarily caused by dynamic extension beyond the physiological limit during head-turned rear impacts.

  6. The effects of preinjury clopidogrel use on older trauma patients with head injuries.

    Science.gov (United States)

    Jones, Kory; Sharp, Collin; Mangram, Alicia J; Dunn, Ernest L

    2006-12-01

    This study was designed to determine whether or not older trauma patients on clopidogrel have an increased risk of morbidity and mortality. A retrospective review was performed on all trauma patients > or =50 years of age between January 1, 2002, and August 31, 2005. The charts of those patients who had documented preinjury use of clopidogrel were further reviewed. A control group of patients with no history of clopidogrel use was matched for age, sex, mechanism of injury, and injury severity score. During this time period, there were 1,020 trauma patients > or =50 years of age admitted, 43 of which had documented preinjury clopidogrel use (P). A higher percentage of patients in the P group underwent cranial surgery, had episodes of rebleeds, and required transfusions of blood products than in the control group. The mortality and length of stay were comparable in both groups. This study indicates that the preinjury use of clopidogrel may cause significant morbidity in patients with closed-head injuries. Further studies are needed to suggest specific treatment modalities.

  7. Variability in the control of head movements in seated humans: a link with whiplash injuries?

    Science.gov (United States)

    Vibert, N; MacDougall, H G; de Waele, C; Gilchrist, D P; Burgess, A M; Sidis, A; Migliaccio, A; Curthoys, I S; Vidal, P P

    2001-05-01

    biomechanical properties of their head-neck ensemble to compensate for the perturbation. In our study, proprioception was the sole source of sensory information as long as the head did not move. We therefore presume that the EMG responses and head movements we observed were mainly triggered by the activation of stretch receptors in the hips, trunk and/or neck. The visualisation of an imaginary reference in space during sideways impulses significantly reduced the head roll exhibited by floppy subjects. This suggests that the adoption by the central nervous system of an extrinsic, 'allocentric' frame of reference instead of an intrinsic, 'egocentric' one may be instrumental for the selection of the stiff strategy. The response of floppy subjects appeared to be maladaptive and likely to increase the risk of whiplash injury during motor vehicle accidents. Evolution of postural control may not have taken into account the implications of passive, high-acceleration perturbations affecting seated subjects.

  8. Trends in head injury incidence in New Zealand: a hospital-based study from 1997/1998 to 2003/2004.

    Science.gov (United States)

    Barker-Collo, Suzanne L; Wilde, Nancy J; Feigin, Valery L

    2009-01-01

    Traumatic brain injury (TBI) is a leading cause of disability and death in young adults. Globally, the incidence of TBI hospitalizations is estimated at 200-300 people per 100,000 annually. Using a national health database, we examined the incidence of TBI-related hospital discharges (including 1-day stays) to New Zealand Hospitals from 1997/1998 to 2003/2004. Crude annual hospital-based incidence rates for the total population ranged from 226.9 per 100,000 in 1998/1999 to a high rate of 349.2 in 2002/2003. There was a noticeable increase in rates with the change from ICD-9 to ICD-10 diagnostic codes and there was also disparity in incidence rates according to ethnicity, age and gender. Crude annual hospital-based incidence rates for males and females in Maori (689/100,000 and 302.8/100,000 person-years) and Pacific Island populations (582.6/100,000 and 217.6/100,000 person-years) were much higher than those for the remaining population (435.4/100,000 and 200.9/100,000 person-years), particularly for males. The overall age-standardized hospital- based incidence rate for 2003/2004 was 342 per 100,000 per year (95% CI = 337-349/100,000), and 458 per 100,000 per year for Maori (95% CI = 438-479/100,000) with Maori males experiencing a peak in incidence between 30 and 34 years of age that was not evidenced for the wider population. Standardized hospital-based incidence rates for the total population and for Maori by age, gender and ICD-10 diagnostic codes are also examined. 2008 S. Karger AG, Basel

  9. Head injury in heroes of the Civil War and its lasting influence.

    Science.gov (United States)

    Sabourin, Victor M; Holland, Ryan; Mau, Christine; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-07-01

    The Civil War era was an age-defining period in the history of the United States of America, the effects of which are still seen in the nation today. In this era, the issue of head injury pervaded society. From the president of the United States, Abraham Lincoln, to the officers and soldiers of the Union and Confederate armies, and to the population at large, head injury and its ramifications gripped the nation. This article focuses on 3 individuals: Major General John Sedgwick, First Lieutenant Alonzo Cushing, and Harriet Tubman, as examples of the impact that head injury had during this era. These 3 individuals were chosen for this article because of their lasting legacies, contributions to society, and interesting connections to one another.

  10. Epidemiology of traumatic head injury from a major paediatric trauma centre in New South Wales, Australia.

    Science.gov (United States)

    Amaranath, Jeevaka E; Ramanan, Mahesh; Reagh, Jessica; Saekang, Eilen; Prasad, Narayan; Chaseling, Raymond; Soundappan, Sannappa

    2014-06-01

    Traumatic brain injury (TBI) is common and is a leading cause of presentations to emergency departments. Understanding the epidemiology of TBI can aid in improving overall management and identifying opportunities for prevention. Currently, there is a paucity of data on paediatric TBI in NSW. The purpose of this study was to determine the demographics, causes, treatment and outcome of TBI at The Children's Hospital at Westmead (CHW), a large trauma referral paediatric hospital. A retrospective chart review was conducted of patients admitted to CHW emergency from 2006 to 2011 with a TBI. Patients who presented to the emergency department and had a history of TBI with either symptoms of concussion and/or positive computed tomography (CT) findings of head injury were selected. Information regarding demographics, injury pattern, CT findings, treatment and outcome were retrieved. Over the 6-year period, there were 1489 presentations at the CHW. Of these, 65% were male and 35% were female. The mean age was 7 years. A total of 93% were classified as mild, 1.5% as moderate and 5.5% as severe. Sports and recreational injuries accounted for 26% of all TBI presentations, while motor vehicle accidents (MVAs) accounted for 77% of all TBI deaths. Sixty-two per cent of children underwent a CT brain, and of those, 40% were normal. The majority of TBI are mild in nature, with younger children and males at greatest risk. There was a low rate of operative intervention and a high rate of good outcomes. Many injuries may be preventable with the adaptation of better public health education programmes, particularly in very young children and those related to MVAs. © 2014 Royal Australasian College of Surgeons.

  11. Presentation and Pattern of Paediatric Head Injury in a Nigerian ...

    African Journals Online (AJOL)

    Hp 630 Dual Core

    2014-02-13

    Feb 13, 2014 ... falls; however, data from our local environment suggest that the most common cause in ... Accidents, falls, assaults, recreational activities (sports, bicycle related injuries) and child .... Bar chart showing the Annual distribution.

  12. Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration.

    Science.gov (United States)

    Rowson, Steven; Duma, Stefan M

    2013-05-01

    Recent research has suggested possible long term effects due to repetitive concussions, highlighting the importance of developing methods to accurately quantify concussion risk. This study introduces a new injury metric, the combined probability of concussion, which computes the overall risk of concussion based on the peak linear and rotational accelerations experienced by the head during impact. The combined probability of concussion is unique in that it determines the likelihood of sustaining a concussion for a given impact, regardless of whether the injury would be reported or not. The risk curve was derived from data collected from instrumented football players (63,011 impacts including 37 concussions), which was adjusted to account for the underreporting of concussion. The predictive capability of this new metric is compared to that of single biomechanical parameters. The capabilities of these parameters to accurately predict concussion incidence were evaluated using two separate datasets: the Head Impact Telemetry System (HITS) data and National Football League (NFL) data collected from impact reconstructions using dummies (58 impacts including 25 concussions). Receiver operating characteristic curves were generated, and all parameters were significantly better at predicting injury than random guessing. The combined probability of concussion had the greatest area under the curve for all datasets. In the HITS dataset, the combined probability of concussion and linear acceleration were significantly better predictors of concussion than rotational acceleration alone, but not different from each other. In the NFL dataset, there were no significant differences between parameters. The combined probability of concussion is a valuable method to assess concussion risk in a laboratory setting for evaluating product safety.

  13. Prediction of outcome after moderate and severe traumatic brain injury: External validation of the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation after Significant Head injury (CRASH) prognostic models

    NARCIS (Netherlands)

    B. Roozenbeek (Bob); H.F. Lingsma (Hester); F.E. Lecky (Fiona); J. Lu (Juan); J. Weir (James); I. Butcher (Isabella); G.S. McHugh (Gillian); G.D. Murray (Gordon); P. Perel (Pablo); A.I.R. Maas (Andrew); E.W. Steyerberg (Ewout)

    2012-01-01

    textabstractObjective: The International Mission on Prognosis and Analysis of Clinical Trials and Corticoid Randomisation After Significant Head injury prognostic models predict outcome after traumatic brain injury but have not been compared in large datasets. The objective of this is study is to

  14. Head kinematics and shoulder biomechanics in shoulder impacts similar to pedestrian crashes--a THUMS study.

    Science.gov (United States)

    Paas, Ruth; Davidsson, Johan; Brolin, Karin

    2015-01-01

    Head injuries account for the largest percentage of fatalities among pedestrians in car crashes. To prevent or mitigate such injuries, safety systems that reduce head linear and rotational acceleration should be introduced. Human body models (HBMs) are valuable safety system evaluation tools for assessing both head injury risk and head kinematics prior to head contact. This article aims to evaluate the suitability of the Total Human Model for Safety (THUMS) version 4.0 for studying shoulder impacts, similar to pedestrian crashes, investigating head, spine, and shoulder kinematics as well as shoulder biomechanics. Shoulder impact experiments including volunteers and postmortem human subjects (PMHSs) were simulated with THUMS. Head linear and angular and vertebral linear displacements of THUMS were compared with volunteers and shoulder deflections with both volunteers and PMHSs. A parameter variation study was conducted to assess head response to shoulder impacts, by varying shoulder posture and impact directions mimicking shoulder-to-vehicle contacts. Functional biomechanics literature was compared with THUMS responses in view of pedestrian-like shoulder impacts. THUMS head linear displacement compared better with tensed than with relaxed volunteers. Head lateral rotation was comparable with volunteer responses up to 120 ms; head twist was greater in THUMS than in the volunteers. The THUMS spine appeared to be stiffer than in the volunteers. Shoulder deflections were smaller than in the relaxed volunteers but matched the PMHSs. Raised shoulder postures decreased the THUMS shoulder deflections and increased head lateral displacements. When the impactor surface orientation or the impact velocity angle was changed from lateral to superolateral, THUMS head lateral displacement decreased. THUMS scapula and clavicle kinematics compared well with previous experimental studies. The shoulder impact conditions influenced the scapula motion over the thorax, which had

  15. Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury: a review.

    Science.gov (United States)

    McMillian, Wesley D; Rogers, Frederick B

    2009-03-01

    Trauma and emergency department clinicians encounter a growing number of patients admitted with traumatic head injury on prehospital antithrombotic therapies. These patients appear to be at increased risk of developing life-threatening intracranial hemorrhage. It is imperative that trauma clinicians understand the mechanism and duration of commonly prescribed outpatient antithrombotics in order to appropriately assess and treat patients who develop intracranial hemorrhage. This review summarizes current literature on the morbidity and mortality associated with premorbid non-steroidal anti-inflammatory drugs, aspirin, clopidogrel, warfarin, and heparinoids in the setting of traumatic head injury, and also examines the current strategies for reversal of these therapies.

  16. A biopsychosocial investigation of changes in self-concept on the Head Injury Semantic Differential Scale.

    Science.gov (United States)

    Reddy, Avneel; Ownsworth, Tamara; King, Joshua; Shields, Cassandra

    2017-12-01

    This study aimed to investigate the influence of the "good-old-days" bias, neuropsychological functioning and cued recall of life events on self-concept change. Forty seven adults with TBI (70% male, 1-5 years post-injury) and 47 matched controls rated their past and present self-concept on the Head Injury Semantic Differential Scale (HISD) III. TBI participants also completed a battery of neuropsychological tests. The matched control group of 47 were from a sample of 78 uninjured participants who were randomised to complete either the Social Readjustment Rating Scale-Revised (cued recall) or HISD (non-cued recall) first. Consistent with the good-old-days bias, participants with TBI rated their pre-injury self-concept as more positive than their present self-concept and the present self-concept of controls (p self-concept ratings were related to lower estimated premorbid IQ and poorer verbal fluency and delayed memory (p self-concept change (p self-concept as significantly more negative than the non-cued group (p self-concept change by affecting retrospective ratings of past self-concept. Further research is needed to investigate the impact of contextual cues on self-concept change after TBI.

  17. Word Memory Test Predicts Recovery in Claimants With Work-Related Head Injury.

    Science.gov (United States)

    Colangelo, Annette; Abada, Abigail; Haws, Calvin; Park, Joanne; Niemeläinen, Riikka; Gross, Douglas P

    2016-05-01

    To investigate the predictive validity of the Word Memory Test (WMT), a verbal memory neuropsychological test developed as a performance validity measure to assess memory, effort, and performance consistency. Cohort study with 1-year follow-up. Workers' compensation rehabilitation facility. Participants included workers' compensation claimants with work-related head injury (N=188; mean age, 44y; 161 men [85.6%]). Not applicable. Outcome measures for determining predictive validity included days to suspension of wage replacement benefits during the 1-year follow-up and work status at discharge in claimants undergoing rehabilitation. Analysis included multivariable Cox and logistic regression. Better WMT performance was significantly but weakly correlated with younger age (r=-.30), documented brain abnormality (r=.28), and loss of consciousness at the time of injury (r=.25). Claimants with documented brain abnormalities on diagnostic imaging scans performed better (∼9%) on the WMT than those without brain abnormalities. The WMT predicted days receiving benefits (adjusted hazard ratio, 1.13; 95% confidence interval, 1.04-1.24) and work status outcome at program discharge (adjusted odds ratio, 1.62; 95% confidence interval, 1.13-2.34). Our results provide evidence for the predictive validity of the WMT in workers' compensation claimants. Younger claimants and those with more severe brain injuries performed better on the WMT. It may be that financial incentives or other factors related to the compensation claim affected the performance. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Snow sports related head and spinal injuries: an eight-year survey from the neurotrauma centre for the Snowy Mountains, Australia.

    Science.gov (United States)

    Siu, T L T; Chandran, K N; Newcombe, R L; Fuller, J W; Pik, J H T

    2004-04-01

    Neurotrauma from snow-sports related injuries is infrequently documented in the literature. In Australia no collective data has ever been published. The aim of this study is to document the injury pattern of snow sports related neurotrauma admissions to The Canberra Hospital, the regional trauma centre for the Snowy Mountains. A computerised hospital record search conducted between January 1994 and July 2002 revealed 25 head and 66 spinal injury admissions. The incidence of severe injuries requiring referral to tertiary trauma hospital was estimated to be 7.4 per 100,000 skier-days and for head and spinal injury 1.8 per 1,000,000 skier-days and 5.6 per 1,000,000 skier-days, respectively. Collision with a stationary object was disproportionately associated with head injury ( [Formula: see text] ) and falling forward with spinal injury ( [Formula: see text] ). Snowboarders tended to sustain cervical fractures more often than skiers ( [Formula: see text] ). The importance of helmet usage in buffering the impact of head-on collision and the proposition of having both feet fastened to a snowboard in leading to cervical injury were highlighted.

  19. Epidemiology and Functional Outcome of Head Injury in Rural Kenya

    African Journals Online (AJOL)

    Conclusion: Outcome depended on age, initial GCS score, pupillary abnormalities, history of loss of consciousness and admission into our Intensive Care Unit. These findings can be used to improve the management criteria in rural hospitals but we recommend establishment of a standardized surveillance system for head ...

  20. Plantar talar head contusions and osteochondral fractures: associated findings on ankle MRI and proposed mechanism of injury

    Energy Technology Data Exchange (ETDEWEB)

    Gorbachova, Tetyana; Wang, Peter S.; Hu, Bing [Einstein Medical Center Philadelphia, Department of Radiology, Philadelphia, PA (United States); Horrow, Jay C. [Drexel University, Department of Anesthesiology and Perioperative Medicine, Philadelphia, PA (United States)

    2016-06-15

    To evaluate the significance of plantar talar head injury (PTHI) in predicting osseous and soft tissue injuries on ankle MRI. The IRB approved this HIPAA-compliant retrospective study. The study group consisted of 41 ankle MRIs with PTHI that occurred at our institution over a 5 1/2 year period. Eighty MRIs with bone injuries in other locations matched for age, time interval since injury, and gender formed a control group. Injuries to the following structures were recorded: medial malleolus, lateral malleolus/distal fibula, posterior malleolus, talus, calcaneus, navicular, cuboid, lateral, medial and syndesmotic ligaments, spring ligament complex, and extensor digitorum brevis (EDB) muscle. Twenty separate logistic regressions determined which injuries PTHI predicted, using the Holm procedure to control for family-wise alpha at 0.05. PTHI strongly predicted the occurrence of injuries involving the anterior process of the calcaneus [24 % of cases, odds ratio (OR) 12.66], plantar components of the spring ligament (27 %, OR 9.43), calcaneal origin of the EDB and attachment of the dorsolateral calcaneocuboid ligament (22 %, OR 7.22), cuboid (51 %, OR 6.58), EDB (27 %, OR 5.49), anteromedial talus (66 %, OR 4.78), and posteromedial talus (49 %, OR 4.48). PTHI strongly predicted lack of occurrence of syndesmotic ligament injury (OR 19.6). The PTHI group had a high incidence of lateral ligamentous injury (78 %), but not significantly different from the control group (53 %). PTHI is strongly associated with injury involving the transverse tarsal joint complex. We hypothesize it results from talo-cuboid and/or talo-calcaneal impaction from a supination injury of the foot and ankle. (orig.)

  1. Working memory and discourse production abilities following closed-head injury.

    Science.gov (United States)

    Youse, K M; Coelho, C A

    2005-11-01

    This study investigated the relationship between working memory (WM) and narrative discourse production in individuals with closed head injury (CHI). It was hypothesized that those individuals with higher performance on tests of WM would demonstrate better performance on measures of discourse production. Correlation coefficients were calculated among five discourse measures from two story narratives and scores from three sub-tests of the Wechsler Memory Scale (WMS). Fifty-five individuals with moderate-to-severe CHI were studied. Participants included 16 females and 39 males ranging in age from 16-69. Narrative discourse samples were elicited from all participants under two conditions: story retelling and story generation. The results revealed a number of modest, significant correlations (r=0.29-0.39, pdiscourse production. Results supported the hypothesis. Story elicitation task differences, limitations of using simple memory span tests as indices of WM and clinical implications of the relationship between WM and discourse production are discussed.

  2. Motorcycle helmet effectiveness in reducing head, face and brain injuries by state and helmet law.

    Science.gov (United States)

    Olsen, Cody S; Thomas, Andrea M; Singleton, Michael; Gaichas, Anna M; Smith, Tracy J; Smith, Gary A; Peng, Justin; Bauer, Michael J; Qu, Ming; Yeager, Denise; Kerns, Timothy; Burch, Cynthia; Cook, Lawrence J

    2016-12-01

    Despite evidence that motorcycle helmets reduce morbidity and mortality, helmet laws and rates of helmet use vary by state in the U.S. We pooled data from eleven states: five with universal laws requiring all motorcyclists to wear a helmet, and six with partial laws requiring only a subset of motorcyclists to wear a helmet. Data were combined in the Crash Outcome Data Evaluation System's General Use Model and included motorcycle crash records probabilistically linked to emergency department and inpatient discharges for years 2005-2008. Medical outcomes were compared between partial and universal helmet law settings. We estimated adjusted relative risks (RR) and 95 % confidence intervals (CIs) for head, facial, traumatic brain, and moderate to severe head/facial injuries associated with helmet use within each helmet law setting using generalized log-binomial regression. Reported helmet use was higher in universal law states (88 % vs. 42 %). Median charges, adjusted for inflation and differences in state-incomes, were higher in partial law states (emergency department $1987 vs. $1443; inpatient $31,506 vs. $25,949). Injuries to the head and face, including traumatic brain injuries, were more common in partial law states. Effectiveness estimates of helmet use were higher in partial law states (adjusted-RR (CI) of head injury: 2.1 (1.9-2.2) partial law single vehicle; 1.4 (1.2, 1.6) universal law single vehicle; 1.8 (1.6-2.0) partial law multi-vehicle; 1.2 (1.1-1.4) universal law multi-vehicle). Medical charges and rates of head, facial, and brain injuries among motorcyclists were lower in universal law states. Helmets were effective in reducing injury in both helmet law settings; lower effectiveness estimates were observed in universal law states.

  3. Traumatic Brain Injury and Metabolic Dysfunction Among Head ...

    African Journals Online (AJOL)

    Traumatic Brain Injury (TBI) is a common health problem which is one of the main causes of chronic disability and it is associated with hormonal and metabolic disorders. This work was carried out to investigate the relationship between some stress hormones (i.e. prolactin and cortisol) and plasma glucose level in TBI.

  4. Traumatic Brain Injury and Metabolic Dysfunction Among Head ...

    African Journals Online (AJOL)

    Traumatic Brain Injury (TBI) is a common health problem which is one of the main causes of chronic disability and it is associated with hormonal and metabolic disorders. This work was carried out to investigate the relationship between some stress hormones (i.e. prolactin and cortisol) and plasma glucose level in TBI ...

  5. Nuclear Medicine Imaging in Concussive Head Injuries in Sports

    NARCIS (Netherlands)

    Vállez Garcia, David; Otte, Andreas; Glaudemans, Andor WJM; Dierckx, Rudi AJO; Gielen, Jan LMA; Zwerver, Johannes

    2015-01-01

    Concussions in sports and during recreational activities are a major source of traumatic brain injury in our society. This is mainly relevant in adolescence and young adulthood, where the annual rate of diagnosed concussions is increasing from year to year. Contact sports (e.g., ice hockey, American

  6. An international review of head and spinal cord injuries in alpine skiing and snowboarding.

    Science.gov (United States)

    Ackery, A; Hagel, B E; Provvidenza, C; Tator, C H

    2007-12-01

    Alpine skiing and snowboarding are popular winter activities worldwide, enjoyed by participants of all ages and skill levels. There is some evidence that the incidence of traumatic brain injury (TBI) and spinal cord injury (SCI) in these activities may be increasing. These injuries can cause death or severe debilitation, both physically and emotionally, and also result in enormous financial burden to society. Indeed, TBI is the leading cause of death and catastrophic injury in the skiing and snowboarding population. Furthermore, there are severe limitations to therapeutic interventions to restore neurological function after TBI and SCI, and thus the emphasis must be on prevention. (1) To examine the worldwide epidemiology of TBI and SCI in skiing and snowboarding; (2) to describe and examine the effectiveness of prevention strategies to reduce the incidence of TBI and SCI in skiing and snowboarding. Searches were performed on a variety of databases to identify articles relevant to catastrophic central nervous system injury in skiing and snowboarding. The databases included PubMed, Medline, EMBASE, CDSR, ACP Journal Club, DARE, CCTR, SportDiscus, CINAHL, and Advanced Google searches. SELECTION CRITERIA AND DATA COLLECTION: After initial prescreening, articles included in the review required epidemiological data on SCI, TBI, or both. Articles had to be directly associated with the topic of skiing and/or snowboarding and published between January 1990 and December 2004. 24 relevant articles, from 10 different countries, were identified. They indicate that the incidence of TBI and SCI in skiing and snowboarding is increasing. The increases coincide with the development and acceptance of acrobatic and high-speed activities on the mountains. There is evidence that helmets reduce the risk of head injury by 22-60%. Head injuries are the most common cause of death among skiers and snowboarders, and young male snowboarders are especially at risk of death from head injury

  7. Delayed homicides due to infant head injury initially reported as natural (cerebral palsy) deaths.

    Science.gov (United States)

    Gill, James R; Morotti, Raffaella A; Tranchida, Vincent; Morhaime, Jacquelyn; Mena, Hernando

    2008-01-01

    A spectrum of neuropathology occurs in infants who sustain traumatic brain injury. Because of a prolonged survival interval, there is a risk that these deaths may not be recognized as a sequel of trauma. We reviewed the records in New York City of 5 delayed fatalities due to nonaccidental infant head injury that had survival intervals from 2.5 to 17 years. The head injuries occurred at 2 to 3 months of age, and death occurred at 2.5 to 17 years of age. Initially, they were reported as natural deaths by treating physicians, families, and/or police. All 5 infants had unexplained or poorly explained remote traumatic head injury that included subdural hematomas. At autopsy, the neuropathologic exam demonstrated remote subdural hemorrhages and lesions related to chronic hypoxic-ischemic injury including atrophy, arterial infarcts, border-zone infarcts, and cystic encephalomalacia. Each child survived the initial injury but later succumbed to the delayed effects of secondary hypoxic-ischemic encephalopathy. These 5 deaths highlight the need to investigate independently the medical history of any child (or adult) who dies with a clinical diagnosis of "cerebral palsy." The term cerebral palsy often is used as a catchall for any patient who has had neurologic impairment since infancy or childhood. If there is a direct link between the initial injury and the death, even if the injury occurred many years before death, then the injury is the proximate cause of death and dictates the manner of death. All 5 deaths were certified as homicides.

  8. Routine Repeat Head CT may not be Indicated in Patients on Anticoagulant/Antiplatelet Therapy Following Mild Traumatic Brain Injury

    OpenAIRE

    McCammack, Kevin C.; Sadler, Charlotte; Guo, Yueyang; Ramaswamy, Raja S.; Farid, Nikdokht

    2014-01-01

    Introduction: Evaluation recommendations for patients on anticoagulant and antiplatelet (ACAP) therapy that present after mild traumatic brain injury (TBI) are controversial. At our institution, an initial noncontrast head computed tomography (HCT) is performed, with a subsequent HCT performed six hours later to exclude delayed intracranial hemorrhage (ICH). This study was performed to evaluate the yield and advisability of this approach. Methods: We performed a retrospe...

