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Zuniga RDDR, Vieira RDCA, Solla DJF, Godoy DA, Kolias A, de Amorim RLO, de Andrade AF, Teixeira MJ, Paiva WS. Long-term outcome of traumatic brain injury patients with initial GCS of 3-5. World Neurosurg X 2024; 23:100361. [PMID: 38511161 PMCID: PMC10950742 DOI: 10.1016/j.wnsx.2024.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
| | | | - Davi Jorge Fontoura Solla
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | | | | | - Robson Luis Oliveira de Amorim
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
- Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Almir Ferreira de Andrade
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Wellingson Silva Paiva
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
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Crowe JR, Regenhardt RW, Dmytriw AA, Vranic JE, Stapleton CJ, Patel AB. Deconstructive repair of a direct carotid-cavernous fistula via a posterior circulation retrograde approach. J Cerebrovasc Endovasc Neurosurg 2024:jcen.2024.E2023.05.001. [PMID: 38523550 DOI: 10.7461/jcen.2024.e2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
We report a case of a 24-year-old patient who presented after a head trauma with a traumatic occlusion of his left internal carotid artery. He underwent diagnostic cerebral angiogram and was found to have a direct left carotid-cavernous fistula (CCF) with retrograde filling from the posterior circulation across the posterior communicating artery. Because of the severe injury to the left internal carotid artery (ICA), reconstructive repair of the ICA was not possible. The patient underwent deconstructive repair of the CCF by coil embolization using a posterior retrograde approach. Coils were successfully placed in the cavernous sinus and back into the left ICA with complete cure of the CCF and restoration of cerebral perfusion distal to the treated CCF. We review the types of CCFs, their clinical presentation, and their endovascular treatments. Retrograde access of a direct CCF is rarely reported in the literature, and we believe this approach offers a viable alternative in appropriately selected patients.
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Affiliation(s)
- Jonathan R Crowe
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
- Brigham and Women's Hospital, Department of Neurology, 75 Francis Street, Boston, MA
| | - Robert W Regenhardt
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
| | - Adam A Dmytriw
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
| | - Justin E Vranic
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
| | | | - Aman B Patel
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
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Wang B, Zhou Y, Ya X, Kong Z. A rare case of craniocerebral trauma-induced cerebral air embolism. Asian J Surg 2024; 47:767-768. [PMID: 37879992 DOI: 10.1016/j.asjsur.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Bing Wang
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, China
| | - Yang Zhou
- Department of Ultrasound, The First Affiliated Hospital of DaLian Medical University, DaLian City, China
| | - Xinwei Ya
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, China
| | - Zixuan Kong
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, China.
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Zein-Elabdin H, Ghanem MA. Two case reports of fatal injuries sustained from tear gas guns loaded with pebbles as missiles. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00756-6. [PMID: 38036763 DOI: 10.1007/s12024-023-00756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
These two case reports are of fatal injuries from less-lethal weapons (tear gas guns) using pebbles as an unconventional ammunition. Reported here are the fatal outcomes of two 19-year-old males, one with head trauma and the other with abdominal trauma. They were admitted to the ED and subjected to immediate exploratory operations, but they passed away. On autopsy, the first case demonstrated a right frontal bone fracture with subdural hemorrhage and a 3 × 2.5 cm pebble retained in the skull. The second case showed severe liver laceration in close vicinity to a cubical pebble (3.2 × 3 cm). The mechanical forces involved in skull fracture and autopsy are discussed. In the current cases, the relatively larger weight and size together with the surface configuration of the pebble projectile were the main influential factors that contributed to the severity of damage and fatality.These case reports are a working example of the effect of the mass of projectiles in increasing the power of penetration. The direct shooting to the head and the abdomen together with the misuse of these weapons are capable of inflicting fatal injuries.
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Affiliation(s)
- Hisham Zein-Elabdin
- Forensic Medicine Corporation and Forensic Medicine and Clinical Toxicology, Department Faculty of Medicine, University of Science and Technology, Omdurman, Sudan
| | - Maha A Ghanem
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Medical Doctorate Degree of Forensic Medicine and Clinical Toxicology, Alexandria University, Alexandria, Egypt.
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Wang Q, Li L, Wang H, Fan XL, Gao JH, Ma N. [Neurobehavioral effects of explosion exposure on acute and chronic traumatic brain injury in rats]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2023; 41:808-813. [PMID: 38073206 DOI: 10.3760/cma.j.cn121094-20221103-00528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objective: To explore the effect of nerve injury in rats by neurobehavioral experiments, in order to provide a model and idea for further clarification of the traumatic brain injury mechanism under explosion exposure. Methods: From May 2021 to August 2022, 160 SPF male rats were randomly divided into four groups, including control group, 60 kPa group (low intensity group), 90 kPa group (medium intensity group) and 120 kPa group (high intensity group). The blast induced traumatic brain injury (bTBI) model of rats was established by using the shock tube platform to simulate the shock wave parameters of the explosion overpressure of 60 kPa, 90 kPa and 120 kPa. Acute observation was carried out after 24 h and 7 d of explosive exposure, and chronic recovery observation was carried out after 28 d and 90 d. The time effect of shock wave brain injury in different situations was discussed by open field, light dark test, active avoidance test. Finally, the results of brain injury in rats were detected by pathological tissue staining. Results: After 24 h explosion exposure, compared with the control group, the rest time of rats in low and high intensity groups increased, the total movement distance decreased, and the number of visits to the camera obscura decreased, with statistical significance (P<0.05). After 7 days of exposure, compared with the control group, the rest time of rats in high intensity group increased, and the number of visits to the obscura decreased, with statistical significance (P<0.05). After 28 and 90 days of exposure, compared with the control group, there were no significant differences in rest time, total exercise distance and times of visiting the camera obscura in all intensity groups (P>0.05). After 24 h of explosive exposure, compared with the control group, the cell morphology of rats in each intensity group was normal, and no inflammatory cell infiltration was observed. Conclusion: In the acute phase (24 h) of blast exposure, rats have no desire to explore the outside world, and shock wave exposure may damage the neurological function of rats.
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Affiliation(s)
- Q Wang
- Biological Effects Technology Laboratory, Institute of Hygiene of the Ordnance Industry, Xi'an 710065, China
| | - L Li
- Biological Effects Technology Laboratory, Institute of Hygiene of the Ordnance Industry, Xi'an 710065, China
| | - H Wang
- Biological Effects Technology Laboratory, Institute of Hygiene of the Ordnance Industry, Xi'an 710065, China
| | - X L Fan
- Biological Effects Technology Laboratory, Institute of Hygiene of the Ordnance Industry, Xi'an 710065, China
| | - J H Gao
- Biological Effects Technology Laboratory, Institute of Hygiene of the Ordnance Industry, Xi'an 710065, China
| | - N Ma
- Biological Effects Technology Laboratory, Institute of Hygiene of the Ordnance Industry, Xi'an 710065, China
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6
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Szummer G, Wutzler S. [Preclinical care of children with multiple trauma]. Med Klin Intensivmed Notfmed 2023; 118:611-618. [PMID: 37344698 DOI: 10.1007/s00063-023-01032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023]
Abstract
Severe multiple trauma in children is rare with approximately 380-550 cases per year in Germany. In addition to the S3 guideline "Polytrauma", which was published more than a decade ago, the S2K guideline "Severe multiple trauma care in childhood" was published in 2020. Accidents and especially the resulting traumatic brain injuries still represent the most frequent cause of death in children. While prehospital treatment according to Prehospital Trauma Life Support (PHTLS®) is basically analogous to that in adults which is based on the ABCDE concept (airway, breathing, circulation, disability, exposure), knowledge of age-dependent anatomical-physiological characteristics is essential. For simplification, various tools and dosing aids, such as the pediatric emergency ruler and specific emergency tables, are available. Further treatment after initial preclinical care should take place in an interdisciplinary manner in designated pediatric trauma centers.
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Affiliation(s)
- G Szummer
- Klinik für Unfall‑, Hand- und Orthopädische Chirurgie, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Deutschland
| | - S Wutzler
- Klinik für Unfall‑, Hand- und Orthopädische Chirurgie, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Deutschland.
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Dabestani PJ, Massenburg BB, Aurit S, Dawson AJ, Susarla SM. Risk factors for inpatient hospital admission following isolated orbital floor fractures. Int J Oral Maxillofac Surg 2023; 52:1039-1048. [PMID: 37003906 DOI: 10.1016/j.ijom.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
Orbital floor fractures are common injuries seen in the emergency department (ED). In this study, the National Trauma Data Bank (NTDB, 2016-2017) was used to identify patients presenting with isolated orbital floor trauma. Patient-specific factors were analyzed to determine associations with management. The sample comprised 912 patients; 285 (31.3%) of these patients were discharged from the ED, 541 (59.3%) were admitted to the hospital but did not undergo an operation, and 86 (9.4%) underwent operative treatment. Pediatric patients and older patients (<18 years and>55 years) were more likely to be admitted than those aged 18-55 years, and pediatric patients were more likely to undergo an urgent operative intervention than those in the other age groups (all P < 0.001). Patients with alcohol use disorder (P = 0.002) and hypertension (P = 0.004) had increased odds of admission. Private and Medicare insurance patients were more likely to be admitted, and self-pay patients less likely (P < 0.001). Older age and Medicaid payor status showed increased odds of a greater hospital length of stay. Biological sex, race/ethnicity, functionally dependent health status, myocardial infarction, steroid use, and substance use disorder were not associated with discharge disposition. There are non-injury related, patient-specific factors that may influence the management of orbital floor fractures.
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Affiliation(s)
- P J Dabestani
- Division of Plastic and Reconstructive Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - B B Massenburg
- Department of Oral and Maxillofacial Surgery and Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, Washington, USA
| | - S Aurit
- Division of Plastic and Reconstructive Surgery, Creighton University, Omaha, Nebraska, USA
| | - A J Dawson
- Division of Plastic and Reconstructive Surgery, Creighton University, Omaha, Nebraska, USA
| | - S M Susarla
- Department of Oral and Maxillofacial Surgery and Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, Washington, USA.
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Forouzannia SM, Najafimehr H, Oskooi RK, Faridaalaee G, Dizaji SR, Toloui A, Forouzannia SA, Alavi SNR, Alizadeh M, Safari S, Baratloo A, Yousefifard M, Hosseini M. Clinical decision rules in predicting computed tomography scan findings and need for neurosurgical intervention in mild traumatic brain injury: a prospective observational study. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02373-y. [PMID: 37747501 DOI: 10.1007/s00068-023-02373-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE In this study, we will compare the diagnostic values of head CT decision rules in predicting the findings of CT scans in a prospective multicenter study in university emergency departments in Iran. METHODS The primary outcome was any traumatic lesion findings in brain CT scans, and the secondary outcomes were death, the need for mechanical ventilation, and neurosurgical intervention. Decision rules including the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS), and Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS) were compared for the main outcomes. RESULTS In total, 434 mild TBI patients were enrolled in the study. The NCWFNS had the highest sensitivity (91.14%) and the lowest specificity (39.42%) for predicting abnormal finding in CT scan compared to other models. While the NICE obtained the lowest sensitivity (79.75%), it was associated with the highest specificity (66.67%). All model performances were improved when administered to predict neurosurgical intervention among patients with GCS 13-15. NEXUS (AUC 0.862, 95% CI 0.799-0.924) and NCWFNS (AUC 0.813, 95% CI 0.723-0.903) had the best performance among all evaluated models. CONCLUSION The NCWFNS and the NEXUS decision rules performed better than the CCHR and NICE guidelines for predicting any lesion in the CT imaging and neurosurgical intervention among patients with mTBI with GCS 13-15. For a subset of mTBI patients with GCS 15, the NOC criteria have higher sensitivity for abnormal CT imaging, but lower specificity and more requested CTs.
