Head Injury Research Articles

Assessment of Functioning and the Integration of Patients After Traumatic Brain Injury in Their Homes and Social Environments Following Inpatient Rehabilitation.

Patients with head injuries usually return to their home environments after completing rehabilitation, which is an additional challenge in the case of functional, motor or cognitive impairment. In order to identify the problems that such patients face and to objectify their problems with integration, we used the Community Integration Questionnaire-Revised (CIQ-R). At the same time, the validity of the translation of the questionnaire into Slovenian was checked. The CIQ-R was translated, and patients were telephoned twice, 14 days apart. In addition, they were assessed using the Functional Independence Measure (FIM) during the first call. The reliability of the CIQ-R in terms of internal consistency was assessed using Cronbach's alpha and Guttman's lambda-2. The reliability in terms of repeated measures was assessed using intraclass correlation (ICC). The association between FIM and CIQ-R scores was assessed using Pearson's correlation. Internal consistency of the CIQ-R was high (α = 0.8, λ = 0.85), and there was a very high re-test stability of the overall CIQ-R score (ICC = 0.95). The cognitive component of the FIM in the home environment was linearly associated with the CIQ-R score (r = 0.8, p ≤ 0.001). The translation of the CIQ-R questionnaire into Slovenian was successfully validated, and we proved its potential suitability for clinical use.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture.

The internal carotid artery occlusion caused by head and neck trauma, also known as traumatic intracranial artery occlusion, is relatively rare clinically. Traumatic skull base fracture is a common complication of traumatic brain injury. Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion. If not detected early and treated in time, the prognosis of patients is poor. This editorial makes a relevant analysis of this disease.

Maternal Perspectives of Newborn Hearing Loss in Resource Constrained Settings of Rawalpindi Pakistan

Objective: The objective of this study was to assess knowledge of mothers regarding risk factors, early identification, and intervention for infant hearing loss and to determine association between hearing loss and consanguineous marriages in Pakistan. Study Design: Analytical cross-sectional study. Place and Duration of Study: Out Patient Department of tertiary care hospitals in Rawalpindi Pakistan, from Mar to Jun 2021. Methodology: 111 mothers consented to participate. Data was collected using a structured researcher administered questionnaire. It included four sections with 37 questions that were answered in yes, no, or unsure. Analysis was done using SPSS software. Results: Mothers' knowledge of two risk factors was high with most respondents being aware of head injury or slap to the ear (n=94) being a risk for hearing loss, followed by ear pain/discharge (n=88). 66.7%(n=72) of participants considered use of ototoxic drugs by mother during pregnancy to be a potent risk factor for neonatal hearing loss. The mothers' understanding of natal causes such as delayed birth cry and neonatal jaundice was poor. Their understanding of postnatal causes such as high fever, frequent hospitalization, and long stay in NICU was also limited. Mothers who were employed had significantly more awareness in certain factors than housewives. 45.4% (n=49) of the mothers believed being in a cousin marriage influenced infant hearing loss while 38.9% (n=42) disagreed, and 15.7% (n=17) were unsure.Conclusion: Only half of all participating mothers were fully aware of the possible risk factors and causes of infant hearing loss. Seminars and public awareness programs should be arranged to educate mothers about risks of infant hearing loss.

Pre and post diagnostic dementia care in four Scottish prisons

Background and purposeThe number of older people in prisons is increasing across the globe. Many have poor physical and mental health, higher prevalence of head injury, cognitive impairment and dementia than found in community populations. Meeting the complex needs of this vulnerable group has become an increasing concern for prison and prison healthcare services. The aim of this multi method qualitative study was to investigate how men with diagnosed or suspected dementia were identified, assessed, and cared for in Scottish prisons. It also explored the lived experience of individuals being assessed for or diagnosed with dementia within four prisons. The data from twenty nine interviews was thematically analysed and used to collaboratively propose principles for dementia care in prison and present the resultant co-designed care pathway.ResultsAt the time of data collection almost all the men known to have a dementia diagnosis or suspected dementia had complex health and social care needs, and some were living with advanced dementia. Prison healthcare staff reported taking a ‘case by case’ approach to their pre- and post-diagnostic care. Meeting these prisoner’s needs was complicated by the absence of organisational leads for care of older adults or people with dementia and there was no pathway or model in place to guide staff. Prison healthcare teams often had difficulty accessing specialist community services to support diagnosis. There was a lack of dementia education and knowledge about how to provide pre and post diagnostic dementia care in this setting amongst staff. The findings arising from this research have informed the co-production of two important evidence informed innovations namely a Model of Care and a pre- and post-diagnostic Care Pathway.ConclusionThis research adds insights critical to understanding the adequacy of current approaches to meeting dementia related needs within the prison setting. To our knowledge this paper offers the first co-produced evidence informed pre- and post- diagnostic dementia care pathway and model of care for use in prisons. These could serve as tools for change that could enable prison healthcare staff to deliver the right care, at the right time, by the right people, and provide an opportunity to assess risk and plan care for the future.