  9. The Effect of Pycnogenol® on Spatial Learning and Memory in Rats with Experimental Closed Head Injury

    Directory of Open Access Journals (Sweden)

    Afşin Emre Kayıpmaz

    2017-06-01

    Full Text Available Aim: Trauma is a leading cause of emergency admissions. In this study, we investigated the effect of Pycnogenol® on spatial learning and memory (SLM function in rats subjected to closed head injury. Methods: The study was a randomized, experimental study of four groups, each containing six rats. Pycnogenol® was administered to rats in two groups (group three and four daily for five days starting on day one. A Barnes maze was used to test SLM in the rats in all four groups. Group 1: These rats did not have a closed head injury and were not administered Pycnogenol®. Group 2: On the day three, closed head trauma was inflicted. Group 3: Pycnogenol® was administered to the rats. On day three, closed head trauma was inflicted. Group 4: Only Pycnogenol® was administered. At the end of day five, the brain tissue of the 24 rats was removed. Results: There were no significant differences between the groups in mean SLM durations on days one through five. No significant differences were detected in the pathological examination between of the four groups. Conclusion: Future studies that employ biochemical markers and free radical levels in the brain are needed.

  10. Application of stereological estimates in patients with severe head injuries using CT and MR scanning images

    DEFF Research Database (Denmark)

    Eriksen, Nanna; Rostrup, E; Andersen, K

    2010-01-01

    applied stereological techniques to representative CT and MRI brain scans from five patients to describe how stereological methods, when applied to scans of trauma patients, can provide a useful supplement to the estimation of structural brain changes in head injuries. The reliability of the estimates...... traditional imaging methods are not always applicable and automatic methods may not be able to match the individual observer. Stereological techniques are alternative tools in the quantitative description of biological structures, and have been increasingly applied to the human brain. In the present study, we......Severe brain damage is often followed by serious complications. Quantitative measurements, such as regional volume and surface area under various conditions, are essential for understanding functional changes in the brain and assessing prognosis. The affected brain tissue is variable, hence...

  11. Biodynamics model for operator head injury in stand-up lift trucks.

    Science.gov (United States)

    Zoghi-Moghadam, Mohamad; Sadegh, Ali; Watkins, Charles B; Dunlap, Dan

    2008-08-01

    Biodynamics and injury potential of operators in stand-up rider lift truck accidents have been investigated with a special focus on head injury. An anthropomorphic test device (ATD) model was used as an operator surrogate in computer simulations of off-the-dock (OTD) and tip-over (TO) accidents. The biomechanical model representing the ATD was developed based on rigid body segments, and then combined with a rigid body truck model in the accident simulations. The operator compartment of the truck model was enclosed with a rear door. The computed kinematics are in agreement with the results of previous experimental testing. A 2D finite element model of the head was created to compute head impact decelerations in the sagittal plane. Values of the head injury criterion for the TO cases were computed from the model and shown to compare favourably with experimental values. The results advance the state of knowledge concerning injury potential in TO and OTD accidents and simulation models for such accidents.

  12. Hemiplegia Following Mild Head Injury in a Child with Sturge-Weber Syndrome - A Diagnostic Dilemma.

    Science.gov (United States)

    Ahmed, Shameem; Paul, Siba Prosad

    2016-08-01

    Sturge-Weber syndrome (SWS) is a neurocutaneous disorder with skin, eye, and brain involvement. Hemiplegia in children with SWS after a mild head injury is known to occur in up to one-fifth of cases. A3-year male child presented with a sudden onset hemiplegia following a mild head injury. He was known to have seizure disorder and was being treated with sodium valproate. CTscan of the brain showed contusion. He was admitted for neurological observations and the patient made complete recovery with conservative treatment. MRI scan of the brain done 5 days later which showed venous malformation of choroid plexus on the left side. These changes were considered to be consistent with a preexisting cerebral lesion which coincidentally got detected at neuroimaging done after the mild head injury. There is need for good seizure control as it is likely to be associated with better neurological outcome. The case emphasizes the need for clinical correlation with findings at neuroimaging in children with SWS presenting with head injuries.

  13. 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...

  14. P300 after head injury : Pseudodelay caused by reduced P3A amplitude

    NARCIS (Netherlands)

    Elting, JW; van der Naalt, J; van Weerden, TW; De Keyser, J; Maurits, NM

    2005-01-01

    Objective: We compared conventional P300 analysis with source analysis in normal subjects and head-injury patients. Based on earlier findings of improved P300 component identification and reduced P3B latency variability with source analysis in normal subjects, our aim was to investigate whether

  15. Depressed Skull Fractures: A Pattern of Abusive Head Injury in Three Older Children

    Science.gov (United States)

    Lee, Anselm C. W.; Ou, Yvonne; Fong, Dawson

    2003-01-01

    Objective: To describe a pattern of abusive head injury in a series of children older than 4 years of age. Methods: A hospital chart review of abused children with skull fractures from 1999 to 2001 was carried out. The clinical features, social background, and subsequent outcome and management are described. Results: An 11-year-old girl and a pair…

  16. Neuropsychological Differences between College Students with Learning Disabilities and Those with Mild Head Injury.

    Science.gov (United States)

    Beers, Sue R.; And Others

    1994-01-01

    Thirty-five college students with learning disabilities (LD) and 25 students with a history of mild head injury (MHI) were compared on tests of neuropsychological, psychological, and academic achievement. Students with LD performed poorly on linguistically oriented psychoeducational tests, whereas students with MHI showed cognitive deficits in…

  17. Guideline compliance in management of minimal, mild, and moderate head injury: high frequency of noncompliance among individual physicians despite strong guideline support from clinical leaders.

    Science.gov (United States)

    Heskestad, Ben; Baardsen, Roald; Helseth, Eirik; Ingebrigtsen, Tor

    2008-12-01

    The evidence-based Scandinavian Guidelines for the Initial Management of Minimal, Mild, and Moderate Head Injuries were developed to provide safe and cost-effective assessment of patients. A survey based on a questionnaire directed to clinical managers in all Norwegian hospitals indicated that the guidelines had influenced management practice significantly. However, implementation of guidelines and compliance from clinical leaders does not necessarily influence individual physicians decisions making. To evaluate physicians-compliance with the Scandinavian Guidelines in individual patients, we conducted a study (January 2003 to January 2004) that included all patients with minimal, mild, and moderate head injury who presented to the emergency department in a Norwegian university hospital. Guideline compliance was evaluated in the assessment and treatment of 508 patients. The management of each single patient was classified as compliant with the guidelines or not. Classification as compliant required correct use of computed tomography (CT) and hospital admission in accordance with the guideline. The overall physicians-compliance with the Scandinavian Guidelines was 51%. A substantial overtriage with unnecessary CT examinations and hospital admissions was seen in patients with minimal and mild head injuries. Among patients with minimal head injury, 69% underwent overtriage, 18% with unnecessary hospital admission, 27% with unnecessary CT, and 24% with both. Among patients with mild head injury, 37% were subject to overtriage, all with admission for observation after a negative CT. All patients with moderate head injury were treated in accordance with the guideline. Guidelines for assessment and treatment of minimal and mild head injuries may not have the intended degree of influence on clinical practice. Even in departments where clinical managers report that the practice is evidence based, physicians may not act in accordance with this in their daily practice. This

  18. 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.

  19. Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination.

    Science.gov (United States)

    Aziz, Hassan; Rhee, Peter; Pandit, Viraj; Ibrahim-Zada, Irada; Kulvatunyou, Narong; Wynne, Julie; Zangbar, Bardiya; O'Keeffe, Terence; Tang, Andrew; Friese, Randall S; Joseph, Bellal

    2013-10-01

    Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI). This is a 3-year retrospective study of all patients of age 2 years to 18 years with blunt TBI admitted to our Level 1 trauma center with an abnormal head CT. Indications for RHCT (routine vs. neurologic deterioration) and their findings (progression or improvement) were recorded. Neurosurgical intervention was defined as extraventricular drain placement, craniectomy, or craniotomy. Primary outcome was a change in management after RHCT. A total of 291 pediatric patients were identified; of which 191 patients received an RHCT. Routine RHCT did not lead to neurosurgical intervention in the mild and moderate TBI group. In patients who received RHCT due to neurologic decline (n = 7), radiographic progression was seen on 85% of the patients (n = 6), with subsequent neurosurgical interventions in three patients. Two of these patients had a Glasgow Coma Scale (GCS) score of less than 8 at admission. Our study showed that the neurologic examination can be trusted and is reliable in pediatric blunt TBI patients in determining when an RHCT scan is necessary. We recommend that RHCT is required routinely in patients with intracranial hemorrhage with GCS score of 8 or less and in patients with GCS greater than 8 and that RHCT be performed only when there are clinical indications. Diagnostic/therapeutic study, level IV.

  20. Moving bullet syndrome: a complication of penetrating head injury.

    Science.gov (United States)

    Zafonte, R D; Watanabe, T; Mann, N R

    1998-11-01

    Penetrating injuries, by definition, result in retained bullets or fragments. Usually, these fragments are removed surgically during wound debridement. Occasionally, the position of the bullet may preclude removal if it is thought that surgery could exacerbate neurologic damage. Complications from retained fragments are uncommon. One rare complication is the spontaneous migration of the fragment. Two cases of spontaneous migration of retained bullets are presented. In both cases neurologic deterioration was noted and computed tomographic imaging was diagnostic. In one case, this complication delayed transfer from the acute care hospital to rehabilitation. In the other case, the migrating bullet was removed during the inpatient rehabilitation stay. Each person improved neurologically after the migrating bullet fragment was removed. Additionally, functional progress was marked in both persons and symptomatic relief noted. Rehabilitation physicians caring for survivors of penetrating brain injuries need to be aware of this potentially devastating phenomenon.

  1. Head injury potential and the effectiveness of headgear in women's lacrosse.

    Science.gov (United States)

    Rodowicz, Kathleen Allen; Olberding, Joseph E; Rau, Andrew C

    2015-04-01

    Over the past 10 years, lacrosse has grown increasingly popular, making it one of the fastest growing team sports in the country. Similar to other sporting activities, head injuries in lacrosse can and do occur, and the number of lacrosse-related head injuries has increased in recent years. In women's lacrosse, protective headgear is not required, but U.S. Lacrosse and the American Society for Testing and Materials are currently working to develop a headgear standard for the women's game. In the interim, some female lacrosse programs and individual players are wearing soft headgear during play. The effectiveness of this headgear is unknown. Testing was conducted to better understand the material properties of various types of headgear that may be used in lacrosse and the effect of this headgear on head impact response and head injury potential. For the evaluation of head impact response, an instrumented Hybrid III anthropomorphic test device (ATD) was impacted on the side of the head with lacrosse balls and the front and side of the head with a lacrosse stick. The linear and rotational impact response of the head and corresponding acceleration-based injury metrics are reported. Testing was then repeated with the ATD wearing different types of headgear. Tested headgear included a men's lacrosse helmet and two brands of commercially-available soft headgear. For the higher velocity ball impacts, there was no statistically-significant difference in the measured linear and rotational response of the head for the no headgear and soft headgear test conditions. For the lower velocity ball impacts, there was a small, yet statistically-significant, reduction in head linear acceleration for one of the soft headgears tested in comparison to the no headgear test condition, but there was not a statistically-significant difference in the rotational impact response with this headgear. These results indicate that the soft headgear would not be effective in reducing head injury

  2. The use of videonystagmography head impulse test (VHIT in the diagnostics of semicircular canal injuries in patients with vertigo

    Directory of Open Access Journals (Sweden)

    Jarosław Miłoński

    2014-08-01

    Full Text Available Objectives: The aim of the study was to assess the function of semicircular canal in videonystagmography head impulse test (VHIT in the patients with vertigo and balance disorders. Material and Methods: The study was performed in 135 patients (86 women and 49 men aged 22–79 years, who were divided into 2 groups: I (study group – 73 patients with vertigo of peripheral, central or mixed origin, II (control group – 62 patients without vertigo (healthy individuals. The function of canal was determined on the basis of GAIN and expressed as DG/RH×100% (where DG is deviation of gaze and RH is rotation of head. Results: In the study group the semicircular canal injuries were found in 37 (50.69% patients, including 24 (32.87% patients with 1 injury and 13 (17.8% patients with 2 or more injuries in semicircular canal. The injured anterior semicircular canal was reported 13 times; the lateral – 9 times and the posterior – 31 times. Conclusions: In the study group, in the VHIT, injuries in semicircular canals were reported in peripheral vertigo, mixed vertigo with non-compensated and compensated function of the labyrinth in 50.68% cases, whereas in the caloric test dysfunction of the labyrinth was found in 58.49% cases.

  3. History of syncope predicts loss of consciousness after head trauma: Retrospective study.

    Science.gov (United States)

    Zyśko, Dorota; Sutton, Richard; Timler, Dariusz; Furtan, Stanisław; Melander, Olle; Fedorowski, Artur

    2014-01-01

    Head trauma may present as transient loss of consciousness (TLOC) currently classified as traumatic in origin, in contrast to non-traumatic forms, such as syncope. Whether past history of syncope predisposes to loss of consciousness after head injury has been poorly studied. A retrospective analysis of data obtained from 818 consecutive patients admitted to Emergency Departments was conducted. Face-to-face semi-structured interviews were performed, where patients' past history of syncope and head injury were explored. Head injury events were stratified as high- or low-energy trauma. Data regarding past syncopal events were explored in regard to number, age at the first occurrence, and syncope circumstances. Multivariate logistic regression model was applied to assess the relationship between loss of consciousness during head injury and past history of syncope. Both past history of non-traumatic TLOC (odds ratio [OR] 3.78; 95% confidence interval [CI] 2.13-6.68, p consciousness after head injury. The clinical importance of this finding merits further investigation.

  4. Injury Surveillance of Head, Neck, and Facial Injuries in Collegiate Ice Hockey Players, 2009-2010 Through 2013-2014 Academic Years.

    Science.gov (United States)

    Simmons, Molly MacMhathan; Swedler, David I; Kerr, Zachary Y

    2017-08-01

      Ice hockey is a high-speed, full-contact sport with a high risk of head/face/neck (HFN) injuries. However, men's and women's ice hockey differ; checking is allowed only among men.   To describe the epidemiology of HFN injuries in collegiate men's and women's ice hockey during the 2009-2010 through 2013-2014 academic years.   Descriptive epidemiology study.   Ice hockey data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program during the 2009-2010 through 2013-2014 academic years.   Fifty-seven men's and 26 women's collegiate ice hockey programs from all NCAA divisions provided 106 and 51 team-seasons of data, respectively.   Injury rates per 1000 athlete-exposures and rate ratios with 95% confidence intervals (CIs).   The NCAA Injury Surveillance Program reported 496 and 131 HFN injuries in men's and women's ice hockey, respectively. The HFN injury rate was higher in men than in women (1.75 versus 1.16/1000 athlete-exposures; incidence rate ratio = 1.51; 95% CI = 1.25, 1.84). The proportion of HFN injuries from checking was higher in men than in women for competitions (38.5% versus 13.6%; injury proportion ratio = 2.82; 95% CI = 1.64, 4.85) and practices (21.9% versus 2.3%; injury proportion ratio = 9.41; 95% CI = 1.31, 67.69). The most common HFN injury diagnosis was concussion; most concussions occurred in men's competitions from player contact while checking (25.9%). Player contact during general play comprised the largest proportion of concussions in men's practices (25.9%), women's competitions (25.0%), and women's practices (24.0%). While 166 lacerations were reported in men, none were reported in women. In men, most lacerations occurred from player contact during checking in competitions (41.8%) and player contact during general play in practices (15.0%).   A larger proportion of HFN injuries in ice hockey occurred during checking in men versus women. Concussion was the most common HFN injury and was most

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

    Science.gov (United States)

    2011-03-01

    bones of 31 subjects with the flat face (area = 6.45 cm2) of an unpadded, cylindrical impactor (3.2 kg), along with the use of acoustic emission ...collection protocol (Gayzik, Hamilton et al. 2009). MRI image data with the participant in the supine position was collected on a 1.5 Tesla ...167(1): 77-82, 1988. Weaver AA, Gayzik FS, Stitzel JD. Biomechanical analysis of pulmonary contusion in motor vehicle crash victims: a crash injury

  6. From conception to evaluation of mobile services for people with head injury: A participatory design perspective.

    Science.gov (United States)

    Groussard, Pierre-Yves; Pigot, Hélène; Giroux, Sylvain

    2015-12-17

    Adults with cognitive impairments lack the means to organise their daily life, plan their appointments, cope with fatigue, and manage their budget. They manifest interest in using new technologies to be part of society. Unfortunately, the applications offered on smart phones are often beyond their cognitive abilities. The goal of this study was to design a mobile cognitive assistant to enhance autonomy of people living with acquired traumatic brain injury. Participatory design methodologies guided this research by involving adults with cognitive impairments (CI) and their caregivers in the early stages of the design process. The population of the study is composed of four male adults who present cognitive impairments (three with head injury and one with stroke) and three caregivers. The first phase of this research was to design the Services Assistance Mobile and Intelligent (SAMI) application based on the needs expressed by the participants. During three focus groups, needs emerged concerning planning, health monitoring and money management and led to the implementation of assistive solutions on an Android mobile phone. During the second phase, the participants evaluated the mobile assistant SAMI at home for eight weeks. The results demonstrate that the participants were able to participate actively in the conception of SAMI and to use it successfully. People with CI showed a slight improvement in their life satisfaction. Due to the small number of participants, these promising results need to be confirmed by a larger-scale study.

  7. Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

    Science.gov (United States)

    Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C

    2016-10-01

    Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61

  8. [Evidence of occult systemic hypoperfussion in head injured patients. Preliminary study].

    Science.gov (United States)

    Murillo-Cabezas, F; Amaya-Villar, R; Rincón-Ferrari, M D; Flores-Cordero, J M; Valencia-Anguita, J; Garcí A-Gómez, S; Muñoz-Sánchez, M A

    2005-08-01

    To determine the correlation between blood lactic acid levels in the first 48 hours and outcome, in hemodynamically stable patients, with moderate or severe head injury (HI), and to investigate the risk factors associated with abnormal lactate levels. A prospective observational study, in 210 adults patients with moderate or severe head injury. When the patients were hemodynamically stable, blood lactate concentrations were measured once on admission, twice daily during the first 2 days and once daily until lactate levels were normalized. The whole group 210 patients were divided into 2 groups. Group 1: (LA or= 2.2 mmol/L) patients with OH. One hundred and fifteen patients (57.76%) were categorized as group 1, and 95 patients (45.24%) as group 2. In the univariate analysis of risk factors for blood lactate >or=2.2 mmol/L the following variables showed statistical significance: severity of the head injury measured by several scales [Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Revised Trauma Score (RTS) and Acute Physiology and Chronic Health Evaluation (APACHE) II], arterial hypotension, hypoxemia, anaemia, hyperglucemia, hypothermia, a greater incidence of norepinephrine infusion, and the higher percentage of type II lesions in the head computerized tomography at admission showed in the group 1 (53.91% vs. 38.94%) (por=2.2 mmol/L (group 2). Although, the percentage of intracranial hypertension and mortality was higher in the group 2, there was no significant difference. In the multivariate analysis, the increase of blood lactate concentration, was not independently associated as a risk factor with studied complications. The presence of OH in patients with moderate or severe head injury, with postres uscitation arterial pressure, according to present recommendations, is associated with a more severe head injury, showed by APACHE II and the total fluid infusion volumes in the first 48 hours. OH in head injury increases the infection rate and length of ICU

  9. Two cases of 16th century head injuries managed in royal European families.

    Science.gov (United States)

    Dowling, Kamilah A; Goodrich, James Tait

    2016-07-01

    In Europe, during the 16th century, there were a number of prominent general surgeons adventurous enough to consider operating on the brain for head injuries. From the time of Hippocrates, operating on the skull and brain was considered both treacherous and too dangerous to be undertaken except on rare occasions. Operating on a member of a royal court was considered even more exceptional because if the outcome was poor, the surgeon could lose a hand or limb, or, even worse, be beheaded. The authors present two interesting cases of royal family members who underwent surgery for head injuries that were quite severe. The surgeons involved, Ambroise Paré, Andreas Vesalius, and Berengario da Carpi, were among the most prominent surgeons in Europe. Despite very challenging political situations, all were willing to undertake a complex surgical intervention on the member of a prominent royal family. The individuals involved, both royal and medical, plus the neurosurgical injuries are discussed.

  10. Delayed Brainstem Hemorrhage Secondary to Mild Traumatic Head Injury: Report of Case with Good Recovery.

    Science.gov (United States)

    Hou, Kun; Zhao, Jinchuan; Gao, Xianfeng; Zhu, Xiaobo; Li, Guichen

    2017-09-01

    In clinical practice, secondary traumatic brainstem hemorrhage often develops during descending transtentorial herniation due to raised intracranial pressure, which is known as Duret hemorrhage. Although usually considered a fatal and irreversible event, in rare circumstances, victims of Duret hemorrhage could gain favorable outcomes. To our knowledge, secondary brainstem hemorrhage due to mild traumatic head injury without descending transtentorial herniation has never been reported. In this report, we present a case of delayed brainstem hemorrhage secondary to a relatively mild traumatic brain injury that experienced a rapid and favorable recovery. A 48-year-old man was admitted for a motorcycle accident. Head computed tomography 2 hours after the accident revealed mild subarachnoid hemorrhage at the interpeduncular cistern. In the following in-hospital days, he experienced 2 episodes of mental state deterioration and increase of the SAH and hematoma extension to the brainstem. A digital subtraction angiography was performed with no positive finding of vascular anomaly and evident cerebral vasospasm. He experienced a rapid and favorable recovery. His Glasgow Outcome Scale score was 5 at 3 months' follow-up. We present a rare case of secondary traumatic brainstem hemorrhage that experienced a rapid and good recovery process. The mechanism is still obscure to us and needs to be further studied. Although traumatic brainstem hemorrhage usually means a fatal event to most of the patients, some patients may experience a favorable recovery. This rare circumstance should be stressed in prognosis consultation and clinical management of these kinds of patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Epidemiology and management of head injury in paediatric age group in North-Eastern Nigeria

    Directory of Open Access Journals (Sweden)

    J Y Chinda

    2013-01-01

    Full Text Available Background: Paediatric head injury (HI is the single most common cause of death and permanent disability in children world over, and this is increasingly becoming worrisome in our society because of increased risks and proneness to road traffic accidents on our highways and streets. The study set to determine causes and management of HI among children in our society. Patients and Methods: A retrospective review of all children aged 0-15 years with traumatic head injury (THIs who were managed at the University of Maiduguri Teaching Hospital between July, 2006 and August, 2008. Results: A total of 45 children with THIs presented to the casualty unit of the hospital; 30 (66.7% were boys and 15 (33.3% were girls. Three (6.7% children were less than 1 year of age, 21 (46.7% were between 1 years and 6 years while 16 (35.6% and 5 (11.0% were aged 7-11 years and 12-15 years respectively. Thirty six (80.0% of the children were pedestrians, 6 (13.4% fell from a height, while 2 (4.4% and 1 (2.2% were as a result of home accident and assault, respectively. Twenty one patients (46.7% had mild HI, while 53.3% had moderate to severe category. Forty one (91.1% of children were managed as in-patients, mostly (95.1% by conservative non-operative management, while 4 (8.9% were treated on the out-patient basis. The mortality rate was 17.8%. Conclusion: H1 among children is of a great concern, because of its incremental magnitude, due to increasing child labour and interstate religious discipleship among children, with attendant high mortality and permanent disabilities. Necessary laws and legislations should be formulated and implemented with organized campaigns and public enlightenment to prevent and mitigate this menace.

  12. Epidemiology and management of head injury in paediatric age group in North-Eastern Nigeria.

    Science.gov (United States)

    Chinda, J Y; Abubakar, A M; Umaru, Habila; Tahir, Chubado; Adamu, S; Wabada, S

    2013-01-01

    Paediatric head injury (HI) is the single most common cause of death and permanent disability in children world over, and this is increasingly becoming worrisome in our society because of increased risks and proneness to road traffic accidents on our highways and streets. The study set to determine causes and management of HI among children in our society. A retrospective review of all children aged 0-15 years with traumatic head injury (THIs) who were managed at the University of Maiduguri Teaching Hospital between July, 2006 and August, 2008. A total of 45 children with THIs presented to the casualty unit of the hospital; 30 (66.7%) were boys and 15 (33.3%) were girls. Three (6.7%) children were less than 1 year of age, 21 (46.7%) were between 1 years and 6 years while 16 (35.6%) and 5 (11.0%) were aged 7-11 years and 12-15 years respectively. Thirty six (80.0%) of the children were pedestrians, 6 (13.4%) fell from a height, while 2 (4.4%) and 1 (2.2% were as a result of home accident and assault, respectively. Twenty one patients (46.7%) had mild HI, while 53.3% had moderate to severe category. Forty one (91.1%) of children were managed as in-patients, mostly (95.1%) by conservative non-operative management, while 4 (8.9%) were treated on the out-patient basis. The mortality rate was 17.8%. H1 among children is of a great concern, because of its incremental magnitude, due to increasing child labour and interstate religious discipleship among children, with attendant high mortality and permanent disabilities. Necessary laws and legislations should be formulated and implemented with organized campaigns and public enlightenment to prevent and mitigate this menace.

  13. An Analysis of Beta-Blocker Administration Pre-and Post-Traumatic Brain Injury with Subanalyses for Head Injury Severity and Myocardial Injury.

    Science.gov (United States)

    Edavettal, Mathew; Gross, Brian W; Rittenhouse, Katelyn; Alzate, James; Rogers, Amelia; Estrella, Lisa; Miller, Jo Ann; Rogers, Frederick B

    2016-12-01

    A growing body of literature indicates that beta-blocker administration after traumatic brain injury (TBI) is cerebroprotective, limiting secondary injury; however, the effects of preinjury beta blocker status remain poorly understood. We sought to characterize the effects of pre- and postinjury beta-blocker administration on mortality with subanalyses accounting for head injury severity and myocardial injury. In a Level II trauma center, all admissions of patients ≥18 years with a head Abbreviated Injury Scale Score ≥2, Glasgow Coma Scale ≤13 from May 2011 to May 2013 were queried. Demographic, injury-specific, and outcome variables were analyzed using univariate analyses. Subsequent multivariate analyses were conducted to determine adjusted odds of mortality for beta-blocker usage controlling for age, Injury Severity Score, head Abbreviated Injury Scale, arrival Glasgow Coma Scale, ventilator use, and intensive care unit stay. A total of 214 trauma admissions met inclusion criteria: 112 patients had neither pre- nor postinjury beta-blocker usage, 46 patients had preinjury beta-blocker usage, and 94 patients had postinjury beta-blocker usage. Both unadjusted and adjusted odds ratios of preinjury beta-blocker were insignificant with respect to mortality. However, postinjury in-hospital administration of beta blockers was found to significantly in the decrease of mortality in both univariate (P = 0.002) and multivariate analyses (P = 0.001). Our data indicate that beta-blocker administration post-TBI in hospital reduces odds of mortality; however, preinjury beta-blocker usage does not. Additionally, myocardial injury is a useful indicator for beta-blocker administration post-TBI. Further research into which beta blockers confer the best benefits as well as the optimal period of beta-blocker administration post-TBI is recommended.

