Horse riding-related falls are a frequent cause of emergency department (ED) presentations; however, their regional epidemiology in France is poorly described. We aimed to quantify the incidence of ED visits after falling from a horse in the Manche Department and characterize the injury patterns, resource use, and short-term outcomes. We conducted a multicenter retrospective study across six hospitals in Manche (France), including all patients presenting to the ED after a fall from a horse between May 1, 2021, and October 31, 2024. Demographics, initial clinical status, imaging findings, anatomical injuries (Abbreviated Injury Scale [AIS]), management, and use of protective equipment were extracted from the electronic records. The incidence was standardized according to the catchment population of each center. Reporting was performed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. This study included 669 ED visits after falling from horses. The average annual incidence was 93.6 per 100,000 inhabitants, with substantial geographical variation. Most patients were women (87%), with a median age of 18years. Spinal (43%), head (39%), and upper limb (33%) injuries were most common. Helmet use was high (97%) and likely contributed to the low rate of severe intracranial injuries. Imaging was performed in 93% of the patients, with 42% showing abnormalities. Most patients (80%) were discharged home, whereas 18% required hospitalization (median stay, 2days), and 8.5% required surgery, mainly for fractures. Horse riding-related falls are a prevalent cause of ED visits in the Manche region, with substantial geographic variation in incidence. Although most injuries are minor, the high frequency of head and spine involvement underscores the importance of protective equipment and targeted prevention strategies. Standardized imaging and discharge pathways can streamline resource utilization while ensuring the detection of clinically significant injuries. Not applicable (retrospective observational study).

Concussion and its sequalae of persistent post-concussion symptoms (PPCS) are significant healthcare burdens in the paediatric population. For affected patients, PPCS significantly impacts their academic performance, social interactions, and quality of life. This study is undertaken to investigate the prevalence of PPCS, identify associated risk factors and outcomes, and evaluate the applicability of the Post-Concussion Symptom Scale (PCSS) in school-going children diagnosed with concussive head injury. This is a single-institution, retrospective study conducted from January 2020 to April 2023 (40months). All patients aged 5 to 18years diagnosed with concussion at the KK Women's and Children's Hospital, Singapore, are included. Subsequently, they are stratified into 2 groups: non-PPCS (symptom resolution within 4weeks) and PPCS (symptoms persisting beyond 4weeks). Data on patient demographics, clinical history, mechanism of head injury, symptomatology, PCSS scores, and recovery times are analyzed. Multivariable logistic regression is performed to identify independent predictors of PPCS. A total of 220 patients were recruited for this study. Eighty-seven (39.5%) patients had PPCS. Sports-related injuries were the most common cause of concussion. Higher PCSS scores were significantly associated with PPCS (p < 0.01). Independent predictors of PPCS included female gender (p = 0.01), history of psychiatric illness (p < 0.01), and childhood headaches (p = 0.01). To our knowledge, this is the first longitudinal study focused on PPCS in a Southeast Asian paediatric population. Early identification of high-risk patients and clinical predictors is crucial to initiate time-sensitive interventions for optimal outcomes.

Spontaneous acute subdural hematoma: Etiologic spectrum, diagnostic approach, and clinical correlates.

Background and Clinical Significance: Traumatic brain injuries (TBI), most frequently caused by falls, represent a major source of morbidity and mortality and pose significant challenges in forensic investigations, especially when events are unwitnessed or testimonies conflict. Despite advances in imaging and autopsy, reconstructing the mechanism of head trauma often remains impossible. The objective of this study is to assess how biomechanical modeling can support forensic practitioners by narrowing the range of plausible scenarios and strengthening evidence-based interpretation in complex medico-legal contexts, without seeking to establish legal causality or certainty. Case Presentation: This case report investigates forensic biomechanics as a decision-support tool using a combined multibody and finite element (FE) modeling approach. An initial set of twenty-five scenarios, derived from witness statements and investigative data, was reconstructed to simulate potential fall- and assault-related mechanisms. Multibody simulations with the human facet model were first performed to estimate head impact velocities and orientations. These parameters were then applied to an FE head model to evaluate tissue response. Conclusions: Skull fracture patterns and intracerebral von Mises stress distributions were analyzed and systematically compared with clinical, radiological, and autopsy findings. Although simulated stress magnitudes were generally lower than injury thresholds reported in the literature, several scenarios reproduced fracture propagation and intracerebral stress patterns consistent with the documented lesions, including corpus callosum involvement. This multidisciplinary approach highlights the growing role of biomechanics in forensic investigations and forensic anthropology.

