Fatal Head Injuries Research Articles

An Application of the Principles of Projectile Motion to a Homicide Investigation

Biomechanics testimony was sought to assess the feasibility of a claim made by the defendant that a fatal head injury sustained by the victim arose as a result of the defendant throwing a child's bicycle a horizontal distance of 7 m which accidentally struck the victim. The method of projection was claimed to involve pushing the bicycle from the chest equally with both hands from a stationary upright standing position in a manner similar to a chest pass in basketball. A further consideration in the case was that the maximum height of the projectile during flight was constrained by the presence of an overhead ceiling. Using equations for uniform motion and based on measurements made at the crime scene, it was determined that the theoretical release speed of the projectile could not have been less than 10.0-11.0 m/s and was probably closer to 14 m/s. These estimated release speeds are substantially higher than the release speeds associated with a comparable movement pattern, namely, the maximal two-handed bench throw (∼2.5 m/s), and instead approximate the release speeds recorded by the best three throwers in the Men's Shot Put at the 2004 Athens Olympic Games (13.60- 13.95 m/s). It therefore seems highly unlikely that the defendant could have thrown the projectile a horizontal distance of 7 m as claimed.

Die Frequenzen by Clemens J. Setz

easy. Dastardlycharacters reemerge to drag themintothenew criminal underworld, and old liberation buddies - now in positions of political power - arejustas guiltyofgreasing thewheelsas everyoneelse. Butthemoreprotectedyou are withhigh fencesand alarms in the Windy City, the more likely you are to be involved when the crime occurs. Car theftbecomes carjacking . Burglarybecomes kidnapping. Mike Nicol places his charactersin thatdelicate middle ground,what he calls "thatinstantbetweenorder and chaos,when everything changes . These characterswalk on that edge constantly.And as they live in a dangerous world, theycan be killedatanymoment"(Litnet.co.za). In thistale,many thingsbreak apart. People are stabbed, gutted, shot,sliced, pummeled,and skewered . The violence can even seem indulgent. But underpinning the violence is a sensitivity to character and social contextthat moves this story from exploitative to thoughtful.Nicol shiftsassuredly between the ethnic groups of the Cape. Bishopand Pylonwheel their finecars between Camps Bay and Khayelitsha township and protect themselves as muchfrom hiv/aidsas fromgunshots. At times, the dialogue can become indistinguishable across characters,who talk the same and often in confusingways. Another unsavoryaspectis thatMace Bishop is not an especially likable main character. Sure,Bishop is a dashing and bravemercenary who once supportedtheliberation struggle, buthe is also stoicalto thepointoffrustration ,motivatedto burstsof action thatcan seemunwarranted. His past lifeof gun smugglinghas throttled his ability to empathize, turning himintoan automaton.Rather,itis Bishop'spartner, Buso,who is pragmatic ,caring,and concernedabout how violence can ripple through friends and family. For soccer fans (like me), Paybackcan be a shocking read after the jubilation of the World Cup. But Mike Nicol's stories challenge us to set down our vuvuzelas fora momentand imaginea different life outsidethestadiums. Deji Olukotun Brooklyn Clemens J.Setz. Die Frequenzen. St. Polten /Salzburg. Residenz. 2009. 