  14. Persistence of cognitive deficits following paediatric head injury without professional rehabilitation in rural East Coast Malaysia.

    Science.gov (United States)

    Abdullah, Jafri Malin; Kumaraswamy, Narasappa; Awang, Naziah; Ghazali, Mazira Mohamad; Abdullah, Mohd Rusli

    2005-07-01

    To use data from a prospective, longitudinal study to determine whether psychomotor functions improve spontaneously during the first year following paediatric traumatic brain injury without modern rehabilitation facilities in a rural area of Malaysia. Thirty-six paediatric patients who were referred for neurosurgical management for mild to severe head injuries were studied over a period of 2 years. No patients had orthopaedic or surgical trauma. Assessment of patients occurred at 3, 6 and 12 months, and patients were subjected to the Bender Gestalt Test, Weschler Intelligence Scale for Children--Revised and subtests from the Weschler Preschool and Primary Scale of Intelligence. None of the patients received professional rehabilitation due to a lack of facilities; only traditional treatment was given during this period. There were no significant changes in any of the parameters, except for integration error, after a period of 1 year. Cognitive function improved in 30% of patients after 1 year of follow-up. Despite an increased relationship of the caregiver to the patient in the first year of trauma, there was no general improvement when compared to the Western literature. A lack of modern resources in the community, a low general practitioner to patient ratio, and no inpatient or outpatient rehabilitation services do not lead to spontaneous improvement in the psychomotor condition of our patients despite good interfamily support. These are important findings for the future restructuring of the psychological service in Malaysia.

  15. Concussive head injury in children and adolescents related to sports and other leisure physical activities.

    Science.gov (United States)

    Browne, G J; Lam, L T

    2006-02-01

    To compare the characteristics of children and adolescents with concussive head injury (CHI) sustained during organised sports or other leisure physical activity. This was a case series study reviewing the medical records retrospectively over a four year period of children 6-16 years presenting to the emergency department with a CHI after participating in sport and/or recreation activity. There were 592 cases of sport and recreation related concussion over the study period (2000-2003). Most of the patients (n = 424, 71.6%) were male, with half (n = 304, 51.4%) being older than 10 years of age. A total of 152 (25.7%) cases of CHI were related to playing sports. Most cases (71.2%) were mild concussion. The cause of injury was a fall (n = 322, 54.4%) or a collision. Nearly a quarter of the children (n = 143, 24.2%) were admitted to hospital, with imaging performed in 134 (22.7%). Most children were treated appropriately and no adverse events were reported. A severe CHI in a child is six times more likely to have resulted from organised sport than from other leisure physical activities. Outcomes for CHI in children is excellent, although their management places a considerable burden on emergency services. The need for activity restriction and the benefits of this in reducing long term cognitive effects of CHI are uncertain.

  16. Nursing care of service members with head injury during the Vietnam war.

    Science.gov (United States)

    Yost, Terri L

    2012-06-01

    The purpose of this article was to describe and analyze the nursing management of head-injured soldiers by military nurses serving in the Vietnam War. This study used traditional historical methods and a military history framework. Primary sources included original military reports, letters, and policies from the Vietnam War period (located in the archives of the Army Medical Department, Office of Medical History in Falls Church, VA); journal articles of the time period; and autobiographical texts. Secondary sources consisted of biographical and historical texts and Web sites of historical societies. Findings supported that advances in medicine, nursing, and technology throughout the 1960s have an overall positive impact on patient care in a combat zone. The Vietnam War was a time when new theories in the management of head injuries led directly to overall improvements in survival. In conclusion, nurses were professionally and emotionally challenged on a near daily basis but were able to directly apply new nursing science in a combat environment to help improve survivability for those who may not have previously survived off the battlefield.

  17. HEAD INJURIES IN FULL CONTACT KARATE COMPETITION! IS THE PREJUDICE IN MANAGEMENT MINIMISING THE REQUIRED INVESTIGATION?

    Directory of Open Access Journals (Sweden)

    Michael R. Graham

    2007-10-01

    Full Text Available A 33 year old male karate practitioner presented himself for a full-contact national karate competition. This individual competed for approximately 2 minutes and received a kick to the head. He collapsed in the competitive arena, and suffered a tonic-clonic seizure, lasting for 3 minutes 25 seconds. Examination in the competitive arena revealed an individual who was unconscious. First aid, and paramedic support was provided immediately. Medical assessment identified the presence of vital signs. Glasgow coma scale (GCS, post trauma was recorded as 3/15 until the fifth minute. A patent airway was established and a neck brace was applied. Blood pressure within 1 minute of trauma was 195/98 mm.Hg, heart rate was 185 bpm and respiratory rate was 40 breaths·min-1. Oxygen was administered via a ventimask. The patient was conveyed to the medical area. The patient regained consciousness one minute after the seizure had resolved, but had amnesia concerning the event. GCS at five minutes was recorded as 13/15. The patient was transferred by ambulance to the nearest Hospital. The patient was discharged, following examination without further investigation. The finding of this study suggests that an individual with a history of head injury should have received computerised tomography as a minimum investigation. This may help eleviate the risk of further medical complications

  18. Causes of fatal childhood accidents involving head injury in northern region, 1979-86.

    Science.gov (United States)

    Sharples, P M; Storey, A; Aynsley-Green, A; Eyre, J A

    1990-11-24

    To examine the causes and circumstances surrounding fatal accidents involving head injuries in children in the Northern region. Retrospective review of the hospital case notes, necropsy reports, and records of the coroners' inquests. Northern Regional Health Authority. All 255 children aged less than 16 years who died with a head injury during 1979-86. Cause of injury and circumstances of accident according to reports of inquests; injury severity score; number of fatal accidents and mortality per 100,000 children in 10 groups of local authority wards ranked according to their score on the overall deprivation index; and distance of site of accident from child's home. Of the 255 children who died after a head injury, 136 (53%) children were playing at the time of the accident. 195 (76%) children sustained the head injury in road traffic accidents, 135 as pedestrians, 35 as cyclists, and 25 as passengers in a vehicle. In 120 accidents in child pedestrians the primary cause of accident was the unsafe behaviour of the child. 172 (67%) accidents occurred within one to two km of the child's home and 153 (63%) between 3 pm and 9 pm. The mortality was significantly related to social deprivation; excluding eight children injured while on holiday in the region, 15-fold decrease in mortality was recorded between the local authority wards that ranked highest on the overall deprivation index and those that ranked lowest (14.0/100,000 children, group 10 v 0.9/100,000, group 1 respectively, p less than 0.00001). The finding that most accidents occurred in children living in deprived areas who were playing unsupervised near their home suggests that childhood mortality might be appreciably reduced if children at play were protected from traffic, particularly in socially deprived areas.

  19. Understanding how a sport-helmet protects the head from closed injury by virtual impact tests.

    Science.gov (United States)

    Luo, Yunhua; Liang, Zhaoyang

    2017-01-01

    Understanding how a helmet protects the head, especially the soft brain tissues, is the prerequisite for improving helmet design. Intracranial pressure and stresses/strains in the brain tissues are the direct indicators of traumatic brain injury and they can be used to measure helmet performance. In this study, the effects of helmet design parameters such as the helmet shell stiffness, liner compliance and thickness on the brain injury indicators were investigated by virtual impact tests. A finite element head model (FEHM) was first constructed from medical images; a personally-fitted helmet made of composite material and foam was virtually prototyped using geometric information extracted from the FEHM; a helmet-head finite element model was then assembled. Virtual impact tests were conducted using the resulting helmet-head model. The obtained results suggested that, if the helmet shell already has adequate strength to resist excessive deformation and fracture, further increasing shell stiffness and strength would not considerably reduce intracranial pressure and brain strains; to reach the maximum protection with the available materials, the key is to effectively use the second stage in the stress-strain history of the liner foam material.

  20. The effect of trauma and patient related factors on radial head fractures and associated injuries in 440 patients

    NARCIS (Netherlands)

    Kodde, Izaäk F.; Kaas, Laurens; van Es, Nick; Mulder, Paul G. H.; van Dijk, C. Niek; Eygendaal, Denise

    2015-01-01

    Radial head fractures are commonly interpreted as isolated injuries, and it is assumed that the energy transferred during trauma has its influence on the risk on associated ipsilateral upper limb injuries. However, relationships between Mason classification, mechanism of injury, and associated

  1. Helmet legislation and admissions to hospital for cycling related head injuries in Canadian provinces and territories: interrupted time series analysis

    Science.gov (United States)

    Ramsay, Tim; Turgeon, Alexis F; Zarychanski, Ryan

    2013-01-01

    Objective To investigate the association between helmet legislation and admissions to hospital for cycling related head injuries among young people and adults in Canada. Design Interrupted time series analysis using data from the National Trauma Registry Minimum Data Set. Setting Canadian provinces and territories; between 1994 and 2003, six of 10 provinces implemented helmet legislation. Participants All admissions (n=66 716) to acute care hospitals in Canada owing to cycling related injury between 1994 and 2008. Main outcome measure Rate of admissions to hospital for cycling related head injuries before and after the implementation of provincial helmet legislation. Results Between 1994 and 2008, 66 716 hospital admissions were for cycling related injuries in Canada. Between 1994 and 2003, the rate of head injuries among young people decreased by 54.0% (95% confidence interval 48.2% to 59.8%) in provinces with helmet legislation compared with 33.1% (23.3% to 42.9%) in provinces and territories without legislation. Among adults, the rate of head injuries decreased by 26.0% (16.0% to 36.3%) in provinces with legislation but remained constant in provinces and territories without legislation. After taking baseline trends into consideration, however, we were unable to detect an independent effect of legislation on the rate of hospital admissions for cycling related head injuries. Conclusions Reductions in the rates of admissions to hospital for cycling related head injuries were greater in provinces with helmet legislation, but injury rates were already decreasing before the implementation of legislation and the rate of decline was not appreciably altered on introduction of legislation. While helmets reduce the risk of head injuries and we encourage their use, in the Canadian context of existing safety campaigns, improvements to the cycling infrastructure, and the passive uptake of helmets, the incremental contribution of provincial helmet legislation to reduce

  2. Did Emperor Moctezuma II's head injury and subsequent death hasten the fall of the Aztec nation?

    Science.gov (United States)

    Sanchez, Gonzalo M

    2015-07-01

    This article analyzes the head injury of Emperor Moctezuma as one of those injuries that affected the course of history. The Emperor's death arguably changed the fate of an entire nation and led to the destruction of the Aztec civilization. Moctezuma died in the evening hours of June 30, 1520, in his palace in the Aztec capital, Tenochtitlan, while a prisoner of the Spanish conquistadors. The Emperor had been speaking to his people in an effort to persuade them to cease hostilities against Hernán Cortés, his Spanish soldiers, and Indian allies. Both Spanish and Indian contemporary sources document that he sustained a severe head injury when one of his own warriors hit him with a rock thrown from a sling. However, after the Conquest of Mexico some of the information collected by Spanish friars from Indian stories, songs, and pictorial representations raised the possibility that Moctezuma died of strangulation or stabbing at the hands of the Spaniards. There is even a suggestion of suicide. This issue remains unresolved and emotionally charged. The historical and clinical analysis of the events surrounding Moctezuma's death indicates that the Emperor most likely died as a consequence of head injury. The author has attempted to present a neutral analysis but agrees with Benjamin Keen that neutrality may be unattainable, no matter how remote the subject of historical inquiry is from the present.

  3. Teaching of the assessment of head and brain injury in UK dental schools--The Headway Survey.

    Science.gov (United States)

    Chapman, H R; Nickson, G P; Curran, A L M

    2005-09-01

    Under the auspices of Headway--the brain injury association, the charity supplies information on head/brain injury and runs a telephone advice line: (0115 924 0800). Questionnaires regarding the undergraduate teaching related to head/brain injuries were sent to, and returned by, all 12 UK dental schools. The replies suggest that undergraduate teaching of this subject is patchy and inadequately prepares dentists to recognise and cope with patients who may have had head, and consequently brain, injuries. It is recommended that dental schools review their teaching of this subject and ensure that it is consistent with the current guidelines issued by the National Institute of Clinical Excellence (NICE) on the recognition of head injury and that the findings are brought to the attention of the General Dental Council in the context of the GDC's "The first five years" report.

  4. Traumatic head injury in the anticoagulated elderly patient: a lethal combination.

    Science.gov (United States)

    Karni, A; Holtzman, R; Bass, T; Zorman, G; Carter, L; Rodriguez, L; Bennett-Shipman, V J; Lottenberg, L

    2001-11-01

    Warfarin is the most common oral anticoagulant used for chronic anticoagulation therapy. Even without any antecedent trauma overanticoagulation can result in intracranial hemorrhage. The triad of anticoagulation with warfarin, age greater than 65 years, and traumatic head injury frequently produces a lethal brain hemorrhage. A retrospective review of more than 2000 patients admitted to the Trauma Service between September 1998 and May 2000 produced 278 patients with head injury and CT-documented intracranial hemorrhage. Of these patients 21 were admitted with an elevated prothrombin time (PT) due to anticoagulation with warfarin. Eighteen patients (86%) were above the age of 70. The most common indications for anticoagulation were atrial fibrillation (71%), deep venous thrombosis (19%), aortic valve replacement (9%), and ischemic cerebral infarcts (9%). Fourteen injuries were the result of a fall, one resulted from a gunshot wound, and one resulted from an assault. The remaining five patients were excluded as their history, workup, and evaluation by neurosurgery suggested a spontaneous bleed leading to fall rather than a fall causing a traumatic bleed. The average Glasgow Coma Score on admission was 11. The average PT and International Normalized Ratio (INR) on admission were 19.2 and 2.99 respectively. Eight of the 16 patients analyzed died. The risk of intracranial hemorrhage with relatively minor head injury is increased dramatically in the anticoagulated patient. A mortality rate of 50 per cent far exceeds the mortality rate in patients with similar head injuries who are not anticoagulated. In addition the risk/benefit equation of anticoagulation for the elderly is more complex and differs from that for younger patients. Perhaps more frequent and judicious monitoring of prothrombin time levels with lower therapeutic ranges (INR 1.5-2) is necessary.

  5. Injuries in national Olympic level judo athletes: an epidemiological study.

    Science.gov (United States)

    Kim, Keun-Suh; Park, Ki Jun; Lee, Jaekoo; Kang, Byung Yong

    2015-09-01

    To present an epidemiological study of injuries found among South Korea's National level Judo athletes as a foundation for future injury prevention and skill enhancement in this group. This study is a prospective study on a 4-year injury assessment held from January 2010 to December 2013 at the training centre in South Korea for National Level athletes. Athlete's weight class, gender, injury location and injury grade (grade I=1-3 treatment days, grade II=4-7 treatment days, and grade III ≥8 treatment days) were analysed. There were a total of 782 injuries recorded during this period, equalling to four injuries per athlete annually. Almost half of these injuries (47%) were grade I injuries. Injury occurrence was the highest in the Lower body (44.2%). This was then followed by injuries in the upper body (29.8%), trunk (20.3%) and head and neck (5.6%). Men and women showed similar, non-significantly different trends in the proportion of body parts injured. Women experienced more grade III injuries than males (p=0.0228). Comparison between women in different weight classes also showed that heavyweights incurred more grade III injuries than lightweights (p=0.0087). Lightweights had a higher rate of injury than heavyweights in males and females, although this was statistically significant only among males (pjudo population. Women, especially those in the heavyweight classification, were more prone to severe injuries. Lightweights experienced more injuries than heavyweights among male athletes. Specifically, further studies are needed to confirm these findings and to address the impact of rapid weight loss practices on injury risk to implement effective preventive measures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Human bite injuries to the head and neck: current trends and management protocols in England and Wales.

    Science.gov (United States)

    Jenkins, Glyndwr W; Isaac, Robert; Mustafa, Shakir

    2018-03-01

    Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper. A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate. The collated results of the survey were entered onto a spreadsheet (Microsoft Excel©) for the purpose of statistical review. A 68% response rate from A&E departments throughout England and Wales demonstrated a lack of consensus in the initial management and subsequent treatment of human bite injuries. Written protocols are in place for human bite injuries in 54.4% of units. In 100% of units, initial management involves irrigation +/- debridement of the wound, though there is a lack of agreement on the surgical management of the wound. 77.9% of units follow 'needle stick protocols' when stratifying risk for blood-borne viruses. Human bites pose a number of unique problems, ranging from cellulitis to the transmission of communicable diseases. The maxillofacial surgeon has the added dilemmas surrounding subsequent repair and reconstruction. Appreciation of the complexity of human bite injuries will ensure optimal care for the patient. We propose a set of guidelines developed 'in-house' to assist in the management of human bite injuries.

  7. Functional neuroimaging and quantitative electroencephalography in adult traumatic head injury: clinical applications and interpretive cautions.

    Science.gov (United States)

    Ricker, J H; Zafonte, R D

    2000-04-01

    Functional neuroimaging and quantitative electroencephalographic procedures are being used increasingly in brain injury research and clinical care. These procedures are also seeing increased use in the context of forensic evaluations, particularly in cases of mild head trauma. This article provides an overview of the use of procedures such as positron emission tomography, single photon emission computed tomography, and quantitative electroencephalogram in adults. Also discussed are the clinical limitations of each procedure within the context of myriad interpretive confounds that can interfere with accurate differential diagnosis of mild head trauma.

  8. The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only.

    Science.gov (United States)

    Garner, Alan A; Mann, Kristy P; Fearnside, Michael; Poynter, Elwyn; Gebski, Val

    2015-11-01

    Advanced prehospital interventions for severe brain injury remains controversial. No previous randomised trial has been conducted to evaluate additional physician intervention compared with paramedic only care. Participants in this prospective, randomised controlled trial were adult patients with blunt trauma with either a scene GCS score <9 (original definition), or GCS<13 and an Abbreviated Injury Scale score for the head region ≥3 (modified definition). Patients were randomised to either standard ground paramedic treatment or standard treatment plus a physician arriving by helicopter. Patients were evaluated by 30-day mortality and 6-month Glasgow Outcome Scale (GOS) scores. Due to high non-compliance rates, both intention-to-treat and as-treated analyses were preplanned. 375 patients met the original definition, of which 197 was allocated to physician care. Differences in the 6-month GOS scores were not significant on intention-to-treat analysis (OR 1.11, 95% CI 0.74 to 1.66, p=0.62) nor was the 30-day mortality (OR 0.91, 95% CI 0.60 to 1.38, p=0.66). As-treated analysis showed a 16% reduction in 30-day mortality in those receiving additional physician care; 60/195 (29%) versus 81/180 (45%), p<0.01, Number needed to treat =6. 338 patients met the modified definition, of which 182 were allocated to physician care. The 6-month GOS scores were not significantly different on intention-to-treat analysis (OR 1.14, 95% CI 0.73 to 1.75, p=0.56) nor was the 30-day mortality (OR 1.05, 95% CI 0.66 to 1.66, p=0.84). As-treated analyses were also not significantly different. This trial suggests a potential mortality reduction in patients with blunt trauma with GCS<9 receiving additional physician care (original definition only). Confirmatory studies which also address non-compliance issues are needed. NCT00112398. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. [Clinical decision to perform cranial computed tomography in children with non-severe head injury].

    Science.gov (United States)

    Franco-Koehrlen, Celine Alicia; Iglesias-Leboreiro, José; Bernárdez-Zapata, Isabel; Rendón-Macías, Mario Enrique

    The main goal of this article was to evaluate if the decision to perform cranial computed tomography (CT) in children with minor head injury is determined by the presence or absence of the physician during assessment in the emergency room. Clinical files of 92 patients from 8 months to 4 years of age were selected. Those children were evaluated at the emergency department of the Spanish Hospital of Mexico due to non-severe traumatic brain injury. Glasgow Coma Scale (GCS) score was determined in all patients. Groups of patients were compared: 1) patients having CT, 2) patients with a physician who attended the initial assessment, 3) patients whose attending physician did not arrive to assess the patient and 4) patients assessed by the emergency room staff. 38% of patients with non-severe brain injury underwent CT, 8.6% had a brain injury visible on the CT. Moderate intensity impacts were greater in patients with CT. Regarding the ECG, it was found that most children scored 15 points (p=0.03). In patients without a physician, a greater trend was demonstrated for performing CT. Patients with minor head injury but without neurological signs should undergo a detailed clinical evaluation in order to avoid unwarranted CT. Copyright © 2015. Publicado por Masson Doyma México S.A.

  10. Study on Brain Injury Biomechanics Based on the Real Pedestrian Traffic Accidents

    Science.gov (United States)

    Feng, Chengjian; Yin, Zhiyong

    This paper aimed to research the dynamic response and injury mechanisms of head based on real pedestrian traffic accidents with video. The kinematics of head contact with the vehicle was reconstructed by using multi-body dynamics models. These calculated parameters such as head impact velocity and impact location and head orientation were applied to the THUMS-4 FE head model as initial conditions. The intracranial pressure and stress of brain were calculated from simulations of head contact with the vehicle. These results were consistent with that of others. It was proved that real traffic accidents combined with simulation analysis can be used to study head injury biomechanics. Increasing in the number of cases, a tolerance limit of brain injury will be put forward.

  11. Comparative analysis of clinical and computed tomography features of basal skull fractures in head injury in southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Eunice O Olabinri

    2015-01-01

    Full Text Available Background: Basal skull fractures (BSF in head injury may be missed clinically. Early detection ensures prompt treatment and prevention of complications We compared the clinical and Computed Tomography (CT features of basal skull fractures in head injured patients in a southwestern Nigerian hospital. Materials and Methods: Head injury patients who had cranial CT at a Southwestern Nigerian hospital were selected. CT images were acquired with a 64-slice Toshiba Aquillion CT scanner using a standard head protocol. The images were evaluated for evidence of skull fractures, and associated complications. The clinical data and CT findings were analyzed. Results: One hundred and thirty patients were evaluated, including 103 (79.2% males. Their ages ranged between 7 months and 81 years, mean 35 years (SD, 20.3. In 59 patients (45.4%, 59/130 BSF was detected on CT, while 71 (54.6% had no evidence BSF. Forty-two (71.2% of the 59 patients detected on CT had clinical suspicion of BSF (P 0.05. The commonest observed clinical feature in patients with confirmed BSF was otorrhagia (45.8% and the petrous temporal bone (45.8% was the most commonly fractured bone. The BSF was caused most commonly by motor bike accidents in 53 (40.8%. The most common associated intracranial injuries were intracerebral haemorrhage (34.6% and subdural (17.3% Conclusion: It appears that neurosurgical evaluation is comparatively reliable in evaluating basal skull fractures in this study area even as they are consistently demonstrated by high resolution CT scanners. A clinical suspicion of BSF should warrant a closer detailed CT evaluation and reporting by radiologists.

  12. A Rare Occipital Condyle Fracture in a Patient With A Minor Head Injury

    Directory of Open Access Journals (Sweden)

    Da-Wei Huang

    2009-06-01

    Full Text Available Occipital condyle fracture (OCF is an uncommon but potentially fatal disease entity. It is most commonly identified in patients suffering from severe craniocerebral trauma. The advent of computed tomography has made early detection possible. Traditional treatment using a hard neck collar is sufficient to produce solid fusion in most OCF patients. Delayed diagnosis, however, may result in neurologic deterioration due to potential displacement of fractured condylar fragments. Here we report a case of isolated, stable OCF in a patient with a minor head injury. A high level of clinical awareness of this rare disease entity is imperative for the management of traumatized patients, especially for those who have minor head injuries but persistent neck pain.

  13. Left-handedness as a risk factor for head injuries | Zverev | East ...

    African Journals Online (AJOL)

    Left-handedness as a risk factor for head injuries. Y. Zverev, A. Adeloye. Abstract. (East African Medical Journal: 2001 78(1): 22-24). Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/eamj.v78i1.9107 · AJOL African Journals Online.

  14. [Displacement of a stapes piston as a consequence of whiplash injury with head impact].

    Science.gov (United States)

    Träger, V; Seidl, R O; Ernst, A

    2005-02-01

    We report the case of a 60 year old patient suffering from a displacement of her stapes piston after a rear-end collision with whiplash injury. Immediately after the accident she complained hearing loss and tinnitus. During the following days, the patient developed vertigo with lateropulsion. Diagnostic tympanoscopy showed a piston dislocation with migration into the vestibulum as a result of the blunt head trauma.

  15. Polytrauma care. The effect of head injuries and timing of skeletal fixation.

    Science.gov (United States)

    Schmeling, G J; Schwab, J P

    1995-09-01

    There is a substantial body of literature supporting early ( traction and recumbency, reduces pain, decreases the stimulus for a systemic inflammatory response, makes nursing care easier, makes the fracture outcome more predictable, and decreases health care costs. If hypotension and hypoxia are avoided, early fixation of long bone fractures does not increase the incidence of adverse cerebral events. The benefits (short and long term), if any, of early fixation of long bone fractures on the recovery from closed head injury remain poorly defined.

  16. The Effect of Pycnogenol® on Spatial Learning and Memory in Rats with Experimental Closed Head Injury

    OpenAIRE

    Afşin Emre Kayıpmaz; Remzi Erdem; Cem Yılmaz; Emine Ebru Deniz; Cemil Kavalcı; Alperen Özdemir; İrem Güler; Eda Caferoğlu; Fatma Serra Kalyoncu; Özgür Güven

    2017-01-01

    Aim: Trauma is a leading cause of emergency admissions. In this study, we investigated the effect of Pycnogenol® on spatial learning and memory (SLM) function in rats subjected to closed head injury. Methods: The study was a randomized, experimental study of four groups, each containing six rats. Pycnogenol® was administered to rats in two groups (group three and four) daily for five days starting on day one. A Barnes maze was used to test SLM in the rats in all four groups. Group 1: These...

  17. Mental fatigue after very severe closed head injury: Sustained performance, mental effort, and distress at two levels of workload in a driving simulator

    NARCIS (Netherlands)

    Riese, H.; Hoedemaeker, M.; Brouwer, W.H.; Mulder, L.J.M.; Cremer, R.; Veldman, J.B.P.

