Cause Of Head Injury Research Articles

Correlation of Computed Tomography findings with Glasgow Coma Scale in patients with acute traumatic brain injury

OBJECTIVE To correlate Computed Tomography (CT) findings with Glasgow Coma Scale (GCS) in patients with acute traumatic brain injury attending in Chitwan Medical College teaching hospital Chitwan, Nepal.MATERIALS AND METHODS A cross-sectional study was performed among 50 patients of acute (less than24 hours) cases of craniocerebral trauma over a period of four months. The patient’s level of consciousness (GCS) was determined and a brain CT scan without contrast media was performed. A sixth generation General Electric (GE) CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.RESULT The age range of the patients was 1 to 75 years (mean age 35.6± 21.516 years) and male: female ratio was 3.1:1. The most common causes of head injury were road traffic accident (RTA) (60%), fall injury (20%), physical assault (12%) and pedestrian injuries (8%). The distribution of patients in accordance with consciousness level was found to be 54% with mild TBI (GCS score 12 to 14), 28% with moderate TBI (GCS score 11 to 8) and 18% with severe TBI (GCS score less than 7). The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan was accompanied by lower GCS.CONCLUSION The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan were accompanied with lower GCS. Patients having single lesion had more GCS level than mixed level and mid line shift type of injury.Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 4-9

A Cross-Sectional Study: Head Injury in Children of Karachi

A cross-sectional study was conducted to determine the prevalence, causes and outcome of head injury in children at Neurosurgery Department of Jinnah Postgraduate Medical Centre from 1st December, 2013 to 1st February, 2014. A total of 37 patients under the age of 12 years, presented with head injuries to the emergency department, were included in the study. A self-designed questionnaire was filled for these children after getting the oral consent from their parents. The questionnaire comprised a complete detail on the causes of head injury, clinical presentation on reaching the hospital, X-rays and Computed Tomography (CT) scans of the children and their reports. SPSS version 20 was utilized as an analytical tool. The mean age of patients was 6.93 years ± 3.02. Out of these 37 patients, 54.1% were males and 45.9% were females. Road traffic accidents accounted for most of cases (48.6%) with marked peak observed in boys as compared to the girls. Majority had a good Glasgow Coma Scale (GCS) score (43.2%) whereas a depressed fracture was found to be the dominant feature (21.6%) on X-rays. Additionally, 29.7% of children had intracranial hemorrhage while 32.4% also acquired other injuries. In total 29.7% were offered surgical intervention with majority (83.8%) landing in neurosurgical ward. As head injury in childhood is an important issue, keeping in view the lack of research in this field we need to properly highlight the burden of such injuries in childhood so that all the concerned governing authorities should take every possible step in preventing as well as managing this devastating health concern.

English

Trauma is the leading cause of death in all age groups, and head trauma is the cause of death in more than 50% of cases. Head injury reduces the level of physical and mental health of a community, ultimately increasing the socioeconomic burden. In our resource limited country, skull x ray was the main mode of investigating head trauma until recently when computerized tomography (CT) scans became the modality of choice in the initial work up of patients. In this study, we sought to document the various posttraumatic CT scan findings following head injury in a tertiary hospital in Lagos and determine the sociodemographic and radiological characteristics of such patients. This was a descriptive, prospective, cross-sectional study of the CT scan findings of 400 cases with acute head trauma, from June 2010 to October 2011. The mean age of the participants was 32.7±18.2 years with a male to female ratio of 2.5:1. Majority, 65.5% of the study subjects had positive CT findings while the remaining, 34.5% had normal CT findings. Road traffic accident (RTA) was found to be the most common cause of head injury, occurring in 69% cases, especially in the 21 to 30 years age group. Cerebral contusions, 35.5% and skull fractures, 34.3% were the most common lesions found while foreign body, 1.5% were the least. This study confirmed the versatility of CT scan in detecting both intracranial and extra cranial lesions in patients with head injury from RTA, which is the most common cause, while the most frequent lesion was cerebral contusion.   Key words: Computerized tomography scan, head trauma, Lagos.

Mortality from Head Injury over Four Decades in Scotland.

