Fatal Head Research Articles

Estimated prevalence of helmet use while bicycling, rollerblading, and skateboarding among middle school students in selected U.S. States— Youth Behavior Risk Survey, 2013–2019

Background: Helmet use helps prevent severe and fatal head and brain injuries from bicycle, rollerblade, and skateboard crashes. This study explores the prevalence of self-reported helmet use among middle school students while bicycling, skateboarding, and rollerblading. Methods: Data from the Middle School Youth Risk Behavior Survey (YRBS) for selected states were analyzed. Self-reported prevalence (frequency) of helmet use while bicycling, rollerblading, or skateboarding and other variables (sex, grade level, and race/ethnicity) are reported. Results: The overall prevalence of rarely or never wearing a helmet while bicycling among middle school students in selected states was 68.6%; decreasing from 71.7% in 2013 to 67.1% in 2019. The overall prevalence of rarely or never wearing a helmet while rollerblading or skateboarding in middle school students in selected states was 74.6%; decreasing from 76.4% in 2013 to 73.5% in 2019. Students in 7th and 8th grade and students of non-Hispanic race/ethnicity had significantly higher odds of rarely or never wearing a helmet while bicycling or while rollerblading and skateboarding than students in 6th grade and non-Hispanic White students. Conclusions: While helmet use among middle school students improved over time, overall helmet use during bicycling, rollerblading, and skateboarding remained low. These estimates illustrate the continued call for universal implementation of helmet use efforts among kids using established strategies. Practical Applications: Future research on helmet use among youth who rollerblade and skateboard, as well as multi-pronged efforts to promote helmet use among middle schoolers who bicycle, skateboard, and rollerblade (inclusive of education, helmet distribution, and social marketing techniques, as well as the provision of helmets at no-cost) may be beneficial for addressing perceived risks for injury and other barriers.

Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports.

Bicycling, snow sports, and other recreational activities and sports are important activities to keep children and youth active as part of a healthy lifestyle. These activities can be associated with serious and fatal head and facial injuries. Helmets, when worn correctly, are effective in decreasing head injuries and fatalities related to these activities. Legislation for helmet use is effective in increasing helmet use in children and, ultimately, in decreasing deaths and head and facial injuries. A multipronged strategy employing legislation, enforcement of laws, and medical clinicians and community programs is important for increasing helmet use to decrease deaths and injuries from recreational sports.

Persistence of blood (DNA/RNA) on shoe soles under varying casework related conditions

Blunt force traumas by footwear can result in severe and even fatal head and upper body injuries. Oftentimes, footwear impressions are only partially available and evidential value is limited. DNA evidence on shoe soles could provide crucial evidence helping to solve crimes by linking target DNA to the activity of interest. Little is known about the persistence and detectability of biological material post such offenses and the interplay of factors affecting the analytical success. In this study, we assessed the persistence of blood on shoe soles under varying parameters such as blood location, different sneakers, weather condition, gait, amount of blood, underground and step count. We applied an optimized DNA/RNA workflow adapted to micro-traces without constraints for the primary DNA pipeline. There is a high probability to link donor DNA to the shoe sole for up to 300–400 steps, regardless of the underground, blood location, and amount of blood. Depending on the sole material and the degree of abrasion of the sole, a longer blood persistence can be observed. Considering blood, 98.2% of the initial DNA amount (1 μl initial blood volume) was lost after 100 steps walked on sole areas that are in constant contact with the ground. Proportion of foreign DNA was marginal (avg. 4.4 alleles), minimizing the probability of unintentional DNA transfer in this context. RNA typing showed high specificity but lower sensitivity than presumptive tests used for body fluid identification (BFI). Luminol is essential for targeted sampling on shoe soles, as latent blood traces (>100–200 steps) provided sufficient biological material for DNA/RNA typing. The generated data help to address the activity of interest and evaluate probabilities about prevalence of target DNA important for casework implications and assessments on activity level.

Fatal head and neck injuries in military underbody blast casualties

IntroductionDeath as a consequence of underbody blast (UBB) can most commonly be attributed to central nervous system injury. UBB may be considered a form of tertiary blast injury but is...