714 pages. €24.90. isbn 978-3-7017-1515-2 AlexanderKerfuchs, thefirst-person narratorof young Austrianauthor Clemens Setz's novel Die Frequenzen (The frequencies), shortlisted for the 2009 German Book Prize and awarded theBremenLiterature Prize,at one pointrecallshis childhood fascination withtheidea ofthe RubeGoldbergmachine:"I dreamed of it forseveral consecutivenights, Nota Bene Carmen Giménez Smith Bring Down the LittleBirds University ofArizonaPress Carmen Giménez Smithexlores the myriad reactions and emotions she experiences in relationto both the concept and the reality ofmotherhood. ArielGore describes Bring Down theLittle Birdsas diving into"allthe richand irritating questions withheart, guts,and humor." Images of Afghanistan ArleyLoewen & JosetteMcMichael, eds. OxfordUniversity Press Subtitled Exploring AfghanCulturethrough Artand Literature, thisfascinatingglimpse intoAfghanistan"give[s]all ofus a more profound understanding ofthe richculture and ancient heritage ofa place manyonly know as a place ofwar"(LyseDoucet, BBC WorldNews). November- December 2010 i 65 as ifit werea visionof myown future/' Theprotagonist's lifedoes indeedunfold as partofanintricate chain reaction, muchlike one of thoseconstructions thatperforms a simpletaskinan exceedingly complexfashion . Theexample givenin thenarrative is the"scalping" ofan egg.Theviolence ofthis wordchoice presages theoutcome ofthestory's ownelaborate causality, whichwill lead to a brutal assaultand a fatal headinjury. The concatenationof elements thatculminates inthisevent includesa numberof characters withcrisscrossing fatesin thecity ofGraz.Amongthemare Valerie, a therapist withwhomAlexander, whomeets herthrough hisjobinan old people'shome,fallsinlove;an aspiring actor namedWalter, whom Valerierecruits to playa roleas a patient in hergroupsessionsand whoalsohappens tobeAlexander's childhoodfriend; an increasingly mentally unhinged womannamed Gabi,whosuffers from tinnitus and joins Valerie's meetings; Alexander's father, whoabandonshiswifeand sonshortly after a dinner with Walter 'sfamilyand befriends Gabi's husband, Wolfgang, whenhe,too, hasrunaway;Valerie's father, who is in a vegetative stateand once worked for Walter's father, a famous architect; and a straydog,Uljana, who had belonged to Valerie's father, was thencaredforby Valerie ,and finally wandersforlornly through thecity andthenovel(severalscenesaretoldfrom thedog's perspective). A key motifof Die Frequenzen, signaledin the title, is the limits ofperception. Alexander evokesit whenhe notesthateveryrainbow extends beyondthevisiblesphere into ultraviolet andinfrared regions, whereits bands of imperceptible colors"invisibly pavethesky."But thepartsoftheopticaland acousticfrequency spectrum thatarenot immediately accessible tothe human senses contain thethreat ofmadness: "Somebirds canseethese frequency ranges, andperhaps that iswhythey so oftenlose theirminds"(as do several characters inthenovel).Yet however dangerous theattunement to ordinarily unheardand unseen frequencies might be, it lies at the heartof Setz's fiction and itsbrilliance .Whether in a fleeting image (a contorted tangleof branches is reminiscent of"a failed imitation of Chinesecalligraphy") oran extended riff (one chapter tellsthestory ofY2Kfora page and a halfas if it had happenedbeforerevealing that, although theglobalcatastrophe did...

Fatal Head Injury in Children Younger Than 2 Years in New York City and an Overview of the Shaken Baby Syndrome

Abstract Context.—Shaken baby syndrome is a controversial topic in forensic pathology. Some forensic pathologists state that shaking alone is insufficient to explain death and that an impact must have occurred even if there is no impact site on the head. Objective.—To examine a large cohort of fatal, pediatric head injuries for patterns of specific autopsy findings and circumstances that would support or dispute pure shaking as the cause of death. Design.—We retrospectively reviewed 59 deaths due to head injuries in children younger than 2 years certified in our office during a 9 year period (1998–2006). The review included autopsy, toxicology, microscopy, neuropathology, and police and investigators' reports. Results.—There were 46 homicides, 8 accidents, and 1 undetermined death from blunt-impact injury of the head. In 10 (22%) of the homicides, there was no impact injury to the head, and the cause of death was certified as whiplash shaking. In 4 (40%) of these 10 deaths, there was a history of shaking....

