Acute Head Trauma Research Articles

Emergency department observation of mild traumatic brain injury with minor radiographic findings: shorter stays, less expensive, and no increased risk compared to hospital admission.

ObjectiveThe management of mild traumatic brain injury (mTBI) with minor radiographic findings traditionally involves hospital admission for monitoring, although this practice is expensive with unclear benefit. We implemented a protocol to manage these patients in our emergency department observation unit (EDOU), hypothesizing that this pathway was cost effective and not associated with any difference in clinical outcome.MethodsmTBI patients with minor radiographic findings were managed under the EDOU protocol over a 3‐year period from May 1, 2015 to April 30, 2018 (inclusions: ≥19 years old, isolated acute head trauma, normal neurological exam [except transient alteration in consciousness], and a computed tomography [CT] scan of the head with at least 1 of the following: cerebral contusions <1 cm in maximum extent, convexity subarachnoid hemorrhage, or closed, non‐displaced skull fractures). These patients were retrospectively analyzed; clinical outcomes and charges were compared to a control cohort of matched mTBI hospital admissions over the preceding 3 years.ResultsSixty patients were observed in the EDOU over the 3‐year period, and 85 patients were identified for the control cohort. There were no differences in rate of radiographic progression, neurological exam change, or surgical intervention, and the overall incidence of hemorrhagic expansion was low in both groups. The EDOU group had a significantly faster time to interval CT scan (Mean Difference (MD) 3.92 hours, [95%CI 1.65, 6.19]), P = 0.001), shorter length of stay (MD 0.59 days [95% CI 0.29, 0.89], P = 0.001), and lower encounter charges (MD $3428.51 [95%CI 925.60, 5931.42], P = 0.008). There were no differences in 30‐day re‐admission, 30‐day mortality, or delayed chronic subdural formation, although there was a high rate of loss to follow‐up in both groups.ConclusionsCompared to hospital admission, observing mTBI patients with minor radiographic findings in the EDOU was associated with significantly shorter time to interval scanning, shorter length of stay, and lower encounter charges, but no difference in observed clinical outcome. The overall risk of hemorrhagic progression in this subset of mTBI was very low. Using this approach can reduce unnecessary admissions while potentially yielding patient care and economic benefits. When designing a protocol, close attention should be given to clear inclusion criteria and a formal mechanism for patient follow‐up.

Scenario of Head Injury Patients in Tertiary Care Hospital of Nepal.

The aim of the study is to find out the age and sex distribution, modes of head injury and correlate Glasgow Coma Scale with Computed Tomography in patients with head trauma in our center. A cross-sectional study was performed among 113 patients of acute head trauma presenting to Emergency department of our hospital for three months. The severity of the head injury was assessed on admission by the Glasgow Coma Scale score and categorized as mild, moderate, or severe head injury. Non contrast head computed tomography was obtained. The mean age of patients studied in this study was 35.53 year in males and 32.1 year in female with male to female ratio being 1.86:1. The most common causes of head injury were road-traffic accident 58 (51%), falls 42 (37%) and physical assault 13 (12%). In our present study, 67 (59.3%) of patients had mild head injury, 27 (23.9%) had moderate head injury and 19(16.8%) had severe head injury. Our study shows presence of multiple lesions with depressed bone fracture of skull bone was associated with lower Glasgow Coma Scale. Significant association between Glasgow Coma Scale and computed tomography finding was seen(p less than 0.001). Glasgow Coma Scale is strongly associated with computed tomography in patients with head injury. Road traffic accident is the commonest mode of injury. Most present with mild head injury.

The Feasibility of Fast MRI to Reduce CT Radiation Exposure With Acute Traumatic Head Injuries.

* Abbreviations: CT — : computed tomography ED — : emergency department TBI — : traumatic brain injury Traumatic brain injuries (TBIs) are among the most common causes of pediatric morbidity and mortality globally. After acute head trauma, children at risk for clinical deterioration must be identified rapidly and accurately, usually in the emergency department (ED) setting. Neuroimaging by computed tomography (CT) for pediatric head trauma proliferated rapidly in the late 1990s1 and remains the diagnostic gold standard for the identification of clinically important TBIs. Therein lies the problem: the risk of missing significant intracranial pathology must be weighted against the risks of radiation-induced malignancy associated with CT imaging.2–4 Reducing CT scans for head-injured children has been the focus of international research5–8 and educational campaigns for nearly 2 decades.9–11 Despite these long-standing efforts, neuroimaging of head-injured children by CT remains elevated.12 MRI presents a potentially attractive alternative to CT that would not expose children to the harmful effects of ionizing radiation. However, the use of MRI for pediatric head trauma has traditionally been limited by the need to remain motionless for a prolonged period and frequently necessitates procedural sedation with its additional inherent risks. A fast MRI protocol that is motion tolerant and sensitive for brain injury would curtail the limitations of conventional MRI. Previous … Address correspondence to Brett Burstein, MDCM, PhD, MPH, Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC H4C 3J1, Canada. E-mail: brett.burstein{at}mail.mcgill.ca

Biomarkers of the brain injuries - the future diagnosis standard in head trauma?

