Fatal Head Injuries Research Articles

Population‐based study of paediatric head injury

There is a paucity of population-based studies regarding the spectrum of paediatric head injury from mild through serious to fatal paediatric head injury. The aims of the present study were to determine the incidence, demographics and outcome of significant head injury in a state-wide population of children aged 0-15 years. A secondary aim was to determine if any serious head injuries were being missed under the current management protocols of the state-wide trauma system. A retrospective review of significant head injury in all paediatric patients over a period of 2 years was undertaken. Data were collected from the Victorian State Trauma Outcome Registry and Monitoring database, the Victorian Emergency Minimum Dataset and from the Victorian Institute of Forensic Medicine. The incidence of paediatric head injury in Victoria over the 2-year period was 765 per 100000 per year. The incidence of admitted head injuries was 75 per 100000 per year and the incidence of significant head injury was seven per 100000 or 151 children. Forty-one per cent of these injuries required surgical intervention. Mortality was 1.6 children per 100000. All patients who died presented with a Glasgow Coma Score (GCS) of 3 and had multiple other risk factors. There were no deaths in patients discharged from hospital. Demographic and clinical factors associated with higher mortality and morbidity was determined. The incidence of significant paediatric head injury was low. Deaths occurred early and were always associated with significant early clinical features of severe head injury. This highlights the importance of strategies for the prevention of head injuries. There appeared to be no serious head injuries missed during the study period.

Pattern of traffic injuries in Shanghai: implications for control

In China, traffic-related injuries are often treated as transportation issues, called ‘accidents’. The objectives of the research are to analyse traffic injury patterns, estimate costs of traffic injuries and provide evidence to develop effective prevention strategies. There were over 1 500 deaths due to traffic-related injuries annually in Shanghai from 1987 to 2003, and it is rising year by year with the rate of growth in motorization. The rates of annual increase are 3.59% in fatalities (from 7.78 to 14.18 per 100 000 population) and 10.46% in non-fatalities (from 53.93 to 264.98 per 100 000 population) respectively during the period. The analysis of the geographic information system showed that the geographic distribution of traffic injuries in the countryside regions of Shanghai had the highest rates. Labour force groups represented the majority of fatalities (70.97%) and serious traffic injuries (90.51%). The mortality rates were 18.40 per 100 000 population and 10.02 per 100 000 population in 45 – 65 year age group and 15 – 44 year age group respectively; the morbidity rates of serious traffic injuries were 121.60 per 100 000 population and 70.46 per 100 000 population in the same groups respectively. And females generally showed a lower incidence than males. In general, fatalities and injuries were higher for drivers, bicyclists and pedestrians. Among road traffic injury-related fatalities, 66.8% were attributed to head injuries. Of those with fatal head injuries, bicyclists accounted for 29.8% of the total; pedestrians accounted for 28.3%; motorcyclists accounted for 25.5%. Total traffic injury cost was estimated at least US$645 989 580 in Shanghai in 2003. Good injury intervention programmes need to be done as soon as possible to effectively reduce traffic injury burden in Shanghai, China.

Hyponatraemic convulsions and fatal head injury secondary to desmopressin treatment for enuresis

Hyponatraemic convulsions and fatal head injury secondary to desmopressin treatment for enuresis

A Fatal Fall from a Balcony? A biomechanical approach to resolving conflicting witness accounts

An adult male was found below a third floor balcony having sustained fatal head injuries. An account provided by a witness described how the deceased had been in high spirits and had engaged in swinging from the third floor balcony rail in an attempt to swing onto a lower second floor balcony and whilst doing so had lost his grip and fallen (10.67 metres) to the ground below. A conflicting account was provided, some weeks later, by a second witness, who claimed to have observed an argument between two men on a third floor balcony, during which one had vigorously pushed the other over the balcony rail. The push, it was alleged, caused the man to move very quickly over the balcony rail and fall in an 'upturned crucifix' position to the ground. This paper describes a series of biomechanical experiments, conducted on a reconstruction of the third floor balcony and the second floor balcony rail, during which a volunteer was subjected to the two fall scenarios, in an attempt to resolve the conflicting witness accounts. Analysis of human movement was performed using a 3-D motion analysis system, markers were placed at the volunteer's key joint centres and were tracked to determine physical parameters. The parameter values were used to calculate what dynamic movements may have occurred had the volunteer been allowed to fall, not just a distance equivalent to the lower balcony rail but a greater distance, equivalent to that between the balcony and the ground. Calculations indicate that during the hanging-fall scenario a range of body rotation was produced between 159 degrees and 249 degrees, that is, an upturned head-first body orientation, consistent with that required to produce the described injuries and consistent with the description provided by the first witness. The push-fall scenario, however, produced a greater estimated body rotation of between 329 degrees and 530 degrees, equal to the body rotating, from the point of free-fall to the moment of impact, between almost 1 and 1.5 times. This was consistent with the described injuries but inconsistent with the description provided by the second witness. It was therefore concluded that although both the accidental and inflicted-push scenarios could produce a body orientation consistent with the reported injuries, only the accidental scenario produced a fall which could be described as an 'upturned crucifix', since the push scenario produced a significantly greater body rotation. The witness who alleged that the deceased had been pushed later retracted his statement.