Cost Effectiveness of Wearing Head Protection on All-Terrain Vehicles

ABSTRACT The use of all-terrain vehicles (ATVs) has increased in the United States and elsewhere over the last three decades, along with an increased frequency of incidents resulting in serious injuries, among which have been head injuries. ATVs are designed for motorized off-highway work and recreation, can weigh up to 600 lbs (272 kg), and may reach speeds as high as 75 mph (120 km/h). ATV crashes, including collisions and overturns, were responsible for 8104 fatalities from 1982 to 2006. One third of those killed were youth under 16 years of age. Helmets may reduce risk of death by 42% and nonfatal injury by 64%. In this study, a decision analysis was applied to determine the potential reduction in the rate of fatal and nonfatal head injuries associated with crashes, based upon the universal wearing of head protection while riding on ATVs. In addition, based upon this reduction in injury rate, a cost-effectiveness analysis was conducted to determine the savings per injury averted among ATV riders with head protection. The authors found that 238 head injuries, including 2 fatalities per 100,000 ATV drivers with an average of 145 hours of annual operation, could be averted by the universal wearing of head protection while riding on ATVs. Taking into account the social direct and indirect costs of fatal and nonfatal head injuries at a 5% discount rate, US$364,306 could be saved per injury averted over a 50-year period if there were universal wearing of head protection by ATV drivers. If the exposure is adjusted to 2000 hours per year for an equivalent work year, 3276 head injuries could be averted including 23 fatalities per 100,000 at a social cost savings of US$509,172.

Traumatic Vertebral Artery Injury

Traumatic vertebral artery injury is frequently fatal from what may often be mild trauma to the head and neck. Detailed examination of vertebral arteries is not frequently undertaken at autopsy: the structural and histologic changes that may be relevant to the development of the injury are not well known. We sampled vertebral arteries bilaterally from 6 forensic autopsies (age = 26-50 years; 3 of 6 suffered from alcohol toxicity) with documented intradural vertebral artery injuries, and 4 nonvertebral-artery-injury-related autopsies (age = 19-70 years). Intradural, dural, and extradural components from each artery were submitted for paraffin-embedded tissue processing. Multiple serial sections and special stains (hematoxylin and eosin, alcian blue pH 2.5, reticulin, Congo red) were independently examined by 2 pathologists. All 6 of 6 injured samples and 4 of 4 control samples showed degenerative changes (intimal fibrosis, focal disruption of the internal elastic lamina, and medial calcification). However, microscopic adventitial hemorrhages were only observed around peripheral nerves adjacent to the injured samples. These may be due to tracking of blood along perineural loose connective tissue regions of reduced resistance, and may be a useful finding that points to underlying vertebral artery injury. Thus, careful dissection and gross and microscopic, examination of the vertebral arteries, with particular attention to the intracranial segments, is recommended in all cases of fatal traumatic head and neck injuries.

Fatal Head Injury in Children Younger Than 2 Years in New York City and an Overview of the Shaken Baby Syndrome

Shaken baby syndrome is a controversial topic in forensic pathology. Some forensic pathologists state that shaking alone is insufficient to explain death and that an impact must have occurred even if there is no impact site on the head. To examine a large cohort of fatal, pediatric head injuries for patterns of specific autopsy findings and circumstances that would support or dispute pure shaking as the cause of death. We retrospectively reviewed 59 deaths due to head injuries in children younger than 2 years certified in our office during a 9 year period (1998-2006). The review included autopsy, toxicology, microscopy, neuropathology, and police and investigators' reports. There were 46 homicides, 8 accidents, and 1 undetermined death from blunt-impact injury of the head. In 10 (22%) of the homicides, there was no impact injury to the head, and the cause of death was certified as whiplash shaking. In 4 (40%) of these 10 deaths, there was a history of shaking. In 5 (83%) of the other 6, there was no history of any purported accidental or homicidal injury. All 8 accidental deaths had impact sites. Of the 59 deaths, 4 (6.7%) had only remote injuries (chronic subdural hematomas, remote long bone fractures) that were certified as undetermined cause and manner. These 4 deaths were excluded from the study. We describe a subset of fatal, nonaccidental head-injury deaths in infants without an impact to the head. The autopsy findings and circumstances are diagnostic of a nonimpact, shaking mechanism as the cause of death. Fatal, accidental head injuries in children younger than 2 years are rare.