Acute head trauma is often a clinical challenge in diagnosing the brain damage, assessing its severity and prognosis, and establishing the optimal treatment. Different patients, with brain damage of apparent comparable severity according to the imaging examination, may have different neurological evolution or different response to therapy.Minor traumatic brain injuries can induce a brief loss of consciousness or confusion, are usually benign, but sometimes they cause persistent and progressive brain symptoms in the long run. However, at present, there are no reliable methods that can diagnose properly minor traumatic brain injuries.Biomarkers of the brain injuries allow the monitoring of both physiological and pathological processes. The identification of such biomarkers could allow a better understanding of the pathological processes involved in traumatic brain injuries, their diagnosis, prognosis and may facilitate the establishment of a better treatment regimen for these patients.In this article, the authors make a brief review of the literature in which they analyse the biomarkers of the lesions of the various brain structures identified so far, which can be detected in biological fluids (blood, cerebrospinal fluid) and the advantages and limitations of their use in the current medical practice.

Surgical treatment of an asymptomatic giant supratentorial cavernous hemangioma. Case report

A case is reported of a 19-year old patient with a supratentorial giant cavernous malformation (GCM). This was an incidental finding in the context of acute head trauma. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a giant supratentorial right mass. Surgical excision was performed, and histopathology findings were consistent with a cavernous malformation (CM). The patient had a complete neurological recovery. To our knowledge, this is the first case of a GCM in an asymptomatic patient with total surgical excision.

GAMBARAN PENANGANAN PASIEN GAWATDARURAT DI INTALASI GAWAT DARURAT RUMAH SAKIT SANTA ELISABETH MEDAN

Emergency is a condition in which someone needs immediate treatment or help because if he does not get first aid quickly it will threaten his soul or cause permanent disability. Patients of emergency are brought to Emergency Installation. Emergency Installation is the spearhead of the hospital where all incoming patients will be handled on this unit. The scope of emergency services is to conduct a primary survey, such as airway, breathing, circulation, disability and secondary survey. Goals:The purpose of this study is to find out the handling of Emergency patients at the Emergency Installation of Santa Elisabeth Hospital Medan in 2017 Methods:The research design used was descriptive. The population used was emergency patients, with sampling technique of pulposive sampling of 297 people. The criteria used were inclusion with the criteria of an acute myocardial infarction patient, head trauma, airway obstruction, pneumothorax, burns and shock Results:Technique used by researcher was documentation study with the results of the study showed male gender of 176 people (59.3%), age&gt; 65 years were 98 people (33%) Handling of the case of the highest emergency patients was acute myocardial infarction 98 people (33%). Conclusion: The conclusion shows that male patients tend to suffer from heart disease. Age&gt; 65 years is age that susceptible to disease because of the lack body system work such as heart

Emergency department neuroimaging for epileptic seizures.

To determine the frequency and yield of neuroimaging in patients with known seizure disorders presenting to the emergency department (ED) with recurrent (nonindex) seizures. We reviewed 822 consecutive ED visits for nonindex seizures at the Oregon Health & Science University and the VA Portland Health Care System. For each visit, we abstracted details of the clinical presentation, whether neuroimaging was obtained, the results of neuroimaging, and the results of previous neuroimaging studies, when available. We determined whether ED neuroimaging led to an acute change in patient management (yield). Clinical factors associated with obtaining ED neuroimaging, and with the yield of neuroimaging, were evaluated by multivariate logistic regression. A majority (78%) of ED seizure visits were for nonindex seizures. Neuroimaging was obtained in 381 of 822 nonindex seizure visits (46%). Of these, 11 imaging studies (3%) led to an acute change in patient management, 8 (2%) after excluding false-positive scans. Acute head trauma, prolonged alteration of consciousness, and a focal neurologic examination at presentation were associated with an increased yield of ED neuroimaging. Absent any of these 3 clinical factors the true positive yield of neuroimaging was zero. ED neuroimaging was performed in nearly half of all patients presenting with nonindex seizures. A more conservative use of ED neuroimaging for nonindex seizures, based on clinical factors at presentation, could decrease imaging frequency with minimal loss of yield.

