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Almuqamam M, Loven TC, Arthur Iii LG, Atkinson NK, Grewal H. Clinical Outcomes in Neurologically Intact Children With Small Intracranial Bleeds and Simple Skull Fractures. Cureus 2023; 15:e42848. [PMID: 37664317 PMCID: PMC10473178 DOI: 10.7759/cureus.42848] [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: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Children with minor intracranial hemorrhage (ICH) and/or simple skull fractures are often hospitalized for monitoring; however, the majority do not require any medical, surgical, or critical care interventions. Our purpose was to determine the rate of significant clinical sequela (SCS) and identify associated risk factors in neurologically intact children with close head trauma. Methods This is a retrospective observational study. Children (≤ 3 years of age) admitted with closed head trauma, documented head injuries (ICH ≤ 5mm and/or simple skull fracture), and a Glasgow Coma Scale (GCS) score of ≥14, between January 2015 and January 2020, were included. We collected demographics, resource utilization, and patient outcomes variables. SCS was defined as any radiologic progression, and/or clinically important medical or neurological deterioration. Results A total of 205 patients were enrolled in the study (65.4% male, mean age 7.7 months). Repeat neuroimaging was obtained in 41/205 patients (20%) with radiologic progression noted in 5/205 (2.4%). Thirteen out of 205 patients (6.3%) experienced SCS. Patients with SCS were more likely to be males (92.3% vs 63.5% in females, P=0.035) to have had a report filed with child protective services due to a concern for abuse/neglect (92.3% vs 61.5% in females, P=0.025), and to have had a non-linear skull fracture (P<0.001). No other factors were shown to be predictive of SCS with enough statistical significance. Conclusion Neurologically intact children with traumatic closed head injury are at low risk for developing SCS. This study suggests that most of these children may not need ICU monitoring. This study also showed that a certain subset might be at an increased risk of developing SCS.
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Affiliation(s)
- Mohamed Almuqamam
- Pediatric Critical Care Medicine, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, USA
| | - Tina C Loven
- Neurosurgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, USA
| | - Lindsay G Arthur Iii
- Pediatric Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, USA
| | - Norrell K Atkinson
- Child Protection Program, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, USA
| | - Harsh Grewal
- Pediatric Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, USA
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2
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Shan W, Guo J, Mao X, Zhang Y, Huang Y, Wang S, Li Z, Meng X, Zhang P, Wu Z, Wang Q, Liu Y, He K, Wang Y. Automated Identification of Skull Fractures With Deep Learning: A Comparison Between Object Detection and Segmentation Approach. Front Neurol 2021; 12:687931. [PMID: 34777193 PMCID: PMC8585755 DOI: 10.3389/fneur.2021.687931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/29/2021] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Skull fractures caused by head trauma can lead to life-threatening complications. Hence, timely and accurate identification of fractures is of great importance. Therefore, this study aims to develop a deep learning system for automated identification of skull fractures from cranial computed tomography (CT) scans. Method: This study retrospectively analyzed CT scans of 4,782 patients (median age, 54 years; 2,583 males, 2,199 females; development set: n = 4,168, test set: n = 614) diagnosed with skull fractures between September 2016 and September 2020. Additional data of 7,856 healthy people were included in the analysis to reduce the probability of false detection. Skull fractures in all the scans were manually labeled by seven experienced neurologists. Two deep learning approaches were developed and tested for the identification of skull fractures. In the first approach, the fracture identification task was treated as an object detected problem, and a YOLOv3 network was trained to identify all the instances of skull fracture. In the second approach, the task was treated as a segmentation problem and a modified attention U-net was trained to segment all the voxels representing skull fracture. The developed models were tested using an external test set of 235 patients (93 with, and 142 without skull fracture). Results: On the test set, the YOLOv3 achieved average fracture detection sensitivity and specificity of 80.64, and 85.92%, respectively. On the same dataset, the modified attention U-Net achieved a fracture detection sensitivity and specificity of 82.80, and 88.73%, respectively. Conclusion: Deep learning methods can identify skull fractures with good sensitivity. The segmentation approach to fracture identification may achieve better results.
