Fatal Head Injuries Research Articles

Helmets for motor cyclists: lower fatal head injury rate but more crashes mean more study

Helmets for motor cyclists: lower fatal head injury rate but more crashes mean more study

Analysis of organ procurement failure at an urban trauma center and the impact of HIV on organ procurement at a regional transplantation center.

A 42-month experience with 100 patients with fatal head injuries was analyzed to identify areas of organ procurement failure. Thirty-six patients were ineligible for organ donation. Reasons for exclusion included advanced age (7), sepsis (16), hepatitis (1), systemic illnesses (3), and HIV infection or risk (9). Resuscitation failure (17 patients) and late deaths from failed support (16 patients) left 31 potential donors. Of the 30 families asked to donate, 17 consented (56.7%). Annual consent rates were 25%, 71%, 75%, and 67%. Efforts to improve organ procurement should focus on resuscitation and physiologic support of potential donors. To assess the impact of HIV infection or risk on organ procurement, a 3-year experience of the regional transplantation center (RTP) was reviewed. Of 1,714 referrals to the RTP from 102 hospitals, 1,120 were from trauma centers. The incidence of rejection because of HIV risk or infection was significantly higher in the trauma center group than in the group from non-trauma centers, 17.2% versus 10.2% (p less than 0.004). A similar difference was noted between metropolitan and suburban hospitals (p less than 0.0001). Hepatitis risk was comparable, 3.9% vs. 3.2%. The risk of HIV infection is emerging as a factor limiting organ donation at urban trauma centers.

Diffuse axonal injury caused by assault.

The case reports of 50 fatal head injuries caused by assault and managed at the Institute of Neurological Sciences, Glasgow, were reviewed. Fifteen cases had diffuse axonal injury. Diffuse axonal injury is a well recognised type of brain damage brought about by a head injury, usually as a result of a road traffic accident or fall from a height. It does not seem to be widely appreciated that it may also occur as a result of an assault. This has important medicolegal implications.

Chest injuries in children: An analysis of 100 cases of blunt chest trauma from motor vehicle accidents

One hundred twenty-eight cases of chest injury were seen in a Paediatric Trauma Unit over a 5 1 2 - year period. One hundred patients sustained motor vehicle accident (MVA)-related blunt chest injuries, 91 of them as pedestrians. Nine children had blunt chest injuries from falls, 10 had stab wounds (3 assault, 7 accidental), and 9 had gunshot injuries (6 from birdshot used by police during civil disturbance). MVA-related injuries were studied separately, as an etiologically homogeneous group. Sixty-five of these patients were under the age of 6. All but 3 also had serious extrathoracic injuries. The mean injury severity score (ISS) in MVA-related injuries was 25. Eight patients died, all with an ISS of 34 or more, 7 of whom had fatal head injuries. In MVA-related injuries, pulmonary contusion (n = 73) was the most frequent lesion seen, followed by rib fracture (n = 62), posttraumatic effusion (n = 58), pneumothorax (n = 38), and pneumatocele (n = 5). In MVA-related injuries, 18 children required ventilation. Thirty-nine (69%) of 56 children with radiologically evident posttraumatic pleural effusion had intercostal chest drainage. Analysis suggests that lung injury is a central event in MVA-related blunt chest trauma. Primary lung injury, radiologically visible as contusion, is complicated by hematoma, posttraumatic effusion, and pneumothorax.

Hippocampal pathology in fatal non-missile human head injury.

The hippocampus has been known to be involved in fatal non-missile human head injury, although detailed histopathology of this lesion has yet to be described. This report documents the frequency and distribution of hippocampal damage in a consecutive series of 112 fatal human non-missile head injuries. Damage to the hippocampus was noted in 94 cases (84%). Lesions always involved the CA1 subfield and were bilateral in 70 cases. Other subfields of the hippocampus were involved less frequently. Lesions were focal in the majority of cases (58%). Pathological evidence of high intracranial pressure was present in 86% of the cases. Hypoxic brain damage in other regions of the brain was present in 74% of cases. Thus, the hippocampus is frequently damaged in fatal non-missile human head injury. The pattern of this damage is similar to that observed in experimental head injury. Hypoxia and high intracranial pressure are likely to contribute to the occurrence of human traumatic hippocampal damage but other mechanisms, such as excitotoxicity, are likely to be operative.