Ventriculosubgaleal shunting-a comprehensive review and over two-decade surgical experience.

The subgaleal space is the fibroareolar layer found between the galea aponeurotica and the periosteum of the scalp. Due to its elastic and absorptive capabilities, the subgaleal space can be used as a shunt to drain excess cerebrospinal fluid from the ventricles. A subgaleal shunt consists of a shunt tube with one end in the lateral ventricles while the other end is inserted into the subgaleal space of the scalp. This will allow for the collection and absorption of excess cerebrospinal fluid. Indications for ventriculosubgaleal shunting (VSG) include acute head trauma, subdural hematoma, and malignancies. VSG shunt is particularly advantageous for premature infants suffering from post-hemorrhagic hydrocephalus due to their inability to tolerate long-term management such as a ventriculoperitoneal shunt. Complications include infection and shunt blockage. In comparison with other short-term treatments of hydrocephalus, the VSG exhibits significant advantages in the drainage of excess cerebrospinal fluid. VSG shunt is associated with lower infection rates than other external ventricular drain due to the closed system of CSF drainage and lack of external tubes. This review discusses the advantages and disadvantages of the VSG shunt, as well as our personal experience with the procedure.

UTILIZATION OF COMPUTED TOMOGRAPHY FOR PEDIATRIC HEAD TRAUMA FROM 2007–2014 IN THE UNITED STATES: BEFORE AND AFTER PECARN CLINICAL DECISION RULES

Abstract BACKGROUND The Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules identify children at low risk of clinically important traumatic brain injury in whom computed tomography (CT) neuro-imaging can safely be avoided. Since publication in 2009, these rules have been externally validated and are widely used in the Emergency Department (ED) assessment of children with acute head trauma. OBJECTIVES This study sought to determine if the proportion of children receiving CT-imaging in US EDs following head trauma has decreased following the development of PECARN rules. DESIGN/METHODS This study was a cross-sectional study using the National Hospital Ambulatory Care Survey (NHAMCS) database from 2007–2014. NHAMCS collects data on approximately 30,000 nationally representative visits annually to 300 randomly selected U.S EDs. We included all children &lt;18 years old presenting with a chief complaint or discharge diagnosis of head injury. We collected data on patient demographics, reason for ED visit, discharge diagnosis, patient disposition, and use of head CT. Multivariable logistic regression was used to identify characteristics of CT use, with appropriate weighting to account for the survey methodology. The primary outcome was proportion of children receiving a head CT before and after 2009. RESULTS There were 55,253 paediatric visits during the 8-year study period. Among these, 2,783 (5.3% 95%CI 5.0%-5.6%) met inclusion criteria, representing 12,417,725 paediatric head trauma visits. Median patient age was 6 years (IQR 2–13 years), 62% were male, and a majority were evaluated in non-teaching and non-paediatric hospitals (88% and 90%, respectively). Overall, 32% (95%CI 29%-35%) underwent CT neuroimaging. There was no significant difference in CT use after 2009 (31% after vs. 33% before, p=0.41). Multivariate analysis similarly demonstrated no difference after adjustment for patient age, gender, race, insurance provider, paediatric or teaching hospital, admission status and triage acuity (AOR 1.02 after vs. before, 95%CI 0.79–1.32, p=0.85). Factors associated with increased CT use were age ≥2 years (AOR 1.4, 95%CI 1.1–1.9, p=0.02), admission (AOR 5.3, 95%CI 2.2–12.4, p&lt;0.001), highest triage acuity (AOR 7.3, 95%CI 3.5–15.3, p&lt;0.001) and presentation to a non-teaching (AOR 1.5, 95%CI 1.1–2.2, p=0.02) or non-paediatric (AOR 1.5, 95%CI 1.3–2.8, p&lt;0.01) hospital. CONCLUSION The use of CT neuro-imaging did not decrease in the 5-year period following derivation of PECARN rules. Findings suggest an important need for quality improvement initiatives to ensure appropriate CT utilization among head injured children.

Effect of Early Vestibular Rehabilitation on Vertigo and Unsteadiness in Patients with Acute and Sub-Acute Head Trauma.

