Cases Of Head Injury Research Articles

Comparative Study on Different Clinical Decision-Making Tools in Pediatric Head Injury Cases

Objective: To carry out a comparative study on effective clinical decision-making tools between Canadian Assessment of Tomography for Childhood Head injury, Pediatric Emergency Care Applied Research Network (PECARN) and Children's Head injury Algorithm for the prediction of Important Clinical Events in pediatrics head trauma cases. Study Design: Validation study. Place and Duration of Study: Department of Surgery, Saif Shaheed Hospital, Haveli Kahota, Azad Kashmir, Pakistan, from Oct 2021 to Nov 2022. Methodology: One hundred and fifty paediatric patients suffering from minor head injury were evaluated on clinical intervention decisions as per emergency procedures during the period of study. Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value of the selected diagnostic tests was checked. Results: Based on the head CT positivity, PECARN was found to be 81.8% sensitive and 61.9% specific. Canadian Assessment of Tomography for Childhood show sensitivity of 90.9 % and specificity of 65.5%. CHALICE had sensitivity and specificity of 63.6% and 61.5% respectively. CHALICE was unable to identify a pathological CT result with statistical significance (p=0.17) however PECARN and CATCH rule proved significant (p<0.05). CATCH rule show highest positive predictive score of 17.2% and negative predictive score of 98.8%. Conclusion: PECARN, CATCH, and CHALICE criteria are effective in deciding whether or not to perform Computerized Brain Tomography (CBT) scans on children with MHT, leading us to believe that employing these criteria could prevent unnecessary CBT scans.

Ensuring Adherence to 2023 National Institute of Excellence (Nice) Guidelines for CT Scans in Head Injury Cases in a Teaching Hospital in Basra, Iraq: A Clinical Audit.

Objective The objective of this audit was to find out whether brain CT scans performed on patients with head trauma in BasraTeaching Hospital (BTH) adhere to the 2023 National Institute of Excellence (NICE) guidance for head injury (NG232) and whether we can improve this with selected interventions. Methodology We performed a clinical audit in two cycles; in the first cycle, we collected data retrospectively over a monthin February 2024. The data was sourced from the imaging request forms and patient records at BTH. We then analyzed the data and implemented four key interventions to improve the outcome. After that, we performed our second audit cycle over an additional 30-day period during April 2024. Results Cycle One involved 59 patients, while Cycle Two involved 46. There was a significant decrease in scans requested outside of the NICE guidance, from 59.3% in Cycle One to 17.4% in Cycle Two (p<0.05). We also noticed a significant increase in the one-hour indication scans, from 32% in Cycle One to 65.2% in Cycle Two (p<0.05). Conclusion Our study findings reveal that by following some simple interventions, we significantly improved the adherence of our emergency department to the 2023 NICE guidelines for head CT following head trauma.