Development of a simulation system for performing in situ surface tests to assess the potential severity of head impacts from alleged childhood short falls

There is considerable debate in the medical literature surrounding the issue of fatal child head injuries being caused by short falls. When reviewing a case history a medical expert will form an opinion of the likely cause of an injury based on his/her knowledge of the literature, training and experience of similar cases. The severity of an injury is determined by the age of the victim, fall height, body impact site and the impact surface. A medical expert, when forming an opinion, is invariably assisted by a description of the scene or scene photographs and assumes the mechanical response of the floor conforms in the same way to “similar” surfaces. The impact response characteristics of the entire surface mixture is critically important when considering the potential for head injury to a child due to a short fall. However, at present during an investigation, the response of a surface to a head impact remains an unknown, since a simple description of, or cursory glance at, a floor surface is insufficient in determining its potential to cause injury. This paper documents the development of a simulation system for assessing the impact response, and potential to cause injury, of domestic floor surfaces during short falls. The method utilises a headform and drop tower adapted from techniques and current standards used to assess the potential for childhood head injuries of playground surfaces and pedestrian–bonnet impacts. The results suggest that the potential of a surface to cause head injury is dependent on the entire surface mixture, including the top surface layer (e.g. carpet and underlay), the underlying surface (wood, chipboard or concrete) and the support material (joists, supports. etc.). The results illustrate a wide range of injury potential between surface mixtures. The simulation system shows the potential to discriminate between differences in surface mixture. In conclusion, the authors suggest that in future investigations, the response of the entire surface mixture be taken into account when forming an opinion on the injury potential of short falls.

Immunohistochemical distribution of S-100 protein in the cerebral cortex with regard to the cause of death in forensic autopsy

S-100 protein (S100) is an acidic calcium-binding protein, which is abundantly found in the brain. The aim of the present study was to investigate the immunohistochemical distribution of S100 in the cerebral cortex in forensic autopsy cases with regard to the cause of death and relationship to its serum levels. The cases ( n=286, 3–48 h postmortem) included fatal head injuries ( n=89), acute death from other blunt injuries ( n=29), sharp instrument injuries ( n=20), asphyxiation ( n=29: strangulation/hanging, n=22; aspiration, n=7), drownings ( n=22), fire fatalities ( n=68), cerebrovascular diseases ( n=9) and acute myocardial infarction/ischemia (AMI, n=20). S100-immunopositivity was mainly observed in the gliacytes, in part, in the neurons and myelins. For S100B-immunostaining, the gliacytes and myelins were positive, whereas the neurons were negative. Positivity in astrocytes was dependent on the cause of death, and was significantly lower in acute deaths due to strangulation/hanging and drowning, and mildly low in those due to injuries. Positivity in neurons and myelins was frequently observed in delayed head injury deaths and fire fatalities, showing an inverse relationship with the positivity in astrocytes in head injury cases. For cases of acute death, there was an inverse relationship between S100-positivity in the astrocytes and the serum S100B level. These observations suggest that astrocytes are more rapidly and severely injured than neurons during fatal brain damage, thereby causing an elevation in the serum S100B level.

Clinical and pathological observations in fatal head injuries. A 5-year survey of 173 cases.

Clinical and pathological observations in fatal head injuries. A 5-year survey of 173 cases.