Vestibular rehabilitation is a treatment option for the management of vertigo and unsteadiness, which are very common in head trauma patients and more challenging in the early months after trauma. This study evaluated the effectiveness of a vestibular rehabilitation program in the recovery of acute and sub-acute head trauma patients. The goal of this study was evaluation of the effect of early vestibular rehabilitation on patients with acute and sub-acute head trauma. This study was performed in 20 head trauma patients with vertigo and unsteadiness. The patients were randomly divided into two groups: one group received medical therapy (Betaserc) and the other received rehabilitation and medical therapy. An individualized vestibular rehabilitation program was designed that was then revised and verified by a joint committee of vestibular rehabilitation groups. The effectiveness of interventions was measured using the Dizziness Handicap Inventory (DHI) by comparing the results before and after therapy. The physical conditions and DHI scores of patients in both groups were similar at baseline. After 1 month of rehabilitation, patients receiving vestibular rehabilitation and medication showed greater progress than patients receiving medication only (P=0.000). Vestibular rehabilitation can aid in the recovery from vertigo and increase the stability of head trauma patients. Simultaneous treatment with medicine and vestibular rehabilitation exercises can result in quicker and better therapeutic effects.

Minor Head Trauma in the Pediatric Emergency Department: Decision Making Nodes.

Minor head trauma is one of the leading causes of accessing pediatric emergency departments; however, only a limited number of patients develops clinically relevant brain injuries. The aim of this review is to provide physicians a clinical pathway for managing pediatric minor head trauma. A Pubmed/Medline search was conducted through the following entries: "minor head trauma", "mild head trauma", "minor head injury", "mild head injury" or "acute head trauma". All the studies including pediatric samples between 2000 and 2015 were considered for a critical review. A few articles written before 2000 were analyzed for their relevance. The Pediatric Emergency Care Applied Research Network (PECARN) algorithm identified children with a very low risk for clinically relevant brain injuries (normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture, no severe headache, no evident clinical worsening over time and no multiple symptoms) and offered the only validated clinical prediction rule to select candidates for CT scans. Other proposed clinical prediction rules (including NEXUS II, CHALICE and CATCH), that were not validated, have a lower sensitivity than PECARN algorithm. Skull X-ray, cerebral magnetic resonance and cranial ultrasonography could provide useful information in selected cases. The critical use of PECARN rule represents the best validated clinical tool for the early identification of children with a clinically relevant brain injury. Its application should be integrated with physician experience and judgement, parental compliance and clinical observation.

Does the Addition of a "Black Bone" Sequence to a Fast Multisequence Trauma MR Protocol Allow MRI to Replace CT after Traumatic Brain Injury in Children?

Head CT is the current neuroimaging tool of choice in acute evaluation of pediatric head trauma. The potential cancer risks of CT-related ionizing radiation should limit its use in children. We evaluated the role of MR imaging, including a "black bone" sequence, compared with CT in detecting skull fractures and intracranial hemorrhages in children with acute head trauma. We performed a retrospective evaluation of 2D head CT and brain MR imaging studies including the black bone sequence of children with head trauma. Two experienced pediatric neuroradiologists in consensus created the standard of reference. Another pediatric neuroradiologist blinded to the diagnosis evaluated brain MR images and head CT images in 2 separate sessions. The presence of skull fractures and intracranial posttraumatic hemorrhages was evaluated. We calculated the sensitivity and specificity of CT and MR imaging with the black bone sequence in the diagnosis of skull fractures and intracranial hemorrhages. Twenty-eight children (24 boys; mean age, 4.89 years; range, 0-15.5 years) with head trauma were included. MR imaging with the black bone sequence revealed lower sensitivity (66.7% versus 100%) and specificity (87.5% versus 100%) in identifying skull fractures. Four of 6 incorrectly interpreted black bone MR imaging studies showed cranial sutures being misinterpreted as skull fractures and vice versa. Our preliminary results show that brain MR imaging complemented by a black bone sequence is a promising nonionizing alternative to head CT for the assessment of skull fractures in children. However, accuracy in the detection of linear fractures in young children and fractures of aerated bone remains limited.

