Assessment Of Head Injury Research Articles

Assessment of head injury (HI) management in the paediatric population at mater dei hospital

Assessment of head injury (HI) management in the paediatric population at mater dei hospital

The Use of Sideline Video Review to Facilitate Management Decisions Following Head Trauma in Super Rugby

BackgroundSideline video review has been increasingly used to evaluate risk of concussive injury during match play of a number of collision sports, with the view to reducing the incidence of match play concussion injuries. The purpose of this study was to evaluate the effectiveness of sideline video review for identifying and evaluating head impact events in Rugby Union.MethodsAll Australian teams’ 2015 Super Rugby season matches were studied. Meaningful head impact events (HIEs) were identified, comprising events identified and acted upon during matches and events identified through a post-season retrospective review. Video footage of each HIE was coded by two experienced independent sports medicine clinicians to evaluate management decisions made by match-day (MDD) and team doctors (TD). HIE incidences for matches with and without sideline video were compared, and the agreement between game-day video interpretation and the independent clinician opinion calculated.ResultsSeventy HIEs were identified in 83 matches (47 identified during matches and 23 identified post-season), equating to 42.5 HIEs per 1000 player match hours. When video review was available, an unnoticed HIE occurred once every 4.3 matches, compared to once every 2.3 matches when the sideline video review was unavailable. Of the 47 identified in-match HIEs evaluated by TD and MDD during the season, 18 resulted in an immediate and permanent removal, 28 resulted in temporary removal for an off-field assessment, and one resulted in the player continuing the game. Game-day head injury assessment process video decisions agreed with the independent clinician view in 72% of cases, κ = 0.49 (95% CI 0.38–0.59, weak agreement).ConclusionsThese findings suggest that access to sideline video review is an important supplementary component to identify potential concussions; however, there is a critical need for improved systems and processes to reduce the likelihood of missing an incident.

Can tackle height influence head injury assessment risk in elite rugby union?

ObjectivesTackle height laws are an area of controversy in rugby union. It is reported that the tackler is at most risk of a Head Injury Assessment (HIA). Therefore, the aim of this study was to use match video evidence of tackles in elite level rugby union to examine the effect of tackle heights on HIA risk for the tackler. DesignQualitative observational case–control study. MethodsEach HIA (n=74) and control tackle (n=965) was categorised based on tackle direction (front- or side-on), tackle type (arm, shoulder or smother) and tackle height (upper trunk, mid-trunk, lower trunk, upper leg or lower leg). The Relative Risk (RR), 95% Confidence Interval (CI) and probability (p) values were calculated for each tackle height. ResultsIntended primary contact at the upper trunk of the ball carrier had a greater propensity to result in a HIA for the tackler for front-on upper body shoulder tackles (RR=1.48; 95%CI=1.16–1.90; p<0.01) and side-on upper body smother tackles (RR=2.30; 95%CI=1.82–2.92; p<0.01). Intended primary contact at the upper leg of the ball carrier had a greater propensity to result in a HIA for the tackler for front-on (RR=2.60; 95%CI=1.70–3.97; p<0.01) and side-on (RR=3.34; 95%CI=1.65–6.79; p<0.01) lower body shoulder tackles. ConclusionsTo reduce tackler HIA risk, the results suggest tackling below the upper trunk for upper body tackles. The results also suggest tackling at the lower trunk for lower body tackles and avoiding the upper legs. Prevention strategies should place emphasis on tackling lower risk body regions such as the mid- and lower trunk.