FORENSIC EVALUATION OF SELF-INFLICTED SUICIDES WITH MULTIPLE GUNSHOT WOUNDS

Suicide is a common cause of premature death and a serious social problem. The use of firearms for suicide is quite common. The infliction of multiple self-inflicted wounds, including a fatal one, is rare among suicides, but it is possible and requires careful investigation. Aim To provide a forensic assessment of the possibility of suicide by multiple gunshot wounds. Methods. Archival material from the Kyiv City Clinical Bureau of Forensic Medicine and the Zhytomyr Regional Bureau of Forensic Medicine (2 "medical examination reports") was used. The objects of the study were: gunshot wounds on the head (wounds, wound channels), elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov", shot products, pistol "Makarov-MP 79" converted to shoot elastic bullets. Their characteristics were examined visually and under the stereo microscope. The detection of shot soot layers on skin flaps and gunsmith's grease was carried out in infrared and ultraviolet rays. The study of the elemental composition of shot products in objects of biological and non-biological origin was carried out using the X-ray fluorescence spectrometer "M4 TORNADO". Standard methods of variational statistics were used in the study. Results. The forensic examination of the entry and exit wounds and wounds on the head of the corpses of persons who died as a result of self-inflicted gunshot wounds, as well as of the bullets and weapons that caused bodily injuries, confirmed the possibility of committing suicide by firing double shots from pistols to shoot bullets of the so-called "non-lethal type": elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov". It was established that in case No 1 the first injury was non-fatal and the second was fatal, accompanied by damage to the skull and brain. In case No. 2, the first wound was fatal and the second was non-fatal, as it damaged only the soft tissues of the head without damaging the bones of the skull and brain. The wounds were caused by automatic shots due to the poor technical condition of the weapon, i.e. partial damage and wear of the trigger mechanism and the pistol sear. This was facilitated by a one-time partial self-destruction of the weapon, followed by the wedging of the next cartridge with an elastic bullet in the lower part of the barrel. Conclusion. Thus, the cases of double head injuries caused by shots from firearms (pistols) for shooting bullets of the so-called "non-lethal type" (elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov") serve as evidence of suicide. In case No. 1, one of the wounds was not fatal, as the wound channel began with an entrance hole in the lower half of the right temporal region, continued on the right through the right mastoid process and the soft tissues of the neck, and ended in the middle with an exit wound in the back of the neck. This wound was the first inflicted. The second wound was final and fatal, as there was damage to the skull and brain, as evidenced by the wound channel which passed through the right temporal cyst, the brain and its membranes, the left occipital bone, and ended with the exit wound in the left occipital region. It was the second in order of entry. In case 2, the first wound was fatal, resulting in damage to the bones of the skull and brain and the presence of an elastic ball in the substance of the brain. The second wound was non-fatal and tangential, injuring only the soft tissues of the head without damaging the bones of the skull and brain. It occurred as a result of automatic (independent) shots due to the poor technical condition of the weapon, namely partial damage and wear of the trigger mechanism and the pistol sear. This was facilitated by a one-time partial self-destruction of the weapon, followed by the wedging of the next cartridge with an elastic bullet in the lower part of the barrel.

The prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants is very low: a retrospective cohort register study

BackgroundCurrent guidelines from Scandinavian Neuro Committee mandate a 24-hour observation for head trauma patients on anticoagulants, even with normal initial head CT scans, as a means not to miss delayed intracranial hemorrhages. This study aimed to assess the prevalence, and time to diagnosis, of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants.MethodUtilizing comprehensive two-year data from Region Skåne’s emergency departments, which serve a population of 1.3 million inhabitants, this study focused on adult head trauma patients prescribed oral anticoagulants. We identified those with intracranial hemorrhage within 30 days, defining delayed intracranial hemorrhage as a bleeding not apparent on their initial CT head scan. These cases were further defined as clinically relevant if associated with mortality, any intensive care unit admission, or neurosurgery.ResultsOut of the included 2,362 head injury cases (median age 84, 56% on a direct acting oral anticoagulant), five developed delayed intracranial hemorrhages. None of these five cases underwent neurosurgery nor were admitted to an intensive care unit. Only two cases (0.08%, 95% confidence interval [0.01–0.3%]) were classified as clinically relevant, involving subdural hematomas in patients aged 82 and 87 years, who both subsequently died. The diagnosis of these delayed intracranial hemorrhages was made at 4 and 7 days following initial presentation to the emergency department.ConclusionIn patients with head trauma, on oral anticoagulation, the incidence of clinically relevant delayed intracranial hemorrhage was found to be less than one in a thousand, with detection occurring four days or later after initial presentation. This challenges the effectiveness of the 24-hour observation period recommended by the Scandinavian Neurotrauma Committee guidelines, suggesting a need to reassess these guidelines to optimise care and resource allocation.Trial registrationThis is a retrospective cohort study, does not include any intervention, and has therefore not been registered.

