Diagnosis Of Intracranial Injury Research Articles

Damage To Eyes, Orbit And Visual Nerve , Combined With Cranial Injury In Emergency Medicine

The features of the clinical course, symptoms and the difficulty of diagnosing traumatic injuries of the eye, orbit and optic nerve are described. A total of 952 patients with concomitant craniocerebral injuries and injuries to the eye, orbit, optic nerve were studied in 2018. The possibilities of computer tomography in the diagnosis of traumatic injuries of the visual tract combined with traumatic brain injury and differential diagnosis of intracranial injuries of the visual tract before the hospital and hospital stages were studied. In the structure of craniocerebral trauma, craniofacial accounted for 187 (19.6%), of which 118 (6%) eye injuries, 20 (10.6%) orbit injuries, 4 (2.1%) optic nerve injuries, 19 (10 %) of patients were diagnosed with a fracture of the walls of the orbit. In 5 (2.6%) patients, an isolated fracture of the lower orbital wall was revealed. Total: 158 men (84.4%), 29 women (15.5%). The patients underwent examination, including examination by a multidisciplinary team (neurosurgeon, maxillofacial surgeon, ENT and ophthalmologist). Anamnesis was studied in all patients, a comprehensive ophthalmological examination was performed: visometry (with optimal correction), refractometry, biomicroscopy, ophthalmoscopy and neuro-ophthalmological examination. All patients underwent radiography of the orbits and skull in frontal and lateral projections, CT, MRI of the brain and orbits. To obtain additional information, 24 (12.8%) patients underwent a two-dimensional ultrasound examination - ultrasound - B SCAN of the eyeball, extraocular muscles and retrobulbar space. Timely topical diagnostics and qualified reconstructive surgeries performed in the early period of craniofacial trauma allows achieving regression of oculomotor disorders in 86.6%, prevents severe consequences and preserves the patient's vision.

46 PAFE: Prevention of farm accidents in children

Farm accidents are a major cause of mortality and morbidity in the pediatric population. Many accidents occur when children are assigned work normally performed by adults, and much of this work is beyond their developmental abilities. Consideration of child development has led to the development of the North American Guidelines for Children’s Agricultural Tasks (NAGCAT). NAGCAT is a collection of guidelines designed to help parents assign suitable tasks to children aged 7 to 16 living or working on farms. The primary objective is to describe the caracteristics of injured children and leading mechanisms of injury. Secondary objectives are to assess the potential of prevention of the NAGCAT and to identify the NAGCAT farm work that was most commonly associated with these injuries. This research is a retrospective case series study. The study population is 282 hospitalized children and 18 children who died from 2002 to 2016 following an agricultural trauma in Quebec. Hospitalization data were consulted at the INSPQ offices. The mortality data was sent to us by the coroner’s office. Sociodemographic data, hospital stay and injury characteristics were recorded for hospitalization cases. The applicability of NAGCAT was evaluated for the most common injury mechanisms. We looked at the age at which the injuries occurred and compared it to the recommended minimal ages for the different farm activities described in the guidelines. Injuries that occurred in the context of an activity not recommended for age were considered preventable. The main mechanisms of injury were tractor related incident, other farm equipment related incident and falls. Boys aged 5 to 9 and 15 to 19 years were the most affected by agricultural trauma. It was possible to evaluate the applicability of NAGCAT on 66% of hospitalizations and 100% of deaths. Of these, 67% of hospitalizations and 83% of deaths were preventable by NAGCAT recommendations on age. For traumatic injuries among hospitalizations from 2006 to 2015, 11% of patients had a diagnosis of intracranial injury, 8% had a broken leg, 6% had a skull fracture and 6% a traumatic amputation of the hand. Boys aged 5 to 9 and 15 to 19 years are the groups with the highest risk possibly due to the more reckless temperament among adolescents, lack of supervision and assignment of age-inappropriate tasks to children. The results suggest that it is imperative to focus on farm accidents and that NAGCAT would be an effective tool in terms of prevention.

Effectiveness of traumatic brain injury management guideline introduction in hungary.

To describe the impact of the Traumatic Brain Injury management guideline introduction in Hungary. Hospital discharge records (HDR) including age, gender, codes of interventions applied, ICD codes of diagnosed disorders of patients admitted between 01/01/2004 and 31/12/2010 with the diagnosis of intracranial injury (S06 by ICD10) from every inpatient institution in Hungary were collected from the database of National Health Insurance Fund (NHIF). The Case Fatality Ratios (CFR) for one week, one month and six months were calculated for the periods before and after the guideline introduction. The change of CFRs was applied as indicators for change of clinical quality elicited by the guideline. The centers together at one week, one month and six months had pre-guideline introduction CFRs of 23.4%, 37.7% and 47.5% and post-guideline introduction CFRs of 22.1%, 39.1%, and 50.0% respectively. The secondary institutions together at one week, one month and six months had pre-guideline introduction CFRs of 21.5%, 34.8% and 46.3% and post-guideline introduction CFRs of 21.9%, 37.0%, and 48.9% respectively. None of the CFRs showed significant change. The effectiveness of TBI management guideline adaptation in Hungary is poor. Without supportive financing and external auditing system, guideline introduction alone cannot achieve standard clinical practice and a reduction in CFR.