Does Equestrian Helmet Type Affect Head Injury? A Study on Equestrian Helmet Use Among Collegiate Athletes.

To characterize helmet use, head injury risk, and to examine rider-related factors that influence these variables. Cross-sectional study. The University of Alabama at Birmingham Equestrian Sports Medicine Collaborative. In total, 357 equestrians competing at the collegiate level participated in this study. χ2 tests were used to evaluate potential associations between a rider's experience level, riding style, and use of helmet designed with MIPS with number of falls, past head injuries, and helmet use frequency. Data regarding helmet use and equestrian-related injuries were collected. χ2 analysis was used to determine potential associations. More than 50% of athletes reported falling off a horse during the course of 1 year. Head injuries occurred with high frequency. Concussion was the most frequently reported type. More than 50% of athletes with self-reported concussion denied receiving medical treatment. The risk of head injury was similar across helmet brands, and between helmets with Multi-Directional Impact Protection System (MIPS) and those without. Riders with the most experience were less likely to report sustaining a head injury than those with less experience. Contrary to current safety guidelines, 78% of equestrians said that they would not replace their helmet after every fall. Collegiate equestrians have a high risk of fall-related traumatic head injury. Despite this risk, they report helmet use practices that are not in line with current recommendations regarding helmet replacement. This suggests thatmany of the athletes are using protective equipment that does not adequately protect against head injury. Neither helmet brand nor liner type was associated with lower rate of head injury.

Osmotic demyelination syndrome: revisiting the diagnostic criteria through two fatal cases

BackgroundOsmotic Demyelination Syndrome (ODS) encompasses Central Pontine Myelinolysis and Extrapontine Myelinolysis, both of which are serious neurological conditions linked to the overly rapid correction of hyponatremia. Despite growing evidence, the exact etiology of ODS remains incompletely understood. The present paper describes two case studies, aiming to provide a comprehensive overview of the pathological findings and clinical outcomes associated with ODS.Case presentationCase #1. A 74-year-old woman was admitted to the emergency department following a head trauma caused by a loss of consciousness. Initial laboratory tests revealed severe hyponatremia (sodium level of 101 mmol/L) and hypokalemia (potassium level of 2.9 mmol/L). The patient underwent corrective therapy with saline and potassium chloride. Despite the correction of electrolyte imbalances, the patient developed a hyperintense lesion in the median portion of the pons on T2-fluid-attenuated inversion recovery (FLAIR) MRI sequence 14 days post-treatment, consistent with ODS. The patient’s condition deteriorated, leading to irreversible coma and status epilepticus, culminating in death 32 days after admission. Case #2. An 81-year-old woman with a medical history of hypothyroidism, hypertension, major depression, and stage 3 chronic kidney disease presented with mild gait disturbances. Subsequent testing revealed severe hyponatremia (sodium level of 100 mmol/L). Following an initial clinical improvement due to sodium correction, the patient’s condition worsened, with symptoms progressing to confusion, lethargy, and eventually, ODS. Dermatological manifestations, including blistering lesions and facial edema, appeared as the condition advanced. The patient succumbed to irreversible coma 47 days after admission.ConclusionODS traditionally carried a poor prognosis, with high mortality rates and diagnoses often made postmortem. However, recent advances in understanding the pathophysiology, along with improvements in diagnostic techniques such as MRI and intensive care treatments, have led to earlier identification, treatment, and recognition of milder forms of the syndrome. Despite these advancements, ODS remains a critical condition with significant risks, particularly following the rapid correction of severe hyponatremia.