Problems of introducing boxing into the system of physical education in educational institutions of Ukraine: the impact on health aspect

The presented work deals with a topical issue for the educational space of modern Ukraine. Considering the fact that Ukrainian society has been facing difficulties caused by the pandemic and the invasion of enemy forces on the territory of the Motherland for several years in a row, the issue of proper physical development of society is extremely important. Therefore, it is necessary to improve the approach to physical education at all levels of education in Ukraine. The authors of this publication propose developing a program component for physical education based on the sport discipline of boxing. An extremely important aspect of this sport was analyzed - its impact on human health. Both negative and positive effects of such an influence were taken into account. It is noted that in boxing, the most significant factor of negative impact on health is the risk of injuries. Cases of upper limb and head injuries are particularly common. Repeated head trauma is a separate problem. At the same time, the positive effects of boxing on the physical fitness of people were revealed, namely, the improvement of the functional capabilities of the musculoskeletal system and the respiratory system. In conclusion, the author's team formulated and proposed key principles based on which it is possible to successfully introduce boxing into the educational environment of Ukraine. It is assumed that by following these principles, it is possible to supplement the current system of physical education in general secondary education institutions with another promising component, which in turn can have a positive effect on the physical education system in higher education institutions. Provided that this program component is systematically used in schools, it will allow the preparation of a generation of physically developed and mentally stable young people with basic self-defense skills. It is also assumed that this component will generate interest among a significant number of students in becoming athlete-boxers, which will have a positive impact on personal growth.

Eye and Orbit Injuries Caused by Electric Scooters and Hoverboards in the United States.

To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019. The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries. Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%). There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.

Supra- and Infratentorial Extradural Hematoma: A Series of Three Cases with Literature Review

AbstractThe extradural hematoma (EDH) of the posterior fossa is a rare clinical condition in head injury cases. The posterior fossa extradural hematoma (PFEDH) contributes to not more than 4 to 8% of all the EDH encountered in traumatic brain injury. The limited volume of the posterior fossa leads to early clinical deterioration and, if not subjected to timely intervention, may be fatal. This rapid deterioration is because of significant compression over the brainstem and cervicomedullary junction as well as obstructive hydrocephalus. The PFEDHs are often associated with fracture of the occipital bone, which may lead to the extension of hematoma in the supratentorial and infratentorial spaces. The traumatic supra- and infratentorial EDH (TSIEDH) constitutes less than 2% of all the EDH. Limited literature is available regarding TSIEDH, and the majority are in the form of isolated case reports. We share our experience of three cases over the last 5 years from a tertiary care referral institute with a literature review of TSIEDH. Two of these cases were managed nonoperatively, and one underwent surgical evacuation of hematoma. In the present study, we share our experience regarding prompt diagnosis and management of this particular subset of traumatic brain injury patients. We also describe the surgical technique for evacuation of TSIEDH. Early diagnosis and prompt surgical intervention can be life-saving as these hematomas may have a benign clinical presentation but rapid clinical deterioration.

Overuse of computed tomography for mild head injury: A systematic review and meta-analysis.

Computed tomography (CT) scan is a common imaging technique used to evaluate the severity of a head injury. The overuse of diagnostic interventions in the health system is a growing concern worldwide. Objectives: The aim of this systematic review is to investigate the rate of CT scan overuse in cases of mild head injury. Eligibility criteria: We encompassed observational studies-either designed as cohort, case-control, or cross-sectional investigations-that reported on CT scan overuse rates for mild head injuries. Studies had to be published in peer-reviewed, English-language sources and provide full content access Information sources: Web of Sciences, Scopus, Medline via PubMed, the Cochrane Library and Embase were searched from inception until April 1, 2023. Studies were included if reporting the overuse of CT scans for mild head injuries using validated criteria. Risk of bias: We used the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool to evaluate the risk bias assessment of included studies. Two independent reviewers evaluated the eligibility of studies, extracted data, and assessed study quality by using the Newcastle-Ottawa Scale. Synthesis of results: Overuse estimates were calculated using a random-effects model. Subgroup analyses were performed to investigate any sources of heterogeneity. Point rate of overuse of CT scans for mild head injuries was the main outcome measured as percentage point estimates with corresponding 95% CIs. Included studies: Of the 913 potentially relevant studies identified, eight studies were selected for the final analysis. Synthesis of results: The pooled rate of CT scan overuse in patients with mild head injury was found to be 27% [95% CI: 16-43; I2 = 99%]. The rate of CT scan overuse in mild head injury cases varied depending on the criteria used. The rate of CT scan overuse was 37% [95% CI: 32-42; I2 = 0%] with the Glasgow Coma Scale (GCS), 30% [95% CI: 16-49; I2 = 99%] with the Canadian computed tomography head rule, and 10% [95% CI: 8-14; I2 = 0%] with the Pediatric Emergency Care Applied Research Network criterion (PERCAN). Based on subgroup analyses, the rate of CT scan overuse in mild head injury cases was observed to be 30% with the Canadian computed tomography head rule criterion, 43% with the National Institute for Health and Clinical Excellence criterion, and 18% with the New Orleans criterion. Limitations of evidence: The restricted number of included studies may impact generalizability. High heterogeneity was observed, leading to subgroup analyses based on age, assessment criteria, and study region. Absent data on overuse causes hinders drawing conclusions on contributing factors. Furthermore, this study solely addressed overuse rates, not associated harm or benefits. Interpretation: The overuse of CT scans in mild head injury patients is concerning, as it can result in unnecessary radiation exposure and higher healthcare costs. Clinicians and policymakers should prioritize the implementation of guidelines to reduce unnecessary radiation exposure, healthcare costs, and potential harm to patients. The study protocol of this review was registered in PROSPERO under the identification code CRD42023416080. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023416080.