In pediatric abusive head trauma (AHT), retinal hemorrhages are a key diagnostic feature. Detection by fundoscopy may be delayed or limited, whereas magnetic resonance imaging (MRI) enables non-invasive, objective assessment on routine brain sequences. To evaluate the diagnostic utility of different MRI sequences-particularly susceptibility-weighted imaging (SWI), T2*-weighted (T2*w), and morphological sequences-in detecting retinal hemorrhages in AHT. In this retrospective multicenter study (2006-2015), 57 well-documented AHT cases from three German institutions were analyzed. A subgroup consisted of "confession cases." MRI scans were reviewed for retinal hemorrhages across SWI, T2*w, T1-weighted, T2-weighted (T2w), and fluid-attenuated inversion recovery (FLAIR) sequences by blinded expert readers. Fundoscopy results served as the gold standard. Sensitivities were calculated for each sequence, and "confession" versus "non-confession" cases were compared. Fundoscopy detected retinal hemorrhages in 44 of 56 evaluable cases (78.6%). MRI identified retinal hemorrhages most frequently on gradient recalled echo sequences, with SWI showing higher sensitivity compared to T2*w (76.9% vs. 47.8%). T2w imaging showed markedly lower sensitivity (30.3%) but detected retinal hemorrhages on one eye missed on T2*w imaging in two cases. In three cases, MRI detected retinal hemorrhages not reported on fundoscopy. No statistically significant differences were found between "confession" and "non-confession" cases across all parameters considered (P>0.05). MRI-particularly SWI and, to a lesser extent, T2*w imaging-may offer a useful tool of detecting retinal hemorrhages in AHT when fundoscopy is limited. T2w imaging may provide complementary information in selected cases.

Motorcycle-related Road traffic accidents (RTAs) are a significant public health concern in Nigeria, disproportionately affecting young adults and imposing both health and economic burdens. This systematic review aims to evaluate the prevalence, injury patterns, risk factors, and outcomes of motorcycle accidents across the country. Following PRISMA 2020 guidelines, a comprehensive search of databases including PubMed, Scopus, AJOL, Medline, and Google Scholar was conducted for studies published between 2019 and 2025. Relevant studies were screened and assessed for quality using the Joanna Briggs Institute (JBI) tools. Motorcycle accidents accounted for up to 54% of all RTAs in Nigeria, with a prevalence rate as high as 68%. Most victims were males aged 20–40 years. Common injuries included limb fractures and head trauma. Major determinants included poor road conditions, inadequate enforcement of traffic regulations, risky riding behaviours, and low helmet usage. Motorcycle accidents in Nigeria are widespread and largely preventable. Addressing this challenge requires a multi-sectoral approach involving infrastructure improvement, stricter enforcement of safety regulations, and public health education initiatives.

With the introduction of andexanetalfa, a specific antidote is now available to address life-threatening bleeding associated with factor Xa inhibitors. In this study, we explore its use in an experimental model of traumatic brain injury (TBI), mimicking a closed head trauma under rivaroxaban-induced anticoagulation. Male C57BL6 mice were fed with rivaroxaban (10mg/kg body weight). Subsequently, TBI was induced by controlled cortical impact (CCI) and andexanetalfa or placebo were administered as intravenous bolus injections. Edema and hemorrhage volume was quantified by magnetic resonance imaging (MRI) 24h and 7days after CCI. Functional outcome was assessed at day 1, 3, and 7 thereafter. Andexanetalfa led to reduced hemorrhage volume 24h and 7days after CCI as compared with control group without reversal of anticoagulation (2.9 ± 1.4µl vs. 5.2 ± 3.3µl, p = 0.02; 3.4µl ± 1.5µl vs. 5.5µl ± 2.4µl, p = 0.04). Along with the smaller hematoma sizes in the MRI, edema volume was significantly lower in mice treated with andexanetalfa 24h and 7days after CCI (-6.3% of contralateral hemisphere, p = 0.0002; and -7.1% of contralateral hemisphere, p = 0.006). While functional outcomes did not differ at 24h following TBI, andexanetalfa improved neurological deficits after 7days. Our experimental data suggests that the use of andexanetalfa improves functional outcomes by reduction of factor Xa inhibitor-associated hematoma expansion in the subacute phase following TBI.