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Affiliation(s)
- Wei Shan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Clinical Medicine of Neurological Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Jianwei Guo
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuewei Mao
- Shandong Key Laboratory of Industrial Control Technology, School of Automation, Qingdao University, Qingdao, China
| | - Yulei Zhang
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Yikun Huang
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Shuai Wang
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Zixiao Li
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Xia Meng
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Pingye Zhang
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Zhenzhou Wu
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Clinical Medicine of Neurological Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Yaou Liu
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Kunlun He
- Laboratory of Translational Medicine, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Clinical Medicine of Neurological Diseases, Beijing, China
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Al Babtain I, Abdullah M Alsahly M, A Aba Alkhail AB, Almutib JT, Al Otaibi RAF, Alsalamah ASH, Asseri YM, Ahmed AO. The Relationship Between Cerebrovascular Injuries and Craniomaxillofacial Fractures: Findings From a Tertiary Hospital in Saudi Arabia. Cureus 2021; 13:e17959. [PMID: 34660147 PMCID: PMC8515776 DOI: 10.7759/cureus.17959] [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] [Accepted: 09/14/2021] [Indexed: 11/08/2022] Open
Abstract
Background and objective Blunt cerebrovascular injuries (BCVIs) can lead to serious outcomes, particularly because they are difficult to detect in the acute phase. There are studies that have described the association between cerebrovascular injuries and craniomaxillofacial (CMF) fractures; however, no such study has been conducted among a Saudi population. In light of this, we conducted this study to evaluate the correlation between BCVI and CMF fractures among the local population in Saudi Arabia. In addition, the most common types of fractures associated with BCVI were identified. Methods This retrospective cohort study was conducted at the King Abdulaziz Medical City, a tertiary hospital in Riyadh, Saudi Arabia. All eligible patients with CMF fractures who were hospitalized at the King Abdulaziz Medical City were included. Consecutive patients were screened; no sampling or randomization was required. Patients with penetrating or avulsive mechanisms of injury were excluded. Results Out of a total of 1,560 patients included in the study, 1,537 (98.5%) had CMF fractures, while 23 (1.5%) had BCVIs. None of the patients with CMF fractures had BCVIs. Among the patients with BCVIs, 12 (52.2%) were men and 11 (47.8%) were women. The mean age of these patients was 46.91 ± 17.04 years. Among patients with CMF fractures, 1,071 (69.7%) were men and 466 (30.3%) were women. Their mean age was 23.93 ± 17.36 years. Conclusion The study did not identify any correlation between BCVI and CMF fractures; however, further studies with larger samples across multiple centers are needed to validate our findings and gain deeper insight into the relationship between BCVI and CMF fractures.
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Affiliation(s)
| | | | | | - Jehad T Almutib
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Rakan Ahmed F Al Otaibi
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Deng H, Qiu X, Su Q, Zeng S, Han S, Li S, Cui Z, Zhu T, Xiong Z, Tang G, Tang S. Epidemiology of skeletal trauma and skull fractures in children younger than 1 year in Shenzhen: a retrospective study of 664 patients. BMC Musculoskelet Disord 2021; 22:593. [PMID: 34174865 PMCID: PMC8236158 DOI: 10.1186/s12891-021-04438-8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background Unintentional injury is one of the top three causes of death for infants. However, the epidemiological studies of skeletal trauma and skull fractures in infants younger than 1 year were poorly understood in China. Therefore, our study aimed to examine accidental and emergency attendance in infants under 1 year. It also tried to determine the prevalence and severity of accident types in infants. Methods A retrospective analysis was performed on the demographic characteristics of infants younger than 1 year with skeletal trauma and skull fractures who visited the Shenzhen Children’s Hospital from January 1, 2016 to December 31, 2019. Age, gender, fracture site and type, mechanism of injury, length of visit, length of hospital stay, hospitalization cost, and treatment methods were analyzed. Results A total number of 675 fractures in 664 infants were included, the median age was 187days (IQR,90-273days), including 394 males and 270 females. The top three fracture sites were the skull (430 sites, 63.70 %), long bones of the limbs (168 sites, 24.89 %), and clavicle (53 sites, 7.85 %). The top three causes of injury were locomotion injuries (256 cases, 38.55 %), falls or trips from low height (from beds, tables, chairs, etc.) (130 cases, 19.58 %), and birth injuries (97 cases, 14.61 %). The greatest amount of fractures occurred in children 1–28 days of life (d) reached a top of 101 cases, followed by 331–365 days, accounting for 15.21 and 10.24 %, respectively. The number of fractures reached a trough of 29 cases in the 29-60d group (4.37 %). And increased again to 65 cases in the 151-180d group (9.79 %). The proportion remained relatively constant at 9 % in the 181-210d group (9.19 %) and 211-240d group (9.64 %). The interval between injury and visiting our hospital was ≤ 72 h in 554 cases. Conclusions Special attention should be given to the demographic characteristics of fractures in infants under 1 year of age, and appropriate outreach should be implemented. For example, health education should be provided to aid in the prevention especially for frequently occurring locomotion injuries, and prompt access to specialist medical care should be recommended for skull fractures, which are prone to delayed treatment. In addition, multidisciplinary collaboration should be implemented in trauma care, while also promoting the establishment of trauma centers in specialist children’s hospitals with a stronger capacity to treat pediatric trauma, and a regional system for pediatric trauma treatment.
