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Fierz A. Risks and regulation of rubber scattershot in Switzerland: a narrative review. Eye (Lond) 2024; 38:2898-2906. [PMID: 38977820 PMCID: PMC11461966 DOI: 10.1038/s41433-024-03215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
Multiple kinetic impact projectiles (KIPs) are responsible for most eye injuries by crowd-control weapons. This review aims to outline an underreported, ongoing series of eye injuries by rubber scattershot in Switzerland, and to relate current knowledge about thresholds for lasting visual loss to the energy limits set on KIPs in crowd control, by way of a retrospective compilation of cases from publicly available records and a review of the pertinent literature. Scattershot can cause irreversible visual loss. Since 1980, there have been 36 known cases of eye injuries by rubber pellets in Switzerland. In 2023, the incidence was higher here than at the peak of protests in France. KIPs were originally cleared for use in crowd control at kinetic and area-normalised energies assumed to lie below the threshold for ocular penetration. However, closed globe injuries suffice to cause permanent visual loss. Lower energy thresholds for lasting damage have been confirmed by the newer literature on paintballs, airbags, air guns and toys. These values may differ in vivo versus in vitro, and in humans versus in animals. There is no clear consensus on how best to predict loss of vision. Underreporting the risks of crowd-control weapons may contribute to their prolonged and increasingly liberal use. Regulations should consider what is known on energy thresholds for permanent visual loss. It is critical for ophthalmologists to be involved in the evaluation and monitoring of eye injuries caused by projectiles, including KIPs and toys. An interdisciplinary approach could help to elucidate damage thresholds.
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Affiliation(s)
- Anna Fierz
- Ophthalmologist in private practice, Kalkbreitestr. 8, 8003, Zürich, Switzerland.
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2
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Haupt TL, Harley EH. Targeting safety: Exploring trends and risk factors in pediatric head and neck BB gun injuries and hospitalization. Int J Pediatr Otorhinolaryngol 2024; 176:111783. [PMID: 37995450 DOI: 10.1016/j.ijporl.2023.111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To examine head and neck injuries caused by BB (Ball Bearing) guns treated in US emergency departments among children under 18 to identify trends in injury frequency over time and risk factors associated with severe injuries leading to hospital admission. METHODS This retrospective study utilized data from the National Electronic Injury Surveillance System (NEISS), a single database, to analyze head and neck injuries caused by BB guns between 1993 and 2019. The analysis explored demographic characteristics and injury patterns, including sex, age, incidence, injury location, hospital type, and disposition. Linear regression was employed to assess trends in the yearly frequency of injuries, while univariate and multivariate binary logistic regression was used to calculate the odds ratios associated with hospitalization. RESULTS A total of 4041 cases of pediatric head and neck injuries caused by BB guns and treated in US emergency departments were identified. Most patients were male (84 %), with the highest proportion of injuries occurring in the 10-14 age group (49.7 %). The face (35.8 %) and eye (27.4 %) were the most affected injury sites, and 7.5 % of patients required hospital admission. No significant linear trend was observed in injury frequency over the study period. However, children aged four and under had higher odds of hospitalization (OR 2.77, 95 % CI 1.61-4.75) despite a lower incidence of injuries. Injuries to the eye (OR 12.37, 95 % CI 8.31-18.43) and neck (OR 7.58, 95 % CI 4.76-12.06) were strong predictors of hospital admission. CONCLUSION Pediatric BB gun-related head and neck injuries remain a source of emergency room visits nationally. Younger children are at increased risk of admission to the hospital. Eye and neck injuries were the strongest predictors of hospital admission. Implementing safety precautions for younger children is crucial, as injuries might be more severe in this age group.
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Affiliation(s)
- Thomas L Haupt
- Howard University College of Medicine, Washington, DC, United States.
| | - Earl H Harley
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, United States.