Modeling of head injuries induced by golf ball impacts

ABSTRACTHead injuries induced by golf ball impacts are studied through computational modeling. A full human body model and a three-piece golf ball model are integrated to construct a new finite element model, and LS-DYNA is employed to perform simulations. The constitutive relations of the brain tissue and golf ball are described using hyperelasticity and viscoelasticity models. To assess head injury risks, the impact force, von Mises stress, pressure, and first principal strain are computed in the current model and compared with existing experimental and simulation data. The frontal impact of a golf ball on a human head at an impact velocity of 35 m/s is taken as the baseline case and studied first. The simulation results reveal that no skull fracture can happen, while mild traumatic brain injuries may take place. The effects of impact location, velocity, and angle are then investigated. Three impact locations (i.e., frontal, lateral, and crown) are considered. The impact velocity is changed from 15 m/s to 76 m/s, and the impact angle is adjusted from 90° (normal) to 45° (oblique). It is found that the lateral (right) impact leads to higher risks of skull fracture and brain injury than the other two impact locations. Also, it is observed that the impact force, the maximum von Mises stress in the skull, and the pressure and first principal strain in the brain increase with the increase of the impact velocity or the impact angle. The findings from the current study provide useful guidelines for further investigations of head injuries induced by golf ball impacts.

Eyeing up the Future of the Pupillary Light Reflex in Neurodiagnostics.

The pupillary light reflex (PLR) describes the constriction and subsequent dilation of the pupil in response to light as a result of the antagonistic actions of the iris sphincter and dilator muscles. Since these muscles are innervated by the parasympathetic and sympathetic nervous systems, respectively, different parameters of the PLR can be used as indicators for either sympathetic or parasympathetic modulation. Thus, the PLR provides an important metric of autonomic nervous system function that has been exploited for a wide range of clinical applications. Measurement of the PLR using dynamic pupillometry is now an established quantitative, non-invasive tool in assessment of traumatic head injuries. This review examines the more recent application of dynamic pupillometry as a diagnostic tool for a wide range of clinical conditions, varying from neurodegenerative disease to exposure to toxic chemicals, as well as its potential in the non-invasive diagnosis of infectious disease.

The Effect of Tackler Technique on Head Injury Assessment Risk in Elite Rugby Union.

This study aimed to use match video evidence of tackles in elite-level rugby union to identify tackler proficiency characteristics, for both lower body and upper body tackles, that result in head injury assessments (HIA) for the tackler. A review of international rugby union matches (2013-2017) and Pro 12/European Rugby Champions Cup matches (2014-2017) from a professional rugby union club was conducted. HIA (n = 74) and non-HIA tackles (n = 233) were categorized as either front-on or side-on upper body or lower body tackles and were scored for tackling proficiency characteristics. A chi-square test (P < 0.05) and phi and Cramer's V were calculated to compare HIA and non-HIA tackling proficiency characteristics. In both front- and side-on upper body and lower body tackles, "head up and forward/face up" and "head placement on correct side of ball carrier" were identified as having a lower propensity to result in an HIA for the tackler. For both front-on and side-on upper body tackles, "identify/track ball carrier onto shoulder" and "shortening steps" were identified. In addition, "straight back, centre of gravity forward of support base" and "identify/track ball carrier onto shoulder" were identified for front-on and side-on lower body tackles, respectively. This study identified tackle characteristics that had a lower propensity to result in an HIA for the tackler in both front-on and side-on upper body and lower body tackles.

Post-mortem diffusion MRI of the cervical spine and its nerve roots

Abstract Purpose The aim of this work is to examine the architectural configuration and the microstructural substrate of the cervical spine and its nerve roots with post-mortem (PM) diffusion tensor imaging (DTI) in non-fixed subjects and to compare these findings with histology. Methods Magnetic resonance imaging (MRI) data were acquired on a 1.5 T MRI scanner in five non-fixed non-trauma deaths. Two different areas were evaluated: 1) the cervical spinal cord and ventral and dorsal nerve roots with a “high in-plane” DTI and a multi-echo fast field echo protocol, and 2) the cervical peripheral nerves with an “isotropic” DTI and a 3D turbo spin echo protocol. Histology samples were obtained matching the anatomical level of the slices of the ‘high in-plane’ DTI protocol. Results We were able to show detailed reconstructions of the dorsal and ventral nerve roots with the ‘high in-plane’ protocol and identified a low fractional anisotropy (FA = 0.30 ± 0.08) in the grey matter and a high FA (0.51 ± 0.13) in the white matter. Both grey and white matter configurations correlated with the anatomical MRI, the diffusion MRI, and with the histological sections. Using the ‘isotropic’ DTI protocol, it was feasible to reconstruct the spinal cord, cervical nerves, and nerve roots in all PM subjects. Conclusion We were able to generate detailed architectural configurations of the ventral and dorsal nerve roots. Anatomical and diffusion MR scans showed good qualitative agreement with histology. We believe that PMDTI will be helpful in the assessment of head and neck injuries in a forensic setting.