Abstract Introduction This cross-sectional study aimed to evaluate the epidemiological, clinical, radiological, and therapeutic aspects of skull base fractures (SBF) in Yaoundé, Cameroon. Methods Patient records from three reference hospitals were reviewed retrospectively for SBF patients admitted between July 2010 and June 2017. Patients with missing data were excluded from the analysis, summary descriptive and unadjusted analyses were conducted. Results Of 867 retrievable head injury charts, 338 (39%) met inclusion criteria. Mean age was 31.2 ± 13.4 years and 86% of participants were male. Road traffic accidents accounted for 84.4% of cases, with motorcycles implicated in 64%. Fractures involved the anterior cranial fossa in 60.1%, middle fossa in 32.5%, combined anterior–middle in 4.4%, and posterior fossa in 2.4%. CT explained clinical signs in 88.3% overall, CSF rhinorrhea had the highest odds of radiological confirmation compared with other anterior signs (OR 6.71; 95% CI, 1.59–28.32) and mastoid ecchymosis showed strong agreement in the middle fossa (OR 5.47; 95% CI, 0.72–41.56). Translabyrinthine temporal bone fractures were strongly associated with cranial nerve VII palsy (OR 4.07; 95% CI, 1.75–9.47) and vestibular symptoms (i.e., vertigo OR 3.30; 95% CI, 1.24–8.80 and tinnitus OR 3.72; 95% CI, 1.05–13.21). Management was conservative in 65.1% and surgical in 34.9%, mainly for persistent CSF leaks. Postoperative complications were rare, but olfactory deficits persisted in 78% of operated cases. Conclusion SBF is common in Cameroon, and its management is made difficult by a lack of resources. Investments in the surgical system must be made to improve patient outcomes.

Nightclubs, often perceived as safe spaces for entertainment, can nevertheless harbour hidden dangers. Despite their popularity among young adults, the prevalence and characteristics of fatalities associated with nightclub attendance remain unknown. This research aimed to characterise the nature and frequency of nightclub-related deaths in the UK. We conducted a retrospective observational study using media reports and coroner verification to identify and characterise nightclub-related deaths in the UK between 2009 and 2024. Nightclub-related deaths encompassed those found deceased inside the venue and those who died within a few hours of attendance, typically on the same night. Articles were screened by hand, and included articles underwent standardised data extraction. Data were corroborated by searching open-source legal proceedings and communicating with the responsible coroner. There were 89 deaths associated with 75 nightclubs, with a median victim age of 22 years (range 16-54 years) and a rate of 5.9 per annum. Trauma-related injuries 45/89 (51%) and drug-related toxicity 36/89 (40%) were the primary causes. Blunt head injuries 19/45, mostly related to altercations 13/19, and penetrating trauma from knife injuries 17/45 accounted for most trauma deaths. MDMA was named as a cause in almost all drug-related deaths, 34/36 (94%), occurring at a rate of 2.4 per annum. Of the 89 victims, seven were under 18-years-old. Only 25/75 (33%) of the nightclubs with a fatal incident remained open under the same name. Using open-source media and coroners, this study identified nearly six deaths per year associated with UK nightclubs. Victims are predominantly young adults, with trauma and drug toxicity the leading causes. These findings underscore the need for targeted interventions, including enhanced safety measures and harm reduction strategies, to prevent future tragedies.

A Closed-Loop Clinical Audit on Compliance With National Institute for Health and Care Excellence (NICE) Guidelines (NG232) for CT Cervical Spine Imaging in Adult Head Injury Patients

Introduction: Paediatric Traumatic Brain Injury (TBI) is a leading cause of morbidity and mortality in children. The accompanying Cervical Spine Injuries (CSI) are not well studied in the Indian subcontinent, particularly with respect to adherence to stabilisation protocols during inter-hospital referrals. Aim: To evaluate the clinical profile, neuroimaging characteristics, and outcomes of paediatric TBI cases at a tertiary care hospital in Gujarat, Western India. Materials and Methods: The present one-year, prospective, observational study included 95 paediatric patients (1 month to 18 years) with head injuries who presented to a tertiary care teaching hospital in Gujarat, Western India, between October 2023 and September 2024. Data were collected on demographics, mechanisms of injury, symptoms, neuroimaging, transport, cervical spine immobilisation, hospital course, and outcomes. Descriptive and inferential analyses were used to describe the profile and examine associations between key parameters. Results: Among 95 patients, 74 (77.9%) were males. Nearly half (47, 49.5%) were below eight years of age. Falls (39, 41.1%) and Road Traffic Accidents (RTA) (38, 40%) were the most common causes of injury. Only 2 (2.1%) children received cervical spine immobilisation during transport. Of the total, 31 (32.6%) were moderate-to-severe cases, and neuroimaging was indicated or performed in 30 (31.9%). Out of these 30, Subdural haematoma (13, 43.3%) and cerebral contusions (10, 33.3%) were the most frequent radiological findings. Most patients (60, 63.2%) were discharged within 48 hours. Full recovery occurred in 77 (81.1%), while 17 (17.9) had disabilities and 1 (1.1%) died. Lack of cervical spine stabilisation and the need for intubation were significantly associated with poorer outcomes (p&lt;0.05). Conclusion: Most patients were male, and mild-to-moderate head injuries were common. A substantial number of severe cases were also noted, with subdural hematoma and contusions strongly linked to poor neurological outcomes. Only two patients received cervical spine stabilisation during transport, highlighting a major gap in prehospital trauma care.

Magnetic Resonance Imaging Reveals an Important Role for Brain Ischemia Across Injury Severity in Abusive Head Trauma in Infants and Young Children.

Scoping review on motorcycle crashes patterns, risk factors, and potential in setting policy priorities in the gulf cooperation council countries (GCC).

A helmet will not fit the same way on different individuals with different head sizes and shapes. However, the degree to which subject-specific fit differences may affect the risk of injury remains understudied. In this study, we used experimentally measured head/helmet contact force to generate different levels of initial padding compression when applied to a finite element head model. The deformed padding configuration was used as the initial condition for subsequent blunt impact analyses. As the level of initial padding compression increased, the resulting maximum force, total impulse, and the resulting head injury metrics increased by up to 20%. The results of this study highlight the importance of accurate modeling of initial pad deformation before blunt impact and provide a workflow for establishing such a configuration in other helmet applications. Intuitively, two different people wearing an identical helmet will experience a different fit, since the size and shape of their heads will differ. However, it is unclear how that variation in fit will affect the risk of injury for most helmet types. In this study, we generated different helmet fit conditions in a simulated model of a head and helmet, based on previous experimental measurements of the force between the helmet padding and the head. Four conditions were generated: zero, low, medium, and high initial fitting forces. Using the different fit configurations, we simulated two types of impacts on the front, back, side, and top of the helmet, and calculated the risk of injury to the brain and skull. Our results suggest that differences in padding compression arising from differences in head shape can significantly change the risk of injury. Higher initial padding compression resulted in greater force applied to the head and higher values of brain and skull injury metrics. These effects were more apparent for lower energy impacts, suggesting that the differences might be important to consider for helmets where the user sees repeated, low-intensity impacts such as in American football. Our analysis was limited to one type of helmet, and we were unable to vary the geometry of the head, meaning that the data should be interpreted cautiously. However, our results provide compelling evidence that the level of initial compression in the padding due to the user's head is an important factor to incorporate when designing new helmets.

Validating the morphology of 3D-printed cranial projectile trauma as a skeletal alternative for utilisation in a court of law

Association between cranial morphology and dysgnathias in adolescents and adults: A prospective case-control study.

TBI-induced vessel softening increases brain susceptibility to injury with repeated head trauma.

We report a case of acute epidural hematoma (AEDH) successfully treated with middle meningeal artery (MMA) embolization. A 59-year-old man presented with headache 2 days after minor head trauma. Head computed tomography (CT) revealed a left-sided AEDH with an associated skull fracture. Although the patient had only mild disturbance of consciousness and no focal neurological deficits, the hematoma volume was significant. Given the absence of mass effect and to prevent further hematoma expansion, emergent MMA embolization was performed via a transradial approach under local anesthesia. Angiography demonstrated contrast extravasation from the MMA, which was successfully embolized using 20% n-butyl-2-cyanoacrylate. The patient's postoperative course was uneventful, and the hematoma showed near-complete resolution on follow-up CT 1 month later. This case highlights the potential utility of MMA embolization as a minimally invasive and effective treatment option for select AEDH cases that do not require emergency craniotomy.

Are enlarged perivascular spaces a predictor of early post-traumatic seizures after traumatic brain injury?- A pilot study.

An alternative linear impactor for impact research.