ACVECC-Veterinary Committee on Trauma registry report 2020-2021.

To report summative data from the American College of Veterinary Emergency and Critical Care (ACVECC)-Veterinary Committee on Trauma (VetCOT) registry, with further individual evaluation of university and private practices and level I and II Veterinary Trauma Centers (VTCs). Multi-institutional registry data report, January 1, 2020, to December 31, 2021. VTCs identified and verified by ACVECC-VetCOT. Dogs and cats with evidence of trauma. Data were input to a web-based data capture system (REDCap) by data entry personnel trained in registry software use and operational definitions of data variables. Patient data on demographics, trauma type, preadmission care, trauma severity assessment at presentation (modified Glasgow Coma Score and Animal Trauma Triage score), key laboratory parameters, interventions, and outcome were collected. Summary descriptive data for each species are reported. Twenty-two VTCs contributed data to the VetCOT registry during a 24-month period, culminating in a total of 9758 complete trauma case records for dogs and 11734 for cats. Head trauma in dogs and cats was seen at a higher percentage in both university-only VTCs (encompassing both level I and II) (20.1% and 24.1%, respectively) and level I-only VTCs (24.3% and 24.1%, respectively), in comparison to private-only VTCs (encompassing both level I and II) (13.5% and 16.2%, respectively) and individual level II VTCs (14.1% and 18.9%, respectively). Canine and feline surgical procedures were performed at a higher percentage at university VTCs (50% and 40.5%, respectively) compared to private VTCs (39.2% and 28.6%, respectively). Overall survival to discharge for dogs and cats remains high at 93.1% and 83.6%, respectively. The VetCOT registry has continued to show powerful potential in collating a large, multifaceted, international dataset in trauma for both dogs and cats. As published in previous VetCOT registry reports, survival to discharge has remained static across both university and private practice veterinary hospitals; however, further breakdown has identified university and level I VTCs admitting and managing a higher number of head traumas, as well as university VTCs performing a higher proportion of surgical procedures. Data from this registry will continue to aid in the design of clinical trials, prospective observational studies, and translational research, which will improve the understanding and outcome of trauma patients.

100. Epidemiology of Mandibular Fracture Cases for Mataram University General Surgery Resident Competence in Hospital Education Center

Introduction: WHO (2024) estimates that 20–50 million individuals get non-fatal injuries and over 1.2 million people globally pass away on traffic accidents. craniomaxillofacial fracture cases can be done by multidisciplinary, depend on diagnosis and competence of surgeons. Methods: This study is quantitative descriptive study using medical record data of craniofacial trauma patients NTB Province General Hospital from January 2022 to September 2024, patients who experienced or who had been diagnosed of craniofacial trauma. Results: 388 patients were diagnosed with craniofacial trauma at NTB Province Hospital. There were had 99 lower face fractures, 120 mid face fractures, and 169 with upper face fractures. It was found male gender was more than female, age range of 21-30 years. the 99 patients with mandibular fractures, 66 simple mandibular fractures obtained that could be done by general surgery resident. In 2022-2023, Unram general surgery residents are not yet in the advanced surgical phase, cannot participate in mandibular fracture surgery. But this data can provide an overview that mandibular fracture cases are sufficient in number for they operative cases. Conclusions: This study, there are 66 cases of mandibular os fracture that can be performed operatively by unram general surgery residents according to competence of general surgeons as stated in the Decree Minister of Health. So that can help in help cranio maxilo facial cases in good interdisciplinary cooperation to get optimal results.

Development and validation of prediction models for prehospital triage of military trauma patients.