    1999-01-01

    In patients with very severe closed head injury (CHI), returning to work is often problematic. The present study focuses on a persistent complaint of these patients, viz. mental fatigue. To study this, the effect of sustained workload is assessed in a continuous dynamic divided attention task. Three

  18. Mental fatigue after very severe closed head injury : Sustained performance, mental effort, and distress at two levels of workload in a driving simulator

    NARCIS (Netherlands)

    Riese, H; Hoedemaeker, M; Brouwer, WH; Mulder, LJM; Veldman, JBP

    In patients with very severe closed head injury (CHI), returning to work is often problematic. The present study focuses on a persistent complaint of these patients, viz. mental fatigue. To study this, the effect of sustained workload is assessed in a continuous dynamic divided attention task. Three

  19. Incidental cranial CT findings in head injury patients in a Nigerian tertiary hospital

    Directory of Open Access Journals (Sweden)

    Godwin I Ogbole

    2015-01-01

    Full Text Available Background: Incidental findings on computed tomography (CT scans are occasionally noted in patients presenting with head injury. Since it can be assumed that head injured patients are of normal health status before the accident, these findings may be a representation of their frequency in the general population. Our aim was to determine the prevalence of such incidental findings among head injured patients in Nigeria′s foremost center of clinical neurosciences. Materials and Methods: We conducted a retrospective review of CT scan images of 591 consecutive eligible patients over a 5-year period (2006-2010 to identify incidental findings. The images were evaluated by consensus agreement of two radiologists. Associations with gender and age were explored using appropriate statistical tests with an alpha level of 0.05. Results: The mean patient age was 34.6 ± 21.2 years, and male to female ratio was 3.2: 1. Incidental findings were noted in 503/591 (85.1 % of the scans. Intracranial calcification was the commonest finding occurring in 61.8% of patients. Over 90% of the findings were benign. Compared with older ones, patients under the age of 60 were less likely, (P < 0.001, to have incidental findings. Conclusion: Although the majority of incidental findings in this African cohort of head injury patients are benign some clinically significant lesions were detectable. It is therefore recommended that such findings be adequately described in the radiological reports for proper counseling and follow-up.

  20. Fracture pattern characteristics and associated injuries of high-energy, large fragment, partial articular radial head fractures: a preliminary imaging analysis.

    Science.gov (United States)

    Capo, John T; Shamian, Ben; Francisco, Ramces; Tan, Virak; Preston, Jared S; Uko, Linda; Yoon, Richard S; Liporace, Frank A

    2015-06-01

    High-energy radial head injuries often present with a large partial articular displaced fragment with any number of surrounding injuries. The objective of the study was to determine the characteristics of large fragment, partial articular radial head fractures and determine any significant correlation with specific injury patterns. Patients sustaining a radial head fracture from 2002-2010 were screened for participation. Twenty-five patients with documented partial articular radial head fractures were identified and completed the study. Our main outcome measurement was computed tomography (CT)-based analysis of the radial head fracture. The location of the radial head fracture fragment was evaluated from the axial CT scan in relation to the radial tuberosity used as a reference point. The fragment was characterized by location as anteromedial (AM), anterolateral (AL), posteromedial (PM) or posterolateral (PL) with the tuberosity referenced as straight posterior. All measurements were performed by a blinded, third party hand and upper extremity fellowship trained orthopedic surgeon. Fracture pattern, location, and size were then correlated with possible associated injuries obtained from prospective clinical data. The radial head fracture fragments were most commonly within the AL quadrant (16/25; 64 %). Seven fracture fragments were in the AM quadrant and two in the PM quadrant. The fragment size averaged 42.5 % of the articular surface and spanned an average angle of 134.4(°). Significant differences were noted between AM (49.5 %) and AL (40.3 %) fracture fragment size with the AM fragments being larger. Seventeen cases had associated coronoid fractures. Of the total 25 cases, 13 had fracture dislocations while 12 remained reduced following the injury. The rate of dislocation was highest in radial head fractures that involved the AM quadrant (6/7; 85.7 %) compared to the AL quadrant (7/16; 43.7 %). No dislocations were observed with PM fragments. Ten of the

  1. Emergency department-reported head injuries from skiing and snowboarding among children and adolescents, 1996-2010

    Science.gov (United States)

    Graves, Janessa M; Whitehill, Jennifer M; Stream, Joshua O; Vavilala, Monica S; Rivara, Frederick P

    2013-01-01

    Objectives To evaluate the incidence of snow-sports-related head injuries among children and adolescents reported to emergency departments (EDs), and to examine the trend from 1996 to 2010 in ED visits for snow-sports-related traumatic brain injury (TBI) among children and adolescents. Methods A retrospective, population-based cohort study was conducted using data from the National Electronic Injury Surveillance System for patients (aged ≤17 years) treated in EDs in the USA from 1996 to 2010, for TBIs associated with snow sports (defined as skiing or snowboarding). National estimates of snow sports participation were obtained from the National Ski Area Association and utilised to calculate incidence rates. Analyses were conducted separately for children (aged 4–12 years) and adolescents (aged 13–17 years). Results An estimated number of 78 538 (95% CI 66 350 to 90 727) snow sports-related head injuries among children and adolescents were treated in EDs during the 14-year study period. Among these, 77.2% were TBIs (intracranial injury, concussion or fracture). The annual average incidence rate of TBI was 2.24 per 10 000 resort visits for children compared with 3.13 per 10 000 visits for adolescents. The incidence of TBI increased from 1996 to 2010 among adolescents (p<0.003). Conclusions Given the increasing incidence of TBI among adolescents and the increased recognition of the importance of concussions, greater awareness efforts may be needed to ensure safety, especially helmet use, as youth engage in snow sports. PMID:23513009

  2. The epidemiology of paediatric head injuries: data from a referral centre in Victoria, Australia.

    Science.gov (United States)

    Crowe, Louise; Babl, Franz; Anderson, Vicki; Catroppa, Cathy

    2009-06-01

    Currently, there are no population-based or hospital-based studies on the full spectrum of paediatric head injuries (HIs) in Australia. We set out to provide detailed information on the incidence rates, causes and clinical management of all severities of HI in children and adolescents at an Australian tertiary referral centre using emergency department (ED) and admission data as a basis for further investigations and prevention efforts. A retrospective chart review of all children aged 0-16 years who attended the Royal Childrens Hospital (RCH), Melbourne, following a HI in 2004 was used. The cases were identified using the International classification of diseases 10th revision codes, and all medical records were reviewed based on a piloted data form. Information was collected on demographics, injury factors and clinical management of HIs in the hospital setting. Over the 12-month period, there were 1115 children with an HI who attended the RCH ED, or were admitted. Ninety per cent were classified as mild, 8% as moderate and 3% as severe. Males and children under 3 years had the higher attendance rates. Falls, sports and motor vehicle accidents were the main HI causes. The main sport played (30%) when sustaining an HI was Australian rules football. Thirty-two per cent of children were admitted, 67% of these with mild HI. Twenty-one per cent had a radiology imaging study, most (67%) with a normal result. Many HI causes appear preventable, in particular, falls from heights in infants and sports safety. High rates of admission and radiology imaging of mild HI warrant further investigation. © 2009 The Authors. Journal compilation © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  3. Intention tremor after head injury. Clinical features and computed tomographic findings

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-02-01

    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 /le/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).

  4. Brain and head injury in infancy and childhood; Schaedel- und Hirntrauma im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Struffert, T. [Abteilung fuer Neuroradiologie, Radiologische Klinik, Universitaet des Saarlandes, Homburg, Saar (Germany); Abteilung fuer Neuroradiologie, Radiologische Klinik, Universitaet des Saarlandes, 66421, Homburg, Saar (Germany); Grunwald, I.; Reith, W. [Abteilung fuer Neuroradiologie, Radiologische Klinik, Universitaet des Saarlandes, Homburg, Saar (Germany)

    2003-11-01

    This article describes typical head injuries in infants and children. In comparison with adults there are distinct differences in the etiology of trauma and in the kind of reaction of the skull and brain. In infants and children there are three different types of trauma: birth trauma, accidental and non-accidental injury. The typical injuries in these three groups are described. (orig.) [German] In diesem Beitrag werden die typischen Schaedel- und Hirnverletzungen bei Kindern zusammengefasst. Bei diesen bestehen im Vergleich zu Erwachsenen deutliche Unterschiede in der Aetiologie und der Reaktion der Kalotte und des Gehirns auf ein Trauma. Bezueglich der Aetiologie kann unterschieden werden in Geburtstrauma, akzidentelles und nichtakzidentelles Trauma. Die typischen Verletzungen dieser 3 Gruppen werden ausfuehrlich beschrieben. (orig.)

  5. Admission to hospital following head injury in England: incidence and socio-economic associations.

    Science.gov (United States)

    Tennant, Alan

    2005-03-04

    Head injury in England is common. Evidence suggests that socio-economic factors may cause variation in incidence, and this variation may affect planning for services to meet the needs of those who have sustained a head injury. Socio-economic data were obtained from the UK Office for National Statistics and merged with Hospital Episodes Statistics obtained from the Department of Health. All patients admitted for head injury with ICD-10 codes S00.0-S09.9 during 2001-2 and 2002-3 were included and collated at the level of the extant Health Authorities (HA) for 2002, and Primary Care Trust (PCT) for 2003. Incidence was determined, and cluster analysis and multiple regression analysis were used to look at patterns and associations. 112,718 patients were admitted during 2001-2 giving a hospitalised incidence rate for England of 229 per 100,000. This rate varied across the English HA's ranging from 91-419 per 100,000. The rate remained unchanged for 2002-3 with a similar magnitude of variation across PCT's. Three clusters of HA's were identified from the 2001-2 data; those typical of London, those of the Shire counties, and those of Other Urban authorities. Socio-economic factors were found to account for a high proportion of the variance in incidence for 2001-2. The same pattern emerged for 2002-3 at the PCT level. The use of public transport for travel to work is associated with a decreased incidence and lifestyle indicators, such as the numbers of young unemployed, increase the incidence. Head injury incidence in England varies by a factor of 4.6 across HA's and PCT's. Planning head injury related services at the local level thus needs to be based on local incidence figures rather than regional or national estimates. Socio-economic factors are shown to be associated with admission, including travel to work patterns and lifestyle indicators, which suggests that incidence is amenable to policy initiatives at the macro level as well as preventive programmes targeted at

  6. Management of acute sports injuries and medical conditions by South Dakota high school head coaches: assessment via case scenarios.

    Science.gov (United States)

    Cross, Patrick S; Karges, Joy R; Horkey, Melissa Ann; Kolb, Ginger A; Alexander, Krystle L; Knippling, Amy L; Jacobsen, Jordan Anthony

    2012-03-01

    When medical coverage does not exist at games and practices, coaches are often responsible for the management of acute conditions. The question that arises is whether they make proper medical decisions concerning the health and safety of their athletes. The purpose of this study was to assess high school head coaches' decision-making skills related to acute medical condition management through the use of case scenarios. A cover letter/web link to the web-based survey was e-mailed to all 2008-2009 school year South Dakota high school head athletic coaches. Head coaches were found to be responsible for the immediate care of injured athletes at practice (87.2 percent) and home competitions (72.3 percent). Less than 75.0 percent of coaches reported feeling "prepared" or "somewhat prepared" to handle 11 of the 16 types of acute athletic injuries and medical conditions presented, with less than 75.0 percent of coaches giving "appropriate" or "overly cautious" responses to eight of the 17 cases. Little to no relationship was found between perceived level of preparedness for treating various conditions and appropriateness of responses. A significant difference was found in appropriateness of decisions based on level of athlete (68.9 percent starters, 79.3 percent non-starters) and event situation (66.5 percent important events, 76.6 percent non-important events). In South Dakota, high school coaches are most often responsible for the initial management of acute injuries; yet, a large percentage of coaches did not feel "prepared" to manage various conditions and/or gave "inappropriate" responses to multiple cases. Furthermore, the level of athlete and the event situation may influence coaches' decisions. Further education may include the proper management of head and neck injuries, multiple concussions, dislocations, heat emergencies, eye injuries and internal organ injuries. Health care workers can be an integral part of training coaches in the care of acute conditions, as

  7. Use of digital camera imaging of eye fundus for telemedicine in children suspected of abusive head injury.

    Science.gov (United States)

    Saleh, M; Schoenlaub, S; Desprez, P; Bourcier, T; Gaucher, D; Astruc, D; Speeg-Schatz, C

    2009-04-01

    Pilot study of the role of RetCam imaging for telemedicine in lieu of availability of ophthalmologist examination for cases of suspected abusive head injury. Cross-sectional observational study. 21 children admitted in the paediatric units of the University Hospital of Strasbourg (France) with suspicion of abusive head trauma were included. Children were examined by standard ophthalmoscopy. Photographs were taken using the RetCam-120 Digital Retinal Camera. Eye fundus images were stored and remotely read by an ophthalmologist. Patients also had radiographic skeletal series to look for bone fractures, and CT scan and/or MRI of the head to look for intracranial haemorrhages. The absence or presence of retinal haemorrhages was assessed by both methods. Feasability, sensitivity and specificity of the digital camera procedure were determined. 85.7% of the children presented cerebral bleeding, and 14 out of the 21 (66.7%) had retinal haemorrhages on ophthalmoscopy. The digital camera detected the retinal abnormalities in all cases. One false-positive case was also reported. The sensitivity of the digital camera detection method was 100% with a specificity of 85.7%. 14 patients were eventually diagnosed as suffering from abusive trauma. RetCam helped establishing the diagnosis of abuse in 92.8% of these cases. Digital photography compared with ophthalmoscopy has a good sensitivity and specificity in detecting retinal haemorrhages. Remote reading of RetCam-120 photographs could be a promising strategy in detecting children with abusive head trauma.

  8. Injury: necropsy studies

    Directory of Open Access Journals (Sweden)

    Roberto Almeida Rêgo de Souza

    2015-12-01

    Full Text Available Objective: to carry out an epidemiological research of trauma related deaths subjected to autopsy. Methods: a retrospective research was held through the analysis of 412 medical records related to traumatic deaths in 2014, subjected to autopsy at the Forensics Department of Itabuna, evaluating the following variables: gender, age, marital status, race, education, pre- hospital care, consequence of death, type of trauma, mechanism of injury, lesion topography, cause of death, day, time and city the incident took place. Data was divided into two groups: I penetrating trauma and II blunt injury. Results: The vast majority was male (93%, brown (95%, single (83%, with education up to elementary school (42% prevailing age group between 25 and 29 years of age (67 %, and death caused by homicide (62%. The most frequent type was penetrating trauma (61%, being the skull the most affected body region (65%. Intracranial hemorrhages were the main causes of death (30.8%. Injuries by firearms projectiles prevailed in group I, and automobile accidents in group II. Conclusion: the population most affected by deaths due to external causes in the city of Itabuna, Bahia, consists of young, brown, single men.

  9. One year outcome in mild to moderate head injury : the predictive value of acute injury characteristics related to complaints and return to work

    NARCIS (Netherlands)

    van der Naalt, J; van Zomeren, AH; Sluiter, WJ; Minderhoud, JM

    Objectives-To determine the prognostic value of characteristics of acute injury and duration of post-traumatic amnesia (PTA) for long term outcome in patients with mild to moderate head injury in terms of complaints and return to work. Methods-Patients with a Glasgow coma score (GCS) on admission of

  10. A history of loss of consciousness or post-traumatic amnesia in minor head injury: "conditio sine qua non" or one of the risk factors?

    NARCIS (Netherlands)

    Smits, M.; Hunink, M.G.M.; Nederkoorn, P.J.; Dekker, H.M.; Vos, P.E.; Kool, D.R.; Hofman, P.A.; Twijnstra, A.; Haan, G.G. de; Tanghe, H.L.; Dippel, D.W.

    2007-01-01

    OBJECTIVE: A history of loss of consciousness (LOC) or post-traumatic amnesia (PTA) is commonly considered a prerequisite for minor head injury (MHI), although neurocranial complications also occur when LOC/PTA are absent, particularly in the presence of other risk factors. The purpose of this study

  11. A CLINICAL STUDY ON BLUNT INJURY ABDOMEN

    Directory of Open Access Journals (Sweden)

    G. Kishore Babu

    2016-10-01

    Full Text Available BACKGROUND Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. Motor vehicle accidents and urban violence, respectively, are the leading causes of blunt and penetrating trauma to this area of the body. Unnecessary deaths and complications can be minimized by improved resuscitation, evaluation and treatment. The new techniques and diagnostic tools available are important in the management of abdominal trauma. These improved methods, however, still depend on experience and clinical judgment for application and determination of the best care for the injured patient. The aim of the study is to 1. Analyse the incidence, clinical characteristics, diagnosis, indications for laparotomy, therapeutic methods and morbidity & mortality rates. 2. To study nature of blunt abdominal trauma. 3. To assess patient for surgical intervention and to avoid negative laparotomy. 4. To assess morbidity rate in different organs injury. 5. To evaluate modalities of treatment, complications and prognosis. MATERIALS AND METHODS This study is a prospective study on 97 patients with Blunt injuries to the abdomen admitted in S.V.R.R.G.G. Hospital, Tirupati during October 2013-15. Inclusion Criteria Patients > 13 years, with Blunt injury to abdomen either by RTA, fall, object contact, assault giving written informed consent. Exclusion Criteria Patients <13 yrs. Blunt injuries due to blasts, patients with severe cardiothoracic and head injuries who are hemodynamically unstable. CONCLUSION Blunt Trauma to abdomen is on rise due to excessive use of motor vehicles. It poses a therapeutic and diagnostic dilemma for the attending surgeon due to wide range of clinical manifestations ranging from no early physical findings to progression to shock. So, the Trauma surgeon should rely on his physical findings in association with use of modalities like x-ray abdomen, USG abdomen and abdominal paracentesis. Hollow viscus perforations are

  12. Health-related quality of life among people with epilepsy with mild seizure-related head injuries.

    Science.gov (United States)

    Friedman, David E; Islam, Shahidul; Ettinger, Alan B

    2013-06-01

    Seizure-related head injury (SRHI) is an under-recognized condition frequently experienced by people with epilepsy (PWE). The purpose of this study is to investigate the potential impact of SRHI on health-related quality of life (HRQOL) among PWE receiving care in a tertiary epilepsy center. Consecutive adult PWE receiving care at the Baylor Comprehensive Epilepsy Center (BCEC) were recruited for the study. After their informed consent was obtained, patients were administered the QOLIE-31 to measure HRQOL and the NDDI-E to screen for depression. Simple linear regression was used to identify clinical variables associated with HRQOL and that included SRHI obtained systematically at each clinic visit. Data were also compared between the SRHI and non-SRHI groups. Participants included 172 subjects. Recurrent mild SRHI occurred in 50 (29%) subjects. Factors with a negative effect on HRQOL included depression (slope=-19.99 [95% CI -25.16, -14.81]; panalysis. With stepwise multiple regression, depression and recurrent SRHI significantly impacted HRQOL with slopes (95% CI; p-value) of (-17.53 [-22.34, -12.73]; p<.0001) and (-14.03 [-18.78, -9.28]; p<.0001), respectively. Patient-derived HRQOL is negatively associated with depression and recurrent SRHI, independently. There has been a justifiable increased awareness of the potential effects of head injuries among healthy individuals. Our data suggest that head injuries can certainly be detrimental among PWE, and greater efforts should be made to recognize and formulate prevention strategies for SRHI. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Intracranial complications of preinjury anticoagulation in trauma patients with head injury.

    Science.gov (United States)

    Mina, Alfred A; Knipfer, John F; Park, David Y; Bair, Holly A; Howells, Greg A; Bendick, Phillip J

    2002-10-01

    We have evaluated our recent experience as a Level I trauma center to test the hypothesis that preinjury anticoagulation adversely affects the morbidity and mortality of trauma patients with an intracranial injury. Records of 380 patients admitted to the trauma service from January 1997 to December 1998 who at the time of admission were taking warfarin, low-molecular-weight heparin, aspirin, nonsteroidal anti-inflammatory drugs, clopidogrel, dipyridamole, pentoxifylline, or naproxen were reviewed. Thirty-seven patients with intracranial injuries were identified and compared with a matched (age, gender, mechanism, and severity of injury) control group of 37 patients with similar head injury but not taking any anticoagulant randomly selected from the trauma registry for that same time period. The control and anticoagulated groups were comparable in terms of age, 75 +/- 8 versus 74 +/- 11 years (p = 0.655); gender, 22 men/15 women versus 21 men/16 women; mechanism of injury, 30 falls/7 motor vehicle crashes versus 30 falls/7 motor vehicle crashes; and length of hospital stay, 11 +/- 14 versus 10 +/- 11 days (p = 0.853). In the anticoagulated group, the mean Injury Severity Score was 17.0 +/- 7.8 and the mean Glasgow Coma Scale score was 11.8 +/- 4.0; these were not significantly different from the control group, which had a mean Injury Severity Score of 19.8 +/- 8.1 (p = 0.143) and a Glasgow Coma Scale score of 12.5 +/- 2.6 (p = 0.378). There were 14 deaths (38%) in the anticoagulation group, versus 3 deaths in the control group (8%) (p = 0.006). In the anticoagulation group, 4 of 12 patients (33%) taking warfarin died, whereas 9 of 19 patients (47%) taking aspirin died (p = 0.285). All deaths were secondary to head injuries; all deaths in the control group and all but one in the anticoagulated group were the result of a fall; 6 of 10 anticoagulated patients who fell on stairs died, and 5 of these were taking aspirin only. These data indicate that the trauma patient

  14. Increased gut absorptive capacity in rats with severe head injury after feeding with probiotics.

    Science.gov (United States)

    Yu, Xiao-Yan; Yin, Hua-Hua; Zhu, Jing-Ci

    2011-01-01

    The absorptive capacity of the gut is decreased after severe head injury (SHI), and this may be related to poor recovery. Probiotics may be a promising approach to improving gut absorption. The aim of this study was to investigate the effect of probiotics on gut absorptive capacity (GAC) after SHI. A rat model in which SHI was induced by air percussion was used. One hundred fourteen Sprague-Dawley rats were randomized into three groups: SHI followed by standard enteral nutrition (group A); SHI followed by standard enteral nutrition plus probiotics (group B); and standard chow diet ad libitum (group C, sham-operated). The enteral diets were infused for 14 d after SHI. SHI induced weight loss and decreased the serum concentration of D-xylose and the apparent protein digestibility. Probiotics significantly improved GAC after SHI. Apparent protein digestibility and the concentration of D-xylose were lower in group A than in B or C after 14 d. The rats receiving probiotics showed less weight loss than group A. SHI induced intestinal flora dysfunction and a decrease in villus height and surface area. Digestive enzyme activities and gut motion were also depressed significantly, and these changes were closely related to the decrease in GAC. Probiotics increased villus height and surface area; Escherichia coli counts decreased significantly, and anaerobic counts increased. Probiotics improve the GAC after SHI, perhaps because of enhanced villus surface area, and correction of intestinal flora dysfunction. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. An assessment of the potential for neck injury due to padding of aircraft interior walls for head impact protection.

    Science.gov (United States)

    1993-08-01

    This report describes a short test program to assess the potential for neck injury induced by placing padding on the interior walls of an aircraft cabin to reduce the possibility of a head injury during a crash. Such padding is a possible mechanism o...

  16. Value of repeat head computed tomography after traumatic brain injury: systematic review and meta-analysis.

    Science.gov (United States)

    Reljic, Tea; Mahony, Helen; Djulbegovic, Benjamin; Etchason, Jeff; Paxton, Hannah; Flores, Michelle; Kumar, Ambuj

    2014-01-01

    Diagnosis and management of traumatic brain injury (TBI) is crucial to improve patient outcomes. While initial head computed tomography (CT) scan is the optimum tool for quick and accurate detection of intracranial hemorrhage, the guidelines on use of repeat CT differ among institutions. Three systematic reviews have been conducted on a similar topic; none have performed a comprehensive meta-analysis of all studies. Search of Medline, the Cochrane Library database, and Clinicaltrials.gov , and a hand search of conference abstracts and references for all completed studies reporting data on change in management following repeat CT was conducted. Two authors reviewed all studies and extracted data using a standardized form. A proportional meta-analysis was conducted using the random-effects model for outcomes related to any change in management following repeat CT. Any change in management included intracranial intervention, change in intracranial pressure monitoring, and/or administration of drug therapy. Search results yielded 6982 references. In all, 41 studies enrolling 10,501 patients were included. Change in management following repeat CT was reported in 13 prospective and 28 retrospective studies and yielded a pooled proportion of 11.4% (95% confidence interval [CI] 5.9-18.4) and 9.6% (95% CI 6.5-13.2), respectively. In a subgroup analysis of mild TBI patients (Glasgow Coma Scale score 13 to 15), five prospective and nine retrospective studies reported on change in management following repeat CT with the pooled proportion across prospective studies at 2.3% (95% CI 0.3-6.3) and across retrospective studies at 3.9% (95% CI 2.3-5.7), respectively. The evidence suggests that repeat CT in patients with TBI results in a change in management for only a minority of patients. Better designed studies are needed to address the issue of the value of repeat CT in the management of TBI.

  17. Online correlation of spontaneous arterial and intracranial pressure fluctuations in patients with diffuse severe head injury.

    Science.gov (United States)

    Reinert, Michael; Andres, Robert H; Fuhrer, Martin; Müller, Alexander; Schaller, Benoit; Widmer, HansRuedi

    2007-07-01

    Determination of relevant clinical monitoring parameters for helping guide the intensive care therapy in patients with severe head injury, is one of the most demanding issues in neurotrauma research. New insights into cerebral autoregulation and metabolism have revealed that a rigid cerebral perfusion pressure (CPP) regimen might not be suitable for all severe head injured patients. We thus developed an online analysis technique to monitor the correlation (AI rho) between the spontaneous fluctuations of the mean arterial blood pressure (MABP) and the intracranial pressure (ICP). In addition, brain tissue oxygen (PtiO2) and metabolic microdialysate measures including glucose and lactate were registered. We found that in patients with good outcome, the AI rho values were significantly lower as compared with patients with poor outcome. Accordingly, microdialysate glucose and lactate were significantly higher in the good outcome group. We conclude that online determination of AI rho offers a valuable additional and technically easily performable tool for guidance of therapy in patients with severe head injury.

  18. Histopathological examination of bone debris from reaming of interlocking intra-medullary nail fixation of long bone fractures with concomitant head injury.