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Marhold F, Scheichel F, Ladisich B, Pruckner P, Strasser E, Themesl M, Ungersboeck K, Popadic B. Surviving the Scene in Civilian Penetrating Brain Injury: Injury Type, Cause and Outcome in a Consecutive Patient Series in Austria. Front Surg 2022; 9:923949. [PMID: 35836601 PMCID: PMC9274525 DOI: 10.3389/fsurg.2022.923949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Penetrating brain injury (PBI) is a heterogeneous condition with many variables. Few data exist on civilian PBI. In some publications, PBI differentiation between low-velocity injury (LVI) and high-velocity injury (HVI) is made, but exact definitions are not given yet. The incidence of PBI depends heavily on the country of origin. Furthermore, captive bolt pistol (CBP) injuries represent a rare type of LVI and almost no reports exist in the human medical literature. Treatment of PBI has been controversially discussed due to high morbidity and mortality with results varying considerably between series. Prognostic factors are of utmost importance to identify patients who presumably benefit from treatment. Methods A retrospective, single-center analysis of a consecutive patient series was performed from September 2005 to May 2018. We included all patients with PBI who reached our hospital alive and received any neurosurgical operative procedure. Results Of 24 patients, 38% died, 17% had an unfavourable outcome, and 46% had a favourable outcome. In total, 58% of patients with PBI were self-inflicted. Leading causes of injury were firearms, while captive bolt pistols were responsible for 21% of injuries. LVI represented 54%, and HVI represented 46%. The outcome in HVI was significantly worse than that in LVI. A favourable outcome was achieved in 69% of LVI and 18% of HVI. Low GCS and pathological pupillary status at admission correlated significantly with an unfavourable outcome and death. Conclusions PBI is a heterogeneous injury with many variables and major geographical and etiological differences. Differentiation between LVI and HVI is crucial for decision-making and predicting outcomes. In patients presenting with object trajectories crossing the midline, no favourable outcome could be achieved. Nevertheless, in total, a favourable outcome was possible in almost half of the patients who succeeded in surgery.
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Affiliation(s)
- Franz Marhold
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
- Correspondence: Marhold Franz
| | - Florian Scheichel
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Barbara Ladisich
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Philip Pruckner
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Elisabeth Strasser
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Melanie Themesl
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Karl Ungersboeck
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Branko Popadic
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
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Dasic D, Morgan L, Panezai A, Syrmos N, Ligarotti GK, Zaed I, Chibbaro S, Khan T, Prisco L, Ganau M. A scoping review on the challenges, improvement programs, and relevant output metrics for neurotrauma services in major trauma centers. Surg Neurol Int 2022; 13:171. [PMID: 35509585 PMCID: PMC9062973 DOI: 10.25259/sni_203_2022] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/20/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
For a neurotrauma unit to be defined as a structured neurotrauma service (NS) the following criteria must be satisfied: A dedicated neurointensive care unit, endovascular neuroradiology, in-hospital neurorehabilitation unit and helicopter platform within the context of a Level I trauma center. Designing an effective NS can be challenging, particularly when considering the different priorities and resources of countries across the globe. In addition the impact on clinical outcomes is not clearly established.
Methods:
A scoping review of the literature spanning from 2000 to 2020 meant to identify protocols, guidelines, and best practices for the management of traumatic brain injury (TBI) in NS was conducted on the US National Library of Medicine and National Institute of Health databases.
Results:
Limited evidence is available regarding quantitative and qualitative metrics to assess the impact of NSs and specialist follow-up clinics on patients’ outcome. Of note, the available literature used to lack detailed reports for: (a) Geographical clusters, such as low-to-middle income countries (LMIC); (b) clinical subgroups, such as mild TBI; and (c) long-term management, such as rehabilitation services. Only in the last few years more attention has been paid to those research topics.
Conclusion:
NSs can positively impact the management of the broad spectrum of TBI in different clinical settings; however more research on patients’ outcomes and quality of life metrics is needed to establish their efficacy. The collaboration of global clinicians and the development of international guidelines applicable also to LMIC are warranted.
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Affiliation(s)
- Davor Dasic
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool,
| | - Lucy Morgan
- School of Health and Care Professions, University of Portsmouth, Portsmouth,
| | - Amir Panezai
- Division of Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom,
| | - Nikolaos Syrmos
- School of Medicine, Aristotle University of Thessaloniki, Greece,
| | | | - Ismail Zaed
- Department of Neurosurgery, Humanitas Research Hospital, Rozzano, Italy,
| | | | - Tariq Khan
- North West General Hospital and Research Centre, Khyber Pakhtunkhwa, Peshawar, Pakistan,
| | - Lara Prisco
- Neuro Intensive Care Unit, Oxford, United Kingdom
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Clinical Significance of Isolated Third Cranial Nerve Palsy in Traumatic Brain Injury: A Detailed Description of Four Different Mechanisms of Injury through the Analysis of Our Case Series and Review of the Literature. Emerg Med Int 2021; 2021:5550371. [PMID: 33976940 PMCID: PMC8087465 DOI: 10.1155/2021/5550371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/18/2021] [Indexed: 11/24/2022] Open
Abstract
Third cranial nerve palsy (3cnP) following traumatic brain injury (TBI) is a worrying neurological sign and is often associated with an expanding mass lesion, such as extradural or acute subdural haematomas. Isolated 3cnP can be found in the absence of posttraumatic space-occupying mass lesion, yet it is often considered as a devastating prognostic factor in the context of diffuse axonal injury (DAI). Through the analysis of five exemplificative cases and a thorough review of the literature, we identified four possible mechanisms leading to 3cnP: (1) a partial rootlet avulsion at the site of exit from the midbrain, representing a direct shearing injury to the nerve; (2) a direct traction injury due to the nerve stretching against the posterior petroclinoid ligament at the base of the oculomotor triangle secondary to the downward displacement of the brainstem at the time of impact; (3) a direct vascular compression as a result of internal carotid artery (ICA) dissection or pseudoaneurysm; (4) an indirect injury caused by impaired blood supply to the third nerve in addition to the detrimental biochemical effects of the underlying brain injury itself. Understanding the exact mechanism underlying the onset of 3cnP is key to provide an informed clinical decision-making to the patients and ensure their best chances of recovery. Our experience corroborates data from the literature showing that, even in Grade III DAI, prompt recognition of isolated 3cnP can guide adequate treatment. Nonetheless, even when an overall good neurological outcome is achieved, recovery of isolated 3cnP is dismal, and only rarely the visual deficit completely resolves.
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Ganau M, Wan Y, Lawrence T, Plaha P. Pitfalls regarding the neurosurgical management of traumatic supra and infratentorial extradural haematomas. Neurosurg Rev 2021; 44:2959-2961. [PMID: 33389343 DOI: 10.1007/s10143-020-01467-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Mario Ganau
- Department of Neurosciences, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | - Yizhou Wan
- Department of Neurosciences, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Tim Lawrence
- Department of Neurosciences, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Puneet Plaha
- Department of Neurosciences, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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Early and Ultraearly Administration of Tranexamic Acid in Traumatic Brain Injury: Our 8-Year-Long Clinical Experience. Emerg Med Int 2020; 2020:6593172. [PMID: 33014471 PMCID: PMC7520008 DOI: 10.1155/2020/6593172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/28/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction The most important result of head trauma, which can develop with a blunt or penetrating mechanism, is traumatic brain injury. Tranexamic acid (TXA) can be used safely in multiple trauma. Recent studies showed that TXA can be useful in management of intracerebral hemorrhage, especially in reducing the amount of bleeding. The TXA given in the first 3 hours has been shown to reduce mortality. The aim of our study was to evaluate the effectiveness of tranexamic acid used in patients with traumatic brain injury. Method Patients with trauma in the emergency room between January 2012 and January 2020 were screened in this retrospective study. The inclusion criteria were being over the age of 18 years, tranexamic acid administration in the emergency department, and traumatic brain injury on brain computerized tomography (CT) and control CT imaging after 6 hours. Results The number of study patients was 51. The median score of GCS was 12.00 (8.00–15.00). Subdural hemorrhage and subarachnoid hemorrhage were the most common findings on brain CT scans. In the group TXA treatment for less than 1 hour, the arrival MAP was low and the pulse was high (p=0.022 and p=0.030, respectively). All the patients were admitted with multiple trauma. None of the 51 patients had thrombotic complications and died due to head injury. Conclusion TXA appears to be a safe drug with few side effects in the short term in head injuries. According to our experience, it comes to mind earlier in multiple trauma, especially in head trauma with pelvic trauma.
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