Although the causes of head injury, the population at risk, and approaches to prevention and treatment are continually evolving, there is little information about how these are reflected in patterns of mortality over time. We used population-based comprehensive data uniquely available in Scotland to investigate changes in the total numbers of deaths from 1974 to 2012, as well as the rates of head injury death, from different causes, overall and in relation to age and gender. Total mortality fell from an annual average of 503 to 339 with a corresponding annual decrease in rate from 9.6 to 6.4 per 100,000 population, the decline substantially occurring between 1974 and 1990. Deaths in children fell strikingly, but rose in older people. Deaths in males fell to a greater extent than females, but remained at a higher rate overall. Initially, a transport accident accounted for most deaths, but these fell by 80%, from 325 per year to 65 per year over the 39-year period. Deaths from falling and all other causes did not decline, coming to outnumber transport accident deaths by 1998, which accounts for the overall absence of change in total mortality in recent years. In order to reduce mortality in the future, more-effective measures to prevent falls are needed and these strategies will vary in younger adults (where alcohol is often a factor), as well as in older adults where infirmity can be a cause. In addition, measures to sustain reductions in transport accidents need to be maintained and further developed.

Computed tomographic pattern of traumatic head injury at a tertiary hospital in Ibadan, South-Western Nigeria: A 10 year review

Background: The World Health Organization has projected that by the year 2020, head trauma from Road Traffic Crashes (RTCs) alone will be the 3 rd leading burden of diseases in developing countries. Computed tomography (CT) is the imaging modality of choice in acute traumatic head injury evaluation and provides an excellent guide to the care of the head injured patient. Aim: The aim of this study was to evaluate the computed tomographic pattern of head injury over a decade. Materials and Methods: This is a 10 year retrospective and descriptive study carried out at the University College Hospital Ibadan, a premier tertiary health institution, which serves as a referral center for cities and towns in South-West Nigeria. All patients with head injury referred to the Radiology Department for cranial CT investigation between January 2003 and December 2012 were recruited into the study. Results: Males accounted for 75.3% of the 2142 head trauma cases with an approximate male to female ratio of 3:1. The mean age of the patients was 34.4 years, and the median age was 32 years (age range: 1-92 years). Patients <39 years accounted for 64.4% of the cases. RTC was the most common etiologic factor accounting for 1,318 head injury cases. Cases due to assault were least seen in 131 (6.3%) of the study population. Abnormal CT findings were present in 77.6% of cases. Intracranial hemorrhage was demonstrated in 1390 patients and was the most common finding. Intraaxial bleeds were present in 60.9%, and the incidence of skull fracture was also high (50.9%). Conclusion: RTC remains the leading cause of head injury but now occurring at an increasing and alarming rate. The most common abnormal CT finding is intraaxial bleeds, followed by skull fractures and extraaxial bleed in decreasing order. A combination of these findings was also frequently recorded.

Chapter 44 - Traumatic brain injury and late-life dementia

Little is known of the impact of traumatic brain injury (TBI) on outcomes decades later when the effects of the injury interact with the aging brain. Some, but not all, epidemiologic studies have reported an association between TBI and increased risk of Alzheimer's disease (AD) and other neurodegenerative disorders years after the injury. There is evidence that this association has a dose-response pattern such that risk of dementia progressively increases as the number and severity of head injuries increase. Some studies have shown that one of the mechanisms underlying the association is that TBI may contribute to earlier onset of dementia. The APOE ϵ4 allele has been proposed as a biological link between TBI and AD because individuals with an APOE ϵ4 allele show typical AD pathology within a short period postinjury and are at increased risk of poorer cognitive outcomes. There are also likely other, yet to be identified factors that interact with the postinjury damage and aging-related brain changes leading to exacerbated cognitive decline and dementia. Given the large number of young individuals with military, sports-related, and other causes of head injuries, there is a window of opportunity and an urgency to understand the link between TBI and dementia before these TBI survivors reach the age of risk for dementia.

The Relationship between Sleep, Depression, and Traumatic Brain Injury: A Study of Ontario Workers with Head Trauma

The Relationship between Sleep, Depression, and Traumatic Brain Injury: A Study of Ontario Workers with Head Trauma While current literature reports associations between psychiatric illnesses and sleep dysfunction, traumatic brain injury (TBI) and sleep dysfunction, and TBI and psychiatric illnesses, the relationship between all three variables has not been examined. The aim of this cross-sectional study was to investigate the relationship between brain injury, sleep complaints, and other clinical variables in individuals presenting with work-related head injury. A medical record review of a consecutive sample of 106 head injured workers was performed. Abstracted data included that related to occupation, cause of head injury, diagnoses of TBI and sleep disorders, self-reported sleep complaints, mental health diagnoses, and demographic characteristics.

Fatal head injuries in children under the age of 5 years in Pretoria.