    Science.gov (United States)

    Khallaf, Fathy G; Kehinde, Elijah O

    2015-12-01

    The aim of study was to test, for the presence of osteoblasts in the reaming debris of intramedullary nailing of femoral and tibial fracture in patients with and without severe head injury. Two groups of patients were studied. Group A (n = 32) had long bone fractures in addition to having head injuries. Group B (n = 35) had only long bone fractures. The fractures in the 2 groups of patients was treated by inter medullary nailing. Osteoblasts in the debris of the inter medullary nailing was compared between the 2 groups of patients. The results demonstrated that histopathological specimens from reaming debris of fractured femur and tibia in patients with head injury showed osteoblasts in (82.9%) and in (27.5%) of patients with isolated long bone fractures (p fractures and concomitant head injury confirm fast and adequate healing in these patients and the presence of plenty of osteoblasts in their reaming debris may reflect a proof of accelerated fracture healing environment.

  19. A clinicopathological study of lipomas of the head and neck ...

    African Journals Online (AJOL)

    Background: Lipoma of the head and neck region are fairly common. Methods: This twelve year retrospective study evaluated thirty-nine cases of head and neck lipomas in Nigerians. Results: They constituted 14.4% of benign tumours of the head and neck region and 17.6% of total body lipomas seen within the study ...

  20. Case report: lethal fetal head injury and placental abruption in a pregnant trauma patient.

    Science.gov (United States)

    Sadro, Claudia T; Zins, Andrea M; Debiec, Kate; Robinson, Jeffrey

    2012-04-01

    Fetal trauma in blunt abdominal trauma is uncommon, but traumatic fetal head injury is almost universally fatal to the fetus. Placental abruption is the most common injury to the gravid uterus in trauma, and when the mother survives, it is the most common cause of fetal death. The imaging diagnosis of these conditions may be difficult since there are only three cases reported in the literature of intrauterine skull fractures on plain films [3, 8, 10], ultrasound is in sensitive in the diagnosis of placental abruption [24], and the most sensitive test to diagnose placental abruption is external fetal monitoring with devices that measure uterine tone and contractility and fetal heart rate [23]. The diagnosis of fetal trauma and placental abruption may be made on contrast enhanced CT performed through the abdomen and pelvis of pregnant trauma patients. For these reasons, it is useful for the radiologist interpreting the CT scan to recognize fetal head injuries and placental abruption in pregnant trauma patients.Fig. 7 Axial scans through the bony pelvis demonstrate an unstable pelvic fracture with posterior pelvic ring disruption.There is a zone 2 fracture of the left sacrum and a fracture of the left obturator ring (arrowheads)

  1. Validation of a prognostic score for early mortality in severe head injury cases.

    Science.gov (United States)

    Gómez, Pedro A; de-la-Cruz, Javier; Lora, David; Jiménez-Roldán, Luis; Rodríguez-Boto, Gregorio; Sarabia, Rosario; Sahuquillo, Juan; Lastra, Roberto; Morera, Jesus; Lazo, Eglis; Dominguez, Jaime; Ibañez, Javier; Brell, Marta; de-la-Lama, Adolfo; Lobato, Ramiro D; Lagares, Alfonso

    2014-12-01

    Traumatic brain injury (TBI) represents a large health and economic burden. Because of the inability of previous randomized controlled trials (RCTs) on TBI to demonstrate the expected benefit of reducing unfavorable outcomes, the IMPACT (International Mission on Prognosis and Analysis of Clinical Trials in TBI) and CRASH (Corticosteroid Randomisation After Significant Head Injury) studies provided new methods for performing prognostic studies of TBI. This study aimed to develop and externally validate a prognostic model for early death (within 48 hours). The secondary aim was to identify patients who were more likely to succumb to an early death to limit their inclusion in RCTs and to improve the efficiency of RCTs. The derivation cohort was recruited at 1 center, Hospital 12 de Octubre, Madrid (1990-2003, 925 patients). The validation cohort was recruited in 2004-2006 from 7 study centers (374 patients). The eligible patients had suffered closed severe TBIs. The study outcome was early death (within 48 hours post-TBI). The predictors were selected using logistic regression modeling with bootstrapping techniques, and a penalized reduction was used. A risk score was developed based on the regression coefficients of the variables included in the final model. In the validation set, the final model showed a predictive ability of 50% (Nagelkerke R(2)), with an area under the receiver operating characteristic curve of 89% and an acceptable calibration (goodness-of-fit test, p = 0.32). The final model included 7 variables, and it was used to develop a risk score with a range from 0 to 20 points. Age provided 0, 1, 2, or 3 points depending on the age group; motor score provided 0 points, 2 (untestable), or 3 (no response); pupillary reactivity, 0, 2 (1 pupil reacted), or 6 (no pupil reacted); shock, 0 (no) or 2 (yes); subarachnoid hemorrhage, 0 or 1 (severe deposit); cisternal status, 0 or 3 (compressed/absent); and epidural hematoma, 0 (yes) or 2 (no). Based on the risk

  2. An Investigation of Head Accelerometry, Cognitive Function, and Brain Blood Flow During Intercollegiate Boxing and its Impact Regarding Head Injury Assessment In Combat

    Science.gov (United States)

    2010-09-06

    Brininger ,Teresa, Kryskow, Elizabeth 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) AND...ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER HQ USAFA/ADPH 2169 Fieldhouse Drive USAFA, CO 80840 USARIEM Natick, MA 01760 9...Injury, Head Acceleration, MBTI Diagnostics, Cognitive Testing, Brain Acoustic Monitoring, Boxing, Neuropsychology 16. SECURITY CLASSIFICATION OF

  3. The use of accident reconstruction for the analysis of traumatic brain injury due to head impacts arising from falls.

    Science.gov (United States)

    Doorly, M C; Gilchrist, M D

    2006-12-01

    Brain injury is the leading cause of death in those aged under 45 years in both Europe and the USA. The objective of this research is to reconstruct and analyse real world cases of accidental head injury, thereby providing accurate data, which can be used subsequently to develop clinical tolerance levels associated with particular traumatic injuries and brain lesions. This paper looks at using numerical modelling techniques, namely multibody body dynamics and finite element methods, to reconstruct two real-life accident cases arising from falls. Preliminary results show the levels of acceleration of the head and deformation of brain tissue correspond well to those found by other researchers, suggesting that this method is suitable for modeling head-injury accidents.

  4. Conduta frente à criança com trauma craniano Management of head injury in children

    Directory of Open Access Journals (Sweden)

    Alfredo Löhr Junior

    2002-08-01

    Full Text Available Objetivo: informar ao pediatra sobre uma visão atual do manejo do trauma craniano em crianças menores e maiores de 2 anos; facilitar a compreensão e permitir uma reflexão dos cuidados necessários ao atendimento da criança com traumatismo craniano. Fontes dos dados: revisão bibliográfica sobre o tema, utilizando-se como base de dados o Medline. Síntese dos dados: foram analisados os aspectos gerais epidemiológicos, o conceito e a fisiopatologia do dano cerebral traumático. Discute-se a avaliação da gravidade do traumatismo cranioencefálico nas diferentes faixas etárias, com a opinião de diferentes autores e com o posicionamento atual sobre os critérios de internamento, solicitação de exames complementares e abordagem terapêutica. Discute-se, ainda, o valor dos exames de neuroimagem no trauma craniano, e, por fim, as estratégias de prevenção e conclusões. Conclusões: a maioria dos casos de traumas cranianos em crianças são classificados como de natureza leve. Não obstante, mesmo sendo considerados da forma leve, em se tratando da população pediátrica, a apresentação clínica muitas vezes é assintomática, e com alterações de neuroimagem, fazendo com que o manejo nessa faixa etária seja diferenciado do trauma craniano em adultos.Objective: to make pediatricians aware of ideas about how to handle head injury in children under and over 2 years of age, to facilitate understanding and to allow a rethinking about the necessary care when attending children with head injury. Sources: a bibliographic review of the theme based on Medline. Summary of the findings: the following aspects were analyzed: the overall epidemiological aspects, the concept and the physiopathology of the damage caused by brain trauma. The assessment of the severity of head injury for different age ranges was discussed, as well as the opinion of various authors and the current ideas about the criteria regarding hospitalization, request for

  5. Expression of S100A6 in Rat Hippocampus after Traumatic Brain Injury Due to Lateral Head Acceleration

    Directory of Open Access Journals (Sweden)

    Bo Fang

    2014-04-01

    Full Text Available In a rat model of traumatic brain injury (TBI, we investigated changes in cognitive function and S100A6 expression in the hippocampus. TBI-associated changes in this protein have not previously been reported. Rat S100A6 was studied via immunohistochemical staining, Western blot, and reverse transcription-polymerase chain reaction (RT-PCR after either lateral head acceleration or sham. Reduced levels of S100A6 protein and mRNA were observed 1 h after TBI, followed by gradual increases over 6, 12, 24, and 72 h, and then a return to sham level at 14 day. Morris water maze (MWM test was used to evaluate animal spatial cognition. TBI- and sham-rats showed an apparent learning curve, expressed as escape latency. Although TBI-rats displayed a relatively poorer cognitive ability than sham-rats, the disparity was not significant early post-injury. Marked cognitive deficits in TBI-rats were observed at 72 h post-injury compared with sham animals. TBI-rats showed decreased times in platform crossing in the daily MWM test; the performance at 72 h post-injury was the worst. In conclusion, a reduction in S100A6 may be one of the early events that lead to secondary cognitive decline after TBI, and its subsequent elevation is tightly linked with cognitive improvement. S100A6 may play important roles in neuronal degeneration and regeneration in TBI.

  6. Evoked potentials and head injury. 1. Rating of evoked potential abnormality.

    Science.gov (United States)

    Rappaport, M; Hall, K; Hopkins, H K; Belleza, T

    1981-10-01

    This paper describes a method for rating the degree of abnormality of auditory, visual and somatosensory evoked potential patterns in head injury (HI) patients. Criteria for judging degree of EP abnormality are presented that allow assessment of the extent and severity of subcortical and cortical dysfunction associated with traumatic brain damage. Interrater reliability data based upon blind ratings of normal and HI patients are presented and shown to be highly significant. Tables of normative values of peak latencies and amplitudes are given and illustrations of EP patterns of different degrees of abnormality are presented.

  7. Vestibular stimulation after head injury: effect on reaction times and motor speech parameters

    DEFF Research Database (Denmark)

    Engberg, A

    1989-01-01

    Earlier studies by other authors indicate that vestibular stimulation may improve attention and dysarthria in head injured patients. In the present study of five severely head injured patients and five controls, the effect of vestibular stimulation on reaction times (reflecting attention) and some...... motor speech parameters (reflecting dysarthria) was investigated. After eight weeks with regular stimulation, it was concluded that reaction time changes were individual and consistent for a given subject. Only occasionally were they shortened after stimulation. However, reaction time was lengthened...

  8. Rugby World Cup 2015: World Rugby injury surveillance study.

    Science.gov (United States)

    Fuller, Colin W; Taylor, Aileen; Kemp, Simon P T; Raftery, Martin

    2017-01-01

    To determine the incidence, severity and nature of injuries sustained during the Rugby World Cup (RWC) 2015 together with the inciting events leading to the injuries. A prospective, whole population study. 639 international rugby players representing 20 countries. The study protocol followed the definitions and procedures recommended in the consensus statement for epidemiological studies in rugby union; output measures included players' age (years), stature (cm), body mass (kg) and playing position, and the group-level incidence (injuries/1000 player-hours), mean and median severity (days-absence), location (%), type (%) and inciting event (%) for match and training injuries. Incidence of injury was 90.1 match injuries/1000 player-match-hours (backs: 100.4; forwards: 81.1) and 1.0 training injuries/1000 player-training-hours (backs: 0.9; forwards: 1.2). The mean severity of injuries was 29.8 days-absence (backs: 30.4; forwards: 29.1) during matches and 14.4 days-absence (backs: 6.3; forwards: 19.8) during training. During matches, head/face (22.0%), knee (16.2%), muscle-strain (23.1%) and ligament-sprain (23.1%) and, during training, lower limb (80.0%) and muscle-strain (60.0%) injuries were the most common locations and types of injury. Being-tackled (24.7%) was the most common inciting event for injury during matches and rugby-skills-contact activities (70.0%) the most common during training. While the incidence, nature and inciting events associated with match injuries at RWC 2015 were similar to those reported previously for RWCs 2007 and 2011, there were increasing trends in the mean severity and total days-absence through injury. 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/.

  9. Traumatic brain injuries in illustrated literature: experience from a series of over 700 head injuries in the Asterix comic books

    OpenAIRE

    Kamp, Marcel A; Slotty, Philipp; Sarikaya-Seiwert, Sevgi; Steiger, Hans-Jakob; Hänggi, Daniel

    2011-01-01

    Abstract Background The goal of the present study was to analyze the epidemiology and specific risk factors of traumatic brain injury (TBI) in the Asterix illustrated comic books. Among the illustrated literature, TBI is a predominating injury pattern. Methods A retrospective analysis of TBI in all 34 Asterix comic books was performed by examining the initial neurological status and signs of TBI. Clinical data were correlated to information regarding the trauma mech...

  10. Dual-wavelength laser speckle imaging for monitoring brain metabolic and hemodynamic response to closed head traumatic brain injury in mice

    Science.gov (United States)

    Kofman, Itamar; Abookasis, David

    2015-10-01

    The measurement of dynamic changes in brain hemodynamic and metabolism events following head trauma could be valuable for injury prognosis and for planning of optimal medical treatment. Specifically, variations in blood flow and oxygenation levels serve as important biomarkers of numerous pathophysiological processes. We employed the dual-wavelength laser speckle imaging (DW-LSI) technique for simultaneous monitoring of changes in brain hemodynamics and cerebral blood flow (CBF) at early stages of head trauma in a mouse model of intact head injury (n=10). For induction of head injury, we used a weight-drop device involving a metal mass (˜50 g) striking the mouse's head in a regulated manner from a height of ˜90 cm. In comparison to baseline measurements, noticeable dynamic variations were revealed immediately and up to 1 h postinjury, which indicate the severity of brain damage and highlight the ability of the DW-LSI arrangement to track brain pathophysiology induced by injury. To validate the monitoring of CBF by DW-LSI, measurements with laser Doppler flowmetry (LDF) were also performed (n=5), which confirmed reduction in CBF following injury. A secondary focus of the study was to investigate the effectiveness of hypertonic saline as a neuroprotective agent, inhibiting the development of complications after brain injury in a subgroup of injured mice (n=5), further demonstrating the ability of DW-LSI to monitor the effects upon brain dynamics of drug treatment. Overall, our findings further support the use of DW-LSI as a noninvasive, cost-effective tool to assess changes in hemodynamics under a variety of pathological conditions, suggesting its potential contribution to the biomedical field. To the best of our knowledge, this work is the first to make use of the DW-LSI modality in a small animal model to (1) investigate brain function during the critical first hour of closed head injury trauma, (2) correlate between injury parameters of LDF measurements, and (3

  11. Minor head injury in anticoagulated patients: a 6-year retrospective analysis in an emergency department

    Directory of Open Access Journals (Sweden)

    Alessandro Riccardi

    2014-05-01

    Full Text Available The appropriate management of minor head injury (MHI in patients receiving oral anticoagulant (OAC is unclear. In this retrospective study, we focused on elderly patients (>65 years treated with OAC, presented to our emergency department with MHI between 2004 and 2010. Three hundred and six patients with MHI were taking OAC: we documented 7.19% hemorrhages at the first computed tomography (C; 18.19% deaths; 50.1% spontaneous reabsorptions; 22.73% deteriorations of intracranial bleeding without surgical intervention (for clinical comorbidity, and 4.55% neurosurgical interventions. We documented a second positive CT scan in 2 patients (1.51% who had no symptoms and remained asymptomatic during observation. In both cases, intracranial bleeding resolved spontaneously. The mean international normalized ratio (INR value was 2.26, higher in the group of patients with bleeding (2.74 than in the group without bleeding (2.19. We found a significant increased risk in patients with posttraumatic loss of consciousness [odds ratio (OR 28.3], diffuse headache (OR 14.79, vomiting (OR 14.2 and neurological signs (OR 5.27. We did not reach significance in patients with post-traumatic amnesia. Our data confirm the need for a CT scan of any patients on OAC with MHI. None of our patients developed any symptoms or signs during observation, and only 2 patients developed an intracranial hemorrhage in the second CT scan with a favorable evolution. Our data need to be confirmed with an observational study, but we suggest that the second CT could be reserved for patients developing symptoms and signs during observation. We also underline the role of the INR in the stratification of risk.

  12. Emergency Department Triage of Traumatic Head Injury Using a Brain Electrical Activity Biomarker: A Multisite Prospective Observational Validation Trial.

    Science.gov (United States)

    Hanley, Daniel; Prichep, Leslie S; Bazarian, Jeffrey; Huff, J Stephen; Naunheim, Rosanne; Garrett, John; Jones, Elizabeth B; Wright, David W; O'Neill, John; Badjatia, Neeraj; Gandhi, Dheeraj; Curley, Kenneth C; Chiacchierini, Richard; O'Neil, Brian; Hack, Dallas C

    2017-05-01

    A brain electrical activity biomarker for identifying traumatic brain injury (TBI) in emergency department (ED) patients presenting with high Glasgow Coma Scale (GCS) after sustaining a head injury has shown promise for objective, rapid triage. The main objective of this study was to prospectively evaluate the efficacy of an automated classification algorithm to determine the likelihood of being computed tomography (CT) positive, in high-functioning TBI patients in the acute state. Adult patients admitted to the ED for evaluation within 72 hours of sustaining a closed head injury with GCS 12 to 15 were candidates for study. A total of 720 patients (18-85 years) meeting inclusion/exclusion criteria were enrolled in this observational, prospective validation trial, at 11 U.S. EDs. GCS was 15 in 97%, with the first and third quartiles being 15 (interquartile range = 0) in the study population at the time of the evaluation. Standard clinical evaluations were conducted and 5 to 10 minutes of electroencephalogram (EEG) was acquired from frontal and frontal-temporal scalp locations. Using an a priori derived EEG-based classification algorithm developed on an independent population and applied to this validation population prospectively, the likelihood of each subject being CT+ was determined, and performance metrics were computed relative to adjudicated CT findings. Sensitivity of the binary classifier (likely CT+ or CT-) was 92.3% (95% confidence interval [CI] = 87.8%-95.5%) for detection of any intracranial injury visible on CT (CT+), with specificity of 51.6% (95% CI = 48.1%-55.1%) and negative predictive value (NPV) of 96.0% (95% CI = 93.2%-97.9%). Using ternary classification (likely CT+, equivocal, likely CT-) demonstrated enhanced sensitivity to traumatic hematomas (≥1 mL of blood), 98.6% (95% CI = 92.6%-100.0%), and NPV of 98.2% (95% CI = 95.5%-99.5%). Using an EEG-based biomarker high accuracy of predicting the likelihood of being CT+ was obtained, with

  13. Comparison of Indiana High School Football Injury Rates by Inclusion of the USA Football "Heads Up Football" Player Safety Coach.

    Science.gov (United States)

    Kerr, Zachary Y; Dalton, Sara L; Roos, Karen G; Djoko, Aristarque; Phelps, Jennifer; Dompier, Thomas P

    2016-05-01

    In Indiana, high school football coaches are required to complete a coaching education course with material related to concussion awareness, equipment fitting, heat emergency preparedness, and proper technique. Some high schools have also opted to implement a player safety coach (PSC). The PSC, an integral component of USA Football's Heads Up Football (HUF) program, is a coach whose primary responsibility is to ensure that other coaches are implementing proper tackling and blocking techniques alongside other components of the HUF program. To compare injury rates in Indiana high school football teams by their usage of a PSC or online coaching education only. Cohort study; Level of evidence, 2. Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2015 high school football season. Players were drawn from 6 teams in Indiana. The PSC group, which used the PSC component, was comprised of 204 players from 3 teams. The "education only" group (EDU), which utilized coaching education only, was composed of 186 players from 3 teams. Injury rates and injury rate ratios (IRRs) were reported with 95% confidence intervals (CIs). During 25,938 athlete-exposures (AEs), a total of 149 injuries were reported, of which 54 (36.2%) and 95 (63.8%) originated from the PSC and EDU groups, respectively. The practice injury rate was lower in the PSC group than the EDU group (2.99 vs 4.83/1000 AEs; IRR, 0.62; 95% CI, 0.40-0.95). The game injury rate was also lower in the PSC group than the EDU group (11.37 vs 26.37/1000 AEs; IRR, 0.43; 95% CI, 0.25-0.74). When restricted to concussions only, the rate was lower in the PSC group (0.09 vs 0.73/1000 AEs; IRR, 0.12; 95% CI, 0.01-0.94), although only 1 concussion was reported in the PSC group. No differences were found in game concussion rates (0.60 vs 4.39/1000 AEs; IRR, 0.14; 95% CI, 0.02-1.11). Findings support the PSC as an effective method of injury mitigation in high school football. Future research

  14. Contributory fault and level of personal injury to drivers involved in head-on collisions: Application of copula-based bivariate ordinal models.

    Science.gov (United States)

    Wali, Behram; Khattak, Asad J; Xu, Jingjing

    2018-01-01

    The main objective of this study is to simultaneously investigate the degree of injury severity sustained by drivers involved in head-on collisions with respect to fault status designation. This is complicated to answer due to many issues, one of which is the potential presence of correlation between injury outcomes of drivers involved in the same head-on collision. To address this concern, we present seemingly unrelated bivariate ordered response models by analyzing the joint injury severity probability distribution of at-fault and not-at-fault drivers. Moreover, the assumption of bivariate normality of residuals and the linear form of stochastic dependence implied by such models may be unduly restrictive. To test this, Archimedean copula structures and normal mixture marginals are integrated into the joint estimation framework, which can characterize complex forms of stochastic dependencies and non-normality in residual terms. The models are estimated using 2013 Virginia police reported two-vehicle head-on collision data, where exactly one driver is at-fault. The results suggest that both at-fault and not-at-fault drivers sustained serious/fatal injuries in 8% of crashes, whereas, in 4% of the cases, the not-at-fault driver sustained a serious/fatal injury with no injury to the at-fault driver at all. Furthermore, if the at-fault driver is fatigued, apparently asleep, or has been drinking the not-at-fault driver is more likely to sustain a severe/fatal injury, controlling for other factors and potential correlations between the injury outcomes. While not-at-fault vehicle speed affects injury severity of at-fault driver, the effect is smaller than the effect of at-fault vehicle speed on at-fault injury outcome. Contrarily, and importantly, the effect of at-fault vehicle speed on injury severity of not-at-fault driver is almost equal to the effect of not-at-fault vehicle speed on injury outcome of not-at-fault driver. Compared to traditional ordered probability

  15. Survivors of self-inflicted gunshot wounds to the head: characterization of ocular injuries and health care costs.

    Science.gov (United States)

    Reddy, Amit K; Baker, Meredith S; Sobel, Rachel K; Whelan, David A; Carter, Keith D; Allen, Richard C

    2014-06-01

    Suicides and attempted suicides are major public health issues in the United States and around the world. Self-inflicted gunshot wounds (SIGSWs) are a common method of attempting suicide, the head being the most commonly injured body region; however, the literature lacks an overview of the orbital and ocular injuries as well as outcomes associated with SIGSWs. To characterize the ocular and orbital injuries and outcomes of patients presenting with SIGSWs and to examine the cost associated with these injuries. Retrospective medical record review was performed of all patients who presented to the University of Iowa Hospitals and Clinics between 2003 to 2013 with the admitting diagnosis of self-inflicted injuries via firearms. Patients with no periorbital or ocular injuries and/or those who did not survive for at least 2 months following the incident were excluded. Ocular injuries and outcomes and health care costs and reimbursements, which were generated by a financial report obtained from the hospital finance department that included data from both the hospital billing and cost accounting systems. All patients in this study (n = 18) were men with a mean age of 47.2 years. Eight patients (44.4%) displayed submental missile entry points, 7 (38.9%) displayed intraoral entry points, and 3 (16.7%) displayed pericranial entry points. Patients with pericranial entries sustained more severe ocular injuries and had poorer ocular outcomes. Seven patients (38.9%) were found at final follow-up to have visual acuity of 20/40 or better in each eye and all showed missile trajectories in the sagittal plane. The mean cost of treatment of these patients totaled $117,338 while the mean reimbursement amount was $124,388. Data regarding ocular injuries and outcomes may assist ophthalmologists in the treatment of patients with SIGSWs in the future. Many patients had extremely functional vision at final follow-ups, which highlights the importance of specialists conducting examinations

  16. Injuries at a Canadian National Taekwondo Championships: a prospective study

    Directory of Open Access Journals (Sweden)

    Pieter Willy

    2004-07-01

    Full Text Available Abstract Background The purpose of this prospective study was to assess the injury rates in male and female adult Canadian Taekwondo athletes relative to total number of injuries, type and body part injured. Methods Subjects (219 males, 99 females participated in the 1997 Canadian National Taekwondo Championships in Toronto, Canada. Injuries were recorded on an injury form to documents any injury seen and treatment provided by the health care team. These data were later used for this study. The injury form describes the athlete and nature, site, severity and mechanism of the injury. Results The overall rate of injuries was 62.9/1,000 athlete-exposures (A-E. The males (79.9/1,000 A-E sustained significantly more injuries than the females (25.3/1,000 A-E. The lower extremities were the most commonly injured body region in the men (32.0 /1,000 A-E, followed by the head and neck (18.3/1,000 A-E. Injuries to the spine (neck, upper back, low back and coccyx were the third most often injured body region in males (13.8/1,000 A-E. All injuries to the women were sustained to the lower extremities. The most common type of injury in women was the contusion (15.2/1,000 A-E. However, men's most common type of injury was the sprain (22.8/1,000 A-E followed by joint dysfunction (13.7/1,000A-E. Concussions were only reported in males (6.9/1,000 A-E. Compared to international counterparts, the Canadian men and women recorded lower total injury rates. However, the males incurred more cerebral concussions than their American colleagues (4.7/1,000 A-E. Conclusions Similar to what was found in previous studies, the current investigation seems to suggest that areas of particular concern for preventive measures involve the head and neck as well as the lower extremities. This is the first paper to identify spinal joint dysfunction.

  17. A retrospective review over 1999 to 2007 of head, shoulder and knee soft tissue and fracture dislocation injuries and associated costs for rugby league in New Zealand.