Concussion in Rugby Union and the Role of Biomechanics

Due to the physical and high-impact nature of rugby, head impacts can occur within the game which can result in concussion injuries as well as other moderate-to-severe head injuries 1. Concussion has been defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”1 and was found to be one of the more common brain injuries throughout the world.2 This is particularly true in sport; it has been estimated that over half of all concussions are sports related.3 A systematic review of the incidence of concussion in contact sports found that rugby union has a higher incidence rate compared with other sports such as American football and soccer.4&#x0D; Unlike other sports injuries, detecting a concussion is difficult as the neuropathological changes cannot be recognized on standard neuroimaging technology.5,6 \Therefore, if a player is suspected of having a concussion, they are removed from play for a Head Injury Assessment (HIA). The HIA is a standardized tool for the medical assessment of concussion injuries in rugby and aims to improve detection and patient education.7 The HIA assesses a range of degenerative concussive symptoms including memory, cognitive ability, balance and player discomfort. This concussion diagnosis protocol therefore relies heavily on side-line medical staff to identify if a player is exhibiting concussive symptoms. A major disadvantage to this is that concussion has a variable natural history, with transient, fluctuating, delayed and evolving signs or symptoms.8) This means that symptoms can take up to 48 hours to become apparent.8 It has therefore been acknowledged that the content of the HIA will be modified as the research around concussion diagnosis evolves.8&#x0D; The reliance on side-line medical staff to accurately identify concussive symptoms means that there is a possibility a concussed player may remain on the field; this is one problem that biomechanical research into concussion is trying to overcome. This study will give an overview of concussion in rugby union with a focus on incidence, severity and protection strategies. It will discuss current biomechanical research and further biomechanical research required in the area of concussion injuries in rugby union.

A Novel Approach to Assessing Head Injury Severity in Pediatric Patient Falls

IntroductionPediatric patient falls with head-to-floor impact have the greatest potential for injury. MethodsAn objective measure of head injury severity, the Head Injury Criterion (HIC15), was calculated from anthropometric and biomechanical components of patient falls. A secondary aim was to compare HIC15 levels with the hospital's subjective assignment of level of harm (1-9 scale) used for regulatory reports. ResultsAdverse event reports yielded a sample of 49 falls from heights of 72.5 to 1793.0 cm by children ages 11 months through 17 years. Contact velocity from beginning to end was 2.81 to 6.16 ms. Mean acceleration was 19.5 to 95.3g. HIC15 levels of impact ranged from 26.4 to 1,330.0, and mean force upon contact was 2.0 to 9.8 N/kg body mass. Seven (14.3%) children's HIC15 levels exceeded age-specific thresholds, with no follow-up scheduled. Hospital-assigned levels of harm were not correlated with HIC15 levels (r = .23, R2 = .05, p = .12). DiscussionA point-of-care computerized HIC15 algorithm would be useful for diagnostic and follow-up decisions.

Significance of the number of vomiting episodes as an indication for imaging in paediatric traumatic brain injury

Background: Vomiting is a nonspecific clinical feature of traumatic brain injury and considered as an indication for imaging the brain in suspected traumatic brain injury. Number of vomiting episodes is discussed as a tool to predict the severity of injury and currently three episodes of vomiting is accepted as an indication for computerized tomography in paediatric head injury assessment

A video analysis of head injuries satisfying the criteria for a head injury assessment in professional Rugby Union: a prospective cohort study

ObjectivesConcussion is the most common match injury in professional Rugby Union, accounting for 25% of match injuries. The primary prevention of head injuries requires that the injury mechanism be known...

Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies

ObjectivesThe tackle is responsible for the majority of head injuries during rugby union. In order to address head injury risk, risk factors during the tackle must first be identified. This...