Evaluation of postmortem S100B levels in the cerebrospinal fluid with regard to the cause of death in medicolegal autopsy

Previous studies have suggested the usefulness of the postmortem serum S100B level as a marker of the severity of brain damage. In this study, we investigated the S100B level in the cerebrospinal fluid (CSF) in serial autopsy cases ( n = 216, within 3 days postmortem), including those of blunt injury ( n = 34: fatal head injury, n = 20; others, n = 14), sharp instrument injury ( n = 9), mechanical asphyxiation ( n = 19), drowning ( n = 11), fire fatality ( n = 26), intoxication ( n = 20), hypothermia (cold exposure, n = 16), hyperthermia (heat stroke, n = 9), acute cardiac death ( n = 52) and pneumonia ( n = 20). The CSF S100B level showed a moderate postmortem time-dependent increase for acute cardiac death ( r = 0.58, p < 0.0001) and asphyxia ( r = 0.741, p < 0.001). In cases of survival time within 48 h, drowning and hypothermia usually showed a lower CSF S100B level (around 500 ng/ml), and the level was higher for delayed head injury death, asphyxia, intoxication, and hyperthermia (around 1500 ng/ml) ( p < 0.05). In fatal head injury cases, however, CSF S100B did not correlate with the survival time or postmortem interval. A CSF S100B level of >2000 ng/ml in the early postmortem period might be considered a biochemical sign of fatally severe brain damage.

Significance of fatal head injuries associated with subependymal hemorrhage at the anterior horns of lateral ventricles

We hypothesize the following items based on 41 autopsy cases with or without head injuries especially on subependymal injuries at the anterior horns of the lateral cerebral ventricles. The subependymal injuries at the regions (1) are not seen in fatal cases that did not have intracranial injuries, (2) have nothing to do with technical procedures for removal of the whole brain at autopsy, (3) are frequently associated with axonal injuries, (4) are presumed to be formed by rotating head injuries in a sagittal direction.

Fatal transorbital head injury by bicycle brake handle

Accidental transorbital head injuries are quite rare. Penetrating head injuries by blunt objects are possible when the site of penetration is through the orbit or the thin temporal bone. The present case is a rare case of transorbital penetrating head injury by a blunt object – bicycle brake handle. Minor external wounds may be misleading and fatal consequences may ensue if cerebral damage is missed on diagnosis. Proper antibiotic coverage to prevent meningitis and neurosurgical intervention can reduce mortality in such cases.

An Unusual Case of a Penetrating Skull-base Injury Caused by a Wild Deer's Antler

Injuries relevant to neurosurgeons in central Europe are rarely caused by wild animal attacks, whereas dog bites in urban areas and farm-related attacks from cattle and horses are well-known to cause sometimes fatal head injuries. The authors describe the first case of a perforating frontobasal injury caused by a wild deer's antler. Associated lesions involved the endonasal area and the left orbit. A multidisciplinary approach was used to address all lesions in a one-stage operation resulting in a full recovery of the patient. Apart from the problem of a possible contamination of the head wound, injuries caused by wild animal attacks should be treated the same way as comparable "regular" cases. Adequate coverage of dural and bone defects with autologous material via a bifrontal intradural approach and meticulous debridement of the intracranial wound usually gives good functional and cosmetic results.