Identifying additional clinical training requirements for military maxillofacial surgeons deploying on current operations

Background: The evolution of surgical training is resulting in ever sub specialisation, with head and neck trauma in a civilian environment now managed by a combination of surgical specialties. However such combinations of specialties may not be present in future United Kingdom (UK) led military settings, necessitating identification of skill sets required for predicted clinical scenarios. Objectives: The aim of this study was to identify any additional training required for maxillofacial surgeons to adequately manage acute head and neck trauma in the current deployed military environment. Methods: A systematic review of the literature was undertaken with Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology to identify surgical procedures necessary to manage head and neck trauma in the deployed military environment. Procedures were matched to those surgical competencies within the UK maxillofacial surgical training pathway. Findings: Damage control surgical procedures required within 12 h of injury comprise tracheostomy, haemorrhage control of the neck, face and head regions, decompressive craniotomy, facial fracture stabilisation and lateral canthotomy. Competencies required within 3–5 days comprise facial fracture internal fixation, ocular repair, evisceration and enucleation. Conclusions: UK maxillofacial surgical training fulfils the majority of those competencies required to treat those predicted head and neck surgical injuries on future operational deployments. Additional training that would be required include orbital evisceration and decompressive craniotomy. Clinical attachments to ophthalmology and neurosurgery are recommended and these may be covered as part of a tailored military specific fellowship.

Optimising the field surgical equipment used by maxillofacial surgeons deploying on future military operations

Background: The 2015 Ministry of Defence Strategic Defence Strategy Review identified the need for highly mobile medical facilities for future conflicts. Field hospitals will include military maxillofacial surgeons capable of providing damage control surgery for injuries to the head and neck. The requirement for speed and mobility necessitates optimisation of the maxillofacial specific equipment. Objectives: The aim of this study was to identify field surgical equipment that can be utilised by maxillofacial surgeons to manage acute head and neck trauma in the current deployed military environment. Methods: A systematic review of the medical and commercial literature was undertaken with Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology to identify surgical procedures necessary to identify portable surgical equipment capable of treating head and neck trauma in the deployed military environment. Findings: A maxillofacial specific field module will be required to supplement the existing orthopaedic module to manage hard tissue craniofacial trauma. This should enable facial fracture intermaxillary and external fixation as well as craniotomy within 72 h. Equipment for internal fixation will be required for 5–7 days post injury. Conclusions: A lightweight, modular and compact trauma module for future conflicts based upon these recommendations is currently being built. All drills and craniotomes are should be battery operated, but the use of compression units are recommended to improve torque. Rapid resupply modules should be available for commonly used components. A cadaver based training programme utilising this equipment is planned for all deployable military maxillofacial surgeons.

Computed Tomographic Evaluation of Orbito-Ocular Injuries in Patients with Acute Head Trauma in University of Abuja Teaching Hospital Gwagwalada.

Computed Tomographic Evaluation of Orbito-Ocular Injuries in Patients with Acute Head Trauma in University of Abuja Teaching Hospital Gwagwalada.

Evaluation of Epidemiological Trends and Severity of Traumatic Brain Injury Using Multi-Detector Computed Tomography Scanner in Uttar Pradesh University of Medical Sciences Hospital

Background: MDCT is very well diagnosed and detecting haemorrhages, skull fracture with the help of new technique like 3D, Volume Rendering Technique (VRT), Multi-planar Reconstruction (MPR) and Maximum Intensity Projection. To evaluate of the epidemiological trends and severity of Traumatic Brain Injury (TBI) using multi-detector computed tomography scanner. Methods: The Present study was conducted with 61 patients, age between 2 year to 70 year mean age (36 Years) presenting to emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, with a history of acute head trauma from Dec 2015 to May 2016. All patients were examined using 64 MDCT. Results: Traumatic brain injury caused by various reasons like 65.57% Road Traffic Accidents (RTA) and 19.67% Fall From Height (FFH) being and 14.75% hit by hard object. Loss of consciousness was the most common complaint of the 60.65% TBI patients followed by 6.56% Vomiting and headache, 21.31% facial injury and 1.47% scalp wounds. All TBI patients were diagnosed by MDCT who was observed 37.7% skull fractures, 9.83%, extra dural hematoma, 14.75% Sub Dural hematoma, 13.11% Sub archnoid haemorrhage, 6.55% Intra cerebral hematoma, 27.86% brain contusions and 9.83% diffuse cerebral edema. Conclusion: MDCT is well characterized to various type severities of the brain injury TBI patients. The present study data is indicated 65.57% majority of TBI patients is suffered by Road traffic accidents involving young adult males predominant.

Can diffusion-weighted imaging be used as a tool to predict seizures in patients with PLEDS?