    Science.gov (United States)

    King, D; Hume, P; Gianotti, S; Clark, T

    2011-04-01

    King et al. reported that of 5 941 moderate to serious claims resulting in medical treatment for rugby league injuries, the knee, shoulder, and head and neck body sites and soft tissue and fracture-dislocation injuries were most frequent and costly in the New Zealand national no-fault injury compensation corporation database during 1999 to 2007. However, additional analyses of knee, shoulder and head and neck body sites by soft tissue and fracture-dislocation injury types was required to enable a greater understanding of the nature of injuries most likely to be seen by sports medical personnel dealing with rugby league players. From 1999 to 2007 the injury claims and costs for head and neck soft tissue, fracture-dislocations, shoulders soft tissue significantly increased. Knee soft tissue injury claims and costs significantly decreased from 1999 to 2007. There was no significant difference in knee fracture-dislocation injury claims but there was a significant increase in knee fracture-dislocation injury costs from 1999 to 2007. Changes in the nature of injuries may be related to changes in defensive techniques employed in rugby league during this time. Sports medical personnel dealing with rugby league players should focus their injury prevention strategies on reducing musculoskeletal injuries to the head and shoulder. There should be a focus on increasing awareness of correct tackling technique, head injury awareness and management of suspected cervical spine injuries. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Diffuse Axonal Injury-A Distinct Clinicopathological Entity in Closed Head Injuries.

    Science.gov (United States)

    Davceva, Natasha; Basheska, Neli; Balazic, Joze

    2015-09-01

    The knowledge about the diffuse axonal injury (DAI) as a clinicopathological entity has matured in the last 30 years. It has been defined clinically (immediate and prolonged unconsciousness leading to death or severe disability) and pathologically (the triad of DAI specific changes). In terms of its biomechanics, DAI is occurring as a result of acceleration forces of longer duration and has been fully reproduced experimentally.In the process of diagnosing DAI, the performance of a complete forensic neuropathological examination is essential and the immunohistochemistry method using antibodies against β-amyloid precursor protein (β-APP) has been proved to be highly sensitive and specific, selectively targeting the damaged axons.In this review, we are pointing to the significant characteristics of DAI as a distinct clinicopathological entity that can cause severe impairment of the brain function, and in the forensic medicine setting, it can be found as the concrete cause of death. We are discussing not only its pathological feature, its mechanism of occurrence, and the events on a cellular level but also the dilemmas about DAI that still exist in science: (1) regarding the strict criteria for its diagnosis and (2) regarding its biomechanical significance, which can be of a big medicolegal importance.

  19. Neuroprotective effects of tetracyclines on blunt head trauma: An experimental study on rats

    Directory of Open Access Journals (Sweden)

    Ozhan Merzuk Uckun

    2015-01-01

    Full Text Available Background: Prevention of primary damage caused by head trauma may be avoided with protective measures and techniques which is a public health concern. Experimental and clinical studies about treatment of head trauma were all centered to prevent secondary damage caused by physiopathological changes following primary injury. Neuroprotective features of tetracyclines were the focus of several experimental studies in the last decade. In the present study we aimed to investigate the neuroprotective effects of tetracycline in an experimental model of blunt brain injury in rats. Materials and Methods: 32 male Sprague-Dawley rats were divided into four experimental groups (n = 8. Head trauma was not performed in control group (group 1, craniectomy only. In the second group, head trauma and craniectomy were performed. Intraperitoneal saline was used in addition to trauma and craniectomy for treatment in group 3 whereas intraperitoneal tetracycline and saline were used for treatment in group 4. Results: When histological examinations performed by transmission electron microscopy were evaluated, injury at ultrastructural level was demonstrated to be less pronounced in tetracycline group with decreased lipid peroxidation levels. Conclusion: In accordance with these findings, we conclude that systemic tetracycline administration is effective in reduction of secondary brain damage and brain edema and thus it may be considered as a therapeutic option.

  20. Dislocation of the fibular head in an unusual sports injury: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Riaz

    2008-05-01

    Full Text Available Abstract Introduction One of the primary functions of the proximal tibiofibular joint is slight rotation to accommodate rotational stress at the ankle. Proximal tibiofibular joint dislocation is a rare injury and accounts for less than 1% of all knee injuries. This dislocation has been reported in patients who had been engaged in football, ballet dancing, equestrian jumping, parachuting and snowboarding. Case presentation A 20-year-old man was injured whilst playing football. He felt a pop in the right knee and was subsequently unable to bear weight on it. The range of movement in his knee joint was limited. Anterior-posterior and lateral X-rays of the knee revealed anterolateral dislocation of the proximal tibiofibular joint. Comparison views confirmed the anterolateral dislocation. He had a failed manipulation under anaesthesia and the joint needed an open reduction in which the fibular head was levered back into place. Operative findings revealed a horizontal type of joint. Conclusion An exceedingly rare dislocation of a horizontal type of proximal tibiofibular joint was presented following a football injury. This dislocation was irreducible by a closed method.

  1. 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.

  2. Posttraumatic Cerebellar Infarction after Repeated Sport-related Minor Head Injuries in a Young Adult: A Case Report

    Science.gov (United States)

    MATSUMOTO, Hiroaki; YOSHIDA, Yasuhisa

    2015-01-01

    A healthy 23-year-old man suffered helmet-to-helmet collisions with an opponent during American football game twice within 3 days. He then experienced continuous vomiting and dizziness. Magnetic resonance imaging revealed acute infarction in the right cerebellar hemisphere, and magnetic resonance angiography revealed transient stenosis of the right superior cerebellar artery. Although minor head injury is not usually accompanied by complications, posttraumatic ischemic stroke has been reported on rare occasions. We report a case of cerebellar infarction after repeated sports-related minor head injuries in a young adult and discuss the etiology. PMID:25746313

  3. Unintentional Injuries and Violence among Adults in Northern Jordan: A Hospital-Based Retrospective Study

    Science.gov (United States)

    Alzghoul, Manal M.; Shakhatreh, Mohammed K.; Al-sheyab, Nihaya

    2017-01-01

    Injuries (unintentional and intentional) are the main cause of death and disability worldwide, including Jordan. The main purpose of this hospital-based retrospective study was to identify characteristics, causes, and risk factors of unintentional injuries and violence among all adult patients who approached the Accidents and Emergency department because of injury in Northern Jordan. Data were collected retrospectively from four major hospitals from January 2008 to January 2013. A total of 2425 Jordanian individuals who accessed and were treated by the four hospitals were included in this study. The findings show that the majority of patients who approached the Accidents and Emergency departments in the four hospitals were males (n = 2044, 87.16%) versus females (n = 301, 12.8%). Violence was the most common reason of injury (70.66%), followed by road traffic crashes (23.21%). The most common anatomical locations of reported injuries were the head (38.74%), followed by abdomen/pelvis and lower back, among males and females (9.93%). Violence had a high significant effect on the site of injuries. Patients who had been injured to the head because of a stab wound or fighting were substantially over-involved in head injuries, with injury rates 3.88 and 7.51 times higher than those who had been injured to the head due to gunshot, respectively. Even patients who had been injured to the head because of assault show much higher involvement in injury risk than non-assault patients (Odds Ratio = 8.46). These findings highlight the need for a large national study to confirm the findings. It also draws attention to the importance of public awareness and to special injury prevention programs that not only focus on saving lives and lessening the number of injuries, illnesses, and fatalities, but also to limit the social and economic burden of injury among adults in Northern Jordan. PMID:28338614

  4. Mild closed head traumatic brain injury-induced changes in monoamine neurotransmitters in the trigeminal subnuclei of a rat model: mechanisms underlying orofacial allodynias and headache

    Directory of Open Access Journals (Sweden)

    Golam Mustafa

    2017-01-01

    Full Text Available Our recent findings have demonstrated that rodent models of closed head traumatic brain injury exhibit comprehensive evidence of progressive and enduring orofacial allodynias, a hypersensitive pain response induced by non-painful stimulation. These allodynias, tested using thermal hyperalgesia, correlated with changes in several known pain signaling receptors and molecules along the trigeminal pain pathway, especially in the trigeminal nucleus caudalis. This study focused to extend our previous work to investigate the changes in monoamine neurotransmitter immunoreactivity changes in spinal trigeminal nucleus oralis, pars interpolaris and nucleus tractus solitaries following mild to moderate closed head traumatic brain injury, which are related to tactile allodynia, touch-pressure sensitivity, and visceral pain. Our results exhibited significant alterations in the excitatory monoamine, serotonin, in spinal trigeminal nucleus oralis and pars interpolaris which usually modulate tactile and mechanical sensitivity in addition to the thermal sensitivity. Moreover, we also detected a robust alteration in the expression of serotonin, and inhibitory molecule norepinephrine in the nucleus tractus solitaries, which might indicate the possibility of an alteration in visceral pain, and existence of other morbidities related to solitary nucleus dysfunction in this rodent model of mild to moderate closed head traumatic brain injury. Collectively, widespread changes in monoamine neurotransmitter may be related to orofacial allodynhias and headache after traumatic brain injury.

  5. The epidemiology of sports-related injuries in older adults: a central European epidemiologic study.

    Science.gov (United States)

    Kammerlander, Christian; Braito, Matthias; Kates, Stephen; Jeske, Christian; Roth, Tobias; Blauth, Michael; Dallapozza, Christian

    2012-10-01

    The population is rapidly aging and remaining more active over the age of 65. An increasing number of sports related injuries in individuals 65 and older are thus anticipated. The aim of this study is to analyze the epidemiology of sports injuries in the age group aged 65 and older. Data from the medical records of adults aged 65 years and older who were treated for sports-related injuries at a level one trauma center between December 1994 and February 2008 was collected and statistically analyzed. A total of 2635 patients met our inclusion criteria. There were 1647 men (62.5%) and 988 women (37.5%) with a mean age of 70.9 years. The yearly number of injuries doubled during the study period (1996-2007). The most common mechanism of injury was a simple fall from standing height (69%). Nearly 75% of all injuries occurred during alpine skiing, cycling or mountain climbing. The median Injury Severity Score was 4. Minor injuries and wounds (40%) were recorded most commonly followed by fractures (27%), sprains, ligament injuries (19%) and injuries of muscles and tendons (6%). The most frequent diagnoses were minor injuries to the head and ligament injuries around the knee joint. Injuries to the upper extremities occurred in 33.7%, injuries to the lower extremities in 29.4% and injuries to the head occurred in 20% of the patients. Women sustained substantially more fractures than men. Adults aged 65 and older are remaining active in sports, which results in higher numbers of sports related injuries in this age group. Identification of type, mechanism and distribution of the injuries can help with the recognition of risk factors for injury. This may enable us to develop appropriate preventative measures to reduce the incidence, and morbidity of such injuries.

  6. Incidence of hospital referred head injuries in Norway: a population based survey from the Stavanger region

    DEFF Research Database (Denmark)

    Heskestad, Ben; Baardsen, Roald; Helseth, Eirik

    2009-01-01

    it with previous Norwegian studies. METHODS: All head injured patients referred to Stavanger University Hospital during a one-year period (2003) were registered in a partly prospective and partly retrospective study. The catchment area for the hospital is strictly defined to a local population of 283...

  7. Famous head injuries of the first aerial war: deaths of the "Knights of the Air".

    Science.gov (United States)

    Koul, Prateeka; Mau, Christine; Sabourin, Victor M; Gandhi, Chirag D; Prestigiacomo, Charles J

    2015-07-01

    World War I advanced the development of aviation from the concept of flight to the use of aircraft on the battlefield. Fighter planes advanced technologically as the war progressed. Fighter pilot aces Francesco Baracca and Manfred von Richthofen (the Red Baron) were two of the most famous pilots of this time period. These courageous fighter aces skillfully maneuvered their SPAD and Albatros planes, respectively, while battling enemies and scoring aerial victories that contributed to the course of the war. The media thrilled the public with their depictions of the heroic feats of fighter pilots such as Baracca and the Red Baron. Despite their aerial prowess, both pilots would eventually be shot down in combat. Although the accounts of their deaths are debated, it is undeniable that both were victims of traumatic head injury.

  8. Age and the risk of All-Terrain Vehicle-related injuries in children and adolescents: a cross sectional study.

    Science.gov (United States)

    McLean, Lianne; Russell, Kelly; McFaull, Steven; Warda, Lynne; Tenenbein, Milton; McGavock, Jonathan

    2017-03-17

    The study was designed to determine if youth injuries related to all-terrain vehicle (ATV) use compared to older adolescents and adults. We performed cross sectional study of children and adults presenting to pediatric and adult emergency departments between 1990 and 2009 in Canada. The primary exposure variable was age injuries than females and passengers. Helmet use was associated with significant protection from head injuries (aOR: 0.59; 95% CI: 0.44-0.78). Youth under 16 years are at an increased risk of head injuries and fractures. For youth and adults presenting to emergency departments with an ATV-related injury, moderate to serious injuries associated with ATV use are more common among drivers and males. Helmet use protected against head injuries, suggesting minimum age limits for ATV use and helmet use are warranted.

  9. Head Start Impact Study. Final Report. Executive Summary

    Science.gov (United States)

    Puma, Michael; Bell, Stephen; Cook, Ronna; Heid, Camilla; Shapiro, Gary; Broene, Pam; Jenkins, Frank; Fletcher, Philip; Quinn, Liz; Friedman, Janet; Ciarico, Janet; Rohacek, Monica; Adams, Gina; Spier, Elizabeth

    2010-01-01

    This report summarizes the findings from a study on the impacts of Head Start on children and families during the children's preschool, kindergarten, and 1st grade years. Its study goals were to: (1) Determine the impact of Head Start on children's school readiness, and on parental practices that support children's development; and to (2)…

  10. Indices of slowness of information processing in head injury patients : Tests for selective attention related to ERP latencies

    NARCIS (Netherlands)

    Spikman, Jacoba M.; Naalt, van der Joukje; Weerden , van Tiemen; Zomeren , van Adriaan H.

    2004-01-01

    We explored the relation between neuropsychological (attention tests involving time constraints) and neurophysiological (N2 and P3 event-related potential (ERP) latencies) indices of slowness of information processing after closed head injury (CHI). A group of 44 CHI patients performed worse than

  11. Head injury resulting from scooter accidents in Rome: Differences before and after implementing a universal helmet law

    NARCIS (Netherlands)

    G. La Torre (Giuseppe); E.F. van Beeck (Ed); G. Bertazzoni (Giuliano); W. Ricciardi

    2007-01-01

    textabstractObjectives: To estimate the incidence rates and related determinants of head injuries before and after the implementation of a new universal helmet law in Italy. Methods: The investigation took place in the Emergency Room of the Accident and Emergency Department, Teaching Hospital

  12. 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.

  13. SPARED RECOGNITION CAPACITY IN ELDERLY AND CLOSED-HEAD-INJURY SUBJECTS WITH CLINICAL MEMORY DEFICITS

    NARCIS (Netherlands)

    Spikman, J.M.; Berg, I.J.; Deelman, B.G.

    This study describes the performance of three groups of subjects on a pictorial forced-recognition task, the Hundred Pictures Test. The aim was to determine whether subjects with memory deficits (elderly and closed-head-injured subjects) would perform as well as healthy young subjects, both on

  14. The contribution of alcohol to fatal traumatic head injuries in the forensic setting.

    LENUS (Irish Health Repository)

    Cryan, J

    2010-11-01

    Excessive drinking increases the risk of dying unnaturally. In the Republic of Ireland such deaths are referred to the State Pathologist. Blood alcohol concentration (BAC) is routinely measured. We created a database of cases presenting to the State Pathologist over a nine year period (2000-2008 inclusive) to evaluate the relationship between alcohol and fatal traumatic brain injuries (FTBI). Of a total of 1778 cases, 332 (275 Male [M]; 57 Female [F]) died of head injuries. Fatalities were highest in males aged 36-50 (N = 97) and 26-35 (N = 73). Assaults (N = 147), falls (N = 95), road traffic accidents (RTA) (N = 50) and suicide (N = 15) were the commonest modes of presentation. A positive blood alcohol concentration (BAC) was found in 36% of assaults, 41% of falls and 40% of suicides. In the RTA group BAC was positive in 59% of pedestrians, 33% of drivers and 14% of passengers. Alcohol clearly plays a significant role in FTBI in the forensic setting.

  15. 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 ... Ocular cranial nerve injury (involving the facial, ... The variation in the. 7. 8 figures observed in the studies could be accounted for by factors such as type of study, sample size and type of hospital. While this study examined 26 consecutively seen.

  16. Intractable epilepsy and craniocerebral trauma: analysis of 163 patients with blunt and penetrating head injuries sustained in war.

    Science.gov (United States)

    Kazemi, Hadi; Hashemi-Fesharaki, Sohrab; Razaghi, Soodeh; Najafi, Masomeh; Kolivand, Peir Hossein; Kovac, Stjepana; Gorji, Ali

    2012-12-01

    Post-traumatic epileptic seizure is a common complication of brain trauma including military injuries. We present clinical characteristics and correlates of post-traumatic epilepsy in 163 head-injured veterans suffering from intractable epilepsy due to blunt or penetrating head injuries sustained during the Iraq-Iran war. The medical records of 163 war veterans who were admitted by the Epilepsy Department of the Shefa Neuroscience Center between 2005 and 2009 were retrospectively reviewed. The mean follow-up period after developing epilepsy was 17.2 years. The time interval between the trauma and the first seizure was shorter and the seizure frequency was higher in epileptic patients suffering from penetrating head trauma. There was no difference in seizure type between epileptic patients traumatised by blunt or penetrating injury. Patients with seizure frequency of more than 30 per month mostly had simple partial seizure. Frontal and parietal semiologies were observed more frequently in patients with penetrating trauma, whereas patients with blunt trauma showed a higher temporal semiology. The most common brain lesion observed by CT scan was encephalomalacia followed by porencephaly and focal atrophy. There was no association between intracerebral retained fragments and different characteristic features of epilepsy. Patients with military brain injury carry a high risk of intractable post-traumatic epilepsy decades after their injury, and thus require a long-term medical follow-up. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Alterations of functional properties of hippocampal networks following repetitive closed-head injury.

    Science.gov (United States)

    Logue, Omar C; Cramer, Nathan P; Xu, Xiufen; Perl, Daniel P; Galdzicki, Zygmunt

    2016-03-01

    Traumatic brain injury (TBI) is the leading cause of death for persons under the age of 45. Military service members who have served on multiple combat deployments and contact-sport athletes are at particular risk of sustaining repetitive TBI (rTBI). Cognitive and behavioral deficits resulting from rTBI are well documented. Optimal associative LTP, occurring in the CA1 hippocampal Schaffer collateral pathway, is required for both memory formation and retrieval. Surprisingly, ipsilateral Schaffer collateral CA1 LTP evoked by 100 Hz tetanus was enhanced in mice from the 3× closed head injury (3× CHI) treatment group in comparison to LTP in contralateral or 3× Sham CA1 area, and in spite of reduced freezing during contextual fear conditioning at one week following 3× CHI. Electrophysiological activity of CA1 neurons was evaluated with whole-cell patch-clamp recordings. 3× CHI ipsilateral CA1 neurons exhibited significant increases in action potential amplitude and maximum rise and decay slope while the action potential duration was decreased. Recordings of CA1 neuron postsynaptic currents were conducted to detect spontaneous excitatory and inhibitory postsynaptic currents (sEPSCs/sIPSCs) and respective miniature currents (mEPSCs and mIPSCs). In the 3× CHI mice, sEPSCs and sIPSCs in ipsilateral CA1 neurons had an increased frequency of events but decreased amplitudes. In addition, 3× CHI altered the action potential-independent miniature postsynaptic currents. The mEPSCs of ipsilateral CA1 neurons exhibited both an increased frequency of events and larger amplitudes. Moreover, the effect of 3× CHI on mIPSCs was opposite to that of the sIPSCs. Specifically, the frequency of the mIPSCs was decreased while the amplitudes were increased. These results are consistent with a mechanism in which repetitive closed-head injury affects CA1 hippocampal function by promoting a remodeling of excitatory and inhibitory synaptic inputs leading to impairment in hippocampal

  18. Lateral impact injuries with side airbag deployments--a descriptive study.

    Science.gov (United States)

    Yoganandan, Narayan; Pintar, Frank A; Zhang, Jiangyue; Gennarelli, Thomas A

    2007-01-01

    The present study was designed to provide descriptive data on side impact injuries in vehicles equipped with side airbags using the United States National Automotive Sampling System (NASS). The database was queried with the constraint that all vehicles must adhere to the Federal Motor Vehicle Safety Standards FMVSS 214, injured occupants be in the front outboard seats with no rollovers or ejections, and side impacts airbags be deployed in lateral crashes. Out of the 7812 crashes in the 1997-2004 weighted NASS files, AIS > or = 2 level injuries occurred to 5071 occupants. There were 3828 cases of torso-only airbags, 955 cases of torso-head bag combination, and 288 inflatable tubular structure/curtain systems. Side airbags were not attributed to be the cause of head or chest injury to any occupant at this level of severity. The predominance of torso-only airbags followed by torso-head airbag combination reflected vehicle model years and changing technology. Head and chest injuries were coupled for the vast majority of occupants with injuries to more than one body region. Comparing literature data for side impacts without side airbag deployments, the presence of a side airbag decreased AIS=2 head, chest, and extremity injuries when examining raw data incidence rates. Although this is the first study to adopt strict inclusion-exclusion criteria for side crashes with side airbag deployments, future studies are needed to assess side airbag efficacy using datasets such as matched-pair occupants in side impacts.

  19. Lateral impact injuries with side airbag deployments—A descriptive study

    Science.gov (United States)

    Yoganandan, Narayan; Pintar, Frank A.; Zhang, Jiangyue; Gennarelli, Thomas A.

    2006-01-01

    The present study was designed to provide descriptive data on side impact injuries in vehicles equipped with side airbags using the United States National Automotive Sampling System (NASS). The database was queried with the constraint that all vehicles must adhere to the Federal Motor Vehicle Safety Standards FMVSS 214, injured occupants be in the front outboard seats with no rollovers or ejections, and side impacts airbags be deployed in lateral crashes. Out of the 7812 crashes in the 1997–2004 weighted NASS files, AIS ≥ 2 level injuries occurred to 5071 occupants. There were 3828 cases of torso-only airbags, 955 cases of torso–head bag combination, and 288 inflatable tubular structure/curtain systems. Side airbags were not attributed to be the cause of head or chest injury to any occupant at this level of severity. The predominance of torso-only airbags followed by torso–head airbag combination reflected vehicle model years and changing technology. Head and chest injuries were coupled for the vast majority of occupants with injuries to more than one body region. Comparing literature data for side impacts without side airbag deployments, the presence of a side airbag decreased AIS = 2 head, chest, and extremity injuries when examining raw data incidence rates. Although this is the first study to adopt strict inclusion–exclusion criteria for side crashes with side airbag deployments, future studies are needed to assess side airbag efficacy using datasets such as matched-pair occupants in side impacts. PMID:16911812

  20. Effect of Pregabalin in Preventing Secondary Damage in Traumatic Brain Injury: An Experimental Study

    OpenAIRE

    Calikoglu, Cagatay; Aytekin, Hikmet; Akg?l, Osman; Akg?l, Mehmet H?seyin; Gezen, Ahmet Ferruh; Akyuz, Feyzullah; Cakir, Murteza

    2015-01-01

    Background In this study we aimed to explore the effects of pregabalin on a traumatic brain injury model in rats. Material/Methods This study included 40 adult male Sprague-Dawley rats randomized into 4 groups, each of which contained equal numbers of animals. The control group had no head trauma and thus was not treated. The trauma group had head trauma but was not treated. The pregabalin group had no head trauma but was treated by pregabalin. The trauma + pregabalin group had head trauma tr...

  1. A Test Bed to Examine Helmet Fit and Retention and Biomechanical Measures of Head and Neck Injury in Simulated Impact.

    Science.gov (United States)

    Yu, Henry Y; Knowles, Brooklynn M; Dennison, Christopher R

    2017-09-21

    Conventional wisdom and the language in international helmet testing and certification standards suggest that appropriate helmet fit and retention during an impact are important factors in protecting the helmet wearer from impact-induced injury. This manuscript aims to investigate impact-induced injury mechanisms in different helmet fit scenarios through analysis of simulated helmeted impacts with an anthropometric test device (ATD), an array of headform acceleration transducers and neck force/moment transducers, a dual high speed camera system, and helmet-fit force sensors developed in our research group based on Bragg gratings in optical fiber. To simulate impacts, an instrumented headform and flexible neck fall along a linear guide rail onto an anvil. The test bed allows simulation of head impact at speeds up to 8.3 m/s, onto impact surfaces that are both flat and angled. The headform is fit with a crash helmet and several fit scenarios can be simulated by making context specific adjustments to the helmet position index and/or helmet size. To quantify helmet retention, the movement of the helmet on the head is quantified using post-hoc image analysis. To quantify head and neck injury potential, biomechanical measures based on headform acceleration and neck force/moment are measured. These biomechanical measures, through comparison with established human tolerance curves, can estimate the risk of severe life threatening and/or mild diffuse brain injury and osteoligamentous neck injury. To our knowledge, the presented test-bed is the first developed specifically to assess biomechanical effects on head and neck injury relative to helmet fit and retention.

  2. Head Impact Exposure in Collegiate Football Players

    OpenAIRE

    Crisco, Joseph J.; Wilcox, Bethany J.; Beckwith, Jonathan G.; Chu, Jeffrey J.; Duhaime, Ann-Christine; Rowson, Steve; Duma, Stefan M.; Maerlender, Arthur C.; McAllister, Thomas W.; Greenwald, Richard M.

    2011-01-01

    In American football, impacts to the helmet and the resulting head accelerations are the primary cause of concussion injury and potentially chronic brain injury. The purpose of this study was to quantify exposures to impacts to the head (frequency, location and magnitude) for individual collegiate football players and to investigate differences in head impact exposure by player position. A total of 314 players were enrolled at three institutions and 286,636 head impacts were recorded over thr...

  3. Experimental Investigation of Cavitation as a Possible Damage Mechanism in Blast-Induced Traumatic Brain Injury in Post-Mortem Human Subject Heads.

    Science.gov (United States)

    Salzar, Robert S; Treichler, Derrick; Wardlaw, Andrew; Weiss, Greg; Goeller, Jacques

    2017-04-15

    The potential of blast-induced traumatic brain injury from the mechanism of localized cavitation of the cerebrospinal fluid (CSF) is investigated. While the mechanism and criteria for non-impact blast-induced traumatic brain injury is still unknown, this study demonstrates that local cavitation in the CSF layer of the cranial volume could contribute to these injuries. The cranial contents of three post-mortem human subject (PMHS) heads were replaced with both a normal saline solution and a ballistic gel mixture with a simulated CSF layer. Each were instrumented with multiple pressure transducers and placed inside identical shock tubes at two different research facilities. Sensor data indicates that cavitation may have occurred in the PMHS models at pressure levels below those for a 50% risk of blast lung injury. This study points to skull flexion, the result of the shock wave on the front of the skull leading to a negative pressure in the contrecoup, as a possible mechanism that contributes to the onset of cavitation. Based on observation of intracranial pressure transducer data from the PMHS model, cavitation onset is thought to occur from approximately a 140 kPa head-on incident blast.