Improved head injury criteria based on head FE model

Head injury remains one of the most frequent and severe injuries sustained by vehicle occupants, motorcyclists, pedestrians and cyclists in road accidents and account for approximately 40% of road fatalities in the European Union (EU). One essential requirement for reducing the incidence of fatal and severe head injuries is to develop head injury assessment methods that can accurately and comprehensively assess the potential head injury risk under a broad range of head impact conditions. At present, the most widely accepted method of assessing head injury risk in road safety research is the Head Injury Criterion (HIC). However, HIC only considers the injury risk to the head resulting from linear head accelerations. In an attempt to develop improved head injury criteria for specific mechanisms, 68 head impact conditions that occurred in motor sport, motorcyclist, American football and pedestrian accidents were re-constructed with a state of the art finite element (FE) human head model (ULP head model). Statistical regression analysis was then carried out on the head loading parameters from the accidents, such as the peak linear and rotational acceleration of the head, and predictions from the head model, such as the Von Mises stress or strain and pressure in the brain, in order to determine which of the investigated parameters provided the most accurate metrics for the injuries sustained in the real world head trauma under consideration. The results show that Von Mises shearing strain within the brain is much better correlated with moderate Diffuse Axonal Injuries (DAI) as HIC or acceleration peaks are. For severe DAI, however, this improvement is less important. Another significant improvement of injury prediction based on FE head model is the one related to skull fracture, for which the proposed criteria present a higher correlation factor than HIC. Finally, SubDural Haematomas (SDH) are also better predicted with the FE model than HIC even if improvement is still needed for this injury mechanism.

Pattern of maxillofacial and associated injuries in road traffic accidents

Road Traffic Accidents (RTAs) are a major cause of morbidity and mortality in Kenya. Victims may suffer multiple injuries including maxillofacial injuries. In most developing countries RTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the government of Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety belts by passenger service vehicles. To describe the characteristics and pattern of maxillofacial and associated injuries sustained in road traffic accidents. A cross-sectional study. Kenyatta National Hospital (KNH). All patients involved in RTAs brought to casualty and the dental department of KNH as well as accident victims admitted to the KNH mortuary over a four- month period from September 2004 to December 2004. Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurred during weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fatal and fatal cases respectively. Most accidents were caused by passenger service vehicles (matatus) which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (STIs) involving the craniofacial region with facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents of other STIs than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1%) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37.7% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases. Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestrians in their third decade of life are most affected with passenger service vehicles being responsible in the majority of the cases. Interventional programmes targeting pedestrians and those in the third and fourth decades of life should be enacted.

Study of injuries combining computer simulation in motorcycle–car collision accidents

This paper presents the approach of computer simulation to clarify the questions faced by forensic experts about what causes the various injuries characteristic of two motorcycle victims, including the motorcycle driver and the back seat occupant on the motorcycle, and how to exactly confirm which one of them is the motorcycle driver. Two typical motorcycle–car accident cases were reconstructed to analyze the movement and the load of both the motorcycle driver and the back seat occupant in the collision course. In case one, the back seat occupant suffered fatal head injuries when he fell on the ground after being thrown higher than the motorcycle driver over the top of the car. In case two, the compressive force loaded by the right tibia of the back seat occupant was larger and more durative compared with the motorcycle driver; the back seat occupant suffered a bursting fracture injury of his right tibia. These results might be useful for forensic experts in dealing with similar motorcycle–car collision accidents in the future.

Helmet Use and Effectiveness in Reducing the Severity of Head Injuries in Thailand

Head injuries due to motorcycle accidents are the main cause of death and disability among motorcycle users in Thailand. It is well known that wearing a helmet is one of the most effective ways to reduce the severity of head injuries due to motorcycle crashes. Although the helmet act for motorcyclists was enacted in Thailand in 1994, the rate of helmet use has not increased, and the rate of head injuries and fatalities due to motorcycle accidents has not been reduced. In this study, a field survey was conducted to observe helmet use in Bangkok and three other major regional provinces. The observation shows that the rate of helmet use is significantly low across the study areas. Age, location, time of day, and seating position significantly affect helmet use, whereas gender and the day of the week do not show any effect. The logit model was also used to evaluate the factors affecting helmet use on the basis of the injury surveillance data of motorcycle accident victims. Results indicate that the victims in the pillion, or passenger, position are less likely to use a helmet and those who ride during the nighttime, regardless of seating position, tend not to wear a helmet. To evaluate the effectiveness of helmet use and other related ways to reduce the severity of head injuries, the ordered logit regression technique was applied to the hospital-based data, using the data on patients suffering from head injuries due to road crashes. It is found that helmet use can reduce the severity of head injuries for motorcycle crash victims. The probability of fatality due to head injuries is reduced by 38% for motorcyclists wearing helmets. For motorcycle riders, helmets are found to be effective in protecting against head injuries, particularly for those riding under the influence of alcohol; the probability of death could be reduced by 43%. Those in the passenger position without helmets are more likely to sustain either serious or fatal head injuries than are riders without helmets. Results also indicate that a 58% reduction in the probability of fatality from head injuries is associated with the use of helmets by motorcycle passengers.

