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Abstract
ABSTRACT We describe 3 infants with skull fractures that involved more than 1 skull bone. On further evaluation, 2 of the 3 infants had additional fractures at other sites of the body and the third infant had concerning bruising of the face. Although an accidental mechanism of injury was initially given as the history in each case, law enforcement investigations led all 3 fathers to confess to crushing their infants' skulls out of frustration. These crushes were caused by their arms or hands. Bilateral skull fractures or those involving more than 1 skull bone can be seen in falls as well as in crush injuries. A crush-like pattern of injury, in the absence of a clear and plausible accidental mechanism, should raise concerns for possible physical abuse especially in nonambulatory infants.
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Affiliation(s)
- Emily C B Brown
- From the Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | | | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Kenneth W Feldman
- From the Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
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Jelodar S, Pourrashidi A, Amirjamshidi A. Uncomplicated Wide Oblique Clivus Fracture, the First Case to be Included in the List of Classification; Report of the Case and Review of Literature. Bull Emerg Trauma 2019; 7:416-419. [PMID: 31858006 PMCID: PMC6911711 DOI: 10.29252/beat-070412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Sheno-occipital diastasis happens more frequently in children and is accompanied with neural and vascular injuries leading to a high rate of mortality. We present a rare type of clival fracture in a 21 years old man who could survive without any deficit even though the fracture extended widely from left Asterion to the right orbit accompanied by widespread damage of the skull base air sinuses in 3D CT scan. To the best knowledge of the authors, neither this type of fracture, nor the clinical presentation, has been reported in relevant literature.
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Affiliation(s)
- Sina Jelodar
- Department of Neurosurgery, Sina Hospital, Emam Ave. Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pourrashidi
- Department of Neurosurgery, Sina Hospital, Emam Ave. Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Emam Ave. Tehran University of Medical Sciences, Tehran, Iran
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Faraji AH, Ochalski PG, Ozpinar A, Blatt JE, Pollack IF. Isolated Traumatic Diastasis of the Clival Synchondroses without Clival Fracture. Pediatr Neurosurg 2018; 53:270-274. [PMID: 29672322 DOI: 10.1159/000488058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/26/2018] [Indexed: 12/22/2022]
Abstract
Traumatic clival fractures in the pediatric population are associated with high mortality rates. In our previously reported series, a subset of clival fractures were associated with traumatic diastasis of the surrounding clival synchondroses. Herein, we describe a pediatric case of an isolated traumatic diastasis of the clival synchondroses without clival fracture with significant injury to neurovascular structures. To our knowledge this is the first report to describe this entity. Careful radiological attention should be made towards the clival synchondroses in crushing head injuries to best tailor screening for cerebrovascular injury even in the absence of clival fractures.
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Affiliation(s)
- Amir H Faraji
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Jason E Blatt
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Chan V, Mann RE, Pole JD, Colantonio A. Children and youth with 'unspecified injury to the head': implications for traumatic brain injury research and surveillance. Emerg Themes Epidemiol 2015; 12:9. [PMID: 26113870 PMCID: PMC4480889 DOI: 10.1186/s12982-015-0031-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background The case definition for traumatic brain injury (TBI) often includes ‘unspecified injury to the head’ diagnostic codes. However, research has shown that the inclusion of these codes leads to false positives. As such, it is important to determine the degree to which inclusion of these codes affect the overall numbers and profiles of the TBI population. The objective of this paper was to profile and compare the demographic and clinical characteristics, intention and mechanism of injury, and discharge disposition of hospitalized children and youth aged 19 years and under using (1) an inclusive TBI case definition that included ‘unspecified injury to the head’ diagnostic codes, (2) a restricted TBI case definition that excluded ‘unspecified injury to the head ‘diagnostic codes, and (3) the ‘unspecified injury to the head’ only case definition. Methods The National Ambulatory Care Reporting System and the Discharge Abstract Database from Ontario, Canada, were used to identify cases between fiscal years 2003/04 and 2009/10. Results The rate of TBI episodes of care using the inclusive case definition for TBI (2,667.2 per 100,000) was 1.65 times higher than that of the restricted case definition (1,613.3 per 100,000). ‘Unspecified injury to the head’ diagnostic codes made up of 39.5 % of all cases identified with the inclusive case definition. Exclusion of ‘unspecified injury to the head’ diagnostic code in the TBI case definition resulted in a significantly higher proportion of patients in the intensive care units (p < .0001; 18.5 % vs. 22.2 %) and discharged to a non-home setting (p < .0001; 9.9 % vs. 11.6 %). Conclusion Inclusion of ‘unspecified injury to the head’ diagnostic codes resulted in significant changes in numbers, healthcare use, and causes of TBI. Careful consideration of the inclusion of ‘unspecified injury to the head’ diagnostic codes in the case definition of TBI for the children and youth population is important, as it has implications for the numbers used for policy, resource allocation, prevention, and planning of healthcare services. This paper can inform future work on reaching consensus on the diagnostic codes for defining TBI in children and youth.