It is unclear which patients with PLEDs will have associated seizures and therefore will need to be treated aggressively with antiepileptic medications. We present a prospective observational study of ten consecutive non-anoxic patients with PLEDs based on continuous 24-hour EEG monitoring. According to the EEG, five of the patients had seizures associated with PLEDs and five had PLEDs but no seizures. The aetiology included: neoplasm (n=1), cortical dysplasia (n=1), acute head trauma (n=1), encephalomalacia related to healed abscess (n=1), intra-parenchymal haemorrhage (n=1), and no structural lesion (n=5). All patients underwent brain MRI using diffusion-weighted imaging (DWI). We found that the five patients who had seizures with PLEDs on continuous EEG had restricted diffusion on DWI. In contrast, the five patients who had PLEDs but no seizures on continuous EEG did not show a restricted diffusion pattern on DWI. We will continue to prospectively assess DWI findings in this group of patients and encourage other centres to also review similar data. If our observation is replicated, this would indicate that restricted diffusion on brain MRI may be a useful marker to identify patients with PLEDs on their EEG who are likely to have associated seizures.

Todd's Paresis in Acute Mild Head Trauma

We present the case of an adult male who sustained Todd's paresis after a traumatically induced seizure in a patient with an isolated facial injury. The precipitating event was head trauma from a golf club. The patient had no previous history of seizures and went on to make a complete neurologic recovery with no cerebral pathology noted. A literature review suggests that Todd's paresis after trauma is very rare as opposed to occurring in the medical or long-term brain injury settings. Although the authors acknowledge that it may occur in trauma, the awareness within the prehospital setting is sufficiently rare for this case report to be of interest to prehospital clinicians; it is important prehospital clinicians are aware of this condition.

Risk for All-cause and Traumatic Death in Head Trauma Subjects: A Prospective Population-based Case-control Follow-up Study.

To investigate long-term mortality for subjects with acute head trauma. It is not known why long-term mortality after head trauma without traumatic brain injury is elevated. All subjects admitted to Oulu University Hospital emergency room in 1999 with an acute head trauma (n = 737) were followed up until February 2014 and compared with age and sex-matched general population controls (n = 2196). Dates and causes of death were obtained from the official Cause-of-Death Statistics. Cox proportional hazard regression models and Kaplan-Meier survival curves were used to identify predictors for alcohol-related, nonalcohol-related, and all-cause death. Alcohol-related deaths were more frequent among the subjects with head trauma (27.8%) than among the population controls (6.9%). Head trauma with or without traumatic brain injury (TBI) shortened mean life expectancy by 8.7 years and by as much as 13 years if only those without TBI were considered. The risk of alcohol-related death was 7-fold (hazard ratio 6.79; 95% confidence interval, 3.94-11.71) among subjects without TBI as compared with general population. Of all future deaths among these cases 17.1% were because of a new trauma, a significantly higher frequency (P < 0.005) than that observed in the general population (3% of all deaths). Alcohol-related cause of death was significantly more common among the subjects who were under the influence of alcohol at the time of the index trauma than among the sober subjects. Head trauma subjects without TBI have an elevated risk of alcohol-related death. Alcohol-related traumas are a major cause of death among these subjects.

Completion CT of Chest, Abdomen, and Pelvis after Acute Head and Cervical Spine Trauma: Incidence of Acute Traumatic Findings in the Setting of Low-Velocity Trauma.

To determine the frequency of acute traumatic findings in computed tomographic (CT) chest abdomen pelvis (CAP) examinations in patients with acute traumatic head and/or cervical spine injury and no evidence suggesting bodily injury. After institutional review board approval with a waiver of informed consent was obtained, a HIPAA-compliant retrospective study was performed. A review of the electronic medical records and dictated reports identified patients who met the following criteria: CT-documented acute head and/or cervical spine trauma, CT CAP performed at least 20 minutes after initial brain and/or cervical spine CT, and no evidence of bodily injury at physical examination or on initial plain radiographs. The types of head and/or cervical injury, as well as mechanisms of injury in these patients, were analyzed. The frequency of acute traumatic injury in the CT CAP examinations was also determined, and 95% confidence intervals were calculated. There were 115 patients who met the study criteria (average age, 67.3 years). Sixty-three (54.8%) patients were male. The average injury severity score was 9.3. No patients who met the criteria for this study were found to have an acute traumatic injury to the chest, abdomen, or pelvis. These 115 CT CAP examinations comprised 7.5% (115 of 1530) of all CT CAP examinations performed in the emergency department over the 15-month study period. CT CAP examinations rarely if ever reveal acute traumatic injury in patients who have experienced low-velocity trauma and have acute head and/or cervical spine trauma in the absence of evidence of bodily injury.