Primary blast lung injury prevalence and fatal injuries from explosions

Primary blast lung injury (PBLI) is an acknowledged cause of death in explosive blast casualties. In contrast to vehicle occupants following an in-vehicle explosion, the injury profile, including PBLI incidence, for mounted personnel following an external explosion has yet to be as well defined. This retrospective study identified 146 cases of UK military personnel killed by improvised explosive devices (IEDs) between November 2007 and July 2010. With the permission of Her Majesty's Coroners, relevant postmortem computed tomography imaging was analyzed. PBLI was diagnosed by postmortem computed tomography. Injury, demographic, and relevant incident data were collected via the UK Joint Theatre Trauma Registry. Autopsy results were not available for 1 of 146 cases. Of the remaining 145 IED fatalities, 24 had catastrophic injuries (disruptions), making further study impossible, leaving 121 cases; 79 were dismounted (DM), and 42 were mounted (M). PBLI was noted in 58 cases, 33 (79%) of 42 M fatalities and 25 (32%) of 79 DM fatalities (p < 0.0001). Rates of associated thoracic trauma were also significantly greater in the M group (p < 0.006 for all). Fatal head (53% vs. 23%) and thoracic trauma (23% vs. 8%) were both more common in the M group, while fatal lower extremity trauma (7% vs. 48%) was more commonly seen in DM casualties (p < 0.0001 for all). Following IED strikes, mounted fatalities are primarily caused by head and chest injuries. Lower extremity trauma is the leading cause of death in dismounted fatalities. Mounted fatalities have a high incidence of PBLI, suggesting significant exposure to primary blast. This has not been reported previously. Further work is required to determine the incidence and clinical significance of this severe lung injury in explosive blast survivors. In addition, specific characteristics of the vehicles should be considered.

Fatal penetrating head injury by bamboo fragments

Penetrating head injury by foreign body is relatively uncommon and has been scattered reported in the literature. In this case, a transorbital impalement wound inflicted by bamboo objects was discussed. A 61-year-old alcoholized man died from a transorbital intracranial wound due to penetration of the left orbit after falling from a slope beside the road. Although the facial impalement injury was small and unobtrusive, the penetrating trauma itself could induce lethal consequences, special attention should be paid to such kind of cases. The autopsy and pathological examination revealed subarachnoid hemorrhage, brain contusion and intraparenchymal hematoma. Some pieces of bamboo were also detected in the left anterior cranial fossa. Based on all of the evidence and information, we can draw a conclusion that the bamboo was the instrument causing the injuries and the case was considered as accident.

Bicycle helmet use after the introduction of all ages helmet legislation in an urban community in Alberta, Canada.

Bicycle trauma is a common cause of recreational death and disability and helmets have been shown to reduce fatal and non-fatal head and face injuries. This study evaluated the effect of mandatory bicycle helmet legislation for all ages in St. Albert, Alberta. We observed bicyclists from June to September of 2006 in St. Albert, a community subject to both provincial (< 18 years old) and municipal (all ages) helmet legislation, and compared our results with observations taken in 2000 when no legislation existed. Helmet wearing and rider characteristics were recorded by trained observers. Poisson regression analysis was used to obtain helmet prevalence (HP) and prevalence ratio (PR) estimates. HP increased from 45% to 92% (PR = 2.03; 95% CI: 1.72-2.39) post-legislation. Controlling for other covariates, children were 53% (PR = 1.53; 95% CI: 1.34-1.74) and adolescents greater than 6 times (PR =6.57; 95% CI: 1.39-31.0) more likely to wear helmets; however, adults (PR = 1.26; 95% CI: 0.96-1.66) did not show a statistically significant change post-legislation. Restricting the analysis to high socio-economic status areas, adult helmet prevalence increased in St. Albert from 58% to 73% post-legislation compared with a 52% to 57% change across the province; this effect was not statistically significant. Helmet legislation in St. Albert was associated with a significant increase in helmet use among child and adolescent cyclists. A larger increase in HP was observed for adults in St. Albert than in other areas of the province; however, this difference was not statistically significant, which may reflect the small sample size or insufficient time passage after bylaw enactment.

Blunt head trauma or extensive tension pneumothorax?

Case reportThe emergency medical squad and police found a 60-year-old alcoholic dead in his unlocked apartment. On firstinspection at the death scene, lividity of the supine bodywas pronounced in the head and neck area (Fig. 1), theeyelids (within the livid area) were discolored blue andmarkedly swollen, and bloody purge trickled from the nose(Fig. 2). Ostensibly subacute, partially scabbed skin lesionson the arms, hands and kneecaps were identified, and abrownish, scabbed, 1 cm-long wound was present on theback of the head, which was suggestive of a possiblephysical argument and battery. Despite the absence of otherinjuries or indications of a struggle at the death scene,investigators postulated that fatal blunt head trauma due toa physical attack had occurred. The man had been last seen4 days earlier when he fell down while intoxicated withoutobvious injury.At forensic external examination, a generalized parch-ment-like, crepitant cutaneous emphysema invested theentire body, notably including a prominently distendedpneumatoscrotum. Autopsy revealed the cause of death tobe an extensive tension pneumothorax, which was charac-terized by the following: (a) collapsed lungs; (b) depressionof the diaphragm; (c) pneumomediastinum; and (d) pneu-mopericardium, which was attributed to (e) a fractured 7thrib in the right posterior axillary line; the sharp-edged bone

Isolated right atrial appendage (RAA) rupture in blunt trauma – a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness

BackgroundHeart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA) is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma.ObjectiveTo report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study.MethodsThe thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table.ResultThe comparison of the data showed that wall thickness of the RAA (0.53 ± 0.33 mm) was significantly thinner than that of RA (1.11 ± 0.42 mm) (p < 0.05).CommentsIn all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture.ConclusionThus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma.