The incidence of fatal injuries in children has been reported to be highest among children aged 1 to 4 years. Major causes of head injury include road traffic accidents, falls, and intentional or inflicted injury (such as nonaccidental injury syndrome). This study reviewed the profile of children (under 5 years of age) who had been admitted to a large urban medicolegal mortuary (in Pretoria, the capital city of South Africa), after having suffered fatal head injuries. This study was conducted over a 5-year period (from January 2004 through December 2008), and a total of 107 cases were identified for inclusion. These cases constituted nearly a fifth of admissions in this age group. The male-to-female ratio was 56%:44%, and the peak age of injury was less than 1 year. Most head injuries were sustained in road traffic accidents (70%) followed by falls (10%) and other types of blunt force injuries (9%). Only 1 case of nonaccidental injury syndrome (child abuse) was found. The great majority of deaths were deemed to have been accidental in nature (91%) with 6 (6%) homicides. Urgent review pertaining to the use of child restraint devices and the safety of pedestrians is required, and the institution of childhood injury registers could aid in reducing childhood fatalities in South Africa.

Head Injury-A Neglected Public Health Problem: A Four-Month Prospective Study at Jimma University Specialized Hospital, Ethiopia

Trauma, especially head trauma, is an expanding major public health problem and the leading cause of death of the young and productive part of the world's population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. The intention of this study was to analyze head injury in a setting where most patients in low- and middle-income countries receive treatment, a referral hospital with general but no neurosurgical service like Jimma University Specialized Hospital. The study aims to provide surgeons, hospital managers and health planners working in similar set-ups with baseline information for further investigation and prevention programs intending to reduce the burden of head injury. All head injury patients presented to Jimma University Specialized Hospital between March and June 2010 were included in this prospective research. Epidemiological, clinical and management data were collected for the study. Out of 52 patients, 47 were males. The median age was 20.0 years (SD=13.3). Fights (n=20, 38.5%) and road traffic accidents (n=19, 36.5%) were the most common causes of head injury. Half of the patients sustained mild and 36.5% sustained severe head injury. The initial GCS had a significant correlation with the outcome. The mortality rate was 21.2%. Of all patients 76.9% were managed conservatively. Prevention of road traffic accidents and improvement of conservative care were identified as major methods to reduce the burden of head injury in a set-up similar to Jimma. Further studies on head injury patients in low-income countries should be done.

Ocular manifestations of head injury and incidence of post-traumatic ocular motor nerve involvement in cases of head injury: a clinical review

As the eyes are in close proximity to the skull, they can get simultaneously affected in head injuries. This close association warrants careful ocular examination in all cases of head injury. This is a prospective non-randomized analytical study to evaluate various ocular manifestations in cases of head injury with special reference to ocular motor nerve involvement, correlation between pupillary changes, and survival. A total of 1,184 patients with head injury were screened for ocular manifestations. This study comprises 594 patients with ocular manifestations of head injury. All the relevant data was compiled and analyzed as per proforma. Ocular manifestations were evaluated in each patient and appropriate investigations were carried out. Patients with ocular morbidity were analyzed for age, sex, mode of injury, Glasgow Coma Score, and associated injuries in addition to ophthalmic and neurosurgical evaluations. Of the 594 patients, 81.6 % were male and 18.4 % were female, with a male-to-female ratio of 4:1. The major cause of head injury was road traffic accidents (70.37 %). The most common age group involved was, 21-40-year-olds (67.40 %). Out of 594 patients, ecchymosis was found in 51.85 %, subconjunctival hemorrhage in 44.44 %, lid edema in 41.48 %, lacerated wound in 22.59 %, pupillary involvement in 21.04 %, ptosis in 6.73 %, cranial nerve palsy in 11.62 %, orbital fractures in 10.44 %, optic nerve trauma in 4.04 %, and exposure keratitis in 4.21 %. Patients with bilaterally dilated or pinpoint fixed pupils had a 10 times higher risk of mortality than patients without pupillary involvement. Third nerve involvement was seen 2.85 times more frequently in frontal and parietal region injuries compared to other sites of injury. The involvement of the sixth nerve occurred 4.6 times more frequently in parietal region injuries compared to other sites of injury.

Ophthalmic complications among cases of head trauma in north-eastern Iran

The aim of this study was to investigate the prevalence and pattern of ocular complications in patients with head trauma admitted to the main trauma centre in north-eastern Iran. A total of 459 head-injured patients (36.56 ± 19.30 years of age) with at least one ocular manifestation were recruited. Each individual patient was examined by a neurosurgeon and an ophthalmologist to confirm the type of ocular complication. In addition, all patients were analysed for age, gender, and cause of head injury in addition to the ophthalmic and neurosurgical examinations. Of the 459 patients, 142 (31 %) were female and 317 (69 %) were male. The maximum rate of ocular complications was during the third decade of life and minimum during childhood and in the elderly (>71 years) population. The leading cause of head trauma was motor vehicle accidents, predominant in male adults aged 21-40 years. Ocular complications observed were classified into three major groups: soft-tissue injuries to the globe and adnexae (n = 434), orbital complications (n = 45) and neuro-ophthalmic complications (n = 152). In conclusion, our data provides a useful estimation of the rate and pattern of ocular complications among patients with head injuries seen in trauma centres in north-eastern Iran. Understanding the pattern of ocular complications helps us to design more appropriate preventive methods.