Tackle technique and body position of the tackler and ball carrier significantly influences head injury risk in rugby union

ObjectiveInterventions to reduce head injury range from law changes to technique training and education. The effective targeting of such interventions requires that the mechanism of injury be well understood. This study describes the events contributing to head injuries in Rugby Union.DesignAn observational study with a cohort comprised of six professional Rugby Union competitions. Every Head Injury Assessment (HIA) reported during a three-year period was documented and described according to 15 descriptive criteria.Outcome measuresDescriptive criteria, and combinations thereof, including preceding and inciting event, tackle type, speed, direction and technique-related variables. The incidence of head injury was calculated per 1,000 events for each variableMain results611 HIAs were performed in 1,516 matches. 464 HIAs occurred after tackles (1.94 HIAs/1000 tackles). Active shoulder tackles, front-on tackles and high speed tackles have the greatest incidence of head injuries. For any tackle type and tackler position, the lowest incidence of HIAs occurs when the ball carrier is bent at the waist (1.2 HIAs/1000 tackles vs 2.4 and 9.8 HIAs/1000 tackles for upright and falling positions, respectively). For any ball carrier position, the greatest risk of head injury exists when the tackler is upright (2.7 HIAs/1000 tackles vs 1.9 and 1.2 HIAs/1000 tackles for bent at waist and diving, respectively).ConclusionsTechnique components of the tackle, related primarily to the body position adopted by the tackler and ball carrier, significantly influence head injury risk. Interventions may be targeted at improving these variables to reduce head injury incidence in the sport.Competing interestsThe primary author is employed in a scientific and research role by World Rugby (Pty) Ltd, who also funded the research study.

HEAD INJURY EVENTS IN RUGBY UNION: DESCRIPTION OF HIGH RISK TACKLE EVENTS

BackgroundHead injuries are a concern in Rugby Union, accounting for 17% of injuries. Until the risk of specific game events is understood, effective interventions to reduce risk cannot be formulated.ObjectiveTo...

Text messaging research participants as a follow-up strategy to decrease emergency department study attrition

Collecting patient-reported follow-up data for prospective studies in the emergency department (ED) is challenging in this minimal continuity setting. The objective of this study was to determine whether text messaging study participants involved in an ongoing randomized trial resulted in a lower rate of attrition as compared to conventional telephone follow-up. This was a nested cohort analysis of research participants enrolled in a randomized controlled trial assessing head injury discharge instructions. During the first 4 months of study follow-up, participants were contacted by a conventional telephone call. For the final 3 months, participants were contacted by text messaging following the first failed telephone attempt. A total of 118 patients were enrolled in the study (78 underwent conventional follow-up, and 40 received text messages). During the period of conventional follow-up, 3 participants withdrew from the study. Of the remaining 75 participants, 24 (32.0%) at 2 weeks and 32 (42.7%) at 4 weeks were unable to be contacted. Of the 40 participants receiving a reminder text message, 4 (10.0%) at 2 weeks and 10 (25.0%) at 4 weeks were unable to be contacted. Overall, text messaging study participants decreased attrition by 22% (95% CI: 5.9%, 34.7%) and 17.7% (95% CI: -0.8%, 33.3%) at 2- and 4-week follow-ups, respectively. In this ED cohort participating in a randomized trial, text message reminders of upcoming telephone follow-up interviews decreased the rate of attrition. Text messaging is a viable, low-cost communication strategy that can improve follow-up participation in prospective research studies.