The introduction of wireless sensors will enable military care providers to continuously and remotely assess/monitor vital signs. Prediction models are needed to use such data adequately and aid military care providers in their on-scene decision-making to optimise prehospital triage and improve patient outcomes. A prospective cohort comprising data from eight Emergency Medical Services and seven inclusive trauma regions was used to develop and validate prediction models that could aid military care providers in their prehospital triage decisions. Healthy (American Society of Anesthesiologists physical status classification 1 or 2) admitted adult trauma patients (aged ≥16 and ≤50 years), who suffered from a trauma mechanism that could occur to military personnel and were transported by ambulance from the scene of injury to a hospital, were included. A full model strategy was used, including prehospital predictors that are expected to be automaticly collectible by wireless sensors or to be incorporated in a personalised device that could run the models. Models were developed to predict early critical-resource use (ECRU), severe head injury (Abbreviated Injury Scale (AIS) ≥4), serious thoracic injury (AIS ≥3) and severe internal bleeding (>20% blood loss). Model performance was evaluated in terms of discrimination and calibration. Prediction models were developed with data from 4625 patients (80.0%) and validated with data from 1157 patients (20.0%). The models had good to excellent discriminative performance for the predicted outcomes in the validation cohort, with an area under the curve of 0.80 (95% CI 0.76 to 0.84) for ECRU, 0.83 (0.76 to 0.91) for severe head injury, 0.75 (0.70 to 0.80) for serious thoracic injury and 0.85 (0.78 to 0.93) for severe internal bleeding. All models showed satisfactory calibration in the validation cohort. The developed models could reliably predict outcomes in a simulated military trauma population and potentially support prehospital care providers in their triage decisions.

Inflammatory Risk Factors for Chronic Subdural Hematoma in a Nationwide Cohort.

The discovery of biomarkers in chronic subdural haematomas (CSDH) suggests that inflammation is part of CSDH pathophysiology. It is unknown whether inflammation reflects an independent CSDH driver or haematoma degeneration. This knowledge holds a potential target for anti-inflammatory treatment in patients at risk of CSDH. This study investigated the association of pro- and anti-inflammatory factors with CSDH development. This cohort study included all individuals in Denmark over 50 years between 2007-2018. The outcome was first-time CSDH surgery. Hazard ratios (HR) according to potential risk factors were estimated using Cox regression, with age as underlying time scale. Among the 2,391,853 individuals, head trauma was registered in 427,612 individuals (17%), and among these, only 812 were operated for CSDH (0.18%). Among individuals without registered head trauma, the pro-inflammatory conditions of alcohol addiction, diabetes, anti-hypertensive treatment, and chronic hepatic disease were significantly associated with CSDH among individuals (50-74 years). The use of glucocorticoids displayed a decreased risk in cohort members aged 75 and older. Non-steroid anti-inflammatory drugs and statins appeared to be risk factors for CSDH in individuals between the ages of 50-64 and 65-74. Although head trauma was a risk factor for CSDH, the absolute risk was low (0.18%), which does not support preventive measures after emergency room contacts for head trauma. Interestingly, pro-and anti-inflammatory factors were significantly associated with CSDH in patients without registered head trauma, and the pronounced age-dependency of the associations suggests that the pathophysiological mechanisms vary with age.

Long-term Morbidity of Traumatic Brain Injury Following Facial Fracture.

Traumatic brain injury (TBI) is underreported in craniofacial trauma patients, and the long-term morbidity of TBI associated with craniofacial trauma is poorly defined. Current literature is limited in scope to TBI identification in the immediate posttrauma time frame. A retrospective, cohort analysis of adult facial fracture patients presenting from February 2022 to February 2023 was performed. Data were collected for demographics, mechanism of injury, fracture pattern, Glasgow Coma Score, admission status, operative intervention, and concomitant injuries. Rivermead Post Concussion Symptoms Questionnaire surveys were given for evaluation of TBI symptoms at most recent follow-up. Statistical significance was accepted when the P value was less than 0.05. Of 232 facial fracture patients, 82 (35%) completed the Rivermead Post Concussion Symptoms Questionnaire. The mean age was 49.8 years, and mean follow-up time was 11.6 months (range, 2-22 mo). The rate of all patients with TBI symptoms at follow-up was 32.9%. Mechanism of injury, presence of multiple fractures, Glasgow Coma Score less than 15, concomitant injuries, and admission status were not significant predictors of TBI. Fractures requiring operative intervention had higher rates of TBI compared with nonoperative fractures (47.1% versus 22.9%, P = 0.02). Operative intervention was the only significant predictor of TBI symptoms at the time of follow-up (odds ratio: 6.268; 95% confidence interval: 1.322-29.744; P = 0.021) by multivariable logistic regression. Craniofacial trauma is associated with persistent TBI symptoms. Surgeons treating this trauma population should screen for TBI to facilitate disease identification and specialty referral.

Risk factors for abusive head trauma in the pediatric population.

Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial yet especially challenging for infants and toddlers as they are preverbal. Current guidelines for child abuse do not sufficiently address the specific needs of a younger population. This study aimed to evaluate clinical factors associated with abuse among such populations. The National Trauma Data Bank was queried from 2017 to 2019 for patients younger than 3 years with acute head trauma. Patients who were suspected of having experienced child abuse (suspected child abuse [SCA] group) were propensity score matched with patients who were not suspected of having experienced child abuse (non-SCA group) based on demographics, comorbidities, and Glasgow Coma Scale (GCS) scores. Paired Student t-test and chi-square tests were used to compare differences in hospital outcomes between the two groups. Multivariable regression analysis was used to determine factors associated with SCA (p < 0.05). The authors identified 10,844 patients in the SCA group and 27,912 in the non-SCA group. Regression analysis results showed that patients in the SCA group had higher rates of prematurity (OR 2.30, p < 0.001), GCS scores < 13 (OR 1.79, p < 0.001), congenital disorders (OR 1.56, p < 0.001), and public insurance use (68.38% vs 52.88% p < 0.001). Black and Hispanic patients were more likely to be in the SCA group (OR 1.56, p < 0.001 and OR 1.35, p < 0.001, respectively). Following propensity score matching, SCA patients had a longer length of hospital stay (3.17 vs 1.34 days, p < 0.001) and higher mortality rate (4.89% vs 3.58%, p < 0.001). Acute head injuries in the SCA group were associated with prematurity, congenital disorder, low GCS score, and public insurance use. As such, the current guidelines should implement clinical history and insurance type to better reflect the at-risk patient population when evaluating infants and toddlers for potential abuse. There could be overidentification of child abuse among Black and Hispanic patients, and further research is warranted.

Intracranial Migration of Intraocular Silicone Oil after Head Trauma

Intracranial Migration of Intraocular Silicone Oil after Head Trauma

Need for neurorehabilitation in the Middle East and North Africa from 1990 to 2021: an analysis based on the global burden of disease study.

This study will present the burden of diseases needing neurorehabilitation in Middle East and North Africa (MENA) countries and describe their epidemiology across age and sex groups. This study was conducted based on the Global Burden of Disease (GBD) 2021 findings. The authors used years of healthy life lost due to disability (YLD) as a proxy for the need for neurorehabilitation, and extracted the YLD rates and counts for neonatal encephalopathy due to birth asphyxia and trauma, stroke, neural tube defects, Parkinson's disease (PD), motor neuron disease, multiple sclerosis (MS), tension-type headache, other neurological disorders (except migraine, dementia, and epilepsy), head injuries, spinal injuries, nerve injury, and asphyxiation across age groups, sexes, and MENA countries. YLD rates of disorders needing neurorehabilitation in 1990 and 2021 were 408.08 and 496.19 per 100 000 people, respectively, indicating a 21.59% rise in YLD. Stroke had the highest YLD rates in both 1990 (150.19 per 100 000) and 2021 (192.75 per 100 000). Syria, Saudi Arabia, and the United Arab Emirates had the highest YLD rates for conditions needing neurorehabilitation. Considering the growing demand for neurorehabilitation with the aging of populations and the historical shortage of rehabilitation services in the region, the gap between the demand and supply may further increase in the coming years, leading to consequences for people living with neurological conditions in the region.

Parameter optimization design of the helmet liner structure for mitigating traumatic brain injury under impact loading

Abstract Helmets play a crucial role in protecting motorcycle riders during two-wheeler accidents by reducing the risk of head injuries. This study investigated the complex interplay between the density, Poisson’s ratio, and Young’s modulus of a helmet liner and their impact on biomechanical factors contributing to traumatic brain injury during collisions. A validated finite element model of a 50th percentile detailed human head was initially used, followed by the development of a coupled helmet head model for collision simulations. The accuracy of the model was assessed by comparing the center-of-mass acceleration data of the head with the experimental results. This study analyzed the von Mises stress, skull stress, and intracranial pressure, and the results revealed patterns in stress distribution and the potential for cranial and brain injuries. Stress concentrations were observed in the cervical region before the impact, characterized by compressive stress on the impacted side and tensile stress on the opposite side, with peak stress levels found in the temporal bone base and frontal bone. After the impact, brain inertia–driven movements can further increase the risk of traumatic brain injury. The study found a positive correlation between liner density and center-of-mass acceleration of the head in the absence of bottoming out of the liner. By optimizing the liner properties, the study achieved a 4.5% reduction in head acceleration, a 10.1% decrease in skull stress, and a 19.8% reduction in intracranial pressure. These findings offer valuable insights for biomechanical research on head injuries caused by traffic accidents and for improving helmet designs to enhance protective measures.