Initial Neurologic Presentation in Young Children Sustaining Inflicted and Unintentional Fatal Head Injuries

BACKGROUND: It remains unclear if fatal brain injuries in young children are characterized by immediate rapid deterioration or can present after an initial period of lucidity. This issue has legal implications in child abuse, for which understanding the clinical course affects perpetrator identification. OBJECTIVE: To determine patterns of neurologic presentation on hospital admission in infants and toddlers who die of inflicted and unintentional injury. DESIGN/METHODS: Data on children 7, and 1.9% presented with a GCS score of >12 (lucid). The incidence of admission a GCS score of >7 varied by mechanism. Overall, children with inflicted injury were 3 times more likely to present with a GCS score of >7 than those injured in MVCs (odds ratio [OR]: 3.6; 95% confidence interval [CI]: 1.2-10.3), but incidence of a GCS score of >7 did not differ between inflicted injuries and falls. Similarly, when considering only those children >or=24 months old, a GCS score of >7 did not differ by mechanism. In contrast, in those 10 times more likely to have a GCS score of >7 than those who died as a result of a MVC (OR: 9.36; 95% CI: 1.3-80.9). CONCLUSIONS: The data suggest an age- and mechanism-dependent presentation of neurologic status in children with fatal head injury. Although infrequent, young victims of fatal head trauma may present as lucid (GCS score: >12) before death. Furthermore, children 7) than those in MVCs. This effect is amplified in the youngest children (12 [5 of 6]). It is unclear whether these differences are the result of inadequate tests to evaluate consciousness in younger children or differences in biomechanical mechanisms of inflicted trauma. Language: en

Initial Neurologic Presentation in Young Children Sustaining Inflicted and Unintentional Fatal Head Injuries: In Reply

Initial Neurologic Presentation in Young Children Sustaining Inflicted and Unintentional Fatal Head Injuries: In Reply

Initial Neurologic Presentation in Young Children Sustaining Inflicted and Unintentional Fatal Head Injuries

It remains unclear if fatal brain injuries in young children are characterized by immediate rapid deterioration or can present after an initial period of lucidity. This issue has legal implications in child abuse, for which understanding the clinical course affects perpetrator identification. To determine patterns of neurologic presentation on hospital admission in infants and toddlers who die of inflicted and unintentional injury. Data on children <48 months of age who sustained a fatal head injury from 1986-2002 were extracted from the Pennsylvania Trauma Outcomes Study. Only those with external-causes-of-injury codes for inflicted injury, falls, and motor vehicle crashes (MVCs) with a recorded Glasgow Coma Scale (GCS) on admission were included. The GCS was compared across mechanisms and age groups (0-11, 12-23, 24-35, and 36-47 months). Of the 314 fatally injured children, 37% sustained inflicted injury, 13% sustained a fall, and 49% sustained an MVC. At admission, 6.8% of all children had a GCS score of >7, and 1.9% presented with a GCS score of >12 (lucid). The incidence of admission a GCS score of >7 varied by mechanism. Overall, children with inflicted injury were 3 times more likely to present with a GCS score of >7 than those injured in MVCs (odds ratio [OR]: 3.6; 95% confidence interval [CI]: 1.2-10.3), but incidence of a GCS score of >7 did not differ between inflicted injuries and falls. Similarly, when considering only those children >or=24 months old, a GCS score of >7 did not differ by mechanism. In contrast, in those <24 months old, children who died as a result of inflicted injury were >10 times more likely to have a GCS score of >7 than those who died as a result of a MVC (OR: 9.36; 95% CI: 1.3-80.9). The data suggest an age- and mechanism-dependent presentation of neurologic status in children with fatal head injury. Although infrequent, young victims of fatal head trauma may present as lucid (GCS score: >12) before death. Furthermore, children <48 months old sustaining inflicted injury are 3 times more likely to be assessed with a moderate GCS score (>7) than those in MVCs. This effect is amplified in the youngest children (<24 months old): those with inflicted injury were 10 times more likely to present with moderate GCS scores than those in MVCs. In addition, this youngest age group seems to be overrepresented in those who present as lucid (GCS score: >12 [5 of 6]). It is unclear whether these differences are the result of inadequate tests to evaluate consciousness in younger children or differences in biomechanical mechanisms of inflicted trauma.

Fatal Head Injury in Homicidal Victims

Homicide represents one of the leading causes of death, and the head is the target in the majority of cases. The objective of the present study was to analyze the pattern of head injury among homicidal death victims. Information was obtained by interviewing the accompanying persons, post-mortem examination and perusal of hospital records. Most of the victims were predominantly male and belonged in the age group 21-30 years. Blunt weapons caused the majority of the injuries. Defence wounds were present in 48% of the victims. The street was the place of crime in the majority of cases (46.7%) and in most of the cases there was more than one offender. Multiple assaults were seen on the body in 70% of cases. The skull was fractured in more than 80% of victims and intracranial haemorrhages were seen in 47 victims. Out of 77 cases, 55 victims showed intracranial lesions along with injuries to the skull and scalp. Associated fatal injuries were most commonly present on the neck and chest. The majority of the victims died instantly or within 24 hours. Blunt force is commonly used when the head is the target. Defence wounds, when present, are indicative of the homicidal nature of the attack, and multiple strokes present over the body indicate determination on the part of the accused to end the life of the victim.