Association of Ocular Injuries in Patients with Head Injury: A Tertiary-Level Armed Forces Experience

ABSTRACT Introduction: The incidence of trauma is on an increasing trend worldwide. It has drastically increased due to urbanization, vehicular congestion, alcoholism, and poor infrastructure facilities, especially in developing countries. In the Armed Forces, the additional burden of trauma is also seen due to various unit activities, organized sports, and other adventure sports. Head injury cases are often associated with various ocular injuries. These ocular injuries, if subtle in nature, can be missed initially and progress into ophthalmological complications and rarely into permanent visual impairment. The aim of this study was to critically analyze the association of various ocular injuries in patients with head injury. Materials and Methods: A cross-sectional study was conducted in a tertiary-level Armed Forces Hospital from July 2016 to December 2018. A total of 40 patients were evaluated who had head injury along with ocular injuries. The Glasgow Coma Scale (GCS) was used to assess the severity of the head injury. Ocular manifestations such as subconjunctival hemorrhage, ecchymosis, soft tissue injuries such as lid tear, corneal injuries, and bony and associated nerve injuries were evaluated. Results: A total of 40 patients with head injury with ocular manifestations were studied. Road traffic accident (RTA) was the most common cause, followed by accidental fall from height and sports injuries. There was a male preponderance (n = 32 (80%)) over females (n = 8 (20%)). Unilateral ocular manifestation (n = 32 (80%)) was more common than bilateral involvement (n = 8 (20%)). The most frequent ocular manifestations were subconjunctival hemorrhage and ecchymosis (35 (87.5%)), followed by lid laceration (6 (15%)), corneal tear (04 (10%)), vitreous hemorrhage (01 (2.5%)), evisceration (2 (05%)), and cranial nerve injury (06 (12.5%)). Orbital wall fracture was seen in 15 (37.5%) patients, including lateral wall fracture (n = 08 (20%)), medial wall fracture (n = 04 (10%)), orbital floor fracture (n = 02 (05%)), and orbital roof fracture (n = 01 (2.5%)). Conclusion: Ocular injuries can occur in patients with head injury irrespective of the mode and kinematics involved (severe head injury may present with minimal ocular manifestations or vice versa). These patients require hospitalization, observation, thorough ophthalmic evaluation, and periodic assessment to minimize morbidity and complications.