Fatal penetrating head injury during a game of soccer

Fatal penetrating head injury during a game of soccer

Organ Procurement in Patients with Fatal Head Injuries The Fate of the Potential Donor

A 46-month, retrospective review of all victims of fatal head injury at a level 1 trauma center was undertaken to estimate donor organ availability, determine causes of procurement failure, and analyze the functional results of organs transplanted from this group of donors. Causes of procurement failure in 126 patients who died principally from their head injuries included failure of initial resuscitation (14%), ineligibility (28%), failure of physiologic support (14%), and denial of consent (20%). Of 73 eligible donors, 29 (41%) were able to donate one or more vascular organs (heart, liver, kidney). In only one instance was an eligible donor not appropriately identified as such. Failure of physiologic support to prevent early death (25%), and denial of consent (34%) were found to be the two major, potentially remediable causes of procurement failure in this series. Based on this data, an estimated 29 patients/million population/year will survive initially and meet all eligibility requirements for organ donation. Data on 47 kidneys transplanted from the donor group demonstrated a 77% overall graft survival rate at a follow-up period averaging 23 months. Prolonged donor hypotension, but not the use of high-dose vasopressors, adversely affected allograft survival. The current limitations of organ procurement in victims of fatal head injury stem from a limited ability to maintain cardiopulmonary function long enough for the procurement process to be completed and a high overall rate (46%) of denial of consent for organ harvest by next of kin.

Rehabilitation of head injured children.

Correspondence to: Dr D M B Hall, Community Health Services, Clare House, St George's Hospital, Blackshaw Road, London SW17 OQT. Epidemiology of head injury in childhood Between the ages of 1 and 14 years accidents constitute the greatest single cause of death and head injuries account for 40% of these, amounting to 403 in the United Kingdom in 1985.1 Only about one quarter of children who received a fatal head injury were travelling in motor vehicles; in most accidents the child was

Ischemic brain damage is still common in fatal nonmissile head injury

Ischemic brain damage is still common in fatal nonmissile head injury

Head injury training for pediatric residents.

Annually, approximately 100 000 children under the age of 15 years suffer traumatic head injury severe enough to be hospitalized. 1 Advances in medical technology and trauma care are enabling more children to survive previously fatal head injuries. Therefore, pediatricians will be called on increasingly to treat and give advice regarding children who have survived traumatic head injuries. Recently, professionals who treat children with head injuries have recommended that pediatricians become involved in the long-term follow-up of children with head injuries, 2 even when the injuries are only mild to moderate. 3 This is an important recommendation because the majority of head injuries are classified as mild. 4 This request for the careful monitoring of children with head injuries stems from recent evidence that even mild injuries may result in long-term physical sequelae, such as seizures 5 and motor impairments, 6 as well as psychosocial and cognitive consequences. 7 Research

Ischaemic brain damage is still common in fatal non-missile head injury.

A detailed neuropathological examination has been undertaken on a consecutive series of head injuries dying in the Institute of Neurological Sciences, Glasgow, between 1968-72 (151 cases) and 1981-82 (112 cases) in order to determine the frequency and distribution of any ischaemic brain damage. Ischaemic damage was found in the brains of 92% of the 1968-72 cases and in 88% of the 1981-82 cases: there was no statistical difference in the amount of moderately severe and severe ischaemic damage in the two groups, 55% and 54% respectively. There was evidence, however, that an increased number of patients with severe ischaemic brain damage was admitted in 1981-82 as a result of a changed admission policy of the Department of Neurosurgery that resulted in an increased detection of intracranial haematomas. It is concluded that ischaemic brain damage is still common after severe head injury, and it seems likely that it remains an important cause of mortality and morbidity.