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada ; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada ; Pediatric Oncology Group of Ontario, Toronto, ON Canada
| | - Robert E Mann
- Centre for Addiction and Mental Health, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada ; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Chan V, Thurairajah P, Colantonio A. Defining pediatric traumatic brain injury using International Classification of Diseases Version 10 Codes: a systematic review. BMC Neurol 2015; 15:7. [PMID: 25648197 PMCID: PMC4335539 DOI: 10.1186/s12883-015-0259-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/07/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although healthcare administrative data are commonly used for traumatic brain injury (TBI) research, there is currently no consensus or consistency on the International Classification of Diseases Version 10 (ICD-10) codes used to define TBI among children and youth internationally. This study systematically reviewed the literature to explore the range of ICD-10 codes that are used to define TBI in this population. The identification of the range of ICD-10 codes to define this population in administrative data is crucial, as it has implications for policy, resource allocation, planning of healthcare services, and prevention strategies. METHODS The databases MEDLINE, MEDLINE In-Process, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Database of Systematic Reviews were systematically searched. Grey literature was searched using Grey Matters and Google. Reference lists of included articles were also searched for relevant studies. Two reviewers independently screened all titles and abstracts using pre-defined inclusion and exclusion criteria. A full text screen was conducted on articles that met the first screen inclusion criteria. All full text articles that met the pre-defined inclusion criteria were included for analysis in this systematic review. RESULTS A total of 1,326 publications were identified through the predetermined search strategy and 32 articles/reports met all eligibility criteria for inclusion in this review. Five articles specifically examined children and youth aged 19 years or under with TBI. ICD-10 case definitions ranged from the broad injuries to the head codes (ICD-10 S00 to S09) to concussion only (S06.0). There was overwhelming consensus on the inclusion of ICD-10 code S06, intracranial injury, while codes S00 (superficial injury of the head), S03 (dislocation, sprain, and strain of joints and ligaments of head), and S05 (injury of eye and orbit) were only used by articles that examined head injury, none of which specifically examined children and youth. CONCLUSION This review provides evidence for discussion on how best to use ICD codes for different goals. This is an important first step in reaching an appropriate definition and can inform future work on reaching consensus on the ICD-10 codes to define TBI for this vulnerable population.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Pravheen Thurairajah
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
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Yanagawa Y. Profiling pediatric patients involved in automobile crashes in Japan. J Emerg Trauma Shock 2011; 4:333-6. [PMID: 21887020 PMCID: PMC3162699 DOI: 10.4103/0974-2700.83838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 12/15/2010] [Indexed: 11/05/2022] Open
Abstract
Introduction: There is little data concerning the injuries induced by being run over in children. Problem: Characteristics of injuries suffered in children by being run over were investigated. Materials and Methods: Between January 1998 and December 2007, the medical charts were retrospectively reviewed to investigate characteristics of the injuries in pediatric patients run over by a car. Patients meeting the following criteria were included: (1) age ≤ 12 years old; (2) the patient was struck by an automobile. The subjects were divided into three groups by the mechanisms of injury: (1) run over; (2) carried away; (3) contact. Results: Twelve patients had been run over, 44 patients were carried away and 44 patients had been hit by a car (contact). The average age in the run over group was the lowest, followed by that in the carried away group and that in the contact group was the highest. The children's coma score and injury severity score were not significantly different among the three groups; however, the average chest abbreviated injury score was the highest in the run over group, followed by that in the carried away group and that in the contact group was the lowest. The average duration of admission and survival rate among three groups, were not significantly different. Conclusion: The patients who were injured due to being run over by a car, tended to be younger and to have severe chest injury.