Real-World Healthcare Resource Utilization, Healthcare Costs, and Injurious Falls Among Elderly Patients with Geographic Atrophy.

This study assessed the clinical and economic burden of geographic atrophy (GA) using real-world data from elderly patients with Medicare Advantage plans in the United States. A retrospective cohort design of patients with GA only, GA + visual impairment (GA + VI), GA + blindness (GA + B), and patients without GA were identified using administrative healthcare claims data from Optum Clinformatics Data Mart. Inverse probability of treatment weighting controlled for confounding when comparing patients with GA only vs without GA, GA + VI vs GA only, and GA + B vs GA only. Endpoints included all-cause and ophthalmic condition-related healthcare resource utilization (HRU), injurious falls, and healthcare costs. HRU and injurious falls were assessed per-person-per-year and per 100 person-years, respectively. Cohorts were compared using rate ratios, 95% confidence intervals (CIs), and p-values from weighted Poisson regression models. Healthcare costs were evaluated per-person-per-year using mean cost differences, 95% CIs, and p-values from weighted linear regression. The study included 18,119 patients with GA only, 2,285 with GA + VI, 1,716 with GA + B, and 72,476 patients without GA. Higher rates of all-cause hospitalizations (RR [95% CI]: 1.08 [1.03, 1.12]), outpatient visits (1.08 [1.05, 1.10]), other visits (1.14 [1.08, 1.21]), and falls with head injuries (1.24 [1.05, 1.45]) were observed in patients with GA vs without GA (P<0.05). GA was associated with higher annual all-cause total healthcare costs, spending an average of $1,171 more after adjustment (P<0.05). Progression to GA + VI and GA + B was associated with a more pronounced burden. The clinical and economic burden of GA is substantial and escalates as the disease advances. These findings suggest early intervention aimed at slowing GA progression may help to mitigate the healthcare burden associated with advancement of GA to visual impairment and blindness.

Epidemiology of paediatric winter sports-related injuries in France: The WINTRAUMA-1 retrospective cohort study.

To describe the epidemiology of injuries related to winter sports in patients younger than 15 years in France. We conducted a retrospective observational multicentre cohort study of patients younger than 15 years who were seen by mountain-community general practitioners for winter-sports injuries in 1999-2022. Of the 108 619 patients (mean age, 11.4 ± 2.8 years), 76 724 (70.6%), 26 186 (24.1%) and 2132 (2.0%) were injured while skiing, snowboarding and sledding, respectively. Helmet use was noted in 50 164 (46.2%) patients and increased over time but remained low among sledders. A collision was the mechanism in 12.3% of patients overall and 32.1% of sledders. The most common injuries overall were wrist fractures (48.5%), head and trunk injuries (42.3%), and anterior cruciate ligament (ACL) tears (23.7%), with wrist fractures being more common in beginners (24.7%) and head/trunk injuries and ACL tears in advanced participants (18.3% and 2.6%, respectively). Only 3699 (3.4%) patients were admitted after the general-practitioner visit, notably for leg or ankle fractures (9.5%). Winter sports-related injuries vary according to age, sex, skill level and sport. Admission rates are low but might be further decreased by better prevention. Protective measures should be tailored to each sport and individual.

Polytrauma in a Jet Pilot After Low-Altitude Ejection Without Parachute Deployment