Massive cerebral air embolism after cardiopulmonary resuscitation

We report a case of massive intracerebral air embolism after cardiopulmonary resuscitation in a patient with a fatal head injury. There was no pneumothorax or extravascular pneumocephalus, however, air was found in the internal carotid artery. Massive cerebral air embolism may occur after entrance of air into the circulatory system via ruptured pulmonary vessels during cardiopulmonary resuscitation.

Epidemiology and prevention of fatal head injuries in Germany – trends and the impact of the reunification

A review of the data published on the epidemiology of traumatic brain injuries (TBI) reveals that the data of almost all studies are drawn from local or regional series. Nationwide data are rarely available, or are extrapolated from regional data. In Germany, there has been a nationwide mortality register with ICD-9-coded diagnoses since 1968. In addition, it has been compulsory since 1994 that all hospitals in Germany provide ICD-9 data on all admissions and discharges. Based on data provided by the Federal Bureau of Statistics (Statistisches Bundesamt) in Wiesbaden, all head injuries between 1972 and 1998 were analyzed according to ICD-9 and after 1998 according to the updated ICD-10. The data of hospitalized cases and fatal cases were correlated with population data to calculate incidences and mortality rates. Age-group specific data were also available and analyzed. Head injuries in Germany accounted in 1998 for 19.59% of all injuries. The incidence is 337/100,000. The incidence rate of serious head injury is 33.5/100,000. Mortality decreased continuously from 27.2/100,000 in 1972 to 9.0/100,000 in 2000. The mortality is highest in the group older than 75 years. 68.4% of persons with head injury die before admission to a hospital. After the reunification in 1989/1990, the number of fatal head injuries showed a temporary increase. The number of patients treated in-hospital remained essentially unchanged (276/564 patients in 1998). The majority of hospitalized patients suffered minor head injury. Analysis of the admission/discharge data of all German hospitals reveals surprising inside views of age group-related incidence and mortality rates of head injuries in this country. Future research should be focused on patients with minor head injuries who account for nearly 200,000 cases of in-hospital treatment.

Medico-legal Aspects of Traumatic Injury of the Vertebrobasilar Artery

Based on our experiences with medico-legal autopsies, we analyzed traumatic injury of the vertebrobasilar artery (VBA) in traffic accident victims. VBA rupture occurred in six cases with traumatic medullary lesions, but in none with cervical cord injury. A relatively small external force applied to the head or neck can induce isolated traumatic subarachnoid hemorrhage (SAH), which accounts for approximately 11% of fatal head injuries. We examined the relationship between site of impact and site of vascular injury in 16 cases of isolated traumatic SAH. The results showed that the vertebral artery (VA) on the side of impact tended to be longitudinally injured in victims experiencing an external force equivalent to that of a fist punch to the head or face. There was no clear relationship between the site of impact and the site of vascular injury in victims who had sustained an external force greater than that of a fist punch. However, our results suggest that an external force causing rotation of the head was likely to cause tearing of the artery. In cases in which an external force equivalent to that of a fist punch was applied to the head, a raised blood alcohol level was a significant risk factor for artery rupture. Furthermore, a difference in the diameters of the left and right VAs was a risk factor for artery rupture. To determine why the VA, the most frequent site of arterial dissection, is also frequently the site of injury, we histologically examined normal and dissected VBAs. We also discuss medico-legal issues of the causal relationship between external force applied and rupture or dissection of the VA.

Scientific worker and licensed professional deaths in Alaska, 1990–2002

Objectives. Between 1990–2002, 797 Alaskans died while working. After a scientific survey team member drowned, we examined the hazards of traumatic death to scientific and professional workers in Alaska. Study design. Surveillance and analysis methods for acute traumatic occupational injuries: The Alaska Occupational Injury Surveillance System (AOISS) uses direct investigation, jurisdictional agency reports, and death certificates to gather data for active surveillance on occupational injury deaths in Alaska. We searched AOISS for deaths which occurred while engaged in scientific or professional work. Commercial pilots, fishermen, loggers, taxi drivers and miners were excluded, as these have been previously studied. Results. During 1990-2002, 85 scientific/professional worker deaths (including 2 suicides) occurred. Fish, game, and mountaineering guides accounted for 28 (33%) of the worker deaths, followed by biologists, who accounted for 11 (13%). Aircraft crashes accounted for 42 (49%) of all these deaths, followed by drownings, 12 (14%), and falls, 9 (11%). A seismologist was fatally mauled by a bear. Of the 14 hunting guide fatalities, 11 were the result of aircraft crashes, one was a suicide, one was a drowning, and one resulted from a motor vehicle crash. Of the 11 hunting guide fatalities, eight died in aircraft crashes, one drowned, one walked into an aircraft prop, and one sustained a fatal head injury in a fall. Conclusions. Scientific and professional workers in Alaska experienced a substantial number of fatalities from traumatic injury. Nearly half of these deaths occurred in aircraft crashes.