Nonfatal Traumatic Brain Injury–Related Hospitalization in Very Young Children—15 States, 1999

To document age-related patterns of nonfatal hospitalization associated with traumatic brain injury (TBI) among children younger than 2 years of age, by intent/cause and diagnosis. Data describing 2536 nonfatal TBI-related hospitalizations in 15 states for the year 1999 were obtained from the Centers for Disease Control and Prevention Central Nervous System Injury surveillance system for children younger than 2 years of age (0-23 months) at the time of injury. Incidence rates (overall, by intent/cause, and by diagnosis) were calculated by combining TBI surveillance data with population data from the US Census Bureau and the National Center for Health Statistics. Overall rates of nonfatal TBI-related hospitalization peaked at 1 month of age (178.0 cases per 100,000 person-years) followed by a secondary peak at 8 months of age (127.9 cases per 100,000 person-years). Rates for fall-related (unintentional) cases and assault-related cases were significantly higher for infants (0-11 months) than for 1-year-olds (12-23 months), with rates for both types of cases peaking in the earliest months of life. Rates for cases with diagnoses of skull fracture and/or intracranial injury were also significantly higher for the younger group. Assault-related cases frequently coincided with a diagnosis of intracranial injury regardless of age. Prevention efforts should focus on falls and assaults, which account for the majority of TBI-related hospitalizations in early childhood. Such efforts may also need to emphasize the unusually high risk during the first few months of life.

Predictors of intracranial injuries in children after blunt head trauma

This study was conducted to determine if clinical features can predict the risk of intracranial injury (ICI) in pediatric closed head trauma. We enrolled 3,806 children under 16 years consecutively referred for acute closed head trauma to the paediatric emergency room of five Italian children's hospitals. Relevant outcomes were death and diagnosis of ICI. Clinical symptoms and signs were evaluated as possible outcome predictors. Children were also classified into five groups according to their clinical presentation. The association of ICI with signs and symptoms and the appropriateness of the five-group classification in predicting the likelihood of ICI were evaluated by logistic regression analyses. ICI was diagnosed in 22 children; 2 of them died. The risk of fatal and nonfatal ICI was 0.5 and 5.2 per 1,000 children with closed head trauma respectively. Significant associations were found between ICI and loss of consciousness, prolonged headache, persistent drowsiness, abnormal mental status, focal neurological signs, signs of skull fracture in non-frontal areas and signs of basal skull fracture. The five-group classification of children allowed an excellent prediction in terms of likelihood of ICI (ROC area 0.972). Selection of children with closed head trauma based on different combinations of signs and symptoms allows for early identification of subjects at different risk for ICI. In patients with minor head injuries, the absence of loss of consciousness, drowsiness, amnesia, prolonged headache, clinical evidence of basal or non-frontal skull fracture identified 100% of children without lesions. Validation of our results with a larger sample of patients with ICI would be highly desirable.

Lumbar puncture in head injuries

Based on a study of the anatomy and physiology of the brain, and on clinical experiences in a series of over 500 cases of head injuries with study of autopsy material together with a review of the literature on the subject, the following deductions are made: 1. 1. The withdrawal of cerebrospinal fluid by lumbar puncture as a diagnostic procedure should be performed in every case of head injury, after the patient has reacted from shock. The pressure should be recorded and the fluid collected in three tubes about 5 c.c. in each. If the fluid is uniformly bloody in the three tubes, and if the supernatant fluid is xanthocromic after centrifuging, and if the pressure is over 10–12 mm. of mercury, a diagnosis of intracranial injury with probable brain laceration or contusion and hemorrhage can be made. If the fluid is clear, but under increased pressure, and if there is other corroborating evidence, a diagnosis of traumatic cerebral edema can be made. If the fluid is clear and the pressure is normal, one is justified in ruling out an intracranial injury even in the presence of a fractured skull. 2. 2. Lumbar puncture is a useful therapeutic procedure in cases of traumatic edema. The pressure should be reduced by half the excess above normal, and the procedure repeated about every six to twelve hours until the pressure is normal. 3. 3. When the fluid is bloody and under increased pressure, no ill effects have been noted from repeated punctures, if the pressure is not reduced suddenly. 4. 4. Adoption of a uniform method of classifying head injuries will help to eliminate the confusion and conflicting opinions which now exist regarding diagnostic and therapeutic procedures and will render our statistics, especially regarding mortality, more reliable.