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Affiliation(s)
- Hansheng Deng
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China
| | - Xin Qiu
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China
| | - Qiru Su
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China
| | - Shuaidan Zeng
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China
| | - Shuai Han
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Shicheng Li
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Zhiwen Cui
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Tianfeng Zhu
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Zhu Xiong
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.
| | - Gen Tang
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.
| | - Shengping Tang
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China. .,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China. .,China Medical University, Shenyang, Liaoning Province, P.R. China.
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5
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Metz JB, Otjen JP, Perez FA, Done SL, Brown EC, Wiester RT, Jenny C, Ganti S, Feldman KW. Delays in care seeking for young children with accidental skull fractures are common. Acta Paediatr 2021; 110:1890-1894. [PMID: 33176011 DOI: 10.1111/apa.15660] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
AIM We sought to determine the frequency and patterns of delayed medical care seeking for young children with skull fractures. METHODS We identified accidental skull fractures <4 years old, 2011-2012. Child abuse paediatricians abstracted retrospective data and paediatric radiologists re-reviewed images. 'Delays' were defined as presentation at ≥6 h. 'Minor accidents' included falls <4 feet and low force trauma, while 'major accidents' included higher height falls and major force events. We studied the frequency and duration of care delays, the signs or symptoms leading to care, and the duration of delays after signs or symptoms developed. RESULTS Two hundred and ten children had accidental skull fractures. Delays were less likely with major accidents (4.9%), than with minor accidents (25.8%) (RR = 0.32 [0.15-0.70]). Children came to care for scalp swelling (STS) (39%), the injury event (36.2%), altered consciousness (15.2%) and vomiting (10.5%). Delayed onset of STS (78.6%) caused most delayed care. Early STS was firm, (17.6%) versus delayed (5.0%), as opposed to soft or fluctuant. CONCLUSION Delayed care seeking is common for minor, but not major accidental infant and toddler skull fractures. Most followed delayed onset of signs and symptoms. Delayed care seeking alone should not imply child abuse.
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Affiliation(s)
- James B. Metz
- Department of Paediatrics University of Vermont Children’s Hospital University of Vermont Burlington Vermont USA
| | - Jeffrey P. Otjen
- Department of Radiology Seattle Children's HospitalUniversity of Washington Seattle Washington USA
| | - Francisco A. Perez
- Department of Radiology Seattle Children's HospitalUniversity of Washington Seattle Washington USA
| | - Stephen L. Done
- Department of Radiology Seattle Children's HospitalUniversity of Washington Seattle Washington USA
| | - Emily C.B. Brown
- Children’s Protection Program Seattle Children's HospitalUniversity of Washington Seattle Washington USA
| | - Rebecca T. Wiester
- Children’s Protection Program Seattle Children's HospitalUniversity of Washington Seattle Washington USA
| | - Carole Jenny
- Children’s Protection Program Seattle Children's HospitalUniversity of Washington Seattle Washington USA
| | - Sheila Ganti
- Clinical Research Coordinator Seattle Children's Hospital Seattle Washington USA
| | - Kenneth W. Feldman
- Children’s Protection Program Seattle Children's HospitalUniversity of Washington Seattle Washington USA
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Igarashi Y, Matsumoto N, Kubo T, Yamaguchi M, Nakae R, Onda H, Yokobori S, Koido Y, Yokota H. Prevalence and Characteristics of Earthquake-Related Head Injuries: A Systematic Review. Disaster Med Public Health Prep 2021;:1-6. [PMID: 33947499 DOI: 10.1017/dmp.2021.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We conducted a systematic review to determine the prevalence and characteristics of earthquake-associated head injuries for better disaster preparedness and management. METHODS We searched for all publications related to head injuries and earthquakes from 1985 to 2018 in MEDLINE and other major databases. A search was conducted using "earthquakes," "wounds and injuries," and "cranio-cerebral trauma" as a medical subject headings. RESULTS Included in the analysis were 34 articles. With regard to the commonly occurring injuries, earthquake-related head injury ranks third among patients with earthquake-related injuries. The most common trauma is lower extremity (36.2%) followed by upper extremity (19.9%), head (16.6%), spine (13.1%), chest (11.3%), and abdomen (3.8%). The most common earthquake-related head injury was laceration or contusion (59.1%), while epidural hematoma was the most common among inpatients with intracranial hemorrhage (9.5%) followed by intracerebral hematoma (7.0%), and subdural hematoma (6.8%). Mortality rate was 5.6%. CONCLUSION Head injuries were found to be a commonly occurring trauma along with extremity injuries. This knowledge is important for determining the demands for neurosurgery and for adequately managing patients, especially in resource-limited conditions.