BACKGROUND: Ejection seats are designed to be a lifesaving device for aircrew in emergencies. Modern ejection seats are widely prevalent in fighter and bomber aircraft and are occasionally associated with acceleration injury from axial loading (Gz) during the catapult phase of ejection, limb flail injury due to windblast, or parachute landing fall, especially if the ejection is outside of the seat’s performance envelope. CASE REPORT: We present the first known case in the medical literature of a military pilot who survived a low-altitude, high-angulation (&gt;90° of bank angle) ejection where the pilot’s ejection seat parachute did not deploy due to contact with the ground before completion of the ejection sequence. The patient’s initial exam upon arrival at a trauma center was significant for a Glasgow Coma Scale of 3T, with evidence of cranial and extremity trauma. The patient presented with respiratory acidosis and required upsizing of his endotracheal tube placed in the field. The patient’s injury list included bilateral subdural and subarachnoid hemorrhages, a Hangman’s fracture, spinal burst fractures, and extensive extremity fractures. After a prolonged hospital stay, the patient was discharged to rehabilitation. The patient made a functional and neurological recovery, including return to independent completion of his activities of daily living. DISCUSSION: This case provides evidence of favorable outcome after a low-altitude, high-angulation ejection without parachute deployment. This case details the medical and traumatic pathology medical personnel should expect from an ejection that occurs outside of the seat’s performance envelope. Zivkovic MM, Inman BL, Figlewicz MR, Burchett JA, Nowadly CD. Polytrauma in a jet pilot after low-altitude ejection without parachute deployment. Aerosp Med Hum Perform. 2024; 95(11):862–866.

Interventions to Reduce Imaging in Children With Minor Traumatic Head Injury: A Systematic Review.

Reducing unnecessary imaging in emergency departments (EDs) for children with minor traumatic brain injuries (mTBIs) has been encouraged. Our objective was to systematically review the effectiveness of interventions to decrease imaging in this population. Eight electronic databases and the gray literature were searched. Comparative studies assessing ED interventions to reduce imaging in children with mTBIs were eligible. Two independent reviewers screened studies, completed a quality assessment, and extracted data. The median of relative risks with interquartile range (IQR) are reported. A multivariable metaregression identified predictors of relative change in imaging. Twenty-eight studies were included, and most (79%) used before-after designs. The Pediatric Emergency Care Applied Research Network (PECARN) rule was the most common intervention (71%); most studies (75%) used multifaceted interventions (median components: 3; IQR: 1.75 to 4). Before-after studies assessing multi-faceted PECARN interventions reported decreased computed tomography (CT) head imaging (relative risk = 0.73; IQR: 0.60 to 0.89). Higher baseline imagine (P < .001) and additional intervention components (P = .008) were associated with larger imaging decreases. The limitations of this study include the inconsistent reporting of important outcomes and that the results are based on non-randomized studies. Implementing interventions in EDs with high baseline CT ordering using complex interventions was more likely to reduce head imaging in children with mTBIs. Including the PECARN decision rule in the intervention strategy decreased orders by a median of 27%. Further research could provide insight into which specific factors influence successful implementation and sustained effects.

Convergence insufficiency as a predictor of poor prognosis after acute mild traumatic brain injury

BackgroundMild traumatic brain injury (mTBI) is becoming a more common emergency department (ED) presentation. Towards this end, many types of testing in the acute setting are being investigated. One of these is screening for convergence insufficiency (CI) symptoms. These are common problems reported by patients with mTBI, but such oculomotor testing is rarely performed in the ED.ObjectiveTo assess the feasibility of convergence insufficiency screening in the ED and investigate whether CI is associated with adverse events such as post-concussive symptoms or hospital admission.MethodsWritten informed consent was obtained from patients age 18 years or older who experienced a mild head injury from any mechanism resulting in an mTBI. Patients underwent screening for CI symptoms using a standardized instrument of 15 questions, known as the convergence insufficiency symptom survey (CISS), with responses based on the Likert scale. These data were correlated to outcomes of hospital admission, occurrence of post-concussive symptoms, and 30-day hospital re-admission.ResultsA total of 116 patients were prospectively enrolled, of which 58 were male. The median age was 31 years, with a range of 18 to 95 years of age. The median CISS score was 13, with an interquartile range (IQR) of 6 to 21 and an overall range of 0 to 53. Females presented with a median CISS score of 14, which was higher compared to the male median score of 10. The higher the CISS score, the more likely the patient was to be admitted to the hospital (p = 0.0378), develop symptoms of post-concussive syndrome at 30-day follow up (p = 0.0322), and be readmitted within 30 days (p = 0.0098).ConclusionsScreening for CI symptoms using the CISS can be a solid adjunct in the evaluation of mTBI in the ED. The CISS is easy and fast to administer, and it is a useful tool to stratify patients in terms of who is at the highest risk of developing complications related to the mTBI.