A novel simplified 3D skull model to predict cranial fracture patterns

Skull fracture is a major cause of head injury involving high morbidity and mortality worldwide. The study of fracture patterns is decisive to determine the factors involved in the cause of death or injury. Furthermore, in-depth evaluation of these patterns can generate very valuable knowledge to further design and manufacture more efficient and secure protective equipment, as well as, innovative cranial implants. Fracture propagation has been studied in several works using post-mortem skulls or complex finite element models; however, injury patters resulted to be complicated and very difficult to understand. In this study, a simplification of a real human skull to perform biomechanical tests is considered. In a first step, a 3D model of a cranium is designed, following expert medical indications. The new model is used to simulate and evaluate several impact forces and their fracture patterns. The results obtained confirm the stress propagation shown in previous studies using post-mortem skulls. Moreover, they validate the simplified 3D model as simpler and effective tool to perform mechanical behaviour tests.

Evaluation of the incidence, nature of injury and clinical outcomes of head injuries in North Eastern part of India

Background : Incidence of head injuries/ traumatic brain injuris(TBI) is increasing day by day,and this is the major cause of morbidity and mortality in developing countries. Objectives : To evaluate the incidence ,nature of injury and clinical outcomes of head injuries in North eastern part of India. Material and Methods : 1300 patients of head injury were included in the study. On presentation a patients clinical status is grossly assessed with the Glasgow Coma Scales (GCS). X-ray cervical spine in suspicious cases and Non contrast computed tomography scan was done of all head injury patients . Result : 21-40 years age group (40.0%) was most commonly affected and most of patients (74%) were male . Road traffic accident (47.07%) was most common cause of head injury followed by fall from height (32%) . Overall mortality in total head injury patient was 13% . According to GCS al 368 (43.5%) patients of severe head injury patient expired while mortality in moderate grade injury was 5.6% and 100% of mild head injury patients were saved . A total of 532 (40.92%) patients had skull bone fracture and among bone fracture simple bone fracture was most common. Conclusion : Most of the injuries occur more commonly in certain age groups, at certain localities and mostly in male. So the knowledge about the causes and pattern of head injury may be extremely helpful in making preventive policies. Key words : head injury, Road traffic accident, GCS

Multiple Densities of the Chronic Subdural Hematoma in CT Scans

ObjectiveDensity of the chronic subdural hematoma (cSDH) is variable. It often appears to be mixed density. Multiple densities of cSDH may result from multiple episodes of trauma. We investigated the frequency of mixed density and the causes of head injuries representing each density.MethodsWe could collect 242 cases of chronic SDH. The cSDHs were classified into four groups; hypodensity, homogeneous isodensity, layered type, and mixed type on the basis of CT scans.ResultsThe density of cSDH was isodense in 115 patients, hypodense in 31 patients, mixed in 79 cases, and layered in 17 cases. The cSDH was on the left side in 115 patients, on the right side in 70 patients, and bilateral in 40 patients. The history of trauma was identifiable in 122 patients. The etiology could be identified in 67.7% of the hypodense hematomas, while it was obscure in 59.5% of the mixed hematomas.ConclusionMixed density of cSDH results from multiple episodes of trauma, usually in the aged. It is hard to remember all the trivial traumas for the patients with the mixed density cSDHs. Although there were membranes within the mixed density hematomas, burr-holes were usually enough to drain the hematomas.

Built environment safety: epidemiology of head and brain injury and fractures from stair falls in Canada

BackgroundFalls are overtaking traffic injuries as the leading cause of not only injury hospitalisation, but also death. Stairs are of special interest for prevention by design, being subject to building...