Brain damage in fatal non-missile head injury in relation to age and type of injury.

Brain damage in a series of 635 fatal non-missile head injuries has been analysed with particular reference to the age of the patient and the type of injury. The differences in the type of brain damage in relation to age were less than we had anticipated, lending further support to the contention that the aged brain has a reduced potential for recovery. The analysis confirms the relationship between road traffic accidents, diffuse axonal injury, gliding contusions and 'basal ganglia' haematomas, and the importance of diffuse brain swelling resulting from a head injury in children.

Head Injuries in Soccer.

In brief: Although soccer is considered a safe sport, fatal head injuries have occurred on rare occasion. Mechanisms of injury include heading the ball improperly and making head-to-head contact; injury may also occur when a forcefully kicked ball strikes a player's head. Goalkeepers most commonly sustain collision injuries when the head strikes the goalpost, the playing field, or another player's elbow, foot, or head. The author reviews the medical literature on soccer injuries and contends that rule changes and other measures may be more appropriate than the use of helmets to prevent head injuries.

Fatal head injury in children.

A comprehensive neuropathological study was undertaken on 87 children aged between 2 and 15 years with fatal head injuries to identify those features which occurred at the time of head injury (fractured skull, contusions, intracranial haematoma and diffuse axonal injury) and those which were subsequently produced by complicating processes (hypoxic brain damage, raised intracranial pressure, infection and brain swelling). The types of brain brain damage identified were remarkably similar to those seen in adults. The only difference was the prevalence of diffuse brain swelling in children.

Brain damage in fatal non-missile head injury without high intracranial pressure.

As part of a comprehensive study of brain damage in 635 fatal non-missile head injuries, the type and prevalence of brain damage occurring in the absence of high intracranial pressure were analysed. Of 71 such cases, 53 sustained their injury as a result of a road traffic accident; only 25 experienced a lucid interval. Thirty eight had a fractured skull, a mean total contusion index of 12.9 and diffuse axonal injury in 29: severe to moderate ischaemic damage was present in the cerebral cortex in 25, brain swelling in 13, and acute bacterial meningitis in nine. The prevalence and range of brain damage that may occur in the absence of high intracranial pressure are important to forensic pathologists in the medicolegal interpretation of cases of fatal head injury.

The autopsy in fatal non-missile head injuries.

The identification and interpretation of brain damage resulting from a non-missile head injury is often not easy — if only because the most obvious structural damage identified post mortem may not be the most important. There must be many occasions when death is certified as being due to fracture of the skull and cerebral contusions when neither may have even been the reason for the patient having been unconscious. Patients with a fracture and quite severe contusions can make an uneventful and complete recovery from their injury if no other types of brain damage are present (cf. Figs. 7 and 9). The aim of this chapter therefore is to advise on a pragmatic approach to the autopsy, to define clearly the various types of brain damage that may occur, and to remind the pathologist that he must know what he is looking for. This is particularly important when there is no evidence of severe cerebral contusions or of a large intracranial haematoma. A patient may die as a result of a non-missile head injury without either of these being present. Thus a systematic approach is required, and the pathologist must be aware of the more subtle — and often most important — types of brain damage that can occur in a patient who sustains a non-missile head injury. Frequently the damage can be identified only microscopically.

Deep intracerebral (basal ganglia) haematomas in fatal non-missile head injury in man.