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Affiliation(s)
- Youichi Yanagawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College (NDMC), Namiki Tokorozawa Saitama, Japan
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Chen AY, Colantonio A. Defining neurotrauma in administrative data using the International Classification of Diseases Tenth Revision. Emerg Themes Epidemiol 2011; 8:4. [PMID: 21569640 PMCID: PMC3121731 DOI: 10.1186/1742-7622-8-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 05/15/2011] [Indexed: 12/03/2022] Open
Abstract
Background It is essential to use a definition that is precise and accurate for the surveillance of traumatic brain injuries (TBI) and spinal cord injuries (SCI). This paper reviews the International Classification of Diseases 10th revision (ICD-10) definitions used internationally to inform the definition for neurotrauma surveillance using administrative data in Ontario, Canada. Methods PubMed, Web of Science, Medline and the grey literature were searched for keywords "spinal cord injuries" or "brain injuries" and "international classification of diseases". All papers and reports that used an ICD-10 definition were included. To determine the ICD-10 codes for inclusion consensus across papers and additional evidence were sought to look at the correlation between the condition and brain or spinal injuries. Results Twenty-four articles and reports were identified; 15 unique definitions for TBI and 7 for SCI were found. The definitions recommended for use in Ontario by this paper are F07.2, S02.0, S02.1, S02.3, S02.7, S02.8, S02.9, S06, S07.1, T90.2, and T90.5 for traumatic brain injuries and S14.0, S14.1, S24.0, S24.1, S34.1, S34.0, S34.3, T06.0, T06.1 and T91.3 for spinal cord injuries. Conclusions Internationally, inconsistent definitions are used to define brain and spinal cord injuries. An abstraction study of data would be an asset in understanding the effects of inclusion and exclusion of codes in the definition. This paper offers a definition of neurotrauma for surveillance in Ontario, but the definition could be applied to other countries that have mandated administrative data collection.
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Affiliation(s)
- Amy Y Chen
- Toronto Rehabilitation Institute, 550 University Ave, Toronto, Canada.
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Ochalski PG, Adamo MA, Adelson PD, Okonkwo DO, Pollack IF. Fractures of the clivus and traumatic diastasis of the central skull base in the pediatric population. J Neurosurg Pediatr 2011; 7:261-7. [PMID: 21361764 DOI: 10.3171/2010.12.peds10190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Fractures of the clivus and traumatic diastases of the clival synchondroses are rare in the pediatric population. The incidence, outcome, and biomechanics associated with these fractures have been difficult to ascertain secondary to the lack of literature pertaining to their occurrence. METHODS A Boolean search of the electronic medical record database at the Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, was performed to identify patients with fractures of the clivus that were diagnosed using CT of the head. A retrospective review of the chart and radiographic imaging was then performed to assess data regarding patient demographics, mechanism of injury, and skull and brain parenchymal injuries, as well as outcomes. RESULTS Between May 2002 and November 2007, 16 patients with fractures of the clivus were identified. The mean age of these patients was 9 years (range 1-16 years). Eleven (68.8%) of the 16 patients had an associated traumatic diastasis of the central skull base. Five (31.3%) of the 16 patients died. However, of the 11 patients who survived, all had a good outcome with a Glasgow Outcome Scale score of 4 or 5 at the time of discharge. The incidence of clival fractures among patients with head injuries was 0.33%. CONCLUSIONS Clival fractures occur with a similar incidence in both the pediatric and adult trauma population. Outcome is not correlated directly with the extent of clival fracture, but rather with the presenting Glasgow Coma Scale score and concomitant brain parenchymal injuries. The identification of traumatic diastases in patients with clival fractures suggests that static loading forces are a significant factor in the biomechanics producing these types of fractures.
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Affiliation(s)
- Pawel G Ochalski
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Baumer TG, Nashelsky M, Hurst CV, Passalacqua NV, Fenton TW, Haut RC. Characteristics and prediction of cranial crush injuries in children. J Forensic Sci 2010; 55:1416-21. [PMID: 20533974 DOI: 10.1111/j.1556-4029.2010.01475.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study documents four clinical cases of fatal crush injuries to children between 1.5 and 6 years of age with correlations between modeled stress and clinically observed fracture patterns. The clinical case fractures were concentrated in the basicranium, bridged the impact sites, and traversed the middle cranial fossa in the area of the spheno-occipital synchondrosis. The crushing forces from these cases were recreated on a simplified finite element model of a cranium by applying bilateral pressures to corresponding regions. Numerous trials were run to develop a representative pattern of principal stress directions. In all cases, the highest tensile stresses were located on the basicranium and corresponded to the observed fracture path(s). These results suggest that prefailure stress field diagrams may predict fracture propagation paths, although these will not be exact. Also, these analyses indicate that quasi-static bilateral loading of the cranium may lead to predictable fracture of the basicranium.
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Affiliation(s)
- Timothy G Baumer
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
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