FATALITIES FROM HEAD AND CERVICAL SPINE INJURIES OCCURRING IN TACKLE FOOTBALL: 50 YEARS' EXPERIENCE

Football head and cervical spine fatalities have been related to 84.9% of all football fatalities from 1945 through 1994. The decade from 1965 through 1974 was responsible for the greatest number and percentage of head and cervical spine fatalities, and the two decades from 1975 through 1994 were associated with the smallest number and percentage. The data reveal that most head and cervical spine fatalities are related to high school football players either tackling or being tackled in a game. Most head fatalities are subdural hematomas, and almost all of the cervical spine fatalities are fractures, dislocations, or fracture-dislocations. There has been a dramatic reduction in these types of fatalities during the last two decades, 1975 through 1994, and the preventive measures that have received most of the credit have been the 1976 rule change that prohibits initial contact with the head and face when blocking and tackling, the NOCSAE helmet standard that went into effect in colleges in 1978 and high schools in 1980, better coaching in the techniques of blocking and tackling, and improved medical care. There has been a reduction of head and cervical spine fatalities, but the analysis of data for the next decade, 1995 through 2004, will reveal the continued effects of the preventive measures discussed and continued research efforts. A number of researchers have stated that in order for the head and cervical spine fatalities to continue decreasing, there must be increased helmet research with an emphasis on concussions and neck injuries. Will the number of fatalities continue to decrease? Only time will tell.

Axonal injury: a universal consequence of fatal closed head injury?

Axonal injury: a universal consequence of fatal closed head injury?

Head and face injuries in bicyclists--with special reference to possible effects of helmet use.

Fatal and nonfatal head and face injuries to unhelmeted bicyclists were analyzed to assess the injury-reducing potential of bicycle helmet use. Of the fatally injured, 64% (median age, 55 years) had fatal head and face injuries compared with 38% (median age, 18 years) with head and face injuries in the nonfatal injury group. The fatally injured often had multiple impact points, mostly to the occipital and temporal regions. Brain contusions, most often to the frontal and temporal lobes, were the most common cause of fatal injury, followed by subdural hematomas. In the nonfatal injury group abrasions/lacerations were most common type of injury, followed by cerebral concussions/contusions and superficial contusions. If all types of injuries to bicyclists are taken into account a helmet might have had an injury-reducing effect in two of every five fatal cases and in one of every five nonfatal cases. To increase the helmet use among bicyclists, a law, as in Australia, would be an excellent instrument.

Ischemic brain damage is still common in fatal nonmissile head injury

Ischemic brain damage is still common in fatal nonmissile head injury

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.

Brain-stem injury and long survival--a forensic analysis.

Out of 1781 autopsies undertaken on fatal head in injuries over a period of 19 years (1960-1979) there were 387 cases with brain-stem lesions; 15 of these had survived more than one month. Detailed macroscopic and microscopical studies showed different types of damage, which could not be explained by secondary processes only. The cases are demonstrated and discussed from the forensic viewpoint.

“Typical” Basal Skull Fracture of Both Petrous Bones" An Unreliable Indicator of Head Impact Site

A basilar skull fracture that extends along both petrous bones is generally considered to be a response to impacts to the lateral aspects of the head. This generalization is not warranted as such a fracture often results from impacts to any point around the base of the skull or to the chin. These facts were appreciated as long ago as 1905 but present-day literature does not adequately reflect them. Eight carefully selected autopsy cases of fatal blunt head injury with well-documented single head impact sites and bilateral petrous bone fractures are presented. They illustrate the variety of impact sites that may produce bilateral petrous bone skull fractures.

Collision With Spring-Loaded Football Tackling and Blocking Dummies

APPROXIMATELY 1,200,000 individuals participate in organized tackle football in this country each fall. Recent reports place the incidence of time-loss injury from this vigorous contact sport at 50% to 86% of the population at risk per season.1,2Fatality rates have averaged two per 100,000 participants per year for direct causes over a 43-year period.3Of the fatalities due to direct causes, the overwhelming majority have been due to head and neck injuries. Schneider4has described a variety of mechanisms responsible for near-fatal and fatal head and neck injuries. These include knee-to-head injuries, tackling by face mask, hyperflexion injuries secondary to spearing and buttblocking, and hyperextension injuries of the cervical spine due to the levering effect of the face mask. The purpose of this communication is to describe a cause of near-fatal and fatal head and neck injury, to our knowledge previously unreported: collision with spring-loaded blocking and