Deep intracerebral (basal ganglia) haematomas were found post mortem in 63 of 635 fatal non-missile head injuries. In patients with a basal ganglia haematoma, contusions were more severe, there was a reduced incidence of a lucid interval, and there was an increased incidence of road traffic accidents, gliding contusions and diffuse axonal injury than in patients without this type of haematoma. Intracranial haematoma is usually thought to be a secondary event, that is a complication of the original injury, but these results suggest that a deep intracerebral haematoma is a primary event. If a deep intracerebral haematoma is identified on an early CT scan it is likely that the patient has sustained severe diffuse brain damage at the time of injury. In the majority of head injuries damage to blood vessels or axons predominates. In patients with a traumatic deep intracerebral haematoma, it would appear that the deceleration/acceleration forces are such that both axons and blood vessels within the brain are damaged at the time of injury.

The limits of cerebral dehydration in the treatment of head injury

Eighteen patients with fatal head injury were matched with survivors for age, sex, and nature and severity of injury. All were treated with cerebral dehydration. Only four patients survived whose peak serum osmolality exceeded 340 mosm/kg; none survived above 378 mosm/kg. Only four patients survived whose peak serum sodium concentration exceeded 155 mEq/L; none survived above 166 mEq/L. Serum osmolality should probably not be allowed to rise above 340 mosm/kg, and serum sodium concentration should not be allowed to exceed 155 mEq/L. Aggressive dehydration, i.e., osmotherapy, is best accomplished with intracranial pressure monitoring.

Acute brain edema in fatal head injury: analysis by dynamic CT scanning.

Dynamic computerized tomography (CT) was performed on 42 patients with acute head injury to evaluate the hemodynamics and to elucidate the nature of fatal diffuse brain bulk enlargement. Patients were divided into two groups according to the outcome: Group A included 17 nonfatally injured patients, eight with acute epidural hematomas and nine with acute subdural hematomas; Group B included 25 fatally injured patients, 16 with acute subdural hematomas and nine with bilateral brain bulk enlargement. Remarkable brain bulk enlargement could be seen in all fatally injured patients with acute subdural hematoma. In 29 (69%) of 42 patients, dynamic CT was performed within 2 hours after the impact. In the nonfatally injured patients with brain bulk enlargement, dynamic CT scans suggested a hyperemic state. On the other hand, in 17 (68%) of the 25 fatally injured patients, dynamic CT scans revealed a severely ischemic state. In the fatally injured patients with acute subdural hematoma, CT Hounsfield numbers in the enlarged hemisphere (hematoma side) were significantly lower than those of the opposite side (p less than 0.001). Severe diffuse brain damage confirmed by follow-up CT scans and uncontrollable high intracranial pressure were noted in the fatally injured patients. Brain bulk enlargement following head injury originates from acute brain edema and an increase of cerebral blood volume. In cases of fatal head injury, acute brain edema is the more common cause of brain bulk enlargement and occurs more rapidly than is usually thought.

Head and neck injuries to motorcycle and moped riders—with special regard to the effect of protective helmets

In a consecutive series of 132 motorcycle and moped riders killed in 1977-1983 in southern Sweden and examined post mortem, almost half of the fatal injuries of the head and neck occurred remote from the point of impact, namely certain intracranial injuries without fractures, ring fractures of the base of the skull, disruption of the junction of the head and neck and injuries of the cervical spine. Ring fractures of the base of the skull were noticeably more frequent in motorcyclists than in car occupants who died. Injuries occurring remote from the point of impact were often the result of impacts against the anterior part of the head, especially against the face. All 5 riders suffering disruption of the junction of the head and neck were helmeted, which suggests that the helmet may promote such injuries. In some of these cases, no sign of impact against the head could be detected. The inertia of the head, enhanced by the helmet, is supposed to contribute to some of these injuries, which calls into question the protection provided by the helmet. Fatal head injuries at the point of impact were mostly found on the lateral-posterior part of the head. These injuries were often irrespective of whether or not a helmet was used. The points of impact were found mainly rung around the head. Protective helmets should be improved in order to give better protection against injuries at the site of impact, especially in the above-mentioned area, to give better protection of the face and to increase energy-absorbing capacity.(ABSTRACT TRUNCATED AT 250 WORDS)