Characteristics of Patients with Epidural Hemorrhage in Head Injury at a RSUP Prof. Dr. I.G.N.G Ngoerah in 2022

Introduction: Head injury is a condition of brain disorder that often occurs in Indonesia and 2 out of 100 head injury cases are epidural hematoma (EDH), which is intracranial hemorrhage where there is an accumulation of blood between the dura mater and internal tabula. Therefore, it is necessary to review the characteristics of epidural hemorrhage. This study aims to determine the characteristics of EDH patients in head injuries at RSUP Prof. Dr. I. G. N. G Ngoerah in 2022. Materials and Methods: This study used a retrospective descriptive method. The data were collected through medical records of epidural hemorrhage patients in 2022 at Prof. Dr. I. G. N. G Hospital, then analyzed descriptively using SPSS version 26. Results: From 88 cases obtained, most of them were male (79.5%), including the age group of adolescents and young adults with an age range of 15–24 years (35.2%). The most common case was mild head injury with a Glasgow Coma Scale of 14–15 (47.7%), bleeding volume in the interval 0–25 cc (60.2%), and found without midline shift (54.5%). Most patients had linear fractures (80.7%) and the majority of patients had bleeding in the temporal region (40.3%). Furthermore, more patients received conventional management (51.1%) than patients with craniotomy surgery (48.9%). Conclusion: In this study, adolescent male patients predominated. Mild head injury was the most common case with a bleeding volume of 0–25 cc without midline shift. Linear fracture and bleeding in the temporal region was the most characteristic result of epidural bleeding with nonoperative management found in most of the patients.

Targeting safety: Exploring trends and risk factors in pediatric head and neck BB gun injuries and hospitalization

ObjectiveTo examine head and neck injuries caused by BB (Ball Bearing) guns treated in US emergency departments among children under 18 to identify trends in injury frequency over time and risk factors associated with severe injuries leading to hospital admission. MethodsThis retrospective study utilized data from the National Electronic Injury Surveillance System (NEISS), a single database, to analyze head and neck injuries caused by BB guns between 1993 and 2019. The analysis explored demographic characteristics and injury patterns, including sex, age, incidence, injury location, hospital type, and disposition. Linear regression was employed to assess trends in the yearly frequency of injuries, while univariate and multivariate binary logistic regression was used to calculate the odds ratios associated with hospitalization. ResultsA total of 4041 cases of pediatric head and neck injuries caused by BB guns and treated in US emergency departments were identified. Most patients were male (84 %), with the highest proportion of injuries occurring in the 10–14 age group (49.7 %). The face (35.8 %) and eye (27.4 %) were the most affected injury sites, and 7.5 % of patients required hospital admission. No significant linear trend was observed in injury frequency over the study period. However, children aged four and under had higher odds of hospitalization (OR 2.77, 95 % CI 1.61–4.75) despite a lower incidence of injuries. Injuries to the eye (OR 12.37, 95 % CI 8.31–18.43) and neck (OR 7.58, 95 % CI 4.76–12.06) were strong predictors of hospital admission. ConclusionPediatric BB gun-related head and neck injuries remain a source of emergency room visits nationally. Younger children are at increased risk of admission to the hospital. Eye and neck injuries were the strongest predictors of hospital admission. Implementing safety precautions for younger children is crucial, as injuries might be more severe in this age group.

Clinico-Epidemiological Study of Fatal Head Injuries in an Autopsy

Introduction: Head injury is a significant public health problem worldwide. Traumatic head injury is a leading cause of death and disability in children and adults in their most productive years. The morbidity and mortality due to head injury is on the rise and is one of the prime importance in today’s medical practice. Objective: To assess the clinico-epidemiological study of fatal head injuries in an autopsy. Methods: The present study was conducted of the Department of Forensic Medicine &amp; Toxicology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January to June 2022. Total 250 patients included in this present study. We selected only fatal head injury cases due to mechanical violence. However, we included severe facial injury cases too as these cases were associated with head injury. But, the present study doesn’t involve crushed head injury or survived cases, referred or LAMA cases brought in the hospital. Results: Maximum cases were seen in the age range of 21-30yrs, 57 cases (22.8%). Maximum cases were seen amongst males, 196 cases, 78.4%. The commonest causes of fatal head injuries are Road Traffic Accident (RTA) cases. Other important causes of fatal head injuries are fall from height, assault &amp; railway accidents. External head injuries were mainly seen on frontal and parietal regions. Amongst the scalp injuries lacerations were very common seen in 114 cases, 36.19%. Skull bone fractures were frequently seen in fatal head injury cases. Presence of skull bone fractures are associated more frequently with fatal complications. Though linear fractures are common in general we observed the comminuted fractures as the commonest type of skull fractures in fatal head injury cases, seen in 73 cases, (58.4%). Depressed fractures were less common in fatal cases. Involvement of cranial fssa was seen in 108 cases. Linear type of fractures both transverse and horizontal type was more common seen in 66 coases amongst the 108 cases of cranial fossa involvement i.e. 61.11%. Involvement of middle cranial fossa was high seen in 45 cases of the 108 cases i.e. (41.66%). Presence of comminuted skull bone fractures is associated with higher rate of mortality. Conclusion: Most of the cases were due to road traffic c accidents and males are more prone to get Head injury. Other important causes of fatal head injuries are fall from height, railway accidents and assaults in descending order. To reduce the morbidity and mortality it’s high time for the concerned authority to take appropriate actions.