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Abstract
OBJECTIVE. The purpose of this study was to assess the incidence of pediatric skull fractures contacting cranial sutures in abusive versus accidental trauma. MATERIALS AND METHODS. A retrospective review was conducted of head CT studies performed for pediatric head trauma at a free-standing tertiary care children's hospital from 2012 to 2019. Statistical odds ratios were evaluated to assess the significance of skull fracture extension to sutures in abusive versus accidental injury. A two-proportion Z-test was used to determine the statistical significance of suture type contacted by skull fractures in accidental versus abusive injury. RESULTS. The records of 47 children with 57 abusive skull fractures and 47 children with 54 accidental skull fractures were evaluated. The patients were 1-36 months old. Fifty-one abusive skull fractures (89%) terminated in contact with a cranial suture; 35 of the 51 (69%) touched two or more sutures, and 12 touched three or more sutures. Forty-two of the 54 (78%) accidental skull fractures contacted a suture; only 3 of the 42 (7%) touched two sutures, and none touched more than two sutures (odds ratio, 28.4 [95% CI, 7.6-105.9]; p < .001). In the abusive fractures, the suture most commonly contacted by a fracture line was the lambdoid (43%; p < .04), followed by the sagittal (23%), coronal (21%), temporal-squamous (12%), and metopic (1%) sutures. There was no statistical difference in which suture was contacted by fracture lines in accidental cases. CONCLUSION. Skull fracture contacting cranial sutures is common in abusive and accidental pediatric head trauma. However, that a fracture contacts two or more cranial sutures is an imaging finding not previously described that has a significantly higher association with abusive than with accidental head injury.
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Barbosa A, Fernandes FAO, Alves de Sousa RJ, Ptak M, Wilhelm J. Computational Modeling of Skull Bone Structures and Simulation of Skull Fractures Using the YEAHM Head Model. Biology (Basel) 2020; 9:E267. [PMID: 32899779 DOI: 10.3390/biology9090267] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 12/01/2022]
Abstract
The human head is a complex multi-layered structure of hard and soft tissues, governed by complex materials laws and interactions. Computational models of the human head have been developed over the years, reaching high levels of detail, complexity, and precision. However, most of the attention has been devoted to the brain and other intracranial structures. The skull, despite playing a major role in direct head impacts, is often overlooked and simplified. In this work, a new skull model is developed for the authors’ head model, the YEAHM, based on the original outer geometry, but segmenting it with sutures, diploë, and cortical bone, having variable thickness across different head sections and based on medical craniometric data. These structures are modeled with constitutive models that consider the non-linear behavior of skull bones and also the nature of their failure. Several validations are performed, comparing the simulation results with experimental results available in the literature at several levels: (i) local material validation; (ii) blunt trauma from direct impact against stationary skull; (iii) three impacts at different velocities simulating falls; (iv) blunt ballistic temporoparietal head impacts. Accelerations, impact forces, and fracture patterns are used to validate the skull model.