Can shaking alone cause fatal brain injury? A biomechanical assessment of the Duhaime shaken baby syndrome model.

A biomechanical model of a one-month old baby was designed and tested by Duhaime and co-workers in 1987 in an attempt to assess the biomechanics of the shaken baby syndrome (SBS). The study implied that pure shaking alone cannot cause fatal head injuries, a factor which has been applied in criminal courts. In an attempt to test the validity of the model a preliminary study was undertaken in which a replica was constructed and tested. The broad description of the design and construction of the Duhaime model allowed for variations and therefore uncertainties in its reproduction. It was postulated therefore that differences in certain parameters may increase angular head accelerations. To further investigate this observation, an adjustable replica model was developed and tested. The results indicated that certain parameter changes in the model did in fact lead to an increase in angular head acceleration. When these parameter changes were combined and an injurious shake pattern was employed, using maximum physical effort, the angular head acceleration results exceeded the original Duhaime et al. (1987) results and spanned two scaled tolerance limits for concussion. Additionally, literature suggests that the tolerance limits used to assess the shaking simulation results in the original study may not be reliable. Results from our study were closer to the internal head injury, subdural haematoma, tolerance limits. A series of end point impacts were identified in the shake cycles, therefore, an impact-based head injury measure (Head Injury Criterion - HIC) was utilized to assess their severity. Seven out of ten tests conducted resulted in HIC values exceeding the tolerance limits (critical load value, Stürtz, 1980) suggested for children. At this present stage the authors conclude that it cannot be categorically stated, from a biomechanical perspective, that pure shaking cannot cause fatal head injuries in an infant. Parameters identified in this study require further investigation to assess the accuracy of simulation and increase the biofidelity of the models before further conclusions can be drawn. There must now be sufficient doubt in the reliability of the Duhaime et al. (1987) biomechanical study to warrant the exclusion of such testimony in cases of suspected shaken baby syndrome.

Lethal head injury due to tear-gas cartridge gunshots

We report a fatal head injury caused by a tear-gas cartridge and point out the underestimated potential injury of this type of weapon. Gas pressure wounds and the death mechanisms are also described. A review of the literature and forensic considerations of head injury without projectile are presented.

Neuropathology of Fatal Infant Head Injury

Journal of NeurotraumaVol. 20, No. 9 Letter to the EditorNeuropathology of Fatal Infant Head InjuryJennian F. Geddes and Helen L. WhitwellJennian F. GeddesSearch for more papers by this author and Helen L. WhitwellSearch for more papers by this authorPublished Online:8 Jul 2004https://doi.org/10.1089/089771503322385836AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Neuropathology of Fatal Infant Head Injury." , 20(9), p. 905FiguresReferencesRelatedDetailsCited byAkute und chronische organische Psychosyndrome im Kindes- und Jugendalter15 February 2023References5 January 2012Contusional brain injury and intracerebral haemorrhage3 January 2013 Volume 20Issue 9Sep 2003 To cite this article:Jennian F. Geddes and Helen L. Whitwell.Neuropathology of Fatal Infant Head Injury.Journal of Neurotrauma.Sep 2003.905-905.http://doi.org/10.1089/089771503322385836Published in Volume: 20 Issue 9: July 8, 2004PDF download

456 スポーツサーフェスへの転倒による頭部傷害のシミュレーション

The aim of this study is to investigate the mechanism of the head injury which occurs when human fell onto a relatively soft sport surface such as a judo tatami. A sports surface consists of FE model of tatami. Human body includes FE model of head, which is added to bridging veins, connected 21segments Multi-body model of human. By using these models, falling impact simulations in case of sports were carried out to investigate the mechanism of the head injury, especially subdural hematoma. As a result of these simulations, it is clarified that peak strain of bridging veins is not associated with surface characteristics. That is, the fatal head injury can occur even if human falls onto softer surfaces.

Golf related head injuries in children

Objectives: To assess the incidence and severity of head injuries to children sustained by a blow from a golf club or ball and to highlight the potential for significant injury....