PROFILING OF MEDICOLEGAL CASES OF MECHANICAL INJURIES TO HEAD AT TERTIARY CARE CENTER - A PROSPECTIVE STUDY

Aims and Objectives: The study aims to profile the medicolegal cases of head injury in relation to its sociodemographic distribution, the type and nature of the injury, and the type of skull fractures reported. Methods: The present prospective study of 318 medicolegal assault cases for mechanical injuries exclusively to the head, including the face, which reported a total of 404 wounds on the head and face, who reported to the emergency, Guru Nanak Dev Hospital attached to Government Medical College, Amritsar was conducted November 1, 2018, to April 2020. The study was conducted after seeking permission from the Institutional Ethics Committee, Government Medical College, Amritsar. Results: Among the total of 318 cases, the majority of them, 289 (90.9%) were male and 29 (9.1%) were female. Two hundred and forty-four (76.7%) of the reported cases belonged to a rural background, whereas 74 (23.3%) were from an urban background. The most common was the cortical cut reported in 29 (37.2%) cases, followed by depressed fractures in 22 (28.2%) cases. The comminuted fractures were present in 18 (23.1%) cases, whereas there was a fissure fracture in 09 (11.5%) cases. Conclusion: It is observed that assault-related cases of medicolegal injuries on the head are much more common in the younger generation and rural population. Thus prevention of assault-related activities, the primary focus should be encouraging the young generation about rationalism and tolerance.

The epidemiology of crib-related head injuries: A ten-year nationwide analysis

IntroductionFalls from cribs resulting in head injury are understudied and poorly characterized. The purpose of this study was to advance current understanding of the prevalence, descriptive characteristics of injury victims, and the types of crib fall-related head injuries (CFHI) using queried patient cases from the National Electronic Injury Surveillance System (NEISS) database. MethodsUsing the US Consumer Product Safety Commission's System NEISS database, we queried all CFHIs among children from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of the incident, diagnoses, ED disposition, and sequelae were analyzed. The number of CFHI from all US EDs during each year was also collected from the database. ResultsThere were an estimated 54,799 (95% CI: 30,228–79,369) total visits to EDs for CFHIs between 2012 and 2021, with a decrease in incidence of approximately 20% during the onset of the COVID-19 pandemic (2019: 5616 cases, 2020: 4459 cases). The annual incidence of injuries showed no significant trend over the 10-year study period. An available subset of 1782 cases of head injuries from approximately 100 EDs was analyzed, and 1442 cases were included in final analysis. Injuries were sorted into three primary categories: unspecified closed head injury (e.g., closed head injury, blunt head trauma, or traumatic brain injury), concussion, or open head injury and skull fracture. Unspecified closed head injuries were the most common of all head injuries (95.4%, 1376/1442). Open head injuries (14/1442, 0.97%) and concussions 3.6% (52/1442, 3.6%) were rare. Most injuries involved children under the age of 1 (42.6%) compared to children who were 1, 2, 3, or 4-years old. About a fourth of patients had other diagnoses in addition to their primary injury including scalp/forehead hematomas, emesis, and contusions. Female patients were more likely to present with other diagnoses in addition to their primary head injury (Difference: 12.3%, 95% CI: 9.87%–15.4%, p < .0001). ConclusionDespite minimum rail height requirements set by the Consumer Safety Product Commission (CPSC), head injuries associated with crib falls are prevalent in the United States. However, most injuries were minor with a vast majority of patients being released following examination and treatment.