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9
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Amengual‐Batle P, José‐López R, Durand A, Czopowicz M, Beltran E, Guevar J, Lazzerini K, De Decker S, Muñana K, Early P, Mariani C, Olby N, Petrovitch N, Gutierrez‐Quintana R. Traumatic skull fractures in dogs and cats: A comparative analysis of neurological and computed tomographic features. J Vet Intern Med 2020; 34:1975-1985. [PMID: 32686202 PMCID: PMC7517851 DOI: 10.1111/jvim.15838] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Traumatic skull fractures (TSF) are relatively frequent in dogs and cats, but little information is available regarding their clinical and imaging features. HYPOTHESIS/OBJECTIVES To describe the neurological and computed tomographic (CT) features of a large cohort of dogs and cats with TSF. ANIMALS Ninety-one dogs and 95 cats with TSF identified on CT. METHODS Multicenter retrospective comparative study. Signalment, cause of trauma, fracture locations and characteristics, presence of neurological deficits, and 1-week survival were recorded. Fractures were classified according to the extent of fragmentation and displacement. RESULTS The cranial vault was affected more frequently in dogs (P = .003), whereas the face and base of the cranium more often was affected in cats (P < .001). Cats presented with multiple fractures more frequently (P < .001). All animals with TSF in the cranial vault were more likely to develop neurological signs (P = .02), especially when depressed fractures were present (95% confidence interval [CI], 1.7-8.2; P = .001). Animals with TSF located only in the facial region were less likely to have neurological signs (odds ratio with Mantel-Haenszel's method [ORMH ], 0.2; 95% CI, 0.1-0.6; P = .004). Most affected animals (84.9%) survived the first week post-trauma. Death was more likely with fractures of the cranial vault (P = .003), especially when fragmented (P = .007) and displaced (P = .004). CONCLUSIONS AND CLINICAL IMPORTANCE Traumatic skull fracture distribution and patterns are different between dogs and cats. Cranial vault fractures were associated with neurological deficits and worse survival. The presence of TSF alone should not be considered a negative prognostic factor because most affected animals survived the first week.
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Affiliation(s)
| | | | - Alexane Durand
- College of Veterinary MedicineNC State UniversityRaleighNorth CarolinaUSA
| | - Michal Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary MedicineWarsaw University of Life Scinces‐SGGWWarsawPoland
| | - Elsa Beltran
- Royal Veterinary CollegeUniversity of LondonHatfieldUnited Kingdom
| | - Julien Guevar
- College of Veterinary MedicineNC State UniversityRaleighNorth CarolinaUSA
| | - Kali Lazzerini
- School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
| | - Steven De Decker
- Royal Veterinary CollegeUniversity of LondonHatfieldUnited Kingdom
| | - Karen Muñana
- College of Veterinary MedicineNC State UniversityRaleighNorth CarolinaUSA
| | - Peter Early
- College of Veterinary MedicineNC State UniversityRaleighNorth CarolinaUSA
| | | | - Natasha Olby
- College of Veterinary MedicineNC State UniversityRaleighNorth CarolinaUSA
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10
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Shah J, Dubb S, Agar S, Shah P, Mirza T. Computed tomographic indications for occult skull fractures in paediatric head trauma diagnosed at the time of wound closure under general anaesthesia. Br J Oral Maxillofac Surg 2020; 59:35-38. [PMID: 32747033 DOI: 10.1016/j.bjoms.2020.07.003] [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: 01/09/2020] [Accepted: 07/02/2020] [Indexed: 11/18/2022]
Abstract
Children with head injuries commonly present to the emergency department with forehead lacerations, and are frequently referred to the oral and maxillofacial team. Assessing the Glasgow coma scale (GCS) and neurological status of these patients is particularly challenging and there remains marked ambiguity regarding the use of computed tomographic (CT) imaging in children who have no obvious signs of traumatic brain injury. We present a case series of three patients who presented to our unit with forehead lacerations following a fall. All had a normal GCS, no obvious neurological signs, and all were listed for wound closure under general anaesthesia. Intraoperatively they were found to have underlying skull fractures that necessitated emergency CT whilst under general anaesthesia. Retrospective analysis was performed. Current guidelines and the literature were reviewed to identify factors that may help to identify occult skull fractures in the context of paediatric head trauma. Despite the subsequent discovery of skull fractures under general anaesthesia, none of our patients would have satisfied the present absolute indications for CT in the current guidelines. A number of helpful factors are not common in the UK guidelines but are present in others, including the presence of an appreciable haematoma and lacerations greater than 5 cm, amongst others. The assessment of paediatric patients with head trauma often remains a challenge when assessing for features such as headache, focal neurology, and amnesia. A high index of suspicion, formal examination under anaesthesia, and communication with the radiology department, are imperative if we are to avoid missing an occult injury that could potentially result in brain injury.