Urban&amp;ndash;rural differences in pediatric traumatic head injuries: A prospective nationwide study

To estimate differences in the incidence of recorded traumatic head injuries by gender, age, severity, and geographical area. The study was prospective and nationwide. Data were collected from all hospitals, emergency units and healthcare centers in Iceland regarding all Icelandic children and adolescents 0-19 years old consecutively diagnosed with traumatic head injuries (N = 550) during a one-year period. Annual incidence of minimal, mild, moderate/severe, and fatal head injuries (ICD-9 850-854) was 6.41 per 1000, with 95% confidence interval (CI) 5.9, 7.0. Annual incidence of minimal head injuries (ICD-9 850) treated at emergency units was 4.65 (CI 4.2, 5.1) per 1000, mild head injuries admitted to hospital (ICD-9 850) was 1.50 (CI 1.3, 1.8) per 1000, and moderate/severe nonfatal injuries (ICD-9 851-854) was 0.21 (CI 0.1, 0.3) per 1000. Death rate was 0.05 (CI 0.0, 0.1) per 1000. Young children were at greater risk of sustaining minimal head injuries than older ones. Boys were at greater risk than girls were. In rural areas, incidence of recorded minimal head injuries was low. Use of nationwide estimate of the incidence of pediatric head injury shows important differences between urban and rural areas as well as between different age groups.

Pattern of fatal head injuries due to vehicular accidents in Mangalore

Head injury is an important cause of mortality worldwide as the head is the most vulnerable part of the body involved in fatal road traffic accidents. The present study was undertaken on 682 victims of road traffic accidents who died due to injuries sustained to the head, which were autopsied at District Wenlock Hospital, Mangalore over a period of 5 years between January 1999 and December 2003.Most of the accidents had taken place during the afternoon and evening hours (1400–2200h). There was a marked male preponderance (84.6%). The most vulnerable age group was found to be between 21 and 30 years. Two wheeler occupants were most commonly involved.Skull fractures were present in 88.88% of the cases. Fractures of the vault were found in 88%, base of the skull in 35.97% and a combination of both in 35% of cases. In most of the cases, fissured fractures were found (23%). Among intra-cranial haemorrhages, subdural haemorrhage was found in 52.63% and subarachnoid haemorrhage in 27.27% of cases. Contusions and lacerations of brain were found equally in 35% of cases.