Clinico-Etiological Profile and Short Term Outcomes in Pediatric Head Injury Cases: Our Institutional Experience

Introduction: In developing countries like India, the incidence of TBI is very high. The pathophysiology, clinical presentations and management are different as compared to adults. Hence the need to have a focused study to evaluate etiology and outcomes in Pediatric traumatic head injury. Material and Method: We retrospectively studied 45 cases of pediatric traumatic head injury upto age 14 years presenting to our institute. The study period was of 1 year from june 2022 to june 2023. Demographic data and clinical features were noted and severity was assessed by GCS scale on admission. CT scan was done in all cases. Result: The number of males were 62.2% while 37.7% were females. The mean age of presentation was 5.7 years. The most common etiology in our study was fall (64%) followed by RTA (24%) and sports and others constituting the least (7%). The most common presenting feature was headache (66.6%), vomitting (63.4%) followed seizures (26.4) and loss of consciousness (6%). On basis of GCS, 90% cases were mild in severity and 8% moderate and 2% severe. CT was normal in 32% cases and abnormal in 68% cases with Fractures being more common finding. The short term outcome was good in 95.6% and 4.4% had neurodeficit. Anti convulsants were prescribed to 26% case. Conclusion: There is a urgent need to have studies focused on pediatric head injury cases. In present study we try to contribute to the current literature available in Indian settings. We also want to increase awareness about preventable cases as most of the head injury cases can be avoided by vigilance and care by the parents.

Epidemiology of head injury in a tertiary care hospital in south India

Introduction: The annual incidence of traumatic brain injury is around 28-70 million in the world which causes morbidity and mortality. In India, around 1 million suffer from severe head injury and the mortality rate is around 1 lakh per year. As time progresses there is an observable increase in rates of Head injuries. This study focuses on the epidemiology of traumatic head injury in a tertiary care centre (Madras Medical College, Chennai- India) Materials and methods: This study is a prospective study covering all head injury cases admitted from January 2022 – December 2022 in our tertiary care centre. These patients are treated according to the protocol of the Institute of Neurosurgery. This study covers the management, discharge and follow-up of these patients. Results: The total number of patients admitted with head injuries from January 2022 to December 2022 was 2061. Among them, RTA tops head injury mortality and morbidity. Among RTA, Two-wheeler-associated injuries were most common. Drunken driving, and not wearing helmets and protective gear played a vital role in head injuries. Conclusion: Primary prevention can be the key to reducing the national burden of head injuries.

Computed Tomography Scan Head Findings in Patients With Various Glasgow Coma Scales Presenting with Head Injury in Emergency of a Tertiary Care Hospital

Objective: To associate the findings of CT scan with the Glasgow coma scale (GCS) of cases presenting with head trauma in the Emergency Department.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Emergency Department, Combined Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2021.&#x0D; Methodology: Ninty head injury cases of either gender, aged 12-60 years were included using non-probability consecutive sampling. The severity of the head injury was determined via GCS. CT scan findings were noted. &#x0D; Results: The mean age was 22.21±11.10 years. The highest frequency of patients was noted in the age group of (13-29 years).The most common cause of head injury in men was road traffic accidents n=39/58(67.24%). As per GCS scoring, 63.3% of patients had mild brain injury. A strong association was observed between GCS and CT scan findings in cases with brain oedema (p=0.002), skull fracture (0.018) and no findings on CT scan (p-value≤0.001). No association between findings on CT scan and GCS scoring was noted in cases with epidural, subdural hematoma, cerebral contusions, intracranial and subarachnoid haemorrhage.&#x0D; Conclusions: There is a lack of association between brain injury based on GCS scoring and CT scan findings. Using GCS scoring only for assessing the degree of brain injury is insufficient.Keywords: Computed tomography (CT) scan, Glasgow coma scales (GDS), Head injury.