Assessment of acute head injury in an emergency department population using sport concussion assessment tool – 3rd edition

ABSTRACTSport Concussion Assessment Tool version 3 (SCAT-3) is one of the most widely researched concussion assessment tools in athletes. Here normative data for SCAT3 in nonathletes are presented. The SCAT3 was administered to 98 nonathlete healthy controls, as well as 118 participants with head-injury and 46 participants with other body trauma (OI) presenting to the ED. Reference values were derived and classifier functions were built to assess the accuracy of SCAT3. The control population had a mean of 2.30 (SD = 3.62) symptoms, 4.38 (SD = 8.73) symptom severity score (SSS), and 26.02 (SD = 2.52) standardized assessment of concussion score (SAC). Participants were more likely to be diagnosed with a concussion (from among healthy controls) if the SSS > 7; or SSS ≤ 7 and SAC ≤22 (sensitivity = 96%, specificity = 77%). Identification of head injury patients from among both, healthy controls and body trauma was possible using rule SSS > 7 and headache or pressure in head present, or SSS ≤ 7 and SAC ≤ 22 (sensitivity = 87%, specificity = 80%). In this current study, the SCAT-3 provided high sensitivity to discriminate acute symptoms of TBI in the ED setting. Individuals with a SSS > 7 and headache or pressure in head, or SSS ≤ 7 but with a SAC ≤ 22 within 48-hours of an injury should undergo further testing.

INTERNAL CAROTID ARTERY DISSECTION AND DELAYED STROKE FOLLOWING RUGBY TACKLE – A CASE REPORT

Following England's grand slam success in the ‘Six Nations’ tournament in 2016, publicity around the safety of rugby football is likely to be greater than ever before. Recent media coverage...

93EMF Out-of-hospital Assessment of Head Injury in Older Adults: Influence on Destination Decisions and Agreement With Emergency Physician Assessment

93EMF Out-of-hospital Assessment of Head Injury in Older Adults: Influence on Destination Decisions and Agreement With Emergency Physician Assessment

Head injury assessment of non-lethal projectile impacts: A combined experimental/computational method

The main objective of this study is to develop a methodology to assess this risk based on experimental tests versus numerical predictive head injury simulations. A total of 16 non-lethal projectiles (NLP) impacts were conducted with rigid force plate at three different ranges of impact velocity (120, 72 and 55m/s) and the force/deformation–time data were used for the validation of finite element (FE) NLP. A good accordance between experimental and simulation data were obtained during validation of FE NLP with high correlation value (>0.98) and peak force discrepancy of less than 3%. A state-of-the art finite element head model with enhanced brain and skull material laws and specific head injury criteria was used for numerical computation of NLP impacts. Frontal and lateral FE NLP impacts to the head model at different velocities were performed under LS-DYNA. It is the very first time that the lethality of NLP is assessed by axonal strain computation to predict diffuse axonal injury (DAI) in NLP impacts to head. In case of temporo-parietal impact the min-max risk of DAI is 0–86%. With a velocity above 99.2m/s there is greater than 50% risk of DAI for temporo-parietal impacts. All the medium- and high-velocity impacts are susceptible to skull fracture, with a percentage risk higher than 90%. This study provides tool for a realistic injury (DAI and skull fracture) assessment during NLP impacts to the human head.

The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby.

To investigate the accuracy and reliability of side-line video review of head impact events to aid identification of concussion in elite sport. Diagnostic accuracy and inter-rater agreement study. Immediate care, match day and team doctors involved in the 2015 Rugby Union World Cup viewed 20 video clips showing broadcaster's footage of head impact events occurring during elite Rugby matches. Subjects subsequently recorded whether any criteria warranting permanent removal from play or medical room head injury assessment were present. The accuracy of these ratings were compared to consensus expert opinion by calculating mean sensitivity and specificity across raters. The reproducibility of doctor's decisions was additionally assessed using raw agreement and Gwets AC1 chance corrected agreement coefficient. Forty rugby medicine doctors were included in the study. Compared to the expert reference standard overall sensitivity and specificity of doctors decisions were 77.5% (95% CI 73.1-81.5%) and 53.3% (95% CI 48.2-58.2%) respectively. Overall there was raw agreement of 67.8% (95% CI 57.9-77.7%) between doctors across all video clips. Chance corrected Gwets AC1 agreement coefficient was 0.39 (95% CI 0.17-0.62), indicating fair agreement. Rugby World Cup doctors' demonstrated moderate accuracy and fair reproducibility in head injury event decision making when assessing video clips of head impact events. The use of real-time video may improve the identification, decision making and management of concussion in elite sports.