  4. Blunt thoracic aortic injuries: an autopsy study.

    Science.gov (United States)

    Teixeira, Pedro G R; Inaba, Kenji; Barmparas, Galinos; Georgiou, Chrysanthos; Toms, Carla; Noguchi, Thomas T; Rogers, Christopher; Sathyavagiswaran, Lakshmanan; Demetriades, Demetrios

    2011-01-01

    The objective of this study was to identify the incidence and patterns of thoracic aortic injuries in a series of blunt traumatic deaths and describe their associated injuries. All autopsies performed by the Los Angeles County Department of Coroner for blunt traumatic deaths in 2005 were retrospectively reviewed. Patients who had a traumatic thoracic aortic (TTA) injury were compared with the victims who did not have this injury for differences in baseline characteristics and patterns of associated injuries. During the study period, 304 (35%) of 881 fatal victims of blunt trauma received by the Los Angeles County Department of Coroner underwent a full autopsy and were included in the analysis. The patients were on average aged 43 years±21 years, 71% were men, and 39% had a positive blood alcohol screen. Motor vehicle collision was the most common mechanism of injury (50%), followed by pedestrian struck by auto (37%). A TTA injury was identified in 102 (34%) of the victims. The most common site of TTA injury was the isthmus and descending thoracic aorta, occurring in 67 fatalities (66% of the patients with TTA injuries). Patients with TTA injuries were significantly more likely to have other associated injuries: cardiac injury (44% vs. 25%, p=0.001), hemothorax (86% vs. 56%, pinjury (74% vs. 49%, pinjury. Patients with a TTA injury were significantly more likely to die at the scene (80% vs. 63%, p=0.002). Thoracic aortic injuries occurred in fully one third of blunt traumatic fatalities, with the majority of deaths occurring at the scene. The risk for associated thoracic and intra-abdominal injuries is significantly increased in patients with thoracic aortic injuries.

  5. Acute Cerebral Perfusion CT Abnormalities Associated with Posttraumatic Amnesia in Mild Head Injury

    NARCIS (Netherlands)

    Metting, Zwany; Rodiger, Lars A.; de Jong, Bauke M.; Stewart, Roy E.; Kremer, Berry P.; van der Naalt, Joukje

    2010-01-01

    Posttraumatic amnesia (PTA) is a common symptom following traumatic brain injury. Although this transient memory deficit implies specific impairment of higher brain function, the actual pathophysiology of PTA is not well understood. The aim of this study was to assess regional cerebral hemodynamics

  6. Adherence to Head Computed Tomography Guidelines for Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Landon A. Jones

    2014-07-01

    Full Text Available Introduction: Traumatic brain injury (TBI is a significant health concern. While 70-90% of TBI cases are considered mild, decision-making regarding imaging can be difficult. This survey aimed to assess whether clinicians’ decision-making was consistent with the most recent American College of Emergency Physicians (ACEP clinical recommendations regarding indications for a non-contrast head computed tomography (CT in patients with mild TBI. Methods: We surveyed 2 academic emergency medicine departments. Six realistic clinical vignettes were created. The survey software randomly varied 2 factors: age (30, 59, or 61 years old and presence or absence of visible trauma above the clavicles. A single important question was asked: “Would you perform a non-contrast head CT on this patient?” Results: Physician decision-making was consistent with the guidelines in only 62.8% of total vignettes. By age group (30, 59, and 61, decision-making was consistent with the guidelines in 66.7%, 47.4%, and 72.7% of cases, respectively. This was a statistically-significant difference when comparing the 59- and 61-year-old age groups. In the setting of presence/absence of trauma above the clavicles, respondents were consistent with the guidelines in 57.1% of cases. Decision-making consistent with the guidelines was significantly better in the absence of trauma above the clavicles. Conclusion: Respondents poorly differentiated the “older” patients from one another, suggesting that respondents either inappropriately apply the guidelines or are unaware of the recommendations in this setting. No particular cause for inconsistency could be determined, and respondents similarly under-scanned and over-scanned in incorrect vignettes. Improved dissemination of the ACEP clinical policy and recommendations is a potential solution to this problem.

  7. Understanding Edward Muybridge: historical review of behavioral alterations after a 19th-century head injury and their multifactorial influence on human life and culture.

    Science.gov (United States)

    Manjila, Sunil; Singh, Gagandeep; Alkhachroum, Ayham M; Ramos-Estebanez, Ciro

    2015-07-01

    Edward Muybridge was an Anglo-American photographer, well known for his pioneering contributions in photography and his invention of the "zoopraxiscope," a forerunner of motion pictures. However, this 19th-century genius, with two original patents in photographic technology, made outstanding contributions in art and neurology alike, the latter being seldom acknowledged. A head injury that he sustained changed his behavior and artistic expression. The shift of his interests from animal motion photography to human locomotion and gait remains a pivotal milestone in our understanding of patterns in biomechanics and clinical neurology, while his own behavioral patterns, owing to an injury to the orbitofrontal cortex, remain a mystery even for cognitive neurologists. The behavioral changes he exhibited and the legal conundrum that followed, including a murder of which he was acquitted, all depict the complexities of his personality and impact of frontal lobe injuries. This article highlights the life journey of Muybridge, drawing parallels with Phineas Gage, whose penetrating head injury has been studied widely. The wide sojourn of Muybridge also illustrates the strong connections that he maintained with Stanford and Pennsylvania universities, which were later considered pinnacles of higher education on the two coasts of the United States.

  8. Knowledge and application of correct car seat head restraint usage among chiropractic college interns: a cross-sectional study.

    Science.gov (United States)

    Taylor, John Am; Burke, Jeanmarie; Gavencak, John; Panwar, Pervinder

    2005-03-01

    Cervical spine injuries sustained in rear-end crashes cost at least $7 billion in insurance claims annually in the United States alone. When positioned correctly, head restraint systems have been proven effective in reducing the risk of whiplash associated disorders. Chiropractors should be knowledgeable about the correct use of head restraint systems to educate their patients and thereby prevent or minimize such injuries. The primary objective of this study was to determine the prevalence of correct positioning of car seat head restraints among the interns at our institution. The secondary objective was to determine the same chiropractic interns' knowledge of the correct positioning of car seat head restraints. It was hypothesized that 100 percent of interns would have their head restraint correctly positioned within an acceptable range and that all interns would possess the knowledge to instruct patients in the correct positioning of head restraints. Cross-sectional study of a convenient sample of 30 chiropractic interns from one institution. Interns driving into the parking lot of our health center were asked to volunteer to have measurements taken and to complete a survey. Vertical and horizontal positions of the head restraint were measured using a beam compass. A survey was administered to determine knowledge of correct head restraint position. The results were recorded, entered into a spreadsheet, and analyzed. 13.3 percent of subjects knew the recommended vertical distance and only 20 percent of subjects knew the recommended horizontal distance. Chi Square analyses substantiated that the majority of subjects were unaware of guidelines set forth by the National Highway Traffic Safety Administration (NHTSA) for the correct positioning of the head restraint (chi(2) (vertical) = 16.13, chi(2) (horizontal) = 10.80, p .05). Interestingly, the 13.3 percent of the subjects who were aware of the vertical plane recommendations did not correctly position their own

  9. Traumatic brain injuries in children: A hospital-based study in Nigeria

    Directory of Open Access Journals (Sweden)

    David O Udoh

    2013-01-01

    Full Text Available Background: Traumatic Brain Injury (TBI is a significant cause of morbidity and mortality worldwide. Our previous studies showed a high frequency of motor vehicle accidents among neurosurgical patients. However, there is a dearth of data on head injuries in children in Nigeria. Aims: To determine the epidemiology of paediatric traumatic brain injuries. Setting and Design: This is a prospective analysis of paediatric head trauma at the University of Benin Teaching Hospital, a major referral centre for all traumatic brain injuries in Nigeria between October 2006 and September 2011. Materials and Methods: We studied the demographic, clinical and radiological data and treatment outcomes. Data was analysed using statistical package for the social sciences (SPSS 16.0. Results: We managed 127 cases of paediatric head injuries, 65 boys and 62 girls representing 13% of all head injuries managed over the 5-year period. They were aged 3 months to 17 years. The mean age was 7.4 years (median 7 years with peak incidence occurring at 6-8 years i.e. 31 (24.4% cases. Motor vehicle accidents resulted in 67.7%, falls 14% and violence 7%. The most frequent computed tomography finding was intracerebral haemorrhage. Mean duration of hospitalization was 18 days (median 11 days. Eleven patients died, mortality correlating well with severity and the presence of intracerebral haematoma. Conclusion: Head injuries in children are due to motor vehicle and motor vehicle-related accidents. Hence, rational priorities for prevention of head injuries in children should include prevention of vehicular, especially pedestrian, accidents in developing countries.

  10. Effects of Neurosurgical Treatment and Severity of Head Injury on Cognitive Functioning, General Health and Incidence of Mental Disorders in Patients With Traumatic Brain Injury

    Science.gov (United States)

    Rezaei, Sajjad; Asgari, Karim; Yousefzadeh, Shahrokh; Moosavi, Heshmat-Allah; Kazemnejad, Ehsan

    2012-01-01

    Background Neurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients’ neuropsychiatric outcomes. Objectives This research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI). Patients and Methods In this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire–28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders. Results Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher's exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while χ2 Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01). Conclusions The implications of this study should be discussed with an

  11. A Retrospective Cohort Study of Traumatic Brain Injury and Usage of Protective Headgear During Equestrian Activities.

    Science.gov (United States)

    Lemoine, Donna S; Tate, Bradley J; Lacombe, Jennifer A; Hood, Theresa C

    Some of the more popular sporting activities for those living in rural areas include equestrian activities such as rodeo events and horseback riding. The lack of helmet use poses a concern for those who participate in these activities due to the risk of sustaining a traumatic brain injury (TBI) and ultimately having a negative effect on their future. A retrospective cohort study was conducted at a trauma center comparing the data on animal-riding patients and their use or lack of use of headgear and incidence of TBI. Of the patients identified, 16.2% sustained a head injury, ranking TBI fourth among all injuries sustained by the animal-riding population. Males were predominantly affected; however, females of pediatric age 5-17 years (54.5%) ranked high among the TBI population. Among all the patients identified with TBI, none of the patients were wearing a helmet and all sustained a head injury. The average injury severity score was 11, with hospital length of stay averaging less than 2 days and the overall mortality was 3.6%. Findings from the study should be considered for the purpose of implementing an age-specific educational program focused on head injury prevention and utilization of protective headgear. Current literature supports the use of protective headgear to reduce the risk of head injuries. Animal riders should be educated on the importance of using headgear as a preventive measure. Future studies are needed to indicate the effectiveness of injury prevention in regard to head injury severity and the use of protective headgear.

  12. Traumatic brain injuries in children: A hospital-based study in Nigeria

    African Journals Online (AJOL)

    related accidents. Hence, rational priorities for prevention of head injuries in children should include prevention of vehicular, especially pedestrian, accidents in developing countries. Key words: Children, head injuries, pedestrian, prevention, ...

  13. Head Injury with Retro-Ocular and Intracerebral Foreign Body in a Five-Year-Old Girl

    OpenAIRE

    Alvarez, Carlos; Servicio de Neurocirugía, Hospital Guillermo Almenara Irigoyen, Lima, Perú; Rosado, Leverrier; Servicio de Neurocirugía, Hospital Guillermo Almenara Irigoyen, Lima, Perú; Rocca, Uldarico; Servicio de Neurocirugía, Hospital Guillermo Almenara Irigoyen, Lima, Perú

    2014-01-01

    Here we introduce the case of a five-year-old girl, who felt down on a corn plant stake, resulting in head injury with prick-cutting injury, leaving some cane fragments along the stretch both retro-ocular and intracerebral. Both remision and recovery ad integrum thanks to surgical management, were obtained. The clinical case and evolution are discussed here. Se presenta aquí el caso de una niña de 5 años de edad que cayó sobre una estaca de caña de maíz, provocándose traumatismo encéfalocr...

  14. Sheep head frame validation for CT and MRI studies

    Directory of Open Access Journals (Sweden)

    marco trovatelli

    2017-05-01

    Full Text Available Abstract   Introductions Aim of EDEN 2020 project’s Milestone 5 is the development of a steerable catheter for CED system in glioblastoma therapy. The VET group is involved in realization and validation of the proper animal model. Materials and methods In this part of the study two fresh sheep’s head from the local slaughter were used. The heads were located into an ad hoc Frame system based on anatomical measures and CT images, producted by Renishaw plc partner in this project. The frame was adapted and every components were checked for the ex vivo validation tests. CT imaging was taken in Lodi at Università degli studi di Milano, Facoltà di Medicina Veterinaria, with CT scanner and MRI imaging was taken in La Cittadina, Cremona Results System validation was approved by the ex vivo trial. The frame system doesn’t compromise the imaging acquisition in MRI and CT systems. Every system components are functional to their aims. Discussion The Frame system is adapted to the sheep head. It is composed by elements able to lock the head during the imaging acquisition. Frame system is characterized by a support base helpings the animals to keep the head straight forward during imaging time, under general anesthesia. The design of these device support the airways anatomy, avoiding damaging or obstruction of airflows during anesthesia period. The role of elements like mouth bar and ovine head pins is to lock the head in a stable position during imaging acquisition; fixing is guaranteed by V shape head pins, that are arranged against the zygomatic arches. Lateral compression forces to the cranium, and the V shape pins avoid the vertical shifting of the head and any kind of rotations. (fig. 1

  15. Multitasking costs in close-head injury patients. A fine-grained analysis.

    Science.gov (United States)

    Dell'Acqua, Roberto; Pashler, Harold; Stablum, Franca

    2003-09-01

    The issue of whether severe close-head injury (CHI) patients suffer from disproportionate dual-task deficits compared with matched controls was investigated in two experiments. In the first experiment, either one or three masked letters were presented at the center of a monitor, followed by a pure tone at variable stimulus-onset asynchronies (SOAs). In half of the blocks of trials, the task on the letters required a delayed report of the letters at the end of each trial; in the other half of the blocks, the letters had to be ignored. The tone task always required an immediate manual response based on the tone pitch. In the second experiment, either three masked letters or three masked digits were presented with equal probability in each trial, followed by a tone at variable SOAs. The task required the delayed report of the characters only if they were letters, or ignoring the characters if they were digits. In both experiments, CHI patients and matched controls both exhibited an SOA-locked slowing of the reaction time (RT) to the tone: When characters had to be encoded for delayed report, tone RT increased progressively as SOA was decreased. The SOA effect on tone RT was more pronounced for CHI patients than for controls, suggesting that a substantial component of the slower processing time for CHI patients was related to a selective increase at a central stage of processing shared by the two tasks. Implications for models of the CHI effects on human performance are discussed.

  16. Role of a dentist in comprehensive management of a comatose patient with post traumatic head injury and neuropathological chewing

    Directory of Open Access Journals (Sweden)

    Sunanda Sharma

    2014-01-01

    Full Text Available Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response.The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.

  17. Treatment Comparison in Rheumatoid Arthritis: Head-to-Head Trials and Innovative Study Designs

    Science.gov (United States)

    Favalli, Ennio Giulio; Bugatti, Serena; Biggioggero, Martina; Caporali, Roberto

    2014-01-01

    Over the last decades, the increasing knowledge in the area of rheumatoid arthritis has progressively expanded the arsenal of available drugs, especially with the introduction of novel targeted therapies such as biological disease modifying antirheumatic drugs (DMARDs). In this situation, rheumatologists are offered a wide range of treatment options, but on the other side the need for comparisons between available drugs becomes more and more crucial in order to better define the strategies for the choice and the optimal sequencing. Indirect comparisons or meta-analyses of data coming from different randomised controlled trials (RCTs) are not immune to conceptual and technical challenges and often provide inconsistent results. In this review we examine some of the possible evolutions of traditional RCTs, such as the inclusion of active comparators, aimed at individualising treatments in real-life conditions. Although head-to-head RCTs may be considered the best tool to directly compare the efficacy and safety of two different DMARDs, surprisingly only 20 studies with such design have been published in the last 25 years. Given the recent advent of the first RCTs truly comparing biological DMARDs, we also review the state of the art of head-to-head trials in RA. PMID:24839607

  18. RISUS study: Rugby Injury Surveillance in Ulster Schools.

    Science.gov (United States)

    Archbold, H A P; Rankin, A T; Webb, M; Nicholas, R; Eames, N W A; Wilson, R K; Henderson, L A; Heyes, G J; Bleakley, C M

    2017-04-01

    To examine injury patterns in adolescent rugby players and determine factors associated with injury risk. Prospective injury surveillance study. N=28 Grammar Schools in Ulster, Ireland (2014-2015 playing season). 825 adolescent rugby players, across in 28 school first XV rugby squads; mean age 16.9 years. Injuries were classified by body part and diagnosis, and injury incidence using injuries per 1000 match hours of exposure. HRs for injury were calculated through Cox proportional hazard regression after correction for influential covariates. A total of n=426 injuries were reported across the playing season. Over 50% of injuries occurred in the tackle situation or during collisions (270/426), with few reported during set plays. The 3 most common injury sites were head/face (n=102, 23.9%), clavicle/shoulder (n=65, 15.3%) and the knee (n=56, 13.1%). Sprain (n=133, 31.2%), concussion (n=81, 19%) and muscle injury (n=65, 15.3%) were the most common diagnoses. Injury incidence is calculated at 29.06 injuries per 1000 match hours. There were no catastrophic injuries. A large percentage of injuries (208/424) resulted in absence from play for more than 28 days. Concussion carried the most significant time out from play (n=33; 15.9%), followed by dislocations of the shoulder (n=22; 10.6%), knee sprains (n=19, 9.1%), ankle sprains (n=14, 6.7%), hand/finger/thumb (n=11; 5.3%). 36.8% of participants in the study (304/825) suffered at least one injury during the playing season. Multivariate models found higher risk of injury (adjusted HR (AHR); 95% CI) with: higher age (AHR 1.45; 1.14 to 1.83), heavier weight (AHR 1.32; 1.04 to 1.69), playing representative rugby (AHR 1.42; 1.06 to 1.90) and undertaking regular strength training (AHR 1.65; 1.11 to 2.46). Playing for a lower ranked team (AHR 0.67; 0.49 to 0.90) and wearing a mouthguard (AHR 0.70; 0.54 to 0.92) were associated with lower risk of injury. There was a high incidence of severe injuries, with concussion, ankle and

  19. Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 1: Coagulopathy as a risk factor in warfarinised head injury patients.

    Science.gov (United States)

    Rendell, Simon

    2014-04-01

    A short-cut review was carried out to determine whether the International Normalised Ratio (INR) value was a predictor of the risk of intracranial haemorrhage in patients taking warfarin after head injury. 796 papers were found using the reported search, of which eighteen were directly relevant. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses are shown in the accompanying table. It is concluded that level of the INR correlates poorly with the risk of haemorrhage and that the risk of haemorrhage remains significant even in patients with a sub-therapeutic INR.

  20. Head Impact Laboratory (HIL)

    Data.gov (United States)

    Federal Laboratory Consortium — The HIL uses testing devices to evaluate vehicle interior energy attenuating (EA) technologies for mitigating head injuries resulting from head impacts during mine/...

  1. Headache after pediatric traumatic brain injury: a cohort study.

    Science.gov (United States)

    Blume, Heidi K; Vavilala, Monica S; Jaffe, Kenneth M; Koepsell, Thomas D; Wang, Jin; Temkin, Nancy; Durbin, Dennis; Dorsch, Andrea; Rivara, Frederick P

    2012-01-01

    To determine the prevalence of headache 3 and 12 months after pediatric traumatic brain injury (TBI). This is a prospective cohort study of children ages 5 to 17 years in which we analyzed the prevalence of headache 3 and 12 months after mild TBI (mTBI; n = 402) and moderate/severe TBI (n = 60) compared with controls with arm injury (AI; n = 122). The prevalence of headache 3 months after injury was significantly higher after mTBI than after AI overall (43% vs 26%, relative risk [RR]: 1.7 [95% confidence interval (CI): 1.2-2.3]), in adolescents (13-17 years; 46% vs 25%, RR: 1.8 [95% CI: 1.1-3.1]), and in girls (59% vs 24%, RR: 2.4 [95% CI: 1.4-4.2]). The prevalence of headache at 3 months was also higher after moderate/severe TBI than AI in younger children (5-12 years; 60% vs 27%; RR: 2.0 [95% CI: 1.2-3.4]). Twelve months after injury, TBI was not associated with a significantly increased frequency of headache. However, girls with mTBI reported serious headache (≥ 5 of 10 pain scale rating) more often than controls (27% vs 10%, RR: 2.2 [95% CI: 0.9-5.6]). Pediatric TBI is associated with headache. A substantial number of children suffer from headaches months after their head injury. The prevalence of headache during the year after injury is related to injury severity, time after injury, age, and gender. Girls and adolescents appear to be at highest risk of headache in the months after TBI.

  2. 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.

  3. Neck injury criteria formulation and injury risk curves for the ejection environment: a pilot study.

    Science.gov (United States)

    Parr, Jeffrey C; Miller, Michael E; Pellettiere, Joseph A; Erich, Roger A

    2013-12-01

    Helmet mounted displays provide increased pilot capability, but can also increase the risk of injury during ejection. The National Highway Transportation Safety Administration's (NHTSA's) neck injury criteria (Nij) metric is evaluated for understanding the impact of helmet mass on the risk of injury and modified risk curves are developed which are compatible with the needs of the aviation community. Existent human subject data collected under various accelerative and head loading conditions were applied to understand the sensitivity of the Nij construct to changes in acceleration and helmet mass, as well as its stability with respect to gender, body mass, neck circumference, and sitting height. A portion of this data was combined with data from an earlier postmortem human subject study to create pilot study modified risk curves. These curves were compared and contrasted with the NHTSA risk curves. A statistically significant difference in the peak mean Nij was observed when seat acceleration increased by 2 G, but not when helmet mass was varied from 1.6 kg to 2 kg at a constant seat acceleration of 8 G. Although NHTSA risk curves predict a 13% risk of AIS 2+ injury for the 8-G, 2-kg helmet condition mean Nij of 0.138, no AIS 2+ injuries were observed. Modified risk curves were produced which predict a 0.91% risk of AIS 2+ injury under these conditions. The Nij was shown to be sensitive to changes in acceleration and generally robust to anthropometric differences between individuals. Modified risk curves are proposed which improve risk prediction at lower Nij values.

  4. Tauopathy PET and amyloid PET in the diagnosis of chronic traumatic encephalopathies: studies of a retired NFL player and of a man with FTD and a severe head injury.

    Science.gov (United States)

    Mitsis, E M; Riggio, S; Kostakoglu, L; Dickstein, D L; Machac, J; Delman, B; Goldstein, M; Jennings, D; D'Antonio, E; Martin, J; Naidich, T P; Aloysi, A; Fernandez, C; Seibyl, J; DeKosky, S T; Elder, G A; Marek, K; Gordon, W; Hof, P R; Sano, M; Gandy, S

    2014-09-16

    Single, severe traumatic brain injury (TBI) which elevates CNS amyloid, increases the risk of Alzheimer's disease (AD); while repetitive concussive and subconcussive events as observed in athletes and military personnel, may increase the risk of chronic traumatic encephalopathy (CTE). We describe two clinical cases, one with a history of multiple concussions during a career in the National Football League (NFL) and the second with frontotemporal dementia and a single, severe TBI. Both patients presented with cognitive decline and underwent [(18)F]-Florbetapir positron emission tomography (PET) imaging for amyloid plaques; the retired NFL player also underwent [(18)F]-T807 PET imaging, a new ligand binding to tau, the main constituent of neurofibrillary tangles (NFT). Case 1, the former NFL player, was 71 years old when he presented with memory impairment and a clinical profile highly similar to AD. [(18)F]-Florbetapir PET imaging was negative, essentially excluding AD as a diagnosis. CTE was suspected clinically, and [(18)F]-T807 PET imaging revealed striatal and nigral [(18)F]-T807 retention consistent with the presence of tauopathy. Case 2 was a 56-year-old man with personality changes and cognitive decline who had sustained a fall complicated by a subdural hematoma. At 1 year post injury, [(18)F]-Florbetapir PET imaging was negative for an AD pattern of amyloid accumulation in this subject. Focal [(18)F]-Florbetapir retention was noted at the site of impact. In case 1, amyloid imaging provided improved diagnostic accuracy where standard clinical and laboratory criteria were inadequate. In that same case, tau imaging with [(18)F]-T807 revealed a subcortical tauopathy that we interpret as a novel form of CTE with a distribution of tauopathy that mimics, to some extent, that of progressive supranuclear palsy (PSP), despite a clinical presentation of amnesia without any movement disorder complaints or signs. A key distinguishing feature is that our patient presented

  5. secondary injury in traumatic brain injury patients - a prospective study

    African Journals Online (AJOL)

    Objective. Secondary insults of hypotension and hypoxia significantly impact on outcome in patients with traumatic brain injury (TBI). More than 4 hours' delay in evacuation of intracranial haematomas has been demonstrated to have an additional impact on outcome. The objective of this study was to document the ...

  6. Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients with Head Trauma and Pre-Injury Warfarin or Clopidogrel Use

    Science.gov (United States)

    Nishijima, Daniel K.; Offerman, Steven R.; Ballard, Dustin W.; Vinson, David R.; Chettipally, Uli K.; Rauchwerger, Adina S.; Reed, Mary E.; Holmes, James F.