Craniofacial Injuries From Slip, Trip, and Fall Accidents of Children

Slips, trips (STs), and falls are frequent events in childhood. As a child is likely to impact head-first in these events, craniofacial injuries are the most common trauma. We retrospectively surveyed our experience with pediatric craniofacial injuries and investigated the distributions of wound type and injury site, severity, and mechanism. A total of 750 children sustaining craniofacial injuries resulting from STs and falls were enrolled in this study. Facial and cranial areas were delimited by an imaginary line extending between the ears and across the eyebrows. Soft-tissue injuries were classified into laceration, contusion, and abrasion. The Glasgow Coma Scale was used to assess the severity of brain injury. Peak incidence of ST-type childhood craniofacial injury occurred at toddler age, whereas falls tended to occur when the children were younger than 1 year old; most of the patients were preschool. The home was the scene for 73% of the STs and 86% of the falls. Lacerations occurred more often in STs (67% vs. 25%), whereas contusions more often resulted from falls (64% vs. 27%). Most of the injuries were to the anterior head with a T-shaped distribution; however, over one third (37%) of the contusions were to the posterior area. Brain injury was absent or only mild in 98% of craniofacial injuries. Falls resulted in a significantly higher incidence of moderate-severe brain injury relative to STs. Childhood craniofacial injuries resulting from STs are more prevalent than are those that were sustained in falls; however, the latter is associated with greater trauma morbidity. The incidence of childhood craniofacial injury appears to be associated with the level of development irrespective of event type. The home is a potentially dangerous environment for children, especially during the preschool years. Padding the hard, acutely angled surfaces of housing structures and furniture around children's activity zones is an effective method of reducing the risk of childhood craniofacial trauma. Serious or fatal head injuries will rarely occur as the result of a fall from furniture or stairs at home.

Pediatric Head Injury

Pediatric Head Injury

Pediatric Head Injury

1. Shireen M. Atabaki, MD, MPH* 1. *Attending Physician, Division of Emergency Medicine, Children's National Medical Center; Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC After completing this article, readers should be able to: 1. Describe the clinical features and management of epidural hematoma. 2. Recognize that the syndrome of inappropriate antidiuretic hormone secretion is possible following head injury. 3. Know the association of cervical cord injury with head trauma. 4. Discuss the long-term cognitive/behavioral consequences of head trauma. Head injury is a leading cause of morbidity and mortality in childhood. More than 1.5 million head injuries occur annually in the United States, resulting in approximately 300,000 pediatric hospitalizations, with males twice as likely as females to sustain a head injury. Overall, up to 90% of injury-related deaths among children are associated with head trauma. Motor vehicle collisions are the most common cause of pediatric head injury, followed by falls. Football is the most common cause of sports-related head injury, with 75% of fatal head injuries occurring in high school students and 74% of football-related head injury fatalities associated with subdural hematomas. Head trauma injuries include scalp hematoma and laceration, skull fracture, intracranial hemorrhage, cerebral contusion, and diffuse axonal injury (DAI). Most children sustaining blunt head trauma have minor traumatic brain injury. The American Association of Neurologic Surgeons defines traumatic brain injury (TBI) as a blow or jolt to the head or penetrating head injury that disrupts the normal function of the brain. Mild TBI may result in a brief change in mental state or consciousness; severe TBI may result in prolonged unconsciousness, coma, or death. Any blow to the head can transfer energy from the skin, through the skull and meninges, to the brain. When evaluating head trauma, the clinician should remember the anatomic layers of the head that may be affected: the skin, galea aponeurotica, periosteum, cranial bone, epidural space, dura mater, subdural space, arachnoid mater, subarachnoid space, and brain (Fig. 1). Figure 1. Layers of the scalp …

Comment on the paper “Talk and Die’ patients presenting to a major trauma centre over a 10 year period: A critical review’

The 1975 paper ‘patients with head injury who talk and die’ depended on the insight of Bryan Jennett who coined the phrase and saw the significance of this group of patients and the excellent neuropathological studies of a large series of fatal head injuries conducted by Hume Adams and David Graham – a type of study almost impossible to replicate. That paper highlighted the distinction between primary head injury, in this group minor, and secondary head injury which was fatal. The important implication of that paper was that the primary head injury itself was potentially survivable. An analysis of ‘talk and die’ patients might therefore be an important audit of a trauma system. Goldschlager et al. in a retrospective review over 10 years, identified 15 patients who died after being admitted with mild head injury to a major trauma centre. This is an incidence of 1.5% per year or >6% of all mild head injuries. The selection of patients is based on coronial reporting but the analysis is based on CT scans rather than neuropathology. The patients were mostly elderly and the majority died as the result of acute subdural haematomas or contusions with swelling.