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Affiliation(s)
- J Shah
- Luton and Dunstable University Hospital.
| | - S Dubb
- Luton and Dunstable University Hospital
| | - S Agar
- Luton and Dunstable University Hospital
| | - P Shah
- Luton and Dunstable University Hospital
| | - T Mirza
- Luton and Dunstable University Hospital
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11
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Crudele GDL, Merelli VG, Vener C, Milani S, Cattaneo C. The Frequency of Cranial Base Fractures in Lethal Head Trauma. J Forensic Sci 2019; 65:193-195. [PMID: 31433492 DOI: 10.1111/1556-4029.14149] [Citation(s) in RCA: 4] [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: 03/16/2019] [Revised: 05/30/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022]
Abstract
The interpretation of cranial base injuries has never been investigated from a purely anthropological perspective. Very little exists in forensic literature in order to interpret the significance of cranial base fractures. We analyzed 296 cases of deaths due to skull-brain injuries. The frequency of vault fractures was 75.7% and that of base fractures was 91.9%. We observed the distribution of cases of death according to manner of death and manner of injury and number of fossae involved. These observations were analytically compared to different variables (age, sex, manner of injury, and mode of injury). The study presented the proportion of base fractures associated with vault fractures, and the frequency of absence of base fracture in subjects with no vault fractures. Interesting associations of base fractures to age and manner of death are shown.
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Affiliation(s)
- Graziano D L Crudele
- Department of Biomedical and Health Sciences, Section of Legal Medicine, University of Milan, Via Luigi Mangiagalli, 37, Milan, 20133, Italy
| | - Vera G Merelli
- Department of Biomedical and Health Sciences, Section of Legal Medicine, University of Milan, Via Luigi Mangiagalli, 37, Milan, 20133, Italy
| | - Claudia Vener
- Laboratory of Medical Statistics and Biometry "GA Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Via Augusto Vanzetti, 5, Milan, 520133, Italy
| | - Silvano Milani
- Laboratory of Medical Statistics and Biometry "GA Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Via Augusto Vanzetti, 5, Milan, 520133, Italy
| | - Cristina Cattaneo
- Department of Biomedical and Health Sciences, Section of Legal Medicine, University of Milan, Via Luigi Mangiagalli, 37, Milan, 20133, Italy
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Ortega Zufiría JM, Prieto NL, Cuba BC, Degenhardt MT, Núñez PP, López Serrano MR, López Raigada AB. [Mild head injury]. Surg Neurol Int 2018; 9:S16-S28. [PMID: 29430327 PMCID: PMC5799943 DOI: 10.4103/sni.sni_371_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/16/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Mild traumatic brain injury (TBI) represents a major health concern, because a sizeable number of patients with mild TBI will develop potentially life-threatening complications. The target of this study was to describe a large series of adult patients suffering from mild TBI, treated at University Hospital of Getafe, between 2010 and 2015 (n = 2480). We examined the patients' epidemiological and baseline clinical profile, diagnosis, treatment and ultimate outcomes, to identify major prognostic factors that influence the final result. METHODS We retrospectively extracted patient data from medical records and performed both bivariate and multivariate statistics. RESULTS In our sample, mild TBI was more common in men, and the most common causative mechanism was a traffic accident. We proposed a model for classifying patients according to risk, dividing them into low, intermediate and high risk, based upon their baseline clinical picture. This classification scheme correlated well with final outcomes. We investigated indications for skull radiography and computed tomography (CT), as well as for hospital admission for clinical observation. CONCLUSIONS In this study, the presence of a neurological focus on clinical examination, the existence of a fracture on plain radiographs, advanced age and the presence of a coagulation disorder were associated with the increased likelihood of intracranial complications and a poor prognosis. The Glasgow Coma Scale was deficient predicting patient outcomes, because it failed to account for concussion-related symptoms like amnesia and loss of consciousness, both very common in patients with mild TBI.