    2012-01-01

    Study Objective Patients on warfarin or clopidogrel are considered at increased risk for traumatic intracranial hemorrhage (tICH) following blunt head trauma. The prevalence of immediate tICH and the cumulative incidence of delayed tICH in these patients, however, are unknown. Methods A prospective, observational study at two trauma centers and four community hospitals enrolled emergency department (ED) patients with blunt head trauma and pre-injury warfarin or clopidogrel use from April 2009 through January 2011. Patients were followed for two weeks. The prevalence of immediate tICH and the cumulative incidence of delayed tICH were calculated from patients who received an initial cranial computed tomography (CT) in the ED. Delayed tICH was defined as tICH within two weeks following an initially normal CT scan and in the absence of repeat head trauma. Results A total of 1,064 patients were enrolled (768 warfarin patients [72.2%] and 296 clopidogrel patients [27.8%]). There were 364 patients [34.2%] from Level 1 or 2 trauma centers and 700 patients [65.8%] from community hospitals. One thousand patients received a cranial CT scan in the ED. Both warfarin and clopidogrel groups had similar demographic and clinical characteristics although concomitant aspirin use was more prevalent among patients on clopidogrel. The prevalence of immediate tICH was higher in patients on clopidogrel (33/276, 12.0%; 95% confidence interval [CI] 8.4-16.4%) than patients on warfarin (37/724, 5.1%; 95%CI 3.6-7.0%), relative risk 2.31 (95%CI 1.48-3.63). Delayed tICH was identified in 4/687 (0.6%; 95%CI 0.2-1.5%) patients on warfarin and 0/243 (0%; 95%CI 0-1.5%) patients on clopidogrel. Conclusion While there may be unmeasured confounders that limit intergroup comparison, patients on clopidogrel have a significantly higher prevalence of immediate tICH compared to patients on warfarin. Delayed tICH is rare and occurred only in patients on warfarin. Discharging patients on anticoagulant or

  7. The head that wears the crown: Henry VIII and traumatic brain injury.

    Science.gov (United States)

    Ikram, Muhammad Qaiser; Sajjad, Fazle Hakim; Salardini, Arash

    2016-06-01

    Henry VIII of England is one of the most controversial figures in European history. He was born on 28 June 1491 as the second son of Henry VII and Elizabeth of York and became the heir to the English throne after his elder brother died prematurely. A contradictory picture of Henry's character emerges from history: the young Henry was a vigorous, generous and intelligent king who saw early military and naval successes. In contrast, in his later years he became cruel, petty and tyrannical. His political paranoia and military misjudgements are in direct contrast to his earlier successes and promise. Several hypotheses have been put forward regarding his transformation from a renaissance king to a later medieval tyrant, including endocrinopathies, psychiatric illnesses and traumatic brain injury. In this paper we examine the historical evidence linking the change in Henry's personality and health problems to traumatic brain injury. To our knowledge this is the first systematic neurological study of traumatic brain injury in Henry VIII. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Analytical modelling of soccer heading

    Indian Academy of Sciences (India)

    Heading occur frequently in soccer games and studies have shown that repetitive heading of the soccer ball could result in degeneration of brain cells and lead to mild traumatic brain injury. This study proposes a two degree-of-freedom linear mathematical model to study the impact of the soccer ball on the brain. The model ...

  9. Risk of traumatic intracranial hemorrhage in patients with head injury and preinjury warfarin or clopidogrel use.

    Science.gov (United States)

    Nishijima, Daniel K; Offerman, Steven R; Ballard, Dustin W; Vinson, David R; Chettipally, Uli K; Rauchwerger, Adina S; Reed, Mary E; Holmes, James F

    2013-02-01

    Appropriate use of cranial computed tomography (CT) scanning in patients with mild blunt head trauma and preinjury anticoagulant or antiplatelet use is unknown. The objectives of this study were: 1) to identify risk factors for immediate traumatic intracranial hemorrhage (tICH) in patients with mild head trauma and preinjury warfarin or clopidogrel use and 2) to derive a clinical prediction rule to identify patients at low risk for immediate tICH. This was a prospective, observational study at two trauma centers and four community hospitals that enrolled adult emergency department (ED) patients with mild blunt head trauma (initial ED Glasgow Coma Scale [GCS] score 13 to 15) and preinjury warfarin or clopidogrel use. The primary outcome measure was immediate tICH, defined as the presence of ICH or contusion on the initial cranial CT. Risk for immediate tICH was analyzed in 11 independent predictor variables. Clinical prediction rules were derived with both binary recursive partitioning and multivariable logistic regression. A total of 982 patients with a mean (± standard deviation [SD]) age of 75.4 (±12.6) years were included in the analysis. Sixty patients (6.1%; 95% confidence interval [CI] = 4.7% to 7.8%) had immediate tICH. History of vomiting (relative risk [RR] = 3.53; 95% CI = 1.80 to 6.94), abnormal mental status (RR = 2.85; 95% CI = 1.65 to 4.92), clopidogrel use (RR = 2.52; 95% CI = 1.55 to 4.10), and headache (RR = 1.81; 95% CI = 1.11 to 2.96) were associated with an increased risk for immediate tICH. Both binary recursive partitioning and multivariable logistic regression were unable to derive a clinical prediction model that identified a subset of patients at low risk for immediate tICH. While several risk factors for immediate tICH were identified, the authors were unable to identify a subset of patients with mild head trauma and preinjury warfarin or clopidogrel use who are at low risk for immediate tICH. Thus, the recommendation is for urgent and

  10. A RETROSPECTIVE STUDY ON PENETRATING INJURIES ABDOMEN

    Directory of Open Access Journals (Sweden)

    Alli Muthiah

    2017-02-01

    Full Text Available BACKGROUND Penetrating abdominal injuries forms an important component of surgical emergencies. It remains one of the commonest reasons for preventable deaths in any trauma systems. 1 Abdominal injuries may be parietal or visceral or perforating through and through injury. Unnecessary exploration leads to increased morbidity. The goal in managing penetrating abdominal injuries is to identify and treat all the damages caused by the weapon and to reduce negative laparotomy and avoid missed injuries. MATERIALS AND METHODS A retrospective study that was carried out in 53 patients in Government Kilpauk Medical College and Government Royapettah Hospital from May 2007 to July 2009 on penetrating injuries abdomen. RESULTS Among 53 patients, maximum number of cases were in the age group of 30-40 years. Assault injuries account for 87% of cases of penetrating abdominal injuries. Small bowel was the commonly injured organ in this study. Laparotomy was therapeutic in 94% of the cases (64% of the cases underwent laparotomy. CONCLUSION Careful and serial clinical examination and appropriate diagnostic investigations leads to successful treatment in these patients. Computed tomography is highly sensitive in predicting both peritoneal penetration and intra-abdominal visceral injuries.

  11. HEAD INJURY ASSESSMENT IN JUVENILE CHINOOK USING THE ALPHA II-SPECTRIN BIOMARKER: EFFECTS OF PRESSURE CHANGES AND PASSAGE THROUGH A REMOVABLE SPILLWAY WEIR

    Energy Technology Data Exchange (ETDEWEB)

    Jonason, C.; Miracle, A.

    2009-01-01

    The cytoskeletal protein alpha II-spectrin has specifi c neurodegenerative mechanisms that allow the necrotic (injury-induced) and apoptotic (non-injury-induced) pathways of proteolysis to be differentiated in an immunoblot. Consequently, αII-spectrin breakdown products (SBDPs) are potential biomarkers for diagnosing traumatic brain injury (TBI). The purpose of the following investigation, consisting of two studies, was to evaluate the utility of the spectrin biomarker in diagnosing TBI in fi sh that travel through hydroelectric dams in the Columbia and Snake Rivers. The fi rst study used hyperbaric pressure chambers to simulate the pressure changes that affect fi sh during passage through a Federal Columbia River Power System (FCRPS) Kaplan turbine. The second study tested the effect of a removable spillway weir (RSW) on the passage of juvenile chinook (Oncorhynchus tshawytscha). This study was conducted in tandem with a balloon-tag study by the U.S. Army Corps of Engineers. Brain samples from fi sh were collected and analyzed using an immunoblot for SBDPs, and imaging software was used to quantify the protein band density and determine the ratio of cleaved protein to total protein. The biomarker analyses found higher SBDP expression levels in fi sh that were exposed to lower pressure nadirs and fi sh that passed through the RSW at a deep orientation. In general, the incidence of injuries observed after treatment positively correlated with expression levels, suggesting that the biomarker method of analysis is comparable to traditional methods of injury assessment. It was also found that, for some treatments, the 110 kDa spectrin fragment (SBDP 110) correlated more strongly with necrotic head injury incidence and mortality rates than did the total cleaved protein or the 120 kDa fragment. These studies will be informative in future decisions regarding the design of turbines and fi sh passage structures in hydroelectric dams and will hopefully contribute to the

  12. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... the head is typically used to detect: bleeding, brain injury and skull fractures in patients with head injuries. ... hard time staying still, are claustrophobic or have chronic pain, you may find a CT exam to ...

  13. A study of bicyclist kinematics and injuries based on reconstruction of passenger car-bicycle accident in China.

    Science.gov (United States)

    Nie, Jin; Yang, Jikuang

    2014-10-01

    Like pedestrians, bicyclists are vulnerable road users, representing a population with a high risk of fatal and severe injuries in traffic accidents as they are unprotected during vehicle collisions. The objective of this study is to investigate the kinematics response of bicyclists and the correlation of the injury severity with vehicle impact speed. Twenty-four car-bicyclist cases with detailed information were selected for accident reconstruction using mathematical models, which was implemented in the MADYMO program. The dynamic response of bicyclists in the typical impact configuration and the correlation of head impact conditions were analyzed and discussed with respect to the head impact speed, time of head impact and impact angle of bicyclists to vehicle impact speed. Furthermore, the injury distribution of bicyclists and the risk of head injuries and fractures of lower limbs were investigated in terms of vehicle impact speed. The results indicate that wrap-around distance (WAD), head impact speed, time of head impact, head impact angle, and throw-out distance (TOD) of the bicyclists have a strong relationship with vehicle impact speed. The vehicle impact speed corresponding to a 50% probability of head AIS 2+ injuries, head AIS 3+ injuries, and lower limb fracture risk for bicyclists is 53.8km/h, 58.9km/h, and 41.2km/h, respectively. A higher vehicle impact speed produces a higher injury risk to bicyclist. The results could provide background knowledge for the establishment or modification of pedestrian regulations considering bicyclist protection as well as being helpful for developing safety measures and protection devices for bicyclists. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Central executive aspects of attention in subacute severe and very severe closed head injury patients : Planning, inhibition, flexibility, and divided attention

    NARCIS (Netherlands)

    Veltman, J.C; Brouwer, W.H.; van Zomeren, Adriaan H; van Wolffelaar, Peter C.

    Central executive aspects of attention were investigated in a group of 20 closed head injury (CHI) patients with an average posttraumatic amnesia duration of 23.9 days, tested in the first half year after injury. Four aspects were distinguished: planning, inhibition, flexibility, and divided

  15. SPECTRUM OF SKULL FRACTURES IN TRAUMATIC BRAIN INJURY (TBI – A CROSS SECTIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Bhola Kumar

    2016-02-01

    Full Text Available BACKGROUND Traumatic brain injury (TBI is a considerable cause of morbidity and mortality in India and around the world. Head injury provides one of the major contributions to death and better practical understanding of intracranial injuries is essential to the forensic expert. The cross sectional CT imaging makes the radiologic contribution to forensic autopsy more valuable and may improve accuracy of forensic investigation. To this reason we retrospectively evaluated the patterns of skull fractures on CT scan imaging of deceased patients. METHODS This cross sectional analysis was conducted in the department of forensic medicine Career institute of Medical Sciences, Lucknow over a period of two years 2013-2015. In this study, we reviewed images of all the deceased patients (died in our hospital who underwent CT scanning at index admission for head injury. Demographic details and mode of injury was recorded from available data. Age was presented using mean and standard deviation, gender, mode of injury and type of skull fractures were presented as numbers and percentages. RESULTS Linear skull fractures were 172 out of which RTA due to unknown was 99 followed by fall of unknown reason was 32, RTA fall from two wheeler was 32. The cause of death in all these cases was due to head injury associated with fracture of skull or intracranial hemorrhages or brain injury. CONCLUSION Majority of fatal head injuries are due to road traffic accidents (RTA especially in younger and middle age, followed by fall from height. The common skull fracture type was linear (fissured skull fractures followed by depressed fractures. Retrospective CT evaluated has reinforced reporting medico legal of these cases.

  16. Predictors of malignancy in pancreatic head mass: a prospective study

    African Journals Online (AJOL)

    A prospective study of patients presented with pancreatic head mass was conducted in a tertiary care referral hospital, Manipal, India from May 2006 to November 2008. The study population was divided into malignant and benign groups based on the final histopathology report. A univariate and multivariate analysis of ...

  17. EPIDEMIOLOGICAL STUDY ON LISFRANC INJURIES

    Science.gov (United States)

    SOBRADO, MARCEL FARACO; SAITO, GUILHERME HONDA; SAKAKI, MARCOS HIDEYO; PONTIN, PEDRO AUGUSTO; SANTOS, ALEXANDRE LEME GODOY DOS; FERNANDES, TÚLIO DINIZ

    2017-01-01

    ABSTRACT Objective: To analyze the characteristics of patients with Lisfranc injuries and their associated fractures. Methods: This is a retrospective analysis on 42 patients with Lisfranc injuries hospitalized at Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, between 2006 and 2010. Parameters on patient profile, risk factors, fracture characteristics, data on treatment and acute complications were analyzed. Results: Analysis of 42 cases showed that in our sample, men were more affected than women, with a ratio of 4.25:1. The most frequent trauma mechanism was car accident, followed by motorcycle accident. The most frequent type of injury was isolated lesion type B of Quenu and Kuss classification, representing 50% of cases. The most common fracture on the sample was the second metatarsal bone, with 16 cases, followed by cuboid bone fracture. Among the 42 cases, 17% had exposed fractures and 33 patients presented other associated fractures. The mean time elapsed between the trauma and definitive treatment was 6.7 days, while the mean length of hospital stay was 13.8 days. Six patients presented acute postoperative complications. Conclusion: Lisfranc injuries are more common in men undergoing automobile trauma. The prevalence of associated fractures is a frequent finding and the hospital stay may be longstanding.Level of Evidence IV, Case Series. PMID:28642650

  18. EPIDEMIOLOGICAL STUDY ON LISFRANC INJURIES.

    Science.gov (United States)

    Sobrado, Marcel Faraco; Saito, Guilherme Honda; Sakaki, Marcos Hideyo; Pontin, Pedro Augusto; Santos, Alexandre Leme Godoy Dos; Fernandes, Túlio Diniz

    2017-01-01

    To analyze the characteristics of patients with Lisfranc injuries and their associated fractures . This is a retrospective analysis on 42 patients with Lisfranc injuries hospitalized at Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, between 2006 and 2010. Parameters on patient profile, risk factors, fracture characteristics, data on treatment and acute complications were analyzed . Analysis of 42 cases showed that in our sample, men were more affected than women, with a ratio of 4.25:1. The most frequent trauma mechanism was car accident, followed by motorcycle accident. The most frequent type of injury was isolated lesion type B of Quenu and Kuss classification, representing 50% of cases. The most common fracture on the sample was the second metatarsal bone, with 16 cases, followed by cuboid bone fracture. Among the 42 cases, 17% had exposed fractures and 33 patients presented other associated fractures. The mean time elapsed between the trauma and definitive treatment was 6.7 days, while the mean length of hospital stay was 13.8 days. Six patients presented acute postoperative complications . Lisfranc injuries are more common in men undergoing automobile trauma. The prevalence of associated fractures is a frequent finding and the hospital stay may be longstanding. Level of Evidence IV, Case Series.

  19. CT evidence for subchondral trabecular injury of the femoral head in transient osteoporosis of the hip: a case report.

    Science.gov (United States)

    Kim, Yong Lae; Nam, Kwang Woo; Yoo, Jeong Joon; Hong, Sung Hwan; Kim, Hee Joong

    2010-01-01

    A 28-yr-old woman presented with both hip pain that started sequentially during the peripartum period. Diagnosis of transient osteoporosis of the hip (TOH) was made based on typical findings of plain radiographs and magnetic resonance images. The subchondral trabeculae of the femoral head were evaluated on serially taken coronal multiplanar reformation computerized tomogram images. At 4 weeks after pain onset, marked decrease in the sclerotic density with irregular discontinuation was observed in the primary compression trabeculae. At 12 weeks, a focal area of irregular thickening of trabeculae was observed. At 20 weeks, sclerotic density of trabeculae recovered markedly and the focal area of irregular trabecular thickening disappeared. At 1 yr, subchondral trabeculae recovered almost completely. The evidence of subchondral trabecular injury was observed in the femoral heads of TOH.

  20. Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation.

    Science.gov (United States)

    Pandor, A; Goodacre, S; Harnan, S; Holmes, M; Pickering, A; Fitzgerald, P; Rees, A; Stevenson, M

    2011-08-01

    Patients with minor head injury [Glasgow Coma Scale (GCS) score 13-15] have a small but important risk of intracranial injury (ICI) that requires early identification and neurosurgical treatment. Diagnostic assessment can use either a clinical decision rule or unstructured assessment of individual clinical features to identify those who are at risk of ICI and in need of computerised tomography (CT) scanning and/or hospital admission. Selective use of CT investigations helps minimise unnecessary radiation exposure and resource use, but can lead to missed opportunities to provide early treatment for ICI. To determine the diagnostic accuracy of decision rules, individual clinical characteristics, skull radiography and biomarkers, and the clinical effectiveness and cost-effectiveness of diagnostic management strategies for minor head injury (MHI). Several electronic databases [including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and The Cochrane Library] were searched from inception to April 2009 (updated searches to March 2010 were conducted on the MEDLINE databases only). Searches were supplemented by hand-searching relevant articles (including citation searching) and contacting experts in the field. For each of the systematic reviews the following studies were included (1) cohort studies of patients with MHI in which a clinical decision rule or individual clinical characteristics (including biomarkers and skull radiography) were compared with a reference standard test for ICI or need for neurosurgical intervention and (2) controlled trials comparing alternative management strategies for MHI. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool (for the assessment of diagnostic accuracy) or criteria recommended by the Effective Practice and Organisation of Care Review Group (for the assessment of management practices). Where

  1. Initial Clinical Findings as a Predictor of Abnormal Scan on Minor Head Injury Patients at Sanglah General Hospital, Bali-Indonesia

    Directory of Open Access Journals (Sweden)

    Ade Chandra

    2012-05-01

    Full Text Available Objective: Minor Head Injury (MHI patients should not cause severe sequelae. In fact, many studies had reported that some MHI patients had abnormal scan, clinical deterioration, and many of them have had neurosurgical intervention. This study analyzed correlations between clinical signs with abnormal scan, clinical deterioration and surgery intervention on minor head injury patients.Methods: A series of 364 MHI patients were prospectively enrolled in this study. In all cases clinical data were collected and a CT Scan was obtained. The relationship between clinical findings (loss of conciousness, amnesia, seizure, vomiting, headache, cepalhameatome, skull fracture, age more than 60 years,were identified as independent risk factors in correlations to abnormal scan, clinical deterioration and surgery intervention using bivariate and logistic regression multivariate analytics with 95 % CI.Results: the incidence of abnormal scan was 13.8% (48 patients, 3.3% (12 patients with clinical deterioration, and incidence of surgery intervention was 3.8% (14 patiens. Lost of conciousness, amnesia, cepalhematoma, skull fracture, and age more than 60 years old are independent variabels had statistically significant with abnormal scan. Amnesia, cepalhematome, skull fracture are independent variables which had statistic significantly with clinical deterioration and surgical intervention.Conclusions: Clinical variables which had statistic significantly can be used as predictors of abnormal scan, clinical deterioration, and surgical intervention. Avoiding systematic CT Scan indication implies a rate of misdiagnosis, but liberal scan can be increasing the cost of patients

  2. Tau phosphorylation induced by severe closed head traumatic brain injury is linked to the cellular prion protein.

    Science.gov (United States)

    Rubenstein, Richard; Chang, Binggong; Grinkina, Natalia; Drummond, Eleanor; Davies, Peter; Ruditzky, Meir; Sharma, Deep; Wang, Kevin; Wisniewski, Thomas

    2017-04-18

    Studies in vivo and in vitro have suggested that the mechanism underlying Alzheimer's disease (AD) neuropathogenesis is initiated by an interaction between the cellular prion protein (PrP(C)) and amyloid-β oligomers (Aβo). This PrP(C)-Aβo complex activates Fyn kinase which, in turn, hyperphosphorylates tau (P-Tau) resulting in synaptic dysfunction, neuronal loss and cognitive deficits. AD transgenic mice lacking PrP(C) accumulate Aβ, but show normal survival and no loss of spatial learning and memory suggesting that PrP(C) functions downstream of Aβo production but upstream of intracellular toxicity within neurons. Since AD and traumatic brain injury (TBI)-linked chronic traumatic encephalopathy are tauopathies, we examined whether similar mechanistic pathways are responsible for both AD and TBI pathophysiologies. Using transgenic mice expressing different levels of PrP(C), our studies investigated the influence and necessity of PrP(C) on biomarker (total-tau [T-Tau], P-Tau, GFAP) levels in brain and blood as measured biochemically following severe TBI in the form of severe closed head injury (sCHI). We found that following sCHI, increasing levels of T-Tau and P-Tau in the brain were associated with the PrP(C) expression levels. A similar relationship between PrP(C) expression and P-Tau levels following sCHI were found in blood in the absence of significant T-Tau changes. This effect was not seen with GFAP which increased within 24 h following sCHI and progressively decreased by the 7 day time point regardless of the PrP(C) expression levels. Changes in the levels of all biomarkers were independent of gender. We further enhanced and expanded the quantitation of brain biomarkers with correlative studies using immunohisochemistry. We also demonstrate that a TBI-induced calpain hyperactivation is not required for the generation of P-Tau. A relationship was demonstrated between the presence/absence of PrP(C), the levels of P-Tau and cognitive dysfunction. Our

  3. Predicting the need for CT imaging in children with minor head injury using an ensemble of Naive Bayes classifiers.

    Science.gov (United States)

    Klement, William; Wilk, Szymon; Michalowski, Wojtek; Farion, Ken J; Osmond, Martin H; Verter, Vedat

    2012-03-01

    Using an automatic data-driven approach, this paper develops a prediction model that achieves more balanced performance (in terms of sensitivity and specificity) than the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule, when predicting the need for computed tomography (CT) imaging of children after a minor head injury. CT is widely considered an effective tool for evaluating patients with minor head trauma who have potentially suffered serious intracranial injury. However, its use poses possible harmful effects, particularly for children, due to exposure to radiation. Safety concerns, along with issues of cost and practice variability, have led to calls for the development of effective methods to decide when CT imaging is needed. Clinical decision rules represent such methods and are normally derived from the analysis of large prospectively collected patient data sets. The CATCH rule was created by a group of Canadian pediatric emergency physicians to support the decision of referring children with minor head injury to CT imaging. The goal of the CATCH rule was to maximize the sensitivity of predictions of potential intracranial lesion while keeping specificity at a reasonable level. After extensive analysis of the CATCH data set, characterized by severe class imbalance, and after a thorough evaluation of several data mining methods, we derived an ensemble of multiple Naive Bayes classifiers as the prediction model for CT imaging decisions. In the first phase of the experiment we compared the proposed ensemble model to other ensemble models employing rule-, tree- and instance-based member classifiers. Our prediction model demonstrated the best performance in terms of AUC, G-mean and sensitivity measures. In the second phase, using a bootstrapping experiment similar to that reported by the CATCH investigators, we showed that the proposed ensemble model achieved a more balanced predictive performance than the CATCH rule with an average

  4. 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.)

  5. Epidemiology of injuries due to tropical cyclones in Hong Kong: a retrospective observational study.

    Science.gov (United States)

    Rotheray, K R; Aitken, P; Goggins, W B; Rainer, T H; Graham, C A

    2012-12-01

    Tropical cyclones are huge circulating masses of wind which form over tropical and sub-tropical waters. They affect an average of 78 million people each year. Hong Kong is a large urban centre with a population of just over 7 million which is frequently affected by tropical cyclones. We aimed to describe the numbers and types of injuries due to tropical cyclones in Hong Kong, as well as their relation to tropical cyclone characteristics. The records of all patients presenting to Hong Kong's public hospital emergency departments from 1st January 2004 to 31st December 2009 with tropical cyclone related injuries were reviewed and information regarding patient and injury characteristics was collected. Meteorological records for the relevant periods were examined and data on wind speed, rainfall and timing of landfall and warning signals was recorded and compared with the timing of tropical cyclone related injuries. A total of 460 tropical cyclone related injuries and one fatality across 15 emergency departments were identified during the study period. The mean age of those injured was 48 years and 48% were female. 25.4% of injuries were work related. The head (33.5%) and upper limb (32.5%) were the most commonly injured regions, with contusions (48.6%) and lacerations (30.2%) being the most common injury types. Falls (42.6%) were the most common mechanism of injury, followed by being hit by a falling or flying object (22.0%). In univariable analysis the relative risk of injury increased with mean hourly wind speed and hourly maximum gust. Multivariable analysis, however, showed that relative risk of injury increased with maximum gust but not average wind speed, with relative risk of injury rising sharply above maximum gusts of greater than 20 m/s. Moderate wind speed with high gust (rather than high average and high gust) appears to be the most risky situation for injuries. Relative risk of injury was not associated with rainfall. The majority of injuries (56

  6. INJURIES IN QUIDDITCH: A DESCRIPTIVE EPIDEMIOLOGICAL STUDY.

    Science.gov (United States)

    Pennington, Rachel; Cooper, Ashley; Edmond, Evan; Faulkner, Alastair; Reidy, Michael J; Davies, Peter S E

    2017-10-01

    Quidditch is a fast growing, physically intense, mixed-gender full-contact sport. Originally adapted from Harry Potter novels, quidditch was first played in 2005 in the USA but is now played worldwide. It is essential to elucidate patterns of injury for the safety and growth of the sport of quidditch. It also provides a unique opportunity to study injury patterns in mixed-gender full-contact sport, an area of increasing importance with the developing culture of transition from single-gender to mixed-gender sports. The purpose of this investigation was to examine the types of injuries sustained while playing quidditch in terms of their incidence, anatomical distribution and severity, and gender distribution. An anonymous self-reporting questionnaire was distributed to all active quidditch players in the UK. Data collection included player demographics, type of injury, mechanism of injury, player position, experience and treatment required, relating to the previous 12 months. A total of 348 participants of 684 eligible athletes responded to the questionnaire representing a 50.87% response rate. There were 315 injuries reported by 180 athletes in total, with an overall incidence of 4.06 injuries per 1,000 hours. A statistically significantly different rate of concussion was observed with female athletes sustaining more concussion than males (p=0.006). The overall rate of concussion was 0.651/1000hrs in males and 1.163/1000hrs in females (0.877/1000 hours overall). This study provides the first quantitative description of injury rates in quidditch. The overall injury rates are no higher than those reported in other recreational contact sports. Female athletes were found to have a higher rate of concussion, which needs further investigation. These findings are relevant to players concerned about safety in quidditch and to governing bodies regarding governance of the sport. 3b.