Hospitalised and Fatal Head Injuries in Viti Levu, Fiji: Findings from an Island-Wide Trauma Registry (TRIP 4)

Background: Globally, head injury is a substantial cause of mortality and morbidity. A disproportionately greater burden is borne by low- and middle-income countries. The incidence and characteristics of fatal and hospitalised head injuries in Fiji are unknown. Methods: Using prospective data from the Fiji Injury Surveillance in Hospital system, the epidemiology of fatal and hospitalised head injuries was investigated (2004–2005). Results: In total, 226 hospital admissions and 50 fatalities (66% died prior to admission) with a principal diagnosis of head injury were identified (crude annual rates of 34.7 and 7.7/100,000, respectively). Males were more likely to die and be hospitalised as a result of head injury than females. The highest fatality rate was among those in the 30–44-year age group. Road traffic crashes were the leading causes of injuries resulting in death (70%), followed by ‘hit by person or object’ and falls (14% each). Among people admitted to hospital, road traffic crashes (34.5%) and falls (33.2%) were the leading causes of injury. The leading cause of head injuries in children was falls, in 15–29-year-olds road traffic crashes, and in adults aged 30–44 years or 45 years and older ‘hit by person or object’. Among the two major ethnic groups, Fijians had higher rates of falls and ‘hit by person or object’ and Indians higher rates for road traffic crashes. There were no statistically significant differences between the overall rates of head injuries or the fatal and non-fatal rates among Fijians or Indians by gender following age standardisation to the total Fijian national population. Conclusion: Despite underestimating the overall burden, this study identified head injury to be a major cause of death and hospitalisation in Fiji. The predominance of males and road traffic-related injuries is consistent with studies on head injuries conducted in other low- and middle-income countries. The high fatality rate among those aged 30–44 years in this study has not been noted previously. The high case fatality rate prior to admission to the hospital requires urgent attention.

Evaluation of acute head injury by computed tomography scan in College of Medical Sciences-Teaching Hospital, Chitwan

This study was conducted to evaluate the computed tomography findings in patient with acute head injury and to emphasize the importance of computed tomography scan in head injury. One hundred consecutive patients presenting to the emergency department with head injury were evaluated by computed tomography scan of the head. Seventy five patients (75%) were male and twenty five (25%) were females. The age of the patients ranged from three to seventy years and the most affected age group was between thirty and forty (40%). The common causes of head injury were motor vehicle accident (70%), fall injury (25% ) and physical assault (5%). The most common computed tomographic findings were: cerebral contusions (52%), skull fractures (41%), intracerebral hematomas (24%), diffuse cerebral edema (23%), midline shift (18%), subdural hematomas (15%), subarachnoid hemorrhage (13%), diffuse axonal injury (8%), intraventricular hemorrhage (6%), extradural hemotomas (4%), pnemocephalus (2%) and normal scans were found in (5%). In conclusion, computed tomography is the mainstay in the imaging of head injury and helps in the patient management. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5971 JCMSN 2011; 7(1): 36-39

Epidemiology of Pediatric Head Trauma in Guilan

BackgroundHead injury (HI) is preventable and knowledge of the epidemiology of children's HI is essential for developing preventive strategies.ObjectivesThe aim of this study was to survey pediatric HI patients admitted to emergency wards at Poursina Hospital in Rasht, Iran, from 2009 to 2010, and to identify the cause of HI in these children.Patients and MethodsIn this retrospective study, all HI patients under the age of 18 who were admitted to emergency wards between March 2009 and March 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed.ResultsA total of 668 patients were included in this study. The mean age was 10.4 ± 5.3 years. The most frequent cause of HI was traffic accidents. The mean Glasgow Coma Scale (GCS) score was 14.5 ± 1.6. The ratio of boys to girls was approximately 3 to 1. The ratio of boys to girls increased with increasing age (P < 0.01). Moreover, an association was found between age at injury and etiology of HI as well as a significant association between age at injury and the place of event (P < 0.01).ConclusionsThe incidence of childhood HI due to traffic accidents is high (81% of pediatric trauma cases). Thus, motorcyclist education and improvement in traffic engineering for pedestrians and bicyclists should be included in prevention programs.

320 柔道頭部外傷 : 事故データによる検討(事故・傷害の解析と予防)

As of April 2012, "Budo", Japanese traditional martial arts, became a compulsory part of health and physical education at junior high schools in Japan, with schools being given the option to choose from judo, kendo, and sumo. Recently, some students died or suffered injuries in judo accidents, and it is feared that such accidents could become common. In this study, we examined cases of head injury suffered by students in judo accidents. The incidence of injury showed two peaks occurring in the first year of junior high and senior high school. In most cases, the judo accident impacted the victim's head, particularly the occipital region. Most of the victims suffered subdural hemorrhage. Osotogari, a judo throwing technique, was found to be the most common cause of head injury. This was true in the alive case of the accidents as well as those who died from head injury.

The epidemiology of sports head injuries in a rural population

There have been very few studies looking into the epidemiology of sports injuries, and in particular sports head injuries (SHI) within a rural location. Head injury is a significant cause...