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Affiliation(s)
| | | | | | | | - Pedro Poveda Núñez
- Servicio de Neurocirugía, Hospital Universitario de Getafe, Madrid, Spain
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Worm PV, do Nascimento TL, do Couto Nicola F, Sanches EF, Dos Santos Moreira CF, Rogério LPW, Dos Reis MM, Finger G, Collares MVM. Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction? Surg Neurol Int 2016; 7:S746-S751. [PMID: 27904754 PMCID: PMC5114860 DOI: 10.4103/2152-7806.193725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 06/25/2016] [Accepted: 09/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background: In cases where autologous bone graft reconstruction is not possible (such as comminuted fractures, bone graft reabsorption, or infection) and the use of synthetic material is required, polymethylmethacrylate (PMMA) use is a safe and efficient solution. Studies comparing the incidence of postoperative complications between autologous and synthetic cranioplasty are heterogeneous, not allowing a conclusion of which is the best material for skull defects reconstruction. Current medical literature lacks prospective well-delineated studies with long-term follow-up that analyze the impact of antibiotic use in PMMA cranial reconstruction of moderate and large defects. Methods: A prospective series of patients, who underwent cranioplasty reconstruction with PMMA impregnated with antibiotic, were followed for 2 years. Authors collected data regarding demographic status, clinical conditions, surgical information, and its complications. Results: A total of 58 patients completed full follow-up with a mean group age of 40 years and a male predominance (77%). Major complications that required surgical management were identified in 5 patients, and 10 patients evolved with minor complications. Postoperative surgical site infection incidence was 3.2%. Conclusion: The infection rate in patients submitted to PMMA flap cranioplasty impregnated with antibiotic is significantly inferior comparing to the data described in medical literature. A lower infection incidence impacts secondary endpoints such as minimizing surgical morbidity, mortality, hospitalization period, and, consequently, costs.
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Affiliation(s)
- Paulo Valdeci Worm
- Department of Surgical Sciences, Post Graduation Program in Medicine, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Fabricio do Couto Nicola
- Cerebral Ischemia Laboratory, Department of Biochemistry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Eduardo Farias Sanches
- Cerebral Ischemia Laboratory, Department of Biochemistry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | | | | | | | - Guilherme Finger
- Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcus Vinicius Martins Collares
- Department of Surgical Sciences, Post Graduation Program in Medicine, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Plastic and Craniomaxillofacial Surgery, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Syed AT, Lone NA, Wani MA, Bhat AS. Clinical management of patients with minor head injuries. Int J Health Sci (Qassim) 2007; 1:131-140. [PMID: 21475463 PMCID: PMC3068669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Injuries are a focus of public health practice because they pose a serious health threat, occur frequently, and are preventable. Globally, thousands of people attend their local Emergency Department daily after suffering a head injury. Early diagnosis and appropriate management improves outcomes but is sometimes more difficult to achieve than might be imagined. Of all types of injury, those to the brain are among the most likely to result in death or permanent disability. Estimates of traumatic brain injury (TBI) incidence, severity, and cost reflect the enormous losses to individuals, their families, and society. The reduction in the number and severity of injuries offers a cost-effective manner in which to improve the health status of populations. METHODS We prospectively studied 485 consecutive patients of traumatic brain injury out of which 280 with GCS of 13, 14, and 15 were subjected to routine early CT scan of head after 4 hours of reporting to Emergency Department. Patients with penetrating head injury were excluded. RESULTS 15 % of patients had abnormal CT Scans and only 4% needed surgical intervention. Though a small number of patients harbour potentially lethal intracranial lesions yet, most of these cases are salvageable if diagnosed early and proper treatment. CONCLUSION This study reveals that the current practice in the some countries of risk stratification of adult MHI based on skull radiography need to be replaced by slightly modified versions of the Canadian CT rule/NICE guidelines. This will result in a large reduction in skull radiography and will be associated with modest increases in CT and admissions rates. The authors also believe that early CT Scanning can detect intracranial lesions and will reduce unnecessary hospital admissions.
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Affiliation(s)
- A. T Syed
- Correspondence:Dr. Syed A. T., Head, Accident & Emergency Department, Sher-e-Kashmir Institute of Medical Sciences, Post Box: 826, GPO, Srinagar – 190001, (India)
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