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Affiliation(s)
| | - Hadis Najafimehr
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Gholamreza Faridaalaee
- Emergency Medicine and Trauma Research Center, Tabriz University of Medical Sciences, Tabriz, IR, Iran
- Department of Emergency Medicine, Maragheh University of Medical Sciences, Maragheh, IR, Iran
| | - Shayan Roshdi Dizaji
- Physiology Research Center, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran
| | - Amirmohammad Toloui
- Physiology Research Center, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran
| | - Seyed Ali Forouzannia
- Physiology Research Center, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran
| | | | - Mohammadreza Alizadeh
- Physiology Research Center, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran
| | - Saeed Safari
- Mens' Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Baratloo
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran.
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave. Enghelab Ave., Tehran, Iran.
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Inoue F, Hongo T, Ichiba T, Otani T, Naito H, Kosaki Y, Murakami Y, Iida A, Yumoto T, Naito H, Nakao A. Collapse-related traumatic intracranial hemorrhage following out-of-hospital cardiac arrest: A multicenter retrospective cohort study. Resusc Plus 2023; 15:100418. [PMID: 37416696 PMCID: PMC10319812 DOI: 10.1016/j.resplu.2023.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
Background Sudden loss of consciousness as a result of cardiac arrest can cause severe traumatic head injury. Collapse-related traumatic intracranial hemorrhage (CRTIH) following out-of-hospital cardiac arrest (OHCA) may be linked to poor neurological outcomes; however, there is a paucity of data on this entity. This study aimed to investigate the frequency, characteristics, and outcomes of CRTIH following OHCA. Methods Adult patients treated post-OHCA at 5 intensive care units who had head computed tomography (CT) scans were included in the study. CRTIH following OHCA was defined as a traumatic intracranial injury from collapse due to sudden loss of consciousness associated with OHCA. Patients with and without CRTIH were compared. The primary outcome assessed was the frequency of CRTIH following OHCA. Additionally, the clinical features, management, and consequences of CRTIH were analyzed descriptively. Results CRTIH following OHCA was observed in 8 of 345 enrolled patients (2.3%). CRTIH was more frequent after collapse outside the home, from a standing position, or due to cardiac arrest with a cardiac etiology. Intracranial hematoma expansion on follow up CT was seen in 2 patients; both received anticoagulant therapy, and one required surgical evacuation. Three patients (37.5%) with CRTIH had favorable neurological outcomes 28 days after collapse. Conclusions Despite its rare occurrence, physicians should pay special attention to CRTIH following OHCA during the post-resuscitation care period. Larger prospective studies are warranted to provide a more explicit picture of this clinical condition.
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Affiliation(s)
- Fumiya Inoue
- Department of Emergency Medicine, Hiroshima City Hospital, 7-33 Motomachi, Hiroshima Naka-ku, Hiroshima 730-8518, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Okayama Kita-ku, Okayama 700-8511, Japan
| | - Toshihisa Ichiba
- Department of Emergency Medicine, Hiroshima City Hospital, 7-33 Motomachi, Hiroshima Naka-ku, Hiroshima 730-8518, Japan
| | - Takayuki Otani
- Department of Emergency Medicine, Hiroshima City Hospital, 7-33 Motomachi, Hiroshima Naka-ku, Hiroshima 730-8518, Japan
| | - Hiroshi Naito
- Department of Emergency Medicine, Hiroshima City Hospital, 7-33 Motomachi, Hiroshima Naka-ku, Hiroshima 730-8518, Japan
| | - Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Yuya Murakami
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency and Critical Care Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan
| | - Atsuyoshi Iida
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Okayama Kita-ku, Okayama 700-8607, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
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Calame DJ, Riaz M. Pediatric craniocerebral firearm injuries: literature review, best practices in medical and surgical management, and case report. Childs Nerv Syst 2023; 39:2195-2199. [PMID: 37100970 DOI: 10.1007/s00381-023-05968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Civilian craniocerebral firearm injuries are extremely lethal. Management includes aggressive resuscitation, early surgical intervention when indicated, and management of intracranial pressure. Patient neurological status and imaging features should be used to guide management and the degree of intervention. Pediatric craniocerebral firearm injuries have a higher survival rate, but are much rarer, especially in children under 15 years old. This paucity of data underscores the importance of reviewing pediatric craniocerebral firearm injuries to determine best practices in surgical and medical management. CASE PRESENTATION A 2-year-old female was admitted after suffering a gunshot wound to the left frontal lobe. Upon initial evaluation, the patient displayed agonal breathing and fixed pupils with a GCS score of 3. CT imaging showed a retained ballistic projectile in the right temporal-parietal region with bifrontal hemorrhages, subarachnoid blood, and a 5-mm midline shift. The injury was deemed nonsurvivable and non-operable; thus, treatment was primarily supportive. Upon removal of the endotracheal tube, the patient began breathing spontaneously and improved clinically to a GCS score of 10-12. On hospital day 8, she underwent cranial reconstruction with neurosurgery. Her neurological status continued to improve, and she was able to communicate and follow commands but retained notable left-sided hemiplegia with some left-sided movement. On hospital day 15, she was deemed safe for discharge to acute rehabilitation.
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Affiliation(s)
- D J Calame
- Medical Scientist Training Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - M Riaz
- Department of Neurosurgery, Denver Health Medical Center, Denver, CO, USA
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Kim JH, Choo YH, Jeong H, Kim M, Ha EJ, Oh J, Lee S. Recent Updates on Controversies in Decompressive Craniectomy and Cranioplasty: Physiological Effect, Indication, Complication, and Management. Korean J Neurotrauma 2023; 19:128-148. [PMID: 37431371 PMCID: PMC10329888 DOI: 10.13004/kjnt.2023.19.e24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023] Open
Abstract
Decompressive craniectomy (DCE) and cranioplasty (CP) are surgical procedures used to manage elevated intracranial pressure (ICP) in various clinical scenarios, including ischemic stroke, hemorrhagic stroke, and traumatic brain injury. The physiological changes following DCE, such as cerebral blood flow, perfusion, brain tissue oxygenation, and autoregulation, are essential for understanding the benefits and limitations of these procedures. A comprehensive literature search was conducted to systematically review the recent updates in DCE and CP, focusing on the fundamentals of DCE for ICP reduction, indications for DCE, optimal sizes and timing for DCE and CP, the syndrome of trephined, and the debate on suboccipital CP. The review highlights the need for further research on hemodynamic and metabolic indicators following DCE, particularly in relation to the pressure reactivity index. It provides recommendations for early CP within three months of controlling increased ICP to facilitate neurological recovery. Additionally, the review emphasizes the importance of considering suboccipital CP in patients with persistent headaches, cerebrospinal fluid leakage, or cerebellar sag after suboccipital craniectomy. A better understanding of the physiological effects, indications, complications, and management strategies for DCE and CP to control elevated ICP will help optimize patient outcomes and improve the overall effectiveness of these procedures.
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Affiliation(s)
- Jae Hyun Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Hee Choo
- Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Heewon Jeong
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jin Ha
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jiwoong Oh
- Division of Neurotrauma & Neurocritical Care Medicine, Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Réa-Neto Á, da Silva Júnior ED, Hassler G, Dos Santos VB, Bernardelli RS, Kozesinski-Nakatani AC, Martins-Junior MJ, Reese FB, Cosentino MB, Oliveira MC, Teive HAG. Epidemiological and clinical characteristics predictive of ICU mortality of patients with traumatic brain injury treated at a trauma referral hospital - a cohort study. BMC Neurol 2023; 23:101. [PMID: 36890473 PMCID: PMC9993710 DOI: 10.1186/s12883-023-03145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) has substantial physical, psychological, social and economic impacts, with high rates of morbidity and mortality. Considering its high incidence, the aim of this study was to identify epidemiological and clinical characteristics that predict mortality in patients hospitalized for TBI in intensive care units (ICUs). METHODS A retrospective cohort study was carried out with patients over 18 years old with TBI admitted to an ICU of a Brazilian trauma referral hospital between January 2012 and August 2019. TBI was compared with other traumas in terms of clinical characteristics of ICU admission and outcome. Univariate and multivariate analyses were used to estimate the odds ratio for mortality. RESULTS Of the 4816 patients included, 1114 had TBI, with a predominance of males (85.1%). Compared with patients with other traumas, patients with TBI had a lower mean age (45.3 ± 19.1 versus 57.1 ± 24.1 years, p < 0.001), higher median APACHE II (19 versus 15, p < 0.001) and SOFA (6 versus 3, p < 0.001) scores, lower median Glasgow Coma Scale (GCS) score (10 versus 15, p < 0.001), higher median length of stay (7 days versus 4 days, p < 0.001) and higher mortality (27.6% versus 13.3%, p < 0.001). In the multivariate analysis, the predictors of mortality were older age (OR: 1.008 [1.002-1.015], p = 0.016), higher APACHE II score (OR: 1.180 [1.155-1.204], p < 0.001), lower GCS score for the first 24 h (OR: 0.730 [0.700-0.760], p < 0.001), greater number of brain injuries and presence of associated chest trauma (OR: 1.727 [1.192-2.501], p < 0.001). CONCLUSION Patients admitted to the ICU for TBI were younger and had worse prognostic scores, longer hospital stays and higher mortality than those admitted to the ICU for other traumas. The independent predictors of mortality were older age, high APACHE II score, low GCS score, number of brain injuries and association with chest trauma.
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Affiliation(s)
- Álvaro Réa-Neto
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil. .,Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, General Carneiro Street, 181, Curitiba, Paraná, 80060-900, Brazil.
| | | | - Gabriela Hassler
- Federal University of Paraná, General Carneiro Street, 181, Curitiba, Paraná, 80060-900, Brazil
| | - Valkiria Backes Dos Santos
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil
| | - Rafaella Stradiotto Bernardelli
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,School of Medicine and Life Sciences, Pontifical Catholic University of Paraná, Imaculada Conceição Street, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Amanda Christina Kozesinski-Nakatani
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,Hospital Santa Casa de Curitiba., Praça Rui Barbosa, 694, Curitiba, Paraná, 80010-030, Brazil
| | - Marcelo José Martins-Junior
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil
| | - Fernanda Baeumle Reese
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Mariana Bruinje Cosentino
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Mirella Cristine Oliveira
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Hélio Afonso Ghizoni Teive
- Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, General Carneiro Street, 181, Curitiba, Paraná, 80060-900, Brazil
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13
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Pantelatos RI, Rahim S, Vik A, Rao V, Müller TB, Nilsen TI, Skandsen T. The Epidemiology of Moderate and Severe Traumatic Brain Injury in Central Norway. Neuroepidemiology 2023; 57:185-196. [PMID: 36682352 PMCID: PMC10866178 DOI: 10.1159/000529072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Few studies account for prehospital deaths when estimating incidence and mortality rates of moderate and severe traumatic brain injury (msTBI). In a population-based study, covering both urban and rural areas, including also prehospital deaths, the aim was to estimate incidence and mortality rates of msTBI. Further, we studied the 30-day and 6-month case-fatality proportion of severe TBI in relation to age. METHODS All patients aged ≥17 years who sustained an msTBI in Central Norway were identified by three sources: (1) the regional trauma center, (2) the general hospitals, and (3) the Norwegian Cause of Death Registry. Incidence and mortality rates were standardized according to the World Health Organization's world standard population. Case-fatality proportions were calculated by the number of deaths from severe TBI at 30 days and 6 months, divided by all patients with severe TBI. RESULTS The overall incidence rates of moderate and severe TBI were 4.9 and 6.7 per 100,000 person-years, respectively, increasing from age 70 years. The overall mortality rate was 3.4 per 100,000 person-years, also increasing from age 70 years. Incidence and mortality rates were highest in men. The case-fatality proportion in people with severe TBI was 49% in people aged 60-69 years and 81% in people aged 70-79 years. CONCLUSION The overall incidence and mortality rates for msTBI in Central Norway were low but increased from age 70 years, and among those ≥80 years of age with severe TBI, nearly all died. Overall estimates are strongly influenced by high incidence and mortality rates in the elderly, and studies should therefore report age-specific estimates, for better comparison of incidence and mortality rates.
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Affiliation(s)
- Rabea I. Pantelatos
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Shavin Rahim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Neuroclinic, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vidar Rao
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Neuroclinic, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tomm B. Müller
- Neuroclinic, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tom I.L. Nilsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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14
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Kähler A, Püschel K, Ondruschka B, Thiesen D, Kleinertz H, Fitzek A. [One and a half years of e-scooters in Hamburg]. Rechtsmedizin (Berl) 2023; 33:163-169. [PMID: 36624757 PMCID: PMC9815051 DOI: 10.1007/s00194-022-00602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 01/06/2023]
Abstract
Background Since the spread of the so-called electric scooters (e-scooters) through rental services in Hamburg as of June 2019, accidents due to the use of this means of transportation have been regularly registered. The most frequent injury patterns among e‑scooter riders involved accidents concerning the upper extremities and the head. There was a relevant accumulation of drunk drivers among the injured persons. Objective The aim of the study is to compare injury patterns in drunk versus non-drunk e‑scooter riders who had an accident. Material and methods Data from the Department of Trauma Surgery at the University Medical Center Hamburg-Eppendorf were retrospectively analyzed for accidents involving e‑scooters and the resulting injury patterns. For this purpose, the gender, age, injury pattern of the persons, the course of the accident, and information on previous alcohol consumption were recorded descriptively for the period from June 2019 to December 2021. Results Drivers were on average 32 (interval: 15-88 years) years old and those under the influence of alcohol were predominantly male (69.9%). Accidents occurred mainly in summer and at night. Common injury patterns were injuries to the face, head, and extremities. Conclusion It should be noted that injuries to the face and head occurred more frequently under the influence of alcohol than in the cohort without alcohol. Education about the health and legal consequences of riding an e‑scooter under the influence of alcohol should be provided to all users. In addition, wearing a helmet or banning driving at night are possible measures to reduce accidents associated with drunk riding.
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Affiliation(s)
- Antonia Kähler
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
| | - Klaus Püschel
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
| | - Benjamin Ondruschka
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
| | - Darius Thiesen
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Holger Kleinertz
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Antonia Fitzek
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
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15
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Rahim S, Laugsand EA, Fyllingen EH, Rao V, Pantelatos RI, Müller TB, Vik A, Skandsen T. Moderate and severe traumatic brain injury in general hospitals: a ten-year population-based retrospective cohort study in central Norway. Scand J Trauma Resusc Emerg Med 2022; 30:68. [PMID: 36494745 PMCID: PMC9733333 DOI: 10.1186/s13049-022-01050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with moderate and severe traumatic brain injury (TBI) are admitted to general hospitals (GHs) without neurosurgical services, but few studies have addressed the management of these patients. This study aimed to describe these patients, the rate of and reasons for managing patients entirely at the GH, and differences between patients managed entirely at the GH (GH group) and patients transferred to the regional trauma centre (RTC group). We specifically examined the characteristics of elderly patients. METHODS Patients with moderate (Glasgow Coma Scale score 9-13) and severe (score ≤ 8) TBIs who were admitted to one of the seven GHs without neurosurgical services in central Norway between 01.10.2004 and 01.10.2014 were retrospectively identified. Demographic, injury-related and outcome data were collected from medical records. Head CT scans were reviewed. RESULTS Among 274 patients admitted to GHs, 137 (50%) were in the GH group. The transferral rate was 58% for severe TBI and 40% for moderate TBI. Compared to the RTC group, patients in the GH group were older (median age: 78 years vs. 54 years, p < 0.001), more often had a preinjury disability (50% vs. 39%, p = 0.037), and more often had moderate TBI (52% vs. 35%, p = 0.005). The six-month case fatality rate was low (8%) in the GH group when transferral was considered unnecessary due to a low risk of further deterioration and high (90%, median age: 87 years) when neurosurgical intervention was considered nonbeneficial. Only 16% of patients ≥ 80 years old were transferred to the RTC. For this age group, the in-hospital case fatality rate was 67% in the GH group and 36% in the RTC group and 84% and 73%, respectively, at 6 months. CONCLUSIONS Half of the patients were managed entirely at a GH, and these were mainly patients considered to have a low risk of further deterioration, patients with moderate TBI, and elderly patients. Less than two of ten patients ≥ 80 years old were transferred, and survival was poor regardless of the transferral status.
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Affiliation(s)
- Shavin Rahim
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Eivor Alette Laugsand
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway ,grid.414625.00000 0004 0627 3093Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600 Levanger, Norway ,grid.52522.320000 0004 0627 3560Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Even Hovig Fyllingen
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7491 Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7006 Trondheim, Norway
| | - Vidar Rao
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Rabea Iris Pantelatos
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Tomm Brostrup Müller
- grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Anne Vik
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Toril Skandsen
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Clinic of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Cairncross M, Gindwani H, Rita Egbert A, Torres IJ, Hutchison JS, Dams O'Connor K, Panenka WJ, Brubacher JR, Meddings L, Kwan L, Yeates KO, Green R, Silverberg ND. Criterion validity of the brief test of adult cognition by telephone (BTACT) for mild traumatic brain injury. Brain Inj 2022; 36:1228-1236. [PMID: 36099151 DOI: 10.1080/02699052.2022.2109744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES There is a growing demand for remote assessment options for measuring cognition after mild traumatic brain injury (mTBI). The current study evaluated the criterion validity of the Brief Test of Adult Cognition by Telephone (BTACT) in distinguishing between adults with mTBI and trauma controls (TC) who sustained injuries not involving the head or neck. METHODS The BTACT was administered to the mTBI (n = 46) and TC (n = 35) groups at 1-2 weeks post-injury. Participants also completed the Rivermead Post Concussion Symptoms Questionnaire. RESULTS The BTACT global composite score did not significantly differ between the groups (t(79) = -1.04, p = 0.30); the effect size was small (d = 0.23). In receiver operating characteristic curve analyses, the BTACT demonstrated poor accuracy in differentiating between the groups (AUC = 0.567, SE = 0.065, 95% CI [0.44, 0.69]). The BTACT's ability to discriminate between mTBI and TCs did not improve after excluding mTBI participants (n = 15) who denied ongoing cognitive symptoms (AUC = 0.567, SE = 0.072, 95% CI [0.43, 0.71]). CONCLUSIONS The BTACT may lack sensitivity to subacute cognitive impairment attributable to mTBI (i.e., not explained by bodily pain, post-traumatic stress, and other nonspecific effects of injury).
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Affiliation(s)
- Molly Cairncross
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Psychology, University of British Columbia, Vancouver, Canada.,Department of Psychology, Simon Fraser University, Vancouver, Canada
| | - Hiresh Gindwani
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Anna Rita Egbert
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health and Substance Use Services Research Institute; Vancouver, Canada
| | - James S Hutchison
- Department of Critical Care and Neuroscience and Mental Health Research Program, The Hospital for Sick Children, the Institute for Medical Science and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Kristen Dams O'Connor
- Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health and Substance Use Services Research Institute; Vancouver, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Louise Meddings
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lexynn Kwan
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Keith O Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Robin Green
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Noah D Silverberg
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Psychology, University of British Columbia, Vancouver, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada
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Park ES, Yang HJ, Park JB. Pediatric Traumatic Brain Injury : The Epidemiology in Korea. J Korean Neurosurg Soc 2022; 65:334-341. [PMID: 35468704 PMCID: PMC9082131 DOI: 10.3340/jkns.2021.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/26/2022] [Indexed: 11/27/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the leading causes of death in the pediatric population in Korea. In addition, it can cause disability in children and adolescents, with physical and mental consequences. This causes a substantial burden on the health care system and occurs globally and not just in Korea. We searched and reviewed current data on the epidemiologic characteristics of pediatric TBI in Korea. Our review provides the recent epidemiological trend mainly focusing on incidence and mortality along with worldwide reported data. This review will be helpful to understand the global epidemiology of pediatric TBI and its differences between countries.
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Affiliation(s)
- Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Abstract
Abusive head trauma (AHT) is the most severe form of physical abuse in children. Such injury involves traumatic damage to the head and/or spine of infants and young children. The term AHT was introduced to include a wider range of injury mechanisms, such as intentional direct blow, throw, and even penetrating trauma by perpetuator(s). Currently, it is recommended to replace the former term, shaken baby syndrome, which implicates shaking as the only mechanism, with AHT to include diverse clinical and radiological manifestations. The consequences of AHT cause devastating medical, social and financial burdens on families, communities, and victims. The potential harm of AHT to the developing brain and spinal cord of the victims is tremendous. Many studies have reported that the adverse effects of AHT are various and serious, such as blindness, mental retardation, physical limitation of daily activities and even psychological problems. Therefore, appropriate vigilance for the early recognition and diagnosis of AHT is highly recommended to stop and prevent further injuries. The aim of this review is to summarize the relevant evidence concerning the early recognition and diagnosis of AHT. To recognize this severe type of child abuse early, all health care providers maintain a high index of suspicion and vigilance. Such suspicion can be initiated with careful and thorough history taking and physical examinations. Previously developed clinical prediction rules can be helpful for decision-making regarding starting an investigation when considering meaningful findings. Even the combination of biochemical markers may be useful to predict AHT. For a more confirmative evaluation, neuroradiological imaging is required to find AHT-specific findings. Moreover, timely consultation with ophthalmologists is needed to find a very specific finding, retinal hemorrhage.
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Affiliation(s)
- Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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19
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Konrad S, Pähler Vor der Holte A, Bertram O, Welkoborsky HJ. [Skull and skull base injuries in children and adolescents : Results of a monocentric analysis]. HNO 2022; 70:352-360. [PMID: 35420311 DOI: 10.1007/s00106-022-01167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The present study comprises a retrospective analysis of skull, skull base, and midface fractures in children, to provide clinical orientation for their management. To date, only few data are available on these injuries in this patient group. METHODS Data from inpatient cases diagnosed with a midface, skull, or skull base fracture in the Children's Hospital Auf der Bult from 2015 to 2020 were evaluated. Age, gender, fracture mechanism, diagnosis, treatment, and possible complications were analyzed. Data of 224 children were grouped into 107 cases with nose fractures, 104 cases with skull fractures, 9 patients with temporal bone fractures, 4 patients with rhinobasal fractures, and 2 cases with fractures of the orbital floor. RESULTS Among patients with nose fractures, the average age was 10.9 years (64% males), among patients with skull fractures 1.0 year (64% males), and in children with skull base fractures 6.0 years (85% males). Falls were the most frequent genesis (63%), followed by car accidents, collisions (25%), and violence (10%). Patients with skull fractures underwent sonography in 94% of cases; in 87% the fracture was verified. Patients with nose fractures underwent x‑ray in 92% of cases, or sonography only in 8%; 95% of patients with nose fractures underwent operative repositioning. Typical fracture signs (i.e., hemotympanum, ophthalmic symptoms) or signs of central nervous system involvement (i.e., nausea, amnesia) occurred in 12 of 13 children with skull base fractures, and CT was performed in all these cases (none of whom developed a cerebrospinal fluid leak). CONCLUSION The imaging modality should be selected based on the clinically suspected diagnosis and the course. Most fractures can be sufficiently treated without any permanent sequelae, except for nose fractures, which frequently require operative repositioning.
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Affiliation(s)
- Simon Konrad
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland.
- Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland.
| | - Anja Pähler Vor der Holte
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland
- Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Oliver Bertram
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland
- Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Hans-Jürgen Welkoborsky
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland
- Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
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Paquin V, Elgbeili G, Munden J, Schmitz N, Joober R, Ciampi A, King S. Conditional associations between childhood cat ownership and psychotic experiences in adulthood: A retrospective study. J Psychiatr Res 2022; 148:197-203. [PMID: 35131588 DOI: 10.1016/j.jpsychires.2022.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 11/16/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022]
Abstract
Ownership of cats in childhood has been inconsistently associated with psychosis in adulthood. Parasitic exposure, the putative mechanism of this association, may be more common with rodent-hunting cats, and its association with psychosis may depend on other environmental exposures. We examined the conditional associations between childhood cat ownership and the frequency of psychotic experiences in adulthood. Adults (n = 2206) were recruited in downtown Montreal to complete a survey about childhood cat ownership (non-hunting or rodent-hunting), winter birth, residential moves in childhood, head trauma history, and tobacco smoking. The frequency of psychotic experiences (PE) was measured with the 15-item positive subscale of the Community Assessment of Psychic Experiences. Associations between exposures and PE were examined in linear regressions adjusted for age and sex. Interactions among variables were explored using a conditional inference tree. Rodent-hunting cat ownership was associated with higher PE scores in male participants (vs. non-hunting or no cat ownership: SMD = 0.57; 95% CI: 0.27, 0.86), but not in female participants (SMD = 0.10; 95% CI: -0.18, 0.38). In the conditional inference tree, the highest mean PE score was in the class comprised of non-smokers with >1 residential move, head trauma history, and rodent-hunting cat ownership (n = 22; mean standard score = 0.96). The interaction between rodent-hunting cat ownership and head trauma history was supported by a post-hoc linear regression model. Our findings suggest childhood cat ownership has conditional associations with psychotic experiences in adulthood.
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Rozema R, El Moumni M, de Vries GT, Spijkervet FKL, Verbeek R, Kleinbergen JYJ, Bens BWJ, Doff MHJ, van Minnen B; REDUCTION study group. A clinical decision aid to discern patients without and with midfacial and mandibular fractures that require treatment (the REDUCTION-II study): a prospective multicentre cohort study. Eur J Trauma Emerg Surg 2022. [PMID: 35211773 DOI: 10.1007/s00068-022-01892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Purpose To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with midfacial and mandibular fractures that require treatment. Methods A prospective multicentre cohort study was conducted in four hospitals in the Netherlands. Consecutive maxillofacial trauma patients were included whereupon each patient underwent a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular trauma, respectively. The primary outcome was the decision whether to treat during the emergency department stay or within 24 h of admission. The diagnostic accuracy was calculated for the individual physical examination findings and ensuing clinical decision aids with the focus being on detecting midfacial and mandibular fractures that require active treatment. Results A total of 766 midfacial trauma patients were identified of whom 339 (44.3%) had midfacial fractures. Of those, 74 (21.8%) required active treatment. A total of 280 mandibular trauma patients were identified of whom 66 (23.6%) had mandibular fractures. Of those, 37 (56.0%) required active treatment. The decision aid for midfacial trauma consisting of facial depression, epistaxis, ocular movement limitation, palpable step-off, objective malocclusion and tooth mobility or avulsion had a sensitivity of 97.3 (90.7–99.3), a specificity of 38.6 (35.0–42.3), and a negative predictive value of 99.3 (97.3–99.8). The decision aid for mandibular trauma consisting of mouth opening limitation, jaw movement pain, objective malocclusion and tooth mobility or avulsion resulted in a sensitivity of 100.0 (90.6–100.0), a specificity of 39.1 (33.2–45.4), and a negative predictive value of 100.0 (96.1–100.0). Conclusion The clinical decision aids successfully identified midfacial and mandibular trauma patients requiring active fracture treatment and so may be useful in preventing unnecessary radiological procedures in the future. Trial Registration The study was registered at ClinicalTrials.gov with the identifier NCT03314480. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01892-4.
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Gennequin M, Bachelet D, Eloy P, Moyer JD, Roquilly A, Gauss T, Weiss E, Foucrier A. Empiric antimicrobial therapy for early-onset pneumonia in severe trauma patients. Eur J Trauma Emerg Surg 2022; 48:2763-2771. [PMID: 35001179 DOI: 10.1007/s00068-021-01870-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The bacterial ecology involved in early pneumonia of severe trauma patients is mostly commensal and would allow wide use of narrow-spectrum antibiotics. We describe risk factors for treatment failure of severe trauma patients' pneumonia with the use of narrow-spectrum antimicrobial therapy in order to develop a score that could help clinicians to determine which patients might be treated with narrow-spectrum antibiotics. METHODS A retrospective, observational, monocentric cohort study was conducted of severe trauma patients requiring mechanical ventilation for > 48 h and developing a first episode of microbiologically confirmed pneumonia occurring within the first 10 days after admission. RESULTS Overall, 370 patients were included. The resistance rate against narrow-spectrum antibiotics (amoxicillin/clavulanic acid) was 22.7% (84 pneumonia). In a multivariate analysis, two independent risk factors were associated with this resistance: prior antimicrobial therapy ≥ 48 h (OR 4.00; 95 CI [2.39; 6.75]) and age ≥ 30y (OR 2.10; 95 CI [1.21; 3.78]). We created a prediction score that defined patient with one or two risk factors at high risk of resistance. This score presented a sensitivity of 0.92 [0.88; 0.94], a specificity of 0.33 [0.28; 0.38], a positive predictive value of 0.29 [0.24; 0.33] and a negative predictive value of 0.93 [0.90; 0.95]. CONCLUSION Simple risk factors may help clinicians to identify severe trauma patients at high risk of pneumonia treatment failure with the use of narrow-spectrum antimicrobial therapy and, thus, use better tailored empiric therapy and limit the use of unnecessary broad-spectrum antimicrobial therapy.
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Affiliation(s)
- Maël Gennequin
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
| | - Delphine Bachelet
- Département d'épidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France
| | - Philippine Eloy
- Département d'épidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France
| | - Jean-Denis Moyer
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Antoine Roquilly
- Intensive Care Unit, Anaesthesia and Critical Care Dept, Hôtel Dieu-HME, University Hospital of Nantes, Nantes, France
| | - Tobias Gauss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
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Jenny C. Mild abusive head injury: diagnosis and pitfalls. Childs Nerv Syst 2022; 38:2301-10. [PMID: 36637470 DOI: 10.1007/s00381-022-05780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/05/2022] [Indexed: 01/14/2023]
Abstract
Clinicians often miss making the diagnosis of abusive head injury in infants and toddlers who present with mild, non-specific symptoms such as vomiting, fussiness, irritability, trouble sleeping and eating, and seizure. If abusive head injury is missed, the child is likely to go on to experience more severe injury. An extensive review of the medical literature was done to summarize what is known about missed abusive head injury and about how these injuries can be recognized and appropriately evaluated. The following issues will be addressed: the definition of mild head injury, problems encountered when clinicians evaluated mildly ill young children with non-specific symptoms, the risk of missing the diagnosis of mild abusive head trauma, the risks involved in subjecting infants and young children to radiation and/or sedation required for neuroimaging studies, imaging options for suspected neurotrauma in children, clinical prediction rules for evaluating mild head injury in children, laboratory tests than can be helpful in diagnosing mild abusive head injury, history and physical examination when diagnosing or ruling out mild abusive head injury, social and family factors that could be associated with abusive injuries, and interventions that could improve our recognition of mild abusive head injuries. Relevant literature is described and evaluated. The conclusion is that abusive head trauma remains a difficult diagnosis to identify in mildly symptomatic young children.
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Huckhagel T, Riedel C, Rohde V, Lefering R. Cranial nerve injuries in patients with moderate to severe head trauma - Analysis of 91,196 patients from the TraumaRegister DGU® between 2008 and 2017. Clin Neurol Neurosurg 2021; 212:107089. [PMID: 34902753 DOI: 10.1016/j.clineuro.2021.107089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) constitutes a major cause of trauma-related disability and mortality. The epidemiology and implications of associated cranial nerve injuries (CNI) in moderate to severe TBI are largely unknown. We aimed to determine the incidence of CNI in a large European cohort of TBI patients as well as clinical differences between TBI cases with and without concomitant CNI (CNI vs. control group) by means of a multinational trauma registry. METHODS The TraumaRegister DGU® was evaluated for trauma patients with head injuries ≥ 2 Abbreviated Injury Scale, who had to be treated on intensive care units after emergency admission to European hospitals between 2008 and 2017. CNI and control cases were compared with respect to demographic, clinical, and outcome variables. RESULTS 1.0% (946 of 91,196) of TBI patients presented with additional CNI. On average, CNI patients were younger than control cases (44.3 ± 20.6 vs. 51.8 ± 23.0 years) but did not differ regarding sex distribution (CNI 69.4% males vs. control 69.1%). Traffic accidents were encountered more frequently in CNI cases (52.3% vs. 46.7%; p < 0.001; chi-squared test) and falls more commonly in the control group (45.2% vs. 37.1%; p < 0.001). CNI patients suffered more frequently from concomitant face injuries (28.2% vs. 17.5%; p < 0.001) and skull base fractures (51.0% vs. 23.5%; p < 0.001). Despite similar mean Injury Severity Score (CNI 21.8 ± 11.3; control 21.1 ± 11.7) and Glasgow Coma Scale score (CNI 10.9 ± 4.2, control 11.1 ± 4.4), there was a considerably higher proportion of anisocoria in CNI patients (20.1% vs. 11.2%; p < 0.001). Following primary treatment, 50.8% of CNI and 35.5% of control cases showed moderate to severe disability (Glasgow Outcome Scale score 3-4; p < 0.001). CONCLUSION CNI rarely occur in the context of TBI. When present, they indicate a higher likelihood of functional impairment following primary care and complicating skull base fractures should be suspected.
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Affiliation(s)
- T Huckhagel
- University Medical Center Göttingen, Department of Neuroradiology, Göttingen, Germany; University Medical Center Hamburg, Department of Neurosurgery, Hamburg, Germany.
| | - C Riedel
- University Medical Center Göttingen, Department of Neuroradiology, Göttingen, Germany
| | - V Rohde
- University Medical Center Göttingen, Department of Neurosurgery, Göttingen, Germany
| | - R Lefering
- University of Witten/Herdecke, Institute for Research in Operative Medicine, Cologne, Germany
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Anderson TN, Schreiber MA, Rowell SE. Viscoelastic Testing in Traumatic Brain Injury: Key Research Insights. Transfus Med Rev 2021; 35:108-112. [PMID: 34607730 DOI: 10.1016/j.tmrv.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
The role of viscoelastic testing in the evaluation and management of traumatic brain injury (TBI) remains a subject of ongoing exploration. This review highlights four key publications that provide significant insights into this subject. Holcomb et al. provided early evidence of the relationship between thromboelastography (TEG) and conventional coagulation tests (CCTs). Later, Samuels et al. used TEG to identify a unique coagulopathy phenotype in TBI characterized by a notable absence of fibrinolytic abnormalities. Dixon et al. built upon these findings by exploring the application of TEG in the context of antifibrinolytic administration, noting a similar lack of effect on LY30. Finally, Guillotte et al. demonstrated the utility of TEG-PM in assessing platelet dysfunction in TBI. While these studies provide key early support for the utility of viscoelastic testing in the TBI, further exploration is needed to define evidence-based guidelines for clinical application.
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Affiliation(s)
- Taylor N Anderson
- Department of Surgery, Stanford University, Stanford, California, USA.
| | - Martin A Schreiber
- Professor of Surgery, Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, USA
| | - Susan E Rowell
- Professor of Surgery, Division of Trauma Surgery and Critical Care Medicine, University of Chicago, USA
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Rozema R, Doff MHJ, El Moumni M, Boomsma MF, Spijkervet FKL, van Minnen B. Diagnostic accuracy of physical examination findings for midfacial and mandibular fractures. Injury 2021; 52:2616-2624. [PMID: 34103150 DOI: 10.1016/j.injury.2021.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/24/2021] [Accepted: 05/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of physical examination findings used to identify patients at risk for midfacial or mandibular fractures. MATERIALS AND METHODS A five-year retrospective cohort was constructed from all emergency department patients with a midfacial or mandibular trauma. The sensitivity, specificity, pre-test probability, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio data was calculated for 19 and 14 physical examination findings for midfacial and mandibular fractures respectively. Computed Tomography and panoramic radiography were used as index tests. RESULTS A total of 1484 patients were identified among whom 40.4% midfacial and 33.4% mandibular fractures were diagnosed. Overall, specificity was found to be higher than sensitivity. Regarding midfacial fractures, high specificity was found for raccoon eyes, malar eminence flattening and all the findings that are related to palpation, the nasal, ocular and intra-oral assessment. Malar eminence flattening, external nasal deformity, nasal septum hematoma, change of globe position and palpable step-off had ad high positive predictive value and positive likelihood ratio. Regarding mandibular fractures high specificity was found for mouth opening restriction, auditory canal bleeding, intra-oral assessment related findings, palpable step-off, inferior alveolar nerve paresthesia, the angular compression test and chin axial pressure test. CONCLUSIONS The diagnostic accuracy of relevant physical examination findings were identified for the prediction of midfacial and mandibular fractures.
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Affiliation(s)
- Romke Rozema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| | - Michiel H J Doff
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Oral and Maxillofacial Surgery, Nij Smellinghe Hospital, Drachten, Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Frederik K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Seok H, Im SB, Hwang SC. Reconstruction of Anterior Skull Base Fracture Using Autologous Fractured Fragments: A Simple Stitching-Up Technique. Korean J Neurotrauma 2021; 17:25-33. [PMID: 33981640 PMCID: PMC8093017 DOI: 10.13004/kjnt.2021.17.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
Objective A displaced fracture in the anterior cranial base may be complicated by cerebrospinal fluid (CSF) rhinorrhea and enophthalmos. This study introduces a reconstruction technique with direct dural repair and reduction and fixation of the autologous fractured fragments. Methods Displaced fractures in the anterior cranial base were reconstructed using a stitching-up technique: A bicoronal scalp incision and frontal craniotomy was performed and the displaced bone was withdrawn. The lacerated dura was repaired primarily using a graft. Small holes were created in the intact cranial bones and the displaced harvest bone. Black silk was passed through the holes and the displaced bone was repositioned on tying the silk. Lumbar drain was not placed in any of the cases. The feasibility and outcome were evaluated. Results Five patients with displaced skull fractures of the anterior cranial base were included. All cases were men who had a direct impact on the forehead and/or eye. All the displaced fractures occurred in the orbital roof, and ethmoid bone fractures were present in 4 cases. Dural laceration was involved in 4 cases and repaired by placing artificial dura in 3 cases and a pericranial graft in 1 case. Following surgery, all cases were uneventful, and the anterior cranial fossa was well reconstructed. CSF leakage or enophthalmos did not occur in any of the cases. Conclusion Direct dural repair and autologous stitching-up reconstruction using the fractured fragment could be an effective method to prevent CSF leakage and enophthalmos in displaced fractures of the anterior cranial base.
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Affiliation(s)
- Hoon Seok
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Soo-Bin Im
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun-Chul Hwang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Distriquin Y, Vital JM, Ella B. Biomechanical analysis of skull trauma and opportunity in neuroradiology interpretation to explain the post-concussion syndrome: literature review and case studies presentation. Eur Radiol Exp 2020; 4:66. [PMID: 33289040 PMCID: PMC7721788 DOI: 10.1186/s41747-020-00194-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/06/2020] [Indexed: 11/10/2022] Open
Abstract
Traumatic head injuries are one of the leading causes of emergency worldwide due to their frequency and associated morbidity. The circumstances of their onset are often sports activities or road accidents. Numerous studies analysed post-concussion syndrome from a psychiatric and metabolic point of view after a mild head trauma. The aim was to help understand how the skull can suffer a mechanical deformation during a mild cranial trauma, and if it can explain the occurrence of some post-concussion symptoms. A multi-step electronic search was performed, using the following keywords: biomechanics properties of the skull, three-dimensional computed tomography of head injuries, statistics on skull injuries, and normative studies of the skull base. We analysed studies related to the observation of the skull after mild head trauma. The analysis of 23 studies showed that the cranial sutures could be deformed even during a mild head trauma. The skull base is a major site of bone shuffle. Three-dimensional computed tomography can help to understand some post-concussion symptoms. Four case studies showed stenosis of jugular foramen and petrous bone asymmetries who can correlate with concussion symptomatology. In conclusion, the skull is a heterogeneous structure that can be deformed even during a mild head trauma.
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Affiliation(s)
- Yannick Distriquin
- Laboratory of Anatomy, School of surgery, Bordeaux University, 146 rue Léo-Saignat, 33076, Bordeaux Cedex, France
| | - Jean-Marc Vital
- Department Head of Spinal Pathology and Spine Surgery, University Hospital Center of Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | - Bruno Ella
- Department Head of Oral Medicine and Surgery, University Hospital Center of Bordeaux, 1, rue Jean Burguet, 33075, Bordeaux Cedex, France.
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Bodwal J, Chauhan M, Behera C, Byard RW. An unusual patterned injury from homicidal craniocerebral impalement with a metal chair leg. Forensic Sci Med Pathol 2020; 17:327-329. [PMID: 32770495 DOI: 10.1007/s12024-020-00289-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
A 26-year-old young man died shortly after he had suffered craniocerebral impalement from a metal chair leg during an affray at an airport bar. At autopsy a 25 mm diameter circular wound was present in the left parietal region with protruding brain tissue. Death was due to craniocerebral trauma from a penetrating injury to the head. Examination of the chair used in the assault showed a metal chair with smeared blood on the front right leg that matched the blood group of the decedent. The fatal wound had been inflicted by the assailant with the victim leaning forward while kneeling on the floor. The assault had produced an unusual circular patterned defect in the left parietal bone with dimensions corresponding to the chair leg. The location of the defect and the use of a chair leg were two very unusual features in this homicide.
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Affiliation(s)
- Jatin Bodwal
- Department of Forensic Medicine & Toxicology, Government Medical College & Hospital, Room No 212, Level II, E-Block, Sector-32, Chandigarh, 160030, India
| | - Mohit Chauhan
- Department of Forensic Medicine & Toxicology, Government Medical College & Hospital, Room No 212, Level II, E-Block, Sector-32, Chandigarh, 160030, India.
| | - Chittaranjan Behera
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Science, New Delhi, 110029, India
| | - Roger W Byard
- Forensic Science South Australia, 21 Divett Place, Adelaide, 5000, Australia.,Adelaide Medical School, The University of Adelaide, Frome Road, Adelaide, South Australia, 5005, Australia
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Bennett DP, Bause GS. Robert Alden Fales, the fifteen-year-old criminal chloroformist. J Anesth Hist 2020; 6:26-7. [PMID: 33674027 DOI: 10.1016/j.janh.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/24/2022]
Abstract
An ex-employee of a Newark straw hat factory, 15-year-old Robert Alden Fales battered the factory's cashier Thomas Haydon on the head multiple times with a wooden staff. Fales then applied a chloroform-soaked handkerchief to Haydon's nose until the cashier stopped moving. Arrested and convicted of murder, Fales had his death sentence commuted to life imprisonment. At 23 years of age, the criminal chloroformist died in jail from tuberculosis.
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Ferreira RES, de Paiva BLC, de Freitas FGR, Machado FR, Silva GS, Raposo RM, Silveira CF, Centeno RS. Efficacy and Safety of a Nasopharyngeal Catheter for Selective Brain Cooling in Patients with Traumatic Brain Injury: A Prospective, Non-randomized Pilot Study. Neurocrit Care 2020; 34:581-592. [PMID: 32676873 DOI: 10.1007/s12028-020-01052-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The efficacy objective was to determine whether a novel nasopharyngeal catheter could be used to cool the human brain after traumatic brain injury, and the safety objective was to assess the local and systemic effects of this therapeutic strategy. METHODS This was a prospective, non-randomized, interventional clinical trial that involved five patients with severe traumatic brain injury. The intervention consisted of inducing and maintaining selective brain cooling for 24 h by positioning a catheter in the nasopharynx and circulating cold water inside the catheter in a closed-loop arrangement. Core temperature was maintained at ≥ 35 °C using counter-warming. RESULTS In all study participants, a brain temperature reduction of ≥ 2 °C was achieved. The mean brain temperature reduction from baseline was 2.5 ± 0.9 °C (P = .04, 95% confidence interval). The mean systemic temperature was 37.3 ± 1.1 °C at baseline and 36.0 ± 0.8 °C during the intervention. The mean difference between the brain temperature and the systemic temperature during intervention was - 1.2 ± 0.8 °C (P = .04). The intervention was well tolerated with no significant changes observed in the hemodynamic parameters. No relevant variations in intracranial pressure and transcranial Doppler were observed. The laboratory results underwent no major changes, aside from the K+ levels and blood counts. The K+ levels significantly varied (P = .04); however, the variation was within the normal range. Only one patient experienced an event of mild localized and superficial nasal discoloration, which was re-evaluated on the seventh day and indicated complete recovery. CONCLUSION The results suggest that our noninvasive method for selective brain cooling, using a novel nasopharyngeal catheter, was effective and safe for use in humans.
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Affiliation(s)
- Raphael Einsfeld Simões Ferreira
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, Av. Moema 170, Cj. 83. Moema, São Paulo, SP, 04077-020, Brazil.
| | | | | | - Flávia Ribeiro Machado
- Departamento de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gisele Sampaio Silva
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, Av. Moema 170, Cj. 83. Moema, São Paulo, SP, 04077-020, Brazil
| | - Rafael Mônaco Raposo
- Serviço de Otorrinolaringologia UNIFESP e Serviço de Otorrinolaringologia, Hospital Santa Paula, São Paulo, Brazil
| | - Conrado Feisthauer Silveira
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, Av. Moema 170, Cj. 83. Moema, São Paulo, SP, 04077-020, Brazil
| | - Ricardo Silva Centeno
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, Av. Moema 170, Cj. 83. Moema, São Paulo, SP, 04077-020, Brazil
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Cancelliere C, Boyle E, Côté P, Holm LW, Salmi LR, Cassidy JD. Development and validation of a model predicting post-traumatic headache six months after a motor vehicle collision in adults. Accid Anal Prev 2020; 142:105580. [PMID: 32445970 DOI: 10.1016/j.aap.2020.105580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/20/2019] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
IMPORTANCE The prognosis of post-traumatic headache is poorly understood. OBJECTIVE To develop and validate a prognostic model to predict the presence of post-traumatic headache six months after a traffic collision in adults with incident post-traumatic headache. DESIGN Secondary analyses of adults with incident post-traumatic headache injured in traffic collisions between November 1997 and December 1999 in Saskatchewan, Canada (development cohort); and between January 2004 and January 2005 in Sweden (validation cohort). SETTING The Saskatchewan cohort (development) was population-based (N = 4162). The Swedish cohort (validation) (N = 379) were claimants from two insurance companies covering 20 % of cars driven in Sweden in 2004. PARTICIPANTS All adults injured in traffic collisions who completed a baseline questionnaire within 30 days of collision. Excluded were those hospitalized >2 days, lost consciousness >30 min, or reported headache <3/10 on the numerical rating scale. Follow-up rates for both cohorts were approximately 80 %. PREDICTORS Baseline sociodemographic, pre-injury, and injury factors. OUTCOME Self-reported headache pain intensity ≥3 (numerical rating scale) six months after injury. RESULTS Both cohorts were predominantly female (69.7 % in Saskatchewan, 65.2 % in Sweden), with median ages 35.9 years (Saskatchewan), and 38.0 years (Sweden). Predictors were age, work status, headache pain intensity, symptoms in arms or hands, dizziness or unsteadiness, stiffness in neck, pre-existing headache, and lower recovery expectations. With a positive score (i.e., ≥0.75 probability), the model can rule in the presence of post-traumatic headache at six months (development: specificity = 99.8 %, 95 % CI 99.5 %-99.9 %; sensitivity = 1.6 %, 95 % CI 1.0 %-2.6 %; positive likelihood ratio (LR+) = 8.0, 95 % CI 2.7-24.1; negative likelihood ratio (LR-) = 1.0, 95 % CI 1.0-1.0; validation: specificity = 95.5 %, 95 % CI 91.1 %-97.8 %; sensitivity = 27.2 %, 95 % CI 20.4 %-35.2 %); LR+ = 6.0, 95 % CI 2.8-13.2; LR- = 0.8, 95 % CI 0.7-0.8). CONCLUSIONS AND RELEVANCE Clinicians can collect patient information on the eight predictors of our model to identify patients that will report ongoing post-traumatic headache six months after a traffic collision. Future research should focus on selecting patients at high risk of poor outcomes (using our model) for inclusion in intervention studies, and determining effective interventions for these patients.
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Affiliation(s)
- Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Centre for Disability Prevention and Rehabilitation, Ontario Tech Universty and Canadian Memorial Chiropractic College, Oshawa, Ontario, Canada.
| | - Eleanor Boyle
- Department of Sport Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Centre for Disability Prevention and Rehabilitation, Ontario Tech Universty and Canadian Memorial Chiropractic College, Oshawa, Ontario, Canada; Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Canada; Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Lena W Holm
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Louis-Rachid Salmi
- ISPED/Bordeaux School of Public Health, University of Bordeaux, F-33000 Bordeaux, France; Centre INSERM U-1219 Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pole de sante Publique, Service d'information médicale, F-33000 Bordeaux, France
| | - J David Cassidy
- Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Galardi MM, Strahle JM, Skidmore A, Kansagra AP, Guilliams KP. Cerebrovascular Complications of Pediatric Blunt Trauma. Pediatr Neurol 2020; 108:5-12. [PMID: 32111560 DOI: 10.1016/j.pediatrneurol.2019.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 12/13/2022]
Abstract
Ischemic and hemorrhagic stroke can occur in the setting of pediatric trauma, particularly those with head or neck injuries. The risk of stroke appears highest within the first two weeks after trauma. Stroke diagnosis may be challenging due to lack of awareness or concurrent injuries limiting detailed neurological assessment. Other injuries may also complicate stroke management, with competing priorities for blood pressure, ventilator management, or antithrombotic timing. Here we review epidemiology, clinical presentation, and diagnostic approach to blunt arterial injuries including dissection, cerebral sinovenous thrombosis, mineralizing angiopathy, stroke from abusive head trauma, and traumatic hemorrhagic stroke. Owing to the complexities and heterogeneity of concomitant injuries in stroke related to trauma, a single pathway for stroke management is impractical. Therefore providers must understand the goals and possible costs or consequences of stroke management decisions to individualize patient care. We discuss the physiological principles of cerebral perfusion and oxygen delivery, considerations for ventilator strategy when stroke and lung injury are present, and current available evidence of the risks and benefits of anticoagulation to provide a framework for multidisciplinary discussions of cerebrovascular injury management in pediatric patients with trauma.
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Ren D, Zheng P, Feng J, Gong Y, Wang Y, Duan J, Zhao L, Deng J, Chen H, Zou S, Hong T, Chen W. Overexpression of Astrocytes-Specific GJA1-20k Enhances the Viability and Recovery of the Neurons in a Rat Model of Traumatic Brain Injury. ACS Chem Neurosci 2020; 11:1643-1650. [PMID: 32401478 DOI: 10.1021/acschemneuro.0c00142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Traumatic brain injury (TBI) is a devastating actuality in clinics worldwide. It is estimated that approximately 10 million people among the world suffer from TBI each year, and a considerable number of patients will be temporarily or permanently disabled or even die due to this disease. Astrocytes play a very important role in the repair of brain tissue after TBI, including the formation of a neuroprotective barrier, inhibition of brain edema, and inhibition of normal nerve cell apoptosis. However, the detailed mechanism underlying this protective effect is still unclear. To investigate the regulatory factors of astrocytes to other neurons post-TBI, we established a TBI rat model and used the AAV to mediate the overexpression of GJA1-20k in astrocytes of rats. And functionally, the specific overexpression of GJA1-20k in astrocytes promoted the viability and recovery of neurons in TBI. Mechanistically, the astrocytes-specific upregulation of GJA1-20k protected the function of mitochondria in neurons of FPI rats, thus suppressing the apoptosis of the damaged neurons. We hereby reported that astrocytes-specific overexpression of GJA1-20k enhanced the viability and recovery of the neurons in TBI through regulating their mitochondrial function.
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Affiliation(s)
- Dabin Ren
- Department of Neurosurgery, the People’s Hospital of Shanghai Pudong New Area Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201299, P. R. China
| | - Ping Zheng
- Department of Neurosurgery, the People’s Hospital of Shanghai Pudong New Area Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201299, P. R. China
| | - Jiugeng Feng
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi, P. R. China
| | - Yuqin Gong
- Department of Operation Room, the Second Affiliated Hospital of Nanchang University, Nanchang 330009, Jiangxi, P. R. China
| | - Yang Wang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi, P. R. China
| | - Jian Duan
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi, P. R. China
| | - Lin Zhao
- Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210009, Jiangsu China
| | - Jun Deng
- Department of Emergency@Trauma Center, the First Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi, P. R. China
| | - Haiming Chen
- Department of Emergency@Trauma Center, the First Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi, P. R. China
| | - Shufeng Zou
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi, P. R. China
| | - Tao Hong
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi, P. R. China
| | - Wei Chen
- Department of Neurosurgery, the People’s Hospital of Shanghai Pudong New Area Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201299, P. R. China
- Department of Emergency@Trauma Center, the First Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi, P. R. China
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Gempeler A, Orrego-González E, Hernandez-Casanas A, Castro AM, Aristizabal-Mayor JD, Mejia-Mantilla JH. Incidence and Effect of Diabetes Insipidus in the Acute Care of Patients with Severe Traumatic Brain Injury. Neurocrit Care 2020; 33:718-24. [PMID: 32207035 DOI: 10.1007/s12028-020-00955-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Literature on diabetes insipidus (DI) after severe traumatic brain injury (TBI) is scarce. Some studies have reported varying frequencies of DI and have showed its association with increased mortality, suggesting it as a marker of poor outcome. This knowledge gap in the acute care consequences of DI in severe TBI patients led us to conceive this study, aimed at identifying risk factors and quantifying the effect of DI on short-term functional outcomes and mortality. METHODS We assembled a historic cohort of adult patients with severe TBI (Glasgow Coma Scale ≤ 8) admitted to the intensive care unit (ICU) of a tertiary-care university hospital over a 6-year period. Basic demographic characteristics, clinical information, imaging findings, and laboratory results were collected. We used logistic regression models to assess potential risk factors for the development of DI, and the association of this condition with death and unfavorable functional outcomes [modified Rankin scale (mRS)] at hospital discharge. RESULTS A total of 317 patients were included in the study. The frequency of DI was 14.82%, and it presented at a median of 2 days (IQR 1-3) after ICU admission. Severity according to the Abbreviated Injury Scale (AIS) score of the head, intracerebral hemorrhage, subdural hematoma, and skull base fracture was suggested as risk factors for DI. Diagnosis of DI was independently associated death (OR 4.34, CI 95% 1.92-10.11, p = 0.0005) and unfavorable outcome (modified Rankin Scale = 4-6) at discharge (OR 7.38; CI 95% 2.15-37.21, p = 0.0047). CONCLUSIONS Diabetes insipidus is a frequent and early complication in patients with severe TBI in the ICU and is strongly associated with increased mortality and poor short-term outcomes. We provide clinically useful risk factors that will help detect DI early to improve prognosis and therapy of patients with severe TBI.
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Huckhagel T, Regelsberger J, Westphal M, Nüchtern J, Lefering R. Damage to the eye and optic nerve in seriously traumatized patients with concomitant head injury: analysis of 84,627 cases from the TraumaRegister DGU® between 2002 and 2015. Scand J Trauma Resusc Emerg Med 2020; 28:15. [PMID: 32122368 PMCID: PMC7052966 DOI: 10.1186/s13049-020-0712-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry. METHODS The TraumaRegister DGU® was searched for patients suffering from serious trauma with a Maximum Abbreviated Injury Scale (AIS) ≥ 3 between 2002 and 2015 in Europe. After excluding cases without significant head injury defined by an AIS ≥ 2, groups were built regarding the existence of a concomitant damage to the prechiasmatic optic system comprising globe and optic nerve. Group comparisons were performed with respect to demographic, etiological, clinical and outcome characteristics. RESULTS 2.2% (1901/84,627) of seriously injured patients with concomitant head trauma presented with additional VSI. These subjects tended to be younger (mean age 44.7 versus 50.9 years) and were more likely of male gender (74.8% versus 70.0%) compared to their counterparts without VSI. The most frequent trauma etiologies were car accidents in VSI patients (28.5%) and falls in the control group (43.2%). VSI cases were prone to additional soft tissue trauma of the head, skull and orbit fractures as well as pneumocephalus. Primary treatment duration was significantly longer in the VSI cohort (mean 23.3 versus 20.5 days) along with higher treatment costs and a larger proportion of patients with moderate or severe impairment at hospital discharge despite there being a similar average injury severity at admission in both groups. CONCLUSIONS A substantial proportion of patients with head injury suffers from additional VSI. The correlation between VSI and prolonged hospitalization, increased direct treatment expenditures, and having a higher probability of posttraumatic impairment demonstrates the substantial socioeconomic relevance of these types of injuries.
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Affiliation(s)
- Torge Huckhagel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Nüchtern
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
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Stuart CA, Brubacher JR, Yau L, Yip R, Cripton PA. Skiing and snowboarding head injury: A retrospective centre-based study and implications for helmet test standards. Clin Biomech (Bristol, Avon) 2020; 73:122-129. [PMID: 31982809 DOI: 10.1016/j.clinbiomech.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Head injury occurs in up to 47% of skiing or snowboarding injuries and is the predominant cause of death in these sports. In most existing literature reporting injury type and prevalence, head injury mechanisms are underreported. Thus, protective equipment design relies on safety evaluation test protocols that are likely oversimplified. This study aims to characterize severity and mechanism of head injuries suffered while skiing and snowboarding in a form appropriate to supplement existing helmet evaluation methods. METHODS A 6-year, multicentre, retrospective clinical record review used emergency databases from two major trauma centres and Coroner's reports to identify relevant cases which indicated head impact. Records were investigated to understand the relationships between helmet use, injury type and severity, and injury mechanism. Descriptive statistics and odds ratios aided interpretation of the data. FINDINGS The snow sport head injury database included 766 cases. "Simple fall", "jump impact" and "impact with object" were the most common injury mechanisms while concussion was observed to be the most common injury type. Compared to "edge catch", moderate or serious head injury was more common for "fall from height" (OR = 4.69; 95% CI = 1.44-16.23; P = 0.05), "jump impact" (OR = 3.18; 95% CI = 1.48-7.26; P = 0.01) and "impact with object" (OR = 2.44; 95% CI = 1.14-5.56; P = 0.05). Occipital head impact was associated with increased odds of concussion (OR = 7.46; 95% CI = 4.55-12.56; P = 0.001). INTERPRETATION Snow sport head injury mechanisms are complex and cannot be represented through a single impact scenario. By relating clinical data to injury mechanism, improved evaluation methods for protective measures and ultimately better protection can be achieved.
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Affiliation(s)
- C A Stuart
- Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada; Orthopaedic and Injury Biomechanics Group, University of British Columbia, Vancouver, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - J R Brubacher
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Yau
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - R Yip
- Faculty of Science, Western University, London, Canada
| | - P A Cripton
- Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada; Orthopaedic and Injury Biomechanics Group, University of British Columbia, Vancouver, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, Canada.
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Rodríguez A, Cervera E, Tuesca R, Flórez K, Romero R, Villalba PJ. The delayed detection of an acute neurological worsening increases traumatic brain injury lethality. ACTA ACUST UNITED AC 2020; 40:89-101. [PMID: 32220166 DOI: 10.7705/biomedica.4786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 11/21/2022]
Abstract
Introduction: Traumatic brain injury is a leading worldwide cause of death and disability in young people. Severity classification is based on the Glasgow Coma Scale. However, the neurological worsening in an acute setting does not always correspond to the initial severity suggesting an underestimation of the real magnitude of the injury.
Objective: To study the correlation between the initial severity according to the Glasgow Coma Scale and the patient outcome in the context of different clinical and tomography variables.
Materials and methods: We analyzed a retrospective cohort of 490 patients with closed traumatic brain injury requiring a stay in the intensive care unit of two third-level hospitals in Barranquilla. The risk was estimated by calculating the OR (95% CI). The significance level was established at an alpha value of 0.05.
Results: Forty-one percent of all patients required orotracheal intubation; 51.2% were initially classified with moderate trauma and 6,0% as mild. The delay in the aggressive management of the traumas affected mainly those patients with traumas classified as moderate in whom lethality increased to 100% when there was delay in the detection of the neurological worsening and in the establishment of the aggressive treatment beyond 4 to 8 hours while the lethality in patients who received this treatment within the first hour reduced to <20%.
Conclusions: The risk of lethality in traumatic brain injury increases with the delayed detection of neurological worsening in an acute setting, especially when aggressive management is performed after the first hour post-trauma.
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Castro-Espicalsky TL, Costa ST, Santiago BM, Freire AR, Daruge Júnior E, Prado FB, Rossi AC. Craniofacial injuries by firearms projectiles: An analysis of 868 deaths in the five regions of Brazil. J Forensic Leg Med 2020; 69:101888. [PMID: 32056805 DOI: 10.1016/j.jflm.2019.101888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 10/04/2019] [Accepted: 12/08/2019] [Indexed: 11/26/2022]
Abstract
Firearms injuries have a legal and medico-legal importance, and are especially lethal when they reach the craniofacial regions of the victim. The present study aims to identify the characteristics of craniofacial lesions resulting from firearm projectiles, to register the most affected craniofacial regions by this type of injury and to verify the demographic profile of the victims. A retrospective study was carried out on the autopsy records produced in the first semester of 2015, in five Institutes of Legal Medicine in Porto Velho, situated in the cities of João Pessoa, Vitória, Porto Alegre and Brasília. Data extracted included sex, skin color and age of the victim, craniofacial region reached, shooting distance, shape and size of the injuries and manner of death (homicide, suicide or accident). Based on the 868 reports analyzed, it was possible to observe 1700 entrance lesions of firearm projectiles in craniofacial regions. Among cases of known manner of death, homicides were the most frequent (97.0%). It was observed a higher frequency of male victims (93.3%), mixed race (62.0%), between the ages of 12 and 29 years (59.4%). In all cases considered as suicide or accident there was only one entrance wound, but in 82.8% of the homicides there were multiple gunshot wounds. The craniofacial most affected regions were temporal (25.2%) and occipital (19.8%). The most common sites of projectiles exit were the temporal (25.3%) and parietal (16.1%). All cases of suicide were related to contact shot (69.2%) or close-range shot (30.8%), and among the homicides the distant range shots were more frequent (54.0%). The shape of entrance wounds was mostly circular (56.8%) and oval (31.3%), and among the exit injuries, the lesions were irregular (43.3%) and starry (24.1%). The entrance wounds showed smaller sizes than the exit lesions (p < 0.0001). The data obtained are useful for guiding research that takes into account craniofacial trauma caused by firearm projectiles, makes it possible to compare this data with those of other countries and can base investigative conclusions based on the analyzes discussed in the present work.
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Affiliation(s)
- Talita Lima Castro-Espicalsky
- Department of Morphology, Anatomy Division, School of Dentistry of Piracicaba, University of Campinas - UNICAMP, Brazil
| | - Sarah Teixeira Costa
- Department of Morphology, Anatomy Division, School of Dentistry of Piracicaba, University of Campinas - UNICAMP, Brazil
| | - Bianca Marques Santiago
- Department of Clinics and Social Dentistry, Federal University of Paraíba, João Pessoa, Brazil
| | - Alexandre Rodrigues Freire
- Department of Morphology, Anatomy Division, School of Dentistry of Piracicaba, University of Campinas - UNICAMP, Brazil
| | - Eduardo Daruge Júnior
- Department of Social Odontology, Forensic Dentistry Division, Piracicaba Dental School, University of Campinas - UNICAMP, Brazil
| | - Felippe Bevilacqua Prado
- Department of Morphology, Anatomy Division, School of Dentistry of Piracicaba, University of Campinas - UNICAMP, Brazil
| | - Ana Cláudia Rossi
- Department of Morphology, Anatomy Division, School of Dentistry of Piracicaba, University of Campinas - UNICAMP, Brazil.
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Stephens S, Ma N. Ceiling Fan-Related Head Injuries in Children: A Queensland Neurosurgical Experience. Pediatr Neurosurg 2020; 55:74-80. [PMID: 32428916 DOI: 10.1159/000507452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ceiling fans are a widespread energy-efficient appliance required for managing the sweltering weather extremes encountered in northern Australian states including Queensland. Ceiling fans are also a rare cause of serious head injury in children requiring neurosurgical intervention. There is limited available evidence on the presentation, mechanism, and management of these injuries. METHODS A retrospective analysis of children who suffered ceiling fan injuries admitted to the Queensland Children's Hospital, a level-1 paediatric trauma hospital in Brisbane, Queensland, under the neurosurgery unit from November 2014 to July 2018 was performed. RESULTS Seventeen children (64.7% male) with a mean age of 4.24 years (range 0.66-7.25) sustained ceiling fan injuries requiring neurosurgical management during this period. Children were injured following being accidentally lifted or thrown into the ceiling fan path; jumping, playing, climbing, or being pushed from a bunk bed; or climbing on other furniture. All patients suffered skull fractures (88.2% depressed), and 65% suffered extra-axial or intracerebral haemorrhage. Operative management was required in 76.5% of the patients. No patients suffered adverse outcomes, and no complications, including infections, were recorded. CONCLUSIONS Despite their rarity, paediatric ceiling fan injuries requiring neurosurgical management are a cause of significant morbidity. Surgical management targeted elevation of depressed fractures and washout of open fractures rather than evacuation of intracranial collections. Almost all included patients required transfer with associated social and economic implications. Such injuries are largely preventable with improved supervision and safety awareness. Hazard modification may be extended to regulatory changes or improved ceiling fan design.
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Affiliation(s)
- Sean Stephens
- Neurosurgical Department, Queensland Children's Hospital, Brisbane, Queensland, Australia,
| | - Norman Ma
- Neurosurgical Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Kronsbein K, Budczies J, Pfeiffer H, Karger B, Wittschieber D. [On the quality of the external post-mortem examination in cases of fatal head trauma : A comparison of death certificate and forensic autopsy]. Anaesthesist 2019; 69:37-48. [PMID: 31784776 DOI: 10.1007/s00101-019-00704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Germany it is required by law that basically every type of physician needs to be capable of executing a correct external post-mortem examination of a corpse. In recent years, numerous investigations on external post-mortem examinations repeatedly reported systematic mistakes and erroneous procedures in various clinical and medicolegal case groups. Accordingly, the completion of death certificates is frequently performed incorrectly. As one of the typical unnatural death cases, decedents dying from fatal head trauma (FHT) represent a special autopsy case group, which is expected to be correctly recognized during the primary external post-mortem examination because the external injuries are mostly obvious. OBJECTIVE The present study aimed at investigating the quality of the external post-mortem examination in medicolegal FHT cases by means of comparison of death certificates and autopsy reports from a 10-year period. MATERIAL AND METHODS In a retrospective study design all autopsy cases from the Institute of Legal Medicine of the University Hospital Münster in the years 2006-2015 (n = 3611) were analyzed as to the presence of FHT. A total of 328 cases with FHT and the concomitant presence of a death certificate filled out before the autopsy were identified. Subsequently, the cause of death according to the death certificate was compared with the cause of death according to the autopsy. The degree of agreement was classified into six different categories from I to VI. While category I represented a complete lack of agreement, category VI was assigned to cases with full agreement. RESULTS In 58.5% of the cases (category VI) FHT was identified correctly during the external post-mortem examination. In 1.5% of the cases, a completely different cause of death was determined during the external post-mortem examination (category I). In 19.2% of the cases, no cause of death or the statement "unclear" was given as the cause of death in the death certificate (categories II and III). Cross-analyses and intuitive heatmap visualization were generated to identify case constellations with an increased risk for discrepancies. These analyses revealed that among all discrepant cases (categories I-V), falls were found significantly more often than in the nondiscrepant cases (p < 0.01), especially falls of women older than 57 years (median age of women) or falls considered as accidents by the examiner. In addition, traffic-associated FHT of men older than 44.5 years (median age of men) was identified more frequently in the external post-mortem examination. CONCLUSION Despite the fact that FHT should be a cause of death that is comparably easy to identify during external post-mortem examination, more than one third of the cases were not sufficiently recognized. Therefore, special attention must still be paid to certain case constellations during the external post-mortem examination. Typical examples of such cases are burned bodies, cases of advanced putrefaction and falls.
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Affiliation(s)
- K Kronsbein
- Institut für Rechtsmedizin, Universitätsklinikum Münster, Münster, Deutschland
| | - J Budczies
- Institut für Pathologie, Abteilung Biostatistik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Pfeiffer
- Institut für Rechtsmedizin, Universitätsklinikum Münster, Münster, Deutschland
| | - B Karger
- Institut für Rechtsmedizin, Universitätsklinikum Münster, Münster, Deutschland
| | - D Wittschieber
- Institut für Rechtsmedizin, Universitätsklinikum Münster, Münster, Deutschland.
- Institut für Rechtsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Verboket R, Verboket C, Schöffski O, Tlatlik J, Marzi I, Nau C. [Costs and proceeds from patients admitted via the emergency room with mild craniocerebral trauma]. Unfallchirurg 2019; 122:618-625. [PMID: 30306215 DOI: 10.1007/s00113-018-0566-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The introduction of the diagnosis-related groups (DRG) in 2003 radically changed the billing of the treatment costs. From the very beginning, trauma surgeons questioned whether the introduction of the DRG could have a negative impact on the care of the severely injured. "Trauma centers in need" was the big catchword warning against shortfalls at trauma centers due to the billing via DRG. This situation was confirmed in the first publications after introduction of the DRG, showing a clearly deficient level of care of polytrauma cases. Over the years, adjustments have led to an improvement in the remuneration for polytraumatized patients. In the emergency room, polytrauma is not always the final diagnosis. A considerable proportion of patients are only slightly injured, but must be admitted via the emergency room due to the circumstances of the accident or suspected diagnosis at the scene of the accident to exclude life-threatening injuries. In this study, patients with the billing diagnosis of mild craniocerebral trauma were selected as an example. The proportion of these patients was 22% during the period of observation in 2017. For these patients, the proportional costs during treatment were calculated. It could be shown that 60.36% of the costs during a 2‑day treatment of these patients were incurred in the emergency room. Costs for material and personnel could not be considered. Despite not including these expenses, the costs were never covered for any of these patients. For patients with slight injuries after trauma management in the emergency room, the present adjustments to the DRG system by increasing the basic case value seem to be insufficient. Additional remuneration for these patients seems absolutely justified to further ensure adequate quality of care.
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Affiliation(s)
- René Verboket
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Uniklinik Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | | | - Oliver Schöffski
- Lehrstuhl für Gesundheitsmanagement, Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - Johanna Tlatlik
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Uniklinik Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Ingo Marzi
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Uniklinik Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Christoph Nau
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Uniklinik Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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Emiroglu M, Alkan G, Feyzioglu B, Aycan AE, Ceyhan M. Recurrent meningitis by Streptococcus pneumoniae in a girl with cochlear implant and head trauma despite 13-valent conjugated pneumococcal vaccine. ARCH ARGENT PEDIATR 2019; 117:e373-e376. [PMID: 31339278 DOI: 10.5546/aap.2019.eng.e373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 01/21/2019] [Indexed: 11/12/2022]
Abstract
Recurrent bacterial meningitis is a very rare phenomenon in children. Skull base fractures and cochlear implant are the important predisposing factors and, Streptococcus pneumoniae is the most frequently isolated agent. Implementation of 13-valent conjugated pneumococcal vaccine (PCV13) has reduced the occurence of invasive pneumococcal diseases. Vaccination breakthrough is typically related to underlying predisposing conditions. Herein, we reported recurrent pneumococcal meningitis in a patient with a cochlear implant who experienced a head trauma after being fully vaccinated with PCV13. The patient experienced three meningitis episodes within one year. S.pneumoniae was determined on CSF culture in the first and third episodes and detected by PCR at the second episode. Neurosurgical intervention was performed after the third meningitis episode, and the patient had no recurrence problems for the following two years. To our knowledge, breakthrough S.pneumoniae serotype 1 meningitis after full PCV13 immunization has not been reported elsewhere in the literature.
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Affiliation(s)
- Melike Emiroglu
- Facultad de Medicina de Selguk Üniversitesi, Departamento de Infectología Pediátrica, Konya, Turquía
| | - Gulsum Alkan
- Facultad de Medicina de Selguk Üniversitesi, Departamento de Infectología Pediátrica, Konya, Turquía.
| | - Bahadir Feyzioglu
- Facultad de Medicina de Necmettin Erbakan Üniversitesi, Departamento de Microbiología Médica, Konya, Turquía
| | - Ahmet E Aycan
- Departamento de Infectología Pediátrica de Hacettepe Üniversitesi, Ankara, Turquía
| | - Mehmet Ceyhan
- Departamento de Infectología Pediátrica de Hacettepe Üniversitesi, Ankara, Turquía
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Wang JS, Ter Louw RP, DeFazio MV, McGrail KM, Evans KK. Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report. Arch Plast Surg 2019; 46:365-70. [PMID: 31336426 DOI: 10.5999/aps.2018.00360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022] Open
Abstract
The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed—correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.
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Nag DS, Sahu S, Swain A, Kant S. Intracranial pressure monitoring: Gold standard and recent innovations. World J Clin Cases 2019; 7:1535-1553. [PMID: 31367614 PMCID: PMC6658373 DOI: 10.12998/wjcc.v7.i13.1535] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/11/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate non-invasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortion-product oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard.
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Seelora Sahu
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Amlan Swain
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Shashi Kant
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
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Nussbaum ES, Graupman P, Patel PD. Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note. Br J Neurosurg 2019:1-5. [PMID: 31220943 DOI: 10.1080/02688697.2019.1630550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report a 45-year-old man who suffered a penetrating nail gun injury resulting in damage to the lateral edge of the superior sagittal sinus. The injury was successfully treated via a parasagittal craniotomy that enabled removal of the nail under direct vision, allowing for rapid suturing of the sagittal sinus. Two neurosurgeons worked together; one carefully withdrew the tip of the nail back into the sinus itself while the second rapidly sutured the hole in the inner superior sagittal sinus leaflet. Postoperatively, the patient made a rapid recovery without neurological deficit.
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Affiliation(s)
- Eric S Nussbaum
- a National Brain Aneurysm & Tumor Center, Department of Neurosurgery , United Hospital , St Paul , MN , USA
| | - Patrick Graupman
- a National Brain Aneurysm & Tumor Center, Department of Neurosurgery , United Hospital , St Paul , MN , USA
| | - Puja D Patel
- b Department of Neuroscience , University of Southern California , Los Angeles , CA , USA
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Kong TH, Lee JW, Park YA, Seo YJ. Clinical Features of Fracture versus Concussion of the Temporal Bone after Head Trauma. J Audiol Otol 2019; 23:96-102. [PMID: 30857384 PMCID: PMC6468275 DOI: 10.7874/jao.2018.00339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Temporal bone fracture (TBF) is a common occurrence in cases of head trauma. Although the incidence of temporal bone concussion (TBC) has increased in cases of head trauma, it has not been extensively studied. We assessed the characteristics of TBF and TBC in patients with head trauma. SUBJECT AND METHODS We conducted a retrospective review of 432 patients with head injury who visited our hospital between January 2011 and April 2016. Of these patients, 211 who met the inclusion criteria were included in the study. Their clinical characteristics, causes of injury, and hearing function were analyzed. RESULTS Among the 211 patients, 157 had TBFs and 54 had TBCs. Ear symptoms were more common among patients with TBF than among those with TBC. Car accidents were the most common cause of both TBF and TBC, but assault and sports injuries were more common among patients with TBC than among those with TBF. The occurrence of facial palsy in both cases of TBF and TBC. Hearing loss was observed among 35 patients with TBF and 11 patients with TBC. However, patients with TBF showed conductive hearing loss with an air-bone gap. Hearing function of these patients with TBF recovered with a reduced air-bone gap, but the patients with TBC showed little recovery. CONCLUSIONS Emergency physicians should focus more on temporal bone injury in patients with head trauma. Therefore, an early complete diagnostic battery, which includes high-resolution computed tomography, audiometric tests, neurologic examination, and vestibular tests, be performed in patients with head trauma.
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Affiliation(s)
- Tae Hoon Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yoon Ah Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Joon Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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Squarza S, Uggetti CL, Politi MA, Pescatori LC, Bisogno R, Campi A, Reganati P, Cariati M. C1-C2 fractures in asymptomatic elderly patients with minor head trauma: evaluation with a dedicated head CT protocol. Radiol Bras 2019; 52:17-23. [PMID: 30804611 PMCID: PMC6383526 DOI: 10.1590/0100-3984.2017.0154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the frequency and types of upper cervical spine injuries in
asymptomatic elderly patients undergoing computed tomography (CT) for the
investigation of minor head trauma. Materials and Methods This was a prospective study of 2613 asymptomatic elderly patients with minor
head trauma seen between January 2015 and December 2016. We adopted a
dedicated head CT protocol that included the C1-C2 region. Results Of the 2613 patients analyzed, 33 (1.26%) had upper cervical spine injuries,
corresponding to 8.37% of the 394 patients with trauma-related findings. Of
those 33 patients, 6 had C1 fractures and 27 had C2 fractures. The use of
16- and 128-slice scanners increased the CT dose by 25.0% and 23.7%,
respectively. Conclusion Inclusion of the C1-C2 region in head CT scans allowed us to identify upper
cervical spine injuries in 1.26% of asymptomatic elderly patients with minor
head trauma. The protocol evaluated helps detect potentially
life-threatening injuries and could be adopted for routine use in elderly
individuals with minor head trauma.
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Affiliation(s)
- Silvia Squarza
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
| | - Carla Luisa Uggetti
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
| | | | | | | | - Adriana Campi
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
| | - Paolo Reganati
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
| | - Maurizio Cariati
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
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McCradden MD, Cusimano MD. Staying true to Rowan's Law: how changing sport culture can realize the goal of the legislation. Can J Public Health 2019; 110:165-168. [PMID: 30694447 DOI: 10.17269/s41997-019-00174-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022]
Abstract
Rowan's Law was recently introduced into Ontario legislation following the death of Rowan Stringer, a young rugby player for whom a string of head injuries culminated in her death. The law mandates the removal from play of any youth athlete suspected to have a concussion and makes concussion education mandatory for certain individuals involved with youth sport. This commentary addresses the larger issues within sport culture that may limit the effectiveness of the law, and describes how awareness alone is not sufficient to generate change. The law can sometimes lead to a false sense of security, as well as retaliatory actions for those who are motivated to hide concussion. We describe the role of all persons involved with youth sport in facilitating a cultural shift to honour the intent behind Rowan's Law.
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Affiliation(s)
- Melissa D McCradden
- St. Michael's Hospital - Neurosurgery, 30 Bond St, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Michael D Cusimano
- St. Michael's Hospital - Neurosurgery, 30 Bond St, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Pons E, Foks KA, Dippel DWJ, Hunink MGM. Impact of guidelines for the management of minor head injury on the utilization and diagnostic yield of CT over two decades, using natural language processing in a large dataset. Eur Radiol 2019; 29:2632-40. [PMID: 30643942 DOI: 10.1007/s00330-018-5954-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/02/2018] [Accepted: 12/04/2018] [Indexed: 01/18/2023]
Abstract
Objectives We investigated the impact of clinical guidelines for the management of minor head injury on utilization and diagnostic yield of head CT over two decades. Methods Retrospective before-after study using multiple electronic health record data sources. Natural language processing algorithms were developed to rapidly extract indication, Glasgow Coma Scale, and CT outcome from clinical records, creating two datasets: one based on all head injury CTs from 1997 to 2009 (n = 9109), for which diagnostic yield of intracranial traumatic findings was calculated. The second dataset (2009–2014) used both CT reports and clinical notes from the emergency department, enabling selection of minor head injury patients (n = 4554) and calculation of both CT utilization and diagnostic yield. Additionally, we tested for significant changes in utilization and yield after guideline implementation in 2011, using chi-square statistics and logistic regression. Results The yield was initially nearly 60%, but in a decreasing trend dropped below 20% when CT became routinely used for head trauma. Between 2009 and 2014, of 4554 minor head injury patients overall, 85.4% underwent head CT. After guideline implementation in 2011, CT utilization significantly increased from 81.6 to 87.6% (p = 7 × 10−7), while yield significantly decreased from 12.2 to 9.6% (p = 0.029). Conclusions The number of CTs performed for head trauma gradually increased over two decades, while the yield decreased. In 2011, despite implementation of a guideline aiming to improve selective use of CT in minor head injury, utilization significantly increased. Key Points • Over two decades, the number of head CTs performed for minor, moderate, and severe head injury gradually increased, while the diagnostic yield for intracranial findings showed a decreasing trend. • Despite the implementation of a guideline in 2011, aiming to improve selective use of CT in minor head injury, utilization significantly increased, while diagnostic yield significantly decreased. • Natural language processing is a valuable tool to monitor the utilization and diagnostic yield of imaging as a potential quality-of-care indicator. Electronic supplementary material The online version of this article (10.1007/s00330-018-5954-5) contains supplementary material, which is available to authorized users.
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