Post-mortem detection of neuronal and astroglial biochemical markers in serum and urine for diagnostics of traumatic brain injury.

Currently available epidemiological data shows that traumatic brain injury (TBI) represents one of the leading causes of death that is associated with medico-legal practice, including forensic autopsy, criminological investigation, and neuropathological examination. Attention focused on TBI research is needed to advance its diagnostics in ante- and post-mortem cases with regard to identification and validation of novel biomarkers. Recently, several markers of neuronal, astroglial, and axonal injury have been explored in various biofluids to assess the clinical origin, progression, severity, and prognosis of TBI. Despite clinical usefulness, understanding their diagnostic accuracy could also potentially help translate them either into forensic or medico-legal practice, or both. The aim of this study was to evaluate post-mortem pro-BDNF, NSE, UCHL1, GFAP, S100B, SPTAN1, NFL, MAPT, and MBP levels in serum and urine in TBI cases. The study was performed using cases (n = 40) of fatal head injury and control cases (n = 20) of sudden death. Serum and urine were collected within ∼ 24h after death and compared using ELISA test. In our study, we observed the elevated concentration levels of GFAP and MAPT in both serum and urine, elevated concentration levels of S100B and SPTAN1 in serum, and decreased concentration levels of pro-BDNF in serum compared to the control group. The obtained results anticipate the possible implementation of performed assays as an interesting tool for forensic and medico-legal investigations regarding TBI diagnosis where the head injury was not supposed to be the direct cause of death.

Management of Abdominal Gunshot Wounds in Children - Case Report

ABSTRACT Introduction One of the causes of mortality in pediatric population is penetrating abdominal injuries, which can affect several organs. Among all types of abdominal trauma, in gunshot wounds a good prognostic requires prompt diagnosis and treatment. In Romania, there is no specific database on gunshot injuries in the pediatric population, but from various sources, it was found that there are 3 cases (1 case of abdominal injury caused by gunshot in rural area and 2 cases of head and cervical spine injury due to gunshot that took place in urban area). Case presentation A 13-year-old boy is brought to the emergency care unit with a penetrating gunshot wound by ricochet in the left lower abdominal quadrant. Abdominal computed tomography revealed abdominal wall discontinuity in the left iliac fossa with oblique and posterior trajectory and a foreign body in the peritoneal cavity measuring 19/7 mm. Intraoperatory, the projectile was found in the sigmoid colon. Conclusion Penetrating gunshot wounds in pediatric population need adequate investigation and prompt diagnosis despite hemodynamic stability at presentation. Successful management of such a patient depends on the accuracy of the surgical intervention as well as the existence of a multidisciplinary medical team, which helps to prevent significant complications, including death.

Non-motor seizure diagnosed after mild traumatic brain injury: a case report

Introduction: In 10% of head injury cases, nonmotor seizures were detected by electroencephalography (EEG) performed in the acute phase. Nonmotor seizures are often not diagnosed at the start of treatment because the symptoms are often not recognized by the patient's family or doctor. The incidence of seizures in patients with minor head injuries is very low. From the literature, it was found that the type and severity of the head injury is a significant factors in the incidence of post-traumatic seizure. Thus, in this article, we report a case of nonmotor seizures in a patient after a minor head injury. Case description: An Indonesian female, 53 years old, complained of sudden silence when speaking after 4 days earlier, she fell and hit her head on the right side. There was no loss of consciousness, headache, vomiting or limb weakness. Complaints of motor seizures and a history of previous seizures were denied. There were no cranium defects, hematomas, or open wounds on examination. The results of laboratory tests and non-contrast head CT scans were expected. On electroencephalography (EEG) examination, epileptiform waves were found in the left temporal region. The patient was given anti-seizure drugs, and complaints improved within 2 days of therapy. It is crucial to carry out an EEG examination in the acute phase of a head injury to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma. Conclusion: EEG examination in the acute phase of head injury is used to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma.